Safe Prescribing 2

Question 1

What are the 3 main sections of the BNF?

Answer 1

• Guidance on prescribing in palliative care and emergency treatment on poisoning
• Chapters on individual therapeutic areas e.g. infections. Individual drug monograms are contained within these chapters
• Appendices e.g. interactions, additives

Question 2

What is a drug monograph?

Answer 2

• Dosing information
• Contains details about the indication for use of that drug
• Some drugs will have different doses for different indications

Question 3

What can gabapentin be used for?

Answer 3

• Seizures (epilepsy)

- Neuropathic pain (not liscensed for this but can still be used)

Question 4

What is amitriptyline licensed for and what else canit be used to treat?

Answer 4

• Licensed for both depression and nocturnal enuresis

- Can also be used for neuropathic pain and migraine prophylaxis

Question 5

Why do you need to be careful when prescribing unlicensed medications?

Answer 5

• You then carry accountability for the prescription

Question 6

Name some epilepsy drugs

Answer 6

• Carbamezipine
• Gabapentin
• Phenytoin

Question 7

Give an example of a drug which can be given with a modified release?

Answer 7

Nifedipine (usually given 3x daily)

• Adalat LA is a formula to be given once daily
• Adalat Retard is given 2x daily

Question 8

How can drug interactions be classified?

Answer 8

• Pharmacodynamic

- Pharmacokinetic

Question 9

What does a pharmacodynamic drug interaction mean?

Answer 9

2 drugs which have an additive or antagonistic pharmacological effect

Question 10

What does a pharmacokinetic drug interaction mean?

Answer 10

When a drug increases or decreases the amount of another drug available in the body by affecting the absorption, distribution, metabolism or excretion of the other drug

Question 11

What does a black dot mean in the BNF?

Answer 11

Serious drug interaction

Question 12

Sources of information regarding prescribing

Answer 12

• Local NHS trust formularies
• BNF
• Pharmacists
• Medicines information department
• EMC

Question 13

What is the difference between qd in the US and UK?

Answer 13

US = once daily 
UK = 4x daily

Question 14

Where can you find information regarding dosing of different formulations of morphine in the BNF?

Answer 14

Palliative care section

Question 15

Where can you find information regarding drug interactions, dosing in renal impairment and administration details of IV infusions of medicines?

Answer 15

Appendix

Question 16

What is a presribing error?

Answer 16

The result of a prescribing decision or prescribing writing process that results in an unintentional but significant reduction in the probability of treatment being timely and effective or an increased risk of harm compared with the generally accepted practice

Question 17

Classify the different types of prescribing errors

Answer 17

• Slips and lapses (accidently writing the wrong thing)

- Mistakes (writing the wrong thing not knowing the usual dose is something else)

Question 18

What are the common causes of prescribing errors

Answer 18

• Inadequate knowledge of the patient and their clinical status
• Inadequate drug knowledge
• Calculation errors
• Illegible handwriting
• Drug name confusion
• Poor history taking

Question 19

What are the 3 different stages of errors in terms of medications?

Answer 19

• Prescribing
• Dispensing
• Administration

Question 20

What percentage of prescriptions are associated with error/

Answer 20

1.5%

Question 21

Give some ‘top tips’ for prescribing (what should you always do/check)

Answer 21

• Check allergy status
• Legible pen
• Sign legibly to legalise
• Approved names of drugs
• Use BLOCK letters
• Sign/date and give reason for discontinuation
• No abbreviations (only GTN is acceptable)
• Write doses in full (e.g micro)
• Antibiotics - state review date or course length
• PRN medications: include max frqncy, mx no of doses in 24 hrs and the indication