Prescription reviews Flashcards
What is a prescription review?
The process of systematically assessing a patient’s medications to ensure they are safe, effective, appropriate, and optimised for their health needs.
What are the Five ‘R’s of Prescribing?
- Right drug
- Right dose
- Right route
- Right frequency
- Right patient
What should be reviewed regarding the indication of a drug?
- Does the patient still need the drug?
- Has the condition changed?
- Is there a better alternative?
What patient-specific factors should be considered in a prescription review?
- Renal and hepatic function
- Pregnancy and breastfeeding
- Age-related changes
What are common drug interactions to check for?
- Warfarin + macrolide antibiotics = ↑ INR
- Multiple antihypertensives causing hypotension
What are some common prescription errors?
- Incorrect dosing
- Inappropriate drug choice
- Contraindicated medications
- Incorrect formulation or route
- Omissions
- Lack of necessary monitoring
What is one example of incorrect dosing?
Overdosing in renal impairment, such as morphine accumulation in CKD.
Name a contraindicated medication in asthma.
Beta-blockers can cause bronchospasm.
What should be done regarding teratogenic drugs during pregnancy?
STOP teratogenic drugs like warfarin and ACE inhibitors.
What is a critical action regarding prescribing in renal impairment?
Dose adjustments are required for drugs like digoxin and aminoglycosides.
What does the STOPP criteria refer to?
Medications to avoid in the elderly.
What should be monitored for patients on warfarin?
INR monitoring.
List the steps in a prescription review.
- Look at the full drug list
- Check for unnecessary medications
- Assess interactions and contraindications
- Check doses for renal/hepatic function
- Ensure correct formulations and routes
- Monitor high-risk drugs
- Assess adherence
- Deprescribe where appropriate
Fill in the blank: A prescription review helps identify drug interactions, inappropriate prescribing, errors, and opportunities for _______.
deprescribing
True or False: All medications should be continued indefinitely regardless of changes in the patient’s condition.
False
What is a common issue identified in an elderly patient with CKD?
Ramipril can risk worsening renal function.
What are the potential risks of prescribing naproxen in a patient with CKD?
Increased risk of GI bleed and nephrotoxicity.
What practical tips should be remembered for PSA exam questions?
- Check drug interactions in the BNF
- Adjust doses for renal/liver impairment
- Deprescribe where possible
- Know monitoring requirements for high-risk drugs
- Ensure appropriate antibiotic duration
What is a prescription review?
The process of systematically assessing a patient’s medications to ensure they are safe, effective, appropriate, and optimised for their health needs.
What are the Five ‘R’s’ of Prescribing?
- Right drug
- Right dose
- Right route
- Right frequency
- Right patient
What should be reviewed regarding the indication for a drug?
- Does the patient still need the drug?
- Has the condition changed?
- Is there a better alternative?
What patient-specific factors should be considered in a prescription review?
- Renal and hepatic function
- Pregnancy and breastfeeding
- Age-related changes
What should be checked for drug interactions and duplications?
- Common interactions
- Avoid polypharmacy where possible
What are the common prescription errors?
- Incorrect dosing
- Inappropriate drug choice
- Contraindicated medications
- Incorrect formulation or route
- Omissions
- Lack of necessary monitoring
What are examples of incorrect dosing errors?
- Overdosing in renal impairment
- Underdosing antibiotics
What are some inappropriate drug choices?
- NSAIDs in heart failure
- Metformin in CKD
Which medications are contraindicated in pregnancy?
- Warfarin
- ACE inhibitors & ARBs
- Sodium valproate
What are the steps in a prescription review?
- Look at the full drug list
- Check for unnecessary medications
- Assess interactions and contraindications
- Check if doses are appropriate
- Ensure correct formulations and routes
- Monitor high-risk drugs
- Assess adherence
- Deprescribe where appropriate
Fill in the blank: The process of assessing a patient’s medications to optimize health is called _______.
[Prescription review]
What are the monitoring requirements for high-risk medications?
- Warfarin: INR monitoring
- Lithium: Plasma levels, U&Es
- Digoxin: Levels, K+, renal function
- Methotrexate: FBC, LFTs
- Clozapine: WBC monitoring
- Statins: LFTs (before and after starting)
True or False: It is important to deprescribe medications when they are no longer needed.
True
What modifications should be made for elderly patients regarding prescriptions?
- Avoid long-term benzodiazepines
- Avoid NSAIDs in CKD
- Consider START criteria for missing medications
What should be done when a patient is on long-term NSAIDs?
Prescribe a PPI to prevent gastrointestinal complications.
What is a critical action when reviewing medications in pregnancy?
STOP teratogenic drugs.
What adjustments are required for prescribing in renal impairment?
- Dose adjustments for digoxin and aminoglycosides
- Stop metformin if eGFR <30 mL/min
What issues were identified in the case example of the elderly patient?
- Risk of worsening renal function from ramipril
- Increased risk of GI bleed and nephrotoxicity from naproxen and warfarin
- Possible pedal oedema from high-dose amlodipine
What are practical tips for PSA exam questions?
- Check drug interactions
- Look for contraindications
- Deprescribe when possible
- Know monitoring requirements
- Ensure appropriate antibiotic duration
What is the importance of a prescription review?
To ensure safe, effective, and appropriate prescribing.
