Prescribing in older patients

Question 1

Why is tramadol contraindicated with patients on SNRIs?

Answer 1

Similar chemical structure so tramadol has seretonin effects

Can cause seretonin syndrome

Question 2

Describe the tramadol vs wafarin interaction

Answer 2

Increases bleeding risk

May need to dose adjust based on INR

Question 3

Which conditions is diclofenac contraindicated in?

Answer 3

CKD

Diabetes

Question 4

What is QRISK3?

Answer 4

Likelihood of stroke/MI in the next 10 years

Question 5

What monitoring is needed to check for anaemia?

Answer 5

FBC

• Haematocrit
• Hb
• RBC
• MCV

Question 6

What monitoring is needed before starting ACEi?

Answer 6

U&Es

• assess renal function for electrolyte balance

Question 7

Why do dispersible soluble tablets cause hypernatraemia?

Answer 7

Lots of sodium as part of its excipients

Question 8

Why do gaviscon cause hypernatraemia?

Answer 8

Lots of sodium as part of its excipients

Question 9

What is the prescribing cascade?

Answer 9

Starting a new med to treat the side effects or prevent the side effects of another

E.g. Morphine causes constipation, so we prescribe bisacodyl

Question 10

What is postural hypotension?

Answer 10

Systolic bp drops by 10 mmHg from sitting to standing