Nursing- Preparing to prescribe > Prescribing lectures > Flashcards

Prescribing lectures Flashcards

(53 cards)

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1
Q

What is independent prescribing?

A

Prescribing by a practitioner responsible and accountable for the assessment of patients with undiagnosed or diagnosed conditions and for decisions about the clinical management required

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2
Q

What is supplementary prescribing?

A

A voluntary partnership between an independent prescriber (doctor) and a supplementary prescriber to implement an agreed patient specific clinical management plan with the patients agreement

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3
Q

What is the process of supplementary prescribing?

A

-Dr makes diagnosis
-patient specific clinical management plan (CMP)
-nurse is competent to manage the patient’s condition using the drug details on the plan
-in place for up to 1 year
-must be in place and signed before prescribing takes place
-can only prescribe within the details of the CMP

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4
Q

What does caveat mean?

A

The expectation that you will prescribe within your scope of practice

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5
Q

What is the difference between prescribing, advising, supplying and administering drugs?

A

Prescribing- legally authorise a patient to obtain specific medicine by writing a prescription

Advising- recommends or suggests a medication or treatment, but does not formally authorise the treatment

Supplying- providing the medication to a patient following the prescription, usually by a pharmacist

Administering- the act of actually giving the medication to a patient by any given route

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6
Q

What is the consultation process?

A

-Assess the patient

-Identify evidence-based treatment options available for clinical decision making

-Present options and reach a shared decision

-Prescribe

-Provide information

-Monitor and review

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7
Q

What are the 4 aspects of prescribing governance?

A

-prescribe safely
-prescribe professionally
-improve prescribing practice
-prescribe as part of a team

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8
Q

What is one consultation model?

A

-consultation
-medical history
-medication history
-allergies sensitivities
-patient specific influences

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9
Q

What are the four key parts of a patient centered consultation?

A

-empathy
-understanding
-communication
-rapport

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10
Q

What is meant by chunking and checking during a consultation?

A

-a key skill used for giving advice during consultations
-chunking is breaking up large pieces of information to it is easier to understand
-checking is checking the patient understands the given information

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11
Q

What is a POM medication classification?

A

Prescription only medication

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12
Q

What is a P medication classification?

A

Pharmacy

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13
Q

What is a GSL medication classification?

A

General sales listed

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14
Q

What is meant by a licensed medication?

A

Licensed- has a marketing authorisation and so has been rigorously tested for its use

A licenced medicine prescribed for the purpose, condition and patients specified in the licence the MA holder is liable for any adverse effects the medicine may have on the patient who take it and is liable for compensation (if proven) for any unexpected harm.

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15
Q

What is meant by off-label medication use?

A

A licensed medication being used in a way that is not covered by its marketing authorisation

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16
Q

What is meant by an unlicensed medication?

A

Unlicensed- does not have a marketing authorisation, can only be used if a licensed medication can’t meet a patients needs. Common in children

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17
Q

What is the role of the Human Medicines Regulation (2012)?

A

To establish a comprehensive legal framework for the authorization, manufacture, distribution, sale, supply, labelling, advertising, and pharmacovigilance (post-market safety monitoring) of medicinal products in the UK

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18
Q

What are the 5 legal requirements for a prescription?

A

-Prescriber signature
-Prescribers work address
-Particulars of the prescriber
-Name and address of patient/ client
-Age of patient if under 12 years old

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19
Q

What are the requirements for prescribing controlled drugs?

A

-formulation must be stated e.g tablet

-quantity prescribed must be in words and figures

-quantity prescribed must not exceed 28 days worth of supply

-number of dosage units e.g 10 tablets of 10mg, rather than 100mg total

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20
Q

What are the four ethical principles?

A
  1. Respect for autonomy- responsible for the decisions we make. Involve patient/ carer/ parent respect autonomous decision
  2. Non maleficence- avoiding unnecessary or unjustifiably harm. Is the level of harm proportionate to the good? Evidence based practice
  3. Beneficence- ensure the best interest of the patient. Medicines optimisation. Evidence based practice
  4. Justice- limited resources, not enough to go round, who gets priority? NICE guidelines and clinical standards
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21
Q

What are the four pillars of accountability?

A
  1. professional
  2. ethical
  3. legal
  4. employment
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22
Q

What is medicines optimisation?

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A

The safe and effective use of medicines to enable the best possible outcomes

23
Q

What are the 4 principles of medicine optimisation which results in a patient-centred approach?

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A
  1. aim to understand the patient’s experience
  2. evidence based choice of medicines
  3. ensure medicines use is as safe as possible
  4. make medicines optimisation part of routine practice
24
Q

What factors contribute to an optimised combination of medication?

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A

-regular review
-adherence
-maintains quality of life
-minimises harm
-cost effective

25
What factors contribute to an inappropriate combination of medication?
-interactions -pill burden -reduced adherence -medicating side effects -expensive
26
What is required to take a drug history?
-current medication including drug, dose, frequency, strength, formulation, route -allergies, sensitivities, reactions -alcohol/ tobacco consumption
27
What is the Medicines Act 1968 role?
governs manufacture and supply of medicine, safeguards the public and establishes medication classifications
28
What is the Misuse of Drugs Act (1971) / Misuse of Drugs Regulations (2001) role?
-defines certain activities in relation to controlled drugs, in particular manufacture, supply, possession
29
What is medicines reconciliation?
The process of accurately listing a person’s current medicines. This could be when they are admitted into a service or when their treatment changes.
30
What is the aim of medicines reconciliation?
To ensure that medicines prescribed on admission correspond to those that the patient was taking before admission as errors commonly occur on transfer between care settings
31
What things contribute to correct prescribing practice?
-time of administration should be circled -prescriber should cross through unwanted administration boxes -frequency should be specified if not daily
32
What do the following accepted abbreviations stand for? OD OM ON NOCTE BD TDS QDS PRN STAT
OD - once daily OM – once in the morning ON – once at night NOCTE – at night BD – twice daily TDS - three times daily QDS – four times daily PRN – as required STAT – immediately
33
For drug dose units, what abbreviations are and aren't accepted?
Accepted: -milligrams = mg -grams = g Must be written in full: -micrograms -nanograms -units
34
What is concordance?
An agreement between the prescriber and patient/ parent reached after negotiation that respects the beliefs and wishes of the patient in determining whether when and how their medicine is taken
35
What is the 5C's approach to safety netting?
-is the patient Capable of assessing themselves? -is the patient legally Competent? -can the patient Comprehend and Comply with instructions? -has their comprehension been Confirmed?
36
What clinical situations require safety netting?
-When there is diagnostic uncertainty during early presentations of illness -When there is diagnostic uncertainty e.g. waiting for the results of investigations -When advice is being given instead of a prescription -When a delayed prescription is being provided -When a prescription is being provided in case of treatment failure -Potential side effects
37
What is the role of patient group directives (PGDs)?
-A legal framework that allows registered health professionals to supply and administer specific medicines to pre-defined groups of patients without the need for a prescription -it is a written document that needs signing by a doctor and pharmacist -e.g clinic for flu vaccine
38
In terms of STOMP, what needs to be considered during a consultation?
-health inequalities -diagnostic overshadowing -higher rates of physical health conditions -provide an opportunity for shared decision making to discuss risks and benefits of medication -difficulties in administration of medicines
39
What is required before writing a prescription when considering STOMP?
-physical health check -behaviour baseline recording -a functional assessment -quality of life measure
40
What is an adverse drug reaction?
Any undesirable effect of a drug which is not an anticipated therapeutic effect occurring during clinical use
41
How should a suspected ADR be responded to?
-assess nature and severity of reaction -take a history of the presenting condition -consider full drug history and review any previous ADRs -review the potential known adverse effects and consider if it keeps in line with them -consider the need for further examinations and investigations
42
What factors can increase someones susceptibility to an ADR?
-age (young and old) -polypharmacy -gender -concomitant disease -race and genetics
43
What is a type A ADR?
-Augmented reaction -result from an exaggeration of a drug's normal pharmacological actions when given at usual dose
44
What is a type B ADR?
-bizzare reaction -not expected from the known pharmacological actions of the drug -less common so may only be discovered after a drug has been made available for general use -e.g anaphylaxis or skin rash (usually immune related)
45
What is a type C, D and E ADR?
type c= continuing type D= delayed type E= end of use
46
How is an ADR reported?
using the yellow card scheme
47
What is a pharmacokinetic interaction?
A drug interaction occurs when the effects of one drug are changed by the presence of another drug, food or drink
48
What is an absorption drug interaction?
A type of pharmacokinetic drug interaction where one drug alters the rate another drug is absorbed into the blood stream
49
What is a distribution drug interaction?
A type of pharmacokinetic drug interaction where one drug alters the distribution of another around the body
50
What is an induction drug metabolism interaction?
Drugs that increase the activity of CYP450 enzymes increase the metabolism of the second drug, resulting in a reduced drug concentration and pharmacological effect, potentially rendering it sub therapeutic
51
What is an inhibition drug metabolism interaction?
Drugs that inhibit the activity of the CYP450 enzymes decrease the metabolism of the second drug resulting in increased drug concentration, pharmacological effect and potential toxicity
52
What is the difference between drug excretion and elimination?
-elimination is the overall process of removing a drug from the body -excretion is one of the main components of elimination- the physical removal through waste products The other part is metabolism- the chemical conversion of a drug into metabolites
53
What are pharmacodynamic drug interactions?
-involves drugs that have either similar or antagonistic pharmacological properties -similar effects are usually due to drugs acting on the same physiological systems, termed additive/ synergistic interactions -this can either provide greater pharmacological effects or cause greater toxic effects
Nursing- Preparing to prescribe
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