Module 2

Medication Orders and Labels

Introduction

Based on Pharmaceutical Jurisprudence and Ethics, only physicians, veterinarians and dentists
can diagnose, prescribe, and treat patient’s disease. Prescribed drugs are written on a prescription for
patients. Prescription must be lawfully filled by the pharmacist. In hospital setting, prescriptions are
written on doctor’s order sheet. These forms are found in the patient’s medical chart.

Medication orders for inpatients in hospitals and other institutions are written by the physician
on forms called the Physician’s Order Sheet. The type of form used varies between institutions,
depending on the unit rendering care. Because these orders are written in a controlled environment,
many of the requirements and restrictions placed on prescription orders for outpatients do not apply in
the institutional setting.

The prescription order is a part of the professional relationship among the prescriber, the
pharmacist, and the patient. It is the pharmacist’s responsibility in this relationship to provide quality
pharmaceutical care that meets the medication needs of the patient.

Objectives:

1. To interpret physician’s medication order or prescription

2. To be able to interpret the labels of the medications.
3. To identify the different information found in medication order and physician’s order sheet.
4. To compare the difference between medication order and physician’s order sheet.
5. To review and to master the English meaning of the latin abbreviation used in writing
medication order.

Contents

A prescription is an order for medication issued by a physician, dentist, or other properly

licensed medical practitioner. Various states also have licensed other prescribers who have limited
scopes of practice. In certain states, nurse practitioners and even pharmacists can issue prescriptions
under protocol or with certain restrictions.

Prescription orders may come in different forms:

1. In an outpatient setting, a doctor or healthcare professional who is licensed to prescribe drugs

writes and order on a prescription form and gives it directly to the patient; it is sometimes
referred to as the medication order.
2. In-patient facilities, doctors generate prescription orders in one of these ways;
a. By entering the order in a computer system that transmits it to the pharmacy and
nurse’s station.
b. By writing om the drug order sheet on the patient’s chart.
c. By faxing the order to the pharmacy.
COMMON MEDICAL ABBREVIATIONS USED IN PRESRIPTION ORDERS:
ABBREVIATION INTERPRETATION ABBREVIATION INTERPRETATION
Route: General:
IM intramuscular ā before
IV intravenous p after
IV PB intravenous piggy back c with
SC* subcutaneous s without
SL sublingual q every
ID intradermal aq water
p.o. by mouth, orally NPO nothing by mouth
O.D. right eye ss one-half
O.S. * left eye gtt drop
O.U.* both eyes tab tablet
A.D.* right ear cap capsule
A.S.* left ear et and
A.U.* both ears noct night
[*} commonly encountered medication error cc* cubic centimeter

ABBREVIATION INTERPRETATION ABBREVIATION INTERPRETATION

Frequency:
a.c. before meals q.i.d. four times a day
p.c. after meals min. minute
ad. Lib. as desired, freely h hour
p.r.n. when necessary q.h. every hour
h.s.* hour of sleep, at bed time q. 2h every two hours
stat immediately, at once q. 3h every three hours
q.d.* once a day, everyday q. 4h every four hours
q.o.d.* every other day q. 6h every six hours
b.i.d. twice a day q. 8h every eight hours
t.i.d. thrice a day q. 12h every twelve hours
MISCELLANEOUS ABBREVIATIONS:
ABBREVIATION INTERPRETATION
AMA against medical advice
ASAP as soon as possible
BP blood pressure
BPM breaths/beats per minute
D/C or dc discontinue
KVO keep vein open
NKA no known allergies
P pulse
R respiration

Prescriptions designate a specific medication and dosage to be administered to a particular

patient at a specified time. Commonly, the prescribed medication also is referred to as the “prescription
by the patient”.

Parts of prescription:

1. Prescriber’s office information

2. Patient information
3. Date
4. Rx symbol (superscription)
5. Medication prescribed (inscription)
6. Dispensing direction to the Pharmacist (subscription)
7. Directions for patients (signa/transcription – to be placed on the label)
8. Refill, special labeling, and/or other instructions
9. Prescriber’s signature and license or Drug Enforcement Agency (DEA) number as required

In practice, some of the above information (such as the patient’s address) may be absent when
the prescription is received by the pharmacist. In these instances the pharmacist obtains necessary
information from the patient of physician, as is required.

Each medication order generally contains the following information:’

1. Date ordered
2. Name of the medication (generic and brand name)
3. Potency or strength of the drug
4. Dosage
5. Schedule or time to be given or frequency
6. Use of the drug (optional)
7. Name of the prescriber
 Physician’s order sheet provides basic information, this include:

1. Name of the patient

2. Address
3. Physician
4. Birthday
5. Date of admission
6. Insurance

The doctor’s order is transcribed by the nurse or pharmacist who is in charge of the unit. The
transcribed order is then sent to the hospital pharmacy department for the pharmacist to prepare and
dispense the drug.

DRUG LABELS

Drug labeling refers to the printed information that accompanies a drug, including the label, the
wrapping and the package insert. Drug labeling is regulated by the Food and Drug Administration (FDA).
This regulation applies to prescription drugs, over-the-counter (nonprescription) drugs, and dietary
supplements.

The FDA requires that drug labeling be balanced and not misleading. The label must be
scientifically accurate and provide clear instruction to health care practitioners for prescription drugs
and to consumers for over-the-counter drugs and supplements. Labeling regulations require that the
statement of ingredients must include all ingredients, in the order in which they are used in the drug.
These ingredients must also be identified by their established name.

Medications are available in different dosage forms and strengths. A careful pharmacist must be
fully aware of the difference to avoid dispensing the wrong medication. Medication label usually
contains the following information important in the process of giving medication. In contains:

1. Bold name of the drug in generic name

2. Trade name of the drug
3. Potency or strength
4. Quantity (in ml for liquid) or weight (in g for solid and semi-solid) or number of medication (per
bottle)
5. Dosage form
6. Direction for mixing if suspension
7. Composition for combination
8. Therapeutic use of the medication
9. Formulation
10. Indication
11. Dosage
12. Drug company
13. Lot number
14. Expiry date
15. Registration number
 In preparing the medication orders, the name of the medication in the order form must be the
same as the label. The right potency and dosage form should likewise be checked. Read the expiry date,
the drug may lose its potency or act differently in the patient’s body. Discard expired drugs. Accuracy in
these aspects is the main responsibility of the pharmacists. Otherwise the pharmacists will be legally
liable for any error.

Practice exercise:

1. Bring two drug labels and fill in the correct answer, using the following information listed below
as your guide.
Trade name Amount of drug in container
Generic name Usual dosage
Dosage form Expiry date
Dosage strength Storage temperature
Name: Date:

Year and section: Score:

Worksheet No. 5
Filling of Medication Label

Paste the medication label

Medication Label #1
Trade name: __________________________________________________________________
Generic name: ________________________________________________________________
Dosage form: _________________________________________________________________
Dosage strength: ______________________________________________________________
Amount of drug in container: ____________________________________________________
Usual dosage: ________________________________________________________________
Expiry date: __________________________________________________________________
Storage temperature: __________________________________________________________
Paste the medication label

Medication Label #2
Trade name: __________________________________________________________________
Generic name: ________________________________________________________________
Dosage form: _________________________________________________________________
Dosage strength: ______________________________________________________________
Amount of drug in container: ____________________________________________________
Usual dosage: ________________________________________________________________
Expiry date: __________________________________________________________________
Storage temperature: __________________________________________________________
 Worksheet No. 6

Interpret the following physician’s drug orders:

1. Valium 5mg p.o. b.i.d.

______________________________________________________________________________
2. Benzyl Penicillin 1,000,000 U IM q6h
______________________________________________________________________________
3. NPH insulin 30 U SQ q.d. 30 min ā breakfast
______________________________________________________________________________
4. Morphine SO4 ¼ gr IM q.4h p.r.n. pain
______________________________________________________________________________
5. Mylanta 5mL p.o. 1h a.c., 1h p.c., h.s., et q2h p.r.n. @ noc.
______________________________________________________________________________
6. Digoxin 25mcg p.o. q.d.
______________________________________________________________________________
7. Toradol 60mg IM stat and q6h
______________________________________________________________________________
8. Tobramycin opth. 2 gtt O.S. q6h
______________________________________________________________________________
9. Antipyrine+Benzocaine otic gtts ii A.U. t.i.d. et h.s.
______________________________________________________________________________
10. Furosemide 20mg IV PB (slowly)
______________________________________________________________________________
11. Colace 100mg PO b.i.d. p.c.
______________________________________________________________________________
12. Folic acid 1mg P.O. daily
______________________________________________________________________________
13. Nifedipine 30mg S.L. q4h
______________________________________________________________________________
14. ASA grain v P.O. t.i.d.
______________________________________________________________________________
15. D/C penicillin I.V., start Penicillin G 800,000 units P.O. q6h
______________________________________________________________________________
Questions:

1. Under the Generics Law, does the pharmacist have the right to choose any brand if the
medication order is in generic?

2. What are the factors to be considered before dispensing multiple medication orders for
outpatient/inpatient?

3. What is the effect of giving the patient wrong potency and route of administration?

4. What is the relevance of the following information found on a drug label?

a. Lot number

b. Expiration date

c. Route of administration

d. Manufacturer

5. What is/are the effect(s) on the drug and on the patient if the instructions for storage
conditions were not followed?