Rx Note

Introduction Giving medicines to infants and children can be challenging because they may refuse to take medications for many reasons, such as fear, taste, embarrassment or inconvenience. Choosing the Right Formulation When selecting medicines for children, it is important to consider factors such as Child's age Swallowing ability Ease of administration Accessibility of suitable formulations of the product Often, oral liquids are the preferred formulation for younger children as they are easier to swallow and allow for flexible dosing based on the child's age and weight. Multiple formulations of the same active ingredient are available and may contribute to dosing errors, such as paracetamol 120 mg/ml and 250 mg/ml suspension. Also, when choosing an oral liquid medicine, the following must be considered: Excipient content, including quantity and suitability Cumulative daily excipient intake from all products being taken Potential adverse effects due to excipients The risk-b...

Introduction A unit-dose medication distribution system uses medications packaged in unit-dose or single-unit packages. A single-unit package contains one dosage form of medication (e.g., one capsule, one 5 ml volume of liquid, etc.). A unit-dose package contains the dose of a medication ordered for a patient (e.g. two 250 mg tablets for a 500 mg dose). However, not all medications are available from the manufacturer in single-unit or unit-dose packages. Hence, pharmacies sometimes have to purchase medications in bulk containers and repackage them in unit-dose or single-unit packages. Important Elements Department's policy and procedures for repackaging should clearly outlines the following elements. Space or facility requirements Clean with adequate lighting and ventilation, as well as temperature and humidity controls Food and beverages must not be allowed in the repackaging area. Labelling format Generic name of medication Name of manufacturer or distributor Dosage form, inc...

Introduction Much of the public's perception of a pharmacist's role is shaped by their interactions in the ward and at outpatient or community pharmacies. However, a significant number of dedicated pharmacists work diligently in inpatient settings, ensuring accurate medication dispensing to hospitalized patients. Daily tasks often involve managing medication stock (through floor stock supply and filling medication trolleys ) and providing patient counselling, especially in wards without dedicated clinical pharmacists. Transition From Outpatient Pharmacy Having transitioned from outpatient to inpatient pharmacy, I personally prefer the latter due to reduced patient-related stress, such as dealing with aggressive patients and dispensing at crowded, noisy counters. Unlike outpatient settings with strict waiting time policies and crowded waiting areas, inpatient pharmacy work seems more flexible, but remains demanding. When staff are absent or in meetings, we still need to comple...

Introduction Beyond standard swallowing, some oral medications require specific methods for optimal absorption and effectiveness. Sublingual Sublingual tablets are placed under the tongue until completely dissolved for a rapid absorption, bypassing the liver first-pass metabolism . Asenapine (Saphris) - Do not split, crush, chew or swallow. Avoid eating or drinking for at least 10 minutes after administration. Desmopressin (Minirin) - Minirin oral lyophilisate 60 mcg is calculated to correspond to Minirin 0.1 mg tablet. Glyceryl Trinitrate - Do not chew, crush, or swallow sublingual tablet. Orodispersible Tablet Orodispersible tablets are solid unit dosage forms similar to conventional tablets, but they contain super disintegrants, which help them dissolve readily in saliva within a minute in the mouth, eliminating swallowing difficulty. Bilastine 10 mg (Bilaxten ODT) - The orodispersible tablet disperses rapidly in saliva and can be easily swallowed. Alternatively, it may be disp...

Introduction Dysphagia is the symptom of difficulty or discomfort during swallowing . Oropharyngeal dysphagia - Difficulty initiating swallowing or coordinating the movement of food or liquid from the mouth to the upper esophagus. Esophageal dysphagia - Difficulty transporting the food or liquid through the esophagus into the stomach. The 3 most significant consequences of dysphagia are Choking risk Aspiration pneumonia Malnutrition Common Causes Optimally, the assessment of swallowing function is performed by a speech therapist or speech language pathologist. The most common cause of oropharyngeal dysphagia is neurological , associated with conditions such as stroke or Parkinson disease, and swallowing can also be affected by drugs such as antipsychotics, barbiturates, anticholinergics, diuretics and mucosal anesthetics. Dysphagia occurring after stroke is reversible or improvable in a majority of cases; however, dysphagia associated with dementia or Parkinson disease has a poore...

Introduction Early Intravenous-Oral Switch Therapy (IVOST) is a key stewardship measure that can help to improve patient care and reduce costs. It involves switching patients from IV antibiotics to oral antibiotics as soon as possible, once they are clinically stable and able to tolerate oral medications. Benefits There are a number of benefits of IVOST, including Cost savings are achieved through lowering direct acquisition costs, eliminating the need for ancillary supplies, reducing pharmacy and nursing time, and shortening the length of hospital stay. Eliminating adverse events associated with IV therapy , such as infection and extravasation. Increasing patient comfort and mobility Increasing the possibility of earlier discharge Criteria Before a patient can be switched to oral antibiotics, specific criteria must be met. These criteria include Tolerating orally Patient is not nil by mouth. Oral absorption is not compromised (e.g. diarrhoea , vomiting, malabsorptive disorder, parti...

Introduction The absorption pattern of drugs differs considerably between individual drug substances, as well as between the different administration routes. A medication administration route is often classified by the location at which the drug is administered, such as oral or intravenous. The choices of routes in which the medication is given depends not only on the convenience and compliance, but also on the drug's pharmacokinetics and pharmacodynamic. The right route of administration and dosage form is selected to maximise outcome of treatment. To illustrate, 32 years old epileptic male with fever and infection on nasogastric feeds , prescribed with phenytoin 300 mg daily. Which dose form do you choose (capsules, suspensions or injections) and why? 48 years old patient with osteomyelitis, microbiological culture positive for the bacteria Methicillin Resistant Staphylococcus Aureus (MRSA). Which dose form do you choose (IV or oral) and why? 4 years old boy diagnosed with bron...

Introduction Halitosis (also known as bad breath ) is mostly caused by sulphur-producing bacteria that normally live on the surface of the tongue and in the throat. About 2.4% of the adult population suffers from bad breath. Because of bad breath, other people may back away or turn their heads. This can cause a loss of confidence and self-esteem. Causes There are many possible causes. Eating certain foods e.g. onions, garlic and spices. Smoking Poor oral hygiene Dry mouth Medications Dental issues e.g. periodontitis, gingivitis , dental caries Other chronic conditions e.g. gastric reflux , diabetic ketoacidosis, liver cirrhosis, kidney failure Management The treatment will depend on the underlying cause. Avoiding dehydration and good oral hygiene are important. Tooth brushing twice a day for 2 minutes with a fluoride toothpaste Daily dental flossing to clean between teeth Regular mechanical tongue cleaning/scraping if coating is present Consider mouthwashes containing antiseptic ag...

Introduction Angina (painful), bullosa (blister), haemorrhagica (blood-filled) is a very rare and benign condition of the oral mucous membrane, characterized by the sudden appearance of blood-filled blister(s) within the oral cavity. The first indication is a stinging pain or burning sensation just before the appearance of a blood blister. The risk of recurrence is 30% and the blister may appear on the same or in another location. Causes The exact mechanism of the disease is unclear, but probably multifactorial. More than 50% of the cases are related to minor trauma caused by Hot foods Restorative dentistry (fillings, crowns, etc.) Periodontal therapy Anaesthetic dental injections Treatment The blisters usually rupture in a day or two and heal spontaneously without any further scarring or discomfort. Blood tests may be carried out to rule out a blood disorder (e.g. thrombocytopenia, von Willebrand disease, leukaemia and some vasculitis) No treatment is usually necessary other than a m...