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PA20322 > Clinical Skills > Flashcards

Clinical Skills Flashcards

1
Q

What are the 4 types of medicines that are identified as high risk, and so useful for MURs

A

NSAIDs –> Adherance to gastric protection?

Anticoagulants (including LMWHs) –> INR

Antiplatelets –> Possible GI Bleed (dont get aspirin!)

Diuretics –> Non-adherence is bad

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2
Q

Name some things that determine whether we monitor certain patients?

A

The drug they’re on –> Warfarin needed more than paracetamol

Disease state –> Drugs like paracetamol are more important when being used in somebody with liver dysfunction, than in those with a healthy liver

Acute Disease –> More intenesive than chronic diseases

Certain Patient Factors –> Eg, when pregnant, immunocomproised and the elderly

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3
Q

Whats the DOTS classification? In terms of adverse drug reactions

A

Dose Relatedness –> They can occur at 3 different levels…

Supratherapeutic = Toxic levels

Therepautic levels = Collateral (unintentional) effects

Subtheraputic = Hypersusceptibility reactions

Time –> Can occur at anytime, but often due to changes in patient factors (such as renal function)

Susceptibility –> Varies due to patient factors (eg, age/gender/pregnancy/co-morbilities/drug interactions)

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4
Q

What is duty of candour?

A

A legal duty that tells us that we have to own up to our mistakes and be held responsible for them

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5
Q

What are the 4 guiding principles of Medicines Optimisation?

A

Aim to understand the patients experience

Evidence based choice of medicine

Ensure medicines use is as safe as possible

Make medicines optimisation a part of routine practice

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6
Q

What’s the difference between an adverse drug reaction, and an adverse drug event?

A

Drug Reaction –> A reaction that is reasonably attributable to the drug

Drug Event –> An event that occurs whilst a patient is taking a drug (but the drug isn’t neccesarily the cause of the event)

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7
Q

What type of monitoring parameter does recording INR fall under?

A

Haemotological

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8
Q

How many of the 400 MURs a year must be done on targeted groups?

A

70%

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9
Q

What are the 4 Patient Orientated Outcomes (POOs)?

A

Reduction in side effect and medication errors

Better access to a large range of services

More effective use of medicines

Greater involvement in my own care with support when needed

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10
Q

What is Medicines Optimisation?

A

An approach to the quality use of medicines that aims to produce the best possible outcomes for patients and maximise the value from medicines

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11
Q

Whats an INR?

A

International Normalised Ratio

A ratio of how long it takes anticoagulated blood (eg, those on warfarin) to clot compared to normal blood

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12
Q

What are the 4 largest groups of drugs that cause ADRs?

A

Diuretics

NSAIDs

Warfarin

Antiplatelets

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13
Q

How long does it normally take an IV drug to reach the steady state?

A

4 half lives

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14
Q

What are the 4 Clinical Laboratory Services?

A

Clinical Biochemistry

Haematology/Immunology

Histopathology

Microbiology/Virology

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15
Q

What are the 2 types of contraindications?

A

Relative –> Caution should be used, but the drugs can be used if the benefits outweight the benefits

Absolute –> The interaction could cause a life-threatening situation. This should always be avoided

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16
Q

What treatments should be given for somebody undergoing an anaphalactic shock?

And why?

A

Adrenaline –> Reduces swelling, wheezing and increases BP

Steroids and Antihistamines –> Reduces swelling and inflammation

IV Fluids –> Replaces fluids that are lost through leaky capillaries

17
Q

Which group of drugs has caused the most ADRs?

A

NSAIDs

18
Q

What are the 4 target areas for an NMS?

A

Hypertension

Antiplatelet/Anticoagulant

Type 2 diabetes

Asthma/COPD

19
Q

What are the conditions for a respiratory MUR?

A

Must be on 2 medications, with at least one being for asthma or COPD and on the list for an NMS

20
Q

What is clinical governance?

A

The recognition and maintainance of good practice, learning from mistakes and improving quality of services provided to patients

21
Q

Medicines optimisation will offer a step change in how issues are addressed through….

A

Patient Engagement

A Focus on Outcomes

Pharmaceutical Leadership

A holisitic view across the medicines pathway

22
Q

When should a Post Discharge MUR be done?

A

4 weeks after discharge ideally…..but can be 8 weeks in certain circumstances

23
Q

What are the main risk factors of the drug to patients, in reference to allergies?

A

Nature of the Drug –> Aspirin/Penicillins/anticonvulsants/antipsychostics

Degree of Exposure –> Occurs more for intermediate courses of moderate doses

Route of Administration –> Oral safer than IV, but topical is more sensitising

Cross-Reactivity

24
Q

What are the conditions for a cardiovascular MUR?

A

Patients with, or at risk of, CVD and on at least 4 medications

One of these medications must be for….

25
Q

What characteristics of a drug means we need to monitor drug levels in the serum?

A

When there is a large degree of inter-patient variability

Narrow therapeutic-index

Odd/unpredictable PKs

26
Q

State the ABCDE classifications of adverse drug reactions

A

A = Augmented

B = Bizzare

C = Chronic –> Continuous exposure

D = Delayed –> occurs a long time after exposure

E = End of use

27
Q

In medicines optimisation, what does QIPP stand for?

A

Quality

Innervation

Productivity

Prevention

28
Q

To be competent, or have capacity to concent, a patient must be able to do what 4 things?

A

Understand the information that has been given

Believe the information

Be able to retain and weight up the information to make a decision

Be free from any kind of duress (against their will) to make the decision

29
Q

Who can report ADRs to the MHRA? (yellow card scheme)

A

Anyone!

30
Q

What’s the difference between Allergy and Intolerance?

A

Allergy –> When an immune system react to substances in the environment that are harmless to most people

A type B (Bizzare) hypersensitivity

Intolerance –> When somebody has a lower threshold to the normal pharmacological action of a drug

A type A (Augmented) hypersensitivity

31
Q

Which is the most frequent type of prescribing error?

A

Dosage errors

32
Q

What was found to have the greatest impact on dispensing errors?

A

Workload

33
Q

What 4 things should the majority of MURs be done on?

A

High risk medicines

Recent discharges

Respiratory disease

CVD –> With 4 medicines

34
Q

How long must a patient be taking medication from a certain pharmacy to be eligible for an MUR?

A

3 months

PA20322 (8 decks)

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