Prescribing Safely

Question 1

How does prescribing differ in children?

Answer 1

• Calculations of drug doses depend on age, weight or surface area of a child

Question 2

Four things you need to prescribe specifically in children, when prescribing fluids?

Answer 2

• Fluid type (concentration)
• Volume (e.g. 500mL bag)
• Rate (mL/hour)
• Additives if required
• Need daily U&Es

Question 3

How do you calculate fluids based on weight, over 24 hours?

Answer 3

• For every kg up to 10kg 100mL/kg/day
• For every kg between 10‐20 kg 50mLkg/day
• For every kg over 20kg 20mL/kg/day

Question 4

How do you calculate fluid deficit in dehydrated children?

Answer 4

%dehydration x weight x 10= total fluid deficit (mls)

This represents the extra fluid that is needed so should be added to total maintenance requirements.

Question 5

The usual fluid for neonates?

Answer 5

10% dextrose

Question 6

Two types of adverse drug reactions?

Answer 6

Type A: pharmacological mechanism of drug causing an effect e.g. badycardia caused by Beta-Blockers, predictable and related to dose.

Type B: idiosyncratic/immunological, not predictable and not necessarily related to dose

Question 7

Percentage of hospital admissions in the UK caused by ADRs?

Answer 7

6-7%

Question 8

Main regulatory agency in the UK for medicines?

Answer 8

The MHRA - The medical and healthcare products regulatory agency

Question 9

Why is post-marketing surveillance (pharmacovigilance) important?

Answer 9

Clinical trials will often only pick up common S/Es

Question 10

Steps in assessing someone with a suspected ADR?

Answer 10

1. Assess the nature and severity of the ADR
2. Take a history of the presenting symptoms including timing and dose.
3. Take a complete drug history.
4. Review the ADR profile of the drug. - has it been reported before, how common is it.
5. Consider further examination and investigations.

Question 11

Steps in managing a suspected ADR?

Answer 11

1. Assess the reaction:
   - Arrange emergency admission if ADR is life threatening
2. Review and discuss treatment with the individual.
   - Consider stopping/alternative/changing dose
3. Manage symptoms.

Question 12

Minimum requirement of information to be reported on a yellow card?

Answer 12

• One piece of patient information
• Names of suspected drug/drugs
• Brief description of the ADR
• Contact details of reporter

Question 13

What drug reactions are particularly important to report?

Answer 13

Children

Elderly people

Black triangle products (new drugs being monitored)

Serious reactions

Congenital abnormalities

Herbal remedies