PRESCRIPTION

HISTORY Ancient prescriptions – China, Egypt and Rome Rx:

• Egyptian ‘Eye of Horus’ • symbol denoting health; • symbolic appeal by physicians to Jupiter for a prescription's

success. • Latin word recipere ( ‘take’ or ‘take thus’)• direction to the pharmacist, preceding the physician's ‘recipe’.

Definitions of Prescription An order to take certain medications. Health-care program implemented by a physician or other

medical practitioner in the form of instructions that govern the plan of care for an individual patient.

An order for medication, issued by a properly licensed medical practitioner, dentist or veterinarian.

Eye of Horus

Communication between the physician and the pharmacist.

May include orders to be performed by a patient, caretaker, nurse, pharmacist.

Legal implications: the prescriber takes responsibility for the clinical care of the patient and in particular for monitoring efficacy and safety.

Originally directed at the pharmacist to take a certain amount of each ingredient and to compound the medicine.

Today, it is directed to the patient to ‘take’ the medicine (consuming it).

‘Pre’ and ‘script’ – ‘to write before’ a drug can be prepared.

The word ‘Prescription comes from the Latin word ‘Praescriptus’.

The prefix ‘pre’ means ‘before’ and ‘scriptus’ means ‘writing’. So, a prescription has to be written before a drug is compounded. 

PRESCRIBING PROCESS

Prescribing:• Evaluate the patient.• Evaluate the need for medication.• Select the right medication.• Determine interactions & allergies.• Prescribe the medications.

Transcription:• Transcribe the prescription or order.• Transmit the prescription or order to pharmacy.

• Right patient• Right drug• Right dose (strength per unit dose)• Right dosage schedule, dosing interval, time of

day• Right route of administration• Right date• Right number of refills• Right duration of treatment• Right to informed consent• Right to refuse treatment

‘RIGHTS’ OF A PRESCRIPTION

COMPONENTS OF A PRESCRIPTION

Superscription, Inscription, Subscription and Signa

Superscription • Symbol ‘Rx’ separates the superscription from the

inscriptions sections. • Contains date the prescription order is written; patient

details and Rx symbol.

Inscription • Body of the prescription (defines the medication) • Composed of: a ‘Basis’ or chief ingredient intended to cure (curare) an ‘Adjuvant’ to assist Basis’ action and make it cure

quickly (cito) a ‘Corrigen’ or corrective to prevent or lessen any

undesirable effect (tuto) a ‘Vehicle’ or ‘excipient’ to make it suitable for

administration and pleasant to the patient (jucunde)

Components (contd’.)

Subscription • Contains dispensing directions to the pharmacist. • May be compounding instructions or quantities.

Signa (Sig or Signatura) • Contains directions to the patient (how to take the

medication)• Interpreted and transposed onto the label by the

pharmacist.

• Refills: the number of refills permitted for the patient.

The patient's name and address • ensures right medication goes to the correct patient;

identification and record-keeping purposes.

Patient’s weight, age, BSA• for medications whose dosage involves calculation.• include both the calculated dose and the dosage

formula (eg.: 240 mg Q8H and 40 mg/kg per day)• allows other health care professionals to double-check

the prescribed dosage.• Pharmacists should always recalculate dosage

equations when filling these prescriptions.

Prescription pad blanks – imprinted with a heading containing the physician’s name, address and phone number of the practice site.

Institutional blanks – don’t bear physician's information.

Controlled substances prescriptions – the name, address and Drug Enforcement Agency (DEA) registration number of the physician.

Proprietary Prescriptions• The medications are indicated by their trade names.

Non-proprietary Prescriptions• The medications are indicated by their generic names.

Pediatric prescriptions • Include the age of the child (< 12 yrs.; < 5 months). • Weight of the child.

Modern prescriptions: ‘extemporaneous’ and ‘non-extemporaneous’.

Extemporaneous prescriptions • prescription is written ‘on-the-spot’ for a specific

patient with a specific ailment. • ‘Compound prescriptions’ ( pharmacist mixes or

compounds the medication in the pharmacy for the specific needs of the patient).

Non-extemporaneous prescriptions• generic recipe for a general ailment.

Modern prescriptions evolved with the separation of the role of the pharmacists from that of the physician .

• Contraindicated drug• Incomplete order• Allergy• Transcribing error• Wrong dose / frequency• Wrong drug• Illegible order• Omission• Altered order• Wrong patient• Wrong route

SOME PRESCRIBING ERRORS

WHAT SHOULD YOU TELL THE PATIENT? • What the drug is • It’s purpose• How it works• How to take it • Precautions• Duration of treatment; risks of discontinuation• Side-effects

Reading Prescription Abbreviations These abbreviations tell when to take the medication:• a.c.   ante cibum before meals • ad lib  ad libitum as much as you want• b.i.d.  bis in die twice a day• cc   cum cibos with food or cubic centimeters• dieb. alt.  diebus alternis every other day• hs   hora somni at bedtime• p.c.  post cibum after meals• p.r.n.  pro re nata as needed• q.d.   quaque die once a day• q.i.d.  quater in die four times a day• q.h.   quaque hora hourly• q.2h.   every 2 hours• q.3h.   every 3 hours• q.4h.   every 4 hours• t.i.d.  ter in die 3 times a day

Medication form, instructions to the pharmacist:• caps   capsules• comp.  compound• daw   dispense as written• gt   gutta drop• nebul nebula a spray• po   per os by mouth• p.r.   by rectum• sol   solutio solution• supp  suppositorium suppository• susp   suspension• syr   syrupus syrup• tab   tabella tablet• top   topical• ung   unguentum ointment• ut dict  ut dictum as directed• vag   vaginally• w   with• w/o   without• X   times

Warning about side effects: • D  drowsiness• H   habit forming• I  interaction• X   SOS contains a substance that could cause problems• ASA  contains acetylsalicylic acid (aspirin)• C   caution• G   glaucoma• S  diabetes

THANK YOU!!!