In pharmacies, pharmacists bear the brunt of the work - to review the prescription, which requires that pharmacists must be calm and cautious, careful and careful. So, what should pharmacists pay attention to when reviewing the suitability of drugs?
(First Pharmacy Intelligence Gallery)
One
Consistency of prescription medication with clinical diagnosis
1. "None" - no indications for medication
2. "Ultra"--no-justified hyper-indication medication
3. "Linkage" - blind combination of drugs
4. "Over" - over-treatment medication
5. "Forbidden" - there are contraindications to medication
1
No indications for medication
The following cases are uninsuitable drugs:
Cough is diagnosed without infection – azithromycin
Influenza – antibiotics
Class I surgical incision - third-generation cephalosporin
Enterococcal infection – clindamycin
2
There is no justifiable reason to use the drug for the indication
The following cases are beyond the scope of the indications in the instructions:
Progesterone – tubal stones
Berberine – lowers blood sugar
Tamsulosin (a drug for the treatment of prostatic hyperplasia) – hypotensive
Atorvastatin – Calcium supplementation
Metformin – non-diabetics lose weight
3
Blind combination of medications
Manifested in:
The cause is unknown
A single antibacterial agent has controlled the infection
Big prescriptions
Multiple drugs (i.e. a generic name of the active ingredient of a drug with multiple different trade names leads to repeated uses)
The combination of more toxic drugs, the dosage has not been reduced, increasing the incidence of adverse reactions
For example, enteritis bacterial infectious diarrhea, the application of "berberine (berberine) tablets + diphenoxylate hydrochloride tablets + octahedral montmorillonite powder", it is a blind combination of drugs.
4
Overtreatment medication
Abuse of antibiotics, glucocorticoids, human blood albumin, fructose diphosphate, and tumor adjuvants.
Blind calcium supplementation without therapeutic indications
For example, for esophageal cancer, the administration of "cisplatin + fluorouracil + epirubicin + etoposide" is an over-therapeutic drug, because: adding epirubicin and etoposide not only can not significantly improve the efficacy, but will increase toxicity.
5
There are contraindications to medication
Ignore the prompts in the drug instructions;
Ignore the condition and the patient's underlying disease.
The following are contraindications to medication:
Anticholines and antiallergics – in patients with glaucoma and benign prostatic hyperplasia – have difficulty urinating
Pseudoephedrine hydrochloride for the treatment of colds and relieves hyperemia of the nasal mucosa - hypertensive crisis in patients with severe hypertension
Fatty milk – acute liver injury, acute pancreatitis, lipid nephropathy, stroke, hyperlipidemia – lipid disorders
The antidepressant slegiline – in patients with urinary retention and prostatic hyperplasia – exacerbates dysuria
Two
Correctness of dosage, dosage and duration
Dosage for the elderly: it should be reduced compared with adults, and the dose of medication for the elderly aged 60 to 80 years can be less than 3/4 of that of adults; the dosage for the elderly over 80 years old can be 1/2 of that of adults.
Dosage for children: The dose for children (per kilogram or per square meter) recommended in the drug instructions should be calculated according to the child's body weight or body surface area.
Three
Rationality of dosage form selection and route of administration
According to the needs of clinical treatment, choose the route of administration, the principle of selection is to be able to take medicine without injection, and to be able to inject without infusion;
In severe and emergency treatment, the drug is required to take effect quickly, and it is appropriate to choose intravenous injection, intravenous infusion, intramuscular injection, inhalation and sublingual administration;
In the treatment of mild and chronic diseases, oral administration is appropriate due to the long-lasting use of drugs;
Skin diseases are suitable for choosing external solutions, tinctures, ointments, film coating agents and other dosage forms;
Topical suppositories should be used in the treatment of cavity diseases.
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