intro to prescribing

Question 1

WHO good prescribing

Answer 1

• Step 1: Define the patient’s problem
• Step 2: Specify the therapeutic objective
– What do you want to achieve with the treatment?
• Step 3: Verify the suitability of your P-treatment (preferred drug)
– Check effectiveness and safety
• Step 4: Start the treatment
• Step 5: Give information, instructions and warnings
• Step 6: Monitor (and stop?) treatment

Question 2

Indications

Answer 2

what is it for?

Question 3

cautions

Answer 3

when not to use

Question 4

impairments:

Answer 4

hepatic
renal: eGFR estimated glomerular filtration rate: blood test, renal functions, measures creatinine. High creatinine/ low eGFR indicates dysfunction

Question 5

pregnancy

Answer 5

general: avoid prescribing to a female who is pregnant, choose safest drug as fetus is exposed

Question 6

side effects

Answer 6

identify 3 key side effects

Question 7

dose

Answer 7

• Common overdose of paracetamol, prescribing paracetamol then prescribing another drug containing paracetamol.
• Small overdoses fatal due to liver damage

Question 8

hospital drug charts key points

Answer 8

(name, address date) state age if under 12
current prescriptions
• Allergies (e.g. penicillin and response)
• Anticoagulants
• Insulin

Question 9

enoxaparin

Answer 9

prevent DVT- whoever hospitalised checked- mild to high risk. Every patient has stockings

Question 10

dosage

Answer 10

•	g, mg, or microgram
•	Microgram not mg or mcg
	E.g. 125 micrograms digoxin
•	Nanogram not ng
•	mL for volumes e.g. 125 mg /mL
•	Write ‘Units’ in full (not u)
	e.g. insulin, heparin

Question 11

check dosage appropriate for

Answer 11

Age
– Weight
– Renal function
– Hepatic function

Question 12

frequency

Answer 12

– o.d.: once daily (long half life)
– b.d.: twice daily
– t.d.s: thrice daily
– q.d.s. : four times daily
• p.r.n: ‘As required’: give minimum dosage interval
• Note: methotrexate is prescribed as a WEEKLY dose

Question 13

route

Answer 13

–	im: intramuscular
–	iv : intravenous
–	sc: subcutaneous (slows down absorption) 
–	neb: nebuliser
–	ihn: inhalation

Question 14

patient counselling

Answer 14

• What the medicine is for
• When to take the medicine
• How to take the medicine
• Dose
• Frequency
• Key side effects
• What to do if miss a dose
• How long for treatment

Question 15

extra points

Answer 15

• Look out for key interactions
• Be familiar with key adverse drug reactions (ADRs)
• Is the patient renally impaired?
• How should the patient be monitored
– Electrolytes? Renal /hepatic function?
• Females of child bearing age? Breast-feeding?
• Key counselling points
– what to tell the patient, including important side effects
• Be alert for key adverse events