Prof. Rakesh Kumar Tewari,

M.D.(Ay.) I.M.S.(BHU),

Head, Deptt Of Dravyaguna,

Govt. Ayurveda College , Jhansi (UP).

E mail : vdrakesh.tiwari@gmail.com

GOOD DISPENSING PRACTICES

DISPENSING IS THE PROCESS OF PREPARING & GIVING

MEDICINE TO NAMED PERSON ON THE BASIS OF A

PRESCRIPTION.

CORRECT INTERPRETATION OF WISHES OF PRESCRIBER.

ACCURATE PREPARATION & LABELLING OF MEDICINE

FOR THE USE OF THE PATIENT.

ANY ERROR IN DISPENSING PROCESS CAN SERIOUSLY

AFFECT CARE OF THE PATIENT.

ALL THE RESOURCES INVOLVED IN PATIENT CARE

PRIOR TO DISPENSING MAY BE WASTED IF CORRECT

DRUG DOES NOT REACH TO CORRECT PATIENT WITH

CORRECT DOSE & ADVICE.

DISPENSING ENVIRONMENT

STAFF- PERSONEL HYGIENE, CLEANLINESS

PHYSICAL SURROUNDINGS- FREE FROM DUST, DIRT &

POLLUTION.

SHELVING & STORAGE AREAS-PROPERLY CLEAN,

LABELLED & ARRANGED ALPHABETICALLY.

SURFACES USED DURING WORK- REGULAR CLEANING

& SP. CARE FOR LIQUIDS.

EQUIPMENTS & PACKAGING MATERIAL- SP. CARE OF

REFRIGERATOR- NOT TO BE USED FOR FOOD & DRINKING

WATER STORAGE.

TEMPERATURE,LIGHT&MOISTURE-AS RECOMMENDED

DISPENSING PERSON

BELIEF THAT ANYONE WHO CAN READ THE PRESCRIPTION,

COUNT & POUR WILL DO IT WITHOUT ANY TRAINING &

SUPERVISION IS NOT TRUE.

SKILFULLY RECEIVING CORRECT MEDICINES FROM STORE/

SUPPLIER WILL IMPROVE QUALITY ASSURANCE.

KNOWLEDGE ABOUT THE MEDICINE BEING DISPENSED

(COMMON USE, CORRECT DOSE, PRECAUTIONS ABOUT

METHOD OF USE, SIDE EFFECTS, COMMON INTERACTIONS

WITH OTHER MEDICINES & FOOD, STORAGE NEEDS ETC.)

GOOD CALCULATION & ARITHMETIC SKILLS.

ATTRIBUTES OF CLEANLINESS, ACCURACY & HONESTY.

COMMUNICATION SKILLS WITH PATIENT.

THE DISPENSING PROCESS

RECEIVE & VALIDATE PRESCRIPTION.

UNDERSTAND & INTERPRET PRESCRIPTION (PATIENT,

MEDICINE, DOSE)

PREPARE & LABEL ITEMS FOR ISSUE (READ THE

LABELS).

MAKE A FINAL CHECK.

RECORD ACTION TAKEN.

ISSUE MEDICINE TO PATIENT WITH CLEAR

INSTRUCTIONS (WHEN TO TAKE MEDICINE IN RELATION

TO FOOD & OTHER MEDICINES, HOW TO TAKE- CHEW/

SWALLOW, HOW TO STORE ETC.).

PROMOTING EFFICIENT MANAGEMENT

IN DISPENSING

WHILE FACING A CROWD- SPEED MUST BE BALANCED

WITH ACCURACY.

PRE-PACKAGING OF COMMONLY USED MEDICINES AND FOR

LONG TERM FIXED DOSE COURSES CAN EASE THE BURDEN.

STOCK ROTATION- WHICH ITEMS TO BE USED FIRST

IN/ FIRST OUT( FIFO) OR FIRST EXPIRY/ FIRST OUT ( FEFO).

PACKAGING & LABELLING OF DISPENSED

MEDICINE

CONTAINER & PACKAGING MATERIAL

SHOULD NOT AFFECT QUALITY OF MEDICINE.

SPECIAL CARE FOR LIQUIDS

BOTTLE GIVEN BY/TO PATIENT SHOULD BE RINSED

PROPERLY.

LABELLING

IS USUALLY INADEQUATE/DOES NOT EXIST.

LABELS PROVIDE VITAL INFORMATION.

PREPACKAGED MEDICINE MUST BE LABELLED.

ABBREVIATIONS & UNFAMILIAR WORDS TO BE AVOIDED

LOCAL LANGUAGE IS MUST.

FACTORS INFLUENCING BEHAVIOUR OF

DISPENSER:

TRAINING & KNOWLEDGE.

PROFESSIONAL COMPENSATION .

COMMUNICATION SKILLS.

AVAILABLE PRODUCT INFORMATION.

AVAILABILITY OF DISPENSING EQUIPMENTS.

DISPENSER PRESCRIBER RELATIONSHIP.

AIDS IN COUNTING TABLETS & CAPSULES:

TABLET COUNTER

PAN WEIGHING SCALES

ELECTRONIC TABLET COUNTER.

PHARMACY PERSONEL:

PHARMACIST

PHARMACY TECHNICIAN

AUXILIARY/ASST. PHARMACY STAFF

UNTRAINED MEDICINE SELLERS.

ASSESSMENT GUIDE:

DISPENSING INDICATORS

DISPENSING REGULATIONS

DISPENSING TRAINING.

DRUG INCOMPATIBILITY

WHEN PRESENCE OF ONE DRUG DECREASES

PHARMACOLOGICAL RESPONSE OF THE OTHER DRUG,

IT IS KNOWN AS DRUG INCOMPATIBILITY. IT IS MORE

OR LESS SIMILAR TO DRUG INTERACTION &/OR

ANTAGONISM

PHYSICOCHEMICAL INTERACTIONS

PHARMACOKINETIC INTERACTIONS

PHARMACODYNAMIC INTERACTIONS.

PHYSICO-CHEMICAL INTERACTIONS

WHICH OCCUR IN COMBINATIONS/SOLUTIONS PRIOR TO

ADMINISTRATION OF DRUG ARE CONCERNED WITH

PHARMACISTS

A. HYDROPHOBIC INTERACTIONS

B. ELECTROSTATIC INTERACTIONS

C. ADSORPTION OF DRUGS ONTO SOLIDS

D. CHELATION & COMPLEXATION OF DRUGS

PHARMACO-KINETIC INTERACTIONS:

1.DECREASED G.I. ABSORPTION

2. CHANGES IN G.I. PH

3. CHANGES IN G.I. MOTILITY

4. COMPETITION FOR PP BINDING & TISSUE BINDING.

5. INHIBITION OF BIOTRANSFORMATION

6. INDUCTION OF MICROSOMAL ENZYME SYSTEMS

7. COMPETITION FOR TUBULAR SECRETION

8. CHANGES IN URINARY PH.

la;ksx% iqu}Z;kscZgwuka ok nzO;k.kkalagrhHkko%] l fo’ks‛kekjHkrs] ;a

iquuSZdSd’ksnzO;k.;kjHkUrs( r|Fkk& e/kqlfiZ‛kks%] e/kqeRL;Ik;lka p la;ksx%A

¼p0fo01@22½

r= e/kqjkEykSjloh;Zfo#)kS e/kqjyo.kkS p] e/kqjdVqdkS p loZr%]

e/kqjfrDrkSjlfoikdkH;ka e/kqjd‛kk;kS p] vEyyo.kkSjlr%]

vEydVqdkSjlfoikdkH;ke~] vEyfrDrkoEyd‛kk;kS p loZr%]

yo.kdVqdkSjlfoikdkH;ka] yo.kfrDrkSyo.kd‛kk;kS p loZr%]

dVqfrDrkSjloh;kZH;kadVqd‛kk;kS p frDrd‛kk;ksjlr%A

¼lq0lw0 20@16½

Ekku fojks/k (Quantitative incompatibility)

xq.k fojks/k (Physicochemical incompatibility)

jl fojks/k

oh;Z fojks/k

foikd fojks/k

deZ fojks/k (Pharmacological incompatibility)

laLdkj fojks/k (Processing incompatibility)

la;ksx ,oa fojks/k

ROLE OF PHARMACISTS IN HERB-DRUG

INTERACTIONS

IMPORTANT ROLE OF ALL HEALTHCARE

PROFESSIONALS

ASK THE PATIENT ABOUT OTHER MEDICINES

MAINTAIN THEIR RECORD APPROPRIATELY

YELLOW CARD REPORT FOR SUSPECTED HDIS FOR

LICENCED & NON-LICENCED HERBAL MEDICINAL

PRODUCTS

ALSO NOTE PATIENT DETAILS, ROUTE, DOSAGE,

REASON FOR USE, BATCH NUMBER, TYPE OF EXTRACT,

LATIN NAME OF PLANT AND PART USED.

OTHER WAYS TO AVOID HERB-DRUG

INTERACTIONS

KNOWLEDGE IS POWER.

PHARMACIST IS A FRIEND OF PATIENT.

BUYER BEWARE.

ONE THING AT A TIME.

WATCH THE KIDS.

WRITE IT DOWN.

TIME IS IMPORTANT.

HAVE A HEALTHY RESPECT FOR NATURE.

AN OUNCE OF PREVENTION.

USE COMMON SENSE.

COMPOSITION OF VARIOUS FORMULATIONS

IDEAL DRUG ¼ iz’kLr Hks‛kt ½

cgqrk r= ;ksX;Roeusdfo/kdYiukA

lEiPpsfr prq‛dks∙;a nzO;k.kka xq.k mP;rsAA

¼p0lw0 9@7½

iz’kLrns’klaEHkwra iz’kLrs∙gfupks)`re~A

;qDrek=a euLdkUra xU/ko.kZjlkfUore~AA ¼lq0lw034@22½

Selection of drugs

/kweo‛kkZfuyDysnS% loZrqZ‛oufHknqzrsA

xzkgf;Rok x`gsU;L;sf}f/kukS‛k/k laxzge~AA

Lkeh{; nks‛kHksnk’p fHkUuku~ feJku~ iz;kst;sr~A

i`Fk³~feJku~ leLRkkUok x.ka ok O;Lrlagre~AA

lq-lw-38@81&82AA

;fLeUuaxs rq nzO;k.kka oh;Za Hkofr pkf/kde~A

rnsokaxe~ iz;qathr era rŸofonkfeee~AA¼i0iz0½

vfrLFkwytVk ;k% L;qLrklka xzkákLRopks cq/kSA

x`g~.kh;kr~ lw{eewykfu ldykU;fi cqf)eku~AA

U;xzks/kknsLRopks xzkák% lkj% L;kn~ chtdkfnr%A

rkyhlkns’p i=kf.k Qya L;kr~ f=Qykfnr%AA

/kkrD;kns’p iq‛ikf.k Luqákns% {khjekgjsr~A

‘kk[kka xqMwfpdknsLrq fu;kZla jkeBkfnr%AA ‘kk0iz01@60&62AA

Examples

xqXxqyqdYi

‚kMaxikuh;&eqLriiZVdks’khjpUnuksnhP;ukxjS%A

vxq#i=k| ¼p0lw05@29½&dq‛B ,oa rxj vf/kd rh{.k gksus ls

f’kjksfojspu es acfg‛d`rA

,j.MoT;Za [kqM~Mkda ¼dk0la0½ vUroZRuh fpfdRlk esa lj xq.k ds

dkj.k oftZrA

iapewY;kS vdk’e;kSZ ¼pSrl ?k`r&mUekn fpfdRlk½ esa xEHkkjh

D;ks acfgLd`r gS Kkr ugha \

Conclusion

vYi’pkfi egkFkZRoa izHkwr’pkYideZrke~A

dq;kZr~ la;ksx fo’ys‛k% dkylaLdkj ;qfDrfHk%AA

p0d012@48&49AA

Acknowledgement

Dr. Ram Milan

Dr. Rajeev Kushwaha

Department of Dravyaguna

Bundelkhand Govt Ayurvedic College , Jhansi (U.P.)