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Over-the-counter Substance

Over-the-counter substance

Over-the-counter (OTC) substances are drugs and other medical remedies that may be sold without a prescription and without a visit to a medical professional, in contrast to prescription only medicines (POM). In the United Kingdom, items may be restricted to sale only under the supervision of a pharmacist in a registered pharmacy — called (P) medicines — or may be sold in any general retail outlet without any professional supervision — called GSL General Sales List items. Restrictions apply both to which items may be sold (P) or GSL and to the quantities that may be purchased , such as for paracetamol. The name "over-the-counter" is somewhat confusing since GSL items are found on the shelves of stores and bought like any other packaged product.

Switches between POM and OTC

As a general rule, over-the-counter drugs have to be primarily used 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 with little abuse potential, though some drugs such as dextromethorphan and codeine skirt the edges of the latter requirement. One of the oldest OTC drugs is aspirin. Over time, drugs that prove themselves safe and appropriate for self-medication, may be switched from POM to OTC. An example of this is diphenhydramine hydrochloride (Benadryl®, for instance) which once required a prescription, but now is available OTC. However, sometimes some OTC drugs are restricted to require prescriptions. Cocaine and various opiates, for instance, were once sold freely OTC, but now are highly restricted. It is somewhat unusual for an OTC drug to be withdrawn from the market, though it has happened — phenylpropanolamine being one good example.
Chemicals
Over-the-counter chemicals may be sold without much suspicion. Many chemicals are becoming harder to get due to regulations designed to thwart underground drug and explosives laboratories. Underground chemists have become exceedingly efficient in extracting essential chemicals from very ordinary items, and using very ordinary items to yield illicit chemicals:
- Ephedrine and pseudoephedrine from cough medicine for methamphetamine or methcathinone
- Potassium permanganate (a filter treatment and water conditioning agent) for methcathinone
- piperidine from pepper for PCP
- safrole from sassafras oil for MDMA
- myristicin from nutmeg oil for MMDA
- benzaldehyde from bitter almond oil for amphetamines
- cinnamaldehyde from cinnamon for allybenzene for phenylacetone for methamphetamine
- Sulfuric acid from Drain Cleaner or Car Batteries
- Acetone and Hydrogen peroxide for Acetone peroxide
- Glycerin and Nitric acid for Nitroglycerin Other over-the-counter drugs are freely available, although not marketed as drugs. For example,
- Morning glory seeds are sold for their gardening purposes, but can be used recreationally as a hallucinogenic drug due to the LSA they contain.
- Nutmeg has also been used to some extent as a hallucinogenic drug, but is considered undesirable to most recreational drug users.
See also
Dextromethorphan
-

Drug
Drug may refer to:
- Medication
- Psychoactive drug
- substances used for recreational drug use
- substances used in drug abuse
- Hard and soft drugs
- A drug or demon in ancient Vedic Hinduism, from the Vedic Sanskrit root druh = "be hostile"
- The Drûg or Drúedain, a race of Men from Middle-earth in the fiction of J. R. R. Tolkien

Medical prescription

A medical prescription (℞) is a written order by a qualified health care professional to a pharmacist for a treatment to be provided to their patient.

Format and definition

Prescriptions are typically handwritten on preprinted prescription forms that are assembled into pads, or alternatively printed onto similar forms using a computer printer. Preprinted on the form is text that identifies the document as a prescription, the name and address of the prescribing doctor and any other legal requirement such as a registration number (e.g. DEA Number in the United States). Unique for each prescription is the name of the patient, date (some jurisdictions may place a time limit on the prescription[http://www.med.rug.nl/pharma/who-cc/ggp/chapter9/page01.htm]), the "recipe" of the medication and the directions for taking it. Finally there is the doctor's signature. The symbol "R_x" meaning "prescription" is a transliteration of a symbol resembling a capital R with a cross on the diagonal (). There are various theories as to the origin of this symbol - some note its similarity to the eye of Horus, others to the ancient symbol for Jupiter, both gods whose protection may have been sought in medical contexts. Alternatively, it may be intended as an abbreviation of the Latin recipere, "to take" [http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=recipe], and it is quite possible that more than one of these factors influenced its form. Literally, "Rx" indicates an instruction "to take" what is specified in the prescription, although this was probably originally directed at the pharmacist who needed to take a certain amount of each drug and prepare them, rather than at the patient who must take the medicine, in the sense of consuming it. The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared. Those within the industry will often call prescriptions simply "scripts".

Contents of the prescription

Both pharmacists and physicians are regulated professions in most jurisdictions. A prescription as a communications mechanism between them is also regulated and is a legal document. Legislation may define what constitutes a prescription, the contents and format of the prescription (including the size of the piece of paper - see Exhibit C paragraph 10) and how prescriptions are handled and stored by the pharmacist. Many jurisdictions will now allow faxed or phone prescriptions containing the same information. Exhibit A below illustrates the legal definition of a prescription. Many brand name drugs have less expensive generic drug substitutes that are chemically equivalent. Prescriptions will also contain instructions on whether the doctor will allow the pharmacist to substitute a generic version of the drug. This instruction is communicated in a number of ways. 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 doctor to check off (but this is easily checked off by anyone with access to the prescription). Other jurisdictions the protocol is for the doctor to handwrite one of the following phrases: "dispense as written", "DAW", "brand necessary", "do not substitute", "no substitution", "medically necessary", "do not interchange"[http://www.alesse.com/pdf/prescribe.pdf]. As a guideline, pediatric prescriptions should include 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.) In some jurisdictions, it may be a legal requirement to include the age of child on the prescription [http://bnf.org/bnf/bnf/current/doc/29440.htm]. Adding the weight of the child is also helpful. Prescriptions often have a "label" box [http://www.sh.lsuhsc.edu/fammed/OutpatientManual/PrescripWriting-PDR.htm]. When checked, pharmacist is instructed to label the medication. When not checked, the patient only receives instructions for taking the medication and no information about the prescription itself. Some doctors further inform the patient and pharmacist by providing the indicator for the medication; i.e. what is being treated. This assists the pharmacist in checking for errors as many common medications can be used for multiple medical conditions. Some prescriptions will specify whether and how many "repeats" or "refills" are allowed; that is whether the patient may obtain more of the same medication without getting a new prescription from the doctor. Legislation may restrict some categories of drugs from being refilled. In group practices, the preprinted portion of the prescription may contain multiple doctors' names. Doctors typically circle themselves to indicate who is prescribing or there may be a checkbox next to their name.

Handling of the prescription

When filled by a pharmacist, as a matter of business practice, the pharmacist may write certain information right on the prescription. This may also be mandated by legislation (see Exhibit D). Information such as the actual manufacturer of the drug and the date the medication was dispensed may be written right onto the prescription. Legislation may require the pharmacist sign the prescription. In computerized pharmacies, all such information is printed and stapled to the prescription. Sometimes such information is printed onto labels and the labels affixed right onto the prescription. When filled by the pharmacist, prescriptions are typically assigned a "prescription number" (often abbreviated "Rx#") that is unique to the pharmacy that filled the prescription. The prescription number is written right on the prescription by the pharmacist. The prescription number has the practical purpose of uniquely identifying the prescription later on while filed (both manual and electronic). The prescription number is also put on the label on the dispensed medication. The patient may be required to reference the prescription number for refills and drug insurance claims. There may also be a legal requirement for prescription numbers for subsequent identification purposes. As a legal document, some jurisdictions will mandate the archiving of the original paper prescription in the pharmacy. Very rarely can the patient take the original prescription with them. Some jurisdictions may entitle patients to a copy. The retention period varies but can be as long as six years. See Exhibit B for sample legislation governing the archiving of prescriptions. Once the retention period has passed, privacy legislation may dictate what can be done with the original paper prescription. Legislation may also dictate what happens to the prescriptions if the pharmacy closes or is sold. For example, if the pharmacy goes out of business, the pharmacist may be required to return the prescription to the patient, to the next closest pharmacy or to the governing body for pharmacists. Prescriptions for non-narcotic drugs may also be "transferred" from one pharmacy to another for subsequent repeats to be dispensed from another pharmacy. The physical piece of paper that is the prescription is not transferred, but all the information on it is transferred from one pharmacy to another. Legislation may dictate the protocol by which the transfer occurs and whether the transfer needs to be noted on the original paper prescription. It is estimated that 3 billion (3 thousand million) prescriptions were written in the United States in 2002[http://www.usaweekend.com/02_issues/021201/021201healthsmart.html][http://www.psychiatrictimes.com/massmedia.html]. This number has grown from 1.5 billion in 1989 and is expected to continue to grow.

Forgeries, thefts and prevention

Prescriptions are sometimes forged because many narcotics are cheaper and safer as prescription drugs than as street drugs. Forgery takes many forms: Doctor's prescription pads are sometimes stolen by drug addicts, amounts may be altered on legitimate prescriptions, call back numbers may be falsified and phoned or faxed prescriptions faked[http://www.deadiversion.usdoj.gov/pubs/brochures/pharmguide.htm]. Some doctors will use prescription pads that contain similar security measures as checks to make photocopying prescriptions harder. These security measures may be mandated by law - see Exhibit C for sample legal specifications. Legislation may mandate that only certain printers may print prescriptions[http://www.in.gov/hpb/boards/isbp/pad.html]. New Jersey, for example, requires that only state approved printers may be used to print official "New Jersey Prescription Blanks."[http://www.state.nj.us/lps/ca/njpb.htm] (See Exhibit E.) Prescribers can make it harder for amount forgeries by writing out the amounts in words. Again, this may be mandated by law[http://www.cpsa.ab.ca/collegeprograms/attachments_tpp/tpp%20information%20for%20prescriber.doc]. Some jurisdictions help control stolen prescriptions by requiring special "triplicate prescriptions" for certain classes of drugs [http://www.cpsa.ab.ca/collegeprograms/attachments_tpp/tpp%20information%20for%20prescriber.doc]. Blank triplicates are only available from the regulating agency and are individually numbered. The doctor retains a copy, the second and third copies are given to the patient to give to the pharmacist. The pharmacist retains the second copy and the third copy is submitted to the regulating agency. The regulating agency can issue lists of stolen prescriptions that pharmacists can check. In this example, the prescription's validity is further limited to 72 hours from issuance. This system also has the further benefit of managing "double doctoring" where patients visit multiple doctors to get prescriptions. States have various laws making theft of prescription blanks or forgery of prescriptions criminal offenses and/or providing special treatment for these offenses (for Example N.J. Stat. 2C:21-1. making forgery of a prescription blank a third degree rather than fourth degree offense).[http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=35399066&Depth=2&TD=WRAP&advquery=prescription%20blank&depth=4&expandheadings=on&headingswithhits=on&hitsperheading=on&infobase=statutes.nfo&rank=&record=&softpage=Document42&wordsaroundhits=2&zz=] When forgery is suspected, pharmacists will call the doctor to verify the prescription and will attempt to detain the suspect pending arrival of authorities. Forged prescriptions are no longer considered medical documents and doctor-patient confidentiality rules no longer apply.

Writing prescriptions

Who can write prescriptions

Who can issue prescriptions are governed by local legislation. In the United States, physicians, veterinarians, dentists, and podiatrists have full prescribing power. In all states optometrists will also issue eyeglass prescriptions for corrective eyeglasses though technically these are not medical prescriptions. In many states, optometrists cannot prescribe medication. States allow mid-level practitioners different prescription privileges. Nurse practitioners (also known as advance practice nurses), physician assistants, optometrists, homeopathic physicians, registered pharmacists, naturopathic physicians, and doctors of oriental medicine currently represent the spectrum of mid-level practitioners. Each state regulates what (if any) prescription powers members of the above group are allowed. Florida, for example, prohibits every member of the above group from any prescription power, where as North Dakota allows registered pharmacists to prescribe certain medications[http://www.deadiversion.usdoj.gov/drugreg/practioners/index.html].In some states, clinical psychologists (PhD's or PsyD's) who have also undergone specialized training in script-writing may prescribe a limited number of drugs to treat nervous and mental disorders.

Legibility of prescriptions

Prescriptions, when handwritten, are notorious for being often illegible (5% according to an Irish study [http://www.imj.ie/news_detail.php?nNewsId=2553&nVolId=98]). Contrary to popular belief, pharmacists do not have special deciphering skills. When in doubt, they call the doctor. At other times, even though some of the individual letters are illegible, the position of the legible letters and length of the word is sufficient to distinguish the medication based on the knowledge of the pharmacist. For doctors that the pharmacist deals with regularly, they learn to read the doctor's handwriting. Patients are advised to ensure that the prescription is legible before leaving the doctor's office. Some jurisdictions have made legible prescriptions a law (e.g. Florida[http://www.flsenate.gov/data/session/2003/senate/bills/billtext/pdf/s2084er.pdf]). Some have advocated the elimination of handwritten prescriptions altogether [http://www.ismp.org/msaarticles/whitepaper.html] and computer printed prescriptions are becoming increasingly common in some places. However, in the United States, computer-printed prescriptions cannot be used to prescribe Schedule II medications; prescriptions for these medications must be in the physician's handwriting, or typewritten, and actually signed by the physician.

Writing good prescriptions

Independent of the actual prescribing decision, elements of a good prescription writing include: [http://bnf.org/bnf/bnf/current/doc/29420.htm] [http://www.healthlibrary.com/reading/rdb/april98/good.htm] [http://www.aafp.org/fpm/20020700/27pres.html]
- careful use of decimal points to avoid ambiguity:
- avoid unnecessary decimal points: 5 mL instead of 5.0 mL to avoid possible misinterpretation of 5.0=50
- always zero prefix decimals: e.g. 0.5 instead of .5 to avoid misinterpretation with .5=5
- never have trailing zeros on decimals: e.g. use 0.5 instead of .50 to avoid misinterpretation with .50=50
- avoid decimals altogether by changing the units: 0.5 g =500 mg
- "mL" is used instead of "cc" or "cm³" even though they are technically equivalent
- directions should be written out in full in English although some common Latin abbreviations are listed below
- quantities can be given directly or implied by the frequency & duration of the directions
- where the directions are "as needed" the quantity should always be specified
- where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication
- use permanent ink
- avoid prn "as needed" - limits & indicators should be specified e.g. "q 3h prn pain"
- for refills - minimum duration between repeats & number of repeats should be specified

Abbreviations

See Appendix 1 for a complete list of common abbreviations found on prescriptions. Many abbreviations are derived from Latin phrases. Hospital pharmacies have more abbreviations, some specific to the hospital. Different jurisdictions follow different conventions on what is abbreviated or not. Prescriptions that don't follow area conventions may be flagged as possible forgeries. Some abbreviations which are ambiguous, or which in their written form might be confused with something else, are not recommended and should be avoided. These are included in a separate list in Appendix 1.

Non prescription drug prescriptions

Prescriptions are also used for things that are not strictly regulated as a prescription drug. Doctors will often give non-prescription drugs out as prescriptions because drug benefit plans may reimburse the patient only if the over-the-counter medication is taken under the direction of a doctor. Conversely, if a medication is available over-the-counter, doctors may ask patients if they want it as a prescription and possibly incur a pharmacist's dispensing fee or whether they want to get it themselves at a lower price. If the patient wants the medication not under prescription, the doctor is usually careful to give the medication name to the patient on a blank piece of paper to avoid any confusion with a prescription. This is applied to non-medications as well. For example, crutches, and registered massage therapy may be reimbursed under some health plans, but only if given out by a doctor as a prescription. Doctors will often use blank prescriptions as general letterhead. A "doctor's note" for absent days from school or work for minor illnesses will often be written on a blank prescription. Legislation may define certain equipment as "prescription devices"[http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFRSearch.cfm?FR=801.109]. Such prescription devices can only be used under the supervision of authorized personnel and such authorization is typically documented using a prescription. Examples of prescription devices include dental cement (for affixing braces to tooth surfaces), various prothesis, gut sutures, sickle cell tests, cervical cap and ultrasound monitor. In some jurisdictions, hypodermic syringes are in a special class of its own, regulated as illicit drug use accessories[http://www.legis.state.il.us/legislation/ilcs/ch720/ch720act635.htm] separate from regular medical legislation. Such legislation will often specify a prescription as the mean by which one may legally possess syringes.

Related usage of the term prescription

Prescription may also be used as a short form for prescription drugs to distinguish from over-the-counter drugs. It may also be used in reference to the entire system of controlling drug distribution (as opposed to illicit drugs). "Prescription" is often used as a metaphor for healthy directions from authority. A "green prescription" is direction from a doctor to a patient for exercise and healthy diet.

History

The concept of prescriptions date back to the beginning of history. So long as there were medications and a writing system to capture directions for preparation and usage, there were prescriptions [http://www.pharmacy.wsu.edu/History/history02.html][http://139.80.66.65/edmedia/HxPharmacy/Pharmacy_main.asp?doMove=NEXT&thisFile=main_002.txt]. Modern prescriptions are actually "extemporaneous prescriptions" from the Latin (ex tempore) for "instant"[http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=extemporaneous]. "Extemporaneous" means the prescription is written on the spot for a specific patient with a specific ailment. This is distinguished from the a non-extemporaneous prescription which is a generic recipe for a general ailment. Modern prescriptions evolved with the separation of the role of the pharmacists from that of the physician[http://www.bartleby.com/65/ph/pharmacy.html]. Today the term "extemporaneous prescriptions" is reserved for "compound prescriptions" which requires the pharmacist to mix or "compound" the medication in the pharmacy for the specific needs of the patient. Predating modern legal definitions of a prescription, a prescription traditionally is composed of four parts: a "superscription", "inscription", "subscription" and "signature"[http://www.henriettesherbal.com/eclectic/potter-comp/prescription.html]. The superscription section contains the date of the prescription and patient information (name, address, age, etc). The symbol "Rx" separates the superscription from the inscriptions sections. In this arrangement of the prescription, the "Rx" is a symbol for recipe or literally "take thou". This is most likely an exhortation to the pharmacist by the doctor, "I want the patient to have the following medication"[http://www.vnh.org/HospitalCorpsman14295/14295_ch6.pdf]. It should not be interpreted as instructions to the patient to "take thou" as patient instructions are in a later section. Some the literal exhortation to the pharmacist is "take thou this recipe". The inscription section defines what is the medication. The inscription section is further composed of one or more of[http://2.1911encyclopedia.org/T/TH/THERAPEUTICS.htm]:
- a "basis" or chief ingredient indended to cure (curare)
- an "adjuvant" to assist its action and make it cure quickly (cito)
- a "corrective" to prevent or lessen any undesirable effect (tuto)
- a "vehicle" or "excipient" to make it suitable for administration and pleasant to the patient (jucunde) The "subscription" section contains dispensing directions to the pharmacist. This may be compounding instructions or quantities. The "signature" section contains directions to the patient[http://www.m-w.com/cgi-bin/dictionary?book=Dictionary&va=signature] and is often abbreviated "Sig."[http://www.bartleby.com/61/96/S0399600.html] or "Signa." It also obviously contains the signature of the prescribing doctor though the word "signature" has two distinct meanings here and the abbreviations are sometimes used to avoid confusion. Thus sample prescriptions in modern textbooks are often presented as: Rx: medication Disp.: dispensing instructions Sig.: patient instructions

Future directions of prescriptions

As a prescription is nothing more than information among a doctor, pharmacist and patient, information technology can be applied to it. Existing information technology is adequate to print out prescriptions. Medical information systems in some hospitals do away with prescriptions within the hospital. There are proposals to securely transmit the prescription from the doctor to the pharmacist using smartcards and the internet[http://www.computer.org/proceedings/hicss/1435/volume6/14350156babs.htm]. In the UK a project called the Electonic Transfer of Presctions (ETP) within the National Programme for IT (NPfIT) is currently piloting such a scheme between doctors and pharmacies. Within computerized pharmacies, the information on the piece of paper that is the prescription is captured immediately. Thereafter, the prescription is simply an entry within the pharmacy's information system and the paper prescription is stored for legal reasons only. In cases where a pharmacy is part of a chain of pharmacies, the pharmacies are often linked together through their corporate headquarters with computer technology. Walgreens, for example, uses satellite technology to share patient information. A person who has a prescription filled at one Walgreens can get a refill of that prescription at any other store in the chain, as well as have their information available for new prescriptions at any Walgreens. Some pharmacies also offer services to customers over the internet. Walgreens' web site, for example, allows customers to order refills for medicine over the internet, and allows them to specify the store that they will pick up the medicine from. Their web site also allows consumers to lookup their prescription history, and to print it out. Pharmacy information systems are a potential source of valuable information for pharmaceutical companies as it contains information about doctor's prescribing habits. Prescription data mining of such data is a developing, specialized field[http://collection.nlc-bnc.ca/100/201/300/cdn_medical_association/cmaj/vol-163/issue-9/1146.htm]. ----

Appendix 1: Complete list of abbreviations

This appendix is meant to be a complete list of all abbreviations used in prescriptions. Its listing here does not mean such abbreviations should be used. See main article for discussion on the use of abbreviations. This listing does not include abbreviations for actual pharmaceuticals (which is a separate article in itself.) Capitalization and the use of a period is a matter of style. In the attached list, Latin is not capitalized whereas English acronyms are. The period is used wherever there are letters omitted in the abbreviation.
- aa (ana) - of each
- ad - to, up to
- a.c. (ante cibum) - before meals
- a.d. (aurio dextra) - right ear
- ad lib. (ad libitum) - use as much as one desires; freely
- admov. (admove) - apply
- agit (agita) - stir/shake
- alt. h. (alternis horis) - every other hour
- a.m. (ante meridiem) - morning, before noon
- amp - ampule
- amt - amount
- aq (aqua) - water
- a.l., a.s. (aurio laeva, aurio sinister) - left ear
- A.T.C. - around the clock
- a.u. (auris utrae) - both ears
- bis (bis) - twice
- b.i.d. (bis in die) - twice daily
- B.M. - bowel movement
- bol. (bolus) - a large pill
- B.S. - blood sugar
- B.S.A - body surface areas
- cap., caps. (capsula) - capsule
- c (cum) - with (usually written with a bar on top of the "c")
- c (cibos) - food
- cc - cubic centimetre; also means "with food" (cum cibos)
- cf - with food
- C.H.F. - congestive heart failure
- comp. - compound
- cr., crm - cream
- D5W - dextrose 5% solution (sometimes written as D₅W)
- D5NS - dextrose 5% in normal saline (0.9%)
- D.A.W. - dispense as written
- dc, D/C, disc - discontinue
- dieb. alt. (diebus alternis) - every other day
- dil. - dilute
- disp. - dispense
- div. - divide
- d.t.d. (dentur tales doses) - give of such doses
- D.W. - distilled water
- elix. - elixir
- e.m.p. (ex modo prescripto) - as directed
- emuls. (emulsum) - emulsion
- et - and
- ex aq - in water
- fl., fld. - fluid
- ft. (fiat) - make; let it be made
- g - gram
- G.I. - gastrointestinal
- gr - grain
- gtt(s) (gutta(e)) - drop(s)
- G.U. - gentiourinary
- H - hypodermic
- h, hr - hour
- H.A. - headache
- H.B.P. - high blood pressure
- h.s. (hora somni) - at bedtime
- HTN - hypertension
- ID - intradermal
- IM - intramuscular (with respect to injections)
- inj. (injectio) - injection
- IP - intraperitoneal
- IV - intravenous
- IVP - intravenous push
- IVPB - intravenous piggyback
- L.A.S. - label as such
- LCD - coal tar solution
- lin (linimentum) - liniment
- liq (liquor) - solution
- lot. - lotion
- M. (misce) - mix
- m, min (minimum) - a minimum
- mcg - microgram
- mEq - milliequivalent
- mg - milligram
- mist. (mistura) - mix
- mitte (mitte) - send
- mL - millilitre
- N&V, N/V - nausea and vomiting
- nebul (nebula) - a spray
- N.K.A. - no known allergies
- N.K.D.A. - no known drug allergies
- N.M.T. - not more than
- noct. (nocte) - at night
- non rep. (non repetatur) - no repeats
- NPO, n.p.o. (nil per os) - nothing by mouth
- NS - normal saline (0.9%)
- 1/2NS - half normal saline (0.45%)
- N.T.E. - not to exceed
- o_2 - both eyes, sometimes written as o₂
- o.d. (oculus dexter) - right eye
- o.s. (oculus sinister) - left eye
- o.u. (oculo utro) - both eyes
- oz - ounce
- per - by or through
- p.c. (post cibum) - after meals
- p.m. (post meridiem) - evening or afternoon
- prn (pro re nata) - as needed
- p.o. (per os) - by mouth or orally
- p.r. - by rectum
- pulv. (pulvis) - powder
- q (quaque) - every
- q.a.d. (quoque alternis die) - every other day
- q.h. (quaque hora) - every hour
- q.1h (quaque 1 hora) - every 1 hour; (can replace "1" with other numbers)
- q.d. (quaque die) - every day
- q.i.d. (quater in die) - four times a day
- q.o.d. - every other day
- q.s. (quantum sufficiat) - a sufficient quantity
- R- rectal
- rep., rept. (repetatur) - repeats
- RL, R/L - Ringer's lactate
- s (sine) - without (usually written with a bar on top of the "s")
- s.a. (secundum artum) - use your judgement
- SC, subc, subq, subcut - subcutaneous
- sig - write on label
- SL - sublingually, under the tongue
- S.O.B. - shortness of breath
- sol (solutio) - solution
- s.o.s., si op. sit (si opus sit) - if there is a need
- ss (semis) - one half
- stat (statim) - immediately
- supp (suppositorium) - suppository
- susp - supsension
- syr (syrupus) - syrup
- tab (tabella) - tablet
- tal., t (talus) - such
- tbsp - tablespoon
- troche (trochiscus) - lozenge
- tsp - teaspoon
- t.i.d. (ter in die) - three times a day
- t.i.w. - three times a week
- top. - topical
- T.P.N. - total parenteral nutrition
- tr, tinc., tinct. - tincture
- u.d., ut. dict. (ut dictum) - as directed
- ung. (unguentum) - ointment
- U.R.I. - upper respitory infection
- U.S.P. - United States Pharmacopoeia
- U.T.I. - urinary tract infection
- vag - vaginally
- V.S. - vital signs
- w - with
- W.B.C. - white blood count
- w/o - without
- X - times
- Y.O. - years old To avoid ambiguity, the following abbreviations are not recommended [http://www.nccmerp.org/council/council1996-09-04.html]:
- a.u., a.d., a.s. - Latin for both, left and right ears; the "a" can be misread to be an "o" and interpreted to mean both, right or left eyes
- d/c - can mean "discontinue" or "discharge"
- h.s. - can mean half strength or "hour of sleep"
- q.d. - meant "every day" but the "." after the "q" is interpreted to be an "i" thus "q.i.d." or quadrupling the dose to 4 times a day
- q.o.d. - meant "every other day" but the "o" can be interpreted as "." or "i" resulting in double or eight times the frequency
- SC/SQ - meant "subcutaneaous" but mistaken for "SL" for "sublingual"
- T.I.W - meant 3 times a week but mistaken for twice a week
- U - meant "units" but mistaken for "0", "4" or "cc" when poorly written; conversely cc can be mistaken for "U"
- μg - meant "microgram" but mistaken for "mg"; this 1000-fold error can cause potentially fatal misunderstandings

Exhibit A: sample legal definition of a prescription

Taken from California's Business and Professions Code Section 4040 [http://www.leginfo.ca.gov/cgi-bin/displaycode?section=bpc&group=04001-05000&file=4015-4043]: :4040. (a) "Prescription" means an oral, written, or electronic transmission order that is both of the following: ::(1) Given individually for the person or persons for whom ordered that includes all of the following:
:::(A) The name or names and address of the patient or patients.
:::(B) The name and quantity of the drug or device prescribed and the directions for use.
:::(C) The date of issue.
:::(D) Either rubber stamped, typed, or printed by hand or typeset, the name, address, and telephone number of the prescriber, his or her license classification, and his or her federal registry number, if a controlled substance is prescribed.
:::(E) A legible, clear notice of the condition for which the drug is being prescribed, if requested by the patient or patients.
:::(F) If in writing, signed by the prescriber issuing the order, or the certified nurse-midwife, nurse practitioner, or physician assistant who issues a drug order pursuant to Section 2746.51,2836.1, or 3502.1.
::(2) Issued by a physician, dentist, optometrist, podiatrist, or veterinarian or, if a drug order is issued pursuant to Section 2746.51, 2836.1, or 3502.1, by a certified nurse-midwife, nurse practitioner, or physician assistant licensed in this state.
:::(b) Notwithstanding subdivision (a), a written order of the prescriber for a dangerous drug, except for any Schedule II controlled substance, that contains at least the name and signature of the prescriber, the name and address of the patient in a manner consistent with paragraph (3) of subdivision (b) of Section 11164 of the Health and Safety Code, the name and quantity of the drug prescribed, directions for use, and the date of issue may be treated as a prescription by the dispensing pharmacist as long as any additional information required by subdivision (a) is readily retrievable in the pharmacy. In the event of a conflict between this subdivision and Section 11164 of the Health and Safety Code, Section 11164 of the Health and Safety Code shall prevail.
:::(c) "Electronic transmission prescription" includes both image and data prescriptions. "Electronic image transmission prescription" means any prescription order for which a facsimile of the order is received by a pharmacy from a licensed prescriber. "Electronic data transmission prescription" means any prescription order, other than an electronic image transmission prescription, that is electronically transmitted from a licensed prescriber to a pharmacy.
:::(d) The use of commonly used abbreviations shall not invalidate an otherwise valid prescription.
:::(e) Nothing in the amendments made to this section (formerly Section 4036) at the 1969 Regular Session of the Legislature shall be construed as expanding or limiting the right that a chiropractor, while acting within the scope of his or her license, may have to prescribe a device.

Exhibit B: sample legal requirement for storage of prescriptions

From the Mississippi Board of Pharmacy [http://www.mbp.state.ms.us/pharma15.htm]: :ARTICLE XIII PRESCRIPTIONS TO BE FILED
:1. All prescriptions shall be filed in one of the following ways:
::A. Three separate files may be maintained; a file for Schedule II prescriptions dispensed; a file for Schedule III, IV and V prescriptions dispensed; and a file for all other prescriptions dispensed.
::B. Two files may be maintained; a file for all Schedule II prescriptions dispensed and another file for all other prescriptions dispensed, including those in Schedule III, IV and V. If this method is used, the prescriptions for Schedule III, IV and V substances must be stamped with the letter "C" in red ink, not less than one inch high, in the lower right-hand corner. This distinctive marking makes the records readily retrievable for inspection. Pharmacies with automatic data processing systems are exempted from marking Schedule III, IV and V controlled substance prescriptions with the red "C".
:2. A hard copy of original prescriptions, whether records are maintained manually or in a data processing system, shall be assigned a serial number and maintained by the pharmacy in numerical and chronological order. All prescriptions shall be maintained for at least five years from the date of original dispensing.
:3. If a pharmacy utilizes a data processing system for record keeping, all computer generated labels should be affixed to the prescription document in such a manner as not to obscure information on the face of the document.

Exhibit C: sample legal requirements for security and format

From Indiana Board of Pharmacy [http://www.state.in.us/legislative/register/Vol24/12Sep/08Q856010150.pdf]: :856 IAC 1-34-2 Security feature requirements
:Authority: IC 35-48-7-8
:Affected: IC 16-42-19-5
:Sec. 2. (a) All controlled substance prescriptions written by licensed Indiana practitioners, as defined by IC 16-42-19-5, must contain the following security features: ::(1) A latent, repetitive "void" pattern screened at five percent (5%) in reflex blue must appear across the entire face of the document when the prescription is photocopied. ::(2) There shall be a custom artificial watermark printed on the back side of the base paper so that it may only be seen at a forty-five (45) degree angle. The watermark shall consist of the words "Indiana Security Prescription", appearing horizontally in a step-and-repeated format in five (5) lines on the back of the document using 12-point Helvetica bold type style. ::(3) An opaque RX symbol must appear in the upper right-hand corner, one-eighth (c) of an inch from the top of the pad and five-sixteenths ( 5 /16) of an inch from the right side of the pad. The symbol must be three-fourths (3/4) inch in size and must disappear if the prescription copy is lightened. ::(4) Six (6) quantity check-off boxes must be printed on the form and the following quantities must appear and the appropriate box be checked off for the prescription to be valid: :::(A) 1-24 :::(B) 25-49 :::(C) 50-74 :::(D) 75-100 :::(E) 101-150 :::(F) 151 and over. ::(5) No advertisements may appear on the front or back of the prescription blank. ::(6) Logos, defined as a symbol utilized by an individual, professional practice, professional association, or hospital, may appear on the prescription blank. The upper left one (1) inch square of the prescription blank is reserved for the purpose of logos. Only logos, as defined by this subdivision, may appear on the prescription blank. ::(7) Only one (1) prescription may be written per prescription blank. The following statement must be printed on the bottom of the pad: "Prescription is void if more than one (1) prescription is written per blank.". ::(8) Refill options that can be circled by the prescriber must appear below any logos and above the signature lines on the left side of the prescription blank in the following order: Refill NR 1 2 3 4 5 Void after_____. ::(9) Practitioner name and state issued professional license number must be preprinted, stamped, or manually printed on the prescription. ::(10) All prescription blanks printed under this rule shall be four and one-fourth (4-1/4) inches high and five and one-half (5-1/2) inches wide. :(b) Nothing in this rule shall prevent licensed Indiana practitioners from utilizing security paper prescriptions for the prescribing of any legend drug. (Indiana Board of Pharmacy; 856 IAC 1-34-2; filed Jul 5, 1995, 9:45 a.m.: 18 IR 2782, eff Jan 1, 1996)

Exhibit D: sample requirements on information added by the pharmacist

Taken from the Ontario's Drug and Pharmacies Regulation Act [http://www.ocpinfo.com/client/ocp/OCPHome.nsf/(LegislationForWeb)/Drug+and+Pharmacies+Regulation+Act+Act!OpenDocument&PFV], paragraph 156.
:(1) Every person who dispenses a drug pursuant to a prescription shall ensure that the following information is recorded on the prescription, ::(a) the name and address of the person for whom the drug is prescribed; ::(b) the name, strength (where applicable) and quantity of the prescribed drug; ::(c) the directions for use, as prescribed; ::(d) the name and address of the prescriber; ::(e) the identity of the manufacturer of the drug dispensed; ::(f) an identification number or other designation; ::(g) the signature of the person dispensing the drug and, where different, also the signature of the person receiving a verbal prescription; ::(h) the date on which the drug is dispensed; ::(i) the price charged. R.S.O. 1990, c. H.4, s. 156 (1).

Exhibit E: New Jersey requirements for prescription blanks

From New Jersey official statutes:[http://lis.njleg.state.nj.us/cgi-bin/om_isapi.dll?clientID=35399066&Depth=4&TD=WRAP&advquery=prescription%20blank&headingswithhits=on&infobase=statutes.nfo&rank=&record=&softpage=Q_Frame_Pg42&wordsaroundhits=2&zz=] :45:14-55 Use of New Jersey Prescription Blanks. :16. a. A practitioner practicing in this State shall use non-reproducible, non-erasable safety paper New Jersey Prescription Blanks bearing that practitioner's license number whenever the practitioner issues prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. :b.A licensed practitioner practicing in this State shall maintain a record of the receipt of New Jersey Prescription Blanks. The practitioner shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the practitioner's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action, including notification to the Department of Human Services and the Attorney General. :45:14-56 Health care facility prescriptions. :17. a. Prescriptions issued by a health care facility licensed pursuant to P.L.1971, c.136 (C.26:2H-1 et seq.) shall be written on non-reproducible, non-erasable safety paper New Jersey Prescription Blanks. The prescription blanks shall be secured from a vendor approved by the Division of Consumer Affairs in the Department of Law and Public Safety. The New Jersey Prescription Blanks shall bear the unique provider number assigned to that health care facility for the issuing of prescriptions for controlled dangerous substances, prescription legend drugs or other prescription items. :b.A health care facility shall maintain a record of the receipt of New Jersey Prescription Blanks. The health care facility shall notify the Office of Drug Control in the Division of Consumer Affairs as soon as possible but no later than 72 hours of being made aware that any New Jersey Prescription Blank in the facility's possession has been stolen. Upon receipt of notification, the Office of Drug Control shall take appropriate action including notification to the Department of Human Services and the Attorney General. :45:14-57 Requirements for prescription to be filled. :18.A prescription issued by a practitioner or health care facility licensed in New Jersey shall not be filled by a pharmacist unless the prescription is issued on a New Jersey Prescription Blank bearing the practitioner's license number or the unique provider number assigned to a health care facility. :45:14-59 Format for New Jersey Prescription Blanks. :20.The Division of Consumer Affairs in the Department of Law and Public Safety shall establish the format for uniform, non-reproducible, non-erasable safety paper prescription blanks, to be known as New Jersey Prescription Blanks, which format shall include an identifiable logo or symbol that will appear on all prescription blanks. The division shall approve a sufficient number of vendors to ensure production of an adequate supply of New Jersey Prescription Blanks for practitioners and health care facilities statewide.

Prescription only medicine

A prescription drug (or POM Prescription Only Medicine, in UK) is a licensed medicine that is regulated by legislation to require a prescription before it can be obtained. The term is used to distinguish it from over the counter drugs which can be obtained without a prescription. Different jurisdictions have different definitions of what constitutes a prescription drug. As a general rule, over the counter drugs are used to treat conditions not necessarily requiring a doctor's care and will have been proven to meet higher safety standards for self-medication by patients. Often a lower dosage of a drug will be approved for OTC use, while higher dosages will remain the province of a doctor's prescription; a notable case is ibuprofen, which has been widely available as an OTC pain killer since the mid-1980s but is still available in doses up to four times the OTC dose for use in cases of severe orthopedic pain. In the United States, the Controlled Substances Act defines what requires a prescription. Prescription drugs are generally authorized by doctors, though nurse practitioners do an increasing amount of drug prescribing. It is generally required that a physician or a nurse practitioner write the prescription; nurses, emergency medical technicians, psychologists (but not psychiatrists, who are MDs), as examples, do not generally have the authority to prescribe drugs. Unlike many other countries, the United States does not have price controls for prescription drugs, and US drug prices are often perceived as inflated in comparison to other countries; therefore, most health insurance programs (generally partially or in full paid for by the patient's employer) have prescription payment plans where the patient pays only a small copayment and the pharmacy is reimbursed for the rest of the cost by the insurance company. In England a patient visits a doctor (usually a general practitioner in the first instance) who is able to prescribe medicines. Each item on the prescription is liable to a prescription charge of £6.40 (as of April 2004). Those requiring regular prescriptions may make a saving by purchasing a pre-payment certificate which covers the cost of all prescriptions required for four months (at a cost of £33.40) or the year (at a cost of £91.80). The money is used to help fund the National Health Service. The devolved legislatures of Scotland and Wales were examining, in 2004, proposals to scrap the charge and provide free prescriptions for all.

External links

- Partnership for a Drug-Free America study finds 1 in 5 teens abused prescription drugs on Wikinews, April 21, 2005
- [http://medcatalog.net Prescription Drug and Medicine Information] Category:Pharmacology

United Kingdom

:For other meanings of the terms "United Kingdom" and "UK" , see United Kingdom (disambiguation) and UK (disambiguation). :For an explanation of terms like England, (Great) Britain and United Kingdom see British Isles (terminology). The United Kingdom of Great Britain and Northern Ireland (usually shortened to the United Kingdom or the UK) is a country located off the north-western coast of continental Europe, surrounded by the North Sea, the English Channel, the Celtic Sea, the Irish Sea, and the Atlantic Ocean. It is composed of four constituent parts: three constituent countries—England, Scotland, and Wales—on the island of Great Britain, and the province of Northern Ireland on the island of Ireland. The border between Northern Ireland and the Republic of Ireland forms the United Kingdom's principal international land border, although there is a nominal frontier with France in the middle of the Channel Tunnel. The UK has several overseas territories and the Crown dependencies of the Isle of Man and the Channel Islands come under the UK's sovereignty. The UK also has close relationships with the fifteen other Commonwealth Realms, as they all share the same head of state. The UK is also one of the largest member states of the European Union and a founding partner of both the UN and NATO.
Terminology

- United Kingdom of Great Britain and Northern Ireland: The official name for the sovereign state
- United Kingdom: an abbreviation of United Kingdom of Great Britain and Northern Ireland
- Britain: an informal term that sometimes means United Kingdom of Great Britain and Northern Ireland and sometimes means Great Britain
- British: an informal term that sometimes means from the United Kingdom of Great Britain and Northern Ireland and sometimes means from Great Britain
- Great Britain (as a geographical term): the largest island of the British Isles
- Great Britain (as a political term): England + Wales + Scotland
- British Isles (as a geographical term): Great Britain + Ireland + many smaller surrounding islands. This term is disputed, please see below.
- Ireland (as a geographical term): the second largest island of the British Isles
- Ireland (as a political term): an abbreviation of the Republic of Ireland, a sovereign state on the island of Ireland
- Northern Ireland: a political region of the United Kingdom of Great Britain and Northern Ireland
- Ulster (as a geographical term): Often used to refer to Northern Ireland. It is derived from the Irish Language term 'Ulad.' It was one of the ancient Irish provinces (the others were Connaught, Leinster and Munster.). Although it is normally used to refer to Northern Ireland, Ulster also (traditionally) includes Counties Cavan, Monaghan and Donegal, which lie in the Republic of Ireland. The term Ulster is often favoured by the Protestant community.
History
Protestant Today's state is the latest of several unions formed over the last 1000 years. Scotland and England have existed as separate unified entities since the 10th century. Wales, under English control since the Statute of Rhuddlan in 1284, became part of the Kingdom of England by the Laws in Wales Act 1535. With the Act of Union 1707, the separate kingdoms of England and Scotland, having shared the same monarch since 1603, agreed to a permanent union as the Kingdom of Great Britain. The Act of Union 1800 united the Kingdom of Great Britain with the Kingdom of Ireland, which had been gradually brought under English control between 1169 and 1691, to form the United Kingdom of Great Britain and Ireland. The United Kingdom of Great Britain and Northern Ireland was formed in 1922, after bitter fighting which echoes down to the current political strife, the Anglo-Irish Treaty partitioned Ireland into the Irish Free State and Northern Ireland, with the latter remaining part of the United Kingdom. As provided for in the treaty, Northern Ireland, which consists of six of the nine counties of the Irish province of Ulster, immediately opted out of the Free State and to remain in the UK. The nomenclature of the UK was changed in 1927 to recognise the departure of most of Ireland, with the current name being adopted. 1927 The United Kingdom, the dominant industrial and maritime power of the 19th century, played a leading role in developing Western world ideas of property, liberty, capitalism and parliamentary democracy - to say nothing of its part in advancing world literature and science. At its zenith, the British Empire stretched over one quarter of the Earth's surface and encompassed a third of its population. The first half of the 20th century saw the UK's strength seriously depleted from the effects of World War I and World War II. The second half witnessed the dismantling of the Empire and the UK rebuilding itself into a modern and prosperous nation. The UK has been a member of the European Union since 1973. Its attitude towards further integration is conservative, and there is significant Euroscepticism in UK politics. It has not chosen to adopt the Euro, owing to internal political considerations and the government's judgement of the prevailing economic conditions.
Government and politics
The United Kingdom is a constitutional monarchy, with executive power exercised on behalf of the Queen by the Prime Minister and other cabinet ministers who head departments. The cabinet, including the Prime Minister, and other ministers collectively make up Her Majesty's Government. These ministers are drawn from and are responsible to Parliament, the legislative body, which is traditionally considered to be "supreme" (that is, able to legislate on any matter and not bound by decisions of its predecessors). The UK is one of the few countries in the world today that does not have a codified constitution, relying instead on customs and separate pieces of constitutional law. While the monarch is Head of State and holds all executive power, it is the Prime Minister who is the head of government. The government is answerable chiefly to the House of Commons and the Prime Minister is drawn from this chamber of Parliament by constitutional convention. The majority of cabinet members will be from the House of Commons, the rest from the House of Lords. Ministers do not, however, legally have to come from Parliament, though that is the modern day custom. The British system of government has been emulated around the world - a legacy of the United Kingdom's colonial past - most notably in the other Commonwealth Realms. The Prime Minister is chosen as the MP who can command a majority in the House of Commons - usually the leader of the largest party or, if there is no majority party, the largest coalition. The current Prime Minister is Tony Blair of the Labour Party, who has been in office since 1997. In the United Kingdom the monarch has extensive theoretical powers, but his or her role is mainly, though not exclusively, ceremonial. The monarch is an integral part of Parliament (as the "Crown-in-Parliament") and theoretically gives Parliament the power to meet and create legislation. An Act of Parliament does not become law until it has been signed by the Queen (being given Royal Assent), although no monarch has refused to assent to a bill that has been approved by Parliament since Queen Anne in 1708. Although the abolition of the monarchy has been suggested several times, the popularity of the monarchy remains strong in spite of recent controversies. Support for a British republic usually fluctuates between 15% and 25% of the population, with roughly 10% undecided or indifferent [http://www.mori.com/mrr/2000/c000616.shtml]. The current monarch is Queen Elizabeth II who acceded to the throne in 1952 and was crowned in 1953. Parliament is the national legislature of the United Kingdom. It is the ultimate legislative authority in the United Kingdom, according to the doctrine of parliamentary sovereignty. It is bicameral, composed of the elected House of Commons and the unelected House of Lords, whose members are mostly appointed. The House of Commons is the more powerful of the two houses. The House of Commons has 646 members who are directly elected from single-member constituencies based on population. The House of Lords has 724 members (though this number is not fixed): hereditary peers, life peers, and bishops of the Church of England. The Church of England is the established church of the state in England. established church]] The two largest political parties are the Labour Party and Conservative Party. The UK has long had a two-party system, but in the last 20 years the Liberal Democrats have re-emerged as a large third party. The electoral system used for general elections is first-past-the-post. The constitution of the United Kingdom is un-codified and partially unwritten, which means that no single document regulates how the government works, and unwritten constitutional conventions are used extensively. The constitution is based on the principle that Parliament is the ultimate sovereign body in the country. There has long been a widespread sense of national identity in the Celtic nations. Throughout the late 19th century the UK debated giving Ireland home rule. The Scottish National Party was founded in 1934, and Plaid Cymru (Party of Wales) in 1925. Referenda for devolution succeeded in 1997 for Scotland and Wales and in 1998 for Northern Ireland. In 1999, the Scottish Parliament and the National Assembly for Wales were established, the former having primary legislative power. Proportional representation is used for the elections, which has resulted in a Labour-Liberal Democrat coalition government in Scotland. Due to internal disagreements, the Northern Ireland Assembly has been suspended since 2002.
Subdivisions
The United Kingdom is a country that is divided into four constituent parts:
- England
- Scotland
- Northern Ireland
- Wales The constituent parts of the United Kingdom have administrative subdivisions as follows:
- The regions and administrative counties of England
- The council areas of Scotland
- The counties and county boroughs of Wales
- The districts of Northern Ireland The Laws in Wales Act 1535 incorporated Wales and England into England and Wales for legal purposes. Although all four have historically been divided into counties, England's population is an order of magnitude larger than the others so in recent years it has for some purposes been divided into nine intermediate-level Government Office Regions. Each region is made up of counties and unitary authorities, apart from London, which consists of London boroughs. Although at one point it was intended that each or some of these regions would be given its own regional assembly, the plan's future is uncertain, as of 2004, after the North East region rejected its proposed assembly in a referendum. Scotland consists of 32 Council Areas. Wales consists of 22 Unitary Authorities, styled as 10 County Boroughs, 9 Counties, and 3 Cities. Northern Ireland is divided into 26 Districts. Also sometimes associated with the United Kingdom, though not constitutionally part of the United Kingdom itself, are the Crown dependencies (the Bailiwicks of Jersey and Guernsey, and the Isle of Man) as self-governing possessions of the Crown, and a number of overseas territories under the sovereignty of the United Kingdom.
Military
The armed forces of the United Kingdom are known as the British Armed Forces or Her Majesty's Armed Forces, officially the Armed Forces of the Crown. Their Commander-in-Chief is the Queen and they are managed by the Ministry of Defence. Ministry of Defence The British Armed Forces are charged with protecting the United Kingdom and its overseas territories, promoting the United Kingdom's wider security interests, and supporting international peacekeeping efforts. They are active and regular participants in NATO and other coalition operations. The United Kingdom fields one of the most powerful and comprehensive military forces in the World. Its global power projection capabilities are second only to those of the United States Armed Forces. The British Army had a reported strength of 112,700 in 2004, including 7,600 women, and the Royal Air Force a strength of 53,400. The 40,900-member Royal Navy is in charge of the United Kingdom's independent strategic nuclear arm, which consists of four Trident Ballistic Missile Submarines, while the Royal Marines provide infantry units for amphibious assault and for specialist reinforcement forces in and beyond the NATO area. This puts total active duty military troops in the 210,000 range, currently deployed in over 80 countries. The UK's special forces, principally the SAS, provides elite commandos trained for quick, mobile, military responses; often where secrecy or covert operations are required. The Royal Navy is the second largest navy in the World in terms of gross tonnage. Despite the United Kingdom's wide ranging capabilities, recent pragmatic defence policy has a stated assumption that any large operation would be undertaken as part of a coalition. Bosnia, Kosovo, Afghanistan, Iraq (Granby, No-Fly-Zones, Desert Fox and Telic) may all be taken as precedent - indeed the last true war in which the British military fought alone was the Falklands War of 1982, in which military action was initiated by Argentina and the UK was fighting a defensive, rather than offensive, campaign. The British army has been actively involved in the Troubles in Northern Ireland. However, a programme of demilitarisation is being gradually implemented.
Geography
Troubles World Factbook Map of the United Kingdom]] Most of England consists of rolling lowland terrain, divided east from west by more mountainous terrain in the Northwest (Cumbrian Mountains of the Lake District) and north (the upland moors of the Pennines) and limestone hills of the Peak District by the Tees-Exe line. The lower limestone hills of the Isle of Purbeck, Cotswolds, Lincolnshire and chalk downs of the Southern England Chalk Formation. The main rivers and estuaries are the Thames, Severn and the Humber Estuary. The largest urban area is Greater London. Near Dover, the Channel Tunnel links the United Kingdom with France. There is no peak in England that is 1000 metres (3,300 ft) or greater. Wales is mostly mountainous, the highest peak being Snowdon at 1085 metres (3,560 ft) above sea level. North of the mainland is the island of Anglesey. The largest and capital city is Cardiff, located in South Wales. Scotland's geography is varied, with lowlands in the south and east and highlands in the north and west, including Ben Nevis, the UK's highest mountain at 1343 metres (4,406 ft). There are many long and deep-sea arms, firths, and lochs. A multitude of islands west and north of Scotland are also included, notably the Hebrides, Orkney Islands and Shetland Islands. The largest city is Glasgow. Northern Ireland, making up the north-eastern part of Ireland, is mostly hilly. The main cities are Belfast ('Beal Feirste' in Irish) and Londonderry / Derry ('Doire' in Irish). The province is home to one of the UK’s World Heritage Sites, the Giant's Causeway, which consists of more than 40,000 six-sided basalt columns up to 40 feett (12 m) high. In total it is estimated that the UK includes around 1098 small islands, some being natural and some being crannogs, a type of artificial island which was built in past times using stone and wood, gradually enlarged by natural waste building up over time.
Economy
artificial island The United Kingdom, a leading trading power and financial centre, has an essentially capitalist economy, the fourth largest in the world in terms of market exchange rates and the sixth largest by purchasing power parity (PPP) exchange rates. Over the past three decades, the government has greatly reduced public ownership by means of privatisation programmes, and has contained the growth of the Welfare State. Agriculture is intensive, highly mechanised, and efficient by European standards, producing about 60% of food needs with only 1% of the labour force. The UK has large coal, natural gas, and oil reserves; primary energy production accounts for 10% of GDP, one of the highest shares of any industrial state. Services, particularly banking, insurance and business services, account for by far the largest proportion of GDP. Industry continues to decline in importance, although the UK is still Europe's largest manufacturer of armaments, petroleum products, personal computers, televisions, and mobile telephones. Tourism is also important: with over 24 million tourists a year, between China (33) and Austria (19.1), the United Kingdom is ranked as the sixth major tourist destination in the world. The Blair government has put off the question of participation in the Euro system, citing five economic tests that would need to be met before they recommend that the UK adopts the Euro, and hold a referendum.
Society

Demographics
At the April 2001 census, the United Kingdom's population was 58,789,194, the third-largest in the European Union (behind Germany and metropolitan France) and the twenty-first largest in the world. Its overall population density is one of the highest in the world. Almost one-third of the population lives in England's prosperous south-east and is predominantly urban and suburban--with about 7.2 million in the capital of London. The United Kingdom's high literacy rate (99%) is attributable to universal public education introduced for the primary level in 1870 and secondary level in 1900 (except in Scotland where it was introduced in 1696). Education is mandatory from ages five through sixteen. referendum The Church of England and the Church of Scotland function as the official national religions in their respective countries, but most religions found in the world are represented in the United Kingdom. Anglicanism is the state religion that has been established in England since 1534 during the reign of King Henry VIII. During his reign, England broke ties with the Roman Catholic church and established the Church of England as the offical religion of England. Reforms to the nature of the church's relationship to the state have been ongoing, especially concerning the nature of the House of Lords and the appointment of a fixed amount of the lordships going to Lords Temporal, bishops of the Church of England. A group of islands close to continental Europe, the British Isles have been subject to many invasions and migrations, especially from Scandinavia and the continent, including Roman occupation for several centuries. Contemporary Britons are descended mainly from the varied ethnic stocks that settled there before the eleventh century. The pre-Celtic, Celtic, Roman, Anglo-Saxon, and Norse influences were blended on Great Britain under the Normans, Scandinavian Vikings who had lived in Northern France. Although Celtic languages persist in Wales, Scotland, and Northern Ireland, the predominant language is English, which is a West Germanic language descended from Old English, featuring a large amount of borrowings from Norman French.The other indigenous languages include the Celtic languages; Welsh, the closely related Irish and Scots Gaelic, and the Cornish language; as well as Lowland Scots, which is closely related to English; Romany; and British Sign Language (Northern Ireland Sign Language is also used in Northern Ireland). Celtic dialectal influences from Cumbric persisted in Northern England for many centuries, most famously in a unique set of numbers used for counting sheep. Recent immigrants, especially from the Commonwealth, speak many other languages, including Bengali, Cantonese, Hindi, Punjabi and Urdu. The United Kingdom has the largest number of Hindi speaking peoples outside of the Indian sub continent.
Culture
Urdu The United Kingdom contains many of the world's leading universities, including the University of Cambridge, the University of Oxford and the University of London (which incorporates, amongst others, Imperial College and University College London), and has produced many great scientists and engineers including Sir Isaac Newton, Charles Darwin and Isambard Kingdom Brunel; the nation is credited with many inventions including the locomotive, vaccination, television, vacuum, and both the internal combustion and the jet engine. The English language has spread to all corners of the world (primarily because of the country’s empire) and is referred to as a ‘global language’. It is now taught as a second language more than any other around the world. Over the next few decades, it is estimated that approximately half the world’s population will be proficient in the language. Playwright William Shakespeare is arguably the most famous writer in the history of the English language; other well-known writers from the United Kingdom include the Brontë sisters (Charlotte, Emily, and Anne), Jane Austen, William Thackeray, J. R. R. Tolkien, John Milton, H. G. Wells and Charles Dickens. Important poets include Lord Byron, Robert Burns, Lord Tennyson and William Blake. Notable composers from the United Kingdom have included William Byrd, John Taverner, William Lawes, John Dowland, Thomas Tallis, and Henry Purcell from the 16th and early 17th centuries, and, more recently, Sir Edward Elgar, Sir Arthur Sullivan (most famous for working with librettist Sir W. S. Gilbert), Ralph Vaughan Williams and Benjamin Britten in the 19th and 20th. George Frideric Handel spent most of his composing life in England. The BBC is the oldest and perhaps the most respected broadcasting network on the globe, with the BBC World Service radio channel and its news output held in particularly high regard. The other main television networks are ITV, Channel 4, five (TV) and Sky Television. Popular programmes in the UK include the three soaps Eastenders, Coronation Street and Emmerdale, as well as the comedy news quiz Have I Got News For You and Reality TV shows Big Brother and The X Factor. Various British TV formats have been exported to other nations, notably Who Wants To Be A Millionaire?, The Weakest Link and The Office. The UK was, with the US, one of the two main contributors in the development of rock and roll, and the UK has provided some of the most famous rock stars, including the Beatles, Queen, Led Zeppelin, Pink Floyd, the Rolling Stones, The Who and many others. The UK was at the forefront of punk rock music in the 1970s with bands such as the Sex Pistols and The Clash, and the subsequent rebirth of heavy metal with bands such as Motörhead and Iron Maiden. In mid to late '90s, the Britpop phenomenon has seen bands such as Oasis, Blur, Radiohead and Coldplay gain international fame. The UK is also at the forefront of electronica, with British artists such as Aphex Twin, Talvin Singh, Nitin Sawhney and Lamb at the cutting edge. The United Kingdom was also associated with music from the Caribbean, with a large number of Jamaicans and other Caribbean nationals being present in the UK.
Sport
A great number of major sports originated in the United Kingdom, including football, golf, cricket, rugby, tennis and boxing. The national sport of the UK is association football, but the UK does not compete as a nation in any major football tournament. Instead, the home nations compete individually as England, Wales, Scotland and Northern Ireland. It is because of this unique four-team arrangement that the UK currently does not compete in football events at the Olympic Games. However, a united team will probably take part in the 2012 Summer Olympic Games, as these are hosted in London. The English and Northern Irish football associations have confirmed participation in this team while the Scottish FA and the Welsh FA have declined to participate. The UK also hosts many world-renowned football clubs, such as Manchester United, Liverpool, Chelsea and Arsenal in England and Rangers and Celtic in Scotland. Clubs compete in national leagues and competitions and some go on to compete in European competitions. Both forms of rugby are national sports. Rugby League originates from and is generally played in the North of England, whilst Rugby Union is played all over Britain. In Rugby League the UK plays as one nation - Great Britain - whilst in union it is represented by the four nations. England are the current holders of the Rugby Union World Cup. Every four years the British and Irish Lions (comprising the best players from England, Scotland, Wales and Ireland) tour other countries. Cricket is also played in the UK, although it is focussed in England. The Wimbledon Championships are an international tennis event held in Wimbledon in south London every summer and are seen as the most prestigious of the tennis calendar. Golf is one of the most popular participation sports played in the UK and St Andrews in Scotland is the sport's home course.
Miscellaneous topics

External links

- [http://www.bbc.co.uk/history/state/nations/ BBC Nations] History of the nations within the UK.
- [http://www.bbc.co.uk British Broadcasting Corporation (BBC)]
- [http://www.cia.gov/cia/publications/factbook/geos/uk.html CIA World Factbook: UK.]
- [http://www.direct.gov.uk Gateway to UK governmental services and websites.]
- [http://www.number-10.gov.uk Number 10 Downing Street]
- [http://www.statistics.gov.uk Office of National Statistics]
- [http://www.opsi.gov.uk Office of Public Sector Information] Source for all UK legislation 1987-present (successor to Her Majesty's Stationery Office).
- [http://www.macs.hw.ac.uk/britishisles/ The British Isles] Independent view of the UK.
- [http://www.royal.gov.uk The British Monarchy]
- [http://www.parliament.uk/ The United Kingdom Parliament]
- [http://www.statistics.gov.uk/StatBase/Product.asp?vlnk=5703&Pos=&ColRank=1&Rank=272 Official Yearbook of the UK] factbook produced by the Office for National Statistics (years 2000 to 2005 available online).
- [http://www.ukcities.co.uk UK Cities] lists a variety of useful resources for every city in the UK.
- [http://www.justuk.org UK travel guide] United Kingdom for travellers.
- [http://www.world66.com/europe/unitedkingdom World66 Guide to United Kingdom] A travel guide written by its users.
- [http://www.multimap.co.uk www.multimap.co.uk] provides online maps and aerial photographs of the UK.
- [http://www.streetmap.co.uk www.streetmap.co.uk] an alternative to multimap.
- [http://www.freeworldmaps.net/europe/united-kingdom/map.html Physical map of United Kingdom.]
- [http://www.upmystreet.com www.upmystreet.com] detailed localised information about places in the United Kingdom.
- [http://www.parks.it/world/UK/Eindex.html UK Parks] National parks, Areas of Outstanding Natural Beauty and other protected areas. ----
Category:British Isles Category:European countries Category:European Union member states Category:Members of the Commonwealth of Nations Category:Monarchies A als:Grossbritannien und Nordirland zh-min-nan:Liân-ha̍p Ông-kok ko:영국 ms:United Kingdom ja:イギリス simple:United Kingdom th:สหราชอาณาจักร

Pharmacist

Pharmacists are health professionals who practice pharmacy. In their best known role, pharmacists typically take a request for medicines from a physician in the form of a medical prescription and dispense the medication to the patient. Pharmacists have many areas of expertise and are a critical source of medical knowledge in clinics, hospitals, and community pharmacies throughout the world. Pharmacists are sometimes small-business owners, owning the pharmacy in which they practice. This unique dichotomy is often the subject of debate within the profession - in part due to the perception of pharmacists as "common shopkeepers" by many in the community. In actuality, while many pharmacists do "keep shop" they are also very skilled and specialized individuals with specific knowledge that makes them a vital part of any healthcare team. They act as a learned intermediary between patients and physicians to ensure that proper medical therapy is chosen and implemented in the best way possible. Pharmacists are sometimes referred to as chemists, which sometimes causes confusion with scientists in the field of chemistry. This term is a historical one, since pharmacists originally were required to complete an undergraduate degree in Pharmaceutical Chemistry (PhC) and were known as "Pharmaceutical Chemists". While the term is widely used in Commonwealth nations, it is unknown in the United States where the term druggist is an alternative term for a pharmacist.

Qualifications and registration

The basic requirement for pharmacists to be considered for registration is an undergraduate or postgraduate Pharmacy degree from a recognized university. In most countries this involves a four-year course to attain a Bachelor of Pharmacy (BPharm) degree. In order to practise as a pharmacist, the person must be registered with the relevant statutory body, which governs the registration and practice of pharmacy within the territory of its jurisdiction. There is often a requirement for the pharmacy graduate to have completed a certain number of hours of experience in a pharmacy, under the supervision of a registered pharmacist. The statutory body will usually administer a written and oral examination to the prospective pharmacist prior to registration. Pharmacists are trained in fields including pharmacology, chemistry, pharmaceutical chemistry, pharmacy practice (including drug interactions, medicine monitoring, medication management), pharmaceutics, pharmacy law, physiology, anatomy, biochemistry, kinetics, nephrology, hepatology, and compounding medications. Additional curriculum covers basic diagnosis with emphasis on disease state management, therapeutics and prescribing (selecting the most appropriate medication for a given patient).

Australia

In Australia, apart from the four-year BPharm course, there is the option of a postgraduate two-year Master of Pharmacy (MPharm) course for those with undergraduate science degree background. Pharmacists are registered by Pharmacy Boards in individual states such as the Pharmacy Board of New South Wales. In Western Australia, pharmacists are registered by the Pharmaceutical Society of Western Australia. Individual states have differing requirements for pharmacy graduates for registration, but generally graduates are required to complete approximately one year of practice under the supervision of a registered pharmacist. In addition, graduates are required to complete an approved graduate training course for that state, for example the Pharmacist Graduate Training Course (PGTC) offered by the Pharmaceutical Society of Australia NSW Branch is required in New South Wales. On meeting these requirements, graduates are eligible to sit the registration examination which may involve both written and oral components.

United Kingdom

In Britain, integration with the European Union has resulted in the BPharm course being superseded by a four-year course for the qualification Master of Pharmacy (MPharm). The Royal Pharmaceutical Society of Great Britain is responsible for regulation of pharmacy affairs. Graduates must complete one year of practical training in a pharmacy prior to eligibility to sit the registration examination.

United States

In the United States, pharmacists must complete a pre-pharmacy undergraduate program. This program consists of a minumum of 100 hours of undergraduate coursework in basic and advanced sciences, but most students go on to complete a four year program leading to a Bachelor of Science degree in biology, chemistry, or a similar field (about 130 hours). Following that, the pharmacist will then complete a four year pharmacy program. Some schools require a high PCAT (Pharmacy College Admission Test ) prior to acceptance at the college of pharmacy. They will be awarded a Doctor of Pharmacy (PharmD) degree upon completion of the program. This degree is equivalent to that earned by a medical doctor (MD) from a traditional medical school. Then a pharmacist will complete an optional post-graduate residency (one to three years) or otherwise enter into the pharmacy practice of their choice, ex. hospital, compounding, nuclear, hospice, community, retail, etc. A person must pass the North American Pharmacist Licensure Examination, or NAPLEX, and an additional state exam before they can acquire a license to practice pharmacy in that state. The NAPLEX was created by the [http://www.nabp.net National Association of Boards of Pharmacy] (NABP).

Roles

Pharmacists are often the first point-of-contact for patients with health enquiries. This means that pharmacists have large roles in the primary healthcare of patients. These roles include, but are not limited to:
- clinical medication management
- specialised monitoring of simple and complex disease states
- reviewing medication regimens
- monitoring of treatment regimens
- general health monitoring
- compounding medicines
- general health advice
- providing specific education to patients about disease states and medications
- oversight of dispensing medicines on prescription
- provision of non-prescription medicines
- counselling and advice on optimal use of medicines
- advice and treatment of common ailments
- referral to other health professionals if necessary
- dosing drugs in renal and hepatic failure
- pharmacokinetic evaluation
- education of physicians on medications and their proper use
- prescribing medications in collaboration with other healthcare professionals
- providing pharmaceutical care

Specialities

Practice specialisation

Specialties exist within the pharmacy profession, with the place of occupation being the major differentiator. Specialities include:
- Clinical pharmacist
- Community pharmacist
- Hospital pharmacist
- Consultant pharmacist
- Home Health pharmacist
- Locum pharmacist
- Drug information pharmacist
- Regulatory-affairs pharmacist
- Industrial pharmacist
- Academic pharmacist

Clinical specialisation

In the United States, there are five specialties in which a pharmacist can become Board-certified. The pharmacotherapy specialty also has two subspecialties, as follows:
- nuclear pharmacy
- oncology
- pharmacotherapy
- cardiology
- infectious disease
- nutritional pharmacy
- psychiatric pharmacy In Australia, accreditation exists only for certain specialties and is provided by professional bodies for the following:
- consultant pharmacist (AACPA), by the Australian Association of Consultant Pharmacy (AACP)
- certified geriatric pharmacist (CGP), by the Society of Hospital Pharmacists of Australia (SHPA)

External links

- [http://pharmacy.utmem.edu pharmacy.utmem.edu] The University of Tennessee College of Pharmacy and Health Science Center
- [http://pharmacy.drake.edu pharmacy.drake.edu] The Drake University College of Pharmacy and Health Sciences Web Site.
- [http://www.pharmacist.com Pharmacist.com] Useful site for practicing pharmacists and students.
- [http://www.pharmacist.com/articles/l_t_0002.cfm Detailed explanation of the Naplex] Available on [http://www.pharmacist.com Pharmacist.com]
- [http://www.prenaplex.com Prenaplex] A practice test for the Naplex created by the NABP that has actual Naplex questions Category:Pharmacy Category:Healthcare occupations ja:薬剤師 th:เภสัชกร

Paracetamol

Paracetamol (INN) or acetaminophen (USAN) is a popular analgesic and antipyretic drug that is used for the relief of fever, headaches, and other minor aches and pains. It is a major ingredient in numerous cold and flu medications and many prescription analgesics. It is remarkably safe in standard doses, but because of its wide availability, deliberate or accidental overdoses are not uncommon. Paracetamol, unlike other common analgesics such as aspirin and ibuprofen, has no anti-inflammatory properties, and so it is not a member of the class of drugs known as non-steroidal anti-inflammatory drugs or NSAIDs. In normal doses paracetamol does not irritate the lining of the stomach nor affect blood coagulation, the kidneys or the fetal ductus arteriosus (as NSAIDs can). Like NSAIDs and unlike opioid analgesics, paracetamol does not cause euphoria or alter mood in any way. Paracetamol and NSAIDs have the benefit of being completely free of problems with addiction, dependence, tolerance and withdrawal. The words acetaminophen and paracetamol both come from the chemical names for the compound: N-acetyl-para-aminophenol and para-acetyl-amino-phenol.

History

In ancient and medieval times, the only antipyretic agents known were compounds contained in willow bark (a family of chemicals known as salicins, which led to the development of aspirin), and compounds contained in cinchona bark. Cinchona bark was also used to create the anti-malaria drug quinine. Quinine itself also has antipyretic effects. Efforts to refine and isolate salicin and salicylic acid took place throughout the middle and late 19th century. When the cinchona tree became scarce in the 1880s, people began to look for alternatives. Two alternative antipyretic agents were developed in the 1880s; Acetanilide in 1886 and Phenacetin in 1887. By this time, paracetamol had already been synthesized by Harmon Northrop Morse via the reduction of p-nitrophenol with tin in glacial acetic acid. While this was first performed in 1873, paracetamol was not used medically for another two decades. In 1893, paracetamol was discovered in the urine of individuals who had taken phenacetin, and was concentrated into a white, crystalline compound with a bitter taste. In 1899, paracetamol was found to be a metabolite of acetanilide. This discovery was largely ignored at the time. In 1946, the Institute for the Study of Analgesic and Sedative Drugs awarded a grant to the New York City Department of Health to study the problems associated with analgesic agents. Bernard Brodie and Julius Axelrod were assigned to investigate why non-aspirin agents were associated with the development of methemoglobinemia, a non-lethal blood condition. In 1948, Brodie and Axelrod linked the use of acetanilide with methemoglobinemia and determined that the analgesic effect of acetanilide was due to its active metabolite paracetamol. They advocated the use of paracetamol (acetaminophen), since it did not have the toxic effects of acetanilide. (Brodie and Axelrod, 1948) The product went on sale in the United States in 1955 under the brand name Tylenol. In 1956, 500 mg tablets of paracetamol went on sale in the United Kingdom under the trade name Panadol, produced by Frederick Stearns & Co, a subsidiary of Sterling Drug Inc. Panadol was originally available only by prescription, for the relief of pain and fever, and was advertised as being "gentle to the stomach", since other analgesic agents of the time contained aspirin, a known stomach irritant. In June 1958 a children's formulation, Panadol Elixir, was released. In 1963, paracetamol was added to the British Pharmacopoeia, and has gained popularity since then as an analgesic agent with few side effects and little interaction with other pharmaceutical agents. The U.S. patent on paracetamol has expired and generic versions of the drug are widely available under the Drug Price Competition and Patent Term Restoration Act of 1984, although certain Tylenol preparations are protected until 2007. U.S. patent 6,126,967 filed September 3, 1998 was granted for "Extended release acetaminophen particles".

Available forms

Panadol, which is marketed in Europe, Asia and Australasia, is the most widely available brand, sold in over 80 countries. In North America, paracetamol is sold in generic form or under a number of trade names: for instance Tylenol (McNeil-PPC, Inc), Anacin-3 and Datril. In some formulations paracetamol is combined with the opioid codeine, sometimes referred to as co-codamol (BAN). In the United States and Canada, this is marketed under the name of Tylenol 1/2/3/4 and in the US only available by prescription, while over-the-counter in Canada. In the UK and in many other countries, this combination is marketed under the names of Tylex CD and Panadeine. Other names include Captin,

Over-the-counter substance

Switches between POM and OTC

Chemicals

See also

Drug

Medical prescription

Format and definition

Contents of the prescription

Handling of the prescription

Forgeries, thefts and prevention

Writing prescriptions

Who can write prescriptions

Legibility of prescriptions

Writing good prescriptions

Abbreviations

Non prescription drug prescriptions

Related usage of the term prescription

History

Future directions of prescriptions

Appendix 1: Complete list of abbreviations

Exhibit A: sample legal definition of a prescription

Exhibit B: sample legal requirement for storage of prescriptions

Exhibit C: sample legal requirements for security and format

Exhibit D: sample requirements on information added by the pharmacist

Exhibit E: New Jersey requirements for prescription blanks

See also

Prescription only medicine

Further reading

External links

United Kingdom

Terminology

History

Government and politics

Subdivisions

Military

Geography

Economy

Society

Demographics

Culture

Sport

Miscellaneous topics

External links

Pharmacist

Qualifications and registration

Australia

United Kingdom

United States

Roles

Specialities

Practice specialisation

Clinical specialisation

See also

External links

Paracetamol

History

Available forms