Pharmacology Lecture-II.pptx
- 1. Introduction to Pharmacology Lecture-II By: Muhammad Aurangzeb BSN, MSPH, MSN Lecturer-INS/KMU
- 2. Objectives At the end of presentation learners will be able to: • Describe the types of drug supply system. • Discuss the drugs standards and legislation. • Identify resource to collect and utilize drug information. • Learn to prepare drugs cards
- 3. Drugs Supply • Drugs supply is defined as the system of drug procurement, storage, and distribution • Efficient drugs supply systems are integrally linked to strong health care systems. • Adequate human resources, sustainable financing, comprehensive information systems, and coordinated healthcare partners and institutions are key components to ensure uninterrupted availability and accessibility of essential medicines
- 4. According to WHO, an efficient drugs supply system should undertake the following function • Selection of Essential Medicines • Quantification and Forecasting Demand for Medicines • Procurement of medicines • Storage of Essential Medicines • Distribution of medicines Drugs Supply
- 5. Drugs Distribution in the Hospitals • Drugs distribution is defined as: “physical transfer of medicines from storage area in the hospital to the patient’s bedside.” • This involves two types of drugs distribution. They are: 1. Inpatient 2. Outpatient
- 6. Out-patient Department (O.P.D) • Out patientrefers to patients not occupying beds in a hospital, clinics, health centers • The patients with minor and common illness go to O.P.D for consultation to the physician
- 7. Classification of Out-Patients • The patients visiting the OPDs may categorized as 1. General Patients e.g. diabetic patients, hypertensive patients 2. Emergency Patients e.g. heart attack, epilepsy patients 3. Referred Patients e.g. Patients suffering from eye, ear, nose and teeth disorders
- 8. In–Patient Services • The drug distribution to the inpatient department can be carried out from the outpatient dispensing area. • The staff involved in dispensing the drugs for outpatient can dispense drugs for inpatients too. • If the work load seems to be heavy then additional personnel can be employed.
- 9. Types of Drugs Distribution Systems There are 4 systems for inpatient drug distribution 1. Individual prescription order system 2. Complete floor stock system 3. Combination of above mentioned 4. Unit dose dispensing method
- 10. 1) Individual Prescription Order System • In this system, the physician write the prescription and ask the patient or the relative of the patient to get the medicine from any licensed medical store or hospital dispensary by paying own charge • This system is mainly used in small or private hospitals because of its economic consideration and reduced manpower requirements Advantages: • Less numbers of staff is required • All medication orders are directly reviewed by pharmacist • It provides a closer connection among pharmacist, physician, nurse and the patient • It provides closer control of inventory
- 11. Disadvantages • There may be possible delay in obtaining the required medications for administration to the patient • Emergency medicines are not quickly supplied • Increase in the cost to the patient
- 12. 2) Complete Floor Stock System • Drugs are stored at the nursing station and are administered by a nurse according to the chart order of the physician • Only commonly used drugs are stocked on the floor Advantages: • The drugs are readily available for administration • Minimum return of drugs • Reduced in-patient prescription orders • Reduction in number of pharmacy personnel required
- 13. Disadvantages • Increase in chance of medication errors, ADRs • Increase in drug inventory • Increase chances of drug deterioration due to lack of proper storage facilities and due to unnoticed drug degradation • Increased workload on nurses • There is more chance of drug stealing
- 14. Drugs on the nursing station are known as Floor Stock Drugs NON-CHARGE FLOOR STOCK DRUGS FLOOR STOCK DRUGS CHARGE FLOOR STOCK DRUGS
- 15. A)Dispensing of Charge Floor Stock Drugs • These are drugs for which patient is charged for every single dose administered to him • Selection of these drugs is made by Pharmacy and Therapeutic committee • Charge floor stock drugs are stored at various nursing stations • An envelope is used to dispense such drugs
- 16. B) Dispensing of Non-charge Floor Stock Drugs • These are medicaments placed at the nursing station for the use of all patients on the floor • These are cheaper and commonly used drugs • The costs of these drugs are included in to the day to day expenditures of the hospitals
- 17. 3) Combinations of Individual Prescription Order and Floor Stock System • It is a type of drug distribution system that uses individual prescription or medication order system as their primary means of dispensing but also utilize a limited floor stock • This system is followed by in the governments and private hospitals who run on the basis of no profit and no loss
- 18. 4) Unit Dose Dispensing • Unit dose medication is defined as those medications which are ordered , packaged, handled, administered and charged in multiples of single doses units containing predetermined amount of drugs or supply sufficient for one regular dose, application or use.
- 19. Advantages • Patient receives improved services and are charged for only those doses which are administered • Nurses get more time for direct patient care • Medication errors are reduced • More spaceis available in nursing station by eliminating bulky floor stock • It eliminates wastage of drug and pilferage
- 20. Disadvantages • It requires separate man power for pre-packaging. • It requires increased number of skilled personnel in the pharmacy • Separate containers, closures, machinery and also space is required
- 22. 1. Centralized Unit Dose Drug Distribution System • All in-patient drugs are dispensed in unit doses and all the drugs are stored in central area of the pharmacy and dispensed at the time the dose is to be given to the patient • To operate the system, delivery devices such as medication carts or pneumatic tubes are required
- 24. 2. Decentralized Unit Dose Drug Distribution System • This operates through small satellite pharmacies located on each floor of the hospital • The main pharmacy is for procurement, storage, manufacturing and packing Procedure: • Patient profile cardis prepared upon admission to the hospital • Prescriptions are sent directly to the pharmacists
- 25. Cont… • Pharmacists checks the medication orders • Junior pharmacists picks medication order and place drugs in cart • Pharmacist check cart prior to release • The nurse administers the drugs and make the entry in their records • Upon return to the pharmacy the cart is rechecked
- 26. Dispensing of Controlled Drugs: • These drugs should kept under lock and key • A separate register should be maintained to register them PROCEDURE • Medical superintendent is overall responsible for handling of controlled drugs. • Chief pharmacist procures, stores and dispense the drugs
- 27. Cont… Prescription of narcotic drugs under Narcotics and psychotropic substances act 1985 must include following information • Patients full name • Address • Date • Name and strength of drug • Quantity of drug • Signature of prescriber • Dose and route of administration
- 28. Cont… • If the required drug is not in the stock, the complete controlled drug prescription must be written on hospital prescription blank form by registered medical practitioner and signed • Delivery of narcotic drugs from pharmacy to wards should be carried out by reliable person • After dispensing, nurses resume responsibility for administration, control and auditing of the inventory • If patient refuse or doctor cancels any dose , nurse should destroy the drug in to sink and record “Refused by patient” or “Cancelled by doctor”
- 29. Drug Regulation and Legislation • Drug regulation is the control of drug use by international agreement and/or by regulatory authorities such as Food and Drug Administration (FDA), the European Medicines Agency (EMA) and the Pharmaceutical and Medical Devices Agency (PMDA). • Pharmacopeias also regulates drugs and makes various legislation for drugs
- 30. Resources to Collect and Utilize Drug Information Primary Resources • Researcher’s and manufacturer’s information • Scientific journals • Provide original studies or reports E.g. Clinical trial, case series, case report Secondary Resources • Abstract or index which summarizes the information arising in primary source
- 31. Cont…… Tertiary Resources • Textbooks • handbooks • online drug compendia Selected websites • http://dda.gov.np/ • http://www.nepalpharmacycouncil.org.np • http:www.nhrc.org.np/
- 32. General Considerations when Examining and Using Textbooks a) The author , publisher , or both: What are the author 's and publisher's areas of expertise? b) The year of publication (copyright date) or last revision date? c) The edition of the text : Is it the most current edition? d) The presence of a bibliography: I f a bibliography is included, are important statements accurately referenced? :
- 33. Cont,…… e) How accessible is the information? f) Alternative resources that are available (e.g. , primary and secondary sources, other relevant texts)
- 34. Other Sources • Libraries Research associations • Government bodies Information center in industries • Analyst labs
- 35. Drug Cards
- 36. Drugs card
- 37. Drug Recomm ended dose Half life /T max Route of adminis tration Indication Contraindicat ions Adverse effects Toxic effects Route of eliminati on Digoxi n 0.25mg IV 40 hours/1Hr Oral/IV CHF, atrial fibrillation Digitalis toxicity, ventricular tachycardia Ventricular fibrillation, obstructive cardiomyopat hy Dizziness, mental disturbances, diarrhea, headache, nausea and vomiting. Bradyarrhyth mias, cardiac arrest heart block ventricular fibrillation ventricular tachycardia hyperkalemia Kidneys Digito xin 1.5-2 ug p/o 160 hours/1-3 Hrs Oral/IV CHF, atrial fibrillation, ischemic heart disease. hypersensitivity reaction, thrombocytopeni a, confusion, Liver Ouaba in 0.42 mg/kg p/o, 0.004 mg/kg i/v 20 hours/ 0.5-1 Hr Oral/IV CHF, atrial fibrillation Nausea, vomiting and pulse irregularities Kidneys
- 38. References • Goyal RK, Parikh RK, Patel MM. A Text book of Hospital Pharmacy.13th edition. Ahmedabad: BS Shah Prakashan; 2015. 101-123. • Nand P , Khar RK. A Textbook of Hospital and Clinical Pharmacy. Delhi: Birla publishers; 2009. 53-70.