Prescriptions & Medication Orders

The practice of pharmacy has undergone a major transformation in the twentieth century. Pharmacists have evolved from herbalists, compounding and dispensing a limited formulary of poorly controlled products to drug information specialists handling thousands of sophisticated and highly refined pharmaceutical products.

Although pharmacists are still in a period of significant professional change, it is doubtful that their role in compounding and dispensing products will ever be totally replaced with other professional responsibilities. Regardless of his or her other professional duties, the pharmacist is ultimately responsible for ensuring that the products which he or she dispenses are safe, accurate, and appropriate for the patient. Hence, the pharmacist must possess skills, knowledge, and understanding of basic principles which allow him to maintain accuracy in compounding and dosing.

Part of the definition of compounding is to prepare, mix, assemble, package, or label a drug or device for dispensing as the result of a practitioner’s Prescription Drug Order or initiative based on the pharmacist/patient/prescriber relationship in the course of professional practice.

Prescription and medication orders convey necessary and specific information to the pharmacist. However, they are typically used in different patient-care settings. Prescriptions generally are used for outpatient care and medication orders are used in institutional care.

                  Jacquelyn Hyde, MD
                  123 Upendown Rd.
                  Nowhere, NC 27000
Phone: 555-1234                         DEA # AH0079411

Name: Dan D. Lyon                         Date:   Today     
Address: 123 Jackla Lane                  Phone: 555-5678
Rx 
    Acetaminophen           gr. v
    Alcohol USP             fl. ss
    Cherry syrup    q.s.    fl. iii
    Sig: 1 tsp. q4-6h prn
    Refills: 1

  ____________________________     ______________________       
  Product selection permitted       Dispense as written

Medication orders are used to order medications for patients in hospitals, nursing homes, and other institutions. Medication orders also contain orders for procedures, laboratory test, and discharge instructions. One medication order form may request many different medications, whereas prescription forms can request only one medication.

Accurate preparation and dosing are achieved only through systematic adherence to a given series of steps. Errors which occur at any step in this process will result in reduced accuracy of dosing to the patient. These steps include:

1. Identify the required elements of a prescription.
2. Review and interpretation (translation) of the prescription.
3. Calculations of measurable quantities of all components.
4. Accurate weight/measurement of all components.
5. Use of appropriate compounding techniques to convert individual components into a finished product.
6. Proper packaging and labeling of the product.
7. Delivery of the correct, completed product to the correct patient with adequate instructions for administration.

Reviewing, interpreting and labeling the prescription involves a “language” that must be learned and utilized. Part of that language includes abbreviations. The health-care professions use an estimated 35,000 abbreviations. There are no guidelines about which abbreviations can be used in written orders, although many institutions have developed some criteria. The pharmacist typically encounters a variety of abbreviations. These might be grouped in the following categories:

• Latin Terms
  Traditionally prescriptions are written in Latin. In recent years physicians have tended to write their prescriptions in English or with very abbreviated Latin instructions. A brief list of terms is available, but the best way to understand the terms is to practice interpreting prescriptions.
• Drug Name Abbreviations
• Medical Abbreviations

Many abbreviations are used in only a limited geographical area or institutional setting, so care must be taken when interpreting any abbreviation. For example, the abbreviation T.I.W. can be interpreted as “three times a week” or “twice a week.” D/C can be interpreted as “Drug Information Center”, “discharge”, or “discontinue.” HS could mean “at bedtime” or “half-strength.”

Frequently the physician omits the “fl” or “f” which should precede the unit sign when liquid measure is intended. The pharmacist must determine whether a volume or weight measurement is intended. Pertinent rules for making such a decision are as follows:

• If the ingredient is a liquid in a liquid preparation, then the quantity is a volume.
• If the ingredient is a solid, then the quantity is a weight.
• In an ointment or other solid preparation, the quantities are always by weight, unless otherwise specified.

Other translation problems come from misreading quantities. You should always remember that quantities may be expressed in metric or apothecary units, and occasionally a prescription will contain both. It is essential that you translate these units into the proper, measurable amounts.

Many other translation problems come from misreading the actual drug or ingredient name. Many drugs appear similar when written or sound alike when spoken. An extensive list of common look-alike, sound-alike drugs is below.

Rx
Zinc Oxide        5.0 
Calamine          5.0  
Hydrocortisone    0.5
Talc q.s.        50.0
M.Ft. pulv. 
Sig: p.a.a. t.i.d.

Rx
Zinc Oxide         5.  
Calamine           5.  
Hydrocortisone      .5  
Talc q.s.         50.   
M.Ft. pulv.
Sig: p.a.a. t.i.d.

Rx
Zinc Oxide          5|  
Calamine            5|  
Hydrocortisone       |5  
Talc q.s.          50|   
M.Ft. pulv. 
Sig: p.a.a. t.i.d.

Rx 
	Potassium Iodide 		7.2 g
	Guaifenesin syrup
	Hydroiodic acid syrup aa. q.s. 120 ml
	M.FT. syrup 

	Sig: i tsp q6h

Rx 
	Benadryl elixir 
	Nystatin oral suspension 	aa. 10 ml 
	Mylanta suspension q.s. 	ad 120 ml
 	M.Ft. susp 

	Sig: 1 Tbl swish and swallow q.i.d, p.c. and h.s.

Rx 
	Acetaminophen 		gr xx 
	Codeine phosphate 	gr v
	Lactose q.s. 		gr C 
	M. et ft. capsules No. XX 

	Sig: i q6h prn pain

Rx 
	Acetaminophen 		65 mg 
	Codeine phosphate 	10 mg 
	Lactose q.s. 		300 mg 
	M. Ft. D.T.D. caps #10 

	Sig: i q6h prn pain

Proper labeling is one of the most important aspects of dispensing a prescription. The label must comply with state and federal regulations and should correctly and clearly convey all necessary information regarding dosage, mode of administration, and proper storage of the product. The quality of the labeling is extremely important to the patient’s perception of the quality of the product and may have profound implications for his or her safe use of the medication and compliance with the prescribed regimen.

Required Label Information

Most pharmacies have the name, address, and phone number of the pharmacy pre-printed on their prescription labels. In addition, federal and state (NC) regulations require that the following information appear on the label.

• prescription (serial) number
• date of initial dispensing
• patient’s name
• directions for use
• name and strength of the drug product (or active ingredient(s) in a compounded prescription)
• prescriber’s name
• name of dispensing pharmacist
• beyond-use date

Labels for controlled substances in schedule II, III, and IV must also contain the statement “Caution: Federal law prohibits the transfer of this drug to any person other than the patient for whom it was prescribed.” in the form of an auxiliary label.

Recommended Label Information

In addition to the information required by law, it is recommended that the following information also be provided on the prescription label.

• Number of dosage units or volume of product dispensed
• Number of refills allowed

You should consider these to be label requirements for the course.

Label Format

Presented below is an example of a proper label. This is the format which you should follow in the course.

UNC School of Pharmacy Chapel Hill, NC 7511 

962-0057

Rx # 123456                                   Dr. Upendown

Pat Annsir                                          9/1/2101
Take one tablet every four to six hours as needed for pain.
Acetaminophen 325 mg, Codeine sulfate 15 mg/tablet (#30)
3 refills; Discard after 9/31/21
Dispensed by Y. Ourname R.Ph.

Other Labeling Guidelines

• Indicate the dosage form to be administered.
  e.g. “Take one tablet every day.” instead of “Take one every day.”
• Use words instead of numbers.
  e.g. “Take one tablet every day” instead of “Take 1 tablet every day.”
• Express quantities to be administered in units which are familiar to the patient, and for which they are likely to have suitable measuring devices.
  e.g. “Take two teaspoonfuls every six hours.” instead of “Take 10 ml. …”
  In some instances it may be critical that an exact volume, such as 2.0 ml, be administered. In such a case, the pharmacist should provide a properly calibrated measuring device along with the medication.
• Specify the route of administration if the medication is not intended for oral use.
  e.g. Insert one suppository vaginally every night at bedtime.
• Do not use abbreviations.
  e.g. “Take two capsules twice a day.” not “Take two caps twice a day.”
• Specify all active ingredients in a compounded prescription. Inert bases or vehicles may, but need not, be labeled.
• In general, the amount of active ingredient per dosage unit should be specified. e.g. Inderal 2 mg/chart, Amoxicillin 250 mg/5ml., Phenergan 25 mg/suppository.
• When dispensing medications in bulk, such as solutions, suspensions, emulsions, ointments, or creams, the amounts of active ingredients are expressed as a percentage strength. This is almost always true of topical preparations. e.g. Hydrocortisone cream 1% or Betadine solution 2%

FDA’s List of “Difficult-to-Compound” Drugs

List of Drug Products that Have Been Withdrawn or Removed from the Market for Reasons of Safety or Effectiveness