Wk 1: Principles of Prescribing Flashcards
Prescriber is responsible to consider the following when prescribing:
Does pt need the drug? Education Financial concerns Individual variations in response Pregnancy / nursing concerns Obtain THOROUGH history
FDA created in 1906, required _______, and only prescribing meds listed in ___________
accurate labeling, and only prescribing USP or National Formulary
Durham Humphrey Amendment ________
1951: Mandated the Provider-Patient relationship for prescription drugs
Kefauver-Harris Amendment _________
1962: Drugs must be safe and effective, ADEs must be reported
Prescription is a method of communication to the pharmacist for a specific ______, specific ______, specific _______, and ________.
Method of communication to a pharmacist, for a specific medication, specific patient, specific time, instructions on how to use it
Controlled substances require a ________ for prescribing
DEA number
FDA site for reporting adverse drug events
Medwatch
Factors that cause confusion / error in prescription handoff include:
Large number of drugs
Numerous forms
Similar sounding names
Varying dosing regimens and usage
Percentage of prescriptions not filled, per Annals of Medicine, most commonly for these types of meds
31%, dermatology, GI, BP meds
Increased likelihood to fill Rx
Older adult
No copay
Frequent provider interaction
Eight components of a prescription:
Date Pt Name / Address / DOB Rx Name / Strength / Dosage form Signa (instructions on how to take it) Dispensing information (how much to dispense) Renewal information (Refills) Prescriber name / info
DEA: Controlled substances cannot be dispensed beyond ____ from date prescribed
6 months
Schedule II substances can be prescribed ______
1 month at a time with NO refills
St Johns Wort is metabolized by CYP___ and may compete for metabolism of ________ leading to ______.
CYP3A4; alprazolam; worsening fatigue
Esomeprazole increases ______, and can decrease _______ of _______
gastric pH; absorption of ketoconazole, iron pills, vit b12
________ abbreviations should not be used on prescriptions
Latin
Teaspoon = ____ mL; Tablespoon = ______mL; Ounce = _____ mL; Ounce = ______ g
Teaspoon = 5mL; Tablespoon = 15mL; Ounce = 30mL; Ounce = 28.35g
Controlled substances have refill limits per ______ and _______
Schedule and state law
All Controlled Substances require ________
DEA Number
Schedule ___ require FULL signature
Schedule II
Controlled Substances Act of 1970 provides a ____________
Legal framework for controlled substances
Drug abuse potential defined by…
Pharmacologic properties
chemical structure
CNS effects
Narcotic is a ______ term to denote controlled substance
Legal
Controlled Substance Scheduling criteria is based on
Dependence liability
Potential for abuse
Approved clinical use
Schedule I drugs:
No therapeutic value, high potential for abuse
APPLICATION TO DEA REQUIRED
Schedule II drugs:
Medical use, but high potential for abuse
Includes Cocaine
Must be WRITTEN prescription on paper (can be done by phone in emergencies but must have written Rx in 72 hours)
30 days max / 100 dosage units max
3-5 day supply sometimes
NO REFILLS
Schedule III drugs:
Medical use, less potential for abuse Anabolic steroids Testosterone/estrogen Buprenorphine Paregoric REFILL OK 5 REFILLS in 6 MONTHS
Schedule IV drugs:
Medical use, less potential for abuse Benzodiazepines Barbiturates Sleep aids (Ambien) REFILL OK 5 REFILLS in 6 MONTHS
Schedule V drugs:
No Prescription required;
18 years old with ID required
Pregabalin / Lyrica
Product Package Insert (PPI or PI) written by _____ and provides _______.
Product Package Insert (PPI or PI)
Provides FDA approved safety & efficacy information
Written by drug manufacturer
Includes BLACK BOX WARNING
The international drug directory is called __________
Index Nominum and Martindale
Natural Product Resources include:
Natural Medicines Comprehensive Database*
The Review of Natural Products
Natural Standard*
PDR for Herbal Medicines*
Complete German Commission E Monographs * Electronic options available
Pharmacist’s Letter herbal supplement
Prescribers typically give a _______ supply if on stable therapy
12 month
4 “S” rule for prescribing
Smart (Always ask about pregnancy possibility)
Safe (clear)
Sensible
Secure
