Prescribing Safety

Assessment
Foundation Year Peer Teaching
Dr Noor Faridah (Newcastle University)
Dr Clifford Sia (Cambridge University)
Dr Shairashree Kumaran (Newcastle University)
Outline
• Brief structure of PSA
• Tips
• How to navigate online BNF, MedicinesComplete and BNF paper book
• Practice Questions
Marking
Section Distribution Marks
1. Prescribing 8 questions – 10 marks each 80
2. Prescription review 8 questions – 4 marks each 32
3. Planning management 8 items – 2 marks each 16
4. Communicating information 6 questions – 2 marks each 12
5. Calculations 8 questions – 2 marks each 16
6. Adverse drug reactions 8 questions – 2 marks each 16
7. Drug monitoring 8 questions – 2 marks each 16
8. Data interpretation 6 questions – 2 marks each 12
TOTAL MARKS 200
Tips
• Know how to use of BNF online and MedicinesComplete.
• Know what is useful in the paper BNF – body surface area, treatment summaries,  electrolyte deficiency,
analgesia conversion.
• Attempt the practice papers on the official PSA site.
• Dual screen – BNF/ Medicines Complete.
• Control+F.
• Multiple tabs open.
• Calculator and pen.
Enzyme Inducers & Inhibitors
• Enzyme Inducers: CRAP GPs Enzyme Inhibitors: SICKFACES.COM
• Carbemazepine • Sodium Valproate

• Rifampicin • Isoniazid
• Cimetidine
• Alcohol (chronic use)
• Ketoconazole
• Phenytoin
• Fluconazole
• Griseofulvin
• Alcohol (binge drinking)
• Phenobarbitol • Clarithromycin
• Sulphonureas • Erythromycin
• St Johns Wort • Sulphonamides
• Smoking • Ciprofloxacin
• Omeprazole
• Metronidazole
Fluid Prescribing
Emergency Emergency Emergency Maintenance without any losses Is there a fluid deficit?
Resuscitation hypoglycaemia hypercalcaemia
0.9% sodium 10% glucose 0.9% sodium Routine maintenance: It is possible that there
chloride chloride • 25-30 ml/kg/day of water is a need for >3L of
150ml over <15 • 1 mmol/kg/day of K+, Na+. Cl- water per day, so it is
500ml over <15 mins 1000ml over 4 • 50-100g/day of glucose likely that they will
mins hours require 1000ml over <6
OR hours, however
e.g. precaution should be
20% glucose 0.9% sodium chloride with 0.3% (40 taken in not giving
mmol/L) potassium chloride fluids too fast.
75ml over <15
mins 1000ml over 8-12 hours e.g.
0.9% sodium chloride
OR with 0.3% potassium
chloride (40 mmol/L)
5% glucose with 0.15% (20 mmol/L)
potassium chloride 1000ml over 4-6 hours

1000ml over 8-12 hours

Statin
• Non-HDL cholesterol
• 3 months use of statins should reduce non-HDL cholesterol by >40%
• >40%  reduction → continue current dose
• =<40% reduction → consider increasing dose

• ALT – statins are known to increase ALT and other LFTs

• ALT increase >1x but <3x upper limit of normal → continue statin, recheck LFTs in 4-6 weeks
• >=3x upper limit of normal → discontinue statin

• Creatine Kinase – known to increase with statin

• CK increase >1x but <5x upper limit of normal → continue statin with regular CK monitoring
• >= 5x upper limit of normal → discontinue statin
Nephrotoxic drugs
• ACE inhibitors and ARBS – perindopril, valsartan
• NSAIDs – ibuprofen, naproxen
• Diuretics – furosemide, spironolactone
• Certain antibiotics – aminoglycosides (gentamicin), vancomycin
• Certain antifungals – amphotericin B
• Certain chemotherapy and immunosuppressants – cyclophosphamide
• Contrast media
Q1
A1

• Tinzaparin sodium 4500 units subcutaneous daily

• Aspirin 75 mg or 150 mg oral daily
• Dalteparin sodium 5000 units subcutaneous daily
• Enoxaparin sodium 40 mg  subcutaneous nightly or
daily
• Rivaroxaban 10 mg oral daily
Q2
A2

Sodium chloride 0.45%/ glucose 5%/ potassium chloride 0.15% solution,

OR sodium chloride 0.18%/ glucose 4%/ potassium chloride 0.3% or
0.15% solution

500ml or 500ml: 4-6 hours

1000ml 1000ml: 8-12
hours
Q3
A3
Q4
A4
Q5

A. Continue sertraline 200 mg PO daily

B. Continue sertraline and add citalopram 20 mg PO
daily
C. Increase dose of sertraline to 250 mg PO daily
D. Stop sertraline and start mirtazapine 30 mg PO
nightly
E. Stop sertraline and start tranylcypromine 10 mg PO
12-hrly
A5
Q6

A. Morphine 10 mg by continuous SC infusion over 24 hours

B. Morphine 15 mg by continuous SC infusion over 24 hours

C. Morphine 30 mg by continuous SC infusion over 24 hours

D. Morphine 45 mg by continuous SC infusion over 24 hours

E. Morphine 60 mg by continuous SC infusion over 24 hours

A6
Q7

A. continue taking all insulin doses as usual

B. continue the usual bolus insulin doses at meal times

and reduce the night time basal insulin dose by 20%

C. continue the usual bolus insulin doses at meal times

and omit the night time basal insulin dose

D. reduce the meal time bolus insulin doses and the

night time basal insulin dose by 20%

E. reduce the meal time bolus insulin doses by 20%

and continue the usual night time basal insulin dose
A7
Q8

A. after administration she should rub the injection site for a few
minutes 
B. she should choose an injection site 2.5 cm away from her
belly button 
C. she should expel the air bubble from the syringe before
administration 
D. she should hold the syringe at a right angle to the skin and
insert the full length of the needle 
E. she should stretch the chosen area of skin between two
fingers before inserting the needle 
A8
Q9
Q10
Q11

A. Agitation

B. Circumoral tingling

C. Paranoia

D. Seizure

E. Ventricular tachycardia
A11
Q12

A. acetylcysteine 200 mg/mL 42 mL by IV infusion over

1 hour
B. acetylcysteine 200 mg/mL 49 mL by IV infusion over
1 hour
C. acetylcysteine 200 mg/mL 57 mL by IV infusion over
1 hour
D. acetylcysteine 200 mg/mL 64 mL by IV infusion over
1 hour
E. acetylcysteine 200 mg/mL 72 mL by IV infusion over
1 hour
A12
Q13

A. fasting plasma glucose

B. liver enzymes

C. renal function

D. serum lipids

E. serum prolactin
A13
Q14

A. full blood count

B. INR

C. liver enzymes

D. renal function

E. serum albumin
A14
Q15

A. levothyroxine sodium 100 micrograms PO daily

B. levothyroxine sodium 125 micrograms PO daily

C. levothyroxine sodium 50 micrograms PO daily

D. levothyroxine sodium 75 micrograms PO daily

E. levothyroxine sodium 25 micrograms PO daily

A15
Q16

A. increase pre-breakfast and pre-lunch insulin aspart

(NovoRapid®) by 2 units 
B. increase bedtime dose of insulin detemir (Levemir®) by 2 units 
C. increase pre-breakfast dose of insulin aspart (NovoRapid®) by 2
units 
D. increase pre-evening meal dose of insulin aspart (NovoRapid®)
by 2 units 
E. increase pre-lunch dose of insulin aspart (NovoRapid®) by 2
units 
A16
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