The prescription label is printed from the drug information entered into the pharmacy management system. It has the following parts:
The Poison Prevention Packaging Act of 1970 mandates that most oral prescription drugs be packed in child-resistant packaging, such as child-safety caps that are not easily opened by children. Violation of this act can result in penalties, including imprisonment. Exceptions can be made, upon patient request, under special circumstances like elderly patients or hand deformities caused by rheumatoid arthritis, etc.
Variations of pharmaceutical packaging include blister packs, alternative tamper-evident packaging, bottles, vials, ampules, intravenous bags, and calendar packs. Packaging should maximize the physical and chemical stability of a drug. Light, temperature, and moisture are common causes of drug stability and potency loss. About 500 drugs need some kind of light-resistant packaging, e.g., doxycycline, zinc sulfate, hydrocortisone, etc. Polyvinyl chloride, PVC, and aluminum are common materials used as blister packaging. Most containers are also made of PVC due to low cost and durability. Some medications, like insulin, nitroglycerine, diazepam, etc, react with PVC, and alternate packing materials like glass are used while packing them.
A lot number is a code that identifies one batch of a product made simultaneously. The purpose of a lot number is to identify one batch of product and to track the product’s transaction history, including who the manufacturer is. It is helpful when product recalls occur. All products that share a lot number have the same expiration date. While a lot number identifies an entire batch of product made, a serial number identifies the lowest sellable unit. The lowest sellable unit is how the manufacturer decides to sell that specific product, e.g., a bottle of 100 pills is one sellable unit. Products in the same lot number can have different serial numbers.
Insulin is self-administered from an insulin bottle using syringes. Needles are attached to the syringes and are labeled by length and thickness as “G” for gauge. The thinner the needle, the higher its gauge. For example, a 31-gauge needle is thinner than a 28-gauge needle.
Syringes and insulin pens deliver insulin through a needle. Some pens use cartridges that are inserted into the pen. Others are pre-filled and discarded after all the insulin is used. The insulin dose is dialed on the pen, and the insulin is injected through a needle. Lancet devices are used to check blood glucose levels by finger prick. They consist of a small, sharp, needle-like lancet and a lancet holder. OneTouch and Freestyle are common brands for lancets. A glucometer is used to measure blood glucose levels. It uses a lancet device and a test strip to measure glucose.
Insulin pumps are small wearable devices surgically placed under the skin of the stomach or upper arm. They deliver automatically adjusted insulin doses after measuring blood glucose levels. Some insulin pumps utilize adhesive skin patches to deliver insulin. Continuous glucose monitoring devices, or CGMs, record blood glucose levels around the clock. Dexcom, FreeStyle Libre, and Medtronic are some common CGM devices. iLet® Bionic Pancreas System, Medtronic MiniMed™, Omnipod®, and Tandem® t: slim are the insulin pump systems available in the United States.
It is important to maintain and review medication stock consistently in order to dispense medications efficiently. Changing demand, supply chain issues, expired drugs, drug overstocking, and drug returns affect drug inventory.
Prescription medication shall not be dispensed after the manufacturer’s container expires. An internal inventory inspection must be done at least once every month to check for correct expiration dates and to remove expired drugs. Unless otherwise stated by the manufacturer or stricter facility policy, open meds generally expire on the printed expiration date or one year after the open date (whichever is sooner).
Soon to expire, drugs are removed from the pharmacy shelves and typically returned to wholesalers. Reverse distribution is when a third party takes the pharmacy’s unsalable, expired drug products and sends them back to manufacturers and/or wholesalers for credit or disposes of them. Return credits are a valuable benefit offered by many pharmaceutical manufacturers and distributors to pharmacies. These credits allow pharmacies to return expired or unsold medications for a credit or refund, which can help offset the costs associated with purchasing and storing these drugs.
Medications not picked up or used 14 days from the fill-date are returned to stock (RTS). The patient is given reminders by their preferred contact method before the medications are returned to stock. Prior to restocking these medications, the contents of the medications are inspected and identified for label accuracy. All return-to-stock medications must have the drug, strength, dosage form, NDC number, manufacturer, and expiration date clearly identified on the label or product packaging. All patient identifiers shall be removed before returning medication to the shelf.
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