Section 1 & 2 - Prescribing and Prescription Review

Question 1

PReSCRIBER

Answer 1

Patient Details - Name, DOB, Hospital #
Reaction - Allergies ?
Signing
Containdications
Route
IV Fluids
Blood Clot Prophlaxis - LMWH/Stockings
Anti-Emetics
Pain Relief

Question 2

Contraindications for Anticoagulants/Antiplatelets

Answer 2

• Active/Suspected Bleeding
• Risk of Bleeding
• Haemorrhagic Stroke
• Spinal Anaesthesia

(LMWH should be avoided in acute ischemic stroke)

Question 3

Contraindications for Steroids

(Remember STEROIDS for Side Effects and thus loosely CI’s)

Answer 3

Stomach Ulcers
Thin Skin
OEdema
R/LHF
Osteoporosis
Infection
Diabetes/Dyscrasia
Cushing’s Syndrome

Question 4

NSAID Safety Considerations

(“NSAID”)

Answer 4

No Urine (Renal Failure)
Systolic Dysfunction
Asthma
Indigestion
Dyscrasia

Question 5

Anti-Hypertensive Contraindications

Answer 5

Hypotension

Mechanistic Effects - B-Blockers & some CCBs cause bradycardia. ACEi & Diuretics cause electrolyte abnormalities.

Specific Adverse Effects:
* ACEi - Dry cough
* B-Blockers - Wheeze (Astham CI), worsened Acute HF.
* CCBs - Peripheral oedema & flushing.
* Diuretics - Renal failure, gout (Bendroflumethiazide), Spironolactone (Gynaecomastia)

Question 6

What changes to anti-emetic prescriptions should be made in vomiting patients?

Answer 6

PO antiemetics should be made IV

The dose of PO to parenteral antiemetics is the same (Cyclizine 50mg 8 Hourly, Metoclopramide 10mg 8 hourly)

Question 7

What fluid should be prescribed as replacement?

Answer 7

0.9% NaCl unless Hyponatraemic or Hypoglycemic (5% Dextrose).

Give Human Albumin Solution in cases of Ascites

Question 8

Fluid Prescription for Shocked Patients

Answer 8

500ml BOLUS (STAT < 15 mins)

250 ml in HF patients.

Question 9

Fluid Prescription for Oligouric patients

Answer 9

1L over 2-4 Hours (Reassess)

Question 10

How can the degree of Fluid Depletion be predicted?

Answer 10

• Reduced Urine Output - 500ml
• Reduced Urine Output + Tachycardia -1L
• Shock - >2L

Question 11

What fluid should be prescribed as maintanence?

Answer 11

3L a day (1 Salty, 2 Sweet):
* 1L of 0.9% NaCl
* 2L of 5% Dextrose
* +/- 40mmol KCl (20 mmol in 2 bags)

Question 12

TED Stockings CI

Answer 12

Peripheral Arterial Disease

Question 13

In which groups should Metoclopramide be avoided?

Answer 13

Metoclopramide (Dopamine Antagonist) - Avoid in Parkinson’s Disease and Young women due to risk of acute dystonia.

Question 14

Anti-Emetic Prescriptions

Answer 14

Nauseated Patients:
Cyclizine 8 Hourly IM/IV/Oral
Metoclopramide 10mg 8 Hourly IM/IV
Ondansetron 4mg IV or 8mg Oral [Caution]

Not-Nauseated:
PRN Cyclizine 50mg Up to 8 Hourly IM/IV/Oral
PRN Metoclopramide 10mg Up to 8 Hourly IM/IV

Question 15

Analgesic Prescribing

Answer 15

No Pain:
* Regular - Nil
* PRN - Paracetamol 1g Up to 6 Hourly PO

Mild Pain:
* Regular - Paracetamol 1g QDS
* PRN - Codeine 30mg Up to 6 Hourly PO

Severe Pain:
* Regular - Co-codamol 30/500 2 Tablets 6 Hourly PO
* PRN - Morphine Sulphate - 10mg/5ml 10mg Up to 6 Hourly PO