Pharmaceutical Care, Medication Safety, and Pharmacovigilance
What the exam tests
Pharmaceutical care and medication safety questions test reconciliation, error classification, ADR assessment, reporting and deprescribing. Iraqi practice expects awareness of the national pharmacovigilance system and Ministry of Health reporting channels.
Core rules
- Medication reconciliation at admission, transfer and discharge prevents most unintended discrepancies.
- High-alert medications include insulin, anticoagulants, opioids, concentrated electrolytes and chemotherapy; use independent double-checks and standardized concentrations.
- Look-alike/sound-alike names and ambiguous abbreviations are systematic risks; use tall-man lettering.
- ADR causality: the WHO–UMC categories (certain, probable, possible, unlikely, conditional, unassessable) and the Naranjo score are standard tools.
- Report suspected ADRs, especially for new drugs, vaccines, serious reactions and unexpected failures, even if the reaction is already listed.
- Deprescribing uses explicit criteria such as the Beers list for older adults.
Worked example
A patient started on trimethoprim–sulfamethoxazole five days ago develops a widespread maculopapular rash and eosinophilia. The temporal relationship, improvement after withdrawal and absence of another cause make the reaction probable by WHO–UMC. Document it, report it to the pharmacovigilance centre, and avoid sulfonamides.
Traps
Reporting only fatal reactions; attributing a reaction to a drug without a temporal check; ignoring dispensing errors because the patient caught it; failing to document an allergy; continuing a high-alert drug without a double-check.