How Dangerous Drugs are dispensed at the Port Moresby General Hospital, Papua New Guinea

1. Level 2 Satellite Pharmacy: Case
presentation1
Dangerous Drug Dispensing
Procedure
Presenter: Heni Oala (Pharmacy Intern)
Preceptor: Jessica Kuyei

2. Outline
• Identification of the patient
• Summary of significant findings:
– History
– Investigation
• Summary of Management
• Learning issue
• Conclusion

3. Patient Identification
• Patient name: GH
• Medical record number: 303803
• Gender/Age: M/58
• Nationality: Papua New Guinea
• Date of admission: 24.05.18 referred to
PMGH from GGH

4. Summary of Significant Findings
History
• GH presented with:
• Lower back pain: 6/52
• Lower limb paralysis: 4/52 unable to walk

5. Summary of Significant Findings
Investigation
• Vitals
– BP: 150/96
– Pulse: 72bpm
– Temperature: 37.4°C: intermittent fever
– RR: 26/min
• FBC:
W
BC
RB
C
Hb HC
T
MCV M
CH
M
CH
C
PL
T
Ur
ea
N cre
ati
nin
e
Na
=
Cl L M TP
8.48 5.09 11.6 35.7 70.1 22.8 32.5 343 3.61 79.2
%
88 136.
0
102.
7
10.6
%
6.6
%
74.6

6. Summary of Significant Findings
Investigation
Albu
min
AST ALP ALT GGT Tot. Bilirubin
36 34 25 121 28 7
Table1 (continued): Full Blood Count results, Patient: GH

7. Summary of Significant Findings
Investigation
• No hx of trauma
• No significant Past Medical History
• No family hx of TB
• Admitting diagnosis: TB Potts with
pyelonephritis (distal obstruction)
• Spinal cord compression
• Neurogenic bladder
• Lower limb paralysis

8. Summary of Significant Findings
Investigation
• X-ray: confirmed Tb potts L.Kidney,
spine,lungs
• Pathology:
– Prostate specific antigen: >100ng/ml
• Final diagnosis: Prostate carcinoma with
metastasis

9. Prostate specific antigen
PSA concentrations (ng/ml)
Age(years) Lower limit Higher limit
<40 0.21 1.72
40-49 0.27 2.19
50-59 0.27 3.42
60-69 0.22 6.16
>69 0.21 6.77
Table2: Prostate specific antigen concentrations

10. Summary of Management
• Treatment based on 2 factors:
– Tumor
• Staging result
• Histology
• PSA Concentration
– Patient
• Age diagnosed
• Life expectancy
• Presence of other diseases
– Cardiovascular
– COPD
– Diabetes

11. Summary of Management
• Review: urology clinic
• Diclofenac
– 50mg tds ‘o’ 2/52
• NSAID
• May take w;/out food
• Do not take aspirin w/ «
• Morphine
– 10mg ‘o’ qid for 2/52
• Opioid analgesic
• May take w;/out food
• Avoid alcohol : ↑ chances dangerous side effects

12. Summary of Management
• Surgical castration
• LHRH anatagonists
• Biphosphonates- bone form
– Pt. Bone metastasis
• Ketoconazole
– Broad spectrum antibiotics
• Dexamethasone
– Spinal cord compression
• Patient education

13. Learning Issue
Dangerous Drug Dispensing
Procedure at PMGH

14. Learning Issue
• Dangerous drug act of 1952 definition
– Any active principle alkaloid, derivative
(natural or synthetic), isomer, ester, ether, salt
or compounds)
– Under Schedule sec.1
• 8. Storage of dangerous drugs
– Stored in a locked cupboard
– Retain the key of the key or cupboard

15. Learning Issue
• PMGH procedure:
– Prescription validity
– Collection of dangerous medicines
– Entering into DD log book
• Date, description, quantity [copy information on
prescription]
• 2 registered pharmacists sign log book
• Prescription is retained by DD officer
– Dangerous Drugs dispensed

16. References
• Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL. 2008.
Harrisons Principles of Internal Medicine, McGraw Hill, New York 16th Edition
• Walker R, Whittlsea C.2012. Clincial Pharmacy and therapeutics, Churchill
livingston, Elsevier. New York. 5th Edition
• Medical tests explained. Prostate Specific Antigen (PSA). Accessed:
http://www.medical-tests-explained.info/index_files/PSA.htm [Date accessed: 21st
June 2018]
• Rooney PJ. 2015. Benign Prostatic Hyperplasia (BPH). Accessed:
http://papuanewguineahealth.com/2015/05/10/benign-prostatic-hyperplasia-bph
[Date accessed:21st June 2018]
• Waine. 2016. Prostate cancer in PNG. Accessed:
https://postcourier.com.pg/prostate-cancer-in-png/ [Date accessed:21st June 2018]
• PNG National Medicines Formulary, 2012. World Health Organization and National
Department of Health
• Independent state of Papua New Guinea. Dangerous drug act 1952(consolidated to
No23 of 1990). Accessed: http://www.scribd.com/doc/147521785/Dangerous-Drugs-
Act-Consolidated-to-No-23-of-1990-pdf [Date accessed: 21st June 2018
• FDA. Avoid food and Drug Interactions pdf [online]. Accessed:
http://www.fda.gov/downloads/Drugs/.../.../UCM229033.pdf [Date accessed: 21st
July 2018]