Medical Prescriptions Notes

Introduction to Medical Prescriptions

Essential tool in modern healthcare.
Allows healthcare providers to order medications and treatments.
Ensures patients receive appropriate drugs, dosages, and administration guidelines.
Key for healthcare professionals to provide safe and effective patient care.

Components and Process of Writing Prescriptions

A prescription includes:
- Patient's name and contact information.
- Drug name and strength.
- Quantity to be dispensed.
- Specific instructions for use.
- Provider's signature and contact details.
Proper prescription writing minimizes:
- Risk of medication errors.
- Drug interactions.
- Improper use.

Definition of a Prescription

Order (often written) issued by a qualified health care professional to a pharmacist.
Instructions to prepare/dispense specific medicines or medical devices for an individual patient.

Rational Prescribing Steps

Make a specific diagnosis.
Consider pathophysiologic implications of diagnosis.
Select a specific therapeutic objective.
Select a drug of choice.
Determine appropriate dosing regimen.
Devise a plan for monitoring drug’s action & determine an endpoint for therapy.
Plan a program of patient education.

Understanding Prescription Components

Patient's name, contact details, and date are crucial for accurate matching.
Drug name, dosage strength, and quantity prevent mix-ups.
Instructions for use outline frequency, timing, and method of administration.
Provider's name, credentials, and contact information validate the order.
Provider's signature is the final authorization.

Prescription Components Importance

These components promote the safe, effective, and appropriate use of medications.
They ensure optimal patient outcomes.

Common Form of Outpatient Prescription (Figure 66-1)

Components are numbered for explanation (see original document for visual).

Prescription Types

Prescription in general practice
Hospital prescription for in-patients.
Hospital prescription for an external pharmacy.

Parts of a Prescription

Superscription: name, professional degree, contact number, address of prescriber, date when order is written, name, address & age of patient & symbol Rx (an abbreviation for "recipe," ! Latin for "take thou."
Inscription: body of Prescription containing name, strength of each drug, & dosage form.
Subscription: quantity to be dispensed, directions to pharmacist (e.g., "make a solution," "mix & place into 10 capsules," or "dispense 10 tablets.").
Transcription: labeling of instruction to Patient, prescriber's signature.

Dosage Calculations and Administration

Accurate calculation and administration are critical for patient safety and therapeutic efficacy.
Providers must understand dosage calculations and proper administration techniques.
Prevents dosing errors leading to adverse drug events, sub-therapeutic effects, or fatal consequences.

Dosage Calculation Factors

Consider patient's age, weight, body surface area, renal function, and other factors.
May involve complex mathematical formulas or standardized dosing charts.
- Especially for medications with narrow therapeutic indices.
- Vulnerable populations like children and elderly.
Be mindful of unit conversions and rounding.

Proper Medication Administration

Includes oral, topical, parenteral, and other routes.
Providers must be familiar with delivery mechanisms and absorption profiles.
Educate patients on correct device use (inhalers, insulin pens, transdermal patches).

Patient Monitoring:

Monitor patient's response to medications for adverse effects or changes in clinical status.
Identify the need for dosage adjustments or alternative treatments.
Through rigorous training, careful calculation, proper administration techniques, and diligent patient follow-up, healthcare providers can optimize the safety and efficacy of medication therapy and promote positive patient outcomes

Writing Drug Names and Strengths

Use either generic (nonproprietary) or brand (proprietary) name.
Strength should be in metric units, not apothecary units.
Conversions:
- $1 \text{ gr} = 60 \text{ mg}$
- $15 \text{ gr} = 1 \text{ g}$
- $1 \text{ ounce (oz) by volume} = 30 \text{ ml}$
- $1 \text{ tsp} = 5 \text{ ml}$
- $1 \text{ tbsp} = 15 \text{ ml}$
- $20 \text{ drops} = 1 \text{ ml}$
- $2.2 \text{ lb} = 1 \text{ kg}$

Writing Individual Dose

For strengths > 1g, use grams.
For strengths < 1g, use milligrams (e.g., 100mg).
For strengths < 1mg, use micrograms (e.g., 100 micrograms, never 'µg').
Avoid unnecessary decimal points (e.g., use 300 mg NOT 0.3 g).

Additional Prescription Information

Check for previous adverse reactions/allergies.
Ask for drug history or medical record.
Check other medication charts (anticoagulants, insulin).
Specify time course: if drug is taken for a number of days/ continuously (course of antibiotic, antihypertensive/ antiparkinson drugs).
As required medications Indication, frequency, minimal time interval between doses & maximum dose in 24 hr period.

Prescription Accuracy

Instructions should be sufficient for a nurse to administer a drug accurately in hospital or for a pharmacist to provide a patient both correct drug & instructions on how to take it.
Medication error is most common medical mistake.

Prescription Drug Classifications

Controlled Substances: Opioid painkillers, stimulants, and benzodiazepines.
- Subject to stringent regulations due to abuse potential.
- Require special licenses, tracking patient usage, and reporting suspicious activity.
Antibiotics: Used to treat bacterial infections.
- Classes include penicillins, cephalosporins, and fluoroquinolones.
- Proper antibiotic stewardship prevents antibiotic-resistant bacteria.

Other Medication Classifications

Chronic Disease Medications: For hypertension, diabetes, asthma, depression.
- Include antihypertensives, insulin, bronchodilators, and antidepressants.
- Require careful monitoring and adjustments.
Specialty Medications: Complex or high-cost drugs.
- Biologics for autoimmune disorders, cancer treatments, medications for rare genetic conditions.
- Require prior authorization, special dispensing channels, and close monitoring.

Prescription for Uncontrolled Drugs

*   Date
*   Identification of patient: name, hospital number, age, sex
*   Name of drug
*   Dose of drug
*   Frequency of administration
*   Route & method of administration
*   Amount to be supplied
*   Prescribers’ signature

Controlled Drugs

Substances that may produce physical or psychological dependence.
Prescribed for no longer than 2 weeks due to withdrawal symptoms.

Classification of Controlled Substances (Schedules I-V)

Based on addiction liability, medical use, and potential for abuse.
Schedule I: No accepted medical use, high abuse potential (heroin, LSD, marijuana).
Schedule II: Accepted medical use, high abuse potential (opioids like morphine, amphetamines).
Schedule III: Accepted medical use, moderate potential for physical dependence, high potential for psychological dependence (weaker opioids, some amphetamine-like drugs).
Schedule IV: Accepted medical use, limited potential for dependence (diazepam, phenobarbital, chloral hydrate).
Schedule V: Accepted medical use, least potential for abuse (cough syrups with codeine, antidiarrheals with diphenoxylate).

Schedules of Controlled Drugs Detail:

Schedule I: Drugs in this schedule have no accepted medical use & have a high abuse potential. Ex. heroin, marijuana, LSD, etc.
Schedule II: Drugs in this schedule have a high abuse potential e severe psychic or physical dependence liability. Included are certain narcotic analgesics, stimulants, & depressant drugs. Ex. opium, morphine, codeine, methadone, cocaine, amphetamine.
Schedule III: Drugs in this schedule have an abuse potential < than those in Schedules I & II & include compounds containing limited quantities of certain narcotic analgesic drugs, & other drugs such as barbiturates. pentobarbital.
Schedule IV: Drugs in this schedule have an abuse potential < than those listed in Schedule III & include such drugs as barbital, phenobarbital, chloral hydrate, chlordizepoxide, diazepam, oxazepam etc.
Schedule V: Drugs in this schedule have an abuse potential < than those listed in Schedule IV & consist primarily of preparations containing limited quantities of certain narcotic analgesic drugs used for antitussive & antidiarrheal purposes.

Prescription Rules for Controlled Drugs

Should not be typed; must be handwritten in ink.
Signed and dated.
Carry prescriber's full name, address, and registration number.
State form of drug and total quantity (e.g., 10.0 mg).
Refill limits:
- Schedule III-IV-V: No more than 5 refills in a 6-month period.
- Schedule II: No refills.

Common Prescription Abbreviations

a.c. - before meals
p.c. - after meal
cap - capsules
g - gram
h - hour
mg - milligram
ml - milliliter
Bid - Twice daily
p.o. - by mouth, orally
p.r.n. - when necessary
q.d. - once a day
q.i.d. - 4 times a day
q.h. - every hour
q.2h. - every 2 hours
t.i.d. - 3 times a day
IA - Intra-arterial
IM - Intramuscular
IV - intravenous
Hs - At bed time
Sup, supp - suppository
Susp - suspension
Tab - tablet
Stat - At once
D/C - Discontinue
CD - Controlled drugs

Computerized Physician Order Entry (CPOE)

Electronic entry of physician instructions, especially for hospitalized patients.
Orders communicated over a computer network.
To medical staff or departments responsible for fulfilling the order.

CPOE Advantages

Decreases delay in order completion.
Reduces errors related to handwriting or transcription.
Provides error-checking for duplicate or incorrect doses or tests.
Simplifies inventory & posting of charges.

Ethical Considerations in Prescribing

Patient-Centered Care: prioritize the well-being and best interests of their patients. Tailor treatment plans accordingly to ensure the safest and mosteffective outcomes
Informed Consent: providers must clearly explain therisks, benefits,and alternatives for any proposedmedicationtherapy, empowering patients to make informed decisions about their own care. transparent communication and shared decision-making foster trust,adherence,and shared accountability between the providerand the patient.
Responsible prescribing: includes carefully considering the patient's clinical needs, avoiding unnecessary or inappropriate medication use, and continuously monitoring for potential adverse effects or unintended consequences. Stay up-to-date on latest clinical guidelines, contraindications, and dosing recommendations
Confidentiality and Privacy: requires healthcare providers to uphold the highest standards of confidentiality and patient privacy. Securely store and handle all patient data, only sharing information with authorized individuals or entities as necessary for the patient's care. Maintaining this trust and respecting the patient's right to privacy is a fundamental ethical obligation.