PRESCRIBING

REAGAN KABUKA
(B.PHARM, MPH)
Outline
• Prescribing
• Rational drug use (RDU)
• Cost effectiveness
• Placebo
• Drug dosage calculations
• Drug interactions
PRESCRIBING
• To advise and authorize the use of a medicine or treatment for a patient
by a health practitioner in writing
• Health institutions often have individualized prescription forms for
purposes of prescribing
• A prescription can be written on paper as long as all necessary legal
elements are present.
• Therefore, as a Medical practitioner you are also equipped with
knowledge to prescribe and use drugs in a rational way.
PRESCRIBING
• Prescription should be legible and signed clearly for optimal
communication between the prescriber and other members of the
health care team
• Prescription should contain sufficient information to permit a pharmacist
or nurse to dispenser or administer the drug correctly
• A valid prescription should include the following: date, patient’s name,
Patients address (DDA), age, sex, weight (infants), name of the drug,
dose of the drug, route of administration, frequency of taking the drug,
duration of treatment, name, number and signature of the prescriber.
• Prescription should have generic drug names only and avoid non-official
abbreviations
Rational drug use
• Requires that patients receive medications appropriate to their
clinical needs, in doses that meet their own individual requirement,
for an adequate period of time and at the lowest cost to them and
their community
• Rational drug use helps to;
Optimize patient outcomes
Enhance compliance to medicines
Ensure that all access to drugs is accompanied by adequate
information
Eradicate unnecessary and inappropriate drug use at all levels in the
society
Save resources
COST- EFFECTIVENESS

• Applies to cost-benefit, cost-minimization, and cost-utility analyses

• Compares the economics of different pharmaceutical products or to

compare drug therapy to other treatments.
PLACEBO
• A placebo is a substance containing no medication and prescribed or
given to reinforce a patient's expectation to get well.
• It is also defined as an inactive substance or preparation used as a
control in an experiment or test to determine the effectiveness of a
medicinal drug.
• A placebo is intended to deceive the recipient. Sometimes patients
given a placebo treatment will have a perceived or actual
improvement in a medical condition, a phenomenon commonly called
the placebo effect.
• Placebos are widely used in medical research and are given as control
treatments and depend on the use of measured deception.
DRUG DOSAGE CALCULATIONS
• Patients may be prescribed doses of a drug
which are not precisely equivalent to
standard presentation. It is necessary to
calculate the quantity of drug preparation
which will contain the prescribed dose
• This is a common source of error in drug
administration
• It is important that you know proper
calculation of drug dosages
• Below are the standard measurements used
in drug preparations
WEIGHTS AND MEASURES
Weight

• 1000 nanograms (ng) = 1 microgram (mcg)

• 1,000 micrograms (mcg) = 1 milligrams (mg)

• 1000 milligrams (mg) = 1 gram (g)

• 1000 grams (g) = 1 kilogram (kg)

Volume

• 1 millilitre (mL) = 1 cubic centimetre (cc)

• 1000 millilitres (ml) = 1 litre (L)

• 100 millilitres (ml) = 1 decilitre (dL)

• 1 Litre of water at 4℃ weighs 1 kilogram

DOMESTIC MEASURES

• 1 teaspoonful = 5ml

• 1 dessertspoonful = 10ml

• 1 tablespoonful = 15ml

• 1 tumblerful = 250mls
DRUG CALCULATION
• The Healthcare giver should know how to calculate dosage because
the amount prescribed may not be the standard in stock.
• The formula to be used for volumes is as follows: Divide the amount
required by amount available and multiply by volume in stock. Thus:

𝑹𝒆𝒒𝒖𝒊𝒓𝒆𝒅 𝑨𝒎𝒐𝒖𝒏𝒕
• Volume to be administered = 𝑿 𝑻𝒐𝒕𝒂𝒍 𝑽𝒐𝒍𝒖𝒎𝒆
𝑨𝒗𝒂𝒊𝒍𝒂𝒃𝒍𝒆 𝑨𝒎𝒐𝒖𝒏𝒕

• Calculate the volume of cortisone to be administered when 100mg is

prescribed and the available stock is 250mg in 10mls
• (100mgs X 10mls)/250mg = 4mls
Calculation of dosage of tablets and capsules
• Doses may be in tablet or capsule form and sometimes are prescribed
according to mass for example, grams (gm), milligrams (mg),
micrograms (mcg). The formula is:

𝑹𝒆𝒒𝒖𝒊𝒓𝒆𝒅 𝑨𝒎𝒐𝒖𝒏𝒕
No. Tablets to be administered =
𝑨𝒗𝒂𝒊𝒍𝒂𝒃𝒍𝒆 𝑨𝒎𝒐𝒖𝒏𝒕

• Example: Prescribed ampicillin 500mg and the stock available is

250mg per capsule. Calculate the number of capsules required.
• 2 capsules
Medicine Calculations in Children
• Children generally require smaller dosages than adults. Most drug
dosages are based on weight and/or body surface area of the patient.
• Example:
• Erythromycin is prescribed for a child. The recommended dosage is
40mg/kg body weight per day. The child requires 4 doses daily. If the
Child’s weight is 15kg,
• Calculate the size of a single dose.
• 40mg x15kg/4 = 150mg
Clark’s Rule
This is the most popular method for determining the dose for children
based on child’s body weight. It states that;
• The child’s dose is equal to weight of child over weight of adult
multiply by adult dose. Thus:
• Child’s dose = Weight of child x Adult dose/ Weight of Adult
• For example, if the adult dose of paracetamol is 500mg, what is the
dose for a 10kg child? We assume normal adult weight is 70kg.
• Child’s dose = 10kg/70kg x 500mg = 71mg
INFUSION SETS
• There are two standard
giving sets of drip rates

• Macro drop factor- drop

size 20 drops deliver 1ml

• Micro drop factor- drop

size 60 drops deliver 1ml
Arithmetic IV infusion
• The fluids are being infused from flask into a drip chamber. A drip
chamber has fixed drops and adjustable rate of flow. There two main
drip chambers in general use; One breaks 20 drops per ml another 60
drops per ml:

𝑽𝒐𝒍𝒖𝒎𝒆 𝒕𝒐 𝒃𝒆 𝒈𝒊𝒗𝒆𝒏 𝑿 𝑫𝒓𝒐𝒑 𝒇𝒂𝒄𝒕𝒐𝒓

• Drops per minute =
𝑻𝒊𝒎𝒆 𝒇𝒂𝒄𝒕𝒐𝒓

• A boy is to receive 400mls of 5% dextrose in 8 hours and the IV set

delivers 60 drops/ml. calculate the rate of drops per minute.
• Drops per minute = 400mls x 60/ (8 x 60)
• 50 drops
DRUG INTERACTIONS
• The pharmacologic activity of a drug is altered by the concomitant use of
another drug or by the presence of some other substance
• Includes drug-drug interactions, drug food interactions, and drug disease
interactions
• The net effect of a drug interaction is generally quantitative i.e. increased
or decreased effect.
• Drug interactions are mostly undesirable but rarely desirable e.g. One drug
may be given to potentiate another for example probenecid which blocks
the excretion of penicillin is sometimes given with penicillin to maintain
adequate blood levels of penicillin for longer periods
• The three main types of drug interactions are:
Addition or Summation: The interacting drugs have similar actions and
the resultant effect is the sum of the individual drug responses. For
example Aspirin and codeine can be given together and they provide
greater relief of pain than when given alone
Synergism or Potentiation: This is the combined action of two drugs
whose combined effect is greater than the sum of their separate
effects. E.g. Combination of Trimethoprim and sulfamethoxazole
Antagonist: The interacting drugs have opposing effects e.g.
Noradrenaline and acetylcholine have antagonizing effects on heart
rate
Liver enzyme Inducers/Inhibitors: Inducers increase the activity of liver
enzymes against the substrate drug. Inhibitors reduce the activity of
liver enzymes against the substrate drug
QUESTIONS??