Year 3 pharmacology

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  • Created by: evepoag
  • Created on: 19-09-23 14:19
Why is the 'green agenda' important?
health systems cause large amounts of carbon emissions
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How many United Nations sustainable development goals are there?
17 SDGs
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What do the United Nation's sustainable development goals aim to achieve?
tackle climate change and preserve forests and oceans
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How can nurses and healthcare systems reduce pharmaceutical waste?
- recycle medicines packets
- improve prescribing and medicine use
- tackling medicine waste
- prevent ill health
- improve ways of working
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How can systems improve prescribing and medicine use?
increase the availability of personalised medicine and pharmacogenomics, reduce medicine waste, reuse of patient-returned medicines
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What is social prescribing, in terms of preventing ill health?
signposting
health coaching
providing services and activities
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What are the 5 main ethical issues in medicine?
1. medical errors
2. end of life care
3. confidentiality
4. resource allocation
5. artificial intelligence
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What is the nurses responsibility in patient risk management?
inform patients of risks associated with treatment, and warn them that not following recommended treatment can poorly affect their health
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What is the nurse's duty of care involving medication?
They are liable for any harm, they must ensure every drug is safely administered
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Name the requirements for inpatient prescriptions
- written in black, legible handwriting from a legal prescriber
- start and end date
- drug name, form, strength, frequency, time, route of administration
- drug dose
- PRN medications should include maximum dose and intervals
- prescriber signature
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What are unlicensed medications?
medicines that are not specifically indicated for that condition or age group
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Before an unlicensed medication can be prescribed, what two reasons must be present?
Alternative licensed medication do not work or meet patient needs, and that there is sufficient evidence to demonstrate the medicine's safety for use
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Does the patient need to know if a medicine is unlicensed?
Yes, the patient must agree and understand the implications
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Can verbal, remote prescribing be accepted?
Remote prescribing only in exceptional circumstances, not as routine.
Verbal cannot be accepted without a fax/email stapled to Kardex
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How long after a prescriber sends a fax/email for remote prescribing must they write and sign a new prescription sheet?
Within 24 hours, maximum of 72 hours during bank holidays/weekends
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When can remote prescribing not be accepted, even in exceptional circumstances?
If the medication has not been prescribed before and prescriber has never assessed the patient before
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What is the Human Medicines Regulations 2012?
UK law regarding medicine for human use
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What are the symptoms of a non-severe penicillin allergy?
Rash, fever, joint pain
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What are the symptoms of a severe penicillin allergy?
Anaphylaxis
Angioedema/swelling
Severe rash
Wheezing or stridor
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What is medicine 'concordance'?
the relationship between healthcare professional and patient in reaching shared treatment decisions
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What is co-production?
Personalised care that meets patient's needs and the patient is involved in the planning and design of care, contributing to the managements of their own condition
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What does co-production aim to AVOID?
Patients making decisions in avoidable ignorance

Doctors providing treatment that leads to underuse and waste
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What are the 4 key elements of shared decision making?
1. unbiased information
2. defined roles
3. present with evidence
4. mutual agreement
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What are the 3 domains of self-care?
1. Biological
2. Psychological
3. Social
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What are patient action plans?
Turning health strategies into action
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What should written action plans include?
Instructions for daily treatment, instructions for escalation treatment in the event of deterioration, information on when to seek urgent medical help
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What is self-efficacy?
A person's belief in their ability to do well
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Describe the Know, Check, Ask process of patient self-medication administration
KNOW your medicines
CHECK you are using medicines correctly
ASK a healthcare professional if you are unsure
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What are the 5 Rights of medication administration?
1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
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What checks should be undertaken to ensure the right patient?
Check patient's name, DOB, H+C number
These should be checked against the patient's wristband, the drug Kardex, and verbal confirmation
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What checks should be undertaken to ensure the right medication?
Check the name of the medicine (avoid brand names), check expiry date, check prescription
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What should you look out for to ensure the right medication and avoid error?
Avoid look-a-likes in similar packaging

Avoid sound-a-likes, ie: insulin pens novomix and novorapid
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What checks should be undertaken to ensure the right dose?
Check prescription, check packaging, check for decimal points, confirm appropriateness with the BNF, if calculations are present - ask a 2nd nurse to check the calculation
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What is the 'more than 3' rule and why is it used?
If you need more than 3 tablets, check with Dr/pharmacist/senior nurse

This rule is because doses do not usually require more than 3 tablets to make up one dose
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What checks should be undertaken to ensure the right route?
Check the prescription, check appropriateness of the route prescribed in the BNF, confirm that the patient can take the medication by this route
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When giving oral/enteral liquid medications, what should you use?
Purple EnFit syringes
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What should you ensure when administering injectable medicines?
All lines are labelled appropriately
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What checks should be undertaken to ensure the right time?
Check the frequency of the medications, double check before administering medication that you are giving it at the correct time, check when the last dose was given
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What is a critical medication and why is it important to give at the right time?
A critical medication is a medicine that is crucial that it is given at a certain time.

It is important because omitted or delayed doses can harm the patient or compromise their treatment
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What are examples of critical medicines?
Anti-infectives, ie: antibiotics
Anticoagulants
Insulin
Parkinson's Disease medicines
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What should you do if a critical medication is not available at the time it is prescribed for?
Inform the Dr/nurse in charge, take action to obtain a supply (including outside pharmacy opening hours), document it
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What are the other 5 rights that are not as commonly known?
1. Right patient education
2. Right documentation
3. Right to refuse
4. Right assessment
5. Right evaluation
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How can you ensure right patient education?
Check if the patient understands what the medication is for, and any side-effects they may experience
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How can you ensure right documentation?
Sign for the medicine AFTER you have administered it, ensure it is prescribed correctly
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How can you ensure the patient's right to refuse?
Gain patient consent before administering medications, be aware that patients can refuse if they have the mental capacity to do so
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How can you ensure the right assessment?
Check that the patient needs the medication, check for contraindications, get baseline observations if needed
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How can you ensure the right evaluation?
Ensure the medication is working properly, oversee regularly if required
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What is model of medication error called?
The Swiss cheese model
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Describe the Swiss cheese model
Multiple small errors line up to make one big error.
The line up starts with the prescriber, then the pharmacist, then the nurse, then the patient.
The nurse is often considered the 'safety net'
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What is transcription?
Transcribing is the act of making an EXACT copy of a prescription, usually in writing.
It is the copying of previously prescribed medicine details, in accordance with the instructions of a prescriber
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Who can transcribe?
Nurses can now transcribe IF their trust policy permits AND they are trained and assessed as competent to do so
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When can nurses refuse to transcribe?
When details are illegible, unclear or incomplete
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When should particular care be taken when transcribing?
When you are transcribing high-risk medicines, such as insulin, anticoagulants, cytotoxic, and controlled drugs
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What is drug titration and what is it's aim?
Personalised changes to medication doses to achieve the best clinical response

To give the patient effective treatment at the lowest dose possible, with aim of minimising unnecessary medication use and side effects
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What is up-titration?
When you increase the dose of medication over time until symptoms relieve or a lab value is met, indicating the most appropriate dose has been found
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What is down-titration?
When you decrease the dose of a medication over time to lessen side effects or find the lowest possible dose that keeps a patient's symptoms and lab values under control
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What is cross-titration?
Up and down-titrating at the same time when one medication is being stopped and another is being started
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What approach should be given to titration?
An individualised, patient-centred partnership approach
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Why does drug titration cause suboptimal adherence?
Difficult for patients to understand and follow
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What does titration improve?
It is improves drug safety
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What pharmacokinetic and pharmacodynamic factors affect the amount of drug required for a patient?
- Absorption
- Bioavailability
- Distribution
- Metabolism
- Excretion
- Magnitude and duration of drug effect
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What drugs are commonly titrated?
Drugs with a narrow therapeutic index
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Describe narrow therapeutic index
The optimisation of drug benefit while minimising the risk of adverse effects
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What drug types commonly require titration and give an example of each?
1. Antibiotics - Vancomycin
2. Anticoagulants - Warfarin
3. Antidiabetics - Insulin

other: antipyschotics, anticonvulsants
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Describe Warfarin titration
Anticoagulant warfarin has a narrow therapeutic index. The anticoagulant effect is assessed by the blood's INR level.
Deviation from the therapeutic INR range is associated with increased risk of haemorrhage if too high, or thrombosis if too low
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What are the 3 legal categories of medicines?
1. Prescription Only Medicines (POM)
2. Pharmacy medicines (P)
3. General Sale List medicines (GSL)
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What is a Prescription Only Medicine?
Drug that must be sold/supplied according to a prescription, and can only be supplied at a pharmacy
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What is a Pharmacy medicine?
Drug that must be sold/supplied at a pharmacy under the supervision of a pharmacist
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What is a General Sale List medicine?
Drugs that can be sold in pharmacies, supermarkets, as long as they can be locked and medicines are pre-packed
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What must be in place for a Prescription Only Medicine?
A signed prescription, a signed Patient Specific Direction (PSD), or a Patient Group Direction
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What is an exemption from medication prescription administration?
Emergencies, such as adrenaline
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What is a Patient Specific Direction (PSD)?
A written instruction, signed by a prescriber, for medicines administered to a list of named patients after each patient has been individually assessed

It is different from an FP10 pharmacy prescription
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What happens if a prescriber gives verbal instructions to alter the dose of a medicine previously prescribed in a Patient Specific Direction?
A clear record of the discussion, rationale and treatment actions, with fax/email evidence
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When is Patient Group Direction used?
For situations in which this offers an advantage for patient care, without compromising patient safety
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Give 2 examples of care facilitates with PGDs and what are the common PGD medications?
1. Endoscopy and midazolam
2. Theatre recovery and paracetamol
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What is the 2 most important thing noted on a PGD prescription?
The dose and the clinical condition or situation to which the direction applies
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What can NOT be prescribed under a PGD?
- unlicensed medications
- most controlled drugs
- dressings and devices
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What is the most common cause of medication errors?
Wrong dose given
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How can you prevent drug calculation errors?
1. understand drug measurements/units
2. double-check all calculations
3. work out weight-based dosages
4. remember that calculation complexity increases risk
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What is a new update in injectable drug labelling?
There is now a large label for infusion bags, and a small label for injections and syringes
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What happens if a sedative is regularly prescribed for the morning and should you question it?
Yes, because the patient can become drowsy
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What is a co-morbidity?
More than one illness or disease occurring in one person at the same time
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What is multi-morbidity?
More than two illnesses or diseases occurring in one person at the same time
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Who is most at risk of developing multimorbidities?
Elderly people
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What 2 difficulties do polypharmacy pose for patients?
Increased risk of drug interactions, and complicated medication regimes that are difficult to follow
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What type of conditions most commonly define a cormobidity?
The index condition - the condition that came first
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Cormorbidities can be defined as clinically dominant, synergistic, and coincidental. Describe what is meant by clinically dominant
Clinically dominant = where one illness trumps another,
ie: the index condition like dementia can overshadow the diagnosis/treatment of another like heart disease
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What is it called when a clinically dominant comorbidity overshadows the diagnosis/treatment of the other condition?
Diagnostic overshadowing
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Describe what is meant by a synergistic comorbidity?
Synergistic = when two diseases are related in how they arise and are treated
For example, COPD and heart disease
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Describe what is meant by coincidental cormorbidity?
Coincidental = when there is no obvious relationship between diseases, and the disease managements are separate
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When coming up with a treatment plan for a patient with comorbidities, what do you need to consider and why?
Patient complexity

A patient's cultural background, personal situation, socio-economic background, living conditions, care roles, etc. all contribute to the patient's complexity
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What is polypharmacy?
The use of multiple medicines at the same time by one person
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How many medications would a patient need to take before it is considered polypharmacy?
Typically 5 or more medications
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Who is at-risk of polypharmacy?
Elderly people, and those with long-term chronic conditions/co-morbidities
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What is the 'law of diminishing returns'?
The certain benefit made by each additional medicine is likely to reduce when a person is taking multiple preventative medicines, but the risk of harm increases
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What are the 2 different types of polypharmacy?
Appropriate and inappropriate polypharmacy
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What is appropriate polypharmacy?
Prescribing for a person for complex or multiple conditions in circumstances when the use of medicines is effective according to best evidence
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What is problematic or inappropriate polypharmacy?
The prescribing of multiple medicines inappropriately, or where the intended benefits are not realised, or the risk of harm from medicines outweighs the benefits
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How many medicines are considered excessive polypharmacy?
6-9 drugs
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What is 'synergy' in the use of multiple medications?
The combined effect of 2 drugs is greater than the sum of their effects when given separately
ie: fentanyl and midazolam or paracetamol and ibuprofen
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