Introduction to Pharmacy PDF

Introduction to Pharmacy (Course Code: Phar2071) Introductory Pharmacy Module (for 1st Year Pharmacy Students) By: Manaye T.  Objectives At the end of this session, you will know about:  Definition of pharmacy  Definition...

Introduction to Pharmacy (Course Code: Phar2071) Introductory Pharmacy Module (for 1st Year Pharmacy Students) By: Manaye T.  Objectives At the end of this session, you will know about:  Definition of pharmacy  Definition of health  Health care system of Ethiopia 1/8/2025 2  Definition of Pharmacy The word ‘Pharmacy’ has two meanings :  General sense – it is a place or shop where medicines are sold.  Professional sense – it is a profession, the members of which deal with drugs. The word ‘Pharmacy’ was derived from the Greek word- “pharmakeia” which means use of drugs. In Greek, “Pharmakon” means - Drug 1/8/2025 3  Cont. …………. Pharmacy is the art and science of preparing and dispensing medications, and the provision of drug related information to patients, public, and professionals. It’s the study of the science of drugs - Where they come from? How they act on the body? How to turn drugs into medicines? 1/8/2025 4 Cont. …………. Pharmacy is a health profession concerned with design of medicine. It’s evaluation, production and use that links the health sciences with the biological, chemical and medical sciences. Person who practice pharmacy is called a pharmacist. 1/8/2025 5 Cont. …………. A pharmacist is the one who is educated and licensed to prepare and dispense drugs and to provide drug related information to the patient, public, and other health professionals. 1/8/2025 6  Introduction to health WHO defines health as “a state of complete physical, mental, and social well-being and not merely the absence of diseases or infirmity”. Some professionals also add emotional and spiritual health dimensions to the WHO’s definition. 1/8/2025 7 Cont. …………. Physical well-being: is concerned with anatomical integrity and physiological functioning of the body. - It means the ability to perform routine tasks without any physical restriction. E.g. physical fitness is needed to walk from place to place. 1/8/2025 8 Cont. …………. Mental well-being: is the ability to learn and think clearly and coherently. E.g. a person who is not mentally fit (retarded) could not learn something new at a pace in which an ordinary normal person learns. 1/8/2025 9 Cont. …………. Social well-being: is the ability to make and maintain acceptable interaction with other people. E.g., to celebrate during festivals; to mourn when a close family member dies; to create and maintain friendship and intimacy. 1/8/2025 10  Cont. …………. Emotional well-being: the ability of expressing emotions in the appropriate way, for example, to fear, to be happy, and to be angry. - Response of body should be congruent with stimuli. - Emotional health is related to mental health and includes feelings. - It’s maintaining one’s own integrity in the presence of stressful situations like tension, depression and anxiety. 1/8/2025 11 Cont. …………. Spiritual well-being: Some people relate health with religion; for others it has to do with personal values, beliefs, principles and ways of achieving mental satisfaction, in which all are related to their spiritual well-being. 1/8/2025 12  Ethiopian Health Care System The health care system in Ethiopia is federally decentralized along the 11 regions and 2 city administrations. The current health care system of the country is arranged in a three-tier (rank) system: 1. Primary level health care. Includes:  Health post  Health center  Primary hospital 1/8/2025 13 Cont. …………. 2. Secondary level health care:  General hospital 3. Tertiary level health care:  Specialized hospital 1/8/2025 14 Cont. …………. Specialized Hospital Tertiary level health care 3.5 – 5.0 Million General hospital Secondary level health care (1,000,000-1,500,000) people Primary hospital 60,000-100,000 Health Health center Primary level center 15,000-25,000 (Rural) health care 40,000 Health post (Urban) 3,000-5,000 1/8/2025 15 Cont. ………….  Health Post  Serve a total of 3,000-5,000 population.  Provides preventive and promotive services.  Collect basic health and health related data.  Staffed with health extension workers. 1/8/2025 16 Cont. ………….  Health Center  First point of consultation for all patients.  Serving a total of 15,000-25,000 in rural and 40,000 population in urban areas.  Provides preventive, promotive, curative, training services as well as referral services.  Collect basic health and health related data.  Staffed with public health officers, GPs and other staffs (nurses, midwives, laboratory technicians, sanitarians, and pharmacists) 1/8/2025 17 Cont. ………….  Primary Hospital  Provides promotive, preventive, curative and training services, with minimum of 50 beds.  Staffed with general practitioners and other staffs (nurses, midwives, laboratory technicians, sanitarians, and pharmacists);  Serve about a population of 60,000 -100,000. 1/8/2025 18 Cont. ………….  General Hospital Provides curative, specialized (secondary and tertiary) services and training services, with minimum of 100 beds. Staffed with specialists of different category, general practitioners and other staffs ( nurses, midwives, laboratory technicians, sanitarians, and pharmacists); Serve a population of 1-1.5 million. 1/8/2025 19  Cont. ………….  Specialized/Teaching Hospitals The last higher level, which provides specialized services (tertiary), teaching, and research, with minimum of 250 beds; Staffed with sub-specialists, specialists of different category, general practitioners and other higher level staffs ( nurses, midwives, laboratory technicians, sanitarians, and pharmacists). 1/8/2025 Serve about a population of 3.5-5 million. 20 Scope of Pharmacy: Education and Careers  Objectives  At the end of this session, you will know about: Education of pharmacy both nationally and internationally  Course comprising national bachelor of pharmacy curriculum  Career opportunities 1/8/2025 22  Education and Careers Pharmacy education, training, and practice vary considerably in the world. Education Many pharmacy schools have Bachelor of Pharmacy (B.Pharm) degree programs, along with tracks for master of science and doctor of philosophy degrees for those interested in graduate education. 1/8/2025 23 Cont. …………. In the United States, doctorate (PharmD) is the only professional degree in pharmacy. The doctor of pharmacy degree requires six academic years to complete the degree requirements. In other regions of the world, pharmacy schools are undergoing changes in order to modify or add pathways for students to transition to a clinically-oriented six- year doctor of pharmacy degree. 1/8/2025 24  Cont. …………. In Ethiopia, in the past, because of the provision of more emphasis to product-centered curriculum, the presence of pharmacists in providing patient care services is found to be extremely low. Due to this fact, nationally harmonized curriculum which is more emphasizing on clinical practices of pharmacy has been designed. The present curriculum also enables the future pharmacists to practice their profession in pharmaceutical settings which requires their knowledge. 1/8/2025 25  Courses  Courses in pharmacy education comprises three categories:  General education courses  Prerequisite/supportive courses  Professional courses 1/8/2025 26 Cont. …………. General education courses:  Communication skills  Writing skills  Civics and Ethical education  General psychology Provide the broad general education required for the professional. 1/8/2025 27 Cont. ………….  Prerequisite/supportive courses:  Organic chemistry  Biomedical sciences (e.g. human anatomy and histology, human physiology, biochemistry, pathophysiology, microbiology, parasitology, immunology)  Biostatistics and epidemiology  Teach the principles, the application of which find their way into many of the upper-level professional pharmacy courses. 1/8/2025 28 Cont. ………….  Professional courses:  Pharmaceutical sciences (pharmacology, Pharmaceutics, medicinal chemistry, pharmacognosy, pharmaceutical analysis )  Pharmacy practice  Clinical pharmacy courses  Elective courses 1/8/2025 29  Careers Dispensing pharmacist (at community pharmacy, hospital pharmacy )  Clinical pharmacist (at hospital wards )  Whole sale pharmacist (at medical supplies importing agents) Policy maker (at Federal Ministry of Health)  Sales representative (for multi-national companies)  Chief officer (at regional, zonal, and district health offices) 1/8/2025 30 Cont. ………….  Production pharmacist, quality control pharmacist, research and development pharmacist, medicine information pharmacist, marketing pharmacist, sales pharmacist, and manager (at pharmaceutical industry)  Inspector of health care institutions, pharmacies, drug stores, medical supplies importing agents (at medicine & health regulatory authority) 1/8/2025 31 Cont. …………. Consultant for governmental and non-governmental organizations  Researcher at research institutes Teacher at universities and colleges 1/8/2025 32 Evolution of Pharmacy  Objectives  At the end of the session, you will know about :  Prehistoric pharmacy  Antiquity  The middle ages  Renaissance  Discoveries and background of modern pharmacy 1/8/2025 34  Evolution of Pharmacy Pharmacy as a skill is perhaps as old as the making of stone implements. However, the practice of this singular art by a recognized specialist is only about 1000 years old. 1/8/2025 35  The Drug-Taking Animal Humans are unique in their nature to treat ailments, physical and mental problems with medicine The profession of pharmacy is perhaps as old as human civilization From archeological evidences, the need to soothe the burdens of disease is as old as humanity search for other bone and stone tools 1/8/2025 36 Cont. …………. Medicines rarely occur in nature in their most useful form First, the active ingredients/drugs must be collected, processed and prepared for incorporation in to medicaments These activities, done since the dawn of humanity, are still the central focus of the practice of pharmacy 1/8/2025 37 Cont. ………….  As with other tools drugs have been used to gain increased control over human lives to make them better and longer  The common wisdom about medicines have been a mixture of myth and science, folklore and demonstrated fact 1/8/2025 38 Prehistoric Pharmacy  Since the dawn of humanity, pharmacy has been part of everyday life, before 30,000 BC  People gathered plants for medicinal purposes for healing illness through their knowledge  Healers approached disease with the context of their general understanding of the world around them 1/8/2025 39 Cont. …………. They consider illness as come from super natural power (bad spirit) and the way of treatment as magic. The tribal healer or Shamans compounded the remedies needed to stave off (avoid) the influence of evil spells or spirits 1/8/2025 40 Pharmacy in Antiquity (ancient times): Organized settlements arose along the great fertile valleys of known rivers Great changes made on the concept of disease and healing Around the 2nd millennium BC, clay tablets & papyri documents were made Examination of these documents reveal the gradual separation of empirical healing from the purely spiritual healing 1/8/2025 41 Cont. ………….  In the Babylon, medical care was provided by two classes of healers: The asipu (magical healer) relied more heavily on spells and used magical stones far more than plant materials The asu (empirical healer) drew upon a large collection of drugs & manipulated them in several dosage forms that are still basic today: suppositories, pills, washes, enemas, & ointments 1/8/2025 42  Cont. …………. The asipu & the asu were not in direct competition and sometimes cooperated on difficult cases Apparently the ill often went back and forth between the two types of healers looking for a cure 1/8/2025 43  Cont. ………….  In the ancient Greeks, some people went to a temple of the god, Asklepios, where they would sleep the whole night with the hope of being visited during the night by the god or his daughter, Hygeia, who carried a magical serpent (snake) and a bowl of healing medicine 1/8/2025 44 Cont. …………. The bowl with a snake coiled around it is called the bowl of Hygieia with the serpent Her symbol was a serpent drinking from a bowl Scientific approach to medicine began with the ancient Greeks 1/8/2025 45  Statues Bowl of Hygieia (symbol of Pharmacy) Asclepius: god of medicine, healing, Hygieia: goddess of good health, rejuvenation & physicians cleanliness, & sanitation  Cup means drug. Snake means health. By combining them we get a healthy drugs Rod of Asclepius (symbol of Medicine) 46 Cont. …………. Hippocrates (460-377 BCE): father of medicine Proposed that disease came from natural, not supernatural causes Constructed rational explanation of illness by forging the conceptual link b/n the four elements (earth, air, fire & water) with the four governing humors of the body (black bile, yellow bile, blood and phlegm) Set criteria for diagnosis of many diseases 1/8/2025 47 Cont. …………. Theophrastus (371 – 287 BC): father of Botany Made the first great study of medicinal plants by combining information form scholars, mid wives, root diggers & traveling physicians Studied the adverse effects of plants 1/8/2025 48 Cont. ………….  Dioscorides (40 – 90 AD) Wrote ‘De Materia Medica’ Concerning medicinal plants, drugs  5 volumes 600 plants & 90 minerals Was the standard encyclopedia of drugs for 100s of years Promulgated excellent rules for collection of drugs, their storage & use 1/8/2025 49 Cont. …………. Galen (129 – 216 AD) Devised the use of drugs of the supposedly contrary nature For example; For external inflammation, cucumber, cool & wet drug was used For diseases considered as related to excess blood, bleeding agents were used 1/8/2025 50 Cont. …………. Promoted the use of poly pharmaceutical preparations (shot gun prescriptions) Administering large collection of the different drug extracts thinking that at least one could cure the illness  Described the process of creating extracts of active medicinal products from plants  Such as tinctures, fluid extracts, syrups, ointments  A class of pharmaceuticals compounded by mechanical means 1/8/2025 51 Cont. …………. Originator of the formula for cold cream, essentially similar to that known today Compilations: Antidotaria: similar to dispensatories Receptaria: more modest formularies 1/8/2025 52 Pharmacy in the Middle Ages Many advances were made Islamic civilization and Arabic pharmacy was developed Monasteries and churches became centers for healing Greek writings about medicine were translated to Arabic Works of Galen and Dioscorides was accepted by Arabs The first Pharmacy establishment in the world was in Baghdad (792 A.D) Elegant & palatable pills & syrups were started to be prepared 1/8/2025 53  Cont. ………….  Pagan temples closed and replaced by Church’s teaching  Diseases and sin have an intimate relationship  Ancient monasteries became the centers for healing both spiritual and corporal  Monks wrote classical medical texts and planted medicinal herbs and relate the healing with the will of God as their faith 1/8/2025 54 Cont. …………. Fredric II, king of Sicilies, declared the separate practice of pharmacy Public pharmacists became common in Europe Pharmacy practitioners joined together within p’cal guilds Medical schools and universities were opened:  Paris (1150): France  Oxford (1167): England  Salerno (1180): Italy 1/8/2025 55  Pharmacy in the Renaissance The beginning of the modern period It was a time for new ideas through reinterpretation of the old classical themes The old concepts of Galen regarding diseases and drugs were casted off 1/8/2025 56 Cont. …………. Valerius Cordus: a German physician, botanist, pharmacologist  Wrote “a formula book“ called dispensatorium and became a standard for the preparation of medicines in Nuremberg Considered as the first pharmacopoeia 1/8/2025 57  Cont. …………. Paracelsus Was an important advocate of chemically prepared drugs He preached the hypothesis of the “doctrine of signature” ‘Nature marks each growth …according to its curative benefit’ A belief that God had placed a sign on healing substances indicating their use against diseases 1/8/2025 58  Cont. …………. E.g. liverwort looks like liver, so it must be good for liver ailments  The geographical discoveries also contributed more to the advancement of pharmacy  E.g. guaiac, cascara sagrada, ipecac and cinchona bark were new plants form the new world  In 1820, quinine was extracted from cinchona bark which was previously come to Europe in 1640 1/8/2025 59 Cont. …………. This disproves Galen’s hypothesis as quinine relieves malarial fever but not fevers of other source Paracelsus strongly did on this, proposed the idea, a specific remedy for a disease 1/8/2025 60 Modern pharmacy There were gradual discoveries through hit and miss research.  Carl Wilhelm Scheele (1742-1786) a Swedish pharmacist- discovered chlorine, glycerin, and several organic acids( e.g., cetric acid) in the laboratory of his pharmacy shop.  Pierre Robiquet (1788-1840), a French pharmacist and phytochemist discovered codeine (analgesic) in 1832. 1/8/2025 61 Cont. ………….  Joseph Pelletier and Joseph Caventou - both French pharmacists isolated several alkaloids, notably quinine (antimalarial drug) in1820.  Friedrich Sertürner – German pharmacist extracted morphine from crude opium (Papaver somniferum) in ~1810.  Johannes Buchner (1783-1852) a pharmacist and a professor of pharmacy in Munich, discovered salicin from willow bark and nicotine from tobacco.  Rudolf Brandes a pharmacist isolated hyoscyamine in1819. 1/8/2025 62 Cont. ………….  Philipp Geiger (1787-1836) a pharmacist in collaboration with Rudolf Brandes discoverd atropine in 1835.  William Withering (1741-1799), a clinician and a botanist in England investigated digoxin from digitalis.  Paul Ehrlich (1854-1915) introduced the concept of chemotherapy.  He researched 606 chemical combinations until he found arsenical that would be effective in combating syphilies. 1/8/2025 63 Cont. …………. o Arsphenamine was patented in 1907 and achieved fame as “magic bullet” against syphilies.  Gerhardt Domagk (1895-1964), a German scientist, discovered prontosil to be effective against hemolytic streptococci( bacteria).  Penicillin in 1942 became the first antibiotic to be used in therapy. It was first observed as an inhibitor of microbial growth by Alexander Fleming at St. Mary’s hospital in London in 1928. 1/8/2025 64 Cont. …………. Later Howard Florey (1898-1968) and his coworkers succeded in first isolating and then making available this lifesaving antibiotic to treat Gram-positive bacterial infection. 1/8/2025 65 Industrialization era  The development of manufacturing pharmacy began.  Rapid mass production of medicines followed.  Physicians shifted away from prescribing complex mixture of ingredients toward ready-made, single-entity medicines.  The mass production of medicines at industry reduced prescriptions compounded at pharmacy. 1/8/2025 66 The Emergence of Clinical Pharmacy  Overburdened by patient loads and explosion of new drugs, physicians turned to pharmacists more and more for drug information, especially within institutional settings.  Pharmacists began to take a more hands on role in dispensing medications and patient education. Drug related problems such as allergic reactions, multiple drug interactions with other drugs, and food increased the therapeutic duties of pharmacists in patient care at pharmacies and hospitals. 1/8/2025 67 Pharmacy Developments Summary 68 History of Drugs and Dosage Forms  Objectives  Up on completion of the session you will be able to:  Define drugs  Understand functions of drugs  Know sources of ancient drugs  Understand ancient dosage forms 1/8/2025 70  History of Drugs and Dosage Forms  A drug is defined as an agent intended for use in the diagnosis, mitigation, treatment, cure, or prevention of disease in humans or other animals.  Drugs are used for treatment of common bacterial and fungal infections, AIDS, tuberculosis, malaria, diabetes mellitus, etc.  They can replenish a body deficient in vitamins, hormones, electrolytes, etc. Cont. ………….  They may be used to reduce pain, fever, lack of sleep, gastric acidity, etc.  Drugs, in the form of vegetation and minerals, have existed as long as humans.  From experience, early humans learnt that certain agents were more effective than others, and from these beginning the practice of drug therapy was came. Cont. ………….  The Ebers papyrus which dating to the 1550 BC indicated more than 700 drugs used by the Egyptians.  The drugs were chiefly botanicals, although mineral and animal drugs are also noted.  Botanical substances such as acacia, castor bean, fennel and minerals such as iron oxide, sodium carbonate, sodium chloride and sulphur. Animal excrements were also used in drug therapy.  The vehicles of the day were mostly beer, wine, milk, and honey.  Cont. ………….  The Egyptians commonly used mortar and pestles, hand mills, sieves, and balances in their compounding of suppositories, gargles, pills, inhalations, troches(lozenges), lotions, ointments, plasters, and enemas. Mortar and Pestle  Cont. ………….  Among the drugs mentioned by Discorides in his Materia Medica include opium, ergot, and hyoscyamus up to the 16th century, most drugs were derived from plants and were made into preparations called galenicals, after the great central figure of Claudius Galen (131–201 AD).  Galenicals are pharmaceutical preparations obtained by macerating or percolating crude drugs with alcohol or some other menstruum to remove only the desired principles and leave the inert constituents undissolved. Cont. ………….  Examples of galenicals include decoctions, extracts, infusions, tinctures, etc.  Goal of medicine preparers since Galen’s time has been to create dosage forms that are stable, free from inert materials, therapeutically efficacious, and easy for handling and administration.  At the beginning of the 19th century many pure drugs were discovered from plant sources such as quinine, morphine, atropine, codeine, etc. Cont. ………….  In the 20th century, many important drugs from animal kingdom such as hormones and vitamins were discovered.  Penicillin, the first antibiotic, was also discovered during this period and this stimulated many researchers to focus on microorganisms as source of drugs.  The advent of biotechnology in the 21st century helped in the production of protein and peptide drugs. Dosage Forms  Pharmaceutical Preparations: Drugs intended for human or veterinary use, presented in their finished dosage form.  Dosage form: Completed forms of the pharmaceutical preparation in which prescribed doses of medication are included.  They are designed to resist action by gastric fluids, prevent vomiting and nausea,….. 1/8/2025 78  Types of Dosage Forms Definition: Dosage forms are the means by which drug molecules are delivered to sites of action within the body. The need for dosage forms: 1- Accurate dose. 2- Protection e.g. coated tablets, sealed ampules. 3- Protection from gastric juice. 1/8/2025 79 Cont. ……………….. 4- Masking taste and odour. 5- Placement of drugs within body tissues. 6- Sustained release medication. 7- Optimal drug action. 8- Insertion of drugs into body cavities (e.g rectal) 1/8/2025 80 Cont. ……………….. Route of administration oPhysical form  Oral Solid  Topical  Rectal Semisolid  Parenteral liquid  Vaginal  Inhaled  Ophthalmic  Otic 1/8/2025 81  Cont. ……………….. 1.Tablets  A tablet is a hard, compressed medication in round, oval or square shape.  The excipients include: - Binders, glidants (flow aids) and lubricants to ensure efficient tableting. - Disintegrants to ensure that the tablet breaks up in the digestive tract. - Sweeteners or flavours to mask the taste of bad-tasting active ingredients. - Pigments to make uncoated tablets visually attractive.. 1/8/2025 82 Cont. ………………..  A coating may be applied to: 1- hide the taste of the tablet's components. 2- make the tablet smoother and easier to swallow. 3- make it more resistant to the environment. 4- extending its shelf life. 1/8/2025 83 Cont. ……………….. A-Buccal and sublingual tablet:  Sublingual and buccal medications are administered by placing them in the mouth, either under the tongue (sublingual) or between the gum and the cheek (buccal).  The medications dissolve rapidly and are absorbed through the mucous membranes of the mouth, where they enter into the bloodstream. 1/8/2025 84 Cont. ……………….. Avoid the acid and enzymatic environment of the stomach and the drug metabolizing enzymes of the liver. Examples of drugs administered by this route: e.g. vasodilators, steroidal hormones. 1/8/2025 85  Cont. ……………….. B-Effervescent Tablet:  Effervescent tablets are uncoated tablets that generally contain acid substances (citric and tartaric acids) and carbonates or bicarbonates which react rapidly in the presence of water by releasing carbon dioxide.  They are intended to be dissolved or dispersed in water before use providing: A- Very rapid tablet dispersion and dissolution. B- pleasant tasting carbonated drink. 1/8/2025 86 Cont. ……………….. C- Chewable tablet: - They are tablets that are chewed prior to swallowing. - They are designed for administration to children e.g. vitamin products, Mebendazole 1/8/2025 87 Cont. ……………….. D- Dental Cones: - A tablet form intended to be placed in the empty socket following a tooth extraction, for preventing the local multiplication of pathogenic bacteria associated with tooth extractions. - The cones may contain an antibiotic or antiseptic. 1/8/2025 88  Cont. ……………….. E-Pills: - Pills are oral dosage forms which consist of spherical masses prepared from one or more medicaments incorporated with inert excipients. - Pills are now rarely used. 1/8/2025 89  Cont. ……………….. 2 - Capsule: A capsule is a medication in a gelatin container. - Advantage: mask the unpleasant taste of its contents. - The two main types of capsules are: 1- hard-shelled capsules, which are normally used for dry, powdered ingredients, 2- soft-shelled capsules, primarily used for oils and for active ingredients that are dissolved or suspended in oil. 1/8/2025 90  Cont. ……………….. 3- Granules: - They are consisting of solid, dry aggregates of powder particles often supplied in single-dose sachets. - Some granules are placed on the tongue and swallowed with water, others are intended to be dissolved in water before taking. - Effervescent granules evolve carbon dioxide when added to water. 1/8/2025 91  Cont. ……………….. 4- Powder (Oral):  There are two kinds of powder intended for internal use. 1-Bulk Powders are multidose preparations consisting solid, loose, dry particles of varying degrees of fineness.  They contain 1 or more AIs, with or without excipients and, coloring agents and flavoring substances. 1/8/2025 92 Cont. ………………..  Usually contain non-potent medicaments such as antacids since the patient measures a dose by volume using a 5ml medicine spoon.  The powder is then usually dispersed in water or, in the case of effervescent powders, dissolved before taking. 2-Divided Powders are single-dose presentations of powder (for example, a small sachet) that are intended to be issued to the patient as such, to be taken in or with water. 1/8/2025 93 Cont. ……………….. 4.1. Powders for mixtures:  The mixed powders may be stored in dry form and mixture prepared by the pharmacist when required for dispensing, by suspending the powders in the appropriate vehicle. 1/8/2025 94 Cont. ……………….. 5 - Liquid preparations: a- Oral solution: Oral solutions are clear Liquid preparations for oral use containing one or more active ingredients dissolved in a suitable vehicle. b- Oral emulsion: Oral emulsions are stabilized oil-in-water dispersions, either or both phases of which may contain dissolved solids. 1/8/2025 95 Cont. ……………….. c-Oral suspension: - Oral suspensions are Liquid preparations for oral use containing one or more active ingredients suspended in a suitable vehicle. - Oral suspensions may show a sediment which is readily dispersed on shaking to give a uniform suspension which remains sufficiently stable to enable the correct dose to be delivered. 1/8/2025 96 Cont. ……………….. d- Syrup: - It is a concentrated aqueous solution of a sugar, usually sucrose. - Flavored syrups are a convenient form of masking disagreeable tastes. e- Elixir: -It is pleasantly flavored clear liquid oral preparation of potent or nauseous drugs. - The vehicle may contain a high proportion of ethanol or sucrose together with antimicrobial preservatives which confers the stability of the preparation. 1/8/2025 97 Cont. ……………….. F- Linctuses:  Linctuses are viscous, liquid oral preparations that are usually prescribed for the relief of cough.  They usually contain a high proportion of syrup and glycerol which have a demulcent effect(protective) on the membranes of the throat.  The dose volume is small (5ml) and, to prolong the demulcent action, they should be taken undiluted. 1/8/2025 98 Cont. ……………….. G-Oral drops:  Oral drops are Liquid preparations for oral use that are intended to be administered in small volumes with the aid of a suitable measuring device. They may be solutions, suspensions or emulsions. h- Mouthwashes:  Are used for oral hygiene and to treat infections of the mouth. 1/8/2025 99  Cont. ……………….. 6 - Topical dosage forms: 1- Ointments: Ointments are semi-solid, greasy preparations for application to the skin, rectum or nasal mucosa. The base is usually anhydrous and immiscible with skin secretions. Ointments may be used as emollients(softening) or to apply suspended or dissolved medicaments to the skin. 1/8/2025 100 Cont. ……………….. 2- Creams: - Creams are semi-solid emulsions, that is mixtures of oil and water. - They are divided into two types: A- oil-in-water (O/W): which are composed of small droplets of oil dispersed in a continuous aqueous phase. More comfortable and cosmetically acceptable as they are less greasy and more easily washed off using water. 1/8/2025 101 Cont. ……………….. B- water-in-oil (W/O) creams: which are composed of small droplets of water dispersed in a continuous oily phase.  Water-in-oil creams are also more moisturizing as they provide an oily barrier which reduces water loss from the stratum corneum, the outermost layer of the skin. 1/8/2025 102  Cont. ……………….. 3- Pastes: - Pastes are basically ointments into which a high percentage of insoluble solid has been added - The extraordinary amount of particulate matter stiffens the system. - Pastes are less penetrating and less macerating and less heating than ointment. 1/8/2025 103 Cont. ……………….. - Pastes make particularly good protective barrier when placed on the skin, the solid they contain can absorb and thereby neutralize certain noxious chemicals before they ever reach the skin. - Like ointments, paste forms are an unbroken relatively water impermeable film 1/8/2025 104 Cont. ……………….. - unlike ointments the film is opaque and therefore can be used as an effective sun block accordingly. - Pastes are less greasy because of the absorption of the fluid hydrocarbon fraction to the particulates. 1/8/2025 105 Cont. ………………..  There are two types of paste: a) Fatty pastes (e.g: leaser's paste). b) Non-greasy pastes (e g: - bassorin paste). 4- Dusting powders: - These are free flowing very fine powders for external use. - Not for use on open wounds unless the powders are sterilized. 1/8/2025 106  Cont. ……………….. 4 - Transdermal Patch:  A transdermal patch or skin patch is a medicated adhesive patch that is placed on the skin to deliver a specific dose of medication through the skin and into the bloodstream.  An advantage of a transdermal drug delivery route over other types such as oral, topical, etc. is that it provides a controlled release of the medicament into the patient.  The first commercially available patch was scopolamine for motion sickness 1/8/2025 107 Cont. ……………….. 5-Plasters: - Plasters are solid or semisolid masses adhere to the skin and they are mainly used to, A- Afford protection and mechanical support. B- Furnish an occlusive and macerating action. C- Bring medication into close contact with the surface of the skin. 1/8/2025 108  Cont. ……………….. 6- Collodion: Collodion is a solution of nitrocellulose in acetone, sometimes with the addition of alcohols. It is highly flammable. As the solvent evaporates, it dries to a celluloid-like film. Compound Wart Remover consists of acetic acid and salicylic acid in an acetone collodion base used in Treatment of warts by keratolysis. 1/8/2025 109 Cont. ……………….. 7- Paints: - Paints are liquids for application to the skin or mucous membranes. - Skin paints contain volatile solvent that evaporates quickly to leave a dry resinous film of medicament. - Throat paints are more viscous due to a high content of glycerol, designed to prolong contact of the medicament with the affected site. 1/8/2025 110 Cont. ……………….. 7- Pressurized Dispensers (Aerosol Sprays): - Several different types of pharmaceutical product may be packaged in pressurized dispensers, known as aerosols. - Surface sprays produce droplets of ≥100 um diameter. - May be used as surface disinfectants, wound or burn dressing, relieve irritation of bites. - Spray-on dusting powders are also available from pressurized containers. 1/8/2025 111 Cont. ……………….. 8.Rectal Dosage Forms: 1- Suppository:  It is a small solid medicated mass, usually cone-shaped ,that is inserted either into the rectum (rectal suppository), sexual organ(vaginal suppository or pessaries) where it melts at body temperature. 1/8/2025 112 Cont. ……………….. 2- Enema: An enema is the procedure of introducing liquids into the rectum and colon via the anus. Types of enema: 1- Evacuant enema: used as a bowel stimulant to treat constipation. E.g. soft soap enema & Mgso4 enema -The volume of evacuant enemas may reach up to 2 liters. -They should be warmed to body temperature before administration. 1/8/2025 113 Cont. ……………….. 2- Retention enema: - Their volume does not exceed 100 ml. - No warming needed. - May exert: A- Local effect: e.g. a barium enema is used as a contrast substance in the radiological imaging of the bowel. B- Systemic effect: e.g. the administration of substances into the bloodstream. This may be done in situations where it is impossible to deliver a medication by mouth, such as antiemetics. e.g. nutrient enema which contains carbohydrates, vitamins & minerals. 1/8/2025 114 Cont. ……………….. 9. Parenteral Dosage Forms: An injection is an infusion method of putting liquid into the body, usually with a hollow needle and a syringe which is pierced through the skin to a sufficient depth for the material to be forced into the body. There are several methods of injection, including: 1-An intravenous injection: It is a liquid administered directly into the bloodstream via a vein. It is advantageous when a rapid onset of action is needed. 1/8/2025 115 Cont. ……………….. 2- Intramuscular Injection: -It is the injection of a substance directly into a muscle. - Many vaccines are administered intramuscularly. - Depending on the chemical properties of the drug, the medication may either be absorbed fairly quickly or more gradually. 1/8/2025 116 Cont. ……………….. Injection fibrosis is a complication that may occur if the injections are delivered with great frequency or with improper technique. 1/8/2025 117 Cont. ……………….. 3-Subcutaneous Injection Subcutaneous injections are given by injecting a fluid into the subcutis  layer of skin directly below the dermis and epidermis. Subcutaneous injections are highly effective in administering vaccines and such medications as insulin. 1/8/2025 118 Cont. ……………….. 10. Inhaled Dosage Forms: 1- Inhaler: - Inhalers are solutions, suspensions or emulsion of drugs in a mixture of inert propellants(gas) held under pressure in an aerosol dispenser. - Release of a dose of the medicament in the form of droplets of 50 μm diameter or less from the container through a spring-loaded valve incorporating a metering device. 1/8/2025 119 Cont. ……………….. - The patient then inhales the released drug through a mouthpiece. - In some types, the valve is actuated by finger pressure, in other types the valve is actuated by the patient breathing in through the mouthpiece. - It is commonly used to treat asthma and other respiratory problems. 1/8/2025 120 Cont. ……………….. 2- Nebulizer or (Atomizer):  A nebulizer is a device used to administer medication to people in forms of a liquid mist to the airways.  It is commonly used in treating asthma, and other respiratory diseases.  It pumps air or oxygen through a liquid medicine to turn it into a vapor, which is then inhaled by the patient. 1/8/2025 121 1/8/2025 122 1/8/2025 123 Cont. ……………….. - As a general rule, doctors generally prefer to prescribe inhalers for their patients, because: 1-These are cheaper 2- more portable 3- carry less risk of side effects. Nebulizers, for that reason, are usually reserved only for serious cases of respiratory disease, or severe attacks. 1/8/2025 124 Cont. ……………….. 11. Ophthalmic Dosage Forms: 1- Eye drops: Eye drops are saline-containing drops used as a vehicle to administer medication in the eye. Depending on the condition being treated, they may contain steroids, antihistamines or topical anesthetics. Eye drops sometimes do not have medications in them and are only lubricating and tear-replacing solutions. 1/8/2025 125 Cont. ……………….. 2- Ophthalmic ointment & gel:  These are sterile semi-solid Preparations intended for application to the conjunctiva or eyelid margin. 1/8/2025 126 Cont. ……………….. 12. Otic Dosage Forms: 1- Ear drops: - Ear drops are solutions, suspensions or emulsions of drugs that are instilled into the ear with a dropper. - It is used to treat or prevent ear infections, especially infections of the outer ear and ear canal. 1/8/2025 127 Cont. ……………….. 13. Nasal Dosage Forms: 1- Nasal Drops and Sprays: Drugs in solution may be instilled into the nose from a dropper or from a plastic squeeze bottle. The drug may have a local effect, e.g. antihistamine, decongestants. Alternatively the drug may be absorbed through the nasal mucosa to exert a systemic effect. 1/8/2025 128 Cont. ……………….. The use of oily nasal drops should be avoided because of possible damage to the cilia of the nasal mucosa. 1/8/2025 129 Cont. ……………….. 14. Intermediate Products Used in Compounding: Extracts: These are concentrated preparations containing the active principals of vegetable or animal drugs which have been extracted with suitable solvents and concentrated to form liquid, soft or dry extract. Glycerin: These are solutions of medicaments in glycerol with or without the addition of water. 1/8/2025 130 Cont. ……………….. Infusions: These are dilute solutions containing the readily soluble constituents of crude drugs and prepared by diluting 1 part of concentrated infusion with 10 parts of water. Concentrated infusions are prepared by cold extraction of crude drugs with 25% ethanol. Oxymels: These are preparations in which the vehicle is a mixture of acetic acid and honey. 1/8/2025 131 Cont. ……………….. Spirits: They are alcoholic or aqueous alcoholic solutions of volatile substances used as flavoring agents. Tinctures: These are alcoholic preparations containing the active principals of vegetable drugs. They are relatively weak compared to extracts. Aromatic waters: These are aqueous solutions, usually saturated of volatile oils or other volatile substances. Used as flavoring agents. 1/8/2025 132  Commonly Used Pharmaceutical & Medical Terminologies 1/8/2025 133  Pharmaceutical Terminologies Pharmacy; derived from Greek word pharmakon (drug). The art and science of preparing and dispensing medications and the provision of drug-related information to the public Drug; any substance intended for use in the diagnosis, cure, mitigation, treatment, or prevention of diseases in humans or animals;  Any substances (other than food) intended to affect the structure or any function of the body of humans or animals 1/8/2025 134 Cont. ………………. A drug entity has several types of names. It can be expressed by its chemical name, its empirical formula, its generic name or one of its brand names. The chemical name and the empirical formula are useful to chemists, but are too confusing for most other people. Drugs are usually referred to by their common (generic) name or by the brand (trade) names assigned to them by the companies that make them. 1/8/2025 135 Cont. ………………. The generic name is owned by no person or company. An international naming organization assigns generic names based on criteria it has selected for naming drugs that belong to certain chemical families. Brand names are names given to the generic entity by the company that manufactures it. 1/8/2025 136 Cont. ………………. The brand name is proprietary, and no one but the company who registered it as a Trademark (denoted by the symbol ®) can use it. E.g 1/8/2025 137 Cont. ………………. Acetaminophen (Generic name) Panadol (Brand name) C8H9NO2 (empirical formula) N-(4-Hydroxyphenyl)acetamide(chemical name) Drug Vs Medicine Vs pharmaceutical? Drug: there is no single, precise definition, as there are different meanings 1/8/2025 138 Cont. ………………. In pharmacology, a drug is a chemical substance used in a) The treatment b)Cure c) Prevention d)Diagnosis of disease Drug types; 1. Medication 2. Recreational drugs 3. Spiritual drugs (have hallucinating effect) 1/8/2025 139 Cont. ………………. Medicine; A medication or medicine is a drug taken to cure and/or meliorate any symptoms of an illness or medical condition, or may be used as preventive medicine that has future benefits but does not treat any existing or pre-existing diseases or symptoms. Pharmaceuticals; includes drugs, medicines, vitamins, and oral rehydration salts (ORS) 1/8/2025 140 Cont. ………………. oPharmacist; a person licensed to prepare, compound, and dispense drugs upon written order (prescription) from a licensed practitioner such as a physician, dentist and veterinarians. A pharmacist is a health care professional who cooperates with, consults, and sometimes advises the licensed practitioner concerning drugs. 1/8/2025 141 Latin Terms and Abbreviations  The use of abbreviations is common on prescriptions. Some are derived from the Latin through its historical use in pharmacy and medicine. Whereas, others have evolved through prescribers’ use of writing shortcuts. 1/8/2025 142  Terms Related to Quantities Abbreviation Latin term English meaning aa ana Of each ad ad Up to; to make No. numero number q.s. Quantum A sufficient quantity sufficiat q.s.ad Quantum A sufficient quantity to make sufficiat ad tsp. teaspoonful tbsp. tablespoonful 1/8/2025 143  Terms Related to Drug Administration Time Abbreviation Latin term English meaning q quaque every qd (q.d.) quaque die Once a day bid (b.i.d.) bis in die Twice a day tid (t.i.d.) ter in die Three times a day qid (q.i.d.) quarter in die Four times a day A.M. ante meridium Morning P.M. post meridium Afternoon; evening h. (hr.) hora Hour h.s. Hora somni At bedtime ante ante Before 1/8/2025 144  Cont. ……….. Abbreviation Latin term English meaning a.c. ante cibos Before meals p.c. post cibos After meals i.c. Inter cibos Between meals noct. nocte Night m&n Morning and night qAM Every morning p.r.n pro re nata When necessary; if needed 1/8/2025 145 Cont. ……….. Abbreviation Latin term English meaning q.h. quaque hora Every hour q2h quaque secunda hora Every two hours q4h quaque quarta hora Every four hours q6h quaque sex hora Every six hours q8h quaque octo hora Every eight hours qod Every other day 1/8/2025 146 Terms Related to Routes of Drug Administration Abbreviation Latin term English meaning po per os by mouth (orally) a.d. aura dextri Right ear a.s. aura sinster Left ear au Each ear o.d ocula dextri Right eye o.s ocula sinster Left eye ou Each eye rect. Rectally 1/8/2025 147  Terms Related to Dosage Forms Abbreviation Latin term English meaning amp. Ampul Ampule aurist. Auristillae Ear drops cap. Capsula Capsule collun. Collunarium Nose wash collut. Collutorium Mouth wash co. Compositus Compound crem Cremor Cream garg Gargarisma Gargle gtt Guttae Drops 1/8/2025 148 Cont. ……….. Abbreviation Latin term English meaning inj. Injecto Injection sol. solutio Solution lot. Lotio Lotion mist. Mistura Mixture narist Naristillae Nose drops Neb. Nebula Spray solution oculent Oculentum Eye ointment past. Pasta Paste pil. Pilula pill pulv. Pulvis powder 1/8/2025 149 Cont. ……….. Abbreviation Latin term English meaning pulv. consp. Pulvis conspersus Dusting powder supp. Suppositorium Suppository susp. Suspension troch. Trochiscus Lozenge ung. Unguentum Ointment vap. Vapor Inhalation syr. syrupus syrup tab. tabletta tablet 1/8/2025 150 Instructions for Preparations & Applications Abbreviation Latin term English meaning M. mice mix div. dividatur divide Non.Rep(N.R.) Do not repeat ft fiat make applic. applicandus to be applied 151 p.a. parti affectae to the affected part part.dolent. parti dolente to the painful part ut dict. ut dictum as directed d.t.d. dentur tales doses give of such doses 1/8/2025  Abbreviations Related to Disease Abbreviations Meaning BM Bowl movement BP Blood pressure BS Blood sugar BPH Benign prostatic hypertrophy CAD Coronary artery disease CHF Congestive heart failure COPD Chronic obstructive pulmonary diseases CP Chest pain 1/8/2025 152 Cont. ……….. Abbreviations Meaning DJD Degenerative joint disease DM Diabetes mellitus GERD Gastro Esophageal reflux disease GI Gastro intestinal GU Genito urinary HA Headache HBP High blood pressure HR Heart rate HRT Hormonal replacement therapy 1/8/2025 153 Cont. ……….. Abbreviations Meaning HTN Hypertension JRA Juvenile rheumatoid arthritis N&V Nausea and vomiting OA osteoarthritis OCD Obsessive compulsive disorder PEFR Peak expiratory flow rate Postop. After surgery PVCs Premature ventricular contractions 1/8/2025 154 Cont. ……….. Abbreviations Meaning PVD Peripheral vascular disease RA Rheumatoid arthritis SLE Systemic lupus erythematosus SOB Shortness of breath SX Symptom TB Tuberculosis TED Thromboembolic disease TIA Transient ischemic attack 1/8/2025 155 Cont. ……….. Abbreviations Meaning UA Uric acid, urinalysis UC Ulcerative colitis URI Upper respiratory infection UTI Urinary tract infection 1/8/2025 156  Other Terms Abbreviation Latin term English meaning c. cum with conc. concentratus concentrated dist. distillatus distilled dil. dilutes diluted dup. duplex double ex aq. ex aqua in water fort. fortis strong et and 1/8/2025 157 Cont. ……….. Abbreviation Latin term English meaning mitt. mitte send Rx recipe Take sec.art. secundum artem with pharmaceutical skill s.o.s si opus sit If there is need sig. (signa) signatura write on label stat. statim immediately ad lib. ad libitum at pleasure, freely 1/8/2025 158 Treatment Related Terminologies Examples; Contraindication; any condition which renders a particular line of treatment improper or undesirable. e.g Tetracycline –pregnant, children. Side effect; A side effect is an expected and known effect of a drug that is not the intended therapeutic outcome. Allergy; is an adverse drug reaction mediated by an immune response (e.g., rash, hives). 1/8/2025 159 Cont. ………………. Compound words  A combining vowel is used to link a stem word to another stem word to another one for a compound word such as: Gastr + o + enter + itis = gastroenteritis (stomach) (intestine) (inflammation) Oste + o + arthr + itis = osteoarthritis (bone) (joint) (inflammation) 1/8/2025 160 Cont. ………………. Suffix  A suffix is a word ending. Changing the suffix gives medical words a new meaning.  Usually indicates a procedure, condition, disorder or disease.  Most suffixes are derived from Greek or Latin words. 1/8/2025 161  Surgical Terms  Enterotomy  Tomy – cut or incision  Appendectomy  Gastrorrhaphy  Rhaphy- sewing  Cystoplasty (bladder augmentation)  Plasty – molding/repair  Steatorrhea (excretion of  Rhea - discharge fat with faeces) 1/8/2025 162 Cont. ……………….  Nephrotomy  Incision of the kidney  Gastroplasty  Surgical operation for morbid obesity that changes the shape of the stomach  Colporrhaphy  surgical repair of a defect in the vaginal wall  Removal/cutting of appendix  Appendectomy 1/8/2025 163  Cont. ……………….  Arthr/o + centesis = arthrocentesis (joint) (puncture)  Thorac/o + -tomy = thoracotomy (chest) (incision)  Gastro/o + -megaly = gastromegaly (stomach) (enlargement)  Colon/o + -scopy = colonoscopy (colon) (see/search) 1/8/2025 164 Disease/Change in Body/Used for Diagnoses  Hepatitis: hepa - liver; itis- inflammation of  Splenomegaly: Spleno – spleen; megaly-large  Acrophobia: acro – edge; phobia- fear of=(fear of heights)  Artheriosclerosis: atherio-artery; sclerosis-hardening of  Cardiogram: cardio-heart; gram - record or write  Laparoscopy: laparo-abdomen; scopy- to look in or search 1/8/2025 165 Cont. ……………….  Prefixes: A prefix is a word element located at the beginning of a word.  Prefixes can alter the meaning of the word.  Usually indicates a number, time, position, direction, color, or sense of negation. 1/8/2025 166 Cont. ……………….  Peri + cardio + logy = pericardiology (around) (heart-pericardium) (study of)  Hyper + therm + -ia = hyperthermia (excessive) ( heat) (condition)  Intra + muscul + -ar = intramuscular (in, within) (muscle) (relating to)  Macro + gloss + -ia = macroglossia (large - enlargement) (tongue) (condition) 1/8/2025 167 Examples of prescription directions to the pharmacist (subscription)  M.et ft. ung.  Mix and make an ointment.  Ft. supp. no xii  Make 12 suppositories.  M. et ft. cap. d.t.d. no. xxiv  Mix and make capsules. Give 24 such doses. 1/8/2025 168 Examples of prescription directions to the patient (signa):  Caps. i. q.i.d. p.c. et h.s.  Take one (1) capsule four (4) times a day after each meal and at bedtime.  gtt. ii o.d. every a.m.  Instill two (2) drops in the right eye every morning.  tab. ii stat. tab. 1 q6h.x 7 d.  Take two (2) tablets immediately, then take one (1) tablet every 6 hours for 7 days.  Propranolol HCl 10 mg p.o. t.i.d. a.c & h.s  Take Propranolol HCl 10 mg by mouth three times a day before food and at bed time. 1/8/2025 169 Introduction to Pharmacy Practices Community Pharmacy  Introduction Community pharmacy is a retail pharmacy where drugs are dispensed to the general public. Community pharmacy is the place where most pharmacists practice the profession of pharmacy. In addition to community pharmacy, the general public may get drugs from drug store (“Medhanit Medebir”), and rural drug vendor (“Yegeter medhanit bet”. 1/8/2025 172  Cont. ……………  In Ethiopia, all licensed private pharmacies, drug stores, and rural drug vendors are required to work under the technical leadership of registered pharmacists, druggists, and pharmacy technicians, respectively.  Previously, nurses and health assistants were eligible to obtain a license and are still working particularly in rural drug vendors. 1/8/2025 173 Cont. …………… Most types of medicines may be available in pharmacy compared to drug store and less types of medicines may be available in rural drug vendor than in drug store. All pharmacies are required to have a pharmacist on duty at all times when open. In Ethiopia, community pharmacy may be owned by the public, privately, or local non – governmental organizations (NGOs). 1/8/2025 174 Cont. ……………  Community pharmacies have major rooms for dispensing, storing, compounding medicines, and counseling clients.  The dispensing environment should possess:  Appropriate temperature  Sufficient lighting  Optimum humidity control  Cold storage facilities 1/8/2025 175 Cont. …………… Adequate number and type of shelves Lockable cabinet for narcotic medicines, psychotropic substances and poisons Patient or care provider waiting area  Dispensing aids, etc 1/8/2025 176  Role of Community Pharmacist  Distribution and control of medication  The classical paradigm in community pharmacy was that the community pharmacist must assess all of the following: Appropriateness of dose for a particular patient Patient allergy to the medication or similar medication Potential interactions with other prescribed and non – prescription medications Contraindications of the medication with other known diseases the patient may have 1/8/2025 177 Cont. …………… o Appropriate dose scheduling to maximize effect and minimize adverse events o Appropriateness of this medication for this patient for his/her health condition o The pharmacist also is, and has been, required to: Assure accuracy of dispensing and labeling Provide the patient with information on proper storage of the medication Advise the patient on potential risks and benefits Advise the patient on how to deal with missed doses 1/8/2025 178  Cont. ……………  Preparation of compounded pharmaceuticals  The vast majority of prescriptions dispensed are for dosage forms manufactured by drug regulatory body approved manufacturers. These standardized dosages meet the needs of most patients and are produced under the Good Manufacturing Practices established by drug regulatory body. 1/8/2025 179 Cont. …………… Many patients, however, need custom-made dosages to solve specific problems. For these unique needs community pharmacists offer specialized compounding services. Patients may need extremely small doses for pediatric or geriatric use. 1/8/2025 180 Cont. …………… They may also need preservative-free products, liquids with special flavors or delivery systems that are not commercially available. Additionally some medications may not have sufficient shelf life to withstand the commercial distribution process and therefore need to be prepared at the time of dispensing. 1/8/2025 181  Arrangement of Medicines  Medicine are arranged on shelves made of steel or treated wood.  Medicines can be arranged using one or a combination of the following commonly used methods of medicine arrangement:  Pharmacotherapeutic category  Alphabetical order by generic name  Dosage forms 1/8/2025 182  Storage Conditions  Storage conditions can be arranged in two classes: 1. Normal storage conditions 2. Special storage conditions Cold storage conditions (eg, vaccines, insulin, etc) Combustible /flammable (eg, alcohol, ether, etc) Secured (eg, narcotic drugs, psychotropic drugs, and their documents). 1/8/2025 183  Dispensing Process Dispensing refers to the process of preparing medicines and distributing to users with provision of an appropriate information, counseling and follow – up. 1/8/2025 184 Cont. …………… 1/8/2025 185 Cont. ……………  Receiving the prescription  It is desirable that the patient present the prescription order directly to the pharmacist because this enhance the pharmacist – patient relationship and facilitates the gathering of essential disease and drug information from the patient.  Evaluation and interpretation of prescription  The prescription order should be read completely and carefully. 1/8/2025 186  Cont. ……………  There should be no doubt as to the ingredients or quantities prescribed.  The pharmacist should determine the compatibility of the newly prescribed medication with other drugs being taken by the patient and also consider if any drug – food or drug – disease interaction may exist.  If something is illegal or if it appears that an error has been made, the pharmacist should consult another pharmacist or prescriber. “NEVER DISPENSE GUESS WORK” 1/8/2025 187  Cont. ……………  A pharmacist should never guess at the meaning of an indistinct word or unrecognized abbreviations.  Unfamiliar or unclear abbreviations represent a source of error in interpreting and dispensing prescriptions.  Pharmacists are frequently confronted in their interpretation of the prescription order with the names of drugs that look alike or sound alike.  These similar names are a potential source of error. 1/8/2025 188  Cont. ……………  Knowledge of patient’s medical problems and diagnosis can often provide the pharmacist with insight into which of the look-like or sound-like drugs is intended for the patient.  The pharmacist must take great care and use his/her broad knowledge of drug products to prevent dispensing errors.  Omissions, such as the failure to specify the desired strength of a medication or its dosage form, must be corrected. 1/8/2025 189  Cont. ……………  In such a case, the pharmacist should never elect to dispense the usual dose or dosage form but instead should consult the prescriber.  To detect such omissions and provide the physician with the necessary information, the pharmacist must be familiar with available strengths and dosage forms of prefabricated drug products.  The amount and frequency of dose must be noted carefully and checked. 1/8/2025 190  Cont. ……………  Selection and manipulation of medicines  The pharmacist should select stock container or pre- packed container by reading the label and cross matching the medicine name and strength against the prescription.  It is advisable to read the container label at least twice during dispensing process. It is also advisable not to select the prescribed medicine according to the color or location of container. 1/8/2025 191 Cont. ……………  Labeling and packaging of the medicine in an appropriate container  Medicines must be suitably contained, protected and labeled from the time of manufacture until they are used by the patient.  The containers used for dispensing must be appropriate for the product dispensed. 1/8/2025 192 Cont. …………… The container must maintain the quality, safety and stability of the medicine throughout this period. 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. 1/8/2025 193  Cont. ……………  All medicines to be dispensed should be labeled and the labels should be unambiguous, clear, legible and indelible. 1/8/2025 194 Cont. ……………  Delivery and patient counseling  The pharmacist personally should present the prescription medication to the patient or family member, or caregiver.  The prepared, packaged and labeled medicine is handed over to the right patient or care provider with appropriate medicine information. 1/8/2025 195  Cont. ……………  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) 1/8/2025 196  Cont. …………… How to store the medicine (e.g., avoid heat, light and dampness)  Not to share medicines with other persons Which types of foods and beverages should avoid while taking the medicine To keep medicines out of reach of children  One has to demonstrate to the patient on how to administer the dispensed medications in case of inhaled administration and suppository application. 1/8/2025 197 Cont. ……………  Recording and filing the prescription  After dispensing of medication prescriptions are recorded and documented as proof of transaction between the patient and the dispenser.  Prescriptions can therefore be traced back if any need arises.  For the recording of dispensed prescriptions Prescription Registration Book (computerized system) may be used. 1/8/2025 198  Cont. ……………  Various prescription file types are available to maintain original prescription orders.  Each prescription should be signed and accountability accepted by the dispenser or other authorized person for the correctness of dispensing of the medicine and confirming that the medicine was supplied.  At the close of each day all dispensed prescriptions are organized and filed sequentially by day in a single container/carton for each month. 1/8/2025 199  Hospital pharmacy  Hospital pharmacy is defined as a department or division of a hospital where in the procurement (purchase), storage, extemporaneous preparations, IV admixtures, dispensing, and distribution of medications are performed by legally qualified, professionally competent pharmacists and their assistants. 1/8/2025 200  Role of Hospital Pharmacist  Broad responsibility for the safe and appropriate use of medications, which includes, among other things, the rational selection, dosing, and monitoring of the patients’ overall medication therapy.  Pharmacists work with various departments to assure the safe, efficient, and cost – appropriate distribution and use of medications with physicians, nurses, and other health care professionals to care for patients. 1/8/2025 201  Cont. ……………  Chief of hospital pharmacy is member of Drug and therapeutics committee (DTC).  The DTC is a committee of the medical staff and is chaired by a physician while the chief of pharmacy commonly functions as secretary.  Typically, it includes representation from medical staff specialties, pharmacy, nursing, quality, laboratory, and other pertinent departments. 1/8/2025 202 Cont. ……………  Historically, some have thought that the sole purpose of DTC was to develop a formulary and a formulary system.  However, the function of this committee include policy development and governance of the medication use process.  Thus, the role is much broader than the formulary system. 1/8/2025 203  Cont. ……………  Another significant activity of the committee is performing Drug Usage Reviews (Drug Usage Evaluations).  The DTC determines the medications or therapeutic indication to be studied, determines the appropriate medication usage criteria, collects data, evaluates actual usage data against approval criteria, and makes recommendations for improvement in the appropriate use of the medication therapy. 1/8/2025 204  Cont. ……………  In addition, the committee is responsible to monitor Adverse Drug Reactions (ADR) and medication errors, as a part of the quality assurance standards of the medical staff.  The DTC also prepares hospital formulary.  Formulary system: The formulary system and formularies have existed in US and in European hospitals for centuries. 1/8/2025 205  Cont. ……………  Hospital formulary attempt to outline scientific data on a medication, including its toxicities, untoward side effects, safety profile, beneficiary effects, and cost.  While the pharmaceutical industry promotes the virtues of a brand name medication, the formulary system evaluates the virtues and defects of that medication in comparison with other brands with similar therapeutic uses. 1/8/2025 206  Pharmacist in Industry  Pharmacists may choose many environments to practice pharmacy and to apply their knowledge and skills to the improvement of patient care.  One area is the pharmaceutical industry where major advances in patient care, research to improve patient’s lives, and education for health care professionals and patients are happening every day. 1/8/2025 207 Cont. ……………  The pharmaceutical industry is a for-profit environment.  Its goal is to bring value to its share-holders, and it does this by doing good for people. 1/8/2025 208  Cont. ……………  Vital to the mission of pharmaceutical company involved in research is the discovery of new chemical entities (NCEs), their toxicological testing, the development of these entities to dosage forms, clinical trials in humans of these investigational drugs or biologics, regulatory review and approval of these new drug products and marketing of the products for appropriate use by health care professionals and consumers. 1/8/2025 209  Cont. ……………  Pharmacists can work in the following areas of pharmaceutical industry:  Production and quality control  Research and development  Sales and marketing  Medicine information  Management and administration 1/8/2025 210  Production and Quality Control  From the very beginning pharmacists have a say on selection of drugs, excipients, packaging materials for utilization in the pharmaceutical industry.  Pharmacists working in production often serve in managerial positions.  They supervise production process of drug products (finished dosage forms). 1/8/2025 211  Cont. ……………  The pharmacist utilize his/her knowledge and experience in counter – acting production of poor quality drug products.  For instance, during tablet production process, the following problems may be encountered:  Production of very hard or soft tablets which do not fulfill pharmacopeia requirements. 1/8/2025 212  Cont. ……………  production of tablets with varying weight, thickness, drug content, abraded surfaces, color, etc.  Pharmacists working in quality control department,  Check qualities of imported drugs, excipients, packaging materials, etc Check quality of water, air Ensure quality of dosage forms during production process 1/8/2025 213  Cont. ……………  Ensure end product qualities before release to the market  Research and development (R&D)  In research and development department of pharmaceutical industry, the following activities are performed. 1/8/2025 214  Cont. ……………  Drug discovery - This is the identification of a lead compound with a sufficient combination of potency and selectivity, as defined by specific biological tests in animals, for it to have the potential to become a new medicine. 1/8/2025 215  Cont. ……………  Drug development : this encompass complex activities required to convert a drug into a marketable medicine, which is safe and effective in human  Some of the activities done in development phase include:  Formulation of dosage forms  Development of stability indicating analytical methods  Scale – up of manufacturing procedures from lab scale to large scale production 1/8/2025 216  Cont. …………… Medicine Information  Health care providers recognize that the pharmaceutical company knows the most about its products.  Medicine information department is responsible to provide information about the safe and effective use of the company’s medicines in response to enquires from members of the medical, pharmaceutical, and other health care professionals. 1/8/2025 217  Cont. ……………  Although previously staffed by physicians, these area has been a primary entrance position for clinical pharmacists in industry since 1980s. 1/8/2025 218  Cont. …………… Industrial Sales The sales area is one of the ways for pharmacists to get into the pharmaceutical industry. The sales representative (professional sales specialist) usually call upon pharmacists, physicians, nurses, in some cases dentists and veterinarians with details on the products of their company. 1/8/2025 219 Cont. …………… The objective of these calls is to provide the various professional audiences with enough comprehensive information on a product to encourage the product’s appropriate use by the health care providers.  Many companies prefer that candidates for a sales position have a science background, and thus they favor applications with pharmacy training. 1/8/2025 220 Cont. ……………  Equally important is the personal traits and attitude of the applicant, such as a congenial personality, effective oral communication skills, and a strong interest in selling. 1/8/2025 221 Cont. …………… Management and Administration As pharmacists in the industry perform successfully at their position, they move up within the department and within company to positions in management and administration. Here they ensure that the department functions smoothly and achieves its objectives. 1/8/2025 222 Cont. ……………  Many of the people in management positions in the industry began their careers at entry level positions and learned the organization from the inside.  Qualities of discipline, hard work, and dedication go along way in helping a pharmacist advance into a management position. 1/8/2025 223  Pharmacists in Regulatory Body  Pharmacists also being employed to work in regulatory bodies such as Ethiopian, Food and Drug Administration Authority (FDA).  Along with other health professionals they supervise health institutions, medicine retail outlets, pharmaceutical manufacturers, Medicine and medical equipments importers, dietary product importers, dietary manufacturers  Issue and renew license of health care professionals 1/8/2025 224  Cont. ……………  Issue and renew a license for health institutions, medicine retail outlets, pharmaceutical manufacturers, Medicine and medical equipments importers, dietary product importers, dietary manufacturers.  Ensure safety and quality of foods  Ensure safety, efficacy, quality, and appropriate use of medicines  Ensure hygiene and environmental health protection suitability for individual and community health. 1/8/2025 225  Pharmacist in Research  In Ethiopia, the proportion of pharmacists working in research areas is very less compared to other areas.  Research institutes such as Ethiopian Public Health Institute employee few pharmacists to work as researchers. 1/8/2025 226  Pharmacists in Academic Area  Currently nine public universities, some regional health colleges, and private colleges train pharmacy professionals  Most of them employ graduate pharmacists willing to work in the academic area. 1/8/2025 227  Pharmacist Role in the Health Care Delivery  The pharmacy professional has a crucial function in the health care system in:  Availing medicines with acceptable quality, safety, & efficacy  Managing stock of medicines in the dispensary  Dispensing of medicines with required information and follow up  Keeping records of patients and dispensed medicines 1/8/2025 228  Cont. ……………  Providing drug information to patients and other health professionals  Participating in the therapy teams to suggest recommendations on: Treatment choices ,dosages ,drug interactions, untreated conditions, etc Monitoring of drug use practice in the institution Ensuring compliance with treatment guidelines 1/8/2025 229  Pharmacy Practice in Ethiopia 1/8/2025 230  Objectives  Early pharmacy and medical practices  Pharmacy practice on the eve of Italian occupation  Pharmacy practice during the Italian occupation (1935- 1941)  Pharmacy practice after independence  Development of modern pharmacy Education in Ethiopia  Development of pharmacy law and regulations Early pharmacy and medical practices  Modern medicine was introduced during the time of Emperor Libne Dingle (1508-1540).  Ever since (until 1935) all white men (the ferenjis) were considered to be physicians (Hakims).  Many travelers to Ethiopia such as, James Bruce, who had no formal medical training, freely distributed drugs to the population. 1/8/2025 232  Cont. ………….  Such pseudophysicians prescribed Epsom salts for almost all intestinal diseases and an emetic ipecacuanha for all diseases in the thoracic cavity.  In addition to these, it was customary in those days for foreign merchants with no medical knowledge to sell drugs in their shops. 1/8/2025 233 Cont. ………….  The 1st retail pharmacy in the country-Pharmacie Le George - opened in 1910, by a French citizen Dr. Merab.  The 2nd retail pharmacy in the country- Pharmacy St. George- opened in 1914, by Walter Zahn (popularly known as “tirse worku Hakim” (the golden-toothed doctor). 1/8/2025 234  Pharmacy practice on the eve of Italian occupation  About six pharmacies in the capital  All were foreigners owned  Concentrated around Zahn’s pharmacy  No trained Ethiopian pharmacy practitioners  Except assistants to foreign pharmacists: Zahn by German speaking-Gebrekidan and Wolde Hawariat 1/8/2025 235  Cont. ………….  An illiterate Ethiopian “pharmacist”, Solla Dachasa, working in the pharmacy of Menelik II Hospital and was allegedly able to identify any drug or chemical on the shelf by its physical characteristics, is widely reported. 1/8/2025 236  Pharmacy practice during the Italian occupation (1935-1941)  All pharmacies were made to work under the regulations of Italian government.  The Italians had organized medical stores at all places they reached such as  central medical store (Gullele) and  branches at Jimma & Gonder 1/8/2025 237  Cont. ………….  Pharmacies were opened out of Addis:  Asmara  Civil Pharmacy  Central Pharmacy  Copra Tevo Pharmacy  Harar  Fornazero pharmacy  Dire Dawa  at the site the present Ethiopian pharmacy 1/8/2025 238 Pharmacy Practice After Independence  All Italian owned pharmacies and stores were confiscated by Ethiopian government.  The Italian pharmacists were employed by the Ethiopian government to run the pharmacies. 1/8/2025 239  Development of modern Pharmacy Education in Ethiopia  The 1st successful pharmacy practitioners training program:  was conducted in 1943 in Menelik II hospital  12 students were enrolled for the training (1 April 1943-10 June1944). Subjects such as physics, organic chemistry, inorganic chemistry, anatomy, physiology, pharmacology and practical pharmacy were given. 1/8/2025 240 Cont. …………. 4 students successfully completed the training Awarded Hospital Dispensing Certificate The first attempt made towards Ethiopianization of pharmacy practitioners. 1/8/2025 241  Cont. ………….  The 2nd training program was designed to train in 1947  Pharmacy & laboratory assistants at imperial Ethiopian medical research institute  Candidates were 6th grade completed  English language test was an entrance examination 1/8/2025 242 Cont. ………….  Courses:  English language  Basic sciences: chemistry, botany, anatomy, and zoology  Professional courses: chemical pharmacy, biological pharmacy, pharmacy practice  11 students were awarded pharmacy assistants certificate in April 1948 1/8/2025 243 Cont. …………. o In 1961  School of pharmacy, AAU was founded as a unit of Faculty of Science oIn 1963, transferred to the Faculty of Medicine o1978 the school attained the status of faculty  1985  Jimma Institute of Health Sciences was established to train pharmacy technicians (diploma)  2004 – University of Gondar began diploma and degree programs 1/8/2025 244 Cont. ………….  1998 The first Master of Science training program in pharmacy, School of pharmacy, AAU (MSc in Pharmaceutics)  2009 Jimma University began master degree in clinical pharmacy.  2011 SoP, AAU began phd in pharmaceutics, phd in pharmacology, and phd in social pharmacy & pharmacoepidemology streams 1/8/2025 245  Development of pharmacy law and regulation In 1930,  The first regulation limiting the practice of pharmacy was issued as part of the first medical regulations of Ethiopia.  Was prepared by foreign physicians working in Ethiopia  No demarcation between the practice of pharmacy and medicine. 1/8/2025 246 Cont. ………….  Physicians were authorized to open and run pharmacies Some articles of pharmaceutical importance  A diploma in pharmacy was made a requirement to run a pharmacy. Presentation of a doctor’s prescription was made requirement for dispensing any drug. 1/8/2025 247 Cont. ………….  Strict instructions for the conduct of pharmacies, such as maintenance of poisons under lock, the setting of minimum standards for pharmacies, etc.  Traders, groceries, shops were forbidden to sale any medicine except castor oil and magnesium sulphate. 1/8/2025 248 Cont. …………. 1943  Registrations of practitioners (pharmacists &druggists)  No one practice pharmacy unless his/her name appear on Negarit gazeta as a person licensed. 1947  United States Pharmacopeia (USP)was adopted as official pharmacopoeia of Ethiopia 1/8/2025 249 Cont. …………. 1964 proclamation  Regulation governing importing of medicines 1993  National health policy  National drug policy 1999  Drug administration and control proclamation no. 176/1999 was promulgated 1/8/2025 250  Types of Dispensed Pharmaceutical Preparations  There are two broad legal classification of medications.  These are prescription medications and non prescription (over – the – counter) medications.  Medications that may be dispensed legally only on prescription are referred to as prescription drugs or legend drugs. 1/8/2025 251 Cont. ……….. Prescription Medications Over-the-counter (OTC) Medications Require a written Can be bought without prescription or order from a prescription physician, dentist, or nurse practitioner Prescribed for the treatment Intended for relief of minor of a specific medical aliments (e.g., headache, problem toothache, dry cough, etc) Usually more potent and Considered safe if warning have more side effects than and directions are followed OTC 1/8/2025 medications 252  Prescription  A prescription is written, verbal, or electronic order or therapeutic transaction between the prescriber and dispenser.  It is a written order by the prescriber to the dispenser on how the drug should be dispensed.  It serves as a means of communication among the prescriber, dispenser, and drug consumer pertaining to treatment or prophylaxis (prevention). 1/8/2025 253  Cont. ………..  Prescription usually are written on preprinted forms that contain blank spaces for the required information.  A written prescription may be presented at the pharmacy by the patient or caregiver, or it may be transmitted from the prescriber by telephone or internet (e-prescription). 1/8/2025 254  Prescription Formatting (1) Name & address of the health institution (2) Patient information (3) Date prescription was written (4) Rx symbol (the Superscription) meaning, ‘‘take thou,’’ ‘‘you take,’’ or ‘‘recipe’’ (5) Medication prescribed (the Inscription) (6) Dispensing directions to the