1 DISPENSING 2 LECTURE

Module 1
Made by: KAVJ

PRESCRIPTION ABBREVIATION - A finished product, a drug or mixture of drugs

1. The symbol u for unit, when hand-written, can be read compounded and dispensed by the
as 0 with a possible resulting ten-fold overdose. The pharmacist pursuant to the instruction of a
word unit should always be written out. prescriber.
2. Mcg is the acceptable abbreviation for microgram - It can be an ordinary prescription or a
because the symbol ug can easily be read as mg. prescription that should be compounded.
3. The symbol o.d. used to indicate every other day has - Written order and instruction to the
been read both as q.d. for daily or q.i.d. for four times pharmacist.
daily. To avoid confusion, every other day should be - Physician → Pharmacist → Patient
written out. - Identifies the medication to be dispensed and
4. The period after the q in the should be accompanied on how it is properly
abbreviation d. meaning everyday, can be mistaken used.
for an i, causing the medication to be given four times
a day. Philippines Regulatory Classification
5. The symbols SC or SQ with the intended meaning ✓ Dangerous Drugs Prescription
of subcutaneous could be misinterpreted as SL, - The yellow prescription
meaning sublingually. - DD as listed in the Comprehensive Drugs
6. The abbreviation I.W., meaning three times a week, Act of 2002 are the ones written in this
has been misread as three times a day or prescription
misinterpreted as two times a week. - Supplied only special DOH prescription form,
7. When the same symbols have more than one meaning, yellow Rx
misinterpretation may result. Common examples - Few are licensed by PDEA
include D/C, which can mean ✓ EDD Prescription
either discontinue or discharge; HS, which can mean - Prescription that carries medicines containing
either at bedtime or half-strength; and IVP, which can any amount of prohibited or regulated drug
mean IV push or Intravenous pyelogram. - With S2 licensed number by a licensed PDEA
8. The Latin abbreviations au, as and ad, which mean, prescribing physician
respectively, both ears, left ear and right ear, have - Can be written in an ordinary prescription with
been misread or misinterpreted as ou, os and od, an updated S2 license number
meaning both eyes, left eye and right eye. Obviously, ✓ Rx
the opposite misinterpretation may also occur.
- Usual prescription/Ordinary prescription
9. When writing whole numbers for medications strengths
or dosages, never add a decimal point without a ✓ Non-Rx
trailing zero. That is, write 25 mg, not 25.0 mg. If the - Medications that do not need any prescription
decimal point is not seen, 250 mg may be read rather
than the desired 25 mg.
10. When writing a decimal fraction for a number less than TYPES OF MEDICATION BASED ON PRESCRIPTION
one, always precede the decimal point with a zero. REQUIREMENTS:
That is, write 0.25 mg, not .25 mg. In this case, if the ✓ Prescription Drugs
decimal point is not seen, 25 mg would be - Ethical or Legend drugs
administered rather than the desired 0.25 mg. - Are pharmaceutical products or drug
11. When writing or typing the names, strengths and units preparations that are to be dispensed only
of drugs, do not omit the spaces between the words, upon written order of a validly registered
unit abbreviations, or set of numbers. For example, physician, dentist or veterinarian for the
write Propranolol 40 mg, not Propranolol 40mg or management or treatment of a condition or
Propranolol40mg. disease.
12. Avoid the symbols / and &, because the symbol / can ▪ With Rx symbol
be taken for a number 1, and the & symbol, when ▪ Caution Statement
handwritten, can look like the number 4. “Foods, Drugs, Devices and
Cosmetics Act 467 prohibits
dispensing without prescription”
INTERPRETATION OF PRESCRIPTION - Ex. Antibiotics
HISTORICAL BACKGROUND ✓ Non-Prescription Drugs
✓ George Urdang - Over-the-counter drugs
- First person to study the prescription of today - Are pharmaceutical products or drug
✓ Prae + Scribo preparations that can be dispensed even
- Prae (before) without the written order of a validly registered
- Scribo (I write) licensed physician, dentist or veterinarian, for
the use of consumers for the prevention or
symptomatic relief of minor or self-limiting
DEFINITION: Prescription ailments
- Paracetamol (headache)
✓ A medication order written by a physician, dentist or other
- Neozep, Bioflu (colds)
licensed medical practitioner and given to the patient for
presentation to the pharmacist. It contains a specific medication ✓ Dangerous Drugs
and dosage to be administered to a particular patient at a - Are pharmaceutical products referring to
specified time. either prohibited or regulated drugs which
- Usually written by a physician, or it could also require a special prescription form usually
be written by a pharmacist in pursuant to the obtained from the Dangerous Drugs Board.
▪ Yellow prescription
telephone dictation of the physician.
2 DISPENSING 2 LECTURE
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▪ Regulating body - PDEA • Physician’s information

- Ex. Midazolam, Meperidine, Fentanyl - Complete name
- PTR number
Dangerous Drugs - S2 License number
Prohibited Regulated - Address and telephone number
Include opium Include sleep inducing • Content of a prescription
sedatives - Brand name / generic name
Has active components such Any that contains an isomer - Total amounts of unit in words
as heroin and morphine of Amphetamines, - Signa, specific signa, no “as needed”
Benzedrine, Dexedrine • Physician’s information
Narcotic drugs Hypnotic drugs - NO REFILL

OTHER CLASSIFICATION OF PRESCRIPTION: INTERPRETATION OF PRESCRIPTION

✓ Polypharmacal Prescription Errors in Prescription
- Containing 10 or more than 10 ingredients of Erroneous Prescription
the same therapeutic use • Brand name precedes generic name
• Generic name is in parenthesis
- aka Shot gun prescription
• Brand is not in parenthesis
✓ Magistral Prescription
• CAN BE DISPENSED
- Is very often prescribed by the same doctor,
of the same ingredients and compounded by
Violative Prescription
the same pharmacist
• Generic name is not written
✓ Coded Prescription • Generic name is not legible but brand name is legible
- Containing words or symbols to represent the • Both are written but with word “NO SUBSTITUTION”
name of the drug • CANNOT BE DISPENSED
- Aka Blind Prescription
Impossible Prescription
Parts of the Prescription • Only generic name is written but not legible
• Prescriber’s information • Generic name does not match with brand name
• Patient’s Information • Both written – both not legible
- Contains pertinent information about the • Drug is not registered with DOH
patient • CANNOT BE DISPENSED
▪ Name (identification purposes)
▪ Address (not as essential) PROCESSING THE PRESCRIPTION
▪ Age, Sex (important details) • Receiving the Prescription
• Date - It is desirable that the patient presents the
- Avoids recycling of prescription prescription order directly to the pharmacist
- Time that the prescription is prescribed by the to enhance the patient-pharmacist
physician relationship
• Superscription (Rx symbol) - The individual receiving the prescription
- “Take though” “Take” should be trained to accept the prescription in
• Inscription (name, strength, dosage form) a professional manner.
- Medication prescribed - Obtain the correct name, address and
- Body of the prescription pertinent information of the patient
▪ Name of product (GN and BN is
written) WHENEVER WE PROCESS MEDICATIONS, WE ALWAYS
▪ According to Generics Act DOUBLE CHECK.
of 1998 (RA no. 6675)
▪ Generic name is necessary IMPORTANT CONSIDERATIONS IN DISPENSING
▪ Dosage form & strength PRESCRIPTION
▪ Strength of the medication • Reading and Checking the Prescription
• Subscription (quantity of the drug) 1. Is the prescription legal?
- Instruction to the pharmacist 2. Who is it for?
- Communication from one pharmacist to 3. What is the name of the medication?
another 4. What is the instruction for the patient?
• Transcription/Signa (directions for use)
- Signature, Mark through, Let it be label Labeling
- Instruction to the patient - Indicated for drug products that are not in their
- Should contain number of units per dose, original containers and transferred to another
frequency of medication, duration of dosing containers
• Refills authorized and special instructions, if any - Should be neat, legible, attractive
• Prescriber’s Signature and License Number ▪ Loose tablets
▪ Isordil is transferred into a
ziplock
PARTS OF YELLOW PRESCRIPTION Important Information in a Label
RA no. 9165 - Dangerous Drugs Act of 2002 • Name and Address of Pharmacy
• Prescription number • Patient’s name
• Date of prescription • Name and Strength of medication (GN/BN)
• Patient information
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• Direction for Use • Combination products

• Manufacturer Lot Number Ex.
• Expiration date - Fosavance
• Name and initial of Dispensing Pharmacist ▪ 70 mg/5600 I.E./U.I.
▪ 70 mg/2800 I.E./U.I.
- Seretide
PREPARING THE PRESCRIPTION ▪ Disk
Prescription ▪ Metered dose inhaler
• Dispensing • Different formulation of the same active drug
- Ex. Enoxaparin (Clexane) - Ex. Ambroxol (Mucosolvan)
▪ 6000 IU (60mg / 0.6 mL) ▪ 24hrs (SR)
▪ 4000 IU (40mg / 0.4 mL) ▪ Plain tablet (30mg)
▪ 2000 IU (20mg / 0.2 mL) ▪ Syrup (6mg/mL)
• Compounding • Different strengths of the same drug
- The pharmacist should consider the physical - Ex. Warfarin
and chemical incompatibilities of the ▪ 9 colors available
ingredients. • Illegible Handwriting
- Ex. Maalox, Nystatin, Diphenhydramine,
Water DRESS your SALAD
✓ Double check
Packaging ✓ Read the label
- Protects the medication from air, moisture, light, loss of ✓ Emphasize
drugs and contaminants. ✓ Set apart
- Based from type & quantity of medication and method of ✓ Spread awareness
use
• Round vials HAM
- Used for solid dosage forms “High Alert Medications”
• Prescription bottles 5 High-Alert medications:
- Liquids of low viscosity • Insulin
• Wide mouth bottles • Opiates and Narcotics
- Used for bulk powders, large quantities of • Injectable Potassium Chloride (or Phosphate)
capsules, and viscous liquids that cannot be concentrate
poured readily • Intravenous Anticoagulants
• Dropper bottles • Sodium Chloride above 0.9%
- Used for ophthalmic, nasal, otic or oral
medications that is administered by drops SPICE your HAM
• Collapsible tube ✓ Separate
• Ointment jar ✓ Pull out
- Used for semi solid dosage forms, such as ✓ Identify
ointments and creams ✓ Compare & confirm
• Sifter top containers ✓ Ensure
- For powders applied by sprinkling
• Hinged-lid containers Compounded Preparations
- For dispensing suppositories or powders ✓ Double check the prescription / Medication order
prepared in packets ✓ Calculation
- Lids connected with a hinge ✓ In process materials / Components
- Molded out of polypropylene or ✓ Label
polyethylene or plastic resin ✓ Final product
• Aerosol containers
- For pharmaceutical aerosol products
DELIVERING AND PATIENT COUNSELING
Rechecking (Prescription and OTC Drugs) • Tell the patient….
✓ Before getting from the shelf • Inform the patient of the dosage regimen
✓ While preparing the product • Ask the patient if he/she will have a problem taking the
✓ When returning the container medication as prescribed
✓ Before dispensing the medication • Tell the patient how long it will take for the drug to show
an effect
• Tell the patient how long he/she might be taking the
CONSIDERATIONS IN WHILE CHECKING MEDICINES medication
SALADs
“Sound-Alike Look-Alike Drugs” ✓ Emphasize the benefits of the medication
- Involve medications that are visually similar and names ✓ Discuss major side effects of the drug
have spelling similarities or phonetics. ✓ Point out that additional, rare side effects are listed in
the information sheet
Factors contributing to SALAD errors: ✓ Discuss precautions and beneficial activities
• Quantity of Drug Names
• Generic and Brand Names
• Spelling errors
- Ex. Clotrimazole & Cotrimoxazole
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DRUGS THAT SHOULD NOT BE CHEWED, CRUSHED OR ▪ Diclofenac

OPENED ▪ Omeprazole
“Don’t rush to crush”
- Use a Tablet cutter Enteric coated medicines
- Accuracy is critical • Usually identifiable by two letters EN or EC at the end
of the name
Potential Consequences of Splitting, Crushing and • Medicine designed not to be released in the stomach
Opening - Protects drug from acidity
• Absorption - Protects the stomach from detrimental effects
• Drug instability of the drug
- Lesser desired clinical effect - Reach the intestine
- Light sensitive drug → photodegradation to ▪ Anthelmintics
dehydronifedipine→dehydronitrosonifedipine
(inactive forms) Film or sugar-coated medicines
▪ Nifedipine • Disruption of the film or sugar coating on drugs may
- Ex. Enteric coated drugs → shift to result in rapid degradation of the active ingredient, poor
suppositories tasting medicines which may be more difficult to
▪ Dulcolax (Bisacodyl tablets) swallow
▪ If it is chewed, there will be
uncomfortable gastric DRUGS THAT SHOULD NOT BE CHEWED, CRUSHED or
spasms OPENED
• Failure to reach site of action It a common knowledge for patients that drugs in tablet
• Produce irritant effect and capsule form are usually taken orally. There are also
▪ Diclofenac Sodium (NSAID) instances that some patients would crush tablets or open
▪ Gastric irritation capsules because of the inability to swallow them. This can be
▪ Alendronate done, however not in all cases.
▪ Mucosal Some tablets and capsules with the following words/letters
ulceration/irritation in their names should never crushed, opened, chewed or
• Occupational health and safety issue sucked.
- Crushing drugs that are carcinogenic (cause
cancer) or teratogenic (harmful for the fetus) Word/Letter Type of Product
may exposed health care professional CR/Chrono Controlled Release
through powder aerosolization
- Hormones, oral contraceptives, hormonal CRT Controlled Release
replacement therapy, corticosteroids EC/EN Enteric Coated
▪ Dexamethasone LA Long Acting
▪ Finasteride MR/Retard Modified Release
▪ Mycophenolate
SA Sustained Action
▪ Valcyte (Valgancyclovir) /
Gancyclovir SR/Dur/Dural Sustained Release
▪ Causes skin irritation XL/XR Extended Release
▪ Tamoxifen
• Unacceptable taste
- Sugar coated tablets DRUGS THAT SHOULD AND SHOULD NOT BE TAKEN
▪ Ibuprofen WITH FOOD
▪ Quinine Medicine / Drug
▪ Iron Supplements • A compound or preparation used for the treatment or
• Changes in Pharmacokinetics and Bioavailability prevention of disease, especially a drug or drugs taken
- If there are alterations, underdosing or by mouth
overdosing occur
▪ Lanoxin (Digoxin) crushing Drug – Food Interaction
▪ Bradycardia Drug interactions can affect the activity of the drugs. Either
▪ Tachycardia increase or decrease the activity/efficacy of the drug.
▪ Pradaxa crushing (Anticoagulant)
▪ Increase in amount of drug Paracetamol (no food) = Cure headache
absorbed (bleeding) Paracetamol (with alcohol) = Hepatotoxicity

Bioavailability is the ability of the drug or substance to be

Different Dosage Form Effects absorbed and used by the body.
Modified release medicines - High risk of treatment failure arising in the fed
• Frequently identifiable by two letters such as m/r, LA, state
SA, CR, XL or SR at the end of the name. • Fed state – when you are digesting the food and
• Words such as “Retard” or “Slow” in the title absorbing nutrients
sometimes used instead ▪ Could reduce bioavailability
• Prolonged period / taken once a day ▪ Gastric acid secretion (reduce or
• MUPS – Multi-Unit Pellet System increase bioavailability)
▪ Verapamil
▪ Propranolol
▪ Felodipine
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Fruit juices
• Grapefruit + Cilostazol (Clazol) (blood thinner) =
Purpura (blood vessels burst and leak under the skin)
or bleeding
• Grapefruit + Aspirin (antithrombotic) = Purpura
(blood vessels burst and leak under the skin) or
bleeding

Statins
• Lovastatin (cholesterol lowering) = WITH food
• Rosuvastatin (antihyperlipidemic) = WITHOUT food

Antibiotics
• Ciprofloxacin = WITHOUT food (calcium and
magnesium)

NSAIDs
• Advil, Naproxen = WITH food
• Paracetamol = WITHOUT food

General Rules:
✓ Follow the instructions you receive with your medicine
✓ Medicines that are supposed to be taken on an empty
stomach should be taken about an hour before a meal
or 2 hours after a meal
✓ Forgetting these instructions on rare occasions is
unlikely to do any harm, but taking these medicines
with food regularly may mean they don’t work