drug storage and stability

UNITED HOSPITAL LTD.

Mohammad Alauddin, B.Pharm (ADUST)Pharmacist- United Hospital Ltd

Presented ByPresented By

DRUG STORAGE & ITS STABILITYGENERAL IDEA ABOUT MEDICATION

DEPARTMENT OF PHARMACY

INTRODUCTION

INTRODUCTION

Hospital pharmacy may be defined as department of hospital wherein procurement, storage, compounding, packaging, dispensing, distribution & monitoring of medication are performed by graduate Pharmacist.

INTRODUCTION

INTRODUCTION

INTRODUCTION INTRODUCTION

Function of Pharmacy:

To ensure the availability of the right medication, at the right time, in the right dose, at the minimum possible cost to the patients.

To provide information concerning medications to physicians and nurses.

To serve as a counseling department To dispense all narcotic drugs and its

monitoringInventory controlSo on

DRUG STORAGE DRUG STORAGE

Proper storage of medication is always an important consideration during periods of extreme heat or cold. Drugs can undergo physical, chemical & microbial changes on storage.

Recommended storage conditions:Store below -50C (freeze)Store between (2 to 8)0C (refrigerate, do not

freeze)Store below 250C (air conditioning)Store below 300C (room temperature)

DRUG STORAGE

DRUG STORAGE

Drug Storage Room Standards:

A lockable room Adequate lighting A temperature of below 250C, with air conditioning

units that operate 24 hrs per day & are connected to an emergency power supply.

A vaccine refrigerator for storage of vaccines & anti-venom.

A nominated refrigerator for cold storage of pharmaceutical products that requires refrigeration.

Adequate shelving for appropriate storage of the different categories of drugs.


All drugs are grouped in the following categories:

Refrigerated ( Heat sensitive products)Oral ( solid & liquid )InjectableTopicalInfusionInhalationNon Drug

In the Central pharmacy or Pharmacy main store, all drugs are displayed or kept in different ways regarding the most easiest way to dispense.Like-

AlphabeticallyTherapeutic class wiseBrand wise and so on.



Drug storage Room Stock Control

Stock Inventory

1. Annual inventory2. Bi- annual inventory3. Monthly inventory4. Weekly inventory5. Real time inventory

To uphold quality standards in drug storage room:

Rotate stock so that the stock closest to expiry date is kept in front.

Maintain FEFO / FIFO / LIFO procedure.

Make sure that there is no expired drugs on the shelves.



First-expiry/first-out procedure(FEFO)

First-in/first-out procedure (FIFO)

Last-in/first-out procedure (LIFO)

DRUG STABILITY

DRUG STABILITY

Drug stability means the ability of the pharmaceutical dosage form to maintain the physical, chemical, therapeutic & microbial properties during the time of storage & usage by the patient.

Expiry Dates

Expiry date means that drug can not be used after this date due to the chance of chemical degradation, harmful to patient or low potency.

DRUG STABILITY DRUG STABILITY

If the expiry date is expressed as month/year only (e.g., 3/2013), this shall be interpreted to mean that the drug may be safely used through the last day of that month, i.e., 3/31/2013.

If the expiration date is expressed as month/day/year (e.g., 15/3/2013), this shall be interpreted to mean that the drug may be safely used through that day only.


Chemical stability of the active ingredient

As the rate of decomposition usually doubles for every 100C rise in temperature, it is important to comply with the storage conditions specified on the container.

DRUG STABILITYDRUG STABILITYOnce opened, the shelf-life of some products,

e.g. eye drops, will be determined not by decomposition of the active drug but by the risk of microbial contamination.

Stability after opening drug container

The stability of products is variable. A product which is stable in its container may become unstable once the container is opened.

DRUG STABILITYDRUG STABILITY

The expiry date will be shorter in case of-

Eye drops: can be used for one month after opening the droppers.

Antibiotic syrups & suspensions: generally can be used for one week by storage in room temperature & for two weeks by storage in refrigerator.

DRUG STABILITYDRUG STABILITY Ampoules: must be used immediately but the vials

(multi-dose) are stable for 24 h in the presence of preservatives.

Nebulizer solution: can be used for one month after opening.

Insulin: once punctured, it must be used within 28 days.

Syrup/Suspension (except antibiotics): can be used

for one month after opening. Tablets & capsules: remain stable in the package but

after removal expiry date will be changed.


Factors affecting drug stability: Temperature: high temperature accelerate

oxidation, reduction & hydrolysis reaction which leads to drug degradation.

PH: acidic & alkaline pH influence the rate of decomposition of most drugs. Many drugs are stable between pH 4 - 8.

Moisture: water catalyses chemical reactions as oxidation, hydrolysis & reduction reaction. Water promotes microbial growth.

Light: affects drug stability through its energy or thermal effect which leads to oxidation.

DRUG STABILITY DRUG STABILITY Oxygen: exposure of drug formulations to

oxygen affects their stability.Drug incompatibility: reactions between

components of pharmaceutical dosage forms itself or between these components & cover of the container.


Degradation processes mainly include:HydrolysisOxidation Photodegradation This is because of the chemistry of the

functional groups in drug molecules and the presence of water and oxygen. Even when factors such as water, oxygen and light have been controlled, degradation will still occur, but at a reduced rate.


HydrolysisThe rate of hydrolysis is affected by access to water and is prevented or lowered by reducing exposure to water. If a drug must be formulated in water, the solution is often buffered to a pH where the rate of hydrolysis is minimal. Substances which are particularly susceptible to hydrolysis are often packed in individual dose units.


Oxidation

Many drugs will react with atmospheric oxygen, so oxidation is a prime cause of degradation.

Control of the pH and protection from light may reduce the rate of oxidation of injectable solutions. The oxidation of some tablets, e.g. chlorpromazine, is reduced by individual blister packaging.


Photodegradation

When light is absorbed by a molecule, it is either re-emitted or transformed into physical or chemical energy. Physical energy is usually lost as heat.

Protection from light is achieved by packaging the products in amber glass bottles or by using coloured film for blister packed products.

Drug-food interaction

What is a drug-food interaction?

The interaction of medications and food is very complex and needs to be individualized for each patient and each medication. However, there are some generalizations that can be made.

A drug-food interaction happens when the food you eat affects the ingredients in a medicine you are taking so the medicine cannot work the way it should.


Are all medicines affected by food?

Not all medicines are affected by food, but many medicines can be affected by what you eat and when you eat it.

The food may delay or decrease the absorption of the drug. This is why some medicines (like azithromycin) should be taken on an empty stomach (1 hour before eating or 2 hours after eating).

On the other hand, some medicines are easier to tolerate when taken with food. Aspirin & Clopidogrel are irritating to the GI tract, so they should be taken after food.

Timing of Drugs - Before or After Food

Taking Drugs Before FoodFor quick action/fast absorptionFor acid sensitive drugs

Some drugs need to be absorbed quickly to have an effect, such as nitrates in angina, drugs to help sleep (hypnotics), drugs to reduce agitation (sedatives) & drugs to reduce vomiting . As food can slow the absorption of these drugs, they need to be taken on an empty stomach.


The acid in the stomach breaks down some drugs, so delayed emptying will mean that more of the drug is broken down, and less of the drug is available, so it will be less effective.

Some Medications which should be taken on an EMPTY stomach:

Alendronate, Bisacodyl, Captopril, Sucralfate, Azithromycin, Co-trimoxazole, Omeprazole, Lansoprazole, Levothyroxine, loratadine, Rifampin, Methotrexate Mycophenolate, Tetracycline ……….etc.


Taking Drugs With or After FoodFor drugs causing stomach upsetFor less soluble drugs

The acid in the stomach changes some drugs, making them more soluble and so more easily absorbed. This means that the drug will be more effective.


NSAIDs can cause stomach upsets by increasing gastric secretion. Taking these drugs with food can reduce the irritation to the stomach lining.

Some drugs have to be taken during or after meals to be effective – for example,

Orlistat is designed to block the absorption of some of the fat in food as a treatment for obesity.



Some Medications which should beTaken with FOOD:

Allopurinol, Clopidogrel, Co-Amoxycillin, Aspirin, Amiodarone, Diclofenac, Carbamazepine, Chloroquine, Spironolactone, Griseofulvin, Metronidazole, Valproic acid, Prednisone, Iron preparations, Bromocriptin, Ticlopidine, fenofibrate, mebendazole ………….etc.

TIPS TO AVOID DRUG-FOOD INTERACTIONS

Take medicine with a full glass of water. Don't stir medicine into your food because

this may change the way the drug works. Don't take vitamin pills at the same time

you take medicine because vitamins and minerals can cause problems if taken with some drugs.

Don't mix medicine into hot drinks because the heat may keep the drug from working.

Never take medicine with alcoholic drinks

TIPS TO AVOID DRUG-FOOD INTERACTIONS

NEVER TAKE MEDICINE WITH ALCOHOL

Over the Counter (OTC) medications

OTC medications are those medicines that do not require a prescription from a physician and are readily available to the public. This does not mean that they do not need to be taken carefully.

The most commonly used OTC medicines are : Pain Relievers Antihistamines Decongestants Cough medicines


Pain RelieversNSAIDS (non-steroidal anti-inflammatory

drugs) such as paracetamol, aspirin, ibuprofen,ketoprofen etc.

NSAIDS work by blocking the synthesis prostaglandins, which are involved in injury or infection and thus reduce pain, fever and inflammation.


NSAIDS can cause stomach upset and occasional gastrointestinal bleeding.

AntihistaminesHistamines are chemicals in our bodies that

produce itching and allergy responses. Antihistamines block these. Some common antihistamines are diphenhydramine HCl , chlorpheniramine etc.


Antihistamines can cause drowsiness. Be careful driving or doing any dangerous work. But, the Non-sedating antihistamines do not cause drowsiness and are now OTC. Some common antihistamines are loratadine, desloratadine, cetrizine & fexofenadine.

DecongestantsThese medicines work by shrinking/constricting

blood vessels in the nose and decrease congestion. The only over the counter decongestant is pseudoephedrine.


Cough Medicines

Cough medicines are two types: antitussives (anti cough) and expectorants (mucous reducer)

Dextromethorphan is the antitussive in most cough medicines.

Guaifensin is the expectorant that is mostly used. Cough Medicines can cause agitation and

confusion for some users.

Medication Safety Tips to avoid serious medication errors

Never take medication intended for someone elseNever keep medications that are expiredNever combine multiple medications in the same

bottleNever take medication that is not clearly markedDon't expect immediate resultsDon't stop taking your medication just because you

feel better especially, antibiotics.Keep all medication away from childrenTo know clearly about existing drug-drug interactions.

Medication Safety Tips to avoid serious medication errors

Patient Safety Solutions


Some proprietary (brand name) and non-proprietary names (generic name) sound or appear to be similar to other drugs when written or spoken. The existence of confusing drug names is the most common causes of medication errors & is of concern worldwide. There are many look and sound alike drugs that would result in medication error.

These errors may cause harm or even death to patients.

Patient Safety SolutionsBrand (Generic) Brand (Generic)

Abetis(Olmesartan) Abmis(Nutritional)

Agotin(Agomelatin) Agoxin(Digoxin)

Alagra(Fixofenadine) Silagra(Sildenafil)

Angicard(Glyceryl trinitrate) Angilat(Metoprolol)

Apresin(Fluphenazine+Nortriptylin) Aprocin(Ciprocin)

Arbit(Ibesartan) Barbit(Phenobarbitone)

Asmanyl(Theophylline) Asmavit(Nutritional)

Betaloc(Metoprolol) Betanol(Atenolol)

Codopa(Levodopa+Carbidopa) Cardopa(Dopamine)

Zelmac(Tegaserod) Zepac(Ketorolac)


Daomin(Metformin)

Brand (Generic) Brand (Generic)

Daonil(Glibenclamide)

Deslor(Desloratadine) Desolone(Desogestrel+Ethinylestradiol)

Flexifen(Baclofen) Flexicam(Piroxicam)

Imigra(Flunarizine) Edegra(Sildenafil)

Larcadip(Larcanidipine) Largactil(Chlorpromazine)

Monocast(Montelukast) Monocard(Isosorbide)

Norbit(Disopyramide) Barbit(Phenobarbitone)

Perkinil(Procyclidine) Perkirol(Ropinirol)

Ramace(Ramipril) Ramex(Chloramphenicol)

Patient Safety SolutionsHOW TO PREVENT THESE MEDICATION

ERRORS ?Manufacturers

Choose unique drug names, easily to write and pronounce

to ensure that there is no drug with similar name in the market.


Physicians

Clearly write the prescriptions with specific dosage form & strength

Avoid using short forms or abbreviation of drug names

Avoid verbal prescriptions to a maximum extent


Pharmacists/Nurses

Keeping LASA drugs separated from one another Double checking the drugContacting the physician in case of any

clarification regarding the prescription Becoming familiar with LASA drugs Emphasize LASA drug name differences on

computer screen by using methods such as --------


“Tall Man “ lettering

The practice of writing part of a drug’s name in upper case letters to help distinguish sound-alike, look-alike drugs from one another in order to avoid medication errors.

“Tall Man “ letteringU.S. Food and Drug Administration (FDA) encourages manufacturers to use Tall Man lettering labels to visually differentiate their drugs' names, and a number of hospitals, clinics, and health care systems use Tall Man lettering.

Examples…

BetaLOC vs. BetaNOL COdopa vs. CARdopaIMIgra vs. EDEgra SedNO vs. sedRONDOBUTamine vs. DOPamine hydrALAZINE vs. hydrOXYzine vinBLAStine vs. vinCRIStine

NATURE THE BIG SOURCE OF…

Think the source of !!!

ULTIMATELY…

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drug storage and stability

Health & Medicine