Prescribing errors

Question 1

any preventable event that may cause or lead to inappropriate medication use or patient harm, while medication is in the control of the health care professional, patient or consumer.

Answer 1

medication error

Question 2

Majority of medication errors happen in

Answer 2

secondary care

Question 3

Drugs commonly associated with ADE related hospital admissions:

Answer 3

IV antibiotics  (common medication error)
NSAIDs 
Anti-platelets
Diuretics
Anticoagulants

Question 4

…. prevent medication error

Answer 4

Pharmacists

Question 5

prescribing decision or prescription writing process

Answer 5

prescribing error

Question 6

deciding which drug to use and how

Answer 6

Prescribing Faults

Question 7

writing process that result in wrong instructions

Answer 7

Prescription Errors

Question 8

errors that arise from poor planning or inadequate knowledge

Answer 8

Mistakes

Question 9

imperfect execution of well-formulated plans when an erroneous (wrong) act is committed

Answer 9

slips

Question 10

lapses when a correct act is omitted.

Answer 10

lapses (missing out)

Question 11

….. are the drugs most commonly involved in medication errors in hospital

Answer 11

Intravenous antibiotic

Question 12

Medication error rates in hospital are higher in ….. and ……

Answer 12

paediatric

ICU

Question 13

Elderly and NSAIDs

Answer 13

high lipid solubility of NSAIDs - widespread distribution due to increased age-related adipose tissue stores.

NSAIDs are extensively protein bound - increased concentration of unbound drug due to reduction in plasma protein found in many older persons.

NSAIDs have decreased renal clearance in older patients, potentially resulting in excessive drug levels and toxicity

Question 14

Adverse Reaction of NSAIDs in elderly

Answer 14

Increase BP
Produce renal insufficiency (both acute renal failure and worsening of chronic renal insufficiency)
Hyperkalaemic and fluid retention
GI side effects including GI bleeds

Need to monitor renal func regularly !!

Question 15

hydrophillic drug that has a narrow therapeutic index

Answer 15

Digoxin

Problem in elderly

Low lean body mass and total body water - decreased Vd of hydropphillic drug - High in plasma
Reduced renal clearance of digoxin:
↓ serum albumin → Higher active unboud drug concentrations
NSAID reduce renal clearance of Digoxin

Monitoring
Appropriate use of digoxin in the elderly
Monitor electrolytes frequently
Renal function (dose

Question 16

long half-life - problem if prolonged
active metabolite “nordazepam” - half life of about 60 hours
some are more lipid soluble than others

Answer 16

Benzodiazepines

With a decrease in hepatic function, there is obviously an increase in half life of the benzo.

With respect to benzos elderly people are more sensitive to their effects- e.g. excessive sedation. Older people show a response to a lower plasma level of benzos than do younger patients

Short acting benzos with low lipid solubility and no active metabolites should be prescribed for elderly when a benzo is indicated—for short term use only. E.g. alprazolam, lorazepam.

Question 17

The 5 Rs

Answer 17

Right patient
Right drug
Right route
Right time
Right dose

Right Formulation?
Sustained Release Preparations
Drugs that must be prescribed by brand
Changing between formulations

Question 18

Cytochrome P450 Inducers

CRAP GPS induce me to madness!!

Answer 18

Carbemazepines (anti-epileptics) and antidepressants (St Johs worts)
Rifampicin
Alcohol (chronic)
Phenytoin & Primidone (Anti-epileptics)

GI drugs (omeprazole)
Phenobarbitone
Sulphonylureas and Smoking

Question 19

P450 Inhibitors

SICKFACES.COM

Answer 19

Sodium valproate 
Isoniazid (antibact)
Cimetidine (GI drugs)
Ketoconazole (antifungals)
Fluconazole (antifungals)
Alcohol..binge drinking 
Chloramphenicol 
Erythromycin (Antibact)
Sulfonamides 
Ciprofloxacin (antibact)
Omeprazole (GI)
Metronidazole (anti-bact)
Grapefruit juice