DISPENSING

Pharmacist’s function of:

• taking the prescription order;
• preparing the drug/s according to the instructions of a physician or dentist and
• delivering it to the patient or client with proper instructions.
Prescription
• written order and instruction from a licensed prescriber to the pharmacist for the
• use of drug product/s for a specific patient.
• identifies the medication/s to be dispensed
• accompanied by directions on its proper use.
Medication orders
• requests for medications by a licensed prescriber
• intended for use in the institutional setting.

• Prescription
• Date (Change Rx to current)
• Patient’s Information
• Name
• Age
• Gender
• Address & Telephone No.
• Superscription
• Subscription
• Inscription
• Signa/Direction for use
• Signature of Doctors
• Licenses- PRC , PTR, S2
• Address & Tel. no of doctor

• Medication Order
Date
Time
Name/s of drugs
Generic name
Brand name
Dosage form/Strength
Route of Administration
Frequency and duration of use
Signature of doctor
Superscription
• Rx symbol which means ‘take or give.’
• beginning of the direct order to fill the order and dispense the prescription.

Inscription
• principal / most important part of the prescription
• names, dose per unit, quantity of each and dosage forms of the medicine/s or drugs

Subscription
• instructions given to the pharmacist
• preparation of drugs which requires compounding.

Signa
• direction to the patient on how to use the medicine.
• repeat verbally and clearly to the patient
• instructions on:
 when to take the medicine (before or after meals),
 precautions, and
 simple instructions on how to take the medicine

R. A. NO. 6675 (SEPTEMBER 13,1988) (GENERICS LAW)

“An act to promote, require, and ensure the drugs and medicines identified by their generic names:
 production of an adequate supply,
 distribution,
 use, and
 acceptance”

Incorrect Prescription

THREE TYPES OF Rx BASED ON GENERAL PRESCRIBING:

I. ERRONEOUS Rx
II. VIOLATIVE Rx
III. IMPOSSIBLE Rx
IV. ERRONEOUS Rx

I. Erroneous if the:
- brand name precedes the generic name
- generic name is the one in the parenthesis
- brand name is not in the parenthesis
Administrative Order No. 90, s. 1990

SUBJECT: Amendment to A.O. 62 s. 1989 RE: Rules and Regulations To Implement Prescribing
Requirements
“Permits the writing of the generic names of more than one drug product in one prescription
form”
A Rx form with more than one drug product is no longer regarded as erroneous

II. VIOLATIVE Rx
 Violative if:
 generic name is not:
 written
 legible and a brand that is legible is written
 brand name is indicated and instructions
(such as the phrase “NO SUBSTITUTION”) that tend to obstruct, hinder, or prevent generic
dispensing

III. IMPOSSIBLE Rx

 Impossible if:
 Only the generic name is written but is not legible
 Generic name does not correspond to the brand name
 Both generic name and the brand name are not legible
 The drug product prescribed is not registered with BFAD
RECORD BOOKS
 POISON BOOK = 5 years
 Prescription Book = 2 years
 Dangerous Drugs Book = 1 year

CLASSIFICATION OF DRUGS
 Prescription or Ethical Drugs
 Non-Prescription Drugs or OTC Drugs

Prescription or Ethical Drugs

 dispensed upon written order of a validly-registered licensed physician, dentist or veterinarian
 for the management or treatment of a condition or disease.
 All antibiotics except some ointments
 All injectables (ampules or vials)
 Cough syrups containing any amount of narcotics (except dextromethorphan)
 Vitamin products containing more than 10,000 units of Vitamin A
 Highly potent drugs for special medication (ex.steroids, digitoxin)
  Paregoric Elixir (in emergency cases, 1 dose may be dispensed without a prescription)
 All drugs bearing the Rx symbol on their labels

Non-Prescription or OTC Drugs

 can be dispensed even without the written order of a validly-registered licensed
physician,dentist or veterinarian
 prevention or symptomatic relief of minor or self-limiting ailments.

Non-Prescription or OTC Drugs

 Multivitamin products of low dosage
 Anti-TB drugs except injectables
 Cough syrups containing dextromethorphan
 Household remedies except paregoric
 Simple analgesics (Aspirin, Acetaminophen, Biogesic, Paracetamol etc.
500 mg (>600 mg Rx required)

DANGEROUS DRUGS (List A Drugs)

Refer to:
 Prohibited Drugs
 Regulated Drugs
- Require a special Rx form
- Use is monitored by the DDB

Prohibited Drugs
Include :
 “opium & its active components & derivatives:
- heroin & morphine
 cocoa leaf & its derivatives
- cocaine alpha & beta Eucaine
- hallucinogenic drugs – mescaline, lysergic acid diethylamide (LSD) & other substances producing
similar effects
 Indian hemp & its derivatives
 All preparations made from any of the foregoing
 Other with the physiological effects of a narcotic drug

DANGEROUS DRUGS (List A Drugs)

Prohibited Drugs

Brown Mixture Tab. Morphine Sulfate H.T.

Brown Mixture Tab. Morphine Sulfate H.T.

Brown Mixture Liq. Morphine with Atropine Tab.

Codeine Sulfate H.T. Morphine Sulfate Amp.

Codeine Sulfate T.T. Morphine Sulfate Tab.

Demerol Amp. Sublimaze Inj.

Demerol Tab. Repifen Inj.

Demerol Vial Codevite Syrup

Dolo-Adamon Supplement. Deka Syrup

Dolo-Adamon Tab. Endotussin Syrup

Elixir Paregoric Raminon Syrup

Innovar Inj. Tussionex Susp.

DANGEROUS DRUGS (List A Drugs)

Regulated Drugs
Include:
 Sleep-inducing sedatives
- secobarbital, phenobarbital, barbital,
amobarbital
 Other drugs containing a salt or derivative of a salt of barbituric acid
 Any salt, isomer or salt of an isomer of amphetamine
- benzedrine or dexedrine
- any drug which produces a pharmacologic
action similar to amphetamine
 Hypnotic drugs
- methaqualone or any other compound producing similar pharmacologic effects
Amytal Sodium Tab. Desozyn Tab.

Amytal Sodium Cap. Dexamyl Spansule No. 1

Amytal Sodium. Amp. Dexedrine Spansule

Benzedrine Tab. Doloxene Compound

Butisol Sod. Tab. Doloxene Plain Tab.

Calcidrine Syrup Drinalfa Vial

Circuline Forte Tab. Gadexyl Tab.

Daprisal Tab. Mandrax Tab.

Mogadon

Nembutol Sod. Vial Plexonal Tab.

Noctec Liq. Robypnol

Noludar Tab. Seconal Sod. Cap.

Nuberene Tab. Sosegon Amp.

Paraldehyde Amp. Sosegon Tab.

Pentothal Sod. Vial Thiopental Sod. Vial

Placidyl Cap. Valamin Tab.

Requirements in the dispensing & compounding of dangerous drugs

 prescribed in special Rx forms issued by the DDB.
 record them in the Dangerous Drugs Book

Pharmacist must:
 check all the required data:
opium license number of the physician,
prof’l license number,
residence certificate of the buyer.
 keep these dangerous drugs in a locked cabinet
 keep and file the original Rx.
 Quarterly report of all transactions (copy of (2) to be submitted to the Municipal Health Officer
within 15 days following the last day of every quarter of the year.

List of Products Requiring Strict Precaution in Prescribing, Dispensing & Use (List B Drugs)

Aminophylline: Suppository/Tablet

Amitriptyline Hydrochloride: Tablet

Betamethasone: Tablet

Busulfan: Tablet

Chlorambucin: Tablet

Chlorpropamide: Tablet
Chlorthalidone: Tablet

Cyclophosphamide: Tablet

Dexamethasone: Tablet

Dexamethasone Acetate: Injectable

Dicumarol: Capsule/Tablet

Epinephrine: Injectable

Estrogens, Conjugated: Injectable

Ethinyl Estradiol: Tablet

Ethosuximide: Capsule

Furazolidone: Suspension/Tablet

Hydrochlorothiazide: Tablet

Hydrocortisone: Injectable

Imipramine Hydrochloride: Tablet

Menadione: Tablet

Menadione Sod. Bisulfate: Tablet

Mephenytoin: Tablet

Methdilazine Hydrochloride: Tablet

Methotrexate: Tablet

Methylergonovine Maleate: Tablet

Nitrofurantoin: Capsule/Suspension/Tablet

Perphenazine: Suppository/Syrup/Tablet/CR Tablet

Phenylbutazone: Capsule/Tablet

Phenytoin: Suspension

Phenytoin Sodium, Extended: Capsule

Phenytoin Sodium, Prompt: Capsule

Probenecid: Tablet

Procainamide Hydrochloride: Capsule/Tablet/CR Tablet

Pyrazinamide: Tablet

Quinidine Sulfate: Capsule/Tablet/CR Tablet

Spironolactone: Tablet

Sulfadiazine, Sulfamerazine, Sulfamethazine: Tablet

 Sulfamethizole: Suspension/Tablet

Sulfisoxazole: Suspension/Tablet

Theophylline: CR Capsule/CR Capsule (Sprinkles)/

Suspension/CR Tablet

Thioridazine Hydrochloride: Tablet

Thyroglobulin: Tablet

Tolbutamide: Tablet

Triamcinolone: Tablet

Warfarin Sodium: Tablet

DISPENSING PROCESS – STEPS IN PROCESSING THE Rx ORDER

Receive the prescription
Read and check/analyze the prescription
Number and date of the prescription
Prepare the label
Prepare/Compound and package the drug product
Recheck the label of the product vs. the Rx
Check the price of the product & inform the buyer
Deliver the product
PROVIDE PATIENT COUNSELING
Record and file the prescription

Magistral Pharmacy
Most important division of true pharmaceutical practice
Preparation or compounding & dispensing of prescriptions extemporaneously or as the occasion
or physician’s needs may require.
Processing of Rx Order
 Enhances the image of pharmacist to both the physician & the patient
 Reflects professional responsibilities

Receiving the Rx
 enhances patient-pharmacist relationship
 facilitates gathering of essential disease & drug info. critical in providing quality pharmaceutical
care

Reading & Checking/Analyzing

Pharmacist should consult another pharmacist or the prescriber in case of:
 Indistinct word/illegible phrases or abbreviations
 Omissions:
- desired strength of medication or its dosage form
- size and frequency of dose be carefully noted and
checked (age, weight and condition of patient, possible influence of
other drugs being taken, frequency of administration)
- familiar with available strengths & dosage forms of
prefabricated drug products

Numbering & Dating the Rx

 place the same number on the label and record book as desired.
- identifies the bottle or package
- reference of the original medication order
 Dating of the Rx
– on the date filled/compounded to establish identity

Labeling

Rx labels should be
 computerized or typewritten - neat, attractive and legible
 With aesthetic and professional appearing label.
 Size in conformance with the size of the prescription container.

Imprinted on the label

 Name, address and telephone number of the pharmacy

Label of Compounded Rx should include:

 Number of Rx
 Date of filling
 Name of Patient
 Quality and quantity of ingredients
 Directions for administration
 Name of Physician
AUXILLARY LABELS provide:
- Provides safety & warning
 proper use
 handling
 storage
 Refill status
 Necessary warnings and precautions

GUIDELINES ON DISPENSING TO IMPLEMENT THE GENERICS ACT OF 1988

II. Label of Unit Dose Rx or dispensing products which are not in their original containers should include:
 Small bottles; Tin cans; Boxes; Plastic or paper envelopes
Information required on drug outlet’s labels:
1. Name of the patient
2. Generic name of the drug
3. Brand name, if any
4. Manufacturer
5. Dosage strength
6. Expiry Date
7. Directions for use
8. Name of the Pharmacist

III. In partial filling of the Rx.

Information required to be written on the Rx:
Date of partial filling
Quantity served & balance of the Rx
Name & address of the drugstore

Additional requirements:
1. The prescriber must have an S-2 license
2. The special DDB Rx form must be used
3. A recording system following pertinent DDB regulation must be covered.

IV. In dispensing drugs in List A and List B:

1. Done by the pharmacist
2. Follow the order & instructions of the doctor on the Rx
3. Partial filling of Rx for drugs in List A:
3.1 Rx must be retained by the pharmacist
3.2 The patient must asked the prescriber for another Rx to complete the total dose of the
medication

4. After the Rx is filled the original copy of the Rx shall be retained & kept for a period of 1 year by the
pharmacist for inspection.
PREPARING/COMPOUNDING

Organize the method

Informations necessary:
 Adjuvant used
 Order of mixing
 Amount of each ingredients
 Capsule size
 Type and size of container
 Name and product identification number of manufacturer.
 Partially filled Rx
- returned to the buyer after recording in the Rx book
 Partial filling of prohibited or List A drugs
- shall not be allowed.

PACKAGING
 use appropriate containers/closures
- colored or plastic containers

Plastic containers:
 Advantages:
lightness of weight, resistance to breakage, versatile design
 Disadvantages:
- permeable to atmospheric gases & moisture vapor
- subject to leaching
- deformed with extreme temperature

RECHECKING
 All details of the label against the Rx order
- to verify directions, patient’s name, Rx number, date and prescriber’s name
 Verify ingredients & amount

Rx PRICING
 Fair/equitable profit/pricing code
3 METHODS OF PRICING Rx:
 % Mark-up Method
– prefabricated (manufactured) dosage forms
For compounded dosage forms
 % Mark-up + minimum fee method
 Professional Fee Method

 % MARK-UP Method
Dispensing price = cost of ing. + (cost of ing. x % mark-up)

 % Mark-up + minimum fee/compounding fee Method

D.P. = cost of ing. + (cost of ing. x % mark-up) + min. fee or compounding fee

 Professional fee Method

D.P. = cost of ing. + professional fee

DELIVERING THE PRESCRIPTION

 Personally present the Rx medication to the patient
 if personal delivery is not possible (delivered to the patient’s home or office.)
- appropriate instructions are provided
- encourage the patient to call should there be any questions.

Finished Rx
 correctly and skillfully compounded
 physical appearance
- indicate the pride and care the pharmacist has taken in his professional work.

INCOMPATIBILITIES

when problems arise during:

 compounding
 dispensing
 administration of pharmaceuticals
problems develop as a result of:
 using two or more drugs
 use of only one drug such as dosage errors
TYPES OF INCOMPATIBILITIES
 PHYSICAL
 CHEMICAL
 THERAPEUTIC
 COMBINATION OF TYPES

Consequences of incompatibility
Patient:
 may not receive the full therapeutic effect of the medication
 adverse effect due to the formation of toxic products

I. PHYSICAL INCOMPATIBILITY
Result of:
 insolubility (most frequent cause),
 liquefaction, or
 physical complexation
Cause:
 non-uniform
 unsightly or unpalatable mixtures
- possess the potential danger or non- uniform dosage

CLASSIFICATIONS OF PHYSICAL INCOMPATIBILITY

A. INCOMPLETE SOLUTION
 due to immiscibility or insolubility
B. PRECIPITATION
 insolubility
C. SEPARATION OF IMMISCIBLE LIQUIDS
D. LIQUEFACTION OF SOLID INGREDIENTS (eutexia)
due to:
- formation of eutectic mixtures
- liberation of water of hydration
E. INCORRECT FORM PRESCRIBED
 Example:
*Alkaloid salt to be dissolved in liquid petrolatum
Free alkaloid should be prescribed
- soluble in liquid petrolatum
Alkaloidal salts
- insoluble in this solvent.
II. CHEMICAL INCOMPATIBILITIES
 Occur as a result of:
- chemical interaction among the ingredients of a Rx.

CHEMICAL INCOMPATIBILITIES
 IMMEDIATE INCOMPATIBILITIES
 DELAYED INCOMPATIBILITIES

IMMEDIATE INCOMPATIBILITY
 Occurs instantaneously upon compounding
 Readily apparent due to:
- effervescence
- precipitation
- color changes
DELAYED INCOMPATIBILITIES
Other mixtures:
 react on such a slow rate
 Occur without appreciable visible change/immediate physical evidence of change
 May or may not result in loss of therapeutic activity
 Rx is dispensed if used up before about 10% of the therapeutic activity is lost.

DELAYED INCOMPATIBILITIES
REMEDY:
 Use auxiliary labels:of
 “Store in a Refrigerator” label
- decrease/slows down the rate of loss of activity/chem. reactions
 “Shake well” label
- promote uniform dosage
 Result of a potentially dangerous product
- should not be dispensed & the physician be consulted

CLASSIFICATION OF CHEMICAL INCOMPATIBILITIES

OXIDATION
 exposure to air, temps., Light
 excessive storage, overdilution, incorrect pH adjustment,
presence of catalysts.
 Undergo auto-oxidation (chain reaction type of oxidation):
*oils & fats, phenolic substances, aldehydes & vitamins -
REDUCTION
 Less common in Rxs although:
- silver, mercury, and gold salts may be reduced
by light to the metallic form
RACEMIZATION
 Conversion of an optically active form to an optically inactive form without changing chemical
constitution
PRECIPITATION
 formation of an insoluble substance
 Flocculent precipitates
- develop several days after a stock solution or Rx is prepared
- evidence of the growth of yeasts, molds or bacteria.
EVOLUTION OF GAS
 effervescence
COLOR CHANGES
EXPLOSIVE COMBINATION
 Oxidizing agents are chemically incompatible with reducing agents (redox reactions)
- serious explosions may result from certain combinations
CEMENTATION
 Rx may set a mass of cement-like hardness.
 Occurs when compounds from:
- hydrates (ex. Plaster of paris) polymerize, or
- convert to new crystal forms
SEPARATION OF IMMISCIBLE LIQUIDS
 Immiscible liquids not soluble in the Rx
GELATINIZATION
 Solutions form a gel when combined with certain substances
DEVELOPMENT OF HEAT OR COLD
Chemical reactions with either
 liberation of heat (compounds will decompose) or
 absorption (form stable compounds) of considerable amounts of heat
HYDROLYTIC CHANGES
 Many substances hydrolyze in water & the change may be hastened by heat, catalyst, esters,
amides, certain metals (Zn, Fe), etc.
INVISIBLE CHANGES
 chem. changes occur without visible evidence of the reaction
DEVELOPMENT OF POISONOUS SUBSTANCES
 Chem. reaction producing products which are more toxic than the original substances
Ex. KI + Hg2Cl2 (calomel) in the presence of
moisture → Hg+2 (toxic)
IMPLOSION
 Weak bottles having thin spots or flaws
- may break inwardly due to the development of a slight vacuum
-due to removal of oxygen from the air in the bottle by oxidation of syrup example: Bottles of a
syrup
OTHER TYPES OF CHEMICAL CHANGE
 Incompatibilities such a polymerization, double decomposition, substitution, addition, etc.
III. THERAPEUTIC INCOMPATIBILITIES
Occur:
 When two drugs or more drugs, IV fluids or both are administered together to produce a
response which differs in nature or intensity from that which was intended
 Occur at the site of the drug action

CONSEQUENCES:
Therapeutic effectiveness reduced or delayed
Loss of activity
delay in the release or absorption of drug

Responsible:
 Physician rather than the pharmacist but the pharmacist may inform the physician to eliminate:
- Errors in Rx writing/interpretation
- Overdose (excessive single dose/too frequent administration)
- Contraindicated drugs (steroids/peptic
ulcer)
- Synergistic/Antagonistic effects
Alteration of Rx order requires permission of prescriber

Factors affecting IV compatibility

 pH
– occurs when the components of an IV solution differ
significantly in pH
 Temperature
– increased storage temperature speeds up drug degradation.
– drug storage in a refrigerator or freezer as appropriate
preserves drug stability
 Degree of dilution
– the more diluted the drugs are in a solution, lessens ion
interaction leading to incompatibility.
 Length of time in solution
– incompatibility increases with the length of time that drugs are in contact with each other.
 Order of mixing
Ex.: Calcium phosphate, should not be added consecutively when an IV admixture is being prepared.
- This keeps these substances from pooling, or forming a layer on top of the IV fluid, decreasing the
chance of incomp.
- Thorough mixing after each addition is essential
DRUG INTERACTIONS
Frequently applied to those situations:
 effects of one drug are altered by the prior or concurrent administration of another
 dietary item influences the activity of a drug (e.g., cheese & monoamine oxidase inhibitors)
 A drug causes alterations of laboratory test values
 A drug essentially interacts with itself (e.g. by stimulating its own metabolism)

DRUG INTERACTIONS
MAY EITHER BE:
 Adverse Drug Interaction
 Beneficial Drug Interaction

Classifications of ADR
1. Type A (Augmented) – actions related to the pharmacological activity of the drug
a) Extension effects
– dose related responses arising from an extension of therapeutic effect
- prevention is adjustment of dosage regimen.
b) Adverse effects
– reactions unrelated to the goal of therapy
2. Type B (Bizarre)
– totally abnormal effects, unrelated from the drug’s known pharmacological actions
- very small doses may elicit the reaction once allergy or idiosyncrasy is established.
3. Type C (Continuous)
– long term effects usually related to the dose and duration of treatment.
Ex. Ethambutol – optic neuropathy
4. Type D (Delayed)
– Carcinogenesis (hormonal/gene toxicity)
- Adverse effects associated with reproduction(teratogens)
5. Type E (Ending of use/Withdrawal syndromes)
– alcohol-delirium tremens (disorientation and visual hallucinations)
barbiturates – restlessness, mental confusion, convulsions
6. Type F (Failure of efficacy/therapeutic failure)
– lack of efficacy of drug products
- result of imperfect or counterfeit manufacture of the product
Examples:
- Failure to control infection/ apparent antimicrobial resistance; uncontrolled hypertension

Causes of ADR

 Pharmaceutical causes – altering the quantity of drug (particle size, nature and quantity of
excipients and coating materials) available for systemic absorption; influencing release rates

 Pharmacokinetic causes – the way a drug is handle by the body during ADME may affect
humans in as adverse manner; ototoxicity with aminoglycosides when used in patients with
renal failure.

 Pharmacodynamic causes – increased sensitivity of target organs in the body to drugs

 Predisposing/Influencing Factors in ADR
 Patient-related factors
- presence of renal, hepatic, and cardiac disease
- age
- previous ADR or drug allergy
- Sex/gender
- genetic influence
- miscellaneous ( diet, smoking, alcohol, environmental exposures)
- Drug-related
- Pharmaceutical properties
- Pharmacokinetic properties
- Pharmacodynamic effects

II. Beneficial Drug Interaction

 Desired & intended, when a combination of medications produces:
*improved therapy
*greater margin of safety
*more appropriate onset or duration of action
*lowered toxicity
*enhanced potency with diminished side effects

MULTIPLE DRUG THERAPY IS JUSTIFIED

IF IT PROVIDES:
 Greater efficacy
 Greater margin of safety
 More satisfactory onset or duration of effect

Clinical Factors in DI
 Diagnostic errors
 Prescribing errors
- insufficient study of the patient
- contraindicated drugs
- excessive single dose
- excessive daily dose
-additive and synergistic combination
- antagonistic combination
- Rx writing errors
-nomenclature error
- dosage form error
 Drug Administration and Patient Care
- placebo and psychosomatic factors
- unpalatability
  Combination of Factors

DRUG INTERACTIONS

Types of Drug-Drug Interactions

 Duplication
– potentiation of effect when 2 drugs with the same active ingredient or with the same action
(synergistic action) are taken at the same time.
 Antagonism
– reduction of efficacy when two drugs with opposing actions are taken together.
 Alteration of Pharmacokinetic Actions – (ADME)
– a second drug may increase or decrease the rate during ADME of first drug.
Dietary supplements or food supplements
- alternative therapy most commonly used, includes:
 medicinal herbs or herbal drugs
 nutraceuticals
- natural substances that includes:
certain herbs, such products as cholesterol-lowering
margarines, psyllium-fortified products
- therapeutic claims not scientifically studied & evaluated by the BFAD
Interactions
 may intensify or reduce the efficacy of a drug or cause a serious side effect.
 avoided by consulting the doctor before taking supplements

DRUG-FOOD INTERACTIONS

May result in any of the following:

 Delayed/reduced absorption of the food nutrients or the drug
 Enzyme inhibition or induction resulting in delayed or hastened drug elimination
 Reduced plasma concentration of the food nutrient or the drug resulting in decreased
therapeutic effect
 Increased or decreased action of the medication or inactivation of the medication

Pharmacist should give proper advice, to avoid the potential adverse drug reaction on whether to:
eliminate the interacting food altogether
adjust the time of intake

Examples of food that should not be taken with drugs as a general rule:
 alcohol
- increases the risk of liver damage, increase drowsiness &/or sedation, or cause nausea.
 Caffeine
 - a CNS stimulant, alters the action of many drugs affecting the CNS depending on whether the drug
is sympathetic or parasympathetic.
 Grapefruit
- causes enzyme induction whereby the biotransformation of some drugs are hastened.
 Milk - dairy product or any product containing Ca, Fe, Mg, Al and other heavy metals (like
antacids & multivitamins), forms a chelate with the drug rendering both the drug & the heavy
metal non-usable by the body.
 Drug that causes gastric irritation - patients are advised to take the medication with milk or
crackers or with a full stomach.
 Antibiotics - almost always taken with an empty stomach unless the patient complains of gastric
irritation.

DRUG-DISEASE INTERACTIONS

Refer to following:
 Worsening of a disease because of a drug
 Alteration of the effect of a drug because of a disease
 Manifestation of side effects because of interaction between the drug & a disease other than
the one for which the drug is being taken

DRUG-DISEASE INTERACTIONS ARE CAUSED BY THE FOLLOWING:

 PHYSIOLOGICAL CHANGES IN THE ELDERLY

 amount of body water ↓while the amount of fat tissue ↑
 amount of acetylcholine in the body ↓ with age resulting in the older patient’s decreased
tolerance to drugs with anticholinergic effects
 KIDNEY IMPAIRMENT
 For the elderly
- kidneys are less able to excrete drugs into the urine
- resulting in the prolonged stay of the drugs in the body
- thus prolonging its effect
 LIVER IMPAIRMENT
 decreases metabolism of many drugs, prolonging its effect
 ALTERED DRUG RESPONSE
 Older people, more sensitive to the effects of many drugs.
- more dramatic effects to elder
 DIFFICULTY IN COMPLIANCE
 Not following doctor’s instructions; not taking the prescribed drug
 Risky & life-threatening
CORRECTION OF INCOMPATIBILITIES
 consult the physician
 use pharmaceutical knowledge
 add an ingredient
 remove an ingredient
 change the vehicle
 change an ingredient
 change the dosage form
 read the literature

Preventing or minimizing incompatibilities

 Each drug should be mixed thoroughly after it is added to the preparation
 Solutions should be administered promptly after they are mixed to minimize the time available
for a potential reaction to occur
 The number of drugs mixed together in an IV solution should be kept to a minimum
 If a Rx calls for unfamiliar drugs or IV fluids, compatibility references should be consulted
Drugs.com - to check for drug incompatibilities

POSOLOGY

Dose for children

 Regulated according to the age or weight, a fraction of the adult dose being given

RULES FOR INFANTS’ & CHILDREN’S DOSES

 Young’s Rule (children 2 years & older)

child’s dose (approx) = Age (yr) x adult dose

Age (yr) + 12

 Clark’s Rule

child’s dose (approx) = Weight (lb) x adult dose

 Fried’s Rule (for infants up to 2 years old)

infant’s dose (approx) = Age (months) x adult dose

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10 STAR PHARMACIST
 Pharmaceutical care giver
 Decision maker
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• Drugs to be taken on an empty stomach examples are:

glibenclamide, glipizide, atenolol, captopril

and several antibiotics:

isoniazid & rifampicin, flucloxacillin, penicillamine, levothyroxine (thyroxine),

penicillin V, oxytetracycline, rifampicin

• Because of the risk of concentration –dependent adverse effects, some drugs should be taken
at set times with relation to meals these include:

phenytoin, propafenone, labetalol, propranolol, metoprolol

• Some drugs are poorly absorbed after oral administration but lack a parenteral formulation,
can be made systemically available but administration with food:

imebendazole, flubendazole, nitrofurantoin, griseofulvin, halofantrine

The ff. are effects of drugs on food:

neutralize drug effects
changes in gastric emptying
drug chelation
changes in the activity of drug metabolizing enzymes
changes in splanchnic blood flow and plasma protein binding
food reduces bioavailability
BRAND NAME GENERIC NAME USE

Zantac Ranitidine Anti-ulcerant

Neobloc Metoprolol B-blocker (Betaloc)

Diuril Furosemide diuretic

Nuelin Theophylline Anti-asthma

Mucosolvan Ambroxol Cough/cold remedy

Budecort Budesonide Anti-asthma/decongestant

Disudrin (NSAID) Phenylpropanolamine Cough & cold remedy

Medicol (NSAID) Ibuprofen Minor aches & pain

Cortal ASA Inflammation, arthritis pain

Nubain Nalbuphine Semi-synthetic opoiod analgesic

Celebrex Celecoxib Anti-rheumatic, anti-inflam, analgesic

Cytoxan Cyclophosphamide antineoplastic

Zovirax Acyclovir antiviral

Rimactane Rifampicin Anti-tb

Mycostatin Nystatin antifungal

Qinolon ofloxacin antibacterial

Pediamox Amoxicillin Antibacterial (Penicillin)

Klaricid Clarithromycin Antibacterial (Macrolide)

Zinnat Cefuroxime Antibacterial (Cephalosporin)

Betnelan Betamethasone Antihistamine, anti-inflam, corticosteroid hormone

Sinemet Carbidopa/Levodopa antiparkinson

Serenace Haloperidol Anti-psychotic (anti-anxiety)

Tranxene Clorazepate di K anxiolytic

Llanol Allopurinol Anti-gout

Buscopan Hyoscine-N-Butylbromide antispasmodic

Imodium Loperamide HCl Anti-diarrheal

Dulcolax Bisacodyl laxative

Imuran Azathioprine immunosuppressant

Maxitrol Dexamethasone Eye antiseptic with corticosteroids (for ocular inflamma

Neomycin SO4

Polymyxin B SO4