Rational Drug Selection and Prescription Writing Flashcards
Before prescribing make sure you document what: (4 things)
A documented provider-patient relationship, thorough H&P, a plan for drug monitoring and titration, and a note documented if any other providers were consulted
How does cost contribute?
contributes to non-adherance
How do guidelines contribute
when in doubt, follow guidelines set out by organizations. However, if you deviate from the standard of care you need to document why
How does availability contribute?
Know the facilities formularies and what Medicaid/Medicare will cover for patients
How do interactions contribute?
Monitor for polypharmacy.
Ask about all current drugs, OTC meds, and herbal preparations
How do side effects contribute?
Asses risk-benefit ratio.
Ask your patient if they have experience side effects after initiating, stopping, or adjusting the dose on a medication
How do allergies contribute?
Critical to determine the type of reaction and document in the chart
How does hepatic and renal function contribute?
Impaired hepatic/renal function could cause an overdose of a medication.
Many drugs have specialized dosing in these circumstances.
Important to know if you can adjust dose or if it is contraindicated.
How does ‘need for monitoring’ contribute?
Assess patients ability to adhere to medication regimen, attend lab draws, and reachability by phone before prescribing a medication that requires monitoring.
Ex: warfarin, lithium, opioids, immunosuppressants
Necessities on a prescription
Prescriber name, license number, and contact information
Prescriber DEA number, if applicable
Patient name and date of birth
Patient allergies
Name of medication
Indication of medication (e.g., atenolol for hypertension)
Medication strength (e.g., 25 mg, 500 mg/mL)
Dose of medication and frequency (e.g., 12.5 mg once daily)
Number of tablets/capsules to dispense
Number of refills
Limitations to telephone prescriptions
Schedule II meds cannot be prescribed or refilled by telephone unless it’s an emergency and only then for a small supply and written prescription must be presented to pharmacy within 7 days
Consider shorter refill time (1-3 mo) when:
- newer medication for patient
- changing dose or frequency
- adding new medication to regimen
- pt having undesired side effects
- you need to see them again before refilling
