PSA 1 Flashcards
Describe the PReSCRIBER mneumonic.
For new drug charts
Patient details
Reaction (i.e. allergy plus the reaction)
Sign the front of the chart
check for Contraindications to each drug
check Route for each drug
prescribe IV fluids if needed
prescribe Blood clot prophylaxis if needed
prescribe antiEmetic if needed
prescribe pain Relief if needed
What is contraindicated in acute ischaemic stroke?
Prophylaxctic heparin due to risk of bleeding into the stroke
What are the potential SEs with steroid use?
Stomach ulcers
Thin skin
oEdema
Right and left HF
Osteoporosis
Infection (including candida)
Diabetes (commonly causes hyperglycaemia, can progress to diabetes)
Cushing’s Syndrome
What are the potential SEs with NSAID use?
No urine (i.e. renal failure)
Systolic dysfunction (i.e. heart failure)
Asthma
Indigestion
Dyscrasia (clotting abnormality)
When can we use aspirin when we wouldn’t typically use other NSAIDs?
Can be used in renal or HF, and in asthma
Give two SEs of calcium channel blockers?
Peripheral oedema and flushing
Give an example and an SE of loop diuretics
Furosemide, can cause gout
Give an example and an SE of potassium-sparing diurectics
Spironolactone, can cause gynaecomastia
How should NBM patients be given their oral medication?
As normal, with a small amount of water
Which fluid do we give when a patient has ascites?
Human-albumin solution (HAS) instead of 0.9% saline, as albumin maintains oncotic pressure (saline will worsen ascites)
Which fluid do we give when a patient is shocked with a systolic BP <90mmHg?
Gelofusine (a colloid) instead as it has a high osmotic content so stays intravascularly, thus maintaining BP for longer
Which fluid do we give if patient is shocked from bleeding?
Give blood transfusion, or a colloid first if no blood available.
How much fluid do we give for fluid replacement, and how fast?
If tachycardia or hypotensive give 500ml bolus immediately (250ml if HF) then reassess, especially HR, BP and U.O. to assess response and speed of next bag of IV fluid.
If only oliguric (and not due to urinary obstruction e.g. BPH) then give 1L over 2-4hr then reassess.
What is the maximum amount of fluid you should prescribe a sick patient?
Up to 2L, and then they would need to be very ill (reduced UO plus tachycardia plus shocked)
How much maintenance fluids do patients generall require?
Adults 3L per 24hr and the elderly 2L per 24hr
Adequate electrolytes are provided by 1L of 0.9% saline and 2L of 5% dextrose (1 salty and 2 sweet)
How much potassium do patients require epr day?
With a normal potassium level, patients require roughly 40mmol KCL per day (so put 20mmol KCL in two bags)
How do thiazide diuretics cause hypokalaemia?
Increasing potassium excretion by the kdiney
How do ACEi cause dry cough?
Accumulation of bradykinin via reduced degradation by ACE
How do ACEi cause hyperkalaemia?
Reduced aldosterone production and thus reduced K+ excretion in the kidneys
Which diurectics cause hypokalaemia?
Loop and thiazide diuretics
How do steroids lead to ulceration?
Inhibit gastric epithelial renewal
Why can’t patients taking methotrexate take trimethoprim?
Both are folate antagonists, so taking both increases risk of bone marrow toxicity. This can lead to pancytopenia and neutropenic sepsis.
How do you alter the methotrexate dose for a patient with sepsis?
Withhold pending exclusion of neutropenic sepsis.
What does neutrophilia indicate?
Bacterial infection
Tissue damage
Steroid use
