1. Prescribing Skills Assessment Prescribing Question Item Authoring Tool
This file contains a guide to authoring question items as well as example question items
Please turn to the next page
Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

2. Information Given to Candidates
This is a Prescribing Skills Assessment created by the Medical Schools Council and British Pharmacological Society with the aim of assessing knowledge, skills and judgement related to prescribing medicines.
This assessment is designed for medical students who are in the final months of their undergraduate studies and are due to graduate shortly.
We are asking you to identify yourself on the next page so that we can look for correlations between results of this test and the local assessment process.
There will be 12 stations testing various aspects of prescribing, reviewing and advising about medicines as a Foundation doctor, mapped against the learning outcomes identified by the General Medical Council in Tomorrow’s Doctors (2009).
You will have 1 hour to complete the whole assessment.
The weighting of each station is summarised on the next page and the marks allocated to individual question items within it will be clearly marked.
This assessment will not carry negative marks.
The invigilator will indicate the time when 15, 30, and 45 minutes have passed.
You are allowed the use of a BNF and a calculator at any time.
Commonly used abbreviations are provided on the page after next.
This page shows you the information provided to the candidates prior to the start of the pilot assessments.
Candidates should be allowed 5 minutes to go through this information

3. Prescribing Skills Assessment – Format
Station
Description
Marks
Comments 1
Prescribing 1 10
1 question item of 10 marks 2
Prescribing 2 3
Prescription Review 1 8
2 question items of 4 marks each 4
Planning Management 5
Communicating Information 6
3 question items of 2 marks each
Drug Calculation Skills
4 question items of 2 marks each 7
Prescribing 3
Prescribing 4 9
Prescription Review 2
Adverse Drug Reactions 11
Drug Monitoring 12
Data Interpretation
TOTAL MARKS
100
This document has been written to help you create question items for the Prescribing Stations.
This page shows you the overall structure of the one hour assessment with the weighting of the individual stations.

4. Abbreviations
Prescribing abbreviations
daily once each day (usually in the morning)
nightly once each day at bedtime
12-hrly twice each day (morning and evening)
8-hrly three times each day
6-hrly four times each day
4-hrly six times each day
as required as often as necessary
IM intramuscular
IV intravenous
ORAL by mouth
SL sublingual
SC subcutaneous
Examination findings
BP blood pressure (mmHg)
HR heart rate (per minute)
HS heart sounds
JVP jugular venous pressure (centimetres)
RR respiratory rate (per minute)
O2 sat arterial oxygen saturation (%)
Investigations
Hb haemoglobin
WCC white cell count
PT prothrombin time
aPTT activated partial thromboplastin time
Na serum sodium
K serum potassium
U serum urea
Cr serum creatinine
eGFR estimated glomerular filtration rate
Bili serum total bilirubin
ALT serum alanine aminotransferase
Alk phos serum alkaline phosphatase
ECG electrocardiogram
CXR chest X-ray
AXR abdominal X-ray
US ultrasound scan
Units
mmol/L millimoles per litre
µmol/L micromoles per litre
g/L grams per litre
Others
PMH past medical history
DH drug history
FH family history
SH social history
BNF British National Formulary
GP general practitioner
KCl potassium chloride
COPD chronic obstructive pulmonary disease
This page is provided to the candidates before the assessment and highlights acceptable abbreviations that you may use when authoring questions

5. This page contains information about the nature and purpose of Prescribing Station question items as described in the assessment blueprint document
PRESCRIBING
Reasoning and judgement: Deciding on the most appropriate prescription (drug, dose, route and frequency) to write, based on the clinical circumstances and supplementary information.
Measurable action: Writing a safe, effective and legal prescription for a single medicine, using the documentation provided to tackle a specific indication highlighted by the question.
This question type will present a clinical scenario followed by a request to prescribe a single appropriate medicine or fluid. It will be distinguished from other station types by the specific requirement to write a prescription on one of a variety of prescription charts. Typical scenarios will involve the treatment of acute conditions (e.g. acute asthma attack, acute heart failure), chronic conditions (e.g. depression, reflux oesophagitis) and important symptoms such as pain. The candidate will have to exercise judgement when deciding between different drugs, different formulations, different routes, different doses, and different dose intervals. Typical medicines that will be prescribed will include those that are high-risk (e.g. anticoagulants, opioids, insulin), those that are in common use (e.g. antibiotics), and intravenous fluids. It is expected that prescriptions will meet appropriate standards: they must be legible, unambiguous and complete (approved name written in upper case, appropriate form and route, correct dose appropriately written without abbreviations, necessary details and instructions, signed).
The purpose will be to demonstrate the ability to write a safe and effective prescription [TD 17(c)][SPWG 3], to manage acute medical emergencies [TD 16(b)], and to plan appropriate drug therapy for common indications [TD 8(e) and 17(b)][SPWG 2].
TD = Tomorrow’s Doctors (General Medical Council, 2009) SPWG = Safe Prescribing Working Group (Medical Schools Council, 2008)

6. The following pages are templates for creating Prescribing Station question items.
Good Prescribing question items should:
be based on a clinical scenario that might be faced by and actions that might reasonably be expected of a Foundation doctor
avoid using over-elaborate clinical scenarios containing excessive amounts of information
state clearly the symptom or problem to be addressed by the prescription within the ‘Prescribing Request’ box
require only one prescription to be written.
You have the option to create items that involve prescriptions written into a variety of prescription forms, including hospital once-only, regular medicines, fluid prescription charts and general practice (FP10) forms.
It is rarely possible to create clinical scenarios that have only one correct answer. We would like you to identify those answers that you believe to be optimal and those that are suboptimal but worthy of credit. This can be done on the Answer page that follows the question template.

7. Please use the British National Formulary, to which the candidates will have access throughout, as the ultimate arbiter of dose ranges, routes, indications, contra-indications, etc.

8. Medicine (Approved name) Prescriber – sign + print
Prescribing Item ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] [Authors should try to adhere to this general layout but there is room for flexibility]
On examination
Temperature xx°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are …….
Investigations
Na+ xxx mmol/L (137–144), K+ xxx mmol/L (3.5–4.9), U xxx mmol/L (2.5–7.0), Cr xxx µmol/L (60–110), eGFR etc.
ECG shows ………
CXR shows ………
[Authors should provide sufficient information from the clinical examination and investigations to enable the candidate to make a sound judgement about the need for and choice of treatment]
Please paste any picture or other illustration that supports the clinical case into this box
ONCE ONLY MEDICINES
Date
Time
Medicine (Approved name)
Dose
Route
Prescriber – sign + print
given
Given by
Prescribing request
Write a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].
(use the hospital ‘once-only medicines’ prescription chart provided)

9. ID A. Drug choice B. Dose and route
Prescribing Item
Answer Page ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose and route 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
It is impossible to write Prescribing items with only one creditworthy answer! Use this page to indicate optimal answers (10/10) but also to anticipate and score as many suboptimal answers using the scoring system below.
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

10. To create further question items simply copy and paste the blank
templates and answer pages
The following pages contain templates for creating Prescribing Station question items that use other prescription charts and forms, such as regular medicines, fluid prescription charts and general practice (FP10) forms

11. Prescribing Item ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] [Authors should try to adhere to this general layout but there is room for flexibility]
On examination
Temperature xx°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are …….
Investigations
Na+ xxx mmol/L (137–144), K+ xxx mmol/L (3.5–4.9), U xxx mmol/L (2.5–7.0), Cr xxx µmol/L (60–110), eGFR etc.
ECG shows ………
CXR shows ………
[Authors should provide sufficient information from the clinical examination and investigations to enable the candidate to make a sound judgement about the need for and choice of treatment]
Please paste any picture or other illustration that supports the clinical case into this box
Date
Time
Drug (Approved name) 6 8
Dose
Route 12
Prescriber – sign + print
Start date 14 18
Notes
Pharmacy 22
Prescribing request
Write a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].
(use the hospital ‘regular medicines’ prescription chart provided)

12. ID A. Drug choice B. Dose, route, freq.
Prescribing Item
Answer Page ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose, route, freq. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
It is impossible to write Prescribing items with only one creditworthy answer! Use this page to indicate optimal answers (10/10) but also to anticipate and score as many suboptimal answers using the scoring system below.
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

13. Prescribing Item ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] [Authors should try to adhere to this general layout but there is room for flexibility]
On examination
Temperature xx°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are …….
Investigations
Na+ xxx mmol/L (137–144), K+ xxx mmol/L (3.5–4.9), U xxx mmol/L (2.5–7.0), Cr xxx µmol/L (60–110), eGFR etc.
ECG shows ………
CXR shows ………
[Authors should provide sufficient information from the clinical examination and investigations to enable the candidate to make a sound judgement about the need for and choice of treatment]
Please paste any picture or other illustration that supports the clinical case into this box
Pharmacy Stamp
Please don’t stamp over age box
Age
0yr 0mths
D.o.B.
00/00/0000
Title, Forename, Surname & Address
Patient Name
Address Line 1
Address Line 2
Town Postcode
Number of days’ treatment
N.B. Ensure dose is stated
Endorsements
Drug name
Dose
Frequency
Signature of Prescriber
Signature
Date
For
Dispenser
No. of
Prescns.
on form
Xxxxx Health Authority Dr
Address
Tel:
FP10NC0105
Prescribing request
Write a prescription for ONE drug that will help to [treat/alleviate/prevent] [symptom or problem].
(use the general practice prescription form provided)

14. ID A. Drug choice B. Dose, route, freq.
Prescribing Item
Answer Page ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose, route, freq. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
It is impossible to write Prescribing items with only one creditworthy answer! Use this page to indicate optimal answers (10/10) but also to anticipate and score as many suboptimal answers using the scoring system below.
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

15. INFUSION THERAPY Infusion solution Medicine added
Prescribing Item ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom] etc. PMH. She/he has suffered from …. [describe any past medical history relevant to the scenario]. DH. She/he normally takes …. [list any current prescriptions]. SH. [include any relevant social history] [Authors should try to adhere to this general layout but there is room for flexibility]
On examination
Temperature xx°C, HR xx/min and regular, BP xxx/xx mmHg, JVP xxxxxx, RR xx/min, O2 sat xx% on air, HS xxxxxx, chest sounds xxxxxxx. Other important observations are …….
Investigations
Na+ xxx mmol/L (137–144), K+ xxx mmol/L (3.5–4.9), U xxx mmol/L (2.5–7.0), Cr xxx µmol/L (60–110), eGFR etc.
ECG shows ………
CXR shows ………
Please paste any picture or other illustration that supports the clinical case into this box
Prescribing request
Write a prescription for ONE intravenous fluid that would be most appropriate for the patient at this point.
(use the hospital fluid prescription chart provided)
INFUSION THERAPY
Date
Start time
Infusion solution
Medicine added
Prescriber’s signature
Given by
Type/strength
Volume
Route
Rate
Duration
Approved name
Dose

16. ID A. Fluid choice B. Volume and duration
Prescribing Item
Answer Page ID
PWS000
This question item is worth 10 marks
You may use the BNF at any time
A. Fluid choice
Score
Feedback/justification
B. Volume and duration 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
It is impossible to write Prescribing items with only one creditworthy answer! Use this page to indicate optimal answers (10/10) but also to anticipate and score as many suboptimal answers using the scoring system below.
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

17. The following pages contain examples of Prescribing Station question items written using the previous templates

18. Medicine (Approved name) Prescriber – sign + print
Prescribing Item ID
PWS001
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A 74-year-old man presents to the medical assessment unit complaining of shortness of breath at rest and swollen legs. These symptoms have been gradually increasing over the last 2 weeks. He has been having difficulty sleeping and sat up in a chair all of last night, calling his doctor this morning. PMH. He has ischaemic heart disease and hypertension, both of which are normally well controlled. DH. He normally takes ramipril 10 mg orally daily, isosorbide mononitrate 60 mg orally daily, simvastatin 40 mg orally nightly, and aspirin 75 mg orally daily. An intravenous infusion of glyceryl trinitrate has just been started.
On examination
HR 105/min and regular, BP 110/70 mmHg, JVP elevated at 6 cm, RR 30/min, O2 sat 93% on air. HS third heart sound. Examination of the chest reveals dullness to percussion both bases and fine inspiratory crackles in both lower and mid zones. Bilateral swollen legs with pitting oedema to knees.
Investigations
Na+ 141 mmol/L (137–144), K+ 4.2 mmol/L (3.5–4.9), U 7.0 mmol/L (2.5–7.0), Cr 120 µmol/L (60–110). ECG shows sinus tachycardia. The CXR is illustrated (right).
ONCE ONLY MEDICINES
Date
Time
Medicine (Approved name)
Dose
Route
Prescriber – sign + print
given
Given by
Prescribing request
Write a prescription for ONE drug that will help to relieve his fluid overload and breathlessness.
(use the hospital ‘once-only medicines’ prescription chart provided)
Prescribing Skills Assessment – Prescribing Question Item Authoring Tool

19. ID A. Drug choice B. Dose and route
Prescribing Item
Answer Page ID
PWS001
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose and route 1
Furosemide 4
This is a powerful loop diuretic and is one of the drugs most likely to achieve a significant diuresis.
40–100 mg IV
This dose and route would be likely to achieve a significant diuresis (doses > 50 mg should be given by slow IV infusion) 2
<40 mg IV
This dose may produce a suboptimal diuresis 3
>100 mg IV
This is an unnecessarily high dose of furosemide that risks causing adverse effects in a diuretic naïve patient
20 mg oral
This dose is unlikely to be effective 5
40–100 mg oral
Any oral route will be less effective than IV 6
>100 mg oral
This dose is excessive and the route would be less likely to achieve a significant diuresis 7
Bumetanide
1–2 mg IV
This dose and route would be likely to achieve a significant diuresis 8
<1 mg IV
This dose runs a significant danger of producing a suboptimal diuresis 9
>2 mg IV
This is an unnecessarily high dose of bumetanide that risks causing adverse effects in a diuretic naïve patient 10
1-2 mg oral 11
oral dose outside this range
This dose and route are inappropriate 12
Torasemide
This is a powerful loop diuretic but is available only via the oral route
5 – 40 mg oral
This is the correct dose of torasemide but a parenteral loop diuretic should have been chosen 13
Any thiazide diuretic
This is a thiazide diuretic, which will not have sufficient efficacy to achieve a significant diuresis
Correct dose and route
This is the correct dose but a parenteral loop diuretic should have been chosen 14
Any other diuretic
This kind of diuretic will not have sufficient efficacy to achieve a significant diuresis 15
Nitrates
The patient is already being given a nitrate 16
Morphine/diamorphine
May redistribute fluid but will not improve fluid overload
2.5–10 mg/2.5–5 mg
Higher doses would be hazardous (0 marks)
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

20. 6 8 12 14 18 22 ID Prescribing Item Case presentation
PWS002
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A 60-year-old man is admitted to the acute medical admission unit with a 2-month history of intermittent epigastric pain radiating to the back, which typically occurs 2 or 3 hours after meals and at night. His weight has remained stable and he has not been vomiting. He has recently been suffering from pain in his left knee. PMH. None. DH. No regular medicines but he has been taking ‘over-the-counter’ pain killers on a daily basis. SH. He is a non-smoker and drinks alcohol in moderation (10 units/week).
On examination
He appears well but has some epigastric tenderness on abdominal examination.
Investigations
Hb and MCV normal. Serum biochemistry normal. Endoscopy reveals a small duodenal ulcer but no evidence of bleeding. Tests for H pylori infection are all negative.
Date
Time
Drug (Approved name) 6 8
Dose
Route 12
Prescriber – sign + print
Start date 14 18
Notes
Pharmacy 22
Prescribing request
Write a prescription for ONE drug that will promote the healing of the duodenal ulcer.
(use the hospital ‘regular medicines’ prescription chart provided)

21. ID A. Drug choice B. Dose, route, frequency
Prescribing Item
Answer Page ID
PWS002
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose, route, frequency 1
Omeprazole 4
A proton pump inhibitor is the optimal choice for the treatment of a benign duodenal ulcer
20 mg oral once daily
This is the optimal dosage and should be given for 4 weeks in the first instance 2
10 mg or 40 mg oral once daily 3
This dosage is too low/too high.
Lansoprazole
30 mg daily oral once daily
15 mg oral once daily
This dosage is too low. 5
Esomeprazole
A proton pump inhibitor is the optimal choice but esomeprazole is much more expensive than others and is not indicated for benign duodenal ulcer
10 or 20 mg oral once daily
This is the correct dosage 6
Pantoprazole
40–80 mg oral once daily
This is the optimal dosage and should be given for 2 weeks in the first instance 7
Rabeprazole sodium
A proton pump inhibitor is the optimal choice but rabeprazole is much more expensive than others 8
Any of the above by the intravenous route in the correct dose
The intravenous route is unnecessary in this clinical situation 9
Ranitidine, cimetidine, famotidine, nizatidine
An H2-antagonist is a good choice for the treatment of a benign duodenal ulcer but is less effective than a proton pump inhibitor
300 mg oral at night or 150 mg oral twice daily 10
An inappropriate but prescribable dose
This is not the optimal dosage of this drug for the indication 11
Misoprostol
A prostaglandin analogue that can be used to treat and prevent duodenal ulcers but is less effective and more expensive than other drugs
400 micrograms oral twice daily
200 micrograms oral four times daily 12
Antacid preparations
Antacids are effective for relieving symptoms but not for healing duodenal ulcers at conventional doses.
Appropriate high antacid dose 13
DeNol/Sucralfate
These preparations are indicated for treating duodenal ulcers but are rarely used and unlikely to be immediately available from a hospital pharmacy
Appropriate doses
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

22. ID Prescribing Item Case presentation
PWS003
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A 68-year-old woman is reviewed in a primary care cardiovascular clinic with hypercholesterolaemia. After a careful explanation she is keen to have drug treatment to lower her cholesterol. PMH. Hypertension. DH. Bendroflumethiazide 2.5 mg orally daily, lisinopril 20 mg orally daily, amlodipine 5 mg orally daily. FH. Nil relevant. SH. She eats a sensible diet and is a non-smoker.
On examination
She has an early corneal arcus in both eyes. BP 130/70 mmHg.
Investigations
Normal FBC, renal, liver and thyroid function tests. Normal fasting plasma glucose and HbA1c.
Serum cholesterol 7.5 mmol/L (<5.2), LDL cholesterol 5.50 mmol/L (<3.36), HDL cholesterol 1.20 mmol/L (>1.55), fasting serum triglycerides 1.90 mmol/L (0.45–1.69). Normal ECG.
Her 10-year cardiovascular risk is estimated to be 23%.
Pharmacy Stamp
Please don’t stamp over age box
Age
0yr 0mths
D.o.B.
00/00/0000
Title, Forename, Surname & Address
Patient Name
Address Line 1
Address Line 2
Town Postcode
Number of days’ treatment
N.B. Ensure dose is stated
Endorsements
Drug Name
Dose
Frequency
Signature of Prescriber
Signature
Date
For
Dispenser
No. of
Prescns.
on form
Xxxxx Health Authority Dr
Address
Tel:
FP10NC0105
Prescribing request
Write a prescription for ONE drug that will reduce her serum cholesterol and risk of cardiovascular events.
(use the general practice prescription form provided)

23. ID A. Drug choice B. Dose, route, frequency
Prescribing Item
Answer Page ID
PWS003
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose, route, frequency 1
Simvastatin 4
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk
20 mg or 40 mg oral once daily
(10 mg too low, 80 mg too high = 2 marks)
This is an appropriate starting dosage and is normally prescribed nightly. 2
Atorvastatin 3
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk but atorvastatin, although more efficacious, is less cost-effective
10 mg oral once daily
20 – 80 mg oral once daily
This is an appropriate starting dosage
This starting dosage is unnecessarily high
Rosuvastatin
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk but rosuvastatin, although more efficacious, is less cost-effective
5–10 mg oral once daily
20 – 80mg oral once daily
Pravastatin sodium
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk but pravastatin is less efficacious and more expensive
10–40 mg oral once daily 5
Fluvastatin
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk but fluvastatin is less efficacious and more expensive
20–40 mg oral once daily
80 mg oral once daily 6
Simvastatin with ezetimibe
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk but use of a combination product is not indicated
40 mg/10 mg oral once daily 7
Ezetimibe
A cholesterol absorption inhibitor that is much less efficacious and more expensive than simvastatin 8
Fibric acid derivatives
Fibric acid derivatives are less efficacious and more expensive than simvastatin
Appropriate dose 9
Bile acid sequestrants
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk and sequestrants are less efficacious and more expensive 10
Nicotinic acid derivatives
A statin is the optimal treatment for lowering LDL cholesterol and cardiovascular risk and nicotinic acid derivatives are less efficacious and more expensive 11
Omega-3 fatty acids
These lower cholesterol but are not indicated
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription

24. Medicine (Approved name) Prescriber – sign + print
Prescribing Item ID
PWS004
This question item is worth 10 marks
You may use the BNF at any time
Case presentation
A 62-year-old woman is admitted to hospital with a 3-day history of increasing breathlessness, wheeze, and dry cough. PMH. Chronic obstructive pulmonary disease with several admissions for exacerbations, and angina pectoris. DH. Salbutamol inhaler 200 micrograms as required, tiotropium inhaler 18 micrograms daily, fluticasone propionate 250 micrograms with salmeterol 50 micrograms inhaler (Seretide 250 Accuhaler®) 12-hrly. Treatment with oral prednisolone has already been started by the GP.
On examination
She appears distressed, and is centrally cyanosed and coughing.
Temperature 37.1°C, HR 112/min, BP 116/72 mmHg, RR 30/min, O2 sat 90% on air. PEFR 120 L/min. She is using her accessory muscles to breathe. Auscultation of the chest reveals widespread wheezes bilaterally.
Investigations
Hb 146 g/L (115–165), WCC 9.8 × 109/L (4.0–11.0).
Na+ 140 mmol/L (137–144), K+ 4.2 mmol/L (3.5–4.9), U 7.2 mmol/L (2.5–7.0), Cr 85 µmol/L (60-110). CXR shows hyperexpanded lungs.
ONCE ONLY MEDICINES
Date
Time
Medicine (Approved name)
Dose
Route
Prescriber – sign + print
given
Given by
Prescribing request
Please write a prescription for ONE drug that will provide rapid relief of her bronchospasm.
(use the hospital ‘once-only medicines’ prescription chart provided)

25. ID A. Drug choice B. Dose and route
Prescribing Item
Answer Page ID
PWS004
This question item is worth 10 marks
You may use the BNF at any time
A. Drug choice
Score
Feedback/justification
B. Dose and route 1
Salbutamol 4
Commonest drug for this situation
2.5 – 5 mg nebulised
Probably the most effective route 2
100– 200 micrograms inhaled
Already on it/less easy to administer/less effective 3
Dosages outside these ranges
Dosages would be hazardous
Other routes with right dosage
Other routes more hazardous or less effective 5
Terbutaline
Equivalent to salbutamol in efficacy
5 – 10 mg nebulised 6
500 micrograms inhaled
May be less easy to administer/less effective 7 8 9
Ipratropium bromide
Anticholinergic drug equally effective in COPD but the patient is already on tiotropium
250– 500 micrograms
This is the correct dose range for the nebuliser 10
Dosage outside this range
Hazardous or ineffective 11
20 – 40 microgram inhaled
Already taking an inhaled anticholinergic drug 12
Duovent
Compound preparation via nebuliser that has equivalent efficacy to either alone.
Correct nebulised dose
The most effective route of administration 13
Combivent 14
Oral theophyllines
Effect too delayed to be useful
Correct oral dosage 15
Aminophylline
This would pose greater than necessary hazards as a firstline treatment
An appropriate intravenous loading dosage (250–500 mg)
This dose implies a body weight of 50–100 kg although weight not given (other doses get zero) 16
Tiotropium
The patient is already taking tiotropium 17
Adrenaline
Would be unacceptably hazardous in this situation 18
Salmeterol, indacaterol, formoterol, bambuterol
Patient is already taking a long-acting beta-2 agonist
Marking guide for A and B. Candidates should be given 4 marks for an optimal answer that can’t be improved. They should get 3 marks for an answer that is good but is suboptimal on some grounds (e.g. cost-effectiveness, likely adherence). They should get 2 marks for an answer that is likely to provide benefit but is clearly suboptimal for more than one reason. They should get 1 mark for an answer that has some justification and deserves some credit.
C. Timing. Candidates will also be given 1 mark for correctly dating (and timing) the prescription
D. Signature. Candidates will also be given 1 mark for signing the prescription