Table 1.
Steps for prescribing a drug | Prescribing an oral hypoglycemic medication | Prescribing fluid therapy |
Define the clinical problem | Diabetes mellitus | Hypovolemia or other fluid responsive state |
Specify the therapeutic objective | Lower blood glucose | Restore absolute/relative fluid deficit |
Verify the suitability of the drug | Class of oral hypoglycemic agent | Crystalloid, colloid or blood product |
Write a prescription to start the drug | Order written by MD, verified and dispensed by pharmacy | Order written by MD, verified by pharmacy, blood bank or RN, administered by RN |
Monitor therapeutic response of the drug | Blood glucose or hemoglobin A1C, evidence of adverse effect/ toxicity | Monitor hemodynamic profile and end-organ perfusion, evidence of dose-response toxicity |
Write an order to discontinue | Order written by MD, verified by pharmacy | Order written by MD, administered by RN |
Adapted from Raghunathan et al[58].