Prescription review

Question 1

PReSCRIBER Mneumonic

Answer 1

Patient details
Reaction (ie. allergy plus the reaction)
Sign the front of the chart
Check for Contraindications to each drug
Check Route for each drug
prescribe IV fluids if needed
prescribe Blood clot prophylaxis if needed
prescribe antiEmetic if needed
prescribe pain Relief if needed

Question 2

4 common drug groups that may be contraindicated

Answer 2

1. BLEEDING - Drugs that increase bleeding should not be given to patients bleeding
2. STEROIDS
3. NSAIDS - renal failure, heart failure, asthma, indigestion, clotting abnormalities
4. ANTIHYPERTENSIVES - individual drug classes have specific side effects

Question 3

STEROIDS side effects

Answer 3

Stomach Ulcers
Thin skin
oEdema
Right and Left heart failure
Osteoporosis
Infection
Diabetes (commonly causes hyperglycaemia)

Question 4

Antihypertensives side effects

Answer 4

1. Hypotension (all groups)
2. Bradycardia (Beta-blockers, some Ca-channel blockers)
3. Electrolyte disturbances (ACEi and diuretics)

Question 5

ACE inhibitors side effects

Answer 5

Dry cough

Question 6

Beta-blockers side effects

Answer 6

Can cause wheeze in asthmatics
Can cause worsening of acute heart failure (but help chronic heart failure)

Question 7

Ca-Channel blockers common side effect

Answer 7

Can cause peripheral oedema and flushing

Question 8

Diuretics common side effect

Answer 8

Can cause renal failure

Thiazide diuretics (e.g. bendroflumethiazide) can cause gout

K-sparing diuretics (e.g. spironolactone) can cause gynaecomastia

Question 9

Replacement fluids: which fluid?

Answer 9

Give all 0.9% saline
Unless:
- hypernatraemic or hypoglycaemic: give 5% dextrose
- has ascites
- is shocked from bleeding: give blood transfusion, but saline first if no blood available