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PSA > Prescription Reviews > Flashcards

Prescription Reviews Flashcards

1
Q

Types of Heparin

A

Unfractionated heparin (UFH) - fondaparinux, argatroban, bivalirudin
Low molecular weight heparin (LMWH) - dalteparin sodium, enoxaparin sodium, tinzaparin sodium)

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2
Q

max dose of paracetamol

A

4g in 24 hours, 1g 6hrly

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3
Q

Essential areas to check on each prescription

A

PReSCRIBER
Patient details
reaction (allergies, and reactions to drugs)
Sign the front of the chart
Contraindications (for each drugs)
Route: check the route for each drug
Blood: Provide blood clot prophylaxis if needed
Emesis: provide an antiemetic if needed
Relief: Provide pain relief if needed

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4
Q

What should be included in patient details

A

new chart = 3 pieces of patient-identifying information on the front (name, dob, hospital number) or sticker

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5
Q

which common antibiotics have penicillin in

A

Tazocin and co-amoxiclav

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6
Q

contraindicated drugs for people who are bleeding, suspected of bleeding or at risk of bleeding

A

Drugs that increase bleeding: aspirin, heparin, warfarin

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7
Q

What can increase your risk of bleeding

A

Those with long prothrombin time due to long term liver disease

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8
Q

when is prophylactic heparin contraindicated

A

acute ischaemic stroke, due to the risk of bleeding into the stroke

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9
Q

which type of drugs do you need to be wary of when prescribing warfarin

A

enzyme inhibitors (e.g. Allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol, sulphonamides).
can increase warfarin effect and thus prothrombin time (PT) and INR.

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10
Q

Side effects of Steroids

A

STEROIDS
Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including candida), Cushings Syndrome

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11
Q

Cautions and Contraindications of NSAIDs

A

NSAID
No urine (renal failure), Systolic dysfunction (heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality)

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12
Q

Which NSAID is not contraindicated in renal or heart failure, or in asthma

A

Aspirin

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13
Q

ACE-inhibitor example and side effects

A

ramipril, lisinopril, enalapril
dry cough, electrolyte imbalance (hyperkalaemia), hypotension (which can lead to dizziness and headaches), fatigue, loss of taste

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14
Q

ARB (angiotensin receptor blockers) example and side effects

A

Candesartan, losartan
Headache, fainting, dizziness, fatigue, rest symptoms, vomiting and diarrhoea, back pain, leg swelling, effect blood flow to the kidneys

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15
Q

CCB types, examples and side effects

A

dihydropyridines - nifedipine, amlodipine
non-dihydropyridines - diltiazem, verapamil
oedema, fatigue, palpitations, flushing, hypotension, bradycardia

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16
Q

Diuretics examples and side effects

A

thiazide - indapemide
Loop - Bumetanide, furosemide
Potassium Sparing - Spironolactone, Eplerenone, Amiloride
Dehydration (increased urination), electrolyte imbalance (Na loss), muscle cramp, joint disorders, impotence, renal failure. Loop diuretics (e.g. furosemide) can cause gout. k-sparing diuretics (e.g. spironolactone) can cause gynaecomastia

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17
Q

BB example and side effects

A

Bisoprolol, atenolol, propanolol
tired, dizzy, light headed, cold peripheries, difficulty sleeping, avoid in asthma patients (wheeze, airway narrowing), bradycardia, worsening of acute heart failure (helps in chronic heart failure)

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18
Q

which routes should be considered if patient is vomiting and for which drugs

A

non oral (IV, IM, SC) for antiemetics
However if vomiting likely to last a short term, changing the route of other prescribed medicine is usually not necessary

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19
Q

Doses of common antiemetics

A

Same regardless of route
cyclizine - 50mg 8-hourly
metoclopramide - 10mg 8-hourly

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20
Q

what route should patients have their medication if they are nil by mouth

A

however they are prescribed, patients should still receive their oral meds, including prior to surgery (apart from those you should stop obviously)

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21
Q

when are IV fluids prescribed

A

replacement - dehydrated and acutely unwell
maintenance - if nil by mouth

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22
Q

Which fluid should you use as replacement?

A

0.9% saline unless:
hypernatraemic (high sodium) or hypoglycaemic - then give 5% dextrose
Ascites - give human-albumin solution (HAS), sodium in saline will worsen ascites
in shock with systolic BP <90mmHg, give gelofusin
is shocked from bleeding: give blood transfusion

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23
Q

for replacement fluids: How much fluid should you give and how fast

A

if tachycardia or hypotensive, give 500ml bolus immediately (250ml if heart failure), then reassess HR, BP and urine output
if oliguric (urinary output less than 400ml per day or less than 20ml per hour) and not due to urinary obstruction, then give 1l over 2-4hrs then reassess

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24
Q

how can observations roughly predict how fluid depleted an adult is?

A

reduced urine output = 500ml fluid depletion
+ tachycardia = 1l fluid depletion
+shocked = >2l of fluid depletion

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25
Q

what is the max amount of fluid you should prescribe for a sick patient

A

2l , should review effect of fluids regularly

26
Q

how should you indicate on a prescription the length of time over which the fluid is to be given

A

e.g. 2 hours, 2-hourly or 2-hrly

27
Q

how much do adults need for maintenance fluids

A

adults 3l over 24hrs
elderly 2l

28
Q

for maintenance, which combination of fluids are used to proved the right elecrolytes

A

1l 0.9 saline and 2l of 5% dextrose (1 salty 2 sweet)

29
Q

how to provide k in fluids

A

bags of 5% dextrose or 0.9% saline containing potassium chloride (KCL) can be used but should be guided by urea and electrolyte results; with a normal potassium level

30
Q

how many K required for a normal K level

A

40mmol KCl in 24hrs

31
Q

what speed should you give IV K

A

Should not be given at more than 10 mmol/hour

32
Q

how fast should you give maintenance fluids

A

if giving 3l per day = 8hrly 1L bags (24/3)
if giving 2l per day = 12hrly bags (24/2)

33
Q

how should you assess the patient when you prescribe fluids

A

check the U&Es to confirm what to give them
check that the patient is not fluid overloaded (eg increased jugular venous pressure, peripheral and pulmonary oedema), ensure the patients bladder is not palpable (which signifies urinary obstruction), if prescribing for reduced urinary output

34
Q

prophylaxis for blood clots, and who gets/doesnt get this

A

majority of patients admitted to hospital will receive prophylactic LMWH (e.g. dalteparin 5000 units daily s/c) and compression stockings for prevention of venous thromboembolism.
criteria for this, but this is given on almost every drug chart so don’t need to learn
if patient bleeding/at risk of bleeding (e.g. recent ischaemic stroke) they should be be prescribed warfarin or heparin.
Patients with peripheral arterial disease should not be prescribed compression stockings (they may cause acute limb ischaemia)

35
Q

prescription for nausea

A

ciclizine 50mg (up to) 8hrly IM/IV/oral
metoclopramide 10mg (up to) 8hrly IM/IV if heart failure

36
Q

which antiemetic should you avoid in heart failure patients and why

A

Cyclizine significantly increased systemic and pulmonary arterial pressures, and right and left ventricular filling pressures, and negated the venodilatory effects of diamorphine. The use of cyclizine in patients with heart failure should, therefore, be avoided.

37
Q

which patients should you avoid metoclopramide?

A

Parkinsons, dopamine antagonist so risk of exacerbating symptoms
young women - risk of dyskinesia (unwanted movements, especially acute dystonia (sudden muscle contraction))

38
Q

If a patient is in no pain what should you prescribe regularly, and what should you prescribe ‘as required’

A

nothing regularly, paracetamol 1g up to 6hrly oral as recquired. can add an NSAID if not contraindicated

39
Q

If a patient is in mild pain what should you prescribe regularly, and what should you prescribe ‘as required’

A

regular paracetamol 1g 6hrly oral, codeine 30mg up to 6hrly oral as required. can add an NSAID if not contraindicated

40
Q

If a patient is in severe pain what should you prescribe regularly, and what should you prescribe ‘as required’

A

co-codamol 30/500 2 tablets 6hrly regular, morphine sulphate 10mg put to 6hrly oral as required. can add an NSAID if not contraindicated

41
Q

what should be prescribed in neuropathic pain

A

first line amitriptyline 10mg oral nightly or pregabalin 75mg oral 12-hrly.
duloxetine 60mg oral daily is indicated in painful diabetic neuropathy

42
Q

what should you check in a prescribing question regarding paracetamol

A

often a trap is to prescribe too much paracetamol, either too frequently (ie 4hrly not 6hrly) or in multiple preparations (co-codamol and paracetamol). they should only have 4g in one day. what you take away (paracetamol or co-codamol) depends on their pain

43
Q

common side effects of thiazide like diuretics

A

Mainly tested: Hypokalemia
Alkalosis hypochloraemic; constipation; diarrhoea; dizziness; electrolyte imbalance (hypokalaemia); erectile dysfunction; fatigue; headache; hyperglycaemia; hyperuricaemia; nausea; postural hypotension; skin reactions; vomiting

44
Q

common side effects of ACE-inhibitors

A

Mainly tested: cough/dry mouth/hyperkalaemia

Alopecia; angina pectoris; angioedema (can be delayed; more common in black patients); arrhythmias; asthenia; chest pain; constipation; cough; diarrhoea; dizziness; drowsiness; dry mouth; dyspnoea; electrolyte imbalance; gastrointestinal discomfort; headache; hypotension; myalgia; nausea; palpitations; paraesthesia; renal impairment; rhinitis; skin reactions; sleep disorder; syncope; taste altered; tinnitus; vertigo; vomiting

45
Q

common side effects of steroids

A

Mainly tested - abdominal discomfort,
Anxiety; behaviour abnormal; cataract subcapsular; cognitive impairment; Cushing’s syndrome; electrolyte imbalance; fatigue; fluid retention; gastrointestinal discomfort; headache; healing impaired; hirsutism; hypertension; increased risk of infection; menstrual cycle irregularities; mood altered; nausea; osteoporosis; peptic ulcer; psychotic disorder; skin reactions; sleep disorders; weight increased

46
Q

Common side effects of NSAIDs

A

Constipation (in adults); diarrhoea (in adults); dizziness (in adults); fatigue (in adults); gastrointestinal disorders (in adults); haemorrhage (in adults); headache (in adults); inflammatory bowel disease (in adults); insomnia (in adults); nausea (in adults); oral disorders (in adults); vertigo (in adults); vomiting (in adults)

47
Q

side effects of opiates

A

constipation
resp depression

Arrhythmias; confusion; constipation; dizziness; drowsiness; dry mouth; euphoric mood; flushing; hallucination; headache; hyperhidrosis; miosis; nausea (more common on initiation); palpitations; respiratory depression (with high doses); skin reactions; urinary retention; vertigo; vomiting (more common on initiation); withdrawal syndrome

48
Q

which pain killer should be avoided in asthmatics

A

NSAIDs - can cause broncho-constriction. so avoided if not closely monitored or strictly necessary

49
Q

which antibiotic is contraindicated if taking methotrexate

A

trimethoprim - folate antagonist, as methotrexate is also a folate antagonist

50
Q

when should a patient on methotrexate have it witheld

A

if they are septic, methotrexate is witheld pending the exclusion of neutropenic sepsis (if in doubt, withhold)

51
Q

Aspirin secondary prevention dose

A

75mg or 150mg daily

52
Q

Aspirin treatment dose

A

300mg daily for 14 days

53
Q

Normal dose of bisoprolol

A

10mg daily

54
Q

Route for insulin

A

s/c, except for sliding scales (act rapid or novorapid) which are given by IV infusion

55
Q

which two cardiomedications should not be prescribed together?

A

Verapamil and beta blockers

56
Q

Which drugs should be stopped before surgery

A

Anti-coagulants (warfarin, Heparin, rivaroxaban, dabigatran, apixaban,
edoxaban)
Anti-platelets (ticegrelor, prasugrel, clopidogrel, aspirin)
Combined oral contraceptive

57
Q

which drugs should be ammended before surgery

A

Diabetic drugs.
Metformin stopped day before and considered for insulin
insulin regimes altered

58
Q

which medications cause drowsiness

A

Anitidepressants, anti-histamines
Opiates

59
Q

which medications must be stopped in AKI

A

ACEi
NSAIDs (but Aspirin okay!)
Metformin
Trimethoprim
K sparing diuretics

60
Q

side effects of thiazide like diuretics

A

Exacerbate gout, diabetes and SLE
Hypokalaemia
Constipation, diarrhoea, dizziness, electrolyte imbalance, erectile dysfunction, postural hypotension, hyperglycaemia, hyperuricaemia, fatigue, headache, skin reaction, N&V

61
Q

How much fluid should you have per day

A

3L
2L in elderly

PSA (9 decks)

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