Prescription review Flashcards
What are the side effects/contraindications to steroids?
STERIODS:
- Stomach ulcers
- Thin skin
- oEdema
- Right and left HF
- Osteoporosis
- Infection (inc candida)
- Diabetes
- cushing’s Syndrome
What are the safety considerations with NSAIDs?
NSAIDS:
- No urine
- Systolic dysfunction
- Asthma
- Indigestion
- Discrasia (clotting abnormality)
remember aspirin is less associated with these risks
Which antihypertensives cause bradycardia?
- BB
- CCB
Which antihypertensives cause electrolyte disturbance?
- ACE-In
- Diuretics
What are the individuals side effects of common antihypertensives?
- ACE-In - dry cough
- BB - wheeze in a asthmatics, worsen acute HF (help chronic)
- CCB - peripheral oedema
- Diuretics - renal failure, thiazide = gout, spiro = gynaecomastia
What is a common trap with IV potassium prescribing?
Should not be given at more that 10mmol/hour
As a general rule how much IV fluids do adults/elderly require per 24hrs?
- Adults - 3L
- Elderly 2L
What fluids would provide adequate electrolytes for one day?
- 1L 0.9% NaCl
- 2L 5% dextrose
(1 salty, 2 sweet)
When should you avoid metaclopramide?
- Pts with PD as is a dopamine antagonist
- Young women due to risk of dyskinesia
What is a good first line antiemetic? When should it be avoided? What is an alternative?
- Cyclizine 50mg 8 hrly
- Cardiac cases (can worsen fluid retention)
- Metoclopramide 10mg 8 hrly
What is the correct Paracetamol prescription?
Paracetamol 1g 6 hourly oral
What does co-cocodamol 30/500 mean?
30mg codeine and 500mg paracetamol
What is the maximum daily paracetamol dose?
4g
What is the max dose of paracetamol in someone <50kg?
- 500mg 6 hourly
- 2g in 24 hours
What drugs cause hyperkalemia?
- ACE-In
- K+ sparing diuretics
- ARBs
- All heparins
- Tacrolimus
- Blood transfusion
What are common causes of hypokalaemia?
- Loop diuretics
- Thiazide
- Steroids
- Salbutamol
What drugs can cause confusion in elderly?
- Antimuscarinics - oxybutinin
- Anticholinergics - cyclizine
- Sedatives - diazepam
- Opioids - tramadol, codeine (co-codamol)
What type of drugs are trimethoprim and methotrexate?
Folate antagonists
What do you need to do with heparin thromboprophylaxis around a stroke?
Stop during acute periods
What is Half Securon SR?
Verapamil
What indicates peripheral oedema is drug induced?
Normal ejection fraction
What two antihypertensives are contraindicated together?
- BB
- Verapamil
What drugs should be stopped before surgery?
I LACK OP
- Insulin
- Lithium
- Anticoagulants/antiplatelets
- COCP/HRT
- K sparing diuretics
- Oral hypoglycaemics
- Perindopril and other ACE-In
When should COCP/HRT be stopped before surgery?
4 weeks before
When should lithium be stopped before surgery?
Day before
Is metformin stopped before surgery?
- Yes
- Patients are ‘nil by mouth’ -> lactic acidosis if metformin is continued
How are steroids altered around surgery?
- Pts on long term steroids often have adrenal atrophy
- Can result in profound hypotension if the steroids are discontinued
- As with sick day rules where steroid doses are doubled, additionally IV steroids are given at induction of anaesthesia
Which drugs should always be continued during surgery?
- BB
- CCB
What drugs can cause hyponatraemia?
- Thiazides
- SSRIs e.g. citalopram
- TCAs - amitriptyline
- Carbamazepine
- Opioids
- PPIs
What drugs cause hypernatraemia?
- Lithium
When should anticoagulants be stopped around surgery?
1 week before
Which drugs are usually prescribed in mcg?
F F LAND
- Folic acid
- Fludrocortisone
- Levothyroxine
- Atropine
- Naloxone
- Digoxin
Which drugs are usually prescribed in g?
- Paracetamol
- Lithium
- calcium carbonate
- NAC
Which drugs should be prescribed for the morning?
- Diuretics
- Steroids
Which drugs should be prescribed for nighttime?
- Statins
- Night sedation
Which medications should be prescribed for weekly?
- Bisphosphonates
- Methotrexate
- Folic acid
- Patches
What drugs cause hyperglycaemia?
- Steroids
- Antipsychotics
- Thiazides
- BB
- Tacrolimus
What drugs cause constipation?
- Opiods
- Iron
- CCB
- Anticholinergics
- Some diuretics
- Some antiemetics
- Some anti epileptics
- Antacids that contain calcium
What groups of drugs have anticholinergic effects?
- Antidepressants
- Antihistamines
- Incontinence meds
- Antipsychotics
What drugs can cause diarrhoea?
- ABX
- PPIs
- Colchicine
- Metformin
What drugs can cause urinary incontinence?
- Alpha blockers
- Diuretics
- Anticholinesterase inhibitors
- Clozapine
What drugs can cause urinary retention?
- Opiods
- Anticholinergics
What drugs can cause falls?
- Benzos
- Antidepressants
- Antipsychotics
- Antihypertensives
- Antiepileptics
- Opioids
- PD drugs
What drugs cause osteoporosis?
- Steroids
- PPIs
What drugs cause HTN?
- Oral contraceptives
- Steroids
- NSAIDs
What drugs cause high cholesterol?
- Steroids
- Thiazides
What drugs should be stopped if intercurrent illness?
- Metformin
- Statins
- -gliflozins
What drugs can worsen PD?
- Antipsychotics
- Antiemetics
- Antidepressants
What drugs can worsen MG?
- Abx
- BB
- LA
- Sedating drugs
What drugs can worsen psoriasis?
- BB
- Li
- Some abx
What drugs can worsen HF?
- NSAIDs
- CCB
- Pioglitazone
What drugs cause pancreatitis?
- Steriods
- DDP4-In
- GLP-1 analogue
- Mesalazine > sulphasalazine
Which drugs should you stop in AKI?
‘Stop the DAMN drugs’
- Diuretics
- ACEIn/ARB
- Metformin
- NSAIDs
