PRESCRIPTION REVIEW

Question 1

When do you stop antiplatelets and anticoagulants?

Answer 1

If the patient is bleeding

Enzyme inducers such as erythromycin can increase warfarins effect

Question 2

Side-effects of steroids

Answer 2

STEROIDS:
stomach ulcers
thin skin
oedema
right and left heart failure
osteoporosis
infection (including candida)
diabetes (causes hyperglycaemia which leads to diabetes)
cushings Syndrome

Question 3

NSAID safety considerations

Answer 3

NSAID:
No urine (e.g. renal failure)
Systolic dysfunction (e.g. HF)
Asthma
Indigestion (any cause)
Dyscrasia (clotting abnormality)

Question 4

Side effects:
ACE-i
B-blocker
Calcium channel blocker
Diuretics

Answer 4

ACE-i - dry cough
B-blocker - wheeze in asthmatic and worsening HF
Calcium channel blocker - peripheral oedema and flushing
Diuretics - renal failure. thiazides (bendroflumethiazide) can cause gout and spironolactone can cause gynaecomastia

Question 5

Typical blood clot prophylaxis in hospital

Answer 5

LMWH (e.g. dalteparin 5000 units daily s/c) and compression stockings (unless PAD)

Question 6

What antiemetic do you give if the Pt is nauseated?

Answer 6

Cyclizine 50mg 8hour IM/IV/oral but can cause fluid retention

Metoclopramide 10mg 8 hourly IM/IV if HF (avoid metoclopramide)

Ondansetron 4mg or 8mg 8 hourly IV/oral

Question 7

What as-required antiemetic do you give if the patient is not nauseated?

Answer 7

Cyclizine 50mg up to 8 hourly IM/IV/oral for most cases but causes fluid retention

Metoclopramide 10mg up to 8hourly IM/IV if HF

Question 8

Analgesic choice:
No pain
Mild pain
Severe pain

Answer 8

No pain - paracetamol 1g up to 6 hourly oral

Mild -
regular paracetamol 1g 6 hourly PO
as required codeine 30mg up to 6h oral

Severe -
co-codamol 30/500, 2 tablets, 6 hourly
as required morphine sulphate (10mg/5ml) 10mg up to 6 hourly oral