PReSRIBER

Question 1

P

Answer 1

Patient details

X3

Question 2

R

Answer 2

Reactions

Including allergies

Question 3

S

Answer 3

Sign the chart

Question 4

C

Answer 4

Contraindications

Bleeding- aspirin, warfarin, heparin.
Prophylaxis Heparin in stroke
Inhibitors plus warfarin

Steroids
Stomach ulcers, Thin skins, Edema, Right and left heart failure, Osteoporosis, infection , diabetes (causing hyperglycaemia (rarely diabetes), Cushing Syndrome

NSAIDs
No urine (renal failure)
Systolic dysfunction (heart failure) 
Asthma 
Indigestion
Dyscrasia (clotting problems)

Aspirin is fine in heart renal failure and asthma

Anti hypotensives

• bradycardia : beta blockers , ccb
• electrolyte: ace-I and diuretics

specific side effects of ace , beta, ccb and diuretics

Question 5

R

Answer 5

Route

Vomiting?

Cyclizine 50mg 8 hourly
Metoclopramide 10mg 8 hourly

NBM can take oral medication

Question 6

I

Answer 6

Iv fluids

Replace-
What
How much and how fast

Maintain
What
How much how fast

Question 7

B

Answer 7

Blood clot prophylaxis

Majority of patients given LMWH plus stockings

Unless
Acute Ischaemic stroke or bleed
Or peripheral arterial disease

Question 8

E

Answer 8

Anti emetic

Nauseated
Regular anti emetic
Cyclizine 50 mg 8 hour (IM IV PO) can cause fluid retention
Metoclopramide 10 mg 8 hour (IM IV)
Not if Parkinson’s or a young woman (risk of dyskinesia )

Question 9

P

Answer 9

Pain relief
No pain - prn paracetamol 1g 6 hourly oral

Mild pain- regular paracetamol as above, prn codeine 30 mg up to 6 hourly oral (tramadol as alternative)

Severe - regular co-codomal 30/500 2 tablets 6 hourly oral. Mindful that 500 mg paracetamol per tab and not exceeding dose
Morphine sulphate 10mg 6 hourly prn

NSAID
400mg 8 hourly

Amitryptyline - stabbing shooting burning
10mg oral nightly
Pregabalin 75mg 12 hourly
Duloxetine 60mg oral daily (diabetic neuropathy)