Module 1: 3.

Counseling the patient (therapeutic effect of

the drug and adverse effect)
Interpretation of Prescription and
Medication Errors Note: Patient should not receive the wrong
drug or take and incorrect dose of the
medicine. Dispensing the wrong drugs are
Prescription giving incorrect usage instruction can lead to
a serious consequence to the patients
- An order for medication issued by a physician,
including deaths.
dentist, veterinarian or other properly
licensed medical practitioner
- Administered to a particular patient.
Note: A prescription must be accurately and Inpatients, a nurse administer the medicine
legibly prepared to identify the patient, the working hand in hand with the doctors.
medication to be dispensed and mode of
administration. We should avoid abbreviations
when we write prescriptions or when the doctors Broad Categories of Prescription
write prescription.
1. Those written for a single component or
Things to consider: prefabricated product and not requiring compounding
or admixture by the pharmacist.
1. Patient
2. Medication order
3. Mode of administration

Different considerations of Doctors when

prescribing prescriptions

1. Evaluate and clearly define the patients

problem
2. To specify the therapeutic objective
3. Select the appropriate drug therapy
4. Initiate therapy with appropriate details
with consideration to none pharmacologic
therapies
5. To give information instructions and
warnings

- Prepared by a pharmacist
They are the bridge between the patients
and doctors who counsel and advise the
patients to maximize the decide effects of the
drugs and minimize the untoward adverse
effects of the drug.
Basic duty of Pharmacist
1. Checking of the prescribed medication Ordinary Prescription
2. Filling the prescription
 - The drug is sildefanil 50 mg tablet. With
special instruction, to give one paper tab
every six hours.

Parts of the Prescription

Patient Information

- Patient require information to help them use

their medicine safely and effectively and o
facilitate an understanding of the possible
harms and benefits of the treatment.
- The details should have the patients name
that always coincide with the patient age and
sex.

Yellow Prescription

2. Those written for more than a single component Superscription

and requiring compounding. - This is the Rx symbol on the prescription form
that designates written document to be a
prescription.
- Rx is an abbreviation for the latin phrase that
says take thou.
Inscription

- It includes the drug name (ampicillin-

sulbactam unasyn), concentration and type of
preparation or dosage form.
- The ideal things to be seen are Generic name,
Brand name, dosage strength and dosage
- Take 1 tablet three times a day for 7 days.
form.
Note: We are not using abbreviation for the
Note: If the generic name is there, it is still
signa this will lessen the confusion and
valid. However, if only the brand name is
medication error.
written, we can ask for its brand name.
Yellow Prescription

- Only can be prescribed by medical

practitioners with valid s2 license granted by
the PDEA. This was usually issued in three
copies with specific direction of use.
- The original copy will be surrender in the drug
store. The duplicate is to the patient. The
Subscription
triplicate copy will be in the prescribing
- This one is the instruction to the pharmacist practitioner.
usually consisting of a short sentence or - It has a specific number to avoid duplication
represented by this number #21 and reuse of it.

- Also the dates shows the communication with

other pharmacist.
- FS means fully served. That means there will
be no dispensing of medicine.

Signa

- This is the instruction to the patient as to how

to take the prescription but it is interpreted
and transpose onto the prescription label with
the pharmacist.
Different Parts of Yellow Prescription - On the lower part you can see the doctor’s
signature and the ptr number of the physician

The standard information to be supplied in the

yellow prescription.

1. Patient Full name

2. Complete business address

3. Telephone no. or email address

4. Current s2 license of the physician

5.Validity of license

Compounding Prescription

- There is a direction for the pharmacist to

prepare the medication in another dosage
form suited for the patient .
- In the example, a pediatric patient could most
likely could not exist a tablet and the dose of
-The PRC license is also needed the drug would be too high.

-The PTR of the doctor should also be included.

- The age, sex and completer address of the patient

- The date of issuance will serve as the proof of

validity.

Inscription, Subscription and Signa

- Generic and brand name, dosage strength and

form and total dosage units or total quantity
of prescription to be supplied in words and
numerical equivalent.
- For the direction of use for the patient such as
take as directed or take as required is not
acceptable.
- The inscription “no refill’ at the face of
prescription and the original signature of the
medical practitioner but in the country we do
not have any refills for a yellow prescription
and there are only a particular number
prescribed for each prescription
Electronic Health Record

- It is a digital version of a patient’s paper chart.

HER are real time patient center record that
make information available instantly and
securely to authorized users. It also contain a
patient’s medical history, diagnosis,
medications, treatment plans immunization
dates, allergy , radiology images and
laboratory test results. Integrated electronic
health information systems allows doctors, Advantages of e-prescription
nurses, pharmacist and others. • Reduced prescription errors due to prescription
- All of the information are confidential. Only legibility. (If the generic, brand name and dosage
the medical team have an access. strength)

• Concurrent software screens for drug interactions

• Reduced incidence of altered or forged prescriptions

• Efficiency for both prescriber and pharmacist

• Convenience to the patient

Medication order

- A medication order is written directions

provided by a prescribing practitioner for a
specific medication to be administered to an
individual. The prescribing practitioner may
Electronic Prescribing
also give a medication order verbally to a
- It was one of the media that is utilized now to licensed person such as a pharmacist or a
prevent those type of errors. nurse.
- Electronic Prescribing System is a computer to - It has subscription, inscription and signa.
computer transfer of prescription information
Typical Medication Order Sheet
between authorized prescribers, pharmacists,
intermediaries and payers under nationally Similarities
accepted standards
- It has patient name, age, sex.
- Most of the medication orders are given to
inpatient.
- It also have Physician and hospital number,
serviced and the room.

Difference

- Most of the medication order is not intended

to be read by the patient. More on for a
 medication order this is intended to be read Prescription and Medication Order Accuracy and
by a pharmacist or a nurse. Verification

• Therapeutically appropriate or the patient

• Prescribed at the correct dose

• Dispensed in the correct strength and dosage form

• Correctly labeled with complete instructions or the

patient or caregiver

• For the patient in a hospital or other health care

facility, each medication must be administered to the
correct patient, at the correct time, and by the correct
rate and route of administration

Step by step procedure in checking for medication

1. Careful Reading

2. Filling including the calculations

3. Checking and dispensing of the prescription

Compounded Prescription orders

Use of Abbreviations and Symbols
- There is a need for PCA, PPM or IV admixtures
they could write it on this prescription. Note: The physician are NOT encouraged to write the
signa and subscription in abbreviation form.

Use of Roman Numerals on Prescription

• Used to designate quantities, as the;

- Quantity of medication to be dispensed

and/or
- Quantity of medication to be taken by the
patient per dose

• VALUES OF SINGLE NUMERALS

ss or ss = 1/2

L or l = 50

I, i, or j = 1

C or c = 100

V or v = 5
D or d = 500 - The legibility of the prescription is given
consideration in this part.
X or x = 10
How to prevent errors and omissions in the
M or m = 1000
prescription
Rules in Roman Numerals
1. Prescriber’s Information - full name and address of
1. A letter repeated once or more, repeats its value. the prescriber

2. One or more letters placed after a letter of a 2. PTR no., PRC no. and Drug Enforcement Agency no
greater value increases the value of the greater value. for yellow prescription.

3. A letter placed before a letter of a greater value 3. Date of the order and its currency to the request or
decreases of the value of the greater letter filling.

4. Use the simplest choice among 4. Patient identification Information (age, weight or
other applicable parameters)
How to prevent errors and omissions in the
prescription 5. Drug prescribe including dose, preparation
strength, dosage form and quantity
Incorrect Frequency
6. Clarity of any abbreviations, symbols and/or unit of
For ex. b.i.d read as thrice it will overdose measure.
Timing 7.Clarity and Completeness of directions or use.
For ex. Drugs for diabetes should be administered 8. Special labeling or auxiliary labels.
before eating or after eating and the proper timing
should be observed for antibiotics, an hour before or 9. For compounding, listing of all the ingridients.
after should be taken to avoid gastric disturbances
Medication Scheduling and Patient Compliance
Improper administration
• Medication scheduling

- Frequency (times per day) and duration

(length of treatment) of drug’s prescribed or
recommended use.
- Frequency is important for the efficacy and
for the adverse effect.

• Patient Compliance

- Patient understanding and adherence to the

directions for use.
- Clearly discuss

• Patient Noncompliance

- Failure to comply with a practitioner’s or

Indecipherable Prescription labeled direction in the self-administration of
any medication.
Patient Non compliance Calculation of Doses General
May involve; Considerations
- overdosage or underdosage Amlodipine Norvasc
- inconsistent or sporadic dosing
- It has 5 mg and 10 mg dose.
- incorrect duration of treatment
- drug abuse with medications (habitual drugs) Dose
Factors resulting to non compliance - It is the quantitative amount administered or
taken by a patient for the intended medicinal
- Unclear or misunderstood directions
effect.
- Undesired side effect of the drug that
- It could be a single dose
discourage use
- Lack of patient confidence in the drug and/or Single Dose
prescriber
- Discontinued use because the patient feels - This is the amount taken at one time.
better or worse (antimicrobial resistance) - It can be a daily dose
- Economic reasons Total Dose
- Absence of patient counseling
- Confusion over taking multiple medications - This is the amount taken during the course of
- Others therapy.
- It can be a divided doses
Consequences of non compliance Two or more times per day depending on
- Worsening of the condition the characteristics of the drug and the illness.
- Requirement of additional and more Dosage Regimen
expensive and more extensive treatment
Hospitalization - This is the schedule of dosing. For example, 4
Surgical procedures times a day for 10 days.
- Increased total health care cost Usual adult dose

-The end - This is the amount that ordinarily produces

the medicinal effect intended in the adult
patient.
- It should not given to children dose
- Should considered some parameters like
patient taking other medications or chronic
kidney.

Median Effective dose

 - This is the amount that produces the desired - For the lungs
intensity effect in 50% of the individuals
Topical
tested.
- Creams, ointments and gels
Minimum Effective dose
Transdermal Patches
- It is the minimum concentration determined
that can be expected to produce the drugs Dosing Options
the side effect.
Low-Dose and High-Dose therapies
Median Toxic Dose
Low-dose therapy examples
- This is the amount produce 50% of toxicity on
individuals tested. In here, we are trying a - Use of aspirin in 81-mg amounts (rather than
particular medication such as vaccine for the usual dose of 325 mg) to lower the risk of
COVID. heart attack and clot-related stroke.

Minimum Toxic Concentration High-dose therapy examples

- The base level of blood serum concentration - Chemotherapeutic treatment of cancer to kill
that produces those related toxic effects. tumor cells
Toxic effects means there is an arise of - Use of high dose progestin in the treatment of
adverse effects. endometriosis.

Different Routes of Administration Fixed-dose Combination Products

Oral - Products containing two or more therapeutic

agents
- Those are tablets, capsules, syrups, - Advantage of combination products: More
suspension convenient – two or more needed drugs may
Sublingual is under tongue be taken in a single dose thus enhance
Buccal is between cheeks and gums compliance and be less expensive for the
patient than taking the same drugs
Parenterals
individually.
- Injection (IV,IM,SC) - Disadvantage – inflexibility in Dosing
Intrathecally is space around the spinal compared with individual drug dosing.
cord.
Splitting Tablets – not advisable
Vaginal and Rectum
- Only if tablets are scored or grooved
- Suppositories, vaginal tablets - Use tablet splitting device.

Drops

- Eyes, optic

Spray

- Nasal

Nebulization or Inhalation
 2. Advise the patient to gently cleanse the
affected eyelid with warm water and a soft
cloth before applying the ointment.

3. Gently pull the lower eyelid downward with

How to administer eye drops the index finger to form a pouch, then
squeeze a thin line (approximately ¼ to ½
Before administering eye drops, remember to: inch) of ointment from the tube into the
- Wash your hands pouch.
- Read the directions on the label 4. Close the eye and rotate the eyeball to
is it both or just one eye? distribute the ointment. Blinking several times
How many drops? may help in evenly spreading the ointment.
- If 2 drops are to be administered to the same
eye, leave 5 minutes between drops 5. Avoid eye make-up while using eye
ointments.
Eye Drops

1. Check solution before use. Do not use the

solution if it is already discolored or has How to use otic drops
changed in any way since it was first used.
1. Wash your hands well with soap and water.
2. Place the head back with chin tilted up and
2. Warm the eardrop bottle by holding it in the
look forward the ceiling.
palm of your hand for a few minutes.
3. With both eyes open, gently draw down the
3. This will make the eardrops more comfortable
lower lid of the affected eye with the index
to instill.
finger. Then drop the directed number of
drops.  Remind the patient not to allow the 4. If it is instructed by your pharmacist or doctor,
dropper tip to touch the surface of the eyelid gently shake the bottle for 10 seconds.
(to avoid contamination of the sterile
4. Remove the cap or dropper from the ear drop
solution). 
bottle. Make sure nothing touches it or the tip of
4. Tell the patient, if possible, to hold the eyelid the container.
open and not to blink for 30 seconds. Wipe
5. Tilt your head to one side or lie down with the
away excess liquid with a clean tissue. 
affected ear facing up.
5. Avoid eye make-up while using eye solutions.
6. For adults or children over three, gently pull the
6. Always tightly cap the bottle after use. top of the ear upward and backward.

  7. For children under three, gently pull the bottom

of the ear back and down. This will straighten the
Eye Ointments
ear canal.
1. To warm or soften the ointment, hold the
8. Instill the correct number of drops in your ears
ointment tube in the hand for a few minutes
as instructed on your prescription label.
before application.
9. Ensure the dropper or the tip of the container Before administering eye drops, remember to:
does not touch the ear or other surfaces, to avoid
- Wash your hands
contamination.
- Read the directions on the label
10. Keep your ear tilted up for three to five is it both or just one nosetril?
minutes. How many drops?

11. Replace and tighten the cap or dropper right Inhalations or Nasal Spray
away. Make sure not to touch the tip of the
1. Blow nose or clear the nasal passages before
container or dropper.
administering spray.
12. Wash your hands to remove any medication
2. Put your finger to block one of your nostrils
13. If you are instilling drops into both ears, wait
3. Hold pump with thumb at bottom and nozzle
5-10 minutes between ears to allow the ear drops
between fingers.
to run into the ear canal.
4. Insert nozzle into nostril, spray upward while
Note: Always follow the directions provided by
breathing through the nose. Repeat in other
your doctor or pharmacist. These instructions are
nostril.
meant to be a general guideline.
5. Remove the spray from the nostril and
Ear Drops 2.0
breathe out through the mouth.
1. Lie the patient at his side so that the affected
6. Keep clean by wiping nozzle.
ear points upward.
How to used metered dose
2. Position the dropper tip just inside the
affected ear canal. For adults, hold the 1. Remove the cap from the inhaler
earlobe up and back; for children, hold the
earlobe down and back to straighten ear 2. Shake the inhaler well for 5 seconds
canal. Then, apply medication. 3. Hold the inhaler firmly by placing your index
3. Let the patient remain lying down for 3 to 5 finger on top of the canister, and thumb on the
minutes so that the drug can spread bottom of the mouthpiece.
throughout the ear canal. Gentle massage on 4. Sit up straight or stand up
the area around the ear may aid in the
distribution of the ear drops in the canal. 5. Tilt you head back slightly

4. A clean cotton pledget maybe placed inside 6.Exhale away from the inhaler
the ear to prevent leakage when head is in 7. Put the inhaler in your mouth. Press the inhaler
upright position. and start breathing in at the same time. Take a
5. It is important to advise patient not to use the slow and deep breath.
ear drops if the eardrum has been damaged. 8. Hold your breath for 10 seconds. Exhale slowly
6. To keep the medicine germ free as possible, through your mouth or nose.
do not touch the dropper to any surface Note: Repeat steps 2 to 8 after 30 seconds, if
including the ear. another dose is required. If you are using
How to Administer Nasal Spray
corticosteroid medication, rinse your mouth after 3. Hold the inhaler horizontally. For loading the
all doses are complete. dose, slide the lever from left to right. You’ll here
a click.
Metered Dose Inhaler (MDIs) 2.0
4. Exhale away from the inhaler.
1. Remove the plastic dust cover from the
mouthpiece. 5. Place the mouthpiece in your mouth. Take
quick and deep breath.
2. Assemble the inhaler.
6. Hold your breath for 10 seconds. (You can hold
3. Invert the assembled MDI.
your breath as long as is comfortable for you or
4. If a spacer is recommended, place it on the possible). Exhale slowly through your mouth or
MDI. nose.

5. Shake the MDI-spacer assembly vigorously. Note: If you are using Flovent Diskus and have
been prescribed to take another dose, then
6. Place the assembled MDI close to the mouth. repeat the steps from 3 to 6 after 30 seconds. If
7. Empty the lungs as completely as possible by you are using corticosteroid medication, rinse
exhaling deeply. your mouth after all doses are complete.

8. Place the mouthpiece in the mouth, closing How to use Handihaler

the lips tightly around the open end of the 1. Open the dust cap by pulling upward
mouthpiece.
2. Open the mouthpiece
9. Inhale deeply while activating the MDI.
3. Keep one end of Capsule in Center Chamber
10. Remove the MDI from the mouth
immediately after the activation. 4. Close the mouthpiece firmly. You’ll here a click.
Leave the dust cap open.
11. Finish the deep inhalation and hold this
breath as long as comfortable. 5. Press the piercing button once. You’ll hear a
click. Doing so makes hole in capsule and easily
12. Exhale slowly, keeping the lips barely open. releases the medicine, when you inhale
13. Clean the MDI and spacer as recommended. 6. Exhale away from the inhaler
14. Keep a record of the number of activations of 7.Hold the handihaler horizontally. Keep the
the device. Subtract one more activation from mouthpiece in your mouth and take a quick and
the total listed on the MDI to determine the deep breath. You’ll hear the capsule rattle.
remaining contents.
8.Hold your breath for 10 seconds. Exhale slowly
How to use Diskus Inhaler through your mouth or nose.
1. Check the dose counter to see number of doses 9. Breath in through the mouthpiece once again.
remaining. This ensures that you get complete dose of
2. Hold the inhaler properly in both the hands. medicine.
Open the inhaler by using the thumb grip side. 9. Open the mouthpiece, removed the used
You’ll here a click capsule and dispose it. Do not keep capsule in the
handihaler.
10. For storing the handihaler. Close the using your dominant hand to place your
mouthpiece and dust cap. suppository at the vaginal opening

Note: If you are using corticosteroid medication, 8. Push the suppository into your vagina. Insert
rinse your mouth after all doses are complete. the suppository applicator your forefinger to
insert the suppository into your vagina. Push it as
far as is comfortable so that it is in your vagina.
How to administer vaginal suppository
9. If you’re using an applicator push the plunger
1. Clean your vagina. Use a mild soap to cwash so all of the suppository is delivered. You’ll know
the outer part of the area around it. Don’t wash if the suppository is in your vagina when about
out inside the vagina. Make sure to wash your half the applicator in the vagina or your forefinger
hands well. Rinse your vaginal area and hans to is in the vagina up to the knuckle dispose of the
completely remove the soap. Pat your skin using applicator remove the applicator and completely
Dry using clean cotton cloth. wash it with some gentle soap and water if it is
reusable or throw it away if it’s not wash and dry
2. Prepare the suppository, unwrap the your hands.
suppository applicator from its packaging and
determine if its prefilled with the cream or tablet. 10. It may take an hour for the suppository to
If it’s not prefilled, hold the applicator between completely dissolve at the point you may notice
your thumb and forefinger and use your other leaking if you’re up walking around follow the
hand to place the cream or tablet on the other manufactures or doctors instruction
end of the applicator .
How to use enema and suppositories
3. To fill the applicator with cream suppository,
2. You need a disposable absorbent pad. Some
connect the tube of cream to the applicator so
water based jelly lubricant and some disposable
that it’s tightly attached.
gloves for you to wear.
4. Squeeze the tube of cream till the correct dose
3. It’ll be good to gather the supplies you need to
is in the applicator remove the tube and save it
help them clean up after a bowel movement as
for your next dose the applicator provided for
well. Like a basin of water and wash cloths or
delivering a cream suppository usually has marks
some wet wipes and some hand sanitizer
on it that tell you how much is in the applicator
such as 1 gram 2 gram, etc 4. Whether you are giving suppository or an
enema wash your hands and start with the person
5. Get your body into a position stand with your
you’re caring for lying in bed. Remove any
legs and knees apart. Raise one foot up on a stool
clothing on their bottom half but keep them as
the edge of the toilet or bathtub or a chair or you
covered as you can with a sheet. Now, help them
can lay on your back with your knees bent.
turn over onto their left side. This helps the
6. Your feet should be about shoulder width medication has into the rectum more easily next
apart. Both of these positions will give you easier move their knee on top so its bent up that’ll make
access to your vaginal opening which will make it it easier for you to see. Tuck the disposable
easier to insert the suppository. absorbent pad under their hip and bottom so if
anything spills the bed is protected
7. Open the lips of your vulva, use your non-
dominant hand to separate lip labia of your vulva. 5. Put on your gloves and use the lubricant to coat
This will expose your vagina . Keep it expose while the tip of the enema or the entire suppository
with a generous amount of lubricant. You can set 3. Take the white cap off the syringe. Draw the
it down on the side of the disposable pad if you plunger on the syringe to the number of units you
need to it anytime. will be injecting.

6.Use your non-dominant hand to separate the 4. Insert the needle into the rubber top of the vial
buttocks cheeks of the person you’re caring for. If and push that amount of air into the vial turn
you notice anything abnormal or any bleeding both of the vial and syringe upside down with
contact their doctor before you go give the your free hand pull the plunger to withdraw the
suppository or enema. correct dose into the syringe.

7. Once you can see their anus have them take a 5. Check the syringe for air bubbles if bubbles are
deep breathe to help them relax their muscles. As present hold the syringe straight up and tap the
they breathe out, insert suppository or the tip of side until the bubbles float to the top. Push any
the enema into the rectum. If you’re using a bubbles out and be sure the correct number of
suppository. Push the suppository into their units are in your syringe.
rectum and use your finger to push it in as far as
6. Wipe your skin with an alcohol pad dry off any
you can go comfortably. Then push it towards the
excess alcohol on your skin before injecting do
side. Slowly remove your finger.
not inject through clothing. Pinch a fold of your
8. For an enema, once the tip is inserted squeeze skin between your thumb and finger with your
the bottle to start the flow of the fluid. Then roll other hand hold the syringe like a pencil at a 90
the bottle up from the bottom to make sure all degree angle to the skin insert the needle with
the fluid goes in. Then slowly remove the bottle one quick motion make sure the needle is all the
and throw it up. way in. Push the plunger at a moderate and
steady pace until it is fully injected.
9. Now, you can remove your gloves and wash
your hands 7. Keep the needle in your skin for five seconds.
Remove the needle at the same 90 degree angle
10. A suppository will usually take about 30
at which it is inserted. Discard your syringe in a
minutes to work and an enema may only take five
container.
minutes.
How to Inject Insulin with a Pen and Pen Needle
How to Inject Insulin with a Syringe
With a pen and pen needle
With a vial and syringe
1. Always start by washing your hands.
1. Always start washing your hands
2. If you take two insulin, check the pen label to
2. If you take two insulins, check the vial label to
make sure it’s the insulin you intend to inject.
make sure it’s the insulin you intent to inject.
Remove the cap and wipe the top of the vial with Note: It’s a good idea to write down the date on
an alcohol swab. You can throw away the cap the vial of when you first opened it as it is only
after its first use good for 28 days.

Note: It’s a good idea to write down the date on 3.Take the cap off of the pen and wipe the tip
the vial of when you first opened it as it is only with the alcohol. Choose one pen needle. Tear the
good for 28 days. paper off and keep the needle in its safety cap.
Screw the pen needle on to the pen until it stops
turning. Take the white safety cap off and remove 2. Apply each patch to a different area of skin to
the colored needle cover. prevent skin irritation or other problems.

4. Perform an air shot by dialing to 2 hold the pen 3. Avoid trimming or cutting the adhesive patch
up and away from you. Push the injection button to adjust the dosage. Check with your doctor
and look for a drop of insulin on the needle tip if if you think the medicine is not working as it
you don’t see a droplet, repeat this step your should.
needle may be bent if no insulin comes out and
you should replace it a new pen needle. Repeat
this step until you see the droplet form.

5. Turn the dial to the correct dose of insulin for 1. Ampicillin = empty stomach               
this example we will use 10 units. Wipe the skin
with the alcohol pad. Dry off any excess alcohol 2. Amlodipine = full or empty stomach
on your skin before injecting. Do not inject 3. Aspirin = full stomach
through clothing, pinch a fold of your skin
between your thumb and finger with your other 4. Bisacodyl = empty stomach
hand hold the pen at a 90 degree angle to the skin 5. Captopril = empty stomach
and insert the pen with one quick motion it helps
to hold the pen like you’re giving a thumbs up and 6. Erythromycin = empty stomach
push the pen injection button with your thumb.
7. Griseofulvin = full stomach
Push the injection at a moderate and steady pace
until the insulin is fully injected. Keep the needle 8. Metformin = full stomach
in your skin for a count of 10. Then, you can pull it
9. Metoprolol = full or empty stomach
out of your body. Remove the needle from the
pen by replacing the large white cover and 10. Omeprazole = full or empty stomach
unscrew it. Dispose of your used pen needle in a
Is the prescription legal and valid?
safe container. Never leave the needle on your
pen doing so can result in leakage or air bubbles. Who will use the medication?
How to administer Patches What is the medication ordered in the
prescription?
Before administering a patch, remember to:
Who ordered the medication?
- Wash your hands
- Read the directions on the label and check Is the ordered medication enough for the entire
that the patch is due to be changed today. dosage regimen?
- Remove the old patch before applying the
new patch How is the medication taken?
- Check the skin where the new patch will be 1. No, because it is considered as violative
applied is clean, dry and cool. prescription due to the statement of “no
- Put it for 30 minutes. substitution”. It will not be filled and prescription
1. Put the patch to a clean, dry skin area that has must be kept and recorded. Also, if in case he will
little or no hair and is free of scars, cuts or present this prescription this day (2020) it will not
irritation. be accepted anymore or invalid. (Date of
Prescription). Lastly, the prescriber has no
signature above her name (Prescriber signature)

2. Mr. Mario Halo (Patient Information)

3. Based on the prescription, it is Clindamycin

(Dalacin C HCl) 300 mg capsule (Inscription)

4. Marie Salome, MD (Prescriber Information)

5. No, because it has no instruction on how many

capsules will the pharmacist should dispense.
(Subscription)

6. It is taken Orally 1 capsule by mouth, twice a

day for 7 days (Signa)
 - Best example is enteric coated tablets. This
are not intended to absorbed in the stomach
but rather in small intestine

Produce irritant effect

- Mucosal and gastric irritation.

Occupational and Health Safety Issue

- Aerosol powder. Unpleasant taste that needs

DISPENSING AND MEDICATION SAFETY to sugar coating
- Crushing products with carcinogenic or
Module 1: Special Drug Instruction 1 (Drugs that teratogenic potential may expose healthcare
should not be chewed, crushed, or opened) professional to health risk to powder
aerosolization. It can also be oral
Reminder: Don’t rush to crush
contraceptives, corticosteroid such as
Accuracy dexamethasone and some other drugs.
Carcinogenic induce cancer such as
- Use a tablet cutter
tamoxifen
- It’s okay if its whole dose to crush
Teratogenic is harmful to the fetus such as
- Do not use kitchen knife or scissors
oral contraceptives, hormonal replacement
As much as possible the cut drugs should
therapy. Drugs such as Valganiciclovir, known
be utilized ASAP. And practice proper storage
as skin irritant.
Potential Consequences of Splitting, Crushing and Corticosteriod
Opening Finasteride, mycophenolate

Absorption Gastric Environment (stomach)

- The pharmacokinetics property of the drugs - Protects the drug from acidity.
differ or can be alter - Protects the stomach from the detrimental
effects of the drug.
Drug instability - Target site of action
- Once you crushed your tablet, the integrity of Small intestine
drug is gone and easily degrade.
- Nifedipine (light sensitive, resulted to - Anthelmintic drugs, for parasites
photodegradationnifedipine to
dehydronifedipine which can further more
Changes in pharmacokinetics and bioavailability
degrade to dehydronitrozonifedipine which
splitting or crushing oral
both are inactive form)
- Dulcolax, if you’re having problem with the - Underdosing or overdosing
tablet you can shift to suppository. If you - Example is lanoxin, once your crushed it will
chew dulcolax there will be gastric spasms. have bradycardia or tachycardia.
- Pradaxa, once you exposed or crushed there
Failure to reach the site of action.
will be increase in the amount of drug that is
absorbed.
 It’s an anticoagulant which there will be
serious bleeding.

Produce irritant effect

- They are formulated or coated to minimize

some risk to patient. Some medications may
cause stomach irritation, ulceration,
pharyngeal, mucosal irritation
- Diclofenac sodium known as NSAID may cause
gastric irritation.
Dispensing and Medication Safety
- Alendronate, likinoid reaction causes mucosal
irritation or ulceration Module 2: Adverse Drug Reaction and Medication
Error
For drugs with particular bitter taste

- A coating usually helps to mask the taste.

- Sugar Coating for ibuprofen and quinine Pharmacovigilance
crushing the coating will result with
- the science and activities relating to the
unpleasant taste.
detection, assessment, understanding and
- Iron supplements has coating
prevention of adverse effects and other
Dosage Form Effects medicine related problems.
- Study of drug related injuries.
Modified release medicines (prolonged period)
- Make warnings to a possible therapeutic
- Frequently identifiable by two letters such as effect.
m/r, LA, SA,CR,XL or SR at the end of the - Withdrawal recommendation.
name. Word such as Retard or Slow in the
Signal
title sometimes use instead.
- Crushing, splitting may result high absorption - Reported information on a possible causal
or low. Some example are verapamin m/r, relation between an adverse event and a
Propranolol, diclofenac, felodipine. These drug, the relation being previously unknown
drugs are taken once a day. Also, omeprazole. or incompletely documented.
They utilize multi unit pellet system (MUPS) - One example is chloramphenicol for typhoid
fever which there are manifestation of
Enteric coated medicines
aplastic anemia and Gray baby syndrome.
- Usually identifiable by the two letters EN or
Adverse drug events
EC at the end of the name. Medicine designed
not to be released in the stomach. - “any untoward medical occurrence that may
present during treatment with a
Film or sugar coated medicines
pharmaceutical product but which does not
- Disruption of the film or sugar coating on necessarily have a causal relationship with
drugs may result in rapid degradation of the this treatment” –WHO
active ingredient, poor tasting medicines - “a response to a drug which is noxious and
which may be more difficult to swallow. unintended and which occurs at doses
normally used in man for prophylaxis,
 diagnosis, or therapy of disease or for the The warfarin is temporary interrupted. If
modification of physiologic function.” –WHO there’s no bleeding you can proceed to
Patient population at risk. warfarin therapy.
What are the drugs that is commonly
Adverse Drug Reaction
responsible.
Increase of number of drugs on the market - It’s a type of ADE whose cause is directly
Aging population attributed to a drug or it physiologic
Note: Allergy information properties.
- Under the upper umbrella
- occurs despite appropriate prescribing and
Side Effects dosing
- occurs at normal doses.
- an expected and known effect of a drug that
is not the intended therapeutic outcome. Medication Error
Tetracycline taken by children, there will be
- Preventable event
mottling of teeth.
- Health care providers are often involved
Minoxidil is a vasodilator; side effect is
increase hair growth that is commonly used Risk factors for ADR
now.
Age Group
Medication Error
- Pediatric and Geriatric
- mishaps that occur during prescribing, Pediatric are underdeveloped organ system
transcribing, dispensing, administering, Pediatric preparation errors in compu.
adherence, or monitoring a drug. Geriatric has co-morbidity. They have two
- Preventable event diseases.
Near Miss Polypharmacy
- Medication errors that are stopped before - Those are taking different medication at the
harm can occur. same time
Bisacodyl suppository, akala nya bisacodyl - Mostly geriatric patients
tablet.
 Same color of capsule, Amber colored Gender
ampule. For ex. diphenhydramine ampl and - Women are 1.5 – 1.7 more at risk. Possible of
paracetamol amp. pharmacokinetics, immunological or
Adverse Drug Event hormonal factors.

- Upper umbrella Co-morbidity

- It may be associated with inappropriate use of Duration
the drug and or other confounders.
- Example, the patient nagkaroon ng - Example is drugs for TB. Rifampicin has red
supratherapeutic INR of 6. The patient has orange discoloration. Ethambutol optic
pulmonary embolism taking warfarin 1 mg neuritis. Isoniazid for peripheral neurofatigue.
but at the sametime he is prescribed with Pyrizzinamide has high uric acid.
ciproxin that leads to a particular bleeding. Ethnicity
 - Example, for hypertension. example, sulfonyl ureas (hypoglycemic
agents). Other ex. is hypertensive agents such
Severity of Reaction
as amlodipine, losartan, diuretic, beta
A. Mild: Bothersome but requires no change in blockers, ace inhibitors which in extension
therapy. causes hypotension. Other ex. CNS
depressant, in extended effect causes
- Taking first generation of antihistamine such as sedation. Other is anticoagulant, in extension
Benadryl, diphenhydramine and Iterax which leads to effect there will be bleeding. Furosemide is a
sedation. Shift to 2nd Gen of antihistamine coz they diuretic, the common manifestations is loss of
are has no sedation. electrolytes.
B. Moderate: Change in therapy, additional Side effect, these are not related to the
hospitalization. pharmacologic use of the drug. For example,
antihistamines for allergy, SE is sedation.
- Example. Warfarin has major bleeding shift to Nitroglycerines for angina, SE is headache.
another anticoagulant. Motor INR Ace inhibitors, SE: cough. Opioid analgesics,
C. Severe: Life threatening SE: constipation. NSAIDs, SE: GI irritation.
Minoxidil causes hypertrichosis. Anti-
- Internal hemorrhages may cause permanent harm to neoplastic, SE: Alupecia. The statins, SE:
the patient. rhabdomyolysis.
D. Lethal: Directly/ Indirectly causes death
ADR Type B: BIZARRE
- Example, Antibiotics possible has allergic reaction.
What if it has anaphylactic shock. - Uncommon
- Not dose related
Types of ADR
- Non-predictable (Not pharmacologically
ADR Type A: AUGMENTED related)
1. Idiosyncratic reaction (Peculiar)
- Dose dependent
- Genetically determined
- Most Common (75% )
Example:
- Avoidable
a. Malignant hyperthermia
- Predictable
- General anesthesia can get this one. It has
- About 80% ADR in the hospital are causing
muscle rigidity, high fever and fast heart rate,
admission to a hospital under type A.
High blood potassium.
- Drug classes that are most common
b. Hemolytic anemia (CI with G6PD
responsible for ADR in adults are
deficiency) leads to paleness, yellowing skin,
adrenalcorticosteriod, antibiotics,
white of the eye, jaundice, fatigue, rapid heart
anticoagulants, antineoplastic and
rate, SOB. Open triggered by bacteria or viral
immunosuppressive drugs, some
infection or certain drugs, one most common
cardiovascular drugs, NSAID and Opiates
is antibiotics and antimalarial drugs, Favism/
- Meanwhile, for children are anti-infectives,
inhaling of pollen (eats fava beans). Mas
respiratory drugs from different vaccines
malimit sa lalaki.
- These type has two class, these are extension
2. Hypersensitivity Reaction
effect and side effect.
I. Anaphylactic/Immediate (IgE)
Extension effect, these are usually related
II. Cytotoxic (IgG, IgM)
to the pharmacologic use of the drug. For
 III. Immune Complex Mediated (IgG, IgM) - For platelets, Aspirin and ibuprofen cause
IV. Delated (T-celled Mediated) thrombocytopenia purpura, GI irritation and
GI bleeding.
Immunoglobulins
IgG – mother to fetus
IgM – made by baby
IgA – prevents attachment of viruses,
bacteria to epithelial cells Type III - Immune Complex Hypersensitivity
IgE – Inflammation, Allergic reaction, - Example are drug induced serum sickness,
combatting parasitic infection. farmer’s lung and SLE
- Occurs when there is accumulation of
Type I – ANAPHYLAXIS immune complexes that have not been
adequately cleared by innate immune cells
- Aka Allergy (IgE) giving rise to an inflammatory response
- Immediate onset - Inflammation such as lymphadenopathy,
- Stimulants (shellfood, pollen, peanuts, splenomegaly, glomerulonephritis and
anesthesia). Antibiotics, vaccines. atralgia.
- Diphenhydramine, antihistamines
- Pathogenesis: involves the degranulation of Causes
mast cells (contains histamine) - Self antigens ( Systemic Lupus Erythematosus)
Histamine triggers the anaphylaxis - Bacteria and viruses
Effect: Vasodilation, Bronchoconstriction - Antiserum from animals
Sign and Symptoms: - Spores
-Swelling in the mouth, eyes and nose.
-Difficulty breathing with wheezing. Type IV -Cell Mediated/ Delayed Type
-Abdominal pain, nausea and vomiting hypersensitivity
-Feeling of having a ball in the throat - The reaction takes several days to develop
-Increased heartbeat. - Its not Immunoglubulin, its T-Cell.
-Urticaria, laryngeal edema
-Bronchoconstriction Causes
-Nasal congestion
- Microbes (e.g. Mycobacterium tuberculosis -
Treatment
Mantoux Reaction) Atopic dermatitis, TB,
-antihistamine
Pneumonitis, granulomatosis with polyangitis.
-Epinephrine
- Uroshiol from Rhus species
-Cromolyn sodium (mast cell stabilizers)
- Nickel and Chromates
-Steroids
ADR TYPE C: CONTINUOUS
Type II – CYTOTOXIC
- Uncommon
- Initiated by antibody (IgG, IgM) directed
- dose and time related
against antigens found on cell membrane of a
- Cumulative dose of the drug (repeated
given target cells
utilization of a drug)
- Blood Cells (leukocytes and erythrocytes)
- Addiction, tolerance and dependence
- RBC -> Chloramphenicol cause aplastic
Addiction - Person takes the drug
anemia. Methyldopa cause hemolytic anemia.
compulsively despite potential harm and
 desire to stop. Example, marijuana, cocaine, stop taking or you lower the dose of the drug
amphetamines, LSD. Cigarette, drinking that is usually used.
alcohol. For amphetamines, mental
ADR TYPE F: Failure of effects
retardation. For cocaine, binubutas sa nose.
Dependence - Without the drug, the - Drug-drug reactions (2 drugs at the same
patient experience withdrawal effects. time, antagonist or potentiate
- 2 Types: 1. Physical dependence: body - Use of counterfeit drugs (fake drugs)
cannot function well. For coffee. 2. - Drug instability
Psychological dependence: mind cannot - Patient non compliance
function well. For example, benzodiazepines. - Wrong route of administration
Tolerance - Lost of response to the drugs - Drug resistance
e.g. Nicotine. Smoking cessation therapy,
taking Nicotine spray, gum or patch.

ADR TYPE D

- Delayed manifestation of ADR

- Manifested long after exposure such as
teratogenic and carcinogenic.
- Carcinogenic for cancer. Example are
asbestos, hydrocarbons. Diethystillbesterol
leads to vaginal adenocarcinoma and breast
cancer.
- Teratogenic for fetus. It is ability to cause fetal
malformations. Cliff palit causes from
benzodiazepines. One example is Phocomelia
for babies, no legs and arms. Thalidomide for
morning sickness, pain. Neural defects from
carbamazepine and valproic acid. Aplasia cutis
from methinazole. Fatal alcohol syndrome,
too much taking of alcohol. Isotretinoin.
Antineoplastic are embryo toxic.

ADR TYPE E: End of use

- Withdrawal symptoms
- One example is opioids such as morphine,
fentanyl use for pain. Codeine for coughing.
- Tachyphylaxis -> rapidly diminishing response
to successive doses of drug rendering it less
effective. Increase dose, no effect or same
effect
increase utilization, decrease effect
- Other example is rebound hypertension –
occurs when blood pressure rises after you