GPhC Patient Safety & Clinical Pharmacy 1 — Questions and Answers
Question 1: What is the 'five rights' framework in medication safety?
- Right patient, right drug, right dose, right route, right time (Correct answer)
- Right drug, right prescriber, right form, right colour, right size
- Right patient, right pharmacist, right signature, right cost, right packaging
- Right doctor, right nurse, right pharmacist, right drug, right cost
Correct answer: Right patient, right drug, right dose, right route, right time
The five rights are a widely used medication safety framework: right patient, right drug, right dose, right route, and right time — all must be confirmed to prevent medication errors.
Question 2: Which drug interaction should be identified when a patient on ramipril is prescribed potassium supplementation?
- Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels (Correct answer)
- Hypokalaemia risk
- Reduced ramipril efficacy
- No significant interaction
Correct answer: Hyperkalaemia risk — ACE inhibitors reduce aldosterone, raising potassium levels
ACE inhibitors reduce angiotensin II-mediated aldosterone secretion, decreasing urinary potassium excretion. Adding potassium supplements increases hyperkalaemia risk, potentially causing dangerous arrhythmias.
Question 3: A patient on warfarin starts a course of amiodarone. What monitoring is required?
- Increased INR monitoring; warfarin dose likely needs to be reduced (Correct answer)
- No change needed
- INR monitoring can be stopped
- Amiodarone and warfarin cannot be co-prescribed
Correct answer: Increased INR monitoring; warfarin dose likely needs to be reduced
Amiodarone inhibits CYP2C9, reducing warfarin metabolism and significantly increasing INR. Warfarin dose often needs to be halved. Enhanced INR monitoring is essential when starting amiodarone.
Question 4: What is meant by 'polypharmacy' and when does it become a concern?
- Use of multiple medicines; becomes a concern when it increases risk of interactions, side effects, and non-adherence (Correct answer)
- Prescribing more than one medicine at any time
- Using medicines from more than one pharmacy
- Prescribing expensive medicines
Correct answer: Use of multiple medicines; becomes a concern when it increases risk of interactions, side effects, and non-adherence
Polypharmacy (typically defined as ≥5 medicines) raises patient safety concerns due to increased drug interaction risk, adverse effects, pill burden, and adherence challenges, particularly in elderly patients.
Question 5: Which score is used to assess bleeding risk in patients with atrial fibrillation being considered for anticoagulation?
- HAS-BLED score (Correct answer)
- CHA₂DS₂-VASc score
- CURB-65 score
- Wells score
Correct answer: HAS-BLED score
HAS-BLED estimates bleeding risk in AF patients on anticoagulation. It scores factors including Hypertension, Abnormal renal/liver function, Stroke history, Bleeding tendency, Labile INR, Elderly (>65), Drugs/alcohol.
Question 6: What is the pharmacist's role in medicines reconciliation on hospital admission?
- Accurately determine the patient's complete pre-admission medication list and reconcile it with hospital prescriptions (Correct answer)
- Only order medicines from the pharmacy dispensary
- Prescribe new medicines independently
- Only monitor controlled drugs
Correct answer: Accurately determine the patient's complete pre-admission medication list and reconcile it with hospital prescriptions
Medicines reconciliation at admission involves verifying what medicines the patient was actually taking (using GP records, patient history, pharmacy records) and ensuring the inpatient prescription accurately reflects this.
GPhC Patient Safety & Clinical Pharmacy 1
What is the 'five rights' framework in medication safety?