Prescribing Safety Assessment: Prescription Review

Question 1

Contraindications to drugs that increase bleeding?

Answer 1

Active bleeding, suspected of bleeding, or at risk of bleeding e.g. PT prolonged because of liver disease

Question 2

Side effects/contraindications of steroids? “STEROIDS”

Answer 2

Stomach ulcers
Thin skin
Edema 
Right and left heart failure
Osteporosis
Infection (inc. candida)
Diabetes/hyperglycaemia
Cushing's Syndrome

Question 3

NSAIDs contraindications? “NSAID”

Answer 3

No urine (renal failure)
Systolic dysfunction (heart failure)
Asthma
Indigestion
Dyscrasia
(Aspirin not contraindicated in asthma/renal failure/heart failure, but is in the other two)

Question 4

Antihypertensives contraindications/side effects?

Answer 4

All can cause hypotension, B-blockers and non-DHP CCBs can cause bradycardia, diuretics and ACEI can cause electrolyte disturbance. Then, each class has specific AEs e.g. dry cough with ACEI, bronchospasm and worsening of acute HF with B-blockers, peripheral oedema and flushing with CCBs, diuretics can cause renal failure (loop diuretics can cause gout and K+ sparing can cause gynaecomastia)

Question 5

Cyclizine normal dose and interval?

Answer 5

50mg (PO or IV) 8 hourly

Question 6

Metoclopramide normal dose and interval?

Answer 6

10mg (PO or IV) 8 hourly

Question 7

When not to give 0.9% saline?

Answer 7

1. Hypernatraemic or hypoglycaemic (5% dextrose)
2. Has ascites (give HAS 20%) [high sodium in 0.9% saline will worsen ascites]
3. Shocked with SBP <90 (give colloid like gelofusine instead) as high osmotic content so stays intravascular for longer
4. Shocked from bleeding (give blood transfusion)

Question 8

What is oliguria?

Answer 8

<30ml urine per hour

Question 9

Max rate for IV K+?

Answer 9

10mmol/hour

Question 10

Who are compression stockings contraindicated for?

Answer 10

Those with peripheral arterial disease as may get acute limb ischaema

Question 11

Choosing between cyclizine and metoclopramide for nausea?

Answer 11

Cyclizine good first choice except in cardiac cases as can cause fluid retention

Question 12

When to avoid metoclopramide?

Answer 12

PD patients, young women (risk of dystonia)

Question 13

How do steroids and NSAIDs cause gastric ulceration?

Answer 13

Steroids by inhibiting gastric epithelial renewal, NSAIDs by inhibiting prostaglandin synthesis needed for gastric mucosal protection

Question 14

LMWH and stroke?

Answer 14

Should not be taking heparin thromboprophylaxis for ~2 months after ischaemic stroke

Question 15

Using non-DHP CCBs and B-blockers together?

Answer 15

Risks bradycardia/asystole/hypotension

Question 16

What drug should migraine patients with aura avoid?

Answer 16

COCP (increases risk of stroke)

Question 17

Which insulins can be given IV?

Answer 17

Short-acting insulin used for sliding scale e.g. ActRapid or NovoRapid

Question 18

What time of day to give ACEI?

Answer 18

Cause postural hypotension so best given at night

Question 19

First drug to LOWER potassium in acute hyperkalaemia?

Answer 19

10 units of ActRapid in 100ml of 20% dextrose over 30 min IV