PST 04101 Dispensing-1

UNITED REPUBLIC OF TANZANIA
Ministry of Health, Community

Development, Gender, Elderly and
Children
PST 04101Dispensing
NTA Level 4 Semester 1
Facilitator Guide
December 2016
PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

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Copyright © Ministry of Health, Community Development, Gender, Elderly and Children – 2016

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Table of Contents
Background iv
Acknowledgment v
Introduction vii
Abbreviations/Acronym ix
Session 1: Introduction to Dispensing 1
Session 2: Medical Prescription 6
Session 3: Interpretation of Various Medical Symbols and Abbreviations in a
Prescription 14
Session 4: Guidelines on Prescribing Medicines 29
Session 6: Prescriptions Errors 55
Session 7: Dispensing Procedures in Pharmacy 62
Session 8: Determining Quantities of Medicine for Dispensing 72
Session 9: Medicines Packaging Materials 87
Session 10: Medicines Label 96
Session 11: Generic and Brand Names of Medicines 105
Session 12: Giving Appropriate Medicine Information to Patients 111
Session 13: Adverse Drug Reactions, Drug Overdose and Intoxication 132
Session 14: Documentation of Medicines and Medical Supplies 141
Session 15: Rational Use of Medicines 152
Session 16: Irrational Prescribing of Medicines 158
Session 17: Irrational Dispensing of Medicines 166
Session 18: Sections in a Pharmacy Department 174

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Background
There is currently an ever increasing demand for pharmaceutical personnel in Tanzania.
This is due to expanding investment in public and private pharmaceutical sector. Shortage of
trained pharmaceutical human resource contributes to poor quality of pharmaceutical
services and low access to medicines in the country (GIZ, 2012).
Through Public-Private-Partnership (PPP) the Pharmacy Council (PC) together with
Development Partners (DPs) in Germany and Pharmaceutical Training Institutions (PTIs)
worked together to address the shortage of human resource for pharmacy by designing a
project named “Supporting Training Institutions for Improved Pharmaceutical Services in
Tanzania” in order to improve quality and capacity of PTIs in training, particularly of lower
cadre pharmaceutical personnel.
The Pharmacy Council formed a Steering committee that conducted a stakeholders workshop
from18th - 22ndAugust 2014 in Morogoro to initiate the implementation of the project.
Key activities in the implementation of this project included carrying out situational analysis,
curriculum review and harmonization, development of training manual/facilitators guide,
development of assessment plan, training of trainers and supportive supervision.
After the curricula were reviwed and harmonized, the process of developing standardised
training materials was started in August 2015 through Writer’s Workshop approach.
The approach included two workshops (of two weeks each) for developing draft documents
and a one-week workshop for reviewing, editing and formatting the sessions of the modules.
The goals of writers workshops were to build capacity of tutors in the development of
training materials and to develop high-quality, standardized teaching materials.
The training package for pharmacy cadres includes a facilitator guide, assessment plan and
practicum. There are 12 modules for NTA level 4 making 12 facilitator guides and one
practicum guide.

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Acknowledgment
The development of standardized training materials of a competence-based curriculum for
pharmaceutical sciences has been accomplished through involvement of different
stakeholders.
Special thanks go to the Pharmacy Council for spearheading the harmonization of training
materials in the pharmacy after noticing that training institutions in Tanzania were using
different curricula and train their students differently.
I would also like to extend my gratitude to St. Luke Foundation (SLF)/Kilimanjaro School of
Pharmacy –Moshi for their tireless efforts to mobilize funds from development partners.
Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale

Zusammenarbeit (GIZ), Merck Kgaa, BoehringerIngelheimGmbhand Bayer Pharma Ag and
action medeor.V for the financial and technical support.
Particular thanks are due to those who led this important process to its completion, Mrs Stella
M. Mpanda Director, Childbirth Survival Intenational, and Members from the secretariat of
National Council for Technical Education (NACTE) for facilitating the process.
Finally, I very much appreciate the contributions of the tutors and content experts
representing PTIs, hospitals, and other health training institutions. Their participation in
meetings and workshops, and their input in the development of this training
manual/facilitators guide have been invaluable.
These participants are listed with our gratitude below:
Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of Pharmacy

Mr.Samwel M. Zakayo- Pharmacy Council
Mr. Amour Idd Pharmacy Council
Mr. Selemani Majiindo NACTE
Mr. Dennis Busuguli MoHCDGEC
Mr. Amani Phillip HKMU
Mr. Karol J. Marwa CUHAS
Mr. John M. Bitoro CUHAS
Mr. Omary S. Mejjah CUHAS
Mr. Sixbert Nkwenge LZHRC
Ms. Ester A. Tuarira MUHAS
Mr. Rajabu I. Amiri MUHAS
Mr. Peter Njalale MUHAS
Ms. Tumaini H. Lyombe MUHAS
Mr. Oswald Paschal KSP
Mr. Peter Benedict KSP
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Mr. Wensaa E. Muro KSP
Ms. Dilisi J. Makawia KSP
Mr. Nsabo J. Kihore KSP
Ms. Julieth Koimerek KSP
Rev. Baraka A.M. Kabudi MEMS
Mr. Kelvin E. Mtanililwa Royal Pharmaceutical Training Institute
Mr. George Kilimanjaro Royal Pharmaceutical Training Institute
Ms. Rose Bulilo CEDHA
Ms. Diana H. Gamuya CEDHA
Dr.Melkiory Masatu CEDHA
Dr. Benny Mboya CEDHA
Mr. Jackson Shayo CEDHA
Dr. Peter A. Sala CEDHA
Mr. Goodluck Mdugi RuCU
Mr. Gaspar Baltazary RuCU
Mr. Silvester Andrew St. Peter College
Mr. Emanuel Mayunga St. Peter College
Mr. Habel A. Habel City College of Health and Allied Sciences
Ms. Zaina Msami Meru District Council
Mr. John Paschal Mount Meru Regional Hospital
Mr. Mugisha G. Wilson JSI
Mr. Matiko M. Machage JSI
Mr. Dickson Mtalitinya SIBS
Mr. Nemes P. Uisso Moshi District Council
Dr. O. Gowele
Director of Human Resources Development
Ministry of Health, Community Development, Gender, Elderly and Children

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Introduction
Module Overview
This module content is a guide for tutors of Pharmaceutical schools for training of students.
The session contents are based on sub-enabling outcomes and their related tasks of the
curriculum for Basic Technician Course in Pharmaceutical Sciences. The module sub-
enabling outcomes and their related tasks are as indicated in the in the Basic Technician
Certificate in Pharmaceutical Sciences (NTA Level 4) Curriculum
Target Audience
This module is intended for use primarily by tutors of pharmaceutical schools. The module’s
sessions give guidance on the time, activities and provide information on how to teach the
session. The sessions include different activities which focus on increasing students’
knowledge, skills and attitudes.
Organization of the Module

The module consists of eighteen (18) sessions; each session is divided into several parts as
indicated below:
 Session Title: The name of the session
 Total Session Time: The estimated time for teaching the session, indicated in minutes
 Pre-requisites: A module or session which needs to be covered before teaching the
session.
 Learning Tasks: Statements which indicate what the student is expected to learn by the
end of the session
 Resources Needed: All resources needed for the session are listed including handouts
and worksheets
 Session Overview: The session overview box lists the steps, time for each step, the
activity or method used in each step and the step title
 Session Content: All the session contents are divided into steps. Each step has a heading
and an estimated time to teach that step as shown in the overview box. Also, this section
includes instructions for the tutor and activities with their instructions to be done during
teaching of the contents
 Key Points: Key messages for concluding the session contents at the end of a session
This step summarizes the main points and ideas from the session, based on the learning
tasks of the sssion
 Evaluation: The last section of the session consists of short questions based on the
learning tasks to check the understanding of students.
 Handouts: Additional information which can be used in the classroom while teaching or
later for students’ further learning. Handouts are used to provide extra information related
to the session topic that cannot fit into the session time. Handouts can be used by the
students to study material on their own and to refer to them after the session. Sometimes,
a handout will have questions or an exercise for the participants including the answers to
the questions.
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Instructions for Use and Facilitators Preparation
 Tutors are expected to use the module as a guide to train students in the classroom and
skills laboratory
 The contents of the modules are the basis for teaching and learning dispensing.
 Use the session contents as a guide
 The tutors are therefore advised to read each session and the relevant handouts and
worksheets as preparation before facilitating the session
 Tutors need to prepare all the resources, as indicated in the resource section or any other
item, for an effective teaching and learning process
 Plan a schedule (timetable) of the training activities
 Facilitators are expected to be innovative to make the teaching and learning process
effective
 Read the sessions before facilitation; make sure you understand the contents in order to
clarify points during facilitation
 Time allocated is estimated, but you are advised to follow the time as much as possible,
and adjust as needed
 Use session activities and exercises suggested in the sessions as a guide
 Always involve students in their own learning. When students are involved, they learn
more effectively
 Facilitators are encouraged to use real life examples to make learning more realistic
 Make use of appropriate reference materials and teaching resources available locally
Preparation with Handouts and Worksheets

 Go through the session and identify handouts and worksheets needed for the session
 Reproduce pages of these handouts and worksheets for student use while teaching the
session. This will enable students to refer to handouts and worksheets during the session
in the class. You can reproduce enough copies for students or for sharing
 Give clear instructions to students on the student activity in order for the students to
follow the instructions of the activity
 Refer students to the specific page in the student manual as instructed in the facilitator
guide
Using Students Manual When Teaching

 The student manual is a document which has the same content as the facilitator guide,
which excludes facilitator instructions and answersfor exercises.
 The student manual is for assisting students to learn effectively and acts as a reference
document during and after teaching the session
 Some of the activities included in facilitator guide are in the student manual without
facilitator instructions

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Abbreviations/Acronym
% Percent
‘S’ or ‘Sig’ Signetur (in Latin). Means, label according to the prescription
API Active Pharmaceutical Ingredient
CEDHA Centre for Educational Development in Health Arusha
CUHAS Catholic University of Health and Allied Sciences
ELCT Evangelical Lutheran Church in Tanzania
FEFO First Expire First Out
FIFO First In First Out
GDP Good Dispensing Practice
GRN Goods Received Note
Giz Deutsche GesellschftFür Internationale Zusammenarbeit
HKMU Hurbert Kairuki Memmorial University
HIV Human Immunodeficiency Virus
HTC Hospital Therapeutic Committee
I.M Intramuscular
I.V Intravenous
INN International Non- Proprieatry Name
JSI John Snow Inc
KSP Kilimanjaro School of Pharmacy
LZHRC Lake Zone Health Resource Centre
MEMS Mission for Essential Medicines Supplies
MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children
MSD Medical Stores Department
MUHAS Muhimbili University of Health and Allied Sciences
NACTE National Council For Technical Education
NTA National Technical Award
OTC Over the Counter
PC Pharmacy Council
PTI Pharmaceutical Training Institution
PVC Poly Vinyl Chloride
R&R Report and Request Form
RuCU Ruaha Catholic University
Rx Recipe or Superscription
S.C Subcutaneous
SIBS Spring Institute of Business and Science
SLF Saint Luke Foundation
USP United States Pharmacopeia
TFDA Tanzania Food and Drugs Authority

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Session 1: Introduction to Dispensing
Total Session Time: 60 minutes

Prerequisites
 None
Learning Tasks
By the end of this session students are expected to be able to:
 Define Dispensing, Dispenser and Medicines
 Describe Importance of Dispensing in Pharmacy
Resources Needed:
 Flip charts, marker pens, and masking tape
 Black/white board, chalk and whiteboard markers
SESSION OVERVIEW
Activity/
Step Time Content
Method
1 05 minutes Presentation Introduction, Learning Tasks
15 minutes Buzzing Definition of Dispensing, Dispenser and
2
Presentation Medicine
30 minutes Presentation
3 Importance of Dispensing in Pharmacy
Small Group Discussion
4 05 minutes Presentation Key Points
5 Evaluation

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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes)
READ or ASK students to read the learning Tasks and clarify
ASK students if they have any questions before continuing.
STEP 2: Definition of Dispensing, Dispenser and Medicine (5 minutes)
Activity: Brainstorming (5 minutes)
Ask students to brainstorm on the following question:
1. What is Dispensing, Dispenser, Medicine?
ALLOW few students to respond?
WRITE their responses on the flip chart/ board
CLARIFY and SUMMARISE by using the content below
Dispensing: The act of preparing medicines and/or medical supplies and distributing to users with
adequate information, counseling and appropriate follow up
Dispensing involves:
 Receiving and Interpretation of prescription from prescriber
 The preparation, packaging, labeling, record keeping, and transfer of a prescription drug to a
patient or an intermediary, who is responsible for administration of the drug
 Dispensing includes;
o The preparation and transfer of a medication to a client
o Taking steps to ensure the pharmaceutical and therapeutic suitability of the medication for its
intended use,
o Taking steps to ensure its proper use of medicines
o It may also include accepting payment for a medication on behalf of a nurse's employer.
 Dispensing occurs when the medications are given to a client
 Dispenser: Any person who is licensed or authorized by the appropriate body to dispense medicines
and/or medical supplies
 Medicine: Any substance or mixture of substances used in the diagnosis, treatment, mitigation or
prevention of a disease in human
o Medicines include narcotic drugs, psychotropic substances and precursor chemicals,
traditional medicines, complementary or alternative medicine; poisons, blood and blood

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products, vaccine, radioactive pharmaceuticals, cosmetics and sanitary items and medical
instruments
STEP 3: Importance of Dispensing (30 minutes)
Activity: Small Group Discussion ( 15 minutes)
DIVIDE students into small manageable groups
ASK students to discuss on the following question
 What are the importance of dispensing?
ALLOW students to discuss for 15 minutes
ALLOW few groups to present and the rest to add points not mentioned
CLARIFY and SUMMARIZE by using the contents below
The following are importance of dispensing:

 Ensure patient receives;
o Correct medicine,
o Crrect amount of medicines
o Correct dose and dosage
o At lower cost
 Patient receives proper information of his/her medicine
 Improves patient compliance to their medications
 As a subject (module) in pharmaceutical dispensing course, it ensures student is equipped with
knowledge, understanding, attitude and skills necessary for dispensing practices

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STEP 4: Key Points (5 minutes)
 Dispensing refers to the process of preparing and giving medicines to a named person on the basis of
prescription
 Dispensing involves the correct interpretation of the wishes of the prescriber and the accurate
preparation and labelling of medicine for use by th patient
 Dispensing process may take place in a public or private clinic, health center, hospital or community
pharmacy setting
 Dispensing is carried out by pharmacists, pharmaceutical technicians, nurses, pharmaceutical
assistants and medicine dispensers
STEP 5: Evaluation (5 minutes)

 What is dispensing?
 What are the importance of dispensing?

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References
Ansel, H. C. (2012). Pharmaceutical Calculations (14th ed.). Philadelfia,United States of America:
LWW. .
Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of pharmaceutics (8th ed.). London, United
Kingdom: Bailliere Tindall.
Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's dispensing for pharmaceutical
students (12th ed.). New Delhi, India: CBS.
Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.). London, United Kingdom:
Churchill Livingstone

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Session 2: Medical Prescription
Prerequisites
 None
Learning Tasks
 Define a Medical Prescription
 List Parts of a Medical Prescription
 Identify Features of Different Parts of a Medical Prescription
Resources Needed:
 Black/white board, chalk and /whiteboard markers
 Handout 2.1: Sample of a Filled Medical Prescription
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 05 minutes Presentation Definition of a Medical Prescription

3 Parts of a Medical Prescription
Small Group Discussion
50 minutes Presentation Features of Different Parts of a Medical
4
Small Group Discussion Prescription
6 Evaluation

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SESSION CONTENTS
READ or ASK students to read the learning tasks and clarify
STEP 2: Definition of Medical Prescription (5 minutes)
Medical Prescription
 A legal written order from a qualified prescriber to a qualified dispenser which contains
instructions to dispense or compound and administer specified medicines to a clearly mentioned
patient
Or
 It is an order for medication issued by a physician, dentist or other properly licensed medical
practitioner
o A prescription designate specific medication and dosage to be prepared by a
pharmacist/pharmaceutical technician and administered to a particular patient
o A medical prescription can be printed or written in ink
Categories of a Medical Prescription

 Those written for single component or prefabricated products and not requiring compounding or
mixing by the pharmacist/pharmaceutical technician
 Those written for more than a single component and requiring compounding

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Fig 2.1: Sample Prescriptions
STEP 3: Parts of a Medical Prescription (50 minutes)
 What are the Parts of a Medical Prescription?
The following are parts of a Medical Prescription:

 Name of the institution/health facility
 Prescriber information and signature
 Patient information
 Date prescription was written
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 The superscription (Rx symbol)
 Inscription (medication prescribed)
 The subscription (dispensing instruction to the pharmaceutical personnel)
 Transcription/ Signatura (Direction to the patient)
Figure 2.2: Sample of Filled Medical Prescription
Refer students to Handout 2.1: Sample of a filled Medical Prescription

STEP 4: Features of Different Parts of a Medical Prescription (50 minutes)

 What are the features of different parts of a Medical Prescription?
Refer students to Handout 2.1: Sample of a Filled Medical Prescription

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The following are features of different parts of a medical prescription:
 Name of the institution/ health facility
o Full address of the institution
 Prescriber’s information and signature
o Name, address and signature of the prescriber together with professional qualification. (ACO,
CO, AMO, MD or DS etc) written and signed in indelible/permanent ink
 Patient information
o Patient information which includes the patient full name, address, hospital registration number,
sex, age and /or body weight of the patient
 Date prescription was written
o The date prescription was written showing day, month and year
 The superscription (Rx symbol)
o Consists of the heading where the symbol Rx (an abbreviation for recipe, the Latin for ‘take
thou’) is found
o The Rx symbol comes before the inscription
 Inscription
o Is also called the body of the prescription
o Provides the names and quantities of the chief ingredients of the prescription to be dispensed
o The dose/strength and dosage form, such as tablet, suspension, capsule, syrup is found
 The subscription (dispensing instruction to the pharmaceutical personnel)
o This gives specific directions for the pharmaceutical personnel on how to compound the
medication
o These directions to the pharmaceutical personnel are usually expressed in Latin or may consist of
a short sentence such as: "make a solution," "mix and place into 10 capsules” or "dispense 10
tablets"
 Transcription
o This gives instructions to the patient for use:
 On how to take the drug; route by which the drug is to be administered.
 How much, how many times per day (frequency of administration), when and how long the
drug is to be taken
 These instructions are preceded by the symbol “S” or “Sig.” from the Latin, meaning "mark."
Or “Label”
 Also may contain special instructions, warnings considered important for the patient

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 A medical prescription should be clearly written for easy reading and to prevent unnecessary
mistakes in interpretation
o If not written clearly, check with the prescriber and never guess
 Not all medications require prescriptions. There are certain medications on the market that can be
purchased over the counter, thus their name Over-the-Counter drugs (OTC)

 What is a Medical Prescription?
 What are the parts of a Medical Prescription?
 What are the features of different parts of a Medical Prescription?

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References
Ansel, H. C. (2012). Pharmaceutical Calculations (14th ed.). Philadelfia,United States of America:
LWW. .

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Handout 2.1: Sample of a Filled Medical Prescription
Note: Strength of amoxicillin used in the prescription is 500mg

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Session 3: Interpretation of Various Medical Symbols and
Abbreviations in a Prescription
Prerequisites
 None
Learning Tasks
 Explain the Overview of Prescription Abbreviations and Symbols
 Describe Various Medical Symbols and Abbreviations
 Interpret Different Medical Symbols and Abbreviations from Filled Prescriptions
Resources Needed:
 Black/white board chalk and whiteboard markers
 Handout 3.1: Master List of Prescription Abbreviations
 Worksheet 3.1: Sample Filled Prescription Forms Serial No. 001-005
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 15 minutes Presentation Overview of Prescription Abbreviations

30 minutes Buzzing
3 Presentation Various Medical Symbols and Abbreviations
60 minutes Small Group

Different Medical Symbols and Abbreviations of
4 Discussion
Filled Prescriptions
Presentation
6 05 minutes Presentation Evaluation

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SESSION CONTENTS
STEP 2: Overview of Prescription Symbols and Abbreviation (15 minutes)

 Abbreviations are shortened form of a word or name that is used in place of the full word or name
 A symbol is a thing that represents or stands for something else, especially a material object
representing something abstract
 These abbreviations and symbols are Latin terms and they usually indicate the route of drug
administration and the frequency of dosing
 These abbreviations should be understood by the dispensers and are internationally recognised
 In every prescription, prescribers use different medical abbreviations to order medication to a patient
STEP 3: Various Medical Abbreviations (30 minutes)
Activity: Buzzing (5minutes)
ASK students to pair up and buzz on the following question for 3 minutes
 What are the common medical symbols and abbreviations used in prescription
writing?
ALLOW few pairs to respond on the question and let other pairs add on points not
mentioned WRITE their response on the flip chart/board
CLARIFY and SUMMARIZE by using the content below

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Table 1: Abbreviations and Symbols for Frequency of Dosing
Symbols Definition Abbreviation

I One o.d. once a day
Ii Two b.i.d. twice a day
Iii Three t.i.d. three times a day
Iv Four q.i.d. four times a day
everynight at
5X five times a day q.h.s.
bedtime
Rx Take this
q.4h every four hours
q.6h every six hours
q.o.d every other hour
Prn as needed
gtt. Drop
a.c. before meals
p.c. after meals
Table 2: Abbreviations for Route of Drug Administration

Abbreviation Interpretation
p.o. By mouth, orally (per oral)
SL Sublingual, under the tongue
ID Intradermal
IM Intramuscular
IV Intravenous
IV PB Intravenous piggyback
SC Subcutaneous.
GT Gastrostomy tube
NJ Naso-jejunal tube
p.r Per rectum
p.v Per vagina
O.D (RE) Right eye
O.S (LE) Left eye
O.U BE) Both eyes
A.D Right ear
A.S Left ear
A.U Both ears

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STEP 4: Interpreting Medical Abbreviations of Filled Prescriptions (60 minutes)
PROVIDE 5 different Sample Filled Prescription Forms to each group
 What are the interpretations of the abbreviations on the Sample Prescription Forms?
REFER Students to Worksheet 3.1: Sample filled Prescriptions Forms Serial No. 001-
005
CLARIFY and SUMMARIZE by using Master List of Prescription Abbreviations Handout

 Abbreviations in the prescriptions have been drawn from Greek and Latin words. It is important to
understand the interpretations of abbreviations used in the prescription before dispensing
 In every prescription, prescribers use different medical abbreviations to order medicines to a patient

 What are the most common used abbreviations in medical prescriptions?
References

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Medical Terminology Abbreviations. Retrieved from

http://www.delmarlearning.com/companions/content/1401852467/student_resources/termabbrev.pdf.
Master List of Prescription Abbreviations. Every Patient’s Advocate. Retrieved from

http://www.everypatientsadvocate.com/columns/prescriptionabbreviations.pdf.

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Handout 3.1: Master List of Prescription Abbreviations
Abbreviation From the Latin Meaning

Aa Ana of each
Ad Ad up to
a.c ante cibum before meals
a.d aurio dextra right ear
ad lib ad libitum use as much as one desires; freely
admov Admove Apply
Agit Agita stir/shake
alt. h alternis horis every other hour
a.m ante meridiem morning, before noon
Amp Ampule
Amt Amount
Aq Aqua Water
a.l., a.s aurio laeva, aurio sinister left ear
A.T.C around the clock
a.u auris utrae both ears
Bis Bis Twice
b.i.d bis in die twice daily
B.M bowel movement
bol Bolus as a large single dose (usually intravenously)
B.S blood sugar
B.S.A body surface areas
cap., caps Capsula Capsule
with (usually written with a bar on top of the
C Cum "c")
C Cibos Food
Cc cum cibos with food, (but also cubic centimetre)
Cf with food
comp Compound
cr., crm Cream
D5W dextrose 5% solution
D5NS dextrose 5% in normal saline (0.9%)
D.A.W dispense as written
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dc, D/C, disc Discontinue
dieb. alt diebus alternis every other day
Dil Dilute

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Master List of Prescription Abbreviations
disp. Dispense
div. Divide
d.t.d. dentur tales doses give of such doses
D.W. distilled water
elix. Elixir
e.m.p. ex modo prescripto as directed
emuls. Emulsum Emulsion
ex aq ex aqua in water
fl., fld. Fluid
ft. Fiat make; let it be made
G Gram
Gr Grain
gtt(s) gutta(e) drop(s)
H Hypodermic
h, hr Hora Hour
h.s. hora somni at bedtime
ID Intradermal
IM intramuscular (with respect to injections)
inj. Injection Injection
IP Intraperitoneal
IV Intravenous
IVP intravenous push
IVPB intravenous piggyback
L.A.S. label as such
LCD coal tar solution
Lin Linimentum Liniment
Liq Liquor Solution
lot. Lotion
M. Misce Mix
m, min Minimum a minimum
Mcg Microgram
mEq Milliequivalent
Mg Milligram
mist. Mistura Mix
Mitte Mitte Send
Page 2 of 4

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mL Millilitre
Nebul Nebula a spray
N.M.T. not more than
noct. Nocte at night
non rep. non repetatur no repeats
NS normal saline (0.9%)
1/2NS half normal saline (0.45%)
N.T.E. not to exceed
o_2 both eyes, sometimes written as o2
o.d. oculus dexter right eye
o.s. oculus sinister left eye
o.u. oculus uterque both eyes
Oz Ounce
Per Per by or through
p.c. post cibum after meals
p.m. post meridiem evening or afternoon
Prn pro re nata as needed
p.o. per os by mouth or orally
p.r. by rectum
pulv. Pulvis Powder
Q Quaque Every
q.a.d. quoque alternis die every other day
quaque die ante
q.a.m. meridiem every day before noon
q.h. quaque hora every hour
q.h.s. quaque hora somni every night at bedtime
every 1 hour; (can replace "1" with other
q.1h quaque 1 hora numbers)
q.d. quaque die every day
q.i.d. quater in die four times a day
q.o.d. every other day
Qqh quater quaque hora every four hours
q.s. quantum sufficiat a sufficient quantity
R Rectal
rep., rept. Repetatur Repeats
"s")
Page 3 of 4

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s.a. secundum artum use your judgement
SC, subc, subq,
Subcutaneous
Subcut
Sig write on label
SL sublingually, under the tongue
Sol Solution Solution
s.o.s., si op. sit si opus sit if there is a need
Ss Semis one half
Stat Statim Immediately
Supp suppositorium Suppository
Susp Suspension
Syr Syrupus Syrup
Tab Tabella Tablet
tal., t Talus Such
Tbsp Tablespoon
Troche Trochiscus Lozenge
Tsp Teaspoon
t.i.d. ter in die three times a day
t.d.s. ter die sumendum three times a day
t.i.w. three times a week
top. Topical
T.P.N. total parenteral nutrition
tr, tinc., tinct. Tincture
u.d., ut. dict. ut dictum as directed
ung. Unguentum Ointment
U.S.P. United States Pharmacopoeia
Vag Vaginally
W With
w/o Without
X Times
Worksheet 3.0: Sample Filled Prescription Forms Serial No.

INCLUD 001-005
EPICTUR
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PST 04101 Dispensing NTA L 4 Semester 1 Facilitator Guide
23
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24
Serial Na. 002
KIHESA HEALTH CENTER
P.O. Box 56
IRINGA
Name: Joyce Kamau
Gender: F
Age: 18Yrs
Weight: 40kg
Rx Miconazole cream 2% p.a.a b.i.d

4/52
Griseofulvin tabs 500 mg p.c od 3/12
Paracetamol Tabs 1g tds 3/7
Prescriber’s Masige Kahwa Malimbo
name MO
qualification
Signature
Serial Na. 004

P.O. Box 56
IRINGA
Name: Marystella Ndauka
Gender: F
Age: 65Yrs
Weight: 80kg
Rx Occu.l tetracycline oint. RE 6hrly

1/52
Paracetamol Tabs PO 1g tds 3/7
name MO
qualification
Signature

25
Serial Na. 005
P.O. Box 56
IRINGA
Name: Marium Abubakar
Gender: Fe
Age: 4Yrs
Weight: 10kg
Rx Metronidazole syrup 1 tsp tds 7/7

Paracetamol syrup 1tsp prn

name MO
qualification
Signature

26
Session 4: Guidelines on Prescribing Medicines
Prerequisites
 None
Students Learning Tasks

 Define Standard Treatment Guideline (STG)
 Explain the Importance of STG
 Describe Categories of Athorized Prescribers
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 05 minutes Presentation Standard Treatment Guideline (STG)

3 Importance of STG
Brainstorming
4 Small Group Categories of Authorized Prescribers
Discussion

27
SESSION CONTENTS

STEP 2: Introduction to Standard Treatment Guideline (STG) (5 minutes)
Standard Treatment Guideline

 STGs may be defined as ‘systematically developed statements to help practitioners or
prescribers make decisions about appropriate treatments for specific clinical conditions’
 STGs or treatment protocols are a proven, effective strategy to promote appropriate
prescribing, when used in conjunction with educational strategies to promote their use
 As a minimum, they should contain information on clinical features, diagnostic criteria,
non-drug and drug treatments (first-, second-, third-line) and referral criteria
STEP 3: Importance of Standard Treatment Guidelines (30 minutes)

 What is the importance of Standard Treatment Guidelines?
ALLOW few students to respond
Standard Treatment Guidelines are very useful in:

 Providing guidance to health professionals on the diagnosis and treatment of specific clinical
conditions
28
 Orienting new staff about accepted norms in treatment
 Providing prescribers with justification for prescribing
 Providing a reference point by which to judge the quality of prescribing
 Aiding efficient estimation of drug needs and setting priorities for procuring and stocking
drugs
STEP 4: Categories of Authorized Prescribers (60 minutes)
DIVIDE students into manageable groups
ASK students to discuss in groups on the following question:
 Who are the authorized prescribers?
ALLOW each groups to present
The following are the authorized prescribers:

 Assistant Clinical Officer Dispensaries
 Clinical Officer Dispensaries, Health Centers
 Assistant Dental Officer Health Centers, District Hospital
 Dental Officer District Hospital, Regional Referral Hospital
 Assistant Medical Officer Health Centers, District Hospital, Regional Referral
Hospital
 Medical Officer Health Center, District Hospital, Regional Referral
Hospital
 Specialists Regional Hospital, Zonal referral Hospitals, National
and specialized Hospitals

 Standard Treatment Guidelines is defined as ‘systematically developed statements to help
practitioners or prescribers make decisions about appropriate treatments for specific clinical
conditions

29
o Provide guidance to health professionals on the diagnosis and treatment of specific
clinical conditions

 What is STG?
 What is the importance of STG?
 Who are the authorized prescribers?
References
GoT (1998). Tanzania National Formulary (1st ed.). Dar es salaam, Tanzania: MOHSW.
GoT (2013). Standard Treatment Guidelines& National Essential Medicines List Tanzania
MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.
GoT (2014-2019). Staffing Levels for Ministry of Health and Social Welfare Departments,
Health Service Facilities, Heath Training Institutions and Agencies. (Revised). Dar es
salaam, Tanzania: MOHSW.

30
Session 5: Policies and Guidelines on Prescribing Medicines
Prerequisites
 No
Learning Tasks
 Define Essential Medicine and Essential Medicine List
 Identify Hospital Formulary
 Explain Tanzania National Formulary(TNF)
 Distinguish between British National Formulary(BNF) and WHO Model formulary
Resources Needed:
 Black/white board, chalk, and whiteboard markers
 Handout 4.1 NEMLIST
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 Essential Medicine, Essential Medicine List
Brainstorming
3 Hospital Formulary
Buzzing
4 Tanzania National Formulary(TNF)
Brainstorming
30 minutes Presentation British National Formulary(BNF) and WHO
5
Model Formulary
SESSION CONTENTS
31
STEP 2: Definition of Essential Medicine and Essential Medicine List (20

minutes)
Ask students to brainstorm on the following questions:
 What are the essential medicines?

 What is Essential Medicine List?
Essential medicines
 Are medicines that satisfy the priority health care needs of the population
o They are selected with due regard to public health relevance, evidence on efficacy and
safety, and comparative cost-effectiveness
o Are intended to be available within the context of functioning health systems
 at all times in adequate amounts
 in the appropriate dosage forms
 with assured quality and adequate information
 at a price the individual and the community can afford
The essential medicine list

 Is the list that gives information of medicines on the name, route of administration,
pharmaceutical forms and strength and indicates the lowest level of health facility where the
medicine may be available
o It aims to identify cost-effective medicines for priority conditions, together with the
reasons for their inclusion, linked to evidence-based clinical guidelines and with special
emphasis on public health aspects and considerations of value of money.
REFER Students to Handout 5.1: Essential Medicine List

32
STEP 3: Hospital Formulary (30 minutes)
Activity: Buzzing (5 minutes)
 What is Hospital Formulary?
ALLOW few pairs to respond and let other pairs to add on points not mentioned
WRITE their response on the flip chart/board
The Hospital Medicine Formulary

 A list consisting of the most cost-effective, safe, readily available medicines of assured
quality that will satisfy the health care needs of the majority of the patients in the hospital.
 Formularies cover all the categories of medicines that patients needs
o Constantly revised and updated to make sure that patients receive appropriate
medications
 Before a medicine is added to or removed from the formulary, teams of pharmacists,
physicians and other healthcare professionals in the hospital do evaluation to make sure that
they are safe, work well and are cost-effective
 These formularies can differ from one institution/hospital to another
STEP 4: Tanzania National Formulary (TNF) (20 minutes)
 What is Tanzania National Formulary?
 Tanzania National Formulary provide guidelines which promote safe, rational, economic
and effective use of medicines in the United Republic of Tanzania
o Concentrates on medicines listed in the NEMLIST and STG

33
o Users are therefore encouraged to use both books together as they complement one
another
STEP 5: British National Formulary (BNF) and WHO Model Formulary

(30minutes)
British National Formulary (BNF)

 Is a pharmaceutical reference book that contains a wide spectrum of information and advice
on prescribing and pharmacology, along with specific facts and details about many medicines
 It is written by Royal Pharmaceutical Society of Great Britain together with the British
Medical Association and it is used in many countries including Tanzania as a reference book.
 It reflects current best practice as well as legal and professional guidelines relating to the uses
of medicines. Contents include:
o Guidance on the drug management of common conditions
o Details of medicines with special reference to their uses, cautions, contra-indications,
side-effects, doses, and relative costs
 Guidance on prescribing, monitoring, dispensing, and administering medicines
WHO Model Formulary

 Since its first publication in 2002, the WHO Model Formulary has become a source of
independent information on essential medicines for pharmaceutical policy-makers and
prescribers worldwide.
 For each medicine, the Formulary provides information on use, dosage, adverse effects,
contraindications and warnings, supplemented by guidance on selecting the right medicine
for a range of conditions

 Essential medicines list aims at providing medicines informations of common disease in the
country based on efficacy, safety and cost-effectiveness.
 Since prescribers and dispensers are encouraged to prescribe/dispense medicines only when
they are essential then the proper use of guides such as EML, Hospital Formulary, TNF, BNF
and WHO Model formulary are very crucial

 What is TNF, NEMList and hospital formulary?
 What are the importances of formularies when prescribing/dispensing medicines?

34
References
GoT (2013). Standard Treatment Guidelines& National Essential Medicines List Tanzania
MainLand ( 4th ed). Dar-es-salaam, Tanzania: MOHSW.
Rice, J. (2011). Principles of pharmacology for medical assisting (5th ed.). Boston, United
States: Cengage Learning.
Roach, S. S., & Ford, S. M. (2008). Introductory clinical pharmacology (8th ed.). Philadelphia,
United States: Lippincott Williams & Wilkins.
Taber, C. W., & Thomas, C. L. Taber's cyclopedic medical dictionary (pp. v.). Philadelphia,
United States: F.A. Davis Co.
Walker, R., & Whittlesea, C. (2012). Clinical pharmacy and therapeutics (5th ed.). Edinburgh,
United Kingdom: Churchill Livingston/Elsevier.

35
Handout 5.1: Essential List of Medicine
NATIONAL ESSENTIAL MEDICINE LIST FOR TANZANIA (NEMLIT)
Name of medicine
Route of
administration
Pharmaceutical forms and strengths
A letter before the name of each medicine indicates the lowest health care
facility where the medicine may be available.
A) Dispensary B) Health Centre C) District Hospital D) Regional and Referral
Hospital
1.0 ANAESTHETICS
1.1 Anaesthetics,
General
C Ether Liquid for inhalation, bottle
anaesthetic 500ml
C Halothane Liquid for inhalation, bottle
250ml
C Injection (hydrochloride), 10mg/ml in
Ketamine 20ml
Powder for injection (sodium salt), 0.5g,
C T
in 20ml
iohpental
C Oxygen Cylinder (medical gas) for
inhalatio
1.2 Anaesthetics,
Local
Injection 0.5% (hydrochloride) in
C Bupivacaine
7.5% dextrose heavy spinal
A Lignocaine Injection (hydrochloride), 1% in 10ml

vial
B Lignocaine Injection (hydrochloride), 2% in 2ml
vial
Injection (hydrochloride), 5% and
C Lignocaine in Dextrose 7.5% dextrose, in 2ml ampoules for
spinal anaesthesia
Injection (hydrochloride) 2% with

B Lignocaine
adrenaline 1:100,000 in 2ml ampoule for
dental use
C Lignocaine Jelly (hydrochloride) 2%, 5% in 30g
tube
MUSCLE RELAXANTS
2.0 AND
CHOLINESTERASE
INHIBITORS
Injection (triethiidide) 40mg/ml in
D
2ml ampoule
Gallamine
Injection (hydrochloride or hydrogen
tartarate),1mg/ml in 1ml ampoule, Injection
C
(hydrochloride or hydrogen tartarate),
Neostigmine
2.5mg/ ml in 1ml ampoule
D Injection (bromide) 4mg/ml in 2ml

Pancuronium ampoule
Powder for injection (bromide or
C
chloride) 50mg/ml in 2ml vial
Suxamethonium
ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY
3.
MEDICINES AND MEDICINES USED TO TREAT GOUT
0
A Acetylsalicylic acid Tablets
300mg
D Allopurinol Tablets
100mg
B Diclofenac Tablets (sodium/potassium salt) 25mg,
50mg
19
4

36
Injection (sodium salt), 25mg/ml in
C Diclofenac
3ml ampoule
A Diclofenac Ge
l
C Diclofenac Tablets 100mg (Slow
release)
C Diclofenac Rectocaps
100mg
C Ibuprofen Tablets
200mg
C Capsules 25mg,
Indomethacine 50mg
A Mefenamic Tablets/Capsules
acid 500mg
A Tablets
Paracetamol 500mg
A Syrup
Paracetamol 125mg/5ml
C Tablets 50mg,
Tramadol 100mg
C Injection 50mg/ml in
Tramadol 2ml
4.0 ANTI-MIGRAINE
MEDICINES
A Acetylsalicylic acid Tablets
300mg
A Tablets
Paracetamol 500mg
5.0 ANALGESICS NARCOTICS AND
ANTAGONISTS
C Morphine Injection (sulfate) 10mg/ml in 1ml
ampoule
Injection (hydrochloride) 0.4mg/ml in
C
1ml ampoule
Naloxone
Injection (hydrochloride) 50mg/ml in 1ml
C
and 2ml ampoule
Pethidine
C Capsules
Pethidine 50mg
ANTI-ALLERGIES AND MEDICINES USED IN ANAPHYLAXIS AND
6.
CARDIOGENIC SHOCK
0
A Chlorpheniramine Tablets (maleate)
4mg
A Chlorpheniramine Injection (maleate10mg/ml in 1ml
ampoule)
A Chlorpheniramine Elixir (maleate)
2mg/5ml
C Loratadine Tablet
10mg
C Loratadine Syrup
5mg/5ml
C Cetrizine Tablets (hydrochloride)
10mg
C Cetrizine Oral solution
5mg/5ml
Adrenaline Injection (as hyrochloride or
A
(Epinephrine) hydrogen tartarate) 1mg/1ml
ampoule
Injection (hyrochloride) 40mg/ml in
D Dopamine
5ml ampoule
Powder for injection (as sodium
A Hydrocortisone
succinate) 100mg in vial
A Tablets (hydrochloride)
Promethazine 25mg
A Injection (hydrochloride) 25mg/ml in
Promethazine 2ml
A Syrup
Promethazine 5mg/5ml
C Injection (phosphate as sodium salt)
Dexamethasone 4mg/ml
19
5

37
7.0 ANTIDOTES
7.1 Antidotes (Non specifi
c)
C Ipecacuanha Syrup, containing 0.14% Ipacacuanha
alkaloid
A Charcoal, Tablets or Powder,
activated 50g
C Magnesium Powder,
sulphate 5g
7.2 Antidotes (Specifi
c)
Injection (sulphate) 600mcg/ml in
B Atropine
1ml ampoule
8.0 ANTI-EPILEPTICS AND ANTI-

CONVULSANTS
C Carbamazepine Tablets 200mg,
400mg
C Carbamazepine Syrup
100mg/5ml
C Tablets 2mg,
Diazepam 5mg
A Diazepam Injection 5mg/ml in 2ml
ampoule
A Phenobarbital Tablets (as sodium) 30mg,
100mg
Injection (as sodium salt), 200mg in
C Phenobarbital
2ml ampoule
Injection (as sodium salt), 100mg in
C Phenobarbital
2ml ampoule
Tablets/Capsules (as sodium salt)
A Phenytoin
50mg, 100mg
A Phenytoin Suspension (as sodium salt)

30mg/5ml
C Magnessium sulphate Injection 50mg/ml in 10ml
vial
9.0 ANTI-INFECTIVE
MEDICINES
9.1 Amoebicides
B Metronidazole Tablets
200mg
Suspension (as benzoate) 200mg/5ml
B Metronidazole
in 100ml
C Tinidazole Tablets
500mg
D Secnidazole Tablets
1000mg
9.2 Anthelminthics
A Albendazole Tablets 200mg, 400mg,
chewable
A Albendazole Suspension 100mg/5ml in 30ml
bottle
A Tablets 3mg,
Ivermectin 6mg
A Levamisole Tablets (as hyrdochloride)
40mg
A Levamisole Suspension as hydrochloride
40mg/5ml
A Mebendazole Tablets 100mg,
chewable
A Mebendazole Suspension 100mg/5ml in 30ml
bottle
B Tablets 500mg,
Niclosamide chewable
C T Tablets 500mg,
iahbendazole chewable
9.3 Anti-bacterial Medicines
A Capsules (as trihydrate) 250mg,
Amoxycillin 500mg
Powder for suspension (as
A
trihydrate), 125mg/5ml in 100ml
Amoxycillin
bottle
19
6

38
Amoxycillin + Clavulanic Tablets (as trihydrate) 500mg +
C
125mg acid clavulanic acid (as potassium salt)
Powder for suspension (as trihydrate)

Amoxycillin +
125mg+ C
Clavulanic 31.25mg (as potassium salt) in 5ml, 100ml
aci
d bottle
Powder for injection (as sodium salt)

C
250mg, 500mg in vial
Ampicillin
D Tablets (as dihydrate)
Azithromycin 250mg
Powder for injection (as pentahydrate)
C Ceftazidime
250mg in vial
C Ceftriaxone Injection 250mg, 1g in
vial
C Ceftriaxone Infusion
2g
A Chloramphenicol Capsules
250mg
Powder for injection (as sodium
A Chloramphenicol
succinate) 1g in vial
B Oily injection (as sodium succinate) 1g in

Chloramphenicol vial
Suspension (as palmitate), 125mg/5ml
A Chloramphenicol injection (as phosphate), 150mg/ml in
2ml ampule
C Ciprofloxacin Tablets (as hydrochloride) 250mg,

500mg
IV solution (as lactate) 2mg/ml in
C Ciprofloxacin
100ml bottle
D Capsules
Clindamycin 150mg
Injection (as phosphate) 150mg/ml in
D
2ml ampule
Clindamycin
C Cloxacillin Capsules (as sodium salt),
250mg
Powder for injection (as sodium salt)
C Cloxacillin
250mg, 500mg in vial
Powder for suspension (as sodium

C Cloxacillin
salt), 125mg/5ml in 100ml bottle
Tablets 480mg (sulphamethoxazole

A Co-trimoxazole
400mg/ trimethoprim 80mg)
Suspension (sulphamethoxazole 200

A Co-trimoxazole
mg/5ml + trimethoprim 40mg/5ml in
100ml bottle
A Doxycycline Tablets/capsules (as hydrochloride),
100mg
Tablets (as stearate or ethyl succinate),
A
250mg, fi lm coated
Erythromycin
Powder for suspension (as
A
ethylsuccinate), 125mg/5ml in 100ml
Erythromycin
bottle
C Flucloxacillin Capsule (sodium)
250mg
C Flucloxacillin Syrup
125mg/5ml
C Flucloxacillin Injection (sodim)
250mg
Injection (as sulphate) 40mg/ml in
A Gentamicin
2ml ampoule
D Powder for injection,
Kanamycin 1g
C Metronidazole Tablets
200mg
19
7

39
Suspension as (benzoate) 200mg/5ml
C Metronidazole
in 100ml
C Metronidazole Injection (I.V) 5mg/ml in 100ml
bottle
C Nalidixic Tablets
acid 500mg
A Nitrofurantoin Tablets
100mg
Powder for injection (as sodium or
A Penicillin,
potassium salt) 3g ( 5,000,000 IU) in vial
benzyl
Penicillin, Powder for injection 1.44g (2,400,000
C
benzathine benzyl IU) in vial
Penicillin,
A Tablets (as potassium salt),
phenoxy methyl-
250mg
Penicillin, Powder for suspension 125mg/5ml in
A
phenoxy methyl- 100ml bottle
Penicillin, Fortified powder for injection 4g
A
procaine benzyl (4,000,000 IU)
C Sulphadiazine Tablets
500mg
C Sulphasalazine Tablets
500mg
C Tablets 100mg,
Trimethoprim 200mg
9.4 Anti-fi
larials
A Tablets 3mg,
Ivermectin 6mg.
B Diethylcarbamazine Tablets (dihydrogen citrate)
50mg
9.5 Anti-leishmaniasis Medicines
D Injection (di-isethionate) 200mg
Pentamidine vial
Injection 10% (equivalent to
D Sodium stilbogluconate
pentavalent antimony 100mg/ml) in
vial
9.6 Anti-malaria Medicines
Artemether/
A Tablets
Lumefantrine (Alu)
20mg/120mg
A Chloroquine Tablets 150mg

base
B Quinine Tablets (as sulphate or bisulphate)
300mg
Injection (as dihydrochloride) 300mg/ml
A Quinine
in 2ml ampoule, 25ml vial
Sulfadoxine + Tablets Sulfadoxine 500mg +

A
Pyrimethamin Pyrimetheamine 25mg
e
Sulfamethoxyprazine + Tablets Sulfamethoxypyrazine
C
Pyrimethamine (salfalene) 500mg+ pyrimethamine
25mg
9.7 Anti-schistosomals
A Praziquantel Tablets
600mg
9.8 Anti-trypanosomals
Injection 3.6% solution (in propylene
C Melarsoprol
glycol containing 5% water)
C Suramin Powder for injection 1g in
sodium vial
19
8

40
9.9 Anti-leprosy Medicines
A Clofazimine Capsules 100mg, tablets
300mg
A Dapsone Tablets 50mg,
100mg
A Sodium fusidate Tablets
250mg
A Sodium fusidate Suspension 250mg/5ml in 100ml
bottle
9.10 Anti-tuberculous Medicines
A Tablets (hydrochloride)
Ethambutol 400mg
A Ethambutol + Tablets 400mg +
Isoniazid 100mg
A Isoniazid Tablets
100mg
A Pyrazinamide Tablets
500mg
A Rifampicin + Capsules/Tablets 150mg +
Isoniazid 75mg
A Rifampicin + Capsules/Tablets 150mg +
Isoniazid 150mg
A Streptomycin Powder fo rinjection (as sulphate) 1g in
vial
Rifampicin +
Isoniazid A + Tablets 150mg + 75mg + 400mg +
Pyrazinamide + 275mg
Ethambutol
9.11 Antiviral Medicines
C Abacavir Tablets
300mg
C Abacavir Syrup 20mg/ml,
240ml
C Acyclovir Tablets 400mg,
800mg
C Acyclovir Cream
5%
C Didanosine Tablets 100mg, 200mg,
400mg
C Efavirenz Capsules 200mg,
600mg
C Ganciclovir Capsules
250mg
C Ganciclovir Powder for injection,
500mg/vial
C Idoxuridine Topical ointment
5%
C Idoxuridine Eye solution
5%
C Indinavir Capsule
400mg
C Lamivudine Tablets
150mg
C Lamivudine Syrup 10mg/ml, 100ml
bottle
Lamivudine
C Tablets 150mg +
+ Zidovudine
300mg
C Lopinavir/Ritonavir Capsules 200mg,
400mg
C Tablets
Nelfinavir 250mg(mesylate)
C Oral powder (mesylate)
Nelfinavir 50mg/g
C Nevirapine Tablets
200mg
C Nevirapine Syrup
10mg/5ml
C Ritonavir Capsules
100mg,
C Ritonavir Syrup
600mg/7.5ml
C Saquinavir Capsules 200mg
(mesylate)
C Saquinavir/Ritonovir Capsules 200mg,
400mg
19
9

41
C Stavudine Tablets/Capsules 15mg, 20mg, 30mg,
40mg
Stavudine + Lamivudine
C Tablets 30mg + 150mg +
+ Nevirapine
200mg
Stavudine + Lamivudine
C Tablets 40mg + 150mg +
+ Nevirapine
200mg
C Zidovudine Tablets 100mg,
300mg
C Zidovudine Syrup 10mg, 100ml
bottle
9.12 Fungicides (Systemic and
Mucosal)
D Amphotericin Powder for injection 50mg in
B vial
B Clotrimazole Vaginal cream (nitrate) 2%,
10%
A Clotrimazole Pessaries
100mg
C Fluconazole Capsules 50mg, 150mg,
200mg
C Fluconazole Suspension
50mg/5ml
I.V infusion 2mg/ml in 25ml and
C Fluconazole
100ml bottle
B Griseofulvin Tablets
500mg
B Griseofulvin Suspension
125mg/5ml
C Ketoconazole Tablets
200mg
C Ketoconazole Suspension 100mg/5ml in 30ml
bottle
C Miconazole Oral
gel
A Nystatin Tablets 500,000
IU
A Nystatin Suspension oral 100,000 IU/ml in 30ml
bottle
9.13 Medicines for Opportunistic
Infeciton
B Co-trimoxazole Tablets
480mg
C Dapsone Tablets 50mg,
100mg
C Fluconazole Capsules 50mg, 150mg,
200mg
C Fluconazole Suspension
50mg/5ml
I.V infusion 2mg/ml in 25ml and
C Fluconazole
100ml bottle
C Flucytocine
I.V infusion 10mg/ml 250ml
bottle
10.0 ANTI-NEOPLASTIC, IMMUNOSUPPRESSIVE AND RELATED
MEDICINES
D Tablets
Cyclophosphamide 50mg
Powder for injection 100mg, 200mg,
D
500mg, 1000mg in vilal
Cyclophosphamide
D Tablets
Prednisolone 5mg
11.0 ANTI-PARKINSONISM
MEDICINES
C Benzhexol Tablets (hydrochloride) 2mg,
5mg
D Biperidine Tablets 2mg/5ml injection 1ml
ampoule
D Levodopa Tablets/capsule 125mg, 250mg,
500mg
D Levodopa+Carbidopa Tablets 100mg +
25mg
20
0

42
12.0 MEDICINES AFFECTING THE
BLOOD
Ferrous sulphate +
A Tablets 200mg +
folic acid
0.25mg
A Ferrous Tablets 200mg (equivalent to 60mg
sulphate iron)
A Ferrous Syrup 20mg/ml (equivalent to 6.5mg
fumarate iron/ml)
A Folic Tablets
acid 5mg
Hydroxocobalamin
C Injection 1mg/ml in 1ml
(Vit B12)
ampoule
Injection 5% (equivalent to 50mg iron/ml)
C Iron
in 5ml and 20ml ampoule
dextran
13.0 ANTI-COAGULANTS AND
ANTAGONISTS
D Acetylsalicylic Tablets
acid 75mg,
Injection (sodium salt) 1,000 IU/ml in
D Heparin
5ml ampoule, flashes
Phytomenadione (Vit.
C K) Injection
1 10mg
Phytomenadione (Vit.
C K) Injection 0.5 mg/ml, 2mg/ml in 2ml
1 ampoule
D Protamine Injection 10mg/ml in 5ml
sulphate ampule
D Tranexamic Tablets
acid 500mg
D Tranexamic Injection 100mg/ml in 5ml
acid ampoule
D Tranexamic Syrup 500mg/5ml in 300ml
acid bottle
D Tablets (sodium salt)
Warfarin 5mg
Powder for injection 250,000 unit or
D Streptokinase
750,000 unit vial
Injection, equivalence of
D Low molecular Heparin
Enoxaparin(sodium) 6000-8000 IU/ml
Injection, equivalence of Edalteparin

D Low molecular Heparin
(sodium) 10,000IU/ml
D Factor VIII 500I
concentrate U
D Factor IX 500
concentrate IU
Fresh frozen
D Bag
plasma (FFP)
s
14.0 PLASMA
SUBSTITUTES
IV solution 6% in sodium chloride bottle
C Dextran
of 500ml
70
C IV solution 3.5%, 500ml
Polygeline bottles
15.0 CARDIOVASCULAR
MEDICINES
15.1 Anti-anginal Medicines
C Glycerly trinitrate Tablets 500 mcg
sublingual
C Isosorbide Dinitrate Tablets 10mg,
20mg
D Nifedipine Capsules/tablets 10mg,
sublingual
C Propranolol Talets
40mg
20
1

43
15.2 Anti-arrhythmic Medicines
D Amiodarone Tablets (hydrochloride)
100mg
Injection (hydrochloride) 30mg/ml in
D
10ml ampoule
Amiodarone
D Tablets 40mg
Verapamil 80mg
D Injection 2.5mg/ml, 2ml
Verapamil ampule
15.3 Anti-hypertensive Medicines
A Methyldopa Tablets
250mg
C Captopril Tablets 12.5mg,
25mg
C Nifedipine Tablets 10mg,
sublingual
C Nifedipine (retard) Tablets 20mg,
30mg
C Atenolol Tablets 50mg,
100mg
A Propranolol Tablets
40mg
15.4 Hypertensive Emergencies
Powder for injection (hydrochloride)
C Hydralazine
25mg/ ml ampoule
C Hydralazine Tablets
25mg
15.5 Cardiac
Glycosides
C Digoxin Tablets 0.25mg
(250mg)
C Digoxin Injection 250mg/ml in 2ml
ampoule
15.6 Diuretics
B Tablets
Frusemide 40mg
Frusemide ampoule
A Hydrochlorthiazide Tablets 25mg,
50mg
C Mannitol IV solution 10% in 200 ml
bottle
D Spironolactone Tablets 25mg,
50mg
A Bendrofluazide Tablets
5mg
15.7 Lipid Lowering
Medicines
D Tablets
Simvastatin 10mg
D Atorvastatin Tablets
10mg
16.0 DERMATOLOGICAL
MEDICINES
16.1 Antiseptic/Disinfectants
A Povidone-iodine Solution 10% (250ml
bottle)
Chlorinated lime+Boaric
A Solution (prepare from raw materials)
Acid
(eusol)
Soluiton 0.5% in water (prepare from
A Gentian violet
raw materials)
B Potassium Solution 1:1000 (prepare from raw
permanganate materials)
20
2

44
16.2 Anti-inflammatory (steroidal) Medicines and Anti-pruritic
Medicines
Skin cream or ointment (valerate) 0.1%
C
in 15g tube
Bethamethasone
C Lotion (valerate) 0.1% in 30ml
Bethamethasone bottle
C Hydrocortisone Cream
0.5%
A Skin
Calamine ointment/lotion
Para aminobenzoic
C Cream/lotion
Acid (PABA)
5%
C Tretinoin Topical cream 0.025%, Gel
acid 0.01%
16.3 Fungicides
(topical)
Ointment (prepare from raw
A Benzoic acid
materials) (whitfied’s)
Compound
C Clotrimazole Cream 1% in 20g
tube
C Clotrimazole Powder
0.01g/g
C Clotrimazole Vaginal pessaries 100mg,
500mg
C Nystatin Cream 100,000 IU/g in 15g
tube
C Nystatin Pessaries 100,000
IU
C Miconazole Pessaries (nitrate)
1.2g
C Miconazole Vaginal cream (nitrate)
2%
C Miconazole Spray (nitrate) 0.16% + oral gel
D Solution 1%
Tolnaftate 10mg/ml
D Cream 1%, 15 and 30g
Terbinafine Tube
16.4 Keratoplastic and Keratolytic
Agents
C Silver nitrate Stick
C Solution 10-25% (prepare from raw
Podophylin materials)
C Coaltar Ointment 5% (prepare from raw
materials)
Topical solution 5% (prepare from
C Salicylic
raw materials)
acid
A Emulsifying agent Cream - the equivalent to E45 or
sofderm
C Cream
Imiquimod 5%
16.5 Anti-infective Agents
(topical)
Oxytetracycline +
B Spray 150mg +
hydrocortisone
50mg
Oxytetracycline +
B Ointment 3%
hydrocortisone
+1%
A Benzoyl peroxide Ointment/cream 2.5%, 5% and
forte
A Chloramphenical Ointment
1%
C Mupirocin Ointment
2%
17.0 GASTRO-INTESTINAL
MEDICINES
17.1 Antacids and Anti-ulcer
Agents
C Cimetidine Tablets 200mg,
400mg
20
3

45
Cimetidine ampoule
C Tablets
Famotidine 40mg
Famotidine ampoule
C Lansoprazole Capsule,
30mg
Tablets (250mg magnesium trisilicate
A Magnesium trisilicate
+ 120mg dried aluminium hydroxide)
co.
C Omeprazole Tablets
20mg
C Ranitidine Tablets
150mg
C Ranitidine Injection
50mg/2ml
C Cholestyramine Sachet
4g
17.2 Anti-spasmodics
A Hyoscine butylbromide Tablets
10mg
C Hyoscine butylbromide Injection 20mg/ml; 1ml
ampoule
17.3 Anti-emetics
A Tablets (hydrochloride/theoclate) 10mg,
Promethazine 25mg
A
2ml ampoule
Promethazine
A Elixir (hydrochloride)
Promethazine 5mg/5ml
D Metoclopramide Tablets
10mg
D Metoclopramide Injection
5mg/2ml
C Prochlorperazine Tablets 5mg,
25mg
C Prochlorperazine Injection (as mesylate) 12.5mg/ml
ampoule
17.4 Cathartics
A Bisacodyl Tablets
5mg
A Bisacodyl Suppositories 5mg,
10mg
C Lactulose Solution 3.1 - 3.7g/5ml, 200ml
bottle
17.5 Anti-haemorrhoids
Suppositories/ointment (Bismuth oxide

Local anaesthetic
25mg + Bismuth subgallate 59mg + Peru
+ C astrigent and
balsam 49mg+Zinc oxide 296mg) equivalent
anti
to Anusol suppositories
inlfamatory
Local anaesthetic Suppositories (Cinchocaine hydrochloride
+ C astrigent and 5mg + Hydrocortisone 5mg) equivalent to
anti ProctosedylR
inlfamatory
Cream/ointment containing (Benzyl benzoate
Local anaesthetic
+1.2%Bismuth oxide 0.875%+Hydrocortisone
+ C astrigent and
acetate 0.5%+Peru balsam 1.85%) equivalent
anti
to Anulgesic
inlfamatory
Suppositories containing (benzyl benzoate
33mg+bismuth oxide 24mg+bismuth
Local anaesthetic
subgallate 59mg+hydrocortisone acetate
+ C astrigent and
5mg+Peru balsam 49mg+bromocaine
anti
HCl 27mg+Zinc oxide 296mg) equivalent
inlfamatory
to Anugesic
20
4

46
17.6 Medicine Used in
Diarrhoea
Sachet to make 1 litre of solution
Oral Rehydration containing Sodium chloride 2.6g, Sodium
A
Salts (ORS) low citrate 2.9g, Potassium chloride 1.5g and
osmolarity Glucose 20.5g) repalcement solution
C Loperamide Tablets/capsules (hydrochloride)

2mg
Tablets dispersible (equivalent to
A Zinc
20mg elemental zinc)
18.0 HORMONES AND ANTIDIABETIC AGENTS AND RELATED

MEDICINES
18.1 Adrenal Hormones and Sysnthetic
Substitutes
D Tablets
Dexamethasone 5mg
Injection (as sodium phosphate) 4 mg/ml
D
in 1 ml ampoule
Dexamethasone
C Hydrocortisone Powder fo rinjection (as sodium
succinate)
C Injection 100mg in
Prednisolone vial
C Tablets
Prednisolone 5mg
18.2 Oestrogens
D Ethinyloestradiol Tablets 50
mcg
18.3 Insulin and Anti-diabetic
Agents
C Chlorpropamide Tablets
250mg
C Glibenclalmide Tablets 2.5mg,
5mg
D Gliclazide Tablets
40mg
C Tablets
Tolbutamide 500mg
C Metformin Tablets
500mg
D Glucagon Injection powder for reconst
10mg/vial
D Glipizide Tablets 2.5mg,
5mg
Insulin-short
C 100
acting (human)
IU/ml100
soluble
Insulin-intermediate
C 100
acting (human)
IU/ml
Insulin-long
C 100
acting (human)
IU/ml
lente
18.4 Ovulation
Inducers
C Tablets
Clomiphene 50mg
18.5 Oral Contraceptives
Ethinyloestradiol +
A Tablets 0.03mg +
Norgestrel
0.3mg
Ethinyloestradiol
A Tablets 0.03mg +
Levonorgestrel
0.15mg
Ethinyloestradiol
A Tablets 0.03mg +
Desogestrel
0.15mg
20
5

47
18.6 Barrier and Other
Contraceptives
Intra Uterine Devices
A Coper T
(IUD)
380A
A Condoms Late
male x
A Condoms Polyurathane sheet 15cm x
female 7cm
18.7 Progesterone
A Levonorgestrel Tablets 0.03mg,
0.07mg
A Medroxyprogesterone Injection acetate (depot)
150mg
D Hydroxyprogesterone Injection (coproate) 200mg/ml in
1ml
A Levonorgesterol Implant 36mg
(set)
D Tablets
Norethisterone 5mg
18.8 Thyroid, Parathyroid Hormones and
Antagonists
C Carbimazole Tablets
5mg
Solution, Iodine 2mg + Potassium Iodide
A Iodine (Lugol’s
4mg/g in water (prepare from raw
solution)
material)
D Levothyroxine Tablets (sodium salt)
0.05g
Capsules with nipple 240mg/0.5ml
A Iodized oil
and 480mg iodine/ml
19.0 SERA AND

IMMUNOGLOBULINS
D Gamma - Injection I.V 500mg, 2.5g,
Globulins 5g
Anti-D(Rho)
C Injection 0.25 mg/ml in set of
Immunoglobuli
5ml
n
Anti-rabies
C Injection 1000 IU/5ml
Immunoglobuli
ampoule
n
Antiserum injeciton (|Central African type)
B Snake venom
in vila
polyvalent
Tetanus
B Injection 1,500 IU in
Immunoglobuli vial
n (human) -
Tetanus
ATS
B Injection 10,000 I.U in
Immunoglobuli vial
n (human) -
Tetanus
ATS
Immunoglobuli vial
n (human) -
Tetanus
ATS
Immunoglobuli vial
n (human) -
20.0 ATS
20.1
VACCINES For
Immunisation
BCG Vaccine
A Injection 20 doses in 10ml
(Bacillus Calmette
vial
Guerin)
DPT Vaccine
A (Diphtheria-Pertussis- Injection 20 doses in 10 ml
Tetanus) vial
DPT Vaccine
(Diphtheria-
A Vaccine
Pertussis-Tetanus) +
injection
Hepatitis Injection
20
6

48
Measles Vaccine
A Injection 10 deses in
(Live attenuated)
vial
Poliomyelitis
A Oral solution 20 doeses in
Vaccine (Live
container
attenuated)
A Tetanus (toxoid) Injection 20 doses in 10ml
Vaccine vial
20.2 For Specific Groups or
Individuals
D Hepatitis B 20mg/ml 1ml 1ml
Vaccine vials
Meningitis vaccine A
D Vaccine
&C
injection
Human Diploid
B Freeze dried rabies
Cell Rabies
vaccine
D Yellow Fever Injection 10 doses in vial (with
Vaccine diluent)
C Pneumococcal vaccine Vaccine injeciton 0.5ml
vial
21.0 OPHTHAMOLOGICAL
PREPARATIONS
21.1 Anti-infective Agents
C Acyclovir Eye ointment
3%
C Chloramphenicol Eye drops 0.5%,
1%
A Chloramphenicol Eye ointment
1%
D Eye drops
Gentamicin 0.3%
C Idoxuridine Eye ointment
0.5%
A Oxytetracycline Eye ointment
3%
21.2 Steroidal Anti-inflammatory Agents
C Hydrocortisone Eye Drops (acetate)
0.5%
21.3 Antiinfective and Antiinlamatory
Agents
Oxytetracycline +
Hydrocortisone +
D Eye
Polymycin B
drops
(Equivalent of
Terracotril)
D Sodium cromoglycate 2% eye
drops
21.4 Anti
Allergy:
D Loratadine Tablets
10mg
C Cetirizine syrup 5mg/5ml
(100ml)
C Sodium Cromoglycate Tablets
10mg
C Sodium Cromoglycate Solution 5mg/ml
(200ml)
C Sodium Cromoglycate Eye
drops
21.5 Drugs for Trachoma &
Onchocerciasis
B Tablets
Azithromycin 500mg
B Capsule
Azithromycin 250mg
B Tablets 3mg,
Ivermectin 6mg.
22.0 MEDICINES USED IN EAR
DISEASES
22.1 Ear
Drops
B Ear drops 5% in
Chloramphenicol 10ml
Dexamethasone
D Ear
+ Neomycin
drops
20
7

49
A Ciprofloxacin Ear
drops
A Aluminium Ear drops
diacetate 3%
22.2 Oral
Antiseptics
Solution 0.1%;prepare from concentrated
A Chlorhexidine gluconate
solution
C Potassium Solution 1:4000; prepare from
permanganate powder/crystals
22.3 Nasal
Preparation
D Spray 0.05% (50mcg/d0se)
Beclomethasone
C Ephedrine Nasal drops 0.5% and
1%
23.0 OXYTOCICS, MYOMETRIAL RELAXANTS (TOCOLYTICS) AND RELATED
MEDICINES
C Salbutamol Tablets
4mg
C Salbutamol Injection 100mcg/ml, 10ml
vial
Injection (mealeate) 0.5mg/ml in
A Ergometrine
1ml ampoule
C Oxytocin Injection 10 IU in 1ml
ampoule
D Misoprostol Tablet 200mcg (rectal,
sublingual)
D Magnesium Injection
sulphate 50%
24.0 PSYCHOTHERAPEUTICS AND RELATED
MEDICINES
D Carbamazepine tablets 200mg,
400mg
A Phenytoin Tablets 50mg,
100mg
A Phenobarbitone Tablets 30mg,
100mg
A Phenobarbitone Injection 200mg/ml in 1ml
ampoule
C Amitriptyline Tablets (hydrochloride)
25mg
Tablets (hydrochloride) 25mg, 100mg
A Chlorpromazine
+ 250mg
B Chlorpromazine
2ml ampoule
C Fluphenazine decanoate Injection 25mg/ml in 1ml

ampoule
B Haloperiodol Tablets 1mg,
5mg
D Haloperiodol Injection 5mg/ml in 1ml
ampoule
B Tablets 25mg,
Imipramine 50mg
C T Tablets
iohridazine 25mg
25.0 MEDICINE ACTING ON RESPIRATORY
TRACT
25.1 Anti-asthmatics
A Aminophylline Tablets
100mg
A Aminophylline Injection 25mg/ml in 10ml
ampoule
Inhalation (dipropionate) 0.05mg per
C
dose (aerosol inhaler)
Beclomethasone
A Ephedrine Tablets (hydrochloride)
30mg
A Ephedrine
1ml ampoule
Nasal spray (di-sodium salt) 2% (sprayer

A Cromoglycate
with pump)
C Salbutamol Tablets (as sulfate)
4mg
20
8

50
C Salbutamol Syrup (as sulfate)
4mg
Inhalation (as sulfate) 0.1mg per dose
D Salbutamol
(aerosol inhaler)
A Adrenaline Injection 1m/1ml
ampoule
25.2 Antitusives
A Codeine Syrup/Linctus
26.0 SOLUTIONS, CORRECTING WATER ELECTROLYTE AND ACID BASE

DISTURBANCES
26.1 Large Volume Intravenous
Solutions
B Darrow’s half 500m
strength l
A Dextrose 5%; 500ml,
1000ml
B Dextrose 10%;
500ml
C Dextrose 25%, 50%; 50ml,
100ml
500ml, 1000ml. Each litre provides
Sodium lactate
approximately Na+ 131 mmol, K+
B compound
5mmol, Ca++2mmol, C1-111mmol and
(Ringer’s solution) 3
HCO -(lactate) 29mmol
Sodium
A 0.9%+5%; 500ml,
chloride+Dextrose
1000ml
B Potassium Solution 7.4% 10ml
chloride Vial
Oral solution containing potassium citrate
C Potassium
30% + citric acid monohydrate 5%
citrate
A Water for 5ml, 10ml
injection vial
27.0 DISINFECTANTS AND
ANTISEPTICS
27.1 Disinfectants
A Sodium hypochlorite Solution 10% (250ml
bottle)
A Hydrogen peroxide Solution 6%
Solution concentrated containing
Chlorhexidine +
A chhlorhexidine digluconate 1.5%+ 15%
Cetrimide
cetrimide in 1litre and 5 litre
A Chlorhexidine Solution 4% in litre and 5

litres
A Chloroxylenol Solution 4.9% BP in litre and 5
litre
A Cresol Solution 3% BP in litre and 5
litre
C solution 36 - 37% stabilised in 1
Formaldehyde litre
Activated solution 2% in 1 litre, 5 litres
C Glutaraldehyde
for scopes sterilization)
A Providone iodine Solution 10% in water 250ml, 500ml, 1

litre
A Methylated spirit 70% in 1 litre, 5
litre
Sodium
A Dichloroisocyanurate Tablets, 1.67g (equal to 1g available
(NODCO) chlorine)
27.2 Antiseptic
A Providone-Iodine Solution (1 litre
bottle)
Chlorinated lime +
A Prepare from raw
Boric Acid Solution
materials
C Potassium Solution 1:
permanganate 1000
20
9

51
permanganate 2000
permanganate 4000
28.0
VITAMINS/MINERALS Gelatin Capsules (with nipple to allow

A Retinol (Vitamin administration drop by drop)
A) 50,000IU, 100,000IU 200, 000IU
Ascorbic acid
C Tablets 100mg and
(Vitamin C)
500mg
C Calcium Injection 100mg/ml in 10ml
gluconate ampoule
Ergocalciferol (vitamin
D Capsules 1.25mg (50,
D)
000IU)
Ergocalciferol (vitamin
D Oral solution 0.25mg/ml
D)
(10,000IU/ml)
Nicotinamide
C B) Tablets
(Vitamin 50mg
3
C Pyridoxine (Vitamin Tablets (hydrochloride)
B 6) 25mg
A T iahmine (Vitamin Tablets (hydrochloride) 50mg,
B 1) 100mg
C T iahmine (Vitamin
1ml ampoule
B 1)
D Vitamin Tablets (hydrochloride)
B12 50mcg
Tablets BP (contains per tablet:
A Vitamin B
nicotinamide 15mg, riboflavin 1mg,
complex
thiamine 1mg)
Syrup (contains per tablet:
A Vitamin B
nicotinamide 15mg, riboflavin 1mg,
complex
thiamine 1mg)
Injection BP in 10ml vial (contains
nicotinamide 200mg, pantothenol 30mg,
C Vitamin B
pyridoxine 20mg, riboflavine 20mg,
complex
thiamine 50mg per 1 ml)
C Potassium Tablets (slow release)

chloride 600mg
21
0

52
Session 6: Prescription Errors
Total Session Time: 120 minutes + 1 hour assignment
Prerequisites
 None
Learning Tasks
 Define prescription error
 List common prescription errors
 Identify common prescriptions errors
Resources Needed:
 Black/white board chalk, and whiteboard markers
 Worksheet 6.1: Prescription Errors
SESSION OVERVIEW
Activity/
Step Time Content
Method
10minutes Presentation
2 Definition of Prescription Error
Brainstorming
3 Common Prescription Errors
Buzzing
60minutes Presentation
Identification of Common Prescription
4 Small Group
Errors
Discussion
7 05 minutes Presentation Assignment

53
SESSION CONTENTS
READ or ASK students to read the learning Tasks and clarify
STEP 2: Definition of Prescription Errors (10 minutes)
 What is a prescription error?
 Prescription errors encompass those related to the act of writing a prescription

 Prescribing faults encompass irrational prescribing, inappropriate prescribing, under
prescribing, overprescribing, and ineffective prescribing
o These faults arise from erroneous medical judgement or decisions concerning
treatment or treatment monitoring
STEP 3: Common Prescription Errors (30 minutes)
 What are the common Prescription Errors?

54
The following are the common prescription errors:
 Omission error
 Wrong dose error
 Extra dose error
 Wrong dose form error
 Wrong time error
 Wrong drug
 Wrong route of administration
 Wrong frequency
 Wrong duration of treatment,
 Poor legibility of handwriting (unknown abbreviations)
 Unintended omissions
 Incomplete Medical Prescription (If any component of a Medical Prescription is not
filled)
STEP 4: Identification of Common Prescription Errors (60 minutes)
 What are the errors in the provided prescriptions?
REFER students to Worksheet 6.1 Prescription Errors SERIAL No. 001-005
Students should be able to identify the following Prescription errors:

 Serial No.001
o Incomplete name of the patient
o No signature
o Duration of medicine missing (erythromycin)
o Wrong frequency of paracetamol
 Serial No. 002
o Name of the institution is not known
o Strength of paracetamol is not known

55
o Prescriber’s name is missing
 Serial No.003
o Age of the patient is missing
o Polypharmacy- no need to dispense two analgesics (paracetamol and aspirin)
o Atenolol strength is not 5.0 but there is 50 mg or 100 mg, mistake in writing
 Serial No.004
o Sex is not indicated (gender)
o Doxycycline and magnesium should not be given together, they interact each other
o Magnesium strength is not shown
 Serial No.005
o No date
o Tetracycline Bd ×2/52
o Wrong medicine for the indication i.e. amoebiasis is treated with Nitronidazole
(Metronidazole, Ttinidazole, Secnidazole)
o Medicine does not tell the dosage form i.e. is it tablet, ointment capsule.
o Drug name should be generic and not trade name (Tulizamol should be written as
Paracetamol)
 Medication errors are common in general practice and in hospitals.

 Both errors in the act of writing (prescription errors) and prescribing faults due to
erroneous medical decisions can result in harm to patients
 Any step in the prescribing process can generate errors
 Inadequate knowledge or competence and incomplete information about clinical

characteristics and previous treatment of individual patients can result in prescribing
faults, including the use of potentially inappropriate medications

 What are prescription errors?
 What are the common prescription errors?

56
References
Cornish, P.L, Knowles, S.R, Marchesano, R, Tam, V, Shadowitz, S, Juurlink, DN, Etchells,
E, E. (2005). Arch Intern Med: Unintended medication discrepancies at the time of
hospital admission. 2005;165:424–9.
Dean, B., Schachter, M., Vincent, C, Barber, N (202). Lancet: Causes of prescribing errors in
hospital inpatients: a prospective study. 359:1373–8.
Dean, B., Vincent, C, Schachter, M., Barber, N (2005). Drug Saf:The incidence of
prescribing errors in hospital inpatients: an overview of the research methods..
28:891–900.
Knudsen, P., Herborg, H., Mortensen, A,R., Knudsen, M., Hellebek, A .(2007). Qual Saf
Health Care:Preventing medication errors in community pharmacy: root-cause
analysis of transcription errors. 16:285–290.
Lesar, T.S., Briceland, L., Stein, D, S. (1997). JAMA:Factors related to errors in medication
prescribing.. 277:312–317.
Spinewine, A., Schmader, K,E., Barber, N., Hughes, C., Lapane, K,L., Swine, C., Hanlon,
J,T. (2007). Lancet: Appropriate prescribing in elderly people: how well can it be
measured and optimised? 370:173–184.
Tam, V,C., Knowles, S,R., Cornish, P,L., Fine., Marchesano, R., Etchells, E,E. (2005).
CMAJ: Frequency, type and clinical importance of medication history errors at
admission to hospital: a systematic review..173:510–5.
Velo, G, P., & Minuz, P. (2009). British Journal of Clinical Pharmacology: Medication
errors: prescribing faults and prescription errors. 67:6

57
Worksheet 6 .1: Prescription Errors Serial No. 001-005
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Serial Na. 001 Serial Na. 002

P.O. Box 558 Name: Mariam Juma
IRINGA
Gender: Me
Name: John
Age: 20Yrs
Gender: Me
Weight: 60kg
Age: 20Yrs
Rx Amoxicillin 500mg tds 7/7
Weight: 60kg
Rx Erythromycin tabs 500mg q.i.d
Paracetamol Tabs 1g Bd 3/7

name MO qualification CO
qualification 11/09/2015 Signature
10/07/2015
Serial Na. 004

P.O. Box 558
IRINGA
Name: Kalunde Athuman
Serial Na. 005
Age: 20Yrs
KIHESA HEALTH CENTER60kg
Weight:
P.O. Box 558
Rx
IRINGA Doxycycline100 Bd 7/7
Name: John Magnisium Tricylicate tds 3/7
Gender: Me Prescriber’s Ulimbo Ole
Age: 20Yrs name MO

qualification
Weight: 60kg
Amoeba Signature
Dx
17/02/2015
Rx Tetracyclin Bd 2/52
Tulizamol Tabs 1g tds 3/7
59
name MO
qualification
Session 7: Dispensing Procedures in Pharmacy
Prerequisites
 Session 1
Learning Tasks

60
 Define dispensing, dispenser, medicine and good dispensing procedures
 Explain good dispensing procedures
 Demonstrate good dispensing procedures
Resources Needed:
 Black/white board, chalk, and whiteboard markers
 Worksheet 7.1: Demonstration on Good Dispensing Procedures
 Worksheet 7.2: Sample Prescription Serial No. 001
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Presentation Definition of Dispensing, Dispenser,
2
Medicine and Good Dispensing Procedures
3 Good Dispensing Procedures
Brainstorming
60 minutes Presentation Demonstration of Good Dispensing
4
Role play Procedures
5 05minutes Presentation Key Points
SESSION CONTENTS

61
Step 2: Define Dispensing, Dispenser, Medicine and Good Dispensing
Procedures (10 minutes)
 Dispensing: The act of preparing medicines and/or medical supplies and distributing to
users with adequate information, counseling and appropriate follow up
 Dispenser: Any person who is licensed or authorized by the appropriate body to dispense
medicines and/or medical supplies
 Medicine: Any substance or mixture of substances used in the diagnosis, treatment,
mitigation or prevention of a disease in human
o Medicines include narcotic drugs, psychotropic substances and precursor chemicals,
traditional medicines, complementary or alternative medicine; poisons, blood and
blood products, vaccine, radioactive pharmaceuticals, cosmetics and sanitary items and
medical instruments
 Good Dispensing Procedures: Refers to the delivery of the correct medicine to the right
patient, in the required dosage and quantities, in the package that maintains acceptable
potency and quality for the specified period, clear medicine information counseling and
appropriate follow up
STEP 3: Good Dispensing Procedures (35 minutes)
 What procedures to follow in Good Dispensing?
Dispensing Procedures
 Procedure 1: Evaluation and interpretation of a prescription
In this step a dispenser should do the following after welcoming and greeting the
patient;
o Make sure that all important parts of the prescription are correct and complete
(refer session 1)
o Arrange prescriptions in order so as to prevent possibility of confusion
o Dispenser should have knowledge of transcribing the prescription
o Make sure that the name of the medicine, dose, dosage, duration are correct
62
o The prescription should be in writing or typed but must be signed by the
prescriber in ink
 Procedure 2: Selection and handling of the medicine. This includes:

o Select stock container of pre-pack reading the label and cross matching the
medicine name and strength against the prescription
o Read the container label at least twice during the dispensing process.
o Do not select the prescribed medicine according to the color or location of
container
o Do not open many stock containers at the same time
 This trend will lead to errors and/or expose the medicines to air and
eventually leads to deterioration in quality
o Open and close containers once at a time
o While counting, pouring or measuring, the following points should be noted:
 Short and/or over counting should be avoided
 Clean counting tray and/or spoon used
 Graduated measuring cylinder and/or flask must be used for measuring
liquid reduction
 If small volume is to be measured, small measuring cylinder/flask has to
be used (if compounding is performed in the pharmacy) provide
appropriate bottles with caps for repackaging liquid preparations
o Dispense liquid preparations in suitable container
 Do not use patient’s own bottle
 Dispense each medicine in a different bottle
In dispensing tablets and capsules:

 Do not use fingers to count tablets as this can lead to contamination of medicines
 Use a spoon to put tablets and capsules onto a counting tray
 Count and put them in a labeled medicine container or pack
 Close stock containers tightly after dispensing
 Keep the spoon clean at all times
 Do not keep the spoon inside the container
 Labeling of dispensed medicines should be clear and legible
 Use separate plastic boxes for different patient's requirements of medicines
 To avoid mix-ups of medicines of different patients, it is a good procedure to
assemble medicines of different patients in separate/different boxes, till they are billed
and packed
 Procedure 3: Labeling and packaging of the medicine in an appropriate container

o The containers used for dispensing must be appropriate for the product dispensed
o All containers intended for medicinal products must be protected and kept free from
contamination
63
o Medicines must be suitably contained, protected and labeled from the time of
manufacture until they are used by the patient
o The container must maintain the quality, safety and stability of the medicine
throughout this period
 Procedure 4: The provision of information and instruction to client

o 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.
o 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.
o Counseling should cover matters that will enhance or optimize medicine therapy. The
information in the form of verbal and/or written instructions should include the
following:
 How much and how often to take the medicine
 When to take the medicine (e.g., before or after meals)
 How long the treatment is to last (e.g., why the entire course of an antibiotic
treatment must be taken)
 How to take the medicine (e.g., with water, chewing or swallowing)
 How to store the medicine (e.g., avoid heat, light and dampness, keep out of reach
of children)
 Not to share medicines with other persons
 Which types of foods and beverages should avoid while taking the medicine
 One has to demonstrate to the patient on how to administer the dispensed
medications in case of inhaled administration and suppository application
 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
 Procedure 5: Recording the transaction

o Prescriptions should be recorded and documented as proof of transaction between the
patient and the dispenser
 Prescriptions can therefore be traced back if any need arises
 All dispensing units should have a standardized Prescription Registration Book (PRB)
for recording every pharmaceutical issued to a patient
o A computerized dispensing and registration system may also be used, but should always
be supported by paper back up
64
 The registration book should be completed at the time of dispensing or at the close of
the working day
o The prescription registration book should be used both when prescriptions are retained
in the pharmacy and when they are returned to the patient
 For a prescription which is returned to a patient because all the items in the original
prescription could not be filled, the medicines that have been dispensed from the
pharmacy should be copied on a blank prescription and the prescription should be
filed appropriately
o On the original prescription, which is retained by the patient, the word “dispensed”
should be stamped adjacent to those items which have been dispensed
o For prescriptions which are to be refilled on a later date, the dispensing information
should be entered into the registration book before returning the prescription to the
patient
 The official seal of the pharmacy/Health institution, name and signature of the
dispenser, the date of dispensing and the next refill date should be written on the
back of the prescription
Source: FMHACA (2012)
Figure 1: Pictorial presentation of dspensing procedure
STEP 4: Demonstration of Good Dispensing Procedure (60 minutes)

Activity: Role Play (30 minutes)
EXPLAIN that this will be a role play between a patient and a dispenser. One volunteer
student will play as dispenser and will demonstrate the necessary steps of Good Dispensing
Procedures through and dispensing medicines to the patient, who will be another student
volunteer.

65
ASK two students to volunteer playing as dispenser and patient respectively.
TELL the rest of students to observe carefully on the procedures of Good Dispensing
EXPLAIN that the patient will handle the prescription to the dispenser and wait for the
medicine. The dispenser should follow all Good Dispensing procedures for dispensing
medicine..
EMPHASIZE that the Dispenser should follow all the guides and steps of Good Dispensing
procedures.
START the role play.
LEAD a discussion after the role play.
DE-ROLE all the students, once the role play is over.
ASK students if they have any questions about the role play.
Refer student volunteer to Worksheet 7.1: Demonstration so that he/she can read
the description of the dispenser
Refer students to Worksheet 7.2: Sample Prescription Serial No. 001

 Dispensing refers to the process of preparing medicines and distributing to users with
provision of an appropriate information, counseling and follow up
 Good dispensing procedures ensure that the correct medicine is delivered to the right patient,
in the required dosage and quantities, with clear instructions, and in package that maintains
an acceptable potency and quality of the medicine
 The medicine should be dispensed in a safe and hygienic manner, making sure that the patient
or care provider understands and appreciates the value of taking specific medicines for
specific indications

 What is dispensing?
 What is Medicine ?
 Which are the Good Dispensing Procedures?

66
References
Cooper, J. W., Gunn, C., & Carter, S. J. (2008). Cooper and Gunn's dispensing for
pharmaceutical students (12th ed.). New Delhi, India: CBS.
FMHACA of Ethiopia (2012). Manual for Medicine Good Dispensing practices. (2nd ed.).
Ethiopia
67
Worksheet 7 .1: Role Play Demonstration on Good
INCLUD Dispensing Procedures
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69
Script:
Your role is to dispense the medicines to a patient who hands the prescription. you should
follow all good dispensing procedures principles as you receive the prescription from the
patient.
 Greet the patient
 Receive the prescription from the patient
 Read the prescription and interpret and understand
 Prepare and select medicines as per given prescription
o Erythromycin Tablets 500mg qid 7/7
o Paracetamol Tablets 1g tds 3/7
 Calculate total quantity of each medicine
o Erythromycin Tablets: 2 Tablets X 4 times a day X 7 days = Pack 56 Tablets
o Paracetamol Tablets: 2 Tablets X 3 times a day X 3 days = Pack 18 Tablets
 Write a label for each medicine then pack according to calculations above
 Record in dispensing register
 Call a patient by name and give instructions on how to use medicines
o Erythromycin Tablets: Take two tablets after every 6 hours for 7 days, swallow with
water after meals.
o Paracetamol Tablets: Take two tablets after every 8 hours for 5 days, swallow with
water.
o You may experience stomach upsets because of medicines given unless is severe
report back to hospital
 Ask the patient to repeat information given for checking understanding
 Wish a patient quick recovery

70
Worksheet 7.2: Sample Pescription Serial No. 001
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Serial Na. 001

P.O. Box
IRINGA
Name: John Kalunde
Gender: Me
Age: 20Yrs
Weight: 60kg
Rx Erythromycin tabs 500mg q.i.d 7/7

Prescriber’s name Masige Kahwa Malimbo
qualification MO
Signature

72
Session 8: Determining Quantities of Medicine for
Dispensing
Total Session Time: 120 minutes + 1 hours Assignment
Prerequisites
 Session 1, 5 and 6
Learning Tasks
 Interpret Information in the Prescription for Medicine Quantities for Dispensing
 Determine Quantities of Tablets/Capsules to be Dispensed
 Determine Eye/Ear/Nasal Preparations to be Dispensed
 Determine Quantities of Injectable Medicine to be Dispensed
 Determine Quantities of Ointment/cream to be Dispensed
 Determine Quantities of Syrup to be Dispensed
Resources Needed:
 Worksheet 8.1: Determine quantities of tablets and capsules to be dispensed
 Worksheet 8.2: Determine eye/ear/nasal preparations to be dispensed
 Worksheet 8.3: Determine quantities of injectable medicine to be dispensed
 Worksheet 8.4: Determine quantities of ointment and cream to be dispensed
 Worksheet 8.5: Determine quantities of syrup and solution to be dispensed

73
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Interpretation of Information for Medicine
2 Presentation
Quantities to be Dispensed
20 minutes Presentation Quantities of Tablet and Capsule to be
3
Case study Dispensed
20 minutes Presentation Quantities of Eye/Ear/Nasal Preparations to
4
Case study be Dispensed
20 minutes Presentation Quantities of Injectable Medicines to be
5
20 minutes Presentation Quantities of Ointment/Cream to be
6
7 Quantities of Syrup to be Dispensed
Case study

74
SESSION CONTENTS
STEP 2: Interpretations of Information in the Prescription for Medicine

Quantities to be Dispensed (10 minutes)
 Whenever a dispenser is required to dispense medicines, make sure always to;
 Identifying different information which provides information about medicines to be
dispensed
 Interpret of information of the prescriber so you can get quantities of medicine to be
dispensed
 Example: In a certain prescription of a specific patient the following medicines were
prescribed:
 Paracetamol tabs 1g tds x 5/7

 Amoxicillin caps 500mg tds x 5/7
Interpretation:
 One Paracetamol tablet has a dosage strength of 500mg, so 1g means 2 tablets of
Paracetamol
o Thus calculation is 2 tablets x 3 times a day x 5 days = 30 tablets of Paracetamol
o Therefore the patient will receive 30 tablets of Paracetamol
 One Amoxicillin capsule has dosage strength of 250mg, so 500mg means 2 capsules
o Thus 2 tablets of Amoxicillin x 3 times a day x 5 days = 30 tablets of Amoxicillin
o Therefore the patient will receive 30 capsules of Amoxicillin

75
STEP 3: Quantities of Drug to be Dispensed - Tablets and Capsules (20
minutes)
Activity: Case Study (15 minutes)
DIVIDE students into small manageable groups.
REFER students to Worksheet 8.1: Calculating quantities of tablets and

capsules
READ or ASK one student to read the scenario in the worksheet and CLARIFY
ASK all groups to answer the three questions in the worksheet for 15 minutes.
ALLOW few groups to present and the rest to add on points not mentioned
The Calculations
 A Paracetamol tablet has dosage strength of 500mg, so 1g means 2 tablets of Paracetamol
o One unit of Paracetamol tablet means one tablet, thus calculation for the total quantity
Paracetamol tablets is 2 tablets x 3 times a day x 5 days = 30 tablets of paracetamol
o Thus dispense total of 30 tablets of paracetamol
 Ampiclox capsule has strength of 500mg, so 500mg means 1 capsule
o One unit of Ampliclox capsule means one capsule.
o Thus total quantity of Ampiclox Capsules to be dispensed is:
1 tablets x 3 times a day x 5 days = 15 capsules
o Therefore dispense a total of 15 capsules of Ampiclox Capsules

76
STEP 4: Calculation of Quantities of Drug to be Dispensed – Ear and Eye
Preparations (20 minutes)

REFER students to Worksheet 8.2: Calculating quantities of ear and eye
preparations
 Information given: Prednisolone Eye drops 0.5% is available in 5ml bottle and assume 20
drops in 1ml
Calculation for Prednisolone:
o Firstly calculate total number of drops of prednisolone needed in 14 days as follows:
1drop x 4 times a day x 14 days = 56 drops
o Then calculate number of mLs containing 56 drops of prednisolone
Iml = 20 drops
? mls = 56 drops
= 56 drops/20drops x 1 ml
= 2.8mls
o Dispense one bottle of 5mls of prednisolone.
 The patient should discard the remained prednisolone (2.2mls) after finishing the
dose required (2.8ml)
 Information given: Sodium Cromoglycate 2% is available in 5ml bottle. Assume 20

drops is 1ml
Calculation for Sodium Cromoglycate:
o Firstly calculate total number of drops of Sodium Cromoglycate needed in 90 days as

follows:
o Then calculate number of mLs containing 360 drops

Iml = 20 drops
77
? mls = 360 drops
= 18mls
o Therefore 4 bottles of sodium cromoglycate, each of 5mls will be dispensed to Ana

Kalunde for the total dose of 18ml to be completed, discarding the remainder
 Information given: Boric Acid Ear drops 0.5% is available in 2ml. Assume 20 drops is
1ml Calculation for Boric Acid:
o Firstly calculate total number of drops of boric acid needed in 7 days as follows:
o Then calculate number of mLs containing 21 drops of Boric Acid
Iml = 20 drops
? mls = 21 drops
= 1.05mls
o Therefore dispense for Benard Sanga 1 bottle of Boric Acid Ear drop with
information that he should discard remaining medicine after 7 days
 Ephedrine Nasal drops 0.5% is available in 2ml. Assume 20 drops is 1ml

Calculation for Ephedrine
o Firstly calculate total number of drops of ephedrine needed in 7 days as follows:
o Then calculate number of mLs containing 21 drops of ephedrine
Iml = 20 drops
? mls = 21 drops
= 1.05mls
o Therefore, dispense for Hadija Hamis 1 bottle of Ephedrine Nasal drop with
information that he should discard remaining medicine after 7 days

78
STEP 5: Calculation of Quantities of Drug to be Dispensed-Injectables (20
minutes)

REFER students to Worksheet 8.3: Calculating quantities injectables
 For Diclofenac Injection:

o Information given: One ampoules of 3mls contains 75mg of Diclofenac injection, But
the required prescription is 150mg od for 3 days
o Calculation: 2 ampoules x once daily x 3 days
o 2 ampoules x 1 x 3
o 6 diclofenac ampoules
o Therefore dispense 6 diclofenac ampoules
 For Gentamicin injection:

o Information given: One ampoule of 2ml contains 20mg of Gentamicin injection
o But required prescription is 40 mg three times daily for five days
o Calculations: 40mg x 3 times daily x 5days
2 ampoules x 3 x 5
= 30 ampoules
Thus dispense 30 ampoules of gentamicin

79
STEP 6: Calculation of Quantities of Drug to be Dispensed- Ointment and
Cream (20 minutes)
REFER students to Worksheet 8.4: Calculating quantities of ointment and

cream
ASK all groups to answer the two questions in the worksheet for 10 minutes.
 The Calculations
 Clotrimazole Ointment; Assuming the amount to be squeezed out of the tube for one
application is 1g, and
 The unit to dispense for Clotrimazole Ointment is a tube of 20g
 Thus calculation for Clotrimazole Ointment for a single application is (1g) × 2
times a day x 7 days = 14g
 Therefore the patient will be given 1 tube of Clotrimazole Ointment, as it
contains 20g
STEP 7: Calculation of Quantities of Drug to be Dispensed-Syrup and

Solutions (15 minutes)

REFER students to Worksheet 8.5: Calculating quantity of syrup and solutions

80
 The Calculations:
 Amoxicillin syrup has strength of 125mg/5ml, so 1 teaspoonful = 125mg syrup
 Paracetamol syrup has strength of 120mg/5ml, so 1 teaspoonful = 120mg syrup
 The unit to dispense for Amoxicillin syrup is a bottle of granules to be reconstituted to
100ml and a unit to dispense for Paracetamol syrup is a bottle of 100ml syrup
 Thus calculation for Amoxicillin syrup is 5ml x 3 times a day x 5 days = 75ml and
 Calculation for Paracetamol syrup is 5ml x 3 times a day x 5 days = 75ml
 Therefore Pack for patient 1 bottle of reconstituted Amoxicillin syrup and 1 bottle
of Paracetamol syrup

 In order to determine the quantities of medicines to be dispensed, it is important to
understand the information which provided in a prescription that provides information
about medicines to be dispensed
 The information must be interpreted correctly to lead a dispenser to correct calculation to
get quantities of medicine to be dispensed
 The quantities to be dispensed are determined through correct calculation as given in
different scenario done in this session

 What are the information that will determine the total quantity of tablets and capsules to
be dispensed?
 What are the information that will determine the total quantity of ear/eye/nasal
preparations to be dispensed?
 What are the information that will determine the total quantity of injectables to be
dispensed?
 What are the information that will determine the total quantity of creams and ointments to
be dispensed?

81
References
Ansel, H. C. (2010). Pharmaceutical Calculations (13th ed.). Philadelphia, United States:

LWW
Ethiopia

82
Worksheet 8.1: Calculating Quantities of Tablets and
INCLUD Capsules to be Dispensed
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Scenario:
A patient Called Juma Said brought a prescription at a dispensing pharmacy which was
written as follows;-
1. Ampiclox Caps 500mg tds 5/7
2. Paracetamol Tabs 1g tds 5/7
Students Leaning Tasks

By the end of the case study activity, students are expected to:
 Interpret the information given in a prescription
 Make decision of a unit to be dispensed that implies the correct amount of
 Calculate the total quantities of medicine to be dispensed
Questions
1. What is the total Ampiclox capsules should be dispensed?

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
2. What is the total Paracetamol tablets should be dispensed?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. What dispensing unit will you dispense for Juma Said?
___________________________________________________________
___________________________________________________________

84
___________________________________________________________
___________________________________________________________
Worksheet 8.2: Calculating Quantities of Eye/Ear/Nasal to

INCLUD be Dispensed
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Scenario:
A patient Called Anna Kalunde brought a prescription at a dispensing pharmacy which was
1. 1 gtt Predinisolone 0.5% qid BE 2/52
2. 1 gtt Sodium Cromoglycate 2% qid BE 3/12
Another patient Called Benard Sanga brought a prescription at a dispensing pharmacy which
was written as follows;-
1. 1 gtt Boric Acid 0.5% aur.dextr tds 7/7
Another patient Called Hadija Hamis brought a prescription at a dispensing pharmacy which
was written as follows;-
1. 1 gtt Ephedrine 0.5% ad.aur tds 7/7

By the end of the case study activity, student will be able to:
 Make decision of a unit to be dispensed that implies the correct amount of medicine.
Questions
1. What is the amount of Predinisolone and Sodium Cromoglycate eye drops should be
dispensed?
___________________________________________________________
___________________________________________________________
2. What is the amount of Boric Acid Ear drops and Ephedrine Nasal drops should be
dispensed?

86
___________________________________________________________
___________________________________________________________
3. What dispensing unit will you dispense for Anna Kalunde, Benard Sanga and Hadija
Hamis?
___________________________________________________________
___________________________________________________________
Worksheet 8.3: Calculating Quantities of Injectables to be
INCLUD Dispensed
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Scenario:
A Nurse has a file of patient Called Mwanaisha Kilimo with a prescription written as
follows;-
1. Diclofenac 150mg od x3/7
2. Gentamycine 40mg x tds5/7
3. (you have Diclofenac ampule 75mg/3mil, Gentamycine 20mg/2mil)

Questions
4. What is the total amount of Diclofenac injection should be dispensed?

___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
5. What is the total amount of Gentamycine injection should be dispensed?
___________________________________________________________

88
___________________________________________________________
___________________________________________________________
___________________________________________________________
6. What dispensing unit will you dispense for Mwanaisha Kilimo?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Worksheet 8.4: Calculating Quantities of Ointments and

INCLUD Creams to be Dispensed
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Scenario:
A patient Called Jumanne John brought a prescription at a dispensing pharmacy which was
1. Apply Clotrimazole Ointment b.d 7/7

Questions
1. What is the total amount of Clotrimazole Ointment should be dispensed?

___________________________________________________________
___________________________________________________________
___________________________________________________________

90
___________________________________________________________
2. What dispensing unit will you dispense for Jumanne John?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Worksheet 8.5: Calculating Quantities of Syrups and

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Scenario:
A Mother with a child called Anisha Juma brought a prescription at a dispensing pharmacy
which was written as follows;-
1. Amoxicillin Syp 5 ml tds 5/7
2. Paracetamol Syp 5 ml tds 5/7

Questions

92
1. What is the total amount of Amoxicillin syrup should be dispensed?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
2. What is the total of Paracetamol syrup should be dispensed?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
3. What dispensing unit will you dispense for Anisha Juma?
___________________________________________________________
___________________________________________________________
___________________________________________________________
___________________________________________________________
Session 9: Medicines Packaging Materials
Prerequisites
 None
Learning Tasks
 Define Packaging Material for Medicines to be Dispensed
 Explain Importance of Packaging Materials for Medicines to be Dispensed
 List Different types of Packaging Material for Medicines to be Dispensed
 Describe Features of Suitable Packaging Materials
 Select and Use Suitable Packaging Material for Medicines to be Dispensed
Resources Needed:
93
 Samples of Packaging Materials
SESSION OVERVIEW
Activity/
Step Time Content
Method
05 minutes Definition of Packaging Material for
2 Presentation
Medicines
10 minutes Presentation Importance of Packaging Materials for
3
Buzzing Medicines
15 minutes Presentation Types of Packaging Material for
4
Brainstorming Medicine to be Dispensed
Features of Suitable Packaging
5 Small Group
Material for Medicine
Discussion
Selection and Usage of Suitable
6 Small Group
Packaging Material for Medicines
Discussion
SESSION CONTENTS
STEP 2: Definition of Packaging Material for Medicine to be Dispensed (5

minutes)
 All medicinal products need to be protected and consequently need to be packaged in
containers that conform to prescribed standards particularly with respect to the exclusion
of moisture and light and the prevention of leaching of extractable substances into the
contents and of chemical interaction with the contents

94
 Packaging material: Any material, including printed material, employed in the
packaging of a pharmaceutical product, excluding any outer packaging used for
transportation or shipment
o Primary packaging materials are those that are in direct contact with the
product
 Packaging may be defined as the collection of different components (e.g. bottle, vial,
closure, cap, ampoule, blister) which surround the pharmaceutical product from the time
of production until its use
 Prepackaging: Is the process by which the pharmacy professional transfers a medication
manually from a manufacturer's original commercial container to another type of
container in advance (before clients come to medicine retail out lets)
STEP 3: Importance of packaging materials for medicines (10 minutes)
 What are the importances of packaging materials for medicine?
 Importance of medicine packaging material

 Containment: This requires the packaging:
 not to leak, nor allow diffusion and permeation of the product;
 to be strong enough to hold the contents when subjected to normal handling
 Not to be altered by the ingredients of the formulation in its final dosage form
 Protection: The packaging must protect the product against all adverse external
influences that may affect its quality or potency, such as:
 Light
 Moisture
 Oxygen
 Biological contamination
 Mechanical damage
 The compatibility: Of the packaging with the active pharmaceutical ingredients is
very important in maintaining the integrity of the product
 Stability: it is necessary to know the possible interactions between the container and
the contents
 The packaging itself should not interact with it so as to introduce unacceptable
changes
95
 Importance of closures is to prevent moisture to reach moisture-sensitive medicines
and also prevent loss of moisture from creams and other water-containing medicines
such as ointments and pastes
STEP 4: Types of Packaging Material for Medicine to be Dispensed (15

minutes)
 What are the types of Packaging materials for medicines?
The following are different types of packaging materials for medicines;

 Ampoule: A container sealed by fusion and to be opened exclusively by breaking. The
contents are intended for use on one occasion only
 Bag: A container consisting of surfaces, whether or not with a flat bottom, made of
flexible material, closed at the bottom and at the sides by sealing; the top may be closed
by fusion of the material, depending on the intended use
 Blister: A multi-dose container consisting of two layers, of which one is shaped to contain
the individual doses
o Strips are excluded
 Bottle: A container with a more or less pronounced neck and usually a flat bottom.
o They can be glass or plastic
 Cartridge: A container, usually cylindrical, suitable for liquid or solid pharmaceutical
dosage forms; generally for use in a specially designed apparatus (e.g. a prefilled syringe)
 Injection needle: A hollow needle with a locking device intended for the administration of
liquid pharmaceutical dosage forms
 Injection syringe: A cylindrical device with a cannula-like nozzle, with or without a fixed
needle and a movable piston, used for the administration, usually parenteral, of an
accurately measured quantity of a liquid pharmaceutical form
o The syringe may be prefilled, and can be for single-dose or multi-dose use
 Pressurized container: A container suitable for compressed, liquefied or dissolved gas
fitted with a device that, after its actuation, produces a controlled spontaneous release of
the contents at atmospheric pressure and room temperature
96
 Single-dose container: A container for single doses of solid, semi-solid or liquid
preparations
 Strip: A multi-dose container consisting of two layers, usually provided with perforations,
suitable for containing single doses of solid or semi-solid preparations. Blisters are
excluded
 Tube: A container for multi-dose semi-solid pharmaceutical forms consisting of
collapsible material and its contents are released via a nozzle by squeezing the package
 Vial: A small container for parenteral medicinal products, with a stopper and over seal
and the contents are removed after piercing the stopper
o Both single-dose and multi-dose types exist
STEP 4: Features of Suitable Packaging Materials (35 minutes)
Activity: Small Group Discussion (15 minutes)
 What are the desirable features of Packaging materials?
The following are desirable features for packaging materials:

 The container should protect the contents from physical and mechanical hazards such as:
o Variation due to transportation
o Compression due to pressure applied during stacking or storage
o Shock due to impact, drops or rapid deceleration
o Puncture due to penetration from sharp objects or during handling operations
o Abrasion
 The container’s material should not interact with the product and vice versa.
o Interactions include migration, absorption, adsorption or extraction whereby
ingredients either from the product or container are lost or gained. There are
numerous possibilities of interactions between (primary) packaging materials and
pharmaceutical products, such as:

97
 the release of chemicals from components of the packaging materials
 the release of visible and/or sub visible particles
 the absorption or adsorption of pharmaceutical components by the packaging
materials
 Chemical reactions between the pharmaceutical product and the packaging
materials
 The degradation of packaging components in contact with the pharmaceutical products
 Container should protect the contents from atmospheric gases
o Oxygen supports the growth of micro-organisms, as well as being involved in
oxidation processes
o Carbon dioxide may cause pH shifts or a chemical reaction if absorbed by a liquid
formulation
 The container must be capable of withstanding extremes of temperature and humidity.
o Protect the contents from both water loss and gain
 Moisture gain may cause chemical reactions, encourage microbial growth or cause
physical changes, e.g. softening of gelatin capsules
 Moisture loss from a product may cause creams to contract and develop a rubbery
feel, and solutions to concentrate
o Protect the contents from loss of volatile materials
o The loss of excipients such as alcohol and chloroform will concentrate the product or
reduce its preservative content
 Protect the contents from light
o Many drugs are photosensitive and degraded in the presence of light
 Protect the contents from airborne particulate contamination
o contamination can be microbiological (bacteria, moulds or yeasts) or can be solid
matter such as dirt, dust, hair, fibres
 Protect the product from animal contaminations, e.g. rodents and insects
 The container should not shed particles into the contents. E.g. spicules from glass bottles
and metal flakes from metal ointment tubes
 The container should have a ‘pharmaceutically elegant’ appearance.

 Should be easy to label and thus to identify the product correctly.
 The container should be convenient and easy to use
o The container should be cheap and economical
STEP 6: Select and use suitable packaging material for medicines (35
minutes)

98

 Which packaging materials are suitable for packing of the following medicine?
o Tablets and capsules?
o Liquids?
o Ointment and creams?
 The selection of packaging for medicines depends on:

o Nature of the medicine
o Type of patient
o Dosage form
o Method of administering the medicine
o Required shelf-life
o Use
The following are the types of packaging materials for medicines:

 Glass materials: Traditional packaging material widely used for both liquid and solid
dosage forms
o Advantages:
 It can be moulded to a rigid construction in a variety of shapes and sizes
 It is available in clear or amber (light-resistant) forms
 It can be sealed hermetically or by removable closures
 It is impermeable to moisture and atmospheric gases
 It is cheap and readily available
 It is easily labelled
o Disadvantages:
 It is fragile – easily breaking when dropped or knocked
 It is heavy, which means transportation costs are high
 It may release alkali to aqueous contents
 Plastic containers: Plastic is a collective term used for a variety of polymeric materials
used for containers and closures
 Advantages:
 Flexible nature
 Less brittle than glass
 Lightweight –therefore transportation costs are cheaper than glass
99
 Can be molded into a multiple of shapes and sizes
 Suitable for both container and closure
 Readily available
 Disadvantages:
 Few will withstand heat without softening or distorting
 Permeability to water vapour and atmospheric gases
 May interact with certain chemicals to cause softening or distortion
 May sorb substances, particularly preservatives, from solution
 Leaching out of plasticizers and stabilizers into solutions
 Relatively expensive
 Metal Containers: Metals used as pharmaceutical packaging materials include
aluminum, tin and tin-coated lead
 Advantages:
 Lightness
 Robustness
 Impermeable to light, moisture and gases
 Can be made into rigid, unbreakable containers or into collapsible tubes or foil
 Labels can be printed directly onto their surface
 Disadvantages:
 Their chemical and electrochemical activity
 They may shed metal particles into the pharmaceutical product
 Expensive
 Not generally available for extemporaneous dispensing
 Unit dose packaging: Unit dose packaging has become increasingly common
 Advantages:
 Hygienic
 Tamper evident
 Lightweight
 Child resistant
 Protects solid dosage forms from moisture and abrasion
 Available as calendar packs to aid patient compliance
 Wastage is reduced
 Accurate volume can be administered
 Disadvantages:
 Expensive
 Patients may experience difficulty in use
 Machinery is required which may be suitable for industrial or hospital use only.
 Types of unit dose packaging for oral medicines include strip packaging, blister
packaging, oral liquid containers and dispensers

100
 The materials used for repackaging include: glass bottles, plastic bottles, collapsible
tubes, paper envelops, plastic envelops. original containers may contain large amount of
medicines, therefore repackaging of medicines into another container may be necessary in
order to dispense medicines for patients.
 The function of a container for a medical preparation is to maintain; the quality, safety,
and stability of its contents
 Medicines must be suitably contained, protected and labeled from the time of
manufacture until they are used by the patient
 The container must maintain the quality, safety and stability of the medicine

 What is packaging, packaging material, repacking?
 What are the features of a suitable packaging material?
 What types of containers are used for medicine packaging?
 What are the factors contribute to the choice of packaging material?
 What are the importances of medicine packaging material?
 What are the advantages and disadvantages of different type of containers?
References
Ethiopia

101
Senya ,S. S., Mwasha, C.Y., Muyinga, A. M., Amiri,R. I., Mauga, E.A.K. (2011)
Tanzania Pharmaceutical Handbook ( 2nd ed. ) Dar eS Salaam, Tanzania: School of
Pharmaceutical Sciences
Session 10: Medicines Label

Prerequisites
 None

102
Learning Tasks
 Define a label of a Dispensed Medicine
 List Essential Features of a Label
 Explain the Importance/ Purpose of a Label of Dispensed Medicine
 Design and prepare appropriate label
Resources Needed:
 Handout 10.1: General Labeling Requirements for Dispensed Medicines
 Worksheet 10.1: Label for Medicine to be Dispensed
SESSION OVERVIEW
Activity/
Step Time Content
Method
15 minutes Presentation Definition of a Label of Medicine to
2
Buzzing be Dispensed
3 Essential Features of a Label
Brainstorming
10 minutes Presentation Purpose/ Importance of a Label of
4
Dispensed Medicine
5 Design and Prepare Appropriate Label
Exercise
SESSION CONTENTS


103
STEP 2: Definition of a Label of Medicine to be Dispensed (15 minutes)
 What is a label of a dispensed medicine?
 Label: Any material which is printed or affixed to a packing material which provides the
necessary information about medicine, and includes an insert
 The main functions of a label on a dispensed medicine are to uniquely identify the
contents of the container and to ensure that patients have clear and concise information
about the use of the medicine
 Each dispensed medicine must be appropriately labeled to comply with legal and
professional requirements
 All medicines to be dispensed should be labeled and the labels should be unambiguous,
clear, legible and indelible
 If possible lettering should be printed
STEP 3: Essential Features of a Label (30 minutes)
 What are the essential features of a label of medicine to be dispensed?

 The information on the labels of dispensed medicines should be:
 Clear, accurate, and concise
 To avoid misunderstanding and obtain greatest benefits from therapy
 Abbreviations and unfamiliar expressions should not be used, especially for
indications for use and dosage instructions
 Legible
104
 Easily readable, the print should not fade when exposed to water or sunlight
 Manufacturers’ labels fulfill established criteria for good readability
 Adequate and relevant
 Care should be taken to avoid confusion
 Too much information on the label may mean that none of it is noted
 Intelligible
 The information should be completely unambiguous and arranged to avoid
confusion
 The terms used should be readily understandable by the lay/unprofessional person
 Graphic symbols for patient instruction should not be used alone but should
always be combined with written instructions
 Label information should include the following:

 Patient name
 Generic name, strength and dosage form of the medicine
 Dose, Frequency and Duration of use of the medicines
 Quantity of the medicine dispensed
 How to take or administer the medicine and cautionary statements, if applicable
 Storage condition
 The name and address of the dispenser

105
Figure 9.1: Sample Label of Medicine
STEP 4: Purpose/ Importance of a Label of Dispensed Medicine (10

minutes)
 The purpose of a label for medicine to be dispensed is:

 To describe and identify a prescribed medicine
 To contribute to optimal therapeutic outcome and to avoid medication errors
 To achieve appropriate handling and storage
 To allow the product to be traced if there are problems with either the manufacturing,
prescribing or dispensing process
 The importance of label for medicine to be dispensed:
 Label information for prescribed medicines should be considered to supplement and
reinforce oral communication between the patient and healthcare provider
 Label should provide the patient with all the information necessary so that the
medicine may be taken or used appropriately
 The presentation of label elements is important for patient understanding
 Written instructions on the use of medicines are very important rather than verbal
information

106
STEP 5: Design and Prepare Appropriate Label (40 minutes)
Activity: Exercise (20 minutes)
REFER students to Worksheet 10.1: Label for Medicine to be Dispensed
ASK all groups to answer the question in the worksheet for 15 minutes.
Themi Pharmacy Themi Pharmacy

P.O Box 3011 P.O Box 3011
Arusha Arusha
Date: 15.01.2015 Date: 15.01.2015
Name of Patient: Aisha Hassan Name of Patient: Aisha Hassan
Paracetamol Syrup 120mg/5ml Amoxicillin Syrup 125mg/5ml
2 teaspoonful x After every 8 2 teaspoonful x After every 8
hours for 5 days hours for 7 days
Keep Away From Children Reach Keep Away From Children Reach
The label on the medicine packaging usually includes:

 The name of Patient
o the generic name for the active ingredient in your medicine (scientific name)
 the name and address of the pharmacy that dispensed medicine
 the date medicine dispensed
 the name of the medicine and the strength
 the dose should be taken, how to take it and how often and how long
 the amount of medicine in the container
 if necessary, any cautions or warning messages that apply to your medicine
 Some examples are:
 shake the bottle
 store in a cool place
 discard 28 days after opening
 do not use after a certain date

107
 Medicine to be dispensed needs a label which is appropriately written to provide a good

communication to a patient. It is to identify the medicine through its name and strength,
provides information of how to take the medicines, the quantity and frequency of a dose
and duration of that dose
 It is also providing other information like storage condition and action to be taken
before use of medicines
 The essential features of a label of medicines to be dispensed includes;- clear, accurate
and concise written, the label written should be legible, the label should be adequately
written and easy to interpret the information provided to a patient

 What is a label for medicine to be dispensed?
 What informations are appropriate to be included in a label of medicine to be dispensed?
 What are the essential features of a label of medicine to be dispensed?

108
References
Ethiopia
WHO (2002). Technical Report Series No. 902. (Annex 9). Geneva

109
 Handout 10.1: General Labeling Requirements for
Dispensed Medicines
Worksheet 10.1: Label for Medicine to be Dispensed

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Scenario:
You are a dispenser at Themi Pharmacy P.O Box 3011, Arusha today. A Mother with a child
called Aisha Hassan gives you a prescription written as follows;-
1. Amoxicillin Syp 250mg tds 5/7
2. Paracetamol Syp 240mg tds tds 5/7
At Themi Pharmacy you have in stock bottles Amoxicillin Dry Suspension 100ml with
strength of 125mg/5ml and Paracetamol syrup 100ml with strength of 120mg/5ml.
Design and prepare an appropriate label for the two medicines prescribed.

112
Session 11: Generic and Brand Names of Medicines
Prerequisites
 None
Learning Tasks
 Define Generic (non-proprietary) and Brand (proprietary) Medicines
 Explain Global and National Initiatives on Generic and Brand Medicines
 Distinguish between Generic and Brand Medicines
 List Advantages and Disadvantages of Generic and Brand Medicines
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Definition of Generic (non-proprietary) and
2 Presentation
Brand (proprietary) Medicines
25 minutes Presentation Global and National Initiatives on Generic
3
and Brand Medicines
30 minutes Buzzing
4 Generic and Brand Medicines
Presentation
30 minutes Brainstorming Advantages and Disadvantages of Generic
5
Presentation and Brand Medicines

113
SESSION CONTENTS
STEP 2: Definition of Generic (Non-Proprietary) and Brand (Proprietary)

Medicines (10 minutes)
Generic medicine
 The generic or scientific or non proprietary name is the term given to the active ingredient
in the medicine that is decided by an expert committee and is understood and used
internationally
o Thus, paracetamol/acetaminophen is the non-proprietary name (generic name)
while Crocin/Metacin/Meftal/Tylenol etc are brand names
Brand medicine
 A brand name drug is a medicine that’s discovered, developed and marketed by a
pharmaceutical company
o This name is given to a medicine by the pharmaceutical company that makes it
o This is also called the "proprietary name"
 A generic drug is a chemically equivalent, lower-cost version of a brand-name drug,
costing 30-80% less!
 A brand-name drug and its generic version must have the same active ingredient, dosage,
safety, strength, usage directions, quality, performance and intended use
STEP 3: Explain Global and National Initiatives on Generic and Brand

Medicines (25 minutes)
 Once a new drug is discovered, the company files for a patent to protect against other
companies making copies and selling the drug
 At this point the drug has two names: a generic name that’s the drug’s common scientific
name and a brand name to make it stand out in the marketplace
o This is true of prescription drugs as well as over-the-counter drugs

114
 An example is the pain reliever Tylenol®. The brand name is Tylenol® and the generic
name is acetaminophen
o Generic drugs have the same active ingredients as brand name drugs already
approved by the Food and Drug Administration (FDA)
o Generics only become available after the patent expires on a brand name drug
o Patent periods may last up to 20 years on some drugs
 The same company that makes the brand name drug may also produce the generic version
or a different company might produce it
 It is a well-known fact that generic drugs are “drugs that are usually intended to be
interchangeable with an innovator product that is manufactured without a license from the
innovator company and marketed after the expiry date of the patent or other exclusive
rights”
 When it is said that doctors should prescribe generic drugs, it means that they should
prescribe drugs manufactured by other companies after expiry of patent of parent drug of
the innovator company
 The patent for paracetamol expired in 2007 after which numerous generic versions have
been developed and sold under various “brand names.”
o If one were to prescribe it only by the name “paracetamol” (generic name), it is up
to the pharmacist to select and dispense a particular brand.
 A simpler and better alternative for cost reduction would be to prescribe
the cheapest “brand” of paracetamol.
 Thus, a better way to prescribe would be to prescribe the cheapest brand of the drug and
include the generic name of the drug in parenthesis, in case that particular brand is not
available.
STEP 4: Distinguish Between Generic and Brand Medicines (30 minutes)
 What are the differences between Generic name (Non-proprietary name) and Brand
name (Proprietary name) of medicine?
 Although the active ingredients are the same, the excipients (inactive ingredients) may
differ
115
o This is only important in rare cases when a patient has an allergy or sensitivity to
one of the excipients
 The product may also be slightly different in:

o Colour
o Shape or markings
o Taste
o Preservatives
o Packaging
 The biggest difference is cost; generic drugs are generally less expensive than brand name
comparators
STEP 5: Advantages and Disadvantages of Generic and Brand Medicines

(30 minutes)
 What are the advantages and disadvantages of generic names (Non-proprietary

names) and Brand names (Proprietary names)?
 Generic drugs cost less than Branded drugs

o The generic drug manufacturer does not have the incurred costs of discovery, research
and development, preclinical and clinical tests as well as advertising/marketing and
promotion
o Therefore it can offer the generic drug at a much lower cost to you/patient
 Generic drugs are more available than Branded drugs
 Generic drugs can be manufactured locally while Branded drugs cannot be manufactured
locally

116
 A generic drug is identical or bioequivalent to a brand name drug in dosage form, safety,
strength, route of administration, quality, performance characteristics and intended use.
 Although generic drugs are chemically identical to their branded counterparts, they are
typically sold at substantial discounts from the branded price
 Generic drugs are essentially the same as brand name drugs since the differences are on
other ingredients other than active ingredient which are binders, coloring agents, and
flavorings but is same in the therapeutic and medicinal portion as well as dose, strength,
route of administration, safety, efficacy and intended use.

 What are the generic names (Non-proprietary name) and brand names (Proprietary
names)?
 What are the differences between generic names and brand names?
 What are the advantages and disadvantages of generic names and brand name?

117
References
Cameron A., Mantel-Teeuwisse A., Leufkens H., Laing R. (2012). Value Health: Switching
from originator brand medicines to generic equivalents in selected developing
countries: how much could be saved? 15, 664–673 PubMed
Davit et al. (2009). Ann Pharmacother:Comparing generic and innovator drugs: a review of
12 years of bioequivalence data from the United States Food and Drug
Administration. 2009;43(10):1583-97
Kesselheim et al. (2008). JAMA: Clinical equivalence of generic and brand name drugs used
in cardiovascular disease: a systematic review and meta-analysis. 300(21)2514-2526

118
Session 12: Giving Appropriate Medicine Information to
Patients
Prerequisites
 None
Learning Tasks
 Define Interaction, Side effects, Precaution and Contraindication
 Give Appropriate Instructions on the Use of Prescribed Medicine(s)
 Give Appropriate Information on Precautions, Interactions, Side effects and Storage of
Dispensed Medicines
 Check Patient Understanding on the Use and Precautions of Dispensed Medicine(s)
Resources Needed:
 Handout 12.1: Warnings/cautions to Patients
 Worksheet 12.1: Sample Prescriptions
 Worksheet 12.2: Giving appropriate instructions on the use of prescribed medicine
 Worksheet 12.3: Giving appropriate precautions, interactions, side effects and storage of
medicines
 Worksheet 12.4: Checking patient understanding on the use and precautions of dispensed
medicines

119
SESSION OVERVIEW
Activity/
Step Time Content
Method
10 minutes Definitions of Drug Interaction, Side effects,
2 Presentation Contraindication and Precautions of
Medicines
30 minutes Presentation Appropriate Instructions on the Use of
3
Role play Prescribed Medicine(s)
30 minutes Presentation Appropriate Information on Precautions,
4 Role play Interactions, Side effects and Storage of
Dispensed Medicines
30 minutes Presentation Patient Understanding on the Use and
5
Role play Precautions of Dispensed Medicine(s)

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SESSION CONTENTS
STEP 1: Presentation of Session Title and Learning Tasks (5 minutes

STEP 2: Definitions of Drug Interaction, Side effects, Contraindication and

Precautions of Medicines (10 minutes)
 Drug Interaction: is a situation in which a substance (usually another drug) affects the
activity of a drug when both are administered
o However, the effect of medicine may be modified by food, smoking, alcohol or
environmental pollutants
o A drug interaction may occur when one drug potentiates or diminishes the action
of another drug
o These actions may be desirable or undesirable
o Drugs may also interact with various foods, alcohol, tobacco, and other substances
 Side effect: is an action or effect of a drug (medicine) other than that desired
 Commonly it is undesirable effect such as nausea, headache, insomnia, rash,
confusion, dizziness, or an unwanted drug-drug interaction
 A side effect is an undesirable action of the drug and may limit the usefulness of the drug
 Contraindication: is something which suggests that someone should not be treated with
a specific drug or not continue with a specific treatment because circumstances make that
treatment unsuitable
 Precaution: is an action taken in advance to protect against danger, harm, or possible
failure
STEP 3: Give Appropriate Instructions on the Use of Prescribed

Medicine(s) (30 minutes)
Activity: Role Play Demonstration on giving appropriate information on the use

medicine (20 minutes)
EXPLAIN that this will be a role play demonstration between a patient and a health care
provider. You (the tutor) will play the Dispenser and lead the conversation of the instructions
on the use of medicines prescribed to the patient, who will be a student volunteer.
ASK a student to volunteer to play the patient role.
Refer student volunteer to Worksheet 12.2: Role Play Demonstration so that he/she
can read the description of the patient.

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TELL the rest of students to observe carefully
EXPLAIN that the patient will listen carefully and provide answers to dispenser as will be
asked to do so.
EMPHASIZE that the Dispenser should concentrate on presenting the instructions on how to
use the prescribed medicines.
DE-ROLE yourself and the student, once the role play is over.
 At a stage of giving information to the patient, a dispenser must instruct and counsel the
patient on the following information:
 Why the patient needs to take medication
 If a patient understands why the medication was given then he/she will be
tempted to take medication
 Drug name, strength and dosage formation and route of administration
 Dose of medicine
 Dose interval/ frequency
 For example after every 6 or 8 hours
 Dosage of medication
 Duration of taking medication
 Any other special instructions, such as there are some drugs which work efficiently if
taken before or after food, for examples:
 Magnesium sulphate anti acids will work effectively if taken one or two hours
after food
 Alcohol reduce potency of different medicines so patient should be advised not to
take alcohol when under medication and it should not be taken with medicines
such as metronidazole, phenobarbitone and antihistamines.
 Patients should be told on cautions of different medicines
o Storage of medicines: Patient should be advised to keep medicines away from the
reach of children as some drug colors might attract children's attention
o The Direct observed treatment (DOT) Strategy

 This is the treatment strategy that emphasizes the use of the most effective
standardized, short-course regimen, and of fixed-dose drug combinations (FDCs)

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under observation to facilitate adherence to treatment and to reduce the risk of the
development of drug resistance
 This means a supervisor watches the patient when swallowing tablets
 It ensures that a patient takes the right drugs, in the right doses and at the right
time intervals.
 Examples of drugs given under DOT strategy are methadone and anti-tuberculosis
medicines.
STEP 4: Give Appropriate Precautions, Interactions, Side effects and

Storage of Dispensed Medicines (30 minutes)
Activity: Role Play Demonstration (30 minutes)
provider. One volunteer student will play the Dispenser and lead the conversation of the
instructions on the use of medicines prescribed to the patient, who will be another student
volunteer.
ASK the students to volunteer to play the dispenser role and the patient role.
Refer students to Worksheet 12.1: Sample Prescription Serial No. 001191.
EXPLAIN that the patient will listen carefully and repeat the information provided when
asked.
EMPHASIZE that the Dispenser should concentrate on presenting the instructions on how to
use the prescribed medicines as well as telling about precautions to a patient, common side
effect of medicines dispensed and the storage condition of medicine

123
The dispenser must give the following information to a patient:
 Effects of the drug: Which symptoms will disappear; and when; how important is it to
take the drug; what happens if it is not taken;
 Dosage and administration, whether the medicine can be given with food, before or
after food, with more water or at night only
 Drug Interactions: two basic interactions are important in medication administration; -
drug-drug interactions and drug-food interactions
 Drug-drug interaction occurs when one drug interacts with or interferes with the
action of another drug. For example taking anti-acid with oral Tetracycline
causes a decrease in the effectiveness of tetracycline.
 Drug-food interaction is when drug is given orally, food may impair or enhance
its absorption
 A drug taken on an empty stomach is absorbed into the bloodstream at a faster
rate than when drug is taken with food in the stomach
 Some drugs must be taken on an empty stomach for example Captopril to
achieve optimal effect
 Side effects: Which side effects may occur; how to recognize them; how long will they
remain; how serious they are; what to do if they occur
Warnings: What not to do (driving, machinery); maximum dose (toxic drugs); need to
continue treatment (antibiotics)
Refer students to Handout 12.1: Warnings/Cautions to Patients for further

reading
STEP 5: Check Patient Understanding on the Use and Precautions of

Dispensed Medicine(s) (30 minutes)
Activity: Role Play Demonstration (30 minutes)
provider. One volunteer student will play the Dispenser and lead the conversation of the
instructions on the use of medicines prescribed to the patient, who will be another student
volunteer.
ASK the students to volunteer to play the dispenser role and the patient role.

124
EXPLAIN that the patient will listen carefully and repeat the information provided when
asked. The dispenser should present the instructions on how to use the prescribed medicines
as well as telling about precautions to a patient, common side effect of medicines dispensed
and the storage condition of medicine
EMPHASIZE that the Dispenser should concentrate on checking the patient understanding
on the use of medicines and the precautions given.
 Checking if everything is understood: Everything is clear to patient or else repeat the

information; let the patient ask any more questions.
 When to take medicine
 The right dose and dosage
 In relation to food and other medicines
 How to take the medicine
 Chewing/swallowed whole
 Taken with plenty of water
 How to store medicine
 Warnings in case of possible common side effect but harmless like nausea, mild
diarrhoea, urine changing colour
 Reporting back in case of an unfavourable or harmful effect of medicine

 The dispenser should give information to the patient about when to take; how to take;
how to store; how long to continue the treatment, what to do in case of problems and
wheather the medicine therapy needs Direct Observed Therapy (DOT)
 The dispenser should also give opportunity to the patient to repeat instructions given
 It is also important to ask questions for further checking of understanding on how to take
medication
 The necessity of reporting back in case of an unfavourable or harmful effect caused by
medicine

125
 Which instructions are important to be given to patient while dispensing medicines?
 What information would a dispenser want to know if a patient has understood the
medication taking instructions?
 Which condition(s) are necessary for patient to report back to prescriber?
 What is DOT?

126
References
States of America: Cengage Learning.
Roach, S. S., & Ford, S. M. (2008). Introductory clinical pharmacology (8th ed.).
Philadelphia, United States of America: Lippincott Williams & Wilkins.
Taber, C. W., & Thomas, C. L. Taber's cyclopedic medical dictionary (pp. v.). Philadelphia,
United States of America: F.A. Davis Co.
Walker, R., & Whittlesea, C. (2012). Clinical pharmacy and therapeutics (5th ed.).
Edinburgh, United Kingdom: Churchill Livingston

127
Handout 12.1: Warnings/Cautions to Patients
WARNINGS/CAUTIONS TO PATIENTS
1. Warning. May cause drowsiness
To be used on preparations for children containing antihistamines, or other preparations

given to children where the warnings of label 2 on driving or alcohol would not be
appropriate.
2. Warning. May cause drowsiness. If affected do not drive or operate machinery. Avoid
alcoholic drink
To be used on preparations for adults that can cause drowsiness, thereby affecting the ability
to drive and operate hazardous machinery; label 1 is more appropriate for children. It is an
offence to drive while under the influence of drink or drugs.
Side-effects unrelated to drowsiness that may affect a patient's ability to drive or operate
machinery safely include blurred vision, dizziness, or nausea. In general, no label has been
recommended to cover these cases, but the patient should be suitably counselled.
3. Warning. May cause drowsiness. If affected do not drive or operate machinery
To be used on preparations containing monoamine-oxidase inhibitors; the warning to avoid

alcohol and dealcoholized (low alcohol) drink is covered by the patient information leaflet.
Also to be used as for label 2 but where alcohol is not an issue.
4. Warning. Avoid alcoholic drink
To be used on preparations where a reaction such as flushing may occur if alcohol is taken
(e.g. metronidazole and chlorpropamide). Alcohol may also enhance the hypoglycaemia
produced by some oral antidiabetic drugs but routine application of a warning label is not
considered necessary.
5. Do not take indigestion remedies at the same time of day as this medicine
To be used with label 25 on preparations coated to resist gastric acid (e.g. enteric-coated
tablets). This is to avoid the possibility of premature dissolution of the coating in the presence
of an alkaline pH.

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Label 5 also applies to drugs such as ketoconazole where the absorption is significantly
affected by antacids; the usual period of avoidance recommended is 2 to 4 hours.
6. Do not take indigestion remedies or medicines containing iron or zinc at the same
time of day as this medicine
To be used on preparations containing Ofloxacin and some other quinolones, doxycycline,

minocycline, and penicillamine. These drugs chelate calcium, iron and zinc and are less well
absorbed when taken with calcium-containing antacids or preparations containing iron or
zinc. These incompatible preparations should be taken 2-3 hours apart.
7. Do not take milk, indigestion remedies, or medicines containing iron or zinc at the
same time of day as this medicine
To be used on preparations containing ciprofloxacin, norfloxacin or tetracyclines that

chelate calcium, iron, magnesium, and zinc and are thus less available for absorption; these
incompatible preparations should be taken 2-3 hours apart. Doxycycline and minocycline are
less liable to form chelates and therefore only require label 6 (see above).
8. Do not stop taking this medicine except on your doctor's advice
To be used on preparations that contain a drug which is required to be taken over long
periods without the patient necessarily perceiving any benefit (e.g. antituberculosis drugs).
Also to be used on preparations that contain a drug whose withdrawal is likely to be a

particular hazard (e.g. clonidine for hypertension). Label 10 (see below) is more appropriate
for corticosteroids.
9. Take at regular intervals. Complete the prescribed course unless otherwise directed
To be used on preparations where a course of treatment should be completed to reduce the

incidence of relapse or failure of treatment.
The preparations are antimicrobial drugs given by mouth. Very occasionally, some may have
severe side-effects (e.g. diarrhoea in patients receiving clindamycin) and in such cases the
patient may need to be advised of reasons for stopping treatment quickly and returning to the
doctor.
10. Warning. Follow the printed instructions you have been given with this medicine
To be used particularly on preparations containing anticoagulants, lithium and oral

corticosteroids. The appropriate treatment card should be given to the patient and any
necessary explanations given.

129
This label may also be used on other preparations to remind the patient of the instructions that
have been given.
11. Avoid exposure of skin to direct sunlight or sun lamps
To be used on preparations that may cause phototoxic or photoallergic reactions if the

patient is exposed to ultraviolet radiation. Many drugs like phenothiazines and
sulphonamides) may, on rare occasions, cause reactions in susceptible patients. Exposure to
high intensity ultraviolet radiation from sunray lamps and sunbeds is particularly likely to
cause reactions.
12. Do not take anything containing aspirin while taking this medicine
To be used on preparations containing probenecid and sulfinpyrazone whose activity is

reduced by aspirin.
Label 12 should not be used for anticoagulants since label 10 is more appropriate.
13. Dissolve or mix with water before taking
To be used on preparations that are intended to be dissolved in water (e.g. soluble tablets) or
mixed with water (e.g. powders, granules) before use. In a few cases other liquids such as
fruit juice or milk may be used.
14. This medicine may colour the urine
To be used on preparations that may cause the patient's urine to turn an unusual colour.
These include phenolphthalein (alkaline urine pink), triamterene (blue under some lights),
levodopa (dark reddish), and rifampicin (red).
15. Caution flammable: keep away from fire or flames
To be used on preparations containing sufficient flammable solvent to render them

flammable if exposed to a naked flame.
16. Allow to dissolve under the tongue. Do not transfer from this container. Keep tightly
closed. Discard eight weeks after opening
To be used on glyceryl trinitrate tablets to remind the patient not to transfer the tablets to
plastic or less suitable containers.

130
17. Do not take more than . . . in 24 hours
To be used on preparations for the treatment of acute migraine except those containing
ergotamine, for which label 18 is used. The dose form should be specified, e.g. tablets or
capsules.
It may also be used on preparations for which no dose has been specified by the prescriber.
18. Do not take more than ... in 24 hours or ... in any one week
To be used on preparations containing ergotamine. The dose form should be specified, e.g.
tablets or suppositories.
19. Warning. Causes drowsiness which may continue the next day. If affected do not
drive or operate machinery. Avoid alcoholic drink
To be used on preparations containing hypnotics (or some other drugs with sedative effects)
prescribed to be taken at night. On the rare occasions (e.g. nitrazepam in epilepsy) when
hypnotics are prescribed for daytime administration this label would clearly not be
appropriate. Also to be used as an alternative to the label 2 wording (the choice being at the
discretion of the pharmacist) for anxiolytics prescribed to be taken at night.
It is hoped that this wording will convey adequately the problem of residual morning sedation
after taking 'sleeping tablets'.
20. ...with or after food
To be used on preparations that are liable to cause gastric irritation, or those that are better
absorbed with food.
Patients should be advised that a small amount of food is sufficient.
21. ...half to one hour before food
To be used on some preparations whose absorption is thereby improved. Most oral

antibacterials require label 23 instead (see below).
22. ...an hour before food or on an empty stomach
To be used on oral preparations whose absorption may be reduced by the presence of food
and acid in the stomach.
23. ...sucked or chewed
To be used on preparations that should be sucked or chewed.

131
The pharmacist should use discretion as to which of these words is appropriate.
24. ...swallowed whole, not chewed
To be used on preparations that are enteric-coated or designed for modified-release.
Also to be used on preparations that taste very unpleasant or may damage the mouth if not
swallowed whole.
25. ...dissolved under the tongue
To be used on preparations designed for sublingual use. Patients should be advised to hold
under the tongue and avoid swallowing until dissolved. The buccal mucosa between the gum
and cheek is occasionally specified by the prescriber.
26. ...with plenty of water
To be used on preparations that should be well diluted (e.g. chloral hydrate), where a high
fluid intake is required (e.g. sulphonamides), or where water is required to aid the action
(e.g. methylcellulose). The patient should be advised that 'plenty' means at least 150 mL
(about a tumblerful). In most cases fruit juice, tea, or coffee may be used.
27. To be spread thinly . . .
To be used on external preparations that should be applied sparingly (e.g. corticosteroids,

dithranol).
28. Do not take more than 2 at any one time. Do not take more than 8 in 24 hours
To be used on containers of dispensed solid dose preparations containing paracetamol for

adults when the instruction on the label indicates that the dose can be taken on an 'as
required' basis. The dose form should be specified, e.g. tablets or capsules.
This label has been introduced because of the serious consequences of over dosage with
paracetamol.
29. Do not take with any other paracetamol products
To be used on all containers of dispensed preparations containing paracetamol.
30. Contains aspirin and paracetamol. Do not take with any other paracetamol products
To be used on all containers of dispensed preparations containing aspirin and paracetamol.

132
31. Contains aspirin
To be used on containers of dispensed preparations containing aspirin when the name on the
label does not include the word 'aspirin'.
32. Contains an aspirin-like medicine
To be used on containers of dispensed preparations containing aspirin derivatives.

133
Worksheet 12.1: Sample Prescriptions
Serial Na. 001

KIDIA HEALTH CENTER
P.O. Box 58
IRINGA
Name: Amina Salehe
Gender: Fe
Age: 17 Yrs
Weight:
Rx Cotrimoxazole tabs 480mg bd 5/7
Paracetamol Tabs 1g 5/7
Prescriber’s name Hamis Juma Mgenja

qualification C/O
Signature
12/6/2015
Serial Na. 002

KIGOMA HOSPITAL
P.O. Box 5
KIGOMA
Name: Peter John
Gender: Me
Age: 25 Yrs
Weight:
Rx Erythromycin tabs 500mg qid 5/7
Prescriber’s name Kisa Mwanjela

qualification MO
Signature
12/6/2015

134
Serial Na. 003
HASSANALI HOSPITAL
P.O. Box 5118
MTWARA
Name: Miriam Kilimilimi
Gender: Fe
Age: 43 Yrs
Weight:
Rx Erythromycin tabs 500mg qid 7/7
Paracetamol Tabs 1g 5/7

Diazepam Tabs 5mg o.d nocte 3/7
Prescriber’s name Kilimani Kajengeni
qualification AMO
Signature
12/6/2015

135
Worksheet 12.2: Role Play Demonstration: Giving
Appropriate Instructions on the Use of Prescribed
Medicine
Script:
REFER Worksheet 7.1: Role Play Demonstration on Good Dispensing Practice
 You act as a Dispenser to give instructions to a patient on how to use medicines as

prescribed.
 Cotrimoxazole Tablets is taken 2 tablets after every 12 hours for 5 days
 Paracetamol Tablets is taken 2 tablets after every 8 hours for 5 days.
 Make sure you emphasize the 12hourly and 8 hourly well to a patient
 After receiving prescription and properly prepare the medicine, when dispensing follow
the following tips;
o Communicate to the patient the correct way to take medication. Give verbal
instructions. Use symbolic instructions in case of illiteracy. Use auxiliary labels if
required.
o In case of illiterate patients or patients familiar with only the regional language,
devise a system of pasting specific colored labels/stickers on strips/ bottles to take it
easier to identify the product.
o Repeat orally the labeled instructions, if possible, in laymen's terms. Do not disturb
any other pharmacy staff person, dispensing or preparing a bill.
o Make the patient repeat the advice to ensure that he/she has understood them.
Emphasize the need for adherence. Inculcate awareness in patients about the
importance of therapy.
o Patient information leaflets can be provided along with a particular medicine or for a
particular illness. Provide warnings and cautions. Give special attention to certain
cases-
 Those with visual impairment
 Illiterates.
 Those taking multiple medications.
 Special group of patients (pregnant, children and elderly patients,
 patients with liver and kidney problem)
o OTC medicines are requested, the pharmacy professionals can evaluate if the product
requested, is appropriate for the patient's condition, and advise accordingly.

136
 Worksheet 12.3: Role Play Demonstration: Giving
appropriate precautions, interactions, side effects and
storage of medicines
Script:

prescribed.
 Erythromycin Tablets is taken 2 tablets after every 6 hours for 5 days
 Make sure you emphasize the 6 hourly and 8 hourly well to a patient
 You must tell the patient about common side effect of Erythromycin Tablets which is
stomach discomfort. It is also enteric coated to avoid stomach discomfort but it should be
stored at a cool and dry place out of children reach. Keeping medicines out of children
reach should apply for Paracetamol also.
 Remember to ask a patient to repeat instructions as given

137
 Worksheet 12.4: Role Play Demonstration: Checking
patient understanding on the use and precautions of
dispensed medicines
Script:

prescribed.
 Erythromycin Tablets is taken 2 tablets after every 6 hours for 7 days
 Diazepam Tablets is taken 1 tablet once a day at night before sleeping for 3 days
 Make sure you emphasize the 6 hourly and 8 hourly and at night before sleeping well to a
patient
 You must tell the patient about common side effect of Erythromycin tablets which is
stomach discomfort.
 It is also enteric coated to avoid stomach discomfort but it should be stored at a cool and
dry place out of children reach.
 Keeping medicines out of children reach should apply for Paracetamol and Diazepam also
 Emphasize on Erythromycin is causing stomach discomfort;
 Diazepam is causing drowsiness on the next day.
 Precaution to a patient not to drive in case of drowsiness
 Remember to ask a patient to repeat instructions as given
 Put more emphasis to patient understanding on the instructions given

138
Session 13: Adverse Drug Reactions, Drug Overdose and
Intoxication
Prerequisites
 None
Students Learning Tasks

 Define ADRs, Drug Overdose and Intoxication
 Identify suspected adverse drug reactions (ADRs), drug overdose and intoxication
 Report suspected adverse drug reactions (ADRs)
Resources Needed:
 Handout 13.1 Adverse Drug Reactions Cases
 Worksheet 13.1 TFDA ADR form
SESSION OVERVIEW
Activity/
Step Time Content
Method
05 minutes Definition of Adverse Drug Reactions, Drug
2 Presentation
Overdose and Intoxication
Identification of Adverse Drug Reactions
3 Brainstorming
(ADRs), Drug Overdose and Intoxication
4 Small Group Reporting Adverse Drug Reactions (ADRs)
Discussion

139
SESSION CONTENTS

STEP 2: Definition of Adverse Drug Reactions (5 minutes)
 Adverse Reaction is a situation where someone experiences harmful effects from the
application of a drug
or is an unfavourable or harmful unintended action of a medicine
 Serious adverse drug reaction: any reaction that is fatal, life-threatening,
permanently/significantly disabling, requires or prolongs hospitalization, causes a
congenital anomaly, or requires intervention to prevent permanent impairment or damage
 Drug Overdose describes the ingestion or application of a drug or other substance in
quantities greater than are recommended or generally practiced
 An overdose may result in a toxic state or death
 Combined drug intoxication (CDI), also known as multiple drug intake (MDI)
or lethal polydrug/polypharmacy intoxication is due to the simultaneous use of
multiple drugs, whether the drugs are prescription, over-the-counter, recreational, or some
other combination
STEP 3: Identification of Adverse Drug Reactions (ADRs) (35 minutes)
 How will one identify Adverse Drug Reactions?
 Patients may experience one or more adverse reactions when they are given medicines
Adverse reactions (Side effect) are undesirable drug effects which may be common or
may occur infrequently
 They may be mild, severe, or life-threatening. They may occur after the first dose, after
several doses, or even after many doses

140
 An adverse reaction often is unpredictable, although some drugs are known to be cause
certain adverse reactions in many patients
 For example the drugs used in the treatment of Cancer and those used in treating
HIV/AIDS, commonly known as Anti-Retralviral Therapy(ART) are very toxic and are
known to produce adverse reactions in many patients receiving them
 Other medicines produce adverse reactions in fewer patients
 Some adverse reactions are predictable, but many adverse drug reactions occur without
warning
 When dealing/ dispensing medicines that are suspected to have ADRs:
o Counsel all patients regarding the possibility of ADRs
o Inform patients of signs and symptoms that may indicate an ADR
o Instruct patients that in the event of an ADR, they should return to the clinic/hospital
immediately if the reaction is life-threatening or contact the MO as soon as possible in
all other instances
o Refer all patients with suspected ADRs to the MO
o After a period to be determined by the ART Eligibility Committee, complete one
ADR form for each ADR reported
 Refer patients with suspected serious ADRs or patients requiring treatment to
the MO
o Work with the Records Officer and the nursing staff to make sure that the original
ADR form is placed in the patient record and the duplicate is received by the
pharmacist
o Maintain a file of all completed ADR forms and related reports
o Review ADR forms on an ongoing basis and alert the ART Eligibility Committee of
unusual trends or findings
o Provide verbal feedback at ART Eligibility Committee meetings, or written feedback
to staff regarding outcomes of referred ADRs so as to encourage continued reporting
o Prepare ADR Summary Report
o Present the ADR Summary Report and findings to the ART Eligibility Committee
 Signs and symptoms of drug overdose vary depending on the drug or toxin exposure
o The substance that has been taken may often be determined by asking the person
o For patients with altered level of consciousness, questioning of their friends and
family may be helpful in order to get information of the drug involved
Refer students to Worksheet 13.1: TFDA ADR FORM

141
STEP 4: Reporting Adverse Drug Reactions (ADRs) (60 minutes)
Activity: Small Group Discussion (30minutes)
REFER students to Worksheet 12.1: TFDA ADR FORM
READ the form and CLARIFY
ASK all groups to discuss about the following question for 15 minutes.
 Where to report in case of ADR?

 What to report on ADR form?
 Who should report?
 How to report?
Where to report
 The National ADRs monitoring centre: This is under the Tanzania Food and Drugs
Authority (TFDA), with offices near EPI-Mabibo, Dar es Salaam.
 The Centre collects and evaluates ADR reports and feedbacks its findings to the
healthcare professionals and the general public.
 Reported information is also communicated to the World Health Organisation
(WHO).
 Zonal Drug Information Centres: Four Zonal Drug information Centres located at;
o Muhimbili National Hospital (Dar es salaam)
o Bugando Medical Centre (Mwanza)
o Kilimanjaro Christian Medical Centre and Mbeya Consultant Hospital
 are responsible with co-ordinating the collection of ADR reports at respective
hospitals and zones.
What to report
 All suspected adverse reactions should be reported whether known or unknown, serious
or not, including minor ones.
 Reports on the new drugs are of great interest because they make easier to monitor the
performance of these drugs in the country for any suspected adverse drug reactions.

142
Who should report
 All health care providers including specialists, doctors, dentists, pharmaceutical personnel
and nurses can report ADRs
 All affected consumers are encouraged to report ADRs directly to their healthcare
professionals and zonal Drug Information centers
How to report
 Adverse drug reaction forms may be obtained from TFDA headquarters, Zonal Drug
Information Centres, offices of Regional Medical Officers or Regional Pharmacists and
healthcare facilities
o The form can be filled online or downloaded from the website
 Suspected adverse reactions for drugs marketed in Tanzania should be reported using a
standardised form which is postage pre-paid and self adhesive
 The reports should be sent to the Director General, TFDA, P.O. Box 77150, Dar es
Salaam, fax +255 22 2450793 email adr@tfda.or.tz
 The forms or reports should contain the following elements:
o Patient information including Patient’s name, Age/Date of birth, Sex, Weight and
relevant medical history
o Description of the adverse reaction including date of onset
o Suspected drug(s): name (including brand name, if known), dosage, route, start and
stop dates and reasons for use.
o Treatment given for the reaction(s)
o Other relevant history, including pre-existing medical conditions
o Outcome of reactions
o Name, date, signature and address of the reporter
 All sections of the form should be dully filled prior submission
o A separated form should be used for each patient

 Adverse reaction is a response to a medicine that is noxious and unintended, and which
occurs at doses normally used in man for the prophylaxis, diagnosis, or therapy of disease
or the modification of physiological function
 All suspected adverse reactions should be reported whether known or unknown, serious
or not, including minor ones
 The word "overdose" implies that there is a common safe dosage and usage for the drug;
therefore, the term is commonly only applied to drugs, not poisons, though even poisons
are harmless at a low dosage
 Reports on the new drugs are of great interest because they make easier to monitor the
performance of these drugs in the country for any suspected adverse drug reactions

143
 The reports should be sent to the Director General, TFDA, P.O. Box 77150, Dar es
Salaam, fax +255 22 2450793 email adr@tfda.or.tz
 Adverse drug reaction forms may be obtained from TFDA headquarters, Zonal Drug
Information Centres, offices of Regional Medical Officers or Regional Pharmacists and
healthcare facilities
 All sections of the Yellow form should be dully filled prior submission

 What is adverse drug reaction?
 When adverse drug reaction occur?
 Why is it important to report adverse drug reaction?
 What is drug overdose?
 What is intoxication?
 Where should the report be sent?
 Who should fill the ADR (Yellow Form) for a patient?
 Why is it important to keep a copy of complete ADR (Yellow Form) for your record?

144
References
Malestrom.(2004) Dictionary of Medical Terms (4th ed.). London, United Kingdom: A & C
Black.
States of America: Cengage Learning.
TFDA, (2006). Guidelines for Monitoring and Reporting Adverse Drug Reactions – ADRs.
Dar; MoH&SW

145
Worksheet 13.1: TFDA ADR FORM

146
147
Session 14: Documentation of Medicines and Medical
Supplies
Prerequisites
 None
Learning Tasks
 Explain the Dispensing Medicine Records and Electronic Records
 Mention Components of Dispensing Register/Prescription Record Book/Sales Book
 Report Information of Dispensed Medicines/Medical Supplies to Dispensing Register/
Prescription Record Book/Sales Book
 Retain and File Prescriptions of Dispensed Medicines and Mdical Supplies
Resources Needed:
 Black/white board, chalk and /whiteboard markers
 Worksheet 14.1 Dispensing Register
 Worksheet 14.2 Prescriptions for Dispensing Records
SESSION OVERVIEW
Activity/
Step Time Content
Method
20 minutes Dispensing Medicine Records and Electronic
2 Presentation
Records
25 minutes Presentation Components of Dispensing Register/
3
Brainstorming Prescription Record Book/Sales Book
30 minutes Presentation Information of Dispensed Medicines into
4
Exercise Dispensing Register
30 minutes Presentation Retention and Filling of Prescriptions of
5
Buzzing Dispensed Medicines

148
SESSION CONTENTS
STEP 2: Dispensing Medicine Records and Electronic Records (20

minutes)
 Prescriptions should be recorded and documented as proof of transaction between the

o Prescriptions can therefore be traced back if any need arise
 All dispensing units should have a standardized Prescription Registration Book (PRB) for
recording every pharmaceutical issued to a patient
 A computerized dispensing and registration system may also be used, but should always
be supported by paper back up
 The registration book should be completed at the time of dispensing or at the close of the
working day
 Importance of documentation of dispensed medicine

o Can be used as back up data when needed
o Is the source of information on the monitoring and evaluation of the daily activities
done in the unit
o Can act as the proof and show the source of purchase of medicine
o Simplify payment of revenue
 Electronic Records
o Electronic Document and Records Management Systems are computer based systems
designed to store a wide range of electronic documents and file types
o These systems can store documents/files created from variety of programs including
Microsoft Office applications and emails
 The following are the Importance of electronic records in pharmacy:
o Providing accurate, up-to-date, and complete information about patients at the point of
care
o Enabling quick access to patient records for more coordinated, efficient care
o Securely sharing electronic information with patients and other clinicians
o Helping providers more effectively diagnose patients, reduce medical errors, and provide
safer care

149
o Improving patient and provider interaction and communication, as well as health care
convenience
o Enabling safer, more reliable prescribing
o Helping promote legible, complete documentation and accurate, streamlined coding and
billing
o Enhancing privacy and security of patient data
o Reducing costs through decreased paperwork, improved safety, reduced duplication of
testing, and improved health
o Help in effective inventory management
STEP 3: Components of Dispensing Register/ Prescription Record

Book/Sales Book (25 minutes)
 What are the components of Dispensing Register?
 Date
o Make sure you write the new date every day
o You are not required to repeat writing the same date for every patient on the same day
but if you have shift on the same day, you should skip one line and write new date
o Start new page for new month
 Serial Number
o Each patient should be given serial number
o This number has no other meaning than just numbering all customers that have been
attended at the particular day
 Full name of a patient
o Write the full name of the patient who will use the medicine as it appears in the
Prescription and not of the one who has collected the medicine
 Age: Write the age of a patient by years but if you cannot get the exact age be sure to
indicate whether is a child or adult
 Address of the patient ( Ward/street): Write the street and the ward from which the
patient is living
 Sex: Indicate if patient is male or female
150
 Generic name of the medicine: Record generic name of the medicine and not trade
name
o For example: Write Paracetamol and not Panadol.
 Direction for use: Write direction for use as indicated in the prescription.
o For example: 2 x 3 x 5/7 Meaning "take 2 tablets after every 8 hours for 5 days"
 Quantity of medicine dispensed: Record the amount of drug dispensed
 Signature of the Dispenser: Themedicine dispenser should sign in the dispensing
register so as to recognize who dispensed medicines on a particular day
 Name of the Health Facility: Dispenser must record the health facility from which the
prescription was written
o This is very important in case of tracking errors at any stage from prescription writing
to dispensing
Refer students to Worksheet 14.1: Dispensing register
STEP 4: Information of Dispensed Medicines into Dispensing Register (30

minutes)
Activity: Exercise ( 15 minutes)
ASK students to discuss the following question
 What informations are to be filled in the Dispensing register provided?

REFER students to the Worksheet 14.2 Prescriptions for Dispensing Records
Serial No. 00660-00664
REFER students to the Worksheet 14.1 Dispensing Register
CLARIFY and SUMMARIZE by using table 1 below
The following is the example of filled dispensing register :

151
Table 1: Dispensing register with filled medicine information
Name of Institution MADUKANI PHARMACY Page No 1
S/ Date Patient name Addre Sex Age Drug Generic Name Dosage Total Name of Sign
Diagnosis
No Quantity Health
Facility
1 15/1/15 Ibrahim Kimongo - Me 39 - Metronidazole tabs 2x3x7 42 tabs Kihesa HC

Paracetamol Tabs 2x3x3 18 tabs
2 15/1/15 Joyce Kamau - Fe 18 - Miconazole Cream 1x2x28 2 tube Kihesa HC
Griseofluvin tabs 1x1x90 90 tabs
Paracetamol tabs 2x3x3 18 tabs
3 20/1/15 Steven Nnyamayao - Me 56 - Mebendazole tabs 1x5x1 5 tabs Kihesa HC
Phenytoin tabs 1x1x3 3 tabs
4 20/1/15 Marystella Ndauka - Fe 65 - Tetracycline Eye 1x4x7 2 tube Kihesa Hc
Oint 2x3x3 18 tabs
Paracetamol tabs
5 13/1/15 Mariam Abubakari - Fe 4 - Metronidazole Syp 1x3x7 1 bottle Kihesa HC
Paracetamol Syp 1x3x 1 bottle
STEP 5: Retaining and Filing Prescriptions of Dispensed Medicines (30

minutes)
 Which dispensing records are to be retained?

 How long the dispensing records can be retained?
 The prescription registration book should be used both when prescriptions are retained in
the pharmacy and when they are returned to the patient
 For a prescription which is returned to a patient due to some of the medicines to be out of
stock the copy of the prescription should be retained
o The word “dispensed” should be stamped/written adjacent to those items which have
been dispensed
o For prescriptions which are to be refilled on a later date, the dispensing information
should be entered into the registration book before returning the prescription to the
patient
 The official seal of the pharmacy/Health institution, name and signature of the
dispenser, the date of dispensing and the next refill date should be written on the
back of the prescription

152
 Prescriptions should be filed sequentially by day in a single container/carton or box for
each month
 The box/container should be labelled with the month and year
 Containers/boxes should be arranged on a monthly basis
 Normal prescriptions should be filed securely for two years and special prescriptions for 5
years
 Thereafter, they should be disposed carefully in the presence of appropriate body
 Prescriptions, patient and medication related records and information should be
documented and kept in a secure place that is easily accessible only to the authorized
personnel

 Prescription shall be documented separated by day, month and year dispensed and archive
for minimum of two years
 Electronic Records Management (ERM) ensures your organization has the records it
needs when they are needed
 Prescriptions should be recorded and documented as proof of transaction between the
 All dispensing units should have a standardized Prescription Registration Book (PRB) for
recording every pharmaceutical issued to a patient

 What is a dispensing register?
 What information is filled in a dispensing register?
 What is the importance of keeping records?
 What is the importance of electronic records?

153
References
Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of pharmaceutics (8th ed.).
London, United Kingdom: Bailliere Tindall.
pharmaceutical students (12th ed.). New Delhi, India: CBS
Ethiopia
Rees, J. A., Smith, I., & Watson, J. Pharmaceutical practice (5th ed.). London, United
Kingdom: Churchill Livingstone

154
Worksheet 14.1: Dispensing Register
Dispensing Register
Name of Institution……………………………………………………………… Page No.. ………………………
S/ Date Patient Address Sex Age Diagnosis Drug Generic Dosage Total Name of Signature
No name Name Quantity Health
Facility
Worksheet 14.2: Prescriptions for Dispensing Records

155
Serial Na. 00661
P.O. Box
IRINGA
Name: Joyce Kamau
Serial Na. 00662
KIHESA HEALTH CENTER Gender: Fe
P.O. Box 18Yrs
Age:
IRINGA
Name: Steven Nnyamayao Weight: 40kg
Gender: Me Rx Miconazole cream 2% p.a.a b.i.d
56Yrs 4/52
Age:
Griseofulvin tabs 500 mg p.c od 3/12
Weight: 74kg
Rx Mebendazole tabs 500mg stat
Phenytoin 10mg nocte OD x 3/7
name MO
qualification
Signature
name MO
15/1/15
qualification
Signature
20/1/15
Serial Na. 00663 Serial Na. 00664

KIHESA HEALTH CENTER KIHESA HEALTH CENTER
P.O. Box P.O. Box
IRINGA IRINGA
Name: Marystella Ndauka Name: Marium Abubakar
Gender: Fe Gender: Fe
Age: 65Yrs Age: 4Yrs
Weight: 80kg Weight: 10kg
Rx Occul tetracycline oint RE 6hrly Rx Metronidazole syrup 1 tsp tds 7/7

1/52 Paracetamol syrup 1tsp prn
Paracetamol Tabs PO 1g tds 3/7
Prescriber’s Masige Kahwa Malimbo Prescriber’s Masige Kahwa Malimbo
name MO name MO
qualification qualification
Signature Signature
20/1/15 13/1/15

156
Session 15: Rational Use of Medicines (RUM)
Prerequisites
 None
Learning Tasks
 Define Rational Use of Medicine
 List Components of Rational Use of Medicine
 List the Consequences of Irrational Use of Medicines
 Outline importance of Rational Use of Medicine
Resources Needed:
 Worksheet 1.1 Sample Prescription
SESSION OVERVIEW
Activity/
Step Time Content
Method

157
2 05 minutes Presentation Definition of Rational Use of Medicine

Presentation Components of Rational Use of
3 20 minutes
Brainstorming Medicines
Presentation
Consequences of Irrational Use of
4 40 minutes Small Group
medicines
Discussion
Presentation
Importance of Rational Use of
5 40 minutes Small Group
Medicines
Discussion
Presentation
8 05 minutes Evaluation
SESSION CONTENTS
STEP 2: Definition of Rational Use of Medicine (5 minutes)

 Rational Use of Medicine: Refers to patients receiving medications appropriate to their
clinical needs, in doses that meet their own individual requirements, for an adequate
period of time and at the lowest cost to them and the community
STEP 3: Components of Rational Use of Medicines (20 minutes)

158
 What are the components of Rational Use of Medicines?
 The following are the components of Rational Use of Medicines

o Appropriate indication: The decision to prescribe drug(s) is entirely based on
medical rationale and the drug therapy is an effective and safe treatment
o Appropriate drug: The selection of drugs is based on efficacy, safety, suitability,
and cost considerations
o Appropriate patient: No contraindications exist, the likelihood of adverse reactions
is minimal, and the drug is acceptable to the patient
o Appropriate patient information: Patients are provided with relevant, accurate,
important and clear information regarding their conditions and the medication(s) that
are prescribed
o Appropriate evaluation: The anticipated and unexpected effects of medications are
appropriately monitored and interpreted
STEP 4: Causes and Consequences of Irrational Use of Medicines (40

minutes)
 What are the causes and consequences of irrational use of medicine?
The following are the causes of Irrational Medicine Use

o Diagnosis
 Inadequate examination of patient
159
 Incomplete communication between patient and doctor doctor
 Lack of documented medical history
 Inadequate laboratory Resources
o Prescribing
 Extravagant prescribing
 Over-prescribing
 Incorrect prescribing
 Under-prescribing
 Multiple prescribing/ers
o Dispensing:
 Incorrect interpretation of the prescription
 Retrieval of wrong ingredients
 Inaccurate counting, compounding, or pouring pouring
 Inadequate labeling
 Unsanitary procedures
 Packaging:
- Poor quality packaging materials
- Odd package size, which may require repackaging repackaging
- Unappealing package
o Patient adherence:
 Poor labeling
 Inadequate verbal instructions
 Inadequate counseling to encourage adherence adherence
 Inadequate follow-up/support of patients
 The following are consequences of irrational use of medicines:
o Ineffective and unsafe treatment
o Prolongation of illness
o Distress and harm to patient
o Increase the cost of treatment
o Lead to antimicrobial resistance
STEP 5: Importance of Rational Use of Medicines (40 minutes)
 What is the importance of Rational Use of Medicine?

160
Importance of Rational Use of Medicines:

 Reducing the incidences of drug resistance
 Improving patience adherence to medicines
 Reducing unnecessary cost of drug acquisition
 Reducing incidences of treatment failure
 Reducing the incidences of drug adverse reaction

 Improving the use of medicines by health workers and the general public is crucial both
in reducing morbidity and mortality from communicable and non-communicable
diseases, and to containing drug expenditure curtail
 Therapeutically sound and cost-effective use of medicines by health professionals and
consumers should be at all levels of the health system, in the public and the private
sectors

 What is Rational Use of Medicines?
 What are the Components of Rational use of Medicines?
 What are the Concequences of Irrational Use of Medicine?
 What is the importance of Rational Use of Medicines?

161
References
Ethiopia
Senya ,S. S., Mwasha, C.Y., Muyinga, A. M., Amiri,R. I., Mauga, E.S.K.(2011). Tanzania
Pharmaceutical Handbook ( 2nd ed.). Dar eS Salaam, Tanzania: School of

162
Session 16: Irrational Prescribing of Medicines
Prerequisites
 None
Learning Tasks
 Define irrational prescribing
 Distinguish types of irrational prescribing practices
 Describe common patterns of irrational prescribing
 Identify irrational prescriptions
 Explain factors contributing to Irrational Prescribing
 Describe Measures to alleviate Irrational Prescribing
Resources Needed:
163
 Black/white board and chalk/whiteboard markers
 Worksheet 16.1 to 16.5: Irrational Prescriptions
SESSION OVERVIEW
Activity/
Step Time Content
Method
2 05 minutes Presentation Definition of Irrational Prescribing

30 minutes Small group
3 Types of Irrational Prescribing Practices
Discussion
4 Common Patterns of Irrational Prescribing
Brainstorming
5 Identification of Irrational Prescriptions
Exercise
6 Factors Contributing to Irrational Prescribing
Brainstorming
7 Measures to Alleviate Irrational Prescription
Buzzing
SESSION CONTENTS
STEP 2: Irrational Prescribing (5 minutes)
 Medicines should be prescribed only when they are necessary, and in all cases the benefit
of administering the medicine should be considered in relation to the risk involved
 Irrational use of Medicines may be defined as: Patients receive medications inappropriate
to their clinical needs, in doses that do not meet their own individual requirements, for
inadequate period of time, and the highest cost to them and their community
STEP 3: Types of Irrational Prescribing Practices (30 minutes)

164
 What are the types of irrational prescribing practices?
 The following are the types of irrational prescribing:Extravagant Prescribing: This

occurs when:
o A less expensive drug would provide comparable efficacy and safety
o Symptomatic treatment of mild condition diverts funds from treating serious illness
o A proprietary product is used where less expensive generic equivalent is available
 Over prescribing: This occurs when:
o The drug is not needed
o The dose is too large
o The treatment period is too long
o The quantity dispensed is too much for the current course of treatment
 Incorrect prescribing: This occurs when:
o The drug is given for an incorrect diagnosis
o A wrong drug is selected for the indication
 Multiple prescribing: This occurs when a drug is prescribed when:

o Two or more medication are used where one or two would achieve virtually the same
effect
o Several related conditions are treated when one or two would achieve virtually the
same effects
o Several related conditions are treated where treatment of the primary condition will
improve or cure the other conditions
 Under prescribing: This occurs when a drug is prescribed when:
o Dosage is inadequate
o length of treatment is too brief
o Need medications are not prescribed
STEP 4: Common Patterns of Irrational Prescribing (20 minutes)

165
 What are the common patterns of irrational prescribing?
Irrational prescribing may be manifested in the following ways:

Over-prescribing
This occurs if a drug is prescribed when:
 The drug is not needed
 The dose is to large
 The treatment period is to long
 The quantity dispensed is too great for the current course treatment
Incorrect Prescribing
 The drug is given for the incorrect diagnosis
 The wrong drug is selected for the indication
 The prescription is prepared incorrectly
 Adjustments are not made for co-existing medical, genetic, environmental, or other
 factors
Multiple Prescribing
 Two or more medications are used where one or two would achieve virtually the same
effect
 Several related conditions are treated where treatment of the primary condition would
alleviate or cure the other conditions
Under-prescribing
 Dosage is inadequate
 Length of treatment is too brief
 Needed medications are not prescribed
STEP 5: Irrational Prescriptions (30 minutes)
Activity: Exercise (20 minutes)

166
REFER students to Worksheet 16.1 to 16.5: Irrational Prescriptions
READ or ASK one student to read and then comment on the following prescription orders
and CLARIFY
 Prescription 16.1
o A patient came with prescription written as Septra tabs 960 mg bd 7/7, Panadol tabs
1 gm tds 3/7 and Cough syrup 10 ml tds 5/7. The diagnosis Cough with chest pain.
Comment
o Answer
This is Extravagant Prescribing: Septra is a brand of cotrimoxazole tabs. It cost
more than generic drug. The prescription should have been prescribed using
generics. Panadol is a trade name too, instead it should have been written
paracetamol which is cheaper than panadol
o A patient aged 55 years, came with prescription written as Paracetamol tabs 1 gm
tds 7/7,Metronidazole tabs 400 mg tds 1/12, Diagnosis tooth extraction
o Answer
This is over prescription: Duration for paracetamol is too long, proper is just 3days
or as needed Metronidazole duration is too long it should have been 5-7 days. For
tooth extraction another antibiotic is needed, ampiclox, Flucamox.
A patient aged 23 years came with prescription written as BBE 25% w/v od 3/7
Diagnosis scabies
o Answer
This is incorrect prescription: The instruction are not correct BBE 25% od x 3/7
does not tell route of administration. BBE is a topical medication. Need to apply
after bath whole body except face and head. Patient should not shower until after
24hrs. Should be applied after every one day (repeat on the third day, and then on
fifth day). That means the course is three times
A patient came with prescription written as Flucamox caps 500 mg tds 10/7, Pen V tabs
500 mg tds 5/7, Ampiclox 500mg tds 5/7, Diagnosis tonsillitis, typhoid, and boils.
o Answer
This is multiple prescription/polypharmacy: The three diseases; tonsillitis, boils
and typhoid can well be treated with flucamox. Is a wide antibiotic which is
indicated for all the three diseases. There was no need of prescribing ampiclox and
Pen V

167
A patient aged 10 years came with prescription written as Paracetamol syrup 5mL tds
3/7 ( available paracetamol syrup 125mg/5mL) Co-trimoxazole syrup 5mL bd 3/7
( available co-trimoxazole syrup 240mg/5mL). Diagnosis pneumonia
o Answer
This is under prescribing : For a child of that age, the dose is too small and the
treatment will not be achieved. That is a dose for below 6 years child.
ASK all groups to answer the above 5 questions for 15 minutes.
CLARIFY if there are any questions
STEP 6: Factors Contributing to Irrational Prescribing (10 minutes)
 What factors contribute to Irrational Prescribing?

The following are factors contributing to irrational Prescribing:
 Inadequate training in clinical pharmacology and therapeutics
 Lack of continuing education and supervision
 practitioner's inappropriate desire for prestige
 promotional activities of company representatives
 Lack of time due to heavy patient load
 Pressure from patient
 Incorrect generalization about a drug from limited experience
STEP 7: Measures to Alleviate Irrational Prescribing (10 minutes)

168
 What are the Measures to alleviate Irrational Prescribing?
 Measures to alleviate irrational prescribing

o Proper use of Standard Treatment Guideline
o Regular supervision of subordinates
o Participating in developing standard treatment protocols
o Participate in continuing education programs through informal one-to-one teaching
and through hospital seminars
o Make appropriate use of available laboratory investigations to confirm diagnosis and
hence appropriate treatment
o Availability of current drug information through reference manuals and drug news
periodical
o Use of hospital formulary to provide scientific justification for appropriate therapeutic
intervention
o Educate and counsel patients on proper use of medicine
o Promotion of cost consciousness among prescribers

 In developed and developing world, medically inappropriate, ineffective, and
economically inefficient use of pharmaceuticals commonly occurs in health care facilities
 The costs of such irrational drug use are enormous in terms of both scarce resources and
the adverse clinical consequences of therapies that may have real risks but no objective
benefits
 Promoting appropriate use of drugs in the health care system is needed not only because
of the financial reasons but also quality of care which is the most concern to practitioners
 Actions or intervention programs to promote the appropriate use of drugs should,
therefore, be continuously implemented and systematically incorporated as an integral
part of the health care system

 What are the commonly encountered irrational prescribing practices?
169
 What is irrational prescribing?
 What are the types of irrational prescribing?
 What factors contribute to irrational prescribing?
 What are the Measures to alleviate irrational prescribing?
References
Ethiopia
Management Sciences for Health (1988). Health Center Prescribing and Child Survival in
East Java and West Kalimantan, Indonesia. Boston: United States of America

170
Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the Tetracycline Go?
Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A strategy for
promoting improved pharmaceutical use: The International Network for Rational Use
of Drugs. 35 (11) 1329–41.
Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K. (2011)
Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of irrational drug
therapy. 1986;16(3):355–61.
Session 17: Irrational Dispensing of Medicine

Prerequisites
None
Learning Tasks
 Define Irrational Dispensing
 Identify Irational Dispensing Practices
 Describe Factors Contributing to Irrational Dispensing
 Determine Measures to Alleviate Irrational Dispensing

171
Resources Needed:
 Black/white board and chalk/whiteboard markers
 Handout 17.1: Factors contributing to Irrational Dispensing
SESSION OVERVIEW
Activity/
Step Time Content
Method
Presentation
2 10 minutes Definition of Irrational Dispensing
Brainstorming
3 Small Group Irrational Dispensing Practices
Discussion
15 minutes Presentation Factors Contributing to Irrational
4
Dispensing
20 minutes Presentation Measures to Alleviate Irrational
5
Brainstorming Dispensing
SESSION CONTENTS

ASK students if they have any questions before continuing
STEP 2: Definition of Irrational Dispensing (10 minutes)

172
 What is Irrational Dispensing?
 Irrational dispensing refers to dispensing practices resulted from errors occurring during
the dispensing process in the pharmacy
o They are different from prescribing errors or errors during consumption of medicine
STEP 3: Irrational Dispensing Practices (55 minutes)

 What are the Different Practices of irrational dispensing observed from

Dispensers?
 Misreading the prescription

 Misinformation to the patient (wrong or failure to give proper information)
 Picking wrong medication (picking errors)
 Overcharging (billing error)
 Mistake in packing and labeling
 Mistaken delivery of medicine i.e giving medicine to a wrong person
 Dispensing Expired Medicine
 Error in dispensing similarly pronounced medicine (similarity errors)
 Errors in counting medicine for dispensing

173
Activity: Exercise ( 25 minutes)
ASK students to Discuss and Comment on cases 17.1-17.3 below

Case 17.1
Mary James, pharmacist, has filled some prescriptions for carbimazole on one working
day. On the same day a customer, epileptic patient, presented him a prescription for
carbamazepine. Glancing at it, Abebe thinks it is carbimazole once again, and that is what
he dispensed. The patient went to his prescriber with complaints of no improvement.
Comment on this case.
Discussion: Mary James, the pharmacist, failed to read and understand the prescription
correctly. This has led to failure of treatment regimen prescribed for the epileptic patient.
Because of the existence of similarity with the names of some medicines, it is important to
read and understand the prescribed medicines carefully and correctly.
Case 17.2
Frank Chacha, went to a medicine shop and made verbal request for ampicillin and cough
syrup for her 8 years old daughter with complaints of cough and poor appetite. As she did
not have enough amount of money, she wanted to purchase only ten capsules of ampicillin
and one bottle of cough syrup suspension. The dispenser fulfilled her request. Comment.
Discussion: Frank chacha made a verbal request for a prescription medicine (ampicillin)
and an OTC cough syrup. The dispenser should have asked her a prescription at least for
ampicillin. Secondly, dispensing inadequate quantity of ampicillin even with prescription
is irrational. Such clients should be referred to authorized prescribers. prescription at least
for ampicillin. Secondly, dispensing inadequate quantity of ampicillin even with
prescription is irrational. Such clients should be referred to authorized prescribers.
Case 17.3
A prescription that calls for atenolol 50 mg tablets is presented to a pharmacy. The total
quantity to be dispensed is not indicated. One Tab. BID po for 4 weeks is written after
Sig. All other information is complete. The pharmacy professional dispensed 28 atenolol
50 mg tablets. Comment.
Discussion: The total quantity dispensed is not correct. According to the prescription, 56
tablets (2 tablets a day for 4 weeks or 28 days) should be dispensed.

174
CLARIFY if there is any question.
STEP 4: Factors Contributing to Irrational Dispensing (15 minutes)
The following are factors contributing to irrational dispensing practices:

 Dispensing:
o Incorrect interpretation of the prescription
 Retrieval of wrong ingredients

o Inaccurate counting, compounding, or pouring
o Inadequate labeling
o Unsanitary procedures
o Packaging:
 Poor-quality packaging materials
 Odd package size, which may require repackaging repackaging
 Unappealing package
o Inadequate verbal instructions
o Inadequate counseling to encourage adherence
o Inadequate follow-up/support of patients
o Treatments or instructions that do not consider the consider the patient’s beliefs, environment,
or culture or culture
Refer students to Handout 17.1: Factors contributing to Irrational Dispensing
STEP 5: Measures to Alleviate Irrational Dispensing (20 minutes)
 What are the measures to alleviate irrational Dispensing?

175
 Dispensing should be done by Pharmaceutical personnel

 Dispenser should follow good Dispensing Practice and abide to dispensing policy
 The dispenser or dispensing team should have knowledge, skills and attitudes to carry out
the dispensing process rationally. These includes
o 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)
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,
o Sufficient training according to the level of the health institution and medicine retail
outlet
o Knowledge about national polices and working guidelines
o Good knowledge of societal norms and cultural values
o Good working relation with other health care professionals
o Good knowledge on medicine supply management
 Maintain a register/chart to record dispensing errors occurring in your pharmacy, with the
possible cause/reason for the error
o Try to work out systems/processes, to avoid such errors in future
 Do not dispense any doubtful prescription if:
o Essential information is missing or doubtful, and the prescriber cannot be contacted
o Safety of the medicines is doubtful
o The prescription does not conform to legal requirements

 Irrational dispensing refers to dispensing practices resulted from errors occurring during
the dispensing process in the pharmacy. Improper attention, careless attitude while
dispensing, not checking carefully before dispensing are among the factors that contribute
to irrational dispensing
 The dispenser or dispensing team should have knowledge, skills and attitudes to carry out
the dispensing process rationally

176
 What is Irrational Dispensing?
 What are the different practices of irrational dispensing observed from Dispensers?
 What are factors that contributing to Irrational Dispensing?
 What are the measures to alleviate Irrational Dispensing?

177
References
Ethiopia
Management Sciences for Health (1988). Health Center Prescribing and Child Survival in
East Java and West Kalimantan, Indonesia. Boston: United States of America
Quick, J.D., Foreman, P., Ross-Degnan, D., et al. Where Does the Tetracycline Go?
Ross-Degnan, D., Laing, R.O., Quick, J,D., et al. (1992). Soc Sci and Med:A strategy for
promoting improved pharmaceutical use: The International Network for Rational Use
of Drugs. 35 (11) 1329–41.
Senya ,S. S, Mwasha, C.Y, Muyinga, A. M, Amiri,R. I. and Mauga E.A.S.K. (2011)
Vance, M.A., Millington, W.R., (1986). Int J Health Serv: Principles of irrational drug
therapy. 1986;16(3):355–61.

178
Handout 17.1 Factors Contributing to Irrational Dispensing

179
Session 18: Sections in a Pharmacy Department
Prerequisites
 None
Learning Tasks
 List Different Sections of Pharmacy Department
 Explain Activities Carried out and Services Offered in Department
 Describe the Requirements for a Functional Dispensing Unit
Resources Needed:
SESSION OVERVIEW
Activity/
Step Time Content
Method
05 minutes Presentation Different Sections of a Pharmacy
2
Buzzing Department
Activities Carried Out and Services Offered
3 Small Group
in a Pharmacy Department
Discussion
40 minutes Requirements for a Functional Dispensing
4 Presentation
Unit
7 Question and Evaluation
answers

180
SESSION CONTENTS
STEP 2: Sections/Units of a Pharmacy Department (5 minutes)
 What are the sections of hospital pharmacy?
 For good pharmaceutical practice, the hospital pharmacy department is organized into the
following sections/area:
o Pharmacy administration section
o Dispensing section
o Compounding section
o Strong room
o Sterile preparations section
o Storage section/main store room
o Drug information section

181
STEP 3: Activities carried out and services offered in pharmacy
department (60 minutes)
 What are the activities that are carried out and services offered in pharmacy
department?
 The following are activities/services offered by pharmacy department:

o Receiving, Storage and distribution of medicines
o Compounding of sterile and non-sterile products
o Dispensing of medicines
o Therapeutic consultations
o Patient counselling
o All other activities associated with the patient’s drug therapy
Step 4: The requirements for a functional dispensing unit (40 minutes)

The following are the requirements of a functional dispensing unit:
 The premises:
o Should inspire confidence in the users of the service
o Should be clean and hygienic
o Well designed and organized
o Regularly monitored
o Tidy, accessible and secure
o Should provide suitable environmental conditions for both personnel and products
 Dispensing and compounding equipments:

o Should be of appropriate design
o Suitable, well maintained and adequate for the work to be undertaken
o All equipment must be maintained in accurate working order
o Checked for cleanliness prior to each use
o A range of glass and plastic beakers and conical flasks
182
o graduated glass and plastic measuring cylinders
o A range of graduated glass and plastic pipettes
o A pipette filler
o Stainless steel & plastic spatulas
o containers for each type of dosage form
o A suitable range of labels
o Spoons & Counting trays for tablets and capsules
o Appropriate information sources, for examplespharmacopoeias
 Quality assurance procedures.
To assure the quality of all medicines prepared or supplied, control procedures are
necessary; these measures include:
o quality of raw materials
o supervision, documentation
o packaging and labelling
o labelling for stock
o Storage conditions and expiry date
 Accessible sources of Drug information
o Competency in the use of information sources is an essential part of pharmacy
practice.
o It is advised to become familiar with these different sources of drug information so
that the required information of various types can be readily retrieved.
o Sources of drug information can be obtained from either of the following:
 Internet source e.g : www.cdnphar , www.which.net/health
 Subscription source or (e.g pharmaceutical journal, bulletin)
 Textbook sources e.g Pharmacopoeia
 The personnel:
o Should be adequately trained and motivated personne
o Pharmacists, Pharmaceutical technicians and Pharmaceutical Assistants together with
appropriate support staff
o Standards of personal hygiene and politeness should be high
o Appropriate protective clothing worn during working hours
o Eating, drinking and smoking should not be permitted in any area where medicines
are prepared or supplied

183
Dispensing Balance
Figure 1: Dispensing Aids
Counting Triangle

184
 The premises on which a dispensing service is provided should reflect the quality of
service and inspire confidence on patients in the nature of pharmaceutical service
delivered
 Maintaining a clean environment requires a regular routine of cleaning shelves and a
daily cleaning of floors and working surfaces
 For good pharmaceutical practice in dispensing and compounding, the hospital pharmacy
department is organized into the following sections/areas; pharmacy administration
section, dispensing section, compounding section, strong room, sterile preparations
section, storage section/main store room, drug information section
 Pharmaceutical personnel working in pharmacy department must be well trained with

necessary knowledge, skills and caring attitude to perform activities of pharmaceuticals
 What are the sections of a pharmacy department?

 What are the activities offered in a pharmacy department?
 What are the requirements for a functional dispensing unit?

185
References
Abraham G/Giorgis (2004). Drug smuggling and counterfeiting in Ethiopia. Masters
Dissertation, University of Bradford, UK
Amanda, L.E., et al.(1999). Intervention research in rational use of drugs. Health policy and
planning 14(2):89-102
Management Sciences for Health (1997). Managing drug supply. West Hartford, United
States of America; Kumarian press
Tietze, K.J., (1997). Clinical skills for pharmacists: a patient focused approach. Philadelphia,
United States of America: Mosby, Inc.
World Health Organization (1997). Quality assurance of pharmaceuticals: a compendium of

guidelines and related materials. Geneva, Vol.1
Bentley, A. O., & Rawlins, E. A. (1977). Bentley's textbook of pharmaceutics (8th ed.)
London, United Kingdom: Bailliere Tindall
Ethiopia

186

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UNITED REPUBLIC OF TANZANIA

Ministry of Health, Community

NTA Level 4 Semester 1

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

Special thanks to John Snow Inc (JSI), Deutsche GesellschaftFür Internationale

These participants are listed with our gratitude below:

Mr.Wilson Mlaki DSt. Luke Foundation/Kilimanjaro School of Pharmacy

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

Organization of the Module

Preparation with Handouts and Worksheets

Using Students Manual When Teaching

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

Total Session Time: 60 minutes

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

READ or ASK students to read the learning Tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Dispensing, Dispenser and Medicine (5 minutes)

Activity: Brainstorming (5 minutes)

Ask students to brainstorm on the following question:

1. What is Dispensing, Dispenser, Medicine?

ALLOW few students to respond?

WRITE their responses on the flip chart/ board

CLARIFY and SUMMARISE by using the content below

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

STEP 3: Importance of Dispensing (30 minutes)

Activity: Small Group Discussion ( 15 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the importance of dispensing?

ALLOW students to discuss for 15 minutes

CLARIFY and SUMMARIZE by using the contents below

The following are importance of dispensing:

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

STEP 5: Evaluation (5 minutes)

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

2 05 minutes Presentation Definition of a Medical Prescription

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

READ or ASK students to read the learning tasks and clarify

ASK students if they have any questions before continuing.

STEP 2: Definition of Medical Prescription (5 minutes)

Categories of a Medical Prescription

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide

STEP 3: Parts of a Medical Prescription (50 minutes)

Activity: Small Group Discussion ( 30 minutes)

DIVIDE students into small manageable groups

ASK students to discuss on the following question

 What are the Parts of a Medical Prescription?

ALLOW students to discuss for 30 minutes

CLARIFY and SUMMARIZE by using the contents below

The following are parts of a Medical Prescription:

Figure 2.2: Sample of Filled Medical Prescription

Refer students to Handout 2.1: Sample of a filled Medical Prescription

DIVIDE students into small manageable groups

ASK students to discuss on the following question

Refer students to Handout 2.1: Sample of a Filled Medical Prescription

ALLOW students to discuss for 15 minutes

CLARIFY and SUMMARIZE by using the contents below

PST 04101 Dispensing NTA Level 4 Semester 1 Facilitator Guide