Introduction to Prescribing Flashcards
WHO Steps of Good Prescribing
- Define patient’s problem (diagnosis)
- Specify therapeutic objective
- Verify suitability of P-treatment (preferred drug)
- Start treatment
- Give information, instructions and warnings (educate)
- Monitor treatment and reconsider
Diagnose, Specify, Verify Suitability, Treatment, Educate, Monitor
REVISE STEP 3!!
BNF
British National Formulary
Indications
What a drug is used for
Cautions
When not to use
Contraindicated
Do not take in x circumstance
REVISE FROM LECTURE NOT SLIDES
Hepatic Impairment
Considerations to take if patient has liver disease
Renal Impairment
Considerations to take if patient has kidney disease
Monitoring Requirements
Body functions that must be monitored before/during/after starting the drug
e.g. Renal function, Liver Function Tests, Electrolytes, Lipids, BP, Plasma Concentrations
(Don’t memorise the examples)
How to communicate side effects to patients
Think of the three main side effects you want to communicate to a patient so that you don’t overwhelm them
Components of a hospital prescription/drug chart
State name and address of patient Start date DoB Current Pescriptions Emergency drugs Regular Drugs (e.g. Antimicrobials) Medicines brought in/stopped Enoxaparin
Hospital Charts
- Allergies (e.g. Penicillin and response)
- Anticoagulants
- Insulin
Stat Drugs
Emergency drugs
Drugs given to patients in an emergency; found on hospital/prescription chart
Dose, drug name, route and condition to treat are provided
Enoxaparin
Anticoagulant; every patient in hospital should be assessed as to whether they need to be prescribed an anticoagulant for deep vein thrombosis as this is much more likely to happen when lying down for long time periods
Stockings are also always given to patients to promote venous return
Information Given on Drug Chart for each drug
Drug Name Dose Route Start/Stop Date Indication Signature at prescription and administration
Notes on writing dosages
g, mg or microgram
Microgram NOT ug or mcg
Nanogram not ng
mL for volumes
Write Units in full
Factors to keep in mind during dosage considerations
Age
Weight
Renal (eGFR)/Hepatic Function
o. d.
b. d.
t. d.s
q. d.s
p. r.n
o. d.: Once Daily
b. d.: Twice Daily
t. d.s: Thrice Daily
q. d.s: Four Times Daily
p. r.n: As required (provide minimum dosage interval)
Methotrexate
Immunosupressant given once a week
BE SUPER CAREFUL OF SEEING THIS; IT IS ALWAYS A WEEKLY!!
What do the following drug administration routes mean po im iv sc neb Ihn
po: Oral
im: Intramuscular
iv: Intravenous
sc: Subcutaneous
neb: Nebuliser
Ihn: Inhalation
PRN Medication (And what to include on drug chart)
Drugs given to patients as required (e.g. as response to side effects)
Medicine Dose Route Min Interval Max Dose 24 hours Indication
Look out for similar sounding drugs
That’s all; you’ve been warned >:)
Factors to consider during drug choice
Guidelines First Line drugs - What to do in therapeutic failure Known drug allergies (IMPORTANT) Concurrent medical conditions Renal/Hepatic Function Drug Interactions
Patient Counselling for Prescription
Tell the patient: What the medicine is for When to take it How to take it Dosage Frequency *Key Side Effects* What to do if miss a dose How long for treatment
Compare carbon footprint of pharmaceutical vs automotive industry
Pharmaceutical Industry > Automotive Industry
Things to consider for sustainable prescribing
Provide digital as opposed to paper resources
Social Prescribing (e.g. exercise)
Recycling
Longer durations of repeat prescriptions to reduce travel to pharmacy
