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Prescribing notes > Psc > Flashcards

Psc Flashcards

1
Q

What are 10 basic principles of prescribing?

A
  1. Legible
  2. Unambiguous(state dose clearly)
  3. In Capital letters
  4. Without abbreviations
  5. Signed
  6. If ‘as required’ give 1)indication 2)maximum frewuency or total dose
  7. If antibiotic then give 1)indicatio n2) stop/review date
    8) include duration of treatment if not long term
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2
Q

Which enzyme metabolises drugs into inactive metabolites? and where?

A

Cytochrome p450

in the liver

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3
Q

What do enzyme inducers do and what does this mean?

A

Enzyme inducers increase activity of enzyme and so quickens metabolism of the drug and thus creates a reduced effect. (More of the drug may be required)

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4
Q

What do enzyme inhibitors do and what does this mean?

A

decrease p450 enzyme activity and so less drug metabolism and so increased level of other drugs in the body. (YOU NEED TO BE CAREFUL WITH THESE)

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5
Q

Name enzyme inducers

A

PC BRAS:

  • Phenytoin
  • Carbamazepine
  • Barbiturates
  • Rifampicin
  • Alcohol (chronic excess)
  • Sulphonylureas
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6
Q

Name enzyme inhibitors

A

AODEVICES:

  • Allopurinol
  • Omeprazol
  • Disulfiram
  • Erythromycin
  • Valproate
  • Isoniazid
  • Ciprofloxacin
  • Ethanol (acute intoxication)
  • Sulphonamides
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7
Q

What happens when you give Warfarin with erythromycin

A

Erythromycin is an enzyme inhibitor and will cause an unpredictable rise in INR!

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8
Q

Why are some drugs continued during surgery?

A

The risk of losing disease control outweighs risk of drug continuation

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9
Q

Which drugs are continued during surgery?

A
  • Steroids
  • Beta-blockers
  • Calcium channel blockers
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10
Q

Patient on long-term corticosteroids present with hypotension after surgery. Why is this?

A

Patients on long term corticosteroids will have adrenal atrophy and therefore are unable to produce a physiological ‘stress’ response after surgery. They will present with hypotension

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11
Q

How are steroids given for surgery?

A

IV pre-surgery during induction of anaesthesia

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12
Q

Which drugs must be stopped before surgery?

A

ILACKOP

  • Insulin
  • Lithium
  • antiplatelets/anticoagulants
  • COCP/HRT
  • K-sparing diuretics
  • Oral hypoglycaemics
  • Perindopril and ACE-inhibiotrs
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13
Q

When must you stop COCP/HRT before surgery?

A

4 weeks before

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14
Q

When must you stop lithium before surgery?

A

Day before

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15
Q

When must you stop K-sparing diuretics

A

Day of surgery

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16
Q

When must you stop anticogulants, warfarin, heparin

antiplatelts, aspirin, clopidogrel, dipyridamole?

A

Variable

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17
Q

When must you stop insulin and oral hypoglycaemics?

A

Variable.
As patients are nil by mouth before surgery insulin and OHG will cause lactic acidosis. tO AVOID THIS insulin should be adjusted on a sliding scale to achieve tight control

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18
Q

What is the safe prescribing mnemonic?

A 
PReSCRIBER
P-patient details 
Re- Reactions and ALLERGIES!
S-sign chart 
C-contraindications of each drug 
R-route 
I- IV fluid (consider need)
B- Blood clot prophylaxis (if needed)
E- Anti-emetic (if needed)
R- Pain Relief (if needed)
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19
Q

What do you do for patient details when using a new chart?

A

Write 3 pieces of info:

Name, DOB, hospital number

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20
Q

What do you do for patient details when amending a current chart?

A

Check patient details are correct

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21
Q

What do you do about reactions and allergies when using a new chart?

A

Fill in allergies section of chart and write out reactions if patient has mentioned them.

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22
Q

What do you do about reactions and allergies when amending a current chart?

A

Check details

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23
Q

What must you remember about Tocazin and Co-amoxiclav?

A

They both have PENICILLIN

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24
Q

List 2 anticoagulants and 1 anti platelet that increase bleeding

A
  • Warfarin
  • Heparin
  • Aspirin
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25
Q

List 4 incidences where anticoagulants and anti-platelets are contraindicated/should nor be given

A
  1. Bleeding
  2. Increased risk of bleeding
  3. SUspected of bleeding
  4. increased prothrombin time due to liver disease
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26
Q

When should you not prescribe prophylactic heparin and why?

A

Acute ISCHAEMIC stroke

There is risk of bleeding into the stroke

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27
Q

What drug should not be prescribed with warfarin?

A

ERYTHROMYCIN

  • increases effect of warfarin
  • INR and PT increase
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28
Q

What are the contraindications of steroids?

A 
STEROIDS 
S-stomach ulcers 
T-Thin skin 
E-Edema
R- right and left heart failure 
osteoporosis 
I-infection (candida)
D-diabetes 
S- Cushings syndrome
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29
Q

What are the contraindications of NSAIDS?

A 
NSAID
N-No urine (kidney failure) 
S-systolic dysfunction (heart failure) 
A- asthma 
I-Indigestion
D-Dyscrasia (clotting abormality)
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30
Q

What is aspirin NOT contraindicated in?

A

Aspirin is an NSAID but is not contraindicated in Renal or Heart failure or ASTHMA

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31
Q

What 3 categories can you divide ANTIHYPERTENSIVE contraindications/side effects into?

A

Sort into:

1) hypotension: may result from all antihypotensives (even postural hypotension)
2) mechanisms
3) individual side effects

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32
Q

Describe the mechanistic category of ANTIHYPERTENSIVE contraindications/side effects

A

1) Bradycardia can be caused by beta blockers or calcium channel blockers
2) electrolyte disturbance can be caused by ACEi or diuretics

33
Q

Describe the individual classes and their individual side effects (ANTIHYPERTENSIVES)

A

1) Beta blockers are contraindicated in asthma nd acute heart failure (treats chronic HF)
2) ACEi causes dry cough
3) Calcium channel blockers cause peripheral odema and flushing
4) Diuretics cause renal failure. Loop diuretics (furosemide)cause gout, K-sparing diuretics cause gynaecomastia.

34
Q

If a patient is vomiting what route of anti-emetic is NOT preffered

A

oral

35
Q

What should you do with the patients other prescriptions if vomiting is only predicted to be short term>

A

Do not change them

36
Q

What are teh antiemtic common doses?

A

Cyclizine: 50mg 8-hourly

Metoclopramide 10mg 8–hourly

37
Q

Why are IV fluids given?

A
  • Replacement (dehydrated/acutely unwell individual)

- Maintenance (nil by mouth)

38
Q

What fluid do you give for replacement?

A

0.9% saline

39
Q

List 4 instances where you would give a different fluid for replacement than saline?

A

1) Hyponatraemic
2) Hypoglycaemic
3) Ascites
4) Shock with Syst Bp <90mmHg
5) Shock from bleeding

40
Q

Which fluid would you give for hyponatraemic/hypoglycaemic patient?

A

5% dextrose solution

41
Q

Which fluid for ascites patient?

A

Human Albumin Solution (HAS)- maintains oncotic pressure

42
Q

Which fluid for patient that is shocked with systolic BP <90mmhg?

A

GELOFUSINE (colloid)- maintains osmotic pressure intravascularly

43
Q

Which fluid for patient in shock from bleeding?

A

Blood transfusion

If blood not available immediately then give colloid.

44
Q

How do you assess how much and how fast replacement fluid should be given?

A

Asses:
HR
BP
Urine output

45
Q

If tachycardic and hypotensive what fluid would you give?

A

500mL bolus (250ml if heart failure) then reasses HR, BP and urine output

46
Q

How much fluid would you give if patient is only oliguric (<30ml/h) and this is not due to urinary obstruction?

A

1L over 2-4 hrs and then reasess

47
Q

How fluid depleted would a patient with reduced urine output be?

A

oliguric <30ml/hr
anuric=0ml/hr

approx 500ml depletion

48
Q

How fluid depleted would someone who has reduced urine output and tachycardic be?

A

1L fluid depletion

49
Q

How fluid depleted would someone who has a reduced urine output, is tachycardic and shocked be?

A

> 2L depletion

50
Q

What is the general rule for prescribing fluids to a sick patient?

A

No more than 2 L IV fluid

51
Q

Maintenace: how much fluid does an adult and an elderly person need?

A

adult: 3L a day (24hrs)
Elderly: 2L a day (24hrs)

52
Q

Which fluids will provide the adequate electrolytes for maintenance?

A

0.9% saline =1L
5% dextrose= 2L
(salty and sweet)

53
Q

WHat should you do before prescribing potassium?

A

Check patients electrolyte levels and needs

54
Q

How much potassium would you give for someone with normal levels?

A

Patient needs 40mmol KCL a day (so use 2 20mmol bags)

55
Q

What rate should KCl be given?

A

not more than 10mmol an hour

56
Q

How fast should you give maintenance fluid for an adult and an elderly person?

A

adult : 24/3= 8 hourly

elderly: 24/2=12 hourly

57
Q

What should you check before giving fluids to a patient?

A

Check that they are not fluid overloaded!

check for urinary obstruction (palpable bladder)

58
Q

How do you check if patient is fluid overloaded?

A

check for

  • peripheral oedema
  • raised JVP
59
Q

What should you NOT prescribe to a patient with peripheral arterial disease (absent peripheral pulses) ?

A

Compression stockings

due to acute limb ischaemia

60
Q

What is a side effect of cyclizine?

A

Fluid retention

61
Q

What drugs, doses and routes can you give for a patient that is nauseated?

A
  • Cyclizine 50mg 8-hourly IM/IV/Oral

- Metoclpramide- 10mg 8-hourly IM/IV (if heart failure)

62
Q

What drugs, doses and routes can you give for a patient that is NOT nauseated?

A
  • Cyclizine 50mg 8-hourly IM/IV/Oral

- Metoclpramide- 10mg 8-hourly IM/IV (if heart failure)

63
Q

Which antiemetic is suitable for patient with heart failure?

A

metclopramide

64
Q

Which patients is metclopramide contraindicated in?

A

Parkinsons- (dopamine agonsit)

Young women- risk of dyskinesia (unwanted movements) especially acute dystonia

65
Q

What is the maximum dose of paracetamol in a day?

A

4g

66
Q

What pain relief would you prescribe regularly to a patient that has no pain?

A

nothing

67
Q

What pain relief could you prescribe ‘as required’ to a patient with no pain?

A

Paracetamol up to 1g 6 hourly (oral)

68
Q

What pain relied would you prescribe regularly to a patient with mild pain

A

Paracetamol 1g 6 hourly (oral)

69
Q

What pain relief would you prescribe ‘as required’ to a patient with mild pain?

A

Codeine 30mg up to 6 hourly (oral)- Tramadol is a suitable alternative

70
Q

Name a suitable alternative to codeine

A

Tramadol

71
Q

What pain relief would you prescribe regularly to a patient with severe pain?

A

Co-codamol 30/500, 2 tablets 6-hourly (oral)

72
Q

What pain relief would you prescribe ‘as required’ to a patient with severe pain?

A

Morphine sulfate 10mg 6hourly- oral

(Oromorph is more effective)

73
Q

What routes can morphine sulphate be given?

A
  • Oral (oromorph)
  • SC
  • IV
74
Q

What strengths of oromorph is available and which is used?

A
  • 10mg/5mL
  • It comes in 2 strengths
  • It is a liquid
  • Stronger is rarely used in hospitals
75
Q

What is the dose of NSAID that can be given and when can it be given?

A

400mg Ibuprofen 8-hourly can be introduced at any stage if not contraindicated

76
Q

What drug would you give for neuropathic pain (stabbing, shooting, burning)>

A

AMITRYPTILINE or Pregabalin

77
Q

What dose of amitriptyline would you give?

A

10mg oral nightly

78
Q

What dose of pregabalin would you give?

A

75mg oral 12-hourly

79
Q

What drug would you give for pain caused by diabetic neuropathy?

A

Duloxetine 60mg oral daily

Prescribing notes (1 decks)

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