I.Yu. Vysotsky, R.A. Chramova, A.A. Kachanova

Medical Prescription

(for foreign students being educated in English)

Sumy, 2008

МІНІСТЕРСТВО ОХОРОНИ ЗДОРОВ`Я УКРАЇНИМІНІСТЕРСТВО ОСВІТИ І НАУКИ УКРАЇНИ

СУМСЬКИЙ ДЕРЖАВНИЙ УНІВЕРСИТЕТ

I.Yu. Vysotsky,R.A. Chramova,A.A. Kachanova

Medical prescription(for foreign students being educated in English)

для студентів спеціальності 7.110101 денної форми навчання

Затверджено на засіданні кафедри

біохімії і фармакології. Протокол №8 від 29.01.2008 р.

Суми Вид-во СумДУ

2008

Introduction in Medical Prescription

The science about drugs consists of two branches of knowledge: pharmacology and pharmacy.

Pharmacology is the science about interaction between an organism and a drug.

Pharmacy is the science which studies questions of search, processing, preparation, and standardization of medicines. It includes pharmacognosy, pharmaceutical chemistry, technology of preparation of the medicinal forms, and prescription.

Prescription is a section of pharmacy, which consists of rules of prescribing and rules of preparation of drugs. Prescription is divided into pharmaceutical and medical one. Pharmaceutical prescription consists of rules of drugs preparation. Medical prescription includes the rules of drugs prescribing. Namely medical prescription has the important meaning in practical activity of the physician.

The most important terms of medical prescription are following. Medicinal substance (in Latin – “substantia pharmaceutica”) is one

chemical substance or chemical element which is used as medicinal remedy.

Medicinal remedy (in Latin – “medicamentum”) is natural or synthetic substance or mixture of substances which are permitted by the Ministry of Public Health Services for treatment and prophylactic of certain diseases.

Pharmaceutical remedy is substance or mixture of substances with determined activity and toxicity which is object for clinical test. After reception of the sanction for using in medical practice, the pharmaceutical remedy is registered in the state register of medicinal remedy.

Depending on a degree of expressiveness of their action upon an organism, all drugs are divided into three groups.

Poisonous substances (Venena, the list A). Drugs with very high toxicity are included into this group. In conditions of clinic, these drugs should be stored in a special safe constantly under the lock. After the ending of the working day this safe should be sealed up. The strict control should be carried out about an expenditure of these drugs.

3

Drastic substances (Heroica, the list B). Drugs, which at the use without the medical control can cause different complications, are included into this group. These drugs should be kept in a separate cupboard with an inscription "Heroica". After the ending of the working day, this cupboard should be closed.

A storage, account, and delivery of poisonous and drastic drugs should be carried out according to the rules which are approved by Ministry of Health.

Low-poisonous substances (Varia) are stored in usual cupboard according to the general rules of their storage.

The list of manufactured medicinal substances and drugs is located in the special book called Pharmacopoeia . Pharmacopoeia is the collection of State standards and the obligatory norms determining quality of medicines. In Pharmacopoeia following information is located: the description of properties, the physical and chemical qualities of medicinal remedies in alphabetic order, and the ways of definition of their suitability to the use. Also, the methods of quantitative definition of medicinal components are located in this book.

It allows on the basis of Pharmacopoeia’s specifications carry out the control over manufacture and application of drugs. In Pharmacopoeia we can find also such important information as the lists of poisonous and drastic drugs, the tables of the maximum single and daily doses for poisonous and drastic drugs (both for adults and children), conditions of storage and delivery of drugs, ways of manufacturing of medicinal forms, the methods of biological standardization and so on.

The drugs included in Pharmacopoeia are referred as officinal drugs (“officina” – “workshop”, “drugstore”).

Magistral drugs are medicines which prescribed by a physician for a particular case. They are made by the pharmacist in a drugstore (“magister” in Latin is “teacher”).

The routes of administration of drugs into organism are divided into two groups: enteral routes (through gastro-intestinal tract) and parenteral ones (passing a digestive tube). The enteral routes are peroral (by mouth), sublingual (under tongue), transbuccal (behind a cheek), into duodenum, and rectal (into rectum). The parenteral routes of drug administration are subcutaneous, intramuscular, intravenous, intra-arterial, inhalations, sub-arachnoidal, intraperitoneal, and so on.

4

The quantity of a drug, which is administered to the patient, is called a dose. A word “dose” is of the Greek origin and in translation to English means a “portion”. The following kinds of doses are distinguished:

- an amount of drug for one-time perception is called single dose;- an amount of drug for use within day is called daily dose;- an amount of drug which is designed for all course of treatment

is called course dose.

Elements of Latin Grammar

Almost all names of medicinal means are nouns of an average sort II declination (Barbamylum, Validolum). The names of acids are expressed by adjectives coordinated with a noun an acid: Acidum nicotinicum, Acidum boricum.

The Latin names of salts are constructed according to the following principle: the cation name (alkaloid or metal) is put on the first place and is expressed by a noun in Genitive case. The name of anion is expressed by a noun in Nominative case.

The names of drugs and other words in the prescription are given according to general rules of Latin grammar. The table with endings of words, which can meet at a spelling of the prescriptions, is given below.

Number Cases DeclinationsI II III IV V

Singular N. a um, us different endings

us es

G. ae i is us eiAcc. am usAbl. a o

Plural N. ae i, aG. arum orum

Acc. as os, aAbl. is is

5

In prescription from names of nouns of IV declinations are used only word “spiritus”, of V declinations – “species”.

It is necessary to remember, that the pretexts “in” and “cum” require Instrumental case for a noun which is written after them, and expression “ut fiat” requires Nominative case for a noun which is written after them.

The doctors are forbidden to prescribe the prescriptions of drugs, which are not solved to application in the country, and at the request of the patients and their relatives without examination of the patient and establishment of the diagnosis.

Prescription: Structure and Rules of Registration A prescription is written direction of the physician to the pharmacy

about preparing and handing over medicinal forms to the patient with the indication of its use. The prescription is important medical and juridical document. For correctness of drugs’ prescriptions the doctor carries the juridical responsibility. When the medication is handing over free, the prescription is also a financial document.

The prescriptions should be written by the pen (not by pencil). The doctor should fill the all stipulated columns of the prescription blank. The doctor should put the signature and personal seal after the last prescription. Corrections in the prescriptions are not permitted.

The prescribed treatment should be entered in an out-patient card of the patient.

Rules of Dosage. Measure of Weight and VolumeIn modern medical practice the doses of drugs are specified in

decimal system of measurement. A unit of weight is the gramme, that is mass of 1 ml of distilled water at temperature 40 С. In the prescription it is designated as 1.0. At dosage of medicines following sizes (which are less than 1 gramme) are used: 0.1 - one decigramme; 0.01 - one centigramme; 0.001 - one milligramme; 0.0001 - one decimilligramme; 0.00001 - one centimilligramme; 0.000001 - one microgram. You should remember that the quantity of dry substances should be given in grammes.

At a spelling of the prescription the quantity of liquid substances may be indicated in milliliters, grammes or drops. Most commonly, the quantity

6

of liquid substances is underlined in milliliters (ml). If the substance is included in structure of the medicinal form in drops, the quantity of drops is designated by the Roman digits before which «gt.» written (the reduced designation of a word “guttas” - "drops" in Instrumental case of plural), for example: “gt. V” (drops 5).

Rules of Registration of Prescriptions in Foreign Countries

In English countries and also in the countries where the training is carried out by English (India, Pakistan and others) the prescription is prescribed by English language on the special form or on a sheet of paper. All structural elements are indicated in the prescription, namely:

1 – Surname and name of the doctor;2 – License qualification of doctor or him professional degree;3 – Address of the doctor;4 – Number of doctor office telephone;5 – Date of registration of the prescription;6 – Surname and name of the patient;7 – Address of patient. The scheme of the special form of the prescription in English

countries is given at the page 8. The order of prescription registration in English countries is following.

Doctor writes the mark “R” in the right top corner, which means “to take” and below in the middle writes the name of the drug from the large letter in the Nominative case (8). In same line a doctor indicates also the dose of the drug (9) and its general amount (10) for course of treatment.

Below, in the right corner after “Stg.” (11) physician writes the detailed instruction for the patient about the use of this drug and makes the mark about the necessity of repeated assignment of the drug (12), and also about the need of its storage in the place, inaccessible for children (13).

The physician gives (14) the information about necessity of observance of the certain rules of safety in drug’s reception (for example “It is impossible to use alcohol”, “Causes drowsiness” and others). In the left corner below doctor puts the signature (15), indicates the identification data (16), and number of state registration of the license (17).

7

1 2JOHN B. DOE, M.D.

1234 SOUTH NORTHEAST DR. 3 WEST CITY, CA 94999 (234)555-6789 4

FOR: 6 DATE: 5ADDRESS: 7R 8 9

(DRUG NAME AND STRENGTH)(QUANTITY)

10

Sig: 11REFILL TIMESORUNTIL 12NOCHILDPROOFCONTAINER

13

WARNING:

14

15

M.D. AD 1234567 16STATE LICENSE NO. 17

8

In Ukraine the structure of the prescription contains the same important information.

The following structure of the prescription is standard.

1 Inscriptio I Medical institution stamp (its name, the address, a number of phone, and a code) is located in this inscription

2 Inscriptio II This inscription includes the age category of patient (children or adult) and date of registration of prescription

3 Nomen aegroti Name and surname of patient and him (or her) age4 Nomen medici Name and surname of doctor who writes out this

prescription5 Invocatio s.

praepositioThe reference of the doctor to the pharmacist with the request to manufacture and give out (or only to give out) a medicine to the patient: the word “take” written in Latin: “Recipe” (commonly it is written in abbreviated form “Rp.:”)

6 Designatio materialum s. ordinatio

Name of medicinal remedy or the list of medicinal remedies included into complex drug which will be manufactured in drugstore

7 Subscriptio s. praescriptio

The instructions of doctor for pharmacist about preparation of certain medicinal form and its distribution in necessary quantities

8 Signatura It is the recommendation of the doctor for the patient about the manner of drug’s use. In this part necessarily indicate the following:- the manner of dosed: to accept 1 teaspoon; 1 ml; 2 tablets and so on;- the route of drug’s administration: subcutaneously, intramuscularly, intravenously, perorally and so on; - frequency or time of the drug’s reception (3 times per day, before meal, at headache, before dream)

The prescription is separated from next prescription by short line. The new prescription begins with a abbreviation “Rp.:”. After last prescription doctor puts the signature.

9

The prescriptions of the medicinal forms can be short or full (unwrapped). The short variant is used basically for prescription of the officinal (ready-made) medicinal forms, and full - for the forms which make in a drugstore. Now the majority of drugs are manufactured by pharmaceutical industry. Therefore, they are prescribed only with short form. The examples of short and full forms of prescriptions are given in material about certain medicinal forms.

The list of abbreviations most commonly used in prescriptions is given below.

āā – ana fifty-fiftyAc. – Acidum acidamp. – ampulla ampouleAq. – Aqua waterBut. – Butyrum oil (solid)D. – Da give outD. t. d. – Da tales doses give out such doses S. – Signa designatedil. – dilutus the dissolvedEmuls. – Emulsum emulsionEmpl. – Emplastrum plasterExtr. – Extractum extractf. – fiat it is formedfol. – folium leafin amp. – in ampoules in ampoulesin caps. – in capsulis in capsulesin tab. – in tabulettis in tabletsInf. - Infusum infusionLin. – Linimentum linimentM. – Misce admixN. – numero quantityPulv. – Pulvis powderq. s. – quantum satis how many it is requiredrad. – radix rootRp. – Recipe takerhiz. - rhizoma rootstockS. – Signa designatesicc. – siccus (a, um) dry

10

simpl. – simplex simpleSol. – Solutio solutionSteril.! – Sterilisetur! sterilizesupp. rect. (vag.)– suppositorium rectale (vaginale)

suppository rectal (vaginal)

Tinct., T-ra – tinctura tinctureung. – unguentum ointment

Rules of Prescribing of Medicinal FormsSolid Medicinal Forms

The solid medicinal forms are powders, tablets, dragee, granules and some others.

Powders – Pulveres (Pulv.)(Nominative case, singular – Pulvis, Genitive case, singular – Pulveris)

Powders are solid medicinal form for external or internal using. Powders are divided into dosed (commonly used for peroral administration) and non-dosed (commonly used for external application) ones.

Powders for External Use

The powders for external use (smallest powder – on Latin “pulvis subtilissimus”) are called on Latin “Aspersio”. This form is most commonly used for processing of injured part of skin. The weight of powder for external use may be from 5 g to 100 g or more. Powders for external use are prescribed both in full form and in short form. The powders for external use containing two or more medicinal substances are prescribed only in full form. In powders for external use, the medicinal substances can be used in pure state or in combination with indifferent (so-called form-building) substances. As form-building substances are used such substances as talc (Talcum), starch (Amylum) or zinc oxide (Zinci oxydum).

The example of prescription of powder for external use in full and in short forms is given below.

For example. Prescribe in full and in short forms of prescription 50 g of powder for external use, which contains 5% of Anaesthesinum. Use for processing of injured part of skin.

11

Full form of prescription. In full form a doctor should list the name of all ingredients of this medicinal form and indicate the quantity of all ingredients in grams.

Quantity of Anaesthesinum we calculate with following way. The general quantity of powder is 50 g. It is 100%. The quantity of Anaesthesinum we designate as x g, but we know that is 5%. On the base of these data we make following proportion:

50 g - 100%x g - 5%And as a result the decision of this proportion we find the necessary

quantity of Anaesthesinum:x = 50 z 5 /100 = 2.5 gAnd so, we should take 2.5 g of Anaesthesinum. As form-building

substance we can use any of possible substances. Let’s take starch for this purpose. We calculate the quantity of starch: 50 g – 2.5 g = 47.5 g.

Now we can prescribe this drug in full form:

Rp.: Anaesthesini 2.5 Amyli 47.5 M. f. pulv. subtilissimus D.S. Use for processing of injured part of skin.

The order of short form of prescription for this drug is following:

Rp.: Aspersionis Anaesthesini 5% - 50.0 D.S. Use for processing of injured part of skin.

In short form of prescription first of all we write the name of medicinal form, after that – the name of medicinal substance and its percentage, after that – general quantity of powder.

Powders for Internal Use

These powders are prescribed with indication of exact single dose of medicinal substance and of general amount of powders. The weight of a powder should be not less than 0.1 g and not more than 1.0 g. If dose of medicinal substance less than 0.1 g, the indifferent substance should be added to this powder (sugar (Saccharum) or glucose (Glucosum)). The optimal weight of dosed powder is 0.3-0.5 g.

The example of dosed powders for internal use is given below.

12

"Misce ut fiat pulvis subtilissimus" – "Mix, that the smallest powder was formed"

For example. Prescribe 20 powders of Calcium gluconate (Calcii gluconas, the single dose is 0.5 g) for peroral administration 3 times per day.

Rp.: Calcii gluconatis 0.5 D. t. d. N. 20 S. Perorally 1 powder 3 times per day.

For example. Prescribe 10 powders of Papaverine hydrochloride (Papaverini hydrochloridum, the single dose is 0.02 g) for internal use 2 times daily.

Rp.: Papaverini hydrochloridi 0.02 Sacchari 0.3 M. f. pulv.

D. t. d. N. 10S. Perorally 1 powder 2 times per day.

Tablets - Tabulettae (Tab.)(Nominative case, singular – Tabuletta; Genetive case, singular –

Tabulettae; Genetive case, plural – Tabulettarum; Instrumental case, plural – in tabulettis)

The tablets are dosed solid medicinal form which is produced by pharmaceutical plants by means of pressing of components. As a rule, tablets are used for peroral administration, but some tablets are used sublingually, or for implantation. Also, some tablets are used for preparation of solutions.

For prescribing of tablets you should know the single dose, the manufactured form (form, in which tablets are produced on the plant), and general amount of tablets which should be prescribed to patient.

If single dose of drug is more than contained in one tablet, we should prescribe for one reception necessary amount of tablets. If single dose of drug is less, than contained in one tablet, we should prescribe for one reception the necessary part of one tablet.

The tablets are prescribed only with short form of prescription. For example. Prescribe 100 tablets which contain 0.3 g of Isoniazid

(Isoniazidum, the single dose is 0.3 g) for peroral administration 3 times per day.

Rp.: Tab. Isoniazidi 0.3 N. 10013

D. S. Take 1 tablet perorally 3 times per day.Also, other variants of prescription are possible:

Rp.: Isoniazidi 0.3 D. t. d. N. 100 in tab. S. Perorally 1 tablet 3 times per day.

Or: Rp.: Tab. Isoniazidi 0.3 D. t. d. N. 100 S. Perorally 1 tablet 3 times per day.

A doctor can use any of these forms in prescriptions.

For tablets which contain several medicinal substances and have special name (for example, “Aeron”, “Allocholum” and so on), the following structure of prescription is used.

For example. Prescribe 30 tablets of “Allocholum” (the single dose is one tablet) for peroral administration 3 times per day before meal.

Rp.: Tab. “Allocholum” N. 30 D. S. Use 1 tablet perorally 3 times daily before meal.

Dragee (Dragee)(Genetive case, singular – Dragee; Instrumental case, singular –

Dragee)

The dragee are solid dosed medicinal form for internal use, which is produced by pharmaceutical plants by reusable stratification of medicinal and auxiliary substances on the sugar granules. The form of prescription for dragee is similar to form of prescription for tablets.

For example. Prescribe 30 dragee containing 0.025 g of Propazine (Propazinum, the single dose is 0.05 g). Take perorally 2 times per day.

Rp.: Dragee Propazini 0.025 N. 30 D. S. Take perorally 2 times per day.

____

Rp.: Propazini 0.025

14

D. t. d. N. 30 in dragee S. Take perorally 1 dragee 2 times per day.

____

Rp.: Dragee Propazini 0.025 D. t. d. N. 30 S. Take perorally 1 dragee 2 times daily.

Capsules - Capsulae (Caps.)(Nominative case, singular – Capsula; Instrumental case, plural –

Capsulis)

The remedies which have unpleasant smell or taste, and irritate the mucosa, should be included into capsules. Capsule is environment for dosed powders, for granulose, pasty or liquid medicinal substances for peroral administration.

The order of prescribing of capsules is following:For example. Prescribe 12 capsules each of which contains 0.05 g of

Doxycycline hydrochloride (Doxycyclini hydrochloridum, the single dose is 0.1 g). Take perorally 1 time daily.Rp.: Doxycyclini hydrochloridi 0.05 D. t. d. N. 12 in caps. S. Take perorally 2 capsules 1 time daily.

Eye Membranulas - Membranulae ophthalmicae(Nominative case, singular - Membranulae ophthalmicae, s. Lamellae, Instrumental case, singular - Membranulas ophthalmicas, s. Lamellas)

The eye membranulas are sterile polymeric plates with size of 9*4.5*0.35 mm, which contain medicinal remedies in definite doses and dissolved in tears liquid. The eye membranes can be stored in hermetically closed containers nearly 1 year.

After applying on the eye conjunctive, the dissolution of polymer is beginning.

In case of the using of eye membrane, the therapeutic concentration of medicinal remedy can be maintained during 24 hours.

In comparison with eye drops, the eye membranulas have the following advantages:

15

- the support of stable therapeutic concentration of medicinal remedy during long period of time;

- the high stability of medicinal form;- the maintenance of sterility during significant period of time;- more exact dosage of a drug.

Nowadays in medical practice the eye membranules (Membranulae ophthalmicae) with pilocarpine hydrochloride, atropine sulphate, neomycine sulphate, and other medicines are used.

The eye membranules are prescribed with short form.

For example. Prescribe 30 eye membranules, which contain Pilocarpine hydrochloride (Membranulae ophthalmicae cum Pilocarpini hydrochlorido). Use one membranula for side of a lower eyelid 1 times daily.

Rp.: Membranulas ophthalmicas cum Pilocarpini hydrochlorido N. 30D.S. Use one membranula for side of a lower eyelid 1 times daily.

The home-tasks for prescription1. Prescribe (in short and full form) 40 g of powder for external use,

which contains 2% of salicylic acid (Acidum salicylicum). Use of processing of injured part of skin.

2. Prescribe 20 powders of nicotinic acid (Acidum nicotinicum, single dose is 0.03 g) for internal use 3 times per day.

3. Prescribe 30 powders of platyphyllin (Platyphyllini hydrotartras, single dose is 0.003 g). Take orally 2 times daily.

4. Prescribe 10 powders of Aspirin (Aspirinum, single dose is 0.25 g). Take perorally in headache.

5. Prescribe 30 capsules each of which contains 0.15 g of Rifampicine (Rifampicinum, single dose is 0.3 g) for peroral administration 2 times daily.

6. Prescribe 50 tablets of Dexamethasone (Dexamethasonum, single dose is 0.0005 g ). The manufactured form: tablets, each of which contains 0.0005 g of medicinal remedy. Take perorally 3 times daily.

7. Prescribe 20 tablets, each of which contains 0.0001 g of Digitoxine (Digitoxinum, single dose 0.00005 g). Use for peroral administration 1 time daily.

16

8. Prescribe 20 tablets “Bellataminalum” (single dose is one tablet). Take perorally 3 times daily.

9. Prescribe Diazoline (Diazolinum, the single dose is 0.05 g). The manufactured form: dragee, each of which contains 0.05 g of medicinal remedy. Take perorally 3 times daily.

10. Prescribe Nimodipinum for internal use 2 times per day (Nimodipinum, the single dose is 0.06 g). The manufactured form: tablets which contain 0.03 g of Nimodipinum.

11. Prescribe Picamilonum for internal use 3 times per day (Picamilonum, the single dose is 0.02 g). The manufactured form: tablets containing 0.02 g of Picamilonum.

12. Prescribe 20 commercial tablets “Nacom” for internal use 2 times per day (the single dose is ½ tablet).

Soft Medicinal FormsThe soft medicinal forms are ointments, pastes, liniments (or liquid

ointments), suppositories, plasters, and creams.

Ointments – Unguenta (Ung.)(Nominative case, singular – Unguentum; Genitive case, singular –

Unguenti)

An ointment is soft non-dosage complex medicinal form, which has viscous homogeneous consistence and is intended for external use.

The ointments are prepared by mixing of various medicinal substances with the form-building substances, which is called as ointment bases. The ointments form an equal film (which does not slip) on a surface of a skin or mucous. As remedies in ointments are used antibiotics, hormones, salts of heavy metals, astringing, irritating, and other substances.

Animal or vegetative fats and their derivative, fat-like substances, carbohydrates, and other substances can be used as the ointments bases. Lanolin and vaseline are most frequently used among them. The bases for ointments should be indifferent, well are mixed with remedy and easily will give back them, not are changed under influence of light and heat, to not react with medicinal substances, and thaw at temperature of a body. The bases for eye ointments should be also sterile and neutral.

The amount of prescribed ointment depends on a way of its use. The eye ointments are prescribed in amount of 5-10 grammes, ointments for lips

17

and nose - in amount of 10-20 grammes, for application on injured parts of the skin - from 15 grammes to 100 grammes and more.

Ointments are non-dosed medicinal forms. Therefore, amount of ointment in prescription is prescribed as a total unit. Simple ointments consist of two ingredients: one active and one inert substance. Complex ointments consist of more than two ingredients.

The percentage of powder-like substances in ointment should not be more then 25%. Differently, ointment turns to paste. Ointments can be prescribed in short and in full forms. Most ointments are prescribed in short form.

In short form of prescription the percentage of active substances are prescribed in percent or in mass units. The short form of prescription is begins with the word “Unguenti” (“Ung.”). After that the name of medicinal remedy is written, its concentration in percents, and general amount of ointment.

In the full form of the prescription, the names of all ingredients of this ointment are listed. The weight of substance should be indicated after the substance’s name. Also, the indication about preparation of ointment from these components (“M. f. ung.”), should be given.

For example. Prescribe 50,0 grammes of ointment which is based on vaseline (Vaselinum) and contains 1% of Tetracycline hydrochloride (Tetracyclinum hydrochloridum). Use for application on injured parts of the skin.

Rp.: Ung. Tetracyclini hydrochloridi 1% - 50.0 D.S. Use for application on injured parts of the skin. This prescription may be written in full form:Rp.: Tetracyclini hydrochloridi 0.5 Vaselini 49.5 M. f. ung. D. S. Use for application on injured parts of the skin.

The ointments are widely used in ophthalmology. Slowly developing effect is the feature of eye ointments. In comparison with eye drops, the duration of eye ointments action is more. The indication “Eye ointment” should be written in signature before the indication about using.

18

For example. Prescribe 10.0 grammes of eye ointment with 2% of Polymyxine M sulfate (Polymyxinum M sulfas). To pawn behind lower eyelid 4 times daily.

Rp.: Ung. Polymyxini M sulfatis 2% - 10.0 D.S. Eye ointment. To pawn behind lower eyelid 4 times daily.

For example. Prescribe with short and full forms 50.0 grammes of ointment, each gram of which contains 10,000 of international units (in Latin – IU) of Erythromycine (Erythromycinum). Use for application on injured parts of the skin.

The full form:

Rp.: Erythromycini 500,000 IU Vaselini 50.0 M.f.ung. D.S. Use for application on injured parts of the skin.

The short form:

Rp.: Ung Erythromycini 50.0 (1,0 – 10,000 IU) D.S. Use for application on injured parts of the skin.

Pastes - Pastae(Nominative case, singular – Pasta; Genitive case, singular – Pastae)

The pastes are non-dosed medicinal form. Pastes are rich ointments, which contain not less than 25% and not more than 65% of dry substances. In comparison with ointments, the pastes have richer consistence and can longer time remain on the body surface. The pastes have adsorbing, drying and anti-inflammatory properties. As a rule, the pastes are used for applying on purulent and wet surfaces.

The structure of pastes includes medicinal remedies and basis. As basis for pastes, the identical substances are used as in ointments. If the amount of dry substance in paste is less than 25%, one or more inert powders (starch (Amylum), talc (Talcum), zinc oxide (Zinci oxidum), white clay (Bolus alba)) should be added. In the prescription inert powders are indicated before bases.

19

Pastes are divided into officinal and magistral ones. The magistral pastes are prescribed only in full forms. The paste prescription is similar to the ointment, only word "Unguenti" is replaced with a word "Pastae".

For example. Prescribe 50,0 g of pasta based on Vaselinum, which contains 5 % of Anaesthesine (Anaesthesinum). Use for application on injured parts of the skin.

Rp.: Anaesthesini 2.5 Talci 10.0 Vaselini ad 50.0 M. f. pasta D. S. Apply on injured parts of the skin.

Because quantity of Anaesthesine is 5%, we should add talc, that the paste be formed. We have added minimum 20% of talc that is equal in this case to 10 grammes.

For example. Prescribe 40.0 g of pasta, which contains 3% of salicylic acid (Acidum salicylicum), 2% of boric acid (Acidum Boricum), and 10% of zinc oxide (Zincum oxydum). Apply on injured parts of the skin in the morning and in the evening.

Rp.: Acidi salicylici 1.2 Acidi borici 0.8 Zinci oxydi 4.0 Talci 12.0 Vaselini ad 40.0 M. f. pasta D. S. Apply on injured parts of the skin in the morning and

evening.

In this case the quantity of powders equals 15 %. Therefore it is necessary to add talc, that the paste be formed. At own discretion we added 12 grammes of talc, or 30% from total quantity of paste.

Thus our paste contains 45 % of powders.The officinal pastes are prescribed in short form. For example. Prescribe 100.0 g of Pasta Zinci-salicylata. Use for

applying on injured parts of the skin.

20

“ad” means “up to”. This word is used when the percentage of dry substances is more than 5%.

Rp.: Pastae Zinci-salicylatae 100.0 D. S. For applying on injured parts of the skin.

This pasta we can prescribe as Pasta Lassari:Rp.: Pastae Lassari 100.0 D. S. For applying on injured parts of the skin.

[For information: This paste contains the following substances:Acidum salicylicum – 2.0Zinci oxidum – 25.0Amylum – 25.0Vaselinum – 48.0]

Suppositories – Suppositoria (Supp.)(Nominative case of singular – Suppositorium; Genitive case of singular – Suppositorii; Dative case of singular – Suppositorium; Dative case of

plural -Suppositoria)

Suppositories are the soft dosed medicinal form, which at room temperature stays in a firm condition and thaws at temperature of a body. The suppositories divide into rectal (are intended for administration into the rectum) and vaginal (for administration into the vagina) ones.

In comparison with peroral ways, medicinal substances from the rectum are soaked up faster, and are not destroyed with enzymes of gastrointestinal tract. Also the drugs are not exposed to primary passage through a liver and do not show unpleasant taste and smell. In some cases the rectal form can replace the form for injection.

Suppositories consist of medicinal substances and basis. The basis should be indifferent, not irritate mucous, poorly soaked up through mucous, and to be steady at a storage. The cocoa oil is more often used basis in suppositories. Rectal suppositories are used both for local and for systemic action. Vaginal suppositories are used basically for local action.

Rectal suppositories have weight from 1.1 grammes to 4.0 grammes, and vaginal ones have weigh from 1.5 grammes to 6.0. If weight is not specified in the prescription, rectal suppositories will be made in weight 3.0 grammes, and vaginal – 4.0 grammes.

The suppositories are prescribed in both short and in full forms. In the full form of prescription a quantity of the basis can be not specified. We can indicate instead of it "quantum satis" – “how many it is necessary”.

21

For example. Prescribe 6 rectal suppositories, each of which contains 0.2 g of Euphylline (Euphyllinum). Use 1 suppository in the rectum 2 times daily.

Rp.: Euphyllini 0.2 Butyri Cacao 2.8 M. f. supp. rect. D. t. d. N. 6

S. Use 1 suppository rectally 2 times daily. Or:

Rp.: Euphyllini 0.2 Butyri Cacao q.s. ut f. supp. rect. D. t. d. N. 6 S. One suppository rectally 2 times daily.

The prescriptions of vaginal suppositories are similar to the rectal ones. Only instead of words “supp. rect.” the words “supp. vag.” should be indicated.

For example. Prescribe 12 vaginal suppositories, each of which contains 0.2 g of Ichthyol ( Ichthyolum). Use 1 suppository in the vagina 2 times daily.

Rp.: Ichthyoli 0.2 Butyri Cacao 4.0 M. f. supp. vag. D. t. d. N. 12 S. Use 1 suppository in vagina 2 times daily.

Or:Rp.: Ichthyoli 0.2

Butyri Cacao q.s. ut. f. supp. vag. D. t. d. N. 12 S. Use 1 suppository in vagina 2 times daily.

Presently, majority of suppositories are made by pharmaceutical industry. Such suppositories are prescribed in short form. The prescriptions are begun from the indication of the medicinal form (Supp.). After that the union “cum” (“with”) is written, and the name of medicinal substance in an

22

instrumental case, and its dose. In next line we indicate “D. t. d. N.” and then make out the signature.

For example. Prescribe 10 officinal rectal suppositories, each of which contains 0.1g of Anaesthesinum. Use 1 suppository rectally when pain appears.

Rp.: Supp. cum Anaesthesino 0.1 D. t. d. N. 10 S. Use 1 suppository rectally when pain appears.

There are also suppositories, which have the commercial names. For example: “Bethiolum”, “Anusol” and so on. They are prescribed in short form.

For example. Prescribe 10 vaginal suppositories “Osarbonum”. Use one suppository in vagina in evening.

Rp.: Supp. “Osarbonum” N. 10 D. S. Use 1 suppository in vagina in evening.

The home-tasks for prescription

1. Prescribe in short and in full forms 50.0 grammes of ointment containing 0.5 % of Neomycine sulfate (Neomycinum sulfas). Use for application on injured parts of the skin.

2. Prescribe 2.5 grammes of eye ointment with 0.5% of Hydrocortisone (Hydrocortisonum). To pawn behind lower eyelid in the morning and evening.

3. Prescribe 10.0 g of sulfuric ointment (Unguventum sulfuratum). Use for application on injured parts of the skin 3 times daily.

4. Prescribe in short and in full forms 50.0 g of ointment which contains in each gramme 15,000 international units (IU) of Mycoheptin (Mycoheptinum). Use for application on injured parts of the skin.

5. Prescribe 10.0 g of ointment which contains 0.3 g of salicylic acid (Acidum salicylicum) and 0.6 g of benzoic acid (Acidum benzoicum). Use for application on injured parts of the skin.

6. Prescribe 10.0 g of officinal eye ointment with Erytromycin (Erytromycinum). To pawn behind lower eyelid 4 times daily.

7. Prescribe 10.0 g of paste which contains 5% of resorcine (Resorcinum). Use for application on injured parts of the skin.

23

8. Prescribe 40.0 g of paste which contains 3% of salicylic acid (Acidum salicylicum), 2% of boric acid (Acidum boricum), and 10% of zinc oxide (Zincum oxidum). Use for application on injured parts of the skin in morning and in evening.

9. Prescribe 30.0 g of paste which contains 10% of Anaesthesine (Anaesthesinum) and 4% of Iodoform (Iodoformium). Use for application on injured parts of the skin 1 time daily.

10. Prescribe 30.0 g of officinal paste with Gramicidine (Pasta Gramicidini). Put bandage with paste on the wound 1 time for two days.

11. Prescribe in short and in full forms 10 vaginal suppositories, each of which contains 0.5 g of Trichomonacide (Trichomonacidum). Use 1 suppository in vagina in evening.

12. Prescribe 20 vaginal suppositories, each of which contains 0.5 g of Metronidasole (Metronidasolum). Use 1 suppository in vagina in evening.

13. Prescribe 10 officinal rectal suppositories, each of which contains 0.5 g of Laevomycetine (Laevomycetinum). Use 1 suppository rectally 3 times daily.

14. Prescribe 20 officinal rectal suppositories “Bethiolum”. Use 1 suppository rectally 2 times daily.

Liquid Medicinal FormsThe liquid medicinal forms include such forms as solutions,

suspensions, emulsions, infusions, broths, liquid extracts, mixtures, tinctures, and some others.

Solutions – Solutiones (Sol.)(Nominative case, singular – Solutio; Genetive case, singular –

Solutionis)

The solutions are divided for external use, for internal use, and for parenteral (intravenous, intramuscular, and so on) administration.

Solutions for External Use

These solutions are non-dosed medicinal forms. For prescribing of these forms it is necessary to know the concentration and general amount of

24

solution (volume). As solvent may be used distilled water (Aqua destillata), ethyl alcohol (Spiritus aethylicus), Glycerin (Glycerinum), or different liquid oils. According to this, solutions are divided to water, alcoholic (in Latin - spirituosae), and oil (in Latin - oleosae) ones.

The volume of solution depends from way of drug using. The solutions for external use (such as drops for eye, ear, and drop

for a nose) are prescribed from 5 to 10 ml. The solutions for washing of wounds, skin or for rinsing are

prescribed from 50 to 500 ml. The solutions for gastric lavage and disinfection are prescribed in amount 1-2 liters.

Let’s prescribe several drugs for external use.

For example. Prescribe 200 ml of 0.02% solution of Furaciline (Furacilinum) for washing of wounds.

The general scheme of short form of prescriptions for external use is following: you indicate the name of medicinal form, next – name of medicinal remedy, the percentage of medicinal remedy, and (after dash) volume of solution.

Rp.: Sol. Furacilini 0.02% - 200 ml D. S. Use for washing of wounds.

Eye drops are water or oil solutions of medicinal remedy (or several remedies) which used for applying in conjunctiva of eye. The eye drops should be sterile. As dissolvent in eye drops are used water for injections or peach-kernel and sweet-almond oils. The eye drops are prescribed both in full and in short forms of prescription. First of all, doctor should indicate in Signature “Eye drops” that testifies to sterility of the solution.

For example. Prescribe eye drops containing 0.3% of zinc sulfate (Zinci sulfas) and 2% of boric acid (Acidum boricum). Drip 1-2 drops in each eye 3 times daily.

Rp.: Zinci sulfatis 0.03 Acidi borici 0.2 Aquae pro injectionibus 10 ml M. D. S. Eye drops. Drip 1-2 drops in each eye 3 times daily.

The volume of medicine is given according to the above-stated rule (10ml). Because the percentage of zinc sulfate is 0.3% (that is 0.3 g of

25

substance is contained in 100 ml of solution), 0.03 g of zinc sulfate should be taken:

0.3 g – in 100 ml;х – in 10 ml;х = 0.3 10/100 = 0.03 (g).

The calculation for boric acid:

2.0 g – in 100 ml;х – in 10 ml;х = 2.0 10/100 = 0.2 (g).

For example. Prescribe eyes drops, which contain 1% of Pilicarpine hydrochloride (Pilicarpinum hydrochloridum). Drip 2 drops in each eye 3 times daily.

Rp.: Sol. Pilocarpini hydrochloridi 2% - 5 ml D. S. Eye drops. Drip in each eye 2 drops 3 times daily.

For example. Prescribe 1% solution of Ephedrine hydrochloride (Ephedrini hydrochloridum). Drip into the nose 3 times daily.

Rp.: Sol. Ephedrini hydrochloridi 1% - 10 ml D. S. Drip into nose 3 times daily.

Solutions for Internal Use

The solutions for internal use are dosed with medicine glass, spoons (tablespoon, teaspoons), or drops.

It is necessary remember that 1 tablespoon contains 15 ml, 1 tea-spoon – 5 ml. 1 ml of water solution contains 20 drops, 1 ml of alcoholic solution contains 50 drops, and 1 ml of oil solution contains 40 drops. Most rationally prescribe the solutions, which are dosed with drops, in amount 10-20 drops for 1 reception.

Traditionally, the solution is dosed with drops, if single dose of medicinal remedy less than 0.05 g. If single dose of medicinal remedy more or equals 0.05 g, its solution is dosed with tablespoons.

The solutions for internal use are prescribed for 10-30 receptions.

26

Pay your attention, that it is necessary give in Signature the indication “Eye drops”.

The solutions for internal use can be prescribed in full and in short forms of prescriptions.

The given examples acquaint for you with rules of drawing up of the short form of prescriptions.

For example. Prescribe solution of Calcium gluconate (Calcium gluconas, single dose is 0.5 g) for internal use 3 times daily.

The course of our reasoning is following.

1. First of all, it is necessary to determine measure which should be used for dosing of solution. In this case, the single dose is more than 0.05 g. Therefore, this solution should be dosed with table-spoons (1 tablespoon contains 15 ml).

2. Next step: it is necessary determine the amount of receptions. Let’s prescribe this drug for 10 receptions.

3. Now we have enough information for calculation of solution volume and concentration:

- for 1 reception patient take 1 tablespoon or 15 ml of solution. Therefore, for 10 receptions it is necessary prescribe 150 ml of solution.

- let’s calculate the percentage of this solution: 0.5 g contains in 15 ml; x g contains in 100 ml. From proportion: 0.5*100/15 = 3.3%. That is concentration of this solution is 3.3%.

Now we have all necessary data for prescribing.

Rp.: Sol. Calcii gluconatis 3.3% - 150 ml D. S. Take perorally 1 tablespoon 3 times per day.

For example. Prescribe solution of Promedolum (the single dose is 0.02 g) for internal use 1 time daily.

Because the single dose is less than 0.05 g, this solution should be dosed with drops. Let’s prescribe for 1 reception 10 drops; and general amount of receptions – 20. Because 10 drops is 0.5 ml, the general volume of this solution is 10 ml (0.5 ml 20 receptions = 10 ml). The general amount of Promedolum is 0.4 g: 0.02 g (single dose) 20 (amount of receptions) = 0.4 g.

Now we have all necessary information for full form of prescription:

Rp.: Promedoli 0.4 Aq. destill. 10 ml M. D. S. 10 drops perorally 1 time daily.

27

Pay your attention, that “M. f. sol.” not is written!

This prescription we can write in short form. In this case, you should calculate the percentage of Promedolum in solution: 0.4 g 100 / 10 = 4%.

Rp.: Sol. Promedoli 4% - 10 ml D. S. 10 drops perorally 1 time daily.

Solutions for Injections

Injections are medicinal form, which used for parenteral administration. Water and oil solutions, sometimes – suspensions, emulsions, sterile powders or tablets (which should be dissolved directly ahead of administration) can be administered parenterally. As a rule, 1-2 ml can be introduced subcutaneously, 3-5 ml – intramuscularly, 5-10 ml (or more) – intravenously. But sometimes you can see exceptions.

Solutions for injections can be administered subcutaneously, intramuscularly, intravenously, intra-arterially and so on. For subcutaneous administration the water solutions are used most commonly. For intramuscular administration the water or oil solutions and suspensions can be used. For intravenous introduction the water solutions are used. The main requirement for these solutions is sterility.

Frequently alongside with term “injection” the term “infusion” is used. The distinction between them is following: relatively small volumes of solutions are administered in injection, but in infusions the more big solution volumes are administered.

Sometimes the solutions for injections can be made by pharmacist. But presently these medicinal forms are made basically in pharmaceutical plants.

In this material we consider only prescription rules for ready-made injection forms.

The pharmaceutical industry makes injection forms in ampoules or in bottles.

Let’s consider the prescription rules for ampoules. As a rule, the volume of ampoule is in a range from 1 ml to 100 ml. Ampoules are dosed medicinal forms. But the single dose can be no identical with amount of drug in ampoule. Therefore it is necessary calculate the amount (or volume) of drug for 1 administration. The amount of ampoules, which are prescribed to patient, depends from duration of treatment. As a rule, 5-10 ampoules are prescribed, sometimes – 20-50 ones.

28

Ampoules are prescribed only with short form of prescription. After abbreviation “Rp.:” it is necessary indicate the name of form, which is located into ampoule (for example: “Sol.” or “Susp.”). Sometimes the sterile powder can be inside of ampoule (in this case you not write the name of this form). After that you write the name of medicinal remedy. After that you write the percentage and volume of solution in one ampoule (for liquid form) or weight of remedy in one ampoule (for sterile powder). In next line you should indicate “D. t. d. N. 10 (or other amount) in amp.”. The next line is “Signa”.

Let’s write several prescriptions for ampoules.

For example. Prescribe solution of Ephedrine hydrochloride (Ephedrini hydrochloridi, the single dose is 0.1 g) for subcutaneous administration 1 time daily. The ready-made form: ampoules, each of which contains 1 ml of 5% solution of Ephedrine hydrochloride.

Rp.: Sol. Ephedrini hydrochloridi 5% - 1 ml D. t. d. N. 10 in amp. S. 2 ml subcutaneously 1 time daily.

0.05 g of ephedrine hydrochloride is contained in 1 ml of 5% solution. The single dose (0.01 g) is contained in 2 ml of this solution. Therefore, 2 ml of solution should be administered.

The ampoule solutions can be officinal or novohalenic, can have special commercial name. In such cases, in prescriptions you should indicate only drug name and its amount in ampoules. The concentration and word “Sol.” are not indicated.

For example. Prescribe Cordiamin (Cordiaminum, single dose is 1 ml) for subcutaneous injections 3 times per day. The manufactured form: ampoules containing 1 ml of drug.

Rp.: Cordiamini 1 ml D .t. d. N. 10 in amp. S. Administer 1 ml subcutaneously 3 times per day.

The powder-like substances, which are destroyed at storage in water solution, also can be made in ampoules. Such powder is dissolved directly before administration. You should give information in “Signa” about this.

29

For example. Prescribe Hexenal (Hexenalum, the single dose is 0.5 g) for intravenous administration. The ready-made form: ampoules containing 1.0 g of dry substance.

Rp.: Hexenali 1.0 D .t. d. N. 10 in amp. S. Dissolve the substance of one ampoule in 20 ml of sterile

water. Administer 10 ml intravenously.

Besides ampoules, the drug for parenteral administration can be made in bottles. In these prescriptions the word “bottle” is not indicated!

For example. Prescribe 20 bottles containing 500,000 IU of dry Benzylpenicillin sodium (Benzylpenicillinum natrium, the single dose is 250,000 IU). Administer intramuscularly 4 times per day.

Rp.: Benzylpenicillini natrii 500,000 IU D .t. d. N. 20 S. Dissolve the substance of 1 bottle in 5 ml of sterile water.

Administer 2.5 ml intramuscularly 4 times per day.

The home-tasks for prescription

1. Prescribe 1,000 ml of 2% solution of Chloramine (Chloraminum). Use for disinfection of instruments.

2. Prescribe 300 ml of 5% solution of Aethacridine lactate (Aethacridini lactas). Use for washing of wounds.

3. Prescribe 0.5% solution of Atropine sulfate (Atropini sulfas). Drip 2 drops in each eye 1 time daily.

4. Prescribe in full and in short forms Atropine sulfate (Atropini sulfas, single dose is 0.0005 g) for peroral use 3 times per day.

5. Prescribe Analginum (single dose is 0.5 g) with Dimedrolum (single dose is 0.01 g) in solution for internal use 3 times per day.

6. Prescribe Platyphyllin hydrotartrate (Platyphyllini hydrotartras, single dose is 0.002 g) in solution for internal use 3 times per day.

7. Prescribe Atropine sulfate (Atropini sulfas, the single dose is 0.00025 g) for subcutaneous administration 1 time daily. Ready-made form: ampoules containing 1 ml of 0.1% solution.

30

8. Prescribe Platyphyllin hydrotartrate (Platyphyllini hydrotartras, single dose is 0.004 g) for subcutaneous administration 2 times per day. The ready-made form: ampoules containing 1 ml of 0.2% solution.

9. Prescribe Hygronium (the single dose equals 0.04 g) for intravenous drop administration. The ready-made form: ampoules containing 0.1 g of dry substance. Before administration the remedy of one ampoule should be dissolved in 100 ml of sterile isotonic solution of sodium chloride.

10. Prescribe Adrenaline hydrochloride (Adrenalini hydrochloridum, single dose is 0.0003 g) for subcutaneous administration. The ready-made form is ampoules containing 1 ml of 0.1% solution.

11. Prescribe Tropaphenum (Tropaphenum, single dose is 0.02 g) for intramuscular administration 1 time daily. The ready-made form is ampoules containing 0.02 g of dry substance.

12. Prescribe Cyanocobalamin (Cyanocobalaminum, single dose is 0.0005 g) for intramuscular administration 1 time per 2 days. The ready-made form is ampoules containing 1 ml of 0.05% solution.

13. Prescribe Streptokinase (Streptokinasum, single dose is 250,000 IU) for intravenous drop administration 1 time daily. The ready-made form is ampoules containing 500,000 IU of dry substance. Before administration dissolve substance according to a ratio 250,000 IU:50 ml of sterile isotonic solution of sodium chloride.

14. Prescribe aminocapronic acid (Acidum aminocapronicum, single dose is 5.0 g) for intravenous drop administration 1 time daily. The ready-made form is bottles containing 100 ml of 5% solution.

15. Prescribe Retabolil (Retabolilum, single dose is 0.025 g) for intramuscular administration 1 time per 3 weeks. The ready-made form is ampoules containing 1 ml of 5% oil solution.

Suspensions - Suspensiones (Susp.)(Nominative case, singular – Suspensio; Genitive case, singular –

Suspensionis)

The suspensions are liquid medicinal form, in which the firm and very small insoluble medicinal substances are in the weighed condition in a liquid (water, vegetable oil, glycerin and so on).

Suspensions are used for external and internal application, and also - for subcutaneous or intramuscular administration. Besides, the suspensions may be administered into body cavities. The suspensions are prescribed in short and in full forms. Short form is used when environment of suspension

31

is water. The suspensions are prescribed similarly to solutions. Only the word “Suspensionis” is written instead of the word “Solutionis”. In signature alongside with the instruction for use of suspension, doctor should indicate "Shake up before the using".

For example. Prescribe 10 ml of water suspension which contains 0.5% of Hydrocortisone acetate (Hydrocortisoni acetas). Drip 2 drops in each eye 4 times per day. Shake up before using.

Rp.: Susp. Hydrocortisoni acetatis 0.5% - 10 ml D. S. Eye drops. To drip 2 drops in both eyes 4 times daily. Shake up before using.

For example. Prescribe the suspension of Hydrocortisone acetate (Hydrocortisoni acetas) for injections into the cavity of joint (the single dose equals 0.05 g) 1 time per three days. The ready-made form: bottles containing 5 ml of 2.5% suspension.

Rp.: Susp. Hydrocortisoni acetatis 2.5% - 5 ml D. t. d. N. 2 S. Administer2 ml into cavity of joint 1 time per 3 days. Shake up before using.

Tinctures and Liquid Extracts – Tincturae et extracta (Tinct., Extr.)

(Tincture – Nominative case, singular – Tinctura; Genitive case, singular – Tincturae; Extract – Nominative case, singular –

Extractum; Genitive case, singular - Extracti)

Tinctures and liquid extracts are called as “Galenic” drugs (in honor of the doctor Galen, which has offered their manufacturing). They are alcoholic (less often alcohol-water or alcohol-ether) extractions from medicinal vegetative raw material without heating. These forms are dosed in drops. They are stable medicinal forms which can be stored long time at room temperature. At manufacturing of tinctures, the 5 or 10 volumetric parts of tinctures are made from 1 part of vegetative raw material. At manufacturing of extracts, the 1 or 2 volumetric parts of an extract are received from 1 part of raw material.

32

Tinctures and extracts are officinal medicinal forms. Therefore, they are prescribed only in short form. A doctor indicates in the prescription the medicinal form, the name of a plant and total quantity of drug in milliliters.

For example. Prescribe 20 ml of tincture of Valeriana. Use 20 drops perorally 4 times daily.

Rp.: Tinct. Valerianae 20 ml D.S. Use 20 drops perorally 4 times daily.

Similar structure of prescription is used for liquid extracts.

For example. Prescribe the liquid extract of Leonurum. The single dose equals 25 drops. Use perorally 3 times daily.

Rp.: Extr. Leonuri fluidi 20 ml D.S. Accept 25 drops perorally 3 times daily.

Except for liquid, the industry made dense extracts (extracta spissa) and dry extracts (extracta sicca). Therefore, it is necessary to do in prescription the indication what extract (liquid, dense or dry) leaves. Dense and dry extracts are made in capsules, powders, tablets, suppositories and pills.

Infusions and Broths (Infusion - Nominative case, singular – Infusum; Genitive case,

singular – Infusi. Broth – Nominative case, singular – Decoctum; Genitive case, singular – Decocti)

The infusions and broths are liquid medicinal forms which represent water extraction from vegetative raw material. The infusions are prepared from soft parts of plants: leaves, flowers and stalks. Besides infusion are prepared from the raw material containing volatile or unstable medicinal substances. The broths are made of dense parts of plants –roots, rhizomes, tubers, a bark, etc.

The infusions and broths are used for internal or for external application. For accepting perorally infusions and broths are dosed by tablespoons (for adults), dessert or teaspoons.

The infusions and broths are prescribed only in the short forms. They are unstable medicinal forms and can be stored no more than 4 days. They

33

are prescribed for 10-16 receptions. The prescription is begun with the indication of the name of the medicinal form (“Infusi” or “Decocti”). Then a doctor indicates the part of plant, which is used. Further, the doctor specifies the plant’s name and indicates its weight in grams and total amount infusion or broth.

For example. Prescribe a infusion with the leaves of Digitalis (single dose equals 0.05 g). Accept perorally 3 times per day.

Rp.: Inf. fol. Digitalis 0.5 – 150 ml D. S. Perorally 1 tabl-spoon 3 times per day.

In this case the amount of receptions is 10 (the amount of receptions is determined by a doctor). According this the total weight of leaves equals 0.05 g 10 = 0.5 g, and total volume of infusion equals 15 ml 10 = 150 ml (15 ml is the volume of 1 table spoon).

The broths are prescribed similarly.

For example. Prescribe a broth with the roots of Ipecacuanha (single dose equals 0.03 g). For accepting perorally 5 times per day.

Rp.: Dec. rad. Ipecacuanhae 0.3 – 150 ml D. S. Take perorally 1 tablespoon 5 times per day.

MixturesMixtures are liquid medicinal forms. The mixtures are made by

mixing or dissolution of some firm substances in various liquids (water, alcohol, glycerin, vegetable oil), or at mixing liquids (solutions, infusions, broths, tinctures, liquid extracts). Mixtures contain 3 or more ingredients. They are used mainly perorally. The mixtures are dosed by spoon (for adults - tablespoon). The mixtures are non-stable medicinal forms and prescribed in amount for 10-12 receptions (for 3-4 days). Doctor prescribes them only in the full form of prescription. In prescription, doctor enumerates all ingredients that are contained in this mixture. After the name of each component doctor indicates its amount. The next line is “M. D. S.”, in which the instruction for patient about use of this mixture is given.

34

For example. Prescribe the mixture which contains Natrii bromidum (single dose equals 0.5 g) and Coffeini-natrii benzoas (single dose equals 0.05 g). Use per orally 3 times per day.

Rp.: Natrii bromidi 5.0 Coffeini-natrii benzoatis 0.5 Aquae destillatae ad 150 ml M. D. S. Use perorally 1 tablespoon 3 times per day.

In this example the calculation is made for 10 receptions. The single dose of Natrii bromidum equals 0.5 g, hence for 10 receptions necessary to take 0.5 (g) 10 (amount of receptions) = 5.0 (g). The single dose of Coffeini-natrii benzoas equals 0.05 g, hence for 10 receptions necessary to take 0.05(g) 10 (amount of receptions) = 0.5 (g). For adult patients mixtures are dosed by tablespoon. One tablespoon contains 15 ml of water. As the total quantity of receptions equals 10, it is necessary to take 150 ml of water (15 ml 10 = 150 ml).

If mixture contains an infusion or a broth, they are written on the first line in the short form. The infusion or the broth in such cases carries out also function of solvent.

For example. Prescribe a mixture which contains the infusion of the grass of Adonis vernalis (single dose equals 0.5 g), Natrii bromidum (single dose equals 0.5 g), and Codeini phosphas (single dose equals 0.01 g). Use perorally 3 times per day.

Rp.: Inf. herbae Adonidis vernalis 5.0 – 150 ml Natrii bromidi 5.0 Codeini phosphatis 0.1 M. D. S. Use perorally1 tablespoon 3 times per day.

For example. Prescribe an infusion of the grass of Adonis vernalis (single dose equals 0.5 g) with the tincture of Convallaria (single dose equals 10 drops). Use perorally 3 times per day.

Rp.: Inf. herbae Adinidis vernalis 5.0 – 150 ml Tinct. Convallariae 2 ml M. D. S. Use 1 tablespoon perorally 3 times per day.

35

It is necessary to pay your attention, how calculation of quantity for tincture of Convallaria (lily of the valley) is made. In 1 ml the alcoholic solution 50 drops are contained. We have made the proportion on the basis of which calculate in what quantity of milliliters the single dose of tincture is contained:

50 drops – 1 ml;10 drops – x ml; x = 10 1: 50 = 0.2 ml.

The total quantity of receptions of mixture equals 10. Hence for 10 receptions we should take 2 ml of tincture (0.2 ml 10 = 2.0 ml).

Liniments(Nominative case, singular - Linimentum, Genitive case, singular –

Linimenti)

Liniment (or liquid ointment) is non-dosed medicinal form intended for external application, which is dense fluid or jelly-like dough and is fluxed at a body temperature. In comparison with usual ointments liniments have more liquid consistence. Liniments are rubbed in a skin.

Liquid oils are used as bases for liniments: liquid paraffin (Oleum Vaselini), linseed oil (Oleum Lini), sunflower-seed oil (Oleum Helianthi), olive oil (Oleum Olivarum) and so on.

Depending on physico-chemical properties, the liniments are divided into two groups.

1. Homogeneous liniments or liniments-solutions . They are molecular solutions or mixtures of two or more mutually soluble ingredients (for example, mixtures of oils with ether, methyl salicylate, chloroform and so on) or semi-transparent homogeneous jelly-like mixtures (soaps in alcohol). Also, some solid medicinal substances (such as menthol, camphor, anaestesinum) may be included in homogeneous liniments.

2. Liniments-suspensions or liniments-emulsions. They are thin colloids of materials unsolvable in a dispersion medium (smallest powders of zinc oxide, starch in water, glycerin, and oils). The conforming emulgents should be added for manufacturing of such liniments. Before using, these liniments should be shaken up.

Liniments are convenient form for processing of burns, freezing injury, for cosmetic using and so on.

The liniments are written out in full of short forms of prescriptions in amount from 50 to 100 ml.

36

For example. Prescribe in full form 100 ml of liquid ointment containing 20% of chloroform (Chloroformium) and 20% of methyl salicylate (Methylii salicylas). Use for processing of joints.

Rp.: Chloroformii Methylii salicylatis āā 20 mlOlei Helianthi ad 100 mlM. f. linimentumD. S. Use for processing of joints. Shake up before using.

For example. Prescribe in short form 50 ml of liniment containing aloe (Aloe).

Rp.: Lin. Aloes 50 mlD.S. Наносити на уражену поверхню 2 рази на день.

The concentration of medicinal remedy on liniment is indicated in prescription only if this liniment manufactured with different concentrations.

For example. Prescribe 10 ml of liniment containing 1% of Sanguitrinum. Use for applying on injured parts of skin 2 times daily.

Rp.: Lin. Sanguitrini 1% - 10 ml D. S. Use for applying on injured parts of skin 2 times daily.

Aerosols – AerosolaNominative case, singular – Aerosolum, Genitive case, singular –

Aerosoli)

An aerosol is the product that is packaged under pressure and contains therapeutically active ingredients that are released upon activation of an appropriate valve system; it is intended for topical application to the skin as well as local application into the nose (nasal aerosols), mouth (lingual aerosols), or lungs (inhalation aerosols).

Pharmaceutical industry manufactures different drugs in aerosols. This medicinal form is written out only in short form of prescription.

For example. Prescribe aerosol “Ingaliptum”. Use for inhalation 3 times per day.

Rp.: Aerosoli “Ingalyptum” 30,0D. S. Make 1 inhalation 3 times per day..

37

The home-tasks for prescription1. Prescribe an infusion of the grass of Thermopsis (Thermopsis,

single dose equals 0.05 g) for accepting perorally 3 times per day. 2. Prescribe an infusion of the roots with rhizomes of Valeriana

(Valeriana, single dose equals 0.5 g) for accepting perorally 3 times per day.

3. Prescribe the tincture of Wormwood (Absinthium, single dose equals 10 drops). Accept perorally 3 times per day before meal.

4. Prescribe liquid extract of Buckthorn (Frangula, single dose equals 30 drops) for accepting orally on evening.

5. Prescribe an infusion of the grass of Adonis vernalis (Adonis vernalis, single dose equals 0.3 g) with the tincture of Lily of the valley (Convallaria, single dose equals 20 drops) and sodium bromide (Natrii bromidum, single dose equals 0.3 g). Accept perorally 3 times per day.

6. Prescribe an infusion of the leaves of Digitalis (Digitalis, single dose equals 0.1 g) with tincture of Strophantus (Strophantus, single dose equals 5 drops) for accepting perorally 3 times per day.

7. Prescribe 0.25% suspension of hydrocortisone acetate (Hydrocortisini acetas, single dose equals 0.025 g). The suspension is manufactured in bottles with volume 5 ml. Administer into a cavity of the joint 1 time per one week.

8. Prescribe the suspension of zinc-insulin (Zinc-insulinum, single dose equals 20 IU) in bottles with volume 5 ml (in 1 ml contains 40 IU of Insulin). Administer subcutaneously 1 time per day.

9. Prescribe the mixture which contains pepsin (Pepsinum, single dose equals 0.2 g) and hydrochloric acid (Acidum hydrochloricum dilutum, single dose equals 10 drops). Accept perorally during the meal.

10. Prescribe an infusion of the roots of Ipecacuanha (Ipecacuanha, single dose equals 0.05 g) with sodium hydrocarbonate (Natrii hydrocarbonas, single dose equals 0.5 g). Accept perorally 4 times per day.

11. Prescribe 10 ml of aerosol of salbutamol (Salbutamolum). Use for inhalation 3 times per day.

38

Contents

Introduction in Medical Prescription...................................................3Elements of Latin Grammar...................................................................5Prescription: Structure and Rules of Prescription...................................6

Rules of Prescribing of Medicinal Forms .............................................11Solid Medicinal Forms......................................................................11

Powders................................................................................................11Tablets..................................................................................................13Dragee...................................................................................................14Capsules................................................................................................15Eye Membranous..................................................................................15The home-tasks for prescription...........................................................16

Soft Medicinal Forms........................................................................17Ointments..............................................................................................17Pastes....................................................................................................19Suppositories........................................................................................21The home-tasks for prescription...........................................................23

Liquid Medicinal Forms....................................................................24Solutions...............................................................................................24The home-tasks for prescription...........................................................30Suspensions..........................................................................................31Tinctures and Liquid Extracts...............................................................32Infusions and Broths.............................................................................33Mixtures................................................................................................34Liniments..............................................................................................36Aerosols................................................................................................37The home-tasks for prescription...........................................................37

39

Навчальне видання

Висоцький Ігор Юрійович,Храмова Раїса Андріївна,Качанова Алла Анатоліївна

Medical prescription(for foreign students being educated in English)

Редактор Н.А. ГавриленкоКомп`ютерне верстання А.А. Качанової

Підписано до друку 1.03.2008, поз. Формат 60 х 84/16. Папір офс. Гарнітура Times New Roman Cyr. Друк офс. Ум. друк. арк. 2,32. Обл.-вид. арк. 2,28. Наклад 60 прим. Вид. № Замовлення

Вид-во СумДУ при Сумському державному університеті 40007, м. Суми, вул. Р.-Корсакова, 2Свідоцтво про внесення суб`єкта видавничої справи до Державного реєструДК № 3062 від 17.12.2007 р. Надруковано у друкарні СумДУ 40007, м. Суми, вул. Р.-Корсакова, 2