Drug storage and Stability


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General Idea about Medication

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Drug storage and Stability

  1. 1. UNITED HOSPITAL LTD. DEPARTMENT OF PHARMACY  DRUG STORAGE & ITS STABILITY GENERAL IDEA ABOUT MEDICATION Presented By Presented By Mohammad Alauddin, B.Pharm (ADUST) Pharmacist- United Hospital Ltd
  2. 2. INTRODUCTION Hospital pharmacy may be defined as department of hospital wherein procurement, storage, compounding, packaging, dispensing, distribution & monitoring of medication are performed by graduate Pharmacist.
  4. 4. INTRODUCTION Function of Pharmacy:  To ensure the availability of the right medication, at the right time, in the right dose, at the minimum possible cost to the patients.  To provide information concerning medications to physicians and nurses.  To serve as a counseling department  To dispense all narcotic drugs and its monitoring  Inventory control  So on
  5. 5. DRUG STORAGE Proper storage of medication is always an important consideration during periods of extreme heat or cold. Drugs can undergo physical, chemical & microbial changes on storage. Recommended storage conditions:  Store below -50C (freeze)  Store between (2 to 8)0C (refrigerate, do not freeze)  Store below 250C (air conditioning)  Store below 300C (room temperature)
  6. 6. DRUG STORAGE Drug Storage Room Standards:  A lockable room  Adequate lighting  A temperature of below 250C, with air conditioning units that operate 24 hrs per day & are connected to an emergency power supply.  A vaccine refrigerator for storage of vaccines & anti-venom.  A nominated refrigerator for cold storage of pharmaceutical products that requires refrigeration.  Adequate shelving for appropriate storage of the different categories of drugs.
  7. 7. DRUG STORAGE All drugs are grouped in the following categories:  Refrigerated ( Heat sensitive products)  Oral ( solid & liquid )  Injectable  Topical  Infusion  Inhalation  Non Drug
  10. 10. DRUG STORAGE
  11. 11. DRUG STORAGE
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  13. 13. DRUG STORAGE
  14. 14. DRUG STORAGE
  15. 15. DRUG STORAGE In the Central pharmacy or Pharmacy main store, all drugs are displayed or kept in different ways regarding the most easiest way to dispense. Like Alphabetically  Therapeutic class wise  Brand wise and so on.
  16. 16. DRUG STORAGE
  17. 17. DRUG STORAGE Drug storage Room Stock Control Stock Inventory 1. Annual inventory 2. Bi- annual inventory 3. Monthly inventory 4. Weekly inventory 5. Real time inventory
  18. 18. DRUG STORAGE To uphold quality standards in drug storage room: Rotate stock so that the stock closest to expiry date is kept in front. Maintain FEFO / FIFO / LIFO procedure. Make sure that there is no expired drugs on the shelves.
  19. 19.    DRUG STORAGE First-expiry/first-out  procedure(FEFO) First-in/first-out procedure (FIFO) Last-in/first-out procedure (LIFO)
  20. 20. DRUG STABILITY    Drug stability means the ability of the pharmaceutical  dosage form to maintain the physical, chemical,  therapeutic & microbial properties during the time of  storage & usage by the patient. Expiry Dates Expiry date means that drug can not be used after this  date due to the chance of chemical degradation, harmful  to patient or low potency.
  21. 21. DRUG STABILITY    If the expiry date is expressed as month/year only  (e.g., 3/2013), this shall be interpreted to mean that  the drug may be safely used through the last day of  that month, i.e., 3/31/2013.  If the expiration date is expressed as  month/day/year (e.g., 15/3/2013), this shall be  interpreted to mean that the drug may be safely used  through that day only.
  22. 22. DRUG STABILITY Chemical stability of the active ingredient As the rate of decomposition usually  doubles for every 100C rise in temperature, it  is important to comply with the storage conditions  specified on the container. 
  23. 23. DRUG STABILITY Once opened, the shelf-life of some products, e.g. eye  drops, will be determined not by decomposition of  the active drug but by the risk of microbial  contamination. Stability after opening drug container The stability of products is variable. A product which is  stable in its container may become unstable once the  container is opened.
  24. 24. DRUG STABILITY The expiry date will be shorter in case of Eye drops: can be used for one month after  opening the droppers.  Antibiotic syrups & suspensions: generally can be  used for one week by storage in room temperature  & for two weeks by storage in refrigerator.
  25. 25. DRUG STABILITY  Ampoules: must be used immediately but the vials (multi- dose) are stable for 24 h in the presence of preservatives.  Nebulizer solution: can be used for one month after  opening.  Insulin: once punctured, it must be used within 28 days.  Syrup/Suspension (except antibiotics):  can be used for  one month after opening.   Tablets & capsules: remain stable in the package but  after removal expiry date will be changed.
  27. 27. DRUG STABILITY Factors affecting drug stability:  Temperature: high temperature accelerate oxidation,  reduction & hydrolysis reaction which leads to drug  degradation.  PH: acidic & alkaline pH influence the rate of  decomposition of most drugs. Many drugs are stable  between pH 4 - 8.  Moisture: water catalyses chemical reactions as  oxidation, hydrolysis & reduction reaction. Water  promotes microbial growth.  Light: affects drug stability through its energy or thermal  effect which leads to oxidation.
  28. 28. DRUG STABILITY  Oxygen: exposure of drug formulations to oxygen  affects their stability.  Drug incompatibility: reactions between components  of pharmaceutical dosage forms itself or between  these components & cover of the container.
  30. 30. DRUG STABILITY Degradation processes mainly include:  Hydrolysis  Oxidation   Photodegradation    This is because of the chemistry of the functional  groups in drug molecules and the presence of water  and oxygen. Even when factors such as water, oxygen  and light have been controlled, degradation will still  occur, but at a reduced rate.
  31. 31. DRUG STABILITY Hydrolysis The rate of hydrolysis is affected by access to water  and is prevented or lowered by reducing exposure to  water. If a drug must be formulated in water, the  solution is often buffered to a pH where the rate of  hydrolysis is minimal. Substances which are  particularly susceptible to hydrolysis are often  packed in individual dose units.
  32. 32. DRUG STABILITY Oxidation Many drugs will react with atmospheric oxygen, so  oxidation is a prime cause of degradation.  Control of the pH and protection from light may  reduce the rate of oxidation of injectable solutions.  The oxidation of some tablets, e.g. chlorpromazine,  is reduced by individual blister packaging. 
  33. 33. DRUG STABILITY Photodegradation When light is absorbed by a molecule, it is either reemitted or transformed into physical or chemical  energy. Physical energy is usually lost as heat.  Protection from light is achieved by packaging the  products in amber glass bottles or by using coloured  film for blister packed products.
  34. 34. Drug-food interaction What is a drug-food interaction? The interaction of medications and food is very complex  and needs to be individualized for each patient and each  medication. However, there are some generalizations  that can be made.  A drug-food interaction happens when the food you eat  affects the ingredients in a medicine you are taking so the  medicine cannot work the way it should.
  35. 35. Drug-food interaction
  36. 36. Drug-food interaction Are all medicines affected by food? Not all medicines are affected by food, but many medicines can  be affected by what you eat and when you eat it.  The food may delay or decrease the absorption of the drug. This  is why some medicines (like azithromycin) should be taken on  an empty stomach (1 hour before eating or 2 hours after  eating). On the other hand, some medicines are easier to tolerate when  taken with food. Aspirin & Clopidogrel are irritating to the GI  tract, so they should be taken after food.
  37. 37. Timing of Drugs - Before or After Food Taking Drugs Before Food For quick action/fast absorption For acid sensitive drugs Some drugs need to be absorbed quickly to have an effect, such as nitrates in angina, drugs to help sleep (hypnotics), drugs to reduce agitation (sedatives) & drugs to reduce vomiting . As food can slow the absorption of these drugs, they need to be taken on an empty stomach.
  38. 38. Timing of Drugs - Before or After Food The acid in the stomach breaks down some drugs, so delayed emptying will mean that more of the drug is broken down, and less of the drug is available, so it will be less effective. Some Medications which should be taken on an EMPTY stomach: Alendronate, Bisacodyl, Captopril, Sucralfate, Azithromycin, Co-trimoxazole, Omeprazole, Lansoprazole, Levothyroxine, loratadine, Rifampin, Methotrexate Mycophenolate, Tetracycline ……….etc.
  39. 39. Timing of Drugs - Before or After Food Taking Drugs With or After Food For drugs causing stomach upset For less soluble drugs The acid in the stomach changes some drugs, making them more soluble and so more easily absorbed. This means that the drug will be more effective.
  40. 40. Timing of Drugs - Before or After Food NSAIDs can cause stomach upsets by increasing gastric secretion. Taking these drugs with food can reduce the irritation to the stomach lining.
  41. 41. Timing of Drugs - Before or After Food Some drugs have to be taken during or after meals to be effective – for example, Orlistat is designed to block the absorption of some of the fat in food as a treatment for obesity.
  42. 42. Timing of Drugs - Before or After Food Some Medications which should beTaken with FOOD: Allopurinol, Clopidogrel, Co-Amoxycillin, Aspirin, Amiodarone, Diclofenac, Carbamazepine, Chloroquine, Spironolactone, Griseofulvin, Metronidazole, Valproic acid, Prednisone, Iron preparations, Bromocriptin, Ticlopidine, fenofibrate, mebendazole ………….etc.
  44. 44. TIPS TO AVOID DRUG-FOOD INTERACTIONS Take medicine with a full glass of water. Don't stir medicine into your food because this may change the way the drug works. Don't take vitamin pills at the same time you take medicine because vitamins and minerals can cause problems if taken with some drugs. Don't mix medicine into hot drinks because the heat may keep the drug from working. Never take medicine with alcoholic drinks
  46. 46. Over the Counter (OTC) medications OTC medications are those medicines that do not require a prescription from a physician and are readily available to the public. This does not mean that they do not need to be taken carefully. The most commonly used OTC medicines are :  Pain Relievers  Antihistamines  Decongestants  Cough medicines
  47. 47. Over the Counter (OTC) medications Pain Relievers NSAIDS (non-steroidal anti-inflammatory drugs) such as paracetamol, aspirin, ibuprofen,ketoprofen etc. NSAIDS work by blocking the synthesis prostaglandins, which are involved in injury or infection and thus reduce pain, fever and inflammation.
  48. 48. Over the Counter (OTC) medications NSAIDS can cause stomach upset and occasional gastrointestinal bleeding. Antihistamines Histamines are chemicals in our bodies that produce itching and allergy responses. Antihistamines block these. Some common antihistamines are diphenhydramine HCl , chlorpheniramine etc.
  49. 49. Over the Counter (OTC) medications Antihistamines can cause drowsiness. Be careful driving or doing any dangerous work. But, the Nonsedating antihistamines do not cause drowsiness and are now OTC. Some common antihistamines are loratadine, desloratadine, cetrizine & fexofenadine. Decongestants These medicines work by shrinking/constricting blood vessels in the nose and decrease congestion. The only over the counter decongestant is pseudoephedrine.
  50. 50. Over the Counter (OTC) medications Cough Medicines Cough medicines are two types: antitussives (anti cough) and expectorants (mucous reducer) Dextromethorphan is the antitussive in most cough medicines. Guaifensin is the expectorant that is mostly used. Cough Medicines can cause agitation and confusion for some users.
  51. 51. Medication Safety Tips to avoid serious medication errors  Never take medication intended for someone else  Never keep medications that are expired  Never combine multiple medications in the same bottle  Never take medication that is not clearly marked  Don't expect immediate results  Don't stop taking your medication just because you feel better especially, antibiotics.  Keep all medication away from children  To know clearly about existing drug-drug interactions.
  52. 52. Medication Safety Tips to avoid serious medication errors
  53. 53. Patient Safety Solutions
  54. 54. Patient Safety Solutions Some proprietary (brand name) and non-proprietary names (generic name) sound or appear to be similar to other drugs when written or spoken. The existence of confusing drug names is the most common causes of medication errors & is of concern worldwide. There are many look and sound alike drugs that would result in medication error. These errors may cause harm or even death to patients.
  55. 55. Patient Safety Solutions Brand (Generic) Brand (Generic) Abetis(Olmesartan) Abmis(Nutritional) Agotin(Agomelatin) Agoxin(Digoxin) Alagra(Fixofenadine) Silagra(Sildenafil) Angicard(Glyceryl trinitrate) Angilat(Metoprolol) Apresin(Fluphenazine+Nortriptylin) Aprocin(Ciprocin) Arbit(Ibesartan) Barbit(Phenobarbitone) Asmanyl(Theophylline) Asmavit(Nutritional) Zelmac(Tegaserod) Zepac(Ketorolac) Betaloc(Metoprolol) Betanol(Atenolol) Codopa(Levodopa+Carbidopa) Cardopa(Dopamine)
  56. 56. Patient Safety Solutions Brand (Generic) Brand (Generic) Daomin(Metformin) Daonil(Glibenclamide) Deslor(Desloratadine) Desolone(Desogestrel+Ethinylestradiol) Flexifen(Baclofen) Flexicam(Piroxicam) Imigra(Flunarizine) Edegra(Sildenafil) Larcadip(Larcanidipine) Largactil(Chlorpromazine) Monocast(Montelukast) Monocard(Isosorbide) Norbit(Disopyramide) Barbit(Phenobarbitone) Perkinil(Procyclidine) Perkirol(Ropinirol) Ramace(Ramipril) Ramex(Chloramphenicol)
  57. 57. Patient Safety Solutions HOW TO PREVENT THESE MEDICATION ERRORS ? Manufacturers Choose unique drug names, easily to write and pronounce to ensure that there is no drug with similar name in the market.
  58. 58. Patient Safety Solutions Physicians Clearly write the prescriptions with specific dosage form & strength Avoid using short forms or abbreviation of drug names Avoid verbal prescriptions to a maximum extent
  59. 59. Patient Safety Solutions Pharmacists/Nurses Keeping LASA drugs separated from one another Double checking the drug Contacting the physician in case of any clarification regarding the prescription Becoming familiar with LASA drugs Emphasize LASA drug name differences on computer screen by using methods such as --------
  60. 60. Patient Safety Solutions “Tall Man “ lettering The practice of writing part of a drug’s name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors.
  61. 61. “Tall Man “ lettering U.S. Food and Drug Administration (FDA) encourages manufacturers to use Tall Man lettering labels to visually differentiate their drugs' names, and a number of hospitals, clinics, and health care systems use Tall Man lettering. Examples…  BetaLOC vs. BetaNOL  COdopa vs. CARdopa  IMIgra vs. EDEgra  SedNO vs. sedRON  DOBUTamine vs. DOPamine  hydrALAZINE vs. hydrOXYzine  vinBLAStine vs. vinCRIStine
  63. 63. Think the source of !!!
  64. 64. ULTIMATELY…