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Prescribing Skills Assessment Prescribing Skills Assessment Training Workshop PSA Question item styles Communicating Information, Calculation Skills, Adverse.

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Presentation on theme: "Prescribing Skills Assessment Prescribing Skills Assessment Training Workshop PSA Question item styles Communicating Information, Calculation Skills, Adverse."— Presentation transcript:

1 Prescribing Skills Assessment Prescribing Skills Assessment Training Workshop PSA Question item styles Communicating Information, Calculation Skills, Adverse Drug Reaction and Drug Monitoring Lynne Bollington Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

2 Prescribing Skills Assessment StationDescriptionMarksComments 1Prescribing 1101 question item of 10 marks 2Prescribing 2101 question item of 10 marks 3Prescription Review 182 question items of 4 marks each 4Planning Management82 question items of 4 marks each 5Communicating Information63 question items of 2 marks each 6Drug Calculation Skills84 question items of 2 marks each 7Prescribing 3101 question item of 10 marks 8Prescribing 4101 question item of 10 marks 9Prescription Review 282 question items of 4 marks each 10Adverse Drug Reactions84 question items of 2 marks each 11Drug Monitoring84 question items of 2 marks each 12Data Interpretation63 question items of 2 marks each TOTAL MARKS100 Prescribing Skills Assessment – Format Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

3 Prescribing Skills Assessment COMMUNICATING INFORMATION Competencies Reasoning and judgement Deciding what are the most important bits of information that should be communicated to patients to allow them to choose whether to take the medicine and to enhance its safety and effectiveness. Measurable action Selecting the information that is most appropriate. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

4 Prescribing Skills Assessment COMMUNICATING INFORMATION This question type will present: a clinical scenario where a patient needs information about their medicines a request to identify the most important bits of information that they would give to the patient This will involve: selecting bits of information that would be of real benefit and disregarding others that would be less appropriate or important Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

5 Prescribing Skills Assessment COMMUNICATING INFORMATION Good Communicating Information question items should: be based on a clinical scenario where a patient is about to start taking a medicine or has other reasons to ask for information that is relevant to its effectiveness and safety express information options using patient-friendly language avoiding medical and scientific jargon Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

6 Prescribing Skills Assessment COMMUNICATING INFORMATION Case presentation A [age] -year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

7 Prescribing Skills Assessment COMMUNICATING INFORMATION Question Select the TWO most appropriate information options that should be communicated to the [patient/mother/staff nurse/GP] from the list provided. (mark them with a tick) Good Communicating Information question items should: be based on a list of 5 information options contain sufficient information to allow a competent candidate to select the 2 best options unambiguously contain 3 distracting options that, while plausible, are clearly less appropriate than the correct answers in relation to the clinical scenario Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

8 Prescribing Skills Assessment Communicating Information Item COM000 ID This question item is worth 2 marks You may use the BNF at any time INFORMATION OPTIONS AOption A ☐ BOption B ☐ COption C ☐ DOption D ☐ EOption E ☐ Case presentation A [age] -year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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 – the presentations should be fairly brief] Question Select the TWO most appropriate information options that should be communicated to the [patient/mother/staff nurse/GP] from the list provided. (mark them with a tick) Place 5 plausible information options in the boxes provided, describing each with clarity Identify the correct answers by placing a tick in the column on the right Answer box Option AJustification Write a brief justification in this box Option BJustification Write a brief justification in this box Option CJustification Option DJustification Option EJustification Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

9 Prescribing Skills Assessment Communicating Information Item COM001 ID This question item is worth 2 marks You may use the BNF at any time INFORMATION OPTIONS A all warfarin 3 mg tablets are blue B the major adverse effect of warfarin is bleeding C warfarin is better tolerated if given twice daily ☐ D warfarin therapy increases the risk of heart attack ☐ E weekly blood tests will be required throughout treatment ☐ Case presentation A 36-year-old man has been admitted with a deep vein thrombosis (DVT) following recent orthopaedic surgery to his knee. On the ward round he has been given the result of his Doppler ultrasound (positive) and told that he will require treatment with warfarin. He is already being given low-molecular-weight heparin injections. After the ward round, warfarin must be prescribed and the patient provided with appropriate information about the new treatment. Question Select the TWO most appropriate information options that should be communicated to the patient. (mark them with a tick) Answer box Option AJustification All warfarin tablets (0.5 mg, 1 mg, 3 mg and 5mg) are colour-coded to aid recognition and estimation of dose. Option BJustification Warfarin is an anticoagulant that carries a significant risk of bleeding. This risk is reduced if the INR is regularly monitored. Option CJustification Warfarin is no better tolerated if given twice daily compared to the normal once daily dosing regimen. Option DJustification There is no evidence that warfarin increases the risk of myocardial infarction. Option EJustification Frequent blood tests are necessary in the early weeks of treatment but once the results are stable the tests are required less often. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

10 Prescribing Skills Assessment StationDescriptionMarksComments 1Prescribing 1101 question item of 10 marks 2Prescribing 2101 question item of 10 marks 3Prescription Review 182 question items of 4 marks each 4Planning Management82 question items of 4 marks each 5Communicating Information63 question items of 2 marks each 6Drug Calculation Skills84 question items of 2 marks each 7Prescribing 3101 question item of 10 marks 8Prescribing 4101 question item of 10 marks 9Prescription Review 282 question items of 4 marks each 10Adverse Drug Reactions84 question items of 2 marks each 11Drug Monitoring84 question items of 2 marks each 12Data Interpretation63 question items of 2 marks each TOTAL MARKS100 Prescribing Skills Assessment – Format Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

11 Prescribing Skills Assessment CALCULATION SKILLS Competencies Reasoning and judgement Making an accurate drug dosage calculation based on numerical information Measurable action Recording the answer accurately with appropriate units of measurement Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

12 Prescribing Skills Assessment CALCULATION SKILLS This question type will present: a scenario that requires an accurate calculation of the dose or rate of administration of a medicine Typically this question type will involve: interpreting the problem correctly using basic arithmetic skills to derive the correct answer Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

13 Prescribing Skills Assessment CALCULATION SKILLS Examples of potential scenarios might include: identifying the correct number of tablets or volume of medicine to achieve a required dose making necessary dose adjustments based on weight or body surface area calculation of appropriate infusion rates or volumes for administration of medicines in an infusion pump testing the candidate’s ability to recognise and convert different expressions of drug doses and concentrations Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

14 Prescribing Skills Assessment CALCULATION SKILLS Good Calculation Skills question items should: be based on a very brief clinical scenario require a calculation to be made in order to select a safe and effective dose or to plan the patient’s treatment in some other way Case Presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] etc. You are required to give a dose of...etc. The patient weighs … [The case presentations should be fairly brief – 2 or 3 sentences] Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

15 Prescribing Skills Assessment CALCULATION SKILLS Good Calculation Skills question items should: contain all the relevant numerical data with standard units and may also contain reasonable distracting data that might require the competent candidate to reject it as irrelevant to the calculation Calculation What is the [total amount/volume/duration/total dose etc.] that the patient [will receive/should be given, etc.] …… ? (Write your answer in the box below) Answerunit Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

16 Prescribing Skills Assessment Calculation Skills Item CAL000 ID This question item is worth 2 marks You may use a calculator at any time Case Presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] etc. You are required to give a dose of...etc. The patient weighs … [The case presentations should be fairly brief – 2 or 3 sentences] Calculation What is the [total amount/volume/duration/total dose etc.] that the patient [will receive/should be given, etc.] …… ? (Write your answer in the box below) Answer box Correct Answer Write the correct answer with units in this box Working Write a brief justification of the answer in this box, sufficient to explain how to calculate the correct answer Answerunit Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

17 Prescribing Skills Assessment Calculation Skills Item CAL001 ID This question item is worth 2 marks You may use a calculator at any time Case presentation An 8-month-old boy weighing 9 kg requires a dose of midazolam 2.5 mg to be administered buccally for febrile convulsions. Buccal midazolam liquid is available as a 10 mg/mL solution. Calculation What volume of liquid should the patient be given? (Write your answer in the box below) Answer box Correct answer 0.25 mL Working The dose of midazolam required is 2.5 mg. The concentration of the solution available is 10 mg/mL. Therefore volume required = 2.5/10 mL = 0.25 mL The weight of the child is irrelevant to the calculation. AnswermL 0.25 Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

18 Prescribing Skills Assessment StationDescriptionMarksComments 1Prescribing 1101 question item of 10 marks 2Prescribing 2101 question item of 10 marks 3Prescription Review 182 question items of 4 marks each 4Planning Management82 question items of 4 marks each 5Communicating Information63 question items of 2 marks each 6Drug Calculation Skills84 question items of 2 marks each 7Prescribing 3101 question item of 10 marks 8Prescribing 4101 question item of 10 marks 9Prescription Review 282 question items of 4 marks each 10Adverse Drug Reactions84 question items of 2 marks each 11Drug Monitoring84 question items of 2 marks each 12Data Interpretation63 question items of 2 marks each TOTAL MARKS100 Prescribing Skills Assessment – Format Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

19 Prescribing Skills Assessment ADVERSE DRUG REACTION Competencies Reasoning and judgement Identifying likely adverse reactions of specific drugs, drugs that are likely to be causing specific adverse drug reactions, potentially dangerous drug interactions and deciding on the best approach to managing a clinical presentation that results from the adverse effects of a drug Measurable action Selecting likely adverse reactions of specific drugs, selecting drugs to discontinue as likely causes of specific reactions, avoiding potential drug-interactions and providing appropriate treatment for patients suffering an adverse event Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

20 Prescribing Skills Assessment ADVERSE DRUG REACTION Good Adverse Drug Reaction question items should: be one of four types (A-D) be based on a list of 5 options (drugs/adverse effects/interactions/actions) relating to the scenario, from which the candidate will be required to select the 2 most appropriate be based on common adverse effects, so that competent candidates are not faced with the need to refer constantly to the British National Formulary Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

21 Prescribing Skills Assessment ADVERSE DRUG REACTION Type A This question type will require the candidate to identify likely adverse effects of a specific drug Examples might include the adverse effects caused by commonly prescribed drugs, such as calcium channel blockers, beta-2 agonists, non-steroidal anti-inflammatory drugs, aminoglycoside antibiotics, etc. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

22 Prescribing Skills Assessment ADVERSE DRUG REACTION Type A Question Select the TWO adverse effects that are most likely to be caused by this treatment. (mark them with a tick) Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

23 Prescribing Skills Assessment Adverse Drug Reactions Item – Type A ADR101 ID This question item is worth 2 marks You may use the BNF at any time ADVERSE EFFECT OPTIONS A diarrhoea ☐ B drowsiness C nausea D palpitations ☐ E sweating ☐ Case presentation A 67-year-old man has started to take oral morphine (Sevredol®) 10 mg 4-hrly for pain associated with a gastric carcinoma. Question Select the TWO adverse effects that are most likely to be caused by morphine. (mark them with a tick) Answer box Option AJustification Morphine is associated with constipation, not diarrhoea. Option BJustification Morphine acts on opioid receptors in the brain to depress neurotransmission and potentially cause drowsiness. Option CJustification Morphine is a well-recognised cause of nausea and vomiting and is sometimes co-prescribed with anti-emetic drugs. Option DJustification Morphine is associated with the development of palpitations but this is a less common adverse effect than either drowsiness or nausea. Option EJustification Sweating and agitation are phenomena associated with withdrawal of opioid analgesics in dependent patients. They can occur as an adverse effect of morphine but less commonly than either drowsiness or nausea. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

24 Prescribing Skills Assessment ADVERSE DRUG REACTION Type B This question type will require the candidate to consider a presentation that could potentially be caused by an adverse drug reaction and identify the medicines most likely to have caused the presentation Examples might include newly recognised renal impairment, hepatic dysfunction, hypokalaemia, urinary retention, etc. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

25 Prescribing Skills Assessment ADVERSE DRUG REACTION Type B Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Question Select the TWO prescriptions that are most likely to be contributing to the [insert adverse effect]. (mark them with a tick) Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

26 Prescribing Skills Assessment Adverse Drug Reactions Item – Type B ADR201 ID This question item is worth 2 marks You may use the BNF at any time PRESCRIPTION OPTIONS A aspirin 75 mg orally daily ☐ B bisoprolol 5 mg orally daily ☐ C digoxin 125 micrograms orally daily ☐ D furosemide 160 mg orally daily E lisinopril 40 mg orally daily Case presentation A 67-year-old man with chronic heart failure is admitted to hospital after his GP notices that his serum creatinine concentration has become acutely elevated from its baseline value of around 150 µmol/L (60–110) to 450 µmol/L. Question Select the TWO prescriptions that are most likely to be contributing to the acute deterioration in renal function. (mark them with a tick) Answer box Option AJustification Aspirin is a non-steroidal anti-inflammatory drug but at this low cardiovascular preventative dose it is unlikely to have any significant effect on renal function. Option BJustification Bisoprolol has little impact on renal function Option CJustification Digoxin is a drug that has to be used with care in patients with renal impairment but is not, itself, a cause of renal impairment. Option DJustification Furosemide is a powerful loop diuretic, use of which can lead to dehydration with consequent impairment of renal function. Option EJustification Lisinopril is an ACE inhibitor that interferes with the intra-renal renin- angiotensin system, which protects renal function when blood flow is reduced. Therefore, this class of drug is associated with renal impairment in vulnerable patients. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

27 Prescribing Skills Assessment ADVERSE DRUG REACTION Type C This question type will require the candidate to consider a presentation where there are potential interactions between medicines currently being prescribed to a patient and identify those that might be clinically important. Examples might include interactions such as warfarin–statins, NSAIDs–ACE inhibitors. etc. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

28 Prescribing Skills Assessment ADVERSE DRUG REACTION Type C Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

29 Prescribing Skills Assessment Adverse Drug Reactions Item – Type C ADR301 ID This question item is worth 2 marks You may use the BNF at any time PRESCRIPTION OPTIONS A fluoxetine 20 mg orally daily ☐ B folic acid 5 mg orally daily ☐ C norethisterone 350 micrograms (Micronor®) orally daily ☐ D propranolol 40 mg orally 8-hrly E salbutamol inhaler 200 micrograms as required Case presentation A 33-year-old woman is being reviewed by her GP. Her current regular prescriptions are listed (right). Question Select the TWO prescriptions that are most likely to interact with each other. (mark them with a tick) Answer box Option AJustification Fluoxetine does not interact with the other drugs. Option BJustification Folic acid has few significant interactions. Option CJustification Norethisterone is a progestogen that does not have a significant interacttion with any of the other drugs listed. Option DJustification Propranolol is a beta-adrenoceptor blocking drug that is contraindicated in asthma because it has the potential to block beta 2 -receptors in the bronchi and precipitate bronchospasm. Option EJustification Salbutamol is a bronchodilator because it activates beta 2 -receptors. It can also induce tremor and anxiety. Therefore, it has an important potential interaction with propranolol. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

30 Prescribing Skills Assessment ADVERSE DRUG REACTION Type D This question type will require the candidate to consider a presentation where a patient is suffering an adverse drug event and decide on the appropriate course of action. Examples of adverse events might include acute anaphylaxis, excessive anticoagulation, drug-induced hypoglycaemia, diuretic-induced dehydration. etc. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

31 Prescribing Skills Assessment ADVERSE DRUG REACTION Type D Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Question Select the TWO most appropriate options for the management of this adverse drug event. (mark them with a tick) Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

32 Prescribing Skills Assessment Adverse Drug Reactions Item – Type D ADR000 ID This question item is worth 2 marks You may use the BNF at any time MANAGEMENT OPTIONS AOption A ☐ BOption B ☐ COption C ☐ DOption D ☐ EOption E ☐ Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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 – the presentations should be fairly brief but there should be sufficient information about the patient and adverse event for the candidate to clearly identify the 2 most appropriate actions at this point] Question Select the TWO most appropriate options for the management of this adverse drug event. (mark them with a tick) Place 5 plausible management options in the boxes provided including the relevant dose and route Identify the correct answers by placing a tick in the column on the right Answer box Option AJustification Write a brief justification in this box Option BJustification Write a brief justification in this box Option CJustification Option DJustification Option EJustification Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

33 Prescribing Skills Assessment Adverse Drug Reactions Item – Type D ADR401 ID This question item is worth 2 marks You may use the BNF at any time MANAGEMENT OPTIONS A adrenaline (epinephrine) 500 micrograms IM ☐ B flumazenil 200 micrograms IV C hydrocortisone 200 mg IV ☐ D naloxone 400 micrograms IV ☐ E oxygen high flow (targeted to O 2 sat 95%) Case presentation A 75-year-old man is having a colonoscopy and, because of marked anxiety, has been given three doses of midazolam 1 mg IV. Five minutes after the last injection his breathing is noted to be very shallow (RR 6/min) and the O 2 sat is 86% on air. A nasopharyngeal airway is inserted. Question Select the TWO most appropriate options for the immediate management of this adverse drug reaction. (mark them with a tick) Answer box Option AJustification This will not address the primary problem, which is oversedation caused by midazolam. Adrenaline is effective in anaphylaxis and cardiovascular collapse. Option BJustification Flumazenil is a benzodiazepine antagonist drug that can be used to treat an overdose of midazolam as well as to reverse sedation with other benzodiazepines. Option CJustification Hydrocortisone and other corticosteroids will have no impact on respiratory depression. Option DJustification Naloxone is a mu opioid receptor antagonist but is unlikely to be of any benefit when respiratory depression seems likely to be secondary to midazolam Option EJustification The delivery of high flow oxygen is a critical step in the treatment of respiratory depression and low O 2 saturation. The oxygen therapy should be targeted to achieve a specific saturation. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

34 Prescribing Skills Assessment StationDescriptionMarksComments 1Prescribing 1101 question item of 10 marks 2Prescribing 2101 question item of 10 marks 3Prescription Review 182 question items of 4 marks each 4Planning Management82 question items of 4 marks each 5Communicating Information63 question items of 2 marks each 6Drug Calculation Skills84 question items of 2 marks each 7Prescribing 3101 question item of 10 marks 8Prescribing 4101 question item of 10 marks 9Prescription Review 282 question items of 4 marks each 10Adverse Drug Reactions84 question items of 2 marks each 11Drug Monitoring84 question items of 2 marks each 12Data Interpretation63 question items of 2 marks each TOTAL MARKS100 Prescribing Skills Assessment – Format Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

35 Prescribing Skills Assessment DRUG MONITORING Competencies Reasoning and judgement Deciding on how to monitor the beneficial and harmful effects of medicines Measurable action Identifying the appropriate methods of assessing the success or failure of a therapeutic intervention Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

36 Prescribing Skills Assessment DRUG MONITORING This question type will involve: a scenario that involves making judgements about how best to assess the impact of treatments that are ongoing or are being planned demonstrating an understanding of how to plan appropriate monitoring for beneficial and harmful effects The correct course of action may involve: taking blood samples at the right time deciding which is the most appropriate assessment of outcome deciding on the timing of those measurements Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

37 Prescribing Skills Assessment DRUG MONITORING Good Drug Monitoring question items should: be based on a clinical scenario where a patient is starting to take a treatment and the candidate is being asked to identify the best ways of monitoring its beneficial or adverse effects Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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] Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

38 Prescribing Skills Assessment DRUG MONITORING Good Drug Monitoring question items should: be based on a list of 5 monitoring options relating to the treatment identified, from which the candidate will be required to select the 2 most appropriate contain 3 distracting options that, while plausible, are clearly less appropriate in relation to monitoring the beneficial or adverse effects of the treatment than the correct answers Question Select the TWO most appropriate monitoring options to assess the [beneficial/adverse] effects of this treatment. (mark them with a tick) Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

39 Prescribing Skills Assessment Drug Monitoring Item TDM000 ID This question item is worth 2 marks You may use the BNF at any time MONITORING OPTIONS AOption A ☐ BOption B ☐ COption C ☐ DOption D ☐ EOption E ☐ Case presentation A [age]-year-old [man/woman/child] presents to [location and situation] complaining of [symptom that might be used as the focus for one of the questions] 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 – the presentations should be fairly brief but identify the treatment that is being started, the therapeutic indication and sufficient information about the patient for the candidate to be able to identify the best monitoring options] Question Select the TWO most appropriate monitoring options to assess the [beneficial/adverse] effects of this treatment. (mark them with a tick) Place 5 plausible monitoring options in the boxes provided, describing each with clarity Identify the 2 correct answers by placing a tick in the column on the right Answer box Option AJustification Write a brief justification in this box Option BJustification Write a brief justification in this box Option CJustification Option DJustification Option EJustification Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

40 Prescribing Skills Assessment Drug Monitoring Item TDM001 ID This question item is worth 2 marks You may use the BNF at any time MONITORING OPTIONS A chest X-ray appearance ☐ B disappearance of basal crackles ☐ C respiratory rate D sputum colour ☐ E temperature Case presentation A 71-year-old woman is admitted with severe community-acquired pneumonia. She has been coughing up thick green sputum for 2 days. Examination reveals that she is pyrexial, tachypnoeic, and has crackles at the right lung base. A chest X-ray confirms a right lower lobe pneumonia. Treatment with co-amoxiclav 1.2 g IV 8-hrly is initiated. Question Select the TWO most appropriate monitoring options to assess the beneficial effects of this prescription in the first three days of treatment. (mark them with a tick) Answer box Option AJustification The chest X-ray appearance is unlikely to resolve in the early stages of treatment. Option BJustification The auscultatory finding of basal crackles at the base of the lung will take several days to resolve. Option CJustification Successful treatment of the pneumonia will improve gas exchange and the hypoxia and reduce the respiratory rate. Option DJustification Sputum colour is a poor guide to the success of treatment for pneumonia. Option EJustification Successful treatment of her pneumonia is likely to lead to a fairly rapid reduction in her temperature. Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.

41 Prescribing Skills Assessment Question time ? Slide compilation © 2011 The British Pharmacological Society & Medical Schools Council. All rights reserved.


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