Principles of Prescription Order Writing
Prescription The prescription Written (V erbal or electronic ) direction from a registered medical practitioner to a pharmacist for preparing and dispensing a particular medication for a specific patient
Prescription Prescription Prescription Physician`s Order Sheet (POS) Physician`s Order Sheet (POS)
Who can write a Prescription? Physicians Physicians Veterinarians Veterinarians Dentists Dentists Nurse Practitioners Nurse Practitioners
Steps for a Prescription writing Diagnosis Diagnosis Focusing on Physiopathology of disease Focusing on Physiopathology of disease Choosing a “Target” Choosing a “Target” Defining of a proper “Dose” and “Duration of treatment” Defining of a proper “Dose” and “Duration of treatment” Follow up the patient Follow up the patient
History Ancient prescriptions can be found in both Chinese and Egyptian writings Ancient prescriptions can be found in both Chinese and Egyptian writings
Drugs Generic Name Generic Name Brand Name Brand Name Chemical name Chemical name 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 Superscription Superscription Inscription Inscription Subscription Subscription
Superscription Physician: Physician: Name & Surname Name & Surname Professional Degree or License Classification Professional Degree or License Classification Phone Number Phone Number Medical Council Number Medical Council Number
Superscription Patient`s: Name & Surname Name & Surname Age Age Weigh Weigh Address Address Date of Prescription Date of Prescription Diagnosis Diagnosis
Inscription R Drug`s name Drug`s name Quantity Quantity Dispensing, Dispensing,
R Derived from the Egyptian "Eye of Horus" symbol ( ) denoting health Derived from the Egyptian "Eye of Horus" symbol ( ) denoting health A symbolic appeal by physicians to the “God Jupiter” for a prescription's success A symbolic appeal by physicians to the “God Jupiter” for a prescription's success 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 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 SubstitutionSignature
Abbreviations Used in Prescriptions
How to use Abbreviation caps ii tid pc: caps ii tid pc: Take two capsules three times a day after meals (after food) suppos I q6h pm: suppos I q6h pm: Unwrap and insert 1 suppository into the rectum every 6 hours as needed. tabs iss stat; tabs I q6h cc: tabs iss stat; tabs I q6h cc: Take one &one halftablets to start (at once): then take 1 tablet every 6 hours with food
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 mL stat, then 5mL 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 q12h ud: Give 10 drops orally every 12 hours as directed
Use “leading” zeros Never use “trailing” zeros Correct Incorrect 5 mg 2 mg 2.0 mg 0.5 ml.5 ml 0.7 mg 0.70 mg Int. units IU mg mgr g gr
Classification of Drugs Over the Counter (OTC) Over the Counter (OTC) Behind the Counter Behind the Counter Prescription Drug Prescription Drug Controlled or Scheduled Drug Controlled or Scheduled Drug
Name of the drug Avoid using of Abbreviations HCTZ : Hydrochlorothiazide MSO4 : Morphine Sulfate
Name of the drug ***Attempts to standardize abbreviations have been unsuccessful Massive number of new drug releases Massive number of new drug releases Massive number of reformulations Massive number of reformulations Drug marketing strategy (Build on established names) Drug marketing strategy (Build on established names)
Drug Quantities Write for specific quantities rather than time period Write for specific quantities rather than time period Dispense #30 vs. dispense for 1 month Dispense #30 vs. dispense for 1 month
Metric System 1 grain (gr) = 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 The name of drug: In full English or Latin The name of drug: In full English or Latin Directions for use can be written in local language (Farsi in IRAN) Directions for use can be written in local language (Farsi in IRAN) Avoid “Take as Directed.” Avoid “Take as Directed.”
How to Write Prescription Order Adults: Adults: For eye drops, and nasal drops use: Instill or place For eye drops, and nasal drops use: Instill or place For tabs and capsules: Take For tabs and capsules: Take For liquid: Take For liquid: Take Suppositories: Unwrap and insert 1 suppository Suppositories: Unwrap and insert 1 suppository Ointment and cream, topical: Apply Ointment and cream, topical: Apply Aerosols: Inhale Aerosols: Inhale Sublingual tablets: Place or dissolve one tablet under the tongue Sublingual tablets: Place or dissolve one tablet under the tongue Effervescent: Dissolve one tablet in water and take Effervescent: Dissolve one tablet in water and take
How to Write Prescription Order Children: Children: Oral liquid, tablets, or capsules use: Give Oral liquid, tablets, or capsules use: Give Chewable tablets use: Chew Chewable tablets use: Chew
Controlled Substances Schedule I – Highest abuse risk. No safe medical use in U.S. Schedule I – Highest abuse risk. No safe medical use in U.S. ie, Heroin, Marijuana, LSD, PCP, Cocaine ie, Heroin, Marijuana, LSD, PCP, Cocaine Schedule II – High abuse risk. Schedule II – High abuse risk. ie, Morphine, Methylphenidate, Dextroamphetamine. ie, Morphine, Methylphenidate, Dextroamphetamine. ***No Refill & Expires after 7 days Schedule III – Abuse risk less than C-II. Schedule III – Abuse risk less than C-II. ie, Acetaminophen/Codeine or Hydrocodone, Propoxyphene ie, Acetaminophen/Codeine or Hydrocodone, Propoxyphene
Controlled Substances Schedule IV– Abuse risk less than C-III ie, Diazepam, Alprazolam, Phenobarbital Schedule IV– Abuse risk less than C-III ie, Diazepam, Alprazolam, Phenobarbital Schedule V – Abuse risk less than C-IV. Schedule V – Abuse risk less than C-IV. Has limited quantities of certain stimulant and narcotics. ie, Antitussive & Antidiarrheal Has limited quantities of certain stimulant and narcotics. ie, Antitussive & Antidiarrheal 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 Group A: No risk Factor Group A: No risk Factor Levothyroxine, Vit. C,B Folic acid 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, Methyldopa, Morphine, Acetaminophen, Penicillin G Penicillin G
Classification by Pregnancy Risk Factors Group C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans 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 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 ACEIs (2 nd & 3 rd Trimester), Atenolol, Valproic Acid ACEIs (2 nd & 3 rd Trimester), Atenolol, Valproic Acid
Classification by Pregnancy Risk Factors Group X: Documented Teratogenic effect in Human. Group X: Documented Teratogenic effect in Human. Anticancer agents, Testosterone, Estrogen, Nicotine, Statins, Misoprostol, Ergotamine C 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.