Orientations Pharmacy PDF

Orientations  Is to be familiar with all Pharmacy aspects of pharmacy orientation profession and pharmacy education. 2 BY Dr/Ibrahim Elbahwy ...

Orientations  Is to be familiar with all Pharmacy aspects of pharmacy orientation profession and pharmacy education. 2 BY Dr/Ibrahim Elbahwy  It is the art and science of preparing and dispensing medications and the provision Pharmacy of drug-related information to the public BY Dr/Ibrahim Elbahwy 3  Pharmacy, also, Means every store or shop licensed by authority where drugs, controlled substances, poisons, medicines or chemicals are stored, dispensed, sold, displayed for sale, or where are compounded. 4 The term includes Outpatient hospital Community Nuclear Institutional Internet pharmacies BY Dr/Ibrahim Elbahwy  Interpretation of prescription orders Compounding Pharmacy Dispensing of drugs and devices Labeling Drug product selection Patient monitoring and intervention Provision of cognitive services related use of medications and devices. 5 BY Dr/Ibrahim Elbahwy Drug or medicine Is a substance or material, other than food intended for use in the diagnosis, cure, mitigation, treatment or prevention of disease in humans or animals, intended to affect the structure or any function of the body of humans or animals. BY Dr/Ibrahim Elbahwy 6 Drug/medicine/pharmaceutical products 7 The drug Is a substance having a pharmacology or therapeutic activity. The medicine Is a drug (the active material) admixed with excipients (inactive materials), formulated, packed, and labeled. Pharmaceutical product Drugs processed on large scale by pharmaceutical manufacturers. BY Dr/Ibrahim Elbahwy  8 Drug product A dosage form containing one or more active ingredients along with other substances included during manufacturing process. Excipient It is anything other than the drug substance in the dosage form (Adjuvant/secondary/Auxiliary/nondrug additive). BY Dr/Ibrahim Elbahwy Pharmaceutical products or medicines should be safe and effective 9 Nature and sources of drugs 1- Plant sources: e.g. Castor oil (laxative) 2- Animal sources: Insulin (pancreas), heparin (the liver or lung tissue) 3- Mineral sources e.g. magnesium sulphate and iodine 4- Microorganisms: e.g. Penicillin (produced by penicillium mold) 5- Synthetic drugs: e.g. aspirin, sulphonamide, barbiturate. 6- Biotechnology (Recombinant DNA): Human insulin, vaccines, and interferon. BY Dr/Ibrahim Elbahwy 10 BY Dr/Ibrahim Elbahwy 11 Classification of drugs 1- Prescription only drugs Drugs prescribed by the physician and dispensed through a prescription. 2- OTC drugs Drugs which the patient can have without prescription according to his choice or according to the pharmacist advice, such drugs may be referred as Over The Counter drugs. BY Dr/Ibrahim Elbahwy 12  Strength It is the concentration of the drug in a dosage form. Dose It is the amount of the drug which is taken each time. It should be safe and effective. Dose regimen It is frequency of drug use. BY Dr/Ibrahim Elbahwy 13 BY Dr/Ibrahim Elbahwy 14  Physical or chemical tests used to ensure the require specifications of a raw material or a dosage form. Quality control Specifications are those given by pharmacopeia or the factory. BY Dr/Ibrahim Elbahwy 15  Stability The ability of the formulation (dosage form), in a specific container closure system, to remain within the defined physical, chemical, microbiological, therapeutics and toxicological specifications till the end of the stated date, under defined storage conditions. BY Dr/Ibrahim Elbahwy 16  The date placed on the container through which the product is expected to remain with in specifications under appropriate storage conditions. Expiration Date It is the time at which 90% of the material remains. BY Dr/Ibrahim Elbahwy 17  Storage Describes the safe keeping of 1- Starting materials 2- Packing materials 3- Drug products in drug stores, pharmacies and hospitals. Storage conditions A- Temperature B- Humidity C- Container D- Light BY Dr/Ibrahim Elbahwy 18  19 Deep freezer: less than -10 °C Refrigerator: between 2-8 °C Temperature for Cold place: Less than 8 °C storing the product Cool place: between 8-15 °C Room temperature (ambient temperature): between 15-30 °C Warm temperature: between 30-40 °C BY Dr/Ibrahim Elbahwy Drug Nomenclature When first synthesized or identified drug from a natural source an organic compound is represented by empirical formula which indicates the number and the atoms comprising the molecule. Empirical formula e.g. C14H19Cl2NO2 (Chlorambucil) It can take four years to go through naming steps, name selection and approval process. BY Dr/Ibrahim Elbahwy 20 I- Chemical name 1- Used by organic chemist to describe the chemical structure of the drug 2- It is named following IUPAC rules (International Union of Pure and Applied Chemistry) 3- Usually a lengthy complex name e.g. 4-[bis(2-chlorethyl)amino] benzene butanoic acid 4- Not for general use. BY Dr/Ibrahim Elbahwy 21 Code number When the chemists first make up compounds, give their new compounds code no. and register them in the database so they keep track of its performance in the studies. Code no. such as. SQ14.225 (the investigational code number for the drug captopril, initially developed by Squibb). The code number stays with a compound from its initial preclinical investigation till human clinical trial. If a compound shows enough promise through preclinical and clinical trials, two naming processes begin to devise a generic name and a brand name for the future drug. BY Dr/Ibrahim Elbahwy 22 II- Generic (official, non-proprietary, approved) name Because of the world growing smaller. People were traveling abroad more frequently. The generic-naming process arose in the 1950s, as a way of establishing a standard so that drugs had the same name everywhere. so that regardless of where someone is located, patients and health care professionals will be able to safely communicate about medications. Today, two different organizations must approve the names of generic drugs 1-United States Adopted Names (USAN) Council 2-World Health Organization (WHO) International Non-proprietary Name (INN) Programme Usually generic drugs have similar suffix in a group (family name), For example. sildenafil. The suffix, “afil,” explains the way it works, meaning it helps control blood flow. “Afil” is also the suffix of other erectile dysfunction generics, such as tadalafil , vardenafil and avanafil. Generic names used for education Short and precise BY Dr/Ibrahim Elbahwy 23 BY Dr/Ibrahim Elbahwy 24 III-Brand (proprietary or commercial or trade) name Name given by pharmaceutical company for commercial purpose Should be easy to be remembered and to pronounce by the patient May have indication to its therapeutic use or name of manufacturer. Physician often use the brand name on prescription. May be contain one or more of generic drugs More expensive than generic BY Dr/Ibrahim Elbahwy 25 Example for generic and brand name BY Dr/Ibrahim Elbahwy 26  Some examples of chemical, generic and brand names Chemical name generic brand 4-[bis(2-chlorethyl)amino] Chlorambucil Leukran® benzene butanoic acid 5,5-diphenyl-2, 4- Phenytoin Epanutin® imidazolidinedione (RS)-2-(4-(2- methylpropyl)phenyl) Ibuprofen Advil® propanoic acid BY Dr/Ibrahim Elbahwy 27 Patency When a drug is under patent protection, the company markets it under brand name. Other companies that file for approval to market the off-patent drug must use the same generic name but can create their own brand name. As a result, the same generic drug may be sold under either the generic name or one of many brand names. BY Dr/Ibrahim Elbahwy 28 Pharmaceutical product names generally should 1-Be short and distinctive in sound and spelling 2-Indicates the general pharmacological or therapeutic class. BY Dr/Ibrahim Elbahwy 29  Cal mag A supplement of ca and mg Spascolon Relives spasm of colon laxolac laxative Calmepam Relives anxiety and stress No migraine Relives migraine Disflatyl Relives flatulance Relax Relaxation for muscle BY Dr/Ibrahim Elbahwy 30 General mission for health care All health care organizations, professional groups should adopt a clear purpose to continually reduce the burden of illness, injury and disability, and to improve the health and functioning of the public. BY Dr/Ibrahim Elbahwy 31  32 1- Safe 2- Effective There are six aims 3- Patient centered essential for the health 4- Timely care system quality 5- Efficient 6- Equitable BY Dr/Ibrahim Elbahwy Pharmacist role in the society: traditional vs modern Pharmacy nowadays does not lie merely in dispensing of medications but in the provision of relevant drug information and drug therapy recommendations to people in the society Rational behind influential role of pharmacists: 1- Direction towards pharmaceutical care to patients: This responsibility is to be shared obligation between the prescriber and the pharmacists. 2- Continuing professional developments: keeping up to date with changes in pharmacy practice and with relevant knowledge and technology. BY Dr/Ibrahim Elbahwy 33 3- Adherence to pharmaceutical code of ethics: Sticking to the ethical rules has helped a lot to establish the pharmacy profession as a noble one in the society. 4- Authentic source of pharmaceutical information: providing relevant and up to date drug information to the people and society 5- Adopting new concepts: The changing global scenario has promoted the pharmacies to adopt new concepts for the welfare of the society. BY Dr/Ibrahim Elbahwy 34 Consumerism vs paternalism Paternalism is the belief that the health care professional knew best It was accepted as standard practice by most health care professional and their patients The medical rights of patients were not as widely recognized as other rights (food, shelter, voting,….) Today, patient have become true consumers of medical care patient have a right to be informed and ask for their consent For health care professional to do otherwise would not only be unprofessional and unethical but also illegal. BY Dr/Ibrahim Elbahwy 35 Patient rights 1- Patient can expect pharmacists will employ their knowledge and experience in caring for them 2- They expect that pharmacists will respond their wishes about their treatment 3- Patient generally choose their own physician, pharmacy and hospital 4- Patients allowed to choose from multiple options of treatment 5- Treatment is both safe and effective BY Dr/Ibrahim Elbahwy 36  Pharmacy symbol Rx symbol, it is an abbreviation of the Latin word “recipere” and appears at the start of prescriptions. means simply “Take” as prescribed and compounded by the pharmacist. The mortar and pestle has long been used as a pharmaceutical symbol. Pharmacists would use the mortar and pestle to crush and mix ingredients to cure diseases. The mortar and pestle are tools of traditional pharmacy. 37 BY Dr/Ibrahim Elbahwy Right symbol of pharmacy BY Dr/Ibrahim Elbahwy 38  The bowl with a snake coiled around it is called the ‘Bowl of Hygieia’ with the serpent of Epidaurus and is the internationally recognized symbol of pharmacy (the profession). Hygieia was the daughter of Aesculapius, one of the Greek gods of medicine, and was herself the Greek Goddess of Good Health. Her symbol was a serpent drinking from a bowl, the snake being wisdom, immortality and healing. BY Dr/Ibrahim Elbahwy 39 Information resources in pharmacy Pharmacists and pharmaceutical scientists in a constant need for reliable and current information Pharmacists in addition to meeting their own information needs, they must also be able to assist patients in their information needs with regard to drugs, therapy, and diseases. BY Dr/Ibrahim Elbahwy 40 Drug information should be Current : uses the most recent, up-to-date sources possible. Critically examined should meet the following criteria: ✓ More than one source should be used when appropriate. ✓ The extent of agreement of sources should be determined; if sources do not agree, good judgment should be used. ✓ The plausibility of information, based on clinical circumstances, should be determined. Relevant must be presented in a manner that applies directly to the circumstances under consideration. BY Dr/Ibrahim Elbahwy 41 Types of information resources of drug A. Primary Literature Primary literature is made up of original research that is written by author (s) without second party Provide new scientific discoveries It provides most current information about drugs. It is the source of information for the development of secondary and tertiary literature resources. Examples ✓ Articles published in scientific journals ✓ Theses/dissertation ✓ Conferences posters. ✓ Clinical trials BY Dr/Ibrahim Elbahwy 42  Format of a published scientific research When researchers have concluded a study, they usually write the results in a standard format that includes: ✓ Abstract or summary ✓ Introduction or a review of post research in the area ✓ A description of the methodology used ✓ Results ✓ Discussion of what the results mean ✓ Conclusion ✓ References 43 BY Dr/Ibrahim Elbahwy Steps of publication The finished article is then submitted to a journal, which is perhaps published by a professional organization or by a commercial scientific publisher. The journal editor then sends the manuscript to be reviewed by one or more researchers in the same field as the authors. Usually the reviewers are unaware of the authors' identities. Manuscripts that are found to meet criterion of sound research are accepted for publication and are published in the journal. within the past years, scientific journals have been produced in electronic form as well as in print. Because of the high costs of printing and mailing, and the great number of subscribers to many specialized journals, research publications may exist only electronically. BY Dr/Ibrahim Elbahwy 44 Examples of excellent primary literature resources Limitation of primary sources Although publication of an article in a well-known, respected journal with high impact factor enhances the credibility of information contained in an article, this does not guarantee that the article is accurate. BY Dr/Ibrahim Elbahwy 46  B. Secondary literature Secondary sources contain information from the primary sources, which has been selected, rearranged or compacted usually by someone other than the original author. Interpretation, indexing and abstracting of original research. Review articles (summary of researches) Examples of secondary sources Abstracting and indexing services e.g. (Pub med) International Pharmaceutical Abstracts (IPA) BY Dr/Ibrahim Elbahwy 47 International Pharmaceutical Abstracts (IPA) Database that is focused on pharmacy and pharmaceutical science and is produced by Thomson Scientific in cooperation with the American Society of Health-System Pharmacists (ASHP). This comprehensive database provides indexing and abstracts for pharmaceutical and medical journals published worldwide. It is essential to anyone interested in keeping abreast of today's health-related drug literature. BY Dr/Ibrahim Elbahwy 48 Limitations of secondary sources Misinterpretation of important information may occur. Pharmacists should obtain and evaluate the original article because abstracts might not tell the whole story. Substantial difference in lag time (interval between publication of an article and citation of the article in an index) among various services. BY Dr/Ibrahim Elbahwy 49 C. Tertiary literature Information collected from either or both of primary and secondary sources. They can be a good place to look up facts or get a general overview of a subject. When to use? When you need to find background information or quick answer. Examples ✓ Drug Compendia (Pharmacopeia, formularies, and Martindale) ✓ Handbooks (e.g Handbook of Pharmaceutical Excipients). ✓ Textbooks ✓ Online drug database BY Dr/Ibrahim Elbahwy 50 Limitations of tertiary sources 1- Lag time: It could take several years to publish a text, so information available in textbooks might not include the most recent developments in the field. Other resources should be used to update, or supplement information obtained from textbooks. 2- The author of a textbook might not have done a thorough search of the literature, so pertinent data could have been omitted. 3- Misinterpretation for primary or secondary literature. BY Dr/Ibrahim Elbahwy 51 Drug compendia (pharmacopeias and formularies) Books containing the standards of drugs and related substances Classification of drug compendia 1- Official drug compendia These books are prepared under authority of government of respective country 2- Non-official drug compendia These books used as a secondary source of reference for drugs BY Dr/Ibrahim Elbahwy 52 Pharmacopoeias, pharmacopeia, or pharmacopoea ✓ The word derived from the ancient Greek word pharmakon meaning (drug) & poi meaning (make), and finally the abstract noun ending (-ia), ″drug-mak-ing″ or ″to make a drug″ In modern sense ✓ Pharmacopoeias are issued or authorized by governments or by international agencies. ✓ Include non-proprietary name, therapeutic use, official standards for purity, quality, and analysis of drugs. BY Dr/Ibrahim Elbahwy 53  Importance of pharmacopeia To maintain the uniformity and control the standards of drugs available in market Avoid adulterated drugs Provide complete information on drugs and their dosage forms Reference for laboratory, industry and academic institutions. The world's best-known national pharmacopoeias are BY Dr/Ibrahim Elbahwy 54 a) United States Pharmacopeia/National Formulary (USP/NF) The USP/NF consists of two separate titles published in one volume. The USP is the larger of the two titles and contains monographs on drugs. The NF includes monographs on excipients. The USP/NF includes only drugs and excipients that have been developed and accepted by the member of USP convention. USP convention: a representative organization of physician, pharmacists and others in the pharmaceutical and health care communities. BY Dr/Ibrahim Elbahwy 55 Monograph Collection of detailed information on particular drug or excipient. BY Dr/Ibrahim Elbahwy 56 Other pharmacopeias b) British Pharmacopeia (BP) C) Japanese Pharmacopeia D) Egyptian Pharmacopeia BY Dr/Ibrahim Elbahwy 57 Martindale: The Extra Pharmacopeia (EP) ✓ By the British pharmacist William Martindale ✓ It is not a true pharmacopeia. ✓ It contains information on drugs and medicines from around the world. ✓ It also includes proprietary products and manufacturers, making it very valuable reference for identifying foreign drugs. BY Dr/Ibrahim Elbahwy 58  History of Martindale 1883 1st edition Extra Pharmacopoeia of Extra, referred to the focus Unofficial Drugs and on drugs and substances not Chemical and included in the British Pharmaceutical Pharmacopoeia (BP) Preparations 1885 4th edition Extra Pharmacopoeia started to include official preparations from the British Pharmacopoeia. 1972 Martindale: The Extra the publication was Pharmacopoeia. increasingly being referred to as Martindale 1999 32nd edition Martindale: The Complete Drug To remove the misplaced Reference. comparison to pharmacopoeias, BY Dr/Ibrahim Elbahwy 59 BY Dr/Ibrahim Elbahwy 60  In the past, formularies were recipe books for making drugs Formularies Now they are usually list of drugs approved for use by special hospital or government. National Formulary (NF) not true formulary, why? BY Dr/Ibrahim Elbahwy 61  Orange book ✓ Approved Drug Products with The Therapeutic Equivalence Evaluations. ✓ It is a reliable resource for the information about the FDA approved drugs. ✓ It is an annual publication that is popularly called the "Orange Book" after the color of its cover. BY Dr/Ibrahim Elbahwy 62  ✓ Access Pharmacy ✓ Daily Med ✓ Facts and Comparisons Online Examples of Online Tertiary ✓ Access Medicine Sources ✓ Drugs.com ✓ Medscape ✓ Lexicomp BY Dr/Ibrahim Elbahwy 63  BY Dr/Ibrahim Elbahwy Pharmacy education 64 Pharmacy education ✓ The first school of Pharmacy in modern history of Egypt was founded by the ruler of Egypt Mohamed Ali Pasha, in 1824AD, as apart of a hospital established in Abu Zabal, in the province of Cairo. ✓ After establishment of Cairo University in 1908, the first "university" pharmacists were graduated in 1929; they were only three. ✓ The Faculty of Pharmacy, Cairo University was announced as separate entity on 1955. BY Dr/Ibrahim Elbahwy 65 Governmental Faculties of pharmacy (State funded) Examples ✓ Al-Azhar Established in 1965 as a department in faculty of medicine. ✓ Cairo ✓ Alexandria ✓ Assiut ✓ Mansoura ✓ Tanta ✓ Zagazig ✓ Suez Canal ✓ Beni-Suef BY Dr/Ibrahim Elbahwy 66 Private university ✓ 6th October , Misr university for science and technology, German , Ahram , Future , Russian, Pharos , Sinai , El Nahda ,badr , Delta, Helipolis and british. ✓ Number of accepted students per year is defined by National Supreme Council of University and taking suggestion from faculties board. BY Dr/Ibrahim Elbahwy 67 ✓ Until the beginning of 19th century, no education requirement for pharmacy practicing pharmacy The apprenticeship system: ✓ An apprentice learns a trade or profession by working for a person who has mastered the field (to gain credentials). ✓ Sole dependence upon on-the job training for pharmacists was eliminated when the first school of pharmacy was founded. BY Dr/Ibrahim Elbahwy 68  The national agencies responsible for accreditation of professional degree programs in pharmacy and surveillance of pharmaceutical curricula are: ✓ The Supreme Council of Universities. ✓ Ministry of higher Education. BY Dr/Ibrahim Elbahwy 69 Awarded Pharmaceutical degrees in Egypt ✓ Bachelor degree (Bachelor in pharmaceutical science) This requires as a minimum standard a five-year course, recently, regulations called for 6-years course ✓ Master degree (Master in pharmaceutical science). This requires a minimum of two years including one-year study, and a practical thesis in the specialized field. ✓ PhD degree (Doctor of philosophy in pharmaceutical science) This requires a minimum timing of two years after which the student should defend a practical thesis. BY Dr/Ibrahim Elbahwy 70 ✓ Diploma In addition to master and doctorate, some faculties award diplomas. A diploma requires a minimum study of one year during which the graduate is completely devoted. ✓ There are many diplomas in the field of pharmacy: e.g. Diploma in Industrial pharmacy Diploma in Hospital pharmacy Diploma in Clinical pharmacy Diploma in Quality pharmacy Diploma in Cosmetics BY Dr/Ibrahim Elbahwy 71 Departments of Faculty of Pharmacy All faculties of Pharmacy have nearly the following departments, it may differ according to different colleges: 1. Department of Pharmaceutics and pharmaceutical technology 2. Department of Pharmacognosy 3. Department of Microbiology 4. Department of Biochemistry 5. Department of Pharmaceutical Chemistry 6. Department of Organic Chemistry 7. Department of Analytical Chemistry 8. Department of Clinical Pharmacy 9. Department of Pharmacology and Toxicology BY Dr/Ibrahim Elbahwy 72 Types of courses A. General Courses General courses in the social sciences, humanities, history, and literature provide the broad general education required of a professional in today's society. B. Prerequisite Courses Mathematics, physical and biological sciences teach the principles. C. Professional Courses Basic to most pharmacy curricula are courses in pharmacology, medicinal chemistry, pharmaceutics, biopharmaceutics, physical pharmacy, Clinical pharmacy, hospital pharmacy, first aid, organic chemistry, analytical chemistry and microbiology. BY Dr/Ibrahim Elbahwy 73 Some courses in pharmacy 1- Organic Chemistry prepares the student for advanced chemistry courses in the pharmacy curriculum. 2- Biochemistry Deals with the chemistry of living matter, enzymes and drug metabolism, and diseases caused by malfunctions of metabolic activities and biochemical systems. 3- Medicinal chemistry, and pharmaceutical chemistry is concerned with relationships of chemical structures of drugs and their biological activities in the body. BY Dr/Ibrahim Elbahwy 74 4- Pharmaceutics Pharmaceutics is the study of formulation of drugs' dosage forms or drug delivery systems (capsule, tablet, injection, ointment, lotion, patches, suppositories, aerosol, suspension, etc...) that help optimize the speed of action, intensity, duration, and effect of drugs as well as offering luxury for patients to choose among various options. 5- Biopharmaceutics and pharmacokinetics are sciences concerned with physicochemical properties of drugs and the significance of these properties on drug's absorption, distribution, metabolism, and excretion within and from the body. 6- Radio-pharmaceuticals are the application of radioactive drugs for diagnosis and therapy in nuclear medicine. BY Dr/Ibrahim Elbahwy 75 7- pharmacology science dealing with drug action on living systems and their constituent parts. Courses that originate from pharmacology include: ✓ Pharmacodynamics concerned with responses of normal, living organisms to drug action. ✓ Pharmacotherapy: deals with organisms in a pathologic state and their responses to chemical stimuli. ✓ Therapeutics: is an advanced pharmacology course with disease orientation that emphasizes clinical aspects and mechanisms of drug action. ✓ Toxicology: is concerned with poisonous materials in biologic systems. BY Dr/Ibrahim Elbahwy 76 8- Clinical Pharmacy Clinical aspects are those concerned with actual observation and treatment of disease in patients rather than artificial experimentation or simulation of reality. BY Dr/Ibrahim Elbahwy 77  78 Scope of work BY Dr/Ibrahim Elbahwy Job opportunities for pharmacists have been growing fast because of 1- Large population 2- Scientific advance providing more drug product 3- New development in administration medicine BY Dr/Ibrahim Elbahwy 79 Why have you attracted to the carrier? 1- Personal relationship 2- Watching community pharmacy 3- College representatives visiting high schools 4- Multimedia 5- Experience of illness within family 6- Salaries BY Dr/Ibrahim Elbahwy 80 Pharmacy is a multifaceted profession ✓ Pharmacist could be 1- Legislator 2- Educator 3- Practitioners 4- Administrators ✓ The licensed pharmacist can work in any of the following fields BY Dr/Ibrahim Elbahwy 81 1- Community pharmacy ✓ Community pharmacists are health professionals most accessible to public ✓ They require well-developed professional skills and management skills Community pharmacists provide several important functions 1- Provide distribution of prescribed drug product 2- Give advice on the treatment of minor health problems and may suggest medicine that you can buy over the counter (OTC drugs). 3- Monitor drug utilization and accounting for the appropriate control of drugs with potential for abuse or misuse. BY Dr/Ibrahim Elbahwy 82 4- Compound prescriptions to meet the specific needs of individual patients 5- Provide pharmaceutical care services and promote health 6- Maximize the intended benefits of drug therapy while minimizing unintended side effects and adverse reactions 7- Preparing dosette and cassette boxes 8- Telling how to use appliances BY Dr/Ibrahim Elbahwy 83 Community pharmacy characters 1- Good communication skills 2- Teamwork 3- Concern for welfare of general public 4- Accuracy and attention to details 5- Understanding business 6- Professional and confident manner 7- Culture competence BY Dr/Ibrahim Elbahwy 84 2- Hospital pharmacy Where does they work? They practice pharmacy in private and government owned hospitals, health maintenance organization, walk in health centers and drug information centers (DIC). BY Dr/Ibrahim Elbahwy 85 Role of hospital pharmacist 1- Dispense medication. 2- Prepare sterile solutions. 3- Advise other professionals and patients on the use of drugs. 4- Monitor drug regimens. 5- Evaluate drug use. 6- Advise other professionals on the selection and effects of drugs and in some cases make medical rounds with them or provide direct patient care. BY Dr/Ibrahim Elbahwy 86 6- Take part in the analysis of drugs in body fluids and participate in the planning of clinical trials. 7- Serve as a member of policy-making committees, including those concerned with drug selection, use of antibiotics and hospital infection. BY Dr/Ibrahim Elbahwy 87 3- Governmental Employment Regulatory control and drug management: they are responsible for: 1- Planning and applying health & drug policy. 2- Registration, approval and quality control of drugs, cosmetics and medical devices. Cosmetics >>> non-medical product intended to keep body integrity and to correct defects in looking. Medical devices >>> e.g. syringes, IV sets …etc. 3- Obtaining and distribution of drug products and their rational use. 4- Selection of essential drugs which are treated in a special way by the government concerning their production, importation, pricing..... etc. 5- Inspection (to follow the stickiness or compliance of pharmacist to pharmacy law) 6- Custom department BY Dr/Ibrahim Elbahwy 88 4- Nuclear Pharmacy (radio pharmacy) It involves preparation of radioactive materials that will be used for diagnosis and treatment of diseases. BY Dr/Ibrahim Elbahwy 89 5- Industrial pharmacy The future of pharmaceutical industry appears to be bright. It continues to discover, develop, produce and market life enhancing and life-saving medicines, that improve the quality of life. BY Dr/Ibrahim Elbahwy 90 Pharmacists in industry can hold positions in 1- Research and development (R&D). 2- Manufacture and production. 3- Quality control (Q.C) and quality assurance(Q.A). Q.A: assuring that the product is good quality 5- Drug information. 6- Clinical trials and post-marketing surveillance. 7- Sales and marketing. 8- Management. BY Dr/Ibrahim Elbahwy 91 6- Family planning Pharmacists are hired in family planning sectors to provide services such as ✓ Inform and educate women about the use of contraceptive pills ✓ Inform and educate people about the use of other methods for contraception. ✓ Advise and educate mothers especially in rural areas about the importance of childcare BY Dr/Ibrahim Elbahwy 92 7- Academic pharmacists Academic Pharmacists are full-time faculty members of an educational institute (e.g. University, Polytechnic, etc.). They are involved in teaching and training of the future generations of pharmacists and pharmaceutical scientists. Besides teaching, academic pharmacists in a university also engage in research. Their research activities may include areas in new drugs discovery, manufacturing technology and formulation of drug products, improvement in pharmacy practice as well as enhancing therapeutic and health outcomes in patients. In addition, they are also involved in consultancy work, service to the university or international health-related organizations, public service and patient care. BY Dr/Ibrahim Elbahwy 93 8- Pharmaceutical journalism It offers rewarding experiences for a number of pharmacists with writing and editing skills as well as for those literate , and with communicative talents. BY Dr/Ibrahim Elbahwy 94 9- Military pharmacy In the military pharmacists can provide the following services: I. Manufacture of generic products. II. Distribute drugs to military areas and hospitals III. Dispense drugs to personnel working in the army. IV. Prepare products to purify water during emergency (Ware time). BY Dr/Ibrahim Elbahwy 95 10- National health projects Pharmacists can share in national health projects as well as campaigns for controlling diarrhea in children through rehydration therapy, stopping smoking , virus C etc. ….. BY Dr/Ibrahim Elbahwy 96 11- Pharmaceutical Sales Representatives (PSRs ) or Medical Representatives ( Medical rep.) Pharmaceutical sales representative are men or women who act a communication links between companies that produce drugs and professional who prescribe and dispense them. Some companies refer to this special personnel category as professional and medical representatives and others simply as sales representatives The first objective of the representative is to inform the physician of the company`s products and answer the physician`s questions. The second objective is to increase the company`s sales of the drug. BY Dr/Ibrahim Elbahwy 97  Pharmacy graduates are highly qualified to serve as PSRs , but to success they must possess selling skills Pharmacists with master`s degree in business (MBA) find additional opportunities in pharmaceutical industry in the marketing, sales, departments. As the representative must also visit pharmacists, clinics, nursing, and hospital. The typical visit to a physician office lasts between five and ten minutes and require planning ,speed, and eagerness on the part of PSRs. BY Dr/Ibrahim Elbahwy 98  Drug promotion Medical Rep. To inform pharmacists, physicians and hospitals about the products of his company Product Manager To train medical representatives Area Manager To supervise medical representatives in an area Marketing manager To put the plan for marketing of a group of products or all products over 1-5 years Medical director To afford researches, brochures and post marketing surveillance. Brochures are leaflets included in the drug product package, containing information about the drug. General Manager To plan, control, and monitor all activities BY Dr/Ibrahim Elbahwy 99 Others 1. Food industry 2. Analysis of water 3. Cultivation of medicated plants 4. Analysis of blood 5. Forensic pharmacy 6. Drug information centers BY Dr/Ibrahim Elbahwy 100 Pharmaceutical BY Dr/Ibrahim Elbahwy 101 What is ethics Set of moral principles that distinguish right from wrong.  ✓ Field of applied ethics (embracing the study of moral values and judgments) in the pharmacy profession. Pharmaceutical ethics ✓ Pharmaceutical ethics shares many principles with other branches of healthcare ethics, such as medical and nursing ethics Ethical codes ✓ Ethical codes provide health care professionals with ethical principles and standards by which they to guide their practice. ✓ However, ethical principles and codes do not provide health care professionals with answers to every moral question. BY Dr/Ibrahim Elbahwy 104 ✓ The purpose of such principles and codes is to offer a framework to use when faced with ethical questions. BY Dr/Ibrahim Elbahwy 105 ✓ The first code of ethics for medicine was created to Hippocrates in the 4th century BC. ✓ Hippocrates is the father of medicine ✓ The Hippocratic code is timeless. ✓ “No physician should give a deadly drug to anybody if asked for it, nor make a suggestion to this effect” assisted suicide. BY Dr/Ibrahim Elbahwy 106  Code of Ethics of American Pharmaceutical Association (APhA) I. A pharmacist respects the covenantal relationship between him and the patient. II. A pharmacist promotes the good of every patient in a caring, compassionate, and confidential manner. III. A pharmacist respects the autonomy and dignity of each patient. IV. A pharmacist acts with honesty and integrity in professional relationships. V. A pharmacist maintins Professional compétence VI. A pharmacist respects the values and abilities of colleagues and other health professionals. VII. A pharmacist serves individual, community, and societal needs. VIII. A pharmacist seeks justice in the distribution of health resources. Ethical principles The tools used by pharmacists daily as they face and moral rules ethical situation. BY Dr/Ibrahim Elbahwy 108 1- Autonomy ✓ It is defined as freedom of choice based on informed decision-making and that individual’s liberty of choice, action and thought is not to be interfered with. ✓ Autonomy is the right of individuals to: 1) Make decisions about what will happen to their bodies 2) What they choose to take, or not to take into their bodies 3) What choice will be made among competing options 4) Choosing among health care providers or refusing medical treatment altogether BY Dr/Ibrahim Elbahwy 109 Exceptions to the principle of autonomy ✓ Weak paternalism ▪ Individual doesn’t appear to be autonomous ▪ It is Ethically justified ✓ Strong paternalism ▪ Violation of autonomy of another person because you believe they are making wrong decisions ▪ it isn’t justified because this is over-riding patient’s autonomy. BY Dr/Ibrahim Elbahwy 110 Diminished capacity concept (discussed under autonomy) ✓ Situation when consent is obtained from the subject at the height of emotional distress. e.g. immediately after a diagnosis ✓ Lack of education about the diagnosis or procedure. BY Dr/Ibrahim Elbahwy 111 2- Confidentiality ✓ Pharmacists should keep sensitive information private from others, unless the patient grants approval for its release. ✓ Medical confidentiality need not to be requested clearly by patients. ✓ Pharmacist must ensure that confidential information remains restricted. ✓ Confidential data: the medical details, address, telephone, family data or financial data. BY Dr/Ibrahim Elbahwy 112 Confidentiality versus privacy Violation of confidentiality ✓ Results from the inappropriate release of personal information to others by a person who has been granted access to such information. Violation of privacy ✓ Results in situation where personal information is revealed by an individual who hasn’t been granted access to such information BY Dr/Ibrahim Elbahwy 113 Cases of disclosure When ✓ The life of the patient is in danger. ✓ A court order demands disclosure. ✓ The patient or a legal guardian of the patient demands disclosure. N.B. ✓ When patient data is used for teaching purposes all efforts must be made to conceal the source of data. BY Dr/Ibrahim Elbahwy 114 3- Beneficence/NonMaleficence ✓ Beneficence: to do good or bring benefit ✓ Non Maleficence: avoiding or preventing harm ✓ They are complementary to each other BY Dr/Ibrahim Elbahwy 115 4-Fidelity ✓ Pharmacists demonstrate loyalty to their patients. ✓ Pharmacists have an obligation of fidelity to all their patients, regardless of the length of the professional relationship. ✓ Eg. Same obligation to an occasional patient as for a regular customer. BY Dr/Ibrahim Elbahwy 116 Placebo ✓ A placebo is a substance with no medical effects, such as sterile water or sugar, talc, and starch pill. ✓ A placebo is a fake treatment that in some cases can produce real response ✓ It is prescribed for psychological benefit to the patient rather than for any physiological effect. BY Dr/Ibrahim Elbahwy 117 5- Veracity (truth, honesty) ✓ Pharmacists should be honest in their dealing with patients. ✓ Violation of Veracity may be ethically justified (as with use of placebo). ✓ Violation for non-patient centered reasons would appear to be unethically justified. BY Dr/Ibrahim Elbahwy 118 6- Distributive justice ✓ The equal distribution of the benefits and burdens of society among all members of this society. ✓ Sadly, issues such as patient’s socioeconomic statue often impact the level & intensity of care provided by healthcare professional. ✓ Patients on health insurance versus cash-paying customers. BY Dr/Ibrahim Elbahwy 119 Justice demands that the focus be on the patient and their medical needs, not on the financial impact on the healthcare professional BY Dr/Ibrahim Elbahwy 120 Values ✓ Values are the important part of ethics and the internal motivators for our actions ✓ Values are developed in childhood and result from such factors such as family, teachers, friends, religious tradition & culture. ✓ Usually, values remain unchanged after one reaches adulthood unless they’re changed by great spiritual or emotional distress or when it become apparent that an old value system doesn’t work anymore. BY Dr/Ibrahim Elbahwy 121 BY Dr/Ibrahim Elbahwy Traditional values of pharmacy profession ✓ Compassion ✓ Faithfulness ✓ Fairness ✓ Patience ✓ Responsiveness and kindness 122  ✓ Legal rights are either guaranteed fundamentally in the constitution or are provided by laws and regulations ✓ Moral rights Legal responsibility versus the right to live without fear of harm and moral obligation the right to food and shelter. Recently, health. ✓ Although pharmacist’s have a moral obligation to care for their patients, this obligation constrained by law. BY Dr/Ibrahim Elbahwy 123 Conflict between legal and morals ✓ Moral rights and legal rights may conflict e.g. Abortion Hippocratic Oath ✓ States that medical professionals have an obligation to-do, whatever is necessary to relieve the pain and suffering of their patients BY Dr/Ibrahim Elbahwy 124 BY Dr/Ibrahim Elbahwy Cultural competence ✓ Ability to provide care to patients with diverse values, beliefs, and behaviors, as well as tailoring to meet patients' social, cultural, and linguistic needs. ✓ This represents a lifelong developmental process with the goal of improving the quality of care for all patients. 125 Model for cultural competence ✓ A model for cultural competence will help pharmacists avoid biases and stereotypes. ✓ Step 1: Understanding that inequalities exist ✓ Minorities tend to receive a lower quality of health care even when factors such as income, age, disease conditions,and symptom expressions are controlled. BY Dr/Ibrahim Elbahwy 126 Step 2: Understanding one's own cultural biases ✓ Culture Is complex system composed of knowledge, beliefs, values, and patterns of behavior shared by member of groups. ✓ Dominant culture (mainstream culture) Collective cultural experience held and shared by the large majority of people ✓ Co-culture (sub-culture but it is problematic). Culture identities (specialized) that exist with in large culture. BY Dr/Ibrahim Elbahwy 127 ✓ Any society is comprised of two or more categories of culture. One can belong to several co-cultures that all affect how one thinks, feels, and behave. ✓ How a person interprets other cultures or co-, cultures often involves ethnocentrism ✓ Ethnocentrism ✓ The view that is one's own group or the group's way of life is superior to others. BY Dr/Ibrahim Elbahwy 128 Stereotyping ✓ The process by which people use social categories in acquiring, processing, and recalling information about others. ✓ Stereotypes help one organize and simplify complex or uncertain situations and give one confidence in his or her ability to understand and respond to a situation. ✓ However, stereotyping can be dysfunctional and inaccurate especially when one tries to ascribe a one-size-fits-all model to individuals. BY Dr/Ibrahim Elbahwy 129 Step 3: effective communication ✓ The biomedical approach Neglect psychosocial factors that often have a major role in explaining diseases. ✓ The narrative communicative approach Allows the patient to discuss his or her perceptions (observations & impression), concerns, attitudes, beliefs, and values regarding his or her health status. The narrative approach allows providers to build a treatment regimen with patients rather than to prescribe a treatment regimen for patients. BY Dr/Ibrahim Elbahwy 130 Step 4: implement the "learn" model guidelines ✓ Listen to the patient. (open ended question, followed by close ended question). ✓ Explain in a way that is easy to comprehend. ✓ Acknowledge the patient's point of view ✓ Recommend treatment while remembering the patient's cultural parameters. Do not force your own attitudes, beliefs, and values on patient, work with the patient to tailor a drug regimen that meets their specific needs. ✓ Negotiate an agreement. BY Dr/Ibrahim Elbahwy 131  Health care team relationship ✓ It must be teamwork & full of communication ✓ Pharmacist is just one component of the multi-professional team. ✓ The multi-discipline team needs to value and understand the contribution of all its members. ✓ The patient is the primary member and the focus of the activity. ✓ Other members of the team include (Medical practitioners, physiotherapists, radiologist, dieticians, nurses……). BY Dr/Ibrahim Elbahwy 132 Teamwork ✓ For the team to function effectively, role boundaries will need to be negotiated, so the roles and responsibilities are clarified. ✓ Effective teams result from understanding people and the way they work, realizing and valuing the fact that people are not all the same, but have different strengths which they can bring to the team as a whole ✓ Within the team each member remains responsible for their own practice. BY Dr/Ibrahim Elbahwy 133 ✓ The patient's health care records are a useful tool of communication within the team ✓ Each member responsible for maintaining their part of the records. ✓ Characteristics of the records ✓ Consecutive ✓ Clear ✓ Confidential BY Dr/Ibrahim Elbahwy 134 Principles of effective Communication ✓ Being greeted warmly ✓ Being listened to ✓ Receiving clear explanations ✓ Being re-assured ✓ Being able to express fear and concern ✓ Being respected ✓ Being given enough time ✓ Being treated as a person not just a case. BY Dr/Ibrahim Elbahwy 135 Trade-Related Aspects of Intellectual Property Rights (TRIPS) ✓ TRIPS Agreement is an international agreement administered by the World Trade Organization (WTO) that sets down minimum standards for many forms of intellectual property (IP) regulation applied between members. ✓ It was negotiated as part of General Agreement on Tariffs and Trade (GATT) in 1994 ✓ Protection of intellectual property rights contributes to the promotion of technological innovation and the transfer and dissemination of technology, in a manner to balance the rights and obligations between producers and users. BY Dr/Ibrahim Elbahwy 136 Patents in Developing and poor countries ✓ Patents have been criticized in the developing world, as they are thought to reduce access to existing medicines. In March 2001, 40 multi-national pharmaceutical companies brought a legal case against South Africa for production of HIV (aids disease). ✓ After international protest in favor of public health rights (Netherlands, Germany, France, and later the US) backed the South African government, and the case was dropped in April of that year. BY Dr/Ibrahim Elbahwy 137 ✓ In 2016, GlaxoSmithKline-GSK (the world’s 6th largest Pharmaceutical) announced that it would be dropping its patents in poor countries so as to allow independent companies to make and sell versions of its drugs in those areas, thereby widening the public access to them. GSK published a list of 50 countries they would no longer hold patents in, affecting 1 billion people worldwide. BY Dr/Ibrahim Elbahwy 138 Counterfeit medicines ✓ A previous WHO definition ✓ "A counterfeit medicine is one which is deliberately (intentional) and fraudulently mislabeled with respect to identity and/or source". ✓ Counterfeiting can apply to both branded and generic products ✓ Counterfeit products may include products with the correct ingredients or with the wrong ingredients, without active ingredients, with insufficient (inadequate quantities of ingredient(s). BY Dr/Ibrahim Elbahwy 139 ✓ WHO still use the term Substandard, Spurious, Falsely labeled, Falsified and Counterfeit (SSFFC) medical products. ✓ The term ‘Counterfeit’ is widely used to include falsified, unlicensed, falsely packaged, stolen and substandard medical products. ✓ It has become important to separate these different categories for the purposes of analysis and identifying strategies to address each issue. BY Dr/Ibrahim Elbahwy 140  ✓ Medicines out of specifications (OOS) are genuine medicines produced by authorized manufacturers which do not Substandard meet quality specifications set for them by National 1 4 1 authorities. Intentional versus Accidental ✓ It is very important to differentiate between deliberate intentional acts to mislead any person concerning a medical product as opposed to a non-deliberate or accidental manufacturing error or poor storage. ✓ No country is free of drug counterfeiting. ✓ WHO analysis shows that counterfeiting is greater in regions where regulatory and legal oversight is weaker. ✓ Most developed countries with effective regulatory systems and market control (e.g., USA, EU, Australia, Canada, Japan, New Zealand, etc.) BY Dr/Ibrahim Elbahwy 142 The problem is worsened by a number of other factors ✓ Scarcity and/or erratic supply of basic medicines ✓ Uncontrolled distribution (no intermediates). ✓ Large price differentials between genuine and counterfeit medicines ✓ Lack of effective intellectual property right protection ✓ Corruption in the health-care system. BY Dr/Ibrahim Elbahwy 143 Dangerous examples ✓ In 1995, 89 people died in Haiti in Germany after ingesting cough syrup manufactured with glycerin contaminated with diethylene glycol (a chemical commonly used as anti- freeze). ✓ A survey of seven African countries by WHO found that between 20% and 90% of all anti-malarial failed quality testing. BY Dr/Ibrahim Elbahwy 144 What kind of products are counterfeited most? ✓ Today, the most counterfeit branded pharmaceuticals include treatments for severe diseases (anticancer, heart diseases, anti cholesterol and antihypertensive drugs, psychologic disorders and infections) whereas before, counterfeit had more to do with lifestyle drugs. ✓ Generally, high volume (high consumption) and expensive medicines are the main targets of counterfeiters. BY Dr/Ibrahim Elbahwy 145 International Medical Products Anti Counterfeiting Taskforce (IMPACT) ✓ The WHO launched IMPACT in 2006. ✓ IMPACT is a taskforce of the WHO, dedicated to drug and medico-surgical material counterfeiting. ✓ IMPACT aims to set up guidelines into models to help countries in their fight against drug counterfeiting. BY Dr/Ibrahim Elbahwy 146 The prescription BY Dr/Ibrahim Elbahwy 147 ✓ A prescription is "the written order from the physician to the pharmacist for the preparation and dispensing of medicines to the patients". ✓ The Prescription order is an important therapeutic interaction between the physician, the pharmacist and the patient. ✓ The word "prescription" can be decomposed into "pre" and "script" and literally means, "to write before" a drug can be prepared BY Dr/Ibrahim Elbahwy 148 ✓ It contains the names and quantities of the desired drugs. ✓ It transfers instructions to the pharmacist for dispensing the medicines as well as to patients on how to take the prescribed medicines. ✓ The prescription must be written correctly and legibly for the correct supply of medicines. ✓ The world's first recorded prescriptions were engraved on a clay tablet in Mesopotamia around 2100 B.C. ✓ The first drugstores were established in the ancient city of Baghdad BY Dr/Ibrahim Elbahwy 149 A typical prescription consists of the following parts: ✓ Patient's name, address and date ✓ Superscription ✓ Inscription ✓ Subscription ✓ Transcription or signature ✓ Prescriber identity BY Dr/Ibrahim Elbahwy 150 Patient's name, address and date ✓ The prescription should bear the name, address, age, weight and date of the patient. ✓ This will help to prevent the possibility of misuse and errors. Further, name and address are legally essential for certain drugs, especially the narcotic drugs. ✓ Medicines differ for babies, children or adults. So, the age and weight are desired to confirm the suitability of doses of prescribed drugs. ✓ The date of prescription is important in medico-legal cases. BY Dr/Ibrahim Elbahwy 151 Superscription ✓ Inscription ✓ It is the main part of the prescription and so, it is called as 'body of the prescription’. ✓ It contains the names and amounts of remedial agents ✓ Drugs are written either by their official names or by their proprietary names followed by the dose in the metric system. ✓ Drug is written on a separate line directly under the preceding one. BY Dr/Ibrahim Elbahwy 153 The inscription of a compound prescription I. Basis: is the chief active ingredient from which the physician expects the true remedial effects. II. Adjuvant= auxiliary: It is a drug that intensifies or assists the action of the basis. III. Corrective (Flavoring agents and/or coloring agents): It is a drug that is used to correct, modify or overcome any undesirable effects of the basis and/or adjuvant, So it improves the effect, appearance or taste of the medicament. IV. Vehicle: A vehicle is no therapeutic activity. It is added to dilute the active ingredients to a reasonable dose size or to provide sufficient bulk. It is termed as ·'diluent' in case ·of liquids and powders and 'excipient' in case of pills and tablets and as 'base' in case of ointments. BY Dr/Ibrahim Elbahwy 154 Subscription ✓ The subscription includes the physician's directions to the pharmacist. ✓ It deals with the method of preparation of the medicine (mix and make a solution) ✓ In case of solid preparations as to the number of pills or tablets to be dispensed. BY Dr/Ibrahim Elbahwy 155 Transcription or signature ✓ It is abbreviated as "Sig" or "s". derived from the Latin word signatura which means "let it be labelled". ✓ The important details of the administration of the drug should be mentioned here, e.g., how to administer or apply the drug(s), its dose and time of administration. ✓ Physicians often write the directions in abbreviated Latin preceded by Sig to save time. So, pharmacist to express them in the ordinary common language when transcribing them on the label. BY Dr/Ibrahim Elbahwy 156 Prescriber identity ✓ The prescription must be signed by the prescriber, be dated and should bear his address. This is required as per drugs act. ✓ This is the final guarantee of the genuineness of the order. BY Dr/Ibrahim Elbahwy 157 Patient information Date Rx superscription Chloral hydrate 8 gm. Inscription Sodium bromide 10 gm. Syrup of raspberry 22.5 ml Water to 60 ml Fait : mix-mitte 100 ml subscription Sig: 3ml before bedtime Signature signa signature BY Dr/Ibrahim Elbahwy 158 Who can write prescriptions Generally, physicians, veterinarians, dentists have full prescribing power. Writing good prescriptions ✓ Careful use of decimal points to avoid ambiguity. ✓ Avoid unnecessary decimal points: 5 mL instead of 5.0 mL to avoid interference of 5.0=50 also, use 0.5 instead of.5 to avoid 5 mL. ✓ "mL“ is used instead of "cc" or "cm3 " even though they are technically equivalent ✓ Where the directions are "as needed" the quantity should always be specified. ✓ Where possible, usage directions should specify times (7 am, 3 pm, 11 pm) rather than simply frequency (3 times a day) and especially relationship to meals for orally consumed medication. ✓ Use permanent ink. BY Dr/Ibrahim Elbahwy 160 Legibility of prescriptions ✓ Prescriptions, when handwritten, are dangerous for being often unreadable. ✓ Contrary to popular belief, pharmacists do not have special decoding skills. ✓ When the prescription is difficult or almost impossible to read, you should call the doctor ✓ Patients are advised to ensure that the prescription is legible before leaving the doctor's office. ✓ computer printed prescriptions are becoming increasingly common in some places.. BY Dr/Ibrahim Elbahwy 161  Classes of prescription order a. Pre-compounded prescriptions 162 b. Extemporaneous or compounded prescriptions c. Narcotic prescriptions. BY Dr/Ibrahim Elbahwy The narcotic prescription must include ✓ The name, address and registration number of the prescriber. ✓ The date when written, the name and address of the patient must also be included ✓ The narcotic prescription must be written by ink or typewriter. ✓ The quantity of narcotic substance must be written in words and numbers. ✓ By the law in Egypt, no prescription order for controlled substances may be dispensed more than 5 days after the date prescribed. ✓ Narcotic prescriptions must be kept in a separate file. BY Dr/Ibrahim Elbahwy 163  Example for Narcotic prescription 1. Patient's name…………..age………….address………… 2. Date………. 164 3. R/ 4. Codeine phosphate 20(twenty) mg 5. Fiat: Capsule, Mitte 16 (sixteen) Caps. 6. Signa: One Capsule Four times a day BY Dr/Ibrahim Elbahwy 7. Prescriber's name: Address: Registry no.: Signature: Dr………….. Checking the compatibility of the prescribed drugs ✓ Some drugs may affect the efficacy of others. They may decrease, increase, or even totally alter the effect of co-administered drugs. ✓ These drugs which exhibit drug-drug interactions are known to be incompatible drugs. BY Dr/Ibrahim Elbahwy 165 Drug incompatibility Physical incompatibility ✓ E.g., precipitation, complexation, liquefaction, etc. ✓ Physical incompatibility can be easily corrected Chemical incompatibility ✓ E.g., Oxidation-reduction reaction, acid-base reactions, hydrolysis. ✓ Chemical incompatibility can be overcome by the pharmacists by using their knowledge of chemistry Therapeutic incompatibility BY Dr/Ibrahim Elbahwy 166 Therapeutic incompatibility Drug synergism ✓ The response increases by the co-administration of the incompatible drug Drug antagonism ✓ The response decreases by the co-administration of the incompatible drug Contraindicated ✓ Should not be administrated together BY Dr/Ibrahim Elbahwy 167  Packaging ✓ Selection is based primarily on the type and quantity of medication to be dispensed and the method of its use. Types of containers generally used in pharmacy BY Dr/Ibrahim Elbahwy 169  Prescription bottles For dispensing tablets Prescription bottles come in several different colors, the most common of which being orange or light brown due to its ability to prevent ultraviolet light from degrading the potentially photosensitive contents through photochemical reactions. Bottles would often include cotton to cushion powdery, breakable pills. In modern times, pills are coated, and thus the inclusion of a cotton ball is no longer necessary. It is recommended to remove any cotton balls from opened pill bottles, as cotton balls may attract moisture into the bottle. BY Dr/Ibrahim Elbahwy 170 Dropper bottles For dispensing ophthalmic (eye), nasal (nose), otic (ear) or oral liquids BY Dr/Ibrahim Elbahwy 171 Applicator bottles ✓ For applying liquid medications to a wound or skin surface BY Dr/Ibrahim Elbahwy 172  For semisolid dosage forms such as ointments Ointment jars and and creams collapsible tube BY Dr/Ibrahim Elbahwy 173  ✓ For powders to be applied by sprinkling Sifter top container BY Dr/Ibrahim Elbahwy 174 Hinged lid container For dispensing suppositories and powders prepared in packets BY Dr/Ibrahim Elbahwy 175 Aerosol containers ✓ For pharmaceutical aerosol products, they are pressurized systems dispensed by the pharmacist in the original container. BY Dr/Ibrahim Elbahwy 176  Amber-colored ✓ Are used most widely because they provide maximum protection of their light-sensitive contents against photochemical deterioration BY Dr/Ibrahim Elbahwy 177  Thank you 178 BY Dr/Ibrahim Elbahwy