principles of prescribing Flashcards
(71 cards)
which three groups of patients do you need to be cautious with when prescribing
- children
- pregnancy/lactation
- elderly
what do training and healthcare professionals place a greater emphasis on
diagnostic rather than therapeutic skills
what does the choice of treatment depend on
the patient
when does prescribing practice need to be adapted
as the patient demographics vary e.g. young, elderly and other ‘at risk’ groups
what 4 things do poor prescribing habits lead to
- ineffective and unsafe treatment
- prolongation of illness
- distress and harm to the patient
- higher costs of treatment
list the 5 stages in the process of rationale prescribing
- specify the therapeutic objective
- make an inventory of possible treatments
- choose a treatment (taking into account efficacy, safety suitability and cost)
- provide patient with clear information and instructions
- monitor the effectiveness of the treatment (if therapeutic objective is being achieved)
this is what we hope to achieve behind prescribing this particular drug
what does someone being under the age of 12 constitute
a child, so be cautious with choice of drug
what is the first step to take if a 10 year old child visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction
define the clinical problem
how do you define the clinical problem of 10 year old child who visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction
give 4 actions
- exclude more serious causes of red eye
- are the signs and symptoms suggestive of seasonal allergic conjunctivitis
- assess the severity of the problem
- are there any associated symptoms
why is it important to find out if there are any associated symptoms with 10 year old child who visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction
with seasonal allergic conjunctivitis, are the eye symptoms associated with nasal symptoms
important because if our therapeutic objective is to treat the eye symptoms, we might control the eye symptoms but we won’t be doing anything for the nasal symptoms
what is the second step to take if a 10 year old child visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction, once you have defined the clinical problem
specify the therapeutic objective
how do you specify the therapeutic objective of 10 year old child who visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction and why
you alleviate the symptoms
because this is the main therapeutic objective and you want to improve the appearance of the eye by controlling the disease
what is the third step to take if a 10 year old child visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction, once you have decided that you want to specify the therapeutic objective
you find an inventory of possible treatments
what is the recommended inventory of possible treatments for a 10 year old child who visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction, who has been defined as having seasonal allergic conjunctivitis
- identify the allergens and avoid if possible (so think about the non pharmacological options available to us)
- recommend antihistamine or mast-cell stabiliser eye drops
which possible treatment of seasonal allergic conjunctivitis provides a more rapid relief of symptoms
topical anti histamine
which topical eye drop may be considered first line for prophylaxis
mast cell stabiliser
how does a mast cell stabiliser work
- it takes several weeks to act
- it reduces degranulation of the mast cells
what will you advise to you px when prescribing them with a mast cell stabiliser for their seasonal allergic conjunctivitis
they may not get relief for the first few weeks, but eventually they will
when will you consider oral antihistamines or intranasal corticosteroids for a patient who suffers from seasonal allergic conjunctivitis
if there are associated symptoms of: rhinorrhoea, sneezing or nasal irritation
as well as taking therapeutic agents, what else can you advise your patient to do if they have seasonal allergic conjunctivitis
a cold compress with a flannel and cold water as this may be soothing
what is the fourth step to take if a 10 year old child visits you complaining of itching epiphora of a 2 week duration, with signs of lid oedema, conjunctival oedema, redness of the tarsal conjunctiva with a papillary reaction, once you have found an inventory of possible treatments
you choose a treatment
what is there limited evidence on about topical antihistamines
that they are quicker to act than mast cell stabilisers
what are anti-allergy drugs not associated with
any significant safety concerns
what should the choice of topical treatment be made according to, when choosing between anti histamines and mast cell stabilisers, to treat seasonal allergic conjunctivitis
the needs and preference of the individual you are treating
