Practical Prescribing Flashcards
In which patients in need of fluid replacement do you give dextrose 5% rather than 0.9% saline?
Hypernatremic
Hypoglycaemic
How much and how fast do you give in a fluid challenge? What about in heart failure?
500ml stat (<15mins)
Heart failure 250ml stat
How do you roughly work out how fluid deplete a patient is?
1) reduce urine output (<30ml/ hour) indicates 500ml deplete
2) reduce U.O plus tachycardia indicates 1L deplete
3) reduce U.O, tachycardia and shocked indicates >2L deplete
Prescribe anti emetics cyclizine and metoclopramide. Indicate when each may be contraindicated?
Cyclizine 50mg / 8hourly oral/IM/IV (CI in heart failure/ problems as causes fluid retention)
Metoclopramide 10mg/ 8 hourly IM/IV (CI in parkinsons as D2 agonist, also young women as causes dyskinesia)
In AF, when should diltazam (CCB) be avoided?
In odeama as CCB worse fluid retention
Which group of people is adenosine contraindicated in?
Asthmatics
Use verapamil instead
In acute asthma (adults) what do you give and how much?
O2
Salbutamol nebs 5mg every 20-30mins
Steriods - pred oral 40-50mg od OR hydrocortisone 100mg IV QDS
Then ipatropium bromide
What level should INR be prior to elective surgery (in someone who will have stopped warfarin 5 days prior) and was is the management if not?
<1.5
If higher give phytomenadione 5mg oral (vit K)
POP and enzyme inducing drugs?
Reduced effectiveness - there change to a alternative contraception until 4 weeks after other medication finished.
How quickly do you give a fluid challenge?
500/15 mins
1000/30 mins
What insulin do you stop/continue/add in someone with a DKA?
Stop short acting, continue long acting and add a fixed rate insulin alongside fluid resuscitation
Which opiates should be used in renal impairment?
Oxycodone as it is metabolised by the liver and will not build up in renal disease.
Patient on amiodarone get thyroid dysfunction, what should be done in regards to the amiodarone?
Stop it
Drugs to stop/change prior to surgery?
Anti-coagulation And contraception - stop
Diabetic meds - switch
What are the main rules for fluid balance?
Input = output
If output in 250ml per hour, 1L in 4 hours this needs replacing at the same rate.
Look at electrolytes, don’t give k+ more than 10mmol/20mmol per hour.
Treatment in hyperkalemia?
10ml 10% IV calcium gluconate, 10units of actrapid insulin with 100ml 20% IV dextrose and nebulised salbutamol.
Causes of hyperkalemia
DREAD Drugs Renal failure Endocrine Artefact Diabetic ketoacidosis
First line management in anaphylactic reactions?
1) stop drug/ source
2) ABCDE
3) adrenaline, chlorphenamine
In a COPD exacerbation what comes after salbutamol nebs?
Ipratropium bromide 500 micrograms neb
What’s the relationship between statins and clarithromycin?
Clarithromycin is a cyp3a4 inhibitor, if taken stop statin as will increase risks of toxicity or side effects.
Don’t eat grapefruits either
Treatment for UC flare? Serve vs mild?
Mild oral steroids eg prednisolone 30mg OD
Severe IV hydrocortisone (100mg) 6-hourly
