After defining your therapeutic objective you should now verify whether your P-drug is suitable for the individual patient. You will remember that you have chosen your P-drugs for an imaginary, standard patient with a certain condition, using the criteria of efficacy, safety, convenience and cost. However, you cannot assume that this ‘first-choice’ treatment will always be suitable for everyone. ‘Cookbook’ medicine does not make for good clinical practice! You should therefore always verify whether your P-drug is suitable for this individual patient. The same applies when you practice within the limits of national treatment guidelines, a hospital formulary or departmental prescribing policies.
Chapter 5 explained the relationship between P-drug and P-treatment. In fact, you should define P-treatments for the most common problems you will encounter in practice; such P-treatments will frequently include non-drug treatment. However, as this manual is primarily concerned with the development of prescribing skills, from now on the focus will be on drug treatment, based on the use of P-drugs. Always keep in mind that many patients do not need drugs at all!
The starting point for this step is to look up your P-drugs (described in Part 2), or the treatment guideline that is available to you. In all cases you will need to check three aspects: (1) are the active substance and the dosage form suitable for this patient? (2) is the standard dosage schedule suitable? and (3) is the standard duration of treatment suitable? For each aspect, you have to check whether the proposed treatment is effective and safe. A check on effectiveness includes a review of the drug indication and the convenience of the dosage form. Safety relates to contraindications and possible interactions. Be careful with certain high risk groups.
Verify the suitability of your P-drug
A Active substance and dosage form
B Standard dosage schedule
C Standard duration of treatment
For each of these, check:
Effectiveness (indication, convenience)
Safety (contraindications, interactions, high risk groups)