DISPENSING 2 LAB

POST ACTIVITY DISCUSSION

(PRELIMS)

Prepared by:
Roma Joy L. Esteban, RPh
PRESCRIPTION ANALYSIS
AND ITS PROPER HANDLING

ACTIVITY # 1
PRESCRIPTION
It is an order written by a physician, dentist, veterinarian or
a registered medical practitioner (RMP) to a pharmacist to
compound and dispense a specific drug for the patient. OR
Prescription is a written order for medication, issued by
physician or RMP
Prescription is relationship between physician and
pharmacist.
The word "prescription" is derived from the Latin term
praescriptus (Prae - 'before' and scribere- meaning 'to
write').
Prescription means 'to write before' which means
prescription had to be written before a drug could be
compounded and administered to a patient.
PARTS OF A PRESCRIPTION
• A typical prescription consists of the following parts:
• 1. Prescriber office information
• 2. Date
• 3. Patient information (Name, Age, Sex And Address Of
The Patient)
• 4. Superscription (symbol ℞)
• 5. Inscription (Medication prescribed)- Main part of
prescription
• 6. Subscription(Direction to Pharmacist/Dispenser )
• 7. Signatura or Transcription (Direction for Patient)
• 8. Renewal instructions
• 9. Prescriber’s signature and registration number
e-prescribing (electronic prescribing)

E-prescribing, or electronic prescribing is a technology

framework that allows physicians and other medical
practitioners to write and send prescriptions to a
participating pharmacy electronically instead of using
handwritten or faxed notes or calling in prescriptions.
• At the most basic level, an e-prescribing system serves as
an electronic reference handbook. More sophisticated e-
prescribing systems act as stand-alone prescription
writers. They can create and refill prescriptions for
individual patients, manage medications and view patient
history, connect to a pharmacy or other drug dispensing
site, and integrate with an electronic medical record
(EMR) system.
Erroneous Prescriptions
Where the brand name precedes the generic name
• Where the generic name is the one in parenthesis
• Where the brand name is not in parentheses
• Where more than one drug product is prescribed on one
prescription form.

• What to do with erroneous prescriptions

Erroneous prescriptions shall be filed. Such
prescription shall also be kept and reported by the
pharmacist of the drug outlet or any other interested party
to the nearest DOH office for appropriate action.
Where the brand name precedes the Where the generic name is the one in
generic name parenthesis
OR
Where the brand name is not in
parentheses
OR
Where the brand name precedes the
generic name
Where the brand name is not in Where more than one drug product is
parentheses prescribed on one prescription form.
Violative Prescriptions
Where generic name is not written
• Where the generic name is not legible and a brand name which
is legible is written
• When the brand name is indicated and instructions added
(such as the phrase " no substitution") which tend to obstruct,
hinder or prevent proper generic dispensing.

• What to do with violative prescriptions

Violative prescriptions shall not be filed. They are kept and
reported by the pharmacist of drug outlet or any other
interested party to the nearest DOH office for appropriate
action. The pharmacist shall advise the prescriber of the
problem and/or instruct the customer to get the proper
prescription.
Where generic name is not written
Where the generic name is not legible and
a brand name which is legible is written
When the brand name is
indicated and instructions
added (such as the phrase "
no substitution") which tend to
obstruct, hinder or prevent
proper generic dispensing.
Impossible Prescriptions
When only the generic name is written but it is not legible.
• When the generic name does not correspond to the brand name
• When both the generic name and the brand name are not legible
• When the drug product prescribed is not registered with FDA

• What to do with impossible prescriptions

Impossible prescription shall not be filed. They shall be and reported
by the pharmacist of drug outlet or any other interested party to the
nearest DOH office for appropriate action. The pharmacist shall
advise the prescriber of the problem and/or instruct the customer to
get the proper prescription.
When only the generic name is
written but it is not legible.
When the generic name does not
correspond to the brand name
When both the generic name and the
brand name are not legible When the drug product prescribed is not
registered with FDA
• Note: In all cases
enumerated in
violative and
impossible
prescriptions, the
local DOH office
shall be responsible
for giving written
notice to the erring
doctor concerned
and for transmitting
through channels
the report of
violation/error to the
Professional
Regulation
Commission (PRC)
or to the fiscal's
office for
appropriate action.
Steps in Dispensing Prescription or
OTC Drugs
• Pharmacy is also a business, money can be involved in every
transaction. Sales and profit are secondary main goals of a
drugstore, which mean the more the buyers and customers are, the
more the sales revenue can accumulate per day.
• Thus, once a customer stops to a drugstore, the establishment must
see to it that the customer's needs are available in them and must be
given or satisfy, so that another time that customer needs drugs again
he shall go back to your drugstore.
• Also the flow of the dispensing process should be fast but accurate,
and proper courtesy and respect must be shown to impress
customer that consequently achieving their loyalty.
• In the Philippines dispensing process is done within 10-15
minutes depending on the number of prescribed drugs, volume of
people and the capacity of manpower a drugstore has.
•
FOR REGULATED DRUGS?
• DISPENSING vs SELLING of medicine?
Steps in Dispensing Drugs
• The customer will approach the pharmacy and call the attention of one of the
personnel.

• The pharmacist or pharmacy assistant will greet the customer and must sustain good
manners all through the transaction.

• The personnel will ask the patient about his/her prescription or drug needs.

• After the presentation of prescription/s or details of drug/s needed, the personnel shall
check the availability of stock on the shelves, the price, the expiration date and other
generic equivalence of that brand or drug/s.

• The prescription/s or drug/s will be priced. Allow the customer to budget his/her
money to decide if he/she can afford the brand of that drug/s.

• Introduce to him/her other generic equivalence or other drugs that contain the same
generic name, strength, dosage form and alike, which can help him/her to save
money or budget his/her money.

• Take time to let the customer to decide what price of drug he/she will buy and the
quantities to be sold. Total the amount incurred by the customer and ask for his/her
payment. (If the patient is senior citizen, ask for requirements, and deduct the
respective percentage).
• If decision was made, prepare the decided drug/s (with
the cheapest price) to be bought by acquiring them from
the shelves. Blistered or foiled packaging will be cut in
the pieces requested by the customer and/or if the
packaging is loose count the number of the drug needed
in the tablet counter and placing them into compact
plastic bottle, wide-mouthed amber bottle or small
capsule cellophane that placing the information of the
patient, information of the drug and quantity of the drug.
Check the drug before and after removing from the
shelf if it is the required drug. Check also for
expiration of the drug and stability of it.

• When the drug is prepared proceed to billing.

• Take back his/her change if there is and counter-check

the drug's name, count and quantities in front of him.

• Counsel the customer about the instruction given to

him/her by the physician, the storage condition, and
other information about the drugs.
• End the transaction by speaking “Thank you!” and
“Come back again!”. The prescription shall be filed and
kept.
MEDICATION AND
PRESCRIPTION ORDERS
DOSING SCHEDULE

ACTIVITY 2
Medication order
• A medication order is written directions provided by a prescribing
practitioner for a specific medication to be administered to an
individual. The prescribing practitioner may also give a medication
order verbally to a licensed person such as a pharmacist or a nurse.
• The common components of a medication script include the
following:
• Drug Name (Generic) vs (Non-Generic)
• Drug Dosage (including numerical value and units)
• Route for administration (eg. by mouth, intra-venous, per rectum,
etc)
• Frequency (how often to take the medication)
• Duration (how long to take the medication for)

• Without this information it is pretty difficult to dispense a medication

properly. But additional information might be included in a medication
order for further details.
Generic vs Branded Generic
• A branded generic is a generic drug that has gone through the ANDA
process, and is assigned a name other than the chemical name.
These branded generic drugs may be developed by a generic drug company,
or by the original manufacturer after patent expiration. The branded generic
name is owned by the company. The branded generic must be bioequivalent
to the original brand product
Additional medication order details may
include:
• The medication form requested (powder, cream, ointment, etc)
• Instructions to „take as needed” “PRN”. And if so, for what
indication (eg. nausea)
• Refill details (how many refills the patient may have)
• Specific instruction for the patient (eg. do not take with alcohol)
• Specific instructions for the nurse (eg. only give while patient
awake)
• The priority of the order (eg. Give STAT)
• Specifics start date / time or specific end date / time
• To only take the medication based on the result of another test or
measurement (eg. a drug level or HgB result)
• Details regarding order activation. Right away vs to be placed into
a „pending list‟ for activation later (eg. after coming out of the ER).
• Can it be crushed or not?
• If the drug can be substituted for generic, and if not why
• How the medication should be prepared / mixed with other drugs
Examples of some different types of
medication orders are:
• • Copy of a written prescription
• • Written order on a consultation form, signed by the
practitioner
• • Written list of medication orders, signed by the practitioner
• • Copy of a pharmacy call-in order, given to you by the
pharmacist*
• • A verbal order given to a licensed person*
• • Electronic prescriptions signed electronically via a secured
system

• "prescribing practitioner“
- This is a term that describes the various health care
professionals who can give medication orders
PRN Medication Order
Day’s Supply
• Days' Supply is referring to how long a prescription order
will last.
• Often it is not as simple as giving a tablet once a day for
30 days; you will frequently need to do calculations for
oral liquid medications, injectable, nasal sprays, and
inhalers, and make estimations for PRN's, ointments and
creams, lotions, eye and ear drops, and ophthalmic
ointments.
Day’s supply for Tablet/ Capsule and Liquid medication

• ANSWER:
Day’s supply for insulin
• Most insulins are called U-100 insulins meaning that each mL contains 100
units. Also most insulin vials are either 10 mL vials or boxes of 5 syringes
containing 3 mL in each syringe for a total of 15 mL in a box. A 10 mL vial of U-
100 strength insulin would contain 1000 units and a 15 mL box of syringes with
U-100 insulin would contain 1500 units.
• With insulin problems, whenever you come out with a decimal number of days
you should always just drop the decimal as you never want a diabetic patient to
run out of their insulin.
• The last thing to keep in mind with respect to an insulin vial is that it
should not be kept for longer than 30 days after it has been
opened. Determining how long a box will last is different since each
syringe is only good for 30 days after it is started, but there are five
syringes. Let's look at an example problem with insulin.
Days' Supply for inhalers and sprays

• Whenever you see instructions on a product for a patient to receive

a particular number of sprays or puffs of a given drug, you should
stop and actually look at the packaging to discover how many
metered inhalations or how many metered sprays are actually in
the container. Lets look at an example problem accompanied by
some of the text from the front of the container.
•
 Days' supply for ointments and creams
• Calculations for creams and ointments are a little more
tricky because you usually don't know exactly how much
will be used in a dose.
• The amount will depend on how large of an area is
affected and how many areas it needs to be applied to.
The amount applied usually does not exceed 500 mg
to 1 g, so unless you know otherwise, use 1 gram for the
dose for each affected area.
Days' supply for ophthalmic and otic preparations
• To solve this type of problem, you need to know a
conversion factor from milliliters to drops.
• Unless your specific medication notes something different,
a dropper should be calibrated by the manufacturer to
deliver between 18 and 22 drops per milliliter.
• Most people just split the difference and estimate 20
gtt/mL.
• Another odd thing to keep track of when dealing with eye
preparations are ophthalmic ointments.
• An ophthalmic ointment is typically applied as a very thin
strip. Treat each dose of an ophthalmic ointment as
100 mg.
Days' supply for various packs
• Many medications (such as birth control, steroids, and antibiotics) may come
in packs with very explicit instructions for use. These instructions often
explain exactly how many days they will last and require no additional
calculations. You must simply read the instructions on the package to know
how long it will last.
 ANSWER: It
requires nothing
more than
observation to
realize it will last
6 days.
Liquid medication orders Medication
orders for liquid medications
• Liquid medication orders Medication orders for liquid medications are
similar in many ways to the medication orders that you get for pills.
• There are some important things to consider for liquid medications.
Medication orders for liquid medications contain information about the
strength or concentration of the drug in the liquid. Liquid medication
orders also contain information about the amount of the liquid medication to
be given
Scheduling Times to Give Medications
• Some medication orders include a specific time of day that you
are supposed to give the medication.
• If this is the case, make sure to follow the order and transcribe
the medication for that time of day.
• Remember that:

• If the person is receiving enteral feedings, you must ask the

pharmacist if the medication and the feeding will interact. If the answer
is yes, you will need to separate the enteral feeding and the
medication by at least 30 minutes.

• Some medications will interact if taken together, and

• • Some medications must be given:
• before meals (ac) on an empty stomach
• after meals (pc) so that there will be food in the stomach
Documentation
• Documentation (record keeping) is very important. Whenever
medication is administered, you must remember to:
• 1. Always follow the medication log exactly when you are giving medications
and sign off on the medication log immediately.
• 2. Double-check the medication log after you have given medications and
again at the end of the day to make sure that your documentation is
complete.
• 3. Some general principles for documentation are listed below:
• It is important that all documentation:
• • Can be read and understood by others
• • Is complete, with no blanks left to be filled in later
• • Is done in blue or black ink. Do not use whiteout! Do not write over, scribble over or
cross out mistakes.
• 4. If you make a mistake documenting, or if you forget to document
when you have given a medication, you should circle the error in ink
and write a note of explanation on the log.
EXTEMPORANEOUS
COMPOUNDING OF
PHARMACEUTICAL PRODUCTS

ACTIVITY # 3
• Extemporaneous compounding
• On-demand preparation of a drug product.
• According to a physician’s prescription.
• Meets the unique needs of an individual patient.
Record Keeping
• Formulation Record
• Formulas and procedures (i.e., recipes) for what should happen
when a formulation is compounded.

• Compounding Record
• A record of what actually happened when the formulation was
compounded.

• Standard Operating Procedures (SOPs)

• Equipment maintenance, equipment calibration, handling and
disposal of supplies, etc.

• Material Safety Data Sheets MSDSs

• Ingredients records with certificates of purity.
Assigning a Beyond-Use Date
• Nonaqueous liquids and solid formulations
• If the source of the active drug is a manufactured drug product, the
beyond-use date is not later than 25% of the time remaining until
the drug product’s expiration date, or 6 months, whichever is
earlier.
• If the source of the active drug is a USP or NF substance, the beyond-
use date is not later than 6 months.

• Water containing formulations

• When prepared from ingredients in solid form, the beyond-use date
should be not later than 14 days when stored at cold temperature.

• For all other formulations

• The beyond-use date is not later than the intended duration of therapy
or 30 days, whichever is earlier.
Types of Equipment
• Measuring
• Balance, Molding
• weights, Hot plates,
• weighing containers, suppository molds,
• volumetric glassware capsule shells,
(graduates, pipets, flasks,
syringes). ointment slabs.
• Mixing
• Beakers, Packaging
• Erlenmeyer flasks, Prescription bottles,
• spatulas, capsule vials,
• funnels, suppository boxes,
• sieves, ointment jars.
• mortar and pestle.
Reason for Accurate Weighing
• Weighing of the product is one of the most essential parts
of the compounding process.
• Weighing the exact amount prescribed is essential in
compounds for several reasons:
• The product cannot be “checked” for content once mixed.
• The quantities weighed out are often very small, and a slight
overage could mean a serious overdose for the patient.
• SPATULA • MORTAR and PESTLE
• Used to transfer solid • The coarser the surface
ingredients or prepare of the mortar and pestle,
ointments and creams or the finer the trituration,
loosening material from grinding, than can be
the surface of a mortar done
and pestle Types
• Stainless steel
glass
• Hard rubber
Wedgewood
• plastic
Porcelain
• COMPOUNDING SLAB
• This is an ideal surface for mixing compounds because of its
nonabsorbent surface

• LEVIGATION
• Techniques used to reduce the particle size of a powder drug by
triturating it with a solvent in which the drug is INSOLUBLE
Volumetric Equipment
• Graduates
• Flask
• Pipets
• Syringes
TAKE NOTE:
• Droppers Selecting a graduated cylinder.
Choose the smallest one capable of containing the
volume to be measured.
Rule: Avoid measurements of volumes that are below 20 %
of the capacity of the graduated cylinder.

Example, a 100 ml graduated cylinder cannot accurately

measure volumes below 20 ml.

When measuring small volumes, such as 20 ml and less,

use a syringe or pipet.
Measuring Liquid Volumes
• Pour the liquid to be measured slowly into the graduate,
watching the level of the liquid in the graduate as you do
so.
• If the liquid is viscous, or thick, then you should attempt to
pour it toward the center of the graduate to avoid having
some of the liquid cling to the sides
Geometric Dilution (Mixing Powders)
• Solutions
• The most commonly compounded products.
• Clear (but not necessarily colorless) liquids in which the drug is
completely dissolved.
• The solubility of the drug must be known before attempting to dissolve it
in a solution. If a drug is not soluble in a vehicle, then no amount of
mixing will help.
• Some solids need to be triturated before mixing in a solution.

• Suspension
• A two phase system consisting of a finely divided solid dispersed
in a liquid.
• Flocculating Agent
• Electrolytes used in the preparation of suspensions to form particles that can
be easily redispersed.
• Thickening Agent
• Ingredient used in the preparation of suspensions to increase the viscosity of
the liquid.
Additives
• Flavoring
• The human tongue contains about 10,000 taste buds which
distinguish salty, bitter, sour, and sweet tastes.
• Sweeteners
• Colorless, odorless, solubility in water at the concentrations needed
for sweetening, pleasant tasting with no “after-taste,” and stable
over a wide pH range.
• Coloring
• Not required in every formulation.
• Contraindicated in all sterile solutions.
• Dark colors, such as dark purple, navy, black, and brown may also
be rejected because they are often associated with poisons.
• OINMENT
• Used as protectant, antiseptic, • EMULSION
emollients, antipruritic, • Emulsifier - a stabilizing agent
keratolytic and astringent in emulsions.
• Ointments are generally • commonly used emulsifying
compounded on an ointment agents include
slab and transferred into an • tragacanth, sodium lauryl sulfate,
ointment jar sodium dioctyl sulfosuccinate, and
polymers known as the Spans®
and Tweens®.
• Primary emulsion
• the initial emulsion to which
ingredients are added to create
the final product.

• Mucilage
• a wet, slimy liquid formed as an
initial step in the wet gum
method.
• Suppositories
• Three types of bases:
• Oleaginous
• primarily synthetic
triglycerides.
• Water soluble
• containing glycerinated
gelatin or polethylene
glycols (PEGs).
• Hydrophyllic :
• mixtures of oleaginous and
water soluble bases. Mold
Suppository box
• CAPSULE
• Hard gelatin capsules consists of
a body and a cap which fits firmly
over the body of the capsule
• For humans used, Eight sizes of
capsule are available
Punch Method
• Used when filling a
small number of
capsules
Labeling, Record Keeping, and Cleanup
After compounding
The product must be labeled with a prescription label, and
a careful record of the compounding operation should be
kept.
Once the compounding operation is finished
 The equipment and area should be cleaned.
 Everything should be returned to their proper places in storage.

NOTE:
Compounding should never be rushed.
• Regardless of their apparent stability, all suspensions
Should be dispensed with an auxiliary label reading
“Shake Well.”
• The qs abbreviation means to add “as much as
necessary” to the specified amount.
• JCAHO (Joint Commission on Accreditation of Healthcare
Organizations ) recommends using text words rather
than abbreviations to minimize a medication error.
DEVELOPMENT OF CARE
PLAN AND MEDICATION
REVIEW

ACTIVITY # 4
Pharmaceutical care planning
• Pharmaceutical care planning is a systematic, comprehensive
process with three primary functions:
• 1. Identify a patient's actual and potential drug-related problems.
• 2. Resolve the patient's actual drug-related problems.
• 3. Prevent the patient's potential drug-related problems.

• The pharmaceutical care plan is a written, individualized,

comprehensive medication therapy plan based on clearly defined
therapeutic goals.
• The pharmaceutical care plan, which is available to all pharmacists
caring for a patient, is updated with each major change in patient
status. It is important that the physician be informed about the care
plan to ensure common goals. Patients should also be informed about
the general content of the care plan as means of gaining their
agreement regarding drug therapy.
Objective of Pharmaceutical Care Plan
includes the following:
• To establish a good and uniformity of our care for patients
in regards with therapeutic issues, resolving, outcome
monitoring and side effects
• 2. To standardize the current procedure for clinical
pharmacy documentation
• 3. To bring us together and close a gap by having a same
understanding on dealing with pharmaceutical related
care issues.
• Create patient database
• The first step in the care planning process is the creation
of a comprehensive patient database, which includes at
minimum, the following information:
• 1. Patient demographics
• 2. Diagnoses and past medical history
• 3. Present medications and medication history
• 4. Medication allergies/intolerances
• 5. Smoking/alcohol/caffeine/drug use history
• 6. Abnormal laboratory and physical exam results
• 7. Renal and liver function
• 1. Collect and organize pertinent patient-specific
information
• Medical: weight & height, acute & chronic medical problems,
current symptoms, vital signs & other monitoring parameters,
allergies, past medical history, laboratory information

• Medication therapy: prescribed medications, nonprescribed

medications, medications used prior to admission, home remedies
& other types of health products used, medication regimen,
compliance

• Behavioral/lifestyle: diet, cigarette use/alcohol use, forms of

exercise, sexual history

• Social/economic: living arrangement, financial/insurance plan e

with therapy
2. Determine presence of medication-therapy
problems
review, integrate and analyze all available patient’s
data to identify medication-related problems.
TYPES OF MRP
• 3. Summarize patient’s healthcare needs
• collect all therapeutic goals and desired outcomes based on the
assessments of all involved healthcare practitioners

• 4. Specify pharmacotherapeutic goal

• therapy should be designed to achieve medication-related outcomes, and
improve patient’s quality of life

Therapeutic goals must be established for each drug-related

problem so that the pharmaceutical care planning process can be
effective. Therapeutic goals should be definite, realistic and, if
possible, measurable. Most therapeutic goals relate to:
• 1. Approach normal physiology (i.e., normalize blood pressure).
• 2. Slow progression of disease (i.e., slow progression of cancer).
• 3. Alleviate symptoms (i.e., optimize pain control).
• 4. Prevent adverse effects.
• 5. Control medication costs.
• 6. Educate the patient about his or her medication.
5. Design a pharmacotherapeutic regimen
should be designed for optimal medication use
within the health facility’s standard treatment guidelines
and the patient’s capabilities and financial resources

6. Design a monitoring plan for the

pharmacotherapeutic regimen monitoring plan
should effectively evaluate achievement of patient-
specific pharmacotherapeutic goals and detect real and
potential adverse effects; measurable and observable
parameters should be identified for each goal and end-
points should be established.
7. Initiate pharmacotherapeutic regimen
depending on the regimen and plan, pharmacist
may initiate all or portions of the regimen in collaboration
with all involved healthcare practitioners; all actions must
be documented in the patient’s health record.

8. Monitor the effects of the pharmacotherapeutic

regimen
changes in the patient’s status, condition,
medication and non-medication therapies must be noted
and documented accurately and consistently with the
monitoring plan.
9. Redesign the pharmacotherapeutic regimen and
monitoring plan
decision to change the regimen and plan should be
based on the patient’s outcome and must be documented
in the same manner as the original regimen and plan.
MEDICATION REVIEW

• A structured, critical examination of a patients medicines

with the objective of reaching an agreement with the
patient about treatment, optimizing the impact of
medicines, minimizing the number of medication-related
problems and reducing waste
• The most common medicines-related problems include
adverse drug reactions and treatment failures. Many of
these can be attributed to lack of monitoring and follow-up
of the effects of medicines, over or under-prescribing and
patients not understanding their medicines and not taking
them as prescribed.
Principles of medication review

• 1. All patients should have a chance to raise questions

and highlight problems about their medicines
• 2. Medication review seeks to improve or optimize
impact of treatment for an individual patient
• 3. The review is undertaken in a systematic way, by a
competent person
• 4. Any changes resulting from the review are agreed with
the patient
• 5. The review is documented in the patient‟s notes 6. The
impact of any change is monitored
There are a number of approaches to
medication review.
• These include:
• 1. Reviews that are carried out without patient involvement have value
but are not as effective as face-to-face discussion with the patient.
• A medication review that does not take account of what the patient actually takes –
rather than what is on the prescription or in the record – is incomplete. It is
important to know what the patient is actually taking, the response to
medication, whether the condition is worsening or improving and if there are
any unrecognized medical needs.

• 2. Face-to-face review also provides the opportunity to discuss the

patient‟s values and beliefs, and how taking medicine fits in with
the patient‟s daily life.
• It provides an opportunity to assess patient‟s knowledge of their medication.

• TAKE NOTE: Whatever the type of review, it is essential that the

patient is informed and involved in the decision making around
changes and is provided with opportunity to discuss and feedback
how they feel about their medication. Any aspect of a review which
leads to a change in medication must be discussed with the patient or
career.
Case Presentation
Check for:
ACTIVITY
• Regular workers of a semiconductor company were advised to undergo vaccination with
Antipneumonia vaccine. There were 50 employees vaccinated, just recently, during this time of
covid19 pandemic. After vaccination, the employees complained of body and muscle pains. Though,
one employee suffered from body and muscle pains and the emergence of rashes that was painful.
She felt as if suffering from a heart attack until she noticed that rashes developed on the breast and
back areas causing pain. The employee went to the company doctor for consultation. The doctor said
that the employee is having shingles. She prescribed the following medications:

• After taking the drugs, for the first dose the employee complaint of dizziness as well as
drowsiness.