Prescription writing (Stasio) Flashcards
Legend drugs
Drugs that may be dispensed by a pharmacist only with a prescription from a licensed physician or other practitioner.
Over the Counter (OTC) Drugs
Drugs that do not require a prescription.
Controlled Drugs
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
Controlled Substances Act of 1970
divides controlled substances int 5 categories/ schedules
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 ?
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.
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.
Schedule IV
Drugs that have less of an abuse potential than those of Schedule III.
Example: benzodiazepines – diazepam, lorazepam, alprazolam, clonazepam, Darvon, Darvocet, Soma.
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 (
what do you need to prescribe a controlled substance?
A physician must obtain a DEA Certificate in order to prescribe any controlled substance.
history of prescription writing
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.
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.
Prescription Writing and Patient Safety
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.
Parts of the Written Prescription
Superscription Inscription Signatura Name and Signature of the Prescriber Labeling Refills
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.
Example: May 19, 2016, not 5/19/16
The symbol “Rx” – abbreviation for “recipe” and the Latin for “take thou”.
Inscription
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%
Subscription
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)
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.
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
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.
Refills:
The physician should indicate the number of refills if any for the patient.
Schedule II drugs are not refillable.
Absolutely necessary on the Rx?
Physician’s signature on the Rx.
Keep it Simple
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
Write legible – PRINT
Use computer generated typed prescriptions if available. Used more often with EMR.
Many medications look and sound alike.
Levitra
Levlen
more helpful hints
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”
Abbreviations
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
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.
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:
Re-enforces the care plan.
Facilitates pharmacist counseling.
Improves physician to physician communication
Add supplemental instructions:
Include additional information or warnings.
Examples:
“Avoid sun exposure” – tetracyclines
“Do not use with alcohol” – metronidazole
“Take with food” – steroids and NSAIDS
Pediatric Prescriptions
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
