Basics of Prescribing

Question 1

What are the basics for all prescribing?

Answer 1

Prescription must be: - legible - unambiguous - approved name - in CAPITALS - without abbreviations - signed - INSTRUCTIONS on indication and maximum frequency

Question 2

What extras are needed for antibiotics? For short term meds?

Answer 2

Abx - indication and stop/review date short term meds: duration

Question 3

Most common enzyme inducers -> what’s the effect?

Answer 3

Inducer -> increased enzyme activity -> decreased drug concentration PC BRAS Phenytoin, Carbamazepine Barbiturates, Rifampicin, chr. excess Alcohol, Sulphonylureas

Question 4

Most common enzyme inhibitors -> what’s the effect?

Answer 4

Inhibitor -> reduced enzyme activity -> increased drug concentration AODEVICES Allopurinol, Omeprazole, Disulfiram, Erythromycin, Valproate, Isoniazid, Ciprofloxacin, Ethanol (acute intox), Sulphonamides

Question 5

Which drugs would you increase before surgery?

Answer 5

Patients on long-term steroids -> IV steroids at induction.

Question 6

Which drugs would you stop before surgery?

Answer 6

I LACK OP

Question 7

Which antibiotics need to be avoided in Penicillin allergies?

Answer 7

Penicillins, but also co-amoxiclav and tazocin, which contain penicillin!

Question 8

Easy rules for fluids:

Replacement for dehydrated/unwell patient.

What?

How much and how fast?

Answer 8

What?

Give 0.9% saline unless patient is

• hypernatraemic/hypoglycaemic
• ascites - give human-albumin solution instead
• shocked with systolic BP < 90 - give gelofusine (colloid)
• shocked from bleeding - blood transfusion or colloid if no blood available

How much and how fast?

• if tachy or hypotensive -> 500mL bolus (250 in cardiac pts)
• if only oliguric -> 1L over 2-4hrs, then reassess
• no more than 2L IV

Question 9

Easy rules for fluids:

Maintenance

Which fluids and how much?

How fast?

Answer 9

Which fluids and how much?

• adults: 3L IV fluids per 24 hrs
• elderly: 2L
• Adequate electrolytes: 1L 0.9 saline and 2L of 5% dextrose - 1 salty and 2 sweet
• beware Potassium - in normal K+, give 40mmol/day (20 in two bags)
  
  • Don’t give more than 10mmol/hr

Question 10

Blood clot prophylaxis

What to give and exceptions

Answer 10

Patients in hospital will be given

• prophylactic LMWH (ie dalteparin 5000units)
• compression stocking
  
  • DO NOT GIVE THESE IN PAD (check for foot pulses)

Question 11

Regular antiemetics and when not to use them:

Nauseated vs not nauseated

Answer 11

Question 12

Name causes of anaemia:

Microcytic

Normocytic

Macrocytic

Answer 12

Question 13

Pain relief

for mild, moderate and severe pain

Breakthrough vs regular meds

Answer 13

Question 14

Which WBCs are raised in

• bacterial infection
• viral infection
• > what else is it affected by?

When are neutrophils decreased

Answer 14

Bacterial

• Neutrophils
  
  • also raised in tissue damage and steroid use

Viral

• Lymphocytes
  
  • also raised in lymphoma and chronic lymphocytic leukaemia

Neutrophils are low in

• viral infection
• Chemo/radiothx
• Clozapine
  
  • Carbimazole

Question 15

Causes of thrombocytosis and thrombocytopaenia:

Answer 15

Question 16

Causes of hyponatraemia

Answer 16

Question 17

Causes of abnormal potassium

Answer 17