[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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OUTLINE
I
II
III
EXTEMPORANEOUS COMPOUNDING
A. Standards of extemporaneous compounding
B. Label Preparation
C. Pharmaceutical Packing
D. Dispensing Procedure On Receipt Of A
Prescription For Extemporaneous Preparations
E. Ingredient consideration in compounding
MEDICATION DISPOSAL
A. Types of pharmaceutical waste
B. Disposal of medication waste
C. General guidelines for the disposal of medication
waste
D. Minimization of pharmaceutical waste
SUITABLE RECORD KEEPING
Employ personal handwashing techniques to
ensure personal hygiene.
Personal Hygiene is extremely important because
mediations are being prepared for patients who may
already be ill.
PERSONAL PROTECTIVE EQUIPMENT
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A clean white coat should be worn
Safety glasses should always be worn
Additional safety equipment (e.g. facemasks, gloves) may
also be required.
Long hair should be tied back and hands washed,
ensuring any open cuts are covered.
To protect the compounder from the product and,
conversely, the product from contamination from the
compounder.
CLEAN WORK AREA AND EQUIPMENT
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EQUIPMENT
A. Standard balances
B. Conical measures
C. Mixing and grinding
D. Methods of comminution in small scale
E. Other equipment’s for compounding
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Before starting to compound a product, the work area and
equipment should be cleaned with a suitable solution
(e.g. industrial methylated spirits (IMS), which must be
allowed to dry fully.”
The risk of contaminating the final product with either dirt or
microorganisms from the surroundings, or from ingredients
from a previous preparation, can be considerable if
attention is not paid to the cleanliness of the work area and
equipment.
EXTEMPORANEOUS COMPOUNDING
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It is important that the compounder adheres to strict
procedures to ensure the safety of the patient.
Compounder experience and expertise are significant
factors in the production of safe and effective
extemporaneous formulations.
Because of the diversity of the types and number of
preparations that can be formulated extemporaneously
APPROPRIATE WORK AREA
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COMPOUNDING (EXTEMPORANEOUS DISPENSING)
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A small-scale manufacture of medicines from basic
ingredients in the community or in hospital pharmacy (vs.
medicines manufactured by the pharmaceutical industry)
Extemporaneous dispensing should only be used when
medicines are not available commercially in the market:
o Low demand
o Requires an individual dose (pediatric)
o Requires an individual formulation for a patient
PREMISES’ STANDARDS
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STANDARDS OF EXTEMPORANEOUS
COMPOUNDING
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The products produced in the pharmacy must be suitable
for use, accurately prepared, and prepared in such a way
as to ensure the products meet the required standard for
quality assurance.
Patients are entitled to expect the standards within a
pharmacy to be comparable to those of a licensed
manufacturing unit.
PERSONAL HYGIENE
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Hygiene standards in a pharmaceutical environment
should be as high as, if not higher than, those found in food
kitchens
Ensure that the work area is suitable for its intended
purpose
Lighting and ventilation need to be adequate
o To prevent mix ups
Some pharmaceutical ingredients are highly volatile and if
the ventilation within the work area is inadequate this could
cause problems for the compounding staff.
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Premises’ decoration should be of a good basic standard.
The floor should be covered but in such a manner as to be
easily cleaned, surfaces should be smooth, impervious to
dirt and moisture, and should be clean and uncluttered.
Sinks should be clean and have a supply of hot and cold
water.
There should be a functioning, clean refrigerator.
o Food of staff and medications should not be kept
in 1 refrigerator.
o Refrigerators used in pharmacies must be capable
of storing medicines between 2oC and 8oC and
must be equipped with a maximum/minimum
thermometer.
There should be a supply of mains (potable) water
o For cleaning
AVOIDANCE OF CONTAMINATION
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Ensure all equipment is clean and dry prior to use.
Keep the dispensing area clear of unnecessary items.
Do not leave lids off stock bottles: always replace
immediately after use.
Do not return material to stock containers once removed.
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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Do not leave weighed and measured items unlabeled on
the work surface.
Do not allow raw materials or the final product to come in
contact with the hands (if necessary, wear gloves).
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LABEL PREPARATION
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The functions of a label are to indicate clearly:
o The contents of the container
o How and when the medicinal product should be taken
or used
o How the product should be stored and for how long
o Any warning or cautions that the patient needs to be
made aware of.
Label must be prepared before starting the compounding
procedure to:
o Enable the product to be labelled as soon as it has
been manufactured and packaged
o Eliminate the possibility that an unlabeled product
will be left on the bench.
o Reduce the possibility of the product being
mislabeled and given to the wrong patient
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If compounded product, you have to write the
dosage of the drug and how did you prepare
it.
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Products for external use
o If the product being made is official the official title
should be used
o If the product is an unofficial one the label title may
reflect the type of external product e.g. the nose
drops, the mouthwash, etc.
o In the case of the product for external use, the
quantitative particulars are expressed as the
complete formula
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Labels must also include an expiry date
Warning labels should be required. These may be
pharmaceutical or pharmacological warnings.
o Enemas: rectal use only
o Gargles and mouthwashes: not to be taken
o Inhalations: not to be taken
o Nasal drops: not to be taken
o Pessaries: vaginal use only
o Suppositories: rectal use only
GENERAL PRINCIPLES OF LABELLING
FUNCTIONS OF A LABEL ARE TO INDICATE
CLEARLY
CONTENTS OF THE CONTAINER
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The date, name, and address of the pharmacy are
also legally required
o The words “keep out of the reach of the children” are
also legally required
All labels must state the name of the product dispensed, the
strength where appropriate, and the quantity dispensed
Products for internal use
o The tile of an extemporaneous preparation if it is an
official product
o Unofficial products must state the full quantitative
particulars on the label
o For preparations intended for internal use this is
expressed as the amount of ingredient per unit
dose
How and when the medicinal product should be taken or
used
How the product should be stored and for how long
Any warning or cautions that the patient needs to be made
aware of
APPEARANCE
POSITIONING
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Medicine bottles: the label should be on the front of a
medicine bottle about third of the way down the container
Cartons: the label should be placed on the large side of the
carton
Ointment jars: The label should be placed on the side of the
jar
CLEANLINESS
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Ensure the container is clean before packing the products
Clean the outside of the container before affixing the label
Never pour any liquids into a pre labelled container to avoid
the risk of spoiling the label with drips of the medication
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Make sure that the label is secure before dispensing the
product to the patient
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The information on the label should be:
o Legible
o Concise
o Adequate
o Intelligible
o Accurate
SECURITY
INFORMATION
DISPENSED TYPE LABELS (C/O LABELLING)
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All the labels for dispensed medicine must have the name
of the patient, preferrable the full name
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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All directions on labels should use active rather than
passive verbs (e.g. Take two) not “two to be taken”
Where possible adjacent numbers should be separated by
the formulation name eg “take two tablets three times a day”
Liquid preparations for internal use usually have their dose
expressed as a certain number of 5mL doses
e.g. 5mL spoon = 10mL tds
Simple language should be used
o Never use the word “take: on a preparation that is
not intended for the oral route of administration
o Use “give” as a dosage instruction on product for
children, as a responsible adult should administer
them
o Only use numerals when quoting number of milliliters
to be given or taken. All the other dosage instructions
should use words in the preference to numerals
o Always be prepared to give the patient a verbal
explanation of the label
PHARMACEUTICAL PACKAGING
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All dispensed medicinal products will need to be dispensed
to the patient in a suitable product container.
The function of a container for a medicinal product is to
maintain the quality, safety and stability of its contents
TO TARE A CONTAINER
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Measure a volume of water equal to that of the product
being prepared. This must be measured accurately using a
conical measure
Pour the water into the container and mark the meniscus
using a small adhesive label
Remove the water from the bottle and drain the bottle
Transfer the prepared mixture into the calibrated bottle.
rinse the measure or mortar used in the preparations of the
product with more vehicle and add this to the bottle
Add any liquid ingredient and make the mixture up to the
volume using the vehicle
Remove the meniscus marker before dispensing
preparation to the patient
CARTON
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They tend to be rectangular in shape and the label is placed
on the larger side of the box
They are used to package blister strips of the tablets or
capsules, powder papers
Additional care must be exercised in the storage of
pharmaceutical products in cardboard cartons as they do
not come with child resistant closures.
IDEAL CONTAINER SHOULD BE
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Robust enough to protect the contents against crushing
during handling and transport
Convenient to use in order to promote good patient
compliance
Easy to open and close, if required, especially if the
medication is for an elderly or arthritic patient
Constructed of material that do not react with the medicine,
so the materials of constructions should be inert
Sufficiently transparent to allow inspection of the content in
the case of liquid preparations
OINTMENT JAR
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Can be made of either colorless glass or amber glass
Amber ointment jars ae used for preparations that are
sensitive to light and to package ointments, creams and
individually wrapped suppositories
Additional care must be exercised in the storage of ointment
jars as they do not come with child resistant closures.
DISPENSING PROCEDURE ON RECEIPT OF A
PRESCRIPTION FOR EXTEMPORANEOUS
PREPARATIONS
TABLET BOTTLES
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They come in variety of shapes and sizes
They are usually made of either glass or plastic
They are usually colored amber to reduce the likelihood of
the contents reacting with light
They are used for solid single dose preparations that are
intended for oral use
MEDICINE BOTTLES
PLAIN AMBER MEDICINE BOTTLES
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Can be used to package all internal liquid preparations
Two different sides: curved and flat
Plain amber medicine bottle com in a variety of sizes
FLUTED AMBER MEDICINE BOTTLES
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They have flat plain side
Side is curved and contains a number of ridges or grooves
running form the top of the bottle down to the bottom
These types of containers are often referred to as external
medicine bottles
CALIBRATED CONTAINERS FOR LIQUID
PREPARATIONS
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A tared bottle is normally only employed when, because of
the viscosity of the final product, the transference loss from
the measure to the container would be unacceptable
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
GUIDE TO AUXILIARY LABELS AND DISCARD
DATES FOR EXTEMPORANEOUS PREPARATIONS
INGREDIENT CONSIDERATION IN COMPOUNDING
SOURCES OF INGREDIENTS
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A USP, NF or FCC substance is the recommended source
of ingredients for compounding all drug preparations.
Alternative high-quality source such as analytical
reagent (AR) or certified American Chemical Society (ACS)
grade may be considered applying professional judgement.
Only manufactured drug products from containers
labeled with a batch control number and a future expiration
date are acceptable as potential source of active
ingredients.
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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When compounding with manufactured drug products, all
ingredients present in the drug product must be
considered relative to the intended use of the
compounded preparation.
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SELECTION OF INGREDIENTS
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Variety of forms
Examples:
o Light Kaolin: Used in suspensions
o Heavy Kaolin: Used in preparation of kaolin
poultice
Synonyms
Examples:
o Wool fat – Anhydrous lanolin
o Hydrous wool fat - Lanolin
Concentrated waters
o All concentrated waters have the same dilution
factor, i.e. 1 part of concentrate plus 39 parts of
water yields 40 parts of flavoured water.
COMPOUNDING INFORMATION SOURCES
COMPOUNDING DATABASES
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Characteristics of inorganic salts, like particle size,
tendency to absorb or give off water and pH, affect their
physical and chemical properties.
Solubility properties of the compound should be
considered.
EXAMPLES
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Acid salts corresponding to an insoluble salt will be more
water soluble than the original salt.
Sulfides
are
water-insoluble,
except
for
their alkali metal salts.
COMPOUNDING WITH ORGANIC SALTS
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Many drugs are “salts”, and the dose may be based on the
“total salt” form or just the “base” form of the drug.
Because many drugs are either weak acids or weak bases
and have limited water solubility, they are often used as
their “salts” to increase their aqueous solubility.
Salt forms may also be used to enhance the stability and
change other attributes of the drug to aid handling during
compounding
www.CompoundingToday.com
EXAMPLES
REFERENCES
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The Art, Science and Technology of Pharmaceutical
Compounding
Ansel’s Pharmaceutical Dosage Forms and Drug Delivery
Systems
Handbook of Extemporaneous Preparation
Pharmaceutical Compounding and Dispensing
Merck Index
Remington: The Science and Practice of Pharmacy
Applied Pharmaceutics in Contemporary Compounding
A Practical Guide to Contemporary Pharmacy Practice
Trissel’s Stability of Compounded Formulations
Handbook of Injectable Drugs
USP/NF
SPECIAL CONSIDERATIONS
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Compounding with hydrates and solvates
Compounding with inorganic salts
Compounding with organic salts
Compounding with esters
Compounding with aliquots, dilutions & concentrates
Compounding with “potency-designated” ingredients
Compounding with complex organic molecules
Compounding with commercial products
COMPOUNDING WITH HYDRATES AND SOLVATES
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The more molecules of water present in the molecule, the
more of the chemical should be weighed to obtain the
actual active drug.
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COMPOUNDING WITH ESTERS
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Dexamethasone contains less than 0.5% of its weight in
water.
Dexamethasone acetate has one molecule of water of
hydration and contains between 3.5 and 4.5% water; the
anhydrous form contains less than 0.4% water.
Dexamethasone
sodium
phosphate
contains
a sum of water and alcohol that may be up to 16.0%.
COMPOUNDING WITH INORGANIC SALTS
Esters are prepared for solubility and stability purposes, to
enhance resistance to degradation after administration and
for use as prodrugs.
Some drugs may cause pain at the site of injection,
especially if they precipitate and damage the surrounding
tissue. This may be overcome by preparing a drug with
increased solubility.
Since some drugs may occur in salt forms, ester forms,
and/or salt-ester forms, it is important to document what
form is used and whether it is a salt, ester, or combination.
Some drugs are very soluble but tend to degrade easily
when in solution. To increase stability, esters that are
poorly soluble are prepared.
“suspension” dosage form in place of a “solution” dosage
form. A drug in suspension degrades at much slower rate
than in solution. After oral administration, the ester is
cleaved, and the active drug moiety released for absorption.
EXAMPLES
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Erythromycin estolate is a salt.
Erythromycin ethylsuccinate is an ester.
Erythromycin stearate is a salt.
COMPOUNDING WITH ALIQUOTS, DILUTIONS &
CONCENTRATES
EXAMPLES
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Albuterol Sulfate Tablets, USP, are based on the
“albuterol” content (present as sulfate form).
Diphenhydramine Hydrochloride Capsules, USP, are
based on the total molecule.
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Reasons for preparing aliquots, dilutions and concentrates:
o Quantities required for dosing or compounding are
too small for accurate weighing.
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Some items (e.g nitroglycerin) are explosive and
must be diluted for safe handling.
o Many substances, such as acids & bases, are
commercially available in percentage strengths that
vary from one acid to another.
Diluted acids are aqueous solutions 10% w/v, but diluted
acetic acid is 6% w/v. Concentrations of official undiluted
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
acids are expressed as percentages weight in weight (w/w),
but the strengths of official diluted acids are expressed as
percentages weight in volume (w/v). Therefore, it is
necessary to consider the specific gravities of the
concentrated acids, when calculating the volume required
to make a given quantity of diluted acid.
COMPOUNDING WITH POTENCY-DESIGNATED
INGREDIENTS
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Some antibiotics, endocrine products, biotechnologyderived products, and biologics, have potencies that are
based on “activity” and are expressed in terms of “units of
activity”.
There is no relationship between the units of potency of one
drug with another different drug.
Determinations of potency are done on the “dried or
anhydrous” basis
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According to the USP, for substances that cannot be fully
characterized by chemical and physical means, it may be
necessary to express quantities of activity in biological units
of potency, each defined by an authoritative, designated
reference standard.
The potency of antibiotics is commonly expressed as “mcg
of activity per mg of substance”.
In some drugs, the actual dose may be expressed in units,
instead of mg.
o Example: heparin and insulin
Each container must be labeled with the actual potency,
and this information is to be used in calculations involving
dosing prior to compounding.
COMPOUNDING WITH COMPLEX ORGANIC
MOLECULES
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Most complex molecules and biotechnology products are
proteins.
Proteins are inherently unstable molecules and require
special handling, and their degradation profiles can be quite
complex.
The pharmacist must be knowledgeable on their
stabilization, formulation and delivery to the site of action.
Protein drugs are very potent and are used in quite low
concentrations. The bulk of compounded preparations
may be the excipients, including the vehicle, buffers and
stabilizers.
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In general, compounding with complex organic molecules require
special formulation, compounding and packaging considerations,
thus appropriate skill and care should be applied.
COMPOUNDING WITH COMMERCIAL PRODUCTS
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pH is key to formulating a stable preparation.
o Physiologic buffers may be used to obtain
optimal pH range.
o An increase in buffer concentration means an
increase in pain on injection
Chelating agents are added to bind trace metals, like
copper, iron, calcium and manganese, and minimize rates
of degradation.
o Example: EDTA (0.01-0.05%)
Antioxidants are incorporated to prevent protein
degradation due to oxidation.
o Examples: ascorbic acid, sodium disulfide, tocopherol (0.05-0.1%)
Preservatives may be required, especially if multiple dose
vials are prepared
o Examples:
phenol, chlorobutanol
and
benzyl alcohol
Oral tablets and capsules are commonly used to prepare
oral liquids (solutions and suspensions) for pediatric use,
and injectable drugs to prepare intravenous admixtures.
Use of commercial products as source of API usually result
in higher prescription cost.
Uncertainties in compounding involve the presence of
excipients and actual assay potency.
The presence of buffers in the commercial drug product
may influence and dictate the pH of the final compounded
preparation.
Modified-release dosage forms, including extendedrelease, delayed-release, repeat-action and targeted
release, should not be used in compounding unless it has
been indicated or documented that they can be used.
When using commercial products in compounding, it is
important to list the manufacturer, lot number, and
expiration date of the product used.
MEDICATION DISPOSAL
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The most appropriate method for medication disposal is
based on government regulations, environmental impact,
type, volume and toxicity of medication being disposed,
setting and risk of diversion.
Optimal method of medication disposal is by incineration.
TYPES OF PHARMACEUTICAL WASTE
HAZARDOUS WASTE
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FACTORS TO BE CONSIDERED
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Addition of stabilizers (e.g. polyols at 1-10%) and tonicityadjusting agents (e.g. sodium chloride and dextrose).
I.
II.
III.
IV.
V.
VI.
VII.
Ignitable
o aqueous drug formulations containing >24% alcohol
by volume, oxidizers or materials that readily supply
oxygen to a reaction in the absence of air (e.g.
AgNO3 applicators), and flammable aerosol
propellants.
Corrosive
o agents with pH<2 or >12.5 and include glacial acetic
acid, NaOH
Reactive
Toxic
o include heavy metals like barium, selenium and
thimerosal
ASHP list of dangerous pharmaceutical waste:
P (acutely hazardous) or U list (toxic) drugs (discarded
commercial chemical products that are acutely hazardous
or toxic)
Chemotherapy agents
Drugs with LD50 of <50 mg/kg
Endocrine disruptors
Immunosuppresants
Drugs meeting NIOSH or OSHA criteria
Drugs with potential toxicity due to chromium, selenium or
cadmium
REGULATED MEDICAL WASTE
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biohazardous waste or infectious medical waste
waste contaminated by blood, body fluids, or other
potentially infectious and sharp materials
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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UNIVERSAL WASTE
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commonly generated hazardous waste like batteries,
pesticides, mercury-containing products and bulbs/lamps.
CONTROLLED SUBSTANCE WASTE
NON-HAZARDOUS MEDICAL WASTE
DISPOSAL OF MEDICATION WASTE
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ASHP recommends that healthcare facilities have a
multidisciplinary waste management team.
Hazardous waste must be incinerated at an EPA-approved
facility.
Nonhazardous pharmaceutical waste should be disposed
of in a medical waste or municipal incinerator.
Disposal by sink or toilet has resulted in increased levels
of pharmaceuticals in rivers, streams and drinking water
supplies.
Medications thrown in the trash with prescription labels still
on them contain personal information which can promote
identity theft.
Disposal of medications in the trash can lead to accidental
exposure of children, pets and wildlife, and can also lead to
pharmaceutical drug diversion.
the completion of the record will be another safety check
for the patient and is an essential part of any standard
operating procedure for extemporaneous dispensing.
● Other records (e.g. fridge temperatures) should be routinely
recorded.
● The notes section is added to allow for any special
instructions with regard to method of preparation.
● Extemporaneous record sheets should be kept for a
minimum of two years, although ideally five years would be
advisable.
Extemporaneous Dispensing Record:
o As much as possible, have someone to double
check calculations.
GENERAL GUIDELINES FOR THE DISPOSAL OF
MEDICATION WASTE
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Utilize medication collection programs whenever possible.
Do not flush away medications.
When disposal programs are not available, throw away
unwanted medications in the trash using appropriate
safeguards
Utilize medication collection programs whenever possible.
Do not flush away medications.
When disposal programs are not available, throw away
unwanted medications in the trash using appropriate
safeguards
Place mixed contents in a sealable bag, empty canister or
other container to prevent the medication from leaking or
breaking out of a garbage bag.
Throw the container away in household trash.
Remove any personal information prior to throwing the
containers away in the garbage.
MINIMIZATION OF PHARMACEUTICAL WASTE
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Controlling inventory levels
Using just-in-time dispensing and compounding practices
Dispensing smaller quantities
Reconsidering 3-month supplies or automatic refills
Using available tools to prevent ADRs and interactions
Improving compliance
Minimizing prescription drug therapies, when appropriate
Pharmacists should play a significant role in minimizing
pharmaceutical waste and educating consumers about
appropriate disposal of medications.
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Suitable record keeping is a vital part of good
extemporaneous preparation because poor record keeping
can lead to dispensing errors which could result in the
patient receiving a product other than that intended by the
prescriber.”
EQUIPMENT
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A wide variety of equipment is used in extemporaneous
dispensing, depending on the product type to be prepared
The selection of complete equipment or ‘tool’ for the job
is essential
The equipment must be used in the correct way
EQUIPMENT REQUIREMENTS
SUITABLE RECORD KEEPING
WEIGHING AND MEASURING PROCEDURE
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[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
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It is preferable to incorporate a weighed or measured
ingredient into a product as soon as possible to prevent any
accidental switching.
When weighing or measuring more than one ingredient,
place each on a piece of labelled paper as soon as it has
been weighed or measured.
Used to weigh amounts below 150 mg.
It has an accuracy of ±1mg.
Minimum amounts that are weighed on these balances
are 50 mg for non potent substances, increasing to 100
mg for potent substances.
WEIGHING
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When weighing pharmaceutical substances, the Systeme
International d’Unites (SI) based around the gram (g), is the
system that is used.
For weights less than 1 mg, the units of the weight are
usually written in full to avoid confusion could then result in
dosing errors of one thousand times plus.
BALANCES FOR WEIGHTS GREATER THAN
50 G
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STANDARD BALANCES
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The balance most commonly found in the pharmacies will
be either a traditional ‘Class II’ dispensing beam balance or
a modern electronic equivalent. Class II balances are
similar to older Class B balances and use the same
weighing techniques.
BALANCES (traditional)
o Different types of balance are designed to weigh
within different ranges to differing degree of
accuracy.
o Balances used in pharmaceutical environmental:
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Class II balance or electronic equivalent.
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Sensitive electronic balances
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Balances for weights greater than 50.
o Balances have different accuracies, precision and
tolerance.
o Classes of balances with their weighing capabilities
ANALYTICAL BALANCE
MEASURING
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TYPE
MINIMUM
WEIGHT
NORMAL
MAXIMUM
WEIGHT
CLASS A
50 mg
1 mg
1g
CLASS B
100 mg
10 mg
50 g
CLASS C
1g
100 mg
2 kg
Ex. Pptabs – class A, Activated charcoal – class C
INCREMENT
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Class I, Class II, Class III, and Class IV
Class B balance – most commonly used balance in
dispensing
Class II balance is its nearest equivalent
CLASS II BALANCES
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A traditional Class II dispensing beam
balance is marked with a maximum
weighable quantity of 25 g and a
minimum weighable quantity of
100mg.
ELECTRONIC PHARMACY BALANCES
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In general conical rather than cylindrical
are used in pharmacy practice because:
o They are easier to fill without spilling
liquid on the sides above the required
level.
o They are easier to clean after use.
Compared to cylinders, with conical
measures, it is harder to read the meniscus
accurately and it is difficult to estimate
volume between graduations.
In measuring large volumes, this is used because it is more
accurate than syringes
REMINDERS WHEN MEASURING LIQUIDS
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Liquids are universally measured in liters
For volumes less than 1 mL, the units of the weight are
usually written in full.
It is also best practice when referring to volumes in multiples
of liters to write the word “liter” or “liters” in full.
Two main types of vessel used within pharmacy for
measuring liquids:
o Conical measures
o Syringes
Graduated cylinders and beakers can also be used
CONICAL MEASURES
NEW CATEGORIES OF BALANCES
●
●
These balances are designed to weigh weights over the
maximum weighable weight (i.e. 25 g) of a class II balance
or electronic equivalent.
The scale pan is made of metal than glass.
Solids are weighed into a watch glass, greasy solids on a
greaseproof paper and liquids into a small pot.
Tare the balance with the container beforehand to ensure
that only the weight of the ingredient will register on the
display.
Sensitive Electronic Balances
●
●
●
The bottom of the meniscus should be in line with the
desired graduation mark.
When reading, ensure that the eye is in line with the
meniscus to avoid parallax error.
The measure should be on a flat surface.
When measuring dark or colored liquids, place a piece of
white or colored card or paper behind the measure.
Avoid spilling of any liquid down the side of the measure to
prevent adding incorrect amount of a substance in the
preparation.
PROTACIO, EUCASION, JUQUIANA | 2E-PH
8
[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
MEASURING LIQUIDS
CORRECT USE OF A MORTAR AND PESTLE
●
●
MIXING AND GRINDING
MORTAR AND PESTLE
●
●
●
●
Mortars and pestles are used to:
o reduce the particle size of powders
o grind crystals into powder form
o mix powders
o mix
powders
and
liquids
o make emulsions
▪
It should be noted
that the mortar is
the
bowl and
pestle
is
the
pounding/shearing/grinding
implement,
so
compounders mix in a mortar with a pestle.
Mortar (bowl) and pestle (pounding device)
Used to reduce the size of powders, mix powders, mix
powders and liquids, and make emulsions.
Two types, each in varying size are used
●
●
●
●
Size reduction using a mortar and pestle
o Selection of the correct type of mortar is vital
o A flat-bottomed mortar and pestle with a flat end should
be chosen
o A flat-ended pestle in a mortar with a round bottom, or
vice versa, will mean a lot of wasted effort
Using a mortar and pestle for mixing powders
o Overfilling of the mortar should be avoided
o Pestle should be rotated in both right and left directions
to ensure thorough mixing
o Undue pressure should not be used to prevent
impaction of the powder on the bottom of the mortar
When using a mortar and pestle to reduce substances
to fine particles:
o The powder is placed in the mortar and the pestle is
used to rub down in a lateral shearing manner on the
powder
o The pestle is given a circular motion accompanied by
downward pressure
▪
Not too much pressure as the powder can become
compacted on the bottom of the mortar
The most effective way to use the pestle is to start in the
center of the mortar and make a circular motion on the
powder, gradually increasing the diameter of the circle with
each revolution until the sides of the mortar are touched,
then reverse the process, making the circles smaller with
each revolution until the center is reached again.
The pestle therefore follows a spiral track around the mortar
Mortars and pestles need to be matched <3
o Flat bottomed mortar will need a flat headed pestle
o Round bottomed mortar will need a round headed
pestle
METHODS OF COMMINUTION IN SMALL
SCALE
●
TWO MAIN TYPES OF MORTAR AND PESTLE
●
●
Glass
o Not usually used for the production
of large quantity products as they
are usually fairly small
o Surfaces of a glass mortar and its
pestle are very smooth, making
them less suitable for size
reduction of powders
o Efficient when grinding crystals
into powder form
o Useful when dissolving small amounts of medicament
or when incorporating substances that are absorbed by
and stain porcelain mortars
o For mixing of substances such as dyes which are
absorbed by and stain composition or porcelain
mortars
Porcelain
o These lend themselves to larger
scale production
o Are ideal for the size reduction of
powders, for mixing powders with
other powders, for mixing powders
with
liquids,
and for
the
preparation of emulsions
●
●
Trituration - is the process of grinding a powder in a
mortar and pestle to reduce its particle size.
Pulverization by Intervention - is the reduction of particle
size with the aid of a second agent which can be readily
removed from the pulverized product
o
Example: Applies to camphor where it is readily
triturated when a few drops of alcohol or other volatile
solvent is added. The pulverized camphor is readily
recovered as the solvent evaporates.
Levigation - is the process of reducing particle size by
first forming a paste of the solid with a minimum amount
of a levigating agent and then triturating the paste in a
mortar or on slab with a spatula.
TILES
●
●
●
Ointment tile or slab is used to
prepare ointments by means of
trituration or levigation
Tiles are usually made of glazed
porcelain or glass
Tiles should be large enough for
the quantity of ointment to be
prepared
STIRRING RODS
PROTACIO, EUCASION, JUQUIANA | 2E-PH
9
[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
●
●
●
Are used to agitate liquids to speed
up the process of dissolution of solids
Usually made of glass
Care must be taken not to stir too
vigorously as this may cause the
stirring rod to break
BURNER
PIPETTES
●
●
When measuring small volumes
a syringe is used but syringes are
less accurate than pipettes and
so traditionally small volumes
have been measured using
graduated pipettes
Two types of pipette are employed, either ‘drainage’ or
‘blow out’
NOTE: Syringes have a high degree of accuracy and are
readily available in most pharmacies
Bunsen burner
WATER BATHS
●
●
●
SUPPOSITORY MOULDS
●
●
●
Used to clarify liquids
Coarse filtration or straining – carried out by pouring the
liquid through muslin.
Filter paper or sintered glass filters – used when finer
degree of filtration is required.
o Disadvantage: can introduce fibers into the filtrate and
may also absorb significant amounts of active
ingredients.
SINTERED GLASS FILTERS
MANIPULATIVE TECHNIQUES
●
MIXING
o Goal: To ensure that even distribution of all the
ingredients has occurred.
o If a sample is removed from any part of the final
preparation it should be identical to a sample taken
from any other part of the container.
●
Simple stirring or shaking is usually all that
is required to mix two or more liquids.
Degree of mixing will depend on the
viscosities of the liquid.
o Liquids of low viscosities – minimal
stirring
o 2 Liquids with high viscosity – vigorous agitation
MIXING OF LIQUIDS
●
MIXING SOLIDS WITH LIQUIDS
●
FILTERS
A heat supply is needed for the production
of suppositories, pessaries, ointments and
creams.
The item to be melted is placed in an
evaporating basin over a water bath
containing hot water and allowed to melt.
Heat sources: Bunsen burner or
Hot plate.
NOTE: As most products only need to be melted gently,
there is no necessity for the water in the bath to be
boiling rapidly.
●
Suppositories
and
pessaries are made using
the same mould.
● The traditional moulds are
made of metal with two or
three
sections
held
together with a
screw
fixing.
● Metal moulds allow the suppositories to set quickly because
of their efficient heat transfer.
NOTE: When no weight is specified a 1g mould is used for
suppositories and the larger 4 g and 8 g moulds are used for
pessaries.
o This is an advantage when making suppositories
that contain an insoluble medicament, because it
does not allow time for the suspended solids to
settle by sedimentation.
● After removal from the mould, the suppositories used to be
dispensed in partitioned boxes of paper board, metal or
plastic and lined with waxed paper.
● Nowadays, in small scale production the use of aluminum
foil is recommended for wrapping.
Tirril burner
Factors to consider:
o Solubility of solids
o Particle size reduction
NOTE: These factors may either speed up the
dissolution process or improve the uniform distribution
of the solid throughout the liquid.
MIXING SOLIDS WITH SOLIDS
●
Stages of mixing:
o The ingredient with the smallest bulk is placed in the
mortar.
o A quantity of the second ingredient, approximately
equal in volume to the first is added and carefully
mixed, using the pestle.
o A further quantity of the second ingredient, approx.
equal in volume to the mixture in the mortar, is now
added.
o This process, known as “doubling-up”, is continued
until all the powder has been added.
MIXING SEMI-SOLIDS
PROTACIO, EUCASION, JUQUIANA | 2E-PH
10
[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
●
●
Occurs in the preparation of ointments where two or more
ointment bases may be mixed together.
METHODS OF MIXING:
o Rubbing them down on an ointment slab,
using spatula.
o Fusion method
▪
Do not add any solid active ingredients to the
basin before the bases have set. Addition of any
further ingredients is best done by rubbing down
on an ointment slab.
Tablet Counting Tray
FrymaKoruma MaxxD is a modular system for the manufacture
of emulsions and suspensions in a wide viscosity range
COUNTING DEVICES
MANUAL METHOD
CAPSULE COUNTERS
o
This consist of pouring the product onto a piece of
clean white demy paper which overlaps another piece.
o The product are then counted off in 10’s using a
spatula, onto the second piece of paper.
o This is formed into a small funnel and the
tablets/capsules poured into the appropriate container
NOTE: Problems with this method are that demy paper is
becoming increasingly difficult to obtain
●
●
PERFORATED COUNTING TRAYS
●
●
●
COUNTING TRIANGLES AND CAPSULE COUNTERS
COUNTING TRIANGLES
●
●
●
●
●
●
●
●
Fast, accurate and simple way to count tablets
Based on Pascal’s Triangle
Made either of metal or plastic
The capsule counter was designed to allow easy counting
of capsules in rows of 10.
For both, the tablets or capsules are placed on the counter
and any excess removed using a spatula.
Two rows of figures are printed or etched along the edge.
Top row of figures – number of rows
Numbers below – number of tablets contained in that
number of row.
Metal rows consisting of 10 rows of grooves.
Efficient method of counting capsules
●
Made of clear perspex
Consist of rectangular box
with a sliding lid, on top of
which
is
placed
in
perforated tray
An experienced operator
can count quite quickly
using this type of counter,
but the novice can find it
quite frustrating.
Disadvantage: necessity to change the trays for different
products
ELECTRONIC COUNTERS
●
●
Electronic Balance
o Between 5 and 20 of the dosage form is put on a
balance pan.
o From the weight of this, a microprocessor within
the device calculated the total number of dosage
forms, as they are added.
o Disadvantages:
▪
For accurate counting, it requires consistent
uniformity of the weights of capsules/tablets.
▪
More problematic when dealing with very
small tablets or sugar-coated tablets
▪
Balance needs to be recalibrated for each
type and size of dosage form counted
▪
It is very sensitive to vibration and air
movement.
Photoelectric Cell Counters
o Products to be counted is poured
through a hopper on the top of
the machine.
o The tablets/capsules are then
channeled into straight line and
counted as they are interrupted
by a beam of light to the
photoelectric cell.
o Accurate
PROTACIO, EUCASION, JUQUIANA | 2E-PH
11
[TRANS] UNIT 9: EXTEMPORANEOUS COMPOUNDING AND DISPENSING
●
Disadvantages:
o They do not discriminate between whole or broken or
fragments of tablets
o Cannot count clear or transparent capsules
o The speed of pouring must be controlled, if not the
system will not cope.
o Difficult to clean
REFERENCES
Notes from the discussion by Assoc. Prof. Nelson Tubon,
Ph.D.
University of Santo Tomas powerpoint presentation:
Extemporaneous Compounding and Dispensing
PROTACIO, EUCASION, JUQUIANA | 2E-PH
12
[TRANS 11]: PROCESSING THE PRESCRIPTION
I
II
III
OUTLINE
Steps In Processing The Prescriptions
Magistral Pharmacy
How Is A Prescription Processed
A
Receiving the Rx
B
Reading and Checking the Rx
C
Numbering and Dating the Rx
D
Labeling the Rx
i
Standard Requirements for Labeling Dispensed
Medicines
E
Preparing the Rx
F
Packaging
i
Types of Containers Generally Used
G Rechecking
H
Delivering the Prescription
i
Provide Patient Counseling
I
Recording
J
Pricing
K
Filing
9.
Patient receives script, pharmacy assistant must offer
counseling to the patient. Then script is rung on cash
register, and insurance log signed
10. Pharmacist provides counseling on the medication
prescribed and all medically related questions.
●
●
●
STEPS IN PROCESSING THE PRESCRIPTIONS
•
•
•
•
•
•
•
•
•
MAGISTRAL PHARMACY
Most important division of true pharmaceutical practice.
Preparation or compounding & dispensing of prescriptions
extemporaneously or as the occasion or physician’s needs
may require.
o Any medicinal product prepared in pharmacy (in
accordance w/ medical prescription or prescription for
an individual patient)
o Official preparation means any medicinal product
which is prepared in pharmacy in accordance w/
prescriptions of pharmacopeia and is intended to be
The extemporaneous compounding of prescription is an
activity for which pharmacists are qualified by virtue of their
education, training and experience.
HOW IS A PRESCRIPTION PROCESSED
Receiving the Prescription
Reading and Checking the Prescription
Numbering and Dating
Prepare the Label
Compound and Package the Drug Product
Recheck the Label of the Product vs the Rx
Check the Price of the Product and Inform the Patient
Delivering the Product and Provide Patient Counseling
Recording and File the Rx
STEPS IN PROCESSING Rx ORDER
Pharmacy Assistant should:
o Give the price of the product
o Get the payment for the product (from the patient)
▪
The pharmacist/pharmacy assistant will prepare
the medicine
o Deliver the drug product
1.
2.
3.
4.
5.
6.
7.
8.
Prescription written by authorized prescriber (in other
countries)
Patient presents prescription to the pharmacy
Prescription is checked for completeness; prescriber info,
drug name, strength, dose and directions
Correct patient info is entered into computer system (by
person at the counter)
Prescription is interpreted and confirmed by pharmacy
system. Third party is billed online (optional)
Pharmacy label is generated. Make sure all the legal items
are identified
Prescription is prepared. Correct amount of med prescribed
is measured and placed into container
Prescription is prepared by pharmacy technician and final
check done by pharmacist.
●
●
1. RECEIVING THE Rx
Enhance the pharmacist patient relationship
Patient may be asked for a brief health and medication
history
PHARMACIST should:
o Estimate length of time required to fill the Rx
o To price the Rx if requested by the patient
For drugs with interactions (food-drug interaction, drug-drug
interaction and drug-lifestyle interaction), pharmacist must
consider alternative drugs and consult the physician to
determine the best therapeutic alternative for the patient
o Need to check the therapeutic classification of the drug
and ask yourself ‘is the prescription right for him/her’
o Ensure dosage is both safe and appropriate based on
age and weight
EUCASION, PROTACIO, TANSIONGCO | 2E-PH
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TRANS [11]: PROCESSING THE PRESCRIPTION
o
o
o
If something is illegible or if it appears that an error has been
made, pharmacist should consult another pharmacist or the
prescriber
o When a pharmacist receives a prescription, they must
check is the prescription is valid and prescriber has
prescribed w/ their permit
o Remember that upon receiving a prescription, evaluate
if it has prescriber details/physician info, patient details
(like age, weight, medical conditions, allergies),
confirm medication items to be dispensed, confirm
indication, preference details and prescription meets
legal requirements (including date, drug, strength,
instructions and signature)
●
●
●
●
Read the Rx in the privacy of the prescription department
There should be no doubt as to the ingredient or quantities
prescribed
o Prescription is usually written on a pre-printed pad w/
doctor’s name, address and phone number
o Found on the top or bottom of prescription is the special
identification numbers such as S2-license of physician,
if that will be dangerous drug, regulated/prohibited drug
or controlled substances
o There is space for your name and address, age, date,
place for doctor’s signature and blank area for doctor
to write following directions: name, dose, how often to
take, when to take and how to take the medication
If something is illegible or if it appears that an error has been
made. Pharmacist should consult another pharmacist (copharmacist) or the prescriber.
Should verify omission or failure to specify desired strength
of medication or its dosage form, should be corrected
o Always consult the prescriber
DOSE
BE
Age
Weight and condition of patient
Possible influence of other drugs being taken
Frequency of administration (if drug is taken twice a day,
thrice a day, every 6 hours or once a day)
PHARMACIST
●
●
Should consult the prescriber
Familiar with available strengths and dosage forms of
prefabricated drug products, to detect such omission and
provide the physician with necessary information
●
It is a universal practice to number the Rx order and to place
the same number on the label.
To identify the bottle or package & to connect it with the
original medication order (reference)
Numbering of Rx:
o Consecutive numbers may be assigned by the use of
a numbering machine.
Dating of the prescription:
o On the date filled/compounded to establish identity &
should never be omitted
▪
Must date every prescription w/ date you gave to
the patient
●
●
●
3. NUMBERING AND DATING THE Rx
▪
▪
Prescription number is prescription being an
abbreviation for prescription. This number
identifies your prescription
Numbers are assigned in the order filled at the
pharmacy
When calling for a refill, providing this number for
easy identification by pharmacy staff
WHAT IS THE PURPOSE OF NUMBERING AND
DATING THE PRESCRIPTION?
●
●
●
●
2. READING AND CHECKING THE Rx
THE SIZE AND FREQUENCY OF
CAREFULLY NOTED AND CHECKED:
●
●
●
●
▪
Ensure medication is compatible w/ current medical
conditions and allergies
Ensure medication is compatible w/ other medication
being taken
Ensure prescription is appropriate for the condition
being treated
●
●
●
●
The same number of the original prescription should
appear at the label of the filled prescription – to avoid error
in dispensing
The date of the prescription is not the same date that
should be placed on the filled prescription – for
identification purposes
4. LABELING THE Rx
Prescription label - prepared by pharmacist, an assistant
may be employed for this purpose
Rx labels should be computerized or typewritten to make
them neat, attractive and legible
o Preparing label is one of the most important aspect of
dispensing a prescription
o The label must comply w/ FDA regulations and should
correctly and clearly convey all necessary information
regarding dosage, mode of administration, and proper
storage of the product
o The quality of labeling is extremely important to
patient’s perception of the quality of the product and
may have profound implications for his/her safe use of
medication and compliance w/ prescribed regimen
o Labeling of medication encompasses the provision of
information and instructions to ensure safe and
effective use of product by patients
o The label of dispensed medication represent one of the
most important sources of information available to
patient
A prescription should have an aesthetic and professional
appearing label
The size of the label should be in conformance with the size
of the prescription container
Name, address and telephone number of the pharmacy are
generally imprinted in the label
The pharmacist should give clear directions to the patient
and complete as possible
LABEL OF COMPOUNDED RX SHOULD INCLUDE:
●
●
●
●
●
●
●
●
●
●
Name and address of the pharmacy
Date of filling/dispensing
Prescription number
Prescriber’s name
Patient’s name
Name and strength of the medication
Directions for administration/use
Manufacturer’s lot number and expiration date
Auxiliary and cautionary labels
Name and initials of the dispensing pharmacists
LABEL OF UNIT DOSE RX SHOULD INCLUDE:
●
●
●
●
●
●
●
Prescription number
Name of patient
Generic name of drug
Brand name
Manufacturer
Dosage strength
Expiry date
EUCASION, PROTACIO, TANSIONGCO | 2E-PH
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TRANS [11]: PROCESSING THE PRESCRIPTION
●
●
Directions for use
Name of pharmacist
●
NOTE: Labels may come w/ more information including adverse
effects, warnings, auxiliary information including specific alerts
that help the patient take the medication safely as intended. The
auxiliary label can include the route of administration or
medication, what to avoid, how to take it.
● AUXILIARY LABELS – emphasize a number of important
aspects of the dispensing medication including:
o Proper use
o Handling
o Storage
o Refill status
o Necessary warning and precautions
▪
Example: “Shake well”, “POISON”, “Should Not
Be Swallowed”, “Keep Out of Reach of Children”
▪
Other examples: “Take medication with full glass
of water”, “Refrigerate and shake well”, “Take with
food” “For the nose”, “Do not drink alcoholic
beverages while taking this medication may cause
dizziness”, “Take with nitrates” or “Take
medication on an empty stomach”
Pharmacist may supplement the instruction or direction of the
prescriber to clarify and expand the instruction
o Eg. If to be taken with water, with or without food,
activities to avoid when taking the medication (like
exercise)
Patient product information must be provided with the
dispensing of certain drugs
o Helps pharmacist to reinforce effort during counseling
o Pharmacist should assist patient to interpret the
information contained in the product information
STANDARD REQUIREMENTS
DISPENSED MEDICINES
●
●
●
FOR
LABELING
Name of the preparation, strength and form
o The name which appears on the label must be the
same as the one which appears on the prescription
Quantity
o The quantity which appears on the label will be the
quantity which has been prescribed
Instruction for use
o No patient should leave a pharmacy without knowing:
▪
How much
▪
How often
▪
How to use
5. PREPARING THE Rx
Pharmacist should organize the method to be used
Information Necessary:
● Compatibility of the ingredient
o Chemical compatibility measures how stable a
substance is when mixed w/ another substance
o If two substances can mix together and undergo a
chemical reaction, they are considered incompatible
o Chemical compatibility is important when choosing
materials for chemical storage/reactions that vessel
and other apparatus will not be damaged by its
contents
o For purposes of chemical storage, chemicals that are
incompatible should not be stored together so that any
leak will not cause even more dangerous situation by
reacting after leaking
o Chemical compatibility refers to the container of
material being acceptable to store the chemical or for
an object that comes in contact w/ chemical to not
degrade
●
●
●
●
●
Adjuvant used
o Adjuvants is an ingredient (in prescription or solution)
that modifies the action of the principal ingredient
o This is a drug or method that enhances the
effectiveness of medical treatment
Order of mixing
o Step by step order that needs to be followed
Amount of each ingredients
o Weigh accurately each ingredient
Capsule size
o If you will be preparing capsule
Type and size of container
Name and product identification number of manufacturer.
In partial filling of the prescription, the following should be written
on the face of the prescription:
o Date of partial filling
▪
Should be placed on the face of prescription
o Quantity served and balance unserved
▪
Should be specified, some are doing it by placing
a circle
o Name and address of the drugstore
▪
There is a rubberstamp for you to place the name
and address of the drugstore
▪
Sometimes the initial of the pharmacy is stated
●
●
●
●
●
•
•
●
●
Partially filled Rx should be returned to the buyer after
recording the partial filling in the Rx book
o Whoever who will be dispensing the remaining quantity
should be the one to file the prescription
Partial filling of prohibited or List A drugs shall not be
allowed.
o Especially the dangerous drugs or regulated/prohibited
drugs
6. PACKAGING
Packaging is the science, art and technology of enclosing
or protecting products for distribution, storage, sale and
use. It also refers to the process designing, evaluating and
producing packages. It protects, preserves, transports,
informs and sells. The primary purpose of packaging is to
protect its contents from any damage that could happen in
transport, handling, and storage. Retains the product intact
throughout its logistics chain from manufacture to the end
user. It protects product from humidity, light, heat and other
external factors
Pharmacist should consider the size, shape, mouth
opening, color and composition in packaging
o Packaging selection is based primarily on the type and
quantity of medication to be dispensed.
3 types of packaging: primary, secondary and tertiary
Use appropriate containers:
o Low viscosity: ordinary Rx bottles
o High viscosity: tablets in bulk, wide-mouth
o Semi-solids: tubes, ointment jar
o Powder: papelitos (or paper tablets)
o Ophthalmic solutions: dropper bottle/applicator bottle
Size of bottle should be enough to hold the content
o Emulsion: space allotted for shaking
▪
Remember you are going to place “Shake well”
label as part of auxiliary label
If not sensitive: colorless
If active ingredient is sensitive: amber colored (avoids photo
degradation)
PLASTIC CONTAINERS
●
Advantages:
o Lightness of weight, resistance to breakage, versatile
design
EUCASION, PROTACIO, TANSIONGCO | 2E-PH
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TRANS [11]: PROCESSING THE PRESCRIPTION
●
Disadvantages:
o Permeable to atmospheric gases & moisture vapor
o Subject to leaching – component of the container
mixes with the active ingredient
o Deformed with extreme temperature
•
•
TYPES OF CONTAINERS GENERALLY USED
•
•
•
•
•
•
•
•
•
Round Vials – for solid dosage forms as capsules and
tablets
Prescription Bottles – for dispensing liquids of low
viscosity
Wide Mouth Bottle – used for bulk powders, large
quantities of tablets or capsule and viscous liquid
Dropper bottle – for ophthalmic, nasal, otic, or oral liquids
to be administered by drop
Application bottle – used for applying liquid medication to
a wound or skin surface
Ointment jars and collapsible tube – ointment and
creams
Sifter-Top Container – for powders applied by sprinkling
Hinger lid or Slide Boxes – for suppositories and powder
packet
Aerosol Container – pharmaceutical aerosol product
PHARMACIST SHOULD CHECK FOR
•
•
•
•
•
Permeability of containers to atmospheric gases and to
moisture vapor
o Permeability is the quality or state of being permeable,
able to be penetrated or pass through especially by a
liquid or gas
Leaching of constituents of the container to internal content
o Leaching is the removal of a solute from a porous solid
using a liquid solvent or when liquid substances are
used to remove porous solid this is the process used
Absorption of drugs from content container
o The chemical composition of the drug and environment
to which a drug is placed work together to determine
the rate and extent of drug absorption
Transmission of light through the container
o Light transmission – when light travels through a
medium (glass) without being reflected, absorbed or
scattered. When this happens the light energy is not
lost and considered 100% transmitted
Alteration of the container on storage, particularly at
extremes in temperature (specific pharmaceutical product)
CHILD RESISTANT CONTAINERS
•
•
●
•
•
•
•
To prevent accidental poisoning resulted from ingestion of
medication and other household chemicals by children.
With safety closures
A child resistant container is designed to be difficult for a
child to open. It is developed to prevent children getting
access to contents of medicine packaging. They are tested
to ensure young children cannot open them
Exempted:
o Oral Contraceptive
o Cardiac Drugs
o Products for childless person, arthritic and debilitated
patient
o Products used in institutionalized setting
Reasons for Exemption
o The container is not appropriate, feasible or practical
o Quick access to medication
7. RECHECKING
The importance of this step should not be overemphasized
Every Rx should be rechecked by the Pharmacist
(ingredients and amounts used)
•
•
•
All details of the label should be rechecked against the Rx
order to verify directions, patient’s name, Rx number, date
and prescriber’s name
Rechecking should be done at least 3 to 4 times
o Before getting from the shelf
o While preparing the product
o When returning the containing
o Before dispensing the medication
8. DELIVERING THE PRESCRIPTION
The pharmacist personally presents the prescription
medication to the patient unless it is to be delivered to the
patient`s home or office
Gives assurance that the patient understands how to use
the medication properly
Make certain (if personal delivery is not possible)
appropriate instructions are provided and encourage the
patient to call should there be any questions
PROVIDE PATIENT COUNSELING
The pharmacist must offer to discuss the following:
● Information on the drug
● Dosage form (like tablets, capsules, suspensions)
● Route of administration
● Special directions for use
● Common side effects or interactions
● Therapeutic contraindications
● Technique for self-monitoring drug therapy
● Proper storage
● Prescription refill information
● Action to be taken in cases of missed dose
NOTE: Written information may supplement but not replace oral
counseling requirement. Pharmacist may also obtain, record
and maintain profiles on patient’s disease state, known allergies,
drug sensitivities, medication history and comments relevant to
the drug therapy. As well as the name, address, telephone no,
Birth date, age and gender of the patient.
9. RECORDING
•
Any record relating to the supply of a prescription medicine
must be kept for the required duration and produced for
inspection when requested (example Food Drug
Administration (FDA) officials
•
Pharmacist should considere any other rules and regulation
regarding with recording of dangerous drug, ordinary
prescription and poison substances if any
•
A record of the prescriptions dispensed should be
maintained in addition to the prescription files
•
This would permit rapid location of prescription orders
•
Different RECORDS used: (for hospital and community
setting)
o Prescription Book = 2 years
o Poison Book (very rare) = 5 years
o Dangerous Drug Record Book = 1 year and reported
twice a year in the Dangerous Drug Board, on January
1-15 and July 1-15
o Referral Book (the latest and is stated in RA 10198) =
2 years
NOTE: These record books shall be available when FDA will
visit your drugstore, present them in case if they are going to
ask.
INFORMATION TO BE
PRESCRIPTION BOOK
•
•
•
RECORDED
IN
THE
Name of physician
Name of the drug (being dispensed)
Quantity
EUCASION, PROTACIO, TANSIONGCO | 2E-PH
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TRANS [11]: PROCESSING THE PRESCRIPTION
•
•
•
Date when dispensed
Balance (quantity if any)
Pharmacist signature, etc.
•
The dispensed price or prescription cost refers to cost when
patient has to pay to get medicine and treatments which are
written as direction on prescription by prescribers
The prescription price is a regular healthcare price for sick
and may mean economic hardship for underprivilege
Code in Pricing – traditional code in which letters selected
should have 10 letters with no duplicate letters.
Example:
•
•
•
10. PRICING THE Rx
o
o
•
•
•
SMIT (code) = 67.89
Today, it is already modern such as cash registry and
price tag
11. FILING
To be kept for 2 years
Prescription File Types:
o Metal or cardboard unit
o Partitioned drawers
FILING:
o Prescription Book = 2 years
o Poison Book = 5 years
o Dangerous Drug Record Book = 1 year
o Referral Book = 2 years
METHODS OF PRESERVING PRESCRIPTIONS
•
•
•
•
•
•
Filing on string or wire
Pasting on scrap book (old method)
Writing a copy in a blank book and returning the original
Wrapping the Rx in packages of 100 and packing ten
consecutive hundreds in wooden box (old method)
Pasting the Rx to a card which is then filed in a cabinet (old
method but some are still using)
Computer filing of prescription is most recommended (latest
filing of prescription)
REFERENCES
Notes from the discussion by Nelson T. Tubon
University of Santo Tomas
Processing the Prescription
powerpoint
presentation:
EUCASION, PROTACIO, TANSIONGCO | 2E-PH
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