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PHARMACOLOGY
1.1A PRESCRIPTION WRITING
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
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
SCHEDULE I (C-1) - 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
Pharmacology
SCHEDULE IV (C-IV) - ABUSE RISK LESS THAN C-III AND SAFE AND
ACCEPTED MEDICAL USE
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
PARTS OF A PRESCRIPTION
Date
Name of patient, information
Superscription
Inscription
Subscription
Transcription
Name of prescriber
SUPERSCRIPTION
Rx
recipere to take
PRESCRIPTION WRITING
Professional privilege
Clinical responsibility
WHO CAN WRITE PRESCRIPTIONS
Practitioners
- Physicians, Vets, 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
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.
AccuprilAccutane
AccuprilMonopril
Acetazolamide.......Acetohexamide
Adderall..Inderal
Amantadine..Ranitidine
Amantadine..Rimantidine
Azithromycin..Erythromycin
CalciferolCalcitriol
Carboplatin..Cisplatin
ChlorpromazineChlorpropamide
ChlorpromazineProchlorperazine
Drug:
- Similar overlapping strengths (100 mg and 200 mg)
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Pharmacology
REFILL
Not required
Important to avoid interrupting maintenance therapy
Non-controlled substances
- No limit to number of refills allowed
Mistaken as IV or 10
Write international
unit
Q.D., Q.O.D.
Decimal point
missed
Write morphine
sulfate or
magnesium sulfate
S.C. or S.Q.
(subcutaneous)
Write Sub-Q or
subQ or
subcutaneously
c.c.
Mistaken for U
(units) when poorly
written
Write ml for
milliliters
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
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Pharmacology
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