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Sometimes the actual size of the ampoule or vial is too small, so the labeling of the high concentration electrolyte (high alert) becomes difficult and covers the vital information including the expiry date.
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If the vials/ampoules are too small to label something simple like putting them into an alternative container that you can label easily may help. That way important information on the vial/ampoule will not be obscured. 
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  • What is the time taken for steady state to be established in adults for ( Mycophenolate mofetil ) ?
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Please bear in mind that there is a large interindividual variability in the bioavailability and therefore the plasma concentration of parent mycophenolate and active metabolite. The variation can b as large as 30%. You may consider checking the plasma concentration in critical cases.
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During this pandemic we have changed our complete ways of practicing of normal way, similarly pharmacist are also shifting toward a new concept of telepharmacy. How does it impact the society in long run. Both the positive and negative effects?
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Hello, On the Long run telepharmacy is the advanced way of Pharmacy in dealing with patients.
For its Positive effects: -Dealing with patients remotely
-Tracing the compliance of Patients
-easier way of communication
For its negative effects: -Elderly are the bigger population among patients thus they have low skills in using technology
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As a Pharmacist, which resource do you use to check whether the Excipients are safe for your patients or not? I have read in some references that Saccharin is hepatotoxic, and when I checked "Handbook of Pharmaceutical Excipients, Sixth Edition", I found nothing about that! So, can you help me with this dilemma?
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For excipients used in pediatrics see the Safety and Toxicity of Excipients for Paediatrics (STEP) database provided by the European Pediatric Formulation Initiative (EUPFI)
Best regards
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As a community Pharmacist, which guideline or resource do you follow for differential diagnosis of common ailments like common cold, allergic rhinitis, and other mild cases ? As well as the established pathway for OTC products to recommend in each of the above mentioned cases ? Do you follow "handbook of nonprescription drugs" or " community pharmacy symptoms diagnosis and treatment" or both combined or something else ?
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There are no guidelines or standards widely accepted for OTC medicines used in community pharmacies, as minor illnesses vary from one region to another. However, you may follow the WHO's brief guidance as you wish. In the UK, three reference books have been used by most pharmacy students and pharmacists:
1. Symptoms in the pharmacy: a guide to the management of common illness. 7th ed. Blenkinsopp A, Paxton P, Blenkinsopp J. Oxford: Wiley-Blackwell; 2014.
*** This book is recommended for pharmacy students and pharmacists, as it provides many good disease and medication points, esp. when to refer patients.
2. Community pharmacy: symptoms, diagnosis and treatment. 4th ed. Rutter P. Edinburgh: Elsevier; 2017.
*** Professor Rutter is an experienced community pharmacist himself and he spent many years writing this book to meet all purposes.
3. Minor illness or major disease. 6th ed. Addison B, Brown A, Edwards R, Gray G. London: Pharmaceutical Press; 2016.
*** It is interesting to see some OTC and P medicines used for both minor and major diseases.
Hope this helps.
Dr Win
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I have researched, and there are many available ways to manage cough in community pharmacy setting, so which resource or reference do you use ?
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I was wondering How do you utilize medicinal chemistry in your daily practice as a community Pharmacist ? or you are no longer utilizing it in any form in your daily practice ?
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If you know one drug is a free acid or free base you can predict what it will react with/precipitate out with in IV solution. Since some community pharmacy practices interface with home infusion, this can be a possible circumstance in which medchem would come into play.
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Would you consider exceeding the "Maximum Dosage" section within websites as overdose? Or there could be overdose even within the normal therapeutic window?
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Acetaminophen toxicity is related to the toxic metabolite that forms when the conjugation enzyme systems in the liver become saturated and N-Acetyl imidoquinone (NAPQI) is formed from the excess drug by the CYP3A4 and CYP2E1 enzymes.
This compound will bind to any available protein and thereby cause serious long term liver damage.
Glutathione can preferentially bind NAPQI if it is available, thereby reducing the levels sufficiently to avoid fulminant liver failure later. To increase the levels of reduced glutathione the patient can be treated with NAC which can also act as a NAPQI scavenger.
Acetaminophen is the most common drug reported for overdosing as it is easily available and also present in many formulations where its presence is not always known.
There are good reviews on acetaminophen toxicity, just search for them on the web.
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Why most websites report frequency of adverse reactions of drugs(In terms of common, rare, etc..)? Does this indicate causal relationship? Like common adverse reactions is established to be induced by the drug and not as an adverse event? Like here in the case of cetirizine or reporting the frequency serves another purpose?
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CIOMS generally gives this classification :
  • Very common ADR occurs in more than 1/10 patients who take the drug
  • Common (frequent) > = 1/100 and < 1/10
  • Uncommon (infrequent) >= 1/1000 and < 1/100
  • Rare >= 1/10000 and < 1/1000
  • Very rare < 1/10000
The frequency of ADR is often determined during the clinical trials, although clinical trials are more designed to assess efficiency than to detect side effects (as clinical trials do not include more than 3000, it is for example impossible to see very rare ADR).
During those clinical trials ADR are assessed with an imputability method, as it is done in real life with pharmacovigilance.
When a patient has a symptom, those data helps health professionals to see if it could be or not an ADR, and if so stop or not the drugs if needed (and ask an expertise).
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What is the allowable time frame for FLUCELVAX Quadrivalent 2017-2018 Preservative-Free Suspension for Injection to be out of the refrigerator?
FLUCELVAX Quadrivalent 2017-2018 Preservative-Free Suspension for Injection by Seqirus product information only allows for storage in the refrigerator. In order to dispense the vaccine efficiently at our institution, we are placing the vaccines in our Automated Dispensing Cabinet (ADC). We want to know if anyone has conducted studies on the vaccines to determine how long the product can be at room temperature without losing it activity/potency. This time is to allow us to stock the product in our ADC. 
Thanks
Akeem Bale, PharmD
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You may want to contact the manufacturer directly as they should have may have some information about their product stability under different conditions. That said, they probably prefer customers to maintain their product under the recommended conditions they have validated.
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I am a student researcher at the USC Leonard D. Schaeffer Center for Health Policy and Economics working on a project detailing the utilization drivers of Avastin (specifically, compounded Avastin intravitreal injections used off label for wet AMD) vs Lucentis, both drugs used to treat wet-AMD, in Medicare patients. Since 2008, we have seen a dramatic rise in the utilization of Lucentis (~$2000/dose) compared to compounded Avastin (~$20/dose) although the CATT report has shown the efficacy and side effect profiles of both drugs to be essentially the same. We are trying to figure out which drivers are influencing these pricing differentials by answering some of the following questions:
-Are there supply chain barriers in certain states that make it difficult or even prohibitive to obtain or use compounded Avastin?
-Are there state specific laws that make it difficult or even prohibitive to obtain or use compounded Avastin?
-How do physicians go about ordering/receiving compounded Avastin? Do they use purchasing groups? Do they compound the drug themselves in office? Do they use compounding pharmacies or outsourcing facilities?
-Are there any other influencers that may cause a physician to use one drug over the other?
Any information, data, charts, figures, or references related to the above topics would be greatly appreciated. Please feel free to contact me with any questions you may have.
Thanks for the help!
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Dear Holloway,
Doctors in Iran use hybrid pharmacies with outsourcing capabilities.
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How to improve hospital and clinical pharmacy service in developing nation like Nepal? How to shift pharmacy profession from product oriented profession to patients oriented health care professionals and how to encourage pharmacist/pharmacy technicians to do such practice in resource limited setting?   
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Hi Ramesh!
When I was working with a local government hospital in the Philippines, we started our Clinical Pharmacy by engaging key doctors who will approve of the idea of having one. We stressed on medication error prevention (there are a lot of researches available online can help justify this) and patient safety. We also talked to the nursing management and told them on the advantages of having a clinical pharmacist (how having one would make their job easier). This is almost the same strategy we did when we were establishing clinical pharmacy in a private - tertiary hospital in the same country. Do you have unit dose distribution in your hospital?
On how to encourage your pharmacists in the shift from product oriented to patient oriented - This is actually hard to do especially for those older Pharmacists who are already satisfied with what they are currently doing. This is easier to do with the younger ones (based on experience). You can make them realize that soon there will be no more room left for just dispensing pharmacists. There are a lot of dispensing machines that can actually take their place. So the need for this shift is important to make the other healthcare professionals and the patients realize the value of the pharmacy profession.
Being resource limited, you can actually start with patient counselling and drug information service. With that service, communication skills and product information are needed which will not be too expensive. The package inserts and MIMS are tools you can use..etc
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Looking for benchmarks for 72 re-admits to the Emergency Dept in acute care general hospitals.
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Consider using Emergency Department task workflow information routing to measure procedures that reduce readmission rates.
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I am interested in how health-care organizations (e.g., hospitals, insurers, pharmacies) and information intermediaries (e.g., drug compendium publishers, health IT developers, trade press) use and/or modify approved labeling for prescription drugs.  I'd appreciate references to the literature, whether peer-reviewed or "gray".
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Thanks for your reply.  I'm curious too!  :)
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What is the provision of disposal of primary pharmaceutical packaging material by patients in developed countries? 
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Dear Prof. Aldallal,
Thank you  for your valuable resource. However, most of the developed countries including Nepal lacking national legislation on this aspect where we sell lot of plastic and glass bottles to the patients during dispensing of medicines. Further, patients were unaware about the disposal of primary pharmaceutical  packaging materials. In this scenario, how we will generate evidence   on necessities of legislation on proper management of such materials.
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In managing a pharmacy inventory, it is impossible to keep your stock accurate with no human errors? Can anyone has an idea from an established literature; to what extent is the human error allowed in managing pharmacy inventory. For instance, in an inventory of worth 1 Million Rs.Pak, is a 3% margin of error acceptable?
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According to experts in mHealth (Mobile Health), mobile healthcare is the future of health care and expected revenue of investments in new technologies and smart phones is about 27 billion US dollars by 2017.
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As I said..here the artcile on mHealth in Malaysia. Also published in JMIR. The source I know. http://www.jmir.org/2016/1/e5/
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In pharmacies, most often, digital electronic devices showing only temperature records of inside and outside environments are used and the temperature is then recorded on manual spread sheet. Is this a standard protocol?
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In Norway, most pharmacies tend to use a libero logger, (in addition to a normal digital temperature device you check every day). The logger logs the temperature and this is then read by plugging it into the computer. It also gives alarms and stuff. http://www.elpro.com/en/products/data-loggers/ 
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How to design research about the benefits of application "one unit dose dispensing method" for inpatients in a hospital?
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Depends on your study design. See for its contribution to cost effectiveness and dose accuracy.
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Is there a simple way to do this? How accurate is this estimation? And, what is the best publication about this topic?
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Human equivalent dose (HED) mg/kg= Animal dose (mg/kg) × (Animal Km/ Human Km). Where Human Km= 37, Mouse Km= 3, Rat Km = 6
eg:- For mice 5 mg/kg
HED= 5 × (3/37) = 0.405 mg/kg
Km = Body weight (Kg)/ Body surface area (BSA) (m2)
Generally Human Km= 37 otherwise add body surface area (BSA) & body weight
REFERENCE: Sushil Middha- Kumann University
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As the system being implemented is only at pharmacy level, prescriptions will still be written manually. All the manual procedures will still be the same, and an additional step will be introduced : transcribing the prescription. The manual prescription will be transcribed into the system by a pharmacy staff. This is to facilitate the stock checking purpose and statistic collection purpose. This system will be implemented in the outpatient and inpatient pharmacy at all times and needs to be updated every time there's a new prescription. Please share your experience if any.
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Dear  R. Michelle Baker, it is a 350 beds hospital, we are implementing this Pharmacy Info System (PhIS) and it's a pilot project. There are many unknowns which we are discovering along the way. However, transcribing is part of the flow of this system and as Mr Sultan Salah mentioned we don't have additional personnel to fool proof this process. Will go through with the project team regarding the transcription errors that you have mentioned in your article and methods to capture them.
Both your input has been very helpful, thank you. 
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Thiamine has been reported to be depleted rapidly by ARV therapy causing peripheral neuropathy and lactic acidosis. The essence of thiamine supplementation in the course of ARV therapy is to replenish its reserve and prevent development of these untoward effects
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It is quite different to differentiate between chemical sellers and community pharmacy aside the wider range of drugs in the community pharmacy. However, the practice of pharmaceutical care in Ghana is prominent only in some private sectors and most of the public hospitals and other health facilities do little more to dispensing of medications and that still puts the medicines at the centre of the pharmacists instead of the patient as it is supposed to be the case. It is my desire to find out the reasons of this problem and make room for the delivery of effective pharmaceutical care to society.
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Make your study purely descriptive, Select a represent sample of community pharmacies and observe key elements in the process of dispensing and patients communication and record that as a descriptive and narrative manner
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I conducted a study on screening for cardiovascular disease risk factors which partly involved checking glucose and cholesterol level in participants using Point of Care Test kits. When the study was done I had no idea of seeking for ethical approval. Now that I would like to publish my findings I would like to know if there is a way of phrasing the ethical consideration for publication in a good journal without experiencing rejection.
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As an editorial board member and reviewer for several dozen professional journals over the past 30 years, I can say with some confidence that NO reputable peer-reviewed journal will accept research conducted on human subjects for participation without PRIOR IRB (i.e., duly constituted ethics review committee) approval. This process has "evolved" over the last 50 years in response to significant instances of abuse and endangerment of human research subjects --- sometimes with the "best" of intentions and sometimes simply as a means to achieve a desired end.
Unfortunately, "ignorance of the law" is, as they say, NO EXCUSE!!
I would suggest that, if positive or encouraging results were obtained in the first unapproved "study" , a new study be designed and receive appropriate IRB approval PRIOR to re-execution. Good luck!!
Sincerely,
Lou
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As the Doctor of Pharmacy is the emerging profession in branch of Pharmacy. I wish to know where exactly the Pharm.D can fit. As many people say many words of carrier... But eager to know what a Pharm.D graduate can do the best as specific to his professional skills exclusive to the Pharm.D
As in India, there are many P.G branches available as M.Pharmaeutics, M.Pharmacology, M.Pharmacy Practice, M.Clinical Pharmacy and M.Clinical Research etc. Every speciality has their own role to play in Patient care and Industry too. But what exactly the role of Pharm.D can be different from that of these speciality branches.
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I feel the 'Doctor of Pharmacy' is an appropriate professional degree in pharmacy which is started with a long delay in India. It can be bright career option in the field of Hospital Pharmacy, Clinical Research, Pharmaceutical and Drug Administration, Pharma-Academia, Rural Healthcare,and Pharmaceutical Care Research and Consultancy. But This could be possible only if Pharmacy Council of India dare to take some strict steps in active coordination with CDSCO and Ministry of Health and Family Welfare. Recently MCI announced to introduce B.Sc in Community Health programme which may cause great decline in interest to Pharm.D. programme as the said B.Sc. degree holders are suppose to practice in rural healthcare units, PHCs, and CHCs -- why not our pharmacy council take and active step to demonstrate the suitability of Pharm.D. course which hasalready been started in several Universities, to be a substitute of B.Sc - Community Health Proposed. By doing this lacks of jobs can be created exclusively for Pharm.d. and Pharm.D. (PB).