MODULE 1 LESSON 1: INTRODUCTION ………...
(2) Non-Prescription Drugs
● George Urdang - first person to study
today’s prescription
● PRESCRIPTION
- “Prae” + “Scribo”
- Before + I write
- Identifies medication to be dispensed
- A medication order written by a physician,
dentist or other licensed medical
practitioner and given to the patient for
presentation to the pharmacist.
- contains a specific medication and
dosage to be administered to a particular
patient at a specified time.
- Can be written by a pharmacist in
pursuant of the prescriber’s instruction
PHILIPPINES REGULATORY CLASSIFICATION
(1) Dangerous Drugs Prescription
- Yellow prescription
- Prescriber/M.D. is licensed by PDEA
(2) EDD Prescription
- For prohibited/regulated drugs
- Ordinary prescription is used
- Prescriber/M.D. should have a S-2 license
issued by PDEA
(3) Rx
- Ordinary prescription (antibiotics)
(4) Non-Rx
- OTC
TYPES OF MEDICATION BASED ON
PRESCRIPTION REQUIREMENTS: ……………….
(1) Prescription Drugs
- Ethical or Legend drugs
- pharmaceutical products or drug
preparations that are to be dispensed only
upon written order of a validly registered
physician, dentist or veterinarian for the
management or treatment of a condition or
disease (ex: antibiotics)
- Ordinary prescription with Rx symbol
- Over-the-counter drugs (OTC)
- Are pharmaceutical products or drug
preparations that can be dispensed even
without the written order of a validly
registered licensed physician, dentist or
veterinarian, for the use of consumers for
the prevention or symptomatic relief of
minor or self-limiting ailments
(3) Dangerous Drugs
- pharmaceutical products referring to either
prohibited or regulated drugs which require
a special prescription form usually obtained
from the Dangerous Drugs Board.
- Comprehensive Dangerous Drugs Act of
2002 (Republic Act No. 6425)
- Yellow Rx
- e.g midazolam, fentanyl, meperidine
- 2 TYPES OF DANGEROUS DRUGS:
- PROHIBITED:
➢ opium and its active derivatives
(heroin, morphine),
➢ coca leaf and its derivatives
(cocaine, LSD)
➢ Has physiological effect of a
narcotic drug
- REGULATED
➢ Sleep inducing drugs “-barbitals”
➢ Isomers of amphetamine
➢ Hypnotic drugs like methaqualone
(4) Regulated Drugs
OTHER CLASSIFICATION OF PRESCRIPTION: ...
(1) Polypharmacal Prescription
- 10 or more drugs of the same
pharmaceutical use; “shotgun Rx”
(2) Magistral Prescription
- Very often prescribed by the same M.D. of
the same ingredients and compounded by
the same pharmacist
(3) Coded Prescription
- Lined prescription
SOME DIFFERENT TYPES OF MEDICATION
ORDERS: ………………………………………….,.
(1) Copy if written prescription
(2) Written order on consultation form
(3) Written list of medication order signed by
the practitioner
(4) Copy of pharmacy call in order given by the
Inscription
pharmacist
- name of medication, strength and dosage
(5) Verbal order given by a licensed person
form
(6) Electronic prescription signed electronically
- Generic name is priority over brand name

MODULE 1 LESSON 1:............................................

PARTS OF THE PRESCRIPTION…………………...

Subscription
- the quantity of the product prescribed;
amount to be dispensed
Patient’s Information
- Instruction for pharmacist
- name and address of the patient
- Communication between pharmacist (ex:
- AGE: Is the patient a child, adult or an
partial dispensing)
elderly?
- SEX: appropriateness of medication, some
medications are intended for male only
(sildenafil) or female only (birth control pills).

Transcription/Signa
- the directions for use; instruction for patient

Date YELLOW PRESCRIPTION

- Check date for validity and to avoid - Prescription number at the upper right
prescription recycling corner
- Important for validity and in establishing a - Date of Prescription
patient's medical records. - COMPLETE patient information must be
written (Name, Age, Address, Sex)
- Physician’s COMPLETE informations must
also be indicated (Name, Address,
Superscription Contact#, PRC and S2 license No. and
- From sign of Jupiter Date of issue) for legitimacy
 - Content of Prescription: Generic name +
brand name
- Specific instructions should be written out
(bawal yung ‘as needed’)
- NO REFILL
PRESCRIPTION ABBREVIATIONS (from canvas)
1. The word UNIT must always be written out.
2. Mcg is the acceptable abbreviation for
microgram because the symbol ug can
easily be read as mg.
3. Every other day should be written out not
o.d.
4. SC or SQ with the intended meaning of
subcutaneous could be misinterpreted as
SL, meaning sublingually.
5. I.W., meaning 3x/week has been misread
as 3x/day or misinterpreted 2x/week
6. When the same symbols have more than
one meaning, misinterpretation may result.
Common examples include D/C, which can
mean either discontinue or discharge; HS,
which can mean either at bedtime or
half-strength; and IVP, which can mean IV
push or Intravenous pyelogram.
7. au, as and ad, which mean, respectively,
both ears, left ear and right ear, have been
misread or misinterpreted as ou, os and
od, meaning both eyes, left eye and right
eye.
8. When writing whole numbers for
medications strengths or dosages, never
add a decimal point without a trailing
zero. That is, write 25 mg, not 25.0 mg.
9. When writing a decimal fraction for a
number less than one, always precede the
decimal point with a zero. 0.25 mg, not
.25 mg.
10. When writing or typing the names,
strengths and units of drugs, do not omit
the spaces between the words, unit
abbreviations, or set of numbers. For
example, write Propranolol 40 mg, not
Propranolol 40mg or Propranolol40mg.
11. Avoid the symbols / and &, because the
symbol / can be taken for a number 1, and
the & symbol, when handwritten, can look
like the number 4.
MODULE 1 LESSON 1.2:.........................................
PROCESSING OF PRESCRIPTION …………….
ERRORS IN PRESCRIPTION
(1) Erroneous Prescription
- Brand name precedes generic name
- (Generic name) is in parenthesis
- Brand name is not in parenthesis
- STILL ALLOWED TO DISPENSE
(2) Violative Prescription
- Generic name is not written
- Generic name is not legible but brand name
is legible
- Both are written but with word “NO
SUBSTITUTION”
- DO NOT DISPENSE / SHALL NOT BE
FILLED
 (3) Impossible Prescription - Age, weight, frequency, possible drug
- Only generic name is written but not legible interactions must be checked
- Generic name does not match with brand - Partial filling- always subtract amount
name (ex. Mefenamic acid (Himox), bought and note the date; note if fully
Paracetamol (Neozep), etc.) served (FS)
- Both written – both not legible
- Drug is not registered with DOH LABELING …………………………………..…………
- DO NOT DISPENSE / SHALL NOT BE - Primarily intended for drug products which
FILLED are not in their original containers and are
TRANSFERRED
PROCESSING THE PRESCRIPTION …………… - For loose tablets (ex. Isordil [isosorbide
dinitrate])
Important Considerations In Dispensing - Labelling = professionalism of the
Prescription: pharmacist; must be legible
● ALWAYS DOUBLE CHECK
IMPORTANT INFORMATION IN A LABEL
(1) Is the prescription legal? ● name and address of pharmacy
- Date ● patient’s name
- Physician’s signature/Information ● name and strength of medication
- S-2 license if yellow prescription ● direction for use
● manufacturer lot number
(2) Who is it for? ● expiration date
- Age: Adult? Child? Elderly? ● name and initial of dispensing pharmacy
- Dosage strength and form appropriateness;
- Is the dosage form given appropriate PREPARING THE PRESCRIPTION ………………
(syrup/tablet; considering if the patient can A. Dispensing
swallow)? - Take note of the dosage strength; some
- Is the dosage strength enough medications have different dosages
(under/overdose)? available (ex. Enoxaparin Sodium
60/40/20mg)
(3) What is the name of the medication? B. Compounding
- Always check the: - Pharmacist must take into consideration
● Generic Name the physical and chemical incompatibilities
● Milligram
● Dosage Form PACKAGING ……………………………………..……
- The product in the prescription must be the - Based on the type and quantity of the
product dispensed medication and use or method used in
preparation
(4) What are the instructions for the - Must protect from air, moisture and
patients? contaminants
- Avoid using abbreviations because patient ● Round Vials
may not be familiar - solid dosage forms
- Amount and frequency must be noted and ● Prescription Bottles
checked - liquid dosage forms
 ● Wide Mouth Bottles
- bulk powders
- large quantity of capsules
- Viscous liquids that cannot be
poured readily
● Dropper Bottles
- Ophthalmic, Nasal, Otic, and oral
● Collapsible Tube and Ointment Jar
- Semi-solid dosage forms
● Sifter Top Containers
- Powders applied by sprinkling
● Hinged Lid Containers
- Suppositories
- Powders in packets
● Aerosol Containers
- Pharmaceutical aerosol products
RECHECKING………………..…………………..……
✓ Before getting from the shelf
✓ While preparing the product
✓ When returning the container
✓ Before dispensing the medication
CONSIDERATIONS IN WHILE CHECKING
MEDICINES:
SALADs
Sound-Alike Look-Alike Drugs
Factors contributing to SALAD errors:
● Quantity of Drug Names
● Generic and Brand Names
● Spelling Errors
- Clotrimazole can be misspelled as
Cotrimoxazole and the other way
around
● Combination products
- Fosavance 70 mg/5600I.E or 70 mg/
2800I.E
- Seretide (has different dosage
forms; inhaler and diskus
● Different formulation of the same active
drug
- Ambroxol is available in sustained
release (24hrs), plain tablet, and
syrup.
● Different strength of the same drug
- Warfarin is available in 6 dosage
strengths
● Illegible handwriting
DRESS your SALAD
✓DOUBLE CHECK
✓READ THE LABEL
✓EMPHASIZE
✓SET APART (different location of SALADs)
✓SPREAD AWARENESS
HAM: High Alert Medications ……………………
● Insulin
● Opiates and Narcotics
● Injectable Potassium Chloride (or
Phosphate) concentrates
● Intravenous Anticoagulants (ex. Heparin)
● Sodium Chloride above 0.9%
SPICE your HAM
➔ SEPARATE
➔ PULL OUT
➔ IDENTIFY
➔ COMPARE & CONFIRM
➔ ENSURE
COMPOUNDED PREPARATIONS:
✓Double check the prescription / Medication
Order
✓ Calculation
✓ In process materials / Components
✓ Label
✓Final Product
ALWAYS CHECK THE:
- Medication order
- Medication to be filled
- Allergies, possible drug interaction,
incompatibilities
Always ask for ANOTHER PERSON to do recheck.
DELIVERING AND PATIENT COUNSELING ……..
● Tell the patient the name, indication, and
route of administration of the medication.
● Ask the patient if he/she will have a
problem taking the medication as
prescribed.
● 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 medication.
● Emphasize the benefits of the medication.
● Discuss major side effects of the drug.
● Point out that additional, rare side effects
are listed in the information sheet.
● Discuss precautions and beneficial
activities
● Check and discuss drug interactions
MODULE 1 LESSON 2: ……...……………………..
DRUGS THAT SHOULD NOT BE CHEWED, …..
CRUSHED or OPENED ……….…………..………..
Abbreviations:
● CR/Chrono = controlled release
● CRT = controlled release
● EC/EN = enteric coated
● LA = long acting
● MR/Retard = modified release
● SA = sustained action
● SR/Dur/Dural = sustained release
● XL/XR = extended release
DO NOT CHEW
“Seniors Erroneously Crush Enter-Coated
Laxatives”
● Changing the dosage form on how it is
presented (cutting/dividing) can result in
instability, etc.
● “Do not rush to crush”
● Never crush/open a tablet without checking
if it is safe to do so
● Check the information leaflet
● Crushing a whole dose and taking it
immediately has no problem as long it is
consumed ASAP
● HALVING doses can cause accuracy
problems (not equally cut); always use a
tablet cutter
Consequence of crushing, opening or chewing
oral medication?
● ABSORPTION
- Effect pharmacokinetic properties
● DRUG INSTABILITY
- Nifedipine - light sensitive; can
result to formation of inactive form:
nifedipine->dehydronifedipine->di
hydronitrosononifedipine
 - Dulcolax - chewing will cause ● UNACCEPTABLE TASTE
uncomfortable gastric spasms; if px - Sugar coating tablets due to bitter
can’t swallow suggest suppositories taste
- Crushing will cause lesser desired - Ibuprofen, quinine, iron supplements
clinical effect
DIFFERENT DOSAGE FORM EFFECTS …………
● FAILURE TO REACH SITE OF ACTION
- Common on enteric coated tablets Modified release medicines
- Enteric coated tablets protect: - Frequently identifiable by two letters such
1. Drug from acidity as m/r, LA, SA, CR, XL or SR at the end of
2. Stomach from effects of the the name.
drug - Words such as "Retard" or "Slow" in the
3. Drug until it reaches site of title sometimes used instead.
action - Alteration of such drugs can cause high/low
absorption
● PRODUCE IRRITANT EFFECT - Usually taken once a day and utilizes
- Diclofenac sodium: gastric irritation MUPS (multi unit pellet system)
- Alendronate: mucosal irritation / - Examples:
ulceration Verapamil M/R
Propranolol
● OCCUPATIONAL HEALTH AND SAFETY Felodipine
ISSUE Diclofenac
- When some tablets are crushed
-Omeprazoles;
some are carcinogenic (cancer
causing) or teratogenic (harmful for
Enteric coated medicines
fetus)
- Usually identifiable by the two letters EN or
- Tamoxifen - carcinogenic
EC at the end of the name.
- Valcyte/Valganciclovir- teratogenic
- Medicine designed not to be released in the
- Birth control pills, hormonal
stomach but in the small intestine.
replacement therapy, corticosteroid
(dexamethasone), mycophenolate,
Film or sugar-coated medicines
finasteride
- Disruption of the film or sugar coating on
drugs may result in rapid degradation of the
● CHANGES IN PHARMACOKINETICS AND
active ingredient, poor tasting medicines
BIOAVAILABILITY
which may be more difficult to swallow.
- Alteration can cause overdosing or
underdosing
- Lanoxin - when crushed can either
cause bradycardia/tachycardia
- Pradaxa - anticoagulant; when
crushed can increase drug
absorption can cause bleeding
 MODULE 1 LESSON 2.2: ……...………………….. General Rules:
DRUGS THAT SHOULD AND SHOULD NOT BE Follow the instructions you receive with
.TAKEN WITH FOOD ……….………….…...……….. your Medicine.
Medicines that are supposed to be taken
MEDICINE / DRUG on an empty stomach should be taken
- a compound or preparation used for the about an hour before a meal, or 2 hours
treatment or prevention of disease, after a meal.
especially a drug or drugs taken by mouth Forgetting these instructions on rare
occasions is unlikely to do any harm,but
● Drug-Food Interactions can result to taking these medicines with food regularly
adverse drug reaction may mean they don't work.
● Drug Interaction - a substance affects the
drug by increasing/decreasing the effect or
MEDICINE EMPTY/FULL
by producing a new effect
Acarbose Taken on the first bite of each
“High Risk of Treatment Failure Arising From meal
Fed State”
Alendronate EMPTY STOMACH
- Body is absorbing and digesting; gastric
acid is high Ampicillin EMPTY STOMACH
- Can reduce bioavailability of drug, reducing
absorption Amlodipine EMPTY / FULL STOMACH
- Chelation can happen
Ascorbic acid EMPTY / FULL STOMACH
**bioavailability - ability of drug to be absorbed in
the body Aspirin FULL STOMACH

Azithromycin EMPTY STOMACH

EXAMPLES:
Bisacodyl EMPTY STOMACH
● Grape Juice + Cilostazol (Clazol)
= purpura rash Captopril EMPTY STOMACH
*** cilostazol is a platelet aggregator Digoxin EMPTY STOMACH

● Lovastatin + Food Erythromycin FULL STOMACH

● Rosuvastatin + NO FOOD
Griseofulvin FULL STOMACH

● Ciprofloxacin + NO FOOD Metformin FULL STOMACH

= if taken w/ food it may cause chelation
Metoprolol FULL STOMACH

● Ibuprofen (Advil) + Food Omeprazole EMPTY STOMACH

= Increased absorption
● Paracetamol (Biogesic) + NO FOOD Paracetamol EMPTY STOMACH
= if taken w/ food, less absorption Rosuvastatin EMPTY / FULL STOMACH