Pharmacy Level-IV
Pharmacy Level-IVBased on Feb, 2018 Version OccupationalStandards and June, 2018 Version 1 CurriculumModule Title:LG Code:TTLM Code:Dispensing PharmaceuticalsHLT PHS4 M01 LO (1-5) LG (01-05)HLT PHS4 TTLM 0221V1February, 2021Bishoftu, Ethiopia
ContentsLO #1-Basic knowledge of anatomy and physiology . 4Instruction sheet . 4Information Sheet 1- Introduction to Anatomy and physiology . 4Self check 1 . 12Information Sheet-2- Anatomy and physiology of the nervous system . 14Self check 2 . 23Information Sheet-3- Anatomy and physiology of the cardiovascular and renal system. 25Self check 3 . 29Information Sheet-4- Blood Physiology . 31Self-Check –4 . 34Information Sheet-5- Anatomy and physiology of the respiratory system . 36Self-Check –5 . 39Information Sheet-6- Anatomy and physiology of the GIT system . 41Self-Check –6 . 43Information Sheet-7-Physiology of endocrine system. 45Self-Check –7 . 49Reference materials . 51LO #2- Basic Drug knowledge . 52Instruction sheet . 52Information Sheet 1- Introduction to Pharmacology. 54Self-Check -1 . 128Information Sheet-2- Drug acting on Autonomic nervous system (ANS) . 134Toc63233754Self-Check -2 . 149Information Sheet-3- Central nervous system drugs . 152Toc63233757Self-Check -3 . 165Information Sheet-4- Drug Acting on Cardiovascular system . 169Self-Check -4 . 188Information Sheet-5- Drug Acting on Respiratory System . 193Self-Check -5 . 201Information Sheet-6- Drug Acting on Gastro-intestinal tract . 204Toc63233766Self-Check -6 . 215Information Sheet-7- Drugs used to treat the diseases of blood, inflammation, goutand allergy . 218Toc63233769Self-Check -7 . 233Information Sheet-8- Drugs used in Endocrine Disorders and Contraceptives . 235Toc63233772Self-Check -8 . 246Information Sheet-9- Anti-infective . 249ii
Self-Check -9 . 302Information Sheet-10- Minerals, vitamins and electrolytes . 306Self-Check -10 . 313Information Sheet-11-Biological and immunological agents . 315Self-Check –11 . 324Information Sheet-12-Dermatological agents . 327Self-Check –12 . 335References materials. 337LO# 3 Dispensing administration tasks . 338Instruction Sheet 1. 338Information sheet 1-Dispensing administration tasks . 339Self-Check -1 . 341Information Sheet-2-Introduction to dispensing . 342Self-Check -2 . 369Information sheet-3-Using barcode technology for dispensing . 371Self-Check -3 . 378References materials. 380LLO #4- Maintaining dispensary information. 382Instruction sheet . 382Information Sheet 1- Generating and maintaining dispensing records . 383Self-Check –1 . 385Information sheet-2-Generating dispensing reports. 387Self-Check –2 . 394Information Sheet-3-Computerized dispensing . 396Self-Check –3 . 404References materials. 406LO# 5. Duties of pharmacy Technicians . 407Information Sheet 1- The scope of practice for pharmacy technicians in dispensing. 408Self-Check -1 . 425Information Sheet-2-Qualities and attributes of a pharmacy technician. 427Self-Check -2 . 429References materials. 431Aknowledgement . 434Answer key for self check . 433Page iii of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
L G#1LO #1-Basic knowledge of anatomy and physiologyInstruction sheetThis learning guide is developed to provide you the necessary information regarding thefollowing content coverage and topics: Introducing anatomy and physiology Understanding Anatomy and physiology of the nervous system Understanding Anatomy and physiology of the cardiovascular and renal system Understanding Blood Physiology Understanding Anatomy and physiology of the respiratory system Understanding Anatomy and physiology of the GIT system Understanding Physiology of endocrine systemThis guide will also assist you to attain the learning outcomes stated in the cover page.Specifically, upon completion of this learning guide, you will be able to: Obtain the required basic knowledge on Anatomy and Physiology. Works with a basic understanding of Anatomy and Physiology. Relate knowledge of Anatomy and Physiology with drugs mechanism of action.Learning Instructions:1. Read the specific objectives of this Learning Guide.2. Follow the instructions described below.3. Read the information written in the ―Information Sheets‖. Try to understand what arebeing discussed. Ask your trainer for assistance if you have hard time understandingthem.4. Accomplish the ―Self-checks‖ which are placed following all information sheets.5. Ask from your trainer the key to correction (key answers) or you can request yourtrainer to correct your work. (You are to get the key answer only after you finishedanswering the Self-checks).6. If you earned a satisfactory evaluation proceed to ―Operation sheets7. Perform ―the Learning activity performance test‖ which is placed following ―Operationsheets‖ ,8. If your performance is satisfactory proceed to the next learning guide,9. If your performance is unsatisfactory, see your trainer for further instructions or goback to ―Operation sheets‖.Information Sheet 1- Introduction to Anatomy and physiology4
1.1.Introduction to anatomy and physiologyDefinitions of Anatomy and PhysiologyHuman Anatomy: It is the branch of science that studies the physical structure ofhuman body. Physiology: It is the branch of biology that deals with the internal working of livingthings, including functions such as metabolism, respiration and reproduction.There are six levels of organization (from smallest to largest)I.The chemical levelIV. The organ levelII.The cellular levelV. The organ system levelIII.The tissue levelVI. The organism levelSYSTEMS OF THE HUMAN BODYPage 5 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
1. Integumentary system (hairs, nails, sweat glands, 7. Endocrine systemoil glands)2.Skeletal system8. . Cardiovascular system3. Muscular system9. Lymphatic system2. Respiratory system10. Digestive system3. Urinary system11. Nervous system4.Reproductive systemHuman anatomy is subdivided into macroscopic (or gross) and microscopic anatomy.Macroscopic anatomy describes structures, organs, muscles, and bones, which arevisible to the naked eye that is macroscopic.Microscopic human anatomy is the study of ―tissues―, that is histology. It may be furtherseparated into cytology, the pure study of cells.The word ―physiology‖ derived from a Greek word for study of nature. It is the study ofhow the body and its part work or function. However, when studying physiology, you willbe looking at the functions of cells and organs within their biological systems, ratherthan their structures.Fig1. schematic representation of Skeletal and Integumentary systemPage 6 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Fig 2. Schematic representation of Muscular and Nervous systemFig 3. Schematic representation of Muscular and Nervous systemPage 7 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Fig 4. schematic representation of lymphatic and Respiratory systemFig,5. schematic representation of Human reproductive systemPage 8 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
BASIC LIFE PROCESSES There are 6 most important life processes of human body are :1. Metabolism: It is the sum of all chemical processes that occurs in the body. a)Catabolism: breakdown of complex chemical substance into simpler componentse.g. digestion of protein into amino acids. b) Anabolism: building up of complexchemical substance from smaller, simpler components e.g. use of amino acids tobuild new proteins of the body.2. Responsiveness: It is the body‘s ability to detect and respond to changes.3. Movement: It includes motion of the whole body, individual organs, single cells etc.4. Growth: It is an increase in body size and weight5. Differentiation: It is the development of a cell from an unspecialized to a specializedstate.6. Reproduction: formation of new cells or to the production of a new individual.Homeostasis (homeo- "like, resembling, of the same kind"; stasis ―standing still‖)means to maintain body functions within specific livable ranges, adjusting to internal andexternal changes. It‘s the self-sustaining mechanisms in organisms that tries to maintainstable internal conditions.Page 9 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Temperature, nutrient concentration, acidity, water, sodium, calcium, oxygen, as wellas blood pressure, heart rate, and respiratory rate are some of the internal bodyvariables that must remain within a certain range. When the body fails to maintaininternal body variables within a certain range, normal function is interrupted, anddisease or illness may result.Without homeostasis, organisms would not be able to have stable internal conditions,and therefore would not be able to survive. Homeostasis is a dynamic condition in response to changing conditions.The two body systems that largely control the body‘s homeostatic state:1. Nervous system2. Endocrine systemBranches of Human AnatomyHuman anatomy is divided into following important branches:1. Gross anatomy: Gross anatomy is the study of macroscopic details of human bodystructure. Because gross anatomy is concerned only with macroscopic details, thereforeit does not require the aid of any instrument. Generally gross anatomy is studied ondead bodies because you cannot dissect a living human just to study anatomy;therefore gross anatomy is also known as cadaveric anatomy.5.Living anatomy: In contrast to the cadaveric anatomy, in living anatomy deals withthe study of live human beings and not dead bodies, therefore methods likedissection cannot be applied. Techniques to study living anatomy include palpation,percussion, auscultation etc.6. Embryology: Embryology is also known as developmental anatomy. It is concernedwith the study of development of an embryo from a single cell to a complete humanbeing.7. Histology: Histology is also known as microscopic anatomy. It deals with the studyof microscopic details of tissues that make human body.8. Clinical anatomy: Clinical anatomy is the application of anatomical knowledge toclinical practice.Page 10 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Page 11 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Self check 1Direction.Written testMatch the following terms in column ―A‖ with their related statement incolumn B. and provide the answer in the next page space providedNOAB1AnatomyAhairs, nails, sweat glands, oil glands2PhysiologyBdescribes structures, organs, muscles, andbones, which are visible to the naked eye3Integumentary systemCapplication of anatomical knowledge to clinicalpractice.4Macroscopic anatomyDstudies the physical structure of human body5Microscopic anatomyEthe study of ―tissues―, that is histology6Metabolism:Fdeals with the internal working of living things7ResponsivenessGthe body‘s ability to detect and respond tochanges.8MovementHthe sum of all chemical processes that occursin the body9HomeostasisImotion of the whole body, individual organs,single cells10EmbryologyJincrease in body size and weightKself-sustaining mechanisms in organisms thattries to maintain stable internal conditionsLPage 12 of 439developmental anatomyFederal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Note: Satisfactory rating - 5 pointsUnsatisfactory - below 5 pointsAnswerSheet1.2.3.4.5.6.7.8.9.10.NameDatePage 13 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Information Sheet-2Anatomy and physiology of the nervous systemNervous system Is a highly complex part of a human that coordinates its actions and sensoryinformation by transmitting signals to and from different parts of its body. It detects environmental changes that impact the body, then works in tandemwith the endocrine system to respond to such events. Is divided into two parts: the central nervous system (CNS) and the peripheralnervous system (PNS).1.2.1 Central nervous systemThe Central nervous system (CNS) is anatomically divided in to: brain and spinal cord.The functional unit of nervous system is called neuron. The structural and functionalproperties of neurons and their specific receptors provides a means to modify CNSfunction by administering drugs that can act at defined receptor sites, either causinginhibition or excitation at the receptor.The brain and spinal cord are protected by bony structures, membranes, and fluid.The brain is formed of 3 main parts:a. The forebrain: the cerebrum, the thalamus, the hypothalamusb. The midbrainc. The hindbrain: the cerebellum, the pons, the medulla oblongataThe outermost layer of the cerebrum is the cortex. The midbrain, pons and medullaoblongata make the brainstem. The nerves involved are cranial nerves and spinalnerves.Page 14 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Neurotransmission is essential for the process of communication between nerve cells(neurons). Neurotransmission is the fundamental process that drives informationtransfer between neurons and their targets.Neurotransmission occurs at specialized regions between neurons and their targets,called the synapse. Neurotransmitters are the chemicals which allow the transmission ofsignals from one neuron to the next across synapses.Important transmitters in the central nervous systemAcetylcholine (Ach): is thought to play a major role in cognitive functions and memoryformation as well as motor control. It acts on muscarinic and nicotinic receptors. Drugsthat decrease Ach are used to treat Parkinson‘s disease. Drugs that increase Ach areused to enhance memory.Dopamine: controls behavior, motor control, hormone release, and emesis. Areas ofthe brain where dopaminergic receptors have been found are limbic system andextrapyramidal system. Dopamine acts on D1 and D2 receptors. Drugs that decreasedopamine are used to treat schizophrenia. Drugs that increase dopamine are used totreat Parkinson‘s disease.Nor-adrenaline and Serotonin (5-HT): involved in arousal, sleep, mood, appetite, andtemperature control and hormone release. Noradrenalin acts on α and β receptors.5-HT acts on 5- HT1 and 5-HT2. Drugs that increase nor-adrenaline and serotonin areused to treat depression. Drugs that decrease serotonin are used to treat schizophrenia.GABA: is a major inhibitory neurotransmitter distributed throughout the brain and thespinal cord. In inhibits motor control, arousal, memory formation and consciousness. Itacts on GABAa and GABAb receptors. Drugs that enhance the action of GABA areused to treat anxiety, insomnia and epilepsy.Enkephalin, Dynorphin, Endorphin: natural opiods that decreases pain.Page 15 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
1.2.2 Peripheral nervous systemThe PNS consists mainly of nerves, which are enclosed bundles of the long fibers oraxons that connect the CNS to every other part of the body. Nerves that transmit signalsfrom the brain are called motor or efferent nerves, while those nerves that transmitinformation from the body to the CNS are called sensory or afferent. Spinal nervesserve both functions and are called mixed nerves.There are subdivisions of the peripheral nervous system called the somatic nervoussystem and the autonomic nervous system. The autonomic nervous system controls theautomatic (involuntary) functions of the body, e.g., breathing, digestion, heartbeat, etc.The somatic nervous system controls the voluntary actions of the body, e.g., skeletalmuscle movements.The ANS is further divided on anatomic grounds into two major portions: Sympathetic nervous system Parasympathetic nervous systemFig 2,1. Divisions of Nervous systemPage 16 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
ANS have two neurons from CNS to the effector tissue. They are called presynaptic andpostsynaptic. The place where the two neurons are connected and communicate witheach other is called synapse. Hence synapse is the junction between two neurons, orbetween a neuron and an effecter organ (muscle or gland).Fig 2.2. Schematic representation of synaptic transmissionFunctions of ANSANS system controls the body's internal organs. It innervates smooth muscles, cardiacmuscle, and glands, controlling the circulation of blood, activity of the gastrointestinaltract and body temperature.Autonomic nervous system is involuntary, that is, the function of sympathetic andparasympathetic nerves cannot be influenced by our mind.Sympathetic and parasympathetic systems have opposing actions in some situations(e.g. control of heart rate), but not in others (e.g. salivary glands). Sympathetic activityincreases in stress ('fight or flight ‗), whereas PNS activity predominates ‗rest & digest‘.Both systems exert a continuous physiological control of specific organs under normalconditions.Page 17 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Sympathetic nervous system functions (SNS)1. Regulating the cardiovascular system Increase cardiac output Causes vasoconstriction2. Regulate body temperature By regulating blood flow to the skin By promoting secretion of sweat, thereby helping the body to cool By inducing piloerection (erection of hair) can promote heat conservation3. Implementing the “ fight – or – flight‖ reaction which consists Increasing heart rate and blood pressure Shunting blood away from the skin and viscera into skeletal muscles Dilating the bronchi to improve oxygenation Dilating the pupil to enhance visual acuity Mobilizing stored energy thereby providing glucose for the brain and fatty acids for musclesFig. Response to sympathetic activationPage 18 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Functions of parasympathetic nervous system (PNS) Slowing the heart rate Increase gastric secretion Emptying of the bladder Emptying of the bowel Focusing the eye for near vision Constricting the pupil Contracting bronchial smooth muscleFig2.3. Parasymphatatic and sympathetic Dominate conditionPage 19 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Fig 2.4. schematic comparison of parasympathetic and sympathetic activityNeurotransmitters in autonomic nervous systemNeurotransmitters are chemical substances that are used for the transmission ofinformation between nerve cells and between nerve cells and their effector )arethemajorautonomicneurotransmitters. Neurons that release norepinephrine are known as adrenergicneurons. Norepinephrine binds to adrenergic receptors. Neurons that releaseacetylcholine are known as cholinergic neurons. Acetylcholine binds to cholinergicreceptors.Autonomic receptors Includes cholinergic and adrenergic receptorsCholinergic receptorsAcetylcholine binds to cholinergic receptors. Cholinergic receptors are classified intomuscarinic and nicotinic cholinergic receptors.Muscarinic receptors Found in many visceral organs such as smooth muscle cells, cardiac cells,exocrine glands, CNS, Autonomic ganglia Further classified into M1, M2, M3, M4 & M5Page 20 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Nicotinic cholinergic receptorsNmSkeletal muscle NMJNnPost ganglionic cell body, dendritesThe action of ACh is quickly terminated through hydrolysis by the enzyme acetylcholinesterase.Adrenergic receptorsReceptors that respond to adrenergic nerve transmitter are termed adrenergicreceptors. These receptors are subdivided into alpha and beta adrenoreceptor types onthe basis of both agonist and antagonist selectivity. The receptors have subclassesdepending on drug selectivity. These are alpha 1 and 2 and beta 1, 2 and 3.The binding of norepinephrine to alpha receptors in the smooth muscle of blood vesselshas a stimulating effect on the muscle that causes the muscle to constrict. The bindingof norepinephrine to beta receptors in the smooth muscle of a different blood vesselproduces opposite effects. The binding of norepinephrine to beta receptors in cardiacmuscle has a stimulating effect that results in a faster and stronger heartbeat. Theactions of norepinephrine and epinephrine are terminated in two ways.Most of the neurotransmitter molecules are taken back up by the synaptic knob of thepostganglionic neurons, where they are broken down by the enzyme monoamineoxidase (MAO). The remaining neurotransmitter molecules are eventually broken downby another enzyme, catechol-O-methyltransferase (COMT).Page 21 of 439Federal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Table 2,1. Adrenergic receptor and their symphatatic effectTypeTissueActionsAlpha1Most vascular smooth musclesContractionPupillary dilator a2Adrenergic nerve terminals tsBeta1HeartAggregationIncreased rate and force ofcontractionBeta2Respiratory, uterine, andRelaxationvascular smooth muscleHuman liverGlycogenolysis &gluconeogenesisBeta3Page 22 of 439Fat cellsFederal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightLipolysisVersion -1February, 2021
Self check 2Written testDirection: Answer the following question and provide the preferred answer on nextpage space provided1. One of the following is functional unit of nervous systemA. NephronB. NeuronC. ReceptorD. Cell2. Which of the following neurotransmitter is responsible for parasympathetic actionA. Nor-epinephrineB. NoradrenalinC. EpinephrineD. Acetylcholine3. Which of the following is not natural opiods that decreases painA. EnkephalinB. Dynorphin,C. MorphineD. Endorphin4. Nerves that transmit signals from the brain to the bodyA. Motor nerveB. Sensory nerveC. Efferent nervesD. A & C5. Which of the following is under the control of somatic nervous systemA. DigestionC. breathingB. skeletal muscle movements.D. heartbeat6. Which of the following is predominates during ‗rest & digest‘.A. Parasympathetic Nervous systemB. sympathetic Nervous system7. Which of the following is not effect observed during of Parasympathetic NervoussystemstimulationA. Increase cardiac outputC. Increase gastric secretionB. Slowing the heart rateD. Emptying of the bladder8. Which of the following enzyme is responsible for metabolism of norepinephrineA. Acetyl cholinesteraseC. catechol-O-methyltransferaseB. monoamine oxidase (MAO)D. B and C9. which of the following is not effect observed upon activation os Alpha1receptorPage 23 of 439A. ContractionC. MiosisB. MydriasisD. Increase force of contractionFederal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
10. which of the following effect is observed during stimulation of Beta2 receptor inliverA. GluconeogenesisC. LipolysisB. MydriasisD. Inhibition of transmitter releaseNote: Satisfactory rating - 5 pointsUnsatisfactory - below 5 pointsAnswer Sheet1.6.2.7.3.8.4.9.5.10.NamePage 24 of 439DateFederal TVET AgencyTVET program title- Pharmacy Level- IVAuthor/CopyrightVersion -1February, 2021
Information Sheet-3Anatomy and physiology of the cardiovascularand renal systemThe cardiovascular system distributes blood throughout the body using blood vesselscalled arteries, capillaries and veins. Blood transports nutrients to the body‘s cells andcarries waste products away from them. Blood is made up of red blood cells, whiteblood cells, platelets, and plasma. Red blood cells (Erythrocytes) transport oxygen fromthe lungs to the body and carbon dioxide from the cells to the lungs. White blood cells(Leukocytes) fight diseases (infections) by producing antibodies.Types of circulation in the anatomy In systemic circulation, arteries carry oxygenated blood from the heart to the restof the body. Veins then return oxygen-depleted blood to the heart. In pulmonary circulation, pulmonary arteries carry oxygen-depleted blood to thelungs, where it is oxygenated and returned to the heart through pulmonary veins. Arteries have thick walls and carry blood away from the heart. Veins have thin walls and return blood to the heart.Location of the heartContrary to comm
Reproductive system Human anatomy is subdivided into macroscopic (or gross) and microscopic anatomy. Macroscopic anatomy describes structures, organs, muscles, and bones, which are visible to the naked eye that is macroscopic. . Gross anatomy: Gross anatomy is the study of macroscopic details of human body structure. Because gross anatomy is .
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Hospital Pharmacy, Final Basel Statements. December 2008. NEW ZEALAND - Pharmacy Council of New Zealand. Competency Framework for the Pharmacy Profession. August 2006. THAILAND - Thai Pharmacy Council. Standard criteria for pharmacy practitioners 2002. Bangkok: Thai Pharmacy Council. 2002 U
