1. Hussein Elghazaly He315@ic.ac.uk
Prescribing Tutorial
Hussein Elghazaly

2. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

3. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

4. Prescribing in the OSCEs
Unlikely to be a station on its own.
Most likely scenario: after history/ examination.
May be part of a clinical skills station e.g. IV fluids.

5. Prescribing in the OSCEs
Unlikely to be a station on its own.
Most likely scenario: after history/ examination.
May be part of a Clinical Skills station e.g. IV fluids.
Example: History
This patient presented with SoB. Take a history and prescribe an appropriate medication.

6. Prescribing in the OSCEs
Unlikely to be a station on its own.
Most likely scenario: after history/ examination.
May be part of a Clinical Skills station e.g. IV fluids.
Example: Examination
This patient presented with SoB. Perform a respiratory examination and prescribe an appropriate medication.

7. Prescribing in the OSCEs
Unlikely to be a station on its own.
Most likely scenario: after history/ examination.
May be part of a Clinical Skills station e.g. IV fluids.
Example: Clinical Skills
This patients needs IV fluids. Prescribe fluids in their drug chart and set-up an IV infusion.

8. Prescribing in the OSCEs
They could ask you to prescribe it on an iPad/ write it down on a piece of paper.
Furosemide, 40 mg, oral, once a day OR
They can ask you to fill in a drug chart:

9. Prescribing in the OSCEs
You do not need to remember the doses *
You may need to work out the medication by yourself, or the examiner will tell you which medication to prescribe.
If you need to work it out yourself:
It will be something really easy
Use the BNF to find the appropriate medication
* Some drugs are worth remembering for the OSCE and written. The main one to remember is Adrenaline.

10. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

11. Anatomy of the Drug Chart
Patient Details
Regular Prescriptions
Once Only Prescriptions
Fluid Prescriptions
Oxygen Prescription

12. Patient Details *
* Tip: If you’re given a drug chart in the OSCE, check the ‘Previous Adverse Reactions’ part of the patient’s drug chart before you prescribe any medication.

13. Regular Prescriptions
Patient Details
Date and Time
Name
Dose
Medication
Route
Frequency
Your Name + Signature

14. Regular Prescriptions
Different drug charts have different structures.
But they all have the same main components.

15. Regular Prescriptions
Different drug charts have different structures.
But they all have the same main components.
Frequency
Abbreviation
stat 
once only 
once a day
O.D.
twice a day
B.D.S.
three times a day
T.D.S.
four times a day
Q.D.S.
five times a day
every X hour(s)/minute(s)/day(s)/month(s)
over X hour(s)/minute(s) 
As required, maximum FREQUENCY
PRN, max X g/24h

16. Once Only Prescriptions

17. Fluid Prescriptions

18. Oxygen Prescriptions

19. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

20. Using the BNF You’re not expected to know the doses for OSCEs.
You will have access to the BNF (most likely electronic) in your stations, if required.
Two Approaches:
Search the condition (if you know the diagnosis)
Search the drug itself (if you know it, or if told by the examiner)

21. Using the BNF
Mrs. Margaret Jenkins (DOB: 20/08/1930) is an 88 year-old lady who became acutely breathless and is coughing up pink frothy sputum. She has a past medical history of hypertension, diabetes and acute coronary syndrome and was diagnosed with left ventricular systolic dysfunction 2 weeks ago. On examination, she has bilateral basal crackles as well as sacral and peripheral oedema.
Diagnosis?

22. Using the BNF
Mrs. Margaret Jenkins (DOB: 20/08/1930) is an 88 year-old lady who became acutely breathless and is coughing up pink frothy sputum. She has a past medical history of hypertension, diabetes and acute coronary syndrome and was diagnosed with left ventricular systolic dysfunction 2 weeks ago. On examination, she has bilateral basal crackles as well as sacral and peripheral oedema.
Diagnosis?
Acute Heart Failure/ Acute Pulmonary Oedema

23. Using the BNF
Searching the condition

24. Using the BNF
Searching the condition

25. Using the BNF
Searching the condition

26. Using the BNF
Searching the drug

27. Using the BNF
Searching the drug

28. Using the BNF
Searching the drug

29. Using the BNF Searching the drug Drug: Furosemide
Dose: 40 mg (20-50mg accepted)
Frequency: Once Daily
Route: IV

30. Using the BNF Searching the drug Drug: Furosemide
Dose: 40 mg (20-50mg accepted)
Frequency: Once Daily
Route: IV

31. Using the BNF Physical Copy
If you are given a physical copy of the BNF, the process is identical.
The only difference is that, instead of searching the condition/ drug, you will need to check them in the index.

32. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

33. Essentials of Every Prescription - Checklist
The Date
Patient ID (Name and Hospital No.)
The Drug
Name and Formulation (if applicable)
Dose
Frequency
Route
Prescriber’s Name and Signature
* If you’re given a drug chart in the OSCE, check the ‘Previous Adverse Reactions’ part of the patient’s drug chart before you prescribe any medication.

34. Things to keep in mind Write in block capitals
Use the generic name not brand name of the drug. The only exceptions:
Insulin
Anti-epileptic drugs (e.g. phenytoin)
Anti-psychotics
Inhalers
For doses, accepted abbreviations are g (grams) and mg (milligrams).
Micrograms must be written in full (Not µg or mcg)
‘Units’ must be written in full

35. Prescribing Medications: Example 1
You take a history from Mr Jason Anderson, a 29 year-old man who has come in with chest pain, preceded by fever, muscle ache and a sore throat. A diagnosis of acute pericarditis is made. Mr Anderson is admitted to the ward for observation and requires regular ibuprofen. Prescribe regular ibuprofen to the patient.

36. Prescribing Medications: Example 1
Ibuprofen, 400mg, oral, three times a day.

37. Prescribing Medications: Example 1
Ibuprofen, 400mg, oral, three times a day.
Jason Anderson
1/1/1990
IBUPROFEN
400 mg
P.O
31/3/19
Your name and signature

38. Prescribing Medications: Example 2
When you get to the ward that morning, Mr Anderson is in a lot of pain. You are decide to prescribe co-codamol (30/500) once only. He also says that he couldn’t sleep overnight due to the pain and so you decide to prescribe paracetamol as required. Prescribe both medications to Mr Anderson.

39. Prescribing Medications: Example 2
Co-codamol (30/500), 2 tablets, oral, once only.
31/3/19
11:30
Co-codamol (30/500)
2 tablets
ORAL
Name and Signature

40. Prescribing Medications: Example 2
2) Paracetamol, 1 g, as required, maximum 4 times per day.
Jason Anderson
1/1/1990
Paracetamol
MAKE SURE THIS GOES IN THE AS REQUIRED SECTION OF THE DRUG CHART! 1g
P.O
PRN for pain, max 4g/24 hr
31/3/19
Your name and signature

41. Outline Prescribing in the OSCEs Anatomy of the Drug Chart
Using the BNF
Prescribing Medications
Prescribing IV Fluids

42. Prescribing IV Fluids
One of the clinical skills stations can be setting-up an IV infusion.
This may be accompanied by prescribing fluids.
IV fluids have a specific section in the drug chart, so make sure you prescribe there.
The prescription should include:
Date of Administration
Route of Administration
Total volume to be administered
Rate of infusion
Approved generic name of the fluid
Approved generic name of any drug added

43. Prescribing IV Fluids
Normal Saline
20 mM KCl in
Normal Saline

44. Prescribing IV Fluids: Examples
Prescribe 300 mL of IV normal saline to Mr Anderson over 6 hours.
A routine ECG revealed that Mr Anderson has broad QRS complexes and tented T-waves. U&Es indicate hyperkalaemia.
Prescribe an infusion of 10 Units of Insulin (Actrapid) in 250 mL of 10% Glucose over 30 minutes.

45. Prescribing IV Fluids: Examples
Prescribe 300 mL of IV normal saline to Mr Anderson over 6 hours.
0.9% Sodium Chloride
300 mL
31/3/19
11:00
50 mL/h
Name and Signature

46. Prescribing IV Fluids: Examples
2) A routine ECG revealed that Mr Anderson has broad QRS complexes and tented T-waves. U&Es indicate hyperkalaemia. Prescribe an infusion of 10 Units of Insulin (Actrapid) in 250 mL of 10% Glucose over 30 minutes.
10% GLUCOSE
250 mL
Over 30 minutes OR
500 mL/h
31/3/19
11:00
Name and Signature
INSULIN (ACTRAPID)
10 units

47. Prescribing: Question 1
Prescribe gliclazide to a 45 year-old patient with uncontrolled T2DM on the ward.

48. Prescribing: Question 1
Prescribe gliclazide to a 45 year-old patient with uncontrolled T2DM on the ward.

49. Prescribing: Question 2
Prescribe an appropriate medication to a patient with Cushing’s syndrome.

50. Prescribing: Question 2
Prescribe an appropriate medication to a patient with Cushing’s syndrome.

51. Prescribing: Question 2
Prescribe an appropriate medication to a patient with Cushing’s syndrome.
Jason Anderson
1/1/1990
METYRAPONE
250 mg
P.O
31/3/19
Your name and signature

52. Prescribing: Question 3
Prescribe an appropriate medication to a 25 year-old patient with hypothyroidism.

53. Prescribing: Question 3
Prescribe an appropriate medication to a 25 year-old patient with hypothyroidism.
Jason Anderson
1/1/1990
LEVOTHYROXINE SODIUM
100 micrograms
P.O
30 mins before breakfast
31/3/19
Your name and signature

54. Prescribing: Question 4
Prescribe insulin to a patient with T1DM.

55. Prescribing Insulin Insulin Example Onset of Action Peak Effect
Duration
Short-Acting
Aspart (NovoRapid)
10-20 mins
1-3 hrs
3-5 hrs
Intermediate-Acting
Isophane (Humulin)
1-2 hrs
4-12 hrs
14-24 hrs
Long-Acting
Glargine (Lantus)
3-4 hrs
No clear peak
22-24 hrs

56. Prescribing Insulin There is no ne way of prescribing insulin.
It needs to be prescribed in the Drugs that Require Monitoring section of the drug chart.
Titrated according to the blood glucose levels.
Knowing which insulin to give and what doses to administer is complex and is very unlikely to come up in the OSCE or written.

57. Extra Practice

58. Thank you for listening
Any Questions?

59. Please fill out feedback
bit.ly/muslimmedics