1. Prescription writing Dr.Saeed Ahmed 2009

2.  A prescription: A physician's order to prepare / to dispense a specific Tr -usually medication- for an individual patient. A physician's order to prepare / to dispense a specific Tr -usually medication- for an individual patient.

3. Rational prescribing: Like any other process in health care, writing a prescription should be based on a series of rational steps: 1- Make a specific diagnosis 2- Consider ! pathophysiologic implications of ! diagnosis 3- Select a specific therapeutic objective 4- Select a drug of choice 5- Determine ! appropriate dosing regimen 6- Devise a plan for monitoring ! drug’s action & determine an end point for therapy 7- Plan a program of patient education.

5.  In ! hospital setting, drugs are prescribed on a particular page of ! patient’s hospital chart called ! physician’s order sheet/ chart order. There are 3 common types of Rx : 1- Prescription in general practice 2- Hospital prescription for in-patients 3- Hospital prescription for an (external pharmacy).

6. Parts of prescrition:  Superscription: name, professional degree, contact no. address of ! prescriber, ! date when ! order is written. name, address & age of ! patient; & ! symbol Rx (an abbreviation for "recipe," ! Latin for "take thou." _ name, address & age of ! patient; & ! symbol Rx (an abbreviation for "recipe," ! Latin for "take thou." _  Inscription : ! body of ! Pres. containing ! name, strength of each drug, & dosage form of ! Tr.  Subscription: quantity to be dispensed. ! directions to ! pharmacist, usually consisting of a short sentence: "make a solution," "mix & place into 10 capsules," or "dispense 10 tablets."  Transcription : labeling of instruction to ! Patient,  prescriber's signature.

7.  When writing ! drug name: -either generic name (nonproprietary name) is used. -OR ! brand name (proprietary name) - ! strength of ! medication should be written in metric units (Not apothecary). 1 gr = 60 mg 15 gr = 1 g 1 ounce (oz) by volume = 30 ml 1 tsp = 5 ml 1 tbsp= 15 ml 20 drops= 1 ml 2.2 ponds (Ib) = 1 kg.

8. Principles for writing pres. for both controlled & uncontrolled drugs Prescribers should:  ALWAYS write legibly in ink (clear writing)  Use metric system (g, L)  ALWAYS sign & date ! the prescription  Precise  Accurate  Use precautions to remind patients about SE  NEVER abbreviate drug names

9.  When writing ! INDIVIDUAL DOSE: for STRENGTHS >1g use grams for STRENGTHS <1g use milligrams e.g.100mg for STRENGTHS <1mg use micrograms e.g. 100 microgram (NEVER use 'µg') AVOID unnecessary decimal points e.g. use 300 mg NOT 0.3 g.

10.  Previous adverse pres./ allergies; ask for drug history or medical record  Check other medication charts (anticoagulants, insulin)  Specify time course; if ! drug is taken for a number of days/ continuously (course of antibiotic, antihypertensive/ antiparkinson drugs.  As required medications  Indication, frequency, minimal time interval btw doses & maximum dose in 24 hr period.

11.  ! instructions should be sufficient for a nurse to administer a drug accurately in ! hospital,  or for a pharmacist to provide a patient e both ! correct drug & ! instructions on how to take it.  Medication error is ! most common medical mistake.

12. Prescription for uncontrolled drugs include: - date - identification of patient: name, hospital number, age, sex - name of ! drug - dose of ! drug - frequency of administration - route & method of administration - amount to be supplied - ! prescriber's signature.

13.  Controlled drugs: Substance, which may produce physical, psychological dependence / both  Prescribed for not > than 2 weeks because sudden withdrawal may lead to withdrawal symptoms.. because sudden withdrawal may lead to withdrawal symptoms..

14. Classification of controlled substances. Based on estimated addiction liability Examples Rationale for category & Rx rules Potenti -al for abuse Class Heroin, LSD ( Lysergic Acid Diethylamide), marijuana No accepted medical use, All no research use forbidden, can Not be prescribed lack of accepted safety as drug High abuse potential I Opioids as morphine, amphetamines Current accepted medical use but abuse may lead to severe physical/ psychic dependence HII Weaker opioids such as codeine, some amphetamine-like drugs Current accepted medical use. moderate or low potential for physical & high potential for psychologic dependence, No refills, Rx must be rewritten after 6 months < class II III

15. Diazepam, phenobarbital, chloral hydrate etc Medical use is accepted. Limited / low potential for dependence < III IV cough syrups e codeine, antidiarrheal e diphenoxylate etc Medical use is accepted. ! least potential for abuse ! least potential for abuse < IV Schedule V

16.  Schedules of Controlled Drugs: ! drugs are divided into 5 schedules: Schedule I Drugs in this schedule have no accepted medical use & have a high abuse potential. Ex. heroin, marijuana, LSD, etc. Drugs in this schedule have no accepted medical use & have a high abuse potential. Ex. heroin, marijuana, LSD, etc. Schedule II  Drugs in this schedule have a high abuse potential e severe psychic or physical dependence liability. Included are certain narcotic analgesics, stimulants, & depressant drugs. Ex. opium, morphine, codeine, methadone, cocaine, amphetamine. Schedule III  Drugs in this schedule have an abuse potential < than those in Schedules I & II & include compounds containing limited quantities of certain narcotic analgesic drugs, & other drugs such as barbiturates. pentobarbital. Schedule IV  Drugs in this schedule have an abuse potential < than those listed in Schedule III & include such drugs as barbital, phenobarbital, chloral hydrate, chlordizepoxide, diazepam, oxazepam etc. Schedule V  Drugs in this schedule have an abuse potential < than those listed in Schedule IV & consist primarily of preparations containing limited quantities of certain narcotic analgesic drugs used for antitussive & antidiarrheal purposes.

17. Rx for controlled drugs:  Should not be typed & written by hand  Written in ink  Signed & dated  Carry ! prescriber's full name, address & registration number  State ! form of ! drug  State ! total quantity of ! drug or ! number of doses units (10.0 mg i.e. ten milligrams) Not be refillable > than 5 times in a 6 months period for schedule III-IV-V Rx;  No refilling for schedule II Rx.

18. before meals a.c. After meal p.c. Capsulescap gramg hourh. milligrammg Abbreviation \ Meaning

19. milliliterml Twice daily Bid by mouth, orally p.o. when necessary p.r.n. once a day q.d. 4 times a day q.i.d.

20. every hour q.h. every 2 hours q.2h. 3 times a day t.i.d. Intra-arterialIA IntramuscularIM intravenousIV HsAt bed time

21. CapsuleCap suppository Sup, supp suspensionSusp tabletTab StatAt once D/CDiscontinue CD Controlled drugs

22. Computerized physician order entry (CPOE): is a process of electronic entry of physician instructions for ! tr of patients (particularly hospitalized patients) under his or her care. is a process of electronic entry of physician instructions for ! tr of patients (particularly hospitalized patients) under his or her care.physician hospitalizedphysician hospitalized These orders are communicated over a computer network to ! medical staff (nurses, therapists, pharmacists, or other physicians) or to ! departments (pharmacy, laboratory or radiology) responsible for fulfilling ! order. computer networkpharmacy radiology computer networkpharmacy radiology

23.  CPOE advantages: -decreases delay in order completion, -reduces errors related to handwriting or transcription,?? transcription - provides error-checking for duplicate or incorrect doses or tests, & - simplifies inventory & posting of charges.