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prescription
A formula (generally written) for the preparation & administration of any therapy or pharmaceutical agent.
* for hand written prescriptions given to patient, write out full name of medication and full description of method of administration i.e. nitroglycerin 0.4 mg sublingual as needed
Management:
1) prior to prescribing medication, ask
- is the medication really necessary?
- are there alternative nonpharmacologic treatments?
- what are the therapeutic endpoints?
- how will they be assessed?
- do the benefits outweigh the risks?
- is one medication being used to treat adverse effects of another?
- is there 1 medication that can be used to treat 2 conditions?
- are there potential drug-drug interactions or drug-disease interactions?
- will the administration times coincide with those of current medications?
- do the patient & caregiver understand
- what the medication is for?
- how to take the medication?
- how long to take the medication?
- when the medication should start to work?
- possible adverse effects?
- what to do in case of adverse effects?
2) general principles
- start with a low dose (if possible)
- titrate upward as needed slowly
- try not to start 2 medications at once
- include the indication(s) for the prescription [5,6]
- use decision support to promote optimum selection of medication [6]
3) followup
- medication reconciliation with each visit
Notes:
- professional education, alerts of drug-disease interactions linked to the medical record & financial incentives reduce hospital admissions for GI bleeding & heart failure [4]
Related
DEA controlled substance
Medicare part D Prescription Drug Plan (PDP)
medication reconciliation
polypharmacy (unecessary drug prescription)
prescribing practices
Specific
appropriate prescription
geriatric prescribing context
inappropriate prescription
prescription for survivorship
General
pharmacology
References
- Stedman's Medical Dictionary 27th ed, Williams &
Wilkins, Baltimore, 1999
- Morgan SG, Bassett KL, Wright JM, Evans RG, Barer ML,
Caetano PA, Black CD.
'Breakthrough' drugs and growth in expenditure on prescription
drugs in Canada.
BMJ. 2005 Oct 8;331(7520):815-6. Epub 2005 Sep 2.
No abstract available.
PMID: 16141448
- Geriatric Review Syllabus, 8th edition (GRS8)
Durso SC and Sullivan GN (eds)
American Geriatrics Society, 2013
- Dreischulte T et al
Safer Prescribing - A Trial of Education, Informatics, and
Financial Incentives.
N Engl J Med 2016; 374:1053-1064. March 17, 2016
PMID: 26981935
http://www.nejm.org/doi/full/10.1056/NEJMsa1508955
- Schiff GD, Seoane-Vazquez E, Wright A
Incorporating Indications into Medication Ordering - Time to
Enter the Age of Reason.
N Engl J Med 2016; 375:306-309. July 28, 2016
PMID: 27464201
http://www.nejm.org/doi/full/10.1056/NEJMp1603964
- Kron K, Myers S, Volk L, et al.
Incorporating medication indications into the prescribing
process.
Am J Health Syst Pharm. 2018 Apr 19;
PMID: 29674327
https://psnet.ahrq.gov/resources/resource/32145