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Pharmacy and Toxicology

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Title: Pharmacy and Toxicology


1
Pharmacy and Toxicology
  • A presentation by
  • HN Abaigar

2
Pharmacology
  • Pharmacology is the science that deals with the
    origin, nature, chemistry, effects, and uses of
    drugs.
  • Pharmacognosy The branch of pharmacology that
    deals with biological, biochemical, and economic
    features of natural drugs and their constituents.
  • Pharmacy The branch of pharmacology that deals
    with the preparation, dispensing, and proper use
    of drugs.

3
Pharmacy Terminology
  • Posology The science of dosages.
  • Pharmacodynamics The study of drug action on
    living organisms.
  • Pharmacotherapeutics The study of the uses of
    drugs in the treatment of disease.
  • Toxicology The study of poisons, their actions,
    their detection, and the treatment of the
    conditions produced by them.

4
Drug Standards
  • The United States Pharmacopoeia and National
    Formulary (USP-NF), provides Standards for the
    use of therapeutic drugs and for pharmaceutical
    necessity.
  • Drug Facts and Comparisons and the Physicians
    Desk Reference (PDR) have multiple indexes of
    commercially available drugs. Advertising outlet
    for manufacturers.
  • Remington The Science and Practice of Pharmacy
    most widely used
  • Pharmacological Basis of Therapeutics blue
    bible of pharmacology

5
Dosage
  • Dose - the amount of medication to be
    administered
  • The study of dosage is called posology.
  • Dosages given in the United States Pharmacopoeia
    and National Formulary (USP-NF) are average
    therapeutic and are known as the usual adult
    doses terms are used in connection with doses.

6
Dosage
  • Therapeutic Dose
  • also referred to as the normal adult dose, the
    usual dose or average dose
  • Dosage Range
  • The minimum and maximum amounts required to
    produce the desired effect
  • Minimum dose least amount to produce
    therapeutic effect
  • Maximum dose largest amount without reaching
    toxic effect
  • Toxic dose least amount producing symptoms of
    poisoning
  • Minimum Lethal Dose
  • dose is the least amount of drug that can produce
    death

7
Factors Affecting Dosage
  • AGE
  • WEIGHT
  • Sex
  • Race
  • Occupation
  • Habitual use
  • Time of administration
  • Frequency of administration
  • Mode of administration.

8
Age
  • Most common factor that influences the amount of
    drug
  • Youngs Rule Childs Dose Adult Dose
  • Childs Age
    Childs Age 12
  • Given Aspirin adult dose 650 mg
  • Find Dose for 3 yr old child
  • Solution Childs dose Adult dose X Childs
    age

  • Childs age 12
  • 650 mg X
    3
  • 3
    12
  • Childs dose 130 mg

9
Weight
  • For pediatric dose, weight has more factor
  • Clarks Rule Childs Dose Adult Dose
  • Childs Wt
    150
  • Given Aspirin adult dose 650 mg
  • Find Dose for child weighing 60 lbs
  • Solution
  • Childs dose Adult dose X Childs Wt
  • 150
  • Wt 650 mg X 60 lbs
  • 150 lbs
  • Childs dose 260 mg

10
Methods of Administering Drugs
  • Oral
  • Parenteral
  • Subcutaneous
  • Intradermal
  • Intramuscular
  • Intravenous
  • Intrathecal or Intraspinal

11
Methods of Administering Drugs
  • Inhalation
  • Vaporization
  • Gas inhalation
  • Nebulization
  • Topical
  • Rectal
  • Vaginal

12
Drug Classification
  • Drugs are classified by set criteria and fall
    into three specific areas
  • General accdg. to source, i.e. animal,
    vegetable or mineral
  • Chemical accdg. to chemical characteristics
  • Therapeutic accdg. to action on the body

13
Drug Nomenclature
  • Chemical name 2,4,7- triamino-6-phenylpteridine
  • Generic name triamterene
  • Trade name - Dyrenium

14
Astringents
  • Cause shrinkage of skin and mucous membranes to
    stop seepage, weeping and discharge
  • Aluminum Acetate (Burows solution) poison ivy,
    insect bites, athletes foot, superficial
    external otitis
  • Calamine lotion do not apply to blisters

15
Emollients
  • Bland or fatty substance for skin application and
    vehicle for meds
  • Theobroma oil (cocoa butter)
  • Petrolatum (petrolatum jelly)
  • Zinc oxide ointment emollient with astringent
    properties, sun screen protection

16
Expectorants and Antitussives
  • Expectorant (Bronchomucotropic)
  • Antitussive (Cough suppressant)
  • Guaifenesin and dextromethorphan (Robitussin DM)
    non-narcotic antitussive
  • Guaifenesin and codeine phosphate (Robitussin AC)
    narcotic antitussive

17
Nasal Decongestants
  • Relieves nose and eustachian tube congestions,
    combined with antihistamines, antitussives and
    expectorants
  • Sudafed
  • Actifed
  • Entex

18
Antihistamines
  • For inflammation, allergies, asthma, hay fever
    causes drowsiness
  • Diphenhydramine hydrochloride (Benadryl)
  • Chlorpheniramine maleate (Chlor-Trimeton)
  • Meclizine hydrochloride (Antivert, Bonine)
    treatment of motion sickness, contraindicated
    with pregnancy
  • Dimenhydrinate (Dramamine) treatment of motion
    sickness

19
Histamine H2 Receptor Antagonists
  • Block histamines causing increase gastric acid,
    short-term treatment of peptic ulcer
  • Cimetidine (Tagamet) duodenal ulcers
  • Ranitidine (Zantac) ulcers, GERD (heartburn)

20
Antacids
  • Counteract hyperacidity, indigestion, heartburn,
    dyspepsia oral drugs not to be taken within 2
    hours of taking antacid be aware of sodium
    content for cardiac patients and patients with
    low sodium diet
  • Magnesium Hydroxide (milk of magnesia) prolong
    use results in kidney stone has laxative effect
  • Aluminum Hydroxide (Amphojel) no systemic
    alkalosis cause constipation
  • Alumina and magnesia oral suspension (Maalox)
    less constipating than amphojel
  • Alumina, magnesia, and simethicone oral
    suspension (Mylanta)

21
Antiseptics, Disinfectants, Germicides
  • Phenol (carbolic acid) standard of all
    antiseptic, disinfectant, germicides inactivated
    by alcohol, never use on rubber, cloth or plastic
  • Povidone-iodine (Betadine) pre-operative skin
    antiseptic
  • Isopropyl Alcohol (Isopropanol) dessicant
    effect on skin
  • Hexachlorophene (pHisoHex) neurotoxic agent,
    dont use on premature infants, denuded skin,
    burns, mucous membrane
  • Glutaraldehyde (Cidex) sterilize fiber optics,
    plastic, rubber
  • Hydrogen peroxide use for Vincents angina,
    Trench mouth (Necrotizing Ulcerative Gingivitis -
    NUG)
  • Silver Nitrate solid form used to cauterize
    mucous membrane and treat aphthous ulcer
  • Silver Nitrate - liquid form used as
    gonorrheal eyedrops on newborn and wet dressing
    on burns
  • (Argyria skin turns to slate gray if
    silver nitrate wet dressing dries out)

22
Sulfonamides
  • Mainly for Urinary Tract Infection (UTI) and
    otitis media precipitate in acid solutions
    (crystalluria) must force alkaline solutions
  • Sulfisoxazole (Gantrisin) UTI, acute otitis
    media
  • Trimethoprim and sulfamethoxazole (Bactrim,
    Septra) UTI
  • Sulfacetamide sodium (Sulamyd) conjunctivitis,
    corneal ulcer
  • Silver sulfadiazine (Silvadene) treatment for
    2nd 3rd degree burns

23
Penicillins
  • Most effective, least toxic antimicrobial agent
    treatment of endocarditis, pneumococcal, Strep,
    gas gangrene, gonoccocal, anthrax, Vincents
    angina, syphilis, rheumatic heart fever
  • Penicillin G (Aqueous) parenteral use
  • Penicillin G benazathine (Botulin) syphilis,
    URI (Strep throat)
  • Penicillin G procaine (Wycillin) uncomplicated
    pneumonia, NUG, PID, pharyngitis
  • Penicillin V potassium (Pen-Vee K) drug of
    choice for uncomplicated strep throat
  • Dicloxacillin sodium (Dynapen) Tx of penicillin
    G-resistant staph
  • Ampicillin (Polycillin) Tx of shigella,
    salmonella, E.coli, gonorrhea
  • Amoxicillin (Amoxil) more effective tx of
    shigella

24
Cephalosporins
  • Related to penicillin
  • 1st Generation cefazolin sodium (Ancef,
    Kefzol)
  • 2nd Generation cefoxitin sodium (mefoxin)
  • 3rd Generation cefotaxime sodium (Claforan)
  • Cefazolin sodium (Ancef, Kefzol) Tx of
    pneumonia, lung abcess, septicemia use as pre-op
    prophylaxis
  • Cephalexin (Keflex) Tx for infection of lower
    tract, skin structures, genitourinary sytem,
    otitis media
  • Cefuroxine (Ceftin, Zinacef) Tx of
    pharyngitis, tonsillitis, bronchitis, mixed skin
    infection (aerobic/anaerobic) pre-op prophylaxis

25
Tetracyclines
  • First truly broad-spectrum antibiotics not
    indicated for children and pregnant women
    producing teeth discoloration, depress bone
    marrow growth major hazard is overgrowth of
    Candida and staphylococci dont use with milk
    products, antacids or iron preparation
  • Tetracycline hydrochloride (Achromycin) Tx of
    rickettsiae (Rocky Mountain spotted fever),
    severe acne
  • Doxycycline hyclate (Vibramycin) Tx of
    uncomplicated chlamydia and gonoccocal infections
  • Minocycline hydrochloride (Minocin)

26
Aminoglycosides
  • Cause ototoxicity, nephrotoxicity and prevalent
    in very young or old folks, presence of renal
    failure or dehydration or use of diuretics
  • Streptomycin Sulfate - Tx of mycobacterium
    tuberculosis in conjunction with Rifampin or
    Isoniazid tx of plague, tularemia, chancroid,
    granulomas
  • Gentamycin sulfate (Garamycin) must monitor
    renal and hepatic functions tx of burns and
    wounds, ophthalmic preparation for eye infection
  • Trobramycin sulfate (Nebcin) Tx of septicemia,
    meningitis, peritonitis
  • Neomycin sulfate (Mycifradin Sulfate) reduce
    intestinal flora prior to surgery

27
Macrolides
  • Often used for penicillin-sensitive patients
  • Erythromycin (E-Mycin, Ilotycin) drug of choice
    when penicillin is contraindicated prophylactic
    agent for colorectal surgery
  • Clindamycin hydrochloride (Cleocin) discontinue
    use if severe colitis and profuse diarrhea occurs
  • Vancomycin hydrochloride (Vancocin) Tx of
    potentially life-threatening disease like
    endocarditis, osteomyelitis, pneumonia and
    septicemia
  • Spectinomycin (Trobicin) sole Tx of gonorrhea,
    for patient allergic to penicillin, NOT for
    syphilis

28
Antifungals
  • Suppress growth of fungi, dermatophytes or
    Candida cause hepatic or renal dysfunction if
    for systemic use
  • Nystatin (Mycostatin) Tx of candida infection
  • Griseofulvin (Gris-PEG, Fulvicin) Tx of fungal
    infection of nails, hair and skin not for Tx of
    superficial fungal infection contraindicated in
    patients with hepatic dysfunction
  • Miconazole nitrate (Monistat, Micatin) Tx of
    cutaneous infection and vulvovaginal candidiasis
  • Undecylenic acid (Desenex) Tx of tinea pedis
    (athletes foot)
  • Tolnaftate (Tinactin, Aftate) first fungicide
    Tx of tinea pedis, corporis, capitis and
    versicolor
  • Clotrimazole (Lotrimin, Mycelex) broad
    spectrum, Tx of Candida and Tinea species

29
Antiparasitics
  • For protozoal (amebiasis, malaria), helminthic
    infection (intestinal worm) and ectoparasites
    (head lice, crab lice)
  • Permethrin (Elimite) Tx of head lice, crab lice
    and scabies caution on use on children and
    pregnant women due to systemic poisoning
  • Crotomiton (Eurax) Tx of scabies (Sarcoptes
    scabiei)
  • Metronidazole (Flagyl) Tx of amebiasis
  • Chloroquine phosphate (Aralen) drug of choice
    for acute malarial attacks
  • Primaquine phosphate drug of choice for
    prevention or relapse of malaria caused by P.
    vivax and P. ovale contraindicated for G6PD
    deficiency
  • Sulfadoxine and pyrimethamine (Fansidar) Tx of
    malaria strains resistant to chloroquine
    prophylactic use in endemic areas

30
Antiparasitics
  • Mebendazole (Vermox) Tx of hookworm, roundworm,
    pinworm and whipworm
  • Pyrantel pamoate (Antiminth) drug of choice for
    pinworm and roundworm
  • Thiabendazole (Mintezol) vermicide to kill
    pinworm, roundworm, threadworm, hookworm and
    whipworm
  • Pyrvinium pamoate (Povan) Tx of pinworm stains
    stool bright red

31
Laxatives
  • Treatment of simple constipation and clean
    intestines of toxic substances (catharsis)
  • Mineral oil use to lubricate fecal mass
    emollient laxative in conjunction with Ex-Lax
  • Glycerin suppositories (Sani-Supp) promote
    peristalsis widely use in children
  • Bisacodyl (Ducolax) nontoxic irritant
    cathartic, prep agent to surgery and X-ray exam
  • Magnesium citrate (citrate of magnesia)
    inhibits water absorption prior to X-ray exam
  • Psyllium hydrophilic mucilloid (Metamucil)
    absorbs water
  • Ducosate calcium (Surfak) stool softener that
    promotes water retention in fecal mass
  • Ducosate sodium (Colace) same as Surfak

32
Antidiarrheals
  • Diarrhea due to food poisoning, parasitic
    infection and GI disease
  • Kaolin mixture with pectin (Kaopectate)
  • Diphenoxylate hydrochloride with atropine sulfate
    (Lomotil) related to Demerol and is classified
    as Schedule V narcotics

33
Diuretics
  • Useful in Tx of hypertension, edematous
    conditions such as congested heart failure and
    acute pulmonary edema
  • Hydrochlorothiazide (Esidrix, Oretic,
    HydroDIURIL) use for edema with congestive
    heart failure (CHF) and to manage hypertension
  • Chlorthalidone (Hygroton)
  • Furosemide (Lasix) potent diuretic in Tx of
    edema associated with CHF must supplement with
    Potassium
  • Acetazolamide (Diamox) diuretic but use for Tx
    of glaucoma
  • Triamterene and hydrochlorothiazide (Dyazid,
    Maxzide) potassium supplement not needed

34
Non-Narcotic Analgesics, Antipyretics, and
Anti-Inflammatory Agents
  • Analgesics relieve pain
  • Antipyretics reduce fever
  • Anti-inflammatory suppress inflammation
  • Aspirin (ASA, CAMA, Ecotrin) cotraindicated in
    peptic ulcer
  • Acetaminophen (Tylenol) use for
    aspirin-sensitive patient no anti-inflammatory
    agent
  • Ibuprofen (Motrin) Tx of arthritis, tendinitis,
    bursitis not use for GI bleed or renal
    impairment
  • Indomethacin (Indocin) Tx of chronic rheumatoid
    arthritis, osteoarthritis and acute gout
  • Naproxen sodium (Anaprox) similar to aspirin
    and indomethacin contraindicated for GI disease
    and peptic ulcer
  • Tolmetin sodium (Tolectin) Tx and long-term
    management of acute rheumatoid arthritis and
    osteoarthritis
  • Piroxicam (Feldene) Tx of acute and chronic
    osteoarthritis and rheumatoid arthritis

35
Central Nervous System Stimulants
  • CENTRAL NERVOUS SYSTEM STIMULANTS primary
    indications are narcolepsy, hyperkinesis and
    attention deficit disorders (ADD) for children
  • Methylphenidate hydrochloride (Ritalin) Tx of
    hyperkinetic and ADD in children, narcoplepsy in
    adult
  • Dextroamphetamine sulfate (Dexadrine) Tx of
    narcolepsy adjunct to diet therapy for over
    eating

36
Central Nervous System Depressants
  • Used mainly as sedative-hypnotics,
    anticonvulsants, anesthetics can cause
    respiratory depression avoid alcohol use
  • Phenobarbital (Luminal) drug of choice for
    Petit mal epilepsy
  • Pentobarbital (Nembutal) Short-term tx of
    insomnia
  • Secobarbital (Seconal) same as nembutal
  • Phenytoin sodium (Dilantin) drug of choice for
    Grand mal epilepsy
  • Ethyl alcohol (ethanol) - sedative

37
Opium and Opium Alkaloides
  • Alkaloids are morphine and codeine used as
    analgesics, cough sedatives and certain types of
    diarrhea
  • Camphorated opium tincture (Paregoric)
    intestinal tranquilizer
  • Morphine sulfate relieve severe pain or pre-op
    sedation not for head injuries and convulsive
    disorders
  • Codeine sulfate 1/6 analgesic and ΒΌ respiratory
    depressant effect of morphine for severe pain
    and antitussive
  • Meperidine hydrochloride (Demerol) synthetic
    analgesic for pre-op sedation

38
Psychotherapeutic Agents
  • Primarily tranquilizers and mood modifiers
  • Chlorpromazine hydrochloride (Thorazine) Tx of
    psychosis, tension and agitation also
    anti-emetic
  • Thioridazine (Mellaril) all-around tranquilizer
  • Prochloperizine (Compazine) Tx of nausea and
    vomiting
  • Haloperidol (Haldol) Tx of schizophrenia and
    manic stage of manic-depressive patients
  • Lithium (Eskalith, Lithonate) drug of choice of
    manic episodes
  • Amitriptyline hydrochloride (Elavil) long-term
    tx of depression
  • Chlordiazepoxide hydrochloride (Librium) tx for
    anxiety and alcohol withdrawal
  • Hydroxyzine pamoate (Vistaril, Atarax)
    anti-anxiety, anti-emetic, anti-spasmotic, muscle
    relaxant not for IV use

39
Psychotherapeutic Agents
  • Diazepam (Valium) drug of choice for status
    epilepticus
  • Fluoxetine hydrochloride (Prozac) Tx of
    depression, bulimia nervosa and
    obsessive-compulsive disorder
  • Temazepam (Restoril) Tx of insomnia
  • Flurazepam (Dalmane) Tx of insomnia

40
Skeletal Muscle Relaxants
  • Tx of muscle spasms
  • Methocarbamol (Robaxin) beneficial for
    neuromuscular manifestations of tetanus
  • Cyclobenzaprine hydrochloride (Flexeril)
  • Chlorzoxazone (Parafon Forte)
  • Orphenadrine citrate, aspirin and caffeine
    (Norgesic)

41
Cardiovascular Agents
  • Affect action of circulatory system
  • Digoxin (Lanoxin) Tx for CHF and arrhythmias
  • Quinidine sulfate indicated for premature
    atrial and ventricular contractions and other
    arrhythmias
  • Amyl nitrate prevention of erection during
    circumcision
  • Nitrogylcerin (Nitrostat, Nitrobid) tx of acute
    and chronic angina pectoris
  • Isosorbide dinitrate (Isordil, Sorbitrate)
    antianginal action
  • Dipyridamole (Persantine) long-term therapy for
    chronic angina pectoris
  • Procainamide hydrochloride (Pronestyl, Procan SR)
    tx of arrhythmias associated with anesthesia
    and surgery
  • Verapamil (Isoptin) Tx of angina and
    hypertension
  • Diltiazem (Cardizem) - Tx of angina and
    hypertension

42
Vasoconstrictors
  • Constricts blood vessels
  • Epinephrine (Adrenaline Chloride, Sus-Phrine)
    relieves acute bronchial asthma (when inhaled),
    respiratory distress (when injected) tx of
    hypersensitivity reactions to drugs, serums,
    insect stings, other allergen
  • Tetrahydrozaline hydrochloride (Visine eye drops)
    relieves irritated eyes
  • Phenylephrine hydrochloride (Neo-sypnephrine)
    relieves nasal congestion
  • Oxymetazoline hydrochloride (Afrin) relieves
    nasal congestion, no more than 3 days use

43
Anticoagulants
  • Prevent blood coagulation
  • Heparin sodium prophylaxis and tx of pulmonary
    embolism and venous thrombolism
  • Warfarin sodium (Coumadin) tx of embolism in
    the prevention of occlusion

44
Vitamins
  • Mostly water-soluble, fat-soluble vitamins (A,D,E
    ,K)
  • A (Retinol) night vision, acne and
    pseudofolliculitis barbae
  • B1 (Thiamine hydrochloride) beriberi
  • B2 (Riboflavin) cheilosis, glossitis, visual
    disturbance, visual fatigue
  • B3 (Niacin) pellagra
  • B6 (Pyridoxine hydrochloride) neuritis due to
    INH therapy
  • B12 (Cyanocobalamin) pernicious anemia
  • C (Ascorbic acid) scurvy
  • D (Sunshine) rickets
  • E (Tocopherol) antioxidant
  • K (Menidione) - blood clotting

45
General and Local Anesthetics
  • Nitrous oxide (Laughing gas) use in dentistry
    or as preinduction agent
  • Halothane (Fluothane) inhaled anesthetics
    contraindicated for OB and hepatic dysfunction
    patients
  • Ketamine hydrochloride (Ketalar) patient will
    be in dream-like state
  • Fentanyl and droperidol (Innovar) narcotic and
    tranquilizer combination
  • Procaine hydrochloride (Novocain) spinal
    anesthesia
  • Lidocaine hydrochloride (Xylocaine) standard to
    which all other anesthetics are compared
  • Dibucaine (Nupercainal) topical anesthetic
  • Proparacaine (Ophthetic, Ophthaine) ophthalmic
    anesthetic

46
Oxytocics
  • Produce a rhythmic contraction of the uterus
  • Ergonovine maleate (Ergotrate Maleate)
    prevention and tx of postpartum and postabortal
    hemorrhage
  • Oxytocin (Pitocin) improvement of uterine
    contractions or to control postpartum hemorrhage

47
Parasympatholytic/ Anticholinergic Drugs
  • Inhibits acetylcholine and secretion of duct
    glands
  • Atropine Sulfate increase respiratory and
    relaxes muscles of the intestinal tract, bronchi,
    ureter, biliary ducts and gall bladder
  • Propantheline Bromide (Pro-Banthine) use as an
    adjunct in tx of peptic ulcer use as
    anti-spasmotic for intestinal spasms
  • PARASYMPATHETIC (CHOLINOMIMETIC) DRUGS
    stimulates structures controlled by
    parasympathetic nerves
  • Neostigmine Methylsulfate (Prostigmin) controls
    Myasthenia Gravis
  • Pilocarpine (Pilocar) decrease glaucoma
    intraocular pressure
  • SYMPATHOLYTIC DRUGS adrenergic blocking agents
  • Propranolol hydrochloride (Inderal) beta
    blocker as prophylaxis for migraine, angina and
    arrhythmias
  • Methyldopa (Aldomet) tx of hypertension

48
Biological Agents
  • Serves as immunization of personnel
  • BUMEDINST 6230.15 (Immunization and
    chemoprophylaxis)
  • Include serums, viruses, toxins, antitoxins,
    antigens and bacterial vaccines
  • Manufacturer licensed by Sec of Treasury and
    monitored by U.S. Public Health Service

49
Biological Agents
  • Label includes
  • Name
  • Address
  • License Number
  • Name of product
  • Lot number
  • Date of manufacture
  • Period of potency
  • Minimum potency

50
Biological Agents
  • Must be stored in cool (6-8C), dry and dark place
  • Yellow fever vaccine must be frozen

51
Examination of Parenteral Solution
  • Examined at least 3 times
  • Upon receiving the solution
  • Periodically while in storage
  • Immediately preceding use
  • May be unfit for use
  • Deterioration from prolong storage
  • Accidental contamination
  • Defects that may develop in containers or seals

52
Immunizing Agents
  • Diphtheria Antitoxin
  • Tetanus Antitoxin phenol or cresol as
    preservative
  • Tetanus Toxoid solution from Clostridium tetani
    treated with formaldehyde
  • Alum Precipitated Diphtheria and Tetanus Toxoids
    and Pertussis Vaccines Combined (DPT)
  • Cholera Vaccine suspension from killed Vibrio
    comma, autolysis may occur on storage

53
Immunizing Agents
  • Poliovirus Vaccine
  • IPV Inactivated Poliovirus Vaccine
  • Recommended shot in U.S.
  • Stored between 2 8C
  • OPV Oral Poliovirus Vaccine
  • Recommended for children
  • Never administered parenterally
  • Stored frozen
  • After thawing, must be used within 7 days and
    stored below 10C

54
Immunizing Agents
  • Yellow Fever Vaccine frozen until rehydration,
    ask patient if allergic to eggs
  • Plague vaccine presence of precipitate means
    contamination
  • Influenza Virus Vaccine ask patient if allergic
    to eggs
  • Dried Smallpox vaccine
  • - stored below 25C and is good for 18 months
  • when reconstituted, store below 4C and is good
    for 3 months
  • Anthrax Vaccine
  • stored between 2-8C
  • Healthy men and women from age 18-65 yrs
  • 3 series given 2 weeks apart, then 6, 12 and 18
    months

55
Toxicology
  • Science of poison, their actions and their
    detection and treatment
  • Local effect
  • Remote effect
  • Cumulative effect

56
Pharmacy
  • Metrology science of weights and measures in
    application to pharmacy

57
Metric System
58
Measuring Eqivalents
59
Metric Equivalents
60
Conversion Table
61
Conversion Table
62
Calculation
  • Percentage - 10 is 0.10 or 10/100
  • Ratio 12
  • Proportion 1224

63
Pharmaceutical Preparation
  • Elixirs aromatic, sweetened hydroalcoholic
    solutions
  • Suspensions coarse dispersion solutions
  • Ointments semisolid, fatty or oily preparation
  • Suppositories solid bodies for orifices in the
    body
  • Capsules gelatin shell containing solid or
    liquid medicinal substance

64
Pharmaceutical Instruments
  • Balances
  • - Class A 120 mg to 120 gm
  • - Class B - gt 648 mg
  • Ribbed Funnel
  • Erlenmeyer Flask
  • Mortar and Pestle triturating (powder form)
  • Spatula
  • Graduated cylinders

65
Drug Incompatabilities
  • Therapeutic
  • Physical
  • Chemical

66
Drug Reactions
  • Contraindication a particular treatment or
    procedure inadvisable
  • Adverse Drug reaction produces unintended and
    noxious effect on the patient
  • Drug Interaction maybe positive or negative to
    produce an outcome that would not occur if each
    drug had administered singly

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

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

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

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

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

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

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

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

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

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