PHARMACOLOGY 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 nickp uic edu Learning Objectives After this presentation the medical student will be able to 1 2 3 4 5 6 7 8 define a prescription and the classification of medications compare and contrast the various schedules of controlled substances compare and contrast a prescription medicine and a nonprescription medicine list the component elements of the prescription list the component elements of a controlled substance prescription classify controlled drugs by their schedule describe writing conventions associated with prescription writing 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 controlledsubstance 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 1 II 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 1Phenylcyclohexyl 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 2 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 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 d A 5 alprazolam Xanax7 pentazocine Talwin7 flurazepam Dalmane7 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 II glutethimide chlorphentermine phenmetrazine anabolic steroids 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 e amphetamines meperidine cocaine secobarbital Robitussin AC Parepectolin Kaopectolin PG New An original prescription order dispensed for the first time 3 6 B Nonprescription 1 2 3 III Refill A repeat dispensing of the original prescription order Usually encompasses patients on maintenance therapy e g digoxin phenytoin Those drug products that can be purchased at pharmacies and retail outlets without a prescription syn over the counter OTC products To date 89 drugs and or drug dosage forms have been Aswitched from prescription to OTC status Note Appendix AA Besides South Africa the US is the only country NOT to have a third class of drugs That is through the pharmacist The State of Florida has a pharmacist only class of medications Component Elements of the Prescription A Heading Physician s name practice address and telephone number DEA
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