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Y4 - Finals Edition > Y3 - Safe prescribing > Flashcards

Y3 - Safe prescribing Flashcards

1
Q

What key investigation should be done in an child with unexplained fever over 38 degrees

A

URINE sample within 24 hours

Send for microscopy and culture

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2
Q

When taking a paediatric medication history, what is it important to ask about?

A
  • 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
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3
Q

E.coli is a …

A

Gram negative rod shaped bacteria

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4
Q

What routine advice should be give to parents of children who develop urinary tract infections to prevent reoccurence?

A
  • Toilet hygiene: wipe front to back
  • keep well hydrated
  • do not delay toilet and hold urine in
  • wear loose underwear
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5
Q

Information from a paediatric history which may suggest constipation?

A
  • decreased stool frequency
  • pain on defaecation
  • recent change in diet
  • overflow soiling mistaken for diarrhoea
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6
Q

Main difference between adult and paediatric management of constipation?

A

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

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7
Q

Recommended fibre intake for adults suffering with constipation

A

30g per day

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8
Q

If a patient is taking liquid preparations in mls, what is important to consider when writing their prescription chart :

A

PRESCRIBE IN mg

Need to work out dose in Mg

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9
Q

What important information should you give the parents of a patient who has just started a disimpaction and maintenance regime for constipation?

A
  • 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
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10
Q

Side effects of constipation treatment in kids

A
  • stomach pains
  • dehydration
  • nausea

Important to keep patient well hydrated

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11
Q

Contraindications for the COCP

A
  • 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
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12
Q

Combined oral contraceptive pill’s should be avoided in patients who have two of the following critiera:

A
  • 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
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13
Q

Important questions to ask patient before starting contraceptoin?

A

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?

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14
Q

Why is it important to ask a patient when they had their last menstrual period when considering starting the progestogen only pill?

A

POP
1. Can be started day 1-5 of menstrual cycle without needing any additional protection

  1. 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

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15
Q

Progesterone only Pill COUNSELLING

MODE OF ACTION

A

MODE OF ACTION

  • suppresses ovulation
  • increases hostile cervical mucus
  • reduction in activity of cilia in the fallopian tube
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16
Q

Progesterone only Pill COUNSELLING

Advantages

A
  • 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
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17
Q

Progesterone only Pill COUNSELLING

Disadvantages

A
  1. pills must be taken same time each day
    —–> 3 hour window
    —–> 12 hour window for desogestrel
  2. Adverse effects
    - unscheduled bleeding
    - breast tenderness
  3. Doesn’t protect against STI
  4. Ovarian cyst
  5. Headache
  6. Libido changes
  7. Cardiovascular disease –> MI, VTE, STROKE
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18
Q

If a women vomits within how many hours of taking an oral contraceptive, should she take another on:

A

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

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19
Q

Missed pill advice for POP

A

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

20
Q

Important additional supplement a women may take during pregnancy

A

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

21
Q

1st line RCOG guidance for nausea and vomiting in pregnancy

A

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

22
Q

Treatment of DVT in pregnancy

A

LMWH –> like enoxaparin SC
–> continue for remainder of pregnancy
–> and at least 6 weeks post natal

23
Q

What would be the drug of choice is a patient with gestational diabetes had high blood sugars despite treatment with metformin

A

INSULIN

24
Q

NICE guidelines for gestational diabetes

A

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

25
Q

opioid example which is safe in breast feeding

A

dihydrocodeine

26
Q

Symptoms of pre-eclampsia include

A
  • Swelling of feet, ankles, face and hands caused by fluid retention
  • severe headache
  • vision problems
  • pain just below ribs
27
Q

What medication options are available to manage raised BP in pregnancy:

A
  1. Labetalol
  2. Or nifedipine

OR if neither labetalol or nifedipine
–> methyldopa

28
Q

For women at high risk of pre-eclampsia - ensure what is prescribed:

A

75-150mg aspirin daily from 12 weeks gestation until birth

29
Q

Patients undergoing elective knee replacement should be given thromboprophylaxis - options include:

A
  1. Aspirin 75mg or 150mg OD for 14 days
  2. LMWH for 14 days w/ anti-embolism stockings until discharge
  3. DOAC (e.g. apixaban, dabigatran or rivaroxaban)
30
Q

What are some indications that a patient may require fluid resuscitation?

A

RR > 20 breaths / minute

HR > 90 beats / minute

Systolic BP < 100mmHg

Cool peripheries or CRT > 2 seconds

45 degree passive leg raise suggests fluid responsiveness

31
Q

NICE guidelines for fluid resuscitation

A

Sodium chloride 0.9%

Hartmann’s

You want to use crystalloids which contain sodium in the range 130-154

Prescribe a bolus of 500mls over 15 minutes

32
Q

Patients at risk of fluid overload should be given what bolus of sodium chloride 0.9%

A

Given 250ml IV fluid bolus of NaCl 0.9% over 10 minutes

33
Q

NICE guidelines for routine maintenance fluids

A

25-30 mL/kg/day of water

1mmol/kg/day of potassium, sodium and chloride

Approximately
50-100g of glucose to limit starvation ketosis

34
Q

Which antibiotic is known to increase the concentration of warfarin thus leading to increased INR and increased risk of bleeding?

A

CLARITHROMYCIN

a potent CYP3A4 inhibitor

35
Q

Appropriate management for a patient with an increased INR? (INR = 8)

A
  • Stop warfarin
  • administer phytomenadione
  • restart warfarin once INR < 5
36
Q

Why is warfarin withheld before surgery:

A
  • long half time
  • need to allow time for INR to fall below at least 1.4 by day of operation
37
Q

How can patients take medication if they are NBM?

A

can use 30mls of water to take regular medication that is being continued on the morning of the operation

38
Q

When prescribing LMWH what is it important to check in a patient?

A
  • renal function
  • weight
  • full blood count
39
Q

Medication considerations in the post-operative period

A
  1. Pain –> may lead to ileus, nausea and vomiting and immune suppression
  2. Nausea and vomiting –> around 25% of patients experience one or both of nausea and vomiting in the post operative period
  3. NBM –> intravenous fluids?
40
Q

Scoring system used to assess whether an anti-emetic needs to be considered in a patient in the post operative period?

A

APFEL SCORE

1 point for
- female
- smoker
- history of post operative nausea and vomiting
- motion sickness

41
Q

Considerations for a patient at discharge after surgery?

A
  1. Pain relief
  2. Anti-emetics
  3. Laxatives
  4. VTE prophylaxis
  5. Regular medications
42
Q

What potential issues are there with prescribing ciprofloxacin:

A
  • prolong QTc
  • can lower seizure threshold
  • can cause photosensitivity
  • can exacerbate myasthenia gravis
43
Q

If metformin alone is not controlling this patients blood glucose level; what options are available for treatment?

A

Metformin should be combined with one of the following:

1. Sulphonylurea
–> can cause hypoglycaemia
–> moderate weight gain

2. Pioglitazone
–> increased risk of heart failure when combined with insulin
–> risk of bladder cancer

3. DPP-4 inhibitor
–> associated with weight gain
–> less incidence of hypoglycaemia

4. SGLT-2 inhibitor
–> when sulphonylureas are contraindicated
–> slight risk of DKA

44
Q
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Q
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Y4 - Finals Edition (40 decks)

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