1. 1 Prescription (Medical Prescription) Prescription writing is the prescriber’s order to prepare or dispense a specific treatment ---- usually medication ---- for a specific patient A written direction for the preparation & administration of a remedy

2. 2 Steps Prescription writing Make a Specific diagnosis Consider the Pathophysiological implications of the diagnosis diagnosis Select a specific therapeutic objective Select a drug of choice Determine the appropriate dosing regimen Devise a plan for monitoring the drug’s action & determine an end point for therapy Plan a program of patient education

3. 3 Who can prescribe? Prescription writing PhysiciansDentistsPodiatristsVeterinariansOsteopaths Pharmacists (specialized Pharmacists) Nurse practitioners Physician’s Assistants Optiometrists

4. 4 Elements Outpatient Prescription Prescriber’s office information Prescriber’s office information Name License classification (Professional degree) Adress Office telephone numbers

5. 5 Elements Outpatient Prescription Patients information Name Age ----- especially extremes of age, children & old aged Weight --- especially children Body surface area Sex Superscription Date e.g. 240 mg every 8 hours (40 mg per kg per day) (wt. =18) (40 mg per kg per day) (wt. =18)

6. 6 Elements Outpatient Prescription Medication prescribed ------ Inscription Names & quantities (amounts) or strength of drug, or or Name & strength of each ingredient Trademarked or manufacturer’s proprietary / brand name brand name Nonproprietary or Generic name Symbol ------ Superscription Symbol ------ Superscription A contraction of Latin verb recipe, meaning take thou or you take take thou or you take

7. 7 Elements Outpatient Prescription Dispensing directions to Pharmacist --Subscription Directions for compounding Dosage forms & number of dosage units supplied e.g. make a solution mix & place into 30 capsules mix & place into 30 capsules dispense 30 tablets dispense 30 tablets Purpose of medication e.g. For control of blood pressure

8. 8 Elements Outpatient Prescription Directions for patient --- Signatura ---- Signa / Sig, S Mark thou, Label Tabs ii q4h (Take two tablets every 4 hours) Instruction for the patient as to how to take the prescription, interpreted & transposed onto the prescription label by the pharmacist

9. 9 Elements Outpatient Prescription How & when to take medication Duration of therapy Purpose of medication Must be explained by both the physician & pharmacist

10. 10 Elements Outpatient Prescription Directions for patient --- Signatura ---- Signa / Sig, S - Language - Use of abbreviations or symbol ---- is discouraged - Instruction “Take as directed” ---- should be avoided should be avoided

11. 11 Elements Outpatient Prescription Directions for patient --- Signatura ---- Signa / Sig, S - e.g. For relief of pain To relieve itching To relieve itching - Route of administration - for oral dosage forms --- “take” or “give” - for oral dosage forms --- “take” or “give” - for externally applied products --- “Apply” - for externally applied products --- “Apply” - for suppositories ---- “Insert” - for suppositories ---- “Insert” - for eye, ear, nose drops ---- - for eye, ear, nose drops ---- “Place” is preferable to “instill” “Place” is preferable to “instill”

12. 12 Elements Outpatient Prescription Dose always should be listed by metric measurements of weight & volume. of weight & volume. Older system of measure e.g. grains for weight & Household measurements e.g. “dropperful” & “teaspoon” “teaspoon” Should be avoided

13. 13 Elements Outpatient Prescription Arabic (decimal) numerals are preferable to Roman numerals, & in some instances it is preferable for the numbers to be spelled out (e.g. Zero)

14. 14 Elements Outpatient Prescription Refill information Waiver of the requirement for childproof containers Additional labeling instructions (e.g., warnings such as (e.g., warnings such as “may cause drowsiness,” “may cause drowsiness,” “do not drink alcohol” “do not drink alcohol”

15. 15 Elements Outpatient Prescription Pharmacist --- must place the expiration for the drug on the label

16. 16 Elements Outpatient Prescription Presciber’s signature Prescriber’s any other identification data

17. 17 Outpatient Prescription Prescriber’s name license classification Prescriber’s name license classification (Professional degree) (Professional degree) Adress Adress Office telephone numbers Office telephone numbers Prescriber’s office information information Patients information Patient’s nameDate Address REFILL TIMES OR UNTIL NO CHILD PROOF CONTAINER Drug name and strength Quantity SIG: WARNINGPRESCIBER’S SIGNATURE Presciber’s other identification data Date Date Inscription & Subscription Superscription Signatura Superscription

18. 18 Prescription writing Abbreviation Meaning tabtablet capcapsule POby mouth PRper rectum SLsublingual IMintramuscular IVintravenous SC, SQsubcutaneous Abbreviation Meaning OTCover-the-counter pcafter meals acbefore meals prnwhen needed qevery q6hevery 6 hours qhs every night at bed time statat once

19. 19 Prescription writing Abbreviation Meaning bidtwice a day tidthree times a day qidfour times a day hsat bed time sosif needed

20. 20 Elements Inpatient Prescription --- Physician order sheet (POS) / chart order DateTime Name & strength of medication, dose, route & frequency of administration frequency of administration Signature of prescriber

21. 21 Prescribing errors Omission of information Poor presciption writing Illegible hand writing Drugs with similar names Acetazolamide ---- Acetohexamide Acetazolamide ---- Acetohexamide Methotrexate --- Metolazone Methotrexate --- Metolazone

22. 22 Prescribing errors Error Misread (Danger) Correct.110.1 1.0101 /1Abandoned 10U10010 units IU10 or 14 µgmgmcg Poor presciption writing Other errors Use leading zeros Never use trailing zeros

23. 23 Prescribing errors Error Misread (Danger)Correct OD (everyday)OD (right eye) QD (every day) QID (four times a day) qod (every-other- day) od (everyday / right eye) qhs (once daily at bed time) qhr (every hour) Poor presciption writing Other errors

24. 24 Prescribing errors Poor prescription writing Other errors Acronyms --- ASA, 6MP Abbreviating drug name Inappropriate Drug Prescription Drug interactions Contraindications Adverse effects

25. 25 Compliance (adherence) Extent to which patients follow treatment instructions Noncompliance --- failure to adhere to drug regimen

26. 26 Controlled Substance Schedules Schedule I Examples: heroin Examples: heroin 1. Potential for abuse ---- High 2. No accepted medical use or lacks accepted safety lacks accepted safety May be used for research purposes by properly registered individuals.

27. 27 Controlled Substance Schedules Schedule II Examples: morphine Examples: morphine 1. Potential for abuse ---- High. 2. Has a currently accepted medical use 3. Abuse may lead to severe psychological or physical dependence. physical dependence.

28. 28 Controlled Substance Schedules Schedule III Examples: anabolic steroids Examples: anabolic steroids 1. Abuse potential less than substances in schedule I or schedule II. 2. Has a currently accepted medical use. 3. Abuse may lead to moderate or low physical dependence or moderate or low physical dependence or high psychological dependence. high psychological dependence.

29. 29 Controlled Substance Schedules Schedule IV Examples: Alprazolam Examples: Alprazolam 1. Abuse potential less than substances in schedule III. schedule III. 2. Has a currently accepted medical use 3. Abuse may lead to limited physical or psychological dependence limited physical or psychological dependence relative to substances in schedule III. relative to substances in schedule III.

30. 30 Controlled Substance Schedules Schedule V Examples: buprenorphine Examples: buprenorphine 1. Low potential for abuse relative to schedule IV. 2. Has a currently accepted medical use 3. Some schedule V products may be sold in limited amounts without a prescription at the discretion amounts without a prescription at the discretion of the pharmacist; however, if a physician wishes of the pharmacist; however, if a physician wishes a patient to receive one of these products, it is a patient to receive one of these products, it is preferable to provide a prescription preferable to provide a prescription 4. Limited dependence possible

31. 31 Controlled Substance - All prescriptions must be written in ink; this practice is compulsory for schedule II drugs is compulsory for schedule II drugs - Date - Prescriber’s name & address - Patient’s name, age, & address - Diagnosis - No abbreviations - All doses, number of ampules, tablets, etc. should be written in words (letters) & in figures (numbers) written in words (letters) & in figures (numbers) - Prescriber’s signature - Prescription is dispensed once, & is kept by pharmacist

32. 32 -Refill - Refill prn (refill as needed) --- is not appropriate - Refill prn (refill as needed) --- is not appropriate - If no refill is desired, “Zero” (not 0) --- should be - If no refill is desired, “Zero” (not 0) --- should be written in the refill space written in the refill space - For schedule II drug ---- no refill - For schedule II drug ---- no refill - For schedule III &IV drug ---- - For schedule III &IV drug ---- not to exceed 5 refills or not to exceed 5 refills or 6 months after the issue date, 6 months after the issue date, whichever comes first whichever comes first - For schedule V drug ---- no restriction