Safe Drug Use

Question 1

The Dunning–Kruger effect is a cognitive bias. What does the first major peak of this relate to?

1 - impostor syndrome
2 - over confidence (Mt stupid)
3 - valley of despair
4 - slope of alignment

Answer 1

2 - over confidence (Mt stupid)
- people think they are experts, in reality they are not

• gaining experience will move into valley of despair as you realise you don’t know everything, and eventually slope of alignment

Question 2

Typically what are the most commonly prescribed medications in GP practices?

1 - analgesics (naproxen and codeine)
2 - lipid regulating (atrovastain)
3 - diabetes (metformin)
4 - anti-epileptics (carbamazepine)

Answer 2

1 - analgesics (naproxen and codeine)
- guidelines play a major role in prescribing

Question 3

Which of the following is a definition of the prescribing cascade?

1 - prescriber does not stay up to date with current guidelines
2 - prescribed keeps prescription on repeat, meaning any new medications just get added and not reviewed
3 - prescriber prescribes new medication to treat symptoms that may be iatrogenic (adverse events of current medication)
4 - prescribed continually increases the dose of a drug to treat the patient

Answer 3

3 - prescriber prescribes new medication to treat symptoms that may be iatrogenic (adverse events of current medication)

• for example, amitriptyline given for insomnia
• common side effects of amitriptyline are constipation, urinary incontinence, dizziness, dry mouth, and dry eyes
• other prescribers then may prescribe docusate with senna for constipation, oxybutynin for urinary incontinence, and eye drops for dry eyes
• 1 drug for insomnia (amitriptyline) has led to 5 drugs being prescribed

Question 4

Match the below definitions with known side effects and adverse events?

• the effect on the patient was unknown
• the effect on the patient is an established effect of the drug

Answer 4

• adverse event = the effect on the patient was unknown
  known side effects = the effect on the patient is an established effect of the drug

Question 5

Which of the following drugs is associated with the most adverse events?

1 - diuretics
2 - NSAIDs
3 - digoxin
4 - beta-blockers

Answer 5

2 - NSAIDs
- closely followed by diuretics

Question 6

Cockcroft Gault: for creatine clearance:

140-AGE (years) X Weight (kg) X Constant*​
Serum creatinine (micromol/L​)
​
Constant = 1.23 male and 1.04 female​
​
Or useMdCalcwith same characteristics

Question 7

Which of these will reduce the anticoagulant effect of warfarin?

1 - Aspirin
2 - Citalopram
3 - Levetiracetam
4 - Prednisolone
5 - Rifampicin

Answer 7

5 - Rifampicin
- CYP450 inducer therefore will reduce the patients INR

Question 8

Which of these can increase the anticoagulant effect of warfarin?

1 - Alcohol (chronic)
2 - Amoxicillin
3 - Grapefruit juice
4 - Metronidazole
5 - Morphine sulfate

Answer 8

4 - Metronidazole
- CYP450 inhibitor therefore will increase the patients INR
- may need a lower dose

Question 9

Calcium gluconate = cardiac stabilising drug in hyperkalaemia

Question 10

Which of the following is the highest priority to check before prescribing antibiotics?

1 - Allergy status
2 - Blood culture results
3 - Medication history
4 - Recent antibiotic course(s)
5 - Renal function

Answer 10

1 - Allergy status

Question 11

Which 2 of the following are safe for a patient with an allergy to penicillin?

1 - Amoxicillin
2 - Co-amoxiclav
3 - Doxycycline
4 - Piperacillin and tazobactam
5 - Ceftriaxone

Answer 11

3 - Doxycycline (Tetracyclines)
5 - Ceftriaxone (Cephalosporin)

• all other drugs have penicillin in them