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PH3611- Clinical module > Rational Prescribing > Flashcards

Rational Prescribing Flashcards

1
Q

Rational Prescribing

A
  • Parish states they prescribing should be
    • Necessary
    • Effective
    • Safe
    • Appropriate
    • Economic
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2
Q

Necessary

A
  • Self limiting conditions
  • To end a consultation
  • Treat by lifestyle changes
  • Iatrogenic disease
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3
Q

Effective

A
  • What is the evidence base
    • Generally applies to a group of drugs
  • NNT
  • Approved by NICE
  • Current guidelines
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4
Q

Knowledge- Which ones are evidence based

A
  • Undergrad education
  • Postgrad education
  • Journals
  • Guidelines
  • CCGs guidance
  • Colleagues
  • Pharmaceutical industry
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5
Q

NNT/NNH

A
  • NNT- expresses the number of people who would need to receive an intervention to prevent one event of interest
    • NNT = 1/ARR
  • NNH- Expresses the number of people who would need to receive an intervention for one person to suffer a harmful event of interest
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6
Q

National Institute for Health and Care Excellence

A
  • Procedure- evidence based guidance and advice for health, public health and social care practioniers
  • Develop quality standards and performance metrics for those providing and commissioning health, public health and social care services
  • Provide a range of informational services for commissioners, practioners and managers across the spectrum of health and social care
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7
Q

Reliable sources of evidence

A
  • NICE guidelines
    • NICE
    • NSF
    • SIGN
    • National specialist interest groups
  • Cochrane
  • CKS
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8
Q

Levels of evidence

A
  • 1- Meta-analysis, systematic review, RCT
  • 2- Case control and cohort studies and systematic reviews
  • 3- Non-analytical studies
  • 4- Expert opinion
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9
Q

What is evidence based practice

A
  • EBP is the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient
  • It means integrating individual clinical expertise with the best available external clinical evidence from systematic research
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10
Q

Safe

A
  • Side effect profile
  • Black triangle
  • CHMP warnings
  • Safe for that patient
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11
Q

Appropriate

A
  • Intentional and non-intentional, non-compliance
    • Regimen, Ability to take/use
  • Co-morbidity
  • Renal/Hepatic function
  • Drug interactions
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12
Q

Economic

A
  • The LAST, NOT the first thing to consider
  • Cost-effectiveness not cost minimisation- think wider than drugs
  • Premium-price preparations
    • MR, isomers, posh delivery, modes
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13
Q

Generic prescribing

A
  • England, generic prescribing rate was 83.7% in 2017
  • England, generic dispensing rate was 77.6% 2017
  • Compared to early-mid 1990s
    • Prescribed- 41%
    • Dispensed-35%
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14
Q

Generic prescribing- advantages

A
  • Saves money
  • One name reduces potential for confusion
  • Guide to the drug’s pharmacology
  • Improves stock control
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15
Q

Generic prescribing- disadvantages

A
  • Patient confidence and confusion because of differing
    • Sizes, shapes, colours, packaging
  • Different excipients can cause ADRs
  • Problems recalling faulty medicines if using subcontractors to manufacture
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16
Q

MUST be brand prescribed

A
  • Certain drugs with narrow TI
    • Li, Ciclosporin, Phenytoin, Carba, Theophylline
  • Certain modified or controlled release drugs
    • MR diltiazem, nifedipine, mesalazine, strong opiates
  • Certain administration devices
    • CFC-free beclomethasone
  • Multiple ingredient products
    • Oral contraceptives, emollient creams
  • Biosimilar medicines
    • Epoetin alpha, epoetin zeta
17
Q

Patent extensions

A
  • Changing formulation e.g. capsule to tablet, MR
  • Combination products
  • Isomers
  • Active metabolites
  • Analogues
18
Q

Rational prescribing

STEPS

A
  • Safety
  • Tolerability
  • Effectiveness
  • Price
  • Simplicity
19
Q

British pharmacological society ten principles of good prescribing

A
  • Be clear about the reasons for prescribing
  • Take into account the patient’s medication history before prescribing
  • Take into account other factors that might after the benefits and risks of treatment
  • Take into account the patient’s ideas, concerns and expectations
  • Select effective, safe and cost-effective medicines individualised for the patient
20
Q

British pharmacological societys ten principles of good prescribing

A
  • Adhere to national guidelines and local formularies where appropriate
  • Write unambiguous legal prescriptions using the correct documentation
  • Monitor the beneficial and adverse effects of medicines
  • Communicate and document prescribing decisions and the reasons for them
  • Prescribe within the limitations of your knowledge, skills and experience

PH3611- Clinical module (28 decks)

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