Prescription Review

Question 1

Side effects of steroids?

Answer 1

S - stomach ulcers
T - thin skin
E - oEdema
R - right and left heart failure
O - osteoporosis
I - infection
D - Diabetes (commonly hyperglycaemia, less commonly diabetes)
S - cushings Syndrome (uncommon)

Question 2

Antiemetics for a nauseated patient?

Answer 2

Cyclizine 50mg 8 hourly IM/IV/Oral (not for patients with HF)

Metoclopramide 10mg 8 hourly IM/IV (if HF)

Ondansetron 4mg or 8mg 8 hourly IV/Oral

Question 3

Antiemetics for a non-nauseated patient?

Answer 3

Prescribe PRN:

Cyclizine 50mg up to 8 hourly IM/IV/Oral

Metoclopramide 10mg up to 8 hourly IM/IV (if HF)

Question 4

Pain relief for someone not currently in pain?

Answer 4

Regular = nothing

PRN = Paracetamol 1g up to 6 hourly oral

Question 5

Pain relief for someone in mild pain?

Answer 5

Regular = Paracetamol 1g 6 hourly oral

PRN = Codeine 30mg up to 6 hourly oral (tramadol a suitable replacement)

Question 6

Pain relief for someone in severe pain?

Answer 6

Regular = Co-codamol 30/500, 2 tablets 6 hourly oral

PRN = Morphine sulphate (10mg/5ml) 10mg up to 6 hourly oral

Question 7

Pain relief for someone with neuropathic pain?

Answer 7

1. Amitriptyline 10mg oral nightly
2. Pregabalin 75mg oral 12 hourly
3. Duloxetine 60mg oral daily (in diabetic neuropathy)

Question 8

Max dose paracetamol?

Answer 8

Adult = 4g per day
<50kg = 2g per day

Question 9

Safety considerations for NSAIDS?

Answer 9

N - No urine (renal failure)
S - systolic dysfunction (HF)
A - Asthma
I - Indigestion
D - Dyscrasia (clotting abnormality)

Question 10

HTN drugs hypo/hyperkalaemia?

Answer 10

Loop + thiazide diuretics = hypokalemia
ARB + ACEi = hyperkalemia

Question 11

Classic symptoms of antimuscarinic toxicity?

Answer 11

• Pupillary dilation (with loss of accommodation)
• Dry mouth
• Tachycardia (after transient bradycardia)
• Acute confusion