Medication Review Cheat Sheet

A one-page clinical checklist from an advanced clinical pharmacist — antibiotic durations, monitoring, standing BP, anticholinergic burden, renal dosing, QT, falls, dependence, prescribing cascades. Free instant download.
 
This one-page A4 cheat sheet is the checklist behind a proper structured medication review — the ten "hills" an advanced clinical pharmacist won't come down from. Print it, pin it above your desk, take it into clinic.
Inside, on a single page:
Antibiotic durations that aren't "7 days by default" — respiratory, UTI, skin
The monitoring you should actually see: ACEi/ARB, lithium, methotrexate, amiodarone, DOACs
Postural hypotension thresholds (↓20 systolic / ↓10 diastolic) and the drugs behind them
Anticholinergic burden as a cumulative total, not one drug at a time
Renally cleared medicines — plus why DOAC dosing needs Cockcroft–Gault CrCl, not eGFR
QT risk as drug + drug + patient
Falls, dependence-forming medicines and the three classic prescribing cascades
Why "stable for years" is a reason to review, not a reason not to