Prescription

1. Prescription Prepared by Dr. SUBHASHIS DEBNATH Department of Pharmaceutics Seven Hills College of Pharmacy Accredited “A” Grade by NAAC Tirupati 517561

2. Prescription: A prescription is a legal order for a specific product, to be dispensed to a patient by a licensed pharmacist. It may also be defined as a written order from a registered medical practitioner, or other properly licensed practitioners, such as dentist, veterinarian etc to a pharmacist to compound and dispense a specific medication for the patient. The prescription also contains the directions for the patient regarding the mode of administration of drugs, which is dispensed to him/her. Thus prescription is a media through which treatment is provided for a patient by the combined skill and services of both the physician and the pharmacist. The prescriptions are generally written in the English language but Latin words and abbreviations are frequently used in order to save time.

4. Parts of a Prescription: A typical prescription consists of following parts. Date Name, age, sex and address of the patient Superscription Inscription Subscription Signatura Renewal instructions Signature, address and registration number of the prescriber. a. Date: It helps a pharmacist to find out the date of prescribing and date of presentation for filling the prescription. The prescription which prescribe narcotic or other habit forming drugs, must bear the date, so as to avoid the misuse of prescription if it is presented by the patient, a number of times for dispensing.

5. b. Name, age, sex and address of the patient: Name, age, sex and address of the patient must be written in the prescription because it serves to identify the prescription. Age and sex of the patient especially in case of children helps the pharmacist to check the prescribed dose of medication. c. Superscription: This is a symbol , Which is an instruction to the pharmacist. It is derived from R, an abbreviation for the Latin word recipe, meaning ‘take though’ . In olden days the symbol was considered to be originated from the sign of Jupitar, The God of healing. This symbol was employed by the ancient in requesting God for the quick recovery of the patient.

6. d. Inscription: This is the main part of the prescription order, contains the names and quantities of the prescribed ingredients. The names of ingredients are generally written in English language but common abbreviation used can be written both in English and Latin languages. Extreme care should be taken by the pharmacist in interpreting the abbreviations, otherwise it can lead to serious errors. The medicaments may be prescribed as An official preparation (eg: Indian Pharmacopoeia, British National Formulary, British Pharmacopoeia, United State Pharmacopoeia). Together with the quantity required. A proprietary product, together with the quantity required A Specific formula – in which case the quantity of each ingredient will be stated together with a description of the type of preparation, eg: mixture, lotion, tablet etc. A non-proprietary product (generic)

7. For a complex prescriptions containing several ingredients the inscription is divided into following parts. • Base: The active medicaments which are intended to produce the therapeutic effect. • Adjuvant: It is included either to enhance the action of medicament or to improve the palatability of the preparation. • Vehicle: It is included in the prescription either to dissolve the solid ingredients or to increase the volume of the preparation. • Nowadays majority of the drugs are prescribed which are already in a suitable formulation. The pharmacist is required to dispense the readymade form of drugs. So, compounding of prescription is almost eliminated.

8. What is the pharmacist to take off the shelf? • Drug Name • Dose = Quantity of drug per dose form • Dose Form = The physical entity needed, i.e. tablet, suspension, capsule • Clarity of number forms 0.2, 20 not 2.0

9. e. Subscription: This comprises direction to the pharmacist for preparing the prescription and number of doses to be dispensed. These days, the prescribers are omitting the specific instructions to the pharmacist because the majority of the prescriptions are not compounded and dispensed. f. Signatura: This consists of the instructions for the patient. This may include – The method of administration or application The dose, if the preparation is for internal use. The time of administration or application. The diluent (eg: water) if relevant or the means of application (eg: brush) The part of the body to which the preparation is to be applied, if for external use.

10. g. Renewal instructions: The prescriber indicate on every prescription order, wheather it may be renewed and if so, how many times. It is very important particularly in the prescription containing the narcotic and other habit forming drugs to prevent its misuse. h. Signature, address and registration number of the prescriber: The prescription must bear the signature of the prescriber along with its registration number and address. It is very important particularly in the prescription containing the narcotic and other habit forming drugs to prevent its misuse. An example of a typical prescription is given below.

12. Handling of prescription Client must be made to feel attended and comfortable by friendly gesture and ambience as soon as they come into the pharmacy. Communication should be opened in such a way by that it encourage the client to convey his/her needs by producing a prescription or by asking for other products or advice. 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, labeling and packaging. Receiving: the prescription should be received from the patient by the pharmacist himself. While receiving the prescription the pharmacist should not change his facial expression which gives an impression to the patients that he is surprised or confused after seeing the prescription. Upon receiving the prescription , the Pharmacist should confirm: (i) Identity of the client (ii) Whether the prescription is presented by the client himself or by someone on the client’s behalf.

13. 2. Reading and checking: The client may be politely requested to wait while the pharmacist review the prescription for: (i) Therapeutic aspects (Pharmaceutical and pharmacological) (ii) Appropriate for an individual (iii) Social, legal & economic aspects (iv) Legality & completeness of prescription Pharmacist should also check, that it is written in a proper format, ie doctor’s pad or OPD slip of the hospital/ nursing home and signed by the prescriber along with date. A prescription should always be screened behind the counter. In case of any difficulty in reading or any doubt regarding the prescription ingredients or directions, the pharmacist should consult the other pharmacist or the prescriber. But under no circumstances patient should come to know about it. Pharmacist should never guess about the meaning of any illegal or confused word. It may lead to serious consequences.

14. Some times prescription is received on telephone by senior pharmacist. In such case, after taking down the prescription, it should be verified by repeating it on phone to the prescriber. It is very important because nowadays, the number of drugs with almost same pronunciation and spelling are available in the market. For example: • AcidinApidin • Prednisone Prednisolone • DigoxinDigitoxin In short while reading Pharmacist should check that the Prescription should be complete with regard to: (i) Name of the Doctor, his /her address and registration number. (ii) Name, address, age, sex of the patient (iii)Name(s) of the medicine(s), potency, dosage, total amount of the medicines to be supplied. (iv) Instruction to the patient (v) Refill information if any (vi) Prescribed doctors’ usual signature.

15. If there is any omission of any important particulars, such as the dose, the prescriber should be contacted. 3. Collecting and weighing the material: Before compounding the prescription, all the materials required for it, should be collected on the left hand side of the balance. After weighing the material, it should be shifted to right hand side of the balance. This gives a check of ingredients which have been weighed. While compounding the label of every stock bottle should be read at least three times in order to avoid any error – When taken from the shelf or drawer When the contents are removed for weighing and measuring When the containers are returned back to its proper place.

16. 4. Compounding, labeling and packaging. Compounding should be carried out in a neat place. All the equipment etc required should be thoroughly cleaned and dried. Only one prescription should be compounded at one time. All the ingredients should be compounded according to the directions of the prescriber or according to pharmaceutical art. The compounded medicament should be filled in suitable containers depending on its quantity and use. The filled containers are suitably labeled. White plain paper of good quality should be used for labeling the containers. The size of the label should be proportional to the size of the containers which is written or typed, giving all the desired information. The label should be fixed with a good quality of adhesive, almost in the center leaving equal space from the bottom and top of the container.

17. The container is polished so as to remove the fingerprints. While delivering the prescription to the patient, the pharmacist should explain the mode of administration, direction for use and storage. Correctness of prescribed medicines The prescription should be checked for: Dosage: Whether the dosage prescribed is within the standard minimum and maximum dose range. Eg: The total maximum dose of paracetamol for an adult is eight 500mg tablets in 24 hours. Wait at least 4 hours between doses. (ii) Double medication (same drug or different drug with same pharmacotherapeutic effect) concurrently prescribed by the same Doctor or by two or more doctors to the same patients undergoing concurrent treatment by more than one doctor.

18. (iii) Interaction between the currently prescribed medicines, OTC medicines being taken by the patient & the medicines being taken from any past prescription (records of which may be available in the Patient’s Medication Records). Any drug interaction likely the render the therapy ineffective or cause undesirable effects to the patients should be brought to notice of the prescribing doctor. (iv) Contraindication: age, sex, disease(s), conditions or other characteristics of a patient that may cause certain prescribed medicines to be contraindicated. (v) History of overuse, under use, or misuse of medicines by the patient. Any of the above as well as handwriting legibility problem should be brought to the notice of the prescribing Doctors. Any necessary change made by the doctor should be recorded on the prescription, with the words “Changes made over the telephone in consultation with the Dr. (name) at (time) on (date)” and should be signed and stamped by the pharmacist. This exercise necessitates a trust based professional relationship with the prescribing doctor incise of any doubt the prescription should be got suitably amended from the doctor.