Download - Prescription Auditing Charts (2)
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8/8/2019 Prescription Auditing Charts (2)
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Prescription auditing charts
Dr.K.Punnagai
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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
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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
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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
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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
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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
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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
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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
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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
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Name of
the drug
Drugs of
choiceDose Duration Route
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
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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
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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
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Name of
the drug
Drugs of
choiceDose Duration Route
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
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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
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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.
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Name of
the drug
Drugs of
choiceDose Duration Route
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
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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
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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.
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Name of
the drug
Drugs of
choiceDose Duration Route
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
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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)
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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
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Name of
the drug
Drugs of
choiceDose Duration Route
Frequen
cyADR
Inj.fluids
Not
necessary
ORS
sufficient
Cap.
ampicillin
Better
choice -
norfloxaci
n
400 mg correct oraltwice
daily
tab.loperam
idecontraindicated
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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)
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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
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Name of
the drug
Drugs of
choiceDose Duration Route
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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