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Drug storage and Stability
1. UNITED HOSPITAL LTD.
DEPARTMENT OF PHARMACY
DRUG
STORAGE & ITS STABILITY
GENERAL IDEA ABOUT MEDICATION
Presented By
Presented By
Mohammad Alauddin,
B.Pharm (ADUST)
Pharmacist- United Hospital Ltd
2. INTRODUCTION
Hospital pharmacy may be defined as department of
hospital wherein procurement, storage, compounding,
packaging, dispensing, distribution & monitoring of
medication are performed by graduate Pharmacist.
4. INTRODUCTION
Function of Pharmacy:
To ensure the availability of the right medication,
at the right time, in the right dose, at the minimum
possible cost to the patients.
To provide information concerning medications to
physicians and nurses.
To serve as a counseling department
To dispense all narcotic drugs and its monitoring
Inventory control
So on
5. DRUG STORAGE
Proper storage of medication is always an important
consideration during periods of extreme heat or cold.
Drugs can undergo physical, chemical & microbial
changes on storage.
Recommended storage conditions:
Store below -50C (freeze)
Store between (2 to 8)0C (refrigerate, do not freeze)
Store below 250C (air conditioning)
Store below 300C (room temperature)
6. DRUG STORAGE
Drug Storage Room Standards:
A lockable room
Adequate lighting
A temperature of below 250C, with air conditioning units that
operate 24 hrs per day & are connected to an emergency
power supply.
A vaccine refrigerator for storage of vaccines & anti-venom.
A nominated refrigerator for cold storage of pharmaceutical
products that requires refrigeration.
Adequate shelving for appropriate storage of the different
categories of drugs.
7. DRUG STORAGE
All drugs are grouped in the following categories:
Refrigerated ( Heat sensitive products)
Oral ( solid & liquid )
Injectable
Topical
Infusion
Inhalation
Non Drug
15. DRUG STORAGE
In the Central pharmacy or Pharmacy main store, all
drugs are displayed or kept in different ways regarding
the most easiest way to dispense.
Like Alphabetically
Therapeutic
class wise
Brand wise and so on.
17. DRUG STORAGE
Drug storage Room Stock Control
Stock Inventory
1. Annual inventory
2. Bi- annual inventory
3. Monthly inventory
4. Weekly inventory
5. Real time inventory
18. DRUG STORAGE
To uphold quality standards in drug storage
room:
Rotate stock so that the stock closest to expiry
date is kept in front.
Maintain FEFO / FIFO / LIFO procedure.
Make sure that there is no expired drugs on
the shelves.
21. DRUG STABILITY
If the expiry date is expressed as month/year only
(e.g., 3/2013), this shall be interpreted to mean that
the drug may be safely used through the last day of
that month, i.e., 3/31/2013.
If the expiration date is expressed as
month/day/year (e.g., 15/3/2013), this shall be
interpreted to mean that the drug may be safely used
through that day only.
27. DRUG STABILITY
Factors affecting drug stability:
Temperature: high temperature accelerate oxidation,
reduction & hydrolysis reaction which leads to drug
degradation.
PH: acidic & alkaline pH influence the rate of
decomposition of most drugs. Many drugs are stable
between pH 4 - 8.
Moisture: water catalyses chemical reactions as
oxidation, hydrolysis & reduction reaction. Water
promotes microbial growth.
Light: affects drug stability through its energy or thermal
effect which leads to oxidation.
30. DRUG STABILITY
Degradation processes mainly include:
Hydrolysis
Oxidation
Photodegradation
This is because of the chemistry of the functional
groups in drug molecules and the presence of water
and oxygen. Even when factors such as water, oxygen
and light have been controlled, degradation will still
occur, but at a reduced rate.
34. Drug-food interaction
What is a drug-food interaction?
The interaction of medications and food is very complex
and needs to be individualized for each patient and each
medication. However, there are some generalizations
that can be made.
A drug-food interaction happens when the food you eat
affects the ingredients in a medicine you are taking so the
medicine cannot work the way it should.
36. Drug-food interaction
Are all medicines affected by food?
Not all medicines are affected by food, but many medicines can
be affected by what you eat and when you eat it.
The food may delay or decrease the absorption of the drug. This
is why some medicines (like azithromycin) should be taken on
an empty stomach (1 hour before eating or 2 hours after
eating).
On the other hand, some medicines are easier to tolerate when
taken with food. Aspirin & Clopidogrel are irritating to the GI
tract, so they should be taken after food.
37. Timing of Drugs - Before or After Food
Taking Drugs Before Food
For quick action/fast absorption
For acid sensitive drugs
Some drugs need to be absorbed quickly to have an
effect, such as nitrates in angina, drugs to help sleep
(hypnotics), drugs to reduce agitation (sedatives) &
drugs to reduce vomiting . As food can slow the
absorption of these drugs, they need to be taken on
an empty stomach.
38. Timing of Drugs - Before or After Food
The acid in the stomach breaks down some drugs, so
delayed emptying will mean that more of the drug is
broken down, and less of the drug is available, so it will
be less effective.
Some Medications which should be taken on an EMPTY
stomach:
Alendronate, Bisacodyl, Captopril, Sucralfate,
Azithromycin, Co-trimoxazole, Omeprazole,
Lansoprazole, Levothyroxine, loratadine, Rifampin,
Methotrexate Mycophenolate, Tetracycline ……….etc.
39. Timing of Drugs - Before or After Food
Taking Drugs With or After Food
For drugs causing stomach upset
For less soluble drugs
The acid in the stomach changes some drugs, making
them more soluble and so more easily absorbed. This
means that the drug will be more effective.
40. Timing of Drugs - Before or After Food
NSAIDs can cause stomach upsets by increasing
gastric secretion. Taking these drugs with food can
reduce the irritation to the stomach lining.
41. Timing of Drugs - Before or After Food
Some drugs have to be taken during or
after meals to be effective – for example,
Orlistat is designed to block the
absorption of some of the fat in food as a
treatment for obesity.
42. Timing of Drugs - Before or After Food
Some Medications which should beTaken with FOOD:
Allopurinol, Clopidogrel, Co-Amoxycillin, Aspirin,
Amiodarone, Diclofenac, Carbamazepine,
Chloroquine, Spironolactone, Griseofulvin,
Metronidazole, Valproic acid, Prednisone, Iron
preparations, Bromocriptin, Ticlopidine, fenofibrate,
mebendazole ………….etc.
44. TIPS TO AVOID DRUG-FOOD
INTERACTIONS
Take medicine with a full glass of water.
Don't stir medicine into your food because
this may change the way the drug works.
Don't take vitamin pills at the same time you
take medicine because vitamins and minerals
can cause problems if taken with some drugs.
Don't mix medicine into hot drinks because
the heat may keep the drug from working.
Never take medicine with alcoholic drinks
46. Over the Counter (OTC) medications
OTC medications are those medicines that do not require a
prescription from a physician and are readily available to the
public. This does not mean that they do not need to be taken
carefully.
The most commonly used OTC medicines are :
Pain Relievers
Antihistamines
Decongestants
Cough medicines
47. Over the Counter (OTC) medications
Pain Relievers
NSAIDS (non-steroidal anti-inflammatory drugs)
such as paracetamol, aspirin, ibuprofen,ketoprofen
etc.
NSAIDS work by blocking the synthesis
prostaglandins, which are involved in injury or
infection and thus reduce pain, fever and
inflammation.
48. Over the Counter (OTC) medications
NSAIDS can cause stomach upset and occasional
gastrointestinal bleeding.
Antihistamines
Histamines are chemicals in our bodies that produce
itching and allergy responses. Antihistamines block
these. Some common antihistamines are
diphenhydramine HCl , chlorpheniramine etc.
49. Over the Counter (OTC) medications
Antihistamines can cause drowsiness. Be careful
driving or doing any dangerous work. But, the Nonsedating antihistamines do not cause drowsiness and
are now OTC. Some common antihistamines are
loratadine, desloratadine, cetrizine & fexofenadine.
Decongestants
These medicines work by shrinking/constricting
blood vessels in the nose and decrease congestion.
The only over the counter decongestant is
pseudoephedrine.
50. Over the Counter (OTC) medications
Cough Medicines
Cough medicines are two types: antitussives (anti cough)
and expectorants (mucous reducer)
Dextromethorphan is the antitussive in most cough
medicines.
Guaifensin is the expectorant that is mostly used.
Cough Medicines can cause agitation and confusion for
some users.
51. Medication Safety Tips to avoid serious
medication errors
Never take medication intended for someone else
Never keep medications that are expired
Never combine multiple medications in the same bottle
Never take medication that is not clearly marked
Don't expect immediate results
Don't stop taking your medication just because you feel
better especially, antibiotics.
Keep all medication away from children
To know clearly about existing drug-drug interactions.
54. Patient Safety Solutions
Some proprietary (brand name) and non-proprietary
names (generic name) sound or appear to be similar to
other drugs when written or spoken. The existence of
confusing drug names is the most common causes of
medication errors & is of concern worldwide. There are
many look and sound alike drugs that would result in
medication error.
These errors may cause harm or even death to patients.
57. Patient Safety Solutions
HOW TO PREVENT THESE MEDICATION ERRORS ?
Manufacturers
Choose unique drug names, easily to write and
pronounce
to ensure that there is no drug with similar name in the
market.
58. Patient Safety Solutions
Physicians
Clearly write the prescriptions with specific dosage
form & strength
Avoid using short forms or abbreviation of drug names
Avoid verbal prescriptions to a maximum extent
59. Patient Safety Solutions
Pharmacists/Nurses
Keeping LASA drugs separated from one another
Double checking the drug
Contacting the physician in case of any clarification
regarding the prescription
Becoming familiar with LASA drugs
Emphasize LASA drug name differences on computer
screen by using methods such as --------
60. Patient Safety Solutions
“Tall Man “ lettering
The practice of writing part of a drug’s name in upper
case letters to help distinguish sound-alike, look-alike
drugs from one another in order to avoid medication
errors.
61. “Tall Man “ lettering
U.S. Food and Drug Administration (FDA) encourages
manufacturers to use Tall Man lettering labels to visually
differentiate their drugs' names, and a number of hospitals,
clinics, and health care systems use Tall Man lettering.
Examples…
BetaLOC vs. BetaNOL
COdopa vs. CARdopa
IMIgra vs. EDEgra
SedNO vs. sedRON
DOBUTamine vs. DOPamine
hydrALAZINE vs. hydrOXYzine
vinBLAStine vs. vinCRIStine