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Dispensing

CHAPTER

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I.

Definitions and Purpose

A. Dispensing is the physical act of giving, providing,
or delivering a drug, chemical, device, or
medication for later oral ingestion, insertion,
application, injection, or other use.
B. The goal of dispensing is to select and dispense
medications in a manner that promotes safe and
effective use.
1. Use the National Drug Code (NDC) number and
other attributes to identify the correct drug
product.
a. The key identifier when selecting a product
in the U.S. is the NDC number, which is
unique to every drug product.
b. NDC is an 11-digit, three-segment number.
The format for all medications follows
55555-4444-22. The first segment of five
numbers is a labeler code assigned by the
Food and Drug Administration (FDA). A
labeler is any firm that manufactures,
repackages, or distributes a drug product.
The second segment of four numbers is the
product code, which indicates a specific
strength, dosage form, and formulation for a
particular product. Lastly, the third segment
of two numbers identifies the package size.
c. When filling a prescription, one can use an
NDC number to verify one has the correct
drug. Generics for the same medication each
have their own NDC.
d. When filling a prescription, verify the
product against its image (if available) and
confirm that it is in good condition. Confirm
the expiration date, dosage form, and
imprint code.
2. Use barcode technology: Newer systems can
include barcode technology that can scan for
the appropriate product and even prevent
dispensing unless the correct product is
selected. This practice is used in hospitals and
retail settings.
3. Check for expiration dates.
4. Check for drug interactions. When checking for
interactions, a pharmacist must review the
patients medication, evaluate and consider the
indication, consider the patients age and hepatic/
renal function, and whether or not the patient is
pregnant. These factors may alter drug therapy.

a. There are many types of drug interactions:

1) Drug-drug interactions
2) Drug-food interactions
3) Drug-disease interactions
4) Drug-herb interactions
5) Drug-pregnancy/lactation effects
b. Many pharmacy computer systems will have
a drug-interaction screening software
program in place. The integrated applications
are usually provided through vendors such as
First DataBank. As each prescription is filled,
the system automatically checks the
medication against other medications the
patient is taking. However, this system is not
always accurate because some people get
prescriptions filled at multiple pharmacies
and the computers are not on the same
network. Ask patients about their use of all
prescriptions, over-the-counter (OTC)
medications, herbal remedies, vitamins,
minerals, and other supplements. Determine
if the patient has any known allergies.
c. There are other resources available to check
for drug interactions including Clinical
Pharmacology, Facts and Comparisons,
Micromedex, and many others.
d. Herb-drug interactions are a concern due to
uncertainty as to how herbs and supplements
will interfere with other medication.
Resources and data are limited in this area.
1) An example of an herb-drug interaction is
St. Johns wort and cyclosporine. The
mechanism for this interaction is proposed
to be induction of cytochrome P-450
enzymes by St. Johns wort.
2) It is important to counsel patients on the
possibility of food-drug interactions.
Grapefruit or grapefruit juice has the
potential to alter the effects of various
medications, including antiarrhythmic
agents, immunosuppressive agents,
statins, and calcium channel blockers.
The interaction is likely the result of
inhibition of intestinal or liver metabolism
by cytochrome P-450.
e. The pharmacist should notify the prescriber
of serious drug interactions (those where the
patient risk exceeds any benefit from the

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