taking a drug history

Question 1

define clinical pharmacology and therapeutics

Answer 1

Clinical pharmacology - the science of drugs and their clinical use. It is underpinned by the basic science of pharmacology with added focus on the application of pharmacological principles and methods in the real world

Therapeutics - the provision of treatment and care to combat disease or alleviate pain or injury. Its tools include drugs, surgery, radiation therapy, mechanical devices, diet and psychiatry.

Question 2

what is the BNF and what does it contain?

Answer 2

The British National Formulary

• guidance on prescribing
• notes on drugs and preparations
• appendicies (interactions, borderline substances, cautionary and advisary labels, wound management, yellow cards)

Question 3

what is the difference between unlicensed and off label drugs?

Answer 3

unlicenced drugs are drugs that are not licenced for use in the UK. They may be used if the clinical need cannot be met by any licenced drugs and should be supported by evidence and experience. Hence, their use is very rare and is only done by experts.

off label drugs are drugs that are licenced but are prescribed for a use that is not covered by the licence. This is used more commonly.

Question 4

why is taking a drug history important?

Answer 4

• to plan future treatment
• to recognise symptoms as adverse effects
• because drugs may alter investigations or mask clinical signs
• understanding attitudes to treatment
• medication may allow us to guess medical history to some extent (be careful when a drug has more than one use)

Question 5

what do you need to ask about in a drug history?

Answer 5

• prescribed drugs - ask specifically about inhalers, creams, eye drops, contraception etc as patients may forget these
• non prescribed drugs - herbal, OTC
• have you had all your vaccinations - why not if no
• dose, frequency and duration
• timing of last dose
• method of administration
• patients knowledge of therapy - why was it given to you?
• complience - do you always take your medicines? ask a patient to show you how they are taking it for certain medications eg. inhaler
• drug allergies or intolerences

remember to ask the patient how they feel about the drug - is it helping? is there any side effects?

sometimes you may have to ask about previous medications such as chemotherapy or radiation

Question 6

what pneumonic can you use to to remember to ask about all the drugs in a drug history?

Answer 6

DRUGS

• doctors - doctor prescribed drugs
• recreational - tobacco, alcohol, illicit drugs
• User - drugs obtained by the user such as over the counter medications, complementary and alternative medicines
• gynaecological - contraceptive and HRT
• sensitivites - any reactions and nature of the reaction

Question 7

what do you need to cover in a drug examination?

Answer 7

signs of administration

• IV track marks
• injection sites eg. insulin
• patches

beneficial effects
- eg. check pulse if on beta blockers or check tremor in parkinsons disease

adverse effects

• pupil size
• rashes

Question 8

define complience / adherence / concordance

Answer 8

the degree to which a patients behaviour (lifestyle, diet, drugs) coincides with medical or health advice

Question 9

what does compliance depend on?

Answer 9

• nature/ regime of treatment
• characteristics of patient
• behaviours of doctor
• type of illness

the rate of errors increases with the number of drugs taken causing unintentional non-adherence.

Question 10

how can you assess complience?

Answer 10

direct methods

• directly observed therapy eg. methadone
• measurement of drug level in blood and urine
• ingestible pill sensors

indirect methods

• self reporting
• pill counting
• prescription rate refills
• measurement of physiological markers
• patient diaries
• smart pill bottles

Question 11

define polypharmacy

Answer 11

traditionally this is more than 4 concurrent use of medications but this is no longer valid as most patients are on this many. You should therefore refer to appropriate polypharmacy vs problematic polypharmacy

Appropriate polypharmacy - prescribing for an individual for complex conditions or for multiple conditions in circumstances where medicines use has been optimised and where the medicines are prescribed according to the best evidence

Problematic polypharmacy - the prescribing of multiple medications appropriately, or where the intended benefit of the medication is not realised.