Basics of prescribing Flashcards
(45 cards)
Which drugs are P450 inducers?
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic abuse)
Sulphonylureas
Which drugs are P450 inhibitors?
AO DEVICES
Allopurinol
Omeprazole
Disulfiram
Erythromycin
Valproate
Isoniazide
Ciprofloxacin
Ethanol (acute intoxication)
Sulphonamides
What is the PReSCRIBER mnemonic?
The mnemonic used for prescribing checks of drugs.
Patient details
Reactions
Sign front of chart
Contraindications
Route of drug
IV fluid if needed
Blood clot prophylaxis
anti-Emetic if needed
Relief if needed of pain
What are the side effects of steroid medications?
“STEROIDS”
Stomach ulcer
Thin skin
oEdema
Right and left heart failure
Osteoporosis
Infection
Diabetes
cushings Syndrome
Safety consideration of NSAID’s?
No urine
Systolic dysfunction
Asthma
Indigestion
Dyscrasia (clotting abnormality)
How do you choose which fluid replacement to presscribe?
Give all patients 0.9% saline unless they are hypernatraemic or hypoglycaemic (5% dextrose instead).
Has ascites: give human albumin solution instead as it maintains oncotic pressure.
Haemorrhagic shock: give blood transfusion but a crystalloid first if no blood available.
Common side effects of Thiazide diuretics?
Gout
Hypokalaemia
Common side effects of Spiranolactone?
Hyperkalaemia
Gynaecomastia
Common side effects of diuretics in general?
Renal failure. Prescribe with caution.
When would you give a STAT infusion of 500ml 0.9% saline?
To a patient whom was haemodynamically unstable
- Tachycardic
- Hypotensive
You would give 250ml in this situation to a patient with heart failure.
In what situation would you give a patient 1L fluid over 2-4 hours? (0.9% saline)
A patient whom was oliguric.
How can you roughly predict the level of fluid depletion in a patient using basic observations?
500ml depleted: reduced urine output <30ml/hr
1L depleted: olguric and tachycardic
> 2L: reduced urine output, tachycardic and shocked.
What is the maximum rate in which potassium can be infused?
Potassium should not be infused at a faster rate than 10mmol/hour.
What are the general fluid requirements of a patient in 24 hours?
Adults 3L IV fluid
Elderly 2L IV fluid
What is a basic fluid regime for a patient?
“1 salty 2 sweet”
1L of 0.9% saline and 2L of 5% dextrose
How much potassium does a patient require each dayt?
Around 40mmol/L a day (put 20mmol of KCl/day in 2 bags)
What is the prophylactic dose of LMWH?
5000 units
When should metocloperamide be avoided?
In patients with Parkinsons disease
In young women as it increases the risk of dyskinesias
Which anti-emetic is best for patients with heart failure?
Metocloperamide 10mg 8 hourly IM/IV
What is the first line treatment for patients with neuropathic pain?
Amitryptilline or Pregabalin
Which weight threshold means that you reduce paracetamol dose?
Body weight of 50kg
Some side effects (including neurological) of anti-muscarinic drugs
Eg. Oxybutynin
Increased confusion, pupillary dilation with loss of accommodation, dry mouth and tachycardia (after transient bradycardia)
Which drugs should not be taken/used with caution alongside methotrexate?
Methotrexate can cause renal impairment so any medications that can lead to this same outcome should be used with caution.
What are the consequences of using calcium channel blockers and beta blockers together?
They are both rate limiting drugs so can therefore result in a
- bradycardia
- asystole
- hypotension
