PrescripciónMd. Imran Nur Manik

LecturerDepartment of Pharmacy

Primeasia University

Doctor

Pharmacy

Patient

DefinitionA prescription is an order form a registered practitioner o0r other properly licensed practitioner such as physician, dentist, veterinarian or dermatologists etc to a pharmacist to compound and dispense a specific medicine for the patient.pre" - before"script" - written

Parts of prescription

1.Date2.Name, Age, Sex and Address of the

patient.3.Superscription (Rx)4.Inscription5.Subscription6.Signatura7.Renewal Instructions8.Name, Signature & Registration no. of

registered physician

DateIt helps the pharmacist to find out the date of prescribing and the date of

prescription for filling. It also helps

-To know when the medicines were last dispensed-To prevent the misuse of the drug by the patients.

The prescription which prescribes narcotic or other habit forming drugs must bear the date so as to avoid the misuse of the prescription.

Name, age, sex and address of the patientName, age, sex and address of the patient must be written in the prescription

because it serves to identify the prescription. Age and sex of the patient especially the children, help the pharmacist to check the prescribed dose of the medicine.

SuperscriptionIt is represented by the symbol Rx, which is written before writing the prescription.

Rx is an abbreviation of the Latin imperative verb, “recipe = take” meaning “to take” (Take though).

Rx symbol-It is an abbreviation of Latin term “Recipe”, meaning “to take” or “take thou”

Inscription This is the main part of the prescription, contains the names and quantities of the

prescribed ingredientsThe names of the ingredients are generally written in English but common

abbreviation used can be written both in English and Latin language. Extreme care should be taken by the pharmacist during interpreting the abbreviations otherwise can lead to serious errors.

Inscription is divided into following parts• Base: The active ingredients which are intended produce the therapeutic

effect.• Adjuvant: It is included either to enhance the action of the medicament or to

improve the palatability of the preparation.• Correction: It is included to prevent or lessen any undesirable effect.• Vehicle: It is included in the prescription either to dissolve the solid ingredients

or to increase the volume of the prescription.

SubscriptionSubscription provides the direction to the pharmacist for the preparation of the prescription information and the quantity and dosage form of the drug to be dispensed.

SugnaturaThis consists of the direction to be given to the patient regarding the

administration of the drugs. The instruction may include• The quantity to be taken or the amount to be used.• The frequency and timing of drug administration• The route of drug administration• The special instruction such as dilution direction.

Renewal instructionThe prescriber indicates on every prescription, whether it may be renewed and

if so how many times. It is particularly important for the prescriptions containing the narcotic and other habit forming drugs to prevent its misuse.

Name, signature, address & registration no. of the prescriberThe prescription must bear the signature of the prescriber along with the

registration number and address.

Heading Name: ABC Date: 7/05/14 Age: 30yrs.

Sex: female

Body Diagnosis: Idiopathic ParkinsonismRx Tab Levodopa 100mg Tab Carbidopa 25mg

2 tablets by mouth 3 times daily for one month . Take with food.

Closing Dr. XYZ Assistant Prof. Neurology, Reg. No. 345

Prescription Formatting

• Heading• Body• Closing

Current Prescription Formatting

• Heading–Name, address, and telephone

number of the prescriber–Name, sex and age of the patient–Date of the prescription

3

Current Prescription Formatting

• Body– The Rx symbol– Name – dose size or concentration (liquids) of

the drug– Amount to be dispensed– Directions to the patient

4

Current Prescription Formatting

• Closing–Prescriber’s signature–Refill instructions–Generic substitution instructions

5

Handling of Prescription

• Receiving• Dosage calculation• Compounding• Finishing• Pricing• Delivering

Receiving the Prescription:-Pharmacist should himself receive the Prescription.

It includesReading the prescriptionChecking the prescription

Reading the prescription:-Prescription should be completely and carefully read from top to bottom.

Checking of prescription:-Prescription should be checked for any incompatibility.

Incompatibility:-

Rx

Acetylsalicylic Acid ................................xxx gmCodeine ...............................................vi gmAmodopyrinae ......................................xxx gm

M. ft. chart. No. vi

Acetylsalicylic acid intensifies the narcotic action of codeine. This combination is questionable.

Dosage calculation:-A child dosage form is calculated by

Young’s rule Age × adult dose Child dose = Age + 12

Fried’s rule:-

Age(month)Child dose= × Adult dose 150

Compounding:-The ingredients are compoundedBy accurate method.

For weighing electrical machines should be used

Finishing the prescription:-

It includes

PackagingLabelingRecheckingFilling

PackagingAfter compounding packaging of prescription should be done.For packaging following containers are used

oRound vialsoOval bottlesoWide mouth bottlesoColored bottlesoCollapsible tubesoPaper wrappersoDropper bottles

Labeling

The filled container should be suitably labeled.The label should be affixed on smooth surface of bottle

Label information'sType of prescriptionName, age & sex of patientDate of dispensingStorage conditionName & address of pharmacyIn case of liquid preparation attach auxiliary label

Route of administration

RecheckingEach prescription should be recheckedAfter labeling container should be thoroughly polished to remove finger prints

RecordingA variety of prescription files are available which serve to maintain and preserve original prescription in numerical order

Pricing of Prescription :-The prescription should be priced immediately after receiving it & informed the patient about it. This should be done before starting the compounding to avoid any dispute..

Delivering the prescription

Three types

Store DeliveryHome DeliveryMail Delivery

The most common problem!

HOW MANY

???

LABELLING OF THE PHARMACEUTICAL

PRODUCTS

GENERAL LABELING REQUIREMENTS

LABELING OF DISPENSED MEDICATIONS.

• The label for a dispensed product should provide the patient with all the information required for its proper use. The information include

• Accurate: The label should be checked immediately after writing and again before fixing to the container.

• Legible: It should be easily readable, it should be either type written or printed.

• Intelligible: The information given on the label should be completely unambiguous (স্পষ্ট) and arranged to avoid any confusion.

• Adequate and relevant: The information provided should be adequate and relevant in order to avoid confusion and anxiety.

Information on the labelThe followings are the important things which

should be included in the label

i. Indicate clearly the patient, for whom it has been prescribed.

ii. Indicate the name and address of the supplier and the date of supply.

iii. In most of the cases give precise details as to the contents of the container when dispensed.

iv. State the storage condition and shelf life of the medicine.

v. Give clear and complete instruction to the patient on how and when to take or use the preparation.

i. Indicate clearly the patient, for whom it has been prescribed.The patient’s title, forename ( নামে�র প্রথ� অংশ), initial name or surname (পদবি�) should appear on the label of each medicine dispensed.  

ii. Indicate the name and address of the supplier and the date of supply.The name and address of the pharmacy may be printed on the dispensing labels.

iii. In most of the cases give precise details as to the contents of the container when dispensed.

This includes • The quantity in the container: The total quantity of the

product dispensed in the container should be indicated on the label.  

• The name of the product /medicine: In the community pharmacy the name written by the prescriber should appear on the label. In the hospital pharmacy only non-proprietary name is used.

•  The strength of the medicine: It is essential for preparations that are essential in different strengths of medicine. e.g. amount in each tablet/capsule.

• Units: Wherever possible quantities should be expressed as whole numbers of unit. e.g. 100 mg rather than 1gm.

• Batch identification: The batch reference should be included in the labeling (UK).

• Diluted products: Particular care should be taken when labeling medicines prepared by the dilution of more concentrated products.

Diluted products– Have reduced shelf life – Indicate the degree of dilution

FOR >1 Ing.

FOR 1 Ing.

Diluted Chloral MixtureHalf Strength

Diluted Chloral Mixture BP containing 250mg/5ml Chloral

Hydrate

iv. State the storage condition and shelf life of the medicine.

This includes• Temperature: A large number of products need to be

stored in a cool place. e.g. suppositories.• Humidity: Solid unit dosage forms should be protected

from moisture. (Air +moisture proof container)• Light: The light sensitive products should be stored in the

amber colored containers.• Sources of ignition: Products containing a large

proportion of flammable ingredients should be labeled “flammable” and keep away from naked flames.

• Shelf life: The period during which the quality of a medicine is expected to remain within the acceptable limits.

v. Give clear and complete instruction to the patient on how and when to take or use the preparation.

This Includes • Directions: Includes quantity to be taken

or amount to be used, frequency and timing of application, route of administration etc.

• Shake the bottle: Emulsion, suspension etc.

• Take with water: Mixtures that can cause gastric irritation. E.g. Disprin(Aspirin)

Cautionary and Advisory labels

Cautionary and Advisory LabelIn general the patient requires adequate information,

so that the medicine can be taken safely and effectively. Guidelines for the pharmacist on the Cautionary and Advisory Label to be applied to the dispensed medicine are provided by the Royal pharmaceutical society of Great Britain. The guidelines are

i. For external use onlyThis label must be applied to the liquid preparations or

gels for external application. The label is also applied to all semisolid or solid medicinal products for external use. e.g. Ointments, Creams, Dusting powders etc.

ii. Not to be takenThis label may be used on preparations that’s are

neither administered by mouth nor used on the skin. This label may be confused with the words “For external use”.

Therefore “For nasal use only” “For rectal use only” “For vaginal use only” label may be preferred.

“Not to be swallowed in a large amount” is a better label for the mouth washes and gargles where swallowing of a small amount is ineffective but swallowing in a large quantity is undesirable.

iii. Hexachlorophane warningProducts containing Hexachlorophane should not be used

indiscriminately in every young child or in certain animals because of the possibility of the serious toxicity. A warning to this effect should be included on the labels of the products containing the substances.

iv. Keep out of reach of childrenAll medicine should be stored in the place inaccessible to

the children and must be so labeled.

v. For animal use/treatment onlyA clear distinction must be made between the

medicine intended for human use and those for veterinary use.

vi. Drowsiness warningPatients should be warned if their medicines are

likely to cause drowsiness, dizziness ( �াথা ঘ�ারা) blurred vision( ঝাপসা দষৃ্টি).

Warning. May cause drowsiness

Potential interactions with food and drinks

• Drugs for which absorption is improved if taken before food.(meal)

• Drugs for which GI irritation occurs if taken before food.(empty stomach)

. . . with or after food

Take half to one hour before food or on an empty stomach

viii. Potential inter actions with other medicines

• Drugs which chelates with calcium, magnesium and iron and are not well absorbed in the presence of irons.

• Drugs whose activity is

reduced by aspirin

Do not take iron, milk or indigestion remedies at the same time of the day as this

medicine

ix. Special methods of administration• For chewable formulations

• For sublingual formulations

Dissolve in the mouth or to be chewed

Dissolve under the tongue

x. Caution in use• a. Preparations which may produce

unusual effect.

 • b. Preparations containing high proportion

of flammable solvent.

This preparation may color the urine or stools

Avoid exposure to direct sunlight and naked flame

• Pressurized inhalations

Pressurized container, keep away from heat source including the sun. Do not puncture or burn even when empty.

Shake before using

• Applications

• Capsules

For external use only

Swallow whole with a draught of water

• Creams

For external use only

Store in cool place but do not freeze

• Dusting powders

Not to be applied to open wounds or weeping surfaces

For external use only

• Emulsions

• Enemas

Shake the bottle

For rectal use only

Shake before use

• Eye drops

• Gargles & Mouthwashes

• Gels

Avoid contamination in use

Discard 28 days after first opening

Not to be swallowed in large amounts

For external use

• Linctuses

• Ointments, Pastes and Paints

To be sipped and swallowed slowly without the addition of water

For external use only

• Tablets

• For chewable tablets

• For sustained-release/enteric coated tabs.

Dissolve or disperse in water before taking

Chew before swallowing

Do not chew or crush