prescription review

Question 1

what drug to stop if patient has any signs of bleeding (haemoptysis)

Answer 1

anitplatelets - aspirin
LMWH - enoxaparin

Question 2

what to check for and stop if patient has high potassium

Answer 2

ace inhibitors - ramipril
any fluids containing K

Question 3

does co-amoxiclav contain penicillin

Answer 3

yes

Question 4

what to check for if prescribed paracetamol
what is max dose

Answer 4

that the dose and frequency is right
Max dose 4g

Question 5

what can increase warfarin’s effect

Answer 5

enzyme inhibitor e.g. erythromycin

Question 6

side effects of steroids

Answer 6

STEROIDS
- stomach ulcers
- thin skin
- oEdema
- right and left heart failure
- osteoporosis
- infection
- diabetes
- Cushing Syndrome

Question 7

safety consideration with NSAIDs

Answer 7

NSAID
- No urine (renal failure)
- Systolic dysfunction (heart failure)
- Asthma
- Indigestion
- Dyscrasia (clotting abnormality)

Question 8

what can worsen acute heart failure

Answer 8

beta blockers
- but they are helpful chronic heart failure

Question 9

side effects of calcium channel blockers, amlodipine

Answer 9

peripheral oedema
flushing

Question 10

side effects of thiazide diuretics, bendorflumethiazide

Answer 10

renal failure
gout

Question 11

side effect of spironolactone

Answer 11

gynaecomastia

Question 12

dose of cyclizine

Answer 12

50mg 8 hourly

Question 13

dose of metoclopramide

Answer 13

10mg 8 hourly

Question 14

what fluid is prescribed to all patients

Answer 14

0.9% saline (crystalloid)

Question 15

what fluid to give if hypernatraemic or hypoglycaemic

Answer 15

5% dextrose instead

Question 16

if a patient has ascites what fluid to give

Answer 16

human-albumin solution

Question 17

fluid to give if patient shock from bleeding but no blood available

Answer 17

crystalloid

Question 18

how much fluid to give if patient tachycardia or hypotensive

Answer 18

500mL bolus immediately

Question 19

how much fluid if someone is oliguric and not due to obstruction

Answer 19

1L over 2-4 hours and assess

Question 20

what is maximum rate of IV potassium

Answer 20

no more than 10mmol/hour

Question 21

do you continue anticoagulants if patient has had recent stroke

Answer 21

no

Question 22

when not to give metoclopramide

Answer 22

parkinson patient
young women

Question 23

what antiemetics to give if patient is nauseated

Answer 23

• cyclizine 50mg 8 hourly (doesn’t matter route)
• metoclopramide 10mg 8 hourly IM/IV if heart failure
• ondansetron 4mg or 8mg 8 hourly IV/oral

Question 24

when not to give cyclizine

Answer 24

cardiac cases as it worsens fluid retention

Question 25

what to prescribe for mild pain as required

Answer 25

codeine 30mg every 6 hours orally

Question 26

what to prescribe regularly for severe pain

Answer 26

co-codamol 30/500 6 hourly oral

Question 27

what to prescribe as required for severe pain

Answer 27

morphine sulphate 10mg/5mL 10mg up to 6 hourly oral

Question 28

what is first line for neuropathic pain

Answer 28

amitriptyline 10mg at night oral

Question 29

other drugs for neuropathic pain

Answer 29

pregabalin 75mg 12hourly oral OR duloxetine 60mg OD oral

Question 30

what is maximum dose of paracetamol for patient <50kg

Answer 30

500mg 6 hourly

Question 31

affect of ace inhibitor on potassium

Answer 31

increases causing hyperkalaemia

Question 32

what is neo-naclex

Answer 32

thiazide diuretic

Question 33

affect of thiazide diuretic on potassium

Answer 33

hypokalaemia

Question 34

if ramipril and ibuprofen prescribed together what is the risk

Answer 34

renal failure

Question 35

what drugs to stop if patient is taking methotrexate

Answer 35

- ibuprofen and other NSAIDs - trimethoprim - contraindicated in active infection

Question 36

what should not be given with beta blocker

Answer 36

calcium channel blocker e.g. verapamil, half securon SR

Question 37

what to be aware of if someone has asthma

Answer 37

beta blockers NSAIDs - ibuprofen, aspirin

Question 38

what is microgynon

Answer 38

COCP - not to be given if patient has migraine - check patient age if they are menopausal

Question 39

how is insulin administered

Answer 39

sub cut - never IV