Prescribing Flashcards

Question

What drugs are measured in 100s mg-grams?

Answer 1

Some antibiotics, metformin, some anti-epileptics?

Answer 2

Paracetamol, calcium carbonate, N-acetylcysteine

Answer 3

Parkinson's disease Anticholinesterases for myaseathenia graves Diuretics

Answer 4

Night sedation | Statins

Answer 5

Bisphosphonates | Antacids

Answer 6

Hypoglycaemics | Pancreatic enzymes

Answer 7

Patches Bisphosphonates Methotrexate/folic acid

Answer 8

``` NSAIDs and COX2 inhibitors Midodrine Pioglitazone Moxonidine Verapamil Several immunosuppressive monoclonal antibodies ```

Answer 9

Diuretics Pyrazinamide Allopurinol and febuxosin in aute gout

Answer 10

QT prolongation

Answer 11

Beta blockers Lithium salts Chloroquine

Answer 12

Tetracyclines Macrolides Quinolones Sedating medications (Z-drugs, benzodiazepines, antipsychotics, opiates) Local anaesthetics (particularly nerve blocks) Beta Blockers

Answer 13

``` Diuretics IV antifungals Cisplatin Steroids Beta-2-agonists Rarely Gentamicin ```

Answer 14

``` ACEi, ARB Spiro/eplerenone/amiloride Heparin and LMWH Tolvaptam Co-trimoxazole ```

Answer 15

``` Thiazide and loop diuretics PPIs Calcium resonium Ciclosporin IV bisphosponates IV antifungals IV aminoglycosides ```

Answer 16

Insulin Sulphonylureas Other anti-diabetic drugs still have the risk but lower apart from metformin

Answer 17

``` Steroids Antipsychotics Thiazide diuretics Beta blockers Tacrolimus ```

Answer 18

``` Systemic steroids Diuretics (thiazide and loop) Antipsychotics Ciclosporin Most HIV meds SGLT2 inhibitors (-flozins) ```

Answer 19

``` NSAIDs Glucocorticoids Mineralocorticoids COCP Mirabegron Clozapine Venlafaxine/triyclic antidepressants Monoamine oxidase inhibitors Selegeline Ciclosporin and Tacrolimus ```

Answer 20

``` Benzodiazepines, Z-drugs Antidepressants MAO inhibitors Antipsychotics Opiates Most antihypertensives (especially alpha blockers, diuretics) Anti-parkinsons meds ```

Answer 21

Steroids PPIs at high doses especially in elderly over long courses Long-term androgen suppression

Answer 22

``` Oxybutinin Atropine Procyclidine Glycopyrroinium Opioids Benzodiazepines Inhalation anaesthesia Antihistamines Antidepressants ```

Answer 23

``` Alpha blockers Diuretics ACEi Clozapine Bromocriptine Benzodiazepines Pregabalin ```

Answer 24

``` Opioids Oral iron Some calcium channel blockers Anti-psychotics Some diuretics Antacids Anti-muscarinics Ondansetron Some anti-parkinsons and some anti-epileptics ```

Answer 25

``` Laxatives Antibiotics Some antacids Orlistat Cholinesterase inhibitors (rivastigmine) Colchicine ```

Answer 26

``` Blood dyscrasias / agranulocytosis QT prolongation, arrythmias Worsening diabetes Worsening Parkinson’s disease Neuroleptic malignant syndrome ```

Answer 27

Drowsiness, constipation, urinary retention, dry mouth, hypotension Weight gain Galactorrhoea, gynaecomastia, sexual dysfunction

Answer 28

FBCs, U+Es, LFTs, lipids, blood glucose, blood pressure Prolactin Physical health (and cardiovascular risk) monitoring, QTc monitoring

Answer 29

Isotretinoin Doxycycline (and other tetracyclines) Amiodarone

Answer 30

``` Metformin (not insulin!) ACEi / ARBs / diuretics NSAIDs (“DAMN” medications) Restart when you are well (after 24-48 hours of eating and drinking normally) ```

Answer 31

``` Never omit insulin (may need increased – local guidance usually provided) Maintain adequate (sugar-free) fluid intake Maintain regular carbohydrate intake – if unable to take solids, in liquid carbohydrate format ``` Consider anti-emetic if nauseated Consider oral electrolyte replacement in diarrhoea If prolonged inability to keep down fluids (e.g. >4hrs), then likely needs hospital admission Increased blood glucose monitoring (e.g. 4hr-ly, and even more frequently if >moderate ketones) Ketone testing 2-4 hrly If persistently elevated, or elevated while low blood glucose – may need hospital admission Diabetic specialist nurse should provide individualised plan

Answer 32

Continue with medication as normal (except metformin if prolonged D/V) Encourage adequate fluid and diet intake Consider providing an oral electrolyte replacement

Answer 33

Minimum of daily self-blood glucose monitoring Advice should be provided regarding the increased risk of hypoglycaemia and reinforce the importance of taking some form of regular carbohydrate Seek advice if blood glucose persistently elevated (e.g. > 17)

Answer 34

Do not stop steroids abruptly Usually taken in morning (reduce nocturnal side effects) Taken with or just after food Should carry steroid card

Answer 35

Under treatment summary surgery and long term medication | more specific 'diabetes, surgery and medical illness' and 'contraceptives, hormonal'

Answer 36

``` Undiagnosed vaginal bleeding Severe liver disease Pregnancy Coronary artery disease Endometrial cancer Recent DVT or stroke ```

Answer 37

Migraine headaches Personal history of breast cancer Personal history of ovarian cancer Venous thrombosis History of uterine fibroids Atypical ductal hyperplasia of the breast Active gallbladder disease (cholangitis, cholecystitis)

Answer 38

Ethinylestradiol with desogestrel

Answer 39

Levonorgestrel

Answer 40

Methotrexate Cyclophosphamide and many other strong immunosuppressants Some chemotherapy (Some antifungals and some antivirals)

Answer 41

Risk of hypoglycaemia Rotate sites of injection Not to massage sites of injection

Answer 42

Should be stopped if continued diarrhoea or vomiting GI side-effects are common and diarrhoea is usually transient Seek immediate medical attention if symptoms such as dyspnoea, muscle cramps, abdominal pain, hypothermia, or asthenia occur (lactic acidosis) GI side-effects can be helped by taking with or just after food

Answer 43

Risk of hypoglycaemia | Can encourage weight gain

Answer 44

Advised to report symptoms of volume depletion including postural hypotension and dizziness Patients should be informed of the signs and symptoms of diabetic ketoacidosis Should be stopped if hospitalised for major surgery or acute serious illnesses Hypoglycaemia risk especially if co-prescribed with sulfonylurea of insulin)

Answer 45

Advice on how to recognise signs of blood, liver, or skin disorders (e.g. fever, rash, mouth ulcers, bruising, or bleeding) and advised to seek immediate medical attention

Answer 46

*Highly teratogenic* - contraindicated in women and girls of childbearing potential unless conditions of Pregnancy Prevention Programme are met Advice on how to recognise signs of liver dysfunction or pancreatitis (e.g. persistent vomiting and abdominal pain, anorexia, jaundice) and advised to seek immediate medical attention

Answer 47

Advice to see their doctor immediately if rash or symptoms of hypersensitivity (risk of Stevens-Johnson syndrome / toxic epidermal necrolysis) Advice on how to recognise signs of bone marrow suppression - anaemia, bruising, or infection.

Answer 48

Treatment summaries Poisoning, emergency treatment

Answer 49

Treatment summaries  Oral anticoagulant

Answer 50

Treatment summaries  Poisoning, emergency treatment

Answer 51

>40% reduction - continue dose | <40% reduction - consider increasing dose (discuss adherence/lifestyle)

Answer 52

Start high-intensity statin (e.g. atorvastatin 80mg on) and continue as tolerated

Answer 53

If between 1x and 5x upper limit of normal - Continue statin, but regular CK monitoring - stop statin if muscle symptoms OR rising CK levels If >5x upper limit of normal - stop statin

Answer 54

If between 1x and 3x upper limit of normal - Continue the statin but recheck LFTs within 4–6 weeks to exclude further increases in transaminase levels - no extra monitoring is required if values are stable. If >3x upper limit of normal - Stop the statin and recheck LFTs within 4–6 weeks to ensure that values settle (consider re-introducing the statin cautiously at a later date), OR reduce the statin dose (if the person is taking a high dose) and recheck LFTs within 4–6 weeks, OR change to a statin in a lower intensity group (for example change to a medium-intensity statin if the person is taking a high-intensity statin) and recheck LFTs within 4–6 weeks. If transaminase levels continue to be three times the upper limit of normal or more, stop the statin and seek specialist advice (for example from a lipid clinic).

Answer 55

Typically adjustments by 10% of dose (varies with experience), e.g. Reducing from 24 units  new dose 22 units Increasing from 16 units  new dose 18 units

Answer 56

Anti-Factor Xa activity. Not routine But may be necessary in patients at increased risk of bleeding / difficult dosing (e.g. in renal impairment and those who are underweight or overweight, pregnancy) NOTE: will need to monitor platelets (for heparin-induced thrombocytopenia)

Answer 57

aPTT (activated partial thromboplastin time) monitored regularly during infusion

Answer 58

0.9% Sodium chloride, 500 ml in 10 minutes | NO potassium

Answer 59

20% Glucose, 50 ml in less than 5 minutes | NO potassium

Answer 60

0.9% Sodium chloride, 1000 ml in 2-4 hours | NO potassium

Answer 61

0.9% sodium chloride with 20 mmol KCl, 1000ml over 8-12 hours 5% glucose with 20 mmol KCl, 1000ml over 8-12 hours

Answer 62

Are there any contraindications in the PMH? Does the DH result in any interactions? Are there any patient preferences in the scenario? Are there any investigation results that influences the selection/dosing? Does patient characteristics (e.g. age, weight) influence your choice?

Answer 63

Which antibiotic is the organism sensitive to? Is there an antibiotic allergy? Choose oral vs intravenous Renal (and liver) function Check past medical history – any other contraindications

Answer 64

Is there indication for intravenous route (e.g. severe infection)? Can/will the patient take oral medications? Is there vomiting or severe confusion declining oral medications?

Prescribing Flashcards

(89 cards)