How should prescriptions be formulated?

How to Use This Tool for Prescription Formulation

This tool should NOT be used to formulate prescriptions for individual patients—prescribing requires direct patient evaluation, which cannot be replaced by an AI system. 1

Critical Safety Requirements Before Prescribing

Direct Patient Assessment is Mandatory

• You must personally evaluate the patient before prescribing any medication. 1
• Prescribing without proper evaluation prevents accurate medication history collection, which is essential for identifying drug interactions, allergies, and contraindications. 1
• 67% of medication histories contain at least one prescription error, with 22% having potential for significant patient harm—this risk increases dramatically without direct assessment. 1
• Physical examination is necessary to identify drug effects and guide appropriate laboratory investigations. 2, 1

Required Pre-Prescribing Steps

• Take a comprehensive medication history including all prescription medications, over-the-counter drugs, herbal remedies, and alternative treatments. 2, 1
• Document drug allergies and intolerances with specific details: the dose, the reaction suffered, and temporal relationship to the drug. 2, 1
• Verify patient identity using two patient identifiers (name, date of birth, address) at the time of prescribing. 2, 1
• Check for drug interactions by reviewing the patient record AND having a direct conversation with the patient about recent medication changes. 2, 1
• Review prescription drug monitoring programs (PDMPs) for concurrent controlled medications prescribed by other clinicians. 1

Appropriate Use of This Tool

What This Tool CAN Help With

• Educational purposes: Learning about medication classes, mechanisms, and evidence-based prescribing practices. 2
• Clinical decision support: Reviewing guidelines and evidence AFTER you have evaluated the patient. 3
• Medication use evaluation: Analyzing prescribing patterns and identifying areas for improvement. 3
• Drug information lookup: Checking dosing, interactions, and monitoring parameters as part of your clinical workflow. 2

What This Tool CANNOT Replace

• Direct patient evaluation and diagnosis—this is legally and ethically required before prescribing. 1, 4
• Clinical judgment about appropriateness of therapy based on patient-specific factors (age, weight, renal function, comorbidities). 1, 4
• Verification of treatment goals and therapeutic objectives specific to your patient. 4, 5
• Patient education and informed consent—you must personally discuss risks, benefits, and alternatives with the patient. 2, 1

Systematic Approach to Prescribing (After Patient Evaluation)

Step 1: Define the Clinical Problem

• Establish a clear diagnosis based on your clinical assessment. 4, 5
• Estimate prognosis and determine if pharmacologic intervention is indicated. 4

Step 2: Establish Therapeutic Objectives

• Specify measurable treatment goals (e.g., symptom relief, disease modification, prevention). 4, 5
• Consider whether non-pharmacologic therapies should be used instead of or alongside medications. 5

Step 3: Select Appropriate Drug Therapy

• Choose medications based on evidence-based guidelines and FDA-approved indications. 3
• Consider patient-specific factors: renal/hepatic function, age, pregnancy/breastfeeding status, drug allergies. 2, 1
• Check for contraindications including drug-drug interactions, drug-disease interactions, and duplicate therapies. 2, 3

Step 4: Determine Dosing Regimen

• Calculate weight-based or body surface area-based doses when appropriate. 2
• For pediatric patients, use established rounding tolerances to ensure safe and practical dosing. 2
• Adjust doses for renal or hepatic impairment based on specific drug requirements. 2
• Specify the exact brand when prescribing critical-dose drugs (e.g., cyclosporin) due to bioavailability variations between formulations. 2

Step 5: Write the Prescription

• Include all legally required elements: patient identifiers, drug name, strength, dose, route, frequency, duration. 2
• Provide clear directions including timing relative to meals, special handling instructions, and whether tablets can be crushed. 2
• Specify the exact brand for drugs with narrow therapeutic indices or significant formulation differences. 2

Step 6: Educate the Patient

• Explain the weekly dosing schedule for medications like methotrexate to prevent daily dosing errors. 2
• Discuss onset of therapeutic benefit (may take 3-12 weeks for some medications). 2
• Warn about specific toxicity symptoms requiring urgent medical attention (fever, mouth ulcers, unexplained bruising, breathlessness). 2
• Advise about drug-food interactions (e.g., avoid grapefruit juice with cyclosporin). 2
• Provide written patient information leaflets to supplement verbal discussion. 2

Step 7: Establish Monitoring Plan

• Schedule appropriate laboratory monitoring based on drug-specific requirements. 2, 3
• For high-risk medications, perform baseline tests (at least 2-3 measurements for creatinine before starting cyclosporin). 2
• Establish frequency of follow-up: every 7-14 days initially, then less frequently once stable. 2
• Verify that toxicity evaluation visits are scheduled (e.g., 2 weeks after starting new therapy). 2

Step 8: Document Everything

• Record all clinical encounters, patient questions, and your responses in the medical record. 2
• Document the information provided to the patient about risks, benefits, and alternatives. 2
• Note any variances in adherence or toxicity at each encounter. 2

Common Pitfalls to Avoid

• Never prescribe based solely on AI-generated recommendations—you must evaluate the patient yourself. 1
• Do not assume generic substitution is safe for critical-dose drugs—specify the brand and educate patients about risks of switching. 2
• Avoid prescribing without checking recent clinical notes to validate the current treatment plan. 2
• Do not refill medications without verifying with the prescriber/patient and reviewing recent labs and clinical status. 2
• Never skip patient education—lack of understanding leads to non-adherence and preventable adverse events. 2

Professional and Legal Standards

• Medical practice standards require a clear understanding of the patient's condition before initiating any treatment. 1
• Prescribing without evaluation may constitute patient abandonment or substandard care. 1
• Professional guidelines mandate that prescribers determine whether medication use is indicated based on scientific evidence AND direct patient assessment. 1