Section 2: Prescription review Flashcards
When do you stop COCP pre-operatively?
4 weeks before surgery
When do you stop lithium pre-operatively?
24h before major surgery, but dose may be continued for minor surgery with careful monitoring of fluids and electrolytes.
When do you stop spironolactone pre-operatively?
K+ sparing diuretics are withheld on the morning/ day of surgery because of the risk of hyperkalemia. This also applies to ACE-i and ARB. which are a/w severe hypoTN after anaesthesia. The BNF treatment summary is entitled ‘Surgery and long-term medication’.
When do you stop ramipril pre-operatively?
24h before surgery, due to risk of severe hypotension under general anaesthetic.
Dose and frequency of methotrexate?
Once weekly. Usually a loading dose dependent on condition being treated, with stepwise 2.5mg increase weekly.
If patient is nauseous and vomiting, what antiemetic would you prescribe?
Cyclizine 5mg TDS, metoclopramide 10mg TDS given by IV/ IM/ SC i.e. non-oral routes
When do you stop aspirin before surgery?
1 week
Do you stop metformin before surgery?
Yes, due to risk of lactic acidosis when patients are NBM i.e. prolonged pre-operative fasting. Stop it 48h before and sometimes 48h after surgery.
Which diuretics cause hypo and hyperkalemia?
Hypo - loop and thiazide
Hyper - K+ sparing i.e. aldosterone antagonists ~ also ACE-i
What anti-folates do you need to avoid prescribing together?
Methotrexate, trimethoprim, proguanil (anti-malarial), pyrimethamine
Following an acute stroke, when do you start heparin thromboprophylaxis?
Around 2 months following the stroke due to risk of bleed (although this varies throughout the UK) - consider mechanical compression
If a patient is taking warfarin with a therapeutic INR, do they still require prophylactic heparin in hospital?
No. This increases risk of bleeding unnecessarily.
Why should verapamil not be used with beta blockers?
Verapamil is a cardio selective CCB and when used with beta blockers may cause profound bradycardia (even asystole) and hypotension.
What drugs to stop in asthma exacerbation?
Ibuprofen and beta blockers - these cause bronchospasms
Aspirin is usually fine in asthmatics but usual at dose of 75mg for cardioprotection (and max 300mg for stroke)
What routes are insulin given by?
Always S/C except for sliding scales using short-acting insuln, which is given IV e.g. Actrapid or NovoRapid