The Safe Prescribing Assessment (You don’t have to know any pharmacology) (but you do need to know how to use your BNF well!)

QUESTION 1 A frail elderly gentleman is admitted from a nursing home with pyelonephritis. The letter from the nursing home states that his usual medication is: Aspirin 75mg each morning Digoxin mg each morning, Paracetamol 1g qds. He also requires IV co – amoxiclav 1.2g tds for the pyelonephritis (to be given for 24 hours & then reviewed). Write up a drug chart for this gentleman. He has no known allergies. Patient: Benjamin Witton Hospital No: B83957 Address: 1 Perth Road Willenhall DOB: 9/4/22 Consultant: Dr A Baker Ward: 12

Aspirin 75mg each morning Digoxin 62.5 mcg each morning, Paracetamol 1g qds. IV co – amoxiclav 1.2g tds also on regular (arrows to indicate review) (not the same as stop!

QUESTION 2 Write a prescription for a patient going home on morphine sulphate modified release 30mg every 12 hours. A 14-day supply is required. Patient: Annie Robson Hospital No: S92938 Address: 49 Newton Ave Nuneaton DOB: 28/6/47 Consultant: Dr J Smith Ward: 14

CD T.T.O. Full name & address don’t forget to sign & print name & date Write prescription as morphine sulphate modified release 30 (thirty) mg b.d. (or MST continuous) 14-days TOTAL 28 (twenty eight) tablets

QUESTION 3 A 70 kg patient who is in atrial fibrillation & has not responded to digoxin, requires an urgent loading dose of amiodarone. The patient requires an infusion 5mg/kg of amiodarone to be administered in 250ml of fluid over 2 hours. Write an IV prescription for the loading dose of amiodarone as a rate controlled infusion. Patient: Carole Smith Hospital No: D53748 Address: 27 Grosvenor Gardens Rugby DOB: 4/8/50 Consultant: Dr S Morrison Ward: 24

70kg X 5 mg = 350mg in 250ml of ? fluid (care) over 2 hours (or 125ml/ hr) On an IV chart On ‘once only’ section of ordinary drug kardex can indicate that there is a prescription on IV chart – do not write as full prescription on both charts - may get given twice

QUESTION 4 A 60 kg man with acute severe asthma is deteriorating & it is decided to treat him with IV aminophylline. He has not previously been treated with theophylline. He has no known drug allergies. Complete an IV prescription for both initial treatment & continued infusion (Prescribe infusion in 500ml fluid at calculated starting dose assuming subsequent review & drug level monitoring. The regimen used should be realistic for clinical use & not impose an undue fluid burden on the patient). Patient: John Knox Hospital No:J42687 Address: 4 Tadcaster Road Bedworth DOB: 12/12/62 Consultant: Dr J Wilson Ward 2

IV aminophylline 60 kg man; dose from BNF IV prescription chart 500ml fluid initial treatment at calculated starting dose continued infusion assuming subsequent review & drug level monitoring regimen used realistic for clinical use & not impose an undue fluid burden on the patient ie keep volume lowish & reasonable rate).

QUESTION 5 A patient has been prescribed morphine sulphate SR 20mg PO b.d. regularly, & morphine sulphate 10mg every four hours when required for breakthrough pain. Tick the box according to which formulations would be appropriate to prescribe (there may be more than one correct answer in each category): regularly?as required? Sevredol 10mg tablets Oramorph liquid 10mg/5ml Sevredol 20mg tabletsMST Continus10mg tablets

QUESTION 6 What effect might you expect co-administration of following drugs to have on warfarin therapy (>1 effect may apply ) DrugIncrease effect of warfarin Decrease effect of warfarin No interaction with warfarin Amiodarone Rifampicin Bendroflumethiazide Ciprofloxacin Phenytoin

QUESTION 7 Classify following 9 antibiotics for administration to a patient who is documented to have had an anaphylactic reaction to penicillin (Tick appropriate column): DrugCan be given safelyTo be avoided Flucloxacillin Augmentin Amoxil Cefuroxime Ciprofloxacin Clarithromycin Tazocin Meropenem Rifampicin

QUESTION 8 An adult patient with known renal impairment & an estimated GFR of 15ml/min is admitted with an acute infection. Microbiology have recommended meropenem to be given as an iv injection over 5 mins. He has no known allergies. Write a prescription for this patient on an inpatient drug chart. Patient: Alan Baxter Address: 7 Yeoman Court Warwick DOB: 19/7/47 Consultant: Dr P Brown Ward 10

Modifying for renal impairment (appendix) estimated GFR of 15ml/min is severe impairment an iv injection over 5 mins How many times a day (modify for renal function) It does not say give one dose only In reg medication section When would you review? Annotate accordingly

END OF ASSESSMENT Thank you for taking part in the Safe Prescribing Skills Assessment NOW PLEASE CHECK YOUR ANSWERS CAREFULLY