SEMINAR PRESENTATION ON

DIS RELATED ACTIVITIES

BY MULAT K.(BSC.,MSC IN PHARMACOLOGY)

March 3,2021
Hawassa-Ethiopia
Outline of presentation
• Medicine Use Education and continuing pharmacy
education
• Poison information service
• Managing Drug Information Queries
 Objectives

• To Provide medicine use education to clients and

CPE to health care providers
• To provide information on poison for hospital
community & make the services more functional.
• To inform how to manage drug information queries
Medicine Use Education and
continuing pharmacy
education
 Medicine Use Education
Basic principles of medicine use education

• Major focus should be rational use of medicines

• Promote informed decision-making
• Consider cultural diversity and influence of
social factors
• Clear and measurable objectives
cont.

• Empowering clients on proper use of medicines

through patient education is essential to improve
treatment outcome.
• Accordingly, community education in general and
patient’s education in the waiting areas in
particular have paramount importance and
sustainable effect.
Principles to guide public education should include:

• Address important drug use issues with special

focus on rational use of medicines.
• Encourage informed decision-making and cover
basic concepts of medicine use, like: -
 How to choose when to self-medicate and when to seek
medical advice,
Which conditions that do not require medication,
How to read a drug label or patient information.
Cont…
• Recognize and consider the cultural diversity and
the influence of social factors.
• Have clear and measurable objectives.
• To change deep-rooted beliefs and practices, it
requires a sustained effort and a stepwise process
which moves from creating awareness, to acquiring
knowledge and finally changing behavior.
 Phases of organizing medicine use
education

phases
Preparatory Phase

Medicine use education

session

Post event
phase
 Preparatory phase
• Need assessment
• Education material
• Communication and engagement with appropriate
unit
• Well preparation on the selected topic
• Identifying convenient location
• Decide Time
• Consider socio-caltural aspects of audience
Medicine use education
• Self introduction
• Session objectives
• Respect clients and supportive
• Make it interactive
• Encourage clients to raise questions
• Ask questions at the end
• Summarize major points
Post event phase
• Recording
• Documentation
• Reporting
Tracking effectiveness of communication techniques.

• Clients will attentively follow your education.

• Clients will raise queries and questions.
• Clients will respond the questions you may raise.
Continuing Pharmacy Education
(CPE):
• A structured process of education designed or intended to
support the continuing development of pharmacists and
other members of the pharmacy workforce to maintain and
enhance their professional competence.

• A CPE activity should promote problem-solving and critical

thinking and be applicable to the practice of pharmacy.
Continuing Pharmacy Education (CPE)
Benefits:-
Enables pharmacists to be competent in managing
practical challenges.
Updates pharmacists on recent developments in
different areas of the profession.
Ensures optimal medication therapy outcomes and
patient safety.
Satisfies the educational requirements of pharmacy
professionals.
Enhances the capacity of pharmacists in delivering
quality care for their patients.
Poison information
service
 Definition
• Poisoning is an exposure to an amount of substance that
is likely to produce unwanted effects in an individual.  

• Poison  information service (PIS) is a specialized area of

medication information that pharmacists practice in
providing information on poisons.

Q. Who will benefit from the Poison information service?

The Global and National Magnitude of poisoning

• Globally incidence and severity of poisoning is unknown.

• Up to half a million people die/year.

• Unintentional poisoning in Africa.

• 16, 500 deaths

• In addition
• 7800 deaths per year in Africa due to deliberate ingestion of pesticides

• between 1400 and 10 000 deaths from snakebite in eastern sub-

Saharan Africa. WHO, 2012
The Global and National Con’d

• In Ethiopia

• various chemicals, herbicides and pesticides are being used

• They contain hazardous substances and impurities

• can harm human health and environment

• However it’s difficult to obtain accurate figures for the

number of poisoning cases

• According to HMIS Report (2001 to 2004 E.C) indicated an increased

morbidity and mortality

Common poisons in Ethiopia

• It is difficult to obtain on the epidemiology of

poisoning in Ethiopia due to poor recording

• Only a couple of researches were conducted to

assess the prevalence of poisoning

• Some of the researches found that the common

poisoning agents
Common Poisons cont’d…

• Household detergents and cleansing agents

• organophosphates

• Drug overdosing

• Rat poison

• Alcohol
SOME RESEARCH WORKS IN
ETHIOPIA
• A study done in Gondar University teaching hospital showed that 0.45%
of all emergency admissions were due to poisoning.
• This study indicated that organophosphates, rat poison and alcohol were
the major cases for suicidal intentions.
• Another study conducted at Tikur Anbessa comprehensive specialized
hospital assessed pattern of acute adult poisoning.
• Out of 116 adult patients presented with poisoning from January 2007 to
December 2008, the number of females exceeded the number of males.
• The mean age was 21 years, most being (96.5%) intentional self-harm
poisonings.
• Household cleansing agents were the leading causes (43.1%) followed by
organo-phosphates (21.6%) and phenobarbitone (10.3%) (Mekonnen and
Azaji, 2011).
CONT…
• Concerning the distribution of acute poisoning in Ethiopia, WHO
reported that acute poising accounts 0.5% of distribution causes of
intentional and unintentional injuries in 2012.
• The percentage of poisoning agent in Ethiopia showed that
Organophosphate (47.2%) were the leading cause reported.
• The other reported causes of poisoning were sodium hypochlorite
(bleaching agents) 12.9%, Drugs (10%), Herbicide (6.2%),
Hydrocarbons (2.9%), Alcohol (2.9%), carbon monoxide (1.4%), and
in 14.8% the cause was not identified (Esayas T. G/Mariam et al).  
• Moreover, Health Management Information System of FMOH for
fiscal years 2001 to 2004 (July 1, 2008 to June 30, 2012) indicated
that there is an increased morbidity and mortality due to poisoning
with more cases falling under 9-14 years of age.
Poison management information service

• A DI pharmacist provides overall information on drugs and

poison.
• All requests for information to a poison are urgent, with
an average response time of 5-30 minutes depending on
the urgency of the call and complexity of information
required.
• Gathering of appropriate information related to the
poisoning is critical
 Poison management cont’d…
The information include
a. Who was exposed? Age, sex and weight are important.

b. What substances were involved in the exposure or a clear description

of the agent

c. How much of the potentially toxic agent was involved in the

exposure?

d. Time of exposure is important to determine the urgency of the

situation.

e. Any initial measures already taken will need to be known and

documented
 ORGANOPHOSPHATES
• Accidental or suicidal exposure to pesticides
• particularly common in rural areas
• Household insect sprays used in agricultural
insecticides and home use products contain low-
potency organophosphates or carbamates.
• Organophosphates include Malathion, parathion,
and tetraethyl pyrophosphate (TEPP).
• Mechanism of toxicity: inhibit ACHE, resulting in accumulation of
excessive acetylcholine at cholinergic receptors.
• Pharmacokinetics: well absorbed by inhalation and ingestion and
through the skin.
• Some organophosphates may lead to delayed and persistent toxicity
for several days after exposure.
• Toxic dose: there is a wide spectrum of relative potency of the
organophosphates and carbamates.
• The degree of intoxication is also affected by the rate of exposure
(acute versus chronic)
• Clinical presentation: four clinical syndromes are identified following
organophosphate exposure; acute poisoning, intermediate syndrome,
chronic toxicity, and organophosphate induced delayed neuropathy.
Cont.
• Signs and symptoms of acute organophosphate poisoning usually
occur within 1–2 h of exposure but may be delayed up to several
hours, especially after skin exposure.
• Clinical manifestations may be classified into peripheral muscarinic
and nicotinic as well as CNS effects.
• Vomiting, diarrhea, abdominal cramping, bronchospasm, miosis,
bradycardia, and excessive salivation and sweating.
• Nicotinic effects include muscle fasciculations, tremor, and weakness.
• Central nervous system poisoning may cause agitation, seizures, and
coma.
• Some organophosphates may cause a delayed, often permanent
peripheral neuropathy.
Cont.
• Chronic toxicity is seen primarily in agricultural
workers with daily exposure, manifesting as
symmetrical sensorimotor axonopathy.
• Diagnosis: is based on history of exposure and the
presence of characteristic peripheral and central
manifestations of acetylcholine excess.
 Treatment

• Emergency and supportive measures:

• Rescuers and health care providers must take
measures to prevent direct contact with the skin or
clothing of contaminated victims, because
secondary contamination and serious illness may
result, especially with potent pesticides and nerve
agents.
 Poison management cont’d…
The general approach in management of poisoned and
overdosed patient
• Resuscitation

• Risk assessment

• Decontamination

• Specific antidote

• Enhanced Elimination

• Psychiatric evaluation and disposition

• ABC of life: pay careful attention to respiratory
muscle weakness; sudden respiratory arrest may
occur.
• If intubation is required, one should be aware of
potential interactions between neuromuscular
blockers and cholinesterase inhibitors.
• Administer supplemental oxygen.
• Monitor patients for hydrocarbon induced
pneumonitis, treat seizures, and coma if they occur.
• Observe patients for at least 6–8 h to rule out
delayed-onset symptoms resulting from skin
absorption.
Cont.
• Decontamination:
• The management of a patient who has ingested
organophosphates must always include safeguards
against exposure for the persons who treat the
patient because the organophosphates are readily
absorbed through the skin and mucous membranes.
• If there is heavy liquid contamination with a solvent,
clothing removal and victim decontamination should
be carried out outdoors or in a room with high-flow
ventilation.
Cont.
• Skin: remove all contaminated clothing and wash exposed
areas with soap and water, including the hair and under the
nails.
• Irrigate exposed eyes with water or saline.
• Ingestion
• Pre-hospital: administer activated charcoal, if available.
• Do not induce vomiting because of the risk of abrupt onset
of toxicity.
• Hospital: administer activated charcoal (cathartics are not
necessary if the patient already has diarrhea).
• Perform gastric lavage for large recent ingestions.
Cont.
• Enhanced elimination: dialysis and hemoperfusion
are not generally indicated because of the large
volume distribution of organophosphates and
effectiveness of the specific therapy described
above.
• Specific drugs and antidotes: include the
antimuscarinic agent atropine and the enzyme
reactivator pralidoxime.
Cont.

Treatment: involves specific antidote

• Atropine
• dose : 0.05 to 0.1 mg/kg to children and 2 to 5 mg for

adolescents and adults.

• Pralidoxime is given before aging.

 Role of DI pharmacist in Poison
Information
• The role of pharmacist working in DIS regarding poison
information include:
• Provide comprehensive and evidence-based information to
health professionals

• Educate clients and the general public through different medias

• Develop, implement, and evaluate measures for toxicovigilance

activities.
Role cont’d…
• Support management of poisoning cases at the scene, pre-
hospital and in facilities
• Prepare educational material on the prevention of poisoning

• Undertake toxicovigilance activities

• Participate in in-service and pre-service trainings to

healthcare professionals
 Managing Drug
Information Queries
 A step-wise approach to respond drug
information queries: Advantages

• Understand the context of the query

• Understand the scope of the query

• Provide credible information

• Facilitates smooth and clear communication

Step-wise approach to
responding DI queries   

“What steps would you follow to

respond to a drug query?”
Step-wise approach in responding to DI queries 
 

  Step 1: Secure Demographics of Requestor

Step 2: Obtain Background Information

Step 3: Determine and Categorize the Ultimate Question

Step 4: Develop Strategy and Conduct Search

Step 5: Perform Evaluation, Analysis, and Synthesis

Step 6: Formulate and Provide Response

Step 7: Conduct Follow-Up and Documentation

 References

• FEDERAL DEMOCRATIC REPUBLIC OF ETHIOPIA MINISTRY OF HEALTH,

NATIONAL DRUG INFORMATION SERVICE TRAINING COURSE FOR
PHARMACISTS PARTICIPANT’SMANUAL  , April2018