Is this all prescription writing exercise is correct ?
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Here is a detailed review of each prescription in the exercise:
Review: Prescriptions in Genitourinary System (UG Journal)
1. Prevention of Conception (Combined Oral Contraceptive Pill)
Prescription written:
- Tab Desogestrel 0.15 mg + Tab Ethinyl estradiol 20 µg (21 tablets)
Assessment: CORRECT with minor notes
| Point | Verdict |
|---|---|
| Drug combination | Correct - Desogestrel + EE is a standard low-dose COC |
| Ethinyl estradiol dose (20 µg) | Correct - low-dose pill, reduces VTE risk |
| Tablet count (21) | Correct - conventional 21-day pack |
| Start on Day 5 of menstruation | Correct - traditional Day 5 start rule |
| Missed pill instructions | Correct and complete |
| Stop 4 weeks pre-surgery | Correct - reduces DVT/PE risk |
| Repeat after withdrawal bleeding | Correct |
One note to add: The dose of Desogestrel is typically written as 0.150 mg (or 150 µg) for clarity. Writing "0.15 mg" is acceptable but "150 µg" is more standard on blister packs. No factual error though.
2. Induction of Labor
Prescription written:
- Inj. Oxytocin 5 I.U./ml ampoule (2 ampoules)
- Directions: 5 I.U. in 500 ml of 5% Dextrose, IV infusion at 4 drops/min, gradually increased to max 20 drops/min
Assessment: PARTIALLY CORRECT - has a significant error
| Point | Verdict |
|---|---|
| Drug choice (Oxytocin) | Correct |
| Concentration (5 IU/ml) | Correct |
| Diluent (5% Dextrose) | Acceptable, though Normal Saline is preferred to avoid water intoxication/hyponatremia, since oxytocin has antidiuretic effect |
| Starting rate (4 drops/min) | Correct (standard starting dose ~1-2 mU/min; 4 drops/min in 500ml gives ~1.33 mU/min - acceptable) |
| Max rate stated as 20 drops/min | Potentially low - standard protocols allow titration up to 20-40 mU/min (60-120 drops/min in some references). However, for a UG prescription exercise, 20 drops/min as a conservative maximum is acceptable |
| Number of ampoules (2 x 5 IU = 10 IU total) | Correct - 10 IU in 500 ml is standard starting dilution |
Key flag: Using 5% Dextrose as diluent is a common exam point - Normal Saline (0.9% NaCl) is pharmacologically preferred because oxytocin's ADH-like action + hypotonic dextrose can cause severe dilutional hyponatremia. Many Indian pharmacology textbooks (KD Tripathi) still list 5% Dextrose, so this may be acceptable per your syllabus - but worth flagging.
3. Post-Partum Hemorrhage
Prescription written:
- Inj. Methylergometrine 0.2 mg/ampoule (3 ampoules) - 2 ampoules IV immediately, repeat after 10 min if needed
- If bleeding doesn't stop in 30 min: Inj. Carboprost 0.25 mg (1 ampoule) IM immediately
Assessment: MOSTLY CORRECT - one important error
| Point | Verdict |
|---|---|
| Drug 1: Methylergometrine 0.2 mg | Correct dose |
| Route - IV immediately | CAUTION - Methylergometrine is generally given IM (0.2 mg IM). IV use is reserved for emergencies only (can cause severe hypertension, coronary spasm). Giving it "IV immediately" as a first line in all PPH cases is not standard. The correct route for routine PPH is IM |
| Repeating after 10 min if needed | Acceptable (can repeat at 2-4 hour intervals in standard use) |
| Drug 2: Carboprost 0.25 mg IM | Correct dose and route |
| Escalation logic (if not controlled in 30 min) | Correct stepwise approach |
Key error: Methylergometrine should be given IM as first line, not IV. IV is for life-threatening emergencies only due to risk of severe hypertension and cardiac events.
4. Prevention of Preterm Birth (Tocolytics)
Prescription written:
- Cap Nifedipine 10 mg (3 capsules)
- Direction: One capsule immediately, then every 20 minutes for 3 doses
Assessment: CORRECT
| Point | Verdict |
|---|---|
| Drug (Nifedipine) | Correct first-line tocolytic |
| Form (capsule for rapid absorption) | Correct - capsules used for acute tocolysis (faster onset than tablets) |
| Loading dose: 10 mg immediately then 10 mg every 20 min x 3 | Correct - standard loading regimen (total loading = 40 mg over ~1 hour) |
| No maintenance dose written | Incomplete - after the loading dose, a maintenance dose is usually prescribed: Tab Nifedipine 20 mg every 4-6 hours or Nifedipine SR 20-40 mg BD for 48-72 hours. The prescription stops at the loading dose only |
5. Erectile Dysfunction
Prescription written:
- Tab Sildenafil 50 mg (5 tablets)
- Direction: One tablet 1 hour before sexual intercourse
- Communication: Stop smoking
Assessment: CORRECT
| Point | Verdict |
|---|---|
| Drug (Sildenafil) | Correct |
| Dose (50 mg) | Correct - standard starting dose; range is 25-100 mg |
| Timing (1 hour before intercourse) | Correct (onset 30-60 min; can be taken 30 min to 4 hours before) |
| Communication - stop smoking | Correct and clinically appropriate (smoking causes endothelial dysfunction and worsens ED) |
| Quantity (5 tablets) | Acceptable for initial prescription |
One addition missing: Should mention "not more than once daily" and to avoid nitrates (severe hypotension interaction) - important patient communication point for a complete prescription.
Summary Table
| Prescription | Verdict | Key Issue |
|---|---|---|
| 1. OCP (Desogestrel + EE) | ✅ Correct | Minor: µg vs mg notation |
| 2. Induction of Labor (Oxytocin) | ⚠️ Mostly correct | Diluent should be Normal Saline, not 5% Dextrose |
| 3. PPH (Methylergometrine + Carboprost) | ⚠️ Error present | Methylergometrine route should be IM, not IV as first line |
| 4. Tocolysis (Nifedipine) | ✅ Mostly correct | Loading dose correct, but maintenance dose is missing |
| 5. Erectile Dysfunction (Sildenafil) | ✅ Correct | Missing: "not more than once daily" + nitrate warning |
Assignment Answers (briefly)
A) Single drug for emergency contraception:
- Tab Levonorgestrel 1.5 mg - single dose within 72 hours of unprotected intercourse (alternatively: ulipristal acetate 30 mg within 120 hours)
B) Single drug for prevention of preterm labour:
- Cap Nifedipine 10 mg loading (as above), then maintenance - OR - Inj. Hydroxyprogesterone caproate 250 mg IM weekly (17-OHPC, for prevention in high-risk cases)
C) Criticism of the given prescription for induction of labour:
- Tab Ritodrine 10 mg + Inj. Methylergometrine 0.2 mg/ml IV
- Ritodrine is a tocolytic (beta-2 agonist) - it STOPS uterine contractions. It is completely wrong for induction of labor (opposite effect)
- Methylergometrine IV is dangerous (hypertension risk) and is used for PPH, not for induction
- Corrected prescription: Inj. Oxytocin 5 IU in 500 ml NS, IV infusion starting at 4 drops/min, gradually increased to achieve regular contractions (as in prescription 2 above)
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