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CHAPTER-7
PHARMACY & MEDICAL STORE PROCEDURE

1. Definition: Pharmacy is the subject which deals with the preparation and
dispensing of a drug and formulation of dosage suitable for administration.
2. Pharmacology: Pharmacology is a subject which deals with the source, physical

and chemical properties, physiological effects and mechanisms of action, absorption and
distribution of drug.
3. Drug: Drugs are chemical substances other than food, which when introduced
into the body, modify the body functions by producing interaction with the living cellular
elements and hence are used to diagnose, or to prevent or to control, or to cure a disease.
4. Differences between drug and medicine.
Drug Medicine
a. Drugs are active substances used to modify a. Medicines are finished products, which
physiological systems or, pathological states contain drugs in active form as well as the
for the benefit of the recipient. recipient.
b. Are with the generic name. b. Are with the brand, or trade name.
c. Do not have suitable forms and doses. c. Have suitable forms and doses.
d. Used to diagnose or to prevent or to control d. Used mainly for the treatment of a disease.
or to cure a disease. e. All medicines are drugs.
e. All drugs are not medicine.
5. Properties of an ideal drug:
a. A drug must have an appropriate size, shape and atomic composition.

b. A drug must have the properties to be transported from its site of administration to
its site of action.
c. A drug should be excreted from the body at a reasonable rate so that its action will
be for an appropriate duration.
COMMON DRUGS & THEIR USES

1. PARACETAMOL: (PARACETAMOL BP 500 mg) paracetamol is used as analgesic
and antipyretic and used in the treatment for relief of pain & reduce temperature e.g.
a. Indication
(1) Headache.
(2) Toothache.
(3) Arthralgia
(4) Myalgia.
(5) Dysmenorrhoea.
(6) Fever etc.
b. Contraindication:
(1) Hemophilia.
(2) Gastro-intestinal ulceration or lesions.
(3) Infants under 1 year.
c. Side effects: Gastro-intestinal irritation with slight asymtomatic blood loss,
increased bleeding time, bronchospasm and skin reactions in hypersensitive patients. Prolonged
administration gives rise to hearing disturbances such as tinnitus.
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d. Dose: Adult:- 300 mg to 900 mg, 4-6 hourly when necessary (usually
after meal) daily.
2. PIRITON (CHLORPHENIRAMINE MALEATE 4 mg): Piriton used as antihistamine

& anti allergic drug.
a. Indication:
(1) Nasal allergy and congestion.

(2) Allergic emergencies.
(3) Angio-oedema.
(4) High fever.
(5) Insect bite.
(6) Acute anaphylaxis.
(7) Cough.
b. Contraindications:
(1) Drowsiness.
(2) Dryness of mouth.
(3) Gastro-intestinal disturbances.
c. Dose: Oral 12 mg daily in divided doses.
3. ANTACID (ALUMINIUM HYDROXIDE + MAGNESIUM TRISILICATE): It is used

as anti dyspeptic & anty Hyperacidity drugs.
a. Indications
(1) Hyperacidity
(2) Gastric ulcer.
(3) Duodenal ulcer.
(4) Gastritis.
(5) Heart burn.
(6) Dyspepsia.
b. Contraindication: Hypophosphataemia : if simethicone is added, contra-
indicate in renal failure, severely debilitated patient.
c. Side effect: Diarrhoea, Constipation, Nausea, Vomiting.
d. Dose: 1-2 tabs chewed half to 1 hour after meals 3 times or 4 times daily.
4. HYOSCINE N BUTYL BROMIDE (BUTAPAN)
a. Indications:
(1) Aid in peptic ulcer treatment.

(2) Spasmodic pain.
(3) Gastro-intestinal spasm.
(4) Biliary spasm.
(5) Spasmodic dysmenorrhoea.
b. Contraindications:
(1) Glucoma.
(2) Pyloric stenosis.
(3) Prostatic enlargement.
(4) Intestinal obstruction.
(5) Paralytic ileus.
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c. Side effects: Dry mouth with difficulty in swallowing & thirst, dilatation
of pupils with loss of accommodation & sensitivity to light.
d. Dose: By mouth, Adult 10mg 3 times daily. By injection, 20 mg I.M or

I.V 8 hourly or SOS
5. METOCLOPRAMIDE (MOTILON)
a. Indication:
(1) Nausea & Vomiting particularly due to gastrointestinal disorders.

(2) Migraine.
(3) Congestive heart failure.
(4) Post operative condition.
(5) Intolerance to drugs (i.e. vomiting) etc.
(1) Drowsiness.
(2) Constipation.
(3) Extra pyramidal affect (specially in children)
c. Dose: 10 mg 3 times daily or SOS.
6. DEXAMETHASONE (ORADEXON)
a. Indication:
(1) Severe asthma.

(2) Rheumatoid arthritis.
(3) Shock and adrenal crisis.
(4) Allergic skin conditions etc.
c. Contraindication:
(1) Active peptic ulcer.
(2) Psychosis.
(3) Renal dysfunction.
(4) Diabetes mellitus.
(5) Glucoma.
(6) Hypertension.
(8) Tuberculosis.
(9) Local or systemic infections unless controlled by chemotherapy.
c. Side effects: Hypertension, Osteoporosis, Peptic ulceration which may.
d. Dose: Dose: By mouth: Adult 1.5 mg-3mg daily in divided dose

reducing by 0.25 or 0.5 mg every 3 or 4 days to maintenance 0.5-1.5 mg daily.
7. AMINOPHYLLINE
a. Indication:
(1) Bronchospasm associated with :
(a) Asthma.
(b) Emphysema
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(c) Chronic bronchitis
(2) Left ventricular failure.
(3) Cardiac asthma.
b. Side effect:
(1) Tachycardia
(2) Palpitations.
(3) Nausea.
(4) Cardiac arrhythmias and convulsions specially if given rapidly by I.V
injection.
c. Dose:
(1) By mouth: Adult initially 100-300 mg bid for one week, then
maintenance dose of 200-600 mg bid.
(2) By injection: 250-500 mg slow by I.V injection in I.V drip.
8. HYDROCORTISONE
a. Indication:
(1) Medical emergencies amenable to intensive corticosteroid therapy

(a) Status asthmatics.
(b) Acute adrenaline crisis.
(c) Cardiogenic haemorrhagic anaphylactic or septic shock
(d) Shock due to burn.
b Contraindication:
(1) Tuberculosis.
(2) Active peptic ulcer.
(3) Psychosis.
(4) Renal dysfunctions.
(5) Diabetes mellitus.
(6) Glucoma.
(7) Hypertension.
(9) Pregnancy.
c. Side effects:
(1) Hypertension
(2) Sodium retention
(3) Potassium loss.
(4) Muscle weakness.
(5) Diabetes.
(6) Osteoporosis (particularly in elderly).
(7) Mental disturbances.
(8) Euphoria is frequently observed.
(9) Peptic ulceration which may result in haemorrhage or perforation.
(10) Suppression of growth (in children).
(11) Spread of infections.
(12) Adrenal suppression.
(13) Menstrual irregularities.
(14) Overdoses may cause Cushing’s syndrome with moon face, striae and
acne.
d. Dose: 100 mg-500 mg. IV repeated as necessary every 2-6 hours.

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9. ATROPINE SULPHATE (ATROPINE)
a. Indication:
(1) Aid in peptic ulcer treatment

(2) Gastrointestinal spasm.
(3) Renal colic and
(4) Biliary colic etc.
(5) As mydriatic.
(6) Organophosphorus poisoning.
b. Contraindication
(1) Glucoma.
(2) Prostatic enlargement.
(3) Intestinal obstruction.
(4) Pyloric stenosis.
(5) Paralytic ileus.
c. Side effects:
(1) Dry mouth with difficulty in swallowing & thirst.

(2) Dilatation of pupils with loss of accommodation and sensitivity to light.
(3) Increased intraocular pressure.
(4) Flushing.
(5) Dry skin.
(6) Bradycardia followed by tachycardia, palpitations and arrhythmias.
(7) Difficulty with micturition.
(8) Constipation.
d. Dose: By mouth 0.25-2 mg daily in single or divided doses. By injection 0.25-2

mg S.C or I.M injection.
10. ADRENALINE
a. Indication:
(1) Bronchospasm.
(2) Chronic bronchitis
(3) Emergency treatment of acute anaphylaxis.
(1) Hyperthyroidism.
(2) Hypertension.
(3) Coronary disease.
c. Side effects:
(1) Anxiety.
(2) Tremor.
(3) Tachycardia.
(4) Cardiac arrhythmias.
(5) Cardiac disease.
(6) Diabetes should not be used within 2 wks of MAO inhibitors not to be
given intravenously because of increased risk of cardiac irregularities.
d. Dosage:
Bronchospasm: As a single dose by S C or I M or oral inhalation of nebulised
solution 200-500 mcg by aerosol inhalation by S C or I M injection 0.5-1 mg daily.
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11. FRUSEMIDE ( lasix)
a. Indication:
(1) Cardiac oedema.

(2) Hepatic or renal origin.
(3) Toxemia of pregnancy.
(4) Mild or moderate hypertension.
(1) Pre-comatose state associated with liver cirrhosis.
c. Side effect:
(1) Rashes.
(2) Tinitus and
(3) Deafness in impaired renal function.
d. Dosage
Adult: By mouth, 20-80 mg once or twice daily by I.M or I.V (slow) injection 20-40-
mg.
12. METRONIDAZOL (FLAGYL): It is an anti-protozoal drug.
a. Indication:
(1) Amoebic.
(2) Liver abscess.
(3) Giardiasis.
(4) Trichomonal vaginitis.
(5) Ulcerative stomatitis and.
(6) Amoebic infections of other organs.
(1) Pregnancy (1st trimester).

(2) Active CNS disease.
c. Side effect:
(1) Nausea.
(2) Headache.
(3) Drowsiness.
(4) Dizziness.
(5) Rashes.
(6) Metallic taste etc.
d. Dose: 200-800 mg 3 times daily for 5-7 days
13. AMOXYCILLIN (FIMOXYL)
a. Indication Amoxycillin is broad spectrum antibiotic used in the treatment of:-

(1) Respiratory tract infection.
(2) Ear infection.
(3) Nose and throat infection.
(4) Biliary tract infection.
(5) Urinary tract infection.
(6) Soft tissue and skin infection
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(7) Gonorrhoea.
(8) Prophylaxis of bacterial endocarditis.
(9) Typhoid fever and.
(10) Dental prophylaxis etc.
(1) Penicillin sensitive patients.
c. Side effect:
(1) Allergic manifestations.

(2) Diarrhoea.
d. Dose: By mouth, 250 mg (or500 mg in severe infections) every 8 hours.

in capsule form. By I M 500 mg every 8 hours in injection form.
14. COTRIMOXAZOLE (COTRIM)
a. Indication: Broad-spectrum chemotherapeutic agent specially used in the treatment of

(1) Typhoid fever.
(3) Genito-urinary tract infection.
(4) Skin and soft tissue infections.
(5) Bone and joint infections.
(6) Sinusitis.
(7) Gonorrhoea in penicillin allergic patient.
(1) Pregnancy.
(2) Infants under 6 weeks.
(3) Renal and hepatic failure.
(4) Jaundice and blood disorder.
c. Side effect:
(1) Nausea.
(2) Vomiting.
(3) Skin rash.
(4) Eosinophilia.
(5) Agranulocytosis.
(6) Leukopenia & Megaloblastic anaemia due to trimethoprim.
d. Dose: 960 mg 12 hourly.
15. CIPROFLOXACIN (CIPROCIN)
a. Indication:
(1) UTI.
(3) Infection of ear.
(4) Infection of nose.
(5) Infection of throat.
(6) Infection of eye.
(7) Infection of skin & soft tissue.
(8) Infection of bone, joints.
(9) Infection of G.I tract.
(10) Gonorrhoea etc.
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(1) Growing adolescents.

(2) Pregnancy and lactation
(3) Epilepsy and history of CNS disorders.
(4) Except where benefits exceed risks.
c. Dose: 500 mg twice daily oral & injectable form.
16. ASPIRIN Aspirin is a analgesic drug.
a. Indication:
(1) As analgesic (Mild to moderate pain including )

(a) Headache.
(b) Toothache.
(c) Earache etc.
(2) As antipyretic.
(a) Fever,
(b) Rheumatic fever.
(3) As anti-inflammatory and anti-rheumatic

(a) Rheumatic arthritis.
(b) Heart diseases.
(4) As antithrombotic drug (reduce platelet adhesion)
(1) Hemophilia.
(2) Gastro-intestinal ulceration or lesions.
(3) Infants under 1 year.
c. Side effect: Gastro-intestinal irritation with slight asymtomatic blood loss,

increased bleeding time, bronchospasm and skin reactions in hypersensitive patients.
Prolonged administration gives rise to hearing disturbances such as tinnitus.
d. Dose: Adult: - 300 mg to 900 mg in water, 4-6 hourly when necessary

(usually after meal) daily.
16. DIAZEPAM (Seduxen/Easium)
a. Indication:
(1) Anxiety.
(2) Insomnia
(3) Night terrors in children.
(4) Adjunctive treatment of acute alcohol withdrawal.
(5) Epilepsy and other convulsion.
(1) Acute pulmonary insufficiency

(2) Respiratory depression.
c. Side effects:
(1) Drowsiness.
(2) Dizziness.
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(3) Ataxia (particularly in elderly) occasionally confusion.
(4) Dry mouth.
(5) Respiratory depression of i.v. Inj. pain & thrombophlebitis.
(6) Neuromuscular disorders.
(7) Closed angle glaucoma.
(8) Respiratory disease.
(9) Late pregnancy.
(10) Nursing mothers.
(11) Reduce dosages in elderly & debiliated patients.
(12) Liver disease.
(13) Renal impairment.
(14) Patient’s ability to avoid alcohol & other CNS depressants.
(15) Avoid abrupt withdrawal.
d. Dose: Anxiety- 2 mg 3 times daily, Insomnia- 5 –30 mg (Maximum) at bed time.
17. PROCHLORPERAZINE MALEATE (STEMETIL, VERGON)
a. Indication
(1) Nausea.
(2) Vomiting.
(3) Vertigo.
(4) Migraine.
(5) Labyrinthine disorders
(6) Minor mental and emotional disturbances.
b. Contraindication
(1) Comatose state.

(2) Bone marrow depression.
(3) Liver damage.
c. Side effect
(1) Dry mouth.
(2) Drowsiness.
(3) With high dose extrapyramidal symptoms may occur particularly in
children. e.g
(a) Facial spasm.
(b) Trismus.
(c) Torticollis etc.
c. Dose By Mouth- 5-20 mg in divided (3) dose., By Inj Adult –12.5 mg by deep I
M, Child-Syrup.
18. RANITIDINE: Ranitidine is the drugs which reduces acid secretion by blocking
the H2-Receptors in the gastric parietal cells.
a. Indication
(1) Duodenal ulcer.

(2) Gastric ulcer (benign).
(3) Zollinger-Ellison syndrome.
(4) Reflux oesophagitis.
(5) Stress ulcers.
(6) Pre anaesthetic medication in emergency operations (To reduce the danger
of acid gastric secretion).
(7) To prevent:
(a) Ulcer due to intensive burn.
(b) Cushing ulcer due to head injury.
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b. Side effect
(1) Headache.
(2) Dizziness.
(3) Nausea.
(4) Skin rashes and itching (Rarely) and
(5) Diarrhoea may occur.
c. Dose: Oral:-Tablet-150 mg twice daily or 300 mg at bed time for 6-8 weeks,
Parenteral:- I.V or I.M 50 mg 6-8 hourly.
19. MORPHINE Morphine used as narcotic analgesics.
a. Indication
(1) As analgesic to relieve severe pain in

(a) Acute myocardial infarction.
(b) Acute pericarditis.
(c) Pleurisy.
(d) Post operative pain.
(e) Fracture of bones.
(2) As anxiolytic to relieve serous and frightening disease like.

(a) Circulatory shock.
(b) Severe haemorrhage.
(c) Accidents etc.
(3) Preoperative medication (as a basal anaesthetic)
b. Contraindication
(1) Acute respiratory depression like –asthma.

(2) Obstructive airways disease.
(3) Acute alcohol intoxication.
(4) Acute abdomen.
(5) Convulsion disorder.
(6) Hepatic function impairment.
(7) Raised intracranial pressure.
(8) Pregnancy (3rd trimester).
(9) Urinary retention.
(10) Biliary colic etc.
c. Side effects:
(1) Drug dependence and addiction.

(2) Nausea.
(3) Vomiting
(4) Severe constipation.
(6) Drowsiness.
(7) Difficulty in micturition.
(8) Ureteric and biliary spasm.
(9) Sweating.
(10) Dry mouth.
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(11) Facial flushing.
(12) Vertigo.
(13) Bradycardia.
(14) Palpitation.
(15) Postural hypotension.
(16) Hypothermia.
(17) Hallucination.
(18) Mode change.
(19) Miosis.
(20) Urticaria.
(21) Pruritus
Dose of morphine: Acute pain- by S C or by I M injection 10 mg 4 hourly, Preoperative

sedation- by S C or I M inj up to 10 mg 60-90 minutes before operation, Postoperative pain- by S
C or I M inj 10 mg every 2-4 hours, Myocardial infarction- by slow I V inj 2 mg /Minute.
20. PETHIDINE In is a narcotic analgesic
a. Indication
(1) As an analgesic in
(a) Labour.
(b) Renal colic.
(c) Minor surgery.
(d) Ophthalmology.
(e) Dentistry.
(2) Pre-anaesthetic medication.
(3) Maintenance of general anesthesia.
(4) Relief of spasm of :
(a) GIT.
(b) Uterus.
(c) Urinary bladder.
b. Contraindication

(2) Obstructive airways disease.
(3) With or within 2 weeks of MAO/S
c. Side effect
(1) Dependence with addiction.
(2) Dizziness.
(3) Nausea.
(4) Vomiting.
(5) Tachycardia
(6) Cardiovascular and respiratory depression.
d. Dose: General analgesia –50 mg-100 mg I.M daily 4-6 hourly or 25-50 mg by
slow I.V injection.
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ROUTES OF ADMINISTRATION OF DRUGS WITH EXAMPLE
1. The main routes of administration of drugs are as follows:-
a. Systemic routes
(1) Enteral routes
(a) Oral routes: Ampicilline, Aspirin
(b) Buccal routes: Thymol glycerin
(c) Sublingual routes: Nitroglycerin
(d) Rectal routes: Bisacodyle, Mono-chlor-carbacol
(2) Parenteral routes
(a) Injection
i. Intradermal/Intracutaneous routes: B C G -Vaccine
ii. Subcutaneous routes: Insulin, Adrenalin
iii. Intermuscular routes : Benzyle penicilline
iv. Intra veineous routes: Aminophylline, blood
v. Intra arterial routes: Floxuridine,Tolazoline.
vi. Intra-thecal routes: Methotrexate, Epidural.
vii. Intra- cardiac routes: Adrenalin, Steroid.
viii. Intra peritoneal routes: Cytotoxic drugs
ix. Intra-articular routes: Corticosteroids.
(b) Inhalation.
i. General anaesthesia
ii. Sulbutamol
iii. Addrenalin.
b. Local routes
(1) Topical routes:
(a) Skin: Scopolamine
(b) Eye: Chloramphenicol
(c) Ear: Neomycin 0.5%
(d) Nose: Xylomatazoline 0.1%
(2) Iontophoresis.
Advantages and disadvantages of subcutaneous routes:
Advantages Disadvantages
a. Self medication is possible a. Large volume of drug is difficult to
b. It is a safe and simple route. administer.
c. Drug effect is sustained and uniform due to b. Infection, irritation or necrosis to the site of
slower absorption. injection may occur.
c. Discoloration of the skin may occur.
Advantages and disadvantages of intra muscular routes:
a. Drug effect is rapid and reliable. a. In is a painful route.
b. Moderate volume of drug (not>5ml) can be b. Self medication is not possible.
administered. c. Local inflammation, infection, irritation,
c. Slight irritant drugs can be administered. hematoma formation, etc. or nerve injury may
d. Suitable for depot preparations (e.g. occur.
medroxy progesterone) d. Not-suitable for administration of large
e. First pass metabolism can be by passed. volume of drug.
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Advantages and disadvantages of intra venous routes:
a. Rapid onset of drug action, hence it is a. Strict aseptic measure is necessary.
termed the route of emergency. b. Self medication is not possible.
b. Bio-availability is 100% c. Increased risk of adverse effects.
c. Suitable for administration of large volume d. Extravasations, air-embolism, thrombosis,
of drug. inflammation, abscess etc. may occur.
d. Irritant, unpleasant drug or hypertonic e. Not suitable for oily solution, or insoluble
solution can be given. and solid substances.
e. First pass metabolism of drugs can be by f. Should be administered slowly and
passed. carefully.
f. Suitable for unconscious patients and g. Duration of drug action is short due to
vomiting or diarrhea cases. rapid excretion.
g. Drug administration can be stopped, if
adverse effect develops.
Advantages and disadvantages of inhalational routes:
a. Rapid onset of drug action, due to a. Dose regulation of the drug is difficult.
immediate absorption. b. Pulmonary epithelium may be irritated.
b. Local desired site of action. c. It is a difficult method of drug
c. First pass metabolism is by-passed. administration.
Advantages and disadvantages of sublingual routes:
a. Drug absorption is quick and reliable so a. Larger dose of drug can not be
onset of action is rapid. administered.
b. No chance of destruction by gastric juice. b. Lipid insoluble drugs can not be
c. First pass metabolism is by-passed. administered.
d. Excess drug can be spitted out. c. Not suitable for irritant drugs.
e. It is a simple and painless route. d. Inconvenient for unconscious or non co-
operative patients.
4. RECTAL ROUTE
a. Advantages
(1) It is suitable for children.

(2) Irritant drugs can be given as suppository.
(3) It is a suitable route in vomiting, motion sickness and non co-operative
patients.
b. Disadvantages:
(1) Patient may be embarrassed.

(2) Rectal inflammation may occur with repeated use
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INDENT
1. Definition It is an order form for medical stores items. (Drugs, Chemicals, Gases,
Equipment &Appliances).
2. Types of indent: The following are the main categories of indents in use in the
Armed forces Hospital and other institutions:
a. Initial supply: It is issued according to the instructions contained in the raising

letter. No indent is required to be prepared and supplies are automatically received by the
unit from AFMSD.
b. Expansion Indents. These indents are submitted only if specifically authorized in
a expansion letter or on the MME scale having been enhanced.
c. Maintenance Indents. These indents are submitted on quarterly basis and include
both expendable and non expendable items. The demands are based on the consumption
during the previous quarters. These indents should reach the depot before.
(1) 15th October for the 1st quarter of the following year.
(2) 15th January for 2nd quarter of the current year.
(3) 15th April for 3rd quarter of the current year.
(4) 15th July for 4th quarter of the current year.
d. Controlled stores indents. These are submitted on quarterly basis like

maintenance indent.
e. Replacement indents. These indents are required to be submitted when the
equipment of a unit has been sent for deposit/ repairs and the unit needs their replacement
urgently.
f. Emergent indents. These indents are meant for emergent demand only which
for some reason were not foresees previously. These can be submitted as and when
required during the quarter such indents should be few and far between.
g. Urgent indents Units may send signals for non controlled medical store
urgently to AFMSD keeping DGMS informed. Such demand will be compiled with by
AFMSD immediately but receipt copies of these issue vouchers will have to be
countersigned by the DGMS before returning them to the MSD (Medical Store Depot).
This must not be done as a matter of routine.
3. Preparation of indents and calculation of demands.
a. It is very essential that the all indents should be carefully prepared and submitted
in due time. Incorrect indents and delay in submission will not only cause inconvenience
to the depot but also delay supplies to other units as the allotment have to be worked out
on Armed Forces basis.
b. The following points must to be kept in mind during the preparation of indents:
(1) PVMS book must be carefully studied and kept amended up-to date.
(2) BAFM-1216 (indent form) small or large should be carefully filled in
c. The following columns required attention:
(1) Name of the indenting unit and its address.
(2) Number, date and classification of the indent.
(3) Authority Government letter or MME scale.
(4) Name of the nearest railway station.
d. Separate sheet should be used for each section of the PVMS. Each sheet must
show the name of the unit its address, the indent number and date.
e. All the columns of the body of the forms also need to be filled in carefully and
demands calculated correctly.
(1) PVMS no. and correct nomenclature should be entered in columns 2 and
3.
(2) Accounting unit should also be mentioned.
(3) Quantity in stock and average monthly consumption (Columns 5 and 6
should be filled in with the figures actually taken from the ledgers and averages
worked out correctly).
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(4) Filling of columns 7 (Quarterly demand) needs maximums care. Figures in
columns 6 (Average monthly consumption) should be multiplied by 6 and the
quantity in stock (Columns-5) should be deducted from the product. This gives
the quantity required, and should, however, in no case exceed 3 times of the
average monthly consumption. If the indent for the current quarter has not yet
materialized and is probably in transit, the average monthly consumption should
then be multiplied by the figure ‘3’ and not 6 and the quantity of stock in column
5 to be deducted.
PROCEDURE OF DRUG TEST
1. Occasions for sampling: Under the following circumstances the drug will be sent to the
AFF & DL for analysis and report.
a. On the expiry of the life of a drug.
b. The turn over period.
c. On apparent change in physical characters.
d. On occurrence of toxic reactions.
2. The following precautions in sending the samples are very important and must invariably
be followed.
a. The quantity required for test and analysis to any sample is given in annex ‘B’ The
samples as far as possible be sent in original containers.
3. Quantity required for test and analysis of drug samples
a. Tablets 100 Tablets

b. Capsules 100 Capsules
c. Liquid oral preparation (Syrup, elixir, Mixture, Suspension)
(1) 2 Ounces packing 6 Phials.
(2) 4 Ounces packing 3 Phials
(3) 8 Ounces packing 2 Phials
(4) 1 Pound packing 1 phials
e. Antibiotic dry Mixture (for reconstitution of syrup/suspension) 4 Phials
f. Injection
(1) Antibiotics 30 ampoules
(2) Vitamin 30 ampoules
(3) Other preparation (1 ml, 2 ml, 5 ml) 50 ampoules
(4) Other preparation(10 ml & above) 30 ampoules
(5) Atropine sulphate/Morphine sulphate 60 ampoules
(6) Water for injection 100 ampoules
g. Raw materials (solid /Powder) 250 gms
h. I.V. Fluid (500 ml, 1000 ml) 3 Bags/Bottles
j. Ointment 50 gms
k. Eye preparation 20 Packing unit.
l. Reagents 2 Bottles.
4. Procedures of sampling
(a) It is necessary that sampling should be carried out by batch number and samples
drawn in the clean dry containers preferably in glass bottles.
(b) In the case of drugs which decompose rapidly on exposure such as Hydrogen
peroxide, liq Ammonia fortis etc is desirable to send the original sealed bottles/
tins as received.
(c) The quantity sent for test will be charged off the ledger by the sender at his end on
receipt of a certificate from the AFF & DL that the sample has been expended in
test. Regular issue vouchers on this account will not be entertained by the COAFF
&DL.
(d) The samples will be sent on the proforma giving in appx ‘C’.
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5. Proforma for samples of med stores for testing & analysis
a Designation of Officer sending samples
b. Postal address.
c. Proforma number.
Nomenclature (General Name)
Type of acen (i.e. store)
Name of Manufacturer
Qty sent for exam

Source of receipt
Type of Package
Date of receipt
Qty in stock
PVMS No
Batch No
Remarks
DOM
DOE
S.No
A/U
(a) (b) (c) (d) (e) (f) (g) (h) (i) (j) (k) (l) (m) (n) (O)
6. Distribution of test reports
(a) The test reports are to be sent to the units with copies to DGMS, DMS by AFF
&DL
(b) AFMSD checks own stocks and segregate the items affected by the unfavorable
reports. The total stocks are then intimated to the DGMS who may also call for similar
information from all the units.
7. Check tests and disposal of stock: When the stock is large, check test will be done
on confirmation of deterioration or toxicity. Aboard of survey on the authority of test report will
give disposal
8. Important precautions: The commanding officer of the unit will ensure.
a. Batch numbers and dates quoted on complaints, test requested and stock returns
are correct.
b. That the toxic reactions are due to the drug and not to faulty technique in
administration.
c. The stock condemned is destroyed in the persence of the board with out waiting
far the approval by the DMS/ ADMS
SURVEY PROCEDURE OF ELECTROMEDICAL EQUIPMENT’S
1. It requires a BLR (Beyond Local Repair) class v certificate from EME work shop to hold
a survey board. After getting the BLR class v certificate permission to be taken from
DGMS.
2. After obtaining permission from DGMS a survey board to be constituted by CTM which
comprises one president and two members (Concerning specialist, a field officer and
EME representative) the senior most officer will be the president.
3. On the day of survey the unserviceable equipment is to be shown to the board with all
supporting documents. Signature to be taken by the members and president of the board
on all the five copies of AFA-2 which are prepared earlier.
4. Proceeding of survey boards to be countersigned by CO of the hospital.
5. After that four copies are to be sent to DGMS via NHQ (DMS) for approval by DGMS
and one copy to be kept in the office for records.
6. After approval one copy is kept in the DGMS office, one copy to be sent to AFMSD and
remaining two copies to be dispatched to NHQ to sent it to individual unit NHQ will keep
one copy as office copy and one copy will be dispatched to individual unit.
7. After receiving the approval copy by the unit, the items to be charged off vide DGMS
letter no and the item to be sent to AFMSD on regular issue voucher with a copy of
survey board proceeding. All necessary documents (log book, catalog, BLR certificate) a
representative also to be sent to AFMSD to hand over the items.
8. The unit will raise a replacement indent to get the replacement of surveyed items.
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CONSTITUTION OF SURVEY BOARD

1. The constitution of the board will depend on the type of the stores to be surveyed. In case
of drugs, only medical specialist will be a member and a field officer will be the president. In
case of surgical equipments and instruments only or mixed stores a surgical specialist and an
EME representative will be other members.
2. For the survey of X-ray and Electromedical equipments the board will be constituted by
the AFMSD/ DMS and in case of checking the receipt stores by the CO of the unit. The board
proceeding will be approved by the concerning authority.
OCCASIONS OF SURVEY BOARD
1. The followings are the occasions when survey board will be held.
a. Routine quarterly survey board- To check the fitness of drugs and serviceability
of the equipments.
b. To check the all consignments received from AFMSD for fitness or serviceability
and to find out any discrepancy.
c. To survey all the surplus stores so declared by the OI/C Medical stores before
their final disposal.
d. To assess the condition of any equipment before sending it for repair or to the
salvage depot.
e. On disbanding of a unit.
f. Before handing or taking over of Medical stores or when considered necessary by
the commanding officer of the unit.
STORAGE OF SOLUTIONS AND CHEMICALS
1. Stock solutions and chemicals should be stored in a separate room away from sensitive
materials, a cool, dry, well ventilated room chosen for the purpose.
2. If solid chemicals are stored in sealed tins. Them it will remain fresh at temperature
between 0-430 C. Some chemicals will absorb moisture whilst others are known to give
up water content so that chemicals not stored in sealed tins are often unreliable because
there dry chemical content is in determinate.
3. Liquids must be stored away from the effects of heat or extreme cold and should never be
kept upon shelves near a window.
4. Solutions should be put into well stoppered bottles. Developer which is to be kept for
some time should be filled in the bottle right up to the cork and a little wax run round the
injection of the bottle neck and the cork to form an airtight seal.
TURN OVER OF SHORT LIFE MEDICINE
1. The turn over period: Turn over means that the old stocks which are likely to
become time expired and thus unfit for use must be consumed forth with and to be replaced by
fresh stocks. Items which are required to be stored for a considerable time e.g. the reserve
medical stores must be turned after a specified period.
STORAGE OF VARIOUS DRUG CHEMICAL AND EQUIPMENT
1. Antibiotics
a. All types of antibiotics should be stored in the dry state in sterile containers and at
a temperature not exceeding 150 C in a dry place. The stability of the antibiotics is closely
related to their moisture. Contents with crystalline forms containing less then 0.5 percent
of moisture retain their potency even at room temperature for two to three years.
Solutions, creams etc are deteriorated much more rapidly specially above 400 C and at
room temperature the loss of potency is considerable within 24 hours
b. Both the crystalline substance and its solutions are remarkably stable and may be
stored at room temperature.
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2. Volatile drugs: All these substances including volatile anesthetics should be stored
in cool storage. The facilities are not available; they may be kept in a dark dry and cool
place. The highly inflammable one should be stored in an isolated building under
adequate fire precautions.
3. Acid and alkalis Should be stored separately in glass containers. These should not
be allowed to come in contact with the body clothes.
4. Rubber Articles They should be kept in inflated condition, properly powdered with
chalk/talcum powder and to be kept in well ventilated place. They should be frequently
turned over.
5. Grouping Sera All blood grouping sera should be stored between 4-60 C
6. Blood infusion sets: ACD/CPD bags of 450 ml capacity including 63 ml
Anticoagulant are used now a day. These sets are supplied by the AFMSD. Blood
collected in ACD and CPD bags can be kept for 21 and 28 days respectively at 4-60 C
LOCAL PURCHAGE PROCEDURE
1. Local purchase of medical stores and spares of electro medical equipment has been
authorized in order to meet the urgent and life saving demands of consumer units and will
be done by the CO unit
2. Funds for local purchase
DGMS place funds at the disposal of units. Only life saving items of medical store
prescribed by concerned specialist and not available will be purchased locally
OINTMENT
1. Definition An ointment is a semisolid preparation containing some active ingredients
containing fatty base, intended for external application with or without rubbing e.g. sulphar
ointment.
2. Active ingradient:
a. Sulphur.
b. Salicylic acid.
c. Benzoic acid etc.
3. Base:
a. Soft paraffin.
b. Wool fat.
c. Soft fat etc.
4. Preparation
a. Ung white field
(1) Acid salicylic-15 gr
(2) Acid benzioc-25 gr
(3) Soff jparaffin-01 OZ
b. 10% Sulphur oint
(1) Sulphur-45 gr
(2) Vaselin-01 Oz
c. 3% Salicylic Acid oint.

(1) Salicylic acid- 15 gr
(2) Vaselin-01 Oz
d. Resorcinal and sulphur oint
(1) Sulphur-6.25 gm
(2) Zinc Oxide-37.5 gm
(3) Resorcinal-6.25 gm
(4) Emulsifying oint 50 gm
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DROP
1. Definition Drop is sterile fluid preparation containing one or more active ingredient
which is used into the eye, nose and ears e.g. Betnosol N eye drop
a. 0.5% Chloramphenical eye/Ears drop
(1) Chloramphenical-500 mg
(2) Dist. Water-100 ml
b. 2% Penicillin eye drop
(1) Penicillin-500000 IU.

(2) Distilled water 025 ml
c. Glycerin in glucose drop
(1) Anhydrous glucose 10 gr

(2) Glycerin –01 Oz
d. Hydrogen peroxide drop
(1) Hydrogen peroxide -25 ml

(2) Distilled. Water –100 ml
e. Ephedrine hydrochloride drop
(1) Ephedrine hydrochloride -=04 gr
(2) Normal saline –01 Oz
RECEIVE, ISSUE AND MAINTENANCE OF MEDICAL STORE.
1. Receive:
a. All items of medical stores and equipment’s are to be received from Armed
Forces Medical Store Depot through proper authority.
b. The items which are not supplied from AFMSD are to collect from local market
as local purchase medicine as advised by concern specialist.
c. Received from various Naval ships and established as short life and slow moving
items.
2. Issue: There are mainly two ways of medical stores issue such as.
a. Main medical store.

(1) Sub medical store.
(2) Ward and various departments etc.
(3) CWC.
b. Sub medical store: Direct issue to the patient.
3. Storage:
a. Stock of any medicine for future use. Various drugs are stored in different
condition according to its properties and use. The drug should be stored according to the
size of the container for quick supply disposal.
b. Stock on shelves in the store should be kept away from floor, wall and ceiling.
The lowest shelf should be at best 1 ft from floor and highest not less than 3 fit from
ceiling, but the height should be convenient for easy access. The distance between the
stacks and walls should be not less then 3 ft and stacking against the walls should not be
done. A distance of about 3 ft should be left between the stacks.
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c. Keep the store clean and free from dust which contains numerous spores and
living organisms causing infestation of the stores should be avoided as for as possible.
d. Bottles, tins, packages etc are best stored in shelves, Ampoules and other such
small containers may be kept in a series of metal trays which should be labeled and
numbered and placed in shelves like other containers in a cub board. Each item should be
carefully numbered and labeled.
e. Storage of antibiotics: All types should be stored in the dry state in sterile
containers and at a temperature not exceeding 150 C in a dry place. The stability of the
antibiotics is closely related to their moisture content. Crystalline forms containing less
than 0.5 percent of moisture retain their potency even of room temperature for two to
three years.
f. Syrup: Syrup should be kept in a separated room in cool and dry place.
g. Fluid: Fluid should be kept in cool and dry place.
h. Vaccines and sera: According to BPC the liquid preparation should be

protected from light and stored at 20 C-80 C
j. Corrosive materials: Corrosive materials should be in a separate room. They

should not be placed in shelves with the other items written above but should be stored
directly on floor.
k. Rubber Articles: They should be kept in inflated condition properly

powdered with chalk/talcum powder and kept in well ventilated places. They should be
frequently turned over.
l. Medical gas cylinder: Cylinders should be stored are separate room keet dry and
clean and well ventilated places.
VARIOUS UNITS OF MEASUREMENT
1. Weights in metric system
1 Kilogram (kg) 1,000 grammes 2.216

1 gramme (G) - 15.43 frains
1 decigram (dgm) 0.10 gramme 1.43 frains
1 centigram (cgm) 0.01 gramme 0.15 grains
1 milligram (mgm) 0.001` gramme 0.015 grains
2. Measurement of fluid: Two systems are employed in pharmacy ig. The imperial
and the metric systems to measure the volume of fluid.
a. Metric system of capacities: 1 litre is the volume of 1 kilogram of water under
stated conditions.
1 decilitre 0.1 Litre 3.52 fl. OZ

1 centilitre 0.01 Litre 0.352 fl. OZ
1 millilitre (ml) 0.001 Litre 16.9 minims
1 millilitre 0.000027 cubic centimetre (c.c)
b. Imperial system of capacities: 1 gallon is the volume of 1 lbs of water

under specified conditions.
1 gallon 8 pints 4.5460 Litres
1 pint 20 fluid ounces (fl. oz ) 586.25 ml
1 fluid ounce 8 fluid drachms(fl. 08) 28.41 ml
1 fluid drachm 60 minims 3.55 ml
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3. Equivalents of weight and volume
a. weight
¼ grain 15 milligrammes 0.015 gramme

1 grain 60 milligrammes 0.06 gramme
1 ½ grains 100 milligrammes 0.16 grammes
15 grains 1 gramme 1.0 gramme
1 ounce 30 grammes 30 grammes
1 pound 450 grammes 450 grammes
2.2 pounds 1 kilogramme
b. Volume
15 minims 1 cc (1 ml)
1 fluid ounce 30 cc
1 fluid drachm 4cc
1 pint 570 cc
1 ¾ pints 1 litre
4. IMPORTANT ABBREVIATION USED IN MEDICAL PRESCRIPTION
ABBREVIATIN ENGLISH LATIN

aa of each ab ana
ac before meals ante cibos
ad. Lib. to the desired amount ad Libitum
alt. die or alternate days alternis diebus.
aq dest distilled water aqua destillata
b.d bis die
twice a day
b.i.d bis in die
c.m tomorrow morning cras mane
c.n tomorrow night cras nocte
c with cum
co compound compositus
ex. aq in water ex aqua
ex. Lact in milk ex Lacte
h.n tonight hac nocte
h.s at bed time hora somni
m in the morning mane
n. at night nocte
p.c. after meals post cibos
p.r by rectum per rectum
p.r.n. as required pro re nata
q.h. four hourly quartis horis.
q.i.d. four times in a day quarter in die
rep. let it be repeated repetatur
s.s half semis
s.o.s as required si opus sit.
stut. immediately statim.
t.d.s. three times a day terdie sumendum
t.i.d three times a day ter in die
156

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PHARMACY & MEDICAL STORE PROCEDURE

2. Pharmacology: Pharmacology is a subject which deals with the source, physical

4. Differences between drug and medicine.

5. Properties of an ideal drug:

a. A drug must have an appropriate size, shape and atomic composition.

COMMON DRUGS & THEIR USES

2. PIRITON (CHLORPHENIRAMINE MALEATE 4 mg): Piriton used as antihistamine

(1) Nasal allergy and congestion.

c. Dose: Oral 12 mg daily in divided doses.

3. ANTACID (ALUMINIUM HYDROXIDE + MAGNESIUM TRISILICATE): It is used

c. Side effect: Diarrhoea, Constipation, Nausea, Vomiting.

4. HYOSCINE N BUTYL BROMIDE (BUTAPAN)

(1) Aid in peptic ulcer treatment.

d. Dose: By mouth, Adult 10mg 3 times daily. By injection, 20 mg I.M or

(1) Nausea & Vomiting particularly due to gastrointestinal disorders.

c. Dose: 10 mg 3 times daily or SOS.

(1) Severe asthma.

(1) Active peptic ulcer.

c. Side effects: Hypertension, Osteoporosis, Peptic ulceration which may.

d. Dose: Dose: By mouth: Adult 1.5 mg-3mg daily in divided dose

(1) Bronchospasm associated with :

(2) By injection: 250-500 mg slow by I.V injection in I.V drip.

(1) Medical emergencies amenable to intensive corticosteroid therapy

d. Dose: 100 mg-500 mg. IV repeated as necessary every 2-6 hours.

(1) Aid in peptic ulcer treatment

(1) Dry mouth with difficulty in swallowing & thirst.

d. Dose: By mouth 0.25-2 mg daily in single or divided doses. By injection 0.25-2

(1) Cardiac oedema.

(1) Pre-comatose state associated with liver cirrhosis.

12. METRONIDAZOL (FLAGYL): It is an anti-protozoal drug.

(1) Pregnancy (1st trimester).

d. Dose: 200-800 mg 3 times daily for 5-7 days

13. AMOXYCILLIN (FIMOXYL)

a. Indication Amoxycillin is broad spectrum antibiotic used in the treatment of:-

(1) Penicillin sensitive patients.

(1) Allergic manifestations.

d. Dose: By mouth, 250 mg (or500 mg in severe infections) every 8 hours.

14. COTRIMOXAZOLE (COTRIM)

a. Indication: Broad-spectrum chemotherapeutic agent specially used in the treatment of

d. Dose: 960 mg 12 hourly.

15. CIPROFLOXACIN (CIPROCIN)

(1) Growing adolescents.

c. Dose: 500 mg twice daily oral & injectable form.

16. ASPIRIN Aspirin is a analgesic drug.

(1) As analgesic (Mild to moderate pain including )

(3) As anti-inflammatory and anti-rheumatic

(4) As antithrombotic drug (reduce platelet adhesion)

c. Side effect: Gastro-intestinal irritation with slight asymtomatic blood loss,

d. Dose: Adult: - 300 mg to 900 mg in water, 4-6 hourly when necessary

16. DIAZEPAM (Seduxen/Easium)

(1) Acute pulmonary insufficiency

d. Dose: Anxiety- 2 mg 3 times daily, Insomnia- 5 –30 mg (Maximum) at bed time.

17. PROCHLORPERAZINE MALEATE (STEMETIL, VERGON)

(1) Comatose state.

(1) Duodenal ulcer.

19. MORPHINE Morphine used as narcotic analgesics.

(1) As analgesic to relieve severe pain in

(2) As anxiolytic to relieve serous and frightening disease like.

(3) Preoperative medication (as a basal anaesthetic)

(1) Acute respiratory depression like –asthma.

(1) Drug dependence and addiction.

Dose of morphine: Acute pain- by S C or by I M injection 10 mg 4 hourly, Preoperative

20. PETHIDINE In is a narcotic analgesic

Pharmacy & Medical Store Procedure.

Pharmacy & Medical Store Procedure.