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Report - Internship in a Community Pharmacy

Student Exchange program

Apotheek Born

02/10/2016 31/10/2016

Kristna Krajoviov

5th year of study, practical training

Faculty of Pharmacy, Comenius University, Bratislava, Slovakia

2th October 2016 Sunday

The day of my arrival from belgian city Mons (where I have done 2 months of my intenship

in a community Pharmacy) to Sittard station. I had a short stay (only for few hours) in

Maastricht and than I retook direct train to Sittard where Mr. Sikkes have been already

waiting. Firstly, we went wind-surfing on belgian lake near borders (me, I was only

observing) and then we arrived home.

3th October 2016 - Monday

Meeting with a doctor

My first task in a Pharmacy was to look at the medical history of few patients. We had 5

patients whose treatement we needed to discuss with their generalist. It consists of elderly

patients with more than 5 medecines. According to their medical history of the last year and

their health problems, we were searching for interactions, contraindications, overdosing,

duplicitating of medecines or other therapeutical problems.

My responsibility was, at first to class molecules according to their ATC groups and to

prepare my questions.

I could see how NCARE system works (the system which shows interactions, CI or missing

thearapy)

Examples of problems, questions:

Elderly patients without supplement of vit. D

ACE-inhibitor + codeine Does the patient suffer froma dry cough? No, codeine was

prescribed as a pain-killer.

Doxisosine + B-blocator Doesnt the patient posses some problems because of this

combination?

In the afternoon I helped with labelling (name of a patient, name of a doctor, name of

a medecine, specials warnings, interactions) pairing of receiptts with the medicine.

Form of dutch prescription (on the left side) and slovak prescription (on the right side)

At the end of my first day, I controlled dosage and drug interactions with Mr. Sikkes

(especially methotrexate - 1x/week, at once take).

And after work, short bike trip in the surronding

4th October 2016 - Tuesday

Introduction to the work in the Pharmacy

Rossetta explained me the system of work in a Pharmacy how the receipt looks like, what

is smart filling, 2 possibilities of receiving receiptt in printed version from a patient or by

electronic system, what we need to control, the system of ranging the medicines, how to pair

medecine with the receipt and required control of prepared treatement for a patient. There is

at least double control the first one during choosing the right medecine (according to the

prescription). The last step before delivering the medicine to the patient is the packing or

preparing for blister. Patients can come to take their treatement at the Pharmacy , at the

branch Pharmacy or their is also the possibility of delivering medicine at home (manly for

elderly patients).

When the new therapy is on, the first time, patient is well informed about taking the

medicine. The second time, he receive the questionnary and is asked if he observes any

problem during treatement.

With Rossetta we went to Grevenbicht where Ive been also solving therapeutical problem of

a patient, man of 53 years old who has a problem with cold hands, muscle stiffness. His

treatement conssist of: pantoprolol, clopidogrel, ASA, metoprolol, perindopril and

simvastatine. According do SPC, we concluded that metoprolol as B-bloc. can be responsible

for cold hands and simvastatine can cause muscle stiffness (undesired effect - myalgia).

In the afternoon, Nastacha explained me the system of ordering, preparaing received orders

for smart filling. They received one order every day in the early morning (once per day) in

contrast with Slovakia, where the most of pharmacies received their orders 3 or more times

per day. I learnt more about using the information system in the Pharmacy where to control

the location of a medicine, how to control the stocks, how to print PIL etc.

For received derivates of opium, it is necessary to control the number of received products,

sign the document of incomming opioids and control the stocks of these products.

I helped with delivering of the medecines in a branch Pharmacy.

With Mr. Sikkes, we discussed what the parallel export means, what the grossery must do

before libere these medicines to trade (change PIL into official language and translate outer

package of a medicine by sticking a label on it).

Kind of a stick English translation

To stock in a fridge

Do not swallow

Inhalation by mouth/ nose

Eye drops

May influence your reaction time

Shake before use

To deliver at home

Opium receipt

To Obbicht (branch Pharmacy)

Therapeutic education needed

Blister is necessary

First use

To use 1 month after openning

Ask us for help, advice

5th October 2016 Wednesday

In the morning, I helped assistants with arranging received order, controlling the stock of

opium drugs and put them on their place. I also labelled medicines, controlled rightness of the

dosage and strength.

Afterwards, I had a preparation to do.

Preparation

Antiepileptic capsules

Phenobarbitalum 22,48 g

Phenytoinum 30,00 g

Cellulosum micro 43,02 g

D.t.d. No 300

Capsules No 0 were used.

I participated on a meeting in the Pharmacy main themes that were discussed how to get

more people on smart filling? Note always the dosage on a label. etc.

Searching information about some molecules/ medicines:

Levetiracetam

anticonvulsant

Dulaglitid

= oral antidiabetic

It is a GLP1 receptor agonist. Dulaglutide has been shown to cause thyroid cancer in rats.

Tafluprost

Is used for treatement of increased pressure in eye (ocular hypertension), open angle glaucoma.

It is an analog of PG.

Mebeverine

= anticholinergic

Indication: irritable bowel syndrome, chronic irritable colon, spastic constipation, mucous colitis. It is

a musculotropic antispasmodic with a direct action on the smooth muscle of GIT, without affecting

normal gut motility.

At the end of this day, we played tennis (me, I tried to play) with Mr. Sikkes and his friends.

6th October 2016 Thursday

Again, I arranged received order, controlled the stock of opium and I put them on their place.

When it was necessary, I used the information system for finding the right location or

controlling the stocks. I also paired recips and prescribed drugs with controlling everything

what is necessary.

It is necessary to put received medicine into drawers or shelfs every morning.

Searching for information:

Sulfametazoltrimetoprim = Bactrimel

Its an antibiotic, combination of sulfamethoxazole which block. Synth. Of dihydrofolic acid

by competing with PABA, and trimethoprim that reversibly inhibate dihydrofolate reductase,

whch produce tetrahydrofolic acid from dihydrofolic acid.

This combination is used for:

Urinary tract infections

Acute otitis media

Acute exacerbations of chronic bronchitide in adults

Shigellosis

Pneumonia

Travelers diarrhea in adults

Mupirocine = Bactroban (creme)

Its an ATB that acts by inhibiting of synthesis of bact. Prot. by reversibly and specifically

binding to bacterial isoleucyl-transfer RNA synthetase. Mupirocine is used again infections

caused by S. Aureus, S. Pyrogenes.

Hydroxychloroquine sulfate = Plaquenil

Has an antimalarial action Plasmodium vivax, P. Malariae, P. Ovale, P. Falciparium. Is

used against lupus erythematosus, rheumatoid arthritis.

Bupropion

Its an antidepressant. Inhibits re-uptake of NAD and DOP without inhib. Of 5-HT re-uptake.

Mycophenolat mofetil

Is an immunosupressant that is used to prevent organ rejection after transplantation kidney,

liver, heart.

7th October 2016

Participation at doctor assistants lesson and visit in Pharmacy assistantss practical lab

With Mr. Sikkes, I participated at the lesson talking about pain killers their classement,

dossage, side effects, CI

1) Non-opioid

a) Paracetamol group

Paracetamol 500mg

Normal dosage: 3x/day

Max dosage: 4x/day 2 tbl

Preaparing medicines for their delivery to patients according to the receipt, typers had to

choose the right medicine (preference of inssurance), strength and then print labels. Labels

are than sticked at the packages (the cross on a pachage means, that this package has been

already open). The choice of right medicine is controlled by computer system.

At the end of the day, I controlled medical prescription right datas, right molecule, right

strength.

Flucloxaciline

Peniciline ATB

Carbasolatcalcium

NSAID

Mercaptopurine

Is used in a treatement of acute lymphatic leukemia. Competes with G and hypoxanthin for

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