1. AFAMS EO 001.04 ANA Formulary (Dari) 01/09/2013

2. AFAMS Importance of Lesson (Dari) Previous lessons made students aware of the Laws, Regulations, and Policies that govern Pharmacy Practice in Afghanistan. Unlike in civilian life, the ANA is the employer, healthcare payer and healthcare provider for soldiers. AFAMS Insert Dari

3. AFAMS Importance of Lesson (Dari) The ANA is responsible for ensuring high level of care to its soldiers. Part of this is the provision of effective and safe medications to ANA soldiers. The ANA must also be loyal to the Afghan people by ensuring only the most cost-effective medications are used. AFAMS Insert Dari

4. AFAMS Importance of Lesson (Dari) This lesson will review the process by which the ANA Healthcare System ensures this occurs. AFAMS Insert Dari

5. AFAMS Overview EO 001.04 (Dari) Definition of a Formulary –Differentiate from National Licensed Drug List Functions of a Pharmacy and Therapeutics Committee. Importance of a Formulary Overview of ANA Formulary Lesson Review Scenarios (not graded) AFAMS Insert Dari

6. AFAMS Definition of a Formulary (Dari) “an official list giving details of prescribable medicines” Oxford Dictionary Essentially, it is a list of medications authorized to be prescribed at the cost of a payer (i.e. organization) AFAMS Insert Dari

7. AFAMS Formulary vs National Licensed Drug List (Dari) National Licensed Drug List: “Contains all medicines that can be imported and sold in Afghanistan...” - It is a importation guideline. - Though comparisons/ review of safety, efficacy, cost, and practice environments are done these comparisons are quite general. AFAMS Insert Dari

8. AFAMS Formulary vs National Licensed Drug List (Dari) Formulary: Since the ANA is the employer, healthcare payer and healthcare provider certain medications may be more appropriate than others in the ANA Healthcare environment. Additional considerations may make one medication more appropriate than another. –E.g. One medication may cause excessive sedation therefore, another is preferred despite being more expensive. AFAMS Insert Dari

9. AFAMS Formulary vs National Licensed Drug List (Dari) Formulary: Hence, the ANA has created a Pharmacy and Therapeutics Committee whose responsibility it is to maintain the ANA Formulary. The Formulary is a list of medications that are authorized by the OTSG to be provided to ANA soldiers and their dependants at the cost of the ANA. AFAMS Insert Dari

10. AFAMS Using the ANA Formulary (Dari) AFAMS Insert Dari Drug name and strength Drug class Dosage form Practice Environment/ Unit

11. AFAMS Check on Learning ارزیابی آموزش Question: Can omeprazole be used at any facility? Next slide Insert Dari

12. AFAMS Using the ANA Formulary (Dari) AFAMS Insert Dari Drug name and strength Drug class Dosage form Practice Environment/ Unit

13. AFAMS Check on Learning ارزیابی آموزش Answer: Can omeprazole be used at any facility Yes Insert Dari

14. AFAMS Check on Learning ارزیابی آموزش Question: Can pantoprazole tablets be used at NMH? Next slide Insert Dari

15. AFAMS Using the ANA Formulary (Dari) AFAMS Insert Dari Drug name and strength Drug class Dosage form Practice Environment/ Unit

16. AFAMS Check on Learning ارزیابی آموزش Answer: Can pantoprazole tablets be used at NMH? No, only the IV pantoprazole formulation can be used at NMH and Regional Hospitals. Insert Dari

17. AFAMS Check on Learning ارزیابی آموزش Question: The prescriber at NMH has written a prescription for pantoprazole tablets. What do you do? Next slide Insert Dari

18. AFAMS Using the ANA Formulary (Dari) AFAMS Insert Dari Drug name and strength Drug class Dosage form Practice Environment/ Unit

19. AFAMS Over the Counter Medications

20. AFAMS Over the Counter Medications Insert Dari Do not require a prescription for purchase outside ANA. Listed in the National Licensed Drug List. They are felt to pose minimum safety concerns for patients. Used to treat mild ailments

21. AFAMS Over the Counter Medications

22. AFAMS Over the Counter Medications

23. AFAMS Over the Counter Medications

24. AFAMS Check on Learning ارزیابی آموزش Answer: Being a well trained Pharmacy Technician you see that there are two other similar medications to pantoprazole on the ANA Formulary. (i.e. rabeprazole and omeprazole) They are all Protein Pump Inhibitors. What do you do now? Insert Dari

25. AFAMS Check on Learning ارزیابی آموزش Answer: Notify the Pharmacist of the prescription and inform them of the information you found so they may contact the prescriber to change the medication to one on the formulary. Why do you need a Pharmacist? Insert Dari

26. AFAMS Check on Learning ارزیابی آموزش Answer: Doses of drugs with similar methods of action (i.e. Protein Pump Inhibitors) usually have different doses. Therefore, the Pharmacist must determine the equivalent dose of omeprazole or rabeprazole to the pantoprazole dose ordered. They will then call the prescriber to suggest the equivalent dose of the Formulary medication. Insert Dari

27. AFAMS Review Dari What type of information can Pharm Techs gather to assist Pharmacists in answering clinical questions? Insert Dari

28. AFAMS Questions? Dari

29. AFAMS Scenarios (Assessment) Dari Formative Assessment: Not marked Used to assess the students understanding of lectures material. Instructors will ask the questions to the class as a whole. Group discussion amongst the students is encouraged to answer the questions. Instructor will provide a debrief after each scenario question to highlight reasons why response was correct or incorrect. Insert Dari

30. AFAMS Scenario One Dari You are working as a Pharm Tech in a Hospital Dispensary. The Pharmacist is talking to the Quarter Master just outside of the pharmacy. The phone rings and you answer it. A physician has called. They state, “I have a question about clarithromycin.” What do you do? Insert Dari

31. AFAMS Scenario One Dari Possible Answer: Ask the Physician for their question. Examples: “Yes Doctor, what is your question?” Or “Yes Doctor, how may I help you?” Insert Dari

32. AFAMS Scenario One Continued Dari Question 1: The Physician asks: “Does clarithromycin suspension have to be stored in the fridge? 1.Can you answer the question or do you need to get the Pharmacist? 2.Why? Insert Dari

33. AFAMS Scenario One Continued Dari Question 1: The Physician asks: “Does clarithromycin suspension have to be stored in the fridge? 1.Can you answer the question or do you need to get the Pharmacist? 2.Why? Answer: Yes, you can answer the question since it does not require professional judgment. The answer is in the drug monograph. Insert Dari

34. AFAMS Scenario One Continued Dari Question 2: The Physician says: “Thank you for the information. If you have another minute I have another question? ” “The patient is also taking the drug atorvastatin is there a drug interaction with clarithromycin?” 1.Can you answer the question? 2.Why? Insert Dari

35. AFAMS Scenario One Continued Dari Answer: No, you cannot answer this question since it requires the professional judgment of a Pharmacist. Though a reference textbook will state there is a drug-drug interaction the Pharmacist must assess using relevant facts (textbook) and circumstances (reason for the atorvastatin, reason for the clarithromycin, length of therapy…) whether or not the interaction is serious and ways to minimize any effect. Insert Dari

36. AFAMS Scenario One Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? Insert Dari

37. AFAMS Scenario One Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? Inform the Physician the Pharmacist cannot come to the phone right away but, you can gather some information for the Pharmacist and they will phone back once they can. Insert Dari

38. AFAMS Scenario One Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? 1.Write down the question. 2.Physician’s name and contact number. 3.Patient name 4.Drug name, dose and frequency (both drugs) 5.Additional info if possible: a.Reasons for each medication. b.When each medication was started. c.How long will the patient be taking each medication. Insert Dari

39. AFAMS Scenario Two Dari You are working at the Polyclinic Dispensary. A patient asks if the medication they just started could be causing them have muscle pain. The Pharmacist is presently talking to another patient. You look in the reference book and see no mention of the drug causing patients to feel tired. Do you provide this information to the patient? Insert Dari

40. AFAMS Scenario Two Dari No, you cannot provide this information to the patient. Professional judgment is required since there are many circumstances involved. i)Is the patient on another medication that could be causing the side effect or a drug-drug interaction. ii)Is it an expected side effect that is short term or could be minimized slowly increasing the dose. Insert Dari

41. AFAMS Scenario Two Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? Insert Dari

42. AFAMS Scenario Two Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? Inform the patient the Pharmacist cannot come to see them right away but, you can gather some information to help the Pharmacist when they come over. Insert Dari

43. AFAMS Scenario Two Continued Dari Since you cannot answer the question, what can you do to help the Pharmacist? 1.Write down the question. 2.Patient’s name 3.Drug name, dose and frequency (both drugs) 4.Additional info if possible: a.Any other medications the patient is taking. b.When each medication was started. c.Why they are taking each medication. Insert Dari

44. AFAMS Questions? Dari