practical 1&2 tutor guide after vetting

7/29/2019 Practical 1&2 Tutor Guide After Vetting

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Skill development Dispensing

BPH 2028Semester 4

2012

Practical 1 & 2

Tutor Guide


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Practical 1 To find errors of omission & commission

Briefing Session (First half an hour)

An example of a prescription:

Rx

Cap Amoxycillin 250mg TDS x 1/52

A prescription is a written order for the preparation and administration of a medicine or other

treatment. Such treatment may be prescribed only by persons professionally and legally

entitled to do so.

Errors in prescribing may be classified into two main types, errors of omission and errors

commission. Errors of omission are defined as prescriptions with essential information missing

while errors of commission involve wrongly written information in the prescriptions. Errors of

Name: Mr. Sajesh K Veettil

Add: A-13-16, Arena Green, KL

Reg. No: 12345

Date: 4th January 2012.Diagnosis: URTI

1. Name, address and registration number of

patient; age and weight should be provided if

necessary to aid dose checking2. Date of prescription

3. Patient diagnosis

4. Product dosage form, name, strength,

frequency,

quantity to be supplied or duration of use

5. Name, uali ications and address o rescriber

Dr. SijiMBBS (IMU)

Klinik Komanwel,

57000 Bukit Jalil, KL


3/27

omission include absence or incomplete specification of dosage form or strength, dose or

dosage regimen, quantity or duration of drug to be supplied as well as prescriptions that are

illegible and prescriptions that violate legal requirements. Whereas, errors of commission

include wrong dose or dosage regimen, wrong drug or its indication, wrong quantity or duration

of therapy, incorrect patients name on the prescription, duplicate therapy and drug-drug

interactions.

Exercise for practical 1 (Error of commission including legal issues)

HOSPITAL IMUPLAZA KOMANWEL,51200 , KUALA LUMPURTEL: (03)8888888

RRRRXXXXFOR TEACHING PURPOSES ONLY

Errors of ommission: (Including Legal issues)

Date not mentioned

Age of the patient

Prescription has no name and signature of prescriber

Dosage form of enalapril (tablets) not mentioned

Errors of commission: Atorvastatin should take at night

Name: Mubarak AhamadReg.No: 43447

Address: KS Apart, Damansara

Dignosis: Hypertension

Enapril 5 mg OD X4/52

Tab. Atorvastatin 10mg OD X4/52


4/27

Station 1


RXRXRXRX

FOR TEACHING PURPOSES ONLY

*Not needed in some dosage form e.g. cream, ointment

Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration numberDate XPrescribers namePrescribers signature XClinic or departmentIllegible X Tab. Loratadine10mg

Tan Kay Ling, Reg:no: 12345Address:8 Garden Condo, Jalan KK 2,KLAge:40 years oldAllergyrhinitis

Drug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

x No durationTab. Loratadine10mg X 1/52

Indication

Name:Reg.No:Address:Age:Date:Diagnosis:

TTaabb.. LLoorraattaaddiinnee1100mmgg

TTaannKKaay LLiinngg112233445588GGaarrddeennCCoonnddoo,, JJaallaannKKKK22,,KKLL4400yyeeaarrssoolldd

AAlllleerrggyyrrhhiinniittiiss

Dr. SheebaIMU Clinic


5/27

Station 2

HOSPITAL IMUPLAZA KOMANWEL,

51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX



Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration numberDate X This day (date of practical)Diagnosis X Bacterial vaginosis

Prescribers namePrescribers signatureClinic or departmentDrug nameDosage Dose*, Frequency, Strength,

Dosage Form, Duration or number of doses(Quantity to supply)

x Insert one pessary daily for 14

days

Indication X For Vaginal use only

Name: EswariReg.No: 43447

Address: 5 Golden circle, Jalan Bukit,KLAge: 20Date:

Miconazole essaries

tanlee

Dr. Tan leeIMU Clinic


6/27

Station 3


51200 , KUALA LUMPURTEL: (03)8888888

RX


Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration number XDate X

Prescribers namePrescribers signature XClinic or departmentIllegible X Injection Chlorphenamine Maleate 10 mg/ml.

Teh Sze WeiAddress:E-3A-7,Savana Condo., Jalan Ampang,KLAge:42 years oldDignosis: Severe Anaphylactic Reactions

Drug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

x No durationInj. Chlorphenamine Maleate 10 mg/ml

(FYI: over 1 minute,max 40 mg in 24 hrs)(Note: restriction does not apply whereadministration is for saving life inemergency)

Indication

Name:Reg.No:

Address:Age:Date:Diagnosis:

IInnjj.. CChhlloorr hheenniirraammiinneeMMaalleeaattee1100mmgg//mmll

TTeehhSSzzeeWWeeiiEE--33AA--77SSaavvaannaaccoonnddoo.. ,,JJaallaannAAmmppaanngg,,kkll,,..

SSeevveerreeAAnnaapphhyyllaaccttiiccRReeaaccttiioonnss4422yyeeaarrssoolldd

Dr. Rohit KumarIMU clinic


7/27

Station 4


RX


Errors of Omission Remarks/RecommendationsPatients nameAge XRegistration numberDate

Prescribers namePrescribers signatureClinic or departmentIllegibleDrug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

X Dose not mentioned2.5 mg

Indication X Hypertension


TTaabb .. RRaammiipprriill OODD XX 11//1122

CChhaann SSzzee MMiinn3322445511RRiissttaa vviillllaa aappaarrttmmeenntt,, PPuuttrraaPPeerrddaannaa,,PPuucchhoonngg

0044..0011..22001122

Zamir

Dr. Mohd . ZamirIMU Clinic


8/27

Station 5


RX


Errors of Omission Remarks/Recommendations

Patients name

Age

Registration number

Date X

Prescribers namePrescribers signature

Clinic or department X

Illegible

Drug name

Dosage Dose*, Frequency, Strength, Dosage

Form, Duration or number of doses (Quantity to

supply)

X No - duration, dose

Liq. Lactulose 10 ml BD for 3

days

Indication X Constipation

Name:

Reg.No:Address:

Age:

Date:

Diagnosis:

Liq. Lactulose - BD

Abdul NasirM0001B-13, Parveen Condo, Jalan lama.2, KL

8 years

Sajesh K Veettil

Dr. Sajesh K Veettil

IMU clinic


9/27

Station 6


51200 , KUALA LUMPURTEL: (03)8888888

RX


Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration number XDate XPrescribers namePrescribers signature XClinic or department X

IllegibleDrug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

X No duration, Wrong doseTab. Atenolol 50mg OD 1/12

Indication

Name:Reg.No:

Address:Age:Date:Diagnosis:

TTaabb.. AAtteennoollooll 55mmgg OODD

MMss.. LLaann KKeeee MMooii

88 SSaavvaaaannaa CCoonnddoo,, JJaallaann KKKK 22,,KKLL4400 yyeeaarrss oolldd

HHyyppeerrtteennssiioonn

Dr. DavidIMU clinic


10/27

Station 7


RX


Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration numberDate

Prescribers name XPrescribers signature XClinic or department XIllegibleDrug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

x No frequency and strength

Indication Asthma


MMDDIISSaallbbuuttaammoollii//ii uuffffPPRRNN

AAlleexx00003322111144PPaallmmggrroovveeCCoonnddoo,, JJaallaannKKKK22,,KKLL66yyeeaarrss0022--0022--22001122


11/27

Station 8


RXRXRXRX


Errors of Omission Remarks/RecommendationsPatients nameAge XRegistration numberDate

Prescribers namePrescribers signatureClinic or departmentIllegibleDrug name X Lipitor (Atorvastatin)Dosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

x capsule lipitor not available,only tablet (Atorvastatin)

Dose of calcium carbonate inCKD is 500mg 1g TDS(Phosphate binder)

Indication


TTaabb.. CCaallcciiuummccaarrbboonnaattee550000mmggOODDCCaapp.. LLiippiittoorr1100mmggOONN

AAgguussttiinn00003322111144 PPaallmmggrroovvee CCoonnddoo,, JJaallaann KKKK22,,KKLL

0044--0011--22001122CCKKDD && HHyyppeerrlliippiiddaaeemmiiaa

Wilson Joseph

Dr. Wilson JosephClinic IMU


12/27

Station 9


RxRxRxRx


Errors of Omission Remarks/RecommendationsPatients nameAge

Registration number XDate XPrescribers namePrescribers signatureClinic or departmentIllegibleDrug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)

xWrong Dose & No duration:MDI. Salmeterol 25 mcg BD 2puff X 1/12

Dose not mentioned:MDI. Salbutamol 200mcg 1 puffPRN

Indication


MDI. Fluticasone 125 mcg 2 puff BD X 1/12

MDI. Salmeterol 25 mg BD

MDI. Salbutamol 1 puff PRN

CChhaanngg KKhhooii

88 SSaavvaaaannaa CCoonnddoo,, ,,KKLL4422 yyeeaarrss oolldd

CCOOPPDD

Raghupariyani

Dr. Raghunath


13/27

Station 10


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX


Errors of Omission Remarks/RecommendationsPatients nameAgeRegistration numberDatePrescribers name

Prescribers signatureClinic or departmentIllegibleDrug nameDosage Dose*, Frequency, Strength,Dosage Form, Duration or number of doses(Quantity to supply)Indication

Name:Reg.No:

Age:Address:Date:Diagnosis:

Tab. Lanoxin 125 mcg OD X3/12

TThhoommaass0000332211

55111144 AArreennaa ggrreeeenn,, JJaallaann KKKK 22,,KKLL0044--0011--22001122AAFF

SajeshKVeettil

Dr. Sajesh K Veettil


14/27

Practical 2 To find errors of omission, commission & Clinical issues

Briefing Session (First half an hour)

Exercise for practical 2 (Errors of omission, commission and clinical issues)

KLINIK IMU NAME : Mr Stephan

PLAZA KOMANWEL, ADDRESS : 32, arena green, Kl

51200, KUALA LUMPUR DATE : 4th January 2012

TEL: (03) 8888888 DIAGNOSIS: CHF

RX

Tab. digoxin 0.125g BD x 1/52jamesfrancis

Dr jamesfrancisClinic IMU, KL.


Medical History: Knee pain X 1 year.Medication history: Diclofenac sodium 25mg PRN

Error of omission:

Age, registration number

Error of commission:

Dose of digoxin is incorrect. It should be 125 g BD and not 0.125 g BD.

Clinical issues:

In patients with cardiac impairment caution is required since NSAIDs may impair renal

function. The dose should be kept as low as possible and renal function should be

monitored. All NSAIDs are contraindicated in sever heart failure. Plasma concentration

of cardiac glycosides possibly increased by NSAIDs.


15/27

Station 1


RX


Errors of commission/clinical issues Remarks/RecommendationsWrong StrengthWrong dosage form

Wrong dosage regimen dose, frequency,duration

X Salbutamol dosage notmentioned. (1-2 puffs).Seretide standard regimen istwice daily

Drug-drug interactions

Therapeutic duplication X Seretide is the combination ofsalmeterol 25mcgs andfluticasone propionate 100mcg.(Different strength available)

Others potential clinical issues/concerns

Drug allergy

Wrong Indication

Name:Reg.No:Address:

Age:Date:Diagnosis:

MDI Salbutamol 100mcgs PRN

MDI Salmeterol 25 mcgs

Accuhaler Seretide 100 1 blister TID

Suriyani Bt Abdul Rahim338425X-12-11, Kiaramas SuteraJalan Desa Kiara.51 yrs12.1.2012Asthma

Yen lin

Dr. Foo Yen LinIMU clinic


16/27

Station 2


RX


PMH: Type II DM & CHF

PMedH: Glibenclamide 5mg ODMetformin 500 mg BDFrusemide 40 mg BD


Errors of commission/clinical issues Remarks/RecommendationsWrong Strength x Lisinopril should be started at a lower dose of 2.5

mg in patients with CHF-Change to 2.5 mg OD

Wrong dosage formWrong dosage regimen dose, frequency,durationDrug-drug interactions X Symptomatic hypotension with Frusemide-

monitor BP- Orthostatic hypotentionLisinopril can potentiate hypoglycaemic responsewith antidiabetic medications

Therapeutic duplicationOthers potential clinical issues/concerns X Lisinopril can cause hyperkalemia, acute renal

failure, hypersensitivity reactions especiallyAngioedema etc

Drug allergyWrong Indication


Tab. Lisinopril 20 mg OD x 2/52

Bala K003221144PPaallmmggrroovveeCCoonnddoo,, JJaallaannKKKK22,,KKLL60 years3/2/2011

CHF

KengKODR KENG KPFAMILY PHYSICIAN

CLINIC IMU


17/27

Station 3


RXReview after one month


Errors of commission/clinical issues Remarks/Recommendations

Wrong StrengthWrong dosage form

Wrong dosage regimen dose, frequency,

duration

X Frequency - not mentioned clearly

Drug-drug interactions X Pharmacokinetic interaction (drug

absorption delayed by complex

formation): If both the drugs taken

together, calcium may form

insoluble complexes with iron, soreducing its absorption. To achieve

maximal absorption, separate the

administration of iron preparationsand calcium as much as possible.

Therapeutic duplication


Drug allergy

Wrong Indication

Name:Reg.No:

Address:

Age:Date:

Dept:

Diagnosis:

T. Ferrous sulfate 200 mg OD X 1/12

T. Calcium carbonate 500 mg OD X 1/12

Ms.AngeleneM00026A-12, 6th floor, Hilton Condo, KL

26 years12/12/2012

OBG

Iron deficiency anemia (Pregnancy)

KengKODR KENG KPFAMILY PHYSICIAN

CLINIC IMU


18/27

Station 4


RX


Errors of commission/clinical issues Remarks/RecommendationsWrong Strength x Co-Diovan ( valsartan and

hydrochlorothiazide) exists in 80/12.5mg, 160/12.5 mg, 160/25 mgWrong dosage formWrong dosage regimen dose, frequency,durationDrug-drug interactions X Synergistic low BP, check BP

Therapeutic duplicationOthers potential clinical issues/concerns

Drug allergyWrong Indication


Tab Metoprolol 50mg b.d. x 2/12

Tab. Co-Diovan 40/62.5mg i/i x 2/12

TanaIsninA 203024438 Garden Condo, Taman L 2, KL40 years1/2/2011Hypertension

KengKO

DR KENG KPFAMILY PHYSICIAN

CLINIC IMU


19/27

Station 5

Wwwww

Remarks/RecommendationsErrors of OmissionPatients nameAgeRegistration numberDate xPrescribers namePrescribers signature XClinic or departmentIllegible

Drug name x AZT = official abbreviation for Zidovudine,can be misunderstood as Azathioprine

Dosage Dose*, Frequency, Strength, DosageForm, Duration or number of doses (Quantity tosupply)

X Capsule AZT

IndicationErrors of Commission/Clinical IssuesWrong StrengthWrong dosage formWrong dosage regimen dose, frequency,duration , total supply

x Suspension Nystatin - 4-6 mL (400,000 to600,000 units) four times daily; continuetreatment for at least 48 hours after perioralsymptoms have disappeared

Drug-drug interactionsTherapeutic duplicationOthers potential clinical issues/concerns x Why single agent only?Drug allergyWrong indication

KLINIC IMU NAME : JustinPLAZA KOMANWEL Reg.NO: 1234551200, KUALA LUMPUR ADDRESS: Arena green, BJ, .TEL: (03) 8888888

AGE : 46-year-oldDiagnosis: HIV + /OralCandidiasis

RxRxRxRxAZT 300mg B.D. x 1/12Susp. Nystatin 4-6 units OD x 3/7

Dr. Martin KingIMU clinic



20/27

Station 6


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX


Medication HistoryTheophylline 250 mg TDS

Salbutamol MDI 200 g PRN


Prescribers name

Prescribers signature

Clinic or departmentIllegible

Drug name

Dosage Dose*, Frequency, Strength, Dosage Form,

Duration or number of doses (Quantity to supply) X Capsule Ciprofloxacin 250 mg BD

Indication

Errors of Commission/Clinical Issues

Wrong Strength

Wrong dosage form

Wrong dosage regimen dose, frequency, duration ,

total supply

Drug-drug interactions X Theophylline is metabolised by cytochrome P450

enzymes (CYP 1A2) while ciprofloxacin is apotent cytochrome P450 enzyme inhibitor. This

leads to decreased clearance of theophylline and

increased risk of theophylline toxicity.

Theophylline-related adverse effects include

nausea, vomiting, palpitations and seizures.



Ciprofloxacin 250 mg BD x 1/52

Name:

Reg.No:

Address:

Age:

Diagnosis:

Stephani

J 39873873

7 Desa Petaling, KL

30-year-old

UTI

Lena pong

DR LENA PONG

MEDICAL

OFFICER

CLINIC IMU


21/27

Drug allergy

Wrong indication


22/27

Station 7


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX


Past Medical History

Renal transplantation, 6 months ago

Medication History

Caps. Ciclosporin 50 mg bd


Prescribers name

Prescribers signature X

Clinic or department

Illegible

Drug name

Dosage Dose*, Frequency, Strength,

Dosage Form, Duration or number of

doses (Quantity to supply)

X Caps Cimetidine

Indication


Wrong Strength 400mg BD or 800mg OD h.s

Wrong dosage form

Wrong dosage regimen dose,frequency, duration , total supply

X Tab. Cimetidine 400mg BD or 800mgOD h.s for at least 1 month. (6weeks

for gastric ulceration)

Drug-drug interactions X cimetidine may inhibit the metabolism

of ciclosprorin and hence, increase its

plasma concentration. This will lead to

increased risk of ciclosporin side

Cimetidine 200 mg ODx 1/12

Name:

Reg.No:

Address:

Age:

Date:

Diagnosis:

Thomas

39873873

11 Taman Segar, KL

60-year-old

05-01-2012

Benign gastric ulcer

Kevin

DR Kevin

IMU Clinic


23/27

effects and toxicity, such as

hypertension and nephrotoxicity.



Drug allergy


24/27

Station 8


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX



Prescribers name X No signature

Prescribers signature X No name


Illegible

Drug name

Dosage Dose*, Frequency, Strength, Dosage Form,

Duration or number of doses (Quantity to supply) X Tab frusemide

Indication


Wrong Strength

Wrong dosage form


total supply

X Frusemide 40 mg OD (Every morning)

Drug-drug interactions X frusemide causes hypokalaemia and that increases

risk of digoxin toxicity



Drug allergyWrong indication

Frusemide 40 mg ON x 1/12Tab. Lisinopril 10mg OD x 1/12Tab. Digoxin 125g 1/1 BD x 1/52

Name:

Address:

Age:

Date:

Diagnosis:

Hadhila

11 Taman Segar, KL

45-year-old

05-01-2012

CHF


25/27

Station 9


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX


Medical History: CKD X 3 years (ESRF; Dialysis last 1 year; 3Xweek), DM X 10yearsMedication History: Ferrous sulphate, calcium carbonate, folic acid, Insulin, Epoetin X 1 year (Dose not

available)


Wrong Strength X Tab. Enalapril 2.5mg OD x 1/52 Max. Initial

dose should be 2.5mg daily if creatinine clearanceless than 30ml/min. (ESRF)

Wrong dosage form


total supply

X Tab. Enalapril 2.5mg OD x 1/52

Drug-drug interactions



Drug allergy

Wrong indication

Tab. Enalapril 5mg OD x 1/52

Name:

Address:

Age:

Date:

Diagnosis:

Joseph

11 Taman Segar, KL

70-year-old

05-01-2012

Hypertension

Martin

DR Martin


26/27

Station 10


51200 , KUALA LUMPURTEL: (03)8888888

RXRXRXRX


Remarks/Recommendations

Errors of Omission

Patients name

Age

Registration numberDate

Prescribers name

Prescribers signature


Illegible

Drug name

Dosage Dose*, Frequency, Strength, Dosage

Form, Duration or number of doses (Quantity to

supply)

Indication


Wrong Strength X Atorvastatin 25 mg, Atorvastatin available as

10, 20 and 40 and 80 mg only. So it may be

20 mg

Wrong dosage form

Wrong dosage regimen dose, frequency, Duration one month more likely for

Name:Reg.No:

Address:

Age:Date :

Diagnosis:

T. Atorvastatin 25 mg OD X 1/12T. Aspirin 300 mg OD X 1/12T. Clopidogrel 75 mg OD X 1/12

Abdul NasirM0001

B-13, 9th floor, Parveen Condo, Jalanlama.2, KL48 years

Unstable angina and NSTEMI

nirmal

Dr. Nirmal

IMU Clinic


27/27

duration , total supply maintenance. So low dose aspirin will be

more appropriate (75-100 mg).

Drug-drug interactions X Synergistic action: Aspirin and Clopidogrel

Increased risk of bleeding.

1. Two antiplatelet drugs are prescribed

together. It may increase the risk of bleeding.So we can use any one.

2. But in the management ofNSTEMI,normally both drugs will be used to avoid

risk. In these cases use drugs in low dose

especially aspirin. In this prescription the dose

of aspirin should be reduced below 100 mg.(possibly aspirin-75 mg)

3.Patients should be warned regarding apossible increased risk of bleeding, andadvised to report any unusual or excessive

bleeding



Drug allergy

Wrong indication

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