Terminology and Abbreviations

1. Terminology and Abbreviations • Every profession has its own unique language. • In the worlds of finance, accounting and equity markets, analysts look at P & L statements, statements of cash flow, accounts receivables, etc. • The medical professions have their own unique language. These terms are usually combinations of prefixes, root words, and suffixes. • The terms have their roots in Greek and Latin. Some knowledge of Greek/Latin will help you in figuring out this complex world of medical terminology.

2. Prefix • A word that when attached to the beginning of a root word modifies it in someway. • i.e. Bio means “life” from the Greek word bios (βίος) If you add this to logy meaning “study of” from the Greek logos (λόγος) you get biology meaning “study of life” • i.e. geront0 means “old” from the Greek word, γέρων (geront) meaning old man and you add this to logy you get gerontology, meaning the study of the social, physiologically and mental aspects of aging. Geriatrics is the branch of medicine that studies disease in elderly people. • A harder one: glio means “gluey” in Greek and glial cells in the brain refers to cells that support other cells in the brain. Blasto comes from a Greek word meaning “sprouting” and refers in science to a developing cell. When this two prefixes are added to “oma” (typically refers to cancer cells) you have the word glioblastoma meaning a cancer of young glial cells in the brain and is the most highly malignant type of brain cancer.

3. Important Prefixes for pharmacy (other listed in text book) • “an” means without/ example: anesthesia • “ante” means before/example: anterior • “anti” means inhibit/example: antibiotic • “brady” means slow/ example:bradycardia, slow heart rate • “Contra” means against/ contraindicated • “dys” means abnormal/ dysmorphic, abnormal shape • “hyper” means too much/ hyperkalemia, too much potassium • “hypo” means too little/ hypokalemia, too little potassium in the blood • “Intra” means within/ intradermal (within the skin), intervenous (within a vein) • “micro” means very small or can mean (1 per 1,000,000) in the metric system i.e. microgram (one millionth of a gram) • “neo” means new/ neonate is a newly born baby. • “poly” means too many/ polypharmacy is used to mean the practice of prescribing to many medications for the same purpose. • “Sub” means below/ sublingual means below the tongue. Subcutaneous means below the skin • Tachy means fast/Tachycardia is a rapid heart rate

4. Important root words in Pharmacy

5. Important Root words in Pharmacy continued

6. Suffix • A suffix is a word that is added at the end of a root word to indicate or qualify its meaning. For example, arthr (joint) plus itis yields the word arthritis which meaning inflammation of a joint.

7. Important Pharmacy related suffixes

8. There are literally hundred of root words and prefixes and suffixes. • These list is not all inclusive by any means. • It is based on my experience on what is important to know • A medical dictionary is key to have and to review on a regular basis • Learning or knowing different languages always helps

9. General Pharmacy Abbreviations

10. General Pharmacy Abbreviations Table 2

11. Pharmacy SIG codes • SIG is the part of the prescription that includes the directions for use. SIG is short for the Latin signetur “let it be written” • You will see on an Rx (remember this abbreviation?) • Sig: 1 tab qd po HS • Qnty: 30 • Refills: 1 • This means “take one tablet very day by mouth at bedtime” dispense 30 tablets and give one refill • We will cover this list in class.

12. Dangers of SIG codes and medical abbreviation in general • The Institute of Safe Medication Practices (ISMP) publishes a list of unsafe medication codes whether SIG codes or other codes for which many hospitals and institutions adhere to in the goal of preventing medication related errors. • The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) also in collaboration with the ISMP publishes a minimum Don’t abbreviate List (Do not use list)that healthcare organization must include. We will cover this list in class in our discussion. • Both the ISMP and JCAHO’s do not use list apply to all health related communication between healthcare practitioners. This means that in addition to drug orders, these abbreviation are not to be used anywhere in a patient’s chart, documentation or reports. • The Institute of Medicine (IOM) in 1999 published a report stating that between 44,000 and 96,000 deaths each year happen due to medical errors, many because of unclear abbreviations and codes

13. Case in point • In 2001, a case was report to the FDA via medwatch, see article, http://www.fda.gov/downloads/Drugs/DrugSafety/MedicationErrors/UCM080654 • The case involved an infant transferred from an obstetrics unit to a nursery for well babies with an order for DTO 0.7 ml PO q4h. • The pharmacist in the case recognized the order as deodorized tincture of opium USP, which has a concentration of 60 mg/ml morphine. The prescribed dose translates into give 0.7 ml (42 mg) by mouth every four hours. This dose is 252 mg per day of morphine, a dose that can kill or send a newborn baby to the hospital for respiratory arrest. • The pharmacist verified the order as diluted tincture of opium which is 25 fold dilution of the original drug. The actual dose is 0.7 ml(1.6 mg) by mouth every four hours.

14. How to report medication errors • Both patients and healthcare providers can report errors involving medications to the ISMP through its website, www.ismp.org. Click onto the MERP, medication error reporting program. • United States Pharmacopeia, www.medmarx.com collects medication errors and adverse events data.

15. Milan’s List of Must Know Drugs

26. Most commonly abbreviated medical conditions you will see

28. Medications commonly abbreviated • The following medications are commonly abbreviated in the field • Joint Commission and the ISMP however have established guidelines to reduce the use of such shortcuts.

29. Medication Abbreviations

30. Medication Abbreviations

31. Medication Abbreviations

32. Most Common Sig Codes in Pharmacy

34. Common Routes of Administration

36. Uncommon Routes of administration • Certain routes are not commonly used • Often to avoid confusion and the potential for error the routes are spelled out on medical orders • Example 1 Epidural • Medication is given just outside the spinal cord next to the dura mater. • Used in cases where high doses of pain medications are needed but side effects need to be minimized. • Used in obstetrics ward in women undergoing labor • Used for post operative patients in PACU • Example of a drug is Fentanyl 2 mcg/ml with 0.0625% bupivacaine in 250 ml of NS

37. Example 2 Intrathecal Route • Involves passing the medication through the spinal cord into the subarachnoid space to allow for direct bathing of the neural tissue in the drug • Intrathecal chemotherapy i.e. methothexate, cytarabine • Intrathecal Baclofen in cerebral palsy patients • Advantages are that very small amounts of drug can be used leading to less side effects • Disadvantages are high risk for infections and inadvertent overdoses

38. Epidural Injection Courtesy of: http://richardspatafora.com/2011/05/19/lumbar-epidural-cortisone-injection/

39. Common Abbreviations for quantities

40. Putting the Rx together • A prescription will consist of the following elements • Sig: • A numerical quantity (with the dosage form) • Route of administration • Time Frequency • Day supply or total quantity • Refills • Example: • Vasotec 5 mg • Sig: take 1 tab qd • 30 tablets • Refills: 2

41. A tougher example: • Humulin N • Sig: inject 25 units qam and 25 units qhs • Refills: 11 • Example 3 • Amoxicillin Susp 400 mg/5 ml • Sig: 1 ½ tsp TID • For 14 days • Refills: 2 • Total amount to dispense for 14 days?

42. JCAHO’s Minimum Do not use List • In 2004, JCAHO published its minimum do not use list which the joint commission encourages health care institutions it accredits to use (at a minimum) g

44. Less commonly known pharmacy terminology