workflow

One, three, check the contents of the seven-to-one confession

The third check: whether the investigating party and the disposal list are consistent before, during and after administration.

The workflow of hospital pharmacy.

Seven pairs: name (including serial number and diagnosis), drug name, specification, dosage, usage, incompatibility, and rationality of drug use.

1. confession: refer the patient to a doctor and ask about medication methods and related matters.

Classification, agreements and prescriptions of commonly used anti-inflammatory and antiviral drugs, abbreviations, symbols and prices

Third, the indications and incompatibility of drugs, especially what kind of pathogenic bacteria are sensitive to.

1, indications of cephalosporins: prostatitis, pelvic inflammatory disease, general postoperative medication and other compatibility contraindications: 0.9%NS250ml or 5%GS250ml can be used for dilution, and sodium bicarbonate solution is not allowed for dilution. It is forbidden for those who have allergic reaction to cephalosporins, but not suitable for those who have a history of allergic shock to penicillins.

Cephalosporins are mainly sensitive to gram-negative cocci.

2. Indications of quinolones: nongonococcal urethritis, prostatitis, and general postoperative drug compatibility contraindications: stock solution, which should not be used with normal saline or sugar saline, nor with other drugs.

Quinolones are mainly sensitive to mycoplasma, chlamydia, gram-positive bacteria or gram-negative bacteria.

3. Macrolide indications: nongonococcal urethritis, common skin infection complicated with gonorrhea and postoperative infection. Contraindications: It can be diluted with 0.9%NS250ml or 5%GS250ml, and it is forbidden for those allergic to azithromycin, erythromycin or any other macrolides.

Macrolide drugs are mainly sensitive to mycoplasma, chlamydia and staphylococcus.

4. Indications of antiviral drugs: Compatibility of condyloma acuminatum with genital herpes: 1) Li Kewei (ganciclovir for injection) can be diluted with 0.9%NS, 5%GS, Ringer's solution or Ringer's solution lactate, and it is forbidden for those who are allergic to this product or acyclovir; 2) Tolerance (foscarnet sodium injection); Central venous catheter infusion should be used directly without dilution. Peripheral intravenous infusion should be diluted with 5%GS and 0.9%NS 100- 150ml. It should not be mixed with other drugs, and it is forbidden for those who are allergic to foscarnet sodium.

Antiviral drugs are mainly sensitive to papillomavirus, herpes simplex type I and herpes simplex type II.

5. Indications of antifungal drugs: contraindication of genital candidiasis complicated with tinea cruris: allergic history of stock solution, fluconazole or other triazole drugs. Prohibited antifungal drugs are mainly sensitive to fungi.

6, immunomodulator indications: suitable for all kinds of immune function decline compatibility contraindications: Borreline must be diluted with 0.9%NS, thymosin can be dissolved in 5% grape granule liquid or physiological saline.

Four, pharmacy drug handover procedures and turnover, fill in the statistical report; Procedures for collecting drugs:

1. The main drugs are counted face to face according to the sales quantity of drugs on that day, and then filled in in time; 2. To purchase drugs that are in arrears, first write an application form for drug purchase, fill in the name, specification, manufacturer, unit price and purchase quantity of drugs carefully, and submit it to the director. Every time you buy drugs, at least two people should personally count the quantity, then put them into storage in different categories, fill in the warehouse receipt, record them in the account book according to the actual purchase price, specification and quantity of drugs, read the drug receipt, and multiply it by the reference wholesale price by 65438.

Dispensing procedure:

1. When receiving the prescription, first carefully examine the prescription, and check the family name history (including serial number and diagnosis), drug name, specification, dosage, usage, compatibility contraindications and rationality of medication. If in doubt, contact the doctor in time; 2, careful pricing, must be checked by two people, and then to the patient; 3, medicine, according to the doctor's advice from the drug price into medicine, and then I looked at the drug price, check with the prescription price:

4. Read the prescription carefully by the second person and check the name, drug, specification, dosage and price again; 5, call the patient's name to send the medicine, and tell the patient to take the medicine carefully and ask the doctor about the medication method and related matters (such as sending Chinese medicine, you should tell the patient to take it back, put it in the fresh-keeping layer of the refrigerator, take it out before taking the medicine, twice a day, one bag at a time. Pay attention to the prohibition of eating cold, seafood and irritating food during taking medicine); 6. After the operation, the dispensers and reviewers should sign the prescription.

Fill in the statistical report:

1, statistics "prescription daily settlement table", statistics of drug quantity and amount by primary and secondary drugs; 2, statistics "medication daily report", patient number, name, medication days, medication content, etc. Fill it out carefully and hand it over to the nurse station; 3, statistics of each doctor's main and auxiliary drugs and the amount, check the total amount of each doctor's main and auxiliary drugs and the amount of main and auxiliary drugs in the prescription day statement, and then pay it to the charging room; When changing shifts every day, you should personally count the number of drugs.

What to say in detail:

Precautions for external preparation:

1. boric acid powder: 50g for a bag of boric acid powder, 5g at a time. Every 5g of boric acid powder is diluted with 1000ml warm water to avoid boric acid solution.

The concentration is too high.

2. Sodium bicarbonate powder: one bag of sodium bicarbonate powder 100g, and one dosage 10g. Every 10g of sodium bicarbonate powder is diluted with 100ml of warm water.

It is appropriate to reach the concentration of 10%.

3. Potassium permanganate tablets for external use: it should be prepared into aqueous solution for external use according to the ratio of 1: 5000, and it is not allowed to be taken orally. At the same time, patients should be told to avoid concentration of aqueous solution.

Too high and burning, usually reddish.

4. Kangfuxin liquid: it can be taken orally or used externally. Therefore, it is necessary to judge medication according to clinical diagnosis or communication with patients.

Whether it is reasonable.

5. Inhalation of Vantorin/Seretide (β2 receptor agonist): It is prone to nausea, dizziness and palpitation. Use with caution in patients with hypertension and hyperthyroidism.

Long-term medication can form drug resistance and reduce the curative effect.

6. Frisonidase/Berkner/Budesonide Inhalation (glucocorticoid): To prevent respiratory fungal or viral infection and hoarseness,

Rinse your mouth in time after each medication to prevent the liquid medicine from remaining in your throat.

7. ipratropium bromide inhaler (M receptor blocker): It is prone to glaucoma and should be used with caution in patients with benign prostatic hyperplasia. A few patients are thirsty.

Bitter.

Precautions for oral drugs:

1. antihistamine: It has the side effect of drowsiness, and it is forbidden to drive, engage in aerial work or perform other delicate and dangerous operations after taking the medicine. In the distribution

Patients should be informed when taking medicine. In addition, taking cimetidine after meals is more effective than taking it before meals. It is generally recommended to take H2 receptor blockers before going to bed (night suppression).

Intermittent gastric acid secretion can reduce the stimulation of gastric acid on ulcer surface, which is beneficial to the healing of ulcer.

2. Sulfonamides (compound sulfamethoxazole): Sulfonamides are mainly excreted through the kidney, which is easy to form crystals to stimulate and block the urinary tract. Drink plenty of water

It can wash away urine crystals, and tell patients to drink plenty of water and alkalize urine to avoid the damage of crystals to urethra.

3. Anti-gout drugs (allopurinol, benzbromarone): When using uric acid drugs to treat gout, you should drink more water to make the daily urine output reach more than 2000ml.

At the same time, the urine should be alkalized to prevent uric acid from forming stones in the urethra during excretion.

4. Hypoglycemic drugs

Glimepiride: Take it before breakfast or the first meal.

Gretchett: Half an hour before dinner.

Glipizide: Half an hour before meals.

Repaglinide: take orally 0-30 minutes before the main meal, mostly 15 minutes before the meal.

Metformin: Take with meals. If your stomach is upset, you can take it after meals.

Acarbose: swallowed whole before meals or chewed with the first few mouthfuls of food.

Pioglitazone: Taking medicine has nothing to do with eating. You can eat it on an empty stomach or after meals.

Rosiglitazone: Taking medicine has nothing to do with eating. You can eat it on an empty stomach or after meals.

5. Gastroenterology drugs:

Omeprazole magnesium: It must be swallowed whole, not chewed, and it should be avoided to take it together with oral imidazole antifungal drugs such as itraconazole and fluconazole.

Use. You can take it before going to bed.

Aluminum phosphate gel: gastritis and gastric ulcer should be taken half an hour before meals, and duodenal ulcer should be taken 3 hours after meals or when it hurts.

Aluminum magnesium carbonate chewable tablets: 65438+ 0-2 hours after meals, if you feel uncomfortable before going to bed or in your stomach, take it when you need to chew.

Sodium bicarbonate: it should be taken 1-2 hours after meals and before going to bed. It is not advisable to take any medicine within 1-2 hours after taking this product orally.

Mosapride: The peak plasma concentration can be reached at 15-30 minutes before meals and at 15-30 minutes after meals.

Polyethylene glycol electrolyte: It is best to take it at a long interval with other drugs (at least 2 hours).

Loperamide: Not suitable for children under 5 years old. Acute bacillary dysentery with high fever and pus is prohibited. Use with caution in elderly patients with constipation. meals

Take it half an hour ago or on an empty stomach.

Montmorillonite powder: taken by patients with esophagitis after meals; Other patients should take it between meals, immediately when acute diarrhea occurs, and the first dose should be increased.

Racecadotril: oral, three times a day, no more than 7 days.

Compound digestive enzymes: take after meals. It is not suitable to take it with acidic drugs, but with acarbose, which reduces the curative effect.

Bifidobacterium triple viable bacteria: take it with warm water half an hour after meals. When babies take it, they can peel off the capsule and pour out the powder, and take it with warm water.

Clostridium butyricum: Take it with warm water half an hour after meals to avoid taking it with antibacterial drugs. If it is necessary to take it, it should be stated that it should be taken at intervals of two hours.

Use.

6. Adjuvant drugs for hepatobiliary diseases:

Compound glycyrrhizin: Take it after meals, and elderly patients should use it with caution. Due to the high incidence of hypokalemia, attention should be paid to it.

Compound azintamide: Take it after meals. Patients with hepatic insufficiency, acute hepatitis and biliary obstruction are prohibited. Avoid taking it together with alkaline drugs.

Adefovir dipivoxil/Lamivudine: Can be taken before or after meals. It is suggested that patients should not stop taking drugs on their own, and should be monitored regularly during treatment.

7. Trace elements:

Iron and calcium: Ten-vitamin iron chewable tablets and vitamin D calcium chewable tablets are well absorbed after meals, chewed 1-2 hours after meals, and supplemented with iron.

Combining with tannin in tea will reduce the efficacy of iron, and you can't drink tea while taking this medicine.

Folic acid tablets: iron deficiency anemia needs folic acid supplementation, but there are two kinds of folic acid, one for anemia patients and the other for pregnancy.

If you don't follow the doctor's advice during pregnancy, using low-dose folic acid will reduce the curative effect and delay the best treatment time.

Vitamin E capsule: Male patients with cerebrovascular sclerosis and cerebral blood supply insufficiency can treat habitual abortion as long as they look at the drug instructions.

Refusing to take it is extremely unfavorable to the treatment of patients.

8. Cardiovascular and cerebrovascular diseases:

Digoxin tablets: The therapeutic dose of some drugs is very close to poisoning, so it should be carried out according to the doctor's advice. Such as drugs for treating heart failure.

Digoxin, some patients do not insist on formal treatment, although the symptoms have improved, but the course of treatment is not enough, and they think that the disease has been cured.

Potassium chloride sustained-release tablets: Potassium chloride is irritating. If it is not used properly according to the doctor's advice, it will damage the gastric mucosa, affect the normal diet or cause hypertension.

Potassium anemia.

Propafenone tablets: severe obstructive pulmonary disease, those with obvious hypotension are prohibited.

Amiodarone tablets: this product has a long half-life. When switching to other antiarrhythmic drugs after stopping taking drugs, attention should be paid to the interaction, and heart rate and blood pressure should be paid attention to at all times.

If the heart rate is lower than 60 beats/min, stop using it.

Felodipine sustained-release tablets: take it on an empty stomach before meals, because the bioavailability of this product is affected by diet.

Metoprolol: Food can increase the plasma concentration of this product to twice that of fasting.

Carvedilol: When taken with food, its absorption slows down, but it has no obvious effect on bioavailability.

Reduce the risk of postural hypotension

Captopril: food in the stomach can reduce the absorption of this product by 30% ~ 40%, so it is appropriate to take it before meals 1 hour.

Fenofibrate: Taking it with food can increase the absorption of fenofibrate. In order to reduce stomach discomfort, it can be taken with diet.

Gefilozzi: Take it 30 minutes before breakfast and dinner.

Lovastatin/Simvastatin/Atorvastatin Calcium: Take it once a night.

Spironolactone: 10 am, taken after meals, reduces gastrointestinal reactions and may improve the bioavailability of the drug.

Furosemide: Take it in the morning 10 to avoid increasing urination at night.

Nitroglycerin tablets should be taken sublingually to avoid the first-pass effect.

Lumbrokinase: it must be taken before meals, and it should be used with caution for those with bleeding tendency.

9. Antipyretic and analgesic drugs:

Diclofenac sodium: taken after meals, this product may induce or aggravate gastrointestinal bleeding, ulcers and perforation in the elderly. Take diuretics or have cells

Use with caution in elderly patients with loss of body fluids.

Compound acetaminophen: forbidden for pregnant women during lactation, which is harmful to the liver. When this kind of antipyretic analgesic is used to reduce fever, it needs to be explained clearly.

Take it when necessary. Don't let some patients rush to reduce their fever and use it repeatedly in a short time, causing sweating or even collapse. Inform the patient,

When the body temperature exceeds 38.5℃, take orally. If the fever persists, the drug can be repeated every 4 ~ 6 hours 1 time.

Ketoprofen: You can take it after meals. When eaten with food and milk, the absorption slows down, but it is still intact, which can avoid irritation to the gastrointestinal tract.

10. Respiratory medicine:

Compound licorice mixture: contains licorice fluid extract, which should be used with caution in patients with hypertension. Licorice is easy to cause water and sodium retention, which will increase blood pressure. diabetic

People should ban it, because licorice has the function of raising blood sugar, so it is very important to strictly follow the doctor's advice.

Ambroxol hydrochloride: Take it after meals, and tell to avoid taking it with powerful antitussive drugs to avoid diluting sputum and blocking airway.

Theophylline sustained-release tablets: should be taken at 8-9 pm. Because asthma often attacks or worsens in the early morning, it is best to do it in.

8-9 pm.

1 1. nervous system class:

Carbamazepine tablets: Large dose can cause atrioventricular block, so the dose should be controlled according to the doctor's advice.

Perphenazine tablets: Long-term large doses can cause tardive dyskinesia, and the dosage and course of treatment should be strictly in accordance with the doctor's advice.

Paroxetine tablets: withdrawal should be gradually reduced, not stopped. It is best to take it in the morning.

Flunarizine capsules: strictly control the dosage of drugs. When the maintenance dose fails to achieve the therapeutic effect or symptoms of extrapyramidal system appear after long-term use, it should be

When the dosage is reduced or stopped. Tell them to take it before bed.

12. Antibiotics:

Metronidazole, cephalosporin and other antibacterial drugs can react with ethanol in a disulfiram-like way, so that ethanol accumulates in the body and causes poisoning, which should be explained.

No alcohol or alcoholic beverages during medication.

Cefuroxime axetil: This product should be taken after meals to increase absorption, increase blood concentration and reduce gastrointestinal reactions.

Cefalexin: this product should be taken on an empty stomach, but if the gastrointestinal tract reacts strongly to cefalexin, it should be taken after meals 1 hour.

Amoxicillin and clavulanate potassium: It can be taken on an empty stomach or after meals, and dispersible tablets can be taken after being dissolved in water.

Penicillin v potassium tablets: food can reduce the absorption of this product and can be taken on an empty stomach.

Doxycycline hydrochloride: Eating has little effect on the absorption of this product, and taking medicine after meals can reduce gastrointestinal reactions.

Roxithromycin: Eating it can reduce the bioavailability by about half. Can be taken on an empty stomach

Clarithromycin: food can slightly delay absorption, but it does not affect bioavailability. Can be taken on an empty stomach.

Norfloxacin:/kloc-forbidden under 0/8 years old, take it on an empty stomach and drink 250ml of water at the same time.

Levofloxacin: Take it after meals. Avoid sunlight when using quinolones to prevent photosensitive reaction.

Sparfloxacin: concentration-dependent drug, preferably limited once a day.

Isoniazid: It's better to eat at night.

Rifampicin: Take it on an empty stomach to ensure the best absorption. If you have symptoms of gastrointestinal irritation, you can take it after meals.

Itraconazole: Take this product immediately after meals, with the highest bioavailability.

Fluconazole: Because the half-life is more than 24 hours, it must be taken in strict accordance with the doctor's advice, otherwise it will easily lead to drug accumulation and poisoning.

13. Antiviral drugs (acyclovir): In order to reduce the damage of acyclovir to renal function, you need to drink plenty of water during medication.

14. anorectal drugs:

Diosmin: Divide the daily dose into lunch and dinner twice.