THE

PRESCRIPTION

1
PRESCRIPTION
Is an order for medication issued by
a physician, dentist, or other
properly licensed medical
practitioner.
Various states also have licensed
other prescribers who have limited
scopes of practice.
designate a specific medication and
dosage to be administered to a 2
particular patient at a specified time
Licensed prescribers
Veterinarian
may prescribe only for animals
Podiatrist
can prescribe only for conditions of
the human foot
Optometrists
have been given authority, in some
states, to use drugs for diagnostic 3

purposes, whereas in others they

 In certain states,
nurse practitioners,
optometrists,
psychologists,
pharmacists,
can issue prescriptions under
4
protocol or with certain
Prescription order
is a part of the professional
relationship among the
prescriber, the pharmacist, and
the patient.
Prescription orders received
verbally should be reduced to
proper written form immediately 5

or entered directly into a

Roles of pharmacist
to provide quality pharmaceutical care that
meets the medication needs of the patient.
must be precise in the manual aspects of
filling the prescription order
must provide the patient with the necessary
information and guidance to assure the
patients compliance in taking the medication
properly. It is
to advise the prescriber of drug sensitivities
the patient may have, previous adverse drug
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reactions (ADRs), and/or other medications
that the patient
 Pharmacists must establish and
maintain the trust of the
prescriber and the patient
Pharmacists now find
themselves frequently
contacting physicians to
suggest alternative drug 7

products for individual patients

 To meet these responsibilities, it is
essential that the pharmacist
maintains a high level of practice
competence,
keeps appropriate records on the
health status and medication
history of his/her patients and
develops professional working 8

relationships with other health

 Pharmaceutical care cannot
optimally occur until the pharmacist
has established a relationship with
the patient.

An important part of this

relationship includes
maintaining confidentiality 9
Classifications of
medications
two broad legal
classifications of
medications:
prescription

without a prescription 10

Nonprescriptiondrugs
Prescription/Legend drugs
Medications that may be dispensed
legally only on prescription
Legend
must appear on the label of the
product as it is provided to the
pharmacist by the manufacturer
Caution: Federal Law Prohibits
Dispensing Without Prescription
Occasionally, physicians may issue 11

prescriptions for nonlegend drugs

 Ways of conveying
prescriptions
may be written by the prescriber
and given to
the patient for presentation at the
pharmacy
may be telephoned or
communicated directly to the
pharmacist by means of a fax
machine, 12

may be electronically sent from a

Electronic prescribing
may become the dominate
means by which pharmacists
receive prescriptions.
minimize medication errors
enforce the use of the
institutions drug formulary,
numerous large hospitals 13

require physicians to enter

Advantages of e-prescribing
(1) reducing or eliminating the errors
associated with illegible handwriting;
(2) prescribers can receive on-screen
prompts for drug-specific dosing
information;
(3) information from the patients
medical record can be linked with
information from the patients
prescription records; 14

(4) prescribers would be notified if a

Components of prescription
1. Prescribers office information
2. Patient information
3. Date
4.symbol or superscription
5. Medication prescribed or inscription
6. Dispensing directions to pharmacist or
subscription
7. Directions for patient or signa(to be placed
on label) 15
8. Refill, special labeling, and/or other
instructions
16
PATIENT INFORMATION
Patients full name and address
are necessary on the prescription for
identification purposes
written illegibly should be clarified on
acceptance of the prescription.
Incorrect spelling of a patients name
on a prescription label might cause
concern in the patients mind as to the
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correctness of the medication
possibly would hamper the desired
 Federal law requires that the full names
and addresses of the prescriber and the
patient be included on prescriptions for
certain controlled substances.
The physicians DEA registration
number also is required on the
prescription.
Controlled substances are drugs
controlled under special regulations by
the federal government.
The address of the patient is useful for 18

identification purposes as well as for

 Some prescription blanks used by
medical specialists, particularly
pediatricians, include a space for
insertion of
patients age
weight
body surface area.
This information is placed on the
prescription by the physician when 19

medication dosage is an important

Date
Prescriptions are dated at the time they are
written and also when they are received and
filled in the pharmacy.
The date is important in establishing the
medication record of the patient.
An unusual lapse of time between the date a
prescription was written and the date it is
brought to the pharmacy may be questioned
by a pharmacist
to determine if the intent of the physician and the
needs of the patient can still be met. 20
The date prescribed is also important to a
pharmacist in filling prescriptions for controlled
 SUPERSCRIPTION
The Rx symbol
Latin verb recipe,
meaning take thou or you take. Some
historians believe this
Some historians believe this symbol
originated from the sign of Jupiter, ,
employed by the ancients in requesting
aid in healing.
21
Today, the symbol is representative of
both the prescription and the pharmacy
 INSCRIPTION
MEDICATION PRESCRIBED
This is the body or principal part of the
prescription order.
It contains
Names
Dosages
quantities of the prescribed ingredients.
Today, the majority of prescriptions are written
for medications already prepared or 22
prefabricated into dosage forms by industrial
manufacturers.
 SUBSCRIPTION
Dispensing direction to Rx
Consist of direction to the pharmacist for the
preparation of the prescription
Serves merely to designate the
Dosage form
Number of dosage units
Examples
M ft caps dtd no xxiv
Mix and make capsules. Dispense 24 such doses
Ft supp No xii
Make 12 suppositories
M ft ung
23
Mix and make an ointment
Disp tab No c
Dispense 100 tablets
 SIGNATURA
Directions for patient
Prescriber indicates the direction for the
patients use of the medication in the portion
of the prescription
Abbreviated Signa or Sig means mark thou
Directions in the signa commonly are written
using abbreviated forms of English or Latin
terms or combination of each
Examples
Tabs ii q4h
Take two tablets every 4 hours 24
Caps I 4xd pc & hs
Take one capsules four times a day after meals and at
 The directions are transcribed by the pharmacist onto
the prescription label of the container of dispensed
medication
Required by US law
Pharmacist must reinforce the directions to the pt
when dispensing the medication
Best time to take the medication
Importance of adhering to the prescribed dosage schedule
If a dose is missed
Permitted use of the medication with respect to food, drink
and/or other medications
Certain manufacturers 25
PPIs for specific products for issuance to patients
SE, potential hazards
 SPECIAL LABELING
& OTHER INSTRUCTIONS
Number of authorized refills should be
indicated on each prescription by the
prescriber
No refills are permitted for Schedule II
controlled substances

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 Commonly used abbreviations in
prescriptions and medication orders
Refer to your notes / handouts

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PRESCRIPTION DRUG
Drug that requires a prescription because it is
considered potentially harm if not used under
the supervision of a licensed health care
practitioner
Known synonymously as a legend drug
because the label of the drug bears the
legend, Caution: Federal Law Prohibits
Dispensing without a Prescription or Rx
only
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Ethical/legend drugs
Prescription drugs requiring ordinary prescription (Rx)
antibiotics
Exempt Preparations requiring ordinary prescription with
prescribers S2 # (EDD, Rx)
Dangerous Drugs requiring yellow prescription in triplicate
(DD, Rx) - demerol

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Controlled or scheduled drug
A prescription drug whose use and
distribution is tightly controlled because of its
abuse potential or risk
Controlled drugs are classified into schedules
Prescriptions for controlled substances have
additional requirements by law
These includes the
potential for abuse
Pharmacological effects
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Risk to public health
History, cope, duration and significance of
 Schedule I
Drugs have a high potential for abuse
No accepted medical use in the US
3 categories of substances
Opiates
Opium derivatives
hallucinogens
Includes drugs claimed to create a serious risk to public
health, whose therapeutic value is not currently
acknowledged by the Commission on Narcotic Drugs.
Includes synthetic pyschedelics such as LSD in addition
to natural psychedelics like DMT (dimethyltryptamine)
isomers, MDMA (methylenedioxyphenylamine) known
as ecstasy, also falls under this category
Other examples:
Heroin, marihuana, peyote, mescaline, psilobycin, THC
(tetrahydrocannabinols), dihydromorphine 33
 Schedule III
Includes barbiturate products with fast or
average effects, which have been the
object of serious abuse even though useful
therapeutically, flunitrazepam and some
analgesics like buprenorphine
Schedule IV
Includes some weaker barbiturates like
(phenobarbital), and other hypnotics,
hypnotic, anxiolytic BZDs except
flunitrazepam and some weaker stimulants.
It has been suggested that THC be moved 34

to this category but it is still listed as

SCHEDULE I
Schedule I
Drugs have a high potential for abuse
No accepted medical use in the US
3 categories of substances
Opiates
Opium derivatives
hallucinogens
Properly registered persons may use schedule I
substance for research purposes.
The FDA has approved the marketing of the
THC product, drona binol (Marinol),
synthetic cannabinoid, nabilone (Cesamet) = tx of n/v
associatied with CA chemotherapy moved to II
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Other examples:
Heroin, marihuana, peyote, mescaline, psilocybin, THC
(tetrahydrocannabinols), dihydromorphine, LSD,
 SCHEDULE II
Drugs have a high potential for abuse
But do not have a currently accepted medical use in
the US
It has been determine that the abuse of a drug, or
other substances included in this schedule =
psychological or physical dependence
Categories
Opiates, opium derivatives
Derivatives of coca leaves and certain CNS
stimulants and dperessants
Examples 36

Narcotic substances opium, morphine, codeine,

Schedule III
Drugs have accepted medical use
Have a lower potential for abuse than
Schedule I and II drugs
Includes compounds containing limited
quantities of certain narcotic drugs, and
nonnarcotic drugs such as
Derivatives of barbituric acid except
Schedule II
Glutethimide, methprylon, nalorphine,
benzphetamine, chlorphentermine, 37

clortermine, phendimetrazine, paregoric

Schedule IV
Drug have low potential for abuse relative to
those in schedule III
Abuse of schedle IV drugs or substances
may lead to limited physical dependence or
psychological adependence as compared to
those included in schedule III
Generally the long-acting barbiturates, certain
hypnotics, minor tranquilizers
For all practical purposes there are no
regulatory differences between Schedule III
and IV
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Examples
Barbital, phenobarbital, methylphenobarbital,
Schedule V
Drugs have the lowest abuse potential of the
controlled substances
Consist of preparations containing limited
quantities of certain narcotic drugs generally
for antitussive and antidiarrheal purposes.
OTC drugs
Mgt: pharmacist should always check the
label to see if the FDA has determined the
item to be prescription-only item
Lomotil
Nonnarcotic substances that may be sold 39
OTC under the terms of the FD&C may apply
to the DEA to have their product excluded
 Schedule I Schedule II
Example: HEROIN MORPHINE

POTENTIAL for abuse: POTENTIAL for abuse:

HIGH HIGH
NO accepted medical Has a currently
use or lacks accepted accepted medical used
safety ( pain killer)
May be used for Abuse may lead to
research purposes by severe psychological or
properly registered physical dependence
individuals

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 Schedule III Schedule IV
ANABOLIC STEROIDS ALPRAZOLAM

Abuse potential less than ABUSE POTENTIAL less

substances as schedule I than substances in
or II Schedule III
Has a currently accepted Has a currently accepted
medical use medical use
Abuse may lead to Abuse may lead to limited
moderate or low physical physical or psychological
dependence or high dependence relative to
psychological dependence substances in schedule III
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 Schedule V
BUPRENORPHINE

LOW POTENTIAL for abuse relatively to Schedule IV

Has a currently accepted medical use
Some schedule V products may be sold in limited
amounts without a prescription at the discretion of the
Rx; however, if a physician wishes to receive one of
these products, it is preferable to provide a prescription
Limited dependence possible

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LIST OF OTC MEDICINES
Anti-hemorrhoids
Cough-suppressants
Anti-acne drugs
NSAIDs some can be brought OTC, other
are available only with a prescription from a
physician or dentist
Antiseptics
Analgesics
Decongestants some decongestant
products requires a physicians prescription
but there are also many non-Rx products
Aspirin
Vasodilators such as minoxidil are sold 43
without Rx
Antacids
Controlled substance
All Rx must be written in ink; this practice is
compulsory for schedule II drugs
Date
Prescribers name and address
Patients name, age, and address
Diagnosis
No abbreviations
All doses, number of ampules, tablets, etc
should be written in words (letters) and in
figures (numbers) 44

Prescribers signature
Refill
Refill prn - - - is inappropriate
If no refill is desired, Zero (not 0) ---
should be written in the refill space

For schedule II drug --- no refill

For schedule III & IV --- not to exceed 5
refills or 6 months after the issue date,
whichever comes first 45
For schedule V drug --- no restriction
Stages in the prescribing
process
Define the patients problem
Specify the therapeutic
objectives
Verify the suitability of the
medicinal tx
Write a rx for the medicinal tx
Monitor the progress of the pt 46
Principles of good
prescribing
Examine the holistic needs of the
patient
Consider the appropriate strategy
Consider the choice of the drug
Negotiate a contract and achieve a
concordance with the patient
Review the patient on a regular
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basis
TYPES OF CONTAINERS
Round vials
Prescription bottles - used primarily for dispensing
liquids of low viscosity
Wide-mouth bottles used for bulk powders
Dropper bottles used for dispensing ophthalmic,
nasal, otic or oral liquids to be adminitstered by drop
Applicator bottles used for applying liquid meds to a
wound/skin surface
Ointment jars and collapsible tubes used to
dispense semisolid DF = ointment/cream
Sifter-top containers used for topical powders to be
applied by sprinkling 48
Hinge-lid/slide boxes used for dispensing supp and
powders prepared in packets
Types of wrong
prescriptions
1. erroneous
2. impossible
3. violative

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Erroneous
Prescription
The brand name precedes the
generic name
The generic name is the one in
parenthesis
The brand name is not in
parenthesis
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Violative prescription
The generic name is not written
The generic name is not legible and
a brand name that is legible is
written
The brand name is indicated and
instructions added (such as the
phrase No Substitution) that tend
to obstruct, hinder or prevent 51

generic dispensing.
Impossible Prescription
Only the generic name is
written but is not legible
The generic name does not
correspond to the brand name
Both the generic name and the
brand name are not legible
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Procedures to be followed for
each incorrect prescription
Erroneous prescription shall be filled. Such as
prescription shall be kept and reported by the
pharmacist to the nearest DOH office for proper
action
Violative or impossible prescriptions shall not be
filled. They shall be kept and reported to the nearest
DOH office for appropriate action

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