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Introduction to BNF and
Prescribing
ICL – 3rd year medical students
•Aim
– To be able to navigate around the BNF
•Objectives
– Summarise the information contained
within each of the sections within the
BNF
– Demonstrate ability to retrieve
information from the BNF
– Prescribe at least one drug on the
Manchester Prescription Chart
Summarising BNF information
• Work with the person sitting next to you
• Activity 1
– Summarise the information in pages 0-42 (or
‘Preliminary’)
• Activity 2
– Describe the information available in section 2 on
‘supraventricular & ventricular arrhythmias’
– Also the information under ‘amiodarone’
Summarising BNF information
• Work with the person sitting next to you
• Activity 3
– Summarise the information contained in appendix 1
(‘appendices’). Identify if there is an interaction between
amiodarone & simvastatin by looking up both drugs PLUS
• Activity 4
– Summarise the information in appendices 2-5. Tell the
group important information about infusing amiodarone
BNF Sections
• Part 1
– Lots of useful information about prescribing and
prescribing in certain conditions e.g. palliative care
• Part 2
– Section 1-15 Individual drug monographs
• Appendix
–
–
–
–
Appendix 1
Appendix 2
Appendix 3
Appendix 4
-
– Appendix 5
-
Interactions
IV additives
Borderline substances
Wound management products &
elasticated garments
Cautionary &advisory labels
• Additional Information (back of BNF)
1
Completing the
Prescription
1112223335
22/9/10
Joseph
25.4.65
• Patient details, NHS
number important as may
have more than one patient
of same name
• Ward and consultant
• Allergies
• Chart details
• Drug by APPROVED name
(unless an exception)
• Dose, use most approp.
Format e.g. 0.5mg write as
500 micrograms (not mcg)
• Route and review/stop date
• Never abbreviate ‘units’ to
‘u’
Dr Shields
Bloggs
75Kg
NKDA
AMOXICILLIN
500mg
IV
22/9
DO
24/9
D Octor
TF S
CAP
7/7
23/9/10
Nasal
24%
2L/min
COPD
DO
D Octor 5555
MAU
1
Completing the
Prescription
• Indicate the frequency
by ticking the times
• Always indicate a
frequency on PRNs
• Don’t forget to indicate
if controlled release
• Only use Latin
abbreviations listed in
BNF (avoid q.q.h. as
often confused with
q.d.s.)
• Always state a
maximum in 24 hours
Bloggs
Joe
1112223335
PARACETAMOL
1g
PO
23/9
DO
28/9
D Octor
TF S
M/R or X/L
ISOSORBIDE Mononitrate
60mg
PO
23/9
DO
n/a
D Octor
TF 23/9
Angina
DIHYDROCODEINE
3 hourly
30mg PO
A Doc
Dr Doc
29/3
PAIN
TFS
240mg
25.4.65
Prescribing Practice
Case 1
Miss Amy Patient, DOB 12/7/72, NHS No. 2819735,
Ward MAU, Consultant Sharma
• One of the nurses asks you, in passing, to
prescribe some ‘PRN paracetamol’ for
Amy. She is not on regular medications
and has no allergies (the reason for
admission is not a contraindication to
paracetamol being prescribed)
Case 1 continued
• The patient has some tests done and a
diagnosis of community-acquired
pneumonia is made
• Your registrar asks you to prescribe ‘oral
Augmentin’
• What further information would you need?
• What information sources would you use?
Don’t forget patient details at top of each page used
PARACETAMOL
1g
oral
D Octor
D Octor
TFS
4-6hrly
28/9
Pain
4g
CO-AMOXICLAV 500/125

22/9

D Octor
25/9

D Octor
TFS
1 tablet
oral
COMMUNITY ACQUIRED PNEUMONIA
7 days
Summary
You will have the opportunity to utilise
these skills over the next 3 years.
.
BNF Questions
1. Your patient is taking warfarin. Is it safe to start
carbamazepine to treat this patient's poorly controlled
epilepsy?
2. You have been asked to provide palliative care
treatment for a patient with cancer. You need to increase
the dose of the patient's morphine modified-release
tablets to 120mg every 12 hours. What would be a
suitable 4 hourly breakthrough dose of morphine sulphate
oral solution?
3. A patient has deteriorating renal function, as indicated
by his eGFR which is 17ml/minute/1.73m2. What dose of
Tazocin should he be prescribed?
4. A doctor wishes to start a patient with liver
impairment on an antidepressant. Is Cipralex safe to
use?
5. The internet is not working so you cannot access
Toxbase. Do you need to prescribe anything for a
patient who took a paracetamol overdose 9 hours ago
and has a level of 60mg/L? They are not taking any
other medications and are generally healthy.
Answers
1.Your patient is taking warfarin. Is it safe to start carbamazepine to treat this patient's poorly
controlled epilepsy?
Appendix 1 - Interactions
Metabolism of coumarins accelerated by carbamazepine therefore INR can be reduced.
2.You have been asked to provide palliative care treatment for a patient with cancer. You need to
increase the dose of the patient's morphine modified-release tablets to 120mg every 12 hours.
What would be a suitable 4 hourly breakthrough dose of morphine sulphate oral solution?
Prescribing in Palliative Care- under subheading ‘Pain management with opioids’
Breakthrough pain is one-tenth to one-sixth of 24 hour total daily dose every 2-4 hours when
required. Total daily dose for this patient is 120mg x 2 = 240mg. Therefore breakthrough
dose is 24mg-40mg depending on clinical assessment of need.
3.A patient has deteriorating renal function, as indicated by his eGFR which is 17ml/minute/1.73m2.
What dose of Tazocin should he be prescribed?
Piperacillin with tazobactam monograph – under subheading ‘Renal Impairment
Maximum dose = 4.5g every 12 hours.
Answers
4.A doctor wishes to start a patient with liver impairment on an
antidepressant. Is Cipralex safe to use?
Escitalopram monograph – under subheading ‘Hepatic Impairment’
Initial dose of 5mg daily for two weeks increasing thereafter to 10mg
daily according to response and LFTs. Particular care should be taken
in severe impairment.
5. The internet is not working so you cannot access Toxbase. Do you need to
prescribe anything for a patient who took a paracetamol overdose 9 hours
ago and has a level of 60mg/L? They are not taking any other medications
and are generally healthy.
Emergency treatment of poisoning section – under subheading
‘Analgesics – Paracetamol’
Using the graph – treatment is not necessary as serum level is below
the treatment line.