Learning outcomes for each session

Taking a safe and effective drug history

Know what information is needed to complete a safe and effective drug history.
Know the different information sources available to you when obtaining or confirming a drug history, and their limitations.
Be able to overcome difficulties in eliciting a drug history.
Be able to identify non-adherence, and the impact this can have on the drug treatments you prescribe.
Understand what is meant by Medicines Reconciliation, and know your role and responsibility in this process.
Understand the importance of effective communication at the transfer of patient care.

Take an accurate history of any previous reactions to drugs, medicinal and related products and non-drug allergies.
Examine a drug chart, and decide which drugs might pose a risk to the patient in light of known allergies.
Recognise the signs and symptoms of allergic reactions to drugs.
Distinguish allergic reactions from other adverse drug reactions.
Manage acute allergic reactions to drugs.
Arrange appropriate follow up in cases of suspected drug reactions.

Know the indications, cautions, duration and monitoring requirements for anticoagulation therapy.
Provide practical guidance on achieving and maintaining a target INR and managing patients with INRs above the recommended therapeutic range.
Understand which parenteral treatment to use until oral anticoagulation cover is achieved. (Trust Policy)
Appreciate the need to balance benefit with the risk of harm when prescribing anticoagulant therapy.
Understand the need to consider lifestyle changes, drug-drug interactions and drug-food interactions when making dosing decisions.

Describe the risks of drugs and how harm from the most dangerous drugs can be minimised.
Discuss the general methods used to limit harm from drugs.
Describe how the prescribing of dangerous drugs requires a concordant approach to therapy to avoid serious harm and adverse drug reactions.
Describe the role of policy and protocol in preventing serious untoward medication errors.
Understand the importance of monitoring drug therapy.

Describe the risks of drugs and how harm from the most dangerous drugs can be minimised.
Discuss the general methods used to limit harm from drugs.
Describe how the prescribing of dangerous drugs requires a concordant approach to therapy to avoid serious harm and adverse drug reactions.
Describe the role of policy and protocol in preventing serious untoward medication errors.
Understand the importance of monitoring drug therapy.

Describe the different classes of antibacterials available and their site of action on a microorganism.
Describe how bacteria can be resistant to antibacterials.
Explain why certain antimicrobials might be restricted in a Trust, and how access to them could be obtained.
Know where to look for guidelines on treating infections and why adherence is important.

Recall the signs and symptoms of hypovolaemia and hypervolaemia.
Understand how to calculate fluid loss, gains and requirements.
Understand how to how to calculate electrolyte requirements.
Describe the difference between crystalloid and colloid fluid replacement therapy and when each might be appropriate for use.
Monitor fluid replacement therapy effectively to avoid adverse effects and achieve optimal response.

Demonstrate knowledge of potential drug-drug interactions (DDIs) mechanisms (pharmacodynamic and pharmacokinetic).
Know patient factors that may intensify drug-drug interactions, related to age, gender, metabolising enzyme profile (sometimes related to ethnicity), disease, diet, smoking and illicit drug use.
Describe some of the common drug interactions seen in clinical practice and strategies for minimising their occurrence.
Know where to find information on potential drug interactions.
Highlight the importance of identifying and reporting ‘suspected’ drug interactions and Adverse Drug Reactions (ADRs) to the Medicines and Healthcare Products Regulatory Agency (MHRA)

Show how impaired renal function alters the pharmacokinetics of drugs.
Know how to assess renal function and the limitations of the available methods.
Know which drugs and agents can be nephrotoxic and how these can cause AKI.
Identify common drugs that need dose adjustment in kidney disease.
Demonstrate effective management of (a) intravenous fluid therapy (b) hyperkalaemia (c) antihypertensive therapy and (d) diuretics in kidney disease.
Know where to find information to guide prescribing in kidney disease.

Understand the processes of absorption, distribution, metabolism and excretion of drugs in the older patient.
Understand how age-related physiological and pathological processes affect how the body reacts to drugs.
Know how physical, cognitive and social aspects may affect an older patient’s ability to adhere to treatment.
Understand the factors that make older adults more at risk of developing adverse drug reactions (ADRs).
Develop strategies to reduce problems with medication in the elderly population

Describe how the WHO Pain ladder assists in rational prescribing of analgesic therapy for both acute and chronic pain.
Understand the risks associated with paracetamol and NSAIDs, and how these may be minimised.
Identify weak opioid analgesics and when they are appropriate for use.
Identify strong opioid analgesics, and how to minimise the risks when switching between different opioid analgesics and titrating doses to meet individual patient requirements. NPSA alert.
Understand the indications and cautions of Patient Controlled Analgesia (PCA).
Recall the stepwise management of neuropathic pain, and understand when a referral to the specialist Pain team is necessary.
Describe the use of local anaesthetics in secondary care setting, and how to recognise and manage toxicity.
Identify patients with complex analgesic requirements where input may be required from specialist teams.