Pharmacology
Allergy/adverse reaction
Agonist: binds receptor causing response (protagonist in play, play the main role)
Antagonist: blocks agonist response (antagonist plays a conflicting role)
- competitive = higher doses of agonist can overcome
- non-competitive = agonist dose independent (i.e. reduces the maximum response of agonist regardless of dose)
reverse agonist: bind receptor causing opposite response
Biologic: drug extracted or semi-synthesised from biological sources: blood products, vaccines, monoclonal antibodies...
Pharmacodynamics
Pharmacokinetics (inc Bioavailability)
Prescribing
Contraindication (common/lifethreatening)
Adverse drug reactions/ Rx / Monitoring (Cr/Lfts)
Interactions (mechanism)
in Breastfeeding
in Pregnancy
Legible
Right Drug, dose, patient, route, time….. etc
BSA (m2) = m x kg / 36 sqrooted
REPORT
- Errors on Incident Information Management System
- Report an adverse event to a medicine to TGA on 1800 044 114 or MIMS online
- Lost (to PBS) or stolen (to police) S4(D) or S8 medications
Daily review for cessation
Prescription = a carefully monitored experiment
Therapeutic goal = normal function for life
Develop a personal formulary of 'P' drugs (personal preference for a given indication). Criteria: efficacy, safety, cost and convenience (infrequent).
Indication
Generic name, route, Dose, freq, times, duration (end point) (must rewrite any changes)
Contraindications
Precautions e.g. dose reduction/increase monitoring, interactions
Monitoring: level, renal, liver function, symptoms
Pt information verbal + written
Cost
Analgesia - pyramid
Gentamicin - good gram negative cover
Levels
Use Paediatric Pharmacopoeia
Prescribe,
ID, allergies, location, other concurrent charts,
MA, neb
Gutt (eye drop), Occ (eye ointment)
Sublingual, PO, NG, NJ, PR, PV
Top, Subcut, IM, IV, IT
0 before NOT after decimal point
Units never U, microg never u/mcg
Write daily or x hourly, M/W/F
Specify concentration
Always rewrite prescription DONT change
Cancelled orders: note reason and date
dispense (I = imp rest, S = pharmacy supplied CD = controlled drug cupboard)
administer (right Drug, dose, route, time, patient)
Monitor
cross out doses note required
line through and write cease, date, sign
90% of neonatal prescriptions off-label or unlicensed.
Off label prescribing is using a drug in a manner not listed by the manufacturer
Clonidine for ADHD, Salbutamol in acute asthma, rectal diazepam
Unlicensed = Drug not registered, or particular formulation not tested
Notification of Adverse Drug Reaction to Therapeutic Drugs Administration
Record event (causality, severity, recommendation) in notes
Update NIMC, eMR, DC sum
Notify consultant
IIMS
http://www.tga.gov.au or Blue Card
Provide medication alert card
Resources:
Learn Paediatrics Orientation Module
Guidelines for use of the National Inpatient Medication Chart (read)
NPS: Easy guide to good prescribing (read)
WHO guide to good prescribing (not read)
AMH
PBS: http://www.pbs.gov.au/pbs/home
Mimms
eTG
Australian Prescriber
Cochrane
Migraine: ?sumatryptan
HTN: salt restriction, wt loss
Chronic pain: relaxation therapy
Depression: CBT
Smoking cessation
Pacemaker/defibrillator
avoidance of precipitants asthma, migraine
Small volume spacers for all ages
Other drugs
Betahistine (see AMH)