Encyclopedia of Family Medicine

Chapter 24: Essentials in the Family Medicine Cabinet (1)
Prescription and OTC Drugs
Prescription drugs refer to drugs that can only be prepared, purchased and used with the prescription of a licensed physician or licensed assistant physician; over-the-counter drugs refer to drugs that consumers can judge, purchase and use without a prescription from a licensed physician or licensed assistant physician.

Since January 2000, 1, the "Administrative Measures for the Classification of Prescription Drugs and Non-Prescription Drugs (Trial)" has been officially implemented, and the first batch of national non-prescription drugs (western medicines, Chinese patent medicines) catalogue has been published, and a total of 1 varieties of Western medicines and 165 varieties of Chinese patent medicines have been collected. , each variety contains a different dosage form.The purpose of implementing classified management of drugs is to strictly and effectively regulate the supervision of prescription drugs, prevent consumers from misusing drugs and endanger their health due to their own misbehavior, and at the same time guide consumers to conduct scientific and rational conduct by regulating and strengthening the guidance on the use of non-prescription drugs. self care.

storage and storage of medicines
The quality characteristics of drugs can be summarized as safety, effectiveness, and stability, which are closely related to the protection of people's lives and health.Its main contents are as follows:

1.drug stability

There are many kinds of medicines, different dosage forms, complex properties, easy to be affected by the outside world, and some changes may occur during storage.There are mainly three aspects:

(1) Chemical changes: The instability of drugs caused by chemical changes mainly manifests in chemical reactions such as hydrolysis, oxidation, photochemical decomposition, and polymerization.Chemical reactions can occur between drugs and drugs, between drugs and solvents, and between drugs and additives, excipients, containers, external substances (air, light, moisture), and impurities, resulting in the deterioration and decomposition of drugs.

(2) Physical changes: Due to changes in the physical properties of the drug, such as moisture absorption, deliquescence, weathering, volatilization, evaporation, solidification, agglomeration, melting, deformation, delamination, etc., the quality of the drug is reduced or cannot be used.

(3) Biological change: due to the growth of microorganisms, the drug will become moldy, corrupted or decomposed.

The stability of a drug is mainly determined by the chemical structure of the drug itself. Under the influence of external factors, the stability of the drug changes, which is often manifested in changes in physical properties.Therefore, the storage and preservation of medicines must be done according to the nature of medicines and various factors that affect them.

2.External Factors Affecting Drug Quality
(1) Air: Oxygen and carbon dioxide in the air have a great influence on the quality of medicines.

Oxygen: some drugs such as vitamin A, vitamin D, pyrazolones, phenothiazine, etc., will be slowly oxidized in the presence of oxygen in the air; others, such as ferrous sulfate, are oxidized to form ferric sulfate, which turns yellow; chloride Oxidation of mercurous to mercuric chloride increases toxicity.After the drug is oxidized, it can change color, stink, decompose, deteriorate, fail, and even become toxic.

Carbon Dioxide: The deterioration of medicines due to their combination with carbon dioxide in the air is called carbonation.For example, aminophylline is exposed in the air to absorb carbon dioxide, and theophylline is insoluble in water; after the sodium salt of sulfa drugs, barbiturate sodium, phenytoin sodium, etc. react with carbon dioxide, free sulfonamides, barbiturates, and phenytoin are generated respectively. Sodium is insoluble in water; sodium hydroxide, magnesium oxide, etc. are easy to absorb carbon dioxide to form carbonate.

In addition, there are many examples of air affecting the deterioration of medicines. For example, medicines with adsorption (such as silver silicate, medicinal charcoal, etc.) can absorb various gases in the air for a long time, reducing the adsorption force and affecting the efficacy of medicines; The pollution of hydrogen oxide by dust in the air can accelerate decomposition and deterioration; many medicines can also undergo quality changes due to the influence of water vapor and microorganisms in the air.

(2) Light: Light can deteriorate medicines, among which ultraviolet light plays a major role, which can directly cause or promote chemical reactions such as deterioration, decomposition, and oxidation of medicines.

Discoloration: if adrenaline is affected by light, it can gradually turn red to brown, which reduces the efficacy or fails; sulfonamides gradually change color when exposed to light; silver salts and mercury salts can precipitate free silver and mercury when exposed to light, and the color becomes darker. Increased toxicity.

Decomposition: Some medicines can decompose after being exposed to light, such as hydrogen peroxide solution.When exposed to light, it decomposes into water and oxygen; when exposed to light, calomel can gradually decompose into mercury and mercury chloride, which turns dark gray and is highly toxic to the human body.

Oxidation: In the presence of air or oxygen, many drugs can accelerate their oxidation process when exposed to light.For example, after chloroform is exposed to light in the air, it is oxidized to produce toxic light, gas and hydrogen chloride; phenolic drugs turn light red or red under the action of oxygen and light; vitamin A, vitamin D, etc., under the influence of light and oxygen, etc. Easy to oxidize and fail.

(3) Temperature: If the temperature is too high or too low, the drug will deteriorate and become invalid.Excessively high temperature can promote chemical reactions such as oxidation and hydrolysis to accelerate the deterioration of drugs. For example, antibiotics will be decomposed and invalidated after being heated; oils and ointments are prone to rancidity and deterioration when heated for a long time.Excessively high temperature can also accelerate the volatilization of volatile medicines such as menthol, ethanol, ammonia water, etc.; medicines containing crystal water can accelerate weathering, and can also destroy dosage forms, such as melting and sticking sugar-coated tablets; melting and stratifying ointments; sticking capsules and suppositories Soft deformation etc.Too low temperature can also cause some drugs to precipitate, freeze, solidify, or even deteriorate and become invalid. For example, biological products lose their activity due to freezing, and insulin may denature after being frozen for a long time; solutions such as calcium gluconate can precipitate and crystallize in a cold place for a long time. ; After the emulsion solution is frozen, the stratification cannot be restored to its original state, and the injection and water-soluble preparations can freeze at a low temperature below 0°C, and the volume expands, causing the glass container to break.

(4) Humidity: The content of water vapor in the air is called humidity.Humidity also has a great influence on the quality of medicines.Excessive humidity can cause deliquescence, dilution, hydrolysis, deformation, and mildew of drugs due to moisture absorption; too low humidity can easily make some drugs weathered.

Deliquescence: The phenomenon that certain water-soluble medicines are exposed to humid air and gradually absorb the moisture in the air to make them partially dissolve into a liquid is called deliquescence.Such as calcium chloride, potassium chloride, sodium citrate, etc. are easy to absorb moisture and deliquescence.

Decomposition: Some medicines can decompose and deteriorate after absorbing water.For example, after aspirin absorbs moisture, it is gradually hydrolyzed into acetic acid and salicylic acid, which increases the irritation to the stomach; sodium bicarbonate slowly decomposes into sodium carbonate after absorbing moisture, and the alkalinity is enhanced; antibiotics such as penicillin, cardiac glycosides such as digitalis, absorb Decomposition is accelerated after tide, which reduces the curative effect.

Deformation: Deformation caused by changes in physical form after the drug absorbs moisture.For example, tablets and pills crack due to the expansion of the disintegrant after absorbing moisture.The sugar-coated tablet melts and sticks, and the glycerin suppository becomes opaque after becoming damp, softening and deforming.

Weathering: Many pharmaceuticals containing water of crystallization are prone to weathering in dry air.Such as sodium sulfate (Na2SO4·H2O), caffeine (qHN4·H2O), codeine phosphate (CHO3N·H3PO4·l.5H2O), etc.The weathering of the medicine does not change its chemical properties and curative effect, but the content is uncertain, and the dosage is difficult to control, especially the poisonous medicine, which may cause accidents due to overdose.

(5) Microorganisms and insects: Drugs exposed in the air are susceptible to contamination, mildew or insects by microorganisms (bacteria, mold, yeast, etc.) and insects. This is especially true for drugs such as fats.The humidity in the air is too high and the temperature is suitable, which is conducive to the growth and reproduction of microorganisms, especially the changes in medicines.

(6) Time: Some medicines will deteriorate and become invalid if they are stored for too long.Such as expired drugs, even if the storage conditions are suitable, the potency will often decrease or the toxicity will increase after the expiration date.There are also some medicines, especially those with unstable properties, such as emulsions, liquids, suppositories, etc., although the expiration date is stipulated, the quality will be affected if the time is too long.Of course, the storage time of medicines has a lot to do with other factors (storage conditions), such as improper storage, even if the storage time is not long or the expiration date has not yet expired, it may also deteriorate and become invalid.

3.Drug storage management
Drugs should be properly stored under different conditions according to their properties and dosage forms.

(1) Airtight storage: The following medicines should be stored in glass bottles with a ground mouth, or sealed with cork and paraffin to prevent moisture absorption and deterioration. Relative humidity below 60% is more suitable for storage.

① Drugs that are easy to absorb moisture and deteriorate: such as sodium hydroxide, anhydrous calcium chloride, concentrated sulfuric acid, sodium bromide, sodium p-aminosalicylate tablets, dry yeast, compound licorice mixture tablets, various antibiotics, pepsin, aspirin , ferrous sulfate, etc.

②Drugs that are easily weathered: various drugs containing crystal water, such as citric acid, copper sulfate, sodium thiosulfate, etc.

③ Volatile drugs: such as concentrated ammonia, hydrogen peroxide, alcohol preparations, peppermint oil, camphor, etc.

(2) Store away from light: In order to avoid the influence of light on the drug, it can be stored in a brown glass bottle or a glass bottle wrapped in black paper to prevent the penetration of ultraviolet rays and cause the drug to change color and deteriorate.

① Drugs stored away from light: silver nitrate, sodium iodide, epinephrine solution, aminophylline, vitamin C, etc.

② Drugs that are easily oxidized when exposed to light: anesthesia ether, epinephrine, etc.

(3) Low-temperature storage: This kind of medicine has the characteristic of heat deterioration and failure.Such as human albumin, human gamma globulin, adrenocorticotropic hormone, protamine, heparin, ergonovine, oxytocin, pituitary hormone, vaccines, serum, antitoxin and biological products, etc., should be stored in the refrigerator Or in the cold storage, the temperature is kept between 2~10°C.

Visual inspection of medicines

(1) Approval number: The health administrative department of the State Council or the health administrative department of a province, autonomous region, or municipality directly under the Central Government, the prescription, process, quality standards, test results, pharmacology, clinical trials, etc. submitted by a pharmaceutical manufacturer to apply for the production of a certain drug Technical data, production conditions, inspection conditions, etc. are reviewed, and those who are considered to have the production conditions are approved, and a specific number is given to the drug applied for production, which is the approval number of the drug.Generally, it is composed of the approval authority, abbreviation, category, year, serial number, etc. The drug approval number is unique (one approval number is issued for each drug specification and dosage form, and other units or drugs are not allowed to counterfeit use), statutory (production unit Drugs must be produced with an approval number, and drugs produced without an approval number will be treated as counterfeit drugs).Therefore, the label and instructions of the drug package must indicate the approval number to show that the drug is legally produced.

(2) The batch number of the drug: the batch number is the sign of the same batch of drugs produced by the pharmaceutical factory.At present, the batch number is usually combined with the manufacturing date in China. From the batch number, the production year, month and batch of the drug can be known, and the storage time of the drug can be known, which is convenient for checking the quality of the drug.Another important function of the batch number is to facilitate the processing of the entire batch number according to the quality found during quality inspection, sampling inspection, and warehousing acceptance.The batch numbers of medicines are arranged according to the production date and expressed in numbers, generally using six digits, the first two digits are the year, the middle two digits are the month, and the last two digits are the day.Some manufacturers pack in more than one shift a day, and add the number of the shift number to the back, which is the sub-batch number.

(3) Trademark: It is a sign of a product.Any commodity sold in the market must have a trademark, which is a mark to distinguish other similar products, and medicines are no exception as special commodities. Article No. 40 of the "Drug Administration Law of the People's Republic of China" stipulates: Except for Chinese herbal medicines and Chinese herbal medicines, medicines must use registered trademarks, and those that have not been approved for registration must not be sold in the market. Protect.Registered trademarks must be indicated on drug packaging and labels.

(4) Validity period of the drug: The validity period of the drug refers to the time required for the content of the drug to drop to 90% under specific storage conditions.The expiry date shall be indicated on the product label.To sum up, there are several representations as follows:

①直接标明有效期为某年某月，如有效期1999年10月即指该药可用到1999年10月31日。

②直接标明失效期为某年某日，如失效期1999年8月，即指该药可用到1999年7月31日。

③ Indicate the length of validity, and write "validity × year" is calculated from the 1st of the next month of the production date (batch number).For example, a drug is valid for 2 years and the batch number is 990801. According to the batch number, the drug is valid until August 2001, 8.

④For the expiration date of foreign products, "Expiration Date" (Exp.date) is often used, but the notation is very inconsistent, and each country has its own customary writing method.

欧洲国家多按日、月、年顺序如8／5／99，即为99年5月8日失效。

美国产品是按月、日、年排列如：Nov.1，98即为98年11月1日失效。

日本按年、月、日顺序排列如失效期为58．6．1即为昭和58年6月1日，换成公元应加25年。

(5) Packaging of medicines
Medicine is a special commodity with different physical and chemical properties, high purity and hygiene requirements, so the storage and sale of products must have special containers and packaging to meet the needs.At the same time, both inner and outer packaging must have correct labels, so that errors and accidents will not occur.

According to the relevant provisions of the "Drug Administration Law" on drug packaging: drug packaging must meet the requirements of drug quality and facilitate storage, transportation and medical use.For drugs with a specified expiration date, the expiration date must be indicated on the package.Labels, cartons, paper bags, plastic bags, etc. are small in size and difficult to print in full, there should be instructions in detail, and there should be no missing items, and the instructions should be attached to the box or box to ensure the safety and effectiveness of the medication.

The packaging container and storage temperature should be implemented in accordance with the provisions of the Pharmacopoeia.According to the nature of the drug, the packaging container of the drug is divided into four types: airtight container, airtight container, melt-sealed or tightly sealed container and light-shielding container.

① Instructions: It is the main medium for drug production units to publicize and introduce drug characteristics, guide rational drug use and popularize medical knowledge to medical personnel and consumers; it is also a scientific basis for medical personnel and patients to treat medication.

The manufacturer is not only responsible for the quality of the drug, but also responsible for whether the content of the product instructions meets the requirements and whether it is true and reliable.

②Label: It is one of the signs that the drug production unit assumes legal responsibility for the quality and quantity of the drug. The content and writing method are similar to those of the instructions, but simple and clear.

Narcotic drugs, psychotropic drugs, toxic drugs for medical use, radioactive drugs, etc. are called special management drugs. If used improperly, they can easily cause harm to people's health and even endanger society.Therefore, special management methods different from general drugs must be implemented for such drugs, such as fixed-point production, fixed-point supply, and limited purchase.In addition, a special logo is printed on the label.

For example, narcotic drugs are blue and white with the word "hemp"

Psychotropic drugs with the words "psychotropic drugs" in green and white

Toxic drugs have the word "poison" in black and white

Radiopharmaceuticals red and blue

drug character test

The property inspection of the drug is mainly through the inspection of the appearance, color, clarity, uniformity and other aspects of the drug to see whether it meets the national pharmacopoeia standards.

Drugs are classified into liquid dosage forms (such as aromatic water, solutions, injections, etc.), solid dosage forms (such as powders, pills, tablets, films, etc.), semi-solid dosage forms (such as ointments, pastes, etc.) according to the dosage form. And gaseous dosage forms (such as aerosol, inhalant, etc.).The main dosage forms are described below.

(1) Tablet: Refers to the drug and suitable excipients made into tablets or special-shaped tablets through preparation technology, mainly for oral administration.Tablets should meet the following requirements: the appearance should be complete and smooth, with uniform color; suitable hardness; accurate drug content; small tablet weight differences; chemical and physical stability under normal storage conditions, etc.

(2) Capsules: divided into hard capsules, soft capsules and enteric-coated capsules, for oral use.Capsules should meet the following requirements: the appearance should be clean and tidy, there should be no bonding, deformation or rupture, and there should be no peculiar smell.

(3) Granules: refer to preparations made of drugs and suitable excipients into dry granules.Divided into soluble granules, suspension granules and effervescent granules, etc., for oral use.The granules should meet the following requirements: the granules should be dry, the granules are uniform, the color is consistent, and there is no phenomenon of softening by moisture absorption, agglomeration, deliquescence, etc., and should be sealed and stored in a dry place.

(4) Ointment: Refers to a paste-like external preparation made of a drug and a suitable base with an appropriate consistency.The ointment should meet the following requirements: the ointment should be uniform and delicate, and it should be non-irritating when applied to the skin; it should have an appropriate viscosity and be easy to apply on the skin or mucous membrane.There should be no deterioration such as rancidity, odor, discoloration, hardening, and oil-water separation.

(5) Injections: Refers to sterile solutions, emulsions or suspensions made of drugs for injection into the body, as well as sterile powders or concentrates for making solutions or mixed solutions before use.Injections should meet the following requirements: Injections must be sterile, have no pyrogens, and must not have visible turbidity or foreign matter, and must not cause tissue irritation or toxic reactions, ensuring safe use.

The equipment of the family medicine cabinet

The standing medicines in the family medicine box should be equipped according to the age and health status of family members.General standing medicines should include: iodine tincture, red syrup, purple syrup, adhesive tape, bandage, gauze, absorbent cotton, potassium permanganate, anti-inflammatory powder, Yunnan Baiyao, sulfonamide ointment, painkillers, common cold medicine, thermometer, tweezers, scissors and other equipment .Families with infants and young children should also be equipped with commonly used medicines for children, such as Pang De Sheng, Xiaoer Jindan, Xiaoer Qingfei San, Baiyanling, Virus Ling, etc.In addition, the medicines in the family medicine box should be equipped with standing medicines according to the season.Summer and autumn seasons should be equipped with medicines for heatstroke prevention and mosquito bites, such as Huoxiangzhengqi pills, Rendan, Fengyoujing, cool oil, and medicines for gastroenteritis, such as chloramphenicol tablets, lactobacillus tablets, furazolidone, etc. .In spring and winter, you should have chilblain ointment and anti-asthma, phlegm-reducing and cough-relieving medicines, such as Chuanbeijing tablets, cough syrup, phlegm-resolving tablets, paracetamol tablets, licorice tablets, etc.In short, the medicines in the family medicine box should be reasonably equipped according to the health status of family members.

According to the health status of family members, you can also make a family first aid kit and put it in the corner of the family medicine cabinet.The preparation of medicines in the first aid kit should be determined according to the different needs of different patients, so that it is convenient to use in the event of an emergency.

Common sense of family medicine storage

(1) The medicines in the family medicine box should be placed neatly, the external medicines and the internal medicines should be opened separately, and the medicines that you are not familiar with should not be placed in the box.

(2) The correct name label of the drug should be affixed on the bottle or box containing the drug, and the method of administration, dosage, and expiration date should be stated.

(End of this chapter)