Patient Safety & Clinical Pharmacy Flashcards

According to NICE, what is the first-line pharmacological treatment for osteoporosis in post-menopausal women?

Answer: Alendronic acid (bisphosphonate) plus vitamin D and calcium

NICE recommends alendronic acid as first-line bisphosphonate for post-menopausal osteoporosis, with calcium/vitamin D supplementation if dietary intake is inadequate.

A patient on ciclosporin is started on clarithromycin. What is the clinical concern?

Answer: Ciclosporin toxicity — clarithromycin inhibits CYP3A4, raising ciclosporin levels

Clarithromycin is a potent CYP3A4 inhibitor. Ciclosporin is extensively metabolised by CYP3A4. Co-administration can lead to significantly elevated ciclosporin levels, risking nephrotoxicity.

Which monitoring should be performed in a patient started on clozapine?

Answer: Full blood count (FBC) — monitoring for agranulocytosis

Clozapine monitoring requires regular FBC because the drug causes agranulocytosis in up to 1% of patients, which can be fatal if undetected. Monitoring frequency decreases as treatment duration increases.

What is the mechanism by which NSAIDs can worsen heart failure?

Answer: Sodium and water retention due to prostaglandin inhibition and reduced renal perfusion

NSAIDs inhibit prostaglandins involved in renal sodium excretion and vascular regulation, leading to fluid retention, increased preload and afterload, potentially precipitating or worsening heart failure.

A patient requires gentamicin therapy. Which monitoring is essential?

Answer: Serum gentamicin levels, renal function, and signs of ototoxicity

Gentamicin is an aminoglycoside with a narrow therapeutic index. Monitoring trough and peak levels, renal function, and symptoms of ototoxicity (hearing loss, tinnitus) is essential to prevent toxicity.

What is the 'medication adherence' concept and why is it clinically important?

Answer: Whether patients take medicines as prescribed; poor adherence reduces therapeutic efficacy and increases disease complications

Medication adherence refers to how consistently a patient takes medicines as prescribed. Poor adherence is a major cause of treatment failure, disease progression, and preventable hospital admissions.