Prescription

Definition :
'’It is an order written by a physician, dentist, veterinarian or a registered medical practitioner (RMP)
to a pharmacist to compound and dispense a specific drug for the patient.’’
OR
‘’Prescription is a written order for medication, issued by physician or RMP’’

 Prescription is relationship between physician and pharmacist.

 Physician (RMP) Pharmacist patients
 The word "prescription" is derived from the Latin term praescriptus (Prae - 'before' and
scribere- meaning 'to write').
 Prescription means 'to write before' which means prescription had to be written before a drug
could be compounded and administered to a patient.

Parts of a Pescription :
A typical prescription consists of the following parts:
1. Prescriber office information
2. Date
3. Patient information
4. Superscription
5. Inscription
6. Subscription
7. Signatura or Transcription
8. Renewal instructions
9. Prescriber’s signature and registration number.
1. Physician (Prescriber) office Information:
‘’Information about physician is essential so that the patient could be contact in emergency.
Following information is mentioned on the prescription;
i. Doctor's or office name.
ii. Address with phone number and e-mail.
iii. Prescription number, (required when calling the pharmacy for a refill)
2.Date :
It helps a pharmacist to find out the date of prescribing.
 It also helps in know when the medicines were last dispensed if the prescription is brought for
redispens.
 In case of habit forming drug the date prevents the misuse of the drug by the patient.

3. Patient information : (Name, Age, Sex and Address of the Patient)

 Name and address of the patient for identification purpose.
 Age and sex of the patient is required for child patient to check the prescribed dose.

4. Superscription : (symbol ℞)
‘’It is represented by ℞ (Latin term) „recipe‟ which means „take thou‟ or „you take‟.
 In olden days, the symbol was considered to be originated from the sign of Jupiter.
 Jupiter is the Greek God of healing.
 This symbol was use for requesting God for the quick recovery of the patient.

5. Inscription : (Medication prescribed)

‘’It is the main part of the prescription. It contains the names and quantities of the prescribed medicaments.’’
The medicament may be official preparation or nonofficial preparation.
A.) Official preparation (i.e. From pharmacopoeia) – Only name of the preparation is written
E.g. Piperazine Citrate Elixir USP
B.) Nonofficial preparation- Quantity of each ingredient will be given and type of
preparation will also be given
6. Subscription : (Direction to Pharmacist)
In this part the prescriber gives direction to the pharmacist-
a) Regarding the dosage form to be prepared.
b) Number of doses to be dispensed.

7. Signatura : (Direction for Patient) - To be placed on the label.

o It is usually written as „Sig.‟.
o The signatura written in english and use some Latin abbreviations like
t.i.d

o (thrice a day), b.i.d (twice a day) and o.d (once a day)

o Instructions should be written on the label of container so that the patient can follow them.
The instructions may include
a) Quantity to be taken (dose of drug)
b) Frequency and timing of administration of the preparation (dose interval)
c) Route of administration
d) Special instruction (if any)

8. Renewal instructions :
 The number of times a prescription is to be repeated is written by the physician.
 It is very important for the case of habit forming drugs to prevent its misuse.

9. Prescriber’s signature and registration number :

 The prescription must be signed by the prescriber by his / her own hand.
 Registration number should be written in the case of dangerous and habit forming drugs.

TYPES OF PRESCRIPTION
Prescriptions can be classified as
a) Compounded prescription
b) Noncompounded prescription

A). Compounded prescription-

 Also known as extemporaneous prescription.
 It is an order that requires mixing of one or more ingredients (active medicaments).
 It contains several ingredients which are divided into the following parts:
(a) Base: The active medicaments (Produce the therapeutic effect).
(b) Additives-
1) It enhances the action of the drug.
2) It makes the preparation more elegant (attractive) and palatable.
(c) Vehicle: It is the main carrier of the drug.
E.g. -In liquid preparations solvent (water) used as vehicle.
 Now a day‟s compounding is omitted from prescription.
E.g.
Sodium bicarbonate 3g
Simple Syrup 6ml
Purified Water (q.s.) 100ml
 B). Noncompounded Prescription :
Does not require compounding of pharmaceutical product.
Precompounded drugs supplied by a pharmaceutical company by its official or proprietary name.

Legal Requirements for a Valid Prescription

1. Prescription should be written in indelible (can not erased) ink (may be handwritten
or computer generated)
2. Prescription must be signed in indelible ink by the practitioner using his own name.
3. Prescription must be dated by the prescriber.
4. Prescription should state address of the practitioner
5. If issued by a dentist the words „for dental use only‟
6. Prescription always writes legibly.
7. Prescription always space out words and numbers to avoid confusion.
8. Prescription always contains complete medication orders.
9. Avoid abbreviations.
 Now a day‟s electronic prescriptions use, to minimize medication errors.
 The use of Latin word in prescription writing is traditional.
 Now a day‟s Latin has slowly gone.

An example of a typical prescription is given as follows:

 HANDLING OF PRESCRIPTION
The following procedures should be adopted by the pharmacist while handling the prescription for compounding
and dispensing:

1. Receiving
2. Reading and checking
⚫ Dosage calculation
⚫ Interactions
⚫ In Compatibilities
⚫ Allergies
⚫ ADRs
3.Preparing the prescription
⚫ Compounding
4. Finishing
⚫ Packaging
⚫ Labelling
⚫ Recording and filling
⚫ Pricing
5. Delivering
6.Prescription refilling

1. Receiving :
The prescription should be received by the pharmacist. While receiving a prescription, a pharmacist should not
change his/her facial expression. It gives an impression that he/she is confused or surprised after seeing the
prescription.

2. Reading and checking :

After receiving the prescription it should be screened behind the counter.
o Prescription authenticity should be checked.
o The signature of the prescriber and the date of prescription should be checked.
o The pharmacist should read all the lines and words of the prescription.
o He/she must not guess any word.
 If there is any doubt, the pharmacist should consult with the other pharmacist or the prescriber over
telephone.
 Checking for drug name, strength, sound like and look like
 Pakistan drug’s watchdog has identified 104 “look-alike, sound-alike”
 Of these 104 medicines, 35 are a serious cause of concern as the confusion can have tremendous
repercussions for the patients.
3.
: Collecting and weighing the material :
Before compounding a prescription all the materials should be collected from the shelves or drawers. All the
materials kept in the left hand side of the balance. After measuring each material should be kept on the right
hand side of the balance.After compounding of the prescription materials are replaced back to the shelves /
drawers.
While compounding every container of material should be checked thrice in the following manner:
(i) When collected from the shelves/drawers.
(ii) When the materials are measured.
(iii) When the containers are replaced back to the shelves/drawers.

4. Compounding :
⚫ The ingredients are compounded by accurate method.
⚫ For weighing electrical machines should be used.

Once the procedure for the formulation is decided, the pharmacist assembles the necessary materials in a single
location.
As each ingredient is used, it is transferred to another location away from the workstation.
The use of this technique provides the pharmacist with a mechanical check on the introduction of each
ingredient.
Through this process, the pharmacist has the opportunity to read the label of each ingredient three times—once
when the container is removed from the shelf, again when the contents are weighed and measured, and finally
when the container is returned to the shelf.

5. Finishing the Prescription :

a. Packaging :
After compounding packaging of prescription should be done. For packaging following containers are used ;
 Round vials
 Oval bottles
 Wide mouth bottles
 Colored bottles
 Collapsible tubes
 Paper wrappers
 Dropper bottles

b. Labelling :
⚫ The filled container should be suitably labeled.
⚫ The label should be affixed on smooth surface of bottle.
⚫ Label information's
 Type of prescription
 Name, age & sex of patient
 Date of dispensing
 Storage condition
 Name & address of pharmacy
 In case of liquid preparation attach auxiliary label
 Shake well before use
 Route of administration

c. Rechecking :
 Each prescription should be rechecked.
 After labeling container should be thoroughly polished to remove fingerprints.

d. Recording :
 A variety of prescription files are available which serve to maintain and preserve original prescription in
numerical order.

6. Pricing of Prescription
The prescription should be priced immediately after receiving it & informed the patient about it.This should be
done before starting the compounding to avoid any dispute.
Although many methods of pricing prescriptions have been used through the years, the most common are as
follow.
Percentage markup:
Dispensing price = Cost of ingredients + (cost of ingredients × percentage markup)
Summation:
Dispensing price = Sum of all costs + profit
Professional fee:
Dispensing fee = cost of ingredients + professional fee
Percentage markup + minimum fee:
Dispensing price = Cost of ingredients + (cost of ingredients × percentage markup) + minimum fee

 Professional fee includes all the dispensing costs and professional remuneration
 A true professional fee is dependent of the cost of the ingredients and thus does not vary from one
prescription to another.

7. Delievering the Prescription :

Three types
 Store Delivery
 Home Delivery
 Courier Delivery

8. Prescription refilling :
 The pharmacy is also notified that the patient needs to see his/her physician and should note on
prescription
 Verify that lab testing/monitoring is not required before ordering refills
 If a medication alert appears when the refill order is placed, verify that the patient has had a previous
order for this medication and history of tolerating the medication, and then proceed to refill.

Care required in dispensing prescription :

Following precautions should be taken while dispensing a prescriptio.
i. The prescription must be carried with the pharmacist while taking the medicine out of the shelves.
ii. The dispensing balance should always be checked before weighing any ingredient.
iii. All the chemicals should be replaced back in to their original positions in the shelf.
iv. Care should be taken to keep the balance clean after each measurement.
v. Liquid preparations for external use the label must display FOR EXTERNAL USE ONLY in red ink.
vi. Before handing over the medicine to the patient, again the preparation should be checked.
Error in Prescriptions
1. Abbreviation
In most of the prescriptions abbreviated terms are used by the prescriber that leads to major
errors during interpretation by the pharmacists.
E.g. „SSKI‟ is the abbreviated term of „Saturated Solution of Potassium Iodide‟. It is preferable
to avoid these types of misleading abbreviations.

2. Name of the drugs

Names of some drugs (especially the brand names) either look or sound alike. So any error in the
Name of a drug will lead to major danger to the patient.
E.g. Althrocin – Eltroxin, Acidin – Apidin , Digoxin- Digitoxin etc.

3. Strength of the preparation

Drugs are available in the market in various strengths. So a drug must not be dispensed if the
strength is not written in the prescription.
E.g. Paracetamol tablet 500mg should not be dispensed when no strength is mentioned in
the prescription.
4. Communication failure
Failures during the process of patient management - Includes illegible handwriting,
incomplete prescribing order.
Common errors include: „g‟ mistaken for „mg‟

4. Dosage form of the drug prescribed

Many drugs are available in more than one dosage forms.
E.g. Liquid, tablets, injections or suppositories.
The dosage form intended for the patient must be mentioned in the prescription to reduce ambiguity.

5. Dose
If unusually high or low dose is mentioned in the prescription then it must be consulted with the
prescriber. Some time a sustained release (SR) dosage form is prescribed thrice or more times
daily. Actually SR dosage forms should be given once or twice a day.

6. Instructions to the patient

Some time the instruction for a certain preparation is either omitted of mentioned partially. The
route of administration should be mentioned clearly.

7. Incompatibilities
It is essential to check that there are no pharmaceutical or therapeutic incompatibilities in the
prescription.
If more than two medicines are prescribed then it is the duty of the pharmacist to see whether their
interactions will produce any harm to the patient or not.
Certain drugs have interactions with food.
E..g, Tetracycline should not be taken with milk or antacid.

Labeling of dispensed medicines

After dispensing the medicine in a container, a label is attached by adhesive. The label on the
dispensed medicines should provide the following information:–
1. Name of the preparation-When the prescriber mentions the name in the prescription the same
name must be displayed on the label.
E.g. PIPERAZINE CITRATE ELIXIR USP
If it is a non-official preparation then the name of the dosage form should be given on the label.
 E.g. THE MIXTURE, THE EMULSION, THE DUSTING POWDER
2. The strength of the medicine- The strength of the active ingredient in the preparation must
be displayed if it is intended for internal (oral) purpose.
The amount in each unit of dose should be mentioned.
E.g. In case of oral liquids “Each 5ml contains 250mg”
e.g. In case of tablet “Each tablet contains 500mg”.
The values must be written in whole numbers and if decimal is not avoidable then a zero is placed
before the decimal point. E.g. Instead of 0.1g it should be 100mg, and instead of .5% it should be
0.5%.
In case of an official preparation the strength is not required to be given, because the name with
reference to the pharmacopoeia is sufficient. E.g. CHLORAMPHENICOL ORAL SUSPENSION IP.

3. The quantity supplied in the container

The total quantity of the product dispensed in the container should be indicated on the label. E.g.
50ml, 4tabs etc.
1. Storage conditions and shelf life (expiry date) of the product
0
(a) Temperature: Many preparations are required to be kept below 15 C. In these cases the
label should indicate KEEP IN A COOL PLACE.
0
Suppositories and pessaries melts at 37 C so the label should indicate KEEP IN A COOL
PLACE.
0
Insulin injections should be stored at 2 to 8 C so the label should indicate KEEP IN
REFRIGERATOR.
(b) Humidity: Powders, tablets and capsules should be stored in an air-tight container. The
label should indicate KEEP THE BOTTLE TIGHTLY CLOSED.
(c) Light: Drugs those degrade in presence of light should be stored in dark place. The
label should indicate KEEP IN A DARK PLACE.
6. Instructions to the patient
(a) Directions
The directions are normally written by the prescriber. These include
(i) The quantity to be taken
(ii) The frequency or timing of administration
(iii) The route of administration
(iv) Or the method of use
The phrases used are generally „to be taken‟, „to be given‟, or „to be used‟.
E.g. One tablet to be taken thrice daily after meal.
(b) Warning label:
For external use In case of external preparations like ointment, pastes, dusting powders
Only. Etc.
Drowsiness Warning: May cause drowsiness. Do not drive or operate machinery or
Warning. Car.
Potential (i) Drugs in which absorption improves if taken before food:
Interactions with Warning: To be taken an hour before meal or in empty stomach.
Food or drink (ii) Drugs causing gastrointestinal irritation
Warning: To be taken with or after meal.
(iii) In case of metronidazole Warning: Avoid alcoholic drink.
Interactions with Tetracycline complexes with calcium, iron, magnesium and inhibits its
Other medicine Absorption, Do not take milk, iron preparation or antacids with this
Medicine.
Special methods of (i) The drug formulation that is required to be dissolved in the mouth
Administration To be sucked or chewed.
(ii) Oral powders or granules are required to be dissolved in water
To be dissolved in water before taking.
(iii) Drugs causing gastro-intestinal irritation
To be taken with plenty of water.
Cautions (i) Preparation that may produce photosensitization
Avoid exposure of skin to direct sunlight.
(ii) The preparation that may produce unusual effect.
The preparation may color the urine or stool.
(iii) In case of inflammable preparation
Keep away from naked flame.

Special instructions to particular dosage form

Application For external use only.
Capsules Swallow with a draught of water.
Creams For external use only and Keep in a cool place.
Dusting powder For external use only.
Not to be applied to open wounds or weeping surfaces.
Ear drops For external use only.
Emulsions Shake the bottle before use.
Enemas For rectal use only and Warm to body temperature before use.
Eye drops To be used within 30days after first opening.
Gargles & mouthwashes Not to be swallowed in large amount.
Linctuses To be sipped and swallowed slowly without addition of water.
Liniments and lotions For external use only.
Shake the bottle before use.
Do not apply on broken skin. ( Because it will produce irritation)
Mixtures Shake well before use.
Nasal drops For nasal use only
Ointments, Pastes and For external use only.
Paints
Pessaries For vaginal use only
Suppositories For rectal use only and Store in a cool place.