Prescription review Flashcards
What is the maxiumum dose of paracetamol a dayfor an adult patient over 50kg
4g
What is tazocin?
Piperacillin and tazobactam! Remember this has penicillin
Give the main side-effects of steroids
S -stomach ulcer
T - thinning skin
E - oEdema
R - right and left heart failure
O - osteoporosis
I - infections, including candida
D - diabetes and hyperglycaemia
S - cushings Syndrome
Give important saftey considerations for NSAIDs.
N - no urine (renal failure)
S - systolic dysfunction (HF)
A - asthma
I - indigestion
D - dyscracia (abnormal clotting)
Give important side effects for anti-hypertensives
- hypotension can occur with all
- bradycardia with b blockers and ca channel blockers
- electrolyte imbalance with ace inhibitors and diuretics
- ace inhibitors = dry cough
- b blockers = wheeze in asthmatics
- ca channel blockers = oedema and flushing
- diuretics = renal failure
- thiazide diuretics = gout
- potassium sparing = gynaecomastia
Which patients should not have 0.9% saline?
- patients who are HYPERNATRAEMIC or HYPOGLYCAEMIC. They should be given 5% dextrose!
- patients with ASCITES give human-albumin sol.
- shock from bleeding, give blood first. Crystalloid if blood is unavailable
Give a list of the enzyme inducers and their effect on the metabolism of the drug processed by P450
BullShit CRAP GPS
Barbituates
St Johns Wort
Carbamazepine
Rifampicin
Alcohol chronic
Phenytoin
Griseofulvin
Phenobarbital
Sulfonylureas (e.g gliclazide)
Enzyme inducers = increased metabolism of drug = decreasec conc and therapeutic affect
Give a list of the enyme inhibitors and the effect on the metabolism of targetted drug
SICKFACES.COM
Sodium valporate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Amiodarone/ Alc XS
Ciprafloxacin/Chloramphenicol
Erythromycin
Sulfonamides (co-trimox, trimeth)
.
Cranberry juice
Omeprazole
Metronidazole
Grapefruit juice
Inhibits P450 = less metabolised = increased conc= increased affect
What are aminosalicylates and give example drugs
Drugs that are used the fight inflammation in the gut.
e.g: mesalamine, sulfasalzine and olsalazine
What are aminoglycocides and give drug examples
Broad spectrum abx generally used for gram neg bacteria.
e.g gentamicin
What are quinilones and give example drugs
broad spectrum abx
e.g ciprofloxacin, levofloxacin
Which drugs need to be stopped before surgery
Insulin and other hypoglycaemics
Lithium
Anti-coags and platelets
COCP/HRT
Diuretics
ACE inhibitors
What would you do for fluid replacement in someone who is tachycardic or hypotensive?
500ml bolus stat then reasess patient.
Give 250ml bolus in patient who has HF
What would you do for fluid replacement in a patient with oliguria (not due to obstruction)
give 1L fluid over 2-4 hours.
never prescribe more than 2L for a sick pt.
How fast can you give IV potassium?
no faster than 10mmol/hr
How do you provide adequate electrolytes with fluid resusitation
give 1L of 0/9% saline and 2L of 5% dextrose
How fast should you give fluids?
adults tend to need approx 3L/24hr
For 3L give 8-hourly bags
elderly patients tend to need approx 2L/24hr
For 2L give 12-hrly bags
Which patients should not be given blood clot prophylaxis?
Patients who are already a bleeding risk should not be prescribed anticoagulants
Patients with PAD shoud not have compression stockings
Which patients should not be prescrived metoclopramide
Metaclopramide is a DOPAMINE ANTAGONIST.
Patients with Parkinsons should not be prescribed this.
Young women.
What is the impact of ace-inhibitors on potassium conc in the blood
ACE-inhibitors cause HYPERKALAEMIA.
ACE-i cause reduced aldosterone production causing reduced ecretion of potassium through the kidneys
What is the impact of thiazide dieuretics on potassium conc in the blood?
Cause HYPOkalaemia
What is the impact of aldosterone antagonist on potassium conc in the blood?
HYPERkalaemia
What type of drug is oxybutynin? Give common side effects of this drug
Anti-muscarinic used to treat urinary frequency and urgency
Side effects:
confusion, pupilliary dilatation, loss of accomodation, dry mouth, tachycardia after transient bradycardia
Why is trimethoprim contra-indicated in the first trimester of pregnancy and for patients on methotrexate therapy
it is a FOLATE ANTAGONIST
when used with methotrexate it can cause bone marrow toxicity.
How should methotrexate dose be managed in a patient with active infection
IT SHOULD BE STOPPED
Give one of the main side effects of ca channel blockers
Oedema
What drug class is verapamil
ca channel blocker
What drugs are contra-indicated in asthma
b-blockers
be wary of NSAIDs
List the b-lactam abx
Penicillins
Cephalosporins
Monobactams
Carbapenems
Give examples of cephalosporins
Cephalexin, ceftriaxone
How would you find for example: all drugs that cause hyperkalaemia
Appendix 1 interactions
What is the maximum rate that potassium can be infused. How many mmol is in 0.15% KCl and 0.3%?
10mmol/hr
0.15 = 20mmol/L
0.3 = 40mmol/L
What drug is used to treat anti-psychotic toxicity?
IV procyclidine
If a drug, e.g adrenaline is stated to be 1:1000. How many mg of the drug is present?
1g of drug in 1000ml
What is the glucose requirement for an adult in a day
50g
Give fluid maintenance for children
100ml/kg/day for first 10kg
50ml/kg.day for next 10kg
20ml/kg/day for every kg over 20kg
