Taking a drug history +BNF introduction Flashcards
Define clinical pharmacology
Define therapeutics
Clinical pharmacology is the science of drugs and their clinical use. It is underpinned by the basic science of pharmacology, with added focus on the application of pharmacological principles and methods in the real world.
Therapeutics is the provision of treatment and care to combat disease or alleviate pain or injury. Its tools include drugs, surgery, radiation therapy, mechanical devices, diet, and psychiatry.
what are the different information given in the bnf
Indications (when it’s used)
Cautions/Contraindications (when it’s NOT)
Hepatic and renal impairment
Pregnancy and Breastfeeding
Side-effects
Dose, for adults, children and elderly
Preparations, Oral, IV, IM, PR …
Cost
What are the 4 BNF appendices
4 Appendices:
- Interactions
- Borderline substances (e.g. nutritional products)
- Cautionary & advisory labels
- Wound management products …. &
Yellow Cards at the back(reporting adverse drug reactions)
Which drugs are included in the BNF?
Define Unlicenced
Define Off label
• BNF contains all licensed drugs used in UK clinical practice
Unlicensed: not licensed for use in the UK
- If the clinical need cannot be met by a licensed medicine
- Use should be supported by evidence and experience for its safety and efficacy
- This is relatively rare in practice – usually for specialist use Off-label: Prescribing a medicine for use outside the terms of it’s product licence • Use of a different dose or prescribed for a different indication • Not given the same degree of scientific scrutiny as labelled indications • Up to 1/5 of medicines use is probably ‘off label’
What is the purpose of a drug history?
Medicines being taken and adherence to treatment – Prescribed – Non-prescribed – Dose, frequency and duration – Timing of the last dose – Method of administration – Patient’s knowledge of the therapy
To aid diagnosis – Indicators for specific diseases – Adverse drug effects – Masking of clinical signs – Altering of investigation results – Medication errors.
To guide future treatment – Identify beneficial medicines – Identify medicines found to be harmful – Avoid withdrawal effects
What to ask in a drug history?
Do you take any medicines that are prescribed? …if so,
• What is the dose? • How do you take them? • Why was it given? • How often do you take them? • How long have you been on them?
Does the medicine have beneficial or adverse effects? Any other medicines? • Inhalers, creams, drops, injections?
Do you take any medicines not prescribed by your doctor? • OTC, herbal or alternative medicines
Do you remember to take your medicines?
Have any medicines ever upset you?
Do you have any allergies?
Have you had all of your vaccinations?
♀: Are you on the OCP? Preparations via non-oral routes
- Topical preparations, eye / ear drops, transdermal patches, inhalers, injections Occasional Prescriptions
- Weekly / monthly injections (e.g. flupenthixol, goserilin) ‘Borderline’ substances
- Food supplements, vitamins, etc. Other specific substances • ‘Baby’ aspirin
DRUGS mnemonic for drug history
Chemotherapy and radiation therapy can have long term side effects on vartius systems.
What are the side effects?
Hearing loss from high doses of chemotherapy, especially drugs like cisplatin
- Nervous system side effects, including peripheral neuropathy)
- Lung and heart problems – lung fibrosis, cardiomyopathy
- Haematological effects - myelodysplasia
Allergy questions
In all cases it is imperative to inquire about a history of drug allergy … especially if you want to prescribe a drug with a risk of allergic reaction e.g. penicillin
Asking specifically about penicillin allergy can be useful?
If Yes …
- what is the nature of the allergy? … true allergy is much rarer than intolerances
- when did the reaction occur? … a clear temporal relationship should be sought
Inspect the medicines - what should you look for>
Examine the drugs themselves
– Identification (?for correct patient)
– Exact regimen on the label
– Sometimes discover errors in drug storage
– Errors in dispensing
– Expired medicines
– Number of dosage forms taken since dispensed
Ask the patient to show you how they take certain medicines (e.g. Inhalers) – Discover errors in drug administration
What database can help identify pill colours
TICTAC
What are the side effect of amocillin
And opiods
Rashes (amoxicillin)
– Pupil size (opioids, TCA OD)
What is the concordance
What happens to rate of errors as more drugs are given
“Degree to which a patient’s behaviour (lifestyle, diet, drugs) coincides with medical or health advice”
More ‘fashionable’ term = Concordance – implies a 2-way decision Dependent on: – Nature /Regimen of treatment – Characteristics of patient – Behaviour of doctor – Type of illness
Higher rate of error
Give examples of compliance aids?
How do you assess adherence of drugs?
Compliance Aids include: Monitored dosage systems e.g. Medidose®, NOMAD® Medication reminder systems (Directly observed treatment)
Many different methods for assessing adherence to medications
Direct methods include:
Directly observed therapy Measurement of drug levels in blood / urine Ingestible pill sensors
Indirect methods include: Self-reporting Pill counts Prescription rate refills Measurement of physiological markers Patient diaries Smart pill bottles
Define polypharmacy
Traditional view of ≥4 concurrent use of medicines no longer valid
We know that polypharmacy can be beneficial for some patients, but also harmful if poorly managed; so – Appropriate polypharmacy = prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and where the medicines are prescribed according to best evidence
– Problematic polypharmacy = the prescribing of multiple medications inappropriately, or where the intended benefit of the medication is not realised.
