1

HOSPITAL AND
CLINICAL PHARMACY

ER-2020

CHAPTER WISE IMPORTANT QUESTION

AND ANSWERS
LALIT SHUKLA
M.Pharm
Patel College Of Pharmacy

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Chapter 1
5 Marks

1. Define Hospital Pharmacy &describe qualification, Responsibilities, and work load requirement
for hospital pharmacy.

Ans: Hospital pharmacy may be defined as a department of hospital where procurement, storage,
compounding, dispensing, or distribution is under a control of legally qualified pharmacist.
QUALIFICATION
Chief pharmacist must be post-graduate (M. Pharmacy) in pharmacy or hospital pharmacy as a special subject & having
an adequate practical experience.
He should be the coordinator for the pharmacy and non -pharmacy staff working under him. He reports to the
administrator and interact with other medical departments.

Responsibilities
1. Specifications for purchase of all drugs, chemicals and pharmaceutical preparations used in treatment of patients.
2. Forecasting the demand of the department.
3. It decides to manufacture or Purchase medicine from the industry.
4. Selection of reliable supplier.
5. Purchasing of drug products from reliable suppliers and maintaining a record of the purchased drug.
6. Purchasing raw material for drug manufacturing and maintaining a record of purchased raw material.
7. Manufacturing of sterile and non-sterile preparation and maintaining manufactured records.
8. Quality control of the manufactured products and maintaining the record of quality control of the manufactured
products.
9. Storage of drugs.

Work Load
The manpower trained in pharmacy varies with the size of the hospital, and the services it offers. The number of
pharmacists required for a hospital is calculated on the basis of some workload norm like the number of prescriptions
received and dispensed or the number of beds available in the hospital & its occupancy rate.
AS a rule of thumb, it can be said that there must be minimum 3 pharmacists in a very small hospital. For a 100-bed
hospital there can be 5 pharmacists, as the number of beds increases, the number of pharmacists also increases, but not
proportionately.
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Pharmacist requirement

Bed strength Number of pharmacists required

Up to 50 beds 3

Up to 100 beds 5

Up to 200 beds 8

Up to 300 beds 10

Up to 500 beds 15

2. Explain Good Pharmacy Practice (GPP) & Hospital Pharmacy Standard (FIP Basel statement &
AHSP).
Ans: GOOD PHARMACY PRACTICE IN HOSPITAL (GPP)
International pharmaceutical federation (FIP) developed standard for pharmacy services under the heading of "Good
Pharmacy Practices in community and hospital pharmacy settings. The mission of good pharmacy practice is to provide
medication and health care products and services to people and society to achieve good outcomes from treatment.
ROLE OF PHARMACIST IN SATISFYING GOOD PHARMACY PRACTICE REQUIREMENT
1. He must establish and maintain relationship particularly with physician as a therapeutic collaborative partnership which
involves mutual trust and confidence in all matters relating to pharmacotherapeutics.
2. All the colleague’s pharmacist must work together to improve pharmacy services.
3. In hospital, pharmacy manager should accept a share of responsibility for the selection, evaluation and improvement of
quality of drugs used.
4. Pharmacist must update the information about therapeutics and medicines in use.
5. Pharmacist must ensure the integrity of supply chain and quality of medicines.
7. Pharmacist must prepare, store, secure distribute and dispose of medical products.
8. Pharmacist must support national policy that promotes improved health outcomes.
HOSPITAL PHARMACY STANDARDS

FIP BASEL STATEMENTS

FIP Is the global federation of national associations of pharmacists and pharmaceutical scientists. It is active across all
areas of pharmacy practice, pharmaceutical science and education, primarily through the work of member associations
and dedicated volunteers. It initiates and implements numerous projects and programs to improve the responsible use of
medicines.
These statements cover following six main areas of hospital pharmacy (FIP Basel statement)
1. Procurement
2 Influences on prescribing
3. Preparation and delivery of medications
4.Medication administration
5. Monitoring medication
6. Human resources and training

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ASHP (AMERICAN SOCIETY OF HEALTH-SYSTEM PHARMACISTS)

American Society of Health-System Pharmacists have been formerly called as American Society of Hospital Pharmacist.
It is a professional organization that represents pharmacists who serve as patient care providers in hospitals and other
health care settings. It is a professional organization that demonstrates the description of minimum standards
competencies of pharmacists in health care settings.

NAQS (NATIONAL QUALITY ASSURANCE STANDARDS)

National Quality Assurance Standards have been developed keeping in the specific requirements for public health
facilities as well global best practices. NQAS are currently available for District Hospitals, CHCs, PHCS and Urban
PHCS. Standards are primarily meant for providers to assess that own quality for improvement through pre-defined
standards and to bring up their facilities for certification.

1 Marks
1. Define hospital.
Hospital is defined as an institution that provides community health, where prevention, diagnosis, treatment, therapy,
rehabilitation, training, and social services are provided
2. GPP stand for… (GOOD PHARMACY PRACTICE) …
3. Prescription is dispensed by …(PHARMACIST)
4. NABA stands for … (National Accreditation Board for Hospital and healthcare)
5. FIP stands for … (INTERNATIONAL PHARMACEUTICAL FEDERATION)
6. Define HOSPITAL PHARMACY
Ans: may be defined as a department of hospital where procurement, storage, compounding, dispensing, or distribution is
under a control of legally qualified pharmacist.

.
Chapter 2
3 marks

1. Write objective, composition & function of PTC.

ANS: PTC is an organization respond to rational use of drugs by creating a mechanism is called as PTC
(pharmacy therapeutic committee) which formulate policy regarding therapeutic use of drugs.
Objective of PTC:
a. Advisory:
It formulates policies regarding selecting, procuring, prescribing, dispensing and administration of the
drug in the hospital.
b.Educational:
It recommended and formulates programs to educate on current knowledge on matters related to drug
and drug use.
Composition of PTC:
1. The PTC should comprise of at least three physicians, a pharmacist, a nurse and administrator.
2. The administrator acts as Director.
3. The PTC appoints a member physician as its chairman and the pharmacist as its secretory.
Functions of PTC:
1. To guide the medical staff and the hospital administration in all matters related to the use of drug.

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2. Lay down written policies and procedure for the appraisal, selection, procurement, storage, and distribution
of drugs.
3. To form the hospitals, own formulary and periodically up-date it.
4. Prepare a list of drugs for emergency kit and first aid kit.
5. Prepare a list of drugs to kept in ward pharmacy, floor stock drug system.
6. Conduct quality audit and check GMP practiced at own and other manufacturing units.
7. To review adverse drug reaction (ADR) to the drug.

2. Write a note on Role of pharmacist in preventing Antimicrobial Resistance.

Ans: Antimicrobial resistance is a natural process. It occurs when microorganisms evolve to be able to resist
the drug that has been used to fight them.
Hospital pharmacists have a key role in avoiding misuse of antibiotics to prevent antimicrobial resistance.
Following are the role of pharmacist in AMR,
1. Infection prevention and control is an essential strategy to reduce infection and the subsequent increased
use of antimicrobials.
2. Immunization is an important part of any infection control strategy. It helps reduce the misuse of
antimicrobials.
3. Advice the hospitals about the selection and use of appropriate antibiotics, disinfectants and sterilant.
4. Arrange the review program for accessing and improving the quality of antimicrobial therapy.
5. Quantitative data on antimicrobial drug use should be routinely generated and used.
6. Offer an effective medication therapy management.
7. Counselling on consumption of medicines and also engage patients in their appropriate, efficacious, safe,
and responsible use.
8. Consulting and collaborating with physicians to ensure optimal and responsible use of antibiotics.

3. Write a note on hospital formulary

Ans: Hospital formulary can be defined as an important document of the hospital containing a collective list of
drugs. This book is used extensively by the interne and fellow doctors. The hospital formulary is to be revised
periodically and should reflect the current, aspects of the clinical judgements of the medical staff.
The hospital formulary system is a powerful tool for improving the quality and controlling the cost of the drug
therapy. The pharmacy therapeutic committee of the hospital is in charge of the preparation and its revision.
Physicians own formula. tound to be useful, is incorporated into the hospital formulary.
Objectives Significances of Hospital formulary system:
1. To provide information on which drug products have been approved for the use by PTC.
2. To furnish staff the basic therapeutic information about each approved drug products.
3. To deliver information on hospital policies and procedures pertaining to the use of drug.
4. To elicit special information of drug about drug dosing, rules and abbreviations used in a hospital.
Limitations of Hospital Formulary System:
1. The system may prevent the physician's right to prescribe and obtain the brand of his choice.
2. The system in many instances permits the pharmacist to act as the sole judge of which brand of
medicine is to be purchased and dispensed.
3. The system do not minimize the cost of medicine to the patient by passing discount or any scheme
received at the time of purchase in bulk quantity by the hospital.
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4. Explain role of PTC in Drug safety

Ans: Drug safety is one of the prime responsibilities of the hospital pharmacist. There is vast advancement of
new categories of therapeutic drugs.
The drug safety aspect being taken for granted by the hospital professionals in our nation. Pharmacy medication
dispensing errors or accidents result in serious conditions or lead to the death of the patient.
Therefore, PTC play a vital role for drug safety in a hospital.
1. The chief pharmacist should be registered pharmacist with minimum B.Pharm. qualification and other
should be diploma holder.
2. Dispensing of medicine shall be done only by the registered pharmacist.
3. Adequate number of pharmacists

5. Explain role of PTC in ADR.

Ans: Sometime the drug may produce unwanted or unexpected effects. this is called adverse drug reaction.
It is a result of overdose, hypersensitivity, or allergic condition.
The committee acts in two ways i.e., to treat such patients and to prevent such happenings in the future. a
physician concerned will submit a report for this.
A typical format of ADR is as follows:
ADVERSE DRUG REACTION REPORT
Report No.: ………………… Date: ………………
Name of the patient: ………………………….
Age: …… Year Sex: ………………. Body weight: ….……kg
Therapy Followed:
a) Report disease / Indication: ………………….
b) Drug that produced ADR: ……………………...
c) Reaction details: ……………………………………
d) Sources of drugs.
 Batch No.: ……………….
 Mfg. and Exp. Date: - ………………….
 Manufacturer: ……………………

Steps taken to treat ADR: …………………….

Name of attending physician: …………………….
Signature of the Physician: …………………….

1 mark

1. What is PTC
is an organization respond to rational use of drugs by creating a mechanism is called as PTC (pharmacy
therapeutic committee) which formulate policy regarding therapeutic use of drugs.
2. What is infection control committee

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The infection control committee is an integral component of the patient safety programmes of the
health care facility, and is responsible for establishing and maintaining infection prevention and control,
its monitoring, surveillance, reporting, research and education.

3. Write the function of PTC

a. To guide the medical staff and the hospital administration in all matters related to the use of drug.
b. To form the hospitals, own formulary and periodically up-date it.
c. Prepare a list of drugs for emergency kit and first aid kit.
d. Prepare a list of drugs to kept in ward pharmacy, floor stock drug system.

4. Hospital formulary is a … (important document of the hospital containing a collective list of drugs).
5. Secretary of PTC is……(Pharmacist)

Chapter 3
5 marks

1. Explain expiry drug removal and disposal method.

Ans: Expired or unwanted medicines that should never be used and should always be considered as pharmaceutical waste.
Most expired medicines become less effective and few might be poisonous, but the defective disposal of them poses
serious hazard to the public health. Standard operating procedures for good disposal practice of expired medicines is
created and available to the all from manufacturers to retailers and the regulating authorities. Following steps require to be
taken when disposing of unwanted pharmaceuticals,
1. Sorting of pharmaceuticals
2. Disposal
SORTING OF EXPIRED PHARMACEUTICALS
The objective of sorting is to isolate the drugs into separate categories for which different removal techniques are used.
The expired medicines are needed to be sorted out into various categories that require different disposal techniques, based
on active ingredients, or based on dosage forms. However, the special attention is needed for disposal of the controlled
drugs like narcotics and psychotropic substances; antineoplastics; antiseptics; disinfectants; anti-infective drugs etc
DISPOSAL METHODS
Disposal options of medicines may vary considerably situations, and the ideal solution may not be feasible. The following
disposal methods are used:
1. Returning to the manufacturer: Wherever possible this should be the first choice because the manufacturer is likely
to have good disposal strategy available at its.
2. Landfill: The waste substances are directly placed into a land discarding site without prior treatment. This is the oldest
and most accepted method for solid waste disposal. Untreated waste must be rapidly covered with other municipal waste
to prevent scavenging. Care should also be taken to avoid contamination of ground water.
3. Waste immobilization (encapsulation): Encapsulation includes immobilizing the drugs in a solid block inside a plastic
or steel drum. They are entirely filled to 75% capacity with solid and semi-solid drugs, and the additional space is filled
by a medium such as cement or cement & lime mixture, plastic foam or bituminous sand. Once the drums are filled to
75% capacity, the mixture of cement, lime and water in the proportions 15:15:5 is added and the drum fully flled. The
sealed drums should be keep at the bottom of a landfill and covered with fresh municipal solid waste.
4, Waste immobilization (inertisation): Inertisation method includes the drugs are removed from the package like
removing pills from blister. The medicines are then ground and a mixture of cement, lime and water added to form a
homogenous paste. The paste is transported in the liquid form by truck to a landfill and emptied into the normal urban
waste.
5 Sewer: Some liquid drugs like syrups, i.v. fluids can be flushed into sewer after dilution, Small amounts of liquid
medicines like antiseptics can be disp0sed of very much diluted prior to flushing.
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6 Burning in open containers: Burning of medications in open containers at low temperature mav cause release of
poisonous contamination to the environment. It is strongly recommended that very small quantities of waste drugs can be
disposed by this method.
7 Incineration: Medium (800-1000°C) and high temperature above 1000°C incineration devices require a capital
investment, operation, and maintenance budget. Large number of medications can be disposed of within a short period of
time but incineration method is recommended only when unconditionally essential.
In retail practice, when it is not possible to return the expired medicines to the supplier, they should be keep separately in
cupboard or rack or any other assigned area with adequate marking "expired good - not for sale".
The following procedure is recommended:
 Cutting the package in such manner that the label is also cut. Tablets and capsules can be destroyed in a bucket of
water.
 Utilizing landfill methodology according to medical waste disposal method. Pouring the liquids into the sink and
flush with adequate water.
 Maintaining a record of all such disposal with full details of drugs destroyed.

2. Define inventory control. write objective and explain different techniques of inventory control.
Ans: INVENTORY CONTROL Drug store management is based on principles of inventory control. Mismanagement of
stores and non-applicability of modern methods has been identified as the main cause of material deficiency in most of the
hospitals.
DEFINITION
It is the balance between not ordering too much and avoiding stockout situation of material.
OBJECTIVES
1. To supply drugs in time
2. Efforts are made to procure drugs at minimum price without bargaining the quality.
3. To avoid stock out situation or shortage
TECHNIQUES OF INVENTORY CONTROL
 Inventory control techniques are the tool available for smooth running of the business enterprises.
 The inventories should be maintained at a level lying between the excessive and the inadequate. This level is
known as the optimum level" of inventories.
 ABC Analysis (Always Better Control)
 VED Analysis (Vital, Essential, Desirable)
 EOQ (Economic order quantity)
 Load time
 Buffer stock
 SOS Classification
 XYZ Classification

ECONOMIC ORDER QUANTITY: (EOQ) It is the quantity of Item to be purchased where inventory carrying cost and
ordering cost are minimum. It is derived from expected usage Cost/work purchase cost etc.

EOQ =

Where,
S = Ordering cost or fixed cost
D= annual quantity demanded
H= Holding cost or variable cost

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Significant position of Pharmacist working capital is tide up in inventory that's small reduction in inventory gives more
benefits like, Significant increase in working capital, decrease in amount of money needed to purchase further quantity
carrying cost includes specific items like insurance, taxes. interest, spoilage during handling, transport.

REORDER QUANTITY LEVEL:

Reorder quantity methods inventory management. Reorder quantity is the quantity of items to be ordered to continue
production without any interruptions in the future.
re-order quantity is the quantity at which additional stock purchase or manufacture for consumption. It maintains buffer
stock otherwise there will be stock out situation. It has to consider time between placing order & receiving goods. For re-
ordering attention must be given to unavoidable large consumption & expiry date of product.

Inventory Turnover:
Inventory turnover is a measure of the number of times inventory is sold or used in a time period such as a year. It is
calculated to see if a business has an excessive inventory in comparison to its sales level.

Inventory Turnover:

calculating inventory turnover helps business make better pricing, manufacturing, marketing and purchasing decisions.
Well managed inventory levels show that a company's sales are at the desired level and costs are controlled. The inventory
turnover ratio is a measure of how well a company generates sales from its inventory. Inventory turnover indicates the rate
at which a company sells and replaces its stock, of goods during a particular period.

3. What high risk medicines, emergency drugs and reserved antibiotics? Give example of each.
Ans: HIGH RISK MEDICINE A high-alert medication is a drug that has a high risk of causing harm to patients when
misused the list includes the following:
Class/category of medications

 anesthetic agents, general, inhaled and IV (e.g., propofol, ketamine)

 chemotherapeutic agents, parenteral and oral
 adrenergic agonists, IV (e.g., norepinephrine, epinephrine, phenylephrine) and antagonists (e.g., labetalol,
propranolol, metoprolol)
 antiarrhythmics, IV (e.g., lidocaine, amiodarone)
Specific medications
 epoprostenol (e.g., Flolan),
 promethazine injection
 potassium phosphates injection
 IV subcutaneous insulin U-500,
 magnesium sulfate injection
EMERGENCY DRUGS Definition: Emergency drugs are the medications which may be essential to receive the
immediate therapeutic requirements of patients and which are not available from any other approved source in necessary
time to prevent risk or harm to patients.
Emergency drugs are important to effectively manage patients in the intensive care unit (1CUs). The absence of
emergency drugs may cause mortality and morbidity. Hence availability of Emergency drugs shall be important in a
designated department.

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Aspirin Antibiotics (range depends on Glucagon

Furosemide local circumstances) Ipratropium nebulization and inhaler
Hydrocortisone Atropine with a spacer
Lignocaine IV Insulin Medical oxygen
Thiamine Naloxone Sodium bicarbonate 8.5%
RESERVED ANTIBIOTICS These antibiotics are reserved for the treatment of confirmed or suspected infections due
to multidrug resistant organisms. Reserve group of antibiotics should be used as "last resort" options. These antibiotics
should be available, but their use should be in highly specific patients or when all antibiotic options have failed or are not
suitable

ceftazidime + avibactam omadacycline Oxazolindinones

tigecycline meropenem + vaborbactam eravacycline
aztreonam linezolid Cefaroline
daptomycin colistin fifth generation cephalosporins
polymyxins plazomicin ceftolozane + tazobactam

4. What is reorder quantity? Describe the procedure for procurement of material in

hospital.
Ans; REORDER QUANTITY LEVEL:
Reorder quantity methods inventory management. Reorder quantity is the quantity of items to be ordered to continue
production without any interruptions in the future.
re-order quantity is the quantity at which additional stock purchase or manufacture for consumption. It maintains buffer
stock otherwise there will be stock out situation. It has to consider time between placing order & receiving goods. For re-
ordering attention must be given to unavoidable large consumption & expiry date of product.

PROCEDURES OF DRUG PURCHASES – DRUG SELECTION, SHORT TERM, LONG TERM AND TENDER
PROCESS.

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Pharmaceutical for hospital use may be purchased in one of the following ways.
By direct purchase from the manufacturer or whole salers. By inviting tender from retail drug store. By a contract
purchase arrangement with manufacturer.
 Purchase Request Form
 Quotation Invitation
 Purchase Order Form
 Return Of Goods
1. PURCHASE REQUEST FORM: The Pharmacist or a person authorized by him complete a purchase request form.
This Form provides the purchase department with the data concerning description specifications, packing. price, quantity
heeded and also information about the inventory balance and anticipated monthly use.
2. QUOTATION INVITATION: On receipt of request for purchase invites competitive rules (quotations) from different
Suppliers. To prevent delay in supply an annual rate contract can also be in consultation with pharmacists and prepares a
purchase order. The purchase order may take the form of any different type it may consist of two page or a many page or a
many page snap out form. However, a multicopy snap out form is suitable as it provides copy for the supplier, accounts
department, purchasing number file, department which sent the purchase requisition, two receiving reports and a copy
which indicate the history of the purchase.
3.PURCHASE ORDER FORM: The purchase officer scrutinizes quotations received, checks the quality expected to be
supplied.
4. RETURN OF GOODS: If for any reason, any portion of the articles received are to be returned to the supplier and
returned goods memorandums must be prepared because it is by its means that the hospital can be assured of receiving
credit for the goods. This form is of the snap out type and provides four copies first to account department, second to the
purchasing officer, third to the store room, fourth to the pharmacy and the supplier.
3 marks

1. Write disposal methods of expired drugs.

Ans: 1. Returning to the manufacturer: Wherever possible this should be the first choice because the manufacturer is
likely to have good disposal strategy available at its.
2. Landfill: The waste substances are directly placed into a land discarding site without prior treatment. This is the oldest
and most accepted method for solid waste disposal. Untreated waste must be rapidly covered with other municipal waste
to prevent scavenging. Care should also be taken to avoid contamination of ground water.
3. Waste immobilization (encapsulation): Encapsulation includes immobilizing the drugs in a solid block inside a plastic
or steel drum. They are entirely filled to 75% capacity with solid and semi-solid drugs, and the additional space is filled
by a medium such as cement or cement & lime mixture, plastic foam or bituminous sand. Once the drums are filled to
75% capacity, the mixture of cement, lime and water in the proportions 15:15:5 is added and the drum fully flled. The
sealed drums should be keep at the bottom of a landfill and covered with fresh municipal solid waste.
4, Waste immobilization (inertisation): Inertisation method includes the drugs are removed from the package like
removing pills from blister. The medicines are then ground and a mixture of cement, lime and water added to form a
homogenous paste. The paste is transported in the liquid form by truck to a landfill and emptied into the normal urban
waste.
5 Sewer: Some liquid drugs like syrups, i.v. fluids can be flushed into sewer after dilution, Small amounts of liquid
medicines like antiseptics can be disp0sed of very much diluted prior to flushing.
6 Burning in open containers: Burning of medications in open containers at low temperature mav cause release of
poisonous contamination to the environment. It is strongly recommended that very small quantities of waste drugs can be
disposed by this method.
7 Incineration: Medium (800-1000°C) and high temperature above 1000°C incineration devices require a capital
investment, operation, and maintenance budget. Large number of medications can be disposed of within a short period of
time but incineration method is recommended only when unconditionally essential.

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2. Write the role of pharmacist in maintaining cold chain.

Ans: Role of pharmacist in maintaining cold chain:
1. Hospital pharmacy administrator is responsible for the safe and proper storage of all medications.
2. Pharmacy team is responsible for following policies and procedures to maintain the cold chain.
3. Standard operating procedures must be in designed within the pharmacy to assure that the cold chain is
maintained throughout the time a product is received, stored, dispensed and administered to the patient.
4. All pharmacy and supporting staff involved in handling cold chain products must be trained on these guidelines
and procedures.
5. Temperature-controlled medicines are extensively available and ensure that remain cold, safe, and effective
throughout the entire supply chain.
6. When dispensing a medication informed and given guidelines on suitable storage requirements.
7. The performance of cold storage equipment is regularly check and if any fault report to technician.
8. Record is maintained for equipment maintenance, calibration, etc.

3. Explain FEFO, FIFO method in inventory management.

Ans: FEFO (First Expiry First Out) and FIFO (First In First Out) method
This technique is utilized for stock management. In order to avoid accumulation of expired and old stock items should be
stores and issued in FEFO or FIFO basis. The stock control system records the expiry date and date of receipt. Stock must
be stored so that earliest expiring or first delivered batches can be selected and issued.
FEFO, is an inventory management technique that permits for products with the earliest expiration date to be distributed
first. This is a simple highly effective inventory management technique that focuses on the handling and moving of date
sensitive inventory. FIFO principle generally have an arrangement of showing and selling older stock prior to selling
recently obtained stock. By rotating stock in this way, its more likely that there will be less inventory waste. Recently
received stock at the back of the shelf or behind the existing stock. For items that come in later but will expire first,
usually the FEFO system is used. Recently arrived inventory sometimes has an earlier expiry date than a previously
received batch of same item. This adjustment is important with item that have short shelf life like vaccines.
Importance of FEFO and FIFO:
1. Enable effective traceability procedures
2. Minimize risk for expired drug
3. Plan for systematic recall measures
4. Monitor the whole supply chain.

4. Define inventory control and write the objective of inventory control.

Ans: Drug store management is based on principles of inventory control. Mismanagement of stores and non-applicability
of modern methods has been identified as the main cause of material deficiency in most of the hospitals
DEFINITION
It is the balance between not ordering too much and avoiding stockout situation of material.
OBJECTIVES
1. To supply drugs in time
2. Efforts are made to procure drugs at minimum price without bargaining the quality.
3. To avoid stock out situation or shortage

5. Define Tender. Explain tender process.

Ans: Tender is the process whereby hospital invites bids for drugs that must be submitted within given time limit. Tenders
are broadly advertised to offer opportunities to a different supplier, encourage competition and make available greater
pool of offer to select forms.

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Tender process:
1. The tenders are invited from various suppliers.
2. The tenders are sent by suppliers in sealed envelope before the due date.
3. Tenders opened on due date and time in the presence of representatives of suppliers.
4. A comparative statement is prepared by Purchase officers from the received tenders.
5. The order is placed to supplier which has quoted lowest rate. However, factors like quality, 9ro period of supply, other
expenses like freight, sale tax, packaging and forwarding charges are nor also to be considered.
E-TENDER
It is the process for sending and getting tenders by electronic means, instead of old paper-based technique.
e-tendering process:
1. The tenders are invited from suppliers by electronic means (e-procurement system)
2. The bids are sent by suppliers through online e-procurement system before the due date.
3. Received e-Tenders downloaded by purchase officer.
4. E-tenders evaluated by purchase officer and the result of an award of contract is uploaded on e-procurement
system.

6. Which documents required for purchase and inventory control.

Ans:
Description Document
Index suppliers It is a list of approved suppliers arranged alphabetically with address, contact
numbers and description of items order from them.
Departmental requisition It is prepared by staff member of department, approved by head of department.
sent to purchase officer and one copy retain by the department.

Quotation request It is written offer to supply material at a given fixed price within a prescribed
period and under specified condition.
Purchase order The purchase order is in written form evidence of agreement between the buyer
and supplier
Goods received note or delivery It enables the supplier to prove their delivery and the client to prove their
note reception.
Purchase Record Form Record the transaction for each item purchased.
Stock Issue Confirmation (CI) Document identifies that requested items were removed from inventory and
released to the patient.
Over the Counter (0C) Document record items are issued immediately upon request.
Stock Return (SN) Document record items that are returned to inventory.
Inventory Adjustment (IA) Correction of inventory or stock records to bring them into agreement with the
findings of the actual physical inventory.
Physical Inventory Purchase Document records adjustment in on hand quantities at a specified unit price.
Input (IP)
Stock Transfer Issue (TI) Initiates the transfer of items from one department to another.

1 mark
1. EOQ stands for …… ECONOMIC ORDER QUANTITY
2. Define inventory turnover
Inventory turnover is a measure of the number of times inventory is sold or used in a time period such as a year. It
is calculated to see if a business has an excessive inventory in comparison to its sales level.
3. Cold storage temperature is …… Cold Storage (2º-8º C)
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4. ILR stands for ---- ILR (Ice-lined refrigerators)

5. Define Quotation
It is written offer by supplier to supply material at a specified fixed price within a given period and under
specified condition.
6. Vitamins store in …… Cool Temperature (8º- 25°C)
7. Reserved antibiotics
Ans: These antibiotics are reserved for the treatment of confirmed or suspected infections due to multidrug
resistant organisms. Reserve group of antibiotics should be used as "last resort" options. These antibiotics should
be available, but their use should be in highly specific patients or when all antibiotic options have failed or are not
suitable example: ceftazidime + avibactam, omadacycline, meropenem + vaborbactam, linezolid, colistin

Chapter 4
5 marks
1. Describe how the drugs are distributed to in patient
ANS: DRUG DISTRIBUTION- INPATIENT SERVICES
Inpatient: Inpatient is the patient those are admitted in the hospital for diagnosis, treatment.
Drugs are distributed to in-patients in a typical hospital.
Distribution of drug to inpatient:
(1) Physician prescribe drug to inpatient
(2) Nurse Prepare requisition of drug & send towards pharmacy department
(3) Pharmacist distributes a drug to nursing unit as per requisition slip.
(4) Nurse brings these drugs towards inpatient & administered to it.
(5) Record keeping for Administered drug
DIFFERENT DRUG DISTRIBUTION SYSTEM TO INPATIENT
Different systems are used to distribute drugs to inpatient
1. Individual prescription medication for each patient
2. Floor stock system
3. Combination of (1) & (2) Method
4. Unit dose dispensing
1. INDIVIDUAL IN-PATIENT PRESCRIPTION ORDER METHOD
In this method physician prescribes the drug for individual patients, who obtains the prescribed drug from any medical
store or hospital dispensary by paying his own charges.
This system is generally used by the small or private hospital due to reduced manpower requirement and desirability to
provide individualized services.
Advantages of individual medication system
1. Close control on stock of medicine is possible.
2. Medication error can easily find out.
Disadvantages
1. This method cannot be practiced in big hospitals.
2. Possibility of delay in obtaining medication.
3. High cost may be passed on to the patients.
2. FLOOR STOCK SYSTEM
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Under this system drugs are given to the patients through the nursing station. Pharmacy supplies the drugs to the nursing
station through the drug store. This system is used in very big hospitals. In this system drugs are classified as...
a. Free floor stock drugs
b. Charge floor stock drugs
When nursing station has both the charge & free floor stock drugs then the system is known as complete floor stock
system.
Advantages
1. Ready availability of medicines.
2. No return of drugs to the pharmacy.
3. Reduction in drug order transcriptions for pharmacy.
4. Reduction in pharmacy personnel requirement.
Disadvantages
1. No review of prescription order by pharmacist & therefore increased risk of medication errors.
2. Increased drug inventory.
3. Drug deterioration hazards.
4. Greater demand on nurse’s time.
5. Extra capital is required for making storage facilities at each nursing point.
6.As nurse dispenses the drugs it infringes the professional duty of pharmacist && may also have legal implications.
FREE FLOOR STOCKS DRUGS (NON-CHARGE FLOOR STOCK DRUGS)
It is an inventory of routinely required medicines as per the predetermined list & are given as a part of hospitalization.
These are not separately charged to the patient account.
Charge floor stock
It is an inventory of expensive drugs for which patients are charged on the basis of dosages given, it is the responsibility
of pharmacist working in co-operation with nursing station to make these drugs always available. Pharmacist should
periodically inspect the drugs stored at nursing station.
3. COMBINATION OF INDIVIDUAL DRUG ORDER AND FL0OR STOCK SYSTEM
Falling into this category are those hospitals which use the individual prescription order system as their primary means of
dispensing and also utilize a limited floor stock. This combination system is most commonly used in hospital today and
also modified to include the use of unit dose medication
4. UNIT DOSE DISPENSING
Definition: These are the medications which are ordered, packaged, handled & charged in multiples of single dose units,
containing a pre-determined amount of drug.
 Here pharmacist makes each & every dose of medication ready for administration. Viz. Solid medicaments are
prepacked, liquids are premeasured & parenteral are premeasured & filled in sterile syringes. Strip packed tablets
are common example of unit dose medication.
 Drug supplies are received in bulk quantity by the pharmacy & making unit doses out of bulk is an important
function carried out in the hospital pharmacy. Such unit dosages are useful for in-patients & out-patients.
 Unit dose dispensing is carried out in centralized way at the level of pharmacy or in decentralized way at the level
of Satellite pharmacy on the floor.
 Once a unit dose container is opened pharmacy will not accept it back.

Centralized Unit Dose Dispensing (CUDD) Decentralized Unit Dose Dispensing (DUDD)
Satellite Pharmacy
In this type of dispensing, medicines are stored in  This system is generally used where
the centrally located pharmacy from where it is hospital has several buildings or floors.
distributed to the patients through medication  This system consists of small satellite
carts or dumb waiters as per the physician's pharmacies located on each floor of the
prescription hospital.
 Medication carts are used for the delivery
of drugs to nursing station.
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Advantages
1. No pilferage & wastage.
2. Operational automation is possible.
3. Accounting becomes easier
4. Patients are charged only for the dose of drug they receive.

Disadvantages
1. Cost of medicine may increase.
2. Need more staff to prepared unit dosage.
3. Extra space and facilities are required

2. Define Out-patient and describe to Out-patient.

ANS: DRUG DISTRIBUTION: OUTPATIENT SERVICES
DEFINITION
Outpatient/ Ambulatory Patient: These are the patients who receive general or emergency treatment which could be
diagnostic, therapeutic, or preventive, without being admitted as an in- patient in the hospital.
These are also known as Ambulatory Patients as these patients are able to walk i.e., they are not bedridden.

TYPES OF Outpatients
Following are the types of outpatients,
1. General outpatient
2. Referred
3. Emergency
4. Special
Location of outpatient dispensing
 There is no hard & fast rule about its location. Wherever located it should not cause any disturbance to inpatients
& should be easily accessible to outpatients.
 Whenever possible there should be a separate independent outpatient dispensary. If it is not possible then
combined unit is used for dispensing to outpatients as well as inpatients. Here dispensing is done from separate
windows.
 The outpatient dispensary should have two separate prescription presenting windows one for men & another for
women. Same windows dispense drugs.
 If needed window points can be raised to avoid overcrowding, but this also increases the manpower requirement
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& cost of the service.

 The medical store of hospital pharmacy provides stock of at least 8 days to the dispensary & emergency supplies
at any time.
 During dispensing total elimination of waiting time is not possible so outpatient dispensary should have well-
furnished waiting room.
Layout of outpatient department
Adequate no. of window for receiving & filling up prescription.
Waiting room should be well furnished.
Sufficient reading material like newspaper, magazine etc. available for patient leisure.
Educative posters also available in outpatient department.If more crowd in outpatient department, then department should
provide more no. of windows & manpower.

3. Write a note on automated drug dispensing system and device.

Ans: AUTOMATED DRUG DISPENSING SYSTEM
automation in drug dispensing includes,

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 Computer- assisted physician order entry

 Robotic handling, packaging, and sorting of drugs in the pharmacy
 Stand-alone nursing-unit based cabinets
 The automated generation of customizable reports and forms

AUTOMATED DRUG DISPENSING DEVICES

AUTOMATED DISPENSING CABINET
Automated dispensing cabinet is a computerized drug storage device or cabinet designed for hospitals. The ADM provides
proper storage, inventory control and security for pharmaceuticals at the point of care. It can be used only by authorized
users who are authenticated by password. It 1s placed in wards, ICU rather than in central pharmacy
Advantages
1. The commonly needed pharmaceuticals are at the point of care. This will reduce the workload of nurses.
2. Controlled substances remain in secure lock box until needed and access is secured by multifactor authentication.
3. ADM can improve patient safety by providing drug allergy alerts, drug-drug interaction and advice on high-risk
medication

Fig.: Automated dispensing cabinet

ROBOTIC DRUG DISPENSING

The robot can store up to 35000 medicines and dispense around 12 prescriptions in less than a minute. So, the patient's
waiting time is significantly reduced. The dispensing process will be paper free as the robot will store the prescription as

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soon as a doctor documents it electronically. This also allows the pharmacist to focus on giving the customers right
instruction on taking the medication

Fig.: Robotic drug dispensing

4. Discuss Floor stock drugs give its advantage and disadvantages.

Ans: FLOOR STOCK SYSTEM
Under this system drugs are given to the patients through the nursing station. Pharmacy supplies the drugs to the nursing
station through the drug store. This system is used in very big hospitals. In this system drugs are classified as...
a. Free floor stock drugs
b. Charge floor stock drugs
When nursing station has both the charge & free floor stock drugs then the system is known as complete floor stock
system.
Advantages
1. Ready availability of medicines.
2. No return of drugs to the pharmacy.
Disadvantages
1. No review of prescription order by pharmacist & therefore increased risk of medication errors.
2. Increased drug inventory.
3. Drug deterioration hazards.
4. Greater demand on nurse’s time.
FREE FLOOR STOCKS DRUGS (NON-CHARGE FLOOR STOCK DRUGS)
It is an inventory of routinely required medicines as per the predetermined list & are given as a part of hospitalization.
These are not separately charged to the patient account.

 Drug basket method.

 Mobile dispensing unit.
Drug basket method:
 In this method nurse of night duty checks the drug inventory in the medicine cabinet, utility room & refrigerator.
 This check is done against the master check list given by the pharmacy.
 Nurse ticks the quantity required for each drug on the requisition for supply.
 Empty containers along with requisition are placed in basket & it is sent to the pharmacy.
 In the morning just after opening the pharmacy, pharmacist fills up empty containers & keeps the in basket.
 These are then sent to the nursing station.
 Nurse administers drug to the inpatient & keeps the record of administered drug.
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Mobile dispensing unit:

 In this method, a trolley with castor wheels is used to carry the drugs to the wards.
 Here, nurse of night duty is relieved of checking the inventory & transporting the empty containers.
 Pharmacist or his assistant checks the nursing station for drug inventory.
 Pharmacist restocks the ward with necessary drugs & leaves requisitions carbon copy at the ward as a proof of
delivery.
 Original requisition is sent back to the pharmacy for replenishment of mobile dispensing unit.

Fig. Mobile dispensing unit

Charge floor stock

It is an inventory of expensive drugs for which patients are charged on the basis of dosages given, it is the responsibility
of pharmacist working in co-operation with nursing station to make these drugs always available. Pharmacist should
periodically inspect the drugs stored at nursing station.
Selection of charge floor stock drugs
 List is prepared by PTC. List may differ from hospital to hospital.
 Hospital pharmacy conforms to the norms laid down by PTC & makes available requisite drugs.
 Selected list is constantly reviewed by the committee for necessary revisions.
 Selection of drugs is need based & generally vital lifesaving drugs are included in this category.
 Ex. Cardiovascular drugs, Antihypertensives, Diuretics, Antibiotics, Antihistaminic, etc.
Dispensing of charge floor stock drug:
Envelope Method:
 In this method Envelopes are used to dispense drugs to wards & also used as charge ticket.
 Pre-labeled envelopes containing name & strength of drug are filled with the specific drug.
 While administering the drug to the patient, nurse puts details of patient’s name && room number on the
envelope & keeps it in the out-basket.
 Then same is sent to the pharmacy for pricing

3 marks

1. Define out-Patient what services are provided by pharmacist to outpatients and different type of
out patients.
Ans: Outpatient/ Ambulatory Patient: These are the patients who receive general or emergency treatment which could be
diagnostic, therapeutic, or preventive, without being admitted as an in- patient in the hospital.
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These are also known as Ambulatory Patients as these patients are able to walk i.e., they are not bedridden.
TYPES OF Outpatients
1. General Out-patient
These are the patients, given treatment on outpatient basis for the conditions other than emergency condition & are not
referred cases.
2. Referred Out-patient
These are the patients referred directly to the OPD by their attending medical or dental practitioner for specific treatment
other than an emergency treatment & who latter returns to their practitioner for further care.
3. Emergency Out-patient
These are the patients, given emergency or accident care for the conditions which require immediate medical attention.
4. Special outpatient
After completion of the general checkup, the patients are asked to go for clinical, pathological or radiological
examinations for accurate diagnosis.

2. What is unit dose dispensing

Ans: Definition: These are the medications which are ordered, packaged, handled & charged in multiples of single dose
units, containing a pre-determined amount of drug.
 Here pharmacist makes each & every dose of medication ready for administration. Viz. Solid medicaments are
prepacked, liquids are premeasured & parenteral are premeasured & filled in sterile syringes. Strip packed tablets
are common example of unit dose medication.
 Drug supplies are received in bulk quantity by the pharmacy & making unit doses out of bulk is an important
function carried out in the hospital pharmacy. Such unit dosages are useful for in-patients & out-patients.
 Unit dose dispensing is carried out in centralized way at the level of pharmacy or in decentralized way at the level
of Satellite pharmacy on the floor.
 Once a unit dose container is opened pharmacy will not accept it back.

Centralized Unit Dose Dispensing (CUDD) Decentralized Unit Dose Dispensing (DUDD)
Satellite Pharmacy
In this type of dispensing, medicines are stored in  This system is generally used where
the centrally located pharmacy from where it is hospital has several buildings or floors.
distributed to the patients through medication  This system consists of small satellite
carts or dumb waiters as per the physician's pharmacies located on each floor of the
prescription hospital.
 Medication carts are used for the delivery
of drugs to nursing station.

Advantages
1. No pilferage & wastage.
2. Operational automation is possible.
3. Accounting becomes easier
4. Patients are charged only for the dose of drug they receive.

3. What is satellite pharmacy

Ans; Satellite pharmacy concept is adopted in very big hospitals, which have multistoried separate buildings in single
premises. Big hospitals everyday face more problems during distribution of drugs to all the wards.
Hence big hospitals are running satellite pharmacies in the form of mini-pharmacies. Satellite pharmacies (Floor
pharmacies) are the branches of pharmacy located on each floor of the hospital.

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Here the main pharmacy serves as a feeder serving to all the satellites. Main pharmacy procures, stores, manufactures &
packages the drugs. These drugs are then dispensed in ready to use form through carts to satellites. Stock for 24 hours is
maintained in satellite pharmacy.
In satellite pharmacy following procedure is adopted for dispensing...
1. Pharmacist prepares Patient profile card, containing personal data & disease parameters of the patient.
2. Physicians prescription is sent to the pharmacy; Pharmacist reviews it & enters it on profile card.
3. Dosage schedule is then communicated to the nurse.
4. Junior pharmacist then dispenses the drugs in the bins & keeps them in carts for transportation.
5. Nurse administers the drug to the patient & makes entry in patients’ medical record.
6. The cart is then returned to the pharmacy, which is then re-checked by the pharmacist.
Advantages
1. Efficiently drug can be distributed.
2. Time of drug dispensing could be reduced.
3. Errors in drug distribution could be stopped.
Disadvantages
1. Overall hospital budget may affect.
2. Additional manpower is required

4. Write a note on location and layout of OPD.

Ans; Location of outpatient dispensing
 There is no hard & fast rule about its location. Wherever located it should not cause any disturbance to inpatients
& should be easily accessible to outpatients.
 Whenever possible there should be a separate independent outpatient dispensary. If it is not possible then
combined unit is used for dispensing to outpatients as well as inpatients. Here dispensing is done from separate
windows.
 The outpatient dispensary should have two separate prescription presenting windows one for men & another for
women. Same windows dispense drugs.
 If needed window points can be raised to avoid overcrowding, but this also increases the manpower requirement
& cost of the service.
 The medical store of hospital pharmacy provides stock of at least 8 days to the dispensary & emergency supplies
at any time.
 During dispensing total elimination of waiting time is not possible so outpatient dispensary should have well-
furnished waiting room.
 Layout of outpatient department
Adequate no. of window for receiving & filling up prescription.
Waiting room should be well furnished.
Sufficient reading material like newspaper, magazine etc. available for patient leisure.
Educative posters also available in outpatient department.
If more crowd in outpatient department, then department should provide more no. of windows & manpower.

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5. Explain storage of narcotics and psychotropic substance.

Ans: Narcotics & psychotropic substances or preparations including certain medicines that are eighter have the potential
to bad, dangerous, or harmful to human health are subjected to control under the Narcotics drugs and psychotropic
substances act 1985.
Schedule 1: The drugs under this schedule have high potential for abuse and have no accepted medical use in treatment
(e.g., Marijuana, raw opium).
Schedule 2: The drugs under this schedule have high potentials for abuse but accepted for medical use (e.g., Cocaine,
morphine).
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Schedule 3: The drugs under these schedules have less as compare to above potentials for abuse, accepted for medical
treatment and have less physical dependence and psychological dependence (e.g., benzodiazepine and painkiller,
phenobarbitone, low strength codeine, steroids etc.
STORAGE

 These drugs should keep under lock and key. A separate register should be maintained to register them.
 Narcotics & psychotropic substances must be stored in separate cupboard with double lock and key.
 The key of the locks should be kept in hand of two different people. Other than narcotics drug no items are
permitted to be stored in the narcotic drug cupboard.
 Narcotics drugs & psychotropic substances must be procured & stored in such a manner so as to prevent their
falling into the hands of unauthorized persons.
 The storage area for the narcotics & psychotropic substances may be opened and accessed by specific pharmacist
In-charge and specific nursing In- charge of respective department.

6. Explain the distribution of drugs to ICCU/ICU/Emergency ward.

Ans: In hospital specialized units dedicated for the patients who have life threatening illness or injuries and need intensive
care and constant observation, Following are the specialized units,

ICU (Intensive Care Unit), is also known as an intensive therapy unit or intensive treatment unit or critical care unit, is a
special department for critical patients who needs intensive treatment and continuous observation.
ICCU (Intensive Coronary Care Unit), is also known as an intensive Cardiac Care unit, is a unit which focused on
intensive treatment for heart issues such as coronary heart disease, cardiac dysrhythmia, heart attack, heart failure and
other cardiac conditions.
NICU A neonatal or newborn intensive care unit) also known as an intensive care nursery (ICN), is an intensive care
unit (ICU) specializing in the care of ill or premature newborn infants.
EMERGENCY WARD also known as an accident & emergency department, emergency room or casualty department, is a
medical treatment facility specializing in emergency medicine, the acute care of patients who present without prior
Appointment; either by their own means or by that of an ambulance.

Chapter 5
3 marks
1. Write a note on TPN.
Ans: total parenteral nutrition (TPN) is a method that bypasses the GIT gastrointestinal tract, because s absorptive
capacity is reduced. Fluids are administered into a vein to deliver most of the nutrients the body needs. In short, when the
GIT is non-functional, TPN is essential for patients to maintain adequate nutrition. TPN provides a mixture of fluid,
electrolytes, carbohydrate, lipids(fats), amino acids (protein), vitamins, minerals.
Definition: Total parenteral nutrition (TPN) is intravenous administration of nutrients in adequate quantities to achieve
tissue synthesis & anabolism
TYPES OF TPN
 Central Parenteral Nutrition
 Peripheral Parenteral Nutrition

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Central Parenteral Nutrition: It is also called total parenteral nutrition (TPN) that is delivered into a central vein. It
includes lipids, vitamins. minerals, amino acids, dextrose & trace elements. Peripheral Parenteral Nutrition (PPN):
PPN is delivered into peripheral vein. Total kcal is limited by concentration & ratio to the volume being administered.
CONTENTS OF TPN
TPN is mixture of separate components which contain Carbohydrates, Lipids (fat), Amino acids, Electrolytes, Trace
elements, Vitamins and Fluids. TPN composition adjusted as per requirement of individual patient.
• Carbohydrates:
Carbohydrates is the main source of energy. Dextrose and monohydrates of glucose used as primary source of
carbohydrate in TPN. Carbohydrate source such as galactose, fructose & sorbitol should not be used as energy sources in
TPN.
• Lipids (Fat):
Linoleic acid is used as primary source of essential fatty acid in TPN. Linoleic acid is useful as precursors of
prostaglandins & in the synthesis of other fatty acids which are essential for cell membrane integrity.
• Electrolytes:
Sodium (Na) - 100 to 200 mEq, Potassium (K) - 80 to 120 mEq, Magnesium (mg) -8 to 16 mEq, Calcium (Ca) -5 to 10
mEq, Chloride (Cl) – 100 to 200 mEq.
Vitamins:
Vitamins are required for the metabolism of carbohydrates, proteins, fats. water soluble (Bl, B2, B3, B5, B6, B7, B9,
B12 & C) & fat-soluble vitamins (A, D, E & K) used in TPN formulation

2. Explain IV admixture service and write causes and consequences of

incompatibilities of IV admixture.
Ans: IV ADMIXTURES These preparations consist of one or more sterile drug products added to IV fluids- generally
dextrose or sodium solution or ringer solution alone or in combination. IV admixture are used for drugs intended for
continuous infusion and for drugs that may cause irritation or toxicity when given via direct IV injection.
definition: An 1V admixture is a preparation of a pharmaceutical mixture of two or more drugs
added into IV fluids alone or in combination for medication purposes.
Following objectives expected to achieve by the pharmacist for the implementation of an IV additive service:
1. Preparation of final product under aseptic condition.
2. Rational choice of additive and mixing techniques for avoiding drug interactions.
3. Appropriate labeling, dispensing and storage of final product.

IV ADMIXTURE INCOMPATIBILITY
Definition: It is the simultaneous dilution and/or administration of two or more drugs that interfere with the therapeutic
efficacy of the medications and patient safety.
The types of incompatibility related with intravenous administration are
 Physical incompatibility
 Chemical incompatibility
CONSEQUENCES OF INCOMPATIBILITIES
The unintentional presence of precipitation and toxic products can induce various negative impacts on the patient.
1. Damage from toxic products multi-organ failure, Severe liver dysfunction, Toxic shock, Local embolus,
Myocarditis, Respiratory difficulties, Systemic allergic reactions, Local allergic reactions, Thrombosis,
Thrombophlebitis, Phlebitis, Local redness
2. Particulate emboli from crystallization and separation A large quantity of particles in injections is considered a
potentially life-threatening health hazard. Drug incompatibility reactions may not only produce particles in the
infusion but also alter the drug into an inactive form and injurious effects on the patient prescribed drug regimen.
3 Tissue irritation due to major pH modifications
4 Therapeutic failures

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5 Adverse effects of drug incompatibilities extend time span and total cost of patient's hospitalization in
hospital.

3. Define IV admixture and write step required in prepration of IV admixture.

Ans: : IV ADMIXTURES These preparations consist of one or more sterile drug products added to IV fluids- generally
dextrose or sodium solution or ringer solution alone or in combination. IV admixture are used for drugs intended for
continuous infusion and for drugs that may cause irritation or toxicity when given via direct IV injection.
definition: An 1V admixture is a preparation of a pharmaceutical mixture of two or more drugs
added into IV fluids alone or in combination for medication purposes.
Following objectives expected to achieve by the pharmacist for the implementation of an IV additive service:
1. Preparation of final product under aseptic condition.
2. Rational choice of additive and mixing techniques for avoiding drug interactions.
3. Appropriate labeling, dispensing and storage of final product.
PREPARATION OF IV ADMIXTURE
1. Upon receipt of the physician original order sheet, a pressure sensitive label must be prepared. which provides the
following information:
Patient name, Patient location, Physician's name, Name of the drugs with quantities added, Date of compounding,
Expiration date, Name of the pharmacist preparing the product
2. Prepare the admixture under the laminar flow hood using sterile needles and syringes or double ended transfer needles.
Sometimes the Cornwall syringe is also useful in the preparation of IV admixture.
3. Once the transfer is made, metadisc of the container must be replaced with a new seal crimped. For safety purposes, A
different colored seal should be utilized that it warns individuals regarding drugs that have been added.
4. Pharmacists must inspect the final product before dispensing the final admixture. The inspection should contain a
review of the label, clarity of the solution, and the calculation involved in the preparation.

1 mark
1. TPN stand for …… total parenteral nutrition.
2. What is bulk compounding
Ans: Compounded drugs can serve an important role for patients whose medical requirements cannot be fulfilled
by an FDA-approved drug. Following are the reasons in which pharmacy decides compounding in hospital:
1. Drug shortage in hospital.
2. Adjustment of dose require in premature infants
3. Changes need in dosage form to make medication easier to ingest in children and elder patients.
4 Patient has an allergy and needs a medication to be made without certain dye.

3. Define IV admixture.
Ans: An 1V admixture is a preparation of a pharmaceutical mixture of two or more drugs
added into IV fluids alone or in combination for medication purposes

Chapter 6
3 marks
1. What are Radiopharmaceuticals? Explain dispensing and disposal of them.
Ans: Definition: Radiopharmaceuticals are medicinal formulations containing radioisotopes which are used in
major clinical areas for diagnosis & /or treatment. Example Xenon133 (133Xe) gas, Sodium iodide 123
(Nal23|), Iodine131(131 I) sodium rose bengal.
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DISPENSING OF RADIOPHARMACEUTICALS
 Dispensing should be safe, straight forward & reliable. An important point in Radiopharmaceutical
dispensing has been the production of ready to use kits or cold kits which provide individual or multiple
doses & can be reconstituted by the addition of the radionuclide at the time of intended use.
 Chemical reagents are prepared in a sterile environment using pyrogen free raw materials & dispensed
into single or multiple unit dose containers. The preparation of individual doses can be carried out
rapidly & safely when required with minimum manipulation.
 The cold kit preparation should be subjected to terminal sterilization preferably by autoclaving or if not
by membrane filtration.
 Radiopharmaceuticals are never dispensed directly to patients; they are provided to trained health care
professionals at the hospital or clinics & then administered to the patients.
 Recommended dosage level is calculated on the basis of patient history, age, weight, surface area &
other factors.
 Dispensing of prescription is done as per applicable pharmacy law & appropriate records are
maintained.
DISPOSAL OF RADIOPHARMACEUTICALS
 Radioactive materials no more required must be disposed to avoid any hazard to environment.
 Practice that produces large volume of waste must be avoided. Dilute & dispense for low level solid,
liquid & gaseous waste.
 Segregate waste according to half- lives, delay & decay for waste that contain short live nuclides. Before
storing, label waste. Release waste into sewage system depending on water flow.
 Longer T1/2 radionuclides should be incinerated or deeply burnt in soil in a separately marked area.

2. Define Radiopharmaceuticals. Discuss storage of them.

Ans: Radiopharmaceuticals are medicinal formulations containing radioisotopes which are used in major clinical
areas for diagnosis & /or treatment. Example Xenon133 (133Xe) gas, Sodium iodide 123 (Nal23|),
Iodine131(131 I) sodium rose bengal.
STORAGE OF RADIOPHARMACEUTICALS
These should be kept in well closed containers & placed in an area assigned for the purpose. The storage
condition should be such that the maximum radiation dose rate to which person may be exposed is reduced to
an acceptable level. Necessary care should be taken to comply with national regulations for protection against
ionizing radiations. Radiopharmaceutical preparations intended for parenteral use should be kept in a glass vial,
ampoule or syringe that is sufficiently transparent to permit the visual inspection of the contents. Glass
containers may get darkened under the effect of radiation.

3. What are diagnostic & therapeutic radiopharmaceuticals.

Ans: Diagnostic radiopharmaceuticals (radDx) are used for diagnostic purposes. They serve as tracers that
when introduced into the body, emit radiations which are subsequently detected & measured.
2. Therapeutic radiopharmaceuticals (radRx) are used as internal or external radiation sources Internal
radiation source: can be administered to a patient for the purpose of delivering radiation to body tissues
internally.
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e.g used in Hyperthyroidism treatment.

4. what are ideal characteristics for radiopharmaceuticals

Ans:
1. It should have relatively short half-life.
2. It should emit gamma particles & not alpha particles or beta particles.
3. Radiopharmaceuticals must be able to localize on target site before being metabolized.
4. The energy of Radiopharmaceutical should range from 30 to 300 kilo electron volts (KeV)
5. It should excrete from body.
6. It should be easily available & should be inexpensive.

Chapter 7

1 mark
1. Define Electronic Health Record.
Ans: EHR systems are computer-based application used to convert all the information found in paper based medical
records to a computer-based system.
Examples: eClinical Works, Allscripts

2. Enlist application of computer in hospital pharmacy

Ans: APPLICATION OF COMPUTER IN HOSPITAL PHARMACY PRACTICE
1. Maintenance of patient records
2. Maintenance of drug records
3. Purchase and Inventory control record
4. Therapeutic drug monitoring
5. Drug Information retrieval
6. Drug dispensing
7. Avoiding medication error
8. Record relating to drugs in hospital formulary

3. How does the computer help regarding medication monitoring?

Ans; to maximize the therapeutics action of medicines, avoiding any toxic effects pharmacist has started taking
assistance of some pharmacokinetic and non-pharmacokinetic parameters. Therapeutic drug monitoring is most
important in geriatric, pediatric and drugs having high tendency for interaction., clinical pharmacist using computer to
calculate drug dosage.

4. Enlist software used in hospital pharmacy.

Ans:
 Electronic Health Record (EHR) Software- eClinicalWorks, Allscripts, Nextgenclinic
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 Medical billing software -Epic Care

 Hospital management software -Availity
 Medical equipment management software -Sortly
 Medical research software- PubMed.gov

Chapter 8
5 marks
1. What is clinical pharmacy? Give its scope and describe development of clinical
pharmacy.
Ans: It is a branch of pharmaceutical science which deals with various aspects of patient care, not only with
dispensing of drugs, but advising the patient on rational selection and safe use of drugs.
SCOPE OF CLINICAL PHARMACY
The scope and responsibilities of the clinical pharmacist in a hospital include the following.
i) Decision Making- To participate in drug use decision making process. He may compile and evaluate patient specific
information and assist the physician in selecting the appropriate drug product, dosage form and formulation.
ii) Drug selection- To select the drug product, source of supply based on comparative evaluation of their bioequivalence,
bioavailability, blood levels achieved and hence the time, intensity and duration of drug action. He may also judge the
quality of products and select manufacturers based on economic and cost considerations and other quality parameters.
iii) Dose schedule- To determine the dose and dosage schedules based on individual pharmacokinetic considerations and
patient's pathological state. He may assess the existing dosage schedule and recommend modifications.
iv) Medication- To prepare medication for patient use and provide drug products ready for administration to various
patient care units.
V) Counseling- To counsel the patients to ensure that they understand the importance, benefits and risks of therapeutic
plans implemented. He provides drug information and encourages compliance.
vi) Monitoring- To monitor the patients for detecting adverse drug reactions, drug interactions, drug abuse and toxicities.

DEVELOPMENT IN INDLA AND OTHER COUNTRIES

 In India, Clinical pharmacy services were initiated in 1992, when 2 Indian hospital pharmacists, B. Suresh and
B.G. Nagavi, of Ooty and Mysore, respectively, sought out clinical pharmacist Frank May in Australia.
 That same year, may visited their schools of pharmacy in India. Clinical pharmacy education programs have been
launched in India still much work will be required to improve and expand these programs to bring the benefits of
clinical pharmacy practice to the huge area of the Indian society.
 In 1997, the hospitals in Ooty and Mysore were the sites of clinical pharmacy practice programs developed in
collaboration with a senior clinical pharmacist from RGH. Developing competencies through academic curricula
and establishing practice centers in hospitals were the target approaches for the programs.
 A new branch in postgraduate courses was introduced, and curricular changes were selected in undergraduate
curriculum development.
 The government sector model and the private sector model such two model centers for the practice of clinical
pharmacy were developed.

2. Explain pharmaceutical care in detail.

Ans: DEFINITION- Pharmaceutical care is the responsible provision of drug therapy for the purpose of achieving
definite outcomes that improve a patient's quality of life.
DRUG RELATED PROBLEMS

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Definition: Drug related problem is an event or circumstance involving drug therapy that actually or potentially interferes
with desired health outcome.
PROCEDURES TO PROVIDE PHARMACEUTICAL CARE
Pharmaceutical care is a prospective patient-centered practice with a focus on identifying, resolving, and preventing drug
therapy problems. This objective is achieved by a patient care process comprising following steps:
1. Assessment of Drug Therapy Need: The pharmacist develops mechanisms to assure the patient has access to
pharmaceutical care at all times. A professional relationship must be established and maintained. Interaction between the
pharmacist and the patient must occur to assure that a relationship based upon trust, caring, cooperation, open
communication, and mutual decision making is established and maintained.
2. Data Collection: Patient-specific medical information must be collected, organized, recorded, and maintained.
Pharmacists must collect patient's general health, past medical history, social history, medication history, history of present
illness, diet and exercise history, and economic situation. Patient information must be maintained in a confidential manner.
3. Information Evaluation and Formulating Plan: Patient-specific medical information must be evaluated and drug
therapy plan developed mutually with the patient. The plan may have various components which address each of the
patient's conditions or diseases. In designing the plan, the pharmacist must carefully consider the psycho-social aspects of
the disease as well as the potential relationship between the cost and/or complexity of therapy and patient adherence. The
essential elements of the plan, including the patient's responsibilities, must be completely and carefully explained to the
patient. The drug therapy plan must be documented in the patient's pharmacy record and communicated to the patient's
other healthcare providers as necessary.
4. Implementing the Plan: The pharmacist assures that the patient has all supplies, knowledge, and information
necessary to carry out the drug therapy plan. The pharmacist must also assure that the patient has a thorough
understanding of the disease and the therapy/medications prescribed in the plan.
5. Monitoring the Plan: The pharmacist reviews, monitors, and modifies the therapeutic plan as appropriate and
necessary, in concert with the patient and healthcare team. Patient progress is accurately documented in the pharmacy
record and communicated to the patient and to the patient's other healthcare providers as appropriate.
6. The pharmacist shares information with other healthcare providers as the setting for care changes thus helping assure
continuity of care as the patient moves between the institutional setting, the community setting, and the long-term care
setting.

3. Describe medication therapy management.

ANS: Definition: Medication therapy management (MTM) is a distinct service or group of services provided by health
care providers, including pharmacists, to ensure the best therapeutic outcomes for patients.
Objective: The ultimate goal of all pharmacists providing MTM is to make sure that the medication is correct to the
patient health conditions to get the best possible outcomes from the treatment.
Following Considerations for Implementation of MTM:
1. MTM service has been implemented in health centers, managed care health systems, patient centered medical homes,
hospital pharmacies, community pharmacies, and primary care clinics.
2. MTM includes five core elements in functioning
i. Medication therapy review
ii. A personal medication records
iii. A medication-related action plan
iv. Intervention or referral
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v. Documentation and follow-up

3. Medication therapy management services (MTMS) have been shown to improve patient health outcomes through
improved control of chronic disease and more careful attention to potential drug-drug interaction.
4. Implementation guidance has been developed by various organizations: Centers for Medicare & Medicaid Services,
American Pharmacists Association's MTM Central, which includes an MTM resource library, implementation guidance,
and information about the added value of MTM.
5. Several federal agencies are working on initiatives that focus on greater involvement of pharmacists in cardiovascular
prevention and MTM.
Role of pharmacist in MTM:
Pharmacists review patient medication for safety, efficacy, and appropriateness
Pharmacists review patient medication record and fill the record form to maintain the updates of health status and
medication of the patient.

4. Describe home medication review.

Ans: Home Medicines Review (HMR) is a patient-focused, careful and collaborative health care service provided in the
community setting, to enhance quality use of medicines and patient understanding. Or it is a service designed to assist
patients living at home to maximize the benefit of their medication regimen & prevent medication related problems.
Objective:
1. To identify, prevent and resolve potential medication-related problems
2. To optimize pharmacotherapy and assist in achieving better health outcomes for patients at home.
Need of HMR:
 The patients find it uneasy and difficult to get medical care in conventional settings like nursing homes, hospitals.
 They are not very much enthusiastic of meeting a doctor and getting evaluated.
 The patient would prefer to receive the health care in a personalized approach with confidentiality where the
others do not come to know regarding his/her illness.
 This also avoided hospital ward charges as well as need for an attendant for patients.
Classification of HMR:
Medication review can be classified into four types:
1. Prescription review
2. Adherence support revie
3. Clinical review
4. Clinical review with prescribing
1. A prescription review aims to address the technical issues of a patient's prescription such as changed items or
anomalies.
2. An adherence support review, with the patient present, addresses a patient's medication- taking behavior focusing on
improving a patient's knowledge of medicines and adherence to them.
3. A clinical medication review, with access to clinical notes and the patient present, is more comprehensive and addresses
the patient's use of medication in the context of their clinical condition.
4. In some countries an extension of type 3 exists and includes the authority for prescribing.
Role of pharmacist in HMR:
1. The HMR consists of visits by a pharmacist and analyzes the patients from the point of lite style, drug and disease.
2. The pharmacist prepares a customized care plan and implements it to the patient by explaining and educating about the
drug, disease, and lifestyle modifications.
3. He also prepares a medication therapy management plan as per the prescription.
4. The pharmacist with his skills tries to interpret the reasons for failed or mixed outcomes.
5. He can communicate with doctors and nurses regarding the diagnosis and treatment to discuss the patient care issues.

3 marks

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1. Describe adverse drug reaction monitoring.

Ans: According to the WHO definition ADR is defined as:
"A response to a drug which is noxious and unintended, and which occurs at doses normally used in man for the
prophylaxis, diagnosis, or therapy of disease, or for the modification of physiological function".
Patient safety is an important issue for hospitals and pharmacies. Research from several countries has found that treatment
related complications, or adverse events, affect 2.5-16.6% of patients admitted to hospitals. The most common adverse
events are those attributable to medication use, or adverse drug events (ADEs). ADEs account for up to a fifth of all
adverse events. ADRs are estimated to account for about 3 to 15% of all hospital admissions and lead to an increase in
morbidity and mortality. Almost 16% of nursing home patients are hospitalized annually due to ADRs.
Goals of Adverse Drug Reaction Monitoring
1.To minimize the risk of adverse drug reaction
2. To reduce consequences after adverse drug reaction
Procedure
Pharmacist is involved in following steps of monitoring of ADR:
1 Literature review
2. Patient history
3. Drug level studies
4. Therapeutic decision making
Pharmacist with better knowledge of the pharmacological action, adverse reaction and the pathophysiology of diseases
can make the therapy to be safer.
Role of Pharmacist in the Management of ADR
1. Monitoring the patients who are at greater risk of developing ADR S
2. Monitoring the patients who are prescribed with drugs highly susceptible to cause ADR's
3. Assessing and documenting the patient's previous allergic status
4.Assessing the patient's drug therapy for its appropriateness
5. Assessing possible drug interactions in case of multiple therapies
6. Assessing health care professionals in detection and assessment of ADR'S
7. Encouraging/ stimulating healthcare professionals in reporting on ADR
8. Documentation of suspected reported reactions for future reference
9. Follow up of patients to assess the outcome of the reaction and management
10. Obtaining feedback about the reported reaction

2. Explain drug information and poison information.

Ans: Definition: Drug information and poison information is an independent body in hospital which provides information
on drugs, poisons & their health aspects.
Goal
1. To uplift the profession of pharmacy by bringing better interaction between the pharmacist & the community.
2.To improve patient compliance with drugs dosage regimen & to improve therapeutic effect.
3. The drug and poison information by using suitable techniques & methods such as verbal, written, or audio-visual
communication for educating & counseling the patient.
4. Drug and poison information can provide information regarding poisons, their toxicity & treatment round the clock.
5. The concept of Drug and poison information is an attempt to collect the information of drugs by abstracting information
about them.
Procedure
 Pharmacists have fundamental responsibility and a function that is unique to their profession as providers of drug
information.
 The information may be either patient specific, as an integral part of pharmaceutical care. or relative to a group of
patients, such as in the development of a therapeutic guideline. publishing an electronic newsletter, or updating a
website.
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 The pharmacist can serve as a resource for issues regarding selection and use of cost- effective mediation,
medication policy decisions (drug benefits), medication information resources election, or practice-related issues.
 Pharmacists involved in patient care areas (e.g., hospitals, clinics, long-term care, and home health care) now
frequently answer drug information questions; participate in evaluating a patient's drug therapy, and conduct
medication usage evaluation activities. Drug Information is the provision of verbal and/or written information or
advice about drugs therapy and drug in response to a request from other healthcare providers, organizations,
patients, committees, or members of the public.
 Drug information service describes activities to optimize drug use undertaken by pharmacists in providing
information.
 Drug information service provides well referenced, critically evaluated, unbiased and up- to-date information on
any aspect of drug use.
 Pharmacist's involvements directly impact patient care, improve medication compliance, and decrease the
likelihood of medication errors.

3. Describe treatment chart review.

Ans: Definition: It is a fundamental responsibility of a pharmacist to ensure the appropriateness of medication orders. It
serves as starting point for other clinical pharmacy activities (ADR, DI, TDM, and medication counseling). Organizing
information according to medical problems (like disease) helps breaking a complex situation into its individual parts.
Goals
1. To optimize the patients drug therapy.
2. To minimize or prevent drug related medication errors /problems.
Procedure
 The patient's medical record should be reviewed in relation with the medication administration record
 Recent consultations, daily progress and treatment plans should be taken into account when determining the
appropriateness of current medication orders and planning each patient's care.
 All recent and current medication orders should be reviewed.
Components of Medication Order Review include
1. Checking that medication order is written in accordance with local and legal requirements.
2. Ensuring that the medication order is unambiguous and comprehensible, that appropriate terminology is used and that
drug name are not abbreviated. Annotate the chart to provide no clarification as required.
3. Detecting orders for medication to which the patient may be intolerant /hypersensitive.
4. Ensuring that medication order is appropriate with respect to:
The patient's previous medication order.
Patient's specific considerations e.g., pregnancy, disease state
- Drug dosage schedule and dose, especially with respect to age, liver function, renal function. - Route, method of
administration and dosage form.

4. Explain ward round participation.

Ans: Definition: A ward round is a visit made by a medical practitioner, alone or with a team of health professionals and
medical students, to hospital inpatients at their bedside to review and follow up the progress in their health.
 At least one ward round is conducted every day to review the progress of each inpatient, more than one can
happen.
 In psychiatry, the "ward round" may be conducted away from the patient's bedside in a non-traditional fashion,
where to review each case, the team meets elsewhere.
Goals for clinical pharmacists on ward rounds
Pharmacists should attend ward rounds and clinical meetings whenever possible as an important member of the healthcare
team. By this way pharmacists can contribute prospectively to patient care through the provision of drug therapy. The
goals of a clinical pharmacist participation in ward rounds are to:
 Gain an increased understanding of patient's clinical progress and status, current therapeutic goals and planned
investigations
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 Provide relevant information on various aspects of the patient's drug therapy such as pharmacokinetics,
pharmacology, drug availability, adverse reactions, drug interactions and cost.
 Optimize therapeutic management by influencing drug therapy selection, implementation, follow-up and
monitoring.
 Investigate unusual drug doses or orders.

5. Define clinical pharmacy and what are the scope of clinical pharmacy.
Ans: It is a branch of pharmaceutical science which deals with various aspects of patient care, not only with
dispensing of drugs, but advising the patient on rational selection and safe use of drugs.
SCOPE OF CLINICAL PHARMACY
The scope and responsibilities of the clinical pharmacist in a hospital include the following.
i) Decision Making- To participate in drug use decision making process. He may compile and evaluate patient specific
information and assist the physician in selecting the appropriate drug product, dosage form and formulation.
ii) Drug selection- To select the drug product, source of supply based on comparative evaluation of their bioequivalence,
bioavailability, blood levels achieved and hence the time, intensity and duration of drug action. He may also judge the
quality of products and select manufacturers based on economic and cost considerations and other quality parameters.
iii) Dose schedule- To determine the dose and dosage schedules based on individual pharmacokinetic considerations and
patient's pathological state. He may assess the existing dosage schedule and recommend modifications.
iv) Medication- To prepare medication for patient use and provide drug products ready for administration to various
patient care units.

6. Explain medication history in clinical pharmacy.

Ans: Definition: pharmacist conducts patient's interview and records all the drugs that the patient has taken in his past
any hypersensitivity to a specific drug, food habits, drug dependence, intoxication with chemicals, idiosyncratic reactions
etc. it should always include OTC (Over the Counter) drugs also.
Goal
1. To help the physician for better faster and more accurate selection of drug therapy for the patients.
2. To study patient's compliance
Procedure
 Initially get the name, address, age, etc. of the patient.
 To collect the past history of the patient, see if the old medications are available with the patient or ask him about
it try to find out if the patient knows why he was taking the medication & what were the side effect if any. So as to
find out self-prescribing (self-medication) habits & OTC preference ask direct questions such as, -what do you
take for headache, cold, constipation or fever?
 Allergic responses of the patient can be known by direct and indirect questions, patient will explain the allergic
response in his own language or terms.
 Apart from this take an account of his habits like alcohol, tobacco, smoking any other
 chemicals or drugs which he comes in contact.
 Study their impacts on compliance by the patient ask him the questions like

7. Patient counselling.
Ans: Patient counselling can be defined as providing medication information orally, in written or by showing
pictograms to the patient or their relatives on the direction of use, precautions, storage and diet etc.
Goals of patient counseling
 To improve the patient compliance & thus can reduce consequences of non-compliance. Patient can understand
the safe & appropriate use of medicines.
 Improves the coping strategies to deal with medication side effects and drug interactions. Motivates the patient to
take medicine for improvement of his/her health status.
 The patient becomes an informed, efficient, and active participant in disease treatment and self-care management.
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 It encourages the patient to establish a working relationship with a pharmacist & foundation for continual
interaction and consultation.
 Patient recognizes the importance of their well-being.

8. Home medication review.

Ans: : Home Medicines Review (HMR) is a patient-focused, careful and collaborative health care service provided in the
community setting, to enhance quality use of medicines and patient understanding. Or it is a service designed to assist
patients living at home to maximize the benefit of their medication regimen & prevent medication related problems.
Objective:
1. To identify, prevent and resolve potential medication-related problems
2. To optimize pharmacotherapy and assist in achieving better health outcomes for patients at home.
Need of HMR:
 The patients find it uneasy and difficult to get medical care in conventional settings like nursing homes, hospitals.
 They are not very much enthusiastic of meeting a doctor and getting evaluated.
 The patient would prefer to receive the health care in a personalized approach with confidentiality where the
others do not come to know regarding his/her illness.
 This also avoided hospital ward charges as well as need for an attendant for patients.
Classification of HMR:
Medication review can be classified into four types:
1. Prescription review
2. Adherence support revie
3. Clinical review
4. Clinical review with prescribing
1. A prescription review aims to address the technical issues of a patient's prescription such as changed items or
anomalies.
2. An adherence support review, with the patient present, addresses a patient's medication- taking behavior focusing on
improving a patient's knowledge of medicines and adherence to them.
3. A clinical medication review, with access to clinical notes and the patient present, is more comprehensive and addresses
the patient's use of medication in the context of their clinical condition.
In some countries an extension of type 3 exists and includes the authority for prescribing
1 mark

1. Define patient counselling

Ans: Patient counselling can be defined as providing medication information orally, in written or by
showing pictograms to the patient or their relatives on the direction of use, precautions, storage and
diet etc.

2. Medication history
Ans: pharmacist conducts patient's interview and records all the drugs that the patient has taken in his past any
hypersensitivity to a specific drug, food habits, drug dependence, intoxication with chemicals, idiosyncratic
reactions etc. it should always include OTC (Over the Counter) drugs also
3. What is demulcent and Astringents:
Demulcents: An agent producing soothing and protective action.
Astringents: The drugs which cause precipitation of superficial proteins of the skin.
4. Hallucinogens
Hallucination: A sensation of false perception without sensory Is. stimulus.
5. Anaphylaxis:
Anaphylaxis: A severe hypersensitivity.
6. Diuretics
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Diuretics Which increase urine output

7. Latin terms meaning in English
 Mane- morning
 S O S- if necessary
 Quarter: Four time
 Post cibos: After meals
 Hora: An hour
 Tussis: Cough
 Statim: Immediately
 Ante cibos: Before meals

Chapter 9
3 marks
1. Explain disorder of water and electrolyte balance.
Ans: Sodium, calcium, potassium, chlorine, phosphate, and magnesium are all electrolytes. We get them from
the foods we eat and the fluids we drink. Levels of electrolytes in your body can become too low or too high.
That can happen when the amount of water in your body changes, causing dehydration or overhydration.
Electrolytes are minerals in your body that have an electric charge. They are in our blood, urine, tissues, and
other body fluids.
Electrolytes are important because they help:

 Balance the amount of water in your body

 Balance our body's acid/base (pH) level
 Move nutrients into cells
 Move wastes out of cells

2. Discuss use of different clearance tests for assessing GFR.

Ans: Glomerular Filtration Rate (GFR): these tests are performed to assess the glomerular filtration test.
GFR provides a useful index of the status of functioning glomeruli.

Renal clearance teats are performed to determine GFR

CLEARANCE TEST is performed to assess the GFR. clearance is define as the volume of plasma that could be
completely cleared off a substance per minute and is expressed as milliliter per minute.

Calculated based on creatinine levels and other factors, GFR estimates how well the kidneys are filtering waste
from the blood. A lower GFR can indicate reduced kidney function.
- Normal Range: Above 90 mL/min/1.73m² (for adults)
- Significance: GFR estimates how efficiently the kidneys are filtering waste from the blood. A lower GFR
can indicate reduced kidney function and may be categorized as stages of chronic kidney disease (CKD).

3. Liver function Test

Ans: Liver function tests (LFTs) are a group of blood tests that assess the liver's health and function.
 Liver function tests (also known as a liver panel) are blood tests that measure different enzymes,proteins, and
other substances made by the liver.
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 LFTs include liver enzymes, albumin and other proteins, and bilirubin. The liver enzymes areproduced by cells
within the liver.
 They include alkaline phosphatase (ALP), ɣ–glutamyl transpeptidase (GGT), alanine aminotransferase
(ALT) and aspartate aminotransferase (AST), but the combination of liverenzyme results you receive
depends on your local laboratory.
They include several markers, each with its normal range and significance:
1. Alanine Aminotransferase (ALT):
- Normal Range: 7-56 U/L (varies by lab)
- Significance: Elevated ALT levels may indicate liver damage, such as hepatitis or cirrhosis.

2. Aspartate Aminotransferase (AST):

- Normal Range: 8-48 U/L (varies by lab)
- Significance: Elevated AST can be a sign of liver, heart, or muscle damage.

3. Alkaline Phosphatase (ALP):

- Normal Range: 44-147 U/L (varies by lab)
- Significance: High ALP can suggest liver or bone issues, like bile duct obstruction or bone disease.
4. Total Bilirubin:
- Normal Range: 0.1-1.2 mg/dL
- Significance: Elevated levels may indicate liver or bile duct problems, leading to jaundice (yellowing of the
skin and eyes).
5. Direct Bilirubin:
- Normal Range: 0.0-0.3 mg/dL
- Significance: Elevated direct bilirubin can point to problems with bile ducts or the liver.
6. Indirect Bilirubin:
- Calculated as Total Bilirubin minus Direct Bilirubin
- Significance: High indirect bilirubin may indicate anemia or issues with red blood cell breakdown.
7. Albumin:
- Normal Range: 3.4-5.4 g/dL
- Significance: Low albumin levels may indicate chronic liver disease or malnutrition.
Liver function tests are most often used to:
• Help diagnose liver diseases, such as hepatitis
• Monitor treatment of liver disease. These tests can show how well the treatment is working.
• Check how badly a liver has been damaged or scarred by disease, such as cirrhosis
Discuss how normal water level is maintained.

4. What are PFT’s? write a note on spirometry.

Ans: Pulmonary Function Tests (PFTs) are a group of medical tests that assess how well your lungs are
functioning. These tests provide valuable information for diagnosing and monitoring lung diseases.

These tests are crucial for diagnosing various lung conditions, monitoring disease progression, and
assessing the effectiveness of treatments. They provide quantitative data on lung function, helping
healthcare providers make informed decisions about patient care. The choice of specific tests depends
on the suspected condition and the information needed for diagnosis and management.
The most common types of PFTs include:

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1. Spirometry: This test measures the amount of air a person can inhale and exhale, and how quickly they can do
it. It can help diagnose conditions such as asthma and chronic obstructive pulmonary disease (COPD).

2. Lung volume measurements: These tests measure the amount of air in the lungs, both when they are full
and when they are empty. They can help diagnose conditions such as interstitial lung disease.

3. Diffusion capacity: This test measures how easily oxygen passes from the lungs into the bloodstream.
It can help diagnose conditions such as pulmonary fibrosis and emphysema.

1 mark
1. What is the normal value and significance of blood sugar.

Blood sugar 80-120 mg/100ml (Normal Range for Blood sugar above normal causes
fasting & post absorptive blood sugar) Diabetes mellitus,(Hyperglycemia)
Blood sugar below normal causes
Hypoglycemia

2. What is the normal value and significance of ESR.

Erythrocyte Methods Normal values High ESR in Coronary thrombosis,

sedimentation rate mm/hr.) cancer, Anaemia Low ESR in Allergy.
(ESR) Male Female
Western 0-15 0-20
Green
Wintrobe’s 0-9 0-15
Culter 0-8 0-10

3. What is the normal value and significance of RBC.

RBC/ Erythrocyte count Men- 4.5 to 5.5 million/mm³ RBC Count increases in heart
Women- 3.5 to 5.5 million/mm³ diseases, polycythemia, cholera.
Children- 4 to 5.5 million/mm? Decrease indicates anemia

4. What is the normal value and significance of Hemoglobin.

Haemoglobin Value Men-15.5 + 2.5 gm% Haemoglobin value above normally

Women- 14 + 2.5 gm% Children- up to indicates Polycythemia Haemoglobin
18 gm% value below normal is seen in
Anaemia

5. …CLEARANCE…. Test measure GFR accurately?

6. Normal value of total T4 ……4.5 to 11.2 (mcg/dL).and T3……80 to 200 (ng/dL)………….
7. Dehydration.
The amount of water that we take in should be equal to the amount we lose. If something upsets this balance,we
may have too little water (dehydration) or too much water (overhydration).
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8. Lipid profile test.

Lipid profile tests are used to estimate increased risk of cardiovascular disease which includes
measurement of:
1. Total serum cholesterol
2. Serum triglycerides
3. HDL cholesterol
4. LDL cholesterol

9. What is the normal value and significance of Blood Pressure.

Blood Pressure 120/80 mm hg Blood Pressure above normally
indicates hypertension blood pressure
value below normal is seen in
hypotension
Chapter 10
5 marks

1. What do you mean by Acute & Chronic poisoning? Classify poison with suitable
examples.
Ans: . Acute poisoning: In such toxicity the symptoms of poisoning appear suddenly after injection or administration of
poison; which rapidly increases severity and followed by death or recovery.
Chronic poisoning: Symptoms develop gradually over a time of period like malase.
Classification of Poisons:
Classified on the basis of mode of actions; and are classified as.
1. Corrosive poisons They produce inflammation and acute ulceration of tissues. The symptoms are pain in throat and
stomach with odour of acid.
 Organic acids e.g., Carbolic acid Oxalic acid
 Inorganic acids e.g., Sulphuric acid Nitric acid
 Strong alkalies e.g., Caustic soda Caustic potash
2. Irritant poisons: These produce intense pain, vomiting, may be collapsed.
 Metals e.g., Lead, Arsenic, Mercury.
 Non-metals e.g., Bromides, Iodides, Boron.
 Organic vegetables e.g., Ergot, Aloes, Castor seeds.
 Animals e.g., Snake venom, Scorpion venom.
3. Neurotic poisons: These act on CNS, producing headache, drowsiness, giddiness, stupor, coma etc.
 Acting on cerebrum e.g., alcohol, chloroform, ether.
 Acting on spinal cord e.g., Nux vomica
 Acting on peripherally e.g., conium, curar
4. Cardiac poisons: Poisons act particularly on the heart producing deterious effect. e.g., Aconite, Quinine etc.
5. Miscellaneous: It includes numerous category drugs, which are capable of producing the toxic effects e.g., phenacetin,
tranquilizers. Lysergic acid derivatives etc

2. Define poison. Explain general treatment of poisoning.

Ans: poison can be defined as a chemical substance which, when administered, inhaled, or swallowed is capable of
producing lethal effect on the body.

General treatment of Poisoning

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Poison in relatively small amounts may cause structural damage or Functional disturbances in the body.
Poisoning can be accidental, suicidal or homicidal. The victim needs immediate treatment. It involves the following
measures:
1. Immediate care of deteriorating body functions.
2. Removal of unabsorbed poison.
3. Elimination of absorbed poison.
4. Use of Antidotes.
5. Supportive measures.

1. Immediate care of deteriorating body functions

It totally depends on the condition of patient; but certain measures that are commonly essential are:
(a) Keeping air way patent by artificial respiration.
(b) Care of blood circulation by treatment of hypotension.
2. Removal of unabsorbed poison
(a) Prevention of further exposure, in case of poison absorbed through skin or inhaled by shifting the patient from that
atmosphere.
(b) Emesis: Syrups like Ipecac are effective in the first 2 hours, produce stimulation of pharynx resulting in emesis.
(c) Adsorbents: Activated charcoal, 10-40 gm in water is given. It adsorbs almost all the poisons but it is not given with
Ipecac.
(d) Gastric lavage: It is adopted in case of unconscious patients, when the poison is infested by GIT can be removed by
washing stomach with saline solution or water to remove unabsorbed poison.
3. Elimination of absorbed poison
Elimination be enhanced by giving saline catheters like MgSO4 or sorbitol
OR The urine is made either acidic or basic in case of basic drugs (eg. amphetamine) and acidic drugs respectively.
4. Use of Antidotes
Antidotes are the substances which antagonise the effect of toxicants, specifically or non-specifically. They are classified
mainly into three groups:
A. Non-systemic antidotes
B. Systemic antidotes
C. Universal antidotes.
(5. Supportive Measures:
The patient is kept warm and comfortable by treating other symptoms mentioned in the following table:
Symptom Therapy
Dehydration Normal saline injection
Glucose level depletion Dextrose infusion
CNS related Anticonvulsants
CVS related Antiarrhythmics
Pain analgesics

3. Explain Poison information center.

Ans: POISON INFORMATION CENTRE (PIC)
The Poisons Information Centre (PIC) is a specialized unit providing information on prevention, early
diagnosis and treatment of poisoning and hazard management
 In India, the National Poisons Information Centre (NPIC) was established in February, 1995 in the
Department of Pharmacology at the All-India Institute of Medical Sciences, New Delhi.
 The centre provides toxicological information and advice on the management of poisoned patients
adapted to the level of the enquirer.
 FUNCTIONS OF PIC
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 1. To provide information & advice about the diagnosis, treatment & prevention of poisoning, about
the toxicity of chemicals & the risks they pose.
 2. It should provide professional program to update healthcare professionals regarding poisoning
treatments.
 3 To organize public education programs to create awareness regarding poison prevention
techniques & inform them about the poison information centers.
 4. To collect data on poisoning & their sources.
 5. To evaluate efficacy of poisoning treatments, develop risk assessment guidelines.
 6. To identify toxicities associated with new drugs & household products.

4. Define antidote. Classify them with example Give composition of universal antidote.
Ans: Antidotes are the substances which antagonise the effect of toxicants, specifically or non-specifically. They are
classified mainly into three groups:
A. Non-systemic antidotes
B. Systemic antidotes
C. Universal antidotes.
(1) Non-systemic antidotes: These are mostly given after emesis by oral • And are further sub-divided on the basis of
how they act.
(a) Mechanical antidotes: These are substances which prevent further absorption of poison. They act forming a coat over
mucous membrane of stomach. e.g., oils, fats and egg albumin etc.
(b) Chemical antidotes: These react by chemical means with poison and neutralise their toxic effect. e.g. magnesium
oxide, calcium oxide and tannins etc.
(ii)Systemic antidotes: Such substances produce the opposite actions of effect to that of poison. These are administered
with care because the antagonism always not complete, the antidote itself may produce unwanted effects. e.g. BAL
(Dimercaprol), EDTA salts etc.
(iii) Universal Antidotes: It is used where the nature of poison is unknown. This is a mixture of three ingredients given
in a dose of tablespoonful, repeated twice or thrice. The composition is given below:
Constituents Quantity Purpose

1 Powdered charcoal (burnt toast) 2 parts Absorbs alkaloid

2. Magnesium oxide (milk of 1 part Neutralize acids

magnesia)
3. Tannic acid (strong tea) 1 part Precipitates alkaloids certain
glycosides and many metals
Uses
(i) Universal antidote is used in the poisoning of - Alkaloids like datura because of charcoal and tannic acid.
(ii) Glycoside and metallic poisoning can be precipitated by the presence of tannic acid.
(iii) In acidic poisoning universal antidote is given which is neutralised by milk of magnesia

5. Drug Information center. discuss the purpose and different sources of drug
information.
Ans: DRUG INFORMATION SERVICES (DIS/DIC): Drug Information center is one of the departments of
the hospital and gives the recent knowledge and information about medical., pharmacy field at any time to the
physicians, staff of the hospital and to the citizens.
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It explains activities under taken by the pharmacist in providing information to optimise rational use of drugs.

Ability / Qualities required by a pharmacist to run DIS/DIB

1. He should be able to edit the information.
2. He can collect the data. quickly and accurately.
3. He should have good communication.
4. He should have a knowledge about research method and about the source of information.
5. He should have a knowledge about medicine, pharmacy and nursing field.
6. He should attend the seminars, conferences and should collect essential information.

UTILITY OF DRUG INFORMATION SERVICES (DIS):

1. To present a specific and vital information to the doctors for drug therapy.
2. To guide on:
A. Pharmacy research project.
B. Educational programmes.
C. Other pharmacy services such as drug distribution, storage and handling of medicine and advice to
patient etc.
3. To provide regular, periodic amendments on drugs to the medical practitioners.
4. To provide research finding to the physician.
SOURCES OF DRUG INFORMATION:
One of the functions of the PTC is to maintain a library and documentation services.
A drug information centre must have a good collection of source material in order to deal with question as they
arise. This should be continually updated and maintained.
 PRIMARY SOURCES:
1. The information obtained from basic researches and developments, which is published in brief for the first
time.
2. The information available on internet, web sites, C.D. ROM etc.
 SECONDARY SOURCES:
Primary information, available in the form of abstracts, journals,periodicals,text books, references and official
book is called secondary sources which is given below:

6. DRUG INFORMATION BULLETIN (DIB)

Ans: The drug information center may publish a journal or periodical or any booklet about current or
amended information on drugs, various technical aspects and modernization of hospital practices for all the
health professionals, which is referred as “drug information bulletin”.
Contents of DIB
1. It contains recent information about the drugs, developments and dosage forms.
2. It contains information about new methods of analysis, services offered by the hospitals, any ADR reported in
the hospital.
3. Question-answer type section.
4. Puzzles.
5. Latest information about developments in medical, paramedical services.
6. It should be published by hospital for internal circulation only.
7. The information in bulletin is collected and edited by the head of PTC.

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8. This bulletin contains names of reference books, journals, proceedings of conferences.

1mark
1. Dimercaprol
(BAL) it has affinity for HEAVY MEATL like arsenic and mercury and inactivates them.
Hence it is used as antidote for arsenic and mercury poisoning.
2. Antidote
Antidotes are the substances which antagonise the effect of poison
3. DIB stands for … DRUG INFORMATION BULLETIN …
4. PIC stands for…… POISON INFORMATION CENTRE
5. Acute poisoning
Sudden appearance of signs and symptoms and Withdrawal symptoms do not occur.
6. Antidote in morphine poisoning
Ans: NALOXONE, NALORPHANE

Chapter 11
3 marks
1. Define Pharmacovigilance. Write aim and scope of pharmacovigilance.
Ans: Pharmacovigilance is the pharmacological field which deals with the detection, assessment,
understanding, and prevention of unintended effect, adverse drug reaction, medication error or any other
drug related problems…’
 All drugs have the capacity to cause adverse effects and no drug is completely safe.
Aim:
 The primary aim of pharmacovigilance is to detect ADRs, which are any harmful or unintended effects
associated with the use of medicines. The timely detection of ADRs can help to prevent serious harm to patients.
 The aim of pharmacovigilance is to minimize the risks associated with the use of medicines. This can involve
changing the way a medicine is used or making changes to the product labeling or packaging.
 Pharmacovigilance aims to promote public health by ensuring that medicines are used safely and effectively.

SCOPE OF PHARMACOVIGILANCE
Based on Adverse drug reactions and adverse events report of new drugs Pharmacovigilance conducting
advanced drug monitoring study include:
1. Irrational use and Medication errors of medicines
2. Traditional, Herbal and complimentary medicines
3. Counterfeit medicines and Substandard medicines
4. Biologicals, Blood products, vaccines and medical devices ADR

2. Explain overview of pharmacovigilance.

Ans:
 To monitor safety of the drugs and provide structured inputs for appropriate regulatory interventions
 To create awareness about ADR monitoring in India
Regional centers will be the secondary pharmacovigilance centers under the National Pharmacovigilance Programmes.

To carry out the functions as envisaged in the “Protocol for the National Pharmacovigilance Programmes”a Coordinator
will have to be designated who will be in-charge of the Pharmacovigilance activities at thedesignated regional center.

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By accepting to participate in the National Pharmacovigilance Programmes all centers explicitly agree thatall Pharmacovigilance
activities at their institutions shall be performed in strict consonance with the National Pharmacovigilance Programmes appended
here (Coordinators of the centers and heads of the institutions are advised to carefully go through the Protocol prior to joining the
programmes
Chapter 12
5 marks
1. What is medication error? Explain type of medication errors.

Ans: A medication error is any preventable event that may cause or lead to inappropriate medication use or
patient harm while the medication is in the control of the health care professional, patient,or consumer.
According to the national coordination council for medication error reporting and prevention
TYPE OF MEDICATION ERRORS
1. Prescribing error: it may result due to insufficient information about the patient medical history. The doctor may
commit the error in writing prescription.
2. Dispensing error: mis-interpretation and mis-perception due to insufficient information in prescription may result in
the wrong calculations of dose especially among children.
3. Drug administration: it occurs due to wrong route of administration wrong dose administration or even the drug being
given to wrong patient.
Reasons of medication error:
1. Wrong interpretation of prescription.
2. Wrong dose due to mis-calculation.
3. Inadequate labeling information for patients
4. No knowledge of proper drug compliance
5. Environment factors such as light, noise and interruption may split concentration of pharmacist.

2. Explain LASA drugs and Tallman lettering as per ISMP.

 Ans: LASA" stands for "Look-Alike-Sound-Alike" drugs, which are medications that have similar
names orpackaging but differ in their active ingredients or dosages.

 Look Alike Sound Alike (LASA) medications involve medications that are visually similar in physical
appearance or packaging and names of medications that have spelling similarities and/or similar
phonetics

 This can lead to medication errors if healthcare providers or patients mistake one drug for another.
 To prevent medication errors with LASA drugs, healthcare providers should always double-check the
medication name and dosage before administering or prescribing it, and patients should always confirm
with their healthcare provider or pharmacist that they have received the correct medication.

 In addition, it's important to store medications in their original packaging and to keep a current list of all
medications, including their names, dosages, and purposes.
Tallman lettering as per ISMP:

 Drug name confusion, particularly because of look-alike/sound-alike (LASA) name attributes,can be a

contributing factor to medication related adverse events.
 TALLman lettering is a method of applying upper-case lettering to sections of LASA drug namesas a
differentiation strategy.

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 Tallman lettering is a technique used by healthcare professionals to differentiate look-alike orsound-alike

medication names to prevent medication errors.
 The technique involves using mixed case letters and placing a tall letter (typically the first letter)in the name
in uppercase letters to make it stand out.
 The Institute for Safe Medication Practices (ISMP) has recommended specific guidelines for theuse of
Tallman lettering.

3. Define term drug interaction. Explain mechanisms of drug interaction with

example.
Ans: A drug interaction is a reaction between two (or more) drugs or between a drug and a food,
beverage, or supplement.
Drug interaction is def. as the effect s of drug altered by another drug or food that is prior or concurrent administration
with it. then it is termed as drug – drug interaction or drug food interaction.

MECHANISM OF DRUG INTERACTION

the mechanism of drug interaction comprises pharmacokinetics and pharmacodynamics which mean what the body does to the drug
and what the drug does to the body respectively.

A) Pharmacokinetics drug interaction.

B) Pharmacodynamic drug interaction.

Pharmacokinetic drug interaction: in this case the drug affects the absorption, distribution, metabolism and extraction
(ADME) of another drug with resultant change in the plasma concentration of another drug.
a. GIT absorption: delay in absorption or interference with it, affects the onset pf action of the drug no. of factors
alter the process of absorption.
change in pH, Adsorption or complexation of drug, GIT status

b. Alteration in distribution: affinity and efficiency of a drug to bind with plasma protein s alter the displacement
from protein binding site. Eg: tolbutamide and salicylates produce hypoglycemia.
Warfarin and phenyl-butazone produces haemorrhage.

c. Change in metabolism: “enzyme induction “i.e. increase in enzymatic activity enhances rate of drug decrease the
therapeutic effect of the drug. e.g. alcohol, phenytoin, choral hydrate is enzyme inducing drug.
“Enzyme inhibition” i.e. decrease in enzymatic activity prolongs the fate of drug there by increasing the effect of
drug. There is the drug that inhibit enzyme activity like chloramphenicol, cimetidine, IMH etc.

d. Change in excretion:
1. PH of urine: ionised drugs easily diffuse and are excreted in the urine. So, any drug that changes pH of urine
affects excretion of weak acid or weak bases.
2. Competitive Excretion: renal tubular transport between concurrently administration drugs generally changes
excretion of one other.

PHARMACODYNAMIC INTERACTION
A. DRUG HAVING OPPOSING PHARMACOLOGICAL ACTION taking at a time, two drugs having opposite
pharmacological action is called antagonism and may be given to the patient by physician for different illness.

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eg: oxyphenonium (anticholinergic) prescribed for antispasmodic action and at the same time patient is receiving
a treatment from ophthalmologist with prescribed drug like pilocarpine.
B. DRUG HAVING SIMILAR PHARMACOLOGICAL ACTION when two drugs given at a time to the patient
which act on same physiological system this results into synergistic effect.
eg: procaine and adrenaline increase in duration of action of procaine
C. DRUG COMPETITION AT RECEPTOR SITE this may occurs at the same receptors site with same target
organ. The effect is produced after binding of a drug at receptor site. Two drugs administration together may
compete to bind with same receptorand it depends on:
 The availability of the free site at receptor binding.
 The affinity of both the drugs for the receptor binding.

D. CHANGE IN ELECTROLYTE LEVEL: the effect of a drug can be modified due to change in fluid and
electrolyte level.
4. Classify pharmacokinetic drug interaction. With example explain the drug
interaction related to distribution alteration.
Ans: Pharmacokinetic drug interaction: in this case the drug affects the absorption, distribution, metabolism and
extraction (ADME) of another drug with resultant change in the plasma concentration of another drug.
e. GIT absorption: delay in absorption or interference with it, affects the onset pf action of the drug no. of factors
alter the process of absorption.
1. change in pH: acidic drugs are readily absorbed from stomach,because they remain in unionized form.
Eg. Salicylates. Basic drugs are easily absorbed from the intestine.
2. Adsorption or complexation of drug: Activated charcoal and kaolin act as adsorbents so are given in case of
poisoning and diarrhoea to absorb unabsorbable poison and bacterial toxins etc.
3. GIT status: Decrease in GIT motility and emptying rate of adsorption.e.g. Decrease in motility increases
absorption of drugs like Prednisone and Digoxin .Increase in emptying rate decreases the absorption of drugs.

f. Alteration in distribution: affinity and efficiency of a drug to bind with plasma protein s alter the displacement
from protein binding site. Eg: tolbutamide and salicylates produce hypoglycemia.
Warfarin and phenyl-butazone produces haemorrhage.

g. Change in metabolism: “enzyme induction “i.e. increase in enzymatic activity enhances rate of drug decrease the
therapeutic effect of the drug. e.g. alcohol, phenytoin, choral hydrate is enzyme inducing drug.
“ Enzyme inhibition” i.e. decrease in enzymatic activity prolongs the fate of drug there by increasing the effect of
drug. There is the drug that inhibit enzyme activity like chloramphenicol, cimetidine, IMH etc.

h. Change in excretion:
1. PH of urine: ionised drugs easily diffuse and are excreted in the urine. So, any drug that changes pH of urine
affects excretion of weak acid or weak bases.
2. Competitive Excretion: renal tubular transport between concurrently administration drugs generally changes
excretion of one other.

3 marks

1. Give consequences of medication error?

Ans: Medical errors can have serious consequences for patients, their families, and healthcare providers. Here
are some of the consequences of medical errors:
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1. Patient harm or death: Medical errors can cause physical harm, emotional trauma, or even death to patients.
2. Longer hospital stays: Medical errors can result in extended hospital stays, increasing healthcarecosts, and
delaying the recovery process.
3. Increased healthcare costs: Medical errors can lead to additional medical interventions, prolongedhospital
stays, and increased healthcare costs.
4. Loss of trust: Patients may lose trust in their healthcare providers or the healthcare system as awhole due to
medical errors.
5. Legal consequences: Medical errors can result in malpractice claims, lawsuits, and legal actions against
healthcare providers or institutions.
6. Psychological impact: Medical errors can cause emotional trauma, stress, anxiety, or depressionfor patients,
their families, and healthcare providers.
7. Reputation damage: Medical errors can damage the reputation of healthcare providers orinstitutions,
leading to loss of business or negative publicity.

2. What is Drug Food Interaction? Give example.

Ans: A food-drug interaction is when medications are affected by the food we eat, or vice versa.
Some minor changes in when or what you eat or drink may be necessary when taking certain drugs.
Food may affect the absorption of the drug. It may be attributed to,
 Dilution of the drug
 Adsorption or complexation of drug
 Alteration of gastric emptying
1. Food reduces absorption of aspirin, Isoniazid (INZ) tetracycline, benzylpenicillin, amoxicillin,
levodopa & Rifampicin
2. Nitrofurantoin is given with food to avoid GIT irritation; this also cause increase in drug
absorption.
3. Meals containing high fat content increases absorption of fat-soluble drug Griseofulvin.
4. Tyramine containing food (cheese, Chocolate, liver and yeast extract) causes hypertension
When patients being treated with MAO inhibitors.

3. Describe strategies to minimize medication error?

Ans: To prevent medication errors over the years, hospitals have developed strategies. Following strategies are used to
reduce medication errors:
1. Double-check the frequency and dosing of all high-alert medications. A list of high alert medications is provided
by the Institute of Safe Medication Practices.
2. If not sure about the dose or the drug, consult to the pharmacist.
3. If the illegible writing, do not give the medication believing that you think you know what it is. To confirm the
drug or dose call the healthcare provider.
4. Recheck the calculation to confirm that the patient will get the right therapeutic dose.
5. Ask another clinician to recheck your calculations.
6. For each medication always write one prescription.
7. Do not sign the prescription; on the preprinted prescription pad always circle your name.
8. When writing orders do not use drug abbreviations.
9. To each prescription always add the patient's weight and age.
10. Do not use abbreviations Write full forms of the route and frequency of dosage.
PATEL COLLEGE OF PHARMACY BY- LALIT SHUKLA