Y3 - Safe prescribing Flashcards
(46 cards)
What key investigation should be done in an child with unexplained fever over 38 degrees
URINE sample within 24 hours
Send for microscopy and culture
When taking a paediatric medication history, what is it important to ask about?
- Birth weight
- drug allergies
- use of inhalers or creams
- any over the counter medication use
- patient tablet or liquid preference
- breast or bottle bed
- is mother on any medication if patient breast fed
E.coli is a …
Gram negative rod shaped bacteria
What routine advice should be give to parents of children who develop urinary tract infections to prevent reoccurence?
- Toilet hygiene: wipe front to back
- keep well hydrated
- do not delay toilet and hold urine in
- wear loose underwear
Information from a paediatric history which may suggest constipation?
- decreased stool frequency
- pain on defaecation
- recent change in diet
- overflow soiling mistaken for diarrhoea
Main difference between adult and paediatric management of constipation?
dietary interventions should not be used alone as 1st line tx, unlike in adults
Combination tx w/
–> laxatives
–> toilet schedules
–> dietary modification (fluid and adequate fibre)
–> encourage physical activity
Recommended fibre intake for adults suffering with constipation
30g per day
If a patient is taking liquid preparations in mls, what is important to consider when writing their prescription chart :
PRESCRIBE IN mg
Need to work out dose in Mg
What important information should you give the parents of a patient who has just started a disimpaction and maintenance regime for constipation?
- open sachets and pour into water, stir until dissolves
- can add squash to make it taste nicer
- can be given at any time of the day: start in the morning so full dose can be given within 12 hours
- don’t have to drink it all in one go
- but must drink it all to have clinical development
- may not work immediately
- Diet and lifestyle: fluid intake, adequate fibre and exercise
- follow up with GP or outpatient services
Side effects of constipation treatment in kids
- stomach pains
- dehydration
- nausea
Important to keep patient well hydrated
Contraindications for the COCP
- history of breast cancer (can be used after 5 years if no evidence and non-hormonal methods unacceptable)
- migraine with aura
- personal PMHx venous or arterial thrombosis
- severe or multiple risk factors for arterial disease OR VTE
- transient cerebral ischaemic attacks without headaches
Combined oral contraceptive pill’s should be avoided in patients who have two of the following critiera:
- obesity (BMI > 30)
- SMOKING
- Diabetes mellitus
- FHx of arterial disease in 1st degree relative aged under 45
- HTN –> blood pressure above 140 systolic or 90 diastolic
- migraine without aura
Important questions to ask patient before starting contraceptoin?
Is she already using contraception?
Has she had emergency hormonal contraception?
Recently given birth?
Has she had a miscarriage or termination?
Does she normally have a regular cycle?
LMP?
Why is it important to ask a patient when they had their last menstrual period when considering starting the progestogen only pill?
POP
1. Can be started day 1-5 of menstrual cycle without needing any additional protection
- If at any point in the cycle
–> pregnancy test first
–> start POP BUT patient needs to use additional barrier methods for the next 48 hours
Starting POP on days 5-28 is OFF LABEL USE
Progesterone only Pill COUNSELLING
MODE OF ACTION
MODE OF ACTION
- suppresses ovulation
- increases hostile cervical mucus
- reduction in activity of cilia in the fallopian tube
Progesterone only Pill COUNSELLING
Advantages
- very effective when taken correctly
- sex doesn’t need to be interrupted
- can be used in women where COC not suitable
- may reduce risk of endometrial cancer
- Desogestrel may help manage dysmenorrhoea
- fertility returns to normal when POP stopped
Progesterone only Pill COUNSELLING
Disadvantages
- pills must be taken same time each day
—–> 3 hour window
—–> 12 hour window for desogestrel - Adverse effects
- unscheduled bleeding
- breast tenderness - Doesn’t protect against STI
- Ovarian cyst
- Headache
- Libido changes
- Cardiovascular disease –> MI, VTE, STROKE
If a women vomits within how many hours of taking an oral contraceptive, should she take another on:
If vomits within 2 hrs of taking pill - another one should be taken
If D&V > 24hrs
- avoid sex or use barrier methods during illness and for 48hrs after
Missed pill advice for POP
If missed POP
- take asap
- then next pill at normal time
- may mean taking 2 pills in 24 hrs
IF UPSI after missed pill and within 48hrs of restarting POP
–> consider emergency contraception
Important additional supplement a women may take during pregnancy
FOLIC ACID 400 micrograms daily up until 12th week of pregnancy
—> reduce risk of neural tube defects
Women who are at higher risk : take 5mg daily until week 12
—> previous spina bifida in pregnancy
—> epilepsy medication?
—> coeliac or malabsorption issues, DM
—> BMI of 30 of more
—> sickle cell, thalassaemia or thalassaemia trait
1st line RCOG guidance for nausea and vomiting in pregnancy
1st line –> CYCLIZINE or PROCHLORPERAZINE
CAUTION
- prochlorperazine in young women due to risk of dystonia
2nd line –> domperidone , metoclopramide
Ondansetron
–> beware concern about cardiac and renal malformations
Treatment of DVT in pregnancy
LMWH –> like enoxaparin SC
–> continue for remainder of pregnancy
–> and at least 6 weeks post natal
What would be the drug of choice is a patient with gestational diabetes had high blood sugars despite treatment with metformin
INSULIN
NICE guidelines for gestational diabetes
Fasting plasma glucose below 7mmol/L
–> diet and exercise trial
If targets not met within 1-2 weeks
—> metformin
Only give insulin if:
—> metformin contraindicated or unacceptable to women
