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.