The document summarizes information about drug storage and stability at United Hospital Ltd's pharmacy department. It discusses proper storage conditions and categories for drugs. Factors like temperature, humidity, light exposure etc. can affect drug stability over time. Expiry dates indicate the last date a drug should be used by. The document provides guidance on first-in-first-out practices and maintaining appropriate inventory controls for drug stock.

1. UNITED HOSPITAL LTD.
DEPARTMENT OF PHARMACY
 DRUG
STORAGE & ITS STABILITY
GENERAL IDEA ABOUT MEDICATION
Presented By
Presented By
Mohammad Alauddin,
B.Pharm (ADUST)
Pharmacist- United Hospital Ltd

2. INTRODUCTION
Hospital pharmacy may be defined as department of
hospital wherein procurement, storage, compounding,
packaging, dispensing, distribution & monitoring of
medication are performed by graduate Pharmacist.

3. INTRODUCTION

4. INTRODUCTION
Function of Pharmacy:
 To ensure the availability of the right medication,
at the right time, in the right dose, at the minimum
possible cost to the patients.
 To provide information concerning medications to
physicians and nurses.
 To serve as a counseling department
 To dispense all narcotic drugs and its monitoring
 Inventory control
 So on

5. DRUG STORAGE
Proper storage of medication is always an important
consideration during periods of extreme heat or cold.
Drugs can undergo physical, chemical & microbial
changes on storage.
Recommended storage conditions:
 Store below -50C (freeze)
 Store between (2 to 8)0C (refrigerate, do not freeze)
 Store below 250C (air conditioning)
 Store below 300C (room temperature)

6. DRUG STORAGE
Drug Storage Room Standards:
 A lockable room
 Adequate lighting
 A temperature of below 250C, with air conditioning units that
operate 24 hrs per day & are connected to an emergency
power supply.
 A vaccine refrigerator for storage of vaccines & anti-venom.
 A nominated refrigerator for cold storage of pharmaceutical
products that requires refrigeration.
 Adequate shelving for appropriate storage of the different
categories of drugs.

7. DRUG STORAGE
All drugs are grouped in the following categories:
 Refrigerated ( Heat sensitive products)
 Oral ( solid & liquid )
 Injectable
 Topical
 Infusion
 Inhalation
 Non Drug

8. DRUG STORAGE

9. DRUG STORAGE

10. DRUG STORAGE

11. DRUG STORAGE

12. DRUG STORAGE

13. DRUG STORAGE

14. DRUG STORAGE

15. DRUG STORAGE
In the Central pharmacy or Pharmacy main store, all
drugs are displayed or kept in different ways regarding
the most easiest way to dispense.
Like Alphabetically
 Therapeutic
class wise
 Brand wise and so on.

16. DRUG STORAGE

17. DRUG STORAGE
Drug storage Room Stock Control
Stock Inventory
1. Annual inventory
2. Bi- annual inventory
3. Monthly inventory
4. Weekly inventory
5. Real time inventory

18. DRUG STORAGE
To uphold quality standards in drug storage
room:
Rotate stock so that the stock closest to expiry
date is kept in front.
Maintain FEFO / FIFO / LIFO procedure.
Make sure that there is no expired drugs on
the shelves.

19. DRUG STORAGE
First-expiry/first-out
procedure(FEFO)
First-in/first-out procedure (FIFO)
Last-in/first-out procedure (LIFO)

20. DRUG STABILITY
Drug stability means the ability of the pharmaceutical
dosage form to maintain the physical, chemical,
therapeutic & microbial properties during the time of
storage & usage by the patient.
Expiry Dates
Expiry date means that drug can not be used after this
date due to the chance of chemical degradation, harmful
to patient or low potency.

21. DRUG STABILITY
 If the expiry date is expressed as month/year only
(e.g., 3/2013), this shall be interpreted to mean that
the drug may be safely used through the last day of
that month, i.e., 3/31/2013.
 If the expiration date is expressed as
month/day/year (e.g., 15/3/2013), this shall be
interpreted to mean that the drug may be safely used
through that day only.

22. DRUG STABILITY
Chemical stability of the active ingredient
As the rate of decomposition usually
doubles for every 100C rise in temperature, it
is important to comply with the storage conditions
specified on the container.

23. DRUG STABILITY
Once opened, the shelf-life of some products, e.g. eye
drops, will be determined not by decomposition of
the active drug but by the risk of microbial
contamination.
Stability after opening drug container
The stability of products is variable. A product which is
stable in its container may become unstable once the
container is opened.

24. DRUG STABILITY
The expiry date will be shorter in case of Eye drops: can be used for one month after
opening the droppers.
 Antibiotic syrups & suspensions: generally can be
used for one week by storage in room temperature
& for two weeks by storage in refrigerator.

25. DRUG STABILITY
 Ampoules: must be used immediately but the vials (multi-
dose) are stable for 24 h in the presence of preservatives.
 Nebulizer solution: can be used for one month after
opening.
 Insulin: once punctured, it must be used within 28 days.
 Syrup/Suspension (except antibiotics): can be used for
one month after opening.
 Tablets & capsules: remain stable in the package but
after removal expiry date will be changed.

26. DRUG STABILITY

27. DRUG STABILITY
Factors affecting drug stability:
 Temperature: high temperature accelerate oxidation,
reduction & hydrolysis reaction which leads to drug
degradation.
 PH: acidic & alkaline pH influence the rate of
decomposition of most drugs. Many drugs are stable
between pH 4 - 8.
 Moisture: water catalyses chemical reactions as
oxidation, hydrolysis & reduction reaction. Water
promotes microbial growth.
 Light: affects drug stability through its energy or thermal
effect which leads to oxidation.

28. DRUG STABILITY
 Oxygen: exposure of drug formulations to oxygen
affects their stability.
 Drug incompatibility: reactions between components
of pharmaceutical dosage forms itself or between
these components & cover of the container.

29. DRUG STABILITY

30. DRUG STABILITY
Degradation processes mainly include:
 Hydrolysis
 Oxidation
 Photodegradation
This is because of the chemistry of the functional
groups in drug molecules and the presence of water
and oxygen. Even when factors such as water, oxygen
and light have been controlled, degradation will still
occur, but at a reduced rate.

31. DRUG STABILITY
Hydrolysis
The rate of hydrolysis is affected by access to water
and is prevented or lowered by reducing exposure to
water. If a drug must be formulated in water, the
solution is often buffered to a pH where the rate of
hydrolysis is minimal. Substances which are
particularly susceptible to hydrolysis are often
packed in individual dose units.

32. DRUG STABILITY
Oxidation
Many drugs will react with atmospheric oxygen, so
oxidation is a prime cause of degradation.
Control of the pH and protection from light may
reduce the rate of oxidation of injectable solutions.
The oxidation of some tablets, e.g. chlorpromazine,
is reduced by individual blister packaging.

33. DRUG STABILITY
Photodegradation
When light is absorbed by a molecule, it is either reemitted or transformed into physical or chemical
energy. Physical energy is usually lost as heat.
Protection from light is achieved by packaging the
products in amber glass bottles or by using coloured
film for blister packed products.

34. Drug-food interaction
What is a drug-food interaction?
The interaction of medications and food is very complex
and needs to be individualized for each patient and each
medication. However, there are some generalizations
that can be made.
A drug-food interaction happens when the food you eat
affects the ingredients in a medicine you are taking so the
medicine cannot work the way it should.

35. Drug-food interaction

36. Drug-food interaction
Are all medicines affected by food?
Not all medicines are affected by food, but many medicines can
be affected by what you eat and when you eat it.
The food may delay or decrease the absorption of the drug. This
is why some medicines (like azithromycin) should be taken on
an empty stomach (1 hour before eating or 2 hours after
eating).
On the other hand, some medicines are easier to tolerate when
taken with food. Aspirin & Clopidogrel are irritating to the GI
tract, so they should be taken after food.

37. Timing of Drugs - Before or After Food
Taking Drugs Before Food
For quick action/fast absorption
For acid sensitive drugs
Some drugs need to be absorbed quickly to have an
effect, such as nitrates in angina, drugs to help sleep
(hypnotics), drugs to reduce agitation (sedatives) &
drugs to reduce vomiting . As food can slow the
absorption of these drugs, they need to be taken on
an empty stomach.

38. Timing of Drugs - Before or After Food
The acid in the stomach breaks down some drugs, so
delayed emptying will mean that more of the drug is
broken down, and less of the drug is available, so it will
be less effective.
Some Medications which should be taken on an EMPTY
stomach:
Alendronate, Bisacodyl, Captopril, Sucralfate,
Azithromycin, Co-trimoxazole, Omeprazole,
Lansoprazole, Levothyroxine, loratadine, Rifampin,
Methotrexate Mycophenolate, Tetracycline ……….etc.

39. Timing of Drugs - Before or After Food
Taking Drugs With or After Food
For drugs causing stomach upset
For less soluble drugs
The acid in the stomach changes some drugs, making
them more soluble and so more easily absorbed. This
means that the drug will be more effective.

40. Timing of Drugs - Before or After Food
NSAIDs can cause stomach upsets by increasing
gastric secretion. Taking these drugs with food can
reduce the irritation to the stomach lining.

41. Timing of Drugs - Before or After Food
Some drugs have to be taken during or
after meals to be effective – for example,
Orlistat is designed to block the
absorption of some of the fat in food as a
treatment for obesity.

42. Timing of Drugs - Before or After Food
Some Medications which should beTaken with FOOD:
Allopurinol, Clopidogrel, Co-Amoxycillin, Aspirin,
Amiodarone, Diclofenac, Carbamazepine,
Chloroquine, Spironolactone, Griseofulvin,
Metronidazole, Valproic acid, Prednisone, Iron
preparations, Bromocriptin, Ticlopidine, fenofibrate,
mebendazole ………….etc.

43. TIPS TO AVOID DRUG-FOOD
INTERACTIONS

44. TIPS TO AVOID DRUG-FOOD
INTERACTIONS
Take medicine with a full glass of water.
Don't stir medicine into your food because
this may change the way the drug works.
Don't take vitamin pills at the same time you
take medicine because vitamins and minerals
can cause problems if taken with some drugs.
Don't mix medicine into hot drinks because
the heat may keep the drug from working.
Never take medicine with alcoholic drinks

45. NEVER TAKE MEDICINE WITH ALCOHOL

46. Over the Counter (OTC) medications
OTC medications are those medicines that do not require a
prescription from a physician and are readily available to the
public. This does not mean that they do not need to be taken
carefully.
The most commonly used OTC medicines are :
 Pain Relievers
 Antihistamines
 Decongestants
 Cough medicines

47. Over the Counter (OTC) medications
Pain Relievers
NSAIDS (non-steroidal anti-inflammatory drugs)
such as paracetamol, aspirin, ibuprofen,ketoprofen
etc.
NSAIDS work by blocking the synthesis
prostaglandins, which are involved in injury or
infection and thus reduce pain, fever and
inflammation.

48. Over the Counter (OTC) medications
NSAIDS can cause stomach upset and occasional
gastrointestinal bleeding.
Antihistamines
Histamines are chemicals in our bodies that produce
itching and allergy responses. Antihistamines block
these. Some common antihistamines are
diphenhydramine HCl , chlorpheniramine etc.

49. Over the Counter (OTC) medications
Antihistamines can cause drowsiness. Be careful
driving or doing any dangerous work. But, the Nonsedating antihistamines do not cause drowsiness and
are now OTC. Some common antihistamines are
loratadine, desloratadine, cetrizine & fexofenadine.
Decongestants
These medicines work by shrinking/constricting
blood vessels in the nose and decrease congestion.
The only over the counter decongestant is
pseudoephedrine.

50. Over the Counter (OTC) medications
Cough Medicines
Cough medicines are two types: antitussives (anti cough)
and expectorants (mucous reducer)
Dextromethorphan is the antitussive in most cough
medicines.
Guaifensin is the expectorant that is mostly used.
Cough Medicines can cause agitation and confusion for
some users.

51. Medication Safety Tips to avoid serious
medication errors
 Never take medication intended for someone else
 Never keep medications that are expired
 Never combine multiple medications in the same bottle
 Never take medication that is not clearly marked
 Don't expect immediate results
 Don't stop taking your medication just because you feel
better especially, antibiotics.
 Keep all medication away from children
 To know clearly about existing drug-drug interactions.

52. Medication Safety Tips to avoid serious
medication errors

53. Patient Safety Solutions

54. Patient Safety Solutions
Some proprietary (brand name) and non-proprietary
names (generic name) sound or appear to be similar to
other drugs when written or spoken. The existence of
confusing drug names is the most common causes of
medication errors & is of concern worldwide. There are
many look and sound alike drugs that would result in
medication error.
These errors may cause harm or even death to patients.

55. Patient Safety Solutions
Brand (Generic)
Brand (Generic)
Abetis(Olmesartan)
Abmis(Nutritional)
Agotin(Agomelatin)
Agoxin(Digoxin)
Alagra(Fixofenadine)
Silagra(Sildenafil)
Angicard(Glyceryl trinitrate)
Angilat(Metoprolol)
Apresin(Fluphenazine+Nortriptylin)
Aprocin(Ciprocin)
Arbit(Ibesartan)
Barbit(Phenobarbitone)
Asmanyl(Theophylline)
Asmavit(Nutritional)
Zelmac(Tegaserod)
Zepac(Ketorolac)
Betaloc(Metoprolol)
Betanol(Atenolol)
Codopa(Levodopa+Carbidopa)
Cardopa(Dopamine)

56. Patient Safety Solutions
Brand (Generic)
Brand (Generic)
Daomin(Metformin)
Daonil(Glibenclamide)
Deslor(Desloratadine)
Desolone(Desogestrel+Ethinylestradiol)
Flexifen(Baclofen)
Flexicam(Piroxicam)
Imigra(Flunarizine)
Edegra(Sildenafil)
Larcadip(Larcanidipine)
Largactil(Chlorpromazine)
Monocast(Montelukast)
Monocard(Isosorbide)
Norbit(Disopyramide)
Barbit(Phenobarbitone)
Perkinil(Procyclidine)
Perkirol(Ropinirol)
Ramace(Ramipril)
Ramex(Chloramphenicol)

57. Patient Safety Solutions
HOW TO PREVENT THESE MEDICATION ERRORS ?
Manufacturers
Choose unique drug names, easily to write and
pronounce
to ensure that there is no drug with similar name in the
market.

58. Patient Safety Solutions
Physicians
Clearly write the prescriptions with specific dosage
form & strength
Avoid using short forms or abbreviation of drug names
Avoid verbal prescriptions to a maximum extent

59. Patient Safety Solutions
Pharmacists/Nurses
Keeping LASA drugs separated from one another
Double checking the drug
Contacting the physician in case of any clarification
regarding the prescription
Becoming familiar with LASA drugs
Emphasize LASA drug name differences on computer
screen by using methods such as --------

60. Patient Safety Solutions
“Tall Man “ lettering
The practice of writing part of a drug’s name in upper
case letters to help distinguish sound-alike, look-alike
drugs from one another in order to avoid medication
errors.

61. “Tall Man “ lettering
U.S. Food and Drug Administration (FDA) encourages
manufacturers to use Tall Man lettering labels to visually
differentiate their drugs' names, and a number of hospitals,
clinics, and health care systems use Tall Man lettering.
Examples…
 BetaLOC vs. BetaNOL
 COdopa vs. CARdopa
 IMIgra vs. EDEgra
 SedNO vs. sedRON
 DOBUTamine vs. DOPamine
 hydrALAZINE vs. hydrOXYzine
 vinBLAStine vs. vinCRIStine

62. NATURE
THE BIG SOURCE OF…

65. Think the source of !!!

67. ULTIMATELY…

68. OPEN DISCUSSION

69. THE END…
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