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Year 3 - Script > Taking a safe and effective drug history > Flashcards

Taking a safe and effective drug history Flashcards

1
Q

what should a comprehensive drug history identify

A
  • all prescription and non prescription drugs
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2
Q

Name a drugs that can cause serotonin syndrome

A
  • Setraline - this is a selective serotonin re-uptake inhibitor SSRI - increases the serotonin levels at the synapse
  • tramadol - serotonergic drug - risk of serotonin syndrome is increased when two or more serotonergic drugs are prescribed concomitantly
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3
Q

What is medicines reconciliation

A
  • the aim of medicines reconciliation on hospital admission is to ensure that medicines prescribed on admission correspond to those that the patient was taking before admission
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4
Q

what are the three stages of medicines reconciliation

A
  1. verification
  2. clarification
  3. reconciliation
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5
Q

describe the three stages of medicines reconciliation

A
  1. verification = collect information from recent and accurate source to verify the drug history
  2. clarification = check this against the current list of medicines prescribed in hospital
  3. reconciliation = document any discrepancies, changes and omissions, whether intentional or unintentional
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6
Q

What can the process of medicines reconciliation do

A
  • reduce medication errors on admission
  • reduce duplication of effort
  • ensure a standard process of documentation
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7
Q

What should your drug history do

A
  • identify current and recently prescribed drugs
  • identify current and recently taken non-prescribed drugs (including over the counter medicines, herbal adn complementary therapies, borderline substances and any recreational drugs)
  • identify any drug related problems such as adverse reactions
  • identify any allergies/hypersensitivities (including signs, symptoms, severity and duration)
  • identify response to treatment
  • identify treatment failure
  • establish adherence to treatment regimens
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8
Q

What should be established for each drug

A
  • the drug name (generic and brand)
  • the formulation
  • the strength
  • the dose
  • the frequency
  • the duration of treatment
  • the indication
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9
Q

how does information gathered from the drug history form part of your differential diagnosis

A
  • has the patient suffered an adverse drug reaction
  • hsa an accidential omission of a drug caused the admission
  • is the admission related to a treatment failure
  • is the admission related to non adherence
  • is the admission related to drug toxicity
  • is the drugs masking any clinical signs
  • is the drugs interfering with test results
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10
Q

if a patient has missed more than 48 hours of dosing..

A

clozapine needs to be re-titrated
if it i not
- orthostatic hypotension
- cardiac or respiratory arrest

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11
Q

what are the risks of an incomplete history

A
  • fails to identify drugs that should be stopped
  • fail to identify when drugs should be started
  • fail to identify when a dose needs reducing
  • fails to identify when a dose needs altering
  • fails to identify non-adherence
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12
Q

Do herbal medicines count in a medical history

A
  • Herbal medicines count

- they can reduce the concentration of a drug and reduce its therapeutic effect

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13
Q

what sources should you site to find a drug history

A

Source at least two sources of information

  • the patient themselves
  • Patients GP surgery
  • patients own drugs - get them to bring it in

Others

  • carers
  • community pharmacist
  • medical notes and electronic prescribing records
  • NHS summary care record
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14
Q

What are drugs commonly forgotten in a drug history

A
  • borderline substances - vitamins and food supplements
  • contraceptives - oral, injection, intra-uterine
  • eye/ear drops
  • herbal medicines and homeopathic therapies
  • inhaler s
  • injections
  • recreational drugs
  • topical preparations
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15
Q

at what time is it difficult to get a drug history

A

Patient is unable to provide one

  • confuse d
  • unconscious

Patient does not known
- dementia

Communication is a problem

  • foreign language
  • learning difficulties
  • hard of hearing or deaf patients

difficulty contacting information sources

  • GP surgery is closed
  • patient is from abroad
  • patient has no carer
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16
Q

what should you look for in a drug examination

A
  • Puncture sites (drugs of misuse - note the site of injection)
  • pupils - opioids causes constriction
  • Urine colour - rifampicin colours, sweat, tears and urine are orange/red
  • patches - nicotine replacement, opioids, GTN
  • Inhaler technique
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17
Q

what can the patients own drugs identify

A
  • non adhernece
  • dispensing erros
  • use of expired drugs
  • understanding of drug treatments
  • name/address and contact of dispensing pharmacist
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18
Q

Where reviewing a patients own drugs what should you check for

A
  • the patients name
  • dispensing errors
  • self-medicating drugs
  • duplicate items
  • adherence
  • expiry dates
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19
Q

when check asthma what should you check for the inhalers

A
  1. technique - check for an effective technique before adjusting treatment regimens
  2. adherence - check if your patient is adhering to the treatment regimen - ask questions like how often do you use this inhaler
  3. the number of doses left in each inhaler - ensure the patient has been receiving a prescribed dose before choosing to adjust regimens
20
Q

What does a monitored dosage system do

A
  • this divides a patients oral medication into days of the week and times of the day
21
Q

If the MDS is self filled what do you have to be aware of

A
  • MDS may contain non prescribed drugs (herbal tablets)
22
Q

if the MDS is filled by the pharmacist it will not have

A

non prescribed drugs

23
Q

What will an MDS not contain

A
  • when required medication (analgesics)
  • cytotoxic agents (methotrexate)
  • once weekly doses
  • variable doses
  • dispersible or effervescent formulations
  • buccal or sublingual formulations
  • chewable tablets due to confusion
24
Q

What should you consider when reviewing MDS

A
  • Is the MDS filled consistently

- are there any obvious errors

25
Q

What database is used for the visual identification of drugs

A

TICTAC

26
Q

What drug information do GP records include

A
  • acute, current and previous drug treatments
  • allergy status
  • adverse reactions
  • vaccination schedules
  • adherence
  • response to treatment
  • treatment failures
27
Q

what are the limitations of using the GP record for drug information

A
  • accuracy = may not always be up to date
  • accessibility = cannot contact GP outside normal working hours
  • self medicating drugs = unusual to know what drugs a patient self-medicates with
  • take as directed = often used when prescribing variable doses such as insulin and warfarin
  • private prescriptions= not recorded on the GP computer system especially if they have been handwritten
28
Q

What is a summary care record

A

This is an electronic record of the patients medication related information

29
Q

What does the summary care record include

A
  • allergies and adverse drug reactions
  • acute prescriptions
  • repeat prescriptions
  • past medical history
  • care plans
30
Q

What are the negatives of using a summary care record

A
  • not all GP surgeries are loaded onto the SCR
  • patients can opt out
  • regular medicines taken by the patient may not be listed
  • some summaries only state the date that the regular prescription was first started and not the date it was last issued to the patient
  • not all SCRs are up to date
31
Q

What information is in medical history

A
  • drug names, strengths, doses, frequency
  • duration of treatment
  • changes to treatment and the rationale for these changes
  • a treatment plan
32
Q

What are relatives and carers helpful in providing information about

A
  • doses of problem drugs
  • adverse effects
  • allergies
  • self-medication
  • adherence
33
Q

how are nursing homes useful in providing drug information

A
  • use medication administration charts - usually printed
34
Q

how is the community pharmacist a source of information

A

Able to provide information about:

  • acute treatment
  • current treatment
  • previous treatment
35
Q

what is the downside of using the community pharmacist as a source of information

A
  • patients dont always attend the same pharmacy for their prescription
  • the information provided by the pharmacist is restricted to the information provided to them from the GP prescription
36
Q

If your patient cannot provide a warfarin history where should you look

A
  • Anticoagulant clinic
  • yellow oral anticoagulant book
  • the medical notes
  • relatives/carers
  • the community pharmacist
37
Q

What do you need to confirm in an anticoagulant treatment

A

INR

  • target INR
  • current INR
  • who monitors it
  • how often they monitor it

Treatment

  • current dose
  • start date
  • end date
  • dose range

Indication
- reason for anticoagulation

Adherence

  • side effects
  • timing of dose
  • strength of tablets
  • quantity at home
38
Q

describe the different doses of warfarin tablets

A
  • 500 micrograms = white
  • 1mg = Brown
  • 3mg = blue
  • 5mg = pink
39
Q

what does the yellow oral anticoagulation book do

A
  • provides a summary of the indication, the target INR, duration of treatment, history of INR results and the current recommended dose
40
Q

What can you find the insulin dose on

A
  • insulin passport
  • medical notes
  • clinical nurse specialist
  • relatives or carers
  • community pharmacist
  • insulin passport
41
Q

What should you do if you cannot confirm the insulin dose

A
  • Type 1 diabetes/unstable type 2 diabetes mellitus = start a sliding scale with soluble insulin
  • stable type 2 diabetes mellitus - may tolerate omission of insulin with appropriate blood glucose monitoring until the insulin dose is confirmed
42
Q

What should you look for in a drug history of an oral cytotoxic (cancer treatment)

A
  • drug name, strength, dose, formulation and frequency
  • duration of treatment
  • stage in treatment
  • indication
43
Q

How should you reduce the risk of harm in patients taking oral cytotoxic drugs

A
  • alert the oncologist or haematologist
  • alter the oncology/haematology pharmacist
  • only allow cancer specialists to prescribe the drug treatment
44
Q

What drugs is it difficult to assess when the next dose is due

A
  • bisphosphonates - can be taken daily, weekly or monthly
  • hydroxocobalamin - given every 2 or 3 months for maintenance therapy depending on indication
  • injectable antipsychotics
  • methotrexate
  • injectable drugs for rheumatic disease
  • goserelin
  • implants
45
Q

When you have confirmed the drug history what should you think of

A
  • do you need to stop the drug
  • do you need to reduce the dose
  • do you need to increase the dose
  • do you need to switch the drug
  • do you need to pause the prescription
  • do you need to report the drug for an adverse reaction
  • do you need to initiate a new treatment
46
Q

ACEs need to be

A

re-titrated

Year 3 - Script (11 decks)

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