Pharmaceutical knowledge skills topic for comprehensive patientcare service provision

1. Pharmaceutical Formulation Systems:
Pharmacy Compounding & dispensing

2. Course Content
 Background of Pharmaceutical Compounding &
Dispensing
 Dispensing & Patient Care
 Extemporaneous Dispensing

3. Description
 Compounding & Dispensing :
 The practice of Pharmacists regarding the process of compounding and
drug delivery
 Good Pharmacy Practice as a Standard
 Pharmaceutical Care
 Extemporaneous dispensing
 Prescription Handling
 Specific aspects in the practice of compounding & dispensing such:
 Prescription screening and address administrative, clinical and farmasetis
 Dose Calculation
 Labelling and determination of Beyond-use date
 Medication error : Prevention and how to overcome it
 Dosage Form and Patient specific drug delivery system

4. Objective:
 Understand the role of compounding Pharmacists dispensing &
in practice
 Able to resolve problems of making preparations-specific
preparations
 Applying the techniques of solving problems related to the
administrative aspects, and clinical farmasetis in the giving of
drugs on patients
 Apply the dose determination based on the patient's condition,
the disease and the presence of drug interactions
 Apply the determination of beyond-use date of drugs given to
patients
 Towards a rational treatment

5. Background:
 Pharmaceutical care
 Patient oriented
 Comprehensive services → improve quality of life of the
patients

6. 6
Uniqueness of Pharmaceutical Care
Traditional Pharmacy Clinical Pharmacy Pharmaceutical Care
Primary focus Prescription order Physicians or other Patient
or OTC request health professionals
Continuity Upon demand Discontinuous Continuous
Strategy Obey Find fault or prevention Anticipate or improve
Orientation Drug product Process Outcomes

7. 7
Why is there a new concept and
whether it's Pharmaceutical Care?

8. 8
1960---------------1990
 An explosion of drug
 961: 656 type  1999: 8000 type
 1971: 140,000 deaths & 1 million treated
 20% of care due to medication errors
 50% actually can be avoided
 45-65% of patients using drugs not in accordance with the
advice of the prescribers

9. 9
 Danger and risk can arise as a result of how
drugs are used, not because of its chemical
composition
 Most of the problems are not inherent to
the cure, but in the way drugs are
Prescribed: tsb
 And Fresh
 Used/consumed

10. 10
 Facts (1)
 A fifth of in-patients undergoing drug therapy
problems even in the most advanced medical
institutions
 76 billion dollar (US)
 The patient's suffering?
 Brigham and women's Hospital:
 6.5% non-obstetric patients suffered an adverse drug event
(30% serius)

11. 11
 Other studies:
 Due to medication error LOS (Length of Stay) rose 5
days, it costs $ 6,000 increase  $ 3 million/yearBedell
1991:
 64% of cardiac arrest at a teaching hospital because of drug
use.
 Other studies:
 Medication Errors occurred on average 10-20% (although not all
serious)

12. 12
Pharmaceutical Care
 Philosophy
 Practice (professionally, individually)
 Patient care process
 Management system

13. 13
Why Pharmaceutical Care ???
 Multiple Prescribers
 Drugs more expensive & potent
 The complexity of the drug
 The information is up to date because of the rapid
developments, should be able to sort out the
information
 Significant relationships:
 drug usage vs morbidity and mortality
 The humanitarian costs, financial result
misadventuring

14. 14
A Philosophy of Pharmaceutical Care
 A set of values
 Defines rules, roles, relationship, responsibilities
 Defines what should be done
 Day to day should reflect
 Priorities
 Ethical dilemmas, management issues, clinical judgment
 Timeless does not change on a daily basis, nor is it
different among and between practitioner

15. 15
Pharmaceutical Care as Practice
 Pharmaceutical care is applying knowledge to promote the
well being of others
 No single health care practitioner has accepted primary
responsibility for drug-related and mortality
 The Patient Care Process
 Identifying, Resolving and Preventing DrugTherapy Problems

16. 16
Pharmaceutical Care
 Is a Practice
 Patient focused
 Direct interaction with patients
 Direct interaction with patients
 Quality of life
 Definite outcome
 Documented
 DRP (Drug Related Problems)

17. 17
Dispensing
 Dispensing + Patient Care

18. 18
Faceless service
 a practice one patient at a time

19. 19
Pharmaceutical care
 Is the direct responsible provision of
medication related care for the purpose of
achieving definit outcomes that improve
patient’s quality of life (ASHP)
 Is a Practice in which the Practitioner
takes Responsibility for a patient’s drug
related needs, and is held Accountable for
this Commitment (Strand)

20. 20
Responsibility
 The fundamental relationship of patient care
 Trust and authority licensed
 Commitment & competency
 Responsibility (documentation)
 Ensure that there was an indication for every item of drug therapy
 Any drug used was the most effective & safest & that the patient
was compliant

21. 21
Medication Related
 Drug therapy
 The decisions of the
 Drug usage
 Consideration of the selection of doses, routes, methods
 Therapeutic drug monitoring
 Granting of the information
 Provision of counseling
 MedicationTherapy Management

22. 22
Care
 The focus of care is the care of Working together
with other health staff in the:
 Designing
 Implement
 Monitoring of the therapeutic plan
 That improvement of patient's quality of life is for sure

23.  Relationships individually Licensed must be:
 Profesional
 Personal
 Commitment
 Mutual respect
 Honestly
 Open communication
 Cooperation
 Empathy
 Sensitivity
 Promotion of patient independence
 Seeing the patient as a person

24. 24
 Patience, understanding,
attention,trust, comfort,
confidence, responsible,
accountable, competence
 Putting the patient first
 Offering reassurance, advocacy
 Supporting the patient

25. 25
Outcomes
 The assurance of improved quality of life
 Cure disease
 Elimination, reduction of symptoms
 Termination/slowing the disease process
 To achieve results
 Identification Of DRP (Drug Related Problem)
 Solve actual DRP
 Prevent potential DRP

26. 26
Quality of Life
 A comprehensive assessment of the quality of life
 Objective assessment
 Subjective assessment
 Patients get involved

27. 27
BASIC SEVEN ELEMENTS
7 elements in Pharmaceutical Care
1. Review all medications
2. Connect vs drug indication
3. DRP
4. Figured out, barring DRP
5. Care plan
6. Follow up/ monitor
7. Documentation

28. 28
National Health Services
 Ministry
 Recipes
 Drug Related Problem
 Patient (pharmacokinetics)
 The cure (Pharmacodynamic)
 Disease/disorders (pathophysiology)

29. Good Pharmacy Practice
Standards for Quality of Pharmacy Services :
Recommendation against the required standard in
ensuring quality/quality of service kefarmasian

30. 30
Good Pharmacy Practice
 Why GPP?
 Aspects of legal competency, and ethics in practice
 Control of the regulation
 Rational use of drugs
 Treatment of high quality, safe and cost-effective
 Optimise patient outcomes
 System and Infrastructure Support

31. 31
Good Pharmacy Practice
 Standard that is used to:
 Health promotion
 Provision of medicines and health equipment
 Patient self care
 Prescribing and drug use
 Medication records
 Patient follow up and monitoring
 Documentation of professional activities

32. 32
Influencing prescribing and medicines use
 Formularies and treatment guidelines
 Generic substitution
 Evaluation of use of medicines
 Adherence support
 Assessment of drug promotion materials
 Medicines information sources
 Reporting of adverse effects, errors, defects in medicine
quality, counterfeits

33. Extemporaneous Dispensing

38. When a prescription is received for an extemporaneous
product, there are a number of considerations to be prior
to dispensing.
1. Use of the product
2. Is it safe and suitable for the intended purpose?
3. Calculation of formula for preparation
4. Method of preparation
1. Solubility when applicable
2. Vehicle/ diluent
3. Preservative
4. Flavouring when appropriate

39. 5. Choice of container
6. Labelling considerations
 Title
 Quantitative particulars
 Product specific cautions (additional labelling requirements)
 Directions to patient – interpretation of Latin abbreviations
when necessary
 Recommended BNF cautions when suitable
 Discard date
 Sample label
7. Advice to patient

40. Extemporaneous Preparation
 Suatu produk dapat diformulasikan secara
extemporaneous hanya jika tidak ada produk sesuai
dengan dikehendaki yang beredar di pasaran
 Example:
Captopril syrup
Captopril powder (puyer)
Omeprazole for NG administration

43.  An awful lot of events in the field of enteric tablet preparations with a salute also
crushed.
 Please note that the material of a tablet that was overlaid with a particular purpose
such as that controlled drug release, or that the drug is not damaged by stomach
acid and can be diabsorpsi in the intestine.
 Mixing antibiotics (e.g. amoxicillin) and drugs NSAIDS (e.g. paracetamol, ibuprofen,
mefenamic acid, etc) in the form of a preparation headache is not ideal because the
prescribing of antibiotics is a drug taken to run out while the NSAID drugs are
medicines that are taken only when necessary.
 We need to know that antibiotics such as amoxicillin should not be crushed because
it can cause shock anafilaktik that can endanger the patient or the officer making the
drug.
 The real headache-making sometimes don't pay attention to hygiene, humidity of the
room, the room temperature, the use of tools that are not clean, compounding
preparations headache while joking, chatting-chat and the don't m. ..

44.  Mixing several kinds of drugs in dosage form of headache without
considering the possibility of interactions between the drugs that affect the
interaction of both farmokinetika as well as farmakodinamik drug.
 No need denying also that the condition of our society actually need these
supplies, headache because it still has a number of advantages and
advantages: easy to dose adjustment according to the age and weight of the
patient.
 Still at least drug preparations that are specific to children so that should
be made in the form of headache preparations.
 Treatment costs become cheaper.
 Preparations can help and ease the headache patient kids who have
difficulty taking the medication in the form of preparations in tablets.

55. General Principles of labelling

62. Any Questions or Additions

63. REFERENCES
 Pharmaceutical Preformulation by J.T.Cartensen published by Technomic publishing
Co., page no:- 1-6, 211-212.
 Ansel’s pharmaceutical Dosage forms & Drug delivery systems, 8th edition by Loyd
V. Allen, Nicholas G.popovich, Howard C. Ansel, publised by B.I.Publication pvt.
Ltd., page no:- 187-193,42 & 43,126-133.
 Textbook of physical pharmaceutics by C.V.S. Subrahmanyam, published by Vallabh
Prakashan, page no:- 182-208, 222-226.
 The theory & practice of industrial pharmacy by Leon Lachman, Herbert A.
Lieberman, Joseph L. Kenig, 3rd edition, published by Varghese Publishing house,
page no:- 171-184.
 Martin’s Physical pharmacy & Pharmaceutical science, 5th edition by Patrick J.
Sinco, Published by Lippincott Williams & Wilkins, page no:- 547-550.
 Pharmaceutical dosage forms : Tablet volume1, edited by Herbert A. Lieberman &
Leon Lachman, published by Marcel Dekker, page no:- 1-10.
 Biopharmaceutics and Pharmacokinetics , By D.M Brahmankar and Sunil
B.Jaiswal,Page :159-177
 Lachman , Page: 772-786
 www.pharmacy.utah.edu/pharmaceutics/pdf/Preformulation.pdf

64. Any Questions or Additions

66. Study Questions
 Define the following generic terms of pharmacy:
 [Preformulation, Formulation, Purity, solubilization, dissolution, ionization, partition, agitation,
complexation, surfactant, colour, odour, suspendibility, penetrability, solubilty, compressibility,
flowability, compatibility, disability, permeability, micelle, hydotrophy, hypotrophy, surfactant,
glidant, colorant, disintegrant, lubricant, oxidant, diluent, humectant, cosolvancy, Crystallinity,
Polymorphism, Hygroscopicity, excipient, binders, fillers, abrasion, friability, disintegrant,
Adhesives,, Antiadherent, Flavor, Sweetener, Dosage, Toxicology, deficiency, synthesis, crystallization,
bioavailability, solubility, solubilization, dissolution, stability, ionization, absorption, adsorption,
metabolism, induction, Crystallinity, polymorphism, Hygroscopicity, polymorphism, diffraction,
hygroscopicity, oxidation, reduction, hydrolysis, photolysis, racemization, bioprecursor, prodrug,
Medication, Compliance, Apothecary, Pharmaceutical compounding, [Preformulation, Formulation, Dosage,
Toxicology, deficiency, synthesis, crystallization, bioavailability, solubility, solubilization, dissolution, stability,
ionization, absorption, adsorption, metabolism, induction, Crystallinity, polymorphism,
Hygroscopicity, polymorphism, diffraction, hygroscopicity, oxidation, reduction, hydrolysis,
tablets, pills, ointments, micelles, creams, lotions, pastes, suppository, pessaries, racemization,
bioprecursor, prodrug, Medication, Compliance, Apothecary, Pharmaceutical compounding,
Millennium, Symptoms, Renaissance, Dosages, Storage, Pharmacopeia, Pharmacology, Pharmaceutics,
Pharmacokinetics, Therapeutics, Pathophysiology, Evolution, Nutrition, Antibiotics, Chemotherapy, Pain
management, Semiotician, Physician, Pharmacist, Diagnosis, Mutual respect, Honesty/ Authenticity, Open
Communication, Cooperation, Collaboration, Empathy, Sensitivity, Promotion, Competence, Assurance,
Confidence, Symptoms, Renaissance, Dosages, Storage, Pharmacopeia, Pharmacology, Pharmaceutics,
Pharmacokinetics, Therapeutics, Pathophysiology, Evolution, Nutrition, Antibiotics, Chemotherapy, Pain
management, Semiotician, Physician, Pharmacist, Diagnosis, Mutual respect, Honesty/ Authenticity, Open
Communication, Cooperation, Collaboration, Empathy, Sensitivity, Promotion, Competence, Assurance,
Confidence, etc]

67. Study Questions
 Respond to the following questions:
 Describe the pre-formulation consideration illustrating the term pharmaceutical compounding
 Describe the formulation consideration illustrating the term pharmaceutical compounding
 Describe the generic pharmaceutical formulation consideration
 What constitutes the preliminary evaluation process in terms of pharmaceutical
manufacturing
 Describe the different types of Organoleptic Properties of Pharmaceutical Powders considered
during pharmaceutical product making
 Describe the different methods considered in the determination of particle sizes of
pharmaceutical particles
 Describe the different properties and habits of pharmaceutical materials in their powder form
flow
 Describe the different properties and habits of pharmaceutical materials in their fluid forms
 Describe the term crystallinity in terms of the shapes of the pharmaceutical crystals and
applications in pharmaceutical processing outcomes
 State and explain the Preformulation characteristics for pharmaceutical formulated products
 State and describe the principle areas of Preformulation
 State and explain the essential considerations in Preformulation process
 Explain in details the process of Preformulation and its role in integrity of the pharmaceutical product
output
 State and explain the critical components of Preformulation considerations

68. Study Questions
 Group work discussional questions for Journal Club Meetings:
 Describe the formulation consideration illustrating the term
pharmaceutical compounding
 Describe the formulation consideration illustrating the term
pharmaceutical compounding
 Describe the generic pharmaceutical formulation
consideration illustrating the term compounding
 State and explain the formulation characteristics for pharmaceutical
formulated products
 State and describe the principal areas of formulation
 State and explain the essential considerations in formulation process
 Explain in details the process of formulation and its role in integrity of
the pharmaceutical product output
 State and explain the critical components of formulation
considerations