DAA

Question 1

What is stability affected by in a DAA?

Answer 1

• Moisture/humidity –> consider seal type
• Light –> consider pack type
• Heat/cold –> consider storage and sealing process
• Contact with other tablets –> how full is the pack?
• Dose design suitability –> effervescent tabs, inhaler etc

Occupational health and safety problems of packing toxic drugs –> use a risk assessment approach

S8 meds = in accordance with S8 regs

Question 2

What medications are unsuitable for DAAs?

Answer 2

• Effervescent or dispersible tablets e.g. effervescent ranitdine, potassium chloride, aspirin, dispersible piroxicam
• Buccal or sublingual tablets e.g. nystatin lozenges, GTN s/l tablets, buprenorphine HCL sublingual tablets
• Chewable tablets e.g. Vit C
• Hygroscopic tablets e.g. Sodium valproate
• Light-sensitive tablets e.g. Nifedipine and tamoxifen
• Heat-sensitive tablets e.g. ropinirole
• Cytototoxic medications* e.g. methotrexate, mercaptopurine
• Moisture sensitive medications e.g. wafer presentations such as olanzapine
• Tablets containing Aluminium hydroxide, Mg Triscilate e.g. Gaviscon tablets, omeprazole (unless packed monthly), hexamine hippurate tablets
• Limited time in DAA appropriate e.g. Levothyroxine
• Medications where specific CI from manufacturer e.g. Dabigatran

Question 3

How should PRN medicines be packed in a DAA?

Answer 3

Must be packed separately and clearly labelled.

> When assigning expiry dates to ‘prn’ packs, pharmacists should consider the stability of medicines packed in the DAA as well as the need to review ‘prn’ use on a regular basis

Question 4

When should oral cytotoxic and hazardous medicines be packed in a DAA?

Answer 4

If there is a clear benefit of improved adherence from using a DAA, which outweighs the risk of exposure during packing or administration

> Patients need to be aware of correct handling and storage of these medicines

Question 5

What is the expiry date of a DAA?

Answer 5

International guidance recommends that medicines should not be left in a DAA for longer than eight weeks

• This maximum time may be reduced by the inclusion of medicines with known storage limitations (e.g. thyroxine sodium [levothyroxine sodium] tablets), or environmental conditions such as humidity

Question 6

What is the labelling requirements of a DAA?

Answer 6

Question 7

What are the features of an ideal DAA system?

Answer 7

Question 8

What information should be documented in DAA patient profile?

Answer 8