Safe prescribing

Question 1

some medication errors (give some examples)

Answer 1

• professional practice
• health care products
• procedures and systems
• product labeling, packaging, and nomenclature
• dispensing
• distribution
• administration
• education
• monitoring

Question 2

Common mistakes with cancer (temazepam)

Answer 2

should have been given tamoxifen

Question 3

giving a contraceptive steroid instead of an ?

Answer 3

antipsychotic injection

Question 4

INR is a measure of?

what is the normal values?

Answer 4

warfarin activation

- should be 2.5-3.5

Question 5

NR 5.0–8.0, minor bleeding - WHAT DO YOU DO?

Answer 5

—stop warfarin sodium; give phytomenadione (vitamin K1) by slow intravenous injection;

Question 6

restart warfarin sodium when?

Answer 6

INR <5.0.

Question 7

NR 5.0–8.0, no bleeding— what do you do?

Answer 7

withhold 1 or 2 doses of warfarin sodium and reduce subsequent maintenance dose.

Question 8

warfarin replacement?

how is this done?

Answer 8

vitamin K or replacement of vitamin K-dependent clotting factors.

IV administration of a prothrombin complex concentrate (PCC),

Question 9

Cytochrome P450 are very ?

Answer 9

potent antifungals,

warfarin wasn’t being metabolised

Question 10

lowest INR level for preventing stroke?

Answer 10

2

Question 11

Types of medication error (4)

Answer 11

• mostly occurs from surgery
• complications from drug treatment
• therapeutic mishaps
• diagnostic errors were the most common non-operative events.

Question 12

Which patients are most at risk? (5)

Answer 12

• Those undergoing cardiothoracic surgery, vascular surgery, or neurosurgery
• Those with complex conditions
• Those in the emergency room
• Those looked after by inexperienced doctors
• Older patients

Question 13

Some factors that could increase the rate of medication errors? (5)

Answer 13

• More rapid throughput of patients
• New drug developments, extending medicines into new areas
• Increasing complexity of medical care
• Increased specialisation
• Increased use of medicines generally
  Sicker and older patients, more vulnerable to adverse effects

Question 14

People related causes of medication incidents?

Answer 14

• Fatigue: Sleep deprivation
• Hunger: Long lapses between food/drink
• Concentration: Lapses
• Stress
• distraction
• lack of training
• lack of access to information

Question 15

Common Prescribing Errors - give some examples

Answer 15

• Wrong drug (e.g. drugs that sound alike)
• Wrong dose
• Inappropriate Units
• Poor/illegible prescriptions
• Failure to take account of drug interactions
• Omission
• Wrong route/multiple routes (IV/SC?PO)

Question 16

some of the most common drug GROUPS that cause harm/incidents

Answer 16

opiates

anticoagulants

anaesthetics

insulin

antibiotics

chemotherapy

infusion

chemotherapy

Question 17

ARI most common drugs prescribed wrong

Answer 17

Paracetamol
Gentamicin
Warfarin
Oxycontin - opiate
Methadone
Insulin

Question 18

Always check the patient information..give examples

Answer 18

• Age
• Weight
• Renal and hepatic function
• Concurrent diseases
• Laboratory test results
• Concurrent medications
• Allergies
• Medical/Surgical/Family - History
• Pregnancy

Question 19

Use 500 mg for

Answer 19

0.5 g

Question 20

Use 125 microgrammes for

Answer 20

0.125 mg

Question 21

oral methotrexate is regularly prescribed how often?

Answer 21

Methotrexate prescribed

as 10mg once weekly

Question 22

what does methotrexate do?

Answer 22

suppress bone marrow - can lead to patient death

Question 23

Prevention of Medication Errors - the FIVE R’s?

Answer 23

Right Patient
Right Drug
Right Dose
Right Route 
Right Time