LECTURE NOTE ON DISPENSING (PHARMACY PRACTICE)

Definition of Dispensing

Dispensing is the art and science of preparing, packaging, labeling, and supplying medicines
to patients based on a valid prescription, ensuring safety, accuracy, and proper patient
understanding.

The Art of Dispensing

The art of dispensing involves communication, empathy, and professional judgment. It

includes counseling patients on medication use, maintaining confidentiality, and ensuring
patients understand their treatment.

The Science of Dispensing

The science aspect involves knowledge of drugs, dosages, interactions, and accurate
preparation. It includes interpreting prescriptions correctly and ensuring the right medicine
is given.

Steps in the Dispensing Process

1. Receiving the prescription

2. Assessing the prescription
3. Preparing the medication
4. Packaging and labeling
5. Patient counseling
6. Documentation

Importance of Dispensing

Dispensing ensures safe use of medicines, prevents errors, improves patient compliance,
and enhances treatment outcomes.

Common Dispensing Errors

Examples include wrong drug, incorrect dosage, poor labeling, and giving medication to the
wrong patient.

Personnel Involved

Dispensing is carried out by pharmacists and pharmacy technicians under supervision in

hospitals, clinics, and community pharmacies.

Conclusion

Dispensing is a vital part of healthcare that combines knowledge and skill to ensure patients
receive the correct medications safely.
The Dispenser’s Role and Professional Responsibilities

In the pharmacy ecosystem, the Pharmacy Technician (or Dispenser) serves as the engine of
the dispensary. While the Pharmacist provides clinical oversight and final accountability,
the Technician ensures the operational accuracy and safety of the medication supply chain.

1. Professional Conduct and Ethics

Professionalism in pharmacy goes beyond wearing a clean tunic; it is about maintaining

public trust.

 Standard of Care: Always acting in the best interest of the patient.

 Confidentiality: Strict adherence to data protection laws (like HIPAA or GDPR).

Patient details, prescriptions, and medical histories must never be discussed outside
the professional circle.

 Integrity: Being honest about errors. If a "near miss" or a dispensing error occurs, it
must be reported immediately to the Pharmacist.

 Professional Boundaries: Maintaining a formal, respectful relationship with

patients and healthcare colleagues.

2. Cleanliness and Environmental Standards

A pharmacy is a clinical environment. Contamination can lead to degraded medication or

patient infection.

 Personal Hygiene: Short, clean nails; minimal jewelry; and hair tied back.
Handwashing is the most effective way to prevent cross-contamination.

 Workstation Management: * "Clear as you go": Never have more than one
patient’s medication on the dispensing bench at a time.

o Sanitization: Counting triangles and electronic counters must be cleaned

after every use, especially after handling "dusty" tablets (like Penicillin or
Prednisolone) to avoid allergic cross-reactions.

 Storage: Ensuring drugs are stored at correct temperatures (e.g., maintaining the
"Cold Chain" for insulin at 2°C to 8°C).
3. The Dispensing Process: Accuracy is Key

Accuracy isn't just about the right drug; it’s about the "Five Rights": Right Patient, Right
Drug, Right Dose, Right Route, and Right Time.

 The Clinical Check: Before you touch a bottle, the Pharmacist must clinically screen
the prescription for safety/interactions.

 Technical Accuracy: 1. Selection: Double-check the drug name and strength

against the prescription. Watch out for "LASA" (Look-Alike, Sound-Alike) drugs. 2.
Labeling: Ensure instructions are clear, concise, and match the prescriber's intent.
3. The Final Check: A systematic check of the drug, the label, and the patient's
details. Never self-check your own work if another staff member is available.

4. Legal Responsibilities and Supervision

The Pharmacy Technician operates under a specific legal framework, primarily dictated by
the concept of Supervision.

 The "Pharmacist in Charge": A Technician cannot open the pharmacy or dispense

medication unless a registered Pharmacist is physically present and in charge of the
premises.

 Legislative Compliance: * Controlled Drugs (CDs): Strict legal requirements for

storage (CD cabinets), record-keeping (CD Registers), and destruction.

o Prescription Validity: Recognizing the legal requirements of a prescription

(e.g., signature, date, patient address).

 Accountability: While the Pharmacist is legally accountable for the pharmacy's

actions, the Technician is professionally accountable for their own practice. You are
responsible for staying within your "Scope of Practice."

Key Takeaway: The Dispenser is the final line of defense before a medication reaches a
patient. Accuracy in this role isn't an aspiration—it’s a legal and ethical mandate.

Introduction to the Dispensing Environment

The dispensing environment is a specialized area within a pharmacy designed for the
accurate preparation, labeling, and issuance of medications. Because this is the final stage
before a patient receives their treatment, the environment must be strictly controlled to
prevent medication errors, contamination, and the degradation of drug products.
1. Physical Environment Requirements

Lighting

Proper lighting is non-negotiable for safety. It reduces the risk of misreading prescriptions
or selecting the wrong medication (look-alike/sound-alike drugs).

 Intensity: A minimum of 500 to 600 lux is generally recommended for general

pharmacy work, with higher intensity (800+ lux) at specific counting and
compounding stations.

 Quality: Lighting should be uniform, glare-free, and designed to minimize shadows.

Natural light is beneficial but must be controlled to prevent direct sunlight from
hitting heat-sensitive medications.

Ventilation and Temperature Control

Medications are chemical entities that can degrade if exposed to improper climates.

 Temperature: The general dispensary should be maintained at a "cool" room

temperature (usually 20°C to 25°C).

 Humidity: Relative humidity should ideally be kept below 60% to prevent

moisture-sensitive tablets or capsules from softening or degrading.

 Airflow: Proper ventilation prevents the accumulation of dust and chemical vapors.
In areas where hazardous drugs (like cytotoxics) are handled, specialized exhaust
systems or laminar flow hoods are required.

Cleanliness and Hygiene

A sterile-like mindset should be applied even in non-sterile dispensing areas.

 Surface Materials: Countertops should be made of non-porous, smooth, and

chemically resistant materials (e.g., stainless steel or high-pressure laminates) to
allow for easy disinfection.

 Waste Management: Separate bins must be available for general waste, clinical
waste (sharps), and pharmaceutical waste (expired/returned drugs).

 Personal Hygiene: Proximity to a sink with hot and cold running water,
antibacterial soap, and hand dryers is mandatory for staff.

2. Essential Dispensing Equipment

To ensure precision, a standard dispensary must be equipped with calibrated and well-
maintained tools.
Balances and Weighing Tools

Accuracy in weighing is the foundation of pharmaceutical compounding.

 Electronic Analytical Balances: Used for high-precision weighing of potent

medicinal powders.

 Class B Beam Balances: Traditionally used for larger quantities, though largely
replaced by digital scales in modern settings.

 Calibration: All balances must be leveled and calibrated daily using standard
weights.

Counting and Measuring Tools

 Counting Trays (Triangles): Used for counting tablets and capsules. Separate trays
should be designated for "dusty" medications or penicillin-based products to avoid
cross-contamination.

 Spatulas: Usually made of stainless steel for strength or hard rubber/plastic for
chemicals that react with metal (like iodine).

 Graduated Cylinders: Used for measuring liquids. Measurements should always be

read at the bottom of the meniscus at eye level.

Compounding Equipment (Extemporaneous Preparations)

 Mortar and Pestle:

o Glass: Best for liquid preparations and staining substances.

o Porcelain/Wedgwood: Best for reducing the particle size of hard crystals

(trituration) due to the rough surface.

 Ointment Slabs: Large glass or porcelain plates used for mixing creams and
ointments.

3. Storage and Organization

A standard dispensary follows the "Aseptic Technique" of organization:

1. Professional Zone: Where the pharmacist reviews the prescription.

2. Dispensing Zone: Where the actual counting and labeling occur.

3. Storage Zone: Organized by "First In, First Out" (FIFO) or "First Expired, First Out"
(FEFO) principles.
 o Cold Chain: Refrigerators must maintain a strict 2°C to 8°C and be
monitored by a calibrated thermometer.

o Secure Storage: Controlled substances (narcotics) must be kept in a double-

locked safe bolted to the floor.

bThe Prescription: Definition and Legal Validity in Nigeria

A prescription is more than just a piece of paper; it is a legal document and a written
instruction from a registered prescriber to a pharmacist or a dispenser. It authorizes the
compounding and dispensing of a specific medication for a specific patient.

1. Definition of a Prescription

In a clinical and legal sense, a prescription is a formal communication between a

healthcare professional (Physician, Dentist, or Veterinary Surgeon) and a Pharmacist.

 Primary Purpose: To ensure the patient receives the correct drug, in the correct
dose, via the correct route, for the correct duration.

 Secondary Purpose: To serve as a legal record of treatment and a tool for

monitoring drug utilization.

2. Legal Validity: What Makes a Prescription Legal in Nigeria?

In Nigeria, the legality of a prescription is governed by the Pharmacists Council of Nigeria

(PCN) Act and the National Drug Policy. For a prescription to be considered legally valid
and "dispensable," it must meet the following criteria:

A. The Prescriber's Qualifications

Only specific professionals registered with their respective regulatory bodies in Nigeria can
legally sign a prescription:

1. Registered Medical Practitioners (Doctors)

2. Registered Dentists (For dental-related conditions)

3. Registered Veterinary Surgeons (For animal treatment only)

Note: In some specific primary healthcare settings, specially trained nurses may have limited
prescribing rights under strict protocols.

B. Essential Legal Components (The Anatomy of a Prescription)

To be legally valid, the document must contain these specific elements:

 1. Prescriber’s Details:

o Full Name and Address of the prescriber.

o Registration Number: The professional license number assigned by the

MDCN or VCN.

o Signature: It must be signed in ink (or a validated electronic signature

where applicable).

2. Patient’s Details:

o Full Name and Address.

o Age/Weight: Especially critical for pediatric (children) and geriatric

(elderly) patients to verify dose safety.

3. The Date:

o A prescription has a "shelf life." Generally, a standard prescription is valid

for 6 months from the date of issue.

o Controlled Drugs: Prescriptions for narcotics or psychotropic substances

often have much shorter validity (typically 2 to 4 weeks) and cannot be
refilled.

4. The Medication Details (The Core):

o Superscription: The symbol Rx (derived from the Latin Recipe, meaning

"Take Thou").

o Inscription: The name of the drug, the strength (e.g., 500mg), and the
formulation (e.g., Tablet, Syrup).

o Subscription: Instructions to the pharmacist (e.g., "Dispense 21 tablets").

o Transcription (Signatura): Instructions to the patient (e.g., "Take one

tablet three times daily after meals").

3. Legal Requirements for Controlled Substances

For "Scheduled" or Controlled Drugs (e.g., Morphine, Diazepam), Nigerian law requires
additional rigor:

 The prescription must be handwritten by the prescriber in some jurisdictions to

prevent forgery.
  The total quantity of the drug must be written in both words and figures (e.g.,
Twenty-one (21) tablets).

 The patient’s full address is mandatory; a P.O. Box is usually insufficient.

4. Why Legality Matters

A pharmacist in Nigeria is legally bound to refuse a prescription if:

 It is undated or the date has expired.

 It is not signed by a recognized, registered professional.

 The ink is altered or there are signs of tampering without a countersignature.

 The dose appears dangerously high or "toxic" for the patient's age/weight.

Key Rule: A prescription is a "permission slip" for a pharmacist to release a regulated

chemical. If the document is legally flawed, the pharmacist bears the liability for any
resulting harm.

Detailed Anatomy of a Pharmaceutical Prescription

A prescription is structured into specific sections, each serving a distinct legal and clinical
purpose. Understanding these parts is essential for any pharmacy professional to ensure the
correct medication is prepared and the patient understands how to use it safely.

1. The Superscription

The Superscription is the traditional opening of the prescription.

 Symbol: It is represented by the symbol Rx.

 Origin: It is an abbreviation for the Latin word Recipe, which translates to "Take
Thou" or "Take."

 Significance: Historically, it was an invocation to the gods for the patient's

recovery, but in modern practice, it serves as the formal "command" or instruction
from the prescriber to the pharmacist to begin the dispensing process.

2. The Inscription

The Inscription is the "body" or the most critical part of the prescription. It identifies
exactly what is being prescribed.
  Content: It includes the names and quantities (strengths) of the medicinal
ingredients.

 Modern Context: In modern practice, this usually consists of a single brand or

generic drug name (e.g., Amoxicillin 500mg capsules).

 Compound Context: For extemporaneous preparations (medicines mixed by the

pharmacist), the inscription lists:

o The Base: The active ingredient.

o The Adjuvant: Aids the action of the base.

o The Corrective: Improves flavor or reduces side effects.

o The Vehicle: The medium (liquid or base) that carries the other ingredients.

3. The Subscription

The Subscription consists of the prescriber’s specific instructions to the pharmacist or

dispenser.

 Purpose: It dictates the pharmaceutical form (e.g., tablet, syrup, ointment) and the
total amount to be dispensed.

 Examples:

o "Mitte 20 tablets": (Mitte is Latin for "Send" or "Dispense") Instructions to

provide 20 tablets to the patient.

o "Fiat Mistura": "Let a mixture be made."

o "Dispense 100ml": Modern instruction for liquid volume.

4. The Signatura (or Transcription)

The Signatura (often abbreviated as Sig. or Signa) contains the instructions intended for
the patient.

 Purpose: These instructions are transcribed by the pharmacist onto the medication
label.

 Content: It includes the dose, the route of administration, the frequency, and any
special conditions.

 Examples:
 o "Take one tablet daily" (Indicates dose and frequency).

o "Apply to the affected area twice daily" (Indicates route and frequency).

o "Take after meals" (Indicates special timing).

5. Other Essential Parts (Auxiliary Data)

For a prescription to be legally complete, the following must accompany the four parts
listed above:

 Date of Issue: Essential for determining if the prescription is still valid (6 months
for standard drugs in Nigeria).

 Patient Identity: Full name, address, and particularly age/weight for pediatric
patients to verify the Inscription’s dosage.

 Prescriber’s Signature & Stamp: The legal "seal" of the document. Without a fresh
signature in ink (or a secure digital equivalent), the prescription is void.

Practical Tip for Students: When screening a prescription, always read from top to
bottom. If the Subscription (amount to send) doesn't match the Signatura (frequency x
duration), you must contact the prescriber to clarify the discrepancy before dispensing.

Medical Abbreviations and Terminology in Pharmacy Practice

In Nigerian clinical practice, many prescribers still utilize Latin abbreviations to

communicate instructions efficiently. For a pharmacy technician or pharmacist, mastering
these is critical for accurately transcribing the Signatura (patient directions) onto the
medication label.

Errors in interpreting these abbreviations are a leading cause of medication errors.

1. Frequency of Administration

These abbreviations tell the dispenser how many times a day the medication should be
taken.

Abbreviation Latin Term English Meaning

b.i.d. bis in die Twice daily (usually every 12 hours)

t.i.d. ter in die Three times daily (usually every 8

Abbreviation Latin Term English Meaning

hours)

quater in die / quater die

q.i.d. / q.d.s. Four times daily (usually every 6 hours)
sumendus

o.d. omne die Once daily

o.m. omne mane Every morning

o.n. omne nocte Every night

2. Timing of Administration

These abbreviations specify when the dose should be taken in relation to meals or sleep,
which often affects drug absorption or gastric irritation.

Abbreviation Latin Term English Meaning

a.c. ante cibum Before meals (usually 30–60 minutes before)

p.c. post cibum After meals (usually 30 minutes after)

h.s. hora somni At bedtime

i.c. inter cibum Between meals

c.m. cras mane Tomorrow morning

3. Usage and Emergency Instructions

These terms define the "why" and "how fast" of the administration.

Abbreviation Latin Term English Meaning

p.r.n. pro re nata As needed / As the occasion arises

stat statim Immediately / At once

sos si opus sit If necessary (often used for a single dose)

q.h. quaque hora Every hour

Abbreviation Latin Term English Meaning

q.4h. quaque quarta hora Every four hours

4. Routes of Administration

While not in your initial list, these are equally vital for a comprehensive lecture note:

 p.o. (per os): By mouth / Orally.

 n.p.o. (nil per os): Nothing by mouth.

 a.d. (auris dextra): Right ear.

 a.s. (auris sinistra): Left ear.

 o.u. (oculus uterque): Both eyes.

5. Best Practices for the Modern Dispensary

While these abbreviations are standard, modern safety protocols (such as those from the
ISMP) suggest a shift toward plain English to avoid confusion.

1. Avoid Ambiguity: The abbreviation q.d. (once daily) can easily be mistaken for
q.i.d. (four times daily). It is safer to write "Daily."

2. Transcription: Never write the Latin abbreviation on the patient's label. The label
must always be in clear, simple English (e.g., Change t.i.d. p.c. to "Take one tablet
three times daily after meals").

3. The "Zero" Rule: Always use a leading zero (0.5mg) but never a trailing zero (5mg,
not 5.0mg) to prevent tenfold dosing errors.

Student Exercise: Practice Scenarios

 Scenario A: A prescription says "Paracetamol 500mg, 2 tabs t.i.d. p.r.n. pain."

o Translation: Take two tablets three times daily as needed for pain.

 Scenario B: A prescription says "Omeprazole 20mg, 1 cap o.d. a.c."

o Translation: Take one capsule once daily before meals.

Pharmaceutical Weights and Measures

In pharmacy, precision is the difference between a therapeutic dose and a toxic one. While
the Metric System is the official standard for prescribing and dispensing in Nigeria,
patients often use Household Measures at home. A key role of the pharmacy technician is
to ensure these two systems are reconciled safely.

1. The Metric System (The Standard)

The metric system is a decimal system (based on units of 10), which makes calculations
straightforward and reduces the risk of error.

Unit Symbol Relationship Common Usage

Microgram mcg or mug 1,000mcg = 1mg Very potent drugs (e.g., Digoxin)

Milligram mg 1,000mg = 1g Most tablet and capsule strengths

Gram g 1,000g = 1kg Bulk powders or ointments

Milliliter mL 1mL = 1cm^3 Liquid doses and injections

Liter L 1,000mL= 1L Large volume infusions (IV fluids)

2. Household Measures in Nigeria

Patients often do not have graduated medicine cups at home and rely on kitchen spoons. In
Nigeria, these are the standardized volumes used for counseling patients:

 1 Teaspoonful approx 5mL

 1 Dessertspoonful approx10mL

 1 Tablespoonful approx 15mL

The "Spoon" Danger

It is important to educate patients that a "teaspoon" used for tea in a Nigerian household
can vary from 3mL to 7mL. For narrow-therapeutic-index drugs (like those for asthma or
heart conditions), always provide a graduated oral syringe or a standardized medicine
cup.
3. Metric-Imperial Conversions (Historical & Practical)

While the Imperial system (Ounces, Grains, Drachms) is largely phased out, some older
references or international texts still mention them.

 Weight:

o 1ounce (oz)approx 28.35g (often rounded to 30g in compounding).

o 1 pound (lb)approx 454g.

o 1grain (gr)approx 65 mg (Note: Do not confuse gr with g).

 Volume:

o 1 fluid ounce (fl oz) \approx 28.4mL (Standardized to 30mL for dispensing).

4. Calculation Rules for Students

1. Never assume: If a prescription says "two spoonfuls," clarify if the prescriber meant
a 5mL teaspoon or a 15mL tablespoon.

2. Move the Decimal: * To convert Grams to Milligrams, move the decimal point 3
places to the right (0.5g = 500mg).

o To convert Milligrams to Grams, move the decimal point 3 places to the

left (250mg = 0.25g).

3. Labeling: Always write the dose in mL on the bottle label, even if the patient is
using a spoon, to ensure the volume is legally documented.

Practice Calculation Exercises: Weights and Measures

To ensure your students have mastered the conversion between the Metric System and
Household Measures, here are five practical scenarios they might encounter in a Nigerian
dispensary.
Exercise 1: Basic Volume Conversion

A prescription for a pediatric cough syrup reads: "Take 5mL t.i.d. for 5 days."

 Question: If the mother only has a standard teaspoon at home, how many
teaspoonfuls should she give per dose? What is the total volume (in mL) needed for
the full 5-day course?

 Answer: 1 teaspoonful per dose; 75mL total.

Exercise 2: Converting Grams to Milligrams

An inscription reads: "Amoxicillin 0.25g capsules." The pharmacy only has 250mg
capsules in stock.

 Question: Is the 250mg capsule the correct strength? Show the calculation.

 Answer: Yes. 0.25g \times 1,000 = 250mg.

Exercise 3: Large Volume (The Dessertspoon)

A patient is prescribed an antacid: "Take 10mL p.c. and h.s."

 Question: How many dessertspoonfuls is this per dose? If the bottle contains
200mL, how many doses are in the bottle?

 Answer: 1 dessertspoonful; 20 doses.

Exercise 4: The Tablespoon Mix-up

A prescription for a bulk laxative says: "Take 1 tablespoonful o.n."

 Question: How many milliliters (mL) is the patient taking each night? If they
accidentally use a teaspoon instead, by how many mL are they under-dosing?

 Answer: 15mL per night; they would be under-dosing by 10mL (15mL - 5mL).

Exercise 5: Rehydration Calculation (ORS)

A mother is told to reconstitute one sachet of Oral Rehydration Salts (ORS) in 1 Liter of
clean water. She has a glass (tumbler) that holds 250mL.

 Question: How many tumblers of water does she need to measure out to reach the
1 Liter mark?

 Answer: 4 tumblers (1,000mL \ 250mL = 4).

Introduction to Dosage Forms

In pharmacy, a Drug is the active pharmaceutical ingredient (API) that has a therapeutic
effect. However, a patient cannot simply take a pure chemical powder. It must be converted
into a usable, safe, and stable format. This format is called a Dosage Form.

Definition: A dosage form is the physical manifestation of a drug (API) combined with non-
medicinal substances called excipients or additives, designed to facilitate administration
and improve patient compliance.

1. Why are Dosage Forms Necessary?

We do not give pure drugs to patients for several critical reasons:

1. Dose Accuracy: Some drugs are potent at microgram ($\mu\text{g}$) levels. It is

impossible for a patient to weigh this at home; a tablet or capsule provides a pre-
measured, accurate dose.

2. Protection: To protect the drug from gastric juice (e.g., enteric-coated tablets) or
from atmospheric moisture and light.

3. Taste Masking: Many drugs are extremely bitter. Coating them or turning them into
flavored syrups makes them palatable, especially for children.

4. Controlled Release: To allow the drug to be released slowly over 12 to 24 hours,

reducing the number of times a patient has to take it.

5. Targeted Delivery: To place the drug exactly where it is needed (e.g., eye drops for
the eye, ointments for the skin).

2. Components of a Dosage Form

Dosage Form = Active Pharmaceutical Ingredient (API) + Excipients

 API: The chemical responsible for the cure or prevention of disease (e.g.,
Paracetamol).

 Excipients: Inactive substances that give the dosage form its shape, bulk, and
stability.

o Examples: Diluents (fillers), Binders (glues), Disintegrants (help tablets

break up in the stomach), and Preservatives.

3. Classification of Dosage Forms

Dosage forms are primarily classified by their Physical State.

A. Solid Dosage Forms

These are the most common and stable forms.

 Tablets: Compressed powders (e.g., Aspirin).

 Capsules: Drug enclosed in a gelatin shell (e.g., Amoxicillin).

 Powders/Granules: Often reconstituted with water (e.g., ORS).

 Suppositories: Solids designed for insertion into the rectum or vagina where they
melt at body temperature.

B. Liquid Dosage Forms

Used for patients who have difficulty swallowing solids (pediatrics/geriatrics).

 Solutions: Clear liquids where the drug is completely dissolved (e.g., Paracetamol
syrup).

 Suspensions: Liquids containing undissolved drug particles that must be shaken

before use (e.g., Antacid gels).

 Emulsions: A mixture of oil and water (e.g., Cod liver oil).

C. Semi-Solid Dosage Forms

Mainly intended for topical application to the skin or mucous membranes.

 Ointments: Greasy/oily bases (e.g., Vaseline-based).

 Creams: Emulsions of oil and water; less greasy than ointments.

 Gels: Transparent, water-based semi-solids.

D. Gaseous Dosage Forms

 Aerosols/Inhalers: Drugs delivered directly to the lungs via a pressurized spray

(e.g., Salbutamol for asthma).

4. Routes of Administration

The choice of dosage form depends heavily on the Route of Administration:

 Oral: Tablets, Syrups (Most common).

 Topical: Creams, Ointments (Local effect on skin).

  Parenteral (Injections): IV, IM, SC (Fastest action).

 Inhalation: Gases, fine powders (For respiratory issues).

Summary Table: Comparison of Major Forms

Form Type Advantage Disadvantage

Solid Stable, accurate dose, easy to carry. Slow onset of action (must dissolve).

Liquid Fast absorption, easy to swallow. Less stable, requires measuring device.

Semi-Solid Targets a specific area (local). Can be messy or stain clothes.

Inhalant Rapid action for lung conditions. Requires specific technique to use.

Labeling and Packaging in the Dispensary

Packaging and labeling are the final steps in the dispensing process. They ensure that the
medication remains stable and, more importantly, that the patient knows exactly how to use
it safely once they leave the pharmacy.

1. Essential Label Information

A label is a legal requirement. In Nigeria, a label must be clear, legible, and written in
English (or the patient's local language if necessary). The following details are mandatory:

 Patient Name: To ensure the right person takes the medication.

 Date of Dispensing: To track the medication's age and validity.

 Name of the Drug: Use the generic name (e.g., Paracetamol) or the brand name if
specifically prescribed.

 Strength and Quantity: (e.g., 500mg tablets, 21 tablets).

 Clear Directions: These must be in plain English, transcribed from the Signatura
(e.g., "Take one tablet three times daily after meals").

 Pharmacy Details: The name and address of the pharmacy where the drug was
dispensed.

 Expiry Date: The date after which the drug should no longer be used.
2. Auxiliary (Cautionary) Labels

Auxiliary labels are secondary instructions that provide critical safety information or
storage advice. They are often printed on colored paper (red, yellow, or blue) to grab the
patient’s attention.

 "Shake the Bottle": Essential for Suspensions and Emulsions where the active
ingredient may settle at the bottom.

 "For External Use Only": Used for creams, ointments, and lotions to prevent
accidental ingestion.

 "Keep Out of Reach of Children": A universal safety warning for all medications.

 "Complete the Course": Crucial for antibiotics to prevent drug resistance.

 "May Cause Drowsiness": For drugs like antihistamines that affect alertness;
advises the patient not to drive or operate machinery.

3. Pharmaceutical Containers

The choice of container depends on the physical form of the drug and its chemical
sensitivity to the environment.

Amber Glass/Plastic Bottles

 Purpose: To protect light-sensitive medications.

 Mechanism: Amber glass filters out ultraviolet (UV) light, which can decompose
certain chemicals (e.g., Vitamin syrups, certain antibiotics).

Tablet Envelopes and Strips

 Purpose: Used for short-term dispensing of solid dosage forms (tablets/capsules).

 Requirement: They must be labeled clearly. However, modern practice prefers

blister packs for better protection against moisture.

Airtight Jars and Child-Resistant Closures

 Airtight Jars: Used for hygroscopic drugs (drugs that absorb moisture from the air)
and semi-solids like extemporaneous creams.

 Child-Resistant Caps: Designed to be difficult for children under five to open,

preventing accidental poisoning.
4. General Rules for Labeling

1. Readability: Use a pen with permanent ink or a printed label. Never use a pencil.

2. No Abbreviations: Do not use "t.i.d." on a label; write "Three times a day."

3. Accuracy Check: Always double-check the label against the original prescription
before sticking it onto the container.

Summary Checklist: The "7 Rights" of Labeling

 Right Patient

 Right Drug

 Right Dose

 Right Route

 Right Time/Frequency

 Right Documentation (Date/Sign)

 Right Warning (Auxiliary Labels)

Aseptic Practices and Hygiene in the Dispensary

In a dispensary, hygiene is not just about neatness; it is a clinical requirement to ensure

patient safety. Aseptic practices refer to the techniques used to prevent the introduction of
microorganisms (bacteria, viruses, fungi) and foreign particles into medicinal preparations.

1. Personal Hygiene and Professional Attire

The dispenser is often the primary source of contamination. Maintaining high standards of
personal hygiene is the first line of defense.

 Hand Washing: This is the most effective way to prevent the spread of infection.
Hands must be washed with antibacterial soap and water before and after handling
any medication.
  Laboratory Coats: * Function: They protect the dispenser’s clothes from chemical
spills and, more importantly, prevent dust and fibers from personal clothing from
falling into the medicine.

o Maintenance: Lab coats must be kept clean, buttoned up, and washed
regularly. They should only be worn inside the pharmacy or lab area—never
in the cafeteria or restrooms.

 Hair and Nails: Hair should be tied back or covered. Fingernails must be kept short
and clean, as long nails can harbor bacteria and tear gloves.

 Avoidance of Habits: Eating, drinking, smoking, or applying makeup in the

dispensing area is strictly prohibited to prevent accidental ingestion or
contamination of drugs.

2. Preventing Cross-Contamination

Cross-contamination occurs when a residue of one drug is accidentally mixed into another.
This is especially dangerous for patients with allergies (e.g., Penicillin allergy).

 Dedicated Equipment: Use separate counting trays and spatulas for highly "dusty"
drugs or known allergens.

 The "Clean-Between" Rule: Every piece of equipment (counting trays, spatulas,

and bench surfaces) must be wiped down with 70% Isopropyl Alcohol after each
use, especially when switching between different types of tablets.

 Dust Control: When pouring tablets or capsules from bulk containers, do so gently
to minimize the release of medicinal dust into the air.

 Direct Contact: Never touch tablets or capsules with bare hands. Always use a clean
spatula or counting triangle.

3. Proper Cleaning of Dispensing Equipment

Equipment used for compounding, such as mortars, pestles, and ointment slabs, must be
cleaned thoroughly to ensure no chemical residue remains for the next preparation.

Cleaning Mortars and Pestles:

1. Initial Rinse: Rinse with warm water to remove the bulk of the preparation.
 2. Detergent Wash: Use a mild, fragrance-free detergent and a brush to scrub the
interior of the mortar and the head of the pestle.

3. Removal of Stains/Odors:

o For oily substances: Use a small amount of alcohol or a specialized

degreaser.

o For stained porcelain (e.g., Iodine): A paste of water and scouring powder or
a dilute bleach solution may be used, followed by a thorough rinse.

4. Final Rinse: Always finish with a rinse of purified or distilled water to remove
mineral deposits from tap water.

5. Drying: Air-dry upside down on a clean lint-free towel or use a drying oven.

Cleaning Ointment Slabs:

 Use a spatula to scrape off as much excess ointment as possible into a waste bin.

 Wipe the glass surface with a paper towel soaked in a solvent (like alcohol or soap
solution) to remove the greasy base.

 Wash with warm soapy water, rinse, and dry.

Practical Rule: If you drop a tablet on the floor or a contaminated surface, it is no longer fit
for use. It must be discarded into the Pharmaceutical Waste bin—never put it back in the
bottle.