PRESCRIPTION WRITING

Department of Pharmacology and Therapeutics

GROUP 2

MEMBERS

Bazanye James Nakidde Bridget Mpewo Jude Thaddeus Kasozi Douglas Wanyenze Florence Nabuwembo Oliver Ahumuza Joan Namatovu Esther Nsawa Ivan Samuel David Zzirube

Cont’d Ocha Jimmy Bigirimana Edson Baluku Fabian Bamwesiga Arnold Barungi Pius Murundu Moreen Ojambo Flavia Arinda Linda Sentenza Musa Nakagwa Hellen

Definition

A prescription is a written, verbal, or electronic order from a prescriber (e.g. physician, dentist,, nurse practitioner) to a pharmacist for a particular medication.

A physician's order for the preparation and administration of a drug or device for a patient.

Common abbreviations in prescription writing qd or od = every day/ once a day • qod = every other day • bid = twice daily • tid = thrice daily • qid = four times/day • ac = before meals • pc = after meals • hs or qhs = at bedtime • disp = dispense

• prn = as needed • po = by mouth (orally) • IV = intravenous • IV push or bolus = at one time • IV infusion = infuse over time • IM = intramuscular • stat = immediately • sq or sc = subcutaneous • sig = label or write or let it be labeled = directions

for use

Here are some examples of changing trends in prescription writing:•Qod and qid can get mixed up; qod and qd

can get mixed up. One solution is to write out “once a day” or

“once every other day” or “four times daily.”•This brings up the confusion between q6h

and qid. Does this medication require a strict 6-hour dosing interval? Or, can it be given four times daily, for example, in a

6:30 AM to 11:00 PM day?

Additional Observations on Dosing IntervalsTID means three times daily, but it does not

specify the time interval between doses, whether these intervals have to be equal, when to start, or whether intake can be at meal times. You will need to specify these parameters when they are relevant.

Similarly, BID means twice daily; it does not necessarily mean q12h (every 12 hours) – be

specific when necessary.

DIVISIONS IN PRESCRIPTION

1. The superscription or heading with the symbol "R" or"Rx", which stands for the word recipe (in Latin) meaning “to take”.

2. The inscription, which contains the names and quantities of the ingredients.

3. The subscription or directions for compounding the drug.

4.The signature which is often preceded by the sign "s" standing for signa (Latin for mark), giving the directions to be marked on the container.

Prescription Writing

The first part -of the prescription lists:Name of medicineFormulation e.g. caps, tabs, syrupStrength of medicine.

Prescription Writing EXAMPLE:

If prescription is for amoxicillin this part of the prescription may read as:

Rx Amoxicillin caps 250 mg

orRx Amoxicillin syrup 125mg/5ml

Prescription WritingSecond part of prescription are the

instructions that go on the label.Traditionally begins with Sig. This is short for Signa which means mark or write. EXAMPLE: Instructions on how to take medicines

can be more detailed

Sig: -Take one hour before food along with a large glass of water. Do not lie down afterwards

For amoxicillin this may be written as: Sig: t.i.d p.o

Prescription WritingThird part of prescription specifies the

quantity to be dispensed.Traditionally prefaced by Mitte or M:For amoxicillin may specify one weeks supply M: 1 weeks supply/ x1/52.Largest quantity dispensed is 3 months supply

except for oral contraceptive which is 6 months supply.

Prescription WritingCOMBINEDRx Amoxicillin caps 250mg

Sig: t.i.d /t.d.s /8 hourly. p.o.M: 1 weeks supply/ x1/52

Prescription WritingIf a prescription is written as a three month supply it will be dispensed all at once: Unless it is an expensive medicine Close Control or CC is written on the script

Consider close control: where there is potential for harm possibility of confusion with medicines

Types of Prescriptions

1. GENERIC NAME- The nonproprietary name provided by the United States Adopted Name (USAN)Council

syn. Chemical Name e.g., amoxicillin, fluoxetine, diazepam, aspirin

2.BRAND NAME- The proprietary name orregistered trademark name provided by thepioneer pharmaceutical company who holds the

patent on the drug e.g., Prozac®,Viagra®, Xanax®

cont’d

New- An original prescription order dispensedfor the first time. Refill A repeat dispensing of the originalprescription order.Usually, encompasses

patients on maintenance therapy, e.g.,digoxin, phenytoin, lovastatin, potassium

chloride.

Component Elements of the Prescription paper

Heading- Physician’s name, practice addressand telephone number. Date prescription is written Patient Information- Name, address, age

(esp.,if for a pediatric or geriatric patient) Body of the Prescription RX- Take Thou.

Name of the prescribed drug or drug product. Also included is the strength of the medication, the number or quantity of the prescribed drug in addition to the dosage form

Body of the Prescription Cont’d DO NOT use abbreviations for drugs prescribed

unless the abbreviation is official, e.g., SSKI (Saturated Solution of Potassium Iodide), NSS (Normal Saline Solution),

Sig- Signatura (i.e., Mark Thou). Directionsfor use, e.g., one cap every 8 hrs. Refills- “N” times or NR. Leaving this section blank implies that the prescription is non-

refillable. Signature Legible in indelible pencil or pen.

MEDICAL ERRORS

1. 50% of medication errors are due to inadequate knowledge by prescriber.

If in doubt - seek advise.2. Another common source of medication error is poor communication: with patient with other health professionals

Risk Management Strategies For Prescribers• Be Professional and Courteous• Keep Good Records• Provide Adequate and Informed Consent • Tell and allow Patients to call when Necessary• Provide the Patient with a Realistic

Assessment of Outcome, Benefit, and Adverse Reactions

• Do not support False Expectations

In general, who can be held responsible for prescription errors?

• Licensed Prescriber• The Pharmacist who Dispensed or

Compounded the Medication• A Nurse who Administered the Medication• Any Employing Institution (e.g., hospital, clinic, practice) In some instances, the physician may

be considered an apparent agent of the hospital; the pharmacists and the nurses are employees.

Some Ways of Avoiding Prescription Errors• Write Legibly• Do not Guess• Be Careful with “look alike”names • Consider writing in the indication to further avoid

confusion • Avoid ten-fold dosing errors: write 1 mg instead of 1.0 mg• Conversely, write: 0.250 mg rather than .250 mg• Write 4 times per day NOT 1x4 daily; Is this qid or for 4 consecutive days

CONTROL SUBSTANCES

Control Substance- Distribution of certain medicines with abuse potential is controlled through the Comprehensive Drug Abuse Prevention and Control Act of 1970

This Act is regulated and enforced by the federal Drug Enforcement Agency (DEA)

MDs must be registered with the DEA to prescribe those drugs under the control of this act.

Re-registration is mandatory every three years.

Classifications of Controlled SubstancesSchedule I• The drug or other substance has a high potential for

abuse. • The drug or other substance has no currently accepted medical use in treatment in USA• Some Schedule I substances are heroin, LSD, marijuana, and methaqualone.

Schedule II

• The drug or other substance has a high potential for abuse.

• The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions. Abuse of the drug or other substance may lead to severe

psychological or physical dependence. • Schedule II substances include morphine, PCP, cocaine,

methadone, and methamphetamine

Schedule III

• The drug or other substance has a potential for abuse less than the drugs or other substances in Schedules I and II.

• The drug or other substance has a currently accepted medical use in treatment in the United States. • Abuse of the drug or other substance may lead to

moderate or low physical dependence or high psychological dependence.

• Anabolic steroids, codeine and hydrocodonewith aspirin or Tylenol, and some barbiturates

Schedule IV

• The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule III.

• The drug or other substance has a currently accepted medical use in treatment in the United States. • Abuse of the drug or other substance may lead to limited

physical dependence or psychological dependence relative to the drugs or other substances in

Schedule III. •e.g. Darvon, Talwin, Equanil, Valium and Xanax.

Schedule V

• The drug or other substance has a low potential for abuse relative to the drugs or other substances in Schedule IV. • The drug or other substance has a currently accepted medical

use in treatment in the United States. • Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence

relative to the drugs or other substances in Schedule IV. • Over-the-counter cough medicines with codeine

are classified in Schedule V.

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