Prescription Writing, Medication Safety, and Drug Costs Flashcards
What level of controlled drugs are we allowed to prescribe, and what do C1 and C2 mean?
C2-C5 is allowed
C1 = high abuse potential with no accepted medical use C2 = current accepted medical use, high abuse potential (i.e. opiates)
What are the laws around prescription of C2? Below C2?
No refills are allowed, and no telephone transmission allowed
Below C2, refills are allowed by limited
What is the most common way to transmit a prescription, and why might the alternative be preferable?
Written, alternative is electronic and preferable due to legibility, necessary data will be available, and more efficient
-> most pharmacies can accommodate electronic, but outpatient practices have been slow to adopt
What should be used instead of QD, QOD, SQ/SC, or U?
QD -> QDAY
QOD -> Q48h (can be confused with qid)
SQ/SC -> subcut
U -> Units
What is the FDA “Orange Book”? How can you circumvent this?
Book of bioequivalent standards between drugs -> when generic is just as good as brand name
Circumvent this with “DAW” or dispense as written when you need the brand name
What is a formulary?
List of approved / recommended medications for a given hospital / health system / plan
-> cheap and efficacious drugs
What is medication error vs adverse reaction vs near miss?
Medication error - preventable mistake
Adverse reaction - side effect which was unexpected
Near miss - medication error which was stopped before it reached the patient
What is the best way for a health system to minimize errors?
Fix the system / processes rather than reprimanding the humor errors that occur. Focus on why the problem happened and how it could’ve been prevented rather than who did it
What are good drug prescribing safeguards to make sure the dosage and medication is correct?
Standardize whenever possible
- prescribe by generic name
- don’t use unsafe abbreviations
- Always use a leading zero and never a trailing zero
- include patient weight and renal function if known
- observe “tallman” lettering to make sure you have the correct sound-alike drug
What is one thing that should be done every patient visit to minimize drug costs?
Med reconciliation
-> eliminate unnecessary and duplicate meds
How can you minimize drug costs when prescribing generic drugs?
Follow the organizational formulary, and be cynical of new drugs that come out
Also, utilize the cheaper route when appropriate (oral vs IV), and IV push vs IV infusion (saline bag will become contaminated and drug unusable)
When should dose adjustments be done?
In renal impairment, and extreme body weight (adjust for adjusted body weight if the drug doesn’t really penetrate adipose tissue)
