Pharmaceutical Sciences Notes

NTA Level 4 • Semester 1 • PST04101 Medicines Label Dispensing • Source Session/Topic 10 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |15 minutes |Presentation |Definition of a Label of | | | |Buzzing |Medicine to be Dispensed | |3 |30 minutes |Presentation |Essential Features of a Label | | | |Brainstorming | | |4 |10 minutes |Presentation |Purpose/ Importance of a Label | | | | |of Dispensed Medicine | |5 |40 minutes |Presentation |Design and Prepare Appropriate | | | |Exercise |Label | |6 |10 minutes |Presentation |Key Points | |7 |10 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Generic and Brand Names of Medicines Dispensing • Source Session/Topic 11 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definition of Generic | | | | |(non-proprietary) and Brand | | | | |(proprietary) Medicines | |3 |25 minutes |Presentation |Global and National Initiatives on | | | | |Generic and Brand Medicines | |4 |30 minutes |Buzzing | Generic and Brand Medicines | | | |Presentation | | |5 |30 minutes |Brainstorming |Advantages and Disadvantages of | | | |Presentation |Generic and Brand Medicines | |6 |10 minutes |Presentation |Key Points | | 7 |10 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Giving Appropriate Medicine Information to Patients Dispensing • Source Session/Topic 12 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definitions of Drug Interaction, | | | | |Side effects, Contraindication and | | | | |Precautions of Medicines | |3 |30 minutes |Presentation |Appropriate Instructions on the Use | | | |Role play |of Prescribed Medicine(s) | |4 |30 minutes |Presentation |Appropriate Information on | | | |Role play |Precautions, Interactions, Side | | | | |effects and Storage of Dispensed | | | | |Medicines | |5 |30 minutes |Presentation |Patient Understanding on the Use and| | | |Role play |Precautions of Dispensed Medicine(s)| |6 |10 minutes |Presentation |Key Points | |7 |05 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Adverse Drug Reactions, Drug Overdose and Intoxication Dispensing • Source Session/Topic 13 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |05 minutes |Presentation |Definition of Adverse Drug | | | | |Reactions, Drug Overdose and | | | | |Intoxication | |3 |35 minutes |Presentation |Identification of Adverse Drug | | | |Brainstorming |Reactions (ADRs), Drug Overdose and | | | | |Intoxication | |4 |60 minutes |Presentation |Reporting Adverse Drug Reactions | | | |Small Group |(ADRs) | | | |Discussion | | |5 |10 minutes |Presentation |Key Points | |6 |05 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Documentation of Medicines and Medical Supplies Dispensing • Source Session/Topic 14 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 Register/ Prescription Record Book/Sales Book • 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |20 minutes|Presentation |Dispensing Medicine Records and | | | | |Electronic Records | |3 |25 minutes |Presentation |Components of Dispensing Register/ | | | |Brainstorming |Prescription Record Book/Sales Book | |4 |30 minutes |Presentation |Information of Dispensed Medicines | | | |Exercise |into Dispensing Register | |5 |30 minutes |Presentation |Retention and Filling of | | | |Buzzing |Prescriptions of Dispensed Medicines| |6 |05 minutes |Presentation |Key Points | |7 |05 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Rational Use of Medicines (RUM) Dispensing • Source Session/Topic 15 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes|Presentation |Introduction, Learning Tasks | |2 |05 minutes|Presentation |Definition of Rational Use of | | | | |Medicine | |3 |20 minutes|Presentation |Components of Rational Use of | | | |Brainstorming |Medicines | |4 |40 minutes|Presentation |Consequences of Irrational Use | | | |Small Group |of medicines | | | |Discussion | | |5 |40 minutes|Presentation |Importance of Rational Use of | | | |Small Group |Medicines | | | |Discussion | | |7 |05 minutes|Presentation |Key Points | |8 |05 minutes|Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Irrational Prescribing of Medicines Dispensing • Source Session/Topic 16 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |05 minutes |Presentation |Definition of Irrational Prescribing| |3 |30 minutes |Small group |Types of Irrational Prescribing | | | |Discussion |Practices | |4 |20 minutes |Presentation |Common Patterns of Irrational | | | |Brainstorming |Prescribing | |5 |30 minutes |Presentation |Identification of Irrational | | | |Exercise |Prescriptions | |6 |10 minutes |Presentation |Factors Contributing to Irrational | | | |Brainstorming |Prescribing | |7 |10 minutes |Presentation |Measures to Alleviate Irrational | | | |Buzzing |Prescription | |8 |05 minutes |Presentation |Key Points | |9 |05 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Irrational Dispensing of Medicine Dispensing • Source Session/Topic 17 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definition of Irrational | | | |Brainstorming |Dispensing | |3 |55 minutes |Presentation |Irrational Dispensing Practices | | | |Small Group | | | | |Discussion | | |4 |15 minutes |Presentation |Factors Contributing to | | | | |Irrational Dispensing | |5 |20 minutes |Presentation |Measures to Alleviate Irrational | | | |Brainstorming |Dispensing | |6 |05 minutes |Presentation |Key Points | |7 |10 minutes |Presentation |Evaluation | 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

NTA Level 4 • Semester 1 • PST04101 Sections in a Pharmacy Department Dispensing • Source Session/Topic 18 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. 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 |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |05 minutes |Presentation |Different Sections of a Pharmacy | | | |Buzzing |Department | |3 |60 minutes |Presentation |Activities Carried Out and Services | | | |Small Group |Offered in a Pharmacy Department | | | |Discussion | | |4 |40 minutes |Presentation |Requirements for a Functional | | | | |Dispensing Unit | |5 |05 minutes |Presentation |Key Points | |7 |05 minutes |Presentation |Evaluation | | | |Question and | | | | |answers | | 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