PSA - DRUGS

Question 1

If a drug is to be used ‘as required

Answer 1

provide two
instructions: (1) indication and (2) a maximum frequency (e.g.
twice daily) or total dose in 24 hours (e.g. 1g)

Question 2

If an antibiotic is being prescribed include

Answer 2

indication and

stop/review date

Question 3

Duration? on script

Answer 3

Include of duration if the treatment is not long term

Question 4

DRUGS TO INCREASE DURING SURGERY

Answer 4

steroids

Question 5

Drugs to stop before surgery

Answer 5

I LACK OP: Insulin, Lithium, Anticoagulants/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, Perindopril and other ACE-inhibitors.

Question 6

SAFE ROUTINE FOR PRESCRIBING

common pitfalls

Answer 6

ensuring we have the correct patient’s prescription/drug chart
● noticing and recording allergies
● signing the front of the chart
● considering the contraindications for each drug we prescribe
● considering the route for each drug we prescribe
● considering the need for IV fluids
● considering the need for thromboprophylaxis
● considering the need for antiemetics
● considering the need for pain relief.

Question 7

Contraindications

rugs that increase bleeding (aspirin, heparin and warfarin)

Answer 7

hould not be given to patients who are bleeding, suspected
of bleeding, or at risk of bleeding (e.g. those with a prolonged prothrombin time due to liver disease). Do not forget that prophylactic heparin is contraindicated in acute ischaemic stroke due to the risk of bleeding into the stroke

Question 8

steroids CI

Answer 8

STEROIDS: Stomach ulcers, Thin skin, oEdema, Right and left heart failure, Osteoporosis, Infection (including Candida), Diabetes (commonly causes hyperglycaemia and uncommonly progresses to diabetes), and Cushing’s Syndrome.

Question 9

NSAIDs CI

Answer 9

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

Question 10

Antihypertensives CI

Answer 10

ypotension (including postural hypotension) that may result from all groups of antihypertensives.

1. Bradycardia may occur with beta-blockers and some
   calcium-channel blockers.
2. Electrolyte disturbance can occur with angiotensin converting enzyme (ACE) inhibitors and diuretics

Question 11

Replacement: which fluid?

Answer 11

Give all patients 0.9% saline (normal saline, a crystalloid) unless the patient:

● Is hypernatraemic or hypoglycaemic: give 5% dextrose instead.

● Has ascites: give human-albumin solution (HAS) instead. The
albumin maintains oncotic pressure; furthermore, the higher
sodium content of 0.9% saline will worsen ascites.

● Is shocked with systolic BP <90 mmHg: give gelofusine (a
colloid) instead as it has a high osmotic content so stays
intravascularly, thus maintaining BP for longer.

● Is shocked from bleeding: give blood transfusion, but a colloid
first if no blood available.

Question 12

Avoid metoclopramide

Answer 12

Patients with Parkinson’s disease due to the risk of
exacerbating symptoms.
● Young women due to the risk of dyskinesia, i.e. unwanted
movements especially acute dystonia.

Question 13

CI/stop in asthma

Answer 13

NSAIDS (incl Aspirin) , Beta blockers,

Question 14

ACE-inhibitors SE

Answer 14

a dry cough through accumulation of bradykinin via reduced degradation by ACE.
hyperkalaemia through reduced aldosterone production and thus reduced potassium excretion in the kidneys.

Question 15

Ibuprofen SE

Answer 15

Gastic issues/ ulcers

AKI - Reducing kidney perfusion and function

Question 16

hyperkalaemia medication causes

Answer 16

Bendroflumethiazide, a thiazide diuretic
Lisinopril (an ACE-inhibitor)  
potassium-sparing diuretics such as: spironolactone (Aldactone), triamterene (Dyrenium), and. trimethoprim-sulfamethoxazole (Bactrim).
NSAIDS 
ARBs

Question 17

Max daily dose of paracetamol

Answer 17

4g see If they have co-codamol

Question 18

Low neutrophils (neutropenia) causes

Answer 18

Viral infection
Chemotherapy or radiotherapy*
Clozapine (antipsychotic)
Carbimazole (antithyroid)

Question 19

Low platelets (thrombocytopenia) causes

Answer 19

Reduced production:

  drugs (esp. penicillamine (e.g. in
rheumatoid arthritis treatment))
                                 myeloma
Increased destruction:
  heparin

coagulation (DIC)

(ITP)

thrombotic thrombocytopenic purpura

Question 20

Features of toxicity Digoxin

Answer 20

Digoxin

Confusion, nausea, visual halos and arrhythmias

Question 21

Lithium Features of toxicity

Answer 21

Lithium
Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus

Question 22

Features of toxicity

Phenytoin

Answer 22

Phenytoin

Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity

Question 23

Gentamicin monitoring

Answer 23

Doses are calculated according to the patient’s weight and renal function.

once-daily regimen the exact monitoring will be determined locally, but usually involves:
● Measuring gentamicin levels at particular times such as 6–14 h
after the last gentamicin infusion is started (i.e. the time of the sample must be recorded).
Or with NORMOGRAM

Question 24

Paracetamol normal metabolism

Answer 24

normally metabolized by the liver

Dépendant on glutathione

Question 25

Warfarin MOA

Answer 25

inhibits synthesis of vitamin K-dependent clotting factors (II, VII, IX and X). This prolongs the prothrombin time (PT) from which the international normalized ratio (INR) is derived: the higher the PT, the higher the INR.

Question 26

Withhold digoxin

Answer 26

Bradycardia

Question 27

Evidence of fluid overload/ pulmonary odema

Answer 27

FUROSEMIDE 40mg IV

Question 28

Neuropathic pain

Answer 28

Amitripyline 10mg

Question 29

STEMI medications

Answer 29

Morphine 10mg IV with metoclamprine
Oxygen if needed
Nitrates (gtn)
Aspirin 300mg

PCI ref

Question 30

NSTEMI medications

Answer 30

MONA

+ clopidogrel 300mg and LMWH

Question 31

Enoxaparin dose

Answer 31

40mg