Prescription Writing

by
Emma Nurdiamah
Department of Pharmacology
and Therapy
 History
 Prescriptions have been
in use since ancient times
 Latin adopted as
standard language
 “Rx” = prescription

 “Sig.” = directions
 Definition and Format
A prescription is a
written, verbal, or
electronic order from
a practitioner or
designated agent to a
pharmacist for a
particular medication
for a specific patient.
Legal Classification of medication

1. Obtained only by prescription

Drug that requires a prescription , because it is
considered potentially harmful if not used under the
supervision of a licenced health care practitioner.
2. Without a prescription ( non prescription drug, or
over the counter- drug = OTC drugs)

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 DRUG LIST CLASSIFICATION
 O  Narcotic drug. Available to the public on prescription
only and drug in this list are under strict supervision by the
Ministry of health.

 G  Drug available to the public on prescription only ( obat

keras ) Red dot.

 W  Drug available to the public only through Apotiks or

licenced drug store. Cautionary labellings required ( Obat
bebas terbatas ) Blue dot.

 B  Drugs freely available to the public ( Obat bebas )

Green dot
Form of the prescription

- Prescription blank

- Color : white

- Measurement / size :

- Width : 10 – 12 cm
-
- Long : 15 – 18 cm
Width : 10-12 cm
Long : 15 – 18 cm
Name :
Address :

License of practice :
Bandung, ………….
R/

Pro :
Age :
Address :

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 Writing Prescriptions
Who can write a Rx?

 Practitioners
 Physicians,
veterinarians, dentists,
podiatrists
The component parts of a prescription :
( Contents of the prescription )

1. Patient information
2. Date
3. Superscription = R/ symbol
4. Inscription = Medication prescribed
5. Subscription = Direction to pharmacist
6. Signa = Direction for patient
7. Refill information
8. Prescriber’s signature, address and other
information
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1. Patient information
 The full name
 Address
 Age and/or weight
2. Date
Is Important :
 for medication record of the patient
 To a pharmacist in filling
prescription of controlled
substances
(Drug abuse control amandement
specify that no prescription order for
controlled substances may be
dispensed or renewed more than 6
months after the date prescribed)
 Date
 Date the prescription is issued or written
 Allows the determination of the life of the
prescription to validate refills
 Ensures continual patient supervision
 Promotes patient follow - up
3. Superscription (R/ symbol )
Contraction of the Latin verb recipe
Meaning “take thou” or “you take “
4. Inscription (Medication Prescribed)

The body or principal part of the prescription order

 Names of ingredient :
 Trademarked / Manufacturer proprietary name
 Non proprietary / generic name
Quantities of ingredient :
 Weight  mcg, mg, g (for solid)
 Volume  mcI, ml, l (for liquid)
 Tablespoon  C = 15 ml , Cth = 5 ml
 % % w/w
% w/v
% v/v
% v/w

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 Selecting the drug
 Determine preference for brand or generic product
 Brand name vs. generic name
 Bioequivalent – same amount of active ingredient is delivered
to body and will produce identical effect in terms of duration
and intensity
 Is Brand always better? NO
 Medication allergies
 Availability
 Cost : cover by assurance
 Full payment
 Name of the 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
 Look Alike/Sound Alike Names
Serzone (nefazodone) vs. Seroquel (quetiapine)
(antidepressant) (antipsychotic)

 Similar overlapping strengths (100 mg and 200 mg)

 Similar dosage forms (tablets)
 Similar dosing interval (b.i.d)
 Similar titration schedule
 Often stocked in close proximity on pharmacy shelf

Prescribing and dispensing errors have led to a number of

adverse events (, hallucinations, , lethargy,
seizures, death)
 Name of the drug
AVOID THE USE OF:
 Abbreviations
 Many drugs identified with abbreviations
 EX: HCTZ for hydrochlorothiazide, MSO4 for morphine
sulfate
 Attempts to standardize abbreviations have been
unsuccessful
 Strength of the drug
 Be familiar with drugs and their various dosing strengths and
dosage forms
 When in doubt, use references or call pharmacy for help
 Be familiar with dosing units and their corresponding
abbreviations
 Weight – based dosing
 Always convert patient weight to correct units (kg)
 Liquid medications
 One product may be available in a number of concentrations
 Be familiar with various product concentrations
 Indicate BOTH concentration and dose of medication
 Example: R/ Cephalexin 125 mg/5 ml suspension 200 ml flc No 1
∫q d d cth 1
 Strength of the drug
 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
5. Subscription (Direction to Pharmacist)

Consist of:
- Direction to the pharmacist for preparing the
prescription (to designate the dosage form as
tablet, capsule , Syrup, ointment , cream, supositories
etc)
- The number of dosage units to be supplied
 utilize Roman numerals, or Arabic numerals

Exp. Roman Arabic Roman Arabic

I 1 X 10
II 2 IX 9
III 3 L 50
IV 4 XL 40
V 5 C 100
VII 7 21 D 500
Example :
Dispense tablets No XII
Capsul No. XV
 m .f .pulv.d.t.d. No XX
(misce fact pulv.dentur tales dosis numerus 20=
mix and make divided powder let such doses
be given number 20 )
 m.f . Supp . No. XII (make 12 suppositories)
 m .f. . Ungt 20 (mix and make oint
6. Signature (Direction for patient)

The direction to the patient contain instruction as:

 Amount of drug to be taken
 Time and frequency of the dose
 Route of administration

The word usually abbreviated as “signa” or “sig”

means “mark thou”
The direction is written using abbreviated form of
English, or Latin terms or combination of each.

Example :
-Take 1 tablet each morning
- S.t.d.d. cap 1 ( Take three time a day cap 1 )
- S.t.d.d Cth. I ( take three time a day cochlear tea I )

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 THE SIGNATURE consisting of direction to the patien, which are
to be written on the label.

Should answer the questions - HOW MUCH, HOW OFTEN, W H E N

and IN WHAT MANNER.

The abbreviations used in the Signature:

. s. d.d. = S. 1. d.d. = semel de die = 1x/day

. b. d.d. = S. 2. d.d. = bis de die = 2x/day
. t. d.d. = S. 3. d.d. = ter de die = 3x/day
. q. d.d. = S. 4. d.d. = quarter de die = 4x/day
. p. r. n. = pro renate = if necessary
. n. s. = si necesse sit = if necessary
. s. o. s. = si opus sit = if necessary
. u. i. = usus internus = internal medicine
. p. i. = pro injectionem = untuk suntikan
. part. dol. Applic.= part dolente applicatum pakai pada bagian yang sakit
.

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REFILL INFORMATION

Prescription blanks include a section where this

information

Schedule II control substances (narcotic)

 No refill are permitted / No ITER
 The full signature of prescriber

Schedule III and IV

 Can not refilled more than five times, within 6 months.
 Invalid / expires in 6 months from date of issue
 Quantity must be written out numerically and as a
word . Exp : Vicodin dispense 20 (twenty )

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 Refills
 To avoid interrupting maintenance therapy,
practitioners can authorize refills on a written
prescription
 Non-controlled substances - No limit to
number of refills allowed. Use Discretion.
 Refills authorized are valid only for life of the
prescription – 1 year
 PRN – Refill as needed for 1 year
 Controlled Substances
 Controlled drugs are divided into Schedules according to abuse
potential
 Schedule I (C-I) – Highest abuse risk. No safe medical use in
U.S. Examples: heroin, marijuana, LSD, PCP, and crack
cocaine.
 Schedule II (C-II) – High abuse risk but have safe and accepted
medical use. Examples: morphine, oxycodone, methylphenidate,
dextroamphetamine.
 Schedule III (C-III) – Abuse risk less than C-II and safe and
accepted medical use. Examples: Codeine (Tylenol #3),
/hydrocodone (Vicodin), propoxyphene (Darvon).
 Schedule IV (C-IV) – Abuse risk less than C-III and safe and
accepted medical use. Examples: diazepam (Valium),
alprazolam (Xanax), phenobarbital, chloral hydrate.
 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.
PHYSICIAN’S PRESCRIPTION
In Indonesia
Name :
Specialist : Prescriber information
Address :
License of Practice
Bandung, …December 2011 Date

R/ Superscription
Ampicillin.500mg caps No.XXIV
Inscription

Subscription

S.4. d. d. caps I a.c. Signatura

Name :
Age : Patient information
Address :
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A. PHYSICIAN’S PRESCRIPTION
In Indonesia
Name :
Specialist : Prescriber information
Address :
License of Practice
Bandung,………2009 Date

R/ Superscription
Diclofenac Sodium 1% emulgel tube 20 g No.I
Inscription
Subscription
S .b..d.d. applic
Name : Signatura
Age : Patient information
Address :
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A. PHYSICIAN’ PRESCRIPTION
In some western country
December 27, 2011 Date
Dee fleming,
817 Woodhaven Dr.
Dallas. Tx 75248 Patient information

R/ Superscription
Ampicillin Oral Susp.250 mg/5ml Inscription
Dispense 200 ml Subscription
Take 5 ml orally at 8 a.m,12 Signature
noon,4p.m. 8 p.m. daily
Do Not Refill Refill information
Jane P Rall.M.D
DEA No.AB 1234321
1407 Colgate Prescriber information
Dallas,TX 74852 30
CLASSES OF PRESCRIPTION ORDERS

1. PRECOMPOUNDED (Formula officinales)

A drug or mixture of drug supplied by pharmaceutical
company by its official/ proprietary (brand) name and
in a form that the pharmacist dispenses without
pharmaceutical alteration.
2. COMPOUNDED (Formula
Magistrales)/Extemporaneus
The physician selects the drugs, doses, pharmaceutical
form desired and the pharmacist prepare the
medication.

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1. PRECOMPOUNDED

Necessary to know :
• name of preparation ;
• dosage form exp : tablet, capsule, syrup, ointment
• single dose
• frequency of administration
• duration of therapy

Example :
R/ Amoxyl 500 mg Caps. No.XXI
S.t.d.d Caps.1
R/ Panadol 500 mg Tab. No.IX
S.3.d.d Tab.1

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2. COMPOUNDED

• the single dose of each ingredient

• frequency of administration
• duration of therapy

Example :
R/ Acetaminophen 250 mg
Chlorpheniramin maleate 2 mg
Dextrametorphan HBr 10 mg
Sucrose q.s.
M.f.pulv dtd No.IX
S.3.d.d pulv.1

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Sample Prescription- “Brand Necessary”

Vycke Yunivita, dr., M.Kes

No. SIP. 12/345/86/2011
Alamat Prakek :
Jl. Cilengkrang I no 62 Bandung
Telp. 022- 76890022
------------------------------------------------------
---
R/ Dumin 500 mg tab No. X
∫ 3 dd 1 tab I pc
__________________________________
R/ Amoxsan 500 mg cap No. XV
∫ 3 dd 1 tab I
________________________________
___

Nama : Ny. N Usia : 5 0 th

Alamat : Jl. Raya Jatinangor 23 sumedang
 CASE #1

Poor handwriting contributed to a medication dispensing error

that resulted in a patient with depression receiving the antianxiety
agent Buspar 10 mg instead of Prozac 10 mg
 CASE #2

A hypertensive patient accidentally received Vantin 200 mg

instead of Vasotec 20 mg when a pharmacist misread this
prescription
 Contents of the Prescription
 Indication
 Encouraged, seldom
practiced
 Helps confirm
appropriateness of
medication
 Reminds patient of
drug’s purpose
 Facilitates
communication
between health care
providers
MAXIMIZE PATIENT SAFETY
 ALWAYS write legibly.
 ALWAYS space out words and numbers to
avoid confusion.
 ALWAYS complete medication orders.
 AVOID abbreviations.
 When in doubt, ask to verify.
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