Category : Science and Education
Archive   : DRUGMAN.ZIP
Filename : INTRO-2

II.DRUG PRESCRIBING.
After the best drug has been selected and a therapeutic
regimen designed, a chart order (for patients in the hospital)
or prescription (for outpatients) must be written.
* Chart orders must contain the date, the drug, the dosage to be
administered, and the name of the physician writing the or-
der. Normally every page in the chart is stamped with the
name of the patient to reduce the possibility of the wrong
patient receiving the drug. It is good practice (most would
consider it essential) to specify the duration of therapy,
ie, total number of doses or days of treatment. Orders to run
indefinitely should be avoided and in many hospitals are sub-
ject to automatic stop orders. Most hospitals have a pharmacy
committee that determines for each drug whether generic or
the more expensive proprietary formulations are to be stocked
as well as other matters pertaining to drug use. Such in-
formation is usually found in the official formulary of the
institution.



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* Prescriptions must contain the patient's name and address,
the prescriber's name and identifying information, and the
name and dosage form of the drug, the amount to be dispensed,
and directions to the patient for use. Formulation size or
concentration should be specified in metric units. For con-
trolled drugs (drugs regulated by ``narcotics laws''), the
prescriber's DEA (Drug Enforcement Agency) license number
must be displayed. In some states, special prescription
blanks must be used for Class II agents (the most rigidly
controlled drugs, see . The prescriber should al-
ways provide his printed name, address, and telephone number
in addition to his signature, in case the pharmacist needs to
reach him. In many states, the law permits the pharmacist to
substitute a generic equivalent for the named drug unless the
prescription bears a ``as written'' or ``no substitution''
flag. Thus, the cheaper generic forms of hydrochlorothiazide
could legally be substituted for Hydrodiuril(tm) at a cost
savings of about 50% to the patient.



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This flexibility does not, however, extend to the substitution of
a congeneric compound, eg, hydrochlorothiazide for polythiazide,
even though the pharmacologic effect would be identical. The
therapeutic equivalence of trademarked and generic drugs is
monitored by the FDA and the results published (Approved Drug
Products With Therapeutic Equivalence Evaluations, 1985, and updates).
Finally, it is good practice to explicitly specify the number
of refills to be permitted for all drugs (this is required
for controlled drugs).

Prescribing categories.
The tables in this book list prescribing codes for each
drug. These codes are in the form ``controlled drug category;
pregnancy safety category.'' The classification of the drug un-
der the controlled substances act (``narcotics laws'')
determines the type of prescription form that must be used, the
number of refills permitted, etc.




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This system is summarized in .
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If a drug is available to the public without pres-
cription (``over the counter''), it is coded ``otc.'' If it is a
prescription item, but not controlled under the narcotics laws,
it is listed as an ``Rx'' item. If the drug is covered under the
narcotics laws, the control level (C-II,III,IV, or V) is shown.
This designation, therefore, is of considerable direct legal
significance for every prescription written. The second part of
the code is the FDA pregnancy prescribing category and is based
on the definitions given in . The pregnancy category
is an attempt to codify the benefit-risk aspects of the use of
a given drug during pregnancy. Its legal significance is in the
implicit liability involved if the drug is so used and a mal-
practice suit results.
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Follow-up after the patient has received the prescription.

The prescriber's responsibility continues long after writ-
ing the prescription. He or she must then determine whether the
patient is taking the drug, monitor the response to establish
whether the drug is accomplishing its therapeutic goals, and de-
cide when to discontinue or modify the therapy.

References
1. Drug Topics RedBook, Medical Economics, Inc, 1986, 1987.
2. Facts and Comparisons, JP Lippincott, 1987.
3. Generic drugs. Med Lett 1986;28:1.
4. Hospital Formulary, 1985-1987. University of California Hos-
pitals and Clinics, 1985.
5. Hansten, PD: Drug Interactions, 5th edition, Lea & Febiger,
1985.
6. Katzung BG, ed: Basic & Clinical Pharmacology, Appleton &
Lange,third edition, 1987.
7. Krupp MA, Schroeder SA, Tierney LM, jr: Current Medical Diag-
nosis & Treatment, Appleton & Lange, 1987.

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8. Prescription practices and regulatory agencies. Chapter 1 in
AMA Drug Evaluations, 6th ed, 1986, pp 1-11.
9. USP DI: Drug Information for the Health Care Provider. Sixth
ed. United States Pharacopeial Convention, Inc, 1986.
















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