Drug Monitoring and Adherence
41 Questions
7 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is the primary purpose of drug monitoring in patient care?

  • To optimise treatment and reduce harm (correct)
  • To solely conduct laboratory tests
  • To assess the financial cost of medications
  • To only screen for adverse drug reactions

    • What is the term for a confidential consultation between a healthcare professional and a patient to review prescribed medications?

  • Medication Review
  • Structured Medication Reviews (correct)
  • Primary Care Consultation
  • Patient Care Assessment

    • What laboratory test is used to monitor heart function?

  • LFTs
  • HbA1c
  • Electrolytes
  • Heart rate (HR) (correct)

    • What is the term for a measurement of kidney function?

    <p>Cr</p> Signup and view all the answers

    In which settings can Structured Medication Reviews take place?

    <p>GP practices, care homes, and within primary care networks</p> Signup and view all the answers

    What is the purpose of measuring Blood pressure (BP) in drug monitoring?

    <p>To monitor cardiovascular health</p> Signup and view all the answers

    What is the primary objective of a medication review?

    <p>To reach an agreement with the patient about treatment and optimise the impact of medicines</p> Signup and view all the answers

    What type of medication review involves a holistic review of a patient's medicines in the context of their clinical condition?

    <p>Type 3 - Clinical medication review</p> Signup and view all the answers

    What is an example of a measurable outcome that may be reviewed during a medication review?

    <p>Blood pressure (BP)</p> Signup and view all the answers

    Why is it important to review laboratory data during a medication review?

    <p>To monitor therapeutic effects of newly prescribed medication</p> Signup and view all the answers

    What is the main goal of therapeutic drug monitoring (TDM)?

    <p>To ensure safe dosing of high-risk medications</p> Signup and view all the answers

    What should be considered when reviewing the effectiveness of a medication?

    <p>Both measurable and subjective outcomes, such as pain or quality of life</p> Signup and view all the answers

    What is an important aspect of monitoring in secondary care?

    <p>All of the above</p> Signup and view all the answers

    What is an example of a potential problem that may be identified during a medication review?

    <p>All of the above</p> Signup and view all the answers

    What is an important consideration when reviewing medication in secondary care?

    <p>Ensuring no interactions between regular medication and newly prescribed medication</p> Signup and view all the answers

    What is a key principle of a medication review?

    <p>Having a competent person conduct the review</p> Signup and view all the answers

    What is the primary mechanism of elimination of digoxin from the body?

    <p>Renal excretion of unchanged drug</p> Signup and view all the answers

    What is the term for the process whereby the clinician and patient collaboratively design a treatment regimen?

    <p>Concordance</p> Signup and view all the answers

    What is the approximate percentage of patients who are prescribed a new medicine and take it as prescribed, experience no problems, and receive as much information as they need?

    <p>16%</p> Signup and view all the answers

    What is the primary goal of the Discharge Medication Service (DMS)?

    <p>To improve communication between healthcare providers during hospital discharge</p> Signup and view all the answers

    What is the term for the extent to which the patient's behavior matches the prescriber's recommendations?

    <p>Compliance</p> Signup and view all the answers

    What is the primary benefit of the Transfer of Care Around Medicines (TCAM) initiative?

    <p>Reducing unintentional changes or errors during hospital discharge</p> Signup and view all the answers

    What is the term for the patient's intentional decision not to follow treatment recommendations?

    <p>Intentional non-adherence</p> Signup and view all the answers

    What is the bioavailability of digoxin affected by?

    <p>The oral formulation of digoxin (liquid vs tablet)</p> Signup and view all the answers

    What is the primary reason for patients to be non-adherent to their medication regimens?

    <p>Unintentional non-adherence due to practical problems</p> Signup and view all the answers

    What is the purpose of recording patient discussions and advice given during medication reviews?

    <p>To document patient understanding and concerns about their medication</p> Signup and view all the answers

    What is the primary site of warfarin metabolism?

    <p>Liver</p> Signup and view all the answers

    Which of the following factors can affect warfarin absorption?

    <p>Food intake</p> Signup and view all the answers

    What is the primary mechanism of warfarin's binding to plasma proteins?

    <p>Albumin binding</p> Signup and view all the answers

    Which of the following enzymes is primarily involved in warfarin metabolism?

    <p>CYP2C9</p> Signup and view all the answers

    What is the primary route of excretion for warfarin and its metabolites?

    <p>Urine</p> Signup and view all the answers

    Which of the following medications is primarily eliminated unchanged by the kidneys?

    <p>Gentamicin</p> Signup and view all the answers

    Which enzyme system is responsible for the metabolism of Phenytoin?

    <p>Cytochrome P450 enzyme system, particularly CYP2C9</p> Signup and view all the answers

    Which medication has a high degree of protein binding, primarily to albumin?

    <p>Phenytoin</p> Signup and view all the answers

    Which of the following medications can induce its own metabolism over time?

    <p>Phenytoin</p> Signup and view all the answers

    Which medication is not significantly metabolized in the body?

    <p>Gentamicin</p> Signup and view all the answers

    Which medication has a relatively short half-life, typically around 2-3 hours in healthy individuals?

    <p>Gentamicin</p> Signup and view all the answers

    Which of the following medications can penetrate well into the kidneys, making it particularly effective in treating urinary tract infections?

    <p>Gentamicin</p> Signup and view all the answers

    Which medication is primarily administered via injection, typically intravenously or intramuscularly?

    <p>Gentamicin</p> Signup and view all the answers

    Which of the following medications has a high degree of absorption when taken on an empty stomach?

    <p>Lithium</p> Signup and view all the answers

    Which medication distributes widely throughout the body, including into the central nervous system and intracellular compartments?

    <p>Lithium</p> Signup and view all the answers

    Study Notes

    Digoxin

    • Poorly absorbed from the GI tract, with different bioavailabilities for liquid and tablet formulations, requiring dose adjustments.
    • Widely distributed in tissues, with a large volume of distribution (e.g., heart, kidney, liver).
    • Mainly excreted unchanged, with a half-life of 30-40 hours in normal renal function.
    • Therapeutic levels: 0.8-2 micrograms/L, with a likelihood of toxicity increasing progressively from 1.5 to 3 micrograms/L.
    • Signs of toxicity: confusion, anorexia, nausea, vomiting, disturbance of color vision, and arrhythmia.
    • Drugs that increase levels: amiodarone, clarithromycin, canagliflozin.
    • Drugs that decrease levels: rifampicin, phenytoin, sulfasalazine.

    Medication Adherence

    • Adherence: the extent to which a patient's behavior matches agreed recommendations from the prescriber, emphasizing patient agreement and freedom to decide.
    • Compliance: the extent to which a patient's behavior matches the prescriber's recommendations, with a focus on the prescriber's instructions.
    • Concordance: a collaborative process between the clinician and patient to design a treatment regimen, focusing on the patient's behavior in taking medicines.
    • Intentional non-adherence: when a patient decides not to follow treatment recommendations.
    • Unintentional non-adherence: when a patient wants to follow treatment recommendations but faces practical problems.
    • Only 16% of patients take their medicine as prescribed, with 55% unaware of incorrect usage and 45% intentionally non-adherent.

    Barriers to Medication Adherence

    • Explore the reason for non-adherence.
    • Ask the patient what they know and believe about their medicines.
    • Ask the patient if they understand their need for the medicine.
    • Greater concordance leads to greater adherence and optimal medicine use.

    Discharge Medication Service (DMS)

    • Essential service since February 2021, aiming to reduce medication-related harm during hospital discharge.
    • Collaborative effort between NHS trusts, community pharmacies, and PCNs.
    • Focuses on high-risk medicines and patients.

    Transfer of Care Around Medicines (TCAM)

    • National initiative to connect hospitals with community pharmacies using the PharmOutcomes platform.
    • Reduces unintentional changes or errors, leading to a decrease in avoidable harm and readmissions.

    Other Ways to Follow Up Patients

    • Examples include medication changes, medication reviews, and discussions around adherence.
    • Record keeping is essential, including patient discussions, advice, and medication reviews.

    Drug Monitoring

    • Management of a patient's drug regimen through laboratory and physical tests to:
      • Optimize treatment
      • Reduce harm
      • Measure therapeutic effectiveness
      • Screen for and prevent adverse drug reactions
      • Assess patient compliance
    • Examples of lab tests include monitoring tests, blood pressure, HbA1c, heart rate, liver function, renal function, full blood count, and chest x-ray.

    Monitoring Individual Drugs

    • Measure therapeutic effectiveness
    • Screen for and prevent adverse drug reactions
    • Assess patient compliance

    Monitoring in Primary Care

    • Structured medication reviews
    • Confidential consultation between a GP/pharmacist/advanced nurse practitioner and a patient
    • Aims to check the appropriateness of prescribed medications and help patients get the best out of their medicines
    • Gives patients the opportunity to ask questions and raise concerns

    Principles of a Medication Review

    • All patients should have the chance to raise questions and highlight problems with medication
    • Seek to improve or optimize the impact of treatment for an individual patient
    • Undertaken in a systematic way by a competent person
    • Any changes resulting from the review are agreed with the patient
    • The review is documented in the patient's notes
    • The impact of any change is monitored

    Medication Review Types

    • Type 1: Prescription review
    • Type 2: Concordance and compliance review
    • Type 3: Clinical medication review (holistic review, involving the patient, medical notes, and lab results)

    Problems with Clinical Medication Reviews

    • Which patients should be reviewed?
    • How to ensure consistent reviews?
    • Will patients want a medication review?
    • Access to notes

    Contents of a Medication Review

    • The medication is appropriate for the patient's needs
    • The medication is effective
    • The medication is cost-effective
    • Appropriate monitoring has been done

    Monitoring in Secondary Care

    • The point of admission: medicines reconciliation, review of therapeutic effects, and potential adverse effects
    • During admission: daily ward round, review of patient's clinical state, monitoring of therapeutic effects, and potential side effects
    • The point of discharge: ensure patient parameters are stable on newly prescribed medication, document further monitoring required in primary care

    Studying That Suits You

    Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

    Quiz Team

    Description

    This quiz covers the management of a patient's drug regimen, including lab tests and physical assessments to optimize treatment, reduce harm, and prevent adverse reactions. It also covers patient compliance and therapeutic effectiveness.

    More Like This

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser