SCRIPT: rational drug choice

Question 1

“The next best thing to knowing something is knowing…

Answer 1

where to find it” [Samuel Johnson]

Question 2

What is ‘evergreening’

Answer 2

Attempts by pharmaceuticals to extend their patent of an old drug due to come off-patient, through a variety of practices. For example:

• A different dosing regimen (e.g. modified release formulation).
• A different delivery profile.
• A new indication (e.g. child health).
• A new mechanism of action.

Question 3

Guidelines for gifts.

a) GMC guidance for doctors
b) ABPI guidelines for reps

Answer 3

a) ‘You must not ask for or accept any inducement, gift or hospitality which may affect or be seen to affect the way you prescribe for, treat or refer patients’

b) - Attendees may be provided with inexpensive notebooks, pens and pencils for use at those meetings’
- ‘They must not bear the name of any medicine or any information about medicines but may bear the name of the company providing them’
- ‘If pens and pads are provided in conference bags at third party organised meetings, then these must not include the names of the donor companies, the name of any medicine or any information about medicines’
- ‘No individual attendee should receive more than one notebook and one pen or pencil. The total cost to the donor company of all such items provided to an individual person attending a meeting must not exceed £6, excluding VAT’
[ABPI Code of Practice,2015].

Question 4

Five steps to evidence-based practice

Answer 4

1. Define the question - PICO
2. Find the best available evidence
3. Appraise the evidence critically
4. Apply the evidence in practice
5. Perform Audit

Question 5

Formula for…

a) NNT
b) NNH
c) ICER

Answer 5

NNT = 1 / absolute risk reduction (ARR)

NNH= 1 / absolute risk excess (ARE)

ICER = Cost (A - B) / QALYs gained (A - B)

Question 6

Audit cycle

Answer 6

• Identify problem
• Set standards
• Collect data
• Analyse data (compare to standards)
• Implement change
• Re-audit

Question 7

What useful information can be found in the summary of product characteristics (SPC)*

• If still unclear on any aspect of a drug, contact the drug manufacturer directly

Answer 7

• Pharmacodynamics
• Pharmacokinetics
• Full list of drug excipients (not found in the BNF)
• Patient information leaflets on drugs if they don’t have one

Found at eMC: www.medicines.org.uk

Question 8

Which source should be used for infectious disease immunisation queries?

Answer 8

‘The Green Book’

• available online via the Department of Health and Social Care website

Question 9

Which source should be used for the visual identification of drugs (primarily tablets and capsules) and substances that may resemble drugs?

Answer 9

TICTAC

Question 10

Which source should be used for toxicology and poisons queries?

Answer 10

TOXBASE

Question 11

Patient presents in unplanned pregnancy and you need to establish if the drugs she is taking are safe in pregnancy.
What sources should you consult?

Answer 11

More than one source, including:

• BNF
• SPC
• Manufacturer directly, if required