RX writing Flashcards
Origin of requirement for prescriptions for all drugs ~ 1950
Social construct***
some need authorization by a licensed prescriber.
What was specified in the Harrison act 1915?
ANTI narcortics- only drug that need RX until 1950
“narcotics” is a legal term not a medical
never used in medicine or pharmacology.
Who gained rights to decide what is OTC and what is a prescription drug in 1951?
Durham-Humphrey Amendment of 1951
one drug/company
What are the seven steps to rationale prescribing?
1- Make a specific diagnosis.
- Consider pathophysiologic implications- Big picture
- Select a specific therapeutic objective. RA TX inflammation
4- Drug of choice- age, sex, other diseases, allergies, cost of the medications etc.
5- Determine the appropriate dosing regimen. CC**
- Devise a plan for monitoring the drug’s action and endpoint. sx to report, blood levels, LFTs. Explain lifetime therapy.
7- Plan a program of patient education. Drug education.
What are on most prescription pads?
Name, credentials, contact, date.
What constitutes the instructions to the pharmacist?
- Patient name
- Patient address
- Drug name
- Drug strength (50 mg pills
- Quantity of drug- small 1st
- Instructions for use- DONT TRUST ANYONE HCP RESPONSE
- Refill information
- Child proof containers (yes/no)
- Drug warnings
- Prescribers signature
16 and 17. Prescribers license, state numbers ,signature
What factors help determine the quantity written for in prescription
- abuse
- cost
- LOW Dose 1st, to rule out intolerance and save money
What was abandoned in the mid 20th century but worth knowing?
**Apothecary vs Metric Units
***1 grain (gr) =65 milligrams (mg)
1 ounce (oz) =30 milliliters (mL)
1 minim = 1 drop (gtt) (L. guttae, drops)
20 drops =1 mL
g/gram = 1 gr/grain = 0.065 g = 65 mg mg/milligram = 0.001 g µg/microgram = 0.001 mg
never use µg, always write out “microgram”
Prescription terms that are required to be learned
bid twice a day qd every morning qh every hour q2h every two hours etc **qhs every night at bedtime qid four times a day **qod every other day **qs sufficient quantity tid three times a day c with s without **ac before meals **dil dissolve, dilute gtt drops hs bedtime
Most common prescribing errors (give examples for each)
errors of omission- clear details
illegible handwriting
inappropriate drug prescription- drug drug interactions
Distractions
Lack of appropriate labeling 1- VARIED by drug class **2- declining renal fx **3- failure to note allergy 4- wrong drug name LAMICTAL VS LAMISIL 5- incorrect dosage calculation 6- decimal point error
why a patient may not be taking the drug as you prescribed?
Compliance:
(a) Patient fails to obtain the medication.
(b) Patient fails to take as prescribed.
(c) Patient prematurely d/c
(d) Patient takes drug inappropriately. shares
Chronic- 43-78%
White coat adherence- 5d /b4 MD appt
Compliance inversely proportional to frequency of dosing required
**Handwriting errors with regard to prescription numbers
Always ADD a Zero before decimal
Always DROP a Zero after decimal
What are difference btwn. Drug Schedule I, II, III, IV, V
what determines where a drug is put in the list
Formulation of drug determines
I- no known medial use LSD
II- high potential for addiction, no refills allowed, DEA registration required, no phone orders, some states special prescription pad
III, IV, V
less potential for addiction,
5 refills allowed
no filling of prescription > 6 mo. old from date of being written.
What is important about Computer Order Entry?
electronic prescription order **Be cautious. can mean a patient’s life*** 1- wrong patient selection 2- wrong med selection 3-unclear log off 4- order lost if crash 5- late in of the day lost 6- lag btwn dose admin and nurse entry-inflexible order
What is approved drug for a clinical condition for which the drug has not been studied and approved by the FDA? Can a rep legal recc off label use?
OFF LABEL USE
NO!!!
Injury =malpractice.
