Prescription Writing and Pharmacopeias

Prescription Drug drug that requires a prescription because it is considered potentially harmful if not used under the supervision of a licensed health care practitioner

Definition and Format of a Prescription A prescription is a written, verbal, or electronic order from a practitioner or designated agent to a pharmacist for a particular medication for a specific patient.

Writing PrescriptionsWho can write a Rx? Practitioners Physicians, veterinarians, dentists, podiatrists Mid-level practitioners nurse practitioners, physician assistants, optometrists, pharmacists

Contents of the Prescription All prescriptions should have the following essential elements: Date of the order Patient Name and Address If the drug is prescribed for an animal, the species of the animal Name of the drug Strength of the drug Quantity of the drug Directions for use Intended use of the drug, unless practitioner feels indication is not in best interest of patient Practitioner Name, Address, Telephone number

Contents of the Prescription Date Date the prescription is issued or written Allows the determination of the life of the prescription to validate refills Legend drugs : are that approved by the U.S. Food and Drug Administration (FDA) and that are required by federal or state law to be dispensed to the public only on prescription of a licensed physician or other licensed provider.

A controlled (scheduled) drug is one whose use and distribution is tightly controlled because of its abuse potential or risk. Controlled drugs are rated in the order of their abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA). The drugs with the highest abuse potential are placed in Schedule I, and those with the lowest abuse potential are in Schedule V. These schedules are commonly shown as C-I, C-II, C-III, C-IV, and C-V.

Legend drugs expire 1 year from date issued Controlled drugs CIII-CV – expire 6 months from date issued CII – expire 7 days from date issued Ensures continual patient supervision Promotes patient follow - up

Contents of the Prescription Patient Name and Address Full first and last name Middle initial may be helpful Full address DOB – not required, but will be helpful in further identifying the correct patient to prevent medication errors

Contents of the Prescription Selecting the drug Determine if the drug is a controlled drug or non-controlled drug (Controlled drugs will have additional law requirements) Determine preference for brand or generic product Brand vs. generic Bioequivalent drugs– same amount of active ingredient is delivered to body and will produce identical effect in terms of duration and intensity Is Brand always better? NO If practitioner prefers brand, he must indicate in print, “Brand Necessary” or “Brand Medically Necessary”

Contents of the Prescription Name of the drug USE WITH CAUTION: There are Look Alike/Sound Alike drug names due to Massive number of new drug releases Massive number of reformulations Drug marketing strategy Build on established names New combination drugs – Use converged names

Look Alike/Sound Alike Names Serzone(nefazodone) vs. Seroquel(quetiapine) (antidepressant) (antipsychotic) These two drugs have Similar overlapping strengths (100 mg and 200 mg) Similar dosage forms (tablets) Similar dosing interval (BID) Similar titration schedule Often stocked in close proximity on pharmacy shelf Prescribing and dispensing errors have led to a number of adverse events (Nausea/Vomiting [N/V], hallucinations, altered mental status [AMS], lethargy, seizures, death)

This is for reference only You don’t have to memorize it READ IT LATER

Contents of the Prescription Name of the drug Avoid the use of Abbreviations Many drugs identified with abbreviations EX: HCTZ for hydrochlorothiazide, MSO4 for morphine sulfate Attempts to standardize abbreviations have been unsuccessful “Do Not Use” Abbreviations, Acronyms, and Symbols

List of dangerous abbreviations, acronyms, and symbols (Please read it later)

List of additional dangerous abbreviations, acronyms, and symbols(Please read it later)

Common Abbreviations You have to memorize it

Contents of the Prescription Strength of the drug Be familiar with drugs and their various dosing strengths and dosage forms When in doubt, use references or call pharmacy for help Be familiar with dosing units and their corresponding abbreviations Weight – based dosing Always convert patient weight to correct units (kg)

Contents of the Prescription When writing the strength of the drug Decimal points Avoid trailing zeros. EX. 5 mg vs. 5.0 mg; can be mistaken for 50 mg Always use leading zeros. EX. 0.8 ml vs. .8 ml; can be mistaken for 8 ml

Contents of the Prescription Quantity of the drug Prescribe only necessary quantity Write for specific quantities rather than time period (for example: dispense #30 vs. dispense for 1 month) Calculate: quantity = frequency per day x treatment days e.g. 3 times a day x 30 days Writing out “Dispense # 90”is helpful (30 x 3 = 90)

Contents of the Prescription Directions for use Write out in full English (or Arabic) Provide clear and specific directions Avoid “Take as Directed.”

Contents of the Prescription Writing indications for drugs Encouraged, but not practiced by doctors Helps confirm appropriateness of medication Reminds patient of drug’s purpose Facilitates communication between health care providers

Contents of the Prescription Practitioner’s Name, Address, and Phone number Validates prescription Provides contact information to clarify any questions Information based on practitioner’s usual place of business

Contents of the Prescription Refills Refills are copies of a prescription (to get the same medicines again without going to doctor e.g. drugs for diabetic patients) To avoid interrupting maintenance therapy, practitioners can authorize refills on a written prescription

Used for non-controlled substances - No limit to number of refills allowed. Refills authorized are valid only for life of the prescription – 1 year Refill as needed for 1 year

Controlled Substances Definition - a prescription drug whose use and distribution is tightly controlled because of its abuse potential or risk Regulation is more strict Federal law and State law regulate the storage, use, and disposal of controlled substances

Controlled Substances Controlled or scheduled drug Controlled drugs are classified into schedules Schedules CI, CII, CIII, CIV, and CV Prescriptions for controlled substances have additional requirements by law

Controlled Substances Controlled drugs are divided into Schedules according to abuse potential Schedule I (C-I) – Highest abuse risk. No safe medical use. Examples: heroin, marijuana, LSD lysergic acid, PCP phencyclidine, and crack cocaine. Schedule II (C-II) – High abuse risk but have safe and accepted medical use. Examples: morphine, oxycodone, methylphenidate, dextroamphetamine. Schedule III (C-III)– Abuse risk less than C-II and safe and accepted medical use. Examples: Acetaminophen/Codeine (Tylenol #3), acetaminophen/hydrocodone (Vicodin), propoxyphene (Darvon).

Schedule IV (C-IV) – Abuse risk less than C-III and safe and accepted medical use. Examples: diazepam (Valium), alprazolam (Xanax), phenobarbital, chloral hydrate. Schedule V (C-V) – Abuse risk less than C-IV and safe and accepted medical use. Mainly consist of preparations containing limited quantities of certain stimulant and narcotic drugs for antitussive and antidiarrheal purposes.

Controlled SubstancesAdditional Law Requirements For CIII to CV prescription drugs Quantity must be written out numerically and as a word Vicodin, Dispense #20 (twenty) (Vicodin is a combination of hydrocodone (a semi-synthetic opioid) and acetaminophen) Number of refills – Limit of 5 refills within 6 months Expires in 6 months from date of issue.

Controlled SubstancesAdditional Law Requirements For CII prescription drugs Schedule II (C-II) –High abuse risk but have safe and accepted medical use. Examples: morphine, oxycodone, methylphenidate, dextroamphetamine. Special prescriptions required Official Prescription Form Refills – No refills allowed Expiration – Expires 7 days after issue

Controlled SubstancesAdditional Law Requirements Practitioner Responsibilities Patient’s complete Name, Address (including city, state, zip code), and age or DOB Date the prescription is written (cannot be post-dated) Controlled substance prescribed Quantity of drug, written numerically and as a word Indication, if not deemed detrimental Preference for brand, if necessary

Bad prescription 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

MAXIMIZE PATIENT SAFETY ALWAYS write legibly. ALWAYS space out words and numbers to avoid confusion. ALWAYS complete medication orders. AVOID abbreviations. When in doubt, ask to verify.

WHAT IS PHARMACOPOEIA Pharmacopoeia is a book or encyclopedia of drugs standards, their formulas, methods for making medicinal preparations and other related information's which is published under the jurisdiction of government body. WHY DO WE NEED IT? To Control the Quality of Medicine as per standard . To Ensure the public health. To Support the availability of safe, effective, good-quality pharmaceutical care for all.

There are two main Pharmacopeias1. United States Pharmacopeia2. British Pharmacopoeia (Note the difference in spellings)

UNITED STATES PHARMACOPEIA USP / NF: United States Pharmacopeia – National Formulary The United States Pharmacopeial(USP) sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the United States by the Food and Drug Administration, and these standards are developed and relied upon in more than 130 countries including Saudi Arabia. USP standards are developed and revised by more than 800 volunteer experts, including international participants.

UNITED STATES PHARMACOPEIA United States Pharmacopeia – National Formulary and its Supplements will become official six months after being released to the public. That is, the USP – NF, which is released on November 1 of each year, will become official on May 1 of the Next year

British Pharmacopoeia (BP) The British Pharmacopoeia (BP) is the leading collection of standards for UK medicinal products and pharmaceutical substances. Produced by the British Pharmacopoeia Commission Secretariat of the Medicines and Healthcare products Regulatory Agency, the BP makes an important contribution to public health by setting publicly available standards for the quality of medicines.

British Pharmacopoeia (BP) Now used in over 100 countries, including Saudi Arabia, the BP remains an essential reference for all individuals and organizations working within pharmaceutical research and development, manufacture and testing across the globe.

Prescription Writing and Pharmacopeias