Prescription review Flashcards
what is the PReSCRIBER mneumonic?
- Patient details
- Reaction (i.e. allergy + reaction to medication)
- Sign the front of the chart
- Contraindications
- Route of drug
- Intravenous fluids - assess if needed
- Blood clot prophylaxis - assess if needed, what to give
- Anti-Emetic - assess if needed
- Pain Relief - assess if needed
What to check for patient details?
needs to have 3 e.g. name, DOB and hospital number
can use patient sticker with all of this on
What are the main groups of contraindications to consider?
- anti-platelets + anti-coagulants not to be given to patients who are actively bleeding, suspected of bleeding or at high risk of bleeding
- SE of steroids (STEROIDS) - Stomach ulcer, Thin skin, oEdema, Right + L HF, Osteoporosis, Infection (incl. Candida), Diabetes, cushing’s Syndrome
- safety of using NSAID - No urine, Systolic dysfunction (HF), Asthma, Indigestion, Dyscarsia (clotting abnormal)
- broad SE of anti-HTN - hypotension, bradycardia (beta-blocker, CCB), electrolyte disturbance (ACEi, diuretics)
What are the SE of steroids?
STEROIDS
- Stomach ulcers
- Thin skin
- oEdema
- Right and left heart failure
- Osteopororsis
- Infection incl. candid
- Diabetes (usually ↑ BM)
- Cushing’s Syndrome
What factors to consider if NSAID is safe to prescribe?
NSAID
- No urine e.g. renal failure
- Systolic dysfunction e.g. HR
- Asthma
- Indigestion
- Dyscrasia (clotting abnormality)
SE of anti-HTN
- Hypotension for all (earliest Sx, postural hypotension)
- Beta-blocker + CCB → bradycardia
- ACEi + diuretics → electrolyte disturbance
- ACEi → dry cough
- Beta-blockers → wheeze in asthmatics, worsening acute HF (useful in chronic)
- CCD → peripheral oedema, flushing
- Diuretics → renal failure
- Thiazide (bendroflumethiazide) → gout
- K+ sparing (spironolactone) → gynaecomastia
what considerations for medication routes are there?
- vomiting - anti-emetic given SC/IM/IV, if only short period of vomiting don’t convert all other
- degree of clinical well/unwell - i.e. IV Abx for very unwell
When should 0.9% NaCl not be used?
What should be given instead?
Hypernatraemia or hypoglycaemia → 5% dextrose instead
Ascites → human albumin solution instead
Shocked from bleeding → blood transfusion, crystalloid until blood available
what indications for fluids?
- acutely unwell or volume depleted
- maintenance fluids in NBM patients or with very low oral intake
what fluids for hypernatraemia or hypoglycaemia?
5% dextrose
what fluids for ascites patients?
human albumin solution to maintain oncotic pressure
what fluids in shocked pt secondary to haemorrhage?
blood transfusion
crystalloid (normal saline) until blood available
what is the maximum amount of IV potassium?
do not give more than 10 mmol/hour
considerations for maintenance fluids?
- General rule - 3L/24hrs for adults, 2L/24hrs for elderly
- Electrolytes - 1L 0.9% saline and 2L of 5% dextrose (1 salty, 2 sweet)
- Normal potassium require 40mmol KCl per day → put 20 mmol in 2 bags
rough maintenance amounts for adults + elderly?
- adults = 3L
- elderly = 2 L
over 24 hours
analgesia prescription for regular and PRN based on severity of pain
