chapter 1: information, sources, regulatory agencies, drug legislation, and prescription writing...

Chapter 1:Chapter 1:

Information, Sources,Information, Sources,Regulatory Agencies,Regulatory Agencies,Drug Legislation, andDrug Legislation, andPrescription WritingPrescription Writing

Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

22Copyright © 2011, 2007 Mosby, Inc., an affiliate of Elsevier. All rights reserved.

Chapter 1 OutlineChapter 1 Outline

Information, Sources, Regulatory Agencies, Information, Sources, Regulatory Agencies, Drug Legislation, and Prescription WritingDrug Legislation, and Prescription Writing HistoryHistory Pharmacology and oral health care providersPharmacology and oral health care providers Sources of informationSources of information Drug namesDrug names Federal regulations and regulatory agenciesFederal regulations and regulatory agencies Clinical evaluation of a new drugClinical evaluation of a new drug Drug legislationDrug legislation Prescription writingPrescription writing


Information, Sources, Regulatory Information, Sources, Regulatory Agencies, Drug Legislation, and Agencies, Drug Legislation, and

Prescription WritingPrescription Writing Haveles (p. 2)Haveles (p. 2)

Pharmacology Pharmacology Derived from Greek prefix Derived from Greek prefix pharmaco-pharmaco-, meaning , meaning

“drug” or “medicine,” and Greek suffix “drug” or “medicine,” and Greek suffix -logy-logy, , meaning “study”meaning “study”

Dorland’s Illustrated Medical DictionaryDorland’s Illustrated Medical Dictionary Any chemical compound used on or administered Any chemical compound used on or administered

to humans or animals as an aid in the diagnosis, to humans or animals as an aid in the diagnosis, treatment, or prevention of disease or other treatment, or prevention of disease or other abnormal condition, for the relief of pain or abnormal condition, for the relief of pain or suffering, or to control or improve any physiologic suffering, or to control or improve any physiologic or pathologic conditionor pathologic condition

cont’d…cont’d…


Information, Sources, Regulatory Information, Sources, Regulatory Agencies, Drug Legislation, and Agencies, Drug Legislation, and

Prescription WritingPrescription Writing These definitions are not completeThese definitions are not complete

Birth control pills are indicated for treatment of Birth control pills are indicated for treatment of which disease?which disease?

A large group of substances (drugs?) have A large group of substances (drugs?) have been categorized as “dietary supplements”been categorized as “dietary supplements” These substances may have pharmacologic These substances may have pharmacologic

effects on the body, but by law are effects on the body, but by law are not not classified classified as drugsas drugs

This classification avoids U.S. Food and Drug This classification avoids U.S. Food and Drug Administration (FDA) approval for efficacy and Administration (FDA) approval for efficacy and safety required for drugssafety required for drugs


HistoryHistory

Haveles (pp. 2-3)Haveles (pp. 2-3) Certain plants were found to alter body Certain plants were found to alter body

functions or awarenessfunctions or awareness Observations were made about which plant Observations were made about which plant

products produced predictable results products produced predictable results Useful agents are prescribed and dispensed Useful agents are prescribed and dispensed

through medicine, dentistry, pharmacy, and through medicine, dentistry, pharmacy, and nursingnursing


Pharmacology and Oral Health Pharmacology and Oral Health Care ProvidersCare Providers

Haveles (pp. 3-4) (Table 1-1)Haveles (pp. 3-4) (Table 1-1) Competencies are tasks that oral health care Competencies are tasks that oral health care

providers should be able to performproviders should be able to perform To perform each competency, certain facts or To perform each competency, certain facts or

concepts must be accessedconcepts must be accessed Decisions that surround performing a competency Decisions that surround performing a competency

depend on depend on foundation knowledgefoundation knowledge Thought, facts, reasoning, and problem solving Thought, facts, reasoning, and problem solving

are involved in making decisions about each are involved in making decisions about each patientpatient



Pharmacology and Oral Health Pharmacology and Oral Health Care ProvidersCare Providers

Haveles (pp. 3-4)Haveles (pp. 3-4) Knowledge of pharmacology is required to Knowledge of pharmacology is required to

perform functions such asperform functions such as Obtaining a health historyObtaining a health history Administering drugs in the officeAdministering drugs in the office Handling emergency situationsHandling emergency situations Planning appointmentsPlanning appointments Nonprescription medicationNonprescription medication Nutritional or herbal supplementsNutritional or herbal supplements Discussing drugsDiscussing drugs Life-long learningLife-long learning


Sources of InformationSources of Information

Haveles (pp. 4-6) (Tables 1-2, 1-3)Haveles (pp. 4-6) (Tables 1-2, 1-3) Sources include reference texts, association Sources include reference texts, association

journals, and the Internetjournals, and the Internet Each publication may be judged on lack of bias, Each publication may be judged on lack of bias,

publication date, readability, degree of detail, and publication date, readability, degree of detail, and priceprice

Every dental office should have at least one Every dental office should have at least one reference book that lists names of both reference book that lists names of both prescription and over-the-counter (OTC) prescription and over-the-counter (OTC) drugsdrugs A standard pharmacology textbook would be A standard pharmacology textbook would be

helpful in understanding the reference bookshelpful in understanding the reference books


Selected Drug Information Selected Drug Information ReferencesReferences

Haveles (p. 5) (Table 1-2)Haveles (p. 5) (Table 1-2) American Health-Systems Formulary ServiceAmerican Health-Systems Formulary Service United States Pharmacopeia-Drug Information United States Pharmacopeia-Drug Information

(USP DI)(USP DI) Drug Facts and ComparisonsDrug Facts and Comparisons Physicians’ Desk Reference (PDR)Physicians’ Desk Reference (PDR) Handbook of Nonprescription Drugs: An Handbook of Nonprescription Drugs: An

Interactive Approach to Self-Care (OTC Interactive Approach to Self-Care (OTC Handbook)Handbook)

PDR for Nonprescription Drugs, Supplements, PDR for Nonprescription Drugs, Supplements, and Herbsand Herbs



Selected Drug Information Selected Drug Information ReferencesReferences

PDR for Herbal MedicinesPDR for Herbal Medicines Natural Products: A Case-Based Approach Natural Products: A Case-Based Approach

for Health Care Professionals for Health Care Professionals Merck Manual for Medical InformationMerck Manual for Medical Information Drug Interaction FactsDrug Interaction Facts Mosby’s Dental Drug ReferenceMosby’s Dental Drug Reference Lexi-Comp’s Drug Information Handbook for Lexi-Comp’s Drug Information Handbook for

DentistryDentistry Goodman and Gilman’s The Pharmacologic Goodman and Gilman’s The Pharmacologic

Basis of TherapeuticsBasis of Therapeutics


United States Pharmacopeia-Drug United States Pharmacopeia-Drug Information (USP DI)Information (USP DI)

Volume 1: Drug Information for the Health Volume 1: Drug Information for the Health Care ProviderCare Provider Provides the health professional with necessary Provides the health professional with necessary

information regarding basic pharmacology and information regarding basic pharmacology and pharmacokinetics, dosing, adverse reactions, and pharmacokinetics, dosing, adverse reactions, and drug interactionsdrug interactions

Volume 2: Advice for the PatientVolume 2: Advice for the Patient Includes appropriate information on Includes appropriate information on

pharmacology, pharmacokinetics, dosing, adverse pharmacology, pharmacokinetics, dosing, adverse reactions, and drug interactionsreactions, and drug interactions


Physician's Desk Reference Physician's Desk Reference (PDR)(PDR)

Most common reference book in the dental Most common reference book in the dental officeoffice Information provided comes directly from the Information provided comes directly from the

manufacturer’s package insert manufacturer’s package insert Manufacturers are listed alphabeticallyManufacturers are listed alphabetically Drugs are listed alphabetically within each Drugs are listed alphabetically within each

manufacturer’s sectionmanufacturer’s section


Mosby’s Dental Drug ReferenceMosby’s Dental Drug Reference

Drugs are presented alphabetically by Drugs are presented alphabetically by generic name generic name Includes indications, contraindications, dental Includes indications, contraindications, dental

considerations, and pharmacologic classificationconsiderations, and pharmacologic classification An alphabetic cross-index offers access to both An alphabetic cross-index offers access to both

brand and generic name drugsbrand and generic name drugs


Lexi-Comp’s Drug Information Lexi-Comp’s Drug Information Handbook for DentistryHandbook for Dentistry

Contains concise lists of drug attributes and Contains concise lists of drug attributes and sections relevant to dentistry for each drugsections relevant to dentistry for each drug Each monograph contains up to 32 fields of Each monograph contains up to 32 fields of

information, including dosage, local information, including dosage, local anesthetic/vasoconstrictor precautions, drug anesthetic/vasoconstrictor precautions, drug interactions, and effects on dental treatmentinteractions, and effects on dental treatment


Drug NamesDrug Names

Haveles (pp. 4, 6)Haveles (pp. 4, 6) All drugs have at least two names, and many All drugs have at least two names, and many

have morehave more Chemical nameChemical name

• The name determined by the chemical structure of the The name determined by the chemical structure of the compoundcompound

• A code name may be used as wellA code name may be used as well




Trade nameTrade name• The name given if a compound is found to be useful and The name given if a compound is found to be useful and

if the determination is made that it will be marketedif the determination is made that it will be marketed• Capitalized, usually chosen so it can be easily Capitalized, usually chosen so it can be easily

remembered and promoted commerciallyremembered and promoted commercially• Registered as a trademark, property of the registering Registered as a trademark, property of the registering

company company • Protected by Federal Patent Law for 20 yearsProtected by Federal Patent Law for 20 years




Generic nameGeneric name The “official” nonproprietary name given the drug The “official” nonproprietary name given the drug

before it is marketedbefore it is marketed Each drug has only one generic nameEach drug has only one generic name Selected by the U.S. Adopted Name Council Selected by the U.S. Adopted Name Council

(USAN)(USAN) Not capitalizedNot capitalized




Haveles (p. 6) (Fig. 1-1)Haveles (p. 6) (Fig. 1-1) ExampleExample

Generic name: LidocaineGeneric name: Lidocaine• Only one nameOnly one name

• First letter lowercaseFirst letter lowercase

Trade name: Xylocaine, OctocaineTrade name: Xylocaine, Octocaine• More than one nameMore than one name

• First letter capitalizedFirst letter capitalized




Haveles (p. 4)Haveles (p. 4) After the original manufacturer’s patent After the original manufacturer’s patent

expires, other companies can market the expires, other companies can market the generic drug under a trade name of their generic drug under a trade name of their choosingchoosing When a patient states an allergy to a particular When a patient states an allergy to a particular

trade name of a drug, the practitioner must know trade name of a drug, the practitioner must know the generic name of the drug so the patient is not the generic name of the drug so the patient is not given another brand of the same generic druggiven another brand of the same generic drug



Drug NamesDrug Names This book uses generic names because only This book uses generic names because only

one generic name is given for each drugone generic name is given for each drug Trade names (proprietary names) appear in Trade names (proprietary names) appear in

parentheses after the generic nameparentheses after the generic name A problem occurs in naming multiple-entity A problem occurs in naming multiple-entity

drugsdrugs These drugs are difficult to discuss by generic These drugs are difficult to discuss by generic

name because they contain several ingredientsname because they contain several ingredients


Drug SubstitutionDrug Substitution

Haveles (p. 6)Haveles (p. 6) The question of generic equivalence and The question of generic equivalence and

substitution arises in the discussion of substitution arises in the discussion of generic and trade namesgeneric and trade names After 17 years, the patent of the original drug After 17 years, the patent of the original drug

expires, and other companies can market the expires, and other companies can market the same compound under a generic namesame compound under a generic name



Drug Substitution Drug Substitution

In 1984, Congress passed the Drug Price In 1984, Congress passed the Drug Price Competition and Patent Term Restoration Competition and Patent Term Restoration Act, which allowed generic drugs to receive Act, which allowed generic drugs to receive expedited approvalexpedited approval The FDA still requires the active ingredient of the The FDA still requires the active ingredient of the

generic product to enter the bloodstream at the generic product to enter the bloodstream at the same rate as the trade name productsame rate as the trade name product




Drugs can be judged “similar” in several waysDrugs can be judged “similar” in several ways When two formulations of a drug meet the chemical When two formulations of a drug meet the chemical

and physical standards established by the regulatory and physical standards established by the regulatory agencies, they are termed agencies, they are termed chemically equivalentchemically equivalent

When the two formulations produce similar When the two formulations produce similar concentrations of the drug in blood and tissues, they concentrations of the drug in blood and tissues, they are termed are termed biologically equivalentbiologically equivalent

When the two formulations prove to have an equal When the two formulations prove to have an equal therapeutic effect in a clinical trial, they are termed therapeutic effect in a clinical trial, they are termed therapeutically equivalenttherapeutically equivalent




A preparation can be chemically equivalent A preparation can be chemically equivalent yet not biologically or therapeutically yet not biologically or therapeutically equivalentequivalent These products differ in bioavailabilityThese products differ in bioavailability

Before generic drugs are marketed, they Before generic drugs are marketed, they must be shown to be biologically equivalent, must be shown to be biologically equivalent, which would make them therapeutically which would make them therapeutically equivalentequivalent


Top 200 DrugsTop 200 Drugs

Haveles (p. 6, Appendix A)Haveles (p. 6, Appendix A) Appendix A lists the 200 drugs most often Appendix A lists the 200 drugs most often

prescribed in 2008prescribed in 2008 The rank order appears in the right column of the The rank order appears in the right column of the

appendixappendix This number represents the position that the drug This number represents the position that the drug

appears in the top 200appears in the top 200



Top 200 DrugsTop 200 Drugs

Both generic and trade names appear on the Both generic and trade names appear on the list, depending on how the prescription is list, depending on how the prescription is writtenwritten The oral health care provider must become The oral health care provider must become

familiar with these names because patients may familiar with these names because patients may know the names of the drugs they are taking but know the names of the drugs they are taking but not know how the names are spellednot know how the names are spelled

Accurate spelling permits the drugs to be Accurate spelling permits the drugs to be accessed in reference sourcesaccessed in reference sources


Federal Regulations and Federal Regulations and Regulatory AgenciesRegulatory Agencies

Haveles (pp. 6-7)Haveles (pp. 6-7) Many agencies are involved in regulating the Many agencies are involved in regulating the

production, marketing, advertising, labeling, production, marketing, advertising, labeling, and prescribing of drugsand prescribing of drugs Harrison Narcotic ActHarrison Narcotic Act U.S. Food and Drug Administration (FDA)U.S. Food and Drug Administration (FDA) Federal Trade Commission (FTC)Federal Trade Commission (FTC) Drug Enforcement Administration (DEA)Drug Enforcement Administration (DEA) Omnibus Budget Reconciliation Act (OBRA)Omnibus Budget Reconciliation Act (OBRA)


Harrison Narcotic ActHarrison Narcotic Act

Haveles (pp. 6-7) Haveles (pp. 6-7) Established regulations governing the used of Established regulations governing the used of

opium, opiates, and cocaine in 1914opium, opiates, and cocaine in 1914 Marijuana laws were added in 1937Marijuana laws were added in 1937

Before this law, mixtures and OTC Before this law, mixtures and OTC medications could contain opium and cocainemedications could contain opium and cocaine


U.S. Food and Drug U.S. Food and Drug Administration (FDA)Administration (FDA)

Haveles (p. 7)Haveles (p. 7) Part of the U.S. Department of Health and Part of the U.S. Department of Health and

Human Services (USHHS)Human Services (USHHS) Grants approval so that drugs can be marketed in Grants approval so that drugs can be marketed in

the United Statesthe United States Requires physical and chemical standards for Requires physical and chemical standards for

specific products and quality control in drug specific products and quality control in drug manufacturing plantsmanufacturing plants

Determines which drugs can be sold by Determines which drugs can be sold by prescription and OTC and regulates the labeling prescription and OTC and regulates the labeling and advertising of prescription drugsand advertising of prescription drugs


Federal Trade Commission (FTC)Federal Trade Commission (FTC)

Haveles (p. 7)Haveles (p. 7) Regulates the trade practices of drug Regulates the trade practices of drug

companiescompanies Prohibits the false advertising of foods, Prohibits the false advertising of foods,

nonprescription (OTC) drugs, and cosmeticsnonprescription (OTC) drugs, and cosmetics


Drug Enforcement Administration Drug Enforcement Administration (DEA)(DEA)

Part of the Department of JusticePart of the Department of Justice Administers the Controlled Substances Act of Administers the Controlled Substances Act of

19701970 Regulates the manufacture and distribution of Regulates the manufacture and distribution of

substances that have a potential for abuse, substances that have a potential for abuse, including opioids (narcotics), stimulants, and including opioids (narcotics), stimulants, and sedatives sedatives


Omnibus Budget Reconciliation Omnibus Budget Reconciliation Act (OBRA)Act (OBRA)

Pharmacists must provide patient counseling Pharmacists must provide patient counseling and a prospective drug utilization review and a prospective drug utilization review (DUR) for Medicaid patients(DUR) for Medicaid patients Many state boards of pharmacy are interpreting Many state boards of pharmacy are interpreting

this law to apply to all patientsthis law to apply to all patients Dental patients who have their prescriptions Dental patients who have their prescriptions

filled at a pharmacy should receive filled at a pharmacy should receive counseling form the pharmacist about their counseling form the pharmacist about their prescriptionprescription


Clinical Evaluation of a New Drug Clinical Evaluation of a New Drug

Haveles (p. 7) (Fig. 1-2)Haveles (p. 7) (Fig. 1-2) A discovered or synthesized compound must A discovered or synthesized compound must

pass through many steps before it is approved pass through many steps before it is approved to become a marketed drugto become a marketed drug Animal studies begin by measuring both acute and Animal studies begin by measuring both acute and

chronic toxicitychronic toxicity The median lethal dose is determined for several The median lethal dose is determined for several

species of animalsspecies of animals



Clinical Evaluation of a New DrugClinical Evaluation of a New Drug

Long-term animal studies continue, including Long-term animal studies continue, including a search for teratogenic effectsa search for teratogenic effects Toxicity and pharmacokinetic properties are also Toxicity and pharmacokinetic properties are also

notednoted An investigational new drug application (INDA) An investigational new drug application (INDA)

must be filed before any clinical trials are must be filed before any clinical trials are performedperformed

Human studies involve four phasesHuman studies involve four phases




Phase IPhase I Small and then increasing doses are administered Small and then increasing doses are administered

to a limited number of healthy human volunteersto a limited number of healthy human volunteers• Primarily to determine safetyPrimarily to determine safety

Determines biologic effects, metabolism, safe Determines biologic effects, metabolism, safe dose range in humans, and toxic effects of the dose range in humans, and toxic effects of the drugdrug




Phase 2Phase 2 Larger groups of humans are given the drug and Larger groups of humans are given the drug and

any adverse reactions are reported to the FDAany adverse reactions are reported to the FDA• Primarily to test effectivenessPrimarily to test effectiveness




Phase 3 Phase 3 More clinical evaluation takes place involving a More clinical evaluation takes place involving a

large number of patients who have the condition large number of patients who have the condition for which the drug is indicatedfor which the drug is indicated• Both safety and efficacy must be demonstratedBoth safety and efficacy must be demonstrated

• Dosage is determinedDosage is determined




Phase 4Phase 4 Postmarketing surveillancePostmarketing surveillance

• Toxicity that occurs in patients taking the drug after it is Toxicity that occurs in patients taking the drug after it is released is recordedreleased is recorded

• Several drugs in recent years have been removed from Several drugs in recent years have been removed from the market only after phase 4 has shown serious toxicity the market only after phase 4 has shown serious toxicity


Drug LegislationDrug Legislation

Haveles (pp. 7-8) Haveles (pp. 7-8) HistoryHistory Food and Drug Act of 1906Food and Drug Act of 1906

The first federal law to regulate interstate The first federal law to regulate interstate commerce in drugscommerce in drugs

Harrison Narcotic Act of 1914 Harrison Narcotic Act of 1914 Provided federal control over narcotic drugsProvided federal control over narcotic drugs Required registration of all practitioners Required registration of all practitioners

prescribing narcoticsprescribing narcoticscont’d…cont’d…



Food, Drug, and Cosmetic Act of 1938Food, Drug, and Cosmetic Act of 1938 Prohibits interstate commerce of drugs not shown to Prohibits interstate commerce of drugs not shown to

be safe and effectivebe safe and effective Durham-Humphrey Law of 1952Durham-Humphrey Law of 1952

Requires that certain types of drugs be sold only by Requires that certain types of drugs be sold only by prescriptionprescription

Requires the drugs be labeled “Caution: Federal law Requires the drugs be labeled “Caution: Federal law prohibits dispensing without prescription”prohibits dispensing without prescription”

Prohibits refilling a prescription unless directions to Prohibits refilling a prescription unless directions to the contrary are indicated on the prescriptionthe contrary are indicated on the prescription




Drug Amendments of 1962 (Kefauver-Harris Drug Amendments of 1962 (Kefauver-Harris Bill)Bill) Manufacturers were required to demonstrate the Manufacturers were required to demonstrate the

effectiveness of drugs, to follow strict rules in effectiveness of drugs, to follow strict rules in testing, and to submit to the FDA any reports of testing, and to submit to the FDA any reports of adverse effects from drugs already on the marketadverse effects from drugs already on the market

Manufacturer’s were also required to list drug Manufacturer’s were also required to list drug ingredients by generic name in labeling and ingredients by generic name in labeling and advertising and to state adverse effects, advertising and to state adverse effects, contraindications, and efficacy of a drugcontraindications, and efficacy of a drug




Drug Abuse Control Amendments of 1965Drug Abuse Control Amendments of 1965 Required accounting for drugs with a potential for Required accounting for drugs with a potential for

abuse, such as barbiturates and amphetaminesabuse, such as barbiturates and amphetamines The Controlled Substance Act of 1970The Controlled Substance Act of 1970

Sets current requirements for writing prescriptions Sets current requirements for writing prescriptions for drugs often prescribed in dental practicefor drugs often prescribed in dental practice


Scheduled DrugsScheduled Drugs Haveles (p. 8) (Table 1-4)Haveles (p. 8) (Table 1-4)

Federal law divides controlled substances Federal law divides controlled substances into five schedules according to their abuse into five schedules according to their abuse potentialpotential Rules differ depending on the drug’s scheduleRules differ depending on the drug’s schedule New drug entities are evaluated and added to the New drug entities are evaluated and added to the

appropriate scheduleappropriate schedule Drugs may be moved from one schedule to Drugs may be moved from one schedule to

another if changes in abuse patterns are another if changes in abuse patterns are discovereddiscovered



Scheduled DrugsScheduled Drugs

Current requirements for prescribing controlled Current requirements for prescribing controlled drugsdrugs Any prescription for a controlled substance requires Any prescription for a controlled substance requires

a DEA numbera DEA number All schedule II through IV drugs require a All schedule II through IV drugs require a

prescriptionprescription



Scheduled DrugsScheduled Drugs Any prescription for schedule II drugs must be written Any prescription for schedule II drugs must be written

in pen or indelible ink or typedin pen or indelible ink or typed• A designee may write the prescription, but the prescriber A designee may write the prescription, but the prescriber

must personally sign the prescription in ink and is must personally sign the prescription in ink and is responsible for what the designee has writtenresponsible for what the designee has written

Schedule II prescriptions cannot be telephoned to the Schedule II prescriptions cannot be telephoned to the pharmacist (except at the discretion of the pharmacist pharmacist (except at the discretion of the pharmacist for an emergency supply to be followed by a written for an emergency supply to be followed by a written prescription within 72 hours)prescription within 72 hours)



Scheduled DrugsScheduled Drugs

Because schedule II prescriptions cannot be refilled, Because schedule II prescriptions cannot be refilled, the patient must obtain a new written prescription to the patient must obtain a new written prescription to obtain more medicationobtain more medication

Certain states require the use of “triplicate” or Certain states require the use of “triplicate” or “duplicate” prescriptions for schedule II drugs“duplicate” prescriptions for schedule II drugs

Prescriptions for schedule III and intravenous drugs Prescriptions for schedule III and intravenous drugs may be telephoned to the pharmacist and may be may be telephoned to the pharmacist and may be refilled no more than five times in 6 months, if so refilled no more than five times in 6 months, if so noted on the prescriptionnoted on the prescription


Prescription WritingPrescription Writing

Haveles (pp. 8-11)Haveles (pp. 8-11) MeasurementMeasurement

Metric systemMetric system Household measuresHousehold measures

PrescriptionsPrescriptions FormatFormat

Explanations accompanying prescriptionsExplanations accompanying prescriptions



Prescription WritingPrescription Writing

Correctly written prescriptions will save timeCorrectly written prescriptions will save time Carefully written prescriptions are less likely Carefully written prescriptions are less likely

to result in mistakesto result in mistakes The dentist can save the patient’s and The dentist can save the patient’s and

pharmacist’s time with extra effort when pharmacist’s time with extra effort when unusual prescriptions are writtenunusual prescriptions are written Problems will be minimized if the unusual is Problems will be minimized if the unusual is

explainedexplained


MeasurementMeasurement

Haveles (p. 9)Haveles (p. 9) Metric systemMetric system

In pharmacy, the primary measuring system is the In pharmacy, the primary measuring system is the metric systemmetric system

Scientific calculations use a base of 10Scientific calculations use a base of 10• The metric system, based on 10, is the language of The metric system, based on 10, is the language of

scientific measurementscientific measurement

Only metric units should be used in scientific Only metric units should be used in scientific measurementmeasurement



MeasurementMeasurement

Haveles (p. 9) (Table 1-5)Haveles (p. 9) (Table 1-5) The basic metric unit for weight is the The basic metric unit for weight is the

kilogram (kg)kilogram (kg) The basic metric unit for volume is the liter (L)The basic metric unit for volume is the liter (L)

One milliliter (ml), or one-thousandth of a liter, is One milliliter (ml), or one-thousandth of a liter, is exactly 1 cubic centimeter (cc)exactly 1 cubic centimeter (cc)

Solid drugs are dispensed by weight Solid drugs are dispensed by weight (milligrams [mg]) and liquid drugs by volume (milligrams [mg]) and liquid drugs by volume (milliliters [ml])(milliliters [ml])


Household MeasuresHousehold Measures

Haveles (p. 9) Haveles (p. 9) Clinicians direct the pharmacist to dispense a Clinicians direct the pharmacist to dispense a

liquid in millilitersliquid in milliliters It is generally converted by the pharmacist into It is generally converted by the pharmacist into

household measures to be included in directions household measures to be included in directions to the patientto the patient

Liquids are converted into teaspoonfuls (5 ml) Liquids are converted into teaspoonfuls (5 ml) and tablespoons (15 ml)and tablespoons (15 ml) A calibrated dosing cup should be usedA calibrated dosing cup should be used


PrescriptionsPrescriptions

Haveles (pp. 9-11) (Fig. 1-3)Haveles (pp. 9-11) (Fig. 1-3) FormatFormat

The part of the prescription are divided into three The part of the prescription are divided into three sectionssections• HeadingHeading

• BodyBody

• ClosingClosing

AbbreviationsAbbreviations


Heading Heading

Haveles (p. 9)Haveles (p. 9) Contains the followingContains the following

Name, address, and telephone number of the Name, address, and telephone number of the prescriber (printed on prescription blank)prescriber (printed on prescription blank)

Name, address, age, and telephone number of the Name, address, age, and telephone number of the patient (written)patient (written)

Date of the prescriptionDate of the prescription


BodyBody

Haveles (pp. 9-10) (Fig. 1-3)Haveles (pp. 9-10) (Fig. 1-3) The The RxRx symbol symbol Name and dose size or concentration Name and dose size or concentration

(liquids) of the drug(liquids) of the drug Amount to be dispensedAmount to be dispensed

For tablets and capsules, “Dispense” is often For tablets and capsules, “Dispense” is often replaced with #, the symbol for a numberreplaced with #, the symbol for a number

Directions to the patientDirections to the patient Preceded by the abbreviation Preceded by the abbreviation Sig:Sig:


ClosingClosing

Haveles (p. 10)Haveles (p. 10) Prescriber's signaturePrescriber's signature DEA number, if requiredDEA number, if required

Needed for controlled substancesNeeded for controlled substances Often used by insurance companies as an Often used by insurance companies as an

identifieridentifier Refill instructionsRefill instructions



ClosingClosing Haveles (p. 10) (Fig. 1-4)Haveles (p. 10) (Fig. 1-4)

All prescriptions must be labeled with the name All prescriptions must be labeled with the name of the medication and its strengthof the medication and its strength The name, address, and telephone number of the The name, address, and telephone number of the

pharmacy, the patient’s and dentist’s names, the pharmacy, the patient’s and dentist’s names, the directions for use, the name and strength of the directions for use, the name and strength of the medication, and the original date and the date filled medication, and the original date and the date filled (refilled) are required(refilled) are required

The quantity of medication dispensed and number of The quantity of medication dispensed and number of refills remaining may be notedrefills remaining may be noted



ClosingClosing

Haveles (p. 11)Haveles (p. 11) In most states, before a dentist can legally In most states, before a dentist can legally

write a prescription for a patient, the following write a prescription for a patient, the following two criteria must be mettwo criteria must be met Patient of record:Patient of record: The person for whom the The person for whom the

prescription is being written is a patient of recordprescription is being written is a patient of record Dental condition:Dental condition: The condition for which the The condition for which the

prescription is being prescribed is a dental-related prescription is being prescribed is a dental-related conditioncondition



Haveles (pp. 9, 11) (Table 1-5)Haveles (pp. 9, 11) (Table 1-5) Used to save time but also makes alteration Used to save time but also makes alteration

of the prescription by a patient more difficultof the prescription by a patient more difficult ac: before mealsac: before meals d: dayd: day h: hourh: hour hs: at bedtimehs: at bedtime pc: after mealspc: after meals




prn: as neededprn: as needed sig: write (label)sig: write (label) stat: immediatelystat: immediately bid: twice per daybid: twice per day tid: three times per daytid: three times per day qid: four times per dayqid: four times per day


Explanations Accompanying Explanations Accompanying PrescriptionsPrescriptions

Haveles (p. 11)Haveles (p. 11) The dental health care worker should be able to The dental health care worker should be able to

answer the patient’s questions about the answer the patient’s questions about the prescriptionprescription Make sure the patient knows how to take the Make sure the patient knows how to take the

medication, what precautions to observe, and the medication, what precautions to observe, and the reason for taking the medicationreason for taking the medication

Information about consequences of noncompliance Information about consequences of noncompliance should be includedshould be included




The dental office should either keep a copy of The dental office should either keep a copy of each prescription written in the patient’s each prescription written in the patient’s record or record the medication, dose, and record or record the medication, dose, and number prescribednumber prescribed A patient should never get home and not know A patient should never get home and not know

which drug is the antibiotic and which is the which drug is the antibiotic and which is the analgesicanalgesic

Side effects should be noted on the labelSide effects should be noted on the label




Prescription blanks should be kept in a Prescription blanks should be kept in a secure placesecure place The dental health care worker should watch to see The dental health care worker should watch to see

they are not scattered around the officethey are not scattered around the office

chapter 1: information, sources, regulatory agencies, drug legislation, and prescription writing...

Documents

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sources of information

prescription writing

prescription writing

nursing slide

history haveles

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knowledge of pharmacology