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Section 4 - Providing Information

Introduction

Section 4 of the Prescribing Safety Assessment focuses on patient counselling when prescribing medications. In this section, you’ll determine the essential information to share with a patient starting a new medication, taking into account their medical history, personal background, and the specifics of the drug. The scope of this section is broad and often overlaps with Section 6 (Adverse Drug Reactions) and Section 7 (Drug Monitoring). While we will explore a wide range of medications, it’s important not to feel overwhelmed. Familiarising yourself with commonly discussed drugs (which we’ve highlighted) and developing a systematic approach for tackling unfamiliar scenarios will help you succeed.

Question Style	MCQ - select 1 option from list of 5
Total Questions	6
Marks per Question	2 (Total of 12 marks)
Advised Time per Question	1 minute

Example Question

Case presentation

A 24-year-old man presents to his GP with low mood and suicidal ideation. His wife is also present. PMH. GORD. DH. Omeprazole 20 mg PO daily. SH. Recently made redundant as a computer engineer.

He is advised to commence treatment with sertraline 50 mg PO daily. Review is organised for one week’s time.

Prescribing request

Select the most important information option that should be provided for the patient and his wife.
(Mark it with a tick)

INFORMATION OPTIONS

His suicidal ideation may worsen in the first 4 weeks after starting sertraline

The antidepressant effects of the medication may not become noticeable for 6 weeks

The dose of sertraline can be increased, if necessary, after several weeks

There may be nausea during the first week after starting sertraline

Withdrawal symptoms may occur if he stops his sertraline abruptly

Source: PSA

Tips for this section

You are being asked to provide the most important information

Questions will ask you for the most important information that needs to be communicated to the patient. It’s not enough to provide information that is merely true. Be aware that there may be several true answer options, but only one will be the most crucial for the patient. Therefore, considering the patient’s context and background is vital for selecting the correct answer.
If I were this patient, what would I need to know?

When answering these questions, ask yourself: “If I were this patient, what would I need to know?” By treating the question as a realistic scenario, you can better determine the most important information for that particular case. This approach may be helpful when tackling questions in this section.
Do not neglect the past medical history

Do not overlook the patient's past medical history and clinical context when answering questions in this section. Remember, the most important information to convey will depend on the specific patient. For example, what is deemed most important to inform an elderly patient will be very different from what is crucial to tell a paediatric patient.
Significant overlap with Section 6

For some drugs, there may be considerable overlap with Section 6 - Adverse Drug Reactions. It is common and crucial to highlight key side effects that patients should be aware of when starting a new medication. Therefore, the content covered in Section 6 will also be essential when preparing for the Providing Information section of the PSA exam.
BNF is still your best friend

The BNF remains very useful for this section, especially if you are unfamiliar with the drug in question. The 'Important safety information', 'Patient and carer advice', and 'Side-effects' sections are particularly helpful.

How to Approach This Section

We recommend familiarising yourself with the key learning material we have provided below. Don’t be overwhelmed by it! We don’t advise memorising all the content. Instead, we suggest understanding the key points and using the following step-by-step method to tackle the questions:

Which statements are true?

If one of the answer options is true, it does not necessarily mean it is the correct answer. Questions in this section often include multiple true answer options, where the statements about the drug are true. However, only one is the correct answer. By first identifying which statements are true and which are false, you can narrow down the possible answer choices and increase your chances of selecting the correct one.
What information is MOST important to the patient given the context?

Out of the remaining true statements, determine which one is most important for the patient to know. What must you inform the patient before they are sent home with their medication? The most important information will depend on several factors, including the drug itself, the patient's medical history, and their background. Therefore, it is crucial to read the question carefully. For example, if a patient has a background of chronic kidney disease, discussing increased risk of side-effects or monitoring may be most important in this case.
Still not sure which answer is correct?

If you are still uncertain at this point or the question asks about an unfamiliar drug, use the BNF. Particularly useful sections include ‘Patient and carer advice’, ‘Important safety information’ and ‘Side-effects’. If this fails, you can also use CTRL+F to search for key terms from the answer options on the drug nomogram page on the BNF.