Clinical Skills Flashcards
What are the 4 types of medicines that are identified as high risk, and so useful for MURs
NSAIDs –> Adherance to gastric protection?
Anticoagulants (including LMWHs) –> INR
Antiplatelets –> Possible GI Bleed (dont get aspirin!)
Diuretics –> Non-adherence is bad
Name some things that determine whether we monitor certain patients?
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
Whats the DOTS classification? In terms of adverse drug reactions
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)
What is duty of candour?
A legal duty that tells us that we have to own up to our mistakes and be held responsible for them
What are the 4 guiding principles of Medicines Optimisation?
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
What’s the difference between an adverse drug reaction, and an adverse drug event?
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)
What type of monitoring parameter does recording INR fall under?
Haemotological
How many of the 400 MURs a year must be done on targeted groups?
70%
What are the 4 Patient Orientated Outcomes (POOs)?
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
What is Medicines Optimisation?
An approach to the quality use of medicines that aims to produce the best possible outcomes for patients and maximise the value from medicines
Whats an INR?
International Normalised Ratio
A ratio of how long it takes anticoagulated blood (eg, those on warfarin) to clot compared to normal blood
What are the 4 largest groups of drugs that cause ADRs?
Diuretics
NSAIDs
Warfarin
Antiplatelets
How long does it normally take an IV drug to reach the steady state?
4 half lives
What are the 4 Clinical Laboratory Services?
Clinical Biochemistry
Haematology/Immunology
Histopathology
Microbiology/Virology
What are the 2 types of contraindications?
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
What treatments should be given for somebody undergoing an anaphalactic shock?
And why?
Adrenaline –> Reduces swelling, wheezing and increases BP
Steroids and Antihistamines –> Reduces swelling and inflammation
IV Fluids –> Replaces fluids that are lost through leaky capillaries
Which group of drugs has caused the most ADRs?
NSAIDs
What are the 4 target areas for an NMS?
Hypertension
Antiplatelet/Anticoagulant
Type 2 diabetes
Asthma/COPD
What are the conditions for a respiratory MUR?
Must be on 2 medications, with at least one being for asthma or COPD and on the list for an NMS
What is clinical governance?
The recognition and maintainance of good practice, learning from mistakes and improving quality of services provided to patients
Medicines optimisation will offer a step change in how issues are addressed through….
Patient Engagement
A Focus on Outcomes
Pharmaceutical Leadership
A holisitic view across the medicines pathway
When should a Post Discharge MUR be done?
4 weeks after discharge ideally…..but can be 8 weeks in certain circumstances
What are the main risk factors of the drug to patients, in reference to allergies?
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
What are the conditions for a cardiovascular MUR?
Patients with, or at risk of, CVD and on at least 4 medications
One of these medications must be for….
What characteristics of a drug means we need to monitor drug levels in the serum?
When there is a large degree of inter-patient variability
Narrow therapeutic-index
Odd/unpredictable PKs
State the ABCDE classifications of adverse drug reactions
A = Augmented
B = Bizzare
C = Chronic –> Continuous exposure
D = Delayed –> occurs a long time after exposure
E = End of use
In medicines optimisation, what does QIPP stand for?
Quality
Innervation
Productivity
Prevention
To be competent, or have capacity to concent, a patient must be able to do what 4 things?
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
Who can report ADRs to the MHRA? (yellow card scheme)
Anyone!
What’s the difference between Allergy and Intolerance?
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
Which is the most frequent type of prescribing error?
Dosage errors
What was found to have the greatest impact on dispensing errors?
Workload
What 4 things should the majority of MURs be done on?
High risk medicines
Recent discharges
Respiratory disease
CVD –> With 4 medicines
How long must a patient be taking medication from a certain pharmacy to be eligible for an MUR?
3 months
