The document provides guidance on rational prescription writing, including introducing the concept of "P-drugs" or personal first-choice drugs, outlining the steps in prescription writing, common abbreviations, and important instructions and information to provide to patients. It also discusses medication errors and how electronic prescribing can help reduce errors by suggesting alternative drugs. The overall goal is to teach students how to properly treat patients through skillful prescribing rather than just knowledge of drugs.

2. Rational prescription writing
By
M. H. Farjoo , M.D. , Ph.D. , Bioanimator
Shahid Beheshti University of Medical Sciences

3. Rational prescription writing
 Introduction
 P-drugs
 Steps in Prescription writing
 Information & instructions for the Patient
 Common Abbreviations
 Common Measures and Clark's rule
 A deadly Weapon
 Do Not Use List
 Electronic Prescribing

4. Introduction
 Pharmacotherapy teaching is NOT the transfer of
knowledge about drugs, but the skill to treat patients.
 The students should be taught how to prescribe, not
what.
 Irrational prescribing is a “disease” which is difficult
to treat
 Prescribing is not a knee-jerk reflex, a recipe from a
'cook-book', or a response to commercial pressure.

7. Introduction
 A survey in Iran in 1393 showed 20% of all the
medical errors were pharmaceutical as below:
 39% prescription errors by physicians
 38% administration errors by nurses
 12% pharmacists and prescription fillers errors
 11% hospital staff errors while transferring physician order
to the nursing files

9. http://www.fda.gov.ir/
‫پزشکی‬ ‫مات‬‫و‬‫ملز‬ ‫و‬ ‫ات‬‫ز‬‫تجهی‬ ،‫یی‬‫و‬‫دار‬ ‫ض‬‫ر‬‫عوا‬ ‫ش‬‫ر‬‫ا‬‫ز‬‫گ‬‫ثبت‬ ‫سامانه‬

10. Introduction
 1.3 million people are injured and 7000 deaths occur each
year in the U.S from medication-related errors.
 Drug-related morbidity and mortality cost $177 billion in
the U.S.
 If there are 800,000 physicians in the United States, each
physician accounts for more than $220,000!
 What is a Medication Error? A medication error is any
preventable event…
 It is not important what is the rest of the definition!
 The important point is: it is preventable!

13. • www.ismp.org
(institute for safe medication practice)
• www.nccmerp.org
(National Coordinating council for medication Error
Reporting and prevention)
• www.who-umc.org
• www.fda.gov/medwatch
• http://www.fda.gov.ir/
• Journal of risk & safety in medicine
• Text book of medication Errors Edited by Michael R
Cohen.
How To Keep Up-To-Date

14. www.ismp.org

15. www.nccmerp.org

16. www.who-umc.org

17. www.fda.gov/medwatch

18. http://www.medscape.com/

20. Martindale 2017

23. IDL

26. P-drugs
 A physician should develop a standard treatment for
common disorders, resulting in a set of first-choice drugs,
called p(ersonal)-drugs.
 Efficacy is the first criterion for selection.
 Look for groups of drugs rather than individual drugs.
 The patient should be able to administer the drug alone.
 Drugs for elderly and children should be in convenient
dosage forms.
 Consider cost of treatment.

27. Steps in Prescription writing
1. Make a specific diagnosis.
2. Consider the pathophysiologic implications of the
diagnosis.
3. Select a specific therapeutic objective.
4. Select a drug of choice.
5. Determine the appropriate dosing regimen: Strength,
Amount, Route, Frequency, Refills
6. Devise a plan for monitoring the drug’s action and
determine an end point for therapy.
7. Plan a program of patient education.

28. Hi there!
Pleas! Write
legible
God damn it!
Write legible!

33. Information & instructions for the Patient
 Effects of the drug
 Why the drug is needed
 Which symptoms will disappear, and which will not
 When the effect is expected to start
 What will happen if the drug is taken incorrectly or not at
all
 Side effects
 Which side effects may occur
 How to recognize them
 How long they will continue
 How serious they are
 What action to take

34. Information & instructions for the Patient
 Instructions
 How the drug should be taken
 When it should be taken
 How long the treatment should continue
 How the drug should be stored
 What to do with left-over drugs
 Warnings
 When the drug should not be taken
 What is the maximum dose
 Why the full treatment course should be taken

35. Information & instructions for the Patient
 Future consultations
 When to come back (or not)
 In what circumstances to come earlier
 What information the doctor will need at the next
appointment
 Everything clear?
 Ask the patient whether everything is understood
 Ask the patient to repeat the most important information
 Ask whether the patient has any more questions

36. Information & instructions for the Patient
 Monitor (and stop?) the treatment
 Passive monitoring:
you explain to the patient what to do if the
treatment is ineffective, inconvenient or if many
side effects occur.
 Active monitoring
you make an appointment to determine yourself
whether the treatment has been effective.

37. Common Abbreviations
 PO (by mouth)
 PR (per rectum)
 IM (intramuscular)
 IV (intravenous)
 ID (intradermal)
 IN (intranasal)
 TP (topical)
 SL (sublingual)
 BUCC (buccal)
 IP (intraperitoneal)

38. Common Abbreviations
 Daily (no abbreviation)
 Every other day (no abbreviation)
 BID/b.i.d. (Twice a Day)
 TID/t.id. (Three Times a Day)
 QID/q.i.d. (Four Times a Day)
 QHS (Every Bedtime)
 Q4h (Every 4 hours)
 Q4-6h (Every 4 to 6 hours)
 QWK (Every Week)

39. Common Measures
 1 Teaspoonful = 5 mL
 1 Tablespoonful = 15 mL
 20 Drops = 1 mL
 2.2 Pounds (lb) = 1 Kilogram (kg)

40. Clark's rule
 Clark's rule is used to calculate the proper dosage of
medicine for children aged 2–17.
 Take the child's weight in Kg, and divide by 68 Kg
(actually 68.04 Kg).
 Then multiply the result by the adult dose.
 The answer is the equivalent child dosage.

41. A deadly Weapon
• Look at a weapon of mass Destruction:
• Be careful of the dots and zeroes!

42. “Do Not Use” List
 U or u (unit) – use “unit”
 IU (International unit) – use “International Unit”
 Q.D./QD/q.d./qd – use “daily”
 Q.O.D./QOD/q.o.d./qod – use “every other day”
 Trailing zeros (#.0 mg) – use # mg
 Lack of leading zero (.#) – use 0.# mg
 MS – use “morphine sulfate” or “magnesium sulfate”
 MS04 and MgSO4 – use “morphine sulfate” or
“magnesium sulfate”

43. “Do Not Use” List
 “ASA” (aspirin), “5-ASA” (5-aminosalicylic acid),
“6MP” (6-mercaptopurine), etc, should not be used
 Drug names should be written out.
 Unclear handwriting can be lethal.
 Acetazolamide / acetohexamide, or methotrexate /
metolazone are easily mistaken.
 In this situation, write the indication for the drug in the
body eg: “acetazolamide, for glaucoma.”
 Do not use vague instructions eg: “Take as directed or
as needed” as the sole direction.

45. “Do Not Use” List
 The most 3 important points in abbreviations
are:
1. Do Not Use Abbreviations!!
2. Do Not Use Abbreviations!!
3. Do Not Use Abbreviations!!

46. Electronic Prescribing
 Electronic or e-prescribing is the transmission of
prescription from the prescriber's computer to a
pharmacy computer.
 The software may suggest alternative drugs that are
either more effective or less costly.
 Prescribers should move to a direct computerized,
order entry system

47. Beneath the rule of men entirely great,
the pen is mightier than the sword...
Edward Bulwer-Lytton, 1839
..and can be just as deadly!!
J. Sabino, 2012

49. Thank you
Any question?

50. 1387
‫تجویز‬ ‫اصول‬
‫دارو‬ ‫منطقی‬
‫معاونت‬ ‫انتشارات‬ ‫از‬
‫دارو‬ ‫و‬ ‫غذا‬
‫و‬ ‫بهداشت‬ ‫وزارت‬
‫درمان‬

51. 2012
Katzung
Basic & Clinical
Pharmacology
12th Edition
Chapter 65
Rational
Prescribing &
Prescription
Writing

53. ‫دستورالعم‬ ‫و‬ ‫قوانین‬ ،‫بیمه‬ ‫با‬ ‫آشنائی‬‫لها‬
‫انواع‬‫بیمه‬:،‫خصوصی‬،‫دولتی‬،‫پایه‬،‫مکمل‬،‫بازرگانی‬‫درمانی‬...
‫تعاریف‬:‫بیمه‬،‫گر‬‫بیمه‬،‫شده‬‫حق‬،‫بیمه‬‫فرانشیز‬...
‫بیمه‬‫های‬‫سالمت‬:‫پایه‬(Basic)،‫مازاد‬(Alternative)،‫مکمل‬(Supplementary)
‫انواع‬‫بیمه‬‫در‬‫کشور‬:
.1‫تامین‬‫اجتماعی‬:،‫اجباری‬،‫اختیاری‬،‫مشاغل‬‫مستمری‬،‫بگیر‬،‫ازکارافتاده‬‫ب‬‫یکاری‬
.2‫خدمات‬‫درمانی‬:‫کارکنان‬،‫دولت‬،‫روستائیان‬‫خویش‬،‫فرما‬‫سایر‬،‫اقشار‬‫بس‬‫تری‬
.3‫نیروهای‬‫مسلح‬:،‫شاغلین‬،‫وابستگان‬‫بازنشستگان‬
.4‫کمیته‬‫امداد‬:،‫شهری‬‫روستائی‬
.5‫بانک‬‫ها‬،‫شهرداری‬...
‫نحوه‬‫ارائه‬‫خدمات‬:،‫مستقیم‬،‫کارت‬‫دفترچه‬
‫قوانین‬:،‫قرارداد‬،‫ضوابط‬،‫تعهدات‬،‫بازرسی‬،‫تعرفه‬،‫فرانشیز‬‫شکایت‬....

57. ‫دانشجو‬ ‫خانوادگی‬ ‫نام‬ ‫و‬‫نام‬:‫مربوطه‬‫استاد‬:
‫دانشجوئی‬ ‫ه‬‫ر‬‫شما‬:‫ودی‬‫ر‬‫و‬: