[REV] Prescription reviews

Question 1

Which drugs are enzymes inducers? (so need the other drug dose to be increased)

Answer 1

PC BRAS
Phenytoin
Carbamazepine
Barbituates
Rifampicin
Alcohol (chronic eccess)
Sulphonylurea

Question 2

Which drugs are enzymes inhibitors (so need lower other drug dose)

Answer 2

ZAG DEVICES

-zoles (omeprazole, ketoconazole, fluconazole)
allopurinol
grapefruit juice
disulfirm
erythromycin
valproate
isoniazd
ciproflox
ethanol
sulphnnamides, STATINS

Question 3

How long before surgery must you stop the COCP?

Answer 3

28 days

Question 4

How long before surgery must you stop lithium?

Answer 4

1 day before

Question 5

How long before surgery must you stop insulin?

Answer 5

0 - and replace with sliding scale

Question 6

How long before surgery must you stop anticoags / platelets ?

Answer 6

5 days before

Question 7

How long before surgery must you stop ACEi, ARB, K sparing?

Answer 7

0

Question 8

When and by how much do you change steroids during surgery?

Answer 8

ON the day of surgery

DOUBLE the steroid dose

Question 9

Which important class of drugs must you avoid giving to someone on an enzyme inhibitor?

Answer 9

Drugs that INCREASE BLEEDING (aspirin, heparin, wartfarin)

Question 10

When must you be cautious with NSAIDS?

Answer 10

NSAID

No urine
Systolic dysfunction
Asthma
Indigestion
Dyscrasia of blood (clotting abnormalitYy)

Question 11

Explain how you should prescribe beta blocker in the context of HF

Answer 11

NOT in acute HF (will worsen it)

YES in chronic HF

Question 12

What broad condition should you avoid diuretics in?

Answer 12

AVOID diuretics in RENAL FAILURE

Question 13

What can loop diuretics precipitate?

Answer 13

GOUT

Question 14

What can spironolactone cause?

Answer 14

Gynaecomastia

Replace with epleronone

Question 15

What is first line antiemetic in most cases?

Answer 15

Cyclizine

Question 16

Contraindication of cyclizine

Answer 16

NOT in HF (as may cause fluid retention)

Question 17

Contraindications of metoclopramide?

Answer 17

NOT in PARKINSONS (Da antagonist > use domperidone)

NOT in young women (risk of dyskinesia)

Question 18

Which antibiotic do you NEVER give warfarin with?

Answer 18

Erythromycin / clarythromycin

Question 19

What medication should you double in ill patients with adrenal insufficiency (Addison’s)?

Answer 19

DOUBLE the steroid

Question 20

CHECK - Antibiotics for neutropoenic sepsis?

Answer 20

Tazocin + gentamiciin

Question 21

Drug for arrythmia and hypotension

Answer 21

Digoxin

Question 22

What baseline blood do you need to do when starting statins?

Answer 22

RF: CK
No RF: ALT

Question 23

When must you check LFTs for statins?

Answer 23

At 3 months and 12 months

Question 24

What antibiotic must you stop statins for?

Answer 24

MACROLIDE (clarythromycin/erythromycin)

Question 25

When do you monitor lithium dose?

Answer 25

12 hours after last dose monitor WEEKLY until levels stable, then every THREE MONTHHS

Question 26

What must you monitor for OCP

Answer 26

Blood pressure monitoring (as it may cause sodium retenton)

Question 27

What must you check before prescribing antipsychotics and why?

Answer 27

ECG - only if RF of CVD

Question 28

What must you monitor when prescribing carbimazole?

Answer 28

FBC (neutrophils) - as it can cause neutropoenia

Question 29

What must you monitor for gentamicin?

Answer 29

UE (AS IT IS HIGHLY NEPHROTOXCIC) - measure pre-dose through and 1 hour peak + auditory monitoring and vestiibular monitoring

Question 30

What cardiac condition are ACEi contraindicated?

Answer 30

Aortic stenosis

Question 31

SE ACEi

Answer 31

Hyperkalaemia Hyponatraemia AKI Cough Angioedema

Question 32

What do you need to do for ACEi monitoring?

Answer 32

UE

Question 33

Digoxin monitoring

Answer 33

UE (min 6 hours post dose)

Question 34

How do you monitor clozpine?

Answer 34

every week for 18 weeks every 2 weeks up to 1year every 4 weeks thereafter

Question 35

How often is cyclizine given?

Answer 35

8 hourly (three times daily)

Question 36

Can pilocarpine be given to asthmatics?

Answer 36

Oral pilocarpine is contraindicated in patients with uncontrolled asthma. Topical pilocarpine is not contraindicated.

Question 37

Can timolol be given as acute angle-closure glaucoma treatment in asthmatics?

Answer 37

BNF advises caution due to the risk of bronchospasm