8-3 Prescription Writing - King Lecture

Question 1

What is a legend drug?

Answer 1

Drugs that may be dispensed by a pharmacist only with a prescription from a licensed physician or other practitioner.

Question 2

What is an OTC drug?

Answer 2

Drugs that do not require a prescription.

Question 3

What is a controlled drug?

Answer 3

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

Question 4

What legislation divided controlled drugs?

Answer 4

¨Controlled Substances Act of 1970, divides these drugs into 5 schedules or categories.

Question 5

What is a schedule I drug? Examples?

Answer 5

¨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 ?

Question 6

What is a schedule II drug? Examples?

Answer 6

¨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.

Question 7

What is a schedule III drug? Examples?

Answer 7

¨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.

Question 8

What is a schedule IV drug? Examples?

Answer 8

¨Schedule IV – Drugs that have less of an abuse potential than those of Schedule III.

¤Example: benzodiazepines – diazepam, lorazepam, alprazolam, clonazepam, Darvon, Darvocet, Soma.

Question 9

What is a schedule V drug? Example?

Answer 9

¨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)

Question 10

How can a physician prescribe a controlled substance?

Answer 10

¨A physician must obtain a DEA Certificate in order to prescribe any controlled substance.

Question 11

What are some general features of a prescription? What is the measurement system?

Answer 11

¨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.

Question 12

How many deaths annually from medication errors? At what cost?

Answer 12

¨7,000 deaths annually have been attributed to medication errors.

¨$37.6 billion is the cost for adverse medical events.

Question 13

What are some major causes of errors with prescriptions?

Answer 13

¨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.

Question 14

What are the parts of the written prescription?

Answer 14

¨Superscription

¨Inscription

¨Signatura

¨Name and Signature of the Prescriber

¨Labeling

¨Refills

Question 15

What’s in the superscription?

Answer 15

¨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”.

Question 16

What does the inscription contain?

Answer 16

¤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%

Question 17

What does the subscription contain?

Answer 17

¨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

Question 18

What does the signatura contain?

Answer 18

¨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.

Question 19

What is not acceptable in the signatura? What is another important part of it, other than directions how to take it?

Answer 19

¤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

Question 20

What is labeling?

Answer 20

¨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.

Question 21

How are refills indicated?

Answer 21

¨Refills:

¤The physician should indicate the number of refills if any for the patient.

¤Schedule II drugs are not refillable.

Question 22

What is the last part of the prescription that’s really important?

Answer 22

¨Physician’s signature on the Rx.

Question 23

What is a good way to avoid medication errors? Should you use abbreviations?

Answer 23

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

Question 24

How are EMRs helpful with prescription safety? If not available, what is important with a hand-written script?

Answer 24

¨Write legible – PRINT

¨

¨Use computer generated typed prescriptions if available. Used more often with EMR.

¨Many medications look and sound alike.

¤Levitra

¤Levlen

Question 25

What kind of dosing information should be on a script? How should you write decimal points?

Answer 25

¨Provide concise dosage information.

¨Abbreviations, decimal point placement, symbols and old terms.

¨Example:

¤Drams and grains – not used, use metric measurement.

¤Decimal points

nUse leading “0” for less than 1 ex: 0.05 mg

nAvoid trailing “0” after decimal

.50 mg looks like 50 mg

Units: mg, mcg, gm, ml

Question 26

Other than concise, what should you do with dosing instructions?

Answer 26

¨Provide clear and specific directions.

¤Avoid “take as directed”, directed by who, for what?

¤

¤PRN – “take as needed” – for what, leads to errors.

Some is good, more is better.

¤Avoid abbreviations in frequency or routes of

administration.

“One tablet by mouth every 6 hours as needed for knee pain”

Take 2 pills every 4 hours for headache not to exceed 10 pills a day

Question 27

How should you use abbreviations on a prescription?

Answer 27

Do not use abbreviations as a general rule.

They must be understood by everyone who reads the Rx or order.

Most hospitals have a list of approved abbreviations and meet legal standards.

Question 28

¨Name these common and accepted abbreviations:

¤ac

¤pc

¤hs

¤BID

¤TID

¤QID

¤QD

¤QOD

¤Q6h

OD/OS/OU

Answer 28

¤ac = before meals

¤pc = after meals

¤hs = at bedtime

¤BID = twice a day

¤TID = three times a day

¤QID = four times a day

¤QD = once a day

¤QOD = every other day

¤Q6h = every 6 hours

¤OD/OS/OU = right eye/left eye/both eyes

Question 29

What is the therapeutic duration?

Answer 29

¨Specify the therapeutic duration.

¤The number of pills or volume should match the expected duration of treatment.

¤Remain cognizant of lethal doses of medications.

¤Tricyclic anti-depressants and narcotics prescribe in sub-lethal doses.

Question 30

What is the indication? Why is it important?

Answer 30

¨Specify indication:

Sig: Take one capsule daily for heartburn in AM

¤Frequently encouraged but seldom followed.

¤Confirms to the pharmacist the use of the medication.

¤Checks and balances:

nRe-enforces the care plan.

nFacilitates pharmacist counseling.

nImproves physician to physician communication.

Question 31

What are the supplemental instructions?

Answer 31

¤Include additional information or warnings.

Examples:

n“Avoid sun exposure” – tetracyclines

n“Do not use with alcohol” – metronidazole

n“Take with food” – steroids and NSAIDS

Question 32

How do you prescribe medications for pedes?

Answer 32

¨Need to calculate the dose, concentration and frequency usually based on the patient’s weight.

¨

¨Example:

Amoxicillin dose = 40mg/kg/day in 2 or 3 divided doses

Patient’s weight = 66 lb

66 lb ÷ 2.2 = 30 kg

Always use a calculator

Question 33

Calculate:

30 kg x 40 mg/kg/day =

2 divided doses/day =

3 divided doses/day =

Answer 33

30 kg x 40 mg/kg/day = 1200 mg/day

2 divided doses/day = 600 mg/dose

3 divided doses/day = 400 mg/dose

Question 34

What other factor is important to figure into a pedes prescription?

Answer 34

¨In what dosage strength and forms is amoxicillin (or any drug) manufactured?

¨Capsules:

¤250 mg

¤500 mg

¨Suspension:

¤125 mg/5 ml

¤250 mg/5 ml

¤400 mg/5 ml

¤500 mg/5 ml