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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5497_Библиотеки_им_академика_М_И_Перельмана.pdf
Pharmacy Practice108
ImporImpor
ImporImpor
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tance of Automatic Drug Stop Ordertance of Automatic Drug Stop Order
tance of Automatic Drug Stop Ordertance of Automatic Drug Stop Order
tance of Automatic Drug Stop Order
• Prevents unnecessarily prolonged therapy (potentially
reducing risk of antimicrobial resistance, super-infection,
adverse events).
• Reduces drug costs.
• Encourages reassessment of need to change therapy or
route of administration.
• May be more useful in similar hospitals or in the event of
pharmacy staff shortages, where pharmacy clinical services
may be limited.
PTPT
PTPT
PT
C RC R
C RC R
C R
ole in Drug Safetyole in Drug Safety
ole in Drug Safetyole in Drug Safety
ole in Drug Safety
The major area of responsibility of the hospital pharmacist is
drug safety. Drug safety includes responsibility from
dispensing of drugs to drug administration and then to observe
possible adverse effects. The increased responsibility also
includes the moral, legal and professional obligations of the
hospital pharmacist of ensuring safety in handling and
administration of drugs. The following are the guidelines issued
by the committee to ensure the adequate safety in handling
and administration of drugs.
• The pharmacists should be aware of narcotic and
psychotropic drugs.
Automatic Drug Stop Order
Patient
Room
Medication(s) Exp. Date/Time
1.
2.
3.
4.
According to hospital policy. The medications listed above will
be discontinued at the date and time noted above.
Date/Time Placed
RPh.
Fig. 11.3: A typical automatic drug stop order
Pharmacy and Therapeutic Committee 109
• Is there proper regulation of dangerous drugs?
• Is there any physical verification of the drugs expired?
• Does the hospital provide adequate, safe work space and
storage facilities for the pharmacy?
• Is there a training programme for the pharmacist to teach
other professional about new drugs?
• Does the hospital have a drug formulary?
• Is the drug formulary periodically revised?
• Are externally used preparations separated from internally
used medications in the pharmacy and in the wards, etc.?
• Is there manufacturing? If yes, does it follow GMP?
PTPT
PTPT
PT
C C
C C
C
RR
RR
R
ole in Adverse Drug Role in Adverse Drug R
ole in Adverse Drug Role in Adverse Drug R
ole in Adverse Drug R
eactioneaction
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As a result of recent advances in drug therapy there is a
proportionate rise in the drug reactions in humans. So to gain
an understanding of the problems regarding drug reactions as
well as drug interactions and to formulate competent opinions
as to the give best type of prevention and treatment therapy,
the Pharmacy and Therapeutic Committee must take up the
responsibility of developing and formulating a procedure for
the purpose of the committee to solve the above mentioned
problems.
EMERGENCY DRUGSEMERGENCY DRUGS
EMERGENCY DRUGSEMERGENCY DRUGS
EMERGENCY DRUGS
Emergency drugs are those which are classified under this
category because they are needed immediately, like in case of
cardiac arrest and hypersensitivity. These dosages also should
be designed and can only be taken with a proper guidance of a
medical practitioner. There is list of medicine available in this
category.
“Emergency drugs are those medicines that are used in
critical or life-threatening conditions like cardiac arrest, septic
shock, convulsion, trauma, etc”.
These drugs help to treat symptoms to save patient life. So,
it is also called life-saving drugs.
Emergency drugs are usually found in the emergency tray
drug list, emergency trolley, ICU (intensive care unit), OT
(operation theatre), CCU (critical care unit), emergency ward,
and other areas of the hospital.
Pharmacy Practice110
The primary goal of using emergency drugs is to save patient
life. So, doctors generally preferred those:
a. Drugs that have a short half-life
If they use the long-acting drug, then the drug may have
long-term side effects. Due to this, the patient may die from
the drug’s side effects too. So, short-acting drugs are the
preferred choice in emergency conditions. These short-
acting drugs should have a half-life in seconds or minutes.
b. Drugs that have fast-acting
Emergency physicians are generally required that drugs
that provide immediate effects. These drugs have a very
short onset of action. They start to work within second or
minutes.
c. Route of administration
The intravenous (IV) route is the preferred route of
administration when the patient is in a life-threatening
condition.
But sometimes, drugs are also used in other parenteral routes
like intramuscular, subcutaneous, sublingual, etc., for different
medical emergencies.
List of Common Emergency DrugsList of Common Emergency Drugs
List of Common Emergency DrugsList of Common Emergency Drugs
List of Common Emergency Drugs
There are list of some emergency drugs that are most
commonly used in life-threatening conditions.
Inj. Adrenaline
Adrenaline injection is a drug of choice in cardiac arrest
(pulseless) conditions. When this drug injects into the vein, it
goes into the bloodstream and directly binds with the beta-1
receptor. As soon as adrenaline strongly binds with the beta-1
receptor, it gives potent cardiac stimulation or contraction by
the SA (sinoatrial) node.
Inj. Dopamine and Dobutamine
These are another two essential emergency medicines of the
catecholamine class. A higher dose of dopamine (10–20 µg/
kg/min IV) increases the blood pressure due to the
vasoconstriction effect. But at a lower dose of dopamine (5–10
Pharmacy and Therapeutic Committee 111
µg/kg/min IV), it stimulates the heart. Dobutamine (2–20 µg/
kg/min IV) is mainly used in acute (sudden) congestive heart
failure because this drug help to increases the cardiac output.
Inj. Calcium Gluconate
Calcium gluconate injection is used in emergency conditions
like cardiac arrest and cardiotoxicity. It is given 10% solution,
15 to 30 ml IV over 2 to 5 mins. Calcium gluconate starts to
work within 3 mins, and it is generally effective for 20 to
60 mins.
Inj. Atropine
Atropine is an antimuscarinic agent or parasympatholytic
agent, or anticholinergic drug.
This drug is used in emergency conditions when the heart
beats too slowly, like severe bradycardia. Atropine immediately
starts to work within 1 minute, and it is generally effective for
30 to 60 mins.
Inj. Magnesium sulfate
This drug should be available in every emergency area of the
hospital. As per a study, intravenous magnesium sulfate
injection is a drug of choice in torsade de points. Torsade de
points is a type of ventricular arrhythmia that can lead to
sudden cardiac death.
Magnesium sulfate is also used in eclampsia conditions
(hypertension + proteinuria + seizure during pregnancy) and
severe acute (or sudden) asthma attacks.
Inj. Mannitol
Mannitol is the preferred drug in emergency situations like
acute congestive glaucoma, shock, head injury, cerebral edema,
and stroke.
Mannitol is also used in acute kidney failure. It is contra-
indicated in pulmonary edema, severe heart failure, and anuria
(kidney stop producing urine).
Pharmacy Practice112
Inj. Furosemide
Furosemide is a powerful loop diuretic agent. It inhibits the
reabsorption of the following electrolytes—sodium, potassium,
and chloride ions.
It is used in emergency situations like:
• Pulmonary edema condition
• Edema, which is caused by liver disease, cardiac disease,
and kidney disease.
Furosemide starts to work within 15 mins after intravenous
administration, the half-life of furosemide is 1 to 1.5 hr.
Inj. Fosphenytoin (Fosolin)
Fosphenytoin is an antiepileptic drug. It is a prodrug of
phenytoin and is used in the treatment of status epilepticus.
Intravenous fosphenytoin injection controls the seizure by block
the sodium channel. It is recommended 15–20 mg/kg slow IV
push followed by continuous infusion 150 mg/min.
Nitroglycerin
It is also known as GTN (glyceryl trinitrate). Nitroglycerin
injection is primarily used to treat the high blood pressure
during surgery. Since it is an antianginal drug. So, it is also
used in unstable angina pectoris, coronary artery spasm, and
myocardial infarction conditions. Given sublingual to terminate
the angina pectoris attack. The sublingual dose is 0.3 – 0.4 mg,
and it starts to work within 1–2 mins.
Snake Antivenom
Snake antivenom is an emergency treatment of snake bites. The
snake bite may cause severe paralysis, breathing problem,
bleeding, and local tissue damages. According to a study, snake
antivenom is the only effective antidote in the treatment of snake
bite. It reverses the effect of snake venom, and this antivenom is
prepared by poisonous snake venom and horse serum.
Inj. Naloxone
This drug is mainly used in emergency conditions when
exposed to opioids (like morphine, heroin, etc.) poisoning. The
Pharmacy and Therapeutic Committee 113
overdose of opioids may cause cardiac arrest, respiratory
depression, and mental depression. Naloxone injection starts
to give effect within 2 minutes when given intravenously.
ROLE OF PTROLE OF PT
ROLE OF PTROLE OF PT
ROLE OF PT
C IN DEVELC IN DEVEL
C IN DEVELC IN DEVEL
C IN DEVEL
OPING EMERGENGOPING EMERGENG
OPING EMERGENGOPING EMERGENG
OPING EMERGENG
Y DRUGS LISTY DRUGS LIST
Y DRUGS LISTY DRUGS LIST
Y DRUGS LIST
Time factor is very important in emergency situations, so it is
necessary for the PTC of a hospital to get prepared boxes
containing emergency drugs which should be always available
for use at the bed-side containing label emergency kit. After
the emergency boxes have been placed in the wards, it is very
essential to check daily by the hospital pharmacist or nursing
supervisor. Following is the list of things in emergency boxes:
• Needles two each of 16, 18, 20, 21, 23 & 26
• Syringes of various range 1 ml, 2 ml and 5 ml.
• Files for breaking the ampoules, oxygen cyclinder, dialysis
unit, etc.
• Drugs like aminophyllin, atropine caffeine, calcium gluco-
nate, digoxin, ephedrin, heparin, salines for injection.
• Others drugs like aspirin venous canulation set, sterile
suction catheters, razor with blade, burn sheets, etc.
• The emergency box contains different syringes, needles,
ampoules, cutters. The list is constantly reviewed by the
PTC.
ISOLISOL
ISOLISOL
ISOL
AA
AA
A
TED KEY POINTSTED KEY POINTS
TED KEY POINTSTED KEY POINTS
TED KEY POINTS
• The Pharmacy and Therapeutics Committee (PTC) is a
policy framing and recommending body of a hospital which
directs the medical staff and the administration of the
hospital about therapeutic use of drugs.
• PTC is composed of physicians, pharmacists and other
health professionals with the inclusion of the medical staff.
• The PTC may by and large be composed of:
i. At least three physicians from the medical staff
ii. A pharmacist
iii. A representative of the nursing staff
iv. A hospital administrator with his/her designated an ex-
officio
Pharmacy Practice114
• The major functions of PTC are:
i. Advisory
ii. Educational
iii. Drug safety and adverse drug monitoring
• In order to avoid misunderstanding amongst members and
medical staff policies of therapeutic committee were
developed.
• The committee should meet regularly at least six times in a
year and also as and when necessary.
• Therapeutic committee consists of the following agenda:
i. Minutes of the previous meeting
ii. Review of the contents of hospital formulary for the
purpose of bringing it up-to-date.
iii. Review of ‘Drug Safety’ in the hospital.
iv. Review of investigational drugs currently under
processing in the hospital.
v. Review of side effects, adverse drug reaction, toxic
effects.
vi. Reports of various sub-committees.
vii. Repots of medical audit.
viii. Any other matter with the permission of chair.
ix. Vote of thanks.
• The inpatient prescribing drugs consist of following:
i. Routine drug orders
ii. Self medication
iii. Medications brought to hospital by patients
iv. Automatic stop order for dangerous drugs
v. Discharge prescriptions
• The outpatient prescribing drugs consist of following:
i. For control drug prescriptions, it requires physician’s
DEA number.
ii. In case of schedule 2 drugs (narcotics), these are limited
to 30-day supply, no refills
iii. Schedule 3 drugs (barbiturates) and schedule 4 drugs
(benzodiazepines), limited to 30-day supply, refilled up
to 5 times within 6 months of issue date.
• Autonomic stop orders for dangerous drugs includes
all drug orders for narcotics, sedatives, hypnotic, antico-
agulants and antibiotics should be automatically dis-
continued after 48 hours unless.
Pharmacy and Therapeutic Committee 115
• PTC role in drug safety includes responsibility from
dispensing of drugs to drug administration and then to
observe possible adverse effects.
• PTC role in adverse drug reaction includes understanding
of the problems regarding drug reactions as well as drug
interactions
• Role of PTC in developing emergengy drugs list in a timely
manner
• Emergency drug list should contain
i. Needles two each of 16, 18, 20, 21, 23 and 26
ii. Syringes of various range 1 ml, 2 ml and 5 ml
iii. Files for breaking the ampoules
iv. Emergency drugs like aminophyllin, atropine and
caffeine.
PRAPRA
PRAPRA
PRA
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONSCTICE QUESTIONS
CTICE QUESTIONS
VV
VV
V
erer
erer
er
y Shory Shor
y Shory Shor
y Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Define Pharmacy and Therapeutic Committee?
2. Give the composition of Pharmacy and Therapeutic
Committee (PTC)?
3. Write the significance of Pharmacy and Therapeutics
Committee?
4. What is the role of PTC in drug product defect reporting
programme?
5. What are therapeutic guidelines?
6. Write the members of PTC.
7. What is the role of PTC in emergency drugs?
8. What is the role of Pharmacy and Therapeutic Committee
in adverse drug reaction?
ShorShor
ShorShor
Shor
t Answer Tt Answer T
t Answer Tt Answer T
t Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Explain the process of development of standard thera-
peutics guidelines?
2. Write the organisation of Pharmacy and Therapeutic
Committee.
3. Write the significance of Pharmacy and Therapeutics
Committee?
Pharmacy Practice116
4. Describe the role of pharmacist in PTC.
5. Explain the function of Pharmacy and Therapeutic
Committee?
6. What are factors affecting the implementation and use of
therapeutic guidelines?
LL
LL
L
ong Answer Tong Answer T
ong Answer Tong Answer T
ong Answer T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. What are the role and responsibilities of pharmacist in
Pharmacy and Therapeutic Committee?
2. Describe the purpose and functions of PTC and how PTC
ensures drug safety in hospital?
3. What is the role of PTC in developing “Emergency Drug
List”?
4. Write the organisational structure and functions of PTC.
5. Explain P&T Committee. Discuss the role of this committee
in:
A. In drug safety
B. In emergency drugs
C. In automatic stop order for dangerous drugs
Objective TObjective T
Objective TObjective T
Objective T
ype Questionsype Questions
ype Questionsype Questions
ype Questions
1. Major functions of P&T committee are:
A. Advisory
B. Educational
C. Drug safety and adverse drug monitoring
D. All of the above
2. P&T Committee should meet regularly at least:
A. 6 times a year
B. 2 times a year
C. 4 times a year
D. 3 times a year
3. Emergency drug list should contain:
A. Band aids and gloves
B. Needles two each of 16, 18, 20, 21, 23, 26
C. Surgical instruments
D. None of these
Pharmacy and Therapeutic Committee 117
4. Match the following:
Prescribing Drugs
A. Inpatient i. Schedule 2 drugs (narcotics)
B. Outpatient ii. Routine drug orders
C. Inpatient iii. Schedule 3 drugs (barbi-
turates), schedule 4 drugs
(benzodiapienes)
D. Outpatient iv. Self medication
5. P&T Committee composed of
, and other
health professionals with the inclusion of the medical staff.
AnswersAnswers
AnswersAnswers
Answers
1. D 2. A 3. B 4. a-iv b-i c-ii d-i
5. Physicians, pharmacists