The document discusses a hospital formulary, which is a list of pharmaceutical agents approved by a hospital's medical staff for use in treating patients. It includes important information about the drugs like dosage, indications, and side effects. The formulary system helps regulate drug procurement, prescribing, dispensing, and administration. It aims to provide effective treatment options while reducing costs and improving quality of care. The formulary must be regularly revised to reflect new drugs and policies. A pharmacy and therapeutics committee manages additions and deletions based on drug evaluations.
The Provision Of Written And/Or Verbal Information About Drugs And Drug Therapy In Response To A Request From Other Healthcare Providing Organizations, Committees, Patients, And Public Community
Objectives, scope, Organization and structure of retail and wholesale drug store, type and design, dispensing of proprietary products, legal requirements
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
The Provision Of Written And/Or Verbal Information About Drugs And Drug Therapy In Response To A Request From Other Healthcare Providing Organizations, Committees, Patients, And Public Community
Objectives, scope, Organization and structure of retail and wholesale drug store, type and design, dispensing of proprietary products, legal requirements
REVIEWING THE CLINICIANS PRESCRIPTION AND TREATMENT PROGRESSION IS THE FUNDAMENTAL RESPONSIBILITY OF PHARMACIST. THIS PRESENTATION WILL DEAL WITH VARIOUS ASPECTS OF REVIEWING PATIENT DRUGTHERAPY PLAN
A Ward round is a visit made by a medical practitioner, alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health.
Usually at least one ward round is conducted
everyday to review the progress of each
patient outcome.
Pharmacist’s participating in medical ward
rounds promotes health care
Participation of the Pharmacists in ward
rounds in various practice settings helps to
provide rational drug use.
Introduction to daily activities of clinical pharmacist.
Drug therapy monitoring,
Medication chart review
Clinical Progress
Pharmacist intervention
Detection and management of ADRs
Formulary is an official or authorised publication of an approved list of medicines for use in a hospital, a group of hospitals a society a state or a region a country or a number of countries.
Hospital Formulary is a continually revised compilation of pharmaceuticals dosage agents and their forms that reflects the current clinical view of the medical staff.
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
medication Adherence defined as the act of filling a new prescription for the first time.
The extent to which the patients take medications as prescribed by the prescriber.
2. Hospital Formulary.pdf unit 2 sem 7 b.pharmacyVedika Narvekar
Hospital formulary
Definition, contents of hospital formulary, Differentiation of hospital formulary and
Drug list, preparation and revision, and addition and deletion of drug from hospital
formulary
A Ward round is a visit made by a medical practitioner, alone or with a team of health care professionals and medical students to hospital in-patients at their bedside to review and follow-up the progress in their health.
Usually at least one ward round is conducted
everyday to review the progress of each
patient outcome.
Pharmacist’s participating in medical ward
rounds promotes health care
Participation of the Pharmacists in ward
rounds in various practice settings helps to
provide rational drug use.
Introduction to daily activities of clinical pharmacist.
Drug therapy monitoring,
Medication chart review
Clinical Progress
Pharmacist intervention
Detection and management of ADRs
Formulary is an official or authorised publication of an approved list of medicines for use in a hospital, a group of hospitals a society a state or a region a country or a number of countries.
Hospital Formulary is a continually revised compilation of pharmaceuticals dosage agents and their forms that reflects the current clinical view of the medical staff.
Pharmacy and Therapeutic Committee (PTC) & Hospital Formulary
The Pharmacy and Therapeutic Committee (PTC) is an advisory group that considers essentially all the matters related to the use of drugs in a hospital including evaluation of drugs & dosage forms and safe use of investigational drugs.
What is a pharmacy and therapeutics committee?
Pharmacy and Therapeutics (P&T) is a committee at a hospital or a health insurance plan that decides which drugs will appear on that entity's drug formulary.
Basic introduction to patient counselling for the clinical pharmacy services. Educating the patient on their disease, medication and lifestyle for better patient care and quicker recovery.
medication Adherence defined as the act of filling a new prescription for the first time.
The extent to which the patients take medications as prescribed by the prescriber.
2. Hospital Formulary.pdf unit 2 sem 7 b.pharmacyVedika Narvekar
Hospital formulary
Definition, contents of hospital formulary, Differentiation of hospital formulary and
Drug list, preparation and revision, and addition and deletion of drug from hospital
formulary
Introduction
Pharmacy & therapeutic committee (PTC)
Hospital formulary
Infection control committee
In these days of modern medicine, a large number of drugs are available for the treatment of a disease.
Considering the complexities surrounding their effective use, it is necessary for the hospital to establish a system to bring the best medicinal agents to the attention of the medical staff and help them in proper selection of therapeutic substances.
In order to ensure proper rationality in the use of drugs a “PHARMACY AND THERAPEUTIC COMMITTEE” need to be organized and constituted in a hospital.
It is an advisory group of medical staff and the administration of hospital on matters related to the therapeutic use of drugs.
FUNCTIONS
To advise the medical staff on usage of drugs.
To develop and compile formulary of drugs accepted for use in the hospital.
To plan/establish suitable educational programs.
To review adverse drug reactions.
To make recommendations concerning drugs to be stocked in hospital patient care areas.
To advise the pharmacy in the implementation of effective drug distribution and control procedures.
HOSPITAL FORMULARY
Hospital Formulary is defined as a list of drugs used in the hospital.
Formulary system is method whereby the medical staff of an institution, working through the PTC, evaluates, appraises, and selects from among the numerous available drug entities & drug products those that considered most useful in patient care.
The P&T committee is generally the medical staff committee responsible for managing the formulary system. The P&T committee provides an evaluative, educational, and advisory service to the medical staff and organizational administration in all matters pertaining to the use of available medications. The P&T committee should be responsible for overseeing policies and procedures related to all aspects of medication use within an institution.
This committee assists in the formulation of broad professional policies regarding the evaluation, selection, procurement, distribution, use, safety procedures and other matters relating to drugs use in the hospital.
A hospital exists mainly to provide therapeutic services to the patients.
Drugs are an integral part of patient care. In every hospital, medicines are crucial to the hospital services.
Appropriate use of medicines in the hospital is a multidisciplinary responsibility that includes doctors, nurses, pharmacists, administrators, support personnel and patients.
The availability of medicines in the hospitals depends not only on good supplies, but also on efficient use through good distribution system, rational prescribing, and dispensing practices.
"When a drug is required, the appropriate drug must be chosen. It must be available at the right time, at the right price. It must be dispensed correctly, must be delivered in a right dose, at the right intervals and for the right length of time".
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
2. • The hospital formulary is a list of pharmaceutical agents
with its important information’s which reflects the current
clinical views of the medical staff.
• The hospital formulary system is a method whereby the
medical staff of a hospital with the help of pharmacy and
therapeutic committee selects and evaluate medical agents
and their dosage form which are considered to be most
useful in the patient care.
• The hospital formulary system provides the information
for procuring, prescribing, dispensing and administration
of drugs under brand/generic names.
3. The need for Hospital Formulary:
• The increasing number of new drugs manufactured and
marketed by drug companies.
• Increasing complexity of untoward effects of modern
potent drugs.
• Newer sales promotion strategies of pharmaceutical
industry.
• The public interest in getting possible health care at lowest
possible cost
4. Advantages of hospital formulary
• It provides the practitioner with approved and
efficacious medicines to treat disease .
• Hospital formulary reduces the inventory cost of the
drugs. It regulates the number of medicines by
improving the procurement and inventory management.
• It improves the quality assurance and easier dispensing.
• It gives stress on medicine information and focused on
patient’s education efforts.
• It removes the irrational combinations of drugs and also
improves adverse drug reaction management.
5. Disadvantages of hospital formulary
• The hospital formulary system deprives the physician of
the right and prerogative to prescribing and obtained the
brand of his choice.
• The system may sometimes permit the pharmacist to act
as the sole judge to which the brands of the drugs to be
purchased and dispensed.
6. Formulary contents & organization
The formulary should consist of three main parts:
1. Information on hospital policies & procedures
concerning drugs.
2. Drug products listing
3. Special information
7. 1. Information on hospital policies & procedures
concerning drugs
i. Categories of drugs
Eg: formulary drugs, non formulary drugs, etc.
ii. Brief description of the PTC including its membership,
responsibilities and operation.
iii. Hospital regulations about prescribing, dispensing &
administration of drugs including writing of drug orders,
verbal drug orders, automatic stop orders, self
administration of drugs by patients.
iv. Pharmacy operating procedures such as prescription
labeling, handling of drug information request and
outpatient prescription policies.
v. Information on using the formulary: It includes how
formulary entries are arranged and the information
contained in each entry.
8. 2. Drug products listing
a) Formulary item entries:
– Alphabetically by generic name
– Alphabetically within therapeutic class
b) Type of information
• Generic name of the product
• Dosage form, strength, packaging
• Active ingredients
• Adult/pediatric dose
• Route of administration, Cost etc
c) Indexes to the drug products listing:
• Generic name/brand name
• Therapeutic /pharmacological index
9. 3. Special information
• Hospital approved abbreviations
• Rules for calculating pediatric dosages
• List of sugar free drugs
• Metric conversion tables
• Poison control information
• Table of drug interactions
10. PREPARATION OF HOSPITAL FORMULARY
• Preparation of a hospital formulary is a principal
responsibility of the pharmacy and therapeutic
committee. However it is also rests primarily on the chief
pharmacist service etc. The committee is free to make
necessary decisions, regarding the material to be included
in the formulary and pharmacist undertaken the production
of the formulary that is compiling and printing etc.
• The physical appearance & structure of the formulary is
important influence on its use. The formulary should be
visually pleasing, easily readable and should appear
professional.
11. 1. Introductory information
• Acknowledgement
• List of abbreviations
• Intended usage of the formulary manual
• Generic Name
• Dosage Form, Strength
• Indications
• Pharmacological Actions
• Precautions
• Side effects
• Dosage Form, Frequency, Drug Interactions
2. Basic information of the drug
12. 3. Supplementary information on each drug
• Price
• Regulatory Category
• Storage Guidelines
• Patient counselling Information
• Brand names
• Principles of prescription writing
• Strength of prescribed medication must be given in
accepted metric system
• Correct dispensing guidelines
• Prevention and Reporting of ADRs
4. Prescribing & dispensing guidelines
13. 5. General drug use advice
• Use of IV drugs
• Special situations like pregnancy, breastfeeding
liver/kidney diseases
• Poisoning information and Antidotes
• Treatment of snake bites and insect bites
• Children’s dose
• Renal adjustments
• Metric units
• Diagnostic aids
6. Miscellaneous section
14. Management of hospital formulary
Formulary Management Principles
• The formulary is a periodically revised list of medicines
that reflects the current judgment of the medical staff. The
formulary system utilizes the medical and pharmacy staff
to evaluate, appraise, and select from among the numerous
available medicines those products that are the most
efficacious, safest, of adequate quality, and available at a
reasonable price. When completed, the formulary should
conform to the following principles—
a. Medicines should be selected based on the needs of the
community; they should treat the locally identified
diseases and conditions.
15. b. The formulary list should have a limited number of
medicines, only those necessary to provide for the needs
of the hospital or clinic; duplication of agents that have
therapeutic equivalence should not occur.
c. International nonproprietary names (INN) (i.e., generic
names) should be used.
d. Combination (fixed-dose) products should be used only
in specific proven conditions (e.g., to treat tuberculosis).
e. The formulary must be consistent with any national or
regional formulary or approved standard treatment
guidelines.
f. Medicines should be restricted to appropriate
practitioners.
16. Distribution of the formulary
• Copies of the formulary should be placed at each patient
care unit including clinics & the emergency room.
• Each division of the pharmacy (IP pharmacy, OP
pharmacy, drug information centre etc) should receive a
copy.
• Head of the department as well as each member of the
medical staff should receive a copy.
17. Revision of formulary
• The PTC holds meetings to discuss about the revision of
the formulary.
• The annual revision is necessary because of the changes
in the drug products, removal of certain drugs from the
market and changes in the hospital policies.
• The addition of details of a drug is done by attaching the
supplement sheets at the back of the formulary.
• The addition of any drug to the formulary is a complex
decision.
• All steps prior to the addition or deletion of a drug must
be reported to the medical staff.
18. Maintaining a Formulary System
• The formulary maintenance process is dependent on two key
components:
a) additions and deletions of medicines, and
b) therapeutic medicine class reviews.
• Additions and deletions should be handled following specific
policies and procedures developed for the PTC. A transparent
methodology must be developed for these important decisions
concerning addition or deletion of a medicine.
• Routine medicine class reviews are important to maintain the
formulary. The medicine class review involves the evaluation of
a complete section of medicines (e.g., cephalosporin antibiotics).
• To maintain the formulary, regularly scheduled meetings must
be established and attended by committee members. Ideally, the
committee would meet monthly or, at the very least, every four
months.
19. • Selecting medicines for the formulary should follow
carefully considered policies and procedures for
determining the most useful medicines. These policies
should be followed routinely and accurately each time an
evaluation is needed.
1. A request for addition of a medicine to the formulary,
which can be made only by a physician or pharmacist, is
done by completing a “Request for Addition/Deletion”
form.
2. Medicine information resources should be obtained,
including primary literature, international newsletters,
standard treatment guidelines, textbooks, and Internet
sources.
20. 3. The evaluation is performed using established criteria
4. The medication information monograph is written. The
medication monograph should include details about the
medicine obtained from several information sources. At a
minimum, the monograph should include
Pharmacology
Pharmacokinetics
Efficacy compared to placebo and other medicines
Clinical trial analysis
ADRs
Medicine interactions
Cost comparison
Sources of supply (to ensure availability)
21. 5. Expert opinions and recommendations should be obtained
from knowledgeable and respected physicians and
pharmacists.
6. The PTC makes a formulary decision (at the PTC
meeting). Information should be presented to the PTC at
a regularly scheduled meeting.
7. The results of the evaluation and PTC’s recommendations
and actions must be disseminated to the health care staff
in the form of minutes or newsletters, or through
department meetings.
22. Selection Criteria for New Medicines
• Selecting medicines for the formulary is the most
important function of the formulary system. The process,
which is multifactorial, ultimately brings the best
medicines to the health care system. The following are the
major criteria to be considered when evaluating all new
requests for addition to the formulary—
Country disease patterns
Efficacy/effectiveness
Safety
Quality
Patient’s acceptability
Cost
23. • Disease Patterns: The morbidity of the region needs to be
assessed carefully before adding or deleting any
medicines. Formulary medicines should be approved only
after confirmation of actual need to treat the known
diseases and medical conditions of the community.
• Efficacy: Proven efficacy is one of the most important
criteria in selecting new medicines for the formulary.
Reviewing information from systematic reviews, e.g., the
Cochrane Collaboration, international pharmaceutical
information newsletters or bulletins, and current textbooks
will provide the reviewer with additional supporting
information concerning efficacy.
24. • Safety: Determining the safety of a medicine requires close
attention to established information on the medicine as well as
current postmarketing surveillance of the medicine’s safety
record. A careful risk-benefit assessment will be necessary for
all medicines before they are added to the formulary.
• Quality: The quality of a medicine that is requested for the
formulary is important. Poor-quality medicines that are
administered to patients may have adverse effects, including—
lack of therapeutic effect, toxic and adverse reactions, waste of
financial resources etc.
• Patient’s acceptability: Patient’s acceptability is very
important especially for orally administered drugs where
palatability and ease of swallowing will contribute to
acceptability.
25. • Cost: Cost considerations are also important since the
aim of formulary is to encourage rational and cost
effective prescribing. Cost effective prescribing
involves the use of a drug with lowest costs, minimal
toxicity and is applicable to patients.
26.
27. ROLE OF PHARMACIST IN HOSPITAL
FORMULARY
• Pharmacist in the PTC has a key role in developing
policies and procedures governing the hospital formulary.
• The chief pharmacist has the primary responsibility for
the preparation of hospital formulary.
• Pharmacist with the advice and guidance of PTC shall
as certain the quantity and source of supply of all drugs,
chemicals, biological and pharmaceutical preparations used
for the diagnosis, and treatment of patients.
• Pharmacist should ensure that quality of drugs is not
compromised by economic considerations.
• He will valuates various drugs as per the guidance of
PTC.
30. GUIDELINE FOR HOSPITAL
FORMULARY
a) The governing body of the hospital shall appoint a
pharmacy and therapeutic committee composed of
physician and pharmacist which will prepare the hospital
formulary system.
b) The medical staff in the governing body shall sponsor and
outline the purpose, organization function and scope of
the hospital formulary system. It should adopt the
principle as per the need of particular hospital.
c) The pharmacy and therapeutic committee shall develop
policy and procedure governing the hospital formulary
and the medical staff shall adopt these policies and
procedures subject to administrative approval.
31. d) The policy and procedures shall afford guidance in the appraisal,
selection, procurement, storage, distribution, use, safety procedures
and other matter relating to drug in the hospital and shall be
published in the hospital’s formulary or other media available to the
member of medical staff.
e) The medical staff shall adopt the policy formula, and procedure for
including drugs in the formulary by their non proprietary names even
though proprietary names continue to being use in the hospital
physicians.
f) In the absence of written policies approved by the medical staff
related to the operation, the hospital shall make it certain that the
nursing personnel are informed in writing though its system of news
of communication that there exits the formulary system in the
hospital and the procedure governing its operations.
32. i) In the formulation of policies and procedure the term substitute or
substitution should be avoid since these term have been used to imply
the unauthorized dispensing of entire different drug, neither of which
takes place under a properly operated hospital formulary system.
j) It shall be made known to the medical staff about the changes in the
working in the hospital formulary system or in the content of the
hospital system.
k) Provision shall be made for the appraisal of the member of the
medical staff for the use of the drug not include in the formulary or
the investigational drugs.
l) The pharmacist with the advice and guidance of the pharmacy and
therapeutic committee, shall ascertain the quantity and source of
supply of all drugs, chemical, biological and pharmaceutical
preparation used for diagnosis and treatment of patient.
m) labeling of drug and medicine container with non proprietary name of
the content always should be proper. The use of proprietary name
other than that describing the actual content is not correct and proper
if it is used in a manner that can be taken as description of the content.