Patient Safety & Clinical Pharmacy Flashcards

What is a 'prescribing cascade' in patient safety?

Answer: When a new drug is prescribed to treat a side effect of a previous drug, leading to further prescribing

A prescribing cascade occurs when a drug side effect is misidentified as a new disease and treated with another drug, creating unnecessary polypharmacy and compounding adverse effects.

Which medication is most commonly implicated in iatrogenic hypoglycaemia?

Answer: Sulphonylureas (e.g., gliclazide) and insulin

Sulphonylureas stimulate insulin secretion regardless of blood glucose, causing hypoglycaemia. Insulin, by its mechanism, can also cause hypoglycaemia, especially with dose errors or missed meals.

What is the significance of the QT interval on an ECG in the context of drug safety?

Answer: QT prolongation increases risk of fatal ventricular arrhythmia (torsades de pointes)

Drug-induced QT prolongation delays ventricular repolarisation, increasing risk of torsades de pointes (TdP), a polymorphic ventricular tachycardia that can degenerate into ventricular fibrillation and death.

Which drug is a known teratogen that must never be prescribed in pregnancy or without effective contraception?

Answer: Sodium valproate

Sodium valproate causes neural tube defects, facial dysmorphism, and cognitive impairment in babies. Under the Valproate Pregnancy Prevention Programme, it must not be prescribed to women of childbearing potential without a pregnancy prevention plan.

A patient is discharged with new amlodipine after a hospital admission. What patient counselling is essential?

Answer: Ankle swelling is a common side effect; avoid grapefruit juice as it inhibits metabolism; take at same time daily

Amlodipine commonly causes peripheral oedema (ankle swelling). Grapefruit juice inhibits CYP3A4, increasing amlodipine levels. Consistent timing helps maintain steady plasma concentrations.

What is the pharmacist's role in the Medicines Optimisation framework?

Answer: Ensuring patients get the best possible outcomes from their medicines through safe, effective, and cost-effective prescribing and adherence support

Medicines Optimisation (NICE NG5) focuses on patient outcomes from medicines, encompassing safety, effectiveness, cost-effectiveness, and patient-centred approaches including shared decision-making and adherence support.