It is of key importance that the quality and the integrity of the medicinal products are maintained during the entire supply chain from the manufacturer to the patient. Today’s distribution network for medicinal products is increasingly complex and involves many players. The revised guidelines, published today, lay down appropriate tools to assist wholesale distributors in conducting their activities and to prevent falsified medicines from entering the legal supply chain.
The revised guidelines introduce the following changes:
the maintenance of a quality system setting out responsibilities, processes and risk management principles in relation to wholesale activities;
suitable documentation which prevents errors from spoken communication;
sufficient competent personnel to carry out all the tasks for which the wholesale distributor is responsible;
adequate premises, installations and equipment so as to ensure proper storage and distribution of medicinal products;
appropriate management of complaints, returns, suspected falsified medicinal products and recalls;
outsourced activities correctly defined to avoid misunderstandings;
rules for transport in particular to protect medicinal products against breakage, adulteration and theft, and to ensure that temperature conditions are maintained within acceptable limits during transport;
Specific rules for brokers (person involved in activities in relation to the sale or purchase of medicinal products)
Drug Regulations has prepared a presentation summarizing the new GDP requirements for Medicinal Products.
Quality Management system in accordance to Vol. 4 EU Guidelines for GMP for Medicinal Products for Human and Veterinary Use Chapter 1 Pharmaceutical QS
ICH Q10/ Q7.
ISO 9001/2015
The European Commission Health and Consumers Directorate – General has published a draft “GUIDELINES ON THE PRINCIPLES OF GOOD DISTRIBUTION PRACTICES FOR ACTIVE SUBSTANCES FOR MEDICINAL PRODUCTS FOR HUMAN USE”.
The guideline addresses Quality systems, Personnel, Documentation, Order, Procedures, Records, Premises and Equipment, Receipts, Storage , Deliveries to Customers, Transfer of Information and Returns.
Following presentation is prepared by “ Drug Regulations” a non profit organization which provides free online resource to the Pharmaceutical Professional.
This presentation contain introduction to Good Distribution Practices Guideline. and Legal GDP requirements put worldwide.
Good distribution practice (GDP) describes the minimum standards that a wholesale distributor must meet to ensure that the quality and integrity of medicines is maintained throughout the supply chain
Each participant in the distribution chain must agree by the relevant requirements in order to retain the original quality of pharmaceutical products.
Each activity in the distribution of pharmaceutical products shall be carried out according to the principles of Good Distribution Practices (GDP) as applicable.
The risks involved are likely to be of a nature comparable to those that are present in the industrial environment, such as mix-ups, adulteration, contamination, cross-contamination, and spurious.
The guideline addresses
Personnel
Quality System
Premises Warehousing and Storage
Documentation
Traceability
Complaints and Returns
Transportation
In the last year or so the FDA and the EMA have issued new guidance/ draft guidance on "Process Validation".These align process validation activities with a product lifecycle concept and the International Conference on Harmonisation (ICH) guidances for industry, Q8(R2) Pharmaceutical Development, Q9 Quality Risk Management, and Q10 Pharmaceutical Quality System. The earlier guidelines were developed before the elaboration of the new ICH guidelines.With these new guidelines, additional opportunities are available to verify the control of the process by alternative means to the manufacture of traditional process validation batches. The main objective of process validation remains that a process design yields a product meeting its pre-defined quality criteria. ICH Q8, Q9 and Q10 provide a structured way to define product critical quality attributes, design space, the manufacturing process and the control strategy. ICH Q8 refers to an ‘enhanced’ approach to pharmaceutical development which includes an alternative to the traditional process validation.
Continuous process verification [see definition in ICH Q8(R2) glossary] can be utilised in process validation protocols for the initial commercial production and for manufacturing process changes for the continual improvement throughout the remainder of the product lifecycle.
There is now a new paradigm in process validation. This presentation has been prepared from material available from FDA , EMA and ICH for beginners to have an overview of the new paradigm.
Quality Management system in accordance to Vol. 4 EU Guidelines for GMP for Medicinal Products for Human and Veterinary Use Chapter 1 Pharmaceutical QS
ICH Q10/ Q7.
ISO 9001/2015
The European Commission Health and Consumers Directorate – General has published a draft “GUIDELINES ON THE PRINCIPLES OF GOOD DISTRIBUTION PRACTICES FOR ACTIVE SUBSTANCES FOR MEDICINAL PRODUCTS FOR HUMAN USE”.
The guideline addresses Quality systems, Personnel, Documentation, Order, Procedures, Records, Premises and Equipment, Receipts, Storage , Deliveries to Customers, Transfer of Information and Returns.
Following presentation is prepared by “ Drug Regulations” a non profit organization which provides free online resource to the Pharmaceutical Professional.
This presentation contain introduction to Good Distribution Practices Guideline. and Legal GDP requirements put worldwide.
Good distribution practice (GDP) describes the minimum standards that a wholesale distributor must meet to ensure that the quality and integrity of medicines is maintained throughout the supply chain
Each participant in the distribution chain must agree by the relevant requirements in order to retain the original quality of pharmaceutical products.
Each activity in the distribution of pharmaceutical products shall be carried out according to the principles of Good Distribution Practices (GDP) as applicable.
The risks involved are likely to be of a nature comparable to those that are present in the industrial environment, such as mix-ups, adulteration, contamination, cross-contamination, and spurious.
The guideline addresses
Personnel
Quality System
Premises Warehousing and Storage
Documentation
Traceability
Complaints and Returns
Transportation
In the last year or so the FDA and the EMA have issued new guidance/ draft guidance on "Process Validation".These align process validation activities with a product lifecycle concept and the International Conference on Harmonisation (ICH) guidances for industry, Q8(R2) Pharmaceutical Development, Q9 Quality Risk Management, and Q10 Pharmaceutical Quality System. The earlier guidelines were developed before the elaboration of the new ICH guidelines.With these new guidelines, additional opportunities are available to verify the control of the process by alternative means to the manufacture of traditional process validation batches. The main objective of process validation remains that a process design yields a product meeting its pre-defined quality criteria. ICH Q8, Q9 and Q10 provide a structured way to define product critical quality attributes, design space, the manufacturing process and the control strategy. ICH Q8 refers to an ‘enhanced’ approach to pharmaceutical development which includes an alternative to the traditional process validation.
Continuous process verification [see definition in ICH Q8(R2) glossary] can be utilised in process validation protocols for the initial commercial production and for manufacturing process changes for the continual improvement throughout the remainder of the product lifecycle.
There is now a new paradigm in process validation. This presentation has been prepared from material available from FDA , EMA and ICH for beginners to have an overview of the new paradigm.
Validation: Validation is a documented program that provides high degree of assurance that a specific process, method or system consistently produces a result meeting pre-determined acceptance criteria.
A primary mission of the Food and Drug Administration is to conduct comprehensive regulatory coverage of all aspects of production and distribution of drugs and drug products to assure that such products meet the 501(a)(2)(B) requirements of the Act. FDA has developed two basic strategies:
. 1) evaluating through factory inspections, including the collection and analysis of associated samples, the conditions and practices under which drugs and drug products are manufactured, packed, tested and held, and
. 2) monitoring the quality of drugs and drug products through surveillance activities such as sampling and analyzing products in distribution.
FDA compliance program “ Drug Manufacturing Inpsections” (7356.002) is designed to provide guidance for implementing the first strategy. Products from production and distribution facilities covered under this program are consistently of acceptable quality if the firm is operating in a state of control.
The inspectional guidance in this program is structured to provide for efficient use of resources devoted to routine surveillance coverage, recognizing that in-depth coverage of all systems and all processes is not feasible for all firms on a biennial basis. It also provides for follow-up compliance coverage as needed.
“Drug Regulations” has prepared a summary from the compliance programme and is given below in the presentation.
This presentation correlates the requirements of Annex 11 guidelines to other official regulations and guidance documents.
The correlation is organized in a tabular format.
In the row lists the contents of Annex 11 together with the paragraph numbers.
Rest of the rows correlate the section numbers of
Annex 11 Versions 1993
US FDA 21 CFR Part 211
US FDA Part 820 and
US FDA 21 CFR Part 11
Top 20 observation series 2: 21 CFR 211.22Sathish Vemula
- 2014 inspectional observations- List of Top observations in 2014- Sec. 21 CFR 211.22 (a) 21 CFR 211.22 (b) 21 CFR 211.22 (c) 21 CFR 211.22 (d) - 483 observations- Warning Letters- Other Guidance- How to avoid observations
Master batch record,batch production record ,Quality Audit Type and plan &Rec...KarishmaFuse
Standard Operating procedure(SOP), Preparation review ,Approval Issuance of master batch Record MBR and Batch Production Record (BPR) and Quality Audit Type, plan and Objectives.
TGA Presentation: What’s happening in regulation?TGA Australia
This presentation provides an overview of the Government's response to the Expert Panel Review of Medicines and Medical Devices, with an emphasis on complementary medicines changes.
Validation: Validation is a documented program that provides high degree of assurance that a specific process, method or system consistently produces a result meeting pre-determined acceptance criteria.
A primary mission of the Food and Drug Administration is to conduct comprehensive regulatory coverage of all aspects of production and distribution of drugs and drug products to assure that such products meet the 501(a)(2)(B) requirements of the Act. FDA has developed two basic strategies:
. 1) evaluating through factory inspections, including the collection and analysis of associated samples, the conditions and practices under which drugs and drug products are manufactured, packed, tested and held, and
. 2) monitoring the quality of drugs and drug products through surveillance activities such as sampling and analyzing products in distribution.
FDA compliance program “ Drug Manufacturing Inpsections” (7356.002) is designed to provide guidance for implementing the first strategy. Products from production and distribution facilities covered under this program are consistently of acceptable quality if the firm is operating in a state of control.
The inspectional guidance in this program is structured to provide for efficient use of resources devoted to routine surveillance coverage, recognizing that in-depth coverage of all systems and all processes is not feasible for all firms on a biennial basis. It also provides for follow-up compliance coverage as needed.
“Drug Regulations” has prepared a summary from the compliance programme and is given below in the presentation.
This presentation correlates the requirements of Annex 11 guidelines to other official regulations and guidance documents.
The correlation is organized in a tabular format.
In the row lists the contents of Annex 11 together with the paragraph numbers.
Rest of the rows correlate the section numbers of
Annex 11 Versions 1993
US FDA 21 CFR Part 211
US FDA Part 820 and
US FDA 21 CFR Part 11
Top 20 observation series 2: 21 CFR 211.22Sathish Vemula
- 2014 inspectional observations- List of Top observations in 2014- Sec. 21 CFR 211.22 (a) 21 CFR 211.22 (b) 21 CFR 211.22 (c) 21 CFR 211.22 (d) - 483 observations- Warning Letters- Other Guidance- How to avoid observations
Master batch record,batch production record ,Quality Audit Type and plan &Rec...KarishmaFuse
Standard Operating procedure(SOP), Preparation review ,Approval Issuance of master batch Record MBR and Batch Production Record (BPR) and Quality Audit Type, plan and Objectives.
TGA Presentation: What’s happening in regulation?TGA Australia
This presentation provides an overview of the Government's response to the Expert Panel Review of Medicines and Medical Devices, with an emphasis on complementary medicines changes.
The European Commission Health and Consumers Directorate – General has published draft “GUIDELINES ON THE FORMALISED RISK ASSESSMENT FOR ASCERTAINING THE APPROPRIATE GOOD MANUFACTURING PRACTICE FOR EXCIPIENTS OF MEDICINAL PRODUCTS FOR HUMAN USE” for public consultation.
Following presentation has been prepared by " Drug regulations" a not for profit organization which provides free online resources for the Pharmaceutical Professional.
A structured approach to the investigation process should be used with the objective of determining the root cause.
The level of effort, formality, and documentation of the investigation should be commensurate with the level of risk, in line with ICH Q9.
This presentation provides an overview of proposals for implementation of several reform initiatives relevant to prescription medicines, including expedited pathways for registration, enhanced post-market monitoring, variations to registered medicines, work sharing with comparable overseas regulators, the use of overseas assessment reports, and reforms to the orphan drug programs. The information session was held ahead of formal public consultations to provide an early view of the reform proposals to those stakeholders who will be most directly involved in the design of the new regulatory arrangements.
This presentation covers the manufacture and testing of all sterile drug products, including drugs that are sterilized by filtration or other means and aseptically processed, and drug products that are terminally sterilized. The type of products covered include sterile bulk drugs, ophthalmic drugs, otic dosage forms, small volume parenteral (SVS) products for small molecule and licensed biological
therapeutic drug products, large volume parenteral (LVP) products, and any other drug products required to be sterile or labeled as sterile. Center for Biologics Evaluation and Research (CBER) regulated products and veterinary drug products are excluded from coverage under this program.
The guidance information is tailored to sterile manufacturing operations and should be used in conjunction with the Compliance Program for Drug Manufacturing Inspections (CP 7356.002).
The TGA Pharmacovigilance Inspection Pilot Program: 2015-2016TGA Australia
Firsthand overview of the TGA's Pharmacovigilance Inspection programme from the perspective of both the TGA and companies that have participated in the 'Pilot Inspection Programme'.
Audit and Inspection in Clinical ResearchClinosolIndia
Audit and inspection are two critical components of quality assurance in the pharmaceutical industry. Both are essential for ensuring compliance with regulatory requirements and for identifying areas where improvements can be made in quality systems.
An audit is a systematic and independent examination of a company's quality system to determine whether it meets the requirements of applicable regulations and standards. The audit process involves reviewing documentation, procedures, and practices to identify potential areas of non-compliance and areas for improvement. The audit can be internal, where a company audits its own quality system, or external, where an independent third-party audits the quality system.
Inspection, on the other hand, is a regulatory process conducted by government authorities to ensure that a company's quality system is compliant with regulations and standards. The inspection process involves a review of a company's facilities, procedures, and documentation to determine whether they meet regulatory requirements. Inspections may be conducted on a routine basis or may be triggered by specific events, such as a product recall or a serious adverse event.
During an audit or inspection, the auditors or inspectors will typically review a range of documents and processes, including:
Standard operating procedures (SOPs) for quality control and quality assurance
Documentation of manufacturing processes and quality control testing
Personnel training records and qualifications
Equipment and facility maintenance and cleaning records
Complaint and deviation handling procedures
Batch records and release testing
The goal of an audit or inspection is to identify any deficiencies in the quality system that could impact product quality or patient safety. Depending on the severity of any non-compliance identified, regulatory action may be taken, such as issuing a warning letter or suspending a company's manufacturing license.
Overall, audits and inspections play a critical role in ensuring the safety, efficacy, and quality of pharmaceutical products, and are an essential part of the regulatory process for the pharmaceutical industry.
Regulatory Reporting in Pharmacovigilance: Compliance and Best PracticesClinosolIndia
Regulatory reporting in pharmacovigilance is a critical component of ensuring patient safety by promptly and accurately communicating adverse events and other safety-related information to regulatory authorities. Compliance with regulatory requirements is essential to maintain public health and trust in the pharmaceutical industry.
This presentation highlights the reasons which lead to the withdrawal of the 2002 Guidance of the FDA and the current issue with Blend Uniformity and Content Uniformity Determinations.
WHO has recently issued draft document titled "Guidelines on Validation". These guidelines (i.e., the main text included in this working document) cover the general principles of validation and qualification.
These guidelines focus mainly on the overall concept of validation and are not intended to be prescriptive in specific validation requirements. This document serves as general guidance only and the principles may be considered useful in its application in the manufacture and control of starting materials and finished pharmaceutical products (FPPs), as well as other areas. Validation of specific processes and systems, for example, in sterile product manufacture, requires much more consideration and a detailed approach that is beyond the scope of this document. The general text in this document may be applicable to validation and qualification of premises, equipment, utilities, systems, processes, and procedures.
The draft on the specific topics, the appendices to this main text, will follow. The following is an overview on the appendices that are intended to complement the text of this working document:
Appendix 1: Validation of heating, ventilation and air-conditioning systems - will be replaced by cross reference to WHO Guidelines on GMP for HVAC systems for considerations in qualification of HVAC systems (update - working document QAS/15.639/Rev. 1)
Appendix 2: Validation of water systems for pharmaceutical use - will be replaced by cross-reference to WHO Guidelines on water for pharmaceutical use for consideration in qualification of water purification systems
Appendix 3: Cleaning validation - consensus to retain
Appendix 4: Analytical method validation - update in process
Appendix 5: Validation of computerized systems - update in process
Appendix 6: Qualification of systems and equipment - update in process
Appendix 7: Non-sterile process validation - update already published as Annex 3, WHO Technical Report Series, No. 992, 2015
Comments on this draft document are due by July 12, 2016.
A presentation on this guidance is given below:
Presentation on New WHO Guidance on Validations
Environmental Monitoring describes the microbiological testing under- taken in order to detect changing trends of microbial counts and micro- flora growth within cleanroom or controlled environments. The results obtained provide information about the physical construction of the room, the performance of the Heating, Ventilation, and Air-Conditioning (HVAC) system, personnel cleanliness, gowning practices, the equipment, and cleaning operations.
Over the past decade, environmental monitoring has become more sophisticated in moving from random sampling, using an imaginary grid over the room and testing in each grid, to the current focus on risk assessment and the use of risk assessment tools to determine the most appropriate methods for environmental monitoring.
This presentation gives current trends in the application of risk assessment to the practice of environmental monitoring.
This presentation is compiled from freely available resources like the websites of FDA, EMA ,WHO and research papers published by experts in this field like Sandle, T Reinmüller, B , Hyde, W,, Costello, E.K., Lauber, C. L., Hamady, M., Fierer, N., Gordon, J.I., Knight, R.
Paper published by T. Sandle on clean room contamination was referred extensively for this presentation. “Drug Regulations” is a non profit organization which provides free online resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest information from the world of Pharmaceuticals.
This presentation gives an overview of : Validation of microbiological methods , Considering some of the limitations and
Key criteria that may be applicable for assessment.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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
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.
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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
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
1. This presentation is prepared by “ Drug Regulations” a
non profit organization which provides free online
resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest
information from the world of Pharmaceuticals.
3/29/2015 1
2. This presentation will cover
◦ Regulations
◦ Major Developments
◦ Definitions
◦ Wholesale Distribution
◦ Quality Management
◦ Personnel
◦ Premises & Equipment
◦ Documentation
◦ Operations
◦ Complaints, Returns, SFMP, Recalls
◦ Outsourced Activity
◦ Self Inspection
◦ Transportation
◦ Special Provisions for Brokers
3/29/2015 2
3. Distribution : Important activity in the integrated supply
chain management.
Lack of adequate control can affect the quality and the
integrity of medicinal products .
New EU Commission guideline ( March 2013)
◦ (94/ C 63 /03 )
These guidelines are based on Article 84 and Article
85(b)(3) of Directive 2001/83/EC of the European
Parliament.
3/29/2015 3
Drug Regulations - Online
Resource for latest information.
4. Important to maintain Quality and the Integrity of the
medicinal products during the entire supply chain from
the manufacturer to the patient.
Distribution network for medicinal products is
increasingly complex and involves many players.
Revised guidelines will assist wholesale distributors
◦ In conducting their activities and
◦ To prevent falsified medicines from entering the legal supply
chain.
3/29/2015 4
Drug Regulations - Online
Resource for latest information.
5. The revised guidelines introduce following
changes:
◦ Maintenance of a quality system setting out
responsibilities, processes and risk management principles
in relation to wholesale activities;
◦ Suitable documentation which prevents errors from spoken
communication;
◦ Sufficient competent personnel to carry out all the tasks for
which the wholesale distributor is responsible;
3/29/2015 5
Drug Regulations - Online
Resource for latest information.
6. ◦ Adequate premises, installations and equipment so as to
ensure proper storage and distribution of medicinal
products;
◦ Appropriate management of complaints, returns, suspected
falsified medicinal products and recalls;
◦ Outsourced activities correctly defined to avoid
misunderstandings;
3/29/2015 6
Drug Regulations - Online
Resource for latest information.
7. ◦ Rules for transport in particular to protect medicinal
products against breakage, adulteration and theft,
◦ Ensure that temperature conditions are maintained within
acceptable limits during transport;
◦ Specific rules for brokers (person involved in activities in
relation to the sale or purchase of medicinal products).
3/29/2015 7
Drug Regulations - Online
Resource for latest information.
8. Wholesale distribution of medicinal products is "all activities
consisting of procuring, holding, supplying or exporting
medicinal products, apart from supplying medicinal products
to the public.
Such activities are carried out with manufacturers or their
depositories, importers, other wholesale distributors or with
pharmacists and persons authorized or entitled to supply
medicinal products to the public in the Member State
concerned".
3/29/2015 8
Drug Regulations - Online
Resource for latest information.
9. Definition of wholesale distribution does not depend on
whether that distributor is established or operating in
specific customs areas.
◦ such as in free zones or in free warehouses.
Wholesale distributor needs to hold wholesale
distribution authorization.
Distributors must follow Good Distribution Practices.
◦ Article 80(g) of Directive 2001/83/EC
3/29/2015 9
Drug Regulations - Online
Resource for latest information.
10. All obligations related to wholesale distribution
activities (such as exporting, holding or supplying)
also apply to these distributors.
Relevant sections of these guidelines should also
be adhered to by other actors involved in the
distribution of medicinal products.
3/29/2015 10
Drug Regulations - Online
Resource for latest information.
11. Other actors such as brokers may also play a role
in the distribution channel for medicinal products.
According to Article 85(b), brokers are subject to
◦ Certain provisions applicable to wholesale distributors,
◦ As well as specific provisions on brokering.
3/29/2015 11
Drug Regulations - Online
Resource for latest information.
12. ◦ Maintain a quality system setting out
Responsibilities,
Processes and risk management principles in relation to their
activities .
◦ Clearly define and systematically review all distribution
activities.
◦ Justify all critical steps and significant changes of
distribution processes
◦ Validate the same when relevant
3/29/2015 12
Drug Regulations - Online
Resource for latest information.
13. ◦ The quality system
Responsibility of management
Requires management leadership and active
participation
Should be supported by staff commitment
3/29/2015 13
Drug Regulations - Online
Resource for latest information.
14. Quality System should encompass the
◦ Organisational structure
◦ Procedures
◦ Processes
◦ Resources
◦ Activities necessary to ensure confidence that the product
delivered maintains
its quality
Integrity
remains within the legal supply chain during storage and/or
transportation.
3/29/2015 14
Drug Regulations - Online
Resource for latest information.
15. Document and monitor the effectiveness of the
Quality System.
Fully define and Document all quality system-
related activities.
Establish a quality manual or equivalent
documentation approach.
3/29/2015 15
Drug Regulations - Online
Resource for latest information.
16. Appoint a responsible person to implement and
maintain a Quality System
Specify his authority and responsibility
Adequately resource all parts of the quality system with
◦ Competent personnel
◦ Sufficient premises
◦ Equipment
◦ Facilities.
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17. Developing & Modifying Quality System
◦ Consider size, structure and complexity of distributor’s
activities
A change control system should be in place.
◦ Incorporate quality risk management principles,
◦ System should be effective.
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18. The quality system should ensure
◦ Compliance to GDP when Medicinal products are procured,
held, supplied or exported
◦ Management responsibilities are clearly specified
◦ That products are delivered to the right recipients within a
satisfactory time period;
◦ That records are made contemporaneously;
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19. The quality system should ensure that:
◦ Deviations from established procedures are documented
and investigated;
◦ Appropriate corrective and preventive actions (commonly
known as CAPA) are taken to correct deviations and prevent
them in line with the principles of quality risk management.
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20. Extend the quality system to the control and
review of any outsourced activities related
to the
◦ Procurement
◦ Holding
◦ Supply
◦ Export of medicinal products
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21. These processes should incorporate quality risk
management and include:
◦ Assessing the suitability and competence of the Contract Acceptor
to carry out the activity
◦ Checking authorisation status, if required
◦ Defining the responsibilities and communication processes for the
quality-related activities of the parties involved
◦ Monitoring and review of the performance of the Contract
Acceptor
◦ The identification and implementation of any required
improvements on a regular basis.
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22. Have a regular formal review of the quality
system.
The review should include:
1. Measurement of the achievement of quality
system objectives;
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23. 2. Assessment of performance indicators that can be
used to monitor the effectiveness of Quality
processes such as
Complaints,
Deviations,
CAPA,
Changes to processes;
Feedback on outsourced activities;
Self-assessment processes including risk assessments
and audits;
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24. ◦ External assessments such as
Inspections,
Findings and
Customer audits;
3. Emerging regulations, guidance and
quality issues that can impact the quality
management system;
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25. 4. Innovations that might enhance the quality
system;
5. Changes in business environment and
objectives.
Document each review in a timely manner
Communicate the outcome internally.
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26. Is a systematic process for the
◦ Assessment,
◦ Control,
◦ Communication and
◦ Review of risks to the quality of medicinal
products.
It can be applied both proactively and
retrospectively.
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27. The correct distribution of medicinal products
relies upon people.
For this reason, there must be sufficient
competent personnel to carry out all the tasks
for which the wholesale distributor is
responsible.
Individual responsibilities should be clearly
understood by the staff and be recorded.
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28. Designate a person as Responsible Person.
Responsible Person should
◦ Meet the qualifications and all conditions provided for
by the legislation of the Member State concerned.
◦ Have a degree in pharmacy (desirable)
◦ Have appropriate competence and experience
◦ Have knowledge of and training in GDP.
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29. The Responsible Person should
◦ Fulfil their responsibilities personally
◦ Be continuously contactable.
The Responsible Person may delegate
duties but not responsibilities.
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30. Have a written job description
Define authority
Provide authority
Provide Resources
Provide Responsibility needed to fulfil their duties
Should carry out their duties to
◦ Demonstrable GDP compliance
◦ To meet public service obligations
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31. The responsibilities of the Responsible
Person include:
◦ Ensuring that a quality management system is implemented
and maintained;
◦ Focusing on the management of authorised activities and
the accuracy and quality of records;
◦ Ensuring that initial and continuous training programmes
are implemented and maintained;
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32. The responsibilities of the Responsible
Person include:
◦ Coordinating and promptly performing any recall
operations for medicinal products;
◦ Ensuring that relevant customer complaints are dealt with
effectively;
◦ Ensuring that suppliers and customers are approved;
◦ Approving any subcontracted activities which may impact
on GDP;
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33. The responsibilities of the Responsible
Person include:
◦ Ensuring that self-inspections are performed at
appropriate regular intervals following a
prearranged programme
◦ Necessary corrective measures are put in place;
◦ Keeping appropriate records of any delegated
duties;
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34. Have adequate number of competent personnel
The number of personnel required will depend on
the volume and scope of activities.
Define organisational structure in an organisation
chart.
Define the role, responsibilities, and
interrelationships of all personnel.
Have written Job Descriptions for key positions
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35. Train all personnel on the requirements of GDP
Personnel should have appropriate competence and
experience prior to commencing their tasks
Training should be based on
◦ Role of each personnel
◦ Written procedures
◦ Written training programme
Personnel should receive initial and continuing training
Responsible Person should also be trained
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36. Also train on
◦ Aspects of product identification and
◦ Avoidance of falsified medicines entering the supply chain
Have special training for products requiring stringent
handling conditions
◦ Hazardous products,
◦ Radioactive materials,
◦ Products presenting special risks of abuse (including narcotic
and psychotropic substances), and
◦ Temperature-sensitive products.
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37. Maintain a record of all training
Periodically assess effectiveness of training
Document the effectiveness assessment
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38. Establish procedures personnel hygiene
Procedures should be relevant to the activities
being carried out.
Procedures should be observed
Procedures should cover health, hygiene and
clothing.
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39. Premises should
◦ Be suitable and adequate
◦ Have suitable and adequate installations and equipment
◦ Ensure proper storage and distribution of medicinal
products
◦ Be clean,
◦ Be dry and
◦ Be maintained within acceptable temperature limits.
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40. The premises should be
◦ Designed or adapted to ensure that the required storage
conditions are maintained
◦ Suitably secure, structurally sound
◦ Of sufficient capacity to allow safe storage and handling of
the medicinal products
◦ Provided with adequate lighting to enable all operations to
be carried out accurately and safely
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41. Where premises are not directly operated by the
wholesale distributor, a contract should be in
place.
The contracted premises should be covered by a
separate wholesale distribution authorisation.
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42. Store Medicinal products in segregated areas
Clearly mark the area and have access restricted to
authorised personnel.
Physical segregation can be replaced by electronic
segregation
Such systems should provide equivalent security
Such systems should be validated.
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43. Following products should be segregated physically
or through an electronic system
◦ Products pending a decision as to their disposition
◦ Products that have been removed from saleable stock
◦ Product suspected of falsification
◦ Returned products.
◦ Medicinal products received from a third country but not
intended for the Union market should also be physically
segregated.
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44. Physically segregate
◦ Any falsified medicinal products
◦ Expired products
◦ Recalled products and
◦ Rejected products found in the supply chain
Apply appropriate security to ensure separation
from saleable stock.
Clearly identify these areas
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45. Store following products in dedicated areas
Follow local legislation
Follow appropriate safety and security measure.
◦ Radioactive materials
◦ Other hazardous products,
◦ Products presenting special safety risks of fire or explosion
(e.g. medicinal gases, combustibles, flammable liquids and
solids)
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46. Design Receiving and dispatch bays to protect
products from prevailing weather conditions
Have adequate separation between the receipt and
dispatch and storage areas
Have procedures in place to maintain control of
inbound/ outbound goods
Designate & suitably equip reception areas where
deliveries are examined following receipt
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47. Prevent unauthorised access to authorised areas
Implement appropriate access control
Implement intruder alarm system
Accompany all Visitors in authorized areas
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48. Premises and storage facilities should be clean and
free from litter and dust.
Cleaning programmes, instructions and records
should be in place
Appropriate cleaning equipment and cleaning
agents should be chosen and used
They should not be a source of contamination.
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49. Design premises to prevent entry of insects,
rodents or other animals.
Equip the premises to prevent entry of insects,
rodents or other animals.
Implement a preventive pest control programme
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50. Segregate rest, wash and refreshment rooms from
the storage areas.
Prohibit food, drink, smoking, medicinal products
for personal use in the storage areas.
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51. Install suitable equipment to check the
environment
Implement procedures to check the environment
Environmental factors to be considered include
◦ Temperature
◦ Light
◦ Humidity
◦ Cleanliness of the premises.
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52. Perform an initial temperature mapping exercise
under representative conditions
Place temperature monitoring probes based on
initial results
Position probes in the areas that experience the
extremes of fluctuations
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53. Repeat the mapping exercise
◦ Based on the results of a risk assessment exercise
◦ Whenever significant modifications are made to the facility
◦ Whenever significant modifications are made to the
temperature controlling equipment
For small premises
◦ (of a few square meters which are at room temperature )
Perform a risk assessment
Place temperature monitors accordingly.
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54. Design, Locate and Maintain equipment impacting
storage and Distribution to a standard intended for
its purpose.
Implement Planned maintenance for key equipment
vital to the functionality of the operation
Calibrate equipment used to control or to monitor
the environment at defined intervals based on a
risk and reliability assessment.
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55. Calibration should be traceable to a national or
international measurement standard.
Install & set alarms for excursions from predefined
storage conditions
Test alarms regularly to ensure adequate functionality
Perform equipment repair, maintenance and calibration
so that the integrity of products is not compromised.
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56. Make and Maintain records of key
equipment for
◦ Repairs
◦ Maintenance
◦ Calibration
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57. Key equipment
◦ Cold stores
◦ Monitored intruder alarm
◦ Access control systems,
◦ Refrigerators,
◦ Thermo hygrometers, or
◦ Other temperature and humidity recording devices,
◦ Air handling units and
◦ Any equipment used in conjunction with the onward supply chain.
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58. System should be capable of achieving the
desired results accurately, consistently and
reproducibly
Perform appropriate Validation or
Verification before use
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59. Prepare a written, detailed description of the system
◦ including diagrams where appropriate
Keep this up to date
Describe
◦ Principles,
◦ Objectives,
◦ Security measures,
◦ System scope and
◦ Main features,
◦ How the computerised system is used and
◦ The way it interacts with other systems.
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60. Only authorized persons should enter or
amend data.
Secure data by physical or electronic means
Check stored data periodically for accessibility
Protect data by backing up at regular intervals.
Retain Backup data for at least 5 years
◦ Follow national legislation
Store this at a separate and secure location.
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61. Define procedures for system failure or
breaks down.
This should include systems for the
restoration of data.
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62. Ensure correct installation and operation
Identify requirement for key equipment
qualifications
Identify requirement for key process validation
Use Risk assessment to define the scope and
extent of such qualification and/or validation
activities
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63. Qualify and/or validate
Before commencing use and
After any significant changes
◦ e.g. repair or maintenance
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64. Prepare validation and qualification reports
◦ Summarise the results obtained
◦ Comment on any observed deviations
Document deviations
Implement CAPA to prevent recurrence
Satisfactory validation and acceptance of a process
or piece of equipment should be produced and
approved by appropriate personnel.
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65. Good documentation is essential part of
quality system.
Written documentation should
◦ Prevent errors from spoken communication.
◦ Permit the tracking of relevant operations during
the distribution of medicinal products.
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66. Documentation comprises all written
◦ Procedures
◦ Instructions
◦ Contracts
◦ Records and data, in paper or in electronic form.
Documentation should be readily
available/retrievable.
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67. Follow Directive 95/46/EC
◦ With regard to the
Processing of personal data of employees,
Complainants or
Any other natural person
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68. Sufficiently comprehensive
Cover all distributor’s activities
Language understood by personnel
Clear
Unambiguous language
Free from errors
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69. Procedures should be
◦ Approved
◦ Signed
◦ Dated by the responsible person.
Documentation should be
◦ Approved,
◦ Signed and dated by appropriate authorised persons
◦ Not be handwritten
◦ Sufficient space should be provided for handwritten entries
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70. Any alteration should be signed and dated;
Alteration should permit the reading of the
original information.
Where appropriate, the reason for the
alteration should be recorded.
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71. Retain documents for at least 5 years
◦ Follow national legislation
Delete or anonymise personal data when
not required
Documents should be easily accessible to
employees.
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72. Use only valid and approved procedures.
Documents should have unambiguous content; title,
nature and purpose should be clearly stated.
Review Document regularly and kept up to date.
Apply version control
Prevent inadvertent use of the superseded documents
Remove & archive superseded or obsolete procedures
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73. Keep records of any transaction in
medicinal products received, supplied or
brokered
◦ Purchase/sales invoices
◦ Delivery slips
◦ On computer
◦ Any other form
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74. Minimum information required:
◦ Date
◦ Name of the medicinal product
◦ Quantity received, supplied or brokered
◦ Name and address of the
Supplier ,Customer Broker or Consignee, as appropriate
◦ Batch number
At least for medicinal product bearing the safety features
◦ Records should be made at the time each operation is undertaken.
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75. All actions should ensure that
◦ The identity of the medicinal product is not lost
◦ The wholesale distribution is performed
according to the information on the outer
packaging.
◦ Risk of falsified medicinal products entering the
legal supply chain is minimized
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76. All medicinal products distributed in the EU
by a wholesale distributor must be covered
by a marketing authorisation granted by the
EU or by a Member State
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77. Distributor, other than marketing authorisation
holder, must notify the marketing authorisation
holder and the competent authority of their
intention to import that product.
All key operations described should be fully
described in the quality system in appropriate
documentation.
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78. Supplies should be from
◦ Persons in possession of a wholesale distribution
authorisation, or
◦ Persons in possession of a manufacturing
authorisation which covers the product in
question
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79. Distributors receiving products for the
purpose of placing these products on the
EU market, must hold a manufacturing
authorisation
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80. Where products are obtained from another distributor the
receiving distributor must verify that the
◦ Supplier complies with the principles and guidelines of good
distribution practices and
◦ That they hold an authorisation for example by using the Union
database.
If the medicinal product is obtained through brokering, the
distributor must verify that the broker is registered and
complies with the requirements specified for them.
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81. Approve and Qualify suppliers prior to any
procurement of medicinal products.
Have a procedure for this approval and
qualification.
Document the results
Review periodically
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82. Carry out ‘due diligence’ for new suppliers to assess the
◦ Suitability,
◦ Competence and
◦ Reliability
Attention should be paid to:
◦ The reputation or reliability of the supplier;
◦ Offers of medicinal products more likely to be falsified;
◦ Large offers of medicinal products which are generally only available in
limited quantities; and
◦ Out-of-range prices.
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83. Supply medicinal products only to persons
◦ Who are in possession of a distribution
authorisation
◦ Who are authorised
◦ Who are entitled to supply Medicinal products to
the public.
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84. Perform Checks and periodic rechecks by
◦ Requesting copies of customer’s authorisations
according to national law,
◦ Verifying status on an authority website,
◦ Requesting evidence of qualifications or
◦ Entitlement according to national legislation.
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85. Monitor transactions and investigate any irregularity in
◦ Sales patterns of narcotics, psychotropic substances or other
dangerous substances.
◦ Unusual sales patterns that may constitute diversion or misuse
of medicinal product
Report to competent authorities where necessary
Take steps to ensure fulfilment of any public service
obligation
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86. Receiving function should ensure that the
◦ Arriving consignment is correct,
◦ Medicinal products originate from approved
suppliers and
◦ Products have not been visibly damaged during
transport.
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87. Prioritise products requiring special
storage or security measures
Transfer to appropriate storage once checks
have been conducted
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88. Transfer Batches to saleable stock only after
confirmation that they are authorised for sale
Put in place written procedures for this operation
Check control report as per Article 51(1) of
Directive 2001/83/EC or
Another proof of release based on an equivalent
system
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89. Store Medicinal products separately from other products
Protect from the harmful effects of
◦ light
◦ temperature
◦ moisture and
◦ other external factors
Particular attention should be paid to products requiring
specific storage conditions.
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90. Clean incoming containers of medicinal products
Maintain appropriate storage conditions
Allow for appropriate security of stocks
Rotate stock: first expiry, first out (FEFO) principle
Document exceptions
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91. Prevent spillage, breakage, contamination and mix-ups.
Do not store products directly on the floor
◦ Exceptions like some medicinal gas cylinders
Withdraw products nearing or are beyond expiry date from saleable
stock
Have segregation either physically or through electronic means
Perform regular stock inventories
◦ Consider national legislation
Stock irregularities should be investigated and documented.
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92. Identify products for destruction
Store separately and
Have a written procedure
Handle as per procedure
Follow national or international requirements for
◦ Handling,
◦ Transport and
◦ Disposal of such products
Maintain records of all destroyed products
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93. Have controls in place to pick correct
product
Product should have an appropriate
remaining shelf life when it is picked.
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94. Have a delivery note for each supply
Details in Delivery Note
◦ date;
◦ name and
◦ pharmaceutical form of the medicinal product,
◦ batch number at least for products bearing the safety features;
◦ quantity supplied;
◦ name and address of the supplier,
◦ name and delivery address of the custome and
◦ applicable transport and storage conditions.
Records should be kept so that the actual location of the product can be
known.
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95. The export of medicinal products falls within the
definition of ‘wholesale distribution’
A person exporting medicinal products must hold a
wholesale distribution authorisation or a
manufacturing authorisation.
This is also the case if the exporting wholesale
distributor is operating from a free zone.
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96. All rules for wholesale distribution apply
However, products do not need a MA of EU
Take measures to prevent these products reaching the EU
Supply products to persons who are authorised to receive
medicinal products for wholesale distribution or
Supply to the public in accordance with the applicable legal
and administrative provisions of the country concerned.
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97. Handle as per written procedures
Make records available to the competent
authorities.
Assess returned products before approval for
resale.
Consistent approach by all partners in supply chain
to fight against falsified medicinal products
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98. Record complaints with all the original details.
Distinguish between Quality & Distribution related complaints
Inform the manufacturer and/or marketing authorisation holder
about Quality Related Complaints
Investigate distribution related complaint to identify the origin of or
reason for the complaint
Appoint a person to handle complaints
Allocate sufficient support personnel
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99. Implement follow-up actions
Implement CAPA
Notify the national competent
authorities
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100. Handle returned products according to a written procedure. Process
should be based on
◦ Risk Assessment
◦ Product concerned
◦ Any specific storage requirements
◦ The time elapsed since the medicinal product was originally
dispatched.
Follow National Law
Follow contractual arrangements between the parties
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101. Products should only be returned to saleable stock if
all of the following are confirmed:
◦ Products are in their unopened and undamaged
secondary packaging
◦ Are in good condition
◦ Have not expired
◦ Have not been recalled
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102. Products should only be returned to saleable stock if
all of the following are confirmed:
◦ Products returned from a customer not holding a
distribution authorisation or from pharmacies should
always be returned to saleable stock if they are
returned within an acceptable time limit, for example
10 days.
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103. Products should only be returned to saleable stock
if all of the following are confirmed:
◦ It has been demonstrated by the customer that the
medicinal products have been transported, stored and
handled in compliance with their specific storage
requirements;
◦ They have been examined and assessed by a sufficiently
trained and competent person authorised to do so;
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104. Products should only be returned to saleable stock if all of the
following are confirmed:
◦ The distributor has reasonable evidence that the product
was supplied to that customer (via copies of the original
delivery note or by referencing invoice numbers, etc.) and
the batch number for products bearing the safety features
is known, and that there is no reason to believe that the
product has been falsified.
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105. For products requiring specific
temperature storage conditions returns to
saleable stock can only be made if there is
documented evidence that the product has
been stored under the authorised storage
conditions throughout the entire time.
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106. For storage condition deviations perform a risk assessment.
The evidence should cover:
◦ Delivery to customer;
◦ Examination of the product;
◦ Opening of the transport packaging;
◦ Return of the product to the packaging;
◦ Collection and return to the distributor;
◦ Return to the distribution site refrigerator.
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107. Products returned to saleable stock
follow ‘first expired first out’ (FEFO)
Stolen products that have been
recovered cannot be returned to
saleable stock and sold to customers.
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108. Inform the competent authority and the marketing authorisation
holder of any suspision
Have a written procedure in place to this effect
Record with all the original details
Conduct an investigation
Physically segregate falsified medicinal products
Store in a dedicated area away from all other medicinal products.
All relevant activities in relation to such products should be
documented and records retained.
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109. Evaluate the effectiveness of recall process at least
annually
Process should be capable of prompt
implementation
Follow the instructions of a recall message
Some recall instructions may require approval by
competent authorities
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110. Record the operation at the time it is carried out
Make records available to the competent authorities.
Make distribution records accessible for recall
Records should contain sufficient information
◦ Distributors and
◦ directly supplied customers (with addresses, phone and/or
fax numbers inside and outside working hours
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111. Records should contain sufficient information
◦ Batch numbers at least for Medicinal products
bearing safety features
◦ Exported products
◦ Medicinal product samples
The progress of the recall process should be
recorded for a final report
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112. Outsourced activity should be
◦ Correctly defined,
◦ Agreed and
◦ Controlled in order to prevent product integrity issues
Written Contract between the Contract Giver and the
Contract Acceptor
Clearly establish the duties of each party
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113. The Contract Giver is responsible for
◦ Activities contracted out.
◦ Assessing the competence of the Contract Acceptor
◦ Ensuring by means of the contract and through audits that the principles and
guidelines of GDP are followed.
Preform and audit of the Contract Acceptor
◦ Before awarding an contract
◦ When there are changes to activities
Audit frequency should be based on risk depending on the nature of the
outsourced activities
Audits should be permitted at any time
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114. The Contract Giver should provide the Contract
Acceptor with all the information necessary to carry out
the contracted operations in accordance with the
specific product requirements and any other relevant
requirements.
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115. Contract Acceptor should have
◦ Adequate premises
◦ Equipment
◦ Procedures
◦ Knowledge
◦ Experience
◦ Competent personnel
to carry out the work ordered by the Contract Giver.
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116. Do not pass contracted work to a third party without the prior
evaluation and approval by the Contract Giver
For such arrangements wholesale distribution information
should be available
Refrain from any activity which may adversely affect the
quality of the products
Forward information that can influence the quality of the
products to the Contract Giver
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117. Conduct self-inspections to
Monitor implementation of GDP
Compliance with GDP principles and
Propose necessary corrective measures
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118. Cover following in self Inspections
◦ All aspects of GDP
◦ Compliance with the regulations, guidelines and procedures
within a defined time frame.
Self- inspections may be divided into several
individual self- inspections of limited scope.
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119. Self-inspections should be
◦ Impartial
◦ Detailed
◦ Conducted by designated competent company personnel.
Independent external audits are useful
◦ This may not be used as a substitute for self-inspection.
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120. Record all self-inspections
Reports should contain all the observations .
Provide a copy to the management and other relevant
persons.
Determine the cause of deficiencies
Implement corrective and preventive actions (CAPA)
Document the actions and follow it up
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121. Responsibility of the supplying wholesale
distributor
◦ To protect medicinal products against breakage,
adulteration and theft;
◦ To ensure that temperature conditions are maintained
within acceptable limits during transport.
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122. Demonstrate that the medicines have not been
exposed to conditions that may compromise their
quality and integrity.
Adopt a risk-based approach when planning
transportation.
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123. Maintain required storage conditions during
transportation.
Report any deviation or damage during transportation,
Report this to the distributor and recipient of the affected
medicinal products.
Have a procedure for investigating and handling temperature
excursions.
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124. Ensure that vehicles and equipment used
Are suitable for their use to
◦ Distribute,
◦ Store
◦ Handle medicinal products
Are equipped to prevent exposure of the products to
conditions that could affect their quality and packaging
integrity.
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125. Have written procedures for
◦ The operation and maintenance of all vehicles
◦ Equipment involved in the distribution process
◦ Cleaning and safety precautions
Use risk assessment of delivery routes to determine
where temperature controls are required.
Calibrate and maintain equipment used for temperature
monitoring at least once a year.
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126. Use dedicated vehicles and equipment for handling medicinal
products.
Have procedures to ensure that the quality will not be
compromised when non- dedicated vehicles and equipment
are used.
Make deliveries to the address stated on the delivery note
only.
Medicinal products should not be left on alternative premises.
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127. For emergency deliveries
◦ Have designated persons
◦ Have written procedures
For third party transportation have a contract meeting
requirements specified under “ Out sourced activities”.
Make transporter aware of the relevant transport
conditions.
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128. Pay attention to temperature monitoring,
cleanliness and the security of any intermediate
storage facilities in case of unloading ,
reloading and transit storage.
Minimise the duration of temporary storage
while awaiting the next stage of the
transportation route.
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129. Transport products in containers that have
◦ No adverse effect on the quality of the products.
◦ That offer adequate protection from external
influences, including contamination.
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130. Base selection on
◦ The storage and transportation requirements;
◦ The space required for the amount of medicines;
◦ The anticipated external temperature extremes;
◦ The estimated maximum time for transportation
including transit storage at customs;
◦ The qualification status of the packaging and the validation
status of the shipping containers.
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131. Container labels should provide sufficient
information on
◦ Handling and storage requirements and
◦ Precautions to ensure that the products are properly
handled and secured at all times.
The containers should enable identification of
the contents of the containers and the source.
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132. Maintain a safe and secure supply chain for
◦ Narcotics or psychotropic substances
◦ Follow National requirements
Have additional controls in place for delivery of
these products.
Have a protocol to address the occurrence of
any theft.
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133. Transport highly active and radioactive
materials in safe, dedicated and secure
containers and vehicles.
The relevant safety measures should be in
accordance with international agreements
and national legislation.
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134. Use qualified equipment for temperature-
sensitive products to ensure correct
transport conditions.
◦ Thermal packaging,
◦ Temperature-controlled containers or
◦ Temperature controlled vehicles
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135. Calibrate and maintain the temperature monitoring
equipment
Perform temperature mapping under representative
conditions
Consider seasonal variations
Provide information to demonstrate that products have
complied with the temperature storage conditions to
customers
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136. Cool packs in insulated boxes should not
come in direct contact with product
Train staff for
◦ Assembly of the insulated boxes (seasonal
configurations)
◦ Reuse of cool packs.
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137. Have a system to control the reuse of cool packs
Ensure that incompletely cooled packs are not used in
error
There should be adequate physical segregation between
frozen and chilled ice packs
Have written procedure for delivery of sensitive
products and control of seasonal temperature
variations.
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138. A ‘broker’ is a person involved in activities in
relation to the sale or purchase of medicinal
products, except for wholesale distribution,
that do not include physical handling and that
consist of negotiating independently and on
behalf of another legal or natural person.
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139. Brokers are subject to a registration requirement.
They must have a permanent address and contact
details in the Member State where they are
registered.
They must notify the competent authority of any
changes to those details without unnecessary
delay.
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140. By definition, brokers do not procure, supply or hold
medicines.
Therefore, requirements for premises, installations and
equipment as set out in Directive 2001/83/EC do not
apply.
However, all other rules in Directive 2001/83/EC that
apply to wholesale distributors also apply to brokers.
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141. Define the quality system of a broker
Document the Quality System, approve and
keep it up to date.
It should set out
◦ Responsibilities
◦ Processes and
◦ Risk management in relation to their activities
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142. Have an emergency plan for recalls
Inform competent authorities immediately
of any suspected falsified medicines offered
in the supply chain.
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143. Train personnel
◦ In the applicable EU Legislation
◦ National legislation
◦ In the issues concerning falsified medicinal
products
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144. The general provisions on documentation chapter apply.
In addition following procedures and reports should be
available
◦ Procedure for complaints handling;
◦ Procedure for informing competent authorities and marketing
authorisation holders of suspected falsified medicinal products;
◦ Procedure for supporting recalls;
◦ Procedure for ensuring that medicinal products brokered have a
marketing authorisation;
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145. In addition following procedures and reports should be
available
◦ Procedure for verifying
That their supplying wholesale distributors hold a distribution
authorisation,
Their supplying manufacturers or importers hold a manufacturing
authorisation and
Their customers are authorised to supply medicinal products in the
Member State concerned;
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146. Keep records either in the form of
◦ Purchase/sales invoices
◦ On computer
◦ In any other form
Records should contain the following information:
◦ Date; name of the medicinal product;
◦ Quantity brokered; name
◦ Address of the supplier and the customer;
◦ Batch number at least for products bearing the safety features.
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147. Make records available
To the competent authorities
For inspection purposes
For the period stated in national legislation but at least 5
years.
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148. This presentation is prepared by “ Drug Regulations” a
non profit organization which provides free online
resource to the Pharmaceutical Professional.
Visit http://www.drugregulations.org for latest
information from the world of Pharmaceuticals.
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