Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

OK. 01 thing I didn't ask, are we recording this? We can do you know how I'm just trying to figure it out? Uh Yes, so OK, I think it records automatically. Amazing. OK, that's what I brought. OK. So that's fine. Um I think we'll get well, so hi, everyone, welcome to the second session of the PSA series which is on planning management and communicate information. Um So the session will be taken by myself and Alex today um where we'll be going over the topics that I've just mentioned. Um And while we're given time for more people to join, um we just wanted to let you know about um a research project that we're undertaking um as part of me this year which um is on the QR code um on the screen at the moment. So if you do scan the QR code while we're just waiting, we're going to start in the next 2 to 3 minutes. So it wouldn't take too long. Um So if you just feel free to scan the QR code, I'll also pop the link in the chat, which you, you should be able to have access to um And then we can just do that in the meantime while we wait for people to join. But yes, welcome to everyone for um who has joined so far. And just throughout the session, if anyone has any questions about what we're gonna cover in this uh session or any other psa related questions, feel free to pop them in the chat and we will uh we'll answer throughout. Ok. OK. Shall we uh shall we start? Yes. Yeah. So, um, in this session we're gonna cover planning management and also communicating information. Um, we have, um, several practice questions on each topic and we're, we're, we go through them. Um, we'll let you guys answer them and we go through the answer and how we got to them and we also have a, a top tips, um, medicine complete bit at the end. So I'll take the planning management, um, part of this session. So pain management comprises of, um, eight questions, er, two marks each. Er, so it's about one minute per question. It's probably a little bit more than that. Uh, but for the sake, um, of this we, we'll give you one minute per question. Er, so it is very time pressured. Um, which is why you need to be, um, quite efficient with using medicines complete. Um, and we, we go over what sort of, um, topics can come up in this but, um, the main parts of the medicine complete that you'll want to use are treatment, summaries, er, drug monographs, but it's also really key to have, um, good knowledge, um, of sort of condition definitions and, um, sort of knowledge around different medications that you can apply to the question, to quickly rule out some of the answers, er, to speed up your, uh, your process when you're answering the questions. So this is the format of the question. So it's single best answer. Um, so you just tip the right one. you read the stem, what's important with, er, actually reading the question is um the wording. So you can see in, for example, here it says most appropriate. Er, so there might be several of the answers that could be appropriate or important. That's the other word they like to use, but it's which one is most important. So then you need to use a bit of your own clinical judgment. So the next slide, this is question one. So read it and answer it. We'll, we'll give you a minute starting now. OK. Yeah. OK. So that's one minute. Um So the answer was d so you switched omeprazole to Famotidine. Um So the reason why you take her off her PPI is because she is having her O GD in four weeks um for this gourd and just given a bit of the sort of the presentation should be w be worked up here for a query, malignancy. Um So if we go to the next slide. So because, because the O GD has been performed to try and rule out um cancer. Uh It's important to take the patient off the O GD because it, it can mask signs and symptoms of gastric cancer. This is found through the B NF. This is quite a tricky question. It's a bit of a uh a tough one to start on actually. Um But essentially, if you go to the drug monograph or omeprazole, go down to the cautions and you can see um this point which would, um which would sort of help you with my, you, you'd, you'd like to think that you'd have some background knowledge and the fact that um you, you think about stopping PPR S before, before an O GD, um if it's not an acute situation, um So putting these two together can help you, um get to this answer. So, as I said, it is a tough one, but the, the answer is there in the B NF if you, if you looked hard enough, so we can move on to the next question. So if you read and answer this question, we'll give you a minute. Seven minute is now off as well. OK. You can go to the answer slide. So, um the answers a because um this patient's had an elective surgeries and they've been started on a variable rate insulin infusion. Um It's important to know that you, this can be found in the B NF and we show you where, but it's important that you give the um long acting insulin with their next meal and then you continue um the verbal rate, um insulin infusion for an hour before you discontinue it just to give that long acting insulin a bit of time to kick in. Um This can be found through the B NF if we go to the next slide. So this is in the treatment summary for diabetes, surgery and medical illnesses. Um So if you search that up, um and then it sort of details um within that document where um that information is and there it is. So the conversion back to the subcut insulin. OK. So we go on to question three and we give you a minute. Yes. So I the minutes compete for this question. OK. So the right answer is the oral Erythromycin. Um So if we go to the next slide, we'll show you how to get there. Um So there, there's a section in the treatment summaries for prophylaxis for antibiotics, uh antibacterials. So, um their, their question was sort of hinting at um which prophylactic. So that, so it's good to know that this is um one of the treatment summaries. And then in this section, you can go to the um the er prom section and if you go to the next side, it, it, if you scroll down, then it shows you Erythromycin, then you'd go through the Erythromycin monograph to find the specific dose um for that um for Erythromycin to be used to treat in prom. So that should have been a more simple one to, to find the answer to rather than digging through lots of text. Yes. So even to question four, the minute is up. OK. So, uh this question sort of involves less use of medicines complete or the B NF um and sort of more clinical knowledge. So, uh there's a, a diagnosis of DKA and this can be seen through the, the V PG with the glucose more than 11 and the ph less than uh 7.3 and then the bicarb less than 15. Um, so you won't find the exact um DK er, treatment summary within um, the B NF. However, this just involves uh requiring your own knowledge. Um, it's a bit simpler than actual, actually prescribing cos you just have to um, click the right answer, um, which should be in the, um, fluids with the fixed rate insulin infusion. So, it is important to familiarize yourself with, er, common with managements for common um, um, emergencies, medical emergencies. Um, and we've, uh, we've got a few here. So DK HHS, hyperkalemia, hyperglycemia saves you a lot of time in the B NF er, in the, in the exam to um be able to draw a knowledge of these, um, rather than trying to search for the answers that may not actually be in the, in the um in the B NF and actually, you can sort of use less than a minute for this and then you might be able to use more than a sort of the time you originally were gonna allocate for other questions. The ones that you might need a bit more digging in the B NF for, OK. So the last question for this section, the time is up for this question. OK. So, um yeah. So, so if you, for the, for the um for this question, uh you have to realize that the patient was palliative. So um it's gonna involve us having to convert his ini initially work out his new total um daily dose of opioid. So, um it's the 80 plus 40. So that's 100 and 20. Um And then because he's palliative, it would be worth converting him to a patch. Um So if we then go on to the next slide. So this is a screenshot from the treatment summary of uh prescribing in palliative care. So we, we can go to where it says 100 and 20. So we can get the conversion dose to the fentaNYL patch to the 50 mcg per hour. Um And then the reason why you, you'd still have the, the breakthrough dose. So that's, it's um 1/10 to 1/6 of um the da the total daily dose. So um you, you have to sort of use a bit of common sense here So 12 mg would be a reasonable um breakthrough dose and you, you, you'd prescribe that as or or more so immediate release. Um So it's, it's, it's good to know that the, the opioid conversion. So thi this is um converting M morphine to fentaNYL patch transdermal patch. But um there's also um different opioid conversions from oral to subcut and different strengths of opioids as well. So it's, it's good to know that um about this treatment summary. So, so the reason why we put them on a patch um is because the stem hinted at the fact that they were palliative um with a terminal diagnosis. Um So if we go back one slide just to, to get up the stair, um so it's not something that you'd, you'd have to, it, it's, it's more the most appropriate option and that's sort of what, why reading the questions um always key because there can, I agree, there's more than one correct answer here, but it's the most appropriate answer. OK. So this is sort of explaining more of that and, and I just want to go back to um the question too, cos I think that was a bit of confusion. So if we, sorry if we go back from the slides is the um the the insulin around surgery question. So, yeah, so you administer the short term um insulin and then after an hour you can discontinue the variable rate insulin infusion. Um So it's not the long acting, it's the short acting that you stop and then uh that you um give them with their meal and then after an hour afterwards you stop the instant infusion. So I just want to clarify that. And then there's another question just about why, why switching to fentaNYL? And it is, again, it's more the fact that you're, you're switching to the, the transdermal patch and that's just the formula that um it comes in as fentaNYL rather than something like morphine. Um But then the breakthrough is always gonna be um or more so immediate release morphine. So that was for the last question. So I think we can move on to the next communicating information. Let you know. Yeah. So the second half of this is going to be about communicating and providing information. Um and someone just put a question in the chat about whether you get access to medicines guidance in the P SA. I'm not sure what you mean by medicines guidance. So the two things you can use are medicines complete. Um or the B DIRECT PNF website which will be available through the um portal for the PSA exam. So you do have access to use either medicines complete or the DNF depending on what you want to do. Hopefully that answers your question if not put more details on the chart and I'll answer it later on. Um So this is just a question showing the format of the provider information question. Um And so it's essentially six questions that you're going to get on this theme and a PSA um which are worth t 12 marks in total. Um because you have six questions who have two marks. So it's going to be 12 out of the 200 marks you get in the two PSA. Um Again, we suggest in about a minute per question and as Alex said, you might have a bit longer just depending on how you choose your timings. But the timings we are working with for today just to kind of get you in the um zone, I guess is basically just a minute per question just to see how time pressure it can be at times. But obviously, depending on how you manage in other sections, you might have a bit more leeway in terms of a minute and a half or slightly less depending on how you get along. Um Just answer the question about prescribing in palliative. Can the treatment summary is part of the B NF what I see in medicines guidance. Um Again, what do you mean by medicines guidance? Is that a, a section of the B NF that you're referring to or is that something in medicines complete? Um So I'll, I'll leave us answer that in the chat bit later on. But yeah, this is just a question showing the format um of the provided information um or communicating information aspect. So with that I will leave you to go straight into the first question of the section and I'll start the timer or Alex can start the timer and, um, in a minute's time we'll let you know when to stop. Yeah. Yeah. So a minute's complete. So I'm going to move on to the answer. Someone's put D and that's great. As I said, guys, honestly, I think the best way you're gonna get the most out of this session is by getting the B NF or the medicines complete up and putting in your answers just seeing what you come to. Um, just so you get a good practice in. Um, so, um, yeah, so the answer for this question is a, um, if the person who's put D in the chat just wants to kind of, you know, talk through why they thought that was, um, the answer. If not, that's fine. But I think, you know, a lot of these things, it's important to kind of just know what, you know, that they may all be right in a way, but it's more the most important information in that, you know, think safety, what is going to harm the patient, um, or what is going to, um, be the most important thing that they might be worried about that might cause them to maybe stop a medication without actually recognizing. So think about common side effects that they might need to know of or dangerous side effects that if they weren't informed about might cause them to stop taking the medication cos what you want to promote is patient safety at the end of the day. Um So if you do look in the B NF for um so someone said y not e so having the LFT S prior to starting treatment, um it is under monitoring requirements. Um Yes, so it is. Yeah. So there is, so going to the question, Amani that answered that in a way because you said I thought it was only contraindicated with active heart failure or increased risk of heart failure with insulin. That is one part of it. But then she also has risk factors. So if you look at the past medical history, you can see that this is a patient who's had a previous M I with a history of hypertension. So her cardiovascular risk means that she is at high risk of heart failure. And in that case, you know, this is a direct patient, previous history of cancer. So multiple comorbidities and specific cardiovascular risk factors that make a higher risk of um heart failure. So even though she's not on insulin, it's not that it has. So she doesn't have to be on insulin for her to be at risk of heart failure. It's just the risk is even greater if she is on insulin. So I think that's where we need to be careful with the question. So they might ask you something like this very easily. And you know, it's not the most obvious stem in that they don't tell you that her risk is going to be greater. But looking at things like past medical history, drug history, um renal function, you know, things like that, if they provide it, they don't provide that information just for the sake of providing it. So I think just look at other elements rather than the obvious things. So someone's just said they've seen in the caution part, risk factors for heart failure. So yeah, as I said, all of these things, well, most of these things probably will be relevant to think about. But again, it's not contraindicated with p patients with active or previous breast cancer, it's more related to bladder cancer. Um So they might catch you up with things like that. So some things might look familiar. So you might know that pioglitazone is, you know, um contraindicated in someone with a certain cancer. And so if you don't remember off the top of your head, you might be tempted to go for the breast cancer. So just be careful and pay attention to things like that. So hopefully that clarifies why a is the answer for this question? So we're going to move on to the second one. And just, yeah, just before we do that, um there's some important sections when it comes to communicating information and um providing information really. So a lot of the questions will probably be related to the points with the arrows. So things like the important safety information that patients need to know contraindications to things side effects, that patients need to be aware of. Things like pregnancy and breastfeeding will be um one of the things that might be considered in the questions, um thinking of hepatic impairment or renal impairment and monitoring requirements and things like patient and carer advice. So it's gonna be one of these sections. But the best tip I can give is control F because obviously, whilst it's gonna be in one of these sections, you don't want to go through every single one of them unless it's obvious what kind of question they're asking you and then you can know which of these sections to go to. So still control F things and try and find that um the quickest way you can and if confused, just go to one of these sections which will hopefully give you some information. So moving on to the next question, you have a minute for this. As I say, please pop your answers in the chat and we'll talk through them. So the one minute is up and well done to those who put C in the chat, the answer is in DC. Um And I think it's one of those things just to be aware of. So some people might think, oh methotrexate and the, and you know, any other medication that involves, you know, contraception might be only for the female involved, but some medications do require, um, a male patient to also be an effective contraception. And so it's important to think of it from, you know, that perspective and don't just, um, just basically think of ways they're not trying to catch you out, but it's important to just consider important information and think and actually just look in the B NF if you're not sure. Um, so I think this was quite a straightforward and easy one to find. Um And so if you have any questions, let me know, but it's quite straightforward and I think I just kind of put some information about things like methotrexate. It's just important to know some drugs that are commonly asked about or that can be easily asked about. Um, you know, things like the fact that it's weekly and not daily and most indications, um contraception is needed for both male and females during treatment for at least six months after folic acids on the days that they're not on methotrexate because it's an anti folic. So it's kind of pointless, taken on the same day, um and avoiding things like concurrent NSAID use because obviously there's increased risk of renal toxicity. And so if both medications have increased risk of renal toxicity, it might be worth, you know, giving them some counseling advice about, you know, other alternatives for things like pain management and things like reporting any features of any blood disorders in terms of side effects and risk of photosensitivity reactions and medications that they interact with, which might come in handy in other sections as well. Um So things like trimethoprim or Cotrimoxazole, because Cotrimoxazole contains trimethoprim and so both can increase the risk of hematological problems. So basically, if they have a uti I, that could easily be a question and um what might be the important thing for someone on methotrexate to know in terms of the management or for the GP to know. So that's another thing that I noticed when I was going through the blueprint. So it's not always just information for the patient to know it might be something for, you know, it might be you're the GP and the, what's important for you to realize in managing this patient. So it's important for what the patient needs to know, but what other healthcare professionals might also need to know in managing this patient safely and appropriately. So just think about things like that. So a minute for this question and we can talk through it. I think most people have got the answer to this as well. So I'm going to head over to the answer which as you guys have said is the up to 10 puffs um of this albut inhaler can be used. Um And what this is one of the ones where it's not in the treatment or the drug action itself. So if you type, you want to look for it that way it you wouldn't find that information. This is something you needed to find in a treatment summary for asthma, acute asthma. And so I've highlighted how you find it or where it says that so maximum of 10 puffs vice spacer can be used while awaiting medical attention. Um And so this was obviously in reference to Children age two and over. But yeah, so that's where you need to find it. So thinking about where you might find things because if you type Altol, you wouldn't have found this, it would just say something like users directed or something random that gives you no information that's useful to you. So just think about things like that and it does. Yeah. So because this is a pediatric patient, you could also find it in the B NFC. Um But yeah, I went through just the B NF itself and it provides you for both Children and adults. So as I selected, this was someone two years and over, but it is always good sometimes to check the B NFC if there is a pediatric specific question because there's some things that come up in the adults for both peds and adults. But sometimes there's some information you will only find if you search for the B NFC, which is a good point. Um Yeah. So then the next question is this, you have a minute. Yeah. So a minute is up for this question. And well done to those that answered it correctly. And so the answer is c um, someone said B or C. Um, and yeah, so I will explain that in a second. I'm just looking through the chat as well just to see some of the questions that came through, someone asked in the chat. If, um, do you get access to VNF treatment? Summaries? So you do get access to the treatment summaries. Um So yeah, what we're telling you is things that you would find. Um, yeah, so you would find access to things like BNF summaries. You just wouldn't be able to access things like the nice C KS. So when people sometimes look for information, they look at things like the clinical knowledge, summaries, you wouldn't have access to that. So you would only have access to treatment summaries and the actual medication information itself. So, um you will have access to that. So I hope that clarifies your question. Yeah. And I think someone else has just said that as well in the chat, which is perfect. Um And so, um yeah, so I wasn't referring to the asthma question in terms of things you can find specifically in the B NFC. So I remember when I was doing my preparation for PSA last year and there was a question, I think I can't remember if it was in the mock or some sort of practice I was doing. I don't know what the question was cos obviously it's been a year but I didn't find it. And a colleague of mine also, we couldn't find it in the B NF at all. But when we checked in the B NFC, it was there. So I think just as a matter of caution, if you do find a question about pediatrics, um I think there's, you, you don't lose anything by going directly to the B NFC if you know that the question is targeted to the pediatric population. Um As I say, the adult will have um pediatric and adult stuff sometimes, but I think it probably is just a safer bet to go straight to the um B NFC. So hopefully that clarifies that. Um Yeah, so the answer to this is C and II highlighted where it shows that in the B NF which it says babies of mothers taking morphine at the time of delivery need to be offered immediate prophylaxis with iron, um Vitamin K And I think as I say, some of the things someone I think said B or C, yes, the babies at increased risk of having a fetal abnormality, which would be important information to know. But at this point, she's presented in labor following a controlled pregnancy. So her knowing that isn't going to change anything at this time is too late. Um Whereas if this was someone who was, you know, at an Antenatal clinic, um say on Warfarin, then I would need to tell her that, you know, while you're on warfarin, then your child has a risk of having a fetal abnormality. Is there something else we can try? So Antifa for lipid syndrome, she wouldn't be able to be on a Doac. Um And so it's just things like that trying to think of management. But in this case, um the best thing to tell her is about what needs to be done following the fact that she's in labor, she needs to have this child or she's going to have this child. So what we can do in terms of safety for her and well, her baby um is immediate prophylaxis with iron, Vitamin K So hopefully that clarifies why this is the most appropriate. So just think about the context. Um and then we'll go from there if that makes sense. Um But yeah, and then the final question for this section is this. So 1010 minutes, one minute ago. Yeah. So the minute as I both to everyone who said, e which is the correct answer. Um So I think cloZAPine monitoring when it comes to psych, there's a lot of things like lithium monitoring. CloZAPine monitoring are topics that are easily testable. Um And so it is important to know that because patients on cloZAPine risk of agranulocytosis, um they kind of need to know how to basically ensure and look out for signs of infection as this can have serious impact on the patient Um And so that would be the answer to that question. And in terms of finding it, as I said, there's different sections which are relevant to things like that. Um To, yeah, so the section to look at will be the things like important safety information if you're um going on the section method of looking for important information, in which case, it talks about things like infection. And I'm looking for signs of clozapin toxicity. So we, we definitely need to make sure that carers are aware of things like that. Um And so that brings us to the end of the questions with regards to communicating and providing information. But one of the things I would encourage everyone to do is again, just have a detailed look at the blueprint which I'm sure you guys would have done anyway, because they do kind of give you clues as to what kind of things can come up. Um And I've had kind of highlighted that on the screen. So things like insulin is an easily testable topic that they're probably going to test you on or may test you on. Um Warfarin salbutamol inhaler, methotrexate and oral hyperglycemic, which I've tried to incorporate. So the oral hyperglycemic being things like the pioglitazone, but also known Glipizides. So the risk of, you know, hyperglycemia was so our urea and things like that. Um Metformin stopping it. Lactic acidosis. Um You know, someone comes in, there's something about high lactate in the stem or any other thing that can point you to that diagnosis because some of the things are indirect. Um So they wouldn't tell you the person has a lactic acidosis. So they might find a roundabout way of telling you that, but it's kind of picking up on the information that they've given you. So I think, you know, do a um H RT things like that are very easily accessible topics. So just have a look at the blueprint and see what they say that they're going to test you on and look through the B NF to kind of know as much of that information as possible without having to search cos that's CV time. And someone says, do you get two screens or split screen in the PSA test? II think I remember splitting my screen. I think that is the best way to kind of do things so you can split your screen unless anything's changed, you can split your screen. Um Yeah. And so in terms of blueprint, um yeah, so again going back to the blueprint. So the information from them about the um station or this part of the exam is that, you know, it's it can be about clinical scenario where someone needs information about medicines. But as I said earlier, it could be a request to identify the most important information that should be provided to a patient, a carer or healthcare professional. So the only thing I didn't do, was do a healthcare professional situation, but it's sometimes for the patients, for the carers. Um, but remember that that could be a doctor to doctor, um, question whereby, you know, a GP needs to know something about medications started by a hospital specialist like methotrexate or vice versa. Um, so don't forget that. And then you need to select what's the most important information, even if other things are seemingly correct. And the other part is um what I found interesting from the example that they gave from the MSC and everyone involved in the PSA was this question about using language that is appropriate for the intended recipient. So if you look at the options from this question about things to let a patient know about Warfarin, it says, and so the option c says Warfarin sodium therapy reduces the risk of a second DVT and may increase the likelihood of bleeding. And so it's just things like remembering that, you know, whilst you might say something that's important, will the patient understand what you're saying? Um And so just making sure that what you're saying, so they might give you two things that are pretty much similar or the same. But what is the impact of what you're saying on the person that you're saying it to if that makes sense. So just try and use patient friendly language um in, you know, select one with a patient friendly language, if it's something you're communicating to a patient or a carer, for example, whereas for if you're complicated to a healthcare professional, then the answer you select for a certain question might be um more relevant in that situation. So hopefully, that makes sense. So just read the question carefully and think about who your appropriate recipient is as that might determine what the most appropriate answer is in that situation. And again, you know, they are very helpful. These are topics that they could test. I think obviously we haven't gone over every one of these tonight. But I think um a lot of resources are out there that can help you with things like that, but focus on these things. Um so that you can, because these are the things that are telling you that that you're going to be tested on. So it will be related to things like that. You know, some of some of the things that are not commonly thought about are things like vaccinations, you know, what advice might you need to give or what might be the most important information to give regarding vaccinations, maybe things like live vaccines, one can or can't they have things like that? So just think about things that are not the common, you know, cloZAPine monitoring or, you know, H RT and contraception related stuff like, you know, anti epileptics and teratogenic drugs. These are important things to know, but also think about the less commonly I guess, spoken about areas of this. So use the blueprint to kind of guide your revision. So hopefully that helps, um, and hand hand over back to Alex to talk through. So this is just going over some uh, general, um, psa top tips. Um, so we've spoken a bit about what we've sort of used interchangeably medicines complete. And B and the B NF, we'd always recommend medicines complete. Um, just because there's a few features that mean that you, um, it, it's more easy to like search information. Er, and essentially all the information in each is the same but actually being able to find it, we think's easier for medicines complete. Um, and one of the things they have is, er, the interaction checker, er, where you just type in the names of drugs, so you just type in the name of drug, enter so on and so on. Um, and then it sort of brings them together and it tells you the severity of each, um, interaction if there is any between medications that you've listed. Um, so you can split the screen. I know someone just asked that and we've covered that. Um, get used to using control F, I'm sure, I'm sure, um, everyone knows how to use it but it, it's key to just quickly going through information and w when you're reading the stem, um, always make sure you, um, sort of pick up on keywords that you might be able to put into control F Um So some, I just, just read in the chart. Someone's just asked where to find the interaction checker. So it, it's hard. So, so for some reason, because we're not a university, we're not on trust, like hospital, trust computers, we can't get medicine complete on our like personal laptops at the minute. So it's hard to like, show you where that is. Um But just off, um someone might be able to answer in the chat that actually has already, uh, um, sort of like, found this. But I believe you go through a drug monograph. So just sort any older drug monograph. And then on the left hand side, if you scroll down a bit, there's something that says, interaction or interactions and I think if you go on there and there's a search bar, um, that's the only way I found it but you may be able to find it some other way, but that's only on medicine complete rather than the B NF. Er, another key thing about medicines complete is you can search terms. Um, so say you wanted to try and find a medication that worsens heart failure, you could actually search heart failure and worsens and it will come up with, um, sort of different medications that have those two terms in it. And that's not necessarily saying that it worsens heart failure, but it's saying that you, um, it, it essentially means that those two words are found within that drug monograph and then you can go through the drug monograph control f heart failure, see if it does say worsens heart failure. Um One of the other thing with the search terms is you can put abbreviations into medicines complete such as CO PD rather than writing out the whole um disease um N name and full. Um So we can go to the next slide, another really um useful um section of the medicines complete slash B NF um is appendix one. So it's, it, it, you can just search it through the search bar and it has a list of tables in alphabetical order of drugs that come under these specific headings. So there's 20 tables. I've highlighted the, the most useful ones such as nephrotoxic, um prolonging Q TC, um hyperkalemia among a few others. Just if you get stuck, obviously, it's good to know uh your nephrotoxic drugs. But some of the other ones, um you, you know, you, you might forget it on the, on the day and uh this is just an easy way of finding it, but it's also good to know what it, what isn't included in this. So you don't waste your time trying to find one of these drugs um in the section that um doesn't actually exist, go to the next slide and then just talking about treatment summaries, um just get really familiar with which ones they are what they're actually called because, um for example, infections it's not cellulitis, it would be under something called skin infections, um or eye infections. It's not, it, it's, it's not conjunctivitis. It would be under eye infections. So, so you have to just get used to sort of navigating them. Um And then you have some more specific ones such as medical emergencies in the community just knowing what's included in that and that exists poisoning. Um is another one. Um So it's difficult in these sessions to go through all of them and have questions touching on all of those. But we try and give you a flavor of what's included, but it is key just, just maybe spend a bit of time to um um just going through them and reading what sort of information is in each one, just spending 1015 minutes doing that um can actually really help in the exam. That's what I found at least. And then this, I've just included because we, I know we haven't fully covered calculations yet or fluids. Um So this might, it, you know, this might not be the most relevant thing right now. But if you're really stuck with some of your calculations, especially something like what, what does 0.15% concentration mean if you just search off the fluid. So you know the standard one sodium chloride um with potassium chloride and glucose. So you just type that in, then you go to the medicinal form and you can drop down on um one of the, the drugs, it doesn't matter which one and it sort of just explains, um you know, what, 10 mg in 1 mL equals 4%. Um So you, I mean, you can do these calculations yourself, but in the heat of an exam you might, your mind might go blank and it's just good to know that this, you can find this information in the PNF. Um you know, and then you can sort of extrapolate this to, to whatever calculation you're doing. But it's just sort of a, you know, like it's, it's getting you your uh concentrations correct? OK. That's uh ok. So, yeah, any questions I think we tried to answer as many as we can in the uh in the chat. Does anyone want to? Ok. A few are coming through now. She got, yeah. So in terms of, yeah, so sorry, you, you, sorry, I think I just saw the one about medicines complete and is it only through our organization of personal computers? So it depends on your university. So our university had um access that we could log in when we are at home. Um, or um at UNI, so it just depends on what access your university provides. You really. So you should be able to, to access it via personal computers and depending on, I can't remember the time frame, I think naturally once the um the PSA website goes live at some point anyway. It will start letting you practice with both, but I just can't remember how long the timing between that is and your actual exam. So, I don't know if Alex wants to add anything to that. Um, I think, I think I got it from my university if I'm honest. Um, but if you have some sort of trust organization access as well, it will be on that. Um, but it's worth getting familiar with it. Um, and then how do you interpret some of the interactions? So when you say interactions is that between medications, oh, this combo increases risk of it, it, it would sort of depend on the question. I think if, um, you'd consider it like how severe it would be and if there's another interaction out of the list that is more significant, I think. So that's sort of where the clinical judgment comes into it. Um, and I think just to add to that, I think sometimes it does come up with a severe. So when you do put two medications in terms of interactions, if it comes up with a severe, then you absolutely don't want to give that. But sometimes it just comes up with like an interaction but not like a severe interaction. In which case, you know, it's trying to think about which one is the most relevant to the question that you're being asked. But there are some that will come up with like a red severe. If I remember correctly. And obviously those ones, um you wouldn't want to give a patient. Whereas if they do just come up as a generic may or may not, that's where you kind of have to use your own clinical judgment inference. But if you use the interactions checker, it does come up with some that kind of stand out as a no. And then I don't think there's any other questions. We, we'd really appreciate um feedback and we've dropped uh the feedback form in a few times uh in the chat. Um It just really helps us um with um providing um high quality um sessions. I think the only other one is someone asked to go back to the slide on appendix one. Well, was, was there anything specific regarding that slide or no worries at all? Yeah. And just to add to that, I think, you know, a lot of people when they find this out think it's the best thing in the world which it is cos it's great. But II was just saying to Alex before we started the session, I remember there was a question that we would have expected to find on in Appendix one in our PSA last year um because it was asked and I think about an electrolyte abnormality. I can't remember exactly what it was, but it was one of the topics in Appendix one and the actual drug was nowhere to be found. So I think under that section. Um So I think it is very useful and I think definitely go through it and know that it exists because it does save you, it does save you in the exam wasting time. Just, you know, thinking about things that you can just find very easily, but just be mindful that if it is a basic or common or something that for some reason they expect you to know it might not be an independent it on and you just might have to use your clinical judgment and kind of think about what the question is really asking you and then try and decipher the information from there, but 100% agree with Alex, I recommend this but just to be aware of that, don't think, oh, I don't need to remember anything because it w an appendix one. Yeah. And then, and then just the last question though about fluids, fluids concentration. So we haven't actually covered fluids. I don't, it, it didn't come up in the previous session. It didn't come up in this one. We will go over that in one of the later ones. Um So that's why I thought that, that that slide I put in, it was more just part of the top tips to know that when you come to sort of practicing um your fluid concentrations that that's there. Um But we will go over in detail how to calculate um the specific amount of each um like electrolyte that you'd need in a, in a, um, in a flu because it's based off um, weight um of patients. Um, see, yeah, I think, I think that's, uh, concludes the session unless there's any other questions. Ok. Well, uh once again, thank, thank you very much everyone for, for attending and er, providing some feedback. Our next session is next Thursday um, at the same time, 7 p.m. so we look forward to, to seeing you then and you'll hear more about it on our, on our social media pages. Thank you very much.