Intro to Writing Prescriptions

Question 1

Define a prescription

Answer 1

: an instrument written by a medical practitioner that authorizes a patient to be provided a medicine or treatment
• It is a written order by an authorized medical provider to a pharmacist in the form of medication instructions for an individual patient
• A prescription is a written order for compounding, dispensing, and administering drugs to a specific patient.

Question 2

Patient information

Answer 2

full name, home address, date of birth, and date prescription was written
• Date: the date written. All prescriptions expire in one year from date written.
• Scheduled drugs fall under different timeframes
• For a pediatric prescription the weight is optional but may be helpful

Question 3

Superscription (Rx):

Answer 3

R – Latin abbreviation for recipe, meaning take. The slanted line through the leg of the Rx used to indicate that the R was an abbreviation. Used to start the prescription

Question 4

Inscription:

Answer 4

drug name (brand or generic), dose, strength, form,
• Brand name (proprietary name)
• Generic—scientifically assigned name
• Strength—amount of drug in the dosage form or a unit of the dosage form
o Example: milligrams of active drug in a tablet
o Many drugs come in multiple strengths so you must designate a strength
• Dosage form: tablet, liquid, suspension, ointment, creams, suppository, injectable

Question 5

Subscription:

Answer 5

quantity to be dispensed, special instructions
• How many?
o Number is based on how often the person takes the drug over a period of time.
o Most prescriptions written for a month’s supply
o Antibiotics, pain medications, and corticosteroids are usually given for a limited time
o Topicals are written for a quantity over time but it is harder to determine the amount needed for a month
o For chronic medications, always take into consideration how many units of the drug are needed for a month’s supply. Tablets are easy but other liquids or other dosage forms may take more computation. Otherwise, the patient runs out of medication before the end of the month or they end up paying more out of pocket to get their medications.
o Insurance may dictate how much medication can be dispensed.

Question 6

Signa:

Answer 6

Abbreviated Sig (abbreviation Latin term meaning write, or let it be labeled.) Includes the patient instructions: route of administration, frequency of dosing, duration of dosing, purpose of medication, special instructions, warnings
• Start with a verb congruent with the directions: Take, chew, inhale, apply
• Number of units to be taken at one time
• Route of administration – by what route will the drug enter the body
o Mouth, nasal, inhalation, skin, buccal, sublingual, rectally, vaginally, subcutaneously
• Frequency—how often
o Daily, twice day, weekly, monthly, as needed

Question 7

Duration of dosing, special instructions or warnings, purpose of treatment

Answer 7

• May not be needed for all medications
• Use for acute treatments when the patient is expected to respond over a short period of time
o Antibiotics, pain medications, topicals, antivirals, corticosteroids
• Special instructions
o Examples: take in the morning, take at bedtime, use sparingly, take until completed, take with food
• Purpose
o Why are they taking the medication?
o “to lower blood pressure”, “to lower blood glucose”, “for pain”, “for infection”, for asthma symptoms”
• Warnings
o Do not take with alcohol
o Avoid taking with antacids
o Avoid exposure to direct sunlight

Question 8

Signature line:

Answer 8

Yours. Include your professional designation

Question 9

Prescriber information

Answer 9

• Supervising physician for PA—can circle at top of prescription if listed
• DEA#: all medical prescribers are required to get a DEA number (contains 2 letters, six numbers and one check digit)—apply once you are fully credentialed

Question 10

Substitution permitted or not?

Answer 10

Brand name indication: must indicate brand necessary or dispense as written

Question 11

Refills:

Answer 11

how often do you want them to refill the medication? Don’t leave blank
• Based on prescriptive authority (435:15-11-1)
o New diagnosis –30-day supply, 2 months for a non-controlled substance
o Established diagnosis – up to 90-day supply with up to one year of refills for non-controlled substance
o Controlled substances—Schedule III, IV, and V can be written for a 30 day supply, no refill
o Controlled substance—Schedule II – can only be written by a PA for use on-site
• Usually based on a monthly basis
• Incorrect refills can result in patients running out of medications or increased cost and more work for you

Question 12

Given a common prescription abbreviation about frequency, define the term

Answer 12

BID: twice daily
TID: three times a day
QID: four times a day
HS: bedtime
h, hr: hour
PRN: as needed or as circumstances warrant

Question 13

Given a common prescription abbreviation about route, define the term

Answer 13

PO: by mouth
SL: sublingual
PR: per rectum
SC: subcutaneous

Question 14

Given a common prescription abbreviation about strenght/vol., define the term

Answer 14

g: Gram
gr: Grain (1 grain = 65 mg)
mg: Milligrams (1,000 mg = 1 gram)
mcg: Micrograms (1,000 mcg = 1 mg)
mL: Milliliter (1,000 mL = 1 L) (*preferred until of measurement for oral liquids)

Question 15

Given a common prescription abbreviation about dosage forms, define the term

Answer 15

tab: tablet
cap: capsule
oint: ointment
crm: cream
susp: suspension
sup: suppository

Question 16

Given a common prescription abbreviation about quantity, define the term

Answer 16

oz: ounce (30 mL)
x: times

Question 17

frequncy modifier abbreviations

Answer 17

a w/ bar above: before
p w/ bar above: after
ac: before meals
pc: after meals
AM: morning
Q. q: every 
c w/ bar above: with 
s w/ bar above: w/o
w/o: without

Question 18

Given a list of prescription abbreviations, identify the abbreviations that are on the Joint Commission’s do not use list.

Answer 18

U, u: should use unit
IU: write international unit
Q.D or QOD: write daily / every other day
Trailing zero (X.0 mg): write X mg
Lack of leading zero (.X mg): write 0.X mg
MS: write morphine sulfate
MSO4: write magnesium sulfate

Question 19

Explain the purpose of the DEA number

Answer 19

DEA number: a number assigned to a health care provider by the US Drug Enforcement Administration
• Required to write for controlled substances
• You will apply for a DEA number after you take your boards after graduation

Question 20

How is a DEA number derived?

Answer 20

Valid DEA number: two letters, six numbers, and one check digit
• The first letter identifies that type of practitioner or an institution
o M is used for PA and other mid-level practitioners
• The second letter is the first letter of the provider’s last name
• The last digit is derived by:
o Add first, third and fifth digits = sum 1
o Add second, fourth, and sixth digits TWICE = sum 2
o Add sum 1 and sum 2 together
o Second digit in the total of sum 1 plus sum 2 is the 7th digit
o Ex. 5623740
o The rightmost digit (the digit in the “ones” place) is the check digit (also called the check sum)

Question 21

PA laws regarding days supply and number of refills that can be authorized

Answer 21

Based on prescriptive authority (435:15-11-1)
• New diagnosis –30-day supply, 2 months for a non-controlled substance
• Established diagnosis – up to 90-day supply with up to one year of refills for non-controlled substance
• Controlled substances—Schedule III, IV, and V can be written for a 30 day supply, no refill
• Controlled substance—Schedule II – can only be written by a PA for use on-site