Learning Module: Dispensing of Pharmaceuticals-I | ORHB

Dispensing of
Pharmaceuticals-I
Learning Module
Module Code: HLT PRA2-M-02 1217 V1

December 2017
Learning Module: Dispensing of Pharmaceuticals-I | ORHB

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Preface
In response to the critical shortage of pharmacy/Medical laboratory personnel in Oromia National
regional state, a group of experts from universities and colleges in the region have developed an
Outcome based TVET Model curriculum for Pharmacy Level II-IV programs in October, 2017
with the initiative of Oromia Regional Health Bureau.

The outcome based curriculum was developed in reference to the level based 2011 Ethiopian
Occupational standard. The guiding principle in the development of the outcome based curriculum
was to train Pharmacy professionals in focused, time efficient and outcome based approach, and
to fill the existing pharmacy works force shortage with competent professionals.

The key features of the outcome based curriculum include: use of variety of teaching/learning
methods, repeated exposure of trainees to skill laboratories, practical attachment/cooperative
training and the delivery of the training in standardized learning modules (information sheets) and
skill lab manual/checklists (Operation sheets).

This learning module was developed by a diverse group of experts from higher teaching
institutions in Oromia region, experts from Oromia Regional health bureau, Oromia TVET,
Oromia COC agency and professional associations.

This Dispensing of Pharmaceuticals I learning Module covers 3 unit of competencies in the level
II pharmacy program. The learning module covers both theoretical and practical aspects of the
competencies.

Dear Trainee, you are expected to read the information presented in the learning module, attempt
all the self-check questions and perform skill activities as per the skill lab learning guide/checklist.

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Acknowledgment

This Dispensing of Pharmaceuticals I learning module and skill lab manual for Retail Pharmacy
assisting Level II Program was developed by experts from Universities and Colleges in Oromia
National Regional State.

Oromia Regional Health Bureau and Oromia TVET Bureau would like to acknowledge the
following individuals and their organization for their dedication, kind participation, and expert
contributions in the development of this training material.

Abay Kasa AHMC

Abdi Leggese ORHB
Abdurazak Jemal Tura Arsi University
Asrat Hordofa AA Uniersity
Biranu Motbaynor Haromaya University
Desalegn Chilo Mettu University
[Link] Bedada Salale University
Edao Sado Wollega University
Ermias Mergia AHMC
Getu Melesie Ambo University
Mamo Abdi ORTETB
Mekuria Kebede OOCAA
Mustefa Ahmed Ambo University
Shibiru Tesema Jimma University
Teferi Guji Jhpiego
Tena Tilki Gimbi [Link]
Tesemma Sileshi Ambo University
Zerihun Ayenew ORHB

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Abbreviations
CDC Centers for Disease Control and Prevention
DICs Drug information centers
FEFO First expiry first out
FIFO First in first out
FMHACA Food, Medicine and Healthcare Administration and Control Authority
FP Flash point
ICD International Statistical Classification of Diseases
OSHA Occupational Safety and Health Administration
OTC Over-the-counter
PPE Personal protective equipment
PRB Prescription registration book
SDSs safety data sheets
SOPs Operating procedures

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Contents
Abbreviations ............................................................................................................................................... iv
1. Dispensing Environment and stock management ................................................................................. 1
1.1. Introduction .................................................................................................................................. 1
1.2. Dispensing environment ............................................................................................................... 2
1.3. Dispensary stock management ..................................................................................................... 9
2. Prescription and Abbreviations in prescription writing ...................................................................... 29
2.1 Introduction to prescription ....................................................................................................... 29
2.2 Common abbreviations in prescription writing .......................................................................... 34
3. Computer and Medication information in pharmacy .......................................................................... 44
3.1 Computer systems in pharmacy ................................................................................................. 44
3.2 Medication information in dispensary ........................................................................................ 46
3.3 Sources of medicine information ................................................................................................ 46
4. Selling products and customer services .............................................................................................. 49
4.1 Client-centered healthcare ......................................................................................................... 50
4.2 Patient counselling in dispensary................................................................................................ 52
5. Principles and processes of good dispensing practice......................................................................... 55
5.1 Principles of Good Dispensing..................................................................................................... 55
5.2 Dispensing process...................................................................................................................... 56
5.3 Dispensing errors ........................................................................................................................ 88
5.4 Refusal to dispense prescriptions ............................................................................................... 92
Module Syllabus ....................................................................................................................................... 100

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1. Dispensing Environment and stock management

Objective
At the end of this chapter you will be able to
o Describe dispensing environment
o Elaborate on the use of dispensing equipments
o Outline the requirement on retail premises and facility in dispensary
o List personal protective equipments in pharmacy
o Sort role of pharmacy profession in dispensing units
o Accomplish appropriately dispensary stock management
o Perform drug arrangement in dispensing units.
o Classify pharmaceutical storage condition

1.1. Introduction

Dispensing refers to the process of preparing and supplying medicines to a named person together
with clear instructions, advice and counselling on the use of medicines. It involves:
correct interpretation of the order for prescribed medicines
accurate preparation
labelling of medicines for use by the patient.
 Good dispensing ensures the right medicines of desired quality are delivered
o to the right patients
o with the right dose (strength, frequency, dosage form, quantity)
o with clear instructions (both written and verbal)
o with appropriate packaging.
 Any error or failure in the dispensing process can seriously affect the care of the patient.
 Programs to improve rational use concentrated on ensuring
o rational prescribing habits
o overlooking dispensing
o patient’s use of medicines.
 Resources involved in patient care prior to dispensing wasted if dispensing does not result in
 named patient receiving effective form of correct drug
 appropriate packaging with correct dose and advice.

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 The following are summary of dispensing

o A process of preparing and giving medicine to a client.
o Correct prescription interpretation.
o Accurate preparation & labeling of medicine.
o Take place in health center, hospital, or community pharmacy setting.
o Carried out by pharmacy professionals with a variety of training

 Accuracy & quality of medicines supplied lies on persons managing dispensing process
 Dispensing staffs need
o technical knowledge and skills necessary to dispense.
o effective communication with patients or care givers.

1.2. Dispensing environment

A safe, clean and organized working environment provides the basis for good dispensing practice.
Dispensing environments must be clean, because medicinal products which are used on human
being should be hygienic and uncontaminated. The environment must also be organized so that
dispensing can be performed accurately and efficiently. In retail environment approaching
customer in good manner, matching customer needs and providing drug information is very vital.

Clients may be required to wait while their prescriptions are being filled, so a waiting area should
be available as pharmacist need enough time to attend to the queries of the patient.

Appropriate waiting area in dispensing room should have the following:

 Comfortable chairs/place to sit (at least for the elderly/disabled/ sick patient to rest
 Current popular health magazines and selected materials related with health to keep the
clients busy/occupied, and prevent boredom while waiting to receive medicines
 Pamphlets and posters related to public, family and other individuals health problems
prominently displayed (as the waiting area could be used as education center)
1. Premise and Facility
The premises on which a dispensing service is provided would reflect the quality of service and
inspire confidence on patients in the nature of pharmaceutical service delivered.

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 Requirements for Premise and Facility

o The walls, floors, windows, ceiling, and all other parts of the premises should be as per
the requirement set by the regulatory body Food, Medicine and Healthcare
Administration and Control Authority (FMHACA).
o Rooms with minimum area specified required for dispensing & storing medicines.
o Toilet with water supply and drainage system is also a requirement.
o All parts of the premises should be maintained in an orderly and tidy condition.
o Pharmaceutical products should be protected from the adverse effect of light, freezing
or temperature extremes and humidity.

 The dispensing environment should possess:

 Appropriate temperature with sufficient lighting
 Optimum humidity control
 Cold storage facilities
 Adequate number and type of shelves
 Lockable cabinet for controlled substance & poisons
 Patient/care provider waiting area
 Sufficient dispensing equipments, etc.
2. Hygiene and Sanitation
 The physical surroundings must be maintained free of dust and dirt materials.
 Locate in a protected place
 Not open to a road or dust, dirt, and pollution.
 Requires a regular routine of cleaning shelves
 A daily cleaning of floors and working surfaces.
There should be a regular schedule for
o Checking, cleaning, and defrosting refrigerator.
o Spills should be wiped up immediately

☞ especially if liquid spilled is sticky, sweet, or attractive to insects.

o Food and drink must be kept out of the dispensing area
o Refrigerator used strictly for medicines use only.
 Smoking should be prohibited in area where medicines are dispensed or supplied.

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 Direct contact between the operator’s hands and the dispensed products should be avoided
 Dispensing equipment used for counting pills should be kept clean at all times.
e.g., uncoated tablets leave a layer of powder on any surface they touch, which can easily
be transferred to other tablets or capsules counted on the same surface.
 All persons engaged in dispensing should
observe high standards of personal cleanliness
wear protective cloths that should be cleaned regularly.
3. Patient counseling area
 A designated area where activities related to patient care/ professional services carried out.
 The patient's attention can be drawn to this area and services offered using suitable panels.
 This serve the following
o clarifications about doubts (no fear of being overheard).
o comfortable and convenient than advising on the counter.
o easy for demonstrations of using devices like inhalers, vaginal or rectal applicators
o Makes the patient confident that he/she will be heard without distractions.
4. Dispensing equipment’s
 Adequate equipment’s on premises are suitable for operations that have to be carried out.
 All equipment should be kept clean and checked for cleanliness prior to each use.
 Thoroughly clean equipments to prevent any risk of contamination.
 Use of stainless steel and glass is recommended.

 Dispensing aids include:

o A dispensing bench of adequate size having a smooth, impervious working surface.
o Easily cleanable tablets and capsules counting devices.
o A refrigerator equipped with a maximum/minimum thermometer adjusting.
o Suitable dispensing containers for drugs with separate sets for internal and external use.
o Adequate shelves and lockable cabinets etc.
o Cleaning equipment used for handling different products, both between uses and at the end
of the day, is essential to prevent cross-contamination.
o Clear labeling that ensure selection of correct preparation & minimize risk of error.

a) Triangular tablet counter

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o made of wood, metal or plastic with raised edges along two sides.
o metal or plastic counters preferred (easily cleaned or washed between uses).
o tablets are counted by counting the number of rows of tablets
o pours tablets into the container using a raised edge as a guide.

b) Capsule counter
a metal tray which consists of 10 rows of grooves.
capsules are poured on to the tray using a spatula lined up in grooves.
each complete row will contain capsules
so the number of complete rows multiplied by 10 gives number of capsules.

c) Electronic tablet counter

 Used when prepackaging is done on a large scale in a teaching hospitals.
o difficult to clean
o may not identify damaged tablets
o expensive for medicine retail outlets.

Figure 1-1: Dispensing equipments used in dispensing units

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5. Personal protective equipment’s

Personal protective equipment (PPE), as defined by the Occupational Safety and Health
Administration (OSHA) is ‘specialized clothing or equipment, worn by an employee for protection
against infectious materials’.
 PPE protects health professional from
o contamination by work area hazards
o prevents contamination of clothes which would carry contamination outside health facility

The Centers for Disease Control and Prevention (CDC) issues recommendations for when and
what PPE should be used to prevent exposure to infectious diseases. The protection of healthcare
personnel from infectious disease exposures in the workplace requires a combination of controls.

There are four major components to healthcare worker safety programs.

Training and administrative controls, like isolation policies and procedures for recognizing
patients with a communicable disease before they expose workers.
Engineering controls like negative pressure rooms for patients with airborne diseases
Work practice controls such as not recapping needles
Finally personal protective equipment.

 Types of PPE used in healthcare settings

o Gloves – protect hands
o Gowns/aprons – protect skin and/or clothing
o Masks- protect mouth/nose, respirators – protect respiratory tract
o Goggles – protect eyes
o Face shields – protect face, mouth, nose, and eyes

6. Dispensing personnel
 Difference between supplying medicines or medical supplies and supplying other goods is
that, with medicines or medical supplies the recipient/patient usually
o does not know the correct use
o unable to judge the quality of the product he or she receives.
o correctness and quality of medicines supplied lies entirely on dispenser’s ability.
 Consequently laws mandate that the distribution of medicines and important medical supplies
to the general public be carried out by pharmacy professionals.

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 Knowledge, skills, and attitudes to complete dispensing process includes

o knowledge about medicines being dispensed (common use, correct dose, precautions,
common side effects & interactions with other medicines or food, storage needs).
o Good calculation and arithmetic skills
o Skills in assessing the quality of preparations
o Attributes of cleanliness, accuracy, and honesty
o Attitudes and skills required to communicate effectively with patients

 The level of training needed for any particular dispensing task is determined by
 range of medicines dispensed and
 extent to which calculation and preparation are required.
 Dispensing personnel must receive an appropriate level of training, which will enable them to
correctly dispense the range of medicines prescribed in their facilities.

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Skill Practice Session 1: Practice on dispensing aid/equipment

Purpose:
 The purpose of this activity is to enable you to practice those skills necessary to use
dispensing equipment or aid.
Instructions:
 Based on the available dispensing aid, practice one by one how to dispense medicine
using dispensing aid.
Resources (Equipment tools and Materials):
 Pill Splitter
 Tablet/Capsule counter tray
 Measuring cylinders
 Dropper

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1.3. Dispensary stock management

 Good stock management facilitates safe and effective dispensing service.

 To ensure proper stock management, the following elements are important:
o Acquisition of medicines
o Stock keeping and rotation
o Arrangement of medicines
o Storage conditions
o Categories of drugs

1. Dispensary Medicines Acquisition

Before medicines and medical supplies are issued from store to dispensing room
Store requisition form should be filled by the dispenser
Duly signed by authorized personnel.
All medicines found in medicine retail outlets should be obtained or collected from legal sources.
 When you receive medicines for dispensing:
 Ensure that there is sufficient storage place
 Prepare and clean the areas for receiving and storing
 Inspect packages for damaged and/or expired products
 Check that all original containers are unopened and in good condition.
 If products are defective:
o Separate the damaged or expired stock from the usable stock
o Refuse to accept the products and note the problem(s) on the delivery note
o Follow your facility’s procedure for handling damaged or expired stock.
o Report quality problem to the nearest regulatory body and fill prepaid adverse drug
event report form and send to FMHACA.

 If Products are not damaged:

o Fill issue voucher and requisition voucher
o Count the number of units for each product received and compares to issue voucher
o Record received item on receiving voucher, bin card and computer (if applicable)
o Ensure the expiry date is visibly marked on every package or unit

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o Arrange products in the storage area that facilitate the dispensing of the first to expire
by first expiry first out (FEFO) or first in first out (FIFO) procedures.

2. Dispensary stock keeping

Medicine should be kept within the dispensary as follows:
o Follow the manufacturer directions when stocking
o Follow labels for storage conditions
o Ensure safe custody of poisons
o Place liquid products on the lower shelves or on bottom of stacks
o Store products that require cold storage in appropriate temperature controlled zones.
o Keep high security/high value products (narcotic and psychotropic substances) in
appropriate secured places
o Separate damaged and expired products from the usable stock without delay and
dispose using established disposal procedures.
o Always store all products in a manner that facilitates FEFO principles
o Report to appropriate body for redistribution of medicines with near expiry date.

3. Dispensary stock rotation

 Following FEFO and FIFO procedures minimize wastage due to product expiry.
o Issue products that expire first, ensuring they are not too close to or past their expiration
date (shelf life remaining is sufficient for product to be used before expiry date).
 To facilitate FEFO, place products that expire first in front of later expiry products.
 Write expiry dates on bin cards, so that stocks can be used before they expire.
 Supplies with no expiry date (gauze, cotton, medical gases etc.) should be stored in
the order received and dispensed accordingly (FIFO).

4. Arranging medications in dispensary

 Dispensing units must have a known system for organizing medicines.
 Medicines should be arranged on shelves made of steel, treated wood, strong and robust.
 Health institutions and retail outlets can use one or a combination of the following:
a. Pharmacotherapeutic category
b. Alphabetical order by generic name
c. Dosage forms of final preparation

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a) Pharmacotherapeutic category
 This method is based on the pharmacological or therapeutics use of drugs.
 Pharmacological classification is an effective way of organizing medicines in dispensaries.
 Pharmacologic class knowledge is critical step in effective dispensing in this system.
b) Alphabetical order
 Alphabetical order by generic name is attractive in dispensaries that keep a small items.
 Each change in the level-of-use list requires reorganization of the dispensary
 May not result in optimal use of available space.
c) Dosage form of final preparation
 Arranging drugs as per the dosage form they are available
 Commonly used in smaller dispensaries.
 Easy to recognize when receiving goods
 Allows optimal use of space.
 Usually used in conjunction with the therapeutic arrangement.
o Solid dosage forms (tablets, capsules, powers) are placed together
o Liquid dosage forms ( elixirs, syrups, suspensions,...) are placed together
o Semi solid dosage forms ( ointments, creams, pastes) are placed together
 In arranging medicines, the following points should be considered:
o Each dosage form of medicine is arranged in separate and distinct areas
o Sufficient empty space should demarcate one medicine or dosage form from another
o Put medicine in well ventilated, dry and place protected from direct sun light and heat
o Store liquids in a pallet on the floor or on the lowest shelf
o Do not store anything directly on the floor and store cold-chain items in refrigerator.

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Skill Practice session 2: GIT Medicines Arrangement

Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction: Demonstrate Arrangement of the following medicines in dispensary based
on their Pharmacological action/class listed on the table below
Sucralfate, Bisacodyl, Meclizine Hydrochloride, Chlorpromazine Hydrochloride,
Metoclopramide, Atropine sulphate, Hyoscine (Scopolamine) Butylbromide,
Oral Rehydration Salt, Esomeprazole, Dimenhydrinate, Cimetidine , Ondansetron,
Magnesium Hydroxide, Cimetidine, Omeprazole, Aluminum Hydroxide+Magnesium
Trisillicate, Ranitidine, Castor oil, Magnesium Sulphate, Loperamide, Zinc Sulphate,
Activated Charcoal, Aluminum Hydroxide + Magnesium Hydroxide + Simethicone

Antacids Antiemetics

Histamine 2 Blockers Cathartics and Laxatives

Proton Pump Inhibitors Medicines Used in Diarrhea

Antispasmodics Antiflatulents

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Skill Practice session 3: CNS and Musculoskeletal System Medicines

Arrangement
Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction: Demonstrate Arrangement of the following medicines in dispensary based
on their Pharmacological action/class listed on the table below
Risperidone , Lithium Carbonate, Levodopa, Carbamazepine, Diazepam, Lidocaine,
Fluoxetine, Impramine, Carbamazepine, Ergotamine Tartate + Caffeine, Tramadol,
Acetaminophen, Indomethacin, Ibuprofen, Morphine, Acetylsalicylic Acid, Bromazepam,
Sumatriptan, Diazepam, Phenytoin, Ibuprofen, Pancuronium, Tetracaine, Clozapine,
Phenobarbitone, Amitriptyline, Codeine Phosphate, Diclofenac, Pethidine, Clonazepam,
Benzhexol, Levodopa + Carbidopa, Chlorpromazine, Allopurinol,

Analgesics/Antipyretics Antimigraine Medicine

Hypnotics and Anxiolytics Antidepressants

Anticonvulsants Anti-Parkinson Medicines

Antipsychotic Medicines Mood Stabilizer

Local Anesthetics Neuromuscular Blockers

Medicines used in Gout

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Skill Practice session 4: CVS Medicines Arrangement

Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction: Demonstrate Arrangement of the following medicines in dispensary based
on their Pharmacological action/class listed on the table below
Procainamide, Enalapril, Propranolol, Captopril, Verapamil, Frusemide, Amiodarone,
Norepinephrine, Phenylephrine, Lidocaine, Metoprolol, , Hydrochlorthiazide, Mannitol,
Spironolactone,Valsartan, Digoxin , Enalapril Maleate, Lisinopril, Amlodipine, Methyldopa,
Nifedipine, Hydralazine, Atrovastatin, Cholestyramine, Simvastatin, Isosorbide dinitrate ,
Atenolol, Nitroglycerine, Dopamine, Dobutamine

Medicines Heart Failure Antiarrhythmics ,

Antihypertensive , Diuretics

Antilipemic Agents, Medicines Used for Angina/Ischemic

Heart Disease,

Medicines Used in Vascular Shock

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Skill Practice session 5: Anti-infective Medicines Arrangement

Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction 1: Arrangement of the following medicines in dispensary based on
their Pharmacological action/class listed on the table below
Artesunate, Tinidazole, Praziquantel, Nystatin, Gentamicin, Ganciclovir, Ketoconazole,
Doxycycline, Amoxicillin, Ampicillin, Amoxicillin + Clavulanic Acid , Chloramphenicol,
Erythromycin, Quinine, Miconazole, Metronidazole, Thiabendazole, Acyclovir,
Clarithromycin, Cephalexin, Ceftriaxone, Ciprofloxacin, Nevirapine, Vanciclovir, Tenofovir,
Chloroquine Phosphate, Fluconazole, Albendazol, Diloxanide Furoate, Artemether +
Lumefantrine, Piperazine, Clindamycin, Ethambutol, Isoniazid , Sulfadoxine +
Pyrimethamine, Zidovudine, Praziquantel , Griseofulvin, Lamivudine, Efavirenz, Lamivudine,
Abacavir, Atazanavir/ Ritonavir, Clotrimazole, Rifampicin, Dapsone, Streptomycin,
Vancomycin, Tetracycline, Norfloxacin, Azithromycin, Penicillin G, Sodium Crystalline,
Cloxacillin , Procaine Penicillin Fortified, Penicillin G Benzanthin

Penicillins Anti- tuberculosis drugs

Anthelmintics Antileprotics

Antiretrovirals Antifungals

Amoebicides Antimalarials

Medicines for Toxoplasmosis Schistosomicides

Antigiardial Agents Antileshmania Medicines

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Instruction 2: Arrange the following Antiinfectives as Antibacterial, Antifungals, Antivirals,

Antiprotozoals and Anthelmintic (tick to the column).
Antiinfectives Antibacterial Antifungals Antivirals Antiprotozoals Anthelmintic
Ampicillin
Ceftriaxone
Metronidazole
Tinidazole
Cephalexin
Doxcycline
Ceftriaxone
Erythromycin
Clarithromycin
Azithromycin
Gentamicin
Ciprofloxacin
Norfloxacin
Artisunate
Chloroquine
Quinine
Mebendazole
Griseoflovin
Fluconazole
Acyclovir
Zidovudine
Efavirenz
Ritonavir
Ivermectin
Albendazole
Isoniazid

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Skill Practice session 6: Arrangement of medicines used in endocrine disorder

and contraceptives
Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction: Demonstrate Arrangement of the following medicines in dispensary based on
their Pharmacological action/class listed on the table below
Propylthiouracil, Metformin, Betamethasone, Glibenclamide, Thyroxine sodium,
Dexamethasone, Hydrocortisone, Methylprednisolone Acetate, Prednisolone, Triamicinolone
Acetonide, Norethindrone (Norethisterone), Hydroxyprogesterone Caproate, Norethindrone
(Norethisterone), Ethinylestradiol, Leovonorgestrel (D-Nongestrel), Leovonorgestrel (D-
Nongestrel), Medroxyprogesterone Acetate, Norethindrone Condoms, Copper T380A,
Glucagon, Insulin , , Levonorgestrel (D-Norgestrel) + Ethinylestradiol ,Estradiol Aqueous
Iodine Solution (Iodine + Potassium Iodide) ,

Corticosteroid Preparations Thyroid Hormones and Anti-

thyroid agents

Anti-thyroid Agents Insulin and Oral Antidiabetic

Agents

Contraceptives Female Sex Hormone

Preparations

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Skill Practice session 7: Miscellaneous Medicines Arrangement

Purpose:
 To enable you to practice those skills necessary to arrange medicines in dispensary.
Instruction: Demonstrate Arrangement of the following medicines in dispensary based on
their Pharmacological action/class listed on the table below
Heparin, Hydrocortisone, Aminophyline, Chlorpheniramine, Dexamethasone, Thiamine
Hydrochloride (Vitamin B1), Methylprednisolone, Adrenaline, Diphenhydramine
Hydrochloride, Loratidine, Ascorbic acid (Vitamin C), Ferrous Salt, Folic Acid,
Cholecalciferol (Vitamin D3), Phytomenadione (Vitamin K1), Diphenhydramine, Pyridoxine
Hydrochloride (Vitamin B6), Calcium Gluconate, Potassium Chloride, Dextrose , Dextrose in
Normal Saline, Lactated Ringer’s Solution, Warfarin , Folinic Acid, Dextromethorphan,
Salbutamol, Adrenaline, Guaifenesin, , Ephedrine +Theophylline

Anticoagulants Antihistamines

Anti-inflammatory/anti-allergic medicines Medicines used in allergic

emergencies

Medicines used in allergy Vitamins

Medicines used for correcting water, Antianemic agents

electrolyte and acid base balance

Antitussives/Expectorants Bronchodilators/Antiasmatics

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5. Storage of pharmaceuticals in dispensary

In dispensing room storage conditions can be arranged in two classes:
A. Normal storage conditions
B. Special storage conditions
a. Cold storage conditions
b. Combustible /flammable
c. Secured storage

A. Normal storage conditions

 Storage in dry, well-ventilated premises at temperatures of 15–25°C or up to 30 °C.
 Unless special storage conditions are stated, it is vital that drugs be stored in:
o a dry place
o adequately ventilated shady
o cool store room.
 Maintain specified storage conditions with regard to exposure to humidity, sunlight, heat.
 When a product label states, ‘protect from moisture’, store the product in a space with no
more than 60% relative humidity.
 Free air circulation through windows, fans or air conditioners reduce effects of humidity.
 Some products are photosensitive and will be damaged if exposed to light.
To protect products from sunlight:
o shade the windows, if they allow passage of direct sunlight, keep products in cartoon
o do not store or pack products in sunlight
 Heat will also affect many products, melts ointments and creams and affects other products.
 Thermometers and hygrometer to regulate the temperature and humidity of storage areas.
B. Special storage conditions
 Some categories of medicines and supplies require special storage conditions
o Cold storage conditions
o Flammable storage conditions
o Secured storage.

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a. Cold storage conditions

 Maintained by using refrigerators and freezers for products that may be degraded rapidly
when kept at room temperature or even at cool places.
 Example of products that should be stored in cold storage condition includes
o Vaccines and insulin preparation
o Oxytocin & ergometrine
o Antirebies and tetanusantitoxine
o Anti-D and biological products.
 The following points are recommended when using refrigerators and freezers:
Refrigerators that open on the top are more efficient than vertical ones, because hot rises
while cold air falls, the coldest part of vertical refrigerators is at the bottom so store
products that are sensitive to freezing or very low temperatures on the upper shelves.
If there is enough space, place a few plastic bottles of water in the refrigerator; this will
help maintain the temperature for a longer period of time if the power is cut off.
The temperature ranges for different storage conditions are shown in the following table.
Opening and closing the door lower the temperature and cause medicines to deteriorate.
Record temperature daily & check enough space around refrigerator so air can move freely.
Do not keep staff food in the refrigerator.
Table 4-1: Terms that relate to storage temperature

No Terms to specify temperature Applications

1. Store frozen(-20oc (4oF)) For products like vaccine which need to transported
within cold chain
2. Store at 2oC – 8oC(36o - 46oF For products which are very sensitive but must not be
frozen. This temperature is appropriate of storing vaccines
for short time.
3. Keep at cool place Kept between 8oC – 15oC (59oF – 77oF) temperature

4. Store at room temperature To be kept between 15oC – 25oC (45oF – 59oF)

Store at the surrounding temperature. It means “room
5. Store at ambient temperature
temperature” or normal storage conditions, i.e. storage in
a dry, clean well-ventilated area room temperature
between 15oC – 25oC (59oF- 77oF) or up to 30oC
depending on climatic condition.
NB: When storing, follow manufacturer’s recommendations on storage conditions of specific
products.
b. Storages for combustible /flammable

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The Occupational Safety & Health Administration defines a flammable liquid as substances having
a flash point of not more than 93°C (199.4°F). The flash point (FP) is the minimum temperature
at which a liquid gives off vapor in sufficient concentration to form an ignitable mixture with air
near surface of the liquid. Relative hazard of flammable liquid increases as flashpoint decreases.

Many common solvents (e.g., acetone, ether, toluene, etc.) present in laboratories have flash points
below room temperature, making proper use, storage and disposal even more critical. Flammable
liquids and mixtures are assigned to one of four hazard categories, as indicated in safety data sheets
(SDSs), based on their flash points and boiling points.
Table 4-2: Categories of flammable substances

Category Criteria Hazard statements

1. FP< 23°C & initial boiling point ≤ 35°C Extremely flammable liquid & vapor
2. FP < 23°C & initial boiling point > 35°C Highly flammable liquid & vapor
3. Flash point ≥ 23°C and ≤ 60°C (140°F) Flammable liquid and vapor
4. FP ≥ 60°C (140°F) ≤ 93°C (200°F) Combustible liquid
 Combustibles like alcohol, ether must be stored in special or separate rooms.
 Flammable materials must be stored in a small, separate special location that prevent fire
spread throughout the store.
 All stores should be equipped with fire extinguishers.
 A good alternative to fire extinguishers is represented by wooden or metal buckets filled
with sand. Store flammables in their original container.

Corrosive or oxidant substances commonly found in hospitals are:

o trichloracetic acid
o glacial acetic acid
o concentrated ammonia solutions
o silver or sodium nitrate
o sodium hydroxide pellets.
 Always store corrosive substances
away from flammables
in a separate steel cabinet to prevent leakage.
use appropriate protective gloves and eyeglasses when handling.

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c. Secured storage conditions

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

☞ those at risk of theft

☞ with abuse potential for addiction

☞ in high demand

☞ those that have potential for resale

Products that require secured storage conditions
 Narcotics: morphine, opium, pethidine, pentazocine, codeine, hydrocodone, oxycodone.
 Psychotropics: clonazepam, diazepam, temazepam, nitrazepam, lorazepam.
 Other medicines: antiretroviral used to treat HIV/AIDS, may need storage in a controlled
facility, because they are scarce, expensive, and in high demand.
 Donation products that also used for other conditions
o medicines used to treat opportunistic infections for HIV/AIDS
o medicines used to treat sexually transmitted infections
o HIV test kits used in use in specific programs, such as preventing mother-to-child
transmission, but can be used for other purposes, such as ensuring blood safety.
 These medicines need greater attention.
 specific procedures needed for procurement, reception, storage and dispensing.
 special ordering forms should be used.
 Controlled substances and their documents kept in securely locked rooms or cupboards.
o keys should be kept in a secure place.
o only authorized pharmacy professional have access.
o warning light or bell will be activated if products are accessed improperly.
o

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6. Drugs categories

Based on legal factors drugs are classified into three legal classes.
 Prescription only drugs/Legend drugs that cannot dispensed by a pharmacist without a
prescription from a physician.
 Controlled drugs in addition to requiring a prescription, these drugs require additional
safeguards for storage and refills are also limited.
 Over-the-counter drugs that do not require a prescription.

A. Controlled drugs
Controlled drug is any drug or therapeutic agent with a potential for abuse or addiction, which is
held under strict governmental control. A controlled (scheduled) drug is one whose use and
distribution is tightly controlled because of its abuse potential or risk. Controlled drugs are rated
in the order of their abuse risk and placed in schedules by the Federal Drug Enforcement
Administration (DEA) of USA.
The drugs with the highest abuse potential are placed in Schedule I, and those with the lowest
abuse potential are in Schedule V. These schedules are commonly shown as C-I, C-II, C-III, C-
IV, and C-V. Substances are placed in their respective schedules based on whether they have a
currently accepted medical use, relative abuse potential & likelihood of dependence when abused.

Table 8-1: Classification of controlled substances

Schedule Abuse potential Comments
I High No accepted medical use; lack of accepted safety as drug. Subject to
all measures of control (use, production, export and import). Example,
heroin, marijuana (cannabis), lysergic acid diethylamide (LSD),
mescaline (peyote), khat, ecstasy, methaqualone, psilocybin.
II High Current accepted medical use. Abuse may lead to psychological or
physical dependence. Less strict control than schedule I drugs.
Example: hydromorphone, methadone, meperidine, oxycodone,
fentanyl, morphine, opium, codeine, amphetamine, methylphenidate
and methamphetamine.
III Less than I or II Current accepted medical use. Moderate or low potential for physical
dependence and high potential for psychological dependence.

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Example: combination products containing less than 15 mg of

hydrocodone per dosage unit, products containing not more than 90
mg of codeine per dosage unit, buprenorphine, barbiturates
(amobarbital, pentobarbital), glutethimide, ketamine, benzphetamine,
phendimetrazine and anabolic steroids
IV Less than III Current accepted medical use. Limited potential for dependence.
Example: Barbiturates (allobarbital, secobarbitol, phenobarbital),
benzodiazepine (alprazolam, clonazepam, clorazepate, diazepam,
lorazepam, midazolam, temazepam, and triazolam), carisoprodol.
V Less than IV Current accepted medical use. Limited dependence possible. Consist
primarily of preparations containing limited quantities of certain
narcotics. Example: cough preparations containing not more than 200
mg of codeine per 100 mL per 100 grams), and ezogabine.

 Required information on the prescription for controlled substances

 date and signature on the day it is issued.
 name and address of the patient.
 name, address, and registration number of the physician.
 may be prepared by the secretary, but must be signed by the physician.

 Refilling prescriptions for controlled substances

Refills for schedule II drugs are not permitted.
Refills for schedule III, IV & V permitted if number of refills is indicated on prescription.
Prescription order renewed only up to five times within six months after the date of issue.
After five renewals or after six months a new prescription order is required.

B. Over the counter drugs

Over-the-counter (OTC) medicines are medicines that may be sold directly to a consumer without
a prescription from pharmacy personnel, as compared to prescription drugs, which are dispensed
only to consumers possessing a valid prescription. While dispensing, asking the patient why he/she
is buying the drug is crucial before dispensing. The maximum quantity to be dispensed at one time
is specified on the National OTC drug list manual 2nd edition, prepared by FMHACA, June 2012.

 FMHACA decide whether a medicine is safe enough when used without prescription.

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 Though legally classified as OTC (no prescription is required), still have some risks.
o Some interact with other medicines, supplements, foods or drinks.
o Others cause problems for people with certain medical conditions.
 Therefore it has to be dispensed by pharmacy personnel with
o a sufficient counseling about the condition/medications
o maximum quantity dispensed at one time should be determined.
 As a general rule, OTC have to be used primarily to treat a condition that does not require the
direct supervision of a doctor and they are proving to be reasonably safe and well-tolerated.
NB: For lists of OTC drugs see annex-1

Self-Check
Match the following drugs with their appropriate storage conditions
A B
1. Flammable liquids A. Refrigerator
2. Corrosive B. Secured storage conditions
3. Controlled drugs C. Steel cabinet
4. Biologicals D. Special or separate rooms
E. Main store on shelf
Short answer questions
1. List components of dispensing environment.
2. List the role of personal protecting equipment.
3. Which stock rotation system is used for medical supplies that have no expiry date?
4. What is the basis for drug arrangement as therapeutic classes?
5. How drug arranged by alphabetic order?
Summary
 Dispensing area is a place that have basic space and equipment needed for dispensing
medication. The facility and equipment in dispensing area include
 a dispensing table to work on,
 proper storage areas
 designated refrigerators
 areas for dispensing medications.

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 Appropriate personal protective equipments are available for safe dispensing.

 Pharmaceuticals are organized in dispensary that enable FEFO or FIFO stock rotations.
 Dispensing units have a system for classifying or organizing medicines that ensure all
employees know the system being used. Major drug arrangement in dispensary:
o Therapeutic classes
o Alphabetical order by generic name
o Dosage form of final preparation
 In dispensing room storage conditions can be arranged in two classes:
 Normal storage conditions
 Special storage conditions
o Cold storage conditions
o Combustible /flammable
o Secured storage
 Based on legal factors drugs are classified into three legal classes.
o Prescription only drugs that cannot dispensed without a prescription.
o Controlled drugs that require prescription and additional safeguards for storage
o OTC drugs that do not require a prescription.

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Skill Practice Session 8: Arrangement of medicines based on their storage conditions

Practice/demonstrate Arrangement of medicines in dispensary based on their storage

conditions
Purpose:
 The purpose of this activity is to enable you to practice those skills necessary to arrange
drugs in dispensary based good storage practice.
Instructions: Dear Trainee, arrange the given medicines according to their storage conditions
as normal, cold, combustible/flammable and secured storage conditions, also discuss the
pharmacology class of these medicines
Oxytocin, Amoxicillin, Omeprazole, Ketamine, Suxamethonium, Pethidine, Diazepam,
Sodium valproate, Ergometrine, Tramadol, Diclofenac, Alcohol, Formaldehyde,
Hydrogen peroxide, Imipramine

Normal storage Cold storage Combustible/flammable Secured storage

conditions conditions storage conditions conditions

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Skill Practice Session 9: Arrangement of medicines as Prescription only medicines

(POM), Over the counter (OTC) and controlled medicines
Purpose: To enable you to practice those skills necessary to arrange drugs based on the
prescription according to the legal requirements.
Instructions: Dear trainees arrange the given medicines as prescription only medicines (POM),
Over the counter (OTC) and controlled medicines and also discuss the pharmacology class of
these medicines.

Pethidine, Paracetamol, Antacid oral suspension, Hydrocortisone, Phenobarbitone,

Dextromethorphan hydrobromide, Ibuprofen, Multivitamin preparations, Iodized salt,
Gentian violet, Gentamicin, Medroxyprogestrone acetate, Condom, Ketoconazole,
Artisunate, Arthemether + Lumfantrine, Metronidazole, Nitroglycerine, Captopril,
Glibenclamide

Prescription only medicines Over the counter (OTC) Controlled medicines

(POM)

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2. Prescription and Abbreviations in prescription writing

Objective
At the end of the chapter you are able to
o Define prescription
o List parts of prescription
o Identify type of prescription
o List commonly used pharmaceutical abbreviation in prescription writing

2.1 Introduction to prescription

Prescription’ means any order for medicines written by a duly licensed medical practitioner issued
to a patient in order to collect medicine from dispensing unit” (FMHACA Proclamation No.
661/2009). Prescriptions designate specific medications and dosages to be administered to a
particular patient at a specified time.
A. Types of prescription
Based on the type of preparation prescribed, prescription is classified into two types.
1. Prescription for pre-compounded medication, it is a type of prescription for already
prepared drug by pharmaceutical companies
2. Prescription for extemporaneous preparation in this prescription the pharmacists
prepare the medication according to the drugs and dosages directed by the physician.
Based on the nature of the drugs prescribed, prescription is also classified into two types.
1. Ordinary prescription: this type of prescription used for all drugs except narcotic and
psychotropic substances, can be prescribed by nurses, physicians, health officers, dentists,
psychiatrics and useful for OTC and prescription only medicines prescribing.
2. Special prescription: it is used for narcotic and psychotropic drugs and prescribed by
specialized professionals. The drugs prescribed on this prescription need special
counselling and drugs cannot be OTC in any level of knowledge.

B. Parts of prescription
The written prescription has stringent requirements designed to inform pharmacy personnel and
protect the patient. Prescription regulations vary from state to state and province to province, but
generally a prescription for a health facility will contain the information illustrated below.

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PRESCRIPTION PAPER Serial No __________

Area Code _________
Institution Name: __________________Tel. No.___________
Patient’s Full Name: __________________________________
Sex: ___ Age: ___ Weight: ______ Card No. _______________
Region: _______Town ________ Woreda______Kebele _____
House No. ____ Tel. No: ________� Inpatient � Outpatient
Diagnosis, if not ICD ______________________________
Medicine Name, Strength, Dosage Form, Dose, Frequency, Price
Duration, Quantity, How to use & other information (dispensers use only)

Amoxicillin 250 mg capsule

TID, PO for seven days

# 21 capsules

Refill ____________

Dispense as Written ___________

Total Prices

Prescriber’s Dispenser’s
Full name ________________________ ________________________
Qualification _____________________ ________________________
Registration #_______________________ ________________________
Signature ________________________ _______________________
Date: _________________________ ________________________
Figure 2-1: Parts of Standard Prescription Paper

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1. Serial number
 FMHACA recommended that prescription paper shall have a serial number with area code
as shown on the top of the prescription paper above.
 14H000000 is a serial number given to Private, Governmental and Non-Governmental
health institutions where 14H is code for these health institutions and 000000 is a
consecutive serial numbers of prescriptions for a given health institution.
2. Name and address of the health institution
o The name of the health institution
o The address of the health institution
 Telephone number , Region, Kebele, Woreda, House number, [Link]
3. Patient information
 Full name of the patient
 Age and sex of the patient
 Card number
 Address of the patient
Telephone number, Region, Town, Kebele, Woreda, House number
 Type of patient: Outpatient or Inpatient
 The name, address, age and sex of the patient help in identifying the prescription
 The prescribed medication is only for the patient whose name is on the prescription.
 Weight, age and sex of the patient are important in verifying the correct patient
and/or dosing of the medication.
4. Type of diagnosis
 Diagnosis is the identification of the nature and cause of a disease.
 The type of diagnosis can be written on a prescription paper either on words or codes
referred to as diagnostic codes.
 In healthcare, diagnostic codes are used to group and identify diseases, disorders,
symptoms, human response patterns, and medical signs, and are used to measure
morbidity and mortality.

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 The International Statistical Classification of Diseases and Related Health Problems

(most commonly known by the abbreviation ICD)
o A medical classification that provides codes to classify diseases and a wide variety of
signs, symptoms, abnormal findings, complaints, social circumstances & external causes
of injury or disease.
o Under this system, every health condition can be assigned to a unique category and given
a code, up to six characters long.
o Most ICD-9 codes are comprised of three characters to the left of a decimal point, and
one or two digits to the right of the decimal point.
 250.0 means diabetes with no complications
 530.81 means gastro reflux disease (GERD)
 079.99 means a virus disease
5. Superscription
 The 'Rx' symbol is called the superscription is used as an abbreviation of the Latin word
recipe, which means, “Take thou” or “you take”
 Rx symbol comes before the inscription, the sign at the foot of the letter R is believed to
represe*nt the sign of Jupiter, the God of Healing
6. Inscription
 The inscription comprises an important part of prescription containing
 Name(s) and strength of drug(s)
 Instruction regarding dosage form like tablet, capsule, suspension, mixture, etc.
7. Subscription
 Gives specific directions for the pharmacist on how to compound the medication.
 Most of direction is usually expressed in contracted Latin or in the form of abbreviation.
 Consists of directions given to the pharmacist with respect to the dosage form and the
number of dosage units/quantity to be supplied.
 Instructions for preparation are also given such as 'make a mixture', 'mix and make 10
tablets', or 'dispense 10 capsules'.

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8. Transcription or Signatura
 Signatura refers to the directions given by the prescribers to the patient.
 In this portion, the physician indicates to the patient:
o how he/she should take the prescribed medicine/s.
o directions are usually written using abbreviated forms of Latin.
o instructions are preceded by abbreviation 'Sig.' from the Latin, meaning ‘mark’
indicates how, how much, when, and how long the drug is to be taken.
o e.g., 1 cap tid po means take one capsule thrice a day orally.
In the best interest of the patient, it is advisable that no abbreviations be used. The prescriber
should preferably write the dosage schedule in simple, unambiguous terms that the patient or his
representative/caretaker can read and understand.
 e.g., ‘take 1 teaspoonful three times a day (every eight hours) after meals.'
If the patient is illiterate, the physician may use pictorial representations to make the patient
understand the dosage properly. If the physician does not write the instructions in layman's terms,
it is the responsibility of the pharmacist to explain the dosage to the client/patient in simple terms.

9. Refill information
In certain cases, a single course of therapy may not be sufficient for effective treatment of the
patient. Under such circumstances, the physician may decide to repeat the course of therapy, and
indicate the same on the prescription. This information is called refill information. The refill
information should indicate the number of times the prescription should be refilled and the
intervals after which it should be refilled. Refill information aids in preventing a person from
having his/her prescription filled more often than the proper dosage regimen warrants, and other
patients from using the prescription for a similar condition, or misusing it.

Example: –
Benzodiazepines are ideally prescribed for short-term therapy for a maximum of two or three weeks. A
physician may therefore write a prescription for say, 10 days, with no refilling instructions. The pharmacist
must ensure that such a prescription is not refilled, unless specified by the doctor, as it can lead to the
patient getting habituated to the use of medicines prescribed.

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10. Prescriber/dispenser information

 Prescriber/dispenser information include:
 Full Name of professional
 Qualification
 Registration number
 Signature; signature of the prescriber/dispenser in his own handwriting.
11. Prescription Date
 Should be written on the top of the prescription paper and/or below the signature of the
prescriber. The date also essential to mark the legality of the prescription.

2.2 Common abbreviations in prescription writing

Many medical and pharmaceutical terms are abbreviated for ease of communication and record
notation. It has been estimated that about 10,000 abbreviations are used in the health sciences.
Many abbreviations are specific for one institution or one area of the country. It is also possible
that one abbreviation may have more than one meaning.

Abbreviations are regularly used in the pharmacy to communicate essential information such as
the dosage form, dosage regimen, and route of administration. To be safe and efficient, technicians
must memorize these commonly used abbreviations and understand their meaning.
Table 2-1: Latin Terms and Abbreviations used in prescription writing
1. Abbreviation for Dosage forms
Abbreviations Latin Name English meaning
caps. Capsula A capsule
cataplasm Cataplasma A poultice
chart Charta A powder
collun Collunarium A nose wash
collut Collutorium A mouth wash
collyr Collyrium An eye lotion
crem Cremor A cream
emp Emplastrum A plaster
emul Emulsio An emulsion
garg Gargarisma A gargle

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gelat Gelatina A jelly

gtt Guttae Drops
Inhal/vap Inhalatio/vapor An inhalation
inj Injectio An injection
insuff Insufflatio An insufflation
linct Linctus A linctus
lin Linimentum A liniment
liq Liquor A solution
lot Lotio A lotion
m., mist Mistura A mixture
narist Naristillae Nasal drops
neb Nebula A spray solution
oblat Oblatum A cachet
oculent Oculentum An eye ointment
past Pasta A paste
pastill Pastillus A pastille
pess Pessus A pessary
pigm Pigmentum A paint
pil Pilula A pill
pulv Pulvis A powder/ dusting
solv Solvellae Solution tablets
sternut Sternutamentum A snuff
suppos Suppositorium A suppository
tab Tabella A tablet
troch Trochiscus A lozenge
ung Unguentum An ointment
vitrell Vitrella A crushable glass capsule

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2. Instructions Relating To Preparation

Abbreviation Latin Name English meaning
add Adde, Addatur Add. Let (it) be added
calef Calefac, Calefiat Warm. Let (it) be warmed
div. in pt aeq Dividatur in Divide into equal parts
partes aequales
div Divide, Divide, Let (it) be divided
Dividatur
ft Fiat / Fiant Let (it) be made
m Misce, Misceatur Mix. Let (it) be mixed

3. Quantity To Be Sent and Manner of Sending

Abbreviation Latin Name English meaning
duplum Duplum Twice the quantity
mitt Mitte Send
p.p.a Phiala prius agitata The bottle being first shaken(attach,
shake the bottle label)
[Link] Quantitas ,duplex Twice the quantity
tal. Talis, Tales, Talia Such

4. Method of Administration or Application

Abbreviation Latin Name English meaning
addend Addendus To be added
applicand Applicandus To be applied
applicat Applicetur Let (it) be applied
capiend Capiendus To be taken
d. Da Give
dand. Dandus To be given
deglut Deglutiendus To be swallowed
infricand Infricandus To be rubbed in
infric Infricetur Let (it) be rubbed in
inhal Inhaletur Let(it) be inhaled

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instilland Instillandus To be dropped in

miscend Miscendus To be mixed
sig. Signa Label
sugend Sugendus To be sucked
s. or sum. Sumendus To be taken
u.a. Ut antea As before

5. Time of Administration or Application

Abbreviation Latin Name English meaning
ad 3 vic. Ad tres vices For three times
alt. hor Alternis horis Every two hours
a.c. Anti cibos./cibum Before meals/food
b.i.d, b.d Bis in die. or bis die Twice a day
b.t.i.d Bis terve in die Two or three times a day
hac noct. Hac nocte Tonight
h.s. / h.d. Hora somni / Hora At bed time
decubitus
i.c. Inter cibos/cibum Between meals/food
inter. noct Inter noctem During the night
m. Mane In the morning
[Link]. Mane sequenti The following morning
noct. /n. Nocte At night
n. et m/n.m. Nocte et Night and morning
mane/Nocte
maneque
od Omne in die Every day/once daily
o.h. qq.h. Omni hora. ,Quaque Every hour
hora
o.m. Omni mane Every morning
o.n. Omni nocte Every night
o.p.d Omni per die Once per day

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o.q.h Omni quarta hora Every fourth hour

p.c. Post cibos. /cibum After meals/food
p.m. Post meridiem Evening or afternoon
prim. luc / prim. m Prima luce / Primo Early in the morning
mane
PRN, prn Pro re nata As needed
Quaque alternis die/
q.a.d./q.o.d Every other day
omni die
Quaque die ante
q.a.m. Every day before noon
meridiem
q.p.m. Quaque die post Every day after noon or every evening
meridiem
q.h. Quaque hora Every hour
q.h.s. Quaque hora somni Every night at bedtime
qq.q.h Quaque quarta hora Every fourth hour
q.i.d or q.d. Quarter in die. Four times a day
/quarter die
quart. hor Quartis horis Every four hours
Quater die sumendus Four times a day
q.d.s.

quot (qd) Quotidie Daily or every day

sec. hor Secundis horis Every two hours
sem. in die Semel in die. or Once a day
semel die
sex. in d. /sex.d. Sexies in die. /sexies Six times a day
die
sext. hor Sextis horis Every six hours
sing. hor. Singulis horis Every hour
t.i.d/t.d Ter in die. or ter Thrice a day
die

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t. in hebdom/ t.i.w. Ter in hebdomada Three times a week

t.q.d Ter quaterve die Three or four times a day
tert. hor Tertiis horis Every three hours
vesp. Vespere In the evening

6. Part of the Body to which Drug is Applied

Abbreviation Latin Name English meaning
auri Auri / auribus To the ear, for the ear
a.d. Auris dextra Right ear
Auris laeva, auris
a.l., a.s. Left ear
sinistra
a.u. Auris utraque Both ears
dext. Dexter Right
[Link] Dolente parti To the afflicted part
,dolentibus partibus
gutt. Gutturi To the throat
in [Link] In aurem sinistram Into the left ear
in [Link] In oculun dextrum Into the right eye
in. [Link] In singulas aures Into each ear
NPO Nil per os Nothing by mouth
ocul Oculis/ oculo For the eyes
o.d/OD Oculus dexter Right eye
o.s./OS Oculus sinister Left eye
o.u. Oculus uterque Both eyes
p.a. Parti affectae To the affected part
p.a.a. Parti affectae To be applied to the affected part
applicandus
p.a. Partibus affectis To the affected parts
p.r. or PR Per rectum By rectum
PV Per vaginam Via the vagina
pro capill Pro capillis For the hair

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pro ocul Pro oculis For the eyes

pro ocul laev Pro oculo laevo For the left eye
pro [Link] Pro singulis oculis For each eye
sinist Sinister Left
dol. urg. Dolore urgente When the pain is severe
freq. Frequenter Frequently
m.d. More dicto / Modo As directed
dicto
quot.o.s Qouties opus sit As often as necessary
si dol. urg Si dolor urgeat If the pain is severe
sos Si opus sit When required, when necessary

Self-Check
Match the following parts of prescription given under column ‘A’ with their description given
under column ‘B’.
A B
1. Superscription A. Direction for pharmacist on how to compound drugs
2. Inscription B. Contain name, strength of drug and dosage form
3. Subscription C. You take
4. Transcription D. Generic substitution directions
5. Dispense as written E. Directions given by the prescribers to the patient
F. Address of patients
G. Diagnosis information
Short answer Questions
1. Write the equivalent meaning for the following abbreviations in English
a. QID e. OD
b. BID f. PO
c. TID g. NPO
d. PRN h. QOD

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Summary
A prescription is a written order from a practitioner for the preparation and administration of a
medicine or a device.
Prescription has the following parts
o Serial number
o Name and address of the health institution
o Patient information
o Type of diagnosis
o Superscription
o Inscription
o Subscription
o Transcription
o Refill information
o Prescriber/dispenser information
o Prescription Date
Abbreviations are regularly used in the pharmacy to communicate essential information such as
the dosage form, dosage regimen, and route of administration. To be safe and efficient, pharmacy
professional must memorize the most commonly used abbreviations with their meaning.

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Skill Practice Session 10: Interpretation of abbreviations used in prescription

Purpose:
 To enable you to practice those skills necessary to interpret abbreviations in prescription
paper according to the legal requirements.
Instructions:
Dear trainees, based on the given prescribed medicine interpret the abbreviations in the
prescription paper.

.GIMBI GENERAL HOSPITAL

PRESCRIPTION PAPER
Tel:+25157771914/15/16 [Link]: 286
Patient’s Full Name: G T
Age: 20 Sex: M Weight: 50 kg MRN: 0000xxxx
Region: Oromia Zone: W/Wollega Woreda/Town: Bube Kebele: 01
House No. New Tel. No: New Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Gastritis + Depression
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Omeprazole 20mg cap, PO, P.C, BID for 15 days

- Amitriptyline 25mg Tab, po/day h.s. for 1 month

- Paracetamol 1g Tab, po, PRN = 10tabs

Total Price
Prescriber’s Dispenser’s
Full Name: AY DD
Qualification: MD Pharmacist
Registration No: XXXX YYYY
Signature: Signed Signed
Date: 22/03/2010 E.C. 22/03/2010 E.C.

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Skill Practice Session 11: Interpretation of abbreviations used in prescription

Purpose:
 To enable you to practice those skills necessary to interpret abbreviations in prescription
paper according to the legal requirements.
Instructions:
Dear trainees, based on the given prescribed medicine interpret the abbreviations in the
prescription paper.

BISHOFTU HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: YT
Age: 18 Sex: F Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: OSZ Woreda/Town: Bishoftu Kebele: 04
House No. New Tel. No: New Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Pneumonia
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Penicillin G,Crystalline 3 MIU IV QID for 5 days

- Paracetamol 1g tab po PRN=10 Tab

Total Price
Prescriber’s Dispenser’s
Full Name: AY DD
Qualification: MD Pharmacist
Registration No: XXXX YYYY
Signature: Signed Signed
Date: 22/03/2010 E.C. 22/03/2010 E.C.

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3. Computer and Medication information in pharmacy

Objective
After completing of this chapter you are able to
 List role of computer in medication dispensing
 Identify sources of medicine information

3.1 Computer systems in pharmacy

Pharmacies use computerized tools that help productivity and maintain dispensary information.
Computerized pharmacy management systems perform the following:
label printing
stock reordering
perform product inventory
medicine pricing or billing
essential information within easy access.
 As a result, professionals dispense more prescriptions and information than ever before.
In Health Commodity Management Information System (HCMIS) computers used to check
o stock status (availability of medicines)
o near expiration,
o overstocked or stock out
o consumption trend,
o consumption by unit,
o loss/adjustment cost of medicines and
o calculating average monthly consumption.
Although each pharmacy computer system has its own specific features, many general principles
of computer usage apply to all systems. The most important element is stated in the classic
computer axiom: garbage in, garbage out, i.e. the information produced by the computer is only
as good as the information that is entered into it. Special care has to be taken when entering
information (data) to make sure it is correct. A simple mistake in data entry can result in the wrong
medication being given to the wrong patient or any number of other serious problems.

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Role of computer in pharmacy

o Update dispensary system information as required
o Back up dispensary system information to ensure secure data
o Enables changes to data stored in dispensary information system
o Maintain confidentiality of dispensary information
Figure 6-1: Function of Computers in pharmacy

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3.2 Medication information in dispensary

Information about medicines is rapidly expanding because of
o new medicine products entering into the markets
o new information about medicines in use.
 Pharmacy professional have to up-to-date his/her medicine information in order to provide
information to
o Patients/clients
o other health care professionals
o a general public
 Pharmacy professionals particularly are in close working relationships with prescribers, where
they can give advice in the following areas:
o Medicine choice, e.g. during pregnancy, breast feeding, etc.
o Dose interval and regimen
o Route of administration
o Adverse drug reactions
o Medicine interactions (drug-drug, medicine-diet, medicine-disease interactions)
o Duration of therapy, formulations, storage and cost of medication
o Promote rational medication therapy
 Patients or care providers require information on prescription or OTC drugs in areas:
o Type of medicine and how it works
o Amount to be taken
o Frequency of administration
o Duration of therapy
o Side effects and precautions
o Storage condition

3.3 Sources of medicine information

Although basic information about medicines is obtained through training in pharmacy profession,
additional knowledge can be gained from various sources. These sources of medicine information
can be classified into primary, secondary and tertiary.

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1. Primary sources
Provide new medicine information mainly based on research in journals.
 Such sources include health journals
 Ethiopian pharmaceutical Journal
 Ethiopian Medical Journal
 Ethiopian Journal of Health Development
 It is important to assess the reputability of the journal and time of publication.
2. Secondary sources
Provide reviews of articles that appear in primary sources
Examples include
medicine information bulletins
adverse medicine reaction bulletin
hospital formularies
standard treatment guidelines etc.
3. Tertiary sources
 Include standard reference books such as
o British National Formulary
o Basic and clinical pharmacology
o Dispensing for pharmaceutical students
o Medical dictionary, etc.
The selection of a particular source of information depends on the type of information required.
Tertiary sources are used first than secondary or primary sources as they provide a broad overview
of particular subject area. Standard books are published at longer time intervals than journals.

Medicine information inquiries that are beyond the ability of medicine dispensers can be referred
to the nearest medicine information centers (DICs). The main aim of these centers is to provide
accurate and precise medicine information for health professionals and the general public.
Medicine information supplied by the pharmaceutical industries either in the form of leaflets in
the packages or via their representatives is being used by many clients. Health professionals should
develop critical attitudes towards information provided by pharmaceutical industry as their
information may be biased.

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Self-Check
Choose the best answer from the given alternative for the following questions.
1. Which one of the following sources of drug information is classified under primary sources?
A. Ethiopian pharmaceutical Journal
B. Hospital formularies
C. Medical dictionary
D. Standard treatment guidelines
2. On which of the following area patient needs drug information from pharmacy professions?
A. Amount to be taken
B. Frequency of administration
C. Duration of therapy
D. All of the above
Summary
Computer applications for pharmaceutical management
Area of activity Uses
Selection Preparation of essential medicines lists and literature searches
Procurement Preparing purchase orders and receiving reports
Inventory control Monitoring of stock positions, expiry dates and invoicing
Registration and control Adverse reaction reporting and medicines recalls
Medicines information Formulary preparation, literature searches, pharmaceutical bulletin
production, training material preparation
Rational use Formulary, standard treatment schedule, calculation of WHO
medicine-use indicators and training (simulation games)
Prescribers, dispensers, and users of medicines all require information on medicines. The sources
of this information can be classified as primary (articles or papers on original research), secondary
(reviews of the primary literature), and tertiary (textbooks or pharmaceutical product information
approved by drug regulatory agencies).

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4. Selling products and customer services

After the end of this chapter you will are able to
List good customer services
Explain selling techniques
Elaborate patient counseling element in medication dispensing
Describe principles of client-centered healthcare
Good customer service requires presenting customer in a calm, courteous & professional manner.
o requires listening to customers
o understanding customer requests for service
o fulfilling those requests accurately or
o explaining to the customer's why the request cannot be serviced.
Customers may often feel sick or irritable and need their medication quickly. Having to wait in a
line may be physically difficult or emotionally upsetting. The cost of the medication may be an
additional worry. Consequently, good customer service is an important in any type of retail
pharmacy that increase patient comfort.

It is important to respond to customers in a positive way at all times. In any situation where a
customer is angry, frustrated, or otherwise dissatisfied, it is important to give a positive response.
This can be done by listening intently and making eye contact with customer. Restating what the
customer has said is also important, since it demonstrates that you have listened to their complaint.

Use positive, not negative, terms to tell the customer what you can do, not what you can't do to
solve their problem. Involve the pharmacist in all difficult situations. If after spending some time
with the customer, you have been unable to resolve the problem, you should inform the pharmacist.
This should be done immediately for serious complaints regarding problems with prescriptions.
Remember that employees who possess well-developed interpersonal skills are good for business
and will be appreciated by employers.

Selling products and services is like an endless cycle: you need to learn all about the products and
services your organization offers, and you need to approach customers with confidence and find
out what their specific needs are. Once you know what they are looking for you can then, using
your product knowledge, recommend products and services that match their needs and handle any
objections that might arise before, closing the sale.

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4.1 Client-centered healthcare

The workplace is an important setting for health protection, health promotion and disease
prevention programs. While employers have a responsibility to provide a safe and hazard-free
workplace, they also have abundant opportunities to promote individual health and foster a healthy
work environment for many workers. A healthy workplace is one in which workers and managers
collaborate to use a continual improvement process to protect and promote the health, safety and
well-being of patients, workers and sustainability of the workplace.
 health and safety concerns in the physical work environment;
 health, safety and well-being concerns in psychosocial work environment
 personal health resources in the workplace and
 participating in community to improve health of workers & members of community.
Principles of client-centered healthcare
o innovative approach to the planning, delivery, and evaluation of health care
o grounded in mutually beneficial partnerships (health care providers, patients & families).
o applies to patients of all ages
o practiced in any health care setting.
Concepts of patient-centered care
There are numerous proposed definitions of patient-centered care that encompass many of the
same core concepts, but there is no globally accepted definition. Modern concepts of patient-
centered care are based largely on research conducted in 1993 by the Picker Institute, in
conjunction with the Harvard School of Medicine. This research identified eight dimensions of
patient-centered care that were originally documented in the book, ‘Through the Patient’s Eyes:
Understanding and Promoting Patient-Centered Care dimensions’.
o respect for patients’ preferences and values
o emotional support
o physical comfort
o information, communication and education
o continuity and transition
o coordination of care
o involvement of family and friends
o access to care.

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Several terms are used interchangeably or associated with ‘patient-centered care.

1. Consumer-centered care
The term ‘consumer-centered care’ is sometimes preferred to ‘patient-centered care’ to
acknowledge that care should focus on people who are actual or potential users of healthcare
services. The term ‘patient’ has passive overtones. In contrast, the term ‘consumer’ is seen as a
more active term, encompassing the need to engage people as partners in health service delivery.
2. Person-centered care
The term ‘patient-centered healthcare’ is often used interchangeably in primary care settings with
terms such as ‘person-centered care’, ‘relationship-centered care’ and ‘personalized care’. Applied
to older people and focuses on developing relationships and plans of care collaboratively between
staff and patients. This term values the needs of patients, careers and staff. ‘Personalized care’ is
the integrated practice of medicine and patient care based on one’s unique biology, behavior and
environment. It uses genomics & molecular-level techniques in clinical care; as well as health
information technology, to integrate clinical care with individualized treatment of patients.
3. Family-centered care
This term emerged in the US in the 1980s in response to the needs of families with children who
could not leave hospital. These families sought to work more collaboratively with healthcare
professionals and successfully advocated for changes to enable them to care for their children in
home and community settings.
Advantages of patient-centered care
 Experience, clinical and operational benefits.
 healthcare administrators, providers, patients and families work in partnership
 decrease cost, quality and safety of health care rises and
 provider and patient satisfaction increase
 Decreased mortality, decreased emergency department return visits
 Fewer medication errors & lower infection rates
 Higher functional status, improved clinical care
 In chronic conditions can improve disease management
o increase both patient and doctor satisfaction
o increase patient engagement and task orientation
o reduce anxiety; and improve quality of life.

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In short person centred care can have a big impact on the quality of care
 improve the experience people have of care and help them feel more satisfied
 encourage people to lead a more healthy lifestyle , such as exercising or eating healthily
 encourage people to be more involved in decisions about their care so they get services
and support that are appropriate for their needs
 improve how confident and satisfied professionals feel about the care provided
4. Principles of client safety
Patient safety is a discipline in the health care sector that applies safety science methods toward
the goal of achieving a trustworthy system of health care delivery. Patient safety is also an
attribute of health care systems; it minimizes the incidence and impact of adverse events, and
maximizes recovery from, adverse events. Patient Safety is prevention of harm to patients.
Emphasis is placed on the system of care delivery that
o prevents errors
o learns from the errors that do occur; and
o built on a culture of safety of health care professionals, organizations, and patients
Many patient safety practices in dispensing units like use of bar coding and computerized
dispensing entry, have been considered as possible strategies to avoid patient safety errors and
improve health care processes.

4.2 Patient counselling in dispensary

Communication skills are very important for dispensers dealing with patients or health care
professionals to convey relevant medicine information effectively and clearly, which can be done
verbally and/or in written form. Medicine dispensers must have the ability to explain information
clearly by the language the patient or care provider can understand and check whether the
information is being understood.
Communication is the art and process of creating and sharing ideas, i.e. transfer of information
meaningful to those involved. Effective communication depends on the richness of those ideas.
Communication process between health professionals and patients serves two functions:
1. Establishes an ongoing relationship between the professional and the patient.
2. Provides exchange of information necessary to assess a patient’s health condition, and
evaluate the effects of treatment on a patient’s quality of life.

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Communication skills are tools used to remove the barriers to effective communication.
 The healthcare professional must be able to
 understand the illness experience of the patient
 perceive each patient’s experience as unique
 foster a more egalitarian relationship with patients
 build a therapeutic alliance with patients to meet mutually understood goals of therapy
 develop self-awareness of personal effects on patients
 Patients encouraged to share experiences with therapy because patients :
o have unanswered questions
o have misunderstandings
o experience problems to therapy
o can monitor their own responses to treatment
o make their own decisions regarding therapy
o may not reveal information to you unless you initiate a dialogue
Communication during drug therapy
 Purpose of medication
 How medication works
 Dose and duration of therapy
 Goals of therapy
 How effectiveness will be monitored
 Adverse effects and how to deal with them
 Drug specific issues
Dissemination of medicine information to health care professionals, patients and the general public
is an important responsibility of pharmacy professionals by both verbal & written communication.
 Verbal communication to medicine information must be:
o Clear and fluent by understandable language
o Well-organized on important details
o With confidence done by maintaining eye contact during face-to-face communication
o Avoid; emotion, negligence, medical languages and unnecessary details.
 Written communication of medicine information for patients must be well-organized,
readable, clear and complete.

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Self-Check
True false questions
1. Communication is important in dispensing medication.
2. Communication is not necessary in counseling.
3. You should expect the same behavior from all of your customers.
4. Quality medicine dispensing is the heart for improving customer services.
Short answer questions
1. List the terms that are used interchangeably or associated with patient-centered care.
2. List two patient safety practices in dispensing units that avoid patient safety errors.
3. List component of patient-centered healthcare.
Summary
Good customer service requires presenting yourself to customers in a calm, courteous, and
professional manner. Listening to and understanding customer requests for service and explaining
to the customer's satisfaction why the request cannot be serviced is important.
Quality medication dispensing is the heart for improving customer services. Communication skill
improve quality dispensing and must be followed by all dispensers.
Workplace is an important setting for health protection, health promotion and disease prevention
programs. While employers have a responsibility to provide a safe and hazard-free workplace, they
also have abundant opportunities to promote individual health and foster a healthy work
environment for many workers.

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5. Principles and processes of good dispensing practice

After completing this chapter you are expected to

Describe principles of good dispensing practices in pharmacy dispensary
Identify types and parts of prescription
Classify pharmaceutical products based on legal requirements
List commonly used pharmaceutical abbreviations with their translation
Perform medication dispensing process accurately

5.1 Principles of Good Dispensing

Good dispensing practice refers to the process of preparing medicines and distributing to users
with provision of an appropriate information, counseling and follow up.

The rational use of medicine requires that patients receive medications appropriate to their clinical
needs, in doses that meet their own individual requirements, for an adequate period of time, and at
the lowest cost to them and their community. Rational use of medicines is a complex issue
demanding mainly an integrated action of prescribers, dispensers and users and/or patients.

It may extend to the level of health administrators and policy makers, for instance, in matters
related to the development of a list of essential medicines and improvement of the availability of
medicine. Dispensing practice plays a central role in the provision of rational medicine use.
Medicine should be dispensed in a safe & hygienic manner, making sure that the patient or care
provider understands the value of taking specific medicines for specific indications.

 Good dispensing practice ensures the correct medicine is delivered

 to the right patient with clear instructions,
 in the required dosage and quantities,
 in package that maintains acceptable potency and quality of medicine.
The dispensing process includes all activities that occur between the time the prescription or
request for medicine is presented up to the time the medicines or other prescribed items are issued
to the patient. This process may take place in health institutions and community medicines retail
outlets. It is often carried out by pharmacy professionals. Any error or failure in the dispensing
process can seriously affect the care of the patient mainly with medical and economical
consequences. Therefore, the dispenser plays a crucial role in the therapeutic process.

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5.2 Dispensing process

The consistent, repeated use of good dispensing procedures is vital in ensuring that errors are
detected & corrected at all stages of the dispensing process. The term dispensing process covers
all activities involved, from receiving prescription to issuing prescribed medicine to patient. Good
dispensing practice is a process that requires knowledge, skill and attitude which is important for
delivery of correct drug and medical supply to the package that maintains acceptable potency and
quality with clearly and up to date information using clean equipment and working area according
to medication order or request.
The development and use of written standard operating procedures (SOPs) for the dispensing
process will improve consistency and quality of work. The framework for such SOPs is based on
the major areas of activity which is called dispensing cycle. In general there are six major

steps to be performed in the dispensing cycle during the dispensing process for
ambulatory patients.

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Figure 1-2 Dispensing cycle (Prescription Process)

Step 1: Receive, Interpret and Evaluate the Prescription
 Upon receiving a prescription confirm patient name to prevent mix up of prescriptions.
 Cross-checking name and identity of the patient when issuing the medicines.
A. Evaluation for legality
 A prescription is legal when:
o written (can also be typed) and signed by authorized prescriber
o medicines are written on the right prescription such as NPS prescription used (narcotic
and psychotropic prescription) for controlled drugs
o date of issue not exceeding 15 days for narcotic & psychotropic substances and 30 days
for other medicines
o has all information required to be contained with respect to parts of prescription.

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B. Evaluation for Legibility

A brief examination of each prescription should be made immediately upon receiving it from the
patient to ascertain the legibility of various parts of the prescription. Any doubt regarding the
reading of the prescription (i.e. name of medicines or directions), should be examined closely and,
if necessary discussed/consulted with other pharmacists or the prescriber without arousing doubts
or fears in the patient.
Handwritten names of patients and medicines are often difficult to read. In case of illegibility of
name, age, etc., ask the patient for the correct spelling tactfully. For example the pharmacy
professional may ask “Excuse me, is the first name Meseret or Mahelet?”

Always use ‘please’, ‘excuse me’ etc. and be polite

Every prescription should be read and understood thoroughly before attempting to dispense it.
Every word, abbreviation, has a meaning. To assume that an illegible or confusing word is
unimportant inviting a costly mistake. In case of doubt, consult another pharmacy professional or
the prescriber. ‘Never dispense guess work’

Legibility is a problem requiring alertness and critical judgment on the part of the pharmacy
professional. Careless handwriting and similarity in spelling names of different medicines add
to the difficulty.

Example of a Reading error:

Medoprazole and mebendazole - due to illegible handwriting of prescribers, Medoprazole could
be read as mebendazole. Medoprazole is a brand containing omeprazole where as mebendazole
is an antihelmentic two different medicines used for two different conditions. When handwriting
is illegible, the best thing to do is to contact the prescriber over the phone and confirm.
Remember, you are dealing with medicines thus & lives of patients. So be sure of what you
are dispensing. Imagine the disastrous consequences of dispensing the wrong medicine.

The dosage form, the dosage and the quantity to be dispensed have to be legible so that dispensing
becomes easier for the pharmacy professional. The instructions written for administration should
state clearly what the prescriber expects from the patient so that the pharmacy professionals can

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counsel the patients efficiently. All terminology, including units of measures and Latin
abbreviations should be properly interpreted and checked.
C. Identifying the patient’s condition
D. Completeness of the prescription
 The prescription serves as a vehicle for communication from the licensed medical practitioner
to the pharmacy professionals about the pharmaceutical care of the patient.
 Details to be checked for completeness of the prescription\
 Seal of the health institution or header
 Prescriber’s details (name of prescriber’s, qualification, signature and date )
 Patient's details (name of patient, address, sex, age, weight and diagnosis)
 Medicine details
 Checking the medicine details will include checking:
o Name of the medicine and Dosage form
o Strength/ potency of the medicine
o Total amount to be dispensed and availability
o Dosage and directions for use
o Frequency of administration and duration of the treatment
1. Name of the medicine
The name of medicine must be legible and correct without a doubt. Since many brands sound alike,
brand confusion is quite common especially if the handwriting is illegible and the pharmacy
professionals proceeds on the basis of guesswork. The prescriber should ideally write the generic
name in parentheses against the brand name or write the generic name alone. This makes it easier
if the pharmacy professional is not familiar with the brand prescribed. It would also aid in avoiding
brand confusion.
If the prescriber writes the generic name alone, the pharmacy professional can give a brand of his
choice. However, pharmacy professional's responsibility is to ensure the brand is of a standard
company and registered by FMHACA, and is cost effective at the same time. The pharmacy
professional has to proceed ethically and morally, and in the best interest of the patient.
2. Dosage Form
Some medicines are available in many different formulations. It is essential to check that the
product on the prescription is available in the correct formulation, and to correctly choose the

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formulation. Confusion and mistakes can be made if the name of the formulation is similar to
another formulation. For example, tablet formulations of a medicine are available as tablets of 25
mg and 50 mg, dispersible/effervescent tablets, and 100mg sustained release tablets.

The same medicine could be available as tablets, capsules, and even injections. It is important
to check the prescriber’s prescription for the dosage form. If the dosage form is not specified,
advisable to call up prescriber & find out if medicine is available as different formulations, e.g.,
diclofenac available as 50mg tablet, 100mg suppository & 75m/3ml injection

Dermatological preparations such as creams, ointments, gels and lotions are not necessarily
interchangeable; in fact wrong use can cause problems. The same medicine could be available as
cream, gel, lotion and ointment and the prescriber may decide the exact dosage form to be
dispensed to a particular condition. But, prescribers may write without specifying the dosage form.
Example – dermovate 25 gram # one tube, apply nocte; retinoic acid 0.5% # one tube; apply once
a day, it may be available as gel and lotion; fucidic acid # one tube; apply bid, it may be available
as cream and ointment forms.
 In such cases, the pharmacy professional has to choose the dosage form: the decision to use an
ointment, paste, cream, or lotion depends on
 degree of skin penetration of the medication
 characteristics of the skin to which the product is being applied.
 For ointments (oleaginous bases) are generally used on dry scaly lesions as their emollient
properties will aid in re-hydrating the skin and they stay on longer.
 Pastes are generally applied to an area that is intended to be protected
3. Strength/potency of the Medicine
The pharmacy professionals should check that the strength is mentioned. There may be cases for
prescribers to prescribe medicine without the strength. If no strength is mentioned, it cannot be
assumed that the lowest or highest strength has to be dispensed. This is because many times the
lower strength may not be sufficient to treat the condition or higher strength may lead to toxicity.
Example, combination of amoxycillin and clavulanate (Augmentin) is available as 1gm, 625mg,
412mg, 375mg, and so on. If a lower dose is given for an adult it may not be sufficient to kill the
microbial load and cure the infection. If the strength is not stated on the prescription, mostly it may
be necessary to contact the prescriber for confirmation of the appropriate strength.

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Activity
The prescriber prescribes a combination of amoxycillin and clavulanate and mentions the dose
as take 5ml twice a day. It is available as amoxicillin 125mg + clavulanic acid 31.25mg and
amoxicillin 200mg + clavulanic acid 28.5mg. What you are going to do?

4. Quantity to be Dispensed
The prescription should lead to arrive at the exact number of the total quantity to be supplied to
the patient. Pharmacy professional should check this quantity to confirm that it is appropriate for
the patient, and that the product can be supplied in such quantity. For any product with a short
expiry period, ensure that the quantity dispensed will not last longer than the expiry date. In case
the duration of therapy or total quantity to be dispensed is not mentioned, it will be necessary to
contact the prescriber.

Activity: On December 7, 2017, the patient brought the prescription which read as follow;
‘metformin 500 mg tablets p.o 1 tablet twice daily for 3 months’ for a chronic patient who has
been taking the medicine since 3 years ago. The stock available of metformin 500 mg tablet in
the pharmacy has an expiry date of January 31st 2018 and no fresh stock is available. What to
do? Is there a way to dispense for him all stocks?

Remember if the expiry date of a product is labeled as January 2018, then the product can
be used until the end of January 31st 2018.
5. Dosage and Directions for use
A knowledgeable and an alert pharmacy professional can be a great asset and a lifesaver especially
if the prescriber makes mistakes (at times major ones) while prescribing.
6. Contraindications
The age, sex, disease(s) conditions, or other characteristics of a patient may cause certain
prescribed medicines to be contraindicated. The pharmacy professional should look out for such
contraindications. The dose should always be checked taking into account the patient's age, and
weight (especially for a child or for the elderly and pregnant woman).
The dose should be carefully checked in case of children, and for all categories of potent medicines.
Confirm the units written on the prescription, i.e. milligrams, micrograms, decimal points, etc. for
medicines like digoxin.

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Example; you need to check carefully whether the prescription states: 0.25 mg or 0.025 mg, 0.5mg
or 50mg, 0.125mg or 125mcg (microgram). Pharmacy professional should verify, whether the
dosage prescribed is within standard minimum and maximum dose range. Use standard textbooks
or reference books for the standard dose.
Medicines that have a very wide dose range can be a little tricky. It may be difficult for pharmacy
professionals to detect inappropriate doses, and extra vigilance is needed. Example for amoxicillin,
the recommended dose is 20-50 mg per kg body weight per day. Thus making it difficult for the
pharmacy professionals to gauge whether the prescribed dose is correct or not.
Develop a professional and good relationship with prescribers in the vicinity of the pharmacy or
with those whose prescriptions come to you, so that you feel confident and not afraid to talk/discuss
with the prescriber about a possible prescribing error.
7. Frequency of Administration
Check if the frequency recommended by the prescriber is as per the standard dosing patterns. Doses
more frequent than standard, proven doses may cause toxic manifestations. At the same time, doses
lesser than standard, required doses may result in failure to treat the condition properly. In addition
to frequency of administration, adherence to the time schedule is also important. For instance,
patients taking medicines for hypertension have to take the medicine at the same time to maintain
blood levels of the medicine.
E. Correctness of the Prescription
 Double medication: (same medicine or different medicine with same pharmaco-therapeutic
effect) concurrently prescribed by the same or different prescribers to the same patient.
 Example; if a patient has been prescribed diclofenac for fever, and if the dentist has
prescribed ibuprofen for the same patient, it could lead to overdosing of anti-pian drugs,
and result in the risk of gastrointestinal bleeding and may aggravate hypertension.
 Interactions: many medicines are known to interact with other prescribed or OTC medicines,
food, diseases, herbal medicines, and laboratory results.
o Ideally, all multiple item prescriptions should be checked for medicine interactions.
o If a prescribed item is known to interact with many medicines or to interact with OTC
medicines then it is imperative that the pharmacy professionals check with the patient
which other medicines or traditional/complementary medicines the patient is taking, in
order to eliminate possible medicines interactions.

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o Any medicine interactions likely to render the therapy ineffective or cause undesirable
effects to the patient, or affect the treatment in any way, should be brought to the notice
of the prescribing prescriber (without unduly alarming the patient).
Example –
o Acetylsalicylic acid taken can increase the effect of an anticoagulant (warfarin) that a
patient is taking, and may thus lead to bleeding.
o Patients taking ciprofloxacin should avoid taking antacid within 2-3 hours because the
antacid can drastically reduce the absorption of ciprofloxacin
 While interactions should be considered when dispensing all prescriptions, some groups of
patients are particularly vulnerable, and extra vigilance is required. (Pregnant women,
children, elderly, and those with kidney or liver malfunction)
 Known allergies should be checked, particularly for antibiotic prescription, where
prescribers fail to consider cross sensitivities within groups of medicines e.g. penicillin.
 Also check if there is any therapeutic or other type of incompatibility.
 e.g., a pharmacy professionals may know that the client regularly takes oral
contraceptives, but the prescriber may not have asked or not known about it.
 At times, a prescriber may have prescribed a medicine without considering certain aspects,
e.g., a prescriber may prescribe a medicine without confirming with a woman whether she
is pregnant or not.
 A pharmacy professional can question the patient politely about, whether she is pregnant,
or the patient/client may pose the question herself while the prescription is being filled.
 History of overuse, under use or misuse of medicines by the patient.
 Check for overwriting: Overwriting can be done by the patient, to buy extra medicines
(especially habit forming medicines or medicines of abuse).
 Fake/false prescription: pharmacy professionals should be alert to detect misuse of
prescription blanks by clients (obtained by stealing from private practitioners or from
Government hospital outpatient departments, where blanks are often left lying around).
 Pharmacy professionals should also be alert to fake prescriptions written/ printed by
the patient or client coming to the pharmacy.
 If the handwriting is not the usual handwriting of the prescriber or you notice it to be
unusual otherwise, confirm with a senior colleague or call the prescriber to confirm.

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 Do not dispense such prescriptions, and be sure to alert the prescriber about misuse.
 For potent medicines, and medicines with a narrow therapeutic index:
o Special care has to be taken with such medicines, as slight changes in systemic
concentration lead to marked changes in pharmacodynamics responses.
o Examples of narrow therapeutic index medicines: digoxin, lithium, phenytoin, warfarin
 Special care has to be taken in case of:
a) Medicines with similar names:
 Certain medicines have names that appear similar when carelessly written or when not
read carefully, particularly likely if strengths & doses of the two preparations are similar.
 Doubts should always be resolved by checking with the prescriber.
 Example of similar names that illustrate the pit falls are: folic acid versus folinic acid.
b) Abbreviations
Although widely used in prescription writing, abbreviations can kill. This is because in health care
there are no recognized standards for abbreviations, and most of the time, prescribers invent their
own. Secondly, different individuals/pharmacy professionals may assume or interpret
abbreviations differently.

Examples: ‘HCT’ 25mg was intended to mean hydrocortisone 25mg, but hydrochlorothiazide
was dispensed. ‘CPZ’ may refer to chlorpromazine, an antipsychotic or to carbamazepine, which
is an anticonvulsant. ‘CPM’ can mean chlorpromazine or chlorpheniramine

Never hint on abbreviations, be sure to confirm with the prescriber.

 Changes to the prescription
Before a pharmacy professional attempts to dispense a prescription, he/she must read and
understand it thoroughly. If any portion of the prescription is not understood, or if he/she has
detected an incompatibility, he/she should consult the prescriber who wrote the prescription.
Any changes made to the prescription over the telephone by the prescriber, should be recorded on
the prescription, with the words “changes made over the telephone, in consultation with the
prescriber at (time) on (date)” and should be signed and stamped by the pharmacy professional.
This exercise facilitates a trust based professional relationship with the prescriber, besides
documenting the changes made to the legal document - the prescription, by the pharmacy
professional. Many pharmacy professionals hesitate to call the prescriber about these matters, but,

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if the calls are executed tactfully, there is no reason why they should not create a better
understanding between the persons of both professions.
F. Therapeutic aspects
 the safety of the medicine,
 possible contra-indications,
 drug/drug interactions,
 drug/food interaction,
 drug/disease interactions, and
 treatment duplications.
G. Appropriateness of the individual
 Confirm that the dose and duration of prescribed medicine are in the normal range for the
patient (noting sex and age or weight)
 Under no circumstances should an untrained person attempt to read or discuss the
prescription with the client.
Step 2: Selection and manipulation of the medicine
 Select stock container of pre-pack reading the label and cross matching the medicine
name and strength against the prescription.
 Read the container label at least twice during the dispensing process.
 Do not select the prescribed medicine according to the color or location of container.
 Do not open many stock containers at the same time. This trend will lead to errors and/or
expose the medicines to air and eventually leads to deterioration in quality.
 Open and close containers once at a time.
 While counting, pouring or measuring, the following points should be noted:
o short and/or over counting should be avoided
o Clean counting tray and/or spoon used
o Graduated measuring cylinder and/or flask must be used for measuring liquid.
o If small volume is to be measured, small measuring cylinder/flask has to be used (if
compounding is performed in the pharmacy).
 Appropriate balance should be used (if compounding is performed in the pharmacy)
 In dispensing liquids (if compounding is performed in the pharmacy):

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 Must be measured in a clean vessel and should be poured from the stock bottle with
the label kept up ward to avoid damage to the label by any spilled or dripping liquid.
 Pour the measured liquid preparation into the container/bottle and label it.
 Provide appropriate bottles with caps for repackaging liquid preparations
 Dispense liquid preparations in suitable containers
 Do not use patient’s own bottle
 Dispense each medicine in a different bottle
 In dispensing tablets and capsules:
o Do not use fingers to count tablets as this can lead to contamination of medicines
o Use a spoon to put tablets and capsules onto a counting tray
o Count and put them in a labeled medicine container or pack
o Close stock containers tightly after dispensing
o Keep the spoon clean at all times
o Do not keep the spoon inside the container
 Labeling of dispensed medicines should be clear and legible.
 Use separate plastic boxes for different patient's requirements of medicines.
 To avoid mix-ups of medicines of different patients, assemble in separate/different
boxes, till they are billed and packed.

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Skill Practice Session 12: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the prescribed
medicines.
 1 Ciprofloxacin 500mg tablet= 0.85 cents
 1 Paracetamol 500mg tablet= 0.15 cents
 1 Antacid Suspension bottle= 18.55 birr

BAKO HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: GG
Age: 28 Sex: M Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: West Shewa Woreda/Town: Bako Kebele: 01
House No. New Tel. No: 09xxxxxxx Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Typhoid Fever
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Ciprofloxacin 500mg tab po BID for 7days

- Paracetamol 500mg tab po PRN=10 Tab

- Antacid Suspension 2tsp pot id for 7 days

Total Price
Prescriber’s Dispenser’s
Full Name:
Qualification:
Registration No:
Signature:
Date:

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Skill Practice Session 13: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the
prescribed medicines.
 One Ciprofloxacin 500mg tablet= 0.85 cents
 One Paracetamol 500mg tablet= 0.15 cents
 One Doxycline 100mg tablet = 0.65 cents

Nekemte Health Center

PRESCRIPTION PAPER
Tel. No: + 251xxxxxx [Link]: xxx
Patient’s Full Name: G T
Sex: F Age: 25 Weight: 50kg Card No. 002511
Region: 04 Town: Nekemte Kebele: 03
House [Link] Tel. No: xxxxx xxx � Inpatient � Outpatient
Diagnosis, if not ICD: Typhoid + Typhus
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

Ciprofloxacin 500mg tablet po/day for 7 days

Paracetamol 500mg tablet po PRN
Doxycline 100mg BID for 7 days
Total Price

Prescriber’s Dispenser’s
Full name: TT
Qualification: HO
Registration # HO/1999/08
Signature: Signed
Date: 22/7/2016 22/7/2016
Step 3: Labeling and packaging of the medicine in an appropriate container
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The containers used for dispensing must be appropriate for the product dispensed. All containers
intended for medicinal products must be protected and kept free from contamination.
A. Packaging of medicines
Medicines must be suitably contained, protected and labeled from the time of manufacture until
they are used by the patient. The container must maintain the quality, safety and stability of the
medicine throughout this period.
 The selection of packaging for medicines depends on:
o Nature of the medicine and dosage form
o Type of patient
o Method of administering the medicine
o Required shelf-life
o Use, such as for dispensing.
Original containers used by manufacturers are expected to protect medicines for their specified
shelf-life. Because original containers may contain large amount of medicines, repackaging of
medicines into another container may be necessary in order to dispense medicines for patients.
Such repackaging procedure can be done at-the –spot or in advance.
Prepackaging is the process by which the pharmacy professional transfers a medication manually
from a manufacturer's original commercial container to another type of container in advance
(before clients come to medicine retail out lets).
The following guidelines are recommended in prepackaging of medicines:
 Prepackaging procedures must comply with laws and regulations.
 Prepackaging operation area must be clean and separate from other pharmacy activities.
 Only one medicine product at a time should be prepackaged in a specific work area.
 Before beginning a prepackaging run, a physical evaluation (color, odor, appearance, and
markings) of medicine being prepackaged should be made to assure product integrity.
 Bulk container should also be examined for evidence of damage and contamination.
 Prepackaging equipment operated in accordance with established instructions.
 There should be valid justification and authorization by the supervisor for any deviation
from those instructions on the part of the operator.
 The pharmacy professional must use available data on the characteristics of all packaging
material used to protect the integrity of the medicine product: data on the chemical

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composition, light transmission, moisture permeability, size, thickness (alone or in

laminate), recommended sealing temperature, and storage requirements.
Upon completion of prepackaging, all unused medicine stock, unused labels and finished packages
should be removed from the prepackaging area. The packaging equipment should then be
completely emptied, cleaned, and inspected before commencing the next prepackaging operation.
All prepackaged medicines stored in a temperature and humidity controlled environment
accordance with the manufacturer's instructions.
The main advantages of prepackaging medicines
o allows enough time for patient counseling
o minimizes dispensing errors from confused operation due to heavy patient load.
B. Packaging aids and Materials
 Re-packing materials: bottles (plastic, glass), collapsible tubes, envelops (plastic, paper) etc.
C. Labeling of medicines
 Functions of a label on a dispensed medicine
o uniquely identify the contents of the container
o ensure patients have clear and concise information about medicines.
 Each dispensed medicine must be
appropriately labeled to comply with legal and professional requirements.
labeled and the labels should be unambiguous, clear, legible and fixed.
If possible lettering should be printed.
 The following information should be indicated on the label of dispensed medicines.
o Patient name, Generic name, strength and dosage form
o Dose, frequency and duration of use
o Quantity of the medicine dispensed
o How to take or administer the medicine?
o Storage condition
 For extemporaneous or prepackaged medicines there should be a batch number, expiry date or
beyond-use date

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Table: Medicine Label information

o Date _______________
o Name of Health Institution ________________________________________________
o Name of Patient
_________________________________________________________
o Generic name, strength and dosage form of medicine
_____________________________
o Frequency and duration of medicine administration
______________________________
o Quantity of the medicine dispensed
__________________________________________
o How to take the medicine
__________________________________________________
o Expiry date
_____________________________________________________________
o Storage condition
________________________________________________________

Labeling problem of drug retail outlets of Ethiopia

 dispensed medicines without a label
 incomplete label, or illegible label.
 used paper envelops size may not allow to write required information.
Case study
Ato Kebede went to a pharmacy with a prescription for nitroglycerin sublingual tablets. The
pharmacy worker repackaged the prescribed number of tablets in paper envelops and dispensed
with appropriate instructions for use. Some other day, Ato Kebede consulted the pharmacy
professional about decreasing efficacy of the medicine dispensed.
Comment on the cause of decreasing effectiveness of the dispensed medicine.
Discussion: Nitroglycerin is volatile medicine. It should be repackaged in tightly closed
containers (bottles). The use of paper envelops for repackaging leads to a reduced efficacy of
nitroglycerin, a possible reason for the complaint of Ato Kebede.

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Case study
The pharmacy professional received a prescription with the following information:
Ibuprofen 400mg tablet
Mitte 60
One t.i.d.
The pharmacy professional dispensed 60 tablets of ibuprofen 400mg and wrote a label that the
patient should take three tablets daily with or after food.
Comment on dosage.
Discussion: The prescription was to take one tablet three times a day. The information on the
label is not clear. Accordingly, the patient may take three tablets at a time, which may lead to
an occurrence of adverse effects or loss of efficacy. Understanding the meaning of Latin
abbreviations that may appear on the prescription papers is important.

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Skill Practice Session 14: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the prescribed
medicines.

BAKO HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: GG
Age: 28 Sex: M Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: West Shewa Woreda/Town: Bako Kebele: 01
House No. New Tel. No: 09xxxxxxx Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Typhoid Fever, Cough
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Ampicillin 500 mg cap po BID for 7 days # 33

- Diclofenac 500 mg tab po PRN=10 Tab # 100

- Diphenhydramine syrup 6 tsp po t id for 7 days # 1/2 bottle

Total Price
Prescriber’s Dispenser’s
Full Name:
Qualification:
Registration No:
Signature:
Date:

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Skill Practice Session 15: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the prescribed
medicines, and use appropriate packaging material.
 One Ciprofloxacin 500 mg capsule= 0.75 cents
 One Diclofenac 50 mg tablet= 0.35 cents
 One Diphenhydramine syrup bottle= 13.25 birr

BAKO HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: GG
Age: 28 Sex: M Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: West Shewa Woreda/Town: Bako Kebele: 01
House No. New Tel. No: 09xxxxxxx Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Typhoid Fever, Cough
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Ciprofloxacin 500 mg cap po QID for 7days

- Diclofenac 50 mg tab po PRN=10 Tab

- Diphenhydramine syrup 2 tsp po t id for 5 days

Total Price
Prescriber’s Dispenser’s
Full Name:
Qualification:
Registration No:
Signature:
Date:

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Step 4: The provision of information and instruction to client

General Steps of Counseling
All medicines should be dispensed with adequate and appropriate information and counseling.
Information must be structured to meet the needs of individual patients and questions and answers
should be used to check the patient understands. Written information should be provided to
supplement verbal communication as appropriate. Counseling should ensure that the patient has
an unequivocal understanding of the instructions for use, and any distinct characteristics or
requirements of the medicine. Counseling should cover matters that will enhance or optimize
medicine therapy. The prepared, packaged and labeled medicine is handed over to the right patient
or care provider with appropriate medicine information. The information in the form of verbal
and/or written instructions should include the following:
o How much and how often to take the medicine
o When to take the medicine (e.g., before or after meals)
o How long the treatment is to last (e.g., why the entire course of an antibiotic treatment
must be taken)
o How to take the medicine (e.g., with water, chewing or swallowing)
o How to store the medicine (e.g., avoid heat, light and dampness)
o Not to share medicines with other persons
o Which types of foods and beverages should avoid while taking the medicine
o To keep medicines out of reach of children
o One has to demonstrate to the patient on how to administer the dispensed medications in
case of inhaled administration and suppository application
o Patients should also be informed not to stop treatment when side effects occur or in the
absence of response without consulting the prescriber or dispenser.
o Finally, check whether patients have understood the information provided (see figure 8-4)

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Figure 8-4: Communicating with a patient at the dispensary

Step 5: Recording the transaction
Prescriptions should be recorded and documented as proof of transaction between the patient and
the dispenser. Prescriptions can therefore be traced back if any need arises. All dispensing units
should have a standardized Prescription Registration Book (PRB) for recording every
pharmaceutical issued to a patient. A computerized dispensing and registration system may also
be used, but should always be supported by paper back up. The PRB should be completed at the
time of dispensing or at the close of the working day.

For a prescription which is returned to a patient because all the items in the original prescription
could not be filled, the medicines that have been dispensed from the pharmacy should be copied
on a blank prescription and the prescription should be filed appropriately. On the original
prescription, which is retained by the patient, the word “dispensed” should be stamped adjacent to
those items which have been dispensed. For prescriptions which are to be refilled on a later date,
the dispensing information should be entered into the registration book before returning the
prescription to the patient. The official seal of the pharmacy/Health institution, name and signature
of the dispenser, the date of dispensing and the next refill date should be written on the prescription.

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Documentation and report

 Receipts for requisition, receiving & prescription registration book should kept properly.
 Blank prescription should be kept carefully, only prescribers have access to them.
 Filled prescription should be kept as a receipt. Prescriptions for narcotic and psychotropic
Substances should be kept for 5 years and other prescriptions for 2 years. Thereafter, they
should be disposed carefully in the presence of appropriate body.
 Regular reports on medicine consumption & prescribing pattern from patient prescription
registration book should be prepared and report to the appropriate body timely.
 Information obtained from prescription registration book could be used for further planning
and efficient utilization of resource.
 The report on physical inventory shall be documented
Tables for PRB
Step 6: Prescription filing
Each prescription should be signed and accountability accepted by the dispenser or other
authorized person for the correctness of the dispensing of the medicine and confirming that the
medicine was supplied.
 At the close of each day all dispensed prescriptions should be organized
 Prescriptions should be filed sequentially by day in a single container/carton for each
month. The container should be labeled with the month and year.
 Containers should be arranged on a monthly basis.
 Normal prescriptions filed securely for two years and special prescriptions for 5 years.
 Prescriptions, patient & medication related records & information should be documented
& kept in a secure place that is easily accessible only to the authorized personnel.

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Skill Practice Session 16: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the prescribed
medicines,

BAKO HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: GG
Age: 28 Sex: M Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: West Shewa Woreda/Town: Bako Kebele: 01
House No. New Tel. No: 09xxxxxxx Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Typhoid Fever, Cough, bacillary dysentery, PUD
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)

- Amoxcillin 500 mg cap po BID for 7days

- Ibuprofen 100 mg tab po PRN=10 Tab

- Cotrimoxazole 480 Po BID for 10 days

- Cimetidine 600 m QID for 10 days

- Dextrometorpan syrup 2 tsp po QID for 5 days

Total Price
Prescriber’s Dispenser’s
Full Name:
Qualification:
Registration No:
Signature:
Date:

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Skill Practice Session 17: Evaluation of prescription

Instructions: Evaluate the prescription, interpret the abbreviations, and calculate the total
quantity to be dispensed, price of each medicine and identify the groups/family of the prescribed
medicines, use appropriate packaging material, write label in the client’s local language and
provide patient counseling.
 One Amoxcillin 500 mg capsule= 0.75 cents
 One Ibuprofen 400 mg tablet= 0.65 cents
 One Cotrimoxazole 480 mg tablet= 0.90 cents
 One Diclofenac 50 mg tablet= 0.35 cents
 One Cimetidine 400 mg= 1.15 birr
 One Diphenhydramine syrup bottle= 13.25 birr

ADAMA HEALTH CENTER

PRESCRIPTION PAPER
Tel:+251xxxxxxx [Link]: xyz
Patient’s Full Name: GG
Age: 28 Sex: M Weight: 55 kg MRN: 0000xxxx
Region: Oromia Zone: West Shewa Woreda/Town: Bako Kebele: 01
House No. New Tel. No: 09xxxxxxx Outpatient: □ Inpatient: □
Specific diagnosis, if not ICD: Bronchitis, bacillary dysentery, PUD
Drug Name, Strength, Dosage Form, Frequency, Duration, Quantity, Price (dispensers use
Route of Administration and Other Information. only)
- Amoxcillin 500 mg cap po TID for 7days
- Ibuprofen 400 mg tab po PRN=10 Tab
- Cotrimoxazole 960 Po BID for 10 days
- Cimetidine 400 m BID for 10 days

- Diphenhydramine syrup 2 tsp po TID for 5 days

Total Price
Prescriber’s Dispenser’s
Full Name:
Qualification:
Registration No:
Signature:
Date:

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Case Scenario
Read the following case scenario to understand the six steps of good dispensing:
Institution Name: Halila Health Center Tel No: 022331….
Patient’s full Name: TH
Sex: F Age: 26 Weight: 68 Card No.: 024456/10
Region: Oromia Town: Asella, Woreda: Tiyo, Kebele: 07
House No. XYX65 Tel. No: 09123
Diagnosis, if not ICD: Osteomyelitis, Vaginal Candidiasis, Minor Skin abrasion
Medicine Name, Strength, Dosage Form, Dose, Frequency, Price
Duration, Quantity, How to use & other information (dispensers use only)
℞
1. Ampicillin capsule, 1 qid # 28
2. Gentian violet solution # 1 bottle
3. Diclofenac e/c 50 mg # 10 tablets
4. Clotrimazole 500mg vaginal tablet, once a day for seven
consecutive days

Prescriber’s Dispenser’s
Full name: Fita Gonfa Bontu Tola
Qualification: Health Officer Pharmacy Technician
Registration No: 4556/2008 663/2008
Signature Signed Signed
Date: 28/03/2010 28/03/2010
See over leaf

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Step 1: Evaluation and interpretation of a prescription

1. Interpreting the type of treatment
Bontu understands the patient’s conditions from prescription i.e. osteomyelitis, vaginal candidiasis
and minor skin abrasion. Based on Standard Treatment Guideline for Health center 2010, she
correlates TH‘s condition with prescribed medicines.
Then, she decides for
 Osteomyelitis- cloxacillin 500 mg P.O every six hours for 3-6 weeks
 Vaginal candidiasis- clotrimazole 100 mg vaginal tablet once a day, at bedtime, for
seven consecutive days and
 Minor skin abrasion genital violate.
Therefore, Bontu politely advises Mr. Fita to change ampicillin with cloxacillin and she excused
TH for delay and called to Mr. Fita. After soft greeting with Fita, she explained him about TH’s
medicines based on formulary and STG for health center. Mr. Fita thanked and asked Bontu to
send TH back. TH got the following corrected prescription and brought to Bontu.

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Corrected Prescription Paper

PRESCRIPTION PAPER
Institution Name: Halila Health Center Tel No: 022331….
Patient’s full Name: TH
Sex: F Age: 26 Weight: 68 Card No.: 024456/10
Region: Oromia Town: Asella, Woreda: Tiyo, Kebele: 07
House No. XYX65 Tel. No: 09123
Diagnosis, if not ICD: Osteomyelitis, Vaginal Candidiasis, Minor Skin abrasion
Medicine Name, Strength, Dosage Form, Dose, Frequency, Price
Duration, Quantity, How to use & other information (dispensers use only)
℞
1. Cloxacillin 500 mg capsule, 1 caps P.O QID for 21 days # 84
caps
2. Gentian violet 1% solution, apply gently on the lesion # 1 bottle
3. Clotrimazole 500mg vaginal tablet, once a day for seven
consecutive days
4. Diclofenac 50 mg e/c tablet, 1 tab P.O TID # 10 tablets

Prescriber’s Dispenser’s
Full name: Fita Gonfa Bontu Tola
Qualification: Health Officer Pharmacy Technician
Registration No: 4556/2008 663/2008
Signature Signed Signed
Date: 28/03/2010 28/03/2010
See over leaf

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2. Evaluation of prescription
 For legality
Bontu ensured the legality of the prescription by checking the prescriber’s information like name
(Fita), titer (signature), registration number (4556/2008), qualification (HO) and heading of
prescription. She also checked the prescription is authentic.
 Evaluation for legibility, completeness and correctness
 Bontu confirmed legibility, completeness & correctness of the prescription.
 Identifying the patient:
o Bontu identified patient name, TH from prescription, a five month pregnant and also she
did not encounter any allergy & had no history of ulcerative, renal and hepatic problems.
 Identifying the medicine
The prescribed medicines were:
1. Cloxacillin 500 mg capsule,
2. Gentian violet 1% solution
3. Clotrimazole 100 mg vaginal tablet
4. Diclofenac e/c 50 mg tablet
a) Checking the dosage form
 The four prescribed medicines were prescribed in appropriate dosage form
 cloxacillin 500 mg capsule,
 gentian violet solution,
 clotrimazole vaginal tablet
 diclofenac enteric coated (e/c) tablet
b) Strength
 The four prescribed medicines were prescribed in appropriate strength
 cloxacillin 500 mg capsule
 gentian violet 1% solution
 clotrimazole 100 mg vaginal tablet
 diclofenac 50 mg enteric coated (e/c) tablet.
c) Appropriateness of dosage
 TH is 29 years old and she did not have renal and hepatic problems. So according to
Health center Formulary were appropriate

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 cloxacillin 500 mg capsule every 6 hour

 clotrimazole vaginal tablet (100mg once a day)
 diclofenac 50 mg e/c tablet every 8 hour
d) Method of administration
 Cloxacillin 500 mg capsule and diclofenac 50 mg e/c tablet are administered orally
 Gentian violet 1% solution is applied topically
 Clotrimazole 100 mg vaginal tablet is administered vaginally
e) Duration of treatment
o Cloxacillin for Osteomyelitis for 3-6 weeks
o Clotrimazole vaginal tablets (100mg once a day), at bed time, for 7 consecutive days.
Bontu confirms the appropriateness of all prescribed medicine for TH based on STG for Health
center (2010) and Health center Formulary and also discussed with senior pharmacist who works
in this health center.
 Therapeutic aspects
a) Safety of the medicine
 TH told Bontu she is not allergic to any medicines she used to take before and she also
added she has no any ulcerative, renal as well as hepatic problems and she was not
alcohol addict.
 Even though TH never encountered any allergic conditions before, it is advisable to tell
the possible allergy due to cloxacillin
b) Possible contra-indications
o Based on the health center’s formulary four of the indicated medications do not
contraindicate with second trimester pregnancy
c) Drug-drug interactions,
o There is no known interaction among the four medicines
o TH told that she is not taking other medications
o Since TH is pregnant Bontu advised not to use any medications during pregnancy
without consulting health professionals
o Bontu advised not to take any alcohol

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d) Drug/food interaction,
o Food affects the bioavailability of cloxacillin when taken with food, so absorption
will be lowered and TH may not respond to the therapy, further this may cause
cloxacillin resistance.
o Therefore Bontu advised TH to take cloxacillin 1 hour before meals
e) Drug/disease interactions-no identified drug disease interaction
f) Treatment duplications – since TH told Bontu that she is not taking any medicines,
there is no treatment duplication.
 Cost of medicine and availability of cheaper alternatives identified
 Any problems with the prescriber and a solution should be worked out in consultation
with the prescriber and patient.
 Before dispensing to TH, Bontu carefully observed step 1(before going to step 2) and she
referred formulary and STG for health Center and adjusted accordingly.
Step 2: The selection and manipulation of the medicine
 While counting, using dry and clean spoon count from clean counting tray to pre-pack.
Step 3: The labeling and supply of the medicine in an appropriate container
The dispensing label shall bear at least the following information:
o generic name of the product or each active ingredient, where applicable
o strength, dose, frequency of administration and total quantity
o expiry date and prescriber’s name
o name of the person for whom the medicines are dispensed
o directions for use
o name and business address of the dispenser
o date of dispensing, and special precautions as applicable

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For example, the label for cloxacillin may be written as following:

Buufata Fayyaa Haliilaa, Lakk. Bilbilaa: 022331….

Cloxacillin 500 mg capsule, #84 capsules
Guyyaa hundaa otuu hin nyaatin
Ganama sa’aatii 1:00tti Ija/habbaa 1 liqimsaa
Guyyaa sa’aatii 7:00tti Ija/habbaa 1 liqimsaa
Galgala sa’aatii 1:00tti Ija/habbaa 1 liqimsaa
Halkan sa’aatii 7:00tti Ija/habbaa 1 liqimsaa
Otoo addaan hinkutin yeroo isaa eegdanii torban sadihiif fudhattu
Natti woyyaa’eera jettanii gorsa ogeessa fayyaatiin ala qoricha addaan hinkutina
Hamma isinii ajajme dabarsitanii ykn xinnessitanii hinfudhatina
Qoricha nama biroof qoodanii kennuun dhoorkaadha
Qorich iddoo ifni aduu hingeenye kaa’a
Ajaja ogeessa fayyaatiin ala qoricha biroo hinfudhatina
Yoo isin hooqsise ykn wanti addaa isin mudate ogeessa fayyaa mari’achiisa
Maqaa dhukkubsataa: _____________________
Maqaa ogeessa fayyaa; ______________________
Guyyaa: _________________________
Guyyaa qorich tajaajila kennuu dhaabu: ___________________
Qoricha iddoo daa’imman hindhaqqabne kaaya

Step 4: The provision of information and instructions to a client

 Name and description of the medicine
 Intended use of the medicine and expected out come
 Dosage form, dose, route of administration
 Duration of therapy with emphasis given to completing the entire course for antibiotics
 Expected time to see a response of the medication and instructions on what to do if the
medicine appears not to have the desired effect.
 The time the medicine taken in relation to other medicines, food, life style interactions
 Clear instructions on measurement and administration of medicine.

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 If necessary a demonstration such as opening and closing containers or using an

aerosol may be necessary.
 Explanation of harmless effects of the medication such as urine discoloration,
 Common severe side or adverse effects or interactions and therapeutic interactions that
may be encountered, including their avoidance and the action that required if they occur
 Storage instructions
 Advice regarding keeping medicines out of reach and sight of children, and clarification
on the consequences of sharing medication or keeping extra doses at home
 Prescription repeats information
Step 6: Prescription filing
 Prescription shall be documented separated by day, month and year dispensed and
archive for minimum of two years.

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Dispensing for in-patients

 There are three basic techniques for hospital medicine distribution to inpatients:
1. Bulk ward stock order system
In a ward stock system, the pharmacy functions as a ware house and dispense bulk containers on
requisition without reviewing individual medicine orders for appropriateness. The main advantage
is shorter turnaround time between prescribing and administering the medicine. The use of stock
medications should be minimized, although it is appropriate and desirable for certain situations:
o In life threatening emergency situations, medicines should be kept in patient care
areas as a time saving measure.
o High volume, low-cost medicines dispensed if there is low risk of medication error.
2. Individual medicine order system
The individual medicine order system closely resembles dispensing to our patients: a course of
therapy is dispensed according to a written prescription for an individual patient. Compared to
ward stock distribution the advantages are:
o Pharmacy professional can review the appropriateness of therapy.
o A patient-specific medication profile can be maintained.
o Pharmacy charges to patients are facilitated.
o Closer control of inventory is possible

3. Unit dose system

The preferred system from a patient care perspective is the unit dose system, in which there is the
lowest possibility for error. Commonly a twenty-four-hour supply is provided. It minimizes
unnecessary expense if treatment is changed. But it requires pharmacy opening for 24 hours.

5.3 Dispensing errors

Dispensing errors are errors that occur during the dispensing process in the pharmacy. They are
different from prescribing errors, or errors during consumption of medicine. Some risk is always
inherent in pharmacy practice, but if dispensing procedures are systematically laid down, and
strictly followed, most dispensing errors can be prevented, or at least minimized.
 Various factors can lead to dispensing errors
o Being busier than normal due to les staff or more customers
o Being a new staff member or trainee pharmacy professional
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o Interruptions like telephone, doubt/query from staff, etc.

o Atmosphere in the pharmacy and attitude of the pharmacy staff.
o Distractions from different sources
o Mood of the staff, e.g., bad moods.
o Not following the laid systems and standard operating procedures (SOPs) in the pharmacy.
Table 5-5 Common pharmaceutical dispensing errors
Common dispensing errors Possible Causes
Misreading the prescription Maybe due to a large number of prescriptions, illegible
handwriting, careless attitude of dispensing staff, or a
bad dispensing environment.
Errors during verbal communication Due to sound-alike name e.g.
metolazone/methazolamide
Picking error - picking the next Due to similar packing or not being on the shelf attentive
medicine or due to some distractions.
Counting error i.e. dispensing the Due to interruption during counting or because of
wrong quantity of medicines work overload/ rush hours
Billing error - entering details on the Due to distraction or inattention while billing, or having
bill incorrectly. Example, name or bill prepared by a newly appointed staff member who is
strength of the medicine, or entering not well acquainted with the billing system.
the patient's name incorrectly.
Packing error: mix parcels, or putting Due to similar patient names or same total on the bill, or
somebody else's medicine in parcel due to distractions while handing over the parcel.
Expiry error i.e., dispensing expired Improper attention/careless attitude while dispensing,
medicines not checking carefully. The letters or writing on the strip
are not easy to read (name of medicine and potency).
Strip or cut strip may accidentally be put in a box of a
similar looking product.

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Example of Picking Errors

You go to pick up metronidazole (manufactured by Cadilla) suspension from the shelf and end up
with picking cotrimoxazole suspension because both medicines have similar type of bottle packing
material. Now, that is not a justified excuse.
Sometimes manufacturer's packs of different drugs can be of similar design, and may lead to
picking errors. Due to similar packing, you could pick the box next to the one you actually intended
to pick. That is why you need to be very alert while removing medicines. Check the medicine in
details against the prescription before you remove it from the shelf. Even if you are in a hurry, take
the time to confirm that you are picking the RIGHT medicine from the shelf. Remember that,
clients depend on you for the RIGHT medicine, so be AWARE of each action at every step while
dispensing.
 Reasons for picking errors
o Not concentrating on the work/task and thinking/dreaming of something else.
o Distractions due to gossiping, talking with other staff, friends at the counter, or
watching TV in the pharmacy.
o Extra workload, doing things at very high speed, or in confusion.
o Assuming that a box picked up is correct, and not verifying it while picking.
o A different medicine placed in the usual place of the required medicine.
It would be unrealistic to state that no error will ever occur in pharmacy. Some error is possible or
likely to occur sometime. The aim, however, should be to keep errors down to a minimum.

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Figure 8-4: Common Dispensing Errors

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5.4 Refusal to dispense prescriptions

The pharmacy professionals should politely refuse to dispense a prescription if:

o Essential information is missing or doubtful, and the prescriber cannot be contacted.
o Safety of the medicines is doubtful.
o The prescription does not conform to legal requirements.
o Fake or illegal alteration of the prescription is suspected
 prescriptions calling for large quantities of potent medicines
 prescriptions written by unfamiliar prescribers for patients unknown to the pharmacy
professionals or for any other reason that is apparent, and which prohibits the pharmacy
professionals from dispensing the medicines prescribed.

Self-Check
Short answer questions
Elaborate on the prescription dispensing process
Summary
 Good dispensing practice refers to the process of preparing medicines and distributing to
users with provision of an appropriate information, counseling and follow up.
 The dispensing process involves the correct interpretation of prescription or oral request,
accurate preparation and labeling of medicines with provision of appropriate information.
 Prescription is an order for medicines written by a duly licensed medical practitioner issued
to a patient in order to collect medicine from dispensing unit
 Medical and pharmaceutical terms are abbreviated for ease of communication.
 The term dispensing process covers all activities involved, from receiving prescription to
issuing prescribed medicine to patient.

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Annex-1
Lists of OTC for Ethiopia
Antacids
MQATD
Ser. Name of Drugs Strength Dosage form at one time
No
1. Aluminum Hydroxide 320 mg/5 mL Mixture/Gel 2 bottles
360 mg/5mL Suspension 2 bottles
500 mg Tablet (Chewable) 30 tablets
2. Aluminum Hydroxide + 220 mg + 195 mg/5mL Suspension 2 bottles
Magnesium Hydroxide♣ 400 mg + 400 mg Tablet (Chewable) 30 tablets

3. Aluminium Hydroxide+ 225mg+200mg+25mg/5mL Suspension 2 bottles

Magnesium Hydroxide+
Simethicone ♣
4. Aluminum Hydroxide + 310 mg + 620 mg/5ml Suspension 2 bottles
Magnesium Trisilicate♣
120 mg + 250 mg ; Tablet (Chewable) 30 tablets
250 mg + 500 mg
5. Magnesium Hydroxide 375 mg/5 ml, 7.75 % Mixture 2 bottles
300 mg; 311 mg Tablet (Chewable) 30 tablets
6. Magnesium Trisilicate 500 mg Tablet (Chewable) 30 tablets
Antispasmodics/Spasmolytic Analgesics
1. Hyoscine (Scopolamine) 5mg/5mL Drops 1 bottle
Butylbromide 10 mg Tablet 10 tablet
7.5 mg, 10mg Suppository 10 supp

♣ And any other combination ratio proven to be therapeutically effective can be used
MQATD = Maximum Quantity Allowed to be Dispensed

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Antiemetic
1. Dimenhydrinate 50mg Tablet 15 tablets
Cathartics and Laxatives
1. Bisacodyl 5mg, 10mg Suppository 10 supp.
5mg Tablet 10 tablets
2. Cascara Sagrada 125mg Tablet 10 tablets
3. Glycerin 1g, 1.36g, 2g, 2.76g Suppository 10 supp.
4. Magnesium Sulphate Oral powder 1 sachet
5. Psyllium Powder 1 bottle
6. Senna total sennosides, 7.5mg Tablet 10 Tablets
Medicines Used for Diarrhea
1. Oral Rehydration Salt Powder 4 sachet
Antiflatulents
1. Activated Charcoal 125 mg, 250 mg Tablet 20 Tablets
2. Simethicone 60 mg, 80 mg, 95 mg Tablet (chewable) 20 Tablets
95 mg, 125 mg Capsule 20 Capsules
Antihaemorrhoidal Agents
Bismuth Subgallate 2.25% +0.875%+ Ointment 2 tube
Compound* (Bismuth 1.875% +10.75%
Subgallage +Bismuth Oxide + 59mg +24mg +49mg Suppository 10 supp.
Peru Balsam+ Zinc Oxide) +296mg

*And any other antihaemorrhoidal preparation proven to be therapeutically effective can be used

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Antitussives/Expectorants/Mucolytics
1. Bromhexine Hydrochloride 4 m g/5ml Elixir 1 bottle
2. Dexchlorpheniramine 2mg/5ml Syrup 1 bottle
2mg, 4mg, 6mg Tablet 10 tablets
3. Dexchlorpheniramine + 2mg +100mg + Syrup 1 bottle
Guaifenesin + Pseudoephedrine 20mg/5ml
4. Dextromethorphan 15mg/ml Drops 1 bottle
Hydrobromide 5mg,7.5mg,15mg/5ml Syrup 1 bottle
15mg Tablet 10 tablets
5. Dextromethorphan 0.3gm+7.6gm/100mL Syrup 1 bottle
Hydrobromide + Guaicol
Sulphonate
6. Diphenhydramine+ 12.5mg +60mg + Syrup 1 bottle
Sodium Citrate+ 130mg/5mL
Ammonium Chloride
7. Guaifenesin 100mg, 200mg Tablet 15 tablets
200mg Capsule 15 Capsules
100mg/5mL Syrup 1 bottle
Antiasthmatics
1. Ephedrine + Theophylline 6mg + 30mg/5ml Elixir 1 bottle
2.24% + 0.30% Syrup 1 bottle
11mg + 120mg Tablet 30 tablets
2. Salbutamol (Albuterol) 0.1mg/dose Oral Inhalation 1 canister
2mg/5ml (aerosol)
2mg, 4mg, 4mg(s/r) Syrup 1 bottle
Tablet 10 tablets
3. Theophylline+ Guaifenesin 150mg + 90mg; 300mg + Capsule 30 capsules
180mg
150mg + 90mg/15ml Elixir 1 bottle
150mg + 90mg Tablet 30 tablets
Antimigraine Headache Medicine

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1. Acetylsalicylic Acid + 250mg + 250mg + 65mg Tablet 20 tablets

Paracetamol+ Caffeine
Analgesics / Antipyretics
1. Acetylsalicylic Acid 75mg, 100mg, (soluble); Tablet 20 tablets
300mg,324mg(microfined
75mg, 81mg, 100mg,
500mg (enteric coated)
2. Diclofenac Sodium 25mg, 50 mg Tablet 20 tablet
3. Ibuprofen 300mg Capsule 20 capsules
200mg, 400mg (enteric Tablet 20 tablets
coated, optional) Syrup 1 bottle
100mg/5mL
4. Paracetamol 100mg/ml Drops 1 bottle
125mg, 250mg Suppository 15 supp.
120mg/5ml, 250mg/5ml Syrup 1 bottle
100mg, 500mg Tablet 20 tablets
Antirheumatics
1. Acetylsalicylic Acid 300mg,324mg(microfined Tablet 20 tablets
500mg (enteric coated)
2. Acetylsalicylic Acid + 250mg + 250mg + 65mg Tablet 20 tablets
Paracetamol+ Caffeine
3. Ibuprofen 300mg Capsule 20 capsules
200mg, 400mg (enteric Tablet 20 tablets
coated, optional) Syrup 1 bottle
100mg/5mL

Anthelmintics
1. Albendazole 100mg/5ml Oral Suspension 3 bottles
200mg, 400mg Tablet 6 tablets
2. Levamisole 40mg Tablet 6 tablets
3. Mebendazole 100mg/5ml Oral Suspension 2 bottles
100 mg, 500 mg Tablet 12 tablets
4. Niclosamide 500mg Tablet (chewable) 4 tablets
5. Piperazine 500mg, 622.5mg, 706mg, 750mg,937.5mg, Elixir 2 bottles
1g /5ml(Citrate) 300mg
(Adipate)
6. Pyrantel pamoate 250mg 250 mg base/5ml Oral Suspension 1 bottle
125mg base Tablet 8 tablets
Analgesics / Antipyretics
1. Ascorbic Acid (Vitamin C ) 200mg/ml Drops 1 bottle

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100mg, 500mg, 1g Tablet 30 tablets

2. Multivitamin Preparations* Drops/Syrup 1 bottle
Tablet 30 tablets
3. Multivitamin with Minerals Drops/Syrup 1 bottle
and/or Extracts* Tablet 30 tablets
4. Vitamin B Complex Tablet 30 tablets
*Any combinations proven to be therapeutically effective can be acceptable
Ear, Nose and Throat Preparations
1. Amyl-Meta-Cresol + 0.6mg + 1.2mg Lozenges 30 Lozenges
Dichlorobenzyl Alcohol
2. Chlorhexidine Gluconate 0. 1 2 % O r a l Solution 1 bottle
3. Dequalinium Chloride 0.25mg Lozenges 30 Lozenges
4. Hexetidine * 0.1% Solution 1 bottle(500 ml)
5. Hexidine 0.1gm/100ml, 0.2% Oral Solution 1 bottle
6. Hydrogen Peroxide 1.5%, 3% Solution 1 bottle
7. Menthol + Eucalyptus Oil + 2% +10% 7% Inhalation 1 bottle
Light Magnesium Carbonate
8. Saline Solution 0.09% Solution 1 bottle
*Any preparation proven to be therapeutically effective can be acceptable
Antihistamines And Antiallergics
1. Chlorpheniramine Maleate 2mg/5ml Syrup 1 bottle
2mg, 4mg, 6mg Tablet 15 tablets
2. Dexchlorpheniramine Maleate 2mg/5ml Syrup 1 bottle
2mg, 4mg, 6mg Tablet 15 tablets
3. Aminosalicylate 50mg, 75mg Tablet 15 tablets
Anti-infectives, Topical
1. Benzoic Acid+ Salicylic Acid 6% +3%, 12% +6% Ointment 2 tubes
2. Benzyl Benzoate 25% Lotion 300 ml
3. Gamabenzene Hexachloride 1% Cream 1 tube
4. Gentian Violet 0.5%, 1% Solution 1 tube
5. Salicylic Acid 2%, 5%, 10% Ointment 1 tube
6. Selenium Sulphide 2.5% Suspension 1 bottle
7. Sulphur 5%, 10% Ointment 1 tube
8. Zinc Undecenoate + 20% +5% Ointment 1 tube
Undecenoin Acid 20% +2% Powder 1 bottle
20% +2% Powder (aerosol) 1 bottle

Keratolytics /Caustics Agents

1. Camphor Cream, Lotion, 1 tube/bottle

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Solution
2. Salicylic Acid 2%, 5%, 10% Ointment 1 tube
3. Salicylic Acid + Lactic Acid + 2gm+0.5gm+0.2gm/10gm Tincture 10 gm
Polidocanol
Topical Agent For Psoriasis and Eczema
1. Ichthammol 10%, 20% Ointment 1 tube
Antiprurities
1. Calamine 5% Lotion 1 bottle
2. Calamine + Zinc Oxide 4%+3% Cream 1 tube
15%+5% Lotion 1 bottle
Skin Disinfecting Agents
1. Chlorhexidine Gluconate + 1.5%+15%, Solution 1 bottle
Cetrimide 0.3%+3%w/v
2. Ethyl Alcohol 70% Solution 1 bottle
3. Hydrogen Peroxide 3%, 6% Solution 1 bottle
4. Iodine 2% Solution 1 bottle
Dermatologicals, Others
1. Methylsalicylate ♣ Ointment 1 tube
2. Talc Dusting Powder Powder 1 bottle
♣ Any other rubifacient proven to be therapeutically effective can be used
Contraceptives
1. Drospirenone+Ethinyl Estradiol 3mg +0.03mg Tablet (film 1 pack
coated)
2. Levonorgestrel (D-Norgestrel) 0.75mg Tablet 1 pack
3. Levonorgestrel (D-Norgestrel)+ 0.15mg + 0.03mg; Tablet 1 pack
Ethinylestradiol with/without 0.25mg + 0.05mg,
Iron* 0.5mg + 0.05mg
4. Norethindrone (Norethisterone) 0.5mg +0.035mg Tablet 1 pack
+ Ehinylestradiol
5. Norethindrone (Norethisterone) 1mg +0.05mg Tablet 1 pack
+Mestranol and Iron*
6. Condoms (Male, Female) As needed
* Each iron tablet contains: Ferrous Fumarate-75mg

Miscellaneous
1. Aluminum Sulphate +Calcium Carbonate in the ratio of Powder(water 1 sachet
Hypochlorite + Sodium 23:1:1 by weight treatment powder)

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2. Calcium Hypochlorite + Iron Powder(water 1 sachet

Sulphate + Bentonite+ treatment powder)
Potassium Permanganate
Polyacrylamide + Sodium
Carbonate
3. Formaldehyde 3 % , 8 % (w/w or v/v) Solution 1 bottle
4. Halazone 4mg Tablet 15 tablets
5. Iodized Salt
6. Sodium Chloride Free Salt Crystal 1 bottle
7. Sodium Dichloroisocyanurate 67 mg, 75mg Tablet 1 bottle
8. Sorbitol

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Module Syllabus
Module title: Dispensing of Pharmaceuticals I
Module code: PRA2 M2 1017
Nominal duration: 288 Hours (6 weeks) Theory 138 hrs. Practice 150 hrs.
Module Description: This module aims to provide the learners with the basic knowledge, skill
and attitude required to apply good dispensing practices.
Unit of Competencies:
 HLT PRA2 05 0611 Sell Products and Services
 HLT PRA2 06 0611 Support Pharmacists by Collecting and Presenting Workplace
Information
 HLT PRA2 07 0611 Organize and Maintain the retail environment
Module Outcomes
At the end of the module the learner will be able to:
o Perform dispensing administration tasks
o Apply product knowledge
o Maintain Dispensary information
o Approach customer services and gather information
o Promote good dispensing techniques
o Identify, prepare and present data and information for use
o Demonstrate the importance of hygiene and infection control in the retail pharmacy
Teaching/learning methods
• Interactive lecture
• Demonstration and coaching
• Guided reading
• Case study
• Group discussion
• Observation of health facility and activity
Teaching/learning materials
 Learning module
 Reference book
 Checklists

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 Registration book
 Guidelines
 Case study
 Dispensing manual
 Packaging and labeling materials
 Prescription paper
 Drug counseling guide line
Methods of assessment
Oral examination
Written examination
Structured observation
Group assignment

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Week Learning Activity Required Reading /Assignment

Day 1
Interactive presentation (4 hrs.)
o Introduction to dispensing
Discussion (4 hrs.)
Major function of dispensing
Day 2
Interactive presentation (2 hrs.)
o Dispensing Environment
o Premise and Facility
o Hygiene and Sanitation
Group discussion (2 hrs.)
 Dispensary Premise and Facility
 Hygiene and Sanitation
Skill practice Session 1 (2hrs)
 Dispensing equipment’s
Week 1 Guided Independent Reading (2hrs)
Day 3
Skill Practice Session 2 (4 hrs.)
 GIT Medicines Arrangement
Skill Practice Session 3 (4 hrs.)
 CNS and MSS Medicines Arrangement

Day 4
Skill Practice Session 4 (4 hrs.) Read on role of dispensers
 CVS Medicines Arrangement
Skill Practice Session 5 (4 hrs.)
 Anti-infectives Medicines Arrangement

Day 5
Skill Practice Session 6 (4 hrs.)
 Endocrine Medicines Arrangement
Skill Practice Session 7 (4 hrs.)
 Miscelleneous Medicines Arrangement
Day 6
Group discussions (2hrs)
 Arranging Medications in Dispensary
Revision on all topics (4 hrs)
Guided Independent Reading (2 hrs)
Week 2 Day 1
Written examination (4 hrs)
Interactive presentation (4 hrs)
 Pharmaceutical storage in Dispensary
 Normal Storage Conditions
 Cold Storage Conditions
 Storages for Combustible /Flammable
 Secured Storage Conditions
Day 2
Skill Practice Session 8 (4 hrs.)

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 Arrangement of medicines based on their

storage conditions
Facilitated discussions (4 hrs)
Day 3
Skill Practice Session 9 (4 hrs.)
 Arrangement of medicines as prescription,
over the counter (OTC) and controlled
drugs
Facilitated discussions (4 hrs)

Day 4
Interactive presentation (4 hrs)
 Prescription and abbreviations in
prescription writing
Skill Practice Session 10 (4 hrs.)
 Interpretation of abbreviations used in
prescription
Day 5
Skill Practice Session 11 (4 hrs.)
 Interpretation of abbreviations used in
prescription
Interactive presentation (4 hrs)
 Computer and Medication Information in
Pharmacy
Day 6
Activity (2 hrs.)
 Refer available source of drug information
from library/skill lab
Revision on all topics (4 hrs)
Guided Independent Reading (2 hrs)
Day 1
Interactive presentation (4 hours)
o Selling products and customer service
Facilitated discussion and guided reading (4
hours)

Week 3 Day 2
Interactive presentation (4hrs)
Principles of Good Dispensing and
dispensing process step 1 and 2
Interactive presentation (4hrs)
Principles of Good Dispensing and
dispensing process step 1 and 2
Day 3
Skill Practice Session 12 (4 hrs.)
 Evaluation of prescription
Facilitated discussion (4 hrs.)
Day 4
Skill Practice Session 13 (4 hrs.)
 Evaluation of prescription
Facilitated discussion (4 hrs.)

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Day 5
Interactive presentation (4hrs)
Principles of Good Dispensing and
dispensing process step 3
Skill Practice Session 14 (4 hrs.)
 Evaluation of prescription
Day 6
Revision on all topics (4 hrs)
Guided Independent Reading (4 hrs)
Week 4 Day 1
Skill Practice Session 15 (4 hrs.)
 Evaluation of prescription
Written Assessment (1 hrs)
Facilitated discussion (3 hrs.)
Day 2
Interactive presentation (4hrs)
Principles of Good Dispensing and
dispensing process step 4-6
Skill Practice Session 16 (4hrs.)
 Evaluation of prescription
Day 3
Skill Practice Session 17 (4hrs.)
 Evaluation of prescription
Facilitated discussion (4 hrs.)

Day 4
Facilitated discussion (4 hrs.)
 Case Scenario
Facilitated discussion (4 hrs.)
 Case Scenario…Continued

Day 5
Interactive presentation (4hrs)
 Dispensing for in-patients
 Dispensing errors
Facilitated discussion (4 hrs.)
Day 6
Revision on all topics (4 hrs)
Guided Independent Reading (4 hrs)
Week 5 Day 1
Written Assessment (1 hr.)
Skill Practice Session 17 (3hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 2
Skill Practice Session 18 (4hrs.)
 Dispense medicines using the six dispensing
steps

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 Learning Module: Dispensing of Pharmaceuticals-I | ORHB

Facilitated discussion (4 hrs.)

Day 3
Skill Practice Session 19 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 4
Skill Practice Session 20 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 5
Skill Practice Session 21 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 6
Revision on all topics (4 hrs)
Guided Independent Reading (4 hrs)
Week 6 Day 1
Skill Practice Session 22 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 2
Skill Practice Session 23 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 3
Skill Practice Session 24 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 4
Skill Practice Session 25 (4hrs.)
 Dispense medicines using the six dispensing
steps
Facilitated discussion (4 hrs.)
Day 5
 Written assessment (2 hrs.)
 Oral Examination (6 hrs.)_
Day 6
 Oral Examination (8 hrs.)_

105