Hospital Pharmacy Functions Explained

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UNIT -1
Hospital
A hospital is a healthcare institution that provides medical and nursing
care to patients who are suffering from acute or chronic illnesses or
injuries. Hospitals are typically staffed by healthcare professionals,
including physicians, nurses, and other allied health professionals, who
are trained to provide a wide range of medical services and treatments.
Hospitals offer a variety of medical services, such as diagnostic testing,
surgery, emergency care, and inpatient care. They are equipped with a
range of medical technologies, including medical imaging equipment,
laboratory facilities, and advanced surgical instruments. Hospitals may
also offer specialized medical services, such as obstetrics and gynecology,
pediatrics, cardiology, oncology, and psychiatry.
Hospitals can be public or private institutions and may vary in size,
ranging from small clinics to large medical centers with hundreds of beds.
In addition to medical services, hospitals may also provide educational
and research opportunities for healthcare professionals, as well as
community outreach and health education programs.
In summary, a hospital is a healthcare institution that provides a wide
range of medical services and treatments to patients who are suffering
from acute or chronic illnesses or injuries. It is staffed by healthcare
professionals and equipped with medical technologies and facilities to
provide the best possible care to patients.
Classification of Hospital
Hospitals can be classified based on a number of factors, including
ownership, level of care, specialty, and size. Here are some common ways
in which hospitals are classified:
1. Ownership: Hospitals can be either public or private. Public hospitals are
owned and funded by the government and provide medical care to the
general public. Private hospitals, on the other hand, are owned and

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operated by private entities such as individuals, corporations, or religious
organizations.
2. Level of care: Hospitals can be classified based on the level of care they
provide. For example, a primary care hospital is focused on providing
basic medical services, such as general medicine, pediatrics, and
obstetrics. A secondary care hospital is focused on providing more
specialized medical services, such as surgery, cardiology, and neurology.
A tertiary care hospital is focused on providing highly specialized medical
services, such as organ transplants, complex surgeries, and cancer
treatments.
3. Specialty: Hospitals can be classified based on the type of medical
services they provide. For example, a children's hospital specializes in
providing medical care to children, while a psychiatric hospital
specializes in treating patients with mental health conditions.
4. Size: Hospitals can also be classified based on their size, which can range
from small clinics to large medical centers with hundreds of beds. Small
hospitals are typically focused on providing primary care services, while
larger hospitals are equipped to provide a wider range of medical services
and treatments.
In summary, hospitals can be classified based on ownership, level of care,
specialty, and size, among other factors. Understanding the different types
of hospitals can help patients and healthcare providers choose the best
hospital for their specific needs.
Primary , Secondary & Tertiary Hospital
Primary, secondary, and tertiary hospitals are classified based on the level
of care they provide to patients.
1. Primary hospital: A primary hospital is typically the first point of contact
for patients seeking medical care. These hospitals are usually small and
focus on providing basic medical services, such as outpatient care, routine
surgeries, and basic diagnostic tests. Primary hospitals may also provide
emergency services and maternity care.

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2. Secondary hospital: A secondary hospital is larger and more specialized
than a primary hospital. These hospitals provide a higher level of medical
care and more specialized services, such as surgical services, critical care
units, and advanced diagnostic tests. They may also have specialized
clinics, such as cardiology, oncology, and neurology clinics.
3. Tertiary hospital: A tertiary hospital is the largest and most specialized
type of hospital. These hospitals provide the highest level of medical care
and the most advanced medical treatments and procedures. They have
highly specialized medical staff and advanced medical technologies,
including intensive care units, transplant units, and specialized surgery
units. Tertiary hospitals may also be teaching hospitals, where medical
students and residents receive training and education.
In summary, primary hospitals are the first point of contact for patients
seeking medical care and provide basic medical services. Secondary
hospitals provide a higher level of medical care and more specialized
services. Tertiary hospitals are the largest and most specialized type of
hospital, providing the highest level of medical care and the most
advanced medical treatments and procedures.
Classification of Hospital on Clinical & Non-clinical Basis
Hospitals can also be classified based on clinical and non-clinical services
they offer.
1. Clinical Hospitals: Clinical hospitals primarily focus on providing
medical care to patients. They have various medical departments, such as
cardiology, gastroenterology, pulmonology, pediatrics, and more. These
hospitals provide diagnosis, treatment, and rehabilitation services to
patients suffering from acute or chronic illnesses.
2. Non-Clinical Hospitals: Non-clinical hospitals provide a range of support
services that help to run and maintain the hospital. These services may
include administration, finance, human resources, housekeeping,
maintenance, and security.
Hospitals can also have a combination of both clinical and non-clinical
services, with some departments dedicated to medical care and others

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focused on support services. For example, a hospital may have a
cardiology department, a laboratory, and a housekeeping department to
ensure the hospital is clean and safe for patients.
In summary, hospitals can be classified based on clinical and non-clinical
services they offer. Clinical hospitals primarily focus on providing
medical care to patients, while non-clinical hospitals provide support
services to ensure the hospital runs efficiently and effectively.
Organization structure of Hospital
The organizational structure of a hospital can vary depending on the size,
type, and goals of the hospital. However, most hospitals have a similar
basic structure that includes the following:
1. Board of Directors: The board of directors is responsible for setting the
overall strategic direction of the hospital and ensuring that it complies
with legal and regulatory requirements.
2. Chief Executive Officer (CEO): The CEO is responsible for the overall
management of the hospital, including its day-to-day operations, financial
performance, and strategic planning.
3. Medical Staff: The medical staff includes physicians, nurses, and other
healthcare professionals who provide medical care to patients. The
medical staff is responsible for diagnosing and treating patients, and for
ensuring that the hospital meets high standards of patient care.
4. Administrative Staff: The administrative staff includes individuals who
are responsible for managing various aspects of the hospital's operations,
such as finance, human resources, marketing, and patient services.
5. Clinical Departments: The clinical departments are responsible for
providing medical care to patients. This may include departments such as
cardiology, oncology, surgery, and pediatrics.
6. Support Departments: The support departments include individuals and
teams who provide support services to the hospital, such as housekeeping,
maintenance, and food services.
7. Quality and Compliance Department: This department is responsible for
ensuring that the hospital meets legal and regulatory requirements, and for
monitoring the quality of patient care and patient outcomes.

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In summary, the organizational structure of a hospital typically includes a
board of directors, a CEO, medical and administrative staff, clinical and
support departments, and a quality and compliance department. The
structure is designed to ensure that the hospital operates efficiently and
effectively, and that it provides high-quality patient care.
Defination of Hospital Pharmacy and its functions
A hospital pharmacy is a specialized pharmacy within a hospital that
provides medication and pharmaceutical care services to patients who are
being treated in the hospital. Hospital pharmacies play an essential role in
ensuring that patients receive the appropriate medications and treatments
they need to recover from illness or injury.
The role of a hospital pharmacy includes the following:
1. Providing medications: Hospital pharmacies are responsible for ordering,
storing, and dispensing medications to patients. They work closely with
physicians and other healthcare providers to ensure that patients receive
the appropriate medications and dosages.
2. Compounding medications: Hospital pharmacies may also be responsible
for preparing customized medications, such as chemotherapy drugs or
intravenous medications, in a sterile environment.
3. Managing medication therapy: Hospital pharmacists work closely with
physicians and other healthcare providers to ensure that patients receive
the most effective medications and treatments for their condition. They
monitor patients' medication therapy and make recommendations for
changes if needed.
4. Educating patients: Hospital pharmacists may provide education to
patients and their families about the medications they are taking, including
proper dosages, potential side effects, and interactions with other
medications.
5. Ensuring patient safety: Hospital pharmacies play a critical role in
ensuring that patients receive the correct medications and dosages. They
use a variety of technologies and systems to verify medication orders,

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check for potential drug interactions, and minimize the risk of medication
errors.
In summary, a hospital pharmacy is a specialized pharmacy within a
hospital that provides medications and pharmaceutical care services to
patients. The role of a hospital pharmacy includes ordering, storing,
dispensing, compounding, managing medication therapy, educating
patients, and ensuring patient safety.
Organization structure of Hospital Pharmacy
Organization Structure of Hospital Pharmacy:
The organizational structure of a hospital pharmacy can vary depending
on the size, type, and services offered by the hospital. However, most
hospital pharmacies have a similar basic structure that includes the
following positions:
1. Pharmacy Director: The Pharmacy Director oversees the operations of the
hospital pharmacy and is responsible for managing its staff, services, and
resources.
2. Clinical Pharmacists: Clinical Pharmacists are responsible for providing
medication therapy management services, reviewing medication orders,
and managing the medication-related needs of patients in the hospital.
3. Pharmacy Technicians: Pharmacy Technicians support the operations of
the hospital pharmacy by performing tasks such as dispensing
medications, managing inventory, and preparing sterile products.
4. Pharmacy Assistants: Pharmacy Assistants perform administrative tasks
such as answering phones, managing patient information, and processing
medication orders.
Location and layout of Hospital Pharmacy
Location and Layout of Hospital Pharmacy:
The location and layout of a hospital pharmacy can vary depending on the
size and services offered by the hospital. However, most hospital
pharmacies are located near the patient care areas and are designed to

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optimize workflow and patient safety. The layout of a hospital pharmacy
typically includes the following areas:
1. Prescription Order Entry Area: This area is where medication orders are
entered into the pharmacy computer system.
2. Dispensing Area: This area is where medications are prepared and
dispensed to patients.
3. Sterile Product Preparation Area: This area is where sterile products, such
as intravenous medications, are prepared.
4. Non-Sterile Product Preparation Area: This area is where non-sterile
products, such as oral medications, are prepared.
Staff requirements & responsibilities of Hospital Pharmacist
Staff Requirements and Responsibilities of Hospital Pharmacists:
The staff requirements and responsibilities of hospital pharmacists can
vary depending on the size and services offered by the hospital. However,
most hospital pharmacists have similar basic responsibilities, including:
1. Reviewing medication orders and ensuring that patients receive the
appropriate medications and dosages.
2. Managing medication therapy for patients, including monitoring for
potential drug interactions, adverse reactions, and therapeutic outcomes.
3. Providing drug information and education to healthcare providers and
patients.
4. Managing the drug formulary and ensuring that the hospital uses the most
cost-effective medications.
5. Participating in interdisciplinary teams to ensure that patients receive
high-quality, comprehensive care.
Functions of Hospital Pharmacist
Functions of Hospital Pharmacists:
The functions of hospital pharmacists can vary depending on the size and
services offered by the hospital. However, most hospital pharmacists have
similar basic functions, including:

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1. Dispensing medications and managing medication inventories.
2. Providing medication therapy management services, including
monitoring for drug interactions, adverse reactions, and therapeutic
outcomes.
3. Reviewing medication orders and ensuring that patients receive the
appropriate medications and dosages.
4. Participating in the development and implementation of hospital policies
and procedures related to medication use.
5. Participating in research and educational activities to improve patient care
and advance the field of pharmacy.
Classification of Adverse Drug Reaction (ADR)
Adverse drug reactions (ADRs) can be classified in various ways,
including by their severity, mechanism of action, and time course. One of
the most commonly used classifications is based on the type of reaction
that occurs. Here are the main types of ADRs:
1. Type A (augmented) reactions: These are dose-dependent and predictable,
and they result from the drug's known pharmacological actions. Type A
reactions are the most common type of ADRs and can include effects such
as nausea, dizziness, and low blood pressure.
2. Type B (bizarre) reactions: These are not dose-dependent or predictable,
and they are often idiosyncratic or allergic in nature. Type B reactions can
include anaphylaxis, drug-induced lupus, and serum sickness.
3. Type C (chronic) reactions: These are dose-dependent and occur after
long-term use of the drug. Type C reactions can include osteoporosis,
diabetes, and adrenal suppression.
4. Type D (delayed) reactions: These occur after a delay in time from drug
exposure, and are often related to the drug's effect on organ systems.
Examples include drug-induced liver injury and tardive dyskinesia.
5. Type E (end-of-treatment) reactions: These occur after the drug is
stopped, and are often related to rebound effects. Examples include
rebound hypertension after stopping a blood pressure medication.

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6. Type F (failure of therapy) reactions: These occur when the drug fails to
achieve its intended therapeutic effect. Examples include antibiotic
resistance and cancer chemotherapy failure.
It is important to note that these classifications are not mutually exclusive,
and many ADRs can fall into more than one category. Furthermore, there
are often complex interactions between the patient's individual
characteristics, drug properties, and disease states that can contribute to
the development of ADRs.
Excessive Pharmacological Effects
Excessive pharmacological effects, also known as drug toxicity, refer to
the harmful or dangerous effects that occur when a person is exposed to
an excessive amount of a drug or a drug that is too potent for their
individual physiology. This can result from taking too high of a dose of a
medication, taking it too frequently, or not adequately clearing the drug
from the body. Excessive pharmacological effects can occur with any
medication, whether over-the-counter or prescription, and can range in
severity from mild to life-threatening.
The symptoms of excessive pharmacological effects vary depending on
the drug involved, but can include:
 Nausea, vomiting, and diarrhea
 Dizziness, confusion, and disorientation
 Rapid or slow heart rate
 Low or high blood pressure
 Seizures or convulsions
 Respiratory depression or failure
 Kidney or liver damage
Treatment for excessive pharmacological effects depends on the severity
of the symptoms and the drug involved. In some cases, simply stopping
the medication and providing supportive care such as fluids and oxygen
can be sufficient. In more severe cases, medications to counteract the
effects of the drug may be necessary, or hospitalization may be required

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for close monitoring and treatment. In some cases, emergency medical
attention may be necessary. To prevent excessive pharmacological
effects, it is important to follow medication instructions carefully,
including dosages, frequency, and duration of use, and to inform your
healthcare provider of any existing medical conditions or other
medications you are taking that may interact with the prescribed
medication.
Secondary pharmacological effects
Secondary pharmacological effects refer to unintended, but potentially
beneficial effects that a drug may have, in addition to its intended
therapeutic effect. These effects can occur due to the pharmacological
properties of the drug, the way it interacts with other medications, or the
unique physiology of the individual taking the medication.
Some examples of secondary pharmacological effects include:
1. Off-label use: A drug may be prescribed for a condition that it was not
originally approved to treat, but has shown to be effective in some cases.
For example, some antidepressant medications are sometimes used to
treat chronic pain.
2. Serendipitous discoveries: Sometimes, a drug may be discovered to have
a beneficial effect on a condition other than the one it was originally
developed to treat. For example, sildenafil (Viagra) was originally
developed to treat hypertension but is now primarily used to treat erectile
dysfunction.
3. Synergistic effects: Two or more medications taken together may have a
combined effect that is greater than the sum of their individual effects. For
example, some cancer treatments involve the use of multiple drugs that
work together to target different aspects of the cancer cells.
4. Adverse effects used therapeutically: Some drugs may have adverse
effects that can be used to treat other conditions. For example, the drug
thalidomide, which was originally used as a sedative and caused severe
birth defects in the 1960s, is now used to treat multiple myeloma, a type
of cancer.

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While secondary pharmacological effects can be beneficial, they can also
be harmful if not monitored carefully. It is important for healthcare
providers and patients to be aware of potential secondary effects, and to
carefully monitor patients for any changes in symptoms or side effects. In
some cases, additional testing or monitoring may be necessary to ensure
that the secondary effect is not causing harm.
Idiosyncrasy
Idiosyncrasy is an abnormal, unpredictable response to a drug that is not
related to its pharmacological action or dose. It is a type of adverse drug
reaction that occurs in a small percentage of people and is not related to
an individual's underlying medical condition. The cause of idiosyncratic
reactions is not well understood, but it is thought to be related to genetic
variations in drug metabolism, immune system function, or other
biological factors.
Idiosyncratic reactions can vary in severity and can occur with any
medication, whether over-the-counter or prescription. Some examples of
idiosyncratic reactions include:
1. Allergic reactions: An allergic reaction is an abnormal response of the
immune system to a drug, and can range from mild skin rash to life-
threatening anaphylaxis.
2. Drug-induced liver injury: Some drugs can cause liver damage in a small
number of people, which can lead to serious complications.
3. Agranulocytosis: Agranulocytosis is a condition in which the body's
ability to produce white blood cells is impaired, which can increase the
risk of infection.
4. Torsades de pointes: Torsades de pointes is a type of abnormal heart
rhythm that can occur with certain medications and can be life-
threatening.
The symptoms of idiosyncratic reactions can vary depending on the drug
involved and the individual's response. It is important to seek medical
attention if you experience any unusual or severe symptoms after taking
a medication. In some cases, discontinuing the medication may be

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necessary, and alternative medications may need to be prescribed. In rare
cases, genetic testing or other diagnostic tests may be needed to identify
the cause of the idiosyncratic reaction.
Allergic drug reactions
Allergic drug reactions occur when the immune system overreacts to a
medication, causing symptoms that can range from mild to severe. An
allergic reaction to a drug can occur with any medication, whether it is
over-the-counter or prescription. The symptoms of an allergic drug
reaction can occur immediately after taking the medication, or may not
appear until several days or weeks after the first dose.
Some of the symptoms of an allergic drug reaction include:
1. Skin rash or hives
2. Swelling of the face, lips, or tongue
3. Itching or redness of the skin
4. Shortness of breath or difficulty breathing
5. Wheezing or coughing
6. Runny nose or sneezing
7. Nausea, vomiting, or diarrhea
8. Abdominal pain or cramping
9. Anaphylaxis, a severe and potentially life-threatening reaction that can
cause difficulty breathing, rapid pulse, and shock.
It is important to seek medical attention immediately if you experience
any of these symptoms after taking a medication, especially if you have
difficulty breathing, swelling of the face or throat, or other severe
symptoms.
Treatment for an allergic drug reaction typically involves discontinuing
the medication and taking steps to manage symptoms. This may include
the use of antihistamines to reduce itching and inflammation, or
corticosteroids to reduce inflammation and swelling. In severe cases,
emergency treatment may be necessary, including epinephrine

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(adrenaline) injections, oxygen therapy, or other measures to manage
symptoms.
To prevent allergic drug reactions, it is important to tell your healthcare
provider about any allergies or prior adverse reactions to medications
before taking a new medication. You should also read medication labels
carefully and follow dosage instructions closely, and be aware of any
potential drug interactions with other medications you may be taking.
Genetically determined toxicity
Genetically determined toxicity refers to the potential for an individual's
genetic makeup to influence their susceptibility to adverse drug reactions.
Certain genetic variations can affect the way a person metabolizes or
processes a medication, which can increase the risk of toxicity or adverse
effects.
There are several genes that have been identified as having an impact on
drug metabolism and toxicity, including genes that code for drug-
metabolizing enzymes, drug transporters, and other proteins that are
involved in drug metabolism and excretion. Some examples of genes that
can influence drug toxicity include:
1. Cytochrome P450 (CYP) enzymes: These enzymes are involved in the
metabolism of many drugs and can be affected by genetic variations. For
example, genetic variations in the CYP2D6 gene can affect the
metabolism of certain antidepressants, causing increased toxicity or
reduced effectiveness.
2. Uridine diphosphate glucuronosyltransferase (UGT) enzymes: These
enzymes are involved in the metabolism of many drugs, including pain
medications and antibiotics. Genetic variations in the UGT1A1 gene can
increase the risk of toxicity with certain drugs, such as irinotecan, a
chemotherapy drug.
3. ATP-binding cassette (ABC) transporters: These proteins are involved in
the transport of drugs across cell membranes and can affect the

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distribution and elimination of drugs. Genetic variations in the ABCB1
gene can affect the response to certain drugs, such as anti-arrhythmic
medications.
Identifying genetic variations that can affect drug toxicity can help
healthcare providers to personalize treatment plans and reduce the risk of
adverse drug reactions. Testing for genetic variations can help to identify
patients who may be at increased risk of toxicity and guide dose
adjustments or alternative treatments.
However, it is important to note that genetic testing is not appropriate for
all patients or all medications. Healthcare providers must carefully weigh
the potential benefits and risks of genetic testing for each patient and
medication, and ensure that patients are fully informed about the potential
implications of testing.
Toxicity following sudden withdrawal of drugs
Toxicity following sudden withdrawal of drugs, also known as
withdrawal syndrome, can occur when a medication is abruptly
discontinued or the dose is rapidly reduced. Withdrawal syndrome can
occur with many different types of medications, including opioids,
benzodiazepines, and antidepressants.
The symptoms of withdrawal syndrome can vary depending on the
medication involved and the individual's response, but may include:
1. Anxiety, agitation, or irritability
2. Insomnia or sleep disturbances
3. Nausea, vomiting, or diarrhea
4. Sweating or fever
5. Headache or dizziness
6. Seizures (in rare cases)
7. Depression or suicidal thoughts (in some cases)
Withdrawal syndrome can occur even with medications that are not
typically associated with addiction or dependence, such as certain

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antidepressants. It is important to follow your healthcare provider's
instructions carefully when stopping or reducing the dose of any
medication, and to seek medical attention if you experience any unusual
or severe symptoms.
Treatment for withdrawal syndrome may involve gradually tapering the
dose of the medication to allow the body to adjust to the changes. This
can help to minimize the risk of withdrawal symptoms and reduce the risk
of rebound effects, such as a return of the original symptoms that the
medication was intended to treat.
In some cases, medications or other therapies may be used to manage
specific symptoms of withdrawal syndrome, such as anxiety or sleep
disturbances. It is important to work closely with your healthcare provider
to develop an individualized treatment plan that meets your specific needs
and helps to ensure a safe and effective transition off of the medication.
Drug interaction
Drug interaction occurs when two or more medications, supplements, or
substances interact in a way that alters the way one or both of the drugs
work, or increases the risk of side effects. The interaction can occur
between prescription medications, over-the-counter medications, herbal
supplements, or even foods.
Drug interactions can occur in several ways, including:
1. Pharmacokinetic interactions: These occur when one medication affects
the way another medication is absorbed, distributed, metabolized, or
excreted. For example, one medication may inhibit the activity of an
enzyme that is needed to metabolize another medication, causing higher
blood levels of the second drug and increasing the risk of toxicity.
2. Pharmacodynamic interactions: These occur when two medications have
similar or opposing effects on the body and can interact to either enhance
or reduce the effectiveness of one or both drugs. For example, taking two
medications that have sedative effects can increase the risk of drowsiness
or confusion.

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3. Combined toxicity: This occurs when two or more medications have toxic
effects when taken together. For example, taking two medications that can
cause liver damage can increase the risk of liver injury.
Drug interactions can occur between medications prescribed by different
healthcare providers, or when patients self-medicate with over-the-
counter drugs or herbal supplements. Some drug interactions are well-
known and can be anticipated, while others may be unexpected and occur
only in certain individuals or in specific circumstances.
To minimize the risk of drug interactions, it is important to provide your
healthcare provider with a complete list of all medications, supplements,
and other substances you are taking, including over-the-counter drugs and
herbal supplements. Your healthcare provider can evaluate the potential
for drug interactions and make recommendations to reduce the risk of
adverse effects. You should also read medication labels carefully and
follow dosage instructions closely, and be aware of any potential drug
interactions with other medications you may be taking.
Beneficial interactions
While drug interactions are generally seen as negative, some drug
interactions can be beneficial and may be intentionally used to enhance
the therapeutic effects of a medication. Beneficial interactions occur when
two or more medications are used together to produce a therapeutic effect
that is greater than the effect of either medication used alone.
For example, some medications are often prescribed together to treat a
specific medical condition. One medication may help to relieve
symptoms, while the other medication may enhance the effectiveness of
the first medication, leading to better symptom control. Additionally,
some medications may be prescribed together to reduce the risk of side
effects or to improve medication tolerability.
Here are some examples of beneficial drug interactions:

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1. Synergistic effect: When two or more medications are used together and
produce a combined effect that is greater than the sum of their individual
effects. For example, some medications that are used to treat high blood
pressure may be prescribed together to reduce the risk of cardiovascular
events.
2. Additive effect: When two or more medications are used together and
produce a combined effect that is equal to the sum of their individual
effects. For example, aspirin and clopidogrel are often used together to
prevent blood clots and reduce the risk of heart attack and stroke.
3. Potentiation: When one medication enhances the effect of another
medication, even though it has no therapeutic effect of its own. For
example, some antidepressants are sometimes used to enhance the pain-
relieving effects of opioids in the treatment of chronic pain.
While beneficial drug interactions can be useful, they also carry the risk
of increased side effects or toxicity. Therefore, it is important to consult
with your healthcare provider before combining medications, and to be
aware of any potential interactions or side effects associated with the
medications you are taking.
Adverse interactions
Adverse interactions, also known as negative drug interactions, occur
when two or more medications or substances interact in a way that can
cause harm or reduce the effectiveness of one or both drugs. Adverse
interactions can result in a range of side effects, from mild to severe, and
may increase the risk of developing new medical conditions or
complications.
Here are some examples of adverse drug interactions:
1. Drug-Drug Interactions: When two or more medications are taken
together and interact with one another in a negative way. For example,
taking two medications that both affect the central nervous system, such
as opioids and benzodiazepines, can increase the risk of respiratory
depression, which can be life-threatening.

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2. Drug-Food Interactions: When a medication interacts with a particular
food or beverage. For example, some antibiotics can interact with dairy
products, reducing their absorption and effectiveness.
3. Drug-Supplement Interactions: When a medication interacts with a
particular supplement or herbal product. For example, St. John's wort can
reduce the effectiveness of some antidepressants, which can lead to a
recurrence of depression symptoms.
4. Drug-Disease Interactions: When a medication interacts with an existing
medical condition. For example, some medications used to treat high
blood pressure can be dangerous for people with kidney disease, as they
can further damage the kidneys.
To minimize the risk of adverse drug interactions, it is important to
provide your healthcare provider with a complete list of all medications,
supplements, and other substances you are taking. Your healthcare
provider can evaluate the potential for drug interactions and make
recommendations to reduce the risk of adverse effects. You should also
read medication labels carefully and follow dosage instructions closely,
and be aware of any potential drug interactions with other medications
you may be taking.
Pharmacokinetics Drug Interactions
Pharmacokinetic drug interactions occur when one drug affects the way
another drug is absorbed, distributed, metabolized, or eliminated in the
body. These interactions can result in increased or decreased drug levels
in the blood, which can affect the drug's effectiveness or increase the risk
of adverse effects.
Some examples of pharmacokinetic drug interactions include:
1. Inhibition of drug metabolism: One drug can inhibit the metabolism of
another drug, leading to increased levels of the second drug in the blood.
For example, grapefruit juice can inhibit the metabolism of certain drugs,
such as statins and some antihistamines.

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2. Induction of drug metabolism: One drug can induce the metabolism of
another drug, leading to decreased levels of the second drug in the blood.
For example, rifampin, an antibiotic used to treat tuberculosis, can induce
the metabolism of many other drugs.
3. Competition for protein binding: Two drugs that are highly protein-bound
can compete for binding sites on plasma proteins, leading to increased
levels of free drug in the blood. This can increase the risk of toxicity. For
example, warfarin, an anticoagulant, is highly protein-bound and can
compete with other drugs for protein binding sites.
4. Alteration of gastrointestinal absorption: Some drugs can affect the
absorption of other drugs in the gastrointestinal tract. For example,
antacids can decrease the absorption of certain antibiotics, such as
tetracyclines.
It is important for healthcare providers to be aware of potential
pharmacokinetic drug interactions and to monitor patients closely when
they are taking multiple medications. Patients should also inform their
healthcare providers of all medications they are taking, including
prescription drugs, over-the-counter medications, and dietary
supplements.
Methods of detecting drug interactions
There are several methods for detecting drug interactions, including:
1. Literature review: Healthcare providers can review the medical literature
to identify potential drug interactions. Many professional organizations
and regulatory agencies provide guidelines and recommendations for
identifying and managing drug interactions.
2. Computerized drug interaction databases: There are several computerized
databases that can help healthcare providers identify potential drug
interactions. These databases contain information about drug metabolism,
drug-drug interactions, and drug-disease interactions.
3. Clinical observation: Healthcare providers can monitor patients for signs
and symptoms of drug interactions. For example, if a patient is taking two

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drugs that can cause sedation, the healthcare provider may monitor the
patient for signs of excessive drowsiness or confusion.
4. Laboratory testing: Some drug interactions can be detected through
laboratory testing. For example, if a patient is taking a drug that can affect
liver function, the healthcare provider may order liver function tests to
monitor for signs of liver damage or dysfunction.
5. Pharmacokinetic studies: Pharmacokinetic studies involve measuring
drug levels in the blood and can help healthcare providers identify
potential drug interactions. For example, if a patient is taking a drug that
can inhibit the metabolism of another drug, the healthcare provider may
measure the blood levels of both drugs to determine if the inhibiting drug
is causing increased levels of the second drug.
It is important for healthcare providers to be vigilant for potential drug
interactions, as they can have significant clinical implications for patient
outcomes. Healthcare providers should regularly review a patient's
medication list and consider potential drug interactions when prescribing
new medications.
Spontaneous case reports and record linkage studies
Spontaneous case reports and record linkage studies are two methods used
in pharmacovigilance to identify and monitor adverse drug reactions
(ADRs).
Spontaneous case reports involve the collection of reports of suspected
ADRs from healthcare providers, patients, and other sources. These
reports are usually submitted to regulatory agencies or pharmaceutical
companies, which then analyze the data to identify potential safety issues
related to drugs. Spontaneous case reports can provide early signals of
potential ADRs, which can then be further investigated through other
methods, such as observational studies or clinical trials.
Record linkage studies involve linking data from different sources, such
as medical records or health insurance databases, to identify potential
ADRs. For example, a record linkage study could link data on medication

22
use and hospital admissions to identify potential ADRs that led to
hospitalization. Record linkage studies can provide a large amount of data
and are often used to identify rare ADRs that may not be detected through
spontaneous case reports.
Both spontaneous case reports and record linkage studies have their
strengths and limitations. Spontaneous case reports are useful for
detecting rare and unexpected ADRs, but they may be subject to
underreporting and bias. Record linkage studies can provide a large
amount of data, but they may also be subject to confounding and selection
bias. As such, both methods are often used in combination with other
methods to provide a comprehensive understanding of the safety profile
of drugs.
Adverse drug reaction reporting and management
Adverse drug reaction (ADR) reporting and management are critical
components of pharmacovigilance, which is the process of monitoring the
safety of drugs and taking action to minimize the risks associated with
their use.
ADR reporting involves collecting and analyzing reports of suspected
ADRs from healthcare providers, patients, and other sources. These
reports are typically submitted to regulatory agencies or pharmaceutical
companies, which then analyze the data to identify potential safety issues
related to drugs. ADR reporting can provide early signals of potential
ADRs, which can then be further investigated through other methods,
such as observational studies or clinical trials.
ADR management involves taking action to minimize the risks associated
with the use of drugs. This can include a range of interventions, such as
changing the drug dose or route of administration, discontinuing the drug,
or providing supportive care to manage the symptoms of an ADR. ADR
management may also involve providing information to patients and
healthcare providers about the risks associated with the use of a drug, and
how to monitor for and manage ADRs.

23
In many countries, ADR reporting is mandatory for healthcare providers,
pharmaceutical companies, and other stakeholders. This helps to ensure
that potential safety issues related to drugs are identified and managed in
a timely and effective manner. Healthcare providers play a key role in
ADR reporting and management, as they are often the first to identify and
report suspected ADRs.
Effective ADR reporting and management require a collaborative
approach between healthcare providers, patients, pharmaceutical
companies, regulatory agencies, and other stakeholders. By working
together to monitor the safety of drugs, we can help to minimize the risks
associated with their use and ensure that patients receive safe and effective
treatment.
Community Pharmacy Organization Structure
The structure of a Community Pharmacy Organization (CPO) can vary
depending on the organization's size, mission, and geographic scope.
However, there are several common components that are typically found
in CPO organizational structures:
1. Board of Directors: The Board of Directors is responsible for setting the
strategic direction of the organization and overseeing its activities. Board
members are typically elected by the membership and may include
pharmacists, pharmacy technicians, and other healthcare professionals.
2. Executive Director: The Executive Director is responsible for managing
the day-to-day operations of the organization and implementing the
strategic direction set by the Board of Directors. The Executive Director
may also be responsible for developing and implementing programs and
services to support the needs of the membership.
3. Committees: CPOs often have committees that focus on specific areas of
interest or concern. For example, a CPO may have a committee focused
on advocacy, continuing education, or membership development.
Committee members are typically appointed by the Board of Directors
and may include both pharmacists and other healthcare professionals.

24
4. Membership: CPOs rely on membership dues and fees to support their
activities and programs. Members typically include pharmacists,
pharmacy technicians, and other healthcare professionals who share an
interest in advancing the practice of pharmacy in the community.
5. Partnerships: CPOs may partner with other organizations to advance their
mission and goals. For example, a CPO may partner with a patient
advocacy group to promote the role of pharmacists in improving patient
health outcomes.
Overall, the structure of a Community Pharmacy Organization is designed
to support the delivery of high-quality pharmaceutical care in the
community by providing education, advocacy, and networking
opportunities to its members. By working together, CPOs help to advance
the practice of pharmacy and improve patient outcomes.
Structure of Retail & Wholesale Drug Store
Retail and wholesale drug stores have different structures, as they serve
different markets and have different business models.
Retail drug stores, also known as community pharmacies, typically have
the following structure:
1. Pharmacy manager: The pharmacy manager is responsible for the overall
operation of the pharmacy, including the provision of pharmaceutical care
to patients, managing the pharmacy staff, and ensuring compliance with
applicable laws and regulations.
2. Pharmacists: Pharmacists are responsible for dispensing medications and
providing medication counseling to patients. They also provide
medication therapy management services and may participate in other
patient care activities.
3. Pharmacy technicians: Pharmacy technicians assist pharmacists with
various tasks, including prescription processing, inventory management,
and customer service.

25
4. Front-end staff: Front-end staff includes cashiers, sales associates, and
other employees who provide customer service and support the operation
of the pharmacy.
Wholesale drug stores, also known as pharmaceutical distributors,
typically have the following structure:
1. Sales team: The sales team is responsible for generating revenue by
selling pharmaceutical products to retailers, hospitals, and other
customers.
2. Operations team: The operations team is responsible for managing the
logistics of the distribution process, including ordering, inventory
management, and shipping.
3. Customer service team: The customer service team provides support to
customers, including order tracking, product information, and problem
resolution.
4. Quality control team: The quality control team is responsible for ensuring
that all products meet regulatory and quality standards.
Overall, the structures of retail and wholesale drug stores reflect the
different roles they play in the pharmaceutical supply chain. Retail drug
stores focus on providing pharmaceutical care to patients, while wholesale
drug stores focus on distributing pharmaceutical products to customers.
Legal requirements for establishment and maintenance of a drug
store
The legal requirements for the establishment and maintenance of a drug
store can vary depending on the jurisdiction and the type of drug store.
However, some common legal requirements include:
1. Licensing: Most jurisdictions require drug stores to be licensed by the
appropriate regulatory agency. To obtain a license, drug store owners may
need to demonstrate that they meet certain requirements related to
qualifications, facility standards, and other factors.

26
2. Personnel qualifications: In many jurisdictions, drug stores must employ
licensed pharmacists and pharmacy technicians who meet specific
qualifications related to education, training, and experience.
3. Record-keeping: Drug stores are typically required to maintain accurate
records related to the dispensing and storage of medications. This may
include records related to prescription orders, inventory management, and
adverse drug reactions.
4. Security: Drug stores may be required to implement security measures to
prevent theft or diversion of controlled substances. This may include
installing security cameras, locking up controlled substances, and
implementing policies and procedures related to the handling and disposal
of these medications.
5. Compliance with laws and regulations: Drug stores must comply with a
variety of laws and regulations related to the dispensing and storage of
medications. These may include federal and state laws related to drug
scheduling, labeling requirements, and patient confidentiality.
6. Inspection and compliance: Drug stores may be subject to periodic
inspections by regulatory agencies to ensure compliance with applicable
laws and regulations.
Overall, the legal requirements for the establishment and maintenance of
a drug store are designed to ensure that medications are dispensed safely
and accurately, and that the privacy and confidentiality of patients are
protected. It is important for drug store owners to be familiar with the
legal requirements in their jurisdiction and to take steps to comply with
them.
Dispensing of proprietary product
Dispensing of a proprietary product in a drug store typically involves
several steps to ensure that the medication is dispensed safely and
accurately. These steps may include:
1. Prescription processing: The pharmacist receives a prescription for the
proprietary product from the prescribing healthcare provider. The
pharmacist reviews the prescription for accuracy, completeness, and

27
appropriateness, and may contact the prescriber if there are any questions
or concerns.
2. Medication dispensing: The pharmacist retrieves the proprietary product
from the drug store's inventory and dispenses the medication in the
appropriate dosage and form. The pharmacist may also provide
medication counseling to the patient to ensure that the medication is used
safely and effectively.
3. Labeling: The pharmacist affixes a label to the proprietary product
container that includes the patient's name, the medication name and
strength, dosage instructions, and any other relevant information.
4. Record-keeping: The pharmacist records information related to the
dispensing of the proprietary product, including the patient's name,
medication name and strength, and any other relevant information. This
information is typically maintained in the drug store's records and may be
shared with other healthcare providers as needed.
5. Adverse drug reaction monitoring: The pharmacist monitors the patient
for any adverse drug reactions or drug interactions that may occur as a
result of taking the proprietary product. If an adverse drug reaction is
detected, the pharmacist may report it to the appropriate regulatory agency
and may also work with the patient and healthcare provider to adjust the
medication regimen as needed.
Overall, the dispensing of a proprietary product in a drug store involves a
careful and coordinated process to ensure that the medication is dispensed
safely and accurately and that the patient receives appropriate medication
counseling and monitoring.
Maintenance of records of retail and wholesale drug store
The maintenance of records is an important aspect of the operation of both
retail and wholesale drug stores. The records help to ensure compliance
with regulations, support patient safety, and facilitate effective
management of inventory and business operations. Some of the records
that retail and wholesale drug stores typically maintain include:
Retail Drug Store Records:

28
1. Prescription records: Retail drug stores maintain records of all
prescriptions dispensed, including information about the patient,
prescriber, medication, dosage, and dispensing date.
2. Medication order records: Retail drug stores keep records of all
medication orders received, including information about the ordering
entity, medication name and quantity, and order date.
3. Inventory records: Retail drug stores maintain records of all medications
in inventory, including information about the medication name, strength,
and quantity.
4. Patient profiles: Retail drug stores maintain patient profiles that include
information about each patient, such as medical history, allergies, and
current medications.
5. Adverse drug reaction reports: Retail drug stores maintain records of any
adverse drug reactions that are reported by patients or healthcare
providers.
Wholesale Drug Store Records:
1. Purchase records: Wholesale drug stores keep records of all purchases,
including information about the supplier, medication name and quantity,
and purchase date.
2. Sales records: Wholesale drug stores maintain records of all sales,
including information about the customer, medication name and quantity,
and sales date.
3. Inventory records: Wholesale drug stores maintain records of all
medications in inventory, including information about the medication
name, strength, and quantity.
4. Product information: Wholesale drug stores maintain records of product
information, such as product literature, labeling, and safety information.
5. Adverse drug reaction reports: Wholesale drug stores maintain records of
any adverse drug reactions that are reported by customers or healthcare
providers.
Overall, the maintenance of records is an essential aspect of the operation
of both retail and wholesale drug stores. The records help to ensure

29
compliance with regulations, support patient safety, and facilitate
effective management of inventory and business operations.

30
UNIT 2
Drug Distribution system in Hospital
A drug distribution system in a hospital refers to the processes and
methods used to ensure that medications are properly ordered, stored,
dispensed, and administered to patients in a safe and efficient manner. The
specific components of a drug distribution system may vary depending on
the size and complexity of the hospital, but generally include the
following:
1. Medication ordering: Physicians, nurse practitioners, and other authorized
prescribers enter medication orders into a computerized system, which
generates labels or medication administration records (MARs) for use in
dispensing and administering medications.
2. Medication storage: Hospitals typically store medications in a centralized
pharmacy, which may be located on-site or off-site. Medications are
stored according to their specific storage requirements, such as
temperature, light exposure, and humidity.
3. Medication dispensing: Pharmacists or pharmacy technicians prepare
medications for distribution, either individually or in bulk. This may
involve repackaging medications into unit-dose packaging or preparing
IV medications for administration.
4. Medication distribution: Medications are delivered to the appropriate unit
or department, where they are stored in medication carts or cabinets until
they are needed for patient administration.
5. Medication administration: Nurses or other healthcare providers
administer medications to patients according to the medication orders and
MARs. They document medication administration in the patient's medical
record.
6. Medication reconciliation: Hospital staff ensure that patients receive the
correct medications at the correct dosages by performing medication
reconciliation during transitions of care, such as admission, transfer, and
discharge.

31
7. Medication monitoring: Hospitals monitor patients for adverse drug
reactions and medication errors. They also track medication use and costs
to ensure that medications are being used effectively and efficiently.
Overall, a drug distribution system in a hospital is a complex process that
involves multiple steps and stakeholders. The system is designed to ensure
that medications are delivered to patients in a safe, timely, and effective
manner, while also complying with regulatory requirements and
controlling costs.
Dispensing of drugs to inpatients
Dispensing of drugs to inpatients in a hospital involves a series of steps
that ensure safe and accurate delivery of medications to patients. The
process generally involves the following steps:
1. Prescription/order verification: A physician, nurse practitioner, or other
authorized prescriber orders medication for the patient. The order is then
verified by a pharmacist to ensure accuracy, appropriateness, and safety.
2. Medication preparation: Once the order has been verified, the pharmacist
or pharmacy technician prepares the medication. This may involve
repackaging the medication into unit-dose packaging or preparing IV
medications for administration.
3. Medication delivery: The medication is delivered to the appropriate unit
or department where the patient is located. Medications may be stored in
medication carts or cabinets until they are needed for administration.
4. Medication administration: The nurse or other healthcare provider
administers the medication to the patient according to the medication
order and medication administration record (MAR). They document the
medication administration in the patient's medical record.
5. Medication reconciliation: Hospital staff ensure that patients receive the
correct medications at the correct dosages by performing medication
reconciliation during transitions of care, such as admission, transfer, and
discharge.

32
6. Medication monitoring: The hospital staff monitor patients for adverse
drug reactions and medication errors. They also track medication use and
costs to ensure that medications are being used effectively and efficiently.
Overall, dispensing of drugs to inpatients in a hospital is a complex
process that involves multiple steps and stakeholders. The process is
designed to ensure that patients receive the correct medication at the
correct dosage, while also minimizing the risk of adverse drug reactions
and medication errors.
Types of drug distribution systems
There are several types of drug distribution systems, each with its own
advantages and disadvantages. The type of drug distribution system used
depends on the specific needs and characteristics of the healthcare facility.
Some common types of drug distribution systems include:
1. Unit-dose system: In this system, medications are dispensed in pre-
packaged unit doses that are labeled with the patient's name and other
relevant information. The medication is prepared by the pharmacy and
delivered to the patient's unit or floor. Nurses or other healthcare providers
administer the medication directly to the patient.
2. Decentralized system: In a decentralized system, medications are stored
and dispensed from decentralized locations, such as medication carts or
cabinets on patient units. The medications are prepared by the pharmacy
and delivered to the decentralized locations for administration by nurses
or other healthcare providers.
3. Centralized system: In a centralized system, medications are stored and
dispensed from a central pharmacy. The medications are prepared by the
pharmacy and delivered to patient units or other areas of the hospital as
needed.
4. Automated dispensing system: An automated dispensing system is a
computerized system that dispenses medications from a secure cabinet or
machine. Nurses or other healthcare providers access the medications
through the system using a password or biometric authentication.

33
5. Bar code medication administration (BCMA) system: A BCMA system
uses barcodes to verify the medication and the patient's identity before
administration. The system is designed to reduce medication errors by
ensuring that the right medication is given to the right patient at the right
time.
Overall, the type of drug distribution system used depends on a variety of
factors, including the size and complexity of the healthcare facility, the
number of patients, and the types of medications being administered. The
goal of any drug distribution system is to ensure safe and effective
medication use, while minimizing the risk of adverse drug events and
medication errors.
Dispensing of drugs to ambulatory patients
Dispensing of drugs to ambulatory patients typically involves a
community pharmacy, where patients can have their prescriptions filled
and receive advice on medication use. The process generally involves the
following steps:
1. Prescription receipt: The patient presents a prescription from a healthcare
provider to the pharmacy.
2. Prescription verification: The pharmacist or pharmacy technician verifies
the prescription for accuracy and appropriateness. They may also check
the patient's medication history to identify any potential drug interactions
or other issues.
3. Medication dispensing: The pharmacist or pharmacy technician fills the
prescription and labels the medication with the patient's name, dosage
instructions, and any other relevant information.
4. Patient counseling: The pharmacist or pharmacy technician counsels the
patient on the proper use of the medication, including dosage, frequency,
and potential side effects. They may also answer any questions the patient
may have about the medication.

34
5. Payment processing: The patient pays for the medication, either out of
pocket or through insurance. The pharmacy may also bill the patient's
insurance provider directly.
6. Medication counseling: The pharmacist or pharmacy technician may
follow up with the patient to provide additional counseling or advice on
medication use.
Overall, dispensing of drugs to ambulatory patients in a community
pharmacy is designed to ensure that patients receive the correct
medication at the correct dosage, while also providing education and
support to help patients use their medications safely and effectively. The
process may vary depending on the specific pharmacy and patient needs.
Dispensing of controlled drugs
Dispensing of controlled drugs is subject to strict regulations and
guidelines to ensure that these drugs are used safely and appropriately. In
the United States, controlled substances are categorized into schedules
based on their potential for abuse and dependence. Schedule I drugs are
considered to have no medical use and a high potential for abuse, while
Schedule V drugs have a low potential for abuse and are commonly used
for medical purposes.
The dispensing process for controlled substances typically involves the
following steps:
1. Prescription verification: The pharmacist must verify that the prescription
for the controlled substance is valid, including verifying the prescriber's
DEA registration number and ensuring that the prescription conforms to
state and federal regulations.
2. Patient identification: The pharmacist must verify the patient's identity
and confirm that they have a legitimate medical need for the controlled
substance.

35
3. Dispensing: The pharmacist must accurately dispense the controlled
substance, including labeling the medication with the patient's name and
dosage instructions.
4. Record keeping: The pharmacy must maintain detailed records of all
controlled substances dispensed, including the date, patient name,
medication name and strength, quantity dispensed, and prescriber
information.
5. Reporting: The pharmacy must report any suspicious or unusual activity
involving controlled substances to the appropriate regulatory authorities,
including the DEA.
In addition to these requirements, pharmacists must also follow specific
storage and security procedures to prevent diversion or theft of controlled
substances. This may include storing controlled substances in a locked
cabinet or safe and limiting access to authorized personnel only.
Overall, dispensing of controlled substances is a highly regulated process
that is designed to ensure that these drugs are used safely and
appropriately to prevent abuse and dependence.
Hospital Formulary
A hospital formulary is a list of medications that a hospital has approved
for use in patient care. The formulary is typically created and maintained
by a multidisciplinary committee of healthcare providers, including
pharmacists, physicians, and nurses.
The purpose of a hospital formulary is to ensure that patients receive safe,
effective, and cost-effective medications during their hospital stay. The
formulary committee carefully selects medications based on several
factors, including their safety profile, effectiveness, availability, and cost.
The committee also considers clinical practice guidelines, current
literature, and feedback from healthcare providers when selecting
medications for the formulary.

36
In addition to providing a list of approved medications, the hospital
formulary may also include information on dosing, administration, and
monitoring for each medication. The formulary may also include
guidelines for the use of specific medications, such as antibiotics or pain
medications, to ensure that these drugs are used appropriately and in
accordance with best practices.
The hospital formulary is a living document that is reviewed and updated
on a regular basis to ensure that it reflects current best practices and new
developments in medication therapy. The formulary committee may add
new medications to the formulary, remove medications that are no longer
considered safe or effective, or make changes to dosing or administration
guidelines based on new information.
Overall, the hospital formulary plays a critical role in ensuring that
patients receive safe and effective medication therapy during their
hospital stay. By carefully selecting and monitoring medications, the
formulary committee can help to improve patient outcomes and reduce
the risk of adverse drug events.
Content of Hospital formulary
The contents of a hospital formulary can vary depending on the hospital
and the patient population it serves. However, a hospital formulary
typically includes the following information:
1. List of approved medications: The formulary will include a list of
medications that are approved for use in patient care. This list may be
organized by therapeutic category or by drug class.
2. Dosing and administration information: The formulary may include
dosing and administration information for each medication. This may
include recommended doses, frequency of administration, and routes of
administration.

37
3. Indications for use: The formulary may include information on the
indications for use of each medication. This will help healthcare providers
determine when a particular medication should be used.
4. Contraindications: The formulary will include information on any
contraindications or precautions for each medication. This will help
healthcare providers determine when a particular medication should not
be used.
5. Adverse reactions: The formulary may include information on potential
adverse reactions or side effects of each medication. This information will
help healthcare providers monitor patients for potential adverse reactions.
6. Availability and cost: The formulary may include information on the
availability and cost of each medication. This information will help
healthcare providers make informed decisions about medication selection.
7. Guidelines for use: The formulary may include guidelines for the use of
specific medications or medication classes. This may include guidelines
for the use of antibiotics, pain medications, or other high-risk medications.
8. Formulary review process: The formulary will include information on the
review process for adding or removing medications from the formulary.
This will help ensure that the formulary reflects current best practices and
new developments in medication therapy.
Overall, the contents of a hospital formulary are designed to help
healthcare providers make informed decisions about medication selection
and administration to improve patient outcomes and reduce the risk of
adverse drug events.
Differentiation of hospital formulary and Drug list
A hospital formulary is a list of medications that a hospital has approved
for use in patient care. The formulary is typically created and maintained
by a multidisciplinary committee of healthcare providers, including
pharmacists, physicians, and nurses. The purpose of a hospital formulary
is to ensure that patients receive safe, effective, and cost-effective
medications during their hospital stay. The formulary may include dosing

38
and administration information, indications for use, contraindications,
adverse reactions, availability and cost, and guidelines for use.
On the other hand, a drug list is a list of medications that a patient is
currently taking. This may include prescription medications, over-the-
counter medications, vitamins, and supplements. A drug list is typically
used to ensure that patients receive appropriate medication therapy and to
avoid potential drug interactions or adverse reactions.
The main difference between a hospital formulary and a drug list is their
purpose and scope. While a hospital formulary is a list of approved
medications for use in patient care within the hospital, a drug list is a list
of medications that a patient is taking, regardless of where they received
the medication. Additionally, a hospital formulary is created and
maintained by a multidisciplinary committee of healthcare providers,
while a drug list is typically created and maintained by the patient or their
caregiver.
In summary, a hospital formulary is a list of medications approved for use
within a hospital, while a drug list is a list of medications that a patient is
currently taking. While both lists are important in ensuring safe and
effective medication therapy, they serve different purposes and have
different scopes.
Addition and deletion of drug from hospital formulary
The process for adding or deleting drugs from a hospital formulary can
vary depending on the hospital's policies and procedures. However, the
process typically involves the following steps:
1. Proposal: Any member of the hospital staff can propose the addition or
deletion of a drug from the hospital formulary. This proposal is typically
submitted to the hospital's pharmacy and therapeutics (P&T) committee.
2. Review: The P&T committee will review the proposal and evaluate the
drug's safety, efficacy, and cost-effectiveness. The committee will also

39
review any relevant clinical studies, guidelines, and regulatory
information.
3. Approval: If the P&T committee approves the addition or deletion of the
drug, the hospital's executive committee or other governing body must
also approve the change.
4. Implementation: Once approved, the change is implemented in the
hospital's electronic medical record system and other relevant systems.
The hospital staff is notified of the change through appropriate channels,
such as staff meetings, memos, or educational sessions.
5. Monitoring: The P&T committee monitors the use of the drug to ensure
its safety, efficacy, and cost-effectiveness. The committee may also
conduct periodic reviews of the hospital formulary to ensure that it reflects
current best practices and new developments in medication therapy.
The process for adding or deleting drugs from a hospital formulary is
designed to ensure that patients receive safe, effective, and cost-effective
medication therapy during their hospital stay. By involving a
multidisciplinary team of healthcare providers and evaluating the drug's
safety, efficacy, and cost-effectiveness, the hospital can make informed
decisions about medication selection and administration.
Therapeutic drug monitoring
Therapeutic drug monitoring (TDM) is the process of measuring drug
levels in a patient's blood to determine if the drug is at the appropriate
concentration for achieving the desired therapeutic effect while avoiding
toxicity. TDM is typically used for drugs with a narrow therapeutic
window, which means that there is a small range of drug concentrations
that provide therapeutic benefit without causing harm. Examples of drugs
commonly monitored using TDM include antibiotics, antiepileptic drugs,
immunosuppressants, and anticoagulants.

40
The process of TDM involves collecting a blood sample from the patient
at a specific time after drug administration, usually just before the next
dose is due. The blood sample is then analyzed in a laboratory using
specialized equipment to determine the drug concentration in the patient's
blood. The results of the TDM test are then used to adjust the patient's
drug dose to achieve the appropriate therapeutic concentration.
TDM is important for several reasons. First, it allows healthcare providers
to individualize drug therapy for each patient, taking into account factors
such as age, weight, kidney function, and other medications the patient
may be taking. Second, TDM can help prevent adverse drug reactions by
avoiding drug concentrations that are too high or too low. Finally, TDM
can improve drug efficacy by ensuring that the drug concentration is
within the therapeutic range.
In summary, therapeutic drug monitoring is the process of measuring drug
levels in a patient's blood to determine if the drug is at the appropriate
concentration for achieving the desired therapeutic effect while avoiding
toxicity. TDM is an important tool for optimizing drug therapy and
improving patient outcomes.
Need for Therapeutic Drug Monitoring
Therapeutic drug monitoring (TDM) is needed for drugs with a narrow
therapeutic window, which means that there is a small range of drug
concentrations that provide therapeutic benefit without causing harm.
Some of the reasons for the need for TDM are:
1. Variability in drug absorption: The absorption of a drug can be affected
by several factors such as food, age, and disease states, which can lead to
variability in drug concentrations in the blood. TDM can help adjust the

41
drug dose to account for this variability and ensure that the drug is at the
appropriate concentration for achieving the desired therapeutic effect.
2. Individual variability in drug metabolism: The rate at which drugs are
metabolized can vary between patients, which can affect the drug
concentration in the blood. TDM can help adjust the drug dose to account
for this variability and ensure that the drug is at the appropriate
concentration for achieving the desired therapeutic effect.
3. Risk of toxicity: Some drugs can be toxic at high concentrations, which
can lead to adverse drug reactions. TDM can help avoid toxic drug
concentrations by ensuring that the drug concentration is within the
therapeutic range.
4. Risk of treatment failure: Some drugs may not be effective at low
concentrations, which can lead to treatment failure. TDM can help ensure
that the drug concentration is within the therapeutic range, which can
improve treatment efficacy.
5. Patient safety: TDM can help prevent adverse drug reactions and improve
patient safety by ensuring that the drug dose is appropriate for each
individual patient.
In summary, TDM is needed for drugs with a narrow therapeutic window
to ensure that the drug is at the appropriate concentration for achieving
the desired therapeutic effect while avoiding toxicity. TDM can help
adjust the drug dose to account for variability in drug absorption and
metabolism, avoid toxic drug concentrations, improve treatment efficacy,
and ensure patient safety.
Factors to be considered during the Therapeutic Drug Monitoring
When performing therapeutic drug monitoring (TDM), there are several
factors that need to be considered to ensure accurate and reliable results.
Some of these factors include:

42
1. Timing of blood sampling: The timing of blood sampling is critical for
accurate TDM results. Blood samples should be taken at the appropriate
time after drug administration, usually just before the next dose is due.
This ensures that the drug concentration in the blood reflects the steady-
state concentration, which is important for determining the appropriate
drug dose.
2. Choice of sample matrix: The sample matrix used for TDM can affect the
accuracy of the results. For some drugs, blood may be the preferred
sample matrix, while for others, urine or saliva may be more appropriate.
The choice of sample matrix should be based on the drug being monitored
and the clinical situation.
3. Interference from other drugs: Some drugs can interfere with the
measurement of drug concentrations in the blood, leading to inaccurate
results. This is particularly important when monitoring drugs that are
highly protein-bound, as other drugs that bind to the same protein can
displace the drug being monitored, leading to falsely elevated drug
concentrations.
4. Patient factors: Patient factors such as age, weight, and kidney function
can affect the pharmacokinetics of the drug and the drug concentration in
the blood. TDM should take into account these patient factors when
determining the appropriate drug dose.
5. Analytical variability: The analytical method used for TDM can affect the
accuracy and precision of the results. Laboratories should use validated
methods and participate in external quality assurance programs to ensure
the reliability of their results.
6. Interpretation of results: The interpretation of TDM results should take
into account the therapeutic range for the drug being monitored, the
patient's clinical situation, and any potential drug interactions. The results
should be used to guide dosing adjustments and optimize drug therapy.
In summary, factors that need to be considered during therapeutic drug
monitoring include the timing of blood sampling, choice of sample
matrix, interference from other drugs, patient factors, analytical
variability, and interpretation of results. Taking these factors into account

43
can help ensure accurate and reliable TDM results that guide dosing
adjustments and optimize drug therapy.
Indian scenario for Therapeutic Drug Monitoring
Therapeutic drug monitoring (TDM) is an important tool in the
management of many diseases and conditions in India, particularly for
drugs with a narrow therapeutic index. Some of the drugs that are
commonly monitored through TDM in India include antiepileptic drugs,
immunosuppressants, antibiotics, and antipsychotics.
The Indian Council of Medical Research (ICMR) has developed
guidelines for the use of TDM in India, which provide recommendations
for the selection of drugs for monitoring, the timing and frequency of
monitoring, and the interpretation of results. These guidelines emphasize
the importance of individualizing drug therapy based on TDM results,
particularly for drugs with a narrow therapeutic index or those that are
associated with a high risk of toxicity.
In India, TDM is usually performed in specialized laboratories that have
the expertise and equipment to measure drug concentrations in biological
fluids such as blood, urine, or saliva. These laboratories typically use
high-performance liquid chromatography (HPLC), gas chromatography
(GC), or immunoassay methods to measure drug concentrations.
The availability of TDM services in India varies widely depending on the
region and the hospital or clinic. In some large hospitals and specialized
clinics, TDM services are readily available and routinely used to optimize
drug therapy. However, in smaller hospitals and clinics, TDM services
may be limited or not available at all.
One of the challenges for TDM in India is the cost of the tests, which can
be prohibitively expensive for many patients. To address this issue, some
hospitals and clinics have developed in-house methods for TDM, which
can be more cost-effective than using commercial laboratories.

44
Overall, while TDM is an important tool in the management of many
diseases and conditions in India, there is a need to improve access to TDM
services and to develop cost-effective methods for monitoring drug
therapy.
Medication adherence
Medication adherence refers to the extent to which a patient takes
medication as prescribed by their healthcare provider. Adherence is an
important aspect of medication management and can have a significant
impact on the effectiveness of the treatment.
Poor medication adherence is a common problem, and studies have shown
that it can result in increased healthcare costs, decreased quality of life,
and worse health outcomes. There are several factors that can contribute
to poor medication adherence, including forgetfulness, lack of
understanding about the medication or its importance, side effects, and
cost.
There are several strategies that can help improve medication adherence,
including:
1. Simplifying the medication regimen: Simplifying the medication regimen
can help make it easier for patients to remember to take their medication
as prescribed. This can include reducing the number of medications or
consolidating doses.
2. Educating patients about their medication: Educating patients about their
medication and the importance of adherence can help improve their
understanding and motivation to take their medication as prescribed.
3. Providing reminders: Reminders such as medication organizers, alarms,
or phone notifications can help patients remember to take their
medication.
4. Addressing side effects: If a medication is causing side effects that are
affecting adherence, it may be necessary to adjust the medication or add
a new medication to address the side effects.

45
5. Addressing cost barriers: If cost is a barrier to medication adherence,
exploring options such as generic medications or patient assistance
programs may be helpful.
6. Involving family and caregivers: Involving family members or caregivers
in medication management can help ensure that medications are taken as
prescribed, especially for patients who have cognitive or physical
limitations.
Overall, medication adherence is an important aspect of medication
management that can have a significant impact on patient outcomes. By
addressing factors that contribute to poor adherence and using strategies
to improve adherence, healthcare providers can help patients achieve the
best possible outcomes from their medication therapy.
Causes of medication non-adherence
There are several factors that can contribute to medication non-adherence,
including:
1. Forgetfulness: One of the most common reasons for medication non-
adherence is forgetfulness. Patients may forget to take their medication or
may not remember if they have taken it.
2. Complexity of medication regimen: Medication regimens that are
complex, involve multiple medications or doses, or have specific
administration requirements can be difficult for patients to follow.
3. Lack of understanding: Patients may not understand why they need to take
their medication or may not fully understand the instructions for taking it.
4. Side effects: Some medications may cause unpleasant side effects, such
as nausea or dizziness, that can make patients hesitant to take them.
5. Cost: Medications can be expensive, and patients may not be able to
afford them or may choose to skip doses to make them last longer.
6. Beliefs and attitudes: Patients may have beliefs or attitudes about
medication that influence their adherence, such as a distrust of
pharmaceutical companies or a preference for natural remedies.

46
7. Mental health issues: Patients with mental health conditions, such as
depression or anxiety, may have difficulty adhering to medication
regimens due to their symptoms.
8. Health literacy: Patients with low health literacy may have difficulty
understanding medication instructions or navigating the healthcare
system.
Overall, medication non-adherence is a complex issue with multiple
potential causes. Addressing these factors and using strategies to improve
adherence can help patients achieve better health outcomes.
Pharmacist role in the medication adherence
Pharmacists play a critical role in promoting medication adherence. They
can:
1. Educate patients: Pharmacists can provide education about the importance
of medication adherence and help patients understand how to take their
medications properly.
2. Address concerns: Pharmacists can address concerns patients may have
about their medication, such as side effects or cost, and work with patients
to find solutions.
3. Simplify medication regimens: Pharmacists can work with healthcare
providers to simplify medication regimens, consolidate medications, or
provide reminders to help patients stay on track.
4. Monitor adherence: Pharmacists can monitor patients' adherence to their
medication regimens and follow up with patients who may be struggling
to take their medications as prescribed.
5. Collaborate with healthcare providers: Pharmacists can work
collaboratively with healthcare providers to optimize medication
regimens, identify potential adherence barriers, and develop solutions to
improve adherence.
6. Provide medication management services: Pharmacists can provide
medication management services, such as medication therapy

47
management or adherence packaging, to help patients better manage their
medications.
7. Utilize technology: Pharmacists can use technology, such as mobile apps
or electronic monitoring devices, to help patients track their medication
use and provide feedback.
Overall, pharmacists can play a critical role in improving medication
adherence and helping patients achieve better health outcomes.
Need for the patient medication history interview
The patient medication history interview is an important tool for
healthcare providers to obtain information about a patient's medication
use. There are several reasons why this interview is necessary:
1. Prevent medication errors: Obtaining a thorough medication history can
help prevent medication errors, such as prescribing a medication that
interacts with a patient's current medication or prescribing a medication
that the patient is allergic to.
2. Ensure appropriate medication use: Understanding a patient's medication
history can help healthcare providers ensure that the patient is taking
medications appropriately, such as at the correct dose and frequency.
3. Identify medication-related problems: Obtaining a medication history can
help healthcare providers identify potential medication-related problems,
such as adverse drug reactions or medication non-adherence.
4. Improve patient outcomes: A thorough medication history can help
healthcare providers develop a comprehensive care plan that takes into
account the patient's medication use, which can lead to improved health
outcomes.
5. Support patient engagement: By engaging in a medication history
interview, healthcare providers can help patients understand the
importance of medication use and encourage them to be active
participants in their care.

48
Overall, the patient medication history interview is a critical component
of medication management and can help healthcare providers ensure that
patients receive safe, effective, and appropriate medication therapy.
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Patients Medication Interview forms

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Community Pharmacy Management- Financial, materials, staff, and
infrastructure requirements
Community pharmacy management involves several requirements,
including financial, materials, staff, and infrastructure requirements.
Some of these requirements are:
1. Financial requirements: Community pharmacies require funding for
various aspects, including purchasing medications and medical supplies,
paying salaries and wages, paying rent, and maintaining the infrastructure.
Financial management is critical to ensure that the pharmacy remains
profitable and sustainable.
2. Materials requirements: A community pharmacy requires adequate
supplies of medications, medical supplies, and equipment. The pharmacy
should also have appropriate storage facilities and systems to ensure that
medications are stored properly and are readily available.
3. Staff requirements: Community pharmacies require qualified and trained
staff, including pharmacists, pharmacy technicians, and support staff.
Adequate staffing is essential to ensure that the pharmacy operates
efficiently, and patients receive high-quality care.
4. Infrastructure requirements: The community pharmacy must have
adequate infrastructure, including a well-designed layout, computer
systems, dispensing equipment, and other necessary facilities. The
pharmacy should be accessible to patients, with appropriate signage and
parking facilities.
5. Regulatory requirements: Community pharmacies must comply with
regulatory requirements, including licensing, accreditation, and other
legal requirements. Compliance with regulations is essential to ensure that
the pharmacy operates legally and ethically.
6. Quality management requirements: Community pharmacies must have
quality management systems in place to ensure that medications are
dispensed safely and effectively. This includes procedures for medication
dispensing, patient counseling, and documentation.

51
Overall, community pharmacy management requires careful planning and
management of financial, materials, staff, and infrastructure resources.
Proper management can help ensure that the pharmacy operates
efficiently, provides high-quality care to patients, and remains sustainable
over the long term.

52
UNIT-3
Organization & structure of Pharmacy & therapeutics committee
A Pharmacy and Therapeutics Committee (P&T committee) is a
multidisciplinary team responsible for overseeing the safe and effective
use of medications within a healthcare organization. The committee is
typically composed of healthcare professionals such as pharmacists,
physicians, nurses, and other relevant specialists. The following are the
typical organizational and structural components of a Pharmacy and
Therapeutics Committee:
1. Purpose and Scope: The committee's mission statement and goals should
be clearly defined. The scope of the committee's activities should also be
outlined, including its role in drug formulary management, medication use
policies, and medication safety initiatives.
2. Leadership: A chairperson or co-chairs are typically appointed to lead the
committee. The chair(s) may be a physician, pharmacist, or other
healthcare professional with expertise in drug therapy management.
3. Membership: The committee's membership should be diverse, including
representatives from different clinical departments, such as pharmacy,
medicine, nursing, and administration. The committee may also include
non-voting members, such as a clinical pharmacist or a medication safety
officer.
4. Meetings: The committee should hold regular meetings, typically on a
monthly or quarterly basis, to discuss drug-related issues, review
medication-use policies, and evaluate the use of new medications. The
meetings should be well-documented with minutes and any
recommendations made.
5. Drug Formulary Management: The committee should manage the
organization's drug formulary, which is a list of medications that are
approved for use within the healthcare organization. The committee
should evaluate new drugs for inclusion on the formulary, review existing
drugs for their continued inclusion, and establish protocols for the use of
medications on the formulary.

53
6. Medication Use Policies: The committee should develop and review
medication use policies that promote safe and effective medication use
within the organization. Policies may include medication storage and
dispensing, medication administration, and medication order review.
7. Medication Safety: The committee should promote medication safety
within the organization by reviewing and analyzing medication errors and
adverse drug events, implementing medication safety initiatives, and
monitoring the use of high-risk medications.
8. Education and Training: The committee should provide education and
training to healthcare professionals on drug therapy management,
medication use policies, and medication safety initiatives. This may
include providing drug information resources, developing continuing
education programs, and providing in-service training.
Overall, the Pharmacy and Therapeutics Committee plays a vital role in
ensuring the safe and effective use of medications within a healthcare
organization. Its organizational and structural components should be
designed to promote collaboration among healthcare professionals and to
promote the highest standards of medication therapy management.
Functions of Pharmacy & therapeutics committee
The Pharmacy and Therapeutics Committee (P&T committee) is a
multidisciplinary team of healthcare professionals responsible for
overseeing the safe and effective use of medications within a healthcare
organization. The committee performs several essential functions,
including:
1. Drug Formulary Management: The P&T committee manages the
organization's drug formulary, which is a list of medications that are
approved for use within the healthcare organization. The committee
evaluates new drugs for inclusion on the formulary, reviews existing
drugs for their continued inclusion, and establishes protocols for the use
of medications on the formulary.

54
2. Medication Use Policies: The P&T committee develops and reviews
medication use policies that promote safe and effective medication use
within the organization. Policies may include medication storage and
dispensing, medication administration, and medication order review.
3. Medication Safety: The P&T committee promotes medication safety
within the organization by reviewing and analyzing medication errors and
adverse drug events, implementing medication safety initiatives, and
monitoring the use of high-risk medications.
4. Drug Utilization Review: The P&T committee performs drug utilization
review, which involves reviewing medication use patterns to ensure that
medications are being used appropriately and that patients are receiving
the most effective and safe treatments.
5. Clinical Practice Guidelines: The P&T committee develops and reviews
clinical practice guidelines that provide evidence-based recommendations
for the use of medications in specific patient populations or disease states.
6. Education and Training: The P&T committee provides education and
training to healthcare professionals on drug therapy management,
medication use policies, and medication safety initiatives. This may
include providing drug information resources, developing continuing
education programs, and providing in-service training.
7. Drug Cost Management: The P&T committee may consider the cost-
effectiveness of medications when making formulary decisions or
developing medication use policies. The committee may work to
negotiate lower drug prices or promote the use of generic medications
when appropriate.
Overall, the Pharmacy and Therapeutics Committee plays a vital role in
ensuring the safe and effective use of medications within a healthcare
organization. Its functions are designed to promote collaboration among
healthcare professionals and to promote the highest standards of
medication therapy management.

55
Policies of the pharmacy and therapeutic committee in including
drugs into formulary, inpatient and outpatient prescription,
automatic stop order, and emergency drug list preparation
Here are some common policies of the Pharmacy and Therapeutics
Committee related to drug formulary management, inpatient and
outpatient prescription, automatic stop orders, and emergency drug list
preparation:
1. Drug Formulary Management: The P&T committee establishes criteria
for the inclusion and exclusion of medications on the organization's
formulary. This may include considering the medication's efficacy, safety,
cost, and clinical appropriateness. The committee may also establish
procedures for formulary updates and drug utilization reviews.
2. Inpatient Prescription Policies: The P&T committee may establish
policies for inpatient medication prescribing, such as dosage limits,
administration guidelines, and drug interactions. The committee may also
develop protocols for medication reconciliation, medication
administration, and patient monitoring.
3. Outpatient Prescription Policies: The P&T committee may develop
policies for outpatient medication prescribing, such as drug utilization
reviews, prescription drug monitoring programs, and prescription drug
abuse prevention. The committee may also establish guidelines for
prescribing controlled substances and other high-risk medications.
4. Automatic Stop Order Policies: The P&T committee may establish
automatic stop order policies for certain medications or classes of
medications. These policies may require healthcare providers to
discontinue or reassess the use of medications after a specified time period
or when certain clinical criteria are met.
5. Emergency Drug List Preparation: The P&T committee may develop an
emergency drug list that includes medications and supplies needed to
manage common medical emergencies. The committee may establish
procedures for reviewing and updating the list regularly and for ensuring
that the emergency drug list is readily available in emergency situations.

56
Overall, the P&T committee plays a crucial role in developing and
implementing policies related to medication therapy management,
including drug formulary management, inpatient and outpatient
prescription policies, automatic stop order policies, and emergency drug
list preparation. These policies promote the safe and effective use of
medications and ensure that healthcare providers follow evidence-based
practices when prescribing and administering medications.
Drugs & Poisons information centre
A Drug and Poison Information Centre (DPIC) is a specialized service
that provides information on drugs and poisons to healthcare professionals
and the general public. These centres are typically staffed by healthcare
professionals, such as pharmacists, toxicologists, and physicians, who
have expertise in the use of medications and the management of
poisonings.
The primary functions of a DPIC include:
1. Providing information on drug therapy: DPICs provide information on
drug therapy, including drug interactions, dosages, adverse effects, and
contraindications. They may also provide information on non-
pharmacological therapies and complementary and alternative medicines.
2. Managing poisonings and overdoses: DPICs provide emergency advice
and management recommendations for suspected poisonings and
overdoses. They may provide guidance on decontamination procedures,
antidotes, and supportive care.
3. Collecting and analyzing poisoning data: DPICs collect and analyze data
on poisonings to identify trends and patterns in poisonings and to develop
strategies to prevent poisonings.
4. Developing and delivering education programs: DPICs develop and
deliver education programs on drug therapy and poison prevention to
healthcare professionals and the public.
5. Participating in research: DPICs may participate in research projects to
advance the understanding of drug therapy and poisonings.

57
Overall, DPICs play an important role in promoting the safe and effective
use of medications and in managing poisonings and overdoses. They
provide valuable information and resources to healthcare professionals
and the public to ensure that medications are used appropriately and that
poisonings are managed promptly and effectively.
Sources of drugs information
There are various sources of drug information available to healthcare
professionals, patients, and the general public. Some of the most common
sources of drug information include:
1. Drug labels and package inserts: These are documents that provide
information on a medication's intended use, dosage, administration, side
effects, contraindications, and warnings. They are required by regulatory
agencies, such as the U.S. Food and Drug Administration (FDA), and are
typically included with the medication.
2. Drug reference books and databases: These are resources that provide
comprehensive information on medications, including their
pharmacology, dosages, adverse effects, interactions, and
contraindications. Examples of drug reference books and databases
include the Physicians' Desk Reference (PDR), Drug Facts and
Comparisons, and Micromedex.
3. Clinical practice guidelines: These are evidence-based recommendations
for the diagnosis and treatment of specific medical conditions. They often
include recommendations for the use of medications and may be
developed by professional organizations or government agencies.
4. Pharmacists and other healthcare professionals: Pharmacists and other
healthcare professionals can provide information on medications,
including their uses, dosages, side effects, and interactions. They can also
provide guidance on how to take medications and answer questions about
medication safety.
5. Online resources: There are various online resources that provide drug
information, such as websites maintained by regulatory agencies,

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