2 Flashcards
(140 cards)
What are the 4 types of medicines that are identified as high risk, and so useful for MURs
NSAIDs –> Adherance to gastric protection?
Anticoagulants (including LMWHs) –> APTT
Antiplatelets –> Possible GI Bleed (No aspirin!)
Diuretics –> Non-adherence is bad
Name some things that determine whether we monitor certain patients?
The drug they’re on –> Warfarin needed more than in paracetamol
Disease state –> Drugs like paracetamol are more important when being used in somebody with liver dysfunction, than in those with a healthy liver
Acute Disease –> More intensive than chronic diseases
Certain Patient Factors –> Eg, when pregnant, immunocompromised and the elderly
Whats the DOTS classification? In terms of adverse drug reactions
Dose Relatedness –> They can occur at 3 different levels…
Supra-therapeutic = Toxic levels
Therapeutic levels = Collateral (unintentional) effects
Sub-therapeutic = Hyper-susceptibility reactions
Time –> Can occur at anytime, but often due to changes in patient factors (such as renal function)
Susceptibility –> Varies due to patient factors (eg, age/gender/pregnancy/co-morbidities/drug interactions)
What is duty of candour?
A legal duty that tells us that we have to own up to our mistakes and be held responsible for them
What are the 4 guiding principles of Medicines Optimisation?
Aim to understand the patients experience
Evidence based choice of medicine
Ensure medicines use is as safe as possible
Make medicines optimisation a part of routine practice
What’s the difference between an adverse drug reaction, and an adverse drug event?
Drug Reaction –> A reaction that is reasonably attributable to the drug
Drug Event –> An event that occurs whilst a patient is taking a drug (but the drug isn’t necessarily the cause of the event)
What type of monitoring parameter does recording INR fall under?
Haemotological
How many of the 400 MURs a year must be done on targeted groups?
70%
What are the 4 Patient Orientated Outcomes (POOs)?
Reduction in side effect and medication errors
Better access to a large range of services
More effective use of medicines
Greater involvement in my own care with support when needed
What is Medicines Optimisation?
An approach to the quality use of medicines that aims to produce the best possible outcomes for patients and maximise the value from medicines
What are the 4 largest groups of drugs that cause ADRs?
Diuretics
NSAIDs
Warfarin
Antiplatelets
How long does it normally take an IV drug to reach the steady state?
4 half lives
What are the 4 Clinical Laboratory Services?
Clinical Biochemistry
Haematology/Immunology
Histopathology
Microbiology/Virology
What are the 2 types of contraindications?
Relative –> Caution should be used, but the drugs can be used if the benefits outweigh the benefits
Absolute –> The interaction could cause a life-threatening situation. This should always be avoided
What treatments should be given for somebody undergoing an anaphalactic shock?And why?
Adrenaline –> Reduces swelling, wheezing and increases BP
Steroids –> Reduction of inflammation and swelling
Antihistamines –> Reduces swelling and inflammation
IV Fluids –> Replaces fluids that are lost through leaky capillaries
Which group of drugs has caused the most ADRs?
NSAIDs
What are the 4 target areas for an NMS?
Hypertension
Anti-platelet/Anticoagulant
Type 2 diabetes
Asthma/COPD
<p>What is clinical governance?</p>
Audits Risk management Education and Training Openness R&D Clinical effectiveness
What are the conditions for a respiratory MUR?
Must be on 2 medications, with at least one being for asthma or COPD and on the list for an NMS
Medicines optimisation will offer a step change in how issues are addressed through….
Patient Engagement
A Focus on Outcomes
Pharmaceutical Leadership
A holistic view across the medicines pathway
When should a Post Discharge MUR be done?
4 weeks after discharge ideally…..but can be 8 weeks in certain circumstances
What are the main risk factors of the drug to patients, in reference to allergies?
Nature of the Drug –> Aspirin/Penicillins/anticonvulsants/antipsychotics
Degree of Exposure –> Occurs more for intermediate courses than of moderate doses
Route of Administration –> Oral safer than IV, but topical is more sensitising
Cross-Reactivity
What are the conditions for a cardiovascular MUR?
Patients with, or at risk of, CVD and on at least 4 medications
One of these medications must be for CVD, Diabetes or thyroid
What characteristics of a drug means we need to monitor drug levels in the serum?
When there is a large degree of inter-patient variability
Narrow therapeutic-index
Odd/unpredictable PKs