– responsible to give proper and informed
advice on medicine] 2) Promote the concept of
Introduction to Dispensing
DISPENSING
 Refers to the process of preparing and giving
medicine to a named person based on a
prescription
 it is the act by a validly registered pharmacist
of filling a prescription or doctor’s order on the
patient’s chart [usually refers to hospital setting]
(AO 63 s. 1989 – “Rules and Regulation to
Implement Dispensing Requirement under the
Generics Act of 1988”)
 refers to the sum of processes performed by a
pharmacist in relation to the sale of
pharmaceutical products, with or without a
prescription or medication order (RA 10918)
 Starts from reading, validating, and interpreting
of prescriptions
 Preparing, packaging, labeling, record
keeping [we have to record the patient’s
name, date of the prescription, medicines,
doctor] [keeping fully-served prescriptions],
and dose calculations
 Patient counselling [very important especially
when dispensing drugs that are OTC]
GOOD DISPENSING PRACTICE
 Ensures that the right drug, in the dosage form
indicated for the patient’s condition is
delivered to the right patient, in the prescribed
dosage and quantity with clear instructions and
in a package that maintains the potency and
stability of the drug
PHARMACIST
 “Is an indispensable provider of the medication
expertise” [we are absolutely necessary]
 Pharmacist refers to a health professional who
has been registered and issued a valid
Certificate of Registration (COR) and
Professional Identification Card by the PRC and
Professional Regulatory Board of Pharmacy
(BOP) (RA 10918)
ROLE OF PHARMACIST
 The World Health Assembly recognizes the key
role of pharmacist in public health and the use
of medicines
 Emphasize responsibility to: 1) Provide
information and objective advice on
medicines and their use [as Pharmacist, we are
pharmaceutical care [it is a practice in which
the pharmacist takes responsibility for a
patient’s drug related needs and they are held
accountable for a certain commitment] [it is
also the contribution of a pharmacist to the
care of individuals in order to optimize
medicines and improve health outcomes]
 Pharmacist can play a key role in helping
people to make informed self-care choices
 Increasingly, people are managing a large
proportion of their ailments without consulting
either a doctor or pharmacist
THE TEN STAR PHARMACISTS – [according to WHO,
a pharmacist should always possess the 10
characteristics including their specific knowledge,
attributes, skills and behavior that will support our
expertise which is as a Pharmacist]
1. Care Giver (Pharmaceutical Care Provider)
 Must provide a patient-centered and
outcomes oriented practice of
pharmacy
 Pharmacist as a key member of the
health care team, with responsibility for
the outcomes of medication therapy
 The pharmacist provides caring services
 Services must be of the highest quality
[we should view our practice as an
integrated and continuous with those of
the healthcare system and other
professionals]
2. Decision-Maker
 The foundation of the pharmacist’s
work must revolve around accurate
decisions that is made or taken
regarding: our appropriate, efficacious,
safe, and cost-effective use of
resources
 The Pharmacist must possess the ability
to: evaluate, synthesize data and
information, and decide upon the most
appropriate course of action
3. Communicator
 The pharmacist must provide a link
between physicians and patients, and
to other healthcare professionals
 Pharmacist must have effective patient
counseling skills
 Strong communication skills will enable
a pharmacist to establish the necessary
rapport to build a trusting relationship
  Major barrier during the dispensing of  The concepts, principles and
medicines commitment to life-long learning must
4. Leader begin with attending pharmacy school
 Whether the pharmacist finds and must be supported throughout the
him/herself in multidisciplinary (ex. pharmacist's career
team) caring situations or in areas  As you continue on your journey, you’re
where other healthcare providers are in still learning
short supply or non-existent, he/she is 8. Researcher
obligated to assume a leadership  The pharmacist must be able to use the
position in overall welfare of the evidence base (e.g., scientific,
community. pharmacy practice, health system)
 Leadership involves compassion and effectively in order to advise on the
empathy as well as vision and the ability rational use of medicines in the
to make decisions, communicate, and healthcare team [unbiased health and
manage effectively. A pharmacist medicines related information –
whose leadership role is to be medical information that are true and
recognized must have vision and the accurate]
ability to lead.  Richest source of data for researcher
 1) Transparency – any changes in the pharmacist is the community
pharmacy should be transparent, 2) pharmacist
Communication – proper 9. Agents for Positive Change
communication with your teammates is  Strong communication skills will enable
important, Accessibility – you should be a pharmacist to establish the necessary
accessible especially when you’re a rapport to build a trusting relationship
leader, 4) Respect – promoting a 10. Entrepreneur
culture of respect and equality among  The pharmacist must learn how to make
health workers is crucial to team market survey in the chosen area, plan,
building, 5) Trust – it will foster honest direct, manage a new pharmacy
conversations and it will allow business
employees to openly express their  Person who organizes and operates a
selves business that takes greater than normal
5. Manager financial risk in order to do so [think of
 The pharmacist must effectively other aspects: pharmaceutical
manage resources (human, physical knowledge, able to solve problems,
and fiscal) and information; he or she and continue to learn the laws and
must also be comfortable being policies]
managed by others, whether an
employer or the manager/ leader of a
health care team
6. Teacher “An effective communication with one type of patient may
 Participating as a teacher not only be totally inappropriate for another.”
imparts knowledge to others, it also
offers an opportunity for the practitioner SERVICES ARE DISTINGUISHED BY FOLLOWING
to gain new knowledge and to fine- FEATURES:
tune existing skills  The customer is a participant in the service
7. Life-Long Learner process
 “The life-long process of active  Services are produced and consume
participation in learning activities that simultaneously [services cannot be
assists individuals in developing and produced ahead of time and stored in
maintaining continuing competence, inventory]
enhancing their professional practice,  Services are perishable
and supporting achievements of their  Services site location is dictated by the
career goals”. consumer
  Economies of scale are difficult to achieve
in services
 Standardization of services is difficult
 Services are labor-intensive
 Output is difficult to measure
 Most important, services are intangible.
While there may be a tangible expression of
the service, in this case a prescription, the
cognitive evaluations and judgment of the
pharmacist always will remain intangible.
TYPES OF VARIABILITY IN DEALING WITH CUSTOMER
a. Arrival – customers do not want service at times
that are only convenient for the company [be
flexible with time]
b. Request Variability – customers’ standards are
not the same
c. Capability Variability – not all patients are
capable to buy branded medicines, that’s
why, generic medicines should always be
available
d. Effect Variability – how much energy will the
customer extent to facilitate service encounter
e. Subjective Variability – customers may vary
their opinion to what it means to be treated
well
What is a good customer service? – adapted from Karr
and Blohowiak, 1997
Delivering good customer service requires the
following:
 Solving customer problems with no hassle
 Solving customer problems promptly
 Providing people who know what they are
doing
 Providing people empowered to solve
customer problems
 Treating people with dignity and empathy
 Correcting mistakes when they are made
SERVICE ENCOUNTER
 The critical point in services
 It is the interaction between the service
organization, the service provider, and the
customer
 It is the familiar scene in the pharmacy where
the patient drops off and picks up the
prescription, as well as being counseled
“If someone has a good experience at your place of work,
they will tell at least three people, while disgruntled
customer will tell twelve people about an unpleasant
experience with a company.” – Orley Ray Wilson (1996)
in “ A Crash Course in Customer Recourse”
FIVE DIMENSIONS
1. Reliability – the ability to perform the
promised service dependably and
accurately
2. Responsiveness – the willingness to help
customers and provide prompt service
3. Assurance – the knowledge and courtesy
of employees and their ability to convey
trust and confidence
4. Empathy – the caring, individualized
attention provided to customers
5. Tangible – the appearance of physical
facilities, equipment, personnel, and
communication materials
*Of these five dimensions, reliability is most highly
valued by consumers. Nothing fancy is required;
just do what you say you will do. (Berry,
Parasuraman, and Zeithaml, 1994)
MEASURING SERVICE QUALITY
 Since services are for the most part
intangible, customers use a psychological
standard to evaluate services and service
quality
 In services, quality is defined by the gap
between the expectation for the service
and the perception of how it was delivered
SEVEN P’S OF SERVICE
1. Product – design, technology, perceived utility,
perceived convenience, perceived quality,
packaging, accessories, warranties
2. Price – skimming pricing, penetration pricing,
value based pricing, cost plus pricing, loss
leader pricing, cost leadership pricing
3. Place – distribution channels, web based
channel, peer to peer, multi-channel
4. Promotion – special offers, advertisements,
promotions, direct marketing, competitions,
joint ventures
5. Physical attributes – interface, artefacts,
facilities
6. Process – standardization, service delivery
7. People – employees, organizational culture,
customer service, customer relationship
management
When things go wrong:
  Service Recovery  “The customer doesn’t
expect everything will go right all the time;
the big test is what you do when things go
wrong. Occasional service failure in
unavoidable.”
CATASTROPHIC PRESCRIPTION ERRORS
 Defined as causing severe damage to a
patient that is not easily reversed, for
example, an error that results in a 4-day stay
in a hospital or worse.
 As a practical matter, a successful response
to a catastrophic medication error
proceeds through the following stages:
 Signal detection
 Preparation and prevention –
prepare to prevent those
catastrophic errors
 Containment/damage limitation –
to limit the immediate damage
 Recovery – involves establishing
procedures for short and long term
business recovery
 Learning
NONCATASTROPHIC PRESCRIPTION ERRORS AND
SERVICE FAILURES
 The damage is easily reversible
 Examples include: technicians re rude,
billings are late
 Five elements for service recovery:
 Apology
 Urgent reinstatement
 Empathy
 Symbolic atonement
 Follow up
 In a retail setting, the recommendations for
service recovery include discount,
correction, manager/employee
intervention, correction plus replacement,
apology, refund, and store credit
Invaluable Skills for Interaction with Customers
 To win a customer over, you need to establish
a rapport early on [this can be done by letting
them know you genuinely care and want to
help]
 Service begin with attitude – always positive
[100% Customer Service is 80% Attitude and 20%
Technique]
 Make an eye contact and smile [If you can’t
help a customer right away, let them know that
you will be with them as soon as possible.
Whatever you do, don’t ignore your customer]
 Customers don’t like to wait especially when
they have a problem they need to solve [A
prompt partial solution is better than a full
resolution that takes a long time]
 Keep the customer updated [If you promise to
look into something, do so, and do it promptly]
SPECIFIC ONES:
 Talk the talk
 Make sure dialogue is as effective as
possible
 Choose your WORDS CAREFULLY
 Choose a word that reflect a service
attitude
Example:
 “May I help you?” vs “How may I
help you?”
 “I apologize for the inconvenience”
 “I don’t know the answer right now,
but I’d be happy to find out for you”
 Show some empathy
 Empathy is MORE than Sympathy
 It means understanding the needs of
your customers
 No one likes having their questions met
with an apathetic or rude response
 Head customer criticism
 If customers constantly make the SAME
complaints, it’s a sign that your service
system needs improvement
 Let them down easily
 If you have to decline a customer
request to uphold a company policy,
DO SO IN A GENTLE WAY. When
possible, offer the customer an
alternate solution.
 Express your disappointment at not
being able to meet the customer’s
needs
Example:
 Discounts
 Purchasing antibiotic without
prescription
Standards for Face-To-Face Customer Service
 Greet customers with a smile and eye contact
 Believe it or not, SMILING can make you
relax and can positively influence your
mood
 It is important to customers when
greeting and speaking to them
 Never ignore a customer
 Acknowledge anyone who the
pharmacist encounter
  Thank customers who have waited, no
matter how long the wait
 It’s all in the name
 Customers feel important when you
show that you remember them from a
previous visits to your work environment
 NOTE: Its always best to address a
customer by their last name ( Mr._______
or Ms.________) or Ma’am / Sir, unless the
customer requests otherwise
 Actions speaks louder than words
 When a customer asks for directions
(location of a product), do not just point
toward the appropriate area, and take
the initiative to walk the customer to
where he/she needs to go. Same as
with how to use some of the medical
devices.
 People first, paper second
 Rather than answer customer’s
question by handling them a brochure
or information card, take the time to
personally help them.
 All’s well that ends well
 Last impressions are just as important as
first ones
 Make customers leave or hang up the
phone on a positive note
 Stay Friendly, maintain eye contact (If in
person), and remember to say “Thank
you!”
 TAKE NOTE: Remember to always ask
customers before they leave the
prescription counter if there are any
questions about their medications
 Follow the golden rule
 Follow the golden rule as it relates to
customer service
Standards for Telephone Customer Service
 Many employees view the phone call as an
interruption
 Something that should be dispensed as
quickly as possible
 REMEMBER: Telephone customer’s service is
just as IMPORTANT as any other activity that
you might be engaging in on a day-to day
basis.
TELEPHONE SERVICE PROBLEMS THE CALLER WISHES
TO AVOID
 Waiting while the phone rings continuously
 Being greeted in a rude fashion
 Being transferred to someone who is not
available or to someone who cannot help
them
 Being placed “ oh hold” for a long period
of time”
 Getting the call transferred several times
Good Customer Telephone Service
 Answer the Phone promptly
 The longer you let the phone ring, the
more impatient the customer gets
 Answering the phone quickly shows
your concern for the customer on the
other hand and it also portrays you as
efficient
 Identify yourself and the pharmacy name
immediately
 It is the polite and professional way to
answer the phone
 It confirms the customer that they have
reached the number that they
intended to call
 BE FRIENDLY: 1) Start with a helpful and
friendly attitude and 2) When you’re on
the phone, your voice always sounds
exactly like your face looks
 Have all the resources available
 Being unprepared gives the impression
that you don’t know what you are
doing
 USE THE CALLER’S NAME  It shows that
you are interested and attentive to him/
her
 Indicate your regret when applicable
 It is important to recognize when you
should express regret, and do so in a
genuine manner
 Example: If the customer was
disconnected from an earlier call
 Don’t interrupt
 It send message that you are not polite
or sensitive to what the customer needs
 It also implies that you are not
listening/missing critical information
 Transfer a call only when necessary
 Try to resolve the customer’s concern
yourself
 If you need to transfer a call Explain the
need to transfer
 Get as much information as quickly as possible
 Speak clearly to make you understood
 Speak slowly to make sure you are not
misunderstood

COMMUNICATION
 It is the transfer of information that is
meaningful to those involved
 A critical component of the pharmacy
education and practice
 The ability to communicate clearly and
effectively with patients, family members,
physicians, nurses, pharmacists, and other
health care professionals is an important skill
 Communication skills can be learned
through experience [poor communication
between a pharmacist and a patient may
result in an inaccurate patient medication
history and inappropriate therapeutic
decision]
 The goal of communication is
understanding. In fact, a message is
successful only when both sender and
receiver perceived it in the same way
 It is the process in which messages are
generated and sent by on person and
received and transferred by another
person. However, the meaning generated
by the receiver can be different from the
sender’s intended message.
ELEMENTS OF COMMUNICATION PROCESS
 “The process of sharing one’s ideas, thoughts
and feelings with other people and having
those ideas, thoughts and feelings understood
by the people we are taking with”
 In most communication encounter, we
typically do not have the opportunity to stop
and analyze the situations. However, to
improve communication skills, we need some
ability to assess a particular situation quickly
a. Sender
 In most situation, sender formulate
(encode) message before
transmitting them.
 However, in some cases, messages
are transmitted spontaneously
without the sender thinking about
them, such as glaring stare or burst
of laughter
b. Message
 It can be thoughts, ideas, emotions,
information, or other factors and
can be transmitted both verbally
(by talking) and nonverbally (by
sing facial expression, hand
gestures and so on)
c. Receiver –
 As the receiver, you “decode” the
message and assign a particular
meaning to it, which may or may
not be the sender’s intended
meaning.
 In receiving and translating the
message, you probably considered
both the verbal and non-verbal
components of the message sent
by the sender.
d. Feedback
 Feedback is the process whereby
receivers communicate back to the
sender their understanding of the
sender’s message.
 In the feedback loop, the initial
receiver becomes the sender of the
feedback, and the initial sender
becomes the receiver of the
feedback
 Feedback allows communication
to be a “two-way” interaction rather
than one-way monologue
 Feedback can be simple. Such as
nodding your head, or more
complex such as repeating a set of
complicated instructions to make
sure that you interpreted them
correctly
 During the communication process,
most of us tend to focus on the
message and frequently miss the
opportunity for feedback
CHARACTERISTICS:
 Maintain composure
 Describe, Do not Judge
 Be specific
 Make the feedback individual
  Solicit, do not impose
 Give suggestion to improve the
situation
 Be realistic and reasonable
 Have a goal or purpose to your
feedback ( do not just criticize)
 Start on a Positive note and end on
a positive note
PROVIDING INFORMATION & FEEDBACK
 K – keep
 I – it
 S – simple, and
 S – sensible
BARRIERS TO EFFECTIVE COMMUNICATION
1. ENVIRONMENTAL BARRIERS (Physical Barrier) –
such as a lack of privacy or furniture that
creates physical barriers between patients and
doctors/pharmacists can prevent effective
communication.
2. SEMANTICS (psychological barriers) – relate to
meanings of words and symbols used in
interpersonal communication.
Effective patient communication requires the use
of words that are carefully chosen.
Jargons should be defined or avoided.
3. PERSONAL BARRIERS – include: low self-
confidence, shyness, dysfunctional, internal
monologue, lack of objectivity. [Cultural
differences, discomfort in sensitive situations
and conflicting values to health practice]
4. POTENTIAL PHARMACIST-RELATED PERSONAL
BARRIERS – include: low self-confidence,
shyness, dysfunction internal monologue, lack
of objectivity, cultural difference, discomfort in
sensitive situation, and negative perception
about the value of patient interaction
5. ADMINISTRATIVE BARRIERS – such
management may view the lack of money
compensated for communication as a reason
not to communicate, More money is made by
prescribing medication, not caring for patient
(PROFIT-ORIENTED)
6. TIME BARRIERS – are interlinked with
administrative barriers because management
is responsible with staffing levels as well as
allocation of work duties. Time limits are very
common when it comes to pharmacist and
patients. Time restraints are often excused not
to counsel, though it often does not take very
long.
PERCEPTION – the meaning of message is
influenced by receiver’s perception of the
message
Importance of Perception in Communication:
Perception is important, because we to
interpret messages based on our perception of:
 What we believe the message says
 The individual sending the message
Perception of Meaning within a Message
 It is very easy for the patients to
misunderstand when you use abstract
terms, such as “Drink a lot of fluid.” What
does “a lot” mean to a patient? A glass? A
cup?
 Another example might be, instead of
asking patients if they “hurt a lot,” you
should ask them, “describe you pain on a
scale of 0 to 10 with 0 being no pain and 10
being the worst pain imaginable.”
Perception of Individuals
 Our perception of the message is also
influenced by our perception of the
individual sending the message, because
we tend to be influenced by a person’s
cultural background, status, and age
 These perceptions are further influenced by
any bias we have or stereotypes we hold of
certain groups of individuals
STEREOTYPES
 People who are mentally ill do not comply
with their medication regimens
 Nurses always complain about pharmacists
 Elderly people can’t hear well and always
talk too much
 People who talk slow are lazy
a  Women with red hair have a temper
Example:
 Patients may perceive you as an
uncaring, busy person who is
concerned only with filling prescriptions
and taking their money
  These stereotypes influence what they may
say to you and how they may listen to you.
If they perceive you as a professional, they
will listen to what you tell them about their
medications
Sharing the Same Perception
 One key to preventing misunderstanding is
try to understand and share the
perceptions of other individuals.
 Many times, using “ lay language” which is
familiar to patients, rather than medical
terminology, which is familiar only to health
care professionals, can enhance
understanding
 Determine the patient’s past experience
with medications or with the particular
drugs may also be helpful.
 Patients who have positive experiences
previously may be more willing to take the
medication.
 However, if their past experiences have
been bad, they may be reluctant to even
begin taking the medication.
Advice Pharmacists should follow when
Communicating with People of Different
Background
 Learn as much as you can about the
patient’s background including beliefs
about taking medications
 View diversity as an opportunity. With a little
patience and the right attitude, you will be
amazed at the opportunities that crop up
to help one another.
 Do not condescend. Patronizing behavior is
not appreciated and is recognized as such
in any culture
 Talk about your differences.
Misunderstanding will often take root when
people from differing background do not
talk to one another
 Be willingly to talk openly and with
constructive attitude.
MISUNDERSTANDING – How to prevent
misunderstanding?
Case Scenario
 A 9-month-old baby is admitted to the
hospital with a severe infection. You, the
pharmacist, speak with the mother upon
admission and learn that about 1 week
ago, her son had developed a minor
bacterial infection and received an
antibiotic
 The mother stopped giving her baby the
antibiotic after 4 days of therapy (rather
than necessary 10 days) because it
appeared that the infection was cured
 When you asked her why she stopped the
antibiotic, the mother stated that she was
just following the directions on the
prescription label: “Take one-half
teaspoonful three times a day for infection
until all gone.” The mother stated that she
gave medication until the infection was “all
gone”
 Unfortunately, the intended message was
that the antibiotic should have been given
until the liquid was all gone
 In this example, the mother understood the
words on the label, but she put them into a
different context and thus derived a
different meaning from the one intended
The social context also influences how messages
are received and interpreted.
The type of relationship that patients have with you
determines the level of acceptance that the
patients have regarding the information provided.
Research has shown that if patients perceive
pharmacist to be credible. Unbiased providers of
useful information, they will listen and retain more
information about their medication.
If they perceived pharmacist to be trustworthy and
honest, they will be more willing to approach
pharmacist for assistance.
To improve the communication process, we must
remember that people assign meanings to
messages based on their background, values and
experiences
MODES OF COMMUNICATION
a. Verbal communication – through words
b. Visual communication – through pictures or
printed materials
c. Kinesthetic communication – through body
language
d. Interpersonal communication – through
social interaction
e. Intrapersonal communication – within our
self
INTERPERSONAL – person-person spontaneous
communication [speaking or writing]
INTERPRETIVE – one-way receptive communication
[listening, reading, viewing]
PRESENTATIONAL – one-way, drafted, edited,
productive communication [speaking/writing]
OTHER TYPES OF COMMUNICATION
a. Small group communication
communication between and among
members of a team who meet for a
common purpose or goal (classrooms,
workplace)
b. Organizational communication
communication with and among large,
extended groups
c. Mass communication – communication to
a large audience via some mediated
channel such as television, radio, internet,
newspaper
d. Public communication – communication in
which one person gives a speech to large
audience in person (aka Public speaking)
FACTORS INFLUENCING COMMUNICATION
INTERCULTURAL COMMUNICATION – refers to
effective communication between people,
workers, patients with different cultural
backgrounds
Culture Differences [Why does culture differs?]
 History
 Educational background
 Social background
 Ethnic
 Religion
 Ecology
 Technology
Need for Intercultural Communication
 Success of any international business
 Allows workers from different cultures to work
together as a group
 Worldwide marketing campaign
 An increase in international business
 In pharmacy, to provide proper dispensing and
patient counseling to achieve optimum
 therapeutic outcomes
– CULTURE COMPETENCE
 PhilPSP:”...must be able to relate and
communicate with people of diverse
values, beliefs, background and
expectations in carrying out his/her
– important roles as medication expert”
 Acknowledge the uniqueness of each
client/ patient
 Deliver quality, effective unbiased care
regardless of age, gender, ethnicity/ race,
religion, socio-economic status and other
demographic identifiers
CULTURE RELATIVISM
 Cultures are unique and must be
evaluated, judge, and helped according
to their own values and standards
Prevention of:
1. Cultural Blindness – inability to be familiar with
or cognize (Know/understand) the culture of
others.
2. Cultural Bias – the firm position or stance that
one’s own values and beliefs must govern the
situation
3. Cultural imposition – inclination to impose
beliefs, values, and patterns of behavior on
clients from another culture.
4. Cultural pain – suffering, discomfort, or being
greatly offended by an individual or group that
shows a lack of sensitivity toward another’s
cultural experiences.
Techniques to Address Multicultural Issues
 Be aware of personal attitudes and
perceptions and multicultural issues
 Make concessions to cultural preferences
and customs
 Recognize poor literacy/ health literacy
skills
 Communicate in an understandable
language
 Be aware of nonverbal language
 Be assertive and empathetic
 Treat each patient as an individual
 Encourage feedback
  Involve family as needed but focus on the
patient
VERBAL COMMUNICATION – a type of
communication when you use words to transmit
message to other [writing]
a. Listening – you’re not simply hearing sounds
ACTIVE LISTENING
 It is a way of listening closely to what a
person has to say.
 It is done by giving the person your full
attention.
 You show interest and appreciation for
his thoughts and concerns. You commit
to him by letting him speak without
interrupting.
 AL lets you show your respect, support,
and concern for the other person.
 AL promotes trust between you and the
other person. You become a information
companion as you listen to his views.
HEARING VS. LISTENING
Hearing is passive Listening is active
Refers to the act Refers to the act
of perceiving a of making a
sound through conscious effort
the ear to perceive the
sound
Does not require Requires a your ability to listen well
a conscious effort conscious effort
involuntary Voluntary
Specific Terms for Verbal Communication
HEARING – We hear a series of words being spoken
by our clients.
ATTENTION – We provide the necessary time and
silence for the client to convey what they need to.
COMPREHENSION – To break down what is heard
by us to figure out what the client perceives as
important
AWARENESS – Recognition and realization of what
is heard and providing paraphrasing as needed
EMPATHIZING – Acknowledging the client that we
understand them and their story. Showing caring
and compassion for what is important to the client.
LISTENING – extremely important to effective
communication
GOOD LISTENING POOR LISTENING
Helps to get better Creates
misunderstanding
Saves time Wastes time
Solves problems Creates problems
Reduces errors Allows for mistakes
FACTORS THAT IMPACT LISTENING (Communication
Habits)
In addition to communication barriers,
some communication habits can interfere with
1. Multitasking – to do things at once (it
evident to patients that they don’t have
your full attention)
2. Planning ahead to what you will say next-
planning next point (Interrupting)
3. Jumping to conclusion before patients
have completed their messages (only
hearing parts of messages)
4. Selective listening – Focusing only on
content (listening with ears only but not
understanding)
5. Judging the person or the message as it is
being conveyed
6. Faking interest and perception
7. Communicating in stereotypes ways.
VERBAL LANGUAGE
 Reflecting the language of the patient will
help build rapport
 Usual: avoid MEDICAL JARGON and
terminology
  Gives clear assurance that messages are
communicated clearly.
 However, some patients may
knowledgeable about their condition or
medicine, using layman’s terms may send
out signals that you are not listening, or that
you do not respect the patient’s
knowledge
APPROPRIATE VERBAL COMMUNICATION
C Clarity Reconfirm that you
understand why the
patient
has come to you and
detail what their needs
are
L Listen Stay actively focused
so that you “hear”
what the
patient is saying
E Encourage Give the patient
confidence to talk and
share
with you
A Acknowledge Identify feelings, the
make it clear to the
patient
that you understand
R Reflect Repeat what the
patient says to be sure
that you understood
and show them that
you understood.
PROBLEMS IN ESTABLISHING HELPING
RELATIONSHIPS
 There are countless sources of problems in
interpersonal communication between
Pharmacist and Patients.
 However, certain pharmacist attitudes and
behaviors are practically damaging in
establishing helping relationships with
patients. These includes: Stereotyping,
Depersonalizing, and Controlling behaviors
be
LISTENING WELL
 Listening well involves understanding both
the content of the information being
provided and the feeling being conveyed.
 Skills that are useful in effective listening
include: Summarizing, Paraphrasing, and
Empathic responding (“Reflection of
feeling” statements that are verbally
convey your understanding of the essence
or emotional meaning of another person’s
communication. In addition, non-verbal
communication that shows caring and
attention to the patient)
BARRIERS TO COMMUNICATION
 A lack of skill and understanding of the structure
of discussion
 Inadequate knowledge of other
communication skills
 Lack of insights into other people’s
communication difficulties.
 A lack of inclination to communicate with
patients (lack of confidence, concerns related
to confidentiality)
 Personal Barriers: tiredness or stress, personality
differences
 Language barriers: Diverse dialects, culture
and literacy
 Organizational barriers: lack of time , pressure
of work and interruptions
 Physical barriers: Large countertops and
display areas behind which many pharmacist
work, Windows with security bars and
protective glass, Drive-through windows that
isolate the pharmacist from the patients,
Elevated pharmacy work area that
accentuates the pharmacist’s position of
authority and places the patient in inferior
position, and Communication with patients in
bed (hospital setting) patients in bed are easily
intimidated by people standing over them.
 Lack of Privacy: Common communication
barrier, do not discuss or debate non-specific or
specific patient data or health care issues in
public areas such as hallways, walkways,
elevators, cafeterias, libraries and parking lots,
 and do not discuss patient-specific information
with family or friends.
 The Telephone: Speak clearly, listen carefully,
be organized and state the fact clearly and
calmly, those initiating the phone conversation
should identify themselves by name and state
the purpose of the call.
BLOCKING BEHAVIORS
 When professionals find it difficult to move
away from medical concerns regarding the
patient in order to deal with “psychological
issues”, and struggle to adopt a more
negotiating and partnership style.
 Demonstrated if there is reluctance to ask
about the social and emotional impact of
problems on the patient and family
 Tendencies: increases patient’s distress,
take up too much time, and threaten our
own emotional survival
 From health professionals: Offering advice
and reassurance too soon in the discussion,
Explaining distress as ‘normal’, Considering
physical aspects only, Changing the topic,
and Jollying patients along
 From patients (reasons): A belief that
nothing can be done, They do not want to
burden the healthcare professional, They
do not want to seem pathetic, They feel
uncomfortable, and they worry
WRITTEN COMMUNICATION SKILLS
 Pharmacist must be able to accurately and
effectively document patient information in the
patient medical record, document patient
information in pharmacy medication profiles
and other pharmacy record, and correspond
with patients and other health care
professionals.
 Guidelines for Writing Medical record notes:
 Use black ink
 Write clearly and legibly
 Label notes with specific descriptive
headings
 Provide the dates and the time on the
notes
 Document the facts and avoid making
unsubstantiated judgments.
 Organize the information using SOAP or
freestyle format
 Sign the note with name and title
Strategies for Developing Strong Professional
Writing Skills (Remember, effective professional
writing is about your audience and its needs,
accuracy, clarity, concision, correctness, and
credibility or confidence in the author)
1. Accept the following truth: There are now
two writers in your head—general and
professional.
2. Invest in planning time.
3. Develop and use trusted colleagues as
proofreaders.
4. Let the document sit before sending it.
5. Adequacy can be a sufficient standard
ASSERTIVENESS
 Is a style of response that focuses on
resolving conflicts in relationship in an
atmosphere of mutual respect
 To be assertive, each person must be able
to directly and honestly convey “ this is
what I think”, “This is how I feel about the
situation”, “ This is what I want to happen”,
“ This is what I am willing to do”
 This type of communication allows people
to stand up for their own rights or what they
believe in without infringing on the rights of
others. You also attempt to understand the
other’s point of view even when there is
disagreement.
 The focus is on problem solving rather than
turning the conflict into a “Win/lose”
situation that damages the relationship.
ASSERTIVENESS SKILLS REQUIRED IN RELATING TO
PATIENTS
 Willingness to initiate communication
 Encouraging patients to be more
assertive with you
 Appropriate response to angry patients
 Empathic response
 Turn criticism into useful feedback
 Do not transmit messages through a
third party.
ASSERTIVENESS SKILLS REQUIRED IN RELATING TO
PHYSICIANS
 No need for anger or apology
 Always introduce yourself
 Apologizing makes you seem insecure
and unassertive
 Do no put the physician “ on the spot”
 Prepare your recommendation and
keep current references “ in reserve”
 Do not expect a “ pat on the back”
 EMPATHY SYMPATHY
The ability to Care for another
understand and share person’s problems and
another person’s feelings
feelings, experience,
etc
EMPATHY AND EFFECTIVE COMMUNICATION
 EMPATHY has many positive effects on a
pharmacist’s relationships with patients. It
helps patients:
 Come to trust you as someone who
cares about their welfare.
 Understand their own feelings more
clearly.
 To alleviate the patient’s sense of
isolation, this often accompanies an
illness experience.
 Facilitate the patient’s own
problem solving ability
NONVERBAL ASPECTS OF EMPATHY
Do a number if things nonverbally to
convey interest and concern:
 Establishing eye contact while
taking to patients
 Leaning toward them slightly with
no physical barriers
 Having relaxed posture
 Head nods and encouragements to
talk
 Tone of voice
 Establishing a sense of privacy by
coming out from behind the
counter
 Conveying that you have time to
listen
 Sensitivity to patients’ nonverbal
cues (feeling, tone of voice, facial
expression and body posture)
NONVERBAL COMMUNICATION
 Involves all aspects of communication
other than spoken or written words,
including facial expression, eye contact,
body position, touching, and voice
characteristics.
 Consists of meaning conveyed through
body language and facial expression
 Involves a complete mix of behaviors,
psychological responses, and
environmental interaction through which
we consciously or unconsciously relate to
another person
 Approximately 55% to 95% of all
communication can be attributed to
nonverbal sources
 Sit or stand at eye level, maintain eye
contact, and use a focused body posture
to convey interest and attentiveness.
 Sitting or standing at eye contact or lower
projects a nonthreatening, equalizing body
position that facilitates open
communication.
 Be physically close enough to the patient,
family members or health care
professionals for clear and comprehensible
communication but do not intrude on the
other person’s personal space
 Invasion of personal space induces
discomfort and may be perceived as
physical threatening; in either case,
communication is compromised.
 Certain gestures and postures provide clues
regarding the other person’s feeling (BUT
NOT THE SAME TO ALL)
Importance of Nonverbal Communication
1. Nonverbal communications are important for
three reasons:
2. They mirror innermost thoughts and feelings
3. It is difficult, and almost impossible to “fake”
during an interpersonal interaction
4. Congruence between verbal and non-verbal
messages: your non-verbal communication
MUST BE CONSISTENT with your verbal
communication or people will be suspicious of
the intended meaning of your message
Elements of Nonverbal Communication
 The manner in which you use your arms, legs,
hands, head, face, and torso may have a
dramatic impact on the messages that you
send.
 It should reflect interest, empathy sincerity,
respect
 In general, individuals from various societies use
different body movements to communicate
certain message
a. Body Language – a complex interplay of
factors including:
 Position: how we position our bodies
(folding arms or inclining the head)
and where we position ourselves in
relation to others;
 Facial expression: smiles, frowns
and raised eyebrows;
  Eye contact: whether we look at
others, and how we do it (staring;
looking away, sideways or over
someone’s shoulder);
 Touch: how and where we touch
ourselves, others, and objects
(spectacles, clothing or pens);
 Physical reactions: perspiring,
blushing or breathing rapidly.
b. Facial Expression
Why do we need Effective Communication Skills?
 To establish the necessary rapport to
building a trusting relationship
 To ensure an effective exchange of
information necessary to understand
patient’s need and provide tailored
counseling
 To achieve improved adherence with
medication use
 To increased satisfaction and improve
relationship
 Fewer unaddressed ADEs
 Improved patient trust in Pharmacist’s
advice and education
KEY POINTS
 Verbal communication includes the written
and spoken word
 Non-verbal communication includes facial
expressions, eye contact and posture
 Body language can enhance or detract from
communication with patients
 Observing patients’ body language can
provide important cues to how they are feeling
 It is important to reflect on verbal and non-
verbal communication skills and how these
affect relationships with patients
EFFECTIVE INTERVIEW SKILLS FOR PHARMACIST
INTERVIEWING
 Interviewing is an important component of
the disease management process
 Process of interviewing goes beyond asking
a series of pre-planned questions in a
certain order
Components of an Effective Interview
 Listening
 Probing
 Asking sensitive questions
 Use of silence
 Establishing rapport
INTERVIEW AND ASSESSMENT
 Educational Diagnosis Sequence
 Asses the patient needs to know
 Assess what the patient already knows
 Identify information gap
 Assess the patient’s ability to learn
 Determine the best way to instruct the patient
 After instruction, assess whether learning
occurred
LISTENING TECHNIQUE FOR PATIENT INTERVIEW
PROCESS
Listening is an ability which effectively enhances
the communication process. Listening techniques
for the patient interview process:
i. Stop talking. You can’t listen while you are
talking
ii. Get rid of distraction
iii. Use eye contact to show you are listening
iv. React to ideas rather than the person
v. Read nonverbal messages
vi. Provide feedback to clarify the messages.
This shows that you listen and are trying to
understand.
Probing
 Is the use of questions to elicit needed
information from patients or to help clarify
their problems or concerns
 Probing skills: 1) Organization of questions,
2) Introduce questions and explain
purpose, 3) Proceed from less to more
personal, 4) Proceed from general to
specific, 5) Group together by topic, 6)
Phrasing of questions
 Several things should be considered before
asking a questions
 The phrasing of the question (“What” or
“How” )
 Balance open-ended, close-ended and
mirror questions
 Avoid double-barreled questions
 Questions should be tactful and should
avoid unnecessary prying
 Several question is succession may
leave the patient with a sense of
being interrogated and, therefore,
may raise the level of defensiveness.
 The patient should be allowed to
finish answering the current
question before proceeding to the
next one.
ASKING SENSITIVE QUESTIONS
 Before asking, let the patient know that the
behaviors or problems you are asking bout are
common.
 Ask whether the situation has ever occurred
then ask about the current situation.
 Use of simple, clear –cut questions and a
matter –of-fact manner are critical.
 Embed more threatening topics among less
threatening topics.
 It may help to discuss the reason why you are
asking a particular question.
USE OF SILENCE
 Learn to treat “pauses” as a necessary part of
the counseling process.
 Many times, the patient needs time to think
about or react to the information you have
provided or the interview with unnecessary talk.
 “Talk ratio” should be in favor of the person
being interviewed.
STARTING THE INTERVIEW
 You should start the interview by greeting
patients by name
 Introducing yourself to patients if you do not
know them. This helps establish rapport with the
patients
 State the purpose of the interviews
 Outline what will happen during the interview,
and put the patient at ease.
 The purpose of the interview should be
stated in terms of the benefit to the
patient
 The amount of time needed
 The subjects to be covered
 And the final outcome should be
mentioned so the patient has a clear
understanding of the process
TIPS TO CONDUCT A MORE EFFICIENT PATIENT
INTERVIEW
1. Avoid making recommendation during the
information-gathering phases of the interview.
Such recommendations prevent the patient
from giving you all needed information and
can interfere with your ability to grasp the big
picture of patient need.
2. Similarly, do not jump to conclusions or rapid
solutions without hearing all of the facts.
3. Do not shift from one subjects to another until
each subjects has been followed through
4. Guide the interview using a combination of
open ended closed ended questions.
5. Similarly, keep your goals clearly in mind, but do
not let them dominate how you go about the
interview.
6. Determine the patient’s ability to learn specific
information in order to guide you in your
presentation of the material. Reading ability,
language, proficiency, and vision or hearing
impairment all would influence the techniques
you use in interviewing and counseling a
patient.
7. Maintain objectivity by not allowing the
patient’s attitude, beliefs, or prejudices to
influence your thinking.
8. Be aware of the patient’s nonverbal messages.
9. Depending on your relationship with patient,
move from less personal to more personal
topics. This may remove some of the patient’s
initial defensiveness.
10. Note taking should be as brief as possible.
 Effective communication between pharmacist
and patients or family members is extremely
important to pharmaceutical care
 Ineffective communication leads to confusion
and misunderstanding and may contribute to
inappropriate decision regarding the therapy
PATIENT TITLES
 Most health care professionals
automatically address patients by their first
name, even when meeting the patients for
the first time; some patients take offense at
being addressed by their first names,
especially if they are much older than the
health care professionals.
 Common courtesy dictates that patients
be addressed by appropriate title (Mr. Mrs.
Ms, Rev, Dr.), however use the correct title
[Ex. Do not assume that all adult women are
married, married or single, want to be
addressed as ”Ms”]
 The best way to avoid confusion is to ask
each patient how he or she wants to be
addressed. This approach conveys a sense
of respect for the patients, allows the
patients to expressed their preference, and
indicates to the patient how to address the
health professionals [Ex. “Hi I am Pharmacist
______, do you wish to be called Ms. or Mrs?,
“Would you prefer to be called Elizabeth?”]
 One exception to this approach is in
addressing disoriented, confused, or
sedated patients; these patients usually
respond better to their first names than their
titles.
RESPECT FOR THE PATIENT
 Display a genuine respect for the patient.
 Respond to the patient as a person, not a
prescription or case
 Maintain a professional relationship and avoid
exchanging personal information and
confidences with the patient,
 Remember: “ An interview is a conversation
with a purpose rather than a conversation with
a potential friend”
 Respect for the patient is conveyed by
acknowledging without judgment, patient-
specific attributes that may be different from
the pharmacist’s value system or even
offensive to the pharmacist.
 Attribute such as smoking, excessive drinking,
use of illicit drugs, self-destructive behavior,
non-adherence to prescribed regimen,
deficient hygiene and gross obesity may be
offensive but must be dealt with non-
judgmentally
PATIENTS’ FEELING AND EMOTIONS
 Although people seek help, they are most
often prompted by concern about their
health and condition (Strong feelings and
emotions)
 If the pharmacist are able to recognize and
understand them, they will be able to
interact and help patients more effectively
 Example of feeling and emotions:
 Anger
 Sadness
 Contempt
 Happiness
 Surprise
 Disgust
  Fear
QUESTIONING TECHNIQUES
 The pharmacist NOT the patient , control the
patient-pharmacist interaction
 The pharmacist controls the interaction by
controlling the types of questions asked and
the time allowed for patient response.
 Controlling the interaction does not mean,
however, that the pharmacist should fire off a
rapid sequence of yes/ no questions or abruptly
cut off patient response
 Early in the interview, ask open-ended
questions that allow patients to talk freely
about their medications and concerns.
 A good initial for both acute care and chronic
care patient is “What medications are you
currently taking?” use minimal facilitators such
as “yes”, “uh huh”, “what else” and provide
nonverbal encouragement by smiling and
nodding when appropriate.
 Give the patient time to answer
 Ask directed and structured questions after the
patient presented his/ her story or have begun
to stray from initial questions.
 Take time during the patient interaction to
summarize the information provided by the
patient. (This lets the patient know what the
pharmacist has learned, give the pharmacist a
chance to verify information, and ensure that
the pharmacist and the patient are in
agreement)
 Close the patient-pharmacist interaction by
providing a final summary of the information
obtained from the patient
 Let the patient make the final clarification or
add additional information.
 End the interaction by thanking the patient
pleasantly and say “good-bye”
PATIENTS INSTRUCTION
 Pharmacist tend to consider the
“prescription label” the primary
communication tool between the
pharmacist and the patient.
 Questions such patients to determine their
depth of knowledge and degree of
understanding; then develop a plan for
patient education.
 Assess patient needs in the context of the
following:
 Patient’s emotional status
 Educational background
 Intellectual ability
 Some patients want to know about their
medication, while other patients do not
want to know anything
 Balance the patient’s desire for information
with the need for information.
 Ask the patient to summarize or repeat the
information discussed
 Example: Do not assume that all asthmatic
patients know how to properly used a
metered- dose inhalers
MEDICAL JARGON
 Avoid medical jargons when communicating
with patients
 This may be challenging, but pharmacist must
able to translate commonly used pharmacy
and medical terms into lay terminology
 Patients misinterpret even commonly used
medical terms (ex. HPN, high blood, Diuretics
for diarrhea, generic- not good/ synthetic)
 The best way to avoid miscommunication and
confusion is to speak in plain English and use
concrete and specific reference
 Provide many opportunities for the patient to
ask questions
 Be aware that some patients, especially those
with chronic diseases, frequent contact with
the health care system, or a healthcare
background, may have sophisticated
pharmacy and medical vocabularies and may
be offended by the use of simplified lay
terminology.
Communication with Special Situations
a. SPECIAL SITUATIONS
 Pharmacist must be able to
communicate with patients who are
unable or unwilling to communicate
along generally accepted societal
norms.
 The patient’s situation or attitude may
compromise communication.
 Some patients are so stressed by acute
or chronic illnesses that they do not
adhere to common rules of courtesy.
 With comprehension difficulties:
 Simplify explanations
 Avoid difficult words
 Involve family and community
caregivers
 Use various counseling method
and aids
 Obtain feedback
 Follow-up
  Be patient but assertive and  Excessive nervous small talk
allow extra time as needed about unrelated matters
 Respect in the individual patient
and his/ her rights
 With disabilities:
 Be alert for signs of disabilities
among patients and learn more
about them
 Treat patients with disabilities
with dignity and respect
 Be prepared for feelings
 Offer assistance
 Allow extra time
c. ELDERLY
 Communicate appropriately
 They may have impaired hearing and
 Involve the patient and solicit
vision.
feedback
 They may not be able to read
 Emphasize nonverbal
prescription labels and other printed
communication
materials, or distinguish among similarly
 Use appropriate counseling
shaped dosage form.
methods and aid for patient’s
 Recognize feeling and attitudes
specific disability
towards aging
b. EMBARASSING SITUATION
 Conduct regular medication reviews
 Most patients find discussion related to
and be alert for DRP’s (Drug therapy
sex, intimate body parts and bodily
Problem)
functions embarrassing.
 Educate elderly patients about self-
 Converse with the patient in as private
monitoring and follow-up
environment as possible
 Allow time (take time to engage elderly
 Be sensitive to clues that suggest
patient in unhurried conversation)
potential embarrassment and
 Speak slowly, distinctly and avoid youth
communicate with patient in a
oriented vernacular or slang.
respectful, professional manner.
 Emphasize adherence
 Project a professional demeanor and
 Treat them with respect
put the patient at ease by discussing
 Select appropriate counseling methods
the issue in a straightforward,
and aids
scientifically appropriate manner.
 Involve caregivers and community
 Use anatomically corrects terms instead
supports.
of slang
 Use large print labels and printed
 Humor, which may be relieve tension,
materials and reinforce written
may make the patient more
information with verbal
embarrassed and should be avoided
communication.
 Clues to patients embarrassment
 Do not assume that every elderly
include the following:
persons has impaired hearing
 Avoidance of eye contact
d. Chronically ill patients
 Blushing
 “in denial stage about their disease
 Stammering is a speech disorder
 They present unique communication
in which the flow of speech is
challenges
disrupted by involuntary
 They may be sophisticated and or
repetitions and prolongations of
demanding health care consumers
sounds, syllables, words or
 Some chronically ill patients knows
phrases as well as involuntary
more about the management if their
silent pauses or blocks in which
disease than many health care
the person who stutters is unable
professionals; this situation may be
to produce sounds.
threatening for the pharmacist.
 Closed body language
  Assess the needs of each patient and
be flexible enough to communicate in
an appropriate level.
 Discussing sophisticated therapeutic
regimens may be pleasure with
pleasant and well-informed patients
but extremely difficult with bitter,
cynical (pessimistic) patients.
 Chronically ill patients must learn to live
with their diseases.
 A chronic illness is a long-term health
condition that may not have a cure.
Examples of chronic illnesses are:
Alzheimer disease and dementia,
Arthritis, Asthma, Cancer, COPD, Crohn
disease, Cystic fibrosis, Diabetes,
Epilepsy, Heart disease, HIV/AIDS, Mood
disorders (bipolar, cyclothymic, and
depression), Multiple sclerosis, Parkinson
disease
e. Terminally ill patient
 They often take complicated drug
regimens requiring detailed instruction
and monitoring
 Many terminally ill patients and their
families have to deal with the stigma of
frequent prescription of high dose
narcotics.
 Treat terminally ill patient with respect
and work with them to achieve optimal
therapeutic efficacy within the
complexities of their illness and health
care environment.
 They need close monitoring and
reassurance about their medication
regimen
 Work with the patient and their family to
legitimize the use of narcotics.
f. Mentally challenged patient
 Communicate clearly and directly with
mentally challenged patients and do
not assume that the patient is
incapable in participating in their
health care.
 Look beyond the disability and deal
directly with the patient
 Many degrees of mental retardations
are possible, be flexible enough to
assess the level to which each patient
can participate and communicate
appropriately for each situation.
g. Antagonistic patients/Angry Patients
 Common reasons: Delay in diagnosis,
Depression and frustration, Family
conflict over health issues, Untreated
pain, Money matters, Disappointment
and hurt in key relationship about
health, Feeling of being abandoned,
Feeling of being trapped, Disappointed
hopes, Multiple losses, and Other health
determinants (socio-economic status)
 The natural response to these type of
patient is to leave them alone and
avoid them as possible. However, these
patients deserve as much attention as
others
 The best way to deal with such patients
are to be as professional and direct as
possible an limit the length of
interaction to as short a period as
possible.
 In managing this type of patients...
 Non-judgmental listening and
validating the patient’s feelings
 Show care and concern the
patient is likely to move the
conversation to the cause of the
anger
 Identify other therapeutic
strategies to suggest and triage
the patient to medical
interventions
h. Difficult Patient/Hard to reach patient
 Includes those low socioeconomic
status, minorities and illiterate person
 Patients of low socioeconomic status
have few resources to deal with health
care issues. They may have little
knowledge about health care in
general and their own health in
particular and may have different
coping mechanism and expectations.
 Look beyond these issues and
communicate clearly and directly with
each patient as an individual,
regardless of the patient’s status
 These patients deserve as much
respect, time and information
 Help illiterate patients organized
complex medication regimen using
different sized bottles for each
medications or color coding the labels.
 “Medication Calendar” or schedule
i. Non-communicative and Overly
Communicative Patients
 Non-communicative patients never
volunteer information or express much
interest in anything anyone has to say.
  These patients answer all
questions with unenthusiastic
yes/no responses.
 To facilitate communication,
get the patient talking about
any topic and then ask simple,
open-ended questions that will
provide at least some of the
information being sought during
the interaction
 Overly Communicative Patients digress
when asked even simple direct
questions.
 The best way to deal with this
type of patient is to take firm
control of the conversation from
the start and redirect the
patient when he or she wanders
off the subject.
j. Mute Patients
 Muteness from endotracheal
intubation, Tracheostomy, or damage
to the vocal cords or trachea from
disease or trauma can be extremely
frustrating for patients
 Written communication and point and
spell letter boards can be timer
consuming but are often are the only
means for two way communication.
 Encourage these techniques and allow
sufficient time for adequate
communication.
 Maintain your end of conversation and
do not limit your verbal responses just
because the patient is mute
k. Hearing impaired patients
 Be sensitive to the potential for patients
to have hearing impairment do not
assume that all people with hearing
impairment can read lips or understand
ASL (American Sign language)
 Also do not assume that a hearing aid
return the patient’s hearing to normal.
 Do not assume that hearing impaired
patients have diminished intellectual
abilities.
 Communicate as clearly as possible
with hearing impaired patients,
verbalize slowly and distinctly, minimize
background noise
 Face patients who can read lips and
avoid turning away from the patient
during conversation
 Written conversation may be necessary
for two-way communication.
l. Physically Challenged Patients
 They often have to deal with multiple
communication
 Communicating with physically
challenge patient is no difference that
communicating with physically able
patients.
 Engage the patient in an unhurried
conversation and give the patient
ample time to respond
 Speak directly to the patient and do not
assume that the patient is incompetent
 Do not assume that the person
accompanying the patient is the
patient’s caregiver
 Do not stare at the patient and avoid
eye contact and do not physically assist
the patient unless invited to do so by the
patient.
m. Children and Pediatric Patients
 Communicate directly with pediatric
patient as well as the parent and
guardian, do not assume that the
children have nothing to contribute to
their health care
 Information must be age appropriate
“ask “why are you going to take the
medication?” “this med. Weill help you
breathe better”
 In-depth information exchange is
appropriate for many preteen and
teenagers. (Direct communication is
important, they exert considerable
control over their lives and need to
understand how to use the
medications.)
COMMUNICATION WITH THE HEALTHCARE
PROFESSIONALS
 Effective communication between
pharmacist, physician nurses and other
pharmacist is essential.
 Poor communication nor only leads to
frustration and lack of respect among
professionals but also may compromise patient
care if important information is misunderstood,
ineffectively conveyed or left out.
a. Pharmacist-Physician Communication
 They often have to deal with multiple
communication
 Communicating with physically
challenge patient is no difference that
 communicating with physically able
patients.
 Engage the patient in an unhurried
conversation and give the patient
ample time to respond
 Speak directly to the patient and do not
assume that the patient is incompetent
 Do not assume that the person
accompanying the patient is the
patient’s caregiver
 Do not stare at the patient and avoid
eye contact and do not physically assist
the patient unless invited to do so by the
patient.
b. Physician-Pharmacist Communication
 Reasons for Communication
 Untreated conditions
 Improper drug selection
 Dosage too high
 Sub therapeutic dosage
 ADR and S/E that cannot be
tolerated or won’t go away
 Drug interaction
 Unnecessary drug therapy
 Compliance problem
 Request for additional
information about the patient
Communication Consideration
 The entire focus should be on
attacking problems or issues, NOT
people or personalities
 Make sure professional boundaries
are respected
 Make sure that you listen
completely to the physician’s
rationale for the decision made
USE 4F Communication: “I know how you
FEEL, I FELT the same way, too, but FOUND
in the literature.....” and stayed FOCUSED
on the problem”
Handling the Communication
 Begin by identifying yourself
 Identify the patient whom you are
too discuss
 Present the issue or concern that
you have identified
 Do not be judgmental
 Use professional rapport to gain
respect
 Be prepared to discuss the issue on
a professional level
 Propose a solution
 Await feedback
 You may not always have all of the
answers to the questions that follow
 Be comfortable saying that you
don’t know the answer at the
moment, that you will look into it
and get back to the provider as
soon as you can
 The provider will respect that you
provide information about which
you are confident
 Over time, you will build a working
relationship with the physicians and
nurses that you will work with.
KEY POINTS:
 Successful communication of information,
ideas, and concepts is an integral skill that must
be learned, developed, and use by all
dispensers
 Relationship between patients and dispenser
provide the basis for effective and valued
communication
 Understanding feelings properly and emphatic
responding strengthens the therapeutic
alliance between the patient and the
dispenser
 Good communication with providers and
patient is essential for successful care and
treatment
 The provision of pharmaceutical care requires
a collaborative relationship and team work
with providers.
c. Pharmacist-Nurse Communication
 Unfortunately, most pharmacist-nurse
communication takes place because
of drug distribution error; much of the
tension between the two professions is
based on their interaction.
 Nurses are pressed to obtained and
administer medications, and
pharmacist are frustrated because
“non-stat” request are presented as
“emergencies”
 The pharmacist and nurse end up in a
“tug-of-war” over work priorities, which
can lead to lack of respect and poor
communication on the part of both
professionals
 Pharmacist and nurses must treat one
another with respect.
 Both professionals must realize that they
share the same goal (OPTIMAL PATIENT
CARE) and are on the same patient
care team.
  Communication should be clear, to the
point, and timely.
d. Pharmacist-Pharmacist Communication
 Pharmacist on the patient care team
need to update consulting pharmacists
frequently
 “Clear and Proper endorsement during
the change of shifts”
HEALTHCARE PROFESSIONALS
 Health care professionals include physician,
pharmacist and nurses.
 Allied healthcare professionals, also known
as “paramedical”, provide health care
services and perform tasks under the
direction of physicians.
a. Physicians
 Doctors who have medical or
osteopathic degrees, are generally
considered the health care team
leader and have the ultimate legal
responsibility for the patient
 Allopathic physicians rely on standard
treatment modalities
 Osteopathic physician use the
additional techniques of spine and joint
manipulation to treat disease.
 Many internist (physician specializing in
internal medicine) elect to specialize in
a subspecialty such as nephrology,
cardiology, oncology, pulmonary
disease, infectious disease or neurology
 A physician must graduate from an
accredited medical school, receiving
passing grades on the medical
licensure examination and complete 1
year of an accredited residency
program to become licensed to
practice medicine. Re-licensure
requires successful completion of
specialized continuing medical
education programs.
Attending Physician
 Is the senior physician of the
medical team
 Assumes responsibility for all patients
assigned to the team and provide
guidance and direction to the team
members
 During round, the attending
physician leads the team through
the decision-making process
Fellows
 Medical fellows are physician who
have completed residency training
and have elected to continue their
training in a research-oriented
fellowship program
 They teach the more junior
members of the team
 Work closely with the attending
physician and have fewer direct
patient care responsibilities than
residents.
Residents
 Physician who have graduated
from medical schools and are in
structured and supervised residency
training program
First Year Residents
 Designated as Post Graduate
Training (PGY 1 or PG1)
 They are known as “Interns”
 Interns, who are licensed physicians,
have an intensive year of training,
with frequent night calls and direct
responsibility for the care of a
variety of inpatient and outpatient.
Second Year Internal Medicine Residents
 Designated as Post Graduate
Training (PGY 2 or PG2)
 They are known as “Junior
Admitting Residents” (JARs)
Third Year Medical Residents
 Designated as Post Graduate
Training (PGY 3 or PG3)
 They are known as “Senior
Admitting Residents” (SARs)
 Final year of 3 year internal
medicine residency program
Chief Medical Resident
 Senior medical resident, who in
addition to the usual resident
responsibilities.
 Have administrative responsibilities
for various aspects of the residency
 program, such as scheduling
rotation and vacation and
organizing and overseeing seminars
and other educational programs
b. Nurses
 Nurses care for the physical and
psychosocial need of patients and
carry out physician-directed orders
regarding patient care.
 Nurses perform many routine task for
physician, including patient interviews
and examination, treatment of minor
illness, patient education and
counseling
c. Physician Assistant
 Physician Assistants perform many
routine task for the physician, such as
patient interviews and examination,
treatment of minor illness, patient
education and counseling
d. Allied Health Care Professionals
e. The Healthcare Team
 The health care team consists of all
health care professionals who have
responsibility for patient
 Although all members of the health
care team interact directly with the
patient, they rarely meet as a group;
instead information and
recommendations are exchanged
through written documentation.
 Verbal information exchange and
recommendation occur on a less
formal basis.
 All members of the health care team
contribute their profession’s unique
knowledge and skills
 Pharmacists, “the drug expert” on the
team, helps develop implement, and
monitor the therapeutic regimen and
provide drug information and
educational services for the patient
and the team
 STUDENTS have a unique role in the
health care team: They represent their
profession and are expected to carry
out their professional responsibilities
under the direct supervision of licensed
professionals
f. The Medical Team
 Teaching hospitals are the primary
training site for most health care
professionals
 Health care services in teaching
hospitals are structured around medical
teaching team composed of physician,
medical students, and depending on
the hospital, other health care
professionals
 The team may provide consultative
services in a medical subspecialty or to
be identified with a specific physician
group practice.
 The medical team, function as a unit,
with the division of labor and
responsibility of each member
delegated according to the status of
each individual.
 The team is structured so that each
team member receives guidance from
a more experienced physician.
 The team is the focus for group
teaching and decision making
discussions.
 Medical Team Composition in Teaching
Hospitals
THE INPATIENT AND OUTPATIENT ENVIRONMENT
THE MEDICAL RECORD
 The inpatient medical record, also known
as “CHART” is a legal document that
includes sections for hospital-specific
admission and insurance information, initial
history and physical examination, daily
progress notes written by every health care
professional that interact with the patient,
consultation, nursing notes, laboratory
results and radiology and surgery reports.
ETHICAL PRINCIPLES
1. Beneficence – is the principle that health
professionals should act in the best interest
of the patient.
2. Autonomy – is the principle that establishes
patient rights to self-determination to
choose what will be done to them
3. Honesty – principle states that patients
have the right to see the truth about their
medical condition, the course of the
disease, the treatments recommended
and the alternative treatments available.
4. Informed Consent – has occurred and
treatment can be implemented if all
relevant information is provided, if the
patients understand the information, and if
consent is given freely without coercion
5. Confidentiality – to assure patients that
information about their medical conditions
and treatment will not be given to
individuals without permission.
6. Fidelity – is the right of the patient to have
health professional provide services that
promote patient’s interest rather than their
own.
* Ethically the responsibilities of physician should be
directed towards the PATEINTS rather than directed
at the FINANCIAL well- being of the clinic.
1. Academic Pharmacist
 Focus on teaching, research, and
training of the upcoming pharmacist
 Education motivates the professionals in
the healthcare system
 From their basic education training and
pre-registration training, students
acquire a broad understanding of the
scientific principles and techniques of
the pharmaceutical sciences and the
ability to keep pace throughout their
careers with developments in medicine
and pharmacy
 Their knowledge and expertise extent to
all aspects of the preparation,
distribution, action, and uses of
medicines
 Education Policy (PACOP)
2. Industrial Pharmacist (Pharmaceutical Industry)
 RESEARCH AND DEVELOPMENT 
contribute in research, and their
expertise in formulation development is
of particular relevance to the biological
of the active ingredient
 MANUFACTURE AND QUALITY
ASSURANCE  (Good manufacturing
practice) Validation of various stages of
production and the testing of products
before release
 PATENT APPLICATION AND DRUG
REGISTRATION  pharmacist is ideally
qualified to understand and collate the
diverse information required for patent
and authorization submission
 DRUG INFORMATION  knowledge and
expertise to provide detailed
information on medicines
 CLINICAL TRIALS AND POST MARKETING
SURVEILLANCE  Pharmacist has the
knowledge of drugs and healthcare
provision required to facilitate
collaboration between companies,
health professionals and government in
relation to clinical trials and surveillance
 SALES AND MARKETING  Can
contribute to proper marketing
practice related to healthcare and to
the provision of appropriate information
to health professionals and public
 MANAGEMENT  the inclusion of
pharmacist in all levels of management
promotes an ethical approach within
management policies
3. Primary Care Pharmacist/Prescribing Advisors
 Also called as Clinical Pharmacist
 They work on national health services
organizations that are in charge of a
range of local health services
 Their job is to ensure the best use of
medicines and resources
4. Hospital Pharmacist
 Vital part of the healthcare team. Part
of the team where the focus is firmly on
patients
  Manufacture of sterile medicines,
managing the care of patients with all
types of condition, working in the
dispensary, providing information on
medicines for the whole hospital
 Takes part in planning and
implementation of clinical trials
 Pharmacy and Therapeutic Committee
(Pharmacist as secretary)
5. Community Pharmacists
 Health professionals most accessible to
the public
 Work at the frontline of healthcare in
cities, towns and villages across nation
 As community pharmacist, job would
be all about helping the public,
assessing their conditions and making
decision about medicines they should
take
 They will be involved in dispensing
medicines and offering patient advices
and practical help on keeping health
THE MAIN ACTIVITIES OF COMMUNITY
PHARMACIST:
 Processing of prescription
 Care of patient or clinical pharmacy
 Monitoring of drug utilization = (DUR)
 Traditional and alternative medicine
 Responding to symptoms of minor
ailments
 Informing healthcare professionals and
the public
 Health promotion
6. Regulatory Control and Drug Management
 Health and drug policy management
 Responsible for drug management
which include selection of essential
drugs
 REGULATORY AND ENFORCEMENT
AGENCY  FDA/PDEA
 PROFESSIONAL AND REGISTRATION
AUTHORITIES  BOP/PRC
What if the pharmacist is not present during and FDA
visit? – Corrective and Preventive Action (CAPA)
PHARMACY AS A COMPLETE PROFESSION: Reflect
on every sector of society in the form of:
a. Artists – designing a drug dosage form
b. Lawyer – having fair knowledge of laws and
legislation about the drugs
c. Engineer – having sound technical knowledge
d. Entrepreneur – with sound knowledge of
management, accounting, marketing,
counseling
e. Health professional – having fair knowledge
regarding health
PRACTICING AS A PROFESSIONAL PHARMACIST
 Professionalism is not learned from a text or
classroom lecture
 It is learned through mentorship and
socialization
 It is important to observe the behaviors and
attitude that are presented by your
educators, peers, and colleagues as these
will help you to define your style of
professionalism
 You will want to seek out and attach
yourself to mentors who are professional
and caring healthcare providers
 Finally, it is important to be aware that the
classroom experiences do not exactly
mimic real-life situations
 The classroom experience gives you the
knowledge to operate in ideal situations,
while the advanced practice courses give
you the real-life experience
 The goal of the advanced practice course
is to enable you to take the knowledge
learned and apply it to the patient care
practice setting
CONCLUSION:
 Pharmacist is the first person of healthcare
system by playing various roles like
academic pharmacist, community
pharmacist, clinical pharmacist, industrial
pharmacist, hospital pharmacist, veterinary
pharmacist, and etc.,
 All pharmacist working in the different fields
of profession are directly or indirectly
related to nation’s health
 Finally pharmacists are responsible for
ensuring that “Right drug to right patient at
the right time in a right dose through right
route on right way.”
 So that Pharmacist is an integral part of
healthcare system
 8. Special Instructions – when needed (Refills and
Labels)
PRESCRIPTION
 An order for medication issued by a Different Prescription
physician, dentist, or other properly 1. Medication Order
licensed medical practitioner  Used in hospitals and other
(veterinarians). institutions
 Designates a specific medication and  Cannot be dispense by community
dosage to be prepared and dispensed by pharmacist
a pharmacist.  It is just almost the same as the
 Rx  recipe, “you take” or “take thou” prescription but it does not need the
 Written Prescriptions (most common type name of the doctor
that is being used by the practitioners)  Date and time are important for this
Pediatric Prescription because it is for inpatients
 Contains some information necessary in 2. Tamper-Resistant Prescription Pads
calculating appropriate doses  Used to prevent unauthorized
 Intended to be taken by pediatric copying, modification, and
patients only counterfeiting of prescription
 Dosage for the children is different from  Accomplished through the use of
the adults security papers, erase-resistant
papers, thermochromatic ink, and
Categories of a Prescription (2 broad categories): embedded holograms
1. Not requiring Compounding – you can 3. E-prescriptions
dispense it as soon as you’ve read the  Computer-to-computer transfer to
prescription prescription
2. Compounding Prescriptions – the  Usually between authorized
pharmacist needs to make it from scratch prescribers, pharmacists,
(instead of the generic or brand name of intermediaries, and payers under
the medication written in the prescription, the nationally accepted standards
the ingredients are written in the ADVANTAGES:
prescription that are needed to  Reduced errors
compound)  Concurrent software screens for
drug interactions
Parts of a Prescription  Reduced incidence of altered
1. Prescriber’s Information – address of the clinic, prescriptions
name and number of the doctor, and signature  Efficiency
2. Patient’s Information – name, age, sex, and  Convenience to the patient
address of the patient
3. Date – always take note of the date (if the date Other Prescription:
is not valid anymore, the prescription cannot a. Hospital
be dispense) [Date validity of prescription: 1-2  Infectious disease
weeks except for the maintenance medication  Cardiac care
but it is not official)  Pediatrics
4. Superscription – recipe, “you take” or “take  Obstetrics
thou”  Orthopedics
5. Inscription – medication prescribed; it is the b. Drug-specific forms:
generic or brand name together with the dose  Heparin dosing
of the medication  Electrolyte infusions
6. Subscription – instructions that are intended to  Morphine sulfate (patient-controlled
be followed by the pharmacist (dispensing anesthesia)
instructions)
7. Signa – instructions to the patient on how to
take the medication
PRESCRIPTION WRITING
Military Time
 May also be used in hospitals, law
enforcement, and emergency services
 Provides an unambiguous expression of
time
 In hospitals: used to record time of
admission, time of medication
administration, time of surgery, etc.
Accuracy and Verification
 The right medicine should be:
 Therapeutically appropriate or the
patient
 Prescribed at the correct dose
 Dispensed in the correct strength
and dosage form
 Correctly labeled with complete
instructions or the patient or
caregiver
 For the patient in a hospital or other
health care facility, each
medication must be administered
to the correct patient, at the
correct time, and by the correct
rate and route o administration
 Medication Verification  performed
initially through the careful reading, filling
(including calculations), checking, and
dispensing of the prescription
medication order
Errors and Omissions
 Among the items that the pharmacist
should check, or the correct reading and
interpretation of a prescription or
medication order are as follows:
 Prescriber information
 Date of the order and its currency to
the request or filling
 Patient identification information
 Drug prescribed
 Clarity of any abbreviations,
symbols, and/or units o measure
 Clarity and completeness of
directions or use by the patient or
caregiver
 Refill and/or generic substitution
authorization
 Need or special labeling
 Ingredients and quantities or orders
to be compounded
Unethical Prescriptions
a. Erroneous Prescription
 Should be filled and reported to
the DOH
 The brand name precedes the
generic name.
 The generic name is enclosed
with a parenthesis instead of the
brand name.
 The brand name is not in
parenthesis.
 More than one drug is
prescribed on one prescription.
b. Violative Prescription
 Should not be filled and should
be reported to the DOH
 The generic name is not written.
 Both the generic name and
brand name are written but,
only the brand name is legible.
 Only the brand name is written
and added with imposing
instruction ("No other substitute")
that can hinder, obstruct or
prevent proper dispensing.
c. Impossible Prescription
 Should not be filled and should
be reported to the DOH
 Only the generic name is written
but illegible.
 The generic name does not
or
correspond with the brand
name.
 Both the generic name and the
brand name are illegible.
 The written drug product is not
registered in FDA.
Roman Numerals
 Commonly used in prescription writing to
designate quantities
Abbreviations and Symbols
 To help reduce medication errors arising
from poorly written, illegible, or
misinterpreted prescriptions and
medication orders are the following:
 A whole number should be shown
without a decimal point and
without a terminal zero
 A quantity smaller than one should
be shown with a zero preceding the
decimal point
 Leave a space between a number
and the unit
 Use the full names of drugs and not
abbreviations
 Use USP designations for units of
measure
 Spell out “units”
 Certain abbreviations that could be
mistaken for other abbreviations
should be written out
 Spell out “every day,” rather than
use q.d.; “every other day,” rather
than q.o.d; “four times a day,”
rather than q.i.d; and “three times a
week,” rather than t.i.w. to avoid
misinterpretation.
 Avoid using d for “day” or “dose”
 Integrate capital or “tall man”
letters to distinguish between “look-
 alike” drug names
 Amplify the prescriber’s directions
on the prescription label when
needed for clarity
MEDICATION SCHEDULING AND ADHERENCE
Medication Scheduling
 May be defined as the frequency and
duration of a drug’s prescribed or
recommended use
 Frequency may be influenced by the
patient’s physical condition and nature of
illness severity
Medication Adherence
 Indicates a patient’s following of the
instructions for taking medications
prescribed
Medication Nonadherence
 Patient’s failure to comply with the
instructions
Patient Nonadherence
 May result from:
 Unclear or misunderstood
directions
 Undesired side effects of the
drug that discourage use
 Lack of patient confidence in
the drug and/or prescriber
 Discontinued use because the
patient eels better or worse
 Economic reasons based on the
cost of the medication
 Absence of patient counseling
and understanding of the need
for and means of compliance
 Confusion over taking multiple
medications
DISPENSING PROCESS
1. Receiving a Prescription
 Upon receiving the prescription, you
have to take note that you have to
review the completeness of prescription
and validate the appropriateness of
prescription
2. Review the Prescribed Medications
 Identify appropriateness of the
medications [you have to correctly
identify patient and obtain
supplementary information  interview]
 Review medication history
3. Consider Supply Arrangements
 Check the availability of medicine
4. Apply legal and ethical considerations in
dispensing
a. Philippine Pharmacy Act
b. Expanded Senior Citizen’s Act
c. Special Law on Counterfeit Drugs
d. Comprehensive Dangerous Drugs Act
e. Generics Law
5. Label and Packaging
 Recording and documentation
 Selecting or preparing the medicine
 Labelling – label the medication
properly
 Counter-checking – double check the
medication
6. Patient Counselling
 In order for you to give proper patient
counselling, you must also have proper
knowledge regarding the drugs that
you are dispensing
Definition of Terms
POSOLOGY
 ”Posos” – how much, “Logos” – science
 It is the branch of medical science which
deals with dosage or quantity of drugs
which can be administered to a patient to
get the desired pharmacological action
DOSE
 Is the quantitative amount administered or
taken by a patient for the intended
medicinal effect
 May be expressed as:
 A single dose, the amount taken at
one time;
 A daily dose, amount taken daily
and may be subdivided and taken
in divided doses; two or more times
per day depending on the
characteristics of the drug and the
illness
 A total dose, the amount taken
during the time-course of therapy
 The schedule of dosing (e.g., four times per
day for 10 days) is referred to as the dosage
regimen
THE THERAPEUTIC DOSE
 It is the quantity of drug which maintains the
minimum effective concentration of drug in
the system
OFFICIAL DOSE
 It is the quantity of drug/doses to be taken
which is mentioned in the official
pharmacopeia like IP, BP, USP, etc.,
*Drug doses vary greatly between drug
substances; some drugs have small doses, other
drugs have relatively large doses.
*The dose of a drug is based on:
 Its biochemical and pharmacologic
activity
 Its physical and chemical properties
 The dosage form used
 The route of administration
 Various patient factors
*The dose of a drug for a particular patient may be
determine in part on the basis of the patient’s age,
weight, body surface area, general physical
health, liver and kidney function (for drug
metabolism and elimination), and the severity of
the illness being treated
 The median effective dose of a drug is the
amount that produced the desired intensity of
effect in 50% of the individuals tested
 The median toxic dose of a drug is the amount
that produces toxic effects in 50% of the
individuals testes
 Drugs intended to produce systemic effects
must be absorbed or placed directly into the
circulation and distributed in adequate
concentrations to the body’s cellular sites of
action
 For certain drugs, a correlation exists between
drug dosage, the drug’s blood serum
concentration after administration, and the
presentation and degree of drug effects
MINIMUM EFFECTIVE CONCENTRATION – that can
be expected to produce the drug’s desired effects
in a patient
MINIMUN TOXIC CONCENTRATION – the base level
of blood serum concentration that produces dose-
related toxic effects
 Appropriate drug dosage should result in blood
serum drug concentrations that are above the
MEC and below the MTC for the period of time
that drug effects are desired
 As shown in Figure 7.2 for a hypothetical drug,
the serum concentration of the drug:
 Reaches the MEC 2 hours after its
administration
 Achieves a peak concentration in 4
hours
 Falls below the MEC in 10 hours
 If it would be desired to maintain the drug
serum concentration above the MEC for a
longer period of time a second dose would be
required at about and 8 hour time frame
  For certain drugs, a larger than usual
initial dose may be required to achieve
the desired blood drug level
 This dose is preferred to as the
priming or loading dose
 Subsequent maintenance doses, similar
in amount to usual doses, are then
administered according to the dosage
regimen to sustain the desire drug
blood levels or drug effects
Factors Influencing Dose
1. Age
 Human being can be categorized into
the following age groups:
 Neonate – from birth up to 30
days
 Infant – up to 1 year age
 Child in between 1 to 4 years
 Child in between 5 to 12 years
 Adult
 Geriatric (elderly patients)
 Age of an individual is one of the
important factor affecting the dose
and pharmacological action of drugs
 Age is concerned with the capacity of
metabolizing and excreting the drugs
from body
 Children and old people need lesser
amount of drug than the normal adult
dose, because they are unable to
excrete drugs to the extent as adults
 Children can tolerate relatively large
amounts of belladonna, digitalis, and
ethanol on the basis of high rate of
metabolism
 Infants do not tolerate large quantity of
drug and are highly sensitive due to
their immature physiological functions
of liver and kidney
 Elderly patients are more sensitive to
some drug e.g. hypnotics and
tranquilizers which may produce
confusion states in them
2. Gender
 Woman require less doses than that of
the male
 Morphine and barbiturates may
produce more excitement before
sedation in woman
 The strong purgatives such as aloes
should be avoided during menstruation
and pregnancy
During lactation, drug like
antihistamine, morphine, and
tetracycline should be avoided
3. Body Weight
 Dose of the drug can be calculating
according to body weight
 Children and malnourished patients
require less doses
 Obese patients require larger dose than
normal patient
Body Size
 It influences the concentration of
drug in the body. The average adult
dose is calculated for a person with
70kg body weight (BW). For
exceptionally obese (fat) or lean
(thin) patient the dose may be
calculated on body weight basis.
 Another method of dose
calculation is according to the
body surface area (BSA). This
method is more accurate than the
body weight method.
 The body surface area (BSA) of an
individual can be obtained from the
following formula:
 BSA Equation – in addition to
the use of the nomogram,
BSA may be determined
through use of the following
formula:
 Calculate the BS for a
patient measuring 165 cm in
height and weighing 65 kg
NOTE: For the sake of comparison, to derive
BSA for the same patient using the
nomogram
4. Time of Administration
 Presence of food in the stomach delays
the absorption of drug. The drug more
rapidly absorbed from empty stomach.
So, the amount of drug is very effective
when taken before meal.
 Appetizer given before meal, digestant
given after meal, laxative given at night
  Iron, aspirin, chloroquine phosphate  In such condition, only maintenance
given after meal to avoid gastric dose of such drug should be continued
irritation to avoid further accumulation
5. Route of Administration  Hence, to avoid the accumulation of
 Route is selected on the basis of severity the drug, one must check liver and
of the diseases kidney function
 Intravenous doses of drugs are usually 9. Physiological State/Emotional Factors
smaller than oral doses, because the  The personality and behavior of a
drug administered intravenously enters physician may influence the effect of
the blood stream directly drugs especially the drug which are
intended for use in a psychosomatic
disorder
 The female are more emotional than
male require less doses
*Placebo medicine – inert substance
10. Idiosyncrasy
 An extra ordinary response to a drug
which is different from its characteristic
pharmacological action
 The word idiosyncrasy has now been
replaced by the term drug allergy
 Lack of enzyme glucose 6 phosphate
dehydrogenase in the body of person
cause hemolysis with primaquine
*Penicillin & sulphonamide
 Small quantity of aspirin may cause
gastric hemorrhage and a small dose of
6. Environmental Factors quinine may produce ringing in the ears
 Affect the dose of the drug to some
physiological changes in the body
functioning
 Daylight is stimulant enhance the effect
of stimulating drugs and diminish the
effect of hypnotics.
 Darkness is sedative. Hypnotic are more
effective at night. The amount of
barbiturates required to produce sleep
during day time is much higher than the
dose require in the night
 Alcohol is better tolerated in cold
11. Drug Interactions
environments than in summer
 Simultaneous administration of two
7. Pathological States
drugs may result in same or increase or
 Drug like barbiturates, chlorpromazine
decrease effects
may produce prolong effect in patients
having liver cirrhosis.
 Streptomycin is excreted mainly by
kidney may prove toxic if kidney is not
functioning properly
8. Accumulation
 Drug excreted slowly may get
accumulated in the body and produce
 Antagonism
toxic effects. Repeated administration
 When the action of one
of drug like digitalis, emetine, and
drug is opposed by the
heavy metal may produce toxic effects
 other drug on the same  E.g. smokers can tolerate nicotine,
physiological system alcoholic can tolerate large amount of
 When adrenaline and alcohol
acetylcholine are given
together, they neutralize
the effect of each other
 Milk of magnesia with
acid poisoning drug
 Synergism
 When two or more drugs
are used in the
combination form, their
*Some time higher dose of a drug is
action is increased. The
required to produce a given response
phenomena is called
(previously less dose was required)
synergism
 Natural Tolerance – some races are
 It is very useful when
inherently less sensitive to some
desired therapeutic
drugs, e.g. rabbits and black race
result needed is difficult
(Africans) are more tolerant to
to achieve with a single
atropine
drug
 Acquired Tolerance – by repeated
 E.g. procaine and
use of a drug in an individual for a
adrenaline
long time require larger dose to
combination, increases
produce the same effect that was
the duration of action of
obtained with normal dose
procaine
previously
 Combination of aspirin
 Cross Tolerance – it is the
and paracetamol
development of tolerance to
increase analgesic
pharmacologically related drugs
effect, combination of
(e.g. alcoholics are relatively more
penicillin and
tolerant to sedative drugs)
streptomycin increase
 Tachyphylaxis – (Tachy = fast,
antibacterial effect of
phylaxis = protection) is rapid
antibiotics
development of tolerance. When
 Additive Effect
doses of a drug is repeated in quick
 When the total
succession, a reduction in response
pharmacological action
occurs. This is usually seen in
of two or more drugs
ephedrine and nicotine
administered together is
 Drug Resistance – it refers to
equivalent to sum of
tolerance of microorganisms to
their individual
inhibitory action of antimicrobials
pharmacological action
(e.g. Staphylococci to penicillin)
 For example,
13. Tachyphylaxis
combination of
 When certain drugs are determined
ephedrine and
repeatedly at short intervals, the cell
aminophylline in the
receptors get blocked up (depletion of
treatment of bronchial
NT takes place) & pharmacological
asthma
response to that particular drug is
12. Tolerance
decreased. The decreased response
 When an usually large dose of drug is
cannot be reversed by increasing the
required to elicit an affect ordinarily
dose.
produced by the normal therapeutic
 E.g. Ephedrine, when given in repeated
dose of the drug
doses at short intervals in the treatment
 of bronchial asthma may produce very
less response due to the tachyphylaxis
14. Genetic Diseases/Metabolic Disturbance
 Changes in water electrolyte balance
and acid base balance, body
temperature and other physiological
factor may modify the effect of drugs.
The absorption of iron from GIT is
maximum if the individual has iron
deficiency anemia
Genetic Basis of Drug Metabolism
16. Dose Measurement
 The slow acetylator phenotype often
experiences toxicity from drugs such as
isoniazid, sulfonamides, procainamide,
and hydralazine, whereas the fast
acetylator phenotype may not respond
to isoniazid and hydralazine in the
management of tuberculosis and
hypertension, respectively.
Drug Metabolism
 Biotransformation or detoxification
 Increases the excretion of the products
by increasing water solubility (polarity)
 Usually causes:
 Loss of pharmacological activity
– changing polarity or structural
alteration
 Exceptions:
 Pro-drugs – themselves
pharmacologically inactive
(Metabolism = activation, e.g.
aspirin  salicylic acid)
 Also can produce active
metabolites from active drugs
(e.g. codeine  morphine,
diazepam  oxazepam)
GENERAL DOSE CALCULATIONS
15. Enzyme Induction vs Inhibition
 Enyzme induction is an increase in
enzyme concentration caused by a
drug or environmental compounds.
Induction may result from
transcriptional activation (more
common with CYP450 enzymes) or
enzyme stabilization. A number of drugs
can cause an increase in liver enzyme
activity over time. This in turn can
increase the metabolic rate of the
same or other drugs.
 Under such circumstances, dosing rates
may need to be increased to maintain
effective plasma concentrations.
 In the institutional setting, doses are
measured and administered by
professional.
 A variety of measuring devices:
calibrated cups for oral liquids, syringes
and intravenous sets for parenteral
medication.
 In the home setting, the adult patient or
a child's parent generally measures and
administers medication.
 Liquid dosage is usually measured in
"household" terms, most commonly by
the teaspoonful and tablespoonful.
TEASPOON AND TABLESPOON
 In calculating doses, pharmacists
and physicians accept a capacity
of 5 mL for the teaspoonful 15 mL for
the tablespoonful.
 It should be noted that the
capacities of household: teaspoons
may vary from 3 to 7 mL,
tablespoons may vary from 15 to 22
mL.
 Such factors as viscosity and surface
tension of a given liquid, as well as
the technique of the person
measuring the liquid, can influence
the actual volume held by a
household spoon.
*NOTE: Any dropper, syringe, medicine cup,
special spoon, or other device used to
administer liquid should deliver 5 mL
wherever a teaspoon calibration is
indicated.
 A pharmacist often needs to calculate:
 The size of a dose
  The number of doses
 The total quantity of medication to
dispense
 The following equation is useful:
a. Calculations of the Size of a Dose
 Example: How many teaspoonful
would be prescribed in each dose
of an elixir if 180 mL contained 18
doses?
b. Calculations of the Total Quantity of Product
 Total amount = no. of dose X size
 Example: How many milliliters of a
liquid medicine would provide a
patient with 2 tablespoonful twice a
day for 8 days?
LOW-DOSE and HIGH-DOSE THERAPIES
 The administration of doses that are much
smaller or much larger than the usual dose
of a drug is referred to as low-dose or high-
dose therapy, respectively
 The example of low-dose therapy is:
 The use of aspirin in 81 mg amounts
(rather than the usual dose of 325
mg) to lower the risk of heart attack
an clot-related stroke
 The use of low-dose
postmenopausal hormone therapy,
in which doses often 50% smaller
than standard doses are
administered
 The example of high-dose therapy is:
 The chemotherapeutic treatment
of cancer, in which there is an
attempt, through increased dose
intensity to kill tumor cells
 The investigational use up to 1000
mg/day of vitamin E (compared
with the recommended daily
allowance of 15 mg/day) to
prevent the progression of
hardening of the arteries
 Pharmacists must be aware of the use of
high-dose therapies while remaining
vigilant in protecting patients against
unintended high doses and consequent
drug overdose
FIXED-DOSE COMBINATION PRODUCTS
 A variety of prescription and
nonprescription products are available
containing two or more therapeutic agents
in fixed-dose combinations
 An advantage of combination products:
 Two or more needed drugs may be
taken in a single dose, which may
be more convenient, enhance
compliance
 Be less expensive for the patient
than taking the some drugs
individually
 A disadvantage:
 The relative inflexibility in dosing
compared with individual drug
dosing
 Whether the fixed-dose combination is a
liquid (e.g., a syrup) or a solid (e.g., a tablet)
dosage form, when a dose is taken, the
component drugs are taken in a fixed-dose
ratio
 To provide some options in dosing, many
combinations of prescriptions drugs are
formulated into different strengths
Definition of Terms
ACTIVE MOIETY – ion excluding those appended
portions of the molecule that causes the drug to be
an ester, a salt or other covalent derivative
API (Active Pharmaceutical Ingredient) – intended
to be used in the manufacture of a
pharmaceutical product as a therapeutically
active compound
ADR – a response to a medicine that is noxious and
unintended, and which occurs at doses normally
used in man.
Batch/Batch Number – a defined quantity of
starting material, packaging material or product
manufactured in a single or series of processes so
that it can be expected to be homogeneous
(Batch Number – distinctive combination of
numbers or letters that specifically identify one
batch)
Contraindication – a statement regarding the
conditions wherein the use of the pharmaceutical
product may cause harm to the patient.
Dosage – the quantity of a medicine given per
administration.
Dosage Form – the pharmaceutical product type
(e.g., tablet, capsule, solution, cream) that
contains a drug substance generally, but not
necessarily, in association with excipient.
Excipient – an ingredient, added intentionally to
the drug substance which should not have
pharmacological properties in the quantity used.
Indication – the FDA-approved clinical use of a
pharmaceutical product
Label – this is the written/printed graphic matter of
any pharmaceutical products; could be found in
its immediate container/tags/suitable material that
is affixed to give information to the product
Package Insert (PI) – the document defining
information that is supplied with a prescription
pharmaceutical product by the MAH (Marketing
Authorization Holder  is any company or
corporate or legal entity in the field of
pharmaceuticals in whose name the MA for
pharmaceutical product has been granred)
Precautions – the instruction and the special care
required in the use of the pharmaceutical product
to avoid undesired effects and to ensure its safe
and effective use
Undesirable Effects – also known as adverse events,
refer to untoward medical occurrence that may
present during treatment with a drug product, but
which does not necessarily have a causal
relationship with this treatment.
Warnings – statements regarding the occurrence
of potential hazards and undesirable effects
associated with the use of the pharmaceutical
product and the limitation of its use.
General Requirements (minimum mandatory
information that shall appear in the labeling
materials which accompanies a pharmaceutical
products)
Special Requirements
a. Product Name
 The product name shall indicate the
generic name and the brand name (if
any) of the drug product
 The generic name shall be as the active
moiety based on the International Non-
proprietary Name (INN), and consistent
with the dosage strength indicated; for
prodrugs, the generic name shall be the
INN of the prodrug itself and not its
active chemical (metabolite) form.
 The generic name shall appear
prominently with an outline box, with
the generic name's prominence over
the other information being clearly and
distinctly readable by normal vision as
may be determined by common visual
sense
 For herbal medicines and traditionally-
used herbal products, the generic
name shall be the botanical origin or as
recognized by FDA
 If a product is identified by a brand
name together with its generic name,
the generic name enclosed in an
outline box shall in all cases appear
immediately above the brand name;
for narrative texts (whether in the unit
carton, primary label or insert), the
brand name shall in all cases be
preceded by the generic name and
enclosed in parentheses or brackets.
 For products with multiple APIs, the
product name shall indicate all of the
APIs, enumerated in the order of
decreasing pharmacologic activity
and placed inside the box in either of
the given format:
b. Dosage Form and Strength
 The label shall specify the (i) dosage
form of the product such as tablet,
capsule, suspension, ointment, etc., (ii)
the specific delivery system, if any, such
as modified release, and (iii) specific
 mode of administration, if any, and
appropriate, such as vaginal/rectal
suppository, etc., as approved by FDA.
If there is no qualifier for tablets, it is
understood as an oral, uncoated,
immediate release tablet
 The label shall specify the dosage
strength of the product which shall be
expressed in metric units reduced to
lowest terms and in the number of the
largest unit specified (e.g. 500 mcg, not
0.5 mg)
c. Pharmacologic Category
 The pharmacologic category shall be
as determined by FDA, taking into
consideration current acceptable
standards for therapeutic categories
 Ex: Antihemorroid drugs, Penicillin
Antibiotics, Analgesics, Anti-acne
drugs, NSAIDs, etc.
d. Formulation/Composition
 The label shall state the name and
strength of all APIs present per unit dose
of the product, which shall be arranged
in decreasing pharmacologic activity,
or if having more or less similar
pharmacologic activity, in decreasing
potency and strength
 The generic name of the API shall be
stated in fulI (including salts and esters,
if any) and correlated to the active
moiety, when applicable. The name of
the API shall be in accordance with its
INN; for herbal medicines and
traditionally-used herbal products, the
official Philippine Pharmacopoeia
name shall be used, or as determined
by FDA
 Alcohol, when present in the product
shall also be indicated, expressed as a
percentage (%). The name "alcohol"
without qualification shall mean ethyl
alcohol.
 The coloring, antimicrobial, and
antioxidant agents, and preservatives
used in the manufacture of the product
that may cause hypersensitivity and/or
other adverse drug reactions shall also
be indicated, with the amount
expressed in the same manner as the
API.
e. Indications
 The indication(s) stated in the labeling
materials shall include only the FDA-
approved clinical use(s) of the drug
product.
f. Dosage and Mode of Administration
 The label shall contain full information
on the product's recommended
dosage, including the (i) initial or
loading dose, (ii) optimal use or usual
dose, (iii) frequency interval, (iv)
duration of treatment, (v) dosage
adjustment, and other pertinent
aspects of drug therapy, if applicable
g. Contraindications, Precautions, Warnings
 The label shall contain full information
regarding the contraindication(s) of the
drug product, as well as the
precaution(s) to be observed in its
administration and use
 The label shall include warning
statements, as required and/or
specified by FDA (e.g. "Flammable," "For
external use only," "Keep out of reach of
children"). Other specific additional
instructions shall be issued by FDA in
appropriate regulations.
h. Interactions
 The label shall include drug-drug, drug-
food, drug-laboratory testing
interactions, as well as other relevant
interactions, if applicable.
i. Adverse Drug Reaction(s)
 The label shall include detailed
information on adverse drug reaction(s)
for a drug product arranged by system
organ class.
j. Overdose and Treatment rendered less legible than other
 The label shall include signs and required labeling information.
symptoms of overdose, as well as  The caution statement, "Foods, Drugs,
possible treatment. Devices, and Cosmetics Act prohibits
k. Storage Condition(s) dispensing without prescription." shall
 The label shall indicate appropriate always be included in the package
storage condition(s) and special insert, unit carton, primary label except
instructions for handling of the drug blister pack, foil strip, and small
product. containers of prescription drug
 Special labeling instructions shall be products. In addition, for products
added for drug products with the classified as Dangerous Drug as per
following properties: Republic Act No. 9165, the caution
Properties Special Labeling Instructions statement shall be followed by an
Cannot tolerate refrigeration “Do not refrigerate or freeze”
additional statement as specified by
Cannot tolerate freezing “Do not freeze”
Light-sensitive “Protect from light” the Philippine Drug Enforcement
Cannot tolerate excessive “Store and transport not Agency (PDEA).
heat, e.g. suppositories above 30°C p. ADR Reporting Statement
Hygroscopic “Store in dry conditions”
 For the product information sheet and
l. Pack Size or Net Content
the unit carton or primary label except
 The unit carton shall indicate the pack
blister pack, foil strip, and small
size of the drug product expressed in
containers of products intended to be
terms of the number of units in the pack
sold without a unit carton, the statement
or the volume of each unit, e.g. 60 mL
“For suspected adverse drug reaction,
(for liquids), 10 blister packs x 10 tablets
report to the FIIA: www.fda.gov.ph" shall
(for tablets), 100 tablets, 12 sachets x 5
appear. In addition, a statement
g, etc.; Provided, that in case of drug
instructing the patient to seek medical
products for reconstitution for oral
attention immediately at the first sign of
administration, the pack size shall
any adverse drug reaction shall
reflect the volume of the product as
appear.
reconstituted.
 The MAH may also include a reporting
 For the primary label excluding blisters
statement for their own
and foil strips, the net content of the
pharmacovigilance system
product, stating the total
q. Registration Number
amount/quantity/number of the
 The label shall indicate the registration
dosage form in a given container shall
number assigned by FDA to the
be expressed in metric units, e.g. 60 mL
product, which is denoted by a
(for liquids), 5 g (for sachets)
combination of letters and/or numbers.
m. Name and Address of MAH
r. Batch Number and Lot Number
 The label shall state the name and full
 The label shall indicate the product's
address of the MAH of the drug
batch number; provided, that if the
product.
entire batch is marketed by one drug
n. Name and Address of Manufacturer
establishment, only the batch number
 The label shall state the name of the
shall be indicated. However, if a batch
manufacturer and full address of the
is divided into lots marketed by different
specific manufacturing site of the drug
drug establishments, the lot number
product as determined by FDA.
and corresponding batch number shall
o. Rx Symbol and Caution Statement
be indicated.
 The labeling materials of prescription
s. Expiration Date and Date of Manufacture
drug products shall always include the
 The label shall bear the month and year
Rx symbol, which shall be prominently
of the product's manufacturing and
displayed. The Rx symbol may be
expiration date either in letters or words
allowed to be over-printed or
and numbers, or in numbers alone; if
superimposed, provided, that such will
expressed in numbers alone, the year
not result in the obliteration by or being
shall be stated completely in order to
 distinguish it from the month; and if the
day is specified, the month shall be
spelled out, as shown below:
 June 2007 or Jun 2007
 06/2007
 03 June 2007 or 03 Jun 2007
 Unless a certain day of the month is
specified, the last day of the stated
month shall be deemed as the date of
the product's expiration/manufacturing
date
 For products reconstituted prior to use
and those which can be administered
multiple times (e.g. suspensions), the
label shall include the period of
guaranteed safety, efficacy, and
quality of the reconstituted preparation
after first opening at a given storage
condition(s).
Special Labelling – In addition to the minimum
mandatory requirements mentioned, the following
shall be required to appear on the label of specific
product types:
1. Parenteral Medications
 For parenteral products, the following
additional information shall be required:
 A statement of the
recommended mode of
administration such as "IV", "IM”
or "SC", etc., as the case may
be.
 Where the product consists of a
concentrated solution for
injection, a direction not to
administer the solution undiluted
and a direction to dilute the
solution with the specified
diluent to the appropriate
volume before use shall be
stated.
2. Fluid Replacement Products
 For fluid replacement products which
follow the standard formulations
contained in the current edition of the
official compendium, the
nomenclature to be adopted as the
generic class name shall be determined
by FDA
 For fluid replacement products not
included in any official compendium,
FDA shall determine the generic class
name
 Directly below the generic class name
but still inside the generic outline box
are the individual components
(including excipients) with the
corresponding mEq/L or mmol/L
enumerated in the order of decreasing
pharmacologic activity
 Where one or more substances are
amino acids and/or proteins, the total
amount of nitrogen in the volume of
fluid in the container shall be reflected
 The osmolality, such as "hypotonic" or
"hypertonic"; and the pH value or range
(where applicable) of the solution shall
be indicated
3. Products for External Use
 For products that are intended for
external use, the statement "For external
use only'' shall appear on all labeling
materials, rendered in capital letters
against a red background or printed in
red font.
4. Supplements (Multivitamin/Mineral Herbal
Products with Non-vitamin/Mineral Herbal
Components)
 Multivitamins, consisting of at least three
vitamins, and minerals, consisting of at
least three mineral ingredients, shall
have the following additional
requirements:
 The generic name adopted for
multivitamin-containing
products shall be "Multivitamins";
for multi-mineral-containing
products the official name shall
be "Minerals".
 For multivitamin and/or multi-
mineral preparations containing
at least three herbal ingredients,
the generic class name of the
herbal ingredients shall be
"Herbs"
 For multivitamin products with
non-vitamin components (i.e.
mineral or herbal ingredient), or
multi-mineral products with
nonmineral components (i.e.
vitamin or herbal ingredient), or
multiherbal products with non-
herbal components (i.e. vitamin
or mineral ingredient) the term
"Multivitamins" or "Minerals" or
"Herbs", respectively, shall first be
stated

5. Drugs under Maximum Drug Retail Price (MDRP)
Control
 On the label of the minimum pack and
the outer presentation of drugs listed
under Section I of Executive Order No.
821 and other drugs as determined by
the Secretary of Health, the following
statement shall be required to appear
in red background or red font:
6. Unique Global Product Identification Number
6. Foreign donations of pharmaceutical products
7. Products that require special handling (e.g.
products that require cold-chain
management, pre-filled syringes)
8. Low volume of importation
*A Generic Labeling Exemption (GLE) application
shall be concurrently submitted by applicant
companies with their application for drug product
registration, except for low volume of importation
which shall be requested yearly. A letter stating the
grounds for which the GLE is requested, as well as
sample labels shall be included in the application.
For low volume of importation, in addition to the
letter a market forecast for the period applied for
shall be included.

SANCTIONS
 Appropriate administrative charges and/or
imposition of administrative sanctions such
as, but not limited to, imposition of fines,
suspension, cancellation or revocation of
any license, permit or registration issued by
FDA.

7. Reproductive Health Products

 The information that is included for this
shall be in pill, the pill shall be written on
English or Filipino or Local Dialect
8. Generic Drug Products with Proven
Interchangeability
 This product has the same therapeutic
efficacy as any other generic product
of the same name
 This product has the same therapeutic
efficacy as the innovator product of the
same generic name

EXEMPTIONS
1. Drug products manufactured for export
2. Veterinary drug products
3. If the container or primary pack containing the
product is enclosed in a transparent covering
and the particulars which are required to be set
on the label on the container or primary pack
are clearly visible through transparent
covering, the transparent covering is
exempted
4. Products that are compounded by a
pharmacist
5. Investigational drugs
 RESPONSIBLE SELF-MEDICATION
 The practice whereby individuals treat
Self-Care their ailments and conditions with
 According to WHO, it is what people do for medicines which are approved and
themselves to establish and maintain available without prescription, and
health, prevent and deal with illness. It is a which are safe and effective when
broad concept encompassing: used as directed
 Hygiene (general and personal)  It requires that:
 Nutrition (type and quality of food  Medicines used are of proven
eaten) safety, quality and efficacy
 Lifestyle (sporting activities, leisure,  Medicines used are those
etc.) indicated for conditions that are
 Environmental factors (living self-recognizable and for some
conditions, social habits, etc.) chronic or recurrent conditions
 Socioeconomics factors (income  Medicines should be specifically
level, cultural beliefs, etc.) designed for the purpose, and will
 Self-medication require appropriate dose and dosage
 Self-care is a broad concept which forms.
encompasses any action you take for your COMMON MINOR AILMENTS
Acne Dizziness Prickly heat
physical, mental and emotional health. It Body aches and Fever Minor skin
can include: pain bacterial infection
 Treatment for a minor illness with Common allergy Flatulence Scabies
Colds Hemorrhoid Sore eyes
minimal supervision from a Cough Minor fungal Sore throat
healthcare professional infections
 Taking a healthy, well-balanced Constipation Hyperacidity Obesity and
overweight
diet
Dandruff Indigestion Worm infestation
 Exercising regularly Dehydration Insect bites
 Finding appropriate methods to Diaper rash Lice infestation
relax after a stressful event Diarrhea Motion sickness

 Self-care is becoming more popular due to FACILITATED SELF-MEDICATION

its perceived convenience and the
potential to save both time and money.
Self-Medication
 Is the selection and use of medicines by
individuals to treat self-recognized illnesses
or symptoms
 Self-medication is the safe and responsible
Working in Partnership with Patients
selection and use of medicines by
individuals to treat self-recognized illnesses
or symptoms
 Self- medication is just one element of self-
care
 Self-medication should only be practiced
for minor illnesses.
 Cases where you should not self-medicate,
include:
 Chronic health conditions such as
Asthma or High Blood Pressure
 Bacterial infections
 Some populations e.g. Infants,
Children, Elderly
 When consumers seek help at the point
of purchase for nonprescription
medicines.
 Where medicines are purchased
through pharmacies, the Pharmacist is
in a strong position to facilitate self-care
decision making by consumers
 Patients are not blank sheets or empty
vessels. They are experts in their own and
their children’s health
 The patient:
 May have experienced the same or
similar condition in the past;
 May have tried different treatments
already;
 Will have their own ideas about
possible causes;
 Will have views about different sorts
of treatments; and
 May have preferences for certain
treatment approaches
Model of Care by Pharmacists
 In the process of self-medication in
pharmaceutical care, it is important to
identify whether the client represent
another customer about whom they are
unable to provide more detailed
information, or if they are responsible for the
patient (caregiver), or they are themselves
the patient.
STEPS:
1. Reception
 Objective: Pharmacist should show
empathy, convey confidence and
be receptive to create conditions
conductive for conducting the
interview and collecting patient
data
2. Data Collection
 Objective: To explore the
information needed to make a
decision on the intervention
3. Data Compilation
 To develop a clinical analysis
regarding the patient’s ailment. If in
doubt, further inquiry should be
made before reaching a decision.
 NOTE: if the conditions is NOT
MINOR, patient or caregiver should
be advised to seek appropriate
professional help, usually from a
physician (REFERAL REGISTRY)
 Essential information for each
product:
 How to take or use the
medicines
 Effects and possible side
effects
 How the effects of the
medicine should be
monitored
 Possible interactions
 Precautions and warnings
 Duration of use
 When to seek professional
advice
4. Monitoring and Evaluation
 Objective: to ensure patient
understands the expected
evolution of the minor disorder to
ensure that selected treatment is
effective
5. Pharmaceutical Intervention
 To address the main complaint and
present the possibilities of
management
Pharmacist Questioning Skills
 Pharmacist should be trained on
questioning skills, so as not to ask for
unnecessary information of the patient has
already provided.
 Deficiencies in communication skills or lack
of knowledge make the process of data
collection inefficient, impairing the
professional’s ability to promote responsible
self-medication.
 Data collection may generate patient/
client mistrust or discomfort
 Special attention should be given to the use
of open questions, in order to avoid
inducing implied responses
 “How are you taking your
medicine? vs “Do you take your
medicine in the morning?”
 The use of negative words should be
avoided, especially by questioning “ WHY”,
since it could suggest that the pharmacist
would prefer responses confirming the
negative, or disapprove of the focus of the
question.
 “Why were you taking the medicine
in the morning?”
 Reword: “FOR WHAT REASON.......”
 Avoid leading questions
 Reword: “Do you use any tobacco
products?”
 Proper timing: Warn a patient that a series
of questions will follow
 “I am going to ask you a series of
questions now”
 “May mga ilang tanong lang po
ako ipapasagot sa inyo bago ko po
kayo mabigyan ng payo”
 Clarify Conflicting Information: Always
accept the blame for inconsistent
information that the patient may tell you or
write
 “I must have written it incorrectly, I
thought you had said...”
 “Mali po yata yung naalala/
naisulat ko, tama po ba ang nasabi
nyo...”
 SUMMARY: prevention, or diagnosis of disease in
 Responsible Self-medication is an important aspect of
Self-care
humans or animals, including the
 Pharmacist can play a key role in helping people to following:
make informed self-care choices. 1) Any article recognized in the
 Pharmacist must enable the patient to participate by
actively eliciting their view and preferences
official United States
 Questioning skill of pharmacist must be honed in order Pharmacopoeia - National
to be successful in facilitating responsible self- Formulary, Homeopathic
medication for their patients.
Pharmacopoeia of the United
States of America, Philippine
Roles of Different Pharmacy Workforce
Pharmacopoeia, Philippine
a. Pharmacist National Formulary, British
 The pharmacist is the licensed Pharmacopoeia, European
professional responsible for the safe, Pharmacopoeia, Japanese
effective, accurate processing and Pharmacopoeia, and any
dispensing of prescriptions. official compendium or any
 Requirements for licensure vary by supplement to them;
state, but one common law in every 2) Any article intended for use in
state is that the pharmacist must verify diagnosis, cure, mitigation,
each prescription before it is given to treatment, or prevention of
the patient. disease of man or animals;
 Pharmacists may hold many titles and 3) Any article, other than food,
have additional responsibilities, such as intended to affect the structure
pharmacy manager, store or or any function of the human
department manager, or general body or animals;
manager 4) Any article intended for use, as
b. Pharmacy Managers a component of articles,
 Pharmacy managers are often specified in clauses (1), (2), and
responsible for deciding how much (3), not including devices or their
inventory to hold, serving as contact components, parts, accessories;
persons for third-party payers and, 208 5. herbal or traditional
(especially auditors), training staff on drugs as defined in R. A. No.
new technologies, addressing customer 9502 known as “Universally
service issues, and maintaining Accessible, Cheaper and
pharmacy workflow. Quality Medicines Act”.
c. Pharmacy Technician  Different classification of drugs
 Pharmacy Technician refers to a person a. OTC Drugs
who assists in compounding and  Refer to medicines used for
dispensing of medicines in community, symptomatic relief of minor
hospital, institutional and industrial ailments and which may be
settings or engaged in other activities dispensed without a
under the supervision of the pharmacist prescription.
as described in Section 39 Article IV of  Most OTC agent are no
the Act. more than “me too”
 The role of the pharmacy technician is products.
to support the pharmacist with order  Drugs that is
fulfillment, manage all tasks not structurally very
requiring a pharmacist’s direct similar to already
known drugs, with
Dispensing of the following Classification of Medicine only minor
1. Drugs differences
 Refer to pharmaceutical products that  Less risky to develop
pertain to chemical compounds or  Approved
biological substances, other than food, “automatically”
intended for use in the treatment,
  Create competition The FDA has reported by trying to create OTC labels that are
easier to read and understand. However, there are no
and drives prices warnings against intentional overuse of the drug to get high
down
ADVANTAGES: Examples:
 Diphenolylate vs Loperamide,
 Benefits outweighs risks  Mefenamic 500 vs. 250mg,
 Low misuse and abuse  Naproxen 550mg vs 275mg
potential b. Prescription Drugs
 Consumers are able to:  Prescription / Ethical
Self-diagnose, Self-treat, Medicines refer to
Self-manage medicines which can only
 Adequately labeled be dispensed by a
DISADVANTAGES: pharmacist to a patient,
 Reduced opportunities upon the presentation of a
to receive counseling valid prescription from a
about possible lifestyle physician, dentist, or
therapies (ex. Exercise veterinarian and for which a
and Diet) pharmacist’s advice is
 Poorer Compliance necessary.
 Misdiagnosis, patients  In dispensing prescription
won’t benefit from the drugs, we all need some sort
drug but will be exposed of tool to help us remember
to its risks to cover all of the important
EXAMPLES OF OTC DRUG medication counseling
CATEGORIES: aspects of the specific drug
 Antacid and Acid and it goes as follows:
reducers  Dosage: discuss the
 Antiemetic medicines dose of the
 Antidiarrheal medication, how it
 Antihistamines should be taken, any
 Cough medicines specific dosage
 Decongestants timing issues, and
 Herbal products and what to do if the
supplements patient misses a
 Laxative dose.
 Pain killers  Results: What should
 Vitamins the patient expect
MISUSE AND ABUSE OF OTC while taking this
DRUGS medication? How is
 Common the drug working in
misconception: OTC are the body, and how
harmless can the patient tell if
By definition: OTC drugs can be used safely and effectively the medication is
by reading and following the directions on the label.
working? It is also
The labeling is written in easily understood language “of low important for the
comprehension” patient to
Recent surveys have reported that: Consumers do not read
understand the
OTC labels. If they do read them, they do not follow the consequences of
directions on the labels. non-adherence
Abuse is most common in adolescents aged 12-17 years  Underlying Issues: It
 Readily available, no suspicion present potential
 Since reporting of this type of abuse is not issues that the
mandatory, the true incidence of OTC abuse is
unknown patient needs to be
aware of when
taking the
 medication, educators so that we may convey such information
in an appropriate manner to our patients.
including: Does this
c. Pharmacist Only OTC
medication have
 Also known as restricted
any Black Box
medicines
Warnings? Is the
 Refer to over-the-counter
patient allergic to
medicines classified by
this medication? Is
appropriate government
the patient taking
agencies that can be
any other
obtained only from a
medications that
pharmacist, with mandatory
may interact with this
pharmacist’s advice on their
medication? Does
selection and proper use
this medication have
 Pharmacist-Only medicines
any specific alcohol,
are a relatively small group
grapefruit, or sun
of medicines that can be
sensitivity warnings?
purchased from a
Does this medication
pharmacist without a
have an effect on
doctor's prescription.
any other disease
 You should use Pharmacist-
states that the
Only medicines only for the
patient may have?
purpose recommended by
Are there any
the pharmacist or included
special precautions
in the printed information.
with the elderly,
 Pharmacist-Only medicines
young, pregnant, or
should not be shared with
breast feeding
other people.
patients? Are there
 The pharmacist should give
any other
you information about the
medication specific
following:
cautions or
 How to use the
precautions that
product
should be
 How often to use it
discussed?
CONTRAINDICATIONS vs. WARNINGS AND PRECAUTIONS
and for how long
 Contraindications – reasons to withhold the  When to seek
medication or treatment. May or may not be medical advice
absolute.
 Warnings and Precautions – reasons to consider the  What side-effects, if
risk v. benefit of the agent in relation to existing any, may be
medical conditions expected and what
 Know absolute contraindications before
administering any agent to do about them
 Know the process for verifying proper action when  What medicines or
there are questions of contraindications or other substances to
precautions
avoid while using the
GENERAL INFORMATION: product.
 Asses the patient's understanding of the above
 The following are some of
information.
 Discuss how to properly store the medication, what the conditions which can be
to do about refills, how to dispose of unused meds, treated with Pharmacist-
and assure that the patient knows who to call for
Only medicines:
questions.
 Speaking as a community pharmacist, many  cramp
patients rely on us for medication information and  eye infections
education.
 Therefore, we need to stay current on our
 fungal infections of
understanding of the important counseling topics the toe or finger nails
with each and every medication we dispense, and  hay fever or rhinitis
it is our duty to maintain our skills as patient
 hemorrhoids
  mouth ulcers concentrates, metabolites and
 nausea caused by synthetic sources of substances
migraine mentioned in (1) and (2).
 skin problems such These are presented in dosage forms or
as itching, rashes, in small unit doses such as capsules,
inflamed fungal tablets, powder, liquids and shall not
infections include any sterile preparations (i.e.
 thrush of the mouth injectibles, eye drops)
 thrush of the vagina  Examples include the following:
 Warts  calcium and vitamin D are
d. Dangerous Drugs important for keeping bones
 Refer to those listed in the: strong and reducing bone loss;
 (1) Schedules  folic acid decreases the risk of
annexed to the 1961 certain birth defects;
Single Convention  and omega-3 fatty acids from
on Narcotic Drugs, fish oils might help some people
as amended by the with heart disease.
1972 Protocol;  Safety and Risk:
 (2) Schedules  Many supplements contain
annexed to the 1971 active ingredients that can
Single Convention have strong effects in the body.
on Psychotropic Always be alert to the possibility
Substances; of unexpected side effects,
 (3) Annex of R.A. No. especially when taking a new
9165, otherwise product.
known as the  Supplements are most likely to
Comprehensive cause side effects or harm when
Dangerous Drugs people take them instead of
186 Act of 2002, and prescribed medicines or when
its amendments. people take many supplements
2. Household/Home Remedies in combination.
 Refer to any preparation containing  Dietary supplements can also interact
pharmaceutical substances of with certain prescription drugs in ways
common or ordinary use to relieve that might cause problems. Here are
common physical ailments and which just a few examples:
may be dispensed without a  Vitamin K can reduce the ability
prescription in original packages, of the blood thinner
bottles or containers, of which the  Coumadin® to prevent blood
nomenclature has been duly approved from clotting.
by the FDA  St. John’s wort can speed the
3. Food Supplements/Health Supplements breakdown of many drugs
 Health Supplements refer to any (including antidepressants and
product that is used to maintain, birth control pills) and thereby
enhance and improve the healthy reduce these drugs’
function of the human body and effectiveness.
contains one (1) or more or a  Antioxidant supplements, like
combination of the following: vitamins C and E, might reduce
1) herbal fatty acids, enzymes, the effectiveness of some types
probiotics and other bioactive of cancer chemotherapy.
substances;  Taking more than you need is always
2) substances derived from natural more expensive and can also raise your
sources, including animal, plant, risk of experiencing side effects.
mineral and botanical materials in  For example, getting too much
the form of extracts, isolates, vitamin A can cause
 headaches and liver damage, REMEMBER!

reduce bone strength, and  Dietary supplements are
cause birth defects. Excess iron products intended to
causes nausea and vomiting supplement the diet.
and may damage the liver and  They are not drugs and,
other organs. therefore, are not intended to
 Quality: treat, diagnose, mitigate,
 Dietary supplements are prevent, or cure diseases.
complex products. The FDA has  No Approved Therapeutic Claims”
established good means – “the claims of these products
manufacturing practices are not validated by the FDA.
(GMPs) for dietary supplements  FDA is not authorized to review
to help ensure their identity, dietary supplement products for
purity, strength, and safety and effectiveness before
composition. These GMPs are they are marketed.
designed to prevent the 4. Cosmetics
inclusion of the wrong  Refer to a substance or preparation
ingredient, the addition of too intended to be placed in contact with
much or too little of an the various external parts of the human
ingredient, the possibility of body or with the teeth and the mucous
contamination, and the membranes of the oral cavity, with a
improper packaging and view exclusively or mainly to cleaning
labeling of a product. The FDA them, perfuming them, changing their
periodically inspects facilities appearance and/or correcting body
that manufacture dietary odor, and/or protecting the body or
supplements. keeping them in good condition, as
 Keep in Mind: defined under R.A. No. 161 9711.
 Don’t decide to take dietary  Cosmeceuticals are products that have
supplements to treat a health both cosmetic and therapeutic
condition that you have (medical or drug-like) effects, and are
diagnosed yourself, without intended to have a beneficial effect on
consulting a health care skin health and beauty. Like cosmetics,
provider. they are applied topically as creams or
 Don’t take supplements in lotions but contain active ingredients
place of, or in combination with, that have an effect on skin cell function.
prescribed medications without A cosmetic product claimed to have medicinal or drug-like
benefits.
your health care provider’s
approval. Products are marketed as cosmetics, but reputedly contain
 Check with your health care biologically active ingredient
provider about the supplements
you take if you are scheduled to
have any type of surgical
procedure.
 The term “natural” doesn’t
always mean safe. A
supplement’s safety depends
on many things, such as its
chemical makeup, how it works Kojic Acid – an organic compound that effectively inhibits
in the body, how it is prepared, the production of tyrosinase and melanin, giving skin a visibly
lighter appearance.
and the dose used. Certain
herbs (for example, comfrey Tranexamic Acid – a peptide proven to inhibit inflammation
and kava) can harm the liver. and melanin formation. It is ideal for stubborn dark spots that
do not respond to other skin lightening ingredients.
5. Medical Supplies/Devices
 Medical Device refers to any
instrument, apparatus, implement,
machine, appliance, implant, in vitro
reagent or calibrator, software,
material or other similar or related
article intended by the manufacturer to
be used alone , or in combination, for
human beings, for one (1) or more of
the specific purpose of:
 diagnosis, prevention,
monitoring, treatment or
alleviation of disease;
 diagnosis, monitoring, treatment
or alleviation of or
compensation for an injury;
 investigation, replacement,
modification or support of the
anatomy of a physiological
process;
 supporting or sustaining life;
 preventing infection;
 control of conception;
 disinfection of medical devices;
 and providing information for
medical or diagnostic purposes
by means of in vitro examination
of specimens derived from the
human body.
 This device does not achieve its primary
intended action in or on the human
body by pharmacological,
immunological, or metabolic means,
but which may be assisted in its
intended function by such means, as
defined under R. A. No. 9711.
6. Biologicals/Pharmaceuticals
 Biopharmaceuticals refer to
pharmaceutical products that are used
for therapeutic or for in vivo diagnostic
purposes, such as vaccines, sera, and
drugs derived from life forms using
biotechnology.
 These include proteins, nucleic acids, or
living microorganisms where the
virulence is reduced and are used for
therapeutic or for in vivo diagnostic
purposes.
Counseling Patients on Minor Ailments/OTC
Medicines
MANAGEMENT OF OTC USE
 Pharmacists interact with patients seeking
help for minor ailments on a daily basis.
EXPECTATIONS OF A PHARMACIST
 ASSISTANCE: Demonstrates expertise in
proper assessment and referral of selection
of OTC medicines from selected common
minor conditions
 DRUG KNOWLEDGE: Provide essential info
OTC medicines for selected common minor
condition
 SOFT SKILLS ON PERSONAL INTERACTIONS:
Use effective communication skills,
empathy, relationship building
PATIENT ASSESSMENT: INTERVIEW
 Patient history
 Pharmacist do not normally have
access to the patient’s medical
record
 No Physical examinations
 No Diagnostic testing
COLLABORATION FOR REFERRALS
 Pharmacist
 Specialist 1
 Specialist 2
ROLE OF A PHARMACIST AS HCP
a. Primordial Prevention
 Change societal structures
 Addressing underlying determinants
 Creating public awareness (campaign,
advocacies)
b. Primary Prevention
 Alter exposure that lead to disease
 Intervention targeted on at-risk patients
c. Secondary Prevention
 “Medication safety and Patient
Education”
 Detection and treatment of ailment at
its early stage when treatment can be
more effective
 Proactive and greater involvement in
health promotion and prevention
d. Tertiary Prevention
 Prevent relapses and further
deteriorations via follow up and
rehabilitation
 Through telephone or SMS
CHARACTERISTICS OF THE MINOR ILLNESS  Remitting factors: What makes it better?
 Etiology 2. QuEST Process
 Epidemiology  Quickly and accurately assess the
 Clinical Presentation patient
 Red flags  Ask about current complaint
 Risk Factors (SCHOLAR)
 Ask about other medications
RECOMMENDED STEPS and other products
STEP 1: Collect  Ask about coexisting conditions
 Collecting information and allergies
 on the chief complaint (current  Establish that the patient is an
signs and symptoms), appropriate self-care candidate
 a medication history,  No severe symptoms
 the patient’s background  No symptoms that persist or
characteristics, return repeatedly without and
 and a host of other aspects such as identifiable cause
a physical examination.  No self-treating to avoid
STEP 2: Assess medical care
 Leads to a prioritization of problems.  Suggest appropriate self-care
 In considering: strategies
 the cause of the problem(s),  Medication
 the patient’s medical history is  General care measures
scrutinized in order to determine if  Talk with the patient
symptoms could be medication-  About medication action
related, and so on (for example,  About administration
congestive heart failure could be a  About adverse effects and how
reason for someone seeking help for to manage them
a cough)  About what to expect from
STEP 3: Plan treatment
 Activities of the first two steps culminate in  About appropriate follow-up
one of three general recommendations: 3. WWHAM Process
 1)recommend some form of  Who for?
therapy,  What symptoms?
 2) refer to another practitioner, and  How long have symptoms been
 3) Recommend self-care until present?
another health care provider can  Action already taken?
be consulted.  Other Medication?
STEP 4: Implement 4. SIT DOWN SIR Process
 Implement the recommendation  Site/location
STEP 5: Follow-up (Monitor and Evaluate)  Intensity/severity
 Will involve monitoring and evaluating it  Type/nature
 Duration
Process of Patient Interaction  Onset
1. SCHOLAR Process  With (i.e. does it occur other symptoms?
 Symptoms: What are the main  aNnoyed or aggravated by
symptoms?  Spread or radiates to
 Characteristics: What are the symptoms  Incidence/frequency pattern
like?  Relieved by
 History: What has been done so far? Has 5. Seven Step Process
this happened in the past?  Step 1: Who is the patient?
 Onset: When did it start?  Step 2: Has a prescriber been seen for
 Location: Where is the problem? this situation?
 Aggravating factors: What makes it  Step 3: Assess the patient’s situation
worse?
  Step 4: Contemplate a tentative course
of action
 Step 5: Inquire into the patient’s health
status
 Step 6: State a recommendation
 Step 7: Provide information on proper
medicine use (if applicable)
6. STARZ Process
 Symptom presentation
 Time of onset and duration
 Associated symptoms
 Recurrence (symptom recurrence in
spite of therapy)
 Zoom into patient’s medical and
mediation history
7. ENCORE Process
 Explore
 No medication option
 Care
 Observe
 Refer
 Explain
8. SHAPED Process
 Symptoms
 Hunches
 Alternatives
 Probable condition testing
 Explanation
 Decide on a plan of action

OTC CONSULTATION