Pharmacy Orientation PDF

## Information Resources in Pharmacy **Dr. Youssef Aboshady** **Pharmacy Orientation** **MIU** **First Year** Pharmacists have a constant need for reliable and current information, and in the modern world information is everywhere. The challenge is sorting out the current information, reliable fr...

## Information Resources in Pharmacy **Dr. Youssef Aboshady** **Pharmacy Orientation** **MIU** **First Year** Pharmacists have a constant need for reliable and current information, and in the modern world information is everywhere. The challenge is sorting out the current information, reliable from the questionable. ### Drug info should be: - Current - Critically examined - Relevant –> presented in a manner that applies directly to circumstances under consideration ### Drug Info resources **Primary Literature** Primary literature forms the bases of the literature ranking. It is the source of information for the development of secondary and tertiary literature resources. Primary literature is made up of original research that is written in the author(s) own word. 1. Researchers conduct their study and finish it 2. Researchers (authors) write the results in standard format manuscript 3. Authors submit the finished article to the journal 4. Journal editor sends the manuscript to referees to be reviewed (Blind vs. double blind) 5. Reviewers send their comments on the article to the journal editor 6. Accepted manuscripts are published in the journal. #### Limitation of Primary sources Although publication of an article in a well-known, respected journal enhances the credibility of information contained in an article, this does not guarantee that the article is accurate. **Secondary literature** Secondary sources contain information from any or all the primary sources previously mentioned, which has been modified, selected, rearranged or compacted, usually by someone other than the original author, possibly for a specific scientific audience or purpose. #### Examples: - Drug in use - Drug dex - Index Medicus #### Limitation of secondary sources They are generally interpretations of a study and therefore a misinterpretation of important information may occur. Pharmacists should obtain and evaluate the original article because abstracts might not tell the whole story. **Tertiary Literature** Tertiary sources of information are those which are derived from either or both previously mentioned groups (i.e. primary and secondary). #### Limitation of tertiary resources It could take several years to publish a text, so information available textbooks might not include the most recent developments in the field. Other resources should be used to update or supplement information obtained from textbooks. #### Examples - Monographs - Merck Index - Textbooks **Pharmacopeias** Official publications issued by highly specialized persons in pharmacy & medicine. - Must be authorized by governments or international agencies - It includes kol haga related I ezzay t3ml dawa - Drug formularies --> Approved by special government or hospital. .. Orange book - Drug compendia --> Short and clear information of use of a drug **Pharmaceutical Organizations** | Name | Type | Role | |---|---|---| | International pharmaceutical | International | Improve global health by advancing pharmacy practice and | | federation (FIP) | International | science to enable better discovery, development, access to and safe use of appropriate, cost-effective, quality medicines worldwide. Its goal is to build a better, healthier future for people all over the world | | World health Organization (WHO) | International | is the middleman between the drug makers and the consumer because it regulates the safety and effectiveness of medicines | | Food and Drug administration (FDA)| USA | It is the national organization representing the interests of pharmacy education in USA | | American association of colleges of pharmacy (AACP)| USA | is made up of practicing pharmacists, pharmaceutical scientists, student pharmacists, pharmacy technicians, and others interested in advancing the profession | | American Pharmacist association (APhA)| USA | It represents virtually all owners of pharmacies including large chains It offers insurance and legal services | | National Pharmacy Association (NPA) | British | It is the organization responsible for pharmacy profession in Egypt and welfare of enrolled pharmacists | | Egyptian Syndicate of the Pharmacist | Egyptian | The Main function of this society is educational | | Egyptian pharmaceutical Society | Egyptian | The committee is responsible for reviewing the pharmacopeia to cancel or add new drugs | | National Pharmacopeial Committee | Egyptian | Monitoring drug and gives approvals for newly joined and manufactured drugs | | Egyptian Authority of Drug (EDA) | Egyptian | | | | | | ### Career Community | Career | Role | Task | Required Skills | |---|---|---|---| | Community | Work according to legal | 1. Dispensing prescription | 1. communication | | Pharmacist | and ethical guidelines to ensure the correct and safe supply of medical products to the general public | 2. Ensuring different treatments are compatible 3. Checking dosage and ensuring that medicines are correctly and (pharmacists are legally responsible for any dispensing errors) 4. Supervising the preparation of any extemporaneous medicines 5. Keeping a register of controlled drugs for legal control purposes 6. Consult doctors about prescriptions 7. Selling over-the-counter (OTC) medicines 8. Measuring blood pressure & sugar levels | 2. Accuracy and attention to details 3. High level of responsibility 4.Loialty | | Hospital Pharmacist | Based within governmental or private hospitals Their role can extend to health centers, nursing homes, and any other health institute | 1. Check prescriptions 2. Provide advice on the dosage of medicines 3. Participate in ward rounds to take patient drug histories 4. Interact with other medical staff to discuss problems patients 5. Discuss treatments with patients' relatives 6. Make sure medicines are stored appropriately and securely 7.Set up and supervise clinical trials | | | Governmental Management Employment | Pharmacists can work as government employees in regulatory control and drug management | 1. Planning and implementing health and drug policy 2. Registration, approval and quality control of drugs 3. Procurement and distribution of drug products to the governmental 4. Selection of essential drugs 5. Inspection 6. Custom department | | | Industrial Pharmacist Family Planning | - Inform and educate women about methods for contraception. - Advise and educate mothers especially in rural areas about the importance of childcare. | | | | Academic Pharmacist | Pharmaceutical education offers opportunities to pharmacists with advanced degrees in any of the professional specialties | | | | Pharmaceutical Journalism and media | It offers experiences for a number of pharmacists with writing and editing skills | | | | Military Services | They provide pharmaceutical services including: - Manufacture of generic products - Distribute drugs to hospitals in army -They dispense drugs to who working in the army and their families | | | | Medical Representative | Communication links between companies that produce drugs and professionals who prescribe and dispense them | Master's degrees in business or in law find opportunities in the pharmaceutical industry in the marketing, sales, and legal departments Companies prepare sales personnel as representatives for their products | | ### Ethical and Principles and moral Roles **Ethics**: Moral principles that govern a person's behavior. - **Ethical codes**: Provide health care professionals with codes and standards to guide their practice. They do not provide right or wrong answer to every question. They also offer a framework to use when faced with ethical questions. - **Hippocratic law**: His direction that a physician should “not give a deadly drug to anyone” provides one moral view on the existing issue of assisted suicide. | Principle | Definition | |---|---| | Autonomy | Freedom of choice based on informed decision. making and that individual's liberty of choice, action, and thought is not interfered with | | Beneficence | Acting in a manner to do good. The act of showing kindness or mercy. | | Non-Maleficence | The actions of any health care provider should always bring positivity. All health care workers should carefully evaluate each situation before making decisions. non-maleficence covers four factors: - an act should not be truly wrong -every action should have a positive benefit - a good effect should never be a result of the wrong action - good outcomes should always outweigh the bad | | Distributive Justice | Patients deserve advanced health care delivery regardless of their situation There have been numerous cases where patients fail to get the necessary treatment due to economic status, ethnicity | | Confidentiality | Sharing patient's information puts the patient in a weak and risky position This information should only be used to the benefit of the patient | | Fidelity | Pharmacists should have a level of loyalty to their patients regardless of the length of the relationship | | Veracity | Truth, Honesty Violation of veracity may be ethically justifiable (e.g., use of placebos)| | Listen | To the patient and understand his view | | Explain | The treatment The decision-making process | | Acknowledge | The patient's point of view Discuss the similarities and differences between his/her and yours | | Recommend | Treatment while remembering the patient's cultural background | | Negotiate | Do not force your own attitudes, beliefs, and values An agreement Patient's health is ultimately in his hands | ### LEARN Model ### The Prescription "The written order from the physician to the pharmacist for the preparation and dispensing of medicines to the patients ### Parts of a prescription - Patient's name, address and date ### Superscription It consists of the symbol Rx (read as R-X). ### Inscription → body of the prescription' ### Subscription → physician's directions to the pharmacist ### Transcription or Signature → Directions for the patient or nurse which the pharmacist is required to put in specific manner on the label of the medicine container ### How to avoid illegible prescriptions? ### Classes of prescription order - **Pre-compounded Prescriptions** → pharmacist dispenses without pharmaceutical alteration. - **Extemporaneous or Compounded Prescriptions** → pharmacist prepares the medication for dispensing to the patient. - **Narcotic Prescriptions** → narcotic properties similar to those of morphine or of drugs expressly mentioned in the law. ### Components of a Narcotic Prescription 1. The name, the address and the registry number of the prescriber. 2. The name and the address of the patient. 3. The narcotic prescription should be written by ink or typewriter. 4. The quantities of the narcotic substance must be written in words and numbers. 5. In the pharmacy, the narcotic prescription must include the date on which the prescription was filled and the name, address and registry number of the pharmacy. 6. Narcotic prescriptions must be kept in a separate file and may not be refilled. ### Dose calculation 1. **Based on age** - Fred's Rule for infants younger than I year: age(months) x adultdose / 150 - Young's Rule: age(years) x adult dose / age +12 2. **Based on weight** - Dose for child = weight(kg)xadult dose / 70 OR weight(lb)xadult dose / 150 3. **Based on BSA** - Child dose = BSA of child(m²)xadultdose / BSA of adults(m²) = BSA of child(m²)×adultdose/1.73m² ### Checking the compatibility of the prescribed drugs - **Physical incompatibility** →precipitation, complexation, liquefaction. Easily overcome by the pharmacists - **Chemical incompatibility** ### Oxidation-reduction reactions, acid-base reactions, hydrolysis, polymerization, etc. These reactions render the product deterioration, discoloration, and precipitation. It can be solved by the pharmacists by using their knowledge of chemistry. ### Therapeutic Incompatibility - Drug synergism - Drug antagonism ### Therapeutic unintentional incompatibilities can be classified as: - **Dosage error**: overdose can result from the administration of excessive single dose or frequent administration of usual doses. - **Synergistic combinations** - **Antagonistic combinations** - **Contraindicated drug**: some combinations may increase the toxicity or decrease the action of drugs ### Introduction to Dosage forms - **Need for suitable dosage forms**: PROTECTION, SUSTAINED RELEASE, MASK ### Characteristics of a dosage form: 1. Not deteriorate in temperature and humidity. 2. Stable from microbial contamination, oxidation or degradation. 3. Acceptable for patients (have proper shape, taste, color, flavor and convenient in use). ### Oral dosage forms - **SOLIDS** #### Advantages - **Powders** It is a dry preparation consisting of finely divided particles. - **Granules** Granules are solid, dry, agglomerate powder particles. They are irregularly shaped. - **Capsules** Solid dosage forms in which one or more medicinal or inert substances are enclosed within a small gelatin shell (hard or soft). - **Spansules** It is a capsule which contains inated granules of medicinal agent. The advantage of this preparation is the gradual and prolonged release of its medicament in intestine. - **Pills** It is a small glodmiar of ovoid mass, containing active drug and is meant for swallowing. They were once prepared by molding. However, they are prepared nowadays on tablet machines. - **Lozenges** Lozenges are spherical or elongated medicinal preparation consisting of sugar, gum and medicament. They are placed in the mouth and allowed to dissolve in saliva for its local action on the oral and pharyngeal mucosa e.g., coughs lozenges. - **Tablets** It is a unit dose of one or more active medicaments. Depending upon the intended use or their method of manufacture, the tablets may vary in weight, shape, size, thickness, hardness and disintegration characters. Tablets are sometimes coated with sugar, gelatin or other suitable specific coating materials. - Excipients (Auxiliary substances) - Diluents (lactose, mannitol, calcium phosphate). - Binding agents - Disintegrating agents (starch, super-disintegrants: primojel). - Lubricants, Glidants and antiadherents (magnesium stearate, talc, stearic acid). - Colors and dye. - Flavoring agents (especially for chewable: menthol). - Sweetening agents (saccharin, cyclamate). - Adsorbents (magnesium oxide, bentonite, silicon dioxide). - Coating agents (sugar, salol). #### Types of tablets 1. Oral tablets (can be swallowed) 2. Sublingual tablets 3. Solution tablets 4. Vaginal tablets 5. Effervescent tablets: 6. Implants ### Liquid oral dosage forms - **Aqua (Water)** Used as a vehicle. For parenteral, they should be pyrogen-free. In some special cases, CO2-and ammonia-free water is used. - **Mixture (Mistura)** Oral aqueous preparations can be in the form of ether a solution or a suspension (these preparations contain one or more solid and/or liquid substances) - **Syrup** Definition: A concentrated aqueous solution of sucrose or other sweetening agents (dextrose, non-sugars like sorbitol, glycerin and propylene glycol) with or without added flavoring agents. - **Elixir** Elixir is a sweeri aromatic hydro-alcoholic solution used orally. It is less sweet and less viscous tihan syrup because of its alcoholic content. - **Infusion** Infusion is a diluted liquid preparation which contains active principles of crude drugs obtained by soaking the crude drug in water with or without alcohol. - **Decoction** Decoction is a liquid preparation of active principle(s) of crude drugs obtained by boiling crude drug(s) in water. - **Linctus** A viscous, syrupy, mucilaginous liquid preparation contains sucrose and medicinal substances - **Spirit** Spirit is an alcoholic solution of volatile oil(s) or chloroform or ether used as flavoring and medicinal agents. - **Tincture** Tincture is an alcoholic solution of active principle(s) of crude drugs (10-20%) ### External dosage forms - **Semi-solids** - Suppositories-Creams-Ointments-Plaster-Poultice - **Liquids** - Drops-Gargles and mouthwashes-Glycerins-Lotions-Liniments-Enemas-Paint ### Parenteral Dosage Forms - **Liquids** #### Uses of parenteral preparations 1. In emergency for rapid onset of the action of drug 2. For depot effect of drugs 3. For drugs not absorbed from gastro-intestinal route such as streptomycin 4. In patients who show inability or unwillingness to swallow the drug 5. To prevent the decomposition of drugs such as insulin 6. When areas are not accessible by other means, e.g., local anaesthetics 7. For replacing large volume of body fluids ### Routes of administration - ORAL - BUCCAL - RECTAL - VAGAINAL - INHALATION - TOPICAL - PARENTRAL #### **Parenteral includes:** - IV - SC - IM