Prescription writing (Stasio)

Question 1

Legend drugs

Answer 1

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

Question 2

Over the Counter (OTC) Drugs

Answer 2

Drugs that do not require a prescription.

Question 3

Controlled Drugs

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

Controlled Substances Act of 1970

Answer 4

divides controlled substances int 5 categories/ schedules

Question 5

Schedule I

Answer 5

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

Schedule II

Answer 6

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

Schedule III

Answer 7

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

Schedule IV

Answer 8

Drugs that have less of an abuse potential than those of Schedule III.
Example: benzodiazepines – diazepam, lorazepam, alprazolam, clonazepam, Darvon, Darvocet, Soma.

Question 9

Schedule V

Answer 9

– 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 (

Question 10

what do you need to prescribe a controlled substance?

Answer 10

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

Question 11

history of prescription writing

Answer 11

One of the most important therapeutic transactions between physician and patient.

The ancients wrote their prescriptions to appeal to the gods for success of their treatments.

The ancient symbol “Rx” was established centuries ago and has been carried down to the present time.

Question 12

Present day prescription

Answer 12

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 13

Prescription Writing and Patient Safety

Answer 13

7,000 deaths annually have been attributed to medication errors.
$177 billion is the cost for adverse medical events.
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

Parts of the Written Prescription

Answer 14

Superscription
Inscription
Signatura
Name and Signature of the Prescriber
Labeling
Refills

Question 15

Superscription:

Answer 15

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.
Example: May 19, 2016, not 5/19/16

The symbol “Rx” – abbreviation for “recipe” and the Latin for “take thou”.

Question 16

Inscription

Answer 16

Contains the name and amount or strength of each medication.

Examples:
Lasix 40 mg
Synthroid 100 mcg
Colchicine 0.4 mg
Amoxicillin Suspension 250 mg / 5 ml
Beclomethasone Cream 0.5%

Question 17

Subscription

Answer 17

How much medication for the pharmacy to dispense.  Write out the amount.
Number of pills.
Volume of liquid.
Size of the tube.
Example:
Disp: # 40 (forty)
Disp: #150 ml (one-hundred fifty)
Disp: #30 grams (thirty)

Question 18

Signatura

Answer 18

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.
Sig: 1 cap TID pc
Sig: one capsule 3 times a day after meals

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.
“for pain”
“to relieve itching”
“for blood pressure”
“for 7 days”
Sig: one tablet daily in the morning for blood pressure
Sig: one capsule 3 times a day for 10 days

Question 19

Labeling: (old term)

Answer 19

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 20

Refills:

Answer 20

The physician should indicate the number of refills if any for the patient.
Schedule II drugs are not refillable.

Question 21

Absolutely necessary on the Rx?

Answer 21

Physician’s signature on the Rx.

Question 22

Keep it Simple

Answer 22

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 23

Write legible – PRINT

Answer 23

Use computer generated typed prescriptions if available. Used more often with EMR.
Many medications look and sound alike.
Levitra
Levlen

Question 24

more helpful hints

Answer 24

Provide concise dosage information.
Abbreviations, decimal point placement, symbols and old terms.
Example:
Drams and grains – not used, use metric measurement.
Decimal points
Use leading “0” for less than 1 ex: 0.05 mg
Avoid trailing “0” after decimal
.50 mg looks like 50 mg
Units: mg, mcg, gm, ml

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.
“Two tablets by mouth every 6 hours as needed for knee pain”

Question 25

Abbreviations

Answer 25

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.

Common and accepted abbreviations:
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 26

Specify the therapeutic duration.

Answer 26

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 27

Specify indication

Answer 27

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:
Re-enforces the care plan.
Facilitates pharmacist counseling.
Improves physician to physician communication

Question 28

Add supplemental instructions:

Answer 28

Include additional information or warnings.
Examples:
“Avoid sun exposure” – tetracyclines
“Do not use with alcohol” – metronidazole
“Take with food” – steroids and NSAIDS

Question 29

Pediatric Prescriptions

Answer 29

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