Prescription Writing

maria Stella T. Giron, MD, PhD

Department of Pharmacology
EAC School of Medicine
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
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
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
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
 Controlled Drugs
Schedule I (C-I) 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) High abuse risk but have safe and 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 and
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 dosage unit (acetaminopehn
with codein), buprenorphine, propoxyphene
Ex of Schedule III non-narcotics: benzphetamine,
phendimetrazine, ketamine, and anabolic steroids
Controlled Drugs

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 and safe and 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
Prescription Writing

Professional privilege
Clinical responsibility
Who Can Write Prescriptions

Practitioners
Physicians, veterinarians, 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
Source: WHO
Parts of a Prescription

Date
Name of patient, information
Superscription
Inscription
Subscription
Transcription
Name of prescriber
Superscription

Rx
recipere to take
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.
Inscription
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
Inscription

Drug:
Similar overlapping strengths (100 mg and
200 mg)
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
 Drug Strength
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
 Drug Strength
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
Subscription

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
 Example: List of Dangerous Abbreviations

Abbreviation Potential Problem Preferred Term

U (unit) Mistaken as zero, four, or Write unit
cc

IU (international Mistaken as IV or 10 Write international unit

unit)

Q.D., Q.O.D. Mistaken for each other. Write daily and every other
Period after Q and O after day
Q can be mistaken for I
Trailing zero and Decimal point missed Never write a zero by itself after
lack of leading a decimal point, and always use
zero a zero before a decimal point
 ABBREVIATON POTENTIAL PROMBLEM PREFERRED TERM
MS, MSO4, MgSO4 Confused for one another Write morphine sulfate
or magnesium sulfate
H.S. (at bedtime or Mistaken for either Write out half strength
half strength) meaning: Also mistaken for or at bedtime
every hour
T.I.W (three times a Mistaken for three times a Write three times
week) day or twice weekly weekly or 3 times
weekly
S.C. or S.Q. Mistaken for SL for Write Sub-Q or subQ
(subcutaneous) sublingual or 5 every or subcutaneously
 ABBREVIATON POTENTIAL PROMBLEM PREFERRED TERM
c.c. Mistaken for U (units) Write ml for
when poorly written milliliters
A.S., A.D., A.U. Mistaken for each other Write out left ear or
(Latin abbrev for (A.S. for O.S., A.D. for right ear or both
left, right, both O.D., A.U. for O.U., visa ears
ears) versa) Write out left eye or
O.S., O.D., O.U. right eye or both
(Latin abbrev for eyes
left, right, 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
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 writing prescription

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.
TIPS, cont.

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