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Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
Rational prescribing & prescription writing
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Rational prescribing & prescription writing

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Please tell me what you think about my slides, you can write to: mh_farjoo@yahoo.com

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  • 1. Rational prescription writing By M.H.Farjoo M.D. , Ph.D.Shahid Beheshti University of Medical Science
  • 2. Introduction  Pharmacotherapy teaching is NOT the transfer of knowledge about drugs, but the skill to treat patients.  The students should be taught how to prescribe, not what.  Irrational prescribing is a “disease” which is difficult to treatM.H.Farjoo Dec. 2006
  • 3. Introduction Cont’d  Prescribing is part of a logical deductive process, based on comprehensive and objective information.  It is not a knee-jerk reflex, a recipe from a cook-book, or a response to commercial pressure.M.H.Farjoo Dec. 2006
  • 4. P-drugs  A physician should develop a standard treatment for common disorders, resulting in a set of first-choice drugs, called p(ersonal)- drugs.M.H.Farjoo Dec. 2006
  • 5. P-drugs Cont’d  Steps in choosing a P-drug 1. Define the diagnosis 2. Specify the therapeutic objective 3. Make an inventory of effective groups of drugs 4. Choose an effective group according to criteria 5. Choose a P-drugM.H.Farjoo Dec. 2006
  • 6. P-drugs, step 1  Define the diagnosis  Fever  Angina pectoris  Cough  Diarrhea  PainM.H.Farjoo Dec. 2006
  • 7. P-drugs, step 2  Specify the therapeutic objective  What do you want to achieve with the treatment?  If you do not know enough about pathophysiology of the disease or of the pharmacological sites of action, you need to update your knowledge.M.H.Farjoo Dec. 2006
  • 8. P-drugs, step 3  Make an inventory of effective groups of drugs  In this step you link the therapeutic objective to various drugs.  Efficacy is the first criterion for selection.  Look for groups of drugs rather than individual drugs.M.H.Farjoo Dec. 2006
  • 9. P-drugs, step 4  Choose an effective group according to criteria  Efficacy again remains of first importance.  Safety (side effects)  Suitability (the patient should be able to administer the drug alone, in the elderly and children drugs should be in convenient dosage forms)  Cost of treatmentM.H.Farjoo Dec. 2006
  • 10. P-drugs, step 5  Choose a P-drug  Choose an active substance and a dosage form  Choose a standard dosage schedule  Choose a standard duration of the treatmentM.H.Farjoo Dec. 2006
  • 11. Prescription writing  The six-step prescription writing routine: 1. Define the patient‟s problem 2. Specify the therapeutic objective 3. Verify the suitability of your p-drug and choose a treatment for this individual patient 4. Write a prescription 5. Inform and instruct the patient 6. Monitor and/or stop the treatment.M.H.Farjoo Dec. 2006
  • 12. Prescription writing, step 1  Define the patients problem  Disease or disorder  Sign of underlying disease  Psychological or social problems, anxiety  Side effect of drugs  Refill request (polypharmacy)  Non-adherence to treatment  Request for preventive treatment  Combinations of the aboveM.H.Farjoo Dec. 2006
  • 13. Prescription writing, step 3  Verify the suitability of your p-drug  Active substance and dosage form  Standard dosage schedule  Standard duration of treatment  Effectiveness (indication, convenience)  Safety (contraindications, interactions, high risk groups)M.H.Farjoo Dec. 2006
  • 14. Prescription writing, step 4  Write a prescription  Write legible  Name and address of the prescriber, with telephone number  Date of the prescription  Name and strength of the drug  R/ (not rx) is derived from recipe (latin for „take‟).  Dosage form and total amount  Prescribers initials or signature  Name and address of the patient; age (for children and elderly)M.H.Farjoo Dec. 2006
  • 15.  A doctor had written a prescription for Amoxil tablets (amoxicillin). The pharmacist misread this and dispensed Daonil (glibenclamide) instead. The patient was not a diabetic and suffered permanent brain damage as a result of taking the drug.M.H.Farjoo Dec. 2006
  • 16. Prescription writing, step 5  Give information, instructions and warnings  The six points listed below summarize the minimum information that should be given to the patient.M.H.Farjoo Dec. 2006
  • 17. Prescription writing, step 5 Cont’d  Effects of the drug  Why the drug is needed  Which symptoms will disappear, and which will not  When the effect is expected to start  What will happen if the drug is taken incorrectly or not at all  Side effects  Which side effects may occur  How to recognize them  How long they will continue  How serious they are  What action to takeM.H.Farjoo Dec. 2006
  • 18. Prescription writing, step 5 Cont’d  Instructions  How the drug should be taken  When it should be taken  How long the treatment should continue  How the drug should be stored  What to do with left-over drugs  Warnings  When the drug should not be taken  What is the maximum dose  Why the full treatment course should be takenM.H.Farjoo Dec. 2006
  • 19. Prescription writing, step 5 Cont’d  Future consultations  When to come back (or not)  In what circumstances to come earlier  What information the doctor will need at the next appointment  Everything clear?  Ask the patient whether everything is understood  Ask the patient to repeat the most important information  Ask whether the patient has any more questionsM.H.Farjoo Dec. 2006
  • 20. Prescription writing, step 6  Monitor (and stop?) the treatment  Passive monitoring means that you explain to the patient what to do if the treatment is not effective, is inconvenient or if too many side effects occur. In this case monitoring is done by the patient.  Active monitoring means that you make an appointment to determine yourself whether the treatment has been effective.M.H.Farjoo Dec. 2006
  • 21.  five Ds:  Diagnosis  Drug  Dose  duration of treatment  different treatmentM.H.Farjoo Dec. 2006
  • 22. Thank you Any question?

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