Gomalion Pharmacists گوملین فارماسسٹ

Key Performance Indicators KPI Certificate Course

2023-05-20T07:19:00.002-07:00

Key Performance Indicators (KPI) Certificate Course That is designed to help organizations measure and improve performance. The course covers topics such as creating and using KPIs, setting goals and objectives, and analyzing and interpreting data. It also provides guidance on how to use KPIs to improve the quality and safety of organizations.

JCI Medication Management and Use (MMU) Certificate Course

2023-03-17T00:13:00.004-07:00

The Joint Commission International (JCI) is an international organization that sets standards for healthcare organizations and provides accreditation services. JCI's Medication Management and Use Standard is designed to ensure safe and effective medication use in healthcare organizations. It includes requirements for prescribing, dispensing, administering, and monitoring medications, as well as proper storage and disposal.

Basic Medication Safety Course

2023-01-19T07:51:00.002-08:00

Basic Medication Safety Course, that is designed to help healthcare providers prevent medication errors and ensure patient safety. The course covers topics such as medication use, medication errors, medication safety systems, and patient education. It also provides tips and strategies to help healthcare providers reduce the risk of medication errors.

Basic Medication Safety Course

SAUDI COMMISSION FOR HEALTH SPECIALTIES (SCHS) – SAUDI ARABIA Stepwise Procedure

2022-02-24T07:56:00.000-08:00

PRIMARY SOURCE VERIFICATION

SAUDI COMMISSION FOR HEALTH SPECIALTIES (SCHS) – SAUDI ARABIA

A STEP BY STEP GUIDE FOR COMPLETING YOUR APPLICATION

IF YOU ARE INDIVIDUAL APPLICANT;

Step One

· Visit www.dataflowgroup.com

· Click on the Saudi Commission for Health Specialties (SCHS) logo.

· Select the “INDIVIDUAL” button.

· Log in using your Email ID and Password.

· If your forgot your password , click the “Forgot Password” button – after which you will receive your new password at your registered email.

Step Two

· If you are a new user, click the “Register Here” button and fill the requested fields.

· If you enter your Eligibility Number, partial details will prepopulate on the portal. Otherwise, you will be required to submit a full application.

Step Three

· Following login, you will land on the “Personal Details” page.

· Enter your personal details, then click “Next” to proceed to the “Education Details” page.

Step Four

· Enter your educational details, then click “Next” to proceed to the “Employment” page.

· You can add multiple components, if required. However, you will incur additional charges for each.

Step Five

· Enter your employment details, then click “Next” to proceed to the “License” page.

· You can add multiple components, if required. However, you will incur additional charges for each.

Step Six

· Enter your health license details, then click “Next” to proceed to the “Letter of Authorization” page.

· You can add multiple components, if required. However, you will incur additional charges for each.

Step Seven

· Upload a signed and scanned copy of your Letter of Authorization.

· Click “Next” to proceed.

Step Eight

· Carefully review your application, then click “Next” to proceed to the payment gateway.

Step Nine

· Review the auto-calculated amount.

· Once you settle your payment, you will be redirected to the portal with a thank you message and payment confirmation email.

Note: Once validation of your submitted documents is complete, a payment receipt will be issued via a separate email for your respective application.

Note: Share your feedback about your application process by selecting one of the emoticons displayed on the page.

IF YOU ARE A FACILITY;

Step One

· Visit www.dataflowgroup.com

· Click on the Saudi Commission for Health Specialties (SCHS) logo.

· Select the “PRO” button.

· Log in using your Email ID and Password.

· If you forgot your password, click the “Forgot Password’ button – after which you will receive your new password at your registered email.

Step Two

· If you are a new user, click “Register Here” and fill the requested fields.

· If you enter your Eligibility Number, partial details will prepopulate on the portal. Otherwise, you will be required to submit a full application.

Step Three

· Enter your personal, education, employment, and health license details, then click “Next” to proceed.

Note: You will be charged based on the package selected and the additional components entered.

Note: Saving details will save the application(s) to the cart summary page.

· To initiate multiple applications, click on the “Add Application” button.

· To make payment in person, visit the SCHS counter and submit the application(s).

· To make a payment via credit card, select the application(s) - after which you will be redirected to the payment summary page.

Note: Once you settle the payment(s), you will be redirected to the portal with a thank you message and payment confirmation email

Note: Once validation of your submitted documents is complete, a payment receipt will be issued via email for your respective application(s).

ACCREDITATION AND REGISTRATION (MUMARIS PLUS SYSTEM0

Step 1

· Sign Up

Step 2

· Put your active Email

Step 3

· Open your email and click the verification link to activate

Step 4

· After activation of your account, you can now LOG IN

Step 5

· Complete your profile

Step 6

· After completing your profile, click on My Service

Step 7

· New applicants click on Professional Classification

Step 8

· Upload all the requirements (scanned)

8.1 Academic qualification.

8.2 Transcript of records or grades.

8.3 certificate of registration/ professional license ID.

8.4 practical training or internship training certificate.

8.5 Previous work experience certificate.

8.6 Authentication or verification result from dataflow group.

- Academic qualification

- Registration/ license

- Work Experience

8.7 Identification letter from current employer (verification from HR/MSD/Military).

8.8 personal identification (national id for Saudi, passport and iqama for non Saudi).

8.9 Photograph/picture.

8.10 Medical report for 65 years old and above.

8.11 Prometric or pearson veu exam result (if available).

Step 9

· After you upload all the requirements make payment through sadad.

Step 10

· After approval print the certificate and submit to HR and to your Department.

For further enquiry

Ph Ijaz Hussain

Hafar Al Batin kigdom of saudi arabia

Ijaz_hussain_20@yahoo.com

Medication Management and Use Plan Template (JCI Requirement)

2021-12-02T05:49:00.004-08:00

1. PURPOSE:

1.1. To establish a process for medications, use in the organization that complies with applicable laws, regulations and organized to meet patient needs.

1.2. To ensure efficient and effective medication management system and use throughout the organization.

2. APPLICABILITY:

2.1. Pharmaceutical Services department.

2.2. Pharmaceutical and therapeutic team.

2.3. Nursing department.

2.4. Medical Departments

2.5. Logistics department.

2.6. All departments in which pharmaceutical products are stored.

3. POLICY:

3.1.1. As per (Organization Name) Medication Management and Use plan, all information and experience related to the hospital system shall be utilized in the hospital systems review annually. This will allow (Organization Name) to understand the need and priority of continued system improvements in quality and safety of medication usage.

3.1.2. The effective medication management program shall include all parts of the hospital’s inpatient and outpatient.

3.1.3. All settings, services and individuals that manage the medication process are included in the organizational structure.

3.1.4. The Medication Management and Use Plan will be reviewed annually to ensure efficient and effective medication management and use, the review includes the elements of Medication Management Program.

3.1.5. Selection and procurement of the medication.

3.1.6. Storage (including Hazard Drug storage)

3.1.7. Ordering and transcribing

3.1.8. Preparing and dispensing

3.1.9. Administration and monitoring

3.1.9.1.1.The Continuous Quality Improvement Department of the hospital shall receive regular reports of the activities of the medication management from the Pharmacy and Therapeutics Committee.

3.1.9.1.2. The Continuous Quality Improvement Department shall review the reports and as appropriate, communicate concern about identified issues back to the chairman of pharmaceutical care services and to the clinical staff.

3.1.9.1.3.The Pharmacy and Therapeutics committee oversees the medication management system in the hospital, develops and approves the policies and procedures, coordinates the required training program, and initiate the quality improvement projects.

3.1.9.1.4.The Director of Pharmaceutical care Services Department shall also collaborate with the Chairman of the Pharmacy and Therapeutic Committee develop reports of medication management program, these will be presented to the Pharmacy and Therapeutics committee meeting including any change in the drug formulary, performance management and improvement activities, and any other medication issues.

3.1.9.1.5.Licensed pharmacy staff are responsible for implementing the appropriate organizational, departmental, and job descriptions required to achieve the highest level of medication management and minimize the potential of diverse outcomes of care and patient safety.

3.1.9.1.6.Pharmacy and Therapeutics committee has recommended and standard precautions or universal precautions be taken in handling hazardous drugs. Given the addition of many non –antineoplastic drugs, drugs in tablet and/or capsule form to the list, no single approach can cover the diverse potential occupational exposures to the drugs. The current NIOSH approach involves three groups drugs:

3.1.9.1.7.Group 1: Antineoplastic drugs (AHFS Classification 10:00) (ASHP/AHFS DI 2013). Note that many of these drugs may also pose a reproductive rick for susceptible populations.

3.1.9.1.8.Group 2: Non-antineoplastic drugs that meet one or more of the NIOSH criteria for a hazardous Drug. Note that some of these drugs may also pose a reproductive risk for susceptible populations.

3.1.9.1.9.Group 3: Drugs that primarily pose a reproductive risk to men and women who are actively trying To conceive and women who are pregnant or breast feeding, because some of these drugs may be present In breast milk .

4. PROCEDURE:

4.1 Elements of Medication Management and Use Program Plan

4.1.1 Planning / Procurement:

A. Hospital develops the medication list of all medication stocked normally in the hospital (drug formulary list).

B. The Pharmacy and Therapeutics committee maintain and monitor the medication list and to monitor the use of medication in the hospital and any new medication added to the formulary for 6 months.

Drug formulary list is listed alphabetically and includes complete drug monograph.
The list reviewed annually based on emerging safety and efficacy information, medication error and adverse drug events.
Drug formulary list is distributed to all medical staff and nursing units through hospital information System.
Physicians makes request for adding or deleting medications from the drug formulary list, then Reviewed and evaluated by Clinical Pharmacist , then approved by Pharmacy and Therapeutics Committee.

4.1.2 Drug Shortages:

Medical supply arranges the drug from other sources when not available in the hospital: such as local drug agents, or other hospitals.
Pharmacy provides notification information to all concerned for long term shortage.
Pharmacist selects available drug as alternative, with its generic equivalent drug, when the prescribed drugs is out of stock and then advises the prescriber on the substitution.
Emergency medication not available in the pharmacy is brought to the patient within 24 hours through proper communication with other hospitals.

4.1.3 Storage:

The medications are stored in the hospitals in the following areas:
A1) Pharmacy
A2) Hospital Wards
Medication is stored under conditions suitable for product stability.
Temperature for all mediations and IV solutions storage areas are monitored and ensure the stability within the normal range by air condition refrigerator.
Pharmacy observes all check list for temperature of medication storage areas, also sign and write frequency.
Narcotic and controlled medications are stored in special cabinets that have double lock and accurately accounted according to the Ministry of health and Saudi Food Drug Authority laws and regulations.
Medications and chemicals used to prepare mediations (extemporaneous preparations) are labelled with open date, the contents, expiry date and special warnings.
The (Organization Name) has a safe and secure system for the storage and safe management of hazardous medications and pharmaceutical chemicals ((Organization Name) System for Hazardous Medications).
Concentrated electrolytes are stored in a separated cabinet and also locked and labelled with blue label in critical areas (e.g. ICU, ER & OR).
Emergency medications are stocked in the wards in safe and secured places with policies and procedures for also monitoring.
Medication stock areas are inspected monthly by In-Patient Pharmacists.
Hazardous drug are stored in proper manner:
L1) Hazardous medications and pharmaceutical chemicals are stored separately following alphabetical system on low shelves as possible and in the original labelled containers.
L2) Flammables and volatile substances are stored in appropriate safety cabinets in well ventilated areas.
L3) The spill kits and personal protective equipment (PPE) are readily available.
L4) Pharmacy Staff involved in the handling of chemicals and hazardous medications who are attempting to conceive, pregnant, or breast feeding, a structured process is in place to review potential exposure risks and offer alternative work assignment.
L5) Material safety data sheets (MSDS) for all available hazardous medications and pharmaceutical chemicals are available accessible to pharmacy staff.
L6) Eyewash station and emergency water shower (when available) are available where hazardous
Medications and pharmaceutical chemicals are located.

4.1.4 Ordering and Transcribing:

The Pharmacy Therapeutics committee develop the policies and procedures that guide the safe Prescribing, ordering and transcribing of the medications.

The organization defines the elements of a complete order or prescription and the type of orders that are acceptable to use.
All medication information is kept in patient medical records.
Attach policy with prohibited abbreviations not to be used to prevent medication error.
Establish policy for receiving verbal or telephone order that are countersigned by the prescriber within 24 hours.

4.1.5 Preparing and Dispensing:

A. The pharmacy receives medication order electronically via computerize physician order entry to ensure that medications are given in right dose to the right patient at the right time

B. Appropriate source of drug information is readily available online.

C. Hospital assures that medication are prepared and dispensed in a clean and safe area that complies with laws and regulations.

D. The medication order verification of the patient should have process and responsibilities in the policy and procedure of preparing.

E. Pharmacist double checks the medication order before dispensing to prevent medication potential error.

4.1.6 Administration:

· Only qualified individuals according to their job description, with the correct certification can administer medication.

· Nurses focus on the ten rights of medication administration.

· the qualified individual verify the following elements before administration:

1. Identity of the patient.

2. medication with the prescription or order

3. time and frequency of administration with the prescription or order

4. dosage amount with the prescription or order,

5. Route of administration with prescription or order.

4.1.7 Monitoring:

All patients monitored on medication by nurses, resident doctors and clinical pharmacists when there is adverse or side effect are reported.
Hospital record adverse drug reactions on the report and discuss in the pharmacy and therapeutics committee.
All patient medications are being evaluated during reassessment by physician, nurse and clinical pharmacist.
The evaluation should include the effect of the medication and the symptom or illness and/or significant lab result and anything else significant needing to be monitored. In addition to that ensuring evaluation of adverse effect s on patient in case the medication needs to be changed/modified or stopped a new medication order will be documented. if patient undergoing.

5. Follow up:

A. The implementation of medication management plan is monitored through the use of measures related to medication management.The policy/plan is evaluated annually.

Medication error reports are monitored.

6. Responsibilities:

A. Hospital leadership.

B. Pharmacy and Therapeutic committee.

C. Physician ,Pharmacist and Nurses

7. Appendices:

A. P&T team, term of reference

5. Reference:

5.1 Joint Commission Standards 7^th Edition 2017/ 7^th Edition April 2020.

5.2 CBAHI standards 2016

Clinical Intervention (Prescription Intervention)

2020-10-08T10:35:00.003-07:00

Drug selection

Problems relating to the choice of drug prescribed or taken

Duplication (D1)

When to Use:

When there are no obvious adverse clinical effects of the two drugs together, but it is either inappropriate or very

unusual to see them prescribed or used together as they are from the same therapeutic class.

This also covers the specific compliance situation where a person may be inappropriately taking two brands of the same drug.

Examples of when to use:

• Patient prescribed Fosamax Plus and also taking cholecalciferol.

• Patient taking Aratac and Cordarone at the same time.

• Patient taking Celebrex sample provided by doctor as well as the Celebrex dispensed at the pharmacy.

• Patient taking OTC Nurofen as well as prescribed Celebrex.

When Not to Use:

If the drugs involved are not of the same therapeutic class, then use “Drug Interaction (D2)”.

If the patient is already experiencing adverse effects due to using the two drugs together, then use “Toxicity, allergic reaction or adverse effect present (T1)”

Drug interaction (D2)

When to Use:

When there are no obvious adverse clinical effects of the drug interaction between two medications that the patient is

taking or intending to take, but the interaction is serious enough to check if the doctor knows of it.

When the patient presents with an OTC request that could result in a major interaction if taken with their concurrent therapy.

Examples of when to use:

• Patient commenced on tramadol who is already taking fluoxetine.

• Patient ceases amiodarone while continuing on warfarin.

• Patient requests to purchase an over the counter antacid when taking doxycycline.

• Patient wishes to use St John’s Wort for depression, but is currently taking tramadol.

When Not to Use:

If the interacting drug is of the same therapeutic class as part of the patient’s existing therapy, then use “Duplication

(D1)”.

If the drug is contraindicated due to an existing medical condition or previous adverse reaction to the medication, then use “Contraindication apparent (D6)”.

If the patient is already experiencing adverse effects due to using the two drugs together, then use “Toxicity, allergic reaction or adverse effect present (T1)”.

Wrong drug (D3)

When to Use:

When the patient is taking a medication that has been incorrectly prescribed (prescribing error) or incorrectly dispensed

(dispensing error).

Examples of when to use:

• Doctor prescribes chlorpromazine 200mg bd but intended carbamazepine 200mg bd.

• Patient supplied with and taking Hydrea 2 m, labelled as Hydrene 2 m.

When Not to Use:

When a drug is discontinued or out of stock on a long-term basis and the doctor is contacted for a change in therapy, then use “Other drug selection problem (D0)”.

Incorrect strength (D4)

When to Use:

When the patient presents with a new prescription that has incorrect or no details about a drug’s strength that may

require clarification from the prescriber.

When a drug chart or hospital discharge shows a strength that appears to be incorrect.

Examples of when to use:

• Prescription presented for ‘Seretide inhaler’ with no strength indicated.

• New prescription for diclofenac 50mg BD, when the patient was previously on 25mg BD and the doctor has not provided the patient with reason for change.

• Locum doctor prescribes Karvea 150mg daily, but previous therapy was 300mg daily.

When Not to Use:

If the patient presents a prescription for an old medication that has been superseded by a newer one that they should be

taking, then use “Other compliance problem (C0)”.

Inappropriate dosage form (D5)

When to Use:

When the formulation of the product is inappropriate or incorrect in terms of the intended use of the product, including

incorrect routes of administration.

Examples of when to use:

• Vancomycin oral capsules prescribed to treat systemic infection.

• Ear drop product ordered or supplied for an eye problem.

• Directions state an unattainable dose such as doxepin 5mg daily (only come as 10mg capsules).

When Not to Use:

If the patient has a physical problem with the administration of the dosage form as it is intended to be used (eg. swallowing a particular form of the medication whole, cannot appropriately insert suppositories, arthritis limiting the use

of an inhaler) or their difficulty is related to a lack of understanding on how to use the dosage form, then use “Difficulty using dosage form (C5)”.

Contraindication apparent (D6)

When to Use:

When there is a contraindication or precaution to that drug being used in a particular patient due to their medical

conditions, not their drug therapy.

When a drug or drug group is prescribed for the patient to which there has previously been a major adverse reaction.

Examples of when to use:

• Augmentin Duo Forte prescription presented for a patient allergic to penicillin.

• Diclofenac prescription for a patient with history of aspirin-induced asthma.

• Patient with Parkinson’s disease prescribed prochlorperazine.

• Doctor prescribes a high dose thiazide in a patient with a history of gout.

• Doctor prescribes enalapril for a lady who is 7 months pregnant.

When Not to Use:

If the drug is contraindicated due to existing drug therapy, then use “Drug interaction (D2)”.

If the patient is already experiencing toxicity or an allergic reaction, then use “Toxicity, allergic reaction or adverse effect present (T1)”.

If the drug is felt to be contraindicated due to therapeutic duplication, use “Duplication (D1)”.

No indication apparent (D7)

When to Use:

When there is no clear apparent reason the drug should be used.

Examples of when to use:

• Patient commenced omeprazole when they were taking Celebrex for a sore knee. Celebrex has been ceased, but they are still taking omeprazole.

• Patient using long-term steroid eye drops without a current indication.

When Not to Use:

If the drug is felt to be unnecessary due to therapeutic duplication, use “Duplication (D1)”.

Other drug selection problem (D0)

When to Use:

When the drug being used is out of date or has deteriorated in some other way.

When a drug is discontinued or out of stock on a long-term basis and the doctor is contacted for a change in therapy. When you believe a more effective drug is available and you suggest it instead of the current therapy.

Examples of when to use:

• Patient is using Anginine tablets that are over 2 years old and/or have been stored incorrectly.

• Patient presents a prescription for trimethoprim for a UTI which is out of stock for another 3 weeks, so the doctor is contacted for an alternative antibiotic.

When Not to Use:

If another brand must be substituted because the ordered brand cannot be used due to a physical problem related to the

patient taking the drug, then use “Difficulty using dosage form (C5)”.

Over or underdose prescribed

Problems relating to the prescribed dose or schedule of the drug

Prescribed dose too high (O1)

When to Use:

When the total daily dose of a medication prescribed is too high for the patient, either based on previous dosage or

reference dose ranges, including situations where the dose that is prescribed is too high by unintentional error.

Includes the situation where the dose is too high because of a particular parameter of the patient such as renal function weight, age etc.

Examples of when to use:

• Patient is prescribed Diamicron MR 180mg in the morning (exceeds maximum recommenced dose of 120mg daily).

• 95 year old 50kg women prescribed norfloxacin 400mg bd (dose potentially too high due to renal impairment).

• Patient is prescribed dexamethasone 50mg daily (doctor was thinking of prednisolone dose).

• Patient prescribed spironolactone 100mg bd for heart failure.

When Not to Use:

If the patient is taking too high a dose as a result of compliance issues, then use “Taking too much (C2)”.

If the patient is already experiencing toxicity symptoms as a result of a high dose, then use “Toxicity, allergic reaction or adverse effect present (T1)”.

Prescribed dose too low (O2)

When to Use:

When the dose prescribed is either too low based on reference dose ranges or too low based on previous therapy.

This includes situations where the dose prescribed is too low by unintentional error.

Examples of when to use:

• Patient with moderate vitamin D deficiency (vitamin D 18 µmol/L) prescribed Ostevit 1000 U daily

(recommended dose is 3000-5000 U daily for 2-3 months, then 1000 U daily).

• Prescription for Singulair 4mg daily for an adult patient.

• A 25kg child is prescribed amoxycillin 125mg/5mL (4mL TDS) .

When Not to Use:

If the actual dose per day is correct, but the duration is too short, then use “Incorrect or unclear dosing instructions

(O3)”.

If the patient is taking a low dose of a drug as a result of poor compliance, then use “Taking too little (C1)”.

Incorrect or unclear dosing instructions (O3)

When to Use:

When the specified dosing time is not optimal.

When the duration of use of the product is too short or too long, including incorrect dose titrations.

When the total dose of a medication is suitable, but the frequency or the dosage schedule is inappropriate.

Examples of when to use:

• Simvastatin ordered as 40mg in the morning.

• Nystatin oral drops ordered only until symptoms resolve, not for the additional 48 hours afterwards.

• Diamicron MR prescribed as three times daily.

• Patient presents a new prescription for lamotrigine 100mg BD with no instructions to increase slowly (dose should start at 25mg/day for 2 weeks and increase by a maximum of 50-100mg every 1-2 wks; even lower starting dose if patient is already on other anticonvulsants).

When Not to Use:

If the patient is not taking the appropriate dose of a product as a result of a lack of understanding of the dosage regimen, then a compliance related code would be more appropriate.

Other dose problem (O0)

When to Use:

Any other dosing problems.

When Not to Use:

If the patient is not taking the appropriate dose of a product because of a lack of understanding of the dosage regimen,

then a compliance related code would be more appropriate.

Compliance

Problems relating to the way the patient takes their medication

Taking too little (C1)

When to Use:

When the patient uses too little of a medication as a result of forgetfulness or lack of understanding of the dosage

regimen prescribed.

When the patient chooses to take a medication PRN instead of on a regular basis.

When the patient chooses to discontinue a medication by choice or for an illogical or irrational reason.

Examples of when to use:

• Patient using Transiderm-Nitro patches only every few days, not regularly.

• Patient not taking medication because he/she believes it will "stop working later on" (e.g. analgesics).

• Patient taking metformin only when required rather than regularly.

• Patient fails to persist with treatment for a chronic disease (e.g simvastatin for hypercholesterolaemia, Flixotide

for asthma).

When Not to Use:

If the underuse is appropriate because of the resolution of symptoms or a condition, then use “No indication apparent

(D7)” and specify that the drug may no longer be required.

If the patient has a physical problem with the administration of the dosage form resulting in too little being used (eg. swallowing a particular form of the medication whole, cannot appropriately insert suppositories, arthritis limiting the use of an inhaler) then use “Difficulty using dosage form (C5)”.

Taking too much (C2)

When to Use:

When the patient uses too much of a medication as a result of forgetfulness or lack of understanding of the dosage

regimen prescribed.

Examples of when to use:

• Patient presents requesting a second Ventolin inhaler 11 days after the previous one was provided.

• Patient was continuing to take 50mg daily of prednisolone because they had forgotten to commence a dose reduction schedule as instructed by the doctor.

• Patient believes they have forgotten a medication and takes a second dose on the same day.

When Not to Use:

If the overuse is due to an appropriate increase in use because of increased symptoms, then use “Condition undertreated

(U1)”.

If the overuse consists of inappropriately taking two different brands or forms of the same ingredient or drug class unknowingly, then use “Duplication (D1)”.

If the patient takes too much and experiences signs or symptoms of toxicity as a result, then use “Toxicity, allergic reaction or adverse effect present (T1)”.

Erratic use of medication (C3)

When to Use:

When a patient is taking the medication on an erratic basis, usually due to poor memory. Includes the situation where

the patient is likely to require a Webster pack.

Examples of when to use:

• Patient presents for their simvastatin prescription which you dispensed 3 days ago, but prior to that it was dispensed 2 months ago.

When Not to Use:

If the amount of medication being taken can be easily quantified, then use “Taking too little (C1)” or “Taking too much

(C2)”.

If the patient is experiencing signs or symptoms of toxicity as a result of a compliance issue, then use “Toxicity, allergic reaction or adverse effect present (T1)”.

Intentional drug misuse including OTCs (C4)

When to Use:

When there is suspected overuse of a particular, potentially abused, product is intentional, including OTC items. Includes the situation where the prescription appears to be a forgery.

Please reserve this category for known drugs of abuse.

Examples of when to use:

• Patient appears to be doctor shopping.

• Patient requests Mersyndol on several different days a week, when they know different pharmacists will be working.

• Patient returns for a repeat prescription for nitrazepam after 1 week, claiming she dropped the previous supply down the toilet.

When Not to Use:

If the overuse is due to an appropriate increase in use because of increased symptoms, then use “Condition undertreated

(U1)”.

If the patient is experiencing signs or symptoms of toxicity as a result of intentional drug misuse, then “Toxicity, allergic reaction or adverse effect present (T1)” may be appropriate.

Difficulty using dosage form (C5)

When to Use:

When the patient lacks understanding on how to use the dosage form.

When the patient has a physical problem with the administration of the dosage form or device as it is intended to be used (eg. swallowing a particular form of the medication whole, cannot appropriately insert suppositories, arthritis limiting the use of an inhaler). Includes when a brand needs to be substituted to improve the patient’s ability to dose themselves.

Examples of when to use:

• Patient cannot swallow her slow release diltiazem capsules.

• Patient with scoliosis cannot insert suppositories.

• Controlled release tablet ordered for a patient who must crush all oral medications.

• Patient requests Pressin instead of Minipress as they are easier to halve.

• Patient has poor technique and is unable to use their eye drops, ear drops and/or inhalers appropriately.

When Not to Use:

If the formulation of the product is inappropriate or incorrect in terms of the intended use of the product, such as an incorrect route of administration, then use “Inappropriate dosage form (D5)”.

Other compliance problem (C0)

When to Use:

When the patient wishes to collect a repeat for a medication that has been ceased or superseded by a new medication.

When a patient is stockpiling medications.

When the compliance category cannot be categorised elsewhere.

Examples of when to use:

• Patient wishes to collect Coversyl from an old prescription when he has been taking Coversyl Plus for the previous three months.

• Patient unwilling to use mirtazapine after reading the package insert.

When Not to Use:

If the compliance issue results in two drugs of the same therapeutic class being taken inadvertently, then use

“Duplication (D1)”.

If the patient does not wish to take the medication because it is causing an adverse event of some sort, then a toxicity or adverse effect category would be appropriate.

Undertreated

Problems relating to actual or potential conditions that require management or prevention

Condition undertreated (U1)

When to Use:

When the patient has a symptom or disease condition that is not being treated adequately.

Examples of when to use:

• Patient taking Hydrene and Coversyl for high blood pressure, but blood pressure continues to be high.

• Patient taking metformin 1g BD but has BSLs consistently over 10mmol/L.

When Not to Use:

If the patient has a condition that is not currently being treated with any medication, then use “Condition untreated

(U2)”

If the patient requires additional therapy as a preventative strategy (eg potassium when on a loop diuretic), then use

“Preventive therapy required (U3)”.

If the patient takes too little and suffers worsening of their condition as a result, then use “Taking too little (C1)”.

Condition untreated (U2)

When to Use:

When the patient has a symptom or disease condition that is not currently being treated.

Examples of when to use:

• Patient has had consistently high blood pressure in the pharmacy over the past few weeks and may require antihypertensive treatment.

• Patient develops nausea as part of a viral illness and requires addition of antinauseant medication.

When Not to Use:

If the patient has a condition that is currently being treated, but is not adequately, then use “Condition undertreated

(U1)”.

If the patient requires additional therapy as a preventative strategy (eg potassium when on a loop diuretic), then use

“Preventive therapy required (U3)”.

If the patient takes too little and suffers worsening of their condition as a result, then use “Taking too little (C1)”.

Preventive therapy required (U3)

When to Use:

When the patient requires additional therapy to prevent a likely adverse event as a result of the patient’s therapy,

coexisting diseases or risk factors. Not to be used if the patient already has the condition.

Examples of when to use:

• Patient commences on morphine slow release without laxative therapy.

• You suggest the addition of antiplatelet therapy in an elderly, obese, male patient with diabetes and hypertension.

When Not to Use:

If the patient already has treatment for a particular problem, but it is not effective enough, then use “Condition undertreated (U1)”.

If the patient already has a condition that is not currently being treated with any medication, then use “Condition untreated (U2)”.

Other undertreated indication problem (U0)

When to Use:

When the patient has any other problem relating to actual or potential conditions that you think requires management.

Monitoring

Problems relating to monitoring the efficacy or adverse effects of a drug

Laboratory monitoring (M1)

When to Use:

When, in the absence of any adverse effects, you believe that a laboratory test is required (e.g. potassium, creatinine,

white cell count, INR). This includes any laboratory test that is not done within the patient’s home, pharmacy or doctor’s surgery, for example a BSL could be formally tested in a laboratory or tested in the home/pharmacy with a BSL monitor. When, in the absence of any adverse effects, you believe that drug level monitoring is required.

Examples of when to use:

• Patient recently increased frusemide dose from 40mg daily to 120mg daily without a change in potassium replacement.

• Patient commenced on cholecalciferol and you recommend his vitamin D levels be checked after 3 months.

• Elderly woman on metformin who has not had her HbA1c checked for two years.

When Not to Use:

If you believe there are already adverse effects associated with the medication in question, then use “Toxicity, allergic

reaction or adverse effect present (T1)”, and specify the parameter to be tested and the current signs and/or symptoms

(eg, patient with leg cramps, suggest magnesium level).

If the need for laboratory monitoring occurs as a result of a newly commenced drug, then use “Drug interaction (D2)”

and the monitoring then becomes a recommendation, not the primary problem.

If the test will be occurring within the patient’s home, pharmacy or doctor’s surgery, then use “Non-laboratory monitoring (M2)”.

Non-laboratory monitoring (M2)

When to Use:

When, in the absence of any adverse effects, you believe that non-laboratory monitoring is required (eg BP, BSL,

temperature, weight). In the future, the self-monitoring of INR at home would also come under this category. Also covers the situation where the test is undertaken as a screening process.

Examples of when to use:

• A patient with heart failure has an appropriate increase in his dose of frusemide and you advise him to weigh himself each day for the next week.

• An elderly patient is starting a new antihypertensive and you advise her to come to the pharmacy to have her blood pressure checked over the next few days.

• You advise a diabetic patient to regularly check his feet.

• You advise a patient on warfarin to regularly check their stools for blood.

When Not to Use:

If you believe there are already adverse effects associated with the medication in question, then use “Toxicity, allergic

reaction or adverse effect present (T1)”, and specify the parameter to be tested and the current signs and/or symptoms. If you recommend monitoring of a parameter (eg weight, BSL ,heart rate) as a result of another drug problem, then that recommendation should be recorded in the Recommendation code section. The type of problem that leads to this recommendation may vary.

Other monitoring problem (M0)

When to Use:

When the patient has another problem related to the monitoring of his drugs for either efficacy or adverse effects.

When the patient should be having monitoring done, but has problems attending the laboratory, or paying for the test or equipment needed.

Education or Information

Where a patient requests further information about a drug or disease state

Patient requests drug information (E1)

When to Use:

When the patient has a reasonable understanding of their condition, but requests further information about their

medication.

Examples of when to use:

• Patient requests information about alendronate and you provide a CMI.

When Not to Use:

If the patient is starting a new prescription item and provision of a CMI is a mandatory requirement.

If the patient requests information primarily about the disease state, rather than a drug, then use “Patient requests disease management advice (E2)”.

Patient requests disease management advice (E2)

When to Use:

When the primary purpose of the interaction with the patient was to inform them of critical aspects of the management or

prevention of a disease or condition. This interaction could be proactive or reactive

Examples of when to use:

• You counsel a patient with heart failure about fluid restriction

• You provide information about weight loss or smoking cessation for a person who has cardiovascular disease.

• You provide weight management tips to a newly diagnosed diabetic

• You counsel a postmenopausal woman about the benefits of weight-bearing exercise

• You help a pregnant lady choose a suitable antihistamine for her allergy symptoms

When Not to Use:

If the patient request information primarily regarding a drug, then use “Patient requests drug information (E1)”.

If the counselling is part of “normal” duties, such as counselling a patient about their new medication.

Other education or information problem (E0)

When to Use:

When another health care worker (e.g. a doctor or another pharmacist) requests information. Also covers any other education or information related problem.

Not classifiable

Problems that cannot be classified under another category.

Clinical interventions that cannot be classified under another category (N0)

When to Use:

Usually all prescriptions should be classified under another category, however the ‘N’ category is to be used when a

pharmacist feels a clinical intervention does not belong elsewhere. Please note that the intervention must still be clinical, not administrative.

When Not to Use:

If the problem is administrative, it is not a clinical intervention and does not need to be recorded. For example;

- When a prescription is illegal due to state or Federal law

- When the prescription does not meet PBS requirements (i.e. incorrect number of tablets or repeats)

- When an Authority prescription is not approved or incorrect

- When the drug is unavailable from the manufacturer or is out of stock temporarily

- When the prescriber is not authorised to prescribe that particular medication.

- When the patient has problems getting to pharmacy or collecting prescriptions.

Toxicity or Adverse reaction

Problems relating to the presence of signs or symptoms that may be attributed to a drug

Toxicity, allergic reaction or adverse effect present (T1)

When to Use:

When the patient has signs or symptoms that suggest toxicity, an allergic reaction or an adverse effect. Also includes the

situation where compliance issues have lead to symptoms of toxicity.

Examples of when to use:

• Patient has increased their dose of tramadol and develops headache, sweating and agitation.

• Promethazine and amitriptyline together causing worsening of dry mouth.

• Patient prescribed Diamicron MR three times daily and has significant hypoglycaemic symptoms.

• Patient intentionally misusing medication presents with signs or symptoms of toxicity.

• Patient taking warfarin develops an elevated INR after commencing metronidazole.

• Patient taking perindopril and frusemide, who commences diclofenac and develops renal dysfunction.

• Patient taking metoprolol exhibits worsening asthma symptoms.

• Patient taking amoxycillin develops an itchy, red rash.

When Not to Use:

If the patient does not have any signs or symptoms of adverse effects and you believe the dose is too high, then use “Dose too high (O1)”.

If the patient has an interacting drug present, but there are NO signs or symptoms of the interaction causing an adverse effect, then use “Drug interaction (D2)”.

Where the patient has been prescribed interacting drugs but has not taken the medications, then use “Drug interaction

(D2)”.

If there are no signs or symptoms of toxicity or allergic reaction, but there is a possibility one could occur because of the patient’s medical conditions or medical history, use “Contraindication apparent (D6)”.

Download BNF 80 (Free)

2020-10-04T12:21:00.002-07:00

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Top 100 Drugs Of Choice For Different Diseases

2020-10-04T11:47:00.003-07:00

Drugs of choice are categorized on the basis of diseases. The following are the most important classes of drugs used as a first choice in the treatment of different diseases.

Drugs Of Choice List in pregnancy

(1)Chloroquine

Drug of choice for malaria in pregnancy

(2) Alpha-Methyldopa

DoC for hypertension in pregnancy

(3) Heparin

For anticoagulation in pregnancy

(4) Labetalol

For the hypertensive crisis in pregnant women.

(5) Acetaminophen

Analgesic DOC

(6) Phenobarbitone

For epilepsy in pregnant women.

(7) Doxylamine & Pyridoxine

For nausea in pregnancy

Drugs Of Choice List in infections

(8) Penicillin G

Drug of choice in

Septicemia,
Meningitis,
Pericarditis,
Endocarditis and
Severe pneumonia.

(9) Ampicillin

Drug of choice in

Listeria,
Enterococcus faecalis.

(10) Vancomycin

Drug of choice for

MRSA,
Coagulase-negative Staphylococcus,
Enterococcus faecium.

(11) Erythromycin

Drug of choice for

Corynebacterium

(12) Doxycycline

Bacillus anthracis,
Borrelia burgdorferi, B.Recurrentis.
Chalmydia & Rickettsiae.

(13) Cotrimoxazole

Drug of choice in

Nocardia

(14) Azithromycin

Drug of choice in

Hemophilus ducreyi &
Mycoplasma.

(15) Ceftriaxone

Drug of choice for

Proteus,
E.coli,
Salmonella

(16) Ciprofloxacin (Ciproxin)

Drug of choice for

Urinary Tract Infection

(17) Metronidazole

Drug of choice for

Bacteriocides

(18) Ceftazidime

DOC for

Burkholderia pseudomallei

Drugs Of Choice List for various types of seizures

(19) Valproate

Drug of choice for

Tonic seizures
Absence seizures
Grand mal (GTCS)
Clonic seizures
Atonic seizures
Myoclonic seizures

(20) Carbamazepine

Partial seizures

(21) Vigabatrin

Infantile spasm with tuberous sclerosis

(22) ACTH

Infantile spasm

(23) Lorazepam (IV)

Status epilepticus

(24) Diazepam

Febrile seizures

(25) Magnesium Sulphate

Seizure in eclampsia

Drugs Of Choice List in poisoning

(26) Physostigmine

Atropine,
Belladonna &
Dhatura poisoning

(27) Atropine

Carbamate,
Early mushroom poisoning,
Organophosphate poisoning.

(28) Flumazenil

Benzodiazepine poisoning

(29) Acetylcysteine

Acetaminophen poisoning

(30) Naloxone

Opioid poisoning

(31) Deferiprone

Chronic iron poisoning

(32) Desferrioxamine

Acute iron poisoning

(33) Glucagon

Beta-blockers poisoning

(34) Amyl nitrate

Cyanide poisoning

Drugs Of Choice List in bronchial asthma

(35) Salbutamol

Salbutamol is the drug of choice for

An acute attack of bronchial asthma in normal patient and pregnant women.
Exercise & Aspirin-induced acute attack of bronchial asthma.

(36) Ipratropium

An acute attack of bronchial asthma during labor.
An acute attack of bronchial asthma on beta-blocker therapy.

(37) Corticosteroids

Prophylaxis of bronchial asthma,
Exercise-induced, and
Aspirin-induced asthma.

Drugs Of Choice List In Antimicrobials Prophylaxis

(38) Ampicillin

Group B streptococcus infection

(39) Amoxicillin

Endocarditis and Otitis media

(40) Azithromycin

Mycobacterium avium complex (MAC) Pertussis

(41) Benzathine penicillin

Rheumatic fever

(42) Procaine Penicillin

Gonorrhea and syphilis

(43) Tetracycline

Rickettsial infection and plague.

(44) Cefazoline

Surgical Prophylaxis

(45) Doxycycline

Anthrax

(46) Trimethoprim and sulphamethoxazole

Toxoplasmosis,
Pneumocystis service UTI

(47) Rifampicin

Hemophilus influenza type B.

(48) Oseltamivir

Influenza Type A & B.

Anesthetic Drugs Of Choice List

(49) Propofol

Daycare

(50) Sevoflurane

Congenital heart disease,
ASD,VSD,PDA

(51) Etomidate

Ischemic heart disease

(52) Ketamine

Asthma and COPD
Shock
CHF, and
congenital heart disease (Right to left shunt)

(53) Thiopentone

Epilepsy
Thyrotoxicosis

(54) Methohexitone

Electroconvulsive therapy

(55) Isoflurane

Cardiac surgery
Neurosurgery
For producing deliberate hypotension

Drugs Of Choice List in Endocrinological Disorders

(56) Insulin

Type 1 DM
Diabetes Mellitus in pregnancy.
Diabetic Ketoacidosis.
Uncontrolled DM.

(57) Metformin

Type 2 DM
Diabetes mellitus in obesity

(58) Sildenafil

Erectile Dysfunction

(59) Hydrocortisone

Acute and chronic adrenal insufficiency.

(60) Nateglinide

Postprandial hyperglycemia.

(61) Methotrexate

Ectopic pregnancy

(62) Oxytocin

Postpartum hemorrhage
Induction of labor

(63) Cabergoline

Acromegaly
Hyperprolactinemia.

(64) Finasteride

Anogenital alopecia.

(65) Alendronate

Osteoporosis

Drugs of choice in fungal infections

(66) Amphotericin B

Amphotericin B is the drug of choice in

Meningeal histoplasmosis
Endocarditis by candida
Sever or CNS blastomycosis
Induction cryptococcal meningitis(For 2 weeks)
Exserohium

(67) Fluconazole

Candida albicans
Maintainance in cryptococcal meningitis

(68) itraconazole

Nonmeningeal histoplasmosis
Sporotrichosis
Para Coccidioidomycosis
Mild or non-CNS blastomycosis
Chromoblastomycosis
Penicillium mameffei

(69) Prednisolone+itraconazole/Voriconazole

Allergic bronchopulmonary aspergillosis.

(70) Caspofungin

Candida glabrate, and
Candida krusei.

Drugs of choice in gastrointestinal disorders

(71) PPIs (Proton Pump Inhibitors)

Gastric ulcer,
Duodenal ulcer,
stress ulcer,
NSAIDs-induced ulcer.
GERD,& Zollinger Ellison syndrome.

(72) Metoclopramide

A migraine-associated or drug or disease-associated vomiting

(73) Domperidone

Levodopa-induced vomiting

(74) Ondansetron

Postoperative or radiation-induced vomiting

(75) 5HT3 antagonist

Cisplatin-induced early vomiting

(76) Lactulose

Hepatic encephalopathy

(77) Methylnaltrexone

Opioid-induced constipation

(78) Octreotide

Diarrhea in carcinoid syndrome

Drugs of choice in Hematological Disorders

(79) Warfarin

DVT prophylaxis
Chronic atrial fibrillation in mitral stenosis,
Advanced kidney disease, and
mechanical prosthetic heart valves

(80) Heparin+Warfarin

Initiation of therapy in DVT.

(81) Vitamin K

Warfarin overdose

(82) Protamine

Heparin overdose

Drugs of Choice in Hypertension

(83) Thiazide diuretics

Hypertension

(84) Prazosin

Hypertension With BPH

(85) Beta-Blockers

Hypertension with ischemic heart disease.(Angina)

(86) ACE inhibitors

Hypertension with chronic kidney diseases.

(87) Alpha methylDopa

Hypertension in pregnancy

(88) Phentolamine

Hypertensive emergencies with cheese reaction

(89) Nitroprusside+Esmolol

Hypertensive emergencies in aortic dissection.

(90) Labetalol

Hypertensive emergencies in pregnancy.

Drugs of choice in shock

(91) Adrenaline

Anaphylactic shock

(92) Dopamine or noradrenaline

Cardiogenic shock

(93) Phenylephrine

Distributive shock

(94) Prazosin

Secondary shock

(95) Dopamine

Shock with oliguria

(96) Corticosteroids

Shock due to adrenal insufficiency

Drugs of choice For viral diseases

(97) Ribavirin

Viral hemorrhagic fever
Measles
Respiratory syncytial virus(in high-risk patient

(98) Zanamivir

Oseltamivir-resistant influenza
Oseltamivir
Seasonal influenza and avian influenza (bird flu)

(99) Acyclovir

Herpes simplex and varicella.
Valacyclovir
Acute herpes zoster.

(100) Gancyclovir

Cytomegalovirus retinitis.

Reference

COMMON ANALYTICAL TECHNIQUES

2020-01-01T22:05:00.002-08:00

Administration Of Drugs by Alternate Routes

2019-12-20T07:09:00.002-08:00

Here we are discussing about alternate routes ,that oral drags can be used in rectal routes,injectable can be given in oral routes eye drops can be used in ear ,before doing that you need to be a competent pharmacist who know about Pharmacokinetics ,pharmacodynamics and Pharmaceutics

HISTORY OF ANTIBIOTICS DISCOVERY

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HISTORY OF ANTIBIOTICS DISCOVERY

Drugs Used In Emergency

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HYPERTENSIVE EMERGENSIES

Systolic Blood PressureMore Than 220 mmHg or diastolic Blood Pressure More Than 120 mmHg with evidence of active end organ damage.

SODIUM NITROPRUSSIDE Dose : 20-300 microgram/ min i.v Because of predictable, instantaneous, titrable and balanced arteriovenous vasodilatory action it is preferred. Toxic in higher dose.And That’s The Reason Proper Monitoring Should Be Done.
LABETALOL for pregnancy induced hypertension.
ESMOLOL can also be used. If injection is not available Use Capsule Nifedipine S/L
PHENTOLAMINE OR LABETALOL for hypertensive episode in pheochromocytoma, cheese reaction or clonidine withdrawal

DRUGS FOR CARDIOVASCULAR SYSTEM EMERGENCIES

CORONARY PAIN SYNDROMES :It is a group of conditions due to decreased blood flow in the coronary arteries such that part of the heart muscle is unable to function properly or dies.It refers to a spectrum of clinical manifestations associated with myocardial infarction and angina.

STABLE ANGINA

Angina pectoris is a throbbing pain, usually felt in the central chest, which may spread to the neck, both arms and occasionally, the back that occurs during exercise or emotional stress and is rapidly relieved by rest.

GLYCERYL TRINITRATE (GTN, NITROGLYCERIN) ) A potent vasodilator, nitro-glycerine relaxes vascular smooth-muscle beds. It works well on coronary arteries, improving blood flow to ischemic areas.Dose : 0.5 mg Tablet is given sublingually every 5 min (max 3 dose)

UNSTABLE ANGINA:

This coronary syndrome is characterised by anginal pain which is severe, of recent onset, or which has recently become abruptly worse. Angina occurring at rest or following recent myocardial infarction is also classified as unstable angina If pain is not relieved by GLYCERYL TRINITRATE GTN then infusion of NTG MORPHINE SULPHATE – Visceral Pain Dose Of 10-15 mg i.m or s.c or 2-3 mg i.v is given. Or TRAMADOL Injected i.v 100 mg tramadol is equianalgesic to 10 mg i.m morphine.

ASPIRIN : It is given for chewing or diluted before administration as soon as MI is suspected. Aspirin slows platelet aggregation, reducing the risk of further occlusion or reclusion of the coronary artery or recurrent ischemic event. Dose: 162-325 mg tablet .Aspirin if diluted in a glass of water before given the disintegration time will be saved and faster action will be obtained.

MYOCARDIAL INFARCTION:

Complete occlusion of a coronary artery leads to the death of the cardiac muscle it supplies. For pain relieve GTN or Morphine is given. Aspirin to limit the infarct size. Thrombolytic Therapy to dissolve the thrombi or emboli and recanalize an occluded vessel. Tenecteplase and Alteplase are preferred as their administration doesn’t require prolonged i.v infusion.

STREPTOKINASE : 1.5 million units i.v over 60 minutes.
UROKINASE :2.5 lac unit i.v over 10 minutes
ALTEPLASE :15 mg bolus i.v followed by 50 mg within half an hour.
TENECTEPLASE :i.v bolus of 0.53 mg/kg over 10 seconds
NITROGLYCERIN) Dose : It Is A potent vasodilator, nitro-glycerine relaxes vascular smooth-muscle beds. It works well on coronary arteries, improving blood flow to ischemic areas.

Dose:0.5 mg Tablet is given sublingually every 5 min (max 3 dose)

CARDIOGENIC SHOCK:

It is defined as a state where the cardiac output is inadequate to maintain tissue perfusion

DOBUTAMINE : It is a beta1 agonist with prominent inotropic action.Dose: 2-20 microgram/kg/min by i.v infusion. Dobutamine is preferred as it increases force of contraction without significant increase in HR.
DOPAMINE :Dose: 2-20 microgram/kg/min by i.v infusion. Preferred in patients with hypotension. Improve cardiac contractility.

CARDIAC ARRYTHMIAS:

ARRYTHMIA DRUG Paroxysmal supraventricular tachycardia Atrial tachycardia (150-200/min) with 1:1 A-V conduction.

ADENOSINE 6-12 mg rapid i.v injection. Causes membrane hyperpolarisation. Atrial Flutter Atria beat at rate of 200-350/min and there is 2:1 or 4:1 AV block.
VERAPAMIL ± DIGOXIN OR AMIODARONE Control ventricular rate Atrial fibrillation Atrial fibres are activated asynchronously at rate of 350-500/min associated with grossly irregular and often fast ventricular response.
AMIODARONE (I.V) 100-300 mg over 30-60 minutes. Above mentioned drugs for vent. rate control
WARFARIN 2-5 mg oral or i.v Ventricular Tachycardia 4 or more consecutive ventricular exrasystoles
LIGNOCAINE i.v 50-100 mg bolus. Suppress VT and prevent VF Torsades de pointes Life threatening form of polymorphic ventricular tachycardia with rapid asynchronous complex and an undulation ECG baseline.
MAGNESIUM SULPHATE 50% 2 gm i.v over 5-10 min. Ventricular fibrillation Irregular, rapid and fractionalized activation of ventricles resulting in uncoordinated contraction of its fibres.
Defibrillation ± i.v AMIODARONE 100-300 mg over 30-60 minutes. AV Block Depression of impulse conduction through AV node and bundle of His. ATROPINE 0.6-1.2 mg i.m if due to vagal over activity. ADREANLINE/ ISOPRENALINE in partial AV block

CARDIAC ARREST:

Cardiac arrest is a sudden stop in effective blood flow due to the failure of the heart to contract effectively.

Defibrillation is the most prompt treatment.
ADRENALINE : Adrenaline concentrates the blood around the vital organs, specifically the brain and the heart, by peripheral vasoconstriction. Adrenaline also strengthens cardiac contractions as it stimulates the cardiac muscle. Amiodarone and Lidocaine are given to control arrhythmias.

Dose: 1 mg i.v bolus (1 ml of 1:1000)

DRUGS FOR RESPIRATORY EMERGENCIES

ASTHMA :

Asthma is chronic inflammatory disease of the airways of the lungs And Status Asthmatics is an emergency condition where asthma attack is not relieved by relievers ( Bronchodilators)

SALBUTAMOL :It is beta-2 agonist and causes bronchial smooth muscle relaxation. Dose Of 100 – 200 microgram/puff. Such 2 puffs are inhaled through meter dose inhaler in case of breathlessness with the help of spacer.
In case of acute asthma- 2.5 mg SALBUTAMOL+ 500 microgram IPRATROPIUM BROMIDE repulse. Aerosolize respule solution by nebulizer and inhale through nose and mouth by face mask.
IPRATROPIUM BROMIDE is anticholinergic and cause bronchodilation by blocking M3 receptor.
HYDROCORTISON HEMISUCCINATE : Steroids improve airway, reduce asthma exacerbation. They also improve response of airway smooth muscle to beta2 agonist and reduce refractoriness to them.Dose: 200 mg given i.v immediately.
AMINOPHYLLINE :250mg/10ml ampoule to be dissolved in 20 ml of 5% glucose and is given i.v slowly. It causes smooth muscle relaxation.

EXACERBATION OF CHRONIC OBSTRUCTIVE AIRWAY DISORDER :

SALBUTAMOL to relieve breathlessness. Ipratropium bromide HYDROCORTISONE and AMINOPHYLINE given i.v for immediate effect.

EPIGLOTTITIS .Epiglottitis is a medical emergency and failure to provide prompt treatment may be fatal. It is due to infection of the epiglottis with Haemophilus influenzae bacteria.

CEFTRIOXONE :Dose: 100mg/kg i.v immediately

PULMONARY OEDEMA:Acute pulmonary oedema is a medical emergency that requires prompt treatment. Oxygen, morphine, vasodilators and diuretics should be used.

FUROSEMIDE :Dose: 40 mg i.v is given immediately. Intravenous furosemide has a beneficial vasodilatory action as well as being a powerful diuretic.
NITROGLYCERINE (INJ) 25 mg in 50 ml normal saline slowly i.v if systolic BP > 100 mm Hg.
DOPAMINE or DOBUTAMINE in case of cardiogenic shock.
MORPHINE :- 2 mg i.v to reduce anxiety and dyspnea.

NEUROLOGIC EMERGENCIES

Most seizures are self-limited and brief. Emergency drug treatment is only necessary if the seizures are prolonged (>5 minutes) or recurrent. Initial treatment is to stop convulsions and maintain ABC SEIZURES

ANTICONVULSANTS: MEDAZOLAM: Injection (solution for injection): 1 mg/ml; 5 mg/ml (administered into the buccal cavity between the gum and cheeks by syringe)
DIAZEPAM : 5 mg intravenous bolus and repeat every 2 minutes to a maximum dose of 20 mg And 0.5 mg/kg per rectum (Intravenous solution can be used , if i.v. line is not assesed ). PLUS for seizures – Injection phenytoin 15 mg/kg via intravenous infusion over 20 minutes followed by maintenance dose.
Thiopentone infusion – For status epilepticus :Thiopentone :5 mg/kg intravenous bolus
Lorazepam:4 mg injected i.v. at the rate of 2mg/min
Fosphenytoin:100-150 mg/min i.v. infusion to a maximum of 1000 mg
Phenytoin sodium:Injected at the rate of 25- 50mg/min.
Phenobarbitone sodium:50-100mg/min i.v. injection to a maximum of 10mg/kg Injection Valproate :5 mg/kg intravenous bolus

TETANUS a) Tetanus immune globulin :This substance neutralizes circulating toxin. Give tetanus immune globulin 4000 units intravenously over 30 minute.

Antimicrobials :Give benzylpenicillin 100,000 units/kg (maximum dose 2.4 million units) intravenously every 4 hours. OR if penicillin sensitive give metronidazole 7.5 mg/kg (maximum dose 500 mg) intravenously every 8 hours c) Morphine and diazepam  used to control muscle spasms.

MENINGITIS: Bacterial meningitis is a medical emergency and antibiotic therapy should not be delayed if there is difficulty in obtaining a CSF sample. In such cases, empirical therapy should be started immediately.

Empirical therapy Penicillin G intravenously 4-hourly for 10 days plus chloramphenicol 750 mg – 1 g intravenously 6-hourly for 10 days In patients hypersensitive to penicillin: Chloramphenicol alone OR Ceftriaxone 4 g intravenously daily in one or two divided doses

ENDOCRINE EMERGENCIES

HYPOGLYCAEMIA :

If the patient is conscious and able to swallow, give a sugary food or drink. And If the patient is unable to swallow or unconscious at home, give sugar paste or honey into the mouth and transfer immediately to the nearest health care facility for intravenous glucose therapy.

Give dextrose 50% 50 ml intravenously followed by continuous intravenous infusion of 5% dextrose for up to 24 hours.

DIABETIC KETOACIDOSIS :

It is characterized by hyperglycaemia, ketosis and acidosis. All patients should be given oxygen via a face mask. Nasogastric tube is recommended to limit regurgitation and aspiration.

Intravenous Fluids :

Initially fluid resuscitation should be with large volumes of normal saline.When the blood glucose falls to below ( 300 mg %) i.e. 15mmol/l then the fluid should be changed to 5% dextrose or dextrose-saline. ( Reason – To clear ketone from blood) c) Insulin

Intravenous bolus dose of 10 units short-acting regular insulin followed insulin intravenous infusion @4 units/hour.
Electrolytes :Potassium : intravenous potassium at a rate of 10-20 mmol/hour .
Bicarbonate : It is only given when the blood pH is less than 7.0. Treatment of underlying cause Hyperosmolar hyperglycaemic state (Non Ketotic)

MYXEDEMA COMA (HYPOTHYROID CRISIS)

Intravenous fluids :Despite their oedematous appearance, most patients have intravascular fluid depletion. This should be corrected by careful administration of 0.9% saline intravenously. Monitoring of central venous pressure and urine output is essential. b) Corticosteroids .Give hydrocortisone 200 mg intravenously stat then 100 mg intravenously 6-hourly.
Thyroid hormone :Give thyroxine 5 microgram/kg via nasogastric tube as a single dose then 50 microgram per day rising to 100 microgram daily after 7 days. Injection T3 – 20-mg loading dose to be infused over 30 min (Take caution of Arrhythmia) PHAEOCHROMOCYTOMA .Give labetalol 0.2 mg/kg intravenously and repeat every 10 minutes OR infuse labetalol until the paroxysm ends or the blood pressure is stable.

ADRENAL INSUFFICIENCY

Intravenous fluids :Use normal saline to correct hyponatraemia and dehydration: • Give 0.9% saline 1000 ml intravenously over 1 hour THEN • Give 0.9% saline 1000 ml intravenously over 2 hours. b) Corticosteroids Give hydrocortisone 200 mg intravenous bolus then give 100 mg every 6 hours

THYROID STORM

Intravenous fluids: Dehydrated or shocked patients should be resuscitated with 0.9% saline. b) Beta-adrenergic antagonists Give propranolol 0.5 mg intravenous bolus every 2 minutes to a maximum of 10 mg using control of tachycardia (pulse <100 beats/minute) as an endpoint. (Cardiac monitoring is desirable.) c) Antithyroid drugs .Give carbimazole 100 mg via nasogastric tube then 20 mg every 8 hours.

TREATMENT FOR SPECIFIC POISON

OPIATES Example ;codeine, heroin, pethidine, morphine, methadone.These drugs cause depression of conscious state and hypoventilation. Particular attention should be paid to the maintenance of the airway and adequate ventilation.
SPECIAL ANTIDOTE • Give naloxone 0.4 mg intravenously or intramuscularly and repeat in 5 minutes if necessary to a maximum of 2 mg.
PARACETAMOL :- minimum toxic dose is 150 mg/kg and almost all patients who ingest more than 350 mg/kg will develop hepatic failure. SPEACIALANTIDOTE • Give acetylcysteine 150 mg/kg intravenously over 15minutes THEN • Give acetylcysteine 50 mg/kg intravenously over 4 hours
ORGANOPHOSPHATE
SPECIALANTIDOTE • Give atropine 2 mg intravenously every 10 minutes till dryness of mouth or other signs of atropinazation apear ( max. 200 mg in administred in a day ) • Pralidoxime 1 g intravenously over 30 minutes and repeat every 12 hours if symptoms persist. ( 500 mg / hour ) ( Muscle power – Neck muscle )
ORAL ANTICOAGULANTS For Example WARFARIN , RAT POISON

Overdose of these substances causes prolongation of the prothrombin time and increased risk of bleeding.

SPECIFIC ANTIDOTE :Give vitamin K 10 mg intramuscularly daily PLUS if necessary (i.e. active bleeding or at high risk because of for example known active peptic ulcer).

Give fresh frozen plasma 2 units intravenously and repeat as necessary to a maximum of 8 units using repeated measurement of the prothrombin time as a guide to therapy

BETA-ADRENERGIC ANTAGONISTS e.g PROPRANOLOL , ATENOLOL
SPECIAL ANTIDOTE : Give adrenaline infusion 10 micrograms/minute and increase by 5 micrograms/minute . Every 2 minutes until the systolic blood pressure is >90 mmHg, to a maximum of 100 micrograms/minute
IRON :Overdose of iron initially causes vomiting, diarrhoea, abdominal pain and sometimes haematemesis. After a variable quiescent period during which these gastro- intestinal symptoms resolve, the patient may develop shock and hypoglycaemia plus cardiac, hepatic and renal failure.
SPECIAL ANTIDOTE :The specific antidote is desferrioxamine but supportive care including intravenous fluid and glucose (if necessary) is important as well. Give desferrioxamine 15 mg/kg per hour by intravenous infusion continued until the patient is asymptomatic (usually 12 to 24 hours)
ASPIRIN :This commonly used drug can be highly toxic in overdose. The toxic dose is greater than 150 mg/kg. Give 0.9% saline (or 0.3% saline with 3% dextrose in children) intravenously at a rate necessary to maintain a urine output greater than 2 ml/kg per hour PLUS .Give sodium bicarbonate 1 mmol/kg intravenously every 4 hours to maintain a urine pH greater than 7.5 PLUS .Give potassium chloride 0.25 mmol/kg intravenously over at least one hour, every 4 hours to maintain serum potassium levels > 4 mmol/l
DIGOXIN Digoxin toxicity causes following condition.

VENTRICULAR TACHYCARDIA Rx – phenytoin 15 mg/kg intravenously – magnesium sulphate 50 mg/kg intravenously (maximum dose 5 g) over 5 minutes

BRADIARRYTHMIAS Rx – atropine 10 microgram/kg intravenous
HYPERKALEMIA Rx – short-acting insulin 10 units intravenous bolus – Give 50 ml of 50% glucose intravenously over five minutes -sodium bicarbonate 100 mmol intravenously over five minutes
TRICYCLIC ANTIDEPRESSANTS (e.g. amitriptyline, doxepin, imipramine) Rx – (a) for seizure • Give diazepam 0.1 mg/kg intravenous bolus and repeat in 5 minutes if necessary
For hypotension – Give 0.9% saline 10 ml/kg intravenous bolus THEN if hypotension persists •Give sodium bicarbonate 1 mmol/kg intravenous .For Ventricular tachycardia • Give sodium bicarbonate 1 mmol/kg intravenous bolus THEN if arrhythmia persists • Give Lignocaine 1 mg/kg intravenous bolus
METHANOL POISONING A blood level of >50mg/dl methanol is associated with sever poisoning. FATAL DOSE :- 75-100 ml SPECIALANTIDOTE  Administer ETHANOL ( 10% water ) through a nasogastric tube; loading dose of 0.7 ml/kg is followed by 0.15 ml/kg/hour.

ANTIDOTES

AMYL NITRITE INDICATION:- Cyanide poisoning
BENZATROPINE (MESILATE ) INDICATION :- Dystonic reaction cause by antipsychotic drug or metoclopromide.
CALCIUM DISODIUM EDETATE INDICATION :- Poisoning with metals , especially lead
CALCIUM GLUCONATE INDICATION :- (1) Hydrofluoric acid skin burn (2) Poisoning with CCB
DIMERCAPROL INDICATION :- Poisoning with arsenic mercury lead
FOMEPIZOLE INDICATION :- Poisoning with ethylene glycol or methanol
FOLINATE –Calcium Leucoverin INDICATION :- methotrexate rescue
FLUMAZENIL INDICATION :- Reversal of benzodiazepine sedation in anasthetic , intesive care and diagnostic procedure
GLUCAGON INDICATION : Poisoning with beta- adrenoreceptor blocking drugs.
PENICILLAMINE INDICATION :- Poisoning wth lead , copper , arsenic .
ISOPRENALINE INDICATION :Hypotension or low cardiac output due to cardiotoxic drugs ( beta- adrenoreceptor drugs and CCB drugs )
PHENTOLAMINE INDICATION : Severe hypertension caused by amphetamines , MAOIs , clonidine . 13. PHYTOMENADIONE ( vit.- k1 )INDICATION ;- poisoning with caumarin anticoagulants .
SODIUM NITRITE INDICATION : Cyanide poisoning
PYRIDOXIME INDICATION:Poisoning with isoniazid,Gyromeria species.
SODIUM BICARBONATE INDICATION :- Poisoning with salicylates , chlorophenoxy herbicides .
SODIUM 2,3-DMPS INDICATION :- Poisoning with metals especially mercury , arsenic , bismuth , copper .
SODIUM NITROPRUSSIDE INDICATION : Severe hypertension due to ergotamine , amphetamine , MAOIs.
SODIUM THIOSULPHATE INDICATION :- Cyanide poisoning
ATROPINE ( SULPHATE ) INDICATION :- Organophosphate or carbamate insectiside poisoning .

OXYGEN

In emergency condition O2 is required for severe physiological stress.Shock ,Traumatic injury , Acute myocardial infarction, Cardiac arrest.Without O2 brain death occurs within 6 minutes
O2 is delivered using nasal mask or intranasal catheter.It is delivered through nasal cannula at the rate of 1- 4 litre/ min ( 24 % ) Through face mask the rate is 5-10 L/min And The oxygen is titrated according to SPO2. (when below 90 %. Caution in cases of COPD patients as they may lose their hypoxic respiratory drive

Reference

Drugs To Avoids During Pregnancy

2017-08-17T10:30:00.002-07:00

These Are The Drugs To avoid when pregnant because these drugs Cause Problems During Pregnancy.
1)Antibiotics

Fluoroquinolones (such as ciprofloxacin, ofloxacin, levofloxacin, and norfloxacin)
Nitrofurantoin
Streptomycin
Sulfonamides (such as sulfasalazine and trimethoprim- sulfamethoxazole)
Tetracycline

Abnormalities Caused By These Drugs
Possibility of bone and joint abnormalities (seen only in animals)
2) Anticonvulsants

Carbamazepine
Phenobarbital
Phenytoin
Valproate

Abnormalities Caused By These Drugs

Bleeding problems in the newborn. This Problem Can be prevented by Taking Vitamin K Orally 30 Days Before Delivery
Cause Risk of birth defects, including neural tube defects (such as spina bifida)
Volproate Cause Some (1%) risk of birth defects, including a neural tube defects (such as a meningomyelocele), cleft palate, and defects of face, the heart, skull, limbs , and spine

3) Antihypertensives
a)Angiotensin-converting enzyme (ACE) inhibitors

Captopril
Benazepril
Fosinopril
Enalapril
Lisinopril
Quinapril
Ramipril
Trandolapril
Perindopril

Abnormalities Caused By These Drugs :Serious Injury To The Fetus ,May Cause Kidney Damage In The Fetus ,Reduce Amniotic Fluid,Also Cause Defects Of Lungs ,Face And Limbs
b)Calcium Channel Blockers:

Isradipine
Nisoldipine
Amlodipine
Verapamil
Nifedipine (sustained-release only)
Diltiazem(sustained-release only)
Nicardipine
Felodipine

Abnormalities Caused By CCB:
Fluid retention in the ankles ,Dizziness, headache, flushing, heartburn,an abnormally fast heart rate (tachycardia) And enlarged gums.
Verapamil also caused Constipation.
c)Beta Blockers Drugs :

Atenolol
Bisoprolol
Metoprolol
Acebutolol
Nadolol
Penbutolol
Propranolol
Betaxolol
Carteolol
Timolol
Nebivolol
Pindolol

Problems Caused By Beta Blockers:
Beta Blockers Caused Slow Growth Rate In The Fetus And Also Cause Low Level Of Blood Sugar And Low Heart Rate .
d)Thiazide Diuretics:

Chlorothiazide
Bendroflumethiazide
Hydroflumethiazide
Chlorthalidone
Hydrochlorothiazide
Methyclothiazide
Metolazone
Indapamide

Problems Caused By Diuretics:
Taking Thiazide Diuretics During Pregnancy Will Cause Decrease In The Level Of oxygen,Potasium Sodium.Also Decrease In Number Of Platelets In The Fetus. Inadequate Growth Before Birth.
4) Antianxiety drug:

Diazepam

Abnormalities Caused By Diazepam :
When This Drug Is Taken In The Third Trimester Of Pregnancy It cause irritability, exaggerated reflexes in the newborn depression, and shaking.
5) Mood-stabilizing drug:

Lithium

Abnormalities:
Poor feeding, Lethargy, reduced muscle tone, nephrogenic diabetes insipidus in the newborn And underactivity of the thyroid gland.
6) Nonsteroidal anti-inflammatory drugs (NSAIDs)

Naproxen
Ibuprofen
Aspirin and other salicylates

Problems Or Abnormalities :
When the medication are taken in large doses, probably miscarriages during the first trimester, a delay within thebegin of labor, premature closing of the connection between the aorta and artery to the lungs (ductus arteriosus), jaundice, necrotizing enterocolitis (damage to the liner of the intestine), and (occasionally) brain injury within thefoetus and bleeding issues within the woman throughout and after delivery and/or within the newborn
When the medication are taken late in pregnancy, a discount in the amount of fluid round the developing foetus.

7)Sex Hormones:

Synthetic progestins (but not the low doses used in oral contraceptives)
Danazol

(When Synthetic Progestin And Danazol are taken In The early stages Of pregnancy, masculinization of a female fetus’s genitals, sometimes requiring surgery for correction)

Diethylstilbestrol (DES)

(Abnormalities of the penis in sons.Abnormalities of the uterus, an increased risk of vaginal cancer ,menstrual problems, and complications during pregnancy in daughters)
8)Vaccines:
Vaccines for polio, measles, mumps or yellow fever
This Vaccine cause Potential infection of the placenta and developing fetus.
Vaccine for chickenpox (varicella) and rubella.
This Is Associated With Unknow Risks.
9)Drugs Used In Skin Treatment:
Isotretinoin
Etretinate
Problems:
Both Of these Drugs Cause Birth defects, such as small ears, heart defects, and hydrocephalus .
While Isotretinoin Also Cause Intellectual disability And Risk of miscarriage.
10) Oral ant diabetic drugs:

Metformin
Glyburide
Tolbutamide
Chlorpropamide

Problems/Abnormalities Caused By These Drugs :
Inadequate control of diabetes in the pregnant woman
When a Pregnant woman with type 2 diabetes Takle The Drugs, possibility of increased risk of miscarriage Are More .

Also Cause a very low blood sugar level in the newborn.
reference:http://www.drugsbanks.com/2017/08/03/drugs-that-cause-problems-during-pregnancy/

Why must some medicines be taken with or after food?

2017-02-06T07:54:00.001-08:00

Some medicines need to be taken with or after food. The six main reasons for this are outlined below.

1. To reduce side effects of nausea or vomiting

It’s better to take some medicines that can cause nausea or vomiting after a meal to reduce these side effects. Examples include allopurinol, bromocriptine and madopar.

2. To reduce side effects of stomach irritation, including indigestion, stomach inflammation or ulcers

Some medicines can irritate the stomach, and taking them with food will reduce this effect. Foods such as biscuits or a sandwich, or a glass of milk, is usually enough. Examples include:Aspirin non-steroidal anti-Inflammatory drugs (NSAIDs), such as diclofenac and ibuprofensteroid medication (corticosteroids), such as prednisolone and dexamethasone

3. To treat problems such as heartburn, reflux or indigestion

Medicines called antacids are taken to prevent heartburn, reflux and indigestion, which usually occur when acid is produced as food enters your stomach. Therefore, these medicines are most effective if taken immediately after, or during, a meal.

4. To ensure the medicine is not washed away

Preparations such as mouthwashes, liquid nystatin and miconazole gel for oral thrush or mouth ulcers must be used after meals. This is because eating food washes the medicine away too quickly.

5. To ensure the medicine is absorbed into the bloodstream properly

Some medications require food in the stomach and gut for the body to absorb them properly, such as the HIV medicines ritonavir, saquinavir and nelfinavir.

6. To help the body process the meal

Medicines for diabetes, if taken by mouth, should usually be taken around meal times to reduce blood sugar levels after eating, and to avoid hypoglycaemia (very low blood sugar).

Refrence source

12 Secrets Every Pharmacist should Know

2016-11-05T09:08:00.003-07:00

Nobody knows more about medications than pharmacists do—not doctors, not nurses, not anyone. As Ronald Jordan, dean of Chapman University's School of Pharmacy, in Orange, California, puts it, "Those with the right to prescribe know far less about drug therapies than pharmacists, and consumers need to make use of that knowledge." Here, find out why generics cost less, how far in advance you should call for a refill, and more.

1. Chain-store pharmacists have quotas to meet.

Fifteen minutes: that's how long pharmacists at chains like CVS, Walgreen's, and Rite Aid have to fill a prescription once it's called in. One CVS pharmacist, who wants to remain anonymous, even compares the process to McDonald's. "Sometimes it's [filling] 25 medications at once, bang, bang, bang," he says. "If we take longer than we're supposed to, we get written up and have to meet with district managers. It can even affect bonuses. It's a lot of pressure."

2. Mornings are the best time to fill prescriptions.

Like doctors, pharmacists—especially those at mom-and-pop shops, who don't have quotas to meet—are less likely to make you wait first thing in the morning. As Martin Ochalek, a pharmacist in Miami, puts it, "Once the doctor calls start coming, it slows down everything." The exception? Independent pharmacies. "Any time of day is a good time to call in a prescription since they need the business," says Joey Jimenez, a former pharmacy tech who specializes in compound (or "made-from-scratch") drugs at Total Pharmacy Supply. Another timesaving tip: call before you go to confirm your prescription is ready for pick up.

3. If it takes longer than 15 minutes, be patient.

Getting the wrong prescription can have serious consequences, which is why it pays to be patient. "Time pressures can contribute to medication errors," says Sally Rafie, PharmD, a medication safety specialist at the UC San Diego Health System. "The pharmacist does far more than count pills and place them into a bottle. Pharmacists are reviewing allergies, drug interactions, dosing, and much more to be sure you get a medication that will be safe and effective for you."

MORE: Natural Alternatives To The Top 10 Most Prescribed Drugs

4. Doctors' handwriting really is that bad...

So bad, in fact, that it can lead to mistakes—which is why pharmacists need to be extra vigilant when filling prescriptions. "It's amazing how horrible their writing is sometimes," says Ochalek, who recalls a time when he received a child's prescription for amoxicillin that appeared to be three to four times the proper dosage. While a call to the doctor can clear up any issues, it's an extra step—one that usually ends with the customer waiting longer. Jimenez is a proponent of electronic scripts. "But not everyone has switched to the system yet because it's an additional cost," he says.

MORE: The Skinny On 8 Bizarre Celebrity Diet Food Trends

5. Pharmacists don't set prices.

There's no denying that medications are expensive, even with health insurance. But unlike typical retail stores that choose how much to mark up products, pharmacies have no say in what they charge. "Customers are not aware of what's going on with the pricing of drugs these days," says Jack Porter, a pharmacist in Beverly Hills. "A cream that used to cost $10 can cost $150 all of a sudden, and I would love for people to be aware of that."

6. You can't—and shouldn't—always get a generic.

First, a primer on generics: According to the FDA, they are "identical to a brand-name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use." So why do they cost less? Once a brand-name drug hits the market, it holds its patent for around 20 years, and no other pharmaceutical company can make or sell it until the patent expires. But once it does, companies are free to manufacture it—without the cost of building it from scratch.

Keep in mind that not every drug has a generic, and that even when one does exist, a pharmacist may not always recommend it. Says Porter: "I don't substitute certain medications that treat seizures because the generic dissolves at a different rate," which is an occasional difference between generic and brand name drugs. "On the generic, there's a chance they could still have a seizure. I wouldn't take the chance."

7. Don't wait until you're out of medicine to order refills.

As we all know, doctors are busy people—and they're the ones who hold the key to you getting a refill for your medication. Which is why it's important to give your pharmacist a few days to get ahold of them. "Doctors don't always call back promptly, and it's not automatic that you can get a refill the same day," Porter says. A good rule of thumb: let the pharmacist know when you have five or six pills left. "This is especially true for maintenance drugs like blood pressure meds. Missing a day or waiting extensive periods of time between dosages can have harmful effects," adds Jimenez.

MORE: The Supplement-Medication Combo You Need To Avoid

8. Don't use the pharmacy checkout if you're not picking up a prescription.

We've all been there before: The checkout line snakes into the aisles and all you want to buy are a few toiletries. But resist the temptation to pay at the pharmacy. "While pharmacists are happy to help, it distracts them from the important work they're doing, which can lead to unintentional errors," Rafie says. "And don't ask the pharmacist where to find the batteries, diapers, or restrooms!"

9. Build a relationship with your pharmacist.

You wouldn't switch doctors each month—and the same approach should be applied to your pharmacist. "Like any healthcare provider, patients are better served if they develop a relationship with their pharmacist," says Jordan. "They're willing to spend extra time with you, and it's always helpful to know the person on the other end of the phone line." In addition to getting more personalized attention, it's also more practical to stick with one place. "It's a lot of extra work for the pharmacy to keep transferring the prescription," says Rafie, adding, "There's no way each pharmacy can have all the information they need on file to make sure a medication is safe for you."

10. Know the meaning of "as directed."

You may have noticed a doctor write "as directed" on a prescription. This indicates to the pharmacist that the doctor has already explained to the patient how to use the medication. While some medicines' instructions are obvious, others can be taken many different ways. "I'll get people who come in with a prescription and ask, 'why am I taking this?' " Porter says. "It's important to look at the prescription when you get it, and leave the office with some understanding of what it is—especially if it says 'as directed.' "

11. Ask the right questions...

...though a good pharmacist will automatically provide many of the answers, including when to take the medication, whether or not to take it with food, what the side effects are, and if it needs to be refrigerated. "A patient needs to walk out of a pharmacy confident that they know what to do," Porter says. "If they're not, then they need to ask more questions." In the end, the customer is the one who will suffer the consequences. According to Jordan, "If people stop taking medication before they should or don't use them as prescribed, they may end up in the emergency room or having to take additional, higher-cost drugs as a result."

And while allergies are typically included in your medical file, speak up if the pharmacist doesn't ask (though he or she should). As Porter puts it, "The ultimate responsibility is on the patient to make the pharmacist aware."

12. Don't buy medicine online.

Just because some prescription drugs are a click away doesn't mean you should give into the convenience—even if they cost a little less. (The exception: something you have been taken regularly without any issues, such as birth control pills.) "The financial advantage is there, but the biggest problem is people end up using medications incorrectly or not recognizing side effects," Jordan says. "You're so much better off going through a pharmacist, where you can get advice face-to-face

Source

Medications should be taken on an EMPTY or Full stomach

2016-02-02T10:38:00.002-08:00

Drug food Interactions

Medications which should be taken on an EMPTY stomach
Alendronate (Fosamax)	Ampicillin	Astemizole	Bethanechol
Bisacodyl	Captopril (Take 1 hour before meals)	Cefibuten (Cedax)	Cilostazol (Pletal)
Demeclocycline	Dicloxacillin	Didanosine (Videx)	Etidronate (Didronel)
Felodipine (Plendil)	Indinavir (Crixivan)	Lansoprazole (take before eating)	Levothyroxine
loratadine (Claritin)	loracarbef (Lorabid)	Methotrexate	Moexipril (Univasc)
Mycophenolate (Cellcept)	Omeprazole Take before eating	Oxacillin	Penicillamine
Perindopril (Aceon)	Repaglinide (Prandin)	Rifampin	Rifabutin (Mycobutin)
Riluzole (Rilutek)	Roxithromycin (take at least 15 minutes before or after a meal)	Sucralfate (Carafate)	Sulfamethoxazole - trimethoprim (Bactrim)
Sulfadiazine	Tetracycline (Do not take with milk or other dairy products)	Tolcapone (Tasmar)	Zafirlukast (Accolate)
Zalcitabine (Hivid)

Medications which should be Taken with FOOD
Allopurinol (take after meal)	Atovaquone (Mepron)	Augmentin	Aspirin
Amiodarone (Cordarone)	Baclofen (Lioresal)	Bromocriptine (Parlodel)	clofazimine (Lamprene)
Carvedilol (Coreg)	Carbamazepine (Tegretol)	Chloroquine	Cimetidine (Tagamet)
Cefpodoxime (Vantin)	Diclofenac (Voltaren_	Divalproex sodium (Depakote)	Doxycycline
Felbamate (Felbatol)	fenofibrate (TriCor)	Fiorinal	Fludrocortisone
fenoprofen	Griseofulvin	glyburide (take with breakfast)	Hydrocortisone
Hydroxychloroquine (Plaquenil)	Indomethacin	Iron preparations (Take between meals--if GI upset occurs take with food)	Itraconazole capsules
Ketorolac	Lithium	Metronidazole	Misoprostol (Cytotec)
methanamine	mebendazole	methylprednisolone	naltrexone
Naproxen	Nelfinavir (Viracept)	Nitrofurantoin	Niacin
Olsalazine	Perphenazine	Pentoxifylline	Pergolide
Piroxicam	Potassium salts	Prednisone	Procainamide
Ritonavir (Norvir)	Salsalate	Saquinavir	Sevelamer (Renagel)
Spironolactone	Sulfasalazine	Sulfinpyrazone	Sulindac
Ticlopidine	Tolmetin	Trazodone	Troglitazone
Valproic acid

Drug - grapefruit interactions: Drugs which may exhibit increased serum concentrations based on this interaction
amiodarone	astemizole	alprazolam	atorvastatin
benzodiazepines	buspirone	carbamazepine	carvedilol
cerivastatin	cilostazol	clarithromycin	Clomipramine
codeine	cyclosporine	dapsone	dextromethorphan
diazepam	diltiazem	estrogens	erythromycin
felodipine	fentanyl	finasteride	haloperidol
indinavir	lercanidipine	lidocaine	lovastatin
midazolam	methadone	nelfinavir	nifedipine
nicardipine	nimodipine	nisoldipine	nitrendipine
ondansetron	paclitaxel	progestins	progesterone
quinidine	ritonavir	salmeterol	saquinavir
simvastatin	tacrolimus	trazodone	triazolam
vincristine	zaleplon	zolpidem
Note: there may be omissions on this list. Absence of a drug does not necessarily indicate that the drug lacks this potential interaction.

Warfarin - food Interactions

Management of Dietary Interactions and Vitamin K: dietary consistency is the key to maintaining a sustained, stable response during warfarin therapy. Patients should be aware of vitamin K content in common foods, particularly foods high in vitamin K (green leafy vegetables (broccoli, Brussel sprouts, turnip greens, kale, spinach, beet greens), Cauliflower , legumes, mayonnaise, canola and soybean oils), and should maintain a consistent amount of these foods in their diet.
The following foods should be avoided or limited, since they also can effect warfarin therapy: caffeinated beverages (cola, coffee, tea, hot chocolate, chocolate milk).

Alcohol intake greater than 3 drinks daily can increase the effect of Coumadin. As long as alcohol intake does not exceed 3 drinks daily, clotting times should not be affected. This amount of alcohol is present in 12 ounces of table wine or three 12 ounce beers. (Acute binges can raise INR. Chronic alcohol ingestion may decrease INR. )

Herbal supplements can affect bleeding time. Coenzyme Q10 is an herbal supplement whose chemical structure is similar to vitamin K, so it has the potential to affect bleeding time. Herbal teas: green tea, buckeye, horsechestnut, tonka, bean, meliot, and woodruff. Other examples include: feverfew, garlic, and ginseng. Herbal medications should either be avoided or used consistently while on warfarin therapy.

Reference

PHARMACY MANAGEMENT

2015-03-07T08:03:00.002-08:00

PHARMACY MANAGEMENT PDF FREE DOWNLOAD

DOWNLOAD HERE

Pharmaceutical Manufacturing Encyclopedia

2015-03-07T07:55:00.001-08:00

Pharmaceutical Manufacturing Encyclopedia pdf free download here

Download here

Drug during pregnency and lactation

2015-03-07T07:50:00.003-08:00

Drug during pregnency and lactation pdf free download

Download here

british national formulary

2015-03-07T07:11:00.003-08:00

free download of british national formulary

Download here

Comprehensive Pharmacy Review

2015-03-07T07:04:00.003-08:00

Download free of Cost Comprehensive Pharmacy Review pdf

Download here

Community pharmacist

2015-03-07T06:27:00.003-08:00

A community pharmacist is a pharmacist who is responsible for controlling, dispensing and distributing medicine inside the community (without health facility) like shopping malls on road side etc. They work to legal and ethical guidelines to ensure the correct and safe supply of medical products to the general public. They are involved in maintaining and improving people's health by providing advice and information as well as supplying prescription medicines.

Community pharmacists also sell over-the-counter medical products and instruct patients on the use of medicines and medical appliances

Job description and tips to improve Business

Community pharmacists work in customer-facing roles and provide an increasing range of services. Typical work activities include:

· dispensing prescription medicines to the public;

· ensuring that different treatments are compatible;

· checking dosage and ensuring that medicines are correctly and safely supplied and labeled (pharmacists are legally responsible for any dispensing errors);

· supervising the preparation of any medicines (not all are supplied ready made-up by the manufacturer);

· keeping a register of controlled drugs for legal and stock control purposes;

· liaising with doctors about prescriptions;

· selling over-the-counter medicines;

· counseling and advising the public on the treatment of minor ailments;

· advising patients of any adverse side-effects of medicines or potential interactions with other medicines/treatments;

· preparing unit doses and cassette boxes, usually for the elderly but also for those with memory/learning difficulties, where tablets are placed in compartments for specified days of the week;

· undertaking Medicine Use Reviews (MUR), an advanced service to help patients understand how their medicines work and why they have to take them;

· managing a needle and syringe exchange;

· arranging the delivery of prescription medicines to patients;

· managing, supervising and training pharmacy support staff;

· budgeting and financial management;

· keeping up to date with current pharmacy practice, new drugs and their uses

Some Extra Suggestion for community Pharmacist To boost up the business while working as a community Pharmacist there is some suggestion

1. Blood pressure Check: if a community pharmacist provides a free BP check facility it will increase the number of customer.
2. Blood Sugar: with a small fee to provide this facility will also give a positive move to yours’ Business.
3. Weight & Height: to measure BMI(body mass index) will help in correct dose calculation and enhance customer satisfaction

Note: beside the above suggestions if community Pharmacist provides some cosmetics. Pregnancy test facility, Smoking rehabilitation, health care electronics like steamer etc., snake and drinks, home delivery service and also a most important thing extemporaneous preparation will boost the business

Reference

DRUGS CONTRAINDICATED IN PREGNANCY

2015-03-02T20:41:00.003-08:00

This chart of drugs are

contraindicated Pregnancy(Pregnancy category

X) This is not an inclusive list of products that

carry that pregnancy category.

Those drugs that are contraindicated at a

certain phase of the pregnancy are listed next

to the product name. For more information on

specific drug monographs, see product entries

or consult the manufacturer and other

Pharmacological data base Like Micromedics

BNF etc

Download Here

Reffrence

Basic life support (BLS)

2014-01-07T09:45:00.001-08:00

Basic life support (BLS)pre-hospital setting, and can be provided without medical equipment.

is the level of medical care which is used for victims of life-threatening illnesses or injuries until they can be given full medical care at a hospital. It can be provided by trained medical personnel,

including emergency medical technicians, paramedics, and by laypersons who have received BLS training. BLS is generally used in the

Many countries have guidelines on how to provide basic life support (BLS) which are formulated by professional medical bodies in those countries. The guidelines outline algorithms for the management of a number of conditions.

Saudi arabia are included in one of those countries,where no professional registration (SCHS) without BLS course here is some helpful stuff to prepare for for BLS

download here

Pharmacist registration In UAE

2012-11-07T21:16:00.000-08:00

To register as a Pharmacist in UAE you will need to apply to the ministry of health for licensure. In order to gain license to practice pharmacy applicants will be required to complete three stages of examinations.

Arabic Language Exam: fluency in Arabic is mandatory for licensure, applicants will be required to prove they can translate medical terminology from both Arabic to English and English to Arabic

Pharmacy exam: questions will cover broadly most area of pharmacy, clinical pharmacology and therapeutics, pharmacy calculations, over the counter medicines and patient counseling

UAE Pharmacy regulation Exam: a multiple choice exam based on UAE federal pharmacy law and the UAE code of conduct for pharmacists.

DETAIL STEPWISE PROCEDURE IS FOLLOWING

The first step is to download the application form and fill it electronically only ( No hand written applications will be accepted) http://edohms.dohms.gov.ae/MPT/Main/Forms.aspx Go to the above link and download the Healthcare Professionals Application Form(DOC) Fill it up electronically and attach the documents mentioned
1) Filled in application form
2) One passport size photograph
3)Copies of your work experience certificates (Normally 3 years work experience should be enough( as required by MOH). But it is always better to keep copies of work experience for the past 5 years - Just in case).
4) Your Pharmacist registration copy. If you have MOH license, you may keep the copy of the same.
5) Your passport copies
6) Good standing letter from your previous employer ( Even if your conduct is mentioned satisfactory on you experience certificate, it would be considered) There are two ways of getting registered.
1) If a pharmacy with Dubai license sponsor's you then the exam fee would be AED 160.00 or
2) You may apply as a private candidate then the exam fee would be AED 1010.00 If you are applying through a dubai registered pharmacy then you would require to submit the Licensure Services Form from the below link and get it signed and stamped by the sponsoring pharmacy in Dubai http://edohms.dohms.gov.ae/MPT/Main/Forms.aspx

Attach the original copy of this application form Once you are done with the above, visit the DHA office at Dubai Health Care city block 64 - 1st floor. (Please get all the photocopies and print outs as there is no internet/ photocopy or fax services available nearby) Be there at around 9.00 ( i believe application will not be accepted after 12 noon) and show your filled in application form at the counter. You will be given a token number and you need to wait till your turn comes. Once your turn comes, you will be directed to a counter where you need to submit your application form for review. You will be asked to pay AED 110.00 ( Keep the receipt as this is required when your application is approved). One your application is submitted, you will be called by DHA in a weeks time to inform whether your application is Approved or Rejected Once you application is approved, you need to visit DHA again, submit the receipt of AED 110.00 at the counter. In a few minutes you will be called and given your application which you submitted earlier along with a token number. Wait for your turn and as earlier you will be directed to one of the counter where you will be asked to buy a Pharmacist Question Book (consists of 1000 questions on pharmacy)for AED 210.00 You will be asked to pay the exam registration fee - For regular it is AED 160.00 if sponsored by a dubai pharmacy or AED 1010 if you are registering as a private candidate. Once you get your exam date, you will be asked to visit PSV department where you need to get registered for screening of your documents by paying AED 900.00. You will be given an email address to which you have to write a mail asking for your screening result which you will get in a months time.
For further information on the licensing process and to obtain an application you should contact the ministry of health as follows:
Address: Ministry of health P.O Box Abu Dhabi United Arab Emirates Tel: 9712 6117-3299712 6117-421 Fax: 9712 6313-742 Email: postmaster@moh.gov.ae Website: www.moh.gov.ae
Sources:
1http://www.uaehrzone.com/forum/topic/90/Procedure_for_applying_DOH_Pharmacist_Exam_in_UAE/
2http://www.pharmainfo.net/kaushalpathak/registration-requirement-pharmacists-united-arab-emirates

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