Prescribing Scenarios at a Glance

293 Pages·2014·5.52 MB·English

by  Emma Baker

Prescribing Scenarios at a Glance
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Prescribing
Scenarios at a
Glance
Emma Baker PhD FRCP
Professor of Clinical Pharmacology
St George’s, University of London
Consultant Physician
St George’s Healthcare NHS Trust, London
Daniel Burrage BSc(Hons) MBBS MRCP FHEA
Academic Clinical Fellow
St George’s, University of London
Specialty Registrar (ST3) in Clinical Pharmacology, General Medicine and
Stroke Medicine
St George’s Healthcare NHS Trust, London
Dagan Lonsdale BSc(Hons) MBBS MRCP FHEA
Academic Clinical Fellow
St George’s, University of London
Specialty Registrar (ST3) in Clinical Pharmacology, General Medicine and
Intensive Care Medicine
St George’s Healthcare NHS Trust, London
Andrew Hitchings BSc(Hons) MBBS MRCP FHEA
Clinical Research Fellow
St George’s, University of London
Specialty Registrar (ST7) in Clinical Pharmacology, General Medicine and
Intensive Care Medicine
St George’s Healthcare NHS Trust, London
This edition first published 2014 © John Wiley & Sons, Ltd.
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chart and discharge prescription are reproduced with permission from St George’s, University of
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SKU: 978EWTLP26358
Library of Congress Cataloging-in-Publication Data
Baker, Emma, author.
Prescribing scenarios at a glance / Emma Baker, Daniel Burrage, Dagan Lonsdale, Andrew
Hitchings.
p. ; cm. – (At a glance)
Includes bibliographical references and index.
ISBN 978-1-118-57086-9 (pbk.)
I. Burrage, Daniel, author. II. Lonsdale, Dagan, author. III. Hitchings, Andrew,
author. IV. Title. V. Series: At a glance series (Oxford, England).
[DNLM: 1. Drug Therapy–Case Reports. 2. Pharmaceutical Preparations–Case Reports. WB
330]
RM300
615.1–dc23
2014000049
A catalogue record for this book is available from the British Library.
Cover image: Reproduced from iStock © joyfnp
Cover design by Meaden Creative
Set in 9/11.5 pt Time New RomanMTStd by Toppan Best-set Premedia Limited
1 2014
Contents
Acknowledgements 7
Dedication 7
List of abbreviations 8
How to use your textbook 10
About the companion website 13
Introduction: Practical prescribing scenarios 14
Please note that the prepared drug charts can be found in the accompanying workbook.
Case Page
Section 1: The acute take Case Drug chart Answer
1 An 82-year-old woman who requires venous thromboembolism prophylaxis 30 1.1 38
2 A 104-year-old woman with respiratory failure 30 2.1 40
3 A 64-year-old man with severe acute abdominal pain 31 3.1 41
4 A 55-year-old woman with atrial fibrillation 31 4.1 43
5 A 32-year-old man with community-acquired pneumonia 32 5.1 45
6 A 45-year-old woman with status epilepticus 32 6.1 47
7 A 27-year-old woman with suspected bacterial meningitis 33 7.1 48
8 A 31-year-old woman with paracetamol overdose 34 8.1 50
9 A 59-year-old man with acute pulmonary oedema 35 9.1 52
10 A 24-year-old woman with acute asthma 35 10.1 54
11 A 57-year-old man who has suddenly deteriorated 36 11.1 57
12 An 84-year-old man taking warfarin who has a headache 36 12.1 59
13 A 66-year-old man with acute coronary syndrome 37 13.1 61
14 A 67-year-old man with an exacerbation of COPD 37 14.1 64
Section 2: On call in the hospital Case Drug chart Answer
15 A 91-year-old man with hypoglycaemia 68 15.1 82
16 A 60-year-old woman requesting night sedation 68 16.1 83
17 A 62-year-old man with suspected opioid toxicity 69 17.1 84
18 A 58-year-old man who has low blood pressure 69 18.1 86
19 A 44-year-old woman who is ‘nil by mouth’ 70 19.1 88
20 A 59-year-old man with circulatory compromise 70 20.1 90
21 A 15-month-old girl with gastroenteritis 71 21.1 93
22 A 5-year-old boy with a painful right arm 71 22.1 94
23 A 12-hour-old boy with signs of sepsis 72 23.1 96
24 A 60-year-old man who has developed a hot joint 72 24.1 97
25 A 65-year-old man with hypokalaemia 73 25.1 99
26 A 69-year-old woman being treated with gentamicin 73 26.1 102
27 A 69-year-old man anticoagulated with warfarin 74 27.1 104
28 A 28-year-old woman with nausea 74 28.1 105
29 A 29-year-old man who is in pain following an operation 75 29.1 107
30 A 49-year-old man due to undergo surgery 75 30.1 110
31 A 79-year-old woman with acute kidney injury 76 31.1 112
32 An 85-year-old woman with hospital-acquired pneumonia 77 32.1 114
33 A 47-year-old man who has developed an abnormal liver profile 78 33.1 116
34 An 83-year-old man who develops diarrhoea 79 34.1 118
35 An 88-year-old man with hyperkalaemia 80 35.1 121
36 A 69-year-old woman with acute alcohol withdrawal 81 36.1 123
Contents  5
Section 3: Routine inpatient review Case Drug chart Answer
37 A 69-year-old woman with constipation 128 37.1 135
38 A 71-year-old man who has developed a tremor 128 38.1 136
39 An 81-year-old woman at risk of fragility fractures 129 39.1 138
40 A 23-year-old pregnant woman with pulmonary embolism 129 40.1 140
41 A 31-year-old man with increased seizure frequency 130 41.1 141
42 A 58-year-old man with diabetes mellitus treated with insulin 130 42.1 143
43 A 53-year-old man who wants to stop smoking 131 43.1 146
44 A 90-year-old woman on numerous medications 131 44.1 148
45 A 54-year-old woman with a peptic ulcer 132 45.1 150
46 A 64-year-old woman with chronic kidney disease 132 46.1 152
47 A 66-year-old man with palpitations 133 47.1 154
48 A 70-year-old man with ST-elevation acute coronary syndrome 133 48.1 156
49 A 49-year-old woman with chronic liver disease complaining of pain 134 49.1 158
50 An 89-year-old man approaching the end of life 134 50.1 160
Appendix 1 Antibiotic guidelines 163
Appendix 2 Case summaries 164
Index 166
6  Contents
Acknowledgements
We are indebted to Dr Katie Pearson, Specialist Trainee in Paedi- We are grateful to Dr Natasha Patel, Consultant in Acute Medi-
atrics, Penninsula Deanery for her contribution as lead author for cine and Diabetes, for her comments on insulin prescribing in
paediatric cases 21–23. These cases arose from a survey she per- Case 42.
formed, which found that over half of foundation doctors were
required to prescribe for children, with analgesia, antibiotics and
fluids being the most common prescriptions.
Dedication
This book is dedicated to our families for their support and
patience over the many months of late evenings and lost weekends
that they’ve had to endure in the course of its preparation!
AAcckknnoowwlleeddggeemmeennttss aanndd DDeeddiiccaattiioonn   77
List of abbreviations
ABCDE approach to the critically unwell patient: airway; FDA Food and Drug Administration
breathing; circulation; disability; exposure FFP fresh frozen plasma
Abdo abdomen (examination) FP10 NHS prescription forms used in the community
ACE angiotensin converting enzyme FH family history
ACR albumin : creatinine ratio FT4 free thyroxine (concentration)
ACS acute coronary syndrome GABA gamma-aminobutyric acid
Adj Ca2+ adjusted calcium concentration GGT gamma glutamyl transferase
ADP adenosine diphosphate GI gastrointestinal
ADR adverse drug reaction Gluc glucose (concentration)
AKI acute kidney injury GP general practitioner
ALP alkaline phosphatase GRACE Global Registry of Acute Coronary Events
ALT alanine transaminase GSL general sales list (medicines)
APTT activated partial thromboplastin time GTN glyceryl trinitrate
ARB angiotensin receptor blocker H histamine
ARF acute renal failure Hb haemoglobin (concentration)
BBB blood–brain barrier HbA glycated haemoglobin
1c
BD (bis die) twice daily HCO– bicarbonate ion (concentration)
3
BE base excess HIV human immunodeficiency virus
Bil bilirubin (concentration) HPC history of presenting complaint
BMI body mass index HR heart rate
BNF British National Formulary 5HT serotonin
BNFc BNF for Children Ig immunoglobulin
BNP brain natriuretic peptide IM intramuscular
BP blood pressure INH inhaled
Ca2+ calcium ion (concentration) INN international non-proprietary name
CBG capillary blood glucose INR international normalised ratio
CIWA-Ar Clinical Institute Withdrawal Assessment for IV intravenous
Alcohol Scale, revised JVP jugular venous pressure
CKD chronic kidney disease K+ potassium ion (concentration)
CLO Campylobacter-like organism (test) kg kilogram
CMV cytomegalovirus kPa kilopascals
COPD chronic obstructive pulmonary disease LMWH low molecular weight heparin
CPAP continuous positive airway pressure MC&S microscopy, culture and sensitivity
Creat creatinine (concentration) MCV mean corpuscular volume
CRP C-reactive protein MHRA Medicines and Healthcare products Regulatory
CSCI continuous subcutaneous insulin infusion Agency
CT computed tomography MI myocardial infarction
CTPA computed tomography pulmonary angiogram mmHg millimetres of mercury
CTZ chemoreceptor trigger zone MR or m/r modified release
CURB-65 pneumonia severity score (confusion, urea, MRSA meticillin resistant Staphylococcus aureus
respiratory rate, blood pressure, age) MSS musculoskeletal system
CVS cardiovascular system Na+ sodium ion (concentration)
CXR chest X-ray NAC N-acetylcysteine
D dopamine NAPQI N-acetyl-p-benzoquinone imine
DH drug history NEB nebulised
DXA dual-energy X-ray absorptiometry Neut neutrophil (count)
EBV Epstein–Barr virus NG nasogastric (tube)
ECG electrocardiogram NICE National Institute for Health and Care Excellence
eGFR estimated glomerular filtration rate NKDA no known drug allergies
eMC electronic Medicines Compendium NMDA N-methyl-d-aspartate
EMA European Medicines Agency NOAC novel oral anticoagulant
Eos eosinophil (count) NPH neutral protamine Hagedorn (refers to
EPO erythropoietin intermediate-acting insulin)
ESR erythrocyte sedimentation rate NRT nicotine replacement therapy
FBC full blood count NS nervous system
8  List of abbreviations