A. Dispensing is the physical act of giving, providing, or delivering a drug, chemical, device, or medication for later oral ingestion, insertion, application, injection, or other use. B. The goal of dispensing is to select and dispense medications in a manner that promotes safe and effective use. 1. Use the National Drug Code (NDC) number and other attributes to identify the correct drug product. a. The key identifier when selecting a product in the U.S. is the NDC number, which is unique to every drug product. b. NDC is an 11-digit, three-segment number. The format for all medications follows 55555-4444-22. The first segment of five numbers is a labeler code assigned by the Food and Drug Administration (FDA). A labeler is any firm that manufactures, repackages, or distributes a drug product. The second segment of four numbers is the product code, which indicates a specific strength, dosage form, and formulation for a particular product. Lastly, the third segment of two numbers identifies the package size. c. When filling a prescription, one can use an NDC number to verify one has the correct drug. Generics for the same medication each have their own NDC. d. When filling a prescription, verify the product against its image (if available) and confirm that it is in good condition. Confirm the expiration date, dosage form, and imprint code. 2. Use barcode technology: Newer systems can include barcode technology that can scan for the appropriate product and even prevent dispensing unless the correct product is selected. This practice is used in hospitals and retail settings. 3. Check for expiration dates. 4. Check for drug interactions. When checking for interactions, a pharmacist must review the patients medication, evaluate and consider the indication, consider the patients age and hepatic/ renal function, and whether or not the patient is pregnant. These factors may alter drug therapy.
a. There are many types of drug interactions:
1) Drug-drug interactions 2) Drug-food interactions 3) Drug-disease interactions 4) Drug-herb interactions 5) Drug-pregnancy/lactation effects b. Many pharmacy computer systems will have a drug-interaction screening software program in place. The integrated applications are usually provided through vendors such as First DataBank. As each prescription is filled, the system automatically checks the medication against other medications the patient is taking. However, this system is not always accurate because some people get prescriptions filled at multiple pharmacies and the computers are not on the same network. Ask patients about their use of all prescriptions, over-the-counter (OTC) medications, herbal remedies, vitamins, minerals, and other supplements. Determine if the patient has any known allergies. c. There are other resources available to check for drug interactions including Clinical Pharmacology, Facts and Comparisons, Micromedex, and many others. d. Herb-drug interactions are a concern due to uncertainty as to how herbs and supplements will interfere with other medication. Resources and data are limited in this area. 1) An example of an herb-drug interaction is St. Johns wort and cyclosporine. The mechanism for this interaction is proposed to be induction of cytochrome P-450 enzymes by St. Johns wort. 2) It is important to counsel patients on the possibility of food-drug interactions. Grapefruit or grapefruit juice has the potential to alter the effects of various medications, including antiarrhythmic agents, immunosuppressive agents, statins, and calcium channel blockers. The interaction is likely the result of inhibition of intestinal or liver metabolism by cytochrome P-450. e. The pharmacist should notify the prescriber of serious drug interactions (those where the patient risk exceeds any benefit from the