Prescribing Flashcards
Background on prescribing
Increasingly complex
Complicated by aged and multi-morbid populations
Prescribed medications are third most common cause of death after heart disease and cancer
What is pharmacokinetics?
What body does to drug
Monitoring measurement of plasma drug concentration
What is pharmacodynamics?
What the drug does to the body
Monitors measurement of clinical effect
What is the sub-competencies in prescribing?
Make a diagnosis > Establish therapeutic goal > Choose the therapeutic approach > Choose the drug > Choose dose and frequency > choose duration of therapy > write prescription > inform the patient > monitor drug effects > review/ alter prescription
What makes a safe prescriber
Communication skills
Knowledge of mediciens
Understanding clinical pharmacology
Experience
Diagnostic skills
Appreciation of risk
Primary care setting prescription
FP10 - Green - thing you’ve been writing all these years
Dental - Yellow
Substance misuse - Blue
Hospital setting prescriptions
Inpatient drug chart
Discharge prescription
Outpatient prescription
What does an inpatient drug chart look like?
Patient information – written or sticky label
Allergies
Once only therapy (STAT)
Oxygen
Antibiotics
VTE prophylaxis
Regular medications
When required (PRN)
IV fluids
Info to produce a legal prescription?
At bottom - 1. Prescribers signature 2. Address of prescriber 3. Date 4. Particulars of prescriber
At top - 5. Patient name 6. Patient address 7. Age (if under 12) 8. Drug name 9. Formulation 10. Dose and frequency 11. Quantity and duration
Why is taking an accurate medication history important?
High risk of prescribing error during transition of care
Optimise medical management
Avoid prescribing interacting medicines
Identify ADRs (5% of all hospital admissions)
Medications may mask clinical signs and alter investigations
What information is needed for a prescription?
Complete and accurate list of medications a patient is currently taking:
-Prescribed (regular, when required, acute)
-OTC
-Internet, herbal, borrowed, illicit
Drug name, dose, formulation, frequency
Indication if known (e.g. anticoagulants)
Any non-adherence (reason, duration)
Recent changes
Drug allergies/intolerances (document reaction
What do we consider when taking a medication history?
Who manages medicines at home?
Are resources for the correct patient?
Are resources up to date?
PMHx
Any recent changes?
Are symptoms due to ADR?
What sources can we use to take a medication history?
Patient +/- Carer
Patients own drugs
Repeat Rx
MAR charts
GP records
Recent TTO
Community pharmacy
Hospital transfer docs
Clinic letters
Questions to ask patients when prescribing
Are you taking any medications at the moment?
Do you take any tablets? Inhalers? Eye drops? Patches? contraceptives/HRT?
How many times a day do you take that tablet?
How many tablets do you take?
Do you know the strength of the tablets?
Do you buy any over the counter medications from the chemist or internet?
Do you take any herbal or recreational drugs?
If on anticoagulants –ask why?
What should we use BNF for?
Provides information about the use of medicines
Individual drug monographs:
- Indication(s) and dose
- Contraindications and cautions
- Side effects
- Interactions
- Use in pregnancy, breastfeeding, organ dysfunction
- Medicinal forms, legal category and price
USE BNF Website, app, and how to use BNF screencast
