Poison antidotes and dosing

Poison Antidote Dose
Iron salt Deferroxamine 15mg/kg/hr
Lead Calcium EDTA 50-75mg/kg/day IM/IV in divided doses for a max. of 5 days
Arsenic, gold and mercury BAL (dimercapol) 3-5mg/kg/4 hourly IM for 2 days followed by 2.5-3mg/kg/6hourly for a week (7 days)
Narcotic drug like morphine Naloxane 1-2mg IM/IV/SC
Barbiturates Coramine IV at dose 5ml increased to 10ml in 15 min followed by 20ml every 30 min till reflexes return
Paracetamol Acetyl cysteine Loading dose 140mg/kg. then 70mg/kg/4 hourly until serum level is 0
Cardiotonic drugs like tricyclic antidepressants quinidine etc. Sodium bicarbonate 1-2mg/kg. care should be taken as antidote may produce heart failure
Physostigmine Atropine 1-2mg every 10-15 min till the symptoms disappear
Organophosphorus compounds like insecticides Atropine followed by parlidoxime Atropine inj. every 20-30 min till the symptoms disappear, followed by 1g IV of parlidoxime every 3-4 hourly

 

Abid Ali @abidaliphm

Doctor of Pharmacy

Percentage stated content of Paracetamol tablet

How to calculate the percentage stated content of sample Paracetamol tablet?

Assay;

  1. 20 tablets of Paracetamol (500mg) taken and crushed into powdered form.
  2. Tablet powder containing 0 .61g is shaken with 300ml of .05M acetic acid.
  3. The extract is then made up to 500ml with 0.05M acetic acid.
  4. The absorbance of the diluted extract is measured at 271nm.
  5. The A (1%, 1cm) value at 257 is 715.

Supposed calculation:

Weight of 20 tablets    = 11.49g

Powder taken (equivalent) = 11.49/20 = 0.57

Absorbance                    =1.462

Expected Content in tablet powder taken:

= wt. of powder taken/wt. of 20 tab x stated content x No. of tablets.

=0.57/11.49 x 500 x 20

=496.08mg

Dilution factor = 50

Calculated Content in tablet powder taken:

Concentration in diluted tablet extract = A/A1%, 1cm

                                    =1.462/715 =0.002g/100ml =2.04mg/100ml

Concentration in original tablet extracts = 2.04 x D.F =2.04 x 50 =102mg/100ml

Volume of original extract    = 500ml

So, amount in original extract= 102 x 5= 510mg

Percentage of stated content = Calculated/Expected x 100  

=510/496.08 x 100 =102%

So, the percentage stated content of sample Paracetamol tablet is 102%

 

Abid Ali @abidaliphm

Doctor of Pharmacy

Poison and its Classification

Poison:

Poison is toxic substance that causes disturbances in organisms, usually by a chemical reaction or other activity at molecular level when sufficient amount is being absorbed by the organism.

Classification of poisons:

  1. On the basis of origin:

Poison may be:

  • Synthetic poison: Synthetic source may include various types of chemicals.
  • Natural poison: Natural poison may be of vegetable, animal or mineral origin and 
  1. On the basis of mechanism of action:

Poisons may be of following types;

1. Irritants: 

They may be inorganic, organic or mechanical irritants.

  • Inorganic irritants/substances: 

They are either metallic or nonmetallic.

Nonmetallic irritant:

Phosphorus, chloride, iodine, bromine are examples

Metallic poisons:

Copper, lead, mercury etc. are examples.

  • Organic poisons:

They are either of:

  • Animal origin: like venom of snake, scorpion, and insects etc.
  • Plant origin: like ergot, aloe, capsicum, and castor seed etc.
  • Mechanical irritant poison:

Powdered glass and diamond may sometime be used as mechanical irritant poison.

2. Corrosive poison: 

Strong acids and bases are the examples of these types of poison. They destroy the organs and tissues internally as well as externally.

Examples: Hydrochloric acid, sulfuric acid and sodium hydroxide etc. may act as poison.

3. Neurotic poison:

They as the name indicates act on the nervous system (central or peripheral) and cause toxic effects.

Examples: Sedative, hypnotics, cocaine, nuxvomica and curare

4. Cardiac poisons:

Digitalis, stropanthus, and aconite are the examples.

5. Respiratory depressants:

Poisonous gases like carbon mono oxide (CO) and coal gas are the examples of respiratory depressant poisons. The patient dies due to the poor supply of oxygen.

6. Miscellaneous poisons: 

Drugs like analgesics, antipyretics, antihistamines, and antidepressants may produce toxicity when consumed in higher doses and finally results in patient’s death.

 

Abid Ali @abidaliphm

Doctor of Pharmacy

Strategies for dispensing during off-hrs.

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When pharmacy services are not available 24 hours, then various strategies are being followed. PTC or equivalent committee existing at hospital makes policies and procedures. It allows and specifies the personnel having approach to pharmacy, list of drugs etc.

The following strategies are being used worldwide:

Use of Nursing supervisors:

It’s the most widely used strategy which allows the nursing supervisor to enter the pharmacy but their services are limited. Though this practice is very dangerous and illegal but a correlation exists between the nurse while making a selection of medicines from drug cabinet (at ward) and selection of the same item from pharmacy. Nurses serving in this category should be limited/restricted to dispensing, from selection of pre-labeled and pre-packed items and especially from compounding a mixture etc.

Emergency boxes and night drug cabinets:

They are installed to provide medications during off-hrs and should be large enough, ready for use, installed at easy accessible place known to all ward personnel and sufficient compact for facilitating handling items.

Use of physician:

In such case, a physician is allowed to enter the pharmacy and may obtain (any) special medication which is not provided through the floor stock, emergency boxes and night drug cabinets. The danger here, is less as compared to the first case, however a physician might waste sufficient time in searching for the desired product.

Pharmacist on-call basis:

In this case, pharmacist services could be available on on-call basis. Pharmacist can be reached whenever needed, however this type of service should be encouraged by extra pay plans or bonus. A rotational plan of on-call will reduce burden on a single individual.

Purchase service:

Such service could be available if a contract is signed with a local community pharmacy for off-hrs and vacations. This is a safe method and is also legal and aims to safeguards health needs on round-the-clock basis. However, only the retail pharmacy with sufficient staff, inventory and delivery services should be contracted.

Automated dispensing devices/machines:

This is an innovative facility to dispense drugs during off-hrs.

Tele-pharmacy:

A modern way is tele-pharmacy which provides all type of pharmacy services, even clinical services when pharmacist is not available at floor. In such case pharmacist or organization providing the service is contacted via online, internet, or videoconferencing.

Abid Ali @abidaliphm

Doctor of Pharmacy

Dispensing at Outpatient Pharmacy

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Prescription that is received at the outpatient pharmacy will generally include employees, private patients (where permitted by a state board of registration in pharmacy), indigent (poor) patients, non-indigent patients and patients being discharged from the hospital, depending upon the location and type of hospital.

Depending upon the type of patient and type hospital, medicines may be supplied either free of cost or on cash payment.

  • Free medicine cases get their medicines directly from the pharmacy.
  • Payment cases pay the cash first (at cash counter) and upon the production of the receipt plus the prescription, handled to the pharmacist in pharmacy and receive medicine.

Dispensing Pattern:

Dispensing pattern involved in providing outpatients and those being discharged with “take home drugs” is identical with that carried out by community pharmacy. In both instances, a physician writes a prescription and the patient or his/her attendant takes it to the pharmacy where the pharmacist compounds it. If there is to be waiting period, the pharmacist makes the prescription call check which identifies the patient numerically  and the finished prescription.

Once the pharmacist has the prescription and label are numbered with the help of numbering machine; the directions and other pertinent information required are placed on the label; ancillary label are affixed; then the proper medication is placed in the container; a check for accuracy is conducted and finally the prepared prescription is wrapped and at the end, dispensed.

Internal Audit:

For this purposes hospital prescription may be separated into outpatient and inpatient discharges and thus may utilize two types of different colored blanks.

Duplicate copy of the prescription or small token is kept by the pharmacist. Then, the retained prescription or token after accounts were written and the pharmacist files it for drugs mentioned in prescription along with patient’s registration number and date.

Abid Ali @abidaliphm

Doctor of Pharmacy

General Medication Errors

Medication error may be related to error/deficiency in any one or combination of the followings:

  • Professional practice                        
  • Health care products
  • Procedures/ policies
  • System

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In addition to these mentioned causes the medication error may result from physiological or social factors/causes.

Physiological causes of medication error:

Each Patient shows unique response to medication which highlights the importance of medication safety. Every person is genetically unique i.e. not same, and the speed at which the body can processes medications may vary tremendously from patient to patient.

For example, a patient may lack an enzyme that helps in removing or eliminating medication from the body, thus may leading to serious harm or even death from an error. Similarly a patient’s kidney functioning is also a physiological cause of medication error.

Social causes of medication error:

Such type of medication errors include failure to follow medication therapy instructions because of cost, noncompliance, or a misunderstanding of instructions (language or cultural barriers).

Patient can also contribute to medication error by:

  • Forgetting to take a dose or doses
  • Taking too many dose
  • Dosing at wrong time
  • Not getting a prescription filled or refilled in timely manner
  • Not following direction on dose administration
  • Terminating the drug regimen too soon

In any event discussed, all of these social circumstances create the potential for medication error.

Abid Ali @abidaliphm

Doctor of Pharmacy

Controlled Drugs/Substances

It may be defined as “a drug/substance with potential for abuse is termed as Controlled Substance or any substance that may be used for production or in manufacturing of narcotic drugs or psychotropic substances”.

Controlled substances may be categorized into five schedules that specify the ways in which they must be stored, dispensed, recorded and inventoried.

The purchasing, manufacturing, storing, prescription and distribution of controlled substances is controlled by the Act specified for such substances.

The controlled substances may be included in any one of the following schedules:

  • Schedule I:

These substances have the highest potential for abuse, not currently accepted for medical use in treatment and they have lack of accepted safety for use even under medical supervision.

  • Schedule II:

These substances have high potential of abuse, recently accepted for their medical use with severe restrictions. Their abuse may lead to severe physiological and physical dependence.

  • Schedule III:

They have less potential for abuse than the first two categories. These have accepted medical use and cause moderate or lower dependence.

  • Schedule IV:

These have low potential for abuse, accepted medical use and cause limited dependence.

  • Schedule V:

These have low potential for abuse, accepted medical use and dependence less than that of Schedule IV.

Abid Ali @abidaliphm

Doctor of Pharmacy

Role of Pharmacist in Hospital

Pharmacist plays a vital role in hospital and is not confined to a single type of role but performs a variety of jobs. Some of the tasks performed by a pharmacist in hospital are:

  • Manufacturing and compounding:

Pharmacist manufactures, plans and develop procedures for manufacturing of medicines, I/V admixtures etc. and compound drugs for patients with prescriptions.

  • Purchasing:

Pharmacist purchases drugs from the market. He plans for purchase, advertisement for purchase and select methods for procurement.

  • Quality Control and Quality Assurance:

Pharmacist evaluates and analyzes the manufactured and/or purchased drugs and procedures of pharmacy practice.

  • Storage and inventory control of drugs:

Pharmacist stores the drugs as required and distributes them to various sections, and maintain the inventory of drugs. They keep a check on the expiry of drugs and report the concerned authority accordingly.

  • Dispensing of drugs:

Pharmacist dispenses drug to the in patient and out patients with medication order and prescriptions.

  • Clinical services:

Besides dispensing, pharmacist provides clinical services like monitoring of drug use, evaluation of adverse drugs reactions, drug interactions and counseling the patients regarding drug utilization and other drug related information.

  • Drug information services:

Pharmacist provides the services of drug information, establishes and maintains drug/medicine information center.

  • Teaching and education:

Pharmacist teaches, educates and trains the patients, public, social workers, health care professionals as well as health care students about the drugs, their uses and pharmaceutical care services.

  • Involvement in committees:

Pharmacist is involved in various administrative and other committees within the institutions.

  • Development of hospital formulary:

Pharmacist being the member of Pharmacy Therapeutic Committee (PTC) is involved in developing and updating the hospital formulary.

Abid Ali @abidaliphm

Doctor of Pharmacy

What Patients actually want?

Healthcare systems are under extreme pressure to optimize the health care delivery. Pharmacists play a vital role and make sure to provide quality care services to the patients. Cost effectiveness as well as patient’s outcomes (therapeutic) has been kept in focus. 

Ease of services:

Patients really want the services they need, should be confined to a certain area. Check up, laboratory tests, consultancy, patient education, all of the services should be provided at a specific area so they feel relaxed and will walk away happy. Diagnosis at one place, lab tests at other, then bringing reports back to the Physician, getting medication from far away, all these rather depress and annoy the patient and ultimately they feel agitated.

Response of Practitioner:

Patients are eager to tell what they feel. Practitioner must cooperate with them by paying special attention towards their views. It will take them into confidence and will increase compliance. The patients value the fact that they have been heard. This will further increase the trust between the practitioner and patient. A lot of patients do not provide confidential information just because of lack of trust and thus the therapy fails.

Cost effectiveness:

Cost effectiveness is being highly valued by the patients. Costly therapy will be challenging for poor patients. So, reducing the cost therapy will in turn maximize not only sales but also will help in financial solvency and optimization of patient outcomes.

Consultation:

Doctors are quite busy in their daily routine. Patients need complete consultation concerned to their therapy and medication problems associated with it. So, here’s one may feel the need of someone to discuss this with. Thus, they consult Pharmacist who can solve their problem and make them satisfy by providing guidance in this regard.

Pharmacists play their roles by providing those services that patients need. Hence, day by day the world is now accepting the pharmacist’s status and role as one of the pillar that held the healthcare system.

Indeed we will get stronger as we grow!!!

Abid Ali @abidaliphm

Doctor of Pharmacy

Pharmacy- Scope and types

Pharmacy covers a wide range and has made an enormous progress in the recent past which gave it a powerful position in Medical field. It has become a mature discipline in terms of scope but unfortunately in Pakistan is yet underdevelopment. It has beaten every every field in terms of therapeutic knowledge. 

Scope:

Pharmacists demand is increasing day by day. As Pharmacy is improving to the next level its popularity makes a mark. Pharmacists jobs at public sector are being created more and more parallel to private jobs which is the indication of the field’s growth.

In Pakistan, Pharmacists are still keep watering it and struggle hard to make its root more firmer. They are keen to make it to the top.

The importance of Pharmacy can’t be neglected as it is one of the LIFE saving profession. Pharmacists work almost everywhere whether it is academia or industry, hospitals or clinics, retail pharmacy or community pharmacy, hence they are serving nationwide to worldwide.

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Types:

On the basis of scope, Pharmacy has numerous types. Some of the important types are as:

  • Hospital Pharmacy
  • Clinical Pharmacy
  • Industrial Pharmacy
  • Nuclear Pharmacy
  • Retail Pharmacy
  • Community Pharmacy
  • Veterinary Pharmacy
  • Compounding Pharmacy
  • Internet/online Pharmacy

Each and every type of pharmacy indicates the scope of pharmacy.

So yes, Pharmacy is a major subject with a phenomenal scope and opportunities. Determination, competition and devotion is must to become a competitive Pharmacist.

Hard work will lead to success, you just need to stick with competency.

Abid Ali @abidaliphm

Doctor of Pharmacy