CD-ROM Today 1996 January

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$Unique_ID{BRK03002} $Pretitle{} $Title{The New Prescription Drug Reference Guide - Filling Your Prescription} $Subject{Latin Greek symbols phrases abbreviations directions pharmacist over-the-counter OTC drugs Generic drug trade name brand substitution quantity store containers refrigerator refrigeration Temperatures children leftover} $Volume{} $Log{ Sample Prescription 1*0300201.scf Sample Prescription 2*0300202.scf Common Abbreviations and Symbols Used in Writing Prescriptions*0300201.tab Definitions Used to Describe Storage Temperatures*0300202.tab} Copyright (C) 1993 Publications International, Ltd. Filling Your Prescription ------------------------------------------------------------------------------ While you're having your prescription filled, you should make sure you understand what the drug is used for, your dosage schedule, how to store the medication properly, what kinds of precautions to take to prevent or reduce side effects, whether you should restrict your diet or drinking habits while taking the drug, which side effects are expected or unavoidable, and which side effects signal a need for a doctor's attention. Your first step in filling your prescription is reading what your doctor has written. READING YOUR PRESCRIPTION Prescriptions are not mysterious--they contain no secret messages. Many of the symbols and phrases doctors use on prescriptions are abbreviated Latin or Greek words; they are holdovers from the days when doctors actually wrote in Latin. For example, "gtt" comes from the Latin word guttae, which means drops, and "bid" is a shortened version of bis in die, which is Latin for twice a day. You do not have to be a doctor, nurse, or pharmacist to read a prescription. You can (and should) learn how to read one yourself--after all, the prescription describes the drug you will be taking. You should understand what your doctor has written on the prescription blank to be sure that the label on the drug container you receive from your pharmacist coincides with your prescription. The accompanying chart lists the most common prescription symbols and abbreviations. Use it as a guide to read the sample prescriptions that follow. Common Abbreviations and Symbols Used in Writing Prescriptions Abbreviation Meaning Derivation and Notes ------------------------------------------------------------- aa of each ana (Greek) ac before meals ante cibum (Latin) AD right ear auris dextra (Latin) AL left ear auris laeva (Latin) AM morning ante meridiem (Latin) AS left ear auris sinistra (Latin) au both ears auris (Latin) bid twice a day bis in die (Latin) C 100 -- c [overscored] with cum (Latin) cap capsule -- cc or cm^3 cubic centimeter 30 cc equals one ounce disp dispense -- dtd# give this number dentur tales doses (Latin) ea each -- ext for external use -- gtt drops guttae (Latin) gt drop gutta (Latin) h hour hora (Latin) hs at bedtime hora somni (Latin) M ft make misce fiat (Latin) mitt# give this number mitte (Latin) ml milliliter 30 ml equals one ounce (1 ml = 1 cc) O pint octarius (Latin) OD right eye oculus dexter (Latin) OL left eye oculus laevus (Latin) OS left eye oculus sinister (Latin) OU each eye oculus uterque (Latin) pc after meals post cibum (Latin) PM evening post meridiem (Latin) po by mouth per os (Latin) prn as needed pro re nata (Latin) q [overscored] every quaqua (Latin) qd once a day; quaqua die (Latin) every day qid four times a quater in die (Latin) day qod every other -- day s [overscored] without sine (Latin) sig label as signa (Latin) follows sl under the sub lingua (Latin) tongue SOB shortness of -- breath sol solution -- ss half unit semis (Latin) stat at once; first statim (Latin) dose susp suspension -- tab tablet -- tid three times a ter in die (Latin) day top apply topically -- ung or ungt ointment unguentum (Latin) UT under the -- tongue ut dict or UD as directed ut dictum (Latin) x times -- ------------------------------------------------------------- The first sample prescription is for a medication called Fiorinal. The prescription tells the pharmacist to give you 24 capsules (#24), and it tells you to take one capsule (cap i) every four hours (q [overscored] 4h) as needed (prn) for pain. The prescription indicates that you may receive five refills (5x), that the label on the drug container should state the name of the drug (yes), and that the pharmacist may substitute (substitution) a less expensive equivalent product. Look at the second prescription. It shows that you will receive 100 (dtd C) tablets of Lanoxin, 0.125 mg. You will take three tablets at once (iii stat), then two (ii) tomorrow morning (AM), and one (i) every (q [overscored]) morning (AM) thereafter with (c [overscored]) orange juice (OJ). You will receive the specific brand noted (dispense as written), you may receive refills as needed (prn), and the name of the drug will be on the package (3). Do remember to check the label on the drug container. If the information on the label is not the same as on the prescription, question your pharmacist. Make sure you are receiving the right medication and the correct instructions for taking it. TALKING TO YOUR PHARMACIST Once you have read the prescription, its directions may seem clear enough, but will they seem clear when you get home? For example, the prescription for the Fiorinal states that you should take one capsule every four hours as needed. How many capsules can you take each day--four, six, more? The phrase "as needed" is not clear, and unless you understand what it means, you don't know how much medication you can take per day. What if your prescription instructs you to take "one tablet four times a day?" What does four times a day mean? For some antibiotics, it may mean one tablet every six hours around the clock. For other medications, it may mean one tablet in the morning, one at noon, one in the early evening, and one at bedtime. For still others, it may mean one tablet every hour for the first four hours after you get up in the morning. Don't leave the pharmacy with unanswered questions; ask your pharmacist for an explanation of any confusing terms on your prescription. Your pharmacist is a valuable resource in your health care. He or she should have a record of ALL the prescription drugs you receive, in order to detect any possible life-threatening drug interactions. It is, therefore, a good idea to purchase your medications through one pharmacy--choose one that maintains careful records. The pharmacist will be able to tell you if your therapy may be affected by smoking tobacco, eating certain foods, or drinking alcohol, and if the drugs you are taking can cause drowsiness or nausea. He or she can tell you what to expect from the medication and about how long you will have to take it. Of course, people's treatments vary tremendously, but you should ask whether you will have to take medication for five to ten days (for example, to treat a mild respiratory infection) or for a few months (for example, to treat a kidney infection). You should discuss with your pharmacist the possible side effects of your medication and ask for a description of symptoms. The pharmacist can tell you which side effects require prompt attention from your physician. For example, one of the major side effects of the drug phenylbutazone is the development of a blood disorder. Since a sore throat can be one of the early symptoms of a blood disorder, your pharmacist may instruct you to consult your physician if this symptom occurs. Your pharmacist can also explain how to take your medicine. You need to know whether to take the drug before or after a meal or along with it. The timing of doses of a drug can make a big difference, and the effectiveness of each drug depends on following the directions for its use. Your pharmacist can tell you what is meant by the phrases "as needed," "as directed," and "take with fluid." For example, you may take water, but not milk, with some drugs. With other drugs, you should drink milk. Your pharmacist can also tell you how many refills you may have and whether you may need them. OVER-THE-COUNTER DRUGS Drugs that can be purchased without a prescription are referred to as over-the-counter (OTC) drugs. They are sold in a wide variety of settings, such as drugstores, grocery stores, and hotel lobbies. There are no legal requirements or limitations on who may buy or sell them. Products sold OTC contain amounts of active ingredients considered to be safe for self-treatment by consumers when labeling instructions are followed. Many people visit a doctor for ailments that can be treated effectively by taking nonprescription drugs. Actually, prescriptions are sometimes written for such drugs. Your pharmacist will be able to recommend appropriate use of OTC medications and preparations. If your pharmacist recommends that you not take certain OTC drugs, follow the advice. OTC drugs may affect the way your body reacts to the prescription drugs you are taking. For instance, people taking tetracycline should avoid taking antacids or iron-containing products at the same time; their use should be separated by at least two hours. Antacids and iron interfere with the body's absorption of tetracycline, thereby decreasing its effectiveness. Be sure you know what you are taking. If you are unsure of the type or contents of your medications, ask your doctor or pharmacist. GENERIC DRUGS One way your pharmacist can help you save money is by dispensing generic drugs. "Generic" means not protected by trademark registration. The generic name of a drug is usually a shortened form of its chemical name. Any manufacturer can use the generic name when marketing a drug. Usually, a manufacturer uses a trade name (or brand name) as well as a generic name for a drug. A trade name is registered, and only the manufacturer who holds the trademark can use the trade name when marketing a drug. For example, only Lederle Laboratories can call their tetracycline product Achromycin V, and only the Upjohn Company can use the trade name Panmycin for tetracycline. Most trade names are easy to remember, are capitalized in print, and usually include the registered symbol ((R)) after them. You should know the generic name and the trade name of every drug you are taking. Many people think that drugs with trade names are made by large manufacturers and generic drugs are made by small manufacturers. But, in fact, a manufacturer may market large quantities of a drug under a brand name and may also sell the base chemical to several other companies, some of which sell the drug generically and some of which sell it under their own brand names. For example, the antibiotic ampicillin is the base for over 200 different products. However, all ampicillin is produced by only a few dozen drug companies. Generic drugs are generally priced lower than their trademarked equivalents, largely because they are not as widely advertised. However, not every drug is available generically, and not every generic is significantly less expensive than its trademarked equivalent. Nevertheless, consumers may be able to save as much as 40 percent by purchasing a generic product. For example, 100 tablets of Inderal (40 mg) may cost $22 to $25. One hundred tablets of the generic equivalent product may cost about $18--a savings of $4 to $7. For certain drugs, however, it's inadvisable to "shop around" for a generic equivalent. Although the Food and Drug Administration has stated that there is no evidence to suspect serious differences between trade-name drugs and generic drugs, differences have been shown to exist between brands of certain drugs. The tablets or capsules from different manufacturers may not dissolve in the stomach at the same rate or to the same extent, because of variations in the way they are made or the fillers (nonactive ingredients) that are used. This is especially true for the various generic digoxin and phenytoin products. It is, therefore, important to discuss with your doctor or pharmacist the advantages or disadvantages of any particular generic product. All states have some form of substitution law that allows pharmacists to fill prescriptions with the least expensive equivalent product. However, your doctor can authorize the use of a specific brand of medication by signing on the appropriate line or otherwise noting this on the prescription form. You should be aware that certain patients can sometimes respond in different ways to various equivalent products, and your doctor may have good reasons for being specific. Discuss this with your doctor. HOW MUCH TO BUY On a prescription, your doctor specifies exactly how many tablets or capsules or how much liquid medication you will receive. But if you must take a drug for a long time, or if you are very sensitive to drugs, you may want to purchase a different quantity. The amount of medication to buy depends on several factors. The most obvious is how much money you have or, for those who have a comprehensive insurance program, how much the insurance company will pay for each purchase. These factors may help you decide how much medication to buy, but you must also consider the kind of medication you will be taking (for example, how long it can be stored). Medications to treat heart disease, high blood pressure, diabetes, or a thyroid condition may be purchased in large quantity. Patients with such chronic conditions take medication for prolonged periods. Chances are, they will pay less per tablet or capsule by purchasing large quantities of drugs. Generally, the price per dose decreases with the amount of the drug purchased. In other words, a drug that usually costs six cents per tablet may cost four or five cents per tablet if you buy 100 at a time. Many doctors prescribe only a month's supply of drugs, even those drugs that will be taken for a long time. If you wish to buy more, check with your pharmacist. It is also important to make sure that you have enough medication on hand to cover vacation travel and long holidays. Serious side effects could occur if you miss even a few doses of such drugs as propranolol, prednisone, or clonidine. If you have been plagued by annoying side effects or have had allergic reactions to some drugs, you may want to ask your pharmacist to dispense only enough medication on initial prescriptions for a few days or a week, so that you can determine how your body reacts to the drug. Pharmacists cannot take back prescription drugs once they have left the pharmacy. You may have to pay more per dose if the pharmacist gives you a small quantity of the prescription, but at least you will not be paying for a supply of medication your body cannot take. Be sure you can get the remainder of the prescribed amount of the drug if no serious or intolerable side effects occur. With some drugs, after you have received part of the intended amount, you cannot receive the remainder without obtaining another prescription. STORING YOUR DRUGS Before you leave the pharmacy, find out how you should store your medication. If drugs are stored in containers that do not protect them from heat or moisture, they may lose potency. All medications should be kept in their original containers. Different medications should NOT be mixed in one container, in order to prevent confusion about which drug is being taken. In addition, some drugs may lose their potency when stored with other medications. Never remove the label from the prescription vial. It contains your prescription number (for refills), the name of the medication, and directions for proper use. You can safely store most prescription drugs at room temperature and out of direct sunlight. Even those drugs dispensed in colored bottles or containers that reflect light should be kept out of direct sunlight. Some drugs require storage in the refrigerator; other medications should not be refrigerated. For example, some liquid cough suppressants thicken as they become cold and will not pour from the bottle. Some people keep nitroglycerin tablets in the refrigerator because they believe the drug will be more stable when kept cold. Nitroglycerin, however, should not be stored in the refrigerator. Even if the label on your medication states "keep refrigerated," this does NOT mean you can keep the drug in the freezer. If frozen and thawed, coated tablets may crack, and some liquids may separate into layers that can't be remixed. Many people keep prescription drugs and other medications in the bathroom medicine cabinet, but this is one of the WORST places to keep drugs. Small children can easily climb onto the sink and reach drugs stored above it. Also, the temperature and humidity changes in the bathroom may adversely affect the stability of prescription and nonprescription drugs. It is required by law that all prescription medications for oral use be dispensed in childproof containers. If you find the container difficult to open AND if there are no small children in your home, you can request that your pharmacist dispense your medication in a nonchildproof container. Definitions Used to Describe Storage Temperatures ------------------------------------------------------------------------------ Excessive Cold Any temperature under 36 degrees_F (2 degrees_C) Refrigerated Any cold place where the temperature is between 36 and 46 degrees_F (2-28 degrees_C) Cool Any temperature between 46 and 59 degrees_F (8-15 degrees_C) Room temperature Temperature usually between 59 and 86 degrees_F (15-30 degrees_C) Excessive heat Any temperature above 104 degrees_F (40 degrees_C) ------------------------------------------------------------------------------ KEEP ALL MEDICATIONS AWAY FROM CHILDREN, and do not keep unused prescription drugs. Flush leftover medication down the toilet or pour it down the sink, and wash and destroy the empty container. Regularly clean out your medicine cabinet and discard all drugs you are no longer using and drugs that have expired (the expiration date is often listed on the prescription label). These drugs can be dangerous to your children, and you might be tempted to take them in the future if you develop similar symptoms. Similar symptoms may not be due to the same disease, however, and you may complicate your condition by taking the wrong medication. If a child accidentally swallows medication or receives too much of a prescribed medication, IMMEDIATELY CALL YOUR LOCAL POISON CONTROL CENTER, A NEARBY EMERGENCY ROOM, OR YOUR DOCTOR for instructions and recommendations. These phone numbers should be written down in a readily accessible place. (For safety's sake, it is wise to keep a list of these and other important telephone numbers, such as those for the police and fire departments, at each and every telephone in your home.) You should also keep a bottle of syrup of ipecac (available without a prescription at your local drugstore) for each child under five years of age in your home (in case the poison control center or emergency room personnel or your doctor recommends that you induce vomiting in the child). Do not, however, use the syrup of ipecac unless instructed to do so by a health professional. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.