8-3 Prescription Writing - King Lecture Flashcards
What is a legend drug?
Drugs that may be dispensed by a pharmacist only with a prescription from a licensed physician or other practitioner.
What is an OTC drug?
Drugs that do not require a prescription.
What is a controlled drug?
Drugs requiring a prescription, as well as additional safe guards and regulations from Federal and/or State Agencies.
Federal Agency = Drug Enforcement Agency (DEA)
State Agency = Division of Narcotics and Dangerous Drugs of DHHR
What legislation divided controlled drugs?
¨Controlled Substances Act of 1970, divides these drugs into 5 schedules or categories.
What is a schedule I drug? Examples?
¨Schedule I – No acceptable medical use and have a very high abuse potential.
Need special authorization from the DEA
¤Example: LSD, heroin, methaqualone, ecstasy, marijuana ?
What is a schedule II drug? Examples?
¨Schedule II – Drugs that have a high abuse potential with physical or psychological dependence.
These medications have a medical use or indication.
Must have written and non-refillable Rx.
Must have appropriate documentation.
¤Example: morphine, fentanyl, hydromorphone, methadone, cocaine, amphetamine, oxycodone, hydrocodone, methamphetamine, Adderall and Ritalin.
What is a schedule III drug? Examples?
¨Schedule III – These drugs have an abuse potential less than I and II and contain limited quantities of certain narcotic analgesics and other medications such as barbiturates.
¤Example: Tylenol #4 (codeine), anabolic steroids, testosterone.
What is a schedule IV drug? Examples?
¨Schedule IV – Drugs that have less of an abuse potential than those of Schedule III.
¤Example: benzodiazepines – diazepam, lorazepam, alprazolam, clonazepam, Darvon, Darvocet, Soma.
What is a schedule V drug? Example?
¨Schedule V – Drugs that have less of an abuse potential than Schedule IV’s.
Contain very limited amount of certain narcotics used for anti-tussive or anti-diarrheal purposes.
Example: Lomotil (diphenoxylate), Robitussin with codeine (<200 mg/100 ml)
How can a physician prescribe a controlled substance?
¨A physician must obtain a DEA Certificate in order to prescribe any controlled substance.
What are some general features of a prescription? What is the measurement system?
¨Present day prescription:
¤Usually contains a single ingredient or drug.
¤Written in English.
¤Doses are in the metric system
¤The ancient “Rx” and Latin “Signatura” abbreviated “Sig:” are all that remain of the ancient art of the prescription.
How many deaths annually from medication errors? At what cost?
¨7,000 deaths annually have been attributed to medication errors.
¨$37.6 billion is the cost for adverse medical events.
What are some major causes of errors with prescriptions?
¨Distractions account for a large portion of the errors – at all levels of health care.
¨Errors are often caused by illegibility and misunderstood translations of symbols or abbreviations.
¨Improvement with EMR.
What are the parts of the written prescription?
¨Superscription
¨Inscription
¨Signatura
¨Name and Signature of the Prescriber
¨Labeling
¨Refills
What’s in the superscription?
¨Superscription:
¤The name, address, age of the patient.
¤The date is written. Do not pre or post date Rx. Date should be written in alpha-numeric notation.
nExample: May 19, 2015, not 5/19/15
¤The symbol “Rx” – abbreviation for “recipe” and the Latin for “take thou”.
What does the inscription contain?
¤Contains the name and amount or strength of each medication.
nExample
nLasix 40 mg
nSynthroid 100 mcg
nColchicine 0.4 mg
nAmoxicillin Suspension 250 mg / 5 ml
nBeclomethasone Cream 0.5%
What does the subscription contain?
¨Subscription:
¤How much medication for the pharmacy to dispense. Write out the amount.
¤Number of pills.
¤Volume of liquid.
¤Size of the tube.
nExample:
nDisp: # 40 (forty) - write in a way so that amount can’t be changed
nDisp: #150 ml (one-hundred fifty)
nDisp: #30 grams (thirty)
n
What does the signatura contain?
¨Signatura:
¤From the Latin “signa” meaning “write”, “make” or “label”.
¤This section contains the directions for the patient.
¤Should always be written in plain English, however physicians continue to insert Latin abbreviations.
What is not acceptable in the signatura? What is another important part of it, other than directions how to take it?
¤The instruction “take as directed” is not satisfactory and should be avoided.
¤The intended use of the medication and/or time limit should be included.
n“for pain”
n“to relieve itching”
n“for blood pressure”
n“for 7 days”
nSig: one tablet daily in the morning for blood pressure
nSig: one capsule 3 times a day for 10 days
What is labeling?
¨Labeling: (old term)
¤When the physician wants the patient to know the name of the drug, the box on the prescription form marked “label” should be checked.
How are refills indicated?
¨Refills:
¤The physician should indicate the number of refills if any for the patient.
¤Schedule II drugs are not refillable.
What is the last part of the prescription that’s really important?
¨Physician’s signature on the Rx.
What is a good way to avoid medication errors? Should you use abbreviations?
Approach medication names with caution.
Some medications names may sound and look alike.
Write the entire drug name out.
DO NOT use drug abbreviations:
TCN = tetracycline or triamcinolone?
quinapril – quinidine
How are EMRs helpful with prescription safety? If not available, what is important with a hand-written script?
¨Write legible – PRINT
¨
¨Use computer generated typed prescriptions if available. Used more often with EMR.
¨Many medications look and sound alike.
¤Levitra
¤Levlen
