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Prof. Rakesh Kumar Tewari,
M.D.(Ay.) I.M.S.(BHU),
Head, Deptt Of Dravyaguna,
Govt. Ayurveda College , Jhansi (UP).
E mail : vdrakesh.tiwari@gmail.com
GOOD DISPENSING PRACTICES
DISPENSING IS THE PROCESS OF PREPARING & GIVING
MEDICINE TO NAMED PERSON ON THE BASIS OF A
PRESCRIPTION.
CORRECT INTERPRETATION OF WISHES OF PRESCRIBER.
ACCURATE PREPARATION & LABELLING OF MEDICINE
FOR THE USE OF THE PATIENT.
ANY ERROR IN DISPENSING PROCESS CAN SERIOUSLY
AFFECT CARE OF THE PATIENT.
ALL THE RESOURCES INVOLVED IN PATIENT CARE
PRIOR TO DISPENSING MAY BE WASTED IF CORRECT
DRUG DOES NOT REACH TO CORRECT PATIENT WITH
CORRECT DOSE & ADVICE.
DISPENSING ENVIRONMENT
STAFF- PERSONEL HYGIENE, CLEANLINESS
PHYSICAL SURROUNDINGS- FREE FROM DUST, DIRT &
POLLUTION.
SHELVING & STORAGE AREAS-PROPERLY CLEAN,
LABELLED & ARRANGED ALPHABETICALLY.
SURFACES USED DURING WORK- REGULAR CLEANING
& SP. CARE FOR LIQUIDS.
EQUIPMENTS & PACKAGING MATERIAL- SP. CARE OF
REFRIGERATOR- NOT TO BE USED FOR FOOD & DRINKING
WATER STORAGE.
TEMPERATURE,LIGHT&MOISTURE-AS RECOMMENDED
DISPENSING PERSON
BELIEF THAT ANYONE WHO CAN READ THE PRESCRIPTION,
COUNT & POUR WILL DO IT WITHOUT ANY TRAINING &
SUPERVISION IS NOT TRUE.
SKILFULLY RECEIVING CORRECT MEDICINES FROM STORE/
SUPPLIER WILL IMPROVE QUALITY ASSURANCE.
KNOWLEDGE ABOUT THE MEDICINE BEING DISPENSED
(COMMON USE, CORRECT DOSE, PRECAUTIONS ABOUT
METHOD OF USE, SIDE EFFECTS, COMMON INTERACTIONS
WITH OTHER MEDICINES & FOOD, STORAGE NEEDS ETC.)
GOOD CALCULATION & ARITHMETIC SKILLS.
ATTRIBUTES OF CLEANLINESS, ACCURACY & HONESTY.
COMMUNICATION SKILLS WITH PATIENT.
THE DISPENSING PROCESS
RECEIVE & VALIDATE PRESCRIPTION.
UNDERSTAND & INTERPRET PRESCRIPTION (PATIENT,
MEDICINE, DOSE)
PREPARE & LABEL ITEMS FOR ISSUE (READ THE
LABELS).
MAKE A FINAL CHECK.
RECORD ACTION TAKEN.
ISSUE MEDICINE TO PATIENT WITH CLEAR
INSTRUCTIONS (WHEN TO TAKE MEDICINE IN RELATION
TO FOOD & OTHER MEDICINES, HOW TO TAKE- CHEW/
SWALLOW, HOW TO STORE ETC.).
PROMOTING EFFICIENT MANAGEMENT
IN DISPENSING
WHILE FACING A CROWD- SPEED MUST BE BALANCED
WITH ACCURACY.
PRE-PACKAGING OF COMMONLY USED MEDICINES AND FOR
LONG TERM FIXED DOSE COURSES CAN EASE THE BURDEN.
STOCK ROTATION- WHICH ITEMS TO BE USED FIRST
IN/ FIRST OUT( FIFO) OR FIRST EXPIRY/ FIRST OUT ( FEFO).
PACKAGING & LABELLING OF DISPENSED
MEDICINE
CONTAINER & PACKAGING MATERIAL
SHOULD NOT AFFECT QUALITY OF MEDICINE.
SPECIAL CARE FOR LIQUIDS
BOTTLE GIVEN BY/TO PATIENT SHOULD BE RINSED
PROPERLY.
LABELLING
IS USUALLY INADEQUATE/DOES NOT EXIST.
LABELS PROVIDE VITAL INFORMATION.
PREPACKAGED MEDICINE MUST BE LABELLED.
ABBREVIATIONS & UNFAMILIAR WORDS TO BE AVOIDED
LOCAL LANGUAGE IS MUST.
FACTORS INFLUENCING BEHAVIOUR OF
DISPENSER:
TRAINING & KNOWLEDGE.
PROFESSIONAL COMPENSATION .
COMMUNICATION SKILLS.
AVAILABLE PRODUCT INFORMATION.
AVAILABILITY OF DISPENSING EQUIPMENTS.
DISPENSER PRESCRIBER RELATIONSHIP.
AIDS IN COUNTING TABLETS & CAPSULES:
TABLET COUNTER
PAN WEIGHING SCALES
ELECTRONIC TABLET COUNTER.
PHARMACY PERSONEL:
PHARMACIST
PHARMACY TECHNICIAN
AUXILIARY/ASST. PHARMACY STAFF
UNTRAINED MEDICINE SELLERS.
ASSESSMENT GUIDE:
DISPENSING INDICATORS
DISPENSING REGULATIONS
DISPENSING TRAINING.
DRUG INCOMPATIBILITY
WHEN PRESENCE OF ONE DRUG DECREASES
PHARMACOLOGICAL RESPONSE OF THE OTHER DRUG,
IT IS KNOWN AS DRUG INCOMPATIBILITY. IT IS MORE
OR LESS SIMILAR TO DRUG INTERACTION &/OR
ANTAGONISM
PHYSICOCHEMICAL INTERACTIONS
PHARMACOKINETIC INTERACTIONS
PHARMACODYNAMIC INTERACTIONS.
PHYSICO-CHEMICAL INTERACTIONS
WHICH OCCUR IN COMBINATIONS/SOLUTIONS PRIOR TO
ADMINISTRATION OF DRUG ARE CONCERNED WITH
PHARMACISTS
A. HYDROPHOBIC INTERACTIONS
B. ELECTROSTATIC INTERACTIONS
C. ADSORPTION OF DRUGS ONTO SOLIDS
D. CHELATION & COMPLEXATION OF DRUGS
PHARMACO-KINETIC INTERACTIONS:
1.DECREASED G.I. ABSORPTION
2. CHANGES IN G.I. PH
3. CHANGES IN G.I. MOTILITY
4. COMPETITION FOR PP BINDING & TISSUE BINDING.
5. INHIBITION OF BIOTRANSFORMATION
6. INDUCTION OF MICROSOMAL ENZYME SYSTEMS
7. COMPETITION FOR TUBULAR SECRETION
8. CHANGES IN URINARY PH.
la;ksx% iqu}Z;kscZgwuka ok nzO;k.kkalagrhHkko%] l fo’ks‛kekjHkrs] ;a
iquuSZdSd’ksnzO;k.;kjHkUrs( r|Fkk& e/kqlfiZ‛kks%] e/kqeRL;Ik;lka p la;ksx%A
¼p0fo01@22½
r= e/kqjkEykSjloh;Zfo#)kS e/kqjyo.kkS p] e/kqjdVqdkS p loZr%]
e/kqjfrDrkSjlfoikdkH;ka e/kqjd‛kk;kS p] vEyyo.kkSjlr%]
vEydVqdkSjlfoikdkH;ke~] vEyfrDrkoEyd‛kk;kS p loZr%]
yo.kdVqdkSjlfoikdkH;ka] yo.kfrDrkSyo.kd‛kk;kS p loZr%]
dVqfrDrkSjloh;kZH;kadVqd‛kk;kS p frDrd‛kk;ksjlr%A
¼lq0lw0 20@16½
Ekku fojks/k (Quantitative incompatibility)
xq.k fojks/k (Physicochemical incompatibility)
jl fojks/k
oh;Z fojks/k
foikd fojks/k
deZ fojks/k (Pharmacological incompatibility)
laLdkj fojks/k (Processing incompatibility)
la;ksx ,oa fojks/k
ROLE OF PHARMACISTS IN HERB-DRUG
INTERACTIONS
IMPORTANT ROLE OF ALL HEALTHCARE
PROFESSIONALS
ASK THE PATIENT ABOUT OTHER MEDICINES
MAINTAIN THEIR RECORD APPROPRIATELY
YELLOW CARD REPORT FOR SUSPECTED HDIS FOR
LICENCED & NON-LICENCED HERBAL MEDICINAL
PRODUCTS
ALSO NOTE PATIENT DETAILS, ROUTE, DOSAGE,
REASON FOR USE, BATCH NUMBER, TYPE OF EXTRACT,
LATIN NAME OF PLANT AND PART USED.
OTHER WAYS TO AVOID HERB-DRUG
INTERACTIONS
KNOWLEDGE IS POWER.
PHARMACIST IS A FRIEND OF PATIENT.
BUYER BEWARE.
ONE THING AT A TIME.
WATCH THE KIDS.
WRITE IT DOWN.
TIME IS IMPORTANT.
HAVE A HEALTHY RESPECT FOR NATURE.
AN OUNCE OF PREVENTION.
USE COMMON SENSE.
COMPOSITION OF VARIOUS FORMULATIONS
IDEAL DRUG ¼ iz’kLr Hks‛kt ½
cgqrk r= ;ksX;Roeusdfo/kdYiukA
lEiPpsfr prq‛dks∙;a nzO;k.kka xq.k mP;rsAA
¼p0lw0 9@7½
iz’kLrns’klaEHkwra iz’kLrs∙gfupks)`re~A
;qDrek=a euLdkUra xU/ko.kZjlkfUore~AA ¼lq0lw034@22½
Selection of drugs
/kweo‛kkZfuyDysnS% loZrqZ‛oufHknqzrsA
xzkgf;Rok x`gsU;L;sf}f/kukS‛k/k laxzge~AA
Lkeh{; nks‛kHksnk’p fHkUuku~ feJku~ iz;kst;sr~A
i`Fk³~feJku~ leLRkkUok x.ka ok O;Lrlagre~AA
lq-lw-38@81&82AA
;fLeUuaxs rq nzO;k.kka oh;Za Hkofr pkf/kde~A
rnsokaxe~ iz;qathr era rŸofonkfeee~AA¼i0iz0½
vfrLFkwytVk ;k% L;qLrklka xzkákLRopks cq/kSA
x`g~.kh;kr~ lw{eewykfu ldykU;fi cqf)eku~AA
U;xzks/kknsLRopks xzkák% lkj% L;kn~ chtdkfnr%A
rkyhlkns’p i=kf.k Qya L;kr~ f=Qykfnr%AA
/kkrD;kns’p iq‛ikf.k Luqákns% {khjekgjsr~A
‘kk[kka xqMwfpdknsLrq fu;kZla jkeBkfnr%AA ‘kk0iz01@60&62AA
Examples
xqXxqyqdYi
‚kMaxikuh;&eqLriiZVdks’khjpUnuksnhP;ukxjS%A
vxq#i=k| ¼p0lw05@29½&dq‛B ,oa rxj vf/kd rh{.k gksus ls
f’kjksfojspu es acfg‛d`rA
,j.MoT;Za [kqM~Mkda ¼dk0la0½ vUroZRuh fpfdRlk esa lj xq.k ds
dkj.k oftZrA
iapewY;kS vdk’e;kSZ ¼pSrl ?k`r&mUekn fpfdRlk½ esa xEHkkjh
D;ks acfgLd`r gS Kkr ugha \
Conclusion
vYi’pkfi egkFkZRoa izHkwr’pkYideZrke~A
dq;kZr~ la;ksx fo’ys‛k% dkylaLdkj ;qfDrfHk%AA
p0d012@48&49AA
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