MODULE 1:

 Pharmacy Organizational Chart

 Pharmacy Internal Set-up
 General Requirements in Opening drugstore
 Small discussion in using E- services of application in opening drugstore.
 Branch set- up and schedule personnel’s

PHARMACY

 is the science and technique pf preparing, dispensing, and providing additional clinical services. It is a
health profession that links health sciences with pharmaceutical sciences and aims to ensure the safe,
effective, and affordable use of drugs.

Pharmacist play a vital role in the health care system through the medicine and information they provide.
Responsibilities include a range of care for patients, from dispensing medications to monitoring patient health
and progress to optimize their response to medication therapies.

Role of Establishment/ Institution

 Providing Healthcare Services

 Safe and effective medicine
 Medication Adherence and ensure proper administration of drugs or medicine through counseling.

General Requirements in Opening a Drugstore

 Application Form – FDA E-services

 Proof of business name and registration- SEC/DTI
 Barangay Clearance
 Credentials of the Pharmacist- PRC, Board Certificate, FDA Licensing Seminar, Resignation from the
previous company/Letter of First Job
 Location Plan- GPS
 Risk Management Plan
 PSNC3- Pharmacy Assistants
MODULE 2: THE PHARMACY OPERATIONS- ORIENTATION AND OVERVIEW

 Briefing on Pharmacy Operation and Services

 Procurement and Supply Management System
 Role of Institution or Establishment

Pharmacy Operation and Services

Schedule of personnel’s – Manpower

Marketing Display

Stock Procurement

Trained staff

SOP’S in the Community Pharmacy

 Operational Schedules
 Monitoring and Recording of Biologicals
 Stocks Procurement
 Product Complaint/ Wrong Dispensing
 Cold Storage
  Product Recall
 Dispensing Practice/ Dispensing Flow
 Good Housekeeping
 Adverse Drug Events Reporting
 Return Goods- Expiring, Damage, Broken
 Good Storage Practice
 Disposal of Expired Products
 Reporting of an Adverse Drug Reaction

Pharmacists Duty and Responsibilities

 Responsible for providing professional information on medicines as well as dispensing of drugs in

accordance with the government regulatory agencies.
 Ensure validity and accuracy of prescription in dispensing medicines
 Engages in patient counseling and queries on drug related matters
 Coordinates with the Chief Pharmacist regarding government regulatory orders for implementation
 Ensures that all reference books are updated and available in the store (generic menu card,
prescription book, dangerous drugs book)
 Prepares periodic reports for regulatory agencies
 Ensures proper storage of loose tablets, vials, and biological, regulated medicines
 Ensures that all bad stocks are pulled out (damaged, expiring/expired) in his/her assigned medicine
cabinet.
 Assists in the maintenance and cleanliness of the work place
 Ensures that all medicines are in good condition
 Represents the store during FDA/PDEA inspection
 Updates store personnel on product awareness and new practices through training
 Performs other related functions that may be assigned by the immediate head or the management
from time to time.

MODULE 3:

What is a Community Pharmacy?

 Community Pharmacy is a healthcare facility (pharmacy, chain pharmacy, department) that

emphasizes providing pharmaceutical services to a specific community. It dispenses medicine and
typically involves a registered pharmacist.

Management of Community Pharmacy

 Community Pharmacy is a place where most pharmacists practice the profession of pharmacy. It
consists of a retail store front with a dispensary where medicines are stored and dispensed.
 Functions of Community:
 Providing health information to patient and public
 Prescription handling
 Patient counselling
 Patient medication record
 Pharmacy administration
 Compounding
EDPMS- Electronic Drug Pricing Monitoring System

The e-DPMS refers to Electronic Essential Drug Monitoring System which was created by the DOH to support
the establishment of an efficient and effective system and procedures for collecting price and inventories of
essential drug and other drugs stated in RA 9502.

The intent is for the DOH and DTI to monitor essential drug price as well as stocks of medicines in the local
market and detect practices such as overpricing and non-compliance to efforts of the DOH to regulate
excessive price of drugs such as the GMAP and the MDRP. It also aims to educate consumer on prevailing
market prices of essential drugs to enable them to make informed choices.

DTI Inspection (Price Act Law) RA 7581

 This act shall be referred to as the “Price Act” (5) Establish a mechanism that will readily protect
consumer from inadequate supply and unreasonable price increase on occasions of calamities,
emergencies and like occurrences.

MDRP- Minimum Drug Retail Price List (Executive order no. 104-2020)

 Improving access to healthcare through the regulations of prices in the retail of drugs and
medicines
Executive Order (EO) No. 104 mandated the implementation for a Maximum Retail Price and/or
Maximum Wholesale Price (MWP) 86 drug molecules or 133 drug dormulas upon the
recommendation of the Department of Health (DOH).

The list of MWPs and MRPs also covers common anti-cancer drugs, immunosuppressant’s,
analgesics, anti-asthmatic, and anti-depressants among others.

Government-Mediated Access Price (GMAP)

  Prices, Availability and Affordability of Medicines with Value- Added Tax Exemption.

Law Pertaining to Community Pharmacy

 RA 9165 Comprehensive Dangerous Drugs Act

 RA 7394 The Consumer Act of the Philippines
 RA 3720 Food, Drug, and Cosmetics Act
 Executive Order No. 821 The Universally Accessible Cheaper and Quality Medicine Act of 2008
 RA 9711 Food Drug Administration (FDA) Act of 2009
 RA 9257 Expanded Senior Citizens Act of 2003
 RA 6675 Generics Act of 1988

RA 8203 Special Law on Counterfeit Drugs

 RA 7581 Price Act Law

 Republic Act No. 10918 Philippine Pharmacy
Act
 Administrative Order No. 2013- 0027 Good
Distribution and Good Storage Practices
 Administrative Order No. 2016-0003-
Guidelines on the Unified Licensing
Requirements and Procedures of the Food
and Drug Administration (FDA)
Module 6 -Type of Prescription

Prescription

An order of medication issued by a by a physician,dentist, veterinarian or other properly licensed medical

practitioners.

It contains names and quantities of the desired substances, with written instructions for the pharmacist
for the preparation of the medicine and to the patient for the use of the medicine at a particular time.

Types of Prescription

Pre-compounded prescriptions

prescription for already prepared drug by pharmaceutical companies

Extemporaneous compounded prescription

The pharmacist prepare the medication according to the drugs and

dosages directed by the physician

Pre-compounded vs. Extemporaneous compounded Prescriptions

Pre-compounding prescriptions

• Contains drugs readily available in pre-compounded form and is dispensed as it is.

• Pharmacists dispense the drugs as directed by the physician

• Relatively safe

Extemporaneous compounding prescriptions

 Involves manual process performed for individual orders

 Pharmacists prepare the medication according to drug and dosage form as directed.

 Involves risk

Parts of Prescription

 Date - date should be mention at the time of writing the prescription

- it helps. The pharmacist in re-dispensing a medicine and to guide the patient

- it is also vital for record keeping

 Patient’s information - this includes :

- Name

-Gender

-Age

-Address

 Superscription - Rx

- Abbreviation for the latin word “ recipere” or “recipe” which means, “take thou”
 Inscription - main part of the prescription

- it contains the medications prescribed by the physician (GN, BN, DF, DS)

 Subscription - contains the prescribers direction to the Pharmacist

-it includes type of dosage form to be prepared and number of doses to be dispensed.

 Transcription - prescribers direction to the patient

 Prescriber’s Information - Name, license number, contact number, signature

- prescription must be signed with prescriber’s own hand.

Benefits of Prescription Assessment

• Improving patient safety

• Reducing prescribing costs by reducing unnecessary prescriptions (e.g. antibiotics), making most efficient use of

therapeutic agents, encouraging generic prescriptions within the bounds of bioavailability and reducing polypharmacy

• Improving patient care and management and reducing noncompliance and waste.

Common Problems Encountered when Processing Prescriptions

 Violations

 Incompleteness

 Illegible prescription

 Abbreviation

Illustrating the Application of Key Elements of the Medication Use System™ to Assess Risk

Background

This manual contains modules pertaining to IMP's Key Elements of the Medication Use System™ (table below). These

are the factors that most significantly influence the medication-use process and safe medication use. The
interrelationships among these key elements form the structure within which medications are used. 2,3

ISMP's Key Elements of the Medication Use System™

I Patient Information

II Drug Information

III Communication of drug orders and other drug information

IV Drug labelling,packaging, and nomenclature

V Drug standardization, storage, and distribution

VI medication devices acquisition, use and monitoring

VII Environmental factors, workflow, and staffing patterns

VIII Staff competency and education

IX Patient education
 X Quality processes and risk management

RA 6675 - GENERICS ACT OF 1988

AN ACT TO PROMOTE, REQUIRE AND. ENSURE THE PRODUCTION OF AN ADEQUATE SUPPLY, DISTRIBUTION, USE
AND ACCEPTANCE OF DRUGS AND MEDICINES IDENTIFIED BY THEIR GENERIC NAMES.

 To promote, encourage and require the use of generic terminology in the importation, manufacture, distribution,
marketing, advertising and promotion, prescription and dispensing of drugs;

 To ensure the adequate supply of drugs with generic names at the lowest possible cost and endeavor to make them
available for free to indigent patients;

 To encourage the extensive use of drugs with generic names through a rational system of procurement and
distribution;

III. Common Contributing Factors Involving Communication

Ambiguous directions

Poor handwriting; see Figure III-4

Misread prescription; see Figure III-5

Oral Rx misheard, see below:

"Avinza 60 mg daily"

misheard as:

"Evista 60 mg daily"

Typing mistake (incorrect data entry code or mnemonic)

Poof fax quality; see Fiqure III-6

Incomplete e-Rx

Ambiquous e-Rx; see Fiqure III-7

Prescriber error

Use of previous drug/dose on profile

Wrong drug, wrong dose, wrong route

Use of error-prone sig and drug name abbreviations or dosage designations;

see Figure III-8

Intimidation/faulty interaction with prescriber or agent

Unable to clarify with physician

No policv on how to resolve conflicts on potentiallv unsafe prescriotion orders

 To emphasize the scientific basis for the use of drugs, in order that health professionals may become more aware and
cognizant of their therapeutic effectiveness; and

 To promote drug safety by minimizing duplication in medications and/or use of drugs with potentially adverse drug
interactions.

Prescription Error

 Erroneous Rx- Brand name precedes to generic name

- Generic name is in the parenthesis

-brand name is not in the parenthesis

 Violative Rx

- Generic name is not written

-Generic name is written illegibly

-“NO SUBSTITUTION” is written

 Impossible Rx

- Both generic and brand name are not illegibly written

-generic name does not corresponds with brand name

-Drug prescribes is not registered to FDA

Record Keeping of Prescriptions

Retention Period

 Simple or Ordinary Prescription : 2 years

 Yellow. Prescription : 1 year

FDA Circular No. 2020-007

 All Drugstore/Pharmacy/Botica and similar outlets shall recognize the validity and effectivity of the
electronicprescriptionissuedbythe licensed physician. Prescription containing antibiotic, anti-infectives and/or
antiviral preparations shall be valid for one (1) week after its issuance.

 All Drugstore/Pharmacy/Botica and similar outlets shall strictly dispense drugs as prescribed by the electronic
prescription and the latter shall be deemed equivalent to a written prescription for all intents and purposes.

 All Drugstore/Pharmacy/Botica. and similar outlets shall not require the actual presence of the individual vulnerable
to COVID-19 before dispensing the needed drugs. A duly authorized representative may purchase the said drugs on
behalf of the latter.

 In the event that the patient is a Senior Citizen and/or Persons with Disability, the following should be presented
together with the electronic prescription prior to the dispensing:

-A letter of authorization duly signed by the concerned individual

-Identification card of the senior citizen and/or persons with disability

Module 7: Medication Order
Medication Order
- A medical order written directions provided by a prescribing practitioner for a specific medication to be
administered to an individual.
 Prescribing practitioner may also give a medication order verbally to a licensed person such as a pharmacist or a
nurse.
 Before dispensing the prescription or medication order, the pharmacist’s responsibility is to evaluate the
prescription or medication order for appropriateness
Types of Medication Order
1. STAT ORDER – a single dose of medication that should be administered immediately.
Ex. July 24, 2006 “Demerol 100 mg IM stat”
2. SINGLE ORDER – one time medication, drug is to be given at a certain time.
Ex. 7:00 AM “second 100 mg po hs before surgery”
3. STANDING – drugs is to be given for a certain number of doses or for a certain number of days. it is administered
routinely until order is cancelled by another order.
Ex. Cefaclor 500 mg po tid 7 days
4. PRN – Drug is administered, when necessary, as needed based on the patient’s needs.
Ex. Give Paracetamol 500 mg 1 tab p.o. Q4H PRN for fever.
Prescription
- An order of medication issued by a physician, dentist, veterinarian or other properly licensed medical practitioner
- It contains names and quantities of the desired substances, with written instructions for the pharmacist for the
preparation of the medicine and to the patient for the use of the medicine at a particular time.
Types of Prescription
1. Simple – ordinary prescription
2. Compounded – includes formulation and extemporaneous preparations
3. Polypharmacy – with ten or more than 2 ingredients of the same therapeutic use.
4. Magistral Prescription – prescribed very often by the same doctor of the same ingredients and compounded by
the same pharmacist
5. Coded Prescription (BLIND Rx) – it is consisting of word, symbols to represent the names of the drugs
6. Yellow Rx – contains controlled drug products.
Unethical Rx
1. Erroneous Rx ( Fill, but get the Rx)
 Brand name precedes to generic name
 Generic name is in parenthesis
 Brand name is not in parenthesis
2. Violative Rx
 Generic name is not written
 Generic name is written illegibly
 “NO SUBSTITUTION” is written
3. Impossible Rx
 Both generic name and brand name are not legibly written
 Generic name does not correspond with brand name, drug prescribed and not FDA registered.
Medication error: why it is concern
 The impact of medication safety incidents on patient outcomes includes increased length of stay, disability and
mortality
 Medication errors are estimated to account for at least 7,000 deaths in the United States alone every year
 At least 1 death occurs per day and 1.3 million people are injured each year due to medication errors.
 Medication error is one of the most common causes of unintentional harm in Australia which results in as
estimated 80,000 hospital admissions every year.
Where can medication error occurs?
 Medication error may be related to professional practice, health care products, procedures and systems, including
prescribing order, communication, product labelling, packaging and nomenclature, compounding, dispensing,
packaging, distribution, administration, education, monitoring and use.

Medication Management process

 PRESCRIBING TRANSCRIBING DISPENSING ADMNISTERING

E WRONG DOSE WRONG DOSE WRONG DOSE WRONG DOSE

R WRONG DRUG WRONG DRUG WRONG DRUG WRONG DRUG

R WRONG
ROUTE/FORM
WRONG ROUTE WRONG ROUTE WRONG ROUTE

O ALLERGY WRONG TIME WRONG TIME WRONG TIME

OMITTED

R DRUG
INTERACTION
WRONG PATIENT WRONG PATIENT WRONG PATIENT

S INCPRRECT
LABELLING
INCORRECT
LABELLING
DRUG
INTERACTION
PRIMARY CATCH
FOR ALLERGY

The medication use process

1. Prescribing
- evaluate patients
- Establish need for medicine
- Select right medicine
- Determine interaction and allergies
- Prescribe medicine
2. Transcribing / Documenting
- Transcribing Rx order
- Transmit to pharmacy
3. Dispensing
- Review Rx order
- Confirm transcription
- Contact prescriber for discrepancies
- Prepare medicine
- Distribute medicine
4. Administering
- Review Rx order
- Confirm transcription
- Review warnings, interaction and allergies
- Evaluate patient
- Administer medicine
5. Monitoring
- Assess patient’s response to medicine
- Report and document result.

Module 8 :

DOSAGE FORMS

• Dosage forms are the means by which drug molecules are delivered to sites of action within the body

THE NEED FOR DOSAGE FORMS

 Accurate dose

 Protection (e.g. Coated tablets, sealed ampules)

 Protection from gastric juice

 Masking taste and odor

 Placement of drugs within body tissues

 Sustained release medication

 Controlled release medication

 Optimal drug action

 Insertion of drugs into body cavities to produce local effects

 Use of desired vehicle for insoluble drugs

CLASSIFICATION OF DOSAGE FORMS

1. BASED ON PHYSICAL FORM

 Solid

 Semi-solid

 Liquid

 Gas

I. BASED ON ROUTE OF ADMINISTRATION

 Oral

 Topical

 Rectal

 Parenteral

 Vaginal

 Inhalational

 Ophthalmic

 Otic

Solids

TABLETS

• Hard, compressed medication in round, oval or square shape.

TYPES OF TABLETS

 Compressed tablets- single compression and have no special coating

 Multiple compressed tablets - layered tablets with more than one compression

 Chewable tablets - chewed or allowed to be dissolved in the mouth

 Sugar-coated tablets - to protect the drug from air and humidity and masks offensive taste

 Film-coated tablets - more durable; resistance to chipping

 Enteric-coated tablets - designed to be dissolved in alkaline pH

 Effervescent tablets intended to be dissolved in water, releasing carbon dioxide

 Sublingual tablets - administered under the tongue

CAPSULE

• Medications that are in a gelatin container

TYPES OF CAPSULES

 Hard gel capsules- intended for dry and powdered medications

 Soft gel capsules -primarily used for oils and liquid preparations

GRANULES

 Consisting of solid, dry aggregates of powder particles often supplied in single dose sachets

 Granules are intended to be dissolved in water before taking

OINTMENTS

 Semi-solid, greasy preparations for application to skin, rectum or nasal mucosa

CREAM

 Semi-solid emulsions, that is mixtures of oil and water

SUPPOSITORIES

 Small solid medicated mass, usually cone-shaped, that is inserted either into the rectum (rectal suppository), vagina
(pessaries) where it melts at body temperature

GELS

 Semi-solid system in which a liquid phase is constrained within a 3D polymeric matrix (consisting of natural or
synthetic gum) having a high degree of physical or chemical cross-linking

 Used for a medication or as lubrication purposes

SYRUPS

 It is a concentrated aqueous solution of a sugar, usually sucrose.

 Flavored syrups are a convenient form of masking disagreeable tastes.

SUSPENSIONS

 A suspension is a heterogeneous mixture in which the solute particles do not dissolve, but get suspended throughout
the bulk of the solvent, left floating around freely in the medium.

OPHTHALMIC SOLUTIONS

 Ophthalmic solutions are sterile,free from foreign particles, and prepared especially for instillation into the eye.
Ophthalmic suspensions are sterile liquid preparations that contain solid particles in a vehicle suitable for instillation
into the eye
NASAL DROPS AND SPRAY

 Drugs in solution may be instilled into the nose from a dropper or from a plastic squeeze bottle.

 The drug may have a local effect ( e.g. antihistamine , decongestant )

NEBULES

 Drugs in solution intended to be administered with the use of nebulizer ( liquid- mist to the airways)

 It is commonly used in the treatment of asthma and other respiratory diseases.

GARGLES AND MOUTHWASHES

 Gargles are aqueous solutions used in the prevention of throat infections

 Mouthwashes are similar to gargles but are used for oral hygiene and to treat infections to the mouth

GAS

INHALERS

 Inhalers are solutions, suspensions and emulsions of drugs in a mixture of inert propellants held under pressure in an
aerosol dispenser.

MODULE 9

Community Pharmacy

• Is an establishment for selling of the product (or service) in individual unit to the final consumer for consumption.
Retailers provide service to the consumer on one hand (primary retail role), and on the other hand, serve producers and
wholesalers (secondary retail role).

What is layout and its importance?

• An arrangement or a plan, especially the schematicarrangement of parts or areas

• Importance

- it plays significant role in the development of the consumers

perception which have a positive on its sale potential

Objective of layout design

• To attract a large number of customer

• To increase the sale and decrease the selling expenses

• To have space for reserve for stock, office and resting place for the employees

• Proper entrance for goods

• To minimize the movement of consumers with within the premises of the drugstore

Types of layout design

• Clerk or personal service

-Exposure of product is less

-Maximum interaction between consumer and the pharmacy personnel

• Self-selection

-Consumer may see handle and select items

-For nutritional supplements, cosmetic, contraceptive and OTC medications

• Self-service

-Minimum clerk service

-Maximum exposure of product to consumers

Style of layout designs

• Grid layout

-Products are displayed in straight and parallel lines

• Free flow layout

- Fixture are irregularly shaped such as circles arches and triangle

Grid layout

• Advantages

• More product exposure

• Possibility of self service

• Familiarity with product that can be needed in the future

• Simplified, secured, minimum pilferage

• Maximum utilization of available space

Free Flow Layout

• Advantages

- Allowance for browsing freely

- Increased impulse purchases

- Visual appeal and flexibility

• Disadvantages

-Loitering encouraged

- Possible confusion

- Waste of floor space and costly

- Possible pilferage

DOH Administrative Order No. 2014-025

• Regulations on the Licensing of Drugstore/ Pharmacy/ Botica and Similar Outlets following Administrative Order No.
2014-0034, dated 13 October 2014

• Picture of Drugstore with Display of Signage

-A picture of the drugstore with signage bearing the name of the establishment consistent with the submitted proof
of business name registration must be submitted

• Specifications

1. A signboard in front of the place of business bearing the registered name of the drug store. For hospital pharmacy, the
sign "Pharmacy" is sufficient. For drug outlet selling exclusively non-prescription or Over the Counter (OTC) drug
product, the signboard should indicate so by putting the symbol non-Rx or its equivalent.

2. A well-ventilated area not less than 15 sq. m. in floor area with

concrete, tile or wooden flooring.

3. A place suitable for compounding prescription and for washing

4. A suitable and proper place for the adequate storage of drugs and biological products as specified on the label.

5. A suitable cabinet for keeping poisons and/or dangerous drugs.

6. An adequate water supply.

FDA COMPLIANCE REQUIREMENTS

 Clinical pharmacy services section/patient counseling section

 Stocks arrangement

 Pharmacy logbooks and records

 Compounding section

 Arrangement of stocks

MODULE 10 : Stockroom and Delivery Process, Therapeutic Classification of Drugs

INTRODUCTION :

 Good Storage Practice (GSP)

- Good Storage Practices are that part of quality assurance that ensures that the quality of pharmaceutical
products is maintained by means of adequate control throughout the storage thereof.

 Good Trade and Distribution Practices (GTDP)

-Good trade and distribution practices are that part of quality assurance that ensures that the quality of
pharmaceutical products is maintained by means of

adequate control throughout the numerous activities which occur during the trade and the distribution process.
 Distribution is an important activity in the integrated supply chain management of

pharmaceutical products. Various people and entities are generally responsible for the handling, storage and
distribution of such products.

 Guidelines are intended to apply all of the following steps in the distribution and supply chain.

 The storage, trade and distribution of pharmaceutical products are carried out by various companies, institutions and
individuals.

 Principle of GMP are applied, of which includes storage, distribution, transportation, packaging, labelling,
documentation and record-keeping practices.

GOOD DISTRIBUTION SYSTEM AND GOOD STORAGE PRACTICE

1. Premises

2.. Security

3. Temperature and humidity control

4. Equipment

5. Personnel

6. Sanitation

7. Receipt of incoming goods

8. Warehousing and Dispatching

9. Transport

PREMISES

-Premises should be of suitable size and construction to facilitate cleaning, maintenance and orderly,

segregated storage

-Storage areas must be designed to provide adequate:

 Illumination
 Ventilation

 Temperature

 Sanitation

 Humidity

 Space

 Security conditions

TEMPERATURE AND HUMIDITY CONTROL

 All materials must be stored at appropriate conditions as stated on the label of the material

 The temperature of all storage areas should be regularly monitored

 Controlled temperature storage areas should be equipped with recorders and devices which indicate when the
specific temperature range has no been maintained

EQUIPMENT

 A computerized system is used for stock control, inventory management and distribution should be validated.

PERSONNEL
 Personnel should be trained in relation to good storage and distribution practice and to the duties assigned to them.

SANITATION

 A written sanitation program should be in place indicating the frequency and method of cleaning.

 A pest control should be in place.

 Eating and drinking should be permitted only in segregated areas and not i those areas used for storage and handling
of drug products.

RECEIPT OF INCOMING GOODS

 It should be carried out to approved adequate SOP

 Visually examine delivery documents of the consignment. (e.g. sales invoice) The documents should be essentially
consists of the following information (Name of material, Name of the information (Name of material, Name
Distributor, Batch number, Manufacturing Date, Expiry Date, Quantity)

 If any discrepancies and rejected materials unfit for retail, the supervising pharmacist informs the supplier

WAREHOUSING AND DISPATCH

 It should be carried out according to approved adequate SOP

 Storage area should be maintained or designed to good storage practice

 Storage area should be suitably secured and of sufficient capacity to allow for the safe storage and handling

 Storage area should be clean and dry maintained within acceptable temperature limit

 Records of temperature monitoring data should be kept and available for review

DOH Administrative Order No. 2013-0027

 Adoption and Implementation of the World Health Organization Annex 5 Guide to Good Distribution Practices (GDP)
for Pharmaceutical Products, and Annex 9 Guide to Good Storage Practices for Pharmaceuticals

 In order to maintain the original quality of the product, every activity in the distribution of pharmaceutical products
should be carried out in the principles of Good Manufacturing Practice (GMP), Good Storage Practice (GSP) and Good
Distribution. Practice (GDP).

SOP- RECEIVING DELIVERIES

1. All invoices from the supplier must be verified by the inventory staff prior receiving and must follow the following
guidelines

 The invoice must be addressed to Morales Pharmacy

 Print the P.O. and validate versus the Sales Invoice

 Only the supervising pharmacist is allowed and authorized to receive any type of delivery

 Upon receiving the validated invoices, pharmacy personnel will prepare the items for checking

 Pharmacy personnel will check the delivered items using the following criteria (Medicine description, Dosage form,
Dosage strength, dosage volume and quantity)

 Check the expiration Date. The standard receiving date must be at least 1 year and above.

 Check quantity. Received quantity should be reflected in the delivery invoice. If there are any discrepancy n the
invoice versus on the delivery stocks, notify supervising pharmacist to call the supplier.

 Storage condition. Pharmacy personnel must observe proper storage of items received.

- Controlled room temperature - items not requiring to be refrigerated should be placed in a temperature of
15-25 degrees celsius.

 Delivery invoice must be posted within 24 hours using BitPOS inventory system.

 All prices discrepancy in the invoice versus system will be procures by the supervising pharmacist.

 All delivery invoice will be kept for the future reference.

MATERIAL MANAGEMENT —— Stocking——Coding

 Material management is a basic function of the business that adds value directly to the product itself. Material
management is the planning, directing, controlling and coordinating the activities concerned with materials and
inventory requirement from the point of their inception to their introduction into the manufacturing process.
OBJECTIVES OF STOCKING

 Easy location of the items in the store

 Proper identification of items

 Speedy issue of materials

 Efficient utilization of space

ARRANGEMENT OF DRUGS IN DRUGSTORES

1. According to distributor/supplier

2. According to therapeutic use

3. Alphabetical order

4. As per old stock date of expiry

FIRST IN/FIRST OUT

A distribution procedure to ensure that the oldest stock is distributed and/ or used before a newer and
identical stock items is distributed and /or used.

CODING OR CODIFICATION

 It is the process of assigning a code number or code symbol to a particular material for easy identification.

 There should be placed for everything and it should be place at their right place. Therefore code numbers are
allocated to various items to facilitate easy identification.

METHODS OF CODIFICATION

1. Alphabetical order method- in this method, coding letter assigned to each items so that they can be very easily
identified.

2. Mnemonic method - coding letters assigned to each items.

3. Numerical method - AKA sequence method

4. Combination method - both mnemonic and numerical methods are used to assign drugs.
Module 11: Dispensing Materials

Commonly Used Dispensing Materials

 Compounding Equipment’s
 Mortar and Pestle
 Spatula and Pill tile
 Dropper
 Graduated cylinder
 Forceps
 Parchment paper
 White Label
 Actual Prescriptions
 Prescription Record Books
 Drug Information Resources

Module 12: Over-the-Counter Medicines

Over-the-Counter Medicines

- non-prescription drugs

- can purchase without a medical prescription

- safe and effective

- need to follow directions on medical label and as directed by medical practitioners

Fast Moving Medicines

Generic Name: Oral Rehydration Salts

Brand Name: Hydrite

Dosage Strength: 4.1grams

Dosage Form: Granules for Solution

Indication: Electrolytes Modifiers

Generic Name: Sodium Ascorbate + Zinc

Brand Name: ImmunPro

Dosage Strength:500mg/10mg

Dosage Form: Capsule

Indication: Vitamins & Minerals

Generic Name: Ibuprofen

Brand Name: Advil

Dosage Strength: 200mg

Dosage Form: Capsule

Indication: Analgesic/Anti-pyretic

Generic Name: Ibuprofen + Paracetamol

Brand Name: Alaxan FR

Dosage Strength: 200mg/325mg

Dosage Form: Capsule

Indication: Analgesic/Anti-pyretic

Generic Name: Carbocisteine

Brand Name: Solmux

Dosage Strength: 500mg

Dosage Form: Capsule

Indication: Mucolytic

Generic Name: Phenylephrine HCl + Chlorphenamine Maleate + Paracetamol

Brand Name: Bioflu

Dosage Strength: 10mg/2mg/500mg

Dosage Form: Tablet

Indication: Decongestant/Anti-histamine/Anti-pyretic

Generic Name: Phenylephrine HCl + Chlorphenamine Maleate + Paracetamol

Brand Name: Symdex-D

Dosage Strength: 25mg/2mg/325mg

Dosage Form: Tablet

Indication: Decongestant/Anti-histamine/Anti-pyretic
 Generic Name: Paracetamol (Top 1 OTC Drug)

Brand Name: Biogesic

Dosage Strength: 500mg

Dosage Form: Tablet

Indication: Analgesic/Anti-pyretic

Activity 13: Patient Counseling on Anti-Diarrheal Drugs

Priority Services in the Community Pharmacy:

 Patient Counseling
 Consultation
 Good Dispensing Practice

Patient Counseling

 Focusing to the patient and drugs

 Directly with the medical issue and medication prescribed
Consultation

 Focusing to the patient and drugs

 Providing strategies or ideas to a patient who will use the medication

Ideal Steps in Patient Counseling:

1. Acknowledge the patient. Establish caring relationships with patients.

2. Assess the patient’s knowledge about his or her health problems and medications.
3. Provide information orally and use visual aids or demonstrations.
4. Verify patient’s knowledge and understanding of medication use.

DIARRHEA

- increase gastro-intestinal tract motility and decreased absorption of fluids.

Causes:
 Sanitation
 Dirty Water
 Crowding
 Nutrition
 Medications
 Bacteria, Viruses, and Parasites
 Cohabitation with Animals
Symptoms:

 Abdominal pain and Cramps

 Nausea
 Fever
 Loose, Watery Stools

Acute Diarrhea

- common problem

- lasts a short time

- one to two days and goes on its own

Chronic Diarrhea

- last at least 4 weeks

- can be symptoms of chronic disorder

- may come and go

Anti-Diarrheals

- anti-motility

- adsorbents

- fluid and electrolytes modifiers/home remedies

Anti-Motility Drugs:
 Loperamide
 Diphenoxylate

Adsorbents:

 Aluminum Hydroxide

Fluid and Electrolytes Modifiers:

 Bismuth subsalicylate
 ORS

Ideal Patient Counseling:

- stay hydrated

- take an OTC medicines

 - eat bland diet

Patient Counseling on Laxative Drugs

Constipation

- action in which bowel movements become less frequent and stools become difficult to pass.

Reasons:

 Drinking insufficient water

 Unhealthy diet
 Medicine
 Pregnancy
 Stress
 A charge of scenery
 Age
 Sedentary lifestyle

Laxatives

 Bulk-forming Laxatives
 Psyllium
 Methylcellulose
 Osmotic Laxatives
 Glycerin
 Lactulose
 Stimulant Laxatives
 Bisacodyl
 Senna
 Castor oil
 Stool softeners
 Docusate
Key notes:

 Safe to use for elderly: BULK-FORMING LAXATIVES

 Not safe to use for Pregnant Women: STIMULANT LAXATIVES
 Patients who should not strain such as Post-Natal, Post-Surgical, Hemorrhoids, Hernias: STOOL SOFTENERS.

Module 14: Patient Counseling on Common Cold

Ideal Steps in Patient Counseling:

1. Acknowledge the patient. Establish caring relationships with patients.

2. Assess the patient’s knowledge about his or her health problems and medications.
3. Provide information orally and use visual aids or demonstrations.
4. Verify patient’s knowledge and understanding of medication use.

Common Colds

- inflammation of the nasal passages caused by any member of respiratory viruses

 - Cold may also involve the sinuses, ears and bronchial tubes

Risk Factors:

 Exposure to infected individuals.

 Touching the nose with contaminated fingers.

Management:

1. Avoid close contact with people who have cold/s.

2. Wash hands frequently.
3. Keep hand away from eyes and nose.
4. Use disposable tissue instead of handkerchief.
5. Cover mouth and nose when coughing or sneezing.
6. Avoid emotional stress, short rest and poor nutrition.

Commonly Prescribed OTC Drugs for Common Colds:

 Decongestants
- temporary relief of nasal congestion

- 3-5 days only

OTC Drugs:

 Phenylephrine
 Phenylpropanolamine
 Sodium Chloride
 Antitussives
- relieve dry, hacking cough associated with colds and flu

OTC Drugs:

 Butamirate citrate
 Dextromethorphan
 Demulcents
- hard or menthol candy

- soothes an irritated throat and bronchial passage

OTC Drug:

 Vicks Candy
 Expectorants and Mucolytics
- loosen and clear mucus and phlegm from the respiratory tract.

- no evidence that they may improve lung function

OTC Drug:

 Ambroxol HCl
 Bromhexine
 Carbocisteine
 Guaifenesin
Patient Counseling on Cough

Cough

- body’s reflex to remove mucus or irritants such as dust and smoke, from the throat and lungs.

- Acute Cough: less than 3 weeks

- Chronic Cough: beyond 3 weeks

Causes:

 Wet Cough - happens when your respiratory system produces mucus.

 Chesty Cough - triggered by excessive mucus in the lungs and lower airways, and you may have difficulty
expectorating.
 Dry Cough - typically happen when airways are inflamed or irritated.
Risk Factors:

 Asthma and or Cystic Fibrosis

 Smoking
 Use of medications such as Ace Inhibitors
 Exposure to dust and smoke.
Management:

 Avoid or quit smoking

 Drink plenty of fluids to avoid hydration and loosen mucus
 Drink warm liquids such as tea or hot water with lemon to sooth the throat.
 Increase number of pillow in sleeping at night for easier breathing
 Consult a doctor if the cough is due to underlying issue or side effects of medication
Commonly Prescribed OTC Drugs for Cough:

 Antitussives
- relieve dry, hacking cough associated with colds and flu

- not recommended with plenty of sputum

OTC Drugs:

 Butamirate Citrate
 Dextromethorphan
 Expectorants
- decrease the thickness and stickiness of mucus by increasing airway water or secretion

OTC Drug:

 Guaifenesin
 Mucolytics
- also decrease the stickiness of cough by destroying the structure of mucus.

OTC Drugs:

 Ambroxol HCl (CAUTION: Pregnant women, also it is excreted in breastmilk and should not be taken
during lactation.
 Lagundi Leaf
- herbal preparation

- can be used in mild to moderate cough

- usually indicated for cough due to asthma

 OTC Drugs:

 Brand Name: ASCOF

 Brand Name: Plemex
Home Remedies for Cough

 Turmeric water
 Hot ginger tea and honey
 Saltwater gargles
 Honey lemon water
 Soup
 Mint tea
Ideal Content of Patient Counseling

 Get hydrated/Proper management/Home remedies

 Take OTC medicines
 Consult a Physician

Module 15: Management of Cold Chain Drugs

Cold Chain Pharmaceutical Products

- this includes modern biologic therapeutics such as monoclonal antibodies and vaccines, cellular and gene
therapies, certain types of insulin, and some cancer treatments.

The process of maintaining the safe temperature range of +2℃ to +8℃ (+35F and +46F) for drugs during the transport,
storage, and handling.

The cold chain is starting at the medicine manufacturer up to the last mile delivery (Patient).

Bio Pharmaceutical/Medical Refrigerator

- used by Community Pharmacy who are having minimal stock of vaccines and biological products only.

- the optimum temperature for refrigeration must be maintained between +2℃ to +8℃ (+35F and +46F).

Cold Chain Products:

 Vaccines
- reduce risks of getting a disease by working with your body’s natural defenses to build protection.

- require an unbroken cold chain.

- Vaccines for tetanus or hepatitis B must be cooled, others are strictly restrained from being stored and
transported at +2℃ to +8℃.

- Example: MMR, Covid-19 Vaccines

CoVid-19 Vaccines
  Covid-19 vaccines validated for use by WHO given Emergency Use Listing
 Recommended for use based on all the available data on safety and efficacy and on its suitability in low- and
middle income countries.
 Assessed to ensure they meet acceptable standards of quality, safety and efficacy using clinical trial data,
manufacturing and quality control processes.

As of 12 January 2022, the following vaccines have obtained EUL:

The Pfizer/BioNTech Comirnaty Vaccine 31 December 2020

CoVid-19 The SII/COVISHIELD and AstraZeneca 16 February 2021 Vaccine
Storage /AZD1222 vaccines

The Janssen/Ad26.COV 2.S vaccine developed by 12 March 2021

Johnson & Johnson

The Moderna COVID-19 vaccine (mRNA 1273) 30 April 2021

The Sinopharm Covid-19 Vaccine 7 May 2021

The Sinovac- CoronaVac Vaccine 1 June 2021

The Bharat Biotech BBV 152 COVAXIN vaccine 3 November 2021

The Covovax (NVX -CoV2373) vaccine 17 December 2021

The Nuvaxovid (NVX-CoV2373) vaccine 20 December 2021

Temperatures:

 +2℃ to +8℃.( Sinovac, AstraZeneca, Johnson&Johnson, Sinopharm )

 Frozen -25℃ to -15℃ (Moderna - can be stored at +2℃ to +8℃ for up to 31 days after thawing)
 Frozen at -90℃ to -60℃ (Pfizer
- can be stored at +2℃ to +8℃ for up
to 31 days after thawing)
  Glaucoma Eye Drops
- eye drops used in managing glaucoma decrease eye pressure by helping the eye’s fluid to drain better
and/or decreasing the amount of fluid made by the eye.

- NOTE: most eye drops are fine to store temperatures between 40 to 60 degrees Farenheit once they
are opened.

 Insulin (Diabetes Treatment)

Diabetes - a metabolic disorder characterized by high blood sugar levels.

 Type I - characterized by the loss of insulin-producing cells, leading to insulin deficiency.

 Type II - described by insulin resistance. It can be developed by a combination of genetics and
lifestyle factors: Obesity, lack of physical activity, poor diet, stress and urbanization.
Insulin

- a hormone created by your pancreas that controls the amount of glucose in your bloodstream
at any given moment. It also helps store glucose in your liver, fat, and muscles.

- tempearture-sensitive insulin are susceptible to any variations in temperature:

hot or cold

- they must never be exposed to heat higher that +8℃ or less than +2℃, as they can become
inactive or even toxic.

Types of Insulin:

 Rapid-Acting
- Lispro (Humalog)
 Short-Acting
- Regular or Novolin

 Intermediate-Acting
- NPH (N) Humulin N

- Neutral Protamine Hagerdon

 Long-Acting
- insulin Glargine (Lantus)

 Premixed/Combined
- Humulin 70/30

- Humalog Mix 75/25

 Biologicals/Biopharmaceuticals
- pharmaceutical drug products that are extracted from organic sources
 - Essential Biologicals - are for example blood components, organs, and tissue transplants or stem cell
therapy.

- Effect faster and stopping the disease progress

- Biological therapy for cancer is used in the treatment of many types of cancer.

- Sensitive to temperature and must be stored at +2℃ to +8℃.

 Anesthesias
- medical treatment that keeps you from feeling pain during procedures or surgery

- the medications used to block pain are called anesthetics

- anesthetic medications numb certain parts of the body, while other medications numb the brain, to
induce a sleep through more invasive surgical procedures, like those within the head, chest or abdomen.

- Sensitive to temperature and must be stored at +2℃ to +8℃.

Types of Anesthesia

 Local Anesthesia
- Lidocaine (Xylocaine)

 Regional Anesthesia
- Epidural

 General Anesthesia
- Propofol

 Sedation
- Isoflurane

Community Pharmacy

- to be able to get a License to Operate (LTO), all establishments have to be compliant and prove that they are
capable of handling vaccines and biological products.

- must have the proper cold chain drug monitoring procedures

- maintenance and proper cleaning procedures of Bio/Medical Refrigerator.

MODULE 16

IMMUNIZING PHARMACISTS

OBJECTIVES

 Explain the importance of immunization, its evidence-based benefits and impacts on public health.
 Differentiate the immunobiological in terms of functions and examples.
  Identify vaccines available in the Philippine market. describe their features and also identify precautions and
contraindications related to their use particularly influenza and pneumococcal vaccines
 Evaluate patient vaccination needs
 Explain the recommended immunization schedules o Ensure vaccine safety through an adverse event reporting
 Explain the appropriate techniques for Intramuscular administration of vaccines

EXPANDED SERVICES

A. Adult vaccination services of Pharmacists

INTRODUCTION

The Food and Drug Administration of the Philippines released an advisory of its plan to authorize Community
Pharmacists in the Philippines to administer vaccines last September 9, 2014.

2. EXPANDED SERVICES

A. Adult vaccination services of Pharmacists

ROLE OF PHARMACIST IN VACCINATION

The Pharmacist will also be able to assist in the important vaccine decisions that are considered part of the
global standards such as recognition of:

(a) The specific disease burden of the country

(b) Assessing severity of the disease

(c) Evaluating vaccine effectiveness and (d) Vaccine safety

The Expanded Program on Immunization (EPI) in the Philippines started in:

1. BCG (started in 1976)

2. DPT

3. oral polio vaccine

4. Tetanus toxoid.

TRAINING AND OBJECTIVES

A. REQUIREMENTS:
 1. Pharmacist should hold a Certificate of Training under a PRC accredited institution, to administer adult
vaccines.

1. Safer administration of adult vaccines

2. management of adverse event following immunization (MEFI)

2. Drugstores should apply for Variation of their License to Operate, to conduct other activities like Adult
Vaccination.

3. Ensure that the vaccine to be administered shall have a doctor's prescription which not more than seven (7)
days old

4. Submit a monthly vaccination report and AEFI report to DOH regional offices using the prescribed form

B. TRAINING

The Food and Drug Memorandum indicated the following modules for the training course

(a) Safe injection techniques,

(b) Cold chain management of vaccines and other biological products

(c) Pharmacovigilance; including recognition reporting of adverse event following immunization (AEFI)

(d) Management of anaphylaxis, in the rare case it occurs

C. OBJECTIVES

(a) Explain the expansion of the role of pharmacists as vaccine providers and describe the status of pharmacists'
authorization to administer vaccine in the Philippines

(b) Demonstrate an understanding of the diseases where vaccination applies including its etiology, clinical features and
epidemiology

(c) Discuss and compare available adult vaccines in the Philippines, including dosage and route of administration and
describe important considerations when deciding which vaccines to offer

(d) Identify who are eligible to receive adult vaccination under the Philippine schedule of vaccination and recognize the
implications for a pharmacy immunization service
(e) outline clinical features of the most common adverse events following immunization and the appropriate
management of these events

(f) Demonstrate the skills necessary in immunization delivery and

(g) Educate patients about the benefits of vaccines and address common concerns about vaccines:

Immunization Program Benefits

A. Prevention of Infection and infectious disease

The hepatitis vaccine which has been shown to provide 90% protection against both symptomatic and
asymptomatic infection (Innis, et al. 1994)

B. Control of Mortality, Morbidity and Complications

B.1 Pre-exposure administration B.2. Post exposure administration

B. Control of Mortality, Morbidity and Complications

 It was estimated that vaccines can annually prevent almost 6 million deaths worldwide (Ehreth, 2003)
 Vaccines for measles were also found to be protective against multiple complications such as dysentery,
bacterial pneumonia, keratomalacia and malnutrition (Strebel, Papania and Halsey, 2004)

C.Protection of Unvaccinated Population

D. Societal and Economic Benefits of Immunization

Globally, the direct savings alone from vaccines have been estimated to be at around 10 billion US dollars
(Ehreth, 2003)
E. Preventing Development of Antibiotic Resistance

Conjugate Pneumococcal vaccine for infants in the US which resulted in a 57% decline in invasive disease caused
by penicillin-resistant strains and a 59% decline in strains resistant to multiple antibiotics by 2004. (Kyaw, et al)

Types of Immune Responses

A. Humoral Immune Response

B. Cellular Immune Response

STRAINS OF MICROORGANISMS

LIVE ATTENUATED INACTIVATED SUB UNIT TOXOID

 Polio (oral)  Japanese encephalitis  Hepatitis B  Diphtheria

 Typhoid (oral)  Tick-borne  Malaria  Tetanus
 Influenza (nasal spray) encephalitis  Typhoid  Pertussis
 Japanese encephalitis  Influenza (shot)  Pneumococcal
 Dengue  Polio (shot)  Human
 Yellow fever  Cholera papillomavirus
 Measles  Rabies  Meningococcal
 Mumps  Typhoid meningitis
 Rubella  Hepatitis A  Haemophilus
 Varicella influenza type B
 Cholera
 Rotavirus
 Tuberculosis
Vaccine-Preventable Disease

- Influenza
- Pneumococcal Disease
 INFLUENZA
 o Infectious agent – influenza virus is a single stranded helically shaped, RNA virus of the orthomyxovirus
family.
o Influenza A virus – Viruses can be further broken down into different strains (H1, H2 and H3)
o H1N1 and H3N2 – influenza A virus found in human
o Influenza B – are not divided into subtypes; but can be further broken down into lineages and strains
o B/Yamagata and B/Victoria
o Influenza C – is rarely reported as a cause of human illness, probably because most cases are subclinical.
o Reservoir – humans and animals
o Transmission – person to person vial large virus-laden droplets or direct/indirect contact with
respiratory secretions
o Risk Factors: 65 years old, young children. Person with underlying medical conditions.
 Influenza Vaccines
o Inactivated influenza vaccine (IIV)
a) Trivalent Influenza Vaccine
b) Quadrivalent Influenza Vaccine
 Potential Adverse Reactions After Vaccination
o Local Reactions
o Fever, chills, Malaise and myalgia
o Rarely immediate hypersensitivity Reactions
 Considerations for patients with EGG ALLERGY - CDC and its advisory committee on Immunization
Practices recommends that people with EGG ALLERGY who received the vaccine. NO LONGER
NEED TO BE OBSERVED FOR 30 MINUTES FOR AN ALLERGIC REACTION.
o Live Attenuated Influenza Vaccine (LAIV)
 This vaccine which was approved in 2003, contains the same viruses as in Inactivated Influenza
Virus and is provided in a single dose sprayer unit designed to deliver half dose in each nostril
 Potential Adverse Reactions After Vaccination
o Cough, runny nose, nasal congestion and chills

THE IMMUNIZING PHARMACIST

Timing of Vaccine Administration

o Patients receiving antibody – containing Blood products

 Inactivated Vaccines
 Live Injected Vaccines
o Vaccines that are administered on the same day and on different days.
 LIVE + Inactivated Vaccines
o Vaccines that are administered on the same day and on different days
 Live Parenteral vaccines + Live attenuated Influenza vaccine.
 Live parenteral + Live parenteral
o Screening Patients Prior to Vaccine Administration
 Contraindication
 Precaution
o Permanent Contraindication to Receiving Vaccines Per CDC
 Severe Allergic Reaction
 Previous dose
 Egg protein
o Two Temporary Precautions to receiving live vaccine
 Pregnancy
 Immunosuppression
Administration of Vaccine

o Pharmacist Training
o Infection Control
o Proper Vaccine Preparation
o Administration and Disposal
o Proper Patient Care

 PHARMACIST TRAINING
o Licensed Pharmacist
o Certified Immunizing Pharmacist
o Patient Care Prior to Administering Vaccines
 Immunization Record
 Patient Screening
o Patient Care During Vaccination
 Help ease and relieve anxiety
 Positioning and comforting restraint
 Pain management
o Patient Positioning and comforting restraint
 Have patient sit during vaccination
o Pain Management
 Avoiding aspiration during vaccine administration
 Administering most painful vaccine last
 Rubbing or stroking the skin near the injection site
 INFECTION CONTROL
o Hand hygiene
o Gloves
o Equipment disposal
o Preparation of the vaccine
 Equipment Selection
 Syringe – 1ml or 3 ml
 Needle – gauge 22-25
 Vaccine Preparation
 Inspection of the vaccine
 Reconstitution
 Beyond use date
 Filling syringe
1. Gather supplies needed
2. Remove the cap from the vial exposing the rubber stopper.
3. Clean the rubber stopper with an alcohol prep pad for 7 secs
4. Remove the syringe from its package
5. With the needle cover still on the needle, pull back on the plunger and pull air
into the syringe
6. Place the medicine vial on a flat surface and insert the medicine straight through
the rubber stopper.
7. Push the plunger of the syringe down and inject air into the vial.
8. Keeping the needle in the vial, turn the vial upside down and make sure the
needle is in the liquid medicine.
9. Check for air bubbles in the syringe
10. Take the needle out of the vial. Carefully recap the needle.
 Steps for administration
1. Locate and clean the injection site
2. Insert at a 90-degree angle with a quick thrust
3. Depress the plunger to administer vaccine
 4. Withdraw the needle and apply light pressure for a couple of seconds on
injection site using a cotton ball or gauze
5. Activate safety shield of the needle (if available) and dispose in sharps container
o Documentation
 Name of the vaccine administered
 Lot number
 Expiry date
 Manufacturer of the vaccine
 Site of administration
 Dosage
 Name, title and signature of immunizer
 Name and address of facility where patient was immunized and where a record is kept.

PATIENT ON THE USE OF DRUGS FOR COMMON SKIN DISORDERS

OBJECTIVES:

At the end of the session the students will be able to:

1. demonstrate competence on the counselling of patients and efficient and effective communication skills.

PATIENT COUNSELING IN THE COMMUNITY:

o
Lack of expectation by customers for counseling and advice SHOULD NOT BE A BARRIER
o
Counseling on medication is not optional but an INTEGRAL PART OF THE DISPENSING of a
prescription
o Pharmacists must ensure that they are VISIBLE and ACCESSIBLE in community pharmacies to provide
it.
FACTORS WHICH NECESSITATE PATIENT COUNSELING

o Increase in drug use-related problems

o Increase in the number of drugs
o Increase in the number of drug regimens
o Inappropriate prescribing
o Increase in self-medication practice
o Increase in the use of alternative medicines
PREPARING FOR THE COUNSELING SESSION

o Pharmacists should spend FEW MOMENTS MENTALLY preparing for the interchange that is about to occur
o Determine the PHYSICAL STATE OF THE PATIENT
o Have as MUCH INFORMATION as possible about the patient
o Review the PRESCRIPTION AND PATIENT’S MEDICATION RECORD
PROCESS

1. Introduce yourself and identify the patient

2. Ask the patient to talk with you about the medication. Explain the purpose and the importance of the counseling
session
3. Update the patient’s medication profile
4. Assess what the patient already knows about the newly prescribed drug and the reason it was prescribed.
5. Assess whether the patient know how to take the medication
6. Assess the patient’s understanding of what to expect from medication including the expected outcomes of the
therapy as well as its potential adverse effects
7. Ask the patient if he or she has any concerns or questions that have not been addressed in the previous
discussion
8. Check patient understanding of the information discussed in the counseling session
 9. Close the session

CONTENT OR SCOPE OF PATIENT COUNSELING

Any counseling episode may contain one or more of the following information as deemed appropriate:

1. Trade name or generic name of drug

2. Use, action and onset of action
3. Route, dosage form and storage
4. Direction for use
5. Action in case of missed dose
6. Precautions
7. Side effects and adverse effects
8. Techniques for self-monitoring
9. Potential drug interactions
10. Contraindications

Introduction:

Pharmacist are qualified healthcare professionals who can offer clinical advice and over-the-counter medicine
for a variety of minor conditions and illnesses, including some skin problems.

Common Skin Disorders

 Dry Skin
 Acne
 Psoriasis
 Fungal Infections
 Dermatitis

SKIN

Skin has three layers:

o The epidermis
o The dermis
o The deeper subcutaneous tissue (hypodermis) is made of fat and connective tissue
Functions:

 Protection
 Secretion
 Sensation
 Heat regulation
 Excretion
 Absorption

DRY SKIN

 A.K.A XEROSIS
 Dry skin (xerosis) is a minor health condition that seldom has serious underlying causes.
 Prevalence of xerosis – everyone will experience xerosis at sometime or other, and most either ignore it
or self-treat.
  Normal Epidermal Turnover
o Its outer layer (stratum corneum) is composed of dead skin cells that act as a barrier against
dehydration of living layers that lie beneath
o Corneocytes are surrounded b an intercellular substance or “cornified envelope”. Composed of
a set of cross-linked proteins (e.g., filaggrin, Loricin) and lipids.
 Risk factors for xerosis
o Age
o Racial background
o Moisture ambient air
 Sequelae of Dry Skin
o Patients scratch the skin obsessively to relieve pruritus, they can excoriate areas that are easily
accessible, such as the torso, lower back, arms and legs.
 Non-Pharmacologic Management
o They should avoid outside activities that expose them to dry air and cold wind
o Pharmacists should advise patients that soap worsens dry skin
o Following the bath, patients should avoid powders on the skin, as they further dry the stratum
corneum
o Clothing can be treated to reduce dry skin damage
 Goal
o Dry skin treatment should reduce skin dryness, irritation, and pruritus, as well as enhance the
skin’s appearance and protective function by restoring the barrier.
 Pharmacologic intervention
o Dry skin is referred to as EMOLLIENTS or MOISTURIZERS
o Smooths and softens rough skin, increasing its capacity to retain moisture and reducing
inflammation and irritation
ACNE VULGARIS
 a common chronic skin disease involving the blockade and or inflammation of the pilosebaceous units.
 Pathophysiology
o Follicular hyper keratinization > increased keratinocyte proliferation and cohesion > formation of ostium
follicular plug > accumulation of keratin, sebum and bacteria > widening of hair follicle > increased
keratin filled microcomodones
 Clinical Presentation
o Noninflammatory Lesions
 Open comedone is a plug of sebum, keratinocytes and microorganism blocking a dilated hair
follicle opening
 Close comedone or whitehead is a similar plug blocking a closed hair follicle opening to the
surface of the skin.
 Grade I: Multiple open comedones
o In comedonal acne, patients develop open and closed comedones but may not develop inflammatory
papules or nodules
 Grade II: Closed Comedones:
o Mild Acne: Characterized by comedones and a few papulopustules
 Grade III: Papulopustules Moderate Acne:
o Has comedones, inflammatory papules and pustules; greater number of lesions are present than in
milder inflammatory acne.
 Grade IV: Multiple Open Comedones, Closed Comedones and Papulopustules, Plus Cyst
o Nadulocyctic acne: characterized by comedones, inflammatory lesions and large nodules greater than 5
mm in diameter. Scarring is often evident.
 Clinical Presentation
o Inflammatory lesions
 A PAPULE is a well-defined, elevated, palpable, distinct area of skin generally less than 1 cm in
diameter involving the epidermis and/or dermis
  Papules may not have a change in skin color, but are always raised and can have variable
textures.

 Frequency
o Race: Darker skin is more prone to post inflammatory hyperpigmentation
o Gender: During adolescence, acne vulgaris is more common in male that in females. In adulthood it
becomes more common in women than in men.
o Age: New born: neonatal cephalic pustulosis, when new born is still under the influence of maternal
hormone and when androgen- producing portion of the adrenal gland is large.
 Adolescents Acne: begins in the onset of puberty, when gonads begin to produce and release
mor androgen hormone 12 % of women and 5% men age 25 years have acne. By 45 years old,
5% of both men and women still have acne.
 Causes
o Genetic predisposition
o Cosmetic agents and air pomades may worsen acne
o Steroids, lithium, some anti-epileptic drugs and iodides
o Endocrine disorder triggering excess androgen releases
o Mechanical occlusions like headbands, back packs. Underwire bras
o Excessive sunlight may improve or worsen. In any case, UV exposure ages skin.
 General Approach to treatment
o TOPICAL TREATMENT forms include creams, lotions, solutions, gels. And disposable wipes.
o Responses to different formulations can be dependent on skin type and individual preferences
o Oily to normal skin types can tolerate gels, solutions, and lotions
o Normal skin can tolerate gels, solutions, lotions and creams
o Normal to dry skin can tolerate lotions and creams.
 Non-pharmacological treatment
o Cleansing has minimal effect. Scrubbing could not affect comedones; too deep.
o Scrubbing could also lead to skin irritation
o To avoid skin irritation and dryness during some acne therapies, it is important to use gentle nondrying
cleansing agents.
 Pharmacologic Therapy
o First-line therapies
 Benzoyl peroxide
 Non-antibiotic antibacterial agents.
 Increases sloughing rate of epithelial cells; loosens follicular plug; thus, can be comedolytic.
 No P.acnes resistance

FUNGAL INFECTIONS

o Fungal infections of the skin, hair, and nails caused by fungi call DERMATOPHYTES.
o The causative fungi in fungal infections of the skin are trichiphyton.
o Microsporum and Epidermophyton.
 Fungal infection symptoms
o Irritation
o Scaly skin
o Redness
o Itching
o Swelling
o Blisters
 Types of fungal infections
o Athlete’s foot
o Jock itch
o Ring worm
 o Yeast infection
 Athlete’s Foot
o Athlete’s foot, also called tinea pedis, is a Fungal infection of your foot
o It happens more often in people who wear tight shoes, who don’t change their sweaty socks, and who
use public baths and pools.
 Jock Itch
o A type of fungus called tinea causes jock itch.
o The infection is also known as tinea cruris.
 Ringworm
o Ringworm, also called tinea corporis, isn’t a worm but a fungal skin infection. It’s named for its ring-
shaped rash with a winding, worm-like edge.
 Treatment
o Clotrimazole (Lotrimin, Mycelex)
o Miconazole (Micatin, Monistat-Derm)
o Terbinafine (Lamisil)
 Non-Pharmacologic Intervention
o Wash and dry the area with a clean towel
o Use the antifungal medicine as directed
o Change clothes – especially your underwear-everyday

HYPERTENSION
o Persitant elevation of arterial blood pressure
o Greater than or equal to 140 mmHg systolic and greater than or equal to 90 mmHg diastolic on two consecutive
appointments.
Cardiac Output

o Major determinant of SBP

o Blood volume
 Sodium
 Mineralocorticoids
 Atrial Natriuretic peptide
o Cardiac Factors
 Heart rate
 Contractility
o BLOOD PRESSURE = Cardiac Output x Peripheral Vascular Resistance
 Peripheral Vascular Resistance
o Neural Factors
 Alpha adrenergic
 Beta adrenergic
o Local Factors
 Autoregulation
 pH
o Kidneys and Adrenals are central players in the blood pressure regulation.
 KIDNEY
o Kidney controls the peripheral vascular resistance via RAAS and controls the cardiac output vis sodium
homeostasis
o Autoregulation via Cardiac Output
 Decreased pressure in the afferent arteriole = decreased pressure, decreased volume then
decreased glomerular filtration rate > increased resorption of sodium in the proximal tubules >
conservation of sodium > fluid retention > increase fluid volume.
 Autoregulation via Peripheral Vascular Resistance: Activation of RAAS
Types of Hypertensions

o Essential or Primary
 From an underlying or pathological mechanism of unknown etiology
 Constitutes 95% of hypertensive cases
 Numerous mechanisms contribute to this so identification of an exact cause is not possible
o Secondary
 Fewer cases
 Mostly or renovascular diseases, pheochromocytoma, cushing’s syndrome, hyperthyroidism,
aldosteronism, pregnancy and drug use.
Secondary disease Drugs

Chronic kidney Disease Adrenal steroids

Cushing’s syndrome Amphetamines

Parathyroid disease Decongestants

Pheochromocytoma Erythopoiesis-stimulating agnets

Thyroid disease NSAID’S, COX-2 inhibitors

Secondary Street Drugs Food

Cocaine Sodium

Ephedra (Ma Huang) Ethanol

Nicotine Licorice

Ergotamine Tyramine – containing foods (w/ MAOIs)

Anabolic steroids

 Pathophysiology
o Humoral abnormalities
o Pathologic disturbance of the CNS
o Abnormal renal and auto regulatory process
o Deficiency of locals synthesis of vasoconstricting substances and/or increased production of
vasoconstricting substances
o High sodium intake
o Increased intracellular calcium concentration
o The main cause of death cerebrovascular accidents, cardiovascular events and kidney failure.
 Clinical Presentation
o Patients with UNCOMPLICATED hypertension are usually ASYMTOMATIC
PHEOCHROMOCYTOMA Primary Aldosteronism Cushing’s syndrome
- Tumor of the adrenal medulla - Hypokalemic  weight gain
 Paroxysmal headaches  Muscle cramps  polyuria
 Sweating  weakness  edema
 Tachycardia  menstrual irregularities
 Palpitation  acne
 Orthostatic hypotension  muscle weakness

 Diagnosis
o Elevated blood pressure of two or more readings taken at each of two or more clinical encounters.
o Progression may lead to signs of end organ damage related to the eye, brain, heart, kidney and
peripheral vessels
o Abnormal vital signs pertaining to cardiac function
o Hypersensitive urgency – is elevated BP with mild to moderate symptoms like headache and chest pain
without end organ damage
o Hypertensive emergency – elevated BP with sign or symptoms if impending end organ damage such as
acute kidney injury, intracranial hemorrhage, papilledema or ECG change suggestive or ischemia or
pulmonary edema.
 o Malignant Hypertension – diagnose on the basis of progressive renal failure and or encephalopathy with
papilledema.

MODULE 21: Senior Citizen and PWD Medical and Related Privileges

Republic Act no. 9994

 An act granting additional benefits and privileges to senior citizens, further amending Republic Act No. 7432 as
amended, otherwise known as “AN ACT TO MAXIMIZE THE CONTRIBUTION OF SENIOR CITIZEN TO NATION
BUILDING, GRANT BENEFITS AND SPECIAL PRIVILEGES AND FOR OTHER PURPOSES”

EXPANDED SENIOR CITIZENS ACT OF 2010

RULE IV- Privileges for Senior Citizen

Article 6: OSCA – issued Senior Citizens’ Identification Card nd

For the availment of benefits and privileges under the Act and these Rules, the senior citizen, or his/her duly authorized
representative, shall present as proof of eligibility, a valid and original Senior Citizens Identification Card issued by the
Head of the Office of Senior Citizen Affairs (OSCA), of the place where the senior citizen resides, and which shall be
honored nationwide.

Section 1: Medical Related Privileges

Essential Medical Supplies, Accessories and Equipment

The 20% discount and VAT exemption privilege shall also apply to the purchase of eyeglasses, hearing aids, dentures,
prosthetics, artificial bone replacements like steel, walkers, crutches wheelchair whether manual or electric- powered,
canes/quad canes, geriatric diapers, and other essential medical supplies, accessories and equipment by or for senior
citizens.

STEPS

Steps 1: Determine the amount of VAT Exempt Sale (VES)

Php Selling Price (SP)/ 1.12 (VAT Rate)

Step 2: Get Senior Discount by deducting the 20% Discount

VAT Exempt Sale (VES) x 0.20 (D)

Steps 3: Final Step- Get the Billable Amount (BA)

VAT Exempt Sale (VES) – Senior Citizen Discount (SCD)

Republic Act No. 10754

Magna Carta for Persons with Disability

 an act expanding the benefits and privileges of persons with disability (PWD)

Section 1. Section 32 of Republic Act No. 7277, as amended, otherwise known as the “Magna Carta for Persons with
Disability”, is hereby further amended to read as follows:

“SEC. 32. Persons with disability shall be entitled to:

“(a) At least twenty percent (20%) discount and exemption from the value-added tax (VAT), if applicable on the
following sale of goods and services for the exclusive use and enjoyment or availment of the PWD:

SECTION 1. Section 32 of Republic Act No. 7277 as amended, otherwise known as the, Magna Carta for Persons with
Disability is hereby further amended to read as follows:

“(3) On the purchase of medicines in all drugstores;

“(4) On medical and dental services including diagnostic and laboratory fees such as, but 'not limited to: x-rays,
computerized tomography scans and blood tests, and professional fees of attending doctors in all government facilities,
subject to the guidelines to be issued by the Department of Health (DOH), in coordination with the Philippine Health
Insurance Corporation (PhilHealth);
“(5) On medical and dental services including diagnostic and laboratory fees, and professional fees of attending doctors
in all private hospitals and medical facilities, in accordance with the rules and regulations to be issued by the DOH, in
coordination with the PhilHealth;

STEPS

Step 1: Determine the amount VAT Exempt Sale (VES)

PHP Selling Price (SP) / 1.12 (VAT Rate)

Step 2: Get PWD Discount by deducting the 20% Discount

VAT Exempt Sale (VES) x 0.20 (D)

Step 3: Final Step - Get the Billable Amount

VAT Exempt Sale (VES)- PWD Discount (PWDD)

SHORTCUT : VES X0.80 = Billable Amount (BA)

MODULE 22-23

BUSINESS PLAN

Objectives

Target

Plans

Needs

Objectives

- Specific commitment to achieve a measurable result.

 You want to achieve

 You need to comply

 Short term Objectives – Directing to the Startup of your Business.

 EXECUTIVE SUMMARY

o Most critical in starting up the Business Plan

o Keep it short and focused

o Used strong positive language

o “Business Model”

 COMPANY DESCRIPTION

o Mission, Vision & Core Values

Target

- Short term Plan, Precise actions to accomplish

 MARKET RESEARCH (Location)

o Target Customers

o Target Competitors

 PRODUCTS

o Target Suppliers & Product Price List

o Target Physical Environment

\
TARGET PHYSICAL ENVIRONMENT

 DESIGNS

o Internal

o External

 STORE LAYOUT

o Grid Layout Plan

o Free Flow Layout Plan

o Racetrack or Loop Plan

 MERCHANDISE DISPLAY

o Entryway Display

o Dump Bins

o Free-Standing Displays

o Gondola Displays

o Window Displays

Plans

- Sequence by methodical activities intended to attain the Objectives and Targets

 MARKETING PLAN (D-I-D)

o Direct Marketing

o In-Store Marketing

o Digital Marketing

 FINANCIAL PLAN

o Statement of Account / Expenses / Salary

 MANAGEMENT PLAN

o Organizational Chart – Management Team

o Personnel Plan (DOLE, Requirements, Contract, etc.)

 OPERATIONS &SERVICES

o Daily Internal Activities (Ops)

o Daily External Activities (Serv)

It will reflect in all Standard Operating Procedures and Job Descriptions & Job Responsibilities.
 Needs

- Extremely necessary for the Pharmacy

 FUND/BUDGET/MONEY

 REGISTERED PHARMACIST

o Valid Requirements

 BUSINESS PAPERS

o Business Name

o FDA License to Operate

 GOALS

o Goals are defined as the desired states that people seek to obtain, maintain, or avoid

o Goals are LONG TERM

o Goals in your Business – Levels up, Upgrade, Innovative

GOALS “LONG TERM”

S - SPECIFIC

- Define your goal in detail. Be as specific as possible.

M - MEASURABLE

- Decide how you will measure success

A - ATTAINABLE

- Set realistic goals that challenge you, but are achievable

R - RELEVANT

- Ensure your goal is results-oriented

T - TIME-BOUND

- Set a clear deadline and monitor your progress

Employees
(Trainings, Physical Operations
Seminars, Environment & Services Branch Out
Salary, Awards, (Expansion / (Additional
Benefits or Renovation) Activities)
Privileges)
PHARMACOVIGILANCE

- Science and activities relating to the detection, assessment, understanding, response and prevention of adverse
drug reactions or any other medicine/vaccine related problem.

AIMS OF PHARMACOVIGILANCE

 Improve patient care & use of drugs (Medical & Paramedical)

 Improve public health & safety in relation to use of medicines

 Contribute to the assessment of the benefits, harm, effectiveness and risk of medicines

 Promote understanding, education and clinical training in Pharmacovigilance

“ENSURE PATIENT SAFETY”

PRE-AUTHORIZATION PV

 During Clinical studies

 Pre-clinical

 Phase I – Phase III

POST -AUTHORIZATION PV

 Collected After Marketing Authorization

 Phase IV

 Spontaneous ADR Reporting

1848 – Hannah’s death caused by chloroform

1937 – USA with the solvent diethyl glycol

1938 – Federal Food, Drug and Cosmetic Act was established and the public health system was renovated

1955 – Gastrointestinal toxicity of ASA was proved

1961 – McBride’s Letter about the tragedy of Thalidomide

1964 – The yellow card was structured in the UK

1965 – European legislation was developed (EC Directive 65/65)

1968 – WHO Programme for International Drug Monitoring was instituted

1995 – EMA was set up

2001 – Eudravigilance was funded

2012- New European Pharmacovigilance Legislation (Directive 2010/84/EU)

2017 – New Eudravigilance Format

ADVERSE DRUG REACTION

- Unwanted of harmful reaction experienced following the administration of a drug or combination of drugs
under normal conditions of use and is suspected to be related to the drug.

IMMUNOLOGIC DRUG REACTIONS

 TYPE I REACTION: IgE-medicated

 TYPE II REACTION: Cytotoxic

 TYPE III REACTION: Immune Complex

 TYPE IV REACTION: Delayed, cell-mediated

NON-IMMUNOLOGIC DRUG REACTIONS

 Predictable

 Unpredictable

Predictable

 Pharmacologic Side Effect

 Secondary Pharmacologic Side Effect

 Drug Toxicity

 Drug-drug Interactions

 Drug Overdos
 ADR

IMMUNOLOGIC
- TYPE I
- TYPE II
- TYPE III
- TYPE IV

NON - IMMUNOLOGIC
PREDICATABLE UNPREDICATABLE
- PSE - PSEUDOALLERGIC
- SPSE - IDIOSYNCRATIC
- DT - INTOLERANCE
- OD
- DO

PREDICTABLE

 Drug-Drug Interactions

o Angiotensin Converting Enzyme (ACE) inhibitors and Spironolactone:

- Spironolactone increases blood potassium levels, which is additive to the blood potassium-
increasing effect of ACE inhibitors.

o Angiotensin Converting Enzymes (ACE) inhibitors and Potassium Supplements:

- Ace inhibitors increase the levels of potassium in the body.

- If potassium supplements are co-administered with ACE inhibitors, there is a potential for
elevated potassium levels in blood (Known as hyperkalemia)

o Digoxin and Amiodarone:

- Amiodarone may lead to increased levels of digoxin in the body and potential toxicity.

o Digoxin and Verapamil:

- Verapamil may decrease the clearance of digoxin, leading to increased levels of digoxin in the
body and potential toxicity.

o Theophylline and Quinolones:

- Quinolones inhibit the metabolism of theophylline, thereby increasing its blood levels and
leading to potential theophylline toxicity and increased likelihood of seizures.
CASE STUDY

A 52-year-old patient commenced on allopurinol 300mg for the prevention of another acute attack of gout that recently
occurred. The patient is known to have moderate to severe renal impairment, but no liver impairment present.

Oher concomitant medicines:

 Iron sorbitol

 Insulin (Short and long acting)

 Calcium carbonate

In the 6ht week after starting the medicine, the patient developed severe aplastic anemia and died.

 What is the likelihood that the aplastic anemia is associated with allopurinol?

a. PROBABLE

b. POSSIBLE

c. UNLIKELY

 Was the dose prescribed by the doctor appropriate for the patients’ renal function?

YES OR NO?

No, the dose prescribed was too high for the renal function of the patient. Dosing advice in renal impairment: Since
allopurinol and its metabolites are excreted by the kidney, impaired renal function may lead to retention of the drug
and/or its metabolites with consequent prolongation of plasma half-lives. In severe renal insufficiency, it may be
advisable to use less than 100mg per day or to use single doses of 100 mg at longer intervals than one day.

 Is aplastic anemia a possible known side-effect with allopurinol?

YES OR NO?

Yes, Undesirable effects for the Blood and lymphatic system disorders:

Agranulocytosis

aplastic anemia

Thrombocytopenia
  Which of the following factors possibly contributed to the harm in this patient?

a. Poor Knowledge of the Prescriber on dosing

b. Lack of Knowledge of possible side effects

c. Hepatic or Renal Impairment

 Do you think that this adverse event possibly due to allopurinol could have been avoided in the patient?

YES OR NO?

Yes, this ADR possibly could have been avoided. If the dose had been prescribed at the appropriate dose for the patient’s
renal function, an ADR could have been less likely.

MODULE 24

Documents for Pharmacy Operations & Services

Organizational Chart

- Diagram that displays a reporting or relationship hierarchy.

- Importance of Organizational Chart: Organization & Management

Organization & Management

- Art of getting people together on a common platform

- To make them work towards common predefined goal
- Helps to extract the best out of each employee so that they accomplish the tasks within the given time frame.

CEO /OWNER

Pharmacist/ Finance
Marketing Officer/
Manager Purchaser

Pharmacy Pharmacy Inventory

Cashier Auditor
Assistant Assistant Clerk

Standard Operating Procedures: (SOP)

- A standard operating procedure is a set of written instructions that can describe how to perform a task or
activity.
 - They’re in-depth rules that could be followed by anyone and should leave very little ambiguity around what
needs to be done.

Importance of SOP:

1. Employees Training Management

● Depending on the complexity of the task and the experience of employees, SOPs may not completely substitute
for training.
● lt is a valuable component of the new-hire toolkit, and can reduce training time.
● They act as reference guides and allow new employees to work independently without excessive reliance on
supervisors.

2. Employees Performance Management

● Develop target ranges and assessment.

● Employees who work in compliance with SOPs know exactly what is expected of them, and they plan their work
schedules to meet their goals with efficiency.

3. Avoidance of Knowledge Loss

● Documentation of job processes survives employee attrition due to retirement and resignation, and allow your
company to carry on as usual.
● it’s hard to replace experienced, skilled workers, but comprehensive well-written SOPs ensure that your valuable
operations & services stay with your business.

4. Control of Quality Operations & Services

● Ensure a Standardized procedures guide workers and reduce the possibility of missed steps or other errors that
impact the quality of the completed product.
● Providing a blueprint for the line of production creates consistency and protects the integrity of your product.

5. For long-term goals

● For branch offices, there are ready-made SOPs make your proven work processes portable.
● New employees at new locations can uphold your reputation by using the SOPs to replicate the products and
services provided at your original place of business.

Contents of SOP:

1. Header (Pharmacy Logo)

2. SOP Information

3. Objectives

4. Scope

5. Definition of Terms
 6. Responsibilities

7. Procedures

8. Supporting Procedures

9. Materials

10. References

Required List of SOP:

1. Pharmacovigilance

2. Procurement

3. Good Dispensing Practice

4. Good storage condition

5. Cold Chain Management

6. Handling Complaints

7. Handling Product Recall

8. Handling Returned Products

9. Handling Expired, Damaged Products

10. Pest Control

11. Good Housekeeping & Sanitation

IMPORTANCE OF RMP
● Before the potential risk occur, the business can save money and protect their future.
● Avoid potential threats, minimize their impact should they occur, and cope with the results.

RISK MANAGEMENT PLAN

Step 1: Identify the Risk

Step 2: Analyze the risk.

● Once risks are identified you determine the likelihood and consequence of each risk
● You develop an understanding of the nature of the risk

Step 3: Evaluate the Risk

● You evaluate or rank the risk

● The risk magnitude, which is the combination of likelihood and consequence.
Step 4: Treat the Risk

● This is also referred to as Risk Response Planning

● Set out a plan to treat or modify these risks to achieve acceptable risk levels.
● How can you minimize the probability of the negative risks as well as enhancing the opportunities?

 Assign Role and Responsibilities

 Preventing Strategies
 Contingency Plan

Step 5: Monitor and Review the risk.

● This is the step where you take your findings.

● Use it to monitor, track and review risks.

Potential Risk

● Risk of Fire
● Risk of System Loss (POS)
● Risk of Natural Disaster
● Risk of Damage to Property
● Risk of Pandemic
● Risk of Finding High-Quality Suppliers
● Risk of Theft
● Risk of Privacy & Security Issues

Benefits of RMP:

1. Creates a safe and secure work environment for all staff and customers.
2. Increases the stability of business operations while also decreasing legal liability.
3. Provides protection from events that are detrimental to both the company and the environment.
4. Protects all involved people and assets from potential harm.
5. Helps establish the organization's insurance needs in order to save on unnecessary premiums.

Basic Customer Care

1. SKILLS
2. KNOWLEDGE
3. ABILITY
SKILLS

● Practiced or Learned behavior

● Develop through training or experience

1. Persuasive Skills
 ● The skills of changing or influencing the behaviors, beliefs, or attitudes of someone or a group towards another
idea, person, or event.

2. Willingness to Learn

● The basis for growing skills as a customer service professional.

3. Time Management Skills

● Spend a little extra time with customers to understand their problems and needs.
● Limit the amount of time you can dedicate to each customer.

KNOWLEDGE:

● Theoretical & Basics (Fact, Figures)

● Acquired through learning or experience

1. Product Knowledge

● Familiarity
● Fully understand and can effectively communicate with customers about the product, its features, benefits,
uses, and support needs.

2. Methodical Approach

● Awareness
● Following the method

3. Management Understanding

● Ethics
● Teamwork and Leadership

ABILITY:

2. Ability to use positive language

● If your customer contacts you, chances are it’s because he or she has a problem.
● In a customer’s anger, frustration, o defeatism, reps need to stay positive.
● It’s okay to empathize with the customer in fact, it’s a key component of great service but keep it as upbeat as
you can.
● Thank customers for their patience, understanding, and valued loyalty.
3. Ability to admit that you don't have an answer

4. Problem Solving Ability

● May simply understand how to offer pre-emptive advice solution that the customer doesn’t even realize is an
option

5. Closing Ability

● Being able to close with a customer as a customer service professional means being able to end the
conversation with confirmed customer satisfaction
● Customer feeling that everything will be taken care of

6. Resilience

● Recover quickly
● Ability not to take things personally

Good Personal Grooming AT WORK

Maintain Personal Hygiene in the Workplace:

● Hair - Keep Hair Clean. Regularly wash and cut your hair to keep a neat appearance.
● Teeth - Care for your Dental Health. Maintaining a healthy, clean mouth is part of maintaining personal hygiene
at work.
● Bathe - Bathe or Shower Regularly.
● Antiperspirant - Use deodorant daily
● Hands - Keep your hands clean and sanitize

Benefits of Good Grooming:

● They feel extra confident about themselves

● They radiate a sense of self-esteem
● They feel extra confident about themselves
● They radiate a sense of self-esteem
● They can make lasting impressions quickly
● They are more likely to draw positive attention