Y3 - Safe prescribing Flashcards
What key investigation should be done in an child with unexplained fever over 38 degrees
URINE sample within 24 hours
Send for microscopy and culture
When taking a paediatric medication history, what is it important to ask about?
- Birth weight
- drug allergies
- use of inhalers or creams
- any over the counter medication use
- patient tablet or liquid preference
- breast or bottle bed
- is mother on any medication if patient breast fed
E.coli is a …
Gram negative rod shaped bacteria
What routine advice should be give to parents of children who develop urinary tract infections to prevent reoccurence?
- Toilet hygiene: wipe front to back
- keep well hydrated
- do not delay toilet and hold urine in
- wear loose underwear
Information from a paediatric history which may suggest constipation?
- decreased stool frequency
- pain on defaecation
- recent change in diet
- overflow soiling mistaken for diarrhoea
Main difference between adult and paediatric management of constipation?
dietary interventions should not be used alone as 1st line tx, unlike in adults
Combination tx w/
–> laxatives
–> toilet schedules
–> dietary modification (fluid and adequate fibre)
–> encourage physical activity
Recommended fibre intake for adults suffering with constipation
30g per day
If a patient is taking liquid preparations in mls, what is important to consider when writing their prescription chart :
PRESCRIBE IN mg
Need to work out dose in Mg
What important information should you give the parents of a patient who has just started a disimpaction and maintenance regime for constipation?
- open sachets and pour into water, stir until dissolves
- can add squash to make it taste nicer
- can be given at any time of the day: start in the morning so full dose can be given within 12 hours
- don’t have to drink it all in one go
- but must drink it all to have clinical development
- may not work immediately
- Diet and lifestyle: fluid intake, adequate fibre and exercise
- follow up with GP or outpatient services
Side effects of constipation treatment in kids
- stomach pains
- dehydration
- nausea
Important to keep patient well hydrated
Contraindications for the COCP
- history of breast cancer (can be used after 5 years if no evidence and non-hormonal methods unacceptable)
- migraine with aura
- personal PMHx venous or arterial thrombosis
- severe or multiple risk factors for arterial disease OR VTE
- transient cerebral ischaemic attacks without headaches
Combined oral contraceptive pill’s should be avoided in patients who have two of the following critiera:
- obesity (BMI > 30)
- SMOKING
- Diabetes mellitus
- FHx of arterial disease in 1st degree relative aged under 45
- HTN –> blood pressure above 140 systolic or 90 diastolic
- migraine without aura
Important questions to ask patient before starting contraceptoin?
Is she already using contraception?
Has she had emergency hormonal contraception?
Recently given birth?
Has she had a miscarriage or termination?
Does she normally have a regular cycle?
LMP?
Why is it important to ask a patient when they had their last menstrual period when considering starting the progestogen only pill?
POP
1. Can be started day 1-5 of menstrual cycle without needing any additional protection
- If at any point in the cycle
–> pregnancy test first
–> start POP BUT patient needs to use additional barrier methods for the next 48 hours
Starting POP on days 5-28 is OFF LABEL USE
Progesterone only Pill COUNSELLING
MODE OF ACTION
MODE OF ACTION
- suppresses ovulation
- increases hostile cervical mucus
- reduction in activity of cilia in the fallopian tube
Progesterone only Pill COUNSELLING
Advantages
- very effective when taken correctly
- sex doesn’t need to be interrupted
- can be used in women where COC not suitable
- may reduce risk of endometrial cancer
- Desogestrel may help manage dysmenorrhoea
- fertility returns to normal when POP stopped
Progesterone only Pill COUNSELLING
Disadvantages
- pills must be taken same time each day
—–> 3 hour window
—–> 12 hour window for desogestrel - Adverse effects
- unscheduled bleeding
- breast tenderness - Doesn’t protect against STI
- Ovarian cyst
- Headache
- Libido changes
- Cardiovascular disease –> MI, VTE, STROKE
If a women vomits within how many hours of taking an oral contraceptive, should she take another on:
If vomits within 2 hrs of taking pill - another one should be taken
If D&V > 24hrs
- avoid sex or use barrier methods during illness and for 48hrs after
Missed pill advice for POP
If missed POP
- take asap
- then next pill at normal time
- may mean taking 2 pills in 24 hrs
IF UPSI after missed pill and within 48hrs of restarting POP
–> consider emergency contraception
Important additional supplement a women may take during pregnancy
FOLIC ACID 400 micrograms daily up until 12th week of pregnancy
—> reduce risk of neural tube defects
Women who are at higher risk : take 5mg daily until week 12
—> previous spina bifida in pregnancy
—> epilepsy medication?
—> coeliac or malabsorption issues, DM
—> BMI of 30 of more
—> sickle cell, thalassaemia or thalassaemia trait
1st line RCOG guidance for nausea and vomiting in pregnancy
1st line –> CYCLIZINE or PROCHLORPERAZINE
CAUTION
- prochlorperazine in young women due to risk of dystonia
2nd line –> domperidone , metoclopramide
Ondansetron
–> beware concern about cardiac and renal malformations
Treatment of DVT in pregnancy
LMWH –> like enoxaparin SC
–> continue for remainder of pregnancy
–> and at least 6 weeks post natal
What would be the drug of choice is a patient with gestational diabetes had high blood sugars despite treatment with metformin
INSULIN
NICE guidelines for gestational diabetes
Fasting plasma glucose below 7mmol/L
–> diet and exercise trial
If targets not met within 1-2 weeks
—> metformin
Only give insulin if:
—> metformin contraindicated or unacceptable to women
