Category: Prescribing

Prescribing in Old Age Psychiatry

The general prescribing principles from both Old Age Psychiatrists and Geriatricians is to start at a low dose for a drug, and then titrate up slowly. A small dose for a general adult patient may be large than for an elderly patient, owing to co-existing factors such as low body mass index (BMI), kidney disease, liver disease, and polypharmacy. Medication choice should also be dictated by likely compliance, especially in light of cognitive impairment leading to unintentional overdose or suicidality. These patients often have a high pill burden and so like in a general hospital, can benefit from medicine reconciliation and optimisation. One way to do this can be by prescribing a modified release single dose of psychiatric medication, as opposed to repeated shorter-acting preparations. 

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Hypercalcaemia

Serum calcium concentration is tightly regulated between 2.1-2.6mmol/L. Severe hypercalcaemia is a life-threatening electrolyte emergency requiring prompt recognition and urgent treatment.   Classification Mild (2.65 – 3.00 mmol/L): Patient is often asymptomatic Moderate (3.01-3.40 mmol/L): Can be asymptomatic or symptomatic Severe (>3.40 mmol/L): Risk of dysrhythmia and coma Serum calcium is found in 2 forms

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Reporting Adverse Drug Reactions

The World Health Organization (WHO) defines adverse drug reactions (ADR) as “any response to a drug which is noxious and unintended, and which occurs at doses normally used in man”. Importantly, these refer to situations when the drug is used normally and at the recommended dosages. ADRs may be classified into six categories, based on

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Hypomagnesaemia

The UK Medicines Information group have provided excellent guidance on how to replace magnesium.Useful advice on treatment: Clinical features Usually asymptomatic Irritability & lethargy Nausea/vomiting Psychiatric: confusion, depression, psychosis Neuromuscular: Tremors, cramps, tetany, weakness & seizures ECG: prolonged PR, ST depression, altered T waves, arrhythmias Causes Dietary such as refeeding syndrome GI losses (D&V, high stoma output)

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Overview of eye drops

Medicines reconciliation is the process of accurately listing a person’s medicines. This often takes place when they’re admitted into a service and is an important day to day job of a junior doctor. It has been demonstrated that patients admitted to the hospital for non-ophthalmic reasons do not always receive their eye drops as prescribed.

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Passing the Prescribing Safety Assessment (PSA)

The PSA is aimed at final year medical students and those graduating overseas to assess their competency at prescribing as Foundation Year 1 Doctors. It can also be taken by FY1s if they have not passed it in their final year or had not attempted it before. You must check out our free PSA course.

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Medications in Diabetes

In this article, we’ll cover the treatments used in Diabetes Mellitus. We’ll look at key things you need to know about each therapy, when you might start it & common adverse effects. This article isn’t comprehensive or a guideline – you should still look up information & a guideline before starting any treatment. Introduction Type

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Common Prescribing Errors

When I supervise and teach FY1s, prescribing is among the top three things they are most concerned about. Usually, they’re worried that they won’t know what to prescribe or that an error will cause serious harm. As with everything, your seniors have all been through this and we are here to help you through. Introduction

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Parkinson’s Disease

In this article, we will present several common scenarios involving Parkinson’s disease (PD) that you might face on the ward or on call. We will not go into too much detail about the pathophysiology of the disease – as fascinating as it is. This is more of a quick practical guide, on how to deal

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Anticoagulation

For new doctors, prescribing anticoagulants can be daunting. A few simple rules can make this easier. Ensure you use your local guidelines in the first instance, which often provides information on first-line agents and dosing. The information below may be incorrect and so hence, as per our disclaimer, do use your own clinical judgement. The

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