[REV] Prescription reviews Flashcards
Which drugs are enzymes inducers? (so need the other drug dose to be increased)
PC BRAS
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic eccess)
Sulphonylurea
Which drugs are enzymes inhibitors (so need lower other drug dose)
ZAG DEVICES
-zoles (omeprazole, ketoconazole, fluconazole)
allopurinol
grapefruit juice
disulfirm
erythromycin
valproate
isoniazd
ciproflox
ethanol
sulphnnamides, STATINS
How long before surgery must you stop the COCP?
28 days
How long before surgery must you stop lithium?
1 day before
How long before surgery must you stop insulin?
0 - and replace with sliding scale
How long before surgery must you stop anticoags / platelets ?
5 days before
How long before surgery must you stop ACEi, ARB, K sparing?
0
When and by how much do you change steroids during surgery?
ON the day of surgery
DOUBLE the steroid dose
Which important class of drugs must you avoid giving to someone on an enzyme inhibitor?
Drugs that INCREASE BLEEDING (aspirin, heparin, wartfarin)
When must you be cautious with NSAIDS?
NSAID
No urine
Systolic dysfunction
Asthma
Indigestion
Dyscrasia of blood (clotting abnormalitYy)
Explain how you should prescribe beta blocker in the context of HF
NOT in acute HF (will worsen it)
YES in chronic HF
What broad condition should you avoid diuretics in?
AVOID diuretics in RENAL FAILURE
What can loop diuretics precipitate?
GOUT
What can spironolactone cause?
Gynaecomastia
Replace with epleronone
What is first line antiemetic in most cases?
Cyclizine
Contraindication of cyclizine
NOT in HF (as may cause fluid retention)
Contraindications of metoclopramide?
NOT in PARKINSONS (Da antagonist > use domperidone)
NOT in young women (risk of dyskinesia)
Which antibiotic do you NEVER give warfarin with?
Erythromycin / clarythromycin
What medication should you double in ill patients with adrenal insufficiency (Addison’s)?
DOUBLE the steroid
CHECK - Antibiotics for neutropoenic sepsis?
Tazocin + gentamiciin
Drug for arrythmia and hypotension
Digoxin
What baseline blood do you need to do when starting statins?
RF: CK
No RF: ALT
When must you check LFTs for statins?
At 3 months and 12 months
What antibiotic must you stop statins for?
MACROLIDE (clarythromycin/erythromycin)
When do you monitor lithium dose?
12 hours after last dose
monitor WEEKLY until levels stable, then every THREE MONTHHS
What must you monitor for OCP
Blood pressure monitoring (as it may cause sodium retenton)
What must you check before prescribing antipsychotics and why?
ECG - only if RF of CVD
What must you monitor when prescribing carbimazole?
FBC (neutrophils) - as it can cause neutropoenia
What must you monitor for gentamicin?
UE (AS IT IS HIGHLY NEPHROTOXCIC) - measure pre-dose through and 1 hour peak
+ auditory monitoring and vestiibular monitoring
What cardiac condition are ACEi contraindicated?
Aortic stenosis
SE ACEi
Hyperkalaemia
Hyponatraemia
AKI
Cough
Angioedema
What do you need to do for ACEi monitoring?
UE
Digoxin monitoring
UE (min 6 hours post dose)
How do you monitor clozpine?
every week for 18 weeks
every 2 weeks up to 1year
every 4 weeks thereafter
How often is cyclizine given?
8 hourly (three times daily)
Can pilocarpine be given to asthmatics?
Oral pilocarpine is contraindicated in patients with uncontrolled asthma. Topical pilocarpine is not contraindicated.
Can timolol be given as acute angle-closure glaucoma treatment in asthmatics?
BNF advises caution due to the risk of bronchospasm
