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PRESCRIPTION ORDER WRITING

Prescription order
Superscription
Inscription
Subscription
Signa or Sig

A sample prescription order


Date ________ DEA # ______________

XXXXX M.D
-------------------
-------------------
-------------------
Phone -----------
Name__________ Age ___________
Address ________ weight _________
_______________
_______________

R
Losartan 50 mg tablets

Dispense # 30

Sig: Take one by mouth daily


For control of Blood Pressure

Refill _____ times


Do not substitute signature
_____________M.D
R is physician’s appeal to God Jupitor for success of prescription
Latin word Recipere, take, take thou, take thus

Heading: Physician’s name, address, Phone


DEA or Registration number [especially for controlled substance]

Components of prescription order


Superscription: Name, address, weight, age of patient & R
Inscription : Body of Prescription
Compound: Name, strength of each ingredient of compound
Dispense: Name & amount or strength of Drug
Subscription: Instruction to Pharmacist
Like “make a solution”
Mix & Place into 30 Caps
Dispense 30 tabs
Signa or sig: Instruction for patient, to take the prescription order, get interpreted & transposed
onto the prescription label by the Pharmacist
Prescription order used to be abbreviations, Latin words are mystifying
Latin is no more Intertnational Language of Medicine
Physician’s intent to be conveyed to Pharmacist like intended purpose of medication
Eg: for relief of pain
To relieve itching

Reinforce route of administration


Take / give oral
Apply External application
Insert suppositories
Place [instill] eye, ear, nose, drops

Avoid confusion in measures


15 minims = 1 ml
1 grain = 60 mg
Use only metric system
ug = mcg or microgram
mg = milligram
0.X milligram [correct]
X.0 milligram [incorrect]
Dropperful [calibrated dropper]
15 mg [0.6 ml] three times a day
Teaspoon = 5 ml
Tablespoon = 15 ml
U / IU = units or International Units

Avoid abbreviation
OD = once a day
BD OR BID = twice a day
TD OR TID = thrice a day
QD or QID = four times a day
QS = quantity sufficient [total dose]

1g give 4 times a day


250 mg 4 times a day

Prescription order is written in ink esply prescriptions for drugs under Controlled Substance Act
Date is important
Prescription order for opioid broughjt 2 weeks after the date is not valid
Controlled substance: dated, signed on, day issued, rtefills
Non CS : one month refill / till next visit
No refills – 0

Brand name
MfR’s Proprietary name
Trade name
Trade mark

Generic name
US adopted name

Pharmacist: authority to dispense generic drugs


Esply when generic drugs meet the same bioequivalence standards as their
brand name counterparts
Unless “Do Not Substitute” order is given

Medical Errors
Approx 50000 deaths annually
3% in hospital, pediatric, neonatal, intensive care units
Minimize medication order errors
Proper communication with patient, pharmacist & other Health Care
professionals

All orders in metric measurements


Arabic numerals rather than Roman numerals
Use leading 0s, not trailing 0s
Avoid abbrevation of drug names
Avoid abbrevation of directions for drug administration
Care with drug names sounding alike [spoken or spelling]
750 such pairs identified [alliterative drug names]
Problematic esply verbal orders
Patient’s diagnosis on prescription order / therapeutic purpose
Poor handwriting

Compliance
Extent to which the patient follows a regimen prescribed by health care
professionals
Patient is final & most important determinant of successful therapy regiment
Compliance, adherence, therapeutic alliance, concordance [agreement]
Doctor – Patient interaction
Doctor as a medical expert has a therapeutic goal
Patient is an expert on himself, his beliefs, values & life styles
Goals may differ, but patient has last word

Therapeutic failure
Error in dosage
Error in schedule
Underuse
Overuse
Termination of therapy
Not refilling

Patient expectation
Clinical, interpersonal relation
Communication
Patient habits
Daily routines
Life style [nigjht shift]
Drug Advertisements
FDA permits print / TV advertising for even prescription drugs
Regardless of target audience
Ad to include effectiveness, side effects & contradictions
Ad to direct consumers to health care professionals
Print ad include risk related sections of package insert
Ad sometimes compromise physician’s ability to educate patients
Patients learn about drugs & interact with health care providers
Ads in print, TV, internet increased consumer demand
Increased number of prescription dispensing
Increased sales
Raised pharmaceutical costs to health insurers, Government, consumers
Patients’ counseling
Evidence based drug information service

Controlled Substances
To restrict to legitimate use
Federal controlled substance act [CSA]
Drug Enforcement Agency [DEA]
State & local acts also govern
Substances come under CSA are in 5 schedules

Schedule I
[Eg: Heroin, LSD, Methylene dioxy methamphetamine, Mescaline]
High potential for abuse
No medical use or not safe
Research use only

Schedule II
[Eg: Morphine, oxycodone, fentanyl, meperidine, d-amphetamine, cocaine,
amobarbital]
High potential for abuse
Medically used
Severe psychological or physical dependence
presigned blanks, oral orders [except emergency], refills not allowed

Schedule III
[Eg: anabolic steroids, nalorphine, ketamine, certain schedule II substances in
suppositories, mixtures, or in limited amounts]
Less potential for abuse
Medical use
Moderate to low physical dependence or high psychological dependence
telephonic orders, up to 5 refills allowed

Schedule IV
[Eg: alprazolam, phenobarb, meprobamate]
Less abuse potential
Medical use
Limited physical or psychological dependence
telephonic orders, up to 5 refills allowed

Schedule V
[Eg: buprenorphine, medication containing low doses of opioid plus a non-
narcotic ingredient [codeine, diphenoxylate, atropine]
Low abuse potential
Medical use
Some may be sold in limited amounts without prescription
no restriction on refills

Possessing drugs without prescriptions is criminal offense


Penalties depend on schedules & amount of drug
DEA registration number is must in prescription order
Not for doctors
Only to maintain addicts on drugs

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