Prescription Review

Question 1

A patient comes in with a new episode of haemoptysis. Which medications should be stopped?

Answer 1

1. antiplatelets e.g. Aspirin
2. anticoagulants e.g. enoxaparin

Question 2

What medications should be stopped when a patient has hyperkalaemia?

Answer 2

1. ACE inhibitors
2. IV fluids containing potassium

Question 3

What is the maximum dose of Paracetamol per day for a patient >50kg

Answer 3

4g/day

Question 4

What does the PReSCRIBER pneumonic stand for?

Answer 4

Patient details
Reaction (e.g. allergy status)
Sign the front of the chart
Contraindications
Route
Intravenous fluids
Blood clot prophylaxis
antiEmetic
pain Relief

Question 5

Is prophylactic heparin appropriate in a patient following an ischaemic stroke?

Answer 5

No

Question 6

What are 8 common side effects of steroids? (STEROIDS pneumonic)

Answer 6

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection (inc Candida)
Diabetes (hyperglycaemia)
Cushing’s syndrome

Question 7

What are some safety considerations for NSAID’s? (NSAID pneumonic)

Answer 7

No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)

Question 8

Give 3 side effects of beta blockers

Answer 8

1. Bradycardia
2. wheeze in asthmatics
3. worsening of acute heart failure

Question 9

Give 2 side effects of calcium channel blockers

Answer 9

1. peripheral oedema
2. flushing

Question 10

Side effect of thiazide diuretics

Answer 10

gout

Question 11

Side effect of potassium-sparing diuretics

Answer 11

gynaecomastia

Question 12

What type of IV fluid should you give to someone who is hypernatraemic or hypoglycaemic

Answer 12

5% dextrose

Question 13

What IV fluid should you give a patient with ascites

Answer 13

human-albumin solution (HAS)

Question 14

What bolus of fluid should you give a patient who is hypotensive with a history of heart failure

Answer 14

250ml

Question 15

what volume of fluid should you give in bolus for a patient who is tachycardic or hypotensive

Answer 15

500ml

Question 16

What is the maximum rate IV potassium should be given at

Answer 16

no more than 10mmol/hour

Question 17

What combination of fluids provide adequate electrolytes?

Answer 17

1L of 0.9% saline and 2L 5% dextrose

Question 18

What should a patient with peripheral arterial disease NOT be prescribed?

Answer 18

compression stockings

Question 19

What 2 groups of people should metoclopramide NOT be given to

Answer 19

1. Parkinson’ s
2. Young women

Question 20

What group of patients should cyclizine be avoided in and what should be used instead

Answer 20

patients with heart failure as cyclizine can cause fluid retention
instead use metoclopramide 10mg 8hrly IV/oral

Question 21

What painkiller is recommended in painful diabetic neuropathy

Answer 21

Duloxetine 60mg

Question 22

What drugs can cause hypokalaemia?

Answer 22

thiazide diuretics
Loop diuretics

Question 23

What drugs can cause hyperkalaemia?

Answer 23

ACE inhibitors
potassium-sparing diuretics

Question 24

Name two drugs which may contribute to indigestion?

Answer 24

Ibuprofen
Oral steroids

Question 25

What drugs can cause renal failure?

Answer 25

NSAIDs
ACE inhibitors
Aminoglycoside antibiotics e.g. gentamicin
Contrast

Question 26

What are some drug causes of confusion in the elderly?

Answer 26

Oxybutynin
Tramadol
Cyclizine
Diazepam

Question 27

Trimethoprim is a direct contraindication to patients taking which drug?

Answer 27

Methotrexate - can cause bone marrow toxicity

Question 28

What class of drugs can cause hyponatraemia

Answer 28

Diuretics

Question 29

What two classes of drugs should be used in caution in asthmatics

Answer 29

Beta blockers
NSAIDs

Question 30

What drug should not be prescribed with beta blockers due to the risk of bradycardia?

Answer 30

Verapamil (CCB)