Health Center Pharmaceutical Guide
Health Center Pharmaceutical Guide
Prepared by:
Drug and Therapeutics Committee (DTC) of --------- Health Center
in collaboration with Dire Dawa Administration Health Bureau and
-------------
Year -------
Pharmaceutical List for --------- Health Center
Prepared by:
Drug and Therapeutics Committee (DTC) of ------- Health Center in
collaboration with Dire Dawa Administration Health Bureau and
---------
Year……
LIST OF DTC MEMBERS
1.
2.
3.
4.
5.
LIST OF EDITORS
1.
2
TECHNICAL ADVISORS
1.
2.
3.
1.
TABLE OF CONTENTS
CONTENTS PAGE
TABLE OF CONTENTS 4
ACKNOWLEDGEMENT 9
FORWARD 10
1. INTRODUCTION 12
GI.100 Anti-acid 17
GI.400 Antiemetic 17
GI.500 Laxatives 18
CV.200 Diuretics 19
RE.100 Antitussives/Expectorant 20
RE.200 Bronchodilators/Antiasthmatic 20
NS.100 Analgesics/Antipyretics 21
NS.300 Anticonvulsant 21
AI.000 ANTI-INFECTIVES 23
AI.100 Antibacterial 23
AI.101 Penicillins 23
AI.103 Anti-Tubercular 24
AI.104 Antileprotics 24
AI.200 Antifungal 24
AI.400 Antiprotozoal 25
AI.401 Antimalarial 25
AI.402 Amoebicides 25
AI.500Antihelmentics 26
AI.501 Schistosomicides 26
ED.200 Contraceptives 27
BL.100 Antiplatlet 28
BL.200 Antianemia 28
WE.100 Oral 29
WE.200 Parenteral 29
VT.000 VITAMINS 29
AL.100 Antihistamines 30
OP.101 Antibacterials 31
DE.400 Antiprurities 32
MI.000 MISCELLANEOUS 34
LR.400 HAEMATOLOGY 35
LR.500 HAEMOGLOBIN 35
LR.600 HAEMOTOCRIT 36
LR.800 PARASITOLOGY 36
LR.900 Serology 36
INDEX 48
ACKNOWLEDGEMENTS
------- Health Center would like to extend its gratitude to the Dire Dawa Administration
Health Bureau and ------- for their technical assistance and advisory support. The Health
Center would also like to give special acknowledgement to the Health Center Drug and
Therapeutics Committee and all participants of workshop for their invaluable contributions to
The provision of complete health care pre-requisites the availability of safe, effective
and affordable drugs of the required quality, in adequate quantity every time. These available
drugs must also be prescribed, dispensed and used by the patient rationally.
It gives me a great pleasure to see the pharmaceutical list, which is the fruit of the joint effort
of the staff of -------- Health Center, especially the drug and therapeutic committee.
I believe that this list has a crucial role parallely with the standard treatment guideline for our
prescribers and dispensers and also serve as useful guide for selection, procurement,
distribution, and use of drugs in our facility. Finally, I would like to express my gratitude to
all those who have directly and indirectly contributed to the preparation and printing of the
list.
Ato ------
-------- Health Center is a public health center found in Dire Dawa. It was
established in ------- E.C. Currently the Health Center serves a total of about -----
populations. The health Center has ------Health Officers,---- B.Sc. Nurses, 18 diploma nurses,
---- Laboratory Technologist, ------ Laboratory Technician, ---- Pharmacists, -----Druggist,
-----Midwifery, -----Environmental Health Experts, ----- Health Extension Professionals,----
Health Extension Workers and a total of ---- Administrative staffs. The major services
provided by the health center are delivery, antenatal care, postnatal care, family planning,
immunization, HIV/AIDS & STI, Laboratory service, Pharmacy service TBL and So on.
The health center DTC was established in August 4 th 2004 E.C. The committee is
composed of representatives from all relevant professional categories. The DTC has its own
Terms of Reference (TOR) which is annexed. Since its establishment the DTC has been
undertaking activities like giving IPLS training for the staffs, developing drug list for each
dispensing units, adopting good dispensing and prescribing practice manual, acting on
improvement of the professionals awareness regarding adherence to STG.
DTC of ---------Health Center took the initiative to develop facility’s own list with
the aim of improving the availability of needed pharmaceuticals in the health center for the
delivery of quality health services. The list which contains all types of pharmaceuticals
(medicines, medical supplies, laboratory chemicals and reagents, medical supplies and
equipments) was developed based on previous morbidity pattern of the health facility. STG
prepared for the level and the National Formulary were used as a reference in the selection of
medicines. Medical supplies and instruments needed for the diagnosis, examination or
management of the various procedures expected to be conducted were also selected. In
addition to the list of morbidities, basic services which might does not appear on the
morbidity list were also considered in the selection of all types of pharmaceuticals. All types
of selected pharmaceuticals are categorized into Vital (V), Essential (E) or Non-Essential (N)
based on their clinical importance in the facility. Then ABC analyzed was done using one
full year consumption. After the draft list was developed by the DTC, it was distributed to
relevant staff for comment. Those comments were collected and reviewed again.
2. PHARMACEUTICALS LIST MANAGEMENT PRINCIPLES
The formulary process is the cornerstone of good pharmaceutical management and rational
medicine use. It consists of preparing, using and updating a pharmaceutical list, a formulary and
standard treatment guidelines (STGs). Choosing the most appropriate therapies and selecting the most
cost-effective good-quality pharmaceuticals leads to better quality of care and more efficient,
equitable use of resources. The purpose of managing the formulary system is to optimize patient care
through rational selection and use of pharmaceuticals within the health care system. Strict adherence
to a pharmaceuticals list alone will not improve treatment practice if medicine selection is not based
on STGs (if there is no consistency between the list and the STGs).
The health facility will apply the following formulary management principles:
Use explicit selection criteria, based on proven efficacy, safety, quality and cost.
Consider request for the addition or deletion of medicines when made by the health care staff.
Require that requests for the addition or deletion of medicines are justified using documented
evidence of efficacy, safety and comparative cost-effectiveness and that the person requesting
any new medicine declare any conflict of interest.
Carry out annual systematic reviews of all therapeutic classes to avoid duplication.
Use the list to restrict the purchasing and donation of pharmaceuticals for the facility.
Encourage prescribers to follow the STG and prescribe from the list.
Addition to or deletion from the list will be based on official request backed by evidence presented
to the DTC using the attached Request Form for Addition/Deletion of Pharmaceuticals. Prescribers
should follow the STGs and the list during prescribing. Procurement of pharmaceuticals that are not
included in the list will be possible for a very limited number of pharmaceuticals if and only if
recommended by the DTC and approved by the management.
3. GENERAL GUIDE FOR PRESCRIBERS AND DISPENSERS
The aim of any pharmaceutical management system is to deliver the correct medicines to the
patient who needs that medicine. All the effort made to avail the medicines will be nullified if
medicines are used irrationally at the level of prescribing, dispensing and patient use. The Rational
Use of Medicines requires that patients receive medications appropriate to their clinical needs, in
doses that meet their own individual requirements, for an adequate period of time, and at the lowest
cost to them and their community.
Appropriate medicine, considering efficacy, safety, suitability for the patient, and cost
Appropriate patient – that is, no contraindications exist, and the likelihood of adverse
reactions is minimal
Correct dispensing, including appropriate information for patients about the prescribed
medicines
To conform to these criteria, prescribers should follow a standard process of prescribing, which
starts with a diagnosis to define the problems that requires treatment. Next, the therapeutic goal
should be defined. The prescriber must decide which treatment is required, based on up-to-date
information on medicines and therapeutics, to achieve the desired goal for an individual patient.
When the decision is made to treat the patient with medicines, the best medicine for the best outcome
is selected based on efficacy, safety and cost. Then, dose, route of administration, and duration of
treatment are determined following the STG, taking into consideration the condition of the patient.
When prescribing a medicine, the prescriber should provide proper information to the patient about
the medicine and the patient’s condition. Finally, the prescriber should decide how to monitor the
treatment.
Then the medicine should be dispensed to the patient in a safe and hygienic manner, making sure
that the patient understands the dosage and course of therapy. Then the patient takes the medicine.
Adherence occurs if the patient and the community understands and appreciates the value of using
specific medicines for specific conditions. Irrational use will occur if problem occurs at one or more
of the three major parties in medicine use (prescriber, dispenser, and patient/community) and can
result in serious consequences.
It is very essential that prescribers follow the STGs, use standard prescriptions (sample attached)
and write all patient and medication-related information on the prescription to maximize the benefit
and minimize the risks associated with the use of medicines. Health professionals are encouraged to
report to Food, Medicines and Healthcare Administration and Control Authority of Ethiopia
(FMHACA) when they come across unusual adverse medicine reactions using the pre-paid Adverse
Medicine Reaction Reporting (ADR) reporting form.
4. LIST OF PHARMACEUTICALS
CV.200 Diuretics
RE.100 Antitussives/Expectorant
RE.200 Bronchodilators/Antiasthmatics
NS.100 Analgesics/Antipyretics
NS.300 Anticonvulsant
AI.000 ANTI-INFECTIVES
AI.100 Antibacterial
AI.400 Antiprotozoal
AI.500 Antehelmentics
AI.501 Schistosomicides
ED.200 Contraceptives
BL.100 Antiplatlet
WE.100 Oral
WE.200 Parenteral
AL.100 Antihistamines
OP.100 Anti-infective,ophthalmic
OP.101 Antibacterials
DE.000DERMATOLOGICAL AGENTS
DE.400 Antiprurities
MI.000 Miscellaneous
LR.400 Haematology
LR.600 Haematocrit
LR.800 Parasitology
LR.900 Serology
5. Capillary tube V
6. Disposable syringe V
7. EDTA capillary tube V
8. Examination glove V
9. Filter Paper V
10. Funnel V
11. Lens tissue paper V
12. Micropippette tip V
13. Microscopic slide V
14. Pasture pipette (plastic) V
15. Safety Box V
16. Sealer V
17. Slide Box V
18. Stool cup V
19. Sputum cup V
20. Test tube glass heat and chemical resistance V
21. Test tube rack V
22. Timer V
23. Tourniquet V
24. Urine cup V
25. Volumetric Flask V
26. Vacutainer needle V
27. Vacutainer tube holder V
28. Waste bin V
Drug and therapeutic committee is a committee that evaluates the clinical use of medicines,
develops policies for managing pharmaceutical care & administration, and manages the formulary
system.
DTC has great benefit if it is functional and performed successfully. Among these to mention:-
Selection of safe, effective, high quality & cost effective pharmaceutical for the
formulary
Identification of medicine use problems
Improved medicine use ( including antimicrobial use)
Improved quality of patient case & health outcomes
Management of antimicrobial resistance
Increased staff & patient knowledge
Decreased adverse drug reactions and medication with improved medication errors
Improved medicine procurement & inventory management
Management & Control of pharmaceutical expenditures through better management
---------health center has been established in 1995 E.C. and serves 25,771 populations. It
provides OPD, inpatient, MCH, VCT, emergency, laboratory and pharmacy services.
Establishment
On August 4th 2004 E.C. as per letter no. ድሬ/17/3-662/04 Melka Jebbdu Health Center Drug and
therapeutic committee has been established. The committee Comprises of 8 members. The DTC
chairperson is Basazinew Fantahun, head of ---------Health Center and secretary is Andualem Ababu,
Pharmacy coordinator.
Each member is nominated to the committee on basis of their specialties from each medical
department and administration in order to make the committee representative.
Basazinew
Fantahun
chair person
Andualem Ababu
secretary
Mikael Yohannes Iftu Beker Demelash Bete Tesfaye Deresa Alfia Duri Sisay Getachew
head of nurse MCH Laboratory Public health enviroment Finance Head
Secretary
Administration and finance members (additional from above duties and responsibilities)
Roles
The committee has broad responsibilities in determining what medicine will be available, at
what cost and how they will be used
To optimize rational use of medicines by evaluating the chemical use of pharmaceuticals
To develop policies for managing medicine use and administration and managing formulary
system.
Function
Meeting
Meeting shall be held on every month on first week of the month at 10:00 PM. Special/ extra
ordinary meeting be handled on call. 2/3 of the membership of the committee will constitute a quorum for
every session. Decisions will be established only on more than 50% of the committee.
Stationary
Fund for tea, coffee, and soft drinks
Fund for different training and educational programs
Amendments
The terms of reference shall be reviewed annually from the date of approval by agreement of more
than half of DTC members and approval by management of the facility.
The above TOR for ---------Health Center DTC have been Discussed in detail and approved on
meeting held on 21/12/2004 E.C and the management approves.
Each member of the committee is agreed to abide with the terms and conditions of TOR.
Name Signature
Basazinew Fantahun
Andualem Ababu
Mikael Yohannes
Tesfaye Deressa
Iftu Beker
Alfiya Durri
Sisay Getachew
Demelash Bete
Appendix II: PRESCRIPTION
PAPER Please Note the Following Information
Address: Tel +251 ________________ • are valid only if it has the seal of the health institution
Patient’s full Name: ___________________________ • Filled and blank are legal documents, treat them as fixed assets
Sex: _____ Age: ____ Weight: ______ Card No.______ • Written and verbal information to the client complement one another
2. The prescriber:
Region: _______Town ________ Woreda _____
•Medicine treatment is only one of the treatment options
Kebele ______ House No. ______ Tel. No: ________
• write the prescription correctly and legibly
Inpatient Outpatient
• Diagnosis and other parts of the prescription have to be complete
Diagnosis ___________________________
• Abbreviations are NOT recommended
Medicine Name, Strength, Dosage Form, Price
Dose, Frequency,Duration, Quantity, How to • Please accept prescription verification call from the dispenser
use & other information (dispensers
3. The Dispenser:
use only)
• check legality of the prescription
• Check for whom the medicine is being dispensed: actual client or care taker
• If in doubt about the contents of the prescription; verify with the prescriber
Full name _____________________________________ • Generic name, strength and dosage form of the medicine
See overleaf
List specific pharmacologic action and therapeutic use that warrants this medicine’s admission to the Formulary:
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If this medicine is admitted to the formulary, the following medicine(s) should be deleted:
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Have you in the past, or are you currently conducting studies with this medicine?
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DTC’s Action:
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Date: ------------------------------------
INDEX
A
Acetyl salicylic acid, 21, 22, 28
Acyclovir, 25
Adrenaline, 19, 20, 30
Albendazole, 26
Aluminium Hydroxide + Magnesium trisilicate, 17
Aluminium Hydroxide + Magnesium trisilicate + Simethicone, 17
Aminophyllin, 20
Amitriptyline, 21
Amoxicillin, 23
Amoxicillin + Clavulanic acid, 23
Ampicillin, 23
Artesunate, 25
Arthemeter, 25
Arthemeter + Lumfantrine, 25
Ascorbic acid (Vitamin C), 29
Atropine sulfate, 33
B
BCG, 34
Benzyl benzoate, 32
Benzoic acid + Salicylic acid, 32
Betamethasone valerate + Phenylephrine + Lidocaine, 18
Bisacodyl, 18
Bismuth subgallate + Bismuth oxide + Peru balsam + Zinc oxide, 18
C
Calamine, 32
Ceftrixone, 23
Chloramphenicol, 23, 31
Chlorohexidine gluconate + Cetrimide, 33
Chloroquine phosphate, 25
Chlorpheniramine maleate, 30
Cimetidine, 17
Ciprofloxacin, 23
Clotrimazole, 28, 32
Cloxacillin, 23
Condom (male), 27
Copper T 380 A, 27
D
Dextropmethorphan, 20
Dextrose in water, 29
Dextrose in normal saline, 29
Diazepam, 21, 22
Diclofenac, 22
Diphenhydramine +Sodium Citrate + Ammonium chloride, 20
Diphtheria + Tetanus toxoid + Pertusis antigen + Haemophilus + influenza type B (Hib) + Hepatitis B surface antigen +
Aluminium phosphate + Sodium chloride, 34
Doxycycline, 23
E
Efavirenz, 24
Erythromycin, 23
Ethambutol, 24
Ethyl alcohol, 33
Etonogestrel, 27
F
Frusemide, 19
Fluconazole, 24
Ferrous sulfate + Folic acid, 28
Fusidic acid, 32
G
Gentamicin, 31
Gentamicin + Dexamethasone, 31
Gentian violet, 31, 32
Griseofulvin, 24
H
Hydralazine, 19
Hydrochlorothiazide, 19
Hydrocortisone, 27, 30, 32
Hydrogen peroxide, 31, 33
Hyoscine, 17
I
Ibuprofen, 22
Ichthamol, 32
Indomethacin, 22
Iodine, 33
Iron gluconate, 28
Isoniazide, 24
K
Ketoconazole, 24, 32
L
Lactated Ringer’s, 29
Lamivudine + Stavudine + Nevirapine, 24
Lamivudine + Zidovudine, 24
Lamivudine + Zidovudine + Nevirapine, 24
Levonorgestrel (D-Norgestrel), 27
Levonorgestrel + Ethinylestradiol with iron, 27
Lidocaine hydrochloride, 22
M
Magnesium sulfate, 21, 28
Measles Virus Vaccine, 34
Mebendazole, 26
Medroxyprogestrone, 27
Methyl dopa, 19
Methyl Salicylate, 33
Metoclopramide hydrochloride, 17
Metronidazole, 25, 28
Miconazole, 24, 31
Miconazole nitrate, 28, 32
Misoprustol, 28
Multivitamin, 30
N
Nevirapine, 24
Nifedipine, 19
Norfloxacin, 23
O
Omeprazole, 17
Oral Rehydration salt, 18, 29
Oxygen, 34
Oxytocin, 28
P
Paracetamol, 21
Penicillin G, Benzanthin penicillin, 23
Penicillin G, Sodium Crystalline, 23
Piperazine, 26
Pneumococcal Polysaccharide vaccine, 34
Poliomyelitis I, II, III, 34
Povidone-Iodine, 31, 33
Praziquantel, 26
Prednisolone, 27, 32
Primaquine, 25
Procaine Penicillin fortified, 23
Promethazine, 17, 21, 30
Q
Quinine dihydrochloride, 25
R
Rifampicin + Dapsone, 24
Rifampicin + Dapsone + clofazimine, 24
Rifampicin + Isoniazid, 24
Rifampicin + Isoniazid + Pyrazinamide, 24
Rifampicin + Isoniazid + Pyrazinamide + Ethambutol, 24
S
Salbutamol, 20
Salicylic acid, 32
Sodium chloride, 29
Streptomycin sulfate, 24
Sulphamethoxazole + Trimethoprim, 23
T
TAT, 34
Tenofovir + Lamivudine, 24
Tetracycline, 23, 31, 32
Theo-ephedrine, 20
Tinidazole, 25
U
Universal antidote, 33
V
Vitamin A, 29
Vitamin B1 + B6 + B12, 30
Vitamin B complex, 30
W
Water for injection, 34
X
Xylometazoline, 31
Z
Zidovudine, 24
Zinc oxide, 32