Overview/Prescribing Flashcards
where can you find the opiod dose equivalence table
prescribing in palliative care
where can you find the glucocorticoid dose equivalence table
corticosteroid section
topical drugs (eg creams) can be prescribed in FTU - what is this?
1 FTU = amount of medication needed to squeeze a line from the tip of an adult finger to the first crease of the finger
-it provides enough to treat on side of both hands
what do enzyme inducers do to drug concentrations
inducers –> increase P450 enzyme activity –> drugs more rapidly metabolised –> DECREASE drug concentration
what do enzyme inhibitors do to drug concentrations
inhibitors –> decrease P450 enzyme activity –> INCREASE drug concentration
eg warfarin + erythromycin –> warfarin INR shoots up can cause an acute bleed
enzyme inducers acronym
PC BRAS
enzyme inducers PC BRAS
Phenytoin Carbamazepine Barbiturates Rifampicin Alcohol (chronic excess; d-wks) Sulphonylurea
enzyme inhibitors ZAG DEVICES
"-zoles" [omeprazole, ketoconazole, fluconazole] Allopurinol Grapefruit juice Disulfiram Erythromycin, Clarithromycin (macrolides) Valproate Isoniazid Ciprofloxacin Ethanol (acute excess - hrs-days) Sulphonamides, Statins (competitive)
Drugs to stop before surgery I LACK OP
Insulin Lithium -day before Antiocoagulants/platelets -variable - sometimes continued COCP/HRT - 4 wks K+ sparing diuretics Oral hypoglycaemics Perindopril + other ACEi
Metformin and surgery rules general
0-1 meal missed, eGFR >60, low risk AKI –> CONT M
2+ meals missed OR AKI risk –> OMIT M + VRII (if >BD)
When to start VRII in diabetics before surgery
T1DM
2+ meals missed
poor control (BM>12) (aim 6-10)
Post-MI with diabetic meds stopped (M, SU)
Warfarin + SURGERY rules x3
- Stopped 5+ days prior + INR 1.5+ –> PO Phytomenadione
- Emergency surgery, can be delayed 6-12 hrs –> iV Pheytomenadione
- Emergency surgery, no delay –> iV phytomenadione + IV PCC
drugs to incr for surgery
STEROIDS x2 (on surgery day)
