PSA 4 Flashcards
Why is “morphine 100 mg PO every 4 hours” a serious prescribing error?
A typical starting dose for opioid-naïve patients is 5-10 mg PO every 4 hours. 100 mg is a lethal dose.
Why should NSAIDs not be prescribed in CKD stage 4 or 5?
They reduce renal perfusion and can worsen renal impairment.
Why is “warfarin and aspirin co-prescribed” without indication a serious error?
Increased risk of major bleeding unless indicated (e.g., mechanical valve).
What do you monitor in a patient on heparin?
APTT (unfractionated heparin), platelet count (risk of heparin-induced thrombocytopenia).
What monitoring is required for patients on statins?
Liver function tests (LFTs) at baseline, 3 months, and 12 months.
What needs monitoring for long-term corticosteroid use?
Blood glucose, bone density (DEXA), blood pressure, and signs of adrenal suppression.
What is the first-line treatment for cellulitis?
Flucloxacillin 500 mg-1 g PO four times daily for 5-7 days.
What is the preferred antibiotic for community-acquired pneumonia in a penicillin-allergic patient?
Doxycycline or clarithromycin.
What is the antibiotic prophylaxis for infective endocarditis in dental procedures for high-risk patients?
Amoxicillin 2 g PO once, 30-60 minutes before the procedure.
What is the composition of Hartmann’s solution?
Contains sodium, chloride, potassium, calcium, and lactate; used for fluid resuscitation
What is the reversal agent for benzodiazepines?
Flumazenil.
What are the common side effects of methotrexate?
Myelosuppression, mucositis, hepatotoxicity, pulmonary fibrosis.
How is digoxin toxicity treated?
Stop digoxin, correct hypokalaemia, and administer digoxin-specific antibody fragments if severe.
What is the stepwise approach in the WHO pain ladder?
- Non-opioids (e.g., paracetamol), 2. Weak opioids (e.g., codeine), 3. Strong opioids (e.g., morphine).
What is the maximum daily dose of codeine?
240 mg (30-60 mg every 4-6 hours).
How do you manage neuropathic pain?
First-line: amitriptyline, duloxetine, gabapentin, or pregabalin.
What is the antihypertensive of choice in breastfeeding?
Labetalol or nifedipine.
How do you adjust levothyroxine dosing in elderly patients?
Start at a lower dose (e.g., 25 mcg/day) and titrate slowly.
What anticoagulants are contraindicated in pregnancy?
Warfarin (teratogenic) unless absolutely necessary.
What must be included in a PRN prescription?
Indication, dose, route, frequency, and maximum daily dose.
Write a PRN prescription for morphine for breakthrough pain.
Morphine 10 mg PO every 4 hours PRN for pain (max 40 mg/day).
What is the dose of adrenaline for anaphylaxis in an adult?
0.5 mg IM (1:1000) every 5 minutes as needed.
How do you manage hyperkalaemia urgently?
Calcium gluconate IV, insulin/dextrose, and salbutamol nebulizer.
