1PHARMACOLOGY 425 Spring Semester, 2005 PRINCIPLES OF PRESCRIPTION WRITING Nicholas G. Popovich, Ph.D., R.Ph. Professor and Head Department of Pharmacy Administration University of Illinois College of Pharmacy 833 South Wood Street Chicago, IL 60612-7230 1-312-996-0877 1-312-996-0868 (fax) [email protected] Learning Objectives: After this presentation, the medical student will be able to 1. define a prescription and the classification of medications. 2. compare and contrast the various schedules of controlled substances. 3. compare and contrast a prescription medicine and a nonprescription medicine. 4. list the component elements of the prescription. 5. list the component elements of a controlled substance prescription. 6. classify controlled drugs by their schedule. 7. describe writing conventions associated with prescription writing. 8. provide examples of look-alike, sound-alike prescription medicines, including tradenames. 9. provide examples of confusing abbreviations used in prescription writing. 10. describe important prescription writing precautions for traditional and controlled-substance prescriptions. 11. define Aoff label@ use of a drug ______________________________________________________________________________ Prescription Order Writing I. Defined: A prescription is a written, verbal, or electronic order from a prescriber (e.g., physician, dentist, podiatrist, nurse practitioner) to a pharmacist for a particular medication for a specific patient at a certain time. Note: In an attempt to minimize medication errors and enforce the use of the institution’s drug formulary, numerous large hospitals now require physicians to enter orders directly into a computer terminal or through a PDA. These orders are screened for potential errors and sent directly to the pharmacy for processing. This practice has been implemented on a much smaller scale in retail pharmacies in some geographic areas. As systems that interface between physician offices and pharmacies are further developed and refined, the practice of electronic prescribing will likely to become widespread.2II. Classification of medications: A. Prescription. Known synonymously as a Alegend@ drug or medication because the label of the drug package bears the legend, “Caution: Federal Law Prohibits Dispensing without a Prescription.” 1. Generic. The nonproprietary name provided by the United States Adopted Name (USAN) Council. Syn. Chemical Name e.g., amoxicillin, fluoxetine, diazepam, aspirin 2. Brand Name. The proprietary name or registered trademark name provided by the pioneer (innovator) pharmaceutical company who holds the patent on the drug, e.g., Prozac7, Viagra7, Xanax7 3. Compounded. Requires preparation of one or more ingredients (i.e., active drug[s]) with one or more pharmaceutical necessities (e.g., liquid vehicle, suspending agent, emulsifying agent) to create a finished product. Among other instances, oral compounded prescriptions may be used to facilitate the administration of a solid dosage form that is not available in liquid form for patients (e.g., pediatric, geriatric) who are unable to swallow the solid dosage form. 4. Control Substance. Distribution of certain medicines (e.g., narcotics, stimulants, depressants) with abuse potential is controlled through the Comprehensive Drug Abuse Prevention and Control Act of 1970. This Act is regulated and enforced by the federal Drug Enforcement Agency (DEA). All physicians must be registered with this agency to prescribe the drugs under the control of this act. Re-registration is mandatory every three years. A partial listing of controlled substances is demonstrated in Appendix A. Further, examples of drugs by schedule are found at http://www.dea.gov/pubs/scheduling.html. a. Schedule I. No medical use with a high abuse and dependence potential. A physician cannot write for this schedule of drugs. e.g., LSD, Marijuana*, Heroin, Mescaline (Peyote), 1-(1- Phenylcyclohexyl)pyrrolidine (i.e., PCP). *Nine states have laws concerning the medical use of marijuana. They are Alaska, California, Colorado, Hawaii, Maine, Maryland, Nevada, Oregon, and Washington. II. A. 4. b. Schedule II. A written prescription is required for this schedule.3 However, there are no refills allowable. Only in an emergency situation is an oral order allowable and acceptable to the dispenser. Such an oral order must be followed by a written prescription within 72 hours. In approximately ten states (including Illinois), the physician must complete a triplicate prescription form to prescribe Class II in ink. The physician should write out the actual amount prescribed besides giving an Arabic Number or Roman Numeral for the quantity. This discourages forging or Aalteration@ of the prescription. A written prescription for this schedule must be filled within seven (7) days of issuance or it expires. e.g., amphetamines, meperidine, cocaine, secobarbital c. Schedule III. Drugs in this schedule have a moderate abuse and dependence potential. This schedule may be prescribed in writing or through verbal order. Further, this schedule of drug may be refilled (up to five times within a six month interval from the date of issuance). e.g., glutethimide, chlorphentermine, phenmetrazine, anabolic steroids. d. Schedule IV. Drugs in this schedule are considered to have low abuse and low dependency potential. This schedule may be prescribed in writing and through verbal order. Further, this schedule may be refilled (up to five times within a six month period from the date of issuance). e.g., alprazolam (Xanax7), pentazocine (Talwin7), flurazepam (Dalmane7) e. Schedule V. Drugs in this schedule have the least amount of abuse potential and an unlikely dependency. This class consists primarily of medications that contain limited quantities of certain narcotic and stimulant drugs generally used as antitussives, antidiarrheals, and analgesics. These can be purchased OTC by the patient who signs a registry. e.g., Robitussin-AC, Parepectolin, Kaopectolin PG II. A. 5. New. An original prescription order dispensed for the first time.46. Refill. A repeat dispensing of the original prescription order. Usually, encompasses patients on maintenance therapy, e.g., digoxin, phenytoin. B.
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