Nairobi Pharmacy Internships, Be Ready!

Photo by David Travis on Unsplash
Photo by David Travis on Unsplash

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;

PAIN KILLERS

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.

Aspirin

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.

Ibuprofen

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.

Paracetamol

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.

CREAMS

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.

ANTACIDS

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.

COUGH SYRUPS

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.

EYE DROPS

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.

ANTIBIOTICS

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.

ANTIFUNGALS

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.

PESSARIES

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.

Here is (5) Five Easy Ways that Can Help Prevent Stock Loss in the Pharmacy

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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.

Avoid expiries

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.

10 Things That Happened in 2018 we are Soon Forgetting About


Photo by Julie Tupas on Unsplash

Finally am posting something in 2019! I wanted to post this a.s.a.p. so that I concentrate on other things as we kick off the year but unfortunately that did not happen. There is a lot I missed to write about that I think I should have at least written something about. I came up with this list as a reminder on some of the things that I missed and which certainly might shape up 2019.  It is not a regular post but I am excited it is somehow going to act like a reference point to some of the things that might come up in 2019 and the future. At some point I wanted to add links, but then I all of a sudden changed my mind.

Codeine based cough syrups moved from OTC to Rx raising the street value of benylin with codeine; addicts were left with no supplies as the PPB continues to tighten its belt.

The PPB improves its website to see pharmaceutical practitioners access most of their manual paper work through a fast developed portal.

GPL opens more pharmacies expanding its chain pharmacy to a dozen more stores in Nairobi and upcountry, also becomes the first pharmacy in Kenya to pull a TV ad.

2018 came to an end with a stimulating debate when it emerged that researchers in China had created the world’s first CRISPR gene edited babies.

What’s the benefit of the internet with frequent cyber bullying? In May 2018 the government of Kenya signed into law the Computer and Cyber Crime Act into law.

Mental health becomes a serious topic of discussion on social media.

KNH amazes everyone after a baby is stolen from the hospital only a day later to be found in Kawagware after news of the loss went viral.

Nairobi governor Mike sonko gives Pumwani hospital an impromptu visit then finds 12 dead babies hidden at hospital, this gave everyone divided views about the quality of treatment in the hospital.

Marie stops Kenya controversial ad leaves Kenyans with no words to say. The ad was about “helping” a pregnant young woman take care of an unplanned pregnancy. No one knew what exactly they meant by helping but at the end of the day the Kenya films and classification board so it pulled down.

Medics east Africa changed their tradition location from Oshwal Centre to KICC due to unavoidable circumstances which turned out to be a more convenient location for visitors although the number of exhibitors has since reduced compared to previous medical shows.

How To Bargain In The Pharmacy

“You are very expensive, by the way you are too expensive” regardless of the pharmacy most customers will always say the prices are high. So many customers if not all think that by saying another pharmacy is selling the same medicines at a cheaper price is the most effective way of forcing a pharmacy to lowering their price. Surprisingly they always manage to convince the person selling the medicines, but let us agree to one thing Kenyans can really bargain! Funny thing, a person will argue the price of a certain item is very high while they have never purchased it before, to the extent of claiming, a given pharmacy had quoted a lower figure and as matter of fact that pharmacy doesn’t even have the item they are taking about. No business is immune to this either, this happens everywhere.

I have come to think of it; that most people prefer paying more to something that gives them more pleasure irrespective of whether they are being overcharged or no. So much energy is used to bargain to the last shilling, energy that could have been useful elsewhere. Sometimes it is even hard to tell whether the price you are being charged is the actual price or price after discount. Most business people raise prices to some random figure so that they have bargaining allowance to the actual price that they are supposed to charge.

Knowing when to bargain and when not to bargain is an art most clients have never felt the interest to nature. Don’t bargain just because you want to bargain, some customers bargain too much to the extent that they irritate the person selling medication for no apparent reason. Imagine serving five customers and all of them don’t agree with you on price, so instead of concentrating on how the medicine works and the vital information that is meant to be passed to the patient most of the time is consumed on bargaining. It is disturbing that a customer can bargain for like 30 minutes just because they want to save 20 shillings. Worse of it all they act shocked when they are told they are supposed to avoid alcohol for a few days. You don’t want to pay for medicine that is less than what you spend on alcohol but still insist you can’t do without alcohol, so you can afford alcohol but can’t afford medicines to treat yourself.

But bargaining is good, you save get to save money that you could have lost if you kept quiet. Especially when a prescription is going for three or more months so much is saved at the end of it all. Comparing prices in one or two pharmacies can help make a wise decision. Asking your pharmacy nicely if the prices could be lower or whether they have discounts is a decent way of making a prescription cheaper. Most guys go with their “full chests” demanding for discounts end up spending even more because of being arrogant.

Cap 244 To Give More Room For Pharmaceutical Imports


Photo by Thomas Kinto on Unsplash

There is always the perception that when you have your own pharmaceutical company which is importing products into the country then you might just be making more than 100% profits. This is true. Cap 244 well known as the pharmacy and poisons act is being reviewed for some considerations and that is either going to be good news or bad news once the health bill reaches parliament. The constitution may give equal rights both for the diploma holder and degree holder to import and do wholesale distribution of poisons. This is where the mess begins at. Some pharmaceutical practitioners have a feeling this is going to be a key to numerous unlimited possibilities.

The pharmaceutical business is doing well; there is so much hope for more success in the coming years. Experts and experienced professions on the other hand are worried a tweak on cap 244 could bring down the healthcare system in no time. There is less or no research going on and the number of professional healthcare think tanks keeps going down as new graduates come in to the industry. This could derail one of President Uhuru Kenyatta’s strategic objectives, that is, Universal Health Coverage. As a pillar for the Big Four Agenda the main aim is to develop the country’s healthcare system and provide all Kenyans with access to quality and affordable healthcare. This could be achieved by allowing more people to import but unfortunately the benefits could outweigh the risks.

The health CS thinks this may disorient the Pharmacy and Poisons Board main goal which is, “to make better provision for the control of the profession of pharmacy and the trade in drugs and poisons”

“If we already have challenges with the few that are importing what about giving more room…” The Cabinet Secretary (CS) for Health, Sicily Kariuki views on the healthcare bill.

There is mixed feelings out there among pharmaceutical practitioners on this topic, anyway a few issues for a fact are going to come up; There is going to be no research with great business. Uncontrolled reckless importing of drugs could lead to more generics & some substandard drugs. Trust issues between the consumer and pharmaceutical practitioner might even become worse. We will have a controlled drug crisis. Patients might get access to cheaper medicines whereby the quality can’t be guaranteed.

May any changes being made be to the best interest of the public, the future is in our hands, decisions made now are the ones that determine our future.

 

123 About Diabetes

 

A projected 300 million people around the world suffer from diabetes. Moreover, the number is set to rise dramatically. Prevention therefore stopping people from getting diabetes in the first place remains the best form of treatment. November being a diabetes awareness month it is advantageous to have your blood glucose reading checked.  This is a simple test, which can be easily done at your closest healthcare provider, pharmacy, laboratory or clinic. Checking the readings regularly for diabetic patients can make a big difference on how they manage the condition.

Diabetes is a long-term disorder characterized by a raised level of glucose {or sugar} in the blood. Permanently elevated blood sugar levels are the key indicator for this metabolic disorder. There are two main types of diabetes mellitus: diabetes mellitus type 1, which mostly affects younger adults, it is when the body cannot make insulin as most insulin-producing cells have been destroyed. The other type is type 2, which is often brought on by a poor diet and lack of exercise. For this case, the body cannot make enough insulin or the insulin produced cannot be used properly, usually occurs later in life but is becoming common in younger population.

Diabetes is a disease with severe complications; this can limit how people function physically. Elevated glucose levels cause long-term damage of kidneys, blood vessels, heart and nerves. Serious complications of diabetes mellitus include renal damage, heart attack, loss of sight, diabetic foot syndrome and even organ failure. In a worst case-scenario, diabetic foot leads to amputation.

I am glad a good number of diabetes patients in Kenya are not ignorant about their condition; most of them are compliant to medication and are cautious about their diet. Mostly diet is crucial in controlling blood glucose levels in combination with medication prescribed by a physician. On the other hand, it is alarming to hear about a group of people that is living in denial. It is always hard for them to understand that diabetes is a long-term condition and most of the time treatment is usually long term. These patients do not take their medications regularly leading to complications and uncontrolled blood glucose.

Just to note Kenyans do not have specific treatment guidelines for diabetes mellitus. This means most of the prescriptions prescribed are typically customized according to the patient’s response to treatment.  The prescriber adopts what works well for the patient; the prescription there after is tailored from time to time.

Happy diabetes month!