Student Training Draft Mannual

8/3/2019 Student Training Draft Mannual

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Health House Pharmacies Group- Pharmacy Students Training Program -2011

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INDEX

PROGRAM DESCRIPTION

SCHEDULE &PROGRAMS

APPENDICES

ACTIVITIES


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(Health House Pharmacies Group)

Pharmacy Students Training Program 2011Program Description

This program is designed to provide students with a basic introduction to

pharmacy practice Student required to complete 120 hours in an actual pharmacy under the

supervision of a practicing pharmacist(Preceptor) at a community pharmacy

The overall goals of the externship are to provide the student with a fundamental

understanding and appreciation of pharmacy practice.

Objectives:1- To provide the pharmacy student with an early practice experience in the

profession of pharmacy

2- To assist the pharmacy student in understanding and relating pharmacy practice

to the total concept of the health care delivery system3- To provide the pharmacy student with beginning knowledge and understanding

of the responsibilities of the pharmacist in providing drug information and clinical

pharmacy services to patient and health professionals

4- To promote development of appropriate communication skills, interpersonal

relations and a professional attitude.

Student responsibilities:1- The student should exhibit professional appearance both in manner and dress

and should adhere to the standards of dress and behavior specified by the

clerkship site. All students should be well groomed and dress in a professionalmanner including shirt , tie, laboratory jackets and identification badges

2- Any information about a pharmacys operation must be considered confidential

and is not to be discussed with other students or with anyone other than the

instructors and the faculty members in charge of the educational program

3- Any information about a patients illness or medication is confidential and is not to

be discussed with anyone other than the instructor, other pharmacists on duty

and when in the patients best interest, with health professionals providing care to

the patient

4- The student is required to observe the functions normally performed by

pharmacist, and will actively participate in those activities which represent

learning experience

5- The student must commit to an active learning process. Learning, especially in

the externship setting, requires initiative, enthusiasm, and active participation on

behalf of the student


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6- The student should never hesitate to admit when he does not know something

and should seek assistance from appropriate individuals

7- The student should never question the advice or direction of the instructor in

public, in front of other students or members of the staff. Disagreements must be

discussed in private

8- The students must not receive financial compensation for participating in the

pharmacy practice externship , or with a preceptor with whom they are related

Preceptors responsibilities:1- At least one instructor at the site should be certified as a preceptors.

2- The instructor should be actively engaged in practice and should provide and

promote optimal pharmaceutical care service

3- The instructor should willing to accept the responsibility for the guidance and

training of the student and be able to devote adequate time to this activity.

4- The instructor should be willing to meet at regular intervals with faculty members

responsible for educational program in order to discuss the current status of the

program and ways to improve it.

5- The instructor should belong to local ,state, and national professional

organizations and should participate regularly in continuing education program.

6- The instructor should attempt to instill the principle of professional ethics in the

student by his actions as well as words

7- The relationship between the instructor and the student should be one of

teacher-student ,rather than employer-employee

8- The instructor should explain in detail what is expected of the student as it relates

to appearance, attitude, the objectives of the rotation and how they will be

accomplished

9- The instructor should meet at regular intervals, usually at least once per week,with the student to discuss any questions the student may have and to provide

an on-going evaluation of the students performance

10-The instructors evaluation of the student should be in private ,whenever

possible, and criticism should be constructive and sympathetic

11- The instructor should never hesitate to admit that he does not know the answer

to a student question, and should seek assistance when appropriate

Textbook:Pharmacy students training manual is required.GradingPass- No pass


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SCHEDULE &

PROGRAMS


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Pharmacy Students Training Program Schedule:

Weeks Task Time

First Week Morning ShiftSaturday Onsite training (Pharmacy) 9:00 AM-3:00PM

Sunday Onsite training (Pharmacy) 9:00 AM-3:00PM

Monday Onsite training (Pharmacy) 9:00 AM-3:00PM

Tuesday Onsite training (Pharmacy) 9:00 AM-3:00PM

Wednesday Onsite training (Pharmacy) 9:00 AM-3:00PM

Second Week Evening ShiftSaturday Onsite training (Pharmacy) 5:00PM-11:00 PM

Sunday Onsite training (Pharmacy) 5:00PM-11:00 PM

Monday Onsite training (Pharmacy) 5:00PM-11:00 PM

Tuesday Onsite training (Pharmacy) 5:00PM-11:00 PM

Wednesday Onsite training (Pharmacy) 5:00PM-11:00 PM

Third Week Evening ShiftSaturday Onsite training (Pharmacy) 5:00PM-11:00 PM

Sunday Onsite training (Pharmacy) 5:00PM-11:00 PM

Monday Onsite training (Pharmacy) 5:00PM-11:00 PM

Tuesday Onsite training (Pharmacy) 5:00PM-11:00 PM

Wednesday Onsite training (Pharmacy) 5:00PM-11:00 PM

Fourth Week Morning ShiftSaturday Onsite training (Pharmacy) 9:00 AM-3:00PM

Sunday Onsite training (Pharmacy) 9:00 AM-3:00PM

Monday Onsite training (Pharmacy) 9:00 AM-3:00PM

Tuesday Onsite training (Pharmacy) 9:00 AM-3:00PM

Wednesday Onsite training (Pharmacy) 9:00 AM-3:00PM


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First Week :

Day Subject

Saturday Orientation to the pharmacy

Sunday Communication skills and patient

counseling.Monday Hypertension & Cholesterol

Management.Tuesday

Wednesday

Second Week:

Day Subject

Saturday Diabetes Mellitus

Sunday

Monday Psychotic DrugsTraining Review & Meeting SessionTuesday

Wednesday

Third Week :

Day Subject

Saturday Dermatology

Sunday

Monday Infectious DiseasesTraining Review & Meeting SessionTuesday

Wednesday

Forth Week :

Day Subject

Saturday Gastroenterology

Sunday

Monday Respiratory Diseases

Training Review & Meeting SessionTuesday

Wednesday


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First Week :

Saturday: Orientation to the pharmacy (Initial Training)Tour of PharmacyThe student should cover the following topics and mark () on each task when done

To Do list Identification the main pharmacy areas (Prescription & OTC ,Cosmetics,

Lab. ,Storage).

Location of Medications (classification of medication).

Location of various Cosmetics products & baby products.

Other areas deemed appropriate & Merchandizing Techniques.

Organization Chart (chain of command) .

Pharmacy Policy and Procedures .

Pharmacy Safety & Security.

Role of Pharmacist (Job Description)

Sunday : Communication skills and patient counseling.See Appendix (A).Monday, Tuesday: Hypertension & Cholesterol Management.The student should cover the following topics and mark () on each task when done

To Do list Hypertension :

Introduction & Definition

Etiology : Hypertension may be primary (85 to 95% of cases) or secondary

Pathophysiology (BP equals cardiac output (CO) total peripheral vascular

resistance (TPR))

Abnormal Na transport

Sympathetic nervous system

Renin-angiotensin-aldosterone system

Vasodilator deficiency: (eg, bradykinin, nitric oxide) classification

General Treatment Weight loss and exercise

Smoking cessation

Diet: Increased fruits and vegetables, decreased salt, limited alcohol

Drugs if BP is initially high (> 160/100) or unresponsive to lifestyle modifications

Drugs for Hypertension

Diuretics:

E.g. (Thiazide diuretics, Loop diuretics and Potassium-sparing )

Angiotensin-Converting enzyme (ACE) inbihitor


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E.g. Captopril, Lisinopril and Enalapril

Angiotensin II receptor antagonists

E.g. Candesartan , Eprosartan, Losartan,Telmisartan and Valsartan)

Sympatholytics : Blockers: E.g. ( Atenolol, Propranolol, Metoprolol and Bisoprolol)

Sympatholytics : centrally acting agoinst E.g. ( Methyldopa, clonidine)

Sympatholytics : Calcium Channel Blocker

E.g. (diltiazem , Verapamil, Amlodipine and Nifedipine) Other combinations

Cholesterol Management Introduction & Definition

Total cholesterol levels are comprised of high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) and triglycerides (TG)

Treatment goals

DRUG THERAPYS ROLE IN COMPLETE CONTROL Statins : HMG CoA Reductase Inhibitors

e.g. (Atorvastatin , Simvastatin and Rosuvastatin)

Fibrates : Fibric Acid Derivatives e.g.( Fenofibrate , Gemfibrozil)

Resins : Bile Acid Sequestrants e.g.(Cholestyramine , Colestipol)

Nicotinic Acid (Niacin ER)

Omega-3 Fatty Acids

Cholesterol Absorption Inhibitors e.g(Ezetimibe)

Second Week :Saturday , Sunday: Diabetes MellitusThe student should cover the following topics with the preceptor and mark () on each task

when done

To Do list Diabetes Mellitus (DM) Definition

Etiology and general Characteristics of Types 1 and 2 Diabetes Mellitus

Symptoms and Signs

Complications(Diabetic retinopathy , Diabetic nephropathy , Diabetic neuropathy ,

Cardiomyopathy and Others)

Diagnosis

Fasting blood glucose levels

Sometimes oral glucose tolerance testing

Treatment Diet and exercise

For type 1 diabetes, insulin

For type 2 diabetes, oral antihyperglycemics, insulin , or both


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Often ACE inhibitors and aspirin to prevent complications

Goals and methods: Goals for glycemic control are Blood glucose between 80 and 120 mg/dL (4.4 and 6.7 mmol/L) during the day

Blood glucose between 100 and 140 mg/dL (5.6 and 7.8 mmol/L) at bedtime

HbA1c levels < 7%

Patient education

Diet Exercise

accessories

Medication: Insulin:types are commonly categorized by their time to onset and

duration of action

Rapid-acting Short-acting Intermediate-acting Long-acting Premixed Complications of insulin treatment

Oral antihyperglycemic drugs: Sulfonylureas

Short-acting insulin secretagogues e.g. ( repaglinide , nateglinide )

Biguanides e.g. (Metformin)

Thiazolidinediones e.g.( troglitazone)

-Glucosidase inhibitors

Monday, Tuesday: Psychotic DrugsThe student should cover the following topics with the preceptor and mark () on each task

when done

To Do list Depression

Definition & Pathophysiology:

Treatment

Reuptake inhibitors (RIs)

Selective serotonin reuptake inhibitors (SSRIs)

E.g (Fluoxetine , Sertraline , Paroxetine , Citalopram, Fluvoxamine) Serotonin and norepinephrine reuptake inhibitors (SNRIs) e.g. (Venlafaxine,

Duloxetine ) Norepinephrine and dopamine reuptake inhibitors (NDRIs) e.g. (Bupropion) Combined reuptake inhibitors and receptor blockers e.g. (Mirtazapine,

Maprotiline) Tricyclic antidepressants (TCAs):e.g. (Clomipramine , Imipramine, Amitriptyline ) Monoamines oxidase inhibitors (MAOIs) e.g. (Moclobemide)

Schizophrenia Definition & Pathophysiology:

Treatment

Typical antipsychotics drugs E.g. (Haloperidol, Chlorpromazine)

Atypical antipsychotics drugs E.g.( Clozapine, Olanzapine, Risperidone,


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Quetiapine, Aripiprazole, Sulpiride)

Anxiety Definition & Pathophysiology:

Treatment

Benzodiazepines e.g. (Diazepam, Clonazepam, Alprazolam)

Serotonin 1A agonists e.g. (Buspar)

Neurological disorders Alzheimer

Definition & Pathophysiology: Treatment

Acetylcholinesterase inhibitors: e.g. (Rivastigmine, Donepezil)

Antagonist of NMDA receptors: (memantine)

Nootropic agents e.g. (Piracetam )

Epilepsy

Definition & Pathophysiology:

Treatment

Sodium channel blockers e.g. (Phenytoin, Carbamazepine, Lamotrigine,Topiramate)

Gamma-aminobutyric acid (GABA) enhancers:e.g. (Sodium Valproate)

GABA precursor formation enhancing:e.g. (Gabapentin

, Pregabalin)

Synaptic vesicle protein 2A binding e.g. (Levetiracetam)

Third Week :Saturday , Sunday: DermatologyThe student should cover the following topics with the preceptor and mark () on each task

when done

To Do list Treatment of :

Acne vulgaris

Cold Sores

Corns and calluses

Dandruff (Pityriasis Capitis)

Eczema/ dermatitis

Fungal infections

Hair loss

Psoriasis

Seborrhoeic dermatitis

Scabies

Warts and verrucas


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Monday, Tuesday: Infectious Diseases-Discuss the following items for each group: ( Mode of action , Spectrum ,therapeutic uses , precaution and significant interaction )


I ) Antibacterial agents :

Aminoglycosides Cephalosporin ( 1st ,2nd ,3rd ,4th generation).

Erythromycins

Penicillins

Sulfonamides

Tetracyclines

Fluoroquinolones

Urinary tract antiseptics

Miscellaneous

II) Antifungal Agents

Systemic agents

Topical agents.

Antiviral agents.

Antithemintics

Antitubercular agents.

Antiprotozoal agents.

Forth Week :Saturday , Sunday: Gastroenterology

The student should cover the following topics with the preceptor and mark () on each taskwhen done


The oral cavity

Mouth ulcers

Oral thrush

Gingivitis

G.I.T.

Dyspepsia

Gastroentritis (Diarrhoea)

Constipation

Haemorrhoids

Abdominal pain (Irritable bowel syndrome)


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Monday, Tuesday: Respiratory DiseasesThe student should cover the following topics with the preceptor and mark () oneach task when done


Cough

The common cold

Sore throat

Allergic rhinitis

Asthma

Acute Bronchitis
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How to Read a Doctor's Prescription?

When doctors write a prescription for a medication, they useabbreviations (based on Latin words) that tell you which medicationto give and directions on how to use that medication.

When writing a prescription, doctor may use either the "generic"name of the medication or the "brand name". For example, sertralineis the "generic" name and Zoloft is the "brand name" used to identify a medication frequentlyprescribed for the treatment of depression.

There is prescription is usually written on a pre-printed pad with doctor's name, address, and phonenumber. space for patients name and address, age, the date, a place for doctors signature, and ablank area in which doctor writes the following directions:

Name of the medication Dose of the medication

How often to take the medication

When to take the medication How to take the medication

Additionally, doctor will indicate how much medicine the pharmacist should give and the number oftimes that prescription can be refilled.

Index for commonly useMedical Abbreviations:

A

ac = before mealad = Right earagit = shake

am = morning

amt = amount

ante = beforeas, al = left ear

ASA = Aspirin

au = both earsaq = water

B

bid = twice daily

bp = blood pressure

C

N

Na = sodiumNaCl = sodium chlorideneg = negative

NKA = no know allergies

NKDA = no know drug allergies

NPO = nothing per mouth (oral)

O

o OD = right eye

oint = ointment

OS, OL = left eyeOU = each eyeoz = ounce

P

o PB = phenobarbital
http://www.wikihow.com/Read-a-Doctor%27s-Prescriptionhttp://www.wikihow.com/Read-a-Doctor%27s-Prescription


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c = with

CBC = complete blood count

Ca = calcium

caps = capsulesCl = chloride

c/o = complaint of

D

D/C = discontinue

diag, Dx = diagnosisdil = dilute

disch = discharge

dr = dram

E,F

et = and

Etoh = alcoholexp = expired

FBS = fasting blood sugarFe = iron

fl = fluid

G

gm = gram

gr = graingt = drop

gtt = drops

H

H, h, hr = hourH20 = water

hs = bed time

Hx = history

I, K, L

IM = intramuscularIV = intravenous

K = potassium

liq = liquid

pc = after meals

per = by

pm = after noon

PO = orallyprn = as needed

Q

o q = every

qd = every day

qh = every hourqhs = at every bed time

qid = 4 times a day

qod = every other dayq6h = every 6 hours

qs = quantity sufficient

R, S

o R/O = rule out

Rx = prescriptionSL = sublingual

SOB = shortness of breath

sol = solutionsq = sub cutaneous

ss = one-half

stat = immediately

T

o tabs = tabletstbsp = tablespoon (15ml)

temp = temperature

tid = three times a daytr, tinc = tincture

tsp = teaspoon (5ml)

U, V, X

o ung = ointment

vag = vaginalvol. = volumeVS = vital signs

x = times


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M

MDI = meter dose inhaler

Mg = magnesiummg = milligram

MgSO4 = magnesium Sulfate

mm = millimeter

MOM = Milk of MagnesiaMS = Morphine Sulfate

How to read the prescription?

A.The doctor's name and contact information., or it could behandwritten in when required for prescribing certain controlledmedications or substances.

B. patient name, address, date of birth (or age). It is important tonote that a prescription is only prescribed for only one person, theperson named on the prescription.

C. The body of the prescription. You will note the abbreviation Rx,which in today's modern society means prescription, but is Latin for"take thou". The body will contain the following:

The name of the medication you are being prescribed can bewritten denoting either the brand name or the generic name.

The dosage or strength of the medication.

The amount or quantity of medication to be dispersed. Many physician's will write either the word "Dispense", oruse the symbol "#" to signify how much medication the pharmacist should give to the patient.

D. Refill instructions. The physician will denote the number of times that a prescription can be refilled.

E. Medication directions. The abbreviation "Sig" is Latin for "label". The directions for taking the medication areprovided here. Those directions may include instructions to take before meals, with food, at bedtime, on an emptystomach, or with plenty of water. The instructions should be followed; otherwise the effectiveness of the medicationmay be hampered.

F. The physician's signature. A prescriber's signature is required on all prescriptions. Prescribers may includeMedical Doctors (MD), Doctors of Osteopathy (DO), Nurse Practitioners (NP), or Physician's Assistants (PA).

G. Instructions to the pharmacist to dispense brand name or generic medications. This allows the pharmacist tosubstitute the least expensive comparable medication available


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Some Examples

Example #1: the diagnosis is high cholesterol

Zocor 10 mg.This is the name of the medication and the dose. Sig: i po qhsinstructions are to take 1 pill, by mouth, at bedtime.Dispense #90will give 90 pills, enough for about 3 months.Refill 0 timesthe doctor has indicated no refills, most likely because she would like to check your blood cholesterol and thendecide if you need more medication or a different dose.DAW left blankthe pharmacist will most likely give simvastatin, the generic version of Zocor.

Example #2:the diagnosis is type 2 diabetes

Glucophage 500 mg.This is the name of the medication and the dose. Sig: i po bid pcthe instructions are to take 1 pill, by mouth, twice each day, after meals this means that should take thismedication right after breakfast and right after dinner.Dispense #90You will give 90 pills, enough for about 3 months.Refill 3 timesthe doctor has indicated 3 refills, enough medication for one year. This may mean that the diabetes is stableand well controlled on this medication.DAW left blank

the pharmacist will most likely give metformin, the generic version of Glucophage.

Example #3: Your diagnosis ishigh blood pressure

Diovan 40 mg.This is the name of the medication and the dose. Sig: i po qdthe instructions are to take 1 pill, by mouth, once each day most likely can take this medication either before orafter a meal since the doctor did not say otherwise.Dispense #90will be give 90 pills, enough for about 3 months.

Refill 0 timesthe doctor has indicated no refills, most likely because would like to check blood pressure and then decide if needmore medication or a different dose.

DAW left blankthe pharmacist will give Diovan since there is no generic available for this drug.

Example #4:Proventil MDI 2 puffs q6h prn SOB.Answer: Proventil meter dose inhaler, 2 puffs every 6 hours as needed for shortness ofbreath.

Example #5:Reglan 10mg 1 tab PO qid and hs.Answer: Reglan 10mg, 1 tablet by mouth four times daily and at bed time.
http://highbloodpressure.about.com/http://highbloodpressure.about.com/http://highbloodpressure.about.com/http://drugsaz.about.com/od/drugs/diovan.htmhttp://drugsaz.about.com/od/drugs/diovan.htmhttp://drugsaz.about.com/od/drugs/diovan.htmhttp://highbloodpressure.about.com/


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Patient Counseling Tips : About How to Administer your Medication properly ?

1- How to Use Ear Drops Properly(Having someone else give you the ear drops may make this procedure easier.)

1Wash your hands thoroughly with soap and water.

2Gently clean your ear with a damp facecloth and then dry your ear.

3Warm the drops to near body temperature by holding thecontainer in the palm of your hand for a few minutes.

4If the drops are a cloudy suspension, shake the bottle well for 10 seconds.

5Check the dropper tip to make sure that it is not chipped or cracked.

6Draw the medication into the dropper, or hold the dropper-top bottle with the dropper tip down.

7Tilt the affected ear up or lie on your side. Pull the earbackward and upward (or if giving to a

child younger than 3 years of age, pull backward and downward) to

open the

ear canal.

8Place the correct number of drops in your ear. Gentlypress on the small skin flap over the ear to help the drops to

run into the ear canal

9Keep your ear tilted up for a few minutes or insert a soft cottonplug in your ear, whichever method has been recommended by your

pharmacist or doctor.

10 Replace and tighten the cap or dropper right away.


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Wash your hands to remove any medication.

2- How to Use Eye Drops Properly

(Using a mirror or having someone else give you the eyedrops may make this procedure easier.)



3Avoid touching the dropper tip against your eye or anything elseeye drops and droppers mustbe kept clean.

4While tilting your head back, pull down the lowerlid of your eye with your index finger to

form a pocket.

5Hold the dropper (tip down) with the other hand, as closeto the eye as possible without touching it.

6Brace the remaining fingers of that hand against your face.

7Gently squeeze the dropper so that the correct number ofdrops falls into the pocket made by the lower eyelid.

8Close your eye for 2 to 3 minutes and tip your head downas though looking at the floor. Wipe any excess liquid fromyour face with a tissue.

9Replace and tighten the cap right away. Do not wipe or rinse the dropper tip.


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10 Wash your hands to remove any medication.

3- How to Use Eye Ointments and GelsProperly

(Using a mirror or having someone else give you the eyedrops may make this procedure easier.)


2Avoid touching the tip of the tube against your eye or anything else - the medication and its container mustbe kept clean.

3Holding the tube between your thumb and forefinger, place it as near to your eyelid as possible withouttouching it.

4Brace the remaining fingers of that hand against your face.

5Tilt your head forward slightly.

6While tilting your head back, pull down the lower lid of your eyewith your index finger to form a pocket.

7Squeeze ribbon of ointment or gel into the pocket made by the lower eyelid. Remove your index finger fromthe lower eyelid.

8Blink your eye gently; then close your eye for 1 to 2 minutes.

9With a tissue, wipe any excess ointment or gel from the eyelids and lashes. With another clean tissue, wipe


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the tip of the tube clean.

10 Replace and tighten the cap right away.


4- How to Use Metered-Dose Inhalers

1Wash your hands thoroughly with soap and warm water.

2Remove the cap and hold the inhaler upright.

3Shake the inhaler.

4Breathe out slowly through your mouth.

5Hold your inhaler as shown in the picture or as recommended byyour doctor.

6While you are breathing in, press down on your inhaler one time to release the medication.

7Continue to breathe in slowly and as deeply as you can.

8Hold your breath for 10 seconds, if you can, to allow themedication to reach deeply into

your lungs.

9Repeat steps 3 to 8 until you have inhaled the number of puffs that your doctor prescribed. Askyour doctor or pharmacist if you need to

wait between puffs of your medication.


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10 Rinse your mouth thoroughly with water.

11 Spit out the water. Do not swallow.

5- How to Use Nose Drops Properly(Having someone else give you the nose drops may make this procedure easier.)

1Blow your nose gently.



4Avoid touching the dropper tip against your clean nose.

5Tilt your head as far back as possible, or lie down on your backon a flat surface (such as a bed) and hang your head over the edge.

6Place the correct number of drops into your nose.

7Bend your head forward toward your knees and gently move itleft and right.

8Remain in this position for a few minutes.

9Clean the dropper tip with warm water. Cap the bottle right away.


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6- How to Use Nasal Sprays Properly


2Blow your nose gently before using the spray.

3Gently insert the bottle tip into one nostril. Press on the otherside of your nose with one finger to close off the other nostril.

4Keep your head upright.

5Breathe in quickly while squeezing the bottle.


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6Repeat in other nostril.


7- How to Use Rectal Suppositories Properly


2If the suppository is soft, hold it under cool water or place it ina refrigerator for a few minutes to harden it before removing the

wrapper.

3Remove the wrapper, if present.

4If you were told to use half of the suppository, cut it lengthwise with a clean, single-edge razorblade.

5Put on a finger cot or disposable glove, if desired (available at a pharmacy).

6Lubricate the suppository tip with a water-soluble lubricantsuch as K-Y Jelly, not petroleum jelly (Vaseline). If you do not

have this lubricant, moisten your rectal area with cool tap water.


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7Lie on your side with your lower leg straightened out and your upper leg bent forward towardyour stomach.

8Lift upper buttock to expose the rectal area.

9Insert the suppository, pointed end first, with your finger untilit passes the muscular sphincter of the rectum, about 1/2 to 1

inch in infants and 1 inch in adults. (If not inserted past this

sphincter, the suppository may pop out.)

10 Hold buttocks together for a few seconds.

11 Remain lying down for about 5 minutes to avoid having the suppository come out.

Physiological values for some body fluids1-Complete Blood Count (C.B.C.):

A CBC test usually includes:

White blood cell (WBC, leukocyte) count.

White blood cells protect the body against infection. If an infection develops,white blood cells attack and destroy the bacteria, virus, or other organismcausing it. White blood cells are bigger than red blood cells but fewer innumber. When a person has a bacterial infection, the number of white cellsrises very quickly. The number of white blood cells is sometimes used tofind an infection or to see how the body is dealing with cancer treatment.

White blood cell types (WBC differential).

The major types of white blood cells are neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Immatureneutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting thebody. The numbers of each one of these types of white blood cells give important information about the immune

system. Too many or too few of the different types of white blood cells can help find an infection, an allergic or toxicreaction to medicines or chemicals, and many conditions, such as leukemia.

Red blood cell (RBC) count.

Red blood cells carry oxygen from the lungs to the rest of the body. They also carry carbon dioxide back to the lungsso it can be exhaled. If the RBC count is low (anemia), the body may not be getting the oxygen it needs. If the count is
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too high (a condition called polycythemia), there is a chance that the red blood cells will clump together and block tinyblood vessels (capillaries). This also makes it hard for your red blood cells to carry oxygen.

Hematocrit (HCT, packed cell volume, PCV).

This test measures the amount of space (volume) red blood cells take up in the blood. The value is given as apercentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood'svolume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia orpolycythemia is present.

Hemoglobin (Hgb).

The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. Thehemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carryoxygen throughout the body.

Red blood cell indices.

There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), andmean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come fromother measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount ofhemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average redblood cell. These numbers help in the diagnosis of different types of anemia. Red cell distribution width (RDW) can also

be measured which shows if the cells are all the same or different sizes or shapes.

Platelet (thrombocyte) count.

Platelets (thrombocytes) are the smallest type of blood cell. They are important in blood clotting. When bleeding occurs,the platelets swell, clump together, and form a sticky plug that helps stop the bleeding. If there are too few platelets,uncontrolled bleeding may be a problem. If there are too many platelets, there is a chance of a blood clot forming in ablood vessel. Also, platelets may be involved in hardening of the arteries (atherosclerosis).

Mean platelet volume (MPV).

Mean platelet volume measures the average amount (volume) of platelets. Mean platelet volume is used along withplatelet count to diagnose some diseases. If the platelet count is normal, the mean platelet volume can still be too highor too low.

Why It Is Done?A complete blood count may be done to:

Find the cause of symptoms such as fatigue, weakness, fever, bruising, or weight loss. Find anemia. See how much blood has been lost if there is bleeding. Diagnose polycythemia.
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Find an infection. Diagnose diseases of the blood, such as leukemia. Check how the body is dealing with some types of drug or radiation treatment. Check how abnormal bleeding is affecting the blood cells and counts. Screen for high and low values before a surgery. See if there are too many or too few of certain types of cells. This may help find other conditions, such

as too many eosinophils may mean an allergy or asthma is present.

A complete blood count may be done as part of a regular physical examination. A blood count can give valuable information about

the general state of health.

White blood cell (WBC, leukocyte) count

Men and non pregnant women: 4,50011,000/mcL3 or 4.511.0 x 109/liter (SI units)

Pregnant women: 1st trimester: 6,60014,100/mcL or 6.614.1 x 109/L

2nd trimester: 6,90017,100/mcL or 6.917.1 x 109/L

3rd trimester: 5,90014,700/mcL or 5.914.7 x 109/L

Postpartum: 9,70025,700/mcL or 9.725.7 x 109/L

White blood cell types (WBC differential)

Neutrophils: 50%62%

Bandneutrophils:

3%6%

Lymphocytes: 25%40%

Monocytes: 3%7%

Eosinophils:0%3%

Basophils: 0%1%

Red blood cell (RBC) count

Men: 4.76.1 million RBCs per microliter (mcL) or 4.76.1 x 1012/liter (SI units)

Women: 4.25.4 million RBCs per mcL or 4.25.4 x 1012/L

Children: 4.05.5 million RBCs per mcL or 4.64.8 x 1012/L

Newborn: 4.87.1 million RBCs per mcL or 4.87.1 x 1012/L

Hematocrit (HCT)

Men: 42%52% or 0.420.52 volume fraction (SI units)
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Women: 37%47% or 0.370.47 volume fraction

Pregnant women: 1st trimester: 35%46%

2nd trimester: 30%42%

3rd trimester: 34%44%

Postpartum: 30%44%

Children: 32%44%

Newborns: 44%64%

Hemoglobin (Hgb)

Men: 1418 grams per deciliter (g/dL) or 8.711.2 millimoles per liter (mmol/L) (SI units)

Women: 1216 g/dL or 7.49.9 mmol/L

Pregnant women: 1st trimester: 11.415.0 g/dL or 7.19.3 mmol/L

2nd trimester: 10.014.3 g/dL or 6.28.9 mmol/L

3rd trimester: 10.214.4 g/dL or 6.38.9 mmol/L

Postpartum: 10.418.0 g/dL or 6.49.3 mmol/L

Children: 9.515.5 g/dL

Newborn: 1424 g/dL

In general, a normal hemoglobin level is about one-third the value of the hematocrit.

Red blood cell indices

Mean corpuscular volume (MCV): 8298 femtoliters (fL)

Mean corpuscular hemoglobin (MCH): 2634 picograms (pg)

Mean corpuscular hemoglobin concentration (MCHC): 3138 grams per deciliter (g/dL) or 31%38%

Red cell distribution width (RDW)

Normal: 11.5%14.6%

Platelet (thrombocyte) count

Normal: Children: 150,000450,000 platelets per mm3 or 150450 x 109/liter (SI units)
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Adults: 150,000400,000 platelets per mm3 or 150400 x 109/liter (SI units)

Mean platelet volume (MPV)

Normal:Children: 7.410.4 mcm3 or 7.410.4 fL

Adults: 7.410.4 mcm3 or 7.410.4 fL

Blood smear

Normal: Blood cells are normal in shape, size, color, and number

High values:

1- Red blood cell (RBC):

Conditions that cause high RBC values include smoking, exposure to carbon monoxide, long-term lung disease, kidney disease,some cancers, certain forms of heart disease, alcoholism, liver disease, a rare disorder of the bone marrow (polycythemia vera), or

a rare disorder of hemoglobin that binds oxygen tightly.

Conditions that affect the body's water content can also cause high RBC values. These conditions include dehydration, diarrhea orvomiting, excessive sweating, severe burns, and the use of diuretics. The lack of fluid in the body makes the RBC volume look high;this is sometimes called spurious polycythemia.

2- White blood cell (WBC, leukocyte):

Conditions that cause high WBC values include infection, inflammation, damage to body tissues (such as a heart attack), severephysical or emotional stress (such as a fever, injury, or surgery), burns, kidney failure, lupus, tuberculosis (TB), rheumatoid arthritis,

malnutrition, leukemia, and diseases such as cancer.

The use of corticosteroids, underactive adrenal glands, thyroid gland problems, certain medicines, or removal of the spleen can alsocause high WBC values.

3- Platelets:

High platelet values may be seen with bleeding, iron deficiency, some diseases like cancer, or problems with the bone marrow.

Low values

1- Red blood cell (RBC)

Anemia lowers RBC values. Anemia can be caused by heavy menstrual bleeding, stomach ulcers, colon cancer, inflammatorybowel disease, some tumors, Addison's disease, thalassemia, lead poisoning, sickle cell disease, or reactions to some chemicalsand medicines. A low RBC value may also be seen if the spleen has been taken out.

A lack of folic acid or vitamin B12 can also cause anemia, such as pernicious anemia, which is a problem with absorbing vitaminB12. The RBC indices value and a blood smear may help find the cause of anemia.

2- White blood cell (WBC, leukocyte)
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Conditions that can lower WBC values include chemotherapy and reactions to other medicines, aplastic anemia, viral infections,malaria, alcoholism, AIDS, lupus, or Cushing's syndrome. A large spleen can lower the WBC count.

3- Platelets

Low platelet values can occur in pregnancy or idiopathic thrombocytopenic purpura (ITP) and other conditions that affect howplatelets are made or that destroy platelets. A large spleen can lower the platelet count

2- Urine test :

More than 100 different tests can be done on urine. A regular urinalysis often includes the following tests.

Color. Many things affect urine color, including fluid balance, diet, medicines, and diseases. How dark or light the color istells you how much water is in it. Vitamin B supplements can turn urine bright yellow. Some medicines, blackberries,beets, rhubarb, or blood in the urine can turn urine red-brown.

Clarity. Urine is normally clear. Bacteria, blood, sperm, crystals, or mucus can make urine look cloudy.

Odor. Urine does not smell very strong, but has a slightly "nutty" odor. Some diseases cause a change in the odor ofurine. For example, an infection with E. colibacteria can cause a bad odor, while diabetes or starvation can cause asweet, fruity odor.

Specific gravity. This checks the amount of substances in the urine. It also shows how well the kidneys balance theamount of water in urine. The higher the specific gravity, the more solid material is in the urine. When you drink a lot offluid, your kidneys make urine with a high amount of water in it which has a low specific gravity. When you do not drinkfluids, your kidneys make urine with a small amount of water in i t which has a high specific gravity.

pH.ThepHis a measure of how acidic or alkaline (basic) the urine is. A urine pH of 4 is strongly acidic, 7 is neutral(neither acidic nor alkaline), and 9 is strongly alkaline. Sometimes the pH of urine is affected by certain treatments. Forexample, your doctor may instruct you how to keep your urine either acidic or alkaline to prevent some types of kidneystones from forming.

Protein. Protein is normally not found in the urine. Fever, hard exercise, pregnancy, and some diseases, especiallykidney disease, may cause protein to be in the urine.

Glucose. Glucose is the type of sugar found in blood. Normally there is very little or no glucose in urine. When the

blood sugar level is very high, as in uncontrolled diabetes, the sugar spills over into the urine. Glucose can also be foundin urine when the kidneys are damaged or diseased.

Nitrites. Bacteria that cause a urinary tract infection (UTI) make an enzyme that changes urinary nitrates to nitrites.Nitrites in urine show a UTI is present.

Leukocyte esterase (WBC esterase). Leukocyte esterase shows leukocytes (white blood cells [WBCs]) in theurine. WBCs in the urine may mean a UTI is present.

Ketones. When fat is broken down for energy, the body makes substances called ketones (or ketone bodies). Theseare passed in the urine. Large amounts of ketones in the urine may mean a very serious condition, diabetic ketoacidosis,is present. A diet low in sugars and starches (carbohydrates), starvation, or severe vomiting may also cause ketones to bein the urine.

Microscopic analysis. In this test, urine is spun in a special machine (centrifuge) so the solid materials (sediment)settle at the bottom. The sediment is spread on a slide and looked at under a microscope. Things that may be seen on the

slide include:

o Red or white blood cells. Blood cells are not found in urine normally. Inflammation, disease, orinjury to the kidneys, ureters, bladder, or urethra can cause blood in urine. Strenuous exercise, such asrunning a marathon, can also cause blood in the urine. White blood cells may be a sign of infection orkidney disease.

o Casts. Some types of kidney disease can cause plugs of material (called casts) to form in tiny tubesin the kidneys. The casts then get flushed out in the urine. Casts can be made of red or white blood
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cells, waxy or fatty substances, or protein. The type of cast in the urine can help show what type ofkidney disease may be present.

o Crystals. Healthy people often have only a few crystals in their urine. A large number of crystals, orcertain types of crystals, may mean kidney stones are present or there is a problem with how the bodyis using food (metabolism).

o Bacteria, yeast cells, or parasites. There are no bacteria, yeast cells, or parasites in urinenormally. If these are present, it can mean you have an infection.

o Squamous cells. The presence of squamous cells may mean that the sample is not as pure as itneeds to be. These cells do not mean there is a medical problem, but your doctor may ask that yougive another urine sample.

Urine test results

Color Normal: Pale to dark yellow

Abnormal: Many foods and medicines can affect the color of the urine. Urine with no color maybe caused by long-term kidney disease or uncontrolled diabetes. Dark yellow urinecan be caused by dehydration. Red urine can be caused by blood in the urine.

Clarity Normal: Clear

Abnormal: Cloudy urine can be caused by pus (white blood cells), blood (red blood cells),sperm, bacteria, yeast, crystals, mucus, or a parasite infection, such astrichomoniasis.

Odor Normal: Slightly "nutty" odor

Abnormal: Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) cancause urine to have a different odor. A sweet, fruity odor may be caused byuncontrolled diabetes. A urinary tract infection (UTI) can cause a bad odor. Urinethat smells like maple syrup can mean maple syrup urine disease, when the bodycannot break down certain amino acids.

Specific gravity Normal: 1.0051.030

Abnormal: A very high specific gravity means very concentrated urine, which may be caused bynot drinking enough fluid, loss of too much fluid (excessive vomiting, sweating, ordiarrhea), or substances (such as sugar or protein) in the urine. Very low specificgravity means dilute urine, which may be caused by drinking too much fluid, severekidney disease, or the use of diuretics.

pH Normal: 4.68.0

Abnormal: Some foods (such as citrus fruit and dairy products) and medicines (such asantacids) can affect urine pH. A high (alkaline) pH can be caused by severevomiting, a kidney disease, some urinary tract infections, and asthma. A low (acidic)pH may be caused by severe lung disease (emphysema), uncontrolled diabetes,aspirin overdose, severe diarrhea, dehydration, starvation, drinking too muchalcohol, or drinking antifreeze (ethylene glycol).

Protein Normal: None

Abnormal: Protein in the urine may mean kidney damage, an infection, cancer, high bloodpressure, diabetes, systemic lupus erythematosus (SLE), or glomerulonephritis ispresent.

Protein in the urine may also mean that heart failure, leukemia, poison (lead ormercury poisoning), or preeclampsia (if you are pregnant) is present.
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Glucose Normal: None

Abnormal: Intravenous (IV) fluids can cause glucose to be in the urine. Too much glucose in theurine may be caused by uncontrolled diabetes, an adrenal gland problem, liverdamage, brain injury, certain types of poisoning, and some types of kidney diseases.Healthy pregnant women can have glucose in their urine, which is normal duringpregnancy.

Ketones Normal: None

Abnormal: Ketones in the urine can mean uncontrolled diabetes, a very low-carbohydrate diet,starvation or eating disorders (such as anorexia nervosa or bulimia), alcoholism, orpoisoning from drinking rubbing alcohol (isopropanol). Ketones are often found in theurine when a person does not eat (fasts) for 18 hours or longer. This may occurwhen a person is sick and cannot eat or vomits for several days. Low levels ofketones are sometimes found in the urine of healthy pregnant women.

Microscopicanalysis

Normal: Very few or no red or white blood cells or casts are seen. No bacteria, yeast cells,parasites, or squamous cells are present. A few crystals are normally seen.

Abnormal: Red blood cells in the urine may be caused by kidney or bladder injury,kidney stones, a urinary tract infection (UTI), inflammation of the kidneys(glomerulonephritis), a kidney or bladder tumor, or systemic lupuserythematosus (SLE). White blood cells (pus) in the urine may be causedby a urinary tract infection, bladder tumor, inflammation of the kidneys,systemic lupus erythematosus (SLE), or inflammation in the vagina orunder the foreskin of the penis.

Depending on the type, casts can mean inflammation or damage to thetiny tubes in the kidneys, poor blood supply to the kidneys, metalpoisoning (such as lead or mercury), heart failure, or a bacterial infection.

Large amounts of crystals, or certain types of crystals, can mean kidneystones, damaged kidneys, or problems with metabolism. Some medicinesand some types of urinary tract infections can also increase the number ofcrystals in urine.

Bacteria in the urine mean a urinary tract infection (UTI). Yeast cells orparasites (such as the parasite that causes trichomoniasis) can mean aninfection of the urinary tract.

The presence of squamous cells may mean that the sample is not as pure

as it needs to be. These cells do not mean there is a medical problem, butyour doctor may ask that you give another urine sample.

Why It Is Done?A urine test may be done:

To check for a disease or infection of the urinary tract. Symptoms of a urine infection may include colored or bad-smellingurine, pain when urinating, hard to urinate, flank pain, blood in the urine (hematuria), or fever.

To check the treatment of conditions such as diabetes, kidney stones, a urinary tract infection (UTI), high blood pressure(hypertension), or some kidney or liver diseases.

As part of a regular physical examination
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APPENDICES

Header 1


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Appendix (A)Improving Communication Skills of Pharmacy Students

Through Effective Precepting

Setting the Stage for Communication

During this first meeting, preceptors can share the history and philosophy of thepharmacy

The history of the site will give students a perspective on how the site has grownand why choices were made to go in certain directions in the areas ofmanagement, service, and patient care.

Student may want to cover the following topics:

To Do listd Why were specific services chosen to be offered?

What role has the site played in the community over the years?d What are the current expectations of the customers and patients (consumer behavior)?

d Who makes the offer to counsel the patient?

d Is every patient counseled on every prescription?

d Does the pharmacist counsel on every new prescription?

d Does the pharmacist actively provide non-prescription counseling?

d What patient care services will the student engage in?

d What written information is used frequently?

Strategies for Establishing the Pharmacist-Patient Relationship

To Do listd Introduce yourself to patients during an encounter.d Outline for the patient what will occur during the encounter.

d Demonstrate empathy or caring attitude so that the patient feels at ease.

d Discuss with the patients the amount time needed for the encounter.

d Discuss the expected outcome of the encounter.

d Use feedback strategies throughout the encounter to ensure patient understanding.

d Ensure sufficient time for patients to ask questions towards the end of the encounter.

d Follow up with patients.


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Effective strategy for patient counseling

utilizes open-ended questions (3 prime questions) and feedback (final verification) strategies,

which make communication between the pharmacist and patient more efficient and engaging.

1- Three prime questions to ask patients who are receiving a newprescription:

To Do listd What did your doctor tell you the medication is for?

d How did the doctor tell you to take it?

d What did the doctor tell you to expect?

2- Final verification or asking the patient for feedback

To Do listd Just to make sure that I didnt leave anything out, please

tell me how you are going to take your medication?

3- Show and tell strategy when a patient is receiving a refill

To Do listd What do you take the mediation for?

d How do you take it?

d What kind of problems are you having?

Interviewing Patients:

1- Student need to be aware of other communication strategies that can help make thepharmacist-patient encounter more meaningful. These include:

To Do listActive listening (focusing on the patient),

Eye contact (being attentive, but not staring),

Being aware of your own body language (facing the patient and giving them your

undivided attention

Recognizing and interpreting nonverbal cues from the patient (comparing their nonverbalbehaviors to their verbal communication),

Being aware of barriers that prevent a good exchange between the pharmacist and patient

(lack of privacy, interruptions, noise, etc)

During this time, pharmacists need to be systematic and organized with the patient interview to

ensure that they are efficient with their time, as well as accurate and comprehensivewith data collection.


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2- Tips for Good Patient Interviews:

To Do listGreet the patient and introduce yourself.

Explain the interview process.

Direct the patient to the consultation area or any appropriate areaExplain why you need to collect the information, what you will do with it, and that it will be treated

confidentially.

Indicate how long the interview will last.

Use words/manners that convey professionalism.

Pay attention to body language.

Ask open-ended questions. Begin with broad questions and then get more specific

Use active listening skills and demonstrate empathy.

Ask the patient to restate any unclear information and use paraphrasing feedback strategies to ensure

that you understood.

Communicate at an appropriate educational level and avoid medical jargon.

3- Data collection form:

Pharmacist preceptors can review these data collection forms ,to help ensure acomplete history is taken ,with the students, discuss how they are used, anddemonstrate the use during a patient interview


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Patient Medical History Form :


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ACTIVITIES


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Patient education

( patient drug information)

The student should cover the following topics for only one drug during his summer

training and give full report in Arabicabout it

Topics to be discussed for the drug :

1- Other names of the drug in local market (Generic /brand)

2- Why is this drug prescribed?

3- When should it be used?

4- How should it be used?

5- What special instruction should I follow while using this drug?

6- What special dietary instruction should I follow when using this drug?

7- What should I do if I forget to take a dose?8- What side effect can this drug cause? What can I do about them?

9- What other precaution should I follow while using this drug?

10- What storage conditions are necessary for this drug ?

The drug is: .

Documents

Student Training Draft Mannual