💊 Station 1 — Prescription Writing for Pulmonary Tuberculosis
Rapid Revision • Prescription Writing • Practical Skills • Viva
🎯 Task
A 35-year-old adult weighing 55 kg has newly diagnosed, bacteriologically confirmed, rifampicin-susceptible pulmonary tuberculosis with no major contraindication to first-line therapy. Write a complete and rational outpatient prescription for this patient.
⚡ Model Station Answer
🔎 Stepwise Procedure / Approach
- Review the supplied case: confirm pulmonary TB diagnosis, body weight and available drug-susceptibility information.
- Check prescribing safety: review allergies, previous TB treatment, pregnancy where relevant, liver/renal disease, current medicines and important drug interactions.
- Complete patient details: write the patient’s name, age/identifier, weight and date clearly.
- Write the diagnosis and place the Rx symbol before the medication orders.
- Write the intensive phase: specify HRZE using generic drug names or the exact FDC composition, dose, oral route, once-daily frequency and 2-month duration.
- Write the continuation phase: specify HR with dose, oral route, once-daily frequency and 4-month duration.
- Check the prescription: confirm correct weight-band dosing, clear units, no ambiguous abbreviations and no omitted drug or duration.
- Authenticate: add the date, prescriber name/registration details and signature according to the examination prescription format.
🖼️ Visual Learning
Correct Pulmonary TB Prescription — 2HRZE/4HR
🎥 Practical Video
Demonstrates the essential components of a medical prescription and works through practical prescription-writing examples. Focus on how patient details, drug name, strength, dose, directions, duration, date and prescriber authentication are arranged.
📝 Important Viva Questions
Q1. What is the standard 6-month regimen for drug-susceptible pulmonary tuberculosis?
Answer: Two months of isoniazid, rifampicin, pyrazinamide and ethambutol followed by four months of isoniazid and rifampicin — 2HRZE/4HR.
Q2. What do H, R, Z and E represent?
Answer: H = isoniazid, R = rifampicin, Z = pyrazinamide and E = ethambutol.
Q3. What information about a drug must be clearly written in a prescription?
Answer: Generic drug name, formulation/strength, dose, route, frequency and duration or quantity as appropriate.
Q4. Why must the patient’s weight be checked before prescribing anti-tuberculous therapy?
Answer: First-line anti-TB medicines and fixed-dose combinations are prescribed according to weight bands, so an incorrect weight may result in under-dosing or excessive dosing.
Q5. Why should drug-susceptibility information be reviewed before finalizing treatment?
Answer: The standard first-line regimen is intended for drug-susceptible TB; detected resistance, particularly rifampicin resistance, requires a different treatment approach.
Q6. Name two important toxicity areas to remember with first-line anti-TB drugs.
Answer: Hepatotoxicity is important with isoniazid, rifampicin and pyrazinamide, while ethambutol can cause optic toxicity with impaired visual acuity or colour vision.
Q7. What common prescription-writing errors should be avoided?
Answer: Avoid illegible writing, unclear abbreviations, missing strength or route, incorrect dose, omitted duration, incomplete patient details and failure to date or authenticate the prescription.