GENERAL INSTRUCTIONS FOR PREPARATION OF MEDICATION FOR PHARMACY NOTE: Please be aware that all information contained in this pharmacy manual is subject to change based on availability, cost, laws of Honduras, and policy changes of the Honduras Baptist Dental Mission, Inc.
1. Order as many drugs as possible from the following: MAP International International Medical Resources P.O. Box 215000 Brunswick, GA 31521-500 Tel: 912-265-6101 Web Site: www.map.org email: email@example.com IDA Foundation Web Site:email: or
2. We recommend that you request pharmacies to save liquid bottles to use to dispense
3. Involve local church members in packing meds. Those who can’t go will often be
more than happy to assist the team in this way.
4. Because of the time involved, most teams prefer to buy generic drugs at cost
through their team pharmacist rather than combine samples. Cost of drugs is not
included in amount charged each team member. This must be raised separately by the
team through area churches and Christians.
5. All medication MUST have an expiration date of AT LEAST ONE YEAR from the time
they go through customs. Medications must have at least 12 months left on them when
they go through customs. Example: If you were shipping meds right now (Nov 2013) and they were passing through customs today, the date would need to be December 2014. If the date on the medication is Nov. 2014, in America it would still have 12 months on it. In Honduras it would be one month short of the 12 months. It would need to be Dec. 2014. This is a Honduran Law. Drugs expire the first day of the month listed on them. US law - the meds expire the last day of the month listed on them. The only law important here is Honduras Law. Another example: If your team has stored meds over from last year, you can still use them as long as the date is good on them. A team coming in Jan. 2014 would only use medicines with a date of Feb. 2015 or later. Anything older would need to be thrown away. NO EXCEPTIONS!!!
This is true whether sent ahead by the team, or brought upon arrival by individuals in their personal bags for private dispensing. Any out of date medication does not just put a patient at risk, it puts the Entire Mission at risk with the government officials in Honduras. They are very strict on this policy. Any meds not meeting these requirements cannot be used and will be disposed of by the Mission. 6. Because of the difficulty in importing controlled medication into Honduras, we strongly recommend that you avoid the use of controlled medication whenever possible as there is never any assurance that the controlled medication will be granted a permit. Should you carry controlled medication, it must be listed on a separate inventory sheet from drugs not controlled. Please note that dental anesthetic is controlled and should be listed on inventory of controlled drugs. 7. The following items are considered controlled drugs in Honduras: Lomotil, Donnatal,cTedral, Propoxphene Comp., APAP #3, Phenabarbital, and need permits. (Put on control list.) 8. Peel-off labels must be prepared in the U.S. For liquid Medicines purchased in Honduras. 9. All other medications should be prepackaged and prelabeled before leaving the U.S. IN ADDITION TO INSTRUCTIONS FOR USE, each label must also contain the pharmacological content of the medication, including the milligrams, expiration date (DO NOT SHOW TEAM DATE ANYWHERE ON LABEL. USE EXPIRATION DATE ONLY), and Manufacturer. In this way, medication that is left by the team can be used safely. 10. Prepare two inventory sheets (one for non-controlled medication and one for controlled medication) of all medication shipped per the sample located in your team folder. BE SURE TO INCLUDE DENTAL ANESTHETIC ON THE CONTROLLED MEDICATION INVENTORY SHEET. Though the Team Pharmacist prepared the inventory, the Team Captain is responsible for getting this inventory to the Honduras Field Director at and copysix weeks before departure date so that permits can be processed. SAMPLE LABEL: TOME DOS TABLETAS CUATRO
VECES AL DIA PARA FIEBRE O DOLOR. ACETAMINOPHEN 325 MG Mutual Pharm Co. Exp. 5/92 Lot #
MEDICATION LIST DRUGS PURCHASED IN U.S. 1. Quantities of injectable antibiotics will depend on physicians preference for use of this medication. 2. Take IM anti-nausea medication if desired. 3. Children’s vitamins with fluoride are available if desired. These items can be purchased in bulk form in lots of 20,000 from the Michigan Pharmaceutical Corp., P.O. Box 730, Murray, KY 42071 (Phone: 1-800-626-3928). 4. You may wish to purchase Vitamin K for emergency use to control bleeding of some dental patients. 5. The medication list should be sufficient to treat approximately 2,000 to 2,500 patients. There is a specific need for Visine generic eye drops if samples are available. 6. The number of topical creams you carry depends on the amount of money available for medication. These cost approximately $1 per tube and almost all patients need them. 7. Consider buying Penn VK Suspension, 250 mg-200ml bottles and dilute to 400 ml. This provides 4 bottles 125 mg/ml- 100ml (cost of approximately $.35). Same is true for Amoxicillin. 8. Tetracycline is usual y effective against UTI’s. Bactrim or some other Sulfa drug can be substituted if desired. 9. Chlorpheneramine may be deleted and more Diphenhydramine added if so desired. Chlorpheneramine is less expensive. 10. Theophyllin is a better product for asthma than Tedral, and even though it costs more, we strongly suggest that you purchase it. 11. To avoid conflicts, we recommend that oral contraceptives be given to regulate
menstrual cycle only. 12. Cost of medication will average approximately $2.00 per patient. This list is in addition to drugs bought in Honduras. 13. There is an excellent booklet which you may wish to make available to your medical personnel. It is entitled “Guide to Antimicrobial Therapy” and can be purchased for $4.75 per copy from Antimicrobial Therapy, Inc., Jay P. Sanford, M.D., P.O. Box 34456, West Bethesda, MD 20817-0456, Phone: 301-299- 8229. This booklet deals with antibiotic dosage and side effects, medication recommended for specific infections, drug interactions, generic and trade names, and many other areas pertinent to antibiotic therapy. 14. Note: We recommend that you buy the Quick Spigot, Item #32157HL (Quick Serve Polypropylene Spigot w/38 mm screw closure) $2.20 each from Consolidated Plastics Company, Inc., 1864 Enterprise Pkwy., Twinsburg, Ohio 44087, Phone: 1-800-321-1980. You will need one for each type of liquid medication used. This makes it possible to dispense liquid meds quickly and neatly. 15. Be sure to take plenty of ballpoint pens for use by people in the pharmacy. 16. When preparing labels, be specific with directions and include the indication (pain, stomach, etc.). 17. We recommend use of CA CO2 (Tums) tablets instead of antacid liquid. Antacid liquid cost $1.00 per 8 oz. Bottle. 18. Use of Lomotil tablets lessens need of Kaopectate. 19. Consider labeling APAP tablets - “1⁄2 tab. QID” for use for small children. 20. APAP liquid cost approximately $20.00/gallon including freight. This supplies 64 - 2 oz. bottles. Consider this instead of APAP drops. 21. You may wish to purchase 4 oz. Ovals to dispense liquid medication. 22. Give pregnant ladies enough vitamins to complete term and 2 or 3 months additional. Also give Folic Acid and Iron to complete term. 23. Teams going to Honduras normally treat 2,500-3,000 patients. The drug list provided should be adequate for Honduras. 24. The cost to purchase this list entirely through a drug wholesaler will be $6,000-$7,000, depending on the number of creams and eye drops, etc. that
you purchase. Also the choice of antibiotics and APAP drops can raise or lower the cost. The cost of the suggested medication in Honduras is $1,000. 25. IF YOU WANT MORE INFORMATION OR ADVICE, email headquarters at
LIQUID MEDICINES PURCHASED IN HONDURAS This is the standard list of liquid medication that will be available for each team on the field. If you want to change this, please notify the office. Description Suggested Amount Price Per Unit Piperazine 2 Gallons $12.00/Gal Vitamins 5 Gallons $10.00/Gal Cough Syrup 9 Gallons $10.00/Gal Histamine 3 Gallons $10.00/Gal Kwell Shampoo 6 Gallons $20.00/Gal Kwell Lotion 2 Gallons $20.00/Gal Antacid $1.00/120-ml Kaopectates 3 Gallons $10.00/Gal Acetaminophen 1 Gallon $12.00/Gal Albendazol 4,000 Tablets $70.00/1,000-Tab These are current prices. Prices are subject to change. When you send your medical inventory in you also need to send a list of medications you want purchased in Honduras. All of these meds are not always available, especially KWELL lotion and shampoo, so we need good lead time to order them. Your liquid med order will become your liquid med purchase. The first day on the field be sure pharmacist inventories liquid medications and makes an accurate count. When team is finished working, take another inventory. Both inventories should be signed by the pharmacist or person responsible for the inventory and by Field Coordinator or a person that he may designate. SUGGESTED MEDICATION ORDER FOR MEDICAL TEAMS
ANALGESICS 50,000 ASPIRIN 325 mg tabs 30/pack 30,000 APAP 325 mg tabs 30/pack 20,000 IBUPROFEN 600 mg tabs 30/pack 1,000 APAP No. 3 tabs 10/pack 180 APAP ORAL DROPS 15ml each VITAMINS 75,000 ADULT MULTI WITH IRON 60/pack 30,000 CHILDREN MULTIPLE VIT. 60/pack 15,000 FOLIC ACID 1 mg tabs 100/pack 15,000 FERROUS SULFATE 5 gr. Tabs 100/pack ANTIBIOTICS 15,000 PEN VK 250 mg tabs 30/pack 15,000 AMOXICILLIN 250 mg 30/pack 2,000 CEPHALEXIN 250 mg Caps 30/pack 3,000 BACTRIM DS GENERIC 20/pack 10,000 TETRACYCLINE 250 mg caps 30/pack 2,000 ERYTHROMYCIN 250 mg tabs30/pack 2,000 METRONIDAZOLE 250 mg tabs 21/pack 96 PEN VK 250 mg/5ml 200 ml Mix/Divide/2 Patients 48 CEPHALEXIN 250 mg/5ml 100 ml each 120 AMOXICILLIN 250 mg/5ml 150 ml each 10 BACTRIM SUSP 480 ml each ANTIHISTAMINE 4,000 DIPHENHYDRAMINE 25 mg caps 20/pack 6,000 ACTIFED GEN tabs 20/pack 2,000 CHLORPHENIRAMINE 4 mg tabs 20/pack 3,000 HYDROXYZINE 25 mg tabs 20/pack TOPICALS 300 TOLNAFTATE CR 15 mg. each 300 TRIPLE ANTIBIOTIC CR 15 gm each
100 MYCOGEN 11 15 gm cream each 300 HYDROCORTISONE 1% cr 30 gm each VAGINALS 96 TRIPLE SULFA VAG CR each EYE-EAR 96 SULFACETAMIDE 10% OPTH SOL each 120 TRIPLE ANTIBIOTIC OPTH OINT each 360 VISINE OPTH DROPS GEN each 120 CORTISPORIN OTIC SUSP GEN each 96 AURALGAN OTIC GEN each MISC. MEDS 2,000 THEOPHYLLINE 200 mg tabs 30/pack 300 NITROGLYCERIN 0.4 mg SL tabs 6,000 CLONIDINE 0.2 mg tabs 100/pack 6,000 HCTZ 25 mg tabs 100/pack 1,000 DIGOXIN 0.25 mg tabs 100/pack 1,000 CHLORPROPAMIDE 250 mg. Tabs 100/pack 4,000 DIMENHYDRINATE 50 mg tabs 20/pack 2,000 MECLIZINE 25 mg tabs 20/pack 12,000 CALCIUM CARBONATE ANTACID 30/pack 1,000 PREDNISONE 5 mg tabs 30/pack 200 VITAMIN K 5 mg tabs (MEPHYTON) 2-10ML VITAMIN K INJ. FOR DENTAL CLINIC 2,000 DILANTIN 100 mg caps 100/pack 2,000 CARBAMAZEPINE 200 mg tabs 100/pack 2,000 DULCOLAX tabs Gen 50/pack 300 PREMARIN 1.25 mg tabs 100/pack 50 doses CEPHALOSPORIN INJ ANTIBIOTIC each 2-10 ML DIMENHYDRINATE 50mg/ml INJ each 2-12’s PROMETHAZINE 50 mg supp 2-12’s PROMETHAZINE 12.5 mg supp
2,000 D.O.S. 100 mg caps 50/pack 2,000 DICYCLOMINE 10 mg caps 50/pack CONTROLLED DRUGS (HONDURAS) 4,000 PHENOBARBITAL 30 mg tabs 100/pack 4,000 LOGEN tabs 20/pack 5,000 ANTISPASMODIC tabs 30/pack SUPPLIES 2,000 120 ml OVAL BOTTLES FOR LIQUIDS 10 16 oz. ALCOHOL 70% 1 Gal. BETADINE GENERIC 2 BATHROOM SCALES 3,000 TONGUE DEPRESSORS 24 16 oz. HYDROGEN PEROXIDE 15,000 3 X 4 ZIPLOCK BAGS (For Pre-packing) BABY FORMULA POWDER – ANY AMOUNT 500 ASST BAND AIDS 500 6” COTTON TIPPED APPLICATORS 200 GUAZE PADS 2X2 200 GUAZE PADS 4X4 24 GUAZE ROLLS 2” 24 COBAN WRAP (VARIOUS WIDTHS) 300 ALCOHOL PREP PADS 36 ADHESIVE TAPE 1” 24 CLOTH TAPE 1” 18 ELASTIC BANDAGES ASST 2”, 3”, 4” 2,000 COTTON BALLS 24 D 5 W WITH SET UP (TUBING AND NEEDLES) 12 RINGERS WITH SET UP FOR EACH 1 BOTTLE GLUCOSE TEST STRIPS VISUAL USE 300 SYRINGES 23G X 1” 12 ORAL THERMOMETERS 12 RECTAL THERMOMETERS
24 PANS (BASINS) FOR PREPS, WASHING HANDS, ETC. 36 DRESSINGS 6 or 8 PLY ABSORBANT 600 SURGICAL GLOVES ASST. MED, LARG, X-LARGE 36 SURGICAL SCRUB BRUSHES TOWELS, LINENS, DRAPES 30 STERILE WATER FOR INJECTION 20 or 30ml size 6 1000 ml STERILE WATER FOR IRRIGATION 6 EAR SYRINGES 2 NASAL RESPIRATORS REHYDRATION SALTS OR ORAL ELECTROLYTES 1 BOTTLE TRACER II BLOOD GLUCOSE TEST STRIPS 100 SYRINGES – 3 CC WITH ASSOCIATED NEEDLES URINE GLUCOSE TEST STRIPS DIRECTIONS FOR PREPARATION OF LABELS FOR MEDICATION (QUANTITIES SHOWN ARE ESTIMATES FOR MINIMUM NEEDED PER TEAM) 1. PIPERAZINE (Anti-parasitic).Prepare 250 labels with the following directions: TOME _____ CUCHARADITAS UNA VEZ AL DIA DURANTE DOS DIAS PARA PARASITOS. (Take _____ teaspoons once a day for two days for parasites.) 2. KAOPECTATE.Prepare 750 labels with the following directions: TOME _____ CUCHARADITAS CUATRO VECES AL DIA PARA DIARREA. (Take _____ teaspoons four times per day for diarrhea.) 3. LIQUID VITAMINS.Prepare 800 labels with the following directions: TOME _____ CUCHARADITAS UNA VEZ AL DIA. (VITAMINAS). Take _____ teaspoons once a day. (Vitamins) 4. ANTIHISTAMINES.Prepare 400 labels with the following directions: TOME _____ CUCHARADITAS _____ VECES AL DIA PARA ALERGIA. Take _____ teaspoons _____ times per day for alergy. 5. ANTIBIOTIC LIQUID.Prepare 300 labels with the following directions: TOME _____ CUCHARADITAS _____ VECES AL DIA PARA INFECCION
(ANTIBIOTICA). Take _____ teaspoons _____ times per day for infection (antibiotic). 6. EYE DROPS.Prepare 500 labels for eye drops with the following directions: APLIQUE AL OJO _____ GOTAS TRES VECES AL DIA PARA DOLOR O INFECCION. Apply to the eye _____ drops three times per day for pain or infection. (Apply labels to the bottles before leaving the U.S.) 7. EAR DROPS.Prepare 200 labels for ear drops with the following directions: APLIQUE AL OIDO _____ GOTAS TRES VECES AL DIA PARA DOLOR O INFECCION. Apply to the ear _____ drops three times per day for pain or infection. (Apply labels to bottles before leaving the U.S.) 8. OINTMENTS: 1. Prepare 200 labels with the following directions: APLIQUE TRES VECES AL DIA PARA HONGOS. Apply three times per day for fungus.(Apply labels to ointment before leaving the U.S.) 2. Prepare 200 labels with the following directions: APLIQUE TRES VECES AL DIA PARA INFECCION. Apply three times per day for infection. (Apply labels to ointment before leaving the U.S.) 3. Prepare 200 labels with the following directions: APLIQUE TRES VECES AL DIA PARA PICAZON. Apply three times per day for itching. (Apply labels to ointment before leaving the U.S.) 9. KWELL LOTION: (Treatment for Scabies).Prepare 400 labels with the following directions: OJO! PELIGRO! NO LO METE EN LA BOCA! APLIQUESE EN LA NOCHE, FROTANDO SUAVEMENTE SOBRE LAS ZONAS AFECTADAS Y DEJESE SECAR. A LA MANANA SIGUIENTE, LAVESE BIEN CON AGUA Y JABON. Notice! Danger! Keep away from mouth. Apply at night, rubbing gently to affected areas and allow to dry. The following A.M., wash thoroughly with soap and water. 10. KWELL SHAMPOO: (Treatment for lice).Prepare 400 labels with the following directions: PELIGRO! NO TOME! ES CHAMPU PARA PIOJOS! PONER CHAMPU EN EL PELO SECO DEJARLO EN EL PELO POR CINCO MINUTOS. LAVA EL PELO DESPUES DE CINCO MINUTOS. (LINDANE CHAMPU)
Danger! Do not take! This is shampoo for lice. Apply to dry hair and leave on for 5 minutes. Lather and wash off after 5 minutes. MISCELLANEOUS LABELS 1. If children’s chewable vitamins are used, print only 350 liquid vitamin labels for small babies. 2. Print 250 labels for APAP drops.TOME _____ GOTAS POR LA BOCA CUATRO VECES AL DIA PARA DOLOR O CALENTURA. (Take _____ drops by mouth four times per day for pain or fever.) 3. Print 1,000 labels as follows: TOME _____ TABLETAS _____ VECES AL DIA. Take _____ tablets _____ times per day. 4. Print 500 labels as follows: TOME _____ CUCHARADITAS _____ VECES AL DIA. Take _____ teaspoons _____ times per day. 5. Print 500 labels for chewable vitamins with the following directions: MASTIQUE UNA TBLETA AL DIA – VITAMINAS (Chew one tablet a day – Vitamins) 6. Print 100 labels for vaginal tablets with the following directions: INSERTE UNA TABLETA ADENTRO LA VAGINA CADA NOCHE PARA INFECCION (insert on tablet inside the vagina each night for infection). 7. Print ___ labels for Asthma – INHALE__VECES POR LA BOCA ___VECES AL DIA PARA ASMA (Inhale ___ times by mouth ___ times a day for asthma. 8. Print ___ labels for Antibiotic Capsules – TOME ___ CAPSULAS ___ VECES AL DIA PARA INFECCION. ANTIBIOTICA (Take ___ capsules ___ times a day for infection. Antibiotic. 9. Print ___ labels for pain medications – TOME ___ TABLETAS ___VECES AL DIA PARA DOLOR O CALENTURA. (Take ___ tablets ___ times a day for pain or fever). 10. Print ___ labels for antihistamine tabs – TOME ___ TABLETAS ___VECES AL DIA PARA ALERGIA O GRIPE. (Take ___ tablets ___ times a day for allergy or cold). 11. Print ___ labels for immodium tabs – TOME ___ TABLETAS ___VECES AL DIA PARA DIARREA. (Take ___ tablets ___ times a day for diarhea). 12. Print ___ labels for Antiacids – TOME ___ TABLETAS ___VECES AL DIA PARA ACIDO ESTOMAGO. (Take ___ tablets ___ times a day for STOMACH ACID).
13. For any other labels needed that is not listed above, or if you have questions about the label, contact the Field Director in Honduras for instructions. NOTE: It is very important that these labels be prepared in the U.S. The directions may be copied onto peel-off, self-stick labels. We cannot over-emphasize the importance of prepackaging and prelabeling everything possible. Every package that you prepare in the U.S. Will save time in Honduras and will enable you to see more patients.
NOTE: TEAMS NEED TO FURNISH THEIR OWN CARDS. CARDS NEED TO BE STRUCTURED TO REFLECT THE INDIVIDUAL TEAM’S MEDICAL INVENTORY. GENERAL INSTRUCTIONS FOR PHARMACY WHILE ON FIELD (PHARMACIST SHOULD TAKE THESE INSTRUCTIONS WITH HIM)
1. A betadine solution should be prepared for use by the team members when washing hands. 2. Patients are registered by Honduran team members who fill in registration cards with pertinent information. Each patient is assigned a number at this time. This number appears in the right-hand corner of the registration card. 3. Give albendazole tablets to Medical to dispense. 4. Give dentists all medication needed by them for their patients, such as pain medication and antibiotics. This should be pre-packaged and pre-labeled if at all possible. In this way, it is not necessary for the dental patients to go through the pharmacy for medication. 5. Give vaginal creams, skin ointments, ear drops, eye drops, etc., to physicians to dispense when patient is seen. 6. Cover area with paper towel where gallon containers of liquid are poured. 7. Eight people working in pharmacy allows for the most ideal setup.
One to stand at door to ask for cards and bottles. ● One to fill prescriptions for vitamins for children and adults. ● One handles aspirin and Tylenol for adults and children. ● One dispenses Penicillin and other antibiotics. ● One handles antihistamine tablets. ● One fills prescriptions for all other tablets and capsules. ● One fills prescriptions for all other liquids. ● One gives the medication to the patient and explains each medication and dosage ● thoroughly. This person must speak Spanish. 8. The person collecting the cards and bottles should get all cards for each family together and send down to be filled as a family. 9. The bottles and cards should be sent down the assembly line in small, sturdy boxes or plastic basins, one family’s cards per box or basin. This small detail is very important, as it eliminates confusion and separation of cards from bottles. 10. The person taking up cards and bottles should check numbers frequently to be sure that patients are being seen in numerical order. 11. As medication is fil ed, it should be checked off on registration card. 12. The name of the patient must be written on the label of every prescription that is dispensed. 13. Dosage for Albendazole: The dosage for adults and children over 2 yrs. of age
would be 400mg. Mothers that are nursing children more than 1 year of age can be treated with Albendazole. Note: Some teams are now using Mebendazole twice daily for three days. This is a more effective treatment. 14. Piperazine liquid can no longer be given to children under 1 year of age. The dose for children more than 1 year of age is 1ml/Kg as one dose. You would dispense 10 ml. Prepare a graduate for measuring this prior to your trip. 15. Keep all cards so that accurate count can be given of number of patients seen and prescriptions filled. It is best to do this at the end of each day. Continue to save cards and return to the Fieldside Coordinator. A REPORT OF THIS DATA IS REQUIRED BY THE GOVERNMENT. The Fieldside Coordinator will file a report based on the data that you furnish. END
AARC Clinical Practice Guideline Spirometry, 1996 Update Reprinted from RESPIRATORY CARE (Respir Care 1996; 41(7):629-636) S 1.0 PROCEDURE: Spirometry (S): The first American Association for Respiratory Care (AARC) Spirometry Clinical Practice Guideline,(1) published in 1991, was based largely on the American Thoracic Society (ATS) 1987 recommendations.(2) Since that time, the ATS has
Available from http://www.jamesalison.co.uk/pdf/cas19.pdf Más allá de la teoría: desatando los nudos de la Redención Esta charla corresponde al capítulo 2 de On Being Liked y es el primer capítulo del tríptico de ensayos sobre la redención que se encuentra en aquel libro. Introducción De Alejandro Magno se dice que resolvió el problema del nudo gordiano con la espada1.