Page 1161 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 65 Rational Prescribing & Prescription Writing 1147

especially important factor and the nature of the patient’s insur-
ance coverage, and whether there is a need for once-daily dos- 1 2
ing. Based on this information, a drug would probably be JOHN B. DOE, MD
selected from the NSAID group. If the patient does not have 1234 SOUTH NORTHEAST DR 3
ulcer disease but does have a need for low-cost treatment, WEST CITY, CA 94999
(234) 555 - 6789
4
ibuprofen or naproxen would be a rational choice.
5. Determine the appropriate dosing regimen: The dosing regi- FOR: 6 DATE: 5
men is determined primarily by the pharmacokinetics of the ADDRESS: 7
drug in that patient. If the patient is known to have disease of the
organs required for elimination of the drug selected, adjustment
of the average regimen is needed. For a drug such as ibuprofen, 8 9
which is eliminated mainly by the kidneys, renal function should (DRUG NAME AND STRENGTH)
(QUANTITY)
be assessed. If renal function is normal, the half-life of ibuprofen 10
(about 2 hours) requires administration three or four times daily. SIG: 11
The dose suggested in this book, drug handbooks, and the
manufacturer’s literature is 400–800 mg four times daily. REFILL TIMES
OR
6. Devise a plan for monitoring the drug’s action and determine UNTIL 12
NO
an end point for therapy: The prescriber should be able to CHILDPROOF 13
CONTAINER
describe to the patient the kinds of drug effects that will be WARNING: 15
monitored and in what way, including laboratory tests (if neces- 14 , MD
sary) and signs and symptoms that the patient should report. For AD1234567 16
conditions that call for a limited course of therapy (eg, most STATE LICENSE NO. 17
infections), the duration of therapy should be made clear so that
the patient does not stop taking the drug prematurely and under- FIGURE 65–1 Common form of outpatient prescription. Circled
stands why the prescription probably need not be renewed. For numbers are explained in the text.
the patient with rheumatoid arthritis, the need for prolonged—
perhaps indefinite—therapy should be explained, including how records environment, prescriptions are executed via electronic order
to obtain refills. The prescriber should also specify any changes entry. The contents of that prescription are specified in the medical
in the patient’s condition that would call for changes in therapy. staff rules by the hospital’s Pharmacy and Therapeutics Committee
For example, in the patient with rheumatoid arthritis, develop- or similar authority. The patient’s name is typed or written on the
ment of gastrointestinal bleeding would require an immediate form; the orders consist of the name and strength of the medication,
change in drug therapy and a prompt workup of the bleeding. the dose, the route and frequency of administration, the date, other
Major toxicities that require immediate attention should be pertinent information, and the signature of the prescriber. If the
explained clearly to the patient. duration of therapy or the number of doses is not specified (which
7. Plan a program of patient education: The prescriber and is often the case), the medication is continued until the prescriber
other members of the health team should be prepared to discontinues the order or until it is terminated as a matter of policy
repeat, extend, and reinforce the information transmitted to routine, eg, a stop-order policy.
the patient as often as necessary. The more toxic the drug A typical chart order might be as follows:
prescribed, the greater the importance of this educational pro- 3/12/16
gram. The importance of informing and involving the patient 10:30 a.m.
in each of the above steps must be recognized, as shown by (1) Ampicillin 500 mg IV q6h 5 days
experience with teratogenic drugs (see Chapter 59). Many (2) Aspirin 0.6 g per rectum q6h prn temp over 101
pharmacies routinely provide this type of information with [Signed] Janet B. Doe, MD
each prescription filled, but the prescriber must not assume Thus, the elements of the hospital chart order are equivalent to
that this will occur.
the central elements (5, 8–11, 15) of the outpatient prescription.
THE PRESCRIPTION
ELEMENTS OF THE PRESCRIPTION
Although a prescription can be written on any piece of paper (as
long as all of the legal elements are present), it usually takes a The first four elements (see circled numerals in Figure 65–1) of
specific form. A typical printed prescription form for outpatients the outpatient prescription establish the identity of the prescriber:
is shown in Figure 65–1. name, license classification (ie, professional degree), address, and
In the traditional hospital setting, drugs have been prescribed office telephone number. Before dispensing a prescription, the
on a particular page of the patient’s hospital chart called the physi- pharmacist must establish the prescriber’s bona fides and should be
cian’s order sheet (POS) or chart order. In the electronic medical able to contact the prescriber by telephone if any questions arise.