Practice Questions Please attempt these questions and bring to the SAHD on 1 st April 2011

Intravenous Fluids It is worth your while looking at what fluids and volumes that are available for use on the wards If you get a chance, pop into a treatment room and have a look at what is there

Prescribe the following intravenous infusions using the supplied sections of the drug kardex

Intravenous infusions Co-amoxiclav 1.2g IV infusion for three days Gentamicin 5mg/kg IV infusion OD in a 60kg patient. To be reviewed at 24 hours Pantoprazole 40mg IV infusion OD Benzylpenicillin 600mg QDS IV infusion Tobramycin IV Infusion in a 66.7kg patient

Infusions Include any information that will enable the drug to be given safely Includes –Drug name, route, frequency, –Infusion fluid and rate –Signature and date

Typical fluids include Sodium Chloride 0.9%, glucose 5%, Hartmann’s 100ml, 250ml, 500ml, 1litre bags Not all fluids are available in each size – always check!

Some BNF instructions include reconstitution You don’t need to worry about this when prescribing – concentrate on the final fluid volume (unless your reconstitution volume is significant)

“Intermittent in sodium chloride 0.9% or Water for injections. Dilute with 100ml infusion fluid and give over minutes.” To ensure the patient only receives the 3 days you want, block off any remaining boxes

“Intermittent or via drip tubing in glucose 5% or sodium chloride 0.9%. Suggested volume for intermittent infusion ml given over minutes (given over 60 minutes for once daily dose regimen).”

“Intermittent in Glucose 5% or Sodium Chloride 0.9% …dilute with 100ml infusion fluid; give 40mg over 15 minutes”

“Intermittent in Glucose 5% or Sodium Chloride 0.9%. Suggested volume 100ml given over 30-60minutes. Continuous infusion not usually recommended.”

“Intermittent or via drip tubing in Glucose 5% or Sodium Chloride 0.9%. For adult intermittent infusion suggested volume ml…given over minutes”

Controlled drugs prescriptions For each prescription, the patient’s details are –Name: Adam Robinson –Address: 2 Clifford Bridge Road, Coventry –Date of Birth: 01/01/1944 –Hospital number: AA –Allergies: Nil known What would you write on the TTO form when sending a patient home on the following?

Two weeks worth of modified release oxycodone 80mg BD. A one week supply of hydromorphone SR 4mg BD and hydromorphone 1.3mg up to 4 hourly when required. Fentanyl lozenges 200micrograms 2 hourly when required for 5 days. Buprenorphine 35 microgram/hour patches for one month. A one month supply of morphine sulphate SR 20mg BD.

Two weeks worth of modified release oxycodone 80mg BD. Prescribe: –Oxycodone MR tablets –80mg BD –Supply 28 (twenty eight) x 80mg tabs

A one week supply of hydromorphone SR 4mg BD and hydromorphone 1.3mg up to 4 hourly when required. Prescribe –Hydromorphone MR Capsules –4mg BD –Supply 14 (fourteen) AND –Hydromorphone 1.3mg Caps –Take 1 capsule 4 hourly when required –Supply 28 (twenty eight)

Fentanyl lozenges 200micrograms 2 hourly when required for 5 days. Fentanyl 200microgram lozenges Suck one lozenge 2 hourly when required for pain relief Supply 30 (thirty)

Buprenorphine 35 microgram/hour patches for one month. Burprenorphine 35microgram/hour patches Apply one patch every 96 hours Supply 8 (eight) patches

A one month supply of morphine sulphate SR 20mg BD. Prescribe –Morphine sulphate SR 10mg tablets –Take 2 BD –Supply 120 (one hundred and twenty) x 10mg tablets