APINCH is describes about the errors while dispensing the high risk medicines.APINCH is the short term for those drugs which are to be given special atention.APINCH has been explained with many examples.

1. Explained and taught by : Mrs.
Neomi S.Mathews (Chief
Pharmacist, Pharmacy
Deptt.),C.M.C,Ldh.
Lecture delivered on 29/09/2018

2. Re written by :Raman Chander Pal

3. ERRORS IN DISPENSING
OF HIGH RISK MEDICINES.

4. High risk medicines are those
medicines which have a narrow
therapeutic index i.e the difference
between a medicine's desired effect
or toxic dose is very small.
In short, a small increase in the
dose , other than prescribed , could
lead to toxicity and fatal
consequences.

5. Therefore , we pharmacists are
instructed to send the
prescription back to the
physician to reconsider the
prescribed dose , if the dose
seems to be higher than the
normal.

6. APINCH is the short term for
those drugs which are to be
given special attention while
dispensing.

7. A stands for aminoglycoside antibiotics
, like gentamicin.Gentamicin courses
that continue for longer than 72 hours,
not acting on a toxic concentration
result could lead to renal impairement
and toxicity , and not acting on a sub-
therapeutic result could lead to
ineffective antibiotic treatment
(Therapeutic Guidelines 2014).

8. P stands for potassium and other
electrolytes.Errors in the intravenous
administration of potassium chloride
are fatal and well known. For example
administration of potassium chloride
ampoule instead of normal saline to
flush a cannula can lead to
hyperkalaemia induced cardiac arrest.

9. I stands for insulin.If a pharmacist receives a
prescription for HumalogMix25R but HumalogR
is given accidently , then it means that the
patient is given a rapid-acting insulin instead of
the combination rapid and intermediate-acting
insulin.Due to this fault , patient becomes
hypoglycaemic.So , confusion between insulin
agents that are similar in name,but have
significantly different results,is likely to lead to
serious harm, especially if high doses are
administered

10. N stands for Narcotics and other
sedatives.When a heat pad is applied over
the site of a fentanyl patch,the absorption
of fentanyl increases.A 70 year old woman
died in Australia, when a heat pad was
applied over the site of a fentanyl
patch,which was also the site of her pain.In
addition, a second patch was also applied
without removing the first one.All these
contributed to her death.

11. C stands for chemotherapeutic
agents.Methotrexate , which is used as a
chemotherapeutic agent , is also used in the
treatment of autoimmune conditions such as
rheumatoid arthritis.For rheumatoid
arthritis,the prescribed medicine of
methotrexate is once a week.But a number of
deaths have been attributed to methotrexate
toxicity when patients have been incorrectly
prescribed or dispensed methotrexate on a
daily rather than weekly basis

12. H stands for Heparin and other anticoagulants.The failure to
prescribe and administer appropriate anticoagulants has been
recognised as a cause of adverse events relating to
anticoagulant use.Nurses are in a position to identify patients
who are at risk of venous thromboembolism and ensure that
appropriate prophylaxix is used.A Canadian patient was
admitted for a laparotomy for removal of an ovarian cancer
and was not prescribed any anticoagulants, despite having a
history of deep vein thrombosis.Two days after discharge she
returned to hospital with shortness of breath.A diagnosis of a
pulmonary embolism was made and anticoagulants were
commenced,yet the patient still died with a massive
pulmonary embolism revealed the case.

13. https://mytechpharmacy.blogsp
ot.com/2018/10/a-pinch.html