Prescription Writing Practice

Pulmonary embolism in renal impairment

Write a prescription for pulmonary embolism and have every line marked: drug choice, dose, route, frequency and duration, checked against the patient's allergies, current medicines, renal function and the interaction database, with each error explained.

hard8 scoring rulesrenal impairment

Patient
70 years, male, 64 kg
Diagnosis
Pulmonary embolism
Renal function
eGFR 24 mL/min/1.73m²
Allergies
None known
Current medicines
amlodipine 5 mg once daily; metformin 500 mg twice daily; bisoprolol 2.5 mg once daily

The scenario

Patient B-217 is a 70-year-old man, weight 64 kg, admitted to the emergency department with sudden-onset pleuritic chest pain and breathlessness. He reports a two-day history of right calf swelling and tenderness. He has a background of hypertension, type 2 diabetes mellitus and chronic kidney disease. His regular medications are amlodipine 5 mg once daily, metformin 500 mg twice daily and bisoprolol 2.5 mg once daily. He has no known allergies. On examination, he is tachypnoeic at 22 breaths per minute, heart rate 110 beats per minute, blood pressure 126/78 mmHg, oxygen saturation 90% on room air, temperature 37.2°C. The right calf is swollen, warm and tender. The chest is clear on auscultation, heart sounds normal. An ECG shows sinus tachycardia. Chest radiograph shows no consolidation or pleural effusion. D-dimer is elevated. CT pulmonary angiogram confirms a thrombus in the right main pulmonary artery. Blood tests: haemoglobin 13.5 g/dL, white cell count 9.1 x10^9/L, platelets 220 x10^9/L, urea 18 mmol/L, creatinine 2.6 mg/dL, eGFR 24 mL/min/1.73m², liver function tests normal. Your task: prescribe the immediate anticoagulant treatment. State the drug name, dose, route and frequency.

What gets marked

  • Whether you chose an indicated drug, and whether you avoided the contraindicated ones.
  • Dose, route, frequency and duration against the range for this patient.
  • Renal and hepatic dose adjustment where this patient's numbers demand it.
  • Allergy cross-reactivity and interactions with the medicines already on the chart.
  • The instructions and monitoring you write, not only the drug you pick.

8 scoring rules apply to this scenario. A single critical error fails the attempt whatever the score.

Log in to prescribe for "Pulmonary embolism in renal impairment"

A free account opens the prescription pad: search the formulary, write the chart, and have it marked line by line by the safety engine.

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Educational content for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.