2201: Prescription and Labeling

Prescripción

Md. Imran Nur Manik

Lecturer

Department of Pharmacy

Primeasia University

PRESCRIPTION

Definition

A prescription is an order form a registered practitioner o0r other properly licensed practitioner such as physician, dentist, veterinarian or dermatologists etc to a pharmacist to compound and dispense a specific medicine for the patient.

Parts of Prescription

1. Date
2. Name, age, sex and address of the patient.
3. Superscription  (Rx)
4. Inscription
5. Subscription
6. Signatura 
7. Renewal instructions
8. Name, signature, address  & registration no. of registered physician

Date

It helps the pharmacist to find out the date of prescribing and the date of prescription for filling. It also helps
-to know when the medicines were last dispensed,

-to prevent the misuse of the drug by the patients.

The prescription which prescribes narcotic or other habit forming drugs must bear the date so as to avoid the misuse of the prescription.

Name, age, sex and address of the patient

Name, age, sex and address of the patient must be written in the prescription because it serves to identify the prescription. Age and sex of the patient especially the children, help the pharmacist to check the prescribed dose of the medicine.

Superscription ( কোনো কিছুর শীর্ষে বা বাইরে লিখিত শব্দাবলী (যেমন চিঠির খামের উপর লিখিত ঠিকানা); উপরিলেখ।)

It is represented by the symbol Rx, which is written before writing the prescription. Rx is an abbreviation of the Latin imperative verb, “recipe = take” meaning “to take” (Take though).

Inscription (অন্তর্লিখন)

This is the main part of the prescription, contains the names and quantities of the prescribed ingredients

The names of the ingredients are generally written in English but common abbreviation used can be written both in English and Latin language. Extreme care should be taken by the pharmacist during interpreting the abbreviations otherwise can lead to serious errors.

Inscription is divided into following parts

1. Base: The active ingredients which are intended produce the therapeutic effect.
2. Adjuvant: It is included either to enhance the action of the medicament or to improve the palatability of the preparation.
3. Correction: It is included to prevent or lessen any undesirable effect.
4. Vehicle: It is included in the prescription either to dissolve the solid ingredients or to increase the volume of the prescription.

Subscription

Subscription provides the direction to the pharmacist for the preparation of the prescription information and the quantity and dosage form of the drug to be dispensed.

Signatura 

This consists of the direction to be given to the patient regarding the administration of the drugs. The instruction may include

a. The quantity to be taken or the amount to be used.

b. The frequency and timing of drug administration

c. The route of drug administration

d. The special instruction such as dilution direction.

Renewal instruction

The prescriber indicates on every prescription, whether it may be renewed and if so how many times. It is particularly important for the prescriptions containing the narcotic and other habit forming drugs to prevent its misuse.

  

Name, signature, address & registration no. of the prescriber

The prescription must bear the signature of the prescriber along with the registration number and address.

PRIME NURSING HOME Banani, Dhaka-1213 Phone:+8802453765

Name : Mr. Shajib Khan     Age: 25 yrs  Sex: Male    Date:30.08.2016 Address:222/2 Middle Auch para, Tongi ,Gazipur-1711         Sodium bicarbonate----3 gm Compound tincture of cardamom---2 gm Inscription       Simple syrup-----------6 ml   Water q.s.  Make a solution (Subscription) Take with water(Signatura) Refil:-                                           Sd Dr. Tarique Nasim M.B.B.S., MD Reg.No.- 1234

Types of prescription

Prescriptions may be of the following types

1. National Health Service Prescriptions.
2. Private prescriptions from doctors, dentists or veterinary practitioner. 
3. Prescription for hospital in patients
4. Prescription for medicine to be taken at home by the patient, discharged from the hospital ward.
5.  Hospital outpatient prescription.

Labeling of Dispensed Medications

The label for a dispensed product should provide the patient with all the information required for its proper use. The information include

1. Accurate: The label should be checked immediately after writing and again before fixing to the container.

2. Legible: It should be easily readable, it should be either type written or printed.
3. Intelligible: The information given on the label should be completely unambiguous (স্পষ্ট) and arranged to avoid any confusion.

4. Adequate and relevant: The information provided should be adequate and relevant in order to avoid confusion and anxiety.

Information on the label

The followings are the important things which should be included in the label

1. Indicate clearly the patient, for whom it has been prescribed.

The patient’s title, forename (নামের প্রথম অংশ), initial name or surname (পদবি) should appear on the label of each medicine dispensed.

2. Indicate the name and address of the supplier and the date of supply.

The name and address of the pharmacy may be printed on the dispensing labels.

3. In most of the cases give precise details as to the contents of the container when dispensed.

This includes 

1. The quantity in the container: The total quantity of the product dispensed in the container should be indicated on the label.
2. The name of the product /medicine: In the community pharmacy the name written by the prescriber should appear on the label. In the hospital pharmacy only non-proprietary name is used.
3. The strength of the medicine: It is essential for preparations that are essential in different strengths of medicine. e.g. amount in each tablet/capsule.
4. Units: Wherever possible quantities should be expressed as whole numbers of unit. e.g. 100 mg rather than 1gm. 
5. Batch identification: The batch reference should be included in the labeling (UK).
6. Diluted products:  Particular care should be taken when labeling medicines prepared by the dilution of more concentrated products.

4. State the storage condition and shelf life of the medicine.

This includes

1. Temperature: A large number of products need to be stored in a cool place. e.g. suppositories.
2. Humidity:  Solid unit dosage forms should be protected from moisture. (Air +moisture proof container)
3. Light: The light sensitive products should be stored in the amber colored containers.
4. Sources of ignition: Products containing a large proportion of flammable ingredients should be labeled “flammable” and keep away from naked flames.
5. Shelf life: The period during which the quality of  a medicine is expected to remain within the acceptable limits. 

5. Give clear and complete instruction to the patient on how and when to take or use the preparation.

This Includes 

1. Directions: Includes quantity to be taken or amount to be used, frequency and timing of application, route of administration etc.
2. Shake the bottle: Emulsion, suspension etc.
3. Take with water: Mixtures that can cause gastric irritation. E.g. Disprin (Aspirin)

Cautionary and Advisory Label

In general the patient requires adequate information, so that the medicine can be taken safely and effectively. Guidelines for the pharmacist on the Cautionary and Advisory Label to be applied to the dispensed medicine are provided by the Royal pharmaceutical society of Great Britain.
The guidelines are as follows

1. For external use only

This label must be applied to the liquid preparations or gels for external application. The label is also applied to all semisolid or solid medicinal products for external use. e.g. Ointments, Creams, Dusting powders etc.

2. Not to be taken

This label may be used on preparations that’s are neither administered by mouth nor used on the skin. This label may be confused with the words “For external use”. Therefore “For nasal use only”
“For rectal use only” “For vaginal use only” label may be preferred.

“Not to be swallowed in a large amount” is a better label for the mouth washes and gargles where swallowing of a small amount is ineffective but swallowing in a large quantity is undesirable.

3. Hexachlorophane warning

Products containing Hexachlorophane should not be used indiscriminately in every young child or in certain animals because of the possibility of the serious toxicity. A warning to this effect should be included on the labels of the products containing the substances.

[A topical antibacterial formerly widely used in wound care and as a surgical scrub. Application to mucousmembranes, denuded or burned surfaces, and intact skin in newborns has resulted in fatal CNS lesions. Use iscurrently restricted to disinfection of intact adult skin. Products containing more than 0.1% hexachlorophene areavailable only by prescription.]

4. Keep out of reach of children

All medicine should be stored in the place inaccessible to the children and must be so labeled.

5. For animal use/treatment only

A clear distinction must be made between the medicine intended for human use and those for veterinary use.

6. Drowsiness warning

Patients should be warned if their medicines are likely to cause drowsiness, dizziness (মাথা ঘোরা) blurred vision(ঝাপসা দৃষ্টি).

       

7. Potential interactions with food and drinks 

1. Drugs for which absorption is improved if  taken before food.(meal)

2. Drugs for which GI irritation occurs if  taken before food.(empty stomach)

8. Potential interactions with other medicines

1. Drugs which chelates with calcium, magnesium and iron and are not well absorbed in the presence of irons.

2. Drugs whose activity is reduced by aspirin

9. Special methods of administration

1. For chewable formulations

2. For sublingual formulations

10. Caution in use

           a. Preparations which may produce unusual effect.

b. Preparations containing high proportion of flammable solvent.

   

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