1. Welcome to the New Year edition of PIL. The year 2014 was a memorable one for the pharmacy depart-
ment. In this newsletter various pharmacy staff reflect on the events that made 2014 a “big year.”
Among these include the main pharmacy getting a new look, and being represented in the international
arena during the International Pharmaceutical Federation (FIP) congress in Bangkok, Thailand. Also
highlighted is the celebration of the World Pharmacists’ Day on 25th September 2014 that was well at-
tended and commendable.
Of course in this issue you can’t miss something to crack your ribs in the humour section in pictures (or
try to at least!). The concluding articles are evidence-based on aspects of medication safety which are
educative. Enjoy the reading and have a fruitful year 2015!
January 2015Volume 2, Issue 1
Pharmacy Information Leaflet
Inside this issue:
Introduction 1
Main Pharmacy “New
Face”
1
Main Pharmacy “New
Face”
2
World Pharmacists’
Day Celebrations
3
International experi-
ence at FIP congress
4
Improving Medication
Use Safety: Part 1
5
Improving Medication
Use Safety: Part 2
6
Editorial Team
Chief Editor
Syed Shamim Raza
Editor
Jaimini Kishore Gohil
Associate Editors
Njeri Gathungu
Carol Maina
Design & Layout
S M Ochungo
The Aga Khan University Hospital, Nairobi
Introduction
Main Pharmacy “New Face” By Immaculate Nzioka, Martin Musili
The Main Pharmacy which is located opposite
the new FMC/ Jubilee Clinic was recently reno-
vated with support from hospital management.
This is the nerve center of the whole pharmacy
department and the new look was designed to
improve the services currently offered and also
allow for future growth plans and services. Be-
low are a few highlights of the new Main Phar-
macy:
Bigger Waiting Area
The new pharmacy has a bigger and more con-
ducive waiting area where patients will comforta-
bly wait for their medication. In addition the wait-
ing area has a television that offers entertain-
ment/ distraction to the patients while they wait.
Counseling Booths
There are two private dedicated areas where
patient counseling for medication is done. This

2. expired medications and medication samples. This is a seclud-
ed place with access control to only the authorized personnel.
This is in line with our policy that all expired, sample or study
medication should be stored away from other medications and
under lock and key.
Drug Information Centre
We have a designated area in Main
Pharmacy aimed to set up a Drug Infor-
mation Centre in the near future. This
centre will offer various pharmacy relat-
ed information to our internal and exter-
nal customers/users including doctors,
nurses and external callers as well.
Storage
Additional storage space for medications has been availed at
the new pharmacy. We have ample space for stocking the phar-
macy hence enhancing our service to our customers by reduc-
ing the trips to our main stores hence reducing the waiting time
for our customers.
Page 2
Pharmacy Information Leaflet
Main Pharmacy “New Look” continued from P1
gives confidence to the patients and makes them open up
and pour out all their concerns during dispensing ensuring
that they leave satisfied.
Manager Offices
The administration side of pharmacy has also been boosted
with having more office space. The renovation has ensured
that there are separate offices for each of the managers
where they are able to attend to their various roles and re-
sponsibilities without unnecessary distractions as experi-
enced earlier.
Cameras and transparency
Several cameras have been strategically installed within the
pharmacy in a bid to improve security and monitoring as well
as encourage transparency in all activities that take place
within the premises.
Quarantine
To adhere to our Storage and Handling policy we have a
quarantine area that is used to store study medications, the
H
U
M
O
U
R

3. The World Pharmacist’s Day is one which we the pharmacists
together with pharmaceutical scientist are encouraged to or-
ganize activities that promote and advocate our roles in im-
proving health in every corner of the world. The year 2014
theme was: “Access to Pharmacists is access to Health”.
The Aga Khan University Nairobi (AKUHN) was no exception
to promotion of these pharmaceutical activities. In the early
morning hours, the pharmacy department did a presentation
on Clinical Management of Poisons courtesy of the hospi-
tal clinical pharmacist Dr. Japheth Gatuiku (pictured). The
presentation was at the hospital lecture theatre open to all
hospital clinical staff. This event was graced by the top man-
agement team among them the Vice President Mr. Salim
Hasham (pictured), Chief Operating Officer (COO), Mr. She-
kar and Chief of Staff, Dr. Majid Twahir.
During the events speech by the invited speak-
ers, the importance of the pharmacy department
and its staff were highly emphasized and the
milestones achieved in the hospital pharmacy
practice. These were not just limited to include the improved
access to medicines and aversion of medication errors or
adverse events. All the pharmaceutical scientists were urged
to be more proactive during provision of health care, as this
would uplift the profession’s image and perception in the hos-
Page 3
Volume 2, Issue 1
World Pharmacist Day celebrated at AKUH,N By David Karenye
pital and society at large. After the motivational speeches, the
World Pharmacist day in AKUHN was officially declared open
by the COO. This was marked with a colourful cake cutting by
pharmacy managers and the hospital management team pre-
sent (pictured). The attendees adorned with theme printed
Green T-shirt were served with cake, juice and biscuits.
In the carry-on of pharmacy activities for the day, small
groups of pharmacy staff went on to provide bed side phar-
maceutical care to randomly selected inpatients. These ser-
vices hardly come along during the patient’s stay in this hos-
pital. Unknown to us, the feedback from the visited inpatients
showed higher customer satisfaction with our pharmaceutical
services. The limited numbers of the pharmacy staff maybe
attributed to lack of this service and henceforth a challenge to
hospital to ensure that bed side pharmaceutical services are
availed to the inpatients.
From us, it is our commitment to provide high
quality pharmaceutical services and to work
harmoniously with other hospital departments
to ensure quality health care to all. Lastly we
look forward to the World Pharmacist day
2015 to showcase many of our achievements.

4. The 74th FIP World Congress of Pharmacy and Pharmaceutical
Sciences 2014 took place in Bangkok, Thailand from 31 August
- 4 September 2014. The theme of last year’s congress was
‘Pharmacists – Ensuring access to health, exploring our
impact on providing medicines, care and information’. One
of our pharmacists who attended gives an account.
Narration by Nath
On 31st September between 13:00 and 14:00 I attended the first
timers’ meeting where we were addressed by experienced con-
gress participants and representatives from FIP sections and
special interest groups. This was a great opportunity to ex-
change ideas and meet interesting people and become involved
in FIP’s global network and vast array of projects that FIP offers
to all its members. I later attended a very elaborate welcome
reception at the exhibition hall from 17:00 to 19:00.
After the opening ceremony the Thai host committee
invited all of us for a warm and festive reception,
where the exhibition was also opened. There was an
FIP showcase as well. All guests were then treated to
drinks and a selection of Thai food, while exhibitions
offered the perfect setting for catching up with friends
or networking.
From 1st to 3rd September I attended and actively par-
ticipated in various session in progress in various
rooms (mainly Hospital and community pharmacy).
The content was very rich but the presenters had lim-
ited time and therefore quickly rushed through their
slides, skipping quite a number due to time con-
straints.
During lunch or coffee breaks, I had an opportunity to
visit exhibitions and view posters covering all sectors
of pharmacy practice. Those I met here were very
educative and had a lot to offer a dynamic hospital
pharmacy like ours. I carried relevant information
which I intend to officially submit to the head of depart-
ment to decide what we can bring on board.
I networked with both young and seasoned Clinical
Pharmacists who imparted many noble ideas and
Page 4
Pharmacy Information Leaflet
An International Experience at FIP congress By Nath Arwa
offered me simple easily applicable and cheap re-
sources (shown on photos beside and available for ref-
erence) they use in daily practice to improve the quality of
services they offer to the multidisciplinary clinical teams during
their routine ward rounds and on a daily basis.
I highly appreciate the golden opportunity FIP granted me to
attend such an international enlightening pharmaceutical con-
gress, where peers provoked me to do much more even with
the resources that I currently have access to. I am committed
to make the kind of difference other Clinical Pharmacists I met
in Bangkok are making. I look forward to attending this year’s
FIP congress which is scheduled for Dusseldorf Germany
come September 2015.

5. Page 5
Volume 2, Issue 1
Medication Reconciliation Process
Use of medications has been associated with many challenges
including irrational use and medication errors. Medication rec-
onciliation is a process of comparing the medications a patient
is taking (and should be taking) with newly prescribed medica-
tions. The aim is to avoid duplications (taking the same drug
twice), omissions (missing a medication that is necessary),
interactions (where one drug increases or decreases the effect
of another), and show the need to continue current medica-
tions.
The whole process depends on effective communication
across the continuum of care and across all the parties in-
volved in prescribing, transcribing and use of medicines. It in-
volves:
 Compiling a list of ALL medications. Information gathered
includes medication name, dose, route, frequency, time
the last dose was administered- in case of new admissions
and indication. The list should include allergies if any, over
-the-counter (OTC) medicines, complementary medicines/
herbal products, vitamins, skin preparations (lotions, oint-
ments, creams), any recreational medications used/taken
and nutraceuticals.
 Ascertaining accuracy of gathered information (review and
compare prior and new lists)
 Reconciling medications and resolving discrepancies.
 Formulating a decision, that is, making a medical judge-
ment with respect to a patient’s condition and medications.
 Optimizing care to best meet a patient’s needs with this
information.
Improving the safe use of medicines: Part 1 By Linus Masese
The need for knowing precisely which medications a person is
taking cannot be overemphasized.
In one hospital in the West an elderly woman presented to the
emergency department with seizures. The admitting nurse
when compiling a medication history, mistakenly selected
methadone 100mg b.i.d. (an opioid analgesic) instead of
metoprolol 100mg b.i.d. (a blood-pressure lowering drug) as
the drug the patient was taking at home. The physician did not
notice the mistake and only wrote prescriptions to continue all
medications. The pharmacist on receiving the prescription con-
tacted the physician to confirm the indication and high dose of
methadone. The physician failed to specify the indication but
instead stated that the medication should be given as written.
The pharmacist dispensed the drug without further investiga-
tion. The patient received two doses of methadone 100 mg and
experienced cardiorespiratory arrest. During resuscitation,
medications were reviewed and naloxone, an opioid antago-
nist, was administered to reverse methadone’s effects. Fortu-
nately the patient recovered. Later, the family reviewed the
hospital medication list and confirmed that the patient hadn’t
been taking methadone at home!
So whose fault was it? Why was the error not recognized early
enough? Was the pharmacist too easily convinced (or perhaps
intimidated) despite having a genuine concern? The case
above illustrates the need for resolving all questions surround-
ing a prescribed medicine before it is dispensed or adminis-
tered. Hence medication reconciliation is a responsibility for
everyone in the healthcare setting.
Bibliography
 The Joint Commission. Standards: Ambulatory Health Care: 2014 Na-
tional Patient Safety Goals 03.06.01. Available at: http://
www.jointcommission.org/assets/1/6/AHC_NPSG_Chapter_2014.pdf
 Cohen MR. Medication Errors. Nursing 2013. p72
 Medication Reconciliation Toolkit. Forum Medical Advisory Council
(MAC) Forum of ESRD Networks, 2009
 Ptasinski C. Develop a medication reconciliation process. Nursing Man-
agement p18. March 2007

6. Pharmacy Information Leaflet
‘Sulfur allergy’ labeling is misleading
The term 'sulfur allergy' is misleading and dangerous and
should not be used. An allergy to a sulfonamide antibiotic may
imply cross-reactivity with other sulfonamide antibiotics, but
does not imply cross-reactivity with non-antibiotic sulfona-
mides or other drugs containing sulfhydryl or sulfate groups.
Patients who suffer from an allergic reaction to the combina-
tion of sulfamethoxazole and trimethoprim should be consid-
ered potentially allergic to trimethoprim and/or sulfamethoxa-
zole until proven otherwise, and not recorded simply as 'sulfur
allergic'. Allergy to sulfonamides also does not imply cross-
reactivity with sulfite preservatives, sulfates or elemental sul-
fur.
Sulfonamides were the first class of antibiotics to be intro-
duced in the 1930s. They remain important because they are
effective, relatively safe and inexpensive, but adverse effects
are relatively common. While most hypersensitivity reactions
are relatively mild, sulfonamides account for a disproportion-
ate number of cases of life-threatening Stevens-Johnson syn-
drome and toxic epidermal necrosis.
The mechanisms of hypersensitivity to sulfonamides are not
completely understood, but some principles are apparent. 1
The term sulfonamide applies to a sulfone group connected to
an amine group (Fig. 1). All antibiotic sulfonamides are aryla-
mines
A- Basic sulfonamide structure – present in many
drugs.
B- Sulfamethoxazole. The arylamine moiety, and
also probably the 5-member ring containing a
nitrogen atom, is thought to be important for hy-
persensitivity reactions.
Improving the Safe Use of Medicines: Part 2 By Japheth Gatuiku
Many commonly used drugs such as thiazide diuretics, sulpho-
nylureas, loop diuretics ,NSAIDS, protease inhibitors, acetazo-
lamide contain a sulfonamide moiety, but none contain the
arylamine group. While it has long been considered that aller-
gic cross-reactivity may exist between sulfonamide antibiotics
and other sulfonamide drugs, this is actually unlikely because
of the structural differences. Reports of cross-reactivity are
based on single cases or small series.2 The co-existence of
hypersensitivity reactions to several drugs does not prove cross
-reactivity between them. A review of all available relevant stud-
ies concluded that the dogma of cross-reactivity between sul-
fonylarylamines and other sulfonamide drugs cannot be sup-
ported by the evidence.3 In patients who have had an allergic
reaction to one drug, allergic reactions to other drugs, even if
entirely unrelated, occur more commonly. In support of this
concept, a very large cohort study showed that the association
between allergy to sulfonylarylamines and other sulfonamide
drugs was no stronger than that between sulfonylarylamines
and the completely unrelated penicillins.4 The evidence there-
fore suggests that non-antibiotic (non-arylamine) sulfonamide
drugs need not be considered as contraindicated in those with
a history of hypersensitivity to antibiotic (sulfonylarylamine)
sulfonamides. This conflicts with the product information of
many drugs.
As a general principle, all allergic adverse reactions to medica-
tions should be recorded in the patient's file with the specific
name of the drug or drugs to which the patient has reacted and
the nature of the reaction. Allergies should not be attributed to
classes or groups of drugs unless proven because assumptions
about cross-reactivity may later be found to be incorrect. The
term 'sulfur (or sulphur, sulpha, sulfa) allergy' should not be
used.
References
1. Slatore CG, Tilles SA. Sulfonamide hypersensitivity. Immunol Allergy
Clin North Am 2004;24:477-90.
2. Ch'ng A, Lowe M. Celecoxib allergies and cross-reactivity. Intern Med J
2006;36:754-5.
3. Johnson KK, Green DL, Rife JP, Limon L. Sulfonamide cross-reactivity:
fact or fiction? Ann Pharmacother 2005;39:290-301.
4. Strom BL, Schinnar R, Apter AJ, Margolis DJ, Lautenbach E, Hennessy
S, et al. Absence of cross- reactivity between sulfonamide antibiotics
and sulfonamide nonantibiotics. N Engl J Med 2003;349:1628-35.