Curriculum standards: LG14: Prescribing

Knowledge guides

LG14: Prescribing

Clinical sciences

Advanced Trainees will describe the principles of the foundational sciences.

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Eligibility considerations

Advanced Trainees will assess the patient’s current condition and plan the next steps.

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Less common or more complex patient considerations

Advanced Trainees will understand the resources that should be used to help manage patients.

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Undertaking therapy

Advanced Trainees will monitor the progress of patients during the therapy.

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Post therapy

Advanced Trainees will know how to monitor and manage patients post-therapy.

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Important specific issues

Advanced Trainees will identify important specialty-specific issues and the impact of these on diagnosis and management, and integrate these into care.

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Clinical trials principles, such as:
- advantages and limitations of clinical trial designs:
  - adaptive
  - basket
  - case series
  - crossover
  - observational
  - parallel
  - platform
  - randomised
  - umbrella
- dosing strategies
- ethical, legal, and regulatory requirements for approval, registration, and reporting
- outcome measures
- phases of clinical trials
- relevant standards and guidelines, such as:
  - common terminology criteria for adverse events (CTCAE)
  - International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use guidance, including good clinical practice (GCP) guidelines
- sample size estimation and power calculation
- scope and limitations
- selection of participants and eligibility criteria
Digital therapeutics, such as:
- applications
- artificial intelligence (AI)
- consultations via phone and video platforms
- electronic medication management systems
Drug / Medication databases
Drug selection
Emerging technologies, such as:
- machine learning in drug discovery
- the role of AI:
  - decision support tools for prescribing
  - personalised therapy
  - predictive modelling
  - reshaping pharmacological research
Forms of target concentration and exposure
Laboratory methods
Principles of deprescribing
Principles of pharmacodynamics and pharmacokinetics
Rational prescribing

AIM

Geriatric pharmacology

Dosing in older patients, considering physiological changes with ageing
Managing polypharmacy
Monitoring and support devices for dementia patients

PCH

Appropriate methods for, and limitations of, extrapolating adult data to children
Principles of prescribing to children, such as:
- adjustments in dosing, such as mg / kg dosing
- selection and concentration of liquid formulations

Indications for, and adverse effects of, commonly used drugs, such as those used in:
- anaesthetics
- emergency medicine, such as:
  - fluid therapy
  - intravenous fluids
- internal medicine
- oncology
- psychiatry
- rheumatology
- vascular and metabolic medicine
Indications, limitations, and usefulness of therapeutic drug management (TDM) in patient management, such as:
- aminoglycosides
- busulfan
- tacrolimus
- warfarin
- vancomycin
Patient history, including previous adverse drug reactions and specific health conditions that influence drug choice
Patients’ current medications and potential drug-drug interactions
Presence of comorbidities, complex multimorbidity, or multimorbidity
Variation based on individual patients’:
- age, including paediatric growth and development and adult senescence
- concomitant medicines and complementary products
- genetics
- lactation
- pregnancy
- sex

AIM

Indications for, and adverse effects of, drugs mainly used for older persons’ health

PCH

Indications for, and adverse effects of, drugs commonly used within paediatrics

Literature search, such as:
- Embase
- New Zealand Formulary (NZF)
- PubMed
Medicine and drug information services
National formulary

Adjustments in therapy based on response and adverse effects
Development and use of patient information resources about drugs
Drug interactions, and their impact on therapy
Monitoring parameters
Off-label / Unlicenced medicines
Patient counselling about pharmacotherapy

PCH

Counselling parents about measuring doses and administering medicines to children
Extemporaneous formulations

Strategies for tapering or discontinuing therapy based on therapeutic goals and patient response
Techniques for monitoring therapeutic outcomes and recognising signs of drug toxicity, such as:
- bedside evaluation
- biomarkers testing, including:
  - hepatotoxicity markers, such as:
    - alanine aminotransferase (ALT)
    - aspartate aminotransferase (AST)
  - nephrotoxicity markers, such as:
    - creatinine

PCH

Strategies for blood sampling, and for measuring analyses with small sample volumes

Decision support tools to assist in drug selection and dosing
Ethical considerations, such as:
- access to treatment
- cost considerations
- managing conflicts of interest, particularly in relation to pharmaceutical industry relations
- patient autonomy in prescribing
Factors that affect drug use, such as:
- age and development
- comorbidity
- concomitant drugs and complementary products
- ethnicity
- lactation
- nationality
- pregnancy
- sex
- socioeconomic status
Factors that affect professional and public perception of drugs and their use, such as the effects of advertising, marketing, and media
Factors that determine the benefit to harm balance in therapeutic interventions
Legal considerations, such as:
- implications of prescribing errors
- importance of documentation and informed consent
- national and local guidelines for the quality use of medicines
Pharmaceutical policy and legislation, such as:
- national and international regulations in drug approval, availability and pricing
Regulation of scheduled substances and the associated scheduling process
Strategies to improve patient adherence, especially in chronic disease management, which is crucial for the efficacy of pharmacological interventions

AIM

Extrapolation of standards adult data to advanced ageing

PCH

Extrapolation of adult data to children
Prescribing and calculation errors in children