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Terminology and Abbreviations
Every profession has its own unique language. In the world of finance, accounting and equity market, analysts look at P & L statements, statements of cash flow, accounts receivables, etc. The medical professions have their own unique language. These terms are usually combinations of prefixes, root words, and suffixes. The terms have their roots in Greek and Latin. Some knowledge of Greek/Latin will help you in figuring out this complex world of medical terminology.
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Prefix A word that when attached to the beginning of a root word modifies it in someway. i.e. Bio means “life” from the Greek word bios (βίος) If you add this to logy meaning “study of” from the Greek logos (λόγος) you get biology meaning “study of life” i.e. geront0 means “old” from the Greek word, γέρων (geront) meaning old man and you add this to logy you get gerontology, meaning the study of the social, physiologically and mental aspects of aging. Geriatrics is the branch of medicine that studies disease in elderly people. A harder one: glio means “gluey” in Greek and glial cells in the brain refers to cells that support other cells in the brain. Blasto comes from a Greek word meaning “sprouting” and refers in science to a developing cell. When this two prefixes are added to “oma” (typically refers to cancer cells) you have the word glioblastoma meaning a cancer of young glial cells in the brain and is the most highly malignant type of brain cancer.
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Important Prefixes for pharmacy (other listed in text book)
“an” means without/ example: anesthesia “ante” means before/example: anterior “anti” means inhibit/example: antibiotic “brady” means slow/ example:bradycardia, slow heart rate “Contra” means against/ contraindicated “dys” means abnormal/ dysmorphic, abnormal shape “hyper” means too much/ hyperkalemia, too much potassium “hypo” means too little/ hypokalemia, too little potassium in the blood “Intra” means within/ intradermal (within the skin), intervenous (within a vein) “micro” means very small or can mean (1 per 1,000,000) in the metric system/ microscope or in the metric system , microgram (one millionth of a gram) “neo” means new/ neonate is a newly born baby. “poly” means too many/ polypharmacy is used to mean the practice of prescribing to many medications for the same purpose. “Sub” means below/ sublingual means below the tongue. Subcutaneous means below the skin Tachy means fast/Tachycardia is a rapid heart rate
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Important root words in Pharmacy
MEANING EXAMPLE Arter Artery Arterial Arthr Joint Arthritis Bronch Airway in the lung Bronchitis Carcino Cancer Carcinogen Cardi Heart Cardiac Derma Skin Dermatits Enter Intestine Enteral nutrition Gastr Stomach Gastric pain Gluco Sugar Glucose meter Hemo Blood Hematology
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Important Root words in Pharmacy continued
MEANING EXAMPLE Hepat Liver Hepatitis My Muscle Myalgia Nasa Nose Nasal Nephr Kidney Nephrology Neur Nerve Neurology Oste Bone Osteoporosis Pneu Lung pneumonia Procto Rectum Proctotitis Pulmo Pulmonary Ren Renal Thromb Clot thrombosis
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Suffix A suffix is a word that is added at the end of a root word to indicate or qualify its meaning. For example, arthr (joint) plus itis yields the word arthritis which meaning inflammation of a joint.
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Important Pharmacy related suffixes
MEANING EXAMPLE Ac Pertaining to Cardiac Al Renal Algia Pain Myalgia Ase Enzyme Protease Cyte Cell Hepatocyte Ectomy Surgical removal Hysterectomy Emia Blood condition hyperkalemia Itis Inflammation Hepatitis Logy Study of Cardiology Rrhea Flowing discharge Diarrhea, rhinorrhea Uro Urine Urology
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There are literally hundred of root words and prefixes and suffixes.
These list is not all inclusive by any means. It is based on my experience on what is important to know A medical dictionary is key to have and to review on a regular basis Learning or knowing different languages always helps
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General Pharmacy Abbreviations
Meaning Abbreviation Adverse drug reaction ADR Average wholesale price AWP Controlled release CR Discontinue DC Dispense as written DAW Drug utilization review DUR Enteric coated EC Extended release ER Fluid Fl. Maximum allowable cost MAC No known drug allergies NKDA Nothing by mouth NPO
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General Pharmacy Abbreviations Table 2
MEANING ABBREVIATION Over the counter OTC Pediatric Ped Prescription Rx Schedule 1 CI Schedule 2 CII Schedule 3 CIII Schedule 4 CIV Schedule 5 CV Solution Soln Suppository Supp Wholesame acquisition cost WAC
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Pharmacy SIG codes SIG is the part of the prescription that includes the directions for use. SIG is short for the Latin signetur “let it be written” You will see on an Rx (remember this abbreviation?) Sig: 1 tab qd po HS Qnty: 30 Refills: 1 This means “take one tablet very day by mouth at bedtime” dispense 30 tablets and give one refill We will cover this list in class.
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Dangers of SIG codes and medical abbreviation in general
The Institute of Safe Medication Practices (ISMP) publishes a list of unsafe medication codes whether SIG codes or other codes for which many hospitals and institutions adhere to in the goal of preventing medication related errors. The Joint Commission on the Accreditation of Healthcare organization (JCAHO) also in collaboration with the ISMP publishes a minimum Don’t abbreviate List (Do not use list)that healthcare organization must include. We will cover this list in class in our discussion. Both the ISMP and JCAHO’s do not use list apply to all health related communication between healthcare practitioners. This means that in addition to drug orders, these abbreviation are not to be used anywhere in a patient’s chart, documentation or reports. The institute of Medicine (IOM) in 1999 published a report stating that between 44,000 and 96,000 deaths each year happen due to medical error, many because of unclear abbreviations and codes
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Case in point In 2001, a case was report to the FDA via medwatch, see article, The case involved an infant transferred from an obstetrics unit to a nursery for well babies with an order for DTO 0.7 ml PO q4h. The pharmacist in the case recognized the order as deodorized tincture of opium USP, which has a concentration of 60 mg/ml morphine. The prescribed dose translates into give 0.7 ml (42 mg) by mouth every four hours. This dose is 252 mg per day of morphine, a dose that can kill or send a newborn baby to the hospital for respiratory arrest. The pharmacist verified the order as diluted tincture of opium which is 25 fold dilution of the original drug. The actual dose is 0.7 ml(1.6 mg) by mouth every four hours.
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How to report medication errors
Both patients and healthcare providers can report errors involving medications to the ISMP through its website, Click onto the MERP, medication error reporting program. United States Pharmacopeia, collects medication errors and adverse events data.
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Milan’s List of Must Know Drugs
BRAND DRUG GENERIC NAME MOST COMMON INDICATION ACTIVASE® ALTEPLASE PULMONARY EMBOLISM ACCUPRIL® QUINAPRIL HYPERTENSION ACTONEL® RISEDRONATE OSTEOPOROSIS ADENOCARD® ADENOSINE RAPID HEART RATE ALDACTONE® SPIRONOLACTONE ALLEGRA® FEXOFENADINE ALLERGIES ALTACE® RAMIPRIL HTN(?), HEART DISEASE
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION AMARYL® GLIMEPIRIDE DIABETES MELLITUS (DM) AMBIEN® ZOLPIDEM INSOMNIA AMIKIN ® AMIKACIN SULFATE BACTERIAL INFECTIONS AMOXIL ® AMOXICILLIN KEFZOL® CEFAZOLIN APRESOLINE® HYDRALAZINE HYPERTENSION (HTN) ARICEPT® DONEPEZIL ALZHEIMER’S DISEASE
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION ASTRAMORPH PF® MORPHINE SULFATE POST OP PAIN, EPIDURAL ANALGESIA ATACAND ® CANDESARTAN HTN ATARAX® HYDROXYZINE ALLERGIES ATIVAN ® LORAZEPAM ANXIETY ATROVENT® IPRATROPIUM BROMIDE COPD, ASTHMA AUGMENTIN ® AMOXICILLIN/CLAVULANATE, POTASSIUM BACTERIAL INFECTIONS AVAPRO ® IRBESARTAN
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION BENADRYL® DIPHENHYDRAMINE INSOMNIA, ALLERGY BIAXIN® CLARITHROMYCIN BACTERIAL INFECTIONS BUSPAR® BUSPIRONE DEPRESSION CALAN® VERAPAMIL HCL HTN, RAPID HEART RATE CAPOTEN® CAPTOPRIL HTN, CARDIAC HEART FAILURE CARBATROL® CARBAMAZEPINE SEIZURES CARDIZEM® DILTIAZEM
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION CATAPRES® CLONIDINE HTN CEFTIN® CEFUROXIME BACTERIAL INFECTIONS CELEBREX® CELECOXCIB RA CELEXA® CITALOPRAM DEPRESSION CIPRO® CIPROFLOXACIN CLARITIN® LORATIDINE SESSIONAL ALLERGIES CLEOCIN® CLINDAMYCIN
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION COMBIVENT® ALBUTEROL/IPRATROPIUM COPD COMBIVIR® ZIDOVUDINE/LAMIVUDINE HIV CORDARONE AMIODARONE CARDIAC ARRTHYMIAS COUMADIN® WARFARIN BLOOD CLOTTING CRIXIVAN® INDINAVIR MESYLATE DEPAKOTE® DIVALPROEX SODIUM SEIZURES DIABETA® GLYBURIDE DM
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION DIFFERIN® ADAPALENE ACNE DIFLUCAN® FLUCONAZOLE FUNGAL INFECTION DIGITEK® OR LANOXIN® DIGOXIN HEART FAILURE DILANTIN® PHENYTOIN SODIUM SEIZURES DILAUDID ®CII HYDROMORPHONE HCL PAIN DIOVAN® VALSARTAN HTN DOBUTREX® DOBUTAMINE HEART FAILURE, LOW BLOOD PRESSURE
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION EFFEXOR® VENLAFAXINE DEPRESSION E-MYCIN® ERY-TAB® ERYTHROMYCIN BASE BACTERIAL INFECTION FEOSOL ® FERROUS SULFATE IRON DEFFICIENCY FIORICET® BUTALBITAL, CAFFEINE AND ACETAMINOPEN PAIN FIORINAL® BUTALBITAL, CAFFEINE AND ASPIRIN FLAGYL®, METROGEL® METRONIDAZOLE PROTOZOAN INFECTION FOSAMAX® ALENDRONATE OSTEOPOROSIS
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION FUNGIZONE® AMPHOTERICIN B SEVERE FUNGAL INFECTIONS FURADANTIN® NITROFURANTOIN URINARY TRACT INFECTIONS GAMMAGARD® INTRAVENOUS IMMUNE GLOBIN BLOOD DISORDERS GLUCOPHAGE® METFORMIN DMII GLUCOTROL® GLIPIZIDE HALDOL® HALOPERIDOL SCHIZOPRENIA, TRANQUILIZER HUMALOG® HUMAN INSULIN LISPRO DMI AND DMII
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION HYDRODIURIL®, Esidrix® HYDROCHLOROTHIAZIDE HTN IMODIUM® LOPERAMIDE DIARRHEA INDERAL® PROPRANOLOL HTN, CARDIAC FAILURE IMDUR® ISOSORBIDE MONONITRATE CARDIAC PAIN (ANGINA) INTROPIN® DOPAMINE HCL LOW BLOOD PRESSURE ISOSORDIL® ISOSORBIDE DINITRATE ANGINA KAYEXELATE® SODIUM POLYSTRENE SULFONATE HYPERKALEMIA
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BRAND DRUG GENERIC NAME MOST COMMON INDICATION KEFLEX® CEPHALEXIN BACTERIAL INFECTIONS LASIX ® FUROSEMIDE HEART FAILURE, EDEMA LIPITOR® ATORVASTATIN HIGH CHOLESTEROL LOPRESSOR® METOPROLOL TARTARATE HTN, CARDIAC FAILURE LOVENOX ® ENOXAPARIN DVT, PE, AND MI MAALOX® ALUMINUM AND MAGNESIUM HYDROXIDE GASTROINTESTINAL UPSET/ACID REFLUX MARCAIN® BUPIVACAINE HCL LOCAL ANESTHETIC
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I will add to this list as time goes on
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Most commonly abbreviated medical conditions you will see
Abbreviation Common meaning Myocardial Infarction MI Heart attack Congestive Heart failure CHF Heart muscle is dying Atrial fibrillation AFib A cardiac heart beat that is fast and abnormal Ventricular Fibrillation VF A cardiac heart beat that is fast and almost always fatal Cerebral Vascular Accident CVA Stroke/loss of blood flow to brain Diabetes Mellitus DM A disorder of carbohydrate metabolism Hypertension HTN High blood pressure
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Medical Conditions Abbreviation Common meaning CABG Coronary artery bypass graft Surgery to re-establish blood flow to the heart ATN Acute tubular necrosis A disorder of the kidney RA Rheumatoid Arthritis A joint disease that effects older people RI Renal Insufficiency Poorly functioning kidneys PE Pulmonary Embolism A blood clot that travels to the lung DVT Deep vein Thrombosis A blood clot in the leg that often travel to the lung Not an all inclusive but include very common conditions
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Medications commonly abbreviated
The following medications are commonly abbreviated in the field Joint Commission and the ISMP however have established guidelines to reduce the use of such shortcuts.
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Medication Abbreviations
Drug Indication ASA Aspirin Pain, post MI use APAP Acetaminophen Pain, fever reducer in children 5FU Flurouracil Anti cancer drug SMX/TMP Sulfamethoxazole/trimethoprim Antibiotic HCTZ Hydrochlorothiazide diuretic INH Isoniazid Anti-TB (tuberculosis) drug 6-MP 6 mercaptopurine Immune suppressant
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Medication Abbreviations
Drug Indication NTG Nitroglycerin Chest pain (angina) SSKI Super saturated potassium iodide Hyperthyroidism T4 Levothyroxine (synthroid®) hyperthyroidism KCL Potassium chloride Potassium deficiency MgSO4 Magnesium Sulfate Magnesium deficiency MSO4 Morphine sulfate Pain killer PCN Penicillin antibiotic
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Medication Abbreviations
Drug Indication AZT Zidovidune HIV NS Normal Saline IV fluid D5W Dextrose 5% in water D5WNS Dextrose 5% in water with normal saline MVI Multiple vitamins Vitamin replacement ISDN Isosorbide dinitrate Chest pain MTX Methotrexate Cancer drug
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Most Common Sig Codes in Pharmacy
Meaning Sig: Let it be written PC Post Cena (after meals) AC Ante Cena (before meals) UD As directed Ad lib As desired PRN As needed HS At bedtime Qd daily
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Sig Meaning Q Every Q+blank+H Every blank hours BID Twice a day TID Three times a day QID Four times a day QOD Every other day QW Every week (once) BIW Twice a week TIW Three times a week
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Common Routes of Administration
Meaning PO By mouth SL Sublingually BU Buccally INH or IN Inhalation IVP Intravenous Push IVPB Intravenous Piggyback IM Intramuscular SC or SubQ Subcutaneously Opth Via the eyes
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Route Meaning OT Otic (via ears) PR Rectally PV Vaginally EX Topically IP Intraperitoneal
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Uncommon Routes of administration
Certain routes are not commonly used Often to avoid confusion and the potential for error the routes are spelled out on medical orders Example 1 Epidural Medication is given just outside the spinal cord next to the dura mater. Used in case where high doses of pain medications are needed but side effect need to be minimized. Used in obstetrics ward in women undergoing labor Used for post operative patient in PACU Example of a drug is Fentanyl 2 mcg/ml with % bupivacaine in 250 ml of NS
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Example 2 Intrathecal Route
Involves passing the medication through the spinal cord into the subarachnoid space to allow for direct bathing of the neural tissue in the drug Intrathecal chemotherapy i.e. methothexate, cytarabine Intrathecal Baclofen in cerebral palsy patients Advantages are very small amounts of drug can be used leading to less side effects Disadvantages are high risk for infections and inadvertent overdoses
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Epidural Injection Courtesy of:
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Common Abbreviations for quantities
Meaning Mg Milligrams G Grams Gr Grains Ml Millilter L Liter Fl. OZ Ounces (fluid) Tab Tablets mEq Milliequivalents Tsp Teaspoon TBSP Tablespoon cc Cubic centimeter (= 1 ml) Gtt(s) Drop(s)
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Putting the Rx together
A prescription will consist of the following elements Sig: A numerical quantity (with the dosage form) Route of administration Time Frequency Day supply or total quantity Refills Example: Vasotec 5 mg Sig: take 1 tab qd 30 tablets Refills: 2
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A tougher example: Example 3 Humulin N Amoxicillin Susp 400 mg/5 ml
Sig: inject 25 u qam and 25 u qhs Refills: 11 Example 3 Amoxicillin Susp 400 mg/5 ml Sig: 1 ½ tsp TID For 14 days Refills: 2 Total amount to dispense for 14 days?
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JCAHO’s Minimum Do not use List
In 2004, JCAHO published its minimum do not use list which the joint commission encourages the health care institutions it accredits to use (at a minimum) Abbreviation Problem Preferred IU Mistaken as IV or 10 International units MS, MSO4 or MgSO4 Confused for each other Morphine sulfate/magnesium sulfate Q.D. and QOD Daily and every other day Trailing zero and no preceding zero (3.0 or .3) 10 fold overdose possible 3 or 0.3 U Look like 0 Use “units” Mistake for mg Write microgram HS or qHS Mistaken for every hour Write at bedtime g
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Abbreviation Problem Preferred AS, AD, AU and OS, OD, OU Mistaken for each other Use “left eye”, “left ear”, etc DC or D/C Mistaken for discontinue meds Write discharge Cc Mistaken for zero’s Write mls SC or SQ Mistaken for SL or 5 every Use subQ or write subcutaneously TIW Mistaken for three times a day Write three times a week
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Less commonly known pharmacy terminology
Meaning Analgesic A drug for pain Anorectic A drug for appetite suppression Analeptic A drug that stimulates the CNS IV Admixture A drug product made by adding the drug to an IV bag Anesthetic A drug that block sensations of pain or feeling in general Anaphylactic Shock A severe allergic reaction to a drug Anticoagulant A drug that blocks blood clotting Antitussive A drug that blocks coughing Antiemetic A drug that stop N/V Antipruritic A drug that stop itching
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Term Meaning Aseptic Techniques Techniques used in making parenteral drug products that minimizes microrganism contamination Clinical Trials Mandated by the FDA for the marketing of new drugs in the US Contraindication An aspect of a patient’s condition that is not compatable with the treatment Emulsion A pharmaceutic dosage form where two immiscible liquid drugs are mixed together NSAID Non steroidal anti-inflammatory drugs Corticosteroids Steroid drugs used in autoimmune conditions Glucocorticoids Same as above. Two terms are used interchangeable Neuroleptics Drugs that cause an effect on the CNS used to refer to old type of anti psychotic drugs like Haldol®
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Term Meaning Narcotic A drug that induces sleep (from the greek word for “stupor”) Antisialagogue A drug that dry mucus and saliva secretion. Used before anesthesia to dry secretions. NMB Neuromuscular blocker Suspension A drug dosage form that consists of suspended drug particles in aqueous solution Solution A uniform homogenous mixture of a drug in water Ointment A semisolid mixture of drug in oily solid base Troche A drug made into a lozenge dose form Tincture An alcoholic mixture of a drug with at 25% V/V alcohol Enema A drug in a fluid vehicle delivered into the rectum
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