Prescribing safety

Question 1

Which medications should be stopped on sick days as per NHS ‘Medicine Sick Day Rules’ card?

Answer 1

SADMAN mnemonic:

S: SGLT2 inhibitors (‘flozins’)
A: ACEI
D: diuretics
M: metformin
A: ARBs
N: NSAIDs

Once feeling better and able to eat and drink for 24–48 hours, can restart. If diuretic for heart failure - assess fluid status first.

Question 2

What are the neonatal complications of lithium?

Answer 2

effects on the central nervous system, respiratory system and thyroid.

Question 3

What is the government agency responsible for monitoring the safety of medicines in the UK.?

Answer 3

Medicines and Healthcare products Regulatory Agency (MHRA)

Question 4

What is the Yellow Card Scheme?

Answer 4

• patients and health professionals can report
• suspected problems or incidents involving:
  Suspected adverse drug reactions (ADRs) to all medicines including:
• vaccines
• blood factors and immunoglobulins
• herbal medicines
• homeopathic remedies

All medical devices available on the UK market

Defective medicines (those that are not of an acceptable quality)

Fake or counterfeit medicines or medical devices

Nicotine-containing electronic cigarettes and refill containers (e-liquids)

Question 5

How long are prescriptions for controlled drugs valid for?

Answer 5

• valid for 28 days from the date of issue.

Question 6

How long are non-controlled drug prescriptions valid for?

Answer 6

• for 6 months (or 12 months for repeatable prescriptions).

Question 7

What are the Controlled Drug Schedule 2 & 3 requirements?

Answer 7

• The patient’s full name, address and age
• clearly state the name, form (e.g. tablets, capsules), strength and dose
• The dose must be as specific as possible
• quantity must be written in words and figures
• total quantity supplied should not exceed 30 days, unless in exceptional circumstances as with all other controlled drugs
• Signed by the prescriber

Question 9

What 4 defence strategies can prevent prescribing errors? (the practice study)

Answer 9

• personal strategies e.g phoning for speciliast pharmacist advice if unfamiliar
• practice-wide strategies e.g. practice precribing lead
• secondary care strategies e.g. hospital policy for GP letters to highlight new meds and reasons
• Technology strategies: e.g alerting to interactions.

Question 10

What is stratified medicine?

Answer 10

the use of genomic testing to ‘prescribe the drug that is most likely to have a positive therapeutic effect, at the optimum dose and in the right combination with other medications to patients at the start of treatment

Question 11

For people at high risk of ulceration (incl previous ulcer) who require an NSAID, which should be given?

Answer 11

consider a cox-2 or low dose ibuprofen in combination with a proton pump inhibitor.

Question 12

What are the emergency doses of adrenaline for anaphylaxis?

Answer 12

IM doses of 1:1000 adrenaline (repeat after five minutes if no better):

• Adult 500 microgram IM (0.5 ml)
• Child more than 12 years: 500 microgram IM (0.5 ml)
• Child 6–12 years: 300 microgram IM (0.3 ml)
• Child less than six years: 150 microgram IM (0.15 ml)