B.Pharm 7th Semester Pharmacy Practice Important Question Answer
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| Pharmacy Practice Important Question Answer |
Pharmacy Practice Very Short Question Answers {2-Marks}
Q1. Suggest few responsibilities of hospital pharmacists.
Ans:
Hospital pharmacists are responsible for proper dispensing of medications, drug storage and procurement, patient counseling, monitoring adverse drug reactions, ensuring rational drug use, maintaining records, and providing drug information to healthcare professionals and patients.
Q2. Suggest the major roles of pharmacist in the medication adherence.
Ans:
Pharmacists improve medication adherence by educating patients on correct drug use, simplifying dosage regimens, addressing side effects, offering reminders, building patient trust, and monitoring therapeutic outcomes regularly through follow-ups and counseling.
Q3. Define adverse drug reaction.
Ans:
An adverse drug reaction (ADR) is a noxious, unintended, and undesired response to a drug that occurs at doses normally used in humans for diagnosis, treatment, or prophylaxis of disease.
Q4. What are the various types of inventory control process?
Ans:
Types of inventory control include ABC analysis (based on cost), VED analysis (based on criticality), FSN (fast, slow, non-moving), HML (high, medium, low cost), SDE (scarce, difficult, easy), and EOQ (economic order quantity).
Q5. How will you differentiate hospitals into clinical and non-clinical basis?
Ans:
Clinical hospitals offer direct patient care and include general, specialty, and teaching hospitals. Non-clinical hospitals deal with administrative, educational, or research functions and don’t involve direct medical treatment of patients.
Q6. What is medication chart review?
Ans:
Medication chart review is a systematic evaluation of a patient's medication records to detect drug-related problems, ensure appropriate drug usage, monitor efficacy and safety, and provide recommendations for better therapeutic outcomes.
Q7. Mention some sources of drug information in Indian context.
Ans:
Sources include Indian Pharmacopoeia, CIMS India, Drugs and Cosmetics Act, AIIMS Drug Formulary, CDSCO guidelines, ICMR reports, and standard medical texts like Goodman & Gilman and Martindale.
Q8. Define patient counseling.
Ans:
Patient counseling is a process by which pharmacists provide personalized information, guidance, and support to patients about their medications, aiming to improve compliance, ensure safety, and achieve optimal therapeutic outcomes.
Q9. Enumerate the contents of hospital formulary.
Ans:
Hospital formulary contains drug names (generic/brand), indications, contraindications, dosage forms, strengths, side effects, storage conditions, prescribing restrictions, and policies for drug selection and rational use.
Q10. What are the legal requirements of maintaining a drug store?
Ans:
Requirements include obtaining a drug license, employing a registered pharmacist, maintaining temperature-controlled storage, proper record-keeping, adhering to labeling and packaging norms, and complying with the Drugs and Cosmetics Act.
Q11. Define ADR.
Ans:
An Adverse Drug Reaction (ADR) is any harmful, unintended, and undesirable effect of a drug occurring at normal therapeutic doses, which may necessitate dose alteration or discontinuation of the drug.
Q12. Explain Therapeutic drug monitoring.
Ans:
Therapeutic Drug Monitoring (TDM) involves measuring drug concentrations in blood at regular intervals to ensure the drug remains within the therapeutic range, improving efficacy and minimizing toxicity for better patient outcomes.
Q13. Give some sources of drug information in Indian background.
Ans:
Indian drug information sources include CIMS, Indian Pharmacopoeia, Drugs and Magic Remedies Act, IPC bulletins, AIIMS and PGI formularies, and official websites like CDSCO and Ministry of Health.
Q14. Structure of retail and wholesale drug store.
Ans:
Retail stores serve patients directly and require a pharmacist, dispensing area, and counseling space. Wholesale stores supply to hospitals or retailers, with a larger storage facility and a registered premises.
Q15. Write the code of ethics of community pharmacy.
Ans:
Community pharmacists must ensure confidentiality, provide unbiased drug advice, avoid overcharging, never substitute without consent, prevent misuse, maintain professionalism, and prioritize patient welfare over commercial interests.
Q16. What is ward round participation?
Ans:
Ward round participation involves pharmacists joining the healthcare team during patient visits to suggest drug therapy modifications, monitor interactions, and improve medication safety and effectiveness.
Q17. What is drug store management?
Ans:
Drug store management involves procurement, storage, stock control, inventory analysis, issuing drugs, ensuring quality standards, and maintaining documentation for efficient and economic supply of medicines.
Q18. Write the concept of clinical pharmacy.
Ans:
Clinical pharmacy focuses on patient-centered care through rational drug use, therapeutic monitoring, minimizing ADRs, educating patients, and participating in the healthcare team to optimize medication outcomes.
Q19. Give the various types of inventory control process?
Ans:
Inventory control methods include ABC (cost-based), VED (criticality-based), FSN (usage rate), SDE (availability), HML (price-based), and EOQ (order optimization), helping manage drug stocks effectively in hospitals.
Q20. Give the objectives of patient counseling.
Ans:
Objectives are to improve compliance, enhance therapeutic outcome, reduce adverse effects, ensure rational drug use, address doubts, and increase patient confidence in medication use.
Q21. Write about the location and size of Pharmacy as per Indian Public Health Standards.
Ans:
As per IPHS, pharmacy should be centrally located near OPD/IPD. Size varies from 6–12 m² in PHCs to larger spaces in CHCs and district hospitals, with proper storage and dispensing areas.
Q22. How adverse drug event is different from adverse drug reaction?
Ans:
Adverse Drug Events (ADEs) include any harm from drug use, whether preventable or not. ADRs are a subset of ADEs that occur at normal doses and are unintentional and harmful.
Q23. Define Medication Adherence. Enlist causes of Medication Non-adherence.
Ans:
Medication adherence is the extent to which a patient follows prescribed treatment. Causes of non-adherence include forgetfulness, side effects, cost, complex regimens, lack of knowledge, and poor patient-provider communication.
Q24. What do you mean by Medication History Interview?
Ans:
A medication history interview is a detailed interaction between pharmacist and patient to document all current and past drug use, including OTC and herbal medicines, to ensure safe and effective therapy.
Q25. Comment on Role of Pharmacist in the Interdepartmental Communication.
Ans:
Pharmacists act as a bridge between pharmacy, nursing, and medical departments by conveying accurate drug information, clarifying prescriptions, preventing errors, and ensuring smooth functioning of hospital drug services.
Q26. Write objectives of “Code of Ethics” for pharmacist.
Ans:
The objectives are to promote professional integrity, ensure patient safety, provide ethical pharmaceutical care, maintain public trust, and establish accountability and respect within the pharmacy profession.
Q27. Define Role of Pharmacist in Drug therapy monitoring.
Ans:
Pharmacists monitor drug levels, detect adverse effects, ensure adherence, evaluate drug interactions, adjust dosages as needed, and collaborate with healthcare teams to optimize therapeutic outcomes.
Q28. How Pharmacists play a crucial role in budget preparation?
Ans:
Pharmacists estimate drug requirements, prioritize cost-effective medications, reduce wastage, evaluate vendor contracts, and ensure optimal utilization of funds through strategic planning and formulary management.
Q29. Define “false-positive test result” with suitable example.
Ans:
A false-positive result shows a positive test despite the absence of the condition. Example: A pregnancy test may turn positive due to hCG-producing tumors or recent miscarriage, even without pregnancy.
Q30. Enlist various biochemical tests performed during urine analysis.
Ans:
Common biochemical urine tests include detection of glucose, protein, ketone bodies, bilirubin, urobilinogen, pH, specific gravity, nitrites, and microscopic elements like red or white blood cells.
Pharmacy Practice Short Question Answers {5-Marks}
Q1. Discuss the various types of classification of hospital. Explain the organization structure of a hospital highlighting its staff requirements.
Ans:
Hospitals can be classified on several bases:
1. Based on ownership:
Public (government) hospitals
Private hospitals
Voluntary or charitable hospitals
Corporate hospitals
2. Based on clinical services:
General hospitals
Specialty hospitals (e.g., cardiology, orthopedics)
Teaching hospitals
Research hospitals
3. Based on size and capacity:
Primary health centers
Community health centers
District hospitals
Tertiary care hospitals
4. Based on length of patient stay:
Acute care hospitals (short stay)
Chronic care hospitals (long stay)
5. Based on system of medicine practiced:
Allopathic hospitals
Ayurvedic/Siddha/Homeopathic hospitals
Organizational Structure of a Hospital:
Hospitals follow a hierarchical and functional structure to ensure smooth operations. It generally includes:
Hospital Administrator/Director: Heads the institution.
Medical Superintendent: In charge of clinical departments and services.
Nursing Superintendent: Responsible for nursing staff and patient care.
Heads of Departments (HODs): Includes departments like Medicine, Surgery, Pediatrics, etc.
Pharmacy Department: Managed by a Chief Pharmacist or Hospital Pharmacist.
Support Services: Laboratory, Radiology, Biomedical Engineering, IT, Housekeeping, Security, etc.
Staff Requirements:
Staffing is based on bed strength, level of care, and departmental needs. This includes doctors, pharmacists, nurses, lab technicians, administrative personnel, and maintenance staff. Pharmacy requires registered pharmacists, storekeepers, and assistants.
This classification and structure help hospitals to function efficiently and deliver quality healthcare services to the population.
Q2. Classify the various types of ADR. Write short notes on genetically determined toxicity.
Ans:
Adverse Drug Reactions (ADRs) are classified based on mechanism, severity, and predictability.
1. Based on mechanism:
Type A (Augmented): Predictable and dose-related, e.g., hypoglycemia with insulin.
Type B (Bizarre): Unpredictable, not dose-related, e.g., anaphylaxis with penicillin.
Type C (Chronic): Occurs due to prolonged use, e.g., corticosteroid-induced osteoporosis.
Type D (Delayed): Appears after drug use, e.g., carcinogenesis from anticancer drugs.
Type E (End of use): Withdrawal reactions, e.g., hypertension after stopping clonidine.
Type F (Failure): Inadequate therapeutic effect, e.g., resistance to antibiotics.
2. Based on severity:
Mild (e.g., mild rash),
Moderate (e.g., change in therapy needed),
Severe (e.g., hospitalization or life-threatening).
3. Based on predictability:
Predictable ADRs
Unpredictable ADRs
Genetically Determined Toxicity:
These ADRs occur due to genetic variations in drug-metabolizing enzymes, transporters, or receptors. For example, individuals with G6PD deficiency may develop hemolytic anemia when exposed to primaquine. Similarly, people with slow acetylator phenotype are more prone to isoniazid-induced peripheral neuropathy. This form of toxicity is unpredictable and may only be identified through pharmacogenetic testing. With the advancement of personalized medicine, understanding genetic polymorphisms is becoming crucial for safer and effective drug therapy. This knowledge helps prevent ADRs by adjusting doses or avoiding specific drugs in genetically susceptible individuals.
Q3. Explain various types of drug distribution system highlighting the process with special reference to ambulatory patients.
Ans:
Drug distribution systems in hospitals refer to the methods through which medications are supplied to patients. Major systems include:
1. Individual Prescription Order System:
Each patient gets medications as per a written prescription. It allows physician control but is time-consuming.
2. Floor Stock System:
Medications are stored in bulk on nursing units. It includes:
Charge floor stock: Billed to individual patients.
Non-charge floor stock: Common drugs used routinely, not charged separately.
3. Unit Dose Drug Distribution System (UDDDS):
Drugs are dispensed in unit doses, labeled individually. It reduces errors, improves inventory control, and supports pharmacist involvement.
4. Satellite Pharmacy System:
A pharmacy is located within patient care areas (e.g., ICU, oncology), improving immediate availability and pharmacist-doctor interaction.
5. Centralized Drug Distribution:
Medications are dispensed from a central pharmacy and transported to wards. Efficient but lacks clinical interaction.
Ambulatory Patients (Outpatients):
Ambulatory patients receive medications via outpatient pharmacies. The process includes:
Prescription review by pharmacist
Counseling on proper drug use
Providing medication in labeled packs
Recording and billing
Ambulatory care requires clear communication and emphasis on patient education for compliance, especially since follow-up is limited compared to inpatients. Modern systems integrate Electronic Medical Records (EMR) for error-free service.
Q4. Suggest the various factors to be considered for therapeutic drug monitoring. Highlight the current scenario in India with respect to Therapeutic Drug Monitoring.
Ans:
Therapeutic Drug Monitoring (TDM) is the measurement of drug concentration in blood to maintain a constant therapeutic level.
Factors to consider in TDM:
Pharmacokinetics: Absorption, distribution, metabolism, and excretion of the drug.
Patient Factors: Age, weight, renal/hepatic function, and genetic makeup.
Drug Factors: Narrow therapeutic index (e.g., digoxin, lithium), route of administration, and half-life.
Timing of Sampling: Trough or peak levels must be collected at appropriate times for accuracy.
Drug Interactions: Concomitant drugs can alter drug metabolism and clearance.
Compliance: TDM can help assess if the patient is taking the drug as prescribed.
Toxicity Symptoms: Presence of side effects may warrant monitoring.
Indian Scenario:
TDM in India is still in a developing phase. Major government and private hospitals offer TDM for critical drugs like anticonvulsants, aminoglycosides, and immunosuppressants. However, challenges include lack of awareness, limited infrastructure, and cost concerns. Few centers like AIIMS, PGIMER, and JIPMER provide structured TDM services. With growing antimicrobial resistance and need for personalized therapy, India is gradually moving toward broader TDM applications. Pharmacists play an increasingly vital role in sample timing, data interpretation, and dose adjustments.
Q5. Explain the organization, functions and policies of Pharmacy and Therapeutic Committee.
Ans:
The Pharmacy and Therapeutic Committee (PTC) is a hospital advisory body responsible for ensuring rational and safe drug use.
Organization:
The PTC typically includes:
Chairperson (Medical Superintendent or HOD)
Clinical Pharmacists
Physicians from different specialties
Nursing staff representative
Hospital administrator
Functions:
Formulary Management: Selects drugs for the hospital formulary based on efficacy, safety, and cost.
Policy Development: Frames policies for procurement, prescribing, and dispensing of medications.
ADR Monitoring: Evaluates adverse drug reactions and promotes pharmacovigilance.
TDM Guidelines: Sets protocols for therapeutic drug monitoring.
Educational Role: Organizes training programs for medical and pharmacy staff.
Cost Control: Promotes use of generics and cost-effective alternatives.
Audit and Review: Periodically reviews drug usage patterns and prescription audits.
Policies:
Use of essential medicines list (EML)
Generic drug prescription encouragement
Antibiotic stewardship programs
Fixed procurement channels for quality assurance
PTC plays a crucial role in ensuring that drug therapy remains safe, cost-effective, and in line with national and hospital guidelines. It also helps reduce medication errors and promotes standard treatment protocols.
Q6. Narrate the principles/procedure to be followed from purchase order, procurement and stocking. Explain economic order quantity (EOQ).
Ans:
Effective drug procurement in hospitals follows a systematic procedure to ensure timely supply and avoid stockouts or overstocking.
1. Purchase Order:
Begins with indenting medicines based on need. Purchase order is prepared and sent to selected vendors with clear quantity, specifications, and delivery terms.
2. Procurement:
Involves selecting suppliers based on quality, cost, and reliability. A tender system is often used for large purchases. Procurement ensures the drugs meet pharmacopoeial standards.
3. Inspection:
Received goods are inspected for quality, quantity, expiry dates, and packing conditions.
4. Stocking:
Accepted goods are entered into stock registers and stored under appropriate conditions (e.g., cold chain for vaccines). FEFO (First Expiry, First Out) and FIFO (First In, First Out) principles are followed.
5. Documentation:
All transactions are recorded systematically for accountability and future audits.
Economic Order Quantity (EOQ):
EOQ is the quantity of stock ordered that minimizes the total inventory cost, including ordering and holding costs.
EOQ formula:
EOQ=2ASICEOQ = \sqrt{\frac{2AS}{IC}}EOQ=IC2AS
Where:
A = Annual demand
S = Ordering cost per order
I = Inventory holding cost
C = Cost per unit
EOQ helps in cost-effective procurement and avoids both understocking and overstocking. It is a vital tool in inventory management for pharmacies to optimize operational efficiency.
Q7. Write short notes on “Drug Therapy Monitoring”.
Ans:
Drug Therapy Monitoring (DTM) refers to the ongoing evaluation of a patient’s medication regimen to ensure safety, effectiveness, and optimal therapeutic outcomes.
Objectives:
Maximize therapeutic benefit
Minimize adverse effects
Improve patient adherence
Prevent drug interactions
Identify subtherapeutic or toxic drug levels
Process:
Patient Assessment: Review diagnosis, lab data, and comorbidities.
Medication Review: Analyze drug indications, doses, timing, and route.
Monitoring Parameters: Assess clinical signs, symptoms, and lab results (e.g., blood glucose, INR, drug levels).
Adjustments: Modify dose/frequency or suggest alternative drugs based on response.
Documentation & Follow-up: Maintain records and ensure regular monitoring.
Role of Pharmacist:
Educate patients about drug use
Report and manage ADRs
Collaborate with healthcare providers for therapy adjustments
Participate in clinical ward rounds
DTM is particularly important for drugs with a narrow therapeutic index such as digoxin, phenytoin, and lithium. It is also used in critical care and chronic disease management. By ensuring safe and effective therapy, DTM contributes significantly to improving patient outcomes.
Q8. Discuss and define the investigational new drug.
Ans:
An Investigational New Drug (IND) is a pharmaceutical substance that has not yet been approved for general use and is under investigation in clinical trials to evaluate its safety and efficacy.
Definition:
According to the U.S. FDA, an Investigational New Drug is one that is being tested in humans but is not yet approved for sale. It allows a sponsor to legally ship an unapproved drug across states to clinical investigators.
Types of IND:
Commercial IND: Submitted by companies for eventual marketing.
Research IND: Submitted by academic investigators for non-commercial research.
Emergency IND: For urgent, life-threatening conditions with no approved therapy.
Purpose of IND:
To obtain approval for conducting clinical trials in humans.
To ensure safety through preclinical data and protocols.
To assess pharmacokinetics, pharmacodynamics, and therapeutic effect.
Process:
Preclinical studies: Conducted on animals to gather toxicity, pharmacology, and dosing data.
Filing the IND Application: Includes data from preclinical studies, manufacturing information, protocols for human studies, and investigator credentials.
Review by Regulatory Authority (e.g., DCGI in India, FDA in the USA): Approval is granted if safety standards are met.
In India, the Central Drugs Standard Control Organization (CDSCO) regulates clinical trials under Schedule Y of the Drugs and Cosmetics Rules. After IND approval, clinical trials are conducted in four phases (I–IV) before marketing.
Investigational New Drug status is essential for evaluating new molecules, biologicals, vaccines, and new uses for approved drugs. It is a key component of drug development and regulatory approval.
Q9. Write a note on drug therapy monitoring and OTC medication.
Ans:
Drug Therapy Monitoring (DTM):
DTM is a systematic approach used to ensure that a patient’s medications are effective, safe, and appropriate. It involves evaluating drug efficacy, adverse effects, interactions, and compliance. Key steps include reviewing patient history, selecting clinical parameters to monitor, interpreting lab values, adjusting dosages, and documenting outcomes. DTM is especially critical for drugs with a narrow therapeutic index (e.g., phenytoin, digoxin, lithium). Pharmacists are key players in DTM, providing interventions, counseling, and working with physicians to optimize therapy.
Over-the-Counter (OTC) Medications:
OTC drugs are medicines that can be sold directly to consumers without a prescription. They are intended for short-term use, minor ailments, and must have a proven safety profile. Examples include paracetamol, antacids, cold and cough medications, and skin ointments.
Advantages of OTC Drugs:
Cost-effective
Convenient access
Reduces burden on healthcare system
Risks:
Self-medication and incorrect use
Drug interactions
Masking of serious diseases
Overdose risks (e.g., paracetamol hepatotoxicity)
Pharmacist's Role:
Educating consumers about proper use
Screening for contraindications
Preventing misuse or drug interactions
Recommending physician consultation when needed
In India, OTC regulation is evolving, with no formal OTC list yet issued by CDSCO. Many drugs sold as OTCs in India are prescription-only in other countries, raising concerns about safety and rational drug use. Proper education and regulatory framework are essential for safe OTC drug usage in the community.
Q10. Define therapeutic drug monitoring and give its factors to be considered and what are the roles in Indian scenario.
Ans:
Therapeutic Drug Monitoring (TDM) is the clinical practice of measuring specific drug levels in a patient’s bloodstream at scheduled intervals to maintain a constant concentration within the therapeutic range, thereby maximizing efficacy and minimizing toxicity.
Factors to be considered in TDM:
Patient Factors: Age, weight, renal and liver function, genetic differences in metabolism.
Drug Factors: Narrow therapeutic index, variable metabolism, or drugs with significant toxicity (e.g., aminoglycosides, digoxin).
Timing of Sampling: Blood should be drawn at the correct time (peak/trough) to reflect accurate levels.
Dosage Form and Route: Oral, IV, sustained-release formulations affect bioavailability.
Drug Interactions and Compliance: Concomitant medications or missed doses can alter drug levels.
Indian Scenario:
TDM is still limited in India, primarily practiced in tertiary care hospitals and academic institutions like AIIMS, PGIMER, and JIPMER. Commonly monitored drugs include antiepileptics, antibiotics, and immunosuppressants. Barriers include high cost, lack of infrastructure, limited trained staff, and poor awareness among practitioners.
However, the need for TDM is increasing due to rising antimicrobial resistance, use of biologics, and complex therapies in transplant and oncology settings. Indian Pharmacists can play a crucial role in monitoring, interpreting results, and educating healthcare providers about TDM benefits.
Efforts are ongoing to expand TDM services across Indian hospitals to improve patient outcomes and reduce adverse drug reactions.
Q11. Define budget and what are the steps involving in preparing a budget? Explain briefly.
Ans:
A budget is a detailed financial plan that outlines expected income and expenditures over a specific period. In hospital pharmacy, a budget helps manage funds efficiently for drug procurement, equipment, and staff.
Steps in Budget Preparation:
Assessment of Needs:
Analyze previous consumption trends, disease burden, seasonal variations, and formulary requirements.
Forecasting Expenditure:
Estimate the cost of drugs, consumables, salaries, maintenance, and contingencies. Include inflation or expected price hikes.
Resource Allocation:
Allocate funds to departments based on priorities, essential drug lists, and service load.
Drafting the Budget:
Prepare a draft proposal with item-wise costs and justifications for each.
Review and Approval:
The draft budget is reviewed by hospital management and finance department before final approval.
Implementation:
On approval, funds are disbursed, and procurement activities commence.
Monitoring and Evaluation:
Regular audit of expenses is done to ensure budget compliance and detect overspending or savings.
Types of Budgets in Hospitals:
Operating Budget: For day-to-day expenses
Capital Budget: For large investments like equipment or infrastructure
Cash Flow Budget: Tracks actual cash inflow and outflow
Effective budgeting ensures optimal drug availability, minimizes wastage, and supports cost-effective treatment. Pharmacists play a key role by forecasting drug needs, selecting cost-effective alternatives, and controlling inventory as per budget provisions.
Q12. Explain the principle involved in the methods of inventory control ABC, VED, EOQ.
Ans:
Inventory control helps manage the availability, storage, and cost of pharmaceuticals in a hospital pharmacy.
1. ABC Analysis (Always Better Control):
Based on annual consumption value:
A items: 10% items = 70% of value (e.g., costly antibiotics)
B items: 20% items = 20% value
C items: 70% items = 10% value
Focus is placed on A items for strict control.
2. VED Analysis (Vital, Essential, Desirable):
Based on criticality of items:
Vital: Life-saving (e.g., adrenaline) – must always be available
Essential: Important but not urgent (e.g., antibiotics)
Desirable: Non-critical items (e.g., multivitamins)
Used during budget cuts or emergency supply planning.
3. EOQ (Economic Order Quantity):
Determines the optimal quantity of stock to be ordered to minimize ordering and holding costs.
EOQ Formula:
EOQ=2ASICEOQ = \sqrt{\frac{2AS}{IC}}EOQ=IC2AS
Where:
A = Annual demand
S = Ordering cost per order
I = Inventory holding cost
C = Cost per unit
Combined Use:
ABC-VED matrix helps prioritize drug procurement based on value and criticality. EOQ supports efficient ordering practices.
These tools together help reduce stockouts, avoid overstocking, minimize cost, and ensure uninterrupted patient care.
Q13. Write the different clinical laboratory tests for blood.
Ans:
Clinical laboratory tests on blood are essential for diagnosis, monitoring treatment, and detecting adverse drug effects. These tests are grouped into hematology, biochemistry, serology, and blood banking.
1. Hematological Tests:
Complete Blood Count (CBC): Includes red blood cells (RBCs), white blood cells (WBCs), hemoglobin, hematocrit, and platelets. Used to detect anemia, infections, or leukemia.
ESR (Erythrocyte Sedimentation Rate): Indicates inflammation or chronic disease.
Clotting Time (CT) and Bleeding Time (BT): Evaluates clotting function.
Prothrombin Time (PT) and INR: Used in anticoagulant monitoring (e.g., warfarin therapy).
2. Biochemical Tests:
Liver Function Tests (LFT): Includes ALT, AST, ALP, bilirubin to assess liver health.
Renal Function Tests (RFT): Includes urea, creatinine, uric acid for kidney assessment.
Blood Glucose: For diabetes screening and management.
Lipid Profile: Includes cholesterol, triglycerides, HDL, LDL to assess cardiovascular risk.
Electrolytes: Sodium, potassium, calcium, chloride levels are crucial for fluid and nerve balance.
3. Serological Tests:
Widal Test: For typhoid fever.
ELISA/Rapid Tests: For HIV, Hepatitis B/C, Dengue.
CRP (C-reactive protein): Marker for inflammation and infections.
4. Blood Typing and Cross Matching:
Used during transfusions to ensure compatibility between donor and recipient.
These tests support therapeutic decisions, monitor drug safety, and guide dose adjustments. Pharmacists often use lab results in therapeutic drug monitoring and detecting drug-induced organ toxicity.
Q14. Give the objective, need, advantage of hospital formulary.
Ans:
A hospital formulary is a continually updated list of medications approved for use within a hospital. It is prepared and maintained by the Pharmacy and Therapeutics Committee (PTC).
Objectives:
Promote rational drug use
Ensure availability of safe and effective drugs
Reduce cost of therapy
Guide prescribing practices
Standardize treatment protocols
Need for Formulary:
To restrict the use of irrational or unsafe medications.
To guide physicians in evidence-based prescribing.
To ensure availability of essential drugs in required dosage forms.
To control hospital drug budgets.
To simplify inventory and procurement systems.
Advantages:
Cost Efficiency: Selection of affordable and cost-effective drugs.
Improved Patient Safety: Encourages use of tried and tested medications with known safety profiles.
Standardization: Supports development of treatment guidelines and therapeutic equivalence.
Better Inventory Control: Reduces storage burden by limiting unnecessary drugs.
Enhanced Communication: Doctors, nurses, and pharmacists stay updated with institutional drug policies.
Contents of a Hospital Formulary:
Drug names (generic and brand)
Indications, dosage, contraindications
Strengths and formulations
Storage conditions
Restrictions and prescribing authority
Hospital formularies may be printed or digital. They are revised periodically based on new drug introductions, resistance patterns, and clinical evidence. Pharmacists contribute by evaluating drug literature, collecting ADR data, and recommending cost-effective alternatives.
Q15. Enlist objectives of hospital pharmacy and describe the functions of hospital pharmacy.
Ans:
Objectives of Hospital Pharmacy:
Ensure safe and effective use of medicines.
Promote rational and economic drug use.
Maintain continuous supply of quality medications.
Prevent medication errors and adverse drug reactions.
Provide drug information and patient counseling.
Functions of Hospital Pharmacy:
Procurement of Drugs:
Selection based on hospital formulary.
Purchase through tenders ensuring quality and cost-efficiency.
Establish contracts with approved suppliers.
Storage and Inventory Management:
Maintain proper storage conditions for different drug categories.
Use of FEFO (First Expiry, First Out) and FIFO systems.
Regular stock verification and control using ABC/VED analysis.
Dispensing of Medications:
For both inpatients and outpatients as per physician’s prescription.
Maintain proper labeling and patient instructions.
Ensure double-checking to prevent dispensing errors.
Clinical Services:
Participate in ward rounds.
Monitor adverse drug reactions and therapeutic drug monitoring.
Educate patients and healthcare staff about drugs.
Formulary and Policy Development:
Collaborate with PTC for formulary updates.
Implement drug usage policies and antimicrobial stewardship.
Record Keeping and Reporting:
Maintain records for purchases, usage, ADRs, and audits.
Comply with Drug and Cosmetics Act and Pharmacy Act regulations.
Hospital pharmacy plays a vital role in ensuring patient safety, optimal drug therapy, and cost-effective healthcare delivery.
Q16. Classify Adverse Drug Reaction and define different types of ADRs with suitable examples.
Ans:
Adverse Drug Reactions (ADRs) are harmful, unintended effects of a drug at normal doses used for treatment, diagnosis, or prevention.
Classification of ADRs (Based on Mechanism):
Type A (Augmented):
Predictable, dose-dependent.
Example: Hypoglycemia with insulin, bleeding with warfarin.
Type B (Bizarre):
Unpredictable, not dose-dependent.
Example: Anaphylaxis with penicillin, Stevens-Johnson syndrome with sulfa drugs.
Type C (Chronic):
Due to long-term use.
Example: Corticosteroid-induced osteoporosis.
Type D (Delayed):
Appears after prolonged use or withdrawal.
Example: Carcinogenicity with anticancer drugs.
Type E (End of use):
Withdrawal effects.
Example: Seizures after stopping benzodiazepines.
Type F (Failure):
Failure of therapy.
Example: Resistance to antibiotics due to improper dosing.
Based on Severity:
Mild: No need to change therapy (e.g., mild nausea).
Moderate: Requires intervention (e.g., rash with antibiotics).
Severe: Life-threatening, hospitalization needed (e.g., anaphylaxis).
Example-based Explanation:
Type A: Diarrhea with antibiotics due to altered gut flora.
Type B: Idiosyncratic hepatotoxicity with isoniazid.
Type C: Tardive dyskinesia with long-term antipsychotics.
Type D: Secondary malignancy from chemotherapy.
Monitoring and reporting ADRs through pharmacovigilance programs like PvPI in India is essential for drug safety and post-marketing surveillance.
Q17. Write a note on material management in community pharmacy.
Ans:
Material management in community pharmacy involves effective planning, procurement, storage, and control of pharmaceutical and non-pharmaceutical products to ensure uninterrupted patient services and business sustainability.
Objectives:
Ensure continuous availability of essential medications.
Minimize wastage due to expiry or damage.
Control inventory cost.
Improve customer satisfaction.
Key Functions:
Demand Forecasting:
Based on seasonal trends, disease patterns, and sales history.
Procurement:
Purchase from licensed wholesalers or manufacturers.
Ensure quality assurance and proper documentation.
Negotiate prices and maintain credit terms.
Inventory Control:
Use ABC, VED, FSN analysis.
Maintain minimum, maximum, and reorder levels.
Avoid stockouts or overstocking.
Storage:
Follow Good Storage Practices (GSP).
Maintain temperature, humidity, and hygiene.
Segregate expired and returned items.
Record Keeping:
Use software for billing and stock control.
Maintain purchase orders, invoices, and tax records.
Track batch numbers and expiry dates.
Loss Prevention:
Monitor theft, pilferage, and damage.
Conduct regular physical stock audits.
Material management ensures smooth pharmacy operations, regulatory compliance, and better healthcare delivery. The pharmacist plays a crucial role in balancing cost-efficiency with quality and customer service.
Pharmacy Practice Long Question Answers {10-Marks}
Q1. Explain hospital pharmacy. Enumerate the layout and staff requirements of hospital pharmacy.
Ans:
A hospital pharmacy is a specialized field of pharmacy located within hospital premises that is responsible for the procurement, storage, compounding, dispensing, and safe use of medicines for inpatients and outpatients. It functions under the supervision of a qualified hospital pharmacist and plays a vital role in patient care and drug management.
Functions of Hospital Pharmacy:
Procurement and inventory control of medicines.
Dispensing medications to inpatients and outpatients.
Extemporaneous compounding and preparation of sterile products.
Therapeutic drug monitoring and adverse drug reaction reporting.
Providing drug information and patient counseling.
Participating in clinical ward rounds and hospital committees.
Layout of Hospital Pharmacy:
The layout is planned to ensure smooth workflow, safety, and efficiency. According to Indian Public Health Standards (IPHS), the pharmacy should be located near OPD or emergency departments. Recommended layout includes:
Dispensing Area: For issuing drugs to patients.
Drug Storage Area: Racks for general medicines, refrigerators for cold chain drugs, and separate storage for narcotics.
Compounding Area: For preparation of extemporaneous formulations.
Administrative Office: Record-keeping, billing, and management area.
Sterile Products Section: If IV admixtures or sterile preparations are done.
Waiting Area: For patients and attendants.
Counseling Chamber: For private patient interaction.
Staff Requirements:
Staffing depends on hospital size and bed strength. Typical staff includes:
Chief Pharmacist/Head Pharmacist: Supervises the pharmacy operations.
Assistant Pharmacists: Dispensing and inventory duties.
Pharmacy Attendants/Technicians: Help in packing, labeling, and logistics.
Storekeeper: Manages drug receipts, issues, and documentation.
Clerk/Billing Personnel: Manages invoices and data entry.
As per IPHS for a 100-bedded hospital, minimum requirement is 1 Pharmacist per 50 beds, with assistants based on workload.
In conclusion, a well-planned hospital pharmacy with adequate layout and trained staff ensures rational drug use, improved patient safety, and optimal therapeutic outcomes.
Q2. What are the various ways of detecting ADR? Suggest some ways to control them.
Ans:
Adverse Drug Reactions (ADRs) are unintended and harmful responses to drugs administered at normal doses. Detecting and controlling ADRs is crucial for patient safety and pharmacovigilance.
Methods of Detecting ADRs:
Spontaneous Reporting System (SRS):
Healthcare professionals voluntarily report suspected ADRs to authorities (e.g., PvPI in India).
Easy to use but may under-report minor ADRs.
Intensive Monitoring:
Conducted in select wards or units where all drug events are closely monitored.
Offers detailed data but is labor-intensive.
Prescription Event Monitoring (PEM):
Follows up patients after a prescription to track any adverse events.
Commonly used in post-marketing surveillance.
Cohort and Case-Control Studies:
Epidemiological methods to study correlation between drug use and adverse events.
Useful for rare ADRs.
Electronic Medical Records (EMRs):
Integration of ADR alert systems in hospital software for flagging unusual lab values or symptoms.
Patient Interviews and Surveys:
Direct questioning of patients during follow-ups to identify unreported ADRs.
Lab Monitoring:
Monitoring liver, kidney functions, or blood counts can help detect subclinical ADRs.
Methods to Control ADRs:
Pharmacovigilance Programs:
Active reporting and review through PvPI and WHO UMC.
Use of Standard Treatment Guidelines (STGs):
Encourages rational drug use to minimize ADR risks.
Therapeutic Drug Monitoring (TDM):
Maintains drug levels within safe limits.
Education and Training:
Continuous medical education (CME) for doctors and pharmacists on ADR identification and reporting.
Patient Education:
Informing patients about potential side effects and encouraging prompt reporting.
Use of Drug Information Centers (DICs):
For real-time alerts on drug safety updates and interactions.
In summary, ADR detection and control require collaborative efforts from pharmacists, physicians, and patients. Early identification prevents serious complications and supports safer healthcare delivery.
Q3. Enumerate the various steps involved in patient counseling. Justify the role of pharmacists as a patient counselor.
Ans:
Patient counseling is a process where pharmacists provide information, advice, and assistance to help patients use their medications safely and effectively. It is a key aspect of pharmaceutical care and improves adherence, treatment outcomes, and patient satisfaction.
Steps Involved in Patient Counseling:
Establishing Rapport:
Greet the patient and create a welcoming atmosphere.
Ensure privacy and comfort.
Patient History Collection:
Ask about current medications, allergies, past medical history, lifestyle, and any adverse drug experiences.
Assessing Patient’s Knowledge and Needs:
Determine what the patient already knows about their condition and medicines.
Providing Information:
Explain drug name, purpose, dosage, timing, route, and duration.
Describe possible side effects, drug interactions, and precautions.
Demonstrate correct use if necessary (e.g., inhalers, insulin pens).
Checking Understanding:
Ask the patient to repeat instructions (teach-back method).
Clarify misunderstandings or doubts.
Encouraging Questions:
Promote open dialogue to address concerns.
Follow-up Advice:
Tell the patient when to return or contact a healthcare provider.
Emphasize importance of adherence and storage conditions.
Documentation:
Record counseling session and any patient-specific information.
Role of Pharmacist as a Counselor:
Drug Expert: Pharmacists possess in-depth knowledge of pharmacology, interactions, and therapeutic alternatives.
Accessible Healthcare Provider: Patients interact with pharmacists more frequently than with doctors.
Improving Adherence: Counseling improves compliance and reduces chances of missed doses.
Reducing ADRs: Educated patients are more likely to recognize and report side effects early.
Promoting Rational Drug Use: Helps prevent unnecessary use of antibiotics, analgesics, etc.
Psychological Support: Chronic patients (e.g., diabetes, cancer) benefit from emotional reassurance and health advice.
Patient counseling is a professional and ethical duty of pharmacists as per PCI guidelines and WHO Good Pharmacy Practices. It transforms dispensing into a therapeutic partnership and enhances the pharmacist’s role in clinical care.
Q4. Classify hospital and explain the organization structure of a hospital highlighting its staff requirements.
Ans:
Classification of Hospitals:
By Ownership:
Government (Public) Hospitals
Private Hospitals
Trust or NGO Hospitals
Corporate Hospitals
By Clinical Services Provided:
General Hospitals
Specialty Hospitals (e.g., Cancer, Cardiology)
Teaching Hospitals
Research Hospitals
By Bed Capacity:
Small Hospitals (up to 100 beds)
Medium Hospitals (100–500 beds)
Large Hospitals (above 500 beds)
By Length of Stay:
Acute Care Hospitals (short-term)
Chronic Care Hospitals (long-term)
By System of Medicine Practiced:
Allopathic
Ayurvedic, Homeopathic, Unani, etc.
By Level of Healthcare:
Primary Health Centers (PHCs)
Community Health Centers (CHCs)
District Hospitals
Tertiary Care Hospitals (e.g., AIIMS)
Organization Structure of Hospital:
Hospitals follow a functional and hierarchical structure for efficient service delivery.
Top-Level Management:
Hospital Administrator/Director: Overall in-charge.
Medical Superintendent: Heads clinical services.
Nursing Superintendent: Manages nursing care.
Chief Pharmacist: Manages hospital pharmacy.
Clinical Departments:
Medicine, Surgery, Pediatrics, Obstetrics & Gynecology, Orthopedics, Psychiatry, etc.
Support Services:
Pharmacy, Laboratory, Radiology, Blood Bank, CSSD, Ambulance
Administrative Services:
Accounts, HR, Purchase, Maintenance, Biomedical Engineering
Staff Requirements:
Staffing depends on the hospital’s size and services. As per Indian Public Health Standards (IPHS):
Doctors: 1 per 10–15 beds
Nurses: 1 per 5–10 beds
Pharmacists: 1 per 50 beds
Lab Technicians, X-Ray Technicians, Administrative Staff
Efficient organization ensures coordinated patient care, accountability, and quality outcomes.
Q5. Discuss various types of drug distribution system in a hospital for In and Out patient.
Ans:
Drug distribution is the process by which medications are delivered from the pharmacy to patients. It differs for inpatients and outpatients based on clinical requirements.
1. Inpatient Drug Distribution Systems:
a. Individual Prescription Order System:
A prescription is written for each patient.
Medications are dispensed from the pharmacy based on the prescription.
Offers control but is time-consuming.
b. Floor Stock System:
Commonly used medications are stocked in the nursing unit.
Two types:
Charge Floor Stock: Billed to patient.
Non-Charge Floor Stock: Supplied free of charge.
Risk of overuse and wastage.
c. Unit Dose System (UDDS):
Medications are dispensed in unit doses labeled for individual patients.
Increases safety and pharmacist involvement.
Types:
Centralized UDDS: Dispensed from central pharmacy.
Decentralized UDDS: Dispensed from satellite pharmacies.
d. Satellite Pharmacy System:
Mini pharmacies located in critical care areas.
Allows faster access and better clinical pharmacist integration.
2. Outpatient Drug Distribution:
a. Outpatient Pharmacy:
Dispenses drugs directly to patients visiting the OPD.
Prescription-based, includes counseling and labeling.
Maintains records for billing and insurance.
b. Automated Dispensing Machines (ADMs):
Installed in advanced hospitals for quick medicine delivery.
Operated by authentication (ID cards or prescriptions).
Comparison:
Inpatients need regular monitoring and dose adjustments, while outpatients require fixed-dose dispensing.
Inpatient systems are more controlled due to hospital stay and supervision.
Pharmacists play a crucial role in ensuring the right drug, dose, and documentation in both settings.
Effective drug distribution ensures medication safety, timely administration, and minimal wastage.
Q6. Write the role of pharmacist in education and training program in the hospital and also explain the internal and external training program in hospital.
Ans:
Pharmacists are not only involved in drug dispensing and therapy management but also play a vital role in education and training programs within hospitals. Their contributions help improve the competencies of pharmacy staff, interns, medical professionals, and even patients.
Role of Pharmacist in Education and Training:
Training Pharmacy Interns and Students:
Supervise and mentor B.Pharm and Pharm.D students.
Conduct practical demonstrations and case discussions.
Evaluate assignments and clinical reports.
Training New Pharmacy Staff:
Orientation programs on hospital policies, drug handling, documentation, and dispensing protocols.
In-service Training for Pharmacists:
Updates on new drug formulations, safety alerts, and clinical guidelines.
Interdepartmental Education:
Educating nurses and physicians about drug compatibility, administration routes, and storage.
Patient Education Programs:
Conduct counseling sessions and awareness campaigns for chronic conditions like diabetes, asthma, hypertension.
Research and Continuing Education:
Participate in research, publish papers, and attend seminars.
Internal Training Programs:
Conducted within the hospital.
Examples:
On-the-job training
Case-based discussion
Drug updates and product presentations
Training on EMR and pharmacy software
Carried out by senior pharmacists, medical officers, or invited faculty.
External Training Programs:
Conducted by universities, pharmaceutical industries, regulatory bodies.
Examples:
PCI-sponsored workshops
Pharmacovigilance training (PvPI)
NABH accreditation programs
CMEs and online certification courses
Benefits:
Improves knowledge, safety, and quality of services.
Keeps pharmacy staff updated with recent developments.
Supports professional growth and compliance with guidelines.
The pharmacist's role in education ensures a knowledgeable and skilled healthcare team, ultimately improving patient care.
Q7. Define hospital and classify hospitals on the basis of different aspects.
Ans:
A hospital is a healthcare institution that provides treatment and nursing care to sick or injured people. It offers diagnostic, therapeutic, and preventive services and can also serve as a teaching and research center.
Definition (WHO):
“A hospital is an integral part of a social and medical organization whose function is to provide complete healthcare, both curative and preventive, to the population and whose outpatient services reach out to the family in its home environment.”
Classification of Hospitals:
1. Based on Ownership:
Public (Government) Hospitals: Funded by government (e.g., AIIMS).
Private Hospitals: Owned by individuals or trusts.
Corporate Hospitals: Managed by business entities.
Charitable Hospitals: Run by NGOs or trusts.
2. Based on Clinical Services:
General Hospitals: Offer broad services (e.g., medicine, surgery).
Specialty Hospitals: Focused care (e.g., eye hospitals, cardiac centers).
Teaching Hospitals: Provide education and clinical training.
3. Based on Size (Bed Strength):
Small (<100 beds), Medium (100–500), Large (>500 beds)
4. Based on Duration of Stay:
Acute Care Hospitals: Short-term illnesses (e.g., trauma units)
Chronic Care Hospitals: Long-term care (e.g., rehabilitation centers)
5. Based on Healthcare Level:
Primary Level: PHCs
Secondary Level: CHCs
Tertiary Level: District hospitals, medical colleges
6. Based on System of Medicine:
Allopathic, Ayurvedic, Homeopathic, Unani, Siddha, etc.
7. Based on Functionality:
Research Hospitals: Focused on clinical trials, e.g., NIMHANS
Military/Defense Hospitals: For armed forces personnel
Hospital classification helps in resource planning, specialization, and defining patient care levels across the health system.
Q8. Define hospital formulary. Describe the types of hospital formularies and highlight the criteria for adding drugs in the formulary.
Ans:
A hospital formulary is an official document listing all medications approved for use within a hospital, including their dosage forms, strengths, and guidelines for use. It is prepared and updated by the Pharmacy and Therapeutics Committee (PTC) to ensure rational, cost-effective, and safe medication use.
Definition:
A formulary is “a continually revised compilation of pharmaceuticals that reflects the current clinical judgment of the medical staff.”
Types of Hospital Formularies:
Open Formulary:
Allows prescribers to order any drug, including those not listed.
Offers flexibility but may lead to irrational use.
Closed Formulary:
Restricts prescriptions to listed drugs only.
Encourages rational and economic prescribing.
Restricted Formulary:
Combines features of both.
Certain high-risk or high-cost drugs are limited to specialist use.
Criteria for Adding Drugs to Formulary:
Therapeutic Efficacy:
Drugs must have proven effectiveness supported by evidence.
Safety Profile:
Fewer side effects, contraindications, and interactions.
Cost-Effectiveness:
Generic availability, reasonable cost per treatment cycle.
Availability:
Drugs should be readily available from reliable suppliers.
Formulation & Stability:
Prefer stable, standard dosage forms with good shelf life.
Ease of Administration:
Preferred route, especially for chronic patients (e.g., oral over injectable).
Prescriber and Patient Acceptability:
Familiarity with the drug and its use.
Formulary maintenance ensures standardized treatment, budget control, and optimal therapeutic outcomes. Pharmacists play a central role in evaluating and proposing drug additions.
Q9. Write in brief about concept of clinical pharmacy and elaborate the scope of clinical pharmacy.
Ans:
Clinical pharmacy is a branch of pharmacy that deals with the science and practice of rational medication use, patient-centered care, and optimizing therapeutic outcomes. Unlike traditional pharmacy, which focuses on compounding and dispensing, clinical pharmacy is integrated into the healthcare team to improve patient care.
Definition:
Clinical pharmacy is the area of pharmacy concerned with the science of therapeutics, involving direct interaction with patients and healthcare professionals to optimize drug therapy.
Concept:
The core concept of clinical pharmacy includes:
Reviewing patient medication therapy
Preventing drug interactions and adverse drug reactions
Ensuring patient adherence
Collaborating with doctors and nurses
Providing drug-related education to patients and professionals
Scope of Clinical Pharmacy:
Hospital Settings:
Participate in ward rounds
Monitor drug therapy and lab results
Adjust doses in renal/hepatic impairment
Report and manage ADRs
Community Settings:
Provide patient counseling
Manage minor ailments
Promote health education and preventive care
Therapeutic Drug Monitoring (TDM):
Measuring drug levels to avoid toxicity or therapeutic failure
Pharmacovigilance:
Detecting and reporting ADRs
Drug Information Services:
Offering unbiased drug knowledge to doctors and patients
Patient Counseling and Education:
Improves adherence and therapeutic outcome
Research and Academia:
Clinical pharmacists participate in research, protocol development, and evidence-based medicine
Specialty Services:
Oncology pharmacy, critical care pharmacy, transplant pharmacy, antimicrobial stewardship
Clinical pharmacy improves patient safety, reduces healthcare costs, and promotes rational drug use. It is an evolving field in India, supported by Pharm.D programs and national healthcare reforms.
B.Pharmacy 7th Semester Pharmacy Practice Important Question Answer
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