2. Objectives of this attachment
To enable students identify those drugs which are commonly available in
community pharmacy.
To enable students identify common emergency medicines available in
community pharmacy.
To enable students develop capacity in provision of pharmaceutical care in
community pharmacy.
To enable students identify those medical supplies which are available in
community pharmacy.
3. INTRODUCTION
Name of the organization is Simret Drug store
Simret Drug store Found in Debrebrehan Town North showa zone Infront
of Debrebrehan Health center 04 kebele.
This organizations are contain two manpower(2 pharmacy professional)
One security
Average number of customers came in pharmacy per day = 55
4. Layout of the pharmacy
Human resource
◦ Pharmacy technicians, = 2
◦ Other support staff ( guard).
◦ Pharmacist(s) and other staff on duty must wear a
name tag or badge indicating his/her name and
designation.
5. Appearance of pharmacy premises
Design and layout:
◦ Permit flow of work, effective communication and
supervision and ensure effective cleaning
◦ Minimize the cross-contamination and anything else
◦ All parts of the premises was maintained in an orderly and
tidy condition.
◦ The external appearance of the pharmacy depict a
professional image.
◦ Entrances, dispensing counters and doorways are
accessible to disabled persons.
6. Security in pharmacy premises
Careful consideration the overall security of the pharmacy.
◦ Access to a pharmacy when it is locked
◦ Control of access to medicine
Safety of pharmacy premises
◦ Working conditions
◦ Fire extinguisher
◦ Electrical equipment → safe and maintained regularly.
Condition of pharmacy premises
The walls, floors, windows, ceiling, and all other parts of the premises →cleaned and good
ordered.
shelves and walls →finished in a smooth, washable and impermeable material.
Site of premises
◦ Fared from areas or premises that can cause contamination to the products and affect health in
general (e.g. public toilets, waste dump site)
7. Construction of pharmacy premises
Preventing from:
◦ floods
◦ entry of insects, animals or birds
Easily cleaned and disinfected
Allows adequate lighting and air movement
Ceiling :
◦ Should minimizes effects of high temperatures
◦ Adequate height
8. Environment in pharmacy premises
Products stored according to recommended conditions
Levels of heat, light, noise, ventilation, etc., must exert no adverse effects on
pharmaceutical stock as well as personnel.
Suitable and effective means of heating or cooling, lighting and ventilation.
Hygiene in pharmacy premises
Regular program for cleaning premises
Area for washing equipment and other utensils (hot and cold tap water).
Toilet facilities must be kept clean and in good order.
Hand-washing facilities
9. Premises Dispensary
The size of the dispensary:
allow a safe and efficient flow of work and
effective communication and supervision
arrangement of available space and
space available elsewhere for storage of stock.
Waiting area
Comfortable seating must be provided.
Appropriate health-related literature must be provided
This pharmacy fulfilled Ethiopian guideline like : 25m²
minimum for dispensary and waiting area with shortest side not
less than 4 m.
10. Suitability of dispensary
The dispensary, its fittings and equipment was adequate and
suitable for the purpose of dispensing.
The temperature in the dispensing maintained below 25°C.
Counseling area
The area(s)
◦ Be easily accessible
◦ Ensured reasonable privacy to the patient at all times and eliminate
background noise as far as possible.
◦ Have sufficient space →appropriate counseling and demonstration
of the correct and safe use of medicines.
11. Storage areas in pharmacy premises
◦ independent and secured
◦ Large enough → orderly arrangement and proper stock rotation
◦ Sufficient shelving
Fulfilled Ethiopian guideline like : 16 m² minimum for storage with
shortest side not less than 3 m.
Other issues
Waste disposal → SOPs
◦ Suitable and adequate means in written form
Dispensing equipment and materials
◦ Adequate, suitable dispensing equipment. (not all)
◦ Maintained clean,
Availability of Refrigerator
12. Services rendered in community
pharmacy
The major work of community pharmacists involves supplying
medicines to the public:
1. Dispensing prescriptions
2. Patient information and advice
3. Compounding
4. Record keeping
5. Public health Services
6. Medication therapy management (MTM) and standards
13. 1. Dispensing prescriptions
1. Dispensing prescriptions
The supply of medicines according to:
Good dispensing practices,
Good compounding practices
Maintaining records and
SOPs followed
14. Good dispensing practices
The dispensing process is divided into three phases, namely:
Phase 1: Interpretation and evaluation of the prescription.
Phase 2: Labeling and preparation of the prescribed medicine.
Phase 3: Hand to the patient and counseling.
Phase 1: Interpretation and evaluation of the prescription
Receipt of the prescription and confirmation of the integrity of the
communication.
◦ identifying the patient, the prescriber,
◦ legality/authenticity of the prescription,
◦ medication history
15. Phase 2: Labeling and preparation of the prescribed
medicine
Labeling of item(s)
Selecting or preparing the medicine
◦ patient-ready packs/pre-packed medicines
◦ extemporaneous preparations
◦ pharmaceutical containers
Checking
Record keeping regarding the supply of medicine
16. Phase 3: Hand to the patient and Counseling
Supply to the patient
Counseling to be done by a pharmacist
Patient information leaflet
Monitoring patient outcomes
assess the patient for signs of compliance, effectiveness and safety
of the therapy
identify areas for interventions, intervene, revise the patient record
and record the action taken
Read: Ethiopian Good Dispensing Manual
17. 2. Patient information and advice
Patient information and advice is of vital importance in the correct use of
medicines
It must respect patient autonomy, improve health and enhance the outcome of
medical treatment by:
◦ empowering consumers to make informed decisions about their treatments and take
responsibility for their own health care;
◦ improving communication between patients and health care providers; and
◦ aiding and encouraging effective use of medicines.
Supplementary written information must be used (as appropriate).
The pharmacist must assess each patient's ability to understand the information
imparted.
Confidentiality of the patient must be respected.
The provision of advice must take place in a suitable environment.
18. Steps for counseling a patient on a new prescription
o Introduce yourself and identify the patient.
o Ask patient to talk with you about the medication.
o Assess the patient's understanding of his/her disease and expected
outcomes of therapy.
o Assess patient’s knowledge about the newly prescribed drug and the
reason it was prescribed.
o Assess patient’s knowledge on how to take the medication as well as its
potential adverse effects.
19. 3. GOOD COMPOUNDING PRACTICE
(GCP)
Definition
Compounding is the preparation of a customized prescription medication to meet the
individual patient needs in response to a licensed practitioner's prescription.
Why Compound?
Problem Solving…
Unavailable Strength/Dosage
Unavailable Medications (limited use, short shelf life, etc.)
Sensitivity to Dyes, Fillers, Preservatives
Basic components of GCP
Personnel
Facilities
Equipment
Ingredients
The compounding process
Packaging and labeling
Stability and beyond-use date
Records and reports
20. 4. Record keeping
Must be both accurate and up-to-date.
◦ Compounding record
◦ Prescription Registration
◦ Patient medication records
◦ Stock records
◦ Health-screening related
21. 5. public health service
Public health is part of the community pharmacist’s roles:
◦ Disease prevention
◦ Health promotion
Promoting healthy lifestyles consists of two separate areas:
◦ prescription-linked intervention
◦ involvement in public health campaigns.
Prescription-linked intervention involves offering opportunistic advice on public
health topics to patients that present a prescription.
Promotion of healthy lifestyles will include offering advice in the following areas:
◦ STDs and HIV/AIDS
◦ Infectious diseases such as malaria, URTIs and diarrheal diseases
◦ FP and child care
◦ Antimicrobial resistance
◦ CVDs, Cancer, Diabetes
Health issues: stopping smoking, alcohol intake, nutrition advice and increased physical
activity, etc.
22. Other professional services
Retailing
Remuneration/methods of payment:
◦ Markups on individual items and income derived solely from the sale of medicines,
◦ Fixed dispensing fees
Managerial skills
Financial strategy and planning
Marketing
Problem solving
Emergency hormonal contraceptives (‘morning-after-pill’).
Emergency contraception (EC) refers to contraceptive methods that may be used in the first
few days after unprotected sexual intercourse, to prevent unwanted pregnancy.
It potentially reduces unintended pregnancy and (unsafe) abortion rates.
23. Health screening:
◦ Body weight and height;
◦ Blood pressure;
◦ Blood glucose;
◦ Pregnancy;
◦ Cholesterol;
◦ Peak flow test;
◦ HIV
Requirements: facilities and training
Appropriate public health education and counseling
24. First aid provision
Emergency treatment of wounds; bone fractures; burns; bleeding;
foreign objects in nose, ear, eye and respiratory system; severe
diarrhea; high fever; poisoning and snake bite; etc.
Adverse drug reaction reporting
o Report suspected adverse drug reactions (ADRs) to the regulatory body
(e.g. Food, Medicines and Healthcare Administration and Control
Authority, FMHACA)
o For new drugs that have received market authorization in the last 2
years) for which any suspected ADRs should be reported
o All other drugs, for which only serious suspected ADRs should be
reported.
Nutrition advice (diabetes, hypertension, pregnancy, etc.)
25. Site for training of pharmacy interns
Drug information services
◦ General public
◦ Healthcare providers
Immunization services
◦ travel,
◦ childhood,
◦ tetanus, etc.
Smoking cessation clinics
Pharmacies are recognized as being well placed to offer a smoking-cessation service as
they are readily accessed by the public and have a resident healthcare professional.
Pharmacists are involved routinely in brief interventions as part of the essential service
promoting healthy lifestyles.
Initial and follow up consultations
Nicotine replacement therapy (NRT)
NRT delivers nicotine in a clean form and helps smokers to overcome withdrawal symptoms such as
irritability and craving while avoiding the many harmful chemicals in tobacco and the carbon monoxide
that cause serious damage.
There are many different forms of NRT available including patches, gum, sublingual tablets, lozenges,
inhalators and nasal spray.
26. 6. Medication therapy management (MTM)
Requirements for MTM Programs are “designed” to “optimize therapeutic outcomes through
improved medication use” and “reduce the risk of adverse events, including adverse drug
reactions.”
Objectives are to increase patient adherence, prevent drug complications, and enhance patient
understanding of their medication therapy.
A MTM program established for targeted beneficiaries such as those who
o have multiple chronic disease states
o are taking multiple drugs,
Core elements for MTM services
Medication therapy review,
Personal medication record,
Medication-related action plan,
Intervention and/or referral, and
Documentation and follow-up
27. OBSERVA TION A ND DISCUSSION
Strength
supplying medicines to the public:
1. Dispensing prescriptions
2. Patient information and advice
3. Record keeping
4. Medication therapy management (MTM)and standards
28. ◦ Minimize the cross-contamination and anything else
◦ All parts of the premises was maintained in an orderly and tidy
condition.
◦ The external appearance of the pharmacy depict a professional
image.
Entrances, dispensing counters and doorways are accessible
to disabled persons.
Safety of pharmacy premises
◦ Working conditions
◦ Fire extinguisher
◦ Electrical equipment → safe and maintained regularly.
29. The walls, floors, windows, ceiling, and all other parts of the premises
→cleaned and good ordered.
shelves and walls →finished in a smooth, washable and impermeable
material.
Construction of pharmacy premises
Preventing from:
◦ floods
◦ entry of insects, animals or birds
Easily cleaned and disinfected
Allows adequate lighting and air movement
Ceiling :
◦ Should minimizes effects of high temperatures
◦ Adequate height
30. Environment in pharmacy premises
Products stored according to recommended conditions
Levels of heat, light, noise, ventilation, etc., must exert no
adverse effects on pharmaceutical stock as well as personnel.
Suitable and effective means of heating or cooling, lighting and
ventilation.
Hygiene in pharmacy premises
Regular program for cleaning premises
Area for washing equipment and other utensils (hot and cold
tap water).
Toilet facilities must be kept clean and in good order.
Hand-washing facilities
31. Waiting area
Comfortable seating must be provided.
Suitability of dispensary
The dispensary, its fittings and equipment was adequate and
suitable for the purpose of dispensing.
The temperature in the dispensing maintained below 25°C.
Counseling area
The area(s)
◦ Be easily accessible
◦ Ensured reasonable privacy to the patient at all times and eliminate
background noise as far as possible.
Have sufficient space
32. Storage areas in pharmacy premises
◦ independent and secured
◦ Large enough → orderly arrangement and proper stock
rotation
◦ Sufficient shelving
Waste disposal → SOPs
◦ Suitable and adequate means in written form
Have Good stock clasification methode
Dispensing equipment and materials
◦ Adequate, suitable dispensing equipment. (not all)
◦ Maintained clean,
33. Weakness
Prescribed Prescription drugs with out physician
No ADR registration form
No Report format (IFRR/RRF)
NO BIN CARd
There is no Compounding room
There is no
secretarial
managerial activities office with appropriate furniture and equipments
stock recording and other relevant documents are no applicable
No participated in Health education
Common ones include:
◦ Tablets and capsules counting equipments/apparatuses have not .
34. Have not Current editions available like :
◦ Martindale;
◦ Drug interactions reference source;
◦ a comprehensive textbook on pharmacology/pharmacotherapy;
◦ Standard Treatment Guidelines and Essential Drug List for the
appropriate level of care.
◦ A pediatric dosing reference guide (where applicable);
◦ A medical dictionary;
Dispensing equipment and materials are
o Not Adequate and suitable dispensing equipment.
Have no Staff room like:-
◦ Cloak room
◦ Tea room
There is no cashier, accountant, cleaner in the layout of the
pharmacy
35. Contribution/lesson learned
during staying
From this lesson I learned about Services given to the
Community Pharmacy like:
1. Dispensing prescriptions
2. Patient information and advice
3. Record keeping
4. Medication therapy management (MTM) and standards
36. I contributed that different areas specialy occurring of the weakness
I make a significant contribution to public health through their day-to-day activities. These
include :-
o provision of information and advice,
o facilitating self-care,
o care and support of drug users,
o visits to the homes of housebound people
o advice on smoking cessation and
o emergency hormonal contraception.
o I dispensed prescription and non prescription drugs with stepwise
o I given adequated patient information and advices
o I prepared adequated record keeping materials
o I given health education about infection prevention for the public
o I recommended to fullfilled the occurrence of weakness like,compounding
room,separate tea room,current editions available,dispensing
equipement,medicine counter and record keeping log books.
37. o Finally ,I contributed and recommended that all pharmacy professionals
responsible for appropriate use of medication, and to achieve optimum therapeutic
outcomes like:-
Cure of a disease
Elimination or reduction of a patient’s symptoms
Arresting or slowing of a disease process
Preventing a disease
38. .During attachment peroid I attracted by availability of
different drugs
patient privacy
Patient satisfaction
39. SUMMA RY A ND R ECOMMENDA TIONS
Based on occurance of the weakness the following recommendations
were made for future actions:
The pharmacy professionals should work hard to fulfilled atleast
minimum standards.
They should fulfilled compounding room in the next months
They should fulfilled secretarial ,managerial activities office with
appropriate furniture and equipments
They should applicable stock recording and other relevant documents
Tablets and capsules counting equipments should be applicable
40. Current editions should be available like :-
◦ Martindale;
◦ Drug interactions reference source;
◦ a comprehensive textbook on pharmacology/pharmacotherapy;
◦ Standard Treatment Guidelines and Essential Drug List for the appropriate
level of care.
◦ A pediatric dosing reference guide (where applicable);
◦ A medical dictionary;
They should be fullfilled Adequate and suitable dispensing equipment.
They should be fulfilled cashier, accountant, cleaner in the layout of the
pharmacy
They should be avail Staff room like:-
◦ Cloak room
◦ Tea room
41. The community pharmacy professionals
should be
avoid non phycians prescreptions
Avail bin card,
Avail ADR registration form
Avail Report format (IFRR/RRF)
6/13/2023 41
42. 3. References
(http://fmhaca.gov.et/Documents/Good Dispensing manual new 2.pdf)
Hassan, W. E. Jr. Hospital Pharmacy, 5th ed. Lea and Febiger,
Philadelphia, 1986.
Remington’s Pharmaceutical Science, 21st ed., Lippincott Williams &
Wilkins, Pennsylvania, 2006.
Peterson A. M. Managing Pharmacy Practice: Principles, Strategies,
and Systems, CRC, Boca Raton, 2004.
FMHACA documents listed in the text.
43. 5 .U N SELIN G TIP M ON OGR A PH
PR EPA R ATION
I. Gastro-intestinal Tract Drugs(G.I.T.)
1. Generic name -Metoclopramide:
2. Brand name :RegurgeR
3. Dosage form available : tablets and solution) and as a parenteral preparation for intravenous or intramuscular
use.
4. Strength available :5mg,10mg
5. MOA:Block dopamine receptors when given in higher doses)also block serotonine receptors in CTZ of the
CNS;enhances the response to Ach ofb tissue in upper RT causing enhanced motility and accelerated gastric
emptying with out stimulating gastric,biliary or pancreatic secretions,increase LEST
6. Indication: In non-ulcer dyspepsia, for speeding transit time of barium during intestinal induced nausea and
vomiting, in oesophageal reflux.
7. Dose and admn : Oral,I.M. or I.V., 10 mg (5 mg in Patients15-19 years) 3 times/day.Child up To 1year1mg twice
/ day;1-3 years1 mg 2-3 times/day; 5-9 years 2.5 mg 3 times /day; 9-14 years 5 mg 3 times / day. Before
radiological examination,a single I.M dose of 10-20 mg (10 mg in young adults); childunder 3 years 1 mg, 5-9
years 2.5 mg, 9-14 years 5 mg by continuous I.V. infusion, before starting chemotherapy, 2-4/kg mg over 15-30
minutes, hen 3-5 mg/kg over 8-12 hours (maximum 10 mg/kg/day).
44. 8.Common S/E: May induce extrapyramidal manifestations (facial and skeletal muscle spasm
and oculogyric crisis) in young patients.
9.C/I: GIT hemorrhage, obstruction, perforation or immediately after surgery
10.Pregnancy category:C
11.Patient instructions: Patient instructions:
Take each dose 30 minutes before meals and at bedtime.
Use caution when performing other tasks requiring mental alertness.
Report any involuntary movements especially in children and elderly.
12.Precautions: Renal and hepatic impairment; in elderly and under 20 years,pregnancy and
lactation, patients with hypertension, parkinsonism,history of depression and after gut
anastomosis in patients with diabetic gastroparesis,insulin dosage or timing might require
adjustment.
45. 1. Generic name - Aluminum Hydroxide Combinations
2. Brand name : ALUSIL,NORMACID MPS GELR
3. Dosage form available :Chewable tablets and Suspensions
4. Strength available :370mg,475mg suspension
5. MOA:by neutralizing Acid-capacity
6. Indication: For use in dyspepsia and in hyperphosphataemia.
7. Dose and admn: Suspension, 5-10 ml (tablets,1-2 tablets chewed)4 times /day between and
bedtime.Child 6-12 year, up to 5 ml times /day.
8. Common S/E: Constipation, intestinal obstruction (large doses),hypercalciuria and risk of
osteomalacia.
9. C/I: Hypophosphataemia, porphyria, undiagnosed gastrointestinal or rectal bleeding.
10. Pregnancy category:C excretion in breast milk unknown
11. Patient instructions:
Do not take for longer than 2 weeks.
Taking too much can cause stomach to secrete excess stomach acid.
Reduce acidity for about 30 minutes when taken on an empty stomach and for about 3
hours when taken 1 hour after meals.
12. Precautions: impaired renal function and renal dialysis, constipation,dehydration, fluid
restriction
46. I. Antispasmodics
1. Generic name : Atropine sulphate
2. Brand name :AtrezaR
,AtropineR
3. Dosage form available : I.V injection
4. Strength available :1mg/ml
5. MOA: Atropine antagonizes the effect of acetylcholine by competing for the muscarinic
receptors peripherally and in the CNS; therefore the effects of atropine are opposite to the
acetylcholine effects.
6. Indication: Adjust to the treatment of gastric and duodenal ulcers to facilitate radiological
examination of the gut,treatment of irritable bowel syndrome,with opiate analgesics in biliary and
ureteric colics, in parkinsonism, in the treatment of some arrhythmias (sinus bradycardia and heart
block), in the treatment of irreversible anti-cholinesterase poisoning, mushroom poisoning as a
pre-medicate in anesthesia with neostigmine to control its side effects in reversal of competitive
neuro-muscular blockers and in ophthalmology ( refraction , iridocyclitis and convergent squint )
47. 7. Dose and admn: Pre-medicated, I.V injection, 300-600 micrograms immediately before
induction and in incremental doses of 100 micrograms for the treatment of bradycardia.With
neostigmine, 0.6-1.2 mg
8. Common S/E:
- lower doses produce sedation
- higher doses produce excitation, agitation and hallucination
- Dry mouth, constipation, mydriasis and cycloplegia,increased intra-ocular pressure, flushing,
rashes, dry skin, palpitations and arrhythmia and difficulty in micturition
9. C/I: Glaucoma, prostatic enlargement, pyloric stenosis,ulcerative colitis, hepatic and renal
disease, tachycardia, myocardial ischemia, myasthenia gravis, unstable cardiovascular status, in
acute hemorrhage.
10. Pregnancy category:C
11. Patient instructions:
Adequate oral fiber intake
Not to drive, dilated pupils (mydriasis).
12. Precautions: Extremes of age, infants below 3 month, fever, thyrotoxicosis,cardiac
insufficiency, hypertension, Down syndrome
48. I. Selective Angiotensin II inhibitor(C.V.S.)
1. Generic name: Nifedipine
2. Brand name :Nife – SSP20,Afeditab CR
3. Dosage form available :20mg,40mg tablets
4. Strength available :20mg,40mg tablets
5. MOA: inhibition of calcium influx in to arterial smooth muscle cells,
6. Indication: Angina pectoris (classic and vasospastic), hypertension and Raynaud disease.
7. Dose and admn: Angina, initially 10mg 3 times /day, increase to 20 mg 3 times / day if
necessary. In elderly initially 5mg 3 times /day (for immediate effect bite capsule and retain liquid
in mouth). Raynaud disease 10mg 3 times /day (maximum 20 mg 3 times /day). Hypertension and
angina prophylaxis 20mg twice daily after food, increased to 40mg twice daily if necessary.
8. Common S/E: Vasodilatation (flushing, headache, hypotension,dizziness, peripheral oedema),
paradoxical increase in ischaemic pain, GIT disturbance, gum hyperplasia and depression.
9. C/I: Cardiogenic shock, pregnancy, porphyria, who experience ischemic pain on its
administration.
10. Pregnancy category:c
11. Patient instructions: Visit dentist on routine basis because gum swelling may occur.
There may be increase chest pain at short medication & with dose changes but this effect is
Transient.
Use caution while performing tasks requiring mental alertness.
Sustained release capsules must be swallowed whole not chewed,divided or crushed.
12. Precautions: Hypotension, patients with poor cardiac reserve and breastfeeding.Reduce dose
in hepatic impairment. Adjustment of anti-diabetic dose may be required.
49. I. (C.V.S.) Anticoagulants(C.V.S.)
1. Generic name: Heparin salts
2. Brand name:Heparin sodium
3. Dosage form available : I.V
4. Strength available :1000iu, 5000 U, 12000 U
5. MOA:Potentiates the action of antithrobin III and inactivates throbin as well as activated
coagulation factor,IX,X,XI,XII and plasmin and prevents the conversion of fibrinogen to fibrin
6. Indication: Initiation of anti-coagulant therapy in deep venous Thrombosis (D V T),
disseminated intravascular coagulopathy and prophylaxis of postoperative thrombosis.
7. Dose and admn: Dose: 5000 U. I.V. followed by I.V. infusion of 1000 –2000 U/hour or 5000-
10,000 U I.V. every 4 hours By S.C prophylaxis of DVT 5000 u/2 hours before surgery, then every
8 – 12 hours until patient is ambulant, in pregnancy 10,000 U/12 hours. Treatment of DVT 10,000-
20,000 U/12 hours. Ampoules 12500 I.U., 20000 U, 5000 U, 12000 U, 5000 I.U. (1mg =130 U)
Indications: Initiation of anti-coagulant therapy in deep venous Thrombosis (D V T),
8. Common S/E: Haemorrhage, thrombocytopenia, hypersensitivity reactions and osteoporosis
after prolonged use.
9. C/I: Hypersensitivty to heparin, severe liver or kidney damage, peptic ulcer infective
endocarditis, hemorrhagic, blood disorders,severe trauma, administration by I.M route and cerebral
aneurysm and severe hypertension.
10. Pregnancy category:B
11. Patient instructions: Consult your physician or pharmacist when considering use of other
medications in particularly aspirin containing products or herbal products.
12. Precautions: When treatment is prolonged monitor activated partial thromoplastin time and
platelet count.
