Unit-I Lecture-II Pharmacology for Nursing &Medical students.pdf

Unit-I Lecture-II Pharmacology for Nursing &Medical students.
very helpful for students of BS nursing. contents are exactly according to HEC curriculum for BS nursing.

1. Introduction to Pharmacology
Lecture-II
By: Muhammad Aurangzeb
Pharm-B, BSN, MSPH, MSN
Assistant Professor-INS/KMU

2. Objectives
At the end of presentation learners will be able to:
•Describe the types of drug supply system.
•Discuss the drugs standards and legislation.
•Identify resource to collect and utilize drug information.
•Learn to prepare drugs cards

3. Drugs Supply
•Drugssupplyisdefinedasthesystemofdrugprocurement,
storage,anddistribution
•Efficientdrugssupplysystemsareintegrallylinkedtostrong
healthcaresystems.
•Adequatehumanresources,sustainablefinancing,
comprehensiveinformationsystems,andcoordinated
healthcarepartnersandinstitutionsarekeycomponentsto
ensureuninterruptedavailabilityandaccessibilityofessential
medicines

4. According to WHO, an efficient drugs supply system should
undertake the following function
•Selection of Essential Medicines
•Quantification and Forecasting Demand for Medicines
•Procurement of medicines
•Storage of Essential Medicines
•Distribution of medicines
Drugs Supply

5. Drugs Distribution in the Hospitals
•Drugsdistributionisdefinedas:“physicaltransferof
medicinesfromstorageareainthehospitaltothepatient’s
bedside.”
•Thisinvolvestwotypesofdrugsdistribution.Theyare:
1.Inpatient
2.Outpatient

6. Out-patient Department (O.P.D)
•Outpatientrefersto patients notoccupyingbedsin a
hospital, clinics, health centers
•The patients with minor and common illness go to O.P.D for
consultation to the physician

7. Classification of Out-Patients
•The patients visiting the OPDs may categorized as
1.General Patients e.g. diabetic patients, hypertensive
patients
2.Emergency Patients e.g. heart attack, epilepsy patients
3.Referred Patients e.g. Patients suffering from eye, ear,
nose and teeth disorders

8. In–Patient Services
•The drug distribution to the inpatient department can be
carried out from the outpatient dispensing area.
•The staff involved in dispensing the drugs for outpatient can
dispense drugs for inpatients too.
•If the work loadseems tobe heavy then additional personnel
can be employed.

9. Types of Drugs Distribution Systems
There are 4 systems for inpatient drug distribution
1.Individual prescription order system
2.Complete floor stock system
3.Combination of above mentioned
4.Unit dose dispensing method

10. 1) Individual Prescription Order System
•In this system, the physician write the prescription and ask the
patient or the relative of the patient to get the medicine from
any licensed medical store or hospital dispensary by paying
own charge
•This system is mainly used in small or private hospitals
because of its economic consideration and reduced
manpower requirements
Advantages:
•Less numbers of staff is required
•All medication orders are directly reviewed by pharmacist
•It provides a closer connection among pharmacist, physician,
nurse and the patient
•It provides closer control of inventory

11. Disadvantages
•There may be possible delay in obtaining the required
medications for administration to the patient
•Emergency medicines are not quickly supplied
•Increase in the cost to the patient

12. 2) Complete Floor Stock System
•Drugs are stored at the nursing station and are administered
by a nurse according to the chart order of the physician
•Only commonly used drugs are stocked on the floor
Advantages:
•The drugs are readily available for administration
•Minimum return of drugs
•Reduced in-patient prescription orders
•Reduction in number of pharmacy personnel required

13. Disadvantages
•Increase in chance of medication errors, ADRs
•Increase in drug inventory
•Increase chancesof drug deterioration due tolack of proper
storage facilities and dueto unnoticed drug degradation
•Increased workload on nurses
•There is more chance of drug stealing

14. Drugs on the nursing station are known as Floor StockDrugs
NON-CHARGE
FLOORSTOCK
DRUGS
FLOORSTOCK
DRUGS
CHARGEFLOOR
STOCKDRUGS

15. A)Dispensing of Charge Floor Stock Drugs
•Theseare drugs for which patient is charged forevery single
dose administered to him
•Selection of these drugs is made by Pharmacy and
Therapeutic committee
•Charge floor stock drugs are storedat various nursing stations
•An envelope is used to dispense such drugs

16. B) Dispensing of Non-charge Floor Stock Drugs
•These are medicaments placed at thenursing station for the
use of all patients on the floor
•These are cheaper and commonly used drugs
•The costs of these drugs are included in to the day to day
expenditures of the hospitals

17. 3) Combinations of Individual Prescription
Order and Floor Stock System
•It is a type of drug distribution system that uses individual
prescription or medication order system as their primary
means of dispensing but also utilize a limited floor stock
•This system is followed by in the governments and private
hospitals who run on the basis of no profit and no loss

18. 4) Unit Dose Dispensing
•Unit dose medication is defined as those medications which
are ordered , packaged, handled, administered and charged in
multiples of single doses units containing predetermined
amount of drugs or supply sufficient for one regular dose,
application or use.

19. Advantages
•Patient receives improved services and are charged for only
those doses which are administered
•Nurses get more time for direct patient care
•Medication errors are reduced
•More spaceis available in nursingstationby eliminating bulky
floor stock
•It eliminates wastage of drug and pilferage

20. Disadvantages
•It requires separate man power for pre-packaging.
•It requires increased number of skilled personnel in the
pharmacy
•Separate containers, closures, machinery and also space is
required

21. METHODS OF
DISPENSINGUNIT
DOSES
DUDD
CUDD

22. 1. Centralized Unit Dose Drug Distribution
System
•All in-patient drugs are dispensed in unit doses and all the
drugs are stored in central area of the pharmacy and
dispensed at the time the dose is to be given to the patient
•To operate the system, delivery devices such as medication
carts or pneumatic tubes are required

23. PNEUMATIC TUBESYSTEM

24. 2. Decentralized Unit Dose Drug
Distribution System
•This operates through small satellite pharmacies located on
each floor of the hospital
•Themain pharmacy is for procurement, storage,
manufacturing and packing
Procedure:
•Patient profile cardis preparedupon admission to the
hospital
•Prescriptions are sent directly to the pharmacists

25. Cont…
•Pharmacists checks the medication orders
•Junior pharmacistspicks medicationorder and place drugs in
cart
•Pharmacist check cart prior to release
•Thenurse administers thedrugs and make the entry in their
records
•Upon return to the pharmacy the cart is rechecked

26. Dispensing of Controlled Drugs:
•These drugs should kept under lock and key
•A separate register should be maintained to register them
PROCEDURE
•Medical superintendent is overall responsible for handling of
controlled drugs.
•Chief pharmacist procures, stores and dispense the drugs

27. Cont…
Prescription of narcotic drugs under Narcotics and psychotropic
substances act 1985 must include following information
•Patients full name
•Address
•Date
•Name and strength of drug
•Quantity of drug
•Signature of prescriber
•Dose and route of administration

28. Cont…
•If the required drug is not in the stock, the complete
controlled drug prescription must be written on hospital
prescription blank form by registered medical practitioner
and signed
•Delivery of narcotic drugs from pharmacy to wards should be
carried out by reliable person
•After dispensing, nurses resume responsibility for
administration, control and auditing of the inventory
•If patient refuse or doctor cancels any dose , nurse should
destroy the drug in to sink and record “Refused by patient” or
“Cancelled by doctor”

29. Drug Regulation and Legislation
•Drug regulationis the control ofdruguse by international
agreement and/or byregulatoryauthorities such as Food
andDrugAdministration (FDA), the European Medicines
Agency (EMA) and thePharmaceuticaland Medical Devices
Agency (PMDA).
•Pharmacopeias also regulates drugs and makes various
legislation for drugs

30. Resources to Collect and Utilize Drug
Information
Primary Resources
•Researcher’s and manufacturer’s information
•Scientific journals
•Provide original studies or reports E.g. Clinical trial, case
series, case report
Secondary Resources
•Abstract or index which summarizes the information arising in
primary source

31. Cont……
Tertiary Resources
•Textbooks
•handbooks
•online drug compendia
Selected websites
•http://dda.gov.np/
•http://www.nepalpharmacycouncil.org.np
•http:www.nhrc.org.np/

32. General Considerations when Examining and
Using Textbooks
a)The author , publisher , or both: What are the author 's and
publisher's areas of expertise?
b)The year of publication (copyright date) or last revision date?
c)The edition of the text : Is it the most current edition?
d)The presence of a bibliography: I f a bibliography is included,
are important statements accurately referenced? :

33. Cont,……
e)How accessible is the information?
f)Alternative resources that are available (e.g. , primary and
secondary sources, other relevant texts)

34. Other Sources
•Libraries Research associations
•Government bodies Information center in industries
•Analyst labs

35. Drug Cards

36. Drugs card

37. DrugRecomm
ended
dose
Half life /T
max
Route
of
adminis
tration
Indication Contraindicat
ions
Adverse effectsToxic effectsRouteof
eliminati
on
Digoxi
n
0.25mg
IV
40
hours/1Hr
Oral/IVCHF, atrial
fibrillation
Digitalis
toxicity,
ventricular
tachycardia
Ventricular
fibrillation,
obstructive
cardiomyopat
hy
Dizziness, mental
disturbances,
diarrhea,
headache, nausea
and vomiting.
Bradyarrhyth
mias,
cardiac arrest
heart block
ventricular
fibrillation
ventricular
tachycardia
hyperkalemia
Kidneys
Digito
xin
1.5-2ug
p/o
160
hours/1-3
Hrs
Oral/IVCHF,atrial
fibrillation,
ischemic
heart
disease.
hypersensitivity
reaction,
thrombocytopeni
a, confusion,
Liver
Ouaba
in
0.42
mg/kg
p/o,
0.004
mg/kg
i/v
20 hours/
0.5-1Hr
Oral/IVCHF,atrial
fibrillation
Nausea, vomiting
and pulse
irregularities
Kidneys

38. References
•GoyalRK,ParikhRK,PatelMM.ATextbookofHospital
Pharmacy.13thedition.Ahmedabad:BSShahPrakashan;
2015.101-123.
•NandP,KharRK.ATextbookofHospitalandClinical
Pharmacy.Delhi:Birlapublishers;2009.53-70.