Prescription review

Question 1

When are anti platelets and anti coagulents contra indicated?

Answer 1

Bleeding
High risk of bleeding e.g. prolonged PT due to liver disease

Do not give prophylactic heparin after a acute stroke

Question 2

Which antibiotic is contraindicated with warfarin therapy?

Answer 2

Erythromycin as it increases the INR

Question 3

What are side effects of steroids?

Answer 3

Stomach Ulcers
Thin Skin
Oedema
Right and left heart failure
Osteoporosis
Infection 
Diabetes
Cushing Syndrome

Question 4

When should NSAIDs be used with caution?

Answer 4

No urine- renal failure
Systolic dysfunction- heart failure
Asthma
Indigestion
Dyscrasia- clotting abnormalities

Question 5

What are the side effects of ACEis?

Answer 5

Cough

Hyperkalaemia

Question 6

What are the side effects of CCBs?

Answer 6

Headache
Flushing
Constipation
Peripheral oedema

Contraindicated in HF with reduced ejection fraction (<40%) and not amlodipine

Question 7

What are side effects of beta blockers?

Answer 7

Bradycardia
Wheeze in asthmatics
Initial worsening of HF before improvement

Question 8

What are side effects of diuretics?

Answer 8

Hyponatraemia
Hypokalaemia
Renal failure
Gout (thiazides)
Potassium sparing- hyperkalaemia and gynaecomastia

Question 9

What fluid should be given when a patient is hypernatraemic or hypoglycaemia?

Answer 9

Dextrose 5%

Question 10

What fluid should be given when a patient is shocked/tachycardic/hypotensive?

Answer 10

500ml bolus of 0.9% saline or Hartmanns over less than 15mins
Give 250ml if heart failure

Question 11

What is the rough guidelines for maintenance fluids?

Answer 11

25-30ml/kg/day fluid
1mmol/kg/day of Na, K and Cl
50-100g/day glucose

Do not infuse more than 10mmol/hr KCl

Question 12

When are compression stockings contraindicated?

Answer 12

When presence of peripheral arterial disease

Question 13

When should metoclopramide be avoided?

Answer 13

Parkinson’s- can worsen symptoms

Young women- risk of dyskinesia

Question 14

What should be prescribed in a nauseated patient?

Answer 14

Regular anti-emetic

• cyclizine 50mg 8hrly IM/IV/oral (can worsen fluid retention so not in HF)
• metoclopramide 10mg 8hrly IM/IV
• ondanestron 4mg or 8mg IV/oral 8hrly

Question 15

What should be prescribed in a non nauseated patient?

Answer 15

As required anti emetic- especially if starting opioids

• cyclzine 50mg oral/IV/IM up to 8hrly (not in HF)
• metroclopamide 10mg up to 8hrly IV/IM if HF

Question 16

What is the treatment of neuropathic pain?

Answer 16

1) amitriptyline- 10mg PO nightly
2) Pregabalin 75mg 12hrly

Diabetic neuropathy
Duloxetine 60mg PO od