Prescriptions

DEFINITION

Prescription is an order written by a physician, dentist, veterinarian or a registered medical practitioner to a pharmacist to compound and dispense a specific medication for the patient.

Important features of a prescription:

·         Directions are given to the pharmacist about what type of preparation (tablet, power, mixture etc.) is to be prepared.

·         It contains directions for the patients, the dose of the drug and the dose interval, and how it is to be taken.

·         Prescriptions are generally written in Latin language, so that the prescription remains unknown to the patients to avoid self-medication.

PARTS OF A PRESCRIPTION

A typical prescription consists of the following parts:

1. Date

Date on the prescription helps the pharmacists to know when the medicines were last dispensed if the prescription is brought for redispensing of the prescription. In case of habit forming drug  the date prevents the misuse of the drug by the patient.

2. Name, age, sex and address of the patient

By name and address the patient and the prescription can be identified. Age and sex of the patient is especially required for child patient to check the prescribed dose.

3. Superscription

It is represented by a Latin symbol ℞, an abbreviation of Latin term ‘recipe’ which means ‘take thou’ or ‘you take’.

[N.B. In olden days, the symbol was considered to be originated from the sign of Jupiter, the Greek God of healing. This symbol was employed by the ancient in requesting God for the quick recovery of the patient.]

4. Inscription

This is the main part of the prescription.  It contains the names and quantities of the prescribed medicaments. The medicament may be official preparation or nonofficial preparation. If is official preparation (i.e. from pharmacopoeia or formulary) then only the name of the preparation is written e.g. Piperazine Citrate Elixir IP.

If it is nonofficial preparation then the quantity of each ingredient will be given. The type of preparation will also be given e.g.               Sodium bicarbonate           3g

                                Simple Syrup                        6ml

                                Purified Water q.s.               100ml

The inscription of prescriptions containing several ingredients are divided into the following parts:

(a)     Base: The active medicaments those are intended to produce the therapeutic effect.

(b)     Adjuvants: These are included either to enhance the action of the drug or to make the preparation more palatable.

(c)     Vehicle: It is the main carrier of the drug. In liquid preparations drugs are either dissolved or dispersed in the vehicle.

5. Subscription

In this part the prescriber gives direction to the pharmacist regarding the dosage form to be prepared and the number of doses to be dispensed.

6. Signatura

It is usually written as ‘Sig.’. The instructions given in the prescription should be written in the label of the container so that the patient can follow them. The instructions may include:

                (a) The quantity to be taken             (b) The frequency and timing of administration of the preparation

                (c) The route of administration         (c) The special instruction (if any)

7. Renewal instructions

The prescriber indicates in every prescription, whether it should be renewed, and if renewed, for how many times. It is very important particularly for the case of habit forming drugs to prevent its misuse.

8. Signature, address and registration number of the prescriber

The prescription must be signed by the prescriber by his / her own hand. His/her address and registration number should be written in the case of dangerous and habit forming drugs.

An example of a typical prescription is given as follows:

SHARMA NURSING HOME New Delhi

Name: Mr. N. Anand           Age: 42 years                       Sex: Male Address: 32, Azad Nagar, new Delhi             ℞ (Superscription)                                 Sodium bicarbonate                           3g Inscription               Compound tincture of cardamom   2ml                                 Simple Syrup                                        6ml                                 Purified Water q.s.                               90ml Fiat misture. (Subscription) Sig. Cochleare magnum ter in die post cibos sumenda. (Signatura) Refill: ________                                                                 Sd/-                                                                                 Dr. Aswini Sharma                                                                                 Regn. No. 14328

HANDLING OF PRESCRIPTION

The following procedures should be adopted by the pharmacist while handling the prescription for compounding  and dispensing:

                (i) Receiving         

(ii) Reading and checking

(iii) Collecting and weighing the materials

(iv) Compounding, labeling and packaging

(i) Receiving

·         The prescription should be received by the pharmacist himself / herself.

·         While receiving a prescription from a patient a pharmacist should bot change his/her facial expression that gives an impression to the patient that he/she is confused or surprised after seeing the prescription.

(ii) Reading and checking

·         After receiving the prescription it should be screened behind the counter.

·         The prescription is a hospital slip or from a nursing home or from a private practitioner and their authenticity should be checked. The signature of the prescriber and the date of prescription is checked.

·         The pharmacist should read all the lines and words of the prescription. He/she must not guess any word. If there is any doubt, the pharmacist should consult with the other pharmacist or the prescriber over telephone.

3. Collecting and weighing the material

Before compounding a prescription all the materials required for it should be collected from the shelves or drawers and kept in the left hand side of the balance. After measuring each material should be kept on the right hand side of the balance. After compounding the prescription the materials are replaced back to the shelves / drawers where from they were collected.

While compounding the label of every container of material should be checked thrice in the following manner:

(i)                   When collected from the shelves/drawers.

(ii)                 When the materials are measured.

(iii)                When the containers are replaced back to the shelves/drawers.

4. Compounding, labeling and packaging

·         Only one prescription should be compounded at a time.

·         Compounding should be done on a clean table.

·         All equipment required should be cleaned and dried.

·         The preparation should be prepared according to the direction of the prescriber or as per methods given in pharmacopoeia or formulary are according to established pharmaceutical art of compounding.

·         The compounded preparations should be filled in suitable containers.

Round vials	For tablets and capsules
Oval prescription bottles Narrow mouthed	For liquid of low viscosity e.g. mixtures, oral emulsions etc.
Wide mouthed bottles	For filling liquids of high viscosity, large quantities of tablets or capsules and bulk powders.
Colored fluted bottles	For external preparations e.g. liniment and lotions.
Ointment jars and collapsible tubes	For ointments, creams or any other semisolid dosage forms.
Paper wrappers and envelops	For oral powders in divided doses.
Dropper bottles	For eye drops and ear drops.
Sifter top containers	For dusting powders.

·         The containers are labeled as per the prescriber. If required some additional instructions may also be given.

The following information should be written on the label:

Type of preparation:	The Emulsion, The Mixture, The Powder etc. Its quantity should also be mentioned.
For:	Name, Age and Sex of the patient.
Date of dispensing:	Date on which the prescription is dispensed.
Expiry date if any:	e.g. ‘Must be taken within 7 days of dispensing.’
Directions for use:	e.g ‘One teaspoonful thrice daily.’
Storage condition:	e.g. ‘Keep in a cool place’
Secondary labeling:	e.g. ‘SHAKE THE BOTTLE BEFORE USE’       ‘FOR EXTERNAL USE ONLY’ etc.
Name and signature	of the pharmacist who dispensed
Name and Address	of the Pharmacy

·         The container should be polished to remove any finger print.

·         While delivering the preparation to the patient the pharmacist should explain the mode of administration, direction for use and storage.