Prescription review Flashcards
Why should an ACE-inhibitor be stopped when a patient is hyperkalaemic?
ACE inhibitors retain potassium, thereby worsening the hyperkalaemia
What is the maximum daily dose of paracetamol?
4g/day
What is the PReSCRIBER mnemonic?
Patient details Reaction (i.e. allergy) Sign the chart Contraindications Route IV fluids (if needed) Blood clot prophylaxis anti-Emesis pain Relief
What are the cautions/contraindications to prescribing NSAIDs? (mnemonic- NSAID)
No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (i.e. blood clotting disorders)
Side effects/cautions of antihypertensives:
a) ACE inhibitors (2)
b) Beta-blockers (2)
c) Calcium blockers (2)
d) Diuretics (2)
a) Dry cough; electrolyte disturbance e.g. hyperkalaemia
b) wheeze in asthmatics; worsening of acute heart failure
c) peripheral oedema; facial flushing
d) renal failure; electrolyte disturbance
In what two situations are IV fluids prescribed?
Replacement/resus for a dehydrated/acutely unwell patient
Maintenance fluids for a patient who is nil by mouth
Fluids (other than 0.9% NaCl) to give if:
a) hypernatraemic or hypoglycaemic
b) ascites
c) shocked from bleeding
a) 5% dextrose
b) human albumin solution
c) blood if available
What factors should be considered when assessing the volume/rate of replacement fluids?
Blood pressure, pulse rate and urine output
If a patient is oliguric but BP and pulse are normal, how quickly should fluids be given?
1L over 2-4 hours then re-assess
If a patient is hypotensive and/or tachycardic, how quickly should fluids be given, and what volume?
Stat; 500ml unless proven/suspected heart failure (250ml). Then re-assess to determine speed of next bag
What is an ideal daily fluid regimen for a normal adult on maintenance fluids?
3L (2L of 5% dextrose, 1L of saline- “1 salty and 2 sweet)
2 x 20mmol potassium chloride
What should always be checked if you are prescribing fluids due to reduced urine output?
Whether or not the patient has a palpable bladder- this could indicate urinary obstruction
What are the signs of fluid overload? (3)
Increased JVP, peripheral oedema, pulmonary oedema
When should a) prophylactic LMWH b) compression stockings not be prescribed?
a) patients bleeding or at risk of bleeding
b) peripheral arterial disease
Anti-emetic choice?
Cyclizine 50mg up to 8hrly IM/IV/oral regularly or as required
What is the main contraindication to cyclyzine?
Heart failure (causes fluid retention) prescribe metoclopramide 10mg up to 8-hourly IM/IV
When should metaclopramide be avoided?
Parkinson’s disease/LBD
Regular analgesia for:
a) mild pain
b) severe pain
a) paracetamol 1g qds
b) co-codamol 30/500, 2 tablets 6hrly
As-required analgesia for:
a) no pain
b) mild pain
c) severe pain
a) paracetamol 1g up to 6-hourly
b) codeine 30mg up to 6-hourly
c) morphine sulphate 10mg up to 6-hourly
What effect do thiazides/loop diuretics have on potassium?
Lower serum K+
Which class of drug is domperidone, and why is it potentially safer to use in Parkinsons disease than metoclopramide?
Dopamine antagonist
Doesn’t cross the blood-brain barrier
Which class of anti-emetic is cyclizine?
Anti-histamine
Under what circumstances should methotrexate be withheld?
If patient is septic (until neutropenic sepsis is excluded)
What could be the result of combining a rate-limiting calcium blocker and a beta blocker?
Brady-arrythmia, potential asystole
