Pocket Prescriber 2009–10


  • Andrew Webb

    1. Senior Lecturer/Honorary Consultant Physician, Clinical Pharmacology, John Vane Science Building, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
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Dr Andrew Webb MRCP PhD, Clinical Pharmacology, John Vane Science Building, William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK.
E-mail: a.j.webb@qmul.ac.uk

Pocket Prescriber 2009–10
Timothy RJ Nicholson, Asham Gunarathne & Donald RJ Singer
Published by Hodder Arnold , 2009 . 264 pages, price £12.99. ISBN-10 0340985224 , ISBN-13 978-0340985229

The Pocket Prescriber 2009–10 is an accessible handbook aimed at junior doctors, medical students and non-medical independent prescribers. An initial section on ‘How to Prescribe Safely’ provides very useful advice. This is set out differently from, but essentially covers the British Pharmacological Society's ‘Ten Principles of Good Prescribing’ and provides additional practical advice on specific elements of prescription writing, and also gives some useful contacts for further information.

The Common/useful drugs section comprises over half the book: drugs are easy to find as they are in alphabetical order; however, drugs are not grouped in classes, so that there is some loss of context, also necessitating the repetition of common information. This also contributes to the large number of entries for different drugs, around 500, somewhat larger than a recommended limited formulary of closer to 100 drugs for new graduates. It also includes many more specialist drugs, which make the book useful for more senior clinicians. Under each drug, the key information is presented clearly, including class/mechanism of action, use, contraindications, cautions, side effects, ‘warn’, interactions and dose. The inclusion of key interactions under each drug is very convenient; indeed, this is an approach that the BNF is planning to adopt. In addition, a grey box highlighting an important aspect of practical prescribing is present for many drugs. This is very effective.

Abbreviations and symbols are used extensively and can be quite challenging. As an amusing illustration, try translating the following: ‘C: dfx assoc w this prep inc xs abbr ⇒ N & ↑ EPSE’ (Caution: defects associated with this preparation include excess abbreviations causing nausea and increased extrapyramidal side effects). On a more serious note, familiarity with these symbols and abbreviations is paramount. For example, ‘P’ appears under metformin, signifying that it is contraindicated in pregnancy, but this could easily be overlooked. This last example also raises the issue of information being kept up to date and compatibility with other sources. The BNF has recently changed its advice from ‘Avoid metformin in pregnancy’ to ‘During pregnancy, women with pre-existing diabetes can be treated with metformin [unlicensed use], either alone or in combination with insulin . . .’. The BNF should be considered as a more definitive handbook source, although as the authors point out, the information has been collated from many sources, and the Summary of Product Characteristics has generally been taken as definitive.

In general, the generic names of drugs are used and trade names are printed in outline font. Occasionally more prominence is given to the trade name, e.g. Tazocin, when perhaps greater use of the generic name (piperacillin-tazobactam) should be encouraged for safer prescribing.

The remaining sections ‘Drug Selection’, which provides very useful practical advice on the treatment of a number of common conditions, ‘How to Prescribe’ (Insulin, Anticoagulants, Thrombolysis and Controlled drugs), ‘Miscellaneous’ and ‘Medical Emergencies’ all provide incredibly useful and accessible information, incorporating national guidelines and are one of the key strengths of the book. The resuscitation and stroke/TIA algorithms are also handily placed at the front and back covers of the book.

The Pocket Prescriber has been adopted by, and achieved considerable popularity amongst, many junior doctors and students. For example, of 237 final year medical students at Barts & The London School of Medicine & Dentistry who responded to a recent survey asking them ‘Which one of the following do you find most useful for practical prescribing?’ 36% chose the Pocket Prescriber, compared with 53% who chose the BNF (with 11% choosing ‘other’).

To achieve ‘balanced prescribing’, junior doctors and students should be encouraged to look up information regularly and frequently when prescribing. Thus having an accessible, easy-to-use handbook that facilitates this is to be commended. The concern in the Drug section is that the Pocket Prescriber is perhaps not the comprehensive and definitive source, and all prescribers and students should also be encouraged to become skilled in using the BNF. However, provided they are used in a complementary manner: the Pocket Prescriber for more frequent, rapid checking, but deferring to the BNF for more detailed information, this could be a safe and effective approach, and the Pocket Prescriber has much else to offer besides, especially in the therapeutics sections.