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PSA Prescribing Exam > Chapter 2- Prescription Review > Flashcards

Chapter 2- Prescription Review Flashcards

0
Q

Side effects and CI to steroids

A 
Stomach ulcers
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection eg. Candida
Diabetes
Syndrome- Cushings
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1
Q

CI to drugs that increase bleeding eg.aspirin, heparin, warfarin, rivaroxaban

A
  • active or suspected active bleeding
  • risk of bleeding (prolonged PT eg. Liver disease)
  • heparin CI in acute stroke: risk of heamorrhagic transformation
  • enzyme inhibitors eg. Erythromycin increase warfarin effect (increase PT, INR)
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2
Q

3 categories of SE of anti HTN medications

A
  1. Those of all antiHTN– postural hypotensino
  2. Mechanistic SE:
    B-blockers and rate limiting CCB –> Bradycardia
    ACEi and Diuretics –> Electrolyte disturbances
  3. Those specific to the drug classification
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3
Q

SE of ACEi (3)

A
  1. Dry cough (increased bradykinin as no ACE to metabolise it)
  2. Hyperkalaemia (Reduced aldosterone, therefore reduced excretion of K+)
  3. Acute renal failure (reduced ANGII so no efferent arteriole constriction if GFR reduces)
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4
Q

SE of B-blockers (3)

A
  1. Bradycardia
  2. Wheeze (brittle asthma)
  3. worsens acute heart failure (cf. Rx in chronic HF)
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5
Q

SE of CCBs (2)

A
  1. Peripheral oedema

2. flushing

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6
Q

SE of diuretics:

  1. All diuretics
  2. K sparing Diuretics
  3. Loop diuretics
A
  1. renal failure due to hypoperfusion of the kidney
  2. eg. frusemide: GOUT
  3. eg. Spironolactone: Gynaecomastia
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7
Q

Antihypertensives causing Hypokalaemia

A

Loop Diuretics: Frusemide

Thiazides:

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8
Q

Antihypertensives causing Hyperkalaemia

A

K sparing diuretics: Spironolactone

ACEi: Perindopril

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9
Q

ACEi- HTN

A

To be used in younger patients (<55years) with HTN (A)
Should not be used in Afro-caribbean pts (angioedema).
Highly indicated for HTN + DM nephropathy
Must stop K supps and K sparing diuretics before use.

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10
Q

ACEi- heart failure

A

Used in acute and chronic HF
Must stop K supps and K sparing diuretics before use.
In pts with HF who are on loop diuretics, can cause first dose hypotension. STOP loops to prevent this. BUT… increased risk of REBOUND PULMONARY OEDEMA.

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11
Q

Renal Effects of ACEi

A
  • Check U&E, Cr before starting
  • hyperK more common in renal impairment (and if on K sparing diuretics)
  • NSAID + ACEi increases risk of renal damamge
  • CI: bilateral RAS
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12
Q

Names of ACEi

A

Capatopril
Enalapril
Lisinopril
Perindopril

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13
Q

Names of ARBs

A

ANG II-R-ANT
Candesartan
Irbesartan

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14
Q

Fluid depletion- clincial examination –> approximation

A

500ml depletion = Oliguria (<30ml/hr or anuria)
1L depletion = OLiguria + tachicardia
2L depletion + Oliguria + shock

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15
Q

Fluid replacement in a tachycardic/hypotensive patient

A

500ml Bolus
1L if Young and fit
250ml if in heart failure

reassess

16
Q

Fluid replacement in an oliguric (and non obstructed patient)

A

1L over 2-4 hours –> reassess.

17
Q

Maintenance fluids of an adult (non elderly)

  • total volume
  • Prescription to give adequate electrolytes
A
  • total volume = 3L/24hours –> 8 hourly bags
  • 1L NaCl + 2L 5% Dexrose / 24 hours (if not eating)
  • K+ supplementation: 40mmol/L/day –> 20mmol KCl in 2 bags of fluid.
  • Plasmalyte- compound sodium acetate
  • Hartmanns contains K and lactate
18
Q

Signs of Fluid Overload

A
  • raised JVP
  • Peripheral oedema
  • Pulmomary oedema
19
Q

Blood Clot prophylaxis

A

LMWH and TED stockings

20
Q

CI to LMWH

A
  • bleeding or risk of bleeding

- recent ischaemic stroke (haemorrhagic transformation risk)

21
Q

CI to TED stockings

A

peripheral arterial disease (absent foot pulses) –> risk of acute limb ischaemia (6Ps)

22
Q

Antiemetics: mechanisms of action

A

H1-ANT: Cyclizine
DA2-ANT: Metoclopramide, Domperidone
DA-ANT: Phenothiazines- block chemo-R trigger zone: Prochlorperazine
5HT3-ANT: Ondansetron

23
Q

Cyclizine

A

H1 ANT
Good first line anti emetic EXCEPT IN HEART FAILURE (SE: fluid retention)
50mg 8hourly (PO/IV/IM)

24
Q

Metoclopramide

A

DA2-ANT
Can be used in heart failure 8hourly IV/IM
AVOID:
1. Parkinsons
2. Young Women –> acute dystonic reactions (oculogyric crisis)

25
Q

Domperidone

A

DA2-ANT

CAN be used in PARKINSONS: doesnt cross BBB

26
Q

Maximum daily dose Paracetamol

A

1g upto 6hourly (Max 4g in 24hours)

27
Q

Maximum Codeine daily

A

30mg up to 6hourly (120mg in 24 hours)

28
Q

Maximum Morphine daily

A

10mg up to 6hourly (40mg daily)

Caution in Oramorph: 10mg/5ml and 5mg/5ml

29
Q

Analgesia in neuropathic pain

A

First line: Amitryptilline, PreGABAlin

Painful diabetic neuropathy: Duloxetine

30
Q

Giving Methotrexate and Trimethoprim (or any other folate ANT) is CI becasue it can cause…..

A

PANCYTOPENIA

31
Q

If a patient is on Methotrexate and develops sepsis….

A

STOP METHOTREXATE IMMEDIATELY until you have excluded neutropenic sepsis

32
Q

breakthrough dose of opiates

A

1/6 of daily morphine dose.

eg. pts usual dose is 30mg BD, so break through dose is 1/6 of 60mg = 10mg

33
Q

should also prescribe this when pt receiving opioids

A

laxative

34
Q

Opioids in CKD…

A

Alfentanil
Buprenorphine
Fentanyl

preferred

35
Q

Pain relief in metastatic bone pain

A

NSAIDS
Bisphosphonates
RT

36
Q

Conversion from codeine to morphine

A

divide by 10

37
Q

conversion from tramadol to oral morphine

A

divide by 10

PSA Prescribing Exam (6 decks)

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