College of Prescription

Nursing
Pharmacy & Analysis
Allied
Health
Sciences
Mary Angelique C. Banogon, RPh
Instructor | Pharm 302
Department of Pharmacy
Prescription
It is a written order from a registered medical practitioner or
other licensed practitioners to a pharmacist to compound and
dispense a specific medication for the patient.

is actually a direct link between physician, pharmacist &

patient. A Prescription is accompanied by direction for
pharmacist and for patient.
Department of Pharmacy

Parts of a
Prescription
Department of Pharmacy
1. Prescriber Information
and Signature:
→ The top of the prescription
usually includes the prescriber’s
name, address and telephone
number.
2. Name, Age, Sex, and
Address of the Px:
→ It serves to identify the owner
of the prescription.
→ Age is needed to be
determined if the prescribed
dose is right for the person, and
prescribed dose varies.
Department of Pharmacy
3. Date
→ Helps a pharmacist to find out
the date of prescribing especially for
filling the prescription.
→ In case of habit-forming drug, the
date prevents the misuse of the
drug by the patient.
Antipsychotic Drugs
Antidepressant Drugs
→ Dates are really needed to be
checked to avoid overuse of the
drug or misuse of the drug.
→ Also, for record keeping and for
checking any medication error.
Department of Pharmacy
4. Superscription
→ Represented by a symbol Rx
which is written before writing the
prescription.
→ Rx is an abbreviation of the Latin
word recipe meaning “You take” or
“take thou.”
• The symbol was considered
to be originated from the sign
of Jupiter, God of healing.
Department of Pharmacy 5. Inscription
→ Main part of the prescription order
which contains the names and quantities
of the prescribed ingredients.
→ The medicament may be official
preparation or nonofficial preparation.
• Official preparation (i.e., from
pharmacopoeia): Only name of the
preparation is written.
* E.g., Piperazine Citrate Elixir IP
• Nonofficial preparation: Quantity of
each ingredient will be given, and
type of preparation will also be
given.
→ Consciousness should be taken by
the pharmacist in interpreting
abbreviation to avoid medication errors.
Department of Pharmacy

6. Subscription
→ This comprises direction to the
pharmacist for preparing the prescription
and number of doses to be dispensed.
Department of Pharmacy
7. Signatura or Transcription
→ Consists of the direction to be given to
the patient regarding the administration of
the drug.
→ It is usually written as Sig on the
prescription.
• Quantity to be taken or amount to be
used
• Frequency and timing of administration
or application
• Route of administration
• Special instructions such as dilution
direction
Department of Pharmacy
* Other instructions
→ Label of the drug that is going to be
dispensed
• If external use or internal use
• Depends on the route
• It depends on the policies of the
pharmacy if it is going to be
included in the label.
Department of Pharmacy
8. Prescriber’s Signature
→ Prescription must be signed with
Prescriber’s own hand. Address and
Registration No. and S2 license number
should be written in case of dangerous
drugs
Department of Pharmacy

Types of Prescription
• Simple
• Compounded
• Yellow
Department of Pharmacy
Simple Prescription
Only one drug is indicated.
Can also be described as
ordinary.
Those written for a single
component.
Prefabricated product that
doesn't need compounding or any
kind of mixing technique or
process that should be done by
the pharmacist.
Department of Pharmacy
Compounded Prescription
Altered specifically for the need of the patient.
Composition of Inscription in Compounded Prescription
• Basis: Chief and active ingredient or the main drug that is responsible for
the therapeutic effect.
• Adjuvant: Used to assist the basis.
o What should be added to promote the therapeutic effect of the drug?
• Corrective: Qualifies the action of the basis and adjuvant.
o What should be added to minimize the undesirable of the main drug
and the adjuvant? (ex. pH buffer, flavoring)
• Vehicle: Added to dilute the active ingredients in processing the
prescription.
o Solvent or excipients added to dilute the active ingredients in
processing the prescription order.
Department of Pharmacy

Basis

Adjuvant
Corrective
Vehicle
Department of Pharmacy
Polypharmacy
Patients taking multiple medications.
Use of multiple medications usually
reaches 5-10 medications.
For patients with diabetes, kidney
problems, cardio problems.
Department of Pharmacy
Yellow Prescription
used to purchase dangerous drugs. Should be filled out
completely by the doctor and should present with duplicate
when trying to buy medicines in drugstore.
Dispensing dangerous drugs are very critical. Pharmacist must
know the expiration date of the S2 license of the doctor, and
the S2 and license no. should be genuine.
Department of Pharmacy
Department of Pharmacy
Prescription Validity
Antibiotic, Anti-infectives and or Antiviral preparations:
- Valid for one (1) week from the date of prescription

For New/First Time Prescription

- Validity of 1 week: drug must be procured within that time period

Maintenance Medication Prescription

- generally valid for six months from the date of prescription
Department of Pharmacy
Prescription Validity
For Senior Citizen:
- Dispensing must be in accordance with the prescription issued by a
physician
- Should not cover more than 1 month supply of medicines

- Drugstores may limit the dispensing of OTCs for a supply of one (1) day
but not to exceed to a maximum of seven (7) day-supply (FDA AO
2010-0032)
Department of Pharmacy

Erroneous, Violative, and

Impossible Prescriptions
Administrative Order No. 62 series of 1989
Section 4
Department of Pharmacy
Erroneous Prescription

Where the
brand name
precedes the
generic name
 Erroneous Prescription
Department of Pharmacy

Where the generic name

is the one in parenthesis
OR
Where the brand name
is not in parentheses
 Erroneous Prescription
Department of Pharmacy

When the brand name is

not in parenthesis.
 Erroneous Prescription
Department of Pharmacy

Where more
than one drug
product is
prescribed on
one
prescription
form.
Department of Pharmacy
Department of Pharmacy What to do with erroneous
prescriptions?
Erroneous prescriptions shall be filled.

Such prescriptions shall also be kept and

reported by the pharmacist of the drug outlet or
any other interested party to the nearest DOH
Office for appropriate action.
Department of Pharmacy Violative Prescriptions
Where generic name is Where the generic name is
NOT WRITTEN not legible and a brand name
which is legible is written
Department of Pharmacy
Violative Prescriptions
When the brand name is
indicated and instructions
added (such as the phrase
" NO SUBSTITUTION") which
tend to obstruct, hinder or
prevent proper generic
dispensing.
Department of Pharmacy What to do with Violative
Prescriptions?
Violative prescriptions shall not be filled.
They shall be kept and reported by the pharmacist of the drug
outlet or any other interested party to the nearest DOH Officer
for appropriate action.
The pharmacist shall advise the prescriber of the problem
and/or instruct the customer to get the proper prescription.
 Impossible Prescriptions
Department of Pharmacy

When only the

generic name is
written but it is not
legible.
Department of Pharmacy
Impossible Prescriptions
When the generic
name does not
correspond to the
brand name
Department of Pharmacy
Impossible Prescriptions
When both the
generic name and
the brand name are
not legible
 Impossible Prescriptions
Department of Pharmacy

When the drug

product prescribed
is not registered
with FDA
Department of Pharmacy
Sources of Error in Prescriptions
• Abbreviations:
✕ Wrong abbreviations:
*Please see/refer to ISMP’s List of Error-Prone Abbreviations, Symbols, and
Dose Designations
• Name of the drug:
▪ If it is not written properly
▪ Spelling of the drugs
▪ SALAD
• *Please see/refer to FDA and ISMP Lists of Look-Alike Drug Names
with Recommended Tall Man Letters
Department of Pharmacy
Sources of Error in Prescriptions
• Strength of the preparation
▪ Should be clearly stated especially when various strengths of the
product are available in the market
• Dosage form
▪ Many medicines have more than one dosage form.
▪ The dosage form should be written in the prescription in order to avoid
ambiguity.
• Dose
▪ Unusually high dose or low dose should be discussed with the
prescriber (specially for children)
Department of Pharmacy
Sources of Error in Prescriptions
• Instructions for the patient
▪ Can be incomplete or omitted
▪ Counselling here is very important (quantity of the drug, frequency
and timing of administration, route of administration should be clearly
discussed)
• Incompatibilities
▪ There should be no pharmaceutical or therapeutic incompatibilities
▪ The different medicines prescribed should not interact with each other
Department of Pharmacy
Prescription vs. Medication Order
a 'prescription' is thought
of as an outpatient
medication request
used in outpatient or
ambulatory setting

a medication 'order' is
considered an inpatient
medication request.
used in the inpatient or
institutional health system
setting
Department of Pharmacy
Medication Orders
May be written, typed, or it may be given verbally or by
telephone to a licensed nurse or pharmacist.
Some healthcare facilities may use electronic prescribing
systems called Computer Prescriber Order-Entry systems or
CPOEs
The information in the medication order is transcribed to a
medication administration record (MAR).
The medication administration record is a part of the patient’s legal
chart which includes the patient’s medications, including dosage,
dosage form, and route and time of administration.
Department of Pharmacy
Medication Orders Requirements
• Patient’s name:
• The medication order should always
include the patient’s full name. This
can avoid any confusion with another
patient that has the same last name.
• Date and time the order is written:
• This information helps the medication
from being overlooked.
• The date and time are also important
for medications given over a specific
time period and needs to be
discontinued on a specific day. When
the medication order is dated and
time you will know which dose will be
the last dose.
Department of Pharmacy
Medication Orders Requirements
• Name of medication to be
administered:
• The name of the medication may be
written as the brand name or the
generic name.
• It is important for a nurse to be
familiar with the brand name and the
generic name of a medication.
• A drug handbook or a
Physicians’ Desk Reference can
be used as source of drug
information.
Department of Pharmacy
Medication Orders Requirements
• Dose of the medication
• The dosage of a medication is
normally stated using the metric
system.
• It is also considered as the
safest system for the
measurement of medication
dosage.
• Route by which the medication is to be
administered
• Specifying the route is important
because some medications can be
given via more than one route.
Department of Pharmacy
Medication Orders Requirements
• Frequency of administration of the
medication
• Specifying the route is important
because some medications can be
given via more than one route.
• Signature of person writing the order
• This refers to the signature of the
prescribing practitioner.
• When a facility uses a computerized
system, the prescriber has a
username and password that
identifies them as the prescriber.
Their information is automatically
added to the medication record.
Department of Pharmacy
Types of Medication Orders
Standing Medication Orders:
This is a set of prewritten
orders that a nurse can use to
administer treatments and
medications.
if a standard written order
doesn't specify a time period,
then it usually remains in effect
until it's discontinued
Department of Pharmacy
Types of Medication Orders
PRN Medication Orders:
P.R.N. comes from a Latin phrase
that means as the occasion arises.
PRN medication orders usually
have instructions and guidelines
for when, what dose, and how
often the medication should be
administered.
These medications are only given
when the patient requires them.
Medications for pain relief, sleep,
and nausea can be written as PRN
orders.
Department of Pharmacy
Types of Medication Orders
Single One-Time
Medication Orders
These medications are
given only once at a
specific time.
Medications given
preoperatively, treatment
of an acute symptom or for
diagnostic procedures are
usually single one-time
medication orders.
Department of Pharmacy
Types of Medication Orders
Stat Medication Orders
These orders are for a
medication that must be given
or administered immediately.
may be written and another
order to continue the same
medication for a specific time
at a specific dose
This medication order must
include all the requirements of
any medication order.
Department of Pharmacy
Types of Medication Orders
Now Medication Orders
These orders are written when the patient needs the
medication quickly but not immediately.
The now medication order is also a single one-time dose of
medication.
Department of Pharmacy
Dosing Schedule
POSOLOGY: Science related to dose.
DOSE: Amount of drug given at a particular time.
MODE OF ADMINISTRATION: Complete description of the
amount of the drug, route of administration, frequency of
administration and duration of treatment.
LOADING DOSE: Single or few repeated doses given in the
beginning to attain target concentration rapidly.
MAINTENANCE DOSE: Dose that is repeated at specified
intervals after the target steady state plasma concentration.
Department of Pharmacy
Factors Affecting Posology
Age
Failure to detoxify and eliminate drugs will lead to toxic accumulation
in the body tissues.
Sex
Difference in the drug response of women and men.
Body Weight
Dose problems in obese people, children, or patients with weight
problems.
Time of Administration
Presence of food in the stomach either rapidly or delay the drug
absorption.
Department of Pharmacy
IDEAL BODY WEIGHT
The weight used to determine the dose also varies depending on the drug’s properties and the
patient’s weight, particularly for adults. An ideal body weight (IBW) for an adult 5 feet tall or
greater can be calculated using the following formulas:
Men: IBW = 50 kg + (2.3 × number of inches over 5 feet in height)
Women: IBW = 45.5 kg + (2.3 × number of inches over 5 feet in height)
• if the patient is underweight and the IBW is used to calculate the dose, the patient may be
overdosed. In this case, the patient’s actual weight should be used to calculate the dose.
• When dosing a patient whose actual weight is close to the calculated ideal weight, the actual or
ideal weight can be used to calculate the dose
• However, when a patient is overweight or obese (> 30% above ideal body weight),
• dosing based on the patient’s actual weight may overdose the medication,
particularly if the drug is hydrophilic and doesn’t distribute widely into fat tissues.
• dosing a hydrophilic drug in an overweight patient based on the ideal weight may
underdose the patient.
Department of Pharmacy
IDEAL BODY WEIGHT
• However, when a patient is overweight or obese (> 30% above ideal body weight),
• dosing based on the patient’s actual weight may overdose the medication,
particularly if the drug is hydrophilic and doesn’t distribute widely into fat tissues.
• dosing a hydrophilic drug in an overweight patient based on the ideal weight may
underdose the patient.
As a result, an adjusted body weight can be calculated for hydrophilic
drugs in overweight or obese patients, which estimates that approximately
40% of the extra weight is lean body mass, into which the drug will
distribute.
Adjusted body weight = IBW + 0.4 (Actual weight - IBW)
 Factors Affecting Posology
Department of Pharmacy

Body Surface Area

Physiological systems and
body surface area are closely
related.

Route of Administration
Therapeutic effectiveness of the drug is affected by its route of delivery.
Emotional Factor
Placebo effect:a patient experiences a perceived or actual improvement in
their condition, even though they received a placebo, due to their belief in
the treatment's efficacy.
Accumulation
Problems with drug elimination can result to a hazardous level in the body.
Department of Pharmacy
Factors Affecting Posology
Environmental Factors
Effectiveness of drugs taken at a particular time of the day.
Presence of Disease
May result to toxic effects of the drugs for people with diseases.
Additive Effect
Two or more drugs taken together.
Idiosyncrasy
Extraordinary response to a drug
Synergism
Combination of drugs to increase its therapeutic effect.
Department of Pharmacy
Factors Affecting Posology
Tachyphylaxis
Acute tolerance or reduced response which is irreversible even with
increases dose.
Antagonism
Activity of the drug is countered by another drug’s action.
Tolerance
Capacity to withstand the effects of a drug through repeated dosage.
Metabolic Disturbances
Alter the effect of the drug.
Accumulation
Drugs used for a long time may produce a toxic effect.
Department of Pharmacy ISMP Acute Care Guidelines for Timely
Administration of Scheduled Medications
Scheduled medications
Include all maintenance doses administered according to a standard,
repeated cycle of frequency. (Examples: Medications given q4h, QID,
TID, BID, daily, weekly, monthly, annually)
✗ DO NOT INCLUDE
✗ STAT and Now doses
✗ First doses and loading doses
✗ One-time doses
✗ Specifically timed doses (e.g., antibiotic for surgical patient to be given a specified amount of
time before incision, drug desensitization protocols)
✗ On-call doses (e.g., pre-procedure sedation)
✗ Time-sequenced or concomitant medications (e.g., chemotherapy and rescue agents, n-
acetylcysteine and iodinated contrast media)
✗ Drugs administered at specific times to ensure accurate peak/trough/serum drug levels
✗ Investigational drugs in clinical trials
✗ PRN medications
Department of Pharmacy
ISMP Acute Care Guidelines for Timely
Administration of Scheduled Medications
Time critical scheduled medications
Includes those where early or delayed administration of maintenance doses
of greater than 30 minutes before or after the scheduled dose may cause
harm or result in substantial suboptimal therapy or pharmacological effect.
Examples of time critical scheduled medications:
Medications with a dosing schedule more frequent than every 4 hours
Scheduled (not prn) opioids used for chronic pain or palliative care (fluctuations in the
dosing interval may result in unnecessary break-through pain)
Immunosuppressive agents used for the prevention of solid-organ transplant rejection or
to treat myasthenia gravis
Medications that must be administered apart from other medications (e.g., antacids and
fluoroquinolones).
Certain medications that require administration within a specified period of time before,
after, or with meals—for example, rapid-, short-, or ultra-short-acting insulins, certain oral
antidiabetic agents (e.g., acarbose, nateglinide, repaglinide, glimepiride), alendronate,
and pancrelipase
Department of Pharmacy
ISMP Acute Care Guidelines for Timely
Administration of Scheduled Medications
Non-time-critical scheduled medications
are those where early or delayed administration within a specified
range of either 1 or 2 hours should not cause harm or result in
substantial sub-optimal therapy or pharmacological effect
Department of Pharmacy

Every
2-3 hours

q8h, q12h
Department of Pharmacy
In hospitals, when dosing times are not specified by the
prescriber, the default times in the table will be used:

Interval Standard Dosing Times

OD / q24˚ 8:00 am
HS 8:00 pm
q12˚ 8:00 am – 8:00 pm
q8˚ 8:00 am – 4:00 pm – 12:00 mn
q6˚ 6:00 am – 12:00 nn – 6:00 pm - 12:00 mn
q4˚ 4:00 am – 8:00 am – 12:00 nn – 4:00 pm – 8:00 pm – 12:00 mn

Reference: DOH National Center for Health Facilities Development (NCHFD) Hospital Pharmacy Management Manual
Department of Pharmacy
Drug Compounding
“to combine, mix of substances or alteration of dosage form or
strength or delivery system of a medicinal product tailored to the
needs and quantity of an individual; includes the combination of
two or more compounded preparation or substances”

-(Good Compounding Practice, 1st Edition, 2018)

Department of Pharmacy
Extemporaneous Compounding
• the preparation of a therapeutic product for an
individual patient in response to an identified
need.

• takes place in community and hospital

pharmacies
Mohiuddin A. K. (2019). Extemporaneous Compounding: Selective Pharmacists with Separate Skill. Innovations in pharmacy, 10(4),
10.24926/iip.v10i4.1660. https://doi.org/10.24926/iip.v10i4.1660 (Retraction published Innov Pharm. 2020 Feb 25;11(1):)
Department of Pharmacy
A compounded preparation should be
prepared only in circumstances when:
a) A registered product is unavailable in the market.
b) A registered product with similar therapeutic effect is
unavailable in the market.
c) A registered product is unsuitable (e.g. if a patient
experiencing allergy to an excipient in the registered product).
d) When undertaking research sanctioned by a recognised
human research ethics committee.
e) A treatment requires tailored dosage strengths/forms for
patients with unique needs (for example, an infant).
Department of Pharmacy Patients where compounding is
necessary:
Pediatric patients
Patients needing an oral solution or suspension of a product
with another dosage form
Patients with sensitivity to additives or inclusions in product
formulations
Dermatological formulations
Specialized dosages for therapeutic drug monitoring
Care for hospice patients
Animal care
Department of Pharmacy Compounding may include the
following:
a) Preparation of drug dosage forms for human patients
b) Modification of registered products that may require the
addition of one or more substances
c) Preparation of drugs or devices for the purposes of research
(clinical or academic), teaching, or chemical analysis.
d) Sterile preparations and preparations which require special
competencies, equipment, processes or facilities and
containing ingredients that pose occupational health and
safety hazard (such as cytotoxic or hormones).
Department of Pharmacy
Guidelines in Compounding

Pharmacists compound drugs based on the

prescriber’s requests.

Compounded products should not be sold to

other pharmacies
Department of Pharmacy
Guidelines in Compounding
The following should be strictly observed and implemented:
There should be a designated area with adequate space.
Pharmacist is responsible for the cleanliness and maintenance of the
equipment.
Not all healthcare workers can access the compounding area.
Health status should be monitored before doing the compounding
process.
Pharmacist should inspect all packaging materials and can reject if
quality does not meet the standards.
Compounding records should be maintained.
Department of Pharmacy
Guidelines in Compounding
Pharmacist should also perform the following functions:
Give information to the healthcare provider regarding the availability
of prescription and nonprescription compounding services.
Do research on other dosage forms, strengths that doctors might
request.
Communicate not only with the doctors but also to other healthcare
workers regarding compounded dosage form.
Department of Pharmacy
Guidelines in Compounding
Qualifications of Pharmacy Personnel:
Education

Training

Proficiency

Knowledgeable on the use of equipment, proper techniques,

properties of dosage forms.

Department of Pharmacy
Guidelines in Compounding
Pharmacist should:
Be knowledgeable on the physicochemical properties of the
ingredients.

Know proper handling of hazardous and nonhazardous materials.

Respond to emergency procedures in case of exposure to harmful

chemicals.

Be well-informed on the abbreviations used by the prescribers.

Be proficient in pharmaceutical calculations.
Department of Pharmacy
Guidelines in Compounding
Other Requirements in Compounding:
Clean clothing
Protective apparel
Clean laboratory gown o Goggles
Gloves
Masks
Double gowns
Foot covers
Eyewash stations
Department of Pharmacy
Guidelines in Compounding
Ingredient Standards:
 Compounding Process
Department of Pharmacy

Perform Prepare the

Analyze the compounding equipment and
Wear proper
prescription attire
calculations tools

Start Assemble all the

equipment and Make sure the
compounding ingredients as well as area is clean Wash hands
the prescription the packaging materials

Check for the following:

weight variation, Record the Clean all equipment
adequacy of mixing,
physical properties, pH,
compounded Label used as well as the
compounding area
and consistency
product
Department of Pharmacy Pharmacists should also adhere to the
following guidelines in reference to packaging,
storage, and labeling:
Check all components such as containers, closures, labeling
Materials should be properly stored
Containers should have the following characteristics: inertness,
visibility, strength, rigidity, protection from moisture, ease of
reclosure, and economy of packaging
Plastic containers that meet USP 34/ NF 29 standards can be used
Chemicals should be stored in tightly closed containers at room
temperature
Chemicals should be stored on shelves
Temperature for storage is based on USP 34/ NF 29 monographs
Department of Pharmacy
Labeling:
Generic name of the drug product should be placed on the
label if a commercial drug product is used as the source of the
drug.
Inactive ingredients should also be listed on the label.
The following should also be included in the label:
Complete list of the ingredients
Date prepared
Assigned beyond use date
Appropriate testing
Control numbers
Department of Pharmacy
Other Terms used in Compounding:
Stability
Extent to which the dosage form retains the properties and characteristics.

Beyond-Use Date
Date when the prescription should no longer be used.

Expiration date
Date set by the manufacturer wherein it can no longer guarantee the
strength and safety of the medication.
Department of Pharmacy Records to be accomplished in
compounding prescriptions:
Formulation records
Compounding records
SOPs
Record of the ingredients