The Bottom Line
- The PSA rewards <strong>risk recognition</strong>: identify what could harm the patient and what you must monitor.
- Use a repeatable scan: <strong>indication → contraindications → interactions → renal/hepatic → pregnancy → monitoring</strong>.
- Most high-stakes mistakes cluster around: <strong>anticoagulants</strong>, <strong>NSAIDs</strong>, <strong>QT-prolongers</strong>, <strong>opioids/benzos</strong>, and <strong>polypharmacy</strong>.
A large portion of “safe prescribing” is not knowing obscure facts—it is behaving like a clinician who systematically checks for predictable harm. The PSA blueprint explicitly tests reasoning around adverse drug reactions, interactions, and safety behaviours.
The PSA safety scan (do this every time)
<strong>1) Why this drug?</strong> (indication)
<strong>2) Who is this patient?</strong> (age, pregnancy, renal/hepatic, frailty)
<strong>3) What else are they taking?</strong> (interactions)
<strong>4) What could go wrong?</strong> (ADR pattern)
<strong>5) What will you monitor?</strong> (explicit monitoring + advice)
<strong>6) What will you tell the patient?</strong> (warnings + safety net)
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Step 1 — Spot the ‘risk multipliers’ in 5 seconds
Before choosing an answer, scan for: CKD, liver disease, pregnancy/breastfeeding, older age/falls risk, anticoagulation, history of GI bleed, QT risk, allergy, and polypharmacy. These drive most of the safe prescribing logic.
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Step 2 — Use pattern-based ADR recognition
Instead of memorising lists, learn patterns:
• <strong>Bleeding</strong> (anticoagulants, antiplatelets, NSAIDs combos)
• <strong>Renal injury</strong> (dehydration + nephrotoxins)
• <strong>Electrolytes</strong> (K+, Na+ disruptions)
• <strong>QT prolongation</strong> (multiple QT agents + risk factors)
• <strong>Serotonin toxicity</strong> (stacking serotonergic meds)
Then map the scenario to the pattern.
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Step 3 — Make monitoring explicit (PSA loves this)
If the safest answer includes monitoring, write/choose the option that states: what you will check, when, and what action you will take if abnormal. “Monitor” alone is vague and often not the best answer.
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Step 4 — Patient advice is part of safety
Many PSA questions reward the option that includes clear advice: red flags, what to avoid, and when to seek help. Safety netting is not fluff—it’s prescribing competence.
The ‘Never Skip’ Checks (fast, universal)
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Avoid the high-risk exam mistake
Do not choose an option because it sounds ‘clinically sensible’ if it fails basic safety checks (renal, pregnancy, interactions). The PSA is designed to punish exactly that type of confidence.
SourcePSA: Blueprint (14.07.2025) — ADRs & interactions are explicit competencies (official PDF)
Open Link SourcePrescribing Safety Assessment — official site
Open Link