Lecture 11: Clinical Pharmacology and Prescribing Flashcards
What should rational prescribers attempt to do?
- Maximise clinical effectiveness
- Minimise harms
- Avoid wasting scarce healthcare resources
- Respect patient choice
What are two aspects to consider when it comes to patient treatment planning?
Identify key management issues with the patient
- i.e patients ideas/expectations/goals, diagnosis, symptom control, disease modification
Consider if current symptoms modifiable by symptomatic treatment or disease modifying treatment
What aspects of a medicine should you consider?
- Efficacy
- Safety
- Appropriateness
- Adherence
- Review medications some are to avoid side effects of other drugs, not to treat disease
What are the four steps prior to a prescription that you should consider?
Make a diagnosis
Consider treatment options
Choose a medicine
Choose a dosing regimen
What are some things to consider when it comes to efficacy of a medicine:
There may be patient and medicine factors to consider:
- Age, gender
- interacting disease, medicines or food
- patient choice and adherence
- pregnancy and lactation
- Pharmacogenetics
- How effective are the treatment alternatives?
- > What is the evidence to support these treatment alternatives?
What are things to consider when it comes to a safety of a medicine?
- General and patient specific contraindications; Allergies, concomitant disease
- Common and potentially serious adverse effects that can occur with this drug.
- What drug interactions need to be considered?
- Is the patient pregnant or lactating?
What are things to consider when it comes to appropriateness of a medicine?
- Adherence considerations (Pts perspective, health belief, dosing factors, needs blood tests (accessibility) and dose adjustments
- Can the pt afford?
- Consider non-pharmacological option
What are things to consider when it comes to choosing a dose?
Population: Same dose everyone
Group: Same dose for similar group
Individual: The dose is determined by the individual response
- Dose response, therapeutic index
- Disease states that influence the response
- Potential drug interactions
What are some methods of drug delivery?
IV injection (rapid, high dose) Depot preparations (Slow release over hours) Skin patches and gels (Lower peak concentrations, bypass metabolism) Local delivery (reduces systemic effects) Oral tablets (Slower rise to later peak conc., 1st pass metabolism)
What information is essential for a legal prescription?
- Prescribers details
- > Full name
- > Signature
- > Work place address
- > MCNZ registration number
- > Contact phone number
- Patient detail
- > Full name
- > Residential address
- > Date of birth (if under the age of 13)
What is the first part of the prescription for the medicine?
Rx = Take thou
- Name of medicine
- Formulation i.e caps, tabs
- Strength of medication
i.e Rx Enalapril 10mg tabs
What is the second part of the prescription of the medicine?
Sig or signa = mark or write
- > Dose
- > Frequency of dose
i.e enalapril
Sig: i BD po
What is the third part of the prescription of the medicine?
M or Mitte = Send to a total of
- > These are the instructions for the pharmacist
- > Total amount of medicine or total period of supply
For enalapril this may specify thirty days supply:
M: 30 days supply
Max supply is 3 months
What are the three steps after writing the prescription?
Communicate with the patient
Monitor response
Review the medicine
Write some notes about patient education when it comes to communicating with the patient?
Patient education
- > Medicine name and dose
- > How and when to take it
- > Reasons for prescribing
- > Benefits and when they should occur
- > Possible adverse effects and how to manage them
- > Possible interactions with food, drink and medicines
- > Timing of follow-up
Dont provide too much info
