Who regulates the distribution of medication in Kenya?
The Pharmacy and Poisons Board is the body mandated by law under the Pharmacy and Poisons Act (cap 244) to protect, promote and maintain the health, safety, and well-being of members of the public by upholding standards and public trust in pharmacy.
The board regulates the practice of pharmacy and the manufacture and trade in drugs and poisons. The body, therefore, sets the standards of conduct by monitoring closely pharmacy professionals and premises ensuring locally manufactured, imported, exported, distributed, sold or used medical products are safe.
Every registered pharmacy has a special code which is meant to be displayed publicly for everyone to see. Any fake or substandard drug can be reported and action taken according to law by the board.
What is the meaning of fake drug?
A fake drug is that which is sold or advertised with similar display as the original form of the drug. This means the fake drug may look exactly like the original or have information that may confuse the consumer if not careful. The pharmacist or user through experience can establish the difference although for a new person this can be difficult. The fake drug may be produced at lower costs and sold at the same price as the original brand.
Why do people refer to certain drugs as original?
An “original” or brand name drug product is usually the first to be developed by a pharmaceutical company. This is usually a multinational brand available in most countries worldwide. The original drug is usually more expensive than generic.
The manufacturing company of a brand name drug spends a lot of time and money to determine clinical safety and efficacy and this justifies why the initial price for a new drug is extremely high regardless of the cost of manufacturing being low.
The high cost covers up for the huge expenses needed to get Food and Drug Administration (FDA) approval which requires a lot of time, study and research too. Furthermore, some drugs may fail to make it out of research labs or may need modifications before the entire process is complete.
Developing a new prescription medicine that gains marketing approval may cost roughly $2.6 billion according to a recent study by Tufts Center for the Study of Drug Development and published in the Journal of Health Economics.
This makes the production of a generic drug be as simple as buying raw materials and getting to work. When the drug goes off patent, that is, after 20 years of them charging high prices – other pharmaceutical companies are allowed to begin making generics. The price of the brand drug may reduce.
Is a generic drug fake?
A generic drug is a pharmaceutical drug that is equivalent to brand-name or original drug in dosage, strength, route of administration, quality, performance and intended use with the same active ingredient as the original.
What does that actually mean? It is the economy, bro. You are used to buying a # 30-day refill but suddenly change to #14 or #7, or things get worse you begin #3 or #1. Patients are asking for cheaper drugs or going for generics. Generics do work and they are equally effective like the brand drugs.
Folks depending on their grown kids for refills, remain silent after they run out of their Rx refills. It is the economy, bro. If they can’t afford #30, that means folks will be calling through for #7 translating to four weeks a month. Who wants to be bothered every week while they are broke? You are trying to survive so that you make ends after all.
Sometimes things don’t go the way you expect. It is the economy, bro. The first week you manage to get #7 pieces. The week that follows, you struggle and miss out some pills. You are not alone! Amazingly you manage to push through and survive. The next week you get another #7 and move on regardless of them saying you are not compliant. The last week of the month you do alternative days because the month is at the corner. For a refill with four or more drugs, the prescription gets more and more expensive.
Some patients kick out drugs they think are less critical especially painkillers and get them only when necessary. It is the economy, bro. Give me the first two leave out the last three. It might look like your doctor wrote some drugs you really don’t need, but the main aim is actually cutting down cost. You are not alone! People Google these days and surprisingly they only see doctors for a professional opinion or just to confirm what they previously know.
You have to save. It is the economy, bro. You don’t struggle with a very expensive prescription. As much as you need a better treatment outcome, a prescription you cannot afford will only frustrate you or at the end of the day, you don’t buy the medicines. Find ways of getting the prescription cheaper, ask for a better price or ask for a generic. Talk… Go back to your doctor he may suggest a better option that might cost less and affordable.
Some drugs are very expensive you might not be able to consider an alternative. Pambana na hali yako. Things will get better.
Wow! Haha! How to become a pharm tech? And die like a pharm tech. Pharmacy is the most trusted profession and this happens all the time. Most students take pharmacy at college for purposes of surviving in the job industry. They missed campus and now they want to make a difference in their lives, studying about medicine. This comes with the hopes that they will be able to advance their studies and become something. Getting accepted in a medical college is usually tough because the number of applicants is most of the time high. KMTC accepts something close to a mean grade B. That grade can get someone a good course at the universities but due to various reasons, individuals choose to do pharmacy. One of the primary reasons is that they come from poor family backgrounds which cannot afford a university education. So they choose pharmacy because it is cheaper (although cheaper is relative maybe I should have said affordable) and they are assured of a job once they have finished because the market has high demand too. They also hope to make a dime and further their studies but forgetting they have a family that is supporting them and they will need to take care of once they land a nice job.
Pharmacy itself at the college level is tough too; most people struggle and only a few manage to graduate. Perhaps that’s why KMTC decided to introduce a double intake and many more colleges are doing the same. Finally, they graduate and get jobs, life begins. Paycheque to paycheque becomes the routine with which is used to chase bills; rent, food, transport 365 days a year. At least you have a job and you are healthy what other people don’t have. Sometimes you help people who can’t afford to see a doctor cross-prescribing. They save money and time they are happy but what about you? The salary you are getting insufficient, although salary is never enough-but for this case it is insufficient. It will take years of saving before you can actually save something to pay for your education to advance to the next level. Your salary only increases with inflation.
By the time you even start thinking of saving you are already approaching the third floor. Years move very fast like they always do. You start thinking of marriage. Marriage with its responsibilities you are left to choose between your profession and family. Some people try tu small biashara on the side, but what does that change? You are still a pharm tech. At this time you are needed fully everywhere while your profession enthusiasm starts declining. If you are working in the same organization for several years you begin leaving most of the work to junior staff, fresh from college. Or to some they start switching jobs with hopes of increasing their paycheque, they may also work several jobs to make ends meet. I mean people know you are a “pharmacist” which you are of course since you have equivalent many years of experience.
An ideal pharm techs life cycle is usually, college-internship-job-another job-pharmacy superintendent-open own pharmacy/start biz-Work for an NGO-retire (and work for God knows what). Opening a pharmacy most of the time follows with becoming broke probably due to fixed capital, poor business or theft from employees. The most mistake pharmaceutical practitioners do is employing someone to work for them while they work somewhere else. Pharmacy business like any other businesses needs close attention and dedication. But that is not usually the case, people open pharmacies just because they want to open, there is a lot to consider before opening any. It turns out that such pharmacies don’t make any much considerable income and most guys don’t quit their primary jobs because they are scared they might not make much out of the business to pay their bills. They stick around hoping for the business to pick up until it finally crumbles down on them.
I have always hoped folks going for pharmacy degree courses would stand out, they still fail. Pharmacy is not like the music industry where you can become super rich in your 20s unless you are inheriting a family business; it takes time with several challenges. It is sad that people put in so much only to be disappointed. Right now graduates as pharmacists don’t know exactly what to do because the people they consider as role models have failed both in the community pharmacy and hospital pharmacy. Most pharmacists end up getting employment in public hospitals, the pay is still less but far much better than a pharm tech. So graduates run most of these public hospitals but we still have poor service with no drugs, what does that mean? We understand what they go through because of public hospital dynamics and all that although there is a lot that needs to be done that is more than a paycheque. But going for a degree and coming back to such a mess doesn’t change anything about you being a pharm tech.
That is why most pharmacists don’t practice. With a few paychecks, they quit pursuing other things. That’s wasted brains, you might as well think. But they just want to distance themselves competing with people with less education. That’s why the pharmaceutical industry is somehow controlled by the pharm techs. In the real sense, they are being controlled. Most of the big faces behind the pharmaceutical industry even don’t have medical backgrounds. They are just successful business people using pharmaceutical practitioners to achieve their goals. They pay them less. And that is how to become a pharm tech and die like a pharm tech. Phew!
So today I am here thinking of writing about nothing. I am
tired of reading these prescriptions; they are not making sense anymore. I have
never been in this state of thought before. Today I am clueless af, let me put
that ink on paper, then type it later. I must be high on something, Ooh and
those prescriptions are goanna fill themselves.
Being in an empty thought of action is equivalent to being
in an unlimited longer duration of happiness. Moreover, it is unpaid for,
essentially it is having a lifetime free plan with no monthly or whatever
subscription. Lately everyone is willing to pay for anything that has a
prolonged duration of action, yes nice and slow release and of course
beneficial. To some up that all long paragraph in one sentence effectiveness is
key. What else do you need other than pleasure lasting longer?
The third paragraph is typically the climax, ooh yeah so I
could do this. I have done this and the feeling is amazing. As this is sinking
in, it is not about time I am dropping my pen, wait for another day to do what
again if I am not going to finish this now. Imagine doing this without being on
any prescription from a GP… what if I was on prescription huh! Alternatively,
probably on an OTC syrup maximum dose doubled in one take. Shit can be amazing
in any way you want it to be.
So once again, well I mean as we are cooling this down
without water or a non-alcoholic soft beverage, let us not forget we are just
passing time. Let nobody tell you that you need to calm down while you have no
idea why you are supposed to calm down. Being on a fast onset of action and short
duration of action should not worry anyone like we just did in less than 10
Proper internship is foundation to building an individual’s future career. The best place to get your pharmacy internship is either community pharmacy within the Nairobi CBD or a hospital setting. Kenyan campuses and institutions providing pharmacy training recommend a student goes through industry, community pharmacy and hospital pharmacy. Most big pharmacies stock almost all the drugs you need to be familiar with, moreover there is a wide range of clients ideal to your learning experience. Most of the time you will realize you have learned a lot in class but it is pretty difficult for you to apply the knowledge that you have gained in the course of your study in real life.
In a hospital setting you will gain experience from different departments. A good hospital has the main pharmacy with sub-pharmacies. With routine CMEs and ward rounds you will learn more.
You will actually find out dispensing is an art that needs to be natured slow by slow with time. The best ideal duration for internship should be at least three months if you are serious and yearning to learn. Most medical students will take internship as a routine experience that is required by their faculty only to be shocked in their first job that they have a lot to catch up.
Most employers prefer someone with real experience and without that, it will be obvious the moment you fill your first prescription because a multitude of avoidable errors will be seen. These errors could lead to accusations which probably may affect your working experience and esteem.
Here is a list with shorts notes to guide you as you continue with your internship. The notes will help much if you are working in a community pharmacy but can also apply elsewhere.
Tip: Master the basics, we begin with;
There is a lot you need to know when you are starting out your internship. First of all you don’t need to know everything, what you have learned in class also may be applied at a very low percentage. The number one thing you need to be familiar about is the pain killers available. Mostly in class you are taught about the generic names but for the practical case you will need to know both the brand name and the active ingredient. You should be able to differentiate over the counter analgesics and prescription only pain relievers, and why they are given on prescription only.
Most common painkillers are ibuprofen, paracetamol, aspirin, diclofenac. Because you will encounter them many times in the pharmacy see notes below on poisoning and overdosing.
Key features of salicylate poisoning are hyperventilation, tinnitus, deafness, vasodilation and sweating. Activated charcoal can be given within one hour of ingesting more than 125mg/kg of aspirin.
Over dosage with ibuprofen may cause nausea, vomiting, epigastric pain and tinnitus, but more serious toxicity is very uncommon. Activated charcoal followed by symptomatic measures are indicated if more than 400mg/kg has been ingested within the preceding hour.
Nausea and vomiting, the only features of poisoning, usually settle within 24 hours. Persistence beyond this time, often associated with the onset of right subcostal pain and tenderness, usually indicates development of hepatic necrosis.
Therefore despite lack of significant early symptoms, patients who have taken an overdose of paracetamol should be transferred to hospital urgently. Activated charcoal should be considered if paracetamol in excess of 150mg/kg or 12gms whichever is smaller, is thought to have been ingested within the previous hour. Acetyl cysteine protects the liver if infused within 24 hours of ingesting paracetamol. Effective if given within 8 hours of ingestion, after which effectiveness declines sharply. Methiomine by mouth is an alternative only if acetyl cysteine cannot be given promptly.
Know what creams sell more , most clients will walk in with a skin rash, swelling or just a simple skin condition and you should be in a position to recommend something safe and effective. Learn what the active ingredients are and what to substitute in case you get an open prescription and the brand you have in mind is not available. You might fail to fill a prescription saying the item is not available and yet you have it.
Patients will walk into the chemist with stomach conditions, this is a community pharmacy therefore you need to get the right diagnosis before you dispense something over the counter. You may need to refer the patient but is it necessary? Maybe it is just a heartburn or indigestion and you already know what to give
DRUGS MEANT FOR LONG TERM TREATMENT.
This category is a prescription only medicines and you need to be careful dispensing and most importantly be accurate as much as possible you will have no excuses for errors med. You will need to understand why antidepressants are kept under lock and key and know which ones are frequently abused to avoid fake prescriptions or filling expired prescriptions.
Most pharmacists will ask if the cough is dry or productive. As an intern you will be required to be familiar with the active ingredient of common cough syrups. This will help decide which cough syrup to give someone with a dry cough or chesty cough.
Note that most of the cough syrups are not recommended in pregnancy and children below the age of two years. Some cough syrups may affect blood glucose levels of someone diabetic so you have to be cautious with what you are giving.
It is not recommended to give an eye drop over the counter unless you are very sure what you are prescribing to the client is right. You will need to know the most commonly prescribed eye drops by physicians with their active ingredient.
Eye drops are generally instilled into the pocket formed by pulling down the lower eyelid and keeping the eye closed for as long as possible after application; one drop is all that is needed. A small amount of eye ointment is applied similarly.
When two different eye-drop preparations are used at the same time of day, dilution and overflow may occur when one immediately follows the other. The patient should therefore leave an interval of at least five minutes between the two.
You will notice amoxicillin is the most prescribed antibiotic molecule in Kenya. Most antibiotics will be prescriptions from prescribers, all you need to know is the side effects and whether they are to be taken before or after meals and why.
A basic pharmacy setting will always have griseofulvin as the SI unit, you will find itraconazole, fluconazole terbinafine etc basically know the indications for the same.
Clotrimazole is prescribed the most. Know the brands available and the correct way of using the pessaries. That awkward client might bust you before you confirm anything they are on you. So be ready and learn how to explain to the with a proper language.
Most pharmacies have closed business because of not managing well their stock. Stock loses can occur due to theft by staff, poor receiving, selling and not charging the client or through expired medicines. Being able to reduce some of these loses and common errors can help prevent stock loss and eventually helping a pharmacy grow especially a community pharmacy. Here are a few ways that can help prevent stock loss either in a pharmacy business or in any other business.
Do stock-take frequently
Most pharmacies do stock take once or twice a year but that seems to be inadequate. If that can be done daily, it would be better. Doing stock take every two weeks for a busy store saves stock loss big time. If you are unable to do it every two weeks, do it at least once a month.
Ensure you are selling drugs on FIFO basis that is first in first out. Don’t sell new stock leaving old stock to expire on the shelves. Make sure the arrangement is made in such a way that medication that will expire early is sold first. Don’t receive medication that is about to expire if you are not going to sell immediately.
Pay for an inventory system
A stock control and financial management system can help in checking the stock movement. You will be able to tell what you have used and what is remaining so that you are able to place an order without overstocking or missing an item out. The software assists also when paying your suppliers. There are so many software in the market the most popular one being Phamacore by Corebase.
Manage your shorts and excesses appropriately
In any pharmacy business, you are likely to encounter variances in a busy set up. It is either a loss or excess. How you handle your shorts* and excesses matters a lot to your business. Excess cash that is not possible to account for should be kept aside, this could be an item someone forgot to post and they cannot remember. The cash can later be used when posting items into your inventory that will be missing after a weekly or monthly random stock take.
Have a proper ordering and Receiving system
Receiving should be done in a specific area, every item counter checked with the delivery invoice. Unless an item is fast moving, do not receive medications with short expiries. Receiving can be done by the person who placed the order, or by counter checking with the purchase order. Writing down expiries on the invoice as you receive can help scrutinize each and every item ensuring no expired drugs are received and the right quantities are delivered.