Chapter-1
PRESCRIPTION
DEFINITION
• Prescription is a written order from a registered medical practitioner or another properly licensed practitioner such as dentist, doctor, veterinarian, etc to a pharmacist to compound and dispensed a specific medication for the patient.
• The prescription also contains the direction for the patients regarding the mode of administration of drugs which dispensed to him.
• Thus prescription is a medium through which treatment is provided to patients by both the physician and pharmacist.
• The prescriptions are generally written in the English language but Latin words or abbreviations are frequently used in order to save time.
PART OF A PRESCRIPTION
Prescriptions are generally written on a typical format which are usually kept as pads. A typical prescription consists of following parts:-
1. Date
2. Name, age, sex and address of the patient
3. Superscription
4. Inscription
5. Subscription
6. Signatura
7. Renewal instructions Signature,
1.Date:
• The date must be mentioned on the prescription when a prescriber prescribes medicine, it helps to the pharmacist to find out the date of prescribing and date of presentation for filling the prescription.
• If the prescription contains narcotics or habit-forming drugs, the prescription must bear the date, so as avoid the misuse of drugs.
2. Name, Age, Sex & Address of the patient:
• The name of the patient should be mentioned on the prescription, it helps to identify the prescription.
• Age and sex of the patient, help the pharmacist to check the prescribed dose of medication. It is most important in children patients.
• In case, if any of this information is missing in the prescription, that may be included by a pharmacist after a proper inquiry from the patients.
3.Superscription:
• This part of the prescription is denoted by the symbol Rx which is written before the writing of a prescription.
• Rx is an abbreviation of the Latin word recipe, meaning 'you take' (take thou).
• In olden days, the symbol was considered as the sign of Jupiter, God of healing. This symbol means requesting God for the quick recovery of the patient.
4.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.
• The name of each ingredient is written on a separate line along with its quantity.
• In complex prescriptions containing several ingredients the inscription is divided into following parts:-
(a) Base : The active medicaments which are intended to produce the therapeutic effect.
(b) Adjuvant : It is included either to enhance the action of medicament or to improve the palatability of the preparation.
(c) Vehicle : It is included in the prescription either to dissolve the solid ingredients or to increase the volume of the preparation.
Nowadays, the majority of the drugs are prescribed which are already in a suitable formulation. The pharmacist is required to dispense the ready-made form of drugs. So, compounding of prescription is almost eliminated.
5. Subscription:
• This part provides direction to the pharmacist for preparing the medicines and the number of doses to be dispensed.
• Nowadays, the prescribers are omitting the specific instructions to the pharmacist because the majority of the prescriptions are not compounded and dispensed.
6. Signature:
• This part is denoted by 'sig' and provides direction to the patient regarding the administration of the drug which dispensed to him.
• The instructions are given in the prescription are required to be transferred to the label of the container in which medicine is to be dispensed, so that the patient can follow it.
• The instruction may be included
(a) the quantity to be taken
(b) which time medicine should be taken e.g. after food or before food.
(c) the frequency of administration or application.
(d) dilution direction, seek before use of syrup, etc.
7. Renewal instructions:
• The prescriber indicates every prescription order, how many days this medicine continues, and whether it may be renewed.
• It is very important especially in the prescription containing the narcotic & another habit-forming to prevent its misuse.
8. Signature, Registration & Address of the prescriber:
• The prescriber must be written his signature with registration number and address on the prescription.
• It is very important especially in the prescription containing the narcotic & another habit-forming to prevent its misuse.
(Prescription Format)
HANDLING OF PRESCRIPTION:
The following procedures are adopted by a pharmacist while handling a prescription for compounding and dispensing.
The prescription should be received from the patient by the pharmacist himself. While receiving a prescription, a pharmacist should not change his facial expression which gives an to the patient that he is surprised or confused seeing the prescription.
While receiving a prescription, always check it that it is written in a proper format i.e doctor's pad or OPD slip of the hospital/nursing home and signed by the prescriber along with the date
A prescription should always be analyzed behind the counter. In case of any problem in reading or any doubt regarding the prescription ingredients or advice, the pharmacist should consult with a senior pharmacist or the prescriber.
3. Collecting and weighting the material
Collect all the material required for compounding. The material should be weighed properly according to dose.
4. Compounding, Labelling, and Packaging
Compounding should be carried out in a suitable place as per IP. All equipment required should be cleaned and dried.
After compounding, the medicine should be filled immediately in a suitable container and stickering with proper labelle. Finally packed in a carton packet and dispensed to the patient.
Modern Methods of Prescribing
Nowadays, the majority of drugs are available in the market as ready-made formulation manufactured by different pharmaceutical companies. There is no need to dispense the drugs by the pharmacist. In the present days, the role of pharmacist is to hand over the ready-made preparation to the patients and provide advice if demanded regarding its mode of administration, dose schedule, drug interaction and adverse reaction etc.
The drugs should be prescribed by its official name(generic name) and not by its trade name. There are certain advantages and disadvantages of prescribing of drugs by its trade name, which are as under:-
Advantages
(1) It is easy to remember proprietary names because they are very catchy e.g., Librium (chlordiazepoxide), Calmpose (diazepam), and Crocin (paracetamol).
(2) It is easy to communicate with the patient.
(3) The continuity can be maintained by prescribing the same pro- prietary name every time.
(4) The bioavailability of drugs changed with the change of adjuvants used in drug formulations manufactured by different manufacturers. So only those proprietary drugs can be prescribed which have a better bioavailability.
Disadvantages
(1) It is cheaper to prescribe the drugs by its official name.
(2) It becomes difficult for a pharmacist to dispense the substitute of the drug which is available in the stock.
There are four types of prescriptions which are generally received by the retail drug store:-
(a) Prescription in general practice
(b) Private prescriptions
(c) Hospital prescriptions meant for 'out patients'
(d) Hospital prescriptions meant for 'in patients'
CARE REQUIRED IN DISPENSING PRESCRIPTION
Following precautions should be taken while dispensing a prescription.
(1) Always keep the prescription before you. Take the prescription with you while taking out the medicine from the shelf. It will serve as a constant reminder of the name and strength of the preparation required and help to avoid mistakes.
(2) Always check the dispensing balance before weighing the ingre- dients which are required during dispensing.
(3) Replace containers of stock preparations or drugs in their proper position after use.
(4) Keep the label in upper position during weighing solid ingredi- ents especially the potent drugs such as morphine hydrochloride to serve as a constant reminder that the correct drug is being used.
(5) When pouring or measuring the liquid ingredients, keep the label upward in order to prevent surplus liquid running down of the bottle and staining the label.
(6) Care should be taken to keep the dispensing balance clean. The powder should be transferred from the stock container by usine a clean spatula. The scale pan should be cleaned immediately after use.
(7) Medicines which are used externally such as lotions, liniments. paints 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.
(8) Before handing over the medicine to the patient, again check that the correct preparation, in the correct strength, has been supplied and correct direction has been stated on the label.
Sources of Error in Prescription
1. Abbreviation : Abbreviation presents a problem in understanding parts of the prescription order. Extreme care should be taken by a pharmacist in interpreting the abbreviation. Pharmacist should not guess at the meaning of an ambiguous abbreviation e.g., to dispense Achromycin for "Achro" may cause difficulty when the intention of the prescriber is to dispense Achrostatin. The abbreviation "SSKI" represents the use of a short hand for saturated solution and chemical symbols for potassium iodide.
2. Name of the drug : There are certain drugs whose name look or sound like those of other drugs. Some of the examples of such drugs are as under:-
Name of the pharmaceutical products have been changed on certain occasion due to the possible confusion with the name of the other product e.g. the name of potassium supplement was changed from Kalyum to Kolyum because of the possible confusion of the former designation with valium.
3. Strength of the preparation : The strength of the preparation should be stated by the prescriber. It is essential when various strengths of a product are available in the market. For example, it will be a wrong decision on the part of a pharmacist to dispense paracetamol tablet 500 mg when prescription for paracetamol tablet is received with no specific strength.
4. Dosage 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 in order to avoid ambiguity.
5. Dose : Unusually high or low doses should be discussed with the prescriber. Paediatric dosage may present a problem. So pharmacist should consult paediatric posology to avoid any error. reasonable dose is administered too frequently e.g., a prescription for sustained release formulation to be administered after very four hours should be thoroughly checked because such dosage forms are usually administered only two or three times a day. Sometimes a
6. Instructions for the patient : The instructions for the patient which are given in the prescription are incomplete or omitted. The quantity of the drug to be taken, the frequency and timing of administra- tion, and route of administration should be clearly given in the prescription so as to avoid any confusion.
7. Incompatibilities : It is essential to check that there are no pharmaceutical or therapeutic incompatibilities in tion and that different medicines prescribed for the same patient do not interact with each other to produce any harm to the patient. Certain antibiotics should not be given with meals since it significantly decrease the absorption of the drug. prescribed prepara-
CALCULATIONS INVOLVED IN DISPENSING
To have a complete understanding of various types of calculations, which are involved in dispensing, it is desirable that the pharmacist should have a thorough knowledge regarding weights and measures which are used in calculations. There are two systems of weights and measures:-
(1) The imperial system
(2) The metric system
IMPERIAL SYSTEM
It is an old system of weights and measures. Measurement of weight in imperial system : Weight is a measure of the gravitational force acting on a body and is directly proportional to its mass.
Previous MCQs And Answers:
Q. 1 The meaning of Latin term Rx:
A. Take Thou
B. When necessary
C. Send
D. Writh
[ESIC 2016]
Q. 2 One fluid ounce is:
A. 60ml
B. 15ml
C. 30ml
D. 10ml
[ESIC 2016]
Q.1 What is prescription?
(A) Written order from registered Pharmacist
(B) Written order from Nurse
(C) Written order from a registered medical practitioner
(D) Written order from any health staff.
Q.2 Latin term Pulvis means -
(A) A pill
(B) Powder
(C) A spray solution
(D) A paste
Q.3 In prescription symbol Rx means-
(A) You take
(B) Take thou
(C) Both A & B
(D) None of these.
Q.4 Latin term Unguentum meaning is -
(A) A suppository
(B) An ointment
(C) Both A & B
(D) None of these.
5. Which part doesn't comes under the handling of prescription?
(A) Reading and checking
(B) Collecting and weighing the material
(C) Compounding , labelling and packaging
(D) Guessing about written medicine.
Q.6 What is the meaning of Latin term Jentaculum?
(A) In morning
(B) Breakfast
(C) Evening
(D) None of these.
Q.7 Latin term Auris Dexter means-
(A) To right ear
(B) To left ear
(C) Both A & B
(D) To the nose
Q.8 In prescription Signatura part consists of the direction to be given -
(A) To the patient
(B) To the pharmacist
(C) To the doctor
(D) To the Nurse
Q.9 Latin term Inter cibos means-
(A) Before meals
(B) After meals
(C) Between meals
(D) Both A and B
Q.10 In inscription part of the presentation which contains-
(A) Direction to the pharmacist
(B) Contains name , quantity of the prescribed ingredients
(C) Direction to the patient
(D) None of these
Q.11 One drop is equal to-
(A) 0.6 ml or 1 minim
(B) 0.4 ml or 2 minim
(C) 0.8 ml or 1 fl oz
(D)lml or 15 minim
Q.12 Cochleare minimum means-
(A) One teaspoonful
(B) One dessertspoonful
(C) One tablespoonful
(D) One wine glass
Q.13 One ounce is equal to-
(A) 480 grain
(B) 520 grain
(C) 120 grain
(D) 560 grain
Q.14 What is the meaning of Latin term Statim ?
(A)As directed
(B)Immediately
(C)When required
(D)All of the above
Q.15 The drug should be prescribed by its
(A)Generic name
(B)Proprietary name
(C)Trade name
(D)Both A and C
16. Which component of the prescription is not always a requirement
(a) Inscription
(b) Subscription
(c) Superscription
(d) Prescriber's Drug Enforcement Administration (DEA) number
17. The most common criterion used to determine the correct pediatric dose of a drug is
(a) Age
(b) Weight
(c) Gender
(d) Body surface area
18. Following are the parts of prescription except
(a) Superscription
(b) Inscription
(c) Subscription
(d) Signa
19.Rx is used to denote
(a) Superscription
(b) Inscription
(c) Subscription
(d) Signature
20. Subscription in a prescription is the part of
(a) Direction of the pharmacist for preparing the prescription
(b) Doctor's information
(c) Body of prescription
(d) Represented by the symbol of Rx
21.SOS' stands for
(a) Immediately
(b) Frequently
(c) Slowly
(d) When necessary
22. Latin term for A Tablet
A. Nebula
B. Pulvis
C. Tabella
D. Mistura
23. Stat. means
A. As stated
B. As guided
C. Immediately
D. As directed
24. ............enhances the action of the medicament or to make the product more palatable
A. Base
B. Adjuvant
C. Vehicle
D. All of the above
25. Inscription is divided into
A. Base
B. Adjuvant
C. Vehicle
D. All of the above
26. ...........is the body of the prescription .
A. Superscription
B. Subscription
C. Inscription
D. Signature
27. Rx is an abbreviation of .............. word recipe,
A. French
B. Greek
C. Latin
D. Arabic
28. A prescription is a written order by a
A. Physician
B. Dentist
C. Veterinarian
D. All of the above
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