Prescribing Safety #2

Question 1

If no comorbidities, what is the starting dosage of morphine for palliative care patients?

Answer 1

if no comorbidities use 20-30mg of MR a day with 5mg morphine for breakthrough pain.

Question 2

When initiating a Opiod what pre cautionary things should you considering also offering due to side effects?

Answer 2

• Laxatives
• Nausea is often transient, however if persistent then anti-emetics
• Consider dose adjustment if transient drowsiness doesn’t settle

Question 3

What medications may exacerbate heart failure?

Answer 3

• thiazolidinediones: pioglitazone
• Verapamil: negative inotropic effect
• NSAIDs**/Glucacorticoids: use with caution as they cause fluid retention

Question 4

For patients with a penicillin allergy, what other antibiotic shoul potentially be avoided?

Answer 4

Around 0.5-6.5% of patients who are allergic to penicillin are also allergy to cephalosporins.

Use an alternative like Amoxicillin-clavulanate instead

Question 5

Describe the usual dose/freq/route for the most commonly used laxatives

Answer 5

Lactulose 15ML PO BD

Macrogol 1-2 Sachets PO BD

Senna 15-30mg PO ON

Question 6

P450 is essential for……

Answer 6

the metabolism of many drugs in the body.

THerefore when inhibited they cause buildup of drugs

and when enhanced they cause a fall in conc/therapeutic failure

Question 7

How to remember inducers of P450 (therefore will cause a fall in drug levels and increased metabolism of drugs)

Answer 7

BullShit CRAP GPS

• Barbituates
• St Johns Wort
• Carbmazapine
• Rifampicin
• Alcohol (chronic)
• Phenytoin
• Ginseng
• Phenobarbitol
• Sulfonylureas

Question 8

How to remember inhibitors of P450 (therefore will cause a rise in plasma drug levels)

Answer 8

VICKS FACE All OVER GQ stops ladies in their tracks

Question 9

the two most important adverse effects in patients taking carbimazole

Answer 9

• Neutropaenia
• Agranulocytosis

Question 10

Digoxin toxicity features

Answer 10

• Generally unwell/lethargy/n+v/ anorexia/confusion/yellow-green vision
• Arrythmias
• Gynaecomastia

Question 11

What precipitates digoxin toxicity?

Answer 11

• Hypokalamia
• inc age
• renal failure

Question 12

Important oral/facial reaction/adverse effect of bisphosphanates

eg; alendronate

Answer 12

oesophageal reactions and osteonecrosis of the jaw

** constipation is an SE but not as important to discuss with patient

Question 13

first line anti-cholinergic for unirnary incontinence?

Answer 13

Oxybutynin 2.5mg PO BD