A Guide To

Pharmacy
Technician

WRITTEN BY:

Dr. Siva Singam M.B.B.S

J.V Kishan M.Pharm

©Technical & Vocational Education & Training (TVET), Ministry of Education, Maldives
 Preface
This book is aimed at health professionals mainly for pharmacy professionals, who are going to
start their career as dispensing pharmacist. Care has been taken to write all chapters in a simple
way and in a simple language, neatness of presentation and clarity of contents.

Thought this book has been written in simple manner, we tried hard to make it more informative
about all types of drugs which are commonly used in pharmacy practice. We hope sincerely it
will fulfill the student requirements.

We do hope to gain your appreciation and encouragement.

October 21, 2014 Dr. S. siva M.B.B.S

J.V.Kishan

M. Pharm, Drug Regulatory affairs

A Guide to Pharmacy Technician 1

 INDEX

Chapter Page
number
1. History of Pharmacy 3
2. Pharmacy Logo-Green Cross 5
3. Demonstrate Knowledge of Pharmaceutical Dose Forms and Accessories 8
4. Abbreviations Used In Prescription for Dispensing Of Drugs 24
5. Introduction to the terms used in Pharmacy Practice 28
6. General Dispensing Procedure 30
7. Respond Effectively To Difficult or Challenging Behavior 33
8. Products related to Allergy 36
9. Products related to Analgesic and Anti- inflammatory 40
10. Drugs related to Cough and Cold 45
11. Drugs related to Eyes 50
12. Drugs related to gastrointestinal conditions 52
13. Drugs related to first aid and wound care 56
14. Drugs related to Skin and Fungal Conditions 58
15. Baby Care Products and Medicines 67
16. Drugs related to Asthma 69
17. Drugs related to Blood pressure 71
80
18. Information on Complementary medicine
19. Drugs related to Diabetes 82
20. Information on Products Related To Anti-Obesity, Diet Management 87
And Nutritional Products
21. Drugs used during pregnancy and maternal health 92
22. Drugs used for smoking cessation 96
23. Products related to Cosmetic, Hair and Teeth 100
24. Interacting with customers and giving oral advice 103
25. Demonstrate Professionalism as a Pharmacy Support Staff or a Pharmacist
106
26. Communication at Work Place 109
27. Merchandise and Stock Control Procedures in Pharmacy 111
28. Minimize Theft 113
29. Safety working practice 115
30. Drugs related to poisoning 118
31. Drugs related to central nervous system 120
32. Drugs related to Blood 124
33. Cold Chain Management 127
34. Schedules in Maldives (Forensic Pharmacy) 130
35. Make Conversions and Calculations 131
36. Recommend and Provide Advice For OTC and Non Medicated Pharmacy Products 137

A Guide to Pharmacy Technician 2

 1. History of Pharmacy

Pharmacy comes from the Greek word pharmakon, meaning drug. Scientific approach to
medicine began with the ancient Greeks. Hippocrates proposed that disease came from natural,
not supernatural causes and established the theory of humors (blood, phlegm, black bile, yellow
bile).

Pharmacy is the health profession that links the health sciences with the chemical sciences, and it
is charged with ensuring the safe and effective use of medication. The scope of pharmacy
practice includes more traditional roles such as compounding and dispensing medications, and it
also includes more modern services related to patient care, including clinical services, reviewing
medications for safety and efficacy, and providing drug information. Pharmacists, therefore, are
the experts on drug therapy and are the primary health professionals who optimize medication
use to provide patients with positive health outcomes. The term is also applied to an
establishment used for such purposes.

Pharmacists are highly-trained and skilled healthcare professionals who perform various roles to
ensure optimal health outcomes for their patients. Many pharmacists are also small-business
owners, owning the pharmacy in which they practice.

History of pharmacy

Muslim pharmacy:
 In the field of pharmacy, the first drugstores were opened by Muslim pharmacists in
Baghdad in 754, while the first apothecary shops were also founded by Muslim
practitioners.

 The advances made in the Middle East by Muslim chemists in botany and chemistry led
Muslim physicians to substantially develop pharmacology. Muhammad ibn Zakariya
Razi (Rhazes) (865-915), for instance, acted to promote the medical uses of chemical
compounds.

 Abu al-Qasim al-Zahrawi (Abulcasis) (936-1013) pioneered the preparation of medicines

by sublimation and distillation. His Liber servitoris is of particular interest, as it provides
the reader with recipes and explains how to prepare the `simples‟ from which were
compounded the complex drugs then generally used.

 Sabur Ibn Sahl (d 869), was, however, the first physician to initiate pharmacopoedia,
describing a large variety of drugs and remedies for ailments. Al-Biruni (973-1050) wrote
one of the most valuable Islamic works on pharmacology entitled Kitab al-Saydalah (The
Book of Drugs), where he gave detailed knowledge of the properties of drugs and
outlined the role of pharmacy and the functions and duties of the pharmacist.

A Guide to Pharmacy Technician 3

  Ibn Sina (Avicenna), too, described no less than 700 preparations, their properties, mode
of action and their indications. He devoted in fact a whole volume to simple drugs in The
Canon of Medicine.

Chinese Pharmacy
 The beginnings of pharmacy in China are ancient. It stemmed from Chinese alchemy.
Shennong is said to have tasted hundreds of herbs to test their medical value.

 The most well-known work attributed to Shennong is the The Divine Farmer's Herb-Root
Classic. This work is considered to be the earliest Chinese pharmacopoeia. It includes
365 medicines derived from minerals, plants, and animals.

 Shennong is credited with identifying hundreds of medical (and poisonous) herbs by

personally testing their properties, which was crucial to the development of Traditional
Chinese medicine.

Dr. John Morgan

 In eighteenth Century
 supported the separation of the professions of pharmacy and medicine

A Guide to Pharmacy Technician 4

 2. Pharmacy Logo-Green Cross

The Green Cross was first introduced as a pharmaceutical symbol in continental Europe in the
early 20th century as a replacement for the Red Cross. The Red Cross, previously used by some
medical institutions and by continental pharmacists, was adopted by the International Red Cross
in 1863, necessitating the need for an alternative. The Green Cross was first adopted by the
Royal Pharmaceutical Society of Great Britain as a standard symbol for British pharmacy. The
Society stipulated that it should be produced in a specified shade of green, or in black and white,
and that the words pharmacy or pharmacist, or the Society‟s name, should appear with it. Now
the same logo is being used in Maldives.

The mark is primarily intended to denote pharmacy premises, but may also be used as a visual
symbol of pharmacy as a discipline, profession or service. Normally, as long as the specifications
are met, MFDA grants use of the mark on the following materials:
 Pharmacy signage
 Medicine labels;
 Bags, pharmacy furniture and pharmacy equipment;
 Letterheads and pharmacy stationery;
 Pharmacists‟ name badges;
 Documentation for pharmacy meetings;
 Press, promotional and exhibition material.
The Society reserves the right to restrict the use of its service mark, and permission for any other
use must be gained in advance from MFDA.

A Guide to Pharmacy Technician 5

 Conditions of use:

The conditions of use for the Pharmacy Green Cross are as follows:
 The mark should not be used for any purpose or in any context that could be regarded as
undignified or unprofessional.
 The appropriate size and color of the mark must be used
 No modification of the design of the cross element of the mark is permitted unless specified by
MFDA.
 No words or additional logo may be superimposed on the cross itself.

Other logos which are widely used worldwide:

Mortar and pestle:
The mortar and pestle has long been used as a pharmaceutical symbol in Britain and on the
European mainland, and is still widely employed as a pharmacy shop sign in Scotland. The
mortar and pestle are tools of traditional pharmacy, hence their use as an easily recognizable.
The mortar and pestle symbol shows that medicine which is prepared using motor and pestle will
cure the disease.

RX:
The recipe sign appears at the start of prescriptions. Although universally accepted as an
abbreviation of “recipe” (Latin for „take thou‟), it has also been suggested that it is the
astronomical sign of the planet Jupiter.

A Guide to Pharmacy Technician 6

Bowl with a snake:
The bowl with a snake coiled around it is called the bowl of Hygeia with the serpent of
Epidaurus, and is a variant on the above. Hygeia was Aesculapius‟s daughter and a Greek
Goddess of health. Her symbol was a serpent drinking from a bowl. The vessel is usually
depicted with a long stem and a shallow, wide bowl as seen here. It also is considered suitable
for pharmacy. The bowl of Hygeia with serpent of Epidaurus shown here is the symbol for
Hungarian pharmacists.

A Guide to Pharmacy Technician 7

 3. Demonstrate Knowledge of Pharmaceutical Dose Forms and Accessories

Introduction:

Drugs can be of different types of dosage forms and the use of dosage forms depends up on the
patient condition and on route of administration. This unit deals with different types of dosage
forms and accessories used in dispensing various types of dosage forms.

Drug is the substance used to cure, treat, restore the health state, or optimize a malfunction.
Fundamentally, this substance is brought from plants or animals. The drug‟s crude form passes
by different processes to give rise to what is called dosage forms.

Dosage form:

It is the form of the drug which is administer into the body to the targeted site of action.

Types of dosage forms:

They are classified according to:

Route of administration Physical form

Oral Solid

Topical Semisolid

Rectal liquid

Parenteral

Vaginal

Inhaled

Ophthalmic

Otic
A Guide to Pharmacy Technician 8
Oral dosage forms:

1-Tablet:

A tablet is a hard, compressed medication in round, oval or square shape. It is having two main
components i.e active pharmaceutical ingredient (API main drug) and excipients (other
ingredients). The excipients include Binders, glidants (flow aids), lubricants, disintegrating
agents etc.

There are different types of tablets available:

1. Plain tablets:
These are starch filled tablets

2. Coated tablets:
Hide the taste of the tablet's components.
Make the tablet smoother and easier to swallow.
Film coated: Extend its shelf life.
Enteric coated: to avoid dissolving in stomach and to pass into intestine

3. Buccal and sublingual tablet:

Sublingual and buccal medications are administered by placing
them in the mouth, either under the tongue (sublingual) or
between the gum and the cheek (buccal). The medications
dissolve rapidly and are absorbed through the mucous membranes

A Guide to Pharmacy Technician 9

 of the mouth, where they enter into the bloodstream.

Buccal administration sublingual administration

4. Effervescent tablet:
Effervescent tablets are uncoated tablets that generally contain acid
substances which react rapidly in the presence of water by releasing
carbon dioxide. They are intended to be dissolved or dispersed in
water before use.

5. Chewable tablet:
They are tablets that chewed prior to swallowing. They are
designed for administration to children.

Storage of tablets: They must be stored in air tight ambered color bottle in dry

A Guide to Pharmacy Technician 10

 Place out of heat and light

2. Capsule:

A capsule is a medication in a gelatin container which contains API and diluents.

The two main types of capsules are:

1- Hard-gelatin capsules, which are normally used for dry, powdered ingredients.

2- Soft-gelatin capsules, primarily used for oils and for active ingredients that are

dissolved or suspended in oil.

Hard gelatin capsule soft gelatin capsule

Storage of capsules: They must be stored in air tight bottle in dry place out of

heat and light

3. Lozenge:

Solid preparation consisting of sugar and gum, the latter giving strength and cohesiveness
to the lozenge and facilitating slow release of the medicament. Mainly used for throat infections.

4. Pastilles: preparations designed to dissolve slowly in the mouth. They are softer than lozenges
and their bases are either glycerol and gelatin, or acacia and sugar.

A Guide to Pharmacy Technician 11

 5. Pills:
Pills are oral dosage forms which consist of spherical masses prepared from one or
more medicaments incorporated with inert excipients.

6. Granules:
Consisting of solid, dry aggregates of powder particles often supplied in single- dose
sachets or in container.

7. Powder (Oral):
They contain one or more active ingredients, with or without excipients and, if
necessary, coloring matter and flavoring substances.
Usually contain non-potent medicaments such as antacids since the patient measures a
dose by volume using a 5ml medicine spoon. The powder is then usually dispersed in
water or, in the case of effervescent powders, dissolved before taking.

A Guide to Pharmacy Technician 12

 Liquid preparations:

1. Oral solution:
Oral solutions are clear Liquid preparations for oral use containing one or more active
ingredients dissolved in a suitable vehicle.

2. Oral emulsion:
Oral emulsions are stabilized oil-in-water dispersions, either or both phases of which may
contain dissolved solids.

All liquid preparations must shake well before use

A Guide to Pharmacy Technician 13

 3. Oral suspension:
- Oral suspensions are Liquid preparations for oral use containing one or more active
ingredients suspended in a suitable vehicle.
- Oral suspensions may show a sediment which is readily dispersed on shaking to give a
uniform suspension which remains sufficiently stable to enable the correct dose to be
delivered.

4. Syrup:
It is a concentrated aqueous solution of a sugar, usually sucrose.
Flavored syrups are a convenient form of masking disagreeable tastes.

5. Elixir:
-It is pleasantly flavored clear liquid oral preparation of potent or nauseous drugs.
- The vehicle may contain a high proportion of ethanol or sucrose together with
antimicrobial preservatives which confers the stability of the preparation.

A Guide to Pharmacy Technician 14

 6. Linctuses:
Linctuses are viscous, liquid oral preparations that are usually prescribed for the relief of
cough.
They usually contain a high proportion of syrup and glycerol which have a demulcent
effect on the membranes of the throat.

7.Oral drops:
Oral drops are Liquid preparations for oral use that are intended to be administered in
small volumes with the aid of a suitable measuring device. They may be solutions,
suspensions or emulsions.
8.Gargles:
They are aqueous solutions used in the prevention or treatment of throat infections.
Usually they are prepared in a concentrated solution with directions for the patient to
dilute with warm water before use.

9.Mouthwashes:
These are similar to gargles but are used for oral hygiene and to treat infections of the
mouth.

A Guide to Pharmacy Technician 15

 Topical dosage forms:

1.Ointments:
Ointments are semi-solid, greasy preparations for application to the skin, rectum or
nasal mucosa.

2.Creams:
Creams are semi-solid emulsions that is mixtures of oil and water.

3.Gels (Jellies):
Gels are semisolid .They are used for medication, lubrication and some
miscellaneous applications like carrier for spermicidal agents to be used intra
vaginally.

A Guide to Pharmacy Technician 16

 4.Pastes :
Pastes are basically ointments into which a high percentage of insoluble solid has
been
added
The extraordinary amount of particulate matter stiffens the system.
Pastes are less penetrating and less macerating and less heating than ointment.

5.Dusting powders:
These are free flowing very fine powders for external use.
Not for use on open wounds unless the powders are sterilized.

6.Transdermal patch:
A transdermal patch or skin patch is a medicated adhesive patch that is placed on the
skin to deliver a specific dose of medication through the skin and into the
bloodstream.

A Guide to Pharmacy Technician 17

 7.Plasters:
Plasters are solid or semisolid masses adhere to the skin when spread upon cotton
felt line.

8. Liniments:
Liniments are fluid, semi-fluid or, occasionally, semi-solid preparations intended for
application to the skin. may be alcoholic or oily solutions or emulsions. Most are
massaged into the skin.

A Guide to Pharmacy Technician 18

 9.Lotions:
These are liquid preparations (aqueous) for external application without friction.

10.Paints:
Paints are liquids for application to the skin or mucous membranes.

11.Pressurized dispensers (aerosol sprays):

Several different types of pharmaceutical product may be packaged in pressurized
dispensers,
known as aerosols.

Rectal dosage forms

1.Suppository:
It is a small solid medicated mass, usually cone-shaped ,that is inserted either into the
rectum (rectal suppository), vagina (vaginal suppository or pessaries) where it melts at
body temperature.

A Guide to Pharmacy Technician 19

 2.Enema:
An enema is the procedure of introducing liquids into the rectum and colon via the anus.

Vaginal dosage forms:

1.Pessary:
Pessaries are solid medicated preparations designed for insertion into the vagina where
they melt or dissolve.

2.Vaginal ring:
Vaginal rings are 'doughnut-shaped' polymeric drug delivery devices
designed to provide controlled release of drugs to the vagina over extended periods of
time.

A Guide to Pharmacy Technician 20

 3.Douche:
A douche is a device used to introduce a stream of water into the body for
medical or hygienic reasons.

Parenteral dosage forms

1.An intravenous injection
It is a liquid administered directly into the bloodstream via a vein.
2.Intramuscular injection:
It is the injection of a substance directly into a muscle.
3.Subcutaneous injection:
Subcutaneous injections are given by injecting a fluid into the subcutis.

Inhaled dosage forms:

1.Inhaler :
Inhalers are solutions, suspensions or emulsion of drugs in a mixture of inert propellants
held under pressure in an aerosol dispenser.

Ophthalmic dosage forms:

1.Eye drops:
Eye drops are saline-containing drops used as a vehicle to administer medication in the
eye.

A Guide to Pharmacy Technician 21

 2.Ophthalmic ointment & gel:
These are sterile semi-solid Preparations intended for application to the conjunctiva or
eyelid margin.

Otic dosage forms:

Ear drops:
Ear drops are solutions, suspensions or emulsions of drugs that are instilled into the ear
with a dropper.

Nasal dosage forms:

Nasal Drops and Sprays:
Drugs in solution may be instilled into the nose from a dropper or from a plastic squeeze
bottle.

A Guide to Pharmacy Technician 22

A Guide to Pharmacy Technician 23
 4. Abbreviations Used In Prescription for Dispensing Of Drugs

ABBRIVATION MEANING
Aa Amount to be taken
Ac Before meals
Amp Ampule
ASA Aspirin
Bid Twice a day
Tid Thrice a day
Hs At bed time
Cm Tomorrow morning
Qid Four times a day
Qhr Every hour
Rx Take though
Pc After meals
Cap Capsule
DS Double strength
Elix Elixir
D5w Dextrose with water
D5LR Dextrose with ringer lactate solution
DS Double strength
RL Ringer lactate
NS Normal saline
NTG Nitroglycerine
INH Isoniazid
KCL Potassium chloride
Kg Kilogram
L Liter
Lb Pound
Liq Liquid
L/min Liters/minute
Mg% Milligrams/100milliliters
Nacl Sodium chloride
MS Morphine sulfate
NPH Neutral protamine Hagedorn- Insulin
NPO Nothing by mouth
OPV Oral polio vaccine
N&V Nausea and vomiting
PABA Para amino benzoic acid
PB Phenobarbital
Pc After meals
PR Through rectum
Stat Immediately
Sos Whenever necessary
Sol Solution

A Guide to Pharmacy Technician 24

Troch lozenge
Supp Suppository
Syr Syrup
Tab Tablets
Tbsp. Tablespoon
Tinc Tincture
Tsp Teaspoon
Oint Ointment
Vit Vitamin
PZI Protamine Zinc Insulin
1°, 2° 1hour, 2hour,etc.
ac Before meals
M&N Morning and night
OD Once daily
Ad Right ear
As Left ear
Aq Water
Au Both ears
Cd Cycle day(menstrual cycle)
Apl Applicatorful(for vaginal creams)
Cmpd Compound
Cr Cream
DC,dc,D/c Discontinue or discharge from hospital
DS Double strength
Dx Diagnosis
Fid Five times a day
5x/d Five times per day
Gtt Drops
HD High dose
H2O Water
IM Intra muscularly
Inj Injection
IV Intravenously
Liq Liquid
Lot. Lotion
Mcg Microgram
Ml Milliliter
Neb. Nebulizer
Noct Night time
Od Right eye
Os Left eye
Ou Both eyes
P After
PV Vaginally
Qd Every day

A Guide to Pharmacy Technician 25

Q4h Every 4 hours
Q7Pm Every day at 7Pm
Qid Four times daily
Qod Every other day
Qs Quantity sufficient
Rept Repeat
Rf Refill
Sc Subcutaneously
Sl Sublingual
Ss One half
Sx Symptoms
Tiw Three times in week
Tx Treatment
Ud,utd As directed
Wc With meals
I.P Indian pharmacopeia
B.P British Pharmacopeia
U.S.P United states pharmacopeia
Ph.Eur European pharmacopeia

Approximate Measures: Apothecary Equivalents:

Liquids Weight

1 fl oz = 30 mL 1 scruple = 20 grains (gr)

1 cup (8 fl oz) = 240 mL 60 grains = 1 dram
1 pint (16 fl oz) = 480 mL 8 drams = 1 ounce
1 quart (32 fl oz) = 960 mL 1 ounce = 480 grains
1 gallon (128 fl oz) = 3800 mL 16 ounces = 1 pound (lb)

1 teaspoon = 5 mL
1 tablespoon = 15 mL

A Guide to Pharmacy Technician 26

 Equivalents: Volume
Approximate Measures:
Weights 60 minims = 1 fluidram
8 fluidrams = 1 fluid ounce
1 oz = 30 g 1 fluid ounce = 480 minims
1 lb (16 oz) = 480 g 16 fluid ounces = 1 pint (pt)
15 grains = 1 g
1 grain = 60 mg

Exact Equivalents
Roman Numerals
1 g = 15.43 grains
1 grain = 64.8 mg I = one
1 mL = 16.23 minims
1 Minim = 0.06 mL V = five
1 oz = 28.35 g
1 lb = 453.6 g (0.4536 kg) X = ten
1 kg = 2.2 lb
1 fluid oz (fl oz) = 29.57 mL L = fifty
1 pint (pt) = 473.2 mL
1 quart (qt) = 946.4 mL C = one hundred
1liter=1000milliliter (ml)
D = five hundred
1ml=1000microliters
1ml= 20 drops M = one thousand
1 kg = 1000 g
1 g = 1000 mg
1 mg = 1000 microgram

A Guide to Pharmacy Technician 27

 5. Introduction to the terms used in Pharmacy Practice

There is an immense need to know the basic terms as pharmacist, because pharmacist is the only
person who can prescribe medicine other than doctor, so this unit deals with the introduction to
terms used in Pharmacy practice.

Pharmacology: Is a science deals with drugs mechanism of action, its absorption, distribution,
metabolism, excretion and uses of drugs.

Pharmaceutics : which deals with manufacturing/preparation of drugs.

Pharmacy practice :which deals with dispensing of drugs.

Drug: Is a substance used to cure diagnosis or prevent a disease.

Pharmacodynamics: which deals with biochemical and physiological effects of drugs and also
their mechanism of action. (What drug does to the body).

Pharmacokinetics: which deals with the absorption, distribution, metabolism and excretion of
drugs and also their mechanism of action. (What drug does to the body).

Therapeutics: which deals with the use of drug for curing disease and relieving symptoms.

Chemotherapy: which deals with effect of drugs on microorganisms and parasites which occur
in living organism. It also includes the treatment of cancer.

Toxicology: which deals with poisonous effects of drugs, detecting of poisoning and its
treatment.

Generic name: The chemical name of the drug.

Brand name: The name given by the manufacturer.

Route: Is site of administration.

Side effect: Unwanted effects caused due to drugs.

Adverse effect: Effect which has more risk of danger.

Prophylaxis: Treatment given to inhibit the reoccurrence of the disease.

Addiction: Psychological and physiological dependence of drug.

A Guide to Pharmacy Technician 28

Misuse: Taking drugs more than prescribed/required.

Abuse: Unnecessary misuse of drugs.

Local action: Drug which can act directly at the site.

Symptom: Is sign of illness or abnormal effect by the body.

Systemic Action: Drugs which show action after distribution in blood circulation.

Contraindication: Is a condition in which patient can‟t use drug.

Dosage form: The final form of the drug.

Allergic reaction: A hypersensitivity reaction caused due to use of drugs or due to climatic
conditions, food, metals or pollen grains.

Acute illness: A short time illness.

Chronic illness: A long time illness.

A Guide to Pharmacy Technician 29

 6. General Dispensing Procedure

Introduction:

The main and foremost role of pharmacist and pharmacy assistant is to dispense medicines
accurately by understanding the prescription. This unit deals with rules to be followed during
dispensing medicines.

Dispensing is concerned with the preparation and supply of medicine. It requires extensive
knowledge of-

 The stability of medicines and their ingredients

 Principles of compounding
 Dosage
 Chemical, physical and therapeutically incompatibilities
 Packaging methods
 Labeling procedures, and
 Legal requirements-affecting the storage, supply records, containers and labeling of
substances affected by the poisons, misuse of drugs, therapeutic substance and medicines
acts.

General dispensing procedure:

 Work on your own

 Wear a freshly laundered overall coat. A well starched or preferably nylon coat reduces
contamination of dispensed products with fibers and other particles.
 Provide yourself with a clean glass cloth, a duster and either a swab or sponge.
 Work on a clean and tidy manner.
 Read the prescription carefully; make sure you understand it and that it is legally
correct.
 Find appropriate sources, if any ingredient is a poison.
 Confirm that there are no pharmaceutical or therapeutically incompatibilities in the
preparation.
 If you are unsure of the correct method of preparation refer to your practical notebook,
which should be well indexed.
 Look up the storage conditions for the preparation.
 work out the calculations.
 Check the calculations.
 Collect the correct container and closure.

A Guide to Pharmacy Technician 30

  See the main label and collect any special labels that are required.
 Make the preparation, pack it in the container
 Check the labels and fix them to the container
 Check the finished preparation.
 Wrap the container and write the patients name and address on the wrapper.
 Make the appropriate records.

The prescription:

A prescription is an order from a doctor, dentist or for the supply of a medicine, dressing or
surgical appliance to a patient. It contains the following information:-

 Name, registration & address of the prescriber

 The patients name and address: For a child the age is also given to help when the
pharmacist is checking dose.

 Date

 A prefix: This is the sign Rx (take thou/you take/take it), which is an instruction to the
pharmacist. It is derived from R, an abbreviation for the Latin word recipe and possibly
the latter „j‟ an invocation to Jove (Jupiter) the god of healing.

 The name and quantities of Medicaments to be supplied:

a. An official (British National formulary, British Pharmaceutical ) Codex with the
quantity required.
b. A proprietary product, together with the quantity required.
c. A special formula- in which case the quantity of each ingredient will be stated
together with a description of the type of preparation, e,g. mixture lotion, tablet.

 Instruction to the pharmacist (i.e. subscription)

 Instruction for the patients : These may include:

A Guide to Pharmacy Technician 31

 a. The method of administration or application.

b. The dose, if the preparation is for internal use.

b. The time of administration of application.

c. The diluent ( e.g. water) if relevant, or the method of application.

d. The part of the body to which the preparation is to be applied, if tor external use.

 The prescriber‟s signature and address.

 The Date on which the prescription was written.

Compounding:

The term compounding usually implies to mixing some ingredients in order to make
medicinal substance. It may also refer to any small scale preparation of any dosage form
according to the prescription in a dispensary or pharmacy. Compounding is a
synonymous to dispensing but only difference is that dispensing includes make up and
delivery of medicine to the patient but compounding is only mixing up ingredients or
preparing the medicine.

Compounding accuracy indicates the mixing of ingredients to make medicine in an

accurate manner. Compounding accuracy is important to disperse the medicine properly
to the patient for their safety. The major operation of a pharmacist is in the area of
prescription compounding & dispensing. Compounding must be accurate also to
administer a dosage form in a suitable way.

A Guide to Pharmacy Technician 32

 7. Respond Effectively To Difficult or Challenging Behavior

Introduction:

The patients or customers who visit pharmacy won‟t behave same. Some will be very
respectable, polite and is easy to deal with . while other few will be difficult to deal due to their
challenging behavior.

Considering Maldivian context, as it is tourism based country the patients or customers who
visits pharmacy will be from different countries with diversified culture and behavior. So
pharmacist holds responsibility to deal effectively with.

This unit deals with, how to respond effectively with individuals possessing challenging
characteristic.

Challenging characteristic:

Behavior that is considered unacceptable and abusive; Verbal abuse (racist comments, threats,
bullying) Physical abuse (assault) Self-destructive/harming behavior, Destructive/harming to
other people, harm to items in the environment, Destruction of property, Illegal behavior ,abuse.

Example: Drug abused person who came pharmacy for syringe or medicines may behave
abnormally.

A Guide to Pharmacy Technician 33

Factors Responsible for challenging characteristics:

Individual Factors:

Physical States:
Some patients or customers may abuse the pharmacist due to their Disability, Illness, Pain,
Maturity, Sexuality, Fatigue, drug abused, Sleep disturbance, Medication side effects Mental
illness.

Emotional States:
Anxiety, fear, confusion, loss dependency, temperament, frustration, Personality

Interaction:

Verbal, Non-verbal (tone of voice, facial expression, body posture, body movement, space, pace)
Subject clarity, understanding, listening and written actions /behavior.

Environment:

Physical Room design and layout, noise, light, temperature, ventilation, crowd ,Privacy, rules
culture, gender, age, ethnicity, time (specific times, experience of time e.g. waiting), effect of
care setting (institutionalization) and organizations (policies, procedures, rules).

Managing difficult situations:

- Primary Prevention
- Secondary Dealing with incidents
- Reviewing incidents and forward planning

Primary Prevention:

 Communicate with others in a manner which is appropriate to them encourages an open

exchange of views and information

 Minimize constraints to communication are free from discrimination and oppression

acknowledges the rights of everyone present

 Maintain the environment with minimal restriction in a way which encourages

meaningful interactions ,calm and safety.
 Diverting into other activities

A Guide to Pharmacy Technician 34

  Providing time and space to calm down and talk through the problem, getting the
individual to describe the problem, think about it and refocus about it, rather than acting
out with anger etc.

 Find alternative ways to express their feelings.

Dealing with Incidents:

 Take constructive action to minimize identified abusive and aggressive behavior.

 Take constructive action to address them, you take prompt action to protect those at
whom the abusive and aggressive behavior is directed; take constructive action to defuse
abusive and aggressive behavior, call for any necessary assistance and support without
delay.

Defusing:

 Control – yourself by defusing ,relaxing (breathing, releasing rigidity of body ,redirect

the mind to positive thoughts, care values/principles. It's not unidirectional / personal;
allow both you and individual an exit ,place furniture between you stay with individual's
direct vision, avoid physical contact and maintain eye- contact.

Reviewing incidents and forward planning:

 After an incident you encourage those involved , to contribute to reviewing the event.

 Share your experience with colleagues; so that everyone involved can express their
feelings, make referrals to the appropriate people about the event.

A Guide to Pharmacy Technician 35

 8. Products related to Allergy

Introduction:

The most common reason consumers turn to anti allergic medications is for seasonal allergy
relief from seasonal allergic rhinitis.

This condition is sometimes referred to as “hay fever” because it is triggered due to climatic
changes. Allergy medications are used whenever it triggered for allergy relief.

Allergies can include cold, Asthma, Eye irritation, rashes and itching ect….

Allergy:

Damaging immune response by the body to a substance, especially a particular food, pollen, fur,
or dust, to which it has become hypersensitive.

Mainly Antihistamines are used in treating Allergy symptoms. Corticosteroid ointments and
creams – as well as non-steroidal topical immune modulators may be used for a variety of skin
allergy conditions, including eczema or atopic dermatitis.

Different types of allergy medications:

Antihistamines:

These are divided into 2 types 1. Sedative 2. Non- sedative

The first category includes the older antihistamines. These drugs relieve allergy symptoms but
cause drowsiness and other side effects, including dry mouth. Newer antihistamines are said to
be non-sedating, although some may experience drowsiness even from these.

All antihistamines work in the same way:

By reducing the characteristic signs and symptoms of an allergic reaction like swelling, tearing,
itching, and increase in bronchial and other secretions. The body releases histamine when having
an allergic response. Antihistamines come as creams, lotions, nasal sprays, and eye drops.

A Guide to Pharmacy Technician 36

Older (first-generation) antihistamines: Newer (second-generation) antihistamines:

 Diphenhydramine  Cetirizine (Zyrtec)

 Chlorpheniramine  Desloratadine (Clarinex)
 Brompheniramine  Fexofenadine (Allegra)
 Carbinoxamine  Loratadine (Claritin)
 Clemastine  Levocetirizine (Xyzal)
 Cyprohepatdine
 Hydroxyzine

Antihistamine nasal sprays: Eyedrops:

 Azelastine  Azelastine
 Olopatadine  Emadastine
 Naphazoline/pheniramine
 Epinastine
 Ketotifen
Antihistamine/decongestant combination  Olopatadine

 Acrivastine

Corticosteroids: These are used in nasal sprays to reduce inflammation and swelling in nasal
passageways. Many ointments and creams used for allergic skin reactions also contain
corticosteroids. If a person is experiencing a severe allergic response, oral or injectable
corticosteroids can be given.

Nasal corticosteroids:

 Budesonide
 Fluticasone furoate
 Fluticasone propionate
 Mometasone furoate
 Triamcinolone acetonide
 Beclomethasone dipropionate

A Guide to Pharmacy Technician 37

Mast cell stabilizers: these will stabilize the specialized cells in the body known as mast cells
release histamine and other substances.

Ex: Cromolyn sodium

Leukotriene inhibitors: these drugs will inhibit, other substances released during an allergic
reaction are leukotriene, which can aggravate allergic conditions and asthma.

Ex: Montelukast

Nasal anticholinergic: A runny nose is a common complaint among those with allergic rhinitis.
Anticholinergic nasal sprays reduce discharge from the nose, but though they do not relieve a
stuffy nose.

Ex: Ipratropium bromide

Decongestants: These relieve a stuffy nose by constricting blood vessels, which limits the
amount of secretions coming from the inner lining of the nose. They are available as nasal
sprays, pills, and liquids.

Ex: Oxymetazoline, Pseudoephedrine, Phenylephrine

Immunomodulators: These are topical medications used to treat skin allergies. They are often
used if other agents are ineffective or intolerable.

Topical steroids for skin allergy:

Examples:

Aclometasone Fluticasone

Fluocinolone Mometasone

Fluocinonide Betamethasone valerate

Desoximetasone
Hydrocortisone
Clobetasol propionate

A Guide to Pharmacy Technician 38

Side effects of allergy medications:

Drowsiness, dizziness, constipation, upset stomach, blurry vision, a dry mouth/nose and throat,
and difficulty urinating, nasal dryness or irritation, nosebleed, throat irritation, headache, nausea,
vomiting, cough, stinging sensation inside the nose for nasal drops, cough, headache, trouble
sleeping, increased blood pressure, loss of appetite.

A Guide to Pharmacy Technician 39

 9.Products related to Analgesic and Anti- inflammatory

Drug that relieves pain without blocking nerve impulse conduction or markedly altering sensory
function is called as analgesics.

Two classes are defined by the type of pain-relieving action.

1.Opioids act on brain receptors to inhibit pain impulses.

They may be used for short- or long-term pain relief, usually by prescription, but carry a risk

of drug addiction. These drugs are controlled and only available at STO pharmacy.

2. Non opioids, used mostly for short-term relief and modest pain, are available without
prescription.

They include NSAIDs (including aspirin and ibuprofen) and acetaminophen (paracetmol).

They all act by inhibiting synthesis of prostaglandins, which causes pain.

Non-opioids:

1.Paracetamol: (acetaminophen) is a pain reliever and a fever reducer. Paracetamol is used to

treat many conditions such as headache, muscle aches, arthritis, backache, toothaches, colds, and
fevers.

It relieves pain in mild arthritis but has no effect on the underlying inflammation and swelling of
the joint.

In children less than 14 years, it is the main drug which is used as pain reliever .

It is safe in pregnancy too. It should not take for longer periods.

Some types of paracetamol, such as liquid forms of paracetamol, are aimed specifically at
children.

A Guide to Pharmacy Technician 40

Dose:

Recommended doses of paracetamol are:

 For adults: 500 mg-1 g every 4-6 hours up to a maximum of 4 g daily.

 For children aged 12-16 years: 480-750 mg every 4-6 hours up to a maximum of 4 doses
daily.
 For children aged 10-12 years: 480-500 mg every 4-6 hours up to a maximum of 4 doses
daily.

Dose of paracetamol every 4-6 hours if needed, up to four times a day. Remember to leave at
least four hours between doses and do not take more than four doses of paracetamol in any 24-
hour period.

This drug usually has no side effects.

A very serious allergic reaction to this drug is rare including: rash, itching/swelling (especially
of the face/tongue/throat), severe dizziness, trouble breathing.

2. NSAID’S (NON STEROIDAL ANTI-INFLAMMATORY DRUGS):

CLASSIFICATION OF NSAIDs

NON SELECTIVE COX INHIBITOR COX-2 SELECTIVE INHIBITORS

- Acetylsalicylic acid at high dosage - Nimesulid

- Diclofenac - Etodolak

- Ibuprofen - Meloxicam

- Indomethacin - Nabumeton

- Piroxicam - celecoxib

A Guide to Pharmacy Technician 41

MECHANISM OF NSAID: inhibition of PROSTAGLANDINs production alleviates most of
the pathologic effects associated with inflammation, but it also interferes with the physiologic
role of these molecules

Pharmacodynamic Effects of NSAIDs:

Analgesic

Anti-inflammatory

Antipyretic

Anti-platelet

ADVERSE EFFECTS OF NSAIDs

1) Gastro-Intestinal effects

2) Renal effects

3) Inhibition of platelet aggregation

4) Central symptoms: headache, decreased hearing, tinnitus, dizziness, confusion, depression.

5) Allergic reactions

A Guide to Pharmacy Technician 42

OPIOID ANALGESICS

Opioid analgesic are the naturally occurring, semi-synthetic and synthetic drugs which have a
morphine like action i.e relief from pain and depression.

Examples: Morphine, Codeine, fentanyl, meperidine, methadone

CLASSIFICATION OF OPIOID ANALGESIC DRUGS

3.Antagonists:
1.Strong Agonists

Morphine
Naloxone: This antagonizes the effects of morphine
Meperidine and other analgesics.
Methadone Naltrexone- longer duration of action than naloxone, a
Heroin single oral dose blocks the effects of injected

Fentanyl heroin (48 hrs)

2.Moderate Agonists:

Propoxyphene

Codeine

Pharmacologic Effects:

Morphine and related opioids produce their major effects on the central nervous system and
gastrointestinal tract

1. Analgesia

2. Sedation

3. Euphoria

4. Mental Clouding

5. Respiratory Depression:

6. Nausea and Vomiting

A Guide to Pharmacy Technician 43

7. Cough Reflex (antitussive effect)

8. Decreases GI motility

9. Bradycardia

10. Orthostatic hypotension

11. Decrease urine production

OTHER OPIOIDS

Codeine –less potent than morphine mainly used as antitussive.

Meperidine: used in muscle spasm and shows little antitussive action.

Diphenoxylate (Lomotil) –meperidine derivative used to treat diarrhea.

Methadone –long duration of action (24 hr) withdrawal protracted and attenuated used to treat
addiction

A Guide to Pharmacy Technician 44

 10. Drugs related to Cough and Cold

COUGH

A cough is the way of responding to irritants in throat and airways

Types of cough:

A dry cough is a cough that does not produce any mucus, irritating to the lungs and throat and
may be a sign of a viral infection or sinus problems.

A wet cough is a cough that produces mucus (sputum), and depending on the color, may indicate
a bacterial infection

A stress cough is a reflexive spasm of the airways caused when you are under stress. It usually
produces no mucus and is not generally related to infections.

A 'barking' cough is usually found in children, and may be associated with other viral illness.

A cough that causes a 'whooping' sound after the cough may be indicative of a serious infection
and should be evaluated by a doctor

Common Causes

1. Common cold
2. Influenza (flu)
3. Inhaling an irritant
4. pneumonia
5. Allergies
6. Asthma
7. GERD- Gastro esophageal reflux
8. Acute sinusitis
9. Smoking
10. TB
11. Copd
12. Lung cancer
13. Dust exposure

Cough Treatment:

Expectorants help thin the mucus and make it easier to expel out.

Ex: expectorants with Quaifenesin

A Guide to Pharmacy Technician 45
Suppressants

Control or suppress the cough reflex and work best for a dry, hacking cough.

Ex: dextromethorphan

Terbutaline

Patients can get symptomatic relief from over-the-counter cough medicines like inhaling steam,
and using cough lozenges. In severe cases a doctor may prescribe codeine, which is an effective
cough suppressant.

Common conditions in which coughing occurs and measures to control it:

 Asthma: Inhaled bronchodilators and inhaled steroids are given to decrease inflammation
of the airways, and reduce wheezing. In some cases, short-term oral steroids can be
prescribed. Terbutaline (Brethine, Bricanyl, Brethaire, or Terbulin)is mostly used in
patients with asthma and cough.

 Gastroesophageal reflux disease (GERD): Treatment includes avoiding foods that

increase reflux, avoiding meals before lying down, elevating the head while sleeping, and
taking medication such as cimetidine (Tagamet), or ranitidine (Zantac) to decrease
stomach acidity.

 Sinusitis : Use of decongestants such as pseudoephedrine (Sudafed) or antihistamines

such as diphenhydramine (Benadryl) are used.

 Inhaled nasal steroids are very effective in treating allergic rhinitis (hay fever), a
common cause of cough. Additionally, other nasal inhalers like ipratropium bromide
(Atrovent) oxymetazoline drops can relieve post nasal drip.

 Infections: Bacterial pneumonia and bronchitis is typically treated with antibiotics such
as cephalosporins and azithromycin (Zithromax) and other antibiotics

A Guide to Pharmacy Technician 46

 Caution: Cough medicines can be prescribed to patients who are taking anti-
hypertensive medicines like ACE inhibitors (angiotensin converting enzyme), for
example, enalapril (Vasotec), captopril (Capoten), lisnopril (Zestril, Prinivil), etc. only
after doctor consultation.

Home remedies for cough:

 Stay hydrated.
 Gargle with hot saltwater to help cleanse the throat and rid it of mucus.
 Elevate your head with extra pillows at night to ease a chronic dry cough.
 Cough drops may soothe an irritated throat.
 Do not smoke or use tobacco products.
 Avoid inhaled irritants such as smoke, dust, or other pollutants.
 Honey often can be an effective treatment for a persistent cough. Add honey to hot tea, or
even grape juice.
 Ginger prepared as a tea, is often used to help reduce symptoms of chronic cough and
clear the nasal passages.

Prevention of chronic cough:

 Don't smoke, as smoking is the most common cause of chronic cough.

 Eat fruit. Research suggests that diets high in fruit fiber and flavonoids may prevent
chronic productive cough.

COMMON COLD

Definition:

The common cold is a viral infection of the upper respiratory system, including the nose, throat,
sinuses, Eustachian tubes, trachea, larynx, and bronchial tubes.

Although more than 200 different viruses can cause a cold, 30-50% are caused by a group
known as rhinoviruses. Almost all colds clear up in less than two weeks without complications.

A Guide to Pharmacy Technician 47

Causes:

1. fatigue and overwork

2. emotional stress
3. poor nutrition
4. smoking
5. living or working in crowded conditions

Effects of cold:

Colds make the upper respiratory system less resistant to bacterial infection. Bacterial infection
may lead to middle ear infection, bronchitis, pneumonia, sinus infection, or sour throat. People
with chronic lung disease, Asthma, diabetes, or a weakened immune system are more likely to
develop these complications.

Transmission of cold:

People with colds are contagious during the first two to four days of the infection. Colds pass
from person to person in several ways. When an infected person coughs, sneezes, or speaks, tiny
fluid droplets containing the virus are expelled. If these are breathed in by other people, the virus
may establish itself in their noses and airways.

Colds may also be passed through direct contact. If a person with a cold touches his runny nose
or watery eyes, then shakes hands with another person some of the virus is transferred to the
uninfected person. If that person then touches his mouth, nose, or eyes, the virus is transferred to
an environment where it can reproduce and cause a cold.

Treatments:

Since there is no cure for the common cold, treatment has two goals: to make you feel better and
to help you fight off the virus.

 Lots of rest is the key treating a cold.

 It's also important to stay hydrated by drinking lots of water and avoiding alcohol and
caffeine. This makes mucus flow more freely and helps with congestion.

No specific treatment exists for the virus that is causing your cold, but in treating the symptoms
you can find relief.

A Guide to Pharmacy Technician 48

Decongestants:

These contains pseudoephedrine and they work by drying and clear nasal passages, but only
temporarily. Decongestant nasal sprays can help, too, but if they're used for more than three to
five days, they may cause a "rebound" effect.

Nasal saline drops Steam inhalation:

Ex: Oxymetazoline drops Ex: menthol, eucalyptus, camphor,

Antihistamines Thymol (karvol plus)

Ex: cetirizine, Levo citirizen, fexofenadine Gargling

Gargling with salt water

Zinc supplements
Vapor rubs
Ex: zinc syrup, tablets or lozenges
Ex: Vicks

Take supplements as needed to ensure you are receiving the recommended dietary allowances
for vitamin A, the vitamin B complex, and vitamin C

Prevention

It is not possible to prevent colds because the viruses that cause colds are common and highly
infectious. However, there are some steps individuals can take to reduce their spread. These
include:

 washing hands well and frequently, especially after touching the nose or before handling
food
 covering the mouth and nose when sneezing
 disposing of used tissues properly

 avoiding close contact with someone who has a cold during the first two to four days of
their infection
 not sharing food, eating utensils, or cups with anyone
 avoiding crowded places where cold germs can spread
 Eating a healthy diet and getting adequate sleep.

A Guide to Pharmacy Technician 49

 11. Drugs related to Eyes

Introduction:

Eyes are organs with a high probability of contracting infections because of their anatomical
position. It is really important, to diagnose corneal infections, because if they are not
appropriately treated they can evolve in corneal opacities, with a deep decrease of sight.

Antibiotic and anti-inflammatory therapy for ocular diseases:

Antibiotics available for topical use in the eye are:

- Chloramphenicol

- Fucidic acid

- Aminoglicosides

- Chlortetracyclines

- Fluoroquinolones(ciprofloxacin, ofloxacin)

- Polymixin

These antibiotics interact with bacterial ribosomes and inhibit the syntesis of bacterial proteins.

Conjunctivitis

Inflammation of the conjunctiva of the eye.

Treatment:
- Polytrim
- Tobramycin
- Gentamycin
- Neosporin
- Erythromycin ophthalmic ointment.

corneal abrasions:
Antibiotics eyedrops or ointments should be used during the healing period of corneal abrasions
to prevent corneal ulcer.
Treatment:
- Gentamicin, Tobramycin, Polytrim

A Guide to Pharmacy Technician 50

Blepharitis

Antibiotic oinments applied at bedtime such as Erytromycin, Bacitracin or Tobramycin can be

useful.

Glaucoma:

Glaucoma is a disease that is often associated with elevated intraocular pressure, in which
damage to the eye (optic) nerve can lead to loss of vision and even blindness.

Treatment:

Prostaglandin analogs

Timolol

acetazolamide

Steroidal anti-inflammatory drugs:

Prednisolone

Prednisolone acetate 1% is the most effective of the topical ophthalmic steroids for the
treatement of corneal inflammations.

Dexamethasone

Fluorometholone acetate

A Guide to Pharmacy Technician 51

 12. Drugs related to gastrointestinal conditions

Nausea and vomiting:

It is the common condition seen among all the ages; it is associated with feeling of vomiting
and bringing out bouts of gastric contents.

Common causes:

 Infections
 Indigestion
 Foodpoisoning
 Diseases of GI tract
 Travelling in speedy vehicle/high alitudes
 Pregnancy
 Emotional disturbances

Drugs used:

 Antiemetics
 Histamine receptor blockers
 Proton pumb inhibitors
 Antacids
 Antihistamines
 Dopamine antagonists

Antiemetics are the drugs which act against vomiting

Hyoscine , also known as scopolamine, is widely used to treat motion sickness.

It is thought to work by blocking some of the nerve signals sent from the vestibular system in
your inner ear that can cause nausea and vomiting

Antihistamines are an alternative type of medicine to hyoscine. They are often used to treat
symptoms of allergies, but can also control nausea and vomiting

Precautions to take/administer:

 epilepsy - a condition that causes fits

 a history of kidney or liver problems
 a history of heart problems
 a history of some digestive system problems, such as gastro-oesophageal reflux disease

A Guide to Pharmacy Technician 52

5-HT3 receptor antagonists block serotonin receptors in the central nervous system and
gastrointestinal tract

 Dolasetron
 Granisetron
 Ondansetron
 Tropisetron
 Palonosetron
 Mirtazapine- anti depressant with strong anti-emetic action

Dopamine antagonists act in the brain and are used to treat nausea and vomiting associated
with neoplastic disease, radiation sickness, opioids, cytotoxic drugs and general anaesthetics.
Side effects include muscle spasms and restlessness.

 Domperidone
 Olanzapine
 Droperidol, haloperidol, chlorpromazine, prochlorperazine.

Some of these drugs are limited in their usefulness by their extra-pyramidal and sedative
side-effects.

 Alizapride
 Prochlorperazine (Compazine, Stemzine, Buccastem, Stemetil, Phenotil)
 Metoclopramide also acts on the GI tract as a pro-kinetic, and is thus useful in
gastrointestinal disease.

NK1 receptor antagonist:

 Aprepitant is a commercially available NK1 Receptor antagonist

 Casopitant is an investigational NK1 receptor antagonist


DIARROHEA

Diarrhea describes bowel movements (stools) that are loose and watery. It is very common and
usually not serious. Many people will have diarrhea once or twice each year. It typically lasts
two to three days and can be treated with over-the-counter (OTC) medicines

Classification of diarrhea:

 Osmotic diarrhea means that something in the bowel is drawing water from the body. A
common example is sorbitol, a sugar substitute found in sugarless candy and gum that
isn't absorbed by the body but draws water into the bowel, resulting in diarrhea.
 Secretory diarrhea occurs when the body is releasing water into the bowel. Many
infections, drugs, and other conditions cause secretory diarrhea.
A Guide to Pharmacy Technician 53
  Exudative diarrhea refers to the presence of blood and pus in the stool. This occurs with
inflammatory bowel diseases such as Crohn's disease or ulcerative colitis, and several
infections caused by bacteria, viruses, parasites and fungi.

Most common cause is eating contaminated food;it turn to be some times physiological and
sometimes pathological.

For physiological conditions we should treat with lamofen,loperamide.

For pathological conditions we should treat with antibiotics or relatively supporting treatment.

METRONIDAZOLE is the most common drug used for the amoebic/parasitic causes.

PAIN ABDOMEN:

Causes for pain abdomen evaluated by clinical examination and radiological investigation for
support.

 Indigestion
 Constipation
 Stomach virus
 Menstrual cramps
 Food poisoning
 Food allergies
 Gas
 Lactose intolerance
 Ulcers
 Pelvic inflammatory disease
 Hernia
 Gallstones
 Kidney stones
 Endometriosis
 Crohn's disease
 Urinary tract infection
 Gastro esophageal reflux disease (GERD)
 Appendicitis

 Abdominal pain is to be carefully evaluated for any one of the cause as above mentioned.
 Generally this condition is treated with NSAID- (Mefenemic acid) for smooth muscle
pain.
 If it is not controlled or very severe immediately patient need to consult the surgeon or
physician

A Guide to Pharmacy Technician 54

Abdominal bloating sensation:

Generally people complaints as “gas”. Treatment for this condition is:

a) Proton pump inhibitors

 Omeprazole
 Lansoprazole
 Rabeprazole
 Pantoprazole
 Esomeprazole

b)H2 blockers

 Cimetidine
 Ranitidine
 Famotidine
 Nizatidine

c)Antacids:

Calcium carbonate antacids are often used to relieve immediate symptoms associated with
ulcers, such as the burning sensation in your stomach.

Another kind of antacid is aluminum/magnesium trisilicate.

These medications all work by slightly changing the pH balance in your stomach to reduce the
acidity.

ProstaglandinsE2: used anti gastric acid secretory medicine.

Examples are Dinoprostone , Cervidil ,Prostin E2

A Guide to Pharmacy Technician 55

 13. Drugs related to first aid and wound care

Wounds occur when the skin is broken or damaged because of injury. The skin can be damaged
in a variety of ways depending upon the mechanism of injury.

 Inflammation is the skin's initial response to injury.

 Superficial (on the surface) wounds and abrasions leave the deeper skin layers intact.
These types of wounds are usually caused by friction rubbing against an abrasive surface.
 Deep abrasions (cuts or lacerations) go through all the layers of the skin and into
underlying tissue like muscle or bone.
 Puncture wounds are usually caused by a sharp pointed object entering the skin.
Examples of puncture wounds include a needle stick, stepping on a nail, or a stab wound
with a knife.
 Human and animal bites can be classified as puncture wounds, abrasions, or a
combination of both.
 Pressure sores (bed sores) can develop due to lack of blood supply to the skin caused by
chronic pressure on an area of the skin (for example, a person who is bedridden, sits for
long hours in a wheelchair, or a cast pressing on the skin). Individuals with diabetes, poor
circulation (peripheral vascular disease), or malnutrition are at an increased risk of
pressure sores.

Proper wound care is necessary to prevent infection, assure there are no other associated
injuries, and to promote healing of the skin.

Wound Signs and Symptoms

 The most common symptoms of a wound are pain, swelling, and bleeding. The amount of
pain, swelling, and bleeding of a wound depends upon the ___location of the injury and the
mechanism of injury.

Treatment:

Most wounds can be treated at home with routine first aid including thorough washing and
dressing to prevent infection.

Some of the following are reasons medical care should be obtained for a wound:

 If the wound is due to significant force or trauma and other injures are be present.
 If bleeding cannot be stopped even with persistent pressure and elevation.
 If there is concern that wound requires repair with sutures (stitches). The size and
___location of the wound are important considerations.
 Most facial wounds may need to be repaired for cosmetic reasons, especially if they
involve the lip or eye.
A Guide to Pharmacy Technician 56
  If the wound is caused by an animal bite.
 At least 50% of dog bites, 80% of cat bites, and 100% of human bites become infected.
There is also a need to consider rabies immunizations if appropriate.
 If the wound is very dirty and cannot be easily cleaned.
 If there is evidence of infection including redness, swelling, increased pain, and pus at the
wound.
 If tetanus immunizations are not up to date, then a booster is needed within 48 hours. If
the patient has never been immunized, the initial tetanus prevention with immunoglobulin
should be given immediately.

For minor cut injuries:

1.cleansing with dettol or savlon or betadine solution

2.Cleaning with hydrogen peroxide

3.Applying neomycin powder / safromycin ointment.

For major cut injuries: Sutures (Stitches)

 Physiologic dressings such as Tegaderm or Hydrogel may be used to promote healing

instead of suturing in the elderly due to their very fragile skin, which makes it difficult to
repair lacerations and tears in the skin.
 Antibiotics for Wounds

If a wound is cleaned and cared for properly, there is often little need to prescribe
antibiotics

Common materials used for dressing:

Medicinal agents: Non medical agents

 ointments  Cotton
 dusting powder  Bandages
 solutions  Plasters
 Splints

A Guide to Pharmacy Technician 57

 14.Drugs related to Skin and Fungal Conditions

Introduction:

Fungal infections can occur on the skin, mucous membranes, subcutaneous tissues or deep seated
organs. These infections can occur as primary disease or secondary to treatment with antibiotics.

Skin Infections are associated with: swelling, tenderness, warm skin, blisters, ulceration, and
fever, rarely systemic disease.

Few Normal Bacteria & Yeast species live in hair follicles skin may cause inflammation of hair
follicles.( Folliculitis), abscess formation ( Boils).

Acne vulgaris:

Acne vulgaris is the most common skin disorder that affects more Jung male adults than females.
Mostly on face and less on other body parts due to accumulation of oil sebaceous glands, dead
tissues and increase of sex hormones in the body. Increase production Androgenic Hormones
after Puberty. Increase activities sebaceous ducts secrets Sebum (Fatty Acid+ Peptides) Increase
keratin & skin desquamation.

Treatment:

Tretinoin- it is a derivative of vitamin A. It is used on the skin (topically) in the treatment

of mild to moderate acne and on skin that has been damaged by excessive exposure to the sun.

Erythromycin- Anti bacterial

Clindamycin phosphate- It helps to decrease the number of acne lesions. it is an antibiotic

which works by stopping the growth of bacteria.

Systemic antibiotics like tetracycline and erythromycin must be used for 90-120 days.

cyproterone and ethinyloestradiol is a contraceptive used for treatment of acne.

A Guide to Pharmacy Technician 58

Psoriasis

Psoriasis is a long-term (chronic) skin problem that causes skin cells to grow too quickly,
resulting in thick, white, silvery, or red patches of skin. Normally, skin cells grow gradually and
flake off about every 4 weeks. New skin cells grow to replace the outer layers of the skin as they
shed. It is believe that psoriasis occurs when the immune system overreacts, causing
inflammation and flaking of skin. In some cases, psoriasis runs in families.

Things to avoid include:

Skin injury

Stress and anxiety

Certain medicines like NSAIDS, Beta-blockers

Overexposure to sunlight

Alcohol

Smoking

Treatment:

For mild psoriasis: corticosteroid creams like hydrocortisone clobetasone (Eumovate),

fluocortolone , betamethasone valerate (Betnovate), fluocinolone clobetasol (Dermovate).

For moderate to severe psoriasis: corticosteroid or a medicine related to vitamin D

called calcipotriene. Other topical medicines include anthralin and tars.

Moisturizers and emollients are also can be used.

Cyclosporin, hydroxyurea cytotoxins are also used based on patient condition.

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Scabies:

Scabies is a contagious, extremely itchy, skin disorder that leads to a rash. It is caused by an
infestation with a parasite - the scabies mite(like a tiny insect) called Sarcoptes scabiei. The mite
lives on the skin and burrows into it. Scabies is spread to others through close skin-to-skin
contact. Most cases of scabies are probably caught from prolonged hand-holding with an
infected person. The patient will have a cream-coloured body, bristles and spines on their back,
and four pairs of legs. The hand is the most common site to be first affected. Close skin-to-skin
contact when having sex is another common way of catching scabies.

Symptoms:
Itching, rashes, scratching, aggravation of pre-existing skin conditions.
Scabies symptoms usually take 2-6 weeks to occur after you are first infected.
Treatment: Side effects:
Permethrin 5% dermal cream
Mild burning or stinging may occur.
Malathion 0.5% aqueous liquid

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Warts:

Warts are local growths in the skin that are caused by human papillomavirus (HPV) infection.
They should be distinguished from sexually transmitted (genital) warts, which are caused by
other HPV types. Commonly warts can be cured itself by the body within 2-3 years of time. In
some cases warts will cause pain, irritation, embarrassing and may spread to other parts of the
body. In that case patient must be treated.

Treatment: Side effects:

Salicylic-acid- contraindicated in diabetic patients  Redness of skin Faint

 Unusual warm skin Difficulty in
Duct tape
breath
Podophyllum- contraindicated in pregnancy.

Dandruff:

Dandruff is a very common skin condition that nearly all people experience at one point in their
lives regardless of age or ethnicity. It affects the not just the scalp, but also the ears, eyebrows,
sides of the nose, beard, and less commonly the central (often hair-bearing) part of the chest.
Dandruff can affect any hair-bearing area or an area with even very small hair follicles.

Causes:

Unknown, increased oil production and secretion, oily skin, and increased numbers of normal
skin yeasts, Poor hygiene, mental stress, climatic conditions.

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Symptoms:
White flakes on shoulders, Itchy scalp, scaly facial skin, facial rash by eyebrows, nose, and ears,
chest rash with dry flakes and red spots.

Treatment:
Side effects:
Coal tar shampoo
Ketoconazole shampoo Dry skin
Selenium sulphide
Temporary hair loss
Pyrithione zinc
Salicylic acid Dizziness

Sunburn:

Due to climatic conditions in Maldives, people may experience sunburns. These can cause a mild

fever and a headache. Lie down in a cool, quiet room to relieve the headache. A headache may

be caused by dehydration. Sunlight is the main reason to cause sunburn and it can leads to other

skin diseases and skin cancer. UV rays from sun causes these skin problems. UV( B) rays causes

sun burn.

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Treatment:

Sun screen lotions: It contains Sun Protective Factors (SPF) which will protect the skin against

UV( B )rays. There are different types of SPF available. They are :

 SPF 15 blocks 93% of UV(B) rays- it implies, it is showing 15 times more effective ness
than without SPF.

 SPF 30 blocks 97% of UV(B )rays – it implies, it is showing 30 times more effective ness
than without SPF.

 SPF 50 blocks 98% of UV(B )rays- it implies, it is showing 50 times more effective ness
than without SPF.

For best protection, it is recommend using minimum SPF sunscreen of 15, applying the proper
amount (2mg/cm2 of skin, or about one ounce for full body coverage), and reapplying every 2
hours.

Prevention:

Use cool cloths on sunburned areas, Take frequent cool showers or baths.
Apply soothing lotions that contain aloe vera to sunburned areas. Topical steroids (such as 1%
hydrocortisone cream) may also help with sunburn pain and swelling. Contraindicated in
children less than 5 years.

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Leprosy:

It is chronic bacterial infection caused by M. leprae. It primarily affects cold body sites, skin,
mucous membranes, peripheral nerves, nose, ears, eye lids and testes. Characterized by multiple
skin lesions accompanied first by sensation loss/ anesthesia. Sensory loss in the affected areas,
toes, finger tips, tissue destructions. Treatment for leprosy will last for years and patients can‟t
miss any dose because it is combination of three drugs. It is spread through long term contact
with a person who has the disease but has not been treated.

Treatment:

Dapsone

Rifampicin

clofazimine

It is Life-long Treatment. There is no cure but Less Tissue Damage and Spread of Infection.

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Eczema:

Eczema develops due to multiple immunological & other medical conditions.. Skin becomes
inflamed or irritated. No infectious agent involved.

Treatment:

Emollients

White soft paraffin

Cetomacragol A

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Classification of antifungals:

Topical anti-fungal: Systemic anti-fungal:

Nystatin Griseofulvin

Pimaricin Amphotericin B

Hamycin

Candicidin

Antipruritics: Used for itching Drugs used for napkin rashes:

calamine lotion Zinc oxice powder
crotamiton lotion Silver dioxide
chlorpheniramine clotrimazole
clemastine

cyproheptadine

diphenhydramine

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 15. Baby Care Products and Medicines

Introduction:

The skin of the infant and the adult differs both histological and physiologically in many
respects. It is less hairy, thinner in infants. There is tendency towards peeling and flaking of skin
during first 3 weeks after birth. Being comparatively thin, skin of infant is expected to be more
permeable to topical agents applied. They are mainly concerned with keeping the baby clear and
comfortable.

Baby care Products:

 Though there is some evidence that oils used and greasy materials can, by occluding the
skin surface, predispose infants to prickly heat, but surprisingly baby oil remains a
popular product.

Essential Baby Care Products:

Baby food, Baby skin care products, Baby diapers, Baby shampoos and hair oils .Cradles Baby
carrier, Feeding bottles Cribs Baby toys.

 Baby Food : Apart from breast milk, babies also require formula milk. It is important to
choose brands which ensure complete nutrients required for the proper growth of the
baby.

 Baby Skin Care: Babies have mild and sensitive skin which requires extra care and
attention. The baby soaps and shampoos need to be gentle on the skin so as to prevent
rashes and other skin irritations.

 Baby Carrier: These are quite essential while taking your baby out for a stroll. Today
various types of carriers are available which can be tied around your waist too.

 Baby Feeding Bottles: Another important baby care product includes feeding bottles.
Feeding bottles are also available in different sizes, shapes and varieties but it is very
important to buy these bottles from a reliable and authentic manufacturer.

 Baby Diapers: One of the most essential baby care products includes diapers. There is
quite an assortment of diapers available in many of the online and offline stores today.
Diapers with elastic, ordinary diapers, diapers with skin care ingredients and so forth.

A Guide to Pharmacy Technician 67

Most commonly used medicines for children and infants:

Paracetamol (Acetaminophen): The Most Commonly used medication both in hospitals and in
the community• Uses - To relieve pain and lower raised temperature.

Who can have it – From neonates (28 weeks) onwards.

How is it given – most commonly by mouth, also given rectally and by IV.

Ibuprofen – To relieve pain, lower raised temperature and reduce inflammation of soft tissue
injuries.

Who can have it – From one month old..

How is it given – By mouth.

Midazolam /benzodiazapine – Given to children with convulsions lasting > 5mins also a
sedative for procedures, pre med and anti epilepsy medication.

Who can have it – From neonate(first 28 days old)

How is it given – By I.V and buccal cavity.

Side Effects – respiratory depression.

Warning in a few patients can cause opposite affect to sedation.

Salbutamol (Albuterol) – To manage bronchoconstriction and asthma.

Who can have it –from 1 month.

How is it given – By I.V, aerosol (inhaler), nebulized inhalation or dry powder.

Side effects - tremor (very common), headache, sweats and tachycardia (fast heart rate).

Caffeine base/citrate– respiratory stimulant – reduces the frequency of neonatal apnea and need
for mechanical ventilation during the first seven days of treatment. Used in management of
preterm infants up to 44 weeks (or as long as required). Any babies born and started on
ventilation will have caffeine

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 16. Drugs related to Asthma

Asthma:

Hyper-reactive airways to external foreign substance is called as bronchial asthma.

Physiology:

 Breathing-in (inspiration) is normal but breathing-out (expiration) is very dificult.

so ,patient feels very difficult to expires out.

 Asthma is a disorder of the lungs that causes intermittent symptoms.

 Production of large amounts of mucus that is thicker than normal
 Narrowing because of muscle contractions surrounding the airways
Symptoms of asthma:
Feeling short of breath, Frequent coughing, especially at night, Chest tightness
Wheezing (a whistling noise during breathing), Difficulty breathing

People with allergies, especially to cats, People who are exposed to environmental irritants

such as tobacco smoke, mold, dust, feather beds, or perfume.

Irritants that bring on asthma symptoms are called "asthma triggers." Asthma brought on by
workplace triggers is called "occupational asthma."

Drugs used for Asthma

1.Beta2 agonist bronchodilator:

3.Corticosteroids:
salbutamol and terbutaline.
prednisolone, hydrocortisone,
nebulisation of salbutamol at 5-10 mg/hour
4.Sympathomemitics:
with an appropriate nebuliser.
deriphylline and aminophilline
2.Ipratropium bromide:

It is an anti-cholinergic drug.

A Guide to Pharmacy Technician 69

Types of asthma inhalers:

There are three types of asthma inhalers

The most common asthma inhalers are the brown inhaler (for prevention) and the blue inhaler
(for attacks of asthma and/or prevention).

 Metered-Dose Inhaler
The standard one is blue inhaler/evohaler (e.g. Ventolin).

 MDI With a Spacer – Asthma in Children

Metered-dose inhalers that come with a spacer is an oval plastic container. On one end you insert
your MDI and on the other end there is a mouthpiece.

 Dry-Powder Inhaler – Breath-Activated Inhalers

This contains dry-powder, Take a deep breath which will make you inhale a single dose.
(e.g) turbohaler ,rotahaler and the diskhaler.
Based on color identification:
 Blue inhalers
This is the most common group of inhalers (also called reliever inhalers) which contain
bronchodilator drugs (usually salbutamol). Brown Inhaler
 Brown (sometimes also red)
This is prevention treatment to be taken every day. It contains steroids that reduce the
inflammation in your lungs

 Green(Long-Acting Asthma Inhalers – Bronchodilator Drugs)

Salumedrol &Formoterol

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 17. Drugs related to Blood pressure

It is the pressure exerted by blood on the walls blood vessels while the ventricles of the heart
contracts.

Like a water passing through a pipe.

"Normal" Blood Pressure

A blood pressure reading has a top number (systolic) and bottom number (diastolic). The ranges
are:

 Normal: Less than 120 over 80 (120/80)

 Pre-hypertension: 120-139 over 80-89

 Stage 1 high blood pressure: 140-159 over 90-99

 Stage 2 high blood pressure: 160 and above over 100 and above

 High blood pressure in people over age 60: 150 and above over 90 and above
People whose blood pressure is above the normal range should consult their doctor about steps to
take to lower it.

Causes High Blood Pressure

The exact causes of high blood pressure are not known, but several factors and conditions may
play a role in its development, including:

 Smoking

 Being overweight or obese

 Lack of physical activity

 Too much salt in the diet

 Too much alcohol consumption (more than 1 to 2 drinks per day)

 Stress

 Older age

 Genetics

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 Family history of high blood pressure

 Chronic kidney disease

 Adrenal and thyroid disorders

Types of hypertension:

1) Essential hypertension 2) Secondary hypertension

Essential Hypertension

Though essential hypertension remains somewhat mysterious, it has been linked to certain risk
factors. High blood pressure tends to run in families and is more likely to affect men than
women. Age and race also play a role.

Essential hypertension is also greatly influenced by diet and lifestyle. The link between salt and
high blood pressure is especially compelling. People living on the northern islands of Japan eat
more salt per capita than anyone else in the world and have the highest incidence of essential
hypertension.

The majority of all people with high blood pressure are "salt sensitive," meaning that anything
more than the minimal bodily need for salt is too much for them and increases their blood
pressure. Other factors that can raise the risk of having essential hypertension include obesity;
diabetes; stress; insufficient intake of potassium, calcium, and magnesium; lack of physical
activity; and chronic alcohol consumption

Secondary Hypertension

When a direct cause for high blood pressure can be identified, the condition is described as
secondary hypertension. Among the known causes of secondary hypertension, kidney disease
ranks highest. Hypertension can also be triggered by tumors or other abnormalities that cause the
adrenal glands (small glands that sit atop the kidneys) to secrete excess amounts of the hormones
that elevate blood pressure. Birth control pills -- specifically those containing estrogen -- and
pregnancy can boost blood pressure, as can medications that constrict blood vessels.

A Guide to Pharmacy Technician 72

 Risk factors :

 People with family members who have high blood pressure

 Smokers

 African-Americans

 Pregnant women

 Women who take birth control pills

 People over the age of 35

 People who are overweight or obese

 People who are not active

 People who drink alcohol excessively

 People who eat too many fatty foods or foods with too much salt

 People who have sleep apnea

Medicines used:

There are five main classes of medicines that are used to lower blood pressure. There are various
types and brands of medicine in each class. The following gives a brief overview of each of the
classes. However, for detailed information about your own medication you should read the
leaflet that comes inside the medicine packet.

Water' tablets (diuretics)

Diuretics work by increasing the amount of salt and fluid that you pass out in your urine. This
has some effect on reducing the fluid in the circulation, which reduces blood pressure. They may
also have a relaxing effect on the blood vessels, which reduces the pressure within the blood
vessels. The most commonly used diuretics to treat high blood pressure (hypertension) in the UK
are thiazides or thiazide-like diuretics.

Examples are bendroflumethiazide,chlortalidone, cyclopenthiazide, andindapamide. Only a

low dose of a diuretic is needed to treat high blood pressure. Therefore, you will not notice much
diuretic effect (that is, you will not pass much extra urine). You will need a blood test before
starting a diuretic, to check that your kidneys are working well. You should also have a blood

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test within 4-6 weeks of starting treatment with a diuretic, to check that your blood potassium
has not been affected. Then, a yearly blood test is usual.

Beta-blockers

Again, there are various types and brands of beta-

blockers: acebutolol, atenolol,bisoprolol, metoprolol, oxprenolol, propranolol, sotalol,
and timolol. They work by slowing the heart rate, and reducing the force of the heart. These
actions lower the blood pressure. Beta-blockers are also commonly used to treat angina, and
some other conditions. You should not normally take a beta-blocker if you have asthma, chronic
obstructive pulmonary disease (COPD), or certain types of heart or blood vessel problems.

Angiotensin-converting enzyme (ACE) inhibitors

ACE inhibitors work by reducing the amount of a chemical that you make in your bloodstream,
called angiotensin II. This chemical tends to narrow (constrict) blood vessels. Therefore, less of
this chemical causes the blood vessels to relax and widen, and so the pressure of blood within the
blood vessels is reduced.
There are various types and brands of ACE
inhibitors: captopril, cilazapril, enalapril,fosinopril, lisinopril, perindopril, quinapril, ramipril,
and trandolapril. An ACE inhibitor is particularly useful if you also have heart
failure or diabetes. ACE inhibitors should not be taken by people with certain types of kidney
problems, people with some types of artery problems, and those who are pregnant. You will need
a blood test before starting an ACE inhibitor. This will check that your kidneys are working well.
The blood test is repeated within two weeks after starting the medicine, and within two weeks
after any increase in dose. Then, a yearly blood test is usual.

Angiotensin receptor blockers

These medicines are sometimes called angiotensin-II receptor antagonists. There are various
types and
brands: candesartan, eprosartan, irbesartan, losartan,olmesartan, telmisartan and valsartan. They
work by blocking the effect of angiotensin II on the blood vessel walls. So, they have a similar
effect to ACE inhibitors (described above).

side-effects:
All medicines have possible side-effects, and no medicine is without risk. However, most people
who take medicines to lower blood pressure do not develop any side-effects, or only have mild
side-effects. A full list of cautions and possible side-effects is listed on the leaflet inside the
medicine packet. The most common ones are:

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  ACE inhibitors - sometimes cause an irritating cough.

 Angiotensin receptor blockers - sometimes cause dizziness.

 Calcium-channel blockers - sometimes cause dizziness, facial flushing, swollen ankles,

and constipation.

 'Water' tablets (diuretics) - can cause gout attacks in a small number of users, or can make
gout worse if you already have gout. Erection problems (impotence) develop in some users.

 Beta-blockers - can cause cool hands and feet, poor sleep, tiredness, and impotence in
some users.

Duration of treatment:
In most cases, medication is needed for life. However, in some people whose blood pressure has
been well-controlled for three years or more, medication may be able to be stopped. In particular,
in people who have made significant changes to lifestyle which can affect blood pressure (such
as lost a lot of weight, or stopped heavy drinking, etc).
Your doctor can advise. If you stop medication, you need regular blood pressure checks. In some
cases, the blood pressure remains normal. However, in others it starts to rise again. Medication
can then be started again.

DIURETICS

Loop diuretics: Thiazide diuretics: Potassium-sparing diuretics:

 bumetanide  epitizide  amiloride

 ethacrynic acid  hydrochlorothiazide and  triamterene
 furosemide  chlorothiazide  spironolactone
 torsemide  bendroflumethiazide

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Adrenergic receptor antagonists

Beta blockers Alpha blockers: Mixed Alpha + Beta blockers:

 metoprolol  doxazosin  bucindolol
 nadolol  phentolamine  carvedilol
 nebivolol  indoramin  labetalol
 oxprenolol  phenoxybenzamine
 pindolol  prazosin
 propranolol  terazosin
 timolol  tolazoline
 atenolol

Calcium channel blockers

Dihydropyridines: Non-dihydropyridines:
 amlodipine  diltiazem
 cilnidipine  verapamil
 felodipine
 isradipine
 lercanidipine
 levamlodipine
 nicardipine
 nifedipine
 nimodipine
 nitrendipine

Angiotensin-converting enzyme

ACE inhibitors inhibit the activity of Angiotensin-converting enzyme (ACE), an enzyme

responsible for the conversion of angiotensin I into angiotensin II, a potent vasoconstrictor.

 fosinopril
 lisinopril
 perindopril
 quinapril
 ramipril
 captopril

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Angiotensin II receptor antagonists work by antagonizing the activation of angiotensin
receptors.

 candesartan
 eprosartan
 irbesartan
 losartan
 olmesartan
 telmisartan
 valsartan
Aldosterone receptor antagonists:

 eplerenone
 spironolactone
Aldosterone receptor antagonists are not recommended as first-line agents for blood pressure,
but spironolactone and eplerenone are both used in the treatment of heart failure.

Alpha-2 adrenergic receptor agonists

Central alpha agonists lower blood pressure by stimulating alpha-receptors in the brain which
open peripheral arteries easing blood flow. These alpha 2 receptorsare known as autoreceptors in
which serves as a negative feedback in neurotransmission (in this case, the vasoconstriction
effects of adrenaline) Central alpha agonists, such as clonidine, are usually prescribed when all
other anti-hypertensive medications have failed. For treating hypertension, these drugs are
usually administered in combination with a diuretic.

 clonidine
 guanabenz
 guanfacine
 methyldopa
 moxonidine
Adverse effects of this class of drugs include sedation, drying of the nasal mucosa and rebound
hypertension.
Some indirect anti-adrenergics are rarely used in treatment-resistant hypertension:

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 guanethidine - replaces norepinephrine in vesicles, decreasing its tonic release
 mecamylamine - antinicotinic and ganglion blocker
 reserpine - indirect via irreversible VMAT inhibition
For the most resistant and severe disease, oral minoxidil (Loniten) in combination with diuretic
and β-blocker or other sympathetic nervous system suppressant may be used.

Blood pressure vaccines

Blood pressure vaccinations are being trialed and may become a treatment option for high blood
pressure in the future. CYT006-AngQb was only moderately successful in studies, but similar
vaccines are being investigated.

Patient Factors Affecting Antihypertensive Drug Choice

The choice between the drugs is to a large degree determined by the characteristics of the patient
being prescribed for, the drugs' side-effects, and cost. Most drugs have other uses; sometimes the
presence of other symptoms can warrant the use of one particular antihypertensive. Examples
include:

 Age can affect choice of medications. Current guidelines suggest starting patients over the
age of 55 years first on calcium channel blockers or thiazide diuretics.
 Anxiety may be improved with the use of beta blockers.
 Asthmatics have been reported to have worsening symptoms when using beta blockers.
 Benign prostatic hyperplasia may be improved with the use of an alpha blocker.
 Diabetes. The ace inhibitors and angiotensin receptor blockers have been shown to prevent
the renal and retinal complications of diabetes mellitus.
 Gout may be worsened by diuretics, while losartan reduces serum urate.[39]
 Kidney stones may be improved with the use of thiazide-type diuretics [40]
 Heart block β-blockers and nondihydropyridine calcium channel blockers should not be used
in patients with heart block greater than first degree.jnc8 not recommended bete blockers as
initial therapy for hypertension
 Heart failure may be worsened with nondihydropyridine calcium channel blockers, the alpha
blocker doxazosin, and the alpha-2 agonists moxonidine and clonidine. Whereas β-blockers,
diuretics, ACE inhibitors, angiotensin receptor blockers, and aldosterone receptor antagonists
have been shown to improve outcome.

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Pregnancy: Although α-methyldopa is generally regarded as a first-line agent, labetalol and
metoprolol are also acceptable.

Atenolol has been associated with intrauterine growth retardation, as well as decreased placental
growth and weight when prescribed during pregnancy. Ace inhibitors and angiotensin II receptor
blockers (ARBs) are contraindicated in women who are or who intend to become pregnant

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 18. Information on Complementary medicine

Definition:

The word "complementary" means "in addition to."Complementary medicine is treatment and
medicine that you use in addition to your doctor's standard care.

A group of diagnostic and therapeutic disciplines that are used together with conventional
medicine.

An example of a complementary therapy is using acupuncture in addition to usual care to help

lessen a patient's discomfort following surgery.

Products available in pharmacy

1. Prescribing multi vitamin capsules with antibiotics

2. Prescribing antacids with analgesics

3. Prescribing iron and folic acid capsules in the early pregnancy

4. prescribing cranberry juice in uterine tract infection etc..

5. Talcum powders and soaps

6. cosmetic products

7. Dry dressing materials

8. Laxatives and lozenges

9. Conventional nutritional supplements.

Reason for using complementary medicine:

People often use complementary medicine to treat long-term health problems or to stay healthy.
But if you are looking for a "cure-all," you may be disappointed. Before you begin to use it,
make sure that you learn how well it is likely to work.

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Part of the philosophy of some forms of complementary medicine is to listen to and touch people
in a healing way. Some people find great comfort in this. Others may be bothered by it.

Benefits:

One benefit is that many people who practice complementary medicine take a "whole person," or
holistic, approach to treatment. They may take an hour or more to ask you questions about your
lifestyle, habits, and background. This makes many people feel better about the treatment, the
person giving the treatment itself, and the condition. In some cases, this type of medicine works
as well as standard medicine.

Some people feel more in control when they are more involved in their own health. And since
most complementary medicine looks at the connection between mind and body, many people
who use it feel better. They like working toward overall wellness instead of just relief from one
problem.

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 19. Drugs related to Diabetes

Glucose is vital to health because it's an important source of energy for the cells that make up
muscles and tissues. It's also brain‟s main source of fuel. In diabetes, no matter what type, it
means too much glucose in blood, although the causes may differ. Too much glucose can lead to
serious health problems. This condition occurs when not enough insulin is produced or is not
produced at all. The body is unable to maintain blood glucose levels. Pancreas plays major role
in maintaining blood glucose level, because it will secret insulin and glucagon. Where Insulin
will decrease blood glucose levels by changing sugar to starch and Glucagon will increases blood
glucose levels by changing starch to sugar.

Chronic diabetes conditions include

Type 1 diabetes (Insulin dependent) IDDM

Type 2 diabetes.(Non-insulin dependent)NIDDM

Although Type 1 diabetes can develop at any age, it typically appears during childhood or
adolescence.

Type 2 diabetes, the more common type, can develop at any age, though it's more common in
people older than 40.

Causes of type 1 diabetes

The exact cause of type 1 diabetes is unknown. Generally known is that immune system
normally fights harmful bacteria or viruses attacks and destroys insulin-producing cells in the
pancreas, results in less production of insulin. Instead of being transported into cells, sugar builds
up in bloodstream.

Itis thought to be caused by a combination of genetic susceptibility and environmental factors

Risk factors:

Family history

Environmental factors

The presence of damaging immune system cells (auto-antibodies).

Dietary factors

Geography

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Symptoms:

Diabetes symptoms vary depending on how much blood sugar is elevated. Some people,
especially those with pre-diabetes or type 2 diabetes, may not experience symptoms initially. In
type 1 diabetes, symptoms tend to come on quickly and be more severe.

Some of the signs and symptoms of type 1 and type 2 diabetes are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)
 Fatigue

Treatment

Replace insulin

Insulin Administration is using a needle & 'insulin syringe' and dose is measured in units. There
are different types on insulin available.

Short acting (soluble) insulin can be given IV, SC, is I m

Medium and long acting insulin‟s must only be given SC

Administration:

Subcutaneously - inject into upper arm, thigh, buttock, and abdomen.

Time of administration:

Before eating:

When eating, insulin need to control the sugar from our food

Exercising:

Hence there is an increased quantity of glucose demand during exercise, insulin must be
administered in advance to enhance glycogen to be converted to glucose.

Insulin must be stored at the temperature between 2-8C(35.6-46.4 F).

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Type 2 diabetes:

In type 2 diabetes, cells become resistant to the action of insulin, and pancreas is unable to make
enough insulin to overcome this resistance. Instead of moving into cells where it's needed for
energy, sugar builds up in bloodstream.

Exactly why this happens is uncertain, although it's believed that genetic and environmental
factors play a role in its development.

Being overweight is strongly linked to the development of type 2 diabetes, but not everyone with
type 2 is overweight.

Risk factors:

Weight

Inactivity

Family history

Race

Age

But type 2 diabetes is also increasing dramatically among children, adolescents and younger
adults.

Polycystic ovary syndrome

High blood pressure

Abnormal cholesterol and triglyceride levels

Symptoms:

Some of the signs and symptoms of type 1 and type 2 diabetes are:

 Increased thirst
 Frequent urination
 Extreme hunger
 Unexplained weight loss
 Presence of ketones in the urine (ketones are a byproduct of the breakdown of muscle and
fat that happens when there's not enough available insulin)
 Fatigue, Blurred vision, Slow-healing sores

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Tests for conformation of diabetes:

Glycated hemoglobin (A1C) test.

Random blood sugar test.

Fasting blood sugar test

Oral glucose tolerance test

Treatment:

-Initially diet and physical activities are to be maintained

-If not controlled then we should go for oral hypoglycemic drugs

-Still not in control of glucose levels, then go for insulin management.

-In pregnancy insulin is safest and doesn‟t cross the placenta.

-oral hypoglycemic drugs are not safe to fetus in pregnancy.

ORAL HYPOGLYCEMIC DRUGS:

BIGUANIDES:

Decreasing the sugar production in the Pancreas.

SULPHONYLUREAS:
Increasing the sugar absorption by muscle cells. Stimulates the pancreas to produce more insulin.
Decreasing the body's need for insulin. Can produce hypoglycemia (abnormally low blood
sugar levels).
Ex:Metformin - Glucophage (Brand name)
Ex:
Side effects:
Glimepiride - Amaryl (Brand name)
Decreased appetite
Gilbenclamide - Daonil
Diarrhea
Gilclazide - Diamicron
Fast or shallow breathing
Gilpizide - Glibenese
Fever or chills
Tolbutamide - Tolbutamide
General feeling of discomfort Side effects:
Lower back or side pain
low blood sugar
Muscle pain or cramping
skin allergy

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Thiazolidinedione’s: They lower the amount of
sugar released by the liver and make fat cells Dipeptidyl peptidase IV (DPP-IV) inhibitors:
more sensitive to the effects of insulin.
These inhibitors work to lower blood sugar in
Ex: Pioglitazone and rosiglitazone. patients with type 2 diabetes by increasing insulin
secretion from the pancreas and reducing sugar
Side effects: production.
Elevated liver enzymes Can take alone or with other medications such as
metformin.
Liver failure

Respiratory infection
Ex: sitagliptin, alogliptin, saxagliptin and
Fluid retention
linagliptin.
Meglitinides: They lower blood sugar by
stimulating the pancreas to release more insulin.
Sodium-glucose co-transporter 2 (SGLT2)
Side Effects:
inhibitors: work by blocking the reabsorption of
 Hypoglycemia (low blood sugar) glucose by the kidney and increasing glucose
 Stomach upset excretions in urine.

Ex: Dapagliflozin and Canaglifozin.

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 20. Information on Products Related To Anti-Obesity, Diet Management

And Nutritional Products

Introduction:

Obesity is a chronic condition that affects many people. If person is struggling with excess
weight, they may find that healthy eating plan and regular physical activity helps to lose weight
and maintain weight loss over the long term. But if these lifestyle changes are not enough,
medications for obesity treatment may be a helpful part of weight-control program.

When combined with healthy eating and regular physical activity, obesity drugs may help some
people lose weight and improve their health. But these drugs have side effects and may not work
for everyone. So individuals must take care in the diet and weight management, it is safe to
maintain the weight according to BMI (Body mass Index).

A Guide to Pharmacy Technician 87

Anti-obesity drugs:

Most weight-loss drugs are only approved for use by adults. “Orlistat” is approved for children
ages 12 and older. Weight loss medications should never be used during pregnancy, and weight
loss is not advised during pregnancy. Women who are thinking about becoming pregnant should
avoid some of these drugs, as they may harm an unborn baby. Most of the drugs act by reducing
LDL level in the body and some of the drugs act by suppressing the appetite.

Statins: Acts by lowering LDL

Bile acid sequestrants: Acts by lowering
Lovastatin (10-80 mg) VLDL, LDL

Simvastatin (5-40 mg) Cholestyramine (4-16 g)

Atorvastatin (10-80 mg) Colestipol (5-30 g)

Rosuvastatin (5-20 mg)

Orlistat:

Orlistat will stop about one-third of the fat from the food from being digested. It does so by
blocking the enzyme lipase, which breaks down fat. When fat is not broken down, the body
cannot absorb it, so fewer calories are taken in. After 1 or 2 years of taking orlistat, patients may
lose about 5 to 7 pounds.

Lorcaserin:

It works by affecting chemicals in your brain that help decrease your appetite and make feel full.

Phentermine:
Phentermine, a medicine approved to suppress appetite. It is medicine approved to control
seizures. It may also be used to prevent migraine headaches.

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Appetite Suppressants: Side effects:

Stomach pain, gas, diarrhea, leakage of oily stools,

Phentermine
Headaches, dizziness, feeling tired, nausea, dry mouth,
Benzphetamine cough, and constipation, dry mouth, difficulty sleeping,
dizziness, headache, feeling nervous, diarrhea, and
Phendimetrazine constipation.

Maintaining a balanced diet:

Dietary management of obesity is lifelong therefore it is important that diets are nutritionally
balanced.

Plan ahead – helps ensure to have the right foods to hand at the right time

•Start the day with a healthy breakfast

•Eat regular, balanced meals

•Aim to include at least five portions of fruit and vegetables each day – have some at every meal

•Half fill your plate with vegetables/salad and divide the other half between meat, fish, egg or

beans, and carbohydrates like potatoes, rice, pasta and bread

•Choose foods and drinks that are low in fat and sugar, and limit sweet and salty snacks

• Alcohol intake must be moderate.

•Watch portion sizes, especially when eating out

•Avoid eating at the same time as doing something else (e.g. watching TV, working or reading)

•Wait at least 5-10 minutes after eating before deciding to take more – it takes time for brain to

know whether stomach is full.

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Nutritional products or dietary supplements:

A product (other than tobacco) intended to supplement the diet that bears or contains one or more
of the following dietary ingredients

 Vitamins
 Minerals
 Herbs or other botanicals
 Amino acids
 Concentrate, metabolite, constituent, extract or combination of above listed ingredients

Nutritional products intended only to supplement diet not represented for use as conventional
food and not intended as sole item of a meal or the diet”.

Green tea:May boost immune system, increase metabolism, act as antioxidant, lower cholesterol
and triglycerides.

Creatinine:

Natural substance produced by body. It Improve muscle power during high intensity and short
duration exercise. it is also claimed as weight gainer.

Side effects: Could cause muscle cramps, headaches, diarrhea, and gastrointestinal pain; stress
on kidneys. Long term effects are unknown. Increases risk of fractures.

Protein/Amino Acids(Protein powders):

Essential macronutrient found in the body and in food. Protein supplement food sources include:
Egg, Soy, Whey.

Protein/amino acids are a major component and the building block of muscle. For this reason,
many strength and power athletes consume protein and amino acids believing that it will build
muscle. Egg, soy and whey protein are popular protein supplements because they are considered
high quality proteins.

Egg protein contains all eight essential amino acids, making it the standard to which all forms of
protein are measured. It digests at a medium pace, supplying a sustained released of amino acids
to the body.

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 Soya protein is a complete protein derived from soya beans that is generally very low in or free
of fat, cholesterol, and lactose. Whey protein comes from milk. During the process of turning
milk into cheese, whey protein separates into the liquid whereas casein separates into the solid.
Whey protein is considered to be a high quality protein because the amino acids it contains.

The list of protein supplements in the market is never ending. The marketing is intense promising
anything from increased strength, energy, and/or muscle mass to losing weight, staying fit, and
obtaining lean slender bodies. Although some studies have found an increased muscle size as a
result of increased protein intake, few have reported an increase in strength. Large protein
consumption in one setting that exceeds the body‟s requirement will be converted into fat. It will
NOT increase muscle mass.

Side Effects:

There are problems with taking protein supplements including dehydration, stress on the kidneys,
and increased calcium excretion. If the athlete is using protein supplements, the dietary intake
may result in reduced intake of vitamins, minerals, fiber and other important nutrients.

A Guide to Pharmacy Technician 91

 21. Drugs used during pregnancy and maternal health

Introduction:

Majority of pregnant women (40 – 90%) are exposed to medications during pregnancy. Many
medications are taken without physician‟s advice or before recognition of the pregnancy.
Maternal and fetal wellbeing is effected by most of the therapeutic agents are unknown for about
one-half of medications. In general drugs, unless absolutely necessary, should not be used during
pregnancy because many can harm fetus. About 2 to 3 % of all birth defects result from the use
of drugs other than alcohol.

Medications frequently used by pregnant women:

 Vitamins
 Iron
 Analgesics
 Diuretics
 Anti-emetics.
 Antimicrobials.
 Antihistamine
 Hypnotic or sedatives
 Laxatives

Drugs taken by a pregnant woman reach the fetus primarily by crossing the placenta, the same
route taken by oxygen and nutrients, which are needed for the fetus's growth and development.
Drugs that a pregnant woman takes during pregnancy can affect the fetus in several ways:
• They can act directly on the fetus, causing damage, abnormal development (leading to
birth defects), or death.
• They can alter the function of the placenta, usually by causing blood vessels to narrow
(constrict) and thus reducing the supply of oxygen and nutrients to the fetus from the
mother. Sometimes the result is a baby that is underweight and underdeveloped.
• They can cause the muscles of the uterus to contract forcefully, indirectly injuring the
fetus by reducing its blood supply or triggering preterm labor and delivery.

Precautions to take Drugs during pregnancy:

 Vaccines made with a live virus (such as the rubella and varicella vaccines) are not
given to women who are, or might be pregnant. Other vaccines (such as those for
cholera, hepatitis A and B, plague, rabies, tetanus, diphtheria, and typhoid) are given
to pregnant women only if they are at substantial risk of developing that particular
infection.

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  However, all pregnant women who are in the 2nd or 3rd trimester during the
influenza (flu) season should be vaccinated against the influenza virus.

 Drugs to lower high blood pressure (antihypertensive) may be needed by pregnant

women who have had high blood pressure before pregnancy or who develop it during
pregnancy. Either type of high blood pressure increases the risk of problems for the
woman and the fetus

 So pregnant women who have to take these drugs are closely monitored.

 Digoxin used to treat heart failure and some abnormal heart rhythms, readily crosses
the placenta. But it typically has little effect on the baby before or after birth.

 Antibiotics which there are no known association with birth defects or other
pregnancy related complications and the drug is probably safe. They are
 Ampicillin
 Dicloxicin
 Macro bid (Nitrofurantoin)
 Amoxicillin
 All prenatal vitamins
 Acetaminophen
 Cephalosporin e.g cephalexin, ceclor (cefaclor)
 Cefadroxil
 Erythromycin
 Azithromycin
 Acyclovir
 Clotrimazole Vaginal
 Drugs which are used with care during pregnancy are:
 Bactrim,
 Trimethoprim,
 Ciprofloxacin,
 Fluconazole,
 Terconazole
 Isoniazid, Rifampin
 Mebendezole
 Diclofenac,

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  Drugs which can‟t be used during pregnancy:
 Tetracycline
 Phenytoin
 Sulfa drugs
 Anticonvulsants
 Isotretinoin
 Thalidomide
 Ribavirin
 Diethylstilbestrol.
 Warfarin
 Pencil amine
 Psychotropic
 Anti-anxiety drugs

Common medication during pregnancy:

Growth and change is so rapid during this period, requirements for all nutrients will increase.
Two are especially of concern, iron and calcium, because of the roles they play in the growing
body.
Iron:
Iron needs can easily be met through a balanced diet that contains foods rich in iron. Some
examples include: meat, fish, dried fruits, nuts, wholegrain breads, green-leafy vegetables, and
iron-fortified cereals. If these needs are not met, iron supplementation may be helpful. Patient
must be advised to take hematinic products because deficiency on iron will cause anemia to the
offspring.

Calcium:
The second common deficiency during pregnancy is calcium deficiency. The recommended
intake of calcium is 1000 mg/day. Calcium deficiency can lead to decreased bone mineral
density, which can increase one‟s risk for breaking bones and can also increase the risk for
osteoporosis later in life. It is especially important to have adequate calcium intake in during
pregnancy.
Calcium needs can easily be met by consuming food rich in calcium, like milk, yogurt, dark-
green vegetables, cheese, and other dairy products. The best source of calcium is through
foods, but calcium supplementation may be needed if they find it hard to get enough calcium
through their diet.

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 Folic acid:
Folic acid is a B vitamin (vitamin B9). It occurs naturally, in the form of folates, in foods such
as dark green leafy vegetables, oranges, whole grains, pulses, and yeast and beef extract. Folic
acid helps to protect your unborn baby from developing neural tube defects such as spina
bifida. Folic acid may also help to prevent other birth defects, such as a cleft palate.

Each day in take during pregnancy:

 While trying to conceive: 400 mcg.

 For the first three months of pregnancy: 400 mcg.
 For month‟s four to nine of pregnancy: 600 mcg.
 While breastfeeding: 500 mcg.

A Guide to Pharmacy Technician 95

 22. Drugs used for smoking cessation

Introduction:

Tobacco use can lead to tobacco/nicotine dependence and serious health problems like lung
cancer, liver diseases, cardiac diseases, vascular diseases. Quitting smoking greatly reduces the
risk of developing smoking-related diseases. Tobacco/nicotine dependence is a condition that
often requires repeated treatments, but effective treatments and helpful resources exist. Smokers
can and do quit smoking.

Health Benefits of Quitting:

Tobacco smoke contains a deadly mix of more than 7,000 chemicals; hundreds are toxic, and
about 70 can cause cancer. Tobacco smoking increases the risk for serious health problems,
numerous diseases, and death.
People who stop smoking greatly reduce their risk for disease and premature death. Although the
health benefits are greater for people who stop at earlier ages, quitting is beneficial at all ages.

Stopping smoking is associated with the following health benefits:

 Lowered risk for lung cancer and many other types of cancer.
 Reduced risk for coronary heart disease, stroke, and peripheral vascular disease.
 Reduced coronary heart disease risk within 1 to 2 years of quitting.
 Reduced respiratory symptoms, such as coughing, wheezing, and shortness of breath. The
rate of decline in lung function is slower among people who quit smoking than among
those who continue to smoke.
 Reduced risk of developing chronic obstructive pulmonary disease (COPD), one of the
leading causes of death all over the world.
 Reduced risk for infertility in women of reproductive age. Women who stop smoking
during pregnancy also reduce their risk of having a low birth weight baby.

A Guide to Pharmacy Technician 96

Methods to Quit Smoking:

Drug Treatment:

Nicotine Patch: The nicotine patch releases a constant amount of nicotine in the body. Unlike
the nicotine in tobacco smoke which passes almost instantaneously into the blood through the
lining of the lungs, the nicotine in the patch takes up to three hours to pass through the layers of
skin and into the user's blood.

The patch must be worn all day, and cannot be put on and removed as a substitute for a cigarette.
Most of the patch products are changed once every 24 hours. One particular patch is worn only
during the waking hours and is removed during sleep.

Side Effects:

 Skin irritation
 Dizziness
 Racing heartbeat
 Sleep problems
 Headache
 Nausea
 Vomiting, muscle aches and stiffness

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Nicotine Gum:

Nicotine gum delivers nicotine to the brain more quickly than the patch however, unlike smoke,
which passes almost instantaneously into the blood through the lining of the lung; the nicotine in
the gum takes several minutes to reach the brain. Nicotine gum is not designed to be chewed like
normal gum. Rather it is used in the "chew and park" method. When you insert a piece of gum
into your mouth, chew it a few times to break it down, then park it between your gum and cheek
and leave it there. This is available in 2mg doses (for smokers of 24 or fewer cigarettes each day)
and 4mg doses (for smokers of 25 or more cigarettes each day).

Nicotine Lozenge:

Nicotine lozenge comes in the form of a hard candy, and releases nicotine as it slowly dissolves
in the mouth. Eventually, the quitter will use fewer and fewer lozenges during the 12-week
program until he or she is completely nicotine-fare. Biting or chewing the lozenge will cause
more nicotine to be swallowed quickly and result in indigestion and/or heartburn.

Nicotine lozenge is available in 2mg or 4mg doses. One lozenge is one dose; maximum dosage
should not exceed 20 lozenges per day.

Each lozenge will last about 20-30 minutes and nicotine will continue to leach through the lining
of the mouth for a short time after the lozenge has disappeared. Do not eat or drink 15 minutes
before using the lozenge or while it is in your mouth.

Side Effects:

 Soreness of the teeth and gums

 Indigestion
 Throat irritation

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Nicotine Nasal Spray:

Nicotine nasal spray, dispensed from a pump bottle similar to over-the-counter decongestant
sprays, relieves cravings for a cigarette. Nicotine is rapidly absorbed through the nasal
membranes and reaches the bloodstream faster than any other product, giving a rapid nicotine
"hit". This feature makes it attractive to some highly dependent smokers. This cannot be sold
without prescription.

Side effects: Nose and Throat irritations

Nicotine Inhaler:

The nicotine inhaler consists of a plastic cylinder containing a cartridge that delivers nicotine
when you puff on it. Use the inhaler when you have a craving for a cigarette. Use no more than
16 cartridges a day for up to 12 weeks.

Although similar in appearance to a cigarette, the inhaler delivers nicotine into the mouth, not the
lung, and enters the body much more slowly than the nicotine in cigarettes. The nicotine inhaler
is available only by prescription.

Each cartridge delivers up to 400 puffs of nicotine vapor. It takes at least 80 puffs to obtain the
equivalent amount of nicotine delivered by one cigarette.

Side effects:

Irritation of the throat and mouth in the beginning.

Non-nicotine medications:

Bupropion SR (Zyban®), Varenicline tartrate (Chantix®)

Common side effects include insomnia, dry mouth and dizziness.

Non drug treatment;

Individual, group, or telephone counseling.
Behavioral therapies (e.g., training in problem solving).
Treatments with more person-to-person contact and intensity (e.g., more or longer counseling
sessions).

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 23. Products related to Cosmetic, Hair and Teeth
Introduction:
Any substance intended to be rubbed, poured, sprinkled, sprayed or applied to any part of human
body for purpose of cleansing, beautifying, promoting attractiveness, or altering the appearance,
and includes any article intended for use as a component of cosmetic.

Classification of cosmetics products:

 Intended for application to the lips; lipsticks products
 Products related for teeth and mouth;
 Products for nail care
 Make-up products for external intimate hygiene; sunbathing products; products for
tanning
 Skin-whitening products and anti-wrinkle products.

Classification of cosmetics hair care products: (hair tints and bleaches, products for waving,
straightening and fixing, setting products, cleansing products (lotions, powders, shampoos),
conditioning products (lotions, creams, oils), hairdressing products (lotions, lacquers); shaving
products (creams, foams, lotions, etc.); products for making-up and removing make-up from the
face and the eyes.

Classification of cosmetics creams: emulsions, lotions, gels and oils for the skin (hands, face,
feet, etc.); face masks (with the exception of chemical peeling products); tinted bases (liquids,
pastes, powders); make-up powders, after-bath powders, hygienic powders, etc.; toilet soaps,
deodorant soaps, etc.; perfumes, toilet waters and eau de Cologne; bath and shower preparations
(salts, foams, oils, gels, etc.); depilatories (Hair removal creams); deodorants and anti-
perseprints.

Lipsticks:
Lipstick is a cosmetic product containing pigments, oils, waxes, and emollients that applies
color, texture, and protection to the lips. Symbol of feminity. Inventor of lipstick: Abu al-Qasim
al-Zahrawi.

Eye shadows:
Eye shadows are preparations designed to enhance the depth of eyes thanks to a colored
background that gives contour to the eyelid. The colored product is applied with a flexible brush
or foam applicator. The raw materials are principally pearlescent agents dispersed in a powder
base composed of talc (which give softness and easy glide), kaolin, titanium dioxide or calcium
carbonate. Volatile silicones help to avoid the chalky effect owed to powders.

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Eye liners:
Eye liners to underline and over line the lower and upper lids; modify and correct the appearance
of the shape of the eye, and are applied with a small brush. There are many different colors but
the most common are black and brown. Two types of eye liners: liquid eye liners which are made
with a non-greasy emulsion, colorants and film-forming agents, and Compact (or cake) eye liners
which are made with pressed powders and colorants (applied with a wet brush).

EYE MASCARA:
Eye mascara used to enhance the eye beauty. It may darken, thicken, lengthen, and/or define the
eyelashes. Formulation: Pigments Oils Waxes preservatives.

NAIL POLISH (nail varnish):

Nail Polish (nail varnish) Lacquer applied to human fingernails or toenails to decorate and/or
protect the nail plate. Formulation: Film former : nitrocellulose Solvents : butyl acetate or ethyl
acetate Resins : tosyl/formaldehyde resin Colors : titanium oxide with mica or lakes of calcium.
Plasticizers : camphor Ultraviolet stabilizers : benzophenone-1 Pigments and sparkling agents :
mica.

Eyebrow pencils:
Eyebrow pencils high wax containing hard crayons for darkening the eyebrows. Formulation:
Yellow wax Paraffin wax Cocoa butter Petrolatum Carbon black.

Shampoos:
Shampoos remove sebum, skin particles, dirt and so on without excessively degreasing the hair.
Inventor : Kasey Herbert

Formulation : Surfactants : ammonium tetra alkyl chlorides Foam boosting actives. (e.g.
alkanolamides)
.
Thickeners or viscosity controlling actives. They make the product more comfortable to use.

Alkanolamides, methylcellulose are Conditioning agents. They minimize the negative effects of
excessive sebum removal (lanolin and poly ethoxyethylenated derivatives, silicones such as
dimethicone, quaternary agents and ceramides).

Opacifiers: They reduce transparency or translucency and improve the final appearance of the
product (ethylenglycol or propylenglygol, magnesium or zinc stearates).

Chelating agents: They form complexes with metal ions (like e.g. calcium present in hard
waters), which could affect product stability. Ex EDTA pH adjusting agents. Citric or lactic acids
Other.

Colouring agents, fragrance actives and preservatives .

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Face powders:

Face powders Improves personal attractiveness.

Formulation: kaolin,mgo,zinc oxide, calcium sulphate. Adherents : zinc stearate, colloidal

clay(purified kaolin).

Depilatories:
To remove undesired hair from body.

Formulation : barium sulphide,sodium sulphide and potassium sulphide

Carrier : corn starch,talc,titanium oxide Binding agent : pulverized soap

Perfumes : rose oils,aromatic ketones.

Dentrifices:

Used to clean oral cavity and teeth using fingers of hand or toothbrush. Counteract bad breadth
and leave a refreshing clean taste in mouth.

Formulation : Polishing agents(abrasives) : remove debris

Ex.: cal. Carbonate, calcium, pyrophosphate,mag. Trisilicate.

Surfactants : help in emulsifying debris and wetting teeth.

Deodorants :
Deodorants Correct bad body odor by deodorizing perspiration without restricting its flow and
also by preventing decomposition through bacteria inhibiting action.

Formulation: Purified zinc peroxide, Boric acid ,Talc perfume

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 24. Interacting with customers and giving oral advice
Pharmacy Assistant is an important link between the customer and the pharmacist.. Provides general
product knowledge and advice to the customer. Refers customers with symptoms or medical conditions or
queries about the medications to the pharmacist.

Important role is to ask the questions to customer listen closely for their responses and then decide if you
should refer them your pharmacist.

Identify customers’ needs is through appropriate questioning and active listening skills, and giving advice
by following different methods. There are different methods to interact with patients and giving advice.
They are:

WWHAMO

CARE

WHAT, STOP, GO

Based on these methods pharmacy assistant can interact with patients. These are designed to ensure you
have asked the right questions and have all the information you need to either:

 Refer to the pharmacist; or Doctor

 Recommend a product, and provide written or verbal information

The skills you require for interacting with customers are:

Speaking
Listening
Asking questions
Use the right language

Speaking:

-Pause between phrases or sentences to ensure

-Use a pleasant voice and sound friendly that the listener can absorb what you have said

-Speak slowly and clearly

-Be honest – it’s okay to say “I don’t know”

-Be polite and use appropriate language

-Avoid talking too loudly, speaking too fast,
mumbling or talking down to the customer
-Vary your tone

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Listening:

-Show interest -Listen carefully to what is being said

-Maintain appropriate eye contact -Don’t interrupt

-Concentrate on feelings as well as facts -Be patient

-Take notice of body language

-Listen carefully to what the customer is saying and
check you have understood the message

WWHAMO:

Who is it for?

What are the symptoms?

How long have they had them?

Action taken

Medication they are on already

Other conditions that they may have or anything else they should know.

CARE:

Check

Assess

Refer or recommend

Explain

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WHAT, STOP, GO

WHAT

Who is the patient?

How long have they had the symptoms?

Actual symptoms?

Treatment

When you have the information needed to decide the best course of action (provide a product or refer to
the pharmacist), the following is needed.

STOP

Symptoms?

Totally sure?

Overuse or abuse?

Pharmacy only or Pharmacist referral?

GO

Once you have made your decision, you need to provide advice with the product or explain why you are
referring to the pharmacist OR doctor.

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25. Demonstrate Professionalism as a Pharmacy Support Staff or a Pharmacist

Pharmacy is the field of expertise that ensures the availability, accessibility, and the responsible
use of medicines. The pharmacist is the professional who is particularly competent within that
field. However, the role and position in society of the pharmacist as a professional are not self-
evident. The professional should be more aware than ever before of his actions in situations that
require his expertise, but in which decisions are not made exclusively by him or in which he
himself cannot give a unanimous opinion based solely on his own competences and expertise.
Such dilemma’s and issues are a natural part of the existence of a professional. This demands a
foundation for the profession.

Pharmacists have opportunities to work in a variety of settings to improve medication use and
overall health care outcomes at the individual patient, community, national or international level.
To be effective in these efforts, pharmacists must interact effectively with and earn the
confidence of patients and their family members, other healthcare providers, and decision
makers. Thus, it is important that you begin to understand the culture of the profession and
improve as professional.

Professionalism:
Professionalism is an ongoing process, it is the process of doing work with honesty, integrity,
respect for others, dedication and commitment to excellence are the essential qualities required to
be a pharmacist.

Attitudes & Behaviors that Detract from Professionalism:

 Complaining  Indifferent
 Negative attitude  Self-centered
 Non-team player  Selfish
 Uncaring  Disrespectful
 Inappropriate dress

A Guide to Pharmacy Technician 106

Importance of professionalism:

 Improved relationships
 Impression of self
 Impression of the profession – Healthcare team
 Credibility – Patients

 Career security

Professionalism at work place:

 Knowledge and skills

 Punctuality
 Diplomacy in dress code
-Business casual

-White Apron (wrinkle free)

 ID card
 General grooming

Be familiar with the dress code policy – Inappropriate “skin” showing – What’s too short?
What’s too tight? Strong perfumes, lotions, cologne etc cannot be allowed.

 Address all medical professionals and patients, by their title – Dr…. – Mr., Mrs., Miss,.
Ms.
 “Be” the Pharmacist
– Maintain this mindset
– Have a sense of ownership
 You don’t know everything (never will!)
 Punctual be a good listener (active listening) Take responsibility for your work & actions.
 Always have reference book in pharmacy to check the drug pharmacological actions, side
effects and latest molecules availability.
 Always follow MFDA website for ADL list.
 Never let ego get in the way of providing patient care

A Guide to Pharmacy Technician 107

COMMITMENT TO EXCELLENCE
Beyond their own self-improvement, pharmacists must strive to advance the profession as a
whole and commit to lifelong engagement and involvement in the profession. This will vary for
each pharmacist, but there are many ways to be involved in the profession of pharmacy.
Pharmacists can participate and engage in activities at the community, or national level.
Likewise, pharmacists should seek leadership positions within the profession, whether locally or
nationally, to influence change and advance the profession.

A Guide to Pharmacy Technician 108

 26. Communication at Work Place

Communication plays a major role in interacting with patients. Pharmacist must have good
communication, problem-solving and listening skills. Pharmacists must also be able to manage
and train staff, and they need business skills for the day-to-day running of a pharmacy.

The purpose of communication is to get your message across to others. This is a process that
involves both the sender of the message and the receiver.

Importance of Communications:

Communication barriers can pop-up at every stage of the communication process (which consists
of sender, message, channel, receiver, feedback and context) and have the potential to create
misunderstanding and confusion.

Basic Counseling and Communication Skills:

Courtesy and rapport:

Quite possibly the most critical skills you will need to develop, and include:

 How to address patients

 Introducing yourself
 Learning patient names
 Being aware of your appearance, attitude, issues
 Respecting patient privacy issues
 Using appropriate body language

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Body Language:

Composed of Body movements

 Facial expression
 Gestures
 Posture and breathing
 Space
Stereotypes:

We all react differently to different kinds of people, and even differently at different times.
Some reactions are overt, some hidden. They all can impact how we relate to patients. We want
to avoid letting stereotypes influence how we react to and interact with our patients.

Listening:

 Stand up.
 Look and act interested.
 Lean forward.
 Actually Listen!
 Nod your head to show your attention.
 Make eye contact with the speaker.

When communicating important information to patients, be sure to:

 State the purpose of your communication.

 Inquire about what the patient needs.
 Use markers for critical information.
 Talk in lay terms, but don‟t oversimplify.
 Avoid technical jargon.
 Avoid information overload.
 Keep it short and simple, to the point.

Gathering Information:

When gathering information. Ask open-ended questions

 Much more information can be gained

 Saves time
 Provides opportunities for patients to reveal information we might not be
thinking about

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 27. Merchandise and Stock Control Procedures in Pharmacy

Merchandise and stock controlling will play major role in Pharmacy maintenance. This chapter
deals with process to follow while merchandise and process to arrange the stock in the pharmacy.

Purchasing should be seen as an important activity. The key considerations follow:

Whichever supplier you choose, ensure that they possess the following characteristics:

Reliability – A reliable supplier must be there and it will be wise to have more than one supplier
for any given product.

Quality – of supply and service needs to be consistent, Quality needs to be monitored.

Value for money – is not only concerned with the lowest price. You require consistent levels of
quality and reliability and should expect to have to pay more for this.

Strong service and clear communication – you need your suppliers to deliver on time or at
least to be honest with you and provide you with sufficient warning if they cannot deliver as
agreed. The best suppliers will want to speak with you regularly to monitor your needs and
identify opportunities to improve their service to you.

Financial security – you need to be assured that your suppliers are financially sound,
particularly as you hope to develop a long-standing and mutually beneficial relationship with
them. It is always worth credit-checking potential new suppliers.

Factors considering for choosing suppliers:

It is well worth examining how many suppliers you actually need to enable you to operate your
business.

Purchasing from targeted suppliers could have the following benefits:

 It will be easier for you to control your suppliers.

 Your business will become more important to them.
 You may be able to make deals that provide you with an extra competitive advantage.

You need to access them by :

 Are they professional?
 Do they have too much work, or not enough?
 How eager are they for your business?
 Do they appear to be financially stable?

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Ask how often prices will rise, what influences will cause them to rise, and how you will be
notified.

 Will the supplier replace the goods?

 Will replacement supplies be delivered immediately, or will you get a credit note?
 Will replacement goods be free? Who will pay for delivery?
 Agree on payment terms.
 Payments in advance should generally be avoided, especially if you are unsure about the
supplier's creditworthiness.
 You should ask for a discount for early payment.

Inventory Control:

Inventory control is the method of maintaining of stock in the pharmacy. Thus it plays the vital
role in maintaining stock. There are certain methods to arrange stock/medicines in pharmacy.
The arrangement of drugs can be in done in following methods.

1.ABC
2.VED
3.FIFO
4.FEFO

It can be defined as “systematic control and regulation of purchase, storage and usage of
materials in such a way that an even flow of product, at the same time avoiding excessive
investment in inventories. Efficient inventory control cuts out losses and wastes of materials.”

ABC:
This method is arrangement of drugs/medicines in alphabetical order either according to brand
name or according to generic name.

VED:
Arrangement of medicines depending on type of medicine
V- it implies vital medicines.
E- it implies essential medicines
D- it implies desired medicines.

FIFO:

FIFO implies first in first out, it means the drugs which bought first must sold first, and the drugs
which bought late must sell later.

FEFO:
FEFO implies first expiry first out, it means the drugs which are going to be expired earlier must
be sold first.

A Guide to Pharmacy Technician 112

 28. Minimize Theft
Theft has become a large part of retail pharmacy shrinkage. No matter how big or small the retail
pharmacy store may, but all types of retailers are susceptible to the growing problem of theft.
This chapter deals with measures to take for minimizing theft and procedures to protect their
store against theft.

In order to stop a theft, retailers must first be familiar with the categories of shoplifters, common
shoplifting methods, and know what to look for in customers who exhibit strange behavior. Find
out how to spot a shoplifter.

Preventive Measures

One of the most effective tools to prevent theft is good store management. Retail pharmacy
should also use store layout, adequate inventory controls and follow common security practices
to combat shoplifting.

It is important to plan store policies and procedures for shoplifting early in the business planning.
Take the following into consideration when writing your shoplifting policies.

Use Store Design to Reduce Shoplifting

It has been reported that employee theft and shoplifting combined account for the largest source
of property crime committed commonly. The easiest way for retailers to discourage theft in a
store is by taking away opportunities to steal. A little thought into the store's layout and design
can prevent theft before a loss occurs.

1. Checkout: Design the store lay out so customers must pass the register area and staff to exit
the store. Never leave the register unlocked or unattended. Do not display merchandise near
the store exits.
2. Tidy Up: Keep the store neat and orderly. Full displays and straightened shelves allow
employees to see at a glance if something is missing.
3. View All: Use mirrors to eliminate blind spots in corners that might hide shoplifters. Maintain
adequate lighting in all areas of the store; keep fixtures and displays low for better visibility.
4. Under Lock and Key: Place small, expensive items in locked cabinets or behind the counter.
Rest rooms and dressing areas should be watched at all times. Keep dressing rooms locked and

A Guide to Pharmacy Technician 113

 limit the number of items taken in by each customer. Use alarms on unlocked exits and close
or block off unused checkout aisles.
5. Signage: Signs and posters reinforcing security messages should be used. Post anti-shoplifting
signs like 'Shoplifters Will Be Prosecuted' in clearly visible locations.
6. Security: Use security equipment such as closed circuit television, security tags and two-way
mirrors. Uniformed security guards are also powerful visual deterrents to the shoplifter.

A Guide to Pharmacy Technician 114

 29. Safety working practice
Safety in dispensing and administrating pharmaceutical agents is important to prevent personal
and client illness or injury. In this chapter you will know safety standards and rules associated
with the pharmacy and identify unsafe practices.

Personnel safety:

• Safety from Physical harm

 Substances
 Supplies (chemicals, poisons, etc.)
 equipment
 improper body mechanics

Always wear apron and use gloves for dispensing

• Employee Responsibilities

 Maintain a safe work place

 Apply principles of proper body mechanics
 Wear appropriate PPE (Personal Protection Equipment) when indicated
 Follow proper procedures in handling pharmaceutical agents that may
pose a hazard to the practitioner.
 Know and apply the policies and procedures in case of emergency

Environmental Safety:

• Environmental Safety

 clean work place

 proper ventilation
 proper lighting
 adequate set-up and layout of work place
 proper functioning equipment

A Guide to Pharmacy Technician 115

Safe Practices:

Patients trust pharmacy personnel to:

 provide accurate and competent service

 safe and effective medications
 dispense according to prescriber‟s directions

Pharmacist must ensure:

 Right drug
 Right patient
 Right dosage
 Right route
 Right time
 Right attitude

Pharmacist must be familiar with:

 Common side effects

 Contraindications
 Drug or food reactions with medications
 Generic drugs that may be substituted

Practitioner should know at minimum the following information for the drugs most used in
individual practice setting or geographical ___location

 Adverse drug reactions

 Side effects
 Contradictions
 Safe/effective dosage range
 Drug/food interactions
 Common dosage regimens
 Dosage forms
 Route of administration

Beware of Dispensing Errors!!

A Guide to Pharmacy Technician 116

Safety in storage of pharmaceuticals:

 Store in original container until dispensed

 Follow manufacturer‟s directions for proper storage
 Follow proper disposal of expired drugs
 Deteriorated drugs are ineffective
 Deteriorated drugs may be a hazard if a condition not treated appropriately
 Deterioration may cause chemical changes leading to dangerous reactions

Safety in the pharmacy :

 It is a shared responsibility between employer and the employee.

 Personal Protection Equipment
 (any five): gloves – goggles – aprons – hair covers – masks – waterproof aprons, gowns,
and suits
 Food and Drug Administration (FDA)
 By meeting strict standards.

A Guide to Pharmacy Technician 117

 30. Drugs related to poisoning

Due to over dose of drugs , heavy metal intake, adverse drug reactions or poison intake will leads
to toxicity in the body. To control or to avoid toxicity antidotes are used. It may be defined as
those substances which react specifically with an ingested poison or toxic substance.

Classification;

1. Physiological antidotes

2. Chemical antidotes

3. Mechanical antidotes

Physiological antidotes;

They act by producing effect opposite to that of poison.

Chemical antidotes;

They act usually by combining with the poison and thus change its nature.

Mechanical antidotes;

They usually act by preventing the absorption of poisons in the body of expelling out the poison
by emesis or elimination through urine and faeces.

Management of overdose and poisoning:

 Recognition of poisoning
 Identification of agents Involved
 Assessment of severity
 Prediction of toxicity

General- management:
 Provision of supportive care
 Prevention of poison absorption
 Enhancement of elimination of poison
 Administration of antidotes

A Guide to Pharmacy Technician 118

Preventing absorption:

Activated charcoal (universal antidote)

 Adsorbs toxic substances or irritants, thus inhibiting GI absorption

 Addition of sorbitol →laxative effect

 Oral: 25-100 g as a single dose

 repetitive doses useful to enhance the elimination of certain drugs (eg, theophylline,
phenobarbital, carbamazepine, aspirin, sustained-release products)

 not effective for cyanide, mineral acids, caustic alkalis, organic solvents, iron, ethanol,
methanol poisoning, lithium.

Some common Antidotes:

Paracetamol - acetylcysteine

Aspirin - Activated charcoal

Heparin poisoning- Protamine sulfate

Opioid overdose- Naloxone hydrochloride

Oral hypoglycemic agents- Octreotide/oral glucose

Iron poisoning - Deferoxamine Mesylate

Insecticides, nerve agents, some mushrooms- Atropine

Sedatives- neostigmine

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 31. Drugs related to central nervous system
This chapter deals with the diseases related to Central nervous system and drugs which directly
act on central nervous system.

General anesthetics:

These are the agents which produce reversible loss of consciousness, so as to enable surgical
operations to be carried out.

Inhalation anesthetics: Local anesthetics: Injectable anesthetics:

Ether Lignocaine Procaine

Halothane Xylocaine Lignocaine

Isoflurane Benzocaine Mepivancaine

Nitrous oxide Tetracaine

Propofol

Ketamine

Hypnotics and sedatives:

Hypnotics are the drugs which produce sleep resembling natural sleep.

Sedatives are the drugs which reduce excitement without producing sleep.

There are different types of sedative- hypnotics:

Barbiturates: Benzodiazepines: Non- benzodiazepines:

Phenobarbitone Diazepam Zopiclone

Thiopentone Flurazepam Zolpidem

Hexobarbitone Nitrazepam

Methohexitone

Note: These are controlled drugs. Only sold in STO pharmacy

A Guide to Pharmacy Technician 120

Drugs for epilepsy:

Epilepsy is a collective term applied for a group of convulsive disorder. The common features of
convulsive disorder are:

 Loss or disturbance of consciousness

 Characteristic body movements
 Autonomic hyperactivity

The different types of epilepsy are grand mal epilepsy(clonic-tonic epilepsy), benign
partial epilepsy.

Anti-epileptic drugs:

Hydantion: Benzodiazepines:

Phenytoin Diazepam

Barbiturates: Clonazepam

Phenobarbitone

Iminostilbenes: Miscellaneous drugs:

Carbamazepine Gabapentine

Succinimides: Vigabatrin

Ethosuximide Lamotrigine

Sodium Valporate: Trimethadione

Valporic acid Phenacemide

Acetazolamide

Note: These are controlled drugs. Only sold in STO pharmacy

A Guide to Pharmacy Technician 121

Antianxiety Drugs:

Anti-anxiety drugs are CNS depressants which control symptoms of anxiety. They produce
calming effect in anxiety states.

There are different types of Anti-anxiety drugs:

Benzodiazepines: Azapirones:
Diazepam Buspirone
Lorazepam

Alprazolam

Note: These are controlled drugs. Only sold in STO pharmacy

Anti-Depressant Drugs:

These drugs used for the treatment of mental depression. They are also called as Psychonaleptics
or mood elevators.

There are different types of Anti-anxiety drugs:

Monoamine oxidase inhibitors: Tricyclic compounds: Serotonin reuptake inhibitors:

Isocarboxazid Imipramine Fluoxetine
Iproniazid Amitriptyline Paroxetine
Phenelzine Nortriptyline Sertaline
Lithium carbonate

Note: These are controlled drugs. Only sold in STO pharmacy

A Guide to Pharmacy Technician 122

Drugs used in Parkinsonism:

Parkinsonism is an extrapyramidal motor disorder. It is characterized by rigidity tremor and

hypokinesia. Secondary manifestations like excessive salivation, changes in mood and dementia
may also occur.

Dopamine precursor: Dopamine Facilitator:

Levodopa Amantadine

De carboxylase inhibitor: Dopaminergic agonist:

Carbidopa Bromocryptine

MAO- b Inhibitor: pergolide

selegiline

Note: These are controlled drugs. Only sold in STO pharmacy

A Guide to Pharmacy Technician 123

 32. Drugs related to Blood
Anemia is a condition in which you don't have enough healthy red blood cells to carry adequate
oxygen to your tissues. Having anemia may make you feel tired and weak. There are many forms
of anemia, each with its own cause. Loss of blood is the most common cause of anemia.

Iron deficiency anemia:

Iron deficiency anemia is also called as microcytic hyprochromic anemia. In this condition red
blood cells are in small size and they contain less hemoglobin. For synthesis of hemoglobin, iron
is necessary. The normal iron content in the body is about 3g.

Causes:

Loss in chronic hemorrhage

Dietary deficiency

Increased demand during pregnancy and puberty

Less absorption

Treatment:

Oral intake Intra muscular: Intravenous Iron:

Ferrous gluconate -900mg/day Dextran iron Iron dextran complex

Ferrous fumarate- 600mg/ day Iron sorbitol citric acid

Megaloblastic Anemia:

It is also called as macrocytic hyperchromic anemia. In this type of anemia, there is a defect in
the maturation of red blood cells. Due to deficiency of vitamin b12 and folic acid this condition
will occur.

Treatment:

Cyanocobalamin injection 50 to 100 micrograms weekly

Hydroxycobalamin injection.

Folic acid tablets 5-20mg/day.

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Blood substitutes and plasma expanders:

When a condition like decrease in circulating fluid volume occur blood substuties or plasma
expanders are prescribed. This can be occurring due to:

 Loss of blood due to hemorrhage

 Loss of plasma into tissue or outside

Treatment:

Blood products: Plasma substitutes: Fluid plasma substitutes:

Blood
dextran Normal saline
plasma
Dextrose solution

Anti- platelets:

Antiplatelet drugs are a type of medication that is used to eliminate or reduce the risk of blood
clots. They are often called “blood thinners”, but these medicines don't really thin the blood.
Instead, these medications help prevent or break up clots in your blood vessels or heart.

Anti- platelet drugs:

Asprin , clopidogrel, dipyridamole

Fibrinolytics:

These are used for dissolution of blood clots. These are used in the treatment of myocardial
infraction, pulmonary embolism, deep vein thrombosis.

Fibrinolytic drugs:

Streptokinase, urokinase

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Anti-coagulants:

An agent that is used to prevent the formation of blood clots. Anticoagulants have various uses.
Some are used for the prevention or treatment of disorders characterized by abnormal blood
clots.

Anti-coagulant drugs:

Heparin, warfarin

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 33. Cold Chain Management
Introduction:

Drugs storage plays major role in the stability of the medicines; drugs should be maintained at
certain temperature to maintain its potency. Vaccines are sensitive to heat and must be kept cold
from the time they are manufactured until they are used. The equipment and people that keep
vaccines cold during their journey are together called the cold chain. Manufacturer to airport;
cold storage at airport. Transport at the correct temperature from airport to storage in central,
regional hospitals, Pharmacy stores and in health centers.

Transported at the correct temperature to outreach sites. Kept at correct temperature during
immunization sessions.

1. Receipt

2. Storage

3. Delivery

Loading Vaccine Refrigerators:

♦ Put vaccines and diluents on the top and middle shelves of the main section.

♦ BCG, Pentavalent and TT vaccines on the middle shelves.

♦ Diluents next to the vaccines with which they were supplied.

♦ Arrange the boxes of vaccine in stacks between which the air can move.

Choosing a Refrigerator and Freezer:

1. Temperature Zone, the average temperature during the hottest/coldest months should be
taken as criteria for the determination of the zones. There are three temperature zones for
which cold chain refrigerators and freezers will be classified:

• Hot zone, 0C to +43C

• Temperate zone, 0C to + 32C

• Cold zone, -5C to +32C

2. Vaccine be stored at 2-+8C

3. Ice pack should be frozen for 24 hours.

A Guide to Pharmacy Technician 127

What to do when a vaccine refrigerator is out of order?

If vaccine refrigerator stops working, first protect the vaccines and then repair the refrigerator.

Protecting the vaccines:

 Move the vaccines to another place until the refrigerator is repaired.

 Use a cold box or vaccine carrier lined with conditioned ice-packs for temporary storage.
For a longer duration, use another refrigerator.
 Always keep a freezer indicator with the freeze-sensitive vaccines to monitor eventual
All the vaccines should be stored in the basket provided with the refrigerator

General rules about refrigerators:

♦ Opening the refrigerator door raises the temperature.

♦ Before you open the door, plan what you are going to do.

♦ When you open the door, do what you have to do quickly and close the door as soon as

possible.

♦ Try not to open the refrigerator door more than three times a day.

Storage Principles:

♦ Vaccines must not be kept

– In the door compartments of domestic refrigerators

– In the salad trays at the bottom of the refrigerator

– In contact with the evaporator plate

♦ Must not be confused with other heat sensitive pharmaceuticals

♦ Diluents must be stored at the same temperature at the point of use. This prevents damage to

the potency of the vaccine.

Maintaining cold boxes and vaccine carriers:

Vaccine carriers and cold boxes must be well dried after their use. If they are left wet with their
lids closed, they will become mouldy. Mould may affect the seal of the cold boxes and vaccine
carriers. If possible, store cold boxes and vaccine carriers with the lid open, when not being used.

A Guide to Pharmacy Technician 128

Knocks and sunlight can cause cracks in the walls and lids of cold boxes and vaccine carriers. If
this happens the vaccines inside will be exposed to heat.

If a cold box or vaccine carrier wall has a small crack you may be able to repair it with adhesive
tape until you can get an undamaged one.

Storage of other pharmaceutical dosage forms:

 Solid dosage forms must be stored at room temperature.

 Semisolid dosage forms must be stored at cool and dark place.
 Liquid dosage forms must be stored at cool and dark place, avoid direct sunlight.

A Guide to Pharmacy Technician 129

 34. Schedules in Maldives (Forensic Pharmacy)

The drugs which are available in Maldives are according to approved drug list. These drugs are
classified based on schedules. They are:

Schedule Significance
S1 Drugs available in ordinary shops and
pharmacies. (without prescription drugs)
S2 Drugs available in Pharmacy/dispensaries
(without prescription drugs)
S3 Prescription only drugs
S4 Narcotic drugs which must be sold in STO
S5 Psychotropic drugs which are sold at STO and
must maintain record for selling these drugs.
S6 National programmed drugs and controlled
drugs.

Recommended Drug Information reference books:

 BNF (British National Formulary)

 MIMS and CIMS
 BPC
 Pharmacopoeias

Roles of Pharmacy Assistant:

• Compounding and dispensing drugs

• Gathers information about patients
• Counsels on possible side effects and adverse reactions
• Advises for self-treatment with over-the-counter (OTC) products sold without a
prescription.
• Provides drug information to other healthcare professionals.
• Advises on home healthcare supplies and medical equipment.
• providing education about lifestyle choices and dietary supplements
• Refer patients to doctors if necessary
• Must have Knowledge about acts and regulations about storage, supply and selling of
drugs.

A Guide to Pharmacy Technician 130

 35. Make Conversions and Calculations

Introduction:

As a pharmacist there is immense need to know the percentage preparations and calculations of
dosage forms. Dosage calculation is a mandatory skill for pharmacist. Since medicine dispensing
is one of the primary roles of pharmacist, being able to calculate correct dosages is paramount to
safe practice. Improper dosage calculations are a common source of medication errors.
Medication errors due to improper dosage calculation can have serious, even fatal, consequences.
Careful attention to the calculation and dispensing of correct dosages must be a priority for
pharmacist.

Dosage Calculation:

Literally, dosage calculation means figuring out the correct dose of a medication. Many times the
medication dose prescribed for the patient is different from the way the medication is supplied.
For example, an order may be written for the patient to receive Amoxicillin 500mg, but the
medication that comes from pharmacy is Amoxicillin 250mg per tablet. You calculate that the
patient needs to take 2 tablets to achieve the full 500mg dose that was ordered. Of course, that
calculation is pretty obvious and can be done „in your head‟.

Before knowing dose calculations, there in need to know about percentage preparations and
calculations. In pharmacy many formulae are written in percentage i.e. the ingredients used for
preparing tablets will be mentioned as percentage in the following ways:

w/w = weight in weight (solid in solid)

w/v = weight in liquid (solid in liquid)

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v/v = volume in volume (liquid in liquid)

Numerator signifies that dosage form of ingredient

Denominator signifies the dosage form of preparation

WEIGHT IN WEIGHT(w/w)

Example of preparation in this type of percentage is used are powders, suppositories, creams and
ointment.

Example

1. Zinc oxide - 25%

Starch powder - 25%
Sterilised talc - 100%
Make 150G
These are all solids, and final preparation is by weight.
1 % W/W =1 G in 100 G of final product.

Therefore,
Ingredient 1. Zinc oxide:

25% w/w =25G in 100 G of final product weight

25% w/w = 25/100 G of final product weight
=25/100(150) G of final product weight
=37.5G of zinc oxide in 150 G

Ingredient 2. Starch Powder:

25% w/w = 25 G in 100 G of final product weight

25% w/w =25/100 G of final product weight
=25/100(150) G of final product weight
=37.5 G of starch powder in 150 G

Ingredient 3. Sterilised Talc:

100% w/w = 100- (25+25) =50 G in 100G of final product weight

100% w/w = 150-(37.5+37.5)

A Guide to Pharmacy Technician 132

 = 75 G of Sterilised Talc

LIQUID IN SOLID (v/w):

Menthol 20%
Wool fat 5%
White soft paraffin upto100%
Make 150 G

Menthol is a liquid and the final product mentioned is weight. To make this preparation,
the amount of each ingredient in grams must be calculated.
Ingredient: 1. Menthol
20% w/w =20 G in 100 G of final product
=20/100 of the final product
=20/100(50)
=30 G of menthol in 150 G

Ingredient : 2. Wool fat

5% w/w =5 G in 100 G of final product
=5/100 of the final product
=5/100(150) G of final product
=7.5 G of wool fat

Ingredient : 2. White soft paraffin

100% w/w = 100- (20+5) =75 G in 100G of final product weight
100% w/w = 150-(30+7.5)
= 112.5 G of White soft paraffin

VOLUME IN VOLUME(v/v):

Castor oil 40%

Cinnamon water 100%
Make : 200ml
Ingredient 1. Castor oil

A Guide to Pharmacy Technician 133

 40% v/v =40ml in 100 ml final product
40% v/v =40/100 of the final product volume
=40/100(200) ml of the final product volume
=80ml castor oil in 200 ml.

Ingredient 2. Cinnamon water

For 100ml it is 100- 40= 60 ml

For 200ml it is 200-80=120ml

WEIGHT IN VOLUME:

Iodine 15% w/v

Water to 100%
Make 500ml

To make this preparation, the weight of sodium chloride in G must be calculated

Ingredient 1. Iodine =15 G in 100 ml final product
=15/100 of the final product volume
=15/100(500) ml
=75 G Iodine in 500 ml final product

Here the above mentioned quantity of iodine cannot be dissolved in 500 ml of solvent
because this would result in a greater volume due to solute. The correct procedure is to
dissolve the solid in part of the solvent and then adjust the volume to 500 ml.

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CONCENTRATED SOLUTION:

some medicament such as antiseptic and disinfectants, may be dispensed in a concentrated from
with instruction to be diluted before use.

In these case, strength are often stated, not as percentage but as part of dissolved substances in
parts of solutions

Example 1 : 2 in 500 solution =2 part of solute in 500 parts of solution

Therefore, 2/500 of the final product is solute

So, % solute in final preparation =2/500(100)

2 in 500 solution =0.4%

Example 2:

Prepare 600ml of ethanol, single strength, (ie.2 in 60 solutions) from concentrated ethanol.

Ethanol single strength is 2 in 60

This means 2 part concentrated ethanol and enough water to produce 60ml chloroform water
single strength.

2ml concentrated +58 ml water gives 60ml final solution.

Amount of concentrate in final solution =2/60 of final solution volume
=2/60(600)ml
=20ml concentrate

Therefore, 20ml of concentrated ethanol and sufficient water to produce 600ml ethanol.

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Dose calculations:

Pharmacist must be able to calculate the number of tablets/capsules/syrup bottles to be dispense

based on prescription accurately.

T.Paracetmol – 500mg qid x 5 days:

Qid – four times daily i.e 4 tablets per day for 5 days.

So its 4x5= 20 Tablets.

C.Amoxicillin- 500mg Q8h x 5 days:

Q8h – for every 8 hours 1 capsule, so per day patient has to take 3 capsules for 5 days

So its 3x5= 15 Capsules.

Syr. Dexorange- 10ml Bid x 60 days: (syrup bottle is 300ml)

10ml Bid – 10ml two times daily i.e 20ml per day for 60 days.

So its 60x20= 1200ml

Each bottle contains 300ml, so its 1200/300 Its 4 bottles

4 bottles should be dispensed

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 36.Recommend and Provide Advice For OTC and Non Medicated Pharmacy Products

One of the main service pharmacists provide is advice on OTC products and non-medicinal
pharmacy products. Patients expect this service to be provided at no cost, so pharmacists have
always played an important role in recommending OTC products to help patients deal with their
health issues. By asking their patients appropriate questions, pharmacists can prescribe/ sell OTC
products. They are common therapy choices for many minor ailments, such as colds, upset
stomachs, sunburns, and headaches. Without them, sufferers may need to opt for more expensive
options or have treatment for various ailments delayed.

Clearly, the opportunity for pharmacists is to take an active role in recommending OTC products,
the key reason why patient will ask for advice to you is because:

1. Pharmacists are very accessible.

2. Pharmacists are trusted by the consumer.
3. Pharmacists are accepted as part of the neighborhood health team.
4. OTC products are very effective when used appropriately.
5. Appropriate use of OTC products saves money while improving outcomes.

As more prescription medicines are switched from prescription to OTC status, so due to this
reason it will improve the patient-pharmacist interaction.

If in case pharmacist think that drug therapy is unnecessary .Pharmacist must be able to:

 Provide assurance that drug therapy is unnecessary;

 Suggest treatment with non-drug measures, OTCs, or both; or
 Refer the patient to appropriate medical personnel. This will depend upon the severity
of symptoms being presented, underlying conditions, previous attempts at treatment on
the part of the patient, whether OTC agents are available for the situation.

Mostly patients will ask for OTC products in case of cough/cold/allergy, dermatology,
gastrointestinal, vitamins/nutrition, and analgesics.

A Guide to Pharmacy Technician 137

 Role of the pharmacist in providing advice for OTC and non-medicated products:

As a communicator

Pharmacist should prescribe/sell OTC medicines by considering following factors:

1. Medicines Prescribed must have proven safety, quality and efficacy.

2. Medicines prescribed should be specifically designed for the purpose, and must prefer

appropriate dose and dosage forms.

3. Products should be supported by information, which describes:

 How to take or use the medicines;

 Effects and possible side-effects;
 How the effects of the medicine should be monitored;
 Possible interactions;
 Precautions and warnings;
 Duration of use; and,
 When to seek professional advice.

As a quality drug supplier

The pharmacist must ensure that the products he/she purchases are from reputable sources and

of good quality ,the pharmacist must ensure the proper storage of these products.

As a Learner:

To ensure up-to-date quality service, to have up to date knowledge on OTC medicines and non-
medicinal products the pharmacist must be encouraged to participate in continuing professional
development activities such as continuing education and following ADL list and other books like
CIMS,MIMS.

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As a health promoter:

As a member of the health-care team, the pharmacist must identify health problems and also
must counsel patients about risk in over use of medicines

And can also refer non-medicated products depending on patient condition. This can enhance
health of patients.

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A Guide to Pharmacy Technician 140