Lecture 18: CP and prescribing

Question 1

What is rational prescribing?

Answer 1

“selection of the most apropriate therapeutic regimen for a specific patient”

Question 2

4 steps before writing a prescription?

Answer 2

1. make a diagosis - patients come with symptoms and sometimes a wrong diagnosis from the internet
2. Make a therapeutic decision - identify what your treatment goals are. What the patient wants (THEIR key issues).

Are the patients symptoms modifiable by symptomatic treatment or disease modifying treatment.

3. Choose a medicine Efficacy, Safety, Appropriateness
4. Choose a dosing regimen - choose a route of delivery and dose

Question 3

efficacy of a medicine?

Answer 3

1. how effectve are the treatment alternatives
2. are there patient related factors that affect efficacy

• age
• disease state
• pregnancy
• genetics
• other medicines or substnaces
• COMPLIANCE??

Question 4

safety of a medicine?

Answer 4

1. What are the contraindications for using this drug in general and specifially in this patient -allergies, concomitant disease including major organ failure.
2. What are the common and potenially serious adverse effects that can occur with this drug - will this influence the patients choice
3. What drug interactions need to be considered? - food, other drugs, drug-disease
4. Is the patient pregnant or lactating?

Question 5

Appropriatness of medicine

Answer 5

1. Can the patient afford it (even if it’s subsidised)
2. Are there considerations for compliance? -more than one a day, empty stomach, needs blood checks, no. of meds

Question 6

Different Routes of delivery?

Answer 6

1. IV injection - high blood conc, instantaneous, potentially dangerous
2. Skin patches - lower preak conc and extended duration
3. local delivery - Site of action targeted, reduced systemiv effects
4. oral tablet
5. deposti preparations

Question 7

Therapeutic index?

Answer 7

The dose that is least likey to lead to adverse effects but most likely to cause therapeutic benefit.

Question 8

A prescription must have?

Answer 8

1. Doctor’s name
2. Signature
3. physical address
4. MCNZ regestration number
5. contact no.
6. Patients name
7. Their address
   
   1. Age

Question 9

R_x, Sig and M

Answer 9

R_x = Name of medicine, formulation, strength

Sig = instructions for the patient

M = instructions for the pharmacist as to quantity dispensed

Question 10

Answer 10

Question 11

Answer 11

Question 12

After writing a prescription?

Answer 12

1. Counsel the patient/communicate information
2. Monitor response - clinical response, biomakers, drug conc. Indications for TDM:

• Event potentially serious but occurs infrequently
• Narrow therapeutic index
• effects correlate better with conc than dose due to variability
• deciding whether or not a symptom is ADR
• detecting non-compliance

3. Review the medicine - efficacy and safety, appropriatness, patient view of drug and adherence.