2. Authors: Pharmacist Liliam Acosta Amaya. Pharmacist Leuvis Pedro Moreno Sánchez.

3. We performed a prospective study on expired medicines in the pharmacy Katutura Intermediate Hospital in the period from October to December of 2012 determined that won 68 Drug which represented a total loss for the institution of 49181.29 ND (Namibiam Dollar) being the Antibiotics and TB drugs the higher incidence, Cotrimoxazole 480mg (Injectable) Rifampicin150mg/Isoniacid75mg (Tablets) besides being the month of December the greatest losses of 20801.27 (42.29%) due to poor organization of medicines in the store without having into account its maturity, the failure to conduct a systematic calculation of the maximum and minimum to achieve quality purchase orders to suppliers, poor maintenance of specific conditions requiring hospital wards, the absence of a system of control and reporting system that enables the period in which they mature, and not performing periodic checks to the medications in the wards.

4. Since the emergence of humanity man has suffered from various ailments that have affected to a lesser or greater extent, character suffering from pandemic diseases such as plague, tuberculosis, yellow fever among others, causing them to give to the task of seek ways to combat them to reduce their negative impact on the population and that is how come Drugs: substances with properties for the treatment or prevention of disease in humans and animals. Also considered as substances that are used or administered with the aim of restoring, correcting or modifying physiological functions in the body or those for making a medical diagnosis. (1, 2.5) These are used in doses so small that in order to administer the correct dose, should be prepared so that they are manageable and so arising (tablets, syrups, suppositories, injections, ointments, etc..) Known as dosage forms. (5) These are used in doses so small that in order to administer the correct dose, should be prepared so that they are manageable and so arising (tablets, syrups, suppositories, injections, ointments, etc..) Known as dosage forms. (5) These drugs not only consist of medicinal substances are those with therapeutic activity and are called Active Principles, often accompanied by other substances that have no therapeutic activity but have an important role, allowing the drug to have stability and preserved properly, some of which are notifiable and very important in the production, storage and release of medicinal substances identified by the name of Excipients. (5) These drugs not only consist of medicinal substances are those with therapeutic activity and are called Active Principles, often accompanied by other substances that have no therapeutic activity but have an important role, allowing the drug to have stability and preserved properly, some of which are notifiable and very important in the production, storage and release of medicinal substances identified by the name of Excipients. (5) Since the emergence of humanity man has suffered from various ailments that have affected to a lesser or greater extent, character suffering from pandemic diseases such as plague, tuberculosis, yellow fever among others, causing them to give to the task of seek ways to combat them to reduce their negative impact on the population and that is how come Drugs: substances with properties for the treatment or prevention of disease in humans and animals. Also considered as substances that are used or administered with the aim of restoring, correcting or modifying physiological functions in the body or those for making a medical diagnosis. (1, 2.5) These are used in doses so small that in order to administer the correct dose, should be prepared so that they are manageable and so arising (tablets, syrups, suppositories, injections, ointments, etc..) Known as dosage forms. (5) These are used in doses so small that in order to administer the correct dose, should be prepared so that they are manageable and so arising (tablets, syrups, suppositories, injections, ointments, etc..) Known as dosage forms. (5) These drugs not only consist of medicinal substances are those with therapeutic activity and are called Active Principles, often accompanied by other substances that have no therapeutic activity but have an important role, allowing the drug to have stability and preserved properly, some of which are notifiable and very important in the production, storage and release of medicinal substances identified by the name of Excipients. (5) These drugs not only consist of medicinal substances are those with therapeutic activity and are called Active Principles, often accompanied by other substances that have no therapeutic activity but have an important role, allowing the drug to have stability and preserved properly, some of which are notifiable and very important in the production, storage and release of medicinal substances identified by the name of Excipients. (5)

5. Nowadays, most medications are prepared by pharmaceutical and, for preparation and distribution, these must be approved by the Ministry of Health of the country preceding a name registered. (1, 4) All processes related to the research, manufacture and distribution are strictly regulated by the laws that protect the health of citizens, among them are those which provide that: Apart from the registered name of the drug, on the outside of the package must be printed a lot of information that can be very useful and it expresses: Apart from the registered name of the drug, on the outside of the package must be printed a lot of information that can be very useful and it expresses: Active Ingredient and the amount contained.  Excipients notifiable.  Laboratory manufacturer.  Batch.  Expiration or maturity date.  Symbols and abbreviations: (2,3) Nowadays, most medications are prepared by pharmaceutical and, for preparation and distribution, these must be approved by the Ministry of Health of the country preceding a name registered. (1, 4) All processes related to the research, manufacture and distribution are strictly regulated by the laws that protect the health of citizens, among them are those which provide that: Apart from the registered name of the drug, on the outside of the package must be printed a lot of information that can be very useful and it expresses: Apart from the registered name of the drug, on the outside of the package must be printed a lot of information that can be very useful and it expresses: Active Ingredient and the amount contained.  Excipients notifiable.  Laboratory manufacturer.  Batch.  Expiration or maturity date.  Symbols and abbreviations: (2,3)

6. All these aspects are essential for the use which gives the drug and within it the significance of the Expiration Date or Expiration of a drug known as: Date placed in a drug packaging which indicates the period during which the product is expected to meet specifications. This date is established for each batch by adding the shelf life from the date of manufacture. Also as: The date provided by the manufacturer in a non-encoded, based on the stability of the drug product and after which the medicine it cannot be used. All these aspects are essential for the use which gives the drug and within it the significance of the Expiration Date or Expiration of a drug known as: Date placed in a drug packaging which indicates the period during which the product is expected to meet specifications. This date is established for each batch by adding the shelf life from the date of manufacture. Also as: The date provided by the manufacturer in a non-encoded, based on the stability of the drug product and after which the medicine it cannot be used.

7. Using as reference texts of pharmacology in principle is considered against the law market or use drugs beyond their expiration date, existing from the theoretical point of view two lines of reasoning that support this policy: 1 - That a expired drug may contain less active ingredient than stated on the label, reducing or compromising therapeutic efficacy in varying degrees. 2 - That the process of drug degradation in storage conditions give rise to hazardous, toxic either director haptens that trigger a hypersensitivity reaction. There is a practical approach that allows overcoming this problem: the product must be discarded. In particular, the antibiotics penicillin derivatives, and various biological agents - which generally require cold chain for proper conservation being the most commonly cited in this category. Product for the above properties are medications that can alter and potential consequences:  Chemical: Each active ingredient can vary its chemical integrity and labeled potency, reduce its therapeutic effect.  Physical: physical properties can be altered original: appearance  Uniformity, dissolution, color, etc.  Microbiological: sterility may be affected or resistance to bacterial growth.  Therapeutic: therapeutic effects may be affected.  Toxicology: Changes may occur in the training toxicity of degradation products that may be toxic, harmful to the body. (1, 3, 4.5) That is why taking into account all the aforementioned aspects we were motivated to conduct a study on the drug expires in Katutura Intermediate Hospital, which is in effect and problems affecting the sector indicators, not to mention the therapeutic implications that would entail the use of one of these drugs, and thus we propose the following objectives: Using as reference texts of pharmacology in principle is considered against the law market or use drugs beyond their expiration date, existing from the theoretical point of view two lines of reasoning that support this policy: 1 - That a expired drug may contain less active ingredient than stated on the label, reducing or compromising therapeutic efficacy in varying degrees. 2 - That the process of drug degradation in storage conditions give rise to hazardous, toxic either director haptens that trigger a hypersensitivity reaction. There is a practical approach that allows overcoming this problem: the product must be discarded. In particular, the antibiotics penicillin derivatives, and various biological agents - which generally require cold chain for proper conservation being the most commonly cited in this category. Product for the above properties are medications that can alter and potential consequences:  Chemical: Each active ingredient can vary its chemical integrity and labeled potency, reduce its therapeutic effect.  Physical: physical properties can be altered original: appearance  Uniformity, dissolution, color, etc.  Microbiological: sterility may be affected or resistance to bacterial growth.  Therapeutic: therapeutic effects may be affected.  Toxicology: Changes may occur in the training toxicity of degradation products that may be toxic, harmful to the body. (1, 3, 4.5) That is why taking into account all the aforementioned aspects we were motivated to conduct a study on the drug expires in Katutura Intermediate Hospital, which is in effect and problems affecting the sector indicators, not to mention the therapeutic implications that would entail the use of one of these drugs, and thus we propose the following objectives:

8. GENERAL OBJECTIVE  To analyze the behavior of the expiry of medicines in the pharmacy Katutura Intermediate Hospital. SPECIFIC OBJECTIVES:  1. Quantifying economic losses for this concept to the Institution.  2. Determine drugs increased incidence in the loss caused.  3. Identify possible causes that led to the expiry of drugs. GENERAL OBJECTIVE  To analyze the behavior of the expiry of medicines in the pharmacy Katutura Intermediate Hospital. SPECIFIC OBJECTIVES:  1. Quantifying economic losses for this concept to the Institution.  2. Determine drugs increased incidence in the loss caused.  3. Identify possible causes that led to the expiry of drugs.

9. MATERIALS AND METHODS: We performed a prospective study of the drugs expired in Katutura Intermediate Hospital of the city of Windhoek capital of Namibia in the period from October to December 2012 For the study data were collected through reports of expired medicines for the months mentioned above (Annex 1), in addition to these in the documents not reason maturity was performed, because of that we check methodological work in the store (Organization and storage of Medicines batch and expiration date, Minimum and Maximum calculation and preparation of medication orders), the data obtained were processed through the Statistical Method Percentage and mathematical calculations were performed to identify the economic loss caused maturity of these drugs to the institution and to determine the month and more influenced medications.

10. The data were taken to tables for better understanding and analysis; the sample consisted of 68 medicines of different pharmacological groups which matured during this period, from 400 that comprise the core of the unit. To characterize the maturity of the study medications were taken into account the following: 1. Maturity date of each drug. 2. Quantity. 3. Price 4. Amount All this research was conducted by the authors of this study with the collaboration of the staff working in the Pharmacy Unit Katutura Intermediate Hospital.

11. 1-Economic loss due concept Months Number of expired drugs Economic Losses (ND) % October2012812.2226.05 November2615567.8031.65 December2220801.2742.29 Total6849181.29100

12. Table 1.1 shows that there were a total economic loss in the period from October to December of 2012 of 49181.29ND for the institution in which the month of December with 20801.27ND have highest incidence (42.29%), followed by November 15567.80 ND (31.65%) and last October 12812.22 ND (26.05%)

13. MonthHigher incidence DrugLoss (ND)% October Rifampicin150mg/Isoniacid 75mg (Tablets) 4608.789.37 November Fusidate Sodium 250mg (Tablets) 3954.288.04 DecemberCotrimoxazole 480mg (Injectable) 5493.6811.7

14. Table 2.2 Of the 68 expired medicines the most impact on the three-month study was Cotrimoxazole 480mg (Injectable) with 11.7% belonging to the class of medicines called antibiotics, followed by Rifampicin150mg/Isoniacid75mg (Tablets) 9.37% belonging to the class of TB being medicines both high acquisition cost for the hospital and great need because of the high prevalence of infectious diseases in the local population of this country.

15.  Taking into account the results, the authors conclude that in this study some serious methodological problems were detected that affect the work being done in the Pharmacy Unit Katutura Intermediate Hospital particularly in the area of the warehouse which results in the loss of important financial resources to the institution which could be avoidable if you take the necessary steps to do so, which would facilitate the implementation of a greater number of treatments to patients who need them and consequently an improvement for the population in addition to better organization and operation of the pharmacy.

16. 1. Among the three months studied, there was a total loss for the Katutura Intermediate Hospital of 49181.29 ND due on account of medicines, December being the highest incidence with an economic loss of 20801.27ND representing 42.29% of the total loss. 2. The drugs that most influence the study period are Cotrimoxazole 480mg (Injectable) with 11.7% belonging to the class of medicines called antibiotics, followed by Rifampicina150mg/Isoniacida75mg (Tablets) 9.37% belonging to the class of medicines Ant tuberculosis 3. The causes that influenced and determined the maturity of the drugs were:  Poor organization of drugs by batch and expiration date.  No calculations are made to maximum and minimum Periodicity, and reanalysis of these for drugs that require it.  The drug orders are not made with the quality required in the absence of a maximum and minimum reliable.  No reports are made quarterly for the expirations of drugs affecting the action to take with them.  No systematic checks are made to the stock of the wards.  There is access for all pharmacy staff to storage area.

17.  1. Organize Drug store pharmacy considering its maturity so that the recent expiration is the first to be dispensed.  2. Recalculate the maximum and minimum of each of the drugs available to the unit to ensure quality order suppliers and avoid unnecessary losses.  3. Perform quarterly reports maturity to understand the behavior of drugs and to make decisions.  4. Conduct a periodic checkup plan to the wards to check the status of drugs and their use and conservation.  5. Consider the possibility of limiting personnel access to the drug store pharmacy

18. Bibliography: 1 - Farmacoymedicine.biogspot.com/2009 /. (Digital version) 2 - Journal of Medicine and Health Sciences, of fortnightly, aimed at health professionals. (Digital Version) 3 - Royal Decree 1345/2007 of 11 October, regulating the procedure of authorization, registration and conditions of supply of medicinal products for human use manufactured industrially. 2007, Ministry of Health. Mexico (digital version) 4 - Law 29/2006 of 26 July, on guarantees and rational use of medicines and health products. 2006, Ministry of Health. Mexico (digital version) 5 - Remington "Pharmacy" Edition. Editorial Panamericana.1999 19. (Digital Version)