Prescription review

Question 1

What are some essential factors to remember to check when reviewing a prescription?

Answer 1

PReSCRIBER pnuemonic

Patient details

Reaction

Sign the front

Contraindications

Route

IVF

Blood clot prophylaxis

anti-Emetic

Relief of pain

Question 2

Fact #1

Answer 2

Do not forget that Co-amox and Tazocin both contain penicillin!!!

Question 3

Which types of patients will you double think anti-platelets and anti-coag for?

Answer 3

those who are bleeding
suspected of bleeding
risk of bleeding

Question 4

Steroids side effects?

Answer 4

Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
Cushing’S

Question 5

what considerations should you make before prescribing an NSAID?

Answer 5

No urine (renal failure)
Systolic dysfunction (HF)
Asthma
Indigestion
Dyscrasia (clotting)

Question 6

what are some anti-hypertensive side effects?

Answer 6

1. hypotension
2. Bradycardia with BB, CCB and electrolyte imbalances with ACEi and diuretics

ACEi dry cough

BB wheeze in asthmatics, worsening HF

CCB peripheral oedema, flushing

Diuretics renal failure, thiazide like gout, potassium sparing gynaecomastia

Question 7

When must you consider routes of medication?

Answer 7

vomiting - non oral routes, unless predicted to be a short time

*common antiemetics dose same regardless of route
*NBM usually receives oral meds still

Question 8

What are the two broad indications for IV fluids?

Answer 8

replacement - dehydrated or unwell
maintenance - NBM

Question 9

what fluid is best to use when replacing?

Answer 9

• 0.9% saline

unless,
- hypernatraemia or hypoglycaemic use 5% dextrose
- shocked due to blood loss give blood transfusion

Question 10

what factors must you assess before considering how much to replace and how fast?

Answer 10

HR
BP
Urine output

*if tachy or hypotensive 500mL bolus or 250mL if HF
*oliguric then 1L over 2-4h then reassess
*never prescribe more than 2L of IVF for sick pt

Question 11

Which fluids to use for maintenance?

Answer 11

• general rule adults require 3L per 24h and elderly 2L
• 1L of 0.9% saline and 2L of 5% dextrose
• 2 x 20mmol KCL in 2 bags for potassium for normal

Question 12

Roughly what are the rules for how fast to give maintenance fluids?

Answer 12

• 3L give it 8 hourly
• 2L give it 12 hourly

Question 13

what must you check before prescribing fluids in real life?

Answer 13

• check U&E
• check not fluid overloaded with JVP, oedema
• ensure patients bladder is not palpable

Question 14

how is blood clot prophylaxis carried out in hospitals?

Answer 14

prophylactic LMWH - dalteparin
compression stockings (unless peripheral arterial disease)

Question 15

When must you avoid metoclopramide?

Answer 15

parkinson’s
young women - risk of dyskinesia

Question 16

what regular antiemetics would you give for nausea?

Answer 16

• cyclizine (except in cardiac)
• metoclopramide (heart failure)

Question 17

what pain relief would you give regularly?

Answer 17

mild - paracetamol 1g 6 hourly oral
severe - cocodamol 30/500, 2 tablets 6 hourly

prn - paracetamol, codeine, morphine sulphate

Question 18

what to consider when prescribing paracetamol?

Answer 18

• daily maximum 4g (8x500mg)
• co-codamol has 50mg codeine and 500mg paracetamol so max 6 hourly
• in patients under 50kg max dose is 500mg 6 hourly

Question 19

What is a common medication that causes hypokalaemia?

Answer 19

thiazide like diuretic

Question 20

what is a common medication that causes hyperkalaemia?

Answer 20

ACE-i

Question 21

how does steroids cause indigestion?

Answer 21

inhibits gastric epithelial renewal, predisposing to ulceration

Question 22

how does ibuprofen cause indigestion?

Answer 22

inhibit prostaglandin synthesis needed for gastric mucosal protection from acid -> risk of inflammation and ulceration