Principles of Prescription Order Writing Prescription The prescription

Principles of Prescription Order Writing

Prescription The prescription Written (Verbal or electronic) direction from a registered medical practitioner to a pharmacist for preparing and dispensing a particular medication for a specific patient

Prescription ü Physician`s Order Sheet (POS)

Who can write a Prescription? ü Physicians ü Veterinarians ü Dentists ü Nurse Practitioners

Steps for a Prescription writing üDiagnosis üFocusing on Physiopathology of disease üChoosing a “Target” üDefining of a proper “Dose” and “Duration of treatment” üFollow up the patient

History ü Ancient prescriptions can be found in both Chinese and Egyptian writings

Drugs Generic Name ü Brand Name ü Chemical name ü The generic name is preferred rather than brand name, But there is possibility of therapeutic inequivalence when patients are switched from one product to another

Prescription

Prescription üSuperscription üInscription üSubscription

Superscription üPhysician: üName & Surname üProfessional Degree or License Classification üPhone Number üMedical Council Number

Superscription Patient`s: ü Name & Surname ü Age ü Weigh ü Address ü Date of Prescription ü Diagnosis

Inscription üR üDrug`s name üQuantity üDispensing,

R n Derived from the Egyptian "Eye of Horus" symbol ( ) denoting health n A symbolic appeal by physicians to the “God Jupiter” for a prescription's success n Rx is said to be an abbreviation for the Latin word recipere, meaning "take" or "take thus" as a direction to a pharmacist, preceding the physician's "recipe" for preparing a medication

Subscription Direction for use Refill number Substitution Signature

Abbreviations Used in Prescriptions

Abbreviations Used in Prescriptions

Abbreviations Used in Prescriptions

Abbreviations Used in Prescriptions

How to use Abbreviation caps ii tid pc: Take two capsules three times a day after meals (after food) n suppos I q 6 h pm: Unwrap and insert 1 suppository into the rectum every 6 hours as needed. n tabs iss stat; tabs I q 6 h cc: Take one &one halftablets to start (at once): then take 1 tablet every 6 hours with food n

How to use Abbreviation § gtts ii ou qid for 7 days: Instil 2 drops into both eyes 4 times a day for 7 days § For a child: 10 m. L stat, then 5 m. L tid for 10 days: give 2 teaspoonful at start: then 1 teaspoonful three times a day for 10 days § gtts iv au qid for 7 days: Instil 4 drops in both ears, 4 times a day for 7 days § tabs ii qam, ss at noon & tabs ii qhs: Take 2 tablets every morning, halftablet at noon and two tablets at bed time. § gtts x po q 12 h ud: Give 10 drops orally every 12 hours as directed

Correct Incorrect 5 mg 5 mg 2. 0 mg 0. 5 ml 0. 7 mg Int. units mg g Use “leading” zeros Never use “trailing” zeros 0. 70 mg IU mgr gr

Classification of Drugs ü Over the Counter (OTC) ü Behind the Counter ü Prescription Drug ü Controlled or Scheduled Drug

Name of the drug Avoid using of Abbreviations HCTZ : Hydrochlorothiazide MSO 4 : Morphine Sulfate

Name of the drug ***Attempts to standardize abbreviations have been unsuccessful üMassive number of new drug releases üMassive number of reformulations üDrug marketing strategy (Build on established names)

Drug Quantities ü Write for specific quantities rather than time period ü Dispense #30 vs. dispense for 1 month

Metric System n n n n 1 grain (gr) = 0. 065 grams (g), often rounded to 60 milligrams (mg) 15 gr = 1 g 1 ounce (oz) by volume = 30 milliliters (ml) 1 teaspoonful (tsp) = 5 ml 1 tablespoonful (tbsp) = 15 ml 20 drops = 1 ml 2. 2 pounds (lb) = 1 kilogram (kg)

Directions for use üThe name of drug: In full English or Latin üDirections for use can be written in local language (Farsi in IRAN) üAvoid “Take as Directed. ”

How to Write Prescription Order n n n n n Adults: For eye drops, and nasal drops use: Instill or place For tabs and capsules: Take For liquid: Take Suppositories: Unwrap and insert 1 suppository Ointment and cream, topical: Apply Aerosols: Inhale Sublingual tablets: Place or dissolve one tablet under the tongue Effervescent: Dissolve one tablet in water and take

How to Write Prescription Order Children: n Oral liquid, tablets, or capsules use: Give n Chewable tablets use: Chew n

Controlled Substances n Schedule I – Highest abuse risk. No safe medical use in U. S. ie, Heroin, Marijuana, LSD, PCP, Cocaine Schedule II – High abuse risk. ie, Morphine, Methylphenidate, Dextroamphetamine. ***No Refill & Expires after 7 days n n Schedule III – Abuse risk less than C-II. ie, Acetaminophen/Codeine or Hydrocodone, Propoxyphene

Controlled Substances n Schedule IV– Abuse risk less than C-III ie, Diazepam, Alprazolam, Phenobarbital Schedule V – Abuse risk less than C-IV. n Has limited quantities of certain stimulant and narcotics. ie, Antitussive & Antidiarrheal n Refill for Schedules III –IV: Limit of 5 refills within 6 months For Schedules V: No restrictions are placed on the number of refills allowed

Poor Handwriting 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

Poor Handwriting A hypertensive patient accidentally received Vantin 200 mg instead of Vasotec 20 mg when a pharmacist misread this prescription

Classification by Pregnancy Risk Factors n Group A: No risk Factor Levothyroxine, Vit. C, B Folic acid Group B: Animal reproduction studies have failed to demonstrate a risk to the fetus, and no adequate and well-controlled studies in pregnant women Methyldopa, Morphine, Acetaminophen, Penicillin G

Classification by Pregnancy Risk Factors n Group C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans Gabapentin, Aspirin, Acetaminophen Codeine, TNG Group D: There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans

Classification by Pregnancy Risk Factors n Group X: Documented Teratogenic effect in Human. Anticancer agents, Testosterone, Estrogen, Nicotine, Statins, Misoprostol, Ergotamine C

The Prescription as a Commodity Physicians should educate their patients about the importance of viewing medicines as only to be used when really needed and that remaining on a particular medicine when their condition is stable is far preferable to seeking the newest medications available.