GOTONEAL COLLEGE

Department Of Pharmacy

Apply Good Dispensing Principles

For Pharmacy Technician Level-IV

By: Melaku M. (BSc. Pharm)

1 Email address:[email protected]
 Analyze Prescription Analysis and Apply
Good Dispensing Principles
Learning outcomes
LO1 Accept Prescription for Dispensing

LO2 Ensure Clinical Evaluation of Prescription by Pharmacist

LO3 Calculate Prescription Quantities

LO4 Prepare Labels According to Legal Requirements

LO5 Establish Counseling Environment

LO6 Provide Patient Counseling Service

LO7 Enter Data in to Dispensing Computer

LO8 Assemble Prescription Items

According to Good Dispensing Practice
2
 LO1 Accept prescription for
dispensing
⚫ Under this LO1 we have three subtopics:
⚫ 1.1. Prescription and types of prescription

⚫ 1.2. Steps in dispensing of prescribed

medications
⚫ 1.3. Validating a Prescription

3
 Presentation
Outlines
 Objectives

 Definition of terms
 Parts of a prescription
 Types of prescription
 Steps in dispensing of prescribed
medications
 Validating a Prescription
4
 Objectives
 After completing this unit you will be
able to:
 Define prescription, prescriber, dispensing,
…..
 Identify parts of a prescription
 Perform steps dispensing of
 Identify types of prescription
prescribed
in medications
 Validate a
Prescription
5
 Definitions of
terms
⚫Prescriber: meansany medical
practitioner who is licensed or authorized
to write prescription.
⚫ Prescription is an order for medication that

issued by properly licensed medical

practitioners.
⚫ Dispensing: means to prepare drugs and/or

medical supplies and distribute them to their

6 users.
 Definitions of terms continued……
⚫ Prescription drugs: means drugs
which are dispensed with prescription
only.
⚫ Over-the-counter drugs(OTC): means
drugs which are dispensed even without
prescription.
⚫ Oral request: means verbal request of
patients or care providers for drugs or
medical supplies without presenting a
7
 Definitions of terms continued……

⚫ Stock: means the amount of drugs and/or

medical supplies available in drug retail

outlets.
⚫ Repackaging: means packaging of a drug

from its original container to another one.

⚫ Prepackaging: means repackaging of
drugs into usable quantities before they
are requested by the patients (users)
8
 1.1. Prescription and
types of
prescription
⚫ Prescription means:

⚫ Any order for drug written and signed

by a
licensed or authorized medical practitioner
issued to a patient in order to collect
drug from dispensing unit.

9
 Continued…….
⚫ The word comes the Latin
"prescription" "praescriptus" from from before +
compounded
“scribere”, "prae",
to write = to write before.
⚫ Historically, a prescription was written before the drug
was prepared and administered.

10
 Parts of a prescription
⚫ Traditionally a prescription is composed of 4
parts:
A. Superscription
B. Inscription

C. Subscription, and

D. Signature

11
 A . The superscription
⚫ This section contains the date of the
prescription and patient information
(name, address, age,etc).
⚫ The symbol "Rx" separates the
superscription from the inscriptions
sections.
⚫ Rx is derived from R,

⚫ an abbreviation for the Latin word

12
 B. The inscription/the main
body of the
⚫ The prescription
inscription is also called the body of
the
prescription
⚫ This is the principal part of the prescription order.

⚫ This section defines what the medication is.

⚫ It contains the Name, Strength or dose and

Quantities of the prescribed ingredients (drugs).

⚫ In⚫ the inscription may find dosage form, such as

1 Tablets (tabs), Capsules(caps), Suspension,
3 Syrup, etc.
 C. The subscription (direction
to the compounder)

⚫ The subscription gives specific directions

for the pharmacist on how to compound
and dispense the medication
⚫ Example: "make a solution," "mix and

place into 10 capsules," or "dispense

10 tablets."
⚫ Prescription orders that requiring the pharmacist
to mix ingredients are known as compounded
prescriptions.
14
⚫ The prescriptions that requiring compounding contain
 D. The signature/directions for
the patient
⚫ This is often preceded by the sign “s”; standing for

signature (Latin, meaning , mark).

⚫ The "signature" section contains directions to the
patient,
⚫ Information on how, how much, when, for how
long the
drug is to be taken.
⚫ The signature contains
⚫ frequency of administration: Daily, BID, TID, QID,
etc
⚫ Route of administration: PO, TOPICAL, RECTAL, etc,
15
for 7 days , 10 days, 2wks, etc.
Sample Prescription

1 1
6 6
superscriptio
n
Inscriptio
n
subscription

Prescriber/
dispenser
information
1
7
 Types and sources
⚫prescription
Source of prescription include
physician, dentist, pharmacist,
psychologists and other properly
licensed medical practitioner.
⚫ Types of prescriptions:

⚫ Prescription papers can be classified in to two

based on the type of the drug prescribed

on them:
18
A. Normal prescriptions
 A. Normal prescription
papers
⚫ These are prescription papers used for
prescribing for prescription only drugs.
⚫ For example, prescription papers for
antibiotics, cardiovascular drugs, and drugs
which are not OTC.
⚫ They have white color and can be prescribed
by any medical practitioner who is licensed or
authorized to prescribe.

19
 B. Special prescription papers
⚫ These prescription papers have two
divisions
⚫ narcotic prescription paper and

⚫ psychotropic prescription papers.

⚫ To avoid miss use of narcotic and

psychotropic drugs, these prescriptions
have blue or other colors other than
white (ordinary prescription papers).
20
 Continued…
⚫.. Miss use of narcotic and psychotropic
drugs
have addictive potential, sedative effects,
etc.
⚫ They are only prescribed by a medical
practitioner
⚫ who is licensed to prescribe them.

⚫ Both are controlled under special

21 regulations by the federal government of

 The Need for Prescription
⚫(why?)
At least there are four points why we
need prescription papers:
1. To ensure proper dispensing
and
prescribing, patient use of
drugsensure
2. To availability and use of
properly standardized printed prescription
paper in all health institutions.
3. To maintain the proper printing,
distribution, storage and use of prescription
paper and
22
 Contents of a Prescription
⚫Paper
The content of any prescription paper shall
include the following points:
1. Serial number and area code

2. Name, level and address of the health

institution.

3. Full name, age, sex, card Number and address

of the patient.

4. If the drug is prescribed for animal,

23
type of the animal and owner's name
 Contents of a Prescription Paper…..
5. Type of Diagnosis or International
classification of disease (ICD) code
number.

6. Name, strength, and dosage form of the drug

7. If the drug is to be compounded, the

type of ingredients needed, direction for
use and how to prepare it should be
included.

8. If the drug is refillable, direction for refill.

24
 Contents of a Prescription Paper…..
9. Prescriber's name, qualification,
registration
number, signature and date on which
the prescription is written.

10. Dispenser's name, qualification,

registration number, signature and date
on which the prescription is filled.

25
26
 Prescription
writing
⚫ A prescription is a written therapeutic

transaction paper between the prescriber and

dispenser.
⚫ It is a written order by the prescriber to the

dispenser on how the medicine should be

dispensed.
⚫ It serves as a means of communication
among the prescriber, dispenser and
medicine
names of consumer.
the
2
7 medicine(s).
 Prescription
⚫writing…..
All written prescriptions should contain:
⚫ Patient's full name and address

⚫ Prescriber's full name, address, telephone

number…
⚫ Date of issuance

⚫ Signature of prescriber

⚫ Drug name, dose, dosage form, amount

⚫ Directions for use

⚫ Refill instructions

28
 Please Note the Following
Information
⚫ The Prescription papers:
⚫ May valid only if it has the seal of the health
institution.
⚫ Filled and blank prescription papers are legal

documents, treat them as fixed assets .

⚫ written information on the prescription papers
and verbal information are complement to the
client with one another.

29
 Please Note the Following
Information…….
Medicine treatment is only one of the treatment
options
⚫ The prescriber should:

⚫ write the prescription correctly and legibly

⚫ have to complete the diagnosis and

other parts of the prescription.

⚫ Have not be used
abbreviations
recommended on
⚫ abbreviations are the
NOT
⚫ accept prescription verification call from the
30
dispenser
 Please Note the Following
Information…….
⚫The Dispenser should:
⚫ check legality of the prescription

⚫ check completeness and accuracies

before dispensing
⚫ check for whom the medicine is
being dispensed (actual client or care
taker)
⚫ if the dispenser has any doubt about the
contents of the prescription; verify with the
prescriber
31 ⚫ labels of drugs should be clear and legible.
 1.2. Steps in dispensing of prescribed
medications

32
PROCESS OF DISPENSING PRACTICE

Prescrib
er

Dispensing process

Client/ Dispens
patient er
33
 What Is
Dispensing?
⚫ Dispensing refers to the process of preparing

drugs and distributing them to their

users with provision of an appropriate
information.
⚫ It may be based on a prescription or an

oral request of users (patients or care

providers) depending on the type of
drugs to be dispensed.
34
 What Is Dispensing?......
⚫ Dispensing includes all the activities that
occur
between the time when the prescription
and oral request of the patient or care
provider is presented and the drug or other
items are issued to them.

⚫ This process may take place in health

institutions and community drug retail

35 outlets.
 What is Good dispensing
practice?
⚫ Good dispensing practice refers to the
delivery of
the correct drug and medical supply to the
right patient, in the required dosage and
quantities, in the package;
⚫ that maintains acceptable potency and quality
for the specified period with clear drug
information.

⚫
36 Dispensing is the core activity of all
 What is Good dispensing
practice?...
⚫ Dispensers should be able to equip themselves

with up- to-date medicine information.

⚫ Dispensers need to have communication skills;

⚫ so as to effectively deal with patients or

health care providers.

⚫ All information should be provided by the
language;
⚫ the patient/care provider can understand.

⚫ Dispensers should check whether the

3
7 information is understood by patients or
 What is Good dispensing
practice?....
⚫ Evaluation of prescriptions is a crucial
step of the dispensing process.
⚫ Counseling patients on medications is a

major part of dispensing.

⚫ Lack or improper counseling by dispensers

leads to incorrect use of medicines by

patients.
⚫ Incorrect use results in loss of efficacy
38
or occurrence of adverse effects.
 Pre- existed Good Dispensing
Practice

Good
dispensin
g process

39 39
39
Compare Pre- existed Good Dispensing Practice
with

Step 1:
Step 6: Filing the Receiving, validation,
prescription and interpretation and Step 2: Billing
transaction evaluation
Good of a and
documents prescription recording
dispensing
process transactions

Step 5:
Provision
of medicines to
Step 3: Selection,
patient
the with
manipulation or
proper Step 4: Packaging compounding of
counseling and the medicine
40 labeling of the
od Dispensing Practice in
medicine APTS
 Dispensing
⚫process
There are six steps in dispensingof
prescribed medications for the
customer;
⚫ Customers include:

⚫ Patient (client)

⚫ Care provider

41
 Dispensing
process…..
⚫ The six steps of dispensing process are:
1. Receive and validate prescription or verbal
request
2. Understanding and Interpreting prescription,
and Bill (the price of medication)
3. Selection, manipulation or
compounding of the
medicine (Prepare Items for issue)
4. Labeling and packaging of medicines.
5. Provision of medicines to the
patient with proper counseling
42
(Issue Drugs to Patient)
 1. Receive and validate
prescription or verbal
request
⚫ Ask the patient to give his/her name and

check the name with that on the

prescription.
⚫ If the dispenser has any doubt ask
for identification card.
⚫ Cross checking the name & identity of the

patient must also be done when issuing

43
the drugs.
 CONT……
…
⚫ Completeness of the prescription:

⚫ Patient‟s name, sex, age, card number, address

⚫ Diagnosis (ICD code number)

⚫ Drug name, strength, dosage form, course of

treatment
⚫ Prescriber‟s name, qualification, signature, R.
No
⚫ Date of the prescription

⚫ Whether appropriate prescription form is issued

or not

44 ⚫ Verbal request can be done only for OTCs

 CONT……
.
⚫ Check the following information on
the prescription:
⚫ Patients name, sex, age, card number,
address
⚫ Diagnosis (ICD code number)

⚫ Drug name, strength, dosage form,

course of treatment
⚫ The prescriber name, qualification, signature,

registration number
45
 CONT…….
.⚫
Date of the
prescription
prescription form
⚫ Whether is
issued or not (e.g. for controlled drugs)
appropriate
⚫ Seal of the health institution, if available.

⚫ Verbal request can be done only for OTCs

with justification.

46
 2. Understand and interpret
the prescription
⚫ Carefully read the prescription or
validate verbal request.
⚫ Check if the prescription is legally
and currently written.
⚫ confirm that the doses prescribed are in the

normal range for the patient (noting sex,

age, wt)
⚫ ‘Never Dispense Guess Work’
47
 2. Understand and
⚫interpret…
Identify common drug interaction(s).
⚫ Verify inadequately written
prescription and make
necessary correction with the prescriber‟s
consent.
⚫ Correctly perform any calculations of dose

and the quantity to issued.

⚫ Check medicines with similar names;
48
⚫ Folic acid versus Folinic acid
 2. Understand and
interpret…
⚫ Check medicines with abbreviations;
⚫ Wrong interpretation of abbreviations can kill
patients

⚫ Examples of confused abbreviations:

⚫ „HCT‟ (hydrocortisone, hydrochlorothiazide)?

⚫ „CPZ‟(Chlorpromazine,Carbamazepine)?

⚫ „CPM‟ (Chlorpromazine or Chlorpheniramine)

49
 3. Selection, manipulation or
compounding of the medicine
(Prepare Items for issue)
⚫ Select stock container of pre-pack reading

the label and cross matching the drug

name and strength against the
prescription.
⚫ Read the container label at least twice
during the dispensing process.
⚫ Do not select the prescribed drugs according

to the color or location of container.

 3. Selection, manipulation or
compounding of the medicine
(Prepare Items for issue)
⚫ While counting,pouring, or measuring, the
following points should be noted.
⚫ Short and over counting should be avoided.

⚫ Clean counting tray and spoon used.

⚫ Graduated measuring cylinder and

flask must be used for
measuring liquid to reduce errors.
⚫ If small volume is to be measured, small
measuring cylinder/flask has to be used.
51
⚫
 3. Selection, manipulation or
compounding of the medicine
(Prepare Items for issue)
⚫ During dispensing of liquids:

⚫ Must be measure in a clean vessel and should be

poured from the stock bottle with the label kept

upward.
⚫ This avoids damage to the label by any spilled or

dripping liquid.
⚫ Pour the measured liquid preparation into
the
container/bottle and label it.
52
 3. Selection, manipulation or
compounding of the medicine
(Prepare Items for issue)
⚫ Providing appropriate bottles with caps
for repackaging liquid preparations.
⚫ Dispense liquid preparations in
suitable containers.
⚫ Do not use patient‟s own bottle.
⚫ Dispense each drug in a different bottle.

53
 3. Selection, manipulation or
compounding of the medicine
(Prepare Items for issue)
⚫ In dispensing tablets and capsules:
⚫ Do not use fingers to count tabletsas this can
lead to contamination of drugs
⚫ Use a spoon to put tablets and capsules onto a
counting
tray
⚫ Keep the spoon clean at all times

⚫ Do not keep the spoon inside the container

⚫ Close stock containers tightly after dispensing

54
 4. Labeling and
packaging of medicines.
⚫ Labeling of dispensed drugs should
be clear and
legible.
⚫ All drugs should be labeled with followin
the g
particulars
⚫ The drug name (use generic name)

⚫ Strength (usually in mg)

⚫ The dose, quantity dispensed and

55
frequency
 4. Labeling and packaging of …
⚫ Direction for use in a familiar
language
⚫ Expiry date or use by date
⚫ The name of the patient
⚫ Thename and address of
pharmacy
⚫ Dispensing date
⚫ Dispenser name and initials
56
 4. Labeling and packaging of
…..
⚫ Medicines must be suitably contained,
protected and labeled from the time of
manufacture until they are used by the
patient.
⚫ The container must maintain the quality,

safety and stability of the medicine

throughout this period.

57
 4. Labeling and packaging of
…..
⚫ The selection of packaging for
medicines depends on:
⚫ Nature of the medicine

⚫ Type of patient

⚫ Dosage form

⚫ Method of administering the medicine

⚫ Required shelf-life

⚫ Use, such as for dispensing.

58
 4. Labeling and packaging of …..
⚫ Packaging aids and materials

⚫ The materials used for repackaging include:

⚫ glass bottles, plastic bottles, collapsible

tubes, paper envelops, plastic envelops,
etc.
⚫ Paper has the least value as the primary
packaging material in terms of maintaining the
quality, safety and stability of packaged medicine.

59
 4. Labeling and packaging of
…..
⚫ Packaging material selection
depends on type of
formulation:
⚫ Creams/ointments = cream or ointment tube
with cap
⚫ Liquids (otic and ophthalmic) =
Amber dropper bottle with cap
⚫ Liquids (oral and topical) = Amber or
opaque bottle with cap
⚫ Tablets/capsules =Blister packages, tightly
60
 5. Provision of medicines to the
patient with proper counseling (Issue
Drugs to Patient)
⚫ The prepared,packaged and labeled drug
ishanded
over to the right patient or care provider
with appropriate drug information.

⚫ The information in the form of verbal/

written instructions should include
the following:
⚫ When to take the drug (e.g., before or after meal)
61
⚫ How long the treatment is to last (e.g.,
 5. Provision of medicines to the patient
with proper counseling (Issue Drugs to
Patient)
⚫ How to take the drug;
⚫ e.g., with water, chewing or
swallowing
⚫ How to store the drug;
⚫ e.g., avoid heat, light and
dampness
⚫ Notto share drugs with others
persons
62 ⚫ To keep drugs out of reach of
 5. Provision of medicines to the patient
with proper counseling (Issue Drugs to
Patient)
⚫One has to demonstrate to the patient on
how to administer the dispensed medications in
case of inhaled administration and suppository
application.
⚫ Patient should be informed not to stop treatment

when side effects occur or in the absence of

response with out consulting the prescriber or
dispenser.

63
 5. Provision of medicines to the patient
with proper counseling (Issue Drugs to
Patient)
⚫ Tell common side effects to patients.

⚫ What should be avoided in the course of

the treatment;
⚫ e.g., alcohol,milk or any food or drink that
may affect the efficacy of the drug.
⚫ Finally, check whetherpatients have
understood the information provided.

64
 5. Provision of medicines to the patient
with proper counseling (Issue Drugs to
Patient)
⚫ Indispensing, the "three checksand seven rights"

should always be observed.

⚫ The three checks are:

⚫ 1. First check of the container label

before taking container from the shelf.
⚫ 2. Second check of the container label
against the prescription during actual
dispensing.
⚫ 3. Third check of the container label
65
before putting the container away.
 6. Documentation and Reporting
(Recording the
transaction)
⚫ The prescription registration book should

be kept properly
⚫ Blank prescription should be kept carefully;

⚫ only prescribers have access to them.

⚫ Filled prescription should be kept as a

receipt.
⚫ Prescriptions for narcotic and psychotropic
66
substances should be kept for 5 years and other
 6. Documentation and
Reporting (Recording the
transaction)
⚫ Thereafter, they should be disposed
carefully in the
presence of inspectors from the
⚫ Regular
drug reports
regulatory drug consumption and
body.
on
from patient
prescribing prescription
registration book should be prepared and
pattern
report to

67 the concerned drug authority timely.

 6. Documentation and
Reporting (Recording the
transaction)
⚫ Information obtained from prescription
registration book could be
used for further planning and
efficient utilization of resource.
⚫ The report on physical inventory shall
be documented

68
 6. Documentation and
Reporting (Recording the
transaction)
⚫ Proper record keeping is an essential part of
dispensing.
⚫ It facilitates good management and

monitoring of services provided.

⚫ All patient and medication related records

should be documented.

⚫ The document should be kept in a secured place;

⚫ It is accessible only to authorized personnel.

69
 1.3. Validating of a Prescription
⚫ Validating of a Prescription confir
means m

truthfulness of a prescription
paper.
⚫ Validating of a Prescription
includes:
⚫ Legality of a prescription

⚫ Legibility of a prescription

70 ⚫ Correctness of the prescription

 Legality of a
prescription
⚫ The dispenser should check the legality of
the prescription as well.
⚫ Legality refers to

⚫ the source of the prescription

⚫ the information on the prescription

⚫ the type of the prescription depending on

the drug prescribed on it.

⚫ check seal of the health institution, if
71 available.
 Legality of a
prescription..
⚫ A prescription is legal
when: authoriz
⚫ It is written and signed by ed

⚫ Thean prescriber
medicines are written on the
right prescription such as normal, NPS and
ART
⚫ Date of issue not exceeding 15 days for NPS
substances
and 30 days for other medicines
72
⚫ Has all the information required to
 Legibility of a
⚫prescription
A prescription paper must be read or
clear
able to enough to be read.
⚫ Legibility is a problem alertness
requiring critical judgment and the
on the
professional. part of pharmacy
⚫ Careless handwriting and similarity
in spelling of names of different
medicines add to the difficulty.
73
 Legibility of a prescription..
⚫ Example of a Reading
error:
prescriber
⚫ Due to illegible s,
Medoprazole could be read as
handwriting
Mebendazole.of

⚫ Medoprazole is a brand of name

omeprazole
⚫ All terminology, including units of
measures and Latin abbreviations should be

74
properly interpreted and checked.
 Correctness of the
prescription
⚫ Correctness of the prescription
means;
⚫ Removing of errors from the prescription
⚫ Meeting a required standard of prescription
writing
⚫ Correctness of the prescription
includes:
A. Double medication
B. Drug Interactions
C. Medication History
D. Check for overwriting
75 E. Fake/false prescription
Correctness of the
prescription-----
⚫ A. Double medication:
⚫ Check medications(the same or
medicine different
medicine with the same pharmaco-
effect
therapeutic concurrentlyprescribed by
)
prescribers
the same
to the
or same patient undergoing
treatment. differe
⚫ Example: If a patient has been nt
prescribed
diclofenac for fever, and if the dentist has
prescribed other NSAIDs for the same patient, it
could lead to overdosing of NSAIDs. Result in the
7
6 risk of GI bleeding and may aggravate
Correctness of the
prescription…
⚫ B. Check drug
Interactions:
⚫ Many medicinesare known to wit othe
interact h r
prescribed or OTC medicines. This
includes:
⚫ Drug/drug interactions

⚫ Drug/food interaction,

⚫ Drug/disease interactions

⚫ Drug/herbal medicines, and

should
⚫ Drug/laboratory results.
be
⚫ Ideally, all multiple item
77
 Correctness of the
⚫prescription…
Example:
⚫ If Acetylsalicylic acid is taken with an
anticoagulant (warfarin) it can increase the effect
of warfarin. So it may lead to bleeding
⚫ Patients taking ciprofloxacin should avoid taking

antacid within 2-3 hours because the antacid

can drastically (significantly) reduce the
absorption of ciprofloxacin
⚫ Known allergies should be checked, particularly

78 for an antibiotic prescription. E. g. Penicillin

 Correctness of the prescription…
⚫ Pharmacy professionals should be alert to
detect;
⚫ Misuse of prescription blanks by client

⚫ Prescriptions writtenby the patient/client

coming to the pharmacy.

⚫ Do not dispense such prescriptions, and be

sure to alert the prescriber about the

misuse.

79
 Correctness of the
prescription---
⚫ C. Medication History:

⚫ Check History of overuse, under use or

misuse of medicines by the patient.

⚫ D. Check for overwriting:

⚫ Overwriting can be done by the patient,

to buy extra medicines (especially habit
forming medicines or medicines of abuse).

80
 Correctness of the
prescription---
E. Fake/false prescription:
⚫ Pharmacy professionals should be:

⚫ alert to detect misuse of prescription

blanks by clients (obtained by stealing from
private practitioners or from Government
hospital OPDs, where blanks are often left lying
around).
⚫ alert to fake prescriptions written/ printed by the
patient
or client coming to the pharmacy.
81
 Correctness of the prescription---
F. potent medicines, and medicines with a Narrow TI:

⚫ Special care has to be taken with such

medicines, as slight changes in systemic
concentration lead to marked changes in
pharmacodynamic responses.
⚫ Examples of narrow therapeutic index
medicines
⚫ 1.Digoxin

⚫ 2.Lithium
82
⚫ 3. Phenytoin
 Correctness of the
⚫prescription---
G. Specialcare has to be taken in case
of:
a. Medicines with similar names:
⚫ Certain medicines have names that
may appear similar when carelessly written
or when not read carefully.
⚫ Example of similar names that illustrate the pit falls
are:
⚫ Folic acid versus Folinic acid

⚫ Dexamethasone versus Desoximetasone

83
 Correctness of the
⚫ prescription---
b) Abbreviations
⚫ Miss interpretations of abbreviations can kill clients!!

⚫ This is because in health care there are no recognized

standards for abbreviations, and most of the time,

prescribers invent their own.
⚫ Different pharmacy professionals may interpret
abbreviations differently.
⚫ Examples of confused abbreviations:
⚫ „HCT‟ (hydrocortisone, hydrochlorothiazide)?

⚫ „CPZ‟(Chlorpromazine,Carbamazepine)?

⚫ „CPM‟ (Chlorpromazine or Chlorpheniramine)

84
 Completeness of a
prescription
⚫ Completeness of a prescription means,

⚫A prescription should have every

necessary part of the prescription.
⚫ everything that is wanted in the
prescription should be fulfilled or a
prescription should have all the necessary
in formations on it.

85
 Completeness of a
prescription…
⚫ Details to be checked for completeness

of the prescription include:

⚫ Seal of the health institution or header

⚫ Prescriber‟s details (Name of prescriber‟s,

Qualifcation,
Signature and Date )
⚫ Patient's details (Patient Name, Patient Address,

Sex, Age, Weight and Diagnosis)

⚫ Medicine details

86
 Completeness of a
prescription…
⚫ Checking the medicine details will include:

⚫ Checking name of the medicine

⚫ Checking dosage form
⚫ Checking strength/ potency of the medicine
⚫ Checking total amount to be dispensed and its
availability

⚫ Checking dosage and directions for use

⚫ Checking frequency of administration and
87 duration of the treatment
Completeness of a prescription…
⚫ Completeness of the prescription should
include:
A. Name of the medicine
B. Dosage form

C. Strength/potency of the medicine

D. Quantity to be dispensed

E. Dosage and directions for use

F. Contraindications
G. Frequency of administration
88
 Completeness of a
prescription…
A. Name of the medicine:
⚫ The name of medicine must be legible and correct

without a doubt.
⚫ Since many brands sound alike, brand confusion

is quite common especially if the handwriting is

illegible and the pharmacy professionals
proceeds on the basis of guesswork.
⚫ The prescriber should ideally write the generic

name in parentheses against the brand name or

write the generic name alone.
89 ⚫ Example: Diclofenac 50mg rather
 Completeness of a
B.prescription…
Dosage form:
⚫ Some medicinesare available in many
different formulations.
⚫ The same medicine could be
available as tablets, capsules, and even
injections.
⚫ Examples: Diclofenac available 50mg tab.,
100mg tab., 100mg suppository and 75m/3ml inj.
C. Strength/potency of the medicine:
⚫ Prescribers to prescribe the medicine
90
without the strength.For example:
 Completeness of a
D.prescription…
Quantity to be dispensed:
⚫ For any product with a short expiry period, ensure that the
quantity
dispensed will not last longer than the expiry date

⚫ Remember if the expiry date of a

product is labeled as July 2022, then
the product can be used until the end of
July 31st 2022
E. Dosage and directions for use:
⚫A knowledgeable and an alert
pharmacy professional can be a great
9 times major ones) while
1
asset and a lifesaver especially if the
 Completeness of a
prescription…
F. Contraindications:
⚫ The dose should always be checked taking into
account
the patient's age,
and weight (especially for a
child or for the elderly and pregnant woman).
⚫ For pregnant woman all categories, A, B, C, D

and X should be checked.

92
 • Medicines under category ‘A’:

⚫ adequate well controlled

studies in pregnant woman do
not show risk to the fetus.
⚫ Examples;

⚫ vitamins like B complex,

⚫ minerals like iron.

93
 ⚫ Medicines under category ‘B „

⚫ either animal findings show risk and

human findings do not, or ,if no adequate
human studies have been done
,animal findings do not show risk.
⚫ Examples:

⚫ cefftriaxone sodium injection,

⚫ chlorpheniramine maleate

94
⚫ Medicines under category ‘C’

⚫ human studies are lacking, and animal studies

either show risk or lacking as well.

⚫ However, potential benefts may out way the
potential risks.
⚫ Examples:

⚫ albendazole,

⚫ aspirin with codeine phosphate.

95
⚫ Medicines under category „D‟;

⚫ investigational or post marketing data show

risk to the fetus.
⚫ Nevertheless, potential benefts may
sometimes
the outweigh
the risk.
⚫ Example:

⚫ Atenolol,

⚫ captopril,

⚫ Phenobarbit
96
als
⚫ Medicines under category „X‟

⚫ studies in animals or humans or

investigational or post marketing
surveillance reports show fetal risk that
clearly outweighs any possible benefits
gained from the drug to the patient.
⚫ Examples;

⚫ Ethinyl estradiol and norethindrone,

⚫ lovastatin, simvastatin,
97
⚫ thalidomide, vitamin A, warfarin sodium
 Completeness of a
G.prescription…
Frequency of administration
⚫ Check if the frequency recommended by the

prescriber is as per the standard dosing patterns.

⚫ Doses more frequentthan standard,proven doses
may cause toxic manifestations.
⚫ At the same time, doses lesser than standard,
required doses may result in failure to treat the
condition properly.

98
 Prescription
⚫assessing
In assessing the prescription;
Use professional skills obtained from
training and experience.
⚫ While reading prescriptions:

⚫ Be alert and concentrate on the prescription.

⚫ Never engage in other activities

⚫ Talking

⚫ Cell phone receiving

⚫ Receiving an other prescription

99
⚫ Starting dispensing of the previous
 THANK YOU

100
 1

GOTONEAL COLLEGE
Department Of Pharmacy

LO2: Ensure Clinical Evaluation of Prescription

by Pharmacist
For Pharmacy Technician Level-IV
By: MELAKU M.
 Lo 2. Ensuring clinical evaluation of
prescription
2

 Under this LO the following subtopics will be covered:

🞑 2.1. Checking for drug incompatibilities
and interactions

🞑 2.2. Checking for contraindications

🞑 2.3. Checking for Adverse Drug Reactions

🞑 2.4. Reports Of ADRs

🞑 2.5. Sources of information for clinical

evaluation of prescriptions
 Objectives
3

 After completing this unit you will be able to:

🞑 Check drug incompatibilities and interactions

🞑 Check contraindications

🞑 Check Adverse Drug Reactions

🞑 Perform Reports Of ADRs

🞑 Identify sources of drug information

 Outline
4

 Drug incompatibilities and interactions

 Drug contraindications
 Adverse Drug Reactions
 Reports Of ADRs
 Sources of drug information
 2.1. Checking for drug incompatibilities
and interactions
5

 Prescription has to be referred to pharmacist for

clinical evaluation
 Pharmacist’s clinical evaluation is confirmed before filling
the Prescription
 Confirm that the doses prescribed are in the
normal range for the patient (noting sex and age)
 Identify common drug- drug interaction(s)
 Drugs –disease interaction
 Drug with individual difference (age, s ex, pregnancy …)
 Drug with food interaction
 2.1. Checking for drug incompatibilities
and interactions….
6

 Incompatibilities means: describes two or more

drugs that should not be used together (not
suitable for use in combination)

🞑 E.g. cefftriaxone with ringer lactate.

 Drugs should not be added to blood, amino acid
solutions or fat emulsions.
 Some drugs, such as diazepam and insulin, bind to
plastic containers and tubing.
 2.1. Checking for drug incompatibilities
and interactions….
7

 Some drugs, when added to IV fluids, may be

inactivated due to change in pH, precipitate formation
or chemical reaction.
🞑 For example, benzylepenicillin and ampicillin loose
potency after 6-8 hours if added to dextrose solutions,
due to the acidity of the solutions.
 Aminoglycosides are incompatible with penicillins &
heparin.
 Hydrocortisone is incompatible with heparin, TTC & CAF.
 2.1. Checking for drug incompatibilities
and interactions….
8

 Incompatibilities in Parenteral admixtures:

🞑 IV Parenteral admixtures are the undesirable reactions
that can occur when two or more drugs are administered
through single IV line or given in a single solution
 4 Types of Incompatibilities in Parenteral admixtures
🞑 Physical Incompatibilities
🞑 Chemical Incompatibilities
🞑 Therapeutic Incompatibilities
🞑 Drug -IV Container Incompatibilities
 2.1. Checking for drug incompatibilities
and interactions….
9

 Physical Incompatibility:
🞑 Results from Incompatibility that is
mainly on solubility changes and container
interactions.
🞑 Various types of physical
incompatibilities may occur as:
 Visible color change or darkening
 Formation of precipitate
 Examples: Insolubility, gas formation, change of pH
of solution
 2.1. Checking for drug incompatibilities
and interactions….
10

 Chemical Incompatibility:
🞑 results from the molecular changes or rearrangement
and leads to chemical decomposition.

🞑 Various types of chemical

incompatibility occur as complexion, oxidation,
reduction and photolysis.

🞑 Example; the combination of an acid and a base in an

IV solution
 2.1. Checking for drug incompatibilities
and interactions….
11

 Therapeutic Incompatibility:
🞑 is a result of antagonistic pharmacological effects of
several drugs in one patient.
🞑 For example: Heparin with antibiotics Intervention:
 It is best to avoid mixing heparin with antibacterial
preparations because Heparin can affect the
stability of certain antibiotics.
 The use of an IV or oral bacteriostatic as tetracycline
with an IV or oral bactericidal as penicillin G, which
results in decreased activity of the penicillin G
 2.1. Checking for drug incompatibilities
and interactions….
12

 Drug-IV Container Incompatibility:

🞑 arise from the chemical reaction of the drug and
the Intravenous container.

🞑 Adsorption: - The property of a solid/liquid to

attract and hold to its surface.

🞑 Absorption: - The act of taking up liquids or other

substances through a surface of the body into
body fluids and tissues.
 2.1. Checking for drug incompatibilities
and interactions….
13

 Drug interaction:
🞑 Drug interaction is a phenomenon, which occurs
when the effects of one drug are modified by the
prior or concurrent administration of another drug.
🞑 Although some medicine interactions could be
beneficial, most are harmful.
🞑 Hence, it is always important to note the possible
medicine interactions prior to concomitant
medicine/food or drink administration.
 2.1. Checking for drug incompatibilities
and interactions….
14

 Drug interactions could occur at different levels,

including:
🞑 Pharmaceutics drug interaction

🞑 Pharmacokinetics drug interaction and,

🞑 Pharmacodynamics drug interaction.

 2.1. Checking for drug incompatibilities
and interactions….
15

 Pharmaceutical Drug Interactions:

🞑 Are physicochemical interactions that occur in an
IV infusion or in the same solution.
 Serious loss of potency can occur from
incompatibility between an infusion fluid and a drug that
is added to it.

🞑 Example, diazepam if added to

infusion fluid, there will be precipitate formed.

🞑 This precipitate leads to loss of therapeutic effect.

 2.1. Checking for drug incompatibilities
and interactions….
16

🞑 Is an interaction at the level of ADME

🞑 Interaction at the level of absorption
🞑 E.g.; Antacid with divalent ion such as Ca2+, Mg 2+:
 TTC with milk (Ca2+);
→ complex formation and ↓ absorption
 TTC with antacid = ↓ absorption of TTC
 Antacid with ketoconazole;
 = ↓ absorption of ketoconazole
 2.1. Checking for drug incompatibilities
and interactions….
17

 Interaction at the level of distribution:

🞑 A drug which is extensively bound to plasma

proteins can be displaced by an other drug. E.g.,

 Sulfonamides can be displaced by salicylates
from plasma proteins and leads to sulfonamide
toxicity.
 Phenylbutazone + warfarin →↑ warfarin effect
 2.1. Checking for drug incompatibilities
and interactions….
18

 Interaction During Biotransformation/metabolism:

🞑 Can be explained by two mechanisms:
 Enzyme Induction
 Enzyme Inhibition

🞑 Enzyme Induction:
 this accelerates biotransformation of drugs
and causes therapeutic failure
 If warfarin + Barbiturate administered
together,
decreased anticoagulation effect of warfarin.
 E.gs., of enzyme inducers are:

 2.1. Checking for drug incompatibilities
and interactions….
19

 Enzyme Inhibition:
🞑 this delays biotransformation of drugs and is the
cause of increased intensity, duration and
sometimes toxicity of drugs.

🞑 E.g. Warfarin + Metronidazole (EI)  Hemorrhage

🞑 Examples of enzyme inhibitors are:

 disulfiram, INH, allopurinol, cemitidine
etc…
 2.1. Checking for drug incompatibilities
and interactions….
20

 Interaction at the level of excretion:

🞑 Some drugs interact with others at the site of

excretion mostly in kidneys.

🞑 E.g. Penicillin + probenecid (antigout) 

Increase the duration of action of penicillin
because both compete for excretion through
tubular secretion.
 2.1. Checking for drug incompatibilities
and interactions….
21

🞑 Is an interaction at the level of receptors

🞑 Types of Pharmacodynamic interactions are:
 Additive,

 Synergistic,

 Potentiation or
 Antagonism:

 The effect of the agonist is blocked

by the
antagonist when given together
 2.1. Checking for drug incompatibilities
and interactions….
22

effect:
🞑 When the total pharmacological action of two
or more drugs administered together is
equivalent to the summation of their
individual pharmacological actions.

🞑 The effect is simple algebraic sum

 expressed by 112 or A + B = AB. E.g.

🞑 Combination of ephedrine & aminophyllin

in the treatment of bronchial asthma.
 2.1. Checking for drug incompatibilities
and interactions….
23

🞑 Is when two drugs are taken together that are similar

in action, an effect is exaggerated

🞑 The total effect is more than the algebraic sum

 Expressed by 1+2 >3. E.g. alcohol + barbiturate
 Normally, taken alone, neither substance would
cause serious harm, but if taken together, the
combination could cause coma or death.
 2.1. Checking for drug incompatibilities
and interactions….
24

🞑 Is when two drugs are taken together and

one of them intensifies the action of the
other.
 Theeffectof one medicine increases by
the presence of another medicine,
🞑 Expressed by 1+0>1, AB > A + B. E.g.
 Amoxicillin + clavulanic acid
 Antacids + simethicone

 2.1. Checking for drug incompatibilities
and interactions….
25

 Drug interactions are some of the most common

causes of adverse reactions.
 As drug reactions could also occur between a
medicine and food or a medicine and drink.
 We should always inform our patients the type of
food or drink which they have to avoid while
taking the medicine.
🞑 NB: Read Drug-food & drug- diseases interactions
 2.2. Checking for contraindications
26

 Contraindication is a condition which makes a particular

treatment is inadvisable (not recommended).
 A contraindication may be absolute or relative
 An absolute contraindication is a situation which makes a
particular treatment is absolutely inadvisable.

🞑 In children, Example, aspirin is almost always

contraindicated because of the danger that aspirin will
cause Reye syndrome.
 2.2. Checking for contraindications…
27

 A relative contraindication is a situation which makes a

particular treatment is possibly inadvisable.
🞑 For example , X- rays in pregnancy are relatively
contraindicated (Because of concern for the developing
of fetus).

🞑 Unless the X- rays are absolutely necessary.

 Contraindications often highlight the balance of risk
versus benefit of a particular treatment or procedure.
 2.2. Checking for contraindications…
28

 Special considerations of contraindications:

🞑 Prescribing for pregnant women

🞑 Prescribing for nursing women

🞑 Prescribing for infants/children

🞑 Prescribing for elderly patients

 2.3. Checking for Adverse Drug Reactions
(ADRs)
29

 ADR is a noxious (harmful) and unintended response to a

medicine that occurs at normal therapeutic doses used in
humans for prophylaxis, diagnosis, or therapy of disease,
for the modification of physiologic function.
 The word “effect” is used interchangeably with “reaction.”

 ADRs & events constitute a serious problem;

🞑 increasing morbidity and mortality and

🞑 Increasing health care costs worldwide.

 2.3. Checking for Adverse Drug Reactions
(ADRs)…
30

Types of adverse drug reaction

 Type A Adverse Drug
Reactions

🞑Pharmacologically
predictable, e.g.
 Hypotension following
antihypertensive drugs.
 Hypoglycemia following
insulin
 Type B Adverse Drug Reactions
 2.3. Checking for Adverse Drug Reactions
(ADRs)…
31

 Serious adverse effect

🞑 Any untoward medical occurrence that
occurs at any dose.
🞑 The results of serious adverse effects:
 requires hospital admission (prolonged hospital stay),
 persistent or significant disability (life threatening)
 Finally death occur,
 2.3. Checking for Adverse
Drug Reactions (ADRs)…
32

 Untoward effects = harmful effects:

🞑 Untoward effects develop with
therapeutic dose of a drug.

🞑 They are undesirable and if very severe,

🞑 It may necessitate the cessation of treatment.

🞑 Examples:
 Diarrhoea with ampicillin and
 potassium loss with diuretics.
 2.3. Checking for Adverse Drug Reactions
(ADRs)…
33

 Side effects:
🞑 Side effects are in fact pharmacological effects produced
with therapeutic dose of the drug. Such effects may be;
 well-known and expected
 Either positive (beneficial) or negative (harmful) effect
 e.g: Dryness of mouth with atropine which is
troublesome in peptic ulcer patients and useful when
used as a pre-anaesthetic medication
🞑 These effects require little or no change in patient
management.
 2.3. Checking for Adverse Drug Reactions
(ADRs)…
34

 Adverse drug event:

🞑 Any untoward medical occurrence that
may be present during treatment with a
medicine.

🞑 Adverse drug events include overdoses

and
 Overdoses: The dose is given for the patient over
medication errors.
the normal dose range.
🞑 Serious drug toxicity may result from overdoses.
 2.3. Checking for Adverse Drug Reactions
(ADRs)…
35

Medication error:
 Medication error means administration
of medicine or dose that differs from written
order.
 That means;
🞑 Wrong dosage form given

🞑 Wrong dose or strength given

 2.3. Checking for Adverse Drug Reactions
(ADRs)…
36

🞑 Wrong preparation of a dose

 e.g., incorrect dilution

🞑 Incorrect administration technique

 e.g., unsterile injection

🞑 Medicine given to a patient with known allergy

🞑 Wrong route of administration used

🞑 Wrong time or frequency of administration

 2.3. Checking for Adverse Drug Reactions
(ADRs)…
37

 Adverse Drug Reactions ‘significantly;

1. Diminish quality of life,

2. Increase hospitalizations

3. Prolong hospital stay

4. Increase mortality’
 2.4. Reports Of ADRs
38

 Reports Of ADRs are commonly done by:

🞑 Pharmacists.

🞑 Nurses,

🞑 Physicians

🞑 Midwives
 Health visitors could also report
suspected Adverse Drug Reactions.
 2.5. Sources of information for clinical
evaluation of prescriptions
39

 As knowledge about medicines is changing,

new medicines are being developed.
 Some medicines known to be effective and safe in
the past may not be effective or safe at present.
 Hence, updating knowledge on every medicine
is indispensable for good dispensing practice.
 So health professionals use sources of
information for clinical evaluation of prescriptions.
 2.5. Sources of information for clinical
evaluation of prescriptions…
40

 2.5. Sources of information for

clinical
evaluation of prescriptions obtained from:
🞑 2.5.1. Sources of medicine information

🞑 2.5.2. Using software for drug interaction,

contraindication.

🞑 2.5.3. Drug formulary,

🞑 2.5.4. Standard Treatment Guidelines (STG)

🞑 2.5.5. Consulting the pharmacist

 2.5.1. Sources of medicine information
41

 Although basic information about medicines is

obtained through training in clinical
medicine profession, additional knowledge can
be gained from various sources.
 These of medicine information can be
sources
classified into;
🞑 primary,
🞑 secondary
and
 2.5.1. Sources of medicine information…
42

 Primary sources: provide new medicine information

mainly based on research in journals.
 Such sources include health journals such as;
🞑 the Ethiopian Medical Journal,
🞑 the Ethiopian pharmaceutical Journal,
🞑 the Ethiopian Journal of Health Development,
🞑 Lancet, and others.
 It is important to assess the reputability of
the journal and time of publication.
 2.5.1. Sources of medicine information…
43

 Secondary sources: provide reviews of articles

that appear in primary sources.
 Examples include;
🞑 Medicine information bulletins,
🞑 Adverse medicine reaction bulletin,
🞑 International Pharmaceutical Abstracts
🞑 PubMed (or Medline),
🞑 Hospital formularies, etc.
 2.5.1. Sources of medicine information…
44

 Tertiary sources: include standard

reference books such as;
🞑 British National Formulary,
🞑 Basic and clinical pharmacology,
🞑 Medical dictionary,
🞑 Ethiopian national drug formulary, etc.
 The selection of a particular source of information
depends on the type of information required.
 2.5.1. Sources of medicine information…
45

 Tertiary sources are used prior to secondary or

primary sources; Why?
 Because of the following reasons;
🞑 They provide a broadoverview of
particular subject area.

🞑 Standard books are published at

longer time intervals than journals.
 2.5.1. Sources of medicine information…
46

🞑 Generally, Tertiary sources:

🞑 Give general information

🞑 Are excellent first-line resources.

 serve as an initial place to identify information

🞑 Easy to use and familiar to most practitioners

🞑 Most of the information needed by

a practitioner can be found in these sources
 2.5.2. Using software for drug interaction,
contraindication.
47

 Identify relevant resources might be a general

Internet search for information
 Internet sources are used for clinical
evaluation of prescription papers.
 unusual diseases, marketed OTC products
and combination dietary supplements
need clinical evaluation.
 2.5.2. Using software for drug interaction,
contraindication.
48

 Internet searches may be useful for topics

🞑 That have recently been in the news;
 where information is changing more rapidly than
standard paper resources can be updated.

🞑 Some examples of soft wares that are

used to clinical evaluation of prescriptions;

🞑 Google, Medscape, Up-To-Date,-----

 2.5.3. Formulary Manuals
49

 These are drug-oriented and contain

summary drug information on a selected number
of drugs;

🞑 sometimesthey combined with

practical prescribing and dispensing
information.
 NB: It is relatively difficult to prepare STGs than
formulary manuals.
 2.5.4. Standard Treatment
Guideline (STGs)
50

 STGs are disease oriented and reflect

a
consensus / widespread agreement/
on
treatments of first choice for a range of medical
conditions.
 Standard treatment guidelines
🞑 Are disease centered

🞑 Provide clinical information on medicines

 2.5.4. Standard Treatment
Guideline (STGs)…..
51

 Advantage of STG for DSM:

🞑 Identification of whichdrugsshould
be available for the prevalent diseases.

🞑 Provides information for purchase of

prepackaged medicines.

🞑 Drug demand will be more predictable

so forecasting become more reliable.
 2.5.4. Standard Treatment
Guideline (STGs)…..
52

 Advantages of STG for health professionals:

🞑 Utilizes only formulary or essential medicines, so
the health care system needs to provide only the
medicines in the STGs

🞑 Provides assistance to all practitioners, especially

to those with lower skill levels

🞑 Enables providers to concentrate on making the

correct diagnosis
 2.5.4. Standard Treatment
Guideline (STGs)…..
53

 Advantages of STG for health professionals:

🞑 Provides a basis for evaluating

quality of care provided by health care

professionals

🞑 Provides effective therapy in terms of quality

🞑 Provides a system for controlling costs

 2.5.4. Standard Treatment
Guideline (STGs)…..
54

🞑 Provides information for practitioners to give to

patients concerning the institution’s standards

of care

🞑 Serves to integrate special programs (diarrhea

disease control, TB) at the primary health care

center with a single set of guidelines

 2.5.4. Standard Treatment
Guideline (STGs)…..
55

 Advantage of STG for patients:

🞑 Patients receive optimal pharmaceutical therapy.

🞑 Enables consistent and predictable treatment from all

levels of providers.

🞑 Allows for improved availability of medicines because

of consistent and known usage patterns.

🞑 Helps provide good outcomes because

patients are receiving the best treatment regimen
available.
 2.5.5. Consulting the pharmacist
56

 Pharmacists are being asked daily to provide responses

to numerous DI requests for a variety of people.

🞑 It is just important to select the

easiest, most familiar resources to find

🞑 information.
Also, other resources, including experts or
specialists in particular areas of practice, may
need to be consulted to ensure clinical evaluation
of prescriptions.
5
7
LO3. Calculating prescription
quantities

For pharmacy technician level-iv

BY: MELAKU M.

1
Outlines
1. Dilution and concentration

2. Reducing and enlarging formulas

3. Calculating oral doses

4. Calculating parenteral doses

5. Calculating pediatric doses

2
•3.1. Dilution and concentration
• 3.1.1. Relationship between total
strength and quantity
• 3.1.2. Dilution and concentration of liquids
• Stock solutions
• Dilution of alcohol
• Dilution of acids
• 3.1.3. Dilution and concentration of solids

3
3.1. Dilution and
concentration
Dilution:
• Is less concentrated liquid

• Is a substance, especially a liquid, that has been made

thinner or weaker by the addition of water or another liquid.

Concentration:
• Is making the liquid thicker or stronger
• Is the removal of water (usually a liquid)
from something to make it thicker or stronger.

4
3.1. Dilution and concentration.......
• The concentration of a solution is the amount of the dissolved
substance (solute) per unit volume of solvent.

• A more concentrated solution can be diluted to a lower

concentration to obtain appropriate strength and precision
when compounding preparations.

• Powders and semisolid mixtures can be triturated or mixed to

achieve lower concentrations.

• Medication may be diluted to meet dosage requirements for

children.

5
3.1. Dilution and concentration...
A solution can be concentrated or diluted
Relative terms, no cut point between them
Pharmaceutical preparation can be concentrated by
Addition of active ingredient
Admixture of solution with higher
strength
Evaporation of continuous phase
Pharmaceutical preparation can be diluted
by addition of solvent or
by mixing with solution with lower
concentration
The extent of dilution depend on the volume of

6
DILUTION AND
CONCENTRATION

7
DILUTION AND CONCENTRATION…
Q1: How many milliliters of a 1% stock solution of a certified red dye
should be used in preparing 4000 mL of a mouthwash that is to
contain 1:20,000 w/v of the certified red dye as a coloring agent?

Solution:
Given:
C1xV1 = C2V2
C1 = 1%
V1 = C2xV2/C1
C2 = 1:20,000 w/v = 0.005%
= 0.005% x4000 ml/1%
V2 = 4000 ml
= 20 ml
Required: V1 = ?

8
3.1.1. Relationship between strength and total
Strength: is the concentration of the active ingredient.
quantity

Total quantity: Is the total mass or volume of the dosage form

For example: 150 ml of 20% w/v solution

Strength = 20% w/v
Total quantity = 150 ml
 If the amount of active ingredient remains constant, any
change in the total quantity is inversely proportional to %
strength. Or

 If a mixture of a given percentage or ratio strength is diluted

to twice its original quantity, its strength will be reduced by
one-half.

9
3.1.2. Dilution and concentration of liquids
• Stock solutions

• Dilution of alcohol

•Dilution of
acids Stock Solutions:
are concentrated
solutions
of active
(e.g., drug)
or inactive (e.g.,

10
colorant) substances.
Stock solutions-----
 To facilitate the dispensing of certain soluble
substances, the pharmacist frequently prepares or
purchases (high) concentrated solutions.

 These concentrated solutions are known as stock

solutions.

 Stock solutions can be diluted to make a product

that has a lower concentration (lesser strength).

11
Q2: How many milliliters of a 1:400 w/v stock solution
should be used to make 4 liters of a 1:2000 w/v
solution?

Q3: How many

milliliters of a 1:400 w/v
stock solution should be
used in preparing 1 gallon
of a 1:2000 w/v
solution?

12
Q4: How many milliliters of a 1:50 stock solution of phenylephrine
hydrochloride should be used in compounding the following
prescription?
Phenylephrine HCl 0.25%
Rose Water ad 30 mL
Sig. For the nose.

 Some interesting calculations are used in pharmacy

practice in which the strength of a diluted portion of a
solution is defined,
 But the strength of the concentrated stock solution used

13
to prepare it must be determined.
Q5: How much drug should be used in preparing 50
mL of a solution such that 5 mL diluted to 500 mL
will yield a 1:1000 solution?

14
 A solution of known volume and strength
may be diluted with water to prepare a
solution of lesser strength.
In such calculations:
• First calculate the quantity of diluted
solution that may be prepared from the
concentrated solution.
• Then, subtract the volume of the
concentrated solution from the total
quantity that may be prepared to

15
Q6: How many milliliters of water should be added to
300 mL of a 1:750 w/v solution of benzalkonium
chloride to make a 1:2500 w/v solution?

16
 If the quantity of a component is given rather than the strength of a
solution,
 The solution may be diluted to a desired strength as shown by
the
following example.
How many milliliters of water should be added to 375 mL of a solution
containing 0.5 g of benzalkonium chloride to make a 1:5000 solution?

17
Q7: How many grams of active ingredient are in 50 g of 10% ointment?
 10 gm drug/100 gm oint (10%) x
50 gm oint (10%)

 = 5 gm drug

Q8: How many grams of a 5% ointment can be made

from 5 g of active ingredient?

5 gm/100 gm x a = 5 gm

5 gm a= 500 gm

a= 500 gm (gm)/5 gm =100 gm

18
Example Q9: You have a stock solution that contains 10 mg
of active ingredient per 5 mL of solution.
• The physician orders a dose of 4 mg.
• How many milliliters of the stock solution will have to be

administered?

19
Example Q10: You are to dispense 300 mL of a liquid
preparation. If the dose is 2 tsp, how many doses will
there be in the final preparation?
Begin solving this problem by converting to a
common unit of measure using conversion values.

Solution 1: Using the ratio proportion method

, X = 30 doses

Teaspoon (~5ml)

20
Tablespoon (~10ml)
Dilution of Alcohol

 When water and alcohol are mixed, there is a physical contraction

such that the resultant volume is less than the total of the individual

volumes of the two liquids.

 Thus, to prepare a volume- in- volume strength of an alcohol

dilution, the alcohol ‘‘solute’’ may be determined and water used to

‘‘q.s.’’ to the appropriate volume.

 Because the contraction of the liquids does not affect the weights of

the components, the weight of water needed to dilute alcohol to a

21
desired weight-in-weight strength may be calculated as it is.
Q11. How much water should be mixed with 5000
mL of 85% v/v alcohol to make 50% v/v alcohol?

50 (%)/85 (%)= 5000 (mL) / x (mL)

x = 8500 mL

Therefore, use 5000 mL of 85% v/v alcohol and

enough water to make 8500 mL, answer.

22
Q12. How many milliliters of 95% v/v alcohol and how much
water should be used in compounding the following prescription?

Xcaine 1g
Alcohol 70%----------------------30 mL

Sig. Ear drops.

95 (%)/ 70 (%) = 30 (mL) / x (mL)

x 22.1 mL

Therefore, use 22.1 mL of 95% v/v alcohol and enough water to

make 30 mL, answer.

23
Q13. How much water should be added to 4000
g of 90% w/w alcohol to make 40% w/w
alcohol?

40 (%) / 90 (%) = 4000 (g) / x (g)

x = 9000 g, weight of 40%

w/w alcohol equivalent to 4000 gm of 90%
w/w alcohol.

9000 g - 4000 g = 5000 g or

5000 mL,

24
Dilution of
Acids
 The strength of an official undiluted (concentrated) acid
is expressed as percentage weight-in-weight.

 However, the strength of an official diluted acid is

expressed as percentage weight-in-volume.

 It is necessary, therefore, to consider the specific gravity

of concentrated acids in calculating the volume to be used
in preparing a desired quantity of a diluted acid.

25
26
Hydrochloric acid is approximately a 37% w/w solution
of hydrochloric acid in water.

Calculate the amount, in g, of hydrochloric acid

contained in 75.0 mL of hydrochloric acid as follows.

[NOTE—The SG of hydrochloric acid is 1.18.]

37% w/w × 1.18 = 43.7% w/v

(43.7 g/100 mL) × 75 mL

= 32.8 g of hydrochloric acid

27
28
3.1.3. Dilution and concentration of Solids.

 The dilutions of solids in pharmacy occurs when there is needed to

achieve a lower concentration of an active component in a more
concentrated preparation.

Example : if 30 gm of a 1% w/w hydrocortisone ointment were diluted

with 12 gm of Vaseline. what would be the concentration of
hydrocortisone in the mixture?

Solution:

30 gm x 1% =0.3 gm hydrocortisone

30 gm + 12 gm = 42 gm weight of mixture.

29
(0.3 gm/42 gm) x 100=0.71 % w/w.
30
31
32
 Reducing or enhancing the strengths of creams and ointments is a
usual part of a compounding pharmacist’s practice to meet the
special needs of patients.
 The dilution of semisolids is a usual part of a compounding
pharmacist’s practice in reducing the strengths of creams and
ointments to meet the special needs of patients.
 How many grams of 20% benzocaine ointment and how many
grams of ointment base (diluent) should be used in preparing 5 lb.
of 2.5% benzocaine ointment?

33
 Quiz
1. If 500 mL of a 15% v/v solution are diluted to 1500 mL, what
will be the percentage strength (v/v)?

2. What is the percentage of zinc oxide in an ointment prepared by

mixing 200 g of 10% ointment, 50 g of 20% ointment, and 100 g
of 5% ointment?

3. A pharmacist has a 70% alcoholic elixir and a 20% alcoholic

elixir. He needs a 30% alcoholic elixir to use as a vehicle for
medications. In what proportion must the 70% elixir and the
20% elixir be combined to make a 30% elixir?

34
3.2. REDUCING AND
ENLARGING FORMULAS
1.Formulas that specify amounts of
ingredients

2. Formulas that specify proportional parts

35
3.2.1. Formulas that specify amounts of
ingredients
 Pharmacists may have to reduce or enlarge formulas for
pharmaceutical preparations in the course of their
professional practice or manufacturing activities.

 Official (United States Pharmacopeia—National

Formulary) formulas generally are
preparation ofbased
1000 on
mL orthe
1000 g.

36
Example :what will be the new formula for 30 gm of
the following preparations?
Ingredients Master formula Quantity for 30
gm
Zinc oxide ----------------12.50 gm ?

Calmine --------------------15.00gm ?

Hydrous wool fat------------25.00 gm ?

White soft paraffin-----------47.50 gm ?

First find the total weight of the master formula
 12.5 gm + 15.00 gm + 25.00 gm + 47.50 gm = 100gm

37
Second find Multiple factor (MF) =

The given Total weight or volume

/ The Total weight or volume of master
formula.
30 gm / 100 gm = 0.3
If the MF is greater than 1, the formula is
called enlarged formula.
If the MF is less than 1, the
formula is called reduced formula.

This formula is called reduced

38
formula because MF is less than 1.
Third

Ingredient Master formula Quantity for 30 gm

Zinc oxide ----------12.50 gm x 0.3 3.75 gm

Calamine -------------15.00gm x 0.3 4.5 gm

Hydrous wool fat----25.00 gm x 0.3 7.5 gm

White soft paraffin---47.50 gm x 0.3 14.25 gm

39
Example 2 : Find the amount of each ingredients to prepare 1500 ml of
ipecac syrup in the following master formula.

Ingredients master formula Quantity for 1500

ml Ipecac extract -------------70 .00 ml ?

Glycerin -------------------100 ml ?

Syrup to make or q s------1000 ml ?

There is no need to add each of the volume of ingredients, because the

total volume is already given ( to make or q s 1000 tells us total volume
is 1000 ml?

Find MF which is = 1500 ml / 1000 ml = 1.5

40
Ingredients Master formula Quantity for 1500 ml

Ipecac extract ---70 .00 ml x 1.5---------- 105.00 ml

Glycerin -----------100 ml x 1.5 ---------- 150.00 ml

Syrup to make or q s---1000 ml x 1.5 to make 1500 ml

This formula is called enlarged formula because MF is >1.

Q 1 : what is the percent of glycerin in the preparation?

• 150 ml/1500 ml= 0.1 x 100 = 10 %

Is it w/v or v/v or w/w ? Answer = v/v

Why ? Because it is liquid & the final preparation also

41
liquid.
3.2.2. Formulas that specify proportional
parts
 On a rare occasion, a pharmacist may encounter an old formula
that indicates the ingredients in ‘‘parts’’ rather than in measures of
weight or volume.

 The parts indicate the relative proportion of each of the

ingredients in the formula by either weight or volume, but not
both.

 A formula for solid or semisolid ingredients, therefore, may be

considered in terms of grams, whereas a formula of liquids may
be considered in terms of milliliters.

42
From the following formula, calculate the quantity of each ingredient

required to make 1000 g of the ointment.

 Coal Tar ………………………….. 5 parts

 Zinc Oxide ……………………… 10 parts

 Hydrophilic Ointment…………….50 parts

 Total number of parts (by weight) = 65

 1000 g will contain 65 parts

(1000 gm x 5 part)/ 65part = coal tar=5000 gm /65 = 76.92 gm

(1000 gm x 10 parts)/65=Zinc oxide=10000 gm /65= 153.85 gm

(1000 gm x 50 parts)/65= hydrophilic ointment=50000 gm/65=769.23

43
gm.
3. Calculating oral doses

1. Powders and granules

2. Tablets and capsules

3. Oral liquids

44
WHAT IS A DOSE?

 The term DOSE refers to the amount of medication that

a patient must take at one time to produce the optimum
therapeutic effect.

The dose may be expressed as

a single dose: the amount taken at one time;

a daily dose; the amount taken in one day;

a total dose, the amount taken during the course of

therapy.

45
 A daily dose may be subdivided and taken in divided doses, two or

more times per day depending on the characteristics of the drug

and the illness.

 The schedule of dosing (e.g., four times per day for 10 days) is

referred to as the dosage regimen.

 The terms "average dose,""usual dose," and "adult dose" are based

on the amount of medication needed to treat the average size adult

70kg.

46
General dose calculation

Number of doses =Total quantity/Size of dose, Example:

Q1. If the dose of a drug is 200 mg, how many doses are contained in 10 g?
10g= 10000mg

Number of doses= 10,000 (mg)/200 (mg)=50 doses

Q2. How many teaspoonfuls would be prescribed in each dose of an elixir if

180 mL contained 18 doses?

Q3. How many milliliters of a liquid medicine would provide a patient with
2 tablespoonfuls twice a day for 8 days?

Q4. If 0.050 g of a substance is used in preparing 125 tablets, how many

micrograms are represented in each tablet?

47
 3.3.1. Powders and granules

 Example of a dry powder for reconstitution to prepare an

oral
solution.
 The label calls for the addition of 127 mL of water to prepare
200 mL of solution having a concentration of 125 mg or

48
• A powder is defined as a dosage form composed of a solid or
mixture of solids reduced to a finely divided state and intended for
internal or external use.
• powders are more stable than liquid dosage forms and are rapidly
soluble, enabling the drug to be absorbed quickly.
• Most powders for internal use are taken orally after mixing with
water.

49
 Preparing Solutions Using Powders:
 Some drugs, most notably antibiotics, lose their potency

in a relatively short period when prepared in a liquid

dosage form.

 To enhance the shelf-life of these drugs,

manufacturers provide products to the pharmacy in
dry powder form for reconstitution with purified water
or special diluent at the time a prescription or
medication order is received.

50
 Depending on the product, the dry powder may be
stable for about 24 months.

 After reconstitution, the resultant solution or suspension

is stable in the quantities usually dispensed for up to 10
days at room temperature or 14 days if maintained
under refrigeration.

 Reconstitution is the process of adding a liquid diluent

to a dry ingredient to make a specific concentration of
liquid.

51
• On receipt of a prescription order, the pharmacist follows
the label instructions for reconstitution:
• adding the proper amount of purified water or

• other diluent to prepare the liquid form.

• Depending on the product’s formulation, reconstitution

results in the preparation of a clear solution (often
called a syrup) or a suspension.

52
 Dry pharmaceuticals are described in terms of the
space they occupy = the powder volume (pv).

 Powder volume is equal to the final volume (fv) minus

the diluent volume (dv).

pv = fv – dv
 When pv and fv are known, the equation can be used
to determine the amount of diluent needed (dv) for
reconstitution.

53
Example 1:
• You are to reconstitute 1 g of dry powder.
• The label states that you are to add 9.3 mL of diluent
to make a final solution of 100 mg/mL.
• What is the powder volume?
• 1 gram = 1000 mg
• 1 00 mg = 1 ml
X = 1 ml x 1000 mg = 10 ml
• 1000 mg = 100 ml
X
• Powder volume final volume (10 ml) –
=
volume (the amount ofdiluent
solvent added) (9.3 ml).
• 10 ml – 9.3 ml = 0.7 ml

54
Example 2:

• The label for a dry powder package of cefprozil for oral

suspension directs the pharmacist to add 72 mL of
purified water to prepare 100 mL of suspension.
• If the package contains 2.5 g of cefprozil;
• What is the powder volume? 28 ml.

• How manymilligrams of the drug would be

contained in each teaspoonful dose of the constituted
suspension?

• 125 mg cefprozil.

55
3.3.2. Tablets and capsules
Q 1. A patient is prescribed metformin1000 mg PO BID for one month. The
drug is available in 500-mg tablets.

What is the total daily dosage of metformin?

How moneytabletsthe pharmacy would dispense
for one month?
Q 2. A patient is prescribed enalapril 8 mg PO daily. The drug is available in
2-mg tablets.

 What is the total daily dosage of enalapril?

Q3. A formula calls for 42 capsules of 300mg of drug.

• How many mgs would be required to make 24 capsules?

• Answer , 171.4 mg

56
3.3.3. Oral liquids

Nitrofurantoin oral suspension 50 mg is prescribed.

The oral suspension contains 25 mg/5 mL.

How much ml of a pharmacy dispenses?

Furosemide (Lasix) 20 mg oral solution is

prescribed.

The oral solution is available in a concentration of 40

mg/5 mL.

How much ml of a pharmacy dispenses?

57
3.4. Calculating Parenteral doses
1. Injectables liquids

2. Injectables powder forms (reconstitution)

3. IV admixtures

4. Insulin doses

58
3.4.1. Inject able liquids
 Injections are sterile pharmaceutical solutions of a drug
substance in an aqueous or non aqueous vehicle.
They are administered by needle into almost any part of

the body.
Some injections are available as prepared solutions with
their drug content
 but Others contain dry powder for reconstitution to
form a
solution by adding a specified volume of diluent prior to use

 The term parenteral is defined as any medication route

other than the alimentary canal and thus includes all routes

59
of injection.
Q1. How many milliliters must be injected from an ampoule of
Prochlorperazine labeled "10 mg/2 ml" in order to administer a
dose of 7.5 mg?
X = 1.5 ml

Q2. You have a 10-ml vial of aminophylline labeled "25 mg per

ml". How many milliliters must be injected to administer a dose of

60
125 mg?
Flow rate calculation:
• When calculating the flow rate of IV solutions, remember that

the number of drops required to deliver 1 ml varies with the

type of administration set.
• Administration sets are of two types:
• Macro drip set (delivers 10-20 drops/ml )
• Micro drip set (60 drops/ml).

61
3.4.2. Calculations involving powders
for reconstitution
Certain medications like penicillin will not be stable if
they are formulated in the form of solutions.

so they will be formulated in powder form to be

reconstituted with a sterile water or normal saline.

when reconstituted, the drug may or may not contribute to

the final volume of the reconstituted solution

62
Example 1:

A prescription calls for 300000 units penicillin G potassium to be

added in 500ml of D5W. A vial of penicillin G contains 1000,000
units, the direction says 4.6 ml should be added for the concentration
of solution 200,000 units/ml. so how many ml of the reconstituted
solution should be taken and added to D5W?

63
⚫ Example 2:

64
3.4.3. PARENTERAL
ADMIXTURES
 The preparation of intravenous admixtures involves the addition of

one or more drugs to large volume sterile fluids such as; sodium
chloride injection, dextrose injection, lactated Ringer’s injection or
others.

 The additives are generally in the form of small-volume

sterile solutions in which some them requires reconstitution with

solvent before transfer.

some of the more common additives in intravenous

therapy include; electrolytes, antibiotics ,vitamins, trace minerals,

heparin, and, in some instances, insulin.

65
⚫ Example 1

66
67
3.4.4. Insulin doses
 Insulin injections are very commonly prescribed for
patients suffering from diabetes.

 It is expressed in units of activity per milliliter.

 For example ‘’insulin 10 units’’ means 10 units of insulin

are present in 1ml of the injection (10 Unit/1 ml).

 Insulin should also always be measured in insulin syringes, which

are calibrated according to the strength of insulin.

68
Q1: Give insulin 35 IU am and 15 IU pm for one month.
How many vials do you dispense? (1Vial = 1000 IU)

35 IU Morning + 15 IU Afternoon = 50 IU

Hence,50 IU/day x 30 days (1 month) = 1500 IU

1 Vial /1000 IU = a/1500 IU = 1.5 Vial ~ 2 Vial.

69
3.5. Calculating paediatric doses
1. Based on age

2. Based on weight

3. Based on body surface area

70
For certain drugs and for certain patients, drug dosage is

determined on the basis of specific patient parameters, like:

Age,

Weight,

Body surface area, and

Nutritional and functional status.

71
Among patients requiring individualized dosage are:

neonates and other pediatric patients,

elderly patients with diminished biologic functions,

individuals of all age groups with compromised liver and kidney

function; thus reduced ability to metabolize and eliminate drug

substances,

critically ill patients, and

patients being treated with highly toxic chemotherapeutic agents.

72
Pediatric Patients

Pediatrics is the branch of medicine that deals with

disease in children from birth through adolescence.

• Neonate (newborn),

• from birth to 1 month

• Infant,

• 1 month to 1 year;

73
 • Early childhood,
• From 1 year through 5 years;

• Late childhood,
• From 6 years through 12 years; and

• Adolescence,
• 13 years through 17 years of age.
A neonate is considered premature if born at less than 37 weeks’
gestation.

74
3.5.1. Drug Dosage Based on Age

Neonates have immature hepatic and renal functions that

affect drug response.

The elderly, in addition to diminished organ function,

frequently have issues of concomitant pathologies and
increased sensitivities to drugs

 So age of a patient is one of the most important

considerations for drug dosage modifications.

75
A few general equations for the dosage calculations based on age are
provided below; However, the use of these equations is rapidly declining
because age is not the only valid criterion for dose modifications.

Young’s Rule is preferably used for children between 1 to 12 years of age.

76
Fried’s Rule is preferably used for infants up to 2 years of age
3.5.2. Drug Dosage Based on Body
Weight
⚫ The patient’s weight is an important factor in

dosing since the size of the body

influences the drug’s concentration in the
body fluids and at its site of action
⚫ A useful equation for the calculation of dose

based on body weight is:

77
78
3.5.3. Drug Dosage Based on Body
Surface Area
⚫ The body surface area (BSA) method of

calculating drug doses is widely used for

two types of patient groups:
⚫ Cancer patients receiving chemotherapy and

⚫ Pediatric patients

⚫ The average adult is considered to have a BSA of 1.73 m2

79
79 4/7/2024
Body Surface Area (BSA) can be determined by the following methods;

• Nomo graph

• BSA equation

Nomo graph: a graph with three lines graduated so that a straight line
intersecting any two of the lines at their known values intersects the
third at the value of the related variable.

• Most BSA calculations use a standard Nomo-graph, which

includes both weight and height.
• The BSA of an individual is determined by drawing a straight
line connecting the person’s height and weight.
• The point at which the line intersects the center column indicates the
person’s BSA in square meters.

80
Nomo graph for Determination of Body Surface Area
from Height and Weight

81
81 4/7/2024
BSA equation: in addition to the use of nomogram,
BSA may be determined through use of the following formula

Example: Calculate the BSA for a patient measuring 165 cm in

height and weighing 65 kg
Solution:
• Given;
• Ht = 165 cm Answer =
• Wt = 65 kg
Required:
• BSA = ?

82
⚫ Example

⚫ If the adult dose of a drug is 75 mg, what would be the dose for a

child weighing 18 kg and measuring 80 cm in height using the BSA

equation?
⚫ Given

⚫ Adult dose = 75 mg

⚫ Weight of child = 18 kg

⚫ Height of child = 80 cm
⚫ Required

⚫ Child dose?

⚫ Solution

⚫ First find the BSA of the child

83
Problems

1. What is the dose of a drug for a 9-month-old infant if the average adult dose is 25
mg?

2. What is the dose of a drug for a 6-year-old child if the average adult dose is 98
mg?

3.What is the dose of a drug for a child who weighs 28 lb if the average adult
dose is 100 mg?

4. What is the dose of a drug for an individual who has a 1.21 m2 body surface
area?
The average adult dose is 400000 units.

5.What is the dose of a medicament for a child who weighs 66 lb if the dose
is stated as 2.5 mg/kg body weight?

84
6.What is the dose of a drug for an average adult patient if the dose of the drug is
 GOTONEAL COLLEGE
LO4 Prepare labels according to legal
requirements
For Pharmacy Technician Level-IV

BY: MELAKU M.
1
 LO 5 Prepare labels according to legal
requirements
⚫ Under this LO5 we have three subtopics:
1. Legal requirements regarding labeling
2. Types of labels
3. Components of labels

2
 Objective
s
⚫ After completing this unit you will be able to:

⚫ Describe legal requirements regarding labeling

⚫ List types of labels

⚫ Identify components of labels

3
 Outline
sLegal requirements regarding labeling
⚫

⚫ Types of labels

⚫ Components of labels

4
 5.1. Legal requirements regarding labeling

⚫ Definition of Label: is written displayed

of

information about a product on its

container, packaging or a product itself.
⚫ There is a legal requirement to be added on the label

of any prescribed or over the counter medicine

⚫ Medicines must be labeled with patients’

local language.
5
 5.1. Legal requirements regarding
labeling…..
 Each dispensed drug must be appropriately labeled
to comply with legal and professional requirements.
 All medicines to be dispensed should be labeled
 The labels should be;
 unambiguous,
 clear,
 legible and
 indelible (unforgettable).
6
 5.1. Legal requirements regarding
labeling…..
Requirements for labels:
⚫ There are both legal and professional requirements
which must be complained between
labeling a dispensed medicine.
⚫ It is the pharmacist responsibility to ensure that;

⚫ these requirements are satisfies and

⚫ all labeling is accurate

⚫ The regulation indicates the standard details which

must appear on label.
7
 5.1. Legal requirements regarding
labeling…..
⚫ The labeling of medicines in drug retail outlets
of Ethiopia is very disappointing.
⚫ It is common to see the dispensed medicines

⚫ without a label,

⚫ incomplete label,

⚫ or illegible label.

⚫ The size of the commonly used paper envelops may

not even allow to write the required information on

8
 5.1. Legal requirements regarding
labeling…..
⚫ The label of a pharmaceutical product has many

functions;
⚫ To indicate clearly the contents of the container

⚫ To indicate clearly to patients

⚫ how and when the drug should be taken or used

⚫ how the product should be stored and for how long

⚫ any warnings or cautions of which they need

to be made aware.
9
 1.Legal requirements
regarding labeling…..
⚫ To uniquely identify the of the
contents container
⚫ To patients‘ giving
increase compliance by concise about the
clear and information
⚫ preparation
To provide information about some
cautions

10
/warnings about the preparations
 5.1. Legal requirements regarding
labeling…..
⚫ Information on the label should be:

⚫ Legible

⚫ Concise

⚫ Adequate

⚫ Intelligible

⚫ Accurate

11
 5.1. Legal requirements regarding
labeling…..
⚫ Legible (readable): Always check label print size and
quality to ensure that it can be read clearly
⚫ Concise (brief): Precise , short, sufficient
information is placed on the label
⚫ Adequate: Ensure that sufficient information is given.

⚫ Intelligible (understandable): Label should be

easily understandable and use unambiguous
terms.
⚫ Accurate (perfect): the instructions are accurate
12
and that the patient name is complete and
 5.2. Types of labels

⚫ Label has two types:

⚫ Main label and

⚫ Auxiliary label

⚫ Main label:

⚫ it consists the common and major components.

⚫ E.g. name of products, expiry date….

13
 5.2. Types of labels…..
⚫ Auxiliary label:

⚫ It consists precautions and other advisory

labels. E.g.
⚫ shack before you use for suspension;
⚫ kept out of the reach of children;
⚫ For external use only

14
 5.3. Components of labels
Minimum drug label information on the
prescribed medicine should include the following:

With H2O,
chewing
Avoid heat, or swallowing
light etc….
The date of compounding If any.
15
 Example of labels

1
6
 Example of label in English

17
 A label must be prepared in a local
language

18
 THANK YOU

19
 Gotoneal College

Department Of Pharmacy

LO5. Establishing Counseling Environment

For Pharmacy Level-IV

By: Melaku M.
Email address:[email protected]
1
 OUTLINE
1. Introduction to General Psychology

1. Meaning of Psychology

2. Goal of psychology

3. Sub Field of Psychology

4. The Nature of Human Development

1. .Aspects of human development

5. Freud‟s Personality Structures

6. Maslow‟s Hierarchy of needs

7. Assertive, Passive, or Aggressive

behavior 2
Learning Objectives/Outcomes:

At the end of this course you will be able to:-

 Define the meaning of Psychology

 Describe the Goal of psychology

 List and define some Sub Field of Psychology

 Describe The Nature of Human Development

 Describe Freud‟s Personality Structures and Maslow‟s Hierarchy

of needs
 Differentiate between Assertive, Passive and
Aggressive behavior
3
5.1. Introduction to general psychology
• Psychology is originated from two Greek words i.e.,

– Psyche soul/spirit
– Logos study
• Thus, originally psychology was defined as the study of “soul” or
“spirit (a person's attitude or state of mind).
• Psychology is the scientific study of mind and behavior.

• Widely used definition: Psychology is the science of

human and animal behavior.
• The terms “science” & “behavior” need further explanation.
4
• What is science?
– Science is a group of related facts and principles of a
particular subject.
– In science we collect related facts by the use of
objective methods to develop a theory to explain those
facts.
– From a given set of conditions, science helps us to
predict future happenings.

5
• Example:
– Biology explains how living things grow and develop.
– Anatomy describes the structure of the body.
– Physiology deals with the function of various parts and
systems of the body.
– The rest of the health sciences are also founded on
science.
– Similarly, Psychology as a science deals with human
behavior, motives, feelings, emotions, thoughts and
actions of men and women.
6
• What is behavior?
– Behavior is the reaction of an individual
to a particular environment.
– Behavior In its broader sense includes all
typesof human activities
– Example:
• Motor activities (Walking, speaking)
• Cognitive activities (perceiving,
remembering, thinking, reasoning)
• Emotional activities (feeling happy, sad, angry, afraid)
7
• Psychologists collect facts of behavior by means of
objective methods such as observation and
experiment and predict human behavior.
• Example:
– a patient may react with anger if his movements are
restricted in the ward.
– If the health professional has knowledge of scientific
psychology, it is possible to predict and control the
patient‟s behavior.
• Wilhelm Wundt is the man most commonly identified
as the father of psychology.
8
• At times psychologists study animal behavior.

• The reasons are:

– The study of animal behavior helps to develop general
laws of behavior that apply to all organisms.
– The studyof animal behavior provides
important clues to answering questions about human
behavior.
– For ethical reasons it is sometimes difficult to conduct
psychological experiments on human beings
9
• What are general psychology studies?
– The broad study of the basic principles, problems,
and methods underlying the science of psychology,
including areas such as;
• Behavior, human growth and development,
emotions, motivation, learning, senses,
thinking the memory,
perception, personality processes,
theory, psychological
testing, behavior.
10
intelligence,
Why we study the course of general psychology?
• Reasons to study psychology:

– Psychology is a (interesting) area of

fascinating study;
• It will help you understand human
behavior and mental processes,
• Itwill allow you to better understand how
we think, act and feel.

11
• Psychology has a contribution to the health professional.

• Some of the contributions are:

1. It helps to understand oneself

2. It assists in understanding other people

3. It enlightens (tells) to appreciate the

necessity of changing the environment and how to
bring it about

12
1. Psychology helps to understand oneself:
– Helps to make rational decisions on becoming
a health professional;
– To fulfill the need for economic self sufficiency;

– Helps to assess ones own abilities & limitations;

– Enables to control situations in the

college and attain goal through self-discipline

13
2. Psychology assists in understanding other people:
• The health professional works with patients, families,
other nurses, doctors and administrative staffs.
• Equipped with the knowledge of psychology, the health
professional will achieve greater success in interpersonal
relationships.
• Psychology helps the health professional to learn why
others differ from him/her in their preferences, customs
and beliefs or cultural patterns

14
3. Psychology enlightens to appreciate the
necessity of changing the environment & how to
bring
– Byit about:
changing the environment, the health
professional can bring about change in the
patient‟s life.
– Example: introducing eyeglasses and hearing devices
into the environment can help people with visual or
auditory impairments.

15
 5.1.2. Goal of psychology
The study of psychology has Four Goals.

1. Describe :
 Describing things is something we do every single day with no conscious
thought or effort.
 But describing in psychology has a slightly different meaning than the
describing we do in our everyday life.
 Describing a problem, an issue, or behavior is the first goal of psychology.

 Descriptions help psychologists to distinguish between normal and

abnormal behavior and
 Gain a more accurate understanding about human and animal
behavior,
actions, and thoughts. 16
 Cont…….
2. Explain :
• Psychologists are very interested in being able to explain
behavior rather than just being able to describe it.

• This helps in providing answers to questions about why

people react in a certain way, why they do the things they
do and the factors which affect their personality, their
mental health, their actions, etc.
17
 CONT……….
3. Predict :
• Making predictions about how we think, and act is the
third goal of psychology.
• By looking at past observed behavior (describing and
explaining) psychologists aim to predict how that behavior
will appear again in the future and whether other people
might exhibit the same behavior.

• Through the process of describing an explanation,

psychologists are able to understand more about what
thoughts, feelings, and behaviors are contributing factors.
• They can then use that knowledge to predict why, when,
how those things might happen in the future.
and 18
 CONT……..
4. Change / Control :
• Psychology aims to change, influence, or control
behavior to make positive, constructive, meaningful,
and
– lasting changes in people's lives and to influence
their behavior for the better.

• This is the final and most important goal of

psychology.

19
5.1.3. Branches/Sub Fields of Psychology

Brainstorming Questions?

• Dear student, can you tell where psychologists

are employed to work after graduation?

20
• psychology has become a very diverse field today that there
are different branches which psychologists can pursue to study.
• Below are some of the branches of psychology.

1. Developmental psychology
• It studies the physical, cognitive and psychological changes
across the life span.
• It attempts to examine the major developmental milestones that
occur at different stages of development.
2. Personality Psychology
• it focuses on the relatively enduring traits and characteristics of
individuals.
• Personality psychologists study topics such as self-concept,
21
aggression, moral development, etc.
3. Social Psychology
• Deals with people„s social interactions, relationships,
social perception, and attitudes.
4. Cross-cultural Psychology
• Examines the role of culture in understanding behavior,
thought, and emotion.
• It compares the nature of psychological processes in different
cultures, with a special interest in whether or not psychological
phenomena are universal or culture-specific.
5. Industrial psychology
• Applies psychological principles in industries and organizations
to increase the productivity of that organization.

22
6. Forensic psychology
• applies psychological principles to improve the legal
system (police, testimony, etc..).

7. Educational Psychology
• Concerned with the application of psychological principles and
theories in improving the educational process including
curriculum, teaching, and administration of academic
programs.

8. Health Psychology
• Applies psychological principles to the prevention and
23
treatment of physical illness and diseases.
9. Clinical Psychology
• Is a field that applies psychological principles to the
prevention, diagnosis, and treatment of psychological disorders.

10. Counseling Psychology

• Is a field having the same concern as clinical psychology but
– Helps individuals with less severe problems than those treated by
clinical psychologists.

24
 5.1.4 The Nature of Human Development
• Psychology is the scientific study of changes that occur in
human beings over the course of their life.
• Originally concerned with infants and children, the field has
expanded to include adolescence, adult development, aging, and
the entire lifespan.
• Developmental psychology informs several applied fields.

• A significant issue is the relationship between innateness

and environmental influence in regard to any particular
aspect of development
25
 CONT…….
Mechanisms of development
• Developmental psychology is concerned not only with
describing the characteristics of psychological
change over time,
• But also seeks to explain the principles and internal
workings underlying these changes.
• Psychologists have attempted to better understand these
factors by using models.
26
 CONT……….
Cognitive development
• It is primarily concerned with the ways that infants and
children acquire, develop, and use internal mental capabilities
such as problem solving, memory, and language.

• Major topics are the study of language acquisition and the

development of perceptual and motor skills.
• Piaget theory suggests that development proceeds through a set
of stages from infancy to adulthood and that there is an end point.
27
 CONT…….
Social and emotional development
• How individuals develop social and emotional competencies
are examined.
• They study how:
• Children form friendships,

• Identity develops,

• They understand and deal with emotions.

• The development of emotional regulation is affected by the

emotional regulation which children observe in parents
and
caregivers. 28
 CONT……….
Physical development
• It concerns the physical maturation of an individual's
body until it reaches the adult structure.
• Simply measured in the form of height, weight, head
circumference, and arm span.
• A few other studies and practices with physical
developmental psychology are the phonological
abilities of mature 5 to 11 years old.
29
Memory development
• Researchers interested in memory development look at the way
our memory develops from childhood and onward.
• According to Fuzzy-trace theory, we have two separate memory
processes: verbatim and gist.
• Children as young as 4 years-old have verbatim memory,
– memory for surface information, which increases up to early
adulthood, at which point it begins to decline.

• Our capacity for gist memory,

– memory for semantic information, increases up to early
adulthood, at
which point it is consistent through old age.
 5.1.5. Freud’s Personality Structures
• According to Sigmund Freud's psychoanalytic theory
of personality, personality is composed of three
elements.

• These three elements of personality--known as the id,

the ego and the superego.

– work together to create complex human behaviors.

31
 CONT………..
1. id
• It is the only component of personality that is present from birth.

• This aspect of personality is entirely unconscious and includes

of the instinctive and primitive behaviors.
• It is the source of all psychic energy, making it the primary
component of personality.
• The id is driven by the pleasure principle, which strives
for immediate gratification of all desires, wants, and
needs.
• If these or
anxiety needs are not satisfied immediately, the result is a
tension. 32
 CONT………..
• For example, an increase in hunger or thirst should produce
an immediate attempt to eat or drink.
• The id is very important early in life, because it ensures that
an
infant's needs are met.
• If the infant is hungry or uncomfortable, he or she will cry
until the demands of the id are met.
• This sort of behavior would be both disruptive and socially
unacceptable.
• According to Freud, the id tries to resolve the tension created by
the pleasure principle through the primary process, which
involves forming a mental image of the desired object as a way of
satisfying the need.
33
 CONT………….
2. ego
• It is the component of personality that is responsible for
dealing with reality.
• The ego develops from the id and ensures that the impulses
of the id can be expressed in a manner acceptable in the real
world.
• The ego functions in both the conscious, preconscious, and
unconscious mind.
• The ego operates based on the reality principle, which strives
to satisfy the id's desires in realistic and socially appropriate
ways.
• The reality principle weighs the costs and benefits of an
action before deciding to act upon or abandon impulses. 34
 CONT……….
• In many cases, the id's impulses can be satisfied
through a process of delayed gratification.
• The ego will eventually allow the behavior, but only in
the appropriate time and place.
• The ego also discharges tension created by unmet
impulses through the secondary process, in which the
ego tries to find an object in the real world that matches
the mental image created by the id's primary process.
35
 CONT……
3. superego
• It is the aspect of personality that holds all of our
internalized moral standards and ideals that we acquire
from both parents and society
• our sense of right and wrong.

• The superego provides guidelines for making

judgments.
• According to Freud, the superego begins to
emerge at
around age five. 36
 CONT………
• There are two parts of the superego:

1.The ego ideal includes the rules and standards for

good behaviors.
• These behaviors include those which are approved of by
parental and other authority figures.
• Obeying these rules leads to feelings of pride, value
and accomplishment.

2.The conscience includes information about things that

are viewed as bad by parents and society.
• These behaviors are often forbidden and lead to bad
consequences, punishments or feelings of guilt and
remorse. 37
 CONT…….
• The superego acts to perfect and civilize our behavior.

• It works to suppress all unacceptable urges of the id

and struggles to make the ego act upon idealistic
standards rather that upon realistic principles.
• The superego is present in the conscious, preconscious
and unconscious.
• According to Freud, the key to a healthy personality is
a balance between the id, the ego, and the superego.
38
 5.1.6. Maslow’s Hierarchy of needs
• Maslow wanted to understand what motivates people.
• He believed that individuals possess a set of motivation
systems unrelated to rewards or unconscious desires.
• Maslow (1943) stated that people are motivated to achieve
certain needs.
• When one need is fulfilled a person seeks to fulfill the next
one, and so on.
• The earliest and most widespread version of Maslow's (1943,
1954) hierarchy of needs includes five motivational needs,
often depicted as hierarchical levels within a pyramid.
39
 CONT……..
 The original hierarchy of needs five-stage model includes:

40
 CONT…………
1. Biological and Physiological needs - air, food, drink, shelter,
warmth, sex, sleep.

2. Safety needs - protection from elements, security, order, law,

limits, stability, freedom from fear.

3. Social Needs - belongingness, affection and love, - from work

group, family, friends, romantic relationships.

4. Esteem needs - achievement, mastery, independence, status,

dominance, prestige, self-respect, respect from others.

5. Self-Actualization needs - realizing personal potential,

self-
fulfillment, seeking personal growth and peak experiences. 41
 CONT…….
 This five stage model can be divided into:
 Basic or deficiency needs : e.g. physiological, safety, love, and
esteem and
 growth needs self-actualization.
 The basic needs are said to motivate people when they are
unmet.
 Also, the need to fulfill such needs will become stronger
the longer the duration they are denied.
 For example, the longer a person goes without food the
more hungry they will become.
 One must satisfy lower level basic needs before progressing on
to meet higher level growth needs.
 Once these needs have been reasonably satisfied, one may be
able 42
 CONT………..
• Every person is capable and has the desire to move up
the hierarchy toward a level of self-actualization.
• But, progress is often disrupted by failure to meet lower
level needs.
• Life experiences including divorce and loss of job may
cause an individual to fluctuate between levels of he
hierarchy.
• Maslow noted only one in a hundred people become
fully self-actualized because our society rewards
motivation primarily based on esteem, love and other
social needs.
43
Characteristics of self-actualizers:
 They perceive reality efficiently and can tolerate uncertainty

 Problem-centered (not self-centered)

 Able to look at life objectively

 Highly creative

 Concerned for the welfare of humanity

 Capable of deep appreciation of basic life-experience

 Establish deep satisfying interpersonal relationships with a

few people
 Democratic attitudes
44
 Strong moral/ethical standards.
5.1.7. Assertive, Passive, or Aggressive
behavior
• Assertive Behavior
• It includes standing up for your rights without
infringing on the rights of others.
• Assertive behavior results in an “win-win”
encounter.
• Assertion involves expressing beliefs, feelings,
and preferences in a way that is direct, honest,
and appropriate and shows a high degree of
respect for yourself and the other.
• Example: “When you talk, I can’t hear the movie.
Please keep it down.”

45
 Assertive Behavior is:
• Self-expressive • Verbal – including
• Honest feelings, thoughts, desires,
• Respectful of the rights of rights, facts, opinions
others • Non-verbal – eye contact,
• Direct and firm voice posture, facial,
• Socially responsible gestures, timing
• Appropriate for the
• Learned, rather than
person, culture
inborn
and situation.
• Equalizing – benefiting
self and other
46
 CONT……………..
Passive Behavior
• It is when someone gives up their own rights and
(directly or indirectly) defers to the rights of another
person.
• Passive behavior results in an “I lose; you win” or
lose-win outcome.
• It includes violating y our own rights through inaction
or by failing to express your thoughts, feelings, or
desires.
• Example: “We can do whatever you want. Your ideas
are probably better than mine.”
47
 CONT………
Aggressive Behavior
• It is when someone stands up for their own rights
without regard for others.
• It results in an “I win; you lose” outcome. Aggression
is self-expression that demands, attacks, or humiliates
other people, generally in a way which shows lack of
respect for others.
• Example: “Hey, I‟m in a hurry. Get out of my way.”
48
 2. Communication skill
Under communication skills the following are included:
1. Introduction to communication
2. Communication process
1. Understanding perception of individual
2. Rapport building skills.
3. Non-verbal communication & body language.

4.Questioning and
listening 2.2.5.Responding and
2.3.explaining
Barriers to communication
49
 2.1. Introduction to communication
• Communication is simply the sending and receiving of
information between at least two people. Or
• Communication is the sharing of information, ideas, thoughts,
and feelings. Information travels from a source, such as a
mouth, to a receiver, such as an ear.
• Therefore, communication is a dialogue not a monologue.

So communication
is a two way
50
process.
 What are communication
skills? skills are the tools that we use to remove the
• Communication
barriers to effective communication.
Communication process:
• Communication process is composed of several stages, each of which
offers potential barriers to successful communication.
• Communication process include:
Sources Decoding
Message Receiver
Encoding Feedback
Channel/medium Context
51
The sources: the sources of a communication is also called
the sender of the communication.
• In an effective two-way communication the sender
(or source);
– Encodes (convert text to code) the message into a form that
the receiver will understand it.
– Relays (sends) the message via an appropriate channel.

– The receiver is then able to:

• access the message

• Decode the message

52
• The receiver in turn becomes the sender, providing an
appropriate response, and the process continues until the
communication concludes.

The message sent must be in a language or code that the receiver

will understand.
Communication problems occur when sender & receiver do not share
the same code or understanding of the language used 53
• The message:

– it is the information that you want to

simply
communicate. message there is no cause of
– communication.
Without
a
– Message is the information that is exchanged between
sender and receiver.
– The sources of the message is the sender

– Information can be a message or a collection of facts.

54
• Encoding:
– is the process of taking your message and transferring
it into the proper format for sharing it with
your audience.
– it requires knowing your audience and ensuring that
your message provides all of the
information that they need.

55
• Channel (medium):

– is the method of communication that you choose such as

face-to-face, by telephone, or via email.
• Your medium to send a message may
be print, electronic, or sound.

– Medium is the channel through which

encoder will communicate his message. How the
message gets there.

– Choice of medium is influence by the

relationship between the sender and receiver. 56
• Decoding (interpreting):
– is the process of receiving the message accurately and
requires that your audience has the means to understand
the information that you are sharing.
• Receiver:
– The person to whom the message is being sent.
– Receiver may be a listener or a reader depending on the choice
of medium by sender to transmit the message.
– Receiver is also influenced by the context, internal and external
stimuli.
– Receiver is the person who interprets the message.
57
• Feedback:
– Response or reaction of the receiver to a message.
– Feedback may be written or oral message.
– Feedback is the most important component of communication
in business.
– Communication is said to be effective only when it receives
some feedback.
– Feedback, actually, completes the loop of communication
• Context (situation/environment):
– involves things such as your relationship with your
audience, the
culture of your organization & your general environment. 58
Communication in the workplace:
 At work place, communication falls broadly into two main
categories:
external communication and
internal communication.
 External communication involves communicating outside
the organization with customers, clients, suppliers,
competitors and other organization.
 Internal communication involves communicating inside the
organization with your colleagues and supervisors (that is the
people you work with).
59
• The need for good communication;

– Interpersonal is a two-way,
communication transactional,
process.
– As we send messages to others, at the same time we
receive verbal and nonverbal signals from them.
– Our interactive style is to a large extent shaped,
and even determined by the other person.

60
• Communication and patient counseling skills;
– For effective pharmacist actions in the promotion of
health, responding to symptoms and management of
disease states, it is necessary to use communication skills
that convey the correct information to the patient and
encourage discussion of health-related problems.
• Patient counseling is undertaken by pharmacists:
• During dispensing
• In disease management
• In providing advice on self-care
61
• Pharmacist actions & communication with patients;

– Ensuring safe and correct use of medicines

– Responding to symptoms

– Discussing patient health-related and social problems

that impact on health status
– Empowering (make powerful) individuals to be active
in health promotion and preservation.

62
• Counseling process during dispensing of medicines;
– How and when to take or use a medicine

– How much to take or use

– How long to continue treatment

– What to do if a dose is missed

– How to recognize side-effects minimize their

and occurrence
– Lifestyle and dietary changes

– Drug–drug and drug–nutrient

interactions. 63
• Key issues of practitioner-patient interaction:

– Patients often do not understand, or

forget, information they are given
– Lack of patient-practitioner concordance/ agreement

– Inattentiveness/not paying attention to the

patient‟s psychosocial needs
– Patients are often dissatisfied with the
advice and information they are given

64
• Dissatisfaction with advice is usually linked to
the following factors:
– Poor practitioner rapport-building skills, e.g. poor level of eye
contact, little empathy, and lack of encouragement
– Patients not receiving the amount of information
they require
– Limited time available for the consultation
– Lack of specificity and precision in the information given
– The way in which information is provided
– Beingunable to access the right person to deal
with their problem
65
• Consequences of the pharmacist as a
skilled communicator;
– Improved patient outcomes

– Improved patient satisfaction with services

– Increased patient-friendly pharmacy practice

– Reduction in patient anxiety

– Increased pharmacist status

– Enhanced pharmacist satisfaction & self-esteem

66
• Consequences of the pharmacist as an unskilled
communicator;
– Reduced adherence to therapeutic regimes
– Decreased satisfaction with the content and process of the
communication
– Insensitivity to the needs of customers
– Increased worry and concern amongst patients
– Decreased pharmacist status
– Formations of job dissatisfaction
– Loss of business and reduced client base
67
• Objectives of patient counseling with
good communication by pharmacists:
– To ensure that patients are adequately informed about
their medication
– To predict any problems which might cause
loss of efficacy of the drug (detrimental to health of
patient)
– To identify any drug-related or health-
related problems
68
2.2. Communication process Include:
1. Understanding perception of individual

2. Rapport building skills.

3. Non-verbal communication & body language

4.Questioning and

listening 2.2.5.Responding and

explaining

69
 2.2.1. Understanding perception of individual
• Through the communication process, anticipate
different perceptions according to the individual‟s needs.
• There are different perceptions according to the
individual‟s needs.
• e.g. social problem associated with occurrence of
acne may impact differently on individuals.

70
 2.2.2. Rapport building skills
• Rapport describes a positive relationship that forms between two
or more persons.
• Once you have identified the possible barriers to effective
communication and considered some strategies to overcome
these barriers, you can then look at how to build rapport with
the client.
• Establishing good rapport with others is an essential skill for
community and disability service workers.
• It is particularly important when you are interviewing clients, as it
allows free and open discussion and provides better outcomes.
71
• Strategies for building good rapport include (1):
– Being clear about your role and the purpose
of the interaction.
– Using a person's preferred name when speaking with them.
– Paying attention to making them comfortable.
– Using a pleasant tone that is clear and precise.
– Explaining words and expressions that may be
unfamiliar and not using jargon
– Asking simple and clear questions.
– Explaining what you already know.
72
• Strategies for building good rapport include (2):
– Explaining clearly any mandated position you have.

• For example, you may have to report

to other authorities any disclosure of
abuse.
– Explaining the actions that are undertaken both during
the interview and as a result of the interview.
– Using appropriate language. Avoid jargon
and use words familiar to the other person.
73
 2.2.3. Non-verbal communication & body
language
There are many different types of
communication but they can be broadly divided into
two:
A. verbal communication and
B. non-verbal communication.

A. Verbal communication:
 You are using verbal communication whenever
you use words to get a message, idea, thought,
74
 Verbal communication can be either;

1. Oral communication or

2. Written communication.

1. Oral communication
Oral communication uses the mouth.

 Most oral communication involves people

speaking to each other either;
directly on the telephone or

over the internet via Skype.

75
2. Written communication
 These words might be:

written on paper, using a pen or pencil

printed on paper or other surface

 typed into a computer and sent via email

or via social media such as Face book or Twitter
copied onto a CD, DVD or USB flash drive.

76
 B. Non-verbal
communication
• Communication can be non-verbal, which
means that it does not use words to transfer
information.
• Characteristics of non-verbal communications:
– Close conversational distance

– Direct eye contact

– Direct body and facial orientation

– Open, forward leaning posture

77
• Non-verbal communication includes:
• Facial expressions

• Gestures (using body parts)

• Symbols /Signals

• Eye contact

• Posture

78
• Facial expressions: We use facial expressions to show
how we feel about something.
• The expression on the face of a person will often reveal :

 A great deal about their attitude and emotions

 Communicating feelings such as happiness, agreement,

confusion, anger, nervousness, defensiveness,

embarrassment (shyness)

79
 Gestures
 We can use gestures to show how we feel and
also to communicate a specific message.
 For instance, a police officer might hold up the
palm of his/her hand to tell drivers to stop their cars
or wave his/her hand to tell them to keep moving.

80
 Symbols

 Non-verbal might also involve

communication symbols such
as road signs.

 Signals

 Signals, such as traffic lights, also used to

are communicate messages and
instructions.

81
81
• Eye contact:
• maintain eye contact during communications give the
impression that they are confident, interested and engaged
in the conversation.
• Posture:
– People who are comfortable and interested in a situation
generally stand, walk or sit in a relaxed manner.
– Slumped shoulders may communicate
feelings of depression or hopelessness.
– An anxious or tense person may sit or stand with
their arms folded tightly in front of themselves
82
 Body language

 We use body language to show our attitudes

and emotions.
Often we are not even aware that we are doing it.

 For example, if you are discussing a project

with someone and you begin to lean back in your
chair, it creates distance between you and the other
person.
 This silently communicates that you are not
83
 2.2.4. Questioning and
listening
1. Effective questioning:
• In our context there are two (Open & closed questions) main
types of questions that can be used depending on:
– the type of information we require and/or
– the type of communication process we want to engage in
• Open and closed questions:
– Closed questions are those that can only be answered with a
'yes' or 'no'. Did you stand by and watch?
– Open questions are questions that cannot be adequately
answered by a yes or no, and usually start with the
words 'how', 'what', 'which', 'who' or 'where'.
• What did you do while this happened?
84
• Consider the following points during
Questioning and listening:
– Ask only one question at a time.

– Use effective questions to obtain information

that is necessary.
– Structure the flow of questions to follow a logical pattern.

– Encourage patient participation by pausing both after asking

a question and after the initial response.
– Practice active listening.

85
• Some useful tips about questioning:
– Be respectful (includes being culturally sensitive)
– Avoid inappropriately personal questions
– Keep questions simple
– Ask one question at a time
– Leave thinking time after have asked a
you question
– Actively listen to people‟s
response
– Clarify responses if required 86
2. Listening techniques
– Stop talking.

• You can‟t listen while you are talking.

– Get rid of distractions.

– Use eye contact to show you are listening.

– React to ideas rather than the person.

– Read nonverbal messages.

– Provide feedback to clarify the message.

87
88
 2.2.5.Responding and explaining

• There are numbers of ways to respond to someone when

in conversation:
– Clarify meaning when you do not understand
– Use a neutral response like („Uha…‟) to encourage the speaker
without leading them
– Simply remain silent & give the speaker time to think
– Repeat a question if it is not being answered
– Place the most important points at the beginning
of the communication session.
– Emphasize key issues.
– Simplify complicated messages
89
• Do you need a response immediately?
– Talking to someone face to face or over the phone means
that you are both communicating at the same time.
– This allows the person you are communicating
with to respond immediately to what you are saying.
– Communicating verbally is often very quick and effective.

– On the other hand, using written communication can take

longer to get a response.

90
 2.3. Barriers to effective communication

• Obstacle or interference that enters into the

communication process, resulting in a decrease in
the effectiveness of the communication is referred
to as a “barrier” to effective communication.
• In pharmacy settings, there are a number of factors
which can be barriers to effective communication.

91
• Barriers to communication in pharmacy:
– Environmental factors:
• Lack of privacy and space in the pharmacy

– Lack of time available for pharmacist:

• to dedicate to the patient for listening (patient
over load)
– Patient characteristics;
• Anxiety, Conflicting information, Forgetfulness, Lack of
Interest to Share their Concerns,
Impaired Vision, Speech, Hearing or Mental
Problems 92
 General Barriers to effective communication
– Physical or environmental barriers
– Language or Semantic barriers

– Psychological barriers

– Cross-cultural barriers
• Physical or environmental barriers include:
– Noise

– Time & distance

– Defects (imperfections) in communication system

– Physiological defects (hearing defects…)

93
 Methods of overcoming physical barriers
• Physical barriers are comparatively easier to overcome.

• The use of loudspeakers and microphones can remove

the

barriers of noise

• Technological advancement has helped in reducing

the

communication gap arising due to time and distance .

• Ensure Visibility & Audibility

• Environmental Comfort
94
 Language or Semantic barriers
• Language is the main medium of communication.

• Language barriers can arise in different ways:

– Jargon or unfamiliar terminology

– Difference in language

– words with Similar sound

– Words with more than one meanings

95
 Methods of overcoming language barriers
• Help a translator or an interpreter

• Clarity should be the main objective when using

language.

• Jargon should be avoided.

• Use of Simple Language

• Symbols & Charts

• Active Listening/ Constructive feedback

96
 Psychological barriers
• Psychological barriers are created in the mind:
– Emotion (feeling)

– Prejudice (discrimination)

– Self-image or different perceptions

– Closed Mind

– Status (rank)

– Inattentiveness and Impatience

97
 Methods of overcoming Psychological barriers

• Adopt flexible and open-minded attitude

• Training of listening skills

• Exposure to different environment, views will help

to broaden outlook
• Listening with empathy helps in making oneself
more adapting to other‟s perceptions.
• Calling Attention & motivation
98
 Cross-cultural barriers
• Culture is the sum total of ideas, customs, arts, and skills of a
group of people.
• Certain habits of working, communicating, eating, dressing etc.
are developed according to cultural conditioning.
• Examples of Cross-cultural barriers include:

– Language

– Values

– Social Relation (greeting style)

– Concept of space (distance b/n persons)

– Gestures 99
Methods of overcoming Cross-cultural barriers

• Understanding of Traditions & Customs

• Understanding Information of all sides of culture

• Exposing oneself to different environments help in

broadening one„s outlook and cultivating tolerance

to multiple views.

• Making oneself more open to others„ perceptions.

100
 Strategies to Improve
Communication
 All patients will benefit from the following strategies:
Explain things clearly in plain (tongue) language.

Focus on key messages and repeat.

 Use a “teach back” or “show me” technique to

check understanding
Effectively solicit (ask for) questions
 Use patient-friendly educational to enhance
materials interaction.
101
102
 3. Counseling
area
• Patient counseling may be defined as;
– providing medication information orally (in written form)
to the patients or their representative.
– providing proper directions of medication use, advice on
medication side effects & storage conditions, advice on
diet and life style modifications
– Counseling is most effective when conducted in a room or
space that ensures privacy and opportunity to engage in
confidential communication.
103
 CONT……
•
……
The effective counseling should encompass all the parameters to
make the patient understand his/her disease, medications
and life style modification required

• In designing or selecting an appropriate area for counseling,

confidentiality of information relating to a patient and their
family should be considered.

• Counseling area is the environment that the

pharmacist distributes medications to the patient
with
appropriate medication information
104
• The counseling area includes:
1. Counseling room and,
2. Special counseling room/cubicle
3.1. Counseling room
• Counseling room is any dispensary room where most patients
are serviced during counseling session.
• Counseling room needs less confidentiality than
special counseling room/cubicle.
• Counseling room fulfils:
– Stationeries, safe environments, demonstration materials ,
appearance and neatness of the room.
105
3.2. Special counseling room/cubicle:
– Special counseling room/cubicle is a room where a few
patients are serviced during counseling session because they
need confidentiality.
– The patients may expect the counseling area is;
• Confidential (Private),
• Secure (Lock) and
• Conducive (Favorable) to learn

– Special Counseling area may be a semi-private, or private

area away from other people and distractions, depending on
the medication(s). 106
• Examples of medications that need semi-private, or private
area during counseling are:
– Suppository Medications Administration, and
– Vaginal Medications Administration.
• If there are other people in the vicinity (surrounding are), be
conscious about voice volume.
• Special counseling area:
– Helps both patients and pharmacists are focused on discussion,
and minimize interruption and distractions
– provides an opportunity for patients to ask questions they may
be hesitant to ask in the public.
107
 4. Identifying drug information
sources for counseling
• As knowledge about medicines is changing, new medicines are
being developed.

• Some medicines known to be effective and safe in the past may

not be effective or safe at present.

• Hence, updating knowledge on every medicine

is indispensable (essential) for good dispensing practice

• Sohealth professionals use sources of medicine

information for counseling.
108
 CONT…………
• Although basic information about drugs is obtained
through training in pharmacy profession,
additional knowledge can be gained from various
sources.
• These sources of drug information can be classified
into:
– Primary sources,

– Secondary sources and

– Tertiary sources 109

• Primary sources: provide new
medicine information mainly based on
research in journals.

• Primary sources include health journals

such as;
– the Ethiopian Medical Journal,

– the Ethiopian pharmaceutical Journal,

– the Ethiopian Journal of Health Development,

– Lancet, and others.

• It is important to assess the reputability 110

• Secondary sources: provide reviews of articles
that appear in primary sources.

• Examples of secondary sources include;

– Medicine information bulletins,
– Adverse medicine reaction bulletin,
– International Pharmaceutical Abstracts
– PubMed (or Medline),
– Hospital formularies, etc.
• Tertiary sources: include standard reference books
111
• Examples of tertiary sources include;
– British National Formulary,
– Basic and clinical pharmacology,
– Medical dictionary,
– Ethiopian national drug formulary, etc.
• The selection of a particular source of
information depends on the type of information required.
• Tertiary sources are used prior to secondary or
primary sources; Why? Because of the following reasons;
– They provide a broad overview of particular subject area.
– Standard books are published at longer time intervals than
journals.
112
Generally, Tertiary sources:
– Give general information

– Are excellent first-line resources.

• They serve as an initial place to identify information

– Are easy to use and familiar to most practitioners

– Most of the information needed by a practitioner can

be found in these sources

THANK YOU
113
 Gotoneal College
Department Of Pharmacy

LO6. Providing Patient Counseling Service

For Pharmacy Level-IV

By: Melaku M.

Email address:[email protected]
1
LO6. Providing patient counseling service
1. Rationale of patient drug counseling
2. Counseling process
1. Recognizing the need for counseling
2. Assessing and prioritizing the needs
3. Checking assessment methods
4. Counseling environment in pharmacy.
5. Professional appearance of pharmacist
3. Standard protocol or procedure of counseling
1. Establishing caring relationship with the patient
2. Assess patient‟s knowledge
3. Providing information
4. Verifying knowledge and understanding
4. Compliance, adherence and concordance
1. Definition of terms
2. Causes of poor adherence
3. Consequences of non-adherence
4. Strategies for improving adherence
2
 2.1. Rationale of patient drug
• counseling
Patient counseling is one of the most important
service provided by drug dispensers.
• Counseling is defined by some authors as advice giving
or provision of information on medications.
• Counseling is usually the last step of dispensing.
• Counseling provides the opportunity for contact between the
pharmacist, patient and their medication.
• Counseling patients regarding their medications is an
important responsibility for pharmacists and an excellent
learning opportunity for students.
3
• Pharmacists are often the only health care providers focusing
patient education on medication:

– how to take it, what to expect,

side effects and drug interactions
• The effective counseling should all the
encompass parameters to make the patient
understand his/her;
– Disease,

– Medications and

– Life style modification required 4

• Objectives of patient counseling:
– To improve professional rapport (relationship) between
the patient & pharmacist
– To recognize patient;
• which means the medication is importance for his/her
well being
– To make the patient to become an informed, efficient
(competent) and active participant in disease treatment
and self care management
– To perceive (look like) the pharmacist as a professional
who offers pharmaceutical care
5
– To prevent drug interaction and adverse drug reactions

– To improve medication adherence

– To reduce incidence of adverse effects and

unnecessary healthcare costs
– To improve patient s‟ quality of life

– To motivate the patient to take medicine for improvement

of his/her health status
– To identify any drug-related or health-related problems

6
• Patient counseling can improve patient care by:

– Reducing medication errors.

– Increasing patients understanding and management of

their medical condition.
– Minimizing incidence of adverse drug
reactions and drug-drug interactions.
– Improving patient outcomes and satisfaction
with care.

7
• Patient counseling should include information on
the who, what, where, when and how:
Patient Who is the patient?
Drug What is the name of the medication?
What is the strength and dosage form?
What is the purpose of the medication?

How should the medication be taken?

• Including duration, frequency and route
of administration
Direction What to do in the event of missed doses?
• If you miss a dose, take it as soon as you
remember; but if it‟s almost time for your next dose, just
skip it. 8
 Con;
t What are potential adverse drug reactions?
Precautions What are potential food/drug interactions and
contraindications?

What are the expected outcomes?

How to monitor if treatment is ineffective?
Monitoring What to do if there are unwanted outcomes?
When to seek medical attention?
When are refills?
9
• The are four structures of the counseling session:

1. Introduction of the counseling session

2. Contents of the counseling session

3. Processes followed during counseling session

4. Conclusions of the counseling session

10
1. Introduction of the counseling session:
– Review the patient record prior to counseling
– Introduce yourself to conduct an appropriate
patient counseling
– Explain the purpose of counseling session
– Obtain pertinent initial drug related information
• E.g.: drug allergies, and other medications

– Warn (advise) the patient about taking other medications

including OTC drugs, herbals, and alcohol. Because these
could inhibit or interact into the prescribed medication
11
1. Introduction of the counseling session…:
– Determine whether the patient has any other medical
conditions that could influence the effects of their
drug or enhance the likelihood of an ADR.
– Asses the patient understandings of reason for
therapy.
– Assess any actual or problems of importance to the
patient

12
2. Contents of the counseling session:
– Discuss the name and indication of the medication
– Explain the dosage regimen including duration of therapy
when appropriate
– Assist the patient in developing a plan to incorporate the
medication regimen into his/her daily routine
– Explain how long it will take for the drug to show
its effect
– Discuss storage and refilling information
– Emphasize the benefits of completing the medication
as prescribed
13
2. Contents of the counseling session…..:
– Discuss the potential side effect
– Discuss how to prevent or manage the side effects of
the drug
– Discuss the precautions
– Discuss the significant drug‐drug, drug‐food,
and drug‐disease interaction
– Explain precisely what to do if the patient misses the
dose
– Explore the potential problems of the patient
14
3. Processes that followed during counseling session:
– Provide accurate information

– Use language that the patient is likely to understand

– Use the appropriate counseling aids support

to counseling
– Present the fact and order in a logical order

– Maintain control & direction of the

counseling session.
– Use open‐ended question
15
4. Conclusions of the counseling session:

– Verify the patient understanding via feedback

– Summaries by acknowledging or emphasizing

key points of information
– Give an opportunity to the patient to put forward any
concerns or questions
– Help the patient to plan, follow up and
next consecutive steps

16
 2.2. Counseling
process
• Patient counseling is undertaken by pharmacists.
• Counseling process during dispensing of medicines includes:
– How and when to take or use a medicine
– How much to take or use the medicine
– How long to continue the treatment
– How to recognize side-effects & minimize their occurrence
– Lifestyle and dietary changes
– Drug–drug interactions,
– drug diseases interactions
– drug-herbal interactions &
– drug–nutrient interactions. 17
2. Counseling process includes:

1. Recognizing the need for counseling

2. Assessing and prioritizing the needs

3. Checking assessment methods

4. Counseling environment in pharmacy

5. Professional appearance of pharmacist

18
 2.2.1. Recognizing the need for counseling
• When a patient presents with a prescription for
dispensing, the desired outcome is that the medicine
is used safely and effectively; in order to
alleviate symptoms or effect a cure.
• There could be a need for counseling and advice in every
such situation.
• The same need may also exist when a patient purchases
an over-the-counter medicine.
19
• In recognizing and assessing needs, an essential first step
is to establish what the patient already knows
about a particular medicine.
• The responsibility for the provision of counseling and
advice is that of the pharmacist who should normally
be personally involved.
• Appropriately trained pharmacy staff may be involved in
assisting both;
– with the recognition of need for counseling & advice and
– in the actual provision of certain aspects of counseling & advice
20
• Most of the time recognizing and assessing the needs for counseling are related

to medication, patient or both.

•
Prescribed medicines;

– have low safety margin

– require several additional labels
• Patient:
– has compliance problems previously identified?

– has physical disabilities?

– Has dysphagia (difficulty in swallowing)?
– has memory problems or is confused or anxious?
21
• The extent of counseling required varies from
one individual to another.
• The following points are recognizing the need for patient
counseling:
1. repeat medication (experienced or new patient)

2. Poly therapy

3. Complex instructions

4. Narrow therapeutic index drugs

5. Patient characteristics
22
1. Is it a repeat medication?
– Patients who have already taken the
medication also require counseling to ensure proper
use of medicines.
– If the patient is taking medication for the first time more
information is required.

2. Poly-therapy:
– patients who are taking more than one medicine
need more support to manage the drug-handling
process
23
3. Complex instructions:
– with medicines that have a complex drug regimen or
require an unusual drug-taking pattern pharmacist needs
to provide counseling and must ensure that the patient has
understood the drug regimen.

4. Narrow therapeutic index drugs:

– the risk associated with these medications is higher if
patient is not aware of how to taken medication, which
side-effects should be reported and the necessity of
relevant routine checks.
24
5. Patient characteristics:
– the pharmacist needs to adapt the counseling
session according to patient characteristics
and to individualize the session.
• (e.g. elderly, frail (in poor health),
psychiatric conditions)

25
 2.2.2. Assessing and prioritizing the needs
• Once the indication for counseling and advice has been
recognized, an individual patient's needs should be assessed
by reference to accurate and appropriate patient and medicine
information.
• Such information may be obtained from a number of
sources including;
– The patient or profession,
– The hospital /community-based health care professionals,
and
– The clinical records if available.
26
• It is the pharmacist's responsibility to ensure that the

counseling undertaken will allow the patient to use their

medication in a safe & effective manner.

• Consideration should be given to any needs not yet addressed
when re-evaluating priorities at a later stage.
• The pharmacist decides to deal with high priority issues only
on the patient's first visit to the pharmacy and he/she is asked
to return for further counseling.

27
• However, patient information leaflets are supplied in
case the patient does not return.
• Patient needs vary according to a number of factors.

• The counseling process has to be developed according to

each individual patient‟s needs.
• Patient priorities in life (e.g. lifestyle) should be taken
into consideration during the counseling session
if maximum patient benefit is expected.

28
• Information about patients that will help to prioritize the

needs includes:

– educational background

– available support

– Physical / abnormality (deafness,

physiological blindness)

– pregnancy and breast-feeding

29
 2.2.3. Checking assessment
methods
• It is all too easy to cover the standard points of advice
required for a particular prescription.
– But the patient's knowledge, understanding or ability to
use the medicine prescribed is not checked.

• Thus, before starting on any counseling and advice-giving

process, the pharmacist should have a mental plan of how
the success of the process can be determined.

30
• Patient counseling may improve therapeutic outcomes by
helping the patient (career) to understand and use the
medicine appropriately.
• It is important for each identified need for counseling.

• The pharmacist makes a mental note of a desired output

– i.e. what wish the patient to know, understand

or be able to do as a result of the counseling.

31
• There are factors during checking the success of
any
counseling:

• These factors include;

– the type and complexity of advice being given,

– the pharmacist is dealing with the directly or

patient
indirectly,
– the pharmacist's knowledge of the patient,

– patient problems with medication (side-effects, complex drug

regimen, drug therapy interfering with lifestyle) &
– medication mismanagement 32
 2.2.4. Counseling environment in
pharmacy
• Counseling should be carried out in non-threatening
and conducive environment.
• Counseling environment should;
– be comfortable, confidential, and safe

– Minimize distractions & interruptions (undivided attention)

– Be equipped with appropriate learning aids,

• e.g., Graphics, anatomical models, medication administration

devices, memory aids, written material, and
audiovisual resources
33
• Counseling is most effective when conducted in a room or
space that ensures privacy and opportunity to engage in
confidential communication.

• In designing or selecting an appropriate area for

counseling, confidentiality of information relating
to a patient and their family should be considered.
• This helps to ensure that the patient is receptive to the
proposed counseling and advice.

34
 2.2.5. Professional appearance of pharmacist

• Pharmacists should have a professional appearance.

• Because professional appearance provides;

– trust to the patient during (counseling)
discussing sensitive issues with the
pharmacist
– Confidence
• Examples to pharmacistappearance
of Professional for his/her work
include:
– Wearing style, hair style, eyeglass, gowning ,tie, shoes

35
 2.3. Standard protocol or procedure of counseling

Standard protocol or procedure of counseling includes:

1. Establishing caring relationship with the patient

2. Assessing patient‟s knowledge

3. Providing information for the patient

4. Verifying patients‟ knowledge and understanding

36
2.3.1. Establishing caring relationship with the patient
• What is the relationship between pharmacist and patient?

– Patient-perceived (understand) an expertise pharmacist is

an independent determinant of:
• relationship quality,

• patient satisfaction, and

• relationship commitment

– Relationship quality also appears to mediate the effect of

perceived expertise on patient satisfaction and relationship
commitment.
37
• To establish caring with the
relationship patient the pharmacist
should:
– Introduce himself/herself with good
facial expression with welcome manner
– Shaw sympathy ,empathy and respect manner
– Explain the purpose and expected length of
the sessions
– Obtain the patient‟s agreement to participate.
– Determine the patient‟s primary spoken language.
38
7. Ways To Build Rapport With Patients
– Maintain Eye Contact: Maintaining eye
contact communicates care and compassion
– Show Empathy: Empathy is the ability to understand the
patient's situation, perspective, and feelings.
– Open Communication
– Make it Personal
– Active Listening
– Practice Mirroring
– Keep Your Word
39
 2.3.2. Assessing patient’s
• knowledge
How do you assess patient‟s knowledge?
• Four Steps to Assess Health Literacy and
Improve Patient Understanding
– Communicate clearly.
• The first in health literacyinvolves
step
communication, clear which can
methods of talkingmove beyondtraditional
and writing.
– Confirm understanding.
– Be creative.
– Clarify and question.
40
• Why do we need to assess the patient's knowledge?
– Remember, patients do not know what they do not know.
They do not necessarily know what questions to ask in
order to use a medication appropriately.
• Therefore, assess the patient's knowledge is very
important. Because;
– Patients' compliance for better health can be achieved if
patients are well aware about their disease and treatment
plan.
– Patient's knowledge about diagnosis and treatment plan
improves outcomes.
41
• One of the essential prerequisites for patient compliance
is good patient knowledge of the medicines
prescribed.

• Inadequate knowledge of medication use may directly

lead to overuse, or patient noncompliance with a
drug regimen, and result in serious outcomes.
• The dispenser is in a position to reinforce patient
knowledge about the drugs dispensed.
42
• Any error or failure in the dispensing process can
jeopardize (put at risk) the care of the patient.
• According to WHO set standards of core drug use
indicators, patients with correct dosage indicator is
used to measure patients‟ knowledge for their
dispensed medications.

43
 In the measurement of patient knowledge of medication;
 the name and purposes of the medication, the dose,

 frequency of dosing,

 duration of treatment and sometimes side effecting are viewed

as essential for safe and appropriate use.

 Therefore, assessment of patients‟ knowledge of their

dispensed medication is very important to act
accordingly.

44
• In the evaluation of patients‟ knowledge of
medicines, the following are regarded as essential
parameters for safe and effective use;
– the names of the medicines,

– the purpose of therapy,

– the duration of therapy,

– the dose and frequency of administration and

– The important side effects.

45
• Inadequate knowledge of medicines by patients may
result in their incorrect use;

– which can lead to treatment failure and puts the health

of the patient at risk.
• Moreover, lack of knowledge may cause unintended
overdose or non-adherence with medicine
regimens, resulting in poor outcomes.

46
• Generally assess the patient’s knowledge include:
– Health problems and medications,

– Physical and mental capability to medications

use the
appropriately
– Attitude toward the health problems and medications.
– Ask open ended questions about each medication‟s purpose
– For refill medications should be asked to describe or show how
they have been using their medications.

– Asked to describe any problems, concerns (uncertainties) they

are experiencing with their medications

– Expects, and ask the patient to describe or show how he or she
will use the medication. 47
 2.3.3. Providing information for the patient

• Provide information orally and use visual aids

or

demonstrations

• Open the medication containers to show patients the colors,

sizes, shapes, and markings on oral solids.
• Marks on measuring devices.

• Demonstrate the assembly and of administration

use devices such as nasal and oral

inhalers
48
• Provide written labels
 2.3.4. Verifying patients’ knowledge & understanding
• Verifying patients‟ knowledge & understanding
prevents
misunderstandings.

• It is an important skill in the communication process because it is

a checkpoint for communication.

• This process involves asking the receiver to state back the

message that was sent by the sender and enables confirmation
of what a person knows. But not what we think they know.

• This tool confirms that the sender's message was translated as

intended. 49
• In a pharmacist‐patient interaction:

– verifying patient‟s understanding confirms that the patient

has received the information necessary to take his or her

medication(s) properly.

• Verifying patient's understanding can be achieved by asking

open‐ended questions.

• For example, can you tell me how you are going to take

your medication?"

50
• The manner in which the questions are phrased
is
important.

• Remember, active communication skills foster

a discussion in which both parties participate.

• Asking questions using phrases such as, "Now tell

me how you are going to take your medication.“

• Effective communication is a dynamic process

that requires using a wide variety of skills
51
What is a good way to verify patient understanding?

• Teach-back steps:
– I explain the concept to my patients, avoiding medical
jargon.
– I assess my patients' understanding by asking them to
explain the concept in their own words.
– I clarify anything my patients did not understand and
reassess their understanding.

52
• Generally Verify patients’ knowledge includes:
– Verify the patient understanding via feedback

– Drug administration , storage, interaction,

amount and frequency and duration, side effect
– Summaries by acknowledging or emphasizing key points of
information.
– Provide an opportunity for final concerns or questions.

– Help the patient to plan, follow up and next

consecutive steps.

53
2.4. Compliance, adherence and concordance

– 2.4.1. Definition of terms

– 2.4.2. Factors/Causes of poor/non-adherence

– 2.4.3. Consequences of non-adherence

– 2.4.4. Strategies for improving adherence

54
2.4.1. Definition of terms

• Compliance is defined as:

– The act of conforming (meeting the requirements) to
the recommendations made by the health care
provider with respect to;
• Timing of medication taking,

• Dosage of medication, and

• frequency of medication taking.

55
• The non-compliance was used to describe
term
significant failure to conform with the advice and
recommendations to interfere with achieving the patient
outcomes planned.

• The concept of compliance seems to denote (mean)

a relationship in which the patient has a passive role and
is expected to follow the doctor‟s orders.
• Since the term does not emphasis patient participation,
there has been a shift towards the use of „adherence‟ as a
term instead.
56
• Adherence is defined as:

– “Adherence is the extent to which a person‟s behavior

corresponds with agreed recommendations from a health
care provider.
– The word “extent” is an important qualifier related to
adherence.
– Person‟s behavior includes:

• taking medication, following a diet, and executing

lifestyle changes.

57
Compare between adherence & compliance
• The word “adherence” is favored because the patient is
free to decide the care provider‟s recommendations.
• So adherence is participation of patients in their care
plan resulting in understanding, consent and
partnership with the health care provider.

58
• But “compliance” advocate (believes) that the patient is
passively following the doctor‟s orders.

– The treatment plan is not based on a therapeutic

agreement established between the patient and the
physician.
• So patient compliance is the extent to which the patient
follows a prescribed drug regime.
• The health care provider should be sensitive to religious,
cultural, and personal beliefs that can affect a patient's
acceptance of medicines.
59
• Concordance: The recent approach of interaction
between health professionals and patients is referred
to as concordance.
• In the concordance approach, the role of the pharmacist
is to support the patient in constructing knowledge
and attitudes towards the use of his/her medication.
• The patient is perceived as an expert on his or her own
disease and medicine use.

60
• The concordance approach has stressed the need for patients;

– to active participants in health care and

– to make more responsibility over their own care in terms

of self-management.
• In the present days, the term concordance is used more often
in place of compliance and adherence.

61
62
 2.4.2. Factors/Causes of poor/non-adherence

• There are different factors which

(causes) contribute to patients‟ poor/non-
adherence.
• –These Factors/Causes
Patient-related factors include:
– Health-system factors

– Therapy-related factors

– Social and economic factors

63
• Patients‟ poor/non-adherence factors include:

– purpose and instructions for

administrationnot clear;
– perceived lack of efficacy;

– real or perceived adverse effects (side effects);

– patient‟s knowledge and Skill to use

the medicine
– Beliefs or attitudes towards medicine &
disease
state 64
– Patient characteristics:
• forgetfulness about taking the medication,

• unable to finish because of feeling better,

• lack of understanding of the prescription,

• fear of dependence,

• social or physical problems to go to drug shops,

• inconvenience of taking drugs everyday)

65
• Health care system;

– long waiting times,

– uncaring staff (Inadequate patient education),

– uncomfortable environment,

– Inaccessible to get prescribed medications,

– inaccessibility of the health institution

(Distance to travel to health settings)

66
– Behavior of prescribers;

• Giving inadequate information on the treatment,

• Poor attitude to patients,

• Negligence,

• Poor perception to team work

– Lack of relationships with the healthcare

team

67
• Therapy-related factors:
• Type of dosage form
–Unattractive formulation (e.g. unpleasant taste).
• Problems with handling
–Physical difficulty in taking medicines (e.g. swallowing
the medicine, handling small tablets, opening medicine
containers)
• Poly pharmacy
–Nature of treatment (complexity of the regime = more
frequency of administration and more number of drugs
prescribed);
• Occurrence of side-effects
68
• Social and economic factors:
– Lack of patient support and income

• unable to pay prescription charges (cost),

– Problems with living conditions

– Problems at home

– Level of education and literacy

• Group of people who adhere less to their medication include:

– Men,

– Youngsters,

– Elderly patients,

– people living alone, etc. 69

 Categories of non-adherence
• Primary non-adherence:
– patient does not have access to medicine

• Secondary non-adherence:
– patient has access to medicine but does not take it.

• Secondary non-adherence includes;

– Accidental non-adherence

– Triggered non-adherence

– Intentional non-adherence.
70
• Accidental non-adherence:

– forgets to take medication

– is unable to take medication due to life style

• Triggered non-adherence:

– cannot take medication due to drug-related problem

• Intentional non-adherence:

– decides not to take medication.

71
 Measurement of Non-adherence

• Direct methods:

– observation of ingestion of the drug or by detecting its

presence in body fluid

• Indirect methods:

– assume ingestion based on proxy evidence such as

patient‟s self-reporting, number of dosages remaining,
number of dosages removed from a container.

72
– Tablet counts:
• counting number of units left in container

– Patient diary cards: reporting by patient

– Electronic monitors:
• incorporation of electronic devices the medicine
into container recording
time and date of usage
– Patient self-reporting on health status and how the
condition has improved.

73
• 2.4.3. Consequences of non-adherence:

– Increase in morbidity and mortality

– Decrease patients‟ quality of life

– Increase drug resistance

– Increase health care cost and burden

74
 2.4.4. Strategies for improving adherence
• Patient adherence can be improved by (1):
– Simplifying therapeutic regime;

– Educating patients on the importance of prescribed medication;

– Improving patient/prescriber or patient /

pharmacist
relationship
– Reviewing patient prescriptions & medications:

• to reduce dosing frequency and multiple drug

therapy if it is relevant
75
2.4.2. Strategies for improving adherence--
– Ensuring that the patients get adéquate information

– Labeling: the label should be large font size, clean

printed, simple, and specific.

– Using compliance aids:

• use of devices that can be used to remind patient to take

medication,

• dispensing medication in blister pack according to dosage

regimen,

• preparing medicine reminder charts, Thank you

• administration devices (e.g. eye-drop applicators) 76