Introduction to community pharmacy

1. Introduction to Community
Pharmacy
Tarek M. Ali, PhD

2. Learning Outcomes
By the end of this lecture, you should be able to
• Define community pharmacy.
• List the categories of products sold in community
pharmacy.
• Describe different functions of community
pharmacist.
• Explain the classes of drugs based on legal
requirements for dispensing.
• Explain the prescription content and prescription
interpretation methodology.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
2

3. Definition
• Community pharmacy is the place where public can
get medicines and other healthcare products.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
3

4. Historical Overview
• The art of compounding was practiced by priests and doctors in many
old civilizations like Egypt and China.
• The first privately owned drug stores were established early in the 9th
century in Baghdad.
• By the 19th century, the distinction between the pharmacist as a
specialist in the preparation of medicines and the physician as a therapist
generally accepted.
• Historically, pharmacy revolved around the
manufacture and provision of medicines, rather
than on those who consumed them.
• Extemporaneous preparations constituted the
major component of dispensed medications.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
4

5. Contemporary Community
Pharmacy
• The focus of pharmacists’ activities shifted towards an
increased emphasis on the effects of medicines, namely
clinical pharmacy.
• Extemporaneous preparations largely disappeared.
• Community pharmacies are managed by pharmacists who
are considered experts in the use of medicines.
• In Egypt, registered pharmacist is a holder of B.Sc. of
pharmacy from a pharmacy school accredited by the
Egyptian MOHE and up-to-date, registration doesn’t
require qualifying exam after obtaining the bachelor
degree.
Sem i, 2019/2020 PHP5208 Community
Pharmacy
5

6. Functions of Today Community
Pharmacy
• Retailing: marketing, financial, business, and
workforce planning.
• Medication dispensing: main function, new
prescription and refill.
• Patient counseling: giving advice to patients on
how to use their medication.
• Provide drug information to other healthcare
professionals.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
6

7. Functions of Today Community
Pharmacy (Cont.)
• Provide advice on appropriate purchase of OTC for
symptomatic relief in the case of self-limiting minor
illnesses and common complaints.
• Health screening: e.g., monitoring blood sugar and
blood pressure.
• Participation in local and national campaigns to raise
awareness of specific health issues, e.g., smoking
cessation, diabetes control, and influenza vaccination
promotion.
• Referral of patients to the most appropriate healthcare
providers.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
7

8. Sem i, 2019/2020
PHP5208 Community
Pharmacy
8

9. Products Sold in a Community
Pharmacy
Pharmaceutical Products Non-pharmaceutical Products
• Prescription only medicines
(POM)
• Narcotics and controlled drugs
• Nonprescription medicines (OTC)
• Herbal medicines
• Nutritional and dietary
supplements
• Cosmetics
• Toiletries
• Medical equipments
Sem i, 2019/2020
9
PHP5208 Community
Pharmacy

10. Medication Dispensing:
Classification and Legal
Requirements

11. Sem i, 2019/2020
PHP5208 Community
Pharmacy
11
Prescription Only
Medicines (POM)
• Only available on a
prescription from an
authorized prescriber
Nonprescription
Medicines (OTC)
• Can be sold under
supervision of a
pharmacist without the
need for a prescription
from a healthcare
professional.
• May be further classified
into:
• General Sales List
(GSL)
• Pharmacy (P) medicines
Medicines Classification

12. OTC Medicines
GSL
• Have a history of being
safe and effective, so,
they can be sold by a
person with no medical
or pharmacy training.
P
• Need a pharmacist’s
expert knowledge of drug
actions and possible
interactions in order to be
supplied to patients in
certain situations, e.g.,
antihistamines (sedation),
nasal decongestants (in
HTN patients).
Sem i, 2019/2020
PHP5208 Community
Pharmacy
12

13. Prescription
• A handwritten, typed, or computer generated form
which serves as a means of communication between
the prescriber and the pharmacist and gives details
of the medicine(s) to be dispensed for a named
patient and is issued by an authorized prescriber.
• It may contain one or more items which may be
medicines, medical appliances, nutritional
supplements, etc.
• It may be a paper or electronic form.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
13

14. Essential Information to be Included on
a Prescription
Patient &
Disease Details
• Name
• Address
• Date of the
prescription
• Diagnosis
Medications
Details
• Name
• Strength
• Dosage form
• Dose and dosing
regimen
• Total amount to
be dispensed
• Directions for use
Prescribers
Details
• Name
• Address
• Telephone
number
• Qualification(s)
• Signature/Stamp
Sem i, 2019/2020
PHP5208 Community
Pharmacy
14

15. Sem i, 2019/2020
PHP5208 Community
Pharmacy
15
Diagnosis: xxxxxx

16. Narcotic and Controlled Drugs
• Listed in three (3) schedules.
• Egyptian company for medicines trade is the only
authorized wholesaler of these drugs.
• Inventory movement must be recorded in certified
registers in the following details:
▫ Amount received and date
▫ Amount dispensed and date
• A quota is allocated for each community pharmacy and
the amount can be increased to 24 hours service
pharmacies.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
16

17. Controlled Drugs Schedules
1st schedule
drugs
• Opioids, tramadol,
and barbiturates.
• The prescription can
contain only one item
and only one pack
can be dispensed.
• The prescription
must be submitted to
the pharmacy and
can’t be returned to
the patient.
2nd schedule drugs
• Benzodiazipines
• The prescription can
contain maximum
two items and
maximum
dispensable amount
is that enough for
one month
consumption.
• The pharmacy stamp
must be placed on
the prescription to
prevent refill.
3rd schedule drugs
• Carovas capsules,
Migranil tablets,
Librax tablets,
Rivotril tablets and
drops, and Cafergot
suppositories.
• The prescription can
be given back to the
patient and no limit
for the amount
dispensable.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
17

18. Controlled Drugs Prescription Form
• For first and second schedule forms, only prescription forms certified by
Medical Professions Syndicates Union can be used.
• The patient ID number should be included in the prescription besides other
information usually given in the normal prescription.
• The controlled items can’t be dispensed after more than five days from the
date the prescription was issued.
• Each pharmacy must hold a register certified by the health department for
each item of schedule 1 and amounts received and dispensed must be
recorded.
• Registers, prescriptions, and invoices of schedule 1 drugs must be kept by
the pharmacy for five years from the date it was issued.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
18

19. Dispensing Process
Processing
the
Prescription
- Screening
- Interpreting the
Prescription
Order
- Handling
Prescriptions
which Require
Clarification
- Handling
Prescriptions in
a Stock-Out
Situation
Preparing
the
Medicines
- Filling
- Labelling
- Checking
Counter-Checking
Recording
Issuing
Medicines
to
the
Patient
Sem i, 2019/2020
PHP5208 Community
Pharmacy
19

20. Screening
▫ To ensure that the prescription is for the correct patient
and it complies with the legal requirements, e.g., signature
of the prescriber, date after which the prescription cannot
be dispensed and prescriber’s registration details.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
20

21. Screening (cont.)
The prescription should have the following information
• Patient Details
1. Name
2. Address
3. Identification number
(IC/Passport No)
• Prescription Details
1. Drug regimen (name of medicine,
dose, frequency, administration
and duration)
2. Doctor’s signature, stamp and
registration number.
3. Doctor’s name and address.
4. Date of prescribing.
Sem i, 2019/2020
21
PHP5208 Community
Pharmacy

22. Interpretation
• It is an approach to ensure that the prescriber’s diagnosis and treatment
choice is conveyed accurately and the correct medication is dispensed to
the patient.
• Check for:
▫ Dose, frequency and duration
Should always be checked with reference to the patient’s age, diagnosis, and
comorbidities.
▫ Drug interactions: Drug-drug and drug food interactions, interaction within the
same prescription and with other medications taken by the patient. Can be done
with the use of specialized software.
▫ Medicine duplication, polypharmacy, inappropriate drug therapy, contra-
indications.
▫ Allergies
▫ Unusual usage and suspected drug misuse or abuse.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
22

23. Handling Prescriptions which
Require Clarification
Incomplete
Prescription /
Clarification
Required
Attempt to
contact
prescriber
Contacted
Documented the
changes on the
prescription and
endorsed with
“PRESCRIBER
CONTACTED”
(PC), dated and
initialled by the
pharmacist/person
dispensing.
Not
Available
Return
Prescription
Sem i, 2019/2020
PHP5208 Community
Pharmacy
23

24. Handling Prescriptions in a Stock-
Out Situation
• Stock-out: a situation where the prescribed medicine is not
available at the pharmacy when a prescription is being processed.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
24
Patient Can
Receive
Medicines Later
Arrange to get
stock
Medicines
Needed
Urgently
- Communicate with the prescriber
- Ask if the prescribed medicine can be
substituted with another medicine which is
readily available.

25. Filling
• Medicines which need to be packed such as loose
capsules/tablets should be packed into a clean, dry
container, such as a bottle or plastic envelope
which will not compromise the quality of the
product after dispensing.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
25
• To prevent medication errors, pick the medicine by reading the
label at least twice and cross-checking the medicine name and
strength against the prescription.
• Don’t get confused with look alike drugs.
• Check the expiry date of dispensed medicines to ensure that they
remain unexpired for the duration of the supply course.
• Medicines should be dispensed in original packaging as far as
possible.

26. Sem i, 2019/2020
PHP5208 Community
Pharmacy
26
Fugure. Look alike medicines

27. Labelling
It is advisable for labels to be printed.
Label should contain:
• Name, address, and contact number of
pharmacy.
• Patient’s name
• Name of medicines
• Dosage form with the strength and
quantity per unit dosage form: mg/ml of
liquid, mg/g for semi-solid preparations.
• Directions for use: dose, frequency and
duration (if necessary)
• Date of supply
• Expiry date
• All controlled medicines should be
labelled with “Controlled Medicine”
• Medicines for external use should be
dispensed in suitable containers and
should be labelled with the words or
“For External Use Only” printed in
red OR on a red background.
• Special precautionary labels should
be used where necessary (e.g.,
“Complete the course” for antibiotics,
“May cause drowsiness” for sedating
drugs, etc).
Sem i, 2019/2020
27
PHP5208 Community Pharmacy

28. Sem i, 2019/2020
PHP5208 Community
Pharmacy
28

29. Checking & Counter-Checking
• Check the prescription and the filled medicines to
ensure that the filled medicines correlate with the
prescription.
• Counter-checking should be done by a second person,
other than the staff who did the previous filling and
labelling tasks.
• Check all the medicines prepared for dispensing
against the prescription.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
29

30. Recording
• If a legal requirement, e.g., controlled drugs, or by the
facility.
• Proper record keeping is an essential part of dispensing as
it facilitates good management and monitoring of services
provided.
• Such records can be used to verify the stocks used in
dispensing, and will be required if a need arises to trace
patients dispensed with a particular medicine.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
30

31. Issuing Medicines to the Patient
5Rs
Right
Patient
Right
Medicine
Right
Dose
Right
Route
Right
Time
Sem i, 2019/2020
PHP5208 Community
Pharmacy
31

32. Arrangement of Drugs in the
Pharmacy
(Pharmacy Merchandising)
Merchandising involves the proper placement of goods on
pharmacy shelves.

33. Methods of merchandising Sem i, 2019/2020
PHP5208 Community
Pharmacy
33
• Products under the same ATC are
placed in the same section. e.g., GIT
drugs, respiratory drugs, antibiotics,
cosmetics, surgical appliances, etc.
Anatomical
Therapeutic Class
• Products of the same dosage form are
placed in one section, e.g., tablets,
syrup, etc..
Dosage form
• Products are arranged alphabetically
based on their trade name.
Alphabetical
• Fast moving items are placed near to
the counter while slow moving items
can be placed in a distant site in the
pharmacy.
Speed of movement

34. Combination of Previous Methods
• Fast moving items near to the counter.
• Controlled drugs, antibiotics, cosmetics, nutritional
supplements, and surgical appliances are placed in separate
sections.
• The rest of items are classified based on dosage form.
• Items are arranged alphabetically in each section.
• Place related departments next to or near each other, e.g., Cosmetics,
hair-care products, and health and beauty aids commonly are located
near toiletries and feminine hygiene products because consumers who
come to a pharmacy to purchase the former products also tend to
need the latter
Sem i, 2019/2020
PHP5208 Community
Pharmacy
34

35. Patient Counseling
• Effective counseling is essential
to get the necessary information
for assessment of patients
presenting to the pharmacy
seeking professional opinion.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
35

36. Counseling Steps
Take Patient
History
• Presenting
complaint
• History of
presenting
complaint
(HPC)
• Past medical
history
(PMH)
• Direct
questioning
• Social/family
history
(SH/FH)
Make evidence
based
recommendation
• Recommend
safe,
effective and
appropriate
for the
condition to
be treated
according to
evidence-
based
guidelines.
Monitor
symptoms
• Not
possible in
self-
limiting
condition.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
36

37. Communication skills in the
pharmacy
• Pay full attention to the patient (empathy); avoid
distractions.
• Privacy should be guaranteed.
• Use appropriate body language to show that the patient
has your attention.
• Use open ended questions when you want the patient to
explain more, use closed ended questions when you want
definite answers from the patient.
• Take the time to reflect back to the patient to clarify what
has been said.
Sem i, 2019/2020
PHP5208 Community
Pharmacy
37