Student Training Draft Mannual

INDEX
PROGRAM DESCRIPTION SCHEDULE & PROGRAMS

APPENDICES ACTIVITIES
Health House Pharmacies Group- Pharmacy Students Training Program -2011
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(Health House Pharmacies Group)
Pharmacy Students Training Program 2011

Program 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 system 3- 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 professional manner 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 Health House Pharmacies Group- Pharmacy Students Training Program -2011
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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. Grading Pass- No pass
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SCHEDULE & PROGRAMS
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Pharmacy Students Training Program Schedule:
Weeks
First Week
Saturday Sunday Monday Tuesday Wednesday
Task
Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy)
Time
Morning Shift
9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM
Second Week
Saturday Sunday Monday Tuesday Wednesday Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy) Onsite training (Pharmacy)
Evening Shift
5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM
Third Week
Evening Shift
5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM 5:00PM-11:00 PM
Fourth Week
Morning Shift
9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM 9:00 AM-3:00PM
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First Week :
Day
Second Week:
Subject
Orientation to the pharmacy Communication skills and patient counseling. Hypertension & Cholesterol Management.
Day
Third Week :
Subject
Diabetes Mellitus Psychotic Drugs Training Review & Meeting Session
Day
Forth Week :
Subject
Dermatology Infectious Diseases Training Review & Meeting Session
Day
Subject
Gastroenterology Respiratory Diseases Training Review & Meeting Session
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First Week :
Saturday: Orientation to the pharmacy (Initial Training) Tour of Pharmacy

The 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 (HDLC) 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 Mellitus

The 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 Drugs

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: Dermatology

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
To Do list
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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 )
Treatment of :
To Do list
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

Treatment of :
To Do list
The oral cavity
Mouth ulcers Oral thrush Gingivitis Dyspepsia Gastroentritis (Diarrhoea) Constipation Haemorrhoids Abdominal pain (Irritable bowel syndrome)
G.I.T.
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Monday, Tuesday: Respiratory Diseases

Treatment of : Cough The common cold Sore throat Allergic rhinitis Asthma Acute Bronchitis
To Do list
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How to Read a Doctor's Prescription?

When doctors write a prescription for a medication, they use abbreviations (based on Latin words) that tell you which medication to 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, sertraline is the "generic" name and Zoloft is the "brand name" used to identify a medication frequently prescribed for the treatment of depression. There is prescription is usually written on a pre-printed pad with doctor's name, address, and phone number. space for patients name and address, age, the date, a place for doctors signature, and a blank 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 of times that prescription can be refilled.
Index for commonly use Medical Abbreviations:
N
Na = sodium NaCl = sodium chloride neg = negative NKA = no know allergies NKDA = no know drug allergies NPO = nothing per mouth (oral)
ac = before meal ad = Right ear agit = shake am = morning amt = amount ante = before as, al = left ear ASA = Aspirin au = both ears aq = water
O
o
B
bid = twice daily bp = blood pressure
OD = right eye oint = ointment OS, OL = left eye OU = each eye oz = ounce
P C
o
PB = phenobarbital
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c = with CBC = complete blood count Ca = calcium caps = capsules Cl = chloride c/o = complaint of
pc = after meals per = by pm = after noon PO = orally prn = as needed
Q D
o
D/C = discontinue diag, Dx = diagnosis dil = dilute disch = discharge dr = dram
E,F
et = and Etoh = alcohol exp = expired FBS = fasting blood sugar Fe = iron fl = fluid
q = every qd = every day qh = every hour qhs = at every bed time qid = 4 times a day qod = every other day q6h = every 6 hours qs = quantity sufficient
R, S
o
G
gm = gram gr = grain gt = drop gtt = drops
R/O = rule out Rx = prescription SL = sublingual SOB = shortness of breath sol = solution sq = sub cutaneous ss = one-half stat = immediately
T
o
H
H, h, hr = hour H20 = water hs = bed time Hx = history
tabs = tablets tbsp = tablespoon (15ml) temp = temperature tid = three times a day tr, tinc = tincture tsp = teaspoon (5ml)
U, V, X I, K, L
o
IM = intramuscular IV = intravenous K = potassium liq = liquid
ung = ointment vag = vaginal vol. = volume VS = vital signs x = times
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M
MDI = meter dose inhaler Mg = magnesium mg = milligram MgSO4 = magnesium Sulfate mm = millimeter MOM = Milk of Magnesia MS = Morphine Sulfate
How to read the prescription?
A. The doctor's name and contact information., or it could be

handwritten in when required for prescribing certain controlled medications or substances.
B. patient name, address, date of birth (or age). It is important to

note that a prescription is only prescribed for only one person, the person 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 be written 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", or use 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 are
provided here. Those directions may include instructions to take before meals, with food, at bedtime, on an empty stomach, or with plenty of water. The instructions should be followed; otherwise the effectiveness of the medication may be hampered.
F. The physician's signature. A prescriber's signature is required on all prescriptions. Prescribers may include
Medical 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 to
substitute 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 qhs instructions are to take 1 pill, by mouth, at bedtime. Dispense #90 will give 90 pills, enough for about 3 months. Refill 0 times the doctor has indicated no refills, most likely because she would like to check your blood cholesterol and then decide if you need more medication or a different dose. DAW left blank the 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 pc the instructions are to take 1 pill, by mouth, twice each day, after meals this means that should take this medication right after breakfast and right after dinner. Dispense #90 You will give 90 pills, enough for about 3 months. Refill 3 times the doctor has indicated 3 refills, enough medication for one year. This may mean that the diabetes is stable and well controlled on this medication. DAW left blank the pharmacist will most likely give metformin, the generic version of Glucophage.
Example #3: Your diagnosis is high blood pressure
Diovan 40 mg. This is the name of the medication and the dose. Sig: i po qd the instructions are to take 1 pill, by mouth, once each day most likely can take this medication either before or after a meal since the doctor did not say otherwise. Dispense #90 will be give 90 pills, enough for about 3 months. Refill 0 times the doctor has indicated no refills, most likely because would like to check blood pressure and then decide if need more medication or a different dose. DAW left blank the 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 of breath.
Example #5: Reglan 10mg 1 tab PO qid and hs.
Answer: Reglan 10mg, 1 tablet by mouth four times daily and at bed time.
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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 the
container 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 ear
backward and upward (or if giving child younger than 3 years of age, pull backward and downward) open ear canal. to a to the
8Place the correct number of drops in your ear. Gently

press on the small skin flap over the ear to help the drops run into the ear canal to
9Keep your ear tilted up for a few minutes or insert a soft cotton
plug in your ear, whichever method has been recommended by your pharmacist or doctor.
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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.)
1Wash your hands thoroughly with soap and water. 2Check the dropper tip to make sure that it is not chipped or cracked. 3Avoid touching the dropper tip against your eye or anything else eye drops and droppers must
be kept clean.
4While tilting your head back, pull down the lower

lid of your eye with your index finger to form a pocket.
5Hold the dropper (tip down) with the other hand, as close
to 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 of
drops falls into the pocket made by the lower eyelid.
8Close your eye for 2 to 3 minutes and tip your head down
as though looking at the floor. Wipe any excess liquid from your face with a tissue.
9Replace and tighten the cap right away. Do not wipe or rinse the dropper tip.
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3- How to Use Eye Ointments and Gels Properly

(Using a mirror or having someone else give you the eyedrops may make this procedure easier.)
1Wash your hands thoroughly with soap and water. 2Avoid touching the tip of the tube against your eye or anything else - the medication and its container must
be kept clean.
3Holding the tube between your thumb and forefinger, place it as near to your eyelid as possible without
touching 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 eye
with 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 from
the 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
Health House Pharmacies Group- Pharmacy Students Training Program -2011 Page 20
the tip of the tube clean.
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Replace and tighten the cap right away. Wash your hands to remove any medication.
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 by

your 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 the
medication to reach deeply into your lungs.
9Repeat steps 3 to 8 until you have inhaled the number of puffs that your doctor prescribed. Ask
your doctor or pharmacist if you need to wait between puffs of your medication.
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Rinse your mouth thoroughly with water.
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. 2Wash your hands thoroughly with soap and water. 3Check the dropper tip to make sure that it is not chipped or cracked. 4Avoid touching the dropper tip against your clean nose. 5Tilt your head as far back as possible, or lie down on your back
on 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 it
left 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

1Wash your hands thoroughly with soap and water.
2Blow your nose gently before using the spray. 3Gently insert the bottle tip into one nostril. Press on the other
side 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.
7Wash your hands thoroughly with soap and water.
7- How to Use Rectal Suppositories Properly

1Wash your hands thoroughly with soap and water. 2If the suppository is soft, hold it under cool water or place it in
a 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 razor
blade.
5Put on a finger cot or disposable glove, if desired (available at a pharmacy). 6Lubricate the suppository tip with a water-soluble lubricant
such 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 toward
your stomach.
8Lift upper buttock to expose the rectal area. 9Insert the suppository, pointed end first, with your finger until
it 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.)
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Hold buttocks together for a few seconds. Remain lying down for about 5 minutes to avoid having the suppository come out.
Physiological values for some body fluids

1- 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 organism causing it. White blood cells are bigger than red blood cells but fewer in number. When a person has a bacterial infection, the number of white cells rises very quickly. The number of white blood cells is sometimes used to find 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. Immature neutrophils, called band neutrophils, are also part of this test. Each type of cell plays a different role in protecting the body. 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 toxic reaction 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 lungs so 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 tiny blood 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 a percentage of red blood cells in a volume of blood. For example, a hematocrit of 38 means that 38% of the blood's volume is made of red blood cells. Hematocrit and hemoglobin values are the two major tests that show if anemia or polycythemia is present.
Hemoglobin (Hgb).
The hemoglobin molecule fills up the red blood cells. It carries oxygen and gives the blood cell its red color. The hemoglobin test measures the amount of hemoglobin in blood and is a good measure of the blood's ability to carry oxygen throughout the body.
Red blood cell indices.

There are three red blood cell indices: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC). They are measured by a machine and their values come from other measurements in a CBC. The MCV shows the size of the red blood cells. The MCH value is the amount of hemoglobin in an average red blood cell. The MCHC measures the concentration of hemoglobin in an average red blood 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 a blood 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 with platelet count to diagnose some diseases. If the platelet count is normal, the mean platelet volume can still be too high or 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: Pregnant women: 4,50011,000/mcL3 or 4.511.0 x 109/liter (SI units) 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: Band neutrophils: Lymphocytes: Monocytes: Eosinophils: Basophils: 50%62% 3%6% 25%40% 3%7% 0%3% 0%1%
Red blood cell (RBC) count

Men: Women: Children: Newborn: 4.76.1 million RBCs per microliter (mcL) or 4.76.1 x 1012/liter (SI units) 4.25.4 million RBCs per mcL or 4.25.4 x 1012/L 4.05.5 million RBCs per mcL or 4.64.8 x 1012/L 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: Pregnant women:
37%47% or 0.370.47 volume fraction 1st trimester: 35%46% 2nd trimester: 30%42% 3rd trimester: 34%44% Postpartum: 30%44%
Children: Newborns:
32%44% 44%64%
Hemoglobin (Hgb)
Men: Women: Pregnant women: 1418 grams per deciliter (g/dL) or 8.711.2 millimoles per liter (mmol/L) (SI units) 1216 g/dL or 7.49.9 mmol/L 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: Newborn: 9.515.5 g/dL 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): Mean corpuscular hemoglobin (MCH): Mean corpuscular hemoglobin concentration (MCHC): 8298 femtoliters (fL) 2634 picograms (pg) 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)

Children: 7.410.4 mcm3 or 7.410.4 fL Normal: 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:
1Red 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 or vomiting, 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), severe physical 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 also cause 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
1Red blood cell (RBC)
Anemia lowers RBC values. Anemia can be caused by heavy menstrual bleeding, stomach ulcers, colon cancer, inflammatory bowel disease, some tumors, Addison's disease, thalassemia, lead poisoning, sickle cell disease, or reactions to some chemicals and 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 vitamin B12. The RBC indices value and a blood smear may help find the cause of anemia. 2White 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. 3Platelets
Low platelet values can occur in pregnancy or idiopathic thrombocytopenic purpura (ITP) and other conditions that affect how platelets 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 is
tells 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 of
urine. For example, an infection with E. coli bacteria can cause a bad odor, while diabetes or starvation can cause a sweet, fruity odor.
Specific gravity. This checks the amount of substances in the urine. It also shows how well the kidneys balance the
amount of water in urine. The higher the specific gravity, the more solid material is in the urine. When you drink a lot of fluid, your kidneys make urine with a high amount of water in it which has a low specific gravity. When you do not drink fluids, your kidneys make urine with a small amount of water in it which has a high specific gravity.
pH. The pH is 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. For example, your doctor may instruct you how to keep your urine either acidic or alkaline to prevent some types of kidney stones from forming.
Protein. Protein is normally not found in the urine. Fever, hard exercise, pregnancy, and some diseases, especially
kidney 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 found in 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 the
urine. 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). These
are 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 be in 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:
Red or white blood cells. Blood cells are not found in urine normally. Inflammation, disease, or
injury to the kidneys, ureters, bladder, or urethra can cause blood in urine. Strenuous exercise, such as running a marathon, can also cause blood in the urine. White blood cells may be a sign of infection or kidney disease. Casts. Some types of kidney disease can cause plugs of material (called casts) to form in tiny tubes in the kidneys. The casts then get flushed out in the urine. Casts can be made of red or white blood
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o o o
cells, waxy or fatty substances, or protein. The type of cast in the urine can help show what type of kidney disease may be present. Crystals. Healthy people often have only a few crystals in their urine. A large number of crystals, or certain types of crystals, may mean kidney stones are present or there is a problem with how the body is using food (metabolism). Bacteria, yeast cells, or parasites. There are no bacteria, yeast cells, or parasites in urine normally. If these are present, it can mean you have an infection. Squamous cells. 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, but your doctor may ask that you give another urine sample.
Urine test results

Color
Normal: Abnormal: Pale to dark yellow Many foods and medicines can affect the color of the urine. Urine with no color may be caused by long-term kidney disease or uncontrolled diabetes. Dark yellow urine can be caused by dehydration. Red urine can be caused by blood in the urine. Clear Cloudy urine can be caused by pus (white blood cells), blood (red blood cells), sperm, bacteria, yeast, crystals, mucus, or a parasite infection, such as trichomoniasis. Slightly "nutty" odor Some foods (such as asparagus), vitamins, and antibiotics (such as penicillin) can cause urine to have a different odor. A sweet, fruity odor may be caused by uncontrolled diabetes. A urinary tract infection (UTI) can cause a bad odor. Urine that smells like maple syrup can mean maple syrup urine disease, when the body cannot break down certain amino acids. 1.0051.030 A very high specific gravity means very concentrated urine, which may be caused by not drinking enough fluid, loss of too much fluid (excessive vomiting, sweating, or diarrhea), or substances (such as sugar or protein) in the urine. Very low specific gravity means dilute urine, which may be caused by drinking too much fluid, severe kidney disease, or the use of diuretics. 4.68.0 Some foods (such as citrus fruit and dairy products) and medicines (such as antacids) can affect urine pH. A high (alkaline) pH can be caused by severe vomiting, 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 much alcohol, or drinking antifreeze (ethylene glycol). None Protein in the urine may mean kidney damage, an infection, cancer, high blood pressure, diabetes, systemic lupus erythematosus (SLE), or glomerulonephritis is present. Protein in the urine may also mean that heart failure, leukemia, poison (lead or mercury poisoning), or preeclampsia (if you are pregnant) is present.
Clarity
Normal: Abnormal:
Odor
Normal: Abnormal:
Specific gravity
Normal: Abnormal:
pH
Normal: Abnormal:
Protein
Normal: Abnormal:
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Glucose
Normal: Abnormal:
None Intravenous (IV) fluids can cause glucose to be in the urine. Too much glucose in the urine may be caused by uncontrolled diabetes, an adrenal gland problem, liver damage, brain injury, certain types of poisoning, and some types of kidney diseases. Healthy pregnant women can have glucose in their urine, which is normal during pregnancy.
Ketones
Normal: Abnormal:
None Ketones in the urine can mean uncontrolled diabetes, a very low-carbohydrate diet, starvation or eating disorders (such as anorexia nervosa or bulimia), alcoholism, or poisoning from drinking rubbing alcohol (isopropanol). Ketones are often found in the urine when a person does not eat (fasts) for 18 hours or longer. This may occur when a person is sick and cannot eat or vomits for several days. Low levels of ketones are sometimes found in the urine of healthy pregnant women. 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. 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 lupus erythematosus (SLE). White blood cells (pus) in the urine may be caused by a urinary tract infection, bladder tumor, inflammation of the kidneys, systemic lupus erythematosus (SLE), or inflammation in the vagina or under the foreskin of the penis. Depending on the type, casts can mean inflammation or damage to the tiny tubes in the kidneys, poor blood supply to the kidneys, metal poisoning (such as lead or mercury), heart failure, or a bacterial infection. Large amounts of crystals, or certain types of crystals, can mean kidney stones, damaged kidneys, or problems with metabolism. Some medicines and some types of urinary tract infections can also increase the number of crystals in urine. Bacteria in the urine mean a urinary tract infection (UTI). Yeast cells or parasites (such as the parasite that causes trichomoniasis) can mean an infection 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, but your doctor may ask that you give another urine sample.
Microscopic analysis
Normal:
Abnormal:
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-smelling urine, 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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Page 33
APPENDICES
Header 1
Page 34
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 the pharmacy The history of the site will give students a perspective on how the site has grown and why choices were made to go in certain directions in the areas of management, service, and patient care.
Student may want to cover the following topics:
To Do list
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 list
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.
Page 35
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 new prescription:
d d
To Do list
What did your doctor tell you the medication is for? 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 list
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
What do you take the mediation for? d How do you take it? d What kind of problems are you having?
d
To Do list
Interviewing Patients:
1- Student need to be aware of other communication strategies that can help make the pharmacist-patient encounter more meaningful. These include:
To Do list
Active 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 nonverbal behaviors 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 comprehensive with data collection.
Page 36
2- Tips for Good Patient Interviews:
To Do list
Greet the patient and introduce yourself. Explain the interview process. Direct the patient to the consultation area or any appropriate area Explain 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 a complete history is taken ,with the students, discuss how they are used, and demonstrate the use during a patient interview
Page 37
Patient Medical History Form :
Page 38
ACTIVITIES
Page 39
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 Arabic about 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? 10What storage conditions are necessary for this drug ?
The drug is: .
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INDEX

PROGRAM DESCRIPTION SCHEDULE & PROGRAMS

Health House Pharmacies Group- Pharmacy Students Training Program -2011

(Health House Pharmacies Group)

Pharmacy Students Training Program 2011

Health House Pharmacies Group- Pharmacy Students Training Program -2011

SCHEDULE & PROGRAMS

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Pharmacy Students Training Program Schedule:

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Saturday: Orientation to the pharmacy (Initial Training) Tour of Pharmacy

Drugs for Hypertension

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

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Second Week : Saturday , Sunday: Diabetes Mellitus

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Complications of insulin treatment

Oral antihyperglycemic drugs:

Monday, Tuesday: Psychotic Drugs

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Quetiapine, Aripiprazole, Sulpiride)

Third Week : Saturday , Sunday: Dermatology

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Monday, Tuesday: Infectious Diseases

Antiviral agents. Antithemintics Antitubercular agents. Antiprotozoal agents.

Forth Week : Saturday , Sunday: Gastroenterology

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Monday, Tuesday: Respiratory Diseases

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Health House Pharmacies Group- Pharmacy Students Training Program -2011

How to Read a Doctor's Prescription?

Index for commonly use Medical Abbreviations:

Health House Pharmacies Group- Pharmacy Students Training Program -2011

pc = after meals per = by pm = after noon PO = orally prn = as needed

D/C = discontinue diag, Dx = diagnosis dil = dilute disch = discharge dr = dram

IM = intramuscular IV = intravenous K = potassium liq = liquid

ung = ointment vag = vaginal vol. = volume VS = vital signs x = times

Health House Pharmacies Group- Pharmacy Students Training Program -2011

How to read the prescription?

A. The doctor's name and contact information., or it could be

B. patient name, address, date of birth (or age). It is important to

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Example #1: the diagnosis is high cholesterol

Example #2:the diagnosis is type 2 diabetes

Example #3: Your diagnosis is high blood pressure

Example #4: Proventil MDI 2 puffs q6h prn SOB.

Example #5: Reglan 10mg 1 tab PO qid and hs.

Health House Pharmacies Group- Pharmacy Students Training Program -2011

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

1- How to Use Ear Drops Properly

8Place the correct number of drops in your ear. Gently

Replace and tighten the cap or dropper right away.

Health House Pharmacies Group- Pharmacy Students Training Program -2011

Wash your hands to remove any medication.

2- How to Use Eye Drops Properly

4While tilting your head back, pull down the lower

Wash your hands to remove any medication.

3- How to Use Eye Ointments and Gels Properly

the tip of the tube clean.

4- How to Use Metered-Dose Inhalers

5Hold your inhaler as shown in the picture or as recommended by

Health House Pharmacies Group- Pharmacy Students Training Program -2011