CHAPTER 2

MY INDUSTRIAL TRAINING EXPERIENCE

At EP Pharmacy we learn mostly from the Superintendent Pharmacist during our
presentation days( Mondays and Fridays) where we discuss a disease, its
pathophysiology and life cases pertaining to each disease. Over my stay at the
Pharmacy, we have done topics like role of pharmacist in the management of Asthma,
tuberculosis, diabetics, malaria, ulcer, diarrhea, hypertension, analgesia, Human
immunodeficiency virus(HIV),allergic reactions. I did my presentation on Role of
pharmacists in management of diabetes.

Role of Pharmacist in management of

Type II Diabetes Mellitus

Diabetes is a chronic health condition that affects how the body turns food into
energy. When someone has diabetes, their body either doesn’t make enough insulin or
can’t use the insulin it makes as well as it should. This causes blood sugar levels to rise,
which can lead to serious health problems over time (Centers for Disease Control and
Prevention, 2023).

Diabetes is primarily categorized into three main types:

● Type 1 Diabetes: An autoimmune condition where the body attacks

insulin-producing cells in the pancreas. Individuals with Type 1 diabetes need
daily insulin therapy.
● Type 2 Diabetes: The most common type, where the body becomes resistant to
insulin or doesn't produce enough insulin. It is often associated with older age,
obesity, and inactivity.
● Gestational Diabetes: Develops during pregnancy and usually resolves after
delivery but increases the risk of developing Type 2 diabetes later in life
(Centers for Disease Control and Prevention, 2023)

Pathophysiology of Type 2 Diabetes

Type 2 diabetes is characterized by insulin resistance and relative insulin deficiency.

The pathophysiology involves several key mechanisms:

Insulin Resistance: In Type 2 diabetes, cells in muscles, fat, and the liver become
resistant to insulin. This means they don't respond effectively to insulin and
cannot easily take up glucose from the blood.

Beta-cell Dysfunction: The pancreatic beta cells, which produce insulin, initially
respond by increasing insulin production. However, over time, these cells become
dysfunctional and fail to produce enough insulin to compensate for insulin
resistance.

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Increased Glucose Production by the Liver: Due to insulin resistance, the liver
releases more glucose into the bloodstream, contributing to hyperglycemia.

Genetic and Environmental Factors: A combination of genetic predisposition and

lifestyle factors, such as obesity and physical inactivity, contribute to the
development of insulin resistance and beta-cell dysfunction.
(American Diabetes Association, 2023)

TREATMENT OF TYPE 2 DIABETES

The treatment of Type 2 diabetes typically involves a combination of lifestyle
modifications, oral medications, and sometimes insulin or other injectable medications.
The primary goals of treatment are to manage blood glucose levels, reduce the risk of
complications, and improve overall health.

Lifestyle Modifications:

● Diet: A balanced diet rich in fruits, vegetables, whole grains, and lean proteins
while limiting sugar and refined carbohydrates.

● Physical Activity: Regular exercise, such as brisk walking, for at least 150 minutes
a week.

● Weight Management: Losing weight can improve insulin sensitivity and blood
glucose control.

Medications:

● Metformin: Often the first-line medication to reduce glucose production by the

liver and improve insulin sensitivity.

● Sulfonylureas: Stimulate the pancreas to release more insulin e.g Glibenclamide.

● DPP-4 Inhibitors: Help increase insulin release and decrease glucagon levels e.g
sitagliptin.

● GLP-1 Receptor Agonists: Slow digestion and increase insulin production e.g
Liraglutide.

● SGLT2 Inhibitors: Help the kidneys remove glucose from the bloodstream e.g
Empagliflozin.

● Thiazolidinediones: Improve insulin sensitivity in muscle and fat tissues e.g

Pioglitazone.

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● Insulin Therapy: May be necessary if other medications are insufficient for

controlling blood glucose levels.

● Regular Monitoring and Management of Complications: Regular check-ups to

monitor blood glucose levels, blood pressure, cholesterol, and screening for
complications like neuropathy, retinopathy, and cardiovascular diseases.
(American Association of Diabete,2023)

Pharmacists play a crucial role in the management of Type 2 diabetes through various
functions:

1. Medication Management: Pharmacists ensure that patients receive the correct

medications and dosages, monitor for drug interactions, and adjust therapies as
needed.

2. Patient Education: They educate patients about their condition, the importance of
adherence to medication regimens, lifestyle modifications, and how to monitor
blood glucose levels.

3. Monitoring and Follow-Up: Pharmacists regularly monitor patients' progress, track

blood glucose levels, and check for any side effects or complications, providing
follow-up care as necessary.

4. Counseling: They provide counseling on diet, exercise, and weight management,

which are critical components of diabetes care.

5. Preventive Care: Pharmacists offer preventive care services, such as

administering vaccinations and screening for diabetes-related complications like
hypertension and hyperlipidemia.

6. Collaborative Care: They work collaboratively with other healthcare providers to

create comprehensive, individualized care plans for patients.
( Choe et al.,2005)

Several tests are used to diagnose diabetes, including:

1. Fasting Plasma Glucose (FPG) Test: Measures blood glucose levels after
an overnight fast. A fasting blood sugar level of 126 mg/dL (7.0 mmol/L) or
higher on two separate tests indicates diabetes.

Hemoglobin A1c (HbA1c) Test: Reflects the average blood glucose levels over the
past two to three months. An A1c level of 6.5% or higher on two separate tests
indicates diabetes.

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2. Oral Glucose Tolerance Test (OGTT): Measures blood glucose levels before
and two hours after consuming a sugary drink. A two-hour blood glucose
level of 200 mg/dL (11.1 mmol/L) or higher indicates diabetes.

3. Random Plasma Glucose Test: Measures blood glucose levels at any time
regardless of when the person last ate. A blood glucose level of 200 mg/dL
(11.1 mmol/L) or higher, along with symptoms of diabetes (such as
increased thirst, frequent urination, and unexplained weight loss), indicates
diabetes.
(American Diabetes Association, 2023)

At EP Pharmacy, we were taught on checking vital signs by the Pharmacist and nurses.
These vital signs include checking of Arterial blood pressure with the use of an Android
sphygmomanometer, checking of fasting blood sugar levels(FBS) with the use of a
glucometer, and checking of Body mass index(BMI).

The aneroid sphygmomanometer makes use of a battery and its principle of use is not
complex. The patient is supposed to sit on a chair and place his/her hands on a desk in
an upright position. The inflatable cuff of the instrument is placed on the arm of the
patient at about ⅔ of the forearm before the antecubital fossa. The instrument is turned
on and then the measurements are taken.

Arterial blood pressure is categorized into several ranges based on the systolic (upper
number) and diastolic (lower number) measurements:

1. Normal: Systolic less than 120 mm Hg and diastolic less than 80 mm Hg.

2. Elevated: Systolic 120-129 mm Hg and diastolic less than 80 mm Hg.

3. Hypertension Stage 1: Systolic 130-139 mm Hg or diastolic 80-89 mm Hg.

4. Hypertension Stage 2: Systolic 140 mm Hg or higher or diastolic 90 mm Hg or

higher.

5. Hypertensive Crisis: Systolic higher than 180 mm Hg and/or diastolic higher than
120 mm Hg, requiring immediate medical attention.
(American College of Cardiology/American Heart Association Task Force on Clinical
Practice Guidelines.2017)

During my stay at EP Pharmacy I was to check the Blood pressure of a patient, an

elderly man in his late 60’s. After the assessment, his BP was 125/83mmHg which was
normal for his age.

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With the aid of a glucometer we were taught on checking the fasting blood sugar level
(FBS). We will counsel the patient a day before, not to eat at night and the next morning.
He/she is to come in the morning at about 8am or 10am. The patient is to sit on the chair
upright and with a cotton swab in methylated spirit, is used to clean the thumb of the
patient. A lancet is used to prick the thumb to allow little exude of blood. The blood is
placed on the glucometer test strip, which is put into the machine and then the result is
gotten and recorded.

Fasting blood sugar (glucose) levels are typically categorized as follows:

1. Normal: Less than 100 mg/dL (5.6 mmol/L)

2. Prediabetes: 100-125 mg/dL (5.6-6.9 mmol/L)
3. Diabetes: 126 mg/dL (7.0 mmol/L) or higher on two separate tests
(American Diabetes Association, 2023)

The checking of Body mass index (BMI) requires the use of the meter rules and also
the weighing scale.

BMI stands for Body Mass Index, which is a measure used to assess an individual's
body weight relative to their height. It is calculated by dividing a person's weight in
kilograms by the square of their height in meters (BMI = weight (kg) / height (m)^2).

BMI is categorized as follows:

1. Underweight: BMI less than 18.5

2. Normal weight: BMI 18.5 to 24.9

3. Overweight: BMI 25 to 29.9

4. Obesity: BMI 30 or higher

(Center for Disease Control and Prevention, 2023)
I once checked the BMI of a 6 year old boy and it was 31 kg/m^2. We told the parent
of the indications and counseled her on what to do to control it.

Over the course of my Industrial training at EP Pharmacy, we were taught the

different classes of drugs, their indications, possible side effects and interactions.
Patients with different complaints come to the Pharmacy and with the help of the
Pharmacist, we ensured they were satisfied with our services.
On Antimalarial, we were taught the common Antimalarial medications based on
their generics, like Artemeter-
Lumenfantrine,Sulfadoxine-Pyrimethamine,Dihydroartemisinin-piperaquine,quinine
sulfate, amodiaquine-artesunate.

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For injections they are alpha-beta arteether, artemether, artesunate injection.

These medications come at different strengths and we were taught that the majority
of the drugs were administered by weight. Sulfadoxine and pyrimethamine come in
different brands like Amala, Swidar. Swidar Is the most common one sold in my
Pharmacy. It comes as a three in one formulation, that is taken once at the same time. It's
used as a preventive measure for Malaria, and can be taken every three(3) months.
Artemeter and Lumenfantrine come in Coartem, Shal'artem, lokmal,diconart, lonart,
arena. It comes as 80/480 and 20/120 for adults and children respectively. This drug is
administered by weight.

Artemether-lumefantrine is a combination medication used to treat uncomplicated

malaria caused by Plasmodium falciparum. The dosage depends on the patient's body
weight and age.

Dosage Guidelines:

Adults and children weighing 35 kg and over: A standard course consists of six doses
over three days:

First dose: 4 tablets at the time of diagnosis

Second dose: 4 tablets 8 hours later
Subsequent doses: 4 tablets twice a day (morning and evening) for the next two days
Children weighing 25 to less than 35 kg:

First dose: 3 tablets

Second dose: 3 tablets 8 hours later
Subsequent doses: 3 tablets twice a day for the next two days
Children weighing 15 to less than 25 kg:

First dose: 2 tablets

Second dose: 2 tablets 8 hours later
Subsequent doses: 2 tablets twice a day for the next two days
Children weighing 5 to less than 15 kg:

First dose: 1 tablet

Second dose: 1 tablet 8 hours later
Subsequent doses: 1 tablet twice a day for the next two days
( World Health Organization, 2015)

Amatem soft gel is the common one sold in my Pharmacy because of its special
formulation to mask the drug taste. Another common Antimalarial sold is P-alaxin(
dihydroartemisinin and piperaquine) and Ibasunate( dihydroart
emisin and piperaquine). Ibasunate is often preferred because it comes coated like
amatem soft gel. But the only disadvantage is that it doesn't come in higher doses. For

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this drug, it comes as 120/960 and 40/320 for adults and children respectively. It is
usually administered by age. For children about 1-6 years they are given 1 tablet, taken
BD( twice daily) for 3 days. Children between the age of 6-16 are given 2 tablets on the
same dosage regimen. For people above 16, they can take 3 tablets of the 40/320 or 1
tablet of the 120/960.
For the injections we were taught that artesunate is given as monotherapy, Artemeter is
given as 160 mg/2 ml daily for three days or 80 mg/ml BD(, twice daily) for three days.
Emal injection is given as 150 mg/2ml or 75 mg/ml as the same dosage regimen as
Artemeter.

Pharmacist ensured we learn how to handle and interpret prescriptions, we were taught
about the prescription abbreviations like bd( twice daily), oD( once daily) qd( every day)
qds( four times daily), prn( as needed), 1/52( one week), 1/12( one month), 1/7( one day)
For an example, a prescription came, showing the following;
Amoxicillin 500mg TDS ×5/7
Metronidazole 400mg TDS ×5/7
Omeprazole 20mg BD ×1/52.
From my experience, I was able to understand and dispense appropriately, even going
further to counsel the patient on some interactions, for the Metronidazole and alcohol (
disulfiram reaction) as taught by the Pharmacist.
Also, the Omeprazole should be taken before a meal for about 30 mins, to ensure
enhanced therapeutic activity.

A man came to the Pharmacy one time and requested to speak to the pharmacist, he
said he was wounded by a rotten nail and needed treatment.
The pharmacist observed the condition and concluded he should be given Tetanus
toxoid injection. This injection was brought out of the freezer and administered by the
nurse Intramuscularly, on the deltoid muscle.
The pharmacist went further to Lecture us on cold chain drugs and explained that
tetanus toxoid, commonly called TT was one of them. A cold chain drug refers to a
medication that must be stored and transported within a specific temperature range,
typically between 2°C and 8°C (36°F and 46°F), to maintain its efficacy and safety. The
cold chain is a temperature-controlled supply chain that ensures the drug remains within
this range from the point of manufacture to the point of administration (World Health
Organization, 2020)

At EP Pharmacy we dispensed anti hypertensive drugs, on prescription.

Drugs like Amlodipine 5mg and 10mg, Novasc(branded Amlodipine) other brands are
Teva, Pocco. The most common one commonly dispensed is Teva. Some
antihypertensive medications came as combinations, for example Pilorem and
Pilorem-Hct, containing Telmisartan/ Amlodipine and Telmisartan/ Amlodipine and
Hydrochlorothiazide)
At strength of 40/5 or 80/10 and 40/5/12.5 and 80/10/25 respectively).

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During my stay at EP Pharmacy I was to dispense some anti hypertensive

medications,prescriptions came and I dispensed appropriately under the supervision of
the Pharmacist.
A female patient came one time with a lab result, showing low packed cell volume(
PCV) and hemoglobin levels of 30% and 9 mg/dl respectively.
The Pharmacist ordered us to dispense Tot' hema, a supplement used to replenish the
blood and iron levels. He went further to Lecture us on its use for Iron and manganese
and copper deficiency.
A prescription was given to me once, by an elderly woman, stating the following;
Clamide 5mg
Plagerine
Panfor 1000mg
After I received the prescription, I was stunned because I haven't seen those brands
before. I went further to inquire from my pharmacist, who said they were Glibenclamide,
clopidogrel and Metformin respectively, I then dispensed the anti diabetic and anti
platelet medications appropriately.

At EP Pharmacy, I've dispensed antifungals, ketoconazole, fluconazole, terbinafine and

clotrimazole. An adult female came to the Pharmacy and complained her ketoconazole
tablets were too many and the doctor requested a change in the medication.
My pharmacist concurred with her and lectured us about ketoconazole and its heavy
first pass effect therefore there will be a low bioavailability and higher doses, thus
fluconazole is preferable.

We were taught antibiotics, their classes and common examples with brands available
in the pharmacy.
Classification of Antibiotics:
● Beta-Lactam Antibiotics:

Penicillins: Penicillin G, Penicillin V, Amoxicillin, Ampicillin.

● Cephalosporins: Cefalexin, Cefuroxime, Ceftriaxone, Cefepime.

● Carbapenems: Imipenem, Meropenem, Ertapenem.

Monobactams: Aztreonam.

● Macrolides:

Erythromycin, Azithromycin, Clarithromycin.

Fluoroquinolones:

● Ciprofloxacin, Levofloxacin, Moxifloxacin.

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● Aminoglycosides:

Gentamicin, Amikacin, Tobramycin, Streptomycin.

● Tetracyclines:

Tetracycline, Doxycycline, Minocycline.

● Glycopeptides:

Vancomycin, Teicoplanin.

● Sulfonamides:

Sulfamethoxazole, Sulfadiazine.

● Lincosamides:

Clindamycin, Lincomycin.

● Oxazolidinones:

● Linezolid, Tedizolid.

● Nitroimidazoles:

Metronidazole, Tinidazole.
( Katzung et al., 2012)

We are taught on antibiotic calculations

10 mg/kg for drugs like Azithromycin and for most antibiotics, 30 mg/kg.
We've had various antibiotic cases like one time, a woman came in with a sore throat
and tonsillitis and requested an antibiotic. She was administered Azithromycin 500mg BD
for 5 days by the pharmacist.
For cases of typhoid, we were taught that ciprofloxacin was the first line in the therapy.

A person entered the Pharmacy, with a lab report. The pharmacist ordered me to deal
with the patient, based on my experience. The report showed the Patient was positive to
malaria parasite and salmonella , thus needed therapy for Malaria- typhoid. The patient
went further to say that he has an ulcer. Based on my experience I suggested
Artemether- Lumefantrine and paracetamol with ciprofloxacin for the typhoid. But I was
told by my Pharmacist about interactions of Artemether- Lumefantrine and ciprofloxacin,
stating that it can result in arrhythmia. He suggested I go with amoxicillin, since the

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patient has ulcer, the drug can augment both the Typhoid and the ulcer. I learnt a lot that
day.
Over my stay at EP Pharmacy, I have dispensed antihelminthic like Pyrantrin( pyrantel
palmate), wormim( mebendazole) this medications were given based on the weight, most
especially the Pyrantrin, this is the most common anthelmintic requested in the
pharmacy.
I have dispensed suppositories and pessaries. Suppositories and pessaries are both
forms of medical preparations designed for insertion into body cavities to deliver
medication or support anatomical structures" (Katzung & Trevor, 2012). Suppositories
are administered in the rectum, while pessaries are administered in the vagina. I have
dispensed Diclofenac suppository, which my pharmacist said was used to control the
pain and inflammation in hemorrhoids, also I have dispensed Clotrimazole pessaries,
used in treatment of candidiasis.
We were taught that for women with vagina infection, an empirical therapy approach
can be used and the preferred medication is Gynomarc( Fluconazole, Azithromycin and
secnidazole) this medication contains fluconazole, an antifungal agent, azithromycin and
secnidazole are antibiotics.
We were taught an empirical and definitive therapy approach. For example, if a patient
comes with discharge from the vagina, not knowing whether it is caused by bacteria or
fungal or even viral, an empirical approach can be done based on understanding of the
signs and symptoms. After this administration the patient can then go to the laboratory
and carry out a HVS for MCS test ( high vaginal swab or microscopy culture and
sensitivity testing) with the lab result, a definitive therapy approach can be done.
Acyclovir is usually administered every 4-6 hours because of its short half life. This is
the only antiviral medication present in my Pharmacy.
Anti ulcer medications, like proton pump inhibitor(ppi) like Omeprazole 20 mg,
Rabeprazole 20 mg, Esomeprazole 20mg, H2 receptor antagonist like cimetidine 400mg is
still used in management of ulcer, but it's not commonly dispensed due to the side effect
of gynecomastia and difficulty in withdrawing. Ulsakit is one of the common dispensed
anti ulcer medications by prescription, it contains Omeprazole, clarithromycin and
tinidazole.

We are taught analgesics. For analgesia we have different classes such as Simple,
compound and opioid.
For simple analgesics, this includes drugs like paracetamol and NSAID( non steroidal
anti inflammatory drugs) like ibuprofen, Diclofenac, piroxicam, naproxen, celecoxib. One
of the most common side effects of this medication is that it can cause ulcers due to the
inhibition of the Cox enzyme responsible for prostaglandin synthesis that stimulates the
mucosal lining covering and also that it is contraindicated in Asthma patients. Only
celecoxib can be used by ulcer patients, but it has serious cardiovascular side effects.
Compound analgesics contain a simple drug and an opioid drug for example
co-codamol ( codeine sulfate and paracetamol). They are usually prescription drugs used
when simple analgesics are no longer effective.

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The opioid analgesics are strictly prescription drugs because of their Central nervous
system( CNS) effect. They include drugs like Morphine, Pentazocine, and Tramadol.
These drugs are only dispensed on prescription. One time a person came with a
prescription for Pentazocine injection. We went further asking questions that led us to
know the person was a sickler.
One common analgesic dispensed for indications of headache and pains is Orsic (
Orphenadrine and paracetamol)
Orphenadrine is a muscular relaxant while paracetamol is an antipyretic medication, also
used for pain.

My stay in EP Pharmacy made me know more about Sildenafil and its side effects. A
guy came in one time requesting for Honnihil, I went further to inquire and found it was
tadalafil. Due to its similarity with Sildenafil I immediately guessed it was a
phosphodiesterase-5 inhibitor (PDE-5) used in ED( erectile dysfunction). From further
questions I found out it was more preferable to Sildenafil due to its little vasodilation side
effect. Other products like Samsu-oil, although herbal, are still used but it has a more
local action, than the PDE-5 inhibitors that are more systemic.
Condoms, Postinor 2, Post- pill are commonly requested items in the pharmacy,this
makes the staff usually refer to the area as the “shrine”.

I can remember one time a woman came over to buy diazepam. Diazepam is a
benzodiazepine used as an anxiolytic, prescribed mostly for cases of insomnia. She
didn't come with a prescription, so we couldn't dispense the medication. That was my
first experience of such.
At EP Pharmacy we have a poison book, where we record drugs like opioids, after
dispensing. This is to ensure a proper record of activities in the pharmacy. Drugs like
codeine, tramadol, morphine and other drugs of similar classes are recorded there.
Drugs acting on the central nervous system (CNS) are heavily controlled drugs. For
drugs like Tegretol( carbamazepine) and Levetiracetam which are anti epileptic drugs,
they must be dispensed with prescription.

The First in First out( FIFO) policy at EP Pharmacy has enabled us to control the rate
at which drugs come in and go out the pharmacy, preventing wastage. Over my stay at
the Pharmacy we have re-shelled two times, this is during my IT hours.

During one of my IT sessions, a woman came in with her son, a 6 year old boy. She
requested to see the pharmacist. We referred her to him and she showed him her child,
saying he has rashes over the body. After a series of talks with the Pharmacist, he said it
was scabies. As at then, it was my first time seeing the case in real life.
Scabies is a contagious skin condition caused by the infestation of the skin by the
human itch mite (Sarcoptes var. ). The mites burrow into the skin to live and lay eggs,
leading to intense itching and a pimple-like skin rash ( Centre for Disease Control, 2020)
He requested we give the woman ivermectin tablets and permethrin cream. He
counseled the woman to administer the ivermectin 4 tabs in the morning before food to

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the child, for three days and then repeat it after 1 week for a day. The permethrin cream
was to be applied twice daily, all over the body and allowed to dry. She complained her
child still goes to school so he said she would apply it only at night and the boy should
sleep naked.
The prescription showed thus;
Ivermectin 4 tabs a.c × 3/7
Repeat 1 week after
Permethrin cream nocte.
At EP Pharmacy I haven't been to see cases of STI( sexually transmitted infection)
although I have dispenser medications on urinary tract infection, where I dispensed
Nitrofurantoin 100mg. Then counseled the patient on the possible side effect of
abdominal discomfort.
I think my lack of STI cases may be due to the fact I only go there about 3 times a week,
2-5 pm. Nevertheless, it has been an amazing ride.

Along with the knowledge about drugs, I have also been to learn some skills in EP
Pharmacy. Before now, I was an alien to presentations, creating slides. But with EP, I
have been able to get accustomed to these skills. I know I can create my slides and do
presentations.
Also, EP Pharmacy has helped in my communication skills. In the health profession,
this is one skill every Health care provider is supposed to possess. The way you deliver a
message to a patient can have some psychological effects on the patient. That's why it's
our responsibility to ensure the message is delivered in the right manner of order.

The most common cases seen in the pharmacy regularly are malaria, typhoid, oral
contraceptives, simple analgesics like paracetamol and ibucap( ibuprofen 400mg).

We have also been taught on antihistamines. This is the first topic taught to us by the
pharmacist, my first day at the premise.

Antihistamines are a class of drugs used to treat allergic reactions by blocking the
effects of histamine, a substance in the body that causes allergy symptoms.

Types of Antihistamines
1. First-Generation Antihistamines: These are older antihistamines that can cross
the blood-brain barrier, causing sedation. Examples include diphenhydramine
(Benadryl), chlorpheniramine, and hydroxyzine.

2. Second-Generation Antihistamines: These are newer antihistamines that are less

likely to cause drowsiness because they do not cross the blood-brain barrier as
easily. Examples include loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine
(Allegra).

Mechanism of Action

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Antihistamines work by blocking histamine receptors (specifically H1 receptors)

on cells, which prevents histamine from exerting its effects, thereby reducing
allergy symptoms like itching, swelling, and rashes.

Uses
● Allergic rhinitis (hay fever)
● Urticaria (hives)
● Allergic conjunctivitis
● Dermatitis (skin allergies)
● Insomnia (particularly first-generation antihistamines due to their sedative effects)
● Motion sickness and nausea (certain first-generation antihistamines)

Side Effects
● First-Generation Antihistamines: Drowsiness, dry mouth, dizziness, urinary
retention, constipation, blurred vision.
● Second-Generation Antihistamines: Generally fewer side effects, though some
may still cause mild drowsiness, headache, dry mouth.

Precautions
● Use with caution in individuals with glaucoma, prostate enlargement, and asthma.
● Avoid alcohol and other central nervous system depressants when taking
first-generation antihistamines due to the risk of increased sedation.
( National Institute of Health, 2020)

At EP, the most commonly dispensed antihistamines are piriton( chlorpheniramine)

and loratadine. Most of the antihistamine are used in formulation of cough syrups like
Tuxil D, Tuxil-N, Emzolyn. We are to counsel the patients on the possible side effects,
depending on the class of antihistamine. If it's a first generation antihistamine, we are to
tell them of side effects like drowsiness and sedation and it is advisable to be taken at
night. If the patient is active during the day, a second generation antihistamine is
preferable, like Loratidine.

Supplements are also drugs commonly sold in the pharmacy. Some of them can come
as counting, cup or sachet. For example the vitamin C we have comes in counting at the
price of N10 for one and also comes in Cup form.
I have dispensed folic acid to a pregnant woman before.

Folic acid (vitamin B9) is vital during pregnancy for the following reasons:

● Prevents Neural Tube Defects (NTDs): Essential in early fetal development to

prevent serious birth defects of the brain and spine.
● Supports DNA Synthesis and Cell Growth: Crucial for DNA synthesis and cell
division, aiding placenta and fetal development.

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● Reduces Other Birth Defects: May help prevent congenital heart defects and cleft
lip/palate.
● Improves Maternal Health: Supports additional blood production and reduces
anemia risk.

Recommended Intake
Before and During Pregnancy: 400 mcg daily before conception, 600 mcg during
pregnancy.

Sources
Natural: Leafy greens, citrus fruits, beans, nuts.
Fortified Foods: Cereals, breads, pastas.
Supplements: Prenatal vitamins.
( Centre for Disease Control, 2021)

Other supplements include cyproheptadine. Some people come in saying they want
medications to gain weight. Cyproheptadine is the drug usually given. It is a first
generation antihistamine in formulation like Supri gold. One of the side effects of the
medication is gluttony and sleepiness.
This is what makes them gain weight.

One medication prohibited by my Pharmacist to sell for weight gain is Dexamethasone,

which comes in brands like Xasten . This is a corticosteroid used sometimes as an
anti-inflammatory. It is mostly abused by women for weight gain. This is because one of
the side effects of the drug is fluid retention and this can lead to peripheral edema.

Over my stay at EP Pharmacy, I have seen drug reps come to market their products. I
once saw my pharmacist purchase Augmentin( Amoxicillin and clavulanate acid) from a
female sales rep.
A man came in one time looking for Mojeaga, which is a herbal blood tonic.
After confirmation from the pharmacist it was concluded that we didn't have the product.
Although some days before in class my pharmaceutics professor said he was
responsible for Mojeaga formulation. After talking to my Pharmacist, he permitted me to
call him. I got his number from my class representative and called.
This action from me led us to purchase Mojeaga from him and also helped in getting
new customers because the drug was making its way in the market.

When we are not dispensing drugs in the Pharmacy, we are having life talks with our
pharmacist. Who teaches us on aspects of pharmacy and also asks about our
specialization or future ambitions. These talks have made me plan ahead for the future.

I have also been to learn about the parenteral route of drug administration from the
nurses, most especially intramuscular. Although I haven't given an injection before.

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Syringes come in 2ml, 5ml and 10ml, the injection depends on its use. We have 21G(
green) 22G( black) 23G( blue) and 25G( orange). These are arranged in order of longest to
shortest. The 21 G is mostly used in adults while 23G mostly used in children. The 25G
can be used on neonates and infants.
During my learning about administration of injections, I learnt that lidocaine, although
being used as an antiarrhythmic drug, is used as a local anesthetic in administration of
Intramuscular injections. Also, for injections like chloroquine, piriton is usually added, to
subdue the effects of pruritus.
My stay at EP Pharmacy has been awesome. I have benefited greatly and am constantly
grateful for the experience. Not only in medicine, but also in other aspects of life, most
especially communications and interactions

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