By C. Roland. Purdue University North Central. 2019.

In view of the absence of an association with oral vitamin K in these data buy generic zoloft online, the authors conducted a subsequent analysis in which the reference group was defined to include infants who had not received vitamin K or who had received it orally discount zoloft online. Thus buy discount zoloft 25mg online, there was no clear difference in the association by type of childhood cancer purchase 50 mg zoloft with amex. When the analysis was confined to records in which the route was clearly stated, the odds ratio for all childhood cancer was 2. These results could not be accounted for by other factors associated with the administration of intramuscular vitamin K, such as type of delivery or admission to a special care unit. Data were collected on 319 variables for all controls and for 111 cases of cancer ascertained from the oncology register of the regional paediatric oncology unit; these data were not obtained for the remaining 84 cancer cases. Of these variables, the presence of rubella antibody, resusci- tation by intermittent positive pressure and paediatric estimate of gestation were statis- tically significant at the 1% level, which is what would be expected by chance. Adjust- ment for these and other variables reported to be associated with childhood cancer or known to be indicators for administering intramuscular vitamin K had little effect on the odds ratio for childhood cancer associated with vitamin K. Nineteen of the cases were diagnosed in the first year of life, and the possibility was considered that these cancers might have been present before the child was born and could therefore not have been initiated by an injection of vitamin K; however, the association persisted after exclusion of these 19 cases from the analysis. When the analysis was restricted to subjects who would have been followed for at least 10 years, by considering only those born in the period 1971–80, the relative risk for all childhood cancer associated with intramuscular vitamin K was 1. Medical records are not necessarily reliable sources of information about pregnancy and childbirth (Hewson & Bennett, 1987; Oakley et al. The relationship between the type of delivery and intramuscular administration of vitamin K differed markedly between the two maternity hospitals in Bristol in which the case and control subjects in the study had been born (Carstensen, 1992; Draper & Stiller, 1992). This raises the issue as to whether bias arose in control selection in that hospital. Neonates whose cancer was diagnosed or strongly suspected during the first day of life were excluded because vitamin K could not have been a factor in those cases. Vitamin K was administered in the delivery room or the nursery, and information about the administration was recorded with other events during and after delivery by observers who were not involved in the clinical care of the mother or the infant. Cancer was diagnosed in 48 of 54 795 liveborn children after the first day of life. For each case, five controls were selected and matched with the index case on length of follow-up. In spite of the prospective recording by the observers, the data on vitamin K administration were not recorded unambiguously for 43 infants; a review of hospital records without knowledge of case or control status resulted in data for 25 (58%) of these. Of a total of 218 children with leukaemia identified as eligible, information on vitamin K prophylaxis was obtained for 136 (62%). For each leukaemia case, one control was selected from the municipality where the patient lived at the time of diagnosis (local control), and a second one (state control) from a municipality selected at random in Lower Saxony by means of a population-weighted sampling scheme. If a control family refused to collaborate in the study or did not return the questionnaire within three months, another control family was invited; control families that returned the questionnaire after more than three months were also included. Information on vitamin K prophylaxis was obtained for 174 (57%) of the local controls and 160 (52%) of the state controls. No population-based controls were selected for these cases, but they were used as addi- tional cases in the study of vitamin K. Of a total of 246 potentially eligible cases of this type, information on vitamin K prophylaxis was obtained for 136 (55%). Data on vitamin K prophylaxis were abstracted from the birth report with no knowledge of the case or control status of each child. Information on the dose and route of vitamin K prophylaxis was obtained from the birth record or in the delivery book for 72% of the 272 cases of leukaemia and other cancers and 64% of the 334 controls. When this information was not available, the index child was assumed to have had the same expo- sure to vitamin K as the child nearest to the index infant in the delivery book with the same route of delivery and same perinatal morbidity (nine cases and six controls). When this could not be established, staff who worked in the delivery unit at the time when the index child was born were asked what kind of vitamin K prophylaxis the index infant would have received, given the birth weight and route of delivery (63 cases and 109 controls). Finally, similar information was sought from medical staff who did not work in the delivery unit at the time the index child was born (four cases and four controls). In the comparison with local controls (n = 107), the risk for leukaemia (n = 107) associated with intramuscular or subcutaneous administration of vitamin K relative to that for oral or no vitamin K prophylaxis was 1. In the comparison with state controls (n = 160; leukaemia cases = 136), the relative risk was 0. When the control groups were pooled (n = 334), the relative risk was close to unity (136 leukaemia cases), and the relative risk for brain tumours, nephroblastoma, neuroblastoma and rhabdomyosarcoma combined (n = 136) associated with vitamin K prophylaxis was 1. When the analyses were repeated for subjects for whom vitamin K prophylaxis had been documented in birth records or delivery books, the results were almost unchanged, except in the comparison of leukaemia cases with local controls, which gave a relative risk of 2. When the analyses were repeated for parenteral prophylaxis versus no prophylaxis, most of the relative risks were slightly decreased. The risk of the sub- group of cases of leukaemia in children aged 1–6 years was analysed as this was consid- ered to be a relatively homogeneous subgroup, most of the cases having common acute lymphoblastic leukaemia. There was no difference between cases and controls in the source of information on vitamin K prophylaxis. The increased relative risk in the comparison with local controls could not be explained by any of the potential confounders. It would be expected that the policy of administration of vitamin K would be more likely to be similar for cases and local controls than for cases and state controls. The non-significantly increased risk relative to local controls may be a chance result in subgroup analysis with multiple testing, as acknowledged by the authors. In a case–control study of childhood leukaemia based on births in three hospitals in England (Cambridge, Oxford and Reading), no association with intramuscular vitamin K, either as determined from hospital records (91 cases, 171 controls) or as imputed from hospital policy (132 cases, 264 controls), was found. In addition, no association was found specifically for acute lymphoblastic leukaemia (Ansell et al. Ninety-two per cent (132/143) of the cases of leukaemia were diagnosed at age 14 or less; these cases and their controls were included in the report of Ansell et al. There was no association between leukaemia and intramuscular vitamin K administration either recorded in the notes (relative risk, 1. The birth records of 701 of these children could not be traced, usually because the maternity unit had retained only its most recent records or because the unit had closed and the records could not be located. Thirty children who had been given vitamin K orally at birth and 16 cases in multiple births were excluded. The controls were selected by taking the fourth, eighth and 12th birth before and after the index birth from birth or admission registers for the hospital of birth of the index child. Towards the end of the study, the number of controls per case was reduced from six to three because of time constraints. When the birth notes for control children could not be located, or when the child selected was found to be on the Malignant Disease Register, the next possible control was selected. The fact of intramuscular administration of vitamin K or non-administration of vitamin K was recorded in the maternity unit records for 438 of 685 cases (case notes). The relative risk for acute lymphoblastic leukaemia associated with vitamin K administration based on case notes was 1. Two secondary analyses were conducted to consider cases typical of the peak incidence of leukaemia in early childhood. In an analysis of 94 children aged 1–6 years at diagnosis, the relative risk was 2. In all of these analyses, adjusted relative risks were calculated separately for the specified potential confounding factors—sex, gestation, birth weight, opiates during labour, assisted delivery, signs of asphyxia at birth, admission to special care or neonatal blood transfusions. Except for adjustment for assisted delivery, admission to special care or opiate exposure in labour, none of these changed any of the relative risks by more than 10%. Adjustment for assisted delivery or admission to special care caused a larger rise in the relative risk. As in many of the other studies, information on hospital policy was obtained in order to impute exposure when this was unclear from medical records. This information was obtained by a research midwife and neonatal staff in each unit in the region and by a paediatrician from current and recently retired medical staff, and this independently obtained information was then cross-validated. When inconsistencies were identified, the case notes were sampled to determine what policy had actually been followed. This enabled a further 226 cases to be included at the analysis; 21 cases were excluded because the policy of the local unit could not be ascertained. The relative risks were similar to but somewhat lower than those in the analysis based exclusively on subjects for whom data on vitamin K exposure was obtained only from medical records.

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With this loading dose formula buy zoloft online now, you are cheap zoloft 100mg on-line, in essence buy genuine zoloft on line, multiplying the desired maintenance dose by a factor (the accumulation factor) representing the sum of the "fraction of doses" that have accumulated at steady state discount zoloft 100mg. This factor describes how much the concentration will be increased at steady state. Begin with our general formula and rearrange it to solve for K0: The first numerator/denominator combination in the above equation is also found in the equation for the loading dose: Therefore, the right-hand term of this loading dose equation can be substituted into the general equation for K0 (Step 1 below) and then rearranged (Step 2 below) to then yield our other loading dose formula: Step 1. However, some prefer the loading dose equation that requires the maintenance dose to be calculated first because it is simple. Based on the estimated parameters, steady state should be attained in three to five half-lives (3 × 4. In this example, the trough level was taken just before the fourth dose was given, and the peak level was obtained just after the fourth dose was given. This procedure is normal and appropriate if the concentrations are at steady state. Figure 12-4 illustrates that, at steady state, Ctrough from a "trough and peak" is equal to the Ctrough from a "peak and trough" because all Ctrough and all Cpeak values are the same. We know that if we measured a Ctrough after the Cpeak, it would equal the Ctrough before the Cpeak. In this case, therefore, when a "peak and trough" is ordered, the literal interpretation would be: 1. In practice, this method is too cumbersome for pharmacy, nursing, and laboratory staff, so usually a "trough and peak" is drawn if steady state has been attained. It is recommended that Cpeak be measured either at the end of a 1-hour infusion, 30 minutes after the end of a 30-minute infusion, or 1 hour after an intramuscular injection. Infusing aminoglycosides over 1 hour allows simpler pharmacokinetic calculations in that the duration of infusion (t) is 1 hour and the infusion rate (K0) is simply the dose given. Lesson 4 explains that it takes three to five drug half-lives to reach steady state. If the drug is not at steady state, the predose Ctrough would be less than the post-dose Ctrough and would overestimate K. How can you determine when to order drug concentration samples so they are likely to be at steady state? Therefore, you must draw blood samples three to five drug half-lives after the first dose. Use judgment when choosing three, four, or five half-lives to calculate time to steady state. Plasma concentration sampling should be scheduled to follow the dose that achieves steady state. You could then schedule Cpeak and Ctrough determinations at the next dose after 24 hours has elapsed. Once patient-specific parameters are known, it is important not to continue to use population estimates to adjust dosages or dosage intervals. The formula for K below comes from a rearrangement of the general equation used to calculate the slope of the natural log of plasma drug concentration versus time line as described in Case 1. Remember that because concentration decreases with time, the slope (and hence -K) is a negative number. Again, remembering a rule of logarithms: ln a - ln b = ln (a/b) we can simplify this equation for hand-held calculators: Either form of this equation may be used to calculate K, as follows: -1 -1 Therefore, K = 0. You can still calculate his K value as follows (Figure 12-5): Note that this K value is the same as the one calculated with the measured Cpeak and Ctrough concentrations. In this case, some of the variables substituted in this equation are different from those used when initially estimating a dose. As when we estimated the first dose, we must first calculate the new dosing interval (τ) and then calculate the new dose. Because our real τ is shorter than previously estimated, Cpeak and Ctrough values less than those predicted also would be expected. In other words, we initially administered a dose every 12 hours when, in actuality, the patient needed a dose every 9 hours. This calculated dosing interval of 9 hours may be rounded down to 8 hours for ease in scheduling. This time, we shall replace the estimates of K and V with the calculated (actual) values and use the adjusted τ value of 8 hours: (See Equation 5-1. Strikeovers in the following equation show differences from initial estimated maintenance dose calculations (see Case 1): If 81. But because we rounded our dosing interval and adjusted the maintenance dose down to practical numbers, we must calculate the steady-state Ctrough that will result. However, his renal function has declined, as seen by an increase in serum creatinine from 1. A new adjusted K, τ, V, and maintenance dose (K0) were calculated using the methods described in Case 3. Therefore, the dose should be held for some time before you begin a new lower dose. This formula is an application of the general formula described in Case 1: -Kt C = C0e (See Equation 3-2. The Ctrough at this time, at steady state, would also be expected to be approximately 3. You can then count the hours needed to reach this 1-mg/L concentration and hold the dose accordingly. Therefore, we can estimate how many drug half-lives to wait for the concentration to approach our desired 1 mg/L as follows. Other pertinent patient data include: height, 5 feet, 4 inches; 3 weight, 52 kg; and serum creatinine, 0. The dose should depend on the immunologic status of the patient and the site of infection. The calculated dose may be infused over 30-60 minutes, and blood samples for Cpeak should be taken at some point after the end of the infusion. Recent evidence has indicated that higher doses of aminoglycosides (gentamicin - 7 mg/kg) may take up to 2 hours to distribute; therefore, sampling for plasma levels before 2 hours may provide erroneous estimations of Cmax. Intermediate and low doses (≤4-5 mg/kg) are thought to distribute completely in 1 hour, so sampling 1 hour after the 19 infusion is completed may be adequate. From population data, Cpeak would be expected to be 15- 20 mg/L and Ctrough less than 0. Steady-state plasma concentrations may be measured, and if the dose needs to be adjusted to achieve the target plasma concentration, individualized pharmacokinetic dosing as previously reviewed may be applied. However, a target peak concentration for extended-interval aminoglycosides has not been clearly established. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimum inhibitory concentration. Experience in monitoring gentamicin therapy during treatment of serious gram-negative sepsis. Postantibiotic effect of aminoglycosides on gram-negative bacteria evaluated by a new method. Single large daily dosing versus intermittent dosing of tobramycin in experimental pseudomonas pneumonia. Factors affecting duration of in vivo postantibiotic effect for aminoglycosides against gram-negative bacilli. A randomized comparison of the safety and efficacy of once daily gentamicin or thrice-daily gentamicin in combination with ticarcillin-clavulanate. A randomized, prospective study comparing once- daily gentamicin versus thrice-daily gentamicin in the treatment of puerperal infection. Does administration of an aminoglycoside in a single daily dose affect its efficacy and toxicity? For systemic infections, vancomycin is only given by the intravenous route; only this route is considered in this lesson. To minimize the occurrence of an adverse reaction called red-man syndrome, vancomycin doses >1000 mg should be diluted in a larger volume of fluid and infused over 2 hours. Vancomycin is the drug of first choice for serious methicillin- resistant staphylococci infections and enterococci (group D streptococcus). Because these organisms have begun to also become resistant to vancomycin, the Centers for Disease Control and 1 Prevention periodically releases recommendations for prudent use of vancomycin.

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Janice Mehler of the Report Review Committee oversaw a careful peer review of the manuscript buy zoloft 100mg lowest price. Many experts outside of the Academies helped the committee and staff with this project purchase 25mg zoloft with visa. Bryan Liang of the University of California best zoloft 50 mg, San Diego zoloft 25mg otc, was not able to serve on the committee but contributed to the frst meeting. Members of the committee and staff traveled to Brasília, Delhi, Ge- neva, Hyderabad, London, and São Paulo, during this project. The committee is grateful to the following participants who spoke at meetings and helped staff plan agendas: Martin Harvey Allchurch Laurie Garrett P. Gaugh Amir Attaran Debora Germano Martin Auton Raj Shankar Ghosh Sunil Bahl Ashif Gogo Roger Bate Antony Raj Gomes Ilisa Bernstein Subhash Gouda Katherine Bond L. Goyal Regina Brown Wendy Greenall Gian Luca Burci Jeffery Gren Claudio Henrique Cabral Catherine Hill-Herndon Nicholas Cappuccino Meghana Inamdar Ranjan Chakrabarti Mariaou Tala Jallow Ranjit Chaudhury Kees de Joncheere Lim Chin Chin Connie Jung John Clark Mohga Kamal-Yanni Charles Clift Harparkash Kaur David Cockburn Sabine Kopp Emer Cooke Alan Leather Ediná Alves Costa Jamie Love Alan Coukell Rohit Malpani Elize Massard da Fonseca Paola Manchisini Filipe Soares Quirino da Silva Linda Marks Ashok Dang Sylvia Meek Joelle Daviaud Mayira Milano Leandro Teixeira de Morais Bejon Misra Jenifer Devine Archna Mudgal Pritu Dhalaria Koduru Surendra Nath Albinus D’Sa Paul Newton Douglas Duarte Fernando Nogueira Paul Ellis Doroteia Koparanova Ollivier Frederico Benite Filho Arun Panda Michele Forzley Sharon Peacock Odile Frank Patrícia Oliveira Pereira Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs Copyright © National Academy of Sciences. Countering the Problem of Falsified and Substandard Drugs Summary The adulteration and fraudulent manufacture of medicines1 is an old problem, vastly aggravated by modern manufacturing and trade. In the last decade, impotent antimicrobial drugs have compromised the treat- ment of many deadly diseases in poor countries. More recently, negligent production at a Massachusetts compounding pharmacy sickened hundreds of Americans. While the national drugs regulatory authority (hereafter, the regulatory authority) is responsible for the safety of a country’s drug supply, no single country can entirely guarantee this today. Illegitimate2 drugs are an international problem, and there is wide consensus that action depends on international cooperation. Productive international discourse has been stymied, however, by dis- agreement about how to frame the problem. The once common use of the term counterfeit to describe any drug that is not what it claims to be is at the heart of the argument. In a narrow, legal sense, a counterfeit drug is one that infringes on a registered trademark. Some generic drug companies and civil society groups object to calling bad medicines counterfeit, seeing it as the deliberate confation of public health and in- tellectual property concerns. This report accepts the narrow meaning of counterfeit, and, because the nuances of trademark infringement must be 1 The terms medicine, drug, and pharmaceutical are used interchangeably in this report in accordance with the defnitions listed in the American Heritage Stedman’s Medical Dictionary. The trade in illegitimate drugs is, however, a problem of public health consequence and the topic of this report. In order to discuss this problem more precisely, the report distinguishes two main categories of poor-quality drugs. First, there are substandard drugs, those that do not meet the specif- cations given in the accepted pharmacopeia or in the manufacturer’s dossier. The other main category of illegitimate products is falsifed drugs, those that carry a false representation of identity or source or both. Many coun- tries also have problems with unregistered medicines, those not granted market authorization in a country. Unregistered drugs may be of good quality, though some research indicates they often are not. Unregistered medicines usually circulate outside the controlled distribution chain and are therefore suspect. The drug failures of public health concern can be divided into two main categories: falsifed and substandard. Falsifed drugs are usually also sub- standard; national specifcations referenced in the defnition of a substan- dard drug can vary. International endorsement of these two categories could advance public discourse on the topic. Recommendation 1-1: The World Health Assembly should adopt def- nitions consistent with the following principles. The spirit of these defnitions and the exclusion of the term counterfeit are central to this recommendation. By far the more common problem, however, is medicine that simply does 3 Some regulatory authorities may accept standards below those in international phar- macopeias. In such cases, a drug that would be generally regarded as substandard might be technically acceptable in a given country. The supporting text describes the committee’s understanding of a substandard drug. Poor-quality medicines cause treatment failure, but doctors do not generally suspect medicines as a cause of disease progression. Lifesaving medicines can be of poor quality, which may be an uncounted root cause of high mortality in low- and middle-income countries. Medications for chronic and infectious diseases alike have been found falsifed and sub- standard. A considerable body of research indicates that inexpensive anti- microbial drugs in low- and middle-income countries are frequently of poor quality. Such drugs not only put patients at risk but also encourage drug resistance, thereby threatening population health for future generations. Substandard antimicrobials often contain low and erratic drug doses, while falsifed ones can be diluted. In either case, exposing pathogens to subtherapeutic doses of medicines selectively allows the growth of resistant organisms. Drug-resistant staphylococcus infections are an emerging problem, especially in India, Latin America, and sub-Saharan Africa. An- timalarial resistance threatens to undo the good that artemisinin therapies have done, threatening global malarial control programs. Medicines are expensive; patients and governments waste money on ineffective ones. Lingering illnesses decrease productivity, causing work- ers to forgo pay and spend more on treatment. Through encouraging antimicrobial resistance, illegitimate medicines reduce the effective life of a drug. Society must bear the cost of drug development, an expense that increases as drugs become more complex. Substandard and falsifed medicines undermine confdence in the health system and in all public institutions. Their sale fnances other crimes, buys weapons and ammu- nition, and conveys power to corrupt offcials. Victims of falsifed and sub- standard drugs usually do not even know they are victims and are therefore deprived of their right to redress. In many ways, the trade in illegitimate pharmaceuticals further erodes the already weak political infrastructure that allows them to circulate, part of a vicious cycle of poverty and crime. Governments and industry monitor problems with drug qual- ity, but this information is not usually public. The Pharmaceutical Security Institute, a network of the security divisions of 25 major pharmaceutical companies, has data that indicate that the illegal trade and manufacture of medicines is a global problem. It affected at least 124 countries in 2011, and the burden is disproportionately felt in the developing world. Interpol, an international organization that facilitates police cooperation, has conducted 11 opera- tions against illicit medicines since 2008. Police working in Interpol raids have confscated tons of suspect products, leading to hundreds of investiga- tions and arrests. Much of the scientifc literature about drug quality is in case studies: reports from clinicians who uncover substandard or falsifed drugs in their routine work. This kind of report provides context on how and when dif- ferent kinds of drugs are compromised; it can also trigger epidemiological investigation.

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The former included materials of the current legislation and scientific publications by I order discount zoloft on-line. The analysis of publications shows that during elimination of a disaster purchase discount zoloft online, the following factors effect the functioning of pharmacies: the number of people affected; epidemiological purchase zoloft 50 mg without prescription, chemical buy 100mg zoloft amex, radiation situation in the emergency area; the location of the pharmacies in the region, the availability of means of communication and transport, work of the electricity network, water supply; resistance of pharmacies‘ buildings to disaster factors. In the process of the study, it was found that in emergency situations all the activities of pharmaceutical institutions of various forms of ownership should be subordinated by the organs of centralized control of pharmaceutical supply of the region and aimed at the full and uninterrupted pharmaceutical care. It is proved that the preparation of pharmaceutical institutions to work in emergencies provides beforehand production of medical equipment reserves in the pharmacy network and search for additional sources of replenishment of its 236 resources, and providing its efficient use; development of measures to ensure supplies of medical equipment to health care institutions timely; the development and implementation of measures to improve the sustainability of pharmaceutical institutions in emergency situations, including the protection of their staff and medical equipment stocks from the effects of damaging factors of emergencies; ensuring the rational use of pharmaceutical staff, including maneuvering of them in order to achieve maximum efficiency when operating in emergency situations. In the event of a large-scale disaster, the supply of medicines to hospitals is performed not only by industrial companies, but also hospital and inter-hospital pharmacies, as well as pharmacies, which are eligible for the extemporaneous preparation of medicines. For the purpose of effective pharmaceutical care of the affected population, pharmacies need to be prepared for the production of a large number and a large assortment of extemporaneous preparations in pharmacies, deployed in adapted premises in the emergency area. In this regard, there is a need to bring a pharmacy in accordance with modern requirements for aseptic units and other production facilities; acquire modern technological equipment for pharmaceutical manufacture of medicaments; establish autonomous sources of heat, water and power supply; prepare the pharmacy to be expanded in the adapted premises of suburban areas in a disaster elimination; to prepare pharmaceutical personnel to perform their duties in emergency situations. On the basis of the study it can be concluded that specific methodological approaches need to be developed, as well as normative legal acts to improve the sustainability of pharmacy institutions in emergency situations with the subsequent practical use of pharmacy institutions in emergency situations in peacetime and wartime. Each year, with the approach of a flu epidemic is increasing relevance of mass vaccination, especially of people of working age. This economic importance due to vaccination shall budgetary savings by reducing complications from influenza. Thus the financial crisis and reduce the solvency of the population becomes particularly relevant study price characteristics vaccines. The analysis indicators index price growth for the vaccine can be used in the planning of the need for vaccination in preparation for epidemics of influenza. Research of pricing characteristics of influenza virus vaccines Materials and methods. Statistical comparative systematic and analytical methods and techniques of price analysis. Registered in the pharmaceutical market of the vaccine presented in two forms release a fixed needle syringes with 84. Investigate to price characteristics of influenza virus vaccines we have selected vaccines recommended by the Ministry of Health of Ukraine for vaccination in epidsezoni 2015-2016 biennium. In the absence of tenders in 2016 we were selected price-list distributors, operating in the domestic pharmaceutical market vaccines against influenza viruses. Сalculate price indices (lg) were carried out monitoring studies of average wholesale prices for vaccines against influenza viruses that were present in the domestic pharmaceutical market in the period 2007-2016. Given the fact that the domestic pharmaceutical market the vaccine recommended for vaccination only foreign, now becomes an important social and economic importance of the implementation of program activities of import substitution. Registered in the pharmaceutical market of the vaccine presented in two forms release a fixed needle syringes with 84. Thus, the results of our research of price characteristics vaccines have proved that today a priority national health care system and pharmacy in addressing the issue of mass vaccination against the influenza virus is to encourage domestic manufacturers to produce vaccines and the development of state programs of pharmaceutical software vaccines. A medication error is "any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer. Such events may be related to professional practice, health care products, procedures, and systems, including prescribing; order communication; product labeling, packaging, and nomenclature; compounding; dispensing; distribution; administration; education; monitoring; and use. Considering the above objective of the research is the study approaches to classification of medications errors an international established practice and Ukraine. In the study, we analyzed scientific articles and guidelines of international organizations on issues definitions and classifications of medication errors. As a result of studying the international experience found that today there is no single classification system. One of the main criteria and approach to the systematization of medications errors is the ways in which errors occur. We were allocated following medication errors according to various scientific sources (Table 1). Table 1 The main types of medication errors according to ways in which errors occur Types of errors Definition Dosage errors Medication administered in doses greater or smaller that what had been prescribed Time errors Medication administered to patient in an time different from that which had been prescribed or predetermined Unauthorized Administering medication that has not been prescribed be the physician Technique Medication incorrectly formulated or manipulated before administering or errors using inappropriate procedures or techniques to administer of medication Administration Administering medications using a route different from what had been route errors prescribed Extra doses Administering and extra dose to what had been prescribed or a medication that had been suspended Prescription Incorrect selection of the medication, dosage, presentation, administration errors route, infusion speed, inadequate use instructions by physician and not registering a verbal prescription Omissions Professional‘s mistake to not administer the medication to the patient 240 Wrong patient Administering the medication to the wrong patient Presentation Administering medication in a way different from what had been errors prescribed At the same in the opinion of Professor Jeffrey K. Aronson, there is another approach to classification based on a psychological theory, that, from his point view, is to be preferred, as it explains events rather than merely describing them. Its disadvantage is that it concentrates on human rather than systems sources of errors. The classification of medication errors based on a psychological approach is presented on Fig. The classification based of medication errors based on a psychological approach It should be noted that, the pharmacovigilance system used other classifications of medications errors and their combinations for research, collection of statistics Unfortunately, in Ukraine, it is impossible to conduct a classification of medication errors, as there is no relevant definition and national pharmacovigilance system only includes data on adverse drugs reaction. However, international experience shows differentiation concepts ―medications errors‖ and ―adverse drug reaction‖ that is included in their pharmacovigilance system. Issues of relationship between medication errors and adverse drug events are the subject of study of American and European scientists. In our opinion, this subject is topical for Ukraine, given the Eurointegration processes and the reform of the domestic health care system. According to the study definition of medication error and the main approaches to the classification established that today the term is not used in Ukraine. Most often of the National pharmacovigilance system applies the term "adverse drug reaction". Regarding the classification of medications errors, can be argued that today based on the study of international experience, there are several approaches to the classification of medications errors, the most common of them is the classification according to methods ways in which errors occur and psychological approach, proposed by Professor Jeffrey K. Term ―medication error‖ is not used in the Ukrainian health care system and pharmacovigilance that is not in accordance with global trends. The homeopathic treatment has attracted the attention of scientists and practical experts of medicine and pharmacy since Ukraine became independent. Thus, in 2001, current State Pharmacopoeia of Ukraine was introduced; it includes sections devoted to homeopathic medicines. The definition of homeopathy, its basic preparations, types of raw materials, general requirements to them and to the method of potentiation and certain types of quality control are provided in the ―Homeopathic Medicines‖ section and its sub-clauses. According to the current law, homeopathic pharmacies (departments) activities are regulated by the Order No. The Order is valid for more than 20 years, and current conditions of the pharmaceutical industry are different, so the provisions of the Order are not relevant now, and they need to be revised and improved in the current situation. The aim of our research is to analyze the main tasks and functions homeopathic pharmacies. Research has been carried out with the use of information materials, including pharmacopoeias, data from literature sources and materials of own research, using conventional empirical methods. All the above-mentioned tasks and functions of homeopathic pharmacies are taken as a basis of modern ―Regulations on Specialized Homeopathic Pharmacy‖ and ―Regulations on homeopathic Pharmacy Department‖. These Regulations define the main principles and activity areas of such pharmacies, their internal structure, tasks, functions, responsibilities, rights and relationships with other pharmacy departments. Scientific achievements have been tested and approved by the ―Pharmacy‖ Problem Committee of the Ministry of Health and National Academy of Medical Sciences of Ukraine and agreed with Medicines and Healthcare Products Regulatory Agency of Ukraine. Practical application has been found in homeopathic pharmacies (departments) of five regions of Ukraine. We have analyzed and summarized the objectives and functions of homeopathic pharmacies for the first time during last years. Taking into account them, the Regulations about homeopathic pharmacy and department, which reflect the specifics of the work of such pharmacies (departments), were developed and proposed. Market pharmaceutical industry takes a special place in the social sector of the economy of each country. The activities of the pharmaceutical market takes place in the form of private enterprise, so all the processes of reorganization and restructuring of the pharmaceutical companies have the same final goal – improving business effectiveness. However, the specificity of the pharmaceutical business, its enormous social responsibilities imposes special requirements to the quality of its operations. In this context, pharmaceutical companies should be considered as special business system. The activities of the modern pharmaceutical enterprise is a series of business processes, representing a sequence of actions and decisions aimed at achievement of a certain goal, therefore as a whole the effectiveness of the company is conditioned by efficiency of their business processes. The aim is research of effectiveness of business processes at the manufacturing pharmaceutical company.

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