Chapter 2: Rational Drug Selection and Prescription Writing

Question 1

responsibility of prescribing

Answer 1

Giving medications and prescribing medications are two very different things ​

There are many different issues to consider when writing a prescription​

Maintain patient safety by being prudent and deliberate in the decision-making process

Question 2

prescription writing decision-making process

Answer 2

Documented provider-patient relationship with the person for whom you are prescribing ​

Person you are prescribing to is a patient of your practice ​

Do not prescribe medications for family or friends, coworker, or for yourself ​

Document a thorough history and physical examination ​

Include any discussions you have with the patient regarding risk factors, side effects, or therapy options ​

Have a documented plan regarding drug monitoring or titration, if applicable ​(ex. warfarin needs INR monitoring)

If you consult additional providers, note that you did so ​

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Question 3

drug selection considering factors

Answer 3

Cost

Guidelines​

Availability​

Interactions​

Side effects

Allergies​

Liver and renal function​

Need for monitoring

Special populations
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Question 4

cost

Answer 4

Patient will not take drug if they cannot afford it. Copays can make medication unaffordable as well

Varies based on location, pharmacy, generic vs. trade name. ​

Generic tends to be covered and less cost ​

New trade name may be cheaper or have coupons ​

GoodRx app ​

Question 5

availability

Answer 5

Depends on formulary​, Insurance companies change what meds that will allow for patients. know your facilities formulary

Question 6

guidelines

Answer 6

set by professional organizations, medical, and nursing societies​

Ensure treatment regimen is individualized for the patient

Question 7

interactions

Answer 7

Other medications or food, Good idea to add one medication at a time. ask about all OTC meds, herbs, etc. need full inventory. Food-to-drug, drug-to-drug​. Adjust regimen to prevent life-threatening complications. monitor for polypharmacy

Question 8

side effects

Answer 8

All drugs have side effects. ask patient about side effects when initiating, changing or stopping medications. Weigh risk vs. benefit. If another medication does the same thing without side effect -> prescribe that one​. Ex. Metformin DMTII -> GI side effects as dose increases. Some individuals lose GI side effects with extended release. Adjust regimen to prevent severe reactions.

Question 9

allergies

Answer 9

Need to know allergy and effects on their body. Ex. Patient reports GI upset as allergy, but it is side effect​. Always document what allergy was. Select alternate medication

Question 10

liver/renal function

Answer 10

affects drug metabolism​. Decrease dose when appropriate. Monitor metabolism and excretion. May need to monitor dosing of medication based on function. Use different drug if available. ​

Question 11

monitoring

Answer 11

depends on the medication​. Regular follow-up for blood draws may be necessary. Some medications need to remain in therapeutic range. ex> warfarin, Li, opioids, immunosuppressants, Avoid medications requiring monitoring to unreliable patients ​(cant attend lab appointments often, cant take meds reliably, not reached easily)

Question 12

special populations

Answer 12

Breastfeeding mothers, children, older adults-> Alternation in medications, dosing, etc. ​

Question 13

parts of prescription

Answer 13

Key elements that must be present in order to compose a complete prescription include:​

Prescriber name, license number, and contact information​

Prescriber DEA number, if applicable​

Patient name and date of birth​, Sometimes patient address as well ​

Patient allergies​

Name of medication ​

Indication of medication (e.g., atenolol for hypertension)​

Medication strength (e.g., 25 mg, 500 mg/mL)​

Dose of medication and frequency (e.g., 12.5 mg once daily)​

Number of tablets/capsules to dispense​

Number of refills

Question 14

prescription tips

Answer 14

no abbreviations

always have a leading 0, never trailing 0.

if patient is not good at following up, limit refills.

Question 15

telephone prescription

Answer 15

Convenient way to create a new prescription or prescription refill ​

Prescription can be called in to a pharmacy by you or a specified designee ​

Ensure all correct information is included ​

Schedule II category medications cannot be prescribed or refilled by telephone​: Must be written and signed​. A small amount can be called in, but must bring written script in in 7 days.

Question 16

written prescriptions

Answer 16

Like telephone calls or electronic scripts, must contain all the necessary elements as previously described ​

May be prepopulated on your script, there are still some important points to consider​: Make sure your name and contact information are printed legibly on the paper, Write all prescriptions in ink or indelible pencil​, Avoid abbreviations such as U (units), MSO4 (morphine), or QD (daily),​ Never write prescriptions on pre-signed scripts or pre-sign blank scripts for other providers or staff, Many facilities provide tamper resistant scripts, and some states require their use, especially in the prevention of substance misuse and abuse. ​

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Question 17

e-prescribing

Answer 17

Many pharmacies now have capabilities to accept electronic prescriptions​

Allows the provider to select a specific, patient selected pharmacy, prescription is automatically sent to the selected pharmacy​: Direct transmission of information, making error less likely​, Prescription can be ready sooner​

Limitations: scheduled medications (require a prescription on tamper-resistant paper); some organizations do not have a functional EMR; pharmacies that do not have the software capabilities to process these requests. In those cases, paper prescriptions are still necessary