WORETA HEALTH SCIENCE COLLEGE

• MODULE TITLE: Apply Good Dispensing

Principles for Department of pharmacy
Level- IV
MODULE CODE: HLT PHS4 M03 02 22
Prepared by
Moges .G [Bsc Pharmacy, Msc PSCM]

Oct/ 2017 E.C

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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
• LO9 .Finalize Prescription, Documentation and
Reporting
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1. ACCEPTING PRESCRIPTION FOR DISPENSING

Intrduction
• The person who receives the
prescription must ensure that the
patients’ name, address, age… is
complete and legible and the
prescription should be handed in by the
patient in person.
•It is the process which starts from
receiving prescription (medication order)
up to providing information to client’s i.e
proper counseling for dispensing.
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 Definition of terms
• Drug: means any substance or mixture of substances used in the
diagnosis, treatment or prevention of a disease in human.
• Prescription: means any order for a drug written and signed by a
properly licensed or authorized medical practitioner issued to a
patient in order to collect drug from dispensing unit.
• Prescriber: means any medical practitioner who is licensed or
authorized to write prescription.
• Dispensing: means to prepare drugs and/or medical supplies and
distribute them to their users.
• Dispenser: means any person who is licensed or authorized to
dispense drugs and/or medical supplies.

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Cont…
• Prescription drugs: means drugs which are
dispensed with prescription only.
Example: Antibiotics.
• Over the counter drugs: means drugs which
are dispensed even without prescription
Example:- Vitamins & food
supplements,
- Antihelminthics,
- Paracetamol,
- Cough preparations.
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Cont..
• Patient: means a person with ill health.
• Packaging: may be defined as the collection of
different components (e.g. bottle, vial, closure, cap,
ampoule, and blister) which surround the
pharmaceutical product from the time of production
until its use.
• 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 of
patients (users).
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Cont…
• A container for pharmaceutical use: is an
article which holds or is intended to contain and
protect a drug and is or may be in direct contact
with it.
• Packaging material: any material, including
printed material, employed in the packaging of
a pharmaceutical product, excluding any outer
packaging used for transportation or shipment

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A prescriber is a medical practitioners who is
licensed or authorize to write prescription.
Who can write drug prescription
• physicians
• dentists
• veterinarians
• Physician assistants
• Nurse practitioner
• clinical Pharmacist
• Or other health care professional who are
authorized to write the prescription
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 prescriber prescribes a drug by
• Generic name (nonproprietary name) or
• brand name (proprietary name)for a special
purpose is used
• Chronically ill patients (CHF, MI, angina…
• strength of a medication
• should be written in metric units (not apothecary).
• Dose and dosage form, dosage and duration of
action

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Cont…
1.1 Types and parts of prescription
Types of prescription

• Normal/Ordinary prescription
Prescription for drug rather than narcotic and
psychotropic substances.
• Which can be:
1. Pre compounded and
2. To be compounded.
• Special/controlled prescription –
Prescription for narcotic (red paper) and psychotropic
substances (blue paper).
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Types of prescription paper con…
Normal prescription paper
• Have white colours
• Dispensed with in 30days after prescribed
• Applicable for both POM and OTC drugs
• Must be registered before dispensed and
documented after dispensing
• Only responsible bodies must dispose after 2years

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Special prescription paper
• Are prepared for a special purpose
• Have colors other than white
• Dispensed within 15days after prescribed
• Applicable only for narcotic drugs and
psychotropic substance
• Must be registered before dispensed and
documented after dispensed
• Only responsible bodies must dispose after 5years

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Parts of prescription

1. Superscription– includes Latin symbols RX

-This is useful when medication dosage is an
important function of age and weight.
2. Inscription – body of the prescription which includes
name of the drug, dosage forms, dose, frequency and
duration.
In compounded prescription, the names and quantities
of each ingredient should be written.

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Cont…

3. Subscription
 it includes the quantity to be dispensed
4.Signature (transcription)
– Signature and name of prescriber and dispenser.

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 parts of prescriptions

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1.2 Collecting prescription and conformity

1.2.1 Client details

• Patient's details (Patient Name, Address, Sex, Age, Weight and
Diagnosis)
• The full name and address of the patient are necessary for
identification purpose.
• Names and addresses written illegibly should be clarified on
acceptance of the prescription.
• Some prescription used by medical specialists, particularly
pediatricians, include a space for insertion of the patient age,
weight or body surface area this is useful when medication
dosage is an important function of age or weight helps in
checking the dose prescribed by the pediatrician.
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Cont…
1.2.2 Prescriber information
• It includes prescriber’s name, qualification, signature
and date.
1.2.3 Legality
• A prescription is legal when:-
• It is written (can also be typed) and signed by an
authorized prescriber.
• The medicines are written on the right
prescription such as normal and NPS.
 NPS prescription (Narcotic and psychotropic
prescription) for Controlled drugs
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Cont…
1.2.4 Validity
• Validating prescriptions received from individuals
involves ensuring that
1. the prescription is correctly written and
2. it contains all the necessary
information.
Sign of the advanced practice registered professional
the names of the advanced practice registered
professional,
the patient's name and address,
the drug ordered,
directions with regard to the taking and
dosage of the drug, and the number of refills.
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 1.2.5 Completeness of
prescription
• Details to be checked for completeness of the prescription:-
A. Seal of the health institution or header
B. Prescriber’s details (Name of prescriber’s, Qualification,
Signature and date)
C. Patient's details (Patient Name, Patient Address, Sex, Age,
Weight and Diagnosis)
D. Medicine details
• Checking the medicine details will include checking:
Name of the medicine
Dosage form
Strength/ potency of the medicine
Total amount(quantity) to be dispensed and its availability
Dosage and directions for use
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Steps of processing prescription

• If Dispensing refers to the process of preparing

drugs and distributing them to their users with
provision of appropriate information.
• So, it follows routine steps

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11/02/2024 21
Steps of processing prescription con…
Step1: 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 in doubt ask for identification card. Cross
checking the name and identity of the patient must
also be done when issuing the drugs.
Check the following information on the
prescription: completeness of prescription: -
• Patient’s name, sex, age, card number, address
• Diagnosis (ICD code number)
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• Drug name, strength, dosage form, course of treatment
• The prescriber name, qualification, signature, registration
number
• Date of the prescription
• Whether appropriate prescription form is issued or not
(e.g. for controlled drugs)
• NB: the dispenser should check the legality of the
prescription as well.
• Legality refers to the source of the prescription and the
information on the prescription and the type of the
prescription depending on the drug prescribed on it.
• Also check seal of the health institution, if available

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Steps of processing prescription con…
• Verbal request can be done only for OTCs with justification.
• Be certain pom drugs are not dispensed with out
prescription at any time
• If there is any doubt on the prescription contact with the
prescriber.
Step 2: understand and interpret the prescription;
checking the prescribers instruction errors:-
• Carefully read the prescription or validate verbal request
• Check if the prescription is legally and currently written
• Correctly interpret and abbreviations used by the prescriber
• confirm that the doses prescribed are in the normal range for
the patient (noting sex, age)
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• 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
Step 3: 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
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• Do not select the prescribed drugs according to the color or
location of container
• Do not open many stock containers at the same time. This
trend will lead to errors and/or expose the drugs to air and
eventually leads to deterioration in quality.
• Open and close containers once at a time
• While counting, pouring, or measuring, the following
points should be noted.
• Short and/or over counting should be avoided
• Clean counting tray and/or spoon used
• Graduated measuring cylinder and/or flask must be used
for measuring liquid reduction. If small volume is to be
measured, small measuring cylinder/flask has to be used.
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• Appropriate balance should be used

• In dispensing 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 spill or dripping liquid
• Pour the measured liquid preparation into the
container/bottle and label it.
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• 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
In dispensing tablets and capsules:
• Do not use fingers to count tablets as this can
lead to contamination of drugs
• Use a spoon to put tablets and capsules onto a
counting tray
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• Count and put them in a labeled drug container or
pack
• Close stock containers tightly after dispensing
• Keep the spoon clean at all times
• Do not keep the spoon inside the container

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11/02/2024 30
Capsule courting tray

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11/02/2024 32
 Labeling of dispensed drugs should be clear and
legible. All drugs should normally be labeled with
the following particulars:
• The drug name (use generic name)
• Strength (usually in mg)
• The dose, quantity dispensed and frequency
• Direction for use in a familiar language
• Expiry date or use by date
• The name of the patient
• The name and address of pharmacy
• Dispensing date
• Dispenser name and initials
• Special caution (whenever applicable)
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 Step 4: Issue drugs to the patient with clear
instructions and advice
• The prepared, packaged and labeled drug is handed
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)
• How long the treatment is to last (e.g., why the entire
course of an antibiotic treatment must be taken)
• How to take the drug (e.g., with water, chewing or
swallowing)
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How to store the drug (e.g., avoid heat, light and
dampness humidity)
• Not to share drugs with others persons
• keep drugs out of reach of children
• One has to demonstrate to the patient on how to
administer the dispensed medications in case of
inhaled administration and suppository application
suppository

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• Patient should be informed not to stop treatment
when side effects occur or in the absence of
response without consulting the prescriber or
dispenser.
• 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 whether patients have understood
the information provided.

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 Step 5: Recording and documentation
There are three different methods that can be used to
keep a record of drugs dispensed. These are: -
• When prescription is retained, the dispensing staff
should put initials and annotates the prescription and
either files or enters the details into a record book.
• When prescription is returned to the patient details of
the drugs dispensed must be entered into a record
book before the items are issued to the patient.
• When computers are used in the dispensing process
the computer program should retain the information,
which can be recalled to generate summary report
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The following information should be included into
the record book and or computer:
• The date, patient’s name, sex, age, name of the
owner (for veterinary drugs)
• The drug name, dosage strength and dosage form
• The name, address and qualification of the
prescriber
• The date on which the drug was prescribed
• The amount issued to the patient
• The dispenser’s name and initials
• The date of dispensing
• Details of repeat indications
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1.4 Reporting discrepancies to pharmacist

• Prescriptions needs to have intended information about the patient,

the prescriber, diagnosis and medication ordered. Pharmacy
professionals are responsible to check all information needed.
• In addition 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).
• Pharmacy professionals should also be alert to fake prescriptions
written/ printed by the patient or client coming to the pharmacy. If
the handwriting is not the usual handwriting of the prescriber or
you notice it to be unusual otherwise, confirm with a senior
colleague or call the prescriber to confirm.
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1.4.1 Incomplete or incorrect prescription
• When we say the prescription is incomplete it lacks
one of the following:-
a. Name of the health institution
b. Prescriber’s details (name of the Prescriber,
qualification, signature and date)
c. Patient’s details (Patient name, address, sex, age,
weight and diagnosis)
d. Medical details which includes name of the
medicine, dosage form, strength, total amount to be
dispensed, direction for use, and frequency of
administration and duration of treatment
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1.4.2 Prescription out of date

• A prescription is valid for 30 days from the date on the prescription,

unless the medicine prescribed contains a controlled drug.
• A controlled drug which includes morphine, pethidine, methadone,
etc are sometimes misused, so strict legal controls apply to their
supply, to prevent them being obtained inappropriately.
• A prescription for a controlled drug is valid for15-28 days from the
date on the prescription.
 The date on the prescription can be:
• The date it was signed by the health professional who issued it.
• The date that the health professional has indicate the prescription
shouldn’t be dispensed before.

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Repeat prescription:

• Allow the same prescription to be dispensed more than

once.
• Must be dispensed for the first time within six months of
the date on the prescription. After this, it can continue to
be valid beyond six months, according to the directions
on the prescription.
1.4.3 Prescription marked “cancelled” or indicates that
it has been dispensed and completed
• It is one of the discrepancies that we face while
dispensing. If patients came up with already dispensed
prescription we should contact the pharmacist instead of
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dispensing.
Cont…
1.4.4 Prescription for a narcotic written by the prescriber for self
treatment
Self-prescribing :-
• is unacceptable and illegal in most instances.
• or prescribing to an individual outside of a valid physician-patient
relationship is against the law.
• Is possible during emergencies
During emergencies, we can prescribe drugs to ourselves, families,
friends and to anyone with whom we have a close personal or emotional
relationship because it is necessary to:
• Save life
• Avoid significant deterioration in the patients’ health
• Alleviate uncontrollable pain.
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Cont…
 If there is no other person with the legal right to
prescribe by assessing the patients clinical
Condition and to delay prescribing would put the
patient’s health at risk, or cause unacceptable pain,
prescribing for close personal or emotional
relationship is possible.
There is a risk that doctors who self-treat may
ignore or deny serious health problems. There is
also a risk that self-prescribing could lead to drug
abuse or addictions like for narcotic drugs.

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1.4.5 Request for excessive
quantities
• The simultaneous supply of multiple quantities of a
particular medicine (i.e. the supply of multiple repeats at
once) may not be in accordance with the prescriber’s
intention and is contrary to good pharmaceutical practice.
• The practice of supplying multiple quantities of a
particular medicine at a single dispensing, or of supplying
multiple quantities to a patient even though a prescriber
may have provided a ‘blanket request/approval’ to a
pharmacist to do so, is contrary to the National Medicines
Policy and Quality Use of Medicines principles.
• If you face such type of prescription you should contact
the prescriber.
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1.5 Determining cost of medication

• The cost of medication can be determined by the

pharmacist
• it is based on the consideration of the price of the
medication obtained, transportation fee, and service
charge.
1.6 Advising client of any foreseen difficulty in filling
the prescription
• When we receive prescription; if we use computer
system drugs should be entered to the computer system,
under this circumstance if we encounter any difficulty;
we need to tell to the patient and make adjustment.
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1.7 Advising client of approximate waiting time and
collection arrangements

• Patient waiting time has been defined as ‘the length of time

from when the patient entered the pharmacy to the time the
patient actually received his or her prescription and left the
pharmacy.
• Most of the patient waiting time in the hospital studied can be
accounted for by delay components of the dispensing
procedure.
• Attempts should therefore be made to reduce the time on
these components of the dispensing process so that more time
could be devoted to counseling while reducing the total time
spent by the patient in having their prescriptions sheets filled.
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Cont…

• Excessive patient waiting time

1. undermines pharmacy efficiency.

2. leads to patient dissatisfaction.

3. lead to poor patient compliance with instructions given

at the pharmacy. Therefore we should advise patents
about the procedure we pass throughout the dispensing
process.
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1.8 checking payment and give medication

• After we determine the cost of the medication, we

give the prescription for the patients and they
make payment. They return back to us, after
payment, with the receipt. Then we check the
number on the receipt and prescription paper and
also check the signature of the finance personnel.
After all checkups we give the medicament with
full counseling.

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2. Ensuring clinical evaluation of prescription by
pharmacist
It includes:-
1. Refer prescription / medication order to pharmacist for
clinical evaluation
2. Confirm pharmacist has completed a clinical evaluation
before filling the prescription / medication order
• These checks are also known as the “Professional Check” and
the “Clinical Check” and may be performed prior to
dispensing, or after dispensing at the same time as the final
accuracy check. The pharmacist will confirm that the
prescription meets all the legal requirements and that the
treatment is suitable for the patient in terms of the drug, the
dose, the formulation, the frequency of administration and the
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Cont…
• The pharmacist will also consider the patient's age and
other conditions affecting their health and/or treatment
options e.g. chronic illnesses, medication taken, allergies
and whether they are pregnant or breast feeding.
• Formal assessments of prescription charts in hospitals
have shown that there are wide variations in the quality of
prescribing and pharmacists are able to identify and
resolve many clinical problems. Patients can be questioned
on their medication histories, including allergies and
intolerances, efficacy of prescribed treatment, side-effects
and adverse drug reactions (ADRs).
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 Cont…
The routine presence of medical and nursing staff on
the ward allows the pharmacist to communicate
easily with other members of the healthcare team
who value the prescription-monitoring service that
clinical pharmacists provide. Patients’ notes are
also accessible, to enable the pharmacist both to
check important information that may affect their
healthcare and to record details of any clinical
pharmacy input made.

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 Type of drug interaction

Drug-drug interaction; these are the most

common type of drug interaction the more
medicines taking greater chance of interaction of
medicines and also can decrease how well
medication work, may increase minor or serious
unexpected side effect or increase the blood level
and possible toxicity of certain drug.
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 cont...

For example interaction between oral contraceptive

and antibiotics rifampicin ,amoxacillin,
metronidazone,ampicillin ,griseofulvin and
tetracycline .
.Drug-food/beverages interaction; this may seen
odd ,but certain medications can interact with
foods or beverages. for example grapefruit juice
can lower the level of enzymes in the liver
responsible for breaking down medications.

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Drug-disease interactions; drug interaction
don’t always occur with just other drugs. For
example oral decongestant like pseudoephedrine
may increase blood pressure and can be dangerous
if patient had hypertension.
Why it is important to check for interaction;
Affect how the medication works by changing
levels of the drugs in the blood.
To decrease risk of side effect and toxicity.
To minimize working of medical condition
patient already have.
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 Checking of contra-indication
• Contraindications' medical condition that may
restrict or prevent a treatment being carried out.
Categorized into absolute and relative contra-
indication.
example children and teenagers with viral
infections should not be given aspirin because of
Reyes syndrome this is absolute
contraindications

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 Adverse drug interaction

Is unwanted ,undesirable effect of medications

that occurs during usual clinical case. Adverse
drug reaction occurs almost daily in health care
institutions and can adversely affect patient
quality of life ,often causing considerable
morbidity and mortality.

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Source of information for clinical evaluation of
prescription
primary and secondary source of information
using soft ware for drug interaction
drug formulary
Standard treatment guideline(STG)
Consulting the pharmacist.

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 Recording and documentation

 Any entries in the appropriate registers e.g. the Controlled Drugs

Register or the prescription-only register could be made after the items
have undergone the final accuracy check if they are to be supplied
immediately.
 Entries are not made in the Controlled Drugs Register until the dispensed
items have been supplied because entries need to be in chronological
order.
 If the dispensed items are not collected straight away they need to be
stored appropriately. The prescription should be kept with the bag of
medicines.
 Controlled Drugs requiring safe custody should be put in the Controlled
Drugs cupboard and the prescription attached to the bag. Other items on
the prescription should be kept in a separate bag and stored in a different
location.
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 Cont…
• There should be a note securely attached to this bag
to remind the member of staff handing out
prescriptions to collect the item from the Controlled
Drugs cupboard and to make any entries in the
Controlled Drugs Register or to tell the person
responsible that this needs to be done.
• Items requiring refrigeration should be stored in a
similar way. The prescription should remain with
the items until they are supplied or returned to
stock.
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3. Calculate prescription quantities

OBJECTIVES
Upon completion of this coure, the student will
be able to:
• Describe the relationship of active ingredients
and diluents if the amount of active ingredient
remains constant and the amount of diluent is
increased or decreased.

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• Determine the percent strength and ratio
strength of a given product when the active ingredient
remains constant and the amount of diluent is
increased or decreased.
• Determine the volume of solution of a desired
strength given a specified quantity of any given
strength.
• Determine the volume of a specified stock
solution needed to prepare a given solution.
• Determine the quantity of an active ingredient
in a specified amount of solution needed to prepare a
given solution.

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• Define the allegation methods of problem
solving.
• Use the allegation methods (allegation
alternate and allegation medial) to determine
the percent strength of alcohol mixtures.
• Perform calculations to reduce or
enlarge formulas for pharmaceutical
preparations stated in metric quantities
• Perform calculations to reduce or
enlarge formulas for pharmaceutical
preparations stated in proportional parts
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3.1.Dilution concentration

• Relationship between strength and total

quantity
• Dimensional analysis is common method
used to perform pharmacy math problems.
• it involves the creation of a ratio-proportion
pathway on a combination of given
quantities.

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• Occasionally in pharmacy practice, a weaker solution must be
made from more concentrated solution such as concentrated
stock solution. These product must often expressed in percent
weight-volume (w/v) or percent weight-weight(w/w).eg product
expressed as 0.3% w/v is interpreted as 0.3gm in 100ml.also
product expressed as 10% w/w is interpreted as 10gm in 100gm.
• many commercially available products are supplied with their
concentration expressed in this format .Fluocinonide solution is
one such product.It is suuplied as 0.05% solution ,meaning that
100ml of this product contains 0.05gm of fluocinonide
• situation sometimes occur when needed strength is not in stock
or strength of commercially available agent is not appropriate
and a lower strength is required for a patient.This can be
accomplished by combining the available product with an
acceptable diluent.
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 Introduction
• Pharmaceutical preparations consist of a number of
different ingredients in a vehicle to produce a product.
The ingredients and vehicles used in a product can be
solid, liquid or gas.
• Concentration is an expression of the ratio of the amount
of an ingredient to the amount of product. It can be
expressed in several ways:
• In the case of a solid ingredient in a liquid vehicle the
ratio is expressed as a weight in volume, denoted by w/v
(for example sugar granules dissolved in a cup of coffee)
• for a liquid ingredient in a solid vehicle the ratio is
expressed as a volume in weight, denoted by v/w (for
example lemon juice drizzled on the top of a cake)
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• if both ingredient and vehicle are liquids the ratio is expressed
as a volume in volume, denoted by v/v (for example milk
added to a cup of coffee)
• When the ingredient and vehicle are both solid the ratio is
expressed as a weight in weight, denoted by w/w (for example
the blueberries as a proportion of the whole blueberry muffin)
1g/100g
• The concentration of pharmaceutical preparations usually
describes the strength of the drug in the preparations. In
practice it is important that the patient receives the correct
amount of the drug
• If a patient receives too much of the drug they are likely to
experience side-effects; side-effects are often dose-related, so
the higher the amount of the drug the stronger the side-effect
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• If a patient receives too little of the drug, then their
treatment is likely to be less effective than the prescriber
intended. This can lead to a deterioration in the health of
the patient.
We know that rational numbers can be expressed as ratios,
fractions, decimals or percentages. As concentrations are
expressions of ratios, they can also be expressed in different
forms. The forms traditionally used are those of amount
strengths, ratio strengths, parts per million and percentage
strength.
Each of these four forms can be expressions of w/w, v/v,
w/v or v/w, depending on whether solids or liquids are
involved.
For ratio strengths, parts per million and percentage
strengths in w/w or v/v the amounts of ingredients and
product must be expressed in the same units:
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A ratio of 7mL to 12mL is the ratio 7:12v/v ■ a ratio of 3mg to
5mg is the ratio 3:5w/w.
As long as the units used are the same, they lead to the same ratio.
For a concentration of 3mg to 5g, we need to change to the same
units before we can express the w/w ratio. Converting 5g to
milligrams:
g– – mg
5g= 5000 =5000mg
The ratio becomes 3mg to 5000mg, which is the ratio 3:5000w/w.
In the case of w/v and v/w there is an agreed convention that
states that weight is expressed in grams and volume is expressed
in milliliters.
Let us now examine each of the traditional ways of expressing
concentrations in more detail.
11/02/2024 69
3.1.1 Relationship Between Strength and Total
Quantity
If a mixture of a given percentage or ratio
strength is diluted to twice its original quantity, its
active ingredient will be contained in twice as many
parts of the whole, and its strength therefore will be
reduced by one-half. So if 50 mL of a solution
containing 10 g of active ingredient with a strength
of 20% or 1:5 w/v is diluted to 100 mL,
the original volume is doubled, but the original
strength is now reduced by one-half to 10% or 1:10
w/v.
11/02/2024 70
If, then, the amount of active ingredient remains
constant, any change in the quantity of a solution or
mixture of solids is inversely proportional to the
percentage or ratio strength; that is, the percentage
or ratio strength decreases as the quantity increases,
and vice versa. In other words, if the amount of
active ingredient remains the same and the volume
gets larger, the concentration gets smaller.
Likewise, if the amount of active ingredient
remains the same and the volume gets smaller, the
concentration increases.

11/02/2024 71
 This relationship is generally true except for
volume-in-volume and weight-involume solutions
containing components that contract when mixed
together. It is not possible to add the volume of
ingredients and get the total volume of the final
product in all cases. It is possible when mixing
solids.
Problems in this chapter generally may be solved
by one of the following methods

11/02/2024 72
1. Inverse proportion:
C1 Q2
C2 Q1
where C = concentration and Q = quantity.
2. The following formula:
(quantity1)(concentration1)(quantity 2)
(concentration 2)
That is,
Q1 C1 Q2 C2

11/02/2024 73
3. Determining the quantity of active constituent
(solute) needed and then calculating the quantity of
the available solution (usually concentrated or stock
solution) that will provide the needed amount of
constituent.
For most situations the student technician is
encouraged to use the formula method of solving
these dilution and concentration problems. Sometimes
the third method is the easiest of the three, usually
when the strength of the product is very small and the
technician is using a prepared strength available in a
vial or ampul. Examples of these are detailed later in
the chapter. In the formula method the second quantity
and second concentration are always that of the final
product, not of the active ingredient or diluent.
11/02/2024 74
 3.1.2 Dilution and Concentration of Liquids
• Determination of Percentage or Ratio Strength
Calculating the percentage or ratio strength of a
solution made by diluting or concentrating (by
evaporation) a solution of given quantity and
strength entails the following.
Examples:1
If 500 mL of a 15% v/v solution of methyl salicylate
in alcohol is diluted to 1500 mL, what is the
percentage strength v/v?

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Q1C1 = Q2C2
500 (mL)×15( )% = 1500 (mL)× X( )%
X = 5%, answer
76
Solve by Inverse Proportion:
1500 mL = 15%
500 mL X%
X = 5%, answer
Examples:2
How much 10% w/w (in grams) ammonia solution can be made from
1800 g of 28% w/w strong ammonia solution?
Q1 C1 Q2 C2
1800 ( )g × 28 ( )% = X ( )g ×10%
X = 5040 g, answer
Solve by Inverse Proportion:
10% = 1800 g
28% Xg
X = 5040 g, answer

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How much (in milliliters) of a 1:5000 w/v solution
of phenylmercuric acetate can be made from 125
mL of a 0.2% solution?
1:5000 = 0.02%
Q1 C1= Q2C2
125 (mL) × 0 .2 ( ) % = X (mL) × 0. 02
()%
X = 1250 mL, answer
Solve by Inverse Proportion:
0. 02% = 125 mL
0. 2 % X mL
X = 1250 mL, answer
11/02/2024 78
liquid and solid dilutions
 When calculating liquid and solid diluents, the following
formula is useful
Q1(quantity 1)*C1(concentration 1)=Q2(quantity
2)*C2(concentration 2)
example liquid dilution how many mls of 0.4% stock
soution are required to make 2L of 0.06% solution using
water as solvent ?(1000ml=1L)
variabl are c1=0.4% q2=2L and C2=0.06% are known.t
he un known variabl which need to be determined is Q1.to
solve the problem ,insert the numerical value in to the
formula and solve for q1

11/02/2024 79
Cont…

2L*1000ml/1L=2000ml
q1=? C1=0.4% q2=2000ml c2=0.06%
q1*0.4%=2000ml*0.06% q1=300ml
therefore ,300ml of 0.4% stock solution is required
to compound the liquid .now we must determine how
many ml of solvent are necessary.to calculate the
amount of solvent to include in the
compound ,simply subtract the volume of the stock
solution from the final volume of the compound.
11/02/2024 80
2000ml (final volume of the compound -
300ml (volume of stock solution =1700ml of
water
thus ,300ml of the 0.4% stock solution and
1700ml of water are requird to make 2000ml
of 0.06% solution
Exercise
what is the new concentration of 750ml ,50%
dextrose solution that is diluted to 1500ml
with water % ?

11/02/2024 81
solid dilution
example how many grams of 5 % lidocaine ointment and
how many grams of an ointment base must be combined to
obtain 3 pounds of 2% lidocain ointment ? hint 1 IB=454gm
3IB=1362gm
q1=? c1=5% q2=1362gm C2=2%
q1*5%=1362gm*2%=544.8gm there fore 545gm of 5%
lidocaine ointment is required to compound the desired
product .the next step is to determine how much of the base
is needed. Since we know the final weight of the product and
the amount of 5% lidocaine ointment (545gm) that is
required, the amount of ointment base can be calculated
=1362gm-545gm=817 gm. of ointment base.

11/02/2024 82
Exercise

A 0.05% fluocinonide 30gm ointment is

combined with 15gm of ointment base .what is
the new percent strength ?

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 3.1.2.1. Stock solutions
Stock solutions are solutions of known concentration that
are prepared by the pharmacist or technician for
convenience in dispensing. They are usually strong
solutions from which weaker ones may be made
conveniently. When correctly prepared, these solutions
enable the pharmacist to obtain small quantities of
medicinal substances that are to be dispensed in solution.
Stock solutions usually are prepared on a weight-in-volume
basis, and their concentration is expressed as a ratio
strength or less frequently as a percentage strength.

11/02/2024 84
Amount of Solution Needed to Prepare Desired
Solution
Calculating the amount of a solution of given strength that
must be used to prepare a solution of desired amount and
strength involves the following.
Examples:
How much (in milliliters) of a 1:400 w/v stock solution
should be used to make 4 L of a 1:2000 w/v solution?
4 L = 4000 mL
1 400:= 0 25. % 1 2000: = 0 05. %
Q1 C1= Q2 C2
X (mL)× 0 25. % = 4000 mL × 0 05. ( )%
X = 800 mL, answer
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 Solve by Inverse Proportion:
0 .25% = 4000 mL
0. 05. % X mL
X = 800 mL, answer
U Using a Stock Vial or Ampules
Sometimes it is necessary to make a specified
concentration of a product so dosing will be easier
for the patient. These are most often products that
are available in vials or ampules with concentrations
in milligrams per milliliter or micrograms per
milliliter. Many injectable products are mixed to
physician-ordered concentrations to be given orally.
11/02/2024 86
• When using small volumes and low-concentration
products, it is usually easier to use the same
method to calculate the amount of drug (stock) and
diluent as to calculate the amount of active
ingredient, since these products are not labeled in
percent or ratio strength, but in milligrams per
milliliter or micrograms per milliliter.
• Examples:
Prepare 30 mL of a 5 mg/mL oral phenobarbital
solution using phenobarbital available from the
manufacturer in a 65 mg/mL solution that comes in
1-mL vials. How much stock solution will be
required?
11/02/2024 87
• Folic acid is available from the manufacturer in a
5 mg/mL injection. Prepare 1 oz. of 25 mEq/mL
oral solution. How much folic acid solution is
required?

11/02/2024 88
3.1.2.2. 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 vol-in-vol strength of an alcohol dilution, the
alcohol “solute” may be determined and water used
to”q.s” to the appropriate volume .B/c the concentration
of the liquids does not affect the weight of the
components ,the weight of water (from this) the
volume ,needed to dilute alcohol to a desired weight –in –
weight strength may be calculated.
E.g1.How much water should be mixed with 5000ml of
85% v/v alcohol to make 50% v/v alcohol?
E.g2.How much water should be added to 4000gm of 90%
w/w alcohol to make 40% w/w alcohol?
11/02/2024 89
 3.1.3. Dilution and concentration of solids and semi-solids

• The dilution of solids in pharmacy occurs when there is

need to achieve a lower concentration of an active
component in a more concentrated preparation.
• The dilution of semi solids is a usual part of a compounding
pharmacist’s practice in reducing the strengths of cream and
ointment to meet the special needs of patients.
E.g1.How many gms of opium containing 15% w\w of
morphine and how many gms of lactose should be used to
prepare 150gm of opium containing 10% w/w of morphine?
Soln :- 15% /10% = 150gm/X
X = 100gm of 15% of opium
And 150gm – 100gm = 50gm of lactose
11/02/2024 90
 Assinment on Stock Solutions value 15%
1. If 250 mL of a 1:800 v/v solution is diluted to 1000 mL,
what will be the ratio strength v/v ?
2. If 400 mL of a 20% w/v solution is diluted to 2 L, what
will be the percentage
3. How much 40% solution is needed to make 500 mL of a
5% solution?
4. How much of a 1:80 solution is needed to make 500 mL
of a 0.02% solution?
5. Hydrocortisone is available in a concentration of 100
mg/2 mL from the manufacturer. You are to prepare 10
mL of a 15-mg/mL preparation. How much
hydrocortisone do you need?
11/02/2024 91
3.1.4. Alligation

• Allegation is an arithmetical method of solving

problems that involve the mixing of ingredients
possessing different percentage strengths. The
student technician must remember that diluents are
substances with no active ingredient and therefore
are at 0%. They include such materials as lactose,
sterile water, and petrolatum. Active ingredients
alone are 100%.

11/02/2024 92
 Alligation Medial
Alligation medial is a method by which the weighted
average percentage strength of a mixture of two or
more substances of known quantity and
concentration may be easily calculated. In other
words, the procedure is to calculate the amount of
active ingredient in each substance in the compound,
then calculate what percent of the whole compound
the active ingredient is. Of course, the quantities
must be expressed in a common denomination,
whether of weight or volume.

11/02/2024 93
Examples:
What is the percentage strength v/v of alcohol in a mixture
of 3000 mL of 40% v/v alcohol, 1000 mL of 60% v/v
alcohol, and 1000 mL of 70% v/v alcohol? Assume no
contraction of volume after mixing.
0. 4 × 3000 mL = 1200 mL, or 40% of 3000.
0. 6 ×1000 mL = 600 mL, or 60% of 1000.
0 .7 ×1000 mL = 700 mL, or 70% of 1000.
Totals:5000 mL 2500 mL (total amount of alcohol)
2500(mL) ÷ 5000(mL) = 0.5×100 = 50%, answer

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Example:
What is the percentage v/v of alcohol in a mixture
containing 500 mL of terpin hydrate elixir (40% v/v
alcohol), 400 mL of theophylline sodium glycinate
elixir (21% v/v alcohol), and sufficient simple syrup to
make 1000 mL?
0. 40 × 500 mL = 200 mL
0. 21 × 400 mL = 84mL
0 × 100 mL = 0mL
Totals: 1000 mL 284 mL
284(mL) ÷1000(mL) = .284 ×100 = 28.4%,
answer
11/02/2024 95
Class work

1. A pharmacist mixes 200 g of 10% ichthammol

ointment, 450 g of 5% ichthammol ointment, and
1000 g of petrolatum (diluent). What is the
percentage of ichthammol in the finished product?

11/02/2024 96
 4.1.5. Allegation alternate

• May be used to determine the proportion or quantities of two or

more components to combine in order to prepare a mixture of a
desired strength.
• E.g. if a pharmacist wished to prepare a solution of a specified
strength by combining two or more other solutions of different
concentrations of the same ingredient, the proportion or
volumes of each solution to use may be determined by
allegation alternate.
• The strength of a mixture must lie somewhere b/n the strengths
of its components; that is ,the mixture must be somewhat
stronger than its weakest component and somewhat weaker than
its strongest.
11/02/2024 97
E.g. In what proportion alcohol of 95% and 50% strengths
should be mixed to make 70% alcohol?

11/02/2024 98
• In what proportion should alcohols of 95% and
50% strengths be mixed to make 70% alcohol? The
difference between the strength of the stronger
component (95%) and the desired strength(70%)
indicates the number of parts of the weaker to be
used (25 parts), and the difference between the
desired strength (70%) and the strength of the
weaker component (50%) indicates the number of
parts of the stronger to be used (20 parts).
• The customary layout of alligation alternate, used
in the subsequent examples, is a convenient
simplification of the nearby figure.
11/02/2024 99
95 20 (parts of 95% alcohol)
Relative amounts
70 20 : 25 or 4 : 5
50 25 (parts of 50% alcohol)
45, sum of parts
The mathematical validity of this relationship can
be demonstrated as:-
Percent given percent desired proportional
parts
require
A x

b 11/02/2024
c y 100
 Cont..

• Given these data, the ratio of x to y may be derived algebraically as follows:-

Ax + by = c(x + y)
Ax + by = cx + cy
Ax – cx = cy – by
X(a – c) = y(c – b)
X=c-b
Y = a–c
• For example: - Given a = 95%, b = 50%, and c = 70%, we may solve the problems
as follows:-
0.95x + 0.50y = 0.70(x + y)
Or 95x + 50y = 70x + 70y
95x – 70x = 70y – 50y
X (95 – 70) = y (70 – 50)
X = 70 – 50 = 20 = 4(parts)
11/02/2024 101
Y 95 – 70 25 5(parts)
Cont…

• The result can be checked by allegation medial:-

95 x 4 = 380
50 x 5 = 250
Total: 9 630
630 ÷ 9 = 70%

11/02/2024 102
 Cont…
E.g.1 A hospital pharmacist wants to use three lots of Zinc Oxide
ointment containing, respectively, 50%, 20%, and 5% of Zinc
Oxide. In what proportion should they be mixed to prepare a 10%
Zinc Oxide?
Soln :-The two lots containing more (50% and 20%) than the desired
percentage may be separately linked to the lot containing less (5%)
than the desired percentage:
50% 5 parts of 50% ointment
20% 10% 5 parts of 20 % ointment
5% 10 + 40 = 50 parts of 5% ointment
Relative amounts: 5:5:50, or 1:1:10
Check : 50 x 1 = 50
20 x 1 = 20
5 x 10 = 50
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 Total: 12 120 120 ÷ 12 = 10%
Exercise
1. In what proportion should 95% alcohol be mixed
with 30% alcohol to make70% alcohol?
2. In what proportion should 30% and 1.5%
hydrogen peroxide solutions be mixed to prepare a
3% hydrogen peroxide solution?

11/02/2024 104
3.2.Reducing and Enlarging Formulas

OBJECTIVES
Be able to reduce or enlarge formulas for both
metric and proportional quantities
Be able to reduce or enlarge formulas for
proportional quantities

11/02/2024 105
3.2.1.Formulas that specify amount of ingredients
Factor calculation
To go from a larger to smaller quantity, or vice
versa, determine the “factor” by which to reduce or
enlarge the formula

11/02/2024 106
• Then multiply the quantity of each ingredient in
the formula given by the factor to determine the
amount of each ingredient needed to prepare the
desired compound
Example 1
If a formula for 1000 mL contains 6 g of a drug,
how many grams of drug are needed to prepare 60
mL of the formula?
60 mL (quantity desired) = 0.06 (factor)
1000 mL (quantity given)
6 g x 0.06 = 0.36 g of drug needed

11/02/2024 107
• Problem 1: Solve by using factor
From the following formula, calculate the quantity
of each ingredient required to make 240 mL of
calamine lotion
Calamine
80 g
Zinc Oxide
80 g
Glycerin 20 g
Bentonite magma 250mL
Calcium hydroxide solution, to make 1000 mL

11/02/2024 108
Solve by using factor
240 mL (quantity desired) = 0.24 (factor)
1000 mL (quantity required)

Calamine: 80 g x 0.24 = 19.2 g

Zinc Oxide: 80 g x 0.24 = 19.2 g
Glycerin: 20 g x 0.24 = 4.8 g
Bentonite: 250 mL x 0.24 = 60 mL
Calcium hydroxide: to make 240 mL

11/02/2024 109
• Solve by Using Dimensional Analysis
Calamine 80 g x 240 mL= 19.2 g
1000 mL
Zinc Oxide 80 g x240 mL =19.2 g
1000 mL
Glycerin 20 mL x 240 mL= 4.8 mL
1000 mL
Bentonite 250 mL x 240 mL= 60 mL
1000 mL
Calcium hydroxide to make 240 mL

11/02/2024 110
Problem 2
• From the following formula for an estradiol
vaginal gel, calculate the quantity of each
ingredient required to prepare 1 lb of gel.
Estradiol 200 g
Polysorbate 80 1g
Methylcellulose Gel, 2% 95 g

11/02/2024 111
3.3 Calculating oral doses
What is mean dose and dosage.
A dose of drug: is the quantity that is intended to
be administered, usually taken at one time or during
one specified period such as per day.
Dosage: refers to the determination and regulations
of the size, frequency, and number doses. The
dosage is the entire regimen or schedule of doses.
Although often used interchangeably, The terms
“dose” and “dosage” do have slightly different
connotation.
11/02/2024 112
• The dose refers to the quantity of drug. The dosage
implies treatment duration and a cumulative effect.
Doses can be expressed as a single dose, a daily
dose, or total dose. A daily dose, in turn, may be
expressed as divided doses.
Example:1. A dose of 50mg is prescribed once
daily for 10 days.
In this case, the single dose, as well as the daily
dose, is 50mg.
Total dose: 50mg/day x10 days=500mg.

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Example:2. A dose of 500mg, three times a days, is
prescribed for seven days.
Solution: The single dose = 500mg
Daily dose: 500mg x 3 = 1500mg
Total dose : 1500mg/day x 7 days = 10,500mg.
Doses and dosage regimens are highly variable
among substances. Each is determined by a drug’s
biochemical and physical properties, the route of
administration, and individual patient factors, A
dose may be based on age ,body weight, body
surface area (BSA), overall health, liver and kidney
function, or the specific illness or condition being
treated.
11/02/2024 114
 Some abbreviation used to determine doses and
total quantities of drugs are:
qd = every day, qod = every other day,
d = daily bid = twice a day
tid = three times a day qid = four times a day
q4h = every 4 hr q6h = every 6 hr
q8h = every 8 hr q4–6h = every 4–6 hr
prn = as needed
Depending on the workplace, you may also see
abbreviation such as the following:
q3d = every three days qmwf = every Monday,
Wednesday, and Friday qw = every week
11/02/2024 115
Dosage Calculations
• Dosage calculations include calculating the number
of doses, dispensing quantities, and ingredient
quantities; these calculations are performed in the
pharmacy on a daily basis. The pharmacy
technician must have a full working knowledge of
how to perform these calculations.
• To perform dosage calculations, you will utilize the
information and principles introduced in the
previous course. You can solve these calculations
by setting up ratios and proportions, keeping like
units consistent, and cross-multiplying.
11/02/2024 116
• Many dosage form including including capsule and
tablet are available in more than strength.
• If a capsule or a tablet of higher strength is
prescribed but unavailable, two capsule or tablet of
one half the strength is prescribed but unavailable,
two capsule or tablets of one half the strength may
be dispensed.

11/02/2024 117
• Thus a pharmacist or health care professional may
need to administer one half of the total strength or
some other portion of the tablet. For example ,if
300mg tablet of ibuprofen are prescribed ,and only
600mg ibuprofen tablets are available .in such case
,one half of the total number of the number of
tablet required should be dispensed to the patients
with clear instruction to take half tablet
11/02/2024 118
• A few help full tips for such calculation are provided
below;
• Don’t break tablet that are not scored.
• Enteric coated tablets are designed to resist the acid
environment in the stomach and release the medication in
the small intestine. If such tablet are broken, there enteric
properties are may be lost .Therefore don’t break them.
• As the general rule, donot divide sustained /controlled
release medications as they may lose their controlled
release properties .However there may be some exception
to this rule. For example, X drugs 240mg tablets which are
given once daily can be split to administer 120mg twice
daily .Therefor ,unless specifically suggested by the
11/02/2024 119

manufacturer ,controlled release tablets shouldn’t be crush.

Example
• If the prescription is received with the instruction of
providing 650mg of drug to a patient and the
pharmacist has 325mg tablets, how many tablet
should the patient be instructed to take?
Answer 2 table must take by the patient.
Class work
1.If the dose is 100mg, and the total amount to be
administered is 4gm, what is the total number of
doses available?
2. If each dose is 5ml, and the total amount to be
administered is 200ml, what is the total number of
doses available?
11/02/2024 120
3. What is the total amount of drug to be administered at
a dose of 1200mg, three times daily, for seven days?
4. How many milliliters will be in each dose if 1 fluid
ounce of medicine contains 60 doses? hint1
ounce=30ml
5. What is the total amount of drug to be administered if
each dose is 25mg and the total number of doses are 40?
6. How do you mix a 30% solution from a70% solution
and a 20% solution?
7. If a patient is prescribed 2tsp of medicine qid daily for
10 days, what is the total dose of medicine the patient
will receive?
11/02/2024 121
3.4 Calculation of parenteral dosages of medication
Most medications prepared in liquid form and packaged in
dose vials
Ampules or prefilled syringes
• Injectable drugs measured in syringes
• All units of measurement must be in same system and all
units must be in same size
• as an example of major difference the in body composition
of elderly if substantially difference from young adult. The
percent fat tissue of the total body weight have average
value of 36% in elderly men and 48% in elderly women .
• the composition of percent fat tissue of total body weight in
young adult was found to be 18% as compared to young.
11/02/2024 122
Parenteral available as:
Liquids in prefilled disposable cartridges or
disposable syringes with specific amt of drug in
specific volume.
Meperidine 50 mg/ml or 100 mg
Single/ multi dose ampules or vials containing
specific amt of liquid form of drug in specific
volume
Epinephrine [Adrenalin] 1:1000 in 0.1 ml
Ampules or vials containing powder or crystals
which must be reconstituted

11/02/2024 123
Disposable syringes or cartridges

Calculate dose
May need to discard remainder to prepare dose

E.g. diazepam 5 mg IM
Available 2 ml disposable syringe labeled 5 mg/ml

11/02/2024 124
Parenteral drugs in single or multi-dose ampules and
vials
• Calculate dose if different from label
• Determine amt to be administered
• Withdraw desired amt from ampule or vial
E.g. chlorpromazine 12.5 mg IM
• Available chlorpromazine 25 mg/ml in 1 ml ampule
• Amt in any multidose vial is not entered into the equation
• Enter as the quantity Q the amt available contained in a
specific volume
• When dose is less than 1 ml, may need to convert to
answer to minims using 15 or 16 minims/ml.
11/02/2024 125
Example
Chlorpromazine 10 mg IM
Available 25 mg/ml
Answer is 2/5 X 15 minims = 6 minims
(also 0.4 cc)
WARNING
• Always check drug labels carefully.
• Some may be labeled differently from others of
same medication.

11/02/2024 126
 Parenteral drugs in dry form
Available in dry or crystal form and must
reconstitute or make into liquid form to be removed
and administered.
 Usual directions:
 Name of solution to be used (sterile water or
normal saline for injection)
Amt of diluent
ALWAYS check label carefully for instructions!

11/02/2024 127
Methicillin sodium:
Reconstitute 1 g vial add 1.5 ml of sterile water for
injection of sodium chloride for injection. Each
reconstituted ml contains approx. 500 mg of
methicillin.
Amt for IM, ID or SC involve very small amts
Amt of IV may involve 50 ml or more
Add to label when reconstituted
Amt of diluent added
Concentration of dose of drug in ml e.g. 500 mg/ml
Date of reconstitution
Exp date.
11/02/2024 128
Handling solutions
• Chemicals may be fragile:
• Affected by heat, light and time
• Change or deteriorate
• Reason why manufactured as powder
• Reconstitute and use within few hrs and protect
from light
-Antibiotics
-steroids

11/02/2024 129
Example 1
Order: Cleocin 150 mg IM every 12 h
•Available: Cleocin 300 mg per 2 mL
•How many mL are needed for each dose?
Dosage calculation based on age
Age of patient is one of the most important
considerations for drug dosage modifications .in the
general the drug elimination is less functional in
newborn improve with age as they grow into
healthy adult individual. Finally as they grow
further to the age of 65 years or above, the
eliminations decline.
11/02/2024 130
dose calculation based on weight
Dose adjustment based on weight was common in
children and also in obese patients the dose
regimen may have to be altered if the volume of
distribution changes.
The volume of distribution is function of the total
body water and extracellular fluids which in turn
are related to the body weight .therefore the
volume of distribution may change with change in
the body weight .

11/02/2024 131
In the case of an obese patient ,the proportion of
body fat is greater and the ratio of body water and
lean body weight to the total body weight is
smaller .
when the percent fat is greater ,the extracellular
fluid is less .there fore less distribution of polar
drug .as result ,the plasma concentration of polar
drug will be higher and there may be a need to
lower the dose of such drug .
In case of nonpolar or lipid soluble drug, there distribution
in cellular tissues will be more and more and there may be
a need to increase the dose of such drug.
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Rate flow of intravenous fluid (iv)
• Intravenous fluid must be precisely regulated
ensure adequate hydration of the patient .Generally
the packaging of the solution administration
equipment will state the drop factor (drop per
milliter) that the set delivers. Intravenous
administration that sets are commercially available
that deliver 10, 12,15,20,60 and other numbers of
drop per ml .

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• Standard iv solution administration set deliver 10gtt
(drops) per ml, blood administration set deliver 15gtt/ml.
Micro drop sets deliver 60gtt/ml .
• The large volume parenteral solution are administered by
either allowing the solution to drip slowly in to vein by
gravity flow or through the use of an electrical or battery
operated volumetric infusion pump.
Medicated iv drip
To calculate the rate of flow (rate of infusion) of iv
solution one can use either method of proportion or the
formula method the rate infusion can be calculated
no of drop per minute=no of ml of solution to be infused
*number of drop per ml(dropfactor)divided by
number of hrs for adm *60min
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• the above formula can be simplified
R=V*D
T
where
R=rate of flow(gtt/min)
V=total volume to be infused (in ml )
D=drop factor
T=total time of infusion

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Example
• An intravenous fluid of 1000ml of ringer lactate
was started in patient at 8 AM and was scheduled to
run for 12hrs.At 3 pm it was found that 800ml of
the fluid remained in the bottle. at what rate of flow
should the remaining fluid be regulated using an iv
set that delivers 15 drop per ml in order to complete
the administration of the fluid in the scheduled
time?

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Answer
fluid remaining =800ml
time remaining =5hr or 300min
no of drop per minute (gtt/min)=800*15/5*60
=40 drops/min
by method pf proportion
a. if 800ml infused in 300min how many ml will be
infused in 1 minute ?

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800 ml =X ml
300min 1 min
X=2.67 ml
b. if 15 drops are contained in 1 ml , how many
drops would be contained in 2.67 ml ?
15 drops =X drops
1 ml 2.67 ml X =40 drops

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 Insulin dosage
Insulin ,a hormone produced by pancreas is
essential for metabolism of glucose ,protein and fat.
Insulin drugs are classified based on the duration
of action as rapid ,intermediate or long acting

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 Insulin Action and Times

11/02/2024 140
Example
a patient is required to take 10units of U-40 isophane insulin
suspension and 18 unit of U-100of protamine zinc insulin .what
volume , ml of each type will provide the desired dosage ?
source U-40 insulin contain 40 units /ml
U-100 insulin contain 100 units/ml
solution
40 units=10 units = X=0.25ml of U-40
1ml X ml
100 units= 18 units= X=0.18ml of U -100
ml X ml
• A physician order 1 unit of insulin injection SC for every 10mg
blood sugar over 175 mg with blood sugar levels and injections
performed twice daily in morning and evening .
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• The patient blood sugar was 210 mg in the morning
and 320mg in evening. how many total unit of
insulin injection should be administered?
210mg-175mg =35mg
1 unit = X unit X=3.5 units
10mg 35mg
320mg-175mg=145mg
1 unit = X unit = X =14.5 unit
10mg 145mg
Answer =3.5 unit+14.5unit=18 unit

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3.5.Calculation of pediatric Doses:
Patient Parameters
Introduction
 The usual dose of a drug is the amount that ordinarily
produces the desired therapeutic response in the majority of
patients in a general, or otherwise defined, population group.
 The drug's usual dosage range is the range of dosage
determined to be safe and effective in that same population group.
provides the prescriber with dosing guidelines in initially
selecting a drug dose for a particular patient and the flexibility to
change that dose as the patient's clinical response warrants.
 Usual doses and dosage regimens are based on the results of
clinical studies conducted during the drug development process
11/02/2024 143
as well as on clinical information gathered
following the initial approval and marketing of the
drug.
• For certain drugs and for certain patients, drug
dosage is determined on the basis of specific
patient parameters.
• include the patient's age, weight, body surface
area, and nutritional and functional status.
Patients requiring individualized dosage are
neonates and other pediatric patients, elderly
patients with diminished biologic functions,
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individuals of all age groups with compromised
liver and/or kidney function (and thus reduced
ability to metabolize and eliminate drug
substances),
critically ill patients, and patients being treated
with highly toxic chemotherapeutic agents.
Certain drugs with a narrow therapeutic window
often require individualized dosing based on blood
level determinations and therapeutic monitoring.
Digoxin at a blood level of 0.9 to 2 ng/mL is
considered therapeutic, but above 2 ng/mL it is
toxic.'
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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;
Premature: born at less than 37 weeks’ gestation.
Infant: 1 month to 1 year;
early childhood: 1 year through 5 years; late
childhood: 6 years through 12 years;
 Adolescence: 13 years through 17 years of age.

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Proper drug dosing of the pediatric patient depends
on a number of factors:
• the patient's age and weight,
• overall health status, the condition of such biologic
functions as respiration and circulation,
• the stage of development of body systems for drug
metabolism (e.g., liver enzymes) and drug
elimination (e.g., renal system).

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In the neonate:
Biologic functions and systems are underdeveloped.
Renal function develops over the span of the first 2
years of life.
the most commonly used drugs in neonates, infants, and
young children are antimicrobial agents, which are
eliminated primarily through the kidney.
If the rate of drug elimination is not properly
considered, drug accumulation in the body could occur,
leading to drug over dosage and toxicity.
Thus, the use of pharmacokinetic data (i.e., the rates and
extent of drug absorption, distribution, metabolism, and
11/02/2024 148
elimination; see together with individual patient drug
handling characteristics and therapeutic response,
provides a rational approach to pediatric drug dosage
calculations.
Dosage Forms Applicable to Pediatrir and Geriatric
Patients
 Solid dosage forms, such as tablets and capsules:
 Are preferred for the oral administration of drugs
because of their convenience, ease of administration,
ready identification, transportation, and lower cost per
dose.
 Are difficult or impossible for the pediatric,
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Liquid forms are preferred, such as oral solutions,
syrups, suspensions, and drops.
An advantage of liquid forms is that the dose can
easily be adjusted by changing the volume of
liquid administered.
When necessary, liquid forms of medication may
be administered by oral feeding tube.
 Chewable tablets and solid gel forms
(medicated "gummy bears") that disintegrate or
dissolve in the mouth are also often used for
pediatric and geriatric patients.
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 DRUG DOSAGE BASED ON AGE
Pediatric Dosing
Pediatric patients, which include both infants and children,
require special dosing that is adjusted for their body weight.
A number of formulas have been used throughout the years to
determine the best dose for pediatric patients, but the most
commonly used method is stated as mg/kg of body weight.
Pediatric Formulas Children need lower dosages of
medication compared to adults. Three formulas are used to
help calculate a pediatric dosage based on whatever
information is available. In some children’s hospitals the
pharmacy may have a preferred formula. However, the
pharmacy technician should be able to calculate the correct
pediatric dosage using each formula.
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11/02/2024 152
CALCULATING PEDIATRIC DOSAGES
USING FRIED’S RULE
EXAMPLE 1 An infant, 15 months old and
weighing 20 pounds, needs
Streptomycin Sulfate, which is usually administered
to adults as 1 gm (1000 mg), as a daily IM injection.
What is the appropriate dosage for the infant?
To calculate the pediatric dosage based on a child’s
age in months, simply use the formula for Friend's
Rule. Using the information provided, you can set
up the calculation as follows:
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 15(age in mounth0
Pediatric dose= __________________ X 1000mg(adult dose)
150
15
Pediatric dose = ___________ X 1000
150
Pediatric dose == 0.1*1000=== 100mg Pediatric dose
So, according to Fried’s Rule, the pediatric dosage appropriate for a 15-
month-old would be 100 mg.
1. A child, 24 months old, needs acetaminophen, and the normal adult
dose is 650 mg. What is the appropriate dosage for the child?
________________
2. An 18-month-old needs amikacin sulfate, and the normal adult dose
is
250 mg. What is the appropriate dosage for the child? ________________
3. 11/02/2024
A child, 30 months old, needs erythromycin, and the normal adult
154

dose is 250 mg QID. What is the appropriate dosage for the child?
CALCULATING PEDIATRIC DOSAGES
USING YOUNG’S RULE
EXAMPLE 2. Now, let’s reexamine Example 1.
using Young’s Rule, which uses the child’s age in
years. The age of a 15-month-old could be expressed
as 1.25 years old, since he or she has lived for 12
months (1 year) 3 months (1/4 or 0.25 of a year).
Using an age of 1.25 years and the information
provided in Example 1, set up the calculation, using
Young’s Rule, as follows:

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 1.25 (Age in years)
Pediatric Dose = _________ * 1000 mg (Adult Dose)
13.25 (Age of child + 12)
Pediatric Dose = 1.25 * 1000
13.25
Pediatric Dose = 0.094 * 1000 Pediatric Dose = 94 mg
• So, according to Young’s Rule, the pediatric dosage
appropriate for a 15-month-old would be 94 mg.

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PRACTICE PROBLEMS
1. A 2-year-old child is prescribed amoxicillin, and
the normal adult dose is
500 mg. What is the appropriate dosage for the child?
________________
2. A 7-year-old needs propylthiouracil, and the
normal adult daily dose is
150 mg. What is the appropriate dosage for the child?
________________
3. A child, 10 years old, is prescribed Tavist®
syrup, and the normal adult dose is 1.34 mg BID.
What is the appropriate dosage for the child?
________________
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CALCULATING PEDIATRIC DOSAGES USING CLARK’S RULE

EXAMPLE Now, let’s reexamine Example 1 using Clark’s Rule,

which uses the child’s weight in pounds.
Using a weight of 20 pounds and the information provided , set up
the calculation, using Young’s Rule, as follows:
20 (Weight in pounds)
Pediatric Dose = _____________ * 1000 mg (Adult Dose)
150
Pediatric Dose = 20 * 1000
150
Pediatric Dose = 0.133 * 1000
Pediatric Dose = 133 mg
So, according to Clark’s Rule, the pediatric dosage, appropriate for a
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15-month-old, weighing 20 pounds, would be 133 mg.

PRACTICE PROBLEMS
1. A child, weighing 85 pounds, is prescribed
hydrochlorothiazide, and the normal adult dose is 50
mg. What is the appropriate dosage for the child?
________________
2. A child, weighing 70 pounds, is prescribed
quinine sulfate, and the normal adult dose is 325 mg
TID. What is the appropriate dosage for the child?
________________
3. A child, weighing 112 pounds, is prescribed
Kaletra®, a protease inhibitor combination therapy. The
normal adult dose is 400 mg lopinavir/100 mg ritonavir.
What is the appropriate dosage for the child?
________________
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DRUG DOSAGE BASED ON BODY WEIGHT
The usual doses for drugs are considered generally
suitable for 70-kg (154-lb) individuals.
The ratio between the amount of drug administered
and the size of the body influences the drug
concentration at its site of action.
Drug dosage may require adjustment from the
usual adult dose for abnormally lean or obese
patients.

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A useful equation for the calculation of dose based on body
weight is
Patient’s dose (mg) = patient’ weight (kg) X drug dos(mg)
1(kg)

The determination of drug dosage for young

patients on the basis of body weight is considered
more dependable than that based strictly on age.
The dosage of a number of drug substances is
frequently expressed on a milligram (drug) per
kilogram (body weight) or milligram per pound
basis.
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Examples: The usual initial dose of Chlorambucil is
150 ug/kg of body weight once a day. How many
milligrams should be administered to a person
weighing 154 lb.?
150 ug = 0.15 mg 1 kg = 2.2 lb.

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Or, solving by dimensional analysis
1mg x 150ug x 1kg x 154ib = 10.5mg
1000ug 1kg 2.2ib 1
The usual dose of sulfisoxazole for infants over 2 months of
age and children is 60 to 75 mg/ kg of body weight. What
would be the usual range for a child weighing 44 lb.?
1 kg = 2.2 lb.
20 kg = 44 lb.
60 mg/kg X 20 kg = 1200 mg
75 mg/kg X 20 kg = 1500 mg
Thus, the dosage range would be 1200 to 1500 mg, answer.
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Example: A hospital pharmacist is called to a
pediatric nursing station to calculate the quantity of
an injection to administer to a pediatric patient. The
daily dose of the injection for the child weight is
stated as 15mg/kg/day, divided in to three equal
portion. The child weighs 10kg,The injection
contains5mg/ml of the prescribed drug.
How many milliliters of injection should be
administered?
Solution:
15mg/kg*10kg=150mg
150mg/3 = 50mg
50mg/5mg/ml=10ml…..Answer.
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DRUG DOSAGE BASED ON BODY SURFACE
AREA (BSA)
widely used in two types of patient groups:
1) cancer patients receiving chemotherapy,
2) pediatric patients of all childhood ages,
Exception: premature and full-term newborns,
whose immature renal and liver functions require
additional assessment in dosing.

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The dose drug for children as well as adult may be
adjusted based the body surface area .the normal
adult body surface area is 1.73m2.The body surface
area can be calculated in any ways .The following
equation provides a useful estimate of the surface
area when the height (in cm)and weight (in kg )of
patient known.

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• Surface area in m2=(height *weight)1/2/60
• Example .in juvenile arthritis, Advil is required to
be given in the dose of 30mg/kg/day .how many
milliliters of Advil suspension (100mg/5ml) should
be given to child weighing 74 Ib?

11/02/2024 167
Solution
74Ib=74/2.2=33.64
In one day, Advil required is 30mg per kg or 30/1 kg
=X/33.64kg
X=1009mg 100mg/5ml=1009mg/X
Therefore, X =millimeters of Advil’s required =50.5ml
Example 2 Alupent has a normal dose of 20mg tid for asthma
.how much Alupent should be given to a child weighing
75Ib?
Dose of child= weight in pound *adult dose
150Ib
=75Ib *20mg/150Ib
11/02/2024 168

=10mg
Example
The height of a child is 120cm and weight is
130Ib.the usual adult dose of Elavil (Amitryptylline
HCL),75mg/day .what should be the dose for a
child based on body surface area?
Answer
Surface area in m2=(height *weight)1/2/60=
130Ib=130Ib/2.2=59.1kg
Surface area =(120*59.1)1/2/60
=1.4m2

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Child dose =surface area of child *adult dose
mg/day =
1.4m2 * 75mg/day
1.73m2 =60.7mg

11/02/2024 170
 4. Preparing Labels According to Legal
Requirement
• It is a written document on the drug to be dispensed to the patient.
• It is a written document on the preparation of drugs by the
manufacturing company for the users.
• Prescription drug labeling information is also known as:-
• Prescribing information
• Package insert
• Professional labeling
• Direction circular
• Package circular

11/02/2024 171
Cant….

• The main functions of a label on a dispensed drug are :-

• to uniquely identify the contents of the container and
• to ensure that patients have clear and concise information
about the use of the drug.
• The label should be placed to leave visible any of the
manufacturer’s statements that may be important to the
patient, including the expiry date, storage conditions and
where possible, the name and strength of the drug.
• The placement of the dispensing label on the product is
largely determined by the design of the medicine package
and the manufacturer’s label.
11/02/2024 172
Cont….
• The dispensing label is to be firmly attached to the
immediate container unless the immediate container
is so small or is so constructed that the label would
compromise the patient’s ability to use the medicine
(e.g. metered aerosols and some eye drops). In such
instances, the label should be attached to the primary
pack or alternatively, purpose-designed labeling tags
or ‘winged’ labels may be used.
• Each dispensed drug must be appropriately labeled
to comply with legal and professional requirements.

11/02/2024 173
Cont….
• Medicines assembled by breaking down bulk
containers into quantities more appropriate for use
against prescriptions have different labeling
requirements to those for dispensed medicines
• Attach the label to the container. The label should be
straight and placed in a suitable location, not
obscuring the name of the product or any
information intended for the patient.

11/02/2024 174
Cont….

• If several boxes of a product are required,

double check they are the same and then label
each one individually. It is recommended that
labels state "This is container 1 of 3" etc. It is
not acceptable to tape or band boxes together
and attach one label to the top pack.

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4.1. Label content
• The information provided on the dispensing label the needs to
contain :
• the name of the product(brand and generic), strength, dosage
form, quantity and duration
• the expiry date and the batch number
• the name and instructions for the patient and
• prescribing health care practitioner,
• the pharmacist’s details and other information relating to the
prescription.
• The name and address of the pharmacy
• any handling and storage requirements,
• Precautions, other advisory labels
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Certain warnings need to be written on the
label.
• This medicine may make you sleepy
• Do not drink alcohol.
• Do not take milk, indigestion remedies or medicines containing iron
or zinc
• Do not take more than...in 24 hours
• Take with, or just after food, or a meal
• To be spread thinly on the affected skin only
• additional phrases on the label:
• “Shake the bottle”
• “For external use only”
• “Store in a cool place”
• “Discard... days after opening” or “Do not use after...”
11/02/2024 177
Cont….
• For extemporaneously prepared medicines and medicines not
dispensed by count,
• the name and strength of each active ingredient, and
• the name and strength of any added preservatives or
• the name of the formula as and
• the date of dispensing or supply should be included on the
label.
• Labeling components dispensed with the drug product would
include the label on the actual drug bottle, the package insert,
the carton the drug is dispensed in, the blister packaging that
houses the drug capsule/tablet and anything else that is
dispensed with the drug product to the patient in the
pharmacy.
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4.1.1. Characteristics

• General Requirements for Prescription Drug

Labeling
• Summary for the safe and effective use of the drug
• Informative and accurate
• Not promotional, false, or misleading
• Based whenever possible on data derived from
human experience

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4.2 Label presentation

• The label for all prescription drugs must include

• (a) The name, address and 10 digit telephone
number of the pharmacy,
• (b) The prescription number and dispensing date,
• (c) The full name of the patient,
• (d) The name of the practitioner,
• (e) The quantity and strength of the drug,
• (f) The practitioner’s directions for use, and
• (g) Any other information required by good
pharmacy practice
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5. Establishing Counseling Environment.

5.1 Introduction to General Psychology

 The scientific study of behavior and the
mental process that is tested through
scientific research.
The field is scientific in that approaches
(should be systematic in approach) to studies
are done orderly and systematically in order
to obtain objective evidence.

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• Psychologists study overt and covert
behavior.
• The overt behaviors are observable behavior,
while covert behaviors include private mental
processes that cannot be directly observed or
measured and must be inferred from overt
behavior.
• Examples of overt behaviours are; laughing,
walking, eating, gestures, facial expression
etc and covert behaviour include the
following; Perceiving, remembering,
reasoning, thinking, creating, feelings etc

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5.1.1 GOALS OF PSYCHOLOGY

Psychologists seek to do four things when studying

behaviors:
• Describe: What is the nature of the behavior? It gathers
information on studied behavior and present what is
known.
• Explain: Why does it occur? Creating a hypothesis
(educated guess) to understand why a behavior is
practiced.
• Predict: By studying past behaviors, future behaviors
can be predicted based upon theory
• Control behavior: What factors influence the behavior?
Influence- using what is known to influence future
behavior.
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HISTORICAL APPROACH TO PSYCHOLOGY

• Structuralism – Study of basic elements that make up

human experiences.
• Wilhelm Wundt – In 1879, used people’s self
observations about their thoughts (introspection) to
map out structure of the thought process.
• Functionalism – study of the function or how people
& animals adapt to environment. William James –
known as the “father of psychology” taught first psych
class in 1875 and wrote first textbook in 1890. He was
concerned with ongoing conscious experience and the
functions of mental processes. His views gave rise to
the branch of psychology called Functionalism.
11/02/2024 184
 Cont’d…

• Inheritable Traits – study of how heredity

influences a person’s ability, character, and behavior.
Is behavior determined by heredity or environment?
• Sir Francis Galton – Concluded that intelligence
was hereditary / good marriages would supply the
world with talented offspring. (1883).
• Gestalt Psychology - Perception is more than the
sum of its parts – it involves a whole pattern.
German group that picked apart cognitive thought
process.

11/02/2024 185
 Cont’d…
Contemporary Approaches to Psychology (mid
1900’s to Present)
• Psychoanalytic Psychology- study of unconscious
motives & conflict determine behavior. Sigmund
Freud – used free association and dream analysis to
study behavior (1940).
• Behaviorism – Study of how organisms learn or
change behavior based upon responses to events in
their environment. (Early-mid1900’s). it held the
view that only overt behavior can be studied
scientifically. They advocated the use of strict
experimental procedure in psychology.
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Contemporary Approaches to Psychology
(mid 1900’s to Present)
Strict behaviorists believed that all behaviours are
shaped by the environment. “Give me a dozen
healthy infants, well-formed,….. regardless of his
talents, penchants, tendencies, abilities, vocations,
and race of his ancestors”…….John Watson.
• Ivan Pavlov – Classical conditioning experiment
with dog’s salivation.
• B.F. Skinner – Introduced concept reinforcement to
show how behaviors repeat.
• John B. Watson –Behavior occurs due to stimuli in
environment.

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 Contemporary Approaches
• Humanistic Psychology – Belief that each person
has freedom in directing his/her future an achieving
personal growth. Humans are not controlled by
environment, but by their own self concept. Humans
are not being controlled by unconscious or
environmental forces, we have free will, goals,
aspirations and other positive motives which should
be studied. It is influenced by Carl Rogers.
• Abraham Maslow – Humanist whose views
differed from behaviorists and psychoanalysts.

11/02/2024 188
 Cont’d…

• Cognitive Psychology – Study of how we process,

store retrieve, and use information and how the
thought process influences our behaviors. (since
1950’s). Jean Piaget – leader in the cognitive field of
psychology.
• Biological Psychology – study of how physical and
chemical changes in our bodies influence behaviors.
Explains the brain, nervous system, hormones effect
on behavior.
• Sociocultural Psychology – study of cultural and
socioeconomic influences on behaviors

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 BRANCHES OF PSYCHOLOGY

• These branches are broadly divided into two

categories;
• Basic Branches: This provides the theoretical
framework of the subject. These branches deals with
formulation of principles, theories and suggest
different methods for the assessment of behaviour.
• The pure branches also suggest certain techniques
for the modification of problematic behaviour.

11/02/2024 190
 Cont’d…
• General psychology: It explains various
psychological processes such as sensations,
perception, emotions, learning, intelligence,
personality etc.
• Developmental psychology: It explains the growth
and development of various processes in relation to
behaviour. It explains human life through the stages of
conception to old age.
• Child psychology: Childhood extends from 2 to 12
years. This is a crucial period in the life. Future life
depends upon development during childhood. Growth
and development will be rapid during this stage. Child
psychology deals with these aspects.
11/02/2024 191
 Cont’d…
• Physiological psychology: This branch describes the
biological basis of behavior.
• Animal psychology: It deals with behaviour of animals.
• Social psychology: It deals with interrelationships of
people among themselves, likes and dislikes of people,
attitudes and interests.
• Experimental Psychology – studies sensation, behavior,
perception, learning, motivation, and emotion in
controlled laboratory conditions.
• Parapsychology: Some of the psychological
experiences are beyond the reach of 5 sense organs.
This is the reason why they are called Extra-sensory
perceptions (ESP)
11/02/2024 192
 Cont’d…
• Applied branches deals with the application of
psychological principles and techniques for
approaching the problems in different fields of life.
• Clinical Psychologist- Diagnoses and treats people
with emotional disturbances (about ½ of all
psychologists are clinical).
• Counseling Psychologist- Help people deal with
problems /challenges of life.
• Educational Psychologist – Study topics related to
educating children such as intelligence, memory,
and problem solving.

11/02/2024 193
 Cont’d…

• Community Psychologist – Studies behavior

in mental health or social welfare institution
in order to design run or evaluate programs
for patients.
• Industrial/Organizational Psychologist –
Studies concepts to make the workplace more
satisfying for employees and managers.

11/02/2024 194
 Cont’d…

• Forensic Psychologist – Studies, diagnoses,

and evaluates testimony regarding the law
and criminal behavior (Also includes effects
of court on children, jury selection,
counseling victims)
• Sports Psychology- Studies athletics and
athletic performance. Often use visualization
to help athletes mentally rehearse successful
steps in completing tasks while reducing
negative thoughts of failure.

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5.2 Assertive, Passive, and Aggressive
Behavior
Assertive Behavior includes standing up for your
rights without infringing on the rights of others.
Assertive
behavior results in an “I win; you 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.”
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Passive/Nonassertive Behavior 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” outcome. Passive behavior
includes violating your 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.”

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Aggressive Behavior is when someone stands
up for their own rights without regard for
others. Aggressive behavior results in an “I
win; you lose” outcome. Aggression is self-
expression that demands, attacks, or
humiliates other people, generaly in a way
which shows lack of respect for others.
Example: “Hey, I’m in a hurry. Get out of my
way.”

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Passive-Aggressive Behavior occurs when
someone acts out aggressive impulses in an
indirect way. When people act passive-
aggressively, they attempt to get what they
need or want indirectly or manipulatively.
Passive-aggressive behavior is an indirect
attempt to control or punish others.
Example: “I’m sorry I’m so late. I didn’t
realize this was such a big deal.” “Oh, don’t
bother, I’ll have to do it
myself.”

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5.2 Communication Skill

5.2.1 Introduction to Communication

This topic gives you an overview of
communication and introduces you to the main
elements in the communication process. It also
highlights the importance of writing clear, positive
messages and offers you some basic tips and
guidelines on this form of communication so that
you may become more proficient in the kind
of writing needed at home as well as in the college
and workplace. You will also learn about some of
the common pitfalls which may impede the
effectiveness of written communication.
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5.2.1 Elements in Communication

Have you ever wondered why some people can communicate

so well while
others fail to get their message across? What are the elements
that must be
present in the communication process before it can be
successful and effective?
Well, communication has been defined as the act of giving,
receiving or
exchanging information, ideas and opinions so that the
„message‰ is completely
clearly that in a communication process, there must be a
sender who speaks or sends a message, and a receiver who
listens or receives the message.

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The sender sends a message with a certain intention in mind. The
receiver of the
message tries to understand and interpret the message sent. He then
gives
feedback to the original sender, who in turn interprets the feedback.
This process,
repeated continuously, constitutes communication.
Clearly, there are several major elements in the communication
process .
sender, message, channel, receiver, feedback, context. There is both a
speakers
intention to convey a message and a listeners reception of what has
been said.
Thus, listening skills are just as important as speaking skills in order
for
communication to be effective.
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This means that if you want to get your message across
accurately, you need to
consider these three things:
• The message;
• The audience or receiver; and
• How the message is likely to be received
A message is only considered successfully communicated
when both the sender and the receiver perceive and
understand it in the same way. If this does not happen,
then there may be a breakdown in communication, which
may ultimately stand in the way of you realising your
goals, either personally or professionally.• How the
message is likely to be received.

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 5.2.2.Factors Affecting Communication

As mentioned earlier, effective communication is a two-way

process but there are
a number of factors which may disrupt this process and affect
the overall
interpretation and understanding of what was communicated.
These can relate to
ny of the elements involved ă the sender, message, channel,
receiver, feedback
and context. It is therefore important to understand some of the
factors that affect
communication so that you can try to get your message across
with minimal
misunderstanding and confusion.
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Below are some possible problem areas that may turn out
to to be barriers to effective communication:
(a) Status/Role
The sender and receiver of a message may be of equal
status within a hierarchy (e.g. managers in an
organisation) or they may be at different levels (e.g.
manager/employee, lecturer/student, business
owner/clients).
This difference in status sometimes affects the
effectiveness of the communication process.

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(b) Cultural Differences
Cultural differences, both within or outside the
organization (for example, inter-departmental dealings
and communication with outside organizations or ethnic
minorities) may impede the communication process.
(c) Choice of Communication Channels
Before you choose your communication channel, you
should ask yourself whether the channel is appropriate
for a particular purpose and the person/receiver you have
in mind. Sending messages via inappropriate
channels can send out wrong signals and end up creating
confusion.

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(d) Length of Communication
The length of the message also affects the
communication process. You need to be sure that it serves
the purpose and is appropriate for the receiver. Is the
message too long or too brief?
(e) Use of Language
Poor choice of words or weak sentence structure also
hampers
communication. The same goes for inappropriate
punctuation. The two sentences below illustrate clearly
how different placement of punctuation can change the
entire meaning of a sentence:
Woman, without her, man is nothing.
Woman, without her man, is nothing
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(f) Disabilities
Disabilities such as impaired sight, dyslexia and poor
mental health can also be barriers to good
communication, and should be taken into
consideration when evaluating the effectiveness of
the communication process. You may need to use
hearing aids, sign language, magnifying
systems, and symbols to alleviate problems caused by
disabilities.

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(g) Known or Unknown Receiver
Whether the receiver is known or unknown to you also
plays a major role in determining the effectiveness of
your communication. A known receiver
may be better able to understand your message despite
having insufficient information as both of you probably
have common experiences and a shared schemata. An
unknown receiver, on the other hand, may require
more information and time to decode the message.

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(h) Individual Perceptions/Attitudes/Personalities
Sometimes, the method of communication needs to take
into consideration the receivers personality traits, age and
preferred style. The elderly and children,
for example, have different communication needs and
preferences when compared to young adults. Is the
receiver of your message a visual, auditory,
or kinesthetic sort of person? How do you think they will
react to your
message? Can you adapt your communication style to suit
theirs?

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(i) Atmosphere/Noise/Distraction
Our surroundings can sometimes pose as barriers to
effective communication.
A noisy place (a party, for instance) usually puts a strain
on oral
communication as both the sender and the receiver need
to put extra effort to get the message across and ensure
that it is understood clearly and correctly.
(j) Clarity of Message
Is the message conveyed in a clear or ambiguous
manner?

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• (k) Lack of Feedback
Feedback is important as it enables confirmation
of understanding to be made by both parties. The
lack of feedback can sometimes create problems
as it can lead to uncertainty and confusion.

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 DEFINING WRITTEN COMMUNICATION

As mentioned earlier, communication can be oral or in written

form. What is the difference between these two main types of
communication?
Oral communication involves conveying ideas, thoughts or
information via
a spoken language.
In written communication, however, information is exchanged
using written symbols, that is, via words and sentences. Written
communication is the sharing and exchanging of written symbols
between individuals or groups.
It is also the presentation of ideas in a coherent manner in written
form.

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Written communication can take place via:
• Letters;
• Faxes;
• Email;
• Reports;
• Memos; and
• Advertisements.
You can acquire good writing skills through extensive
reading, note-taking and listening. In order to
communicate effectively via writing, you need to have a
sound grounding in grammar and vocabulary so that you
can present ideas, together with supporting details, in a
unified and coherent manner.
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 The Writing Process
Successful written communication requires careful
thought and planning. It
should contain comprehensive information about a
specific subject and yet be clear, correct and easy to
read.
A well-written piece of work requires you to pay
attention to the following three
stages in the writing process:
• Planning;
• Writing; and
• Editing.
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 CHALLENGES IN WRITTEN
COMMUNICATION
Although some people are intimidated by writing, there
are times when writing is perceived as the best way to
communicate and to get your message across.
Some people consider written communication to be more
concrete and „solid as
there is less room for errors and mistakes when compared
with other forms of communication like oral
communication.

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New Technologies

Written communication, however, poses challenges

such as spelling, grammar, punctuation, style of
writing, and actual wording. Thankfully, todays
technology makes writing memos, reports, letters,
and proposals a breeze by
providing tools that can check and even correct
misspelt words and incorrect grammar.

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Unfortunately, these tools are not foolproof and will
require your attention, thus making knowledge in this
area important. Currently, you can even send
messages electronically via e-mails or networking
technologies such as SMS.
Irrespective of the form that written communication
takes, you need to adhere to
certain accepted norms when communicating;
otherwise, others might not be able, or want to,
communicate with you.

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6. Providing Patient Counseling Service
INTRODUCTION
Definition: Patient counseling refers to
the process of providing information,
advice and assistance to help patients
use their medications appropriately.
The information and advice is given by
the pharmacy profesional.

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• Patient counseling is an acquired
• skill of a pharmacist.
• Its simplest act to interact with the
• patient- provide pharmaceutical care
• Platform for improving patient
• medication adherence and developing
• monitoring plans.
• Patient counseling eliminates
• barriers in providing pharmaceutical
• care.

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7.Entering data in to the dispensing
computer
7.1 Computerized dispensing system
Definition of computer
Computer is an electronic machine that:
• receives data from an input devices,
• carries out arithmetic and logical operations,
• stores the processed data, and
• sends the processed data to an output devices.

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 Pharmacy computer system
Computers can be used in all aspects of the
pharmaceutical management cycle from selection to
use, using communication device, users can
exchange or share information with other computer
at the same site through a local area network or with
computer any where in the world
A computerization process is easier when
Efficient manual procedure exist
Staff members are capable of, and interested in
learning to use computers
A reliable power supply exists
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Benefit of computerization
• simplify and speed up complex task
• Increase accuracy by checking spelling and
calculation
• Update and access information quickly
• Automat repetitive tasks
• Generate timely report without repetition
• Allow organization to expand operation

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Computerized dispensing
• Dispensing is done by electronically
• It is better way of dispensing specially for patients
of refile treatment to
• Know previous treatment regimen type
Types of drug
oDose
oFrequency
oDosage form
oDosage
oDuration
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Advantages of electronic dispensing computer
Consider computer advantages
Easy to regenerate the next dispensing
People are using computers to perform different
tasks quickly and easily.
It saves time and effort.
Reduces the overall cost to complete a particular
tasks than performing manually.

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7.2 Entering data in to computer system
• When electronic data processing equipment is
supplied by any pharmacy, input of drug
information may be performed by a prescriber or a
pharmacist, if prescription drug orders are entered
by other personnel the pharmacist or the prescriber
must certify the accuracy of the information entered
and verify the prescription drug order,
• prior to the dispensing of the medication, the
unique identifier of the person entering the
prescription drug order must be retain in the
computer record.
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Electronic data processing equipment when used to
store prescription information must
• Be structured in such a manner that all prescription
drug order communicated to a pharmacy by way of
electronic transmission, will be transmitted with no
intervening person having access to the information
contained in the prescription drug order
• Not infringe on patients freedom of choice
pharmacy provider
• Guarantee the confidentiality of the information
contained in the systems storage device and data
bases.
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Produce a hard copy daily summary of controlled
substance transaction and be capable of producing a
hard copy print out of legend drug transactions
going back 2 years, except that if this information is
already available in hard copy form, it is not
necessary to duplicate the data through a computer
generated hard copy be capable of recording and
caring in the record all data's of refills of any
prescription drug order and the unique identifier of
the pharmacist
Creating New Profiles: The pharmacy technician is
often responsible for entering the new prescription
order and creating or updating the computerized
patient profile.
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Protection of electronic data
• Data collection and electronic storage by
pharmacists pose significant risks to patient
privacy.
Pharmacy proprietors and pharmacists in charge of
a dispensary or pharmacy department must:
• Ensure that appropriate measures are in place to
ensure electronic data is stored securely
• Ensure that software programs used by pharmacies
only access and transmit the data permitted by law

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 ensure that appropriate backup and disaster recovery
processes are in place and in accordance with any state or
territory pharmacy premises registering authority
requirements, to ensure the integrity of data is maintained
 ensure that pharmacists are aware of threats to maintaining
secure electronic data, such as malicious software, which
can be used to block access to a computer system and
encrypt data such as patient records
 ensure that pharmacists take reasonable steps to ensure that
electronic data is protected, and
 consult with their computer software and hardware
providers to ensure that appropriate protection measures are
in place.
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7.3 Barcode technology for the dispensing process
Bar Coding
• barcodes stored data in series of parallel black and
white bars of various widths and spacing. They can be
read by optical scanners called barcode readers or
scanned from an image by special software.
• The Universal Product Code (UPC) is a specific
type of barcode, that is widely used in the United
States and Canada for tracking trade items in stores.
• Turkey code: 869
• Code 128, Code 39
• EAN Code(International Article Number)-Europe and
Turkey
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Barcode Types

Country code Firm code Product code Control digit

4 digits (can 5 digits(can

3 digits 1 digit
change) change)

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Scanners
• Pharmacists should use barcode scanners when
dispensing medicines in pharmacies and pharmacy
departments. Barcode scanners are an aid to
minimizing selection errors but not a substitute for
other checking procedures.
Barcodes should be scanned:
• on products where barcodes exist, and
• on the dispensing label in circumstances where a
barcode is printed.

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7.4 Checking accuracy of data
Why checking data is vital?
Use of inaccurate data is DANGEROUS
Producing data is EXPENSIVE
Inaccurate data are USELESS data
What to do if you find errors?
• Find the cause
• Correct the error
• Prevent future errors

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• After the prescription has been prepared and prior to
the delivery of the order, a pharmacist shall inspect the
prescription product to verify its accuracy in all
respects, and place his initials on the record of
dispensing as a certification of the accuracy of, and the
responsibility for, the entire transaction..
• If more than one pharmacist is involved in verifying the
accuracy of the prescription product, a record shall be
maintained identifying the date of dispensing, each
pharmacist involved in the process, and the individual
task for which he is responsible for verifying the
accuracy. Such record showing verification of accuracy
shall be maintained on a pharmacy record.
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• an alternate record consistent with for the required
time period of two years, unless otherwise
specified in regulation.

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9.Finalizing prescription And documentation

9.1 Complete recording of prescribed

medications
9.1.1 Completing prescription record book
• Recording the transaction Prescriptions should be
recorded and documented as proof of transaction
between the patient and the dispenser. Prescriptions
can therefore be traced back if any need arises

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 All dispensing units should have a standardized Prescription
Registration Book (PRB) for recording every pharmaceutical
issued to a patient . A computerized dispensing and
registration system may also be used, but should always be
supported by paper back up. The registration book should be
completed at the time of dispensing or at the close of the
working day.
The prescription registration book should be used both when
prescriptions are retained in the pharmacy and when they are
returned to the patient. For a prescription which is returned
to a patient because all the items in the original prescription
could not be filled, the medicines that have been dispensed
from the pharmacy should be copied on a blank prescription
and the prescription should be filed appropriately
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On the original prescription, which is retain by the patient,
the word “dispensed” should be stamped adjacent to those
items which have been dispensed. For prescriptions which
are to be refilled on a later date, the dispensing information
should be entered into the registration book before
returning the prescription to the patient.
The official seal of the pharmacy/Health institution, name
and signature of the dispenser, the date of dispensing and
the next refill date should be written on the back of the
prescription.
Prescriptions for narcotic and psychotropic Substances
should be kept for 5 years and other prescriptions for 2
years. Thereafter, they should be disposed carefully in the
presence of appropriate body.
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Record keeping for controlled drugs
• Controlled drugs held as stock must record in the
cd record book
• All entries should be signed by registered nurse or
relevant clinician and should be witnessed by a
second registered nurse or other health professional
• Each page in the cd record book must be specify
at the head of the page, the generic name, brand
name, strength and form of the drug to which the
entries on that page relate

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• Each drug and each strength and each form must be
separate pages so the running balance can be kept
easily.
• Entries should be chronological order in ink
• If a mistake is made it must be bracketed in such a
way that the original entry is still clearly legible.
this should be signed, dated and witnessed by a
second registered nurse or other registered health
professional
• No enteriesin the CD record book must be over
written,earased or otherwise obscured.
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Transfer to a new page
• On reaching the end of the page ,the balance should be
transferred to the next available page and the following
record all the bottom of the finished page, record the new
page number where the balance has been transferred to
• On the new page, record the quantity transferred and the
page number where the balance has been transferred
from
• Update the index as the front of the CD recorded book
with the new page number
• The transfer should be witness and signed by a second
registered nurse or other registered health professional
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9.2 Prescription filing
• Each prescription should be signed and
accountability accepted by the dispenser or other
authorized person for the correctness of the
dispensing of the medicine and confirming that the
medicine was supplied
• At the close of each day all dispensed prescriptions
should be organized
• Prescriptions should be filed sequentially by day in a
single container/ carton for each month.
• The container should be labeled with the month and
year.
• Containers should be arranged on a monthly basis.
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• Normal prescriptions should be filed securely for
two years and special prescriptions for 5 years.
• Prescriptions, patient and medication related
records and information should be documented and
kept in a secure place that is easily accessible only
to the authorized personnel.

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 thanks
THANKs a lot

lot
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