Occupational And Environmental

Hazards
Dr James Swao, FRACP
 Occupational And Environment
Hazards
Definition:
This is work or environment related ill health that
can lead to permanent disability or death.
1. Is a public health issue.
2. Every work/job has health risk.
3. These risks (hazards) are varied in type.
3.1 Physical
3.2 Chemical
3.3 Biological
3.4 Psychological
 THE OCCUPATION
• A) Factory related:
• 1. Chemicals (Contact, inhalation)
• 2. Machines
• 3. Fumes
• B) Office related
• 1. Chemicals (contact, inhalation)
• 2. Immobility
• 3. Environment (psychological)
• C) Mine related
• 1. Heavy metals (Contact, inhalation)
 THE OCCUPATION
D) Transport related:
1. Immobility (LD drivers)
2. Accidents (tromour)
E) Health:
1. Disease
2. Patient
3. Drugs
4. Stress
 THE ENVIRONMENT
A) Pollution
1. Fumes (Industrial, MV)
2. Waste disposal (Industrial, domestic)
3. Noise
B) Weather
1. Floods (water borne diseases, hunger)
2. Heat wave (Dehydration and death)
3. Cold (Diseases and death)
C) Radiation
1. Cancer cluster
 PREVENTION OF OCCUPATIONAL
HAZARDS
• 1. Work place safety (Identify and address safety concerns)
• 2. Regular reviews of those concerns

• 3. Work place protocols

• 4. Communication between staff

• 5. Emergency kits
 PREVENTION OF ENVIRONMENTAL
HAZARDS

1. Identify the health problem within the

environment
2. Classify the problem:
2.1 Contamination
2.2 Infection
2.3 Spread
2.4 Risks
3. Pass the information to the public health
personnel/administration.
TINDA
 HEAVY METAL POISONING
• DEFINITION: Why are they called heavy
metals?
a) The atomic weight
b) The specific gravity
c) The periodic table
d) Metals that may cause human toxicity.
 THE HEAVY METALS
1. LEAD
2. MERCURY
3. CADIUM
4. ZINC
5. COPPER
6. MANGANESE
7. ARSENIC
8. BERRYLIUM
9. LITHIUM
10. ALUMINIUM
11. BARIUM
 EXPOSURE TO HEAVY METALS
A) DIETARY SUPPLEMENTS
B) MEDICATION
C) LIFESTYLE (used topically to whiten skin)
D) ENVIRONMENT (water, bore holes)
E) WORK PLACE
F) PLAY
 EFFECTS OF EXPOSURE
1. Accumulation in the body causing damage to:
1.1 Heart
1.2 Kidneys
1.3 Brain
1.4 Bone
1.5 Liver
2. Displacement of other nutritional minerals.
2.1 Disrupting normal biological functions.
 ARSENIC TOXICITY
Source: 1. Untreated water
2. Bore hole water
3. Waste product of smelting plants
4. Pesticides, wood preservatives, herbicides
5. Soil (common in Rice)
6. Chicken feeds (fattening, parasitic infection)
USE: 1. Criminal intent
1.1 Has been used in history to get rid of opponents (inheritance powder)

2. Suicidal intent
3. Chemotherapeutic agent (arsenic trioxide)
 CLINICAL PRESENTATION
• HEADACHE
• CONVULSION
• BLOODY URINE
• FINGERNAIL PIMENTATION
• NIGHT BLINDNESS.
• COMA AND DEATH
 CLINICAL PRESENTATION
ACUTE POISONING:
1. GIT bleeding
CHRONIC EXPOSURE
2. Dehydration
1.Hyperglycaemia
3. Haemolysis.
2.Gangrene forma.
4. Renal failure
3.Peripheral neurop
5. Headache….
4.Night blindness
6. Confusion….
5. Finger pigmen…
7. Coma …………
8. Blindness……
9. Haematuria..
 ARSENIC POISONING
DIAGNOSIS
Presence of arsenic poisoning can be made by
examining:
A) URINE TEST
B) BLOOD TEST
C) HAIR
D) FINGERNAILS
 EMERGENCY CARE
A) REMOVAL OF ARSENIC
1. Activated charcoal
2. Aluminium oxide
3. Iron oxide
4. Renal replacement therapy (RRT)
5. Chelation

B) Potassium replacement
C) Fluid replacement
D) Public health
 ARSENIC CHELATION
1. Dimercaprol (BAL)

2. Dimercaptosuccinic acid (DMSA)

3. Penicillamine
 DIMERCAPROL
• Also known as British ant-Lewisite (BAL)
• Used as an antidote for lewisite (an organo-arsenic
compound used in 2nd world war)
• It binds the heavy metal, creating chemically
inert complex that is excreted in urine.
• Usually given intramuscularly 6hrly for 2 days.
• Used in the past for the treatment of Wilson’s
disease.
 OTHER INDICATIONS FOR
DIMERCAPROL
1. Has been used for the treatment of Wilson’s
disease.
2. Chelation of mercury from the kidneys.
3. As adjunct in management of acute
encephalopathy due to lead toxicity.
 DRAW BACKS
• It is a toxic substance and must be administered
under close supervision.
• Has narrow therapeutic range.
• May shift and concentrate arsenic in some
organs.
• Pain and abscess at site of injection
• Nephrotoxicity
• Hypertension.
• Headaches
 LEAD POISONING
Also known as a) Painter’s colic (paints)
b) Plumbism (plumbing)
Has medical effect on various organs:
a) Heart
b) Bones
c) Kidneys
d) Reproductive systems
e) CNS
 LEAD POISONING
Lead poisoning is usually due to occupational
exposure to contaminated:
a) Air
b) Water
c) Soil
d) Food
e) Contaminated products (from China)
f) Paints (old homes)
 CLINICAL PRESENTATION
Common problem in children
Presents with none specific symptoms:
Insomnia
Tremor
Cognitive impairment in children
Confusion
Convulsions
Organ lead poisoning develops very rapidly than
none organic.
Has accumulative effect , hence a chronic disease.
 LEAD POISONING
CLINICAL PRESENTATION

• IN ADULTS:
a) Abdominal pain
b) Memory loss
c) Kidney failure
d) Tingling sensation
e) Anaemia
 DIAGNOSIS OF LEAD POISONING
1. Medical history

2. Serum blood lead level (BLL)

3. Blood peripheral film (Basophilic stippling, microcytosis

and hypochromasia)

3. Bone x-ray may show lead lines

4. Stool lead levels (SLL) in children

 MANAGEMENT OF
LEAD POISONING
This involves treatment of:
a) Iron , calcium and manganese
b) Removal of the patient from lead source
c) Lead removal from the patient.
 LEAD POISONING
CHELATORS
1. EDTA
i. m administration
2. BAL

3. SUCCIMER (DMSA)
Oral administration
4. PENICILLAMINE
 CONTRAINDICATIONS
1. Pregnancy
2. Elderly patients
3. Breast feeding mothers
4. Renal impairment
5. Raised liver enzymes
 CHELATION
DEFINITION:
This is a medical procedure that involves
administration of a chelating agent to remove
heavy metals from the body.
 CHELATING MOLECULE
Has at least two negatively charged groups
allowing it to form complexes with positively
charged heavy metals.
Lead has multiple positive charges forming an
inert complexes that can be excreted in urine.
 CHELATING AGENTS
These agents are used in detoxifying arsenic (or
any other heavy metal) by chemically rendering it
inert and therefore excreted without being able
to interact with the body.
It is usually administered under very strict
medical supervision because of their potential
adverse effects or risks.
 CHELATING AGENTS
1. Dimercaprol (BAL)
2. Ethylenediaminetetraacetic acid (EDTA)
3. Dimercapto succinic acid (DSMA)
3. Dimecarpto-propane sulfonic acid (DMPS)
4. Alpha lipoic acid(ALA)
5. Penicillamine
6. Deferoxamine
 MODE OF ACTION
-It involves ions and molecules binding the
metal ions.
-This detoxifies the heavy metal and chemically
rendering it inert and excreted without being
able interact with the body.
- Route of administration depends on the type
of the poisoning agent (I.V or I.M or P.O.)
 INDICATIONS FOR CHELATORS
A) Acute lead poisoning
B) Severe poisoning
C) CNS signs (encephalopathy)
D) High serum lead levels
E) Asymptomatic individuals with very high
serum lead levels
 1.Ethylene-diamine-tetra-acetate
(EDTA)
• Is an amino-polycarboxylic acid.
• Produced as many salts:
a) Disodium EDTA (Na₂EDTA)
b) Disodium calcium EDTA (CaNa₂EDTA)

Is a colorless water soluble salt.

 INDICATIONS
• Is used for the chelation of certain heavy
metals:
a) Lead
b) Mercury
C)Excess iron following repeated transfusions
• OTHER USES
a) Anticoagulant as in blood samples.
b) Dental surgery
 SIDE EFFECTS
• NAUSEA AND VOMITING
• NEPHROTOXICITY
• BLEEDING
 3. Dimercaptosuccinic Acid
(DMSA, Succimer)
• An oral chelating agent
• Rapidly absorbed with peak concentration in
3hours
• Is albumin bound in plasma
• Only 20% of oral DMSA is eliminated unchanged
in urine.
• Is indicated in high serum lead levels.
• Water soluble analogue of dimercaprol.
• Much safer than both BAL and Na₂CaEDTA.
 INDICATIONS FOR DMSA
1. Arsenic

2. Lead

3. Mercury
 DMSA ADVERSE EFFECTS
It is important to note that DAMSA is a much
safer chelator with minimal, if any, adverse
effects.
1. Mild elevation of hepatic transaminases
2. Neutropenia
3. Skin reaction
 4. PENICILLAMINE
. A penicillin degradation product.
. Administered orally with rapid absorption,
reaching peak level within 1 to 3 hours.
. Food, antacids and iron impedes its absorption.
.Pharmacologically protein bound in both blood
and tissues.
. Slow release with substantial reservour.
 INDICATIONS FOR PENICILLAMINE
1. COPPER
2. GOLD
3. ARSENIC
4. LEAD
 METABOLISM OF PENICILLAMINE
• Is excreted through the kidneys.
• Fecal elimination does occur but not much.
• Metabolism to S-methylpenicillamine in the
liver is quite minimal
• Has slow release from tissues and prolonged
elimination.
 ADVERSE EFFECTS OF
PENICILLAMINE
• Zinc deficiency
-Leading to skin reaction at pressure points
-Delayed wound healing
-Alopecia
-Glossitis and stomatitis
• Others
-Leucopenia
-Thrombocytopenia
-Abdominal pain
 4. DMPS ( Unithiol)
• A chelating agent
• Similar to both dimercaprol and DMSA
• Water soluble
• Is available for p.o., i.v, and i.m.
• Less toxic than dimercaprol.
• Protein(albumin) bound.
• Prolonged half-life
• Intravenous route has long elimination half-life.
• Eliminated through the kidneys.
 DMPS INDICATIONS
• Is used for the removal heavy metals:
-Mercury
-Copper
-Lead
-Arsenic
• Some studies comparing DMPS with DMSA
and EDTA, did not find it superior.
END
 DESFERRIOXAMINE
• This is iron chelating compounds produced by
Actinobacteria.
• Given as daily subcutaneous injections
• Can also be given as an intravenous infusion.
• Binds blood iron forming an inert complex
easily eliminated in urine.
• Its effectiveness is enhanced by administration
of vitamin c (given separately).
 INDICATIONS OF DESFERROXAMINE
1. Iron poisoning as in children
2. Excess iron as in Thalassaemia.
3. Iron toxicity as in haemochromatosis
4. Aluminium toxicity as in haemodialysis.
5. In trying to prevent doxorubicin cardiac
toxicity.
 ADVERSE EFFECTS OF
DESFERROXAMINE
1. Hepatic toxicity
2. Nephrotoxicity
3. Skin reaction
4. Impaired hearing and vision
5. Pain at the injection site.
6. Gastrointestinal disturbances.
END
 NEONATAL PRESCRIPTION
1. WHAT IS NEONATE?
A newborn aged less than four weeks
The newborn:
1.0 Full term:
1.1 LBW
1.2 NBW

2.0 Preterm
2.1 LBW
 SPECIAL ASPECTS OF
NEONATAL MEDICATION
• WHAT DO WE NEED TO KNOW?
• A) Dosing
• B) Administration
• C) Monitoring
• D) Potential risks
• C) Risk prevention.
 THE NEONATES
• Their developmental physiology
• How does this impact on drug:
a) Absorption
b) Distribution
c) Metabolism
d) Elimination
e) Pharmacokinetic and pharmcodynamic of the
drug?
 DEFINITION
1. BIOAVAILABILITY:
2. The proportion of the dose of a drug that
reaches systemic circulation intact after
administration by a specific route.
 DRUG ABSORPTION
A)ORAL

B) INTRAMUSCULAR

C) SUBCUTANEOUS

D) RECTAL

E) INHALATION
 ORAL ABSORPTION
Physiological factors Full-term Neonate

Gastric pH 1-3 >5

Emptying time Reduced Variable

Intestinal SA Reduced Reduced

Intestinal Transit time Reduced Reduced

Pancreatic/biliary function Very immature Immature

 NEONATAL GI PHYSIOLOGY
• 1. HIGH STOMACH pH
1.1 ↑ bioavailability of weak bases.
1.2 ↑ bioavailability of acid labile drugs
1.3 ↓ bioavailability of weak acids
• 2. DELAYED GASTRIC EMPTYING
2.1 ↓ drug absorption.
• 3.0 PROLONGED INTESTINAL TRANSIT TIME
3.1 ↑ bioavailability
 INTRAMUSCULAR AND SUBCUTANEOUS
MEDICATIONS
1. DRUG ABSORPTION
1.1 Unreliable
1.1.1 Variable blood flow in the first 2-3weeks of life.
1.1 2 Limited muscle bulk and subcutaneous fat
1.1.3 Poor circulation in the extremities during
hypotension
1.1.4 Variable absorption
2.
 SUBCUTANEOUS ABSORPTION
1. Faster and higher in the neonates because of:
1.1 Thin skin
1.2 Well-hydrated stratum corneum
1.3 Large surface area
 RECTAL DRUG ABSORPTION
• Difficult to retain in the neonates
• Not significantly modified by age
• First-pass effect:
• High up travels directly to the liver
• Low deposition, travels into system through
inferior veins.
 DRUG ABSORPTION BY
INHALATION
• Neonates have small airways:
• Drugs may not reach the alveoli
• Greater drug deposition in upper airways.
• Nose breathing will expel most of the drugs
• Difficulty in administering the correct dose
hence ↑drug deposition in the upper airways
 DRUG DISTRIBUTION
DEFINITION:
This is drug movement through various body
compartments, tissues and cells.
 FACTORS AFFECTING
DRUG DISTRIBUTION
• There are certain factors that do affect drug
distribution in the body:
1. Body composition
2. Volume of distribution (VD)
3. Plasma binding protein.
4. Haemodynamic factors:
4.1 Cardiac output
4.2 Haemodynamics
4.3 Membrane permeability
5. Ability to penetrate target site
 1. BODY COMPOSITION
(TBW)
• AGE BODY MASS H₂O PROTEIN FAT

• FT NEW BORN 3.5 74 11 14

• 4 MONTHS 7.0 61.5 11.5 27

• 12 MONTHS 10.5 60.5 15 24.5

• ADULT 70 55-60
 2. VOLUME OF DISTRIBUTION
• This is basically the relationship between the
total amount of drug in the body and its
plasma concentration.
• The volume of distribution (VD) for H₂O
soluble drugs is ↑ in preterm infants and
neonates.
• Drugs with high VD have ↓peak concentration
 Volume Of Distribution L/kg
DRUG NEONATES ADULTS CHANGE
Gentamycin 0.77 – 1.62 0.30 – 0.67 2.5 X↑
Theophylline 0.20 – 2.80 0.44 – 0.50 3X↑
Diazepam 1.40 – 1.82 2.20 – 2.60 ¹/₃X↓
Phenytoin 1.20 – 1.40 0.60 – 0.67 2X↑
 3. PLASMA PROTEIN BINDING
1. Albumin is the major binding protein
2. ↑ in unbound drug:
2.1 ↑ drug distribution into tissues
2.2 ↑ VD of the drug
2.3 ↑ renal clearance
2.4 ↑ hepatic metabolism
 DRUG DISTRIBUTION IN
THE NEONATES
• This is defined as process of drug movement
though various body compartment.
• It is determined by the level of serum albumin
(binding protein)
• The unbound protein is pharmacologically active.
• Preterm infants have:
a) ↓binding protein (albumin)
b) ↑ body water
c) ↑free fraction of drug.
d) ↑volume of distribution.
 DRUG METABOLISM IN
THE NEONATES
• This occurs in the liver and involves:
1. Acceptor proteins within the hepatocytes
2. Specialized reactions carried out in phase
• Preterm infants have low or absent acceptor
proteins
• These acceptor proteins start to increase in
the 1st one week.
 DRUG ELIMINATION
• Excretion of drug is most done by the kidneys.
• This is dependent on the renal glomerular
filtration (GFR) and tubular functions
• GFR is reduced with increasing prematurity.
• At 40weeks, the GFR is 2.0 – 4ml/min.
• At 3months it 50% of the adult.
• Inefficient excretion and prolonged
elimination in the neonates.
END
 PAEDIATRIC PRESCRIPTION
PAEDIATRIC POPULATION:
1. Neonates:
Birth up to 1 month
2. Infants:
1 month to 2 years
3. Children:
2 years to 12 years
4. Adolescents:
12 years to 17 years
 2. INFANTS
• Just not neonates any more
• Has the medical physiology changed with age?
• Would the pharmacokinetics of a drug differ
between the two groups?
• What we know:
a) Neither preterm nor newborn.
b) Not adult either
c) They small children
 3. THE CHILDREN
1. Just not yet adults
2. The developmental physiology is much more
developed than in the neonates.
3. The principles of pharmacokinetics and
pharmacodynamics of various medications
are markedly improved.
4. Drug administration is purely dependent on
dose adjustment based on body weight.
 EFFECTIVENESS OF PAEDIATRIC
PHARMARCOLOGY
1. Bioavailability
2. Efficient drug absorption
3. Adequate drug metabolism by the liver.
4. Fully functioning GFR for drug elimination.
5. Correct dose to achieve these based on:
5.1 Body weight
END
 GERIATRICS
• This is a medical specialty responsible for the
health care of the elderly
 INTRODUCTION
• Physiological changes related to age do affect drug:
1. Absorption
2. Metabolism
3. Elimination.
• Advanced age is related with:
1. Multiple medical problems
2. Polypharmacy
3. More side effects
 DRUG ABSORPTION IN
GERIATRICS
1. ↓Gastric acidity
2. ↓ GIT blood flow
3. Delayed gastric emptying
4. Slow gastric emptying time
CLINICAL EFFECTS
1. None on absorption and bioavailability for most drugs
2. May affect transport and bioavailability of some drugs
4. ↓first-pass effect hence ↑bioavailability for some drugs
 DRUG DISTRIBUTION IN
GERIATRICS
1.↓ total body water
1.1↓volume of distribution
1.2↑plasma concentration of water soluble drugs
1.3 Hence lower doses are required.
2. ↓lean body mass and ↑body fat
2.1 ↑volume of distribution
2.2 ↑longer half-life of water soluble drugs
3. ↓serum albumin
3.1 ↑unbound drugs
 DRUG METABOLISM IN
GERIATRICS
• This mostly occurs in the liver and therefore
dependent on:
1. Liver function and
2. Blood flow.
• The ability of the liver to metabolize drugs
does not seem to be affected with advancing
age.
 DRUG ELIMINATION IN
OLD AGE

a) There are physiological changes that occur to

the kidneys with advancing age:
1. ↓renal blood flow
2. ↓GFR
3.↓renal mass
b) ↓clearance of drugs
1.↑ half-life of drugs normally eliminated by the kidneys
 ADVERSE DRUG REACTIONS
IN THE ELDERLY
This is very common in the elderly due to:
1. Multiple medical conditions
2. Polypharmacy
3. Prescribing errors:
-Polypharmacy
-Drug interactions with other prescriptions
-Patient’s physical capability
-Poor patient memory
 ELDERLY PATIENTS
COMPLIANCE
1. Elderly patients have poor drug compliance
because of:
1. Poor memory
2. Previous painful side effects
3. Physical disability
2. This can be improved by:
1. Good medical history
2. Indiscrete prescription
3. High suspicion of drug interaction
4. Simplified drug regimen.
END
 THERAPEUTIC AND TOXIC
POTENTIAL OF OTC DRUGS
• Over the counter (OTC) medications are drugs
one can buy without prescription.
• They can be obtained from:
1. Supermarkets
2. Drug stores
3. Chemists
4. Pharmacy.
5. Kiosk
7. Anywhere
 OTC DRUGS
• Are usually regulated, through regulatory
agency (Drugs and poisons board)
• Make sure active pharmaceutical ingredients
(API) are:
a) Safe
b) Effective
c) Any ingredient combination.
THE INGREDIENTS
 REGULATORY AGENCY
• Regulate the API
• Freedom to formulate drug combination
-Maramoja (paracetamol, ASA, and Caffeine)
-Calcium-vitamin D
-Omega 3
-Cod liver oil (seven seas)
• Some OTC may require assistance of
pharmacist
REGULATORY AGENCY
 WHY OTC
• Treatment of conditions that do not require
supervision of a doctor
• They must be safe
• Reasonably tolerable
• Little or no abuse potential
• Usually never:
1. Upgraded to prescription drug
2. From the market because of safety concerns
. But prescription drugs do move to OTC with time
 TOXIC POTENTIAL OF OTC
1. This is rare but possible
2. Strict adherence to both:
a) API
b) Appropriate combination without
c) Drug interaction.
3. Responsibility of regulatory agency
 RISKS OF OTC
• 1. Lack of supervision
1.1 Unaware of adverse effects
1.2 Overdose
1.3 Addiction
• 2. Wrong medication
2.1 Friend/advert
2.2 Symptoms
• 3. May have cumulative effect
3.1 Unlimited acquisition.
• 4. Legal responsibility with the patient
END
 RATIONAL PRESCRIBING
• Rational prescribing is a complex undertaking ,
which requires:
1. Diagnostic skills
2. Absolute knowledge of medicine
3. Mastery of principles of pharmacology
4. Communications skills.
5. Risks and uncertain outcome.
 THE PRESRIBER
• Major player in this complex requirement.
• He must aim at the best outcome
• Should avoid any harm, knowingly or
otherwise based on basic principles of clinical
pharmacology.
• Understand and appreciate cost of medicine.
• Above all, respect wishes of the patient.
 PRESCRIPTION
• DEFINITION:
• This is a written instructions or orders
detailing plan of care for an individual patient.
• It is part of logical conclusion based on
deductive process of history taking, clinical
examination and investigative results.
 STEPS IN PRESCRIBING
1. What is the diagnosis?
2. Identify treatment objective
3. What group of drugs are you likely to
prescribe?
4. Choose the drug according to criteria.
5. Personal drugs
 DIAGNOSIS
1. OEDEMA
2. COUGH
3. FEVER
4. PAIN
5. BLEEDING
 STEP 2: TREATMENT OBJECTIVE
1. Are you sure about the diagnosis?
2. Do you understand pathophysiology of the
disease/diagnosis?
3. Does the patient really need a prescription?
4. What do you expect to achieve?
 STEP 3: CHOOSING AMONGST
1. Think of a group of drugs you are aware can
be used in this disease.
2. Make sure it is the best, cheapest with
minimal adverse effects.
3. Your previous experience with such drug
would be of help.
 STEP 4: CRITERIA
1. Your patients well being is paramount
2. Despite cost of the drug, respect the efficacy
of the drug you opt to prescribe.
3. Consider every aspect of your choice:
- Availability
- Side effects
-Easy administration (elderly, young)
 STEP 5: THE CHOICE
1. Understand the actual active ingredient.
2. Identify the dose based on:
2.1 Drug
2.2 Diagnosis
2.3 Body weight, age
2.4 Possible side effects
3. Stick to the standard duration of therapy
 PRESCRIPTION
1.It carries orders to be performed by:
-Patient, Nurse, carer (caretaker), Nurse, other colleagues,
Pharmacist
2. These orders or instructions may concern:
2.1 Medication
2.2 Physiotherapy
2.3 Dressing
2.4 Nursing
2.5 Feeding

3. It now includes
Laboratory, imaging, clinical assessments
 PRESCRIPTION FORMAT
• It can be in many formats:
1. Electronic and transmitted directly to the
pharmacy
2. Hand written on:
2.1 Special prescription forms,
2.2 Pads or
2.3 Computer print out.
2.4 Phone
 PRESCRIPTION CONTENTS
• A medical prescription must include:
1. Name of the prescriber.
2. Address of the prescriber
3. Other legal issues:
3.1 Prescriber number
3.2 Medical board registration
4. Name and address of the patient (Child include age and body weight).
5. Date of issue
6. Signature of the prescriber
 THE MEDICATIONS INSTRUCTIONS
AND PRESCRIPTION
1. The drugs must be numbered:
• 1……..
• 2…….
2. The drug must be written in full (avoid abreviations)
3. Indicate:
3.1 Type of medicine (Injection, tabs, inhaler, pessary)
3.2 Route of administration (im, oral, pr, pv, ia, tablets, syrup)
3.3 Frequency (once, twice)
3.3 Duration of treatment
3.4 Repeat or refills.
 PRESCRIPTION AND MEDICATION
DETAILS
• A prescription will also contain purpose:
• THE MEDICATION.
1. Generic
1.1 Cheaper substitutes
1.2 Therapeutically and chemically similar
2. Original
2.0 More expensive
3. The prescriber must indicated:
3.1 Do not substitute
3.2 Do not interchange
3.3 Substitution permitted
 AVOID AMBIQUITY
1. Legibility
2. Remember:
2.1 Always use 3mls and not 3.0mls (to avoid 3.0 as 30mls)

2.2 Always use 0.5ml instead of .5ml (to avoid .5 as 5)

2.3 Always use 0.5ml instead of .50 or 0.50 (to avoid .50 as 50)

2.4 to use “mL” instead of “cc”( to avoid “0”)

 PRESCRIPTION AND
CLARITY
1. The instruction must be in English.
2. Quantities to be given must be clear
3. Frequency (where possible indicate 7am,
3pm and 11pm) and not x3 a day.
4. Permanent ink must be used.
5. Avoid units like “teaspoonful”.
 PRESCRIPTION AND THE PATIENT
It is basically the transfer of knowledge about
drugs to the patient with an aim to treat.
It is your duty to explain:
1. Why drugs are necessary
2. Relief of symptoms (which ones and when)
3. Importance of taking medicine as prescribed.
4. List all possible side effects
5. How to recognize them, duration and what to do.
 REMEMBER SOMETHING
ABOUT YOUR PRESCRIPTION
1. It carries your legal instruction(s).
2. It can not be changed without your consent.
3. Avoid possibility of abusing your prescription:
3.1 Patients
3.2 Colleagues
4.3 Others
4. Avoid self prescription
5. Do not put a line along what you had prescribed
but across it and sign with a date.
6. It must always remain legible.