PLAB Part 1 Prescribing Safety Practice Questions
Prescribing safety is a critical component of medical practice, focusing on preventing medication errors and ensuring appropriate drug use. For PLAB Part 1, this involves understanding drug interactions, contraindications, adverse drug reactions, and safe prescribing practices in various patient populations and clinical scenarios, adhering strictly to UK guidelines like NICE and the BNF.
A 78-year-old man with type 2 diabetes mellitus and hypertension is admitted to the ward with community-acquired pneumonia. He is currently prescribed metformin 500mg three times daily, ramipril 5mg once daily, and bisoprolol 5mg once daily. His admission blood tests show an eGFR of 28 mL/min/1.73m². What is the most appropriate modification to his current medication regimen?
A 65-year-old woman with a history of atrial fibrillation is prescribed warfarin. She presents to the GP surgery with a 3-day history of a productive cough, fever, and muscle aches. She is diagnosed with a bacterial chest infection. Her current INR is 2.3. The GP decides to prescribe a course of antibiotics. Which of the following antibiotics is most likely to significantly increase her INR and risk of bleeding?
A 28-year-old pregnant woman in her first trimester presents with severe morning sickness. She has tried dietary modifications without success. Her GP is considering prescribing an antiemetic. Which of the following medications is generally considered safe and appropriate for use in the first trimester of pregnancy for nausea and vomiting?
A 45-year-old man with a history of asthma controlled with a salbutamol inhaler as needed, presents to the ED with a severe allergic reaction after eating peanuts. He is hypotensive and wheezing. Adrenaline is administered. After initial stabilisation, the team considers prescribing a beta-blocker for his hypertension. Which of the following beta-blockers would be the most appropriate choice to minimise the risk of exacerbating his asthma?
A 68-year-old woman with chronic pain due to osteoarthritis is prescribed co-codamol (paracetamol 500mg/codeine 8mg) four times daily. She also takes paracetamol 1g four times daily for breakthrough pain. She has recently been experiencing increasing confusion and abdominal pain. Her liver function tests show elevated transaminases. What is the most likely cause of her symptoms and abnormal LFTs?
Prescribing Safety — frequently asked
How important is the BNF for PLAB Part 1 prescribing questions?
The British National Formulary (BNF) is absolutely essential. PLAB Part 1 prescribing questions are heavily based on BNF guidance for drug indications, contraindications, interactions, doses, and special precautions (e.g., in renal/hepatic impairment, pregnancy, or breastfeeding). You must be familiar with common drug classes and their key safety considerations as outlined in the BNF.
Do I need to memorise all drug interactions for PLAB Part 1?
While you don't need to memorise every single interaction, you should focus on clinically significant and common interactions. These include those that can lead to serious adverse effects (e.g., warfarin with macrolides/CYP inhibitors, ACE inhibitors with NSAIDs/potassium-sparing diuretics, sildenafil with nitrates) or those that are frequently tested. Understanding the mechanisms (e.g., CYP inhibition, additive effects) can also help.
How should I approach questions involving drug prescribing in specific patient groups like pregnant women or those with renal impairment?
Always consider the specific patient's physiological state. For pregnancy, recall drugs that are contraindicated or require caution in different trimesters. For renal/hepatic impairment, remember common drugs that require dose adjustment or are contraindicated. NICE guidelines and the BNF are your primary sources for this information. Look for keywords like 'eGFR', 'liver cirrhosis', 'first trimester', etc., in the vignette.
Are ethical considerations related to prescribing safety also tested?
Yes, ethical considerations are often integrated. This can include issues like informed consent for medication, prescribing for off-label indications, managing patient expectations, or dealing with potential misuse/diversion of controlled drugs. The GMC's 'Good Medical Practice' guidelines are key here, alongside the Mental Capacity Act 2005 for patients lacking capacity to make prescribing decisions.
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