Prescription repeat

DW, a 78-year-old Caucasian man, presents to the emergency room with complaints of a headache persisting over the last 3 days. Repeated blood pressure measurements average 200/11 0 mm Hg. He reports no other symptoms and physical examination and laboratory tests are unremarkable as is his past medical history with the exception of hypertension diagnosed in his early 60s. DW reports that he is struggling on a fixed retirement income with no prescription coverage and takes "what I can afford." Blood pressure medications are carvedilol 25 mg twice daily, amlodipine 10 mg once daily, torsemide (Demadex )... 

Abuse. We have all heard the terms substance abuse, drug abuse, alcohol abuse, cocaine abuse, and so on. In one sense, any illicit use of a substance is abuse. For example, from the legal point of view, whenever someone smokes crack (even if it is the only time), (s)he has broken the law and abused cocaine. Likewise, if you borrow a prescription sedative or pain reliever from a friend, then you have similarly abused that medication. That is an appropriate use of the term in many cases, but this is not customarily the way that mental health specialists use the term. From our perspective, substance abuse involves a pattern of repeated use over time that results in problems in one or more areas. These include compromised physical health and well-being, legal proceedings, job status, and relationships as well as overall day-to-day functioning. 

Corbamazepine is slowly absorbed and tends to exhibit erratic absorption following oral administration. Hence, when dispensing repeat prescriptions for corbamazepine, it is advisable to avoid changing the formulation of corbamazepine. 

Progressive companies use a more structured and comprehensive team approach to identify root causes. Scientific principles and concepts are applied to determine root causes and make recommendations to prevent recurrence. Effective investigations should use tested data analysis tools and methodologies to seek the identification of multiple causes. To be repeatable, the investigation should use a systematic approach, which may also be prescriptive. As a rule, the benefits of this systematic approach result from two actions ... 

Unlike the procedure followed in developing logic trees, the investigation team does not construct the tree. Rather they apply each causal factor to each branch of the predefined tree in turn, and those branches that are not relevant to the incident are discarded. This prescriptive approach offers consistency and repeatability by presenting different investigators with the same standard set of possible root causes for each incident. 

This brief survey of the FDA regulation of pharmaceutical products demonstrates the breadth and depth of FDA activity in this field. Although there are repeated calls for reform of the IND/NDA system, it appears unlikely that any substantial change will occur in the near future. It is therefore important that any person who enters the prescription drug industry in the United States be fully informed about the requirements, understand the regulatory risks involved, and comply adequately with all of the FDA requirements. 

The PBAC meets three times per annum, in March, July and November, as the culmination of the 17 week pre-meeting application cycle (see Section 4.8). Positive PBAC recommendations are published on the PBS website approximately 6 weeks after the PBAC meeting. If an application for listing is successful, the PBAC recommends the maximum quantity to be dispensed on each prescription and the number of repeat prescriptions. The PBAC may also recommend prescribing restrictions - an authority required item requires the prescriber to obtain prior approval from the Health Insurance Commission (HIC), by telephone or post, and restricted benefit items may only be prescribed for specified therapeutic uses. 

In the early 1960s, when Enoch Powell was Minister of Health in Macmillan s Conservative government, the DoH bought large quantities of tetracycline from Poland for NHS hospital use. This was found to be clinically ineffective and of substandard quality a public outcry in the medical press followed. The cheap drugs exercise was not repeated, but bulk hospital purchase at competitive contract prices continues, and this leads to wide discrepancies between the hospital price and the price charged to prescriptions written in the primary healthcare sector. 

Each month of therapy, the patient must have a negative result from a urine or serum pregnancy test. Repeat the pregnancy test each month prior to the female patient receiving each prescription. 

Requests for confirmation of treatment despite apparent lack of effectiveness may be expression of the fact that the patient has already tried to stop the drug but became subjectively worse due to withdrawal rather than the re-emergence of the original symptoms. On the other hand requests for repeat prescription may also indicate a dependence in a therapeutic relationship, the patient needing support and contact. The prescription of a drug is then merely a vehicle which the patient finds acceptable as a reason for approaching the doctor. This may be particularly true for elderly, lonely patients. 

The extensive use of any psychoactive substance carries some risk of misuse. This very general assertion is often challenged, but in the author s experience is true to a greater or lesser extent. No patient should be given uncontrolled repeat prescriptions of such substances. 

The standard dose is 11 mg (base)/kg (maximum, 1 g), given orally once with or without food. For pinworm, the dose is repeated in 2 weeks, and cure rates are greater than 95%. The drug is available in the USA without prescription for this indication. 

Emergency contraceptive Levonorgestrel, 0.75 mg tablet taken as soon as possible but no later than 72 hours after unprotected intercourse repeat dosage 12 hours later Plan Levonorgestrel prevents ovulation and may inhibit fertilization or implantation. Reduces the chance of pregnancy by up to 89% when taken as directed within 72 hours after unprotected intercourse. Plan is available behind the counter at pharmacies and sold under the supervision of a licensed pharmacist. A prescription is needed for women < 17 years of age. 

Stimulants increase the overall activity of the nervous system by boosting the release of various neurotransmitters such as dopamine, norepinephrine, and glutamate. The result is increased alertness, attention, and energy. Unfortunately, prescription stimulants can be highly addictive and cause cardiovascular side effects (increased heart rate, blood pressure, and irregular heart rate) as well as respiratory side effects (dilated airways and increased breathing rate). Taking stimulants repeatedly and in excessive doses can... 

Findlay CA, Macdonald JF, Wallace AM, Geddes N, Donaldson MD. Childhood Cushing s syndrome induced by betamethasone nose drops, and repeat prescriptions. BMJ 1998 317(7160) 739-40. 

Mr George Smith, 61 years old, presents you with his repeat prescription. He is concerned that one of his medications is affecting his vision and asks you to identify the one that is likely to be causing this. 

The summary shows the steps that we have considered (Figure N2-11). Here we repeat every project is different, and so is every team. This is not a prescription, only a suggestion. Feel free to do things differently. 

---