Prescribing Flashcards
Name some Enzyme Inducing drugs
What is the effect of this?
PC BRAS
Phenytoin
Carbemazapine
Barbituates
Rifampicin
Alcohol (Chronic Excess)
Sulphonylureas
These drugs increase enzyme activity and so decrease drug concentration
Name some Enzyme Inhibiting drugs
What is the effect of this?
AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
These drugs DECREASE enzyme activity so INCREASE drug concentration
Outline VTE Prophylaxis options
Pharmacological: LMWH/ Anticoagulant
Mechanical: TED stockings/ IPS
LMWH = most effective –> all patients with decreased mobility should be given a LMWH.
Contraindications: Active bleeding, stroke –> Mechanical - TED/IPC instead
Patients already on anticoag = continue pre-prescribed medication, no enoxaparin.
Name common drugs which should be STOPPED before surgery
I LACK OP
Insulin,
Lithium, (day before surgery)
Anticoagulants/antiplatelets, (variable - occasionally continued)
COCP/HRT, (4 weeks before surgery)
K -sparing diuretics,
Oral hypoglycaemics,
Perindopril + other ACE-inhibitors.
What is the mnemonic to remember a Safe Prescribing routine?
PReSCRIBER
Patient Details
Reaction - Allergies
Sign the front of the chart
Contraindications - check for contraindications to each drug
Route
IV fluids - prescribe if needed
Blood clot - prescribe VTE prophylaxis if needed
Emetic - Prescribe Anti-emetic if needed
Relief - Prescribe pain relief if needed
What is important to remember when checking patient details?
If working with a new chart then you must write three pieces of patient-identifying information on the front of the chart (e.g. patient name, date of birth and hospital number) or use a hospital addressograph sticker.
• If amending a chart then ensure that you have the correct patient’s drug chart.
What is important to remember about checking for allergic reactions?
If working with a new chart then complete the allergy box including any drug reaction mentioned by the patient.
• If amending a chart then check the allergy box before prescribing.
REMEMBER: Tazocin and Co-amoxiclav contain penicillin
Which 4 groups of drugs must you know the contraindications for?
Antiplatelets/Anti-coagulants
Steroids
Antihypertensives
NSAIDs
What are the contraindications to drugs that increase bleeding? (E.g. anti-platelets and anti-coagulants)
- Active bleeding, suspected bleeding or at risk of bleeding (e.g. Prolonged Prothrombin time due to liver disease)
-
Name an enzyme inhibitor and explain how this might interact with Warfarin?
Erythromycin
Can increase Warfarin’s effect (and therefore increase PT and INR) despite a stable dose.
Should be considered in patient’s presenting with excessive anticoagulation
What are the side effects of Steroids?
STEROIDS mnemonic
Stomach Ulcers
Thin skin
Edema
Right & Left Heart Failure
Osteoporosis
Infection (including Candida)
Diabetes (commonly causes hyperglycaemia)
Syndrome - Cushing’s syndrome
What are the safety considerations which should be remembered when prescribing NSAIDs?
NSAIDs mnemonic
No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)
(Aspirin is technically an NSAID but is used at relatively low doses for management of CV & cerebrovascular disease - not subject to same level of caution as NSAIDs used for pain management)
What are some side effects of all antihypertensives?
Hypotension, including postural hypotension
Which antihypertensives might cause bradycardia?
Beta blockers and some CCBs
Which antihypertensives can cause electrolyte disturbance?
ACEi and diuretics
Which antihypertensives can cause a dry cough?
ACEi
which anti-hypertensives can cause peripheral oedema and flushing?
CCBs
Which anti-hypertensives can cause wheeze in asthmatics and worsening of acute heart failure?
Beta-blockers
They cause worsening of acute heart failure, but help in chronic heart failure
What side effects can diuretics cause?
Diuretics can cause renal failure
Thiazide diuretics can cause gout
potassium sparing diuretics can cause gynaecomastia
What 2 situations are fluids prescribed in?
REPLACEMENT: for dehydration/acutely unwell patient
MAINTENANCE: In a patient who is nil by mouth
Give all patients 0.9% saline (normal saline, a crystalloid) unless…
- Hypernatraemic or hypoglycaemic
- Ascites
- Is shocked from bleeding
What should you give a patient who is hypernatraemic or hypoglycemic?
5% dextrose
what fluids should you give a patient with ascites?
HAS - albumin maintains oncotic pressure - plus higher sodium content in 0.9% saline will worsen ascites
What should you give a patient in shock from bleeding?
Blood transfusion, crystalloid if no blood is available.
How do we decide how much fluid to give and how fast?
Assess HR, BP and UO