RJAV - Dispensing

Cards (100)

  • Dispensing
    The act by a validity-registered pharmacist of filling a prescription or doctor's order on the patient's chart
  • Requirements in dispensing
    • Receiving and validating
    • Interpreting the prescription and filling
    • Packaging and labeling
    • Rechecking
    • Dispensing
    • Medication Advice or Patient Counselling
    • Recording and Filling
  • Good Pharmacy Practice (GPP)

    Practice of pharmacy that responds to the needs of the people who use the pharmacists' services to provide optimal, evidence-based care
  • Mission of pharmacy practice

    To contribute to health improvement and to help patients with health problems to make the best use of their medicines
  • Roles of pharmacists
    • Academe
    • Regulatory
    • Manufacturing
    • Community, Hospital, Institutional
    • Public Health
  • Prescription
    Written order and instruction of a validity registered physician, dentist or veterinarian for the use of a specific drug product (or medical device) for a specific patient
  • Parts of a prescription
    • Prescriber info
    • Date – valid for 1 month
    • Patient info
    • Superscription – recipe
    • Inscription
    • Subscription
    • Transcription
    • Prescriber signature and license
  • Commonly used abbreviations in prescription & medication order
    • aa - of each
    • abd -Abdomen
    • ac - before meals
    • ad - To, up to
    • a.d - Right ear
    • ad lib - At pleasure, freely
    • AM - morning
    • amp - Ampule of medication
    • aq - water
    • a.s - left ear
    • ASA - Aspirin
    • ATC - around the clock
    • au - each ear
    • BCP - Birth Control Pill
    • bid - Twice a day
    • BM - Bowel movement
    • BP - Blood Pressure
    • BPH - Benign prostatic hypertrophy
    • BS - Blood sugar
    • BSA - Body Surface Area
    • c - with
    • Ca - Calcium
    • CAD - Coronary Artery Diseases
    • DJD - Degenerative joint disease
    • DM - Diabetes mellitus
    • DO - Doctor of osteopathy
    • DW - Distilled water
    • Dx - Diagnosis
    • elix - Elixir
    • EtOH - Ethanol
    • Ft - Make, let it b made
    • g - Gram
    • GERD - Gastro esophageal reflux Disease
    • GI - Gastrointestinal
    • GU - Genitourinary
    • gr - grain
    • gtt - a drop
    • HA - Headache
    • HBP - High blood pressure
    • HCTZ - Hydrochlorothiazide
    • HR - Heart rate
    • HRT - Hormone replacement therapy
    • hs- at bed time
    • HTN - hypertension
    • inj - an injection
    • IV - Intravenous injection
    • IM - Intramuscular injection
    • ID- Intradermal injection
    • IU - International unit
    • JRA - Juvenile rheumatoid arthritis
    • KCl - Potassium Chloride
    • kg - kilogram
    • L - liter
    • mcg - microgram
    • mEq - milliequivalent
    • mg - milligram
    • mg/kg - milligrams/kilogram
    • mg/m2 - milligrams/square meter
    • ml - milliliter
    • mOsmol - milliosmole
    • min - minimum
    • MOM - Milk of Magnesia
    • MS - Morphine Sulfate
    • MTX - Methotrexate
    • MVI - multivitamins
    • m - mix
    • N&V - Nausea and vomiting
    • non rep/NR - Do not repeat
    • noct - at night
    • NS - Normal Saline
    • NTG - Nitroglycerine
    • OA - Osteoarthritis
    • OCD - Obsessive compulsive disorder
    • OJ - Orange Juice
    • O2 - Oxygen
    • ou - Each eye
    • od - Right eye
    • os - Left eye
    • P - Pulse
    • pc - after eating
    • PEFR - Peak expiratory flow rate
    • pm - evening
    • qid - four times daily
    • qod - every other day
    • qs - as much as is sufficient
    • qs ad - a sufficient quantity to (prepare)
    • qh - every hour
    • RA - rheumatoid arthritis
    • RN - Registered Nurse
    • Rect - use rectally
    • s - without
    • ss - one-half
    • SC - Subcutaneous injection
    • Sig - write on label
    • SL - Sublingual
    • SLE - Systemic lupus erythematous
    • SOB - Shortness of breath
    • sol - Solution
    • SQ or SubQ - Subcutaneous injection
    • stat - immediately
    • sup - Suppository
    • Susp - Suspension
    • Sx - Symptom
    • syr - Syrup
    • T - temperature
    • TB - tuberculosis
    • TCN - Tetracycline
    • TED - Thromboembolic disease
    • TIA - Transient ischemic attack
    • tid - three times a day
    • tiw - three times a week
    • tbsp. - tablespoon
    • TMP-SMX - Trimethoprim-sulfamethoxazole
    • tsp - teaspoon
    • top - (use) topical
    • Tx - treatment
    • U - unit
    • UA - Uric acid, urinalysis
    • UC - Ulcerative colitis
    • ud - as directed
    • ung - ointment
    • URI - Upper respiratory infection
    • ut dict - as directed
    • UTI - Urinary tract infection
    • WA - while awake
    • wk - week
    • caps- Capsule
    • cc - cubic centimeter (ml)
    • CHF - Congestive heart failure
    • COPD - Chronic obstructive pulmonary disease
    • CP - Chest pain
    • dil - dilute
    • dtd - let such doses be given
    • DC - Discontinue medication
    • DES - Diethylstilbestrol
    • disp - Dispense
    • div – Divide
  • Medication error
    Information to be included: patient info (including room number), date (including time), medication prescribed, prescriber's name, transcriber's signature
  • Dangerous drugs prescription

    Issued by PDEA, requires S2 license, for dangerous drugs, partial filling allowed, no refills, triplicate (yellow - pharmacist, white - physician, green - patient)
  • Drugs requiring S2 license

    • Alprazolam
    • Bromazepam
    • Clonazepam
    • Codeine (as phosphate)
    • Diazepam
    • Fentanyl (as citrate)
    • Ketamine
    • Methylphenidate
    • Midazolam
    • Morphine (as sulfate)
    • Nalbuphine
    • Oxycodone
    • Phenobarbital
    • Pethidine (meperidine)
    • Remifentanil
    • Zolpidem
  • Dangerous drug categories

    • Barbiturates
    • Benzodiazepines
    • Opioids
  • Schedule I drugs
    • No currently accepted medical use in treatment in the Philippines, lack of accepted safety for use of the drug under medical supervision
  • Schedule II drugs

    • High potential for abuse, currently accepted with medical use but with some restrictions, can lead to severe psychological or physical dependence
  • Schedule III drugs

    • Potential for abuse less than Schedule II or/and abuse may lead to moderate or low physical dependence or high psychological dependence
  • Schedule IV drugs

    • Low potential for abuse relative to drugs in Schedule III, abuse may lead to limited physical dependence or psychological dependence
  • Schedule V drugs

    • Low potential of abuse than Schedule IV, consist primarily and preparations containing limited quantities of certain narcotics, generally used as antitussive, antidiarrheal and analgesic purposes
  • Generic prescribing offenses

    • Erroneous: Brand name comes before generic name, Generic name is the one in parenthesis, Brand name not in parenthesis
    • Violative: Only brand name is written, Brand name is more legible/ prominent than the generic name, Brand name is also written, but with instructions that prevent other brands to be used
  • Schedule V

    Has low potential of abuse than Schedule IV and consist primarily and preparations containing limited quantities of certain narcotics. These are generally used as antitussive, antidiarrheal and analgesic purposes
  • Schedule V drugs

    • Pregabalin (Lyrica)
    • Brompheniramine/Codeine (Nelex Ac)
    • Locosamide (Vimpat)
    • Atropine/ Diphenoxylate (Vi-Atro)
    • Codeine/Phenylephrine (Ala-Hist)
    • Codeine/Phenylephrine/Pyralamine (Codimal PH)
    • Codeine/Phenylephrine/Tripolidium (Arislex Ac)
    • Brompheniramine/ Codeine/ Phenylephrine (Brovex PBC)
    • Chlorpheniramine/Codeine/Pseudophedrine (Co-Histine OH)
    • Codeine/Guiafenesin/Phenypropanolamine (Enditussin Exp)
  • Generic prescribing offenses

    • Erroneous
    • Violative
    • Impossible
  • Erroneous
    • Brand name comes before generic name
    • Generic name is the one in parenthesis
    • Brand name not in parenthesis
    • Dispense, report
  • Violative
    • Only brand name is written
    • Brand name is more legible/ prominent than the generic name
    • Brand name is also written, but with instructions that prevent other brands to be used (ex. "no substitution")
    • Do not dispense, report
  • Impossible
    • Generic name and/ or brand name is written, and both are not legible
    • Generic name does not correspond to the brand name
    • Drug prescribes is not registered with Philippine FDA
    • Do not dispense, report
  • Prescription record keeping

    • Prescription record book – keep for 2 years
    • Dangerous drug record book – kept for 1 year
    • Poison book – keep for 5 years
  • Filling the order: Compounding/ Dispensing

    • Retrieval
    • Tall man lettering
    • Extemporaneous compounding
    • Sterile compounding
  • Retrieval
    • Be careful with SALAD/ HAM
    • Sound alike look alike
    • High alert medications: (narrow Therapeutic Index)
    • Tablet counter
    • Reconstitution
    • Mixing
    • Medication counselling in dispensing
    • Use of medical devices
  • Tall-man Lettering

    • From US FDA, ISMP – Institute for Safe Medication Practices
    • Examples: acetaZOLAMIDE vs. acetoHEXAMIDE, buPROPion vs. busPIRone, chlorproMAZINE vs. chlorproPAMIDE, cycloSERINE vs. cycloSPORINE, DOBUTamine vs. DOPamine, hydrALAzine vs. hydrOXYzine
  • Extemporaneous compounding

    • Label
    • Content
    • Name of components
    • Quantity
    • As written in the Prescription
    • Expiry date
    • Auxiliary label
    • Prepared by
    • Date of preparation
  • Sterile compounding

    • Aseptic techniques
    • Terminal sterilization
  • Aseptic techniques

    • Laminar airflow hood
    • Vertical LAF – do not stack
    • Horizontal LAF – do not block
  • Terminal sterilization methods

    • Moist heat (Autoclave)
    • Dry heat (Oven)
    • Membrane filtration
    • Gas (Ethylene oxide)
    • Ionizing radiation (Gamma rays)
  • Moist heat

    Protein coagulation, Autoclave (121°C, 15psi, 15-30mins)
  • Dry heat

    Oxidation, Oven (160°C., 2-4hrs)
  • Gas
    Alkylation, Ethylene oxide (carboxide: 10% EtO + 90% CO2)
  • Ionizing radiation

    DNA mutation, Gamma rays
  • Types of incompatibility

    • Physicochemical Incompatibility
    • Therapeutic Incompatibility/ Drug interaction
  • Physicochemical Incompatibility

    Problem that may arise when two or more drugs are combined during compounding, dispensing or administration, directly observable
  • Therapeutic Incompatibility/ Drug interaction
    When 2 or more drugs are administered and response is different from intended, Precipitant drug: causes interaction, Object drug: affected by interaction
  • Manifestations of physicochemical incompatibility

    • Formation of precipitate
    • Change in color or odor
    • Formation of gas
    • Change of physical state from solid to liquid