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PrescriptionsDr. Chamath FernandoLecturerDepartment of Family MedicineFMSUSJP

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What is a prescription?

A document where the doctor writes down the medication to be taken with details of how to administer etc.

What other modes of medication are there?

Self medication, OTC

Is a prescription always necessary?

No. Charge for the consultation and not for the drugs.

What factors influence that?

Doctor’s preference, experience, post graduate training, usual pattern of prescribing

Patients factors: expectations, socio-economic cultural factors,

Setting: SL vs Australia

+ Purposes of prescribing?

Cure – Antibiotics for skin sepsis

Symptomatic relief – Anti-emetics for patients undergoing chemotherapy

Prevention of complications – Aspirin in HT and DM

Control of a ongoing disease process – Steroid for Asthmatics

Prevention of disease progression – Acyclovir for Chickenpox (Varicella zoster) exposed patients

Some other reasons (Tactical)

Trials, To buy time till a definitive diagnosis is reached, To terminate the consultation/ Placebo effect

Make sure no harm done

+ What to prescribe?

Patient factors:

Age, (biological age) and Sex

Severity of symptoms and the disease, Coping strategies of the patient

Co-morbidies

Physiological factors : Pregnancy- teratogenic drugs,even ; local isotrexin, Breast feeding – chemotherapy drugs, amiadarone, lithium, retenoids

Drugs the patient is already on

Patient’s preference among choices given

Family support and whether compliance can be expected

Functional factors / Occupational – e.g Exams

Economic factors

Religious/cultural beliefs e.g OCP for certain ethnic groups

+ Drug factors:

Adverse effects profile

The benefit over risk ratio

Drug- patient, drug-drug (Antibiotics and oral contraceptives. Varies. Significant – Only Rifampicin)), drug disease interactions

Therapeutic effect

Cost

+ Writing a Prescription

Paper with letterhead

Legible

Components

Patient’s name

Age

Sex

Address and Contact details

Date

(If it’s a computer generated prescription all these details will be there by default)

Presenting complaint or the diagnosis / DD

+● Rx – Recipe● Name of the drug/s (Generic/ Brand name)● Dosage● Route of administration● Frequency (bd/tds or 6H/8H)● Relationship to the intake of meals● Duration● Total number of tablets/ capsules etc to be issued● Whether the recipe cannot be repeated (Anxiolytics, steroids)

● Doctor’s details Name SLMC registration number Qualifications Designation Signature Address Contact details – Telephone/ e-mails

+ At the end:

Inform the patient regarding the name of the drug, how it should be taken, importance of compliance, possible side effects

Ask for concerns

To make sure the patient has understood well, ask him/her to repeat the instructions.

Relatives’, guardians’ help

+ For optimum compliance

A strong doctor-patient relationship – patient believes in the doctor

Effective two way communication – active listening, genuine interest, empathy and concern

A simple affordable regimen

Clear and concise instructions – no jargon, nor too little neither excessive information, write clear instructions on the reverse of the prescription paper

e.g. How to take Cloxacillin 6H

Divide waking hours to 4

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Thank you!