What A Pharmacy Technician Should Know?

A pharmacy technician should be expert in: 

•     Dispensing 
•     Compounding 
•     Aseptic handling 

Dispensing: 
Dispensing includes prescription checking, interventions and counseling. 
 
a) Medicine related factors: 
1) Check deviation from usual dose range. 
Rx Albendazole 100mg x 2 x 3 days 
Prescriber wished to write Mebendazole 100mg x 2 x 3 days but incorrectly wrote albendazole. 
 
2) Check if unit dose exceeds maximum unit dose. 
Rx Glibenclamide 15mg x 1 x 30 days 
Maximum unit dose of glibenclamide is 10 mg. Higher doses should be given in divided doses. 
 
3) Check if daily dose exceeds maximum daily dose 
Rx Metformin 1000mg x 3 x 30 days 
Max daily dose of metformin is 2000mg. Little benefit seen above total daily dose of 2000mg. 
 
4) Check if daily dose is less than minimum daily dose 
Name: XXXX Age: 2.5 yrs Wt: 15 Kg 
Rx Amoxycillin 125 mg x 3 x 5 days 
Min total daily dose of Amoxycillin is 50 mg/Kg (i.e. 750 mg) daily. 
 
5) Check maximum frequency 
Rx Glibenclamide 5mg x 2 x 30 days 
Glibenclamide's effect persists for 24 hours after single morning dose. So upto 10 mg should be given as single morning dose. 
 
6) Check if the medicine can be used PRN use. 
Rx Beclomethasone dipropionate (200 mcg/puff inhaler) 2 puff x PRN x 30 days  
Beclomethasone is a steroid and should be given on regular basis. 
 
7) Check if the medicine is appropriate for children. 
Name: XXXX Age: 2.5 yrs Wt: 15 Kg 
Rx Salbutamol(100 mcg/puff) 2 puff x PRN x 30 days 
According to manufacturer salbutamol inhaler is ineffective to children below 4 years. So salbutamol syrup can be alternative. 
 
8) Check if patient is allergic to any drug. 
Based on his previous profiles check whether the patient can be allergic to medicine you are dispensing. If a patient is allergic to ibuprofen then serious reactions can occur after administration of diclofenac. 
 
9) Check precautions to be taken in renal impairment, hepatic impairment, pregnancy and breast-feeding related to the medicine. 
To chronic alcoholic: Paracetamol 1000mg x 4 x 5 days 
To breast-feeding woman: Rx codeine 15mg x 3 x 7 days 
To pregnant woman: Rx Atenolol 25 mg x 1 x 30 days 
Alternatives should be used instead of codeine and atenolol. Paracetamol dose should be reduced appropriately. 
 
10) Check drug-drug interactions. 
Rx ciprofloxacin 500mg x 2 x 7 days 
Aminophylline 100mg x 3 x 30 days 
Serious and fatal arrhythmia can occur if the above two medicines are given concurrently. 
 
Rx Salbutamol 4mg x 3 x 30 days 
Atenolol 25 mg x 1 30 days 
The above two medicines represent agonist-antagonist combination. 
 
Rx Azithromycin 500mg x 1 x 5days 
Chloramphenicol 500mg x 4 x 10 days 
Chloramphenicol antagonizes the effects of azithromycin; the concurrent use is not recommended. 
 
Rx calcium gluconate 0.1 mmol Ca/Kg/hour in 1 Lit of D5 
Ceftriaxone 1000mg x 2 x 5 days 
Ceftriaxone and IV calcium-containing solutions should not be administered within 48 hours of each other in any patient. Cases of fatal reactions with calcium-ceftriaxone precipitates in the lungs and kidneys has been reported 
 
 
b) Instructions to patients 
 
1) Check physical interactions between medicines and recommend dosing time 
Rx Doxycycline 100mg x 2 x 5 days 
Ferrous sulphate 200mg x 2 x 30 days 
Instruct patients to take ferrous sulphate 2 hours after doxycycline 
 
2) Recommend dosing time according to maximal effect of medicine. 
Rx Atrovastatin 10mg x 1 x 30 days 
Atrovastatin is more effective when taken at bed time. Instruct atrovastatin to take at bed time. 
 
Thyroxine 100mcg x 1 x 30 days 
Thyroxine is least absorbed so instruct to take at 1 hour before morning breakfast. 
Isosorbide dinitrate 10mg x 2 x 30 days 
Instruct to take two doses in a day at interval of 8 hours and maintain 8 hours as drug-free interval. 
 
3) Check food-drug interactions. 
-NSAIDs, fluoxetine always with food whereas cloxacillin, norfloxacin, chloramphenicol always in empty stomach (1 hour before or 2 hour after meal) 
-For maximal effect omeprazole given 30 minutes before meals. 
-Instruct not to take ecess tea or coffee during course of aminophylline. 
 
4) Check possible interactions with OTC products. 
Rx Ciprofloxacin 500mg x 2 x 7 days 
Instruct not to take antacids during course of ciprofloxacin.  
 
5) Instruct possible pregnancy precautions. 
Rx Albendazole 400mg x 2 x 30 days 
If woman of child-bearing age then instruct not to become pregnant at least 1 months after completion of course. 
 
6) Check interactions with alcohol 
Rx Metronidazole 400mg x 3 x 7 days 
Instruct that metronidazole not be used concurrently with, or for at least 3 days following, ingestion of alcohol 
 
7) Provide general warnings. 
Name: XXXX Age: 2.5 yrs Wt: 15 Kg 
Rx Ibuprofen 100mg x 3 x 3 days 
Instruct not to give ibuprofen if child is dehydrated due to vomiting or other cause. 
 
Rx Chlorpheniramine 4 mg x 3 x 5 days 
Instruct not to drive after taking medicine. 
 
8) Instruct dose in final form 
Rx Mannitol 20% 50gram stat 
Instruct to use 250 mL of the mannitol 20% 
 
 
c) Injection related instructions 
 
1) Check whether the salt is appropriate for the route of administration. 
Rx Inj Hydrocortisone 100mg IVPush x 2 x 2 days 
Hydrocortisone sodium succinate can be given through IV. Hydrocortisone acetate should never be given through IV. 
 
2) Check route of administration 
Rx Adrenaline 1mg IVPush Stat 
Adrenaline 1:10000 strength can be given by IVPush. Adrenaline 1:1000 strength should be given by IM or SC (never IV) 
 
Rx Diclofenac 75mg IV x 2 x 3 days 
Diclofenac should never be given by IV. It should be given by IM. 
 
3) Instruct mode of IV administration 
Rx Ampicillin 1000mg x 4 x 5 days 
IV ampicillin upto 500mg should be given as IVPush. Ampicillin dose greater than 500 mg should be given as Intermittent IV. Continuous IV is not recommended for ampicillin. 
 
4) Instruct site of administration 
Rx Adrenaline 2mg IM stat 
Instruct to inject only into the anterolateral aspect of the thigh or the deltoid region of the arm. Do not inject into the buttocks, hands or feet. 
 
Rx Insulin mix (70/30) 20 Unit x 2 x 15 days 
Instruct to rotate the subcutaneous injection site so that the same site is not used more than approximately once a month 
 
5) Instruct rate of administration. 
Rx Adenosine 6 mg IVPush stat 
Instruct to give rapidly over 2 seconds 
 
Rx Ceftriaxone 1000 mg IVPush x 1 x 5 days 
Instruct to give over 5 minutes 
 
6) Instruct reconstitution and dilution method if dispensed to out patients 
Pharmacy technician should have clear knowledge how to reconstitute powders for injections and how to dilute injections.  
Rx Benzylpenicillin 1 million units IVPush x 4 x 5 days 
Add 3 mL of St.WFI to 1 million unit vial of benzylpenicillin and shake the vial vigorously. Dilute required dose with twice volume of D5W or NS 
 
Rx Ranitidine 50 mg IVPush x 2 x 3 days 
Dilute 50 mg or ranitidine to 20mL with NS 
 
Amphotericin should be diluted with D5 only. NS should never be used. 
 
d) Pharmaceutical factors 
 
1) Consider effect of preservative 
- Only preservative-free injections allowed to given intrathecally 
- Benzoate containing injections should not be used in neonates (<28 days) and mercurial-containing injections not be used in children under 6 months 
 
2) Breaking of tablets 
- Don’t break sustained-release or enteric coated tablets to give half of the tablet. 
 
3) Differentiate between plain and sustained relesase tablets. 
E.g. Nifedipine plain tablet can be used to reduce blood pressure in emergency condition. Nifedipine SR is ineffective in this condition. 
 
4) Check dosage form 
Isosorbide dinitrate sublingual tablet can be used in emergency and not the Isosorbide dinitrate plain tablet. 
 
5) Instruct stability information 
Instruct shelf life of reconstituted solutions and extemporaneous preparations. 
E.g. Amoxycillin powder for suspension. When reconstituted it expires after 7 days. 
 
E.g. After reconstitution ampicillin should be used within one hour and discarded after one hour. 
 
6) Check incompatibility among drugs mixed (especially for injections) 
E.g. Ceftriaxone should not be diluted with Ringer's lactate. 
 
 
Aseptic handling: 
Aseptic handling includes: 
1) Reconstitution, dilution and IV admixture methods and their calculation 
E.g. preparation of D7% with 1/5 NS from D5, D10 and NS 
 
2) Operate laminar flow hood 
3) Autoclaving and sterilization 
4) Parenteral nutrition calculation and preparation 
 
 
Compounding: 
Compounding includes: 
1) Tablet dilution 
E.g. Dilute 250 mcg tablet of digoxin for administration of 50 mcg to a child 
 
2) Preparation of extemporaneous preparations and deciding their appropriate shelf life