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High-risk medicine clinical check — GPhC CRA MCQ

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ModerateDispensing and SupplyHigh-risk medicine clinical checkGPhC CRA

A frail older adult presents a new discharge prescription for digoxin 250 micrograms daily. The discharge summary says renal function deteriorated during admission but gives no current result or indication for the dose. What should the pharmacist do?

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Correct answer: B — Clarify indication, renal function and intended digoxin dose before supply

Clarify indication, renal function and intended digoxin dose before supply: Digoxin has a narrow therapeutic index and is renally cleared; frailty and deteriorating renal function make an unverified 250-microgram dose potentially toxic. Supply 250 micrograms and accept the dose recorded at discharge: Discharge status does not remove the pharmacist’s duty to resolve a potentially unsafe dose. Supply 62.5 micrograms after making a pharmacy-led dose reduction: The pharmacist should not make an unauthorised dose change without the necessary clinical information. Supply 250 micrograms and check a digoxin concentration after three months: Potential toxicity requires clarification before exposure and much earlier monitoring if treatment proceeds. Omit digoxin and request permanent removal from the repeat list: Digoxin may still be appropriate at an individualised dose; blanket discontinuation is not justified.

Reference: BNF: digoxin: https://bnf.nice.org.uk/drugs/digoxin/