DƯỢC LÍ Goodman & Gilman's The Pharmacological Basis of Therapeutics 12th, 2010

shorter due to limits and pressures of physician reimbursements,
patients often feel that a trip to the doctor
that does not result in a new prescription somehow is a
failed visit or a lost opportunity. Similarly, physicians
may feel that they have fulfilled their role if the patient
leaves with a prescription. Physicians must educate
their patients about the importance of viewing medicines
as to be used only when really needed and that
remaining on a particular medicine when their condition
is stable may be preferable to seeking the newest
medications available.
Prescription Drug Advertising
The Federal Food, Drug, and Cosmetic Act as amended
(Food and Drug Administration Modernization Act of
1997) permits the use of print and television advertising
of prescription drugs. The law requires that all drug
advertisements contain (among other things) summary
information relating to side effects, contraindications,
and effectiveness. The current advertising regulations
specify that this information disclosure needs to include
all the risk information in a product’s approved labeling
or must direct consumers to healthcare professionals to
obtain this information. Typically, print advertisements
will include a reprinting of the risk-related sections of
the product’s approved labeling (package insert), while
television advertising will not. In addition, advertisements
cannot be false or misleading or omit material
facts. They also must present a fair balance between
effectiveness and risk information.
The benefits of these types of direct-to-consumer
(DTC) advertising, including Internet advertising, are
controversial (Findlay, 2001). Dramatizations employed
by television commercials may be a disservice to the
physician’s ability to educate and care for the patient
if such advertisements only create brand loyalty.
Alternatively, patients who learn about drugs on television
may interact more effectively with their healthcare
providers by asking questions about the medicines they
take. Prescription drug advertising has alerted consumers
to the existence of new drugs and the conditions
they treat, but it has also increased consumer demand
for drugs. This demand has increased the number of
prescriptions being dispensed (raising sales revenues)
and has contributed to the higher pharmaceutical costs
borne by health insurers, government, and consumers.
In the face of a growing demand for particular brandname
drugs driven by advertising, physicians and pharmacists
must be able to counsel patients effectively and
provide them with evidence-based drug information
(Khanfar et al., 2007).
ERRORS IN DRUG ORDERS
The Institute of Medicine (IOM) estimates that the
annual number of medical errors in the U.S. that
results in death is between 44,000 and 98,000 (Kohn
et al., 2000). Although there is some controversy
about these estimates (Sox and Woloshin, 2000), it is
clear that the large number of medical errors includes
medication errors resulting in adverse events, including
death (Mangino, 2004; Tzimenatos and Bond,
2009). Databases of anonymously reported errors are
maintained jointly by the Institute for Safe Medication
Practices (ISMP), the U.S. Pharmacopeia Medication
Errors Reporting Program (USP MERP), and the FDA’s
MedWatch program. Adverse drug events occur in ~3%
of hospitalizations, and this number is larger for special
populations such as those in pediatric and neonatal
intensive care units (Chedoe et al., 2007).
By examining aspects of prescription writing that
can cause errors and by modifying prescribing habits
accordingly, the physician can increase the probability
that the patient will receive the correct prescription. By
being alert to common problems that can occur with
medication orders and communicating with the patient’s
physician, pharmacists and other healthcare professionals
can assist in reducing medication errors (Murray et al.,
2009). Good practice in the preparation of medication
orders in both the institutional and outpatient settings
can be summarized as follows:
• Write all orders clearly using metric measurements
of weight and volume.
• Include patient age and weight on the prescription,
when appropriate, so dosage can be checked.
• Use Arabic (decimal) numerals rather than Roman
numerals (e.g., does “IL-II” mean “IL-11” or “IL-2”?);
in some instances, it is preferable for numerals to be
spelled out.
• Use leading zeros (0.125 milligrams, not .125 milligrams);
never use trailing zeros (5 milligrams, not
5.0 milligrams).
• Avoid abbreviating drug names; abbreviations may
lead to misinterpretation.
• Avoid abbreviating directions for drug administration;
write out directions clearly in English.
• Be aware of possibilities for confusion in drug
names. Some drug names sound alike when spoken
and may look alike when spelled out. The U.S.
Pharmacopeial Convention Medication Errors
Reporting Program maintains a current list of drug
names that can be confused (www.usp.org). The
list of alliterative drug names currently contains
1883
APPENDIX I
PRINCIPLES OF PRESCRIPTION ORDER WRITING AND PATIENT COMPLIANCE