HUMAN BODY

The Tooth
A tooth is a hard structure, set in the upper or lower jaw, that is used for chewing food. Teeth also give shape to the face and aid in the process of speaking clearly. The enamel that covers the crown (the part above the gum) in each tooth can be broken down by acids produced by the mouth for digestive purposes. This process is called "decay". To prevent decay, good oral hygiene, consisting of daily brushing and flossing, is necessary. The hardest substance in the human body is one of the four kinds of tissue which make up the tooth. It is enamel and covers the crown (area above the gum line) of the tooth. A bony material called "cementum" covers the root, which fits into the jaw socket and is joined to it with membranes. "Dentin" is found under the enamel and the cementum, and this material forms the largest part of the tooth. At the heart of each tooth is living "pulp," which contains nerves, connective tissues, blood vessels and lymphatics. When a person gets a toothache, the pulp is what hurts. Salivary Glands The mouth also contains the salivary glands which are accessory digestive glands that produce a fluid secretion called saliva. Saliva functions as a solvent in cleansing the teeth and dissolving food particles so that they may be tasted. Saliva also contains starch-digesting enzymes and mucus, which lubricates the pharynx to facilitate swallowing. There are three major pairs of salivary glands. The largest of which is the parotid gland and is located anteriorly and inferiorly to the ear between the skin and the muscle of chewing, the masseter. The parotid duct carries its contents and drains into the mouth. It is the parotid gland that becomes swollen and infected with the mumps or parotitis. The submandibular gland is located inferiorly to the mandible or jawbone midway along the inner side of the jaw. It has a muscular covering and empties its contents by way of the submandibular duct into the floor of the mouth on both sides. The sublingual gland, as its name implies, lies under the floor of the mouth and on the side of the tongue. Each sublingual gland possesses several small sublingual ducts that empty into the floor of the mouth in an area posterior to the submandibular duct. Mouth (An Overview) The function of the mouth and its associated structures is to form a receptacle for food, to begin mechanical digestion through chewing (mastication), to swallow food, and to form words in speech. It can also assist the respiratory system in the passage of air. Epiglottis The epiglottis is the flap of cartilage lying behind the tongue and in front of the entrance to the larynx (voice box). At rest, the epiglottis is upright and allows air to pass through the larynx and into the rest of the respiratory system. During swallowing, it folds back to cover the entrance to the larynx, preventing food and drink from entering the windpipe. The throat contains both an air passage (the wind pipe) and a food passage (the esophagus). If these passages were both open when a person swallowed, air could enter the stomach and food could enter the lungs. Part of the safety hatch that seals off the windpipe is the "epiglottis," a little valvelike cartilage, which works with the larynx to act as a lid every time we swallow. The larynx draws upward and forward to close the windpipe. This keeps solid food and liquid out of the respiratory tract. At the end of each swallow, the epiglottis moves up again, the larynx returns to rest, and the flow of air

into the windpipe continues. The uvula (Latin for "little grape") is a fleshy piece of muscle, tissue and mucous membrane that hangs down from the palate. It is the part that moves upward when we say, "Ah!" It flips up and helps close off the nasal passages when we swallow. Contrary to the depictions seen in cartoons, the uvula does not vibrate during singing and shouting and, in fact, has nothing to do with the voice. Trachea The trachea begins immediately below the larynx (voicebox) and runs down the center of the front part of the neck ends behind the upper part of the sternum. Here it divides to form two branches which enter the lung cavities. The trachea (windpipe) forms the trunk of an upsidedown tree and is flexible, like a vacuum tube, so that the head and neck may twist and bend during the process of breathing. The trachea, or windpipe, is made up of fibrous and elastic tissues and smooth muscle with about twenty rings of cartilage, which help keep the trachea open during extreme movement of the neck. The lining includes cells that secrete mucus along with other cells that bear very small hairlike fringes. This mucus traps tiny particles of debris, and the beating of the fringes moves the mucus up and out of the respiratory tract, keeping the lungs and air passages free. In Russian folk medicine, there is the thought that rubbing the chest with pork fat will cure a cold. Mustard plasters and boiled snails in barley water were thought to be effective by others, and nobody knows what the ingredients were for early "cure-all tonics" and "snake oil" kits. It is now believed that the best medicine is to rest, keep warm, drink plenty of fluids, and eat good, digestible meals. Sounds good to me...and certainly better smelling. Esophagus The esophagus is a muscular tube which carries food and liquids from the throat to the stomach for digestion after it has been chewed and chemically softened in the mouth. Food is forced downward to the stomach (or upwards, if one is standing on his head) by powerful waves of muscle contractions passing through the walls of the esophagus. Because these contractions are so strong in the throat and the esophagus, we can swallow in any position -- even upside-down! If the food is bad, poison, or more than we can "stomach," it may travel back by the same force to be thrown out through the mouth, which is called vomiting. The esophagus has a ring of muscle at the top and at the bottom. These rings close or contract after the food passes through and enters the stomach, where there is an abundance of churning acid waiting to digest the food. If the bottom muscle weakens, stomach contents, along with the stomach acid, may return to the esophagus and cause an uncomfortable, burning sensation known as "heartburn", although it is not connected with the heart at all, but be careful next time you are forced to swallow your pride. Liver Thirty per cent of the blood pumped through the heart in one minute passes through the body's chemical factory, which is called the liver. The liver cleanses the blood and processes nutritional molecules, which are distributed to the tissues. The liver also receives bright red blood from the lungs, filled with vital oxygen to be delivered to the heart. The only part of the body which receives more blood than the liver is the brain. The liver is located at the top of the abdomen, just below the diaphragm and has two main lobes. It is the largest gland in the body, weighing 2.5 to 3.3 pounds. When we eat, more blood is diverted to the intestines to deal with digestive processes; when not eating, three-fourths of the blood supply to the liver comes from the intestines. It also produces about two and one-half pints of bile in its ducts, which is delivered to

the gallbladder through a small tube called the "cystic duct" for storage. "Liver" is probably an appropriate name for this gland, which makes the important decision as to whether incoming substances are useful to the body or whether they are waste. The liver is an extremely important organ and has multiple functions. The liver detoxifies blood cells by mixing them with bile and by chemical alteration to less toxic substances, such as the alteration of ammonia to urea. Many chemical compounds are inactivated by the liver through modification of chemical structures. The liver converts glucose to a storage form of energy called glycogen, and can also produce glucose from sugars, starches, and proteins. The liver also synthesizes triglycerides and cholesterol, breaks down fatty acids, and produces plasma proteins necessary for the clotting of blood, such as clotting factors I, III, V, VII, IX and XI. The liver also produces bile salts and excretes bilirubin. A "lily-livered coward" was someone whose liver contained no blood. The Greeks and Romans sacrificed animals to the gods before going into battle. When the liver was examined, if it was healthy and the blood was bright red, a victory was promised; if it was diseased or the blood was pale, defeat was predicted Stomach A hollow, sac-like organ connected to the esophagus and the duodenum (the first part of the small intestine), the stomach consists of layers of muscle and nerves that continue the breakdown of food which begins in the mouth. It is also a storage compartment, which enables us to eat only two or three meals a day. If this weren't possible, we would have to eat about every twenty minutes. The average adult stomach stretches to hold from two to three pints and produces approximately the same amount of gastric juices every twenty-four hours. The stomach has several functions: (1) as a storage bin, holding a meal in the upper portion and releasing it a little at a time into the lower portion for processing; (2) as a food mixer, the strong muscles contract and mash the food into a sticky, slushy mass; (3) as a sterilizing system, where the cells in the stomach produce an acid which kills germs in "bad" food; (4) as a digestive tub, the stomach produces digestive fluid which splits and cracks the chemicals in food to be distributed as fuel for the body. The process of digestion is triggered by the sight, smell or taste of food, so that the stomach is prepared when the food arrives. Every time you pass a bakery shop or smell your mother's good cooking, the body begins a digestive process. If the stomach is not filled, these gastric juices begin eroding the stomach lining itself, so fill 'er up! Gallbladder The gallbladder is an active storage shed, which absorbs mineral salts and water received from the liver and converts it into a thick, mucus substance called "bile," to be released when food is present in the stomach. The gallbladder is a small, pear-shaped sac which is situated just below the liver and is attached to it by tissues. It stores bile and then releases it when food passes from the stomach to the duodenum (the first part of the small intestine) to help in the process of digestion. It has a capacity of around one and one-half fluid ounces. When food leaves the stomach, a secretion causes the gallbladder to contract and expel its contents into the duodenum, where the bile disperses the fats in the food into liquid. Pythagoras, the 6th Century BC Greek mathematician, believed that life is based on the four elements of earth, air, fire and water which correspond to the body's "humors": blood (hot and moist), phlegm (cold and moist), yellow bile (hot and dry) and black bile (cold and dry). The perfect or imperfect balance of these humors supposedly determined one's health and intelligence. We still speak in terms of "melancholia" (excess black bile, leading to depression) and "phlegmatic" (sluggish or impassive) and scientists

have named the heavy mucus secreted in the respiratory passages - phlegm. Pythagoras was kind of a "square". Oh, come on; where's your sense of "humor"? Spleen The spleen is the largest of the lymphoid tissues. It is just about the size of the heart and is a spongy material which will hold up to .3 gallons of blood. It is located on the left side of the body, just behind the stomach. The spleen is a valuable organ which produces some of the white blood cells, filters the blood, destroys old, worn-out red blood cells and returns needed iron to the blood, disposing of the rest as waste. The spleen also stores excess blood for emergencies; for example, when oxygen in the circulatory system is short. We often hear that the victim of an auto accident has had a ruptured spleen which has been removed surgically. Because the spleen is so soft and spongy, it cannot be repaired by surgery, so it is removed to stop the loss of blood. Omentum The omentum is an apronlike double fold of fatty membrane that hangs down in front of the intestines. It contains blood vessels, nerves, lymph vessels and lymph nodes. It acts as a storage for fat and also may limit the spread of infection in the abdominal cavity. Large Intestine The large intestine, or colon, consists of ascending, transverse, descending, and sigmoid portions. The ascending portion extends from the cecum superiorly along the right abdominal wall to the inferior surface of the liver and bends sharply at a right angle to the left at a curve called the hepatic flexure. From there, it crosses the abdominal cavity as the transverse colon to the left abdominal wall at the splenic flexure and begins the descending colon which traverses inferiorly along the left abdominal wall to the pelvic region. The colon then forms an angle medially from the pelvis to form an s-shaped curve called the sigmoid colon. The last few inches of the colon is the rectum which is a storage site for solid waste which leaves the body by way of an external opening called the anus, controlled by muscles called sphincters. Substances which have not been absorbed in the small intestine enter the large intestine in the form of liquid and fiber. The large intestine or "bowel" is sometimes called the "garbage dump" of the body, because the materials that reach it are of very small use to the body and are sent on to be disposed of. The first half of the colon absorbs fluids and recycles them into the blood stream. The second half compacts the wastes into feces, secretes mucus which binds the substances, and lubricates it to protect the colon and ease its passage. Of the two to two and one-half gallons of food and liquids taken in by the average adult, only about twelve ounces of waste enters the large intestine. Feces are comprised of about three quarters water. The remainder is protein, fat, undigested food roughage, dried digestive juices, cells shed by the intestine, and dead bacteria. A common disorder of the large intestine is inflammation of the appendix, or appendicitis. Waste that accumulates in the appendix cannot be moved easily by peristalsis since the appendix has only one opening. The symptoms of appendicitis include muscular rigidity, localized pain in the right lower quarter of the abdomen, and vomiting. The chief danger of appendicitis is that is may rupture and empty its contents of fecal matter and waste into the abdominal cavity producing an extremely serious condition called peritonitis.

Small Intestine If the small intestine were not looped back and forth upon itself, it could not fit into the abdominal space it occupies. It is held in place by tissues which are attached to the abdominal wall and measures eighteen to twenty-three feet in the average adult, which makes it about four times longer than the person is tall. It is a three-part tube of about one and one-half to two inches in diameter and is divided into three sections: (1) the duodenum, a receiving area for chemicals and partially digested food from the stomach; (2) the jejunum, where most of the nutrients are absorbed into the blood and (3) the ileum, where the remaining nutrients are absorbed before moving into the large intestine. The intestines process about 2.5 gallons of food, liquids and bodily waste every day. In order for enough nutrients to be absorbed into the body, it must come in contact with large numbers of intestinal cells which are folded like gathered skirts. Each of these cells contain thousands of tiny finger-like projections called "villi," and each villus contains microscopic "microvilli". In one square inch of small intestine, there are about 20,000 villi and ten billion microvilli. Each villus brings in fresh, oxygenated blood and sends out nutrient-enriched blood. The villi sway constantly to stir up liquefied food and remove the nutrients which can be absorbed and then passed through the membranes of the villi into the blood and lymph vessels. The fatty nutrients go to the lymph vessels, and glucose and amino acids go to the blood and on to the liver. The muscles which encircle this tube constrict about seven to twelve times a minute to move the food back and forth, to churn it, knead it, and to mix it with gastric juices. The small intestine also makes waves which move the food forward, but these are usually weak and infrequent to allow the food to stay in one place until the nutrients can be absorbed. If a toxic substance enters the small intestine, these movements may be strong and rapid to expel the poisons quickly. Appendix Digestion takes place almost continuously in a watery, slushy environment. The large intestine absorbs water from its inner contents and stores the rest until it is convenient to dispose of it. Attached to the first portion of the large intestine is a troublesome pouch called the (veriform) appendix. The appendix has no function in modern humans, however it is believed to have been part of the digestive system in our primitive ancestors. Rectum The rectum is a short, muscular tube that forms the lowest portion of the large intestine and connects it to the anus. Feces collects here until pressure on the rectal walls cause nerve impulses to pass to the brain, which then sends messages to the voluntary muscles in the anus to relax, permitting expulsion.

HUMAN BODY The human body is the entire structure of a human organism, and consists of a head, neck, torso, two arms and two legs. By the time the human reaches adulthood, the body consists of close to 10 trillion cells, the basic unit of life. These cells are organised biologically to eventually form the whole body. Size, type and proportion Body proportion The average height of an adult male human (in developed countries) is about 1.71.8 m (5'7" to 5'11") tall and the adult female about 1.61.7 m (5'3" to 5'7") tall. This size is firstly determined by genes and secondly by diet. Body type and body composition are influenced by postnatal factors such as diet and exercise. Systems Organ systems The organ systems of the body include the musculoskeletal system, cardiovascular system, digestive system, endocrine system, integumentary system, urinary system, lymphatic system, immune system, respiratory system, nervous system and reproductive system. Cardiovascular system Cardiovascular system and Human heart The cardiovascular system comprises the heart, veins, arteries and capillaries. The primary function of the heart is to circulate the blood, and through the blood, oxygen and vital minerals to the tissues and organs that comprise the body. The left side of the main organ (left ventricle and left atrium) is responsible for pumping blood to all parts of the body, while the right side (right ventricle and right atrium pumps only to the lungs.[2][3] The heart itself is divided into three layers called the endocardium, myocardium and epicardium, which vary in thickness and function Digestive system Digestive system and Human gastrointestinal tract The digestive system provides the body's means of processing food and transforming nutrients into energy. Integumentary system Integumentary system The integumentary system is the largest organ system in the human body, and is responsible for protecting the body from most physical and environmental factors. The largest organ in the body, is the skin. The integument also includes appendages, primarily the sweat and sebaceous glands, hair, nails and erectores pili (tiny muscles at the root of each hair that cause goosebumps).

Lymphatic system Lymphatic system and Immune system The main function of the lymphatic system is to extract, transport and metabolise lymph, the fluid found in between cells. The lymphatic system is very similar to the circulatory system in terms of both its structure its most basic function (to carry a body fluid). Musculoskeletal system Musculoskeletal system The human musculoskeletal system consists of the human skeleton, made by bones attached to other bones with joints, and skeletal muscle attached to the skeleton by tendons. Bones Human skeleton and List of bones of the human skeleton An adult human has approximately 206 distinct bones: Spine and vertebral column (26) Cranium (8) Face (14) Hyoid bone, sternum and ribs (26) Upper extremities (64) Lower extremities (62) Nervous System Nervous system and Human brain The nervous system is a network of specialized cells that communicate information about an organism's surroundings and itself. Reproductive system Reproductive system Human reproduction takes place as internal fertilization by sexual intercourse. During this process, the erect penis of the male is inserted into the female's vagina until the male ejaculates semen, which contains sperm, into the female's vagina. The sperm then travels through the vagina and cervix into the uterus or fallopian tubes for fertilization of the ovum. The human male reproductive system is a series of organs located outside the body and around the pelvic region of a male that contribute towards the reproductive process. The primary direct function of the male reproductive system is to provide the male gamete or spermatozoa for fertilization of the ovum. The major reproductive organs of the male can be grouped into three categories. The first category is sperm production and storage. Production takes place in the testes which are housed in the temperature regulating scrotum, immature sperm then travel to the epididymis for development and storage. The second category are the ejaculatory fluid producing glands which include the seminal vesicles, prostate, and the vas deferens. The final category are those used for copulation, and deposition of the spermatozoa (sperm) within the female, these include the penis, urethra, vas deferens and Cowper's gland. The human female reproductive system is a series of organs primarily located inside of the body and around the pelvic region of a female that contribute towards the reproductive process. The human female reproductive system contains three main parts: the vagina, which acts as the

receptacle for the male's sperm, the uterus, which holds the developing fetus, and the ovaries, which produce the female's ova. The breasts are also an important reproductive organ during the parenting stage of reproduction. The vagina meets the outside at the vulva, which also includes the labia, clitoris and urethra; during intercourse this area is lubricated by mucus secreted by the Bartholin's glands. The vagina is attached to the uterus through the cervix, while the uterus is attached to the ovaries via the fallopian tubes. At certain intervals, typically approximately every 28 days, the ovaries release an ovum, which passes through the fallopian tube into the uterus. The lining of the uterus, called the endometrium, and unfertilized ova are shed each cycle through a process known as menstruation.

A pharmaceutical drug, also referred to as medicine, medication or medicament, can be loosely defined as any chemical substance intended for use in the medical diagnosis, cure, treatment, or prevention of disease Classification Medications can be classified in various ways, such as by chemical properties, mode or route of administration, biological system affected, or therapeutic effects. An elaborate and widely used classification system is the Anatomical Therapeutic Chemical Classification System (ATC system). The World Health Organization keeps a list of essential medicines. A sampling of classes of medicine includes: - Antipyretics: reducing fever (pyrexia/pyresis) - Analgesics: reducing pain (painkillers) - Antimalarial drugs: treating malaria - Antibiotics: inhibiting germ growth - Antiseptics: prevention of germ growth near burns, cuts and wounds Types of medications (type of pharmacotherapy) For the gastrointestinal tract (digestive system) Upper digestive tract: antacids, reflux suppressants, antiflatulents, antidopaminergics, proton pump inhibitors (PPIs), H2-receptor antagonistss, cytoprotectants, prostaglandin analogues Lower digestive tract: laxatives, antispasmodics, antidiarrhoeals, bile acid sequestrants, opioid For the cardiovascular system General: -receptor blockers ("beta blockers"), calcium channel blockers, diuretics, cardiac glycosides, antiarrhythmics, nitrate, antianginals, vasoconstrictors, vasodilators, peripheral activators Affecting blood pressure (antihypertensive drugs): ACE inhibitors, angiotensin receptor blockers, blockers Coagulation: anticoagulants, heparin, antiplatelet drugs, fibrinolytics, anti-hemophilic factors, haemostatic drugs Atherosclerosis/cholesterol inhibitors: hypolipidaemic agents, statins. For the central nervous system See also: Psychiatric medication and Psychoactive drug Drugs affecting the central nervous system include: hypnotics, anaesthetics, antipsychotics, antidepressants (including tricyclic antidepressants, monoamine oxidase inhibitors, lithium salts, and selective serotonin reuptake inhibitors (SSRIs)), antiemetics, anticonvulsants/antiepileptics, anxiolytics, barbiturates, movement disorder (e.g., Parkinson's disease) drugs, stimulants (including amphetamines), benzodiazepines, cyclopyrrolones, dopamine antagonists, antihistamines, cholinergics, anticholinergics, emetics, cannabinoids, and 5-HT (serotonin) antagonists. For pain & consciousness (analgesic drugs) Analgesic The main classes of painkillers are NSAIDs, opioids and various orphans such as paracetamol, tricyclic antidepressants and anticonvulsants. For musculo-skeletal disorders

The main categories of drugs for musculoskeletal disorders are: NSAIDs (including COX-2 selective inhibitors), muscle relaxants, neuromuscular drugs, and anticholinesterases. For the eye General: adrenergic neurone blocker, astringent, ocular lubricant Diagnostic: topical anesthetics, sympathomimetics, parasympatholytics, mydriatics, cycloplegics Anti-bacterial: antibiotics, topical antibiotics, sulfa drugs, aminoglycosides, fluoroquinolones Antiviral drug: Anti-fungal: imidazoles, polyenes Anti-inflammatory: NSAIDs, corticosteroids Anti-allergy: mast cell inhibitors Anti-glaucoma: adrenergic agonists, beta-blockers, carbonic anhydrase inhibitors/hyperosmotics, cholinergics, miotics, parasympathomimetics, prostaglandin agonists/prostaglandin inhibitors. nitroglycerin For the ear, nose and oropharynx sympathomimetics, antihistamines, anticholinergics, NSAIDs, steroids, antiseptics, local anesthetics, antifungals, cerumenolyti For the respiratory system bronchodilators, NSAIDs, anti-allergics, antitussives, mucolytics, decongestants corticosteroids, beta-receptor antagonists, anticholinergics, steroids For endocrine problems androgens, antiandrogens, gonadotropin, corticosteroids, human growth hormone, insulin, antidiabetics (sulfonylureas, biguanides/metformin, thiazolidinediones, insulin), thyroid hormones, antithyroid drugs, calcitonin, diphosponate, vasopressin analogues For the reproductive system or urinary system antifungal, alkalising agents, quinolones, antibiotics, cholinergics, anticholinergics, anticholinesterases, antispasmodics, 5-alpha reductase inhibitor, selective alpha-1 blockers, sildenafils, fertility medications For contraception Hormonal contraception Ormeloxifene Spermicide For obstetrics and gynecology NSAIDs, anticholinergics, haemostatic drugs, antifibrinolytics, Hormone Replacement Therapy (HRT), bone regulators, beta-receptor agonists, follicle stimulating hormone, luteinising hormone, LHRH gamolenic acid, gonadotropin release inhibitor, progestogen, dopamine agonists, oestrogen, prostaglandins, gonadorelin, clomiphene, tamoxifen, Diethylstilbestrol For the skin emollients, anti-pruritics, antifungals, disinfectants, scabicides, pediculicides, tar products, vitamin A derivatives, vitamin D analogues, keratolytics, abrasives, systemic antibiotics, topical

antibiotics, hormones, desloughing agents, exudate absorbents, fibrinolytics, proteolytics, sunscreens, antiperspirants, corticosteroids For infections and infestations antibiotics, antifungals, antileprotics, antituberculous drugs, antimalarials, anthelmintics, amoebicides, antivirals, antiprotozoals For the immune system vaccines, immunoglobulins, immunosuppressants, interferons, monoclonal antibodies For allergic disorders anti-allergics, antihistamines, NSAIDs For nutrition tonics, iron preparations, electrolytes, parenteral nutritional supplements, vitamins, anti-obesity drugs, anabolic drugs, haematopoietic drugs, [[food product drug]s For neoplastic disorders cytotoxic drugs, therapeutic antibodies, sex hormones, aromatase inhibitors, somatostatin inhibitors, recombinant interleukins, G-CSF, erythropoietin For diagnostics contrast media For euthanasia See also: Barbiturate#Other non-therapeutical uses and barbituates An euthanaticum is used for euthanasia and physician-assisted suicide. Euthanasia is not permitted by law in many countries, and consequently medicines will not be licensed for this use in those countries. Legal considerations Medications may be divided into over-the-counter drugs (OTC) which may be available without special restrictions, and prescription only medicine (POM), which must be prescribed by a licensed medical practitioner. The precise distinction between OTC and prescription depends on the legal jurisdiction. A third category, behind-the-counter medications (BTMs), is implemented in some jurisdictions. BTMs do not require a prescription, but must be kept in the dispensary, not visible to the public, and only be sold by a pharmacist or pharmacy technician. The International Narcotics Control Board of the United Nations imposes a world law of prohibition of certain medications. They publish a lengthy list of chemicals and plants whose trade and consumption (where applicable) is forbidden. OTC medications are sold without restriction as they are considered safe enough that most people will not hurt themselves accidentally by taking it as instructed. Many countries, such as the United Kingdom have a third category of pharmacy medicines which can only be sold in registered pharmacies, by or under the supervision of a pharmacist. For patented medications, countries may have certain mandatory licensing programs which compel, in certain situations, a medication's owner to contract with other agents to manufacture the drug. Such programs may deal with the contingency of a lack of medication in the event of a serious epidemic of disease, or may be part of efforts to ensure that disease treating drugs, such as AIDS drugs, are available to countries which cannot afford the drug owner's price. In some countries, government-regulated cannabis is available by prescription. Blockbuster drug A blockbuster drug is a drug generating more than $1 billion of revenue for its owner each year.[4] The search for blockbusters has been the foundation of the R&D strategy adopted by big

pharmaceutical companies, but this looks set to change. New advances in genomics, and the promise of personalized medicine, are likely to fragment the pharmaceutical market[citation needed]. A recent report from Urch Publishing estimated that about one third of the pharma market by value is accounted for by blockbusters. About 100 products are blockbusters. The top seller was Lipitor, a cholesterol-lowering medication marketed by Pfizer with sales of $12.2 billion. Environmental impact Since the 1990s water contamination by pharmaceuticals has been an environmental issue of concern. Most pharmaceuticals are deposited in the environment through human consumption and excretion, and are often filtered ineffectively by wastewater treatment plants which are not designed to manage them. Once in the water they can have diverse, subtle effects on organisms, although research is limited. Pharmaceuticals may also be deposited in the environment through improper disposal, runoff from sludge fertilizer and reclaimed wastewater irrigation, and leaky sewage. In 2009 an investigative report by Associated Press concluded that U.S. manufacturers had legally released 271 million pounds of drugs into the environment, 92% of which was the antiseptics phenol and hydrogen peroxide. It could not distinguish between drugs released by manufacturers as opposed to the pharmaceutical industry. It also found that an estimated 250 million pounds of pharmaceuticals and contaminated packaging were discarded by hospitals and long-term care facilities. History Ancient pharmacology Using plants and plant substances to treat all kinds of diseases and medical conditions is believed to date back to prehistoric medicine. The Kahun Gynaecological Papyrus, the oldest known medical text of any kind, dates to about 1800 BCE and represents the first documented use of any kind of medication It and other medical papyri describe Ancient Egyptian medical practices, such as using honey to treat infections. Ancient Babylonian medicine demonstrate the use of prescriptions in the first half of the 2nd millennium BC. Medicinal creams and pills were employed as treatments. On the Indian subcontinent, the Atharvaveda, a sacred text of Hinduism whose core dates from sometime during the 2nd millenium BCE, although the hymns recorded in it are believed to be older, is the first Indic text dealing with medicine. It describes plant-based medications to counter diseases.. The earliest foundations of ayurveda were built on a synthesis of selected ancient herbal practices, together with a massive addition of theoretical conceptualizations, new nosologies and new therapies dating from about 400 BCE onwards.. The student of yurveda was expected to know ten arts that were indispensable in the preparation and application of his medicines: distillation, operative skills, cooking, horticulture, metallurgy, sugar manufacture, pharmacy, analysis and separation of minerals, compounding of metals, and preparation of alkalis. The Hippocratic Oath for physicians, attributed to 5th century BCE Greece, refers to the existence of "deadly drugs", and ancient Greek physicians imported medications from Egypt and elsewhere. The first drugstores were created in Baghdad in the 8th century CE. The injection syringe was invented by Ammar ibn Ali al-Mawsili in 9th century Iraq. Al-Kindi's 9th century CE book, De Gradibus, developed a mathematical scale to quantify the strength of drugs.

The Canon of Medicine by Ibn Sina (Avicenna), who is considered the father of modern medicine, reported 800 tested drugs at the time of its completion in 1025 CE. The Canon is considered the first pharmacopoeia, or organized list of medications and their preparation Ibn Sina's contributions include the separation of medicine from pharmacology, which was important to the development of the pharmaceutical sciences.Islamic medicine knew of at least 2,000 medicinal and chemical substances. Medieval pharmacology Medieval medicine saw advances in surgery, but few truly effective drugs existed, beyond opium and quinine. Folklore cures and potentially poisonous metal-based compounds were popular treatments. Theodoric Borgognoni, (1205-1296), one of the most significant surgeons of the medieval period, responsible for introducing and promoting important surgical advances including basic antiseptic practice and the use of anaesthetics. Garcia de Orta described some herbal treatments. Modern pharmacology For most of the nineteenth century, drugs were not highly effective, leading Oliver Wendell Holmes, Sr. to famously comment in 1842 that "if all medicines in the world were thrown into the sea, it would be all the better for mankind and all the worse for the fishes". During the First World War, Alexis Carrel and Henry Dakin developed the Carrel-Dakin method of treating wounds with an irrigation, Dakin's solution, a germicide which helped prevent gangrene. In the inter-war period, the first anti-bacterial agents such as the sulpha antibiotics were developed. The Second World War saw the introduction of widespread and effective antimicrobial therapy with the development and mass production of penicillin antibiotics, made possible by the pressures of the war and the collaboration of British scientists with the American pharmaceutical industry. Medicines commonly used by the late 1920s included aspirin, codeine, and morphine for pain; digitalis, nitroglycerin, and quinine for heart disorders, and insulin for diabetes. Other drugs included antitoxins, a few biological vaccines, and a few synthetic drugs. In the 1930s antibiotics emerged: first sulfa drugs, then penicillin and other antibiotics. Drugs increasingly became "the center of medical practice". In the 1950s other drugs emerged including corticosteroids for inflammation, rauwolfia alkloids as tranqulizers and antihypertensives, antihistamines for nasal allergies, xanthines for asthma, and typical antipsychotics for psychosis.As of 2008, thousands of approved drugs have been developed. Increasingly, biotechnology is used to discover biopharmaceuticals. In the 1950s new psychiatric drugs, notably the antipsychotic chlorpromazine, were designed in laboratories and slowly came into preferred use. Although often accepted as an advance in some ways, there was some opposition, due to serious adverse effects such as tardive dyskinesia. Patients often opposed psychiatry and refused or stopped taking the drugs when not subject to psychiatric control. Governments have been heavily involved in the development and sale of drugs. In the U.S., the Elixir Sulfanilamide disaster led to the establishment of the Food and Drug Administration, and the 1938 Federal Food, Drug, and Cosmetic Act required manufacturers to file new drugs with the FDA. The 1951 Humphrey-Durham Amendment required certain drugs to be sold by

prescription. In 1962 a subsequent amendment required new drugs to be tested for efficacy and safety in clinical trials. Until the 1970s, drug prices were not a major concern for doctors and patients. As more drugs became prescribed for chronic illnesses, however, costs became burdensome, and by the 1970s nearly every U.S. state required or encouraged the substitution of generic drugs for higher-priced brand names. This also led to the 2006 U.S. law, Medicare Part D, which offers Medicare coverage for drugs. As of 2008, the United States is the leader in medical research, including pharmaceutical development. U.S. drug prices are among the highest in the world, and drug innovation is correspondingly high. In 2000 U.S. based firms developed 29 of the 75 top-selling drugs; firms from the second-largest market, Japan, developed eight, and the United Kingdom contributed 10. France, which imposes price controls, developed three. Throughout the 1990s outcomes were similar.

Medical prescription A prescription () is a health-care program implemented by a physician or other medical practitioner in the form of instructions that govern the plan of care for an individual patient.[1] Prescriptions may include orders to be performed by a patient, caretaker, nurse, pharmacist or other therapist. Commonly, the term prescription is used to mean an order to take certain medications. Prescriptions have legal implications, as they may indicate that the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety. However, as medications have increasingly become prepackaged manufactured products and medical practice has become more complex, the scope of meaning of the term "prescription" has broadened to also include clinical assessments, laboratory tests, and imaging studies relevant to optimizing the safety or efficacy. Format and definition Prescription symbol Prescriptions are handwritten on preprinted prescription forms that are assembled into pads, or alternatively printed onto similar forms using a computer printer. Preprinted on the form is text that identifies the document as a prescription, the name and address of the prescribing provider and any other legal requirement such as a registration number (e.g. DEA Number in the United States). Unique for each prescription is the name of the patient. In the United Kingdom the patient's name and address must also be recorded. Each prescription is dated and some jurisdictions may place a time limit on the prescription [2]. There is the specific "recipe" of the medication and the directions for taking it.

is a symbol meaning "prescription". It is sometimes transliterated as "Rx" or just "Rx". There

are various theories about the origin of this symbol - some note its similarity to the Eye of Horus[3] [4], others to the ancient symbol for Jupiter, both gods whose protection may have been sought in medical contexts. Alternatively, it may be intended as an abbreviation of the Latin "recipe" [5], the imperative form of "recipere", "to take or take thus"[6], and it is quite possible that more than one of these factors influenced its form. Literally, "Recipe" means simply "Take...." and when a medical practitioner writes a prescription beginning with "", he or she is completing the command. This was probably originally directed at the pharmacist who needed to take a certain amount of each ingredient to compound the medicine, rather than at the patient who must "take" the medicine, in the sense of consuming it. The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared. Those within the industry will often call prescriptions simply "scripts". Another theory exists that the "" may have originally been a "Px", where the "P" is short for "pre", and the "x" is short for "script". Contents Both pharmacists and prescribers are regulated professions in most jurisdictions. A prescription as a communications mechanism between them is also regulated and is a legal document. Regulations may define what constitutes a prescription, the contents and format of the prescription (including the size of the piece of paper - see Exhibit C paragraph 10) and how prescriptions are handled and stored by the pharmacist. Many jurisdictions will now allow faxed or phone prescriptions containing the same information. Exhibit A below illustrates the legal definition of a prescription.

Drug companies use direct-to-prescriber advertising in an effort to convince prescribers to dispense as written with brand-name products rather than generic drugs. Many brand name drugs have less expensive generic drug substitutes that are therapeutically equivalent. Prescriptions will also contain instructions on whether the prescriber will allow the pharmacist to substitute a generic version of the drug. This instruction is communicated in a number of ways. In some jurisdictions, the preprinted prescription contains two signature lines: one line has "dispense as written" printed underneath; the other line has "substitution permitted" underneath. Some have a preprinted box "dispense as written" for the prescriber to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the prescriber to handwrite one of the following phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange"[7]. In other jurisdictions may they use completely different languages, never mind a different formula of words. In some jurisdictions, it may be a legal requirement to include the age of child on the prescription [8]. For pediatric prescriptions some advise the inclusion of the age of the child if the patient is less than twelve and the age and months if less than five. (In general, including the age on the prescription is helpful.) Adding the weight of the child is also helpful. Prescriptions often have a "label" box [9]. When checked, pharmacist is instructed to label the medication. When not checked, the patient only receives instructions for taking the medication and no information about the prescription itself. Some prescribers further inform the patient and pharmacist by providing the indicator for the medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions. Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the medical practitioner. Regulations may restrict some types of drugs from being refilled. In group practices, the preprinted portion of the prescription may contain multiple prescribers' names. Prescribers typically circle themselves to indicate who is prescribing or there may be a checkbox next to their name. [edit] Handling When filled by a pharmacist, as a matter of business practice, the pharmacist may write certain information right on the prescription. This may also be mandated by legislation (see Exhibit D). Information such as the actual manufacturer of the drug and the date the medication was dispensed may be written right onto the prescription. Legislation may require the pharmacist sign the prescription. In computerized pharmacies, all such information is printed and stapled to the prescription. Sometimes such information is printed onto labels and the labels affixed right onto the prescription. When filled by the pharmacist, prescriptions are typically assigned a "prescription number" (often abbreviated "Rx#" in the US) that is unique to the pharmacy that filled the prescription. The prescription number is written right on the prescription by the pharmacist. The prescription number has the practical purpose of uniquely identifying the prescription later on while filed (both manual and electronic). The prescription number is also put on the label on the dispensed medication. The patient may be required to reference the prescription number for refills and drug

insurance claims. There may also be a legal requirement for prescription numbers for subsequent identification purposes. As a legal document, some jurisdictions will mandate the archiving of the original paper prescription in the pharmacy. Often the patient cannot take the original prescription with them. Some jurisdictions may entitle patients to a copy. The retention period varies but can be as long as six years. See Exhibit B for sample legislation governing the archiving of prescriptions. Once the retention period has passed, privacy legislation may dictate what can be done with the original paper prescription. Legislation may also dictate what happens to the prescriptions if the pharmacy closes or is sold. For example, if the pharmacy goes out of business, the pharmacist may be required to return the prescription to the patient, to the next closest pharmacy or to the governing body for pharmacists. Prescriptions for non-narcotic drugs may also be "transferred" from one pharmacy to another for subsequent repeats to be dispensed from another pharmacy. The physical piece of paper that is the prescription is not transferred, but all the information on it is transferred from one pharmacy to another. Legislation may dictate the protocol by which the transfer occurs and whether the transfer needs to be noted on the original paper prescription. It is estimated that 3 billion (3 thousand million) prescriptions were written in the United States in 2002[10]. This number has grown from 1.5 billion in 1989 and is expected to continue to grow. [edit] Forgeries and prevention Prescriptions are sometimes forged because many narcotics are cheaper and safer as prescription drugs than as street drugs. Forgery takes many forms: Prescription pads are sometimes stolen, amounts may be altered on legitimate prescriptions, call back numbers may be falsified and phoned or faxed prescriptions faked [11]. Some medical practitioners will use prescription pads that contain similar security measures as checks to make photocopying prescriptions harder. These security measures may be mandated by lawsee Exhibit C for sample legal specifications. Legislation may mandate that only certain printers may print prescriptions [12][dead link]. New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks."[13][dead link] (See Exhibit E.) Prescribers can make it harder for amount forgeries by writing out the amounts in words. Again, this may be mandated by law[14][dead link]. Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs [15][dead link]. Blank triplicates are only available from the regulating agency and are individually numbered. The medical practitioner retains a copy, the second and third copies are given to the patient to give to the pharmacist. The pharmacist retains the second copy and the third copy is submitted to the regulating agency. The regulating agency can issue lists of forged prescriptions that pharmacists can check. In this example, the prescription's validity is further limited to 72 hours from issuance. California has recently replaced triplicate forms with new forms that are impossible to photocopy or fax: the background is printed with repetitions of the word void in a color that shows up as black on a photocopy. States have various laws making theft of prescription blanks or forgery of prescriptions criminal offenses and/or providing special treatment for these offenses (for Example N.J. Stat. 2C:21-1. making forgery of a prescription blank a third degree rather than fourth degree offense).[16] When forgery is suspected, pharmacists will call the medical practitioner to verify the prescription. Forged prescriptions are no longer considered medical documents and doctorpatient confidentiality rules no longer apply.

[edit] Writing prescriptions [edit] Who can write prescriptions Who can issue prescriptions is governed by local legislation. In the United States medical practitioners, veterinarians, dentists, and podiatrists have prescribing power. In addition, clinical pharmacists are allowed to prescribe in some states through the use of a drug formulary or collaboration agreements. In all states, optometrists prescribe medications to treat certain eye diseases, and also issue spectacle and contact lens prescriptions for corrective eyewear.[17] States allow registered certified physician assistants (also known as physician associates or PAs) prescription powers in all 50 states. Several states have passed RxP legislation, allowing clinical psychologists (PhD's or PsyD's) who are registered as medical psychologists and have also undergone specialized training in script-writing to prescribe a limited number of drugs to treat emotional and mental disorders. [edit] Legibility Prescriptions, when handwritten, are notorious for being often illegible. In the US, medical practitioners' sloppy handwriting kills more than 7,000 people annually, according to a July 2006 report from the National Academies of Science's Institute of Medicine (IOM).[18] Historically, physicians used Latin words and abbreviations to convey the entire prescription to the pharmacist. Today, many of the abbreviations are still widely used and must be understood to interpret prescriptions. At other times, even though some of the individual letters are illegible, the position of the legible letters and length of the word is sufficient to distinguish the medication based on the knowledge of the pharmacist. When in doubt, pharmacists call the medical practitioner. Some jurisdictions have legislated legible prescriptions (e.g. Florida [19]). Some have advocated the elimination of handwritten prescriptions altogether [20] and computer printed prescriptions are becoming increasingly common in some places. [edit] Conventions for avoiding ambiguity Over the years, prescribers have developed many conventions for prescription-writing, with the goal of avoiding ambiguities or misinterpretation.[21] [22] [23] These include: Careful use of decimal points to avoid ambiguity: Avoiding unnecessary decimal points: a prescription will be written as 5 mL instead of 5.0 mL to avoid possible misinterpretation of 5.0 as 50. Always using zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation of .5 as 5. Avoiding trailing zeros on decimals: e.g. 0.5 instead of .50 to avoid misinterpretation of .50 as 50. Avoiding decimals altogether by changing the units: 0.5 g is less easily confused when written as 500 mg. "mL" is used instead of "cc" or "cm" even though they are technically equivalent to avoid misinterpretation of 'c' as '0' or the common medical abbreviation for "with" (the Latin "cum"), which is written as a 'c' with a bar above the letter. Further, cc could be misinterpreted as "c.c.", which is an uncommonly used abbreviation for "take with meals" (the Latin "cum cibum"). Directions written out in full in English (although some common Latin abbreviations are listed below). Quantities given directly or implied by the frequency and duration of the directions. Where the directions are "as needed", the quantity should always be specified.

Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication. The use of permanent ink. Avoiding unspecified prn or "as needed" instructionsinstead, specific limits and indicators are provided e.g. "every 3 hours prn pain." For refills, the minimum duration between repeats and number of repeats should be specified. Providing the indication for all prescriptions even when obvious to the prescriber, so that the pharmacist may identify possible errors. Avoiding units such as "teaspoons" or "tablespoons." Writing out numbers as words and numerals ("dispense #30 (thirty)") as in a bank draft or cheque. The use of apothecary/avoirdupois units and symbols of measure -- pints (O), ounces (), drams (), scruples (), grains (gr), and minims () -- is discouraged given the potential for confusion. For example, the abbreviation for a grain ("gr") can be confused with the gram, abbreviated g, and the symbol for minims (), which looks almost identical to an 'm', can be confused with micrograms or meters. Also, the symbols for ounce () and dram () can easily be confused with the numeral '3', and the symbol for pint (O) can be easily read as a '0'. Given the potential for errors, metric equivalents should always be used. The use of the degree symbol (), which is commonly used as an abbreviation for hours (e.g., "q 2-4" for every 2 - 4 hours), should not be used, since it can be confused with a '0'. Further, the use of the degree symbol for primary, secondary, and tertiary (1, 2, and 3) is discouraged, since the former could be confused with quantities (i.e. 10, 20 and 30, respectively). [edit] Abbreviations See list of abbreviations used in medical prescriptions. Many abbreviations are derived from Latin phrases. Hospital pharmacies have more abbreviations, some specific to the hospital. Different jurisdictions follow different conventions on what is abbreviated or not. Prescriptions that don't follow area conventions may be flagged as possible forgeries. Some abbreviations which are ambiguous, or which in their written form might be confused with something else, are not recommended and should be avoided. These are included in a separate list in Appendix 1. However, all abbreviations carry an increased risk for confusion and misinterpretation and should be used cautiously. [edit] Non-prescription drug prescriptions Prescriptions are also used for things that are not strictly regulated as a prescription drug. Prescribers will often give non-prescription drugs out as prescriptions because drug benefit plans may reimburse the patient only if the over-the-counter medication is taken under the direction of a medical practitioner. Conversely, if a medication is available over-the-counter, prescribers may ask patients if they want it as a prescription or purchase it themselves. Pharmacists may or may not be able to price the medication competively with over-the-counter equivalents. If the patient wants the medication not under prescription, the prescriber is usually careful to give the medication name to the patient on a blank piece of paper to avoid any confusion with a prescription. This is applied to non-medications as well. For example, crutches, and registered massage therapy may be reimbursed under some health plans, but only if given out by a prescriber as a prescription.

Prescribers will often use blank prescriptions as general letterhead. Legislation may define certain equipment as "prescription devices"[24]. Such prescription devices can only be used under the supervision of authorized personnel and such authorization is typically documented using a prescription. Examples of prescription devices include dental cement (for affixing braces to tooth surfaces), various prostheses, gut sutures, sickle cell tests, cervical cap and ultrasound monitor. In some jurisdictions, hypodermic syringes are in a special class of their own, regulated as illicit drug use accessories [25] separate from regular medical legislation. Such legislation will often specify a prescription as the means by which one may legally possess syringes. [edit] Related usage of the term prescription Prescription may also be used as a short form for prescription drugs to distinguish from overthe-counter drugs. In reference to the entire system of controlling drug distribution (as opposed to illicit drugs), "prescription" is often used as a metaphor for healthy directions from a prescribing medical practitioner. A "green prescription" is direction from a medical practitioner to a patient for exercise and healthy diet. [edit] History The concept of prescriptions dates back to the beginning of history. So long as there were medications and a writing system to capture directions for preparation and usage, there were prescriptions [26]. Modern prescriptions are actually "extemporaneous prescriptions" from the Latin (ex tempore) for "at/from time" [27]. "Extemporaneous" means the prescription is written on the spot for a specific patient with a specific ailment. This is distinguished from a non-extemporaneous prescription which is a generic recipe for a general ailment. Modern prescriptions evolved with the separation of the role of the pharmacists from that of the physician [28]. Today the term "extemporaneous prescriptions" is reserved for "compound prescriptions" which requires the pharmacist to mix or "compound" the medication in the pharmacy for the specific needs of the patient. Predating modern legal definitions of a prescription, a prescription traditionally is composed of four parts: a "superscription", "inscription", "subscription" and "signature" [29]. The superscription section contains the date of the prescription and patient information (name, address, age, etc). The symbol "" separates the superscription from the inscriptions sections. In this arrangement of the prescription, the "" is a symbol for recipe or literally the imperative "take." This is an exhortation to the pharmacist by the medical practitioner, "I want the patient to have the following medication" [30] - in other words, "take the following components and compound this medication for the patient." The inscription section defines what is the medication. The inscription section is further composed of one or more of[31]: a "basis" or chief ingredient indended to cure (curare) an "adjuvant" to assist its action and make it cure quickly (cito) a "corrective" to prevent or lessen any undesirable effect (tuto) a "vehicle" or "excipient" to make it suitable for administration and pleasant to the patient (jucunde) The "subscription" section contains dispensing directions to the pharmacist. This may be compounding instructions or quantities.

The "signature" section contains directions to the patient [32] and is often abbreviated "Sig." [33] or "Signa." It also obviously contains the signature of the prescribing medical practitioner though the word "signature" has two distinct meanings here and the abbreviations are sometimes used to avoid confusion. Thus sample prescriptions in modern textbooks are often presented as: : medication Disp.: dispensing instructions Sig.: patient instructions [edit] Use of Technology As a prescription is nothing more than information among a prescriber, pharmacist and patient, information technology can be applied to it. Existing information technology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within the hospital. There are proposals to securely transmit the prescription from the prescriber to the pharmacist using smartcard or the internet.[34] In the United Kingdom a project called the Electronic Transfer of Prescriptions (ETP) within the National Programme for IT (NPfIT) is currently piloting such a scheme between prescribers and pharmacies. Within computerized pharmacies, the information on paper prescriptions is recorded into a database. Afterward, the paper prescription is archived for storage and legal reasons. A pharmacy chain is often linked together through corporate headquarters with computer networking. Walgreens, for example, uses satellite technology to share patient information. A person who has a prescription filled at one Walgreens can get a refill of that prescription at any other store in the chain, as well as have their information available for new prescriptions at any Walgreens. Some online pharmacies also offer services to customers over the internet. Walgreens' web site, for example, allows customers to order refills for medicine over the internet, and allows them to specify the store that they will pick up the medicine from. Their web site also allows consumers to lookup their prescription history, and to print it out. Many pharmacies now offer services to ship prescription refills right to the patient's home. CVS, for example, will ship refills free of charge. They also offer mail service where you can mail in a new, original prescription and a signed document, and they will ship the filled prescription back to you. Pharmacy information systems are a potential source of valuable information for pharmaceutical companies as it contains information about the prescriber's prescribing habits. Prescription data mining of such data is a developing, specialized field.[35] Many prescribers lack the digitized information systems that reduce prescribing errors.[36] To reduce these errors, some investigators have developed modified prescription forms that prompt the prescriber to provide all the desired elements of a good prescription. The modified forms also contain pre-defined choices such as common quantities, units and frequencies that the prescriber may circle rather than write out. Such forms are thought to reduce errors, especially omission and handwriting errors and are actively under evaluation. (See: Kennedy AG, Littenberg B. A Modified Outpatient Prescription Form to Reduce Prescription Errors. Joint Commission Journal of Quality and Safety 2004; 30:480-487.) [edit] Exhibit A: sample legal definition of a prescription Taken from California's Business and Professions Code Section 4040 [37]:

4040. (a) "Prescription" means an oral, written, or electronic transmission order that is both of the following: (1) Given individually for the person or persons for whom ordered that includes all of the following: (A) The name or names and address of the patient or patients. (B) The name and quantity of the drug or device prescribed and the directions for use. (C) The date of issue. (D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, his or her license classification, and his or her federal registry number, if a controlled substance is prescribed. (E) A legible, clear notice of the condition for which the drug is being prescribed, if requested by the patient or patients. (F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, or physician assistant who issues a drug order pursuant to Section 2746.51,2836.1, or 3502.1. (2) Issued by a precribing medical practitioner if a drug order is issued pursuant to Section 2746.51, 2836.1, or 3502.1. (b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name and address of the patient in a manner consistent with paragraph (3) of subdivision (b) of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail. (c) "Electronic transmission prescription" includes both image and data prescriptions. "Electronic image transmission prescription" means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber. "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy. (d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription. (e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device. [edit] Exhibit B: sample legal requirement for storage of prescriptions From the Mississippi Board of Pharmacy [38]: ARTICLE XIII PRESCRIPTIONS TO BE FILED 1. All prescriptions shall be filed in one of the following ways: A. Three separate files may be maintained; a file for Schedule II prescriptions dispensed; a file for Schedule III, IV and V prescriptions dispensed; and a file for all other prescriptions dispensed. B. Two files may be maintained; a file for all Schedule II prescriptions dispensed and another file for all other prescriptions dispensed, including those in Schedule III, IV and V. If this method is used, the prescriptions for Schedule III, IV and V substances must be stamped with the letter "C" in red ink, not less than one inch high, in the lower right-hand corner. This distinctive

marking makes the records readily retrievable for inspection. Pharmacies with automatic data processing systems are exempted from marking Schedule III, IV and V controlled substance prescriptions with the red "C". 2. A hard copy of original prescriptions, whether records are maintained manually or in a data processing system, shall be assigned a serial number and maintained by the pharmacy in numerical and chronological order. All prescriptions shall be maintained for at least five years from the date of original dispensing. 3. If a pharmacy utilizes a data processing system for record keeping, all computer generated labels should be affixed to the prescription document in such a manner as not to obscure information on the face of the document. [edit] Exhibit C: sample legal requirements for security and format From Indiana Board of Pharmacy [39]: 856 IAC 1-34-2 Security feature requirements Authority: IC 35-48-7-8 Affected: IC 16-42-19-5 Sec. 2. (a) All controlled substance prescriptions written by licensed Indiana practitioners, as defined by IC 16-42-19-5, must contain the following security features: (1) A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied. (2) There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five lines on the back of the document using 12-point Helvetica bold type style. (3) An opaque RX symbol must appear in the upper right-hand corner, one-eighth (1/8) of an inch from the top of the pad and five-sixteenths (5/16) of an inch from the right side of the pad. The symbol must be three-fourths (3/4) inch in size and must disappear if the prescription copy is lightened. (4) Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid: (A) 1-24 (B) 25-49 (C) 50-74 (D) 75-100 (E) 101-150 (F) 151 and over. (5) No advertisements may appear on the front or back of the prescription blank. (6) Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank. (7) Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad: "Prescription is void if more than one (1) prescription is written per blank.". (8) Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order: Refill NR 1 2 3 4 5 Void after_____.

(9) Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription. (10) All prescription blanks printed under this rule shall be four and one-fourth (4-1/4) inches high and five and one-half (5-1/2) inches wide. (b) Nothing in this rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions for the prescribing of any legend drug. (Indiana Board of Pharmacy; 856 IAC 1-342; filed Jul 5, 1995, 9:45 a.m.: 18 IR 2782, eff Jan 1, 1996) [edit] Exhibit D: sample requirements on information added by the pharmacist Taken from the Ontario's Drug and Pharmacies Regulation Act [40], paragraph 156. (1) Every person who dispenses a drug pursuant to a prescription shall ensure that the following information is recorded on the prescription, (a) the name and address of the person for whom the drug is prescribed; (b) the name, strength (where applicable) and quantity of the prescribed drug; (c) the directions for use, as prescribed; (d) the name and address of the prescriber; (e) the identity of the manufacturer of the drug dispensed; (f) an identification number or other designation; (g) the signature of the person dispensing the drug and, where different, also the signature of the person receiving a verbal prescription; (h) the date on which the drug is dispensed; (i) the price charged. R.S.O. 1990, c. H.4, s. 156 (1). [edit] Exhibit E: New Jersey requirements for prescription blanks From New Jersey official statutes:[41] 45:14-55 Use of New Jersey Prescription Blanks. 16. a. A practitioner practicing in this State shall use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks bearing that practitioner's license number whenever the practitioner issues prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. b. A licensed practitioner practicing in this State shall maintain a record of the receipt of New Jersey Prescription Blanks. The practitioner shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the practitioner's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action, including notification to the Department of Human Services and the Attorney General. 45:14-56 Health care facility prescriptions. 17. a. Prescriptions issued by a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be written on non-reproducible, non-erasable safety paper New Jersey Prescription Blanks. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. The New Jersey Prescription Blanks shall bear the unique provider number assigned to that health care facility for the issuing of prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. b. A health care facility shall maintain a record of the receipt of New Jersey Prescription Blanks. The health care facility shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey

Prescription Blank in the facility's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action including notification to the Department of Human Services and the Attorney General. 45:14-57 Requirements for prescription to be filled. 18.A prescription issued by a practitioner or health care facility licensed in New Jersey shall not be filled by a pharmacist unless the prescription is issued on a New Jersey Prescription Blank bearing the practitioner's license number or the unique provider number assigned to a health care facility. 45:14-59 Format for New Jersey Prescription Blanks. 20.The Division of Consumer Affairs in the Department of Law and Public Safety shall establish the format for uniform, non-reproducible, non-erasable safety paper prescription blanks, to be known as New Jersey Prescription Blanks, which format shall include an identifiable logo or symbol that will appear on all prescription blanks. The division shall approve a sufficient number of vendors to ensure production of an adequate supply of New Jersey Prescription Blanks for practitioners and health care facilities statewide.