Prescription review, Sick day rules, Renal/ liver dysfunction Flashcards
Name some drugs that should be stopped when starting on antibiotics
PPIs (C diff risk)
Chemotherapy drugs (stop during infx)
Should insulin be increased or decreased when unwell
Increase insulin
BM increases when sick. If insulin not increased, risk of DKA
What does 1% medication mean
1g in 100ml
Name some drugs that should be stopped during AKI
CARDIO
Apixaban
ACEi
Diuretics
MSK
Allopurinol
What to do if patient is on warfarin and INR >8
Major bleed: IV Vit K, prothrombin complex, stop warfarin
Minor/no bleed: IV Vit K, stop warfarin
What to do if patient is on warfarin and INR 5-8
Major bleed: IV Vit K, prothrombin complex, stop warfarin
Minor bleed: IV Vit K, stop warfarin
No bleed: Withhold 1-2 doses warfarin
What to do if patient is on warfarin and INR >3 but <5
Major bleed: IV Vit K, prothrombin complex, stop warfarin
Minor/ no bleed: correct underlying cause
What drugs can worsen seizure control in epileptic patients
BAD NAP
Bronchodilator: aminophylline, theophylline
Antibiotics: ciprofloxacin, levofloxacin
Drugs: cocaine, amphetamines
NSAID: mefenamic acid
Alcohol
Psych drugs: bupropion, methylphenidate (used in ADHD)
Drugs to stop before surgery
I LACK OP
Insulin Lithium Anticoagulants/ antiplatelets COCP/ HRT K sparing diuretics Oral hypoglycaemia Perindopril and ACEi
If INR is >1.5 on the day before surgery, what drug should be given
Vit K 1-5mg PO
Drugs that need to be taken with food
Rivaroxaban
What type of contraception needs to be changed when starting an enzyme inducing drugs eg topiramate
Oral progestogen-only preparation
Drugs that must be stopped in peripheral vascular disease
Beta blockers (always stopped) ACEi (in severe disease)
What should morphine be substituted with in reduced renal function
Oxycodone (metabolised by liver into inactive metabolites vs morphine will give active metabolites that accumulate in kidney)
How should insulin amounts be changed in hyperglycaemia
Increase insulin by 10percent
What gastric protection medication should be used in low Mg2+
H2RA
Don’t use PPI
How is the insulin regime changed in DKA
Fixed rate infusion
Stop short acting insulin. Continue long acting insulin
What is a problem when a patient who is on ACEi develops DnV
Risk of AKI
Which antidepressant is safest after an MI
Sertraline
Oxygen amount to prescribe in COPD (CO2 retainer)
24percent oxygen
At what level of renal dysfunction should metformin be stopped
Stop metformin when
creatinine > 150 umol/l or eGFR <30 ml/min
When does steroid withdrawal need to be tapered down
> 3 weeks treatment
> 40mg daily for over 1 week
Repeated courses recently
