Writing a Prescription

The Basics Patient’s name today’s date ( +/- date of birth) Line 1: drug name dose Line 2: number to take route how often* Line 3: number to dispense refills *use only most basic abbreviations (BID, TID, QID or QHS) or just use plain English (twice a day) and avoid using UNC Prohibited Abbreviations

Paul R. Smith DOB: 5/6/1978 6/29/09 enalapril 10mg one PO every day for hypertension #90 (ninety) 3 refills John Hancock, MD

Writing a Prescription Legible, please Treat zeros with respect –use for 0.5mg but not for 5.0mg Write purpose of medication –“for high blood pressure” Write as needed for what –“prn for nausea”

Writing a Prescription Confirm allergies Confirm dose if not absolutely 100% sure Consider interactions –epocrates –warfarin –seizure meds –immunosuppressants

Writing a Prescription Think about QTc Pregnancy ? Monitoring –Baseline (need creatinine before metformin, ALT before statin) –Later (need creatinine and K after Ace-i, drug levels for lithium)

Writing a Prescription # pills acceptable for given insurance (only 30 for Medicaid, 30 or 90 for Wal-Mart $4) Wal-Mart Use generics whenever possible Forgery issues –microprinting on WebCIS –write out numbers (# thirty) –no mistakes on controlled substances prescriptions

Narcotics –Schedule I: no medical use (heroin, LSD) –Schedule II: medical use, high abuse/addiction potential (morphine, oxycodone) –Schedule III: lower potential (codeine, hydrocodone) –Schedule IV: even lower potential (benzodiazepines, propoxyphene) –Schedule V: very low potential (codeine in cough syrup) Keep records organized and detailed: –strength, how many, any refills, when/from whom can get more

Narcotics –Schedule I: no medical use (heroin, LSD) –Schedule II: medical use, high abuse/addiction potential (morphine, oxycodone) –Schedule III: lower potential (codeine, hydrocodone) –Schedule IV: even lower potential (benzodiazepines, propoxyphene) –Schedule V: very low potential (codeine in cough syrup) Keep records organized and detailed: –strength, how many, any refills, when/from whom can get more

Narcotics –Schedule I: no medical use (heroin, LSD) –Schedule II: medical use, high abuse/addiction potential (morphine, oxycodone) –Schedule III: lower potential (codeine, hydrocodone) –Schedule IV: even lower potential (benzodiazepines, propoxyphene) –Schedule V: very low potential (codeine in cough syrup) Keep records organized and detailed: –strength, how many, any refills, when/from whom can get more

Narcotics –Schedule I: no medical use (heroin, LSD) –Schedule II: medical use, high abuse/addiction potential (morphine, oxycodone) –Schedule III: lower potential (codeine, hydrocodone) –Schedule IV: even lower potential (benzodiazepines, propoxyphene) –Schedule V: very low potential (codeine in cough syrup) Keep records organized and detailed: –strength, how many, any refills, when/from whom can get more