Prescription reviews

Question 1

Which drugs are enzymes inducers? (so need the other drug dose to be increased)

Answer 1

PC BRAS
Phenytoin 
Carbamazepine 
Barbituates 
Rifampicin 
Alcohol (chronic eccess)
Sulphonylurea

Question 2

Which drugs are enzymes inhibitors (so need lower other drug dose)

Answer 2

ZAG DEVICES

-zoles (omeprazole, ketoconazole, fluconazole)
allopurinol 
grapefruit juice 
disulfirm 
erythromycin 
valproate 
isoniazd 
ciproflox 
ethanol 
sulphnnamides, STATINS

Question 3

How long before surgery must you stop the COCP?

Answer 3

28 days

Question 4

How long before surgery must you stop lithium?

Answer 4

1 day before

Question 5

How long before surgery must you stop insulin?

Answer 5

0 – and replace with sliding scale

Question 6

How long before surgery must you stop anticoags / platelets ?

Answer 6

5 days before

Question 7

How long before musat you stop ACEi, ARB, K sparing

Answer 7

0

Question 8

When and by how much do you change steroids during surgery?

Answer 8

ON the day of surgery

DOUBLE the steroid dose

Question 9

which important class of drugs must you avoid giving to someone on an enzyme inhibitor

Answer 9

Drugs that INCREASE BLEEDING (aspirin, heparin, wartfarin)

Question 10

When must you be cautious with NSAIDS

Answer 10

NSAID

No urine 
Systolic dysfunction 
Asthma 
Indigestion 
Dyscrasia of blood (clotting abnormalitYy)

Question 11

Explain how you should prescribe beta blocker in the context of HF

Answer 11

NOT in acute HF (will worsen it)

YES in chronic HF

Question 12

what broad condition should you avoid diuretics in

Answer 12

AVOID diuretics in RENAL FAILURE

Question 13

What can loop diuretics precipitate?

Answer 13

GOUT

Question 14

What can spironolactone cause?

Answer 14

gynaecomastia

Question 15

What is first line antiemetic in most cases

Answer 15

cyclizine

Question 16

contraindication of cyclizine

Answer 16

NOT in HF (as may cause fluid retention)

Question 17

Contraindications of metoclopramide

Answer 17

NOT in PARKINSONS (Da antagonist > use domperidone)

NOT in young women (risk of dyskinesia)

Question 18

which antibiotic do you NEVER give warfarin with

Answer 18

never give WARFARIN with erythromycin / clarythromycin

Question 19

what medication should you DOUBLE in ill patients with ADDISONS

Answer 19

DOUBLE the steroid

Question 20

antibiotics for neutropoenic sepsis

Answer 20

Tazocin + gentamiciin

Question 21

drug for arrythmia and hypotension

Answer 21

DIGOXIN

Question 22

what baseline blood do you need to do when starting statins?

Answer 22

RF: CK

No RF: ALT

Question 23

when must you check LFTs for statins?

Answer 23

At 3 months and 12 months

Question 24

what antibiotic must you stop statins for?

Answer 24

MACROLIDE (clarythromycin/erythromycin)

Question 25

When do you monitor lithium dose

Answer 25

12 hours after last dose monitor WEEKLY until levels stable, then every THREE MONTHHS

Question 26

what must you monitor for OCP

Answer 26

Blood pressure monitoring (as it may cause sodium retenton)

Question 27

what must you check before prescribing antipsychotics and why?

Answer 27

ECG - only if RF of CVD

Question 28

What must you monitor when prescribing carbimazole?

Answer 28

FBC (neutrophils) - as it can cause neutropoenia

Question 29

What must you monitor for gentamicin

Answer 29

UE (AS IT IS HIGHLY NEPHROTOXCIC) - measure pre-dose through and 1 hour peak + auditory monitoring and vestiibular monitoring

Question 30

what cardiac condition are ACEi contraindicated

Answer 30

aortic stenosis

Question 31

SE ACEi

Answer 31

``` hyperkalaemia hyponatraemia AKI cough angioedema ```

Question 32

what do you need to do for ACEi monitoring

Answer 32

UE

Question 33

Digoxin monitoring

Answer 33

UE (min 6 hours post dose)

Question 34

How do you monitor clozpine?

Answer 34

every week for 18 weeks every 2 weeks up to 1year every 4 weeks thereafter