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Author: Michael Thompson, Ph.D.

1. Prescription Writing and DEA Drug Schedules

1.1. Prescription Writing

  1. You may legally prescribe only those drugs appropriate to your practice (i.e., you may not legally prescribe drugs to treat a vaginal yeast infection).
  2. Know the patient, patient's history, current medications and disease status. (Don't prescribe as a "favor" for someone.)
  3. Prescribe only those drugs with which you are familiar. Do not allow the patient to prescribe for you.
  4. Use the metric system.
  5. Use generic names unless the prescribed item is a fixed combination.
  6. Do not abbreviate.
  7. Write clear and complete instructions in English and in ink. Do not use "as directed."
  8. Prescribe the correct quantity, e.g., 7-10 day supply for most full-course antibiotic therapies; 2-3 day course of analgesics and/or sedatives.
  9. Prescribe a reasonable number of refills, including zero (third-party payors may limit the number of refills).
  10. Prescribe real-world doses, i.e., doses that are both correct and measurable. (It's tough to give half a capsule.)
  11. Maintain records of what you prescribe.
  12. Establish a good rapport with the patient and explain how to use the prescribed medication.
  13. Communicate telephone orders directly and clearly to a pharmacist when telephoning prescriptions.
  14. Instruct the patient to
    • Take the drug as prescribed.
    • Read the label on the prescription container.
    • Store drugs properly.
    • Discard after one year.
  15. Store controlled substances appropriately and keep necessary records.
  16. Establish a rapport with a pharmacist and use him/her as an information source.

1.1.1. Elements of a prescription include:

Patient's name, address, and age:

Print clearly where indicated

Date:

State requirements vary, but most prescriptions must be filled within 6 months

Rx (Recipe):

Drug name, strength, and type usually listed as the generic name, and if you specifically want a brand name you must designate "no substitution." Rx is from the Latin for "recipe." List the strength of the product (usually in mg) and the form (e.g., tablets, capsule, suspension, transdermal).

Dispense:

Amount of drug (number of capsules), or time period (1 month supply, etc.)

Refills:

Indicate how many times that drug can be refilled

Substitution:

Can a generic drug be used instead of the one prescribed

1.1.2. Frequently used abbreviations

T
one
PO
by mouth
qd
daily
PRN
as needed
qhs
every night at bedtime
q6h
every six hours
qid
four times a day
Distinction between q6h and qid
qid and q6h are not the same orders. qid means that the medication is given four times a day while awake (e.g., 8 am, 12 noon, 6 pm, and 10 pm). q6h means that the medication is given four times a day, but by the clock (e.g., 6 am, 12 noon, 6 pm, and 12 midnight).

1.1.3. Sample prescription

Sample prescription

The prescription contains

  1. Prescriber's name, address, telephone number
  2. Patient's name, age, address, date
  3. Drug
  4. Directions
  5. Quantity
  6. Refills
  7. DEA #
  8. INTERCHANGE is mandated unless the practitioner writes the words "NO SUBSTITUTION" in this space

1.2. DEA Drug Schedules

Schedule I Heroin, marijuana
No proven therapeutic indication
Significant abuse potential
No FDA approval
Usually used only for research purposes
Schedule II Narcotics and amphetamines
Limited therapeutic indications
High abuse potential
FDA-approved clinical indications
Records: receipt and dispensing at pharmacy and physician's office; need special order forms; need DEA number to prescribe; no refills; emergency telephone orders (prescriptions) only
Schedule III/IV Opiate-like drugs, e.g., pentazocine, propoxyphene, drug combinations
Limited therapeutic applications
Lower, but real abuse potential
FDA-approved indications
Records: Need DEA number to prescribe; maximum of five refills in 6 months
Schedule V Formerly "exempt narcotics," i.e., Terpin Hydrate and Codeine
Codeine-containing cough preparations
Limited abuse potential
Records: Need DEA number; maximum of five refills in 6 months
Laws and regulations vary by state
Schedule VI Only in Massachusetts
All prescription "legend" drugs. Legend refers to the FDA-required statement, "Caution-Federal Law Prohibits Dispensing Without a Prescription"