How many drugs are commonly prescribed?

[bowlofmushypeas]

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Totally random question out of curiosity..

What number of prescription and OTC meds would you guess are "commonly prescribed" -- like, a list of X # of drugs would represent what 80-90% of patients are taking in outpatient and inpatient settings.

As a 4th year, I've been reflecting on what all we've learned in preparation for residency, and I feel like I encounter the same meds over and over. Drugs.com supposedly lists 24,000 prescription and OTC drugs, but I'd guess I could list only under 500.

Yup.. I should be working on my personal statement but am instead posting random questions on SDN.

 

[survivordo]

Totally random question out of curiosity..

What number of prescription and OTC meds would you guess are "commonly prescribed" -- like, a list of X # of drugs would represent what 80-90% of patients are taking in outpatient and inpatient settings.

As a 4th year, I've been reflecting on what all we've learned in preparation for residency, and I feel like I encounter the same meds over and over. Drugs.com supposedly lists 24,000 prescription and OTC drugs, but I'd guess I could list only under 500.

Yup.. I should be working on my personal statement but am instead posting random questions on SDN.

If you can list 500 drugs off the top of your head that's pretty impressive. I would say I see the same 50-100 drugs over and over.

Survivor DO

 

[e30ftw]

http://www.rxlist.com/script/main/art.asp?articlekey=79509

here ya go dude.

notice 9/10 of the top rx are opiates/benzos/psych........................................

our pt population for the most part are a bunch of pansy whiners if you haven't figured it out already.

you don't need to memorize every rx med to be a good physician, you just need experience knowing how to fix clinical problems using the resources you have on hand. I probably give the same 40 or so drugs over and over again.

so many clinical interventions actually do not have externally validated studies showing mortality benefit anyway, it really doesn't matter.

HOG rule 13: THE DELIVERY OF GOOD MEDICAL CARE IS TO DO AS MUCH NOTHING AS POSSIBLE

 

[alpinism]

Anti-hypertensives, anti-cholesterol meds, analgesics, and of course psych meds.

Just an estimate but I'd guess those 4 make up over 75% of all scripts.

 

[neusu]

I probably routinely Rx under 10 meds. Seizure, pain, spasm, and vasospasm. The rest of them I'd prefer their PCP to write for.

 

[Houmd]

Totally random question out of curiosity..

What number of prescription and OTC meds would you guess are "commonly prescribed" -- like, a list of X # of drugs would represent what 80-90% of patients are taking in outpatient and inpatient settings.

As a 4th year, I've been reflecting on what all we've learned in preparation for residency, and I feel like I encounter the same meds over and over. Drugs.com supposedly lists 24,000 prescription and OTC drugs, but I'd guess I could list only under 500.

Yup.. I should be working on my personal statement but am instead posting random questions on SDN.

As far as the outpatient setting when I was working in pharmacy we had to know the "Top 200 Drugs" which pretty much encompasses your 80-90% of scripts seen in any given day. We also shelved them in a section on their own for our convenience

 

[mvenus929]

The drugs you most commonly encounter during residency and practice will depend on the field you go into. Tetracycline is encountered more in the adult world than in peds, for instance. Urology will have a different set of drugs than Ortho, though some of them may overlap.

 

[Bamfu]

I asked my wife (pharmacist). Pharmacists have to learn a list of the top 200 drugs. This includes brands, generic, therapeutic category, mechanism of action, strengths/dosages, indications, etc.. There is a new list (mostly the same ofc) every year, and there are different lists for hospital v retail.

 

[BigRedBeta]

You could probably start with the Walmart $4 list:

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

...although, looking over the list, I'm kind of surprised - like why all the systemic albuterol (which is less effective and with way worse side effects) but no metered dose inhalers? Interesting antibiotic choices as well. Clearly high blood pressure meds are among the most commonly prescribed...

Also agree with whoever talked about how different specialties use entirely different medications. When I was a peds resident - where patient size really matters - I got to the point that I could dose amoxicillin (in all concentrations), tylenol, motrin, and liquid oxycodone to the nearest mL just by looking at a kid (ie without looking at the weight), because I wrote for them all the time. If you just want typical dosing, I can tell you typical per kg doses of ativan, versed, fosphenytoin, vanc, ampicillin, cefotaxime (in both normal and meningitic doses), clindamycin, fentanyl, decadron, and Orapred without a moment's hesitation. All about familiarity, though in the adult world, probably easier to remember things since the doses are standardized and you rarely have to worry about multiple concentrations.

 

[bowlofmushypeas]

As far as the outpatient setting when I was working in pharmacy we had to know the "Top 200 Drugs" which pretty much encompasses your 80-90% of scripts seen in any given day. We also shelved them in a section on their own for our convenience

Interesting.. do you know where we can find a list? Med students and docs could certainly use something like that

 

[NeuroLAX]

Interesting.. do you know where we can find a list? Med students and docs could certainly use something like that

Worth a Google... The link above is for 2005. Below is for 2011.

Top 200 Drugs of 2011: http://www.pharmacytimes.com/publications/issue/2012/July2012/Top-200-Drugs-of-2011.

 

[Raryn]

You could probably start with the Walmart $4 list:

http://i.walmartimages.com/i/if/hmp/fusion/customer_list.pdf

...although, looking over the list, I'm kind of surprised - like why all the systemic albuterol (which is less effective and with way worse side effects) but no metered dose inhalers? Interesting antibiotic choices as well. Clearly high blood pressure meds are among the most commonly prescribed...

Also agree with whoever talked about how different specialties use entirely different medications. When I was a peds resident - where patient size really matters - I got to the point that I could dose amoxicillin (in all concentrations), tylenol, motrin, and liquid oxycodone to the nearest mL just by looking at a kid (ie without looking at the weight), because I wrote for them all the time. If you just want typical dosing, I can tell you typical per kg doses of ativan, versed, fosphenytoin, vanc, ampicillin, cefotaxime (in both normal and meningitic doses), clindamycin, fentanyl, decadron, and Orapred without a moment's hesitation. All about familiarity, though in the adult world, probably easier to remember things since the doses are standardized and you rarely have to worry about multiple concentrations.

The $4 list only includes generic drugs. There haven't been any generic metered dose inhalers of any form since congress (in their infinite wisdom) banned all uses of CFCs as propellants as of ~2008. Given the complexities of patent laws as they apply to devices (as opposed to how they apply to drugs), we likely won't see generic MDIs for another 20 years.

 

[BigRedBeta]

The $4 list only includes generic drugs. There haven't been any generic metered dose inhalers of any form since congress (in their infinite wisdom) banned all uses of CFCs as propellants as of ~2008. Given the complexities of patent laws as they apply to devices (as opposed to how they apply to drugs), we likely won't see generic MDIs for another 20 years.

thanks, hadn't realized it was tied to going to HFA's

 

[type b pharmD]

thanks, hadn't realized it was tied to going to HFA's

The walmart or retailers $4 generic lists are not always logically related to clinical efficacy/safety or even acquisition costs. They're more tied to marketing strategies. For some drugs , $4 still represents a reasonable margin but some are sold at a loss in order to bring in patients with disease states which are likely going to be treated with multiple, more expensive or higher margin drugs.

 

[CritCare PharmD]

In the pharmacy world, the idea of a Top 200 Drugs isn't completely based on popularity/sales -- drugs can make it to the list if they represent a new therapeutic class (eg, Xarelto or Pradaxa) or have important counseling points (warfarin, fentanyl patches). Also, some medications make it to the list because of total revenue/sales (usually branded drugs) whereas others make it to the list because of number of sales (usually generic drugs). Some pharmacy schools also add over-the-counter meds, which aren't tracked like prescription medications.

There's a lot of different resources for learning the drugs (eg, brand/generic, dose, adverse effects, drug class indications, etc.) -- most students go with commercial flashcards, but these usually have too much extra information and are usually better for reference material.

If you're interested, I maintain an Android/iPhone flashcard and quiz-based app for the top 200 drugs (http://clincalc.com/mobile/FlashRX.aspx). Here's a few free iTunes promo codes if you want to try it out:
KLFW6YMKJL4F
XR6XPYL9PPH3
NLRTEMWT4JEW