NTA Level 4 • Semester 1 • PST04101

Dispensing – Complete Full Notes

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UNITED REPUBLIC OF TANZANIA

Ministry of Health, Community Development, Gender, Elderly and Children

Facilitator Guide

Children – 2016

Table of Contents

Background iv

Acknowledgment v

Introduction vii

Abbreviations/Acronym ix

Session 1: Introduction to Dispensing 1

Session 2: Medical Prescription 6

Session 3: Interpretation of Various Medical Symbols and Abbreviations in a

Prescription 14

Session 4: Guidelines on Prescribing Medicines 29

Session 6: Prescriptions Errors 55

Session 7: Dispensing Procedures in Pharmacy 62

Session 8: Determining Quantities of Medicine for Dispensing 72

Session 9: Medicines Packaging Materials 87

Session 10: Medicines Label 96

Session 11: Generic and Brand Names of Medicines 105

Session 12: Giving Appropriate Medicine Information to Patients 111

Session 13: Adverse Drug Reactions, Drug Overdose and Intoxication 132

Session 14: Documentation of Medicines and Medical Supplies 141

Session 15: Rational Use of Medicines 152

Session 16: Irrational Prescribing of Medicines 158

Session 17: Irrational Dispensing of Medicines 166

Session 18: Sections in a Pharmacy Department 174

Background

There is currently an ever increasing demand for pharmaceutical personnel

in Tanzania. This is due to expanding investment in public and private

pharmaceutical sector. Shortage of trained pharmaceutical human resource

contributes to poor quality of pharmaceutical services and low access to

medicines in the country (GIZ, 2012).

Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together

with Development Partners (DPs) in Germany and Pharmaceutical Training

Institutions (PTIs) worked together to address the shortage of human

resource for pharmacy by designing a project named “Supporting Training

Institutions for Improved Pharmaceutical Services in Tanzania” in order to

improve quality and capacity of PTIs in training, particularly of lower

cadre pharmaceutical personnel.

The Pharmacy Council formed a Steering committee that conducted a

stakeholders workshop from18th – 22ndAugust 2014 in Morogoro to initiate

the implementation of the project.

Key activities in the implementation of this project included carrying out

situational analysis, curriculum review and harmonization, development of

training manual/facilitators guide, development of assessment plan,

training of trainers and supportive supervision.

After the curricula were reviwed and harmonized, the process of developing

standardised training materials was started in August 2015 through Writer’s

Workshop approach.

The approach included two workshops (of two weeks each) for developing

draft documents and a one-week workshop for reviewing, editing and

formatting the sessions of the modules.

The goals of writers workshops were to build capacity of tutors in the

development of training materials and to develop high-quality, standardized

teaching materials.

The training package for pharmacy cadres includes a facilitator guide,

assessment plan and practicum. There are 12 modules for NTA level 4 making

12 facilitator guides and one practicum guide.

Acknowledgment

The development of standardized training materials of a competence-based

curriculum for pharmaceutical sciences has been accomplished through

involvement of different stakeholders.

Special thanks go to the Pharmacy Council for spearheading the

harmonization of training materials in the pharmacy after noticing that

training institutions in Tanzania were using different curricula and train

their students differently.

I would also like to extend my gratitude to St. Luke Foundation

(SLF)/Kilimanjaro School of Pharmacy –Moshi for their tireless efforts to

mobilize funds from development partners.

Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür

Internationale Zusammenarbeit (GIZ), Merck Kgaa, BoehringerIngelheimGmbhand

Bayer Pharma Ag and action medeor.V for the financial and technical

support.

Particular thanks are due to those who led this important process to its

completion, Mrs Stella M. Mpanda Director, Childbirth Survival

Intenational, and Members from the secretariat of National Council for

Technical Education (NACTE) for facilitating the process.

Finally, I very much appreciate the contributions of the tutors and content

experts representing PTIs, hospitals, and other health training

institutions. Their participation in meetings and workshops, and their

input in the development of this training manual/facilitators guide have

been invaluable.

These participants are listed with our gratitude below:

Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of

Pharmacy

Mr.Samwel M. Zakayo- Pharmacy Council

Ms. Ester A. Tuarira MUHAS

Ms. Tumaini H. Lyombe MUHAS

Ms. Dilisi J. Makawia KSP

Ms. Julieth Koimerek KSP

Rev. Baraka A.M. Kabudi MEMS

Mr. Kelvin E. Mtanililwa Royal Pharmaceutical Training Institute

Ms. Rose Bulilo CEDHA

Ms. Diana H. Gamuya CEDHA

Dr.Melkiory Masatu CEDHA

Mr. Habel A. Habel City College of Health and Allied

Sciences

Ms. Zaina Msami Meru District Council

Director of Human Resources Development

Ministry of Health, Community Development, Gender, Elderly and Children

Introduction

Module Overview

This module content is a guide for tutors of Pharmaceutical schools for

training of students. The session contents are based on sub-enabling

outcomes and their related tasks of the curriculum for Basic Technician

Course in Pharmaceutical Sciences. The module sub-enabling outcomes and

their related tasks are as indicated in the in the Basic Technician

Certificate in Pharmaceutical Sciences (NTA Level 4) Curriculum

Target Audience

This module is intended for use primarily by tutors of pharmaceutical

schools. The module’s sessions give guidance on the time, activities and

provide information on how to teach the session. The sessions include

different activities which focus on increasing students’ knowledge, skills

and attitudes.

Organization of the Module

The module consists of eighteen (18) sessions; each session is divided into

several parts as indicated below:

• Session Title: The name of the session

• Total Session Time: The estimated time for teaching the session,

indicated in minutes

• Pre-requisites: A module or session which needs to be covered before

teaching the session.

• Learning Tasks: Statements which indicate what the student is expected to

learn by the end of the session

• Resources Needed: All resources needed for the session are listed

including handouts and worksheets

• Session Overview: The session overview box lists the steps, time for each

step, the activity or method used in each step and the step title

• Session Content: All the session contents are divided into steps. Each

step has a heading and an estimated time to teach that step as shown in

the overview box. Also, this section includes instructions for the tutor

and activities with their instructions to be done during teaching of the

contents

• Key Points: Key messages for concluding the session contents at the end

of a session This step summarizes the main points and ideas from the

session, based on the learning tasks of the sssion

• Evaluation: The last section of the session consists of short questions

based on the learning tasks to check the understanding of students.

• Handouts: Additional information which can be used in the classroom while

teaching or later for students’ further learning. Handouts are used to

provide extra information related to the session topic that cannot fit

into the session time. Handouts can be used by the students to study

material on their own and to refer to them after the session. Sometimes,

a handout will have questions or an exercise for the participants

including the answers to the questions.

Instructions for Use and Facilitators Preparation

• Tutors are expected to use the module as a guide to train students in the

classroom and skills laboratory

• The contents of the modules are the basis for teaching and learning

dispensing.

• Use the session contents as a guide

• The tutors are therefore advised to read each session and the relevant

handouts and worksheets as preparation before facilitating the session

• Tutors need to prepare all the resources, as indicated in the resource

section or any other item, for an effective teaching and learning process

• Plan a schedule (timetable) of the training activities

• Facilitators are expected to be innovative to make the teaching and

learning process effective

• Read the sessions before facilitation; make sure you understand the

contents in order to clarify points during facilitation

• Time allocated is estimated, but you are advised to follow the time as

much as possible, and adjust as needed

• Use session activities and exercises suggested in the sessions as a guide

• Always involve students in their own learning. When students are

involved, they learn more effectively

• Facilitators are encouraged to use real life examples to make learning

more realistic

• Make use of appropriate reference materials and teaching resources

available locally

Preparation with Handouts and Worksheets

• Go through the session and identify handouts and worksheets needed for

the session

• Reproduce pages of these handouts and worksheets for student use while

teaching the session. This will enable students to refer to handouts and

worksheets during the session in the class. You can reproduce enough

copies for students or for sharing

• Give clear instructions to students on the student activity in order for

the students to follow the instructions of the activity

• Refer students to the specific page in the student manual as instructed

in the facilitator guide

Using Students Manual When Teaching

• The student manual is a document which has the same content as the

facilitator guide, which excludes facilitator instructions and answersfor

exercises.

• The student manual is for assisting students to learn effectively and

acts as a reference document during and after teaching the session

• Some of the activities included in facilitator guide are in the student

manual without facilitator instructions

Abbreviations/Acronym

|% |Percent |

|‘S’ or |Signetur (in Latin). Means, label according to the |

|‘Sig’ |prescription |

|API |Active Pharmaceutical Ingredient |

|CEDHA |Centre for Educational Development in Health Arusha |

|CUHAS |Catholic University of Health and Allied Sciences |

|ELCT |Evangelical Lutheran Church in Tanzania |

|FEFO |First Expire First Out |

|FIFO |First In First Out |

|GDP |Good Dispensing Practice |

|GRN |Goods Received Note |

|Giz |Deutsche GesellschftFür Internationale Zusammenarbeit |

|HKMU |Hurbert Kairuki Memmorial University |

|HIV |Human Immunodeficiency Virus |

|HTC |Hospital Therapeutic Committee |

|I.M |Intramuscular |

|I.V |Intravenous |

|INN |International Non- Proprieatry Name |

|JSI |John Snow Inc |

|KSP |Kilimanjaro School of Pharmacy |

|LZHRC |Lake Zone Health Resource Centre |

|MEMS |Mission for Essential Medicines Supplies |

|MoHCDGEC |Ministry of Health, Community Development, Gender, Elderly and|

|MSD |Children |

|MUHAS |Medical Stores Department |

|NACTE |Muhimbili University of Health and Allied Sciences |

|NTA |National Council For Technical Education |

|OTC |National Technical Award |

|PC |Over the Counter |

|PTI |Pharmacy Council |

|PVC |Pharmaceutical Training Institution |

| |Poly Vinyl Chloride |

|R&R |Report and Request Form |

|RuCU |Ruaha Catholic University |

|Rx |Recipe or Superscription |

|S.C |Subcutaneous |

|SIBS |Spring Institute of Business and Science |

|SLF |Saint Luke Foundation |

|USP |United States Pharmacopeia |

|TFDA |Tanzania Food and Drugs Authority |

| | |

Session 1: Introduction to Dispensing

Total Session Time: 60 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Dispensing, Dispenser and Medicines

• Describe Importance of Dispensing in Pharmacy

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning Tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Dispensing, Dispenser and Medicine (5 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is Dispensing, Dispenser, Medicine? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Dispensing: The act of preparing medicines and/or medical supplies and

distributing to users with adequate information, counseling and appropriate

follow up

Dispensing involves:

• Receiving and Interpretation of prescription from prescriber

•

The preparation, packaging, labeling, record keeping, and transfer of a pre

scription drug to a patient or an intermediary,

who is responsible for administration of the drug

• Dispensing includes;

o The preparation and transfer of a medication to a client

o Taking steps to ensure the pharmaceutical and therapeutic suitability

of the medication for its intended use,

o Taking steps to ensure its proper use of medicines

o It may also include accepting payment for a medication on behalf of a

nurse's employer.

• Dispensing occurs when the medications are given to a client

• Dispenser: Any person who is licensed or authorized by the appropriate

body to dispense medicines and/or medical supplies

• Medicine: Any substance or mixture of substances used in the diagnosis,

treatment, mitigation or prevention of a disease in human

o Medicines include narcotic drugs, psychotropic substances and

precursor chemicals, traditional medicines, complementary or

alternative medicine; poisons, blood and blood products,

vaccine, radioactive pharmaceuticals, cosmetics and sanitary

items and medical instruments

STEP 3: Importance of Dispensing (30 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the importance of dispensing? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are importance of dispensing:

• Ensure patient receives;

o Correct medicine,

o Crrect amount of medicines

o Correct dose and dosage

o At lower cost

• Patient receives proper information of his/her medicine

• Improves patient compliance to their medications

• As a subject (module) in pharmaceutical dispensing course, it ensures

student is equipped with knowledge, understanding, attitude and skills

necessary for dispensing practices

STEP 4: Key Points (5 minutes)

• Dispensing refers to the process of preparing and giving medicines to a

named person on the basis of prescription

• Dispensing involves the correct interpretation of the wishes of the

prescriber and the accurate preparation and labelling of medicine for use

by th patient

• Dispensing process may take place in a public or private clinic, health

center, hospital or community pharmacy setting

• Dispensing is carried out by pharmacists, pharmaceutical technicians,

nurses, pharmaceutical assistants and medicine dispensers

STEP 5: Evaluation (5 minutes)

• What is dispensing?

• What are the importance of dispensing?

References

Ansel, H. C. (2012). Pharmaceutical Calculations (14th ed.).

Philadelfia,United States of America: LWW. .

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Session 2: Medical Prescription

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define a Medical Prescription

• List Parts of a Medical Prescription

• Identify Features of Different Parts of a Medical Prescription

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and /whiteboard markers

• Handout 2.1: Sample of a Filled Medical Prescription

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Medical Prescription (5 minutes)

Medical Prescription

• A legal written order from a qualified prescriber to a qualified

dispenser which contains instructions to dispense or compound and

administer specified medicines to a clearly mentioned patient

• It is an order for medication issued by a physician, dentist or other

properly licensed medical practitioner

o A prescription designate specific medication and dosage to be prepared

by a pharmacist/pharmaceutical technician and administered to a

particular patient

o A medical prescription can be printed or written in ink

Categories of a Medical Prescription

• Those written for single component or prefabricated products and not

requiring compounding or mixing by the pharmacist/pharmaceutical

technician

• Those written for more than a single component and requiring

compounding

[pic]

Fig 2.1: Sample Prescriptions

STEP 3: Parts of a Medical Prescription (50 minutes)

|Activity: Small Group Discussion ( 30 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the Parts of a Medical Prescription? |

| |

|ALLOW students to discuss for 30 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are parts of a Medical Prescription:

• Name of the institution/health facility

• Prescriber information and signature

• Patient information

• Date prescription was written

• The superscription (Rx symbol)

• Inscription (medication prescribed)

• The subscription (dispensing instruction to the pharmaceutical

personnel)

• Transcription/ Signatura (Direction to the patient)

[pic]

Figure 2.2: Sample of Filled Medical Prescription

[pic][pic] Refer students to Handout 2.1: Sample of a filled Medical

Prescription

STEP 4: Features of Different Parts of a Medical Prescription (50 minutes)

|Activity: Small Group Discussion ( 30 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|[pic] ASK students to discuss on the following question |

|What are the features of different parts of a Medical Prescription? |

| |

|[pic] Refer students to Handout 2.1: Sample of a Filled Medical |

|Prescription |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are features of different parts of a medical prescription:

• Name of the institution/ health facility

o Full address of the institution

• Prescriber’s information and signature

o Name, address and signature of the prescriber together with

professional qualification. (ACO, CO, AMO, MD or DS etc) written and

signed in indelible/permanent ink

• Patient information

o Patient information which includes the patient full name, address,

hospital registration number, sex, age and /or body weight of the

patient

• Date prescription was written

o The date prescription was written showing day, month and year

• The superscription (Rx symbol)

o Consists of the heading where the symbol Rx (an abbreviation for

recipe, the Latin for ‘take thou’) is found

o The Rx symbol comes before the inscription

• Inscription

o Is also called the body of the prescription

o Provides the names and quantities of the chief ingredients of the

prescription to be dispensed

o The dose/strength and dosage form, such as tablet, suspension,

capsule, syrup is found

• The subscription (dispensing instruction to the pharmaceutical personnel)

o This gives specific directions for the pharmaceutical personnel on how

to compound the medication

o These directions to the pharmaceutical personnel are usually expressed

in Latin or may consist of a short sentence such as: "make a

solution," "mix and place into 10 capsules” or "dispense 10 tablets"

• Transcription

o This gives instructions to the patient for use:

▪ On how to take the drug; route by which the drug is to be

administered.

▪ How much, how many times per day (frequency of administration),

when and how long the drug is to be taken

▪ These instructions are preceded by the symbol “S” or “Sig.” from

the Latin, meaning "mark." Or “Label”

▪ Also may contain special instructions, warnings considered

important for the patient

STEP 5: Key Points (5 minutes)

• A medical prescription should be clearly written for easy reading and to

prevent unnecessary mistakes in interpretation

o If not written clearly, check with the prescriber and never guess

• Not all medications require prescriptions. There are certain medications

on the market that can be purchased over the counter, thus their name

Over-the-Counter drugs (OTC)

STEP 6: Evaluation (5 minutes)

• What is a Medical Prescription?

• What are the parts of a Medical Prescription?

• What are the features of different parts of a Medical Prescription?

References

Ansel, H. C. (2012). Pharmaceutical Calculations (14th ed.).

Philadelfia,United States of America: LWW. .

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

|[pic] |Handout 2.1: Sample of a Filled Medical Prescription |

[pic]

Note: Strength of amoxicillin used in the prescription is 500mg

Session 3: Interpretation of Various Medical Symbols and Abbreviations in a

Prescription

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Explain the Overview of Prescription Abbreviations and Symbols

• Describe Various Medical Symbols and Abbreviations

• Interpret Different Medical Symbols and Abbreviations from Filled

Prescriptions

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board chalk and whiteboard markers

• Handout 3.1: Master List of Prescription Abbreviations

• Worksheet 3.1: Sample Filled Prescription Forms Serial No. 001-005

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Overview of Prescription Symbols and Abbreviation (15 minutes)

• Abbreviations are shortened form of a word or name that is used in place

of the full word or name

• A symbol is a thing that represents or stands for something else,

especially a material object representing something abstract

• These abbreviations and symbols are Latin terms and they usually indicate

the route of drug administration and the frequency of dosing

• These abbreviations should be understood by the dispensers and are

internationally recognised

• In every prescription, prescribers use different medical abbreviations to

order medication to a patient

STEP 3: Various Medical Abbreviations (30 minutes)

|Activity: Buzzing (5minutes) |

| |

|ASK students to pair up and buzz on the following question for 3 |

|minutes |

| |

|What are the common medical symbols and abbreviations used in |

|prescription writing? |

| |

|ALLOW few pairs to respond on the question and let other pairs add on |

|points not mentioned WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

Table 1: Abbreviations and Symbols for Frequency of Dosing

| | | | |

| | | |n |

|I |One | |o.d. |once a day |

|Ii |Two | |b.i.d. |twice a day |

|Iii |Three | |t.i.d. |three times a |

| | | | |day |

|Iv |Four | |q.i.d. |four times a |

| | | | |day |

|5X |five times | |q.h.s. |everynight at |

|Rx |Take this | | | |

| | | |q.4h |every four |

| | | |q.6h |every six |

| | | |q.o.d |every other |

| | | |Prn |as needed |

| | | |gtt. |Drop |

| | | |a.c. |before meals |

| | | |p.c. |after meals |

Table 2: Abbreviations for Route of Drug Administration

|Abbreviation |Interpretation |

|p.o. |By mouth, orally (per oral) |

|SL |Sublingual, under the tongue |

|ID |Intradermal |

|IM |Intramuscular |

|IV |Intravenous |

|IV PB |Intravenous piggyback |

|SC |Subcutaneous. |

|GT |Gastrostomy tube |

|NJ |Naso-jejunal tube |

|p.r |Per rectum |

|p.v |Per vagina |

|O.D (RE) |Right eye |

|O.S (LE) |Left eye |

|O.U BE) |Both eyes |

|A.D |Right ear |

|A.S |Left ear |

|A.U |Both ears |

STEP 4: Interpreting Medical Abbreviations of Filled Prescriptions (60

minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|PROVIDE 5 different Sample Filled Prescription Forms to each group |

| |

|ASK students to discuss on the following question |

| |

|What are the interpretations of the abbreviations on the Sample |

|Prescription Forms? |

|REFER Students to Worksheet 3.1: Sample filled Prescriptions Forms |

|Serial No. 001-005 |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using Master List of Prescription |

|Abbreviations Handout |

STEP 5: Key Points (5 minutes)

• Abbreviations in the prescriptions have been drawn from Greek and Latin

words. It is important to understand the interpretations of

abbreviations used in the prescription before dispensing

• In every prescription, prescribers use different medical abbreviations to

order medicines to a patient

STEP 6: Evaluation (5 minutes)

• What are the most common used abbreviations in medical prescriptions?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Medical Terminology Abbreviations. Retrieved from

http://www.delmarlearning.com/companions/content/1401852467/student_resource

s/termabbrev.pdf.

Master List of Prescription Abbreviations. Every Patient’s Advocate.

Retrieved from

http://www.everypatientsadvocate.com/columns/prescriptionabbreviations.

pdf.

|[pic] |Handout 3.1: Master List of Prescription Abbreviations |

|Abbreviation |From the Latin |Meaning |

|Aa |Ana |of each |

|Ad |Ad |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 |left ear |

| |sinister | |

|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 |as a large single dose (usually |

| | |intravenously) |

|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 |cum cibos |with food, (but also cubic centimetre) |

|Cf | |with food |

|comp | |Compound |

|cr., crm | |Cream |

|D5W | |dextrose 5% solution |

|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 |

| | | |

Master List of Prescription Abbreviations

|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 |

|ex aq |ex aqua |in water |

|fl., fld. | |Fluid |

|ft. |Fiat |make; let it be made |

|G | |Gram |

|Gr | |Grain |

|gtt(s) |gutta(e) |drop(s) |

|H | |Hypodermic |

|h, hr |Hora |Hour |

|h.s. |hora somni |at bedtime |

|ID | |Intradermal |

|IM | |intramuscular (with respect to |

| | |injections) |

|inj. |Injection |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 |

| | | |

Page 2 of 4

Master List of Prescription Abbreviations

|mL | |Millilitre | |

|N.M.T. | |not more than | |

|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 | |

|Oz | |Ounce | |

|Per |Per |by or through | |

|p.r. | |by rectum | |

|q.o.d. | |every other day | |

|R | |Rectal | |

| | |"s") | |

| | | | |

Master List of Prescription Abbreviations

| | | | |

|Sig | |write on label | |

|SL | |sublingually, under the tongue | |

|sit | | | |

|Tsp | |Teaspoon | |

|t.i.w. | |three times a week | |

|top. | |Topical | |

|T.P.N. | |total parenteral nutrition | |

|U.S.P. | |United States Pharmacopoeia | |

|Vag | |Vaginally | |

|W | |With | |

|w/o | |Without | |

|X | |Times | |

|[pic] |Worksheet 3.0: Sample Filled Prescription Forms Serial No. |

| |001-005 |

|Serial Na. 001 |

|KIHESA HEALTH CENTER |

|P.O. Box 56 |

|IRINGA |

|Name: |Ibrahim Kimongo |

|Gender: |M |

|Age: |39Yrs |

|Weight: |65kg |

|Rx |Paracetamol tabs 1g |

| |t.d.s 3/7 |

| |Metronidazole Tabs 480 |

| |mg tds 7/7 |

| |Clotrimazole cream p.a.a|

| |Bd x2/52 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] |

|Serial Na. 002 |

|KIHESA HEALTH CENTER |

|P.O. Box 56 |

|IRINGA |

|Name: |Joyce Kamau |

|Gender: |F |

|Age: |18Yrs |

|Weight: |40kg |

|Rx |Miconazole cream 2% |

| |p.a.a b.i.d 4/52 |

| |Griseofulvin tabs 500 mg|

| |p.c od 3/12 |

| |Paracetamol Tabs 1g tds |

| |3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] |

|Serial Na. 003 |

|KIHESA HEALTH CENTER |

|P.O. Box 56 |

|IRINGA |

|Name: |Steven Nnyamayao |

|Gender: |Me |

|Age: |56Yrs |

|Weight: |74kg |

|Rx |Mebendazole tabs 500mg |

| |stat |

| |Phenytoin 10mg nocte OD x|

| |3/7 |

| | |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] |

|Serial Na. 004 |

|KIHESA HEALTH CENTER |

|P.O. Box 56 |

|IRINGA |

|Name: |Marystella Ndauka |

|Gender: |F |

|Age: |65Yrs |

|Weight: |80kg |

|Rx |Occu.l tetracycline |

| |oint. RE 6hrly 1/52 |

| |Paracetamol Tabs PO 1g |

| |tds 3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] |

|Serial Na. 005 |

|KIHESA HEALTH CENTER |

|P.O. Box 56 |

|IRINGA |

|Name: |Marium Abubakar |

|Gender: |Fe |

|Age: |4Yrs |

|Weight: |10kg |

|Rx |Metronidazole syrup 1 |

| |tsp tds 7/7 |

| |Paracetamol syrup 1tsp |

| |prn |

| | |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] |

Session 4: Guidelines on Prescribing Medicines

Total Session Time: 120 minutes

Prerequisites

• None

Students Learning Tasks

By the end of this session students are expected to be able to:

• Define Standard Treatment Guideline (STG)

• Explain the Importance of STG

• Describe Categories of Athorized Prescribers

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Introduction to Standard Treatment Guideline (STG) (5 minutes)

Standard Treatment Guideline

• STGs may be defined as ‘systematically developed statements to help

practitioners or prescribers make decisions about appropriate treatments

for specific clinical conditions’

• STGs or treatment protocols are a proven, effective strategy to promote

appropriate prescribing, when used in conjunction with educational

strategies to promote their use

• As a minimum, they should contain information on clinical features,

diagnostic criteria, non-drug and drug treatments (first-, second-,

third-line) and referral criteria

STEP 3: Importance of Standard Treatment Guidelines (30 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is the importance of Standard Treatment Guidelines? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Standard Treatment Guidelines are very useful in:

• Providing guidance to health professionals on the diagnosis and treatment

of specific clinical conditions

• Orienting new staff about accepted norms in treatment

• Providing prescribers with justification for prescribing

• Providing a reference point by which to judge the quality of prescribing

• Aiding efficient estimation of drug needs and setting priorities for

procuring and stocking drugs

STEP 4: Categories of Authorized Prescribers (60 minutes)

|Activity: Small Group Discussion ( 40 minutes) |

| |

|DIVIDE students into manageable groups |

| |

|ASK students to discuss in groups on the following question: |

| |

|Who are the authorized prescribers? |

| |

|ALLOW students to discuss for 20 minutes |

| |

|ALLOW each groups to present |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are the authorized prescribers:

• Assistant Clinical Officer Dispensaries

• Clinical Officer Dispensaries, Health Centers

• Assistant Dental Officer Health Centers, District Hospital

• Dental Officer District Hospital, Regional Referral Hospital

• Assistant Medical Officer Health Centers, District Hospital,

Regional Referral

Hospital

• Medical Officer Health Center, District Hospital, Regional

Referral

Hospital

• Specialists Regional Hospital, Zonal referral

Hospitals, National

and specialized

Hospitals

STEP 5: Key Points (10 minutes)

• Standard Treatment Guidelines is defined as ‘systematically developed

statements to help practitioners or prescribers make decisions about

appropriate treatments for specific clinical conditions

o Provide guidance to health professionals on the diagnosis and treatment

of specific clinical conditions

STEP 6: Evaluation (10 minutes)

• What is STG?

• What is the importance of STG?

• Who are the authorized prescribers?

References

GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania:

MOHSW.

GoT (2013). Standard Treatment Guidelines& National Essential Medicines

List Tanzania MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.

GoT (2014-2019). Staffing Levels for Ministry of Health and Social Welfare

Departments, Health Service Facilities, Heath Training Institutions

and Agencies. (Revised). Dar es salaam, Tanzania: MOHSW.

Session 5: Policies and Guidelines on Prescribing Medicines

Total Session Time: 120 minutes

Prerequisites

• No

Learning Tasks

By the end of this session students are expected to be able to:

• Define Essential Medicine and Essential Medicine List

• Identify Hospital Formulary

• Explain Tanzania National Formulary(TNF)

• Distinguish between British National Formulary(BNF) and WHO Model

formulary

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk, and whiteboard markers

• Handout 4.1 NEMLIST

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Essential Medicine and Essential Medicine List

(20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following questions: |

| |

|What are the essential medicines? |

|What is Essential Medicine List? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Essential medicines

• Are medicines that satisfy the priority health care needs of the

population

o They are selected with due regard to public health relevance,

evidence on efficacy and safety, and comparative cost-effectiveness

o Are intended to be available within the context of functioning health

systems

▪ at all times in adequate amounts

▪ in the appropriate dosage forms

▪ with assured quality and adequate information

▪ at a price the individual and the community can afford

The essential medicine list

• Is the list that gives information of medicines on the name, route of

administration, pharmaceutical forms and strength and indicates the

lowest level of health facility where the medicine may be available

o It aims to identify cost-effective medicines for priority conditions,

together with the reasons for their inclusion, linked to evidence-

based clinical guidelines and with special emphasis on public health

aspects and considerations of value of money.

[pic]REFER Students to Handout 5.1: Essential Medicine List

STEP 3: Hospital Formulary (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is Hospital Formulary? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

The Hospital Medicine Formulary

• A list consisting of the most cost-effective, safe, readily available

medicines of assured quality that will satisfy the health care needs of

the majority of the patients in the hospital.

• Formularies cover all the categories of medicines that patients needs

o Constantly revised and updated to make sure that patients receive

appropriate medications

• Before a medicine is added to or removed from the formulary, teams of

pharmacists, physicians and other healthcare professionals in the

hospital do evaluation to make sure that they are safe, work well and

are cost-effective

• These formularies can differ from one institution/hospital to another

STEP 4: Tanzania National Formulary (TNF) (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is Tanzania National Formulary? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Tanzania National Formulary provide guidelines which promote safe,

rational, economic and effective use of medicines in the United Republic

of Tanzania

o Concentrates on medicines listed in the NEMLIST and STG

o Users are therefore encouraged to use both books together as they

complement one another

STEP 5: British National Formulary (BNF) and WHO Model Formulary

(30minutes)

British National Formulary (BNF)

• Is a pharmaceutical reference book that contains a wide spectrum of

information and advice on prescribing and pharmacology, along with

specific facts and details about many medicines

• It is written by Royal Pharmaceutical Society of Great Britain together

with the British Medical Association and it is used in many countries

including Tanzania as a reference book.

• It reflects current best practice as well as legal and professional

guidelines relating to the uses of medicines. Contents include:

o Guidance on the drug management of common conditions

o Details of medicines with special reference to their uses,

cautions, contra-indications, side-effects, doses, and relative

costs

▪ Guidance on prescribing, monitoring, dispensing, and

administering medicines

WHO Model Formulary

• Since its first publication in 2002, the WHO Model Formulary has

become a source of independent information on essential medicines for

pharmaceutical policy-makers and prescribers worldwide.

• For each medicine, the Formulary provides information on use, dosage,

adverse effects, contraindications and warnings, supplemented by

guidance on selecting the right medicine for a range of conditions

STEP 6: Key Points (5 minutes)

• Essential medicines list aims at providing medicines informations of

common disease in the country based on efficacy, safety and cost-

effectiveness.

• Since prescribers and dispensers are encouraged to prescribe/dispense

medicines only when they are essential then the proper use of guides such

as EML, Hospital Formulary, TNF, BNF and WHO Model formulary are very

crucial

STEP 7: Evaluation (10 minutes)

• What is TNF, NEMList and hospital formulary?

• What are the importances of formularies when prescribing/dispensing

medicines?

References

GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania:

MOHSW.

GoT (2013). Standard Treatment Guidelines& National Essential Medicines

List Tanzania MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.

Rice, J. (2011). Principles of pharmacology for medical assisting (5th

ed.). Boston, United States: Cengage Learning.

Roach, S. S., & Ford, S. M. (2008). Introductory clinical pharmacology (8th

ed.). Philadelphia, United States: Lippincott Williams & Wilkins.

Taber, C. W., & Thomas, C. L. Taber's cyclopedic medical dictionary (pp.

v.). Philadelphia, United States: F.A. Davis Co.

Walker, R., & Whittlesea, C. (2012). Clinical pharmacy and therapeutics

(5th ed.). Edinburgh, United Kingdom: Churchill Livingston/Elsevier.

|[pic] |Handout 5.1: Essential List of Medicine |

Session 6: Prescription Errors

Total Session Time: 120 minutes + 1 hour assignment

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define prescription error

• List common prescription errors

• Identify common prescriptions errors

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board chalk, and whiteboard markers

• Worksheet 6.1: Prescription Errors

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning Tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Prescription Errors (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is a prescription error? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Prescription errors encompass those related to the act of writing a

prescription

• Prescribing faults encompass irrational prescribing, inappropriate

prescribing, under prescribing, overprescribing, and ineffective

prescribing

o These faults arise from erroneous medical judgement or decisions

concerning treatment or treatment monitoring

STEP 3: Common Prescription Errors (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 5 |

|minutes |

| |

|What are the common Prescription Errors? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

The following are the common prescription errors:

• Omission error

• Wrong dose error

• Extra dose error

• Wrong dose form error

• Wrong time error

• Wrong drug

• Wrong route of administration

• Wrong frequency

• Wrong duration of treatment,

• Poor legibility of handwriting (unknown abbreviations)

• Unintended omissions

• Incomplete Medical Prescription (If any component of a Medical

Prescription is not filled)

STEP 4: Identification of Common Prescription Errors (60 minutes)

|Activity: Small Group Discussion ( 40 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the errors in the provided prescriptions? |

|[pic]REFER students to Worksheet 6.1 Prescription Errors SERIAL No. |

|001-005 |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Students should be able to identify the following Prescription errors:

• Serial No.001

o Incomplete name of the patient

o No signature

o Duration of medicine missing (erythromycin)

o Wrong frequency of paracetamol

• Serial No. 002

o Name of the institution is not known

o Strength of paracetamol is not known

o Prescriber’s name is missing

• Serial No.003

o Age of the patient is missing

o Polypharmacy- no need to dispense two analgesics (paracetamol and

aspirin)

o Atenolol strength is not 5.0 but there is 50 mg or 100 mg, mistake in

writing

• Serial No.004

o Sex is not indicated (gender)

o Doxycycline and magnesium should not be given together, they interact

each other

o Magnesium strength is not shown

• Serial No.005

o No date

o Tetracycline Bd ×2/52

o Wrong medicine for the indication i.e. amoebiasis is treated with

Nitronidazole (Metronidazole, Ttinidazole, Secnidazole)

o Medicine does not tell the dosage form i.e. is it tablet, ointment

capsule.

o Drug name should be generic and not trade name (Tulizamol should be

written as Paracetamol)

STEP 5: Key Points (5 minutes)

• Medication errors are common in general practice and in hospitals.

• Both errors in the act of writing (prescription errors) and prescribing

faults due to erroneous medical decisions can result in harm to patients

• Any step in the prescribing process can generate errors

• Inadequate knowledge or competence and incomplete information about

clinical characteristics and previous treatment of individual patients

can result in prescribing faults, including the use of potentially

inappropriate medications

STEP 5: Evaluation (5 minutes)

• What are prescription errors?

• What are the common prescription errors?

References

Cornish, P.L, Knowles, S.R, Marchesano, R, Tam, V, Shadowitz, S, Juurlink,

DN, Etchells, E, E. (2005). Arch Intern Med: Unintended medication

discrepancies at the time of hospital admission. 2005;165:424–9.

Dean, B., Schachter, M., Vincent, C, Barber, N (202). Lancet: Causes of

prescribing errors in hospital inpatients: a prospective study.

359:1373–8.

Dean, B., Vincent, C, Schachter, M., Barber, N (2005). Drug Saf:The

incidence of prescribing errors in hospital inpatients: an overview of

the research methods.. 28:891–900.

Knudsen, P., Herborg, H., Mortensen, A,R., Knudsen, M., Hellebek, A

.(2007). Qual Saf Health Care:Preventing medication errors in

community pharmacy: root-cause analysis of transcription errors.

16:285–290.

Lesar, T.S., Briceland, L., Stein, D, S. (1997). JAMA:Factors related to

errors in medication prescribing.. 277:312–317.

Spinewine, A., Schmader, K,E., Barber, N., Hughes, C., Lapane, K,L., Swine,

C., Hanlon, J,T. (2007). Lancet: Appropriate prescribing in elderly

people: how well can it be measured and optimised? 370:173–184.

Tam, V,C., Knowles, S,R., Cornish, P,L., Fine., Marchesano, R., Etchells,

E,E. (2005). CMAJ: Frequency, type and clinical importance of

medication history errors at admission to hospital: a systematic

review..173:510–5.

Velo, G, P., & Minuz, P. (2009). British Journal of Clinical Pharmacology:

Medication errors: prescribing faults and prescription errors. 67:6

|[pic] |Worksheet 6 .1: Prescription Errors Serial No. 001-005 |

|Serial Na. 002 |

|Name: |Mariam Juma |

|Gender: |Me |

|Age: |20Yrs |

|Weight: |60kg |

|Rx |Amoxicillin 500mg tds |

| |7/7 |

| |Paracetamol Tabs 100g |

| |tds 3/7 |

|qualifica|CO |

|tion | |

|Signature|[pic]10/07/2015 |

|Serial Na. 001 |

|KIHESA HEALTH CENTER |

|P.O. Box 558 |

|IRINGA |

|Name: |John |

|Gender: |Me |

|Age: |20Yrs |

|Weight: |60kg |

|Rx |Erythromycin tabs 500mg |

| |q.i.d |

| |Paracetamol Tabs 1g Bd |

| |3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica|11/09/2015 |

|tion | |

|Serial Na. 003 |

|KIHESA HEALTH CENTER |

|P.O. Box 558 |

|IRINGA |

|Name: |Salum Hussein |

|Gender: |Me |

|Weight: |60kg |

|Rx |Asprin 300mg tds 7/7 |

| |Paracetamol Tabs 1g tds |

| |3/7 |

| |Atenolol 5.0mg Od 1/30 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]20/04/2015 |

|Serial Na. 004 |

|KIHESA HEALTH CENTER |

|P.O. Box 558 |

|IRINGA |

|Name: |Kalunde Athuman |

|Age: |20Yrs |

|Weight: |60kg |

|Rx |Doxycycline100 Bd 7/7 |

| |Magnisium Tricylicate |

| |tds 3/7 |

|Prescribe|Ulimbo Ole |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]17/02/2015 |

| | |

|Serial Na. 005 |

| |

|KIHESA HEALTH CENTER |

|P.O. Box 558 |

|IRINGA |

|Name: |John |

|Gender: |Me |

|Age: |20Yrs |

|Weight: |60kg |

|Dx |Amoeba |

|Rx |Tetracyclin Bd 2/52 |

| |Tulizamol Tabs 1g tds |

| |3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

Session 7: Dispensing Procedures in Pharmacy

Total Session Time: 120 minutes

Prerequisites

• Session 1

Learning Tasks

By the end of this session students are expected to be able to:

• Define dispensing, dispenser, medicine and good dispensing procedures

• Explain good dispensing procedures

• Demonstrate good dispensing procedures

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk, and whiteboard markers

• Worksheet 7.1: Demonstration on Good Dispensing Procedures

• Worksheet 7.2: Sample Prescription Serial No. 001

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

Step 2: Define Dispensing, Dispenser, Medicine and Good Dispensing

Procedures (10 minutes)

• Dispensing: The act of preparing medicines and/or medical supplies and

distributing to users with adequate information, counseling and

appropriate follow up

• Dispenser: Any person who is licensed or authorized by the appropriate

body to dispense medicines and/or medical supplies

• Medicine: Any substance or mixture of substances used in the diagnosis,

treatment, mitigation or prevention of a disease in human

o Medicines include narcotic drugs, psychotropic substances and precursor

chemicals, traditional medicines, complementary or alternative

medicine; poisons, blood and blood products, vaccine, radioactive

pharmaceuticals, cosmetics and sanitary items and medical instruments

• Good Dispensing Procedures: Refers to the delivery of the correct

medicine to the right patient, in the required dosage and quantities, in

the package that maintains acceptable potency and quality for the

specified period, clear medicine information counseling and appropriate

follow up

STEP 3: Good Dispensing Procedures (35 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What procedures to follow in Good Dispensing? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Dispensing Procedures

• Procedure 1: Evaluation and interpretation of a prescription

In this step a dispenser should do the following after welcoming and

greeting the patient;

o Make sure that all important parts of the prescription are correct

and complete (refer session 1)

o Arrange prescriptions in order so as to prevent possibility of

confusion

o Dispenser should have knowledge of transcribing the prescription

o Make sure that the name of the medicine, dose, dosage, duration

are correct

o The prescription should be in writing or typed but must be signed

by the prescriber in ink

• Procedure 2: Selection and handling of the medicine. This includes:

o Select stock container of pre-pack reading the label and cross

matching the medicine name and strength against the prescription

o Read the container label at least twice during the dispensing

process.

o Do not select the prescribed medicine according to the color or

location of container

o Do not open many stock containers at the same time

▪ This trend will lead to errors and/or expose the medicines

to air and eventually leads to deterioration in quality

o Open and close containers once at a time

o While counting, pouring or measuring, the following points should

be noted:

▪ Short and/or over counting should be avoided

▪ Clean counting tray and/or spoon used

▪ Graduated measuring cylinder and/or flask must be used for

measuring liquid reduction

▪ If small volume is to be measured, small measuring

cylinder/flask has to be used (if compounding is performed in

the pharmacy) provide appropriate bottles with caps for

repackaging liquid preparations

o Dispense liquid preparations in suitable container

▪ Do not use patient’s own bottle

▪ Dispense each medicine in a different bottle

In dispensing tablets and capsules:

• Do not use fingers to count tablets as this can lead to contamination

of medicines

• Use a spoon to put tablets and capsules onto a counting tray

• Count and put them in a labeled medicine container or pack

• Close stock containers tightly after dispensing

• Keep the spoon clean at all times

• Do not keep the spoon inside the container

• Labeling of dispensed medicines should be clear and legible

• Use separate plastic boxes for different patient's requirements of

medicines

• To avoid mix-ups of medicines of different patients, it is a good

procedure to assemble medicines of different patients in

separate/different boxes, till they are billed and packed

• Procedure 3: Labeling and packaging of the medicine in an

appropriate container

o The containers used for dispensing must be appropriate for the product

dispensed

o All containers intended for medicinal products must be protected and

kept free from contamination

o Medicines must be suitably contained, protected and labeled from the

time of manufacture until they are used by the patient

o The container must maintain the quality, safety and stability of the

medicine throughout this period

• Procedure 4: The provision of information and instruction to

client

o All medicines should be dispensed with adequate and appropriate

information and counseling. Information must be structured to meet the

needs of individual patients and questions and answers should be used

to check the patient understands.

o Written information should be provided to supplement verbal

communication as appropriate.

▪ Counseling should ensure that the patient has an unequivocal

understanding of the instructions for use, and any distinct

characteristics or requirements of the medicine.

o Counseling should cover matters that will enhance or optimize medicine

therapy. The information in the form of verbal and/or written

instructions should include the following:

▪ How much and how often to take the medicine

▪ When to take the medicine (e.g., before or after meals)

▪ How long the treatment is to last (e.g., why the entire course of

an antibiotic treatment must be taken)

▪ How to take the medicine (e.g., with water, chewing or

swallowing)

▪ How to store the medicine (e.g., avoid heat, light and dampness,

keep out of reach of children)

▪ Not to share medicines with other persons

▪ Which types of foods and beverages should avoid while taking the

medicine

▪ One has to demonstrate to the patient on how to administer the

dispensed medications in case of inhaled administration and

suppository application

▪ 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

▪ Finally, check whether patients have understood the information

• Procedure 5: Recording the transaction

o Prescriptions should be recorded and documented as proof of transaction

between the patient and the dispenser

▪ Prescriptions can therefore be traced back if any need arises

▪ All dispensing units should have a standardized Prescription

Registration Book (PRB) for recording every pharmaceutical issued to a

patient

o A computerized dispensing and registration system may also be used, but

should always be supported by paper back up

▪ The registration book should be completed at the time of dispensing

or at the close of the working day

o The prescription registration book should be used both when

prescriptions are retained in the pharmacy and when they are returned

to the patient

▪ For a prescription which is returned to a patient because all the

items in the original prescription could not be filled, the medicines

that have been dispensed from the pharmacy should be copied on a blank

prescription and the prescription should be filed appropriately

o On the original prescription, which is retained by the patient, the

word “dispensed” should be stamped adjacent to those items which have

been dispensed

o For prescriptions which are to be refilled on a later date, the

dispensing information should be entered into the registration book

before returning the prescription to the patient

▪ The official seal of the pharmacy/Health institution, name and

signature of the dispenser, the date of dispensing and the next

refill date should be written on the back of the prescription

[pic]

Source: FMHACA (2012)

Figure 1: Pictorial presentation of dspensing procedure

STEP 4: Demonstration of Good Dispensing Procedure (60 minutes)

Activity: Role Play (30 minutes)

EXPLAIN that this will be a role play between a patient and a dispenser.

One volunteer student will play as dispenser and will demonstrate the

necessary steps of Good Dispensing Procedures through and dispensing

medicines to the patient, who will be another student volunteer.

ASK two students to volunteer playing as dispenser and patient

respectively.

TELL the rest of students to observe carefully on the procedures of Good

Dispensing

EXPLAIN that the patient will handle the prescription to the dispenser and

wait for the medicine. The dispenser should follow all Good Dispensing

procedures for dispensing medicine..

EMPHASIZE that the Dispenser should follow all the guides and steps of Good

Dispensing procedures.

START the role play.

LEAD a discussion after the role play.

DE-ROLE all the students, once the role play is over.

ASK students if they have any questions about the role play.

[pic]Refer student volunteer to Worksheet 7.1: Demonstration so that

he/she can read the description of the dispenser

[pic] Refer students to Worksheet 7.2: Sample Prescription Serial No. 001

STEP 5: Key Points (5 minutes)

• Dispensing refers to the process of preparing medicines and

distributing to users with provision of an appropriate

information, counseling and follow up

• Good dispensing procedures ensure that the correct medicine is

delivered to the right patient, in the required dosage and

quantities, with clear instructions, and in package that

maintains an acceptable potency and quality of the medicine

• The medicine should be dispensed in a safe and hygienic manner, making

sure that the patient or care provider understands and appreciates the

value of taking specific medicines for specific indications

STEP 6: Evaluation (5 minutes)

• What is dispensing?

• What is Medicine ?

• Which are the Good Dispensing Procedures?

References

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania:

MOHSW.

|[pic] |Worksheet 7 .1: Role Play Demonstration on Good Dispensing |

| |Procedures |

|Script: |

|Your role is to dispense the medicines to a patient who hands the |

|prescription. you should follow all good dispensing procedures |

|principles as you receive the prescription from the patient. |

|Greet the patient |

|Receive the prescription from the patient |

|Read the prescription and interpret and understand |

|Prepare and select medicines as per given prescription |

|Erythromycin Tablets 500mg qid 7/7 |

|Paracetamol Tablets 1g tds 3/7 |

|Calculate total quantity of each medicine |

|Erythromycin Tablets: 2 Tablets X 4 times a day X 7 days = Pack 56 |

|Tablets |

|Paracetamol Tablets: 2 Tablets X 3 times a day X 3 days = Pack 18 |

|Tablets |

|Write a label for each medicine then pack according to calculations |

|above |

|Record in dispensing register |

|Call a patient by name and give instructions on how to use medicines |

|Erythromycin Tablets: Take two tablets after every 6 hours for 7 days, |

|swallow with water after meals. |

|Paracetamol Tablets: Take two tablets after every 8 hours for 5 days, |

|swallow with water. |

|You may experience stomach upsets because of medicines given unless is |

|severe report back to hospital |

|Ask the patient to repeat information given for checking understanding |

|Wish a patient quick recovery |

|[pic] |Worksheet 7.2: Sample Pescription Serial No. 001 |

|Serial Na. 001 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |John Kalunde |

|Gender: |Me |

|Age: |20Yrs |

|Weight: |60kg |

|Rx |Erythromycin tabs 500mg q.i.d 7/7 |

| |Paracetamol Tabs 1g tds 3/7 |

|Prescriber’s |Masige Kahwa Malimbo |

|name |MO |

|qualification | |

|Signature |[pic] |

Session 8: Determining Quantities of Medicine for Dispensing

Total Session Time: 120 minutes + 1 hours Assignment

Prerequisites

• Session 1, 5 and 6

Learning Tasks

By the end of this session students are expected to be able to:

• Interpret Information in the Prescription for Medicine Quantities for

Dispensing

• Determine Quantities of Tablets/Capsules to be Dispensed

• Determine Eye/Ear/Nasal Preparations to be Dispensed

• Determine Quantities of Injectable Medicine to be Dispensed

• Determine Quantities of Ointment/cream to be Dispensed

• Determine Quantities of Syrup to be Dispensed

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Worksheet 8.1: Determine quantities of tablets and capsules to be

dispensed

• Worksheet 8.2: Determine eye/ear/nasal preparations to be dispensed

• Worksheet 8.3: Determine quantities of injectable medicine to be

dispensed

• Worksheet 8.4: Determine quantities of ointment and cream to be dispensed

• Worksheet 8.5: Determine quantities of syrup and solution to be dispensed

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Interpretations of Information in the Prescription for

Medicine Quantities to be Dispensed (10 minutes)

• Whenever a dispenser is required to dispense medicines, make sure always

to;

• Identifying different information which provides information about

medicines to be dispensed

• Interpret of information of the prescriber so you can get quantities of

medicine to be dispensed

• Example: In a certain prescription of a specific patient the following

medicines were prescribed:

|Paracetamol tabs 1g tds x 5/7 |

|Amoxicillin caps 500mg tds x 5/7 |

Interpretation:

• One Paracetamol tablet has a dosage strength of 500mg, so 1g means 2

tablets of Paracetamol

o Thus calculation is 2 tablets x 3 times a day x 5 days = 30 tablets

of Paracetamol

o Therefore the patient will receive 30 tablets of Paracetamol

• One Amoxicillin capsule has dosage strength of 250mg, so 500mg means 2

capsules

o Thus 2 tablets of Amoxicillin x 3 times a day x 5 days = 30

tablets of Amoxicillin

o Therefore the patient will receive 30 capsules of Amoxicillin

STEP 3: Quantities of Drug to be Dispensed – Tablets and Capsules (20

minutes)

|Activity: Case Study (15 minutes) |

| |

|DIVIDE students into small manageable groups. |

| |

|[pic]REFER students to Worksheet 8.1: Calculating quantities of tablets|

|and capsules |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the three questions in the worksheet for 15 |

|minutes. |

| |

|ALLOW few groups to present and the rest to add on points not |

|mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

The Calculations

• A Paracetamol tablet has dosage strength of 500mg, so 1g means 2 tablets

of Paracetamol

o One unit of Paracetamol tablet means one tablet, thus calculation for

the total quantity Paracetamol tablets is 2 tablets x 3 times a day x

5 days = 30 tablets of paracetamol

o Thus dispense total of 30 tablets of paracetamol

• Ampiclox capsule has strength of 500mg, so 500mg means 1 capsule

o One unit of Ampliclox capsule means one capsule.

o Thus total quantity of Ampiclox Capsules to be dispensed is:

1 tablets x 3 times a day x 5 days = 15 capsules

o Therefore dispense a total of 15 capsules of Ampiclox Capsules

STEP 4: Calculation of Quantities of Drug to be Dispensed – Ear and Eye

Preparations (20 minutes)

|Activity: Case Study (15 minutes) |

| |

|DIVIDE students into small manageable groups. |

|[pic]REFER students to Worksheet 8.2: Calculating quantities of ear and|

|eye preparations |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the three questions in the worksheet for 15 |

|minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Information given: Prednisolone Eye drops 0.5% is available in 5ml bottle

and assume 20 drops in 1ml

Calculation for Prednisolone:

o Firstly calculate total number of drops of prednisolone needed in 14 days

as follows:

1drop x 4 times a day x 14 days = 56 drops

o Then calculate number of mLs containing 56 drops of prednisolone

Iml = 20 drops

? mls = 56 drops

= 56 drops/20drops x 1 ml

= 2.8mls

o Dispense one bottle of 5mls of prednisolone.

▪ The patient should discard the remained prednisolone (2.2mls) after

finishing the dose required (2.8ml)

• Information given: Sodium Cromoglycate 2% is available in 5ml bottle.

Assume 20 drops is 1ml

Calculation for Sodium Cromoglycate:

o Firstly calculate total number of drops of Sodium Cromoglycate needed in

90 days as follows:

1drop x 4 times a day x 90 days = 360 drops

o Then calculate number of mLs containing 360 drops

Iml = 20 drops

? mls = 360 drops

= 360 drops/20drops x 1 ml

= 18mls

o Therefore 4 bottles of sodium cromoglycate, each of 5mls will be

dispensed to Ana Kalunde for the total dose of 18ml to be completed,

discarding the remainder

• Information given: Boric Acid Ear drops 0.5% is available in 2ml. Assume

20 drops is 1ml Calculation for Boric Acid:

o Firstly calculate total number of drops of boric acid needed in

7 days as follows:

1drop x 3 times a day x 7 days = 21 drops

o Then calculate number of mLs containing 21 drops of Boric Acid

Iml = 20 drops

? mls = 21 drops

= 21 drops/20drops x 1 ml

= 1.05mls

o Therefore dispense for Benard Sanga 1 bottle of Boric Acid Ear drop

with information that he should discard remaining medicine after 7

days

• Ephedrine Nasal drops 0.5% is available in 2ml. Assume 20 drops is 1ml

Calculation for Ephedrine

o Firstly calculate total number of drops of ephedrine needed in 7 days

as follows:

1drop x 3 times a day x 7 days = 21 drops

o Then calculate number of mLs containing 21 drops of ephedrine

Iml = 20 drops

? mls = 21 drops

= 21 drops/20drops x 1 ml

= 1.05mls

o Therefore, dispense for Hadija Hamis 1 bottle of Ephedrine Nasal drop

with information that he should discard remaining medicine after 7

days

STEP 5: Calculation of Quantities of Drug to be Dispensed-Injectables (20

minutes)

|Activity: Case Study (15 minutes) |

| |

|DIVIDE students into small manageable groups. |

|[pic]REFER students to Worksheet 8.3: Calculating quantities |

|injectables |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the three questions in the worksheet for 15 |

|minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

• For Diclofenac Injection:

o Information given: One ampoules of 3mls contains 75mg of Diclofenac

injection, But the required prescription is 150mg od for 3 days

o Calculation: 2 ampoules x once daily x 3 days

o 2 ampoules x 1 x 3

o 6 diclofenac ampoules

o Therefore dispense 6 diclofenac ampoules

• For Gentamicin injection:

o Information given: One ampoule of 2ml contains 20mg of Gentamicin

injection

o But required prescription is 40 mg three times daily for five days

o Calculations: 40mg x 3 times daily x 5days

2. ampoules x 3 x 5

= 30 ampoules

Thus dispense 30 ampoules of gentamicin

STEP 6: Calculation of Quantities of Drug to be Dispensed- Ointment and

Cream (20 minutes)

|Activity: Case Study (10 minutes) |

| |

|DIVIDE students into small manageable groups. |

|[pic]REFER students to Worksheet 8.4: Calculating quantities of |

|ointment and cream |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the two questions in the worksheet for 10 |

|minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The Calculations

▪ Clotrimazole Ointment; Assuming the amount to be squeezed out of the

tube for one application is 1g, and

▪ The unit to dispense for Clotrimazole Ointment is a tube of 20g

▪ Thus calculation for Clotrimazole Ointment for a single application

is (1g) × 2 times a day x 7 days = 14g

▪ Therefore the patient will be given 1 tube of Clotrimazole Ointment,

as it contains 20g

STEP 7: Calculation of Quantities of Drug to be Dispensed-Syrup and

Solutions (15 minutes)

|Activity: Case Study (10 minutes) |

| |

|DIVIDE students into small manageable groups. |

|[pic]REFER students to Worksheet 8.5: Calculating quantity of syrup and|

|solutions |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the three questions in the worksheet for 10 |

|minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

• The Calculations:

▪ Amoxicillin syrup has strength of 125mg/5ml, so 1 teaspoonful =

125mg syrup

▪ Paracetamol syrup has strength of 120mg/5ml, so 1 teaspoonful =

120mg syrup

▪ The unit to dispense for Amoxicillin syrup is a bottle of granules

to be reconstituted to 100ml and a unit to dispense for Paracetamol

syrup is a bottle of 100ml syrup

▪ Thus calculation for Amoxicillin syrup is 5ml x 3 times a day x 5

days = 75ml and

▪ Calculation for Paracetamol syrup is 5ml x 3 times a day x 5 days

= 75ml

▪ Therefore Pack for patient 1 bottle of reconstituted Amoxicillin

syrup and 1 bottle of Paracetamol syrup

STEP 8: Key Points (5 minutes)

• In order to determine the quantities of medicines to be dispensed, it is

important to understand the information which provided in a prescription

that provides information about medicines to be dispensed

• The information must be interpreted correctly to lead a dispenser to

correct calculation to get quantities of medicine to be dispensed

• The quantities to be dispensed are determined through correct calculation

as given in different scenario done in this session

STEP 9: Evaluation (5 minutes)

• What are the information that will determine the total quantity of

tablets and capsules to be dispensed?

• What are the information that will determine the total quantity of

ear/eye/nasal preparations to be dispensed?

• What are the information that will determine the total quantity of

injectables to be dispensed?

• What are the information that will determine the total quantity of creams

and ointments to be dispensed?

References

Ansel, H. C. (2010). Pharmaceutical Calculations (13th ed.). Philadelphia,

United States: LWW

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

|[pic] |Worksheet 8.1: Calculating Quantities of Tablets and |

| |Capsules to be Dispensed |

|Scenario: |

|A patient Called Juma Said brought a prescription at a dispensing |

|pharmacy which was written as follows;- |

|Ampiclox Caps 500mg tds 5/7 |

|Paracetamol Tabs 1g tds 5/7 |

Students Leaning Tasks

By the end of the case study activity, students are expected to:

• Interpret the information given in a prescription

• Make decision of a unit to be dispensed that implies the correct amount

• Calculate the total quantities of medicine to be dispensed

Questions

1. What is the total Ampiclox capsules should be dispensed?

___________________________________________________________

2. What is the total Paracetamol tablets should be dispensed?

___________________________________________________________

3. What dispensing unit will you dispense for Juma Said?

___________________________________________________________

|[pic] |Worksheet 8.2: Calculating Quantities of Eye/Ear/Nasal to be|

| |Dispensed |

|Scenario: |

|A patient Called Anna Kalunde brought a prescription at a dispensing |

|pharmacy which was written as follows;- |

|1 gtt Predinisolone 0.5% qid BE 2/52 |

|1 gtt Sodium Cromoglycate 2% qid BE 3/12 |

| |

|Another patient Called Benard Sanga brought a prescription at a |

|dispensing pharmacy which was written as follows;- |

|1 gtt Boric Acid 0.5% aur.dextr tds 7/7 |

| |

|Another patient Called Hadija Hamis brought a prescription at a |

|dispensing pharmacy which was written as follows;- |

|1 gtt Ephedrine 0.5% ad.aur tds 7/7 |

Students Leaning Tasks

By the end of the case study activity, student will be able to:

• Interpret the information given in a prescription

• Make decision of a unit to be dispensed that implies the correct amount

of medicine.

• Calculate the total quantities of medicine to be dispensed

Questions

1. What is the amount of Predinisolone and Sodium Cromoglycate eye drops

should be dispensed?

___________________________________________________________

2. What is the amount of Boric Acid Ear drops and Ephedrine Nasal drops

should be dispensed?

___________________________________________________________

3. What dispensing unit will you dispense for Anna Kalunde, Benard Sanga

and Hadija Hamis?

___________________________________________________________

|[pic] |Worksheet 8.3: Calculating Quantities of Injectables to be |

| |Dispensed |

|Scenario: |

|A Nurse has a file of patient Called Mwanaisha Kilimo with a |

|prescription written as follows;- |

|Diclofenac 150mg od x3/7 |

|Gentamycine 40mg x tds5/7 |

|(you have Diclofenac ampule 75mg/3mil, Gentamycine 20mg/2mil) |

Students Leaning Tasks

By the end of the case study activity, student will be able to:

• Interpret the information given in a prescription

• Make decision of a unit to be dispensed that implies the correct amount

of medicine.

• Calculate the total quantities of medicine to be dispensed

Questions

4. What is the total amount of Diclofenac injection should be dispensed?

___________________________________________________________

5. What is the total amount of Gentamycine injection should be dispensed?

___________________________________________________________

6. What dispensing unit will you dispense for Mwanaisha Kilimo?

___________________________________________________________

|[pic] |Worksheet 8.4: Calculating Quantities of Ointments and |

| |Creams to be Dispensed |

|Scenario: |

|A patient Called Jumanne John brought a prescription at a dispensing |

|pharmacy which was written as follows;- |

|Apply Clotrimazole Ointment b.d 7/7 |

Students Leaning Tasks

By the end of the case study activity, student will be able to:

• Interpret the information given in a prescription

• Make decision of a unit to be dispensed that implies the correct amount

of medicine.

• Calculate the total quantities of medicine to be dispensed

Questions

1. What is the total amount of Clotrimazole Ointment should be dispensed?

___________________________________________________________

2. What dispensing unit will you dispense for Jumanne John?

___________________________________________________________

|[pic] |Worksheet 8.5: Calculating Quantities of Syrups and |

| |Solutions to be Dispensed |

|Scenario: |

|A Mother with a child called Anisha Juma brought a prescription at a |

|dispensing pharmacy which was written as follows;- |

|Amoxicillin Syp 5 ml tds 5/7 |

|Paracetamol Syp 5 ml tds 5/7 |

Students Leaning Tasks

By the end of the case study activity, student will be able to:

• Interpret the information given in a prescription

• Make decision of a unit to be dispensed that implies the correct amount

of medicine.

• Calculate the total quantities of medicine to be dispensed

Questions

1. What is the total amount of Amoxicillin syrup should be dispensed?

___________________________________________________________

2. What is the total of Paracetamol syrup should be dispensed?

___________________________________________________________

3. What dispensing unit will you dispense for Anisha Juma?

___________________________________________________________

Session 9: Medicines Packaging Materials

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Packaging Material for Medicines to be Dispensed

• Explain Importance of Packaging Materials for Medicines to be Dispensed

• List Different types of Packaging Material for Medicines to be Dispensed

• Describe Features of Suitable Packaging Materials

• Select and Use Suitable Packaging Material for Medicines to be Dispensed

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Samples of Packaging Materials

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Packaging Material for Medicine to be Dispensed (5

minutes)

• All medicinal products need to be protected and consequently need to be

packaged in containers that conform to prescribed standards particularly

with respect to the exclusion of moisture and light and the prevention of

leaching of extractable substances into the contents and of chemical

interaction with the contents

• Packaging material: Any material, including printed material, employed in

the packaging of a pharmaceutical product, excluding any outer packaging

used for transportation or shipment

o Primary packaging materials are those that are in direct contact

with the product

• Packaging may be defined as the collection of different components (e.g.

bottle, vial, closure, cap, ampoule, blister) which surround the

pharmaceutical product from the time of production until its use

• Prepackaging: Is the process by which the pharmacy professional transfers

a medication manually from a manufacturer's original commercial container

to another type of container in advance (before clients come to medicine

retail out lets)

STEP 3: Importance of packaging materials for medicines (10 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the importances of packaging materials for medicine? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Importance of medicine packaging material

▪ Containment: This requires the packaging:

▪ not to leak, nor allow diffusion and permeation of the product;

▪ to be strong enough to hold the contents when subjected to normal

handling

▪ Not to be altered by the ingredients of the formulation in its

final dosage form

▪ Protection: The packaging must protect the product against all

adverse external influences that may affect its quality or potency,

such as:

▪ Light

▪ Moisture

▪ Oxygen

▪ Biological contamination

▪ Mechanical damage

▪ The compatibility: Of the packaging with the active pharmaceutical

ingredients is very important in maintaining the integrity of the

product

▪ Stability: it is necessary to know the possible interactions between

the container and the contents

▪ The packaging itself should not interact with it so as to

introduce unacceptable changes

▪ Importance of closures is to prevent moisture to reach moisture-

sensitive medicines and also prevent loss of moisture from creams and

other water-containing medicines such as ointments and pastes

STEP 4: Types of Packaging Material for Medicine to be Dispensed (15

minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the types of Packaging materials for medicines? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

The following are different types of packaging materials for medicines;

• Ampoule: A container sealed by fusion and to be opened exclusively by

breaking. The contents are intended for use on one occasion only

• Bag: A container consisting of surfaces, whether or not with a flat

bottom, made of flexible material, closed at the bottom and at the sides

by sealing; the top may be closed by fusion of the material, depending on

the intended use

• Blister: A multi-dose container consisting of two layers, of which one is

shaped to contain the individual doses

o Strips are excluded

• Bottle: A container with a more or less pronounced neck and usually a

flat bottom.

o They can be glass or plastic

• Cartridge: A container, usually cylindrical, suitable for liquid or solid

pharmaceutical dosage forms; generally for use in a specially designed

apparatus (e.g. a prefilled syringe)

• Injection needle: A hollow needle with a locking device intended for the

administration of liquid pharmaceutical dosage forms

• Injection syringe: A cylindrical device with a cannula-like nozzle, with

or without a fixed needle and a movable piston, used for the

administration, usually parenteral, of an accurately measured quantity of

a liquid pharmaceutical form

o The syringe may be prefilled, and can be for single-dose or multi-

dose use

• Pressurized container: A container suitable for compressed, liquefied or

dissolved gas fitted with a device that, after its actuation, produces a

controlled spontaneous release of the contents at atmospheric pressure

and room temperature

• Single-dose container: A container for single doses of solid, semi-solid

or liquid preparations

• Strip: A multi-dose container consisting of two layers, usually provided

with perforations, suitable for containing single doses of solid or semi-

solid preparations. Blisters are excluded

• Tube: A container for multi-dose semi-solid pharmaceutical forms

consisting of collapsible material and its contents are released via a

nozzle by squeezing the package

• Vial: A small container for parenteral medicinal products, with a stopper

and over seal and the contents are removed after piercing the stopper

o Both single-dose and multi-dose types exist

STEP 4: Features of Suitable Packaging Materials (35 minutes)

|Activity: Small Group Discussion (15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the desirable features of Packaging materials? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are desirable features for packaging materials:

• The container should protect the contents from physical and mechanical

hazards such as:

o Variation due to transportation

o Compression due to pressure applied during stacking or storage

o Shock due to impact, drops or rapid deceleration

o Puncture due to penetration from sharp objects or during handling

operations

o Abrasion

• The container’s material should not interact with the product and vice

versa.

o Interactions include migration, absorption, adsorption or extraction

whereby ingredients either from the product or container are lost or

gained. There are numerous possibilities of interactions between

(primary) packaging materials and pharmaceutical products, such as:

▪ the release of chemicals from components of the packaging

materials

▪ the release of visible and/or sub visible particles

▪ the absorption or adsorption of pharmaceutical components by the

packaging materials

▪ Chemical reactions between the pharmaceutical product and the

packaging materials

• The degradation of packaging components in contact with the

pharmaceutical products

• Container should protect the contents from atmospheric gases

o Oxygen supports the growth of micro-organisms, as well as being

involved in oxidation processes

o Carbon dioxide may cause pH shifts or a chemical reaction if absorbed

by a liquid formulation

• The container must be capable of withstanding extremes of temperature and

humidity.

o Protect the contents from both water loss and gain

▪ Moisture gain may cause chemical reactions, encourage microbial

growth or cause physical changes, e.g. softening of gelatin

capsules

▪ Moisture loss from a product may cause creams to contract and

develop a rubbery feel, and solutions to concentrate

o Protect the contents from loss of volatile materials

o The loss of excipients such as alcohol and chloroform will concentrate

the product or reduce its preservative content

• Protect the contents from light

o Many drugs are photosensitive and degraded in the presence of light

• Protect the contents from airborne particulate contamination

o contamination can be microbiological (bacteria, moulds or yeasts) or

can be solid matter such as dirt, dust, hair, fibres

• Protect the product from animal contaminations, e.g. rodents and insects

• The container should not shed particles into the contents. E.g. spicules

from glass bottles and metal flakes from metal ointment tubes

• The container should have a ‘pharmaceutically elegant’ appearance.

• Should be easy to label and thus to identify the product correctly.

• The container should be convenient and easy to use

o The container should be cheap and economical

STEP 6: Select and use suitable packaging material for medicines (35

minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

|Which packaging materials are suitable for packing of the following |

|medicine? |

|Tablets and capsules? |

|Liquids? |

|Ointment and creams? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• The selection of packaging for medicines depends on:

o Nature of the medicine

o Type of patient

o Dosage form

o Method of administering the medicine

o Required shelf-life

o Use

The following are the types of packaging materials for medicines:

← Glass materials: Traditional packaging material widely used for both

liquid and solid dosage forms

o Advantages:

▪ It can be moulded to a rigid construction in a variety of shapes

and sizes

▪ It is available in clear or amber (light-resistant) forms

▪ It can be sealed hermetically or by removable closures

▪ It is impermeable to moisture and atmospheric gases

▪ It is cheap and readily available

▪ It is easily labelled

o Disadvantages:

▪ It is fragile – easily breaking when dropped or knocked

▪ It is heavy, which means transportation costs are high

▪ It may release alkali to aqueous contents

• Plastic containers: Plastic is a collective term used for a variety of

polymeric materials used for containers and closures

▪ Advantages:

▪ Flexible nature

▪ Less brittle than glass

▪ Lightweight –therefore transportation costs are cheaper than

glass

▪ Can be molded into a multiple of shapes and sizes

▪ Suitable for both container and closure

▪ Readily available

▪ Disadvantages:

▪ Few will withstand heat without softening or distorting

▪ Permeability to water vapour and atmospheric gases

▪ May interact with certain chemicals to cause softening or

distortion

▪ May sorb substances, particularly preservatives, from solution

▪ Leaching out of plasticizers and stabilizers into solutions

▪ Relatively expensive

• Metal Containers: Metals used as pharmaceutical packaging materials

include aluminum, tin and tin-coated lead

▪ Advantages:

▪ Lightness

▪ Robustness

▪ Impermeable to light, moisture and gases

▪ Can be made into rigid, unbreakable containers or into

collapsible tubes or foil

▪ Labels can be printed directly onto their surface

▪ Disadvantages:

▪ Their chemical and electrochemical activity

▪ They may shed metal particles into the pharmaceutical product

▪ Expensive

▪ Not generally available for extemporaneous dispensing

• Unit dose packaging: Unit dose packaging has become increasingly common

▪ Advantages:

▪ Hygienic

▪ Tamper evident

▪ Lightweight

▪ Child resistant

▪ Protects solid dosage forms from moisture and abrasion

▪ Available as calendar packs to aid patient compliance

▪ Wastage is reduced

▪ Accurate volume can be administered

▪ Disadvantages:

▪ Expensive

▪ Patients may experience difficulty in use

▪ Machinery is required which may be suitable for industrial or

hospital use only.

▪ Types of unit dose packaging for oral medicines include strip

packaging, blister packaging, oral liquid containers and dispensers

STEP 7: Key Points (5 minutes)

• The materials used for repackaging include: glass bottles, plastic

bottles, collapsible tubes, paper envelops, plastic envelops. original

containers may contain large amount of medicines, therefore repackaging

of medicines into another container may be necessary in order to dispense

medicines for patients.

• The function of a container for a medical preparation is to maintain; the

quality, safety, and stability of its contents

• Medicines must be suitably contained, protected and labeled from the time

of manufacture until they are used by the patient

• The container must maintain the quality, safety and stability of the

medicine

STEP 8: Evaluation (10 minutes)

• What is packaging, packaging material, repacking?

• What are the features of a suitable packaging material?

• What types of containers are used for medicine packaging?

• What are the factors contribute to the choice of packaging material?

• What are the importances of medicine packaging material?

• What are the advantages and disadvantages of different type of

containers?

References

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Senya ,S. S., Mwasha, C.Y., Muyinga, A. M., Amiri,R. I., Mauga, E.A.K.

(2011) Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam,

Tanzania: School of Pharmaceutical Sciences

Session 10: Medicines Label

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define a label of a Dispensed Medicine

• List Essential Features of a Label

• Explain the Importance/ Purpose of a Label of Dispensed Medicine

• Design and prepare appropriate label

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Handout 10.1: General Labeling Requirements for Dispensed Medicines

• Worksheet 10.1: Label for Medicine to be Dispensed

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of a Label of Medicine to be Dispensed (15 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What is a label of a dispensed medicine? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Label: Any material which is printed or affixed to a packing material

which provides the necessary information about medicine, and includes an

insert

• The main functions of a label on a dispensed medicine are to uniquely

identify the contents of the container and to ensure that patients have

clear and concise information about the use of the medicine

• Each dispensed medicine must be appropriately labeled to comply with

legal and professional requirements

• All medicines to be dispensed should be labeled and the labels should be

unambiguous, clear, legible and indelible

▪ If possible lettering should be printed

STEP 3: Essential Features of a Label (30 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the essential features of a label of medicine to be |

|dispensed? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• The information on the labels of dispensed medicines should be:

▪ Clear, accurate, and concise

▪ To avoid misunderstanding and obtain greatest benefits from

therapy

▪ Abbreviations and unfamiliar expressions should not be used,

especially for indications for use and dosage instructions

▪ Legible

▪ Easily readable, the print should not fade when exposed to water

or sunlight

▪ Manufacturers’ labels fulfill established criteria for good

readability

▪ Adequate and relevant

▪ Care should be taken to avoid confusion

▪ Too much information on the label may mean that none of it is

noted

▪ Intelligible

▪ The information should be completely unambiguous and arranged to

avoid confusion

▪ The terms used should be readily understandable by the

lay/unprofessional person

▪ Graphic symbols for patient instruction should not be used alone

but should always be combined with written instructions

• Label information should include the following:

▪ Patient name

▪ Generic name, strength and dosage form of the medicine

▪ Dose, Frequency and Duration of use of the medicines

▪ Quantity of the medicine dispensed

▪ How to take or administer the medicine and cautionary statements, if

applicable

▪ Storage condition

▪ The name and address of the dispenser

[pic]

Figure 9.1: Sample Label of Medicine

STEP 4: Purpose/ Importance of a Label of Dispensed Medicine (10 minutes)

• The purpose of a label for medicine to be dispensed is:

▪ To describe and identify a prescribed medicine

▪ To contribute to optimal therapeutic outcome and to avoid medication

errors

▪ To achieve appropriate handling and storage

▪ To allow the product to be traced if there are problems with either

the manufacturing, prescribing or dispensing process

• The importance of label for medicine to be dispensed:

▪ Label information for prescribed medicines should be considered to

supplement and reinforce oral communication between the patient and

healthcare provider

▪ Label should provide the patient with all the information necessary

so that the medicine may be taken or used appropriately

▪ The presentation of label elements is important for patient

understanding

▪ Written instructions on the use of medicines are very important

rather than verbal information

STEP 5: Design and Prepare Appropriate Label (40 minutes)

|Activity: Exercise (20 minutes) |

| |

|DIVIDE students into small manageable groups. |

| |

|[pic]REFER students to Worksheet 10.1: Label for Medicine to be |

|Dispensed |

| |

|READ or ASK one student to read the scenario in the worksheet and |

|CLARIFY |

| |

|ASK all groups to answer the question in the worksheet for 15 minutes.|

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

The label on the medicine packaging usually includes:

• The name of Patient

o the generic name for the active ingredient in your medicine

(scientific name)

• the name and address of the pharmacy that dispensed medicine

• the date medicine dispensed

• the name of the medicine and the strength

• the dose should be taken, how to take it and how often and how long

• the amount of medicine in the container

• if necessary, any cautions or warning messages that apply to your

medicine

▪ Some examples are:

▪ shake the bottle

▪ store in a cool place

▪ discard 28 days after opening

▪ do not use after a certain date

STEP 6: Key Points (10 minutes)

• Medicine to be dispensed needs a label which is appropriately written to

provide a good communication to a patient. It is to identify the medicine

through its name and strength, provides information of how to take the

medicines, the quantity and frequency of a dose and duration of that dose

▪ It is also providing other information like storage condition and

action to be taken before use of medicines

• The essential features of a label of medicines to be dispensed includes;-

clear, accurate and concise written, the label written should be legible,

the label should be adequately written and easy to interpret the

information provided to a patient

STEP 7: Evaluation (10 minutes)

• What is a label for medicine to be dispensed?

• What informations are appropriate to be included in a label of medicine

to be dispensed?

• What are the essential features of a label of medicine to be dispensed?

References

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS.

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

WHO (2002). Technical Report Series No. 902. (Annex 9). Geneva

|[pic] |Handout 10.1: General Labeling Requirements for Dispensed |

| |Medicines |

[pic]

|[pic] |Worksheet 10.1: Label for Medicine to be Dispensed |

|Scenario: |

|You are a dispenser at Themi Pharmacy P.O Box 3011, Arusha today. A |

|Mother with a child called Aisha Hassan gives you a prescription |

|written as follows;- |

|Amoxicillin Syp 250mg tds 5/7 |

|Paracetamol Syp 240mg tds tds 5/7 |

| |

|At Themi Pharmacy you have in stock bottles Amoxicillin Dry Suspension |

|100ml with strength of 125mg/5ml and Paracetamol syrup 100ml with |

|strength of 120mg/5ml. |

| |

|Design and prepare an appropriate label for the two medicines |

|prescribed. |

Session 11: Generic and Brand Names of Medicines

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Generic (non-proprietary) and Brand (proprietary) Medicines

• Explain Global and National Initiatives on Generic and Brand Medicines

• Distinguish between Generic and Brand Medicines

• List Advantages and Disadvantages of Generic and Brand Medicines

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Generic (Non-Proprietary) and Brand (Proprietary)

Medicines (10 minutes)

Generic medicine

• The generic or scientific or non proprietary name is the term given to

the active ingredient in the medicine that is decided by an expert

committee and is understood and used internationally

o Thus, paracetamol/acetaminophen is the non-proprietary name

(generic name) while Crocin/Metacin/Meftal/Tylenol etc are brand

names

Brand medicine

• A brand name drug is a medicine that’s discovered, developed and marketed

by a pharmaceutical company

o This name is given to a medicine by the pharmaceutical company that

makes it

o This is also called the "proprietary name"

• A generic drug is a chemically equivalent, lower-cost version of a brand-

name drug, costing 30-80% less!

• A brand-name drug and its generic version must have the same active

ingredient, dosage, safety, strength, usage directions, quality,

performance and intended use

STEP 3: Explain Global and National Initiatives on Generic and Brand

Medicines (25 minutes)

• Once a new drug is discovered, the company files for a patent to protect

against other companies making copies and selling the drug

• At this point the drug has two names: a generic name that’s the drug’s

common scientific name and a brand name to make it stand out in the

marketplace

o This is true of prescription drugs as well as over-the-counter

drugs

• An example is the pain reliever Tylenol®. The brand name is Tylenol® and

the generic name is acetaminophen

o Generic drugs have the same active ingredients as brand name drugs

already approved by the Food and Drug Administration (FDA)

o Generics only become available after the patent expires on a brand

name drug

o Patent periods may last up to 20 years on some drugs

• The same company that makes the brand name drug may also produce the

generic version or a different company might produce it

• It is a well-known fact that generic drugs are “drugs that are usually

intended to be interchangeable with an innovator product that is

manufactured without a license from the innovator company and marketed

after the expiry date of the patent or other exclusive rights”

• When it is said that doctors should prescribe generic drugs, it means

that they should prescribe drugs manufactured by other companies after

expiry of patent of parent drug of the innovator company

• The patent for paracetamol expired in 2007 after which numerous generic

versions have been developed and sold under various “brand names.”

o If one were to prescribe it only by the name “paracetamol” (generic

name), it is up to the pharmacist to select and dispense a

particular brand.

▪ A simpler and better alternative for cost reduction would

be to prescribe the cheapest “brand” of paracetamol.

• Thus, a better way to prescribe would be to prescribe the cheapest brand

of the drug and include the generic name of the drug in parenthesis, in

case that particular brand is not available.

STEP 4: Distinguish Between Generic and Brand Medicines (30 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the differences between Generic name (Non-proprietary name) |

|and Brand name (Proprietary name) of medicine? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Although the active ingredients are the same, the excipients (inactive

ingredients) may differ

o This is only important in rare cases when a patient has an allergy

or sensitivity to one of the excipients

• The product may also be slightly different in:

o Colour

o Shape or markings

o Taste

o Preservatives

o Packaging

• The biggest difference is cost; generic drugs are generally less

expensive than brand name comparators

STEP 5: Advantages and Disadvantages of Generic and Brand Medicines (30

minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the advantages and disadvantages of generic names |

|(Non-proprietary names) and Brand names (Proprietary names)? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Generic drugs cost less than Branded drugs

o The generic drug manufacturer does not have the incurred costs of

discovery, research and development, preclinical and clinical tests

as well as advertising/marketing and promotion

o Therefore it can offer the generic drug at a much lower cost to

you/patient

• Generic drugs are more available than Branded drugs

• Generic drugs can be manufactured locally while Branded drugs cannot be

manufactured locally

STEP 6: Key Points (10 minutes)

• A generic drug is identical or bioequivalent to a brand name drug in

dosage form, safety, strength, route of administration, quality,

performance characteristics and intended use.

• Although generic drugs are chemically identical to their branded

counterparts, they are typically sold at substantial discounts from the

branded price

• Generic drugs are essentially the same as brand name drugs since the

differences are on other ingredients other than active ingredient which

are binders, coloring agents, and flavorings but is same in the

therapeutic and medicinal portion as well as dose, strength, route of

administration, safety, efficacy and intended use.

STEP 7: Evaluation (10 minutes)

• What are the generic names (Non-proprietary name) and brand names

(Proprietary names)?

• What are the differences between generic names and brand names?

• What are the advantages and disadvantages of generic names and brand

name?

References

Cameron A., Mantel-Teeuwisse A., Leufkens H., Laing R. (2012). Value

Health: Switching from originator brand medicines to generic

equivalents in selected developing countries: how much could be

saved? 15, 664–673 PubMed

Davit et al. (2009). Ann Pharmacother:Comparing generic and innovator

drugs: a review of 12 years of bioequivalence data from the United

States Food and Drug Administration. 2009;43(10):1583-97

Kesselheim et al. (2008). JAMA: Clinical equivalence of generic and brand

name drugs used in cardiovascular disease: a systematic review and

meta-analysis. 300(21)2514-2526

Session 12: Giving Appropriate Medicine Information to Patients

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Interaction, Side effects, Precaution and Contraindication

• Give Appropriate Instructions on the Use of Prescribed Medicine(s)

• Give Appropriate Information on Precautions, Interactions, Side effects

and Storage of Dispensed Medicines

• Check Patient Understanding on the Use and Precautions of Dispensed

Medicine(s)

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Handout 12.1: Warnings/cautions to Patients

• Worksheet 12.1: Sample Prescriptions

• Worksheet 12.2: Giving appropriate instructions on the use of prescribed

medicine

• Worksheet 12.3: Giving appropriate precautions, interactions, side

effects and storage of medicines

• Worksheet 12.4: Checking patient understanding on the use and precautions

of dispensed medicines

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definitions of Drug Interaction, Side effects, Contraindication and

Precautions of Medicines (10 minutes)

• Drug Interaction: is a situation in which a substance (usually another

drug) affects the activity of a drug when both are administered

o However, the effect of medicine may be modified by food, smoking, alcohol

or environmental pollutants

o A drug interaction may occur when one drug potentiates or diminishes the

action of another drug

o These actions may be desirable or undesirable

o Drugs may also interact with various foods, alcohol, tobacco, and other

substances

• Side effect: is an action or effect of a drug (medicine) other than that

desired

▪ Commonly it is undesirable effect such as nausea, headache,

insomnia, rash, confusion, dizziness, or an unwanted drug-drug

interaction

• A side effect is an undesirable action of the drug and may limit the

usefulness of the drug

• Contraindication: is something which suggests that someone should not be

treated with a specific drug or not continue with a specific treatment

because circumstances make that treatment unsuitable

• Precaution: is an action taken in advance to protect against danger,

harm, or possible failure

STEP 3: Give Appropriate Instructions on the Use of Prescribed Medicine(s)

(30 minutes)

Activity: Role Play Demonstration on giving appropriate information on the

use medicine (20 minutes)

EXPLAIN that this will be a role play demonstration between a patient and a

health care provider. You (the tutor) will play the Dispenser and lead the

conversation of the instructions on the use of medicines prescribed to the

patient, who will be a student volunteer.

ASK a student to volunteer to play the patient role.

[pic]Refer student volunteer to Worksheet 12.2: Role Play Demonstration so

that he/she can read the description of the patient.

[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.

001190

TELL the rest of students to observe carefully

EXPLAIN that the patient will listen carefully and provide answers to

dispenser as will be asked to do so.

EMPHASIZE that the Dispenser should concentrate on presenting the

instructions on how to use the prescribed medicines.

START the role play.

LEAD a discussion after the role play.

DE-ROLE yourself and the student, once the role play is over.

ASK students if they have any questions about the role play.

• At a stage of giving information to the patient, a dispenser must

instruct and counsel the patient on the following information:

▪ Why the patient needs to take medication

▪ If a patient understands why the medication was given then

he/she will be tempted to take medication

▪ Drug name, strength and dosage formation and route of administration

▪ Dose of medicine

▪ Dose interval/ frequency

▪ For example after every 6 or 8 hours

▪ Dosage of medication

▪ Duration of taking medication

▪ Any other special instructions, such as there are some drugs which

work efficiently if taken before or after food, for examples:

▪ Magnesium sulphate anti acids will work effectively if taken one

or two hours after food

▪ Alcohol reduce potency of different medicines so patient should

be advised not to take alcohol when under medication and it

should not be taken with medicines such as metronidazole,

phenobarbitone and antihistamines.

▪ Patients should be told on cautions of different medicines

o Storage of medicines: Patient should be advised to keep medicines away

from the reach of children as some drug colors might attract

children's attention

o The Direct observed treatment (DOT) Strategy

▪ This is the treatment strategy that emphasizes the use of the

most effective standardized, short-course regimen, and of fixed-

dose drug combinations (FDCs) under observation to facilitate

adherence to treatment and to reduce the risk of the development of

drug resistance

▪ This means a supervisor watches the patient when swallowing

tablets

▪ It ensures that a patient takes the right drugs, in the right

doses and at the right time intervals.

▪ Examples of drugs given under DOT strategy are methadone and anti-

tuberculosis medicines.

STEP 4: Give Appropriate Precautions, Interactions, Side effects and

Storage of Dispensed Medicines (30 minutes)

Activity: Role Play Demonstration (30 minutes)

EXPLAIN that this will be a role play demonstration between a patient and a

health care provider. One volunteer student will play the Dispenser and

lead the conversation of the instructions on the use of medicines

prescribed to the patient, who will be another student volunteer.

ASK the students to volunteer to play the dispenser role and the patient

role.

[pic]Refer student volunteer to Worksheet 12.3: Role Play Demonstration so

that he/she can read the description of the patient.

[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.

001191.

TELL the rest of students to observe carefully

EXPLAIN that the patient will listen carefully and repeat the information

provided when asked.

EMPHASIZE that the Dispenser should concentrate on presenting the

instructions on how to use the prescribed medicines as well as telling

about precautions to a patient, common side effect of medicines dispensed

and the storage condition of medicine

START the role play.

LEAD a discussion after the role play.

DE-ROLE all the students, once the role play is over.

ASK students if they have any questions about the role play.

The dispenser must give the following information to a patient:

• Effects of the drug: Which symptoms will disappear; and when; how

important is it to take the drug; what happens if it is not taken;

▪ Dosage and administration, whether the medicine can be given with

food, before or after food, with more water or at night only

▪ Drug Interactions: two basic interactions are important in

medication administration; – drug-drug interactions and drug-food

interactions

▪ Drug-drug interaction occurs when one drug interacts with or

interferes with the action of another drug. For example taking

anti-acid with oral Tetracycline causes a decrease in the

effectiveness of tetracycline.

▪ Drug-food interaction is when drug is given orally, food may

impair or enhance its absorption

▪ A drug taken on an empty stomach is absorbed into the

bloodstream at a faster rate than when drug is taken with food in

the stomach

▪ Some drugs must be taken on an empty stomach for example

Captopril to achieve optimal effect

• Side effects: Which side effects may occur; how to recognize them; how

long will they remain; how serious they are; what to do if they occur

Warnings: What not to do (driving, machinery); maximum dose (toxic

drugs); need to continue treatment (antibiotics)

[pic][pic] Refer students to Handout 12.1: Warnings/Cautions to Patients

for further reading

STEP 5: Check Patient Understanding on the Use and Precautions of

Dispensed Medicine(s) (30 minutes)

Activity: Role Play Demonstration (30 minutes)

EXPLAIN that this will be a role play demonstration between a patient and a

health care provider. One volunteer student will play the Dispenser and

lead the conversation of the instructions on the use of medicines

prescribed to the patient, who will be another student volunteer.

ASK the students to volunteer to play the dispenser role and the patient

role.

[pic]Refer student volunteer to Worksheet 12.4: Role Play Demonstration so

that he/she can read the description of the patient.

[pic] Refer students to Worksheet 12.1: Sample Prescription Serial No.

001192

TELL the rest of students to observe carefully

EXPLAIN that the patient will listen carefully and repeat the information

provided when asked. The dispenser should present the instructions on how

to use the prescribed medicines as well as telling about precautions to a

patient, common side effect of medicines dispensed and the storage

condition of medicine

EMPHASIZE that the Dispenser should concentrate on checking the patient

understanding on the use of medicines and the precautions given.

START the role play.

LEAD a discussion after the role play.

DE-ROLE all the students, once the role play is over.

ASK students if they have any questions about the role play.

• Checking if everything is understood: Everything is clear to patient or

else repeat the information; let the patient ask any more questions.

▪ When to take medicine

▪ The right dose and dosage

▪ In relation to food and other medicines

▪ How to take the medicine

▪ Chewing/swallowed whole

▪ Taken with plenty of water

▪ How to store medicine

▪ Warnings in case of possible common side effect but harmless like

nausea, mild diarrhoea, urine changing colour

▪ Reporting back in case of an unfavourable or harmful effect of

medicine

STEP 6: Key Points (10 minutes)

• The dispenser should give information to the patient about when to take;

how to take; how to store; how long to continue the treatment, what to do

in case of problems and wheather the medicine therapy needs Direct

Observed Therapy (DOT)

• The dispenser should also give opportunity to the patient to repeat

instructions given

• It is also important to ask questions for further checking of

understanding on how to take medication

• The necessity of reporting back in case of an unfavourable or harmful

effect caused by medicine

STEP 7: Evaluation (5 minutes)

• Which instructions are important to be given to patient while dispensing

medicines?

• What information would a dispenser want to know if a patient has

understood the medication taking instructions?

• Which condition(s) are necessary for patient to report back to

prescriber?

• What is DOT?

References

Rice, J. (2011). Principles of pharmacology for medical assisting (5th

ed.). Boston, United States of America: Cengage Learning.

Roach, S. S., & Ford, S. M. (2008). Introductory clinical pharmacology (8th

ed.). Philadelphia, United States of America: Lippincott Williams &

Wilkins.

Taber, C. W., & Thomas, C. L. Taber's cyclopedic medical dictionary (pp.

v.). Philadelphia, United States of America: F.A. Davis Co.

Walker, R., & Whittlesea, C. (2012). Clinical pharmacy and therapeutics

(5th ed.). Edinburgh, United Kingdom: Churchill Livingston

|[pic] |Handout 12.1: Warnings/Cautions to Patients |

WARNINGS/CAUTIONS TO PATIENTS

1. Warning. May cause drowsiness

To be used on preparations for children containing antihistamines, or other

preparations given to children where the warnings of label 2 on driving or

alcohol would not be appropriate.

2. Warning. May cause drowsiness. If affected do not drive or operate

machinery. Avoid alcoholic drink

To be used on preparations for adults that can cause drowsiness, thereby

affecting the ability to drive and operate hazardous machinery; label 1 is

more appropriate for children. It is an offence to drive while under the

influence of drink or drugs.

Side-effects unrelated to drowsiness that may affect a patient's ability to

drive or operate machinery safely include blurred vision, dizziness, or

nausea. In general, no label has been recommended to cover these cases, but

the patient should be suitably counselled.

3. Warning. May cause drowsiness. If affected do not drive or operate

machinery

To be used on preparations containing monoamine-oxidase inhibitors; the

warning to avoid alcohol and dealcoholized (low alcohol) drink is covered

by the patient information leaflet.

Also to be used as for label 2 but where alcohol is not an issue.

4. Warning. Avoid alcoholic drink

To be used on preparations where a reaction such as flushing may occur if

alcohol is taken (e.g. metronidazole and chlorpropamide). Alcohol may also

enhance the hypoglycaemia produced by some oral antidiabetic drugs but

routine application of a warning label is not considered necessary.

5. Do not take indigestion remedies at the same time of day as this

medicine

To be used with label 25 on preparations coated to resist gastric acid

(e.g. enteric-coated tablets). This is to avoid the possibility of

premature dissolution of the coating in the presence of an alkaline pH.

Label 5 also applies to drugs such as ketoconazole where the absorption is

significantly affected by antacids; the usual period of avoidance

recommended is 2 to 4 hours.

6. Do not take indigestion remedies or medicines containing iron or zinc at

the same time of day as this medicine

To be used on preparations containing Ofloxacin and some other quinolones,

doxycycline, minocycline, and penicillamine. These drugs chelate calcium,

iron and zinc and are less well absorbed when taken with calcium-containing

antacids or preparations containing iron or zinc. These incompatible

preparations should be taken 2-3 hours apart.

7. Do not take milk, indigestion remedies, or medicines containing iron or

zinc at the same time of day as this medicine

To be used on preparations containing ciprofloxacin, norfloxacin or

tetracyclines that chelate calcium, iron, magnesium, and zinc and are thus

less available for absorption; these incompatible preparations should be

taken 2-3 hours apart. Doxycycline and minocycline are less liable to form

chelates and therefore only require label 6 (see above).

8. Do not stop taking this medicine except on your doctor's advice

To be used on preparations that contain a drug which is required to be

taken over long periods without the patient necessarily perceiving any

benefit (e.g. antituberculosis drugs).

Also to be used on preparations that contain a drug whose withdrawal is

likely to be a particular hazard (e.g. clonidine for hypertension). Label

10 (see below) is more appropriate for corticosteroids.

9. Take at regular intervals. Complete the prescribed course unless

otherwise directed

To be used on preparations where a course of treatment should be completed

to reduce the incidence of relapse or failure of treatment.

The preparations are antimicrobial drugs given by mouth. Very occasionally,

some may have severe side-effects (e.g. diarrhoea in patients receiving

clindamycin) and in such cases the patient may need to be advised of

reasons for stopping treatment quickly and returning to the doctor.

10. Warning. Follow the printed instructions you have been given with this

medicine

To be used particularly on preparations containing anticoagulants, lithium

and oral corticosteroids. The appropriate treatment card should be given to

the patient and any necessary explanations given.

This label may also be used on other preparations to remind the patient of

the instructions that have been given.

11. Avoid exposure of skin to direct sunlight or sun lamps

To be used on preparations that may cause phototoxic or photoallergic

reactions if the patient is exposed to ultraviolet radiation. Many drugs

like phenothiazines and sulphonamides) may, on rare occasions, cause

reactions in susceptible patients. Exposure to high intensity ultraviolet

radiation from sunray lamps and sunbeds is particularly likely to cause

reactions.

12. Do not take anything containing aspirin while taking this medicine

To be used on preparations containing probenecid and sulfinpyrazone whose

activity is reduced by aspirin.

Label 12 should not be used for anticoagulants since label 10 is more

appropriate.

13. Dissolve or mix with water before taking

To be used on preparations that are intended to be dissolved in water (e.g.

soluble tablets) or mixed with water (e.g. powders, granules) before use.

In a few cases other liquids such as fruit juice or milk may be used.

14. This medicine may colour the urine

To be used on preparations that may cause the patient's urine to turn an

unusual colour. These include phenolphthalein (alkaline urine pink),

triamterene (blue under some lights), levodopa (dark reddish), and

rifampicin (red).

15. Caution flammable: keep away from fire or flames

To be used on preparations containing sufficient flammable solvent to

render them flammable if exposed to a naked flame.

16. Allow to dissolve under the tongue. Do not transfer from this

container. Keep tightly closed. Discard eight weeks after opening

To be used on glyceryl trinitrate tablets to remind the patient not to

transfer the tablets to plastic or less suitable containers.

17. Do not take more than . . . in 24 hours

To be used on preparations for the treatment of acute migraine except those

containing ergotamine, for which label 18 is used. The dose form should be

specified, e.g. tablets or capsules.

It may also be used on preparations for which no dose has been specified by

the prescriber.

18. Do not take more than … in 24 hours or … in any one week

To be used on preparations containing ergotamine. The dose form should be

specified, e.g. tablets or suppositories.

19. Warning. Causes drowsiness which may continue the next day. If affected

do not drive or operate machinery. Avoid alcoholic drink

To be used on preparations containing hypnotics (or some other drugs with

sedative effects) prescribed to be taken at night. On the rare occasions

(e.g. nitrazepam in epilepsy) when hypnotics are prescribed for daytime

administration this label would clearly not be appropriate. Also to be used

as an alternative to the label 2 wording (the choice being at the

discretion of the pharmacist) for anxiolytics prescribed to be taken at

night.

It is hoped that this wording will convey adequately the problem of

residual morning sedation after taking 'sleeping tablets'.

20. …with or after food

To be used on preparations that are liable to cause gastric irritation, or

those that are better absorbed with food.

Patients should be advised that a small amount of food is sufficient.

21. …half to one hour before food

To be used on some preparations whose absorption is thereby improved. Most

oral antibacterials require label 23 instead (see below).

22. …an hour before food or on an empty stomach

To be used on oral preparations whose absorption may be reduced by the

presence of food and acid in the stomach.

23. …sucked or chewed

To be used on preparations that should be sucked or chewed.

The pharmacist should use discretion as to which of these words is

appropriate.

24. …swallowed whole, not chewed

To be used on preparations that are enteric-coated or designed for modified-

release.

Also to be used on preparations that taste very unpleasant or may damage

the mouth if not swallowed whole.

25. …dissolved under the tongue

To be used on preparations designed for sublingual use. Patients should be

advised to hold under the tongue and avoid swallowing until dissolved. The

buccal mucosa between the gum and cheek is occasionally specified by the

prescriber.

26. …with plenty of water

To be used on preparations that should be well diluted (e.g. chloral

hydrate), where a high fluid intake is required (e.g. sulphonamides), or

where water is required to aid the action (e.g. methylcellulose). The

patient should be advised that 'plenty' means at least 150 mL (about a

tumblerful). In most cases fruit juice, tea, or coffee may be used.

27. To be spread thinly . . .

To be used on external preparations that should be applied sparingly (e.g.

corticosteroids, dithranol).

28. Do not take more than 2 at any one time. Do not take more than 8 in 24

hours

To be used on containers of dispensed solid dose preparations containing

paracetamol for adults when the instruction on the label indicates that the

dose can be taken on an 'as required' basis. The dose form should be

specified, e.g. tablets or capsules.

This label has been introduced because of the serious consequences of over

dosage with paracetamol.

29. Do not take with any other paracetamol products

To be used on all containers of dispensed preparations containing

paracetamol.

30. Contains aspirin and paracetamol. Do not take with any other

paracetamol products

To be used on all containers of dispensed preparations containing aspirin

and paracetamol.

31. Contains aspirin

To be used on containers of dispensed preparations containing aspirin when

the name on the label does not include the word 'aspirin'.

32. Contains an aspirin-like medicine

To be used on containers of dispensed preparations containing aspirin

derivatives.

|[pic] |Worksheet 12.1: Sample Prescriptions |

|Serial Na. 001 |

|KIDIA HEALTH CENTER |

|P.O. Box 58 |

|IRINGA |

|Name: |Amina Salehe |

|Gender: |Fe |

|Age: |17 Yrs |

|Weight: | |

|Rx |Cotrimoxazole tabs 480mg|

| |bd 5/7 |

| |Paracetamol Tabs 1g 5/7 |

|Prescriber’s |Hamis Juma Mgenja |

|name |C/O |

|qualification | |

|Signature |[pic] 12/6/2015 |

|Serial Na. 002 |

|KIGOMA HOSPITAL |

|P.O. Box 5 |

|KIGOMA |

|Name: |Peter John |

|Gender: |Me |

|Age: |25 Yrs |

|Weight: | |

|Rx |Erythromycin tabs 500mg |

| |qid 5/7 |

| |Paracetamol Tabs 1g tds|

| |5/7 |

|Prescriber’s |Kisa Mwanjela |

|name |MO |

|qualification | |

|Signature |[pic] 12/6/2015 |

|Serial Na. 003 |

|HASSANALI HOSPITAL |

|P.O. Box 5118 |

|MTWARA |

|Name: |Miriam Kilimilimi |

|Gender: |Fe |

|Age: |43 Yrs |

|Weight: | |

|Rx |Erythromycin tabs 500mg |

| |qid 7/7 |

| |Paracetamol Tabs 1g 5/7 |

| |Diazepam Tabs 5mg o.d |

| |nocte 3/7 |

|Prescriber’s |Kilimani Kajengeni |

|name |AMO |

|qualification | |

|Signature |[pic] 12/6/2015 |

|[pic] |Worksheet 12.2: Role Play Demonstration: Giving Appropriate |

| |Instructions on the Use of Prescribed Medicine |

|Script: |

|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |

|Practice |

| |

|You act as a Dispenser to give instructions to a patient on how to use |

|medicines as prescribed. |

|Cotrimoxazole Tablets is taken 2 tablets after every 12 hours for 5 |

|days |

|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |

|Make sure you emphasize the 12hourly and 8 hourly well to a patient |

|After receiving prescription and properly prepare the medicine, when |

|dispensing follow the following tips; |

|Communicate to the patient the correct way to take medication. Give |

|verbal instructions. Use symbolic instructions in case of illiteracy. |

|Use auxiliary labels if required. |

|In case of illiterate patients or patients familiar with only the |

|regional language, devise a system of pasting specific colored |

|labels/stickers on strips/ bottles to take it easier to identify the |

|product. |

|Repeat orally the labeled instructions, if possible, in laymen's terms.|

|Do not disturb any other pharmacy staff person, dispensing or preparing|

|a bill. |

|Make the patient repeat the advice to ensure that he/she has understood|

|them. Emphasize the need for adherence. Inculcate awareness in patients|

|about the importance of therapy. |

|Patient information leaflets can be provided along with a particular |

|medicine or for a particular illness. Provide warnings and cautions. |

|Give special attention to certain cases- |

|Those with visual impairment |

|Illiterates. |

|Those taking multiple medications. |

|Special group of patients (pregnant, children and elderly patients, |

|patients with liver and kidney problem) |

|OTC medicines are requested, the pharmacy professionals can evaluate if|

|the product requested, is appropriate for the patient's condition, and |

|advise accordingly. |

|[pic] |Worksheet 12.3: Role Play Demonstration: Giving appropriate |

| |precautions, interactions, side effects and storage of |

| |medicines |

|Script: |

|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |

|Practice |

| |

|You act as a Dispenser to give instructions to a patient on how to use |

|medicines as prescribed. |

|Erythromycin Tablets is taken 2 tablets after every 6 hours for 5 days |

|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |

|Make sure you emphasize the 6 hourly and 8 hourly well to a patient |

|You must tell the patient about common side effect of Erythromycin |

|Tablets which is stomach discomfort. It is also enteric coated to avoid|

|stomach discomfort but it should be stored at a cool and dry place out |

|of children reach. Keeping medicines out of children reach should apply|

|for Paracetamol also. |

|Remember to ask a patient to repeat instructions as given |

|[pic] |Worksheet 12.4: Role Play Demonstration: Checking patient |

| |understanding on the use and precautions of dispensed |

| |medicines |

|Script: |

|[pic] REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing |

|Practice |

| |

|You act as a Dispenser to give instructions to a patient on how to use |

|medicines as prescribed. |

|Erythromycin Tablets is taken 2 tablets after every 6 hours for 7 days |

|Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days. |

|Diazepam Tablets is taken 1 tablet once a day at night before sleeping |

|for 3 days |

|Make sure you emphasize the 6 hourly and 8 hourly and at night before |

|sleeping well to a patient |

|You must tell the patient about common side effect of Erythromycin |

|tablets which is stomach discomfort. |

|It is also enteric coated to avoid stomach discomfort but it should be |

|stored at a cool and dry place out of children reach. |

|Keeping medicines out of children reach should apply for Paracetamol |

|and Diazepam also |

|Emphasize on Erythromycin is causing stomach discomfort; |

|Diazepam is causing drowsiness on the next day. |

|Precaution to a patient not to drive in case of drowsiness |

|Remember to ask a patient to repeat instructions as given |

|Put more emphasis to patient understanding on the instructions given |

Session 13: Adverse Drug Reactions, Drug Overdose and Intoxication

Total Session Time: 120 minutes

Prerequisites

• None

Students Learning Tasks

By the end of this session students are expected to be able to:

• Define ADRs, Drug Overdose and Intoxication

• Identify suspected adverse drug reactions (ADRs), drug overdose and

intoxication

• Report suspected adverse drug reactions (ADRs)

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Handout 13.1 Adverse Drug Reactions Cases

• Worksheet 13.1 TFDA ADR form

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Adverse Drug Reactions (5 minutes)

• Adverse Reaction is a situation where someone experiences harmful effects

from the application of a drug

or is an unfavourable or harmful unintended action of a medicine

• Serious adverse drug reaction: any reaction that is fatal, life-

threatening, permanently/significantly disabling, requires or prolongs

hospitalization, causes a congenital anomaly, or requires intervention to

prevent permanent impairment or damage

• Drug Overdose describes the ingestion or application of a drug or other

substance in quantities greater than are recommended or generally

practiced

▪ An overdose may result in a toxic state or death

• Combined drug intoxication (CDI), also known as multiple drug

intake (MDI) or lethal polydrug/polypharmacy intoxication is due to the

simultaneous use of multiple drugs, whether the drugs

are prescription, over-the-counter, recreational, or some other

combination

STEP 3: Identification of Adverse Drug Reactions (ADRs) (35 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|How will one identify Adverse Drug Reactions? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Patients may experience one or more adverse reactions when they are given

medicines Adverse reactions (Side effect) are undesirable drug effects

which may be common or may occur infrequently

• They may be mild, severe, or life-threatening. They may occur after the

first dose, after several doses, or even after many doses

• An adverse reaction often is unpredictable, although some drugs are known

to be cause certain adverse reactions in many patients

• For example the drugs used in the treatment of Cancer and those used in

treating HIV/AIDS, commonly known as Anti-Retralviral Therapy(ART) are

very toxic and are known to produce adverse reactions in many patients

receiving them

• Other medicines produce adverse reactions in fewer patients

• Some adverse reactions are predictable, but many adverse drug reactions

occur without warning

• When dealing/ dispensing medicines that are suspected to have ADRs:

o Counsel all patients regarding the possibility of ADRs

o Inform patients of signs and symptoms that may indicate an ADR

o Instruct patients that in the event of an ADR, they should return to the

clinic/hospital immediately if the reaction is life-threatening or

contact the MO as soon as possible in all other instances

o Refer all patients with suspected ADRs to the MO

o After a period to be determined by the ART Eligibility Committee,

complete one ADR form for each ADR reported

▪ Refer patients with suspected serious ADRs or patients requiring

treatment to the MO

o Work with the Records Officer and the nursing staff to make sure that the

original ADR form is placed in the patient record and the duplicate is

received by the pharmacist

o Maintain a file of all completed ADR forms and related reports

o Review ADR forms on an ongoing basis and alert the ART Eligibility

Committee of unusual trends or findings

o Provide verbal feedback at ART Eligibility Committee meetings, or written

feedback to staff regarding outcomes of referred ADRs so as to encourage

continued reporting

o Prepare ADR Summary Report

o Present the ADR Summary Report and findings to the ART Eligibility

Committee

• Signs and symptoms of drug overdose vary depending on the drug or

toxin exposure

o The substance that has been taken may often be determined by asking the

person

o For patients with altered level of consciousness, questioning of their

friends and family may be helpful in order to get information of the

drug involved

[pic][pic] Refer students to Worksheet 13.1: TFDA ADR FORM

STEP 4: Reporting Adverse Drug Reactions (ADRs) (60 minutes)

|Activity: Small Group Discussion (30minutes) |

| |

|DIVIDE students into small manageable groups. |

| |

|[pic]REFER students to Worksheet 12.1: TFDA ADR FORM |

| |

|READ the form and CLARIFY |

| |

|ASK all groups to discuss about the following question for 15 minutes.|

| |

|Where to report in case of ADR? |

|What to report on ADR form? |

|Who should report? |

|How to report? |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the content below |

Where to report

• The National ADRs monitoring centre: This is under the Tanzania Food and

Drugs Authority (TFDA), with offices near EPI-Mabibo, Dar es Salaam.

▪ The Centre collects and evaluates ADR reports and feedbacks its

findings to the healthcare professionals and the general public.

▪ Reported information is also communicated to the World Health

Organisation (WHO).

• Zonal Drug Information Centres: Four Zonal Drug information Centres

located at;

o Muhimbili National Hospital (Dar es salaam)

o Bugando Medical Centre (Mwanza)

o Kilimanjaro Christian Medical Centre and Mbeya Consultant Hospital

▪ are responsible with co-ordinating the collection of ADR reports at

respective hospitals and zones.

What to report

• All suspected adverse reactions should be reported whether known or

unknown, serious or not, including minor ones.

• Reports on the new drugs are of great interest because they make easier

to monitor the performance of these drugs in the country for any

suspected adverse drug reactions.

Who should report

• All health care providers including specialists, doctors, dentists,

pharmaceutical personnel and nurses can report ADRs

• All affected consumers are encouraged to report ADRs directly to their

healthcare professionals and zonal Drug Information centers

How to report

• Adverse drug reaction forms may be obtained from TFDA headquarters, Zonal

Drug Information Centres, offices of Regional Medical Officers or

Regional Pharmacists and healthcare facilities

o The form can be filled online or downloaded from the website

• Suspected adverse reactions for drugs marketed in Tanzania should be

reported using a standardised form which is postage pre-paid and self

adhesive

• The reports should be sent to the Director General, TFDA, P.O. Box 77150,

Dar es Salaam, fax +255 22 2450793 email adr@tfda.or.tz This email

address is being protected from spambots. You need JavaScript enabled to

view it. [pic]

• The forms or reports should contain the following elements:

o Patient information including Patient’s name, Age/Date of birth, Sex,

Weight and relevant medical history

o Description of the adverse reaction including date of onset

o Suspected drug(s): name (including brand name, if known), dosage,

route, start and stop dates and reasons for use.

o Treatment given for the reaction(s)

o Other relevant history, including pre-existing medical conditions

o Outcome of reactions

o Name, date, signature and address of the reporter

• All sections of the form should be dully filled prior submission

o A separated form should be used for each patient

STEP 5: Key Points (10 minutes)

• Adverse reaction is a response to a medicine that is noxious and

unintended, and which occurs at doses normally used in man for the

prophylaxis, diagnosis, or therapy of disease or the modification of

physiological function

• All suspected adverse reactions should be reported whether known or

unknown, serious or not, including minor ones

• The word "overdose" implies that there is a common safe dosage and usage

for the drug; therefore, the term is commonly only applied to drugs,

not poisons, though even poisons are harmless at a low dosage

• Reports on the new drugs are of great interest because they make easier

to monitor the performance of these drugs in the country for any

suspected adverse drug reactions

• The reports should be sent to the Director General, TFDA, P.O. Box 77150,

Dar es Salaam, fax +255 22 2450793 email adr@tfda.or.tz This email

address is being protected from spambots. You need JavaScript enabled to

view it. [pic]

• Adverse drug reaction forms may be obtained from TFDA headquarters, Zonal

Drug Information Centres, offices of Regional Medical Officers or

Regional Pharmacists and healthcare facilities

• All sections of the Yellow form should be dully filled prior submission

STEP 6: Evaluation (5 minutes)

• What is adverse drug reaction?

• When adverse drug reaction occur?

• Why is it important to report adverse drug reaction?

• What is drug overdose?

• What is intoxication?

• Where should the report be sent?

• Who should fill the ADR (Yellow Form) for a patient?

• Why is it important to keep a copy of complete ADR (Yellow Form) for your

record?

References

Malestrom.(2004) Dictionary of Medical Terms (4th ed.). London, United

Kingdom: A & C Black.

Rice, J. (2011). Principles of pharmacology for medical assisting (5th

ed.). Boston, United States of America: Cengage Learning.

TFDA, (2006). Guidelines for Monitoring and Reporting Adverse Drug

Reactions – ADRs. Dar; MoH&SW

|[pic] |Worksheet 13.1: TFDA ADR FORM |

[pic]

Session 14: Documentation of Medicines and Medical Supplies

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Explain the Dispensing Medicine Records and Electronic Records

• Mention Components of Dispensing Register/Prescription Record Book/Sales

Book

• Report Information of Dispensed Medicines/Medical Supplies to Dispensing

• Retain and File Prescriptions of Dispensed Medicines and Mdical Supplies

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and /whiteboard markers

• Worksheet 14.1 Dispensing Register

• Worksheet 14.2 Prescriptions for Dispensing Records

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Dispensing Medicine Records and Electronic Records (20 minutes)

• Prescriptions should be recorded and documented as proof of transaction

between the patient and the dispenser

o Prescriptions can therefore be traced back if any need arise

• All dispensing units should have a standardized Prescription Registration

Book (PRB) for recording every pharmaceutical issued to a patient

• A computerized dispensing and registration system may also be used, but

should always be supported by paper back up

• The registration book should be completed at the time of dispensing or at

the close of the working day

• Importance of documentation of dispensed medicine

o Can be used as back up data when needed

o Is the source of information on the monitoring and evaluation of the

daily activities done in the unit

o Can act as the proof and show the source of purchase of medicine

o Simplify payment of revenue

• Electronic Records

o Electronic Document and Records Management Systems are computer based

systems designed to store a wide range of electronic documents and

file types

o These systems can store documents/files created from variety of

programs including Microsoft Office applications and emails

• The following are the Importance of electronic records in pharmacy:

o Providing accurate, up-to-date, and complete information about

patients at the point of care

o Enabling quick access to patient records for more coordinated,

efficient care

o Securely sharing electronic information with patients and other

clinicians

o Helping providers more effectively diagnose patients, reduce medical

errors, and provide safer care

o Improving patient and provider interaction and communication, as well

as health care convenience

o Enabling safer, more reliable prescribing

o Helping promote legible, complete documentation and accurate,

streamlined coding and billing

o Enhancing privacy and security of patient data

o Reducing costs through decreased paperwork, improved safety, reduced

duplication of testing, and improved health

o Help in effective inventory management

STEP 3: Components of Dispensing Register/ Prescription Record Book/Sales

Book (25 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the components of Dispensing Register? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Date

o Make sure you write the new date every day

o You are not required to repeat writing the same date for every patient

on the same day but if you have shift on the same day, you should skip

one line and write new date

o Start new page for new month

• Serial Number

o Each patient should be given serial number

o This number has no other meaning than just numbering all customers

that have been attended at the particular day

• Full name of a patient

o Write the full name of the patient who will use the medicine as it

appears in the Prescription and not of the one who has collected the

medicine

• Age: Write the age of a patient by years but if you cannot get the exact

age be sure to indicate whether is a child or adult

• Address of the patient ( Ward/street): Write the street and the ward

from which the patient is living

• Sex: Indicate if patient is male or female

• Generic name of the medicine: Record generic name of the medicine and not

trade name

o For example: Write Paracetamol and not Panadol.

• Direction for use: Write direction for use as indicated in the

prescription.

o For example: 2 x 3 x 5/7 Meaning "take 2 tablets after every 8 hours for

5 days"

• Quantity of medicine dispensed: Record the amount of drug dispensed

• Signature of the Dispenser: Themedicine dispenser should sign in the

dispensing register so as to recognize who dispensed medicines on a

particular day

• Name of the Health Facility: Dispenser must record the health facility

from which the prescription was written

o This is very important in case of tracking errors at any stage from

prescription writing to dispensing

[pic][pic] Refer students to Worksheet 14.1: Dispensing register

STEP 4: Information of Dispensed Medicines into Dispensing Register

(30 minutes)

|Activity: Exercise ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss the following question |

| |

|What informations are to be filled in the Dispensing register provided?|

|[pic]REFER students to the Worksheet 14.2 Prescriptions for Dispensing |

|Records Serial No. 00660-00664 |

| |

|[pic]REFER students to the Worksheet 14.1 Dispensing Register |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using table 1 below |

The following is the example of filled dispensing register :

Table 1: Dispensing register with filled medicine information

Name of Institution MADUKANI PHARMACY Page No 1

|S/ |

|No |

• The prescription registration book should be used both when prescriptions

are retained in the pharmacy and when they are returned to the patient

• For a prescription which is returned to a patient due to some of the

medicines to be out of stock the copy of the prescription should be

retained

o The word “dispensed” should be stamped/written adjacent to those items

which have been dispensed

o For prescriptions which are to be refilled on a later date, the

dispensing information should be entered into the registration book

before returning the prescription to the patient

▪ The official seal of the pharmacy/Health institution, name and

signature of the dispenser, the date of dispensing and the next

refill date should be written on the back of the prescription

• Prescriptions should be filed sequentially by day in a single

container/carton or box for each month

▪ The box/container should be labelled with the month and year

▪ Containers/boxes should be arranged on a monthly basis

• Normal prescriptions should be filed securely for two years and special

prescriptions for 5 years

▪ Thereafter, they should be disposed carefully in the presence of

appropriate body

• Prescriptions, patient and medication related records and information

should be documented and kept in a secure place that is easily accessible

only to the authorized personnel

STEP 6: Key Points (5 minutes)

• Prescription shall be documented separated by day, month and year

dispensed and archive for minimum of two years

• Electronic Records Management (ERM) ensures your organization has the

records it needs when they are needed

• Prescriptions should be recorded and documented as proof of transaction

between the patient and the dispenser

• All dispensing units should have a standardized Prescription Registration

Book (PRB) for recording every pharmaceutical issued to a patient

STEP 7: Evaluation (5 minutes)

• What is a dispensing register?

• What information is filled in a dispensing register?

• What is the importance of keeping records?

• What is the importance of electronic records?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

|[pic] |Worksheet 14.1: Dispensing Register |

Dispensing Register

Name of Institution……………………………………………………………… Page No.. ………………………

|S/ |Date |

|No | |

|Serial Na. 00660 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |Ibrahim Kimongo |

|Gender: |Me |

|Age: |39Yrs |

|Weight: |65kg |

|Rx |Paracetamol tabs 1g |

| |t.d.s 3/7 |

| |Metronidazole Tabs 480 |

| |mg tds 7/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]15/1/15 |

|Serial Na. 00661 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |Joyce Kamau |

|Gender: |Fe |

|Age: |18Yrs |

|Weight: |40kg |

|Rx |Miconazole cream 2% |

| |p.a.a b.i.d 4/52 |

| |Griseofulvin tabs 500 mg|

| |p.c od 3/12 |

| |Paracetamol Tabs 1g tds |

| |3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic] 15/1/15 |

|Serial Na. 00662 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |Steven Nnyamayao |

|Gender: |Me |

|Age: |56Yrs |

|Weight: |74kg |

|Rx |Mebendazole tabs 500mg |

| |stat |

| |Phenytoin 10mg nocte OD |

| |x 3/7 |

| | |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]20/1/15 |

|Serial Na. 00663 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |Marystella Ndauka |

|Gender: |Fe |

|Age: |65Yrs |

|Weight: |80kg |

|Rx |Occul tetracycline oint |

| |RE 6hrly 1/52 |

| |Paracetamol Tabs PO 1g |

| |tds 3/7 |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]20/1/15 |

|Serial Na. 00664 |

|KIHESA HEALTH CENTER |

|P.O. Box |

|IRINGA |

|Name: |Marium Abubakar |

|Gender: |Fe |

|Age: |4Yrs |

|Weight: |10kg |

|Rx |Metronidazole syrup 1 |

| |tsp tds 7/7 |

| |Paracetamol syrup 1tsp |

| |prn |

| | |

|Prescribe|Masige Kahwa Malimbo |

|r’s name |MO |

|qualifica| |

|tion | |

|Signature|[pic]13/1/15 |

Session 15: Rational Use of Medicines (RUM)

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Rational Use of Medicine

• List Components of Rational Use of Medicine

• List the Consequences of Irrational Use of Medicines

• Outline importance of Rational Use of Medicine

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

• Worksheet 1.1 Sample Prescription

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Rational Use of Medicine (5 minutes)

• Rational Use of Medicine: Refers to patients receiving medications

appropriate to their clinical needs, in doses that meet their own

individual requirements, for an adequate period of time and at the

lowest cost to them and the community

STEP 3: Components of Rational Use of Medicines (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the components of Rational Use of Medicines? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• The following are the components of Rational Use of Medicines

o Appropriate indication: The decision to prescribe drug(s) is entirely

based on medical rationale and the drug therapy is an effective and

safe treatment

o Appropriate drug: The selection of drugs is based on efficacy,

safety, suitability, and cost considerations

o Appropriate patient: No contraindications exist, the likelihood of

adverse reactions is minimal, and the drug is acceptable to the

patient

o Appropriate patient information: Patients are provided with relevant,

accurate, important and clear information regarding their conditions

and the medication(s) that are prescribed

o Appropriate evaluation: The anticipated and unexpected effects of

medications are appropriately monitored and interpreted

STEP 4: Causes and Consequences of Irrational Use of Medicines (40 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the causes and consequences of irrational use of medicine? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

The following are the causes of Irrational Medicine Use

o Diagnosis

▪ Inadequate examination of patient

▪ Incomplete communication between patient and doctor doctor

▪ Lack of documented medical history

▪ Inadequate laboratory Resources

o Prescribing

▪ Extravagant prescribing

▪ Over-prescribing

▪ Incorrect prescribing

▪ Under-prescribing

▪ Multiple prescribing/ers

o Dispensing:

▪ Incorrect interpretation of the prescription

▪ Retrieval of wrong ingredients

▪ Inaccurate counting, compounding, or pouring pouring

▪ Inadequate labeling

▪ Unsanitary procedures

▪ Packaging:

– Poor quality packaging materials

– Odd package size, which may require repackaging repackaging

– Unappealing package

o Patient adherence:

▪ Poor labeling

▪ Inadequate verbal instructions

▪ Inadequate counseling to encourage adherence adherence

▪ Inadequate follow-up/support of patients

• The following are consequences of irrational use of medicines:

o Ineffective and unsafe treatment

o Prolongation of illness

o Distress and harm to patient

o Increase the cost of treatment

o Lead to antimicrobial resistance

STEP 5: Importance of Rational Use of Medicines (40 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What is the importance of Rational Use of Medicine? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

Importance of Rational Use of Medicines:

• Reducing the incidences of drug resistance

• Improving patience adherence to medicines

• Reducing unnecessary cost of drug acquisition

• Reducing incidences of treatment failure

• Reducing the incidences of drug adverse reaction

STEP 6: Key Points (5 minutes)

• Improving the use of medicines by health workers and the general public

is crucial both in reducing morbidity and mortality from communicable

and non-communicable diseases, and to containing drug expenditure

curtail

• Therapeutically sound and cost-effective use of medicines by health

professionals and consumers should be at all levels of the health system,

in the public and the private sectors

STEP 7: Evaluation (5 minutes)

• What is Rational Use of Medicines?

• What are the Components of Rational use of Medicines?

• What are the Concequences of Irrational Use of Medicine?

• What is the importance of Rational Use of Medicines?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Senya ,S. S., Mwasha, C.Y., Muyinga, A. M., Amiri,R. I., Mauga,

E.S.K.(2011). Tanzania Pharmaceutical Handbook ( 2nd ed.). Dar eS

Salaam, Tanzania: School of Pharmaceutical Sciences

Session 16: Irrational Prescribing of Medicines

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• Define irrational prescribing

• Distinguish types of irrational prescribing practices

• Describe common patterns of irrational prescribing

• Identify irrational prescriptions

• Explain factors contributing to Irrational Prescribing

• Describe Measures to alleviate Irrational Prescribing

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Worksheet 16.1 to 16.5: Irrational Prescriptions

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Irrational Prescribing (5 minutes)

• Medicines should be prescribed only when they are necessary, and in all

cases the benefit of administering the medicine should be considered in

relation to the risk involved

• Irrational use of Medicines may be defined as: Patients receive

medications inappropriate to their clinical needs, in doses that do not

meet their own individual requirements, for inadequate period of time,

and the highest cost to them and their community

STEP 3: Types of Irrational Prescribing Practices (30 minutes)

|Activity: Small Group Discussion ( 15 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the types of irrational prescribing practices? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• The following are the types of irrational prescribing:Extravagant

Prescribing: This occurs when:

o A less expensive drug would provide comparable efficacy and safety

o Symptomatic treatment of mild condition diverts funds from treating

serious illness

o A proprietary product is used where less expensive generic equivalent

is available

• Over prescribing: This occurs when:

o The drug is not needed

o The dose is too large

o The treatment period is too long

o The quantity dispensed is too much for the current course of treatment

• Incorrect prescribing: This occurs when:

o The drug is given for an incorrect diagnosis

o A wrong drug is selected for the indication

• Multiple prescribing: This occurs when a drug is prescribed when:

o Two or more medication are used where one or two would achieve

virtually the same effect

o Several related conditions are treated when one or two would achieve

virtually the same effects

o Several related conditions are treated where treatment of the primary

condition will improve or cure the other conditions

• Under prescribing: This occurs when a drug is prescribed when:

o Dosage is inadequate

o length of treatment is too brief

o Need medications are not prescribed

STEP 4: Common Patterns of Irrational Prescribing (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the common patterns of irrational prescribing? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

Irrational prescribing may be manifested in the following ways:

Over-prescribing

This occurs if a drug is prescribed when:

• The drug is not needed

• The dose is to large

• The treatment period is to long

• The quantity dispensed is too great for the current course treatment

Incorrect Prescribing

• The drug is given for the incorrect diagnosis

• The wrong drug is selected for the indication

• The prescription is prepared incorrectly

• Adjustments are not made for co-existing medical, genetic,

environmental, or other

• factors

Multiple Prescribing

• Two or more medications are used where one or two would achieve

virtually the same

effect

• Several related conditions are treated where treatment of the primary

condition would

alleviate or cure the other conditions

Under-prescribing

• Dosage is inadequate

• Length of treatment is too brief

• Needed medications are not prescribed

STEP 5: Irrational Prescriptions (30 minutes)

|Activity: Exercise (20 minutes) |

| |

|DIVIDE students into small manageable groups. |

| |

|[pic]REFER students to Worksheet 16.1 to 16.5: Irrational Prescriptions|

| |

|READ or ASK one student to read and then comment on the following |

|prescription orders and CLARIFY |

| |

|Prescription 16.1 |

|A patient came with prescription written as Septra tabs 960 mg bd 7/7, |

|Panadol tabs 1 gm tds 3/7 and Cough syrup 10 ml tds 5/7. The diagnosis |

|Cough with chest pain. Comment |

|Answer |

|This is Extravagant Prescribing: Septra is a brand of cotrimoxazole |

|tabs. It cost more than generic drug. The prescription should have been|

|prescribed using generics. Panadol is a trade name too, instead it |

|should have been written paracetamol which is cheaper than panadol |

| |

|Prescription 16.2 |

|A patient aged 55 years, came with prescription written as Paracetamol |

|tabs 1 gm tds 7/7,Metronidazole tabs 400 mg tds 1/12, Diagnosis tooth |

|extraction |

|Answer |

|This is over prescription: Duration for paracetamol is too long, proper|

|is just 3days or as needed Metronidazole duration is too long it |

|should have been 5-7 days. For tooth extraction another antibiotic is |

|needed, ampiclox, Flucamox. |

| |

|Prescription 16.3 |

|A patient aged 23 years came with prescription written as BBE 25% w/v |

|od 3/7 |

|Diagnosis scabies |

|Answer |

|This is incorrect prescription: The instruction are not correct BBE 25%|

|od x 3/7 does not tell route of administration. BBE is a topical |

|medication. Need to apply after bath whole body except face and head. |

|Patient should not shower until after 24hrs. Should be applied after |

|every one day (repeat on the third day, and then on fifth day). That |

|means the course is three times |

| |

|Prescription 16.4 |

|A patient came with prescription written as Flucamox caps 500 mg tds |

|10/7, Pen V tabs 500 mg tds 5/7, Ampiclox 500mg tds 5/7, Diagnosis |

|tonsillitis, typhoid, and boils. |

|Answer |

|This is multiple prescription/polypharmacy: The three diseases; |

|tonsillitis, boils and typhoid can well be treated with flucamox. Is a |

|wide antibiotic which is indicated for all the three diseases. There |

|was no need of prescribing ampiclox and Pen V |

| |

|Prescription 16.5 |

|A patient aged 10 years came with prescription written as Paracetamol |

|syrup 5mL tds 3/7 ( available paracetamol syrup 125mg/5mL) |

|Co-trimoxazole syrup 5mL bd 3/7 ( available co-trimoxazole syrup |

|240mg/5mL). Diagnosis pneumonia |

|Answer |

|This is under prescribing : For a child of that age, the dose is too |

|small and the treatment will not be achieved. That is a dose for below |

|6 years child. |

| |

|ASK all groups to answer the above 5 questions for 15 minutes. |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY if there are any questions |

STEP 6: Factors Contributing to Irrational Prescribing (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What factors contribute to Irrational Prescribing? |

| |

|ALLOW few students to respond? |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

The following are factors contributing to irrational Prescribing:

• Inadequate training in clinical pharmacology and therapeutics

• Lack of continuing education and supervision

• practitioner's inappropriate desire for prestige

• promotional activities of company representatives

• Lack of time due to heavy patient load

• Pressure from patient

• Incorrect generalization about a drug from limited experience

STEP 7: Measures to Alleviate Irrational Prescribing (10 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the Measures to alleviate Irrational Prescribing? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• Measures to alleviate irrational prescribing

o Proper use of Standard Treatment Guideline

o Regular supervision of subordinates

o Participating in developing standard treatment protocols

o Participate in continuing education programs through informal one-to-

one teaching and through hospital seminars

o Make appropriate use of available laboratory investigations to confirm

diagnosis and hence appropriate treatment

o Availability of current drug information through reference manuals and

drug news periodical

o Use of hospital formulary to provide scientific justification for

appropriate therapeutic intervention

o Educate and counsel patients on proper use of medicine

o Promotion of cost consciousness among prescribers

STEP 8: Key Points (5 minutes)

• In developed and developing world, medically inappropriate, ineffective,

and economically inefficient use of pharmaceuticals commonly occurs in

health care facilities

• The costs of such irrational drug use are enormous in terms of both

scarce resources and the adverse clinical consequences of therapies that

may have real risks but no objective benefits

• Promoting appropriate use of drugs in the health care system is needed

not only because of the financial reasons but also quality of care

which is the most concern to practitioners

• Actions or intervention programs to promote the appropriate use of

drugs should, therefore, be continuously implemented and

systematically incorporated as an integral part of the health care

system

STEP 7: Evaluation (5 minutes)

• What are the commonly encountered irrational prescribing practices?

• What is irrational prescribing?

• What are the types of irrational prescribing?

• What factors contribute to irrational prescribing?

• What are the Measures to alleviate irrational prescribing?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Management Sciences for Health (1988). Health Center Prescribing and Child

Survival in East Java and West Kalimantan, Indonesia. Boston: United States

of America

Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the

Tetracycline Go?

Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A

strategy for promoting improved pharmaceutical use: The International

Network for Rational Use of Drugs. 35 (11) 1329–41.

Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K.

(2011) Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam,

Tanzania: School of Pharmaceutical Sciences

Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of

irrational drug therapy. 1986;16(3):355–61.

Session 17: Irrational Dispensing of Medicine

Total Session Time: 120 minutes

Prerequisites

None

Learning Tasks

By the end of this session students are expected to be able to:

• Define Irrational Dispensing

• Identify Irational Dispensing Practices

• Describe Factors Contributing to Irrational Dispensing

• Determine Measures to Alleviate Irrational Dispensing

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board and chalk/whiteboard markers

• Handout 17.1: Factors contributing to Irrational Dispensing

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing

STEP 2: Definition of Irrational Dispensing (10 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What is Irrational Dispensing? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Irrational dispensing refers to dispensing practices resulted from errors

occurring during the dispensing process in the pharmacy

o They are different from prescribing errors or errors during

consumption of medicine

STEP 3: Irrational Dispensing Practices (55 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the Different Practices of irrational dispensing observed |

|from Dispensers? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned|

| |

|CLARIFY and SUMMARIZE by using the contents below |

• Misreading the prescription

• Misinformation to the patient (wrong or failure to give proper

information)

• Picking wrong medication (picking errors)

• Overcharging (billing error)

• Mistake in packing and labeling

• Mistaken delivery of medicine i.e giving medicine to a wrong person

• Dispensing Expired Medicine

• Error in dispensing similarly pronounced medicine (similarity errors)

• Errors in counting medicine for dispensing

|Activity: Exercise ( 25 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to Discuss and Comment on cases 17.1-17.3 below |

|Case 17.1 |

|Mary James, pharmacist, has filled some prescriptions for carbimazole|

|on one working day. On the same day a customer, epileptic patient, |

|presented him a prescription for carbamazepine. Glancing at it, Abebe|

|thinks it is carbimazole once again, and that is what he dispensed. |

|The patient went to his prescriber with complaints of no improvement.|

|Comment on this case. |

| |

|Discussion: Mary James, the pharmacist, failed to read and understand|

|the prescription correctly. This has led to failure of treatment |

|regimen prescribed for the epileptic patient. Because of the |

|existence of similarity with the names of some medicines, it is |

|important to read and understand the prescribed medicines carefully |

|and correctly. |

| |

|Case 17.2 |

|Frank Chacha, went to a medicine shop and made verbal request for |

|ampicillin and cough syrup for her 8 years old daughter with |

|complaints of cough and poor appetite. As she did not have enough |

|amount of money, she wanted to purchase only ten capsules of |

|ampicillin and one bottle of cough syrup suspension. The dispenser |

|fulfilled her request. Comment. |

| |

|Discussion: Frank chacha made a verbal request for a prescription |

|medicine (ampicillin) and an OTC cough syrup. The dispenser should |

|have asked her a prescription at least for ampicillin. Secondly, |

|dispensing inadequate quantity of ampicillin even with prescription |

|is irrational. Such clients should be referred to authorized |

|prescribers. prescription at least for ampicillin. Secondly, |

|dispensing inadequate quantity of ampicillin even with prescription |

|is irrational. Such clients should be referred to authorized |

|prescribers. |

| |

|Case 17.3 |

|A prescription that calls for atenolol 50 mg tablets is presented to |

|a pharmacy. The total quantity to be dispensed is not indicated. One |

|Tab. BID po for 4 weeks is written after Sig. All other information |

|is complete. The pharmacy professional dispensed 28 atenolol 50 mg |

|tablets. Comment. |

|Discussion: The total quantity dispensed is not correct. According to|

|the prescription, 56 tablets (2 tablets a day for 4 weeks or 28 days)|

|should be dispensed. |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned|

| |

|CLARIFY if there is any question. |

STEP 4: Factors Contributing to Irrational Dispensing (15 minutes)

The following are factors contributing to irrational dispensing practices:

• Dispensing:

o Incorrect interpretation of the prescription

• Retrieval of wrong ingredients

o Inaccurate counting, compounding, or pouring

o Inadequate labeling

o Unsanitary procedures

o Packaging:

▪ Poor-quality packaging materials

▪ Odd package size, which may require repackaging repackaging

▪ Unappealing package

o Inadequate verbal instructions

o Inadequate counseling to encourage adherence

o Inadequate follow-up/support of patients

o Treatments or instructions that do not consider the consider the

patient’s beliefs, environment, or culture or culture

[pic][pic] Refer students to Handout 17.1: Factors contributing to

Irrational Dispensing

STEP 5: Measures to Alleviate Irrational Dispensing (20 minutes)

|Activity: Brainstorming (5 minutes) |

| |

|Ask students to brainstorm on the following question: |

| |

|What are the measures to alleviate irrational Dispensing? |

| |

|ALLOW few students to respond |

| |

|WRITE their responses on the flip chart/ board |

| |

|CLARIFY and SUMMARISE by using the content below |

• Dispensing should be done by Pharmaceutical personnel

• Dispenser should follow good Dispensing Practice and abide to dispensing

policy

• The dispenser or dispensing team should have knowledge, skills and

attitudes to carry out the dispensing process rationally. These includes

o Knowledge about the medicines being dispensed (common use, usual

dosage, precautions about the method of use, common side effects,

common interactions with other medicines or food, storage condition)

o Good calculation and arithmetic skills

o Skills in assessing the quality of preparations

o Attributes of cleanliness, accuracy and honesty

o Attitudes and skills required to communicate effectively with

patients,

o Sufficient training according to the level of the health institution

and medicine retail outlet

o Knowledge about national polices and working guidelines

o Good knowledge of societal norms and cultural values

o Good working relation with other health care professionals

o Good knowledge on medicine supply management

• Maintain a register/chart to record dispensing errors occurring in your

pharmacy, with the possible cause/reason for the error

o Try to work out systems/processes, to avoid such errors in future

• Do not dispense any doubtful prescription if:

o Essential information is missing or doubtful, and the prescriber

cannot be contacted

o Safety of the medicines is doubtful

o The prescription does not conform to legal requirements

STEP 6: Key Points (5 minutes)

• Irrational dispensing refers to dispensing practices resulted from errors

occurring during the dispensing process in the pharmacy. Improper

attention, careless attitude while dispensing, not checking carefully

before dispensing are among the factors that contribute to irrational

dispensing

• The dispenser or dispensing team should have knowledge, skills and

attitudes to carry out the dispensing process rationally

STEP 7: Evaluation (10 minutes)

• What is Irrational Dispensing?

• What are the different practices of irrational dispensing observed from

Dispensers?

• What are factors that contributing to Irrational Dispensing?

• What are the measures to alleviate Irrational Dispensing?

References

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.). London, United Kingdom: Bailliere Tindall.

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.).

London, United Kingdom: Churchill Livingstone

Management Sciences for Health (1988). Health Center Prescribing and Child

Survival in East Java and West Kalimantan, Indonesia. Boston: United States

of America

Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the

Tetracycline Go?

Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A

strategy for promoting improved pharmaceutical use: The International

Network for Rational Use of Drugs. 35 (11) 1329–41.

Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K.

(2011) Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam,

Tanzania: School of Pharmaceutical Sciences

Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of

irrational drug therapy. 1986;16(3):355–61.

|[pic] |Handout 17.1 Factors Contributing to Irrational Dispensing |

[pic]

Session 18: Sections in a Pharmacy Department

Total Session Time: 120 minutes

Prerequisites

• None

Learning Tasks

By the end of this session students are expected to be able to:

• List Different Sections of Pharmacy Department

• Explain Activities Carried out and Services Offered in Department

• Describe the Requirements for a Functional Dispensing Unit

Resources Needed:

• Flip charts, marker pens, and masking tape

• Black/white board, chalk and whiteboard markers

SESSION OVERVIEW

SESSION CONTENTS

STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Sections/Units of a Pharmacy Department (5 minutes)

|Activity: Buzzing (5 minutes) |

| |

|ASK students to pair up and buzz on the following question for 2 |

|minutes |

| |

|What are the sections of hospital pharmacy? |

| |

|ALLOW few pairs to respond and let other pairs to add on points not |

|mentioned |

| |

|WRITE their response on the flip chart/board |

| |

|CLARIFY and SUMMARIZE by using the content below |

• For good pharmaceutical practice, the hospital pharmacy department is

organized into the following sections/area:

o Pharmacy administration section

o Dispensing section

o Compounding section

o Strong room

o Sterile preparations section

o Storage section/main store room

o Drug information section

STEP 3: Activities carried out and services offered in pharmacy department

(60 minutes)

|Activity: Small Group Discussion ( 20 minutes) |

| |

|DIVIDE students into small manageable groups |

| |

|ASK students to discuss on the following question |

| |

|What are the activities that are carried out and services offered in |

|pharmacy department? |

| |

|ALLOW students to discuss for 15 minutes |

| |

|ALLOW few groups to present and the rest to add points not mentioned |

| |

|CLARIFY and SUMMARIZE by using the contents below |

• The following are activities/services offered by pharmacy department:

o Receiving, Storage and distribution of medicines

o Compounding of sterile and non-sterile products

o Dispensing of medicines

o Therapeutic consultations

o Patient counselling

o All other activities associated with the patient’s drug therapy

Step 4: The requirements for a functional dispensing unit (40 minutes)

The following are the requirements of a functional dispensing unit:

• The premises:

o Should inspire confidence in the users of the service

o Should be clean and hygienic

o Well designed and organized

o Regularly monitored

o Tidy, accessible and secure

o Should provide suitable environmental conditions for both personnel and

products

• Dispensing and compounding equipments:

o Should be of appropriate design

o Suitable, well maintained and adequate for the work to be undertaken

o All equipment must be maintained in accurate working order

o Checked for cleanliness prior to each use

o A range of glass and plastic beakers and conical flasks

o graduated glass and plastic measuring cylinders

o A range of graduated glass and plastic pipettes

o A pipette filler

o Stainless steel & plastic spatulas

o containers for each type of dosage form

o A suitable range of labels

o Spoons & Counting trays for tablets and capsules

o Appropriate information sources, for examplespharmacopoeias

• Quality assurance procedures.

To assure the quality of all medicines prepared or supplied, control

procedures are necessary; these measures include:

o quality of raw materials

o supervision, documentation

o packaging and labelling

o labelling for stock

o Storage conditions and expiry date

• Accessible sources of Drug information

o Competency in the use of information sources is an essential part of

pharmacy practice.

o It is advised to become familiar with these different sources of drug

information so that the required information of various types can be

readily retrieved.

o Sources of drug information can be obtained from either of the

following:

▪ Internet source e.g : www.cdnphar , www.which.net/health

▪ Subscription source or (e.g pharmaceutical journal, bulletin)

▪ Textbook sources e.g Pharmacopoeia

• The personnel:

o Should be adequately trained and motivated personne

o Pharmacists, Pharmaceutical technicians and Pharmaceutical Assistants

together with appropriate support staff

o Standards of personal hygiene and politeness should be high

o Appropriate protective clothing worn during working hours

o Eating, drinking and smoking should not be permitted in any area where

medicines are prepared or supplied

[pic]

Dispensing Balance

Figure 1: Dispensing Aids

[pic]

Counting Triangle

STEP 6: Key Points (5 minutes)

• The premises on which a dispensing service is provided should reflect the

quality of service and inspire confidence on patients in the nature of

pharmaceutical service delivered

• Maintaining a clean environment requires a regular routine of cleaning

shelves and a daily cleaning of floors and working surfaces

• For good pharmaceutical practice in dispensing and compounding, the

hospital pharmacy department is organized into the following

sections/areas; pharmacy administration section, dispensing section,

compounding section, strong room, sterile preparations section, storage

section/main store room, drug information section

• Pharmaceutical personnel working in pharmacy department must be well

trained with necessary knowledge, skills and caring attitude to perform

activities of pharmaceuticals

STEP 7: Evaluation (5 minutes)

• What are the sections of a pharmacy department?

• What are the activities offered in a pharmacy department?

• What are the requirements for a functional dispensing unit?

References

Abraham G/Giorgis (2004). Drug smuggling and counterfeiting in Ethiopia.

Masters Dissertation, University of Bradford, UK

Amanda, L.E., et al.(1999). Intervention research in rational use of drugs.

Health policy and planning 14(2):89-102

Management Sciences for Health (1997). Managing drug supply. West Hartford,

United States of America; Kumarian press

Tietze, K.J., (1997). Clinical skills for pharmacists: a patient focused

approach. Philadelphia, United States of America: Mosby, Inc.

World Health Organization (1997). Quality assurance of pharmaceuticals: a

compendium of guidelines and related materials. Geneva, Vol.1

Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of

pharmaceutics (8th ed.) London, United Kingdom: Bailliere Tindall

Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's

dispensing for pharmaceutical students (12th ed.). New Delhi, India:

CBS

FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices.

(2nd ed.). Ethiopia

[pic]

———————–

PST 04101Dispensing

NTA Level 4 Semester 1

December 2016

A) Dispensary B) Health Centre C) District Hospital D) Regional and

Referral Hospital

194

NATIONAL ESSENTIAL MEDICINE LIST FOR TANZANIA (NEMLIT)

Name of medicine Route of administration

Pharmaceutical forms and strengths

A letter before the name of each medicine indicates the lowest health care

facility where the medicine may be available.

1.0 ANAESTHETICS

1.1 Anaesthetics, General

C Ether anaesthetic

Liquid for inhalation, bottle 500ml

C Halothane

Liquid for inhalation, bottle 250ml

C Ketamine

Injection (hydrochloride), 10mg/ml in 20ml

C T iohpental

Powder for injection (sodium salt), 0.5g, in 20ml

C Oxygen

Cylinder (medical gas) for inhalatio

1.2 Anaesthetics, Local

C Bupivacaine

Injection 0.5% (hydrochloride) in 7.5% dextrose heavy spinal

A Lignocaine

Injection (hydrochloride), 1% in 10ml vial

B Lignocaine

Injection (hydrochloride), 2% in 2ml vial

C Lignocaine in Dextrose

Injection (hydrochloride), 5% and 7.5% dextrose, in 2ml ampoules for spinal

anaesthesia

B Lignocaine

Injection (hydrochloride) 2% with adrenaline 1:100,000 in 2ml ampoule for

dental use

C Lignocaine

Jelly (hydrochloride) 2%, 5% in 30g tube

MUSCLE RELAXANTS 2.0 AND CHOLINESTERASE

INHIBITORS

D Gallamine

Injection (triethiidide) 40mg/ml in 2ml ampoule

C Neostigmine

Injection (hydrochloride or hydrogen tartarate),1mg/ml in 1ml ampoule,

Injection (hydrochloride or hydrogen tartarate), 2.5mg/ ml in 1ml ampoule

D Pancuronium

Injection (bromide) 4mg/ml in 2ml ampoule

C Suxamethonium

Powder for injection (bromide or chloride) 50mg/ml in 2ml vial

3.0

ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES AND

MEDICINES USED TOTREAT GOUT

A Acetylsalicylic acid

Tablets 300mg

D Allopurinol

Tablets 100mg

B Diclofenac

Tablets (sodium/potassium salt) 25mg, 50mg

195

C Diclofenac

Injection (sodium salt), 25mg/ml in 3ml ampoule

A Diclofenac

Gel

C Diclofenac

Tablets 100mg (Slow release)

C Diclofenac

Rectocaps 100mg

C Ibuprofen

Tablets 200mg

C Indomethacine

Capsules 25mg, 50mg

A Mefenamic acid

Tablets/Capsules 500mg

A Paracetamol

Tablets 500mg

A Paracetamol

Syrup 125mg/5ml

C Tramadol

Tablets 50mg, 100mg

C Tramadol

Injection 50mg/ml in 2ml

4.0 ANTI-MIGRAINE MEDICINES

A Acetylsalicylic acid

Tablets 300mg

A Paracetamol

Tablets 500mg

5.0 ANALGESICS NARCOTICS AND ANTAGONISTS

C Morphine

Injection (sulfate) 10mg/ml in 1ml ampoule

C Naloxone

Injection (hydrochloride) 0.4mg/ml in 1ml ampoule

C Pethidine

Injection (hydrochloride) 50mg/ml in 1ml and 2ml ampoule

C Pethidine

Capsules 50mg

6.0

ANTI-ALLERGIES AND MEDICINES USED IN ANAPHYLAXIS AND CARDIOGENIC SHOCK

A Chlorpheniramine

Tablets (maleate) 4mg

A Chlorpheniramine

Injection (maleate10mg/ml in 1ml ampoule)

A Chlorpheniramine

Elixir (maleate) 2mg/5ml

C Loratadine

Tablet 10mg

C Loratadine

Syrup 5mg/5ml

C Cetrizine

Tablets (hydrochloride) 10mg

C Cetrizine

Oral solution 5mg/5ml

A

Adrenaline (Epinephrine)

Injection (as hyrochloride or hydrogen tartarate) 1mg/1ml ampoule

D Dopamine

Injection (hyrochloride) 40mg/ml in 5ml ampoule

A Hydrocortisone

Powder for injection (as sodium succinate) 100mg in vial

A Promethazine

Tablets (hydrochloride) 25mg

A Promethazine

Injection (hydrochloride) 25mg/ml in 2ml

A Promethazine

Syrup 5mg/5ml

C Dexamethasone

Injection (phosphate as sodium salt) 4mg/ml

196

7.0 ANTIDOTES

7.1 Antido

Syrup 5mg/5ml

C Dexamethasone

Injection (phosphate as sodium salt) 4mg/ml

196

7.0 ANTIDOTES

7.1 Antidotes (Non speciﬁ c)

C Ipecacuanha

Syrup, containing 0.14% Ipacacuanha alkaloid

A Charcoal, activated

Tablets or Powder, 50g

C Magnesium sulphate

Powder, 5g

7.2 Antidotes (Speciﬁ c)

B Atropine

Injection (sulphate) 600mcg/ml in 1ml ampoule

8.0 ANTI-EPILEPTICS AND ANTI-CONVULSANTS

C Carbamazepine

Tablets 200mg, 400mg

C Carbamazepine

Syrup 100mg/5ml

C Diazepam

Tablets 2mg, 5mg

A Diazepam

Injection 5mg/ml in 2ml ampoule

A Phenobarbital

Tablets (as sodium) 30mg, 100mg

C Phenobarbital

Injection (as sodium salt), 200mg in 2ml ampoule

C Phenobarbital

Injection (as sodium salt), 100mg in 2ml ampoule

A Phenytoin

Tablets/Capsules (as sodium salt) 50mg, 100mg

A Phenytoin

Suspension (as sodium salt) 30mg/5ml

C Magnessium sulphate

Injection 50mg/ml in 10ml vial

9.0 ANTI-INFECTIVE MEDICINES

9.1 Amoebicides

B Metronidazole

Tablets 200mg

B Metronidazole

Suspension (as benzoate) 200mg/5ml in 100ml

C Tinidazole

Tablets 500mg

D Secnidazole

Tablets 1000mg

9.2 Anthelminthics

A Albendazole

Tablets 200mg, 400mg, chewable

A Albendazole

Suspension 100mg/5ml in 30ml bottle

A Ivermectin

Tablets 3mg, 6mg

A Levamisole

Tablets (as hyrdochloride) 40mg

A Levamisole

Suspension as hydrochloride 40mg/5ml

A Mebendazole

Tablets 100mg, chewable

A Mebendazole

Suspension 100mg/5ml in 30ml bottle

B Niclosamide

Tablets 500mg, chewable

C T iahbendazole

Tablets 500mg, chewable

9.3 Anti-bacterial Medicines

A Amoxycillin

Capsules (as trihydrate) 250mg, 500mg

A Amoxycillin

Powder for suspension (as trihydrate), 125mg/5ml in 100ml bottle

197

C

Amoxycillin + Clavulanic Tablets (as trihydrate) 500mg + 125mg acid

clavulanic acid (as potassium salt)

Amoxycillin + Clavulanic

acid

Powder for suspension (as trihydrate) 125mg+ C 31.25mg (as

potassium salt) in 5ml, 100ml

bottle

C Ampicillin

Powder for injection (as sodium salt) 250mg, 500mg in vial

D Azithromycin

Tablets (as dihydrate) 250mg

C Ceftazidime

Powder for injection (as pentahydrate) 250mg in vial

C Ceftriaxone

Injection 250mg, 1g in vial

C Ceftriaxone

Infusion 2g

A Chloramphenicol

Capsules 250mg

A Chloramphenicol

Powder for injection (as sodium succinate) 1g in vial

B Chloramphenicol

Oily injection (as sodium succinate) 1g in vial

A Chloramphenicol

Suspension (as palmitate), 125mg/5ml injection (as phosphate), 150mg/ml in

2ml ampule

C Ciproﬂoxacin

Tablets (as hydrochloride) 250mg, 500mg

C Ciproﬂoxacin

IV solution (as lactate) 2mg/ml in 100ml bottle

D Clindamycin

Capsules 150mg

D Clindamycin

Injection (as phosphate) 150mg/ml in 2ml ampule

C Cloxacillin

Capsules (as sodium salt), 250mg

C Cloxacillin

Powder for injection (as sodium salt) 250mg, 500mg in vial

C Cloxacillin

Powder for suspension (as sodium salt), 125mg/5ml in 100ml bottle

A Co-trimoxazole

Tablets 480mg (sulphamethoxazole 400mg/ trimethoprim 80mg)

A Co-trimoxazole

Suspension (sulphamethoxazole 200 mg/5ml + trimethoprim 40mg/5ml in 100ml

bottle

A Doxycycline

Tablets/capsules (as hydrochloride), 100mg

A Erythromycin

Tablets (as stearate or ethyl succinate), 250mg, ﬁ lm coated

A Erythromycin

Powder for suspension (as ethylsuccinate), 125mg/5ml in 100ml bottle

C Flucloxacillin

Capsule (sodium) 250mg

C Flucloxacillin

Syrup 125mg/5ml

C Flucloxacillin

Injection (sodim) 250mg

A Gentamicin

Injection (as sulphate) 40mg/ml in 2ml ampoule

D Kanamycin

Powder for injection, 1g

C Metronidazole

Tablets 200mg

198

C Metronidazole

Suspension as (benzoate) 200mg/5ml in 100ml

C Metronidazole

Injection (I.V) 5mg/ml in 100ml bottle

C Nalidixic acid

Tablets 500mg

A Nitrofurantoin

Tablets 100mg

A Penicillin, benzyl

Powder for injection (as sodium or potassium salt) 3g ( 5,000,000 IU) in

vial

C

Penicillin, benzathine benzyl

Powder for injection 1.44g (2,400,000 IU) in vial

A

Penicillin, phenoxy methyl-

Tablets (as potassium salt), 250mg

A

Penicillin, phenoxy methyl-

Powder for suspension 125mg/5ml in 100ml bottle

A

Penicillin, procaine benzyl

Fortiﬁed powder for injection 4g (4,000,000 IU)

C Sulphadiazine

Tablets 500mg

C Sulphasalazine

Tablets 500mg

C Trimethoprim

Tablets 100mg, 200mg

9.4 Anti-ﬁ larials

A Ivermectin

Tablets 3mg, 6mg.

B Diethylcarbamazine

Tablets (dihydrogen citrate) 50mg

9.5 Anti-leishmaniasis Medicines

D Pentamidine

Injection (di-isethionate) 200mg vial

D Sodium stilbogluconate

Injection 10% (equivalent to pentavalent antimony 100mg/ml) in vial

9.6 Anti-malaria Medicines

A

Artemether/ Lumefantrine (Alu)

Tablets 20mg/120mg

A Chloroquine

Tablets 150mg base

B Quinine

Tablets (as sulphate or bisulphate) 300mg

A Quinine

Injection (as dihydrochloride) 300mg/ml in 2ml ampoule, 25ml vial

A

Sulfadoxine + Pyrimethamine

Tablets Sulfadoxine 500mg + Pyrimetheamine 25mg

C

Sulfamethoxyprazine + Pyrimethamine

Tablets Sulfamethoxypyrazine (salfalene) 500mg+ pyrimethamine 25mg

9.7 Anti-schistosomals

A Praziquantel

Tablets 600mg

9.8 Anti-trypanosomals

C Melarsoprol

Injection 3.6% solution (in propylene glycol containing 5% water)

C Suramin sodium

Powder for injection 1g in vial

199

9.9 Anti-leprosy Medicines

A Clofazimine

Capsules 100mg, tablets 300mg

A Dapsone

Tablets 50mg, 100mg

A Sodium fusidate

Tablets 250mg

A Sodium fusidate

Suspension 250mg/5ml in 100ml bottle

9.10 Anti-tuberculous Medicines

A Ethambutol

Tablets (hydrochloride) 400mg

A Ethambutol + Isoniazid

Tablets 400mg + 100mg

A Isoniazid

Tablets 100mg

A Pyrazinamide

Tablets 500mg

A Rifampicin + Isoniazid

Capsules/Tablets 150mg + 75mg

A Rifampicin + Isoniazid

Capsules/Tablets 150mg + 150mg

A Streptomycin

Powder fo rinjection (as sulphate) 1g in vial

Rifampicin + Isoniazid A + Pyrazinamide +

Ethambutol

Tablets 150mg + 75mg + 400mg + 275mg

9.11 Antiviral Medicines

C Abacavir

Tablets 300mg

C Abacavir

Syrup 20mg/ml, 240ml

C Acyclovir

Tablets 400mg, 800mg

C Acyclovir

Cream 5%

C Didanosine

Tablets 100mg, 200mg, 400mg

C Efavirenz

Capsules 200mg, 600mg

C Ganciclovir

Capsules 250mg

C Ganciclovir

Powder for injection, 500mg/vial

C Idoxuridine

Topical ointment 5%

C Idoxuridine

Eye solution 5%

C Indinavir

Capsule 400mg

C Lamivudine

Tablets 150mg

C Lamivudine

Syrup 10mg/ml, 100ml bottle

C

Lamivudine + Zidovudine

Tablets 150mg + 300mg

C Lopinavir/Ritonavir

Capsules 200mg, 400mg

C Nelﬁnavir

Tablets 250mg(mesylate)

C Nelﬁnavir

Oral powder (mesylate) 50mg/g

C Nevirapine

Tablets 200mg

C Nevirapine

Syrup 10mg/5ml

C Ritonavir

Capsules 100mg,

C Ritonavir

Syrup 600mg/7.5ml

C Saquinavir

Capsules 200mg (mesylate)

C Saquinavir/Ritonovir

Capsules 200mg, 400mg

200

C Stavudine

Tablets/Capsules 15mg, 20mg, 30mg, 40mg

C

Stavudine + Lamivudine + Nevirapine

Tablets 30mg + 150mg + 200mg

C

Stavudine + Lamivudine + Nevirapine

Tablets 40mg + 150mg + 200mg

C Zidovudine

Tablets 100mg, 300mg

C Zidovudine

Syrup 10mg, 100ml bottle

9.12 Fungicides (Systemic and Mucosal)

D Amphotericin B

Powder for injection 50mg in vial

B Clotrimazole

Vaginal cream (nitrate) 2%, 10%

A Clotrimazole

Pessaries 100mg

C Fluconazole

Capsules 50mg, 150mg, 200mg

C Fluconazole

Suspension 50mg/5ml

C Fluconazole

I.V infusion 2mg/ml in 25ml and 100ml bottle

B Griseofulvin

Tablets 500mg

B Griseofulvin

Suspension 125mg/5ml

C Ketoconazole

Tablets 200mg

C Ketoconazole

Suspension 100mg/5ml in 30ml bottle

C Miconazole

Oral gel

A Nystatin

Tablets 500,000 IU

A Nystatin

Suspension oral 100,000 IU/ml in 30ml bottle

9.13 Medicines for Opportunistic Infeciton

B Co-trimoxazole

Tablets 480mg

C Dapsone

Tablets 50mg, 100mg

C Fluconazole

Capsules 50mg, 150mg, 200mg

C Fluconazole

Suspension 50mg/5ml

C Fluconazole

I.V infusion 2mg/ml in 25ml and 100ml bottle

C Flucytocine

I.V infusion 10mg/ml 250ml bottle

10.0 ANTI-NEOPLASTIC, IMMUNOSUPPRESSIVE AND RELATED MEDICINES

D Cyclophosphamide

Tablets 50mg

D Cyclophosphamide

Powder for injection 100mg, 200mg, 500mg, 1000mg in vilal

D Prednisolone

Tablets 5mg

11.0 ANTI-PARKINSONISM MEDICINES

C Benzhexol

Tablets (hydrochloride) 2mg, 5mg

D Biperidine

Tablets 2mg/5ml injection 1ml ampoule

D Levodopa

Tablets/capsule 125mg, 250mg, 500mg

D Levodopa+Carbidopa

Tablets 100mg + 25mg

201

12.0 MEDICINES AFFECTING THE BLOOD

A

Ferrous sulphate + folic acid

Tablets 200mg + 0.25mg

A Ferrous sulphate

Tablets 200mg (equivalent to 60mg iron)

A Ferrous fumarate

Syrup 20mg/ml (equivalent to 6.5mg iron/ml)

A Folic acid

Tablets 5mg

C

Hydroxocobalamin (Vit B12)

Injection 1mg/ml in 1ml ampoule

C Iron dextran

Injection 5% (equivalent to 50mg iron/ml) in 5ml and 20ml ampoule

13.0 ANTI-COAGULANTS AND ANTAGONISTS

D Acetylsalicylic acid

Tablets 75mg,

D Heparin

Injection (sodium salt) 1,000 IU/ml in 5ml ampoule, ﬂashes

K

C Phytomenadione (Vit. 1

)

Injection 10mg

K

C Phytomenadione (Vit. 1

)

Injection 0.5 mg/ml, 2mg/ml in 2ml ampoule

D Protamine sulphate

Injection 10mg/ml in 5ml ampule

D Tranexamic acid

Tablets 500mg

D Tranexamic acid

Injection 100mg/ml in 5ml ampoule

D Tranexamic acid

Syrup 500mg/5ml in 300ml bottle

D Warfarin

Tablets (sodium salt) 5mg

D Streptokinase

Powder for injection 250,000 unit or 750,000 unit vial

D Low molecular Heparin

Injection, equivalence of Enoxaparin(sodium) 6000-8000 IU/ml

D Low molecular Heparin

Injection, equivalence of Edalteparin (sodium) 10,000IU/ml

D Factor VIII concentrate

500IU

D Factor IX concentrate

500 IU

D

Fresh frozen plasma (FFP)

Bags

14.0 PLASMA SUBSTITUTES

C Dextran 70

IV solution 6% in sodium chloride bottle of 500ml

C Polygeline

IV solution 3.5%, 500ml bottles

15.0 CARDIOVASCULAR MEDICINES

15.1 Anti-anginal Medicines

C Glycerly trinitrate

Tablets 500 mcg sublingual

C Isosorbide Dinitrate

Tablets 10mg, 20mg

D Nifedipine

Capsules/tablets 10mg, sublingual

C Propranolol

Talets 40mg

202

15.2 Anti-arrhythmic Medicines

D Amiodarone

Tablets (hydrochloride) 100mg

D Amiodarone

Injection (hydrochloride) 30mg/ml in 10ml ampoule

D Verapamil

Tablets 40mg 80mg

D Verapamil

Injection 2.5mg/ml, 2ml ampule

15.3 Anti-hypertensive Medicines

A Methyldopa

Tablets 250mg

C Captopril

Tablets 12.5mg, 25mg

C Nifedipine

Tablets 10mg, sublingual

C Nifedipine (retard)

Tablets 20mg, 30mg

C Atenolol

Tablets 50mg, 100mg

A Propranolol

Tablets 40mg

15.4 Hypertensive Emergencies

C Hydralazine

Powder for injection (hydrochloride) 25mg/ ml ampoule

C Hydralazine

Tablets 25mg

15.5 Cardiac Glycosides

C Digoxin

Tablets 0.25mg (250mg)

C Digoxin

Injection 250mg/ml in 2ml ampoule

15.6 Diuretics

B Frusemide

Tablets 40mg

C Frusemide

Injection 10mg/ml in 2ml ampoule

A Hydrochlorthiazide

Tablets 25mg, 50mg

C Mannitol

IV solution 10% in 200 ml bottle

D Spironolactone

Tablets 25mg, 50mg

A Bendroﬂuazide

Tablets 5mg

15.7 Lipid Lowering Medicines

D Simvastatin

Tablets 10mg

D Atorvastatin

Tablets 10mg

16.0 DERMATOLOGICAL MEDICINES

16.1 Antiseptic/Disinfectants

A Povidone-iodine

Solution 10% (250ml bottle)

A

Chlorinated lime+Boaric Acid

Solution (prepare from raw materials) (eusol)

A Gentian violet

Soluiton 0.5% in water (prepare from raw materials)

B Potassium permanganate

Solution 1:1000 (prepare from raw materials)

B Potassium permanganate

Solution 1:2000 (prepare from raw materials)

B Potassium permanganate

Solution 1:4000 (prepare from raw materials)

203

16.2 Anti-inﬂammatory (steroidal) Medicines and Anti-pruritic Medicines

C Bethamethasone

Skin cream or ointment (valerate) 0.1% in 15g tube

C Bethamethasone

Lotion (valerate) 0.1% in 30ml bottle

C Hydrocortisone

Cream 0.5%

A Calamine

Skin ointment/lotion

C

Para aminobenzoic Acid (PABA)

Cream/lotion 5%

C Tretinoin acid

Topical cream 0.025%, Gel 0.01%

16.3 Fungicides (topical)

A Benzoic acid Compound

Ointment (prepare from raw materials) (whitﬁed’s)

C Clotrimazole

Cream 1% in 20g tube

C Clotrimazole

Powder 0.01g/g

C Clotrimazole

Vaginal pessaries 100mg, 500mg

C Nystatin

Cream 100,000 IU/g in 15g tube

C Nystatin

Pessaries 100,000 IU

C Miconazole

Pessaries (nitrate) 1.2g

C Miconazole

Vaginal cream (nitrate) 2%

C Miconazole

Spray (nitrate) 0.16% + oral gel

D Tolnaftate

Solution 1% 10mg/ml

D Terbinaﬁne

Cream 1%, 15 and 30g Tube

16.4 Keratoplastic and Keratolytic Agents

C Silver nitrate

Stick

C Podophylin

Solution 10-25% (prepare from raw materials)

C Coaltar

Ointment 5% (prepare from raw materials)

C Salicylic acid

Topical solution 5% (prepare from raw materials)

A Emulsifying agent

Cream – the equivalent to E45 or sofderm

C Imiquimod

Cream 5%

16.5 Anti-infective Agents (topical)

B

Oxytetracycline + hydrocortisone

Spray 150mg + 50mg

B

Oxytetracycline + hydrocortisone

Ointment 3%+1%

A Benzoyl peroxide

Ointment/cream 2.5%, 5% and forte

A Chloramphenical

Ointment 1%

C Mupirocin

Ointment 2%

17.0 GASTRO-INTESTINAL MEDICINES

17.1 Antacids and Anti-ulcer Agents

C Cimetidine

Tablets 200mg, 400mg

204

C Cimetidine

Injection 100mg/ml in 2ml ampoule

C Famotidine

Tablets 40mg

C Famotidine

Injection 100mg/ml in 2ml ampoule

C Lansoprazole

Capsule, 30mg

A Magnesium trisilicate co.

Tablets (250mg magnesium trisilicate + 120mg dried aluminium hydroxide)

C Omeprazole

Tablets 20mg

C Ranitidine

Tablets 150mg

C Ranitidine

Injection 50mg/2ml

C Cholestyramine

Sachet 4g

17.2 Anti-spasmodics

A Hyoscine butylbromide

Tablets 10mg

C Hyoscine butylbromide

Injection 20mg/ml; 1ml ampoule

17.3 Anti-emetics

A Promethazine

Tablets (hydrochloride/theoclate) 10mg, 25mg

A Promethazine

Injection (hydrochloride) 25mg/ml in 2ml ampoule

A Promethazine

Elixir (hydrochloride) 5mg/5ml

D Metoclopramide

Tablets 10mg

D Metoclopramide

Injection 5mg/2ml

C Prochlorperazine

Tablets 5mg, 25mg

C Prochlorperazine

Injection (as mesylate) 12.5mg/ml ampoule

17.4 Cathartics

A Bisacodyl

Tablets 5mg

A Bisacodyl

Suppositories 5mg, 10mg

C Lactulose

Solution 3.1 – 3.7g/5ml, 200ml bottle

17.5 Anti-haemorrhoids

Local anaesthetic + C astrigent and anti

inlfamatory

Suppositories/ointment (Bismuth oxide 25mg + Bismuth subgallate 59mg + Peru

balsam 49mg+Zinc oxide 296mg) equivalent to Anusol suppositories

Local anaesthetic + C astrigent and anti

inlfamatory

Suppositories (Cinchocaine hydrochloride 5mg + Hydrocortisone 5mg)

equivalent to ProctosedylR

Local anaesthetic + C astrigent and anti

inlfamatory

Cream/ointment containing (Benzyl benzoate +1.2%Bismuth oxide

0.875%+Hydrocortisone acetate 0.5%+Peru balsam 1.85%) equivalent to

Anulgesic

Local anaesthetic + C astrigent and anti

inlfamatory

Suppositories containing (benzyl benzoate 33mg+bismuth oxide 24mg+bismuth

subgallate 59mg+hydrocortisone acetate 5mg+Peru balsam 49mg+bromocaine HCl

27mg+Zinc oxide 296mg) equivalent to Anugesic

205

17.6 Medicine Used in Diarrhoea

A

Oral Rehydration Salts (ORS) low osmolarity

Sachet to make 1 litre of solution containing Sodium chloride 2.6g, Sodium

citrate 2.9g, Potassium chloride 1.5g and Glucose 20.5g) repalcement

solution

C Loperamide

Tablets/capsules (hydrochloride) 2mg

A Zinc

Tablets dispersible (equivalent to 20mg elemental zinc)

18.0 HORMONES AND ANTIDIABETIC AGENTS AND RELATED MEDICINES

18.1 Adrenal Hormones and Sysnthetic Substitutes

D Dexamethasone

Tablets 5mg

D Dexamethasone

Injection (as sodium phosphate) 4 mg/ml in 1 ml ampoule

C Hydrocortisone

Powder fo rinjection (as sodium succinate)

C Prednisolone

Injection 100mg in vial

C Prednisolone

Tablets 5mg

18.2 Oestrogens

D Ethinyloestradiol

Tablets 50 mcg

18.3 Insulin and Anti-diabetic Agents

C Chlorpropamide

Tablets 250mg

C Glibenclalmide

Tablets 2.5mg, 5mg

D Gliclazide

Tablets 40mg

C Tolbutamide

Tablets 500mg

C Metformin

Tablets 500mg

D Glucagon

Injection powder for reconst 10mg/vial

D Glipizide

Tablets 2.5mg, 5mg

C

Insulin-short acting (human) soluble

100 IU/ml100

C

Insulin-intermediate acting (human)

100 IU/ml

C

Insulin-long acting (human) lente

100 IU/ml

18.4 Ovulation Inducers

C Clomiphene

Tablets 50mg

18.5 Oral Contraceptives

A

Ethinyloestradiol + Norgestrel

Tablets 0.03mg + 0.3mg

A

Ethinyloestradiol Levonorgestrel

Tablets 0.03mg + 0.15mg

A

Ethinyloestradiol Desogestrel

Tablets 0.03mg + 0.15mg

206

18.6 Barrier and Other Contraceptives

A

Intra Uterine Devices (IUD)

Coper T 380A

A Condoms male

Latex

A Condoms female

Polyurathane sheet 15cm x 7cm

18.7 Progesterone

A Levonorgestrel

Tablets 0.03mg, 0.07mg

A Medroxyprogesterone

Injection acetate (depot) 150mg

D Hydroxyprogesterone

Injection (coproate) 200mg/ml in 1ml

A Levonorgesterol

Implant 36mg (set)

D Norethisterone

Tablets 5mg

18.8 Thyroid, Parathyroid Hormones and Antagonists

C Carbimazole

Tablets 5mg

A Iodine (Lugol’s solution)

Solution, Iodine 2mg + Potassium Iodide 4mg/g in water (prepare from raw

material)

D Levothyroxine

Tablets (sodium salt) 0.05g

A Iodized oil

Capsules with nipple 240mg/0.5ml and 480mg iodine/ml

19.0 SERA AND IMMUNOGLOBULINS

D Gamma – Globulins

Injection I.V 500mg, 2.5g, 5g

C

Anti-D(Rho) Immunoglobulin

Injection 0.25 mg/ml in set of 5ml

C

Anti-rabies Immunoglobulin

Injection 1000 IU/5ml ampoule

B Snake venom polyvalent

Antiserum injeciton (|Central African type) in vila

Tetanus

B Immunoglobulin (human) – ATS

Injection 1,500 IU in vial

Tetanus

B Immunoglobulin (human) – ATS

Injection 10,000 I.U in vial

Tetanus

B Immunoglobulin (human) – ATS

Injection 100,000 I.U in vial

Tetanus

B Immunoglobulin (human) – ATS

Injection 500,000 I.U in vial

20.0 VACCINES

20.1 For Immunisation

A

BCG Vaccine (Bacillus Calmette Guerin)

Injection 20 doses in 10ml vial

DPT Vaccine

A (Diphtheria-Pertussis-Tetanus)

Injection 20 doses in 10 ml vial

A

DPT Vaccine (Diphtheria-Pertussis-Tetanus) + Hepatitis Injection

Vaccine injection

207

A

Measles Vaccine (Live attenuated)

Injection 10 deses in vial

A

Poliomyelitis Vaccine (Live attenuated)

Oral solution 20 doeses in container

A Tetanus (toxoid) Vaccine

Injection 20 doses in 10ml vial

20.2 For Speciﬁc Groups or Individuals

D Hepatitis B Vaccine

20mg/ml 1ml 1ml vials

D

Meningitis vaccine A & C

Vaccine injection

B

Human Diploid Cell Rabies

Freeze dried rabies vaccine

D Yellow Fever Vaccine

Injection 10 doses in vial (with diluent)

C Pneumococcal vaccine

Vaccine injeciton 0.5ml vial

21.0 OPHTHAMOLOGICAL PREPARATIONS

21.1 Anti-infective Agents

C Acyclovir

Eye ointment 3%

C Chloramphenicol

Eye drops 0.5%, 1%

A Chloramphenicol

Eye ointment 1%

D Gentamicin

Eye drops 0.3%

C Idoxuridine

Eye ointment 0.5%

A Oxytetracycline

Eye ointment 3%

21.2 Steroidal Anti-inﬂammatory Agents

C Hydrocortisone

Eye Drops (acetate) 0.5%

21.3 Antiinfective and Antiinlamatory Agents

D

Oxytetracycline + Hydrocortisone + Polymycin B (Equivalent of Terracotril)

Eye drops

D Sodium cromoglycate

2% eye drops

21.4 Anti Allergy:

D Loratadine

Tablets 10mg

C Cetirizine

syrup 5mg/5ml (100ml)

C Sodium Cromoglycate

Tablets 10mg

C Sodium Cromoglycate

Solution 5mg/ml (200ml)

C Sodium Cromoglycate

Eye drops

21.5 Drugs for Trachoma & Onchocerciasis

B Azithromycin

Tablets 500mg

B Azithromycin

Capsule 250mg

B Ivermectin

Tablets 3mg, 6mg.

22.0 MEDICINES USED IN EAR DISEASES

22.1 Ear Drops

B Chloramphenicol

Ear drops 5% in 10ml

D

Dexamethasone + Neomycin

Ear drops

208

A Ciproﬂoxacin

Ear drops

A Aluminium diacetate

Ear drops 3%

22.2 Oral Antiseptics

A Chlorhexidine gluconate

Solution 0.1%;prepare from concentrated solution

C Potassium permanganate

Solution 1:4000; prepare from powder/crystals

22.3 Nasal Preparation

D Beclomethasone

Spray 0.05% (50mcg/d0se)

C Ephedrine

Nasal drops 0.5% and 1%

23.0 OXYTOCICS, MYOMETRIAL RELAXANTS (TOCOLYTICS) AND RELATED MEDICINES

C Salbutamol

Tablets 4mg

C Salbutamol

Injection 100mcg/ml, 10ml vial

A Ergometrine

Injection (mealeate) 0.5mg/ml in 1ml ampoule

C Oxytocin

Injection 10 IU in 1ml ampoule

D Misoprostol

Tablet 200mcg (rectal, sublingual)

D Magnesium sulphate

Injection 50%

24.0 PSYCHOTHERAPEUTICS AND RELATED MEDICINES

D Carbamazepine

tablets 200mg, 400mg

A Phenytoin

Tablets 50mg, 100mg

A Phenobarbitone

Tablets 30mg, 100mg

A Phenobarbitone

Injection 200mg/ml in 1ml ampoule

C Amitriptyline

Tablets (hydrochloride) 25mg

A Chlorpromazine

Tablets (hydrochloride) 25mg, 100mg + 250mg

B Chlorpromazine

Injection (hydrochloride) 25mg/ml in 2ml ampoule

C Fluphenazine decanoate

Injection 25mg/ml in 1ml ampoule

B Haloperiodol

Tablets 1mg, 5mg

D Haloperiodol

Injection 5mg/ml in 1ml ampoule

B Imipramine

Tablets 25mg, 50mg

C T iohridazine

Tablets 25mg

25.0 MEDICINE ACTING ON RESPIRATORY TRACT

25.1 Anti-asthmatics

A Aminophylline

Tablets 100mg

A Aminophylline

Injection 25mg/ml in 10ml ampoule

C Beclomethasone

Inhalation (dipropionate) 0.05mg per dose (aerosol inhaler)

A Ephedrine

Tablets (hydrochloride) 30mg

A Ephedrine

Injection (hydrochloride) 30mg/ml in 1ml ampoule

A Cromoglycate

Nasal spray (di-sodium salt) 2% (sprayer with pump)

C Salbutamol

Tablets (as sulfate) 4mg

209

C Salbutamol

Syrup (as sulfate) 4mg

D Salbutamol

Inhalation (as sulfate) 0.1mg per dose (aerosol inhaler)

A Adrenaline

Injection 1m/1ml ampoule

25.2 Antitusives

A Codeine

Syrup/Linctus

26.0 SOLUTIONS, CORRECTING WATER ELECTROLYTE AND ACID BASE DISTURBANCES

26.1 Large Volume Intravenous Solutions

B Darrow’s half strength

500ml

A Dextrose

5%; 500ml, 1000ml

B Dextrose

10%; 500ml

C Dextrose

25%, 50%; 50ml, 100ml

Sodium lactate

B compound (Ringer’s solution)

500ml, 1000ml. Each litre provides approximately Na+ 131 mmol, K+ 5mmol,

Ca++2mmol, C1-111mmol and HCO -(lactate) 29mmol

A

Sodium chloride+Dextrose

0.9%+5%; 500ml, 1000ml

B Potassium chloride

Solution 7.4% 10ml Vial

C Potassium citrate

Oral solution containing potassium citrate 30% + citric acid monohydrate 5%

A Water for injection

5ml, 10ml vial

27.0 DISINFECTANTS AND ANTISEPTICS

27.1 Disinfectants

A Sodium hypochlorite

Solution 10% (250ml bottle)

A Hydrogen peroxide

Solution 6%

A

Chlorhexidine + Cetrimide

Solution concentrated containing chhlorhexidine digluconate 1.5%+ 15%

cetrimide in 1litre and 5 litre

A Chlorhexidine

Solution 4% in litre and 5 litres

A Chloroxylenol

Solution 4.9% BP in litre and 5 litre

A Cresol

Solution 3% BP in litre and 5 litre

C Formaldehyde

solution 36 – 37% stabilised in 1 litre

C Glutaraldehyde

Activated solution 2% in 1 litre, 5 litres for scopes sterilization)

A Providone iodine

Solution 10% in water 250ml, 500ml, 1 litre

A Methylated spirit

70% in 1 litre, 5 litre

Sodium

A Dichloroisocyanurate (NODCO)

Tablets, 1.67g (equal to 1g available chlorine)

27.2 Antiseptic

A Providone-Iodine

Solution (1 litre bottle)

A

Chlorinated lime + Boric Acid Solution

Prepare from raw materials

C Potassium permanganate

Solution 1: 1000

210

C Potassium permanganate

Solution 1: 2000

C Potassium permanganate

Solution 1: 4000

28.0 VITAMINS/MINERALS

A Retinol (Vitamin A)

Gelatin Capsules (with nipple to allow administration drop by drop)

50,000IU, 100,000IU 200, 000IU

C

Ascorbic acid (Vitamin C)

Tablets 100mg and 500mg

C Calcium gluconate

Injection 100mg/ml in 10ml ampoule

D

Ergocalciferol (vitamin D)

Capsules 1.25mg (50, 000IU)

D

Ergocalciferol (vitamin D)

Oral solution 0.25mg/ml (10,000IU/ml)

B

C Nicotinamide (Vitamin 3

)

Tablets 50mg

C Pyridoxine (Vitamin B6)

Tablets (hydrochloride) 25mg

A T iahmine (Vitamin B1)

Tablets (hydrochloride) 50mg, 100mg

C T iahmine (Vitamin B1)

Injection (hydrochloride) 1000mg/ml in 1ml ampoule

D Vitamin B12

Tablets (hydrochloride) 50mcg

A Vitamin B complex

Tablets BP (contains per tablet: nicotinamide 15mg, riboﬂavin 1mg, thiamine

1mg)

A Vitamin B complex

Syrup (contains per tablet: nicotinamide 15mg, riboﬂavin 1mg, thiamine 1mg)

C Vitamin B complex

Injection BP in 10ml vial (contains nicotinamide 200mg, pantothenol 30mg,

pyridoxine 20mg, riboﬂavine 20mg, thiamine 50mg per 1 ml)

C Potassium chloride

Tablets (slow release) 600mg

Themi Pharmacy

P.O Box 3011

Arusha

Date: 15.01.2015

Name of Patient: Aisha Hassan

Paracetamol Syrup 120mg/5ml

2 teaspoonful x After every 8 hours for 5 days

Keep Away From Children Reach

Themi Pharmacy

P.O Box 3011

Arusha

Date: 15.01.2015

Name of Patient: Aisha Hassan

Amoxicillin Syrup 125mg/5ml

2 teaspoonful x After every 8 hours for 7 days

Keep Away From Children Reach

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