WHEEL CHAIRS

 A wheel chair is a chair with wheels to move a person who is not able to walk.

Wheel chairs are standard or battery powered. A standard wheel chair can be pushed by someone or moved
by rolling the wheels with patient’s hands. Other wheel chairs have a battery-powered motor to move the
chair.

 The lower front part of the chair has metal leg plates and footplates to rest the feet. The footrests may be
moved to the side of the chair or taken off. This makes it easier to get in and out of the chair and to store
the chair. The wheels usually have a lock to keep the chair from moving when the patient gets in or out.

Use

Precautions

 The floor must be clean, dry, and well lighted.

 All electrical cords must be out of the way.

 The patient should try to stay to the right side of halls (big rooms) and footpaths when outside home. This
gives

people room to move around the patient. The patient must slow down at corners. This gives the patient a
chance to see people or objects that might cause an accident.

1. N.B.
Standard wheel chair: A standard wheel chair can be used by most people. The standard chair comes ready-
made but changes to the chair can be made to fit your needs. Your caregiver will help you decide what your special
needs are and how to change your wheel chair.
Battery powered wheel chair: A motorized wheel chair gets the power from a battery. This battery is
usually near the floor on the back of the chair. The batteries are charged at night so that you have enough power to use
the chair the next day. Some motorized chairs have a toggle switch that you turn with your hand to move the chair. The
switch is usually turned in the direction you want to move. Other motorized chairs have a mouthpiece if you cannot use
your hands. Usually the mouthpiece is attached to a tube, which is connected to the motor. You blow into the
mouthpiece to move the chair. Another type of motorized chair has a chin device. This chin device may be attached to
an arm of the chair that is connected to the battery cable. You can push the device in the direction you want to move
with your chair.

2. CANES AND CRUTCHES

Cane

A walking cane serves two purposes:

(i) Weight transfer – It provides a mean to reduce the weight of the weak limb. e.g. if a patient carries a
cane on the side

of his weak limb and puts 50lbs of weight on it, then he transfers 50lbs off his weak limb.
(ii) Balance– During walking good balance is required. Whenever people walks by keeping their feet
apart the center of
 gravity (e.g.) transfers from on limb to another. When a foot is raised the e.g. transfers to the other foot to
avoid falling. This is called “waddling”. The patient should carry the cane on the side of his strong limb to
avoid waddling thus keeping the e.g. on the strong limb.

1. Cane Fitting
0
After holding the cane during walking the patient’s arm should make an angle of 150–160 (from vertical)
bend at elbow because it is the best position of firm support. Height of the cane: The tip of the cane is
0
placed at 4 inches in front of the toe and at 45 angle.

Crutches

Fore arm crutches:

They are commonly known as Canadian Crutches and Lofstrand crutches. It is a shaft made of wood or
aluminium channels. On the lower end a tip is fitted. On the upper side a collar or cuff is present so that it
encircles the fleshiest part of the forearm. The cuff is

open in one side so that the patient can throw away the crutch if the he / she falls. The handgrip projects from the
main shaft and it is held in a direction so that it points forward.
Commonly two-point gait is adopted.

Axillary Crutches

These are wooden or aluminiumm under-arm crutches. The crutch is fitted under the armpit. In erect condition there
should be 1.5 inches gap in between the armpit and the top of the crutch. The handgrip is positioned so that the
elbow bends when the patient holds the handgrip.
There are different axillary crutch gait:

1. Four-point gait: The safest and most common gait is four-point gait. Patient moves left crutch. Moves his
right leg forward. Moves his right crutch up to right leg. Moves his left leg forward. Moves his left crutch
up to left leg.

2. Two-point gait: Both left crutch and right leg move forward. Both right crutch and left leg move forward.

3. Three-point gait: There are two type swing-to and swing-through gait.

Swing-to gait: Both crutches move forward. Both legs swing forward simultaneously but up to a point in
between the two tips of the crutches.
Swing-through gait: Both crutches move forward. Both legs swing forward simultaneously but up to a
ahead of the two tips of the crutches.

4. Hemiplegic gait: Single axillary crutch placed in the strong side. Crutch moves forward along with the
weak limb. Strong limb moves then.

BED PANS

Use
Bed pans are used for collection of feces of bedridden patients.
Construction: It may be round or oval in shape. It may be made of plastic, stainless steel, enamelware or
porcelain. There is also available a smaller, sloping and flatter bedpan (called fracture bedpan) used for urine
collection of immobilized or overweight patients.
Precautions:
When using a bedpan the back and knee should be elevated. In patient’s home four or five pillows should be placed
behind the back for comfortable use of bedpan.

V APORIZERS
Use: The vaporizers generates hot steam for the relief of upper respiratory illnesses e.g. colds, sinusitis etc. Portable
room humidifiers are used to humidify rooms and chambers those are dried out by room heater during winter
season. The cool-mist generated by the humidifiers produce expectorant action in the upper respiratory tract.
Construction:
The vaporizer is a electric kettle to generate heat and steam. They are equipped with a regulator so that when they
are dry the heating unit automatically shuts off.
The portable humidifier is an instrument that produces a cool-mist to humidify the dry air of a room.
Precautions: The steam-vaporizers are very hot hence should be kept out of reach of children.

SYRINGES
Syringes are instruments intended for injecting injectable preparations in to the body or
its cavities. Classification on the basis of principle of action:
(a) plunger syringes e.g. hypodermic syringes
(b) bulb syringes e.g. ear syringes, ulcer syringes
(c) gravity syringes e.g. fountain syringes.
Classification on the basis of size:
(a) small: capacity less than or equal to 10ml e.g. hypodermic syringe
(b) medium: capacity ranges from 10 to 100ml in volume e.g. ear and ulcer
syringes.
(c) large: capacity more than 500ml e.g. enema and vaginal syringes.
Use:
Hypodermic syringes
These syringes are used to administer medication subcutaneously (under the skin),
intradermally (into the dermis), intravenously (into a vein or artery) or intramuscularly
(into the muscle).
e.g. Luer Syringes: In this syringe the outside barrel and the plunger are both made
of ground-glass so that they fit air-tightly. The barrel is graduated in ml or
minims or unit of insulin.
e.g. The tuberculin syringe (also called vaccine syringe) is a small syringe with
minimum graduation of 0.1 to 0.01ml per division.
e.g. The disposable syringes carry a single dose of an injection and also fitted with
the needle. They are packed in sterile packs. After administration the syringe and the
needle should be disposed off.
Precautions
To test the efficiency of a hypodermic syringe the tip is closed with a finger and the
plunger is withdrawn. If the plunger and barrel fits perfectly then the vacuum created in
the cylinder will prevent the withdrawal of the plunger.
HYPODERMIC NEEDLES
Hypodermic needles fitted with Luer syringes are of metal, and consists of a hub that
locks to the ground glass tip of the syringe by friction. The shaft diameter and length
varies.
They are made of stainless steel, carbon steel, chromium, nickeloid, platinum, platinum-
iridium, silver or gold.
Size: Selection of size of a needle in governed by four factors:
(a) safety, (b) flow rate, (c) comfort of patient and (d) depth of penetration.
Length: The length of the shaft (excluding the hub) ranges within 1⁄4 to 3 1⁄2 inches.
Gauge : The gauge of a needle is measured by the outside diameter of needle shaft. The
usual range of
diameter is 13 gauge (largest diameter) to 27 gauge (smallest diameter). Use:
(a) Long-bevel or long tapered needles are used for local anaesthesia, aspirating and for
subcutaneous administration.
(b) A short-bevel needle is used for intravenous injections, infusions and transfusions.
(c) A special short-bevel needle is used for intradermal and spinal administration.
(d) Some other special needles are available for abcess, eye, hemorrhoidal, tonsil,
laryngeal and
pneumothorax use.
FIRST-AID SUPPLY
The following items fall in this class: absorbent cotton, cotton balls and buds, sterile rolls
and pads of gauze, elastic bandages, disposable fabric tissues and underpads, eye pads,
sponges, tissues and towels, adhesive elastic bandages, aerosol adherent, spray dressings,
first-aid kits, scissors, scissors, tweezers, and applicators.
The family medicine cabinet
There is place in every home where the medicine is placed. This should contain
medicines, information literature on first-aid, poison antidotes etc.
Precaution:
The medicine cabinet should either be locked or completely out of reach of children.
Every bottle or box should be labeled clearly.
Unused prescription medication and OTC drugs and expired drugs should be removed.
3

Snake bite kits

Anyone in snake, bee or wasp country should carry snakebite kit. They usually are
available in compact plastic or metal case maintaining a tourniquet rubber or other lymph
constrictor, antiseptic, razor blade, or knife, one or more suction cups or syringes.
Hot water bottle
Hot water bottles are made of rubber and has an opening through which warm water is
poured inside and the opening is closed with a stopper.
Hot-water bottles are used as “face bottle” in neuralgia of the head, back pains,
spondilytis etc.
Precautions:
§ When filling hot-water bottle, it should be touched with the back of the hand or fore-
arm to insure that the temperature is not too high.
§ Bare rubber should never be allowed to come in contact with skin, or burns may
result. The bottle should be wrapped with a rubber pad, flannelette bags or even with a
towel gives necessary heat and comfort.
§ After use the empty hot-water bottles should be hung in inverted condition for
complete drainage of water.
§ Water of boiling temperature, oil, grease, alcohol or turpentine oil should not come
in contact with rubber bottle.
§ When not in use all rubber devices should be protected from direct light to avoid
hardening of rubber.
Ice bags
These are rubbers or rubberised macintosh bag with a large opening in the top to
introduce crushed ice.
Use:
§ In deep inflammation like appendicitis application of cold gives some relief.
§ Ice-caps are placed on the head in high fever conditions.
§ Collar-shaped rubber bags are used for throat inflammation.
§ Long ice-bags are required for throat and spinal inflammations.
Clinical thermometers
Thermometers are instruments used for measurement of body temperature. It is made of
glass with a capillary bored at the center. At the bottom a bulb full of mercury is placed.
Graduations are there in both Centigrade and Fahrenheit scale. The range given in the
scale is 35 to 420C and 94 to 1080F.
Use:
1. Determination of temperature in fever.
2. Determination of temperature to prepare the basal temperature graph to prepare the
ovulation chart.
Types of thermometer
Three bulb types of clinical thermometers are available:
(a) the oral type, having slender mercury reservoir most sensitive for taking temperature
from under the tongue.
(b) the rectal type has a blunt, strong, pear-shaped bulb for safety and ensure retention in
the rectum and
(c) the universal, security or snub is a small, sturdy, short bulb for oral and rectal use in
children and irritational
patients.
Taking body temperature
For oral temperature the thermometer is placed in the mouth with the bulb placed under
the back of the tongue. The lip should be closed. The thermometer is rotated from time to
time. In this way it is placed for at least 3 minutes.
Rectal temperature should be taken with a rectal or stubby bulb thermometer. The bulb is
first sterilized, lubricated with vaseline and then gently inserted deeply enough to pass the
constricting muscle, leaving about the thermometer exposed.
Babies should be held firmly face down, their buttock separated with one hand and the
thermometer held with the other hand. The thermometer should be placed at least for 4
minutes in the rectum.
Axillary (under arm) temperature is taken only when all other methods are immposible.
Normal temperature
Oral: 98.60F Rectal: 99.60F
Special features of clinical thermometers
The capillary has a constriction just above the bulb. When the bulb of the thermometer
comes in contact with high temperature the mercury rises through the capillary tube but it
can not come down on its own due to the constriction above the bulb. So clinical
thermometer is a self-registering device. After taking the reading the thermometer should
be shaken so that the mercury returns back into the bulb.
Precaution
1. Before taking the reading the thermometers should be sterilized by alcohol and shaken
down below 970F.
2. When taking the reading the thermometer should be held horizontally with the right
hand, about 1 ft from the eyes.
The thermometer is rotated slowly until the mercury is visible.
3. The bulb should never be held with the hand while taking reading.
4. After taking the reading the thermometer should be shaken own so that it is ready for
taking next reading.
5. Thermometers should never be exposed to heat sources, sunrays etc.
6. Oral temperatures should not be taken within 30 minutes after exercise, smoking,
eating or taking hot or cold fluid.

SYRINGES
Syringes are instruments intended for injecting injectable preparations in to the body or
its cavities. Classification on the basis of principle of action:
(a) plunger syringes e.g. hypodermic syringes
(b) bulb syringes e.g. ear syringes, ulcer syringes
(c) gravity syringes e.g. fountain syringes.
Classification on the basis of size:
(a) small: capacity less than or equal to 10ml e.g. hypodermic syringe
(b) medium: capacity ranges from 10 to 100ml in volume e.g. ear and ulcer
syringes.
(c) large: capacity more than 500ml e.g. enema and vaginal syringes.
Use:
Hypodermic syringes
These syringes are used to administer medication subcutaneously (under the skin),
intradermally (into the dermis), intravenously (into a vein or artery) or intramuscularly
(into the muscle).
e.g. Luer Syringes: In this syringe the outside barrel and the plunger are both made
of ground-glass so that they fit air-tightly. The barrel is graduated in ml or
minims or unit of insulin.
e.g. The tuberculin syringe (also called vaccine syringe) is a small syringe with
minimum graduation of 0.1 to 0.01ml per division.
e.g. The disposable syringes carry a single dose of an injection and also fitted with
the needle. They are packed in sterile packs. After administration the syringe and the
needle should be disposed off.
Precautions
To test the efficiency of a hypodermic syringe the tip is closed with a finger and the
plunger is withdrawn. If the plunger and barrel fits perfectly then the vacuum created in
the cylinder will prevent the withdrawal of the plunger.
HYPODERMIC NEEDLES
Hypodermic needles fitted with Luer syringes are of metal, and consists of a hub that
locks to the ground glass tip of the syringe by friction. The shaft diameter and length
varies.
They are made of stainless steel, carbon steel, chromium, nickeloid, platinum, platinum-
iridium, silver or gold.
Size: Selection of size of a needle in governed by four factors:
(a) safety, (b) flow rate, (c) comfort of patient and (d) depth of penetration.
Length: The length of the shaft (excluding the hub) ranges within 1⁄4 to 3 1⁄2 inches.
Gauge : The gauge of a needle is measured by the outside diameter of needle shaft. The
usual range of
diameter is 13 gauge (largest diameter) to 27 gauge (smallest diameter). Use:
(a) Long-bevel or long tapered needles are used for local anaesthesia, aspirating and for
subcutaneous administration.
(b) A short-bevel needle is used for intravenous injections, infusions and transfusions.
(c) A special short-bevel needle is used for intradermal and spinal administration.
(d) Some other special needles are available for abcess, eye, hemorrhoidal, tonsil,
laryngeal and
pneumothorax use.
FIRST-AID SUPPLY
The following items fall in this class: absorbent cotton, cotton balls and buds, sterile rolls
and pads of gauze, elastic bandages, disposable fabric tissues and underpads, eye pads,
sponges, tissues and towels, adhesive elastic bandages, aerosol adherent, spray dressings,
first-aid kits, scissors, scissors, tweezers, and applicators.
The family medicine cabinet
There is place in every home where the medicine is placed. This should contain
medicines, information literature on first-aid, poison antidotes etc.
Precaution:
The medicine cabinet should either be locked or completely out of reach of children.
Every bottle or box should be labeled clearly.
Unused prescription medication and OTC drugs and expired drugs should be removed.
3

Snake bite kits

Anyone in snake, bee or wasp country should carry snakebite kit. They usually are
available in compact plastic or metal case maintaining a tourniquet rubber or other lymph
constrictor, antiseptic, razor blade, or knife, one or more suction cups or syringes.
Hot water bottle
Hot water bottles are made of rubber and has an opening through which warm water is
poured inside and the opening is closed with a stopper.
Hot-water bottles are used as “face bottle” in neuralgia of the head, back pains,
spondilytis etc.
Precautions:
§ When filling hot-water bottle, it should be touched with the back of the hand or fore-
arm to insure that the temperature is not too high.
§ Bare rubber should never be allowed to come in contact with skin, or burns may
result. The bottle should be wrapped with a rubber pad, flannelette bags or even with a
towel gives necessary heat and comfort.
§ After use the empty hot-water bottles should be hung in inverted condition for
complete drainage of water.
§ Water of boiling temperature, oil, grease, alcohol or turpentine oil should not come
in contact with rubber bottle.
§ When not in use all rubber devices should be protected from direct light to avoid
hardening of rubber.
Ice bags
These are rubbers or rubberised macintosh bag with a large opening in the top to
introduce crushed ice.
Use:
§ In deep inflammation like appendicitis application of cold gives some relief.
§ Ice-caps are placed on the head in high fever conditions.
§ Collar-shaped rubber bags are used for throat inflammation.
§ Long ice-bags are required for throat and spinal inflammations.
Clinical thermometers
Thermometers are instruments used for measurement of body temperature. It is made of
glass with a capillary bored at the center. At the bottom a bulb full of mercury is placed.
Graduations are there in both Centigrade and Fahrenheit scale. The range given in the
scale is 35 to 420C and 94 to 1080F.
Use:
1. Determination of temperature in fever.
2. Determination of temperature to prepare the basal temperature graph to prepare the
ovulation chart.
Types of thermometer
Three bulb types of clinical thermometers are available:
(a) the oral type, having slender mercury reservoir most sensitive for taking temperature
from under the tongue.
(b) the rectal type has a blunt, strong, pear-shaped bulb for safety and ensure retention in
the rectum and
 (c) the universal, security or snub is a small, sturdy, short bulb for oral and rectal use in
children and irritational
patients.
Taking body temperature
For oral temperature the thermometer is placed in the mouth with the bulb placed under
the back of the tongue. The lip should be closed. The thermometer is rotated from time to
time. In this way it is placed for at least 3 minutes.
Rectal temperature should be taken with a rectal or stubby bulb thermometer. The bulb is
first sterilized, lubricated with vaseline and then gently inserted deeply enough to pass the
constricting muscle, leaving about the thermometer exposed.
Babies should be held firmly face down, their buttock separated with one hand and the
thermometer held with the other hand. The thermometer should be placed at least for 4
minutes in the rectum.
Axillary (under arm) temperature is taken only when all other methods are immposible.
Normal temperature
Oral: 98.60F Rectal: 99.60F
Special features of clinical thermometers
The capillary has a constriction just above the bulb. When the bulb of the thermometer
comes in contact with high temperature the mercury rises through the capillary tube but it
can not come down on its own due to the constriction above the bulb. So clinical
thermometer is a self-registering device. After taking the reading the thermometer should
be shaken so that the mercury returns back into the bulb.
Precaution
1. Before taking the reading the thermometers should be sterilized by alcohol and shaken
down below 970F.
2. When taking the reading the thermometer should be held horizontally with the right
hand, about 1 ft from the eyes.
The thermometer is rotated slowly until the mercury is visible.
3. The bulb should never be held with the hand while taking reading.
4. After taking the reading the thermometer should be shaken own so that it is ready for
taking next reading.
5. Thermometers should never be exposed to heat sources, sunrays etc.
6. Oral temperatures should not be taken within 30 minutes after exercise, smoking,
eating or taking hot or cold fluid.

4/8/20
Budgeting, Purchasing and Inventory Control in Hospital Pharmacy
Developing the budget
Budget- Short-range plan for future operations
12
34
56
à Define purpose of the unit
à Establish policies for its operation à Project the hospital’s growth
BUDGET
Three parts
a. Income accounts
b. Expense accounts
c. Capital Equipment
Requests
INCOME ACCOUNT
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4/8/20
EXPENSE ACCOUNT
Categories
a. Administration and general
b. Professional care of patients
c. Out-patient and emergency
d. Other expenses
PHARMACY DEPARTMENT
1. Salaries and wages
2. Supplies and expenses
3. Drugs and Pharmaceutical
4. Purchased Services
5. Miscellaneous
78
9 10
EQUIPMENT and CONSTRUCTION BUDGET
Purchasing and Inventory
Assures standard and specification for all drugs, chemicals, diagnostic agents etc used in pxs
DEFINITION OF TERMS
COMPETITIVE BIDDING
--- drug is used in large amounts and future use of the drug is certain.
QUOTATION REQUEST
----directed to manufacturer or supplier that would offer the drug at its lowest price
Annual inventories
11 12
2

13 14
15 16
17 18
4/8/20
Duties of a purchaser
1. Issues purchase orders
2. Maintains purchase records
3. Follows up on delayed orders
4. Initiates competitive bidding procedures
5. Obtains quotations from specified sources
Procurement and Requisition
o Determine, accredit and monitor supply sources o Evaluate suppliers’ performance
o Choose a buying strategy/ approach
o Monitor drug delivery
o Assess clinical pure outcomes o Evaluate new product
Procurement and Requisition
o Consult PTC concerning modification of drugs o Reject drug products based on a sound
judgement
o Obtain medicinal products which are required in the trust premises.
Ways of purchasing pharmaceuticals
Ways of purchasing pharmaceuticals
3 ways to get discount or savings
VOLUME CONTRACTS
DEALS
DISCOUNTS
3

19 20
4/8/20
Control on Purchases
Inventory turnover- cost of goods sold over fiscal period
Low turnover indicates:
1. Duplication of stock
2. Large purchases of slow moving items
3. Dead inventory
High turnover indicates: Small volume purchasing
VOLUME CONTRACTS
- Contracts covering total purchases of parenteral solutions, ampoules, tablets.
-rebate check at the end of the year.
DEALS
-represent that type of transaction that involves the purchase of a specified volume and receiving
certain merchandise at no additional cost.
Ex. 10 + 1 promo 3 + 2 promo
21 22
DISCOUNTS
o -prompt payment of pharmaceutical bills
Markings of Merchandise
<4- OVERSTOCKING
>5- UNDERSTOCKING
1- SOUND INVENTORY
Marking machine- date received, cost price & selling price
 23 24
4

4/8/20
Markings of Merchandise
12/13 P35.00 P47.25
*30% income
(Mark-up may differ according to dosage forms)
DEFINITION OF TERMS
COST PRICE
---Original price of an item
SELLING PRICE
---What consumers pay for when purchased directly
PROFIT
---Selling Price- Cost Price
25 26
DEFINITION OF TERMS
ACTUAL COST
---- all expenses in acquiring an item are added to the cost of items to establish what the goods
actually cost
COST
---- Actual value of the item when last purchased
DEFINITION OF TERMS
AVERAGE COST
----old stock + new stock/ total no. of units
27 28
29 30
EXAMPLE
S 8125
P 334,150 (minus tax)
Ordering Procedures
PRE-PRINTED ORDER FORMS Contains the ff information: •Name of the drug
•Dosage form
•Dosage
•Packaging (by box of 100s) •Amount ordered
•Unit price
5

4/8/20
Ordering Procedures
o Three copies of the order should be made, dated and countersigned by the person in charge of
the health facility.
o Two copies ( delivery note, invoice; supplier’s record)
o Third copy - hospital pharmacy
 31 32
33 34
RECEIVING OF ORDER
o Accompanied with a delivery note or an invoice showing the number of packages and their
contents.
o Number of packages should be checked immediately. Then, their contents can be checked.
Ex: Appearance, Expiry date, Labelling etc
35 36
6

4/8/20
Pricing of Drugs
1. Direct Personnel Costs
2. Drug costs
3. Other direct supply cost
4. Fixed overhead costs
5. Direct costs
6. Revenue Deductions
7. Profit margins
Pharmacy Pricing Methods
1. Percentage Mark-up method
2. Dispensing fee method
3. Per diem charge method
37 38
Considerations in designing a pharmacy pricing system
1. Collection of Charge data
2. Clerical and administrative item
requirements
3. Generation of adequate charge detail
4. Assurance of adequate revenue
Considerations in designing a pharmacy pricing system
5. Ease of logical revision
6. Explainability
7. Acceptance of third party payers
39 40
PHYSICAL INVENTORY
o Amount of stock or merchandise that is available for sale to present and future clientele.
Basic stock + safety stock
o The taking of total physical inventory in the pharmacy is usually required by the auditing firm
employed to audit the hospital’s fiscal operations.
DEFINITION OF TERMS
o Inventory turns - the number of times per year inventory is sold and replaced at cost.
o Procurement costs (ordering costs) - include but are not limited to the costs of placing the
order, receiving goods, and processing payment.
o Carrying costs - all costs associated with carrying maintaining inventories.
o Gross Margin Return On Investment (GMROI) – measures the operational profitability of a
pharmacy.
41 42
7

4/8/20
DEFINITION OF TERMS
o Basic stock - is the amount of inventory carried to meet an average demand level.
o Safety stock - the amount of inventory carried to account for fluctuations in demand and in
order cycle times.
o Order cycle time - is the amount of time that elapses between the placement of an order and the
receipt of the merchandise.
DEFINITION OF TERMS
o Monthly consumption
This is calculated from the exits recorded on the stock cards: add the quantities in the outgoing
column from several months (3, 6 or 12) and divide the total by the number of months.
o Working stock
corresponds to the amount of each drug consumed between supply of the pharmacy.
Example:
Working stock = monthly consumption / 3 mos.
43 44
Problem solving
In a Hospital Pharmacy, Profurex 750 mg IV seems to be fast moving. In the month of August, it
has reached 5,750 vials, in September 5,777 vials and in October had 6,004 vials dispensed.
What is the working stock for Profurex?
DEFINITION OF TERMS
o Quantity to order
The amount to order based on the information on the stock cards.
0rder = (working stock + safety stock) - remaining stock on the day the order was made.
45 46
Functions of Inventory Management
o Increase Profitability
o Get the maximum amount for the business'
investment
o Balancing supply and demand o Improving efficiency
o Establishing a safety stock and geographical specialization
METHODS OF INVENTORY
OPEN TO BUY METHOD
budget method limits purchases to a specific amount of funds available for purchasing
pharmaceuticals during a specified period.
SHORT LIST METHOD
identifies the items that are in short supply
47 48
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4/8/20
METHOD OF INVENTORY
MINIMIUM and MAXIMUM METHOD
is to determine when and how much to order of each item
STOCK RECORD CARD
used to record information on the movement of
goods in and out of the storage area.
Story of a rich man, poor man
49 50
STOCK CARD METHOD
o Movements of stock, in or out
o Theoretical stock level
o Consumption of consumers
o Orders to be correctly foreseen
o Assessment of what and how much has been
lost
LOSS= Theoretical- Actual Stocks
51 52
53 54
9

4/8/20
Information on stock cards
o The name of the product with DF and dose o Drug movements with dates
o Orders made and the date
o Inventories and the date
o Safety stock
o Maximum stock o Storage area
o Price
Return Policies and Procedures
• Ensure optimum health outcome of pxs
• Continue to practice good business
• Develop relationship with manufacturers or
suppliers
• Maintain the credibility of pharmacists
55 56
EXAMPLE
United Laboratory Amherst Laboratory Pascual Laboratory Glaxo Smith Klein Pfizer Laboratory
Product Recall
o Seldane (Terfenedine) – 1998
o Hismanal (Astemizole) – 1999
o Prepulsid (Cisapride) – 2000
o Baycol (Cerivastatin) – 2001
o ... most recently Vioxx (rofecoxib)
57 58
PRODUCT RECALL
A request to return to the maker a batch or an entire production run of a product, usually due to
the discovery of safety issues.
Product recall
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Product recall
Product recall
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NUTRITION
Pharm. 5L (Hospital Pharmacy)
Eduardo V. Soriano, Jr., RPh, MHA, MPH Assistant Professor 2
UPH-DJGTMU College of Pharmacy

Nutrition
• Study of food in relation to health
• Science of food, the nutrients and other substances.

Nutrients
• These are chemical substances in food that are needed by the body for proper functioning
• Its role includes: provide energy, building material, maintenance and repair, and support
growth.
• Types: Macronutrients (CHO, fats, CHONS) Micronutrients (Vitamins; Minerals)

Calories
• Units of energy
• Kilocalorie = kcalorie = calorie
• Used to measure energy in food
Energy Nutrient
Energy
Carbohydrate
4 cal/g
Fat (lipid)
9 cal/g
Protein
4 cal/g
 Example of Calorie Computation
2 slices of loaf bread with 1 teaspoonful of butter contains 2 g protein, 23 g carbohydrate and 5 g
of fat. What is its total calorie value?
Solution:
Protein Carbohydrates Fat
2 g x 4 kcal = 8
23 g x 4 kcal = 92
5 g x 9 kcal = 45
Total = 145 kcal

Malnutrition
• It is a pathologic state of poor nutrition.
• It is a generic term which encompasses the different clinical malnutrition forms.
• The different malnutrition forms result from a deficiency or excess of the macro and micro-
nutrients in general or from a multi-system dysfunction.

Types of Malnutrition
• Marasmus – a nonedematous syndrome characterized by gradual emaciation associated with
near starvation and predominant energy deficit.
• Kwashiorkor – a syndrome characterized by bipedal edema that progresses rapidly, associated
with predominant protein deficiency and varying degrees of energy deficit.

Types of Malnutrition
• Marasmic kwashiorkor – combines edema and emaciation associated with chronic energy
deficiency and chronic or acute protein deficit.

Nutrition Calculations IDEAL BODY WEIGHT

Ideal body weight (IBW) was initially introduced by Devine in 1974 to allow estimation of drug
clearances in obese patients.
Devine Formula:
Male Ideal Body Weight = 50kg + 2.3kg x (Height[in] - 60)
Female Ideal Body Weight = 45.5kg + 2.3kg x (Height[in] - 60)

Nutrition Calculations BODY MASS INDEX

• The BMI or Quetelet Index is a simple index of weight-for-height that is commonly used to
classify overweight and obesity in adults.
• It is defined as a person's weight in kilograms divided by the square of his height in meters
(kg/m2).
• BMI greater than or equal to 25 is overweight
• BMI greater than or equal to 30 is obesity.
http://www.who.int/mediacentre/factsheets/fs311/en/

Nutrition Calculations BASAL ENERGY EXPENDITURE

• also called basal metabolic rate or BMR
• This is the energy needed to carry out fundamental metabolic functions, such as breathing, ion
transport, normal turnover of enzymes and other body components, etc.
Harris-Benedict Equation:

Nutrition Calculations TOTAL ENERGY EXPENDITURE

• Total Energy Expenditure is calculated from age, gender, weight, height and the activity factor.
• Kcal/day = BEE x stress factor x activity factor

•
Nutrition Calculations PHYSICAL ACTIVITY LEVEL
The PAL is a way to express a person's daily physical activity as a number, and is used to
estimate a person's total energy expenditure.
In combination with the basal energy expenditure, it can be used to compute the amount of food
energy a person needs to consume in order to maintain a particular lifestyle.
•

Nutrition Calculations PHYSICAL ACTIVITY LEVEL

PAL = Total Energy Expenditure / Basal Energy Expenditure

TOTAL PARENTERAL NUTRITION

• TPN or Intravenous Hyperalimenattion
• A complete form of nutrition containing carbohydrates, proteins, fats, and added vitamins,
electrolytes and trace minerals as needed for the patient.