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Prescribing Tips |BulgarianStudentSupportNetworkFeedback formtoreceiveacopyofthe powerpointandacertificate ofattendance.ABOUT OUR SPEAKER Dr.JamesMoore MUSgraduation-Jan2019 CurrentPost-IMT2 Deanery-EastofEnglandPaper vs Electronic Prescribing ● Trustspecific ● Electronicprescribing(EPMA) ○ variousprogrammes ○ mandatorytrainingforaccess ● PaperprescribingwithFP10 ● FluidsAllergies ● Wheretofindallergyinformation? ○ EPMA ○ summarycarerecord(SCR) ○ previousdischargeletters ○ Hxofpatient ○ collateralhistory ● Determinereactionseverity ● Allergymistakes ○ e.g.penicillamine Medication Reconciliation ● Supportedbypharmacists ● Sourcinginformation ○ patient ○ SCR ○ Previousdischargesummaries ○ collateralhistory ○ Admissionhistory ● OnEPMA ● Confirmallergies ○ doublecheckwithpatient ○ prescribeasappropriate Admission Medication ● Followingmedicationreconciliationprescriberegularmedicationsasappropriate ● Considersuspendingmedicationthatareinappropriatewhenpatientisacutely unwell-e.g.metformin,antihypertensivesand*doublingsteroids ● Consider: ○ renalfunction ○ Acidosis ○ BP ○ bleedingrisk-pendinginvestigations-eg.awaitingCThead?ICH ● Bewareoftimecriticalmedicationseg.Parkinson'smedicationandinsulin ● PrescribeadditionalmedicationforcurrentclinicalepisodeaspermanagementplanVTE Prophylaxis ● LMWH-prophylacticdosevs treatmentdose(considerweight) ● Considerexistinganticoagulation ● ConsiderINR-isbridgingtherapy appropriate? ● Dosemodificationbasedonrenal function ● Calculatebleedingvsthrombosisrisk PRN (pro re nata “as required”) ● Antiemetics ○ eg.cyclizine,metoclopramide,ondansetron ● Analgesia ○ eg.paracetamol(weightspecific),opioids-morphine,oxycodone ○ GTN ● Laxatives ● Adrenaline ○ e.g.ferrinject(ironinfusion) ● Inhalers ● Anxiolytics/Sedatives ○ lorazepam,promethazine ● Insomnia ○ zopiclone ● Anticipatorymedications Pain ● Painladder ● Paracetamol,NSAIDs,opioids, patches ● Paintype ○ eg.neuropathic-gabapentin, pregabalin,amitriptyline, duloxetine,NSAIDs ● PCAAntibiotics ● IVvsoral ● Includestopdatesandindication ● Trustguidelines-Microguide ● UTI-eg.uncomplicatedvscomplicated, recurrentorcatheterassociated ● CAPvHAP-consideratypicalcover, CURB65 ● Skinandsofttissuee.g.flucloxacillin ● IntraAbdominale.g.AMG ● Otherinfectionse.g.infective endocarditisAnticipatory Medications ● Considerrenalfunctionandtrust specificguidelines ● Secretions-e.g.hyoscine butylbromide ● Pain-e.g.morphine,oxycodone, alfentanil ● Agitation-e.g.midazolam ● N+V-e.g.haloperidol, levomepromazine ● CSCI-syringepump/driver ● Seek-specialistpalliativecare input Useful Resources ● BNFbookandapp ● Microguide ● Renaldrughandbook ● Toxbase ● BMJbestpractice ● MDcalc ● Pharmacistsandoncallpharmacists, specialtypainteam,palliativecare specialistteam,diabeticspecialist team,COPDspecialistteamand otherspecialtyreferrals.Q&A
