PSA: prescription writing Flashcards
what must all prescriptions include
- legible
- unambiguous (don’t give a range of doses)
- approved generic name (unless brand is important)
- IN CAPITALS
- no abbreviations
- signed and with a bleep number
- if ‘as required’ provide a) indication and b) max freq or total dose in 24hrs
- if it is an antibiotic, include indication and stop/review date
- include duration
what are the most common cytochrome p450 inducers. what does this mean?
increased enzyme activity –> decreased drug concentration as it is metabolised quickly
PC BRAS
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic excess)
Sulphonylureas
what are the most common cytochrome p450 inhibitors. what does this mean?
decreased enzyme activity –> increased drug concentrations as not metabolsied quickly
AODEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazid
Ciprofloxacin
Ethanol (Acute intoxication)
Sulfonamides
what does o.n mean
omni nocte (every night)
what does o.m. mean
o. m. = omni mane (every morning)
what does p.c. mean
p. c. = post cibum (after food)
what does PRN mean
p. r. n. = pro re nata (when required)
Management of delirium
- treatment of the underlying cause
+ modification of the environment - haloperidol 0.5 mg oral every 2-4 hours until there is a clinical response. or olanzapine.
USE FOR 1W OR LESS - lorazepam 0.5mg-1mg oral every 2 hours until response. max 2mg/24hr. prescribe at STAT. can do IM or slow IV inj if req
USE FOR 48 hr OR LESS
management iron salt poisoning eg Ferrous sulphate tablets
desferrioxamine mesilate
intravenous infusion
initial infusion up to a rate of 15 mg/kg/hour, (max. 80 mg/kg in 24 hours)
dosing sertraline depression
50mg od
key features for identifying opioid overdose
pinpoint pupils
resp depression
PReSCRIBER mneumonic
Patient details
Reaction (allergy plus reaction)
e
Sign front of chart
Route
IV fluids needed?
Blood clot prophylaxis needed?
antiEmetic needed?
pain Relief needed?
what drug in heart failure reduces morbidity and mortality
beta blocker
bisoprolol
what to include in a prescription for controlled drugs
Name and address of patient (printed or written, but no sticky labels)
Approved product name, strength (where more than one exists), and formulation (e.g. solution)
Dose (‘when required’ or ‘as directed’ is not acceptable unless accompanied by an actual dose)
Total quantity to supply must be in words and figures.
Prescriber’s handwritten signature, and date (can be word-processed or handwritten)
Prescriber’s address.
Writing adrenaline drug name for anaphylaxis
Drug: Adrenaline (1:1000)
500mcg = 0.5ml of 1:1000
Writing aciclovir prescription for HSV encephalitis
frequency : x hourly (change in renal impairment)
duration : 14 days
when prescribing a topical treatment sucha s a steroid, what is important in the drug name
the concentration and formulation eg.
Hydrocortisone 1% cream
major fracture, pain relief?
iv morphine
if a pt is vomiting, what route should antiemetics be given
not oral ie iv im or subcut
who gets blood clot prophylaxis? who to be careful of?
almost everyone - assessment is on the drug card
LMWH eg dalteparin 5000 units daily s/c + compression stocking
dont give anticoagulation if risk of bleeding eg recent stroke
dont give compression stocking if PAD
write a prescription for regualr paracetamol
paracetamol 1g oral 6 hourly
write a prescription for regular co-codamol
Co-codamol 30/500, 2 tablets, 6hourly, oral
write a PRN prescription for paracetamol
paracetamol 1g up to 6 hourly oral
write a PRN prescription for codeine
codeine 30mg up to 6 hourly oral
write a PRN prescription for oromorph
morphine sulphate (10mg/5ml)
10mg
up to 6 hourly
oral
write a prescription neuropathic pain
amitryptilline 10mg oral nightly
for how long should you not give thromboprophylaxis stroke
varies but typically a few months
Prescribe for scabies
permethrin 5% cream
Apply to whole body
Topical
Once weekly for two doses
Prescribe for GORD
omeprazole
20mg
oral
1 month
Prescribe for bph
Tamsulosin hydrochloride oral - 400 micrograms once daily
prescribe for stress incontience
duloxetine 40mg PO BD
1st step pharmacological copd management
SABA or SAMA
copd pt is on saba and sama but still uncontrolled, next step?
Do they have asthmatic features/features suggesting steroid responsiveness?
Yes: Long-acting beta agonist (LABA) and Inhaled corticosteroid (ICS) (+SABA/SAMA as required)
No: LABA and LAMA. if taking SAMA, switch to SABA
management copd
- SABA (e.g. salbutamol) or SAMA (e.g. ipratropium bromide)
- Do they have asthmatic features/features suggesting steroid responsiveness?
Yes: Long-acting beta agonist (LABA) and Inhaled corticosteroid (ICS) (+SABA/SAMA as required)
No: LABA and LAMA. if taking SAMA, switch to SABA - Triple therapy: LABA + LAMA + ICS (+ SABA as required)
- Specialist guided
3rd line treatment copd
Triple therapy LABA + LAMA + ICS (+ SABA as required)
what criteria determines whether a pt has asthmatic/steroid resposnsive features?
history:
any previous, secure diagnosis of asthma or of atopy
investigations:
a higher blood eosinophil count - note that NICE recommend a full blood count for all patients as part of the work-up
substantial variation in FEV1 over time (at least 400 ml)
substantial diurnal variation in peak expiratory flow (at least 20%)
name SABA
salbutamol
name SAMA
ipratropium
name LABA
salmeterol
name LAMA
tiotropium
name a combined LABA + ICS
Formoterol with budesonide
prescribe oral for fungal nail infection
terbinafine 250mg oral once daily 6 weeks
management fungal nail infections
limited involvement amorolfine 5% nail lacquer; 6 months for fingernails and 9 - 12 months for toenails. extensive involvement oral terbinafine
who is at high risk of neural tube defects and therefore requires 5mg folic acid
maternal folate deficiency, maternal vitamin B12 deficiency, previous history of having an infant with a neural tube defect, smoking, diabetes, obesity, use of antiepileptic drugs and sickle cell disease.
prescribe rampiril
nightly
prescribe GTN
Glyceryl trinitrate spray
dose: 2 sprays
route: sublingual
angina treatment algorithim
asprin + statin + sublinguial nitrate
1. BB or CCB (non-di) 2. increase to max dose 3. BB + CCB
4. one of: a long-acting nitrate
ivabradine
nicorandil
ranolazine
hypertension treatment algorithm
- A or C 2. A+C or A/C + D 3. A+C+D 4. if K <4.5 spiro, if K>4.5 alpha blocker or beta blocker
heart failure with normal EF treatment algorithm
- furosemide for symptomatic relief
+SGLT-2 inhibitor eg dapagliflozin
heart failure with reduced EF treatment algorithm
+furosemide for symptoms
1. ACEi + BB (1 at a time)
2. MRA eg Spironolactone
3. specialist advice
when do you not offer ACEi for heart failure
clinical suspicion of hemodynamically significant valve disease, until the valve disease has been assessed by a specialist
if can’t tolerate aCEi heart fialure, what do you do
offer ARB
heart failure, which to start first out of ACEi or BB in diabetes
ACEi
heart fialure, which to start first out of ACEi or BB in fluid overload
ACEi
(a beta-blocker may make the symptoms of heart failure worse)
Prescribe fluid for emergency resus
sodium chloride 0.9% 500ml over 15 minutes
prescribe fluid for hypoglycaemia
glucose 20% 100ml over 15 mins
or
glucose 10% 150mls over 15 mins
both give 15-20g over 15 mins
prescribe fluid for emergency hypokalaemia
sodium chloride 0.9%/potassium chloride 0.3% 1000ml over 4 hours
prescribe fluid for emergency hypercalcaemia
sodium chloride 0.9% 1000ml over 4 hours
maintenance +defecits fluids calcs
correct over 4 hours
if defecits of water use 30ml/kg calc instead of 25
in what circumstances should you be cautious about glucose fluids
AVOID in first 24 hours after ischaemic stroke or head trauma - risk of cerebral oedema
caution in impaired glucose tolerance,
caution in severe malnutrition (risk of re-feeding),
caution in thiamine deficiency
Prescribe a drug for hypoglycaemia
glucagon
How to decide what indication to give fluid to children eg do they need resus, maintenance, somthing else?
Is the pt shocked/haemodynamically compromised? –> yes –> resus fluids
can the pt meet their fluid requirements enterally? –> no –> are there signs of clinical dehydration?
–> yes –> calculate fluid defecit + routine maintenance
–> no –> calculate routine maintenance
child resus fluids
10ml/kg sodium chloride 0.9% over <10 minutes
neonate resus fluids
10-20ml/kg sodium chloride 0.9% over <10 mins
how to calculate fluid defecit
fluid defecit (%) = %dehydration x weight (kg) x 10
dehydration = 5%
shock = 10% (but youd be doing resus in this scenario anyway)
fluid defecit + routine maintenance = total to be given in 24 hours
maintenance fluids children
isotonic crystalloid - unclear if this includes glucose
0.9% sodium chloride (+ 5% glucose (+/- KCl))
First 10 kg 100 ml/kg
Next 10 kg 50 ml/kg
Every other kg 20 ml/kg
Rate (ml/h): Total (ml) / 24
Sodium: 2-4mmol/kg/day
Potassium: 1-2mmol/kg/day
maintenance fluids neonates ie <28 days
10% dextrose
Day 1 – 60 mls/kg/day
Day 2 – 90 mls/kg/day
Day 3 – 120 mls/kg/day
Day 4 – 150 mls/kg/day
From day 2
Na 3 mmol/kg/day
K 2 mmol/kg/day
Ca 1 mmol/kg/day (rarely)
in terms of maintenance fluids what is your upper limit children
over a 24‑hour period, males rarely need more than 2,500 ml and females rarely need more than 2,000 ml of fluids.
prescribe an iv fluid for children for hypoglycaemia
“500mg/kg to be administered as glucose 10%”
500 x kg = xmg
glucose 10% = 10g=100ml
= 0.1g = 1ml
100mg =1ml
xmg = yml
(x x 1)/100 = yml
first step in DKA management
fluid resuscitation
prescribing antiemetics route?
if vomiting, not oral - IM or IV if already has access
if not vomiting - oral
what type of insulin infusion is used DKA
fixed rate IV insulin infusion
0.1 units/kg/hr
pt on warfarin, witheld prior to surgery but INR > 1.5 on the day of surgery - plan?
give 1-5mg oral vit k using the IV preparation - on the day of surgery
when should warfarin be withheld surgery
5 days prior
if pt is elderly, what should you check for indications and dosing
elderly dosing
