Hazards of administration and prescribing errors

Question 1

What are some hazards of drug administration

Answer 1

Allergy – mild​

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Allergy – severe – anaphylaxis​

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Drug interactions​
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Acute toxic reactions​

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Death​

Question 2

What is an allergy reaction and what drugs usually cause them

Answer 2

Reaction of the immune system​

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Common symptoms include:​

Rash/ Hives​

Itching of skin/ eyes​

Runny nose/ Sneezing​

Coughing/ wheezing​

Nausea/ vomiting​

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E.g. Penicillin, NSAIDs, anticonvulsants​

Question 3

What is anaphylaxis

Answer 3

Severe and potentially life-threatening allergic reaction​

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Occurs rapidly after exposure to allergen​

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Urgent medical treatment is required- adrenaline!

Question 4

What are some symptoms of anaphylaxis

Answer 4

Hives
swelling of eyes/tongus/throat
loss of conciousness
shortness of breath
loss of bladder control
fast or slow heart rate

Question 5

What is a drug interaction

Answer 5

Drug interaction is a reaction between 2 or more drugs or between drugs and food/ drink/ supplement. ​

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Drug interactions can affect how a drug works or cause unwanted side effects. ​

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Drugs can interfere with the absorption, action or metabolism of other drugs. ​

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Question 6

What are examples of drug interactions

Answer 6

Protein binding – Warfarin & aspirin/NSAIDS​

Drug metabolism – warfarin, simvastatin​

Erythromycin​

Fluconazole​

Carbamazepine

Question 7

What is drug toxicity

Answer 7

Drug toxicity is when a person has too much of a drug in their system leading to adverse effects

Question 8

What determines the toxicity of the drug

Answer 8

Chemical structure​

Absorption​

Body’s ability to metabolise and eliminate drug (liver, kidney function, hydration)​

Usually due to taking more than prescribed dose, or prescribed dose too high, can occur at therapeutic dose. ​

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Threshold between therapeutic and toxic dose can be narrow. ​

Question 9

What are acute toxic reactions

Answer 9

Adverse effects of a substance that occur following single exposure or multiple exposures in a short period of time​

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Potentially life threatening

Question 10

What are examples of acute toxic reactions

Answer 10

Bone marrow suppression​

Hepatotoxicity & biliary stasis​

Acute nephrotoxicity

Question 11

How can fatality using drugs be reduced

Answer 11

Safe prescribing​

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Treat the whole person – NOT just the condition or disease​

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Prescribe only when necessary​

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Use of drug must be justified​

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Consideration of Risk Vs Benefit​

Question 12

What medications can NHS primary care dentists prescribe

Answer 12

medicines listed in DPF

Question 13

Is there a limit on what private or hospital based dentists can prescribe

Answer 13

Yes, only those in the BNF

Question 14

When is remote prescribing allowed

Answer 14

When there is no other viable option

Question 15

What is the BNF

Answer 15

Provides guidance on prescribing, dispensing and administering medicines ​

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It details all medicines that are generally prescribed in the UK- Intended for use by prescribers in the NHS ​

Question 16

What does DPF stand for

Answer 16

Dental Practitioners’ Formulary

Question 17

What does the DPF provide

Answer 17

Guidance on drug management of dental and oral conditions​

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General guidance, medical emergencies and other problems in dental practice.​

Question 18

What prescription forms do primary care dentists in scotland use

Answer 18

GP14

Question 19

What prescription forms do hospital based dentists use

Answer 19

HBP (hospital based prescriptions)

Question 20

What information should be on a prescription

Answer 20

Full name & address of patient ​

Age if under 12 years (age and date of birth of all patients preferable but not essential. If under 12 - age is essential – legal requirement for POM medication). CHI Number not essential but put it in if you have it.​

Date (valid for 6 months) ​

Name & address of prescriber (stamp) ​

Status of prescriber ​

Signature of prescriber (in ink, computer generated signatures do not meet the legal requirement) ​

Name of drug/preparation written clearly and not abbreviated: Generic name​

Form & strength of preparation ​

Dose & dose frequency; if the medicine is to be taken as required a minimum dose interval should be specified​

Duration of treatment ​

Total quantity of drug e.g. SEND: 15 tablets ​

Instructions: How & when e.g. LABEL: one tablet to be taken three times daily for five days ​

Residual space on form – score out​

Question 21

How should you write a prescription

Answer 21

Written in ink or type-written (PC-generated) ​

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Must be legible​

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Do not use abbreviations​

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May prescribe more than one item per form​

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Must be signed in ink

Question 22

Can more than one item be prescribed per prescription

Answer 22

Yes

Question 23

How should advice for dosage and administration to patients be given

Answer 23

WRITTEN instructions
-stressed patients may not remember verbal instructions
-language barriers may be present
-contact number is useful incase the patient encounters any issues

Question 24

What information should be included in advice/instructions

Answer 24

Take drugs at correct time and finish the course​

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Unexpected reactions: STOP! and contact prescriber​

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Known side-effects should be discussed e.g. Metronidazole and alcohol ​

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Keep medicines safe: especially from children

Question 25

What are common prescribing errors

Answer 25

The Decision To Prescribe​
-Would a different treatment be a better option​
-Consider Local measures​
-Most common dental prescribing error​

Prescribing the wrong drug​
-ADR (adverse drug reactions)
-Ineffective/ Less effective

Completing prescription form incorrectly​