PRESCRIPTION WRITING BY DR AZT

IMPORTANT DOSES
FEBRUARY 2025 EDITION
 Basics of Prescription Writing

- Use only a black pen; other ink colors are designated for different staff members.

- Write neatly and clearly.

- DRUG NAMES & ROUTES MUST BE WRITTEN IN CAPITAL LETTERS

You must write the following in capital letters: your name, the consultant's name,
patient demographics, medication names and their routes.

If your handwriting is difficult to read, you can write the entire prescription in capital letters.
1. Write your full name and GMC number at the top of the first page of the prescription chart.

2. Complete the top left section with details such as ward name, hospital name,
consultant's name, date of admission, weight, height, and the date written (exam date).
(This applies to pages 1 and 3). All of this information must be in capital letters.
3. Affix a patient sticker in the top right section after verifying and matching the patient's details
with the stem and handover note. (This applies to pages 1 and 3).
If patient sticker is incorrect or not available, then write patient details. All of this information must be in capital letters.
4. Note any allergies, specifying the drug name and type of reaction.
- If the patient has no allergies, write "NKA". Ensure your name, signature, and the date are included.
5. Once-only and Pre-medication Section:
- This section is for stat medications, loading doses, or one-time medications.
Be sure to include the date, time, drug name, route, dose, your signature, and bleep number.
6. Oxygen Section:
- Record the year, circle the target oxygen saturation (94-98% or 88-92%),
specify the device and flow rate, and indicate whether the oxygen is PRN or continuous.
Clearly write your name, signature, bleep number, and the exam date as the start date.

7. Antibiotic section:

- Write the Antibiotic name in capital letter, specify the dose, route, start and stop date.
Write your name and signature, along with GMC and bleep number.
Don't forget to write the indication in the box provided.

- Write in the additional information - review in 48 hours.

- Specify the timings in the 24 hour time format (OD - 8:00, BD - 8:00 and 20:00, TDS -
8:00, 16:00, 00:00 and QDS - 6:00, 12:00, 18:00 and 00:00)

8. Regular Section:

- This section is for the patient’s routine regular medications or any short courses of medications
(e.g., a short course of steroids for acute COPD exacerbation).

- Write the drug name in capital letters, specify the dose, route, start date and stop date (not
always applicable). Write your name and sign clearly, write bleep number and add any
additional information if applicable.

- Do not forget to tick the specific time at which they are supposed to take the regular medication.

For Regular medications:

Mane/OD - tick the morning box

BD - tick the morning and evening box
TDS - tick the morning, midday and evening box
QDS - tick the morning, midday, evening and bedtime box
Nocte - tick the bedtime box
9. As Required Section:
- This section is for as required medications only.
- Write the drug name in capital letters, indication, specify dose, route and frequency
(hourly not BD, TDS or QDS), write the maximum dose in 24 hours.
Write your name and signature clearly, bleep number.

10. Your signature can be anything but should be the same throughout the entire prescription chart.
On top of the first page of the prescription chart: Full name and GMC number.
Elsewhere on the prescription chart: Full name, First name or Surname; any one of these will do.
Abbreviations – dosage

Abbreviations – routes
Oxygen Prescribing Flowchart
The task is always important. If the consultant is asking you to write a new medication or an antibiotic,
then you must write down these drugs first. Failing to write these drugs would be a costly mistake!

Only after you are done with your task, then you may write down your Regular and PRN drugs.

Open the BNF Open the BNF Open the BNF

If you make an error while writing, this is what you

need to do.

After crossing out the wrong entry, prescribe in

the new medication box below.

Antibiotic
 Marking Criteria

Data Gathering Marks:

Record patient and hospital data accurately in the prescription charts.

Note down any allergies specified in your task.

IPS Marks:

Enter the station confidently, maintaining eye contact, greet the examiner and introduce yourself for identification.
Before leaving the station, keep your table tidy by closing the BNF or returning charts and items to their place, and close your pen.
Thank the examiner before leaving.
Ensure your handwriting is clear and easy to read; avoid writing in other staff members' boxes.
If you make a mistake, cross out that section and fill another box.

Management Marks:

Write the correct dose, frequency and duration of the drugs in the prescription chart and open the BNF in scenarios where required.
If all doses are provided in the task, then there's no need to open the BNF.
Complete each drug task thoroughly, ensuring all boxes are filled, including your name and bleep number from handover notes.

IMPORTANT NOTE: Always cross check the patient information on the sticker/affix label with the patient
information mentioned in your task/question! Using an incorrect patient sticker or affix label would be a costly mistake.
 DEXAMETHASONE 9.9 MG IM OD for 2 days in the Regular section
(You can prescribe DEXAMETHASONE either in the Regular section or the Once Only section)

Please note:
The dose for DEXAMETHASONE has changed as per the BNF
As per the new change in dose, it is 9.9 MG IM OD for two days. Previously it was 12 MG.

You have two options for Dexamethasone:

1. Whatever the dose is mentioned in your prescription scenario, whether 12 mg or 9.9 mg,

prescribe that particular dose without having the need to cross check the dose in the BNF
2. Or, if the dose is not specified in the scenario, then open the BNF and prescribe the dose as mentioned in the
BNF

Usually, in this scenario, the dose for Dexamethasone and Erythromycin is given in the task itself.
So you can simply prescribe as per the dose mentioned in your prescription task

QUINSY
Quinsy, look for oral tolerance in the scenario.

If the scenario does not specify oral tolerance, then you can prescribe PO or IV antibiotics.

Prescribe IV antibiotics if the child is unable to tolerate orally.

6 hourly for 7 days

However,

6 hourly for 7 days, review in 48 hours

For other age groups, please refer to the BNF

NOTE:
There's no IV Phenoxymethylpenicillin
There's no PO Benzylpenicillin Sodium
For the Quinsy station, if the patient is allergic to Penicillin, you can prescribe either Clarithromycin or Erythromycin

as per the BNF. This is a rare scenario

QUINSY

(memorize)

IMPORTANT
If the scenario states to prescribe Phenoxymethylpenicillin and Metronidazole,
but the patient is allergic to penicillin and cannot tolerate orally,
then prescribe IV Erythromycin and IV Metronidazole.

If the scenario states to prescribe Phenoxymethylpenicillin and Metronidazole,

but the patient is allergic to penicillin and can tolerate oral medications,
then prescribe oral Clarithromycin and oral Metronidazole.

Please note:
For Clarithromycin, intravenous infusion is not licensed for use
in children under 12 years.
Prescribe Metronidazole only if the scenario advises to do so.
PO - Metronidazole (Child 2 months - 11 years) 7.5 MG/KG 8 hourly - 5 days
IV - Metronidazole 7.5 MG/KG 8 hourly - 5 days
(memorize)
for 5 days
 Unable to tolerate orally:

Prescribe the antibiotic for 5 days and review in 48 hours.

CEFUROXIME (IV OR PO) - Prescribe for 5 days and review in 48 hours.

Able to tolerate orally:

If the scenario advises you to prescribe Chlorphenamine, the dose as per the BNF is as follows

(memorize)

Clarithromycin COPD EXACERBATION

dose in COPD Exacerbation or CAP:
or CLARITHROMYCIN
PO or,, IV: 500 MG BD for 5 days
Prescribe as mentioned below:
Doxycycline dose in COPD Exacerbation or CAP:
200 MG PO in the Once Only section

100 MG PO OD for the next 4 days in the Antibiotic section

IMPORTANT:

With regards to community acquired pneumonia or COPD exacerbation, if the patient is allergic to Penicillin

and Azithromycin, and in the scenario the consultant has advised you to prescribe Clarithromycin,

please DON'T prescribe Clarithromycin.

Clarithromycin and Azithromycin are both Macrolides!

DOXYCYCLINE is the choice of antibiotic here!

NOTE:
For CAP or COPD Exacerbation, allergic to Penicillin, prescribe Clarithromycin
For CAP or COPD Exacerbation, allergic to Penicillin, Clarithromycin or Azithromycin, prescribe Doxycycline
 advised CO AMOXICLAV PO

OR
LEVOFLOXACIN 500 mg IV BD for 5 days, (Additional information: to be given over at least 60 minutes)
As per the BNF, for severe CAP, either IV Clarithromycin or IV Levofloxacin

antibiotics or you must prescribe CO-TRIMOXAZOLE with either GENTAMICIN OR METRONIDAZOLE. So

prescribe according to the scenario.

LOWER

The BNF states that the first-line oral antibiotics for treating lower urinary tract infections are either
Nitrofurantoin or Trimethoprim.
It is crucial to prescribe the antibiotic specified in the given scenario.
However, before prescribing either Nitrofurantoin or Trimethoprim, the eGFR level should be checked.

NITROFURANTOIN
30-44
dose for normal eGFR or > 30
100 MG PO BD for 3 days in Women
in women and 100 mg PO BD for 7 days in men
100 MG PO BD for 7 days in Men
If the eGFR is below 30, then we can't prescribe Nitrofurantoin but can prescribe Trimethoprim

Trimethoprim dose for normal eGFR or > 30

200 mg twice daily for 3 days in women
200 mg twice daily for 7 days in Men

For eGFR between 15 - 30, the following dose for Trimethoprim should be used:
Men: 200 mg PO BD for 3 days and then 100 mg PO BD for the next 4 days
WOMEN: 200 mg PO BD for 3 days

For eGFR less than 15, the following dose for Trimethoprim should be used:
MEN: TRIMETHOPRIM 100 MG PO BD for 7 days
WOMEN: TRIMETHOPRIM 100 MG PO BD for 3 days.
LOWER URINARY TRACT INFECTIONS
For your reference

TRIMETHOPRIM

NITROFURANTOIN
 MRSA

(If the duration for vancomycin is not specified in the scenario,

then prescribe for 5 days)

1.5 G

Meropenem and Penicillin are Beta Lactam antibiotics

 DVT OR PE
According to the BNF, either APIXABAN or RIVAROXABAN can be used for treating DVT or PE.

However, it's essential to follow the specific anticoagulant mentioned in the prescription scenario.

If the scenario doesn't specify which anticoagulant to use, you have the option to prescribe either
APIXABAN or RIVAROXABAN.

Avoid prescribing ANTI-COAGULANTS

RIVAROXABAN
and ANTI-PLATELETS together

For PE treatment, either Rivaroxaban or

Apixaban, the duration of treatment for the
maintenance dose is usually specified
(3 or 6 months) in the scenario.
 What is parity?
Parity is the number of times a woman has given birth to a live neonate (any gestation) or at 24 weeks or more,
regardless of whether the child was viable or non-viable (i.e. stillbirths).

,
the dose for Enoxaparin, Dalteparin and Tinzaparin will be mentioned according to the weight of the patient.
We have to select the dose of the LMWH according to the weight of the patient.

, if weight is 60 KG,

IMPORTANT
Enoxaparin is the safest option in breastfeeding patients. Prescribe Enoxaparin (dose according to the weight of the

patient) S/C once daily for at least 10 days. If the patient is not breastfeeding, then you can prescribe any LMWH as per

the VTE chart.

or Review after 7 days

 In the Hip Fracture scenario, please pay attention to the age of the patient because with regards to Morphine,
the oral dose for an adult and elderly is different

In the Hip Fracture scenario, please pay attention to whether the patient is able to eat and drink or not.
Able to eat or drink = PO Morphine and PO Cyclizine in the PRN section
Unable to eat or drink = IV Morphine and IV Cyclizine in the PRN section

Either IV or PO, both Cyclizine and Morphine in the PRN section

Morphine
Cyclizine
By mouth
IV
Adult
Initially 10 mg every 4 hours, dose to be adjusted according to response.
(max 60 mg in 24 hours) By mouth, or by intravenous injection, or
by intramuscular injection
Elderly Adult or Elderly
Initially 5 mg every 4 hours, dose to be adjusted according to response.
(max 30 mg in 24 hours) 50 mg every 8 hours. (max 150 mg in 24 hours)

By slow intravenous injection 50 mg, 8 hourly, maximum in 24 hours = 150 mg)

Adult or Elderly
Initially 5 mg every 4 hours, dose to be adjusted according to response.
(max 30 mg in 24 hours)

Adults (aged 19 to 64)

Elderly (aged 65 and over)
(As METHOTREXATE and FOLIC ACID are regular medications, write their doses as per the scenario)

MORPHINE OR DIAMORPHINE (SYRINGE DRIVER AND BREAKTHROUGH PAIN)

Syringe Driver Dose : (24 hour S/C infusion) in the SYRINGE DRIVER CHART, if SYRINGE DRIVER CHART not available,
then prescribe in the REGULAR SECTION.
To calculate the Breakthrough Pain Dose, you need to divide the total 24 hour syringe driver dose by 6

example : syringe driver dose is 30 mg

Breakthrough pain dose = 30/6 = 5 mg

FORMULAE

SYRINGE DRIVER DOSE = BREAKTHROUGH PAIN DOSE X 6

BREAKTHROUGH PAIN DOSE = SYRINGE DRIVER DOSE / 6

Please note, if you get the syringe driver prescription chart, then prescribe the syringe driver dose only in the syringe driver
prescription chart.

If no syringe driver prescription chart provided, only then prescribe the syringe driver dose in the regular section.
 either in the Regular section or PRN section.

However, prescribing paracetamol in the PRN section is fine too.

For Adults
Acute Pyelonephritis (for children)

(memorize)

for 5 days
(memorize)

Please prescribe the Antibiotic and Paracetamol as per the weight and age of the child mentioned in your task
Routine medications include Sodium Valproate (for epilepsy) and Lansoprazole or Omeprazole (for Gastritis)

As these two are the routine medications, please prescribe the dose as per the information provided in the task.

You need to prescribe any one Antibiotic for Pyelonephritis

Prescribe Cefalexin (PO) as per the weight and age of the child as mentioned in the BNF (Children)

Prescribe Cefuroxime (IV) as per the weight and age of the child as mentioned in the BNF (Children). Only prescribe

IV if the child is severely unwell or unable to take oral treatment

 Acute Pyelonephritis

If the child is taking Lithium, then prescribe CO-AMOXICLAV.

Both Cefalexin and Lithium can increase the risk of nephrotoxicity.

(memorize)
 Prescribe Paracetamol only if there's any
PARACETAMOL (for a child) indication (pain or fever) in the scenario or you have been
(PRN section) advised to do so in the scenario
Please note, PO or IV Paracetamol, the frequency
is 6 hourly.

(memorize)

(memorize)

(memorize)

(memorize)
For Adults: example weight 65 KG

Total fluid requirement in the 24-hour period is 30ml/KG/day, memorize this formula

65 KG x 30 = 1950 ml

Divide the total 24 hour fluid volume by 24 to get the hourly rate

1950 ml / 24 = 81.25 ml/hr

You need to prescribe the appropriate number of fluid bags to meet the 24 hour fluid requirement.
So prescribe 2 one litre bags

For Adults, in Acute Pancreatitis we prescribe either 0.9% Normal Saline or Hartmann's as specified in the scenario
The following formula for conversion is only applicable to S/C route (memorize)
To convert from S/C Diamorphine to S/C Morphine, simply Multiply the Diamorphine dose by 1.5
To convert from S/C Morphine to S/C Diamorphine, simply Divide the Morphine dose by 1.5

For your reference

*Rescue dose is actually Breakthrough pain dose

For your reference
 For your reference

IMPORTANT : Even if the scenario advises you to prescribe Hartmann's, you still have to prescribe

0.9 % NaCl + 5 % DEXTROSE (add 10 mmol KCL per 500 ml)

For your reference