University​ ​of​ ​Santo​ ​Tomas 

Faculty​ ​of​ ​Pharmacy 
Department​ ​of​ ​Pharmacy 

Pharmaceutical​ ​Care​ ​4​ ​Laboratory 

Introduction 
 
Prescription 
● An  order  for  medication  for  use by a patient issued by a physician, dentist, veterinarian or 
other​ ​licensed​ ​practitioner​ ​who​ ​is​ ​authorized​ ​to​ ​prescribe 

 
Parts​ ​of​ ​a​ ​Prescription 
● Patient’s​ ​Information​ ​-​ ​Name​ ​of​ ​patient,​ ​age,​ ​gender,​ ​height,​ ​weight 
● Date​ ​-​ ​Dictates​ ​the​ ​urgency​ ​of​ ​the​ ​prescription 
● Superscription​​ ​-​ ​Start​ ​of​ ​the​ ​prescription​ ​order 
● Inscription​​ ​-​ ​Body​ ​of​ ​the​ ​prescription 
○ Basis​ ​-​ ​Active​ ​ingredient 
○ Adjuvant​ ​-​ ​Aids​ ​the​ ​basis 
○ Corrective​ ​-​ ​Corrects​ ​the​ ​undesirable​ ​property​ ​of​ ​a​ ​basis 
○ Vehicle​ ​-​ ​Increase​ ​bulk​ ​of​ ​the​ ​preparation 

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University​ ​of​ ​Santo​ ​Tomas 
Faculty​ ​of​ ​Pharmacy 
Department​ ​of​ ​Pharmacy 

● Subscription​ ​-​ ​Instruction​ ​of​ ​the​ ​physician​ ​to​ ​the​ ​pharmacist 

● Transcription​ ​-​ ​Instruction​ ​of​ ​the​ ​physician​ ​to​ ​the​ ​patient 
● Prescriber’s​ ​Information​ ​-​ ​Prescriber’s​ ​name,​ ​License​ ​number 

Extemporaneous​ ​Compounding 
● According  to  the  United  States  Pharmacopeia  (USP),  ​Compounding  is  defined  as  the 
preparation,  mixing,  assembling,  altering,  packaging  and  labeling  of a drug, drug delivery 
device  or  device  in  accordance  with  a  licensed  practitioner’s  prescription,  medication 
order,  or  initiative  based  on  the  practitioner/patient/pharmacist/compounder  relationship 
in​ ​the​ ​course​ ​of​ ​professional​ ​practice  
● Compounding​ ​includes​ ​the​ ​following: 
○ Preparation​ ​of​ ​drug​ ​dosage​ ​form​ ​for​ ​both​ ​human​ ​and​ ​animal​ ​patients 
○ Preparation  of drugs or device in anticipation of prescription drug orders based on 
routine​ ​,​ ​regularly​ ​observed​ ​prescribing​ ​patterns 
○ Reconstitution  or  manipulation  of  commercial  product  that  may  require  the 
addition​ ​of​ ​one​ ​or​ ​more​ ​ingredient 
○ Preparation  of  drug  or  devices  for  the  purpose  of,  or  as  an  incident  to,  research 
(clinical​ ​or​ ​academic),​ ​teaching,​ ​or​ ​chemical​ ​analysis 
○ Preparation  of  drugs  and  device  for  prescriber’s  office  use  where  permitted  by 
federal​ ​and​ ​state​ ​law 
● Purpose  of  compounding  is  to  prepare  an  individualized  drug  treatment  for  a  patient 
based​ ​on​ ​an​ ​order​ ​from​ ​a​ ​duly​ ​licensed​ ​prescriber. 

Incompatibilities 
● Incompatibility​ ​refers​ ​to​ ​the​ ​combination​ ​of​ ​ingredients​ ​which​ ​possess​ ​antagonistic 
qualities​ ​of​ ​either​ ​therapeutic,​ ​physical​ ​or​ ​chemical​ ​nature 
○ Possible​ ​Interaction 
○ Intentional​ ​Interaction 
 

● Physical​ ​Incompatibility 
○ Question​ ​of​ ​relative​ ​solubility 
○ Failure​ ​of​ ​ingredient​ ​to​ ​combine​ ​&​ ​make​ ​satisfactory​ ​product 
○ Does​ ​not​ ​involve​ ​chemical​ ​reaction 
○ Evidences:  
■ Incomplete​ ​solution   ■ Liquefaction​ ​of​ ​solid 
■ Precipitation  ingredients 
■ Separation​ ​of  ■ Wrong​ ​form​ ​of 
immiscible​ ​liquid   ingredient 

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University​ ​of​ ​Santo​ ​Tomas 
Faculty​ ​of​ ​Pharmacy 
Department​ ​of​ ​Pharmacy 

■ Gelatinization 
○ Remedy: 
■ Dispensing​ ​separately  Use​ ​of​ ​different​ ​form 
■
■ Alteration​ ​of​ ​solvent  Addition​ ​of​ ​ingredient 
■
■ Changing​ ​order​ ​of  that​ ​promote​ ​solubility 
mixing  ■ Emulsification/ 
Suspension 
*NO​ ​addition​ ​of​ ​correction​ ​except​ ​when​ ​demanded​ ​by​ ​necessity​ ​&​ ​will​ ​not​ ​cause 
impaired​ ​therapeutic​ ​effect 
 
● Chemical​ ​Incompatibility 
○ Ingredients​ ​undergo​ ​chemical​ ​reaction​ ​whereby​ ​the​ ​original​ ​composition​ ​is​ ​altered 
○ Chemical​ ​reaction​ ​are​ ​indicated​ ​as​ ​a​ ​change​ ​in​ ​physical​ ​appearance,​ ​change​ ​in 
color,​ ​effervescence 
○ Product​ ​of​ ​chemical​ ​reaction​ ​is​ ​usually​ ​insoluble 
■ Evidences 
● Oxidation  ● Cementation 
● Reduction  of​ ​ingredients 
● Racemization  ● Separation​ ​of 
● Formation​ ​of  immiscible 
precipitate  liquid 
● Evolution​ ​of  ● Development 
gas  of​ ​heat​ ​or​ ​cold 
● Color​ ​change  ● Hydrolytic 
● Production​ ​of  changes 
explosion  
■ Remedies 
● Prevent​ ​precipitation​ ​by​ ​adding​ ​glycerin,​ ​syrup​ ​or​ ​honey​ ​to 
incompatible​ ​ingredients 
● If​ ​precipitate​ ​is​ ​harmless,​ ​suspend​ ​&​ ​provide​ ​with​ ​shake​ ​well  
● Dilute​ ​before​ ​mixing 
 
● Therapeutic​ ​Incompatibility 
○ Ingredients​ ​or​ ​antagonistic​ ​medicinal​ ​activity​ ​are​ ​prescribed​ ​together 
■ Contraindicated​ ​drugs 
■ Synergistic​ ​or​ ​Antagonistic 
■ Drug​ ​Interaction 
 
Patient​ ​Counseling 
A. Introduction 
a. Identify​ ​patient​ ​by​ ​name 
b. Identify​ ​yourself​ ​by​ ​name 
c. Identify​ ​the​ ​prescriber​ ​by​ ​name 
d. Get​ ​patient​ ​consent 
e. Establish​ ​the​ ​purpose​ ​length​ ​&​ ​importance​ ​of​ ​counseling 
f. Verify​ ​medication​ ​allergies 

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University​ ​of​ ​Santo​ ​Tomas 
Faculty​ ​of​ ​Pharmacy 
Department​ ​of​ ​Pharmacy 

g. Verify​ ​taking​ ​OTC 

h. Verify​ ​other​ ​agents​ ​(herbal,​ ​vitamin​ ​&​ ​supplement) 
i. Explain​ ​change​ ​in​ ​therapy​ ​(if​ ​intervention​ ​was​ ​necessary) 
j. State​ ​generic​ ​name​ ​when​ ​appropriate 
B. Use​ ​1st​ ​Prime​ ​Question​ ​“What​ ​the​ ​medication​ ​is​ ​for?”  
a. Verify​ ​the​ ​current​ ​condition 
b. Explain​ ​indication​ ​for​ ​use 
c. Explain​ ​how​ ​the​ ​medication​ ​works​ ​in​ ​layman’s​ ​term 
C. Use​ ​2nd​ ​Prime​ ​Question​ ​“How​ ​to​ ​Take” 
a. State​ ​the​ ​schedule  
b. State​ ​the​ ​dose​ ​&​ ​duration​ ​of​ ​use 
c. Teach​ ​the​ ​proper​ ​administration​ ​if​ ​particular​ ​technique​ ​is​ ​required 
d. Probe​ ​for​ ​adherence​ ​problems 
e. Recommend​ ​strategies​ ​to​ ​enhance​ ​adherence  

f. Instruct​ ​on​ ​how​ ​to​ ​handle​ ​a​ ​missed​ ​dose 

g. Explain​ ​special​ ​storage​ ​condition 
D. Use​ ​3rd​ ​Prime​ ​Question​ ​“Positive​ ​Effect​ ​of​ ​the​ ​Drug” 
a. Explain​ ​expected​ ​outcome  
b. Explain​ ​how​ ​to​ ​monitor​ ​for​ ​efficiency 
E. Use​ ​4th​ ​Prime​ ​Question​ ​“Side​ ​Effect​ ​of​ ​the​ ​Drug” 
a. Explain​ ​warning​ ​or​ ​precaution 
b. Explain​ ​side​ ​effect​ ​of​ ​high​ ​frequency​ ​or​ ​clinical​ ​signs 
c. Explain​ ​how​ ​to​ ​avoid​ ​/​ ​manage​ ​side​ ​effect 
d. Explain​ ​drug​ ​interaction​ ​or​ ​meds​ ​to​ ​avoid 

 
*​ ​Ask​ ​for​ ​final​ ​verification​ ​for​ ​key​ ​information.  
*​ ​Make​ ​open​ ​ended​ ​request​ ​for​ ​more​ ​questions.  
*​ ​Give​ ​written​ ​information​ ​leaflet​ ​about​ ​the​ ​medication​ ​if​ ​possible. 
*​ ​Make​ ​yourself​ ​available​ ​in​ ​the​ ​future 
*​ ​Thank​ ​the​ ​patient 

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