Learn how to answer PSA Prescription Review questions using a pharmacist-led framework. Includes common prescribing errors, worked examples and exam tips for medical students.
Prescription Review questions are among the most challenging areas of the Prescribing Safety Assessment (PSA). Unlike many other question types, the correct answer is often hidden within a prescription that appears reasonable at first glance.
To score highly, candidates must identify prescribing errors, patient safety concerns, contraindications, drug interactions, monitoring issues and inappropriate medication choices that could place a patient at risk.
The good news is that successful candidates do not rely on guesswork. Instead, they use a structured approach to reviewing every prescription. By learning how pharmacists and experienced prescribers assess medication orders, you can develop a repeatable method that improves both accuracy and confidence.
This guide explains exactly what PSA Prescription Review questions are testing, the most common errors seen in examinations, and a simple framework you can apply to every question you encounter.
Prescription Review questions assess your ability to identify prescribing errors and patient safety issues within a medication chart or prescription. Rather than asking you to write a prescription, these questions require you to review an existing prescription and decide whether anything is unsafe, inappropriate or potentially harmful. You may need to identify:
Incorrect doses
Drug interactions
Contraindications
Allergies
Therapeutic duplication
Missing monitoring requirements
Inappropriate formulations
Prescribing omissions
Renal dosing issues
The focus is always patient safety.
Whenever you encounter a Prescription Review question, work through the following steps.
1. Confirm the Patient Details
Check for:
Age
Weight
Renal function
Relevant medical history
These details often contain clues that explain why a prescription may be inappropriate.
2. Check for Allergies
Always review documented allergies before assessing the medication.
Questions involving penicillins, NSAIDs and previous adverse reactions are common PSA themes.
3. Confirm the Indication
Ask yourself:
Why is this patient receiving this medicine?
If you cannot identify an appropriate indication, there may be a prescribing error.
4. Review the Dose
Look carefully for:
Excessive doses
Sub-therapeutic doses
Incorrect frequencies
Failure to account for renal impairment
Wrong-dose questions are among the most common prescribing errors tested.
5. Check the Route
Ensure the route is appropriate.
For example:
IV instead of oral
Oral instead of subcutaneous
Modified-release formulations being prescribed incorrectly
Route-related errors can significantly affect patient safety.
6. Look for Drug Interactions
Consider:
Warfarin interactions
DOAC interactions
Macrolide antibiotics
QT-prolonging medicines
NSAID combinations
Students frequently miss interaction-based questions.
7. Consider Monitoring Requirements
Many medicines require additional monitoring.
Examples include:
Warfarin (INR)
ACE inhibitors (renal function)
Methotrexate (blood monitoring)
Lithium (serum concentrations)
Failure to monitor can represent a significant prescribing risk.
Medical Student Completing PSA Prescription Review Questions During Exam Revision
Worked Example 1
Warfarin and Ibuprofen
A patient taking warfarin is prescribed ibuprofen 400 mg three times daily.
What Is the Problem?
NSAIDs increase the risk of bleeding when combined with warfarin.
Why Is This Unsafe?
The combination increases the likelihood of gastrointestinal bleeding and other haemorrhagic complications.
Safer Alternative
Paracetamol may be more appropriate depending on the clinical scenario.
Worked Example 2
Penicillin Allergy
A patient with a documented anaphylactic reaction to penicillin is prescribed amoxicillin.
What Is the Problem?
Amoxicillin is a penicillin antibiotic.
Why Is This Unsafe?
The patient may experience a severe allergic reaction.
Key Learning Point
Always check allergies before reviewing any prescription.
Worked Example 3
Acute Kidney Injury
A patient with significant renal impairment receives a full dose of a renally cleared medicine without adjustment.
What Is the Problem?
The medication may accumulate.
Why Is This Unsafe?
Drug accumulation increases the risk of toxicity.
Key Learning Point
Always review renal function when assessing a prescription.
Missing documented allergies
Forgetting to assess renal function
Incorrect dose selection
Missing a major drug interaction
Duplicate therapy
Inappropriate route of administration
Failure to consider monitoring requirements
Prescribing despite contraindications
Not identifying high-risk medicines
Rushing through the prescription
Before submitting your answer, ask yourself:
✅ Allergy checked?
✅ Correct indication?
✅ Appropriate dose?
✅ Appropriate route?
✅ Interactions considered?
✅ Renal function reviewed?
✅ Monitoring requirements identified?
Using the same structured approach for every question can dramatically reduce errors.
To improve your performance in Prescription Review questions:
Practise regularly using realistic PSA-style scenarios.
Use a structured review method every time.
Focus on patient safety rather than memorisation.
Familiarise yourself with common high-risk medicines.
Become confident using the BNF efficiently.
Remember, the PSA is not trying to catch you out. It is assessing whether you can identify and prevent medication-related harm.
Prescription Review questions assess one of the most important skills of any prescriber: recognising when something is unsafe before it reaches the patient.
The highest-performing candidates do not rely on instinct. They follow a consistent framework, systematically review each prescription and focus on identifying potential patient safety concerns.
If you can develop this habit during your PSA preparation, you will not only improve your exam performance but also strengthen a skill that will remain vital throughout your clinical career.
Struggling with Prescription Review, calculations, fluid prescribing or exam technique?
Work with an experienced pharmacist, Clinical Prescribing Tutor and Prescribing Lead to build the confidence, knowledge and decision-making skills needed to perform at your best in the PSA.
Book your free 10-minute PSA consultation today and start preparing smarter, not harder.
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