PrescribingPrescribing(making a (making a

prescription)prescription)Nicolaski Lumbuun, dr., SpFKNicolaski Lumbuun, dr., SpFK

Faculty of MedicineFaculty of Medicine

Universitas Pelita HarapanUniversitas Pelita Harapan

Rational Drugs UseRational Drugs Use

Rational use of medicines requires that "patients receive medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and their community".

•WHO estimates that more than half of all medicines are prescribed, dispensed or sold inappropriately, and that half of all patients fail to take them correctly.

http://www.who.int/medicines/areas/rational_use/en/

Case oneCase one• You sit in with a general practitioner and You sit in with a general practitioner and

observe the following case. observe the following case. • A 52-year old taxi-driver complains of a sore A 52-year old taxi-driver complains of a sore

throat and cough which started two weeks throat and cough which started two weeks earlier with a cold. He has stopped sneezing earlier with a cold. He has stopped sneezing but still has a cough, especially at night. The but still has a cough, especially at night. The patient is a heavy smoker who has often patient is a heavy smoker who has often been advised to stop. Further history and been advised to stop. Further history and examination reveal nothing special, apart examination reveal nothing special, apart from a throat inflammation.from a throat inflammation.• What would you do?What would you do?• Write a prescription for this patient!Write a prescription for this patient!

Case twoCase two• A-60-year old man, with no previous medical history. A-60-year old man, with no previous medical history.

During the last month he has had several attacks of During the last month he has had several attacks of suffocating chest pain, which began during physical suffocating chest pain, which began during physical labor and disappeared quickly after he stopped. He has labor and disappeared quickly after he stopped. He has not smoked for four years. His father and brother died of not smoked for four years. His father and brother died of a heart attack. Apart from occasionally taking some a heart attack. Apart from occasionally taking some aspirin he has not used any medication in the past year. aspirin he has not used any medication in the past year. Auscultation reveals a murmur over the right carotid Auscultation reveals a murmur over the right carotid artery and the right femoral artery. Physical examination artery and the right femoral artery. Physical examination reveals no other abnormalities. Blood pressure is reveals no other abnormalities. Blood pressure is 140/95, pulse 98 regular, and body weight is normal. 140/95, pulse 98 regular, and body weight is normal. • What do you think about this case?What do you think about this case?• What would you do?What would you do?• Write a prescription for this situation!!Write a prescription for this situation!!

Case threeCase three

• Woman student, 19 years. Complain of a Woman student, 19 years. Complain of a slowly progressive fever in the morning to slowly progressive fever in the morning to afternoon, which is as high as 40 °C at afternoon, which is as high as 40 °C at night. She felt like this for up to a week. She night. She felt like this for up to a week. She also feels profuse sweating, abdominal also feels profuse sweating, abdominal discomfort and nonbloody diarrhea. She cant discomfort and nonbloody diarrhea. She cant eat, because of always vomits when she eat, because of always vomits when she tried to eat something?tried to eat something?• What would you do?What would you do?• Write a prescription for this patient!!Write a prescription for this patient!!

Write a prescription for Write a prescription for this conditionthis condition

• Boy, 14 years. Acute conjunctivitis. R/Oxytetracycline Boy, 14 years. Acute conjunctivitis. R/Oxytetracycline 0.5% eye drops, 2 drops every six hours, give 10 ml.0.5% eye drops, 2 drops every six hours, give 10 ml.

• Child, 6 years. Giardiasis with persistent diarrhoea. Child, 6 years. Giardiasis with persistent diarrhoea. R/metronidazole 200 mg/5 ml oral suspension, 5 ml R/metronidazole 200 mg/5 ml oral suspension, 5 ml three times daily, give 105 ml.three times daily, give 105 ml.

• Woman, 22 years. New patient. Migraine with Woman, 22 years. New patient. Migraine with increasingly frequent vomiting. Paracetamol no longer increasingly frequent vomiting. Paracetamol no longer effective during attacks. You explain to her that the effective during attacks. You explain to her that the paracetamol does not work because she vomits the paracetamol does not work because she vomits the drug before it is absorbed. You prescribe paracetamol drug before it is absorbed. You prescribe paracetamol plus an antiemetic suppository, metoclopramide, plus an antiemetic suppository, metoclopramide, which she should take first, and wait 20-30 minutes which she should take first, and wait 20-30 minutes before taking the paracetamol.before taking the paracetamol.