Pharmacology lectures

Question 1

What does mind the gap stand for for drugs with a narrow therapeutic index?

Answer 1

Morphine 
Insulin
Neoplasm (chemotherapy)
Digoxin 
Theophylline/aminophylline
Hypoglycaemia 
Epilepsy 
Gentamicin 
Anticoagulants 
Psychiatric (lithium)

Question 2

What are the three classes of medicines

Answer 2

Prescription only medicine: can only be obtained from a pharmacist with a prescription from an approved practitioner
Pharmacy only medicine- need supervision from pharmacist
General sales list- medicine can be brought from any outlet without prescription or supervision by pharmacist

BNF- all medicines licensed for prescription in the UK

Question 3

What are the three written orders that can be done for prescriptions

Answer 3

FP10- what GPs use
Traditional hospital chart
Electronic prescribing

Question 4

What are some questions you may want to ask someone about drug intolerances?

Answer 4

Are they allergic to any drugs?
If yes- what happens when they took the medication?
Are there any that they cannot take?
If so what happens when they do take them?

Question 5

What are dose related ADR

Answer 5

Side effects
80-90% of all ADR
These are common and well known
Dose related- almost everyone will get them if they are given enough of a drug
Predictable from the pharmacology of the drug
Close temporal relation with drug administration
Can be managed by dose reduction or stopping the drug

Question 6

What are drug allergies- idiosyncratic/bizarre reactions

Answer 6

Allergies are uncommon- affecting 1/100 to 1/1000 people
• Immunologically mediated
○ Immediate- IGE hypersensitivity- anaphylaxis angioedema
○ Delayed IgG hypersensitivity
Triggered by interaction b/w drug and host protein- generating a hapten this drives an immune response
• Unpredictable do not know when going to occur, can be life threatening
Range from rashes to anaphylaxis
Even a rash is important

Question 7

What is the balancing act in prescribing about?

Answer 7

All prescribing is a balancing act:
	• Likely benefits 
		○ Life saving 
		○ Symptom relief 
		○ Preventative 
		○ Life style 
	• Likely risk 
		○ SE 
		○ Allergy reaction 
		○ Special circumstances 
			§ Safe for some not others

Question 8

What should you think about when taking an accurate medical history

Answer 8

Taking an accurate medication history
	• List drugs 
		○ Prescription only
		○ Over the counter 
		○ Complementary therapy 
		○ Illicit drugs
	• Check if taking forgettable drugs
		○ Contraception
		○ Inhalers, sprays and drops and creams 
	• For prescription drugs
		○ Record dose, freq, timing

Question 9

What are the elements of an inpatient prescription

• Patient data
• Drug prescriptions
• Infusion prescriptions
• Additional components

Answer 9

• Patient data: demographics, drug intolerances
• Drug prescriptions: regular, as required, once only
• Infusion prescriptions: IV fluid/drugs given by infusion
• Additional components: O2 prescription, prescriptions with special requirements, medicine reconciliation, VTE risk assessment