Prescribing

Question 1

How to get from morphine to diamorphine

Answer 1

10 mp morphine= 3.3 mg diamorphine

So divide by three to get from morphine to diamorphine

Question 2

How to get from oral morphine to oral oxycodone

Answer 2

10mg morphine= 6.6 mg oxycodone

So divide by 3 and times by 2

Question 3

What morphine dose to give to opiate naive patients

Answer 3

20-30 mg of modified release morphine sulphate tablets with 5mg oral morphine solution for breakthrough pain

Always coprescribe laxatives

Question 4

What eGFR determines opioid choice in cancer pain

Answer 4

30-60 -> mild-moderate renal impairment -> give oxycodone

<30 -> severe renal impairment -> give fentanyl / buprenorphine

Question 5

What is oramorph

Answer 5

Brand name for immediate release morphine

Comes in tablets

Question 6

How much fluid does an adult need in a day

Answer 6

25-35 ml/kg/day

So a 60kg person needs 1.5L a day

Question 7

How much glucose does someone need per day and how would you prescribe that for someone NBM

Answer 7

50-100 g / day

You get 50g in 1 L of 5% dextrose

So give them 1L of 5% dextrose

Question 8

How much na, k , cl does a person need and hw do you prescribe this

Answer 8

1 mol/kg/day

Sodium chloride 0.9% has 154mmol in a Litre

If someone is 75kg then they need 500mls sodium chloride in a day

Add potassium on as an additive- potassium chloride ?ignore the fact that chloride is in it?

Question 9

How to calculate paeds maintainance fluids

Answer 9

In a day:

100ml per kg in the first 10 kg of weight

50ml per kg in the second 10 kg of weight

After that is 20ml per kg

So a 22kg kid needs 1000+500+40=1,540 ml of fluids per day

Don’t forget to divide into hourly for the rate!

Question 10

How to calculate a fluid deficit in a child

Answer 10

%dehydration x weight x 10

So a 12kg kid who is 5% dehydrated= 5x12x10=600

Don’t forget to add on their maintainance when presciribing so would be 1100+600=1,700

Question 11

How to calculate resuscitation fluids in a child

Answer 11

0.9% sodium chloride

10ml/kg

Over <10 minutes

Question 13

What does lidocaine 2% mean in terms of amount of drug in a certain amount of mls

Answer 13

2% means there is 2g of it in 100mls

Question 14

What ph

Question 15

Wet ARMD management

Answer 15

Anti- Vascular endothelial growth factor agents

E.g. ranibizumab

Given normally in 4 weekly injections

Question 16

Dose of adrenaline in an adult , child <6 and child 6-12 in anaphylaxis

Answer 16

Adult = 500 micrograms which is 0.5ml of 1 in 1000 adrenaline IM

<6 = 150 micrograms

6-12 =-6 300 micrograms

(Cardiac arrest = 1mg which is 10ml of 1 in 10,000 (or 1 ml of 1 in 1000))

Question 18

Haloperidol ci

Answer 18

Long QT

Arrythmia

Parkinson’s

Give lorazepam,

Question 19

OD reversal for opioids, tricyclics and benzos

Answer 19

Naloxone

Sodium bicarbonate

Flumazenil

Question 20

The