Dispensing Pharmaceuticrtuffdsgfgxffgals.ppt

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1. dispensing
07/31/2022 1
By: Fitsum.T

2. Outline
Handling of pharmaceuticals
Prescription analysis
Selection & manipulation
Labeling & supply
Counseling
Documentation
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3. Chapter one
Introduction to dispensing practice
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4. What are drugs?
canbedefinedas“chemicalsthatcanalter
functionsoflivingorganismsatsmall
concentration”arealldrugs
Formedicalcasethesedrugsareintended
for:treatment,diagnosis,preventionand
controlofdiseasesarecalled
medications
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5. Terminologies
DosageForms/RoutesofAdministration
CommonRoutesofAdministration
Enteralaregivenorallyandpassthroughthe
GItract.Thisincludesoral,naso-gastric,and
rectalroutes.
Parenteralmedicationsreferstoinjection
Inhalationroutesofadministrationareinhaled
throughthemouthorthenoseandusuallyact
directlyontherespiratorysystem
Topicaldosagesareappliedtotheskinsurface
oramucousmembrane
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6. Dosage Form
Tablet
Capsules
OralSuspensionsThedrugismixedwithliquid
SyrupsContainahighconcentrationofsucroseor
sugartosweeten,foreaseofuse.
Elixirscontainbetween5%and40%alcohol.
TincturesMaycontainaslittleas17%alcoholoras
muchas80%alcohol.
Emulsionsisasuspensioninvolvingoneliquidina
secondliquidwithwhichthefirstwillnotmix.(oilin
waterorwaterinoil)
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7. Dosage Form……
OralpowdersDrugswhichareinapowderformand
areusuallydissolvedinjuiceorwaterbefore
administration
LozengeandTrocheLozengesandTrochesaremeant
tobedissolvedslowlyinthemouth
RectalSuppositoriesSolidorsemi-solidbulletshaped
dosageforms.
EnemasDrugissuspendedinasolutionandinfused
intotherectum.
TransdermalpatchAmedicatedadhesivepatch
applieddirectlyontheskin
InhalationInhaledthroughthemouthornoseand
usuallyactdirectlyontherespiratorysystem
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8. 1. Dispensing medicine
Definition
Includesallactivities,whichoccurfromthetimethe
prescriptionisreceivedinthedispensaryuntiltheitems
havebeencollectedbythepatient.Thereforeit
includes
Reviewofprescription
Anyactiontoaddressconcernssoidentified
Correctdispensinginappropriatecontainerwith
correctlabeland
Provisionofadviceorinformationasappropriate
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9. Dispensing medicine…
Dispensingrequiresabasicknowledgeof:
pharmacology
Principleofcompounding
Stabilityofmedicationandtheiringredients
Counselinginformationandadvice
Dispensingcontainersandpackagingmethods
Labelingofdispensedmedicine
Storage
Incompatibility(physical,chemical,therapeutic)
Legalrequirements
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10. Dispensing medicine…
Dispensingpractice
Gooddispensingpracticereferstothedeliveryofa
correctdrug,totherightpatient,intherequireddosage
andquantity,inthepackagethatmaintainsacceptable
potencyandqualityforthespecifiedperiodswithclear
information.
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11. Dispensing medicine…
Irrationaldispensingpractice–itisapracticeincluding
thefollowing
¥Dispensingprescriptiononlydrugswithoutprescription
¥Dispensingprescriptiononlydrugswithpartialdose
evenwithprescription
¥Poorlabelingofdispenseditems
¥Inappropriatepatientcounseling
¥Incompleterecording
¥Chargingpatientswithunreasonablehighprice
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12. 2. The premise
Thepremiseonwhichadispensingserviceis
providedwouldreflectthequalityofserviceand
inspireconfidenceinthenatureofthehealthcare
thatisdelivered.
Everydispensingstaffisrecommendedtomaintain
thepremisesinacleanandtidymannertofacilitate
accurateandefficientdispensing
I. Safety
Workingconditionsarearrangedastotakeinto
considerationthesafetyandhealthofthepublicand
peopleworkinginthepremise.
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13. The premise……
II. Condition
Thewalls,floorswindowceilingandallotherpartsof
thepremisearerecommendedtobekeptcleanand
hygienictoavoidriskofinfestationandcontamination
Wasteshouldbeproperlykeptandtimelydisposedof.
Wallsarerecommendedtobefinishedwithsmooth
imperviousmaterials
Maintainingcleanenvironmentrequiresregularcleaning
ofshelves,dailycleaningfloorsandworkingsurfaces,
anddailyremovalofgarbage(waste)
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14. The premise……
III.Tidiness
Allpartsofthepremisearerecommendedtobe
maintainedinorderlyandtidycondition.
Stockcontainersandpre-packedmedicinesmustbe
storedinorganizedmannere.galphabetical
Allstockcontainersmustbeclearlyandaccurately
labeledtoensuresafeselectionsothaterroris
minimized.
Stockrotationshouldbecarriedoute.gFIFO,FEFO
Theexpirydateofmedicinesshouldberegularly
monitored
Dangerousdrugsshouldbestoredseparatelyunder
lockandkey
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15. The premise……
Theenvironmentinwhichyouworkwillhave
considerableinfluenceonyourefficiencyand
thereforeitisimportanttodevelopatidyand
organizedmethodofworking.Thepharmacistwho
workswithadispensingbenchclutteredwithseveral
containersallcontainingdifferentingredientsismore
likelytoselecttheincorrectone.Alwaysreturn
ingredientstotheirappropriateshelfwhenyouhave
measuredouttherequiredquantity.
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16. The premise……
IV.Environment
Allmedicinesshouldbestoreundersuitable
conditions,appropriatetothenatureandstability
ofthematerialconcerned.
Theyshouldbeprotectedfromcontamination
sunlight,moisture,freezingandothertemperature
extremesanddampness.
Leveloflight,heat,noiseventilationetc,are
recommendednottoexertadverseeffecton
personnel.
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17. The premise……
V.size
Dispensarieswouldbedesignedtoaccommodatethe
anticipatedworkload.
VI.Security
Carefulconsiderationistobegiventotheoverall
securityofthedispensaryandstores.
Specialattentionfordrugstobelockedproperly
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18. 3.Dispensary design and
equipment
TheDispensary,itsfittingsandequipmentshouldbe
adequateforthepurposeofdispensing
Workingsurfacesandshelving
Workingsurfaces,cupboardsandshelvesneedtobeina
goodstateofrepairandincleanandtidycondition.
theyarerecommendedtobesmooth,washable,and
impervioustomoisture
Aclearareaofbenchspaceisrecommendedtobeset
asidefordispensing
Foodanddrinksshouldbekeptawayfromtheworking
area.
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19. Dispensary design…………
Watersupply
Thedispensaryisrecommendedtobeprovidedwith
distilledand/purifiedwater
Dispensaryequipment
Alldispensingequipmentisrecommendedtobeof
suitablematerial,cleanandgoodstateofrepair.The
followingistherecommendedlist
1.Tabletandcapsulecountingdevice
Theyshouldbecleanedregularlytopreventcross
contaminationb/nproducts
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20. Dispensary design…………
Uncoatedtabletsleavealayerofpowderon
surfacestheytouch,thiscanbetransferredto
othertabletsorcapsulecountedonthesame
surface----calledcrosscontamination
e.gdangerouscrosscontaminationwithAspirin
orPenicillin,tooneofwhichapatientis
sensitive.
Therefore,cleaninganyequipmentusedfor
handlingdifferentproductsbetweenuseandat
theendofthedayisessential.
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21. Counting triangle
http://iforg.com/blog/?p=17
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22. Capsule counter
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23. Perforated Counting Tray
http://www.adelphi-coldstream.uk.com/products/pharmacyl-dispensing-equipment/tablet-capsule-
counters/tumatic-capsule-counter.html
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24. Dispensary design…………
2.Arangeofgraduated,stamped/plastic
measures
3.Arefrigeratorequippedwithamaximum
/minimumthermometerandcapableof
storingproductsattemperaturebetween2
dcand8dc.
Therefrigeratorneedstobecleanedand
checkedperiodicallytoensureefficient
running
Regularmonitoringoftherefrigerator
temperatureshouldbeestablished
Therefrigeratorshouldbeusedstrictlyfor
medicinesonly.
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25. Dispensary design…………
4.Asuitablerangeofdispensingcontainersfor
pharmaceuticalproductswithseparatesetforinternal
andexternaluse.
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26. Pre -dispensing Activities
Check the following:-
The room, shelves and dispensing
counter are clean and organized
Wear a clean and white gown
Attach your identification tag on the
gown in such a way that it is visible to
clients
Availability dispensing aid,(counting
try, labeling materials, packaging
materials, sufficient no of spoons etc).
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27. Cont…
Availability updated drug list, OTC list
,good dispensing manual, STG,
formulary ,prescription registration
book.
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28. Reception
As clients come into the pharmacy
section, they must be made to feel
attended to and comfortable by:
Friendly gestures
A smile
Eye-to-eye contact
A friendly welcome
Politeness
Feeling of caring
NB. Verbal request can be done only for OTCs with
justification.
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29. Arrangement of medicines
Medicines should be arranged on
shelves made of steel or treated wood
and the shelves should be strong and
robust. Health institutions and
medicine retail outlets can use one or
a combination of the following
commonly used methods of medicine
arrangement:
1. Pharmacotherapeutic category
2. Alphabetical order by generic name
3. Dosage forms
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30. In arranging medicines, the following
points should be considered:
•Each dosage form of medicine is
arranged in separate and distinct
areas
• Sufficient empty space should
demarcate one medicine or dosage
form from another.
• Put medicine in well ventilated ,dry
and place protected from direct sun
light and heat.
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31. Cont…
• Store liquids in a pallet on the floor or
on the lowest shelf.
• Do not store anything directly on the
floor.
• Always store cold-chain items in the
refrigerator.
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32. SAQ-05
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The prescriber prescribes a
combination of amoxycillin and
clavulanate and mentions the dose as
take 5ml twice a day. It is available as
Amoxicillin 125mg+ Clavulanic acid
31.25mg and Amoxicillin 200mg+
Clavulanic acid 28.5mg. Which one to
dispense?
In this case the pharmacy professional
has to be sure about which
preparation to dispense. The best
option would be to consult the

33. Con…
What to do?
If the strength is not stated on the
prescription, mostly it may be
necessary to contact the prescriber for
confirmation of the appropriate
strength.
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34. Expiry date
Remember if the expiry date of a
product is labeled as July 2011, then
the product can be used until the end
of July 31st 2011. In case the duration
of therapy or total quantity to be
dispensed is not mentioned, it will be
necessary to contact the prescriber.
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35. LEARNING OUTCOME two
Processing prescription and medication
order
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36. Introduction
Apractitioner'sdecisiontotreata
patientassumesthatthepatienthas
beenevaluatedanddiagnosed.Drug
therapyismostcommonlychosen.
Inmostcases,thisrequiresthewriting
ofaprescription.
Theprescriptionorderisthemost
importanttherapeutictransaction
betweenaphysicianandapatient.
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37. 2.1. Definition of prescription
“Amedicalprescriptionisanorderfroma
prescribertoadispenserthatincludesinstruction
forpreparinganddispensingmedicinestoacertain
patient.”
Theprescriptionrepresentsamechanismthrough
whichatreatmentmodalityisprovidedtothe
patient.
Theprescriptionforeachpatientisauniqueentity,
designatingaspecificmedicationormedicationsfor
aspecificpatientataspecifictime.
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38. Who is prescriber ?
Aprescriptionordermaybewrittenandissuedbya
physician,nurse,dentist,veterinarian,orother
properlylicensedmedicalpractitioner.
Whoisdispenser?
Adispenserispharmacist,pharmacytechnicianor
anylicensedmedicalpersonnel.
Allprescriptionordersshouldbecorrect,
unambiguous,withoutcross-outsandsignedclearly
foroptimalcommunicationbetweenprescriber,
pharmacist,andnurse
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39. 2.2.Types of prescription
Prescriptionscanbeclassifiedas
compoundedandnoncompounded.
Compounded prescription, or
extemporaneousprescriptionisanorderthat
requiresmixingofoneormoreingredients
(activemedicaments)withoneormore
pharmaceuticalnecessities(vehicle,
suspendingagent).
Thephysicianselectsthedrugs,doses,and
pharmaceuticalformthathe/shedesiresandthe
pharmacistpreparesthemedicationaccordingly.
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40. Thenameofeachdrugisplacedonaseparateline
rightundertheprecedingone
Exampleofcompoundedprescription
Rx. Calamine 4gm
Zincoxide 4gm
Bentonite 1gm
Glycerine 1ml
Ca(OH)q.s 50ml
Sig.applyonceaday
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41. Noncompoundedprescriptiondoesnotrequire
mixingoftwoormoreingredientstoobtaina
finishedproduct.
Aprecompoundedorderconsistsofadrugora
mixtureofdrugssuppliedbyapharmaceutical
companybyitsofficialorproprietarynameand,ifit
containsmorethanonesubstance,thespecific
ingredientsdonothavetobelisted.
Example
RxDoxycycline100mg
#14caps
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42. Othertypesofprescriptioninclude
Inpatient
Outpatient
Handwritten
Electronicallygenerated
Whiletheprescriptioncanbewrittenonanypiece
ofpaper,itusuallytakesaspecificprintedform.
Thatformpossessesblankspacesforthenecessary
information.
Suchblanksareoftensuppliedtothephysicianin
theformofapadcontainingapproximately100
blankforms.
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43. Prescription Registration
book(PRB)
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44. SAQ-01
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45. SAQ-02
2. The main part of prescription order,
contains the name and prescribed
ingredients or drugs
Subscription
Inscription
Subscription
All
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46. SAQ-03
3. A part of prescription that comprises
direction to pharmacist
Signature
Subscription
Inscription
Superscription
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47. SAQ-04
4. One of the following prescription
information are used to adjusting of the
dose of the drugs
Sex
Age
Address
Diagnosis
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48. 2.3. COMPONENT PARTS OF THE
PRESCRIPTION
Theprescriptionconsistsofsevenparts
1.date
Herewrittenare:thenameandthesurnameofthe
doctor,thehospital,clinicorpolyclinicmedical
center,theiraddress,andthedate.
Thedateisimportantforascertainingor
determiningthelifeoftheprescription.
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49. Example
Theprescriptionofnarcoticsandcontrolled
substancesaregovernedbyspeciallawsand
regulations–itcannotbefilledaftermorethan
30daysfromthedateofissuance
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50. 2.SUPERSCRIPTION
consistsofthemessagetothedispenser.
thesymbol℞fromtheLatinrecipe,meaning
“take.”
AlwaysWrittenatthebeginningofthedrug
information
3.INSCRIPTION
isthemainpartofthemedicalprescription,
becausethisisthedoctor’sorder.
Herearethenamesofdrug,thedosageforms,
strengthandthedosages.
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51. a)Nameofdrugarerequiredtobeginwitha
capitalletter
b)thedosageformisplacedafterthedrug’s
name.
c)thedoseisnotedafterdosageform.
d)Thestrengthofthemedicationshouldbe
writteninmetricunits.
Example:Rx./Paracetamoltab500mg
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52. 4. SUBSCRIPTION
In this part are written, if necessary, instructions to
the chemist such as
how to make the preparation(extemporaneus)
Total quantity to be dispensed
the number of doses, or dosage forms to be
supplied to the patient.
Exampe: Rx./ Paracetamol tab 500 mg
Da scatulam № 2 ( D. scat. №2 ) = Give 2
blisters
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53. 5. SIGNATURA (MARK, LABEL)
itisusuallyprecededbyanStorepresenttheLatinsigna,
meaning“mark.”Thesignaturaiswherethehealthcare
providerindicateswhatinstructionsaretobeputonthe
outsideofthepackagetotellthepatient
Thisinformationmustbesufficienttoallowthepatientto
understandfully
theamountofthedrugproducttobetaken
thefrequencyofadministration
Atwhattimethedrugtobetaken:
ifthedrughastobeusedexternallyonly,ortobeshaken
wellbeforeuse,orwhetheritisapoison,andothersuch
factsareincluded.
Example:SignaorScribe(S.)onetabletthreetimesaday
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54. 6.Name, qualification and address of the
prescriber
Thesignatureofthedoctormaybeplacedonthe
designatedarea,orafterthelastdrug,andthisisfor
identificationdata.
7.Patientinformation
Name,address,cardno.,weightandageofthe
patient.
Thispartservestoidentifyforwhomthe
prescriptionisintended.Thefullnameandthe
addressarerequiredbylawonallprescriptionsfor
controlledsubstances.
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55. Theageofthepatientisagoodadditionalpiece
ofinformation,especiallywithpediatricpаtient
wheredosagecalculationshavetobedouble-
checkedforsafety.Thispartislocatedonthe
designatedarea.
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58. 2.4. JUSTIFICATION FOR VARIOUS
PARTS
OF A PRESCRIPTION
Aprescriptionhasvariousparts;someof
them“mandatoryandsomeofthem
thoughnotmandatory,importantfor
betterunderstandingoftheprescription
bythepharmacistandthepatientalso.
Thejustificationmayarisefrom
rationality,legality,practicalityor
situationalrealities.
Thesevariousaspectsarediscussed
below
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59. A. Details pertaining to the prescriber
Prescribers 's full name
Why needed?
Toauthenticatetheprescriptionbefore
dispensing.Theprescriptionisalegaldocument.
Itcanbeusedinthecourtoflaw.
Legal Requirement? –yes
What happens if missing?
Thepharmacypersonnelwillbeindilemma
whethertheprescriptionisgenuine.Ifthe
prescriptionisfromahospital,itisnotknown
whichofthefacultydoctorshasprescribedit.
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60. A. Details pertaining to the prescriber….
Doctor's details such as address,
Consultation timings, telephone/Contact
numbers printed on the letterhead
Why needed?
Helps the patient as well as the
Pharmacist to contact the doctor in case of
discrepancies and doubts Over
prescription
Legal Requirement? –yes
What happens if missing?
The prescription cannot be dispensed
unless the query is resolved
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61. A. Details pertaining to the prescriber….
Doctor'sQualificationprintedonthe
letterhead.
Whyneeded?
Forverifyingtheauthenticityofthedoctor
LegalRequirement?–yes
Whathappensifmissing?
Thepatientmayenduptakingmedicines
prescribedbyunauthorizedpersonnel
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62. A. Details pertaining to the prescriber….
Doctor's full Signature and date,both in
blue indelible ink.
Why needed?
for verifying the authenticity of the doctor
and ,to avoid misuse of blank prescription
pads.
LegalRequirement?–yes
Whathappensifmissing?
If the prescription has been typed or
printed, the Pharmacy personnel cannot
confirm that it is the doctor who has
actually prescribed the medicine.
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63. A. Details pertaining to the
prescriber….
Date of prescribing
Why needed?
To know the validity of Prescription and to
avoid Unnecessary refilling of the
prescription.
Legal Requirement? –yes
Whathappensifmissing?
Pharmacy personnel cannot identify an
old Prescription brought for refill; and in
many cases not advisable..
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64. A. Details pertaining to the
prescriber….
Rx superscription
Why needed?
This is a matter of practice..
Legal Requirement? –no
Whathappensifmissing?
None
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65. B. Details pertaining to MEDICINES
Name of medicine
Why needed?
handwriting,andtoomanyconfusing,
similargeneric&brandnamescause
difficultiesinthePharmacyPharmacists
haveproblems
Legal Requirement? –yes
Whathappensifmissing?
Chances of errors during dispensing can
increase.
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66. B. Details pertaining to MEDICINES
Strengthorpotencyofmedicine
Whyneeded?
Manymedicinesareavailableinvarying
potencies,andunlesspotencyiscorrectly
writtenthepharmacistcannotdispensethe
correctmedicine.
LegalRequirement?–yes
Whathappensifmissing?
Itbecomesdifficultforthepharmacytodecide
which
Particularstrengththedoctorintendedto
prescribe.
Thiscoulddelaythetreatment
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67. B. Details pertaining to MEDICINES
Dosage form
Why needed?
Unlesscorrectdosageformiswritten,the
pharmacistoftenisinadilemmawhich
particularonetogive,becauseattimes,
medicinesareavailableindifferentformsE.g.
caportablet,orsyrupetc.
A dosage form suitable for one patient may not
be suitable for another. For example a child
may require a syrup form rather than a tablet.
Legal Requirement? –yes
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68. Whathappensifmissing?
Pharmacy has to do guesswork often
the pharmacist is not available for
making a decision
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69. B. Details pertaining to MEDICINES
Dosage & dosing instructions
Why needed?
Patientneedstoknowthequantityof
tablets/cap/liquid&numberoftimesthe
medicineneedstobetaken.
Thepharmacistcanalsocounselthepatient.
Legal Requirement? –yes
1.Dose The amount of medicine to be taken
taken, or given, at one time.
2.The sum of doses may be the dosage or the
total dose.
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70. What happens if missing?
Patientisconfusedwhatdosetotake
andhowoften.
Whatthepharmacymaysuggestmay
notalwayscoincidewithwhatthedoctor
hadinmind.
Also,thepharmacistcannotpredictthe
doseinallcases,sinceitisbasedon
diagnosisorextentofdisease/ailment.
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71. Total quantitiy
Why needed?
Avoid ambiguity for both patient and the
pharmacist as to the quantity to be
dispensed.
Prevent patients from using more/less of
the medicine.
Legal Requirement? –yes
What happens if missing?
This leaves the Prescription open for
Repeat purchase with no controls
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72. 3. Details pertaining to PATIENT
Patient's Full Name
Why needed?
For proper Identification of a patient.
Legal Requirement? –yes
What happens if missing?
If the name is absent, it cannot be linked
to a Particular patient with certainty.
There is room for error
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73. 3. Details pertaining to PATIENT
Patient's age, weight
Why needed?
Useful Information especially for
children for whom dosage is based on
body weight
It acts as a safety measure against
dosage errors .
Legal Requirement? –No
What happens if missing?
Maymake it difficult for the pharmacy to
confirm the medication.
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74. 3. Details pertaining to PATIENT
Patient's address and Telephone number
Why needed?
Essentialforfollow-upofpatient,ortoget
intouchwiththepatient,especiallyincase
ofprescribingorDispensingerrors.
Legal Requirement? –No
What happens if missing?
Difficulttotracethepatientincaseofa
dispensingproblem/error.
Writing the address on the cash memo is a
Legal requirement.
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75. 3. Details pertaining to PATIENT
Patient's Sex
Why needed?
Importantforpharmacisttoknow/assess
Appropriatenessforpatient,particularlyinview
ofillegiblehandwritingorConfusinglysimilar
names.
Specialprecautionsarerequiredinpregnancy
andbreastfeeding.
Legal Requirement? –No
What happens if missing?
MedicinesforGynecologicalproblemsare
Obviouslyunsuitableformalepatients.
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78. 2.5. Types of prescription
papers
1.Standard drug prescription paper
Is a prescription paper for regular
(normal) use drugs ( i.e drugs that are
not narcotic or psychotropic)
e.g of drugs
Antiinfectives
Cardiovascular drugs
Drugs acting on autonomic nervous
system,etc
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79. Types of prescription papers …
2.Narcoticdrugsprescriptionpaper
isaprescriptionthatcontainsthe
followingnarcoticdrugs
Codeine Phosphate
Fentanyl
Morphine 5.
Pethidine
Methadone
Others if present
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80. Types of prescription papers …
3. psychotropic drugs prescription paper
is a prescription that contains the
following psychotropic drugs
Alprazolam
Pentobarbitone
Chlordiazepoxide
Phenobarbitone
Clonazepam
Temazepam
Diazepam
Other combination drugs containing
Medazepam controlled psychotropic substances
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81. Over-the-counter medicines( OTC):
Medicines that can be dispensed
without prescription
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82. 2. SYMBOLS AND ABBREVIATIONS
USED IN PRESCRIPTION
Common Route Abbreviations:
PO (by mouth)
PR (per rectum)
IM (intramuscular)
IV (intravenous)
ID (intradermal)
IN (intranasal)
TP (topical)
SL (sublingual)
BUCC (buccal)
IP (intraperitoneal)
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83. Common Frequencies Abbreviations:
daily (qd)
every other day (q.o.d)
BID/b.i.d. (Twice a Day)
TID/t.id. (Three Times a Day)
QID/q.i.d. (Four Times a Day)
QHS (Every Bedtime)
Q4h (Every 4 hours)
Q4-6h (Every 4 to 6 hours)
QWK (Every Week)
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84. Table P9 Abbreviations commonly used in prescriptions
abbreviation Latin Meaning
ac ante cibum before meals
ad lib ad libitum freely, as desired
agit. ante us agitaante usum shake before taking
alt hor alternishoris every other hour
bid bisin die use twice a day
c Cum With
gtt Guttae Drops
od omnidie RightEar
oh omnihora every hour
om omnimane every morning
on omninocte every night
pc post cibum after eating
po per os by mouth
prn pro re nata use as needed
qd quaquein die use every day
qh quaquehora use every hour
qid quaterin die use four times a day
ql quantum libet as much as desired
s Sine Without
sig Signa Label
soln Solutio Solution
tab Tabella Tablet
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85. 2.7. UNITS OF MEASUREMENT
USED IN THE PRESCRIPTION
Thestrengthofthedrugsshouldbewritteninmetric
units.
Quantitiesofdrugsaremeasuredingrams,
milligrams,andmicrograms.
Thegram(g)isthebasicunitofweightinthemetric
system.
Oneone-thousandthofagramis1milligram(mg).
Oneone-thousandthofamilligramis1microgram
(μg)or1mcg.Onethousandgramsisonekilogram
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86. Theliteristhebasicunitofvolumeinthe
metricsystem.
commonlyusethemilliliter(ml),which
isoneone-thousandthofaliter.
Theunitcubiccentimeter,orcc,isusedas
anequaltoml.
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87. 8
7

88. 2.8. Steps of prescription processing
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89. Objectives
UPONCOMPLETING THISCHAPTER,YOUSHOULD
BEABLETODOTHEFOLLOWING:
Describetheresponsibilitiesofatechnicianfilling
prescriptionswithinacommunitysetting.
Listthenecessaryinformationrequiredforprescriptions
Demonstratetheabilitytoprioritizethefillingof
prescriptions.
Differentiatefillingmethodsbetweencontrolledsubstances
andnon–controlledsubstances.
Describelawspertainingtothetechnician’sresponsibilities
whenfillingprescriptions.
Listthestepsofcarefullyfillingamedicationorder.
Differentiatebetweeninpatientandoutpatientinformation
requirements.
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90. s
Dispensing
process
Recording
transaction
Receive &
validate
prescription
Understand and
interpretation of
prescription
Selection and
manipulation of
medicine
Labeling &
packaging of
medicine
Provision of
information
and
instruction
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91. Six major steps (activities) of dispensing
process include
1.Receive and validate prescription
2.Understand and interpret prescription
3.Select appropriate medicine/item
4.Label and packaging of medicine
5.Issue the drug to the patient with clear
instruction and advice
6.Record the actions taken
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92. step 1.
Receive and validate
prescription
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93. step 1. Receive and
validate………………… .
Aprescriptioncanarriveinapharmacybyvarious
methods.
writtenorder
FaxedAprescriptioncanbefaxedfromthe
physician’sofficetothepharmacy.
E-prescribingComputergeneratedprescriptions,
withelectronictransmissiononlineorviamobile
devices,arebecomingcommonaswell.
Usegoodcommunicationskill
Uponreceivingconfirmthenameofpatienttoassurethe
rightpatientgetstherightmedicine,
Validateverbalrequest(onlyforOTCdrugs)
5/8/2024
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94. Reception
Asclientscomeintothepharmacysection,they
mustbemadetofeelattendedtoandcomfortable
bythefollowinggoodcommunicationskills:
Friendlygestures
Asmile
Eye-to-eyecontact
Afriendlywelcome
Politeness
Feelingofcaring
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95. step 2. Understand and
interpret prescription
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96. step2.Understandandinterpret………………
I.Legality
Thepharmacypersonnelshouldconfirmthe
legalityofprescription
Aprescriptionislegalwhen:
Itiswritten(canalsobetyped)andsignedbyan
authorizedprescriber
Themedicinesarewrittenontherightprescription
suchasnormal,NPSandART
Dateofissuenotexceeding15daysfornarcotic
andpsychotropicsubstancesand30daysforother
medicines
Hasalltheinformationrequiredtobecontained
withrespecttopartsofprescription 9
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97. step2.Understandandinterpret……
II.Legibility
Abriefexaminationofeachprescription
shouldbemadeimmediatelyuponreceiving
itfromthepatienttoascertainthelegibility
ofvariouspartsoftheprescription.
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98. e.g of prescription with illegible handwriting
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99. ExampleofaReadingerror:
MedoprazoleandMebendazole-Duetoillegible
handwritingofprescribers,Medoprazolecouldbe
readasMebendazole.
Medoprazoleisabrandcontainingomeprazole
whereas
mebendazoleisanantihelmentictwodifferent
medicinesusedfortwodifferentconditions.
Whenhandwritingisillegible,thebestthingtodo
istocontacttheprescriberoverthephoneand
confirm.
‘NEVER DISPENSE GUESS WORK ’
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100. step 2. Understand and interpret……
III. Completeness of prescription
Details to be checked for completeness of the
prescription
A. Seal of the health institution or header
B. Prescriber’s details (Name of prescriber’s,
Qualification, Signature andDate )
C. Patient's details (Patient Name, Patient
Address, Sex, Age, Weight and Diagnosis)
D. Medicine details
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101. step 2. Understand and interpret……
Checkingthemedicinedetailswill
includechecking:
Nameofthemedicine
Dosageform
Strength/potencyofthemedicine
Totalamounttobedispensedandits
availability
Dosageanddirectionsforuse
Frequencyofadministrationand
durationofthetreatment
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102. A)Nameofthemedicine
Thenameofmedicinemustbelegibleand
correctwithoutadoubt.
Sincemanybrandssoundalike,brandconfusion
isquitecommonespeciallyifthehandwritingis
illegible
Example:Theprescriptioncouldstate–
Diclofenac50mgratherVoltaren50
Iftheprescriberwritesthegenericnamealone,
thepharmacyprofessionalcangiveabrandof
hischoice.
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103. Activity
Discussthefollowingsituation:
Aclientcomestothepharmacyinthe
lateeveningforaprescriptionof
1)‘A’brandofVibromycinforsevere
painandinflammation.Youdonothave
‘A’brandstock,thereisnoother
pharmacycloseby,andtheprescriberis
notcontactable.Whatdoyoudo?
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104. B)Dosageform
Thesamemedicinecouldbeavailableastablets,
capsules,andeveninjections.
Itisimportanttochecktheprescriber’sprescription
forthedosageform.
Ifthedosageformisnotspecified,itisadvisableto
calluptheprescriberandfindout,especiallyifthe
medicineisavailableasdifferentformulations.
Examples–diclofenacavailable50mgtab.,100mg
tab.,100mgsuppositoryand75m/3mlinj.
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105. C) Strength/potency of the medicine
check that the strength is mentioned.
There may be cases for prescribers to prescribe the
medicine without the strength.
Forexample:
Amlodipine 5mg……………………… ..Correct way
Amlodipine…………………………… ...Incorrect way
What to do?
Ifthestrengthisnotstatedontheprescription,
mostlyitmaybenecessarytocontacttheprescriber
forconfirmationoftheappropriatestrength.ssss
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106. IV.Correctnessofprescription
A.Doublemedication:
samemedicineordifferentmedicinewith
samepharmaco-therapeuticeffectconcurrently
prescribedbythesameordifferentprescribersto
thesamepatientundergoingtreatment
B. Interactions:
Manymedicinesareknowntointeractwithother
prescribedorOTCmedicines,food,diseases,herbal
medicines,andlaboratoryresults.
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107. Example–
Acetylsalicylicacidtakencanincreasethe
effectofananticoagulant(warfarin)thata
patientistaking,andmaythusleadto
bleeding.
Patientstakingciprofloxacinshouldavoid
takingantacidwithin2-3hoursbecausethe
antacidcandrasticallyreducetheabsorption
ofciprofloxacin 1
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108. Contraindication
Theage,sex,disease(s)conditions,or
othercharacteristicsofapatientmay
causecertainprescribedmedicinestobe
contraindicated.
e.g,pregnancy,breastfeeding,children
,elderlyetc
Thepharmacyprofessionalshouldcheck
forsuchcontraindications. 1
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109. Examples–
Aspirin is not recommended for
children below 12 years of age
Atenolol is contraindicated in asthma.
Tretinoin contraindicated in pregnancy
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110. V.Interpreteabbreviation
Althoughwidelyusedinprescriptionwriting,
abbreviationscankill!!
Differentpharmacyprofessionalsmayassumeorinterpret
abbreviationsdifferently
Examples
‘HCT’25mgwasintendedtomeanHydrocortisone
25mg,butHydrochlorthiazidewasdispensed.
‘CPZ’mayrefertoChlorpromazine,anantipsychoticor
toCarbamazepine,whichisananticonvulsant.
‘CPM’canmeanChlorpromazineorChlorpheniramine
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111. VI.Correctlyperformanycalculationsofdoseand
thequantitytobeissued
VII. Appropriateness of the individual
Confirm that the dose and duration of prescribed
medicine are in the normal range for the patient
(noting sex and age or weight)
VIII.CallthePrescriber(verifytheprescription)
Ifanydetailsareillegible,missingorincomplete,
thispreventsanymistakes/errorswhiledispensing.
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112. PRESCRIPTION PAPER Code: 0124
InstitutionName:Bole17HealthCenterTel.No011552---
Patient’sfullName:HanaMetasebiaSex:FAge:29Weight:68Card
No.10964/03Region:A.ATown:A.AWoredaBoleKebele17HouseNo.
6245 Tel.No:09123…. Inpatient Outpatient
Diagnosis,ifnotICD:Osteomyelitis,VaginalCandidiasis,
Prescriber’s
Full name
TaddessessTilahu
Registration 661/2003
Signature (signed)
Qualification HO
Dispenser’s
Marta Tarekegn
Druggist 772/1998
Date: May 7, 2012
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113. Summary of step two
Thepharmacypersonnelshould
checkthelegalityofprescription
checkthelegibilityofprescription
Checkthecompletenessprescription
Detailstobecheckedforcompletenessof
theprescription
Sealofthehealthinstitutionorheader
Prescriber’sdetails(Name ofprescriber’s,
Qualification,SignatureandDate)
Patient'sdetails(PatientName,PatientAddress,Sex,
Age,WeightandDiagnosis)
Medicinedetails
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114. Correctly Interpret any abbreviation
Correctly perform any calculations of dose
and the quantity to be issued
Check appropriateness of the individual
verify the prescription by calling the
Prescriber
1
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115. Step 3: Selection
and manipulation
of the medicine
1
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116. Thisincludes:
1.Selectstockcontainerofpre-packreading
thelabelandcrossmatchingthemedicine
name andstrengthagainstthe
prescription.
2.Readthecontainerlabelatleasttwice
duringthedispensingprocess.
3.Donotselecttheprescribedmedicine
accordingtothecolororlocationof
container.
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117. 4.Donotopenmanystockcontainersatthe
sametime.Thistrendwillleadtoerrors
and/orexposethemedicinestoairand
eventuallyleadstodeteriorationinquality.
5.Openandclosecontainersonceatatime.
6.Whilecounting,pouringormeasuring,the
followingpointsshouldbenoted:
◦shortand/orovercountingshouldbeavoided
◦Cleancountingtrayand/orspoonused
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118. ◦Graduatedmeasuringcylinderand/orflask
mustbeusedformeasuringliquidreduction.
◦Ifsmallvolumeistobemeasured,small
measuringcylinder/flaskhastobeused(if
compoundingisperformedinthepharmacy).
7.Appropriatebalanceshouldbeused(if
compoundingisperformedinthepharmacy)
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119. 8.Indispensingliquids(ifcompoundingis
performedinthepharmacy):
Mustbemeasuredinacleanvesseland
shouldbepouredfromthestockbottlewith
thelabelkeptupward.Thisavoidsdamage
tothelabelbyanyspilledordrippingliquid.
Pourthemeasuredliquidpreparationintothe
appropriatecontainer/bottleandlabelit.
Dispenseliquidpreparationsinsuitable
containers
Donotusepatient’sownbottle
Dispenseeachmedicineinadifferentbottle
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120. 9.Indispensingtabletsandcapsules:
•Donotusefingerstocounttabletsasthis
canleadtocontaminationofmedicines
•Useaspoontoputtabletsandcapsules
ontoacountingtray
•Countandputtheminalabeledmedicine
containerorpack
•Closestockcontainerstightlyafter
dispensing
•Keepthespooncleanatalltimes
•Donotkeepthespooninsidethecontainer
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121. Step 4: Labeling and packaging of
the medicine in an appropriate
container
1
2
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122. A.Packagingofmedicines
Medicinesmustbesuitablycontained,
protectedandlabeledfromthetimeof
manufactureuntiltheyareusedbythe
patient.
Thecontainermustmaintainthequality,
safetyandstabilityofthemedicine
throughoutthisperiod.
Thecontainersusedfordispensingmustbe
appropriatefortheproductdispensed.
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2
2

123. Theselectionofpackagingformedicines
dependson:
•Natureofthemedicine
•Typeofpatient
•Dosageform
•Methodofadministeringthemedicine
•Requiredshelf-life
•Use,suchasfordispensing.
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2
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124. Originalcontainersusedbymanufacturersare
expectedtoprotectmedicinesfortheirspecified
shelf-life.
Becauseoriginalcontainersmaycontainlarge
amountofmedicines,repackagingofmedicines
intoanothercontainermaybenecessaryin
ordertodispensemedicinesforpatients.
Prepackagingistheprocessbywhichthe
pharmacyprofessionaltransfersamedication
manuallyfromamanufacturer'soriginal
commercialcontainertoanothertypeof
containerinadvance(beforeclientscometo
medicineretailoutlets)
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125. Uponcompletionofprepackaging,allunused
medicinestock,unusedlabelsandfinishedpackages
shouldberemovedfromtheprepackagingarea.
Thepackagingequipmentshouldthenbecompletely
emptied,cleaned,andinspectedbeforecommencing
thenextprepackagingoperation.
Allprepackagedmedicinesshouldbestoredina
temperatureandhumiditycontrolledenvironment.
Prepackagingmaterialsshouldbestoredandused
inaccordancewiththemanufacturer'sinstructions.
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126. Advantagesofprepackagingmedicines
itallowsenoughtimeforpatientcounseling
and
minimizesdispensingerrorsresultingfrom
hecticoperationduetoheavypatientload.
NBUnfortunately,thematerialscommonlyused
forrepackaginginmanymedicineretailoutlets
ofEthiopiaareordinarypapersandthe
labelingisincomplete.
Insuchcases,repackagingofmedicinesis
likelytohavemanydisadvantagesthan
advantages
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127. Packaging aids and materials
Thematerialsusedforrepackaginginclude:
glassbottles,
plasticbottles,
collapsibletubes,
paperenvelops,
plasticenvelops,etc.
Paperhastheleastvalueastheprimary
packagingmaterialintermsofmaintaining
thequality,safetyandstabilityofpackaged
medicinecontainersforpackagingdifferent
DF
1
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128. Case study 2.1.
AtoKebedewenttoapharmacywitha
prescriptionfornitroglycerinsublingual
tablets.Thepharmacy worker
repackagedtheprescribednumberof
tabletsinpaperenvelopsand
dispensedwithappropriateinstructions
foruse.Someotherday,AtoKebede
consultedthepharmacyprofessional
aboutdecreasingefficacyofthe
medicinedispensed.Comment.
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129. Labeling of medicines
Themainfunctionsofalabelonadispensed
medicinearetouniquelyidentifythecontentsof
thecontainer
i.eandtoensurethatpatientshaveclear
andconciseinformationabouttheuseofthe
medicine.
Eachdispensedmedicinemustbeappropriately
labeledtocomplywithlegalandprofessional
requirements.
Allmedicinestobedispensedshouldbe
labeledand
thelabelsshouldbeunambiguous,clear,legible
andindelible.
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130. Case study 2.2.
The pharmacy professional received a
prescription with the following
information:
Tabs Ibuprofen 400mg
Mitte 60
One t.i.d.
The pharmacy professional dispensed 60
tablets of ibuprofen 400mg.and wrote a
label that the patient should take three
tablets daily with or after food. Comment
on dosage
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131. Step 5:
The provision of information and instruction
to client
1
3
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132. GeneralStepsofCounseling
Allmedicinesshouldbedispensedwith
adequateandappropriateinformation
andcounseling.
questionsandanswersshouldbeused
tocheckthepatientunderstands.
Writteninformationshouldbeprovided
tosupplementverbalcommunication
asappropriate.
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133. Issuemedicinestopatientwithclearinformationand
advice
Theinformationintheformofverbal
and/orwritteninstructionsshouldinclude
thefollowing,
Nameanddescriptionofthemedicine
Intendeduseofthemedicineand
expectedoutcome
Dosage form,dose,routeof
administration
◦Howmuchandhowoftentotakethemedicine
◦Whentotakethemedicine(e.g.,beforeorafter
meals)
◦Howtotakethemedicine(e.g.,withwater,chewingor
swallowing)
1
3
3

134. Durationoftherapywithemphasisgivento
completingtheentirecourseespeciallyforantibiotics
Howlongthetreatmentistolast(e.g.,whythe
entirecourseofanantibiotictreatmentmustbe
taken)
Expectedtimetoseearesponseofthemedication
instructionsonwhattodoifthemedicineappearsnot
tohavethedesiredeffect.
Thetimethemedicineshouldbetakeninrelationto
othermedicines,food,lifestyleinteractionsetc
Whichtypesoffoodsandbeveragesshouldavoid
whiletakingthemedicine
1
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4

135. Clearinstructionsonmeasurementand
administrationofmedicine.
i.e,Ifnecessaryademonstrationsuchas
openingandclosingcontainersorusingan
aerosolmaybenecessary.
Explanationofharmlesseffectsofthe
medicationsuchasurinediscoloration,
Commonseveresideoradverseeffects
orinteractionsandtherapeuticinteractions
thatmaybeencountered,includingtheir
avoidanceandtheactionthatrequiredif
theyoccur
1
3
5

136. e.g Patients should also be informed
not to stop treatment when side
effects occur or in the absence of
response without consulting the
prescriber or dispenser.
1
3
6

137. Storageinstructions
Howtostorethemedicine(e.g.,avoidheat,lightand
dampness)
Adviceregardingkeepingmedicinesoutofreachand
sightofchildren,and
clarificationontheconsequencesofsharingmedication
orkeepingextradosesathome
Nottosharemedicineswithotherpersons
Prescriptionrepeatsinformation
Finally,checkwhetherpatientshaveunderstoodthe
informationprovided
1
3
7

138. Communicating with a patient at the
dispensary
1
3
8

139. Step six
Recording and
documenting the
transaction
1
3
9

140. Prescriptionsshouldberecordedand
documentedasproofoftransaction
betweenthepatientandthedispenser
Alldispensingunitsshouldhavea
standardizedPrescriptionRegistration
Book(PRB)forrecordingevery
pharmaceuticalissuedtoapatient
Acomputerizeddispensingand
registrationsystemmayalsobeused,but
shouldalwaysbesupportedbypaper
backup.
1
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141. a) Recording
The registration book should be
completed at the time of dispensing
or at the close of the working day
PRB should be used both when
prescriptions are
retained in the pharmacy and
when they are returnedto the patient
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1

142. Foraprescriptionwhichisreturnedtoapatient
themedicinesthathavebeendispensedfrom
thepharmacyshouldbecopiedonablank
prescriptionandtheprescriptionshouldbefiled
appropriately.
stamptheword“dispensed”onthe
prescription,whichisretainedbythepatient,
enteredthedispensinginformationPRBbefore
returningtheprescriptiontothepatient.
1
4
2

143. For prescription retained in the
pharmacy
Enter the detail of dispensing
information in to the PRB before
dispensing or at the end of working
day
1
4
3

144. Information to enter in to PRB include
Date
Prescriptionnumber
Patientinformation(nameofpatient,sex,age,weight)
Diagnosis
Descriptionofmedicinedispensed(nameofmedicine,
dose,strength,Qtydispensed,
Prescriberinformation(nameofprescriber,
qualification)
Dispenserinformation(nameofdispenser,
qualification)
Remark(credit,free,prisoner)
1
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145. Auditable Pharmaceuticals Transactions
and Dispensing Solutions (APTDS) Base
codes
Dosage Form Base Code Range
➢Capsules ➢01 to 09
➢Tablets, Lozenge ➢10 to 19
➢Oral preparation (such as
suspension, syrup, solution, drop,
elixir, gel, emulsion, oral powder,
paste) ➢20 to 29
➢Injectable, implants, Infusion ➢30 to
39
1
4
5

146. APTDS
➢Eye, Ear & Nasal preparations (such
as drops, solution, suspensions,
ointments, spray, Inhaler, aerosol) ➢
40 to 49
Topical preparations (such as cream,
ointments, lotion, shampoo, gel,
powder) ➢50 to 59
Note: Cream Starts from 50 whereas
ointment starts from 56 but lotions and
shampoos start from 50
1
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6

147. APTDS
Suppositories, pessaries, Vaginal
creams, Vaginal ointment and tablets,
Vaginal Ovule ➢Note: Creams starts
from 60 and vaginal ointment starts
from 66
60 to 69
➢Medical Supplies Reagents (such as
lab reagents), radiology chemicals ➢
70 to 99 1
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7

148. APTDS
Raw chemical for Laboratory, raw
materials for extemporaneous
preparation) ➢1-01 to 1-09
Sanitary chemicals (antiseptics and
disinfectants) ➢2-01 to 2-09
Consumable instruments ➢3-01 to 3-
09
Others (like close, woods etc.…) ➢4-
01 to 4-09
1
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8

149. b)Documentationandreport
Thereceiptsforrequisition,receivingaswellasthe
prescriptionregistrationbookshouldbekeptproperly.
Blankprescriptionshouldbekeptcarefully,only
prescribershaveaccesstothem.
Filledprescriptionshouldbekeptasareceipt.
PrescriptionsfornarcoticandpsychotropicSubstances
shouldbekeptfor5yearsandotherprescriptionsfor2
years.
Prescriptionshouldbedisposedcarefullyinthe
presenceofappropriatebody.
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150. Regularreportsonmedicineconsumptionand
prescribingpatternfrompatientprescription
registrationbookshouldbepreparedandreport
totheappropriatebodytimely.
Informationobtainedfromprescription
registrationbookcouldbeusedforfurther
planningandefficientutilizationofresource.
Thereportonphysicalinventoryshallbe
documented
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151. Prescription filing
Eachprescriptionshouldbesignedand
accountabilityacceptedbythedispenserorother
authorizedpersonforthecorrectnessofthe.
1.Atthecloseofeachdayalldispensed
prescriptionsshouldbeorganized
2.Prescriptionsshouldbefiledsequentiallybyday
inasinglecontainer/cartonforeachmonth.The
containershouldbelabeledwiththemonthand
year.
3.Containersshouldbearrangedonamonthlybasis.
. 1
5
1

152. 4.Normalprescriptionsshouldbefiled
securelyfortwoyearsandspecial
prescriptionsfor5years.
5.Prescriptions,patientandmedication
relatedrecordsandinformationshould
bedocumentedandkeptinasecure
placethatiseasilyaccessibleonlyto
theauthorizedpersonnel
THANKS
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