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

may be telephoned to a pharmacy only in emergency
situations. To be an emergency:
• Immediate administration is necessary
• No appropriate alternative treatment is available
• It is not reasonably possible for the physician to provide
a written prescription prior to the dispensing.
For an emergency prescription, the quantity must
be limited to the amount adequate to treat the patient during
the emergency period, and the physician must have
a written prescription delivered to the pharmacy for that
emergency within 72 hours. If mailed, the prescription
must be postmarked within 72 hours. The pharmacist
must notify the DEA if this prescription is not received.
Refills
No prescription order for a schedule II drug may be
refilled under any circumstance. For schedule III and IV
drugs, refills may be issued either orally or in writing,
not to exceed five refills or 6 months after the issue date,
whichever comes first. Beyond this time, a new prescription
must be ordered. For schedule V drugs, there are no
restrictions on the number of refills allowed, but if no
refills are noted at the time of issuance, a new prescription
must be made for additional drug to be dispensed.
Preventing Diversion
Prescription blanks often are stolen and used to sustain
abuse of controlled substances and to divert legitimate
drug products to the illicit market. To prevent this type
of diversion, prescription pads should be protected in
the same manner as one would protect a personal
checkbook. A prescription blank should never be presigned
for a staff member to fill in at a later time. Also,
a minimum number of pads should be stocked, and they
should be kept in a locked, secure location except when
in use. If a pad or prescription is missing, it should be
reported immediately to local authorities and pharmacies;
some areas have systems in place to allow the
rapid dissemination of such information. Ideally, the
physician’s full DEA number should not be pre-printed
on the prescription pad, because most prescriptions will
not be for controlled substances and will not require the
registration number, and anyone in possession of a valid
DEA number may find it easier to commit prescription
fraud. Some physicians may intentionally omit part or
all of their DEA number on a prescription and instead
write “pharmacist call to verify” or “call for registration
number.” This practice works only when the pharmacist
may independently verify the authenticity of the prescription,
and patients must be advised to fill the prescription
during the prescriber’s office hours. Pharmacists can
ascertain the likely authenticity of a physician’s DEA
number using an algorithm.
Another method employed by the drug seeker is
to alter the face of a valid prescription to increase the
number of units or refills. By spelling out the number of
units and refills authorized instead of giving numerals,
the prescriber essentially removes this option for diversion.
Controlled substances should not be prescribed
excessively or for prolonged periods, as the continuance
of a patient’s addiction is not a legitimate medical
purpose.
DRUG STANDARDS
AND CLASSIFICATION
The U.S. Pharmacopeial Convention, Inc. is a nongovernmental
organization that promotes the public
health and benefits practitioners and patients by disseminating
authoritative standards and information on
medicines and other healthcare technologies. This
organization is home to the U.S. Pharmacopeia (USP),
which, together with the FDA, the pharmaceutical
industry, and health professions, establishes authoritative
drug standards. These standards are enforceable
by the FDA and the governments of other countries
and are recognized worldwide. Drug monographs are
published in the USP/National Formulary (USP-NF),
the official drug standards compendia that organize
drugs into categories based on pharmacological actions
and therapeutic uses. The USP also provides chemical
reference standards to carry out the tests specified in the
USP-NF. For example, a drug to be manufactured and
labeled in units must comply with the USP standard for
units of that compound. Such standards are essential for
agents possessing biological activity, such as insulin.
The USP also is home to the USP Dictionary of
U.S. Adopted Names (USAN) and International Drug
Names. This compendium is recognized throughout the
healthcare industry as the authoritative dictionary of
drugs. Entries include one or more of the following:
U.S. Adopted Names, official drug names for the
National Formulary (NF), previously used official
names, International Nonproprietary Names, British
Approved Names, Japanese Accepted Names, trade
names, and other synonyms. In addition to names, the
records in this file contain other substance information
such as Chemical Abstract Service (CAS), registry
number (RN), molecular formula, molecular weight,
pharmacological and/or therapeutic category, drug
sponsor, reference information, and structure diagram,
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APPENDIX I
PRINCIPLES OF PRESCRIPTION ORDER WRITING AND PATIENT COMPLIANCE