prescription drug drug that requires a prescription because it is considered potentially harmful if...

Prescription Writing and Pharmacopeias

Prescription Drug

drug that requires a prescription because it is considered potentially harmful if not used under the supervision of a licensed health care practitioner

Definition and Format of a Prescription

A prescription is a written, verbal, or electronic order from a practitioner or designated agent to a pharmacist for a particular medication for a specific patient.

Writing PrescriptionsWho can write a Rx?

• Practitioners – Physicians, veterinarians, dentists, podiatrists

• Mid-level practitioners – nurse practitioners, physician assistants, optometrists,

pharmacists

Contents of the Prescription

• All prescriptions should have the following essential elements:1. Date of the order2. Patient Name and Address3. If the drug is prescribed for an animal, the species of the

animal4. Name of the drug5. Strength of the drug6. Quantity of the drug7. Directions for use8. Intended use of the drug, unless practitioner feels indication is

not in best interest of patient9. Practitioner Name, Address, Telephone number

Contents of the PrescriptionDate

• Date the prescription is issued or written• Allows the determination of the life of the

prescription to validate refillsLegend drugs :

• are that approved by the U.S. Food and Drug Administration (FDA) and that are required by federal or state law to be dispensed to the public only on prescription of a licensed physician or other licensed provider.

A controlled (scheduled) drug • is one whose use and distribution is tightly

controlled because of its abuse potential or risk. • Controlled drugs are rated in the order of their

abuse risk and placed in Schedules by the Federal Drug Enforcement Administration (DEA).

• The drugs with the highest abuse potential are placed in Schedule I, and those with the lowest abuse potential are in Schedule V. These schedules are commonly shown as C-I, C-II, C-III, C-IV, and C-V.

• Legend drugs • expire 1 year from date issued

• Controlled drugs• CIII-CV – expire 6 months from date

issued• CII – expire 7 days from date issued

• Ensures continual patient supervision• Promotes patient follow - up


Patient Name and Address• Full first and last name

• Middle initial may be helpful• Full address• DOB – not required, but will be helpful in

further identifying the correct patient to prevent medication errors

Contents of the PrescriptionSelecting the drug

• Determine if the drug is a controlled drug or non-controlled drug (Controlled drugs will have additional law requirements)

• Determine preference for brand or generic product• Brand vs. generic• Bioequivalent drugs– same amount of active ingredient

is delivered to body and will produce identical effect in terms of duration and intensity

• Is Brand always better? NO• If practitioner prefers brand, he must indicate in print,

“Brand Necessary” or “Brand Medically Necessary”


Name of the drug

USE WITH CAUTION:– There are Look Alike/Sound Alike drug names

due to • Massive number of new drug releases• Massive number of reformulations• Drug marketing strategy

–Build on established names–New combination drugs – Use converged

names

Look Alike/Sound Alike Names

Serzone (nefazodone) vs. Seroquel (quetiapine)(antidepressant) (antipsychotic)

These two drugs have• Similar overlapping strengths (100 mg and 200 mg)• Similar dosage forms (tablets)• Similar dosing interval (BID)• Similar titration schedule• Often stocked in close proximity on pharmacy shelf

Prescribing and dispensing errors have led to a number ofadverse events (Nausea/Vomiting [N/V], hallucinations,

altered mental status [AMS], lethargy, seizures, death)

This is for reference onlyYou don’t have to memorize it

READ IT LATER


Name of the drug

Avoid the use of Abbreviations• Many drugs identified with abbreviations

–EX: HCTZ for hydrochlorothiazide, MSO4 for morphine sulfate

• Attempts to standardize abbreviations have been unsuccessful

“Do Not Use” Abbreviations, Acronyms, and Symbols

Abbreviation Potential Problem Preferred Term

U (unit) Mistaken as zero, four, or cc Write “unit”

IU (international unit) Mistaken as IV or 10 Write “international unit”

Q.D., Q.O.D. Mistaken for each other. Period after Q and O after Q can be mistaken for “I”

Write “daily” and “every other day”

Trailing zero and lack of leading zero

Decimal point missed Never write a zero by itself after a decimal point, and always use a zero before a decimal point

MS, MSO4, MgSO4 Confused for one another Write “morphine sulfate” or “magnesium sulfate”

List of dangerous abbreviations, acronyms, and symbols

(Please read it later)

List of additional dangerous abbreviations, acronyms, and symbols(Please read it later)

ABBREVIATON POTENTIAL PROMBLEM PREFERRED TERM

µg (microgram) Mistaken for mg (milligram) Write “mcg”

H.S. (at bedtime or half – strength)

Mistaken for either meaning: Also mistaken for every hour

Write out “half – strength” or “at bedtime”

T.I.W (three times a week) Mistaken for three times a day or twice weekly

Write “three times weekly” or “3 times weekly”

S.C. or S.Q. (subcutaneous) Mistaken for SL for sublingual or “5 every”

Write “Sub-Q” or “subQ” or “subcutaneously”

D/C Interpreted as discontine whatever medication follows(typically discharge meds)

Write “discharge”

c.c. Mistaken for U (units) when poorly written

Write “ml” for milliliters

A.S., A.D., A.U. (Latin abbreviations for left, right, both ears)O.S., O.D., O.U. (Latin abbreviations for left, right, both eyes)

Mistaken for each other (A.S. for O.S., A.D. for O.D., A.U. for O.U., visa versa)

Write out “left ear” or “right ear” or “both ears”Write out “left eye” or “right eye” or “both eyes”

Common Abbreviations

You have to memorize it


Strength of the drug

• Be familiar with drugs and their various dosing strengths and dosage forms • When in doubt, use references or call

pharmacy for help • Be familiar with dosing units and their

corresponding abbreviations• Weight – based dosing

• Always convert patient weight to correct units (kg)


When writing the strength of the drug

Decimal points• Avoid trailing zeros. EX. 5 mg vs. 5.0

mg; can be mistaken for 50 mg • Always use leading zeros. EX. 0.8 ml

vs. .8 ml; can be mistaken for 8 ml


Quantity of the drug• Prescribe only necessary quantity• Write for specific quantities rather than time

period (for example: dispense #30 vs. dispense for 1 month)

• Calculate: quantity = frequency per day x treatment days e.g. 3 times a day x 30 days

• Writing out “Dispense # 90” is helpful

(30 x 3 = 90)


Directions for use

• Write out in full English (or Arabic)

• Provide clear and specific directions• Avoid “Take as Directed.”


• Writing indications for drugs

• Encouraged, but not practiced by doctors• Helps confirm appropriateness of medication• Reminds patient of drug’s purpose• Facilitates communication between health

care providers


Practitioner’s Name, Address, and Phone number

• Validates prescription• Provides contact information to clarify any

questions• Information based on practitioner’s usual

place of business


• Refills• Refills are copies of a prescription (to get

the same medicines again without going to doctor e.g. drugs for diabetic patients)

• To avoid interrupting maintenance therapy, practitioners can authorize refills on a written prescription

• Used for non-controlled substances - No limit to number of refills allowed.

• Refills authorized are valid only for life of the prescription – 1 year

• Refill as needed for 1 year

Controlled Substances

• Definition - a prescription drug whose use and distribution is tightly controlled because of its abuse potential or risk

• Regulation is more strict• Federal law and State law regulate the

storage, use, and disposal of controlled substances

• Controlled or scheduled drug

• Controlled drugs are classified into schedules

• Schedules CI, CII, CIII, CIV, and CV

• Prescriptions for controlled substances have additional requirements by law



• Controlled drugs are divided into Schedules according to abuse potentialSchedule I (C-I) – Highest abuse risk. No safe medical use. Examples: heroin, marijuana, LSD lysergic acid, PCP phencyclidine, and crack cocaine.Schedule II (C-II) – High abuse risk but have safe and accepted medical use. Examples: morphine, oxycodone, methylphenidate, dextroamphetamine. Schedule III (C-III) – Abuse risk less than C-II and safe and accepted medical use. Examples: Acetaminophen/Codeine (Tylenol #3), acetaminophen/hydrocodone (Vicodin), propoxyphene (Darvon).

Schedule IV (C-IV) – Abuse risk less than C-III and safe and accepted medical use. Examples: diazepam (Valium), alprazolam (Xanax), phenobarbital, chloral hydrate. Schedule V (C-V) – Abuse risk less than C-IV and safe and accepted medical use. Mainly consist of preparations containing limited quantities of certain stimulant and narcotic drugs for antitussive and antidiarrheal purposes.

Controlled SubstancesAdditional Law Requirements

For CIII to CV prescription drugs• Quantity must be written out numerically and as

a word• Vicodin, Dispense #20 (twenty)• (Vicodin is a combination of hydrocodone (a

semi-synthetic opioid) and acetaminophen)• Number of refills – Limit of 5 refills within 6

months• Expires in 6 months from date of issue.


For CII prescription drugs

• Schedule II (C-II) – High abuse risk but have safe and accepted medical use. Examples: morphine, oxycodone, methylphenidate, dextroamphetamine. – Special prescriptions required

• Official Prescription Form– Refills – No refills allowed– Expiration – Expires 7 days after issue


Practitioner Responsibilities– Patient’s complete Name, Address (including city,

state, zip code), and age or DOB– Date the prescription is written (cannot be post-

dated)– Controlled substance prescribed– Quantity of drug, written numerically and as a

word– Indication, if not deemed detrimental– Preference for brand, if necessary

Bad prescription

Poor handwriting contributed to a medication dispensing error that resulted in a patient with depression receiving the antianxiety agent Buspar 10 mg instead of Prozac 10 mg

MAXIMIZE PATIENT SAFETY

• ALWAYS write legibly.• ALWAYS space out words and numbers to

avoid confusion.• ALWAYS complete medication orders.• AVOID abbreviations.• When in doubt, ask to verify.

WHAT IS PHARMACOPOEIA

Pharmacopoeia is a book or encyclopedia of drugs standards, their formulas, methods for making medicinal preparations and other related information's which is published under the jurisdiction of government body.

WHY DO WE NEED IT?

To Control the Quality of Medicine as per standard . To Ensure the public health. To Support the availability of safe, effective, good-quality pharmaceutical care for all.

There are two main Pharmacopeias

1. United States Pharmacopeia2. British Pharmacopoeia (Note the difference in spellings)

UNITED STATES PHARMACOPEIA

USP / NF: United States Pharmacopeia – National Formulary• The United States Pharmacopeial (USP) sets standards

for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. USP’s drug standards are enforceable in the United States by the Food and Drug Administration, and these standards are developed and relied upon in more than 130 countries including Saudi Arabia.

• USP standards are developed and revised by more than 800 volunteer experts, including international participants.

UNITED STATES PHARMACOPEIA

• United States Pharmacopeia – National Formulary and its Supplements will become official six months after being released to the public.

• That is, the USP – NF, which is released on November 1 of each year, will become official on May 1 of the Next year

British Pharmacopoeia (BP)

• The British Pharmacopoeia (BP) is the leading collection of standards for UK medicinal products and pharmaceutical substances.

• Produced by the British Pharmacopoeia Commission Secretariat of the Medicines and Healthcare products Regulatory Agency, the BP makes an important contribution to public health by setting publicly available standards for the quality of medicines.

British Pharmacopoeia (BP)

• Now used in over 100 countries, including Saudi Arabia, the BP remains an essential reference for all individuals and organizations working within pharmaceutical research and development, manufacture and testing across the globe.

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