Prescription Writing For Pediatrics by Dr. Daniel Garang Aluk Dinyo at St. Paul's Hospital Millennium Medical College 2017

Prescription writing
BY: DANIEL GARANG ALUK DINYO

Prescription writing
- Symbol represent Latin imperative verb

recipe/ recipere; to take, take thou
- Folks theories for symbol; eyes of Horus,
Zeus or Jupiter gods
- Prescription: Pre; before & Script; writing
hence, it's an order that must be written
down before a compound can be prepared.
Those in the industry simply call it scripts
Prescription writing con’t…
Definition: a health care provider’s written authorization for a

patient to purchase a prescription drug/ medical equipment from
pharmacist or
A written order by a physician to a pharmacist to dispense a
therapeutic agent to a patient.
Formats of prescriptions:
- Electronic
- Handwritten
- Orally communicated
Prescription legal implications:

- Prescriber is responsible of clinical care of patient
- Both pharmacists and prescribers are regulated professions in
most jurisdictions
- A prescription being a mechanism of communication between
them is regulated as well and is a legal doc.
Types of prescription:
- Ordinary prescription:
• White in color
• use for all other med except controlled drugs
- Special prescription:
• for controlled drugs
• Red color for narcotic drugs
• Blue color for psychotropic drugs
Parts of prescription:
Traditionally 5 parts:
- Superscription
- Inscription
- Transcription
- Subscription and
- Signature
Parts of prescription…
- Superscription: the head of prescription
• Name of institution
• Patient ID; name, age, sex, address, card no., dx
- Inscription: separated from Superscription via Rx
• Name of drug
• Dosage form and
• Strength
Parts of prescription…
- Transcription: Direction for the patient
• Dose
• Route
• Frequency
- Subscription: Direction for pharmacist
• Duration of RX or
• Amount of drug
- Signature
Contents of prescription
• Patient’s name
• the name and strength of medication
• the dose
• the route and frequency of administration
• the date and time
• the signature of prescriber
Who can write prescriptions?

• MD: in Ethiopia and North America
• Licensed certified Physician Assistant ; district of Columbia
• All registered Nurses and nurse- Midwives US
• Clinical pharmacists
Factors affecting prescription writing in children

- Oral absorption
• gastric emptying Prolonged until age of 6 months
• Gastric acid output (⬆PH) reach adult after 2nd year of life
- Distribution
• they requires higher dose of water-soluble drugs as mg/kg due to ⬆ body
water
• ⬇plasma protein binding in neonates due to ⬇ albumin and globulins and ⬆
circulating bilirubin in neonates displaced drugs from albumin
Factors affecting prescription writing in children...

- Metabolism
• Enzyme system may be absent at birth or presence in considerably reduced
amount
• Metabolic rate is dramatically increased in children > adult
• Hence children required their doses on mg/kg
- Excretion
• Complete renal maturation is reached around 6-8 months
- Compliance
• Is affected by route of administration, formulation, taste, appearance, hence
avoid painful IM injections if possible
Abbreviations in prescription writing
abbreviation meaning in latin and/english

rx recipere
iv, im, po, sc routes of administration
ac ante cibum ( before meal)
pc post cibum
bid bis in die
qid quarter in die
tid ter in die
qd quaque die (every day)
abbreviation meaning in latin and/english

Abbreviations in prescription writing
q3h quaque 3 hora
hs hora somni
Po Per os
Prn Pro re natal (as needed
Mg Milligram
Kg Killogram
Steps in writing a prescription

1. Make a diagnosis, consider its phathophysiology
2. Selective therapeutic objective
• pain relief
• reduction of inflammation
• arresting the course of disease progress
3. Select a drug of choice based on therapeutic goals
- Consider the following while doing so
• the age, clinical presentation, co-morbid illnesses, pt tolerance, pt adherence, affordability, drug-drug
interactions, drug allergy, S/E and toxicity
Steps in writing a prescription

4. Determine appropriate dosing regimen based on
• pharmacokinetics on that patient
• presence and absence of Renal or liver disease
5. Devise a plan for
• Monitoring drug action
• determine and end point for therapy
6. Plan a patient’s education program
Errors in prescription writing

- Omission of needed information
- Poor writing resulting in wrong drug, dose or timing
- Prescribing drugs that are inappropriate for a given condition
Writing a good prescription in pediatrics

- Write it legibly
- Spell the name of drugs correctly
- Use a proper English grammar
- Avoid confusing abbreviation as much as possible
- Avoid phrases “as needed”, “as directed” specify exactly
- Avoid ambiguities or symbols that can be misinterpreted:
• unnecessary decimal points e.g 5.0 mL instead of 5mL
• Always use 0.5 mg instead of .5mg
• Avoid trailing zeros e.g use 0.5mL instead of .50/0.50
• Use mL instead of “cc” or cm3; c may look like 0 or cc as c.c.
• Specify the time if possible 11am, 3pm and 11 pm than just tid
• Avoid PRN instead PRN pain or every 6 hrs
Writing a good prescription in pediatrics

- Prescribe medication only when essential with benefits outweighing the risks involved
esp. in children, pregnancy, elderly and breast feeding
- Determine child-safe dosages using body weight
Calculation of dose in children

- Children dose may be calculated from adult dose using
• Age, body weight, or body surface area or
• combination of these
• Most reliable ones are those based on body surface area
Rules for calculating Child's dose from adult dose

1. Qoung's rule: applies to children over 2 years of age
- Child dose = age (yr) x adult dose /age(yr) + 12
• calculate CD of mebendazole for a 4 yrs old child if the average daily adult dose is 400 mg
100 mg
Answer:____________
2. Fried’s rule: mainly applicable to children < 1yr of age

- CD = Age (months) x adult dose / 150
3. Chark’s rule for young children, use weight in pounds
- CD = wt (Ib) x AD/150
- If adult dose of gentamycin is 160mg, how many mg should be given to 20 Ib child?
- 21 mg
Answer: ______?
4. Kg rule: use wt of the child in (kg) instead of Ib

- CD = wt (kg) x AD/70
5. Mg/kg rule:
- Requires a great deal of understanding about the medication being prescribed
- Determine child-safe dosage using the child’s body wt
5. Mg/kg rule….
- e.g if CD of quinine is 10mg/kg/day in 3 divided doses how can it be given to a 15kg child?
- 50 mg
Answer ______ q8hrly
References:
- Drug formulary for pediatrics

- Rang and Dale’s pharmacology 6 edition
- A guide to a good prescribing
- Medical Wikipedia
For questions, comment or feedback
Contacts
E-mails: danielalukdinyo9@gmail.com
danielalukdinyo9@live.co.uk
danielalukdinyo9@yahoo.com
Facebook: www.facebook.com/daniel.garang
Skype: Daniel Garang Aluk Dinyo
Instagram: daniel_garang_aluk_dinyo
Twitter: @Daniel Garang
Youtube: youtube.come/danielgarangalukdinyo
Myspace: Daniel.Garang.Aluk.Dinyo9
LinkedIn: Daniel Garang
Phone: +211927445041
And many more …

Prescription Writing For Pediatrics by Dr. Daniel Garang Aluk Dinyo at St. Paul's Hospital Millennium Medical College 2017

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Prescription writing

BY: DANIEL GARANG ALUK DINYO

- Symbol represent Latin imperative verb

Definition: a health care provider’s written authorization for a

Prescription legal implications:

Who can write prescriptions?

Factors affecting prescription writing in children

Factors affecting prescription writing in children...

Abbreviations in prescription writing

abbreviation meaning in latin and/english

abbreviation meaning in latin and/english

Prn Pro re natal (as needed

Steps in writing a prescription

Steps in writing a prescription

Errors in prescription writing

Writing a good prescription in pediatrics

Writing a good prescription in pediatrics

Calculation of dose in children

Rules for calculating Child's dose from adult dose

2. Fried’s rule: mainly applicable to children < 1yr of age

4. Kg rule: use wt of the child in (kg) instead of Ib

- Drug formulary for pediatrics

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