Prescription Review Flashcards
What is the PReSCRIBER mnemonic?
Patient details
Reaction i.e. allergy plus the reaction
Sign the front of the chart
Check for contraindications
Route of each drug
IV fluids if needed
Blood clot prophylaxis if needed
anti-Emetic if needed
pain Relief if needed
What drugs increase bleeding and should not be given to which patients?
anti-platelets, anti-coagulants
Do not give to those who are bleeding, suspected bleeding or at risk e.g. prolonged PT time due to liver disease
What are the side effects of steroids?
STEROIDS
Stomach ulcers
Thin skin
Oedema
Right and left heart failure
Osteoporosis
Infection (including candida)
Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes)
Cushing’s
What drugs is it important to remember contain penicillin?
Co-amoxiclav and Tazocin
What are important safety considerations with NSAIDs?
No urine (renal failure)
Systolic dysfunction i.e. heart failure
Asthma
Indigestion - any cause
Dyscrasia - clotting abnormality
What are the side effects of antihypertensives?
Hypotension and postural hypotension
Bradycardia - beta blockers and some CCBs
Electrolyte disturbance with ACEi and diuretics
ACEi - dry cough
Beta blockers - wheeze in asthmatics, worsen acute heart failure (help chronic)
CCBs can cause peripheral oedema and flushing
Diuretics can cause renal failure
Thiazide diuretics can cause gout
K sparing diuretics can cause gynaecomastia
What are the rules in prescribing replacement fluids?
(For dehydrated/acutely unwell)
0/9% saline unless -
Hypernatraemic/hypoglycaemia 5% dextrose
Ascites - human albumin solution
Shocked from bleeding - blood
If tachypnoea/hypotension 500ml bolus
If only oliguric (no obstruction) - 1L over 2-4 hours then reassess
How fluid depleted can a patient be based on their signs?
Reduced urine output - 500ml depleted
Reduced output plus tachycardia - 1L of fluid depletion
Reduced output plus tachycardia plus shock indicates >2L of fluid depletion
What rate should IV potassium be given at?
No more than 10mmol/hour
Who are maintenance fluids for?
Patients who are nil by mouth
What is the general rule of maintenance fluid requirements?
Adults 3L per 24 hours
Elderly 2L per 24 hours
Adequate electrolytes given by 1 salty 2 sweet: 1L of 0.9% saline and 2L of 5% dextrose
To give potassium - require roughly 40mmol KCl per day - 20mmol in 2 bags
How fast should you give maintenance fluids?
If giving 3l per day - 8 hourly bags (24/3)
If giving 2l per day - 12 hourly bags
How must a patient be reassessed following fluid prescription?
Check patient’s U&Es to confirm what to give them
Check not fluid overloaded e.g. raised JVP, peripheral and pulmonary oedema
Ensure patient’s bladder not palpable (urinary obstruction) - if giving fluids and still reduced urine output
What is it important to note in blood clot prophylaxis?
Majority of patients receive LMWH e.g. 5000 units dalteparin daily s/c, and stockings
Remember if a patient is bleeding or at risk of bleeding including recent ischaemic stroke - do not prescribe anti-coagulants.
Do not prescribe stockings in peripheral arterial disease.
Who should metoclopramide be avoided in?
Dopamine antagonist - anti-emetic
Avoid in those with parkinson’s due to risk of exacerbating symptoms
Avoid in young women due to risk of dyskinesia
