The PSA
Section 2 of 8
Prescription review
Review a chart of 6–10 drugs; identify inappropriate, unsafe or ineffective items, interactions and dosing errors.
32 marks · 16% of the exam8 items × 4
What it tests
Second-heaviest (32 marks). You are shown a drug chart and asked which items are unsafe/inappropriate in the clinical context. Reward comes from finding the dangerous errors, not the trivial ones.
How to tackle it
- 1Cross-check each drug against the indication — is it needed, and is the dose right for this patient?
- 2Scan for interactions and contraindications (renal, hepatic, allergy, pregnancy)
- 3Look for dangerous omissions (VTE prophylaxis, regular meds not re-prescribed) and duplications
- 4Prioritise: flag the items that could cause real harm
Worked example
A chart lists both verapamil and bisoprolol for a patient with AF.
Answer
Stop one — verapamil + a β-blocker risks severe bradycardia, heart block and asystole.
Pitfalls & high-yield
- Don’t get distracted by minor issues — mark the most clinically dangerous items.
- Classic traps: NSAID in AKI/heart failure, verapamil + β-blocker, two nephrotoxics, an ACE inhibitor + potassium-sparing diuretic (hyperkalaemia).
- Use the BNF interactions appendix.
How it’s marked
4 marks per item, 8 items = 32 of 200 marks. Standard-set per sitting (pass mark ≈ 60–63%, varies).