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Pharmacology A – Laboratory 1.

1 [2015 David Gigawin, FEU Institute of Medicine]

STEPS IN RATIONAL PRESCRIBING Important Parts of the Prescription Form:

1. Make a specific diagnosis  Date when the prescription was written (5)
2. Consider pathophysiologic implications of the dx  Name, Address, and Age of the patient (6,7)
3. Select a specific therapeutic objective  Drug Name, Strength (dose), and Quantity* (8,9,10)
4. Select a drug of choice Weights and measure should always be written in metric system.
5. Determine the appropriate dosing regimen  Directions to pharmacist and patient
6. Devise a plan for monitoring the drug's action  Signature – completes the form
7. Determine an end point for therapy
8. Plan a program of patient education Rx stands for the Latin word recipe meaning "to take”. It is also similar to
the astrological sign for Jupiter probably to invoke the god's blessing
3 General Types of Prescriptions: for recovery.

1. Physician's order in the patient's chart SIG. is an old latin abbreviation used to start out the instructions line on
2. Written order to which the pharmacist refers the prescription. It means write on label.
3. Patient's medication container with a label affixed
Example:
On the basis of availability of the prescribed medication, orders may be
divided into two (2) Classes of Prescription Orders: - sig: 1 tablet twice a day (8AM, 8PM) with food
- sig: apply to rash every 4 hours or as needed for itching
1. Precompounded – as is, as supplied by pharmaceutical company;
pharmacist dispenses without pharmaceutical alteration. Note: Never write “sig. as directed”. It is a lazy physician's way of
saying "I already told the patient what to do with it, so I'm not
2. Extemporaneous (compounded) – physician selects the desired writing it down. The instructions are already in the packaging. The
drugs, dosage and form & the pharmacist mix/prepare the patient can just read it.” For pediatric patients, write “give” instead
medication. of “take”.

Common Types of Prescription Error

1. Omission of Information
- Common in hospital orders such “resume pre-op meds”,
“continue present IV fluids”
- Failure to discontinue drugs
- Failure to indicate indications for “as needed”

2. Illegible handwriting
- Misplaced or naked decimal point - .1 >> 0.1
- Unnecessary decimal point – 1.0 >> 10
- Abbreviation “U” for units – 10U >>100
- Unspecified units – one ampule, one vial

3. Inappropriate Drug Prescription


- Failure to recognize contraindications
- Failure to obtain information about other drugs being taken
- Failure to recognize incompatibilities between drugs

THE LAW ON PRESCRIBING DRUGS: RA 6675

Republic Act No. 6675: “The Generics Act of 1988”:

 Promote and require the use of generic terminology in the importation,


manufacture, distribution, prescription and dispensing of drugs

 Emphasize the scientific basis for the use of drugs, in order that health
professionals may become cognizant of the therapeutic effectiveness

 Ensure the adequate supply of drugs with generic names at the lowest
possible cost and endeavor to make them available free for indigent
patients
VIOLATIVE PRESCRIPTIONS include: *fill up everything: date, name, address, age of patient...

 Generic name is not written


 Generic name is not legible & the brand name is legible
 Brand name is indicated & instructions were added such as "no
substitution" w/c tend to prevent proper generic dispensing

Violative prescriptions shall not be filled and should be reported by the


pharmacist or any other interested party to the nearest DOH office for
appropriate action.

Penalties:
First conviction – reprimand, reported to PRC
Second conviction - fine of not less than P2,000
Third conviction – fine of P5,000-P10,000, 30days lic suspension Phenobarbital 60 mg/dose
Fourth & subsequent – fine >P10K, 1 year suspension or longer (Bellatal)
ERRONEOUS PRESCRIPTIONS include:
tab. # 20

 Brand name precedes the generic name Give one tab. twice a day for 10 days

 Generic name is the one in parenthesis


 Brand name is not in the parenthesis
 More than one drug product is prescribed on one form*

Erroneous prescription shall still be filled but it should be kept and


reported by the pharmacist to DOH for appropriate action.

IMPOSSIBLE PRESCRIPTIONS include:

 Only the generic name is written but is not legible


 Generic name does not correspond to the brand name Note: The patient will be given 120 mg/day in two divided doses, 60
 Both the generic and brand names are not legible mg per dose (1tab/dose).
 Drug product prescribed is not registered with FDA
Case 2: A 44-lb boy was prescribed Amoxicillin due to infection at
Impossible prescriptions shall not be filled and shall be confiscated by 50 mg/kg/day in 4 divided doses per day for 7 days. Amoxi-
the pharmacist. cillin is available in suspension 250 mg/5 mL in 60 mL bottle.
(1 tsp = 5 mL)
THE ACCEPTABLE PRESCRIPTION:

 Generic name (of the active ingredient) must be clearly


written in full (but salt & chemical form maybe abbreviated)
immediately after the Rx symbol
 Generic name is always written first before the brand name
 Brand name is enclosed in a parenthesis: if written on a
prescription pad – write brand name below the generic name;
on px chart same line after the generic name
 Legibility of brand name not necessary
 No instructions added (“no substitution”)
 Precriber must also ensure to write the ff. information:
Strength or dose level using the metric system (1 gr. = 60 mg) Amoxicillin Oral Suspension 250 mg/5mL
Delivery mode: quick-dissolve, sustained-release, etc and the 60-mL bot. # 3
corresponding dose frequency and interval.

Give one teaspoon at 8 A.M, 12 noon, 4 P.M.,


8 P.M. daily for seven days for infection.
PRESCRIPTION WRITING EXAMPLES

Case 1: A 12kg patient needs phenobarbital (general CNS depressant) at


10 mg/kg/day BID for 10 days. Phenobarbital is available at
1gr/tab. (1 grain = 60 mg). Write a prescription:

Please see: Safe Dosage Preparation for computations.


LIST of PRESCRIPTION ABBREVIATIONS CONVERSION TABLE

Abbreviation For the Latin Meaning Apothecaries System -> Metric -> Household Units
a.c. ante cibum before meals
ad ad up to Apothecaries Metric Household
a.d. aurio dextra right ear 1 grain (gr.) 60 mg
a.l., a.s. aurio laeva sinister left ear ½ grain 30 mg
a.u. auris utrae both ears ¼ grain 15 mg
ad. lib. ad libitum as much as desired 15 grains 1g
admov. admove apply 1/60 grain 1mg
alt. h. alternis horis every other hour 1 ounce 31 g
aq. aqua water
aq. dest aqua distillate distilled water 1 minim 0.06 mL
bis bis twice 15 minims 1 mL
B.I.D bis in die twice daily 1 dram 5 mL 1 teaspoon (tsp.)
bol. bolus as a large single dose 4 drams 20 mL 1 tablespoon (tbsp.)
c cum with 1 fluid ounce 30 mL
cc or cf cum cibos with food 2 fluid ounces 60 mL 1 wineglassful
caps. capsula capsule 4 fluid ounces 120 mL 1 teacupful
charts. chartula paper (for powder) 8 fluid ounces 240 mL 1 glassful
dc, D/C, disc discontinue 16 fluid ounces 480 mL 1 pint
dieb. alt. diebus alternis every other day 128 fluid ounces 3800 mL 1 gallon
e.m.p. ex modo prescripto as directed 1 quart 960 mL
comp. compositus compound 4 quarts 3840 mL
et et and
emuls. emulsio emulsion ** 750 mg = 10 milliequivalents (mEq)
ext. extraction extract ** 1 kg = 2.2 pounds (lb)
gtt(s) gutta(e) drop(s)
** 1 pound = 12 ounces
disp. dispensa dispense
div. divide divide
ft. fiat make
h hora hour
h.s. hora somni at bedtime
IVPB intravenous piggyback
lin. linimentum liniment
M misce mix
m. et. n mane et nocte day and night
mist. mistura mixture
N.M.T. not more than
N.T.E. not to exceed
N.R. non repetatur don’t repeat
O.D. omni die once a day
o.m. omni mane every morning
o.n. omni nocte every night
o.d. oculus dexter right eye
o.s., or l.d oculus sinister left eye
o.u., o2 oculus uterque both eyes
p.c. post cibum after meals
p.p.a phialaperios agitate shake before using
prn pro re nata as needed
p.o per os by mouth or orally
p.r. by rectum
q quaque every
q.d. quaque die every day
q.a.d. quoque alternis die every other day
q.h. quaque hora every hour
q.h.s. quaque hora somni every night at bedtime
q.2h quaque 2 hora every 2 hours
QID quater in die four times a day
Q.R quantum rectum quantity is correct
of drug exceeding ordinary dosage
q.s. q.s.ad quantum sufficit as much as required
RL, R/L Ringer's lactate
s sine without
s.a. secundum artum use your judgment
S or sig. signa write on label
s.o.s. si opus sit if necessary
ss semis one half
stat. statim at once immediately
TID ter in die three times a day
ut diet as directed
gr grain RA No. 9165: The Dangerous Drug Act of 1972, Amended