Prescribing

Question 1

List the barriers to medication adherence (3)

Answer 1

Complex drug regimens/polypharmacy- try and decrease nonessential medications.

Difficult schedules- try to choose longer acting medications. For example, a teenager who presents with chlamydia infection is more likely to be compliant with a one time dose of azithromycin verses 7 days of doxycycline BID.

Understanding: Explain the why and the importance of the medication. Many people want to stop medication once symptoms resolve, explain the dangers in that. Follow up appointments to address compliance and unwanted side effects.

Question 2

How to monitor effectiveness

Answer 2

1. Passive monitoring: educate on expected outcome and instruct pt to follow up if symptoms persist or do not improve.
   Ex. UTI treatment
2. Active monitoring: Follow up labs or tests. Ex. BP after antihypertensive medication is started.

Question 3

Routes of administration

Answer 3

Oral/sublingual/rectal: Have first pass through liver

Parenterial (IV/IM/SQ): Bypasses first pass with liver

Question 4

Loading doses

Answer 4

An initial higher dose at the initiating of the treatment before decreasing to a lower maintenance dose.

Loading doses are used to achieve therapeutic drug concentrations faster

Ex. azithromycin for tonsillitis, usually day 1 have loading dose (typically twice the dose) followed by half the dose for 5 days.

Question 5

What criteria should you look at for older population?

Answer 5

BEER’s criteria

Question 6

bioavailability

Question 7

metabolism

Question 8

Half life

Answer 8

The period of time which the drug concentration will be decreased by 50%. Therefore, blood levels decrease by 50% in one half life, 75% in two half lives, etc.