Prescribing

(making a
prescription)
Nicolaski Lumbuun, dr., SpFK
Faculty of Medicine
Universitas Pelita Harapan

Rational Drugs Use

Rational use of medicines requires that
"patients receive medications appropriate to
their clinical needs, in doses that meet their
own individual requirements, for an adequate
period of time, and at the lowest cost to
them and their community".
WHO estimates that more than half of all
medicines are prescribed, dispensed or sold
inappropriately, and that half of all patients fail
to take them correctly.
http://www.who.int/medicines/areas/rational_use/en /

Case one
You sit in with a general practitioner and
observe the following case.
A 52-year old taxi-driver complains of a sore
throat and cough which started two weeks
earlier with a cold. He has stopped sneezing
but still has a cough, especially at night. The
patient is a heavy smoker who has often been
advised to stop. Further history and
examination reveal nothing special, apart
from a throat inflammation.
What would you do?
Write a prescription for this patient!

Case two
A-60-year old man, with no previous medical history.
During the last month he has had several attacks of
suffocating chest pain, which began during physical labor
and disappeared quickly after he stopped. He has not
smoked for four years. His father and brother died of a
heart attack. Apart from occasionally taking some aspirin
he has not used any medication in the past year.
Auscultation reveals a murmur over the right carotid
artery and the right femoral artery. Physical examination
reveals no other abnormalities. Blood pressure is 140/95,
pulse 98 regular, and body weight is normal.

What do you think about this case?

What would you do?
Write a prescription for this situation!!

Case three
Woman student, 19 years. Complain of a
slowly progressive fever in the morning to
afternoon, which is as high as 40C at night.
She felt like this for up to a week. She also
feels profuse sweating, abdominal discomfort
and nonbloody diarrhea. She cant eat,
because of always vomits when she tried to
eat something?
What would you do?
Write a prescription for this patient!!

Write a prescription for

this condition
Boy, 14 years. Acute conjunctivitis. R/Oxytetracycline
0.5% eye drops, 2 drops every six hours, give 10 ml.
Child, 6 years. Giardiasis with persistent diarrhoea.
R/metronidazole 200 mg/5 ml oral suspension, 5 ml
three times daily, give 105 ml.
Woman, 22 years. New patient. Migraine with
increasingly frequent vomiting. Paracetamol no longer
effective during attacks. You explain to her that the
paracetamol does not work because she vomits the
drug before it is absorbed. You prescribe paracetamol
plus an antiemetic suppository, metoclopramide, which
she should take first, and wait 20-30 minutes before
taking the paracetamol.