DISPENSING AND MEDICATION

COUNSELING

DEFINE: PRESCRIPTION

PRESCRIPTION
A written order by the doctor to a
pharmacist specifying the
medications to be dispensed to a
specific patient and usually
accompanied by directions for use
and administration.
"pre"- before
"script" - written

Enumerate the parts of a

prescription:

parts of a prescription

prescriber's information
patient's information
date
superscription
inscription
subscription
transcription
special labeling/other instruction
such as refill number

sample prescription

Three Types of Unethical

Prescription.

Describe Violative Rx.

types of unethical prescription

violative prescription
where generic name is not written
where the generic name is not legible
while the brand name is legibly written
when the brand name is indicated with
instruction such as "no substitution" is
written which hinder proper generic
dispensing

violative prescription
2

3
1

Describe Erroneous Rx.

types of unethical prescription

erroneous prescription
where the brand name precedes the
generic name
where the generic name is the one in the
parenthesis
where the brand name is not in
parenthesis
where more than one product is
prescribed on one prescription form

erroneous prescription

Describe Impossible Rx.

types of unethical prescription

impossible prescription
where only the generic name is written but
is not legible
where the generic name does not
correspond to the brand name
where both the generic name and the
brand name are not legibly written
when the drug product prescribed is not
registered with FDA

impossible prescription

What to do with this kinds of

Rx?

what to do if you receive such

type of prescription
erroneous prescription
shall be filled
such prescription shall be kept and
reported to the nearest FDA office for
appropriate action

violative and impossible

prescriptions
shall not be filled
pharmacist shall advise the prescriber of
the problem and instruct the customer to
get te proper prescription
such prescription must be kept and
reported to the nearest FDA office for
appropriate action

What to do upon receipt of Rx?

Proper handling of
Prescription
1. Receiving the prescription
2. Reading & checking the prescription
3. Numbering & dating
4. Labeling
5. Preparing the prescription
6. Packaging
7. Rechecking
8. Delivery & counseling
9. Recording & filing
10.Pricing the prescription

Prescription then what?

What to check out for?

Read and Check Rx for:

I DEALCASE-

Interaction
Dose
Evidence of harm/ benefit
Appropriate
Legal and complete
Cost effective
Acceptable to the px

Prescription vs non-rx?

Broad classification of
medication
OTC / Non-prescription Drug
drugs that do not require a doctor's
prescription
can be bought off-the-shelf in stores
regulated by FDA through the OTC drug
monograph

Broad classification of
medication
Prescription / Legend Drug
prescribed by a doctor
can only be bough at a pharmacy
prescribed for and intended to be used by
one patient
regulated by FDA through the New Drug
Application process

What is a narcotic drug?

NARCOTICS
a drug that produce analgesia,
narcosis, and addiction
narcotic prescription
(should be in triplicate)
one copy for the medical practitioner
one copy for the pharmacy/pharmacist
one copy for the patient

Controlled (Regulated) drug

substance
Any drug or therapeutic agent
commonly understood to include
narcotics, with a potential for abuse
or addiction, which is held under
strict governmental control and are
placed in specific schedules.
Require specialized prescription
blanks.

FDA Controlled Substances

Drugs, substances, and certain
chemicals used to make drugs are
classified into five (5) distinct
categories or schedules depending
upon the drugs acceptable medical
use and the drugs abuse or
dependency potential.

FDA Controlled Substances

Schedule I
drugs with no currently
accepted medical use
high potential for abuse
most dangerous drugs of
all the drug schedules
with potentially severe
psychological or physical
dependence.

No
prescriptions
may be
written for
Schedule I
substances,
and they are
not readily
available for
clinical use.

Give an example of drugs

under Schedule I.

Schedule I

Gamma-Hydroxybutyric Acid (GHB)

12-Methoxyibogamine (Ibogaine)
Marijuana (cannabis)
Methaqualone
Diacetylmorphine (Heroin)
Pholcodine
methylenedioxymethamphetamine (MDMA) or (ecstasy)
Mescaline (Peyote)
alpha-methyltryptamine (AMT)
Bufotenin
dextorphan (DXO)
Benzylpiperazine (BZP)
lysergic acid diethylamide (LSD)

FDA Controlled Substances

Schedule II
drugs with a high
potential for abuse but
less abuse potential
than S- I drugs
with use potentially
leading to severe
psychological or
physical dependence

Substance II drugs
may not be
dispensed without
written prescription
from a doctor.
Prescriptions of
substance II drugs
are in a "closed
system". This means,
the prescription may
not be refilled, unless
medically required.

Give an example of drugs

under Schedule II.

Schedule II

Methylphenidate (Ritalin)
Meperidine (Demerol)
Cocaine
Opium
Methadone (Dolophine)
Oxycodone (OxyContin)
Fentanyl (Sublimate)
Morphine
Mixed Amphetamine Salts (Adderall)
Lisdexamfetamine (Vyvanse)
Dextroamphetamine (Dexedrine)
Methamphetamine (Desoxyn)
Hydrocodone (Vicodin)
Hydromorphone (Dilaudid)
Secobarbital (Seconal)
Pethidine
Nabilone (Cesamet)
Tapentadol

FDA Controlled Substances

Schedule III
drugs
with
a
moderate
to
low
potential for physical
and
psychological
dependence.
with
a
currently
accepted medical use
in treatment

Schedule III drugs may not be

used without prescription from
a doctor. Prescriptions may not
be refilled after six months of
the date they were issued for
use.

Give an example of drugs

under Schedule III.

Schedule III

Anabolic Steroids
Buprenorphine
Amphetamine
Dihydrocodeine
Ketamine
Xyrem
Hydrocodone/Codeine
Marinol
Lysergic Acid Amide (LSA)
Paregoric
Barbiturates (Short acting)

FDA controlled substances

Schedule IV
drugs with a low
potential for abuse and
low risk of physical or
psychological
dependence.
with
a
currently
accepted medical use
in treatment.

Prescriptions for
Schedule IV
drugs may be
refilled up to five
times within six
months.

Give an example of drugs

under Schedule IV.

Schedule IV

Alprazolam (Xanax)
Diazepam (Valium)
Lorazepam (Ativan)
Temazepam (Restoril)
Barbiturates (Long acting)
Modafinil (Provigil)
Dextropropoxyphene (Darvon)
Carisoprodol (Soma)
Propoxyphene (Darvon)
Zolpidem (Ambien)
Tramadol
Difenoxin

FDA Controlled Substances

Schedule V
drugs with lower potential for
abuse than S- IV and consist of
preparations containing limited
quantities of certain narcotics.
Abuse of the drug may lead to
limited physical dependence or
psychological dependence.
generally used for antidiarrheal,
antitussive,
and
analgesic
purposes.

No drug found in
schedule V may
be dispensed or
distributed for
anything other
than medicinal
use.

Give an example of drugs

under Schedule V.

Schedule V
cough preparations with less than 200 mg of
codeine (Robitussin AC)
Lomotil
Motofen
Lyrica
Parepectolin

Give one tip to avoid ambiguity

in prescription.

Conventions in avoiding
ambiguity
1.
2.
3.
4.
5.
6.
7.
8.

Careful use of decimal point

Directions in full english
Direction should be specific
Use of permanent ink
Avoid units such as tsp/ tbsp
Writing out numbers as words
Use of apothecary units
Use of degree symbol

How can we classify if a drug

is considered safe for
Pregnant women?

FDA Pregnancy Categories

The FDA has established five
categories to indicate the
potential of a drug to cause
birth defects if used during
pregnancy. The categories
are determined by the
reliability of documentation
and the risk to benefit ratio.

FDA Pregnancy Categories

Category A
Adequate and well-controlled studies have
failed to demonstrate a risk to the fetus in the
first trimester of pregnancy (and there is no
evidence of risk in later trimesters).

levothyroxine
folic acid
magnesium sulfate
liothyronine

FDA Pregnancy Categories

Category B
Animal reproduction studies have failed to
demonstrate a risk to the fetus and there are no
adequate and well-controlled studies in
pregnant women.

metformin
hydrochlorothiazide
cyclobenzaprine
amoxicillin
pantoprazole

FDA Pregnancy Categories

Category C
Animal reproduction studies have shown an
adverse effect on the fetus and there are no
adequate and well-controlled studies in
humans, but potential benefits may warrant use
of the drug in pregnant women despite potential
risks.

tramadol
gabapentin
amlodipine
trazodone
prednisone

FDA Pregnancy Categories

Category D
There is positive evidence of human fetal risk
based on adverse reaction data from
investigational or marketing experience or
studies in humans, but potential benefits may
warrant use of the drug in pregnant women
despite potential risks.

lisinopril
alprazolam
losartan
clonazepam
lorazepam

FDA Pregnancy Categories

Category X
Studies in animals or humans have
demonstrated fetal abnormalities and/or there is
positive evidence of human fetal risk based on
adverse reaction data from investigational or
marketing experience, and the risks involved in
use of the drug in pregnant women clearly
outweigh potential benefits.

atorvastatin
simvastatin
warfarin
methotrexate
finasteride