Pharmacy and Toxicology

1
Pharmacy and Toxicology

• A presentation by
• HN Abaigar

2
Pharmacology

• Pharmacology is the science that deals with the
  origin, nature, chemistry, effects, and uses of
  drugs.
• Pharmacognosy The branch of pharmacology that
  deals with biological, biochemical, and economic
  features of natural drugs and their constituents.
• Pharmacy The branch of pharmacology that deals
  with the preparation, dispensing, and proper use
  of drugs.

3
Pharmacy Terminology

• Posology The science of dosages.
• Pharmacodynamics The study of drug action on
  living organisms.
• Pharmacotherapeutics The study of the uses of
  drugs in the treatment of disease.
• Toxicology The study of poisons, their actions,
  their detection, and the treatment of the
  conditions produced by them.

4
Drug Standards

• The United States Pharmacopoeia and National
  Formulary (USP-NF), provides Standards for the
  use of therapeutic drugs and for pharmaceutical
  necessity.
• Drug Facts and Comparisons and the Physicians
  Desk Reference (PDR) have multiple indexes of
  commercially available drugs. Advertising outlet
  for manufacturers.
• Remington The Science and Practice of Pharmacy
  most widely used
• Pharmacological Basis of Therapeutics blue
  bible of pharmacology

5
Dosage

• Dose - the amount of medication to be
  administered
• The study of dosage is called posology.
• Dosages given in the United States Pharmacopoeia
  and National Formulary (USP-NF) are average
  therapeutic and are known as the usual adult
  doses terms are used in connection with doses.

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Dosage

• Therapeutic Dose
• also referred to as the normal adult dose, the
  usual dose or average dose
• Dosage Range
• The minimum and maximum amounts required to
  produce the desired effect
• Minimum dose least amount to produce
  therapeutic effect
• Maximum dose largest amount without reaching
  toxic effect
• Toxic dose least amount producing symptoms of
  poisoning
• Minimum Lethal Dose
• dose is the least amount of drug that can produce
  death

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Factors Affecting Dosage

• AGE
• WEIGHT
• Sex
• Race
• Occupation
• Habitual use
• Time of administration
• Frequency of administration
• Mode of administration.

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Age

• Most common factor that influences the amount of
  drug
• Youngs Rule Childs Dose Adult Dose
• Childs Age
  Childs Age 12
• Given Aspirin adult dose 650 mg
• Find Dose for 3 yr old child
• Solution Childs dose Adult dose X Childs
  age
• 
  Childs age 12
• 650 mg X
  3
• 3
  12
• Childs dose 130 mg

9
Weight

• For pediatric dose, weight has more factor
• Clarks Rule Childs Dose Adult Dose
• Childs Wt
  150
• Given Aspirin adult dose 650 mg
• Find Dose for child weighing 60 lbs
• Solution
• Childs dose Adult dose X Childs Wt
• 150
• Wt 650 mg X 60 lbs
• 150 lbs
• Childs dose 260 mg

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Methods of Administering Drugs

• Oral
• Parenteral
• Subcutaneous
• Intradermal
• Intramuscular
• Intravenous
• Intrathecal or Intraspinal

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Methods of Administering Drugs

• Inhalation
• Vaporization
• Gas inhalation
• Nebulization
• Topical
• Rectal
• Vaginal

12
Drug Classification

• Drugs are classified by set criteria and fall
  into three specific areas
• General accdg. to source, i.e. animal,
  vegetable or mineral
• Chemical accdg. to chemical characteristics
• Therapeutic accdg. to action on the body

13
Drug Nomenclature

• Chemical name 2,4,7- triamino-6-phenylpteridine
• Generic name triamterene
• Trade name - Dyrenium

14
Astringents

• Cause shrinkage of skin and mucous membranes to
  stop seepage, weeping and discharge
• Aluminum Acetate (Burows solution) poison ivy,
  insect bites, athletes foot, superficial
  external otitis
• Calamine lotion do not apply to blisters

15
Emollients

• Bland or fatty substance for skin application and
  vehicle for meds
• Theobroma oil (cocoa butter)
• Petrolatum (petrolatum jelly)
• Zinc oxide ointment emollient with astringent
  properties, sun screen protection

16
Expectorants and Antitussives

• Expectorant (Bronchomucotropic)
• Antitussive (Cough suppressant)
• Guaifenesin and dextromethorphan (Robitussin DM)
  non-narcotic antitussive
• Guaifenesin and codeine phosphate (Robitussin AC)
  narcotic antitussive

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Nasal Decongestants

• Relieves nose and eustachian tube congestions,
  combined with antihistamines, antitussives and
  expectorants
• Sudafed
• Actifed
• Entex

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Antihistamines

• For inflammation, allergies, asthma, hay fever
  causes drowsiness
• Diphenhydramine hydrochloride (Benadryl)
• Chlorpheniramine maleate (Chlor-Trimeton)
• Meclizine hydrochloride (Antivert, Bonine)
  treatment of motion sickness, contraindicated
  with pregnancy
• Dimenhydrinate (Dramamine) treatment of motion
  sickness

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Histamine H2 Receptor Antagonists

• Block histamines causing increase gastric acid,
  short-term treatment of peptic ulcer
• Cimetidine (Tagamet) duodenal ulcers
• Ranitidine (Zantac) ulcers, GERD (heartburn)

20
Antacids

• Counteract hyperacidity, indigestion, heartburn,
  dyspepsia oral drugs not to be taken within 2
  hours of taking antacid be aware of sodium
  content for cardiac patients and patients with
  low sodium diet
• Magnesium Hydroxide (milk of magnesia) prolong
  use results in kidney stone has laxative effect
• Aluminum Hydroxide (Amphojel) no systemic
  alkalosis cause constipation
• Alumina and magnesia oral suspension (Maalox)
  less constipating than amphojel
• Alumina, magnesia, and simethicone oral
  suspension (Mylanta)

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Antiseptics, Disinfectants, Germicides

• Phenol (carbolic acid) standard of all
  antiseptic, disinfectant, germicides inactivated
  by alcohol, never use on rubber, cloth or plastic
• Povidone-iodine (Betadine) pre-operative skin
  antiseptic
• Isopropyl Alcohol (Isopropanol) dessicant
  effect on skin
• Hexachlorophene (pHisoHex) neurotoxic agent,
  dont use on premature infants, denuded skin,
  burns, mucous membrane
• Glutaraldehyde (Cidex) sterilize fiber optics,
  plastic, rubber
• Hydrogen peroxide use for Vincents angina,
  Trench mouth (Necrotizing Ulcerative Gingivitis -
  NUG)
• Silver Nitrate solid form used to cauterize
  mucous membrane and treat aphthous ulcer
• Silver Nitrate - liquid form used as
  gonorrheal eyedrops on newborn and wet dressing
  on burns
• (Argyria skin turns to slate gray if
  silver nitrate wet dressing dries out)

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Sulfonamides

• Mainly for Urinary Tract Infection (UTI) and
  otitis media precipitate in acid solutions
  (crystalluria) must force alkaline solutions
• Sulfisoxazole (Gantrisin) UTI, acute otitis
  media
• Trimethoprim and sulfamethoxazole (Bactrim,
  Septra) UTI
• Sulfacetamide sodium (Sulamyd) conjunctivitis,
  corneal ulcer
• Silver sulfadiazine (Silvadene) treatment for
  2nd 3rd degree burns

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Penicillins

• Most effective, least toxic antimicrobial agent
  treatment of endocarditis, pneumococcal, Strep,
  gas gangrene, gonoccocal, anthrax, Vincents
  angina, syphilis, rheumatic heart fever
• Penicillin G (Aqueous) parenteral use
• Penicillin G benazathine (Botulin) syphilis,
  URI (Strep throat)
• Penicillin G procaine (Wycillin) uncomplicated
  pneumonia, NUG, PID, pharyngitis
• Penicillin V potassium (Pen-Vee K) drug of
  choice for uncomplicated strep throat
• Dicloxacillin sodium (Dynapen) Tx of penicillin
  G-resistant staph
• Ampicillin (Polycillin) Tx of shigella,
  salmonella, E.coli, gonorrhea
• Amoxicillin (Amoxil) more effective tx of
  shigella

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Cephalosporins

• Related to penicillin
• 1st Generation cefazolin sodium (Ancef,
  Kefzol)
• 2nd Generation cefoxitin sodium (mefoxin)
• 3rd Generation cefotaxime sodium (Claforan)
• Cefazolin sodium (Ancef, Kefzol) Tx of
  pneumonia, lung abcess, septicemia use as pre-op
  prophylaxis
• Cephalexin (Keflex) Tx for infection of lower
  tract, skin structures, genitourinary sytem,
  otitis media
• Cefuroxine (Ceftin, Zinacef) Tx of
  pharyngitis, tonsillitis, bronchitis, mixed skin
  infection (aerobic/anaerobic) pre-op prophylaxis

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Tetracyclines

• First truly broad-spectrum antibiotics not
  indicated for children and pregnant women
  producing teeth discoloration, depress bone
  marrow growth major hazard is overgrowth of
  Candida and staphylococci dont use with milk
  products, antacids or iron preparation
• Tetracycline hydrochloride (Achromycin) Tx of
  rickettsiae (Rocky Mountain spotted fever),
  severe acne
• Doxycycline hyclate (Vibramycin) Tx of
  uncomplicated chlamydia and gonoccocal infections
• Minocycline hydrochloride (Minocin)

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Aminoglycosides

• Cause ototoxicity, nephrotoxicity and prevalent
  in very young or old folks, presence of renal
  failure or dehydration or use of diuretics
• Streptomycin Sulfate - Tx of mycobacterium
  tuberculosis in conjunction with Rifampin or
  Isoniazid tx of plague, tularemia, chancroid,
  granulomas
• Gentamycin sulfate (Garamycin) must monitor
  renal and hepatic functions tx of burns and
  wounds, ophthalmic preparation for eye infection
• Trobramycin sulfate (Nebcin) Tx of septicemia,
  meningitis, peritonitis
• Neomycin sulfate (Mycifradin Sulfate) reduce
  intestinal flora prior to surgery

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Macrolides

• Often used for penicillin-sensitive patients
• Erythromycin (E-Mycin, Ilotycin) drug of choice
  when penicillin is contraindicated prophylactic
  agent for colorectal surgery
• Clindamycin hydrochloride (Cleocin) discontinue
  use if severe colitis and profuse diarrhea occurs
• Vancomycin hydrochloride (Vancocin) Tx of
  potentially life-threatening disease like
  endocarditis, osteomyelitis, pneumonia and
  septicemia
• Spectinomycin (Trobicin) sole Tx of gonorrhea,
  for patient allergic to penicillin, NOT for
  syphilis

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Antifungals

• Suppress growth of fungi, dermatophytes or
  Candida cause hepatic or renal dysfunction if
  for systemic use
• Nystatin (Mycostatin) Tx of candida infection
• Griseofulvin (Gris-PEG, Fulvicin) Tx of fungal
  infection of nails, hair and skin not for Tx of
  superficial fungal infection contraindicated in
  patients with hepatic dysfunction
• Miconazole nitrate (Monistat, Micatin) Tx of
  cutaneous infection and vulvovaginal candidiasis
• Undecylenic acid (Desenex) Tx of tinea pedis
  (athletes foot)
• Tolnaftate (Tinactin, Aftate) first fungicide
  Tx of tinea pedis, corporis, capitis and
  versicolor
• Clotrimazole (Lotrimin, Mycelex) broad
  spectrum, Tx of Candida and Tinea species

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Antiparasitics

• For protozoal (amebiasis, malaria), helminthic
  infection (intestinal worm) and ectoparasites
  (head lice, crab lice)
• Permethrin (Elimite) Tx of head lice, crab lice
  and scabies caution on use on children and
  pregnant women due to systemic poisoning
• Crotomiton (Eurax) Tx of scabies (Sarcoptes
  scabiei)
• Metronidazole (Flagyl) Tx of amebiasis
• Chloroquine phosphate (Aralen) drug of choice
  for acute malarial attacks
• Primaquine phosphate drug of choice for
  prevention or relapse of malaria caused by P.
  vivax and P. ovale contraindicated for G6PD
  deficiency
• Sulfadoxine and pyrimethamine (Fansidar) Tx of
  malaria strains resistant to chloroquine
  prophylactic use in endemic areas

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Antiparasitics

• Mebendazole (Vermox) Tx of hookworm, roundworm,
  pinworm and whipworm
• Pyrantel pamoate (Antiminth) drug of choice for
  pinworm and roundworm
• Thiabendazole (Mintezol) vermicide to kill
  pinworm, roundworm, threadworm, hookworm and
  whipworm
• Pyrvinium pamoate (Povan) Tx of pinworm stains
  stool bright red

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Laxatives

• Treatment of simple constipation and clean
  intestines of toxic substances (catharsis)
• Mineral oil use to lubricate fecal mass
  emollient laxative in conjunction with Ex-Lax
• Glycerin suppositories (Sani-Supp) promote
  peristalsis widely use in children
• Bisacodyl (Ducolax) nontoxic irritant
  cathartic, prep agent to surgery and X-ray exam
• Magnesium citrate (citrate of magnesia)
  inhibits water absorption prior to X-ray exam
• Psyllium hydrophilic mucilloid (Metamucil)
  absorbs water
• Ducosate calcium (Surfak) stool softener that
  promotes water retention in fecal mass
• Ducosate sodium (Colace) same as Surfak

32
Antidiarrheals

• Diarrhea due to food poisoning, parasitic
  infection and GI disease
• Kaolin mixture with pectin (Kaopectate)
• Diphenoxylate hydrochloride with atropine sulfate
  (Lomotil) related to Demerol and is classified
  as Schedule V narcotics

33
Diuretics

• Useful in Tx of hypertension, edematous
  conditions such as congested heart failure and
  acute pulmonary edema
• Hydrochlorothiazide (Esidrix, Oretic,
  HydroDIURIL) use for edema with congestive
  heart failure (CHF) and to manage hypertension
• Chlorthalidone (Hygroton)
• Furosemide (Lasix) potent diuretic in Tx of
  edema associated with CHF must supplement with
  Potassium
• Acetazolamide (Diamox) diuretic but use for Tx
  of glaucoma
• Triamterene and hydrochlorothiazide (Dyazid,
  Maxzide) potassium supplement not needed

34
Non-Narcotic Analgesics, Antipyretics, and
Anti-Inflammatory Agents

• Analgesics relieve pain
• Antipyretics reduce fever
• Anti-inflammatory suppress inflammation
• Aspirin (ASA, CAMA, Ecotrin) cotraindicated in
  peptic ulcer
• Acetaminophen (Tylenol) use for
  aspirin-sensitive patient no anti-inflammatory
  agent
• Ibuprofen (Motrin) Tx of arthritis, tendinitis,
  bursitis not use for GI bleed or renal
  impairment
• Indomethacin (Indocin) Tx of chronic rheumatoid
  arthritis, osteoarthritis and acute gout
• Naproxen sodium (Anaprox) similar to aspirin
  and indomethacin contraindicated for GI disease
  and peptic ulcer
• Tolmetin sodium (Tolectin) Tx and long-term
  management of acute rheumatoid arthritis and
  osteoarthritis
• Piroxicam (Feldene) Tx of acute and chronic
  osteoarthritis and rheumatoid arthritis

35
Central Nervous System Stimulants

• CENTRAL NERVOUS SYSTEM STIMULANTS primary
  indications are narcolepsy, hyperkinesis and
  attention deficit disorders (ADD) for children
• Methylphenidate hydrochloride (Ritalin) Tx of
  hyperkinetic and ADD in children, narcoplepsy in
  adult
• Dextroamphetamine sulfate (Dexadrine) Tx of
  narcolepsy adjunct to diet therapy for over
  eating

36
Central Nervous System Depressants

• Used mainly as sedative-hypnotics,
  anticonvulsants, anesthetics can cause
  respiratory depression avoid alcohol use
• Phenobarbital (Luminal) drug of choice for
  Petit mal epilepsy
• Pentobarbital (Nembutal) Short-term tx of
  insomnia
• Secobarbital (Seconal) same as nembutal
• Phenytoin sodium (Dilantin) drug of choice for
  Grand mal epilepsy
• Ethyl alcohol (ethanol) - sedative

37
Opium and Opium Alkaloides

• Alkaloids are morphine and codeine used as
  analgesics, cough sedatives and certain types of
  diarrhea
• Camphorated opium tincture (Paregoric)
  intestinal tranquilizer
• Morphine sulfate relieve severe pain or pre-op
  sedation not for head injuries and convulsive
  disorders
• Codeine sulfate 1/6 analgesic and ¼ respiratory
  depressant effect of morphine for severe pain
  and antitussive
• Meperidine hydrochloride (Demerol) synthetic
  analgesic for pre-op sedation

38
Psychotherapeutic Agents

• Primarily tranquilizers and mood modifiers
• Chlorpromazine hydrochloride (Thorazine) Tx of
  psychosis, tension and agitation also
  anti-emetic
• Thioridazine (Mellaril) all-around tranquilizer
• Prochloperizine (Compazine) Tx of nausea and
  vomiting
• Haloperidol (Haldol) Tx of schizophrenia and
  manic stage of manic-depressive patients
• Lithium (Eskalith, Lithonate) drug of choice of
  manic episodes
• Amitriptyline hydrochloride (Elavil) long-term
  tx of depression
• Chlordiazepoxide hydrochloride (Librium) tx for
  anxiety and alcohol withdrawal
• Hydroxyzine pamoate (Vistaril, Atarax)
  anti-anxiety, anti-emetic, anti-spasmotic, muscle
  relaxant not for IV use

39
Psychotherapeutic Agents

• Diazepam (Valium) drug of choice for status
  epilepticus
• Fluoxetine hydrochloride (Prozac) Tx of
  depression, bulimia nervosa and
  obsessive-compulsive disorder
• Temazepam (Restoril) Tx of insomnia
• Flurazepam (Dalmane) Tx of insomnia

40
Skeletal Muscle Relaxants

• Tx of muscle spasms
• Methocarbamol (Robaxin) beneficial for
  neuromuscular manifestations of tetanus
• Cyclobenzaprine hydrochloride (Flexeril)
• Chlorzoxazone (Parafon Forte)
• Orphenadrine citrate, aspirin and caffeine
  (Norgesic)

41
Cardiovascular Agents

• Affect action of circulatory system
• Digoxin (Lanoxin) Tx for CHF and arrhythmias
• Quinidine sulfate indicated for premature
  atrial and ventricular contractions and other
  arrhythmias
• Amyl nitrate prevention of erection during
  circumcision
• Nitrogylcerin (Nitrostat, Nitrobid) tx of acute
  and chronic angina pectoris
• Isosorbide dinitrate (Isordil, Sorbitrate)
  antianginal action
• Dipyridamole (Persantine) long-term therapy for
  chronic angina pectoris
• Procainamide hydrochloride (Pronestyl, Procan SR)
  tx of arrhythmias associated with anesthesia
  and surgery
• Verapamil (Isoptin) Tx of angina and
  hypertension
• Diltiazem (Cardizem) - Tx of angina and
  hypertension

42
Vasoconstrictors

• Constricts blood vessels
• Epinephrine (Adrenaline Chloride, Sus-Phrine)
  relieves acute bronchial asthma (when inhaled),
  respiratory distress (when injected) tx of
  hypersensitivity reactions to drugs, serums,
  insect stings, other allergen
• Tetrahydrozaline hydrochloride (Visine eye drops)
  relieves irritated eyes
• Phenylephrine hydrochloride (Neo-sypnephrine)
  relieves nasal congestion
• Oxymetazoline hydrochloride (Afrin) relieves
  nasal congestion, no more than 3 days use

43
Anticoagulants

• Prevent blood coagulation
• Heparin sodium prophylaxis and tx of pulmonary
  embolism and venous thrombolism
• Warfarin sodium (Coumadin) tx of embolism in
  the prevention of occlusion

44
Vitamins

• Mostly water-soluble, fat-soluble vitamins (A,D,E
  ,K)
• A (Retinol) night vision, acne and
  pseudofolliculitis barbae
• B1 (Thiamine hydrochloride) beriberi
• B2 (Riboflavin) cheilosis, glossitis, visual
  disturbance, visual fatigue
• B3 (Niacin) pellagra
• B6 (Pyridoxine hydrochloride) neuritis due to
  INH therapy
• B12 (Cyanocobalamin) pernicious anemia
• C (Ascorbic acid) scurvy
• D (Sunshine) rickets
• E (Tocopherol) antioxidant
• K (Menidione) - blood clotting

45
General and Local Anesthetics

• Nitrous oxide (Laughing gas) use in dentistry
  or as preinduction agent
• Halothane (Fluothane) inhaled anesthetics
  contraindicated for OB and hepatic dysfunction
  patients
• Ketamine hydrochloride (Ketalar) patient will
  be in dream-like state
• Fentanyl and droperidol (Innovar) narcotic and
  tranquilizer combination
• Procaine hydrochloride (Novocain) spinal
  anesthesia
• Lidocaine hydrochloride (Xylocaine) standard to
  which all other anesthetics are compared
• Dibucaine (Nupercainal) topical anesthetic
• Proparacaine (Ophthetic, Ophthaine) ophthalmic
  anesthetic

46
Oxytocics

• Produce a rhythmic contraction of the uterus
• Ergonovine maleate (Ergotrate Maleate)
  prevention and tx of postpartum and postabortal
  hemorrhage
• Oxytocin (Pitocin) improvement of uterine
  contractions or to control postpartum hemorrhage

47
Parasympatholytic/ Anticholinergic Drugs

• Inhibits acetylcholine and secretion of duct
  glands
• Atropine Sulfate increase respiratory and
  relaxes muscles of the intestinal tract, bronchi,
  ureter, biliary ducts and gall bladder
• Propantheline Bromide (Pro-Banthine) use as an
  adjunct in tx of peptic ulcer use as
  anti-spasmotic for intestinal spasms
• PARASYMPATHETIC (CHOLINOMIMETIC) DRUGS
  stimulates structures controlled by
  parasympathetic nerves
• Neostigmine Methylsulfate (Prostigmin) controls
  Myasthenia Gravis
• Pilocarpine (Pilocar) decrease glaucoma
  intraocular pressure
• SYMPATHOLYTIC DRUGS adrenergic blocking agents
• Propranolol hydrochloride (Inderal) beta
  blocker as prophylaxis for migraine, angina and
  arrhythmias
• Methyldopa (Aldomet) tx of hypertension

48
Biological Agents

• Serves as immunization of personnel
• BUMEDINST 6230.15 (Immunization and
  chemoprophylaxis)
• Include serums, viruses, toxins, antitoxins,
  antigens and bacterial vaccines
• Manufacturer licensed by Sec of Treasury and
  monitored by U.S. Public Health Service

49
Biological Agents

• Label includes
• Name
• Address
• License Number
• Name of product
• Lot number
• Date of manufacture
• Period of potency
• Minimum potency

50
Biological Agents

• Must be stored in cool (6-8C), dry and dark place
• Yellow fever vaccine must be frozen

51
Examination of Parenteral Solution

• Examined at least 3 times
• Upon receiving the solution
• Periodically while in storage
• Immediately preceding use
• May be unfit for use
• Deterioration from prolong storage
• Accidental contamination
• Defects that may develop in containers or seals

52
Immunizing Agents

• Diphtheria Antitoxin
• Tetanus Antitoxin phenol or cresol as
  preservative
• Tetanus Toxoid solution from Clostridium tetani
  treated with formaldehyde
• Alum Precipitated Diphtheria and Tetanus Toxoids
  and Pertussis Vaccines Combined (DPT)
• Cholera Vaccine suspension from killed Vibrio
  comma, autolysis may occur on storage

53
Immunizing Agents

• Poliovirus Vaccine
• IPV Inactivated Poliovirus Vaccine
• Recommended shot in U.S.
• Stored between 2 8C
• OPV Oral Poliovirus Vaccine
• Recommended for children
• Never administered parenterally
• Stored frozen
• After thawing, must be used within 7 days and
  stored below 10C

54
Immunizing Agents

• Yellow Fever Vaccine frozen until rehydration,
  ask patient if allergic to eggs
• Plague vaccine presence of precipitate means
  contamination
• Influenza Virus Vaccine ask patient if allergic
  to eggs
• Dried Smallpox vaccine
• - stored below 25C and is good for 18 months
• when reconstituted, store below 4C and is good
  for 3 months
• Anthrax Vaccine
• stored between 2-8C
• Healthy men and women from age 18-65 yrs
• 3 series given 2 weeks apart, then 6, 12 and 18
  months

55
Toxicology

• Science of poison, their actions and their
  detection and treatment
• Local effect
• Remote effect
• Cumulative effect

56
Pharmacy

• Metrology science of weights and measures in
  application to pharmacy

57
Metric System
58
Measuring Eqivalents
59
Metric Equivalents
60
Conversion Table
61
Conversion Table
62
Calculation

• Percentage - 10 is 0.10 or 10/100
• Ratio 12
• Proportion 1224

63
Pharmaceutical Preparation

• Elixirs aromatic, sweetened hydroalcoholic
  solutions
• Suspensions coarse dispersion solutions
• Ointments semisolid, fatty or oily preparation
• Suppositories solid bodies for orifices in the
  body
• Capsules gelatin shell containing solid or
  liquid medicinal substance

64
Pharmaceutical Instruments

• Balances
• - Class A 120 mg to 120 gm
• - Class B - gt 648 mg
• Ribbed Funnel
• Erlenmeyer Flask
• Mortar and Pestle triturating (powder form)
• Spatula
• Graduated cylinders

65
Drug Incompatabilities

• Therapeutic
• Physical
• Chemical

66
Drug Reactions

• Contraindication a particular treatment or
  procedure inadvisable
• Adverse Drug reaction produces unintended and
  noxious effect on the patient
• Drug Interaction maybe positive or negative to
  produce an outcome that would not occur if each
  drug had administered singly

67
Prescription

• Chap 21, MANMED, NAVMED P-117
• DoD Prescription DD Form 1289 (outpatient use)
• Polyprescription, NAVMED 6710/6

68
Parts of Prescription

• Superscription Rx means to take thou or in
  effect
• Inscription lists names and quantities of the
  ingredients to be used
• Subscription direction to the compounder
• Signa gives direction to the patient

69
Authorized Presciber

• Medical and Dental Corps Officer
• Medical Service Corps, optometrists, physician
  assistants and podiatrists
• Civilian physicians employed in the Navy
• Independent Duty Hospital Corpsman
• Nurse practitioners (when authorized by C.O.)
• Nurse anesthetists and midwives (when authorized
  by the C.O.)
• Medical and Dental students prior to internship
  not allowed to write Schedules II and III
  substances

70
Verification and Accuracy

• Check ID card for complete name and expiration
  date of ID
• Read information on label 3 times
• When container is taken from shelf
• Before the contents are removed from the
  container
• Before the container is returned to the shelf

71
Filling Prescriptions

• Schedule II and III narcotics preceded by the
  letter N and filed separately
• Alcohol preceded by letter A and filed
  separately
• Scheduled III (non-narcotic), IV and V numbered
  in the same manner as general files
• General files all other prescriptions are
  numbered consecutively and filed together

72
Controlled Substance Schedules

• Schedule I high abuse potential and no accepted
  medical use (heroin, marijuana, LSD)
• Schedule II high abuse potential and severe
  psychological and/or physical dependence
  liability (narcotics, amphetamines and
  barbiturates), must be filled within 7 days
• Schedule III less abuse potential than schedule
  II and moderate dependence liability
  (nonbarbiturate sedatives, nonamphetamine
  stimulants, must be filled within 30 days
• Schedule IV less abuse potential than schedule
  III and limited dependence liability, must be
  filled within 30 and refilled up to 5 times
  within 6 months
• Schedule V limited abuse potential
  (antitussives or antidiarrheals with small amount
  of narcotics (codeine)), must be filled within 30
  days and may be refilled up to 5 times within 6
  months

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Security and Custody of Controlled Substance

• Schedule I and II and ethyl alcohol require
  vault for safe storage and inventory by the
  Controlled Substance Inventory Board, a copy of
  safe combination kept in a sealed envelope
  deposited with C.O. or representative
• Schedule III, IV and V require locked cabinet
  security
• Custodial responsibility on hospitals is
  entrusted to a commissioned officer or a civilian
  pharmacist appointed by the C.O.
• On board naval vessels, the C.O. will appoint an
  officer of the Medical Dept or another officer in
  writing as bulk custodian and senior medical
  officer for small vessels

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Inventory Of Controlled Substances

• Inventory monthly by the Controlled Substances
  Inventory Board
• Exception will be on ships with IDC which may be
  conducted quarterly if there were no transactions
  of controlled substances
• C.O. appoints the members of the board in writing
• Board consists of 3 members, at least 2
  commissioned officers
• Officer having custodial responsibility cannot be
  a member of the board
• SMDR may be a board member on small ships and
  installations

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Survey Of Controlled Substances

• Schedule I and II controlled substances, ethyl
  alcohol that have been outdated, deteriorated,
  questionable potency or purity and identity
  compromised must be reported to the C.O.
• Destruction must be witness by a member of the
  Controlled Substance Inventory Board
• Destruction certificate will include
  nomenclature, quantity of substances and method
  of destruction

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Any questions?