2. Prescription
• A prescription is an order issued by a physician, dentist or the other
properly licensed medical practitioner to a pharmacist giving
instructions regarding the dispensing of prescribed medicaments
• It is a part of professional relationship between prescriber, pharmacist
and patient
• Prescription designate a specific medication and dosage to a
particular patient
• Prescriptions are usually written on printed form called “Prescription
blank”
3. Types of Prescription
• Two broad, legal type of prescription
• Non-Prescription Drugs (OTC Drugs)
• Prescription drugs
• Branded name prescription drugs
• Generic prescription drugs
4. Parts of prescription
• Prescriber information
• The date
• Name, Age, Gender, Address of patient - Patient demographic
• Superscription
• Inscription
• Subscription
• Signa
• Refill information
• Signature of the prescriber
5. The date
• Prescriptions are dated at the same time as they are written or
ordered by the physicians
• Also it is dated when received and filled in the pharmacy
• The date is important for
• Establishing the medical record of the patient
• Helps the pharmacist to find the cases where old prescriptions are to
be repeated for a long time as in case of asthma
• It is also important in case of filling a narcotic prescription.
6. Name and address of the patient
• It is important to identify the patient correctly
• All names should be correctly spelled
• An address or telephone number are imp in case it become necessary
to contact the patient at a later time
• Age and gender of the patient become more imp in case of children
to check the dose of the medication
7. Superscription
• The Rx Symbol is heads the introduction to the prescribed
medications
• Rx is a latin verb “recipe” meaning “Take thou” or “you take”
• It is supposed to be the god of healing “Jupiter” for quick recovery
from illness
8. Inscriptions
• This part of prescription contains the name, strength and quantity of
medication to be prepared
• In case of complex prescription , inscription can be divided into four
parts like the active ingredient, additives, vehicles and any other
corrective measure to avoid possible incompatibilities
9. Subscription
• This section ma include any special instruction or diections to the
pharmacist about the method of preparation and dispensing
10. Signa
• This part usually contain the information for the patient i.e. how to
use and when to use the prescribed medication
• If prescriber needs any specific use , he will mention in this portion
11. Refill information
• It is important for the patient to know if their medication can be
refilled without returning to the prescriber
• If there is no refill then it is important to mention the word “No” or
“Nil”
12. Medication order
• Date & time
• Name of the drug
• Dosage form
• Route of administration
• Administration schedule
• Specifications
• Prescriber signature
• Provision for pharmacist or nurse
13. Processing of prescription order
• Receiving the prescription
• Reading and checking the prescription
• Numbering and dating the prescription
• Preparing or compounding and labeling the prescription, packaging
• Rechecking, delivering and counselling, recording and filing
• Pricing the prescription
14. Receiving the prescription
• It improves the pharmacist – patient relationship
• This helps pharmacist to collect complete data of health and
medication history of the patient
• If the pharmacist is unable to receive the prescription order
personally, he should be available to provide information regarding
refilling of prescription and to price it, if required by the patient
• A pharmacist should not give such facial expression to the patient
that he is surprised or confused
15. Reading and Checking the prescription
• No doubt as to the ingredients or quantities prescribed, units of
weights and measure, quantity to be supplied and direction for use
• Checking of compatibility and interactions i.e. Drug-Drug and Drug-
Food interactions
• Checking of dose prescribed according to age, gender
• In case of any compatibility, Pharmacist should consider the
alternative and ask the prescriber for best therapeutic alternative
• If some error is found, pharmacist can consult another pharmacist or
prescriber
16. Reading and Checking the prescription
• No guess about the meaning of any indistinct or unrecognizable
abbreviation
• Unfamiliar or unclear abbreviations can be a source of error – clear
them by the prescriber
• Care for Look-alike and Sound-alike brands
• Omission of dosage form, strength and quantity must be addressed
and corrected with consultation of prescriber
• The amount and frequency of the dose must be noted carefully
17. Reading and Checking the prescription
• To avoid error in administration of accurate quantity of the drug a
calibrated spoon may be given along with the prescription
• Reference guides for the appropriate reading and checking the
prescription include
Physcian’s Desk reference
Drugs Today
American Hospital Formulary System
Pediatric Dosage Handbook
Drug Facts and comparisons
www.drug.com
18. Numbering and dating
• Number the prescription and place same number on the label
• Consecutive numbers are assigned by the computer generated
software's or manually
• Numbering is helpful in identification of bottle or package
• Numbering is helpful in the refill and track of the prescription, if it is
lost
• Date is helpful in finding out the number of refill
• It indicate the patient compliance, appropriate patient refill frequency
19. Preparing the prescriptions
• After receiving the prescription, decide whether to dispense simply or
it needs compounding
• Dispensing is giving prefabricated dosage form to the patient as per
need – at most of the pharmacies
• Pharmacist should check the manufacturer label, compare it with the
prescriptions before and after filling the prescriptions
20. Preparing the prescriptions
• For compounding, these must be checked
The chemical and physical compatibility of the ingredients
The proper order of mixing
Need for special adjuvants or techniques
Mathematical calculations
• Compounding must be accurate and precise
• Quantity of adjuvant use, order of mixing, capsule size and all related
information must be recorded
21. Labelling
• Labelling must be appropriate, readable and accurate
• Following must be a part of a good label
• Identification of the product – Brand or Generic name
• Patient information
• Therapeutic indications
• Instructions for use
• Date of dispensing and Pharmacist information
• Storage – Temperature, Humidity, Light
22. Labelling
• Instructions to the patients
Directions – simple and without any confusion
Shake the bottle before use – for liquid formulations
Take with water – for those ingredients which cause gastric
irritation
23. Cautionary labels
Drug Category Precaution
Schedule G Drugs
(Hormonal Preparation)
It is dangerous to tale this preparation except under medical
supervision
Schedule H Drugs
(POM)
Sold on the prescription of registered medical practitioner only
Symbol Rx is prominently placed on the label
Symbol NRx is placed if drug is narcotic
Schedule X Drugs
(teratogenic and high
potential for abuse)
All regulation of Schedule H
Symbol XRx is placed
Ophthalmic Preparation Use within one month of opening
Name and concentration of the preservative
Do not touch the dropper tip
24. Warnings
• Special warning signs should be the part of the label, if needed
• These are for the special conditions that need to be sure before or
after taking the drug
• May cause drowsiness, do not drive after taking medication
• To be taken hour before food or empty stomach
• To be taken with or after food
• Avoid use of alcohol with medication – for interacting drugs
with alcohol
25. Auxiliary Labels
• It is used to emphasized an
important aspect of the dispensed
medication
• Should be placed in conspicuous
spot on the prescription container
• For example “For external use
only”, “For use in ear only” are for
proper use of medication
26. Package Inserts
• A document provided along with a prescription medicine to provide
additional information
• It follows a standard format for every medication
• It usually contain information about clinical pharmacology, indication
and usage, contraindications, warnings, precautions, adverse
reactions, drug abuse and dependences, overdosage and how
supplied
27. Packaging
• Different packaging containers are available
• Round bottles, dropper bottles, applicator bottles, ointment jars,
collapsible tubes, sifter top container, hinged lid, slide box, aerosol
container
28. Packaging
Preparation Container Important auxiliary Label
Capsules, Tablets Amber tablet bottle with CRC Swallow with draught of
water
Creams, Gels, Pastes,
Ointments
Amber glass jar, collapsible
tube
For external use only
Enemas Amber glass bottle, plastic
bottle
For rectal use only
Suspension and
emulsion
Amber glass bottle Shake well before use
Suppositories Wrapped in foil and packed in
glass jar
For rectal use only
Store at cool place
29. Pricing the prescription
• Prescription is priced according to the price of the ingredients plus
usual pharmacy profit
• In case of dispensing of pre-fabricated dosage forms – Price is
mentioned on the packing including all usual allowance
30. Rechecking
• After preparation, packing and labeling, it must need to be rechecked
• This must be done by the qualified pharmacist
• Every prescription, ingredients amount must need to be rechecked
and verified
• All details on the label must be according prescription order
• Patient name, age, gender, date also need to be re-varified
31. Delivering the prescription
• Pharmacist should personally present the medication to patient
• Pharmacist also should call attention to the auxiliary label, if any
• Must need to be verified that patient has understand the label
properly
• If medication are to be delivered to patient address then pharmacist
must ensure that all necessary information should reach to the
patient
• Patient is encouraged to call pharmacy in any confusion and need
32. Patient counselling
• Communication – Comprehension – Compliance
• Unless counsel – most patient did not take medication properly
• Remove any barrier to good communication
• Be good listener, and use open-ended questions
• Select only few key counselling points
• Verify that patient understand what they need to be known
• Stress about how important is to take medication and what may
happen if the patient did not take the medication properly
33. Recording and filing
• Record is maintained through
• Computer generated software
• Hard copy prescription file
34. Prescription refilling
• Refilling information is provided by the prescriber either in
prescription order or verbal
• All non-controlled prescription have no limitation on refilling
• No prescription should be renewed indefinitely without re-evaluation
• No refill for controlled substance
35. Errors in prescription
• Improper diagnosis – malpractice
• Ordering a medication for patient with known allergies
• Current medication may react with the previous medication
• People with current medical complications – Liver and Kidney
diseases
• Wrong medication and wrong dose
36. Preventing prescription errors
• Reduction of complexity in the act of prescribing by the introductiom
of automation
• Improved prescribers knowledge by education and online resources
• Feedback control system and monitoring of the effects of
interventions
37. Legal and Ethical aspects
• The legal aspects of handling a prescription are incorporated in both
State and Federal law
38. Narcotic prescription
• Prescription for narcotic drugs conatin some additional information
such as
• Name, address and registration number of Pharmacy
• Name, address and registration number of Prescriber
• Name, address of the patient
• Date of issue
39. Categories of Narcotic Drugs
• Categorized according to degree of addiction
• Class – A Narcotic:
• Includes pure form of the drug like Morphine, Mepridine and other Opium
and Coca derivative
• Can only be dispensed upon written prescription of registered medical
practitioner
• Copy of it must retain by the pharmacist after dispensing
40. Categories of Narcotic Drugs
• Class – B narcotics:
• Thee include the class A narcotic substances dispensed in combination with
other non-narcotic substances
• Amount of narcotic drug should not exceed fro certain specified limit
• These narcotic may be dispensed on the oral order of the registered medical
prescriber
41. Categories of Narcotic Drugs
• Class – X narcotics:
• Includes those preparation that contain less then specified amount of narcotic
drug per fluid once
• May be dispensed without the prescription
• Class – M narcotics:
• Includes those preparation that contain little or no additive liabiity
• May be dispensed without the prescription
42. Narcotic “Don’ts” for the Pharmacist
• Don't leave the prescription pads exposed and caution the doctor
about your supply of narcotic substance
• Don’t leave narcotic drug exposed near wraping counter
• Don’t accept the prescription order written with lead pencil. It is not
valid order even when written by a qualified physician
• Don’t carry a large stock of narcotic substances only three month
supply is good practice
• Don’t leave the key inserted in the lock of your narcotic cabinet. Keep
cabinet lock
43. Narcotic “Don’ts” for the Pharmacist
• Don't place your narcotic stock where it is accessible to other. Avoid
storage near sink or toilet
• Don’t become rattled by a rush request of the narcotic prescription
• Don’t be taken in by the person wearing a white uniform of nurses or
white coat of doctors
• Don’t fill telephone order for narcotic until you are assured that the
prescription will be available upon delivery
• Don’t fill prescription for unusual quantities of narcotic substances
unless checked by a physician
44. Narcotic “Don’ts” for the Pharmacist
• Don't refill narcotic prescription without getting a new prescription
• Don’t hesitate to call the physician about a narcotic prescription you
may be questioning
• Don’t dispense any exempt narcotic without keeping the record
• Don’t violate the law to accommodate others or for the business
expediency
• Don’t hesitate to call the burear of narcotics to get or give
information
