Practical aspects of Prescribing

Question 1

What are the 2 most common causes of a disproportionate urea:creatinine ratio?

Answer 1

• Upper GI Bleed

- Hypovolemia

Question 2

What factors can increase risk in prescribing?

Answer 2

• Pharmacological factors

- Human factors

Question 3

What drugs are known to have a narrow therapeutic index?

Answer 3

M - Morphine
I - Insulin
N - Neoplastic drugs
D - Digoxin

T - Theophylline / Aminophylline
H - Hypoglycaemic agents
E - Epilepsy drugs

G - Gentamicin
A - Anticoagulants
P - Psychiatry drugs

Question 4

What steps are taken to ensure patients on a drug that has narrow therapeutic index are given a safe dose?

Answer 4

=> Calculation of dose:
- Based of patients weight, body surface and carefully accounting for renal or hepatic impairments

=> Measurement of the blood concentration

=> Careful monitoring for adverse effects:

Question 5

What are the different human factors that increase risk in prescribing?

Answer 5

=> Doses, dosage units and intervals

=> Contextual factors (ambiguity, distraction, time pressures

=> Bias

Question 6

What are the different types of bias?

Answer 6

=> Availability bias:
- A preference of diagnosis that comes to mind easily

=> Base rate neglect:
- Not accounting for the prevalence for the condition in the general population

=> Confirmation bias:
- Interpreting info in a way to confirm pre-conceived bias

=> Search satisfying:
- Ceasing search for further info once enough info has been gathered ti support initial thought

=> Diagnostic momentum:
- Failing to question judgements made previously

=> Commission bias:
- A preference for action rather than inaction

Question 7

What steps are taken to reduce bias in practice?

Answer 7

=> increasing awareness of bias

=> Slowing down

=> Metacognition (thinking about thinking)

=> Checklists