Psc Flashcards
(79 cards)
What are 10 basic principles of prescribing?
- Legible
- Unambiguous(state dose clearly)
- In Capital letters
- Without abbreviations
- Signed
- If ‘as required’ give 1)indication 2)maximum frewuency or total dose
- If antibiotic then give 1)indicatio n2) stop/review date
8) include duration of treatment if not long term
Which enzyme metabolises drugs into inactive metabolites? and where?
Cytochrome p450
in the liver
What do enzyme inducers do and what does this mean?
Enzyme inducers increase activity of enzyme and so quickens metabolism of the drug and thus creates a reduced effect. (More of the drug may be required)
What do enzyme inhibitors do and what does this mean?
decrease p450 enzyme activity and so less drug metabolism and so increased level of other drugs in the body. (YOU NEED TO BE CAREFUL WITH THESE)
Name enzyme inducers
PC BRAS:
- Phenytoin
- Carbamazepine
- Barbiturates
- Rifampicin
- Alcohol (chronic excess)
- Sulphonylureas
Name enzyme inhibitors
AODEVICES:
- Allopurinol
- Omeprazol
- Disulfiram
- Erythromycin
- Valproate
- Isoniazid
- Ciprofloxacin
- Ethanol (acute intoxication)
- Sulphonamides
What happens when you give Warfarin with erythromycin
Erythromycin is an enzyme inhibitor and will cause an unpredictable rise in INR!
Why are some drugs continued during surgery?
The risk of losing disease control outweighs risk of drug continuation
Which drugs are continued during surgery?
- Steroids
- Beta-blockers
- Calcium channel blockers
Patient on long-term corticosteroids present with hypotension after surgery. Why is this?
Patients on long term corticosteroids will have adrenal atrophy and therefore are unable to produce a physiological ‘stress’ response after surgery. They will present with hypotension
How are steroids given for surgery?
IV pre-surgery during induction of anaesthesia
Which drugs must be stopped before surgery?
ILACKOP
- Insulin
- Lithium
- antiplatelets/anticoagulants
- COCP/HRT
- K-sparing diuretics
- Oral hypoglycaemics
- Perindopril and ACE-inhibiotrs
When must you stop COCP/HRT before surgery?
4 weeks before
When must you stop lithium before surgery?
Day before
When must you stop K-sparing diuretics
Day of surgery
When must you stop anticogulants, warfarin, heparin
antiplatelts, aspirin, clopidogrel, dipyridamole?
Variable
When must you stop insulin and oral hypoglycaemics?
Variable.
As patients are nil by mouth before surgery insulin and OHG will cause lactic acidosis. tO AVOID THIS insulin should be adjusted on a sliding scale to achieve tight control
What is the safe prescribing mnemonic?
PReSCRIBER P-patient details Re- Reactions and ALLERGIES! S-sign chart C-contraindications of each drug R-route I- IV fluid (consider need) B- Blood clot prophylaxis (if needed) E- Anti-emetic (if needed) R- Pain Relief (if needed)
What do you do for patient details when using a new chart?
Write 3 pieces of info:
Name, DOB, hospital number
What do you do for patient details when amending a current chart?
Check patient details are correct
What do you do about reactions and allergies when using a new chart?
Fill in allergies section of chart and write out reactions if patient has mentioned them.
What do you do about reactions and allergies when amending a current chart?
Check details
What must you remember about Tocazin and Co-amoxiclav?
They both have PENICILLIN
List 2 anticoagulants and 1 anti platelet that increase bleeding
- Warfarin
- Heparin
- Aspirin
