Principles of Prescription Order Writing

1. Principles of Prescription Order Writing

2. Prescription The prescription Written (Verbal or electronic) direction from a registered medical practitioner to a pharmacist for preparing and dispensing a particular medication for a specific patient

3. Prescription • Prescription • Physician`s Order Sheet (POS)

4. Who can write a Prescription? • Physicians • Veterinarians • Dentists • Nurse Practitioners

5. Steps for a Prescription writing • Diagnosis • Focusing on Physiopathology of disease • Choosing a “Target” • Defining of a proper “Dose” and “Duration of treatment” • Follow up the patient

6. History • Ancient prescriptions can be found in both Chinese and Egyptian writings

7. Drugs • Generic Name • Brand 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

8. Prescription

9. Prescription • Superscription • Inscription • Subscription

10. Superscription • Physician: • Name & Surname • Professional Degree or License Classification • Phone Number • Medical Council Number

11. Superscription Patient`s: • Name & Surname • Age • Weigh • Address • Date of Prescription • Diagnosis

12. Inscription • R • Drug`s name • Quantity • Dispensing,

13. R Derived from the Egyptian "Eye of Horus" symbol ( ) denoting health 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

14. Subscription Direction for use Refill number Substitution Signature

15. Abbreviations Used in Prescriptions

16. Abbreviations Used in Prescriptions

17. Abbreviations Used in Prescriptions

18. Abbreviations Used in Prescriptions

19. How to use Abbreviation caps ii tidpc: Take two capsules three times a day after meals (after food) supposI q6h pm: Unwrap and insert 1 suppository into the rectum every 6 hours as needed. tabs iss stat; tabs I q6h cc: Take one &one halftablets to start (at once): then take 1 tablet every 6 hours with food

20. How to use Abbreviation • gtts ii ouqid 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. • gttsx po q12h ud: Give 10 drops orally every 12 hours as directed

21. Use “leading” zerosNever use “trailing” zeros

22. Classification of Drugs • Over the Counter (OTC) • Behind the Counter • Prescription Drug • Controlled or Scheduled Drug

23. Name of the drug Avoid using of Abbreviations HCTZ : Hydrochlorothiazide MSO4 : Morphine Sulfate

24. Name of the drug ***Attempts to standardize abbreviations have been unsuccessful • Massive number of new drug releases • Massive number of reformulations • Drug marketing strategy (Build on established names)

25. Drug Quantities • Write for specific quantities rather than time period • Dispense #30 vs. dispense for 1 month

26. Metric System • 1 grain (gr) = 0.065 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)

27. Directions for use • The name of drug: In full English or Latin • Directions for use can be written in local language (Farsi in IRAN) • Avoid “Take as Directed.”

28. How to Write Prescription Order Adults: For eye drops, and nasal drops use: Instill or place For tabs and capsules: Take For liquid: Take Suppositories: Unwrap and insert 1 suppository Ointment and cream, topical: Apply Aerosols: Inhale Sublingual tablets: Place or dissolve one tablet under the tongue Effervescent: Dissolve one tablet in water and take

29. How to Write Prescription Order Children: Oral liquid, tablets, or capsules use: Give Chewable tablets use: Chew

30. Controlled Substances • Schedule I – Highest abuse risk. No safe medical use in U.S. ie, Heroin, Marijuana, LSD, PCP, Cocaine • Schedule II – High abuse risk. ie, Morphine, Methylphenidate, Dextroamphetamine. ***No Refill & Expires after 7 days • Schedule III – Abuse risk less than C-II. ie, Acetaminophen/Codeine or Hydrocodone, Propoxyphene

31. Controlled Substances • Schedule IV– Abuse risk less than C-III ie, Diazepam, Alprazolam, Phenobarbital • Schedule V – Abuse risk less than C-IV. • 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

32. 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

33. Poor Handwriting A hypertensive patient accidentally received Vantin 200 mg instead of Vasotec 20 mg when a pharmacist misread this prescription

34. Classification by Pregnancy Risk Factors Group A: No risk Factor 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, Penicillin G

35. 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 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 (2nd & 3rd Trimester), Atenolol, Valproic Acid

36. Classification by Pregnancy Risk Factors Group X: Documented Teratogenic effect in Human. Anticancer agents, Testosterone, Estrogen, Nicotine, Statins, Misoprostol, Ergotamine C

37. 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.