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COLLEGE OF PHARMACY University of Bohol BSPh 304 Lesson 1 Prescription Analysis Objective At the end of this lesson, students are expected to:  Interpret and analyze various prescriptions and medication orders  Design and analyze appropriate dosing schedules  Solve and check a...

COLLEGE OF PHARMACY University of Bohol BSPh 304 Lesson 1 Prescription Analysis Objective At the end of this lesson, students are expected to:  Interpret and analyze various prescriptions and medication orders  Design and analyze appropriate dosing schedules  Solve and check appropriate dosage regimens deemed necessary for the medication order The Prescription is an order for medication issued by a physician, dentist, or other properly licensed medical practitioner designate a specific medication and dosage to be prepared by a pharmacist It is important to recognize two broad categories of prescriptions: - written for a single component or prefabricated product and not requiring compounding or admixture by the pharmacist - written for more than a single component and requiring compounding The Prescription are usually written on preprinted forms containing the traditional symbol "Rx" (meaning "recipe," "take thou," or "you take"), name, address, telephone number, and other information regarding the physician or other prescriber.  Prescriber information and signature  Patient information and signature  Date prescription was written  Rx symbol (Superscription)  Medication prescribed (Inscription)  Dispensing instructions to the Pharmacist (Subscription)  Directions to the patients (Signa)  Special Instructions The Prescription medication orders - are frequently received by the pharmacist by telephone or by direct communication. - the pharmacist immediately reduces the order to a properly written form or computer entry. in hospitals and other institutions, the forms are somewhat different and are referred to as medication orders. - typical medication order sheet is shown in figure The Prescription Prescriptions and medication orders written for infants, children, and sometimes the elderly may also include the age, weight, and/or body surface area (BSA) of the patient. - this information is sometimes necessary in calculating the appropriate medication dosage. Prescriptions should contain the chemical or nonproprietary (generic) name of the substance and may include manufacturer's brand or trademark name. Prescriptions requiring compounding contain the quantities of each ingredient required.  The Prescription The extemporaneous compounding of prescriptions is an activity for which pharmacists are uniquely qualified by virtue of their education, training, and experience. The Prescription: RA 6675 Additional Prescribing Guidelines Use generic names in all prescriptions The generic name must be written in full but the salt or chemical form may be abbreviated The generic name must be clearly written immediately after the Rx symbol or on the patient’s chart Inclusion of brand name is optional, must be written below the generic name and enclosed in a parenthesis Only 2 drugs per prescription is allowed. Pharmacist’s Responsibility to Prescription It is the responsibility of the pharmacist to ensure that each prescription and medication order received is correct in its form and content:  Prescriber information, including address and telephone number, Drug Enforcement Administration (DEA) number (for authority to prescribe schedule drugs including narcotics), and state license number and signature  Date of the order and its currency to request for the filling  Patient information, including dose relevant information, such as the age and/or weight of the patient  Drug prescribed, including dose, preparation strength, dosage form and quantity  Clarity of any abbreviations, symbols and/or units of measure  Clarity and completeness of directions for use by the patient or caregiver  Refill and/or generic substitution  Need for special labelling, such as expiration date, conditions for storage, and food an/or other medications not to take concomitantly Pharmacist’s Responsibility to Prescription Once the prescription is filled and the label is prepared, before dispensing, the pharmacist should make certain of the following: The filled prescription contains the correct drug, strength, dosage form and quantity. The label has the name of the correct patient and physician; the correct drug name, quantity and strength; the name or the initials of the pharmacist who filled the order; ad the number of refills remaining(if applicable) Additional label information and/or auxiliary labels may be required according to good pharmacy practice and by federal and state law depending on the drug dispensed Prescription Errors Violative Prescription Generic name is not written Generic name is not legible while the brand name is legibly written Brand name is written and a “no substitution” order is written Note: Do not fill a violative prescription, keep and report to DOH. Prescriber is advised of the problem and patient is instructed to get the proper prescription Prescription Errors Erroneous Prescription Brand name precedes generic name Generic name is the one in parenthesis Brand name is not in the parenthesis Note: Erroneous prescriptions can be filled, keep and report to DOH Prescription Errors Impossible Prescription Only the generic name is written but not legible Generic name and brand name do not match Generic name and brand name are not legible The drug prescribed is not registered with FDA Note: Do not fill impossible prescription, keep and report to DOH, prescriber is advised of the problem and patient is instructed to get the proper prescription. Medication Scheduling May be defined as the frequency (i.e. times per day) and duration (i.e. length of treatment) of a drug prescribed. Some medications, because of their physical, chemical and biological characteristics or their dosage formulations, maybe taken just once daily for optimum benefit, whereas other drug products must be taken two, three, four or more times daily for the desired effect. Medication Scheduling Frequency of medication scheduling is also influenced by the patient's physical condition and the nature and severity of the illness or condition being treated. - Indigestion: may require a single dose of medication for correction. - A systemic infection may require multiple daily, around-the-clock dosing for 10 days or more. - Long- term maintenance therapy for such conditions as diabetes and high blood pressure may require daily dosing for life. Dosing The usual dose refers to the amount that ordinarily produces the desired therapeutic response in the majority of patients in a general, or otherwise defined, population group. Since age, body weight, and body surface area are often factors in determining the dose for pediatric and elderly patients, these parameters represent the majority of calculations Dosing: Pediatric Pediatric is the branch of medicine that deals with disease in children from birth through adolescence Factors affecting Drug dosing in pediatric patient: - Patient’s age and weight - Overall health status - Condition of biologic functions (e.g. respiration and circulation) - The stage of development of body systems drug metabolism Dosing: Geriatric Special Considerations in Dose Determination for elderly patients frequently require consideration of some or all of the following: Therapy is often initiated with a lower-than- usual adult dose Dose adjustment may be required based on the therapeutic response The patient’s physical condition may determine the drug dose and the route of administration employed The dose maybe determined, in pat, on the patient’s weight, body surface area, health and disease status and pharmacokinetic factors Concomitant drug therapy may affect drug/ dose effectiveness A drug’s dose may produce undesired adverse effects and may affect patient compliance Complex dosage regimens of multiple drug therapy may affect patient compliance Dosing: Geriatric Patient Compliance Defined as patient understanding and adherence to the directions for use. Compliance includes taking medication at the desired strength, in the proper dosage form, at the appropriate time of day and night, at the desire strength, in the proper interval for the duration of the treatment, and with proper regard to food and drink and consideration of other concomitant medications and herbal remedies  Patient Compliance What is the compliance rate if the patient returned in 100 days for a refill? Answer: 90% % Compliance rate= 90 days X 100 100 days Patient Compliance Patient noncompliance is the failure to comply with a practitioner's or labeled direction in the self-administration of any medication. Noncompliance involved: - underdosage or overdosage - inconsistent or sporadic dosing - incorrect duration of treatment - drug abuse or misadventuring with medications Patient Compliance Factors that may lead to patient’s noncompliance: unclear or misunderstood directions undesired side effects of the drug that discourage use lack of patient confidence in the drug and/or prescriber discontinued use because the patient feels better or worse economic reasons based on the cost of the medication absence of patient counseling and understanding of the need for and means of compliance confusion over taking multiple medications Patient Compliance Consequences of noncompliance: worsening of the condition the requirement of additional and perhaps more expensive and extensive treatment methods or surgical procedures unnecessary hospitalization increased total health care cost Patient Compliance Techniques in Improving Patient’s Compliance  Emphasize key points.  Give reasons for key advice.  Give definite, concrete, explicit instructions  Provide key information at the beginning and end of the interaction.  End the encounter by giving patients the opportunity to provide feedback about what they learned. Conclusion  Proper analysis and interpretation of various prescriptions and medication orders by the Pharmacist are one of the vital steps in dispensing  Pharmacist should be keen in checking prescriptions inorder to avoid medication errors  Appropriate medication scheduling and dosing are essential in achieving compliance for the patients.  Patient compliance can be achieved through proper dispensing techniques by the Pharmacist  COLLEGE OF PHARMACY University of Bohol Transforming lives for a great future.