Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Assist with prescription preparations

At the end of the chapter the learner will be able to:
 Accept prescription for dispensing
 Ensure clinical evaluation of prescription by pharmacist
 Prepare labels according to the legal requirements
 Enter data in to dispensing computer and calculate prescription quantities
 Assemble prescription items according to good dispensing practice
 Finalize prescription and documentation
Introduction to prescription processing
This topic is concerned with the assistance with preparation of prescriptions in accordance with the
legal and good pharmacy practice requirements. Work performed requires a range of well-developed
skills where some discretion and judgment are required. Individuals will take responsibility for their
own outputs and limited responsibility for the output of others.
Prescription
 A prescription is an important therapeutic transaction between the prescriber and medicine
consumer through a dispenser.
 Prescriptions designate specific medications and dosages to be administered to a particular
patient at a specified time.
 It is a written order of the prescriber for one or more medication, and instructs the dispenser
how to prepare and dispense medicines and the patient how to use them.
 Prescription is a written order from a registered medicinal practitioner or other licenced
practitioners such as Dentist, Veterinarian, etc. to pharmacist to compound and/or dispense a
specific medication to a patient.
 So, prescription is a media through which treatment is provided for a patient by the
combined skill and service of both the physician and the pharmacist.
 A prescriber is a health professional who makes the diagnosis and orders medicine(s) to
patients. All prescribers are not at the same professional level.
 A prescriber may be: Nurses, health officers, psychiatrics, Dentist, Medical
doctor,etc.
 The dispenser is a person who is authorized to dispense medicines and medical supplies to end
users.
 Dispensers include:
Pharmacists
Druggists
Pharmacy technician
 Depending on the level of dispensaries, pharmacy professionals of varying level of
qualification may be licensed for dispensing practices.
 All licensed private pharmacies, medicine shops and rural medicine vendor are required to
work under the technical leadership of registered pharmacists, druggists and pharmacy
technicians.
 Previously, nurses and health assistants were eligible to obtain a license for and are still
working particularly in rural medicine vendor shops.
 Druggists and pharmacy technicians may also work in pharmacies under the supervision of the
pharmacist.
 The medicine outlets within public health institutions are to be managed by appropriately
qualified staff such as a pharmacist or druggists.
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 The dispensing of medicines (except emergency medicines) in ordinary private clinics is,
however, illegal.
 The responsibility for the correctness and quality of medicines supplied, therefore, lies entirely
on the person dispensing them.
 All of the resources required to deliver a medicine to the patient may be wasted if dispensing
does not ensure that the correct medicine is given to the right patient in an effective dosage and
amount, with clear instructions, and in packaging that maintains the integrity of the medicine.
 Since the dispenser is often the last person to see the patient before the medicine is used, it is
important that the dispensing process be efficient, as it affects medicine use.
 The dispenser or dispensing team should have knowledge, skills and attitudes to carry out
the dispensing process rationally. These include:
 Knowledge about the medicines being dispensed (common use, usual dosage,
precautions about the method of use, common side effects, common interactions with
other medicines or food, storage condition)
 Good calculation and arithmetic skills
 Skills in assessing the quality of preparations
 Attributes of cleanliness, accuracy and honesty
 Attitudes and skills required to communicate effectively with patients,
 Sufficient training according to the level of the health institution and medicine retail
outlet
 Knowledge about national polices and working guidelines
 Good knowledge of societal norms and cultural values
 Good working relation with other health care professionals
 Good administrative knowledge and skill
 Fair attitude towards patient interest and commercial pressure
 Respect to pharmacy law and professional code of ethics.
 Good knowledge on medicine supply management
 Knowledge on quality assurance of services
 Good clinical knowledge
Requirements for a prescription
 Should be written on a standard prescription blank
 Should be written in ink, legible, clear, not ambiguous
 Should be written in generics, as brands could be expensive, promotional and do not give
freedom to the dispenser to dispense the most affordable one.
 Should be written in English with some Latin abbreviations
 The quantity of ingredients should be expressed in metric system
Types of prescription
I. Based on the type of preparation prescribed, prescription is classified into two types.
1. Prescription for pre-compounded medication: it is a type of prescription for already
prepared drug by pharmaceutical companies
2. Prescription for extemporaneous preparation (Compounded) prescription : in this
prescription the pharmacists prepare the medication according to the drugs and dosages
directed by the physician.
II. Based on the type of prescription
1- Official preparation prescription

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 This types of prescription is official in BNF in which the name of the prescription and quantity
required are mentioned in this book.
Example:- Rx
Kaolin mixture
Paediatric BNF
Send 200ml
Sig. two tsp tid
 This prescription is to be compounded.
2- Special formula prescription
 This formula the prescription must be completed in regarding each constituent i.e. each
ingredient will be stated with a prescription.
Example:- Rx
Coal tar solution -------------- 2ml
NaHco3 ------------------------ 1.5ml
Water ad ----------------------- 100ml
Make lotion
Sig. to be applied on infected skin
 This prescription is also to be compounded.
3- Proprietary product prescription
 It is the prescription for already made product and the role of the pharmacist is just dispending.
Example:- Rx
Omeprazole 20mg capsule bid for 10 days
 Amoxicillin 500mg capsule po tid for 7 days
III. Based on the nature of the drugs prescribed, prescription is also classified into two
types.
1. Ordinary prescription
 This type of prescription used for all drugs except narcotic and psychotropic substances and
Antiretroviral drugs.
 Can be prescribed by nurses, physicians, health officers, dentists, psychiatrics and useful for
OTC and prescription only medicines prescribing.
 Kept after dispensing for 2 years
 White in colour
 Need less medical counselling.
2. Special prescription
 Used for Narcotic drugs, Psychotropic drugs and Antiretroviral drugs.
 After dispensing kept at least for 5 years.
 Prescribed by specialized professionals.
 Red colour Narcotic prescription, Light green for Psychotropic drugs and White for
Antiretroviral drugs.
 Need special counselling.
 The drugs cannot be OTC in any level of knowledge.
Ensuring quality of written prescription before dispensing
 The quality of prescription is evaluated by observing whether it contains necessary information
and free from error.
 A prescription should be generally written in English, but Latin words and abbreviations can be
used to save time.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 A prescription should be easily understandable and readable to dispenser otherwise it leads to

medication error.
 A prescription should be written by the legally ascertained practitioners or certified or
registered and allowed by law.
 Generally the quality of prescription is ensured from its parts that the prescriber included in it.
PARTS OF PRESCRPTION
Content of prescription paper
 According to Guidelines for the control of use of prescription paper (Jan, 2004), published by
the Food, Medicine and Health Care Administration and Control Authority (FMHACA) the
content of any prescription paper should include the following information:
1. Serial number and area code.
2. Name, level and address of the health institution.
3. Full name, age, weight, sex, card number and address of the patient.
4. Type of diagnosis or International classification of disease (ICD) code number.
5. Name, strength, dosage form, treatment duration and dose of the medicine.
6. If the medicine is to be compounded, the type of ingredients needed how to prepare it, and
directions on how to use it.
7. If the medicine is refillable directions for refill.
8. Prescriber’s name, qualification, registration number, signature & date on which prescription is
written.
9. Dispenser’s name, qualification, registration number, signature and the date on which the
prescription is filled.
10. Summarized directions to be followed by prescribers and dispensers.
 The written prescription has stringent requirements designed to inform pharmacy personnel and
protect the patient. Prescription regulations vary from state to state and province to province,
but generally a prescription for a health facility will contain the information illustrated below.
PRESCRIPTION PAPER Serial No __________
Area Code _________
Institution Name: __________________Tel. No.___________
Patient’s Full Name: __________________________________
Sex: ___ Age: ___ Weight: ______ Card No. _______________
Region: _______Town ________ Woreda______Kebele _____
House No. ____ Tel. No: ________􀀁 Inpatient 􀀁 Outpatient
Diagnosis, if not ICD ______________________________
Medicine Name, Strength, Dosage Form, Dose, Frequency, Price
Duration, Quantity, How to use & other information (dispensers use only)

Amoxicillin 250 mg capsule

TID, PO for seven days

# 21 capsules

Refill ____________

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Dispense as Written ___________

Total Prices

Prescriber’s Dispenser’s
Full name ________________________ ________________________
Qualification _____________________ ________________________
Registration #_______________________ ________________________
Signature ________________________ _______________________
Date: _________________________ _______________________
1. Serial number
 FMHACA recommended that prescription paper shall have a serial number with area code as
shown on the top of the prescription paper above.
 14H000000 is a serial number given to Private, Governmental and Non-Governmental health
institutions where 14H is code for these health institutions and 000000 is a consecutive serial
numbers of prescriptions for a given health institution.
2. Name and address of the health institution
o The name of the health institution
o The address of the health institution
 Telephone number , Region, Kebele, Woreda, House number, P.O.Box
3. Patient information
 Full name of the patient
 Age and sex of the patient
 Card number
 Address of the patient
Telephone number, Region, Town, Kebele, Woreda, House number
 Type of patient: Outpatient or Inpatient
 The name, address, age and sex of the patient help in identifying the prescription
 The prescribed medication is only for the patient whose name is on the prescription.
 Weight, age and sex of the patient are important in verifying the correct patient and/or dosing
of the medication.
4. Type of diagnosis
 Diagnosis is the identification of the nature and cause of a disease.
 The type of diagnosis can be written on a prescription paper either on words or codes referred
to as diagnostic codes.
 In healthcare, diagnostic codes are used to group and identify diseases, disorders, symptoms,
human response patterns, and medical signs, and are used to measure morbidity and mortality.
 The International Statistical Classification of Diseases and Related Health Problems (most
commonly known by the abbreviation ICD)
5. Superscription
 The 'Rx' symbol is called the superscription is used as an abbreviation of the Latin word recipe,
which means, “Take thou” or “you take”.
 Rx symbol comes before the inscription, the sign at the foot of the letter R is believed to
represent the sign of Jupiter, the God of Healing

6. Inscription

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 The inscription comprises an important part of prescription containing

 Name(s) and strength of drug(s)
 Instruction regarding dosage form like tablet, capsule, suspension, mixture, etc.
7. Subscription
 Gives specific directions for the pharmacist on how to compound the medication.
 Most of direction is usually expressed in contracted Latin or in the form of abbreviation.
 Consists of directions given to the pharmacist with respect to the dosage form and the number
of dosage units/quantity to be supplied.
 Instructions for preparation are also given such as 'make a mixture', 'mix and make 10
tablets', or 'dispense 10 capsules'.
8. Transcription or Signatura
 Signatura refers to the directions given by the prescribers to the patient.
 In this portion, the physician indicates to the patient:
o how he/she should take the prescribed medicine/s.
o directions are usually written using abbreviated forms of Latin.
o instructions are preceded by abbreviation 'Sig.' from the Latin, meaning ‘mark’ indicates how,
how much, when, and how long the drug is to be taken.
e.g., 1 cap tid po means take one capsule thrice a day orally.
 In the best interest of the patient, it is advisable that no abbreviations be used. The prescriber
should preferably write the dosage schedule in simple, unambiguous terms that the patient or
his representative/caretaker can read and understand.
9. Refill information
 In certain cases, a single course of therapy may not be sufficient for effective treatment of the
patient.
 Under such circumstances, the physician may decide to repeat the course of therapy, and
indicate the same on the prescription. This information is called refill information.
 The refill information should indicate the number of times the prescription should be refilled
and the intervals after which it should be refilled.
 Refill information aids in preventing a person from having his/her prescription filled more
often than the proper dosage regimen warrants, and other patients from using the prescription
for a similar condition, or misusing it.
10. Prescriber/dispenser information
 Prescriber/dispenser information include:
 Full Name of professional
 Qualification
 Registration number
 Signature; signature of the prescriber/dispenser in his own handwriting.
11. Prescription Date
 Should be written on the top of the prescription paper and/or below the signature of the
prescriber. The date also essential to mark the legality of the prescription.
 Date is helps the dispenser to find out the date of prescribing and date of presentation for filling
the prescription
 This helps to dispenser for controlling the supply of controlled drugs.
 The prescription which prescribe narcotic or other habit forming drugs must bear date, so to
avoid the misuse of the drugs if it is presented by the patient A number of times for dispensing.
 Date is also useful when a prescription is brought for dispensing long time its issue.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Common abbreviations in prescription writing

 Many medical and pharmaceutical terms are abbreviated for ease of communication and record
notation. It has been estimated that about 10,000 abbreviations are used in the health sciences.
Many abbreviations are specific for one institution or one area of the country. It is also possible
that one abbreviation may have more than one meaning.
 Abbreviations are regularly used in the pharmacy to communicate essential information such as
the dosage form, dosage regimen, and route of administration. To be safe and efficient,
technicians must memorize these commonly used abbreviations and understand their meaning.
Table: Latin Terms and Abbreviations used in prescription writing
1. Abbreviation for Dosage forms
Abbreviation Latin Name English meaning
s
caps. Capsula A capsule
Cataplasm Cataplasma A poultice
chart Charta A powder
Collun Collunarium A nose wash
Collut Collutorium A mouth wash
Collyr Collyrium An eye lotion
crem Cremor A cream
Emp Emplastrum A plaster
Emul Emulsio An emulsion
Garg Gargarisma A gargle
Gelat Gelatina A jelly
Gtt Guttae Drops
Inhal/vap Inhalatio/vapor An inhalation
Inj Injectio An injection
insuff Insufflatio An insufflation
Linct Linctus A linctus
Lin Linimentum A liniment
Liq Liquor A solution
lot Lotio A lotion
m., mist Mistura A mixture
narist Naristillae Nasal drops
neb Nebula A spray solution
oblat Oblatum A cachet
oculent Oculentum An eye ointment
past Pasta A paste
pastill Pastillus A pastille
pess Pessus A pessary
pigm Pigmentum A paint
pil Pilula A pill
pulv Pulvis A powder/ dusting
solv Solvellae Solution tablets
sternut Sternutamentum A snuff
suppos Suppositorium A suppository
tab Tabella A tablet
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

troch Trochiscus A lozenge

ung Unguentum An ointment
vitrell Vitrella A crushable glass capsule

2. Instructions Relating To Preparation

Abbreviation Latin Name English meaning
add Adde, Addatur Add. Let (it) be added
calef Calefac, Calefiat Warm. Let (it) be warmed
div. in pt aeq Dividatur in Divide into equal parts
partes aequales
div Divide, Divide, Let (it) be divided
Dividatur
ft Fiat / Fiant Let (it) be made
m Misce, Misceatur Mix. Let (it) be mixed
3. Quantity To Be Sent and Manner of Sending
Abbreviation Latin Name English meaning
duplum Duplum Twice the quantity
mitt Mitte Send
p.p.a Phiala prius agitata The bottle being first shaken(attach,
shake the bottle label)
qt.dx Quantitas ,duplex Twice the quantity
tal. Talis, Tales, Talia Such
4. Method of Administration or Application
Abbreviation Latin Name English meaning
addend Addendus To be added
applicand Applicandus To be applied
applicat Applicetur Let (it) be applied
capiend Capiendus To be taken
d. Da Give
dand. Dandus To be given
deglut Deglutiendus To be swallowed
infricand Infricandus To be rubbed in
infric Infricetur Let (it) be rubbed in
inhal Inhaletur Let(it) be inhaled
instilland Instillandus To be dropped in
miscend Miscendus To be mixed
sig. Signa Label
sugend Sugendus To be sucked
s. or sum. Sumendus To be taken
u.a. Ut antea As before
5. Time of Administration or Application
Abbreviation Latin Name English meaning
ad 3 vic. Ad tres vices For three times
alt. hor Alternis horis Every two hours
a.c. Anti cibos./cibum Before meals/food
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

b.i.d, b.d Bis in die. or bis die Twice a day

b.t.i.d Bis terve in die Two or three times a day
hac noct. Hac nocte Tonight
h.s. / h.d. Hora somni / Hora At bed time
decubitus
i.c. Inter cibos/cibum Between meals/food
inter. noct Inter noctem During the night
m. Mane In the morning
m.seq. Mane sequenti The following morning
noct. /n. Nocte At night
n. et m/n.m. Nocte et mane/Nocte Night and morning
maneque
od Omne in die Every day/once daily
o.h. qq.h. Omni hora. ,Quaque Every hour
hora
o.m. Omni mane Every morning
o.n. Omni nocte Every night
o.p.d Omni per die Once per day
o.q.h Omni quarta hora Every fourth hour
p.c. Post cibos. /cibum After meals/food
p.m. Post meridiem Evening or afternoon
prim. luc / prim. m Prima luce / Primo Early in the morning
mane
PRN, prn Pro re nata As needed
Quaque alternis die/
q.a.d./q.o.d Every other day
omni die
Quaque die ante
q.a.m. Every day before noon
meridiem
q.p.m. Quaque die post Every day after noon or every evening
meridiem
q.h. Quaque hora Every hour
q.h.s. Quaque hora somni Every night at bedtime
qq.q.h Quaque quarta hora Every fourth hour
q.i.d or q.d. Quarter in die. Four times a day
/quarter die
quart. hor Quartis horis Every four hours
q.d.s. Quater die sumendus Four times a day
quot (qd) Quotidie Daily or every day
sec. hor Secundis horis Every two hours
sem. in die Semel in die. or Once a day
semel die
sex. in d. /sex.d. Sexies in die. /sexies Six times a day
die
sext. hor Sextis horis Every six hours
sing. hor. Singulis horis Every hour
t.i.d/t.d Ter in die. or ter Thrice a day
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

die
t. in hebdom/ t.i.w. Ter in hebdomada Three times a week
t.q.d Ter quaterve die Three or four times a day
tert. hor Tertiis horis Every three hours
vesp. Vespere In the evening
6. Part of the Body to which Drug is Applied
Abbreviation Latin English meaning
Name
auri Auri / auribus To the ear, for the ear
a.d. Auris dextra Right ear
Auris laeva, auris
a.l., a.s. Left ear
sinistra
a.u. Auris utraque Both ears
dext. Dexter Right
dolent.part Dolente To the afflicted part
parti ,dolentibus
partibus
gutt. Gutturi To the throat
in aur.sinist In aurem sinistram Into the left ear
in ocul.dext In oculun dextrum Into the right eye
in. sing.aur In singulas aures Into each ear
NPO Nil per os Nothing by mouth
ocul Oculis/ oculo For the eyes
o.d/OD Oculus dexter Right eye
o.s./OS Oculus sinister Left eye
o.u. Oculus uterque Both eyes
p.a. Parti affectae To the affected part
p.a.a. Parti affectae To be applied to the affected part
applicandus
p.a. Partibus affectis To the affected parts
p.r. or PR Per rectum By rectum
PV Per vaginam Via the vagina
pro capill Pro capillis For the hair
pro ocul Pro oculis For the eyes
pro ocul laev Pro oculo laevo For the left eye
pro sing.ocul Pro singulis oculis For each eye
sinist Sinister Left
dol. urg. Dolore urgente When the pain is severe
freq. Frequenter Frequently
m.d. More dicto / Modo As directed
dicto
quot.o.s Qouties opus sit As often as necessary
si dol. urg Si dolor urgeat If the pain is severe

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

STEPS IN PROCESSING OF PRESCRIPTION

 The manner in which the pharmacist or druggist handle and process a prescription order is
important in fulfilling his or her professional responsibilities and can enhance his/her image
with both the physician and the patient.
 The following procedures should be followed in processing prescriptions for compounding and
dispensing:
1. Receiving the prescription
 The patient should directly deliver prescription to the dispenser b/c this:
a) Enhance patient dispenser relationship
b) Facilitate quantity of pharmaceutical care.
2. Reading and checking prescription
 The prescription order first should be read carefully and completely, there should be no doubt
as to the ingredient or quantity and doses of the prescribed drug.
 The dispenser should determine the compatibility of the newly prescribed medication with
other medication being taken by the patient and also consider if any drug interaction may exist.
 If there is probability of drug interaction the dispenser should first consider alternative drug
products used and then consult the prescriber to determine best therapeutic alternative for the
patient.
3. Pricing prescriptions
 A prescription should be priced immediately after receiving and checking it and the patient
should be informed.
 This should be done before starting the compounding of prescription so that there will be not
disagreement.
4. Numbering and dating of prescription
 It is legal requirement to number prescriptions and to place the same number on the label.
 This helps to identify the bottle or package and to connect it with the original order for
reference or to renew the prescription.
 Dating of prescription on the date filled is also legal requirement.
 This is important in determine the appropriate refill frequency, patient compliance, and as an
alternative means of locating prescription order.
5. Marking the prescription
 Prescription is marked with rubber stamp to indicate that it has been dispensed.
6. Labelling
 The prescription label may be type written or prepared by computer using information entered
by dispenser.
 The label is written before dispensing the prescription so as to prevent dispensing of excessive
dose, since the label states the strength of the preparation supplied and the actual amount that
the patient has to take at a particular time.
 A prescription should have aesthetic and professional appearing label.
 If the label and the container are not neat and professional in appearance, the patient may
conclude that the medication itself also was prepared in a careless manner. This may result in
loss of confidence in the pharmacist or druggist.
7. Preparing the prescription
 When a prescription requiring compounding is received, the pharmacist should take into
consideration the chemical and physical compatibility of the ingredients, the proper order of
mixing, the need of special adjuvants, or technique and mathematical calculations required.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 While compounding the label of each container should be read at least three times.
8. Packaging
 In filling the prescription the dispenser may select a container but the selection is based
mainly on the type and quantity of medication to be dispensed and the method of its use.
9. Rechecking
 Rechecking is especially important for those drugs that are available in multiple strength.
Example:- Augmentin 625mg, 375mg
 Propranolol 10mg, 20mg, 40mg
 Amoxicillin 250mg, 500mg
 Diclofenac 50mg, 100mg
 Albendazole 200mg. 400mg
 Asprin 100mg, 300mg
 Paracetamol 100mg. 500mg, etc.
 What should be Rechecked?
 Ingredients
 Amount and labels should be rechecked against the prescription order
Example:- directions
 Patient name
 Prescription number
 Date
 Prescribers information, etc.
10. Delivering and counselling
 The dispenser should personally prevent medication to the patient or family.
 Suggested questions to ask the patient when dispensing a new medication include:
 What did the doctor tell you to take the medication?
 How did the doctor tell you to take the medication?
 What did the doctor tell you to expect from the medication?
Collecting Prescription and Confirming
Reception
 Reception is a formal party which is given to welcome someone or to celebrate a special event.
As clients come into the pharmacy section, they must be made to feel attended to and
comfortable by:
 Friendly gestures and smile
 Eye-to-eye contact
 A friendly welcome
 Politeness and feeling of caring
Techniques for interacting with clients at the counter
☆ Listening carefully
☆ Making eye contact
☆ Repeating what the customer said
☆ Using positive rather than negative words
☆ Language to describe what you can do
☆ Calling the patient by name
Client details: Full name, age, sex and weight, address, patient condition, diagnosis and details of
medicine prescribed
Prescriber information: Full name, registration number, qualification, signature and date

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Legality and Validity

A prescription is legal when:
 it is written (can also be typed) and signed by an authorized prescriber
 NPS prescription ( narcotic and psychotropic prescription) for controlled drugs
 The medicines are written on the right prescription such as normal, NPS and ART
 Date of issue not exceeding 15 days for narcotic drugs and psychotropic substances and 30
days for other medicines
 Has all the information required to be contained with respect to parts of prescription
Completeness of the prescription
 The prescription serves as a vehicle for communication from the licensed medical practitioner
to the pharmacy professionals about the pharmaceutical care of the patient.
Details to be checked for completeness of the prescription:
 Seal of the health institution or header
 Prescriber’s details
 Patient's details
 Medicine details
Checking the medicine details will include checking:
 Name of the medicine
 Dosage form
 Strength/ potency of the medicine
 Total amount to be dispensed and its availability
 Dosage and directions for use
 Frequency of administration and duration of the treatment
Reporting discrepancies to pharmacists
o Incomplete or incorrect prescription
o Prescription out of date
o Prescriptions marked “cancelled” or indicate that it has been dispensed and completed
o Prescriptions for a narcotic written by the prescriber for self-treatment
o Questionable dosages and administration method for commonly used drugs
o Request for excessive quantities
o Determining cost of medication
o Advising client of any foreseen difficulty in filling the prescription
o Advising client of approximate waiting time and collection arrangements.
o Checking payment and issue receipt
Clinical evaluation of prescription
1. Identifying the patient’s condition
2. Completeness of prescription
a) Name of the medicine
 The name of medicine must be legible and correct without a doubt.
o since many brands sound alike, brand confusion is quite common especially if the handwriting is
illegible & pharmacy professionals proceeds on basis of guesswork.
o prescriber should ideally write the generic name in parentheses against the brand name or write
the generic name alone.
o this makes it easier if the pharmacy professional is not familiar with the brand prescribed. It
would also aid in avoiding brand confusion

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Example: The prescription could state metronidazole 250 mg rather than Mezil 250 mg
Activity
Discuss amongst your colleagues the following situation:
A client comes to the pharmacy in the late evening for a prescription of
1) ‘X’ brand of indomethacin for severe pain & inflammation. You do not have ‘X’ brand stock,
there is no other pharmacy close by & the prescriber is not contactable. What do you do?
2) ‘Y’ brand from a reputed multinational has been prescribed for a severe chest infection. You
do not have the brand prescribed, and are not in a position to procure it for the client within 24
hours. What do you do?
b) Dosage form
- Some medicines are available in many different formulations.
- It is essential to check that the product on the prescription is available in the correct formulation,
and to correctly choose the formulation.
- Confusion and mistakes can be made if the name of the formulation is similar to another
formulation. For example, tablet formulations of a medicine are available as tablets of 25mg and
50mg, dispersible/effervescent tablets, and 100mg sustained release tablets.
The same medicine could be available as tablets, capsules, and even injections.
important to check the prescriber’s prescription for the dosage form.
if the dosage form is not specified, it is advisable to call up the prescriber and find
out, especially if the medicine is available as different formulations.
Examples, diclofenac available as 25mg, 50mg, 100mg tablets, 100mg suppository and
75m/3ml injection

c) Strength/potency of the medicine

The pharmacy professionals should check that the strength is mentioned.
There may be cases for prescribers to prescribe the medicine without the strength.
For example:
Paracetamol …………………………………….. Incorrect
Paracetamol 100 mg ……………………………. Correct

 If no strength is mentioned, it cannot be assumed that the lowest or highest strength has to be
dispensed. This is because many times the lower strength may not be sufficient to treat the
condition or higher strength may lead to toxicity. E.g. combination of amoxicillin &
clavulanate (Augmentin) is available as 1gm, 625mg, 412mg, 375mg, and so on. If a lower
dose is given for an adult it may not be sufficient to kill the microbial load and cure the
infection.
Example, the prescriber prescribes a combination of amoxicillin and clavulanate and mentions the
dose as take 5mL twice a day. It is available as amoxicillin 125mg+ clavulanic acid 31.25mg and
amoxicillin 200mg+ clavulanic acid 28.5mg. In this case the pharmacy professional has to be sure
about which preparation to dispense. The best option would be to consult the prescriber.
d) Quantity to be dispensed
o The prescription should lead to arrive at the exact number of the total quantity to be supplied to
the patient.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o The pharmacy professional should check this quantity to confirm that it is appropriate for the
patient, and that the product can be supplied in such quantity.
o For any product with a short expiry period, ensure that the quantity dispensed will not last longer
than the expiry date.
Example:
If the prescription reads ‘Hydrochlorothiazide 25mg tablets p.o per day for 3 months’ for a chronic
patient who has been taking the medicine since 3 years ago, on May 15, 2017, and the stock available
of Hydrochlorothiazide in the pharmacy has an expiry date of July 2017, and no fresh stock is
available, what to do? Is there a way to dispense for him all stocks? Here the patient should be politely
asked to show which stock he has been taking? Thereafter, he can be advised to take 30 or 60 tablets
according to the stock he has, and then to collect the balance tablets later when the pharmacy can
arrange for fresh stock.
In case the duration of therapy or total quantity to be dispensed is not mentioned, it will be necessary
to contact the prescriber.
e) Dosage and directions for use
 A knowledgeable and an alert pharmacy professional can be a great asset and a lifesaver
especially if the prescriber makes mistakes (at times major ones) while prescribing.
f) Contraindications
 The age, sex, disease(s) conditions, or other characteristics of a patient may cause certain
prescribed medicines to be contraindicated. The pharmacy professional should look out for
such contraindications.
 The dose should always be checked taking into account the patient's age, and weight
(especially for a child or for the elderly and pregnant woman).
Contraindications in pregnancy
 Pregnancy has the potential of causing women to increase their intake of drugs.
 Many of these drugs cross placenta and may induce deleterious effect on the foetus.
Factors that favour passage of drug through placenta
I. Lipid solubility
II. Molecular weight
III. Time of exposure
Teratogens
 Teratogens are drugs which cause physical malformation on the foetus.
 This malformation will occur at birth or at any time in the letter life.
FDA classification of drugs
 Food and drug administration classified drugs into Five Category
 For pregnant woman all categories, A, B, C, D and X should be checked; i.e.
I- Medicines under category ‘A’
 Adequate well controlled studies in pregnant woman do not show risk to the fetus.
Example: vitamins like B complex, minerals like iron.
II- Medicines under category ‘B ‘
o Either animal findings show risk and human findings do not, or, if no adequate human studies
have been done, animal findings do not show risk.
Example like ceftriaxone sodium injection, chlorpheniramine maleate
III- Medicines under category ‘C’
Human studies are lacking, and animal studies either show risk or lacking as well. However,
potential benefits may out way the potential risks.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Example: albendazole, aspirin with codeine phosphate.

IV- Medicines under category ‘D’

 Investigational or post marketing data show risk to the fetus .nevertheless, the potential benefits
may sometimes outweigh the risk.
Example: Atenolol, captopril, phenobarbitals
V.Medicines under category ‘X’
o Studies in animals or humans or investigational or post marketing surveillance reports show fetal
risk that clearly outweighs possible benefits gained from drug to the patient.
Example: ethinylestradiol and norethindrone, lovastatin, simvastatin, thalidomide, vitamin A,
warfarin sodium.
More examples:
Aspirin is not recommended for children ˂12 years age; so caution should be taken.
Atenolol is contraindicated in asthma.
 The pharmacy professional should always check that the dose, dosage regimen and any
directions for use are appropriate for the patient and the medicine.
 Any suspected medicine under dose/overdoses or inappropriate dosing should always be
referred to the prescriber.
 The dose should be carefully checked in case of children, and for all categories of potent
medicines. Confirm the units written on the prescription, i.e. milligrams, micrograms, decimal
points, etc. for medicines like digoxin.
Drugs Contraindication during Lactation
 Levodopa
 Bromocriptin
 Ergot alkaloids
 Some antibiotics: CAF, Ciprofloxacillin, etc.
 Benzodiazepines
 Anticancer drugs
 Narcotic drugs, etc.
Example:
 You need to check carefully whether the prescription states:
0.25 mg or 0.025 mg.
0.5mg or 50mg
0.125mg or 125mcg (microgram)
o The pharmacy professional should verify, whether the dosage prescribed is within the standard
minimum and maximum dose range. Use standard textbooks or reference books for the standard
dose.
o Develop a professional and good relationship with prescribers in the vicinity of the pharmacy or
with those whose prescriptions come to you, so that you feel confident and not afraid to
talk/discuss with the prescriber about a possible prescribing error.
g) Frequency of administration
 Check if the frequency recommended by prescriber is as per the standard dosing patterns.
 Doses more frequent than standard, proven doses may cause toxic manifestations.
 At the same time, doses lesser than standard, required doses may result in failure to treat the
condition properly.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 In addition to frequency of administration, adherence to the time schedule is also important. For
instance, patients taking medicines for hypertension have to take the medicine at the same time to
maintain blood levels of the medicine.

3. Correctness of the prescription

a) Checking double medication
 Same medicine or different medicine with same pharmacotherapeutic effect concurrently
prescribed by the same or different prescribers to the same patient undergoing treatment.
Example: If a patient has been prescribed diclofenac for fever, and if the dentist has
prescribed other NSAIDs for the same patient, it could lead to overdosing of NSAIDs,
and result in the risk of GI bleeding and may aggravate hypertension.

b) Interactions
Drug Interactions
 Drug interaction is a situation in which the effect of one drug is altered by prior or
concurrent administration of another drug.
 It is the modification of the effect of one drug (the object drug ) by the prior
concomitant administration of another (precipitant drug).
 An interaction is said to occur when the effects of one drug are changed by the presence
of another drug, herbal medicine, food, drink or by some environmental chemical agent.
 Many medicines are known to interact with other prescribed or OTC medicines, food, diseases,
herbal medicines, and laboratory results.
 Ideally, all multiple item prescriptions should be checked for medicine interactions.
(Unfortunately, checking for medicine interactions is a major problem in Ethiopia because of
the large number of medicines prescribed by prescribers.
 If a prescribed item is known to interact with many medicines or to interact with OTC
medicines then it is imperative that the pharmacy professionals check with the patient which
other medicines or traditional/complementary medicines the patient is taking, in order to
eliminate possible medicines interactions
 Any medicine interactions likely to render the therapy ineffective or cause undesirable effects
to the patient, or affect the treatment in any way, should be brought to the notice of the
prescribing prescriber (without unduly alarming patient).
Drug interactions are harmful to the patient:
 Increasing toxicity
 Increasing side effects
 Decreasing the therapeutic effect of co administered drugs
 The outcome can be harmful if the interaction causes an increase in the toxicity of the
drug.
 A reduction in efficacy due to an interaction can sometimes be just as harmful as an
increase E.g. patients taking warfarin who are given rifampicin.
 These unwanted and unsought-for interactions are adverse and undesirable.
Other interactions that can be beneficial and valuable:
 Increasing the therapeutic effect of the other drug
 Decreasing toxicity
 Decreasing side effects of co administered drugs.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Outcomes of drug interactions

1) Loss of therapeutic effect
2) Toxicity
3) Unexpected increase in pharmacological activity
4) Beneficial effects e.g additive & potentiation (intended)
or antagonism (unintended).
5) Chemical or physical interaction
e.g I.V incompatibility in fluid or syringes mixture
Mechanisms of drug interaction
 The mechanisms of interactions can be subdivided into those that involve the
pharmacokinetics of a drug, and those that are pharmacodynamics.
1. Pharmacokinetic interactions
1.1. Drug absorption interactions
(a) Effects of changes in gastrointestinal pH
 The passage of drugs through mucous membranes by simple passive diffusion depends
upon the extent to which they exist in the non-ionized lipid-soluble form.
 Absorption is governed by the pKa of the drug, its lipid-solubility, the pH of the
contents of the gut and various other parameters relating to the pharmaceutical formulation of
the drug.
(b) Adsorption, chelation and other complexing mechanisms
 Certain substances can bind with other drugs there by preventing absorption.
Example: TTC combines with metals such as calcium, magnesium, aluminium, etc.
Therefore, TTC should not be given with dietary items like Milk, antacids and iron
preparations
(c) Changes in gastrointestinal motility
 Most drugs are largely absorbed in the upper part of the small intestine.
 Drugs that alter the rate at which the stomach empties can affect absorption.
(d) Induction or inhibition of drug transporter proteins
 The oral bioavailability of some drugs is limited by the action of drug transporter
proteins, which eject drugs that have diffused across the gut lining back into the gut.
 The most well characterized drug transporter is P-glycoprotein.
(e) Malabsorption caused by drugs
 The effect is to impair the absorption of a number of drugs including digoxin and
methotrexate.
1.2. Drug distribution interactions
(a) Protein-binding interactions
 The binding of drugs to the plasma proteins is reversible, an equilibrium being
established between those molecules that are bound and those that are not.
 Only the unbound molecules remain free and pharmacologically active, while those that
are bound form a circulating but pharmacologically inactive reservoir which, in the case of
drugs with a low-extraction ratio, is temporarily protected from metabolism and excretion.
(b) Induction or inhibition of drug transport proteins
 Distribution of drugs into the brain, and some other organs such as the testes, is limited
by the action of drug transporter proteins such as P-glycoprotein.
 These proteins actively transport drugs out of cells when they have passively diffused
in.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

1.3. Drug metabolism (biotransformation) interactions

(a) Changes in first-pass metabolism
(i) Changes in blood flow through the liver
 A number of highly lipid-soluble drugs undergo substantial biotransformation during
this first-pass through the gut wall and liver.
 Some drugs can have a marked effect on the extent of first pass metabolism by altering
the blood flow through the liver.
(ii) Inhibition or induction of first-pass metabolism
 Some drugs can have a marked effect on the extent of first-pass metabolism by
inhibiting or inducing the cytochrome P450 isoenzymes in the gut wall or in the liver.
Example: grapefruit juice seems to inhibit the cytochrome P450 isoenzyme CYP3A4, mainly in
the gut, and therefore reduces the metabolism of oral calcium-channel blockers.
(b) Enzyme induction
 The extent of the enzyme induction depends on the drug and its dosage, but it may take
days or even 2 to 3 weeks to develop fully, and may persist for a similar length of time when
the enzyme inducer is stopped.
 Enzyme induction interactions are delayed in onset and slow to resolve.
(c) Enzyme inhibition
 More common than enzyme induction
 Unlike enzyme induction, enzyme inhibition can occur within 2 to 3 days, resulting in
the rapid development of toxicity
 The clinical significance of many enzyme inhibition interactions depends on the extent
to which the serum levels of the drug rise
(d) Genetic factors in drug metabolism
 Some of the cytochrome P450 isoenzymes are subject to genetic polymorphism.
1.4. Drug excretion interactions
 With the exception of the inhalation anaesthetics, most drugs are excreted either in the
bile or in the urine.
 Interference by drugs with renal tubular fluid pH, with active transport systems and
with blood flow to the kidney can alter the excretion of other drugs.
(a) Changes in urinary pH
 Passive reabsorption of drugs depends upon the extent to which the drug exists in the
non-ionised lipid-soluble form, which in its turn depends on its pKa and the pH of the urine.
(b) Changes in active renal tubular excretion
 Drugs that use the same active transport systems in the renal tubules can compete with
one another for excretion.
(c) Changes in renal blood flow
 The flow of blood through the kidney is partially controlled by the production of renal
vasodilatory prostaglandins.
2. Pharmacodynamics interactions
 Are those where the effects of one drug are changed by the presence of another drug at
its site of action.
 The drugs may directly compete for particular receptors but often the reaction is more
indirect and involves interference with physiological mechanisms.
a) Drug having opposite pharmacologic effect

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 If two or more drugs having opposite pharmacologic effect of one of these drugs
will be nullified by the effect of the other drug(s).
Example: effect of Insulin or Tolbutamide (hypoglycaemic agents) will be
counteracted by the effect of Thiazide if they are co administered.
b) Drug having similar pharmacologic effect
 Drug having similar pharmacologic effect will cause synergic effect if they are co
administered.
Example: giving CNS depressant when the patient had alcohol.
I. Additive or synergistic interactions
 Two drugs that have the same pharmacological effect are given together the effects can
be additive.
 Additive effects can occur with both the main effects of the drugs as well as their
adverse effects.
II. Antagonistic or opposing interactions
 Drugs have activities that are opposed to one another.
Drug-food interactions
 Food can cause clinically important changes in drug absorption through effects on
gastrointestinal motility or by drug binding.
 food may affect absorption of drugs due to:
 Dilution of the drug
 Adsorption and complexation
 Alteration of gastric emptying time.
Effect of food on some drugs
a) Food reduces absorption of Aspirin, INH, TTC, Ampicillin, Cloxacillin, Rifampicin, etc.
b) Absorption of Hydralazine, Lithium, Propranolol, etc is increased in the presence of food.

 Tips for Managing Drug Interactions

1. Using relevant and updated references or checklist
2. Consistently following the 6 steps of dispensing
3. Ask the patient what additional drugs he/she is taking(using) at home
o On OTC basis
o On Prescription only basis (POM)
o Herbal or traditional medicines
o Recreational drugs
4. Assessing if the current medications on the prescription interact with each other or with those
mentioned in no 3.
5. Determine the type of interaction
• (Pharmacokinetic or Pharmacodynamics; drug –drug, or drug – food, or drug – laboratory value,
drug- disease interactions)
6. Ruling out whether the interaction is significance or not; with emphasis given to the significant
types
7. If the drugs interact, listing all the possible consequences of the interaction
o Enhanced toxicity
o Therapeutic failure including drug resistance
o Beneficial effect etc.
8. Recognizing the interaction /s/ by assessing sign and symptoms of the interaction
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

9. Management of the interaction

 Timing between doses of each interacting drugs or foods
 Dose adjustment
 Switching to/substitute with safer alternative
 Effective counseling, etc…
10. Documentation and Reporting of drug interactions
c) History of overuse, under use or misuse of medicines by the patient.
d) Check for overwriting
 Overwriting can be done by the patient, to buy extra medicines (especially habit
forming medicines or medicines of abuse).
e) Fake/false prescription
 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.
 Do not dispense such prescriptions & be sure to alert the prescriber about the misuse.
f) For potent medicines, and medicines with a narrow therapeutic index
 Special care has to be taken with such medicines, as slight changes in systemic
concentration lead to marked changes in pharmacodynamic responses.
 E.g., of narrow therapeutic index medicines: digoxin, lithium, phenytoin, warfarin
g) Special care has to be taken in case of:
o Medicines with similar names
o Abbreviations
h) Changes to the prescription
 Before a pharmacy professional attempts to dispense a prescription, he/she must read and
understand it thoroughly.
 If any portion of prescription is not understood, or has detected an incompatibility, he/she
should consult pharmacist/ the prescriber who wrote the prescription.
 Any changes made to the prescription over the telephone by the prescriber, should be recorded
on the prescription, with the words “changes made over the telephone, in consultation with the
prescriber at (time) on (date)” and should be signed and stamped by the pharmacy professional.
This exercise facilitates a trust based professional relationship with the prescriber, besides
documenting the changes made to the legal document - the prescription, by the pharmacy
professional.
 Many pharmacy professionals hesitate to call the prescriber about these matters, but, if the calls
are executed tactfully, there is no reason why they should not create a better understanding
between the persons of both professions.
4. Therapeutic aspects
a) the safety of the medicine
 Choosing effective group of medicines according to efficacy, safety, suitability and cost of
treatment.
Example:

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o The benefit of adding digoxin to a diuretic and vasodilator counterpart the risk of its
toxicity in the treatment of congestive cardiac failure. This might depend on the cause of the
heart failure, patient compliance, renal function and ease of monitoring of plasma digoxin
concentration.
o The benefit from a course of antibiotic in treating urinary tract infection in two months
pregnant as compared to the risk of treatment to the fetus. Here the risk of teratogenesis
needs to be compared to the risk of renal damage to the mother as a result of untreated
infection.
b) possible contra-indications: e.g., avoid aspirin in a patient on warfarin treatment
c) drug/drug interactions
d) drug/food interaction
e) drug/disease interactions, and
f) Treatment duplications.
5. Appropriateness of the individual
 Confirm that the dose and duration of prescribed medicine are in the normal range for the
patient (noting sex and age or weight)
 NB. Under no circumstances should an untrained person attempt to read or discuss the
prescription with the client.
Prepare Labels for Dispensed Medications
Definition of Labels
 Label is a slip of paper or other material, marked or inscribed, for attachment to medicines to
indicate its manufacturer, nature, ownership, destination, etc.
 The prescription label provides information to the patient regarding the dispensed medication
and how to take it.
 Additionally, the label includes information about the pharmacy, the patient, the prescriber, and
the prescription or transaction number assigned to the prescription.
Reason for having labels
o indicate clearly the contents of the container
o indicate clearly to patients how & when medicinal product should be taken or used
o indicate clearly to patients how the product should be stored and for how long
o indicate clearly to patients any warnings or cautions need to be made aware.
Contents of label
 Minimum drug label information should include the following:
o Patient name
o Generic name, strength and dosage form of the medicine
o Dose, Frequency and Duration of use of the medicines
o Quantity of the medicine dispensed
o How to take or administer the medicine?
o Storage condition
o For extemporaneous preparations a batch number may be included.
 All labels must be unambiguous, legible, accurate and comprehensible.
Direction for use
 Directions should start with a verb (take, instill, inhale, insert, apply) and completely,
clearly, and accurately describe the administration of the medication.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Indicate the route of administration. E.g., ‘take one capsule by mouth,’ ‘apply to affected
area,’ ‘insert rectally,’ ‘place one tablet under the tongue,’ etc.
 Use whole words, not abbreviations. E.g., use ‘tablets’ not ‘tabs.’
 Use familiar words, especially in measurements. E.g., use ‘two teaspoonful’ or ‘10 mL’ as
most measuring droppers and spoons are calibrated in teaspoons and mL.
 Double check that the units listed on the label match the units on the measuring spoon or
dropper supplied
Auxiliary labels
 Colored auxiliary labels may be applied to the prescription container to provide additional
information to the patient (Shake Well, Keep Refrigerated, Take with Food).
 Many computerized prescription systems will automatically print out the appropriate labels to
use.
Examples of auxiliary labels
TAKE WITH FOOD
MAY CAUSE DROWSINESS
DONOT DRINK ALCOHOL BEVERAGES WHEN TAKING THIS MEDICINE
TAKE MEDICATION ON EMPTY STOMACH
THIS DRUG MAY IMPAIR YOUR ABILITY TO DRIVE OR OPERATE MACHINERY
FOR EXTERNAL USE ONLY
AVOID PROLOGED EXPOSURE TO SUNLIGHT WHILE TAKING THIS MEDICINE
Labels Characteristics
1. Legible
 Always check label print size and quality to ensure that it can be read clearly.
 If there is too much information to place on one label, consider placing the additional
information on a secondary label, rather than reducing the size of the print or trying to
include too much information on one label.
2. Concise
 Although it is important that sufficient information is placed on the label, it must be
remembered that it is important not to confuse the patient by placing too much
information on the label.
 If the label contains too much information, rather than assisting patients, they may feel
overwhelmed and as a result they may read none of the information.
3. Adequate
 Ensure that sufficient information is given. For example, the term ‘when required’
raises the questions how much? How often? When required for what?
4. Accurate
 It is important that the title is accurate, the instructions are accurate and that the
patient name is complete and accurate.
Labeling problem of drug retail outlets of Ethiopia
 dispensed medicines without a label
 incomplete label, or illegible label.
 used paper envelops size may not allow to write required information.
Case study
Ato Kebede went to a pharmacy with a prescription for nitroglycerin sublingual tablets. The pharmacy
worker repackaged the prescribed number of tablets in paper envelops and dispensed with appropriate

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

instructions for use. Some other day, Ato Kebede consulted the pharmacy professional about
decreasing efficacy of the medicine dispensed.
Comment on the cause of decreasing effectiveness of the dispensed medicine.
Discussion: Nitroglycerin is volatile medicine. It should be repackaged in tightly closed containers
(bottles). The use of paper envelops for repackaging leads to a reduced efficacy of nitroglycerin, a
possible reason for the complaint of Ato Kebede.
Case study
The pharmacy professional received a prescription with the following information:
Ibuprofen 400mg tablet Mitte 60 One t.i.d.
The pharmacy professional dispensed 60 tablets of ibuprofen 400mg and wrote a label that the patient
should take three tablets daily with or after food.
Comment on dosage.
Discussion: The prescription was to take one tablet three times a day. The information on the label is
not clear. Accordingly, the patient may take three tablets at a time, which may lead to an occurrence of
adverse effects or loss of efficacy. Understanding the meaning of Latin abbreviations that may appear
on the prescription papers is important.
HANDLING AND DISPENSING OF NARCOTIC AND PSYCHOTROPIC
DRUGS
Definition:- Narcotic and Psychotropic drugs shall mean any drugs suggested to control according to
Narcotic and Psychotropic drugs convention of united nations verified by Ethiopia.
 Any Narcotic or psychotropic substance shall only be dispensed in accordance with narcotic
drug or psychotropic drug prescription only that is properly written and signed by authorized
medical practitioner.
 It should be prescribed using only special prescription paper meant for such drugs.
FILLING THE NARCOTIC AND PSYCHOTROPIC PRESCRIPTION
 Any dispenser shall fill or dispense these prescription if:
a) Prescription fulfil the narcotic, psychotropic prescription format
b) Prescription is no copy (photo copy)
c) The narcotic psychotropic are prescribed on their prescription only.
d) No more than one narcotic or psychotropic drugs prescribed on a single
prescription.
e) The serial number of the prescription is not deleted.
f) Fifteen days have not elapsed since the date on which it was issued.
g) The right drug is prescribed in the right prescription paper.

 During dispensing of Narcotic and psychotropic prescription the Dispenser should:

 Check if the prescription is legible and neat in appearance.
 Check quantities, directions or dosage that are un usual.
 Register and keep the filled prescription for at least 5 years.
 Do not dispense copied prescriptions.
PROHIBITION IN NARCOTIC AND PSYCHOTROPIC DRUGS
1. Prescribing narcotic psychotropic drugs on ordinary prescriptions.
2. Dispensing narcotic psychotropic drugs with ordinary prescriptions
3. Using narcotic psychotropic prescription to prescribe other drugs than controlled drugs.
4. Prescribing / dispensing more than one drug in a single prescription.
5. Prescribing narcotic drugs on psychotropic prescription or vice versa.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

6. Dispensing of narcotic psychotropic prescription after the elapsing of 15 days from the date
on which it was issued.
Modern method of prescribing
 Now a days the majority of drugs are available in the market as readymade formulations
manufactured by different pharmaceutical companies.
 Thus in present day the role of the pharmacist is to dispense the readymade product and to
advice the patient:
 regarding dose  adverse drug reactions
 mode of administration  storage conditions
 schedule of administration  precautions. Etc.
 drug interaction
 Rather writing prescription is more significant.
 The prescription should be precise accurate and clear and easily readable.
 As much as possible Latin words and abbreviations should be avoided.
 A drug is better prescribed by its official or Generic name.
 There are certain advantages and disadvantages of prescribing drug by its proprietary ( trade )
name.
Advantage of trade (brand) name
 It is easy to remember trade names because they are attractive
Example:
 Augmentin = Amoxicillin +  Meazil = Metronidazole
clavulic acid  Daonil = Glibenclamide
 Amiral = Amitriptyline  Vermox = mebendazole
 Sinamet = Levodopa +
carbidopa
 It is easy to communicate with patient.
 The bioavailability of the drug may change of additives used in the drug formulations
manufactured by different companies. So only those propriatory product which have better
bioavailability should be prescribed.
Sources of error in prescription writing and dispending
1. Inappropriate prescribing of drugs by prescribers
2. Dispensing error. This could be due to:-
 Wrong interpretation of abbreviation and some Latin terms
 Guessing of unreadable and unclear prescription.
 Dispensing one instead of the other particularly if the shelf is arranged
alphabetically.
3. Patient themselves: if the patient did not tell all the signs and the symptoms of his disease.
Delivering drug to the patient
 The prescribed drugs should directly delivered to the patient or patient family and instructions
should be told correctly to increase patient compliance.
 What is patient compliance?
 Compliance is with therapy it is obeying instructions given correctly about the way of
administration, dosage, frequency, etc.
Synonyms: adherence, persistence, concordance.
 The term non-compliance is the opposite of the former term and it suggests that there is
fault on the correct use of medications.
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Types of non-compliance
1. Failure to have the prescription dispensed or renewed
2. Omission of doses
3. Errors of dosage
4. Incorrect administration of therapy
5. Premature discontinuation of therapy.
Consequences of non-compliance
 In many cases non-compliance result in under use of drugs i.e the patient will not have
the therapeutic benefit and this in turn may lead to worsening of the present condition
or it may lead to other complication of the condition being treated.
Factors associated with non-compliance
1. Disease: the nature of patients illness may lead to non-compliance.
Example:- Psychosis, chronic disease
2. Treatment regimen
a) Multiple drug therapy
 The greater the number of drugs a patient is taking the higher risk of non-compliance.
b) Frequency of administration
 The larger the frequency of administration the higher risk of non-compliance.
c) Duration of therapy
 The risk of non-compliance is greater as the duration of therapy is prolonged.
d) Adverse events
 If a drug has discouraging adverse effects patient will be non-compliant
Example: - Anticancer therapy – loss of hair
 Antipsychotic, antidepressants and antihypertensive agents - sexual dysfunction
e) Taste of medication
 This is a big problem of children
 Can be improved by adding flavours during formulations
3. Failure to know the importance of therapy
 Patients know little about their disease and treatment benefit it of a drug. So, they establish
their own belief and expectation and if the drug does not meet their expectation, they are
more likely to be non-compliant.
 Educating patients about the limitation and benefit of treatment agent and about their
condition have role in minimizing non-compliance.
4. Poor understanding of instructions

Classification of medication
1. Prescription only medicines (POM) the legend drugs
 Are drugs that one considered useful only after expert diagnosis or too dangerous for in
self- medication.
2. Non-prescription (NP) medicine / over the counter (OTC) drugs
 Are drugs deemed safe enough for use by the layman in the self-treatment of simple
conditions for which competent medical care is not sought.
 OTC drugs are medicines that may be sold directly to a consumer without a prescription
from pharmacy personnel, as compared to prescription drugs, which are dispensed only to
consumers possessing a valid prescription.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 The Food, Medicines and Healthcare Administration and Control Authority (FMHACA) of
Ethiopia decide whether a medicine is safe enough when used without prescription.
 Though these drugs are legally classified as over-the-counter (i.e., no prescription is required),
they still have some risks.
 Some interact with other medicines, supplements, foods or drinks. Others cause problems for
people with certain medical conditions.
 Therefore it has to be dispensed by pharmacy personnel with a sufficient counselling about the
condition as well as the medicament besides the maximum quantity dispensed at one time
should be determined.
 As a general rule, over-the-counter medicines have to be used primarily to treat a condition that
does not require the direct supervision of a doctor and they are proving to be reasonably safe
and well-tolerated.
Criteria to determine whether the drug is OTC/ POM
I. Safety of drugs
II. Liability for abuse / dependency
III. Ability of the patient to recognize and diagnose the condition
IV. Ability of the patient to extract key information from the leaflet
V. Requirement of drug medical supervision

Name Strength Dosage Form, Maximum Quantity Allowed to be Dispensed Of OTC drugs
Antacids
1. Aluminum Hydroxide 320 mg/5 ml 360 mg/5 ml 500 mg Mixture/Gel Suspension Tablet
(Chewable), 2 bottles, 30 tablets
2. Aluminum Hydroxide + Magnesium Hydroxide, 220 mg + 195 mg/5ml 400 mg + 400 mg
Suspension Tablet (Chewable), 2 bottles 30 tablets
3. Aluminium Hydroxide+ Magnesium Hydroxide+ Simethicone, 225mg+200mg+25mg/5ml
Suspension 2 bottles
4. Aluminum Hydroxide + Magnesium Trisilicate, 310 mg + 620 mg/5ml 120 mg + 250 mg ; 250 mg
+ 500 mg, Suspension Tablet (Chewable), 2 bottles 30 tablets
5. Magnesium Hydroxide 375 mg/5 ml, 7.75 % 300 mg; 311 mg, Mixture Tablet (Chewable)
2 bottles 30 tablets
6. Magnesium Trisilicate 500 mg Tablet (Chewable) 30 tablets

Antispasmodics/Spasmolytic Analgesics
1. Hyoscine (Scopolamine) Butylbromide, 5mg/5ml 10mg 7.5mg, 10mg, Drops Tablet Suppository, 1
bottle 10 tablet 10 suppositories
Antiemetic
Dimenhydrinate 50mg Tablet, 15 tablets
Cathartics and Laxatives
Bisacodyl 5mg, 10mg 5mg Suppository Tablet, 10 suppositories 10 tablets
2. Cascara Sagrada 125mg Tablet 10 tablets
3. Glycerin 1g, 1.36g, 2g, 2.76g Suppository 10 suppositories
4. Magnesium Sulphate Oral powder 1 sachet 5. Psyllium Powder 1 bottle
6. Senna total sennosides, 7.5mg Tablet 10 tablets
Medicines Used for Diarrhea
1. Oral Rehydration Salt Powder 4 sachets

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Antiflatulents
1. Activated Charcoal 125mg, 250mg Tablet 20 tablets
2. Simethicone 60mg, 80mg, 95mg 95 mg, 125 mg, Tablet (chewable) Capsule
20 tablets 20 capsules
Antihaemorrhoidal Agents
1. Bismuth Subgallate Compound* (Bismuth Subgallage +Bismuth Oxide + Peru Balsam+ Zinc
Oxide) , 2.25% +0.875%+ 1.875% +10.75% , 59mg +24mg +49mg +296mg Ointment
Suppository, 2 tube, 10 suppositories
Antiasthmatics
1. Ephedrine + Theophylline 6mg + 30mg/5ml 2.24% + 0.30% 11mg + 120mg, Elixir Syrup Tablet, 1
bottle 1 bottle 30 tablets
2. Salbutamol (Albuterol) 0.1mg/dose, 2mg/5ml, Oral Inhalation (aerosol) Syrup, 1 canister
1 bottle
Antitussives/Expectorants/Mucolytics
1. Bromhexine Hydrochloride 4mg/5ml Elixir 1 bottle
2. Dexchlorpheniramine 2mg/5ml 2mg, 4mg, 6mg Syrup Tablet, 1 bottle 10 tablets
3. Dexchlorpheniramine + Guaifenesin + Pseudoephedrine 2mg +100mg + 20mg/5ml
Syrup 1 bottle
4. Dextromethorphan Hydrobromide, 15mg/ml 5mg,7.5mg,15mg/5ml 15mg Drops Syrup Tablet, 1
bottle 1 bottle 10 tablets
6. Dextromethorphan Hydrobromide + Guaicol Sulphonate 0.3gm+7.6gm/100ml Syrup, 1 bottle
7. Diphenhydramine+ Sodium Citrate+ Ammonium Chloride 12.5mg +60mg + 130mg/5ml
Syrup 1 bottle
8. Guaifenesin 100mg, 200mg 200mg 100mg/5ml, Tablet Capsule Syrup, 15 tablets 15 Capsules 1
bottle
9. Theophylline+ Guaifenesin 150mg + 90mg; 300mg + 180mg, 150mg + 90mg/15ml 150mg + 90mg
Capsule Elixir Tablet, 30 capsules, 1 bottle 30 tablets
Analgesics / Antipyretics
1. Acetylsalicylic Acid 75mg, 100mg, (soluble); 300mg,324mg(microfined) 75mg, 81mg, 100mg,
500mg (enteric coated), Tablet 20 tablets
2. Diclofenac Sodium 25mg, 50 mg Tablet 20 tablet
3. Ibuprofen 300mg 200mg, 400mg (enteric coated, optional) 100mg/5ml Capsule Tablet Syrup 20
capsules 20 tablets 1 bottle
4. Paracetamol 100mg/ml 125mg, 250mg 120mg/5ml, 250mg/5ml 100mg, 500mg Drops Suppository
Syrup Tablet 1 bottle 15 suppositories 1 bottle 20 tablets
Antimigraine Headache Medicine
1. Acetylsalicylic Acid + Paracetamol+ Caffeine 250mg + 250mg + 65mg Tablet 20 tablets
Antirheumatics
1. Acetylsalicylic Acid 300mg,324mg (microfined) 500mg (enteric coated) Tablet 20 tablets
2. Acetylsalicylic Acid + Paracetamol + Caffeine 250mg + 250mg + 65mg Tablet 20 tablets
3. Ibuprofen 300mg 200mg, 400mg (enteric coated, optional) 100mg/5ml , Capsule Tablet
Syrup, 20 capsules 20 tablets, 1 bottle
Anthelmintics
1. Albendazole 100mg/5ml 200mg, 400mg, Oral Suspension Tablet, 3 bottles 6 tablets
2. Levamisole 40mg Tablet 6 tablets
3. Mebendazole 100mg/5ml 100mg, 500 mg Oral Suspension Tablet 2 bottles 12 tablets

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

4. Niclosamide 500mg Tablet (chewable) 4 tablets

5. Piperazine 500mg, 622.5mg, 706mg, 750mg,937.5mg, 1g /5ml Elixir 2 bottles
6. Pyrantel Pamoate 250mg base/5ml 125mg base Oral Suspension Tablet 1 bottle 8 tablets Vitamins
1. Ascorbic Acid (Vitamin C ) 200mg/ml 100mg, 500mg, 1g, Drops Tablet, 1 bottle 30 tablets
2. Multivitamin Preparations* Drops Syrup Tablet, 1 bottle 1 bottle 30 tablets
3. Multivitamin with Minerals and/or Extracts, Drops Syrup Tablet, 1 bottle 1 bottle 30 tablets
4. Vitamin B Complex Preparations, Tablet 30 tablets
Ear, Nose and Throat Preparations
1. Amyl-Meta-Cresol + Dichlorobenzyl Alcohol, 0.6mg + 1.2mg Lozenges 30 Lozenges
2. Chlorhexidine Gluconate
0.12% Oral Solution 1 bottle 3. Dequalinium Chloride 0.25mg Lozenges 30 Lozenges
4. Hexetidine 0.1% Solution 1 bottle(500 ml)
5. Hexidine 0.1gm/100ml, 0.2% Oral Solution, 1 bottle
6. Hydrogen Peroxide 1.5%, 3% Solution, 1 bottle
7. Menthol + Eucalyptus Oil + Light Magnesium Carbonate 2% +10% 7% Inhalation 1 bottle
8. Saline Solution 0.09% Solution 1 bottle

Antihistamines And Antiallergics

1. Chlorpheniramine Maleate 2mg/5ml 2mg, 4mg, 6mg, Syrup Tablet, 1 bottle 15 tablets
2. Dexchlorpheniramine Maleate 2mg, 4mg, 6mg 2mg/5ml, Tablet Syrup, 15 tablets 1 bottle
3. Pheniramine Aminosalicylate 50mg, 75mg Tablet 15 tablets
Anti-infectives, Topical
1. Benzoic Acid+ Salicylic Acid 6% +3%, 12% +6% Ointment 2 tubes
2. Benzyl Benzoate 25% Lotion 300 ml
3. Gamabenzene Hexachloride 1% Cream 1 tube
4. Gentian Violet 0.5%, 1% Solution 1 tube
5. Salicylic Acid 2%, 5%, 10% Ointment 1 tube
6. Selenium Sulphide 2.5% Suspension 1 bottle
7. Sulphur 5%, 10% Ointment 1 tube
8. Zinc Undecenoate + Undecenoin Acid 20% +5% 20% +2% 20% +2%, Ointment Powder Powder
(aerosol), 1 tube 1 bottle 1 bottle
Keratolytics /Caustics Agents
1. Camphor Cream, Lotion, Solution 1 tube/bottle
2. Salicylic Acid 2%, 5%, 10% Ointment 1 tube
3. Salicylic Acid + Lactic Acid + Polidocanol, 2gm+0.5gm+0.2gm /10gm
Tincture 10 gm
Topical Agent For Psoriasis and Eczema
1. Ichthammol 10%, 20% Ointment 1 tube
Antiprurities
1. Calamine 5% Lotion 1 bottle 2. Calamine + Zinc Oxide 4%+3% 15%+5% Cream, Lotion
1 tube, 1 bottle
Skin Disinfecting Agents
1. Chlorhexidine Gluconate + Cetrimide 1.5%+15%, 0.3%+3%w/v, Solution 1 bottle
2. Ethyl Alcohol 70% Solution 1 bottle
3. Hydrogen Peroxide 3%, 6% Solution 1 bottle
4. Iodine 2% Solution 1 bottle

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Dermatologicals, Others
1. Methylsalicylate, Ointment 1 tube
2. Talc Dusting Powder Powder 1 bottle
Contraceptives
1. Drospirenone +Ethinyl Estradiol 3mg +0.03mg Tablet (Film Coated), 1 pack
2. Levonorgestrel (D-Norgestrel) 0.75mg Tablet 1 pack
3. Levonorgestrel (D-Norgestrel)+ Ethinylestradiol with/without Iron*, 0.15mg + 0.03mg; 0.25mg +
0.05mg, 0.5mg + 0.05mg, Tablet 1 pack 0.3mg + 0.03mg, 0.05mg +0.03mg (6tablets), 0.075mg +
0.04mg (5tablets), 0.125mg +0.03mg (10tablets)
4. Norethindrone (Norethisterone) + Ehinylestradiol 0.5mg +0.035mg Tablet 1 pack
5. Norethindrone (Norethisterone) + Mestranol and Iron*, 1mg +0.05mg Tablet 1 pack
6. Condoms (Male, Female) As needed
* Each iron tablet contains: Ferrous Fumarate-75mg
POSOLOGY
 Posos meaning how much and logos meaning science.
 Posology is a branch of medical science which deals with dose or quantity of drugs which can
administered to a patient to get the desired pharmacological actions.
 The drug dose is estimated to target therapeutic level of the drug to the body.
 The drug can be classified into three:
i. The usual dose
ii. Under dose
iii. Over dose
 The usual dose: the dose of a drug expected to give the designed therapeutic effect of the drug
on a majority of the patient or that amount which may be expected to produce in the majority
the medicinal effect for which it is indicated.
 Dose less than usual dose are called under dose
 Dose greater than usual dose are called over dose.
 The dose of a drug cannot be fixed rigidly because there are so many factors that influence the
doses.
Factors influencing dose and action of drugs
 The optimum dose of a drug which produces the desired therapeutic effect varies from person
to person, because every individual varies both in degree and character of response produce by
drug. due To these reasons the dose of official preparations of drugs are expressed in the form
of a range which influence the dose.
1. Age
 The pharmacokinetics of many drugs changes with age.
 So while determining the dose of a drug, age of an individual is a great significance.
 Children’s and old people need lesser amount of drug than the normal adult dose, because they
are unable to excrete drugs to that extent as adult.
 The variation of body composition and the maturity of liver and kidney potential source of
differences in pharmacokinetics with respect to age.
Infant and children
 In general complete hepatic function and renal function are not attained and/or matured in
infant and children.
 New born show only 30 to 50% the renal activity of adults on the basis of activity per unit of
body weight.
2. Weight
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Weight of an individual can influence the action of a drugs

 Dosing by actual body weight may result in over dose for drugs such as the Aminoglycosides
eg. Gentamycin that are very polar and are distributed in extra cellular fluids.
 On contrary drugs that are polar and high volume of distribution like Digoxin, Barbiturates,
Antipsychotics need dose increment in obese patients.
3. Presence of disease
 Drug like barbiturates and chlorpromazine may produce usually prolonged effect patients
having liver cirrhosis.
 Streptomycin is excreted mainly by kidney may prove toxic if the kidney of the patient is not
working properly.
4. Simultaneous administration of two or more drugs
a) Addition: the effect produced is the algebraic sum of the two drugs.
b) Synergism: the effect produced is greater than the algebraic sum of the two drugs
c) Antagonism: when two drugs having opposite effect.
5. GI emptying time and food.

Calculate prescription quantities

 Proper dosing of medications is important to ensure patient safety.
 Calculating dosages, dosage regimens, and compounding formulas involves the use of simple
math principles.
 You can solve many of these problems by setting up ratios and proportions using the
information given in the question and keeping like units consistent.
 In order to calculate quantity and day supply, it is important to understand unit of measure and
Latin abbreviations used on prescriptions.
 A review of unit of measure abbreviations and Latin abbreviations are beyond the scope of this
module.
 Readers are encouraged to refer to the dispensing medicine module I and pharmaceutical
science module.
Definition of Doses:
 The dose of a drug is the quantitative amount administered or taken by a patient for the
intended medicinal effect.
 The dose may be expressed as a single dose, the amount taken at one time; a daily dose; or a
total dose, the amount taken during the course of therapy.
 A daily dose may be subdivided and taken in divided doses, two or more times per day
depending on the characteristics of the drug and the illness. The schedule of dosing (e.g., four
times per day for 10 days) is referred to as the dosage regimen.
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
pharmaceutical science module I. You can solve these calculations by setting up ratios and
proportions, keeping like units consistent, and cross-multiplying.
The dose of a drug is based on:
o biochemical and pharmacologic activity

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o physical and chemical properties

o the dosage form used
o the route of administration, and
o various patient factors
Calculating the number of doses
 To calculate the number of doses, you should first determine which information presented is
actually applicable to the question. Too often mistakes are made on dosage calculations
because we overcomplicate them.
Dose Measurement
 In the institutional setting, doses are measured and administered by professional and
paraprofessional personnel.
 In the home setting, the adult patient or a child’s parent generally measures and administers
medication.
 Exceptions occur when home health care personnel are involved in a patient’s care.
 Liquid dosage is usually measured in ‘‘household’’ terms, most commonly by the teaspoonful
and tablespoonful.
 An oral dispenser finds use in administering calibrated quantities of liquid medication to
children. For calculating dosages, useful equivalent measures are provided.
Teaspoon and Tablespoon
 In calculating doses, pharmacy personnel and physicians accept a capacity of 5 mL for the
teaspoonful and 15 mL for the tablespoonful.
Table: Useful approximate equivalent of household measure

1 Teaspoonful = 5 mL
1 Tablespoonful = 15 mL
1 Tea cupful = 120 mL
A wine glassful = 60 mL
A tumblerful = 240 mL (1 full glass)

The Drop as a Unit of Measure

 The drop (abbreviated gtt) is used as a measure for small volumes of liquid medications.
 A drop does not represent a definite quantity, because drops of different liquids vary greatly.
 In an attempt to standardize the drop as a unit of volume, the United States Pharmacopeia
defines the official medicine dropper as being constricted at the delivery end to a round
opening with an external diameter of about 3 mm.
 The dropper, when held vertically, delivers water in drops, each of which weighs between 45
and 55 mg. accordingly, the official dropper is calibrated to deliver approximately 20 drops of
water per milliliter (i.e., 1 mL of water 1 gram or 1000 mg ÷ 50 mg /drop = 20 drops).
General Dose Calculations
 A pharmacist often needs to calculate the size of a dose, the number of doses, or the total
quantity of medication to dispense.
 For these calculations the following equation is useful with the terms rearranged depending on
the answer required. In using the equation, the units of weight or volume must be the same for
the total quantity and size of the dose.

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon
Total quantity
Number of doses=
¿ dose
Example Calculations of the Number of Doses
1. If the dose of a drug is 200 mg, how many doses are contained in 10 g?
10 g = 10,000 mg
10 , 000(mg)
Number of doses= =50 doses
200( mg)
Or, Solving by dimensional analysis:
1 dose 1000 mg
x x 10 g=50 doses
200 mg 1g
2. If the dose of a drug is 50 µg, how many doses are contained in 0.020 g?
0.20 = 20 mg
0.020g=20mg
50µg= 0.05mg
20 mg
Number of doses= =400 doses
0.05 mg
Example Calculations of the Size of a Dose
Total quantity
¿ doses=
Number of doses
 The size of the dose is expressed in whatever denomination is chosen for measuring the given
total quantity.
1. How many teaspoonful would be prescribed in each dose of an elixir if 180 mL contained 18
doses?
180 ml
¿ doses= =2 teaspoonfuls(10 ml)
18 doses
2. How many drops would be prescribed in each dose of a liquid medicine if 15 mL contained 60
doses? The dispensing dropper calibrates 32 drops/ml.
480 ( drops )
15 mL= 15 x 32 drops = 480 drops, ¿ doses= = 8 drops
60
Example Calculations of the Total Quantity of Product
Total quantity = Number of doses x Size of dose

 It is convenient first to convert the given dose to the denomination in which the total quantity is
to be expressed.
1. How many milliliters of a liquid medicine would provide a patient with 2 tablespoonfuls twice a
day for 8 days?
Number of doses = 16
Size of dose = 2 tablespoonful or 30 mL
Total quantity =16 x 30 mL = 480 mL
2. How many milliliters of a mixture would provide a patient with a teaspoonful dose to be taken
three times a day for 16 days?
Number of tsp doses = 16 x 3 = 48 tsp
Total quantity = 48 x 5 mL = 240 mL
3. How many grams will be needed to prepare 72 dosage forms if each is to contain 30 mg?
Number of doses = 72
Size of dose = 30 mg
Total quantity = 72 x 30 mg = 2160 mg = 2.16 g
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

4. It takes approximately 4 g of ointment to cover an adult patient’s leg. If a physician prescribes an

ointment for a patient with total leg eczema to be applied twice a day for 1 week, which of the
following product sizes should be dispensed: 15 g, 30 g, or 60 g?
Number of doses = 2 per day x 7 days = 14
Size of dose =4g
Total quantity =14 x 4 g = 56 g; thus, 60 g product size
Splitting Tablets
 A number of tablets are scored, or grooved, to allow breaking into approximately equal pieces
(usually halves). This allows dosage flexibility, particularly when a patient is started at a half
dose and then is titrated up to a full dosage level. It also enables a patient to take a product at a
strength that is not otherwise available.
 Patients use tablet-splitting devices to cut scored or unscored tablets for economic reason.
 For some medications, the price of tablets of twice the strength required is similar to the lower-
strength tablets, and the patients can double his or her supply by tablet splitting.
o this practice often results in unequal portions of tablets, thus uneven doses.
 Additionally, patients may not be aware that many solid dosage forms should not be cut or
crushed but must remain intact for proper drug absorption. However, for tablets that can be
crushed without destroying desired absorption characteristics, tablet crushing is a commonly
employed practice for home- or institutional-patients who are unable to swallow intact solid
dosage forms. In these instances, mortars and pestles or specially designed tablet crushers are
used. After crushing, the resulting particles may be suspended in a beverage or mixed with a
foodstuff as yogurt prior to administration.
Calculating the quantity of doses
 Always use the higher dosage amount when performing dosage calculations on prescriptions
that have a range for the dose. This will provide the most conservative solution and ensure the
most accurate potential for days’ supply.
 To calculate the appropriate quantity to dispense, use the following formula:
Quantity to dispense = Dose x Frequency x Duration of treatment

Example:
1. How many tablets are provided in the prescription below?
Phenobarbitone on hand 15mg tablet
Rx - Phenobarbitone 30mg tablet po BID for 30 days
15mg = 1tablet
Dose = 1 tablet
Frequency = BID= every twelve hours= 2 tablet
Duration = 30 days
 Quantity to dispense = Dose x Frequency x duration
= 1x2x30 = 60 tablets
 Therefore, the quantity to dispense is, 60 tablets
2. Rx - Penicillin G, Crystalline sodium 3 MIU IV, QID, for 7 days
Hint: 1 vial of Crystalline sodium injection = 1 MIU
 Calculate the quantity you dispense for this patient?
Vial = 1 MIU
Dose = 3 MIU
Frequency = Every six hours= 4

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Duration = 7 days
Quantity to dispense = Dose x Frequency x Duration
= 3 x 4 x 7 = 84 vials
Exercises:
1. How many capsules, each containing a 150-mcg dose of a drug may be prepared from 0.12 g of
the drug?
2. The following regimen for oral prednisone is prescribed for a patient: 50 mg/ day x 10 days; 25
mg/day x 10 days; 12.5 mg/day x10 days; 5 mg/day x 10 weeks. How many scored 25-mg
tablets and how many 5-mg tablets should be dispensed to meet the dosing requirements?
3. You receive a prescription for phenindione tablets 50 mg with the following instructions: ‘200
mg on day 1, 100 mg on day 2, then 50 mg daily there after’. Mitte: 56 days’ supply.
4. If a liquid medicine is to be taken three times daily, and if 180 mL are to be taken in 4 days,
how many tablespoonful should be prescribed for each dose?
5. What quantity should be dispensed if 50 mg of amitriptyline has been prescribed daily for 3
weeks, if the medication on your hand is 25mg?
6. A prescription was written for 750mg dose of drug X to be taken 3 times a day for 10 days.
There are 500mg of drug X in 1 tablet. How many tablets should be dispensed for a 10-day
supply?
7. A prescription is written for the patient to take 2 tablets Q 8 hours. The prescription calls for
180 tablets to be dispensed. How long with this prescription last? Calculate the day’s supply.
Calculation of Parenteral Doses
 Drugs for parenteral use must be in liquid form before they are administered. Parenteral drugs
may be available in the following forms:
1. As liquids in disposable cartridges or disposable syringes:
o that contain a specific amount of a drug in a specific volume, for example, meperidine 50
mg/ mL. After administration, the cartridge or syringe is discarded.
2. In ampules or vials
That contains a specific amount of the liquid form of the drug in a specific volume.
The vials may be single-dose vials or multi-dose vials.
A multidose vial contains more than one dose of the drug.
3. In ampules or vials that contain powder or crystals
o To which a liquid (called a diluent) must be added before the drug can be removed from
the vial and administered.
o Vials may be single dose or multidose vials.
Calculation of Parenteral dose
Formula: D x Q = X
H
Examples:
1) Order: Bentyl 20mg IM qid
Available: Bentyl injection 10mg/ml in 10ml multi dose vial.
How many millilitres should be administered as a single dose?
X=DxQ X = 20mg x 1ml = 2ml
H 10mg

2) Order: Adrenalin 0.25mg sc bid

Available: Adrenalin 1mg/ml

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

X = 0.25mg x 1ml
1mg
= 0.25ml , bid 0.25 x 2 = 0.5ml
3) Order: Heparin 8000 u SC bid
Available: a vial of Heparin sodium injection 10,000 u/ml
X = 8000 x 1ml
10,000
= 0.8ml
1) Order: Atropine sulphate 0.15mg SC stat
Available: Atropine sulphate 0.4mg/ml
X = 0.15mg x 1ml
0.4mg
= 0.375ml
Example Calculations of Measures of Activity or Potency
 Determinations of the activity or potency of a biologic material considered in this chapter may
be performed through the use of ratio and proportion or dimensional analysis, as demonstrated
by the following examples.

Calculations involving units of activity are exemplified as follows.

Example:
1. How many milliliters of U-100 insulin should be used to obtain 40 units of insulin? U-100
insulin contains 100 units/mL
100 (units ) 1 ( ml )
= =0.4 ml
40 ( units ) x ( ml )
2. A physician prescribed 100 units of insulin to be added to 500 mL of D5W in treating a patient
with severe diabetic acidosis. How many milliliters of insulin injection concentrate, U-500,
should be used? U-500 insulin contains 500 units/mL
100(units) 1 ( ml )
= =0.2 ml
100 ( units ) x ( ml )
3. How many milliliters of a heparin sodium injection containing 200,000 units in 10 mL should
be used to obtain 5,000 Heparin Sodium Units that are to be added to an intravenous dextrose
solution?
200,000 (units ) 10 ( ml )
= =0.25 ml
500 (units ) X ( ml )
4. Rx- Lente Insulin 30IU a.m /20IU p.m for 60 days. How many vials you dispense for this
patient? Hint: U-100 insulin contains 100 units/mL
Vial = 10mL
Dose=30 IU + 20 IU = 50 IU
Duration= 60 days
Vial to dispense= 50 IU x 60 days= 3000 IU
Therefore, 1000IU = 1vial
3000 IU = X
X= 3 vials
5. Rx- Fortified Procaine Penicillin (PPF) 800,000 IU/day for 7 days.
How many vials you dispense for this patient? ( 1 vial = 4,000,000IU)
First calculate the dose = 1vial=10ml= 4000000IU

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

By dimensional analysis,
800000 X (mL )
= =2 mL
4000000 10(mL )
Quantity in mL = 2 mL x 1x 7= 14Ml, Vial to dispense = 2 vials
Calculation of Pediatric Doses
 Pediatrics is the branch of medicine that deals with disease in children from birth through
adolescence. Because of the range in age and bodily development in this patient population, the
inclusive groups are defined further as follows:
 Neonate (newborn) - from birth to 1 month
 Infant - 1 month to 1 year
 Early childhood - 1 year through 5 years
 late childhood- 6 years through 12 years and
 Adolescence 13 years through 17 years of age
 The dose of a drug for a particular patient may be determined in part on the basis of the
patient’s age, eight, body surface area, general physical health, liver and kidney function (for
drug metabolism and elimination), and severity of the illness being treated

Drug Dosage Based on Age

 The age of the patient is a consideration in the determination of drug dosage. As stated
previously, neonates have immature hepatic and renal functions that affect drug response.
 The elderly, in addition to diminished organ function, frequently have issues of concomitant
pathologies and increased sensitivities to drugs.
Young’s Rule
Age
Dose for child= x Adult dose
age+ 12
Fried’s Rule for infants
Age (¿ months)
Dose for child= X Adult dose
150
 Note: The value of 150 in Fried’s rule was an estimate of the age (12.5 years or 150 months)
of an individual who would normally receive an adult dose, and the number 150 in Clark’s
rule was an estimate of the weight of an individual who likewise would receive an adult dose.
 Drug Dosage on Body Weight
Clark’s Rule
WeightxAdult dose
Dose for child=
150
Examples:
1. If the adult dose of a drug is 5mg. what will be the dose of the drug for children 8 years old?
Paediatric dose = Age x Adult dose
Age + 12
P.D = 8 x 5mg = 2mg
8+12
2) If the adult dose of a drug is 0.1ml, what will be the dose for a child 12 years old?
P.D = 12 x 0.1ml = 0.5 x 0.1ml = 0.05ml

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

12 + 12
3) The usual dose of Atropine sulphate is 0.5mg. calculate the dose for an infant six month old?
Infant dose = Age (month) x adult dose
150
I.D = 6 month old x 0.5mg
150
= 0.02mg
Practice problems
1) How many Codeine phosphate and how much ammonium chloride will be contained in each
dose of the following prescription?
Rx
Codeine phosphate ----------- 0.6g
Ammonium chloride --------- 6g
Cherry syrup add ------------- 120ml
Sig teaspoon full for cough
Codeine phosphate Ammonium chloride
X = 5ml x 0.6g X = 5ml x 6g
120ml 120ml
= 0.025g = 0.25g
2) the Doctors order reads codeine sulphate 60mg po q 4h prn. The drug label states codeine sulphate
30mg per tablet, how many tablets should be given for a dose?
X = 60mg x 1 tablet
30mg
= 2 tablets
3)How many millilitres of a medicine would provide a patient with two table spoon full twice a day for
8 days?
2 x 15 x 2 x 8 = 480ml
Dispensing Environment and stock management
Introduction
 Dispensing refers to the process of preparing and supplying medicines to a named person
together with clear instructions, advice and counselling on the use of medicines. It involves:
correct interpretation of the order for prescribed medicines
accurate preparation
labelling of medicines for use by the patient.
 Good dispensing ensures the right medicines of desired quality are delivered
o to the right patients
o with the right dose (strength, frequency, dosage form, quantity)
o with clear instructions (both written and verbal)
o with appropriate packaging.
 Any error or failure in the dispensing process can seriously affect the care of the patient.
 Programs to improve rational use concentrated on ensuring
o rational prescribing habits
o overlooking dispensing
o patient’s use of medicines.
 Resources involved in patient care prior to dispensing wasted if dispensing does not result in
 named patient receiving effective form of correct drug
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 appropriate packaging with correct dose and advice.

 The following are summary of dispensing
o A process of preparing and giving medicine to a client.
o Correct prescription interpretation.
o Accurate preparation & labeling of medicine.
o Take place in health center, hospital, or community pharmacy setting.
o Carried out by pharmacy professionals with a variety of training
 Accuracy & quality of medicines supplied lies on persons managing dispensing process
 Dispensing staffs need
o technical knowledge and skills necessary to dispense.
o effective communication with patients or care givers.
Dispensing environment
 A safe, clean and organized working environment provides the basis for good dispensing
practice.
 Dispensing environments must be clean, because medicinal products which are used on human
being should be hygienic and uncontaminated.
 The environment must also be organized so that dispensing can be performed accurately and
efficiently.
 In retail environment approaching customer in good manner, matching customer needs and
providing drug information is very vital.
 Clients may be required to wait while their prescriptions are being filled, so a waiting area
should be available as pharmacist need enough time to attend to the queries of the patient.
Appropriate waiting area in dispensing room should have the following:
 Comfortable chairs/place to sit (at least for the elderly/disabled/ sick patient to rest
 Current popular health magazines and selected materials related with health to keep the
clients busy/occupied, and prevent boredom while waiting to receive medicines
 Pamphlets and posters related to public, family and other individuals health problems
prominently displayed (as the waiting area could be used as education center)
1. Premise and Facility
 The premises on which a dispensing service is provided would reflect the quality of service and
inspire confidence on patients in the nature of pharmaceutical service delivered.
 Requirements for Premise and Facility
o The walls, floors, windows, ceiling, and all other parts of the premises should be as per the
requirement set by the regulatory body Food, Medicine and Healthcare Administration and
Control Authority (FMHACA).
o Rooms with minimum area specified required for dispensing & storing medicines.
o Toilet with water supply and drainage system is also a requirement.
o All parts of the premises should be maintained in an orderly and tidy condition.
o Pharmaceutical products should be protected from the adverse effect of light, freezing or
temperature extremes and humidity.
 The dispensing environment should possess:
 Appropriate temperature with sufficient lighting
 Optimum humidity control
 Cold storage facilities
 Adequate number and type of shelves
 Lockable cabinet for controlled substance & poisons
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Patient/care provider waiting area

 Sufficient dispensing equipments, etc.
2. Hygiene and Sanitation
 The physical surroundings must be maintained free of dust and dirt materials.
 Locate in a protected place
 Not open to a road or dust, dirt, and pollution.
 Requires a regular routine of cleaning shelves
 A daily cleaning of floors and working surfaces.
There should be a regular schedule for
o Checking, cleaning, and defrosting refrigerator.
o Spills should be wiped up immediately
☞ especially if liquid spilled is sticky, sweet, or attractive to insects.
o Food and drink must be kept out of the dispensing area
o Refrigerator used strictly for medicines use only.
 Smoking should be prohibited in area where medicines are dispensed or supplied.
 Direct contact between the operator’s hands and the dispensed products should be avoided
 Dispensing equipment used for counting pills should be kept clean at all times.
e.g., uncoated tablets leave a layer of powder on any surface they touch, which can easily be
transferred to other tablets or capsules counted on the same surface.
 All persons engaged in dispensing should
observe high standards of personal cleanliness
wear protective cloths that should be cleaned regularly.
3. Patient counseling area
 A designated area where activities related to patient care/ professional services carried out.
 The patient's attention can be drawn to this area and services offered using suitable panels.
 This serve the following
o clarifications about doubts (no fear of being overheard).
o comfortable and convenient than advising on the counter.
o easy for demonstrations of using devices like inhalers, vaginal or rectal applicators
o Makes the patient confident that he/she will be heard without distractions.
4. Dispensing equipments
 Adequate equipments on premises are suitable for operations that have to be carried out.
 All equipment should be kept clean and checked for cleanliness prior to each use.
 Thoroughly clean equipments to prevent any risk of contamination.
 Use of stainless steel and glass is recommended.
 Dispensing aids include:
o A dispensing bench of adequate size having a smooth, impervious working surface.
o Easily cleanable tablets and capsules counting devices.
o A refrigerator equipped with a maximum/minimum thermometer adjusting.
o Suitable dispensing containers for drugs with separate sets for internal and external use.
o Adequate shelves and lockable cabinets etc.
o Cleaning equipment used for handling different products, both between uses and at the
end of the day, is essential to prevent cross-contamination.
o Clear labeling that ensure selection of correct preparation & minimize risk of error.
a) Triangular tablet counter

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o made of wood, metal or plastic with raised edges along two sides.
o metal or plastic counters preferred (easily cleaned or washed between uses).
o tablets are counted by counting the number of rows of tablets
o pours tablets into the container using a raised edge as a guide.
b) Capsule counter
a metal tray which consists of 10 rows of grooves.
capsules are poured on to the tray using a spatula lined up in grooves.
each complete row will contain capsules
so the number of complete rows multiplied by 10 gives number of capsules.
c) Electronic tablet counter
 Used when prepackaging is done on a large scale in a teaching hospitals.
o difficult to clean
o may not identify damaged tablets
o expensive for medicine retail outlets.

Figure: Dispensing equipments used in dispensing units

5. Personal protective equipments
Personal protective equipment (PPE), as defined by the Occupational Safety and Health
Administration (OSHA) is ‘specialized clothing or equipment, worn by an employee for protection
against infectious materials’.
 PPE protects health professional from
o contamination by work area hazards
o prevents contamination of clothes which would carry contamination outside health facility
The Centers for Disease Control and Prevention (CDC) issues recommendations for when and what
PPE should be used to prevent exposure to infectious diseases. The protection of healthcare personnel
from infectious disease exposures in the workplace requires a combination of controls.
There are four major components to healthcare worker safety programs.
Training and administrative controls, like isolation policies and procedures for recognizing
patients with a communicable disease before they expose workers.
Engineering controls like negative pressure rooms for patients with airborne diseases
Work practice controls such as not recapping needles
Finally personal protective equipment.
 Types of PPE used in healthcare settings
o Gloves – protect hands
o Gowns/aprons – protect skin and/or clothing
o Masks- protect mouth/nose, respirators – protect respiratory tract
o Goggles – protect eyes
o Face shields – protect face, mouth, nose, and eyes
6. Dispensing personnel
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Difference between supplying medicines or medical supplies and supplying other goods is that,
with medicines or medical supplies the recipient/patient usually
o does not know the correct use
o unable to judge the quality of the product he or she receives.
o correctness and quality of medicines supplied lies entirely on dispenser’s ability.
 Consequently laws mandate that the distribution of medicines and important medical supplies
to the general public be carried out by pharmacy professionals.
 Knowledge, skills, and attitudes to complete dispensing process includes
o knowledge about medicines being dispensed (common use, correct dose, precautions, common
side effects & interactions with other medicines or food, storage needs).
o Good calculation and arithmetic skills
o Skills in assessing the quality of preparations
o Attributes of cleanliness, accuracy, and honesty
o Attitudes and skills required to communicate effectively with patients
 The level of training needed for any particular dispensing task is determined by
 range of medicines dispensed and
 extent to which calculation and preparation are required.
 Dispensing personnel must receive an appropriate level of training, which will enable them to
correctly dispense the range of medicines prescribed in their facilities.

Dispensary stock management

 Good stock management facilitates safe and effective dispensing service.
 To ensure proper stock management, the following elements are important:
o Acquisition of medicines
o Stock keeping and rotation
o Arrangement of medicines
o Storage conditions
o Categories of drugs
1. Dispensary Medicines Acquisition
Before medicines and medical supplies are issued from store to dispensing room
store requisition form should be filled by the dispenser
duly signed by authorized personnel.
All medicines found in medicine retail outlets should be obtained or collected from legal sources.
 When you receive medicines for dispensing:
 Ensure that there is sufficient storage place
 Prepare and clean the areas for receiving and storing
 Inspect packages for damaged and/or expired products
 Check that all original containers are unopened and in good condition.
 If products are defective:
o Separate the damaged or expired stock from the usable stock
o Refuse to accept the products and note the problem(s) on the delivery note
o Follow your facility’s procedure for handling damaged or expired stock.
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o Report quality problem to the nearest regulatory body and fill prepaid adverse drug
event report form and send to FMHACA.
 If Products are not damaged:
o Fill issue voucher and requisition voucher
o Count the number of units for each product received and compares to issue
voucher
o Record received item on receiving voucher, bin card and computer (if
applicable)
o Ensure the expiry date is visibly marked on every package or unit
o Arrange products in the storage area that facilitate the dispensing of the first
to expire by first expiry first out (FEFO) or first in first out (FIFO)
procedures.
2. Dispensary stock keeping
Medicine should be kept within the dispensary as follows:
o Follow the manufacturer directions when stocking
o Follow labels for storage conditions
o Ensure safe custody of poisons
o Place liquid products on the lower shelves or on bottom of stacks
o Store products that require cold storage in appropriate temperature controlled zones.
o Keep high security/high value products (narcotic and psychotropic substances) in
appropriate secured places
o Separate damaged and expired products from the usable stock without delay and
dispose using established disposal procedures.
o Always store all products in a manner that facilitates FEFO principles
o Report to appropriate body for redistribution of medicines with near expiry date.
3. Dispensary stock rotation
 Following FEFO and FIFO procedures minimize wastage due to product expiry.
o Issue products that expire first, ensuring they are not too close to or past their expiration
date (shelf life remaining is sufficient for product to be used before expiry date).
 To facilitate FEFO, place products that expire first in front of later expiry products.
 Write expiry dates on bin cards, so that stocks can be used before they expire.
 Supplies with no expiry date (gauze, cotton, medical gases etc.) should be stored in the
order received and dispensed accordingly (FIFO).
4. Arranging medications in dispensary
 Dispensing units must have a known system for organizing medicines.
 Medicines should be arranged on shelves made of steel, treated wood, strong and robust.
 Health institutions and retail outlets can use one or a combination of the following:
a. Pharmacotherapeutic category
b. Alphabetical order by generic name
c. Dosage forms of final preparation
a) Pharmacotherapeutic category
 This method is based on the pharmacological or therapeutics use of drugs.
 Pharmacological classification is an effective way of organizing medicines in dispensaries.
 Pharmacologic class knowledge is critical step in effective dispensing in this system.
b) Alphabetical order

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Alphabetical order by generic name is attractive in dispensaries that keep a small items.
 Each change in the level-of-use list requires reorganization of the dispensary
 May not result in optimal use of available space.
c) Dosage form of final preparation
 Arranging drugs as per the dosage form they are available
 Commonly used in smaller dispensaries.
 Easy to recognize when receiving goods
 Allows optimal use of space.
 Usually used in conjunction with the therapeutic arrangement.
o Solid dosage forms (tablets, capsules, powers) are placed together
o Liquid dosage forms ( elixirs, syrups, suspensions,...) are placed together
o Semi solid dosage forms ( ointments, creams, pastes) are placed together
 In arranging medicines, the following points should be considered:
o Each dosage form of medicine is arranged in separate and distinct areas
o Sufficient empty space should demarcate one medicine or dosage form from another
o Put medicine in well ventilated, dry and place protected from direct sun light and
heat
o Store liquids in a pallet on the floor or on the lowest shelf
o Do not store anything directly on the floor and store cold-chain items in refrigerator.
5. Storage of pharmaceuticals in dispensary
 In dispensing room storage conditions can be arranged in two classes:
A. Normal storage conditions
B. Special storage conditions
a. Cold storage conditions
b. Combustible /flammable
c. Secured storage
A. Normal storage conditions
 Storage in dry, well-ventilated premises at temperatures of 15–25°C or up to 30 °C.
 Unless special storage conditions are stated, it is vital that drugs be stored in:
o a dry place
o adequately ventilated shady
o cool store room.
 Maintain specified storage conditions with regard to exposure to humidity, sunlight, heat.
 When a product label states, ‘protect from moisture’, store the product in a space with no more
than 60% relative humidity.
 Free air circulation through windows, fans or air conditioners reduce effects of humidity.
 Some products are photosensitive and will be damaged if exposed to light.
To protect products from sunlight:
o shade the windows, if they allow passage of direct sunlight, keep products in cartoon
o do not store or pack products in sunlight
 Heat will also affect many products, melts ointments and creams and affects other products.
 Thermometers and hygrometer to regulate the temperature and humidity of storage areas.
B. Special storage conditions
 Some categories of medicines and supplies require special storage conditions
o Cold storage conditions

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o Flammable storage conditions

o Secured storage.
a. Cold storage conditions
 Maintained by using refrigerators and freezers for products that may be degraded rapidly when
kept at room temperature or even at cool places.
 Example of products that should be stored in cold storage condition includes
o Vaccines and insulin preparation
o Oxytocin & ergometrine
o Antirebies and tetanusantitoxine
o Anti-D and biological products.
 The following points are recommended when using refrigerators and freezers:
Refrigerators that open on the top are more efficient than vertical ones, because hot rises while
cold air falls, the coldest part of vertical refrigerators is at the bottom so store products that are
sensitive to freezing or very low temperatures on the upper shelves.
If there is enough space, place a few plastic bottles of water in the refrigerator; this will help
maintain the temperature for a longer period of time if the power is cut off.
The temperature ranges for different storage conditions are shown in the following table.
Opening and closing the door lower the temperature and cause medicines to deteriorate.
Record temperature daily & check enough space around refrigerator so air can move freely.
Do not keep staff food in the refrigerator.
b. Storages for combustible /flammable
The Occupational Safety & Health Administration defines a flammable liquid as substances having a
flash point of not more than 93°C (199.4°F). The flash point (FP) is the minimum temperature at
which a liquid gives off vapor in sufficient concentration to form an ignitable mixture with air near
surface of the liquid. Relative hazard of flammable liquid increases as flashpoint decreases.
Many common solvents (e.g., acetone, ether, toluene, etc.) present in laboratories have flash points
below room temperature, making proper use, storage and disposal even more critical. Flammable
liquids and mixtures are assigned to one of four hazard categories, as indicated in safety data sheets
(SDSs), based on their flash points and boiling points.
 Combustibles like alcohol, ether must be stored in special or separate rooms.
 Flammable materials must be stored in a small, separate special location that prevent fire
spread throughout the store.
 All stores should be equipped with fire extinguishers.
 A good alternative to fire extinguishers is represented by wooden or metal buckets filled with
sand. Store flammables in their original container.
Corrosive or oxidant substances commonly found in hospitals are:
o trichloracetic acid
o glacial acetic acid
o concentrated ammonia solutions
o silver or sodium nitrate
o sodium hydroxide pellets.
 Always store corrosive substances
away from flammables
in a separate steel cabinet to prevent leakage.
use appropriate protective gloves and eyeglasses when handling.
c. Secured storage conditions
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

 Products that need storage in an access-controlled (security for storage) environment.

☞ those at risk of theft
☞ with abuse potential for addiction
☞ in high demand
☞ those that have potential for resale
Products that require secured storage conditions
 Narcotics: morphine, opium, pethidine, pentazocine, codeine, hydrocodone, oxycodone.
 Psychotropics: clonazepam, diazepam, temazepam, nitrazepam, lorazepam.
 Other medicines: antiretroviral used to treat HIV/AIDS, may need storage in a controlled
facility, because they are scarce, expensive, and in high demand.
 Donation products that also used for other conditions
o medicines used to treat opportunistic infections for HIV/AIDS
o medicines used to treat sexually transmitted infections
o HIV test kits used in use in specific programs, such as preventing mother-to-child transmission,
but can be used for other purposes, such as ensuring blood safety.
 These medicines need greater attention.
 specific procedures needed for procurement, reception, storage and dispensing.
 special ordering forms should be used.
 Controlled substances and their documents kept in securely locked rooms or cupboards.
o keys should be kept in a secure place.
o only authorized pharmacy professional have access.
o warning light or bell will be activated if products are accessed improperly.
Computer and Medication information in pharmacy
Computer systems in pharmacy
 Pharmacies use computerized tools that help productivity and maintain dispensary information.
Computerized pharmacy management systems perform the following:
label printing
stock reordering
perform product inventory
medicine pricing or billing
essential information within easy access.
 As a result, professionals dispense more prescriptions and information than ever before.
 In Health Commodity Management Information System (HCMIS) computers used to check
o stock status (availability of medicines) o consumption by unit,
o near expiration, o loss/adjustment cost of medicines and
o overstocked or stock out o calculating average monthly
o consumption trend, consumption.
Role of computer in pharmacy
o Update dispensary system information as required
o Back up dispensary system information to ensure secure data
o Enables changes to data stored in dispensary information system
o Maintain confidentiality of dispensary information
Medication information in dispensary
 Information about medicines is rapidly expanding because of
o new medicine products entering into the markets
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o new information about medicines in use.

 Pharmacy professional have to up-to-date his/her medicine information in order to provide
information to
o Patients/clients
o other health care professionals
o a general public
Provision of Medicine information to patients
 Many patients do not take the prescribed medicines correctly or regularly or do not take them at
all for the following reasons:
 Complicated dosage schedule
 The medicines not perceived as effective
 Disappearance of symptoms
 Occurrence of side effects.
 Pill burden
 Inadequate information
 Patient compliance may be improved by
• Prescribing a carefully selected medicine: Creating a good prescriber- patient relationship,
established through respect for the patients feeling and idea, thereby making the patient treatment
partner
• Providing the necessary information: The information should provide the knowledge to accept and
follow treatment, and to acquire the necessary skills to take the medicine as prescribed. The
information should be given clearly in a language the patient understands, and should be checked
whether the patient has understood the information correctly by letting him/her to repeat it in his/her
own word.

General Steps of Counseling

 All medicines should be dispensed with adequate and appropriate information and counseling.
Information must be structured to meet the needs of individual patients and questions and
answers should be used to check the patient understands.
 Written information should be provided to supplement verbal communication as appropriate.
Counseling should ensure that the patient has an unequivocal understanding of the instructions
for use, and any distinct characteristics or requirements of the medicine.
 Counseling should cover matters that will enhance or optimize medicine therapy. The prepared,
packaged and labeled medicine is handed over to the right patient or care provider with
appropriate medicine information.
 The information in the form of verbal and/or written instructions should include the following:
o How much and how often to take the medicine
o When to take the medicine (e.g., before or after meals)
o How long the treatment is to last (e.g., why the entire course of an antibiotic treatment must be
taken)
o How to take the medicine (e.g., with water, chewing or swallowing)
o How to store the medicine (e.g., avoid heat, light and dampness)
o Not to share medicines with other persons
o Which types of foods and beverages should avoid while taking the medicine
o To keep medicines out of reach of children
o One has to demonstrate to the patient on how to administer the dispensed medications in case
of inhaled administration and suppository application
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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

o Patients should also be informed not to stop treatment when side effects occur or in the absence
of response without consulting the prescriber or dispenser.
Finally, check whether patients have understood the information provided
Sources of medicine information
 Although basic information about medicines is obtained through training in pharmacy
profession, additional knowledge can be gained from various sources. These sources of
medicine information can be classified into primary, secondary and tertiary.
1. Primary sources
 Provide new medicine information mainly based on research in journals.
 Such sources include health journals
 Ethiopian pharmaceutical Journal
 Ethiopian Medical Journal
 Ethiopian Journal of Health Development
 It is important to assess the reputability of the journal and time of publication.
2. Secondary sources
 Provide reviews of articles that appear in primary sources
Examples include
medicine information bulletins
adverse medicine reaction bulletin
hospital formularies
standard treatment guidelines etc.
3. Tertiary sources
 Include standard reference books such as
o British National Formulary
o Basic and clinical pharmacology
o Dispensing for pharmaceutical students
o Medical dictionary, etc.
 The selection of a particular source of information depends on the type of information required.
 Tertiary sources are used first than secondary or primary sources as they provide a broad
overview of particular subject area. Standard books are published at longer time intervals than
journals.
 Medicine information inquiries that are beyond the ability of medicine dispensers can be
referred to the nearest medicine information centers (DICs). The main aim of these centers is to
provide accurate and precise medicine information for health professionals and the general
public. Medicine information supplied by the pharmaceutical industries either in the form of
leaflets in the packages or via their representatives is being used by many clients.
 Health professionals should develop critical attitudes towards information provided by
pharmaceutical industry as their information may be biased.

Senario
 Read the following case scenario to understand the steps of good dispensing:
Institution Name: Halila Health Center Tel No: 022331….
Patient’s full Name: TH
Sex: F Age: 26 Weight: 68 Card No.: 024456/10
Region: Oromia Town: Asella, Woreda: Tiyo, Kebele: 07
House No. XYX65 Tel. No: 09123…. Inpatient  Outpatient
Diagnosis, if not ICD: Osteomyelitis, Vaginal Candidiasis, Minor Skin abrasion

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Prescription hand out for pharmacy TVET level III students Prepared by:- Bekuwet Solomon

Medicine Name, Strength, Dosage Form, Dose, Frequency, Price

Duration, Quantity, How to use & other information
(dispensers use only)

1. Ampicillin capsule, 1 qid # 28

2. Gentian violet solution # 1 bottle

3. Diclofenac e/c 50 mg # 10 tablets

4. Clotrimazole 500mg vaginal tablet, once a day for

seven consecutive days

Prescriber’s Dispenser’s
Full name: Fita Gonfa Bontu Tola
Qualification: Health Officer Pharmacy Technician
Registration No: 4556/2008 663/2008
Signature Signed Signed
Date: 28/07/2010 28/07/2010

“Always Enjoy your time by processing of Prescription”

“DO GOOD AVOID EVIL”

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