Pass the PSA, 1e

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You must make sure that there are no contraindications or allergies to any drug you want to prescribe. The list of contraindications of each drug is available in the BNF. Prescribing a drug that is contraindicated will likely cause you to score 0 mark for the whole question. For the first, second and third types of questions, you may sometimes find that more than one of the answer choices could be the correct answer. In this case, you should take into consideration how common each adverse effect or drug interaction is. If they seem equally common, then you should exclude the answer choice that is less likely based on your own understanding of the drugs' pharmacology. Questions will cover Medicine, Surgery, General Practice, Psychiatry, Paediatrics, Obstetrics & Gynaecology, and Geriatrics. By William Brown, BSc MBBS MRCP(UK) FHEA, Kevin W Loudon, MBBS, MRCP(UK), FHEA, James Fisher, BSc, MSc, MBBS and Laura B Marsland, MPharm, ClinDip The aim is to assess the outcomes required of newly qualified doctors in Outcomes for graduates (originally published in Tomorrow's Doctors) as they relate to prescribing. The content of each question is relevant to the prescribing tasks expected of a Foundation Year 1 doctor as outlined in Tomorrow's Doctors 2009, so the questions refer to ailments and drugs that students are likely to be dealing with in Foundation Year 1. Students taking the test can refer to the content of the online British National Formulary at any point during the assessment. While the BNF is a recommended resource, it is important to understand it does not answer all questions on prescribing.

It is understandable that candidates would wish to review their results and go over the questions on which they lost marks. However, the question bank has a limited number of questions and so every question made public is in need of replacement. The development of new questions is a complex process requiring considerable time and expertise. For each question in this section, there will be a clinical scenario with results of investigations and you have to make a change to the drug prescriptions. The investigations may include plasma drug concentration. Among the 5 choices of answers, there may be more than one correct monitoring options, but only one is the most appropriate. Prescribing is a fundamental part of the Foundation Programme as doctors will write and review many prescriptions on a daily basis. The British Pharmacological Society and MSC Assessment have worked together to develop the PSA which allows all final year students and postgraduate doctors to demonstrate their competences in relation to the safe and effective use of medicines.If the question states that the patient in the case does not want a particular type or form of drug, you should avoid prescribing that if possible. If you still prescribe it, you will not be able to score full marks. The questions in the Planning Management, Providing Information, Adverse Drug Reactions, Drug Monitoring and Data Interpretation sections are in the Single Best Answer (SBA) format. For each question, there are 5 choices of answers where you have to choose the one that is the most appropriate. The treatment summaries can help in this section if you are not sure what drug should be used. However, having a good basic understanding of most conditions allows you to focus on looking up the appropriate drug based on your prior understanding which helps save time. Enzyme inhibitors: AO DEVICES – allopurinol, omeprazole, disulfiram, erythromycin, valproate, isoniazid, ciprofloxacin, ethanol (acute intoxication), sulphonamides. Others: grapefruit juice, amiodarone, and SSRIs (fluoxetine, sertraline). Your revision should be done through understanding rather than memorising. For every fact you come across, try to either seek an explanation or come up with your own explanation. Even a wrong explanation is usually alright as the PSA won't test on the explanation. This helps you remember the fact much better compared to simply memorising.

The PSA is based on the competencies identified in the General Medical Council’s Outcomes for graduates (originally published in Tomorrow’s Doctors), such as writing new prescriptions, reviewing existing prescriptions, calculating drug doses, identifying and avoiding both adverse drug reactions and medication errors and amending prescribing to suit individual patient circumstances. The eight distinct prescribing areas: prescribing, prescription review, planning management, providing information about medicines, calculation, adverse drug reactions, drug monitoring and data interpretation, are delivered over two hours. The content of each question refers to ailments and drugs you are likely to encounter in year one of the Foundation Programme. Koul PB. Diabetic ketoacidosis: a current appraisal of pathophysiology and management. Clin Pediatr (Phila) 2009;48(2):135-44.

If that section is not there, then you should start by identifying the answer choices with correct information and eliminating those with wrong information, using your clinical knowledge. The BNF is often helpful in this, but you will waste time if you look it up for every one of the choices. Then, you have to use your judgement to determine which of the correct information is the most appropriate to be given to the patient. After you prescribe a drug, you have to state the dose and route of administration. For regular medicines and general practice prescriptions, you also have to state the frequency. You need not state the duration. Refer to the BNF for the correct dose, route and frequency under the right indication. Generally, you should take into consideration the plasma drug concentration, response to the drug and features of toxicity. If the plasma concentration is below normal range and the response is inadequate, then increase the dose, usually by the smallest increment among the answer choices. If the response is adequate but the plasma concentration is below normal, do not change the dose.