Pharmacy practice

Outline
• Introduction
• Definition of community pharmacy
• scope of community pharmacy
• community pharmacy Areas
• Types of prescription
• Parts of prescription
• Steps of prescription processing
• Legality of prescription
• Completeness of prescription
• Interpreting and verifying the prescription order
• Checking for drug interaction
• Checking for drug contraindication
• Checking for pharmaceutical incompatibilities
 Introduction
 Pharmacy practice is the discipline of pharmacy which involves
developing the professional roles of pharmacists pertinent to different
pharmacy practice settings.
 Pharmacy practice course deals with the practical principles of the
pharmacy profession in various pharmacy practice settings.
 Introduction..
 Pharmacy service is an essential component of health care
 It contributes to improved treatment outcomes through
ensuring availability and rational use of quality, safe and
effective medicines.
 Provision of effective pharmacy service is also crucial for
early recognition & prevention of medication errors
 It also promotes optimal use of meager resources thereby
improving quality of care resulting in better health outcomes.
 pharmacy services should provide assurance that quality and
safety is maintained at all stages of service provision
 Pharmacy practice areas
 Pharmacy practice encompasses various specialized
areas where pharmacists provide healthcare services,
education, and expertise
 list of pharmacy practice areas includes:
1. Community Pharmacy: Providing direct patient care, dispensing
medications, and offering health services in retail settings.
2. Hospital Pharmacy: Managing medication distribution within
hospital settings, including compounding, sterile preparations, and
clinical services such as pharmacokinetic dosing and drug therapy
monitoring.
3. Clinical Pharmacy: Providing direct patient care in collaboration
with healthcare teams, focusing on optimizing medication therapy
and patient outcomes.
Pharmacy practice areas cont.…
4. Ambulatory Care Pharmacy:
 Providing pharmaceutical care in outpatient settings, including
clinics, physician offices, and specialty clinics, with a focus on
chronic disease management and preventive care.
5. Geriatric Pharmacy:
 Specializing in medication management for elderly patients,
including addressing polypharmacy, medication adherence, and
geriatric-specific conditions.
6. Pediatric Pharmacy:
 Providing specialized pharmaceutical care to pediatric patients,
including dosing adjustments, compounding, and addressing
pediatric-specific conditions.
7. Nuclear Pharmacy:
 Compounding and dispensing radioactive medications for
diagnostic and therapeutic purposes, often used in nuclear
medicine procedures.
Pharmacy practice areas cont.…
8. Industrial Pharmacy:
 Involves drug development, manufacturing, quality control, and
regulatory affairs within pharmaceutical industries.
9. Clinical Research and Drug Development:
 Conducting clinical trials, drug research, and development activities
10. Academic Pharmacy:
 Involves teaching, research, and scholarly activities within academic
institutions, preparing future pharmacists
11. Managed Care Pharmacy:
 Involves medication management within managed care organizations,
including formulary management, medication therapy management, and
cost-effective prescribing practices.
12. Public Health Pharmacy:
 Addressing population health issues through medication distribution,
immunizations, health education, and disease prevention initiatives.
Pharmacy practice areas cont.…
13. Regulatory Pharmacy:
 compliance with pharmacy regulations, drug laws, and
oversight of pharmaceutical practices to ensure patient
safety and adherence to standards.
14. Specialty Pharmacy:
 Focuses on providing medications and services for patients
with complex, chronic, or rare diseases, often involving
specialty medications with unique handling and
administration requirements.
15. Telepharmacy:
 Providing pharmacy services remotely through technology
16. Veterinary Pharmacy:
 Providing pharmaceutical care to animals, including
medication compounding, dosing, and therapeutic
monitoring.
Community pharmacy
definition of community pharmacy
 Refers to the branch of pharmacy that is primarily
responsible for providing pharmaceutical services to
the general public in a community setting.
 It is where pharmacists dispense prescription
medications, offer counseling on the proper use of
medications, provide over-the-counter products, and
offer various healthcare services to promote
wellness and disease prevention.
 Hybrid of professionalism and business
organizational structure of a community
pharmacy
1. Ownership and Management:
 Owner:
 The owner of the pharmacy may be an individual pharmacist, a
group of pharmacists, a corporation, or a healthcare organization.
 Pharmacy Manager:
 Responsible for overseeing daily operations, managing staff,
ensuring regulatory compliance, and implementing policies and
procedures
2. Pharmacy Staff:
 Pharmacists: responsible for dispensing medications,
providing medication counseling, conducting patient
consultations, and ensuring the safe and effective use of
medications.
 Pharmacy Technicians: responsible for assisting
pharmacists with medication dispensing, inventory
management, administrative tasks, and customer service.
3. Pharmacy Departments:
 Dispensing Area: Where prescription medications are
dispensed to patients. This area typically includes prescription
counters, computer terminals, and storage for medications.
 Compounding Area: If the pharmacy offers compounding
services, there will be a designated area for preparing
customized medications according to specific patient needs.
 Counseling Area: A private space where pharmacists provide
medication counseling, patient consultations, and other
healthcare services in a confidential setting.
4. Facilities and Equipment:
 Pharmacy Premises:
 The physical space where the pharmacy operates,
including the sales area, dispensing area,
compounding area, counseling area, and
administrative office.
 Pharmacy Equipment:
 Essential equipment and technology used in pharmacy
operations, such as prescription counters, computer
systems, medication storage units, compounding
equipment, and counseling booths.
 Safety and Security Measures:
 Implementing safety protocols, security systems, and
emergency procedures to protect staff, patients, and
pharmaceutical inventory.
Scope of community pharmacy
 Dispensing Prescription Medications:
 primary functions of a community pharmacy is to dispense
prescription medications.
 Pharmacists ensure the accuracy of prescriptions, provide
counseling on proper medication use, and offer guidance on
potential side effects or interactions.
 Medication Counseling:
 Pharmacists provide personalized medication
counseling to patients, addressing questions or
concerns about their prescriptions.
 This may include information on dosage,
administration instructions, storage requirements,
and potential side effects.
Scope of community pharmacy cont.…
 Over-the-Counter (OTC) Medication Recommendations:
 advice on the selection and use of over-the-counter
medications for common ailments such as allergies, colds,
pain relief, and digestive issues.
 Medication Therapy Management (MTM):
 Pharmacists provide medication therapy management
services to optimize medication regimens, improve
adherence, and prevent medication-related problems. This
may involve medication reviews, identifying drug
interactions, and recommending adjustments to treatment
plans.
 Immunizations:
 community pharmacies offer immunization services,
including vaccinations for influenza, pneumonia, shingles,
and other preventable diseases.
Scope of community pharmacy cont.…
 Compounding Services:
 community pharmacies offer compounding services, where
pharmacists prepare customized medications tailored to the
specific needs of patients. This may include adjusting dosage
forms, flavors, or removing allergens from medications.
 Health Screenings:
 Some community pharmacies provide health screening services
to assess risk factors for various health conditions. This may
include screenings for blood pressure, cholesterol, blood glucose,
and body mass index (BMI).
 Health Education and Promotion:
 Community pharmacies may organize health education events,
workshops, or seminars on topics such as medication safety,
healthy living, and disease prevention. These initiatives aim to
empower patients to make informed decisions about their health.
Scope of community pharmacy cont.…
 Compounding Services:
 Some community pharmacies offer compounding services,
where pharmacists prepare customized medications tailored to
the specific needs of patients. This may include adjusting
dosage forms, flavors, or removing allergens from medications.
 Healthcare Advocacy:
 Pharmacists in community settings advocate for patients'
health and safety by promoting medication safety initiatives,
raising awareness about public health issues, and advocating
for policy changes that improve access to healthcare services.
 Smoking Cessation Support:
 Pharmacists offer counseling and support to individuals looking
to quit smoking. They provide information on smoking cessation
aids such as nicotine replacement therapy (NRT)
 community pharmacy Areas
1. Dispensing Area:
• This area should be large enough to accommodate pharmacy
staff, prescription filling equipment, and storage for prescription
medications.
• Prescription counter for receiving, processing, and dispensing
medications.
• Computer terminals for entering prescription information,
verifying insurance coverage, and printing labels.
• Prescription filing system for organizing and retrieving filled
prescriptions.
• Workflow management tools to track prescription status and
ensure timely dispensing
Consultation Area:
• is a private space within the pharmacy premises where pharmacists conduct
patient consultations, medication therapy management (MTM) sessions, and
medication counseling.
• The counseling area should provide a private and comfortable space for
pharmacists to conduct patient consultations, medication counseling
sessions, and other healthcare services.
• Comfortable seating for patients and caregivers.
• It may include seating arrangements, privacy screens, and counseling booths
to ensure confidentiality and comfort for patients during consultations..
Compounding Area:
 should be designed to meet the specific requirements for

compounding medications, including space for compounding

equipment, work surfaces, and storage of compounding

ingredients.

 This area is equipped with specialized equipment,

compounding tools, and safety measures to ensure accurate

and sterile preparation of compounded medications.

Waiting Area:
 Some community pharmacies feature a waiting area where
customers can wait comfortably while prescriptions are being
filled or while receiving pharmacy services.
 The waiting area may include seating, reading materials, and
informational displays to enhance the customer experience
while waiting.
Medication Storage Room

• for storing prescription medications, OTC products,

medical supplies, and pharmaceutical inventory.

• Refrigeration units for temperature-sensitive

medications.

• Inventory management system for tracking stock

levels, expiration dates, and ordering replenishments.

Health Services Area (Optional):
• Space for providing additional healthcare
services, such as immunizations, health
screenings, medication therapy management,
and compounding.
• Equipment and supplies needed for
administering vaccines, conducting tests, and
performing clinical assessments.
• Collaboration with healthcare providers or
community organizations to offer integrated
care services.
Prescription: Definition
 A prescription is a written or electronic request from a
licensed healthcare provider to authorize the
dispensing of a specific medication or treatment for a
patient.
 It serves as a legal document
 Prescriptions designate a specific medication and
dosage to be prepared by a
pharmacist/druggist/pharmacy technician and
administered to a particular patient.
 Prescriptions are usually written on preprinted forms
containing the traditional symbol “ Rx” (meaning
“recipe,” take thou,” or “you take”), name, address,
telephone number, other pertinent information
regarding the physician or other prescriber.
 Types of Prescription
 Written Prescription: This is the traditional form of prescription, where
the healthcare provider writes the prescription on a paper prescription pad
 Electronic Prescription (e-prescription):
 E-prescribing enhances prescription accuracy, improves medication
safety, and streamlines the prescription fulfillment process.
 Verbal Prescription:
 at emergency situations or when electronic or written prescriptions are
not feasible,
 However, verbal prescriptions are generally discouraged due to the risk of
miscommunication or errors.
 They should only be used when absolutely necessary and should be
followed up with a written or electronic prescription as soon as possible.
 Fax Prescription:
 Fax prescriptions involve the transmission of prescription orders via
facsimile from the prescriber's office to the pharmacy.,
 fax prescriptions may still be used, particularly when electronic
prescribing is unavailable or impractical.
 Refill Prescription:
 Refill prescriptions are renewals of existing prescriptions that allow
patients to obtain additional supplies of their medications without the
need for a new prescription order from the prescriber .
Prescription paper
 Prescription paper is specialized paper used for
printing prescription orders.
Types of prescription paper
 Standard Prescription Paper: This type of
prescription paper is the most basic and commonly
used.
 Standard prescription paper meets the minimum
requirements for prescription printing but may not have
advanced security features.
 Controlled Substance Prescription Paper: In
many jurisdictions, prescriptions for controlled
substances (such as opioids, stimulants, and certain
sedatives) must be printed on specialized prescription
paper with enhanced security features.
Drug categories/Types of prescription
1. Prescription drugs
2. Controlled Substances
3. Non-prescription/OTC/ drugs
Prescription Drugs
 Prescription drugs are drugs that the federal government has
designated to be potentially harmful unless their use is
supervised by a licensed health care provider, such as a nurse
practitioner, physician, or dentist.
 Although these drugs have been tested for safety and
therapeutic effect, prescription drugs may cause different
reactions in some individuals.
Examples;
 Antibiotics
 CV-drugs
Controlled Substances
 Controlled substances are the most carefully monitored of all
drugs.
 These drugs have a high potential for abuse and may cause
physical or psychological dependence.
 Physical dependency is a compulsive need to use a substance
repeatedly to avoid mild to severe withdrawal symptoms; it is
the body’s dependence on repeated administration of a drug.
 Psychological dependency is a compulsion to use a
substance to obtain a pleasurable experience; it is the mind’s
dependence on the repeated administration of a drug.
 One type of dependency may lead to the other type.
classes of controlled substances
1. Schedule I:
 are considered to have a high potential for abuse and have
no accepted medical use in the United States.
 These substances are deemed unsafe for use
 Examples include heroin, LSD (lysergic acid diethylamide),
MDMA (3,4-methylenedioxymethamphetamine or
"ecstasy"), marijuana (cannabis), and peyote.
1. Schedule II:
 Schedule II substances also have a high potential for abuse
but have accepted medical uses with severe restrictions.
 Abuse of Schedule II substances may lead to severe
psychological or physical dependence.
 Examples include opioids such as morphine, oxycodone,
hydrocodone, methadone, and stimulants like cocaine,
amphetamine, and methamphetamine.
3. Schedule III:
 have a lower potential for abuse compared to Schedule I and II
drugs and have accepted medical uses.
 Abuse of Schedule III substances may lead to moderate to low
physical or high psychological dependence.
 Examples include certain opioids like codeine and hydrocodone
combinations, anabolic steroids,
4. Schedule IV:
 have a lower potential for abuse compared to Schedule III drugs
and have accepted medical uses.
 Schedule IV substances may lead to limited physical or
psychological dependence
 Examples include benzodiazepines , certain sedatives and hypnotics (e.g.,
zolpidem, eszopiclone)
5. Schedule V:
 have the lowest potential for abuse among controlled substances
and have accepted medical uses.
 may lead to limited physical or psychological dependence
 Examples include certain cough medicines containing codeine or
dihydrocodeine, antidiarrheal medications containing loperamide
Summary
Narcotics prescription paper
Psychotropic prescription paper
Non-prescription Drugs
 Nonprescription drugs are drugs that are designated by the NRA
to be safe (if taken as directed) and obtained without a prescription.
 These drugs are also referred to as over-the-counter (OTC) drugs
and may be purchased in a variety of settings, such as a pharmacy,
drugstore, or in the local supermarket. OTC drugs include those
given for symptoms of the common cold, headaches, constipation,
diarrhea, and upset stomach.
 These drugs are not without risk and may produce adverse
reactions.
 For example, acetylsalicylic acid, commonly known as aspirin, is
potentially harmful and can cause gastrointestinal bleeding and
salicylism.
Examples of OTC Drugs
 Antacids
 Antiemetic: Dimenhydrinate
 Cathartics and Laxatives: Bisacodyl,glycerine
 Medicines Used for Diarrhea: ORS
 Antitussives/Expectorants/Mucolytics
 Antiasthmatics: salbutamol
 Analgesics: ASA,Diclofenac,Ibubrofen,paracetamol
 Anthelmintics: mebendazole,albendazole,piperazine
 The parts of a Hard- copy of Prescription
A complete prescription includes the following:
 Name of the Health Facility
 Name and Address of Patient Information
 Types diagnosis
 Superscription
 contains the traditional symbol Rx meaning you take
 Inscription
 contains the list of ingredients and their quantities
 Subscription
 contains the necessary directions to be labeled on the container for use
by the patient.
 Prescriber and dispenser information
Sample prescription paper
Back of the prescription paper
Steps of prescription processing
 The dispensing of medicine involves interpretation of the
prescription instruction, technical knowledge required to carry
out the instructions & delivers with accuracy & safety to the
patient by an authorized & qualified pharmacy professional.
 There are a considerable variety of factors that require close
attention in dispensing, and proficiency requires the
establishment of a routine system which can be followed
safely even under stress.
 In fact, for OTCs, dispensers may be involved in selection of
medicines for their users.
Pre-dispensing Activities
1. Getting prepared for dispensing Check the following
 The room, shelves and dispensing counter are clean and
organized
 Wear a clean and white gown
 Attach your identification tag on the gown in such a way that it
is visible to clients
 Availability dispensing aid,(counting try, labeling materials,
packaging materials, sufficient no of spoons etc)
 Availability updated drug list, OTC list ,good dispensing
manual, STG, formulary ,prescription registration book.
Pre-dispensing Activities
2. Reception(Receiving a prescription)
 As clients come into the pharmacy section, they must be
made to feel attended to and comfortable by:
Friendly gestures
A smile
 Eye-to-eye contact
 A friendly welcome
Politeness
Feeling of caring
Prescription processing
(Dispensing Process)
Dispensing Procedures(stapes)-6
Step 1: Interpretation and evaluation of
prescription

1. Evaluation of prescription
2. Interpret prescription or verbal request
for OTC
Evaluation of a prescription
1. Legality
2. Legibility
3. Identifying of the patient’s condition
4. Completeness of the prescription
5. Correctness of the prescription
6. Therapeutic aspects
7. Appropriateness of the individual
Evaluation of prescription
Legality
A prescription is legal when:
 It is written (can also be typed) and signed by an authorized
prescriber
 NPS prescription( Narcotic and psychotropic prescription) for
Controlled drugs
 The medicines are written on the right prescription such as
normal, NPS and ART
 Date of issue not exceeding 15 days for narcotic drugs and
psychotropic substances and 30 days for other medicines.
 Has all the information required to be contained with respect to
parts of prescription.
Evaluation of prescription: Legibility
 A brief examination of each prescription should be made
immediately upon receiving it from the patient to ascertain the
legibility of various parts of the prescription.
 Any doubt regarding the reading of the prescription (i.e. name
of the medicines or directions, or if it appears that an error has
been made by the prescriber), should be examined closely
and, if necessary discussed/ consulted with other pharmacists
or the prescriber himself/herself without arousing doubts or
fears in the patient.
Evaluation of prescription: Legibility
a. Handwritten names of patients and medicines are
often difficult to read.
 In case of illegibility of name, age, etc, ask the patient for the
correct spelling tactfully.
 For example the pharmacy professional may ask “Excuse me.
Is the first name Gamachu or Gamachis?”
Evaluation of prescription: Legibility
 Every prescription should be read and understood thoroughly
before attempting to dispense it.
 Every word, abbreviation, has a meaning.
 To assume that an illegible or confusing word is unimportant
inviting a costly mistake. In case of doubt, consult another
pharmacy professional or the prescriber.
‘NEVER DISPENSE GUESS WORK’

 Legibility is a problem requiring alertness and critical judgment

on the part of the pharmacy professional. Careless handwriting
and similarity in spelling of names of different medicines add to
the difficulty.
Example
Evaluation of prescription: Legibility
b) The dosage form, the dosage and the quantity to be
dispensed have to be legible so that dispensing becomes
easier
 The instructions written for administration should state clearly
what the prescriber expects from the patient so that the
pharmacy professionals can counsel the patients efficiently.
 All terminology, including units of measures and Latin
abbreviations should be properly interpreted and checked.
Evaluation of prescription:
Completeness of the prescription
Details to be checked for completeness of the
prescription:
 Seal of the health institution or header
 Prescriber’s details
 Name of prescriber’s,
 Qualification,
 Signature and Date

 Patient's details
 Patient Name,
 Patient Address,
 Sex,
 Age,
 Weight and
 Diagnosis
Evaluation of prescription:
Completeness of the prescription
 Medicine details
 Name of the medicine
 Dosage form
 Strength/ potency of the medicine
 Total amount to be dispensed and its availability
 Dosage and directions for use
 Frequency of administration and duration of the treatment
Evaluation of prescription:
Completeness of the prescription
Name of the medicine:
 name of medicine must be legible and correct without a doubt.
 The prescriber should ideally write the generic name in
parentheses against the brand name or write the generic
name alone.
 This makes it easier if the pharmacy professional is not familiar with the
brand prescribed.
 It would also aid in avoiding brand confusion.

Example: The prescription could state – Diclofenac 50mg

rather Voltaren 50
Activity
Discuss amongst your colleagues the following situation:
 A client comes to the pharmacy in the late evening for a
prescription of ‘A’ brand of Vibromycin for severe pain and
inflammation. You do not have ‘A’ brand stock, there is no
other pharmacy close by, and the prescriber is not
contactable. What do you do?
Evaluation of prescription:
Completeness of the prescription
Dosage form:
 Some medicines are available in many different formulations.
 It is essential to check that the product on the prescription is
available in the correct formulation, and to correctly choose
the formulation.
 Confusion and mistakes can be made if the name of the
formulation is similar to another formulation.
 For example, tablet formulations of a medicine are available as
tablets of 25mg and 50mg, dispersible/effervescent tablets,
and 100mg sustained release tablets
Evaluation of prescription:
Completeness of the prescription
Evaluation of prescription:
Completeness of the prescription
Strength/potency of the medicine:
 The pharmacy professionals should check that the strength
is mentioned.
 There may be cases for prescribers to prescribe the
medicine without the strength.
For example:
Enalapril 5mg …………………….correct
way
Enalapril………….......................Incorrec
t way
 If no strength is mentioned, it cannot be assumed that the
lowest or highest strength has to be dispensed.
 This is because many times the lower strength may not be
sufficient to treat the condition or higher strength may lead
to toxicity.
Evaluation of prescription:
Completeness of the prescription
Example:
 combination of amoxycillin and clavulanate (Augmentin) is available as
1gm, 625mg, 412mg, 375mg, and so on. If a lower dose is given for an adult
it may not be sufficient to kill the microbial load and cure the infection.

 What to do? If the strength is not stated on the prescription, mostly

it may be necessary to contact the prescriber for confirmation of
the appropriate strength.
Evaluation of prescription:
Completeness of the prescription
Quantity to be dispensed:
 The prescription should lead to arrive at the exact number of
the total quantity to be supplied to the patient.
 The pharmacy professional should check this quantity to
confirm that it is appropriate for the patient, and that the
product can be supplied in such quantity.
 For any product with a short expiry period, ensure that the
quantity dispensed will not last longer than the expiry date.
Evaluation of prescription:
Completeness of the prescription
Dosage and directions for use:
 A knowledgeable and an alert pharmacy professional can be a
great asset and a lifesaver especially if the prescriber makes
mistakes (at times major ones) while prescribing.
Evaluation of prescription:
Completeness of the prescription
Contraindications:
 The age, sex, disease(s) conditions, or other characteristics of
a patient may cause certain prescribed medicines to be
contraindicated.
 The pharmacy professional should look out for such
contraindications.
 The dose should always be checked taking into account the
patient's age, and weight (especially for a child or for the
elderly and pregnant woman).
 For pregnant woman all categories, A, B, C, D and X should be
checked.
Evaluation of prescription:
Completeness of the prescription
More Examples:
 Aspirin is not recommended for children below 12 years of
age; so caution should be taken.
 Atenolol is contraindicated in asthma.
 The pharmacy professional should always check that the dose,
dosage regimen and any directions for use are appropriate for
the patient and the medicine.
 Any suspected medicine under dose/overdoses or
inappropriate dosing should always be referred to the
prescriber.
Evaluation of prescription:
Completeness of the prescription
 The dose should be carefully checked in case of children, and for all
categories of potent medicines.
 Confirm the units written on the prescription, i.e. milligrams,
micrograms, decimal points, etc. for medicines like digoxin.
Example –
 You need to check carefully whether the prescription states:
 0.25 mg or 0.025 mg.
 0.5mg or 50mg
 0.125mg or 125mcg (microgram)
 The pharmacy professional should verify, whether the dosage
prescribed is within the standard minimum and maximum dose range.
 Use standard textbooks or reference books for the standard dose.
Evaluation of prescription:
Completeness of the prescription
Frequency of administration:
 Check if the frequency recommended by the prescriber is as per
the standard dosing patterns.
 Doses more frequent than standard, proven doses may cause
toxic manifestations.
 At the same time, doses lesser than standard, required doses
may result in failure to treat the condition properly.
 In addition to frequency of administration, adherence to the time
schedule is also important.
 For instance, patients taking medicines for hypertension have to
take the medicine at the same time to maintain blood levels of
the medicine.
Evaluation of prescription:
Correctness of the prescription
 Double medication
 Interactions
 History of overuse, under use or misuse of medicines by the patient
 Check for overwriting
 Fake/false prescription
 For potent medicines, and medicines with a Narrow Therapeutic Index:
 Changes to the prescription:
 Therapeutic aspects
Evaluation of prescription:
Completeness of the prescription
Double medication:
 same medicine or different medicine with same pharmaco-
therapeutic effect) concurrently prescribed by the same or
different prescribers to the same patient undergoing
treatment.
Example –
 If a patient has been prescribed diclofenac for fever, and if the
dentist has prescribed other NSAIDs for the same patient, it
could lead to overdosing of NSAIDs, and result in the risk of GI
bleeding and may aggravate hypertension.
Evaluation of prescription:
Correctness of the prescription
Interactions:
 Many medicines are known to interact with other
prescribed or OTC medicines, food, diseases, herbal
medicines, and laboratory results.
 Ideally, all multiple item prescriptions should be checked
for medicine interactions.
 (Unfortunately, checking for medicine interactions is a
major problem in Ethiopia because of the large number of
medicines prescribed by prescribers.
 If a prescribed item is known to interact with many
medicines or to interact with OTC medicines then it is
imperative that the pharmacy professionals check with
the patient which other medicines or
traditional/complementary medicines the patient is taking,
in order to eliminate possible medicines interactions
Evaluation of prescription:
Completeness of the prescription
Example –
 Acetylsalicylic acid taken can increase the effect of an
anticoagulant (warfarin) that a patient is taking, and may thus
lead to bleeding.
 Patients taking ciprofloxacin should avoid taking antacid within 2-
3 hours because the antacid can drastically reduce the absorption
of ciprofloxacin.
 While interactions should be considered when dispensing all prescriptions,
some groups of patients are particularly vulnerable, and extra vigilance is
required. (Pregnant women, children, elderly, and those with kidney or
liver malfunction)
 Known allergies should be checked, particularly for an antibiotic
prescription, where prescribers may fail to consider cross sensitivities
within groups of medicines e.g. penicillins.
Evaluation of prescription:
Completeness of the prescription
 Also check if there is any therapeutic or other type of
incompatibility. For example, a pharmacy professionals may
know that the client regularly takes oral contraceptives, but
the prescriber may not have asked or not known about it.
 At times, a prescriber may have prescribed a medicine without
considering certain aspects.
 For example, a prescriber may prescribe a medicine without
confirming with a woman whether she is pregnant or not. A
prescriber may miss asking this question.
 A pharmacy professional can question the patient politely
about, whether she is pregnant, or the patient/client may pose
the question herself while the prescription is being filled.
 Evaluation of prescription:
Completeness of the prescription
Fake/false prescription:
 Pharmacy professionals should be alert to detect misuse
of prescription blanks by clients (obtained by stealing
from private practitioners or from Government hospital
OPDs, where blanks are often left lying around).
 Pharmacy professionals should also be alert to fake
prescriptions written/printed by the patient or client
coming to the pharmacy.
 If the handwriting is not the usual handwriting of the
prescriber or you notice it to be unusual otherwise,
confirm with a senior colleague or call the prescriber to
confirm.
 Do not dispense such prescriptions, and be sure to alert
the prescriber about the misuse.
Evaluation of prescription:
Completeness of the prescription
For potent medicines, and medicines with a Narrow
Therapeutic Index:
 Special care has to be taken with such medicines, as slight changes
in systemic concentration lead to marked changes in
pharmacodynamic responses.
 Examples of narrow therapeutic index medicines:
• Digoxin
• Lithium
• Phenytoin
• Warfarin
Evaluation of prescription:
Completeness of the prescription
Special care has to be taken in case of:
 Medicines with similar names:
 Example of similar names that illustrate the pit falls are:
Folic acid versus Folinic acid
Dexamethasone versus Desoximetasone
 Abbreviations
 Although widely used in prescription writing,
abbreviations can kill!!
 This is because in health care there are no recognized
standards for abbreviations, and most of the time,
prescribers invent their own. Secondly, different
individuals/pharmacy professionals may assume or
interpret abbreviations differently.
 Evaluation of prescription:
Completeness of the prescription
Examples
 ‘HCT’ 25mg was intended to mean Hydrocortisone 25mg, but
Hydrochlorthiazide was dispensed.
 ‘CPZ’ may refer to Chlorpromazine, an antipsychotic or to
Carbamazepine, which is an anticonvulsant.
 ‘CPM’ can mean Chlorpromazine or Chlorpheniramine
Evaluation of prescription:
Completeness of the prescription
Changes to the prescription:
 Before a pharmacy professional attempts to dispense a
prescription, he/she must read and understand it
thoroughly.
 If any portion of the prescription is not understood, or if
he/she has detected an incompatibility, he/she should
consult the prescriber who wrote the prescription.
 Any changes made to the prescription over the
telephone by the prescriber, should be recorded on the
prescription, with the words “changes made over the
telephone, in consultation with the prescriber at (time)
on (date)” and should be signed and stamped by the
pharmacy professional.
Evaluation of prescription:
Completeness of the prescription
 This exercise facilitates a trust based professional relationship
with the prescriber, besides documenting the changes made
to the legal document - the prescription, by the pharmacy
professional.
 Many pharmacy professionals hesitate to call the prescriber
about these matters, but, if the calls are executed tactfully,
there is no reason why they should not create a better
understanding between the persons of both professions.
Evaluation of prescription:
Therapeutic aspects
the safety of the medicine,
 possible contra-indications,
drug/drug interactions,
drug/food interaction,
drug/disease interactions, and
Treatment duplications.
Evaluation of prescription:
Appropriateness of the individual
 Confirm that the dose and duration of prescribed medicine are
in the normal range for the patient (noting sex and age or
weight)
 NB. Under no circumstances should an untrained person
attempt to read or discuss the prescription with the client.
Interpret prescription or verbal request for OTC
 Correctly interpret any abbreviations used by the prescriber
 Correctly perform any calculations of dose and the quantity to
be issued
Call the Prescriber:
 If any details are illegible, missing or incomplete, this prevents
any mistakes/errors while dispensing.
 The pharmacy professional can assure himself as well as the
patient that the medicines dispensed by him/her are according
to the prescription.
cases
 Ato Abebe, pharmacist, has filled some prescriptions
for carbimazole on one working day. On the same
day a customer, epileptic patient, presented him a
prescription for carbamazepine. Glancing at it, Abebe
thinks it is carbimazole once again, and that is what
he dispensed. The patient went to his physician with
complaints of no improvement.
Comment on this case
 Ato Tamiru is a licensed druggist working in his
private drug store. His wife assists him although she
is not pharmacy or health care professional. On a day
Ato Tamiru was out of the drug store, she dispensed
an expired gentamicin kept on the shelf for a patient.
 Woizero Aster went to a drug shop and made verbal request
for ampicillin and cough syrup for her 8 years old daughter
with complaints of cough and poor appetite. As she did not
have enough amount of money, she wanted to purchase only
ten capsules of ampicillin and one bottle of cough syrup
suspension. The dispenser fulfilled her request. Comment.
 An extemporaneous prescription order calls for 200ml of a 1 in
5000ml solution of a drug. A busy pharmacy professional
prepared it by taking 5 ml of a 4%w/v stock solution and 195
ml of the appropriate diluent. Comment on the strength of the
finished product
 A client presented an ordinary prescription that calls for 20
tabs of diazepam 10 mg. and 10 paracetamol 500 mg. tablets
to a pharmacy. The pharmacy professional dispensed both
drugs with appropriate instructions for use. Comment
 A prescription that calls for atenolol 50 mg. tablets is
presented to a pharmacy. The total quantity to be dispensed is
not indicated. One Tab. BID po for 4 weeks is written after Sig.
All other information is complete. The pharmacy professional
dispensed 28 atenolol 50 mg tablets. Comment