Prescription Review

Question 1

PReSCRIBER - safe routine for prescribing

Answer 1

Patient identifiers x3
Reactions  (ie. allergy plus rtn)
Sign the chart
CI
Route
IV fluids
Blood clot prophylaxis
antiEmetic
pain Relief

Question 2

what do co-amoxiclav and tazocin both contiain

Answer 2

PENICILLIN

Question 3

Common CI for drugs that INCR bleeding

Answer 3

pt who are bleeding, or at risk of bleeding (prolonged PT due to liver disease)

• prophylactin heparin is not used in acute ischaemic stroke due to risk of HAEMORRHAGIC TRANSFORMATION = bleeding into the stroke
• enzyme inhibitors eg erythromycin can increase warfarins effect

Question 4

steroid side effects mnemonic = STEROIDS

Answer 4

Stomach ulcers
Thin skin
oEdema
Right + left HF
Osteoporosis
Infection (incl candida)
Diabetes (commonly --> hypergylcaemia and uncommonly --> diabetes)
cushings Syndrome

Question 5

NSAIDs safety considerations with mnemonic NSAIDs

Answer 5

No urine (renal failure)
Systolic dysfunction (ie.HF)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)

Question 6

Antihypertensives SE

Answer 6

Hypotension
Bradycardia (BB, CCBs)
Electrolyte disturbances (ACEi, Diuretics)

Question 7

Individual SE of antihypertensives:

• ACEi
• BB
• CCBs
• Diuretics

Answer 7

• ACEi: dry cough (due to accumulation of bradykinin from via reduced degradation by ACE)
• BB: asthmatic wheeze, WORSEN ACUTE HF (helps chronic)
• CCBs: peripheral oedema, flushing
• Diuretics: Renal Failure, gout (loop or thiazide diuretics), gynaecomastia (spironolactone)

Question 8

Anti-emetics for nauseated pts 1st line + 2nd line

Answer 8

1. CYCLIZINE - 50mg 8 hourly, IM/IV/Oral

2. METOCLOPRAMIDE - 10mg 8 hourly, IM/IV/Oral

Question 9

in what 2 categories of pts do you avoid metoclopramide (dopamine ANTAgonist)

Answer 9

PD - worsens PD - lowers DA so instead use domperidone (won’t cross BBB)
Young women - risk of dyskinea (acute dystonia)

Question 10

Anti-emetics for NOT nauseated pts

Answer 10

Cyclizine 50mg 8 hourly - for ALL except CARDIAC cases (–> fluid retention)
Metoclopramide 10mg 8 hourly in HF

Question 11

Blood clot prophylaxis for most ppl + when NOT to

Answer 11

LMWH + compression stockings

-NOT if at risk of bleeding/recent ischaemic stroke<2m/ if pt has PAD (absent foot pulses)

Question 12

what to do with beta blocker in acute hF

Answer 12

STOP IT

Question 13

which diuretics INCREASE potassium vs DECREASE potassium

Answer 13

THIAZIDE diuretic - incr excretion via Kidneys –> LOW K+
LOOP diuretic - LOW K+

ACEi - INCR K+
K+ sparing diuretic - INCR K+

Question 14

how do NSAIDs cause indigestion

Answer 14

inhibit PG SYNTHESIS needed for gastric mucosal protection from acid

Question 15

how do Steroids cause indigestion

Answer 15

inhibit GASTRIC EPITHELIAL RENEWAL thus predisposing to ulceration

Question 16

oxybutynin antimuscarinic drug effects in OD + in elderly

Answer 16

precipitate acute confusion in elderly
pupil dilation 
loss of accomodation
dry mouth 
tachycardia

Question 17

NSAIDs + methotrexate caution

Answer 17

incr risk nephrotoxicity

Question 18

Trimethoprim + methotrexate CI

Answer 18

both folate ANTAGONISTS –> BM toxicity, pancytopaenia, neutropenic sepsis

Question 19

Active Infection + methotrexate what to do

Answer 19

M CI in active infection + should be withheld

-long half life so missing a dose won’t affect RhA

Question 20

should pts with INR>2 on warfarin also be given prophylactic blood thinning LMWH

Answer 20

NO - incr risk of bleeding

Question 21

can aspirin be used if asthmatic

Answer 21

NSAIDs - except aspirin should be avoided in asthamtics due to risk of bronchospasm
-similarlyl for Beta blockers