Prescription Review Flashcards by Aimee Tarpey

What does PReSCRIBER mnemonic stand for?

P = patient details (3 forms of identification - name, DOB, NHSno.)

R = Reaction (allergies? if so write down reaction it causes)

e = irrelevant

S = Sign front with name and bleep no.

C = Contraindications (any other drugs it doesn’t work with/past medical history)

R = Route (orally unless continuous episodes of vomiting/ anti-emetics doses doesn’t change so whatever is preferred)

I = IV fluids (what they need, how much)

B = Blood clot prophylaxis (do they need VTE/ compression stockings?)

E = antiEmetics

R = pain Relief (NSAIDs, opioids, paracetamol dosage)

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what 2 drugs contain penicillin but not obviously?

tazocin

co-amoxiclav

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if there is a risk of bleeding/ suspected bleeding/active bleeding or prolonged prothrombin time what should not be give?

anticoagulation or antiplatelet

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what side effects do steroids cause?

S = stomach ulcers
T = thin skin
E = oedema
R = Right sided heart failure
O = Osteoporosis
I = infection susceptibility
D = Diabetes Hyperglycaemia
S = Cushing Syndrome

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what contraindications and side effects do NSAIDs cause?

N = no urine/ renal insufficiency
S = Systolic dysfunction
A = asthma
I = Indigestion/ulcers
D = dyscrasia (clotting problems)

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What anti-hypertensives cause bradycardia?

calcium channel blocker
beta blocker

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what anti-hypertensives cause electrolyte imbalance (raised potassium)

ace inhibitor

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what can thiazide and loop diuretics such as bendroflumothiazide and furosemide cause?

hypokalaemia and hyponatraemia

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what condition can thiazide diuretics cause?

gout

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what condition can K+ sparing diuretics cause?

gynaecomastia

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what side effects come from calcium channel blockers e.g., amlodipine?

peripheral oedema
flushing

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what side effects can come from beta-blockers

exacerbated asthma/wheeze
acute heart failure

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what side effects can ACE inhibitors such as ramipril cause?

hyperkalaemia
cough

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what is something to remember in patients who are nil by mouth (2)

they still receive maintenance fluid

they still receive oral medications

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when do we give IV fluid (2 occasions)

replacement fluid for dehydration
maintenance in NBM patients

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what fluid is standard to give?

0.9% sodium chloride 500ml immediate

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when should 0.9% sodium chloride not be given?

3 types of patients

hypoglycaemia
or hypernatraemia

= 5% dextrose instead

Ascitic patients

= HAS solution given (human albumin)

Bood loss

= blood transfusion or crystalloids given

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how much fluid does a normal adult require over 24 hours?

3L - usually 1L 0.9% NaCl, 2L dextrose 5%

1 salty, 2 sweet

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how much fluid does a normal elderly person require over 24 hours?

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if a patient is hypotensive and tachycardic what is given with regards to fluid?

500ml bolus of 0.9% NaCl over 15 minutes

250ml bolus of 0.9% NaCl if heart failure history

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how much fluid should be given to someone with oliguria?

1L over 24 hours

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how much potassium can be given over an hour?

10mmoll/hour

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how much KCL can be given daily?

40mmol

20mmol per bag

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how fast can we give fluids to an elderly

12 hourly if not an emergency

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how fast can we give fluids to an average adult?

8 hourly if not an emergency (24/3)

when should VTE prophylaxis not be given (LMW Heparin)

stroke history within recent months (up to 3 months)

when should VTE prophylaxis not be given (compression stockings)

PAD = limb ischaemia

what is the first line and after anti-emetic drug and dose?

cyclizine 50mg over 8 hours metoclopromide 10mg over 8 hours if heart failure history ondansetron 4mg/8mg over 8 hours if nauseous still

when should metoclopormadie be contraindicated?

1. parkinsons 2. young women as risk is acute dystonic reaction

What is the average dose for NSAIDs first line to be introduced (ibuprofen)

ibuprofen 400mg over 8 hours

What NSAIDs are given with neuropathic pain?

1. amitriptyline 10mg nightly PO 2. pregabalin 75 mg 12hrly PO 3. duloxetine 60mg OD PO

what NSAID is given specifically for diabetic neuropathy ?

duloxetine 60 mg OD PO

how much paracetamol can be prescribed to a healthy adult in 24hours?

4g (1g every 6 hours)

how much paracetamol can be prescribed to an elderly adult in 24 hours?

2g (500mg every 6 hours)

what is prescribed if there isn't any pain but potential pain?

1g paracetamol every 6 hours PRN

what is prescribed with minimal pain?

regular = 1g paracetamol every 6 hours PRN = 30mg codeine up to every 6 hour

what is to be prescribed with severe pain/

regular = co-codamol 30/500mg 2 tablets every 6 hours PRN = Morphine Sulphate 5mg/10mg every 6 hours usually oral.

what is a common thing to check with regards to paracetamol on this section?

dosage, no double dosing with co-amoxiclav

what is the max paracetamol dose in someone weighing <50kg?

500mg every 6 hours of

what is an enzyme inhibitor drug?

drug that reduces activity of cytochrome P450 enzyme which leads to less drug breakdown and therefore an increase in drug concentration

what is the mnemonic for the common enzyme inhibitor drugs?

AO DEVICES

What does AO DEVICES stand for?

Allopurinol Omeprazole Disulfiram Erythromycin Valproate (sodium) Isonazid Ciprofloxacin Ethanol Sulphonamides

what is a enzyme inducer?

a drug that increases the activity of cytochrome p450 therefore increases the metabolism and breakdown of the drugs = reduced drug concentration

what is the mnemonic for common enzyme inducers?

PC BRAS

what does PC BRAS stand for?

Phenytoin Carbamazepine Barbituates Rifampacin Alcohol in excess/chronic Sulphonylurea

what drugs need to be doubled on sick days?

steroids insulin metformin

what acronym is used for drugs that need to be stopped before surgery?

I LACK OP

what does I LACK OP stand for

Insulin Lithium Anticoagulation/antiplatelets COCP/HRT K+ sparing diuretics Orał hypoglycemics Perindopril and other ACE inhibitors

when does COCP/HRT need to be stopped before surgery?

4 weeks before

when does anticoagulation/platelets need t be stopped before surgery?

same day

when does insulin need to be stopped before surgery?

variable between hospitals

when does K+ sparing diuretics need to be stopped before surgery?

same day

when does ACE inhibitors need to be stopped before surgery ?

same day

when does lithium need to be stopped before surgery?

day before

why does metformin need stopping in surgery?

can lead to lactic acidosis

Dalteparin typical dose for VTE prophylaxis?

5000 units s/c

what is a key VTE prophylaxis to remember in PAD?

No compression stocking s

What is the safest choice of anti-emetic

Cyclising 50mg 8 hourly unless cardiac patient then metoclopromide 10mg 8 hourly as it can cause fluid retention

What pain relief is used for diabetic neuropathy?

Duloxetine 60mg OD PO

What treatment is usually first line for neuropathic pain?

Amitriptyline 10mg PO nightly Pregabalin 75 mg PO 12 hourly

When can tramadol be taken?

Suitable replacement fo rcodeine

What is the max paracetamol dose?

4g 2g in anyone <50kg

Serum dose level of drugs and stopping increasing reducing explained?

Drugs such as - digoxin - theophylline -lithium -phenytoin - vancomycin - gentamicin Have narrow therapeutic index Bad response, low serum = little increase Good response clinically, low serum = no change Good response, high serum (everything but gent) = omit for a few days Good response, high serum (gent) = reduce administration frequency

Digoxin drug toxicity symptoms?

1. Confused 2. Nauseous 3. Visual halos 4. Arrythmias

Lithium drug toxicity symtpoms?

1. Tremors 2. Tiredness 3. Arrythmias, seziures, coma, renal imparment with diabetes Insipidous

Phenytoin toxicity symtpms

Ataxia Nystagmus Peripheral neuropathy Teratogenic Gum hyperplasia

Gent and vanc toxicity symtpoms

Ototoxicity and nephrotoxicity

How to read a gent monograph?

Serum concentration plotted if q24 then dosing stays normal, if 36 then 36 if 48 then 48 Divided doses can be given with gent if endocarditis or poor renal clearance 1mg/kg 8 hourly ENDO 12 hourly renal

How to read a paracetamol nomograph

4 hours post ingestion Below line = no treatment Above line = NAC Not sure when ingested = NAC Staggered dose = NAC

Warfarin and iNR treatment?

INR 1 = normal INR 2.5 = warfarin treatment INR 2.5-3 =-mechanical aortic valve INR 3.5 =mechanical mitral valve or recurrent VTE 5-8 no bleed = omit dose 2 days and reduce 8+ no bleed = omit warfarin, 1-5mg vit k orally 5-8 bleed = omit warfarin 1-5mg vitamin K IV 8+ bleed = omit warfarin 1-5mg vitamin K IV Major haemorrhage = vit k and prothrombin complex

INR and prothrombin time relation?

Same thing INR big = big PT

Parkinson’s main drug/

levodopa and co-careldopa

Epilepsy’s drugs main stay?

Focal = lamotrigine Seizure = levetiracetam Males = valproate Absent = ethosuximide

How to induce remission in a chrons flare?

Mild-mod = 20mg prednisolone orally daily Severe = 3-4x daily IV hydrocortisone Rectal = rectal hydrocortisone

How to maintain remission in a chrons flare?

Azathioprine

main thing to check with azathioprine?

TPMT levels Absent = methotrexate Low = start but lower dose

Epilepsy medication side effects/

Lamotrigine = Steven johns Levetiracetam = mood and irritiabiltiy disorders and fatigue Valproate = weight gain, tremor and teratogenic Phenytoin = ataxia, peripheral neuropathy, nystagmus, gum hyperplasia Carbamazepine = rash, joint pain, ataxi and nystagmus