Prescription Auditing Charts (2)

8/8/2019 Prescription Auditing Charts (2)

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Prescription auditing charts

Dr.K.Punnagai


2/26

Question - 1

Audit the following prescription

Miss. A 21 yrs female With Mild bronchial asthma

1. Tab.Salbutamol 8mg t.i.d x 5 days

2. Tab.theophylline retard 150mg b.i.d x 5 days

3. tab. Prednisolone 10 mg t.i

4. Linctus codeine 15 mg/ml x 5days

Review after 5 days


3/26

Answer - 1

Not given in the prescription format. No details about thedoctor, patient, superscription and signature of thedoctor.

Salbutamol inhalation route preferred, less systemic

ADR, quick action, more effective.

Theophylline not necessary in mild cases.

Prednisolone not necessary, inhalation steroid preferred.

Codeine contraindicated, retains secretion & harmful


4/26

Name of the

drug

Drugs of

choiceDose

Duratio

nRoute

Frequenc

yADR

Salbutamol correct incorrect correct

Inhalationbetter.

100 200

g

6ht hrly

Less

adverse

effects

TheophyllineNot

necessaryincorrect correct

3times

daily

Prednisolone

Not

necessary incorrect

Correct

3-5days

inhalation2 times

daily

Linctus

Codeinecontraindicated


5/26

Question -2

Audit the following prescription

Miss X 17 yr female, common cold

1. Tab.Roxithromycin 150mg bid 2. Tab.Astemizole 10mg od

3. Tab.Aspirin 600mg qid

4. Tab.B-complex 1od for 7 days


6/26

Answer -2

Not given in the prescription format

Antibiotic not necessary for common cold of viraletiology

Astemizole cause drug interaction. Prolong QTinterval causing polymorphic ventriculartachycardia with roxithromycin. Roxithromycin isan inhibitor of CYP4503A4

Paracetamol preferred to aspirin because ofgastritis

B-complex not necessary


7/26

Name of

the drug

Drugs of

choiceDose Duration Route

Frequen

cyADR

Roxithromy

cin

Not

necessarycorrect given oral correct

Pro

QT interval

VT

astemizoleNot usedCetrizine

preferred

Correct 3days Oral CorrectProQT interval

VT

AspirinParaceta

mol

High

dose 3 days Oral2 times

daily gastritis

B-complexNot necessary

Vit c preferred


8/26

Question - 3

Miss. B 18 yrs female with acute urinary tractinfection.

1.Inj.ampicillin 1 gm im tid x 2 days

2. inj.gentamicin 80mg im tid x 2 days 3. tab.furosemide 40 mg tid x 2 days

4. disodium hydrogen citrate (1.4gm/5ml) 10 mltid x 2 days

5. tab. Paracetamol 1gm qid , sos

Urine for culture & sensitivity . Review after 2days


9/26

Answer-3

Oral route sufficient unless compellingreasons for parenteral therapy

Antibiotic not necessary now. One canwait for culture & sensitivity results beforechoosing antibiotics

Plenty of fluids is sufficient , diuretics not

necessary Disodium hydrogen citrate may be given

Paracetamol given only if there is fever


10/26

Name of

the drug

Drugs of


Frequen

cyADR

Inj.ampicillin

Notnecessary

incorrect Incorrect correctincorrect

Local pain

Inj.gentaNot

necessary

Correct incorrect correctinCorre

ct

nephrotoxi

city

frusemide contraindicated

Disodiumhydrogen

citrate

Necessar

yCorrect Incorrect Oral Correct

Tab.paracet

amolNot necessary


11/26

Question -4

Mr.B 45yrs male

Newly diagnosed type- II Diabetes Mellitus

1. diabetic diet 2. inj. lente insulin 10 units morning, 25 u

night sc

3. tab.glibenclamide 5mg od 4. metformin 500mg tid


12/26

Answer-4

Inj. Insulin not necessary in a newlydiagnosed case unless complicated byinfection, gestation or emergency

Glibenclamide can be added if diet alonefails but start with low dose and escalateaccording to response. Given hour

before food Metformin can be given if diet fails and ifpatient is obese. Given after food


13/26

Name of

the drug

Drugs of


Frequen

cyADR

Inj.lenteinsulin

Notnecessary

Dependson BSL

- correctDepends on

BSL

hypoglycemia

Tab.glibenc

lamide

correct.,

can be

given ifdiet fails

Depends

on BSL

Life long

Oral, 30

mints

beforefood

Depend

s on

BSL

hypoglyce

mia

Tab.metfor

min

Necessar

y if pt. is

obese &

sugar not

controlled

Depends

on BSLLife long

Oral after

food

Depend

s on

BSL

Lactic

acidosis


14/26

Question-5

Mr.A 47yrs male

H.pylori infection

1. aluminium hydroxide + magnesiumtrisilicate (antacid gel) 2 tsp tid x 1 month

2. tab.Bismuth subcitrate 150mg tid x 4 wk

3. tab. Ranitidine 150 mg bid x 4 wks


15/26

Answer - 5

Antacid can be given sos for symptomatic reliefespecially for first few days. If antacid is usedalone 3 tsp given 1hr before, 2 hrs after food,and once at bed time for 4-8 wks given.

Bismuth subcitrate needs an acidic PH for betteracting. Hence atleast 2hrs interval should bethere between bismuth subcitrate& antacid.Bismuth subcitrate taken on empty stomach,30mints before food. Causes blackening ofstools

Either bismuth subcitrate or ranitidine is given.No need to give both the drugs to gether.


16/26

Name of

the drug

Drugs of


Frequen

cyADR

antacid Notnecessary

correct incorrect correct Beforefood

constipation

bismuth correct 120 mg 2 wks

Oral, 30

mints

beforefood

QIDBlackening

of tongue

Tab.ranitidi

necorrect

Incorrect

-300mg2 wks

Oral after

food

Once

daily

Interacts

with

antacid

antibiotics

Amoxycillin- 750 mg tds + Metronidazole-500mg tds + Ranitidine

300 od X 2 wks


17/26

Question -6

Mr.A 60 yrs male

Hypertensive with mild CCF

Tab.amlodipine 5 mg bid x 15 daysTab. Furosemide 40 mg bid X 15 days

Tab. Digoxin 0.25 mg X15 days

Salt restricted diet


18/26

Answer - 6

Negative inotropic, contraindicated in

CCF, ACE inhibitor or angiotensin II

receptor blocker may benefit both

hypertension as well as CCF

May be retained but add supplemental

potassium to prevent hypokalemia

Adverse reaction with digoxin if

hypokalemia develops.


19/26

Name of

the drug

Drugs of


Frequen

cyADR

Tab.amlodipine

contraindicated

Tab.furose

mide

Not

necessay

incorrect correct oralOnce

daily

hypokalem

ia

Tab.digoxin correct correct correct OralOnce

daily

Digoxintoxicity

with

hypokalem

ia

Saltrestricted


20/26

Question - 7

Mr. A 36 years male bacillary dysentry

1. Iv fluids, 5% dextrose, 2 bottles-slow iv

over 10 hrs, 5% DNS2. Cap. Ampicillin 500 mg od for 5 days

3. Tab.Loperamide 4mg stat, then 2mg

after each stool (Max. 8 tab)


21/26

Answer- 7

Iv fluid not necessary, unless severe

vomiting with dehydration. ORS is

sufficient & balanced diet

Can be changed to a better choice

May be harmful not necessary


22/26

Name of

the drug

Drugs of


Frequen

cyADR

Inj.fluids

Not

necessary

ORS

sufficient

Cap.

ampicillin

Better

choice -

norfloxaci

n

400 mg correct oraltwice

daily

tab.loperam

idecontraindicated


23/26

Question - 8

Mr.B 30 yrs male

Acute intestinal amoebiasis

1. Inj.metronidazole 500mg stat2. Tab.metronidazole 500mg tid X 5days

3. Tab.diloxanide furoate 500mg tid X 5

days4. Tab.loperamide 2 mg following each

stool (Max. 8 tab)


24/26

Answer-8

Inj. Metronidazole not necessary, unless

there is vomiting and severe infection

Tab.metronidazole given for 5- 7days tab.diloxanide furoate given for 10 days

Contraindicated


25/26

Name of

the drug

Drugs of


Frequen

cyADR

Inj.metronid

azole

Notnecessary correct

Twice

daily

Nausea,vo

miting,

metallic

taste

Tab.metroni

dazolecorrect 400 mg correct oral

twice

daily

tab.loperam

idecontraindicated

Tab.diloxan

ide furoatecorrect correct

5-10

dayscorrect tds flatulence


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Prescription Auditing Charts (2)

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