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Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
Drug prescription
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Drug prescription

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  • 1. Art of Drug Prescription in Dentistry Iyad M. Abou Rabii Assistant professor, DDS.OMS. MSc. PhD
  • 2. Objectives 1- Perform a correct prescription writing and edit a good and comprehensive drug prescription 2- Identify Latin abbreviations, components of, and write prescriptions for use by a dentist. 3- Identify the major routes of drug administration. 4-Take decisions about medication use strategy (Delivery route, type, Dose). 5-Dtinguish between characteristics of brand name and generic name drugs.. 6-Understand the current evidence and promising practices related to utilizing these tools and systems. 7-Be aware of the challenges of Patient Safety in dental clinics linked with medication prescription, dispensation, administration and observance 8-Identify human Factors and ErrorsDescribe the Clark’s Rule and the Young’s Rule for calculating doses for children.
  • 3. Methods of administering drugs <ul><li>Drugs may be introduced into the body in several ways </li></ul><ul><li>Oral </li></ul><ul><li>Buccal </li></ul><ul><li>Topical </li></ul><ul><li>Parenteral </li></ul><ul><li>Inhalation </li></ul><ul><li>Rectal </li></ul><ul><li>Vaginal </li></ul>
  • 4. ORAL : ADVANTAGES <ul><li>Among the advantages of administering medication orally (as opposed to other methods) are the following: </li></ul><ul><li>· Oral medications are convenient. </li></ul><ul><li>· Oral medications are cheaper. </li></ul><ul><li>· Oral medications do not have to be pure or sterile. · A wide variety of oral dosage forms </li></ul>
  • 5. ORAL : DISADVANTAGES <ul><li>· Some patients may have difficulty swallowing tablets or capsules. </li></ul><ul><li>· Oral medications are often absorbed too slowly. </li></ul><ul><li>· Oral medications may be partially or completely destroyed by the digestive system </li></ul>
  • 6. Buccal <ul><li>Topical administration </li></ul><ul><li>Local administration </li></ul><ul><li>General administration </li></ul>
  • 7. BUCCAL : ADVANTAGES <ul><li>High local concentration of the drug </li></ul><ul><li>Less side effects </li></ul><ul><li>Les complications </li></ul><ul><li>More accepted by patient </li></ul><ul><li>Non-invasive alternative to parenteral way </li></ul>
  • 8. BUCCAL : DISADVANTAGES <ul><li>· salivary Flow </li></ul><ul><li>· Hurdling functions of the oral cavity. </li></ul><ul><li>· Unwanted drug swallowing </li></ul>
  • 9. PARENTERAL <ul><li>Intramuscular </li></ul><ul><li>Intravenous </li></ul><ul><li>Subcutaneous </li></ul><ul><li>Intrapulpal </li></ul><ul><li>Intradermal </li></ul><ul><li>Interseptal </li></ul><ul><li>intraosseous </li></ul>
  • 10. PARANTERAL : ADVANTAGES <ul><li>High local concentration of the drug </li></ul><ul><li>Less side effects </li></ul><ul><li>Les complications </li></ul><ul><li>More accepted by patient </li></ul><ul><li>Non-invasive alternative to parenteral way </li></ul>
  • 11. PARANTERAL : DISADVANTAGES <ul><li>· Some patients may have difficulty swallowing tablets or capsules. </li></ul><ul><li>· Oral medications are often absorbed too slowly. </li></ul><ul><li>· Oral medications may be partially or completely destroyed by the digestive system </li></ul>
  • 12. OTHERS <ul><li>· Rectal root is suitable when rapid drug effect is desired (Sodium Diclofenac) in case of pain. </li></ul><ul><li>· Inhalation is rarley used in Dental Clinic (Anesthesia on Ozone-induced). </li></ul><ul><li>· Vaginal rout is not used in dentistry </li></ul>
  • 13. Essential Components of Prescriptions <ul><li>All written prescriptions should contain: </li></ul><ul><li>Patient's full name and address </li></ul><ul><li>Prescriber's full name, address, telephone number, </li></ul><ul><li>Date of issuance </li></ul><ul><li>Signature of prescriber </li></ul><ul><li>Drug name, dose, dosage form, amount </li></ul><ul><li>Directions for use </li></ul><ul><li>Refill instructions </li></ul>
  • 14. Essential Components of Prescriptions
  • 15. Latin abbreviations <ul><li>Rx : abbreviation of the Latin word &quot;recipe” x as a substitute period. </li></ul><ul><li># ac (ante cibum) means &quot;before meals&quot; </li></ul><ul><li># bid (bis in die) means &quot;twice a day&quot; </li></ul><ul><li># gt (gutta) means &quot;drop&quot; </li></ul><ul><li># hs (hora somni) means &quot;at bedtime&quot; </li></ul>
  • 16. Latin abbreviations <ul><li># od (oculus dexter) means &quot;right eye&quot; </li></ul><ul><li># os (oculus sinister) means &quot;left eye&quot; </li></ul><ul><li># po (per os) means &quot;by mouth&quot; </li></ul><ul><li># pc (post cibum) means &quot;after meals&quot; </li></ul><ul><li># prn (pro re nata) means &quot;as needed&quot; </li></ul>
  • 17. Latin abbreviations <ul><li># q 3 h (quaque 3 hora) means &quot;every 3 hours&quot; </li></ul><ul><li># qd (quaque die) means &quot;every day&quot; </li></ul><ul><li># qid (quater in die) means &quot;4 times a day&quot; </li></ul><ul><li># Sig (signa) means &quot;write&quot; </li></ul><ul><li># tid (ter in die) means &quot;3 times a day&quot; </li></ul>
  • 18. Drug Types <ul><li>a) Schedule I </li></ul><ul><ul><li>Substances with no accepted medical use </li></ul></ul><ul><ul><ul><li>Examples: heroin, LSD, peyote, mescaline, psilocybin, THC, etc. </li></ul></ul></ul><ul><li>b) Schedule II </li></ul><ul><ul><li>Substances that have a high abuse potential with severe psychic or physical dependence liability </li></ul></ul><ul><ul><li>This list consists of certain narcotic, stimulant, and depressant drugs </li></ul></ul><ul><ul><ul><li>Examples: morphine, codeine, percodan </li></ul></ul></ul>
  • 19. Drug Types <ul><li>c) Schedule III </li></ul><ul><ul><li>Substances with abuse potential less than those in Schedule I and II </li></ul></ul><ul><ul><ul><li>Examples: preparations containing certain quantities of narcotics; derivatives of barbituric acid (barbiturates) except those listed in another schedule, par_egoric and others </li></ul></ul></ul><ul><li>d) Schedule IV </li></ul><ul><ul><li>Substances with an abuse potential less than those in Schedule III </li></ul></ul><ul><ul><ul><li>Examples: barbital, phenobarbital, chloral hydrate, meprobamate (Equannil, Miltown), diazepam (Valium), etc </li></ul></ul></ul>
  • 20. Drug Types <ul><li>e) Schedule V </li></ul><ul><ul><li>Substances with an abuse potential less than that of Schedule IV substances </li></ul></ul><ul><ul><li>Consist of certain preparations containing limited quantities of certain narcotic drugs generally for the antitussive and antidiarrheal purposes </li></ul></ul><ul><ul><li>In many states, these can sold OTC by a pharmacist and certain restrictions apply </li></ul></ul>
  • 21. Controlled Substance Prescriptions <ul><li>C-I Examples -- Heroin, Marihuana, LSD </li></ul><ul><li>C-II Examples -- Morphine, Methadone, Meperidine (Demerolâ), Codeine, Oxycodone, Mehthylphenidate (Ritalinâ) </li></ul><ul><li>C-III Examples -- Chlorphentermine, Paregoric, Nalorphine </li></ul><ul><li>C-IV Examples -- Choral hydrate, Phenteramine (Fastinâ), Diazepam (Valiumâ), Lorazepam (Ativanâ), Phenobarbital, Clonazepam (Klonopinâ) </li></ul><ul><li>C-V Examples -- Cough syrus with codeine, buprenorphine </li></ul>
  • 22. Controlled Substance Prescriptions <ul><li>Prescriber's Identification </li></ul><ul><li>Not refillable </li></ul><ul><li>Valid six months from issuance date </li></ul><ul><li>Must be signed by prescriber </li></ul><ul><li>May be faxed if original prescription is presented prio to dispensing </li></ul><ul><li>Pre-printed prescriptions are not valid </li></ul><ul><li>No phone in orders except for emergency dispensing </li></ul><ul><li>Dispensing for emergency situation: </li></ul><ul><li>a) Permits a verbal order from physician to pharmacist </li></ul><ul><li>b) Written prescription must be delivered to pharmacist within 72 hours </li></ul>
  • 23. Controlled Substance Prescriptions <ul><li>C-III-IV Prescriptions </li></ul><ul><ul><li>Refillable up to five times in a six month period </li></ul></ul><ul><ul><li>Valid twelve months from issuance date </li></ul></ul><ul><ul><li>May be faxed </li></ul></ul><ul><ul><li>May be given as verbal prescriptions </li></ul></ul><ul><ul><li>Pre-printed prescriptions are not valid </li></ul></ul>
  • 24. Controlled Substance Prescriptions <ul><li>C-V and Unscheduled Prescriptions </li></ul><ul><ul><li>Unlimited refills </li></ul></ul><ul><ul><li>Valid twelve months from issuance date </li></ul></ul><ul><ul><li>May be faxed </li></ul></ul><ul><ul><li>May be given as verbal prescriptions </li></ul></ul><ul><ul><li>Pre-printed prescriptions are valid (not true of C-V) </li></ul></ul>
  • 25. Errors of prescription writing Omissions a) DAW (Dispense as written) b) Refill quantity c) Dosage form d) Length of therapy/quantity e) Patient allergies f) Date g) Route h) Signiture i) Prescriber identification
  • 26. Errors of prescription writing Dose or Directions a) Dose significantly different from normal standards b) Error in dose c) Prescriptions for unavailable dosage forms/strengths d) Misleading, incomplete or confusing directions e) Take as directed f) PRN directions or refills g) Unclear dose based on a concentration h) Sustained release dosage forms
  • 27. Errors of prescription writing Legal Requirements a) Omissions of Prescriber identification b) Omissions of patient's address c) Prescriptions refills for C-IIs d) Partial fillings of C-IIs e) Generic prescribing for unavailable or inappropriate prescriptions
  • 28. Errors of prescription writing Quantity a) Unclear amount b) Odd amount c) Prescription for an amount that doesn't exist Duration of Therapy a) Prescriptions for a duration that is substantially different from normal standards b) Not specified
  • 29. Avoiding Prescription Errors <ul><li>How to avoid forged prescriptions </li></ul><ul><li>a) Keep all blank prescription pads in a safe place </li></ul><ul><li>b) Minimizing the number of prescription pads in use </li></ul><ul><li>c) Write in ink </li></ul><ul><li>d) Write out the amount prescribed in addition to the numerical number </li></ul><ul><li>e) Avoid large quantities </li></ul><ul><li>f) Only use prescription pads for prescriptions </li></ul><ul><li>g) Don't sign prescriptions in advance </li></ul><ul><li>h) Put only one prescription on a blank prescription form </li></ul>
  • 30. Avoiding Prescription Errors <ul><li>Controlled or Unscheduled Medications </li></ul><ul><li>a) Put the patient's diagnosis or the purpose of therapy on the prescription </li></ul><ul><li>b) Print </li></ul><ul><li>c) Include the patient's age and weight if relevant on the prescription </li></ul><ul><li>d) Use the metric system unless dealing with units </li></ul><ul><li>e) Avoid uncommon abbreviations </li></ul><ul><li>f) Be consistent </li></ul><ul><li>g) Sign your own prescriptions </li></ul><ul><li>h) Inform patient about medications </li></ul><ul><li>i) Never leave a decimal point naked </li></ul>
  • 31. Clark’s Rule <ul><li>Clark's Rule </li></ul><ul><li>Divide the child’s weight (in pounds) by 150 to get the approximate fraction of the adult dose to give to the child. </li></ul><ul><ul><ul><li>Example: For a 50 pound child give 50/150 (or 1/3) of the adult dose. Therefore, if the adult dose is 30 drops taken 3 times per day, the child’s dose will be 10 drops taken 3 times per day </li></ul></ul></ul><ul><ul><ul><li>(not 30 drops taken 1 time per day). </li></ul></ul></ul>
  • 32. Continuous Evaluation <ul><li>Case history, a 10-year-old schoolboy, was referred to your clinic, He had suffered from swollen chin due to a dental abscess. </li></ul><ul><li>You decided to give him antibiotic and medication to release pain. </li></ul><ul><li>Go online (Link to the website is available on the E-learning Center) and write your prescription. </li></ul><ul><li>You will get my feedback within one week. </li></ul>
  • 33. Thank You

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