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Wednesday, June 24, 2015

Pharmacy Community Posting (6/6)

Week 6 Community Posting in  Pharmacy Shop



        Activities this week is mainly continuing the activities done previously. Since there are holiday in between this weekdays, less customers can be observed during that days. The sales usually will be bit slow on that day. When there is less customers, I able to discuss and learn many things with the pharmacist.

        When the medication needed by the customer is not available at the pharmacy, the following steps usually take place. First, the pharmacist will take the order, take the name, phone number, cash deposit from the customer and finally produce receipt of payment. After that, the pharmacist will check in the MIMS book about the availability and price of the item and the company supplying the item. Then a phone call is made to the company to survey about the item and immediately make the order. When the product arrived to the pharmacy, a phone call will be made to the customer.




        The information that I gained during this week is about counterfeit EYEMORE product which will have 5 years shelf-life but the original one will only have 3 years shelf-life. Next thing is about dispensing tramadol. The drug is usually being given for customer who are continuing the medication, not for those who request for the strongest painkiller since not many people can tolerate with the drug and thus may experience nausea and vomiting. For consumption of anti-constipation tablet, time taken for the Bisacodyl tablet to show its effect (going to defecate)  will take about 8 hours. That’s why the customer will be counselled to take before sleep at night and then they will defecate as soon as they wake up in the morning. Next information is about the use of Dyfazine cream. The active ingredient of the cream contain silver sulphadiazine 1% w/w which is given for burn (melecur) cases in order to prevent the skin from forming bubble (kembung). The cream usually keep by some people when emergency happen. Another new information about Gingko biloba tablet, beside for warming the body, it is also being given for the cases which he/she become bit ‘deaf’ because of fever.     


        Since there are things that is not very clear to me about the choice to be given for gout patient, I asked the locum pharmacist. He told that Colchicine (Goutnor) and/or NSAID can be dispensed when the patient is having gout attack. However, in practice at the pharmacy that I observe, colchicine is more preferably and commonly dispensed than NSAID. When the patient is not in gout attack, Allopurinol can be given. Ural/U-lite can also be given simultaneously which will help to reduce uric acid level in the blood. Ural and U-lite have same ingredients and only differ in price and company producer. However, Allopurinol should be withhold during the attack and only colchicine can be taken at that time. Throughout the attachment weeks, I can observe that all of the gout patient are male.


        I am also able to discuss in details with the pharmacist about the blood glucose device set. I just come to realise that there are two types of enzyme being used in the glucose test strip which are FAD and PQQ enzyme. FAD is more accurate and more preferable since the result will not be interfered with other type of glucose which are present in the blood such as maltose and galactose. The presence of another type of sugar will cause false-high result. This is dangerous especially for a self-medicated patient who are on insulin since there have been some cases which the patient has die because of hypoglycemic. Another precious information about the blood glucose strip is that, it requires special handling care such as do not expose to heat/ sunlight, do not transfer into another container, and do not expose to the air. For each type of strip from different company, it will have different amount of blood to be withdrawn.

        Next thing that I learnt this week is about topical steroid. Steroid can be categorized according to onset of action and potency. Hydrocortisone (cortisol) is short acting while Prednisolone, prednisone, methylprednisolone, triamcinolone are intermediate acting. Dexamethasone and betamethasone are long acting steroid. For classification of steroid according to the potency (when compare with hydrocortisone), there is an informational booklet by KotraPharma/Axcel which explains in details.
Class 1 – Very potent (up to 600x) :
                Betamethasone dipropionate & Clobetasol propionate
Class 2 – Potent (50-100x) :
                Betamethasone dipropionate, Diflucortolone valerate, Fluticasone valerate, Hydrocortisone 17-butyrate, Mometasone
                furoate, Methylprednisolone aceponate.
Class 3 – Moderately potent (2-25x) :
                Clobetasone butyrate, Triamcinolone acetonide, Fluocilonone acetonide, Betamethasone valerate
Class 4 – Mild : Hydrocortisone 0.5 - 2.5%


        According to ‘Four Generation of Progestins in Oral Contraceptives’ article by Davtyan C (2012), there are four generation of progestin. The generation refers to how long it has been on the market, 1st generation having been available the longest and so on.
1st  generation: Estranes derived from testosterone (norethindrone, norethynodrel, norethindrone acetate, ethynodiol diacetate) & Pregnanes derived from 17-OH progesterone (medroxyprogesterone acetate, chlormadinone acetate)
2nd generation: Gonanes derived from testosterone (levonorgestrel, norgestrel)
3rd generation: Gonane (Levonorgestrel) derivatives (desogestrel, gestodene, norgestimate/norelgestromine, etonorgestrel)
4th generation :Non ethylated estranges (dienogest, drospirenone) & Pregnanes (19-norprogesterones) (nestorone, nomegestrol acetate, trimegestone).
2nd generation progestin has deep vein thrombosis (DVT) as side effect while the 3rd generation progestin which has cardiovascular  (CVS) effect.


        There are various situations that can be observed as usual. Usually there is less customers when there is holidays in between the weekdays. Firstly, there is customer who do not know that POP is causing her not to have menses. After discussing with the pharmacist, she changed to COC (Microgynon) since she wants to have regular monthly menses. Next style of customer is that the customer only want the pharmacist preparing and dispensing their medication and thus they usually will only come when the pharmacist is available. There are also customer who take so many combination of medication for pain-relieving such as Lyrca, Celebrex, and Tramadol. Another case is about acne which requested by a girl. Initially she requested for the acne but then asked whether the cream able to heal the scar. According to the pharmacist, Clindamycin is given if there is pus, while Vitamin E is given to heal scar acne. Important things to be remember is about warranty card. There are customers who just buy blood pressure (BP) device set and have not yet use the device, the warranty could not be traced and the cuff already damaged. Then, a customer requested antibiotic for an accident injury and Cloxacillin is being dispensed. Lastly, there are customer who have lost voice to speak and was dispensed with Denzo and Amxol. Denzo is for throat inflammation and Amxol to remove phlegm.

FINISHED!!!!! 

Woahhhh it takes so long to finish compile this up. Already get tired. haha... There is a long list of my posts waiting to publish...







 Here is the link for your reading on Week 1 if you have not read it yet. haha

Jaane~

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