PSA tips Flashcards
what to look at in the prescription review section to check for errors?
they are testing your ability to find out what is INAPPROPRIATE, UNSAFE or INEFFECTIVE for that particular patient based on their clinical situation?
Look at doses/units, frequency and route.
drugs most likely to cause hypoglycaemia
Insulin, sulphonureas, beta blockers
drugs most likely to cause hyperglycaemia
steroids, beta blockers, tacrolimus, ciclsporin, antipsychotics, THIAZIDES,
Drugs most likely to cause constipation
Opioids, iron, CCBs (amlodipine, verapamil), some diuretics, some antiemetics (ondansetron), some antiepileptics, some Parkinson’s medications, antacids that contain calcium, anticholinergics (antidepressants, antihistamines, incontinence medications, antipsychotics)
Drugs most likely to cause diarrhoea
Antibiotics- Clindamycin, cephalosporins, and fluoroquinolones (C. diff), colchicine, metformin, PPIs, antacids that contain magnesium, laxatives
Drugs most likely to cause urinary retention
Opioids, anticholinergics
Drugs most likely to cause urinary incontinence as in relax the sphinchter too much !
Alpha-blockers, diuretics, cholinesterase inhibitors, clozapine
Drugs most likely to cause confusion
Opioids, sedatives, anticholinergics
Drugs most likely to cause falls
Benzodiazepines, antidepressants (esp TCAs and SNRIs), MAO, antipsychotics, opiates, most antihypertensives, Parkinson’s medications (ropinirole, selegiline), antiepileptics, in theory those that cause hypoglycemia
Drugs most likely to cause gout
diuretics esp thiazide (loop and thiazide will, K+ sparing wont)
Drugs most likely to cause osteoporosis
Steroids, PPIs, GHRH agonists (bureslin, goreslin)
Drugs most likely to cause hypertension
NSAIDs, steroids, oral contraceptives, mirabegron, sumatriptan and amitripytlline may.
Drugs most likely to cause high cholesterol
Steroids, thiazides, tacrolimus? ciclosporin?
Drugs most likely to cause hyponatremia
- anti-psychotics (carbamezapine, valproate), anti-depressants (SSRI, amytriptylline), PPIs (omeprazole and lansoprazole), analgesics (incl. opioids and NSAIDS!) SSRIs (sertraline, citalopram, fluoxetine)- remember to find which of these is more likely either click the most commonly used drug (as this is usually the one that most commonly causes electrolyte imbalances, or go onto the individual drug and look at whether ‘electrolyte imbalance’ is in the common or uncommon section of side effects
Drugs most likely to cause hypernatremia
- Lithium
- Demeclocycline
in intercurrent illness should these drugs be continued or stopped?
steroids, metformin, statins, -gliflozins
Continued if intercurrent illness - steroids (double dose)
Stop if intercurrent illness - metformin, -gliflozins
statins keep the same
generally how long before surgery to stop DOACs, clopidogrel and warfarin?
doacs- 48hr
clopidogrel- 7 days
warfarin-
5 days before surgery: Stop warfarin.
24–48 hours after stopping warfarin: Start LMWH (if bridging is needed).
12–24 hours before surgery: Stop LMWH. IF YOU HAVENT BRIDGED WITH LMWH NO WORRIES BUT YOU NEED TO (EVEN IF YOU HAVE) MEASURE THE INR 24 HOURS BEFORE SURGERY AND IF INR ≥1.5 YOU NEED TO GIVE ORAL VITAMIN K
6–12 hours after surgery: Consider resuming LMWH.
12–24 hours after surgery: Restart warfarin (depending on bleeding risk).
which drugs exaccerbate myasthenia gravis
antibiotics- macrolides and fluroquinolones, beta-blockers, general anaesthetia, sedating drugs, high dose steroids.
which drugs are low mg DOSES
- Atropine (0.5-1.2mg), adrenaline (1mg), estradiol (1mg oral tablets), ACE-I , then warfarin, then thiazides and SGLT2, then DOACS, then corticosteroids and SSRIs (not sertraline but escitalopram (20mg max, or 10mg in elderly), citalopram (40mg max or 16mg in elderly) paroxetine (40mg) and fluoxetine (60mg),
which drugs are high mg
antibiotics, antifungals, antidiabetics (except insulin), antipsychotics (except when depot), antivirals, analgesics, amiodarone,
which drugs are given in micrograms (MCG) ?
levothyroxin, digoxin, atropine, inhaled steroids (fluticasone), inhaled salbutmaol/terbutaline (saba) or folmeterol (laba), folic acid, sumatriptan orally.
if ever you see a woman is pregnant….
always always always look in the indications section for a separate area for pregnancy (as is the case for heparins) or in the pregnancy area (as is the case for vaginal candida treatment).
THE SAME RULES APPLY FOR ELDERLY TOO!
In the prescribing section when prescribing a drug, as well as weight, age, pregnancy, interactions with other drugs, also make sure you look at their conditions. i.e., a clear example would be NSAIDS and gastric ulcer but another example might be TRIPTANS + HTN or contraceptives and vomitting/diarrhoea. And when you think you’ve got it question yourself once more but on the route this time or the duration because topical NSAIDS + gastric ulcers are okay, and contraceptive patches and diarrhoea is okay and thrombolysis with a history of stroke is okay (If it was >3 months ago)
when prescribing antifungals ALWAYS check for drug interactions
if more than the required number of drugs come up on the appendix for hyponatremia/kalaemia etc. to decide which one it is go to the side effects of each drug and check if it is classified as ‘common’ or ‘uncommon’
appendix 1 also has a section for ‘sedation, cns effects and antimuscarinics’
this is good for questions ie cognitive impairment ?
children. If you are given weight and height and there is any mention of a cautious drug then assume you need to check their weight for their age, if it is above this, use ideal body weight to calculate body surface area to make calculations for doses.
