Prescribing Flashcards
High BP in pregnancy
Labetalol hydrocholoride
100mg
PO
BD
ACE inhibitor for HTN
Ramipril should be started at 2.5mg twice daily for three days before being increased to 5mg twice daily
Opioid toxicity
Naloxone 400mcg IV.
Isosorbide for angina
0.05% solution = 0.05g in 100ml = 50mg in 100ml = 0.5mg/ml
Requires 8mg/hr
8 / 0.5 = 16 ml/hr
A patient on metformin recently had an MI, how should this patient be managed?
Metformin should be stopped following a myocardial infarction due to the risk of lactic acidosis. It may be introduced at a later date. Diabetic control may be achieved through the use of a insulin/dextrose infusion
Maximum dose of paracetamol per day
4000mg
What is the maximum dose of ibuprofen per day?
one or two 200mg tablets or capsules 3 times a day
Gout flare up
500 micrograms colchicine 2–4 times a day until symptoms relieved,
Prophylaxis of gout
Initially 100 mg of allopurinol daily, for maintenance adjust dose according to plasma or urinary uric acid concentration, dose to be taken preferably after food.
Alendronic acid
10 mg once daily or 70 mg in a week, NEVER 70 mg a day
Activated charcoal
50g PO Once only
Tamulosin
400 microgram OD
Spirnolactone
100-400mg daily
Colecalciferol loading
50 000 units once weekly for 6 weeks [loading]
Cholecalciferol maintenance
800–2000 units daily,
Colecalciferol primary prevention
400 units daily.
Opioid overdose
Naloxone hydrochloride 400mcg IV
Impetigo rash
HFA
Hydrogen peroxide first line
If he was systemically unwell or at higher risk of complications, a topical (e.g., fusidic acid) or oral (e.g., flucloxacillin) antibiotic should be offered. Clarithromycin is a suitable alternative for patients who are penicillin allergic.
A child with eczema herpeticum should be admitted to hospital for IV aciclovir. This management is not appropriate in this scenario.
Gonnorehea
1 DOSE 1G IM
Chlamydia
Doxocycline 100 mg twice daily for 7 days.
How to write insulin prescription
Units not U
Hypoglycaemia in unconscious patient
Hypoglycaemia which causes unconsciousness is a medical emergency and should typically be treated with 1 mg glucagon IM immediately. However, the BNF state that glucagon is ineffective where liver glycogen is depleted, i.e. prolonged fasting, chronic hypoglycaemia or alcohol-induced hypoglycaemia. Additionally, glucagon may be less effective in patients taking a sulfonylurea (e.g. gliclazide). In these cases, intravenous glucose is required.
150 – 200 mL glucose 10% IV infusion over 15 minutes or
75 – 100 mL glucose 20% IV infusion over 15 minutes should be given.
Fluids for an adult
25-30ml/kg/day of water
Approx. 1mmol/kg/day of K+, Na+ and Cl-
Approx. 50-100g/day glucose to limit starvation ketosis
Shingles
Aciclovir 800mg PO is the correct dose for patients with suspected shingles. Aciclovir is taken 5 times a day for 7 days. Patients over the age of 50 should receive antiviral treatment to reduce the risk of long term post-herpetic neuralgia.
Candidiasis of vagina
Fluconazole - 150mg - PO - ONCE
Itraconazole - 200 mg - PO - twice daily for 1 day
Clotrimazole cream (10%) - 1 applicatorful (5g) - intravaginal - NOCTE - ONCE
Econazole nitrate - 150mg single-dose pessary - intravaginal
Miconazole nitrate - 1.2g single-dose pessary - intravaginal
Chlamydia treatment
Suitable treatment options for chlamydia in this scenario include:
Doxycycline 100 mg twice daily for 7 days
Azithromycin 1 g orally as a single dose for 1 day, followed by 500 mg orally once daily for 2 days.
Diabetes insipidus
100 micrograms demospressin TDS
Mild acne vulgaris
For the management of mild-moderate acne vulgaris, the BNF recommends the use of topical preparations, such as:
Fixed combination topical adapalene (0.1%) with benzoyl peroxide (2.5%)
Fixed combination topical benzoyl peroxide with clindamycin
Fixed combination topical tretinoin with clindamycin
Naloxone in children
The recommended dose of naloxone in children under the age of 11 is 100 mcg/kg as an intravenous infusion. The child has a weight of 22kg, which would correspond to 2200 mcg or 2.2 mg - however, this exceeds the maximum permitted dose of 2 mg; thus, the correct dose is the maximum in this case.
GORD
20 mg omeprazole OD for 4-8 weeks
Lansoprazole 15 mg - 30 mg PO once daily
Esomeprazole 20 mg PO once daily
Pantoprazole 20 mg PO once daily
Non-bullous impetigo
As this patient has localised, non-bullous impetigo, the BNF recommends the treatment of choice is hydrogen peroxide 1% cream (Crystacide). In adults, the recommended dosing regime of this preparation is 2-3 times a day for 5-7 days total.
Prolactinoma
Cabergoline 500 micrograms once weekly PO
Bipolar
For patients on lithium therapy, it is reasonable to aim for serum lithium levels of 0.4-1.0mmol/L. As this patient has a plasma lithium level of 0.35, and levels have been consistently on the lower end of the normal range for his past few plasma lithium level checks, it is appropriate to consider increasing the dose of lithium.
Anaphylaxis in children
This child has clinical features of anaphylaxis (stridor, wheeze, rash) and therefore requires urgent administration of IM adrenaline (1:1000). For children between the ages of 6-11, the BNF recommends a dose of 300 micrograms.
Chlorphenamine, hydrocortisone and salbutamol (if wheeze present) should also be administered following initial treatment with IM adrenaline.
Primary hyperparathyroidism
. The optimal pharmacological treatment is cinacalcet 30mg PO BD, as outlined in the hyperparathyroidism treatment summary.
Methotrexate dose
7.5mg
Monteuleukast in asthma
10mg PO OD at night
Post operative pain
morphine 5mg IV every four hours
Heart failure rate control
Bisoprolol fumarate 1.25mg PO OD
Acute diverticulitis
Intravenous first line:
Co-amoxiclav, or cefuroxime with metronidazole, or amoxicillin with gentamicin and metronidazole.
Alternative in penicillin and cephalosporins allergy: ciprofloxacin with metronidazole.
Parecetemol
Acute diverticulitis (penicillin allergy)
Ciprofloaxin and metronidazole
PCP
Co-trimoxazole
What is co-trimoxazole?
Sulfamethoxazole and trimethoprim are used in combination (as co-trimoxazole)
What is the maximum prescribed dose of colchicine for a complete course?
Should not exceed 6mg
How is colchicine prescribed?
500 micrograms 2–4 times a day until symptoms relieved, total dose per course should not exceed 6 mg, do not repeat course within 3 days.
What is the dose of salbutamol on a nebuliser?
Salbutamol 5mg nebulised STAT
How is folic acid prescribed in pregnancy?
In pregnant women with sickle cell disease, the BNF advises folic acid 5mg daily and to continue throughout pregnancy.
What is given to prevent pneumococcal infections in sickle cell anaemia?
Phenoxymethylpenicillin is used first line to prevent pneumococcal infection in patients with sickle-cell disease.
How are insect bites treated?
Treat like cellulitis or erysipelas
0.5–1 g 4 times a day for 5–7 days then review.
What is prescribed in iron overdose?
desferrioxamine mesilate;
What is prescribed for croup?
The BNF recommends a once-only dose of oral dexamethasone at 150 micrograms/kg.
How is pertussis treated?
Clarithromycin
Headache MIGRAINE prophylaxis
Propnaolol 40mg BD PO
How should croup that is not resolving with dexamethasone be managed?
nebulised adrenaline 1:1000 should be given. The dose is 400 micrograms/kg (max 5mg). This can be administered by diluting 1:1000 adrenaline solution with sterile sodium chloride 0.9%.
Apart from morphine, what other prescription is needed to manage crushing chest pain?
400–800 micrograms, to be administered under the tongue and then close mouth, dose may be repeated at 5 minute intervals
How is iron prescribed?
Ferrous sulfate - PO 200mg once daily
How is morphine prescribed for intense pain?
Conditions such as this require strong analgesia and it is reasonable to use opioid medications to achieve adequate pain relief. The BNF recommends a starting dose of up to 5mg intravenous morphine every 4 hours,
What is given for COPD exacerbation in the way of steroids?
Prednisolone 30 mg PO once daily
What is given for the first infusion for paracetemol overdose?
150mg/kg administered over 1 hour
Pain relief for MI?
Morphine: 5-10mg, followed by 5-10mg if required, dose to be administered at a rate of 1-2mg/minute
Diamorphine hydrochloride: 5 mg, followed by 2.5–5 mg if required, dose to be administered at a rate of 1–2 mg/minute
Surgical antibacterial prophylaxis?
An open compound fracture requires antimicrobial coverage to begin at the time of assessment. Given this patient is normally fit and well, with no history of allergies, 1.2g co-amoxiclav, three times a day,
How is pabrinex prescribed?
the patient should receive two or three pairs of Pabrinex, three times a day for the first 3 to 5 days.
Suggest a useful prescription for reducing withdrawal bleeds in menopausal women.
Who can have unopposed oestrogen?
Only woman that have undergone a hyseterectomy
How is scarlet fever treated in children?
Phenoxymethylpenicillin 125mg PO 6 hours for 10 days
How is cyclizine prescribed?
50mg TDS IV
What is the maximum dose of citalopram?
20mg in the elderly and 40mg in adults
How is candida treated in pregnancy?
How is insulin managed in DKA?
Stop short acting, continue long acting like glargine and then fixed rate.
How is nitrofurantoin prescribed in women?
Nitrofurantoin Immediate-release: 50 mg 4 times a day for 3 days
Occular hypertension
Raised intra-ocular pressure in open-angle glaucoma,
Ocular hypertension
for latanoprost
To the eye
Adult
Apply once daily, to be administered preferably in the evening.
Hepatic encephalopathy
30ml lactulose TDS
Prednisolone dose for COPD
30mg PO OD.
Cefalexin for UTI in pregnancy
500 mg orally twice daily for 7 days
How should dexamethasone Maxidex (dexamethasone 0.1% eye drops) be applied in anterior uveitis?
For anterior uveitis, dosing may initially be as often as hourly. However, once symptoms are controlled, this can be reduced to 4-6 times a day
Terbinafine for nail infection
Adult
250 mg once daily for 6 weeks-3 months (occasionally longer in toenail infections).
Uncomplicated gonorrhea
1g IM Once only
Anaphylaxis prophylaxis or emergency treatment in 6-12 year old
Women with pre-eclampsia risk?
Women at risk of pre-eclampsia (which includes patients who have had pre-eclampsia/ eclampsia in a previous pregnancy) should be prescribed low-dose aspirin from 12 weeks until the birth of the baby
Mucolytic in CF
