Prescription Review (Section 1)

Question 1

Give 8 cautions/contraindications to be aware of when prescribing steroids

Answer 1

Stomach Ulcers

Thinning Hair

Oedema

Right/Left Heart Failure

Osteoporosis

Infection (candida)

Diabetes

Cushing’s Syndrome

Question 2

Give 5 cautions/contraindications to be aware of when prescribing NSAIDs

Answer 2

Renal Failure (no urine)

Systolic dysfunction (heart failure)

Asthma

Indigestion

Dyscrasia (clotting abnormality)

Question 3

What electrolyte imbalance can be caused by thiazide/loop diuretics?

Answer 3

Hypokalaemia

Question 4

What electrolyte imbalance can be caused by ACEi/Aldosterone Antagonists?

Answer 4

Hyperkalaemia

Question 5

What electrolyte imbalance can be caused by all diuretics?

Answer 5

Hyponatraemia

(but they can precipitate dehydration, causing hypernatraemia too)

Question 6

What is the max dose of paracetamol someone can have in 1 day?

Answer 6

4g

(so always check how much a patient is taking, especially if they’re taking paracetamol with cocodamol)

Question 7

What common side effect can be caused by NSAIDs and Steroids? How does this happen?

Answer 7

Gastric Ulceration

NSAIDs - Inhibit Prostaglandin Synthesis - erodes gastric protection

Steroids - Inhibit gastric epithelial renewal

Question 8

What can Oxybutynin (muscarinic antagonist) cause in elderly?

Answer 8

Confusion

(lower doses recommended in elderly)

Question 9

Why should trimethoprim and methotrexate never be co-prescribed?

Answer 9

Due to risk of bone marrow suppression

Question 10

Should methotrexate be continued during active infection?

Answer 10

No - It should be discontinued during intercurrent illness

Question 11

What anti-hypertensive treatment should not be given in conjunction with beta blockers? and why?

Answer 11

Verapamil/Diltiazem

Due to risk of heart block

Question 12

If there are no obvious errors in a prescription, what subtle ones should you check for? (6)

Answer 12

Are the doses correct?

Correct Route?

Any incorrect/dangerous drug combinations?

Allergy contraindications? Hidden? E.g co-amoxiclav

Contraindications based on condition? E.g Asthma and Beta Blockers

Taking too much Paracetamol? Is the max frequency stated?

Question 13

Patients with an immediate hypersensitivity to penicillin should not receive what?

Answer 13

A cephalosporin (cefotaxime, ceftriaxone ect)

Question 14

Give 4 subtle types of penicillin

Answer 14

Co-amoxiclav (Augmentin)

Co-fluampicil (Magnapen)

Piperacillin with tazobactam (Tazocin)

Ticarcillin and clavulanic acid (Timentin)

Question 15

Give 2 medications that are usually prescribed weekly in the UK

Answer 15

Bisphosphonates (Oral alendronate)

Methotrexate (taken weekly due to toxicity)

Question 16

Give 2 medications that are usually taken at night

Answer 16

Statins

Amitriptyline