Child resistant containers

Containers used for dispensing should always be labelled accordingly, preferably also with cautionary labels. Child-resistant containers may be difficult to use by elderly patients. Not all containers should be cleaned with alcohol before use as the medicine may interact with the alcohol. 

Methadone, used as an analgesic, may be dispensed in any licensed pharmacy. Methadone dispersible tablets are for oral administration only. This preparation contains insoluble excipients and therefore must not be injected. It is recommended that methadone dispersible tablets, if dispensed, be packaged in child-resistant containers and kept out of the reach of children to prevent accidental ingestion. 

Simple measures such as assessment of ability to use and open conventional and child-resistant containers, handle large bottles of liquids (lactulose) should be made before discharge and appropriate steps taken to deal with any problems. 

Because central vision tends to recover spontaneously even without treatment, patients with acute quinine toxicity should generally be managed by supportive measures alone. Hyperbaric oxygen has been used in an attempt to increase oxygen delivery to the retina. The use of oral activated charcoal or any other gastric decontamination procedures does not improve clinical outcome and may, in fact, be harmful to the patient. It is important to emphasize preventive measures, such as patient education and dispensing of quinine in child-resistant containers. 

Medicine containers. Reclosable child-resistant containers and blister packs are increasingly used, as is dispensing in manufacturers original sealed packs containing a patient information leaflet. These add to immediate cost but may save money in the end (increased efficiency of use, and safety). 

AUDIT QUESTION 1. Were the prescriptions labelled in a logical manner 2. Were the labels produced in the order they were on the prescription form 3. Was the pharmacist alerted to any interactions 4. Were the directions on the label easy to follow and accurate 5. When assembling the prescription were the items selected from the prescription form 6. Is the dispensing bench free from clutter 7. Does the dispensed item look presentable and reflect well on the professionalism of the pharmacist or pharmacy technician 8. Has a patient information leaflet been included 9. Is the item dispensed in a child-resistant container YES NO COMPLIANCE RECOMMENDATIONS... 

Similarly when completing an MUR you may find that a patient is not fully compliant because of problems of manual dexterity, either due to inflammatory conditions such as arthritis or neurological disease such as Parkinson s disease. These types of problems can make even the simplest packaging an obstacle to taking the medicine. It is often said that grandma asks the grandchildren to open her child-resistant containers. 

The total number and rate of poisonings have been increasing, but preventive measures, such as child-resistant containers, have reduced mortality in young children. 

Iron poisoning often is not recognized as a potentially serious problem by parents or victims until symptoms develop, and thus valuable time to institute treatment is lost. Parents should be made aware of the potential risks and asked to observe basic poison prevention measures. Many chewable vitamins with iron are shaped like animal or cartoon characters that can be attractive to children and can lead to poisoning. Some hard-coated iron tablets resemble candy-coated chocolates and are confused easily by children. Based on these considerations and the frequency of this poisoning, iron tablets are packaged in child-resistant containers. 

Although there are no EU requirements for child-resistant closures for medicines, there are directives (91/442 and 90/35) which require containers for products that are toxic or corrosive to be made child-resistant. For pharmaceutical products individual countries have introduced requirements for example, the Pharmaceutical Society of Great Britain requires in its code of practice that all solid and liquid preparations be dispensed in reclosable child-resistant containers, unless ... 

B. Use child-resistant containers to store prescription and nonprescription medications. However, child-resistant containers are not childproof they only slow down the time it takes a detennined child to get into the container. 

Salicylates are widely used for their analgesic and anti-inflammatory properties. They are found in a variety of prescription and over-the-counter analgesics, cold preparations, and topical keratolytic products (methyl salicylate), and even Pepto-Bismol (bismuth subsalicylate). Eiefore the introduction of child-resistant containers, aspirin overdose was one of the leading causes of accidental death in children. Two distinct syndromes of intoxication may occur, depending on whether the exposure is acute or chronic. 

Besides discussing packaging forms such as bottles, tubes, strips and bags some generally used dosage delivery devices (Sect. 24.4.19), child-resistant containers (Sect. 24.4.20), containers for arthritic patients (Sect. 24.4.21) and stock containers (Sect. 24.4.18) are also... 

ISO 8317 (2004) for reclosable child-resistant containers for pharmaceutical products. 

The two standards describe the quality requirements for child-resistant containers as well as their validation. 

For a reclosable child-resistant container the screw-press-principle is the most widely used. A combination of actions (pressing and unscrewing a cap at the same time) is very difficult for a child. 

The use of child-resistant containers (opened only with difficulty and know-how), strip packages (with pills and capsules sealed individually in a plastic strip), and safe storage have reduced the incidence of accidental poisoning, especially among children. 

Accidental ingestion of aspirin by young children in the home remains a major problem in many countries despite the introduction of child-resistant containers (27 ). The ready availability and palatability of junior aspirin may be a factor — these preparations are not available in India where aspirin poisoning seems to be very rare in young children (29 ). Therapeutic overdosage in adults has already been mentioned (18, 19, 23 ), and some bizarre presentations have been recorded. 

---