Section 1 - Prescription review

Question 1

What would you check when reviewing a prescription?

Answer 1

PReSCRIBER

Patient details
Reaction (allergy + details)
Sign front of chart
Contraindications (check)
Route (check)
IV fluids
Blood clot prophylaxis
anti-Emetic
pain Relief

Question 2

Working with a new chart, would do you need to add?

Answer 2

3 pieces of patient-identifying info

OR

hospital addressograph sticker

Question 3

Is heparin prescriped for someone with acute ischaemic stroke?

Answer 3

No

Risk of bleeding into stroke

Do not prescribe for at least 2 months

Question 4

What antibiotic shouldn’t be given with warfarin?

Answer 4

Erythromycin

Question 5

What are the side effects of steroids?

Answer 5

Stomach ulcer
Thin skin
oEdema
Right and left HF
Osteoporosis
Infection (candida)
Diabetes (hyperglycaemia)
cushing’s Syndrome

Question 6

Side effects of NSAIDs:

Answer 6

• *N**o urine (i.e. renal failure)
• *S**ystolic dysfunction (i.e. HF)
• *A**sthma
• *I**indigestion (any cause)
• *D**yscrasia

Question 7

What anti-emetics to prescribe for someone not tolerating oral meds?

Answer 7

1st = CYCLIZINE 50mg 8^

2nd = METOCLOPRAMIDE 10mg 8^

Question 8

When would you not want to prescribe cyclizine?

Answer 8

If a patient has cardiac failure, as it can worsen fluid retention

Question 9

When would you not want to prescribe metoclopramide?

Answer 9

Parkinson’s –> use DOMPERIDONE

Yound women –> can cause dyskinesia

Question 10

When would you give a patient 5% DEXTROSE instead of 0.9% NaCl?

Answer 10

Hypernatraemic or hypoglycaemic

Question 11

When would you give a patient Human-Albumin Solution instead of 0.9% NaCl?

Answer 11

Ascites

Albumin maintains oncotic pressure, whereas higher Na content in saline actually worsens ascites

Question 12

When would you give a patient GELOFUSINE instead of 0.9% NaCl?

Answer 12

Shocked with SBP < 90

A colloid fluid, has a high osmotic content so stays in intravascular space –> better to maintian BP

Question 13

What would you give someone as fluid replacement if they are shocked from bleeding?

Answer 13

Blood transfusion

if no blood availble instantly, give a colloid

Question 14

Patient is hypotensive + tachycardiac, wyd?

Answer 14

500ml bolus STAT (250ml if HF)

Reassess

Question 15

Patient needs fluids, is oliguric but otherwise stable, wyd?

Answer 15

1L over 2-4h

Reassess

Question 16

Describe how you can roughly predict how fluid-depleted an adult is.

Answer 16

Reduced UO (<30 ml = oliguric) –> 500mL

Reduecd UO + tachycardic –> 1L

Reduced UO + tachycardic + shock –> 2L +

Question 17

As a general rule, how much is daily maintenance fluids in adults?

Answer 17

Adults = 3L / day

Elderly = 2L / day

Question 18

What maintenance fluids would you prescribe a normal adult?

Answer 18

1 salty, 2 sweet –> 1L of 0.9% NaCl + 2L of 5% dextrose

50mmol KCl per day –> 20 mmol KCl in two bags (10mmol/hour max)

Question 19

Maximum dose paracetamol?

Answer 19

4g / day –> 1g 6^o

Question 20

How would you prescribe ibuprofen for pain?

Answer 20

IBUPROFEN 400mg 8^o

Question 21

What would you precsribe for neuropathic pain?

Answer 21

AMITRYPTILINE 10mg PO nightly
OR
PREGABALIN 75mg PO 12^o
OR
DULOXETINE 50mg PO OD

Question 22

What drug for painful diabetic neuropathy?

Answer 22

DULOXETINE 60mg PO OD

Question 23

What would you prescibe for ‘no pain’?

Answer 23

Regular –> nil

PRN –> PARACETAMOL 1g up to 6^o

Question 24

What would you prescibe for ‘mild pain’?^oo

Answer 24

regular –> PARACETAMOL 1g 6^o

PRN –> CODEINE 30mg PO up to 6^o

Question 25

What would you prescribe for 'severe pain'?

Answer 25

regular --\> CO-CODAMOL 30/500, 2 tablets 6^o PO PRN --\> MORPHINE SULPHATE 10mg PO up to 6^o

Question 26

Side effect of THIAZIDE and LOOP DIURETICS?

Answer 26

Hypokalaemia

Question 27

Side effect of ALL DIURETICS?

Answer 27

Hyponatraemia Hypotension AKI

Question 28

Side effect of ACEi?

Answer 28

Hyperkalaemia Dry cough CI in pregnancy (teratogenic) Postural hypotenson --\> **give in evenings**

Question 29

Side effect of AMILORIDE?

Answer 29

K-sparing diuretic --\> hyperkalaemia

Question 30

Side effect of CCB?

Answer 30

Peripheral oedema Hypotension Bradycardia Flushing

Question 31

Patient is hypernatraemia / hypoglycaemic - what fluids?

Answer 31

5% dextrose

Question 32

Patient has ascites and needs fluids - which fluids to give?

Answer 32

Human albumin solution

Question 33

Patient is shocked with SBP \<90 - what replacement fluids?

Answer 33

gelofusine

Question 34

Patient is tachycardic and/or hypotensive - how fast do you give fluids?

Answer 34

500 mL bolus (over 15-30 minutes) Heart failure --\> 250 mL REASSESS

Question 35

Patient is oliguric but otherwise well - what fluids?

Answer 35

1L over 2-4 hr and reassess

Question 36

Patient is nauseated - what do you prescribe?

Answer 36

Cyclizine 50mg 8 hourly IM / IV / PO Heart failure --\> metoclopramide 10mg 8 hr IM / IV

Question 37

When would you NOT give metoclopramide?

Answer 37

Parkinsons or young female

Question 38

Patient is septic and has RA - what must you be worried about?

Answer 38

Methotrexate should be held if suspecting sepsis, due to chance of it causing neutropenic sepsis

Question 39

Patient taking methotrexate has UTI - what now?

Answer 39

Trimethoprim is a FOLATE ANTAGONIST and is therefore a direct contrandiciation to methotrexate therapy

Question 40

Patient with stroke and on heparin?

Answer 40

Should not be taking heparin thromboprophylaxis for 2 months after an acute stroke