1
Q
What are the two factors that optimize the pharmacy service delivery?
A
- Competence of the pharmacist providing the service. (Pharmacy council competence standards)
- The quality of system through which that service is delivered. (Pharmacy service standards)
2
Q
What is the 7 pharmacy service standards? (DCRP MoDERS)
A
- Consumer rights.
- Organizational management.
- Continuum of service delivery.
- Safe and appropriate environment.
- Dispensing, compounding, repackaging and batch preparation.
- Aseptic dispensing of sterile products in community pharmacies.
- Aseptic dispensing of sterile products in hospital pharmacies.
3
Q
What is a good practice?
A
The current accepted range of safe and reasonable actions that result in effective and efficient use of available resources to achieve quality outcomes and minimize risk for the consumers.
4
Q
What is competence standards?
A
The competence standards are a written description of the skills, knowledge and attitude a pharmacist must have to be competent.
5
Q
What is the purpose of competence standards?
A
- Ensure the pharmacists possess all relevant competencies to undertake the roles and services described in the pharmacist scope of practice.
- Assist the individual pharmacist to facilitate their continuing professional development.
- Assist in the development of education and training and development of pharmacists and intern pharmacist. Helps identify the learning outcomes and self-assessment.
6
Q
The 7 competency standards?
A
- Practice pharmacy in a professional and culturally competence manner.
- Contribute to the quality use of medicine.
- Provide primary health care.
- Apply management and organization skills.
- Research and provide information.
- Dispense medicine.
- Prepare pharmaceutical products.
7
Q
What is profession?
A
An occupation requiring advanced education and involving intellectual skills of the practice, medicine, pharmacy, law etc.
8
Q
What dose it mean to belong to a profession?
A
To agree to abide （守份）by all rules of that profession.
9
Q
What is culture competence?
A
Is the ability to interact respectfully and effectively with persons for a background that is different from one’s own.
10
Q
What is clinical competence?
A
The application of knowledge and skills to ensure the safe and quality use of medicines to optimize health outcomes.
11
Q
What is ethical conduct?
A
Expression of code of ethics principles and values that underpin the pharmacy profession.
12
Q
What is standard operating procedure?
A
A standard operating procedure specifies in writing what should be done, when, where and by whom.
13
Q
What is the purpose of standard operating procedure?
A
- it is designed to put in place strategies for risk management and risk minimization.
- it allows the continual improvement of Standards of service and provide evidence of commitment to protecting patients.
14
Q
What is the outline of standard operating procedure?
A
- objective ( what is the procedure trying to achieve?)
- scope (what areas of work are to be covered by the procedure?)
- stage of the process (describe ho the task is to be carried out).
- responsibility
- other useful information (I.e. the expiry date etc)
- review (to update to make sure it is still relevant)
15
Q
What is the benefit of having SoP?
A
- To ensure quality of services and good practice is achieved at all times.
- Enable pharmacists to delegate and may free up time for other activities.
- Role clarification, help avoid confusion of who does what.
- Provide advice and guidance to locums 臨時代理and part time staff.
- Useful training tools for new members.
- Provide a contribution to the audit 審計process.
16
Q
Why dispense oral liquids?
A
Solid forms not suitable for children under 4 years old.
Some adults can’t swallow capsules or tablets.
17
Q
Disadvantage of oral liquids
A
Unpleasant to taste.
Uniformity is doubtful ( shaking to improve).
Stability is a problem (chemical, microbial).
18
Q
What are some of the examples of suspending agents and preservatives?
A
Suspending agents: methyl cellulose, tragacanth.
Preservatives: benzoin acid, parabens.
19
Q
Three Alternative pathways of breaking the tablet or capsule.
A
- alternative drug with liquid forms available.
- sprinkle medication onto food or into the liquid ( problems arose when food or drink not finished, or when active ingredients not soluable)
- oral injections ( when some tablets are dissolved in NaOH to form injection this can decrease the bioavailability as it forms salt when meets acid in stomach).
20
Q
What are the three deterioration of oral preparations?
A
Chemical instability.
Microbiological instability.
Physical instability.
21
Q
What are the causes of chemical instability?
A
Hydrolysis, oxidation and reduction.
PH, metals, light exposure, temperature.
Excipients in tablets can also reduce the chemical stability by changing the PH.
22
Q
What are the causes of microbiological instability?
A
High levels of Mo growth can be toxic.
Can cause color and odour changes.
By products of the Mo metabolism may cause change in PH and reduce chemical stability or solubility of drug.
23
Q
What is physical instability?
A
Sedimentation may lead to erratic dosage measurement.
Shaking is important.
Refrigeration increases chemical stability and reduce microbial growth, but also increase viscosity.
24
Q
What is pharmaceutical suspension?
A
It is a disperse system in which one substance (the disperse phase) is distributed in particulate form throughout another (the continuous phase)
25
Pharmaceutical uses of suspensions
1. Low water solubility medications can be made.
2. To allow patients to take the medication even they have swallowing difficulties.
3. Masking unpleasant taste of oral liquids.
4. To avoid hydrolysis of medicaments. Some drugs are degraded when dissolve in water.
5. Injections as suspensions can prolong the release of the drug.
6. External use, to leave a thin coating of medicaments on skin.
26
How to decrease sedimentation rate?
Reduce the particle size of the suspended solids,
| Decrease the viscosity of the liquid aha she to decrease sedimentation rate.
27
Advantages of suspensions?
- insoluble drugs may be more palatable and stable.
- enable easy administration of bulk insoluble powders.
- absorption will be faster than solid.
- lotions give cooling effect.
28
Disadvantages of suspension
- requires shaking.
- accuracy of dose more likely to be less than equivalent solution.
- storage conditions can effect the dispersed systems.
- bulky, difficult to transport with big breakage containers.
29
Properties of god suspension
- after gentle shaking, the medicaments stay in suspension long enough for a dose to be accurately measured.
- suspension is pourable.
- particles in suspension are small and relatively uniform to avoid gritty texture.
30
How to compound suspension?
Grind solids finely in mortar with pestle.
Mix with syrup or suspending agents to make a paste.
Add a bit vehicle.
Add preservative.
Add vehicle up to volume.
31
What is a mucilage?
It is a colloidal dispersion.
| Made by methyl cellulose powder in water.
32
What is emulsions?
An emulsion is a thermodynamically unstable system consisting of at least 2 immiscible liquid phases-- one phase is dispersed as globules in other liquid stabilized by an emulsifying agent.
33
Pharmaceutical uses of emulsion
1. For oral, rectal and topical administration of oils and oil-soluble drugs.
2. Formulation of oil and water- soluble drugs together.
3. Allow oil drugs to be more palatable.
4. To increase the oil and oil soluble drugs to go through intestinal wall.
5. Slow release Intra-muscular injections.
34
The three types of emulsions
1. Oil in water emulsions (o/w), oil is the dispersed phase and water in continuous phase.
2. Water in oil emulsions (w/o), water is dispersed phase and oil in continuous phase.
3. Multiple emulsions, a water droplet enclosed in an oil droplet and is dispersed in water.
35
What is an ideal emulsion formulation ?
| And what is the aim of emulsion formulation?
The goblets of dispersed phase retain their initial character and distribute evenly in water.
It aims to prevent coalescence of disperse phase ( cracking) and control the rate of creaming.
36
What is the purpose of emulsion agents?
- to reduce interfacial tension of oil and water.
| - maintain separation of droplets by forming barrier at the interface.
37
Ideal emulsifying agents should be...
Colorless, odour less, tasteless, non-toxic, non-irritant.
Able to produce stable emulsion at low conc.
E.g. Hydrophilic colloid, acacia, methyl cellulose.
38
What are the three thermodynamically unstable conditions of emulsions?
1. Phase inversion, emulsion changing from one phase type to another. Irreversible.
2. Cracking, dispersed globules coalesce and disperse phase forms a separate layer. Irreversible.
3. Creaming, aggregation of globules of disperse phase at top or bottom of emulsion like the cream on top of milk. Reversible with shaking. Can increase the likelihood of cracking.
39
How can the stability of emulsions be improved?
1. Globule size reduction= increase surface area.
2. Control temperature. Cool.
3. Increase viscosity, slows the liquid movement thus decrease the likelihood of separations.
4. Anti-oxidant maybe required. (Make sure preservative is stable in aqueous states so its preservative water not oil).
40
What is dry gum method?
Clean, dry motar.
Method:
1. Drain oil
2. Disperse acacia over oil, mix gently.
3. Add water all at once and stir in one direction until the clicking sound (=primary emulsions).
4. Gradually dilute primary emulsion with vehicle and dissolved ingredients.
41
What is wet gum method?
1. Add water to acacia gum and quickly triturate to make a mucilage.
2. Add oil in small amounts to mucilage.
3. Triturating thoroughly after each addition until thick primary emulsion is formed.
4. Stabilize by mixing for several minutes then add other ingredients as for dry gum method.
42
Problems when compounding emulsions?
Phase inversions
Incorrect quantities of oil and water
Cross contamination of water and oil
Excessive mixing at first stage with dry gum method.
Diluting primary emulsion too soon and too rapidly.
43
What are the basic ingredients in emulsions?
Water, oil and emulsifying agents (gum), surfactant
44
What's the difference between surfactant and emulsifying agent?
an emulsifier/emulsifying agent is a substance which stabilizes an emulsion.
Surfactants reduce the surface tension of water by adsorbing at the liquid-gas interface. They also reduce the interfacial tension between oil and water by adsorbing at the liquid-liquid interface.
45
What is suppositories?
Suppositories are solid dosage forms for insertion into reaction where they melt or soften to allow the active ingredients to exert local (glycerine) or systematic effects.
46
What is pharmacy service standard?
It is to set minimum quality standards for the delivery of the services from a pharmacy.
47
What is the advantages of recital administration?
1. Not expose to degradation of gastric acid
2. No direct irritation to stomach
3. First by pass metabolism
4. For patients who cannot swallow or vomiting.
48
What does an ideal suppository base should contain?
1. Melt just below body temperature.
2. Solidify quickly after melting.
3. Easy to be mould and removed from mould.
4. Be chemically stable when molten.
5. Release the active ingredient readily.
6. Easy to handle is not toxic nor irritant.
49
What are the examples of fatty bases and water bases used in suppository?
Fatty base: synthetic Novata B
| Water soluble and water-miscible bases: macrogols.
50
What is The displacement value of drug?
It is the number of parts, by weight of the drug which displaces one part of the base.
I.e. drug X has displacement value of 2.7 that means...
2.7g drug X= 1g base.
51
Key points for accurate calculations
1. Always work methodically and write down calculations clearly.
2. Check calculations using different methods.
3. Estimate answer before you start.
4. Try to visualize the quantities you are using in the calculations.
5. Check units.
6. Ask yourself whether the amount/number is reasonable.
52
What is a right?
Any advantage or benefit given to a person by a rule of law.
53
What are the four types of law?
Right
Liberties
Power
Immunities
54
What is the purpose of HDC code of health and disability consumer rights?
To promote and protect the rights of health consumers and disability service consumers.
55
What does the "informed choice and consent" (right 7) describe?
The consumers have the right to make informed choice and give informed consent.
56
What is a informed choice?
The consumers have the choice to receiver services, refuse services and to withdraw consent to services.
57
What is informed consent?
The permission to proceed with a particular course of action and the principle reflects the right of patients to determine what happens to their own bodies.
58
What should a informed consent be like?
- Freely given by health consumer or where applicable by any person who is responsible to consent on the health of that consumers behalf.
- obtained in accordance with such requirements are prescribed by the code (the right to effective communication)
59
What is the right to effective communication?
1. Every consumer has the right to effectively communicate in the language and manner that enables consumer to understand the information.
2. Every consumer has the right to an environment that enable the consumer and provider to communicate openly and honestly.
60
What information should be given to the patient? (Six key ones)
```
Explanation of their condition.
Explanation of options available.
Advice the duration of treatment.
Results of tests and treatment.
Honest and accurately answer to enquiry.
Right to receive on request a written summary information.
```
61
What does health information privacy code include?
Confidentiality of collection.
Sensitivity of information.
Ongoing use by various providers.
62
What are the legal labeling requirements? (Seven of them)
1. Name or content of the medication.
2. Name of patient.
3. Name and address of the pharmacy.
4. Internal medication: dosage and frequency.
5. External medication: directions for use and frequency, not to be taken or external only.
6. An unique identification code for recording purposes.
7. The date of the dispensary.
63
Why is medicine classified?
1. Avoid potential abuse.
2. Avoid communal harm (when community resistant arise)
3. Toxicity.
4. Precautions/ side effects.
64
What is morality, value and ethics?
Morality: the standard of right or wrong behavior, values and duties adopted by individuals, groups or society.
Values: ideas, beliefs, attitudes and characteristics considered to be valuable and worthwhile by an individual, group or society.
Ethics: concerned with evaluating practices.
65
What is ethical theories and what are the three normative theories?
Ethical theories provide a frame work within which acceptable actions and morality of judgements can be assessed.
Normative theory includes:
1. Virtue ethics.
2. Duty based.
3. Consequentialism.
66
What are the ten principles of code of ethics? ( IN T JS A B CCD)
1. Autonomy
2. Beneficence
3. Non-maleficence
4. Justice
5. Spirit of enquiry
6. Integrity
7. Trustworthy
8. Dignity
9. Cooperation
10. compassion
67
What is code of ethics and what is its role?
Code of ethics is the publicly proclaimed outlines for standards of professional conduct.
The role of ethics is:
The outline of the principle that underpin the practice of pharmacy and provide guidance on what is satisfactory practice to be performed in professional duties.
68
What is the responsibility of pharmacist in the code of ethics?
1. Respect patients.
2. Respect for professionalism and profession.
3. Respect for other professions.
4. Respect for professional expertise and duties.
5. Respect community health and society.
Pharmacy 201
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