High-Risk Medications
What type of weight classification is used to dose aminoglycosides?
Answer: Lean body weight.
Explanation: This was updated in the 2025 Therapeutic Guidelines. Previously, adjusted body weight was used to guide aminoglycoside dosing.
A lean body weight calculator is available in the Therapeutic Guidelines to guide clinicians.
What is the formal process of comparing a patient’s current medication list with admission, transfer, and discharge orders to identify and resolve any discrepancies?
Answer: Medication reconciliation.
Explanation: transition points of care are particularly prone to unintentional changes to therapy.
10-67% of medication histories have at least one error, and up to ONE THIRD of these have the potential to cause harm.
85% of medication discrepancies are the result of poor medication history taking.
Patients with one or more medicines missing from their discharge information are 2.3 times more likely to be readmitted to hospital (than those without errors).
Source: Australian Commission
This NSW Health system provides real-time prescription monitoring for S8 and S4D medications.
Answer: Safescript NSW
Explanation: Safescript was introduced in HNELHD and CCLHD in November 2021. This was then phased into the rest of NSW with the entire state receiving access by May 2022.
Safescript is NOT opt-out. Clinicians directly involved in the patient's care are authorised under law to access a patient's Safescript record without consent.
Source: https://www.health.nsw.gov.au/pharmaceutical/safescript/consumers/Pages/faqs.aspx
Which receptor sub-type is most associated with the analgesic effects of opioid medicines?
Answer: μ opioid receptor (mu)
When was the very first NSW standardised intravenous heparin guideline published?DD.MM.YYYY?
Answer: Friday 21 November 2025!
Explanation: Yes, this was very recent as you may have seen in Lucy's Ledgers and announcements! This is an incredible piece of work which was led by Kate R, Dan and Bayan. Congratulations!
What colour syringes are to be used when drawing up neuromuscular blocking agents?
Answer: Red (specifically, red coloured barrel/plunger syringes).
Explanation: The CEC specifically has an implementation checklist for neuromuscular blocking agents under "High Risk Medicines". This ensures compliance and should be used in line with the National Standard for User-Applied Labelling of Injectable Medicines Fluids and Lines.
To prevent transcription and selection errors, the ACSQHC recommends this typographical strategy, which highlights differing portions of similar drug names.
Answer: Tall man lettering or mixed-case lettering.
Explanation: The Commission formulates a list (first commenced in 2011) of look-alike-sound-alike (LASA) drugs and displays them in pairs.
In 2023, the list was reviewed to include specialised medicines: monoclonal antibodies (-mabs) and tyrosine kinase inhibitors (-nibs).
The NSW Health policy directive that consolidates medication handling standards is known by this code.
Answer: PD2022_032
What class of medicines can cause tendon rupture and why?
Answer: Fluoroquinolones.
Explanation: Fluoroquinolones inhibit collagen synthesis and disrupt collagen turnover. This leads to weakened tendons and ruptures (most commonly Achillies rupture). This is most likely to occur within the first 30 days of commencing therapy. Prevalence is roughly 2% of patients > 65 years of age. This classifies this as a "common" ADR (NPS definition 1-10%).
Patients > 60 years of age and on concurrent corticosteroid therapy are at most risk. Tendons ruptures in the hand and wrist are less common but do occur.
Who is responsible for restricted medicines on a hospital ward?
Nurse Unit Manager
When prescribing digoxin, clinicians must monitor (mainly) this electrolyte closely to avoid toxicity.
Answer: Potassium.
Explanation: Digoxin is an anti-arrhythmic and works by inhibition of the Na-K-ATPase pump. It competitively binds with potassium, which is why when potassium levels drop significantly, there are more binding sites for digoxin. This leads to digoxin toxicity.
Salbutamol is a common interaction! Why is that?
This NSW Health initiative was established to help improve the safe and quality use of medicines when patients transfer between and within health care settings. The primary focus of this program is medication reconciliation and medication review. This program is called...?
Answer: CMM - Continuity of Medication Management.
Explanation: 50% of hospital medication errors occur at admission at discharge and up to one third of these have the potential to cause harm.
Errors include: omission of regular medicines, restarting discontinued medicines, duplication and incorrect drug or dose recording.
The CMM provides resources and support to LHDs and assists them in meeting the NSQHS standards. Resources include a med rec toolkit and the CMM e-learning module.
Opioid patches should NOT be initiated in this patient group.
(There are likely a few answers, but there's one particularly bad one we're looking for!)
Answer: Opioid-naive
Explanation: There is a big, boxed warning in the AMH and precautions are repeated in many sections in the PI (increased risk of life-threatening respiratory depression). Deaths have occurred as a result of disregarding this warning.
- Accidental application or consumption (children/pets)
- Use of saunas, heat sources, heat patches
Has anyone had any experiences with fentanyl being prescribed in opioid-naive patients - how did you react or intervene?
Which two clotting factors does heparin inhibit?
Answer: Thrombin and factor Xa
Is implementation of a NSW Health Guideline optional?
Guidelines establish recommended practices in relation to clinical and non-clinical activities and functions and are to be adopted and implemented by NSW Health organisations. Sound reasons must exist for a NSW Health organisation to depart from the recommended practices within a guideline issued through the Policy Distribution System.
This anticoagulant reversal agent is used for dabigatran in cases of severe bleeding.
Answer: Idarucizumab
Explanation: idarucizumab is a monoclonal antibody which binds specifically to dabigatran and works within minutes of administration. Idarucizumab's irreversible bonding to dabigatran is 350-fold higher than dabigatran's bonding to thrombin. Once dabigatran binds to idarucizumab, it is neutralised. Since it's specific to dabigatran, it does not cause any off-target effects.
The “Five Rights” of medication administration include these five checks. Which one is missing?
Right patient, right drug, right dose, right route, and ...?
Answer: Right time.
Explanation: This list can be found in the Medication Handling Policy Directive PD2022_032 under section 6.6 "Principles for Safe Medication Administration".
New-grad nurses are trained up in these skills using the competency assessment matrix with a Clinical Nurse Educator. There is currently no HETI module which specifically includes the 5-rights.
When prescribing medications such as certain antiarrhythmics or antipsychotics, clinicians must evaluate this electrocardiographic interval to prevent life-threatening arrhythmias.
Answer: QT interval.
Explanation:
QTc (men) > 440 ms
QTc (women) > 460 ms
The effect of drugs is additive (use of 2 or more agents concurrently should be reviewed). QTc prolongation can lead to life threatening TDP (torsades de pointes) and ventricular tachycardia/fibrillation.
Other drug classes: antidepressants, antimicrobials, domperidone, loperamide, methadone.
Has anyone had any interesting cases? We had to change our endophthalmitis guidelines at SSEH. Moxifloxacin (~15-20 ms QTc increase) vs Ciprofloxacin (2-5 ms QTC increase)... what if quinolones couldn't be used?
What is the enzyme produced by some bacteria that breaks down some penicillins and cephalosporins
Answer: Beta-lactamase.
Explanation: beta-lactamase hydrolyses the beta lactamase ring which inactivates the drug. Dicloxacillin and Flucloxacillin are effective against S. aureus (as opposed to amoxycillin, benzylpenicillin and phenoxymethylpenicillin) as their beta-lactam rings are protected by large side chains.
How many documents are active in the PDS system (roughly)?
a) ~460
b) ~750
c) ~1470
c) ~3250
e) None the Grinch stole them
Answer: B - there are 731 right now.
Resource: NSW Health > Policy Documents by A-Z. Scroll right to the bottom to see 731!
Insulin glargine comes in two strengths: 300 units/mL and 100 units/mL.
These are known not to be interchangeable. When switching from the 300 units/mL to the 100 units/mL strength, what % do you need to lower the insulin dose by?
Answer: 20%
Explanation: These two strengths are not interchangeable and switching between them (due to stock constraints or otherwise) is generally not recommended without endocrine input.
The AMH 2025 recommends reducing the dose by 20% when switching from the 300 units/mL to 100 units/mL concentration.
If switching from 100 units/mL to 300 units/mL, start off with the same number of units and titrate to effect. Generally a higher dose of 18-20% is likely to be required.
How many medicines for continuous infusion will have their concentrations standardised across NSW?
Answer: 70+
Explanation: See Josh/Vicky/Mel/Dan if you need more info on this project.
For drugs extensively metabolized by the liver, prescribers use this scoring system to estimate safe dosing in patients with liver impairment.
Answer: Child-Pugh score
Explanation:
Child-Pugh scores are calculated using parameters such as presence of ascites, encephalopathy and certain pathology parameters (INR, bilirubin and albumin).
Child-Pugh class A (well-compensated disease)
Child Pugh class B (significant functional compromise)
Child-Pugh class C (decompensated disease).
These classes correlate with one and two-year patient survival: class A: 85-100%; class B: 60-80%; and class C: 35-45%.
SELECT THE MOST CORRECT ANSWER.
Adrenaline is a:
a) positive inotrope and chronotrope (beta1 receptors)
b) vasodilator at low dose (beta2 receptors)
c) vasoconstrictor at high dose (alpha1 receptors)
d) all the above.
Answer: d) all the above
How many years does a medication requisition/purchase order need to be retained by a NSW Health facility?
2 years