MINISTRY OF PUBLIC HEALTH OF UKRAINE
I.Ya.
The Department of Pharmacology
with Clinical Pharmacology
Prof. K.A. Posokhova, c.m.s. O.M. Oleshchuk, O.O. Shevchuk
RULES OF MEDICAL PRESCRIPTION WRITING
METHODICAL INSTRUCTIONS FOR STUDENTS
Third edition
TERNOPIL
2011
Chapter I
General information about medical prescription
Medical prescription. It is a section of the science about medical agents, which concerns the rules of dispensing them in the various forms. Shortly, it is a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient. Any prescription relating to restricted drugs must be directed to a qualified pharmacist and can be authorized only by a registered veterinarian, dentist or medical practitioner.
Some terms, which we shall meet with during study pharmacology and execution of the prescription are explained in the Law of Ukraine “ On Medicines” (from 04.04. 1996).
Medical agents these are substances or their mixtures natural, synthetic or biotechnological origin, which are applied to preventing pregnancy, prophylaxis, diagnosis and treatment of the human diseases or to changing status and function of the organism. There are such medical agents: a) active substances; b) ready-made medical agents (medicines, medical preparations, drugs); c) homeopathic agents; d) agents used for revealing pathogens – illnesses agents and also for fight for pathogenic organisms and parasites; e) medical cosmetic agents and medical admixtures to food – stuffs.
Ready-made medical agents (medicines, medical preparations, drugs) – these are dosed medical agents in the form, which they are applied in.
Active agents (substances) – biologically active substances, mighty to change the organism status and functions or can have preventive, diagnostic or curative action and are used for manufacturing the ready-made medicines.
Auxiliary substances are the additional substances necessary for preparation of the ready-made medicines.
Narcotic medical agents, these are referring to narcotic according to the legislation medicines.
Poisonous medical agents are the medicines referred to poisonous by the Ministry of public health of
Strong-acting medical agents these are medicines referred to strong-acting by the Ministry of public health of
The state register of the medical agents of
State Pharmacopoeia of Ukraine is the legal act, that includes the general demands for medical agents, pharmacopoeia articles and also control methods of medicines quality (physical-chemical, chemical and biological methods).
Pharmacopoeia article, this is normative-technological document, which determines the demands for medical agents, their packing, conditions and terms of their storage, the control methods of their quality.
The set of properties, which are up to the requirements fixed by legislation and gives for medical agents an ability to satisfy the consumers according to their assignments, is named quantity.
Pharmacopoeia contains the inquiry tables, the tables of maximum single and daily doses poisonous and strong-acting medical agents for adults and children.
Medicines, the components, doses and the way of their preparation are directing in pharmacopoeia are named officinal (from lat. officina – laboratory, workshop), and pharmaceutical forms, which are preparing in drugstore after doctor’s prescription are called magisterial (from lat. magister – teacher, govern).
Nowadays in many countries of the world there is the tendency to apply the international names of medicines according to the united Latin chemical nomenclature of the medical agents, which is recommended by the World Health Organization and is given in the international pharmacopoeia (Pharmacopoeia Internationals). First of all its necessary for correct orientation of the doctors and pharmaceutists in huge quantity of the medicines, which are exported from one country to another. The same medical agent, which international name is known by experts all over the world, is manufactured out under various original names in the various countries and by various firms. The Pharmacopeia’s demands are compulsory for all enterprises of chemical-pharmaceutical industry, medical and preventive establishments.
The pharmaceutical form is the issue form of medical agents, that the best accords to application aim. It is the most advantageous for the usage with curative and preventive purpose.
There are Classifier of finished pharmaceutical forms, which has been developed according to Article 12 of The Law of Ukraine “ On Medicines”:
- Solid pharmaceutical forms;
- Soft pharmaceutical forms;
- Liquid pharmaceutical forms;
- Pharmaceutical forms which are sprayed;
- Pharmaceutical plant raw material;
- Other pharmaceutical forms.
The arsenal of medicines consists of the agents mineral, vegetative, animal parentage, products of micro-organisms vital activity and chemically synthesized.
Galen’s preparation (such are named after Claudy Galen – Ancient Roman doctor) are the medicines which are received by simple extraction from vegetative raw material by means of the water, alcohol or other. Besides active substances they contain other, ballast substances (cellulose, proteins, oils pigments, pitches, saponins and others). They are: extracts, infusions, tinctures and others, for example: tincture Valerianae, extract of Viburnum liquid.
New galen’s preparations, these are the persistent extracts from vegetative raw material cleaned as much as possible from ballast substances; for example – Omnopon (opium allcaloids admixture), Adoniside (from Adonis vernalis), Digalen-neo (from leaves of foxglove – Digitalis L.) and others. Such preparations can be applied parenterally.
Pharmacy, drugstore (gr. – apotheke which means store, pantry).
– establishment for storage, preparation and selling medicines storage and selling curative mineral waters, dressings, the patient care things, sanitation products, personal hygiene things and so on.
In the drugstore all medical agents are parted on 3 groups:
1. Poisonous – Venena, list A. the poisonous and narcotic substances belong to them. They are kept locked in cases with inscription “Venena” and “A” in specially equipped rooms. The severe registration of their expense is conducted. In the end of working-day the case, where they are kept, is sealed up.
2. Strong-acting – Heroica, list B. Those medicines are also kept separately from other medical agents in the cases with inscription “Heroica” and “B”. After working-day this case is closed by a key.
3. Other Medical agents, which are stored in the drugstore according to the demands of pharmacopoeia.
Chapter II
The prescription
The prescription (lat. receptum – received) it is the doctor’s written appeal to the pharmaceutist about producing and selling medicines to the patient with indicating of the way of their use. It is the important document. The prescription must be written by the rules fixed by the Order of the Ministry of Health of
The rules of writing out the prescriptions medical
Agents and products of medical assignment
1. The doctors of the curative and prophylactic establishments are obliged to write out prescription to the patient on medicines and products of medical assignment certified by the signature and personal seal. The prescription should be written in Latin with indicating of the patient’s age, the way of the payment for medical agents and products of medical assignment, the way of using. Also it should be written on the form printed in the printing-house according to the forms (addition № 1,2,3) predicated by the Order of the Ministry of public health service of Ukraine № 117 from 06.30.94. in special cases the prescription must be assured by the seal of the treatment and prophylactic establishment, research institute, medical educational establishments.
2. The prescription form №2 intended for subscribing of the medicines and products of medical assignment free-of-charge or on favorable terms and medical agents which have stupefy qualities, according to the list predicated by the Order of the Ministry of public health services of
3. The prescription form №3 intended for subscribing of narcotic medical agents in the pure state or in the admixture with indifferent substances according to the list, that affirms by the Ministry of public health services of
4. All others medical agents, including ethyl alcohol, are subscribed on the prescription form № 1.
5. It is allowed to the doctors of the municipal establishments of public health services, doctors of other establishments, enterprises, organizations, which have corresponding means for payment such prescriptions, and also manager of the medical assistant’s posts, medical assistant’s and obstetrical posts (according to the list confirmed by government bodies of public health services) to write out the prescriptions for reception of medicines, products of medical assignment free-of-charge or on favorable terms. The prescriptions are written in one copy. In case of writing out the prescription of narcotic medical agents free-of-charge or on favorable terms, both prescription form №3 and №2 have to be filled.
6. As a rule doctors write out the prescriptions after patient examination with obligatory registration about medicines assignment in the medical documentation (medical card of an ambulatory patient or medical card of the stationary patient).
It is forbidden to write out the prescriptions on medicines which are not permitted for medical application in
- The prescriptions should be filled legible and precisely by ink or ball pen with obligatory
filling of all necessary elements in the form. Corrections in the prescription are not allowed.
8. On the prescription form №3 and №2 it is allowed to write out only one name of the medical agent. On the form №1 we can write out not more than 3 names of the medicines.
9. It is necessary to write in Latin medical agent’s composition, definition of the medical form, reference to the pharmacist about preparation and distribution of the medicines.
Usage Latin abbreviations is allowed according only to accept ones in medical and pharmaceutical practices (Addition).
It is forbidden to use the abbreviation of components with alike names, because it is difficult to indicate what medicine prescribed.
10. The names of poisonous and narcotic medical agents have to be written at the beginning of the prescription and all others – further.
11. It is necessary to give medicines immediately, in the upper part of prescription we must put the mark “cito” (fast) or “statim” (immediately).
12. When we write the prescription on the liquid medical agents their quantity is indicated in milliliters or drops, all other – in grams.
13. In case of necessity it is allowed to prescribe medical agents in quantities necessary for prolongation or repetition of treatment course, except the medicines that has the fixed norms of the serving. On the prescription form the appropriate record is made by the doctor and additionally has to be confirmed by hi s signature and personal seal.
14. Ethylmorphine hydrochloride, codeine, codeine phosphate, pentobarbital (Aethaminalum – natrium), barbamil, esthocine tab. (Aesthocinum tab.), phepranone (Phepranonum) and pachycarpine hydroiodide (Pachycarpini hydroiodidum) are the narcotic medical agents which in the pure appearance or on admixture with indifferent substances had to be written on the prescription form №3. The prescription form №3 additionally is signed by the head of establishment of public health services or his medical part assistant and also is assured by a seal of establishment of public health services.
15. Prescriptions of the tablets Codterpine (Codterpinum), alnague (Alnagonum and tablets for tussis (composition: herbs Thermopsis – 0,02 gr, codeine – 0,01 gr, Sodium hydrocarbonate 0,2 gr; roots of licorice (Glycyrrhyza) in a powder – 0,2 gr) and medicines, which include poisonous medical agents of the list “A”, codeine, codeine phosphate, ethylmorphine hydrochloride, pentobarbital, barbamil, ephedrine hydrochloride in admixture with other medicines, hypnotic agents, neuroleptic agents, tranquilizers, clopheline (Clophelinum), preparations, which include 8-oxyquinoline derivates, tincture Aralia (Echinopanax elatum) are subscribed on the prescription form №1 and in addition are assured by the establishment of public health services seal “For the prescription”.
16. The prescriptions on medical agents, which are subscribed on the prescription form № 2, have to be assured by the establishment of public health services seal “For the prescriptions”.
17. Doctor must write dose of the medical agent by the letters and put the exclamation mark writing out poisonous or strong-acting medical agents referred to the list “A” or “B” in doses exceeding maximum permissible single dose.
18. The doctors might write out the prescriptions on ethyl spirit in admixture with other substances or in the pure state in quantities not more than 150ml with medical indications. Diabetic and oncology patients (if they make injections themselves) are prescribed free-of-charge up to 100 ml of the ethyl spirit on month. Over this norm diabetic and oncology patients pay complete cost.
19. It is forbidden to write out the prescriptions for the ambulatory patients on medical ether or anesthetic ether (in pure appearance) chlorethyl, kalipsol and other medical agents for narcosis.
20. It is not allowed to write out in one prescription given below medical agents in quantity more than fixed in the table 1.
Aethylmorphine hydrochloride has to be subscribed in the eye drops and ointments in quantities up to
21. The prescriptions on medical agents, which contain Phenobarbital, pentobarbital, sodium barbital in admixture with other substances for patients with lingering and chronic diseases has to be written out on the prescription form №2 on a course of treatment about one month with the obligatory doctor’s indicating “By special assignment”, certified by signature, personal doctor’s seal and seal of establishment of public health services “For the prescriptions
22. It is allowed to write out the prescriptions for the chronic patients within one year except:
- Medical agents, which are the subjects of the object-quantitative accounting;
- Medical agents, which are selling free-of-charge and on favorable terms;
- Anabolic steroids, medical agents contained poisonous substances of the list “A” (except for those which are applied for treatment glaucoma and cataract).
23. While writing out such prescriptions doctor must make the indication “for chronic patient”, mark valid term of the prescription and periodicity of giving medicines (every week, every month and so on), assure the indication by the signature and personal seal.
24. It is allowed to write out the prescriptions for some patient categories, whom have free-of-charge or on favorable terms, on eye drops and other medicines with short keeping term, which are used during the long period, at the same time in quantities necessary for treatment during the month, except the narcotic agents, anabolic steroids and stupefy agents.
25. It is allowed the doctors to write out the prescriptions on medical agents for patients with diabetes, bronchial asthma, with oncology and hematological diseases, tuberculosis, hard skin diseases and others if it is necessary (business trip, holidays and so on) in quantities stipulated for the double-month treatment course consideration medical agents selling norms, including ethyl alcohol, in one prescription.
26. While writing out such prescription doctor must make the indication “for chronic patient”, mark valid term of the prescriptions and in addition assure by the signature and personal seal
Table 1
The maximum quantities of some medicines that can be prescribed out
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The medicines names
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Maximum permissible preparations quantity on the one prescription
|
|
Alganol (Alnagolum)
Barbamil (Barbamilum)
Tablets “Codterpinum”
Tablets for tussis with next composition: herbs Thermopsis 0,02gr codeine 0,01gr sodium hydrocarbonate 0,2gr powder roots of licorice 0,2gr
Pachycarpine hydroiodide (Pachycaprini hydroiodidum)
Hypnotic agents *
Phepranone (Phepranonum) 0,025gr
Ephedrine hydrochloride (Ephedrini hydrochloridum)
Aesthocine tab. (Aesthocinum)
Pentobarbital (Aethaminalum-natrium)
Aethylmorphine hydrochloride (Aethylmorphini hydrochloridum)
|
20 tab.
2 grams
0,2 grams
20 tab.
1,2gr
10-20 tab.
50 dragee
0,6 gr
12 tab.
1 gr
0,2 gr |
* In case of the delivery preparations in original packing which contain more tablets than in the fixed norms, it is allowed to write out in the prescription one packing, but no more than 50 tablets
27. The dentists, medical assistants, obstetrics may write out the prescriptions on medical agents necessary for giving emergent medical help (except narcotic agents) indicated their medical position and assured the prescription by their signature and the establishment of public health services seal.
28. Medical assistants – the managers of the medical assistant’s and obstetrical posts, the public health stations, medical posts might write out the prescriptions for the patients oecessary medicines, except the poisonous (besides those are industry manufactured in therapeutic closes) and narcotic agents in pure state or in admixture with indifferent substances, drugs which have stupefy properties and anabolic steroids. In cases when manager of the medical assistant’s and obstetrical posts realized medicines through chemist’s posts secondary category, the prescriptions have to be written only in cases of selling the medical agents to the patients free-of-charge or on the favorable terms. The prescribing of the medicines is reflected in the medical documentation (medical card of the ambulatory patient).
29. The prescription that is written out with violation of directed rules or contains incompatible medical agents, is considered not valid. And that’s why medicines could not be given. The prescription is marked by “The Prescription is invalid” and is returned to the patient.
30. The doctors and other medical workers, whom write out the prescriptions, bear the responsibility for prescribing medicines and following the rules of writing out the prescription in accordance with established procedure.
31. It is forbidden to assure by the seal of the establishment of public health services the prescription forms, not filled and not signed by the medical worker.
32. Medical agents and products of medical assignment for needs of treatment and prophylactic establishments have to be written out on the demands forms (which are affirmed by the Order Ministry of public health service of
The dentists may write out the demands only on the suggested below poisonous and strong-acting substances, which are applied in the stomatology (without rights of distribution them to the patients):
– adrenaline hydrochloride (solution 0,1% in the original packing, in ampullae);
– nitric acid (in the pure state);
– amyl nitrite (in ampullae’s);
– iodoform (in the powder, paste, emulsion);
– caffeine and sodium benzoate (in ampullae);
– cocaine hydrochloride (in pastes);
– arsenic trioxide (in pastes with contain up to 50%);
– novocain (in the pure state, solution up to 4%, in ampullae);
– silver nitrate (in crystals and solutions);
– phenol (in the pure state and in admixture with other substances);
– chloroform;
– ethyl chloride (in ampullae);
– Ether medical.
The demands on cocaine hydrochloride (in pastes), arsenic trioxide (in pastes with contain up to 50%), silver nitrate (in crystals and solutions) besides the signature of the dentist, have to be certified by the signature of the head of establishment or has assistant on the medical part.
The stages of writing out the prescription
1. To check up whether the code of the treatment and prophylactic establishment (where doctor works) corresponds the form code.
- To underline the word “childish” or “adult” depending on the age of the patient.
- To mark the date of writing out the prescription; for example – “October 15,
2011” . - To put the surname and initials of the patient and also his (her) age.
5. To put the surname and initials of the doctor (legibly) or to put the die with designation of his (her) surname and initials.
6. If the person who has written out the prescription is not the doctor, but doctor’s assistant, obstetrics or dentist it is necessary to sign his (her) position and rank.
7. There is a further part of the prescription that is named “Praepositio” or “Invocatio”. It is the appeal of the doctor to the drugstore with the offer to take the prescription under the responsibility concerning manufacturing the medicines. This part of the prescription begins from Latin word Recipe, Rp. in reduced, that means – take. After “Rp.” substances necessary for preparation the medicines are accounted (this part is called “Designatio materiarum”). The names of these substances are written on Latin in the genitive case, each from the capital letter and from the new line. After the medicine name its quantity (dose) is indicated. For liquid medical agents – in milliliters or drops (for example: 0,1 ml, 1 ml, 10 ml; gtts III, gtts x and so on). And for the solid pharmaceutical forms, viscosity liquids (liniments, suspensions in grams for example: 20,0, 0,03, 0,005, that means accordingly
If the medical agent is dosed in activity unit (OD), in the prescription activity unites quantity is specified (for example: 2000 000 OD). In case when two or more medical agents have to be written out on the prescription in the identical doses, this quantity specified once, only after the name of the last substance. Thus “ana” is put before quantity of agent; it means fifty-fifty (for example: ana 0,1). Accounting all medical substances, which are included into the medicine structure, it is necessary to begin from poisonous and narcotic agents, then – all other preparations. In different in the pharmacological attitude substances, which help to give to the active substances one or other medicine form are written at the end.
8. The doctor gives orders to the drugstore, what substances, in what quantity and of what medicine form chemist must make (this part is named “subscriptio”). From the new line is written: Misce (mix), fiat (make, let will be made), pulvis (powder), or suppositorium (suppository), or unguentum (ointment) and so on. Here may be such words, as: Da (give), tales (such), doses (doses), and also letter № (Numero – number) after what it is marked quantity of the doses, for example: № .3 or №. 12 and so on.
9. Fro the new line the signature is written (signature, reduced form – s). this prescription part is appointed for the patient, That’s why it is written in state language or other languages according to the law of
10. At the end the prescription has the doctor’s signature and his (her) personal seal.
11. Additionally doctor regulate duration the written out prescription validity the way of deleting of some terms. Specifically, the prescriptions on medical agents written out on the form №3 are valid during 5 days, on stupefy agents and medicines for free-of0charge selling (form №2) and also medicines specified on the item 15 above mentioned Rules – are valid during 10 days, and on other medical agents – during 2 month from the date of writing out the prescription.
The reduction of the designations in the prescription is allowed only in conformity to the rules accepted in medical and pharmaceutical practice (see addition).
Prescription symbol
The abroad prescription
The prescription in the foreign countries has such function as in our country. It is the document what contains the doctor’s appeal to the pharmacist about preparation or selling medicines for define patient. In the English speaking countries and countries with English speaking education system (
The first four stages contain: 1. doctor’s surname, 2. license classification or his professional degree, 3. address and 4. work number telephone of the doctor. Thanks to those facts pharmacist can communicate with doctor with his own questions.
On the next line, on the left (5) it is writing the date of wrote out the prescription. On the same line to the right (6) – surname of the patient and the line below (7) – his (her) address.
Then to the right it is writing the mark “P”, that means our “Rp.”, and then, below, in the middle of the paper leaf (8) – the drug name from the capital letter in the nominative case therefore used the international name or the firm name. On this line (9) the dose of the medicine is indicated, more often on the metric weight system, that means in milliliters (ml) or milligrams (mgr); then followed the quantity of the medical agent (10), what is determine by the duration of the treatment course.
Below in the right corner after “Stg:” (11, our “S:”) it is noted the detailed directions for the patient about usage of this medicine.
Below there is special line (12) where doctor marked the needs of repetition treatment or necessity of keeping this medicine in the inaccessible for children (13).
And then below there is the information about necessity to keep some precautionary measures during reception of this drug, for example: “It is forbidden to use alcohol” or “Provoke the sleepiness”.
In the left corner below there is doctor’s signature (15) and it is indicated other identifications doctor’s facts (16) and the state license number (17.)
In some jurisdictions, the preprinted prescription contains two signature lines: one line has “dispense as written” printed underneath; the other line has “substitution permitted” underneath. Some have a preprinted box “dispense as written” for the prescriber to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the prescriber to handwrite one of the following phrases: “dispense as written”, “DAW”, “brand necessary”, “do not substitute”, “no substitution”, “medically necessary”, “do not interchange”.In other jurisdictions may they use completely different languages, never mind a different formula of words. In some jurisdictions, it may be a legal requirement to include the age of child on the prescription. For pediatric prescriptions some advise the inclusion of the age of the child if the patient is less than twelve and the age and months if less than five. (In general, including the age on the prescription is helpful.) Adding the weight of the child is also helpful.
Prescriptions often have a “label” box. When checked, the pharmacist is instructed to label the medication. Wheot checked, the patient only receives instructions for taking the medication and no information about the prescription itself.
The classification of the medical forms we will use during our study pharmacology are below. There are such medical (pharmaceutical) forms (table 2):
1. Firm (solid) medical forms;
2. Soft medical forms;
3. Liquid medical forms;
4. Gasiform;
5. Medical forms for injections.
|
Firm (solid) |
Soft |
Liquid |
Gasiform |
Forms for injections |
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Powders Capsules Species Tablets Dragee Granules Caramel Pastilles Films (inserts) Sponges Extracts dry Plasters
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Ointments Pastes Liniments Transdermal systems Creams Gels Extracts dense Lotions Shampoos Suppositories
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Solutions Enemas (rectal injections) Tinctures Extracts liquid New galen’s preparations Infusions Decoctions Emulsions Suspensions Balsams Mixtures
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Aerosols Inhalations
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Ampoules Bottles Sterile solutions Suspensions Emulsions Powders Tablets
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Table 2
The classification of medical (pharmaceutical) forms used in clinical practice
Chapter III
The firm (solid) medical forms
The powders, capsules, tablets, dragee and species (collections) and other medicinal products belong to the firm (solid) pharmaceutical forms.
Powders
Powders (Pulvis – nominative singular case, pulveris – genitive singular case) are the pharmaceutical form intended for internal and external application, consisting of solid separate dry particles of varying grinding degree. Various synthetic preparations, products of vital activity of the microorganisms (antibiotics), vegetative and animal parentage substances can be used for manufacturing powders. Hygroscopic substances (calcium chloride – Calcii chloridum, sodium bromide – Natrii bromidi, potassium acetate – Kalii acetas and others), substances, that after mixing form wet masses and fluid (antipyrine – Antipirinum and quinine – Chininum), easy decomposed (silver nitrate – Argenti nitras) in admixture with organic combination) or formed explosive substances are not prescribed in powders.
Powders are classified by the way of use, by the corpuscles size, by the composition and dosage.
By the way of use powders are distinguished for internal use (pulveres ad usum internum) and for axternal use (pulveres ad usum externum) powders. By the grinding degree there are smallest (pulveres subtilissimi), small (pulveres subtiles) and large (pulveres grossi) powders and others. As a rule, smallest powders are intended for external applications (pulveres ad usum externum).They are quickly sucking in, less irritating the tissues. Nontoxic substances and substances with moderate activity which are prescribed in large doses or used inside after previous dissolution (for example – magnesium sulfate (Magnesii sulfas) are releasing as large powders. Medical agents look like the small powders frequently are used for internal applications (pulveres ad usum internum).
Depending on quantity of the acting substances what powder structure includes, are discerned simple powders, contained only one medical agent (pulveres simplicis), compound powders, what consist of the two or more substances (pulveres compositi).The drugstore releases dosed powders, divided into separate receptions (pulveres divisi) and undosed powders (pulveres indivisi).As a rule, the dosed powders are prescribed inside, undosed powders more offer are intended for external application, less offer they are prescribed inside.
Undosed powders for external and internal use are prescribed in quantities from 5,0 up to 100,0 and more. Writing the prescription on the simple undosed powder it is necessary to indicate the name, quantity and grinding degree of the medical substance after the word Recipe: Further from a new line write down Da. Signa (or D.S. in brief – release, indicate) and the way of use.
The name of medical agents we put in a genitive case after word Rp.: , because Rp. concerned to the quantity of substances.
Prescribing complex undosed powders all substances which are included into their structure had to be recalculated with indication quantities each of them. Then from the new line write down Misce, fiat pulvis (Mix for forming the powder), further – D.S. and the way of using.
Rp.: Natrii hydrocarbonatis 20,0
Natrii chloridi 10,0
Misce, fiat pulvis
Da. Signa. Dissolve one tea spoon
of the powder in a glass of warm water.
Use the solution for gargling the throat.
Undosed powders frequently are applied as dusting powder (Aspersio), that is for applying on the skin, mucous coats and wound surfaces.Such powders had to be subtilissimi what obligatory is indicated in prescription.
Rp.: Aethazoli subtilissimi 50.0
D.S.Apply on the wound surface.
Sometimes medical substance is only certain part of the compound dusting powder .In different substances, which are the formative agents (Constituens) are made up the rest part of the powder. Talc (Talcum), starch (Amylum), less often, lycopodium (Lycopodium) or zinc oxide (Zinci oxydum), sometimes white clay (Bolus alba) are used as the formative substances for preparation dusting powders. If the structure of the dusting powder includes one base substance (basis) and one formative substance, we can write out prescription by two ways:
a) short; b) full;
a) Rp.: Aspersionis Amycazoli 5% 100,0
D.S. Apply on the skin of inter digital spaces twice a day.
b) Rp.: Amycazoli 5,0
Talci ad 100,0
Misce, fiat pulvis
Da. Signa. Apply on the skin of inter digital spaces twice a day.
If dusting powder is compound, so it is possible to write it out only by the developed way:
Rp.: Bismuthi subnitratis 10.0
Zinci oxydi
Amyli ana ad 100,0
Misce,fiat pulvis
D.S. Apply on the lesion parts of the skin.
As a rule, the dosed powders are prescribed for internal usage. The mass of such powder changes in limits from 0,1 to
Writing out the dosed powder we must indicate the medicine substance with designation of its single dose in the prescription. Then it is necessary to indicate quantity these powders have to be given out: Dentur tales doses N. (Let will be given such doses by number), further Signa.
Rp.: Pancreatini 0,5
D. t. d. N. 24
S. In one powder three times a day before meal.
In case of prescription of compound powder it is necessary to note:
Rp.: Platyphyllini hydrotartratis 0,005
Dibazoli 0,02
Sacchari 0,3
M. f. pulvis
D. t. d. N. 12
S. In one powder twice a day.
Prescribing the plant origin powders sampler of writing begins from the word Pulveris, then indicates the part of plant, its name and dose.
Rp.: Pulveris foliorum Digitalis 0,05
D. t. d. 12
S. In one powder three times a day.
Flying and hydroscopic powders are released in waxed paper (Charta cerata) or paraffin paper (Charta paraffinata) packing, what is marked in prescription.
Rp.: Camphorae tritae 0,2
D. t. d. N. 12 in charta cerata
S. In one powder three times a day.
Powders for inhalation (pulveres pro inhalationibus) are the smallest powders which are applied by means of inhalators, sometimes by retraction through the nose (insufflations).
Such smallest (subtilissimi) powders therefore are applied on the wound surfaces, on the eye conjunctiva and ear application. All they concern to the indivisible powders and are prescribing iot great quantities (5,0 – 10,0). They often have local action but they also can be used for achievement of the systemic effect.
Capsules
The medical substances, which have unpleasant taste or smell, harmfully acting on the teeth or have irritation action, are prescribed in medical capsules (capsulae). Depending on the material, they are made of, there are:
a. starchy capsules or oblatae (capsulae amylaceae, s. oblatae);
b. gelatinous capsules (capsulae gelatinosae), which are hard (capsulae gelatinosae durae), elastic (capsulae gelatinosae molles, seu elasticae) and with lids (capsulae gelatinosae operculatae);
c. glutoidous capsules (capsulae glutoidales, s. gelloduratae).
d. different synthetic capsules (are very popular now).
Soft and hard gelatinous capsules contain 0,2-0,5 gr of the medical substances. Discharging medicines in capsules it is necessary to indicate in the prescription: to release in gelatinous, starchy or glutoidous capsules – in capsulis gelatinosis, amylaceis, glutoidalibus.
Rp.: Extr. Filicis maris spissi 0,5
D. t. d. N. 12 in caps. gelatinosis
S. Drink all capsules during 30 minutes, each of them should be wash
down by the 1% solution of sodium hydrocarbonate.
The variety of the capsules
Pearls (perlae gelatinosae) are the gelatinous capsules with capacity 0,1-0,2 ml., are filled up the oily limpid medicine fluid. They are variety of the elastic gelatinous capsules and are filling up on the manufacture.
Rp.: Clofibrati 0,25
D. t. d. N. 50 in perlis gelatinosis
S. In one pearl three times a day.
Modern pharm-industry produces micro-capsules. They are the finest fraction of the firm gasiform or liquid substance, covered with coating or pellicle material.
Size of the micro-capsules are from 1 to 500 mkm. Nanocapsules are called fractions with shape less 1 mkm. They are intended for parenteral applications. Micro-capsules with micro-dragees, micro-tablets and granules (50 – 400 pieces) can be filled in the hard gelatinous capsules, which are called spansules (spansulae). They are polyreservoired medical form, consisted of the substances with different time of the absorption and different dissolvability degree and with prolonged acting
Rp.: Spansulas Feospani N. 100
D. S. In one spansula three times a day.
In some cases medical substances in capsules are leading in rectal, vaginal applications and by inhalations.
Rectal and vaginal capsules (capsulae rectales et vaginales) are the coating definite scale filled up with medical agents like the powders, solutions, emulsions and suspensions.
They are intended for introduction in the rectal or vaginal cavities. Rectal capsules, look like oblong drop, especially widely are used in pediatrics.
Capsules for inhalations (capsulae pro inhalationibus) are used by means of special inhalators for treatment bronchial asthma (drug Intale).
Tablets
Tablets (tabuletta – nominative singular; tabulettam – accusative singular; tabulettas – accusative plural; tabulettis – locative plural) are the solid pharmaceutical form received by pressing medical substances or medical and auxiliary substances. The main kinds of tablets are presented in table 3.
Tablets mainly are prescribed inside. Some kinds of tablets are used externally after the previous dissolution.
The tablets intended for application in an oral cavity, may be dispersed, chewing, sublingual (Tabulettae sublingualis). There are also tablets for hypodermal introduction – implantation tablets (Tabulettae implantatae).
The tablets are made by factory way, the drugstores only release them. If tablets contain more then one medical substance it is not necessary to write Misce, fiat.
If tablets are simple, they can be written out by developed or reduced way.
Table 3
Various kinds of the tablets
|
Of shape |
Of composition |
Of technology |
Of purpose the application |
|
plane round oval concavo – concave convexo – convex
|
simple complex combine – with comercial (firm) name |
dissoluble (sparkling) tablets UPSA – gastric-release tablets – enteric-release tablets – coating tablets – micro-tablets – frame tablets – multicoating tablets
|
– per oral application – sublingual tablets – dissolve tablets – buccal tablets – external application – tablets for implanta- tions – vaginal tablets |
Rp.: Analgini 0,5
D. t. d. N. 10 in tabulettis
S. One tablet in the time of headache.
Rp.: Tabulettam Analgini 0,5
D. t. d. N. 10
S. One tablet in the time of headache.
Rp.: Tabulettas Analgini 0,5 N. 10
D. S. One tablet in the time of headache.
The complex tablets are written out by the developed way:
Rp.: Platyphyllini hydrotartratis 0,005
Papaverini hydrochloridi 0,02
D. t. d. N. 10 in tabulettis
S. In one tablet twice a day.
But such variant is also possible:
Rp.: Tabulettam
Platyphyllini hydrotartratis 0,005
cum Papaverini hydrochlorido 0,02
D. t. d. N. 10
S. In one tablet twice a day.
Some complex tablets, such as Aeronum, Verodonum and other, are made under the special commercial name. These tablets are prescribed only by reduced way:
Rp.: Tablettas Aeronum N. 10
D. S. In one tablet under tongue until complete
decomposition in half an hour before flight.
In cases when substances induded into the structure of the tablets have unpleasant taste, smell, irritation action or may be blasted under the action of oxygen, air moisture, gastric contentes, they have to be covered with coating:
Rp.: Tab. Pentoxyli 0,2 obductas N. 20
D. S. In one tablet three times a day.
Or:
Rp.: Pentoxyli 0,2
D. t. d. N. 20 in tabulettis obductis
S. In one tablet three times a day.
It is not recommended to prescribe tablets for small children, people with dissonance of the swallowing act, consciousness and psychical-illnesses.
Dragee
Dragee (accusative case singular and plural – Dragee) – the firm dosed out pharmaceutical form for internal use, which is received by the way of stratification of the acting substances and recipients. Dragee as the tablets are made by the factory way.
It is possible to prescribe dragee by reduced and developed ways:
Rp.: Dragee Diazolini 0,05
D. t. d. N. 20
S. In one dragee twice a day.
Rp.: Dragee Diazolini 0,05 N. 20
D. S. In one dragee twice a day.
Species (collections)
Species (collections) ( Species – nominative plural, Specierum – genitive plural) are the firm medical form, which is a mix of the grinding plant raw material (flowers, roots, leaves), sometimes with addition of salts, other oils or other medicinal substances.
Collections (species) are intended for internal use (after the appropriate processing, they are used as tinctures, decoctions or infusions), for burning and inhalation formed smoke (species for smoking), for external use (for gargling and poultices). Prescribing this medical form the doctor must indicate in signatura not only the way of use, but also the way of preparing the medicines.
In addition, the collections can be classified as dosed and undosed ones. As a rule, the dosed species are prescribed, when the plant raw material contains strong acting substances. Then each plant component and its quantity are indicated on the prescription. Further write Misce, fiant species. D. t. d. . . . and the Signatura.
For example: Rp.: Herbae Adonidis vernalis 2,0
Rhizomatis cum radicibus
Valerianae 1,5
M. fiant species
D. t. d. N. 10
S. Boil a packet of species in a glass of water and infuse during
30 minutes. Take in one table-spoon three times a day.
Undosed species are prescribed such way:
Rp.: Florum Chamomillae 20,0
Fructuum Rhamni catharticae 30,0
M. f. species
D. S. Boil one table-spoon of the species in a glass of water
and infuse during two hours and filter it. Take half of
the glass before sleep.
Officinal collections are written out by reduced way:
Rp.: Specierum antiasthmaticarum 100,0
D. S. Burn 1/2 of the species tea-spoon and inspire the smoke.
Granules
Granules (granula – nominative singular, granulam – accusative singular and granulas – accusative plural) – the firm medicinal form which looks like homogeneous fractions (grains, kernels) spherical, cylindrical or anomalous form, scale 0,2-0,3 mm, which consists of the mixture of acting substances with or without fillers. They are produced at the factories and plants in single-dosed or multi-dosed containers.
The medicinal substances with unpleasant taste, smell, irritant action, but not enough toxic are produced in granules. Thats why they dosed in tea-spoons and are released by common weight Granules, usually are intended for direct per oral applications. They also may be coated or uncoated. Nowadays some granules, especially for children, are produced in packets, preliminarily dissolved in the indicating volume of the warm boiling water and prescribed as liquid medical forms in tea-spoons or table-spoons. Granules are officinal forms, thats why they are prescribed by reduced way.
Rp.: Granulas Urodani 100,0
D. S. In one tea – spoon three times a day,
preliminarily dissolved in 1/2 glass of water.
Rp.: Granulorum Plantaglucidi 50,0
D. S. In one tea-spoon in 1/4 glass of water three times a day.
Pencil
Pencil (stilus) – firm pharmaceutical form, cylinder – shaped with pointed or rounded end, for external application.
Sinapismes (mustard plasters)
Sinapismes (Charta sinapis, Charta sinapisata) are the firm medical form as the rectangular-shaped pieces of paper coated with an oil-free powder black or zarephthal mustard.
Mustard plasters are issued in packages. They are intended for application to skin. These are the officinal forms, wrote out by the reduced way.
Rp.: Chartae sinapisatae N. 10
D. S. Moisten in warm water and put on the thorax.
Medical films
Films or inserts (membranulae) are the form dosed medical form, which is made by factory way as polymeryc films. They look like polymeryc plates with oval form and appropriate size. Films are classified on eye, intravaginal, stomatological onis. They consist of a matrix in which acting substances are included or the acting substance surrounded by a membrane which controls rate of release. There are ophthalmic films (intended for an insect to the conjunctival bag with local action) and oral films (glue to the mucous membrane of the gums at the level of the first premolar tooth). Each film is issued in the individual sterile container. Oral films have general action (for smoking prophylaxis and prophylaxis of the stenocardic attacks). By method of including in biodissolvable polimeryc films the medical agents are ensured fast coming of the effects and prolonged action after moistening by tissue fluid or secretion. Films are the officinal medical forms.
Rp.: Membranulas ophthalmicas cum
Pilocarpini hydrochlorido N. 30
D. S. Pawn one film on the lower edge of the eyelid one time a day.
Rp.: Membranulam Trinitrolongi 0,001
D. t. d. N. 20
S. Glue in the region of the upper gum two or three times a day.
Plates
Plates are the firm medical forms intended for wounds treatment. They are made from the collagen with admixing medical substances (analogous of the medical films). They are intended for applications on the wound surfaces with local action, released sterile. Prescribing plates we must indicate size according shapes of the wound.
Dental powder
Dental powder (pulvis dentalis) – it is a firm medical form, white powder with calcium carbonate precipitated as general component. Besides dental powders include other oils (mint, anise, pink or gum -tree oils) attached them pleasant smell and deodorant property. Dental powders are classified on hygienic and treatment-and-prophylactic ones with different degree of the abrasive action. In case of need, doctor can prescribe main treatment-and-prophylactic dental powder instead of the selling ones. They are prescribed like undosed powders for external applications (dusting – powders) with mass – 100 gr.
Rp.: Calcii carbonatis praecipitati 20,0
Magnesii subcarbonatis 5,0
Olei Menthae piperitae gtts
M. f. pulvis dentalis
S. Dental powder.
Caramel
Caramel (carameles) – the firm pharmaceutical form which prepared as sweets by the way of addition of melting acting substances, some sugar, treacle, with subsequent addition of flavouring, aromatic, dye components. Caramel is intended for per oral applications and for applications in an oral cavity (sublingual or intrabuccal applications attached to diseases of the gums, mucous membranes and throat) for dispersion. They are officinal medical firms, thats why caramels are prescribed by reduced way:
Rp.: Caramelem Decamini 0,00015
D. t. d. N. 50
S. In one caramel resolve in the oral cavity tree times a day.
Pastilles
Pastilles or trochee (trochisci) – the firm dosed medical forms, have the shape of a plate of the different form, intended for dissolution in the oral cavity (dispersion) for treatment diseases of the gums and oral mucous membranes; and are used inside for treatment diseases of the digestive tract.
Pastilles are produced by formation paste-like form of medical agents with sugar, chocolate, with addition of water, syrup, mucus. The paste obtained is unroll to make a thin layer, cut out plates of the appropriate shape and size, and then dry up. Prescribed like dosed medical form by the reduced way:
Rp.: Trochiscos Drill N. 10
D. S. In one trochee two or three times a day into the oral
cavity to the complete dissolution.
Sponges
Sponge (spongia – accusative plural) – the firm medical form looks like dry porous mass as a powder or plates made of gelatin, collagen or ried up plasma, impregnated with a solution of medicinal substances. Antiseptic product (with sizes 2 * 2 * 1 or 10 * 10 * 1 cm.) sticking together tissues is applied as styptic. By application it is classified as antiseptic and hemostatic. Sponges are intended for external (application to skin, long – unhealing wounds and ulcer) applications, rectal and vaginal. Sponge is not extracting from the wounds, because it resolved gradually and had prolonged action.
Rp.: Spongias haemostaticas 5 x 5 x 1 cm N. 10
D. S. Apply to the bleeding surface for stopping hemorrhage.
Chapter 4
The soft medical forms
Suppositories, ointment, pastes, creams, liniments and other medicinal products concern to the soft pharmaceutical form.
Suppositories
Suppositories (suppositorium – nominative singular, suppositorium- accusative singular and suppositoria – accusative case plural) – the dosed medical forms. They are solid at the room temperature and are dissolved or melted at a body temperature. Differed suppositories rectal (suppositoria rectalia) and suppositories vaginal (suppositoria vaginalia), sticks (bacilli) – suppositories intended for introduction in the cervical channel of the uterus, in urinary channel, acoustical duck, nose, which have cylinder shape with pointed end.
By medical purpose rectal suppositories are divided into 2 groups: 1) with local action – antihemorrhoidal, suppositories for healing cracks and breaks, for treatment inflammation processes of the rectum; 2) with resorbtive action – suppositories showed systemic action (medicinal substances which they contain (enzymes, antibiotics, barbiturates, antiseptic, hormones, vitamins, spasmolytics, analgetics, diuretics etc.) are soaked in to the general blood flow through the system of the inferior and middle hemorrhoid veins. That’s why prescribing in rectal suppositories strong – acting and poisonous substances, it is necessary to follow the same rules of dosed as for the medical forms used inside.
Suppositories contain one or more acting substances, dispersed or dissoluble in a simple or complex basis which can be dissolved, dispersed, melted at body temperature. A suppository may include additional components, such as solvents, absorbents, lubricant substances, antimicrobial agents, dues and also solid fats, macrogols, gelatin mixtures (gelatin, water, glycerin), being their basis.
So, suppositories include medical agent (agents) and formative substances (constituens). As formative substances are used such substances:
a) Cacao-seed oil (oleum Cacao, s. butyrum Cacao);
b) Butyrol (butyrolum – hydrogenizated fat with various chemical structure);
c) Gelatinous mixture (mass) (
d) Synthetic basis – polyaethylen-oxydum and others.
Rectal suppositories are cone-shaped or cylinder-shaped with rounded end one’s. Their weight changes from 1,1 until to 4,0gz.The maximum permissible diameter is 1,5 cm. If the weight suppositories is not indicated, they are made with mass 3,0 gr.
Vaginal suppositories are differed by shape on: globuli (globuli – spherical), ovuli (ovulae – oviform) and pessary (pessaria – flat body with rounded end). The weight of vaginal suppositories is from 1,5 to 6,0 gr. If in the prescription the weight is not indicated, they are made in mass – 4,0 gr.
Main (magistral) suppositories made in the drugstore may be prescribed in several ways.
The first way. After the word Rp. it is necessary to write the name of medical substance (substances), the single dose of each of them and formative substance with its quantity (on 1 supp.).
It is allowed not to indicate the quantities of the constituens in the prescription. In such case it is necessary to write q. s. (quantum satis – how much it is necessary) instead of the quantities formative substances. Before signature we must sign D. t. d. N… (Da tales doses numero… – Give out such doses by number… ) cause suppositories are dosed medical forms.
Rp.: Dimedroli 0,01
Olei Cacao 3,0
M. f. suppositorium rectale
D. t. d. N. 12
S. In one suppository into the rectum by night.
Or:
Rp.: Dimedroli 0,01
Olei Cacao q. s.
Ut fiat suppositorium rectale
D. t. d. N. 12
S. In one suppository into the rectum by night.
The second way. In this case it is necessary to note not single doses of substances, which are included into the suppositories structure, containing basis, but quantities necessary for preparing all suppositories. For their definition we must multiply single dose on the quantity of suppositories, what is written out. Then it is necessary to write Misce, fiant suppositoria rectalia numero … .
Rp.: Dimedroli 0,12
Olei Cacao 36,0
M. fiant suppositoria rectalia N. 12
D. S. In one suppository into the rectum by night.
Or: Rp.: Dimedroli 0,12
Olei Cacao q. s.
Ut fiant suppositoria rectalia N. 12
D. S. In one suppository into the rectum by night.
Nowadays the majority of the suppositories is officinal. They are written out by the reduced way: Rp.: Suppositorium cum Ichthyolo 0,2
D. t. d. N. 10
S. In one suppository into the rectum in
the morning and in the evening.
Where the word “suppository” is used in the accusative case singular (suppositorium), further after adjective cum (with) we wrote the name of medicinal substance with its quantity, at the end of prescription we wrote D. t. d. N… and signature.
Some complex officinal suppositories have the commercial name, for example, suppositoria “Anuzolum”, “Bethiolum” and other. Prescribing them at first we must write the word suppositories in the accusative case plural (suppositoria) and then the name of the suppositories with their quantity. If the name is not bracketed we use it in the genitive case singular.
Rp.: Suppositoria “Bethiolum” N. 10
D. S. In one suppository into the rectum twice a day,
previously unwrapped it.
Sticks
Sticks (bacilli) – are the variety of the suppositories intended for introduction in the cervical channel of the uter-nus, in urinary channel, acoustical duet, nose. They have cylinder shape with pointed end with indication of their diameter in the prescription.
Rp.: Bacillas cum Suprastino 0,05
D. t. d. N. 10
S. In one stick into the nose ducts twice a day.
Dental cones
Dental cones (conusi dentales) are intended for application into the inflamed alveolus of the removed tooth. They have cone shape with base diameter 6,5 mm, height 12 mm and mass 0,147 gr. Dental cones are used in stomatology practice.
Rp.: Laevomycetini 0,01
Dexamethasoni 0,0005
Olei Cacao q. s.,
ut fiat conus dentalis
D. t. d. N. 10
S. Put in one cone into the inflamed alveolus of the removed tooth.
Ointments (unguents)
Ointments (unguents) (unguentum – nominative singular, unguenti – genitive singular) – the soft medical form intended for external application. Unguents contain one or more active substances and formative agents. As a base for the ointments are used:
a) Vaseline or white petrolatum (Vaselinum);
b) Lanolin (Lanolinum);
c) Pork cleared fat (Adeps suillus depuratus, s. Axungia porcina depurata);
d) officinal glyceric unguent (Ung. Glycerini);
e) officinal naphthalan unguent (Ung. Naphthalani);
f) officinal spermacetical unguent (Ung. Cetacei).
Preparing ophthalmic ointments we are using basis, what contained 10 parts of Lanolin and 90 parts of special Vaseline (“for ophthalmic ointments”).
Depending on a base ointments can be hydrophobic (carbohydrate basis – vaseline, vaseline oil, paraffin etc.), hydrophilic (a water-soluble basis).
The ointments basis determines quality of the unguent in the certain measure. Unguents, which are made on the pork cleared fat, quickly spoil on account of hydrolysis of the fat on glycerin and fatty acids. The ointments, which are made on Vaseline and lanolin, are stable enough and can be stored for a long time. Pork fat, lanolin and spermacetical unguent promote the suction medicinal agents through the skin. Vaseline and naphthalan unguent are not soaked up through the skin, that’s why they are used for manufacturing ointments with superficial action.
There are magistral (main) and officinal ointments. The main unguent, that contained one medical substance and Vaseline, can be written out by reduced and complete ways. In the first case we write Unguenti, name of the medicinal substance and its concentration in %, total quantity of the ointment after the word Rp.
Rp.: Ung. Prednisoloni 0,5% 20,0
D. S. Grease the affected regions of the skin
Prescribing this unguent by complete way, after the word Rp. we must recount all medical agents, included into the ointment, their quantity, further from a new line – Misce, fiat unguentum (reduced M. f. ung.); D. S. and mark the way of its use. In such case it is possible to give account how many grams of prednisolone and vaseline we need to take for preparing the unguent, knowing concentration and total quantity of the ointment. We reflect on such way:
0,5% prednisolone unguent – this is such unguent, which contains
0,5 gr of prednisolone in own 100 grams. So, grams of prednisolone will be in the 20 grams of this unguent. These correlations formed such proportion:
100,0 – 0,5 20,0 x 0,5 : 100,0 = 0,1
20,0 –
Thus, for preparing 20 grams of the 0,5% prednisolone unguent we must take 0,1 gr prednisolone and the rest will be made by vaseline.
Rp.: Prednisoloni 0,1
Vaselini ad 20,0
M. f. unguentum
D. S. Grease the affected regions of the skin.
If we write out the unguent by reduced way (the ointment basis is not specified), such unguent is prepared on vaseline in the drugstore.
The ointments are written out only by the developed way in case it is necessary to prepare unguent not on vaseline, but on other bases, and also when unguent contains two or more medical substances.
Rp.: Anaesthesini 0,5
Xeroformii 5,0
Vaselini ad 50,0
M. f. ung.
D. S. Grease the affected regions of the skin.
Rp.: Streptocidi 4,5
Lanolini 5,5
Vaselini 25,0
M. f. ung.
D. S. Grease the nipples when they are cracked.
The officinal unguents are prescribed only by the reduced way, irrespective of their structures. In the prescription we indicate its name and total quantity. The concentration has not need to be specified.
Rp.: Ung. Hydrargyri oxydi flavi 10,0
D. S. Pawn for lower eyelid by night.
Total quantity of the unguent for treatment the skin (mucous) is 20,0-100,0 gr and more and as for ophthalmic unguent – it is 5,0-10,0 gr.
If structure of the ointment includes medicinal substance what quantity is underlined on the action units (OD), the prescription on such unguent can be written out by the reduced way (if unguent should be made on vaseline) with indication of the OD drug quantity in the 1 gram of unguent.
Rp.: Ung. Tetracyclini 20,0 (1g- 10000 OD)
D. S. Grease the skin in the affected regions.
If this ointment is made not on vaseline, but on other base, prescribing it by the complex way we must recalculate the OD quantity of the medicinal substance to all unguent quantity:
10000 OD (tetracycline quantity in the 1 gram of ointment) in 20,0 (grams quantity of the unguent) are equal 200000 OD.
Rp.: Tetracyclini 200000 OD
Ung. Naphthalani ad 20,0
M. f. unguentum
D. S. Grease the skin in the affected regions.
Dosed ointment (unguentum divisum) are intended for application medicinal substances with resorptive action. Thats why they are applied by the portions contained the single dose of the medical substance. They can be magistral (main) but seldom. Often the dosed ointments are officinal. They are produced with indication of the concentration:
Colchamine ointment 0,5%: Unguentum Colchamini 0,5% (single permissible dose – 1,5 gr.);
Unguent Nitro 2%: Unguentum Nitro 2% (from 0,5 till 5 cm of the column);
Pyromecaine ointment 5%: Unguentum Pyromecaini 5% (single dose – 1,0).
Rectal unguent (unguentum rectale). Officinal unguent produced by pharmaceutical industry in the special forms for application into the rectum cavity. It is the dosed form because this ointment is mentioned for resorbtive action.
Vaginal unguent (unguentum vaginale). It is the officinal dosed unguent intended for introduction into the vagina. This ointment is produced in the special forms.
Urethral unguent (unguentum urethrale). This is the variety of the dosed ointment intended for inroduction into the urinary channel. It has the local action. This unguent is produced in the syrettes for dosed applications connected with narrow aperture of the urethra.
Pastes
Paste (pasta – nominative singular, pastae – genitive singular) – is the soft medicinal product for local application, the variety of the ointment, that contained from 25 % up to 65 % powder like substances, so it is the thick unguent. Paste contains one or more active substances and fats and fat like substances which are used for manufacturing unguents, forming the base. If powder medical substances which are contained into the paste, make less than 25 % of its weight, then in those case it is necessary to increase their quantity by expense of addition of indifferent substances as talc (Talcum), zinc oxyde (Zinci oxydum), starch (Amylum), lycopodium (Lycopodium), white clay (Bolus alba) and others.
Magistral (main) pastes are prescribed only by developed way. For example, if it is necessary to write out 50,0gr. of paste, what contained 10 % of anaesthesine (Anaesthesinum) and 1 % of menthol (Mentholum). For receiving paste consistence, it is necessary to add the indifferent powder in any quantity in limits 25-65 % from the total paste quantity.
All ingredients of the paste are written out in the weight units. So, we must to make the proportion:
For anaesthesine 10,0 – 100,0 = 10 x 50 : 100 = 5,0
– 50,0 = 5,0
That means, anaesthesine needs to be taken 5 gr.
For menthol 1,0 – 100,0 1,0 x 50,0 : 100,0 = 0,5
– 50,0 = 0,5
That means, menthol needs to be taken 0,5 gr.
The quantity of the indifferent powder (for example, talc) can be in limits 12,5-32,5 gr. (25-65 % from 50 gr of paste).
The vaseline quantity is necessary to calculate like this: subtract from total paste quantity (50 gr.) the weight of all previous components (5 gr anaesthesine, 0,5 gr menthol, 12,5 gr talc) or write out – ad 50,0.
Rp.: Anaesthesini 5,0
Mentholi 0,5
Talci 12,5
Vaselini ad 50,0
M. f. pasta
D. S. Apply to the affected parts of the skin.
If medicinal substance, included into the paste structure, is a powder and is not dissolved in the unguent base; prescribing paste it needs to be taken in account, that total quantity of powder in the paste was not more, than 65 % from the paste general mass.
For example, it is necessary to prescribe 50 gr. of the paste, that consists of 20 % zinc oxide. In such case preparing paste it is necessary to take the quantity of the indifferent powder, not more than 45 %, because 20 % + 45 % = 65 % (the top limit of the allowable quantity of the powder in the paste). The prescription looks like this:
Rp.: Zinci oxydi 10,0
Talci 15,0
Vaselini ad 50,0
M. f. pasta
D. S. Apply to the affected parts of the skin.
In this case the powders weight is 50 % of the total paste mass. The officinal pastes are prescribed by the reduced way:
Rp.: Pastae Antisepticae biologicae 10,0
D. S. Apply to the gums by night.
Stomatological pastes (pastae stomatologicae). They are used in stomatological practice for treatment caries, pulpits and also for prophylaxis dental caries. They are preparing in small amounts from 1,0 g up to 15,0 g near the patient chair.
In the drugstore is prepared only arsenic paste for devitalization of the pulp. They include powder like substances (sometimes in combination with liquid substances) and constituents as glycerin (Glycerinum), camphorated oil (Oleum camphoratum), oil of cloves (Oleum Caryophyllorum), eugenol (Eugenolum). Stomatological pastes are prescribed only by the complex way:
Rp.: Natrii fluoridi 15,0
Olei Caryophyllorum ad 20 ml
M. f. pasta
D. S. For tooth fluoridization.
Rp.: Iodoformii 10,0
Olei camphorati q. s.
ut f. pasta
D. S. For treatment deep caries
Tooth-paste (pastae dentales). They can be hygienic and treatment – and – prophylactic one’s. Tooth-pastes contain calcium carbonate purificant, (as the base), glycerin, bound substances, antiseptic, detergent and air – way (other oils). We clean teeth with hygienic pastes for moving off the food remainders or the dental deposit. Their nomenclature is extraordinary various. They are produced by perfumery industry and are differed by gustatory and cleaning kinds.
Treatment – and – prophylactic pastes contain still bioactive substances (salts, enzymes, extracts of the medicinal herbs, vitamins, microelements). There are saline pastes (“Balsam” and others), chlorophyl pastes (“Karophyll”, “Forestry”, and others), boran-glyceric and fluor-contained pastes (“Colgate”, “Ftordent” and others). Depending on the acting substance these pastes have various treatment action and prophylactic action, used for treatment different stomatological pathologies.
Liniments
Liniments (linimentum – nominative singular, linimenti – genitive singular) are also the variety of the unguents. But these are the soft medical products, liquid unguent for local application, which contain up to 5 % of hard substances.
As constituens for preparing liniments are used vegetative or mineral oils ( Ol. Lini – linseed oil, Ol. Helianthi – sunflowerseed oil, Ol. Hyoscyami – henbane oil, Ol. Olivarum – olive oil, Ol. Amygdalarum – almond oil, Ol. Persicorum – peach – kernel oil, Ol. Vaselini – vaseline oil, Ol. Ricini – ricin oil, tar, ichthyol and others). Liniments are prescribed only by the developed way. We must recalculate all ingredients and their quantities after the word Rp., then from a new line write down Misce, fiat linimentum (reduced – M. f. Lin.) and D. S. , the way of use.
Rp.: Mentholi 2,0
Ol. Helianthi ad 50,0
M. f. lin.
D. S. Rub in strucked joints.
Officinal liniments are written out by the reduced way.
Rp.: Lin. Ammoniati 40,0
D. S. For rubbing lumbar region.
Rp.: Lin. Sythomycini 10% 25,0
D. S. Render to the edges of the wound.
Creams
Creams (cremor – nominative singular, cremoris – genitive singular) are the soft medicinal products for local application, the variety of the emulsion ointments, produced without addition of the emulsifier. They represent one, two – or multiphase dispersion systems, which dispersion environment at certain storage temperature is, as a rule. They differed from ointments by sourcream-like (semiliquid) consistence and small stability. Creams have cooling action and rapidly skin soaked. Into the medicinal and cosmetic creams are added aromatic substances.
Creams are intended for application to skin and its appendages wounds, ulcers, certain mucous membranes.
They are prescribed by the reduced way with indication of the percentage concentration medical substance or only its quantity (for the officinal creams).
Rp.: Cremoris Canesteni 1% 20,0
D. S. Rub skin in the strucked regions.
Gels
Gels (gelum – nominative singular, geli – genitive singular) are the soft medicinal products for local application; the ointments prepared on the hydrophilic bases with gel – like (semi – liquid, galantine – like) consistence. They are one, two – or multiphase dispersion systems with the liquid dispersion medium, which rheological properties are conditioned by presence of gelatinizes in small concentration. Gelatinizes can act as stabilizers of suspensions. That’s why such gels can refer to suspension gels or emulgels, respectively. In gels medicinal substances allotted to skin more evenly and acts for the tissues.
By mode of application the gels can be divided in gels for external application (troxevasin-gel, voltaren-gel, indovasine-gel), for peroral application (jelly), which is the most frequently used in pediatric practice (almagel, phosphalugel), as well as nasal, eye, ear, rectal, vaginal, cervical, ure-thral, stomatological gels, gels for inhalations (“Mentoclar”). Gels are prescribed by the reduced way (officinal gels) or with indication percentage substance concentration.
Rp.: Geli Troxevasini 2 % 40,0
D. S. Grease in the region of the foot atrophic ulcer.
Lotions
Lotions (lotio – nominative singular, lotionis – genitive singular) – alcohol – oiling liquids, which contained cooling and anticeptic substances. They are intended for external applications (for purification, disinfection the skin of the face, ears, sometimes nose mucous); there are also eye lotion.
Lotions are prescribed as officinal medicinal forms.
Rp.: Lotionis Zinci spirituosae 100 ml
D. S. For application on damaged skin.
Plasters
Plasters (emplastrum – nominative singular, emplastri – genitive singular, emplastra – nominative plural) are the soft medical form, transdermal therapeutic systems. They are looking like the plastic mass which capable of melting at body temperature and sticking to skin, or the mass applied on the carrier (fabric). Plasters are intended for external application (for skin application) and have local action. There are regular (hard) and liquid (skin glues) plasters, smeared (on the fabric or paper bases) and unsmeared (look like conic or cylindrical pulley-blocks) plasters; and also rubber (an adhesive plaster, capsicum, corn) plasters.
By medicinal prescription they are differed to the epidermatic plasters (without medical agents, used as dressing material – leucoplasters) and endermatic plasters with keratolytic, depilatory and other medical substances for treatment dermal diseases (local action) and with irritative substances (reflex action).
Ability for melting and sticking to skin provides with plaster-base, which is prepared on fusion of the rosin, paraffin, wax, caoutchouc and some other substances. They are manufacturing in the plants and at the factories.
Plasters are prescribed by the reduced way, because they are undosed medicinal forms. After indication of the form (emplastri-genitive singular) we must write down the plaster name, its quantity (if it is unsmeared and prescribed on the hard blocks –20,0-50,0, or its size (if it is fabric smeared with indication length and width).
Rp.: Emplastri bactericidi adhaesivi 10 x 6 cm
D.S. Fix the edges of the wound.
Liquid plasters. It is the skin lacquers which contain the volatile substances, formed the skin films after dissolvent evaporation. They are produced by the way of dissolution the medical substances and detergents in the volatile fluid likes ether or ethyl spirit.
They are officinal plasters produced in the bottles or in the aerosol balloons. Liquid plasters are widely used in the surgical and dermatological practices, for example – cleol (Cleolum) and collodion (Collodium).
Rp.: Cleoli 100 ml
D.S. For protection of scratched skin.
Transdermal systems (Transdermalia systemata) or diadermatic plasters are intended for medicinal agents penetrating through the skin with resorbtive action and with influence over the more deeply situated layers of the skin. Nowadays native and foreign industries produce such plasters with nitroglycerin: nitroderm (“Nitroderm”), nitrodur (“Nitrodur”) and nitradisc (“Nitradisc”). They are dosed (50 mcg nitroglycerin in one plaster) and ensured long action of the medicine by the way of its entering into the blood (up to 24 hours). They are sticking to skin of the left front-lateral thorax surface or to the skin of the left forearm for treatment of ischemic heart disease.
Chapter 5
Liquid pharmaceutical forms
Liquid medical forms include solutions, tinctures, infuses, decoctions, balsams, liquid extracts, mixtures, elixirs, suspensions, syrups, juices, musses and other medicinal products. These medical forms are dosed in milliliters, some of them – in drops. Liquid forms are better entering into the blood, soaking up in the skin and acting more quickly, than solid medicinal forms. But these forms have such short-comings of using them in drops, spoons or cups doses. Their peculiarities may change over influence of surrounding environments, such as light, air.
Solutions
Solutions (Solutiones; solutio – nominative singular, solutionis –genitive singular) are the simplest liquid medical form which is intended for external applications, per oral applications and for parenteral administrations. This form is representing a homogeneous transparent system including one or more active substances, received by the way of dissolution of the solid, liquid and gasiforme substances in the solvent or by the way of mixing two or more substances. The most frequently used solvents are: distilled water (Aqua destillata) or bidistilled water (Aqua bidestillata), ethyl spirit (Spiritus aethylicus) with concentrations 90%, 70%,40% est., glycerin (Glycerinum) and oils: peach-kernel oil (Oleum Pecsicorum), olive oil (Oleum Olivarum), Vaseline oil (Oleum Vaselini) and others.
By type of solvent the solutions can be divided into water, alcoholic, oil, combined (hydroalcoholic, alcohol-aqueous) and other (non-aqueous) solvents.
If solvent is not water, this should be specified while composing a pharmaceutical form. If solvent is not specified in the prescription, than solution is prepared on the distilled water. If concentration is not indicated in the prescription too, the chemist prepares solution on ethyl spirit with concentration 90%.
Solutions for internal use are dosed in drops, table-spoons, tea-spoons and dessert-spoons. The average capacity of the table-spoon is 15 ml of water solution; of dessert-spoon – 10 ml and of tea-spoon – 5 ml.
Solutions are prescribed by reduced and developed ways. Prescribing solutions for internal use we must write down after the word Rp.: the name of the medical agent, then solvent, their quantities. At the end of prescription are written words Misce. Da. Signa (reduced M.D.S. that means: Mix. Give out. Indicate) with indication of the way of use (for example: “In one table-spoon three times a day”, or “In 15 drops three times a day in half of hour after a meal”).
The quantities of medical substances, included into solution, and quantity of the solvent is necessary to account based on the single dose, the way of dosage and the common quantity of receptions. For example, we must prescribe sodium bromide solution for internal use in single dose 0,3 gr. The patient must take this drug in one table-spoon three times a day during four days. These calculations are made like:
all receptions: 4 x 3 = 12
necessary quantity of sodium bromide: 0,3 g x 12 = 3,6 g
common quantity of solution: 15 ml x 12 = 180 ml
So, prescription looks like this:
Rp.: Natrii bromidi 3,6
Aqua destillatae ad 180 ml
M.D.S. In 1 table-spoon three times a day.
If solutions are dosed in tea-spoons or in dessert-spoons the common quantity is recalculated by multiplying the number of receptions on 5 or 10 ml.
This solution we can prescribe by the reduced way. In such case it is necessary after the word Rp.: write down Solutions (reduced Sol.), then medicines name, solution concentration (in %) and its quantity, and also symbol D.S. and the method of reception. For receiving solution concentration it is necessary to make the proportion:
180 – 3,6 x = 3,6 :180 x 100 % = 2 %
100 – x
We can calculate this solution concentration in such way: 15 ml of the solution (1 table-spoon) contain 0,3 g. Sodium bromide and 100 ml of the solution include X g; x = 2 %.
This prescription we will write like:
Rp.: Sol. Natrii bromidi 2 % 180 ml
D.S. In 1 table-spoon three times a day.
Solutions for internal use, closed in drops are written out by the same way as the solutions dosed in spoons.
Solutions, prescribed for internal use in drops, are discharged by the same way as solutions dosed by spoons. It is necessary to recalculate common number of the drops in the volume unit (ml) of the drug quantity. The common number of the drops is recalculated multiplying single drops dose on the receptions number. This value is transferred into milliliters by the way of its division on the number of drops in one milliliter. We must take into account that 1 ml of the water or water solution includes 20 drops. 1 ml of the spirit or alcoholic solutions contains 50 drops, 1 ml of the ether solution – near 80 drops, 1 ml of the oil solution – 30 drops in average.
For example, it is necessary to prescribe for patient Platyphyllin hydrotartras (Platyphyllini hydrotartras, pro dosi 0,002 g) solution intended for internal use in 10 drops twice a day during 20 days.
These calculations are made:
Commoumber of receptions 2 x 20 = 40
Quantity of platyphyllin 0,002 x 40 = 0,08 (g)
Solution common quantity 10 x 40 = 400 (drops) or
400 x 20 = 20 (ml); or
0,5 ml x 40 (receptions) = 20 (ml)
So, prescription will be like this:
Rp.: Platyphyllini hydrotartratis 0,08
Aquae destillatae ad 20 ml
M.D.S. For internal use in 10 drops twice a day.
For write out this prescription by the shorted method we must calculate solution concentration in percents
20 – 0,08 X = 0,08 : 20 x 100 % = 0,4 %
100 – X
Solution concentration we can recalculate also like this:
0,5 ml solution (10 drops) contain 0,002 g Platyphyllin
100 ml solution contain X g Platyphyllin; X – 0,4 %
Our prescription looks like:
Rp.: Sol. Platyphyllini hydrotartratis 0,4% 20 ml
D.S. For internal use in 10 drops twice a day.
Solutions for external application are prescribed by the same way as solutions for internal use (large-scaled and reduced methods).
So, in case of prescribing solutions by the reduced way concentration may be shown – a) in percent (%), b) in relative units (on correlation) and c) in mass-volume correlation.
So, first of all after the word Rp.: we write down Sol., medicine name, concentration and solution quantity, and then D.S. and the way of usage.
a) Rp.: Sol. Furacilini 0,02 % 500 ml
D.S. For bathing of the wounds.
Solution concentration we can express not only in percents but also in relative units (on correlation):
b) Rp.: Sol. Furacilini 1: 5000 500 ml
D.S. For bathing of the wounds.
Proceeded from that 0,02 % solution furacin – this is the solution, 100 ml of what contain 0,02 g furacilin, and X ml – will contain 1,0 g of this medicine.
100 – 0,02
X – 1,0 X = 1,0 x 100 : 0,02 = 5 000
Mainly, it concerns to the great dilutions, we can indicate also medicine quantity what is necessary for preparing some solution quantity (mass-volume correlation) – (c).
c) Rp.: Sol. Furacilini ex 0,1 500 ml
D.S. For bathing of the wounds.
0,02 % furacin solution – that is solution which contained 0,02 g of the medical agent in the 100 ml. 500 ml of this solution contained X g of furacilin:
100 – 0,02 X = 0,02 x 500 : 100 = 0,1
500 – X
This solution we can prescribe by developed way.
Rp.: Furacilini 0,1
Aquae destillatae ad 500 ml
M.D.S. For bathing of the wounds
Solutions for internal and external use prescribed by reduced way are preparing on distilled water if the solvent is not noted. The name of prescription must include words “spirituosae”, “oleosae” if we use oil or alcohol as solvent. But it is necessary to remember, that drug-store will prepare spirituous solutions on 90% spirit and oil solutions on peach-kernel oil according to this prescription.
Rp.: Sol. Camphorae spirituosae 5 % 50 ml
D.S. For rubbing into the skin in the painful joint area.
Rp.: Sol. Mentholi deosae 1 % 20 ml
D.S. Fall in each nostril 2-3 drops twice a day.
Solutions, prepared on the other solvents, are prescribed only by large-scale method.
Officinal solutions for external and internal applications are written out only by reduced way like: after the word Rp. are indicated name, quantity and then D.S., the way of use.
Rp.: Liquoris Kalii arsenitis 10 ml
D.S. For 3 drops three times a day.
Rp.: Sol. Ammonii caustici 10,0
D.S. To moisten the cotton, let patient inhale
it in the times of consciousless.
We prescribe solutions for external use in quantity 5-100 and more milliliters; ear, eye and nose drops – 5-10 ml.
Some complex solutions include 2, 3 and more medical agents (combine) and have commercial names. For example, essentiale, panangine and others. They are administered parenteral by various ways, are produced in ampoules (see Chapter 6). They are prescribing without indications of the medicinal form and concentration.
Rp.: Asparcam 10 ml
D.t.d. N 10 in ampullis
S. For intravenous administration (dropply!)
twice a day by 10 ml, preliminary it must be
diluted in 100 ml of water for injections.
Infusions, broths
Infusion (infusum – nominative singular, infusa – nominative plural, infusi – genitive singular). These are aqueous extracts from plant raw material; which are obtained by the way of drawing the grinded, dried leaves, flowers, herbs on the water bath or by the way of soling extracts. Infusions frequently are prescribed for internal use and rarely – for external use (for example, for throat gargling). Infusion for internal applications are dosed by table-spoons, dessert-spoons and tea-spoons. They are written out on such method: after the word Rp. it is necessary to write down infusi (inf.), then indicate what parts of the plants are used for preparing infusion (herbs, flowers, leaves), the name of medicinal herb (from capital letter), the raw material quantity and the infusion quantity. Then we must write down D.S. and the way of use. The common dose of medicinal raw material and quantity of infusion are calculated basing on the single dose, the commoumber of receptions and the volume for one reception.
For example, it is necessary to prescribe infusion of Thermopsis herb, which has to be taken for one table-spoon three times a day during three days (the commoumber of receptions will be 9). We need to take 135 ml (1 table-spoon includes 15 ml, but 9 table-spoons include 135 ml). According to Pharmacopoeia infusion of Thermopsis herb is made using correlation that 1 part of raw material is for 400 parts of infusion. It means that 400 ml of infusion are prepared using 1 g of the herb. For manufacturing infusion in quantity 135 ml it is necessary to take 0,33 gr. of the herb:
1 – 400
X – 135; X = 0 33
Prescription looks like this:
Rp.: Inf. herbae Thermopsidis ex 0,33 135 ml
D.S. In 1 table-spoon three tines a day
Sometimes, as above, it is noted in prescription the quantity of row material for preparing infusion.
Rp.: Inf. foliorum Uvae ursi 200 ml
D.S. In 1 table-spoon three times a day.
In those cases drug-store is directed using such instructions of Pharmacopoeia: Infusions from medical plants with strong acting substances are prepared using correlation 1 : 400 (for example, folia Digitalis – Foxglove leaves, radix Ipecacuanhae – roots of Ipecacuanha, herba Thermopsidis – Thermopsis herb).
Infusions from medical plants with less intensive action are prepared using correlation 1 : 30 (for example, Adonidis vernalis – Adonis herb, rhizoma Valerianae – rhizome Valerian, Secale cornutum), other infusions – with correlation 1 : 10.
There are also officinal infusions like: Inf. Valerianae, Inf. Sennae compositum and others.
Rp.: Inf. Valerianae 120 ml
D.S. In 1 dessert-spoon four times a day.
Infusions are the labile medical forms, that why they are prescribed only for 3-4 days.
Decoctions
Decoctions – Decocta (decoctum – nominative singular, decocti – genetive singular) are the liquid medical forms which are also obtained by the way of water extracting acting substances from plant material on the water bath or by the way of solving the concentrates. For preparation decoctions we usually use roots, rhizome or cortex. Decoctions are easy broken that’s why they had to be prescribed only for 3-4 days and kept in the cold place.
They are written out like this:
Rp.: Dec. corticis Quercus ex 10,0-100 ml
D.S. For rinsing out mouth.
Chemist shop prepares decocts with correlation 1 : 10 when it is not noted in the prescription the quantity of plant raw material. Except of the decoction from Senega root (radix Senegae) what is made using correlation 1 : 30.
Emulsions
Emulsions (emulsum – nominative singular, emulsi – genitive singular) are liquid pharmaceutical form, two-phase system with dispersion phase like unsolvable in water liquid, fat or ether oils, balsams. The disperse medium is offered by water. The emulsions are represented by the stable suspensions of the fat-drops in water. There is two kinds of emulsions such as: seminal (Emulsa seminalia) and oil (Emulsa oleosa).
Seminal emulsions are preparing from the seeds of some medicinal plants: sweet almond (semen Amygdali dulcis), poppy (semen Papaveris), pumpkin (semen Cucurbitae), some nuts (semen Arachidis hypogaea) and others.
For receiving seminal emulsions are taken 1 part of the pounded seeds on every 10 parts of emulsions.
Composition of each seed kind includes not only fats but also specific substances – emulsifiers. That’s why there is no need to introduce the emulsifiers into the seminal emulsions.
We can prescribe seminal emulsions by two ways: large-scaled and reduced.
Rp.: Seminis Amygdali dulcis 18,0
Aquae destillatae ad 180 ml
M.f. emulsum
D.S. In 1 table spoon three times a day
Or:
Rp.: Emulsi seminum Amygdali dulcis 180,0
D.S. Take in 1 table spoon three times a day.
(seminum – genitive case plural from semen, seminis – genitive case singular from semen).
Preparing oil emulsions it is necessary to take not only the corresponding oil and distilled water, but some emulsifying agents, which provide the stable state of the fat drops in the water thickness for a long time. The wide using emulsifiers are Gelatosa, Arabian gum (Gummi Arabicum), apricot gum (Gummi Armeniacae), chicken egg yolk (Vitellum ovi) and others. Usually on every 2 parts of oil 1 part of the emulsifier and 17 parts of water are taken (correlation 2: 1: 17). The yolk of the one egg is used for preparing emulsion that includes oil 15 g (emulsion volume is 150 ml), but 3 g Apricot gum – for 10 g of the oil (for 100 ml emulsion).
Oil emulsions are prescribed also by developed and reduced ways. Prescribing emulsion by large-scale method we recalculate all components (oil, water and emulsifier) with their quantity according to correlation after word Rp. Then write down M.F. emulsum. D.S. and the way of application.
Rp.: Olei Amygdalarum 10 ml
Gummi Arabici 5,0
Aquae destillatae 85 ml (or: ad 100 ml)
M.f. emulsum
D.S. Take inside in one dessert-spoon
three times a day.
Using reduced way of prescription it is necessary to indicate the oil name, its quantity and common emulsion quantity after medical form name (Emulsi)
Rp.: Emulsi olei Lini ex 10ml -100ml
D.S. In 1 tea-spoon three times a day.
In cases when quantity of the oil is not noted in the prescription, from 10 oil parts must be prepared 100 parts of emulsion. For example, for preparing 200 ml of emulsion it is necessary to take oil 20 g, Gelatosae – 10 g and 170 ml of water.
Suspensions
Suspensions (Suspensio – nominative case, singular, suspensionis – genitive case, singular) – are the liquid medical forms, two-phase system, which contains disperse phase formed by particles of unsoluble in the water medical agents (powders) and disperse medium represented by water, oils, glycerin or other fluids. This medicinal form is intended for external, internal and parenteral applications.
insulin aspart protamine suspension 70%
(recombinant), insulin aspart 30% (recombinant)
100 Units/mL; SC inj; contains zinc, m-cresol.
The prescriptions for magistral (main) suspensions are written out by developed or reduced ways, but for officinal suspensions – only by reduced way.
Rp.: Oxytetracyclini 1,0
Olei Olivarum ad 100,0
M.f. suspensio
D.S. In 1 tea-spoon three times a day.
Rp.: Suspensionis Hydrocortisoni 2,5 % 5 ml
D.t.d. N.5
S. Inject into the muscle by 5 ml (before injecting
shake the content).
Tinctures
Tinctures – Tincturae (tinctura – nominative singular, tincturae – genitive singular) – are represented by (spirituous) alcoholic, hydroalcoholic, alcohol-ether liquid extracts from plant raw material. There are three methods of preparing tinctures, such as maceration (drawing), percolation (pressing) or dissolving of the dry extracts. All tinctures are officinal. It means that their concentration is detected by Pharmacopeia. And they are manufacturing on the pharmaceutical factiries. They are stable and can be keeping for a long time. Prescribing such forms it is not necessary to indicate number of the plant parts, tincture concentration in the prescription because they are officinal.
Prescription has such form: medicinal form name – Tincturae, then the name of plant and tincture quantity are noted. Those forms are dosed by drops – from 5 to 30 drops for one reception depending on the action intensity. Accordingly we write out the common quantity in ml (5-30 ml).
Rp.: T-rae Valerianae 20 ml
D.S. In 20 drops three times a day.
The equal parts of tinctures are taken (if they have equal therapeutic dosage) if we prescribed combination of them (complex tinctures).
Rp.: T-rae Valerianae
T-rae Convallariae ana 10 ml
M.D.S. In 20 drops twice a day.
In cases when the doses of the mixed tinctures are different, then one of them is taken in quantity that is less than quantity of the second in the number of times in which it’s one time dose is less then the second one’s. It is necessary to prescribe mixture of the strophanthus tincture (T-ra Strophanthi), single dose is 5 drops, and valerian tincture (T-ra Valerianae), single dose is 15 drops.
Rp.: T-rae Strophanthi 5 ml
T-rae Valerianae 15 ml
M.D.S. In 20 drops three times a day.
Tinctures may be included to the mixtures with other medicinal compounds.
Extracts
Liquid extracts (Extracta fluida) are the concentrated drawing usually obtained from medicinal plant raw material. Extraction substances are water, ethyl alcohol, hydroalcoholic solutions. All liquid extracts are officinal forms. They are written out and prescribed the same way as the tinctures.
Rp.: Extr. Viburni fluidi 30 ml
D.S. In 30 drops twice a day.
By definitions extracts besides liquid are dry (Extra sicca) and dense (thick) (Extracta spissa). Dry and dense extracts are prescribed and produced in powders, tablets, suppositories and in other medicinal forms.
New Galen medicines
New Galen medicines, these are aqueous, hydro-alcoholic and chloroform-alcoholic and other extracts from plant raw material. They are distinguished from Galen medicines by maximal purity from ballast substances and by bigger pharmacologic activity. They are officinal forms and are prescribed like tinctures, by the same way:
Rp.: Adonisidi 15 ml
D.S. In 15 drops three times a day.
Mixtures
Mixtures (Mixturae) – liquid medical form consisting of the solvent (water, aromatic distilled water, alcohol, infusions, decoction, emulsions, tinctures, glycerin, etc) and two or more solid medical agents dissolved in or received by the way of mixing some liquids.
If mixture contains tincture, decoction, emulsion it is necessary to write down their name on the first place.
Aqua Menthae piperitae, aqua Foeniculi, aqua Amygdalarum amararum, aqua Rosae and others are the basic aromatic waters, which are used for preparing mixtures. Aromatic waters, contained to the composition of the mixture, are not the solvents but also they improved medicine taste, smell and some times had additional qualities too. For example, aqua Menthae piperitae impairs fermentation process in the intestinal tract; aqua Amygdalarum amararum partially removes the gastric pain.
For improving taste and smell of the mixtures we admix other substances with corrigent action (corrigens). Mainly these substances are represented by syrups (10-30% of the common mixture volume), for example: Sirupus simplex – sugar syrup, Sirupus Citri unshiu – peel mandarin syrup, Sirupus Rubi idaei – raspberries syrup, Sirupus Cerasi – cherry syrup, Sirupus Rhei, Sirupus Glycyrrhizae – lignorice root syrup.
In case, when the mixture contains substances with expressed irritative action it is necessary to add to the mixture instead of the solvent part mucus (30-60 % of the common mixture volume): mucilago Salep – mucus Salep, muc. Gummi arabici – Arabian gum mucus, muc. Amyli (Solani, Majydis, Oryzae, Tritici) – Starch (potatoes, maize, rice, wheaten) mucuses. Mucus is included into the mixture also when unsolvable substances are precente there too. In fact, the role of mucuses is that they are promoted forming suspension from these unsolvable substances. These mixtures must be mixed before taking what is indicated in the signature.
Mixture is dosed by spoons when its liquid phase was represented by water, aromatic water, decoction, infusion, emulsion. If tinctures or liquid extracts are the liquid mixture phase it must be dosed by drops.
Mixtures are convenient for prescribing to the hard sick patients, children, old people for internal and external using. Solved in mixtures medicinal substances are better adsorbed and act more quickly in comparison to the powders and tablets. But mixtures have such defect qualities as: they are not accurate in dosage, not portative and not stable (written out only for 3-4 days).
For prescribing mixture all calculation we must base on the single dose and commoumber of reception. For example, it is necessary to write out tincture for 4 days, dosed in 1 table-spoon 3 times a day. This mixture will contain sodium bromide (Natrii bromidi) single dose – 0,3 gr., codeine phosphate (Codeini phosphas) single dose 0,015 gr.
Calculation:
number of reception 3 x 4 = 12;
Natrii bromidi 0,3 g x 12 = 3,6 g;
Codeini phosphatis 0,015 g x 12 = 0,18 g;
Water is used as solvent, if there was no other notes.
solvent quantity: 15 ml x 12 = 180 ml;
Prescription will look like this:
Rp.: Codeini phosphatus 0,18
Natrii bromidi 3,6
Aquae destillatae ad 180 ml
M.D.S. In 1 table-spoon three times a day.
Prescribe mixture, including chloral hydrate, single close – 1,0 g, and mucus Salep. Prescribe for 2 curative enemas.
Rp.: Chlorali hydratis 2,0
Mucilaginis Salep 40,0
Aquae destillatae ad 100,0
M.D.S. For 2 curative enemas.
Prescribe mixture (for 4 days) that contains infusion Thermopsis herb, sodium benzoate (pro dosi 0,05 g) and Lignorice root syrup. Use – 1 table-spoon three times a day.
Rp.: Infusi herbae Thermopsidis ex 0,45-180,0
Natrii benzoatis 0,6
Sirupi Glycyrrhizae 18,0
M.D.S. In 1 table-spoon three times a day.
For this prescription we take 10 % syrup from mixture common quantity. That’s why we caot take it to account (because dosage by table-spoons isn’t so punctual) and take away 18 ml of the mixture contain. But if we take syrup in quantity 54 ml (30 %), it must be taken to calculation.
Chapter 6
Medical forms for injections
To the medical forms, which are intended for injections, belong: sterilized water and solutions, suspensions, emulsions and also powders, and tablets, which are dissolved in the appropriate dissolvent before injecting. They are mainly used for hypodermic (subcutaneous), intramuscular, intravenous and intraarterial injections.
As against solutions for external use, the solutions for injections are prepared on water for injections (bidistilled, sterilized, apirogenic water – it does not cause the increase of body temperature at parenteral injection). The medical forms for injections demand: sterility, absence of mechanical impurity, stability, apirogenity and in some of cases – isotonicity.
The medicines for injections, which are produced in ampoules and bottles by a pharmaceutical industry, are already sterilized, in a drugstore they are not sterilized, drugstore only sales them.
The solutions for injections, which are prepared in a drugstore, are the subject to on obligatory sterilization. In the prescriptions it is noted by a word “Sterilisetur” (“Da sterilis”, “Pro injectionibus”).
The solutions for injections in ampoules are prescribed out by the reduced way. After a word Rp.: the medical form Solutionis… is specified, name of a medicine, its concentration in percentage and its quantity. After that D.t.d.N… in ampullis, and signatura S.
Rp.: Solutionis Glucosi 40 % 50 ml
D.t.d.N. 10 in ampullis
S. For intravenous injection 50 ml.
Prescribing a dry substance in ampoules the name of the substance is specified and its quantity in one ampoule. Then D.t.d.N… in ampullis, and signatura S. The order of dissolution of substances, the way of introduction, periodicity of injections are specified in signatura.
Rp.: Vincristini 0,005
D.t.d.N. 6 in ampullis
S. To dissolve contents of ampoule in 5 ml of isotonic sterilized
solution of Sodium chloride. To inject intravenously 1 time a week.
Besides, in ampoules new Galen preparations, preparations of organs and tissues, officinal solutions are prescribed out. In these cases after a word Rp.: specify only the name of the preparation and its quantity D.t.d.N…. in ampullis and signatura.
Rp.: Digalen – neo 1 ml
D.t.d.N. 10 in ampullis
S. Infuse hypodermic 1 ml 1 time a day.
Rp.: Pituitrini pro injectionibus 1 ml (5 U)
D.t.d.N. 6 in ampullis
S. Infuse hypodermic 1 ml 1 time a day.
Some medicines for injections are prescribed in bottles. Prescribing medicines in bottles adhere to those rules, as those of prescribing in ampoules. The only difference is that after D.t.d.N… we don’t make any designations. If we prescribe a preparation in bottles of dark glass, we write D.t.d.N… in vitro nigro.
Rp.: Ampicillini 0,5
D.t.d.N. 10
S. To dissolve the content of the bottle in 2 ml 0,5 % of a solution
of Novocainum. Inject intramuscular 4 times a day.
Rp.: Suspensionis Hydrocortisoni acetatis 2,5 % 5 ml
D.t.d.N. 6
S. Inject 5 ml intramuscular 1 time a day.
In some cases the name of the ready medical forms for injections, according to Pharmacopoeia, includes the words “pro injectionibus”, for example, Corticotropium pro injectionibus, Parathyreoidinum pro injectionibus. It doesn’t mean, that these medicines are sterilized in a drugstore; they are already sterilized and are selling in a ready state.
Rp.: Corticotropini pro injectionibus 30 U
D.t.d.N. 5
S. To dilute the content of the bottle in 3 ml of the water for
injections. Inject intramuscular 1 time a day.
If we prescribe a preparation, activity of which is indicated in units, it is necessary to mark them in the prescription. For example, it is necessary to prescribe out 6 bottles of Insulin 5 ml each, with activity 40 U in 1 ml.
Rp.: Insulini pro injectionibus 5 ml (40 U – 1 ml)
D.t.d.N. 6
S. 0,5 ml under skin 2 times a day.
Rp.: Insulini pro injectionibus 5 ml (200 U)
D.t.d.N. 6
S. 0,5 ml under skin 2 times a day.
Discharging of the prescriptions on solutions for injections, which are prepared in a drugstore, their sterility is necessarily indicated. If medicines contain several components, after their recalculation write M. Sterilisetur. Then D.S. and Signatura.
Rp.: Sol. Natrii nucleinatis 2 % 25 ml
Sterilisetur!
D.S. Inject intramuscular 5 ml 1 time a day.
Or: Rp.: Natrii nucleinatis pro injectionibus 2 % 25 ml
D.S. Inject into muscle on 5 ml 1 time a day.
Or: Rp.: Sol. Natrii nucleinatis 2% 25 ml
Da sterilis!
S. Inject into muscle on 5 ml 1 time a day.
Or: Rp.: Natrii nucleinatis 0,5
Aquae pro injectionibus ad 25 ml.
Misce. Sterilisetur!
D.S. Inject intramuscular 5 ml 1 time a day.
If structure of the medicine form for parenteral introduction includes substances, which are easily destroyed at sterilization, for example solution of epinephrine (Adrenalinum), then they are added aseptically after sterilization of the basic solution. Thus we write Adde aseptice in the prescription:
Rp.: Novocaini 1,25
Sol. Natrii chloridi isotonicae 0,9 % ad 500 ml
M. Sterilisetur!
Adde aseptice Sol. Adrenalini hydrochl. 0,1 % gtts. XXV
D.S. For infiltrative anesthesia.
Over-the-counter (OTC) drugs
Over-the-counter (OTC) drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they are ingredients that are safe and effective when used without a physician‘s care. OTC drugs are usually regulated by active pharmaceutical ingredients (APIs), not final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures.
The term over-the-counter may be somewhat counter-intuitive, since, in many countries, these drugs are often located on the shelves of stores like any other packaged product. In contrast, prescription drugs are almost always passed over a counter from the pharmacist to the customer. Some drugs may be legally classified as over-the-counter (i.e., no prescription is required), but may only be dispensed by a pharmacy employee after an assessment of the patient’s needs and/or the provision of patient education. In many countries, a number of OTC drugs are available in establishments without a pharmacy, such as general stores, supermarkets, gas stations, etc. Regulations detailing the establishments where drugs may be sold, who is authorized to dispense them, and whether a prescription is required vary considerably from country to country.
As a general rule, over-the-counter drugs have to be used primarily to treat a condition that does not require the direct supervision of a doctor and must be proven to be reasonably safe and well-tolerated. OTC drugs are usually also required to have little or no abuse potential, although in some areas drugs such as codeine are available OTC (usually in strictly limited formulations or requiring paperwork or identification to be submitted during purchase). One of the oldest OTC drugs is aspirin.
Over time, often 3–5 years, drugs that prove themselves safe and appropriate as prescription medicines may be switched from prescription to OTC. An example of this is diphenhydramine (Benadryl), which once required a prescription but now is available OTC nearly everywhere. Diphenhydramine is an anti-histamine. More recent examples are cimetidine and loratadine in the United States, and ibuprofen (Herron Blue/Nurofen) in Australia.
It is somewhat unusual for an OTC drug to be withdrawn from the market as a result of safety concerns, rather than market forces, though it does happen occasionally, phenylpropanolamine is one such example, after it was removed from sale in the United States over concern regarding strokes in young women.
In the United Kingdom, it was announced In February 2007, that Boots the Chemist would try over-the-counter sales of Viagra in stores in Manchester, England (previous available as prescription only). Men aged between 30 and 65 would be eligible to buy four tablets after a consultation with a pharmacist.
Addition
Partial list of prescription abbreviations
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ABBREVIATIONS COMMONLY USED IN PRESCRIPTIONS |
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ABBREVIATION |
LATIN |
MEANING |
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a.c. |
ante cibum |
before meals |
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A.T.C. |
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around the clock |
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aa |
ana |
of each |
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ac., acid |
acidum |
acid |
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ad |
ad |
up to |
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ad lib. |
ad libitum |
freely, as desired |
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amp. |
Ampulla |
ampoule |
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aq. |
aqua |
water |
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aq. pro inject. |
aqua pro injectionibus |
water for injections |
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aq. purif. |
aqua purificata |
purified water |
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bis |
bis |
twice |
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b.d./b.i.d. |
bis in die |
use twice a day |
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q.i.d. |
quater in die |
four times a day |
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t.i.d. |
ter in die |
three times a day |
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t.d.s. |
ter die sumendum |
three times a day |
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t.i.w. |
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three times a week |
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bol. |
as a large single dose (usually intravenously) |
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but. |
butyrum |
solid oil |
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c. |
cibus |
food |
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a.c. |
ante cibum |
before meals |
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c.c. |
cum cibo |
with food, (but also cubic centimetre) |
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c.f. |
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with food |
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p.c. |
post cibum |
after meals |
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cap., caps. |
capsula |
capsule |
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comp., cps., cp. |
compositus (a, um) |
compound |
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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cort. |
cortex |
bark |
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cr., crm |
cream |
cream |
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|
D.S. |
Da. Signa; Detur. Signetur |
Give. Mark; Let it be given. |
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|
d.t.d.N |
dentur tales doses |
give of such doses a number |
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dec. |
decoctum |
Broth, decoction |
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|
dil. |
dilutus |
dilute |
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|
div. in par. aeq. |
divide in partes aequales |
divide on equal parts |
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e.m.p. |
ex modo prescripto |
as directed |
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elix. |
elixir |
elixir |
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emuls. |
emulsum |
emulsion |
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et |
et |
and |
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ex aq. |
ex aqua |
in water |
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extr. |
MINISTRY OF PUBLIC HEALTH OF UKRAINE
The Department of Pharmacology with Clinical Pharmacology
Prof. K.A. Posokhova, c.m.s. O.M. Oleshchuk, O.O. Shevchuk
RULES OF MEDICAL PRESCRIPTION WRITING
METHODICAL INSTRUCTIONS FOR STUDENTS
Third edition
TERNOPIL 2011 Chapter I General information about medical prescription
Medical prescription. It is a section of the science about medical agents, which concerns the rules of dispensing them in the various forms. Shortly, it is a written directive, as for the compounding or dispensing and administration of drugs, or for other service to a particular patient. Any prescription relating to restricted drugs must be directed to a qualified pharmacist and can be authorized only by a registered veterinarian, dentist or medical practitioner. Some terms, which we shall meet with during study pharmacology and execution of the prescription are explained in the Law of Ukraine “ On Medicines” (from 04.04. 1996). Medical agents these are substances or their mixtures natural, synthetic or biotechnological origin, which are applied to preventing pregnancy, prophylaxis, diagnosis and treatment of the human diseases or to changing status and function of the organism. There are such medical agents: a) active substances; b) ready-made medical agents (medicines, medical preparations, drugs); c) homeopathic agents; d) agents used for revealing pathogens – illnesses agents and also for fight for pathogenic organisms and parasites; e) medical cosmetic agents and medical admixtures to food – stuffs. Ready-made medical agents (medicines, medical preparations, drugs) – these are dosed medical agents in the form, which they are applied in. Active agents (substances) – biologically active substances, mighty to change the organism status and functions or can have preventive, diagnostic or curative action and are used for manufacturing the ready-made medicines. Auxiliary substances are the additional substances necessary for preparation of the ready-made medicines. Narcotic medical agents, these are referring to narcotic according to the legislation medicines. Poisonous medical agents are the medicines referred to poisonous by the Ministry of public health of Strong-acting medical agents these are medicines referred to strong-acting by the Ministry of public health of The state register of the medical agents of State Pharmacopoeia of Ukraine is the legal act, that includes the general demands for medical agents, pharmacopoeia articles and also control methods of medicines quality (physical-chemical, chemical and biological methods). Pharmacopoeia article, this is normative-technological document, which determines the demands for medical agents, their packing, conditions and terms of their storage, the control methods of their quality. The set of properties, which are up to the requirements fixed by legislation and gives for medical agents an ability to satisfy the consumers according to their assignments, is named quantity. Pharmacopoeia contains the inquiry tables, the tables of maximum single and daily doses poisonous and strong-acting medical agents for adults and children. Medicines, the components, doses and the way of their preparation are directing in pharmacopoeia are named officinal (from lat. officina – laboratory, workshop), and pharmaceutical forms, which are preparing in drugstore after doctor’s prescription are called magisterial (from lat. magister – teacher, govern). Nowadays in many countries of the world there is the tendency to apply the international names of medicines according to the united Latin chemical nomenclature of the medical agents, which is recommended by the World Health Organization and is given in the international pharmacopoeia (Pharmacopoeia Internationals). First of all its necessary for correct orientation of the doctors and pharmaceutists in huge quantity of the medicines, which are exported from one country to another. The same medical agent, which international name is known by experts all over the world, is manufactured out under various original names in the various countries and by various firms. The Pharmacopeia’s demands are compulsory for all enterprises of chemical-pharmaceutical industry, medical and preventive establishments. The pharmaceutical form is the issue form of medical agents, that the best accords to application aim. It is the most advantageous for the usage with curative and preventive purpose. There are Classifier of finished pharmaceutical forms, which has been developed according to Article 12 of The Law of Ukraine “ On Medicines”:
The arsenal of medicines consists of the agents mineral, vegetative, animal parentage, products of micro-organisms vital activity and chemically synthesized. Galen’s preparation (such are named after Claudy Galen – Ancient Roman doctor) are the medicines which are received by simple extraction from vegetative raw material by means of the water, alcohol or other. Besides active substances they contain other, ballast substances (cellulose, proteins, oils pigments, pitches, saponins and others). They are: extracts, infusions, tinctures and others, for example: tincture Valerianae, extract of Viburnum liquid. New galen’s preparations, these are the persistent extracts from vegetative raw material cleaned as much as possible from ballast substances; for example – Omnopon (opium allcaloids admixture), Adoniside (from Adonis vernalis), Digalen-neo (from leaves of foxglove – Digitalis L.) and others. Such preparations can be applied parenterally. Pharmacy, drugstore (gr. – apotheke which means store, pantry). – establishment for storage, preparation and selling medicines storage and selling curative mineral waters, dressings, the patient care things, sanitation products, personal hygiene things and so on. In the drugstore all medical agents are parted on 3 groups: 1. Poisonous – Venena, list A. the poisonous and narcotic substances belong to them. They are kept locked in cases with inscription “Venena” and “A” in specially equipped rooms. The severe registration of their expense is conducted. In the end of working-day the case, where they are kept, is sealed up. 2. Strong-acting – Heroica, list B. Those medicines are also kept separately from other medical agents in the cases with inscription “Heroica” and “B”. After working-day this case is closed by a key. 3. Other Medical agents, which are stored in the drugstore according to the demands of pharmacopoeia.
Chapter II The prescription
The prescription (lat. receptum – received) it is the doctor’s written appeal to the pharmaceutist about producing and selling medicines to the patient with indicating of the way of their use. It is the important document. The prescription must be written by the rules fixed by the Order of the Ministry of Health of
The rules of writing out the prescriptions medical Agents and products of medical assignment
1. The doctors of the curative and prophylactic establishments are obliged to write out prescription to the patient on medicines and products of medical assignment certified by the signature and personal seal. The prescription should be written in Latin with indicating of the patient’s age, the way of the payment for medical agents and products of medical assignment, the way of using. Also it should be written on the form printed in the printing-house according to the forms (addition № 1,2,3) predicated by the Order of the Ministry of public health service of Ukraine № 117 from 06.30.94. in special cases the prescription must be assured by the seal of the treatment and prophylactic establishment, research institute, medical educational establishments. 2. The prescription form №2 intended for subscribing of the medicines and products of medical assignment free-of-charge or on favorable terms and medical agents which have stupefy qualities, according to the list predicated by the Order of the Ministry of public health services of 3. The prescription form №3 intended for subscribing of narcotic medical agents in the pure state or in the admixture with indifferent substances according to the list, that affirms by the Ministry of public health services of 4. All others medical agents, including ethyl alcohol, are subscribed on the prescription form № 1. 5. It is allowed to the doctors of the municipal establishments of public health services, doctors of other establishments, enterprises, organizations, which have corresponding means for payment such prescriptions, and also manager of the medical assistant’s posts, medical assistant’s and obstetrical posts (according to the list confirmed by government bodies of public health services) to write out the prescriptions for reception of medicines, products of medical assignment free-of-charge or on favorable terms. The prescriptions are written in one copy. In case of writing out the prescription of narcotic medical agents free-of-charge or on favorable terms, both prescription form №3 and №2 have to be filled. 6. As a rule doctors write out the prescriptions after patient examination with obligatory registration about medicines assignment in the medical documentation (medical card of an ambulatory patient or medical card of the stationary patient). It is forbidden to write out the prescriptions on medicines which are not permitted for medical application in
filling of all necessary elements in the form. Corrections in the prescription are not allowed. 8. On the prescription form №3 and №2 it is allowed to write out only one name of the medical agent. On the form №1 we can write out not more than 3 names of the medicines. 9. It is necessary to write in Latin medical agent’s composition, definition of the medical form, reference to the pharmacist about preparation and distribution of the medicines. Usage Latin abbreviations is allowed according only to accept ones in medical and pharmaceutical practices (Addition). It is forbidden to use the abbreviation of components with alike names, because it is difficult to indicate what medicine prescribed. 10. The names of poisonous and narcotic medical agents have to be written at the beginning of the prescription and all others – further. 11. It is necessary to give medicines immediately, in the upper part of prescription we must put the mark “cito” (fast) or “statim” (immediately). 12. When we write the prescription on the liquid medical agents their quantity is indicated in milliliters or drops, all other – in grams. 13. In case of necessity it is allowed to prescribe medical agents in quantities necessary for prolongation or repetition of treatment course, except the medicines that has the fixed norms of the serving. On the prescription form the appropriate record is made by the doctor and additionally has to be confirmed by hi s signature and personal seal. 14. Ethylmorphine hydrochloride, codeine, codeine phosphate, pentobarbital (Aethaminalum – natrium), barbamil, esthocine tab. (Aesthocinum tab.), phepranone (Phepranonum) and pachycarpine hydroiodide (Pachycarpini hydroiodidum) are the narcotic medical agents which in the pure appearance or on admixture with indifferent substances had to be written on the prescription form №3. The prescription form №3 additionally is signed by the head of establishment of public health services or his medical part assistant and also is assured by a seal of establishment of public health services. 15. Prescriptions of the tablets Codterpine (Codterpinum), alnague (Alnagonum and tablets for tussis (composition: herbs Thermopsis – 0,02 gr, codeine – 0,01 gr, Sodium hydrocarbonate 0,2 gr; roots of licorice (Glycyrrhyza) in a powder – 0,2 gr) and medicines, which include poisonous medical agents of the list “A”, codeine, codeine phosphate, ethylmorphine hydrochloride, pentobarbital, barbamil, ephedrine hydrochloride in admixture with other medicines, hypnotic agents, neuroleptic agents, tranquilizers, clopheline (Clophelinum), preparations, which include 8-oxyquinoline derivates, tincture Aralia (Echinopanax elatum) are subscribed on the prescription form №1 and in addition are assured by the establishment of public health services seal “For the prescription”. 16. The prescriptions on medical agents, which are subscribed on the prescription form № 2, have to be assured by the establishment of public health services seal “For the prescriptions”. 17. Doctor must write dose of the medical agent by the letters and put the exclamation mark writing out poisonous or strong-acting medical agents referred to the list “A” or “B” in doses exceeding maximum permissible single dose. 18. The doctors might write out the prescriptions on ethyl spirit in admixture with other substances or in the pure state in quantities not more than 150ml with medical indications. Diabetic and oncology patients (if they make injections themselves) are prescribed free-of-charge up to 100 ml of the ethyl spirit on month. Over this norm diabetic and oncology patients pay complete cost. 19. It is forbidden to write out the prescriptions for the ambulatory patients on medical ether or anesthetic ether (in pure appearance) chlorethyl, kalipsol and other medical agents for narcosis. 20. It is not allowed to write out in one prescription given below medical agents in quantity more than fixed in the table 1. Aethylmorphine hydrochloride has to be subscribed in the eye drops and ointments in quantities up to 21. The prescriptions on medical agents, which contain Phenobarbital, pentobarbital, sodium barbital in admixture with other substances for patients with lingering and chronic diseases has to be written out on the prescription form №2 on a course of treatment about one month with the obligatory doctor’s indicating “By special assignment”, certified by signature, personal doctor’s seal and seal of establishment of public health services “For the prescriptions 22. It is allowed to write out the prescriptions for the chronic patients within one year except:
23. While writing out such prescriptions doctor must make the indication “for chronic patient”, mark valid term of the prescription and periodicity of giving medicines (every week, every month and so on), assure the indication by the signature and personal seal. 24. It is allowed to write out the prescriptions for some patient categories, whom have free-of-charge or on favorable terms, on eye drops and other medicines with short keeping term, which are used during the long period, at the same time in quantities necessary for treatment during the month, except the narcotic agents, anabolic steroids and stupefy agents. 25. It is allowed the doctors to write out the prescriptions on medical agents for patients with diabetes, bronchial asthma, with oncology and hematological diseases, tuberculosis, hard skin diseases and others if it is necessary (business trip, holidays and so on) in quantities stipulated for the double-month treatment course consideration medical agents selling norms, including ethyl alcohol, in one prescription. 26. While writing out such prescription doctor must make the indication “for chronic patient”, mark valid term of the prescriptions and in addition assure by the signature and personal seal
Table 1 The maximum quantities of some medicines that can be prescribed out
* In case of the delivery preparations in original packing which contain more tablets than in the fixed norms, it is allowed to write out in the prescription one packing, but no more than 50 tablets 27. The dentists, medical assistants, obstetrics may write out the prescriptions on medical agents necessary for giving emergent medical help (except narcotic agents) indicated their medical position and assured the prescription by their signature and the establishment of public health services seal. 28. Medical assistants – the managers of the medical assistant’s and obstetrical posts, the public health stations, medical posts might write out the prescriptions for the patients oecessary medicines, except the poisonous (besides those are industry manufactured in therapeutic closes) and narcotic agents in pure state or in admixture with indifferent substances, drugs which have stupefy properties and anabolic steroids. In cases when manager of the medical assistant’s and obstetrical posts realized medicines through chemist’s posts secondary category, the prescriptions have to be written only in cases of selling the medical agents to the patients free-of-charge or on the favorable terms. The prescribing of the medicines is reflected in the medical documentation (medical card of the ambulatory patient). 29. The prescription that is written out with violation of directed rules or contains incompatible medical agents, is considered not valid. And that’s why medicines could not be given. The prescription is marked by “The Prescription is invalid” and is returned to the patient. 30. The doctors and other medical workers, whom write out the prescriptions, bear the responsibility for prescribing medicines and following the rules of writing out the prescription in accordance with established procedure. 31. It is forbidden to assure by the seal of the establishment of public health services the prescription forms, not filled and not signed by the medical worker. 32. Medical agents and products of medical assignment for needs of treatment and prophylactic establishments have to be written out on the demands forms (which are affirmed by the Order Ministry of public health service of The dentists may write out the demands only on the suggested below poisonous and strong-acting substances, which are applied in the stomatology (without rights of distribution them to the patients): – adrenaline hydrochloride (solution 0,1% in the original packing, in ampullae); – nitric acid (in the pure state); – amyl nitrite (in ampullae’s); – iodoform (in the powder, paste, emulsion); – caffeine and sodium benzoate (in ampullae); – cocaine hydrochloride (in pastes); – arsenic trioxide (in pastes with contain up to 50%); – novocain (in the pure state, solution up to 4%, in ampullae); – silver nitrate (in crystals and solutions); – phenol (in the pure state and in admixture with other substances); – chloroform; – ethyl chloride (in ampullae); – Ether medical. The demands on cocaine hydrochloride (in pastes), arsenic trioxide (in pastes with contain up to 50%), silver nitrate (in crystals and solutions) besides the signature of the dentist, have to be certified by the signature of the head of establishment or has assistant on the medical part.
The stages of writing out the prescription 1. To check up whether the code of the treatment and prophylactic establishment (where doctor works) corresponds the form code.
5. To put the surname and initials of the doctor (legibly) or to put the die with designation of his (her) surname and initials. 6. If the person who has written out the prescription is not the doctor, but doctor’s assistant, obstetrics or dentist it is necessary to sign his (her) position and rank. 7. There is a further part of the prescription that is named “Praepositio” or “Invocatio”. It is the appeal of the doctor to the drugstore with the offer to take the prescription under the responsibility concerning manufacturing the medicines. This part of the prescription begins from Latin word Recipe, Rp. in reduced, that means – take. After “Rp.” substances necessary for preparation the medicines are accounted (this part is called “Designatio materiarum”). The names of these substances are written on Latin in the genitive case, each from the capital letter and from the new line. After the medicine name its quantity (dose) is indicated. For liquid medical agents – in milliliters or drops (for example: 0,1 ml, 1 ml, 10 ml; gtts III, gtts x and so on). And for the solid pharmaceutical forms, viscosity liquids (liniments, suspensions in grams for example: 20,0, 0,03, 0,005, that means accordingly If the medical agent is dosed in activity unit (OD), in the prescription activity unites quantity is specified (for example: 2000 000 OD). In case when two or more medical agents have to be written out on the prescription in the identical doses, this quantity specified once, only after the name of the last substance. Thus “ana” is put before quantity of agent; it means fifty-fifty (for example: ana 0,1). Accounting all medical substances, which are included into the medicine structure, it is necessary to begin from poisonous and narcotic agents, then – all other preparations. In different in the pharmacological attitude substances, which help to give to the active substances one or other medicine form are written at the end. 8. The doctor gives orders to the drugstore, what substances, in what quantity and of what medicine form chemist must make (this part is named “subscriptio”). From the new line is written: Misce (mix), fiat (make, let will be made), pulvis (powder), or suppositorium (suppository), or unguentum (ointment) and so on. Here may be such words, as: Da (give), tales (such), doses (doses), and also letter № (Numero – number) after what it is marked quantity of the doses, for example: № .3 or №. 12 and so on. 9. Fro the new line the signature is written (signature, reduced form – s). this prescription part is appointed for the patient, That’s why it is written in state language or other languages according to the law of 10. At the end the prescription has the doctor’s signature and his (her) personal seal. 11. Additionally doctor regulate duration the written out prescription validity the way of deleting of some terms. Specifically, the prescriptions on medical agents written out on the form №3 are valid during 5 days, on stupefy agents and medicines for free-of0charge selling (form №2) and also medicines specified on the item 15 above mentioned Rules – are valid during 10 days, and on other medical agents – during 2 month from the date of writing out the prescription. The reduction of the designations in the prescription is allowed only in conformity to the rules accepted in medical and pharmaceutical practice (see addition).
Prescription symbol The abroad prescription
The prescription in the foreign countries has such function as in our country. It is the document what contains the doctor’s appeal to the pharmacist about preparation or selling medicines for define patient. In the English speaking countries and countries with English speaking education system ( The first four stages contain: 1. doctor’s surname, 2. license classification or his professional degree, 3. address and 4. work number telephone of the doctor. Thanks to those facts pharmacist can communicate with doctor with his own questions. On the next line, on the left (5) it is writing the date of wrote out the prescription. On the same line to the right (6) – surname of the patient and the line below (7) – his (her) address. Then to the right it is writing the mark “P”, that means our “Rp.”, and then, below, in the middle of the paper leaf (8) – the drug name from the capital letter in the nominative case therefore used the international name or the firm name. On this line (9) the dose of the medicine is indicated, more often on the metric weight system, that means in milliliters (ml) or milligrams (mgr); then followed the quantity of the medical agent (10), what is determine by the duration of the treatment course. Below in the right corner after “Stg:” (11, our “S:”) it is noted the detailed directions for the patient about usage of this medicine. Below there is special line (12) where doctor marked the needs of repetition treatment or necessity of keeping this medicine in the inaccessible for children (13). And then below there is the information about necessity to keep some precautionary measures during reception of this drug, for example: “It is forbidden to use alcohol” or “Provoke the sleepiness”. In the left corner below there is doctor’s signature (15) and it is indicated other identifications doctor’s facts (16) and the state license number (17.) In some jurisdictions, the preprinted prescription contains two signature lines: one line has “dispense as written” printed underneath; the other line has “substitution permitted” underneath. Some have a preprinted box “dispense as written” for the prescriber to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the prescriber to handwrite one of the following phrases: “dispense as written”, “DAW”, “brand necessary”, “do not substitute”, “no substitution”, “medically necessary”, “do not interchange”.In other jurisdictions may they use completely different languages, never mind a different formula of words. In some jurisdictions, it may be a legal requirement to include the age of child on the prescription. For pediatric prescriptions some advise the inclusion of the age of the child if the patient is less than twelve and the age and months if less than five. (In general, including the age on the prescription is helpful.) Adding the weight of the child is also helpful. Prescriptions often have a “label” box. When checked, the pharmacist is instructed to label the medication. Wheot checked, the patient only receives instructions for taking the medication and no information about the prescription itself.
The classification of the medical forms we will use during our study pharmacology are below. There are such medical (pharmaceutical) forms (table 2): 1. Firm (solid) medical forms; 2. Soft medical forms; 3. Liquid medical forms; 4. Gasiform; 5. Medical forms for injections.
Table 2 The classification of medical (pharmaceutical) forms used in clinical practice
Chapter III The firm (solid) medical forms
The powders, capsules, tablets, dragee and species (collections) and other medicinal products belong to the firm (solid) pharmaceutical forms.
Powders Powders (Pulvis – nominative singular case, pulveris – genitive singular case) are the pharmaceutical form intended for internal and external application, consisting of solid separate dry particles of varying grinding degree. Various synthetic preparations, products of vital activity of the microorganisms (antibiotics), vegetative and animal parentage substances can be used for manufacturing powders. Hygroscopic substances (calcium chloride – Calcii chloridum, sodium bromide – Natrii bromidi, potassium acetate – Kalii acetas and others), substances, that after mixing form wet masses and fluid (antipyrine – Antipirinum and quinine – Chininum), easy decomposed (silver nitrate – Argenti nitras) in admixture with organic combination) or formed explosive substances are not prescribed in powders. Powders are classified by the way of use, by the corpuscles size, by the composition and dosage. By the way of use powders are distinguished for internal use (pulveres ad usum internum) and for axternal use (pulveres ad usum externum) powders. By the grinding degree there are smallest (pulveres subtilissimi), small (pulveres subtiles) and large (pulveres grossi) powders and others. As a rule, smallest powders are intended for external applications (pulveres ad usum externum).They are quickly sucking in, less irritating the tissues. Nontoxic substances and substances with moderate activity which are prescribed in large doses or used inside after previous dissolution (for example – magnesium sulfate (Magnesii sulfas) are releasing as large powders. Medical agents look like the small powders frequently are used for internal applications (pulveres ad usum internum).
Depending on quantity of the acting substances what powder structure includes, are discerned simple powders, contained only one medical agent (pulveres simplicis), compound powders, what consist of the two or more substances (pulveres compositi).The drugstore releases dosed powders, divided into separate receptions (pulveres divisi) and undosed powders (pulveres indivisi).As a rule, the dosed powders are prescribed inside, undosed powders more offer are intended for external application, less offer they are prescribed inside. Undosed powders for external and internal use are prescribed in quantities from 5,0 up to 100,0 and more. Writing the prescription on the simple undosed powder it is necessary to indicate the name, quantity and grinding degree of the medical substance after the word Recipe: Further from a new line write down Da. Signa (or D.S. in brief – release, indicate) and the way of use. The name of medical agents we put in a genitive case after word Rp.: , because Rp. concerned to the quantity of substances. Prescribing complex undosed powders all substances which are included into their structure had to be recalculated with indication quantities each of them. Then from the new line write down Misce, fiat pulvis (Mix for forming the powder), further – D.S. and the way of using. Rp.: Natrii hydrocarbonatis 20,0 Natrii chloridi 10,0 Misce, fiat pulvis Da. Signa. Dissolve one tea spoon of the powder in a glass of warm water. Use the solution for gargling the throat. Undosed powders frequently are applied as dusting powder (Aspersio), that is for applying on the skin, mucous coats and wound surfaces.Such powders had to be subtilissimi what obligatory is indicated in prescription. Rp.: Aethazoli subtilissimi 50.0 D.S.Apply on the wound surface. Sometimes medical substance is only certain part of the compound dusting powder .In different substances, which are the formative agents (Constituens) are made up the rest part of the powder. Talc (Talcum), starch (Amylum), less often, lycopodium (Lycopodium) or zinc oxide (Zinci oxydum), sometimes white clay (Bolus alba) are used as the formative substances for preparation dusting powders. If the structure of the dusting powder includes one base substance (basis) and one formative substance, we can write out prescription by two ways: a) short; b) full;
a) Rp.: Aspersionis Amycazoli 5% 100,0 D.S. Apply on the skin of inter digital spaces twice a day.
b) Rp.: Amycazoli 5,0 Talci ad 100,0 Misce, fiat pulvis Da. Signa. Apply on the skin of inter digital spaces twice a day.
If dusting powder is compound, so it is possible to write it out only by the developed way: Rp.: Bismuthi subnitratis 10.0 Zinci oxydi Amyli ana ad 100,0 Misce,fiat pulvis D.S. Apply on the lesion parts of the skin. As a rule, the dosed powders are prescribed for internal usage. The mass of such powder changes in limits from 0,1 to Writing out the dosed powder we must indicate the medicine substance with designation of its single dose in the prescription. Then it is necessary to indicate quantity these powders have to be given out: Dentur tales doses N. (Let will be given such doses by number), further Signa. Rp.: Pancreatini 0,5 D. t. d. N. 24 S. In one powder three times a day before meal.
In case of prescription of compound powder it is necessary to note: Rp.: Platyphyllini hydrotartratis 0,005 Dibazoli 0,02 Sacchari 0,3 M. f. pulvis D. t. d. N. 12 S. In one powder twice a day. Prescribing the plant origin powders sampler of writing begins from the word Pulveris, then indicates the part of plant, its name and dose. Rp.: Pulveris foliorum Digitalis 0,05 D. t. d. 12 S. In one powder three times a day. Flying and hydroscopic powders are released in waxed paper (Charta cerata) or paraffin paper (Charta paraffinata) packing, what is marked in prescription. Rp.: Camphorae tritae 0,2 D. t. d. N. 12 in charta cerata S. In one powder three times a day. Powders for inhalation (pulveres pro inhalationibus) are the smallest powders which are applied by means of inhalators, sometimes by retraction through the nose (insufflations). Such smallest (subtilissimi) powders therefore are applied on the wound surfaces, on the eye conjunctiva and ear application. All they concern to the indivisible powders and are prescribing iot great quantities (5,0 – 10,0). They often have local action but they also can be used for achievement of the systemic effect.
Capsules The medical substances, which have unpleasant taste or smell, harmfully acting on the teeth or have irritation action, are prescribed in medical capsules (capsulae). Depending on the material, they are made of, there are: a. starchy capsules or oblatae (capsulae amylaceae, s. oblatae); b. gelatinous capsules (capsulae gelatinosae), which are hard (capsulae gelatinosae durae), elastic (capsulae gelatinosae molles, seu elasticae) and with lids (capsulae gelatinosae operculatae); c. glutoidous capsules (capsulae glutoidales, s. gelloduratae). d. different synthetic capsules (are very popular now).
Soft and hard gelatinous capsules contain 0,2-0,5 gr of the medical substances. Discharging medicines in capsules it is necessary to indicate in the prescription: to release in gelatinous, starchy or glutoidous capsules – in capsulis gelatinosis, amylaceis, glutoidalibus. Rp.: Extr. Filicis maris spissi 0,5 D. t. d. N. 12 in caps. gelatinosis S. Drink all capsules during 30 minutes, each of them should be wash down by the 1% solution of sodium hydrocarbonate.
The variety of the capsules Pearls (perlae gelatinosae) are the gelatinous capsules with capacity 0,1-0,2 ml., are filled up the oily limpid medicine fluid. They are variety of the elastic gelatinous capsules and are filling up on the manufacture. Rp.: Clofibrati 0,25 D. t. d. N. 50 in perlis gelatinosis S. In one pearl three times a day. Modern pharm-industry produces micro-capsules. They are the finest fraction of the firm gasiform or liquid substance, covered with coating or pellicle material. Size of the micro-capsules are from 1 to 500 mkm. Nanocapsules are called fractions with shape less 1 mkm. They are intended for parenteral applications. Micro-capsules with micro-dragees, micro-tablets and granules (50 – 400 pieces) can be filled in the hard gelatinous capsules, which are called spansules (spansulae). They are polyreservoired medical form, consisted of the substances with different time of the absorption and different dissolvability degree and with prolonged acting Rp.: Spansulas Feospani N. 100 D. S. In one spansula three times a day. In some cases medical substances in capsules are leading in rectal, vaginal applications and by inhalations. Rectal and vaginal capsules (capsulae rectales et vaginales) are the coating definite scale filled up with medical agents like the powders, solutions, emulsions and suspensions. They are intended for introduction in the rectal or vaginal cavities. Rectal capsules, look like oblong drop, especially widely are used in pediatrics. Capsules for inhalations (capsulae pro inhalationibus) are used by means of special inhalators for treatment bronchial asthma (drug Intale).
Tablets Tablets (tabuletta – nominative singular; tabulettam – accusative singular; tabulettas – accusative plural; tabulettis – locative plural) are the solid pharmaceutical form received by pressing medical substances or medical and auxiliary substances. The main kinds of tablets are presented in table 3. Tablets mainly are prescribed inside. Some kinds of tablets are used externally after the previous dissolution.
The tablets intended for application in an oral cavity, may be dispersed, chewing, sublingual (Tabulettae sublingualis). There are also tablets for hypodermal introduction – implantation tablets (Tabulettae implantatae). The tablets are made by factory way, the drugstores only release them. If tablets contain more then one medical substance it is not necessary to write Misce, fiat. If tablets are simple, they can be written out by developed or reduced way.
Table 3 Various kinds of the tablets
Rp.: Analgini 0,5 D. t. d. N. 10 in tabulettis S. One tablet in the time of headache. Rp.: Tabulettam Analgini 0,5 D. t. d. N. 10 S. One tablet in the time of headache. Rp.: Tabulettas Analgini 0,5 N. 10 D. S. One tablet in the time of headache. The complex tablets are written out by the developed way: Rp.: Platyphyllini hydrotartratis 0,005 Papaverini hydrochloridi 0,02 D. t. d. N. 10 in tabulettis S. In one tablet twice a day. But such variant is also possible: Rp.: Tabulettam Platyphyllini hydrotartratis 0,005 cum Papaverini hydrochlorido 0,02 D. t. d. N. 10 S. In one tablet twice a day. Some complex tablets, such as Aeronum, Verodonum and other, are made under the special commercial name. These tablets are prescribed only by reduced way: Rp.: Tablettas Aeronum N. 10 D. S. In one tablet under tongue until complete decomposition in half an hour before flight. In cases when substances induded into the structure of the tablets have unpleasant taste, smell, irritation action or may be blasted under the action of oxygen, air moisture, gastric contentes, they have to be covered with coating: Rp.: Tab. Pentoxyli 0,2 obductas N. 20 D. S. In one tablet three times a day. Or:
Rp.: Pentoxyli 0,2 D. t. d. N. 20 in tabulettis obductis S. In one tablet three times a day. It is not recommended to prescribe tablets for small children, people with dissonance of the swallowing act, consciousness and psychical-illnesses.
Dragee
Dragee (accusative case singular and plural – Dragee) – the firm dosed out pharmaceutical form for internal use, which is received by the way of stratification of the acting substances and recipients. Dragee as the tablets are made by the factory way. It is possible to prescribe dragee by reduced and developed ways: Rp.: Dragee Diazolini 0,05 D. t. d. N. 20 S. In one dragee twice a day.
Rp.: Dragee Diazolini 0,05 N. 20 D. S. In one dragee twice a day.
Species (collections) Species (collections) ( Species – nominative plural, Specierum – genitive plural) are the firm medical form, which is a mix of the grinding plant raw material (flowers, roots, leaves), sometimes with addition of salts, other oils or other medicinal substances. Collections (species) are intended for internal use (after the appropriate processing, they are used as tinctures, decoctions or infusions), for burning and inhalation formed smoke (species for smoking), for external use (for gargling and poultices). Prescribing this medical form the doctor must indicate in signatura not only the way of use, but also the way of preparing the medicines. In addition, the collections can be classified as dosed and undosed ones. As a rule, the dosed species are prescribed, when the plant raw material contains strong acting substances. Then each plant component and its quantity are indicated on the prescription. Further write Misce, fiant species. D. t. d. . . . and the Signatura. For example: Rp.: Herbae Adonidis vernalis 2,0 Rhizomatis cum radicibus Valerianae 1,5 M. fiant species D. t. d. N. 10 S. Boil a packet of species in a glass of water and infuse during 30 minutes. Take in one table-spoon three times a day.
Undosed species are prescribed such way: Rp.: Florum Chamomillae 20,0 Fructuum Rhamni catharticae 30,0 M. f. species D. S. Boil one table-spoon of the species in a glass of water and infuse during two hours and filter it. Take half of the glass before sleep. Officinal collections are written out by reduced way: Rp.: Specierum antiasthmaticarum 100,0 D. S. Burn 1/2 of the species tea-spoon and inspire the smoke.
Granules Granules (granula – nominative singular, granulam – accusative singular and granulas – accusative plural) – the firm medicinal form which looks like homogeneous fractions (grains, kernels) spherical, cylindrical or anomalous form, scale 0,2-0,3 mm, which consists of the mixture of acting substances with or without fillers. They are produced at the factories and plants in single-dosed or multi-dosed containers. The medicinal substances with unpleasant taste, smell, irritant action, but not enough toxic are produced in granules. Thats why they dosed in tea-spoons and are released by common weight Granules, usually are intended for direct per oral applications. They also may be coated or uncoated. Nowadays some granules, especially for children, are produced in packets, preliminarily dissolved in the indicating volume of the warm boiling water and prescribed as liquid medical forms in tea-spoons or table-spoons. Granules are officinal forms, thats why they are prescribed by reduced way. Rp.: Granulas Urodani 100,0 D. S. In one tea – spoon three times a day, preliminarily dissolved in 1/2 glass of water.
Rp.: Granulorum Plantaglucidi 50,0 D. S. In one tea-spoon in 1/4 glass of water three times a day.
Pencil Pencil (stilus) – firm pharmaceutical form, cylinder – shaped with pointed or rounded end, for external application. Sinapismes (mustard plasters) Sinapismes (Charta sinapis, Charta sinapisata) are the firm medical form as the rectangular-shaped pieces of paper coated with an oil-free powder black or zarephthal mustard. Mustard plasters are issued in packages. They are intended for application to skin. These are the officinal forms, wrote out by the reduced way. Rp.: Chartae sinapisatae N. 10 D. S. Moisten in warm water and put on the thorax.
Medical films Films or inserts (membranulae) are the form dosed medical form, which is made by factory way as polymeryc films. They look like polymeryc plates with oval form and appropriate size. Films are classified on eye, intravaginal, stomatological onis. They consist of a matrix in which acting substances are included or the acting substance surrounded by a membrane which controls rate of release. There are ophthalmic films (intended for an insect to the conjunctival bag with local action) and oral films (glue to the mucous membrane of the gums at the level of the first premolar tooth). Each film is issued in the individual sterile container. Oral films have general action (for smoking prophylaxis and prophylaxis of the stenocardic attacks). By method of including in biodissolvable polimeryc films the medical agents are ensured fast coming of the effects and prolonged action after moistening by tissue fluid or secretion. Films are the officinal medical forms.
Rp.: Membranulas ophthalmicas cum Pilocarpini hydrochlorido N. 30 D. S. Pawn one film on the lower edge of the eyelid one time a day.
Rp.: Membranulam Trinitrolongi 0,001 D. t. d. N. 20 S. Glue in the region of the upper gum two or three times a day.
Plates Plates are the firm medical forms intended for wounds treatment. They are made from the collagen with admixing medical substances (analogous of the medical films). They are intended for applications on the wound surfaces with local action, released sterile. Prescribing plates we must indicate size according shapes of the wound.
Dental powder Dental powder (pulvis dentalis) – it is a firm medical form, white powder with calcium carbonate precipitated as general component. Besides dental powders include other oils (mint, anise, pink or gum -tree oils) attached them pleasant smell and deodorant property. Dental powders are classified on hygienic and treatment-and-prophylactic ones with different degree of the abrasive action. In case of need, doctor can prescribe main treatment-and-prophylactic dental powder instead of the selling ones. They are prescribed like undosed powders for external applications (dusting – powders) with mass – 100 gr. Rp.: Calcii carbonatis praecipitati 20,0 Magnesii subcarbonatis 5,0 Olei Menthae piperitae gtts M. f. pulvis dentalis S. Dental powder.
Caramel Caramel (carameles) – the firm pharmaceutical form which prepared as sweets by the way of addition of melting acting substances, some sugar, treacle, with subsequent addition of flavouring, aromatic, dye components. Caramel is intended for per oral applications and for applications in an oral cavity (sublingual or intrabuccal applications attached to diseases of the gums, mucous membranes and throat) for dispersion. They are officinal medical firms, thats why caramels are prescribed by reduced way:
Rp.: Caramelem Decamini 0,00015 D. t. d. N. 50 S. In one caramel resolve in the oral cavity tree times a day.
Pastilles Pastilles or trochee (trochisci) – the firm dosed medical forms, have the shape of a plate of the different form, intended for dissolution in the oral cavity (dispersion) for treatment diseases of the gums and oral mucous membranes; and are used inside for treatment diseases of the digestive tract. Pastilles are produced by formation paste-like form of medical agents with sugar, chocolate, with addition of water, syrup, mucus. The paste obtained is unroll to make a thin layer, cut out plates of the appropriate shape and size, and then dry up. Prescribed like dosed medical form by the reduced way: Rp.: Trochiscos Drill N. 10 D. S. In one trochee two or three times a day into the oral cavity to the complete dissolution. Sponges Sponge (spongia – accusative plural) – the firm medical form looks like dry porous mass as a powder or plates made of gelatin, collagen or ried up plasma, impregnated with a solution of medicinal substances. Antiseptic product (with sizes 2 * 2 * 1 or 10 * 10 * 1 cm.) sticking together tissues is applied as styptic. By application it is classified as antiseptic and hemostatic. Sponges are intended for external (application to skin, long – unhealing wounds and ulcer) applications, rectal and vaginal. Sponge is not extracting from the wounds, because it resolved gradually and had prolonged action. Rp.: Spongias haemostaticas 5 x 5 x 1 cm N. 10 D. S. Apply to the bleeding surface for stopping hemorrhage.
Chapter 4 The soft medical forms
Suppositories, ointment, pastes, creams, liniments and other medicinal products concern to the soft pharmaceutical form. Suppositories
Suppositories (suppositorium – nominative singular, suppositorium- accusative singular and suppositoria – accusative case plural) – the dosed medical forms. They are solid at the room temperature and are dissolved or melted at a body temperature. Differed suppositories rectal (suppositoria rectalia) and suppositories vaginal (suppositoria vaginalia), sticks (bacilli) – suppositories intended for introduction in the cervical channel of the uterus, in urinary channel, acoustical duck, nose, which have cylinder shape with pointed end. By medical purpose rectal suppositories are divided into 2 groups: 1) with local action – antihemorrhoidal, suppositories for healing cracks and breaks, for treatment inflammation processes of the rectum; 2) with resorbtive action – suppositories showed systemic action (medicinal substances which they contain (enzymes, antibiotics, barbiturates, antiseptic, hormones, vitamins, spasmolytics, analgetics, diuretics etc.) are soaked in to the general blood flow through the system of the inferior and middle hemorrhoid veins. That’s why prescribing in rectal suppositories strong – acting and poisonous substances, it is necessary to follow the same rules of dosed as for the medical forms used inside. Suppositories contain one or more acting substances, dispersed or dissoluble in a simple or complex basis which can be dissolved, dispersed, melted at body temperature. A suppository may include additional components, such as solvents, absorbents, lubricant substances, antimicrobial agents, dues and also solid fats, macrogols, gelatin mixtures (gelatin, water, glycerin), being their basis. So, suppositories include medical agent (agents) and formative substances (constituens). As formative substances are used such substances: a) Cacao-seed oil (oleum Cacao, s. butyrum Cacao); b) Butyrol (butyrolum – hydrogenizated fat with various chemical structure); c) Gelatinous mixture (mass) ( d) Synthetic basis – polyaethylen-oxydum and others. Rectal suppositories are cone-shaped or cylinder-shaped with rounded end one’s. Their weight changes from 1,1 until to 4,0gz.The maximum permissible diameter is 1,5 cm. If the weight suppositories is not indicated, they are made with mass 3,0 gr. Vaginal suppositories are differed by shape on: globuli (globuli – spherical), ovuli (ovulae – oviform) and pessary (pessaria – flat body with rounded end). The weight of vaginal suppositories is from 1,5 to 6,0 gr. If in the prescription the weight is not indicated, they are made in mass – 4,0 gr. Main (magistral) suppositories made in the drugstore may be prescribed in several ways. The first way. After the word Rp. it is necessary to write the name of medical substance (substances), the single dose of each of them and formative substance with its quantity (on 1 supp.). It is allowed not to indicate the quantities of the constituens in the prescription. In such case it is necessary to write q. s. (quantum satis – how much it is necessary) instead of the quantities formative substances. Before signature we must sign D. t. d. N… (Da tales doses numero… – Give out such doses by number… ) cause suppositories are dosed medical forms. Rp.: Dimedroli 0,01 Olei Cacao 3,0 M. f. suppositorium rectale D. t. d. N. 12 S. In one suppository into the rectum by night. Or: Rp.: Dimedroli 0,01 Olei Cacao q. s. Ut fiat suppositorium rectale D. t. d. N. 12 S. In one suppository into the rectum by night. The second way. In this case it is necessary to note not single doses of substances, which are included into the suppositories structure, containing basis, but quantities necessary for preparing all suppositories. For their definition we must multiply single dose on the quantity of suppositories, what is written out. Then it is necessary to write Misce, fiant suppositoria rectalia numero … . Rp.: Dimedroli 0,12 Olei Cacao 36,0 M. fiant suppositoria rectalia N. 12 D. S. In one suppository into the rectum by night. Or: Rp.: Dimedroli 0,12 Olei Cacao q. s. Ut fiant suppositoria rectalia N. 12 D. S. In one suppository into the rectum by night. Nowadays the majority of the suppositories is officinal. They are written out by the reduced way: Rp.: Suppositorium cum Ichthyolo 0,2 D. t. d. N. 10 S. In one suppository into the rectum in the morning and in the evening. Where the word “suppository” is used in the accusative case singular (suppositorium), further after adjective cum (with) we wrote the name of medicinal substance with its quantity, at the end of prescription we wrote D. t. d. N… and signature. Some complex officinal suppositories have the commercial name, for example, suppositoria “Anuzolum”, “Bethiolum” and other. Prescribing them at first we must write the word suppositories in the accusative case plural (suppositoria) and then the name of the suppositories with their quantity. If the name is not bracketed we use it in the genitive case singular. Rp.: Suppositoria “Bethiolum” N. 10 D. S. In one suppository into the rectum twice a day, previously unwrapped it.
Sticks Sticks (bacilli) – are the variety of the suppositories intended for introduction in the cervical channel of the uter-nus, in urinary channel, acoustical duet, nose. They have cylinder shape with pointed end with indication of their diameter in the prescription. Rp.: Bacillas cum Suprastino 0,05 D. t. d. N. 10 S. In one stick into the nose ducts twice a day. Dental cones Dental cones (conusi dentales) are intended for application into the inflamed alveolus of the removed tooth. They have cone shape with base diameter 6,5 mm, height 12 mm and mass 0,147 gr. Dental cones are used in stomatology practice.
Rp.: Laevomycetini 0,01 Dexamethasoni 0,0005 Olei Cacao q. s., ut fiat conus dentalis D. t. d. N. 10 S. Put in one cone into the inflamed alveolus of the removed tooth.
Ointments (unguents) Ointments (unguents) (unguentum – nominative singular, unguenti – genitive singular) – the soft medical form intended for external application. Unguents contain one or more active substances and formative agents. As a base for the ointments are used: a) Vaseline or white petrolatum (Vaselinum); b) Lanolin (Lanolinum); c) Pork cleared fat (Adeps suillus depuratus, s. Axungia porcina depurata); d) officinal glyceric unguent (Ung. Glycerini); e) officinal naphthalan unguent (Ung. Naphthalani); f) officinal spermacetical unguent (Ung. Cetacei).
Preparing ophthalmic ointments we are using basis, what contained 10 parts of Lanolin and 90 parts of special Vaseline (“for ophthalmic ointments”). Depending on a base ointments can be hydrophobic (carbohydrate basis – vaseline, vaseline oil, paraffin etc.), hydrophilic (a water-soluble basis). The ointments basis determines quality of the unguent in the certain measure. Unguents, which are made on the pork cleared fat, quickly spoil on account of hydrolysis of the fat on glycerin and fatty acids. The ointments, which are made on Vaseline and lanolin, are stable enough and can be stored for a long time. Pork fat, lanolin and spermacetical unguent promote the suction medicinal agents through the skin. Vaseline and naphthalan unguent are not soaked up through the skin, that’s why they are used for manufacturing ointments with superficial action. There are magistral (main) and officinal ointments. The main unguent, that contained one medical substance and Vaseline, can be written out by reduced and complete ways. In the first case we write Unguenti, name of the medicinal substance and its concentration in %, total quantity of the ointment after the word Rp. Rp.: Ung. Prednisoloni 0,5% 20,0 D. S. Grease the affected regions of the skin Prescribing this unguent by complete way, after the word Rp. we must recount all medical agents, included into the ointment, their quantity, further from a new line – Misce, fiat unguentum (reduced M. f. ung.); D. S. and mark the way of its use. In such case it is possible to give account how many grams of prednisolone and vaseline we need to take for preparing the unguent, knowing concentration and total quantity of the ointment. We reflect on such way: 0,5% prednisolone unguent – this is such unguent, which contains 0,5 gr of prednisolone in own 100 grams. So, grams of prednisolone will be in the 20 grams of this unguent. These correlations formed such proportion: 100,0 – 0,5 20,0 x 0,5 : 100,0 = 0,1 20,0 – Thus, for preparing 20 grams of the 0,5% prednisolone unguent we must take 0,1 gr prednisolone and the rest will be made by vaseline. Rp.: Prednisoloni 0,1 Vaselini ad 20,0 M. f. unguentum D. S. Grease the affected regions of the skin. If we write out the unguent by reduced way (the ointment basis is not specified), such unguent is prepared on vaseline in the drugstore. The ointments are written out only by the developed way in case it is necessary to prepare unguent not on vaseline, but on other bases, and also when unguent contains two or more medical substances. Rp.: Anaesthesini 0,5 Xeroformii 5,0 Vaselini ad 50,0 M. f. ung. D. S. Grease the affected regions of the skin.
Rp.: Streptocidi 4,5 Lanolini 5,5 Vaselini 25,0 M. f. ung. D. S. Grease the nipples when they are cracked. The officinal unguents are prescribed only by the reduced way, irrespective of their structures. In the prescription we indicate its name and total quantity. The concentration has not need to be specified. Rp.: Ung. Hydrargyri oxydi flavi 10,0 D. S. Pawn for lower eyelid by night. Total quantity of the unguent for treatment the skin (mucous) is 20,0-100,0 gr and more and as for ophthalmic unguent – it is 5,0-10,0 gr. If structure of the ointment includes medicinal substance what quantity is underlined on the action units (OD), the prescription on such unguent can be written out by the reduced way (if unguent should be made on vaseline) with indication of the OD drug quantity in the 1 gram of unguent. Rp.: Ung. Tetracyclini 20,0 (1g- 10000 OD) D. S. Grease the skin in the affected regions. If this ointment is made not on vaseline, but on other base, prescribing it by the complex way we must recalculate the OD quantity of the medicinal substance to all unguent quantity: 10000 OD (tetracycline quantity in the 1 gram of ointment) in 20,0 (grams quantity of the unguent) are equal 200000 OD. Rp.: Tetracyclini 200000 OD Ung. Naphthalani ad 20,0 M. f. unguentum D. S. Grease the skin in the affected regions. Dosed ointment (unguentum divisum) are intended for application medicinal substances with resorptive action. Thats why they are applied by the portions contained the single dose of the medical substance. They can be magistral (main) but seldom. Often the dosed ointments are officinal. They are produced with indication of the concentration: Colchamine ointment 0,5%: Unguentum Colchamini 0,5% (single permissible dose – 1,5 gr.); Unguent Nitro 2%: Unguentum Nitro 2% (from 0,5 till 5 cm of the column); Pyromecaine ointment 5%: Unguentum Pyromecaini 5% (single dose – 1,0). Rectal unguent (unguentum rectale). Officinal unguent produced by pharmaceutical industry in the special forms for application into the rectum cavity. It is the dosed form because this ointment is mentioned for resorbtive action. Vaginal unguent (unguentum vaginale). It is the officinal dosed unguent intended for introduction into the vagina. This ointment is produced in the special forms. Urethral unguent (unguentum urethrale). This is the variety of the dosed ointment intended for inroduction into the urinary channel. It has the local action. This unguent is produced in the syrettes for dosed applications connected with narrow aperture of the urethra.
Pastes Paste (pasta – nominative singular, pastae – genitive singular) – is the soft medicinal product for local application, the variety of the ointment, that contained from 25 % up to 65 % powder like substances, so it is the thick unguent. Paste contains one or more active substances and fats and fat like substances which are used for manufacturing unguents, forming the base. If powder medical substances which are contained into the paste, make less than 25 % of its weight, then in those case it is necessary to increase their quantity by expense of addition of indifferent substances as talc (Talcum), zinc oxyde (Zinci oxydum), starch (Amylum), lycopodium (Lycopodium), white clay (Bolus alba) and others. Magistral (main) pastes are prescribed only by developed way. For example, if it is necessary to write out 50,0gr. of paste, what contained 10 % of anaesthesine (Anaesthesinum) and 1 % of menthol (Mentholum). For receiving paste consistence, it is necessary to add the indifferent powder in any quantity in limits 25-65 % from the total paste quantity. All ingredients of the paste are written out in the weight units. So, we must to make the proportion: For anaesthesine 10,0 – 100,0 = 10 x 50 : 100 = 5,0 – 50,0 = 5,0 That means, anaesthesine needs to be taken 5 gr. For menthol 1,0 – 100,0 1,0 x 50,0 : 100,0 = 0,5 – 50,0 = 0,5 That means, menthol needs to be taken 0,5 gr. The quantity of the indifferent powder (for example, talc) can be in limits 12,5-32,5 gr. (25-65 % from 50 gr of paste). The vaseline quantity is necessary to calculate like this: subtract from total paste quantity (50 gr.) the weight of all previous components (5 gr anaesthesine, 0,5 gr menthol, 12,5 gr talc) or write out – ad 50,0. Rp.: Anaesthesini 5,0 Mentholi 0,5 Talci 12,5 Vaselini ad 50,0 M. f. pasta D. S. Apply to the affected parts of the skin. If medicinal substance, included into the paste structure, is a powder and is not dissolved in the unguent base; prescribing paste it needs to be taken in account, that total quantity of powder in the paste was not more, than 65 % from the paste general mass. For example, it is necessary to prescribe 50 gr. of the paste, that consists of 20 % zinc oxide. In such case preparing paste it is necessary to take the quantity of the indifferent powder, not more than 45 %, because 20 % + 45 % = 65 % (the top limit of the allowable quantity of the powder in the paste). The prescription looks like this: Rp.: Zinci oxydi 10,0 Talci 15,0 Vaselini ad 50,0 M. f. pasta D. S. Apply to the affected parts of the skin. In this case the powders weight is 50 % of the total paste mass. The officinal pastes are prescribed by the reduced way: Rp.: Pastae Antisepticae biologicae 10,0 D. S. Apply to the gums by night. Stomatological pastes (pastae stomatologicae). They are used in stomatological practice for treatment caries, pulpits and also for prophylaxis dental caries. They are preparing in small amounts from 1,0 g up to 15,0 g near the patient chair. In the drugstore is prepared only arsenic paste for devitalization of the pulp. They include powder like substances (sometimes in combination with liquid substances) and constituents as glycerin (Glycerinum), camphorated oil (Oleum camphoratum), oil of cloves (Oleum Caryophyllorum), eugenol (Eugenolum). Stomatological pastes are prescribed only by the complex way: Rp.: Natrii fluoridi 15,0 Olei Caryophyllorum ad 20 ml M. f. pasta D. S. For tooth fluoridization.
Rp.: Iodoformii 10,0 Olei camphorati q. s. ut f. pasta D. S. For treatment deep caries Tooth-paste (pastae dentales). They can be hygienic and treatment – and – prophylactic one’s. Tooth-pastes contain calcium carbonate purificant, (as the base), glycerin, bound substances, antiseptic, detergent and air – way (other oils). We clean teeth with hygienic pastes for moving off the food remainders or the dental deposit. Their nomenclature is extraordinary various. They are produced by perfumery industry and are differed by gustatory and cleaning kinds. Treatment – and – prophylactic pastes contain still bioactive substances (salts, enzymes, extracts of the medicinal herbs, vitamins, microelements). There are saline pastes (“Balsam” and others), chlorophyl pastes (“Karophyll”, “Forestry”, and others), boran-glyceric and fluor-contained pastes (“Colgate”, “Ftordent” and others). Depending on the acting substance these pastes have various treatment action and prophylactic action, used for treatment different stomatological pathologies.
Liniments Liniments (linimentum – nominative singular, linimenti – genitive singular) are also the variety of the unguents. But these are the soft medical products, liquid unguent for local application, which contain up to 5 % of hard substances.
As constituens for preparing liniments are used vegetative or mineral oils ( Ol. Lini – linseed oil, Ol. Helianthi – sunflowerseed oil, Ol. Hyoscyami – henbane oil, Ol. Olivarum – olive oil, Ol. Amygdalarum – almond oil, Ol. Persicorum – peach – kernel oil, Ol. Vaselini – vaseline oil, Ol. Ricini – ricin oil, tar, ichthyol and others). Liniments are prescribed only by the developed way. We must recalculate all ingredients and their quantities after the word Rp., then from a new line write down Misce, fiat linimentum (reduced – M. f. Lin.) and D. S. , the way of use. Rp.: Mentholi 2,0 Ol. Helianthi ad 50,0 M. f. lin. D. S. Rub in strucked joints. Officinal liniments are written out by the reduced way. Rp.: Lin. Ammoniati 40,0 D. S. For rubbing lumbar region.
Rp.: Lin. Sythomycini 10% 25,0 D. S. Render to the edges of the wound.
Creams Creams (cremor – nominative singular, cremoris – genitive singular) are the soft medicinal products for local application, the variety of the emulsion ointments, produced without addition of the emulsifier. They represent one, two – or multiphase dispersion systems, which dispersion environment at certain storage temperature is, as a rule. They differed from ointments by sourcream-like (semiliquid) consistence and small stability. Creams have cooling action and rapidly skin soaked. Into the medicinal and cosmetic creams are added aromatic substances. Creams are intended for application to skin and its appendages wounds, ulcers, certain mucous membranes. They are prescribed by the reduced way with indication of the percentage concentration medical substance or only its quantity (for the officinal creams). Rp.: Cremoris Canesteni 1% 20,0 D. S. Rub skin in the strucked regions.
Gels Gels (gelum – nominative singular, geli – genitive singular) are the soft medicinal products for local application; the ointments prepared on the hydrophilic bases with gel – like (semi – liquid, galantine – like) consistence. They are one, two – or multiphase dispersion systems with the liquid dispersion medium, which rheological properties are conditioned by presence of gelatinizes in small concentration. Gelatinizes can act as stabilizers of suspensions. That’s why such gels can refer to suspension gels or emulgels, respectively. In gels medicinal substances allotted to skin more evenly and acts for the tissues. By mode of application the gels can be divided in gels for external application (troxevasin-gel, voltaren-gel, indovasine-gel), for peroral application (jelly), which is the most frequently used in pediatric practice (almagel, phosphalugel), as well as nasal, eye, ear, rectal, vaginal, cervical, ure-thral, stomatological gels, gels for inhalations (“Mentoclar”). Gels are prescribed by the reduced way (officinal gels) or with indication percentage substance concentration. Rp.: Geli Troxevasini 2 % 40,0 D. S. Grease in the region of the foot atrophic ulcer.
Lotions Lotions (lotio – nominative singular, lotionis – genitive singular) – alcohol – oiling liquids, which contained cooling and anticeptic substances. They are intended for external applications (for purification, disinfection the skin of the face, ears, sometimes nose mucous); there are also eye lotion. Lotions are prescribed as officinal medicinal forms. Rp.: Lotionis Zinci spirituosae 100 ml D. S. For application on damaged skin.
Plasters Plasters (emplastrum – nominative singular, emplastri – genitive singular, emplastra – nominative plural) are the soft medical form, transdermal therapeutic systems. They are looking like the plastic mass which capable of melting at body temperature and sticking to skin, or the mass applied on the carrier (fabric). Plasters are intended for external application (for skin application) and have local action. There are regular (hard) and liquid (skin glues) plasters, smeared (on the fabric or paper bases) and unsmeared (look like conic or cylindrical pulley-blocks) plasters; and also rubber (an adhesive plaster, capsicum, corn) plasters. By medicinal prescription they are differed to the epidermatic plasters (without medical agents, used as dressing material – leucoplasters) and endermatic plasters with keratolytic, depilatory and other medical substances for treatment dermal diseases (local action) and with irritative substances (reflex action). Ability for melting and sticking to skin provides with plaster-base, which is prepared on fusion of the rosin, paraffin, wax, caoutchouc and some other substances. They are manufacturing in the plants and at the factories. Plasters are prescribed by the reduced way, because they are undosed medicinal forms. After indication of the form (emplastri-genitive singular) we must write down the plaster name, its quantity (if it is unsmeared and prescribed on the hard blocks –20,0-50,0, or its size (if it is fabric smeared with indication length and width). Rp.: Emplastri bactericidi adhaesivi 10 x 6 cm D.S. Fix the edges of the wound. Liquid plasters. It is the skin lacquers which contain the volatile substances, formed the skin films after dissolvent evaporation. They are produced by the way of dissolution the medical substances and detergents in the volatile fluid likes ether or ethyl spirit. They are officinal plasters produced in the bottles or in the aerosol balloons. Liquid plasters are widely used in the surgical and dermatological practices, for example – cleol (Cleolum) and collodion (Collodium). Rp.: Cleoli 100 ml D.S. For protection of scratched skin. Transdermal systems (Transdermalia systemata) or diadermatic plasters are intended for medicinal agents penetrating through the skin with resorbtive action and with influence over the more deeply situated layers of the skin. Nowadays native and foreign industries produce such plasters with nitroglycerin: nitroderm (“Nitroderm”), nitrodur (“Nitrodur”) and nitradisc (“Nitradisc”). They are dosed (50 mcg nitroglycerin in one plaster) and ensured long action of the medicine by the way of its entering into the blood (up to 24 hours). They are sticking to skin of the left front-lateral thorax surface or to the skin of the left forearm for treatment of ischemic heart disease.
Chapter 5 Liquid pharmaceutical forms
Liquid medical forms include solutions, tinctures, infuses, decoctions, balsams, liquid extracts, mixtures, elixirs, suspensions, syrups, juices, musses and other medicinal products. These medical forms are dosed in milliliters, some of them – in drops. Liquid forms are better entering into the blood, soaking up in the skin and acting more quickly, than solid medicinal forms. But these forms have such short-comings of using them in drops, spoons or cups doses. Their peculiarities may change over influence of surrounding environments, such as light, air.
Solutions Solutions (Solutiones; solutio – nominative singular, solutionis –genitive singular) are the simplest liquid medical form which is intended for external applications, per oral applications and for parenteral administrations. This form is representing a homogeneous transparent system including one or more active substances, received by the way of dissolution of the solid, liquid and gasiforme substances in the solvent or by the way of mixing two or more substances. The most frequently used solvents are: distilled water (Aqua destillata) or bidistilled water (Aqua bidestillata), ethyl spirit (Spiritus aethylicus) with concentrations 90%, 70%,40% est., glycerin (Glycerinum) and oils: peach-kernel oil (Oleum Pecsicorum), olive oil (Oleum Olivarum), Vaseline oil (Oleum Vaselini) and others. By type of solvent the solutions can be divided into water, alcoholic, oil, combined (hydroalcoholic, alcohol-aqueous) and other (non-aqueous) solvents. If solvent is not water, this should be specified while composing a pharmaceutical form. If solvent is not specified in the prescription, than solution is prepared on the distilled water. If concentration is not indicated in the prescription too, the chemist prepares solution on ethyl spirit with concentration 90%. Solutions for internal use are dosed in drops, table-spoons, tea-spoons and dessert-spoons. The average capacity of the table-spoon is 15 ml of water solution; of dessert-spoon – 10 ml and of tea-spoon – 5 ml. Solutions are prescribed by reduced and developed ways. Prescribing solutions for internal use we must write down after the word Rp.: the name of the medical agent, then solvent, their quantities. At the end of prescription are written words Misce. Da. Signa (reduced M.D.S. that means: Mix. Give out. Indicate) with indication of the way of use (for example: “In one table-spoon three times a day”, or “In 15 drops three times a day in half of hour after a meal”). The quantities of medical substances, included into solution, and quantity of the solvent is necessary to account based on the single dose, the way of dosage and the common quantity of receptions. For example, we must prescribe sodium bromide solution for internal use in single dose 0,3 gr. The patient must take this drug in one table-spoon three times a day during four days. These calculations are made like: all receptions: 4 x 3 = 12 necessary quantity of sodium bromide: 0,3 g x 12 = 3,6 g common quantity of solution: 15 ml x 12 = 180 ml So, prescription looks like this: Rp.: Natrii bromidi 3,6 Aqua destillatae ad 180 ml M.D.S. In 1 table-spoon three times a day. If solutions are dosed in tea-spoons or in dessert-spoons the common quantity is recalculated by multiplying the number of receptions on 5 or 10 ml. This solution we can prescribe by the reduced way. In such case it is necessary after the word Rp.: write down Solutions (reduced Sol.), then medicines name, solution concentration (in %) and its quantity, and also symbol D.S. and the method of reception. For receiving solution concentration it is necessary to make the proportion: 180 – 3,6 x = 3,6 :180 x 100 % = 2 % 100 – x We can calculate this solution concentration in such way: 15 ml of the solution (1 table-spoon) contain 0,3 g. Sodium bromide and 100 ml of the solution include X g; x = 2 %. This prescription we will write like: Rp.: Sol. Natrii bromidi 2 % 180 ml D.S. In 1 table-spoon three times a day. Solutions for internal use, closed in drops are written out by the same way as the solutions dosed in spoons. Solutions, prescribed for internal use in drops, are discharged by the same way as solutions dosed by spoons. It is necessary to recalculate common number of the drops in the volume unit (ml) of the drug quantity. The common number of the drops is recalculated multiplying single drops dose on the receptions number. This value is transferred into milliliters by the way of its division on the number of drops in one milliliter. We must take into account that 1 ml of the water or water solution includes 20 drops. 1 ml of the spirit or alcoholic solutions contains 50 drops, 1 ml of the ether solution – near 80 drops, 1 ml of the oil solution – 30 drops in average. For example, it is necessary to prescribe for patient Platyphyllin hydrotartras (Platyphyllini hydrotartras, pro dosi 0,002 g) solution intended for internal use in 10 drops twice a day during 20 days. These calculations are made: Commoumber of receptions 2 x 20 = 40 Quantity of platyphyllin 0,002 x 40 = 0,08 (g) Solution common quantity 10 x 40 = 400 (drops) or 400 x 20 = 20 (ml); or 0,5 ml x 40 (receptions) = 20 (ml) So, prescription will be like this: Rp.: Platyphyllini hydrotartratis 0,08 Aquae destillatae ad 20 ml M.D.S. For internal use in 10 drops twice a day. For write out this prescription by the shorted method we must calculate solution concentration in percents 20 – 0,08 X = 0,08 : 20 x 100 % = 0,4 % 100 – X Solution concentration we can recalculate also like this: 0,5 ml solution (10 drops) contain 0,002 g Platyphyllin 100 ml solution contain X g Platyphyllin; X – 0,4 % Our prescription looks like: Rp.: Sol. Platyphyllini hydrotartratis 0,4% 20 ml D.S. For internal use in 10 drops twice a day. Solutions for external application are prescribed by the same way as solutions for internal use (large-scaled and reduced methods). So, in case of prescribing solutions by the reduced way concentration may be shown – a) in percent (%), b) in relative units (on correlation) and c) in mass-volume correlation. So, first of all after the word Rp.: we write down Sol., medicine name, concentration and solution quantity, and then D.S. and the way of usage. a) Rp.: Sol. Furacilini 0,02 % 500 ml D.S. For bathing of the wounds. Solution concentration we can express not only in percents but also in relative units (on correlation): b) Rp.: Sol. Furacilini 1: 5000 500 ml D.S. For bathing of the wounds. Proceeded from that 0,02 % solution furacin – this is the solution, 100 ml of what contain 0,02 g furacilin, and X ml – will contain 1,0 g of this medicine. 100 – 0,02 X – 1,0 X = 1,0 x 100 : 0,02 = 5 000 Mainly, it concerns to the great dilutions, we can indicate also medicine quantity what is necessary for preparing some solution quantity (mass-volume correlation) – (c). c) Rp.: Sol. Furacilini ex 0,1 500 ml D.S. For bathing of the wounds. 0,02 % furacin solution – that is solution which contained 0,02 g of the medical agent in the 100 ml. 500 ml of this solution contained X g of furacilin:
100 – 0,02 X = 0,02 x 500 : 100 = 0,1 500 – X This solution we can prescribe by developed way. Rp.: Furacilini 0,1 Aquae destillatae ad 500 ml M.D.S. For bathing of the wounds Solutions for internal and external use prescribed by reduced way are preparing on distilled water if the solvent is not noted. The name of prescription must include words “spirituosae”, “oleosae” if we use oil or alcohol as solvent. But it is necessary to remember, that drug-store will prepare spirituous solutions on 90% spirit and oil solutions on peach-kernel oil according to this prescription. Rp.: Sol. Camphorae spirituosae 5 % 50 ml D.S. For rubbing into the skin in the painful joint area.
Rp.: Sol. Mentholi deosae 1 % 20 ml D.S. Fall in each nostril 2-3 drops twice a day.
Solutions, prepared on the other solvents, are prescribed only by large-scale method. Officinal solutions for external and internal applications are written out only by reduced way like: after the word Rp. are indicated name, quantity and then D.S., the way of use. Rp.: Liquoris Kalii arsenitis 10 ml D.S. For 3 drops three times a day.
Rp.: Sol. Ammonii caustici 10,0 D.S. To moisten the cotton, let patient inhale it in the times of consciousless. We prescribe solutions for external use in quantity 5-100 and more milliliters; ear, eye and nose drops – 5-10 ml. Some complex solutions include 2, 3 and more medical agents (combine) and have commercial names. For example, essentiale, panangine and others. They are administered parenteral by various ways, are produced in ampoules (see Chapter 6). They are prescribing without indications of the medicinal form and concentration. Rp.: Asparcam 10 ml D.t.d. N 10 in ampullis S. For intravenous administration (dropply!) twice a day by 10 ml, preliminary it must be diluted in 100 ml of water for injections.
Infusions, broths Infusion (infusum – nominative singular, infusa – nominative plural, infusi – genitive singular). These are aqueous extracts from plant raw material; which are obtained by the way of drawing the grinded, dried leaves, flowers, herbs on the water bath or by the way of soling extracts. Infusions frequently are prescribed for internal use and rarely – for external use (for example, for throat gargling). Infusion for internal applications are dosed by table-spoons, dessert-spoons and tea-spoons. They are written out on such method: after the word Rp. it is necessary to write down infusi (inf.), then indicate what parts of the plants are used for preparing infusion (herbs, flowers, leaves), the name of medicinal herb (from capital letter), the raw material quantity and the infusion quantity. Then we must write down D.S. and the way of use. The common dose of medicinal raw material and quantity of infusion are calculated basing on the single dose, the commoumber of receptions and the volume for one reception. For example, it is necessary to prescribe infusion of Thermopsis herb, which has to be taken for one table-spoon three times a day during three days (the commoumber of receptions will be 9). We need to take 135 ml (1 table-spoon includes 15 ml, but 9 table-spoons include 135 ml). According to Pharmacopoeia infusion of Thermopsis herb is made using correlation that 1 part of raw material is for 400 parts of infusion. It means that 400 ml of infusion are prepared using 1 g of the herb. For manufacturing infusion in quantity 135 ml it is necessary to take 0,33 gr. of the herb: 1 – 400 X – 135; X = 0 33 Prescription looks like this: Rp.: Inf. herbae Thermopsidis ex 0,33 135 ml D.S. In 1 table-spoon three tines a day Sometimes, as above, it is noted in prescription the quantity of row material for preparing infusion. Rp.: Inf. foliorum Uvae ursi 200 ml D.S. In 1 table-spoon three times a day. In those cases drug-store is directed using such instructions of Pharmacopoeia: Infusions from medical plants with strong acting substances are prepared using correlation 1 : 400 (for example, folia Digitalis – Foxglove leaves, radix Ipecacuanhae – roots of Ipecacuanha, herba Thermopsidis – Thermopsis herb). Infusions from medical plants with less intensive action are prepared using correlation 1 : 30 (for example, Adonidis vernalis – Adonis herb, rhizoma Valerianae – rhizome Valerian, Secale cornutum), other infusions – with correlation 1 : 10. There are also officinal infusions like: Inf. Valerianae, Inf. Sennae compositum and others. Rp.: Inf. Valerianae 120 ml D.S. In 1 dessert-spoon four times a day. Infusions are the labile medical forms, that why they are prescribed only for 3-4 days.
Decoctions Decoctions – Decocta (decoctum – nominative singular, decocti – genetive singular) are the liquid medical forms which are also obtained by the way of water extracting acting substances from plant material on the water bath or by the way of solving the concentrates. For preparation decoctions we usually use roots, rhizome or cortex. Decoctions are easy broken that’s why they had to be prescribed only for 3-4 days and kept in the cold place. They are written out like this: Rp.: Dec. corticis Quercus ex 10,0-100 ml D.S. For rinsing out mouth. Chemist shop prepares decocts with correlation 1 : 10 when it is not noted in the prescription the quantity of plant raw material. Except of the decoction from Senega root (radix Senegae) what is made using correlation 1 : 30.
Emulsions Emulsions (emulsum – nominative singular, emulsi – genitive singular) are liquid pharmaceutical form, two-phase system with dispersion phase like unsolvable in water liquid, fat or ether oils, balsams. The disperse medium is offered by water. The emulsions are represented by the stable suspensions of the fat-drops in water. There is two kinds of emulsions such as: seminal (Emulsa seminalia) and oil (Emulsa oleosa). Seminal emulsions are preparing from the seeds of some medicinal plants: sweet almond (semen Amygdali dulcis), poppy (semen Papaveris), pumpkin (semen Cucurbitae), some nuts (semen Arachidis hypogaea) and others. For receiving seminal emulsions are taken 1 part of the pounded seeds on every 10 parts of emulsions. Composition of each seed kind includes not only fats but also specific substances – emulsifiers. That’s why there is no need to introduce the emulsifiers into the seminal emulsions. We can prescribe seminal emulsions by two ways: large-scaled and reduced. Rp.: Seminis Amygdali dulcis 18,0 Aquae destillatae ad 180 ml M.f. emulsum D.S. In 1 table spoon three times a day Or: Rp.: Emulsi seminum Amygdali dulcis 180,0 D.S. Take in 1 table spoon three times a day. (seminum – genitive case plural from semen, seminis – genitive case singular from semen). Preparing oil emulsions it is necessary to take not only the corresponding oil and distilled water, but some emulsifying agents, which provide the stable state of the fat drops in the water thickness for a long time. The wide using emulsifiers are Gelatosa, Arabian gum (Gummi Arabicum), apricot gum (Gummi Armeniacae), chicken egg yolk (Vitellum ovi) and others. Usually on every 2 parts of oil 1 part of the emulsifier and 17 parts of water are taken (correlation 2: 1: 17). The yolk of the one egg is used for preparing emulsion that includes oil 15 g (emulsion volume is 150 ml), but 3 g Apricot gum – for 10 g of the oil (for 100 ml emulsion). Oil emulsions are prescribed also by developed and reduced ways. Prescribing emulsion by large-scale method we recalculate all components (oil, water and emulsifier) with their quantity according to correlation after word Rp. Then write down M.F. emulsum. D.S. and the way of application. Rp.: Olei Amygdalarum 10 ml Gummi Arabici 5,0 Aquae destillatae 85 ml (or: ad 100 ml) M.f. emulsum D.S. Take inside in one dessert-spoon three times a day. Using reduced way of prescription it is necessary to indicate the oil name, its quantity and common emulsion quantity after medical form name (Emulsi) Rp.: Emulsi olei Lini ex 10ml -100ml D.S. In 1 tea-spoon three times a day. In cases when quantity of the oil is not noted in the prescription, from 10 oil parts must be prepared 100 parts of emulsion. For example, for preparing 200 ml of emulsion it is necessary to take oil 20 g, Gelatosae – 10 g and 170 ml of water.
Suspensions Suspensions (Suspensio – nominative case, singular, suspensionis – genitive case, singular) – are the liquid medical forms, two-phase system, which contains disperse phase formed by particles of unsoluble in the water medical agents (powders) and disperse medium represented by water, oils, glycerin or other fluids. This medicinal form is intended for external, internal and parenteral applications. insulin aspart protamine suspension 70% (recombinant), insulin aspart 30% (recombinant) 100 Units/mL; SC inj; contains zinc, m-cresol.
The prescriptions for magistral (main) suspensions are written out by developed or reduced ways, but for officinal suspensions – only by reduced way. Rp.: Oxytetracyclini 1,0 Olei Olivarum ad 100,0 M.f. suspensio D.S. In 1 tea-spoon three times a day.
Rp.: Suspensionis Hydrocortisoni 2,5 % 5 ml D.t.d. N.5 S. Inject into the muscle by 5 ml (before injecting shake the content).
Tinctures Tinctures – Tincturae (tinctura – nominative singular, tincturae – genitive singular) – are represented by (spirituous) alcoholic, hydroalcoholic, alcohol-ether liquid extracts from plant raw material. There are three methods of preparing tinctures, such as maceration (drawing), percolation (pressing) or dissolving of the dry extracts. All tinctures are officinal. It means that their concentration is detected by Pharmacopeia. And they are manufacturing on the pharmaceutical factiries. They are stable and can be keeping for a long time. Prescribing such forms it is not necessary to indicate number of the plant parts, tincture concentration in the prescription because they are officinal. Prescription has such form: medicinal form name – Tincturae, then the name of plant and tincture quantity are noted. Those forms are dosed by drops – from 5 to 30 drops for one reception depending on the action intensity. Accordingly we write out the common quantity in ml (5-30 ml). Rp.: T-rae Valerianae 20 ml D.S. In 20 drops three times a day. The equal parts of tinctures are taken (if they have equal therapeutic dosage) if we prescribed combination of them (complex tinctures). Rp.: T-rae Valerianae T-rae Convallariae ana 10 ml M.D.S. In 20 drops twice a day. In cases when the doses of the mixed tinctures are different, then one of them is taken in quantity that is less than quantity of the second in the number of times in which it’s one time dose is less then the second one’s. It is necessary to prescribe mixture of the strophanthus tincture (T-ra Strophanthi), single dose is 5 drops, and valerian tincture (T-ra Valerianae), single dose is 15 drops. Rp.: T-rae Strophanthi 5 ml T-rae Valerianae 15 ml M.D.S. In 20 drops three times a day. Tinctures may be included to the mixtures with other medicinal compounds.
Extracts Liquid extracts (Extracta fluida) are the concentrated drawing usually obtained from medicinal plant raw material. Extraction substances are water, ethyl alcohol, hydroalcoholic solutions. All liquid extracts are officinal forms. They are written out and prescribed the same way as the tinctures. Rp.: Extr. Viburni fluidi 30 ml D.S. In 30 drops twice a day. By definitions extracts besides liquid are dry (Extra sicca) and dense (thick) (Extracta spissa). Dry and dense extracts are prescribed and produced in powders, tablets, suppositories and in other medicinal forms.
New Galen medicines New Galen medicines, these are aqueous, hydro-alcoholic and chloroform-alcoholic and other extracts from plant raw material. They are distinguished from Galen medicines by maximal purity from ballast substances and by bigger pharmacologic activity. They are officinal forms and are prescribed like tinctures, by the same way: Rp.: Adonisidi 15 ml D.S. In 15 drops three times a day.
Mixtures Mixtures (Mixturae) – liquid medical form consisting of the solvent (water, aromatic distilled water, alcohol, infusions, decoction, emulsions, tinctures, glycerin, etc) and two or more solid medical agents dissolved in or received by the way of mixing some liquids. If mixture contains tincture, decoction, emulsion it is necessary to write down their name on the first place. Aqua Menthae piperitae, aqua Foeniculi, aqua Amygdalarum amararum, aqua Rosae and others are the basic aromatic waters, which are used for preparing mixtures. Aromatic waters, contained to the composition of the mixture, are not the solvents but also they improved medicine taste, smell and some times had additional qualities too. For example, aqua Menthae piperitae impairs fermentation process in the intestinal tract; aqua Amygdalarum amararum partially removes the gastric pain. For improving taste and smell of the mixtures we admix other substances with corrigent action (corrigens). Mainly these substances are represented by syrups (10-30% of the common mixture volume), for example: Sirupus simplex – sugar syrup, Sirupus Citri unshiu – peel mandarin syrup, Sirupus Rubi idaei – raspberries syrup, Sirupus Cerasi – cherry syrup, Sirupus Rhei, Sirupus Glycyrrhizae – lignorice root syrup. In case, when the mixture contains substances with expressed irritative action it is necessary to add to the mixture instead of the solvent part mucus (30-60 % of the common mixture volume): mucilago Salep – mucus Salep, muc. Gummi arabici – Arabian gum mucus, muc. Amyli (Solani, Majydis, Oryzae, Tritici) – Starch (potatoes, maize, rice, wheaten) mucuses. Mucus is included into the mixture also when unsolvable substances are precente there too. In fact, the role of mucuses is that they are promoted forming suspension from these unsolvable substances. These mixtures must be mixed before taking what is indicated in the signature. Mixture is dosed by spoons when its liquid phase was represented by water, aromatic water, decoction, infusion, emulsion. If tinctures or liquid extracts are the liquid mixture phase it must be dosed by drops. Mixtures are convenient for prescribing to the hard sick patients, children, old people for internal and external using. Solved in mixtures medicinal substances are better adsorbed and act more quickly in comparison to the powders and tablets. But mixtures have such defect qualities as: they are not accurate in dosage, not portative and not stable (written out only for 3-4 days). For prescribing mixture all calculation we must base on the single dose and commoumber of reception. For example, it is necessary to write out tincture for 4 days, dosed in 1 table-spoon 3 times a day. This mixture will contain sodium bromide (Natrii bromidi) single dose – 0,3 gr., codeine phosphate (Codeini phosphas) single dose 0,015 gr. Calculation: number of reception 3 x 4 = 12; Natrii bromidi 0,3 g x 12 = 3,6 g; Codeini phosphatis 0,015 g x 12 = 0,18 g; Water is used as solvent, if there was no other notes. solvent quantity: 15 ml x 12 = 180 ml; Prescription will look like this:
Rp.: Codeini phosphatus 0,18 Natrii bromidi 3,6 Aquae destillatae ad 180 ml M.D.S. In 1 table-spoon three times a day. Prescribe mixture, including chloral hydrate, single close – 1,0 g, and mucus Salep. Prescribe for 2 curative enemas. Rp.: Chlorali hydratis 2,0 Mucilaginis Salep 40,0 Aquae destillatae ad 100,0 M.D.S. For 2 curative enemas. Prescribe mixture (for 4 days) that contains infusion Thermopsis herb, sodium benzoate (pro dosi 0,05 g) and Lignorice root syrup. Use – 1 table-spoon three times a day.
Rp.: Infusi herbae Thermopsidis ex 0,45-180,0 Natrii benzoatis 0,6 Sirupi Glycyrrhizae 18,0 M.D.S. In 1 table-spoon three times a day. For this prescription we take 10 % syrup from mixture common quantity. That’s why we caot take it to account (because dosage by table-spoons isn’t so punctual) and take away 18 ml of the mixture contain. But if we take syrup in quantity 54 ml (30 %), it must be taken to calculation.
Chapter 6Medical forms for injections To the medical forms, which are intended for injections, belong: sterilized water and solutions, suspensions, emulsions and also powders, and tablets, which are dissolved in the appropriate dissolvent before injecting. They are mainly used for hypodermic (subcutaneous), intramuscular, intravenous and intraarterial injections. As against solutions for external use, the solutions for injections are prepared on water for injections (bidistilled, sterilized, apirogenic water – it does not cause the increase of body temperature at parenteral injection). The medical forms for injections demand: sterility, absence of mechanical impurity, stability, apirogenity and in some of cases – isotonicity. The medicines for injections, which are produced in ampoules and bottles by a pharmaceutical industry, are already sterilized, in a drugstore they are not sterilized, drugstore only sales them. The solutions for injections, which are prepared in a drugstore, are the subject to on obligatory sterilization. In the prescriptions it is noted by a word “Sterilisetur” (“Da sterilis”, “Pro injectionibus”). The solutions for injections in ampoules are prescribed out by the reduced way. After a word Rp.: the medical form Solutionis… is specified, name of a medicine, its concentration in percentage and its quantity. After that D.t.d.N… in ampullis, and signatura S. Rp.: Solutionis Glucosi 40 % 50 ml D.t.d.N. 10 in ampullis S. For intravenous injection 50 ml. Prescribing a dry substance in ampoules the name of the substance is specified and its quantity in one ampoule. Then D.t.d.N… in ampullis, and signatura S. The order of dissolution of substances, the way of introduction, periodicity of injections are specified in signatura. Rp.: Vincristini 0,005 D.t.d.N. 6 in ampullis S. To dissolve contents of ampoule in 5 ml of isotonic sterilized solution of Sodium chloride. To inject intravenously 1 time a week. Besides, in ampoules new Galen preparations, preparations of organs and tissues, officinal solutions are prescribed out. In these cases after a word Rp.: specify only the name of the preparation and its quantity D.t.d.N…. in ampullis and signatura. Rp.: Digalen – neo 1 ml D.t.d.N. 10 in ampullis S. Infuse hypodermic 1 ml 1 time a day.
Rp.: Pituitrini pro injectionibus 1 ml (5 U) D.t.d.N. 6 in ampullis S. Infuse hypodermic 1 ml 1 time a day. Some medicines for injections are prescribed in bottles. Prescribing medicines in bottles adhere to those rules, as those of prescribing in ampoules. The only difference is that after D.t.d.N… we don’t make any designations. If we prescribe a preparation in bottles of dark glass, we write D.t.d.N… in vitro nigro. Rp.: Ampicillini 0,5 D.t.d.N. 10 S. To dissolve the content of the bottle in 2 ml 0,5 % of a solution of Novocainum. Inject intramuscular 4 times a day.
Rp.: Suspensionis Hydrocortisoni acetatis 2,5 % 5 ml D.t.d.N. 6 S. Inject 5 ml intramuscular 1 time a day. In some cases the name of the ready medical forms for injections, according to Pharmacopoeia, includes the words “pro injectionibus”, for example, Corticotropium pro injectionibus, Parathyreoidinum pro injectionibus. It doesn’t mean, that these medicines are sterilized in a drugstore; they are already sterilized and are selling in a ready state. Rp.: Corticotropini pro injectionibus 30 U D.t.d.N. 5 S. To dilute the content of the bottle in 3 ml of the water for injections. Inject intramuscular 1 time a day. If we prescribe a preparation, activity of which is indicated in units, it is necessary to mark them in the prescription. For example, it is necessary to prescribe out 6 bottles of Insulin 5 ml each, with activity 40 U in 1 ml. Rp.: Insulini pro injectionibus 5 ml (40 U – 1 ml) D.t.d.N. 6 S. 0,5 ml under skin 2 times a day.
Rp.: Insulini pro injectionibus 5 ml (200 U) D.t.d.N. 6 S. 0,5 ml under skin 2 times a day. Discharging of the prescriptions on solutions for injections, which are prepared in a drugstore, their sterility is necessarily indicated. If medicines contain several components, after their recalculation write M. Sterilisetur. Then D.S. and Signatura. Rp.: Sol. Natrii nucleinatis 2 % 25 ml Sterilisetur! D.S. Inject intramuscular 5 ml 1 time a day.
Or: Rp.: Natrii nucleinatis pro injectionibus 2 % 25 ml D.S. Inject into muscle on 5 ml 1 time a day.
Or: Rp.: Sol. Natrii nucleinatis 2% 25 ml Da sterilis! S. Inject into muscle on 5 ml 1 time a day. Or: Rp.: Natrii nucleinatis 0,5 Aquae pro injectionibus ad 25 ml. Misce. Sterilisetur! D.S. Inject intramuscular 5 ml 1 time a day. If structure of the medicine form for parenteral introduction includes substances, which are easily destroyed at sterilization, for example solution of epinephrine (Adrenalinum), then they are added aseptically after sterilization of the basic solution. Thus we write Adde aseptice in the prescription: Rp.: Novocaini 1,25 Sol. Natrii chloridi isotonicae 0,9 % ad 500 ml M. Sterilisetur! Adde aseptice Sol. Adrenalini hydrochl. 0,1 % gtts. XXV D.S. For infiltrative anesthesia.
Over-the-counter (OTC) drugs Over-the-counter (OTC) drugs are medicines that may be sold directly to a consumer without a prescription from a healthcare professional, as compared to prescription drugs, which may be sold only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they are ingredients that are safe and effective when used without a physician‘s care. OTC drugs are usually regulated by active pharmaceutical ingredients (APIs), not final products. By regulating APIs instead of specific drug formulations, governments allow manufacturers freedom to formulate ingredients, or combinations of ingredients, into proprietary mixtures. The term over-the-counter may be somewhat counter-intuitive, since, in many countries, these drugs are often located on the shelves of stores like any other packaged product. In contrast, prescription drugs are almost always passed over a counter from the pharmacist to the customer. Some drugs may be legally classified as over-the-counter (i.e., no prescription is required), but may only be dispensed by a pharmacy employee after an assessment of the patient’s needs and/or the provision of patient education. In many countries, a number of OTC drugs are available in establishments without a pharmacy, such as general stores, supermarkets, gas stations, etc. Regulations detailing the establishments where drugs may be sold, who is authorized to dispense them, and whether a prescription is required vary considerably from country to country. As a general rule, over-the-counter drugs have to be used primarily to treat a condition that does not require the direct supervision of a doctor and must be proven to be reasonably safe and well-tolerated. OTC drugs are usually also required to have little or no abuse potential, although in some areas drugs such as codeine are available OTC (usually in strictly limited formulations or requiring paperwork or identification to be submitted during purchase). One of the oldest OTC drugs is aspirin. Over time, often 3–5 years, drugs that prove themselves safe and appropriate as prescription medicines may be switched from prescription to OTC. An example of this is diphenhydramine (Benadryl), which once required a prescription but now is available OTC nearly everywhere. Diphenhydramine is an anti-histamine. More recent examples are cimetidine and loratadine in the United States, and ibuprofen (Herron Blue/Nurofen) in Australia. It is somewhat unusual for an OTC drug to be withdrawn from the market as a result of safety concerns, rather than market forces, though it does happen occasionally, phenylpropanolamine is one such example, after it was removed from sale in the United States over concern regarding strokes in young women. In the United Kingdom, it was announced In February 2007, that Boots the Chemist would try over-the-counter sales of Viagra in stores in Manchester, England (previous available as prescription only). Men aged between 30 and 65 would be eligible to buy four tablets after a consultation with a pharmacist.
Addition Partial list of prescription abbreviations
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