Prescribing and medicines safety are tested throughout PLAB 1 and the UKMLA AKT — not as a separate section, but woven into clinical scenarios asking for the right drug, dose, route or monitoring. The highest-yield areas are anticoagulants, insulin and diabetes drugs, antibiotics and allergy, analgesia and opioids, corticosteroids, and the high-risk drugs that need monitoring. The recurring theme is safety: the exam rewards the choice that is correct and safe for this patient. For UK prescribing detail — doses, interactions and cautions — the BNF is the definitive reference to build the habit of checking.
Key takeaways
- Prescribing is tested throughout the paper, framed around safety and the right decision.
- High-yield: anticoagulants, insulin/diabetes drugs, antibiotics + allergy, analgesia/opioids, steroids, high-risk drugs.
- Common traps: ignoring interactions, renal/hepatic dose adjustment, allergy status and contraindications.
- Know the monitoring requirements for high-risk drugs (e.g. lithium, methotrexate, anticoagulants).
- The BNF is the standard UK reference for doses and interactions; learn to check it reflexively.
How prescribing is tested
PLAB 1 won't usually ask "what's the dose of X" in isolation. It embeds prescribing in scenarios: the patient with a contraindication, the interacting drug already on the chart, the allergy in the history, the dose that needs adjusting for kidney function. The tested skill is choosing the option that is both clinically correct and safe — so the distractors are often effective drugs that are wrong for this patient.
The high-yield prescribing areas
| Area | Why it's tested | The common trap |
|---|---|---|
| Anticoagulants (warfarin, DOACs, heparin) | High-risk, common, monitoring-heavy | Interactions, bleeding risk, missing required monitoring |
| Insulin & diabetes drugs | Common, with emergency relevance (DKA, hypos) | Wrong regimen in acute illness; metformin cautions |
| Antibiotics & allergy | Ubiquitous, safety-critical | Prescribing despite a documented allergy; wrong first-line |
| Analgesia & opioids | Common, safety- and law-relevant | Ignoring renal function, dose conversion, cautions |
| Corticosteroids | Frequent, with important cautions | Abrupt withdrawal; missing sick-day or interaction issues |
| NSAIDs | Common, multiple contraindications | Prescribing in renal impairment, GI risk or with anticoagulants |
| Antihypertensives | High-frequency chronic prescribing | Wrong agent for the patient group; missing contraindications |
| High-risk monitored drugs (lithium, methotrexate, gentamicin) | Safety-critical monitoring | Not knowing the required monitoring or toxicity signs |
The decisions that earn marks
- Check allergy status and contraindications first. The "best" drug is wrong if the patient can't safely take it.
- Account for renal and hepatic function. Dose adjustment — or avoiding a drug entirely — is a recurring tested point.
- Watch for interactions with what's already prescribed; the interacting drug is often hiding in the drug history.
- Default to the UK first-line. When several agents work, the NICE/CKS first-line is usually the answer.
- Know the monitoring. For high-risk drugs, the tested point is frequently the required monitoring or a sign of toxicity.
A note on sources
For UK prescribing decisions, clinicians use the BNF as the standard reference for doses, interactions and cautions — and getting into the habit of checking it for every prescribing question is good practice that carries into your F2 job. For the clinical reasoning behind a choice, anchor your answer to the relevant NICE, CKS or SIGN recommendation rather than memorising in isolation.
How to drill prescribing for the exam
Prescribing improves fastest through scenario questions plus deliberate review of the safety point you missed — the allergy, the interaction, the renal dose. Track why you got a prescribing question wrong, because the same safety traps recur.
iatroX supports this: its explanations are grounded in UK guidance (NICE, CKS, SIGN and the SmPC), Ask iatroX lets you verify a management or prescribing pathway against UK sources, and the Socratic Tutor surfaces the safety reasoning — the contraindication or interaction — behind the right answer rather than just naming it. You can drill prescribing-heavy systems through the UKMLA Academy. iatroX covers PLAB 1 and UKMLA on one subscription (£29/month or £99/year), with free sample questions.
Frequently asked questions
Is prescribing heavily tested in PLAB 1 and the UKMLA AKT? Yes. Prescribing and medicines safety are woven throughout both exams — dosing, interactions, contraindications, allergy and monitoring — rather than confined to one section.
What prescribing topics are highest-yield? Anticoagulants, insulin and diabetes drugs, antibiotics and allergy, analgesia and opioids, corticosteroids, NSAIDs, antihypertensives, and high-risk monitored drugs such as lithium and methotrexate.
What's the most common prescribing mistake in these exams? Choosing an effective drug that's unsafe for the specific patient — ignoring a documented allergy, an interaction on the drug chart, or the need to adjust the dose for renal or hepatic function.
What reference should I use for UK prescribing? The BNF is the standard UK reference for doses, interactions and cautions. Build the habit of checking it for prescribing questions, and ground the clinical reasoning in the relevant NICE, CKS or SIGN guidance.
Do I need to memorise drug doses for PLAB 1? Less than you'd think — the exam tests safe, appropriate prescribing decisions more than exact doses. Knowing first-line choices, contraindications, interactions and monitoring matters more than rote dose recall.