Sunteți pe pagina 1din 32

GUIDE OF PRACTICAL WORK

PHARMACOLOGY AND THERAPY DEPARTMENT

BLOCK 22

MODUL NAME
1. Nosocomial Infection
2. Tropical Medicine
3. TB Control Program
4. Substances Abuse

1
PHARMACOLOGY AND THERAPY DEPARTMENT
FACULTY OF MEDICINE
UNIVERSITAS GADJAH MADA
RULES AND REGULATIONS GOVERNING LABORATORY WORK
IN THE DEPARTMENT OF PHARMACOLOGY AND THERAPY, FACULTY OF
MEDICINE, UNIVERSITAS GADJAH MADA

1. In the laboratory of Pharmacology dnd Therapy Department, the students have to


wear laboratory coats and shoes, and are not allowed to wear sandals.
2. It is imperative that students be in the laboratory in time. Those who arrive 15
minutes after the due time are denied permission into the laboratory
3. Before a session, the students will receive assignments to be prepared for the
following session.
4. After taking part in the three sessions, the students will have to sit for an exam, the
time for which will be announced later.
5. The total grade a student will get comprises 50% for the exam and 50% for
laboratory report.

2
WRITING PRESCRIPTION

Aims
The aims of this session are student will be able to:
Calculate drug dose
Determine the proper medication dosage regimen, including dose, route of
administration, frequency of administration, time of administration, and duration of
therapy
Write a prescription

BACKGROUND
One of the processes in an integrated patient management is prescribing. After the
doctors examine the patient, make a diagnosis, and determine the treatment plan, the next
step often done by a physician is writing a prescription. Prescribing process is as important
as the previous processes. Through this prescription sheet, doctors will indirectly
communicate with patients through a pharmacist.
To write a good and right prescription, students need to understand how to calculate
drug dosages, routes of administration, frequency of administration, time of administration,
and duration of therapy. In addition, there are other things that need to be observed when
prescribing, which is drug dosage form available in the market.

TOOLS AND MATERIALS


Scenarios
Prescription paper
F4 paper

PROCEDURES
Ten cases of scenario below should be done by each student. Each case then will be
discussed and presented to the other students. The following should be considered in the
discussion of each case
1. Determine the proper medication dosage regimen include: dose, route of
administration, frequency of administration, time of administration, and
duration of therapy
2. Write a prescription medicine

The following are the case:


1. A Physician wants to prescribe paracetamol tablets for Aldi, a 12 year-old boy, 40
kg, suffering from common cold.

3
Generic name Drug Dosage Generic form
Paracetamol 10-15 mg/kg/dose, every 4-6 hours Tablet 500 mg
Syrup (60 ml) 120
mg/5ml
Raw material

2. A Physician wants to prescribe antacid chewable tablet to Mrs. Dede, a 30 year-old


woman, 50 kg, suffering from acute gastritis.
Generic name Drug Dosage Generic form
Mixture of Al(OH)3 can be given up to 1 Antasida DOEN chewable
Al(OH)3 and gram//administration tablet contains Al(OH)3 200
Mg(OH)3 Mg(OH)3 can be given up to mg and Mg(OH)3 200 mg
1 gram//administration Antasida DOEN suspension
(60ml), each 5 ml contains:
Al(OH)3 200 mg and
Mg(OH)3 200 mg

3. Physicians want to prescribe Cotrimoxazol syrup for Clara, 3 years 15 kg, suffering
from dysentery basiler.
Generic name Drug Dosage Generic form
Cotrimoxazol 48-60 mg/kg/day divided in 2 Tablet 120 mg, 480 mg
dosage Syrup (60 ml) 240 mg/5 ml

4. Physicians want to prescribe Paracetamol pulveres for Kinanti, 1 year 10 kg


suffering from post-immunization fever.
Generic name Drug Dosage Generic form
Paracetamol 10-15 mg/kg/dose, every 4-6 hours Tablet 500 mg
Syrup (60 ml) 120 mg/5ml
Raw material

5. A Physician wants to prescribe gentamicin sulfate eye drops for Mr. Anton, 45
years old suffering from bacterial conjunctivitis in his left eye.
Generic name Drug Dosage Generic form
Gentamicin sulfat 1-2 drops every 4 hours Eye drop 0.3% in bottle 5 ml
Skin ointment 0.1% in tube 5 g

6. A Physician wants to prescribe Antihemorroid DOEN suppository to Mr. Dian, 54


years old 70 kg suffering from internal hemorrhoids.

4
Generic name Drug Dosage Generic form
Antihemorroid Once a day, 1 suppository Each 1 rectal suppository of
DOEN before sleep Antihemoroid DOEN
contains:
Bismuth subgalat 150 mg
Hexachlorofen 2.5 mg
Lidokain 10 mg
Seng oksida 120 mg
Supp ad 2 g

7. Mrs Susan 36 years old came to the doctor with complaints of itching after using a
certain brand of talcum powder. Physical examination found erythematosa
papulovesicula in the armpit, chest and elbows. Doctor diagnosed that she has
allergic contact dermatitis. The doctor then prescribed hydrocortisone cream.
Generic name Drug Dosage Generic form
Hydrocortisone Dosage 0.5-1%. Hydrocortison cream 1% or
Topically used every 6-12 hours 2.5% in tube 5 g

8. Odin (20 years old, 60 kg) came to doctor with fever since 5 days ago, and
complaint in difficult defecation. In physical examination, doctor found typhoid
tongue, and the temperature of 39.1C. Tubex TF Test showed positive results. For
pharmacological therapy, the doctor will give cyprofloxacin tablets for 14 days.
Generic name Drug Dosage Generic form
Cyprofloxacin 5-10 mg/kg/dose, every 12 jam Tablet 250 mg and 500 mg
Raw material

9. Ny.Sarbini, a fifty-year-old woman (50 kg), saw a doctor about her paroxysmal
fever with shaking chill for four days. She used to have malaria. Physical
examination indicated that the woman had jaundice, anemia and splenomegaly. In
thin blood smears, P. falciparum were discovered. The diagnose was malaria and
the doctor prescribed artesunate+amodiaquine + primaquine.

Generic name Drug Dosage Generic form


Artesunate+Amodiaqui Artesunate : 4 mg/kgbb/day Combination Tablet:
ne single dose, for 3 Amodiaquine : 10 mg/kgbb/day
Artesunate 50 mg +
days + primaquine on Primaquine : 0,75 mg/kgbb/day
Amodiaquine 200 mg
first day
Primaquine tablet 15
mg

10. Dino, 15 years old, came to a doctor about his bloody diarrhea and had defecated
three times a day for two days. Physical examination indicated that there were no

5
signs of dehydration. The faeces examination infested with trophozoit of
Entamoeba hystolitica. The diagnose was Amoebiasis without dehydration and the
doctor prescribed metronidazol and oral rehydration liquid.
Generic name Drug Dosage Generic form
Metronidazole Adult: 500-750 mg/dose, every Tablet 250 mg and 500 mg
8 hours
Oralit Adults: 200 to 400 mL for every Oralit 200 ml/sachet
diarrhea

Location : Pharmacology and Therapy Department, Faculty of Medicine, Universitas


Gadjah Mada
Duration : 1 x 120 minutes

EVALUATION
Assignment during laboratory practice.

REFERENCES
Roach, S. 2004. Introductory Clinical Pharmacology. 7th ed.
ISFI, 2007. ISO Indonesia (Informasi Spesialite Obat Indonesia),
Sri Suharmi, 2002, Resep Dokter dan Proses Preskripsi yang Benar dan Rasional, Bagian
Farmasi Kedokteran Fakultas Kedokteran UGM, Yogyakarta
Syarif, R.A, Murini, T., dan Wahyuningsih, M.S.H. 2012. Pedoman Dasar Penulisan
Resep Dokter untuk Pasien Anak. Bagian Farmakologi dan Terapi Fakultas Kedokteran
UGM.
Zaman-Joenoes, N. 2001. Ars Prescribendi Resep Yang Rasional. Edisi 1. Airlangga
University Press.

6
PRESCRIPTION ANALYSIS

AIM:
After doing the activity it is expected that students knowledge about prescription
writing increases and student are able to think critically to any prescription which they read
and analyze.

RESUME OF THEORY
Until now it is still found that a prescription is illegible and not written completely.
Health Ministerial Regulation No 26/1981 article 10 regulates that a prescription must be
written legibly and comprehensively. Minister of Health Decree No 280/1981 article 2
regulates that a prescription must contain
name, address and practice license number of doctor (Doctors identity)
date when a prescription written (Superscription)
name/composition and amount or strength of the drug (Inscription)
R/.(an abbreviation for Recipe) symbol on the left side of the prescription
form (Superscription)
Signature/Initial/Initials
Patients name (or patients identity consisting of name, age, body weight)
Besides those, a complete prescription also contains subscription (the direction to
the pharmacist, usually consisting of a short sentence such as make a cream, dispense
10 capcules) and signatura (the direction to the patients).
Therefore, it is necessary to provide the student how to write a good prescription by
giving some samples of doctors prescription to be read and analyzed. After doing it, it is
expected that they will write a complete, right, and rational prescription in the future.

TOOL AND MATERIAL


- Samples of doctors prescription
- LCD projector
- Notebook/computer

7
PROCEDURE
Method
Students are divided into some groups (3-4 persons/group). One week before this
session, each group will receive assignments to be prepared for this session. The
assignment is a doctors prescription to be analyzed by using the following criteria below.
The students have to make a repot of the assignment and submit it one day before the
practical work. On D-day the student present the short report written on transparent plastic
and discuss it with other groups.

8
FORM OF PRESCRIPTION ANALYSIS
A. Completeness of a prescription
Complete Right/legible Explanation
(yes/no) (yes/no)
Doctors Identity
Superscription R1/.
R2/.
R3/.
etc.
Inscription R1/.
R2/.
R3/.
etc.
Subscription R1/.
R2/.
R3/.
etc.
Signa (Signatura) R1/.
R2/.
R3/.
etc.
Doctors signature R1/.
R2/.
R3/.
etc.
Patients Identity

9
B. Prescription form
1. Type of prescriptions
R1/.
R2/.
R3/. etc.
2. Magistral form (present/none)
If there is magistral form, explain using the criteria:

Ingredients The name of active Effects/Functions


medicinal agent
Remedium Cardinale
(principal drugs)
Remedium Adjuvant
(adjuvant)
Corrigens
Constituents/vehicle

3. Official form (present/none)


If there is official form, explain composition and effects of the medicine
4. Special form (present/none)
If there is special form, explain the content and effect of the medicine
5. Narcotic drugs (present/none)
Name :
Write the drug in a prescription.

B. 1 Dosage regimen (dosage, route of administration, frequency, time of


administration, and duration of treatment)
2. Drug Interaction (present/none)

C. Pharmaceutical dosage form selected by the doctor


(Explain specification of available dosage form, advantages and disadvantages of
the pharmaceutical dosage form)

10
D. Diagnose
Base on the medicines written in the prescription, what is/are the possibility of
patients diagnose?

E. 1. Conclusion and advice (advices which have to be given to the patient relating to
the disease)
2. Write the right and rational prescribing in a prescription form.

After the students analyze and make a report about the prescriptions, on D-Day they
present and discuss them with other groups.
Each group presents:
1. Original doctors prescription
2. The calculation of drug doses for this patient
3. The right and rational prescribing according to studentss opinion

Example:
1. Look at the original doctors prescription below

dr. Mrichi Mary


Sip : 007/2000

Home: Pratice site :


Jl.Angsa 20 Jl.Anggrek 70
Yogyakarta Yogyakarta

Yogyakarta, 10 Juni 2007

R/. Erythromycin mg 200


Sacch.lactis q.s.
m.f.l.a.pulv.d.t.d.No XII
S.3.d.d.pulv.
________________________

Pro : Nila
Age : 1 year old

11
2. In that prescription, we do not find body weight of the patient, so we look for it
from weight for age table. From it, we obtain that the body weight of a-year-old
child is 8 kilograms. References show that erythromycin dosage is 30-50 mg/kg
body weight/day in four-divided dose. So,
Doses of erythromycin for Nila is 8 x (30 50) mg/day
or 240-400 mg/day
or 60 100 mg/dose
In prescription above we also find that signa is not complete. The doctor didnt
write how many package or medicine and when the medicine must be taken by the patient.
So, you have to complete the signa as prescription below.

3. The right and rational prescribing for Nila is :

dr. Mrichi Mary


SIP : 007/2000

Home: Practice site :


Jl.Angsa 20 Jl.Anggrek 70
Yogyakarta Yogyakarta

Yogyakarta, 10 Juni 2007

R/. Erythromycin mg 100


Sacch.lactis q.s.
m.f.l.a.pulv.d.t.d.No XII
S.3.d.d.pulv.I p.c.
________________________

Pro : Nila
Age : 1 year old (10 kg)

Location : Pharmacology and Therapy Department, Faculty of Medicine, Universitas


Gadjah Mada
Duration : 1 x 120 minutes

12
REPORT
The students have to submit the report to laboratory of Medical Pharmacy one day before
the practical work.

EVALUATION
Presentation and report

REFERENCES
Goodman and Gilman, 2001, The Pharmaceutical Basis of Therapeutics, Ed.8th,
Macmillan Publishing Company, New York

Hoover, J.E., 2002, Remingtons Pharmaceutical Sciences, Ed.15th, Mack Publishing


Company, Pennsylvania

ISFI, 2007. ISO Indonesia (Informasi Spesialite Obat Indonesia),


Sri Suharmi, 2002, Resep Dokter dan Proses Preskripsi yang Benar dan Rasional, Bagian
Farmasi Kedokteran Fakultas Kedokteran UGM, Yogyakarta

13
CASE PRESENTATION:
STEPS OF PRESCRIPTION WRITING

AIM:
The students are able to apply the steps of prescription writing to realize a rational
treatment.

RESUME OF THEORY
A study obtained that the fresh-graduated-doctor prescribed wrong drug, or benefit
of drug was hesitated on a half of cases; a third prescribing was wrong and two thirds
prescriber did not give important drug information to patient (WHO, 1994).
Prescribing is pharmacotherapy creation that it has to be right and rational. To
create rational pharmacotherapy in prescription writing, it is necessary to understand steps
to write rational prescription published by WHO. The steps are to choose the
pharmaceutical dosage form suitable to patient condition, determine dosage regimen
(doses, route of administration, frequency, time of administration, and duration of
treatment), write the prescription, and give important information about dosage regimen,
adverse effect which should be known by patient.

TOOL AND MATERIAL


- The fictive cases
- LCD Projector
- Laptop/computer

PROCEDURE
Method
Each group of students are divided into some subgroups (3-4 persons/subgroup).
One week before this session, each subgroup will receive an assignment to be prepared for
this session. The assignment contains a fictive case and steps to write prescription. Each
subgroup of students has to make a report of the assignment and submit it one day before
practical work. On D-day the student present the short report written on power point slides
and discuss it with students in other groups.

14
Example of clinical case to be presented:
Mr. K, a forty-year-old man, (65 kg), who lives in Papua, came to a doctor about his
paroxysmal fever with shaking chill for four days. Physical examination indicated that the
man had jaundice, anemia and slight splenomegaly. In thin blood smears, P. falciparum
were discovered. The doctor diagnosed uncomplicated malaria and prescribed DHP
(dihydroartemisinin + piperaquine) and primaquine.
The steps of prescription writing :
1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

Answer:
1. Combination of triple drugs (dihydroartemisinin + piperaquine + primaquine) are
one of artemisinin base combination treatments (ACT) which effective for
treatment malaria caused by P. falciparum. Artemisinin derivates is drug of partner
choice for combination drugs due to good absorption, safe, have a short half-time
(2 hours), good activity, and it is changed to active metabolite immediately.
Dihydroartemisinin-piperaquine combination is well tolerated, fast effect, prevent
the formation gametocytes, effective for parasites which resistance to multidrugs.
The use of combination is able to prevent resistance for single drug. It is
recommended by Health Minister of Republic Indonesia to treat malaria in Papua
and surrounding this area. It is expected it ensure patients adherence because they
are only taken single dose, for short duration, three days and one day for
dihydroartemisinin + piperaquine and primaquine, respectively. The forms are

15
available in tablet which is no problem for adult to swallow and no need special
storage requirement, only in room temperature and keep out of the reach of
children.
There is no contraindication for the patient and no interaction among these
antimalarial drugs prescribed.

2. Pharmacutical dosage form available in market:


Dihydroartemisinin + piperaquine
Generic : -
Brand name :
Arterakin : tablet Dihydroartemisinin 40 mg + piperaquine 320 mg
D-Artepp : tablet Dihydroartemisinin 40 mg + piperaquine 320 mg

Primaquine :
Generic : tablet 7, 5 mg; 15 mg.
Brand name :
Malirid-DS: tablet 7, 5 mg; 15 mg.

For Mr. K, tablet is prescribed on the assumption that he able to swallow tablet, the
dosage form is easy to carry everywhere and easy to get from pharmacy and public
health care.

16
3. Dosage of those medicine for adult
Dihydroartemisinin : 2-4 mg/kgBW = 60 kg (2-4 mg) = 120-240 mg
Piperaquine : 16-32 mg/kgBW = 60 kg (16-32 mg) = 960-1920
So, DHP tablet needed is 3-6 tablets
Primaquine : 0,75 mg/kgBB = 60 kg x 0,75 mg = 45 mg or 3 tablets
According to guideline from Health Minister RI (2008) the dosage for person over
15 years old is 3-4 tablet of DHP per day and 2-3 tablet of primaquine on first day.
Therefore, 3 tablets DHP and primaquine are chosen.
Frequency of administration: single dose (DHP on 1st-3th day and primaquine only
on 1st day)
Route of administration: orally
Time of administration: before meal, because the drugs cause gastric irritation
Duration of the treatment: 3 days for DHP and 1 day for primaquine

4. Prescription
The possibility of prescription forms which may be written:
A. Official prescription

dr. Budiman
SIP : 007/2009

Home: Practice site :


Jl.Angsa 20 Jl.Anggrek 70
Yogyakarta Yogyakarta

17
Yogyakarta, 10 April 2016

R/. Tab.primaquine mg 15 No III


S.haust.
________________________

Pro : Mr.K
Age : 40 y.o.

B. Spesial prescription

dr. Budiman
SIP : 007/2009

Home: Practice site :


Jl.Angsa 20 Jl.Anggrek 70
Yogyakarta Yogyakarta

Yogyakarta, 10 April 2016

R/. Tab.Arterakin No III


S.haust.
________________________

Pro : Mr.K
Age : 40 y.o.

18
Magistral prescription isnt written for the case because the preparation containing
the dose of all medicine needed are already available both in generic and brand
product.
Type of prescription chose: official prescription for primaquine and special
prescription for DHP.

5. Write effects, side effects, instructions, warnings which will be informed and
should be obeyed by patient

Location : Pharmacology and Therapy Department, 2nd floor of Radiopoetro Building,


School of
Medicine, Universitas Gadjah Mada
Duration : 1 x 120 minutes

19
REPORT
The students have to submit the report to laboratory of Pharmacology and Therapy one day
before the practical work.

EVALUATION
Presentation and report

REFERENCES
Depkes RI. 2008. Pedoman Penatalaksanaan Kasus Malaria di Indonesia.Dirjend.
Pengendalian Penyakit dan Penyehatan Lingkungan.

Goodman and Gilman, 2001, The Pharmaceutical basis of Therapeutics, Ed.8th, Macmillan
Publishing Company, New York

Sri Suharmi, 2002, Resep Dokter dan Proses Preskripsi yang Benar dan Rasional, Bagian
Farmasi Kedokteran Fakultas Kedokteran UGM, Yogyakarta

WHO, 1994, Guide to Good Prescribing, Geneva

20
Block 22
CODE: A1
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Bapak Palopo , a thirty-year-old man, saw a doctor about his paroxysmal fever with
shaking chill for four days. Physical examination indicated that the man had jaundice,
anemia and splenomegaly. In thin blood smears, Plasmodium falciparum were discovered.
The diagnose was uncomplicated malaria, then the doctor prescribed quinine, primaquine,
and acetaminophen for the patient.

The steps of prescription writing :


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

21
BLOCK 22
CODE: A5
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Ibu Wira , a forty five-year-old woman, came back from endemic malaria area and saw a
doctor about his paroxysmal fever with shaking chill for four days. Physical examination
indicated that the woman had jaundice, anemia and splenomegaly. In thin blood smears,
malaria parasites (P.vivax) were discovered. The doctor prescribe malaria and give The
diagnose was malaria and the doctor prescribed artesunat, amodiaquine, and
acetaminophen for the patient.

The steps of prescription writing :


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

22
BLOCK 22
CODE: B5
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Lala, a five-year-old girl (14 kg), was taken to a doctor due to unintended weight loss. The
girl looked thin. She lived with her grandpa who had tuberculosis. Physical examination
found no abnormality, tuberculine test was positive . A laboratory examination however
indicated relative lymphocytes and increase in erythrocytes sedimentation rate. X-ray
examination showed Primary Complex Tuberculosis. The doctor diagnosed Primary
Tuberculosis and prescribed antituberculosis isoniazid, ethambutol, rifampicine and
pyrazinamide for intensive phase of treatment.

The steps of prescription writing :


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

23
BLOCK 22
CODE: B6
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Bedu, a four-year-old boy (13 kg), was taken to a doctor due to unintended weight loss.
The girl looked thin. She lived with her grandpa who had tuberculosis. Physical
examination found no abnormality, tuberculine test was positive. A laboratory examination
however indicated relative lymphocytes and increase in erythrocytes sedimentation rate. X-
ray examination showed Primary Complex Tuberculosis. The doctor diagnosed Primary
Tuberculosis and prescribed antituberculosis isoniazid, ethambutol, rifampicine and
pyrazinamide for continuation phase of treatment.

The steps of prescription writing :


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

24
BLOCK 22
CODE: B7
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Lili, a seven-year-old girl (25 kg), was taken to a doctor due to unintended weight loss.
The girl looked thin. She lived with her grandpa who had tuberculosis. Physical
examination found no abnormality, tuberculine test was positive . A laboratory
examination however indicated relative lymphocytes and increase in erythrocytes
sedimentation rate. X-ray examination showed Primary Complex Tuberculosis. The doctor
diagnosed Primary Tuberculosis and prescribed antituberculosis isoniazid, ethambutol,
rifampicine and pyrazinamide for intensive phase of treatment.

The steps of prescription writing :


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

25
BLOCK 22
CODE: C1
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Mr A., 23 year-old-man, comes to your clinic. A week ago you asked him to undergo HIV
test in consideration of the abnormal data obtained from anamnesis and physical exam. The
test shows that he is HIV positive. After performing some additional tests, you conclude
that he suffers from HIV stage 2 without any co-infection (CD4 count = 200 cells/mm3).
Youve never been experienced giving HIV treatment, and now you are little bit confuse
on what you will prescribe. You decide to give combination therapy of zidovudine +
lamivudine + tenofovir and cotrimoxazol.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

26
BLOCK 22
CODE: C2
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Mrs B., 23 year-old-woman, comes to your clinic. A week ago you asked her to undergo
HIV test in consideration of the abnormal data obtained from anamnesis and physical
exam. The test shows that he is HIV positive. After performing some additional tests, you
conclude that he suffers from HIV stage 2 without any co-infection (CD4 count = 200
cells/mm3). Youve never been experienced giving HIV treatment, and now you are little
bit confuse on what you will prescribe. You decide to give combination therapy of
zidovudine + lamivudine + nevirapine and cotrimoxazole.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

27
BLOCK 22
CODE: E1
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

A 29-year-old construction worker present to the emergency department with a puncture


wound on his left foot, which he suffered when he stepped on a board with protruding nails
at a job site. The wound appears to be contaminated with dirt. The patient reports that he
received with all immunization as a child and was last given a tetanus booster in high
school at 16 years of age. He is otherwise healthy. The doctor in emergency room gives
antitetanus serum and tetanus toxoid for tetanus prophylaxis.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

28
BLOCK 22
CODE: E3
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

A 46-year-old woman present to emergency department complaining of facial spasm and


muscle stiffness. Five days ago, while working with barbed wire on her ranch, she
sustained a deep puncture wound of the left palmar. This morning during breakfast, she
experienced difficulty opening the mouth and felt pain with swallowing; this has
progressed to stiffness and pain in her back, neck, thighs, and abdomen. On examination,
patients face is held in a stiff grimace.Any sudden stimulus produces tonic muscle
contraction. The doctor in emergency room gives diazepam to treat this patients muscle
spasm, antitetanus and diphteroid toxoid.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

29
BLOCK 22
CODE: F1
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Bp. Bajuri, a 54-year-old man presents to your clinic because of hipertension and itching
on his back. He has a history of diabetes. His blood pressure is 160/100 mmHg. Physical
examination on his back showed single plaques its diameter is 4 cm with scaling, erythema
at the edge and cenral clearing. You diagnosed hipertension with Tinea corporis and
prescribed hydrochlorotiazid + captopril and ketoconazole for him.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

30
BLOCK 22
CODE: F2
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

Ibu Rosana, a 51-year-old woman presents to your clinic as a new7 patient because of
hipertension, vaginal discharge, and itchy on genital. She has a history of diabetes. Her
blood pressure is 170/95 mmHg and on genital appears white plaques adhere to inflamed
mucous membranes. You diagnose hipertension and candidiasi vulvovaginitis and
prescribed hydrochlorotiazid + furosemid and nistatin.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

31
BLOCK 22
CODE: G1
PHARMACOLOGY AND THERAPY DEPART.
FACULTY OF MEDICINE UGM

Case Presentation:
Steps to Write Prescription

ATH, a 14 year-old-girl comes to your clinic assisted by her mother. The mother
complains about the fever and skin rash of her daughter. The symptoms began 4 years ago.
The rash then turned into itchy, fluid-filled blisters that eventually turned into scabs. The
rash has first showed up on the face, chest, and back then spreaded to the rest of the body.
You diagnosed her with varicella zoster. You start to give acyclovir cream and
acetaminophen.

The steps of prescription writing:


1. Are the P-drugs suitable for the patient? (verify the suitability of the P-drug by
checking the active substance, dosage form, standard dosage schedule including
standard duration of treatment). If not suitable, which ones are/is suitable for him?
Give explanation!
2. Describe the various kind of pharmaceutical dosage form and the strength of those
suitable drugs (both generic and brand), and which one is suitable for the patient?
3. Establish the proper dosage regimen (dosage, frequency of administration, route of
administration, time of administration, and duration of the treatment) of those drugs
4. Write all of the possible prescription forms (magistral, official, and special) then
select which is the most suitable for the patient!
5. Give information about the medicines to the patient (effects, side effects,
instructions, warnings)

32