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PSAsession 4;Calculations and Data Interpretation 25/1/25 Dr KathDr Yi Tao Simolme Number of Recommended Section Questions Marks per Question Overall Timing Prescribing 8 10 45-50 mins Prescription Review 8 4 20 mins Planning Management 8 2 8 mins Providing Information 6 2 6 mins Calculation Skills 8 2 10 mins Adverse Drug Reactions 8 2 8 mins 8 2 Drug Monitoring 8 mins Data Interpretation 6 2 6 minsLearning objectives Calculations ● Basic drug dosage calculations ● Fluids and paediatric fluids calculations ● Infusion rates ● Opiate prescribing Data Interpretation: ● Insulin ● Blood work; lipids, HbA1c, TFTs etc ● Gentamicin ● INR ● How to use medicines complete to guide medication adjustmentCalculationsCalculations ● 8 questions ● 2 marks per question Shorter section - generally straightforward fluids/drug calculations. Commonly tested areas include paediatric fluid calculations, infusion rates and opiate breakthrough dosages.QuestionsAndAnswerswith ExplanationA 70 kg patient is being prescribed Amlodipine, a calcium channel blocker, for A 30mg hypertension. The prescribing instructions B 35mg state to administer Amlodipine at 0.5 mg/kg once daily. What is the correct dose of C 40mg Amlodipine to be administered to the patient? D 45mg E 50mgA 70 kg patient is being prescribed Amlodipine, a calcium channel blocker, for A 30mg hypertension. The prescribing instructions B 35mg state to administer Amlodipine at 0.5 mg/kg once daily. What is the correct dose of C 40mg Amlodipine to be administered to the patient? D 45mg E 50mgExplanation The dose is prescribed based on weight (0.5 mg per kg). To calculate the dose: 0.5 mg/kg×70 kg=35 mg0.5mg/kg×70kg=35mg Therefore, the correct dose of Amlodipine is 35 mg.A 10-year-old child weighing 30 kg is admitted A 1350mls to hospital. You assess their fluid status and find them to be euvolemic. Using the 4-2-1 rule, calculate their total daily fluid requirement. B 1440mls ● 4 mL/kg/hr for the first 10 kg of body C 1680mls weight ● 2 mL/kg/hr for the next 10 kg of body D 1730mls weight ● 1 mL/kg/hr for the remaining body weight E 2000mls over 20 kg How much fluid should be administered over the first 24 hours?A 10-year-old child weighing 30 kg is admitted A 1350mls to hospital. You assess their fluid status and find them to be euvolemic. Using the 4-2-1 rule, calculate their total daily fluid requirement. B 1440mls ● 4 mL/kg/hr for the first 10 kg of body C 1680mls weight ● 2 mL/kg/hr for the next 10 kg of body D 1730mls weight ● 1 mL/kg/hr for the remaining body weight E 2000mls over 20 kg How much fluid should be administered over the first 24 hours?Explanation The 4-2-1 rule is a simple formula for calculating the amount of intravenous fluid required for children based on their weight. This is an important and commonly tested fact in the PSA! For maintenance fluid calculations the 4-2-1 rule can be applied. ● First 10 kg: 4 mL/kg×10 kg=40 mL/hr ● Next 10 kg: 2 mL/kg×10 kg=20 mL/hr ● Remaining 10 kg (30kg - 20 kg): 1 mL/kg×10kg= 10ml/hr Now, add all three components: 40 mL+20 mL+10 mL=70ml/hr 70mls x 24 hrs = 1680mls Thus, the total fluid to be administered in 24hrs is 1680 mL.Explanation If the child is dehydrated/shocked, we assume 10% dehydration based on body weight. Therefore, to calculate the total 24-hour fluid requirements we would use the following two formulae: ● Fluid deficit (mL) = 10% dehydration x weight (kg) x 10 ● Total fluid requirement (mL) = maintenance fluids (mL) + fluid deficit (mL) So in this example, if the child was shocked: Fluid deficit (mL) = 10 x 30 x 10 =3000mls Total fluid requirement = 1680 + 3000 = 4680mlsA 70 kg patient is prescribed Vancomycin for a severe infection. The dosing guideline for A 2000mg Vancomycin recommends an initial loading doseB 2500mg of 25 mg/kg followed by 15 mg/kg every 12 hours as a maintenance dose. C 3650mg The patient has normal renal function. D 3850mg What is the total amount of Vancomycin the patient will receive in the first 24 hours, including both the loading and maintenance E 4250mg doses?A 70 kg patient is prescribed Vancomycin for a severe infection. The dosing guideline for A 2000mg Vancomycin recommends an initial loading doseB 2500mg of 25 mg/kg followed by 15 mg/kg every 12 hours as a maintenance dose. C 3650mg The patient has normal renal function. D 3850mg What is the total amount of Vancomycin the patient will receive in the first 24 hours, including both the loading and maintenance E 4250mg doses?Explanation 1. Loading dose: The patient weighs 70 kg, and the initial loading dose is 25 mg per kg. 25 mg/kg × 70 kg = 1750 mg 2. Maintenance dose: After the loading dose, the maintenance dose is 15 mg per kg, to be given every 12 hours. 15 mg/kg×70 kg=1050 mg per dose Since the maintenance dose is given twice in 24 hours, the total maintenance dose is: 1050 mg × 2 = 2100 mg 3. Total dose in 24 hours: 1750 mg (loading)+ 2100 mg (maintenance) = 3850mg Thus, the total Vancomycin dose the patient will receive in the first 24 hours is 3850mgA patient is receiving Furosemide A 20mg intravenously for acute pulmonary edema. The IV dose prescribed is 40 mg. The doctor B 60mg decides to switch the patient to oral Furosemide, and the recommended C 80mg conversion is that oral Furosemide is absorbed at 50% bioavailability compared to D 120mg the IV dose. E 160mg What is the equivalent oral dose of Furosemide for this patient?A patient is receiving Furosemide A 20mg intravenously for acute pulmonary edema. The IV dose prescribed is 40 mg. The doctor B 60mg decides to switch the patient to oral Furosemide, and the recommended C 80mg conversion is that oral Furosemide is absorbed at 50% bioavailability compared to D 120mg the IV dose. E 160mg What is the equivalent oral dose of Furosemide for this patient?Explanation The patient is currently receiving 40 mg IV. Oral Furosemide has 50% bioavailability, so the oral dose needs to be twice the IV dose: 40 mg × 2=80 mg Thus, the equivalent oral dose is 80 mg.A 70-year-old patient with advanced cancer is prescribed a continuous morphine sulfate A 10mg infusion at a rate of 30 mg/hour for pain B 20mg management. The patient reports experiencing breakthrough pain. Guidelines recommend that C 60mg breakthrough doses should be 1/6th of the total daily dose of the regular opioid regimen. D 120mg What dose of morphine sulfate should be prescribed for each breakthrough pain episode? 360mgA 70-year-old patient with advanced cancer is prescribed a continuous morphine sulfate A 10mg infusion at a rate of 30 mg/hour for pain B 20mg management. The patient reports experiencing breakthrough pain. Guidelines recommend that C 60mg breakthrough doses should be 1/6th of the total daily dose of the regular opioid regimen. D 120mg What dose of morphine sulfate should be prescribed for each breakthrough pain episode? 360mgExplanation Step 1: Calculate the total daily dose of morphine sulfate The patient is receiving a continuous infusion of 30 mg/hour. To calculate the total daily dose: Total daily dose = 30mg/hour x 24 hrs = 720mg Step 2: Determine the breakthrough dose Breakthrough doses of opioids are typically calculated as 1/6th of the total daily dose of the opioid. Breakthrough dose = 720mg/6 = 120mg Step 3: Confirm the appropriate dose The correct dose to prescribe for each breakthrough pain episode is 120 mg. It’s worth noting that high breakthrough doses and opiate prescriptions are common in palliative care. On a regular medical ward it’s extremely unlikely that a prescription so high would be correct - so would be worth double checking if it was!Data InterpretationData Interpretation ● 12 marks ● 6 questions x 2 marks Clinical scenarios where you have to make the decision! ● Stop a drug ● Increase dose ● Decrease dose ● Start a new drug ● Prescribe a drug together with existing ones ● NothingQuestionsAndAnswerswith ExplanationA 68 year old woman is attending a GP follow up appointment to review blood results. She reports no symptoms since her Aast Increase to Amlodipine 10 mg OD review appointment. PMHx: Hypertension B Add Atorvastatin 20 mg OD Dx: Amlodipine 5 mg OD Sx: Smokes 12 cigarettes a day. Mainly sedentary lifestyle Add Atorvastatin 80 mg OD FHx: Unstable Angina on Paternal side D Add Atorvastatin 10 mg OD Ix: ● BMI: 36.7 ● BP 132/74 E Add Ezetimibe 10 mg OD ● Qrisk: 21.2% (<10%) ● Total Cholesterol 15.2 ● HDL 2.1 ● LDL 7.2 ● Triglycerides 10.8 Select the most appropriate decision in regards to the aboveAtorvastatin andQRISK A 68 year old woman is attending a GP follow up appointmAnt to Increase to Amlodipine 10 mg OD review blood results. She reports no symptoms since her last review appointment. B Add Atorvastatin 20 mg OD PMHx: Hypertension Dx: Amlodipine 5 mg OD C Add Atorvastatin 80 mg OD Sx: Smokes 12 cigarettes a day. Mainly sedentary lifestyle FHx: Unstable Angina on Paternal side D Add Atorvastatin 10 mg OD Ix: ● BMI: 36.7 E Add Ezetimibe 10 mg OD ● BP 132/74 ● Qrisk: 21.2% (<10%) ● Total Cholesterol 15.2 (<5.0) ● HDL 2.1 (>1.0) ● LDL 7.2 (<3.0) ● Triglycerides 10.8 (<1.7) Select the most appropriate decision in regards to the aboveA 26 year old man presents attends his GP appointment for lack of energy and intolerance to cold despite being Summer. A Levothyroxine 25 micrograms OD PMHx Acne Vulgaris, Hypothyroidism Dx Levothyroxine 75 micrograms OD B Levothyroxine 75 micrograms OD He takes his medications one time C Levothyroxine 125 micrograms OD regularly. He has NKDA. D Levothyroxine 150 micrograms OD Ix: ● TSH 8.3 (0.4-5.0) E Levothyroxine 50 micrograms OD ● T4 7.9 (10.0-22.0) Select the most appropriate decision in regards to the aboveLevothyroxine A 26 year old man presents attends his GP appointment for lack of energy and intolerance to cold despite being A Levothyroxine 125 micrograms OD Summer. PMHx Acne Vulgaris, Hypothyroidism B Levothyroxine 75 micrograms OD Dx Levothyroxine 75 micrograms OD C Levothyroxine 100 micrograms OD He takes his medications one time regularly. He has NKDA. D Levothyroxine 150 micrograms OD Ix: E Levothyroxine 50 micrograms OD ● TSH 8.3 (0.4-5.0) ● T4 7.9 (10.0-22.0) regards to the aboveopriate decision in pH 7.42 (7.35-7.45) pCO2 4.9 (4.7-6) A 50 year old man who was referred to Gastroenterology12.8 (11-13) for a progressive distended abdomen (confirmed to beCO3– 22.9 (22 – 26) Ascites on CTAP) has mentioned during the ward roundse Excess (BE) -0.8 (-2 to +2) that he has started to get palpitations in his cheNa+ 137 (135-145) PMHx Liver Cirrhosis secondary to ETOH, HTN, Bilateral.6 (3.5-5) Cataracts, B12 deficiency, Essential Tremors Ca2+ 2.3 (2.2 to 2.6) Cl- 100 (95-108) Dx: Started PO 200 mg Spironolactone on admission, Amlodipine 5 mg OD, Cyanocobalamin IM 1 mg once a Lactate 1.2 (0.5-2.2) month, Propranolol 40 mg BD Glucose 5.5 (4-7) Examination: 98% O2 room air, HR 140, BP 134/58, RR 22, Temp 36.8 C A Start Furosemide 40 mg IV STAT Tachycardia noted. CRT <2 B Start back to back NEB Salbutamol totalling 20 mg ECG: QRS Complex 0.24s (0.12), narrow T waves, T wave amplitude 12mm (5mm), PR interval 0.30s (0.12-0C20) Start 10 units Actrapid + IV 250 ml 10% Dextrose over A VBG was taken (results shown). The causative medication was stopped. 15 mins Select the most appropriate decision in regards to thetart 30 ml Calcium Gluconate 10% over 5 mins above E Start Sodium zirconium cyclosilicate 10 g TDS to review in 72 hours pH 7.42 (7.35-7.45) pCO2 4.9 (4.7-6) Spironolactone and Hyperkalaemia pO2 12.8 (11-13) HCO3– 22.9 (22 – 26) Base Excess (BE) -0.8 (-2 to +2) A 50 year old man who was referred to Gastroenterology Ascites on CTAP) has mentioned during the ward round+ 137 (135-145) that he has started to get palpitations in his chest.6.6 (3.5-5) Ca2+ 2.3 (2.2 to 2.6) PMHx Liver Cirrhosis secondary to ETOH, HTN, Bilateral Cataracts, B12 deficiency, Essential Tremors Cl- 100 (95-108) Lactate 1.2 (0.5-2.2) Dx: Started PO 200 mg Spironolactone on admission,Glucose 5.5 (4-7) Amlodipine 5 mg OD, Cyanocobalamin IM 1 mg once a month, Propranolol 40 mg BD Examination: 98% O2 room air, HR 140, BP 134/58, RR 22,art Furosemide 40 mg IV STAT Temp 36.8 C Tachycardia noted. CRT <2 B Start back to back NEB Salbutamol totalling 20 mg ECG: QRS Complex 0.24s (0.12), narrow T waves, T wave amplitude 12mm (5mm), PR interval 0.30s (0.12-0.20) Start 10 units Actrapid + IV 250 ml 10% Dextrose over 15 mins A VBG was taken (results shown). The causative medication was stopped. D Start 30 ml Calcium Gluconate 10% over 5 mins Select the most appropriate decision in regards to the above E Start Sodium zirconium cyclosilicate 10 g TDS to review in 72 hours Suspect Hyperkalaemia? On U+E result: REPEAT SYMPTOMATIC/ON VBG VBG: ECG! Hyperkalaemia: Normal; K+: Relax Panic + ECG TREAT TREAT Hierarchy of treatment: 1) 30 ml Calcium Gluconate 10%: stabilises Myocardium; reduces arrhythmias 2) 10 units short acting insulin (e.g Actrapid) + 10% Dextrose / NEB back to back Salbutamol 10-20mg total: Drives K+ Intracellularly (temporary measure) 3) Sodium Zirconium/Calcium Resonium; absorbs excess K+ and carries it to be excreted via rectum (slow process!)A 40 year old woman is just admitted to the Urology ward for treatment of Urosepsis secondary to Pyelonephritis. She weighs 60 kg. Her Urine Dipstick confirms 3+ Nitrites and 2+ Leukocytes. PMHx: Previous Cystitis, Migraines Dx PO Propranolol 80 mg OD. Penicillin and Macrolide allergic. Currently started on 420 mg IV Gentamicin (7mg/kg) 24 hourly. NEWS: 5, Temp 38.9 C Hb 132 (115-165), WCC 16.2 x10^9L (3.0-10.0), Na+ A Gentamicin 420 mg IV 24 hourly 139 (137-144), K+ 4.1 (3.5-5.3), U 6.8 (2.5-7.0), Cr 82μmol/L (60-110), eGFR 82 (>60) B Gentamicin 180 mg IV 36 hourly Gentamicin level: 5.0 (taken 11 hours since last dose) C Gentamicin 180 mg IV 24 hourly Select the most appropriate decision in regards to the above D Gentamicin 420 mg IV 36 hourly E Gentamicin 420 mg IV 48 hourlyGentamicin Monitoring A 40 year old woman is just admitted to the Urology ward for treatment of Urosepsis secondary to Pyelonephritis. She weighs 60 kg. Her Urine Dipstick confirms 3+ Nitrites and 2+ Leukocytes. PMHx: Previous Cystitis, Migraines Dx PO Propranolol 80 mg OD. Penicillin and Macrolide allergic. Currently started on 420 mg IV Gentamicin (7mg/kg) 24 hourly. NEWS: 5, Temp 38.9 C A Gentamicin 420 mg IV 24 hourly Hb 132 (115-165), WCC 16.2 x10^9L (3.0-10.0), Na+ 139 (137-144), K+ 4.1 (3.5-5.3), U 6.8 (2.5-7.0), Cr 82μmol/L Gentamicin 180 mg IV 36 hourly (60-110), eGFR 82 (>60) C Gentamicin 180 mg IV 24 hourly Gentamicin level: 5.0 (taken 11 hours since last dose) D Gentamicin 420 mg IV 36 hourly Select the most appropriate decision in regards to the above E Gentamicin 420 mg IV 48 hourlyGentamicin level: 5.0 (taken 11 hours since last dose) From the chart we need to extend the dose interval from 24 hourly to 36 hourly Gentamicin Monitoring requirements 2 ways to monitor Gentamicin Dosing 1) Gentamicin Nomogram 2) Peak and Trough values Peak value = Does dose need to change? Too high means reduce Trough = does the time between dose need to extend or stay the same? Too high means increase time between dose (24 to 36 to 48 hours)A 20 year old male university student presents to A&E at 03:00 after his mate found him lying on the sofa feeling nauseous and drowsy. He is otherwise well and not A STAT PO Activated Charcoal 50 g vomiting. He admits to ingesting 30 500mg Paracetamol tablets in one swallow due to stress in university with relationship issues at 20:00 the previous day. He weighs 60 B No intervention required kg. PMHx: Childhood asthma (no exacerbations), T2DM C IV N-Acetylcysteine 9000 mg over 1 hour in 200ml 5% Dextrose Dx: Nil D IV N-Acetylcysteine 9000 mg over 1 hour in Ix: 200ml 0.9% NaCl ● Plasma Paracetamol Concentration = 95 mg/L ● Bilirubin 7 (0-21) E IV N-Acetylcysteine 9000 mg over 24 hours ● ALT 21 (10-35) in 200ml 5% Dextrose ● Albumin 36 (35-50) ● ALP 69 (40-150) ● INR 1.0 ● Random Glucose: 10 (3-7) Select the most appropriate decision in regards to the above ParacetamolOD A STAT PO Activated Charcoal 50 g A 20 year old university student presents to A&E at 03:00 after his mate found him lying on the sofa feeling nauseous and drowsy. He is otherwise well and not vomiting. He admits to ingesting 30 500mg No intervention required Paracetamol tablets in one swallow due to stress in university with relationship issues at 20:00 the previous day. He weighs 60 kg. He hasn’t taken any other substances since. C IV N-Acetylcysteine 9000 mg over 1 hour in 200ml 5% Dextrose PMHx: Childhood asthma (no exacerbations), T2DM Dx: Metformin 500 mg OD D IV N-Acetylcysteine 9000 mg over 1 hour Ix: in 200ml 0.9% NaCl ● Plasma Paracetamol Concentration = 95 mg/L E IV N-Acetylcysteine 9000 mg over 24 hours ● Bilirubin 7 (0-21) in 200ml 5% Dextrose ● ALT 21 (10-35) ● Albumin 36 (35-50) ● ALP 69 (40-150) ● INR 1.0 ● Random Glucose: 10 (3-7) Select the most appropriate decision in regards to the aboveTotal dose of Paracetamol OD: 60kg x 75mg = 30 tablets x 500 mg = 15 000 4500 mg (yep mg! he’s toast) Time between taking dose and admission for treatment = 7 hours Consider which Type of overdose: Acute Overdose ● Staggered Overdose ● Therapeutic OverdoseFOR PSA EXAM: the graphs are calibrated for the standard 21 hour regime only!! Paracetamol PLasma Concentration = 95 mg/L Timeframe = 7 hours Lies above treatment line = NEEDS ACETYLCYSTEINE!!Weight = 60 kg 60kg x 150mg = 9000 mg over 1 hour Glucose high, therefore 0.9% NaCl is best answerA 76 year old woman was brought into A&E after being found by a neighbour on the floor. The fall was unwitnessed. She is feeling SOB and has pleuritic pain at the right side of the chest. PMHx: AF, Osteoporosis, HTN, Basal Cell Carcinoma. She weighs 65 A Tranexamic Acid 1g IV once only kg. B Idarucizumab 5 g IV once only Dx: Warfarin 4mg OD for 4 months, Alendronic Acid 70 mg OD, Amlodipine 5mg OD, Candesartan 8mg OD C 1 unit Fresh Frozen Plasma Ix D 1 unit Cryoprecipitate ● HR 135, BP 70/45, CRT 4.5s, Pale and clammy ● Hb 59, INR 9.9 (target 2.5), U 6.9 (2.5-7.0), Cr 89 (60-110) ● CT Chest: R sided Haemothorax confirmed E Dried Prothrombin Complex Concentrate (Beriplex) 50 units/kg 3 units of Red Cells are planned to be transfused. The patient has IV fluids running. Warfarin was stopped and Phytomenadione 5mg IV STAT was given. Select the most appropriate decision in regards to the above INR A 76 year old woman was brought into A&E after being found by a neighbour on the floor. The fall was unwitnessed. She is feeling SOB and has pleuritic pain at the right side of the chest. PMHx: AF, Osteoporosis, HTN, Basal Cell Carcinoma. She weighs 65 Tranexamic Acid 1g IV once only kg. Dx: Warfarin 4mg OD for 4 months, Alendronic Acid 70 mg OD, B Idarucizumab 5 g IV once only Amlodipine 5mg OD, Candesartan 8mg OD C 1 unit Fresh Frozen Plasma Ix ● HR 135, BP 70/45, CRT 4.5s, Pale and clammy D 1 unit Cryoprecipitate ● Hb 59, INR 9.9 (target 2.5), U 6.9 (2.5-7.0), Cr 89 (60-110) ● CT Chest: R sided Haemothorax confirmed E Dried Prothrombin Complex Concentrate 3 units of Red Cells are planned to be transfused. The patient (Beriplex) 50 units/kg has IV fluids running. Warfarin was stopped and Phytomenadione 5mg IV STAT was given. Select the most appropriate decision in regards to the aboveINR and Bleeding Intervention Status INR 5-8, No bleed Withhold 1-2 doses of Warfarin. Reduce dosing when restarting when INR <5 INR 5-8, Minor bleed Stop Warfarin Slow IV Phytomenadione Restart when INR <5 INR >8, no bleed Stop Warfarin PO Phytomenadione 1-5mg Repeat INR every 24h; if still high give another dose of Phytomenadione Restart warfarin when INR <5 INR >8, minor bleed Stop Warfarin IV Phytomenadione 1-5mg Repeat INR every 24h; if still high give another dose of Phytomenadione Restart warfarin when INR <5 MAJOR BLEED Stop Warfarin (Haemorrhage) IV 5mg Phytomenadione + Prothrombin Complex at 30 units/kg STAT Major Haemorrhage ProtocolA 13 year old girl attends a Paediatric diabetic clinic with her family for a routine clinic review. Her family has kindly helped her record her CBG levels regularly each day. PMHx T1DM Dx: ● Insulin Aspart (NoVoRapid) 4-6 units (according to carbohydrate intake) at meal times SC A Increase pre evening dose (Novorapid) by 2 ● Insulin Glargine (Lantus) at bed time 15 units SC units On examination: Appears well. GCS 15/15. Height 140cm, B Increase pre evening dose (Novorapid) by 4 weight 42 kg units Ix: HbA1c 47 mmol/mol (20-42) C Increase bed time dose (Lantus) by 2 units Select the most appropriate decision in regards to the above D Increase bed time dose (Lantus) by 4 units E Increase pre breakfast dose (Novorapid) by 2 units Insulin A 13 year old girl attends a Paediatric diabetic clinic with her family for a routine clinic review. Her family has kindly helped her record her CBG levels regularly each day. PMHx T1DM Dx: ● Insulin Aspart (NoVoRapid) 4-6 units (according to carbohydrate intake) at meal times SC A Increase pre evening dose (Novorapid) by ● Insulin Glargine (Lantus) at bed time 15 units SC 2 units On examination: Appears well. GCS 15/15. Height 140cm, weight 42 kg B Increase pre evening dose (Novorapid) by 4 units Ix: HbA1c 47 mmol/mol (20-42) Select the most appropriate decision in regards to the C Increase bed time dose (Lantus) by 2 units above D Increase bed time dose (Lantus) by 4 units E Increase pre breakfast dose (Novorapid) by 2 units ● Each CBG level is taken BEFORE each event (AKA BEFORE a meal, and BEFORE bed time). Insulin is only taken after eating, and basal before sleeping ● Aim of this monitoring is to assess if PREVIOUS doses of insulin taken has done its job to keep glucose in its range ● If its out of range in a specific time = PREVIOUS DOSE IS NOT ENOUGH Therefore in this example, since pre bedtime glucose is high, it means the insulin taken after dinner/evening meal is not enough! Safe increase of insulin = 2 units! HRT A 28 year old woman attends her GP clinic for follow up A Abstain from coitus and use barrier contraception for 7 since starting Microgynon 30 3 months ago. She is just days about to finish her 3rd month pack She has stated that she had forgotten to take 3 pills B Take today’s pill, as well as yesterday’s pill dose, continue the rest of the pack, abstain from coitus and from the 3rd row, as she had accidentally left them at use barrier contraception for 7 days home before a short trip to Ibiza, where she flew back 24 hours ago. Whilst on her trip she has had been C Emergency Intra-uterine Device insertion, organise a sexually active with multiple partners follow up appointment within 21 days of unprotected PMHx nil coitus, abstain from further coitus and use barrier contraception for 7 days Dx: Nil. Only uses Microgynon for contraception D STAT dose PO Mifepristone 600 mg Examination: Alert and Oriented. Asymptomatic E Ignore the remaining pills. Start new pack immediately, Select the most appropriate decision in regards to the above abstain from coitus and use barrier contraception for 7 days HRT A 28 year old woman attends her GP clinic for follow up A Abstain from coitus and use barrier contraception for 7 since starting Microgynon 30 3 months ago. She is just days about to finish her 3rd month pack She has stated that she had forgotten to take 3 pills B Take today’s pill, as well as yesterday’s pill dose, continue the rest of the pack, abstain from coitus and from the 3rd row, as she had accidentally left them at use barrier contraception for 7 days home before a short trip to Ibiza, where she flew back 24 hours ago. Whilst on her trip she has had been C Emergency Intra-uterine Device insertion, organise a sexually active with multiple partners follow up appointment within 21 days of unprotected PMHx nil coitus, abstain from further coitus and use barrier contraception for 7 days Dx: Nil. Only uses Microgynon for contraception D STAT dose PO Mifepristone 600 mg Examination: Alert and Oriented. Asymptomatic E Ignore the remaining pills. Start new pack Select the most appropriate decision in regards to the above immediately, abstain from coitus and use barrier contraception for 7 daysLearning objectives Calculations ● Basic drug dosage calculations ● Fluids and paediatric fluids calculations ● Infusion rates ● Opiate prescribing Data Interpretation: ● Insulin ● Blood work; lipids, HbA1c, TFTs etc ● Gentamicin ● INR ● How to use medicines complete/BNF to guide medication adjustmentResources for learning ● PSA blueprint: https://prescribingsafetyassessment.ac.uk/resources/PSA-Blueprint-July-2023.pdf ● BPS eLearning ○ 9 free modules ○ Mock papers available to purchase - 3 for £40 ● Geekymedics ○ PSA question bank ● Passmedicine ○ PSA question bank ● https://bnf.nice.org.uk/interactions/appendix-1-interactions/ ● SCRIPT modules ○ https://www.safeprescriber.org/modules/ ○ “Monitoring medicines”, “Toxic tablets” READ THROUGH BNF and MEDICINES COMPLETE (tip: also read through nursing sections)FeedbackForm :) SEEYOUSOONFOR https://linktr.ee/medtic.teachingALS SERIES! 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