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PHARMACOLOGY
1.1A PRESCRIPTION WRITING
PRESCRIPTION
A physician's written order for one or more medicinal agents,
together with his directions to the pharmacist for their
preparation, and to the patient, for their use.
Cary Eggleston, MD 1913
Any recommendation, written or verbal, by a physician to a
patient for any remedial measure, be it medicinal, dietary,
physical exercise, change of climate, etc.
WHO:
- Instruction from a prescriber to a dispenser
- Prescriber
> Not always a doctor
> Paramedical worker: medical assistant, midwife, nurse
Dispenser
> Not always a pharmacist
> Pharmacy technician, assistant or nurse
No gold standard
Clear
Legible
Indicate precisely what should be given
Local language is preferred
Format
- Written
- Verbal
- Electronic

PRESCRIBING
A complex task requiring:
- Diagnostic skills
- Knowledge of medicines
- Understanding of the principles of clinical pharmacology
- Communication skills
- Appreciation of risk and uncertainty

- The prescriber and the patient should agree on the health


outcomes and the strategy for achieving them.
- Consider religious, cultural and personal beliefs that may
affect acceptance of medicines.
- Keep drug regimes simple and review regularly
- Combination treatments only if benefits outweigh risks

PRESCRIBER RESPONSIBILITIES
Prescribe only medicines that you are competent to prescribe
Prescribe only medicines if they are necessary
Prescribe only if benefits of medication outweigh the risks
Discuss treatment options with the patients
Indicate likely/degree of benefit, onset and duration
Discuss side-effects/tolerability
PRESCRIPTION
Concordance

PRESCRIPTION DRUG
Drug that requires a prescription because it is considered
potentially harmful if not used under the supervision of a
licensed health care practitioner
Legend drug - the label of the drug bears the legend, Caution:
Federal Law Prohibits Dispensing without a Prescription or Rx
only (US)
CONTROLLED DRUG
Or scheduled drug
- A prescription drug whose use and distribution is tightly
controlled by the government because of its abuse potential or
risk
- Classified into schedules
> Schedules CI, CII, CIII, CIV, and CV
Prescriptions for controlled substances have additional
requirements by law
Classified (by law) based on their benefit when used in medical
treatment and their harm if misused
Require: proof of identity
Validity: schedules 2,3,4 - 28 days
Schedules 2 and 3:
- Name and what form its in
- Strength and dose
- Total quantity or number of doses, shown in both words and
figures
SCHEDULE I (C-1) - HIGHEST ABUSE RISK
No currently accepted medical use
A lack of accepted safety for use under medical supervision
High potential for abuse
Ex: heroin, marijuana, LSD, PCP, and crack cocaine. cannabis
and cannabisresin and mescaline, peyote, methaqualone, and
3,4-methylenedioxymethamphetamine ("Ecstasy")
Only certain persons have been licensed to possess them for
research and other special purposes in the public interest

SCHEDULE II (C-II) - HIGHEST ABUSE RISK BUT HAVE A SAFE &


ACCEPTED MEDICAL USE

May lead to severe psychological or physical dependence

Examples of Schedule II narcotics: hydromorphone


methadone, meperidine, oxycodone, fentanyl, morphine,
opium, and codeine

Ex Schedule II stimulant: amphetamine, methamphetamine,


and methylphenidate

Amobarbital, glutethimide, and pentobarbital


SCHEDULE III (C-III) - ABUSE RISK LESS THAN C-II AND SAFE &
ACCEPTED MEDICAL USE

Abuse may lead to moderate or low physical dependence or


high psychological dependence

Ex of Schedule III narcotics: combination products containing


less than 15 milligrams of hydrocodone per dosage unit,
products containing not more than 90 milligrams of codeine per
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Pharmacology

1.1A PRESCRIPTION WRITING

dosage unit (acetaminopehn with codein), buprenorphine,


propoxyphene
Ex of Schedule III non-narcotics: benzphetamine,
phendimetrazine, ketamine, and anabolic steroids

SCHEDULE IV (C-IV) - ABUSE RISK LESS THAN C-III AND SAFE AND
ACCEPTED MEDICAL USE

Part 1 (CD Benzodiazepines)

Part 2 (CD Anabolic Steroids

Subject to lesser control

Invoices must be retained for two years.


SCHEDULE V (C-V) - ABUSE RISK LESS THAN C-IV & SAFE &
ACCEPTED MEDICAL USE

Mainly consist of preparations containing limited quantities of


certain stimulant and narcotic drugs for antitussive and
antidiarrheal purposes

Ex of Schedule V substances: cough preparations containing


not more than 200 milligrams of codeine per 100 milliliters or
per 100 grams

CONTROLLED DRUGS
ADDITIONAL LAW REQUIREMENTS
Prescribers Responsibilities
- Patients complete Name, Address (including city, state, zip
code), and age or DOB
- Date the prescription is written (can not be post-dated)
- Controlled substance prescribed
- Quantity of drug, written numerically and as a word
- Indication, if not deemed detrimental
- Preference for brand, if necessary

PARTS OF A PRESCRIPTION
Date
Name of patient, information
Superscription
Inscription
Subscription
Transcription
Name of prescriber

SUPERSCRIPTION
Rx
recipere to take

PRESCRIPTION WRITING
Professional privilege
Clinical responsibility
WHO CAN WRITE PRESCRIPTIONS
Practitioners
- Physicians, Vets, Dentists
Mid-level practitioners
- Nurse practitioners, physician assistants, optometrists,
pharmacists
INFORMATION ON A PRESCRIPTION
Name and address of prescriber , tel no
Date
Name and strength of drug
Dosage form and total amount
Information for the package label
Prescribers initial or signature
Name and address of patient; age for children and elderly

INSCRIPTION
Body of the prescription
Official name/s of the drugs
Ingredients (plus solvents, diluents, coloring or flavoring
agents, or other vehicle as may be requisite or desired for the
perfection of the preparation
Approved medicine name:
- Dosage strength
- Route of administration or dosage form
- Frequency of administration or dosing interval
International Nonproprietary Name (INN) of the drug should
always be used
- The trade name can be added
- Generic substitution allowed in some countries
- The pharmaceutical form: ex tablet, oral solution, eye
ointment) should also be stated
Strength of the drug: stated in standard units using
abbreviations that are consistent with the Systme International
(SI)
- Microgram and nanogram should not be abbreviated
- units should not be abbreviated
- Avoid decimals whenever possible
- If this is unavoidable, a zero should be written in front of the
decimal point.

Name of drug: USE WITH CAUTION:


- Look Alike/Sound Alike drug names
> Massive number of new drug releases
> Massive number of reformulations
> Drug marketing strategy
- Build on established names
- New combination drugs Use converged names

AccuprilAccutane
AccuprilMonopril
Acetazolamide.......Acetohexamide
Adderall..Inderal
Amantadine..Ranitidine
Amantadine..Rimantidine
Azithromycin..Erythromycin
CalciferolCalcitriol
Carboplatin..Cisplatin
ChlorpromazineChlorpropamide
ChlorpromazineProchlorperazine

Drug:
- Similar overlapping strengths (100 mg and 200 mg)
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Pharmacology

1.1A PRESCRIPTION WRITING

- Similar dosage forms (tablets)


- Similar dosing interval
- Similar titration schedule
- Often stocked in close proximity on pharmacy shelf

Drug: AVOID THE USE OF:


- Abbreviations
> HCTZ for hydrochlorothiazide
> MSO4 for morphine sulfate
Drug strength
- Be familiar with drugs and their various dosing strengths and
dosage forms
- Be familiar with dosing units and their corresponding
abbreviations
- Weight based dosing
> Always convert patient weight to correct units
- Liquid medications
> One product may be available in a number of
concentrations
> Indicate BOTH concentration and dose of medication
Ex. Cephalexin suspension 125 mg/5 mL
- Decimal points
> Avoid trailing zeros.
EX. 5 mg vs. 5.0 mg; can be mistaken for 50 mg or
> 0.7 g vs. .70 g; can be mistaken for 70 g
- Always use leading zeros.
EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml
Drug Quantity
- Prescribe only the necessary quantity
- Write for specific quantities rather than time period
EX: dispense #30 vs. dispense for 1 month
- Calculate: quantity = frequency per day x treatment days
- Writing out Dispense # X is helpful
SUBCRIPTION
Necessary directions to the pharmacist for the proper
preparation or compounding of the several ingredients for use
by the patient
TRANSCRIPTION
Necessary directions to the patient for his use of the drug
Signatura: S., Sig., Signa
Should include
- Size of the dose,
- Frequency of its repetition,
- Necessity for its dilution or other modification
- Other information as may be needed to guide the patient in its
safe and proper use
Direction for use
- Write out in full English
- Avoid Dangerous Abbreviations
- Provide clear and specific directions
> Avoid Take as Directed.
Indication
- Encouraged, seldom practiced
- Helps confirm appropriateness of medication
- Reminds patient of drugs purpose
- Facilitates communication between health care providers

REFILL
Not required
Important to avoid interrupting maintenance therapy
Non-controlled substances
- No limit to number of refills allowed

LIST OF DANGEROUS ABBREVIATIONS


ABBREVIATION
POTENTIAL
PREFERRED TERM
PROBLEM
U (unit)
Mistaken as zero,
Write unit
four, or cc
IU (international unit)

Mistaken as IV or 10

Write international
unit

Q.D., Q.O.D.

Mistaken for each


other. Period after Q
and O after Q can be
mistaken for I

Write daily and


every other day

Trailing zero and


lack of leading zero

Decimal point
missed

Never write a zero


by itself after a
decimal point, and
always use a zero
before a decimal
point

MS, MSO4, MgSO4

Confused for one


another

Write morphine
sulfate or
magnesium sulfate

H.S. (at bedtime or


half strength)

Mistaken for either


meaning: Also
mistaken for every
hour

Write out half


strength or at
bedtime

T.I.W (three times a


week)

Mistaken for three


times a day or twice
weekly

Write three times


weekly or 3 times
weekly

S.C. or S.Q.
(subcutaneous)

Mistaken for SL for


sublingual or 5
every

Write Sub-Q or
subQ or
subcutaneously

c.c.

Mistaken for U
(units) when poorly
written

Write ml for
milliliters

A.S., A.D., A.U.


(Latin abbrev for left,
right, both ears)
O.S., O.D., O.U.
(Latin abbrev for left,
right, both eyes)

Mistaken for each


other (A.S. for O.S.,
A.D. for O.D., A.U.
for O.U., visa versa)

Write out left ear or


right ear or both
ears
Write out left eye or
right eye or both
eyes

PRESCRIPTION INFORMATION
Prescriber Name, with contact details
- Date of prescription;
- Patient
> Name and/or registration number
> Date of Birth and/or Age, especially for children older
persons
Approved medicine name
- Dosage strength
- Route of administration or dosage form
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Pharmacology

1.1A PRESCRIPTION WRITING

- Frequency of administration or dosing interval


Duration of therapy or duration of supply
Signature and initials of prescriber
Prescriber name, contact details: allow either the patient or the
dispenser to contact the prescriber for any clarification or
potential problem with the prescription
Date of the prescription: in many countries, the validity of a
prescription has no time limit, but in some countries
pharmacists do not dispense drugs on prescriptions older than
36 months
GUIDE TO PRESCRIPTION WRITING
ALWAYS write legibly in ink or other indelible
ALWAYS sign & date the prescription
NEVER abbreviate drug names
NEVER use proprietary names
ALWAYS use generic names
PREFERABLY use plain English for dosing directions
TIPS FOR PREVENTING MEDICATION ERRORS
Limit each prescription to one medication
Approach medication names with caution
(www.usp.org/reporting/review/rev_066a. htm)
Eliminate drug abbreviations
Use metric measures for dosages.
Add the patients age (or weight) to the prescription.
Avoid writing as directed.
Eliminate abbreviations in routes of administration
Specify the therapeutic duration
Prescribe specific quantities rather than dispensing for time
periods
Remain cognizant of lethal doses of medications
Specify the indication
Write additional instructions about side effects
When writing individual dose:
- for STRENGTHS >1g use grams
- for STRENGTHS <1g use millgrams e.g. 100 mg
- for STRENGTHS <1mg use micrograms e.g. 100 microgram
(NEVER use 'g')
- AVOID unnecessary decimal points e.g. use 300 mg NOT
0.3 g

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END OF TRANX

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