Prescribing Flashcards
What important info do you need to write down first before you do anything
Right patient?
Right DOB?
Right patient no
Check allergies and reactions
What are the sections of the drug chart
Once only drugs Oral anticoagulant for VTE prophylaxis Regular prescriptions As required prescriptions IV and SC infusions Drugs on admission Drugs not administered
What details do you need to include when prescribing
Name of generic medication Dose Route Frequency Valid period Other instructions Signature and contact details
What dose abbreviations are acceptable?
What are not
L
ml
g
mg
Micrograms
Nanograms
Units
How would you write the dose
-what rules should you follow
No trailing 0s
Do not omit the 0 in no’s less than 1
Prescribe in whole numbers
Write the total dose
-if 2x500mg tablets => 1g
What are the abbreviations for these routes
- intravenous, intramuscular
- subcutaneous, sublingual
- oral, rectal, vaginal, PEG tube
- buccal
- inhaler, intraooseous
- nebuliser, nasogastric, nasojejunal
IV, IM SC, SL PO, PR, PV, BUCC INH, IO
What are the abbreviations for the frequency
- once/twice/thrice/four times a day
- every night/morning
- as required
- immediately
- doses X hours apart
How would you write down the times
How would you omit a dose
OD, BD, TDS, QDS ON, OM PRN STAT X-hourly
Circle times that you want to give medication
Cross out times that you want to ignore
24hour clock
Cross out the times on the given date and extend the line to whichever date you want to restart the does
When would you not use the generic drug names only
Generic name (brand name)
- inhalers
- insulin
- psychiatric drugs
- epilepsy drugs
What do you need to take in mind when prescribing ABx or steroids
ALWAYS mention indication and length of use
What drugs have a narrow therapeutic range
Gentamycin Warfarin Lithium Digoxin Theophylline Methotrexate Phenytoin Insulin Ciclosporin
How would you prescribe solutions
- drug
- dose
Drug : drug and conc
Dose : mls of solution
How would you prescribe inhalers
- drug
- dose
Drug : drug and puff content
Dose : puffs
How would you prescribe combined drugs
- drug
- dose
Drug : combination and ratio of each one
Dose :
How would you prescribe oxygen
- target saturation
- additional info
Regular prescription
- circle saturation
- indication, device, flow rate
How would you prescribe IV or SC infusions
- drug and dose
- type of infusion fluid and volume
- time to run
Drug and dose - can be left blank if only giving fluid
Infusion type and volume - 0.9% saline/Hartman’s etc
Time to run - in ml/hour
How would you manage any drugs on admission
Write down all drugs on admission
- if needed => add it to regular prescriptions
- if not needed => add it to drugs not administered
Doses to know by heart
-paracetamol PO
PO 1g every 4-6hrs
MAX 4g A DAY
Doses to know by heart
-metoclopramide
Nausea, vomiting
-chemo, RT induced
-post-op
PO/IM/IV
U60kg
-500micrograms/kg total in 3 divided doses
60kg
-10mg up to TDS
Doses to know by heart
-enoxaparin
Med
-SC 40mg every 24hrs
Surgical moderate risk
-SC 20mg given 2hrs before surgery
-SC 20mg every 24hrs
Surgical high risk (orthopedic, cancer)
-SC 40mg given 12hrs before surgery
-SC 40mg every 24hrs
Doses to know by heart
-dalteparin
Med
-SC 5000UNITS every 24hrs
Surgical moderate risk
-SC 2500UNITS given 1-2hrs before surgery
-SC 2500UNITS given every 24hrs
Surgical high risk
-SC 5000UNITS given evening before surgery
-SC 5000UNITS given every 24hrs
Doses to know by heart
-salbutamol
Acute asthma
-INH 5mg O2 driven NEB every 20-30mins
COPD exacerbation
-INH 5mg repeated up to QDS or more frequently if severe
Doses to know by heart
-senna
Constipation - stimulant laxative
-7.5-15mg OD at bedtime
Doses to know by heart
-lactulose
Constipation - non-absorbable sugar laxative
-15ml BD, adjust according to response
Doses to know by heart
-morphine
Acute pain - adults
-PO 10mg every 4hrs, adjust according to response
Acute pain - elderly
-PO 5mg every 4hrs, adjust according to response
Acute pain - adults
-IV 5mg every 4hrs, adjust according to response
-reduced dose in frail and elderly
Breakthrough
-PO 1/6-1/10 of total daily PO morphine dose
-taken PRN, no more than 2hourly
-MAX 6 doses in 24HRS
Doses to know by heart
-pred in asthma, COPD
Asthma
-PO 50mg OD 5DAYS
COPD
-PO 30mg OD 5DAYS
Doses to know by heart
-aspirin
Secondary prevention CVD
-PO 75mg OD
MI, TIA, ischemic stroke
-PO 300mg OD
Doses to know by heart
-clopidogrel
Secondary prevention of TIA
-PO 75mg OD
Doses to know by heart
-atorvastatin
Primary prevention
-PO 20mg OD
Secondary prevention
-PO 80mg OD
Doses to know by heart
-domperidone
35kg+
-PO 10mg TDS
-MAX 1WEEK due to risk of arrythmias
