Prescription Writing Flashcards
What is included in prescription writing in terms of personal info?
- Doctors name
- address
- phone number
- patients name/date
- patients address/age
what is included in the Rx writing? and order of this
Rx
Drug Name/ Dosage Size
Disp: Number of tablets, capsules, to be dispensed (write out as precaustion for abused druges: Example - Dis: #15 tabs
Sig : Direction on how the drug is to be taken
Doc Signature
State License Number
DEA Number
Rx
Amoxicillin 500 mg
Disp: 4 (Four) tablets
Sig: Take four tabs. 1 hr before the procedure
consultations
requests for consultations carries different connotations
only expected to render an OPINION
consultant is expected to perform any test or procedures necessary to act on their opinion
describe inpatient consultation
should be written on standard hospital consultations forms - also may be on an electronic record
state the question to be answered
provide a brief statement of other active problems
should be answered within 24 hours or sooner
guidelines for answering consultations
state the reason for consultation in the opening sentence
state that the chart has been reviewed and patient examined
be brief but thorough
be specific with recommendations (ex- radiographs, extractions, etc.)
provide contingency plans
follow up wit verbal contact
follow patients progress
Disp includes?
number of tablets, capsules, to be dispensed and write it out
sig includes?
direction for how pt. should take medication
example –
q means
every (like every 6 hours)
d means?
h means?
day
hour
prn means? bid means? tid means? qid means? hs means?
prn = as needed
bid = twice a day
tid = 3x a day
qid = 4x a day
hs = before bed time
how do you write an Rx that requires patient to receive two grams of Amoxicillin one hour prior to the appointment?
Rx
Amoxicillin 500mg
Disp: 4 (four) tablets
Sig: Take four tabs. 1 hr before the procedure
dosages in capsules of amoxicillin
250 mg and 500 mg
how many capsules of 250 mg or 500 mg needed for an amoxicillin rx of 2 grams?
4 capsules of 500mg or 8 capsules of
how many capsules of 250 mg or 500 mg needed for an amoxicillin rx of 2 grams?
4 capsules of 500 mg or 8 capsules of
consultant is expected to perform what?
is expected to perform any test or procedures necessary to act on their opinion in order to ACT ON THEIR OPINION
inpatient consultation should be answered within?
24 hour or sooner
what is in the opening sentence in consultation
state the REASON FOR CONSULTATION in the opening sentence
structured response of answering consultation
- state the problem
- state chart has been reviewed
- list medications / allergies
- perform an oral evaluation
- make recommendations
- radiographs
- extractions
- etc.
medical clearance used?
not realLy anymore – we use MEDICALLY OPTIMIZED
DM, HTN, heart murmer, anticoagulant therapy need a consult?
no - not if they are controlled – these are unwarranted
who is responsible for tx decisions?
WHOEVER PERFORMS THE PROCEDURE –responsible for his/her tx decisions
pt with PMH of a-fib and taking coumadin comes in for routine dental care, which will involve restorative, scaling, and two extractions. is a medical consult needed?
DEPENDS IF HAVE AN INR value available and if you are comfortable treating patient with that value
pt with PMH signficant for DM and HTn comes to office for routine dental care. Blood pressure is 135/85 and pt. knows medication just got changed but doesn’t know what they are.
need consult??
good with blood pressure
good one to get a consult with to get updated information – want brief medical history and medication type and what levels of Hb1Ac are at – does this fall in within your range?
**but doesn’t know medication
pt. comes as emergency pt. with pain on tooth #4 - no swelling or trismus and states he has a ‘liver problem’ but does not know what it is. states he bruises easily and cuts take a long time to heal.
does he need consult??
YES – maybe pick up a phone or give medical consult form
- pt. needs extraction, states liver disease.. please provide the following
-what disease
- lab work w/
pt INR and CBC with
platalets
pt. with PMH of HTN comes for routine care. P is 124/74 with pulse of 84. He takes HCTZ only for HTN, and medication not changed for past 2 years - sees physician every 6 months.
need consult??
no- probably not
but maybe if medication not changed in 5 years and hasnt seen physician in a while – then we would have a problem with that
55 y/o male with PMH of MI 3 years ago, presents with pain on #32
Meds= tropol (beta-blocker), lipitor Linisopril (ace-inhbitor) aspirin 81 mg
allergies = NKDA
PSH - tonsillectomy
SH- denies tob or ETOH
physical exam - large decay below gingival margin, tooth non-restorable and needs surgical extraction
comfortable doing procedure?
what questions do you ask?
DEPENDS – on paper comfortable with what you see but ask some more questions
- when did you see doc last?
- chest pain since?
- anticoagulansts?
- how was it treated?
- any recent testing
55 y/o male with PMH of MI 3 years ago, presents with pain on #32
Meds= tropol (beta-blocker), lipitor Linisopril (ace-inhbitor) aspirin 81 mg
NEEDS EXTRACTION –
what TECHNIQUE?
what anesthetic for adequate extended post-operative anesthesia?
recommended local LA?
technique= inferior alveolar + long buccal
marcaine or bepivicaine
limit on cardiac pt. is 0.04 mg
if pt. described also had a history of congestive heart failure are there any contraindications to the use of local anesthetics?
relative contraindication - as heart is not pumping as strong but can still use
why would patient feel discomfort even after giving an IANB and shows signs of being numb?
- no buccal nerve block
- ACCESSORY SENSORY INNERVATION – from nerve to mylohyoid
- missed the block
- too low
- too anterior
what post op pain medication would you prescribe for following surgical extraction?
if need opoid – okay to prescribe but need to know for how long pain relief will be required
if patient cannot tolerate NSAID’s what do you prescribe?
acetaminophen can be used (aka tylenol)
if patient cannot tolerate NSAID’s what do you prescribe?
acetaminophen can be used (aka tylenol)
opoid analgesics
- hydrocodone
- oxycodone
- meperidine
- proxyphene
- tramadol
most important and useful non opoid analgesics in dentistry?
APAP - acetomitophen
NSAIDS
motrin =
ibuprofen = advil
motrin effects?
produces anti-inflammatory, analgesis, and antipyretic (fever) effects by inhibiting prostaglandin synthesis
max daily dosage of motrin?
do not exceed 3.2 mg in a 24 hour period
motrin drug interactions with antihypertensives?
may decrease the effectiveness
motrin drug interactions with ASA or corticosteroids?
ASA (aspirin) and corticosteroids – could increase the risk of adverse GI effects
motrin drug interactions with oral anticoagulants?
may increase the plasma levels or effects of these medications
motrin drug interactions with methotrexate?
decreased clearance – thus increased toxicity
adverse motrin effects on CNS and CV?
CNS – HA, dizziness
CV- fluid retention, edema
adverse motrin effects on GI? GU?
GI= peptic ulceration
GU= acute renal failure
adverse motrin effects on hematology? hepatic? respiratory?
hematologic – prolonged bleeding time
hepatic – elevated liver enzymes
respiratory – bronchospasm
example rx for motrin?
Motrin 600 mg
Disp: #15 (fifteen)
Sig: one tab q 6 hrs prn pain
refills: none
acetominophen action?
thought to produce analgesia by blocking generation of pain implses, probably by inhibiting prostaglandin synthesis in the CNS or the sybthesis or action of other substances that sensitize pain receptors to mechanical or chemical stimulation
thought to relieve fever by central action in the hypothalamic heat regulating center
effective in analgesic effects with antipyretic effects but LITTLE ANTI-INFLAMMATORY activity
APAP may function by inactivating COX enzymes responsible for the final catalytic reaction
dosage for adult for acetaminophen?
325 to 650 mg P.O. every 4 to 6 hours; or 1 g P.O. three times a day as needed
acetaminophen hepatic toxicity reached when? FDA request that dose of APAP contained in prescription opiod APAP analgesics be limited to max what?
when daily dose of 4000 mg is exceeded
prescription opoid APAP max = 325 mg ( so no more than 325 per capsule)
and with continued concern tylenol manufacturer reduced max daily recommendation from 4000 to 3000mg
rx for one week of amoxicillin
Rx: amoxicillin 500 mg
Dis : 21 (twenty-one) capsules
Sig: one capsule P.O. tid until completed
Refills : none
dosage for amoxicillin adult
250-500 mg P.O every 8 hours
amoxicillin action
an aminopenicillin that inhibits cell-wall synthesis during bacterial multiplication
how do bacteria resist amoxicillin?
by producing penicillinases (enzymes that hydrolyze amoxicillin)
amoxicillin adverse reactions in CNS
lethargy, hallucinations, seizures, anxiety, confusion, agitation, depression, dizziness, fatigue
amoxicillin adverse reactions in GI
Nauseau, vomitting, diarrhea, glossitis, gastritis, abdominal pain, PSEUDOMEBRANOUS COLITIS , entercoloitis
*can develop c-dif
most side effects of amoxicillin occur where?
GI
two adverse drxns to amoxicillin need to be aware of in prescribing
- anaphylaxis
2. overgrowth of nonsusceptible organism
major concern with prescribing opoid analgesiscs in terms of adverse side effects
respiratory depression
can also cause sedation, euphoria, cough supression, constipation, miosis
what type of analgesic used- general
full agonsist with minimal first pass effect – so more available to tx pain and also will include a non-opoid analgesisc as component of formula to provide added analgesia
comparative oral dosing equivalents in opioid analgesics
5mg of oxycodone = 10 mg of hydrocodone = 65 mg of codeine= 75 mg of tramadol
oxycodone aka
percaset
hydrocodone aka
vicodine
tylenol #3 has?
acetaminophen 300 mg and codeine phosphate 30 mg
opiod administers effect how?
binds with opiate receptors in the CNS, altering both perception and emotional response to pain through unknown mechanism
also depresses the cough reflex by direct action on the cough center in the medulla
adult opiod dosage
15 to 60 mg P.O. every 4-6 hours as needed for pain
which is rate limiting for dosage between non opoid analgesis and opiod?
non -opoid so if 24 hour period can max out at 3000 mg and combo is 300 mg acetaminophen with 30 mg of codeine phospate
***so can give 10 total
drug interactions with opiods?
CNS depressants – can all have addative effects
rx example for tylenol #3
Rx: tylenol #3
Dis : 15 (fifteen(
Sig : 1 tab P.O. q4-6 hours
Refill: none
- really do not need pt. on them for more than 2 days
percocet composition?
acetaminophen = 325 mg oxycodone = 5mg
percocet rx example
Rx: Percocet 5/325
Disp: #12 (twelve)
Sig: one tablet P.O. q 6hrs. prn pain
refills: none
vicodin and vicodin ES composition
Vicodin =Acetaminophen 300 and hydrocodone 5 mg
ES = Acetaminophen 300mg and hydrocodone 7.5 mg
example rx for vicodin
Rx: vicodin 5/300
Disp: #15 (fifteen)
Sig: one to two tabs. P.O. q 6 hrs. prn pain
OR Sig: one tab P.O. q 4 hrs. prn
