Principles of Clinical Pharmacology

Principles of Clinical
Pharmacology
FOUNDATIONS OF MEDICINE
2020-2021
Medication Errors
 More than 1 million serious medication errors

occur every year in U.S. hospitals. Many medication
mistakes are never reported.
 7,000 people die each year as a result of medication

errors.
 At least 400,000 drug-related injuries occur each year in

hospitals or approximately one medication error per
patient per day.
1. Kuperman GJ, Bobb, A, Payne TH et al. Medication-related Clinical Decision Support in Computerized
Provider Order Entry Systems: A Review. J Am Med Inform Assoc. 2007; 14(1):29-40.
2. Shah NR, Seger AC, Seger DL et al. Improving acceptance of computerized prescribing alerts in
ambulatory care. J Am Med Inform Assoc. 2006 Jan-Feb;13(1):5-11.
Medication Errors
 “Any error occurring in the medication use process”. Institute

for Safe Medication Practices.
 Type of errors:
 Prescribing
 Dispensing
 Drug administration errors
 Transcription errors
 Prescribing errors account for somewhere between 20%-

60% of all medication errors
 Illegible handwriting on prescriptions or orders alone

count for 15-25% of all medication errors.
Guessing Game- not fun
A B
ASA 81 mg po daily Norvasc 10 mg P.O. daily.
4
Principles of Prescription Order Writing
History:
 Rx = prescription or treatment
 Rooted in ancient alchemical practice
 Egyptian “Eye of Horus” symbol = HEALTH
 God Jupiter to denote prescription success
 Latin: recipere = “take”
 Sig: Latin “signatura”: to mark directions for use

Current practice:
 Superscription
 Inscription
 Subscription
 Signa
 Name and signature of the prescriber
Prescriber
information
Date
Patient information prescription
(name; age) issued
Medication
information
Dispensing directions
for pharmacist
Directions for use
Special instructions Prescriber signature

Elements of confusion:
 Units of measure:
 Use metric weight of active ingredients/ mg, gram, mcg
instead of g
 Liquid formulations: unit of volume
 Zeros: use leading zeros (0.5 mg and not .5 mg) and not
trailing zeros (5 mg instead of 5.0 mg)
 Avoid household measurements/ teaspoon
 Avoid IU or U and write “unit”
 Abbreviations
 Writing way and handwriting
Commonly used abbreviations

Term or phrase Abbreviation Meaning
ad ad to, up to
ad libitum ad. lib. at pleasure
ana a.a. of each
ante cibos a.c. before meals
aqua aq. water
bis in die b.i.d. twice a day
collyrium collyr. eye lotion
cum c. with
cum aqua cum aq. with water
dentur tales doses d.t.d. give such doses
gutta, guttae gtt. drop, drops
Commonly used abbreviations
Term or phrase Abbreviation Meaning
hora somni h.s. at bedtime
misce m. mix
non repetatur non. rep. do not repeat
omni die o.d. daily
omni mane o.m. every morning
omni nocte o.n. every night
per os p.o. by mouth
post cibos p.c. after meals
pro re nata p.r.n. as the occasion arises
quater in die q.i.d. four times a day
sine s,s without
si opus sit s.o.s. if necessary
ter in die t.i.d. three times a day
unguentum ungt. ointment
ut dictum ut dict. as directed
General rules:
 Prescriptions should be written in ink

 Put patient’s name and address
 Weight, age and BSA may be needed
 Avoid abbreviations in drug names and directions,
especially for sound-alike and look-alike drugs
 Use metric measurements/ mg, g, ml
 Use leading zeros and never put trailing zeros
General rules:
 Decimal points should be indicated clearly

 Inclusion of the purpose of treatment is encouraged e.g.
“for blood pressure control”
 Arabic numerals are preferable to Roman numerals
 Clearly state route of administration:
 Oral  “take” or “give”
 Externally applied products  “apply”
 Suppositories  “insert”
 Drops/ eye or ear  place
General rules:
 Include total calculated dose and dosage formula if needed
e.g. 40 mg/kg per day (240 mg every 8 hours)
 Include date of prescription, name of the physician, address

and phone number of the practice site
 Avoid the instruction: “take as directed”
 For controlled substances: include name, address and Drug

Enforcement Agency registration number of the physician,
and prohibition of filling and refilling
Prescriptive Authority:
 In the US, MDs, DOs and other healthcare

professionals/ licensed physicians’ assistants,
nurse practitioners and pharmacists can prescribe
medications.
Errors in drug orders:

 Large number of medical errors is due to medication
errors
 ADE occur in 3% of hospitalizations
 Databases of anonymously reported errors

[maintained by ISMP (institute for safe medication
practices), USP MERP (medication error reporting
program) and FDA MedWatch]
Reporting ADR and Medication Errors
Institute of Safe Medication

Practices (ISMP)
Databases of
United States Pharmacopoeia anonymously
Medication Errors Reporting reported errors
Program (USP MERP)
The Food and Drug

49 % of the time the
Administration’s MedWatch
primary error in
program
preventable events
occurred in the drug
ordering stage
Drug prescription in specific populations
Pregnancy and lactation:

 Mention of the woman’s status is recommended
 Gestational age should preferably be mentioned
 Reason of the prescription should be stated clearly
Children:
 Include dose per body weight and total calculated dose
 Indicate clearly route of administration
 Indicate clearly preparation method and explain to
delivering person
Drug prescription in specific populations
Elderly:
 Indicate body weight

 Mention treatment indications
 Inclusion of co-morbodities may be of help
 Clearly indicate route of administration
 Explain carefully to the patient all drug-related
information
Sample of a Complete Order
Medication name Frequency
Docusate 100mg PO daily prn constipation
Dose ROA PRN indication
Note: writing the strength of the tablet or vial is not

sufficient to process the order
Example: 1 ampule of KCL is not acceptable, it should be

written as KCL 20mEq
Examples of Current Medication Orders
PRN Orders
 Acceptable:
 Morphine 2mg IV Q6h prn severe pain
 Panadol 500mg PO Q6h prn fever
 Unacceptable:
 Panadol 2 tab po
 Panadol prn
 Panadol 500mg PO Q6H PRN
Other Pointers
 Look-Alike/Sound-Alike Medications:
 be very careful when ordering those meds
 Prescribers should consider using ‘tall man’ lettering for LASA

orders. Examples:
 DOPamine, DOBUTamine
 GLYBURide; GLIPIZide
 predNISONE, predNISOLONE
You Are the Prescriber
BE THE SAFE PRESCRIBER!

PATIENT’S HEALTH IS IN YOUR
HANDS

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Principles of Clinical

 More than 1 million serious medication errors

 7,000 people die each year as a result of medication

 At least 400,000 drug-related injuries occur each year in

 “Any error occurring in the medication use process”. Institute

 Prescribing errors account for somewhere between 20%-

 Illegible handwriting on prescriptions or orders alone

ASA 81 mg po daily Norvasc 10 mg P.O. daily.

 God Jupiter to denote prescription success

 Latin: recipere = “take”

 Sig: Latin “signatura”: to mark directions for use

Directions for use

Special instructions Prescriber signature

Commonly used abbreviations

 Prescriptions should be written in ink

 Decimal points should be indicated clearly

 Include date of prescription, name of the physician, address

 Avoid the instruction: “take as directed”

 For controlled substances: include name, address and Drug

 In the US, MDs, DOs and other healthcare

Errors in drug orders:

 ADE occur in 3% of hospitalizations

 Databases of anonymously reported errors

Institute of Safe Medication

The Food and Drug

Pregnancy and lactation:

 Indicate body weight

Medication name Frequency

Docusate 100mg PO daily prn constipation

Dose ROA PRN indication

Note: writing the strength of the tablet or vial is not

Example: 1 ampule of KCL is not acceptable, it should be

 Prescribers should consider using ‘tall man’ lettering for LASA

BE THE SAFE PRESCRIBER!

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