PSI Dispensing Practice 3 — Questions and Answers
Question 1: When dispensing warfarin, which additional monitoring information should the pharmacist check?
- Recent INR result and current INR target range (Correct answer)
- Blood pressure only
- HbA1c
- Serum creatinine only
Correct answer: Recent INR result and current INR target range
Warfarin is a narrow therapeutic index drug monitored by INR. The pharmacist should check that the INR is within the patient's target range and that the dose dispensed aligns with the INR result and clinic instructions.
Question 2: The 'right drug, right patient, right dose, right route, right time' is known as the:
- Five Rights of Medicines Administration (Correct answer)
- Seven Rights of Dispensing
- WHO Surgical Safety Checklist
- PSI Dispensing Protocol
Correct answer: Five Rights of Medicines Administration
The Five Rights (or expanded Seven Rights) is a fundamental patient safety framework for medicines administration and dispensing, minimising errors across prescribing, dispensing and administration.
Question 3: A prescription is received for 'morphine sulphate MR 30 mg tablets — take ONE twice daily'. This requires which CD prescription requirements?
- Full Schedule 2 CD prescription requirements: dose in words and figures, prescriber signature, patient details, total quantity (Correct answer)
- Standard non-CD prescription
- Schedule 3 requirements only
- Only the prescriber's DEA number
Correct answer: Full Schedule 2 CD prescription requirements: dose in words and figures, prescriber signature, patient details, total quantity
Morphine is a Schedule 2 CD. Irish law requires: total quantity in both words and figures, dose, patient name/address, date, prescriber's signature and address. Electronic CD prescriptions are now permissible.
Question 4: Which storage temperature range is considered 'refrigerated' for medicinal products?
- 2°C to 8°C (Correct answer)
- 8°C to 15°C
- -20°C to -10°C
- 15°C to 25°C
Correct answer: 2°C to 8°C
Refrigerated storage (2–8°C) is required for vaccines, insulin, some eye drops and many biologics. Temperatures outside this range can irreversibly damage the product.
Question 5: A patient presents a forged prescription. The pharmacist's immediate obligation is to:
- Retain the prescription, refuse to dispense and notify the relevant authorities (Correct answer)
- Dispense but note the forgery
- Return the prescription to the patient
- Only document the incident internally
Correct answer: Retain the prescription, refuse to dispense and notify the relevant authorities
Prescription fraud is a criminal offence. The pharmacist should retain the prescription (do not return it), refuse to dispense, and report to Garda and the prescribing practice if appropriate.
Question 6: Blister packaging for dispensed medicines is preferable to loose tablets in a bottle for which reason?
- Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance (Correct answer)
- Blisters are cheaper to produce
- Bottles are legally prohibited
- Loose tablets improve dose accuracy
Correct answer: Each tablet is individually protected from moisture, air and light — improving stability and aiding compliance
Blister packs protect each unit individually and the date-sequencing aids patient adherence (knowing which tablet to take each day). Bottles expose all tablets to humidity and air each time they are opened.
PSI Dispensing Practice 3
When dispensing warfarin, which additional monitoring information should the pharmacist check?