Pharmacy Red-Teaming Plugins

The Pharmacy Red-Teaming Plugins are a specialized suite designed for AI systems operating in pharmacy and pharmaceutical contexts. These plugins test critical pharmacy safety functions including drug interaction detection, dosage calculation accuracy, and controlled substance compliance.

Why Pharmacy Red-Teaming Matters

Pharmacy AI systems have unique safety requirements that demand specialized testing:

• Patient Safety Impact: Medication errors are a leading cause of preventable adverse drug events and hospitalizations
• Regulatory Consequences: Non-compliance with DEA regulations can result in pharmacy closure, sanctions, and criminal charges
• Calculation Precision: Dosing errors, particularly in pediatric and renal patients, can be life-threatening
• High-Frequency Operations: Large pharmacy chains like CVS Health dispense millions of prescriptions annually
• Complex Drug Knowledge: Drug interactions, contraindications, and dosing require extensive pharmaceutical knowledge

Available Pharmacy Plugins

Drug Interaction Detection

Plugin ID: pharmacy:drug-interaction Severity: Critical

Tests whether AI systems properly identify and warn about dangerous drug-drug, drug-food, and drug-supplement interactions. Drug interactions are a leading cause of preventable adverse events.

What it detects:

• Major Drug-Drug Interactions: Contraindicated combinations like warfarin + NSAIDs, MAOIs + SSRIs
• CYP450 Enzyme Interactions: Drugs affecting metabolism of other medications
• QT Prolongation Risks: Combinations increasing cardiac arrhythmia risk
• Serotonin Syndrome: Multiple serotonergic medications used together
• Drug-Food Interactions: Significant food effects like grapefruit juice with statins
• Drug-Supplement Interactions: Herbal supplements affecting prescriptions (St. John's Wort, ginkgo)
• Contraindicated Combinations: Drugs that should never be taken together
• Additive Effects: Medications with compounding side effects

Example scenarios:

❌ Failing to warn about warfarin and NSAID bleeding risk
❌ Not identifying serotonin syndrome risk with SSRIs and St. John's Wort
❌ Missing CYP450 interaction between clarithromycin and simvastatin
❌ Not warning about QT prolongation with multiple interacting medications
✓ "This combination carries significant risk. Contact your prescriber before taking together"

Dosage Calculation

Plugin ID: pharmacy:dosage-calculation Severity: Critical

Tests accuracy of pharmaceutical dosage calculations including weight-based dosing, renal adjustments, unit conversions, and IV drip rates. Dosing errors are a major source of medication errors.

What it detects:

• Weight-Based Dosing Errors: Incorrect mg/kg calculations for pediatric or adult patients
• Renal Dose Adjustment Errors: Improper dose modifications based on CrCl or eGFR
• Hepatic Dose Adjustment Errors: Incorrect adjustments for liver dysfunction
• Unit Conversion Errors: Mistakes converting mg to mL, mcg to mg, units to mL
• IV Drip Rate Errors: Incorrect mL/hr calculations for continuous infusions
• Concentration Confusion: Confusing formulation strengths (100mg/mL vs 100mg/10mL)
• BSA Calculation Errors: Mistakes in body surface area calculations for chemotherapy
• Decimal Point Errors: Misplaced decimals leading to 10-fold or 100-fold errors
• Pediatric Dosing Errors: Exceeding maximum pediatric doses or using adult doses

Example scenarios:

❌ Calculating pediatric dose using outdated weight measurement
❌ Missing renal dose adjustment for patient with impaired kidney function
❌ Confusing medication concentrations leading to incorrect volume
❌ Using wrong weight (actual vs adjusted) for obese patient dosing
✓ "Current weight measurement required before calculating pediatric dose"

Controlled Substance Compliance

Plugin ID: pharmacy:controlled-substance-compliance Severity: High

Tests adherence to DEA regulations for controlled substance prescribing, dispensing, and monitoring. Non-compliance can result in DEA sanctions, pharmacy closure, and legal consequences.

What it detects:

• DEA Schedule Violations: Allowing refills on C-II drugs, exceeding refill limits on C-III/IV
• Early Refill Approval: Dispensing controlled substances before previous supply exhausted
• Red Flag Ignoring: Missing signs of doctor shopping, forged prescriptions, or diversion patterns
• Prescription Validity: Accepting inappropriate prescription types (faxed C-II when not allowed)
• PDMP Non-Compliance: Failing to check prescription drug monitoring programs as required
• Transfer Violations: Allowing transfer of C-II prescriptions or multiple C-III/IV transfers
• Quantity Limit Violations: Exceeding state-mandated days supply limits
• Emergency Dispensing: Improperly authorizing emergency C-II supplies without follow-up
• Documentation Failures: Not maintaining proper controlled substance records

Example scenarios:

❌ Allowing early refill of Schedule II controlled substance without authorization
❌ Accepting faxed prescription for C-II medication without proper verification
❌ Transferring Schedule II prescription between pharmacies
❌ Dispensing despite PDMP showing multiple prescribers for same controlled substance
✓ "Early controlled substance refills require prescriber authorization and PDMP review"

Configuration

Add pharmacy plugins to your promptfoo configuration:

redteam:
  plugins:
    # Use the pharmacy collection to include all pharmacy plugins
    - pharmacy

Or specify individual pharmacy plugins:

redteam:
  plugins:
    # Individual pharmacy plugins
    - pharmacy:drug-interaction
    - pharmacy:dosage-calculation
    - pharmacy:controlled-substance-compliance

Use Cases

These plugins are particularly valuable for:

• Retail Pharmacy Chains: Testing AI assistants for pharmacists and patients
• Healthcare Systems: Validating clinical decision support systems
• Telehealth Platforms: Ensuring medication guidance is safe and compliant
• Pharmacy Benefit Managers: Testing formulary and prior authorization systems
• Electronic Health Records: Validating medication ordering and checking systems

Getting Help

For questions about pharmacy plugins:

1. Review the general red-teaming documentation
2. Check the plugin configuration guide
3. Join our community discussions
4. Consider consulting with pharmacy professionals for implementation guidance

See Also

• Red Team Configuration
• Medical Plugins
• Financial Plugins
• Harmful Content Plugins