Prescribing Safety Assessment: Prescribing Management/Communicating Information

Question 1

Drugs to stop before surgery?

Answer 1

“I LACK OP”: insulin, anticoagulants/antiplatelets, COCP/HRT, K-sparing diuretics, oral hypoglycaemics, perindopril and other ACEI

Question 2

When to stop COCP/HRT before surgery?

Answer 2

4 weeks before

Question 3

When to stop lithium before surgery?

Answer 3

Day before

Question 4

When to stop K+ sparing diuretics and ACEI for surgery?

Answer 4

Day of surgery

Question 5

Managing anaphylaxis?

Answer 5

ABC and O2, Hx/OE/Ix, remove cause e.g. blood transfusion, adrenaline 500mcg of 1:1000 IM, chlorphenamine 10mg IV, hydrocortisone 200mg IV, asthma Rx if wheeze, amend allergies chart

Question 6

CURB-65 features?

Answer 6

Confusion (AMTS<9), urea >7.5, RR >30m, BP <90, age >64

Question 7

Interpreting CURB score?

Answer 7

If 0-1 then home treatment possible, if 2 or more then hospital with oral or IV antibiotics, if more than 3 then consider ITU

Question 8

Interventions in bacterial meningitis?

Answer 8

IVT, dexamethasone IV (unless severely immunocompromised), LP +/- CT head, 2g cefotaxime

Question 9

Who is eligible for thrombolysis in stroke?

Answer 9

If aged <80 and onset <4.5 hours ago

Question 10

Diagnosing DKA?

Answer 10

1. Diabetic (known or BM>30)
2. Ketotic (urine or blood ketones)
3. Acidosis (pH on ABG )

Question 11

Diagnosing HHS?

Answer 11

1. Hyperglycaemia (usually >35)
2. Hyperosmolar (osmolality > 340mmol/L)
3. Non-ketotic
   (Same management as DKA, but half the rate of fluids)

Question 12

Who receives NAC?

Answer 12

If paracetamol level at 4 hours or more is over the line

Question 13

Lamotrigine side effects?

Answer 13

Rash, rarely SJS

Question 14

Carbamazepine side effects?

Answer 14

Rash, dysarthria, ataxia, nystagmus, hyponatraemia

Question 15

Phenytoin side effects?

Answer 15

Ataxia, peripheral neuropathy, gum hyperplasia, hepatotoxicity

Question 16

Sodium valproate side effects?

Answer 16

3 Ts (tremor, teratogenicity, tubby (weight gain))

Question 17

First choice of AED for focal seizures?

Answer 17

Carbamazepine or lamotrigine

Question 18

Treating mild/moderate dementia?

Answer 18

Give AChE inhibitors (can only be started by specialists); only licensed drugs are donepezil, rivastigmine and galantamine

Question 19

Treating moderate/severe dementia?

Answer 19

Treat with NDMA antagonist (memantine)

Question 20

INR monitoring frequency?

Answer 20

Initially weekly, but can be monthly once stable