Dispensing practice

DISPENSING
• refers to the process of preparing and giving
medicine to a named person on the basis of a
prescription. It involves the correct
interpretation of the wishes of the pre- scriber
and the accurate preparation and labeling of
medi- cine for use by the patient.
 DISPENSING
• Dispensing of medication can be described as
preparing, packaging, labeling and then
providing the medication to a patient or their
representative to be taken at a later time
 MEDICATION ERRORS
• prescribing faults
• prescription errors
• transcription errors
• dispensing errors
• administration errors
• across settings errors
 DISPENSING ERRORS
• A dispensing error is a discrepancy between a
prescription and the medicine that the
pharmacy delivers to the patient or distributes
to the ward on the basis of this prescription,
including the dispensing of a medicine with
inferior pharmaceutical or informational
quality
 DISPENSING ERRORS
• Dispensing medicine for the wrong patient (or
for the wrong ward)
• Dispensing the wrong medicine
• Dispensing the wrong drug strength
• Dispensing at the wrong time
• Dispensing the wrong quantity
• Dispensing the wrong dosage form
 DISPENSING ERRORS
• Dispensing an expired or almost expired medicine
• Omission (i.e. failure to dispense)
• Dispensing a medicine of inferior quality
(pharmaceutical companies)
• Dispensing an incorrectly compounded medicine
(compounding in pharmacy)
• Dispensing with the wrong information on the
label
 DISPENSING ERRORS
• Incorrect patient name
• Incorrect drug name
• Incorrect drug strength
• Incorrect instruction (including incorrect
dosage)
• Incorrect drug quantity
• Incorrect dosage form
 DISPENSING ERRORS
• Incorrect expiry date
• Omission of additional warning(s)
• Incorrect pharmacy address
• Other labelling errors
• Dispensing with the wrong verbal information
to the patient or representative
 DISPENSING ERRORS
• failure to detect and correct a prescribing
error before dispensing
• failure to detect a manufacturing error before
dispensing
• failure to provide adequate patient
counselling in order to prevent administration
errors.
 CAUSES OF DISPENSING ERRORS
• being busy
• being short-staffed
• being subject to time constraints
• fatigue of healthcare providers
• interruptions during dispensing
• look-alike/sound-alike medicines
• Handwriting
• lack of effective controls
 CAUSES OF DISPENSING ERRORS
• talkative customers, conversations with
customers, customers with many
prescriptions, and customers in a hurry.
• the risk of dispensing drugs with potential
drug–drug interactions is significantly related
to pharmacist workload, overall pharmacy
workload, and automated telephone systems
for prescription orders
 STRATEGIES FOR MINIMIZING DISPENSING
ERRORS
• Ensure correct entry of the prescription. ...
• Confirm that the prescription is correct and
complete. ...
• Beware of look-alike, soundalike drugs. ...
• Be careful with zeros and abbreviations. ...
• Organize the workplace. ...
• Reduce distraction when possible.
 STRATEGIES FOR MINIMIZING DISPENSING
ERRORS
• Focus on reducing stress and balancing heavy
workloads
• Take the time to store drugs properly.
• Thoroughly check all prescriptions.
• Always provide thorough patient counseling.
 EMULSIONS
• An emulsion is a mixture of two or more liquids
that are normally immiscible. Emulsions are
part of a more general class of two-phase
systems of matter called colloids.
• emulsion should be used when both phases,
dispersed and continuous, are liquids
• In an emulsion, one liquid (the dispersed phase)
is dispersed in the other (the continuous
phase).
 EMULSIONS
• Two liquids can form different types of
emulsions. As an example, oil and water can
form, first, an oil-in-water emulsion, wherein
the oil is the dispersed phase, and water is the
continuous phase.
• they can form a water-in-oil emulsion,
wherein water is the dispersed phase and oil is
the continuous phase.
 EMULSIFYING AGENTS

• Emulsions are stabilized by adding an emulsifier or

emulsifying agents.
• These agents have both a hydrophilic and a
lipophilic part in their chemical structure.
• All emulsifying agents concentrate at and are
adsorbed onto the oil:water interface to provide a
protective barrier around the dispersed droplets.
• emulsifiers stabilize the emulsion by reducing the
interfacial tension of the system.
 EMULSIFYING AGENTS

• Some commonly used emulsifying agents include

tragacanth, sodium lauryl sulfate, sodium dioctyl
sulfosuccinate, and polymers known as the Spans � and
Tweens�.
• Emulsifying agents can be classified according to: 1)
chemical structure; or 2) mechanism of action. Classes
according to chemical structure are synthetic, natural,
finely dispersed solids, and auxiliary agents.
• Classes according to mechanism of action are
monomolecular, multimolecular, and solid particle films.
 EMULSIFYING AGENTS
• all emulsifying agents must be :
• chemically stable in the system, inert and
chemically non-reactive with other emulsion
components
• nontoxic and nonirritant.
• They should also be reasonably odorless and
not cost prohibitive.
 TYPES OF EMULSIONS
• Macroemulsions (Simple Emulsions)
• Oil in water (o/w): Oil droplets are dispersed in a
continuous aqueous phase.
• This emulsion is generally formed if the aqueous phase
constitutes more than 45 % of the total weight
• a Hydrophilic emulsifier is used.
• These are [referred for oral administration and
cosmetics.
• These are useful as water washable drug bases .
• The globule size is 0.25 to 10 microns.
 TYPES OF EMULSIONS
• Water in oil (w/o):  Aqueous droplets are
dispersed in continuous oily phase.
• This emulsion is generally formed if the oily
phase constitutes more than 45 % of the total
weight
• a lipophobic emulsifier is used.
• These are used for cosmetics.
• They are employed for treatment of dry skin and
emollient applications.
 TYPES OF EMULSIONS
• Multiple emulsions: w/o/w , o/w/o
• They are developed with a view to delay the
release of an active ingredient.
• They have three phases.
• They may be oil-in-water-in-oil (o/w/o) or of
water-in-oil-in-water (w/o/w). 
• An emulsifier is present to stabilize the emulsions
and various ionic and nonionic surfactants are
available for this purpose.
 TYPES OF EMULSIONS
• Lipophilic (oil-soluble, low HLB) surfactants are used to
stabilize w/o emulsions
• hydrophilic (water-soluble, high HLB) surfactants are
used to stabilize o/w systems
• In these emulsions within emulsions any drug present
in innermost phase must now  cross two phase
boundaries to reach the external continuous phase.
• Such emulsions also can invert to form simple
emulsions. So a w/o/w emulsion will get inverted to
o/w emulsion.
PREPARATION OF MULTIPLE EMULSIONS

• Aqueous phase is added to oily phase,

containing a lipophilic surfactant.
• Upon mixing a w/o emulsion is formed.
• This w/o emulsion is then poured into a
second aqueous solution,contain hydrophilic
surfactant.
• Upon mixing multiple emulsion w/o/w is
formed.
 MICROEMULSIONS
• They may be defined as dispersions of insoluble
liquids in a second liquid that appears clear and
homogenous to the naked eye.
• They are frequently called solubilised systems
because on a macroscopic basis they seem to
behave as true solutions. 
• Terms as transparent emulsions, micellar solutions,
solubilised systems, and swollen micelle have all
been applied to the same or similar systems.
 MICROEMULSIONS
• They have globule radius below the range of
10-75 nm.
• The appearance of emulsion depends on the
wavelength of visible light i.e. globules less
than 120 nm do not reflect light and appear
transparent to the eye.
• As in microemulsions the globule size is less
than 120 nm, they appear to be transparent.
 USES (APPLICATIONS) OF EMULSIONS

• Emulsions can be used for oral, parenteral or

topical pharmaceutical dosage forms.
• Emulsions are used for administering drugs
orally due to following reasons:
• More palatable: Objectionable taste or texture
of medicinal agents gets masked.
• Better absorption: Due to small globule size,
the medicinal agent gets absorbed faster.
 TOPICAL PRODUCTS
• O/W emulsions are more acceptable as water washable
drug bases for cosmetic purposes.
• W/O emulsions are used for treatment of dry skin.
Emulsions have following advanyages when used for
topical purpose:
• A.    Patient acceptance: Emulsions are accepted by
patients due to their elegance, easily
• B.     washable character,
• C.     acceptable viscosity,
• D.    less greasiness.
 PARENTERAL EMULSIONS
•  i.v rout:  Lipid nutrients are emulsified and given
to patients by i/v rout. Such emulsions have
particle size less than 100 nm.
• B.     Depot injections : W/o emulsions are used
to disperse water soluble antigenic materials in
mineral oil for i/m depot injection.
• Diagnostic purposes
• Radio opaque emulsions have been used in X-ray
examination.
 IDENTIFICATION TEST OF EMULSION

• Dilution test
• Conductivity Test
• Dye-Solubility Test
• Fluorescence Test
• Cobalt Chloride Test
 FORMULATION OF EMULSIONS
• 1.      Emulsifying agents (emulsifiers)
• 2.      Antioxidants (Stabilizers)
• 3.      Antimicrobial preservatives
• 4.      Colours and flavourings
 EMULSIFYING AGENTS
• An emulsifying agent is any material that
enhances the stability of an emulsion
• Prevention of coalescence and reducing
creaming.
• The ideal emulsifying agent is colourless,
odourless, tasteless, non-toxic, non-irritant
and able to produce stable emulsions at low
concentrations.
 EMULSIFYING AGENTS
• Hydrocolloids.
• Surface active agents (SAA) (surfactants).
•   Finely divided solids.
•   Auxiliary emulsifiers.
•  Natural emulsifying agents. :Acacia,
tragacanth, agar, pectin, lecithin
• Natural emulsifying agents from animal
source gelatin . Lecithin.cholestol
 ANTIMICROBIAL AGENTS
• Emulsions often contain a number of ingredients
such as carbohydrates, proteins, sterols and
phosphatides.All of which readily support the
growth of a varity of microorganisms.
• Even in the absence of any of the above
mentioned ingredients, the mere presence of a
mixture of lipid and water in intimate contact
frequently allows microorganisms growth. So
preservative is a must for emulsions.
 ANTIMICROBIAL AGENTS
• Microbial contamination may occur due to:Contamination
during development or production of emulsion or during
its use.
• Usage of impure raw materials.
• Poor sanitation conditions. Invasion by an opportunistic
microorganisms.
• Contamination by the consumer during use of the product.
• Precautions to prevent microbial growth ;Use of
uncontaminated raw materials Careful cleaning of
equipment with live straem
 ANTIMICROBIAL AGENTS

•          Acids and acid derivatives - Benzoic acid - Antifungal agent

•           Aldehydes –  Formaldehyde - Broad spectrum
•          Phenolics - Phenol - Broad spectrum
                       Cresol
                       Propyl p-hydroxy benzoate
•          Quaternaries -Chlorhexidine and salts  - Broad spectrum
                        Benzalkonium chloride
                        Cetyl trimethyl ammonium bromide
• •          Mercurials -Phenyl mercuric acetate - Broad spectrum
 Colours and flavourings
• Colour is rarely needed in an emulsion, as
most have an elegant white colour and thick
texture. Emulsions for oral use will usually
contain some flavouring agent.
METHODS OF PREPARATION OF EMULSIONS

• 1) Dry Gum Methods

• 2) Wet Gum Methods
• 3) Bottle Method
• 4) Beaker Method.
• 5) In situ Soap Method
 LARGE SCALE METHODS
• Mechanical Stirrers
• Propeller Mixers
• Homogenizers
• Colloid Mills
• Ultrasonifiers
 SHELF LIFE, STORAGE, CONTAINERS
• Emulsions should be stored at room temperature
and will either be recently or freshly prepared.
• Some official preparations will have specific expiry
dates.
• They should not be frozen.
• A plain amber medicine bottle is used for internal
use with an airtight child-resistant closures.
• Containers with a wide mouth are useful for very
viscous preparation
 FLOCCULATION
• Neighboring globules come closer to each other and
form colonies in the continuous phase. This
aggregation of globules is not clearly visible. This is the
initial stage that leads to instability. Flocculation of the
dispersed phase may take place before, during or after
creaming.The extent of flocculation of globules
depends on
• (a) globule size distribution.
• (b) charge on the globule surface.
• (c) viscosity of the external medium.
 CREAMING
• Creaming is the concentration of globules at the top
or bottom of the emulsion.
• Droplets larger than 1 mm may settle preferentially
to the top or the bottom under gravitational forces.
• Creaming may also be observed on account of the
difference of individual globules (movement rather
than flocs).
• It can be observed by a difference in color shade of
the layers.
 CREAMING
• It is a reversible process, i.e., cream can be
redispersed easily by agitation, this is possible
because the oil globules are still surrounded
by the protective sheath of the emulsifier.
• Creaming results in a lack of uniformity of
drug distribution. This leads to variable
dosage.
 COALESCENCE
• If the sizes of globules are not uniform, globules
of smaller size occupy the spaces between the
larger globules.
• A few globules tend to fuse with each other and
form bigger globules.This type of closed packing
induces greater cohesion which leads to
coalescence.
• In this process, the emulsifier film around the
globules is destroyed to a certain extent.
 BREAKING (CRACKING)
• Separation of the internal phase from the external
phase is called breaking of the emulsion.
• This is indicated by complete separation of oil and
aqueous phases
• is an irreversible process, i.e., simple mixing fails.
• In breaking, the protective sheath around the globules
is completely destroyed and oil tends to coalesce.
 Phase inversion

• This involves the change of emulsion type from

o/w to w/o or vice versa.
• When we intend to prepare one type of
emulsion say o/w, and if the final emulsion
turns out to be w/o, it can be termed as a sign
of instability. 
• It can be minimized by keeping concentration of
disperse phase between 30-60%
 PHASE INVERSION

It may due to
•       By addition of an electrolyte
•       By changing Phase-Volume ratio
•       By temperature change
•       By changing emulsifying agent
 OINTMENT
• a smooth oily substance that is rubbed on the
skin for medicinal purposes or as a cosmetic.
• a thick substance, usually containing medicine,
that is put on the skin where it is sore or where
there is an injury, in order to cure it
• a salve or unguent for application to the skin
specifically : a semisolid medicinal preparation
usually having a base of fatty or greasy material.
 OINTMENT
• Ointment: An oil-based preparation that is applied
to the skin. Whereas an ointment has an oil base, a
cream is water soluble.
• Creams and ointments contain a different
proportion of oil to water. Ointments have a higher
concentration of oil, compared to creams. The more
oil, the greasier and stickier the product. Creams
may work better on larger areas of the skin because
of their "spreadability" factor, compared to
ointments.
 OINTMENT
• A reduction in prostaglandin production reduces pain
and inflammation. Topical anti-inflammatories work in
the same way but, instead of having an effect on all of
the body, they only work on the area to which you
have applied them.
• Vaseline is one of the most effective and cheapest skin
salves around. ... “Unlike Vaseline, which is 100%
petrolatum, Aquaphor Healing Ointment also contains
other moisturizing ingredients like mineral oil,
panthenol, and glycerin to create a less tacky texture,
 OINTMENT
• Ointments, creams and lotions are different
ways to formulate over-the-counter products
or medicines. An ointment is 80 percent oil
and 20 percent water. A cream is 50 percent
oil and 50 percent water. A lotion is similar to
a cream but it's an even lighter or less thick
formulation.
 EXPIRY DATES
• Ointment / creams in tubesor with a pump
dispense-Six months from date of opening or
manufacturer's recommendation where shorter.
For unopened creams follow the
manufacturer's expiry date
• Ointment / creams in tubes with a lid-Three
months from date of opening or manufacturer's
recommendation where shorter. For unopened
creams follow the manufacturer's expiry date
 EXPIRY DATES
• Preparations that have not been opened can
be kept and used up to their expiry date. Once
they are opened the above guidance will
apply.
• All medicines should be stored in a cool
(below 25°C), dry place, away from sunlight.
 EXPIRY DATES
• Every pharmaceutical product has an expiry
date that is stated on the packaging. The use
of the product past its expiry date may result
in a lower active ingredient or changes to the
product that may cause patient discomfort, for
example, PHchanges or a safety hazard due to
microbiologicalcontamination.
 EXPIRY DATES
• Medication for PRN use should be prescribed
in quantities that will be used within three
months from dispensing to avoid wasteful
returns of unused medication.Homes should
only order PRN items when stocks will run out
during the next month
 PACKAGING, STORAGE, AND LABELING
• In large-mouth ointment jars or in metal or plastic tubes;
• In well-closed containers to protect against
contamination and in a cool place to protect against
product separation due to heat;
• When required light sensitive preparations are packaged
or light resistant containers.
• In addition to the usual labeling requirements for
pharmaceutical products, the USP directs that the labeling
for certain ointments and creams include the type of base
used (e.g., water-soluble or water- insoluble).
 ointment
• “Ointments are semi-solid preparations for
application to the skin.”
• Types of Ointments:Medicated ointments Non-
medicated ointments
• Non sensitizing;Non irritating
• Pharmaceutically elegant
• Efficient release of medicament at the site of
application
• Water -washable
 Ointment Bases
• I. Oleaginous bases
• II. Absorption bases
• III.Water removable bases
• IV.Water soluble bases
 Ointment Bases
• Oleaginous bases are also termed as hydrocarbon
bases. On application to the skin emollient effect
occlusive dressings protect against the escape of
moisture
• Petrolatum from petroleum(vaseline)
• White petrolatum
• Yellow ointment (USP) is mixture (1000g) of
yellow wax (50g) and petrolatum (950g).
• White ointment
 Ointment Bases
• Absorption bases are of two types:
• Those that permit the incorporation of
aqueous solutions resulting in the formation
of water-in-oil emulsions (e.g., hydrophilic
petrolatum)
• Those that are water-in-oil emulsions and
permit the incorporation of additional
quantities of aqueous solutions (e.g., Lanolin)
 Ointment Bases
• Examples of Absorption bases
• a) Hydrophilic petrolatum Hydrophilic
petrolatum, USP has the following formula for
the preparation of 1000 g: Cholesterol 30 g
Stearyl alcohol 30 g White wax 80 g White
petrolatum 860 g
• b) Lanolin  obtained from the wool of sheep; 
is a purified, wax-like substance that has been
cleaned, deodorized, and decolorized.
 Ointment Bases
• Water-removable bases are oil-in-water
emulsions resembling creams in appearance.
• Because the external phase of the emulsion is
aqueous, they are easily washed from skin and
are often called ‘water washable’ bases.
• They may be diluted with water or aqueous
solutions e.g. Hydrophilic ointment
 Ointment Bases
• Water-soluble bases do not contain oleaginous
components.
• They are completely water-washable and often
referred to as ‘greaseless’.
• Because they soften greatly with the addition of
water, large amounts of aqueous solutions are not
effectively incorporated into these bases.
• They mostly are used for the incorporation of
solid substances. E.g. Polyethylene glycol ointment
SELECTION OF APPROPRIATE BASE
• Release rate
• Topical or percutaneous drug absorption
• Occlusion
• Stability of drug
• Effect of drug on ointment base
• Easily removable
• Characteristics of surface for application
 PREPARATION OF OINTMENTS
• By the incorporation method, the components
are mixed until a uniform preparation is
attained
• Incorporation of solids: The ointment base is
placed on one side of the working surface and
the powdered components, previously
reduced to fine powders and thoroughly
blended in a mortar, on the other side.
 PREPARATION OF OINTMENTS
• Incorporation of solids : The drug (the pink
powder) is usually the smaller quantity of the
two ingredients. Add an amount of the
ointment that is approximately equal in size to
the drug.
• Incorporation of solids : Spatulate the mixture.
Continue adding until all of the ointment is
used. Spatulate after each addition.
 PREPARATION OF OINTMENTS
• Incorporation of Liquids
• Liquid substances are added to an ointment
after consideration of an ointment bases
capacity to accept the volume required.
• Small amount of an aqueous solution may be
incorporated into an oleaginous ointment
• Hydrophilic ointment bases readily accept
aqueous solution.
 PREPARATION OF OINTMENTS
• Addition of aqueous preparation to a
hydrophobic base
• First the aqueous solution incorporated into a
small amount of a hydrophilic base.
• Second that mixture then added to the
hydrophobic abase.
 PREPARATION OF OINTMENTS
• Fusion is the act or procedure of liquefying or
melting by the application of heat.
• By the fusion method, all or some of the
components of an ointment are combined by
melted together and cooled with constant
stirring until congealed.
• Heat labile substances added last, when the
temperature of the mixture is low enough not
to cause decomposition of the ingredients.
 PREPARATION OF OINTMENTS
• In a small scale, the fusion process conducted
in a porcelain dish or glass beaker.
• In large scale, it is carried out in large steam-
jacketed kettles. After congealing the
ointment may be passed through an ointment
mill (in large scale), in small scale rubbed with
spatula or in a mortar to ensure uniform
texture.
 CREAMS
• Creams are semisolid dosage forms containing more
than 20% water or volatile components and typically
less than 50% hydrocarbons, waxes, or polyols as
vehicles.
• They may also contain one or more drug substances
dissolved or dispersed in a suitable cream base.
• reams are semi-solid emulsions of oil and water
• Emulsion of oil and water in approximately equal
proportions
 CREAMS
• Oil-in-water creams are more comfortable and
cosmetically acceptable as they are less greasy and
more easily washed off using water.
• Water-in-oil creams are more difficult to handle but
many drugs which are incorporated into creams are
hydrophobic and will be released more readily from a
water-in-oil cream than an oil-in-water cream.
• Water-in-oil creams are also more moisturising as they
provide an oily barrier which reduces water loss from
the stratum corneum, the outermost layer of the skin.
 Uses of creams
• The provision of a barrier to protect the skin
– This may be a physical barrier or a chemical barrier as with
sunscreens
• To aid in the retention of moisture (especially water-in-oil
creams)
• Cleansing
• Emollient effects
• As a vehicle for drug substances such as local anaesthetics,
anti-inflammatories (NSAIDs or corticosteroids),
hormones, antibiotics, antifungals or counter-irritants.
 CREAM COMPOSITION
• Water
• Oil
• Emulsifier
• Thickening agent
CREAM COMPOSITION
CREAM COMPOSITION
CREAM BASES
METHODS OF PREPARING CREAMS
METHODS OF PREPARING CREAMS
METHODS OF PREPARING CREAMS
METHODS OF PREPARING CREAMS
CREAMS
CREAMS
CREAMS
CREAMS
CREAMS