Rational prescribing

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Rational prescribing
Dr. Munawar Aziz

"Medicine is a science before one graduates, and an art after it". Rational prescribing requires taking proper history of the patient and knowledge of the drugs being prescribed, their indications, side effects and interactions with other drugs. But these days one often sees un-necessary drugs being prescribed, either under the influence of medical representatives of different pharmaceutical companies or simply lack of enough knowledge about the drugs.

Rational prescribing requires history of the economic status of the patient, age, weight and history of other drugs the patient may be using.


Dr. Munawar Aziz

Proper, to the point prescription makes compliance easy and yields good results to the satisfaction of the patient. Most often advising the patient to stop taking some medicines is all that is required.e.g.in infants one sees lot of antibiotics being prescribed for simple diarrhoea which is mostly caused by viral infections, stopping the antibiotics, and adding probiotics, ORS(oral rehydration salts),banana, and rice with yogurt often stops the diarrhoea.

Some of the patients seen in my clinic having side effects due to irrational prescribing and improper history taking are narrated below.

1. One lady brought her frail father aged 80 years weighing only 40kg,stating that he was taken to a nearby public hospital last evening complaining of urinary problem, a young doctor on duty prescribed some medicine after taking one tab he became delirious and excited, wouldn't sleep and while everybody was sleeping he would go downstairs and on to the road, shouting "Pakistan Zindabad, Kashmir Banay Ga Pakistan" and slogans from the India/Pakistan partition days. The worried siblings kept on bringing him upstairs repeatedly but he would slipover again, the vigil lasted till morning when he was brought for checkup.

On taking history it was revealed that he was prescribed "ciprofloxacin"750mg twice daily, which was very high dose for his age and weight, he was sedated and the whole family took a sigh of relief. Ciprofloxacin causes extreme stimulation, absolute insomnia besides other side effects especially in aged underweight patients.

2. A lady would bring her children for checkup to my clinic, she would always cover(hide) her face. One day she asked me whether I can prescribe her some remedy for her face, which was studded with boil like lesions, after taking history it was revealed that she was taking "Carbamezipine" tabs prescribed by some doctor, after substituting the drug with another salt, her face became clear after some days. A common side effect of that drug in question is rash which in her case was on face.

3. A banker brought his mother complaining of dry cough since three months, different cough syrups etc were of no use, her chest x-ray was within normal limits. History revealed that she was put on "Lisinopril" tabs for her high blood pressure, since then she was having irritation in the throat and cough, stopping the medicine and replacing it with an alternate medicine for her high blood pressure, relieved her from the irritating cough.

4. An asthmatic patient complained of aggravated cough and wheezing after he was prescribed "propranol" a beta blocker,(contraindicated in asthmatics),stopping it solved the problem.

5. A lady came to clinic complaining of extreme weight gain, diabetes, after taking pills given by some quack for her knee pain. It turned out that "steroids" were added in high doses in the pills she was taking since more than a year, causing a condition called "Cushing's syndrome" which causes moon face, weight gain etc. Tapering out the drug helped her a bit.

6. A female patient brought to my clinic with bruises on forehead, arms and legs, attendants stated that she slipped and fell down and injured herself from hillside while cutting grass for the cattle, detailed history revealed that she fell because of an epileptic fit! Diagnosed, she was put on treatment, which saved her from future falls, which might would have proven fatal.

Lesson to be learnt by our younger colleagues is to spend some time to take proper history instead of hurriedly prescribing symptomatic treatment without finding the cause of the problem.

*Dr. Munawar Aziz
102/1,Rah-e-Sakoon,
Habibullah Colony,
Abbottabad.
0321-9961962
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