Storage and Maintenance of Drugs Prof Dr Basavaraj

Storage and Maintenance of Drugs Prof. Dr. Basavaraj K. Nanjwade M. Pharm. , Ph. D Department of Pharmaceutics KLE University College of Pharmacy BELGAUM-590010, Karnataka, India E-mail: nanjwadebk@gmail. com Cell No, : 0091 -9742431000 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 1

Storage and Maintenance of Drugs • • • Definitions Introduction Near Expiring drugs Chart List of Available Medicine for Public Classification and Arrangement of Drugs Calendar of Drugs 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 2

What is a drug • A drug can be given three possible operational definitions: • A chemical substance that affects the processes of the body or mind; • Any chemical compound used on or administered to humans or animals as an aid in the diagnosis, treatment or prevention of disease, or other abnormal condition, for the relief of pain or suffering, or to control or improve any physiologic or pathologic state; • A substance used recreationally for its effects on the central nervous system. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 3

Introduction • The Drugs which are purchased from the market are stored in drug stores to provide a uniform supply of drugs to the patients. • The drugs are stocked in containers, such as drums and boxes and on flexible racks and shelves etc. • It must be ensure that drugs which are stored in a drug store remain preserved during their storage. • There should not be any damage due to high temperature or exposure to sunlight. • The drugs are to be stored as per the prescribed conditions of their storage. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 4

Introduction • The drugs stored in a drug store be arranged in such a way that they are easily traceable as and when required. 1. According to manufacturers 2. According to pharmacological action 3. Alphabetically 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 5

Storage and Maintenance • Drugs to be stored under condition that prevent contamination & as far as possible, deterioration • “Well closed container” precautions to be taken in relation to the effects of the atmosphere, moisture, heat &light. • “Protected from moisture” means that the product is to be “stored in air tight container” 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 6

Protected from light • “Protected from light” the product is to be stored either in a container made of material that absorbs actinic light sufficiently to protect the contents from change induced by such light. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 7

Temperature • • In a deep freeze In a refrigerator Cold or cool Room temperature 25 April 2012 (-15°C) 2°C -8°C 8°C-15°C-25°C ATI-Intensive Training Programme (ITP), Health, Belgaum. 8

Storage, Maintenance & Security • All drugs, including samples, should be maintained separate from non-medications in a locked cabinet or drug room which is sufficiently secure to deny access to unauthorized persons. • Key should be available only to authorized personnel who are assigned medication-related responsibilities. • Place medication in to stock immediately upon receipt. • Store medications that are “for external use only” separate from medications intended for internal use. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 9

Storage, Maintenance & Security • Store look-alike and sound-alike drugs separately. • Store drugs in conditions required per labeling or other official guidelines. • Maintain temperature between 59 degree and 86 degrees Fahrenheit for non-refrigerated medications. • Where refrigeration is necessary use a “Medications Only” refrigerator and maintain temperature between 36 degrees and 46 degrees Fahrenheit. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 10

Storage, Maintenance & Security • On daily basis check, verify and document the proper temperature • All multiple-dose injectable medications should be initialed and have the date of first entry recorded on the label. • Multiple dose vials remain potent until manufacturer’s date on the vial. • Rotate medication stock monthly employing a “FIFO” (first in/first out) process. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 11

Storage requirements - Selection of drugs Distribution of drugs Safe administration of drugs Rational use of drugs Labelling, including cautionary labelling Recall of drugs Reporting of drug product defects 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 12

Storage • Products should be stored Batch wise and Product wise on raised platforms. • The storage should not hinder the cleaning and should have sufficient space for movement of stocks and handling. • Products are to be stored in a manner that prevents damage due to excessive vertical stacking heights as per Manufacturers Instructions and in no case not to exceed eight stacks. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 13

Storage • The products must not get exposed to direct sunlight, rain etc. • Store the products as per product storage condition (As per label) to prevent deterioration of finished product on storage. • Monitor and record the temperature of storage area on daily basis. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 14

Storage Premises • The Storage area must be free from unsanitary conditions(Ex Rodents, insects, Birds, litter etc). • The floor of the warehouse should be made of hard floor (Concrete /Kota/Epoxy) and must be in a good state of repair and appearance at all times. • The floors are kept clean and free of trash, dirt, sippage water, drain water etc. • The area must be kept clean and free of refuse. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 15

Storage Premises • The area used for storage of IV fluids should have adequate space and to prevent exposure to direct sunlight. • Secured area availability for damaged, rejected and expired goods. • Ensure adequate pest control program in place and shall be carried out at a minimum frequency of a year. • The Pest control shall cover treatment for Termite and Rodents. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 16

Drug expiry • Shelf life- the time where a given product stored under reasonable condition, is expected to remain stable (>90%potency) • Essential drugs- drugs that satisfy the health care needs of the majority of the population. • Essential drugs should there fore available at all times in adequate amounts & in appropriate dosage forms at a price the individual & the community afford 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 17

Expiry dates • Medications must not be administered, and products and equipment must not be used beyond their expiry dates. • Cleaning and sterilizing reusable equipment. • All medical equipment, dressings and solutions used during invasive procedures must be sterile. • All medical equipment such as drip stands, mechanical and electronic infusion devices etc 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 18

Expiry dates • Cleaning should be followed by disinfection, if necessary, in line with local policy. • Sterilisation and disinfection solutions must be in accordance with manufacturers guidelines. • Disinfection solutions must be bactericidal, virucidal, fungicidal, sporicidal and tuberculocidal. • Single-use devices are meant for single use only and must not be re-used. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 19

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 20

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 21

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 22

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 23

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 24

List of Essential Medicine 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 25

Drug Storage 1. Proper drug storage 2. Storage Environment 3. Arrangement of drugs on shelves 4. The storeroom 5. The dispensary 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 26

Proper drug storage • Drugs are stored in a specially designed secure area or space of a building in order to: • Avoid contamination or deterioration, • Avoid disfiguration of labels, • Maintain integrity of packaging and so guarantee quality and potency of drugs during shelf life, • Prevent or reduce pilferage, theft or losses, • Prevent infestation of pests and vermin. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 27

Storage Environment • The storage environment should possess the following: • Adequate temperature, • Sufficient lighting, • Clean conditions, • Humidity control, • Cold storage facilities, • Adequate shelving to ensure integrity of the stored drugs. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 28

Arrangement of drugs on shelves • Shelves should be made of steel or treated wood. • Shelves should be strong and robust. • Drugs are arranged in alphabetical order of generic names. • Each dosage form of drug is arranged in separate and distinct areas. • Sufficient empty space should demarcate one drug or dosage form from another. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 29

Arrangement of drugs on shelves • Most recently received drugs are placed behind old stock on the shelf except where new drugs have shorter expiration dates. • Keep the environment clean. • Always put lids properly on tins always and at the close of the day. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 30

Arrangement of drugs on shelves • Put drugs in a dry place protected from light and heat. • Store liquids on a pallet on the floor or on the lowest shelf. • The store must be cleaned daily and mopped at least once a week. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 31

The storeroom • A well-arranged store enables easy identification of drugs and saves time when picking a drug from the shelves. • Put drugs on the shelves in alphabetical order corresponding to the essential drug list. • This helps remove drugs quickly and makes for easy inventory control. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 32

The storeroom • The rule of FIRST IN FIRST OUT (FIFO) should be applied always. • So, drugs that were received first should be used first, except where the new stock has shorter expiration dates than the old stock. • In this regard, the principle of FIRST TO EXPIRE FIRST OUT (FEFO) should apply. • To have access to drugs with shorter expiration dates first, put these in front of the shelves. • Those with longer expiration dates should be placed behind those with shorter dates. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 33

The dispensary • Retain a daily drug use record in the dispensary. • Provide a table for dispensing drugs. • To facilitate work, do not overcrowd the dispensing table. • Arrange documents in an orderly manner on the table, away from the dispensing area. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 34

The dispensary • Clean after each use tablet counters and place within easy reach on the table. • Avoid dispensing wrong drugs by arranging drugs on the table in alphabetical order so that the drug being dispensed is not confused with another. • Always close drug containers from which drugs are not being dispensed to prevent spillage or dispensing the wrong drug. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 35

Classification of Drugs • Allopathic Drugs: The term "Allopathy" refers to the principle of curing a disease by administering substances that produce the opposite effect of the disease when given to a healthy human. • Allopathic drugs can be further classified as: A) Non Prescription Drugs: Non Prescription Drugs are the drugs, which can be purchased from a pharmacy without the prescription of a doctor. • Non prescription drugs are also called as Over-thecounter drugs (OTC drugs). 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 36

Classification of Drugs 1. 2. 3. 4. 5. 6. 7. 8. Anti-Hemorrhoid Drugs Topical Antibiotics Cough-Suppressants Anti-acne Drugs Non-steroidal Anti-inflammatory Drugs Antiseptics Analgesics Salicylates 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 37

Classification of Drugs 9. Vasodilator 10. Antacids 11. Expectorants 12. Anti-fungal Drugs 13. Anti-Histamines 14. Antigas Agents 15. Smoking Cessation Drugs 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 38

1. Anti-Hemorrhoid Drugs • Anti-Haemorrhoid Drugs are medicines that reduce the swelling and relieve the discomfort of haemorrhoids. • Antihemorrhoid drugs are available as creams, ointments and suppositories. • Most can be bought without a physician's prescription 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 39

2. Topical Antibiotics • Topical Antibiotics are medicines applied to the skin to kill bacteria. • Topical Antibiotics helps in preventing infections caused by bacteria that get into minor cuts, scrapes, and burns. • Treating minor wounds with Antibiotics allows quicker healing. • If the wounds are left untreated, the bacteria will multiply, causing pain, redness, swelling, itching, and oozing. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 40

3. Cough-Suppressants • Cough Suppressants are medicines that prevent or stop coughing. • Cough Suppressants act on the center in the brain that controls the cough reflex. • They are meant to be used only to relieve dry, hacking coughs associated with colds and flu. • They should not be used to treat coughs that bring up mucus or the chronic coughs associated with smoking, Asthma, Emphysema or other lung problems. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 41

4. Anti-acne Drugs • Anti-acne drugs are medicines that help clear up pimples, black heads, white heads, and more severe forms of acne. • Different types of anti-acne drugs are used for different purposes. • For example, lotions, soaps, gels, and creams containing benzoyl peroxide or tretinoin may be used to clear up mild to moderately severe acne. • Isotretinoin is prescribed only for very severe, disfiguring acne. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 42

5. Non-steroidal Anti-inflammatory Drugs • Non-steroidal Anti-inflammatory Drugs are medicines that relieve pain, swelling, stiffness, and inflammation. • Non-steroidal Anti-inflammatory Drugs (NSAIDs) are prescribed for a variety of painful conditions, including Arthritis, Bursitis, Tendinitis, Gout, sprains, strains, and other injuries. • Non-steroidal Anti-inflammatory Drugs relieve pain, stiffness, swelling, and inflammation, but they do not cure the diseases or injuries responsible for these problems. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 43

6. Antiseptics • Antiseptics are medicines that slow or stop the growth of germs and help prevent infections in minor cuts, scrapes, and burns. • Antiseptics are applied to the skin to keep bacteria from getting into wounds and causing infection. • Although Antiseptics do not usually kill bacteria, they do weaken them and slow their growth. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 44

6. Antiseptics • Simply applying an Antiseptic to a wound is not adequate treatment. • The wound should be cleaned first and in most cases it should be covered with a bandage or other type of dressing to keep it clean and moist while it heals. • However, some Antiseptics, such as Phenol, can damage the skin if the wound is covered after they are applied. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 45

7. Analgesics • Analgesics are medicines that relieve pain. • Analgesics are prescribed to relieve pain of all sorts headaches, backaches, joint pain, sore muscles and pain that results from surgery, injury or illness. • Among the most common Analgesics are Aspirin, Choline Salicylate, Magnesium Salicylate and Sodium Salicylate. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 46

7. Analgesics • Ibuprofen, Naproxen Sodium and Ketoprofen are all in the general category known as Non-Steroidal Anti. Inflammatory Drugs (NSAIDs). • NSAIDs relieve pain and also reduce inflammation. • Another common analgesic, Acetaminophen provides pain relief but does not reduce inflammation. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 47

8. Salicylates • Salicylates are medicines that relieve pain and reduce fever. • Aspirin belongs to group include Sodium Salicylate, Choline Salicylate, and Magnesium Salicylate. • Aspirin is used to relieve many kinds of minor aches and pains-headaches, toothaches, muscle pain, menstrual cramps, the joint pain from arthritis, and aches associated with colds and flu. • Aspirin is also known as acetylsalicylic acid. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 48

9. Vasodilator • Vasodilators are medicines that act directly on muscles in blood vessel walls to make blood vessels widen (dilate). • Vasodilators are used to treat high blood pressure (hypertension). • By widening the arteries, these drugs allow blood to flow through more easily, reducing blood pressure. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 49

10. Antacids • Antacids are medicines that neutralize stomach acid. • Antacids are used to relieve acid indigestion, upset stomach, sour stomach, and heartburn. • Some antacid products also contain the ingredient Simethicone to relieve gas. • Antacids are taken by mouth and work by neutralizing excess stomach acid. • Antacids contain ingredients such as Aluminum Hydroxide, Calcium Carbonate, Magnesium Hydroxide, and Sodium Bicarbonate, alone or in various combinations. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 50

11. Expectorants • Expectorants are drugs that loosen and clear mucus and phlegm from the respiratory tract. • Guaifenesin is an ingredient in many cough medicines, such as anti--Tuss, Dristan Cold & Cough, Guaifed, Guai. Cough, and some Robitussin products. • Some products that contain guaifenesin are available only with a physician's prescription; others can be bought without a prescription. • They come in several forms, including capsules, tablets, and liquids. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 51

12. Anti-fungal Drugs • Fungi cause fungal infections. • These fungi surround us and frequently land on our skin and are inhaled into our lungs. • Many fungi are harmless, some cause minor and irritating infections while a few can cause much more severe infections. • People with compromised immune systems, such as AIDS and cancer patients, may be more susceptible to fungal infections than others. • Anti-fungal drugs are used to treat fungal infections. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 52

13. Anti-Histamines • Antihistamines are drugs that block the action of histamine (a compound released in allergic inflammatory reactions) at the H 1 receptor sites, responsible for immediate hypersensitivity reactions such as sneezing and itching. • By inhibiting the activity of histamine, they can reduce capillary fragility, which produces the erythema, or redness, associated with allergic reactions. • They will also reduce histamine-induced secretions, including excessive tears and salivation. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 53

14. Antigas Agents • Antigas Agents are medicines that relieve the uncomfortable symptoms of too much gas in the stomach and intestines. • Antigas agents help relieve the symptoms by preventing the formation of gas pockets and breaking up gas that already is trapped in the stomach and intestines. • Antigas agents are sold as capsules, liquids, and tablets (regular and chewable) and can be bought without a physician's prescription. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 54

15. Smoking Cessation Drugs • Smoking-cessation Drugs are medicines that help people stop smoking cigarettes or using other forms of tobacco. • People who smoke cigarettes or use other forms of tobacco often have a difficult time when they try to stop. • Most Smoking-Cessation products contain nicotine, but the Nicotine is delivered in small, steady doses spread out over many hours. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 55

15. Smoking Cessation Drugs • Smoking Cessation Drugs that contain Nicotine are also called Nicotine Substitution products or Nicotine Replacement therapy. • Smoking Cessation Drugs come in four formschewing gum, skin patch, nasal spray, and inhaler. • Another type of Smoking Cessation drug, Bupropion (Zyban) also reduces craving and withdrawal symptoms, but it contains no Nicotine. 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 56

Calendar of Drugs 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 57

THANK YOU E-mail: nanjwadebk@gmail. com Cell No, : 0091 -9742431000 25 April 2012 ATI-Intensive Training Programme (ITP), Health, Belgaum. 58