PSA - DRUGS Flashcards
If a drug is to be used ‘as required
provide two
instructions: (1) indication and (2) a maximum frequency (e.g.
twice daily) or total dose in 24 hours (e.g. 1g)
If an antibiotic is being prescribed include
indication and
stop/review date
Duration? on script
Include of duration if the treatment is not long term
DRUGS TO INCREASE DURING SURGERY
steroids
Drugs to stop before surgery
I LACK OP: Insulin, Lithium, Anticoagulants/antiplatelets, COCP/HRT, K-sparing diuretics, Oral hypoglycaemics, Perindopril and other ACE-inhibitors.
SAFE ROUTINE FOR PRESCRIBING
common pitfalls
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.
Contraindications
rugs that increase bleeding (aspirin, heparin and warfarin)
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
steroids CI
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.
NSAIDs CI
No urine (i.e. renal failure), Systolic dysfunction (i.e. heart failure), Asthma, Indigestion (any cause), and Dyscrasia (clotting abnormality).
Antihypertensives CI
ypotension (including postural hypotension) that may result from all groups of antihypertensives.
- Bradycardia may occur with beta-blockers and some
calcium-channel blockers. - Electrolyte disturbance can occur with angiotensin converting enzyme (ACE) inhibitors and diuretics
Replacement: which fluid?
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.
Avoid metoclopramide
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.
CI/stop in asthma
NSAIDS (incl Aspirin) , Beta blockers,
ACE-inhibitors SE
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.
Ibuprofen SE
Gastic issues/ ulcers
AKI - Reducing kidney perfusion and function
hyperkalaemia medication causes
Bendroflumethiazide, a thiazide diuretic Lisinopril (an ACE-inhibitor) potassium-sparing diuretics such as: spironolactone (Aldactone), triamterene (Dyrenium), and. trimethoprim-sulfamethoxazole (Bactrim). NSAIDS ARBs
Max daily dose of paracetamol
4g see If they have co-codamol
Low neutrophils (neutropenia) causes
Viral infection
Chemotherapy or radiotherapy*
Clozapine (antipsychotic)
Carbimazole (antithyroid)
Low platelets (thrombocytopenia) causes
Reduced production:
drugs (esp. penicillamine (e.g. in
rheumatoid arthritis treatment))
myeloma
Increased destruction:
heparin
coagulation (DIC)
(ITP)
thrombotic thrombocytopenic purpura
Features of toxicity Digoxin
Digoxin
Confusion, nausea, visual halos and arrhythmias
Lithium Features of toxicity
Lithium
Early: tremor
Intermediate: tiredness
Late: arrhythmias, seizures, coma, renal failure and diabetes insipidus
Features of toxicity
Phenytoin
Phenytoin
Gum hypertrophy, ataxia, nystagmus, peripheral neuropathy and teratogenicity
Gentamicin monitoring
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
Paracetamol normal metabolism
normally metabolized by the liver
Dépendant on glutathione
Warfarin MOA
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.
Withhold digoxin
Bradycardia
Evidence of fluid overload/ pulmonary odema
FUROSEMIDE 40mg IV
Neuropathic pain
Amitripyline 10mg
STEMI medications
Morphine 10mg IV with metoclamprine
Oxygen if needed
Nitrates (gtn)
Aspirin 300mg
PCI ref
NSTEMI medications
MONA
+ clopidogrel 300mg and LMWH
Enoxaparin dose
40mg
