PH-PSC 211 Dispensing 1 Midterms PDF

___________________________________________________________________________________________________________ PH-PSC 211: DISPENSING 1 II. RECEIVING, REVIEWING, AND VALIDATING THE MODULE 4: PRESCRIPTIONS AND MEDICATION PRESCR...

___________________________________________________________________________________________________________ PH-PSC 211: DISPENSING 1 II. RECEIVING, REVIEWING, AND VALIDATING THE MODULE 4: PRESCRIPTIONS AND MEDICATION PRESCRIPTION ORDERS a. Receiving and Screening the Prescription OUTLINE When a customer/patient comes in, the 1. THE DISPENSING PROCESS 2. RECEIVING, REVIEWING, AND VALIDATING pharmacy/pharmacy assistant (PA) checks their 5 THE PRESCRIPTION particular needs—usually by presenting the -2 a. Receiving and Screening the Prescription b. Steps to Perform upon Receiving and prescription to the pharmacy/PA. Screening the Prescription 24 3. PARTS OF THE PRESCRIPTION b. Steps to Perform upon Receiving and Screening the a. Prescription Prescription b. Parts of the Prescription 4. GENERIC PRESCRIBING a. Generics Act of 1988 1. Verify the identity of the patient/representative ee b. AO No. 62 s. 1989 Usually starts by saying a generic line/script to say c. Generic Prescribing in greeting the customer 5. PRESCRIBING DANGEROUS DRUGS 6. REVIEWING AND EVALUATING THE Greeting includes getting their name. itt PRESCRIPTION Verifying their identity Determining whether the one who is buying I. THE DISPENSING PROCESS m the medicine is the actual patient or just a representative. om Covers all the activities involved in dispensing Sum of processes that includes: 2. Enter/update patient data in the database (if applicable) 1. Receiving and validating prescription Only applicable if the pharmacy uses a particular 2. Filling database C 3. Packaging and Labeling Includes getting the customer’s basic details 4. Rechecking If the customer has an existing record in the s 5. Dispensing pharmacy (old customer), only the name is 6. Recording and Filing ic needed. 7. Providing Medication Advice or Patient If a new customer, a new entry in the Counseling m database is needed. Considered as a cycle because the same, consistent set of steps is performed for every customer or de 3. Identify and categorize patient need prescription encountered. Patients/customers come into the pharmacy for Consistent repeated use of a good different reasons, so it is important to determine what ca dispensing procedure is vital in ensuring their particular need is: that errors do not occur; if they occur, they Over-the-counter medication can be immediately detected and corrected ➔ Customers do not need to present a A at the stages of the dispensing process. prescription; they only ask for a Consistency in the dispensing process recommendation of an OTC ensures safe medication use for the product they can use to alleviate patients. the symptoms. Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 1 ___________________________________________________________________________________________________________ New prescription ➔ Pharmacists have a priority list ➔ Patients with a prescription may based on the orders s/he currently give the pharmacy/PA a new has. prescription (a new medication) Ensures that the most that has not been filled before; thus, critical (time-sensitive) it includes slightly different steps orders will be processed 5 in dispensing. first. -2 Maintenance medication ➔ Includes patients who are already 4. Ask for additional documents/ information as needed 24 highly familiar with their drugs IDs, senior citizen/PWD booklet, authorization and have an established routine Must be asked from the customers early on for taking their medication. the dispensing process. ee Compounded prescription If they lack the required documentation, the ➔ Includes prescription that requires a dispensing process might not proceed. compounding step itt Dangerous drugs, regulated, and 5. Review the prescription for: controlled substances Completeness ➔ There procedure is a slightly in m different dispensing Different from validity Looks at the presence of all the required om dangerous drug prescriptions. information in a prescription STAT orders (in the hospital setting) Validity ➔ “STAT” is an abbreviation of the Look at the compliance—is the prescription Latin term “statin”, meaning compliant with the current legal C “immediately”. requirements? “ASAP”, “start ➔ Compliance to generic prescribing s immediately”, and “now” ➔ Dangerous drugs/preparation can also be used to ic (1) SAMPLE SCENARIO indicate an urgent need for A patient enters the pharmacy and goes straight to medication. m the pharmacy counter saying: “Hello, may gamot ➔ In the inpatient setting, different ba kayo para sa sakit ng lalamunan?” prescriptions may require de Based on the information provided, the different urgencies. category of the patient's need is ➔ Includes prioritizing drug orders Over-The-Counter medication. ca Prioritizing orders → Not all patients who come into the comparing the urgency of pharmacy have a prescription; some of a new order with the them might not have sought a physician’s A urgency of all the orders consultation yet, rather only asking for that require the the pharmacist’s recommendation to pharmacist’s attention. help alleviate the symptoms they are experiencing. Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 2 ___________________________________________________________________________________________________________ III. PARTS OF THE PRESCRIPTION a. Prescription PRESCRIPTION Serves as a means of communication for the 5 prescriber to give instructions to the dispenser of the medication or to those who will be administering -2 the medication. For this communication to be effective, the 24 prescription needs to contain complete Figure 1. Prescription (left) vs. Medication order (right). information regarding the patient, prescriber, Prescription and medication order may have slight differences in terms and the medication/s ordered. of appearance and parts, but they serve the same purpose. ee According to AO No. 62 s. 1989: Rules and Regulations to Implement Prescribing b. Parts of the Prescription Requirements under the Generics Act of 1988, a itt 1. Prescriber Information prescription is "the written order and instruction of a validly-registered physician, dentist, or veterinarian for the use of a specific drug product for a specific patient". m om "The doctor's orders on the patient's chart for the use of specific drug(s) shall be considered a prescription." This is also known as medication order. Medication order is a written request of a C physician on an order form or given verbally in an inpatient setting. s Can be a physician, dentist, or veterinarian Must be clearly stated ic Prescription Medication Order Includes the following: Full name Office address m Used in the Used in the outpatient setting, inpatient setting, Contact details such as community such as hospitals, ➔ Full name, office address, and contact details are usually found at de pharmacies. clinics, and other healthcare facilities the top part of the prescription. where the patient is ➔ However, the name might not confined. always be at the top, only the ca clinic, office address, and contact Both serve the same purpose–to serve as a details. means of communication for the prescriber to ➔ If the name of the prescriber is not communicate his/her instructions to the written at the top part, it must be A dispenser, to the nurse who administers the written at the lower portion. medication, and to the patient. Signature Professional registration number/license number ➔ To determine that the prescriber is validly licensed and authorized to prescribe Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 3 ___________________________________________________________________________________________________________ Body surface area (for pediatric patients) ➔ Must pass licensure exams to have ➔ Especially for pediatric patients; 12 y/o and their PRC license below Professional tax receipt (PTR) number ➔ For dosage calculation ➔ Number issues to the prescriber as proof that they are paying 3. Date their professional taxes in the local government ➔ Certain prescribers may be 5 exempted for this: "exempted" is written or simply blank -2 ➔ Those prescribers who work for the government are exempted from paying the tax 24 S2 License number (for dangerous drugs) ➔ May not be present in all prescriptions, only for dangerous drugs ee ➔ Philippine Drug Enforcement Agency (PDEA) is the government Usually located at the upper right side of the agency that issues this license. prescription ➔ A special permit/authorization for Prescriptions are dated at the time they are written itt the prescriber to prescribe a Important in establishing the medication record of the dangerous drug patient especially for controlled substances ➔ S-2 license for prescriber; S-3 Determines the validity of the prescription wholesaler m license for retailer; S-4 license for Must never be tampered By convention, a prescription is valid up to 1 month but does not apply to all cases. om 2. Patient Information Applicable to maintenance medication ➔ If the prescriber issues a 1-month supply of maintenance medication, then the prescription is valid within 1 month. C Not applicable to antibiotics ➔ Antibiotics are usually taken for 7 days; meaning, the prescription is s valid only for 7 days. ic 4. Superscription m Full name de Address Contact details Age Sex ca Weight ➔ Especially for pediatric patients; 12 y/o and below A ➔ For dosage calculation Height Rx symbol on the upper left side ➔ Especially for pediatric patients; 12 y/o and From Latin verb "recipe" or "recipere" meaning below "take thou" or "you take" ➔ For dosage calculation Also believed to be originated from the Eye of Horus, an ancient Egyptian symbol associated with healing powers Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 4 ___________________________________________________________________________________________________________ 5. Inscription Labeling (information to be placed on the label) Loose forms Dispensing quantity, dosage forms 7. Transcription/Signa (Directions to Patient) 5 -2 24 Medication prescribed Body or main part of a prescription order ee Contains: Medication(s), or ingredients prescribed (for compounding) Generic name and brand name (if any) itt Dosage form Signa/Signatura or Directions to the Patient ➔ Tablets, capsules, syrup, etc. “you mark” Potency or dosage strength Instructions given to the patient include: ➔ In g, mg, mcg, etc. m Quantity of the prescribed ingredients and drugs Number of dosage units per dose (e.g., 1 tab) Route of administration om Administrative Order (AO) No. 90 series of 1990 Frequency of dosing permits the writing of more than 1 drug product in Duration of dosing, and 1 prescription Use of the drug (optional) Revised certain sections of AO No. 62 s. Usually written in abbreviated form of English or Latin 1989: Rules and Regulations to terms C Implement Prescribing Requirements, Must be reinforced and repeated to the patient specifically the part where it prohibited through patient counseling writing more than 1 product per (2) SAMPLE SCENARIO s prescription ic 6. Subscription (Dispensing Directions) m de ca A Directions to the pharmacist for preparing the prescription A. Prescriber information Used for: B. Superscription (supeRx) Preparations (such as compounding) Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 5 ___________________________________________________________________________________________________________ C. Inscription c. Generic Prescribing D. Transcription (Translate); "#21" serves as part of the Subscription or the number of dosage units to GENERIC PRESCRIBING The generic name must be written in full. be dispensed; "patient information" was written; Not abbreviated however, "address" of the patient was failed to be Salt/chemical form may be abbreviated. Ex. Metformin HCl included For drugs with 2 or more AI, the generic name as 5 determined by FDA shall be used. Ex. Co-amoxiclav (Augmentin) is an -2 IV. GENERIC PRESCRIBING FDA-recognized generic name for the combination of Amoxicillin and Clavulanic a. Generics Act of 1988 acid. 24 Generic names must be written after the Rx symbol GENERICS ACT OF 1988 Brand name may be indicated in addition to the generic name Enclosed in parenthesis ee Written below the generic name (prescription) Written after the generic name (medication Generics Act of 1988 promotes, encourages and order itt requires the use of generic terminology in the prescription and dispensing of drugs VIOLATIONS TO GENERIC PRESCRIBING All government health agencies and personnel m All medical, dental, & veterinary practitioners shall write prescriptions using the generic Erroneous 1. Brand name Violative 1. Generic name Impossible 1. Only generic om name. The brand name may be included if precedes generic is not written name is written desired. name 2. Generic name but not legible 2. Generic name is not legible; 2. Generic name b. AO No. 62 s. 1989 is in parenthesis brand name is does not 3. Brand name is legible correspond to the C AO NO. 62 S. 1989 not in parenthesis 3. Brand name is brand name indicated and 3. Both generic instructions added name and brand (“no substitution”) name are not s legible ic 4. Drug prescribed is not FDA registered m More specific regulation that details requirements for prescribers - Filled - Not Filled - Kept and - Kept and reported to DOH/FDA Gives the definition of generic name and brand name reported to - Advise prescriber of problem de DOH/FDA Generic Name Brand Name In case the generic name is not legible, look for other ca Scientifically and Proprietary name information indicated in the prescription or best to internationally given by the contact the prescriber. recognized name manufacturer to of the active distinguish its However, there are Sound-Alike Look-Alike Drugs (SALADs) that can cause medication A ingredient(s), as product from those approved by the of competitors errors. In such cases, tallman lettering is FDA. Differs from country used. Different countries to country, or one ➔ Ex. clonazePAM – LORazepam use the same institution to generic name for a another. particular API. Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 6 ___________________________________________________________________________________________________________ (3) SAMPLE SCENARIO expired, and has a generic name that is illegible, whereas the brand name is legible (violative). [Example 1] [Example 4] 5 -2 24 Incorrect-erroneous prescription Incorrect-impossible prescription ee The brand name precedes the generic name. Only the generic name is written, but it is not legible. [Example 2] itt [Example 5] m om C Incorrect-violative prescription Incorrect-erroneous prescription s “no substitution" instruction prevents proper generic The brand name precedes the generic name. The dispensing ic generic name is in the parentheses, instead of the brand name. [Example 3] m [Example 6] de ca A Incorrect-violative prescription Incorrect-impossible prescription The prescription lacks prescriber information Both the generic name and the brand name are not (name, address, and contact details), is already legible Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 7 ___________________________________________________________________________________________________________ V. PRESCRIBING DANGEROUS DRUGS There should be only 1 dangerous drug preparation in 1 single prescription form AO NO. 62 S. 1989 Partial filling is allowed For DD, the pharmacist should dispense the full quantity prescribed, unless: 1) the required quantity is not available, and 2) budgetary constraints 5 Defines Dangerous Drugs Dangerous Drugs – Prohibited Drugs or Strictly no refill -2 Regulated Drugs which require a special Prescription cannot be reused to purchase a prescription (List A1) new set of medications. ➔ List A1 – DD (Dangerous Drugs) If the prescription has been fully filled, the 24 ➔ List A2 – CC (Controlled pharmacist must mark the prescription with Chemicals) the statement: ➔ “USED IN FULL” YELLOW PRESCRIPTION ➔ In bold letters across the original Official prescription form used for dangerous drugs ee copy of the prescription Issued by the PDEA and distributed through DOH ➔ Must be signed and dated Issued in triplicate copy: If the prescription is only partially filled, it 1. Original (yellow) – pharmacist has to be marked with the statement: itt 2. Duplicate – patient ➔ “USED FOR __ ONLY” To verify if the buyer is the actual ➔ Blank refers to the no. of units or patient dosage that is left (Ex. “USED 3. Triplicate – physician Only released in regulated quantities m Each prescriber can only get a maximum of 10 prescription pads FOR FIVE (5) TABLETS ONLY) ➔ Must be signed and dated om Prescription shall be retained for a period of 1 year Cannot be reprinted by the prescribers Pharmacists must keep the original copy Issued only by the DOH of the dangerous drug prescription. Given to prescribers who have S-2 license Shall contain the following information: C 1. Prescriber information Prescription form for Dangerous Drug Full name, complete business address, telephone number/ email, S-2 license number and validity, s PTR number 2. Patient information ic Full name, age, complete address (required; since DD are highly m regulated and for proper tracing if ever there are suspicious incidents/ incidents that require investigation de by the PDEA) 3. Date 4. Generic and brand name of the preparation to be supplied ca For yellow prescriptions, the brand name is usually seen along with the generic name. 5. Dosage strength, form, and total number A of dosage units/ quantity to be supplied This is an example of a complete and correct in words and its Roman numerical prescription form for DD. equivalent The category of Morphine is Philippine Schedule II. 6. Direction of use 7. “No refill” Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 8 ___________________________________________________________________________________________________________ PHILIPPINE Generic Names Requirement Philippine Schedule V Ephedrine Oral dosage SCHEDULES of Ketamine forms can be FDA-registered - Has a currently Nalbuphine prescribed drug accepted medical use using ordinary preparations in treatment in the Rx (triplicate) Philippines; has Philippine Schedule I No legally N/A potential for abuse that Parenteral registered product may lead to from low to dosage forms 5 - Has no currently high psychological or will require accepted medical use (Drugs that are physical dependence. special -2 in treatment in the illegal to prescription Philippines. distribute/possess) - Dangerous Drugs in form (triplicate) - Has a lack of the Philippines only 24 accepted safety for use of the drug under medical supervision. CONTROLLED Generic Names of Requirement Philippine Schedule II Fentanyl Special CHEMICALS FDA-registered drug ee Morphine prescription preparations - May have currently Oxycodone form (triplicate) accepted medical use Pethidine List A2 Ergometrine/ Ordinary Rx in treatment in the Methylphenidate Ergonovine (triplicate) itt Philippines. Remifentanil Ergotamine - Has high potential for Norephedrine/ abuse that may lead to Phenylpropanolamine severe psychological or dependence. physical m Example of S-2 License ID om Philippine Schedule III Buprenorphine* Special Pentobarbital prescription - Has a currently form (triplicate) accepted medical use in required treatment in the C Philippines *Exempt from - Has a potential for special abuse less than the prescription s drugs in Schedules I form; to be and II that may lead to prescribed This is issued by the PDEA; only physicians, dentists, ic moderate or low using ordinary or veterinarians can have this license. S-2 license physical dependence or Rx (triplicate) number follows a format: 5 numbers for the high psychological m dependence. permanent number, followed by a letter (N/R/E), followed by another letter indicating the specialty of Philippine Schedule IV Alprazolam Oral dosage the prescriber (M/D/V), followed by a 2-digit number de Bromazepam forms can be for the year when it was issued, then another 3-digit - Has a currently Clonazepam prescribed number corresponding to the region where it was accepted medical use in Clorazepate using ordinary paid, and L# corresponding to the reported losses of treatment in the Diazepam Rx (triplicate) the ID. ca Philippines; has a low Midazolam The format tells the validity of the S-2 license. potential for abuse less Phenobarbital Parenteral than the drugs in Phentermine dosage forms Schedule III that may Zolpidem will require REMINDER: A lead to limited physical special dependence or prescription Not all dangerous drugs need to be prescribed psychological form (triplicate) using the Special Prescription Form. Schedule IV dependence and V can be prescribed in ordinary Rx but must still be in triplicate copies. Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 9 ___________________________________________________________________________________________________________ VI. REVIEWING AND EVALUATING THE PRESCRIPTION If the drug prescribed is out-of-stock: Stock-out – a situation wherein the prescribed The person receiving the prescription should check medication is not available at the pharmacy where the for: prescription is being processed; temporarily Route, frequency, dose, dosage form, out-of-stock or does not really keep stock of that duration particular medicine. Drug interactions, medicine duplication, polypharmacy, inappropriate drug If the medicine cannot be substituted with another 5 therapy, contraindications medicine that is available, inform the patient. Allergies There are instances that medicines can have -2 Unusual usage and suspected drug generic substitution; for generic equivalence, misuse or abuse substitution is allowed. 24 For partial medicine supply, ensure that the subsequent supply does not exceed the quantity If the patient agrees for medicine to be supplied at for the duration prescribed a later time, arrange to get stocks so as to enable The remaining balance of the medication in prompt supply to the patient. partial filling should only be enough to Option 1: Ask the patients if they are willing ee complete the duration of the medication to return to the pharmacy and wait for the used. stocks Option 2: Refer the patients to a different If the prescription requires clarification: pharmacy itt Attempt to contact the prescriber Must have a database of prescribers in the If patient requires the medicine urgently, discuss community; if none, refer to the prescription with the prescriber if medicine can be substituted for the contact details m If the prescriber can be contacted, arrange for the with another medicine which is readily available If urgent and no stocks even in other pharmacies, discuss with the prescriber if an om incomplete/ missing details to be inserted on the alternative medication can be given. prescription by the prescriber Therapeutic substitution – substituting one If there are any remedial actions needed for medicine for a completely different medicine; the prescription, discuss it first with the different generic names prescriber prior to sending it back to him/her C Any therapeutic substitution of medicine must be If the prescriber is not available to amend the approved by the prescriber and documented on prescription himself/herself, authorization to the prescription s make the change may be obtained verbally through the phone ic General reminder: This will be the midterms reviewer Amendments should be documented on the released for the subject of Dispensing 1. prescription and endorsed with “Prescriber m Contacted”, dated and signed by the pharmacist. Does not mean making a new prescription, de only making adjustments on behalf of the prescriber If the prescriber cannot be contacted, the patient ca should be informed, and the prescription should be sent back to the prescriber with information of the clarification/action needed. Patients are expected to be confused and A get upset, so explain the situation to them and endorse them the instructions to be relayed to the prescriber. Prepared by: AA Giron Updated by: Quijano, PRA Reviewed by: Adan, AMG 4ADM-XWTT-L6XD-VXJU 10