Prescription auditing charts

Dr.K.Punnagai
 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.d x 5days
4. Linctus codeine 15 mg/ml x 5days

Review after 5 days

 Answer - 1
• Not given in the prescription format. No details about the
doctor, patient, superscription and signature of the
doctor.

• 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

Name of the Drugs of Frequenc
Dose Duration Route ADR
drug choice y

Inhalation
Less
better.
Salbutamol correct incorrect correct 6ht hrly adverse
100 – 200
effects
μg

Not 3times
Theophylline incorrect correct
necessary daily

Not Correct
2 times
Prednisolone necessary incorrect 3-5 inhalation
daily
days

Linctus
contraindicated
Codeine
 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
 Answer -2
• Not given in the prescription format
• Antibiotic not necessary for common cold of viral
etiology
• Astemizole cause drug interaction. Prolong QT
interval causing polymorphic ventricular
tachycardia with roxithromycin. Roxithromycin is
an inhibitor of CYP4503A4
• Paracetamol preferred to aspirin because of
gastritis
• B-complex not necessary
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Pro
Roxithromy Not
correct given oral correct QT interval
cin necessary
VT

Not used Pro

astemizole Cetrizine Correct 3days Oral Correct QT interval
preferred VT

Paraceta High 2 times

Aspirin 3 days Oral gastritis
mol dose daily

Not necessary
B-complex
Vit c preferred
 Question - 3
• Miss. B 18 yrs female with acute urinary tract
infection.
• 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 ml
tid x 2 days
• 5. tab. Paracetamol 1gm qid , sos
• Urine for culture & sensitivity . Review after 2
days
 Answer-3
• Oral route sufficient unless compelling
reasons for parenteral therapy
• Antibiotic not necessary now. One can
wait for culture & sensitivity results before
choosing antibiotics
• Plenty of fluids is sufficient , diuretics not
necessary
• Disodium hydrogen citrate may be given
• Paracetamol given only if there is fever
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Inj.ampicilli Not incorrec

incorrect Incorrect correct Local pain
n necessary t

Not inCorre nephrotoxi

Inj.genta Correct incorrect correct
necessary ct city

frusemide contraindicated

Disodium
Necessar
hydrogen Correct Incorrect Oral Correct
y
citrate

Tab.parace
Not necessary
tamol
 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
 Answer-4
• Inj. Insulin not necessary in a newly
diagnosed case unless complicated by
infection, gestation or emergency
• Glibenclamide can be added if diet alone
fails but start with low dose and escalate
according to response. Given ½ hour
before food
• Metformin can be given if diet fails and if
patient is obese. Given after food
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Depend
Inj.lente Not Depends hypoglyce
- correct s on
insulin necessary on BSL mia
BSL
correct., Oral, 30
Depend
Tab.glibenc can be Depends mints hypoglyce
Life long s on
lamide given if on BSL before mia
BSL
diet fails food

Necessar
y if pt. is Depend
Tab.metfor Depends Oral after Lactic
obese & Life long s on
min on BSL food acidosis
sugar not BSL
controlled
 Question-5
• Mr.A 47yrs male
• H.pylori infection
• 1. aluminium hydroxide + magnesium
trisilicate (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
 Answer - 5
• Antacid can be given sos for symptomatic relief
especially for first few days. If antacid is used
alone 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 better
acting. Hence atleast 2hrs interval should be
there between bismuth subcitrate& antacid.
Bismuth subcitrate taken on empty stomach,
30mints before food. Causes blackening of
stools
• Either bismuth subcitrate or ranitidine is given.
No need to give both the drugs to gether.
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Not Before constipatio

antacid correct incorrect correct
necessary food n

Oral, 30
mints Blackening
bismuth correct 120 mg 2 wks QID
before of tongue
food

Interacts
Tab.ranitidi Incorrect Oral after Once
correct 2 wks with
ne -300mg food daily
antacid

Amoxycillin- 750 mg tds + Metronidazole-500mg tds + Ranitidine

antibiotics
300 od X 2 wks
 Question -6
Mr.A 60 yrs male
Hypertensive with mild CCF
Tab.amlodipine 5 mg bid x 15 days
Tab. Furosemide 40 mg bid X 15 days
Tab. Digoxin 0.25 mg X15 days
Salt restricted diet
 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.
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Tab.amlodi contraindi
pine cated

Tab.furose Not Once hypokalem

incorrect correct oral
mide necessay daily ia

Digoxin
toxicity
Once
Tab.digoxin correct correct correct Oral with
daily
hypokalem
ia
Salt
restricted
 Question - 7
• Mr. A 36 years male bacillary dysentry
1. Iv fluids, 5% dextrose, 2 bottles-slow iv
over 10 hrs, 5% DNS
2. Cap. Ampicillin 500 mg od for 5 days
3. Tab.Loperamide 4mg stat, then 2mg
after each stool (Max. 8 tab)
 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
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Not
necessary
Inj.fluids
ORS
sufficient
Better
Cap. choice - twice
400 mg correct oral
ampicillin norfloxaci daily
n

tab.loperam
contraindicated
ide
 Question - 8
• Mr.B 30 yrs male
• Acute intestinal amoebiasis
1. Inj.metronidazole 500mg stat
2. Tab.metronidazole 500mg tid X 5days
3. Tab.diloxanide furoate 500mg tid X 5
days
4. Tab.loperamide 2 mg following each
stool (Max. 8 tab)
 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
Name of Drugs of Frequen
Dose Duration Route ADR
the drug choice cy

Not Nausea,vo
Inj.metronid necessary Twice miting,
correct
azole daily metallic
taste

Tab.metron twice
correct 400 mg correct oral
idazole daily

tab.loperam
contraindicated
ide

Tab.diloxan 5-10
correct correct correct tds flatulence
ide furoate days