22.

Just a quick question regarding the clinical checking exam - In scenario

1 you provided some counselling points for the patient on zomorph (take
12 hours apart etc). However if the prescription is clinically appropriate
you click ' yes' and move onto the next rx. Does this mean you only
provide counselling points to the patient if there has been an error on the
prescription or is it worth adding these counselling points on all the
prescriptions?
You only need to discuss counselling of there have been changes
to the prescription.
21. I saw in one of your answers to a student question you noted that a
counselling point could be written as "counsel patient on bisphosphonate
administration as per the information in BNF" - is writing a point like this in
the exam sufficient for counselling points in the BNF?
That would be fine as it would show that you know that the drug
needs additional counselling.
For example if we had a Methotrexate prescription would writing 'counsel
on methotrexate monitoring and side effects as per the information in the
BNF' - or should we list the points in bullet points?
Would write counsel as per BNF and/or methotrexate book as
there is a lot of information to write and you only have 1 hour.
20. You mentioned that only FP10 and hospital drug charts would be
examined. Would other FP10 prescriptions such as FP10MDA (blue), FP10D
(yellow), FP10CDF, etc. be included in the examination, or would we be
examined on the normal green prescriptions only? See response above
19. In exercise prescription 7.3 wc 9.11.15, I noticed that the prescribed
dose for atorvastatin is 40mg daily, compared to the initial 10mg daily
dose recommended in the BNF 66. However, nothing was mentioned
about this in the mark scheme provided. Is there some other specific
circumstances that permits the use of a higher initial dose of atorvastatin
that I may have overlooked?
The BNF states that you can increase up to 80 mg once a day so I
would have no issue with the 40 mg a day dose.
18. Must the patient's NHS number be stated on hospital drug charts? Or
is a K number ( a hospital number) sufficient ?
Should have an NHS number and a hospital ID number. For the
purposes of the assessment, one or the other is fine
And is the Rx legally invalid without either?
Technically no, as a hospital inpatient is not a prescription (see
MEP). For the purposes of your SOP, include it as part of a legal
validity check
17. For prn medicines must the minimum interval and maximum dose in
24 hours be stated on the Rx?

Yes, however there are exceptions e.g GTN for chest pain or
salbutamol inhalers where there is no maximum
16. Is the Rx invalid if they are not stated?
Yes, this would be part of the clinical checking process
15. Will we get any information on the patient's past medical history,
information on why they were admitted or patients biochemistry results to
accompany the drug chart?
Very simple information will be provided to assist you. As the
assessment is only 1 hour, you will not be required to read
through lots of information.
And finally what does DH nil regular mean when written in the medicines
reconciliation section of a drug chart?
No regular medicines taken as part of the medication history (DH)
14. For the mock prescription 7.2, you would receive the full 15 marks for
signing off the prescription as it is. I saw that the prescription was for a 3
year-old, and listed that the prescription should state to 'give' rather than
'take the medication' as the only problem. For my action, I simply stated
that the mother should be counselled on how to give 7.5ml spoonfuls to
child. Would I lose marks for this?
No marks would be lost for this action.
13. For medicines optimisation, is it okay for us to assume what condition
the patient have (when the indication of medicine is not stated) and
suggest any changes to make to the medicine?
For example the SHP drug chart where trimethoprim was prescribed, the
suggested answer was " trimethoprim- likely for a UTI", leading to a
suggested change to nitrofurantoin.
BNF has also indicated the use of trimethoprim for acute and chronic
bronchitis, and also pneumocytis pneumonia( this condition can be
excluded as there is no other combination of drug given together with
trimethoprim, eg: dapsone). So, isn't there any chances that the lady was
prescribed trimethoprim for bronchitis?
Where there is are multiple indications for medicines, either some
additional information will be given to aid you or a combination of
medications will guide to a particular condition.
12. I have been through the sample exam questions on moodle and have
a question regarding the drug chart (prescription 7.3). The patient has
been prescribed enoxaparin which interacts with their aspirin potentially
increasing the risk of bleeding complications. I just wanted to clarfiy if this
would be marked as incorrect if identified in the exam as if wasn't
identified as a problem in the mark scheme for prescription 7.3?
Prophylactic doses of enoxaparin are continued alongside aspirin.
Yes there is an increased risk of bleeding but it is not considered
an issue at low doses. With treatment doses of enoxaparin, any

concurrent antiplatelet therapy is reviewed and either continued

or discontinued as per prescriber advice.
I was also wondering for the community prescriptions in the clinical
checking exam if they are all going to be FP10SS or will there also be
requisitions, methadone, private prescription scripts, dental ect?
FP10 SS
11. May I kindly ask if we are allowed to include in our SOPs the type of
monitoring that we may carry out for patient that are on certain type of
medication group? (eg. I make a table where "Blood Pressure medications"
in stated one column, the next column states the monitoring that I would
do such as BP monitoring)
No, you cannot state specific monitoring. The SOP needs to be
generic.
9. In the case of drug charts, will clinical notes be attached (as they are on
moodle), or does it depend on the case?
There will be a small amount of information provided with respect
to hospital patients but not a great amount as the exam is only 1
hour long.
8. On our SOPs, are we allowed to give examples? For example, I have
written down check for patient factors e.g. HR, BP, Pt count? Would that
be acceptable?
No specific examples are allowed e.g. "monitor BM" for
metformin. The BNF advises (within the side effect, caution,
contraindication and general information sections) about
monitoring needed for drugs so there would be no need to write
the need to monitor in the SOP.
7. For our action /follow up plan' are we required to include lifestyle points
to counsel the patient on, or are we to just focus on the medicine changes
to be made?
Focus on medicine changes and include any relevant counselling
and/or lifestyle points. You can write (and are strongly advised to)
in bullet points so make any information given, to the point. For
example, if the patient is on a bisphosphonate, then write
"counsel patient on bisphosphonate administration as per the
information in BNF"
6. After completing DYS drug chart exercise, I had a question regarding
the answer given. The BNF 66 states that the recommended H.Pylori
treatment in adults is omeprazole 20mg BD + clarithromycin 250mg BD +
metronidazole 400mg BD. However, the NUH guidelines state that
clarithromycin should be prescribed at 500mg BD. Would the BNF 66
answer be marked wrong in the exam? If so, will we have access to the
hospital guidelines during the exam?

Use only the BNF, you will not have access to any hospital
guidelines.
2. I have another quick question to add to the one below. When actually
writing the answers in the exam do we structure it as done in the
'answers' given in the guides on moodle, eg headings 'what are the
medicines for' or should it be written in more of an essay format.
Please write your answers as given in the sample exam questions
on Moodle. There are 7 for you to work through. There is also a
document which shows you the layout of the answer sheet so you
know what to expect.
1. I was just wondering whether in this exam we also have to state legal
checks too or should be just stick to the clinical problems?
Please state any issues relating to BOTH legality and clinical
issues.