PRESCRIBING

Question 1

What does an enzyme inducer do to the P450 system?

Answer 1

Increase activity of P450 resulting in a reduced effect

Question 2

Examples of enzyme inducers

Answer 2

PC BRASS
Phenytoin
Carbamezapine
Barbituates
Rifampacin
Alcohol (chronic excess)
Sulphonylureas

Question 3

What does an enzyme inhibitor do to P450 system?

Answer 3

Decrease the P450 system which will lead to increased levels of other drugs

Question 4

Examples of enzyme inhibitors

Answer 4

AODEVICES
Allopurinol
Omeprazole
Disulfram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides

Question 5

How do you prescribe topical drugs?

Answer 5

Fingertip units (FTU)

Question 6

Which drugs should be stopped before surgery?

Answer 6

I LACK OP:
Insulin
Lithium
Anticoagulants/antiplatelets
COCP/HRT
K- sparing diuretics
Oral hypoglycaemic
Perindopril and other ACE-i

Question 7

When do you stop the COCP or HRT before surgery?

Answer 7

4 weeks before

Question 8

When do you stop lithium before surgery?

Answer 8

1 day before

Question 9

When do you stop K+ sparing diuretics and ACEi before surgery?

Answer 9

The day of surgery

Question 10

When do you stop anticoagulation before surgery?

Answer 10

Variable - occasionally continued

Question 11

When do you stop oral hypoglycaemic and insulin before surgery>

Answer 11

Variable - if patients are NBM metformin should be stopped as it causes hypoglycaemia

Question 12

Prescribing (ACCURATE)

Answer 12

Allergies
Correct patient
Contraindications
Units
Route (vomit, swallow, NBM)
Analgesia, anti-emetic
Thromboprophylaxis
End of date of course

Question 13

Replacement fluids

Answer 13

0.9% saline

if hypoglycaemic or hypernatraemia then 5% dextrose

Question 14

Maintenance fluids

Answer 14

25-30ml/kg/24h water

1mmol/kg/24h Na+ and K+
50-100g/24h glucose
1l over 8-12h

Question 15

Fluid losses

Answer 15

NaCl 0.9% and K 0.3% (40mmol)
1l over 4-6h

Question 16

Hypoglycaemia fluid replacement

Answer 16

Glucose 20%
100ml over 15 mins

Question 17

Resuscitation (low BP and high HR) fluid

Answer 17

NaCl 0.9%
500ml over 15 mins or less

Question 18

Hypokalaemia fluid replacement

Answer 18

Max 10mmol/h
NaCl 0.9% and K 0.3% (40mmol)
1l over 4h

Question 19

Hypercalcaemia fluid replacement

Answer 19

NaCl 0.9%
1l over 4h

Question 20

Fluid resus in children

Answer 20

10ml/kg
NaCl 0.9%
100ml/kg/24h for first 10kg
50ml/kg/24h for next 10kg
20ml/kg/24h for anything after

Question 21

What drugs can you use for DVT?

Answer 21

Dalteparin
Enoxaparin

Question 22

When is the best time of day to prescribe an ACE-i?

Answer 22

Evening as they can cause postural hypertension

Question 23

What do you give in acute asthma?

Answer 23

Salbutamol nebulisers

Question 24

What fluid do you give in DKA?

Answer 24

50 units of ActRapid with 0.9% saline via IV