RULES OF THE DRUG PRESCRIPTION
PRESCRIPTION
• official document compiled in accordance with fixed
rules.
• written in Latin
• must have all parts filled up, must be legible
• corrections should be signed by the physician following
the abbreviation corr.(correxit-corrected)na
• written in a non-erasible manner
• max. 2 kinds of medicines/Rx
RULES OF DRUG PRESCRIPTION
• refers to the valid Pharmaceuticals Act and from
the related acts and regulations.
Electronic Prescription
• Physician
• Central server for data storage (SÚKL)
• Pharmacy
• Patient + his password/PIN
www.sukl.cz/erecept
Common and E- prescription
• Ready-made preparations (RMP)- final
preparations made by pharm. companies, ready
to be issued by the pharmacy to patients without
any further modifications
• Individually prepared preparations (IPP) –
prepared in the pharmacies on the base of
individual medical prescriptions
Drug preparations
Covered by insuarance company (fully)
Covered by patient + ins. comp. (in part)
Covred by patient (fully)
Expedition is bound
upon prescription
unbound upon Rx
(OTC)
only in
pharmacies
Both in pharmacies
and in other places
(supermarkets,
petrol stations, etc
„earmarked drugs“ (since 1998): act 378/ 2007, 106/2008 Sb.,
„about good pactice of the sellers of earmarked drugs and about the
specialized education of sellers of earmarked drugs“
Prescription composition
• Inscriptio the heading of the prescription
• Personalia aegroti patient s personal data (name,
surname, birth number and domicile).
• Invocatio - induced by the abbreviation Rp.
(recipe take).
• Ordinatio - the actual prescription of the healing
preparation
= compositio + subscriptio + signatura
compositio
• RMP – the trade name in the nominative, specification
of pharmaceutical dosage form,
dose and package
• IPP – list of pharmacopoeial (officinal) names of
substances in the genitive of singular + dosages
subscriptio
• RMP – how many packages should be issued
• IPP – how the preparation should be made of the
prescribed components
• signatura – instructions how the preparation should be
used by the patients.
• date
• the stamp of the health facility, the identification
of the physician, and the physician s personal
signature
Validity of Prescription
• Common Rx – 14 days
• ATB – 5 days
• ATB topically – 14 days
• Narcotics, Psychotropics
– 14 days
• Rx for repeated issue – 6 moths, max 1 Year
• Rx issued by emergency next day after the Rx issue
• (= max. 48 h)
• Date – Rx not valid if missing
• Validity may be prologned by physician (pollen vaccines-
allergology)
• Max. no. of medicines usually for 3 months
(= usually max. 3 packages)
• If more packages to be issued „Rx. for repeated
issue“
• 6 months of validity if not specified differently
• Max. number of issues has to be specified
Rx for repeated issue
REPETATUR
2x bis
3x ter
4x quater
5x quinquies
6x sexies
7x septies
8x octies
9x nonies
10x decies
Inscriptio
Personalia aegroti
Invocatio
Ordinatio
Compositio (Praescriptio)
Subscriptio
Signatura
Stamp,
Physician identification
Date Signature
Symbols in Rx formulary
I – fully paid by insuarance company
C – partially paid by patient and insuarance comp.
P – fully paid by patients
Symbols on prescription
„HRADÍ NEMOCNÝ/COSTS COVERED BY PATIENT“ - fully paid by
patients
(instead of I, C, P)
„ZVÝŠENÁ ÚHRADA/INCR. RATE OF COVERING “ – drug has two
different levels of payment from insuarance comp.
„NEZAMĚŇOVAT/NOT TO BE SUBSTITUTED“ - physician specify „not to be
substituted with generic medicine“
! a) when max. dose was exceeded
b) different indication from SPC (+ dg. number)
dg. http://www.uzis.cz/cz/mkn/index.html
„POHOTOVOST/EMERGENCY“ – Rx issued by emergency
RMP
• introduced into the marked under their trade
names
• ready to be issued by the pharmacy to patients
without any further modifications
• are manufactured in charges(= amount of
product manufactured in one production cycle)
• charge number must be given on the package
of the preparation
• longer usable life than IPP (on the outer and
inner package –“Exspir./ Exp./ Best before“)
PRAESCRIPTIO
• the trade name in the nominative
• specification of pharmaceutical dosage form,
dose and package
• If not specified – the lowes strenght and smallest
package is issued
SUBSCRIPTIO
• how many original packages (ampules, tablets)
Expeditionem originalem numero unam –
Exp.orig.No.I (unam)
Amp. Orig. No. I (unam)
Expeditiones originales numero duas –
Exp.orig.No.II (duas)
Tbl. orig. No. XXX (triginta)
SIGNATURA
• necessary data, which inform patient about
the proper use of the preparation respecting
the optimum dosage scheme
Rp.
BRUFEN 400 por. tbl. flm.
Tbl.100x400mg
Exp.orig.no.II(duas)
D.S. 1-3 tablets/day
IPP
prepared in the pharmacies on the base of individual
medical prescriptions (magistraliter)
enables individualization of prescriptions
3-8 % of receipts  (e.g.
ophthalmology, dermatology, ORL, dentistry).
Risk of incompatibilities and mistakes in prescription and
preparation
IPP
Ordinatio –
= compositio + subscriptio + signatura
• = compositio
composition of preparation
= list of pharmacopoeial (officinal) names of
substances in the genitive of singular + dosages
e.g. Paracetamoli 0.5
Morphini hydrochloridi trihydrici 0.03
• remedium cardinale- component showing the major
therapeutic effect
• remedium adiuvans- supplementary substance
improving the effect of the major active
component or attenuating its adverse effects,
• remedium corrigens - component modifying/
unpleasant taste and/or improving undesirable
appearance and/or aroma of the preparation,
• remedium constituens or vehiculum- pharmaceutical
excipient
Compositio
• Doses – DTS
• Exceeding of D max. !
• Doses always in units of grams
• decimals !
• Doses of some drugs spec. in IU, ggts
• Doses of vehiculum „q.s.“
Subscriptio
detailed instructions for the pharmacy how to
prepare
fixed Latin abbreviations are being used
Most often:
Misce fiat (sg.) or Misce fiant (pl.) = mix to make
e.g. M. f. sol./ung./oculogutt.
Signatura
detailed instructions for the patient how to use the
medicine
or drug is prescribed for the physician´s use
Ad usum medici, Pro medico, Pro ordinatione
201
Mr. Ordinary Guy
220426/5698
Brno, Česká 2, 600 00
Acidi borici 2,0
Vaselini albi ad 100,0
M. f. ung.
D.S. …
MUDr. Radím Uzel
13. 2. 2011
Drugs of abuse and psychotropic substances
• §§ - Drugs of abuse group I
very strong narcotic effect
e.g. fentanyl, morphine, cocaine, methadone
• § psychotropic substances, group II
strong psychotropic effect
e.g. amphetamin, flunitrazepam
Narcotic substances
– §§ alfentanyl
– §§ diphenoxylate
– §§ fentanyl
– §§ hydrocodone
– §§ cocaine
– §§ methadone
– §§ morphine
– §§ oxycodon
– §§ oxymorfon
– §§ pethidine
– §§ sufentanyl
– §§ remifentanyl
– §§ tilidin
– §§ opium crudum
Psychotropic substances
– § aphetamin
– § buprenorfin
– § phencyclidin
– § flunitrazepam (Rohypnol)
– § methamphetamin
– § pentazocin
– …
Rules for prescription
• prescribed on prescriptions and/or order
forms with an oblique blue stripe
• very strict accounting
• three copies
• only one preparation
• number of doses in package
• 14 days of validity
Examples
Rp.
Durogesic 25 g/h empl.
EMP 5x2,5 mg (10 cm2)
Emp. orig No. X (decem)
D.S. …
Transdermal
patches
Rp.
Dolsin inj.
INJ 10x1 ml 5%
Amp. orig No. X (decem)
D.S. …
Injections
Rp.
MST Continus 10 mg tbl. ret.
TBL RET 60x10 mg (miligrammata decem)
Tbl. orig No. LX (sexaginta)
D.S. …
Tablets
Rp.
Valoron gtt.
GTT 10 ml 10%
Lag. orig. 10 ml No. I (unam)
D.S. …
drops
Rp.
Morphini hydrochloridi trihydrici 0,03
Lactosi q.s.
M.f.pulv.
D.t.d. No. XX (viginti) ad caps. gelat.
D.S. …
IPP
Drug information databases
Micromedex
LEXICOMP
EMA, FDA AISLP
SPCs
Drugs.com
In Czech:
AISLP
Infopharm
Pharmindex Vademecum
Pharmindex Compendium
Remedia Compendium