Prescription audit-Questions

1.
• A 44-year-old lady presents with complaints of pain,
swelling and stiffness of the interphalangeal and
metacarpophalangeal joints of both hands for the last
8 months.After a thorough evaluation she was
diagnosed to have rheumatoid arthritis. The
neighbourhood doctor prescribed her Diclofenac sod.
75 mg SR tab twice daily and Pantoprazole 40 mg tab
once daily in the morning.
• Though, initially she was getting good relief, but now
the relief is incomplete, and she is disabled for 2–3
hours in the morning.
• Do the prescription audit to this patient.
 2.
A taxi driver aged 30 years presented with sudden onset running and
itchy nose, bouts of sneezing, partial nasal blockage, redness and
watering from the eyes, but no fever, body ache or malaise. He gave
history of similar episodes occurring off and on during the spring
season. A diagnosis of seasonal allergic rhinitis was made and the
doctor prescribed the following medication and upon using these
medication he is complaining of impaired alertness.
1. Tab. ATARAX ( Hydroxyzine) 10mg BD morning and at bed time for
3 days
2. Tab. Chlorpheniramine 2mg OD in the afternoon for 3 days
3. Fluticasone nasal spray (50 micrograms per actuation) 3 puffs a
day for 1 week

• Do the prescription audit for this patient and write the correct
prescription
 3.
A 3.5 year old child was brought with loose stools for one day. On
examination the child was a bit irritable but was recognising her
parents and relatives, eyes were Slightly sunken ; vital parameters
showed increased heart rate, decreased peripheral pulses,
Tachypnea , prolonged Capillary refill time but with normal BP and
temperature. A diagnosis of nonspecific diarrhoea with moderate
dehydration was done and prescribed the following:
– Tab.loperamide t.d.s.
– ORS powder
– Inj. Vitamin B complex
– Syrup. erythromycin 200 mg t.d.s.
• Do the prescription audit for the above prescription.
 4.
A 54 yr. old female came with complaints of breathlessness, cough,
wheezing for the last 2 days which started after having an outdoor activity
in a garden. She was able to speak 2-3 sentences at a stretch after which
she is feeling breathless. She gave h/o same symptoms during rainy
season for the last 2 years but ignored as the episodes were mild. On
further evaluation a diagnosis of mild bronchial asthma was made which
is aggravated by allergens and prescribed the following drugs.
1. Cap. Duralyn CR (Theophylline) 100mg TDS
2. Tab. Cetrizine 10mg HS
3. Piriton expectorant (Chlorpheniramine)1 tsp TDS
4. Beclate Inhaler (Beclomethasone dipropionate) 2 puffs twice daily.

• Do the prescription audit for the above prescription.

 5.
A 25yr old female came with complaints of fever with chills,
cough with wheezing, headache, body pains, nausea for the last 2
days. Peripheral smear had shown vivax malarial parasite and
made the diagnosis of Malarial fever. The following drugs were
prescribed.
1.Inj. Chloroquine phosphate 40mh/ml;1 ampoule of 5ml IM
stat
2. Tab. Chloroquine phosphate 500mg stat, repeat after 6
hours, followed by 250mg on 2nd and 3rd days
3. Tab. Nimesulide 100mg BD for 3 days
4. Tab. Ranitidine 150mg BD for 3 days
5. Cap. Omeprazole 20mg HS for 3 days
Do the prescription audit for the above prescription.
 6.
• A 45 year old chronic smoker came to the OPD with complaints
of difficulty in breathing and cough with copious purulent
expectoration for the past three weeks. He also complains of
occasional blood-streaked sputum production. A provisional
diagnosis of bronchiectasis was made and he was admitted in
the Medicine ward for further evaluation.
• Along with the antibiotics he was started on two syrups, viz.,
Ascoril and Deletus-D.
– Syp. Ascoril contains bromhexine, guaifenesin and
terbutaline.
– Syp. Deletus-D contains dextromethorphan, triprolidine and
phenylephrine.
• Do the prescription audit for the above case scenario.
 7.
A 60-year-old male patient of moderately severe chronic
obstructive pulmonary disease (COPD) with FEV1 45% of
predicted, who has quit smoking for the last 5 years, and is
maintained on—
1. Ipratropium br. 20 μg/puff MDI, 2 puffs 3 times a day
2. Theophylline 400 mg SR tab. twice a day.
One day he came to the hospital with fever & sore throat for the
last 4 days and was prescribed—
3. Tab. Erythromycin 250 mg, one tab 4 times a day for 5 days
4. Tab. Paracetamol 500 mg 3 times a day till fever persists
After 3 days he came with pain in epigastrium, restlessness,
palpitation, tremors & vomiting. Do the prescription audit to
this prescription. Re-write the correct prescription.
 8.
Mr. Kumar, a 51-year-old patient with
schizophrenia was put on tab. haloperidol 10 mg
tid. He developed rigidity and bradykinesia after
12 months of therapy. He was diagnosed to have
haloperidol induced extrapyramidal symptoms
such as drug induced parkinsonism. He was
started on tab. levodopa (100mg) + carbidopa
(25mg) tds. There was no improvement in the
symptoms. Comment, correct and rewrite the
prescription
 9.
A 55-year-old male presented with symptoms of tremors
even at rest of his right upper arm ,slowness of movements
along with gait disturbance. He also gives the history of
severe abdominal bloating, nausea, indigestion and frequent
vomitings. After thorough evaluation, diagnosis of Parkinson's
disease with acid peptic disease was made and prescribed
1. Tab. LEVODOPA+CARBIDOPA 100+25 mg thrice daily orally
after food for 1 week.
2. Tab. Pantoprazole 40mg on empty stomach for 1 week
3. Tab. Metoclopramide 10 mg TID before food for 1 week
After 1 week patient came back without any improvement in
the motor symptoms.
Do the prescription audit to the above prescription.
 10.
• A 40 year old female was admitted with the complaints of
irritability, motor restlessness, high energy level, nonstop
talking, little need for sleep, sometimes violent behaviour
for the last 2 weeks. After a thorough evaluation the
diagnosis of Acute mania has been made. After treating
the acute attack with Inj.olanzapine 10mg , she has
been put on Tab. Lithium for maintanence therapy. She is
a known hypertensive and on regular treatment with
Tab.Telma-H (Telmisartan 40mg + Hydrochlorthiaze
12.5mg). After 2 weeks she was brought to the ED with
complaints of coarse tremors, ataxia, motor
incoordination, nystagmus and her plasma lithium levels
were found to be 1.46 mEq/L.
• Do the prescription audit to this patient.