Prescribing Medications and Drug Charts. More Fun than a Night in the Union. Introduction.
More Fun than a Night in the Union
Prescribing drugs is potentially one of the most hazardous areas for PRHOs (and patients!). Write up a wrong drug, wrong dose or incorrect route of administration and the effects can be lethal. Many of you will be confident prescribing drugs on a chart but it never hurts to refresh and practice these skills
This module will direct your learning but it is up to you to put the knowledge and skills into practice.
You will need the charts from your pack and a BNF.
This module is designed to direct your learning around the knowledge and skills associated with prescribing medications on a drug chart
By the end of this module students should
I apologise most humbly to all of you who think this introductory section is patronising and insulting. However in my ten+ years experience teaching finalists I am continually dumbfounded (hence the silly grin) by a small percentage of students who have obviously never seen a drug chart or written up a set of medications. If you feel confident that this is NOT you – please feel free to pass onto the prescribing exercises. If you are unsure or in fact positive that I am talking about you – then just sneak a look at the following few slides ‘as a refresher’ so to speak. What is important is that you will get this correct in any assessment over the coming year, on day one of your PRHO job and forever more!
TO COMPLETE THE FOLLOWING SECTIONS YOU WILL NEED:-
THE DRUG CHART AND PHOTOCOPIED COMPONENTS FROM YOUR FOLDER
Remember – what you write on the charts is your responsibility! If you have never heard of a preparation or trade name – Don’t just blindly prescribe it - look it up in the BNF.
(2) List three drugs you would commonly see, written on
(a) the once only and (b) the prn parts of the chart
(3) Write up a five day course of cephalexin po using the drug chart provided
Do not adjust your eyes – these are all out of focus!
Please note - The correct answers are not provided in this module – it is designed to help you learn some prescribing skills and therapeutics. You should practice these skills on all your firms by offering to write and re-write the charts, noting where and how medications are prescribed, altered and discontinued. You should get your versions checked by a friendly PRHO or SHO. The answers should be include in your folder.
My auntie Marge (hold that name), My auntie Marge, she’s been so unwell for so long now we can’t believe she’s not better ……(please yourselves!)
A 79 yo woman is admitted to hospital with septic shock and HONK. You are asked to prescribe her a stat dose of cefuroxime 750 mg IV, gentamicin 160 mg IV and clexane 40mg sc.
Please write up the medications on the appropriate part of the chart (photocopy)
For each of the following scenarios write up the patient’s regular medications on the charts provided. Any medication that you are uncertain of its side effects or actions please annotate your prescription using the BNF
Often sited on the same page as the once only section but not in this case!
Used to write up medications which may be required from ‘time to time’
Laxatives are commonly written here but should be written regularly to have a good effect
An 85 yo man is admitted to hospital with ACS. Overnight he becomes agitated and confused and is written up for PRN haloperidol along with the ‘usual’ PRN medications for ACS.
Please write up the PRN medications on the chart provided.
- Arterial and Venous thrombo –embolic disease and prophylaxis
INR 2 – 3: DVT, PE, AF, Arterial thrombosis
INR 3 – 4: Metallic heart valve
Fennerty nomogramFennerty A, Thomas P, Backhouse G, Bentley DP, Campbell IA, Routledge PA. Flexible induction dose regimen for warfarin and prediction of maintenance dose. Br Med J 1984; 288:1268-70.
This protocol is designed to
However: it does not eliminate INR overswings entirely, and a lower loading dose of 5mg may be used in patients thought to be especially at risk.
Day INR Warfarin dose (mg) Predicted maintenance dose: 4th Day
1st < 1.4 10 INR Warfarin (mg)
2nd < 1.8 10 <1.4 >8
1.8 1.0 1.4 8
> 1.8 0.5 1.5 7.5
3rd <2.0 10 1.6-1.7 7
2.0-2.1 5 1.8 6.5
2.2-2.3 4.5 1.9 6
2.4-2.5 4 2.0-2.1 5.5
2.6-2.7 3.5 2.2-2.3 5
2.8-2.9 3 2.4-2.6 4.5
3.0-3.1 2.5 2.7-3.0 4
3.2-3.3 2 3.1-3.5 3.5
3.4 1.5 3.6-4.0 3
3.5 1.0 4.1-4.5 Miss out next day's 3.6-4.0 0.5 dose, then give 2 mg
>4.0 0 >4.5Miss out 2 days' doses then give 1 mg
Please change the route of administration and the dose (when required) of
Using the drug charts provided write up medications for each of the patients below. The management is entirely up to you but any drugs you are unfamiliar with you should annotate the chart from the BNF.
At this point you should
If you are unable to achieve all of these outcomes at this point you will need to continue to practice the skills and re-visit the webpages to refresh your knowledge
All photocopied pages should be placed in your PPD folders. They will not be formally assessed but they WILL be appraised to ensure you have completed these sections. Failure to do so will mean your entry into the final MBBS examinations may be delayed.