Prescription

Prescription: definition, parts and handling

1. Prescription Mahendra Patel Associate Professor Sri Aurobindo Institute of Pharmacy, Indore

2. prescription A prescription contains handwritten instructions for the dispensing and administering of  medications . It can be more than an order for drugs as it can also include instructions for the patient, nurse, pharmacist or a lab technician for orders for lab tests, X-rays, and other assessments. A pharmacist must take reasonable steps to ensure that the dispensing of a medicine in accordance with a prescription is consistent with the safety of the person.

3. Prescriptions have following sections: T he heading with the date and the patient’s name, address, age, etc. Superscription (Symbol Rx) - the Rx stands for "recipe" which in Latin means " you take " Inscription - the information about the medication. It has the name of the ingredients and the amount needed. It includes the main ingredient, anything that helps in the action of the drug, something to modify the effects of the main drug, and the "vehicle" which makes the medicine more pleasant to take. Subscription - The subscription section tells the pharmacist how to dispense the drug. This will have instructions on compounding the drug and the amount needed. Signatura - The signatura has the directions that are to be printed on the medicine. The word "sig" means "write on label."

4. In dispensing a prescription, a pharmacist has to exercise an independent judgment to ensure the medicine is safe and appropriate for the patient, as well as that it conforms to the prescriber’s requirements. If there is any doubt, the prescriber is to be contacted. In conforming to the above principle, dose, frequency and route of administration, duration of treatment, the presence or absence of other medicines, the patient’s illness, medication history , and other relevant circumstances need to be taken into account.

5. Handling of Prescription The following procedure should be adopted by the pharmacist while handling the prescription for compounding and dispensing. Receiving Reading and Checking Collecting and weighing the materials Compounding, labelling and packging

6. Care required in dispensing Prescription Always keep the prescription in hand while taking out the medicine from the self. Always check the dispensing balance before weighing the ingredients which are required during dispensing, Replace containers of stock preparation or drugs in their proper position after use. Keep the label in proper position during weighing solid ingredients especially the potent drugs such as morphine HCl to serve as a constant reminder that the correct drug is being used.

7. Care required in dispensing Prescription…………… When pouring or measuring the ingredients, keep the label upward in order to prevent surplus liquid running down of the bottle and staining the label. Care should be taken to keep the dispensing balance clean. The powder should be transferred from the stock container by using a clean spatula. Medicines which are used externally such as lotions, liniments etc. should be supplied in vertically fluted or ribbed bottles in order to distinguish it by touch. They must be labelled in red or against a red background. FOR EXETERNAL USE ONLY

8. Sources of Error in Prescription: Lack of Concentration One of the chief causes of error in dispensing. The work should not be carried out while engaged in a conversation or when the mind is struggling with other problems. Ones whole attention must be given to the dispensing operation in hand, no matter how simple. Checking The name on the container of the substance being weighed or measured should be checked when the container is removed from and when it is returned to the self.. Failure deliberately to check calculations of quantities to be weighed are measured is a serious dispensing mistake.

9. Labelling Error The label should always be written before the dispensing is done and carefully checked before affixing. Weighing Error Weights should be checked when removing them from the box and when returning them after the weighing has been completed. Arithmetic Slips Only careful concentration, and the realisation that even the simplest operation requires ones whole attention, will avoid such errors.

10. Abbreviation: They presents a problem in understanding parts of the prescription order. Pharmacist should not guess at the meaning of an ambiguous abbreviation e.g. to dispense Achromycin for “ Achro ” may cause difficulty when the intension of the prescriber is to dispense Acrostatin . Names of the drug: There are certain drugs whose name look or sound like of those of other drugs.

11. Some of the examples of such drugs are as under Indosin Prednisone Digoxin Doridon Pabalate Ananase Lincocin Prednisolone Digitoxin Doxidan Robalate Orinase

12. Strength of the preparation: The strength of the preparation should be stated by the prescriber. Ex. It will be wrong decision on the part of a pharmacist to dispense paracetamol tablet 500mg when prescription for paracetamol tablet is received with no specific strength. Doses form of the drug prescribed: Many medicines are available in more than one dosage form e.g. liquid, tablet, capsule, and suppository. The pharmaceutical form of the product should be written on the prescription.

13. Dose: Unusually high or low doses should be discussed with the prescriber. Pediatric dosage may present a problem. So pharmacist should consult pediatric posology to avoid any error. Care should be taken in the case of sustain release dosage form. Instructions for the patient: The instruction for the patient which are given in the prescription are omitted when incomplete. The quantity of the drug to be taken, the frequency and timing of administration, and route of administration should be clearly given in the prescription so as to avoid any confusion.

14. Incompatibilities: It is essential to check that there are no pharmaceutical or therapeutic incompatibilities in a prescribed preparation. Certain antibiotics should not be given with meals since it significantly decrease the absorption of the drug.

15. Latin Terms and Abbreviations Quantities of Ingredients Quantum Sufficiat (or Sufficit ) ( q.s .) – As much as is sufficient Ad – Up to , Sufficient to produce Ana ( aa ) – Of each

16. Remedies/ Preparations Auristillae ( auristill ) – Ear Drops Capsula (caps.) – A Capsule Charta (chart.) – A Powder Collunarium ( collun .) – A nose wash Collutorium ( collut .) – A mouth wash Cremor ( crem .) – A Cream Emulsio ( emul .) – An emulsion Gargarisma ( garg .) – A gargle Gelatina ( gelat .) – A jelly Guttae (gtt.) – Drops

17. Remedies……………. Haustus (ht.) – A draught Injectis (inj.) – An injection Liquor (liq.) – A solution Lotio (lot.) – A lotion Mistura (m., mist.) – A mixture Naristillae ( narist .) – Nasal Drops Nebula (neb.) – A spray solution Pasta (past.) – A paste Pigmentum ( pigm .) – A paint (like throat paints)

18. Remedies……………. Pilula ( pil .) – A pill Pulvis ( pulv .) – A powder Tabella (tab.) – A tablet Trochiscus ( troch .) – A lozenge Unguentum ( ung .) – An ointment Vapor ( vap .) – An inhalation

19. Instructions Relating to Preparation Adde , Addatur (add.) – Let (it) be added or simply add Calefac , Calefiat ( calef .) – Let (it) be warmed or warm it Dividatur – B e divided Dividatur in partes aequales (div. in pt. aeq .) – Divide into equal parts Fiat (ft.) – Let (it) be made; make it Fiant (ft.) – Let them be made; make them Misce . Misceatur (m.) – Mix it Misce secundum ( m.s.a .) – Mix Pharmaceutically Solve – Dissolve Infricetur ( infric .) – Let (it) be rubbed in

20. Instructions Relating to Preparation Instillandus ( instilland .) – To be dropped in Miscendus ( miscend .) – To be mixed Signa (sig.) – Label Sumendus (s. or sum.) – To be taken Ut antea ( u.a .) – As before Utendus (u. or utend .) – To be used

21. Dosage • Ad libitum ( ad. Lib.) – As much as you please • Dimidium ( dimid .) – Half • Dosis (dos.) – A dose • Guttatim ( guttatim ) – Drop by drop • Mensura ( mens .) – By measure • Pro (pro) – For; on behalf of • Pro dosi – As a dose • Reliquum ( reliq .) – The remainder

22. Qty. to be sent and manner of sending Duplum – Twice the quantity In phiala - In a bottle Mitte (mitt.) – Send Phiala prius agitata ( p.p.a ) – Shake the bottle first Quantitas duplex (qt. dx .) – Twice the qty. Talis , Tales, Talia ( tal .) - Such

23. Time of administration/application • Semel in die. ( sem in die) – Once a day • Bis in die. ( b.i.d or b.d .) – Twice a day • Ter in die. ( t.i.d or t.d .) – Thrice a day • Quarter in die. ( q.i.d or q.d .) – Four times a day • Vel – Or • Bis terve in die ( b.t.i.d .) – Two or three times a day • Ter quaterve die ( t.q.d .) – Three or four times a day • Quotidie (quot.) – Daily • Vices ( vic ) – Time • Ad tres vices (ad 3 vic ) – For three times

24. Parts of the Day • Primo mane (prim. m) – Early in the morning • Mane (m.) – in the morning • Omni mane ( o.m .) – Every morning • Jentaculum ( jentac .) – Breakfast • Meridie – Noon • Prandium ( prand .) – Dinner • Vespere ( vesp .) – Evening • Nocte (n.) – Night • Inter noctem (inter noct .) – During the night

25. Parts of the Day………. Hora decubitus ( h.d ) or Hora somni ( h.s .) – At bedtime Hac nocte ( hac noct .) – To-night Cras vespere ( cras vesp .) – Tomorrow morning Mane sequenti (m.seq.) – The following morning

26. Correlated time & Other Terms • Ante cibos . or Ante cibum ( a.c .) – Before meals or food • Post cibos or Post cibum (p.c.) – After meals or food • Inter cibos or Inter cibum ( i.c .) – Between meals or food • Dolore urgente – When the pain is severe • Frequenter – Frequently • Lente – Slowly Si opus sit ( s.o.s .) – when required or when necessary • More dicto or Modo dicto (m.d.) – As directed • Pro re nata ( p.r.n ) – Ocassionally

27. Correlated time & Other Terms……… • Quoties opus sit ( quot.o.s .) – As often as necessary • Saepe – Often • Statim (stat.) – Immediately; at once • Tussi urgente ( tuss . Urg ) – When cough is troublesome

28. Parts of the body Auris dexter ( a.d .) - To right ear Auris laevus ( a.l .) - To left ear Oculis dexter ( o.d .) - To right eye Oculis laevus ( o.l .) - To left eye Brachis ( brach .)- To the mouth Jugulo (jug.)- To the throat Naso – To the nose Os, oris ( o.s .) - To mouth Pro oculus (pro. Ocul .)- For the eyes Sterno (stern.)- To the chest

29. General Dispensing Procedures and Labelling Dispensing means to prepare and supply of a medicine to an individual in accordance with the prescription of a practitioner. Always wear a white overall coat . It helps to protect the clothes and reduces contamination of dispensed products with fibers and other foreign particles. Keep a duster, clean glass-cloth and sponge in your drawer. Glass cloth-------- Polishing containers Duster-------------- wiping of bench Sponge------------- Cleaning the surface of the balance

30. General Dispensing Procedures……………… Work in a clean and tidy manner. Do not accumulate stock bottles and used equipment in the working area, in order to reduce the risk of errors and contamination. Read the prescription carefully . Make sure that it is legally correct and there is no doubt in understanding it. Consult the pharmacopoeia or any other reference book , in case there is a need to find the formula of the preparation. Check the dosage of prescriptions which are meant for internal use. Check that there is no incompatibility in the preparation. Consult the official book or reference book to find the storage conditions for the preparation or medicaments. This information will determine the choice of container and label.

31. General Dispensing Procedures……………… Work out the calculations. Check the calculations. Collect the correct container and closure. Prepare the label as per requirement of the container. Make the preparation, transfer to it into the container and polish it. Fix the label to the container. Check the finished preparation. Wrap the container. Write the name and address of the patient on the wrapper. Maintain the record of the preparation which is dispensed.

32. Preparation of labels for dispensed medicines The label on the dispensed medicines should provide the following information:- Name and address of the patient: This is done to minimise confusion with other members of the same family with similar medicines. Name and address of the supplier and date of supply: The name and address of the pharmacy where the drug is dispensed. Precise details regarding contents of the container when dispensed: The name of the medicine

33. Preparation of labels for dispensed medicines…………….. The strength of the medicine The quantity in the container Storage conditions and self life of the products: Temperature: Suppositories below 15 Immunological products and insulin injections b/w 2 - 8 Humidity: For solid dosage form and powders Light: light sensitive products stored in amber colored containers. Instruction to the patients: Directions: These includes the quantity to be taken or the amount to be used , frequency and timing of administration or application and the route of administration .

34. Preparation of labels for dispensed medicines…………….. Shake the bottle before use: Emulsion, Suspension and Aerosols. Take with water: Mixtures which can cause gastro-intestinal irritation. Mixtures for adult patient having a dose of 10 ml.

35. Cautionary and advisory labels For external use only: ointment, creams, pastes and dusting powder. Not to be taken: used for the preparation that are neither administered by mouth nor used on the skin. “ For nasal use only or For rectal use only” Drowsiness warning: used for the medicine which causes drowsiness, dizziness, or blurred vision. The following wording may be written on the label. Warning: May cause drowsiness. If affected, do not drive or operate machinery, avoid alcoholic drink.

36. Cautionary and advisory labels 4. Potential interactions with food or drink: Drugs in which absorption is improved if taken before food. Drugs which causes gastro-intestinal irritaion or are absorbed with the food. Warning: To be taken an hour before food or an empty stomach. Warning: To be taken with or after food.

37. Cautionary and advisory labels……….. Drugs such as antibiotics where the absorption is significantly decreased by the presence of food and acid in the stomach. Potential interactions with other medicines: Drugs which chelate with calsium , magnesium, and iron and are not well absorbed in the presence of these ions. Do not take milk, iron preparation with this medicines. Warning: To be taken an hour before food or an empty stomach.

38. Cautionary and advisory labels……….. Special method of administration: The drugs formulation which is required to be dissolved in the mouth. The drugs which are to be absorbed through the sublingual mucosa. The drugs which are soluble in water or for powders or granules to be dispersed in water before taking. To be sucked or chewed. To be dissolved under the tongue. Dissolve or mix with water before taking

39. Cautionary and advisory labels……….. The drugs which are to be used for enteric coated, sustained release or having unpleasant taste. Cautions in use: The preparation which may induce photosensitization. The preparation which contains a high proportion of flammable solvent. To be swallowed whole, not to be chewed. Avoid exposure of skin to direct sunlight. Keep away from naked flames.

40. Special labelling instructions for particular type of dispensed dosage forms. Aerosol inhalations: Applications: Pressurised container, keep away from heat source. Shake before use Do not exceed the prescribed dose. Follow the instructions For external use only.

41. Special labelling instructions for particular type of dispensed dosage forms. Capsules: Cream: Dusting powders: Swallow with a drought water Store in a cool place. For external use only. For external use only. Not to be applied to open wound or to raw or weeping surfaces.

42. Special labelling instructions for particular type of dispensed dosage forms. Ear drops: Emulsion: Enemas: Store in a cool place. For external use only. For rectal use only. Warm to the body temperature before use. Shake the bottle before use.

43. Special labelling instructions for particular type of dispensed dosage forms. Eye drops: Eye lotions: Gargles and mouth washes: To be used within 30 days after first opening Not to be swallowed in large amounts. To be used within 24 hours after first opening

44. Special labelling instructions for particular type of dispensed dosage forms. Liniments and lotions: Mixtures: For external use only. Shake the bottle before use. Do not apply on broken skin. To be taken after diluting with water. Shake the bottle before use.

45. Special labelling instructions for particular type of dispensed dosage forms. Nasal drops: Ointments: Pastes: Pessaries : For nasal use only. For external use only. For external use only. For vaginal use only. Store in cool place.

46. Special labelling instructions for particular type of dispensed dosage forms. Solutions: Suppositories: Tablets: For soluble or dispersible tablets For nasal use only. For rectal use only. Dissolved or dispersed in water before taking. Store in cool place.

47. Special labelling instructions for particular type of dispensed dosage forms. Tablets: For chewable tablets For sustained release, enteric-coated or unpleasant tasting tablets Chew before swallowing. Do not crush or chew.

48. Thanks