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3 types of medication names
1. Drug name: generic
2. Propriety name: Brand
3. Chemical name
FDA:  Food and Drug Administration
Main governing body that rigorously regulates and evaluates prescription (legend) and OTC drugs.....but not herbals and suppliments (DSHEA)
“Legend drug”
any item that federal law prohibits dispensing without a prescription from a licensed prescriber
Schedule #1
-Highest potential for abuse

-Not used for medical treatment in the U.S. or is considered unsafe for use in medically supervised treatment
examples of schedule 1 drugs
Examples:  Heroin, LSD, Mescaline, Peyote, PCP
Schedule #2
-High potential for abuse

-Used in medical treatments in U.S. or used with severe restrictions

-Abuse may result in severe physical or psychic dependence
Examples of Schedule 2 drugs
Examples:  Marijuana, opiates (Oxycontin®, Kadian® "ER morphine sulfate", methadone, fentanyl), amphetamine, methamphetamine, methylphenidate, pentobarbital
Schedule 3 drugs
-Potential for abuse is less than substances in schedules I & II

-Abuse may lead to low-moderate physical dependence or high psychological dependence
Examples of Schedule 3 drugs
Examples:  testosterone, Lortab® (hydrocodone),       Norco® (hydrocodone + tylonol) , codeine, ketamine, Suboxone® (opiate addiction recovery), Tylenol #3®
Schedule 4 drugs
-Low potential for abuse compared to schedule III

-Abuse may lead to limited physical or psychological dependence relative to schedule III
Examples of Schedule 4 drugs
Examples:  benzodiazepines , phentermine (weight loss drug, brand name Adipex-P) , Ambien®, Midrin®, Lunesta®, Provigil®, Darvocet®, Sonata

"Uppers and Downers"
Schedule 5 drugs
-Low potential for abuse relative to schedule IV

-Limited physical and physiological dependence relative to schedule IV
Examples of Schedule 5 drugs
Examples:  codeine (Robitussin AC®) "Cherritussin" OTC in some pharmacies-codeine + mucinex, diphenoxylate/atropine (Lomotil®)-for diahrrea, Lyrica®
What should be on a prescription?  
Nurse practitioners and Physician assistants are required to write prescriptions on pre-printed prescription pads which include:
PREPRINTED
-Name:  supervising physician and PA -Address
-Telephone number

WRITTEN
-Date of issuance
-Name of prescriber + supervising physician (see preprint)
-Name of patient
-Name of drug, strength, dosage, form...Ex:  phenergan 25mg tablets
-Quantity prescribed in numerals and letters...Ex:  40 (forty)
-Directions for use
-Refill instructions
-Prescriber signature
-DAW (dispense as written), if desired
***tamper resistent
What type of paper do you use to write your prescriptions and why?
Type: preprinted tamper ressistent pads
B/C: Medicare and Medicaid require it
If you are writing a prescription for a controled substance (2-5) what must be on the prescription?
-everything on the non-controlled script and
-Legend drug requirements
-Patient name and address
-Prescribers name, address, and DEA#  
Requirements for faxed schedule 3-5 prescriptions?
-Must be received from prescriber or prescriber’s agent...Faxed only from your office! 
-Any faxes received from another source are information only
What are the 3 cases in which a faxed schedule 2 prescription is considered an original?
1:  Prescription is to be compounded for the direct administration to the patient by parenteral, IV, IM, SC, or intraspinal infusion

2:  The prescription is for a resident of a Long Term Care Facility (LTCF)

3:  The prescription is for a patient of a Medicare or state licensed Hospice agency

***must be faxed from your office
The only case in which a schedule 2 can have refills and what must be written on the prescription?
-Prescriptions written or faxed for terminally ill patients must be signed by prescriber, and prescriber must indicate “the patient is terminally ill” or “the patient is a long term facility patient”

-This allows pharmacy to refill prescription 10X in 60 days

***‘titrate to comfort’ also allows the infusion pharmacy to adjust the patient’s medication without further physician orders
What is the pharmacist never allowed to change on a prescription you have written?
-Name of the patient
-Name of the drug (except generic substitution permitted by state law)
-Name of the prescribing practitioner (including signature)
-Date of the prescription
What is a pharmacist permitted to change following consulting with you over the phone on a prescription that you have written?
-Patient’s address
-Drug strength
-Drug quantity
-Directions for use
What is the pharmacist permitted to add to a prescription that you have written?
-Patient’s address, upon verification
-Dosage form, after consultation with prescribing practitioner
You can write up to how many separate prescriptions for the same control 2 drug....what must you include to distinguish them?
How many: 3 WITH the SAME issuance date (3 months worth)

Distinguished by:  a separate spot that says do not fill till _______ "specified date" 
In what control class must each separate drug for the same patient be written seperately?

What are the exceptions to this rule?
Class 2


-Hospitals
-Nursing homes
-Assisted care living facilities
-Mental health facilities
-Local, state or federal correctional facilities
What are the time limits from date written to date filled for each control class in TN?
Class 2: 1yr--No federal time limit

Class 3 & 4: 6 months

Class 5: 1yr---No federal time limit
Sig Code
directions to the patient
ASA =
acetyl salicylic acid (Aspirin)
APAP =
acetaminophen
HCTZ =
hydrochlorothiazide
NTG =
nitroglycerin
HA =
headache
N/V =
nausea and vomiting
SOB =
shortness of breath
UTI =
urinary tract infection
PO =
by mouth
PR =
per rectum
SL =
sublinqual
IM =
intramuscular
SQ or SC or SubQ =     
subcutaneously
QHS =
at bedtime
Qday=
1x/day
BID =
2x/day
TID=
three x/day
QID=
4x/day
QOD=
every other day
QWK=
1x/wk
ATC=
around the clock
Q4H=
every 4 hours
Q46H=
every 4-6 hours
QAM
in the morning
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