Читать книгу The Dentist's Drug and Prescription Guide - Mea A. Weinberg - Страница 14

1 Q. What is a legend drug?

2 A. A legend drug is a drug that can only be dispensed by a pharmacist with a prescription. Labels on these medications carry the legend: “Caution! Federal law prohibits dispensing without a prescription.”

3 Q. What is the chemical name of a drug?

4 A. The chemical name describes the chemical make‐up of a drug. For example, the chemical name for acetaminophen is N‐acetyl‐p‐aminophenol.

5 Q. What is the proprietary name of a drug?

6 A. Other terms for proprietary name are brand or trade name and refer to the drug name assigned by the specific manufacturer which is protected by copyright. For example, one of the brand names for ibuprofen is Motrin® (McNeil).

7 Q. How long is a prescription valid until it is filled?

8 A. Every state has different rules which apply to prescriptions. A nonnarcotic prescription is valid for 365 days (one year) from the date on the prescription. Check with the local state boards for state‐specific laws.

9 Q. How is the quantity of the drug being dispensed written?

10 A. The symbol # is acceptable to indicate number and informs the pharmacist to dispense tablets, capsules or liquid ounces. Sometimes the prescriber will write Disp: before the #, meaning “dispense.” For example: Disp: # 12.

11 Q. What does “Sig” refer to?

12 A. Sig refers to the Latin word signatura, meaning “write,” “make” or “label.” This is the direction to the patient on how to take the medication.

13 Q. Should the dosage form of the drug be indicated on the prescription?

14 A. Yes. Tablets, capsules, suspension, or solution must be indicated on the prescription. For example, amoxicillin 500 mg Disp: # 28 capsules.

15 Q. Should the drug strength be written on the prescription?

16 A. Yes. The correct strength of the drug prescribed must be clearly written on the prescription. For example, amoxicillin 500 mg.

17 Q. Should the route of administration be specified on the prescription?

18 A. Yes. The dentist must indicate the correct route of administration of the drug prescribed even if it is orally.

19 Q. Should the duration of the drug prescribed be specified on the prescription?

20 A. Yes. The number of days or weeks must be written on the prescription. For example, penicillin V, 500 mg tid for seven days.

21 Q. Does the number of refills need to be written on the prescription?

22 A. Yes. If no refills are required, then “NR” or “zero” should be checked or written on the prescription. The number of refills should be spelled out. Do not just write “0.” Some prescriptions have a checkoff box for “None.”

23 Q. How many refills are allowed for nonscheduled and scheduled drugs?

24 A. The prescriber can write for no refills, indicated by NR (no refills). Prescription drugs may be refilled for only one year after the date of the prescription. A prescription for a controlled substance listed in Schedule III–V can only be refilled for six months or five refills, whichever comes first, after the date on such a prescription. After five refills or six months, whichever occurs first, a new prescription is required. For Schedule II drugs, there are no refills allowed.

25 Q. What is the law for dispensing a controlled substance for office use?

26 A. A blanket prescription cannot be written to provide a medical/dental office with medications for administration. If the office requires C‐II medications, a DEA 222 form must be used to transfer the C‐II stock. For all other medications, an invoice must be utilized.

27 Q. What does “label” on the prescription mean?

28 A. When the prescriber wants the patient to know the name of the drug, the box on the prescription form marked “label” should be checked.

29 Q. Can I phone in a prescription for a medication?

30 A. Yes. A nonnarcotic medication (e.g., antibiotics, nonsteroidal antiinflammatory drugs [NSAIDs]) can be phoned into the pharmacist and does not require a follow‐up written prescription to be sent to the pharmacist.When phoning in a controlled substance (e.g., Vicodin® C‐II, Tylenol® with codeine C‐III, Percocet C‐II), the rules are different. Schedule II drugs cannot be phoned into the pharmacy except in an emergency and must be followed up with a written prescription usually within 72 hours (states may require that the prescription be sent to the pharmacist in a shorter time frame and the more restrictive clause prevails) and only for a three‐day supply. Schedule III drugs can be dispensed by an oral (verbal) or written prescription and does not need a follow‐up written prescription (the pharmacist writes all information which is equivalent to a written prescription). Renewal of Schedule III–V drugs can be called in to the pharmacy.

31 Q. Is there a limit on the quantity prescribed for a Schedule II, III, or V narcotic?

32 A. Although some states and many insurance companies limit the quantity of controlled substances dispensed to a 30‐day supply or 120 doses, whichever is less, there are no specific federal limits to quantities of drugs dispensed by a prescription. Review the law in individual states. Remember the most restrictive clause will prevail, whether state or federal.

33 Q. Can a Schedule II narcotic (e.g., Percocet) be phoned into the pharmacy?

34 A. Yes, but only for emergency situations. Federal law requires the prescriber to follow up with a written prescription sent to the pharmacy within 72 hours, but different states have different time limits. No refills are allowed.

35 Q. What is the purpose of e‐prescribing?

36 A.In 2010, the DEA legalized e‐prescribing of controlled substances to reduce drug fraud and abuse. All nonnarcotic prescriptions can be e‐prescribed. New York has the I‐STOP law (Internet System for Tracking Over Prescribing) which requires all prescriptions to be sent to pharmacies through e‐prescribing. In addition, as of 2016, all prescribers have to monitor patient use of controlled substance prescriptions via the PDMP.According to the DEA, as of 1 June 2010, it is permissible to have e‐prescribing for controlled substances in all 50 states; however, not all states are using it. E‐prescribing software must meet the DEA requirements and have the required certifications before e‐prescribing is allowed. In addition, some state laws and regulations will require changes before controlled substance e‐prescribing will be fully legal. E‐prescribing helps to reduce medication errors associated with prescribing (https://decisionresourcesgroup.com/drg‐blog/health‐reform/states‐require‐e‐prescribing‐combat‐fraud‐abuse).

37 Q. Can a Schedule II prescription be faxed to the pharmacy?

38 A. According to the DEA, in order to expedite the filling of a prescription, a prescriber may transmit a Schedule II prescription to the pharmacy by fax, but the original prescription must be presented to the pharmacist before the drug can be dispensed. The faxed copy is just an alert to the pharmacist that the patient is on the way with an original prescription. Otherwise, a fax for a Schedule II drug is not accepted.

39 Q. In which situations can a faxed C‐II prescription serve as an original prescription?

40 A. A faxed C‐II prescription can serve as an original for patients in a long‐term care facility (LTCF), community‐based care, enrolled in hospice, or receiving home infusion/IV pain management therapy. The fax must be signed by the prescriber.

41 Q. Can a Schedule III–V prescription be faxed to the pharmacist?

42 A. It depends. According to federal law, Schedule III–V substances can be faxed but certain states do not allow faxing of prescriptions for any controlled substance. The most restrictive clause will prevail. So, if federal law allows faxing but state law does not, the state law will succeed. According to the DEA, Schedule III–V prescriptions can be communicated orally, in writing, or by fax to the pharmacist and may be refilled (not more than five times within six months) as written on the prescription or by call‐in.

43 Q. Are preprinted prescriptions for controlled substances allowed?

44 A. No.

45 Q. What are the more common Latin abbreviations used in prescription writing?

46 A. See Table 2.2. Table 2.2 Common Latin abbreviations used in dental prescription writingAbbreviationMeaningqevery hourqhsevery nightqdevery dayq8hevery 8 hoursbidtwice a daycapcapsuletidthree times a dayqidfour times a daystatimmediatelyacat meal timeshhourhsat bedtimeNRno refillspcafter mealspoorally (by mouth)prnas neededtabtablet

47 Q. What are the different measurement systems used in pharmacy and for writing prescriptions?

48 A. The metric system which bases calculations on the base of 10. There is a metric unit of weight (gram [g]) and a metric unit of volume (liter [L]). The apothecary system, which is becoming obsolete, uses old measures of weights and volumes such as grains (gr). This system is also confusing because the abbreviation “gr” can be mistaken for gram, which is abbreviated “g.” The avoirdupois system or household system of weights is used for ordinary commodities such as ounce, teaspoonful, and tablespoonful.

49 Q. What is a milligram (mg)?

50 A. A milligram (mg) is a unit (metric system) of mass equal to one thousandth of a gram. Thus, 1 gram (g) equals 1000 milligrams (mg). It is advised to write “g” instead of “gm” as an abbreviation for gram because “gm” can easily be misinterpreted as “mg.”

51 Q. What is a grain?

52 A. A grain (gr) is a unit of (apothecary) measurement of mass and 1 g = 64.79 mg = 0.06479 g. It is often confused with grams, which is abbreviated “g.”

53 Q. What does the term “parts per million” mean when expressing permissible exposure to fluorides?

54 A. Parts per million when referring to permissible exposure to fluorides means the number of grams (g) per million mL of solution. For example, one part per million (ppm) is interpreted as one gram per million mL of solution.

55 Q. What does a 1 : 100 solution mean?

56 A. In calculating the amount of a drug that must be administered, especially if it is in solution, there is specific information that is required to do the calculations. The concentration of the drug in solution is expressed as gm/mL, or as a percent or as a ratio such as 1 : 100, 1 : 1000 and so on. A percent solution means what percentage of a drug is in 100 mL of solution.For example: 1 : 100 means that there is 1 g of drug in 100 mL of solution (1 g/100 mL) = 0.01 g/mL = 10 mg/mL = 1%1 : 100 000 = 1 mg/100 mL = 0.01 mg/mL = 0.001%5% solution means that there is 5000 mg/100 mL or 50 mg/mL. A simple way to figure this out is just to move the decimal one place to the right of the percent.3% hydrogen peroxide means 3 g of hydrogen peroxide in 100 mL of solution or 3000 mg/100 mL or 30 mg/mL.

57 Q. What is a Black Box Warning regarding certain drugs?

58 A. A Black Box Warning (sometimes called a boxed warning) is a warning found on the package insert of a drug. It is given this name because there is a black border around the text of the warning. According to the FDA, a boxed warning is given to drugs that have a significant risk of serious or life‐threatening adverse reactions. Note that every Black Box Warning has the date that the warning was announced by the FDA. Not all drugs have a boxed warning. Examples of some drugs related to dentistry with boxed warnings include the following.March 2011: fluoroquinolone antibiotics including levofloxacin (Levaquin®) can exacerbate muscle weakness in persons with myasthenia gravis.January 2011: the FDA asked drug manufacturers to voluntarily limit the strength of acetaminophen in prescription drug products, which are predominantly combinations of acetaminophen and opioids. This action will limit the amount of acetaminophen in these products to 325 mg per tablet, capsule, or other dosage unit, making these products safer for patients.In addition, a Boxed Warning highlighting the potential for severe liver injury and a Warning highlighting the potential for allergic reactions (e.g., swelling of the face, mouth, and throat, difficulty breathing, itching, or rash) are being added to the label of all prescription drug products that contain acetaminophen. These actions will help to reduce the risk of severe liver injury and allergic reactions associated with acetaminophen.Note: over‐the‐counter (OTC) products containing acetaminophen (e.g. Tylenol) are not affected by this action. Information about the potential for liver injury is already required on the label for OTC products containing acetaminophen. The FDA is continuing to evaluate ways to reduce the risk of acetaminophen‐related liver injury from OTC products.April 2009: onabotulinumtoxinA (marketed as Botox®/Botox Cosmetic®) and rimabotulinumtoxinB (marketed as Myobloc®) have the possibility of experiencing potentially life‐threatening distant spread of toxin effect from the injection site after local injection to produce symptoms consistent with botulism. Symptoms such as unexpected loss of strength or muscle weakness, hoarseness or trouble talking (dysphonia), trouble saying words clearly (dysarthria), loss of bladder control, trouble breathing, trouble swallowing, double vision, blurred vision, and drooping eyelids may occur. The other botulinum toxin product in this class, abobotulinumtoxinA (marketed as Dysport®), was approved on April 29, 2009 and included the Boxed Warning.July 2008: fluoroquinolone antibiotics (ciprofloxacin [Cipro®], levofloxacin [Levaquin®]) have an increased risk of tendonitis and tendon rupture that could cause permanent injury. This risk is further increased in patients over 60 years of age, in patients taking corticosteroid drugs, and in those with kidney, heart or lung transplants.November 2005: Clostridium difficile‐associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin HCL, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile. C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin‐producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotics or surgical intervention may be required.April 2005: the FDA concluded that the benefits of Celebrex® outweigh the potential risks in properly selected and informed patients. Accordingly, the FDA allowed Celebrex to remain on the market and asked the manufacturer Pfizer to take the actions listed below. According to the FDA requirements, the Celebrex label must:include a Boxed Warning containing the class NSAID warnings and contraindication (see below) about cardiovascular (CV) and gastrointestinal (GI) risk, plus specific information on the controlled clinical trial data that demonstrate an increased risk of adverse CV events for celecoxib (Messerli and Sichrovsky 2005)encourage prescribers to discuss with patients the potential benefits and risks of Celebrex and other treatment options before a decision is made to use Celebrexencourage practitioners to use the lowest effective dose for the shortest duration consistent with individual patient treatment goals.April 2005: the FDA asked manufacturers of all OTC products containing ibuprofen (Motrin, Advil®, Ibu‐Tab 200®, Medipren®, Cap‐Profen®, Tab‐Profen®, Profen®, Ibuprohm®), naproxen (Aleve®), and ketoprofen (Orudis®, Actron®) to revise their labeling to include more specific information about the potential CV and GI risks and instructions about which patients should seek the advice of a physician before using these drugs.July 2001: warning about the abuse potential of OxyContin, a Schedule II controlled substance.

59 Q. How do I write for a prescription for doxycycline?

60 A. See Figure 2.1.Interpretation of prescription: the salt form of doxycycline is hyclate or monohydrate. Doxycycline monohydrate is used in the treatment of acne. Doxycycline hyclate is used for other bacterial infections. So it is necessary to identify the correct salt form. Also, in order to write a prescription, it must be known whether to write for capsules or tablets. Doxycycline is supplied as 50, 75, and 100 mg capsules or tablets. In this prescription, the prescriber prescribed capsules. Latin abbreviations were used but they were written legibly. It is probably safest not to use Latin abbreviations but rather write the prescription in English. The number of days the patient should take the medication for was indicated (× 10 days; the × refers to “for”). Also, it is important for the safety of the patient to write on the prescription “for dental infections” because the patient may be taking many different medications and may have a lot of pill containers in the medicine cabinet. Identifying this prescription bottle for use for a dental infection will make it easier for the patient to pick up that container. Directions for use (Sig:): Take one capsule orally every 12 hours on day 1, then one capsule every day for 10 days for dental infections.