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Level 2 Satellite Pharmacy: Case
presentation1
Dangerous Drug Dispensing
Procedure
Presenter: Heni Oala (Pharmacy Intern)
Preceptor: Jessica Kuyei
Outline
• Identification of the patient
• Summary of significant findings:
– History
– Investigation
• Summary of Management
• Learning issue
• Conclusion
Patient Identification
• Patient name: GH
• Medical record number: 303803
• Gender/Age: M/58
• Nationality: Papua New Guinea
• Date of admission: 24.05.18 referred to
PMGH from GGH
Summary of Significant Findings
History
• GH presented with:
• Lower back pain: 6/52
• Lower limb paralysis: 4/52 unable to walk
Summary of Significant Findings
Investigation
• Vitals
– BP: 150/96
– Pulse: 72bpm
– Temperature: 37.4°C: intermittent fever
– RR: 26/min
• FBC:
W
BC
RB
C
Hb HC
T
MCV M
CH
M
CH
C
PL
T
Ur
ea
N cre
ati
nin
e
Na
=
Cl L M TP
8.48 5.09 11.6 35.7 70.1 22.8 32.5 343 3.61 79.2
%
88 136.
0
102.
7
10.6
%
6.6
%
74.6
Summary of Significant Findings
Investigation
Albu
min
AST ALP ALT GGT Tot. Bilirubin
36 34 25 121 28 7
Table1 (continued): Full Blood Count results, Patient: GH
Summary of Significant Findings
Investigation
• No hx of trauma
• No significant Past Medical History
• No family hx of TB
• Admitting diagnosis: TB Potts with
pyelonephritis (distal obstruction)
• Spinal cord compression
• Neurogenic bladder
• Lower limb paralysis
Summary of Significant Findings
Investigation
• X-ray: confirmed Tb potts L.Kidney,
spine,lungs
• Pathology:
– Prostate specific antigen: >100ng/ml
• Final diagnosis: Prostate carcinoma with
metastasis
Prostate specific antigen
PSA concentrations (ng/ml)
Age(years) Lower limit Higher limit
<40 0.21 1.72
40-49 0.27 2.19
50-59 0.27 3.42
60-69 0.22 6.16
>69 0.21 6.77
Table2: Prostate specific antigen concentrations
Summary of Management
• Treatment based on 2 factors:
– Tumor
• Staging result
• Histology
• PSA Concentration
– Patient
• Age diagnosed
• Life expectancy
• Presence of other diseases
– Cardiovascular
– COPD
– Diabetes
Summary of Management
• Review: urology clinic
• Diclofenac
– 50mg tds ‘o’ 2/52
• NSAID
• May take w;/out food
• Do not take aspirin w/ «
• Morphine
– 10mg ‘o’ qid for 2/52
• Opioid analgesic
• May take w;/out food
• Avoid alcohol : ↑ chances dangerous side effects
Summary of Management
• Surgical castration
• LHRH anatagonists
• Biphosphonates- bone form
– Pt. Bone metastasis
• Ketoconazole
– Broad spectrum antibiotics
• Dexamethasone
– Spinal cord compression
• Patient education
Learning Issue
Dangerous Drug Dispensing
Procedure at PMGH
Learning Issue
• Dangerous drug act of 1952 definition
– Any active principle alkaloid, derivative
(natural or synthetic), isomer, ester, ether, salt
or compounds)
– Under Schedule sec.1
• 8. Storage of dangerous drugs
– Stored in a locked cupboard
– Retain the key of the key or cupboard
Learning Issue
• PMGH procedure:
– Prescription validity
– Collection of dangerous medicines
– Entering into DD log book
• Date, description, quantity [copy information on
prescription]
• 2 registered pharmacists sign log book
• Prescription is retained by DD officer
– Dangerous Drugs dispensed
References
• Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL. 2008.
Harrisons Principles of Internal Medicine, McGraw Hill, New York 16th Edition
• Walker R, Whittlsea C.2012. Clincial Pharmacy and therapeutics, Churchill
livingston, Elsevier. New York. 5th Edition
• Medical tests explained. Prostate Specific Antigen (PSA). Accessed:
http://www.medical-tests-explained.info/index_files/PSA.htm [Date accessed: 21st
June 2018]
• Rooney PJ. 2015. Benign Prostatic Hyperplasia (BPH). Accessed:
http://papuanewguineahealth.com/2015/05/10/benign-prostatic-hyperplasia-bph
[Date accessed:21st June 2018]
• Waine. 2016. Prostate cancer in PNG. Accessed:
https://postcourier.com.pg/prostate-cancer-in-png/ [Date accessed:21st June 2018]
• PNG National Medicines Formulary, 2012. World Health Organization and National
Department of Health
• Independent state of Papua New Guinea. Dangerous drug act 1952(consolidated to
No23 of 1990). Accessed: http://www.scribd.com/doc/147521785/Dangerous-Drugs-
Act-Consolidated-to-No-23-of-1990-pdf [Date accessed: 21st June 2018
• FDA. Avoid food and Drug Interactions pdf [online]. Accessed:
http://www.fda.gov/downloads/Drugs/.../.../UCM229033.pdf [Date accessed: 21st
July 2018]

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Dispensing Procedure of Dangerous Drugs

  • 1. Level 2 Satellite Pharmacy: Case presentation1 Dangerous Drug Dispensing Procedure Presenter: Heni Oala (Pharmacy Intern) Preceptor: Jessica Kuyei
  • 2. Outline • Identification of the patient • Summary of significant findings: – History – Investigation • Summary of Management • Learning issue • Conclusion
  • 3. Patient Identification • Patient name: GH • Medical record number: 303803 • Gender/Age: M/58 • Nationality: Papua New Guinea • Date of admission: 24.05.18 referred to PMGH from GGH
  • 4. Summary of Significant Findings History • GH presented with: • Lower back pain: 6/52 • Lower limb paralysis: 4/52 unable to walk
  • 5. Summary of Significant Findings Investigation • Vitals – BP: 150/96 – Pulse: 72bpm – Temperature: 37.4°C: intermittent fever – RR: 26/min • FBC: W BC RB C Hb HC T MCV M CH M CH C PL T Ur ea N cre ati nin e Na = Cl L M TP 8.48 5.09 11.6 35.7 70.1 22.8 32.5 343 3.61 79.2 % 88 136. 0 102. 7 10.6 % 6.6 % 74.6
  • 6. Summary of Significant Findings Investigation Albu min AST ALP ALT GGT Tot. Bilirubin 36 34 25 121 28 7 Table1 (continued): Full Blood Count results, Patient: GH
  • 7. Summary of Significant Findings Investigation • No hx of trauma • No significant Past Medical History • No family hx of TB • Admitting diagnosis: TB Potts with pyelonephritis (distal obstruction) • Spinal cord compression • Neurogenic bladder • Lower limb paralysis
  • 8. Summary of Significant Findings Investigation • X-ray: confirmed Tb potts L.Kidney, spine,lungs • Pathology: – Prostate specific antigen: >100ng/ml • Final diagnosis: Prostate carcinoma with metastasis
  • 9. Prostate specific antigen PSA concentrations (ng/ml) Age(years) Lower limit Higher limit <40 0.21 1.72 40-49 0.27 2.19 50-59 0.27 3.42 60-69 0.22 6.16 >69 0.21 6.77 Table2: Prostate specific antigen concentrations
  • 10. Summary of Management • Treatment based on 2 factors: – Tumor • Staging result • Histology • PSA Concentration – Patient • Age diagnosed • Life expectancy • Presence of other diseases – Cardiovascular – COPD – Diabetes
  • 11. Summary of Management • Review: urology clinic • Diclofenac – 50mg tds ‘o’ 2/52 • NSAID • May take w;/out food • Do not take aspirin w/ « • Morphine – 10mg ‘o’ qid for 2/52 • Opioid analgesic • May take w;/out food • Avoid alcohol : ↑ chances dangerous side effects
  • 12. Summary of Management • Surgical castration • LHRH anatagonists • Biphosphonates- bone form – Pt. Bone metastasis • Ketoconazole – Broad spectrum antibiotics • Dexamethasone – Spinal cord compression • Patient education
  • 13. Learning Issue Dangerous Drug Dispensing Procedure at PMGH
  • 14. Learning Issue • Dangerous drug act of 1952 definition – Any active principle alkaloid, derivative (natural or synthetic), isomer, ester, ether, salt or compounds) – Under Schedule sec.1 • 8. Storage of dangerous drugs – Stored in a locked cupboard – Retain the key of the key or cupboard
  • 15. Learning Issue • PMGH procedure: – Prescription validity – Collection of dangerous medicines – Entering into DD log book • Date, description, quantity [copy information on prescription] • 2 registered pharmacists sign log book • Prescription is retained by DD officer – Dangerous Drugs dispensed
  • 16. References • Fauci AS, Kasper DL, Longo DL, Braunwald E, Hauser SL, Jameson JL. 2008. Harrisons Principles of Internal Medicine, McGraw Hill, New York 16th Edition • Walker R, Whittlsea C.2012. Clincial Pharmacy and therapeutics, Churchill livingston, Elsevier. New York. 5th Edition • Medical tests explained. Prostate Specific Antigen (PSA). Accessed: http://www.medical-tests-explained.info/index_files/PSA.htm [Date accessed: 21st June 2018] • Rooney PJ. 2015. Benign Prostatic Hyperplasia (BPH). Accessed: http://papuanewguineahealth.com/2015/05/10/benign-prostatic-hyperplasia-bph [Date accessed:21st June 2018] • Waine. 2016. Prostate cancer in PNG. Accessed: https://postcourier.com.pg/prostate-cancer-in-png/ [Date accessed:21st June 2018] • PNG National Medicines Formulary, 2012. World Health Organization and National Department of Health • Independent state of Papua New Guinea. Dangerous drug act 1952(consolidated to No23 of 1990). Accessed: http://www.scribd.com/doc/147521785/Dangerous-Drugs- Act-Consolidated-to-No-23-of-1990-pdf [Date accessed: 21st June 2018 • FDA. Avoid food and Drug Interactions pdf [online]. Accessed: http://www.fda.gov/downloads/Drugs/.../.../UCM229033.pdf [Date accessed: 21st July 2018]

Editor's Notes

  1. Intermittent fever: indicative of infection
  2. Metastasis: spread from a initial/primary site to a secondary/ different site. Other than where it started