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$Title{Filling Your Prescription}
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Copyright (C) 1991 Publications International, Ltd.


Filling Your Prescription
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     While you're having your prescription filled, you should make sure you
understand what the drug is used for, your dosage schedule, how to store the
medication properly, what kinds of precautions to take to prevent or reduce
side effects, whether you should restrict your diet or drinking habits while
taking the drug, which side effects are expected or unavoidable, and which
side effects signal a need for a doctor's attention.  Your first step in
filling your prescription is reading what your doctor has written.

READING YOUR PRESCRIPTION

     Prescriptions are not mysterious--they contain no secret messages.  Many
of the symbols and phrases doctors use on prescriptions are abbreviated Latin
or Greek words; they are holdovers from the days when doctors actually wrote
in Latin.  For example, "gtt" comes from the Latin word guttae, which means
drops, and "bid" is a shortened version of bis in die, which is Latin for
twice a day.
     You do not have to be a doctor, nurse, or pharmacist to read a
prescription.  You can (and should) learn how to read one yourself--after all,
the prescription describes the drug you will be taking.  You should understand
what your doctor has written on the prescription blank to be sure that the
label on the drug container you receive from your pharmacist coincides with
your prescription.
     The accompanying chart ("Prescription Symbols") lists the most common
prescription symbols and abbreviations.  Use it as a guide to read the sample
prescriptions that follow ("Sample Prescription 1" and "Sample Prescription
2").
     The first sample prescription is for Darvon Compound-65 (Darvon cpd-65).
The prescription tells the pharmacist to give you 24 capsules (#24), and it
tells you to take one capsule (cap i) every four hours (q[overscored] 4h) as
needed (prn) for pain.  The prescription indicates that you may receive five
refills (5x), that the label on the drug container should state the name of
the drug (yes), and that the pharmacist may substitute (substitution) a less
expensive equivalent product.
     Look at the second prescription.  It shows that you will receive 100 (dtd
C) tablets of Lanoxin, 0.125 mg.  You will take three tablets at once (iii
stat), then two (ii) tomorrow morning (AM), and one (i) every (q [overscored])
morning (AM) thereafter with (c [overscored]) orange juice (OJ).  You will
receive the specific brand noted (dispense as written), you may receive
refills as needed (prn), and the name of the drug will be on the package
(check mark).
     Do remember to check the label on the drug container.  If the information
on the label is not the same as on the prescription, question your pharmacist.
Make sure you are receiving the right medication and the correct instructions
for taking it.

TALKING TO YOUR PHARMACIST

     Once you have read the prescription, its directions may seem clear
enough, but will they seem clear when you get home?  For example, the
prescription for Darvon Compound-65 tells you to take one capsule every four
hours as needed.  How many capsules can you take each day--four, six, more?
The phrase "as needed" is not clear, and unless you understand what it means,
you don't know how much medication you can take per day.  What if your
prescription instructs you to take "one tablet four times a day"?  What does
four times a day mean?  For some antibiotics, it may mean one tablet every six
hours around the clock.  For other medications, it may mean one tablet in the
morning, one at noon, one in the early evening, and one at bedtime.  For still
others, it may mean one tablet every hour for the first four hours after you
get up in the morning.  Don't leave the pharmacy with unanswered questions;
ask your pharmacist for an explanation of any confusing terms on your
prescription.
     Your pharmacist is a valuable resource in your health care.  He or she
should have a record of ALL the prescription drugs you receive, in order to
detect any possible life-threatening drug interactions.  It is, therefore, a
good idea to purchase your medications through one pharmacy--choose one that
maintains careful records.
     The pharmacist will be able to tell you if your therapy may be affected
by smoking tobacco, eating certain foods, or drinking alcohol, and if the
drugs you are taking can cause drowsiness or nausea.  He or she can tell you
what to expect from the medication and about how long you will have to take
it.  Of course, people's treatments vary tremendously, but you should ask
whether you will have to take medication for five to ten days (for example, to
treat a mild respiratory infection) or for a few months (for example, to treat
a kidney infection).
     You should discuss with your pharmacist the possible side effects of your
medication and ask for a description of symptoms.  The pharmacist can tell you
which side effects require prompt attention from your physician.  For example,
one of the major side effects of the drug phenylbutazone is the development of
a blood disorder.  Since a sore throat can be one of the early symptoms of a
blood disorder, your pharmacist may instruct you to consult your physician if
this symptom occurs.
     Your pharmacist can also explain how to take your medicine.  You need to
know whether to take the drug before or after a meal or along with it.  The
timing of doses of a drug can make a big difference, and the effectiveness of
each drug depends on following the directions for its use.  Your pharmacist
can tell you what is meant by the phrases "as needed," "as directed," and
"take with fluid."  For example, you may take water, but not milk, with some
drugs.  With other drugs, you should drink milk.  Your pharmacist can also
tell you how many refills you may have and whether you may need them.

OVER-THE-COUNTER DRUGS

     Drugs that can be purchased without a prescription are referred to as
over-the-counter (OTC) drugs.  They are sold in a wide variety of settings,
such as drugstores, grocery stores, and hotel lobbies.  There are no legal
requirements or limitations on who may buy or sell them.
     Products sold OTC contain amounts of active ingredients considered to be
safe for self-treatment by consumers when labeling instructions are followed.
     Many people visit a doctor for ailments that can be treated effectively
by taking nonprescription drugs.  Actually, prescriptions are sometimes
written for such drugs.  Your pharmacist will be able to recommend appropriate
use of OTC medications and preparations.
     If your pharmacist recommends that you not take certain OTC drugs, follow
the advice.  OTC drugs may affect the way your body reacts to the prescription
drugs you are taking.  For instance, people taking tetracycline should avoid
taking antacids or iron-containing products at the same time; their use should
be separated by at least two hours.  Antacids and iron interfere with the
body's absorption of tetracycline, thereby decreasing its effectiveness.  Be
sure you know what you are taking.  If you are unsure of the type or contents
of your medications, ask your doctor or pharmacist.

GENERIC DRUGS

     One way your pharmacist can help you save money is by dispensing generic
drugs.  "Generic" means not protected by trademark registration.  The generic
name of a drug is usually a shortened form of its chemical name.  Any
manufacturer can use the generic name when marketing a drug.  For example,
many manufacturers make a drug called tetracycline.
     Usually, a manufacturer uses a trade name (or brand name) as well as a
generic name for a drug.  A trade name is registered, and only the
manufacturer who holds the trademark can use the trade name when marketing a
drug.  For example, only Lederle Laboratories can call their tetracycline
product Achromycin V, and only the Upjohn Company can use the trade name
Panmycin for tetracycline.  Most trade names are easy to remember, are
capitalized in print, and usually include the registered symbol ((R)) after
them.  You should know the generic name and the trade name of every drug you
are taking.
     Many people think that drugs with trade names are made by large
manufacturers and generic drugs are made by small manufacturers.  But, in
fact, a manufacturer may market large quantities of a drug under a brand name
and may also sell the base chemical to several other companies, some of which
sell the drug generically and some of which sell it under their own brand
names.  For example, the antibiotic ampicillin is the base for over 200
different products.  However, all ampicillin is produced by only a few dozen
drug companies.
     Generic drugs are generally priced lower than their trademarked
equivalents, largely because they are not as widely advertised.  However, not
every drug is available generically, and not every generic is significantly
less expensive than its trademarked equivalent.  Nevertheless, consumers may
be able to save as much as 40 percent by purchasing a generic product.  For
example, 100 tablets of Inderal (40 mg) may cost $22 to $25.  One hundred
tablets of the generic equivalent product may cost about $18--a savings of $4
to $7.
     For certain drugs, however, it's inadvisable to "shop around" for a
generic equivalent.  Although the Food and Drug Administration has stated that
there is no evidence to suspect serious differences between trade-name drugs
and generic drugs, differences have been shown to exist between brands of
certain drugs.  The tablets or capsules from different manufacturers may not
dissolve in the stomach at the same rate or to the same extent, because of
variations in the way they are made or the fillers (nonactive ingredients)
that are used.  This is especially true for the various generic digoxin and
phenytoin products.  It is, therefore, important to discuss with your doctor
or pharmacist the advantages or disadvantages of any particular generic
product.
     All states have some form of substitution law that allows pharmacists to
fill prescriptions with the least expensive equivalent product.  However, your
doctor can authorize the use of a specific brand of medication by signing on
the appropriate line or otherwise noting this on the prescription form (see
the sample prescriptions).  You should be aware that certain patients can
sometimes respond in different ways to various equivalent products, and your
doctor may have good reasons for being specific.  Discuss this with your
doctor.

HOW MUCH TO BUY

     On a prescription, your doctor specifies exactly how many tablets or
capsules or how much liquid medication you will receive.  But if you must take
a drug for a long time, or if you are very sensitive to drugs, you may want to
purchase a different quantity.
     The amount of medication to buy depends on several factors.  The most
obvious is how much money you have or, for those who have a comprehensive
insurance program, how much the insurance company will pay for each purchase.
These factors may help you decide how much medication to buy, but you must
also consider the kind of medication you will be taking (for example, how long
it can be stored).
     Medications to treat heart disease, high blood pressure, diabetes, or a
thyroid condition may be purchased in large quantity.  Patients with such
chronic conditions take medication for prolonged periods.  Chances are, they
will pay less per tablet or capsule by purchasing large quantities of drugs.
Generally, the price per dose decreases with the amount of the drug purchased.
In other words, a drug that usually costs six cents per tablet may cost four
or five cents per tablet if you buy 100 at a time.
     Many doctors prescribe only a month's supply of drugs, even those drugs
that will be taken for a long time.  If you wish to buy more, check with your
pharmacist.  It is also important to make sure that you have enough medication
on hand to cover vacation travel and long holidays.  Serious side effects
could occur if you miss even a few doses of such drugs as propranolol,
prednisone, or clonidine.
     If you have been plagued by annoying side effects or have had allergic
reactions to some drugs, you may want to ask your pharmacist to dispense only
enough medication on initial prescriptions for a few days or a week, so that
you can determine how your body reacts to the drug.  Pharmacists cannot take
back prescription drugs once they have left the pharmacy.  You may have to pay
more per dose if the pharmacist gives you a small quantity of the drug, but at
least you will not be paying for a supply of medication you cannot take.  Be
sure you can get the remainder of the prescribed amount of the drug if no
serious or intolerable side effects occur.  With some drugs, after you have
received part of the intended amount, you cannot receive more without
obtaining another prescription.

STORING YOUR DRUGS

     Before you leave the pharmacy, find out how you should store your
medication.  If drugs are stored in containers that do not protect them from
heat or moisture, they may lose potency.
     All medications should be kept in their original containers.  Different
medications should NOT be mixed in one container, in order to prevent
confusion about which drug is being taken.  In addition, some drugs may lose
their potency when stored with other medications.  Never remove the label from
the prescription vial.  It contains your prescription number (for refills),
the name of the medication, and directions for proper use.
     You can safely store most prescription drugs at room temperature and out
of direct sunlight.  Even those drugs dispensed in colored bottles or
containers that reflect light should be kept out of direct sunlight.
     Some drugs require storage in the refrigerator; other medications should
not be refrigerated.  For example, some liquid cough suppressants thicken as
they become cold and will not pour from the bottle.  Some people keep
nitroglycerin tablets in the refrigerator because they believe the drug will
be more stable when kept cold.  Nitroglycerin, however, should not be stored
in the refrigerator.
     Even if the label on your medication states "keep refrigerated," this
does NOT mean you can keep the drug in the freezer.  If frozen and thawed,
coated tablets may crack, and some liquids may separate into layers that can't
be remixed.
     Many people keep prescription drugs and other medications in the bathroom
medicine cabinet, but this is one of the WORST places to keep drugs.  Small
children can easily climb onto the sink and reach drugs stored above it.
Also, the temperature and humidity changes in the bathroom may adversely
affect the stability of prescription and nonprescription drugs.  (See the
table "Storage Definitions".)
     It is required by law that all prescription medications for oral use be
dispensed in childproof containers.  If you find the container difficult to
open AND if there are no small children in your home, you can request that
your pharmacist dispense your medication in a nonchildproof container.
     KEEP ALL DRUGS AWAY FROM CHILDREN, and do not keep unused prescription
drugs.  Flush leftover medication down the toilet or pour it down the sink,
and wash and destroy the empty container.  Regularly clean out your medicine
cabinet and discard all drugs you are no longer using and drugs that have
expired (the expiration date is often listed on the prescription label).
These drugs can be dangerous to your children, and you might be tempted to
take them in the future if you develop similar symptoms.  Similar symptoms may
not be due to the same disease, and you may complicate your condition by
taking the wrong drug.
     If a child accidentally swallows medication or receives too much of a
prescribed medication, IMMEDIATELY CALL YOUR LOCAL POISON CONTROL CENTER, A
NEARBY EMERGENCY ROOM, OR YOUR DOCTOR for instructions and recommendations.
These phone numbers should be written down in a readily accessible place.  You
should also keep a bottle of syrup of ipecac (available without a
prescription) for each child under five years of age in your home (in case the
poison control center or emergency room personnel or your doctor recommends
that you induce vomiting in the child).  Do not, however, use the syrup of
ipecac unless instructed to do so by a health professional.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
