MLACases

[Prescriptions > Anticoagulation]

1) DVT Rivaroxaban

Task

Where you are:

FY2 in A&E

Who the patient is:

Mr. David Blaine, aged 48, has been diagnosed with a DVT.

Other information you have about the patient:

Regular medications:

• Amlodipine 10mg OD PO
• Aspirin 75 OD PO
• Paracetamol 1g QDS

What you must do:

Prescribe Rivaroxaban for 6 months and his regular medications.

Hospital: Manchester Royal Infirmary

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Model Answer

Further Explanation

Smart Revision Planner >> Anticoagulants >> DVT Rivaroxaban

2) PE Apixaban

Task

Where you are:

FY2 in Medicine

Who the patient is:

Mrs. Stacy Smith, aged 63, has been admitted to the hospital because of shortness of breath. She was diagnosed with a pulmonary embolism and is being managed in the hospital.

Other information you have about the patient:

She has a history of hypercholesterolaemia. She had a long-haul flight 10 days ago. She was prescribed the following medications:

• Apixaban for 6 months
• Aspirin 75mg OD
• Atorvastatin 20mg OD

Her eGFR is 89, D-dimer is increased.

Special Note:

She is allergic to Codeine. She gets itching after taking Codeine. 

What you must do:

Write down the prescription for the above medications.

Hospital: Manchester Royal Infirmary

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Model Answer

Further Explanation

Smart Revision Planner >> Anticoagulants >> DVT Apixaban

3) VTE Prophylaxis in a Medical Patient with a Fall

Task

Where you are:

You are FY2 in Surgery

Who the patient is:

Mrs. Lucy Nightingale, aged 83, was admitted following a fall.

Other information you have about the

• Past Medical History: Osteoporosis, Hypertension
• Medication history: Atorvastatin 20 mg OD, Acal D3 1 tablet in the afternoon, Amlodipine 5mg OD, Levothyroxine 75 micrograms, Alendronic acid 70mg OD on Tuesdays, Co- codamol 8/500 QDS As Required
• Allergic History: NKDA
• Weight: 65 Kg
• Height: 160 cm
• eGFR: 33 ml/min

What you must do:

Prescribe VTE prophylaxis and other medications for this patient.

Hospital: Manchester Royal Infirmary

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Model Answer

Further Explanation

Smart Revision Planner >> Anticoagulants >> VTE Prophylaxis In a Medical Patient With a Fall

4) Post-Natal VTE Prophylaxis (Updated)

RCOG Post Natal Thromboprophylaxis Risk Assessment sheet required ~ see top of lesson for full document

Scenario A

Task

Where you are:

FY2 in Obstetrics & Gynaecology.

Who the patient is:

Miss Jessica Khan, aged 42, had her 4th delivery yesterday. It was a normal vaginal delivery. She has been bleeding post delivery and is currently in pain.

You have been asked to perform a VTE risk assessment and to prescribe an anticoagulant for her.

Other information you have about the patient:

• Past Medical History: Unremarkable
• Allergies: NKDA
• Weight: 62 kg
• Height: 163 cm

Special Note:

None.

What you must do:

Prescribe VTE prophylaxis for this patient.

Hospital: Manchester Royal Infirmary

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Royal College of Obstetricians & Gynaecologists

Model Answer

Scenario B

Task

Where you are:

FY2 in Obstetrics & Gynaecology.

Who the patient is:

Miss Jessica Khan, aged 32, had her 4th delivery 3 hours ago. It was an instrumental delivery. She has lost more than 1 litre of blood post delivery and is currently in pain. She has started breastfeeding.

You have been asked to perform a VTE risk assessment and to prescribe an anticoagulant for her.

Other information you have about the patient:

• Past Medical History: Unremarkable
• Allergies: NKDA
• Weight: 62 kg
• Height: 163 cm

Special Note:

None.

What you must do:

Prescribe VTE prophylaxis for this patient.

Hospital: Manchester Royal Infirmary

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Royal College of Obstetricians & Gynaecologists

Model Answer (Rest as Scenario A)

Further Explanation

Smart Revision Planner >> Anticoagulants >> Post-Natal VTE Prophylaxis

5) Stroke Prophylaxis in Non-Valvular AF

Task

Where are you:

You are FY2 in Medicine

Who the patient is:

Mrs. Katerina Jankowski, aged 83, was diagnosed with non-valvular atrial fibrillations.

Other information you have about the patient:

She had a CABG 10 years ago.

Serum creatinine is 154 μmol/L

Patient was prescribed Apixaban and Atenolol 25 mg PO OD

Special Note:

None

What you must do:

Write down the prescription for the above medications.

Hospital: Manchester Royal Infirmary 

Consultant: Dr Alan Smith

Bleep: 7777

Note: Where there is the option to affix a patient ID sticker (e.g. p.1 and 3 of standard prescription chart), you should do so. This will save you time and prevent transcription errors. You will be provided with ID stickers in the exam. 

BNF

Model Answer

Further Explanation

Smart Revision Planner >> Anticoagulants >> Stroke Prophylaxis in Non-Valvular AF