Prescribing

Question 1

Give 4 types of prescription

Answer 1

• paper drug charts
• electronic medication records
• outpatient prescription
• FP10

Question 2

4 legal classification of medication

Answer 2

General sales list
pharmacy only
prescription only
controlled drugs

Question 3

4 people who can prescribe

Answer 3

doctors
nurses
dentists
vets

Question 4

7 legal requirements for prescriptions

Answer 4

Dated
Name and Address of patient
Address of prescriber
Indication of the type of prescriber
Signed in ink

If under 12 years Age needs to be included
Weight of child if dose is to be checked per Kg

Question 5

4 good practise elements of prescribing

Answer 5

DOB and age of patient (nb. legal requirement in Controlled Drug prescriptions)
Name of doctor
Treatment duration
Drug allergies/intolerances

Question 6

what has to be included on the prescription for schedule 2 and 3 controlled drugs

Answer 6

The dose, drug form and instructions must be included

The total quantity of the drug must be included in words and figures e.g. FOURTEEN (14) tablets

Question 7

example of schedule 2 or 3 controlled drugs

Answer 7

tramadol
codeine
morphine
zopiclone

Question 8

6 basic processes involved in prescribing

Answer 8

1. define problem
2. define therapeutic objective
3. choose tx- consider efficacy, safety, tolerability and cost
4. start tx
5. monitor effects
6. stop tx if required

Question 9

challenges when prescribing remotely

Answer 9

E.g. over the phone, via skype or on behalf of someone
Not always able to do a full clinical review yourself
Limitations of communication
Access to patient’s medical record
Harder for pharmacist to follow up hand written prescriptions
Increased risk of errors (e.g. not checking allergies)
Potential for abuse
Impaired continuity of care

Question 10

ways to minimise the risk of prescribing

Answer 10

Prescriber satisfied they can prescribe safely
Adequate knowledge of the patient’s health
Knowing the risks and benefits of treatment in that situation
Satisfied that the medication prescribed serves the patient’s needs acutely
Hand over any prescriptions (verbally & written)
Be contactable to pharmacy

Question 11

what is wrong in this “ml”

Answer 11

should be mL

Question 12

are ug and ng acceptabile abbreviations?

Answer 12

NOPE

Question 13

Variables to consider when selecting drug doses

Answer 13

age
body size
body composition
renal function
hepatic function
CO
indication 
co-morbidity
concurrent tx
formulation 
administration route
practicability
plasma concentration

Question 14

How do you calculate ideal body weight for men?

Answer 14

(0.91 x [height (cm) -152.4]) +50

Question 15

How do you calculate ideal body weight for women?

Answer 15

(0.91 x [height (cm) -152.4]) +45.5

Question 16

how do you calculate adjusted body weight?

Answer 16

Ideal body weight + (0.4 x [TBW-IBW])

Question 17

how do you calculate concentration?

Answer 17

Mass/ Volume

Question 18

How do you calculate rate?

Answer 18

volume/time
mass/time
mass/ body weight/time

Question 19

How do you convert % solution to mg/mL? E.G 0.9% sodium chloride

Answer 19

x10

9mg/mL

Question 20

How do you convert % strength to mg/mL? E.g. lidocaine 1%

Answer 20

x10

Question 21

What does this mean? Adrenaline 1:1000

Answer 21

This is the equivalent of saying 1mg in 1000mL

Question 22

Give 3 examples of crystalloids?

Answer 22

sodium chloride 0.9%

Glucose 5%

Hartmann’s solution

Question 23

What is a colloid?

Answer 23

fluid preparation containing large, osmotically active molecules (e.g. albumin or modified gelatin) distributed in a a crystalloid solution (e.g. sodium chloride)

Question 24

3 compartments for fluid in the human body

Answer 24

intracellular
extracellular
intravascular

Question 25

Ion in intracellular space

Answer 25

Potassium

Question 26

Ion in extracellular space

Answer 26

Na+

Question 27

Basics of IV fluids

Answer 27

1) Na+ is relatively constrained to the extracellular compartment by the Na+/K+-ATPase pump on cell surface membranes
2) Albumin (and other large, osmotically-active molecules) are relatively constrained to the intravascular water compartment by the vascular endothelium
3) Water can move freely between body water compartments, and will do so as necessary to equalise their tonicity (by osmosis)

Question 28

Daily maintenance requirements of:

• water
• sodium
• potassium
• glucose

Answer 28

water: 25-30 mL/kg
sodium: 1mmol/kg

Potassium: 1mmol/kg

Glucose: 50-100g

Question 29

Basic way to ensure daily fluid requirements are ,et with IV fluids

Answer 29

1) decide how to provide 1mmol/kg/day of sodium
2) calculate and prescribe the hourly infusion rate (1mL/kg/h)
3) make up the rest of the water requirement with 5% glucose
4) if renal and serum K are normal, include potassium chloride 0.3% (40mmol/L) in each of the glucose and sodium chloride bags.

Question 30

Volume and infusion rate for fluid resus

Answer 30

250-500mL over 5mins