Conservative Prescribing Quiz Flashcards
Use only a few drugs and learn to use them well.
A) Is an important principle of conservative prescribing
B) Is not recommended as clinicians are encouraged to experiment with newly approved drugs
C) Instead clinicians should rush to prescribe newly approved drugs having unique mechanisms of action
D) Clinicians should only prescribe medications that are heavily advertised to the public
A
T or F: Reserve unproven and off-label use for situations when your patient is unable to use recommended and proven treatments
True
T or F: Always start treatment with more than one drug at a time
False
You should prescribe a newly approved drug when:
A) A paid speaker tells you how much success she has with this new drug while the drug rep buys you an expensive dinner
B) Whenever a new drug has a unique mechanism of action
C) Use newly approved drugs once they have demonstrated superior safety and/or superior clinical outcomes
D) Improvements in lab values always result in improvement in clinical outcomes
C
There is compelling evidence to support non-drug treatment or off label treatments for the following conditions:
A) Hypertension, T1D, insomnia, back pain
B) Hypertension, T2D, insomnia, back pain
C) Arthritis, headache, and congestive heart failure
D) Non-Hodgkin’s lymphoma, von Willebrands disease, HIV
E) COVID pneumonia
B
Today’s patient is a 58 year old man, taking 8 different medications on a daily basis. Pantoprazole was started 12 weeks ago while hospitalized. He is concerned about the cost, side effects, his long term health and wants to know if all of these medications are really necessary.
Which indication listed below would be eligible for deprescribing of pantoprazole?
A) Severe esophagitis
B) ICU stress ulcer prophylaxis
C) Documented history of bleeding GI ulcer
D) Barrett’s esophagus
B
An 87-year-old woman was recently seen in a hospital emergency department (ED) for pain in her back and buttocks after a fall 2 weeks earlier. She was diagnosed with sciatica and given prescriptions for a short course of prednisone and baclofen and sent home.
Three days later, she developed delirium, necessitating another trip to the ED and a subsequent admission to the hospital. Her mental status returned to baseline 2 days later and she was discharged home. The final diagnosis was drug-induced delirium.
A few weeks later, she returned to the ED complaining of stomach pain. She was given prescriptions for an antibiotic and a proton-pump inhibitor and asked to follow up with a gastroenterologist.
Within a month, she developed severe diarrhea of several days’ duration, and again returned to the ED, where this time she was given a prescription for dicyclomine.
Two days after beginning this new drug regimen, she again became delirious and was readmitted to the hospital for several days. She was subjected to multiple laboratory tests and imaging studies, the results of which were all normal. Thankfully, she was again discharged home.
- Which medications were unintentionally prescribed to manage a side effect of another medication?
- Which prescribed medications for this case were unnecessary?
- PPI and antibiotics – her stomach pain was most likely due to the prednisone and not some other gastrointestinal cause.
Dicyclomine – the diarrhea she was experiencing was also likely due to the steroids/prednisone, and not the result of a GI condition. Dicyclomine is also associated with drug induced delirium, so it should not have been prescribed in our patient’s case, as she had had a recent bout of believed drug induced delirium.
- The initial prescription of prednisone and baclofen was unnecessary, as they are not indicated for sciatica, and they likely induced her initial bout of delirium. The subsequent PPI, antibiotic, and dicyclomine prescriptions were also unnecessary and could have been avoided if the initial prednisone and baclofen were not prescribed.
The term “novel compound” means:
A) This study was conducted to help establish the efficacy and safety of this untested compound
B) The study demonstrated an important clinical endpoint, like mortality
C) Novel compounds are far superior to undistinguished familiar compounds
D) Novel compounds are superior to the older more banal compounds
A
