Biomedical subjects

Alison George

Publications and source records attributed to Alison George.

11 recordsLinked to original sources

PubMed2003

Diagnosis and therapeutic goals. What are you actually treating?

BACKGROUND: Bad prescribing frequently involves writing a prescription for a symptom or a diagnosis and not considering the other steps in the prescribing process. OBJECTIVE: To illustrate the process of therapeutic goals. DISCUSSION: Therapeutic goals are the answer to the patient's question: 'Why am I taking this medication?' Taking this step in the prescribing process allows for a greater consideration of available treatment options, greater individualisation of therapy, avoids treatment on the basis of surrogate endopoints, and may result in greater patient concordance.

Adult↗

PubMed2003

Therapeutic approach: how to get there.

BACKGROUND: After determining the therapeutic goals for an individual patient, the next step in good prescribing is planning a therapeutic approach to achieve these goals. OBJECTIVE: This article aims to illustrate the process of the therapeutic approach. An example of a patient with asthma is discussed, and the evidence base for the possible lifestyle interventions is reviewed. DISCUSSION: Clinicians often treat the therapeutic approach as a two step process of identifying nonpharmacological then drug related interventions. However, the scope of therapeutic approaches is really much broader than this. It encompasses lifestyle change, education, avoidance of triggers, procedural interventions, patient self management, as well as drug treatment. The latter may actually include medication cessation.

Adult↗

PubMed2003

Which drug class and why?

BACKGROUND: Having made the diagnosis, decided on therapeutic goals and the therapeutic approach, the next step is choice of drug class. OBJECTIVE: This article discusses the four factors to be considered when choosing an appropriate drug class: efficacy, safety, suitability and cost. DISCUSSION: The first consideration in choosing a drug class is the relative efficacy compared with other agents for the particular therapeutic goal. Safety is a broad issue involving adverse reactions, toxicity, tolerance and dependence, teratogenicity, and consideration of special at risk populations. Suitability involves consideration of contraindications to the medication as well as other factors such as the requirements for monitoring, drug formulation and the number of daily doses. Cost includes consideration of drug acquisition as well as the total cost of therapy, including by whom the cost is borne.

Humans↗

PubMed2003

Choosing a drug from within a class.

BACKGROUND: Having decided on a drug class, an individual drug needs to be chosen. OBJECTIVE: This article discusses the same four factors used in deciding the generic drug within a class as well as between different drug classes: efficacy, safety, suitability, and cost. DISCUSSION: The example of hypertension will be used to illustrate the choice of individual drugs within beta blockers and calcium channel blockers. Although a large number of options exist within each class, by considering the above factors, the choice is narrowed to only 1-2 preferred options. These drugs should then be added to the P- or Personal-drug list. By only prescribing agents on the P-drug list, the prescriber will become more familiar with their closing, adverse effects, and interactions, resulting in improved patient outcomes. Also when a new drug becomes available, it clearly needs to be better for the patient in terms of these factors, before it is added to the P-drug list.

Adrenergic beta-Antagonists↗

PubMed2003

Individualising therapy. The right dose, dosage form, frequency and duration.

BACKGROUND: Having chosen which drug to prescribe, the prescription now needs to be individualised for the patient in front of you. OBJECTIVE: This article discusses the factors that have to be considered when individualising drug therapy for each patient. DISCUSSION: Before considering writing a prescription it is important to develop a personalised approach for the individual patient. The prescription should also then be individualised as to the route of administration, dosage, dosage form, frequency, and duration of the medication being prescribed.

Aged↗

PubMed2003

Check suitability, minimise sue-ability!

BACKGROUND: Having chosen which drug to prescribe, the suitability of the medication needs to be checked before the prescription is written. OBJECTIVE: This article discusses what checking for suitability means and how it differs from specific considerations that a patient may have. DISCUSSION: A drug is unsuitable for a patient if it is very likely to cause a predictable adverse reaction, and its prescription, in the absence of extenuating circumstances, would be difficult to defend. A simple example is anaphylaxis to penicillins. It is important to distinguish between patients for whom certain drug therapy is unsuitable, and others who have specific considerations, where the drugs can still be prescribed, but where additional steps need to be undertaken either in prescribing or monitoring. Examples of each of these will be discussed.

Adrenergic beta-Antagonists↗

PubMed2003

Writing the prescription and informing the patient.

BACKGROUND: Having decided on the generic drug to prescribe the prescription needs to be written and the patient informed regarding the treatment. OBJECTIVE: This article discusses some regulatory requirements for writing a legal prescription, but predominantly discusses important aspects of informing patients regarding drug therapy. DISCUSSION: The actual writing of a prescription is a small part of the prescribing process and needs to comply with local regulations. Including patients in the decision to embark on a treatment and informing them of drug treatment is a very important part of the prescribing process. There is no simple formula, but patients need to be informed on what they want to know, when they want to know it, and in the way that is most acceptable to them. It is important to use both verbal and written forms of communication and to allow patients to reflect over the information, ask questions, and be further informed over subsequent consultations. Consumer medicine information leaflets can be a useful aid, but require that the clinician understand and be prepared to answer questions raised by them.

Aged↗

PubMed2003

Introduction to monitoring. What is what you prescribed actually doing?

BACKGROUND: Having written a prescription for the patient, it is important to monitor for the effects of the drug. OBJECTIVE: This article discusses the importance of patient monitoring as part of the prescribing process, and in particular, what factors to monitor. DISCUSSION: Monitoring of drug therapy is an important part of the prescribing process in enhancing the drug's effectiveness. This is partly due to the large variability in patient response to any given dose of a drug. The drug's effect as well as adverse effects should be actively sought, and dosage alterations made in order to enhance the drug's effect. In some cases, this involves directly monitoring for the drug's effects, and in other cases using surrogate markers.

Acetaminophen↗

PubMed2003

Monitoring in high level care.

BACKGROUND: Prescribing for elderly patients in nursing homes in an area where appropriate patient monitoring is poorly managed. OBJECTIVE: This article discusses the use of some commonly prescribed medications in elderly nursing home residents and how these medications should be monitored. DISCUSSION: Many of the medications prescribed to nursing home residents may be appropriately prescribed initially, but their continuing prescription may be inappropriate in the setting of lack of effect and adverse reactions. It is important to appreciate that the response rate to many of the commonly prescribed medications such as tricyclic antidepressants, selective serotonin reuptake inhibitors, anticholinergics and antipsychotics, is limited in this population of patients and that they also have quite a significant potential for toxicity. Therefore, monitoring for the effects of therapy, as well as any potential adverse effects, is important to ensure the ongoing appropriateness of such prescriptions.

Aged↗

PubMed2003

Monitoring: to infinity and beyond!

BACKGROUND: For many patients, the initial prescription is only the beginning of the prescribing process, with the prescription needing to be repeated, sometimes for the life of the patient. OBJECTIVE: This article discusses the factors to consider when reviewing a patient for a repeat prescription and some approaches to long term pharmacotherapy. DISCUSSION: When writing repeat prescriptions it is important to take time to consider the physiological changes of aging, emergence of new contraindications in the patient, emergence of new evidence regarding drug therapy, and whether it is appropriate to consider drug withdrawal. The role of the pharmacist in the prescribing process, particularly in performing home medicine reviews, is also briefly discussed.

Aged↗

PubMedDate not supplied

Prescribing: what's all the fuss?

BACKGROUND: Prescribing is a commonly used skill which has until recently been poorly taught in medical school curricula. This is despite the fact that there are a number of proven approaches to teaching better prescribing. OBJECTIVE: The WHO Guide to Good Prescribing is discussed, with an example elaborating the steps involved in the process. DISCUSSION: Central to this approach is the development of a rational and evidence based list of P- or personal drugs which the prescriber develops familiarity with and uses regularly for specific indications.

Drug Prescriptions↗