LEGESLATION, RECEIPE

and

DOSAGE FORM

Drs Bambang Sidharta,Apt MS

Laboratorium Farmasi

RSU Dr Saiful Anwar/ FKUB

PATIENT MANAGEMENT

Anamnesa

Physical Examination

Supporting Examination

Medical History

Diagnose

Therapy

Drug and Therapy

Drug is

a substance or a combination of substances that used to:

- determine diagnose,

- prevent, reduce, eliminate, cure the disease & symptoms

- prevent, reduce, eliminate, cure the injury or abnormality of

body and spiritual in human or animal

- beautify the body or the part of body.

Administration Therapy

1. Drugs therapy

- Causative

- Symtomatic

- Adjuvant

2. Non drugs Therapy

- Information & education

- Medical & Non medical actions

- Reference

THE RATIONAL THERAPY

Administration drug therapy :

Right drugs

Right dose

Right dosage form

Right time

Right patients

Cautious the side effects

ADMINISTRATION THERAPY

A. Giving the drugs directly

1. Intravascular injection drugs

2. Oral drugs for emergency

3. There is no private pharmacy

B. Giving the drug with a receipe

receipe

Request in note from physician, dentist, veterinarian to

pharmacist to made or prepare drugs in specific dosage form

and give it to patients with information.

“Final touch / actions“ from physician to patient

The last manifestation of physician’s competence, knowledge

and skill in implementing their knowledge in pharmacology,

clinical and therapy

Manifestation of professional relationship between physician,

pharmacist and patients

WHO ARE PERMITTED ?

Physician, medical specialist, for all kinds of drug

Dentist, especially drugs for teeth.

Veterinarian, all kinds of drug for animals

HISTORY OF receipe

Abbreviate with R/

In Ancient Medical Knowledge, receipe written by symbol : Y , Yupiter symbol is main God in mithology to cure Greek people

Or Ra : symbol :” hieratic eyes “ from “ Sun God “ Ancient Egypt is hieratic eyes symbol of Sun God that are Life and Protection God

Symbols Y and/or Ra becomes R/ ( receipe atau take)

RECEIPE’S SHEET

Size (10-12 cm) X ( 15 – 18 cm )

White

Save in the safe place.

Save the receipe in pharmacy at least 3 years. It can be

liquidated by made an announcement for the goverment.

APOGRAPH ( COPY of RECEIPE )

Pharmacist gives the apograph to the patient, if :

There is sign “ Iter”

Patient’s request,

- as a patient’s file or request from work place

- can be repeated if R/ not contain narcotics,

psychothropics and ethical drugs

Drugs is not fully bought by the patients

The apograph is saved like a receipe.

THE COMPLETE receipe MODELS

1. Name, address, SIP, phone number, time and date of doctor’s practical.

2. City and date

3. Sign R/

Number 1 - 3 are Inscriptio

4. Name and amount of given drugs

4.1 Kinds/compound of drugs in receipe

remidium cardinale

remidium adjuvans

corrigent, (odoris, flavoris atau saporis , coloris )

Vehikulum

Continued..

4.2 amount of the drugs compound: solid with unit heavy,

liquid with unit volume

5. Dosage form , mf or mfla

Number 4 –5 are prescriptio

6. Instruction, S or Signa

7. Patient’s identity, name, age, weight and address

Number 6 –7 are signatura

8. Signature or initial, is subscription

dr Riski Husada Prima, Sp A ( K )

SIP : 077/DS/99

Praktek : Jl Merapi No. 2 Telp 7777777 Malang Inscriptio

Kantor : Lab Ilmu Kesehatan Anak RSSA

---------------------------------------------------------------

Malang , 07 Apr 2011

R / Thiamfenikol 300 mg

Amoksisilin 275 mg

Dextromethorphan HBr 7,5 mg R Cardinale

Pseudophedrin HCL 20 mg Presciptio

Chlorpheniramin maleat 2 mg

Vitamin B kompleks ¾ tab R Adjuvan

Saccharum Lactis qs Vehicula

mfla pulv dtd No XV

S 3 dd pulv I , 1 h pc habiskan

-------------,, ---------------- prf subscriptio

---------------------------------------------------------------- Signatura

Pro : An Samone ( 6 th/ 22 kg )

Alamat : Jl. Tidore 33 Malang

CONVENTION TO WRITE receipe

receipe is physician’s responsibility

Written with black or blue ink, don’t use a pencil or “spidol”

Name and amount of drug and signature are written clearly, at least by Pharmacist or Assistant.

Avoid write the receipe by chemical abbreviation, write the drug in ‘latin’ language or in generic or INN (International Non-proprietary Name)

Continued…

City & Date must be written clearly

Avoid to write amount of drug in decimal,

- less than 1 gram miligram (500 mg not 0,5 g)

- less than 1mg microgram (100 mcg not 0,1 mg)

- A half tablet write ½ tablet not 0,5 tablet

Do not abbreviate gram to gr (gr = granum = 65 mg ) but

with g or gm

Liquid drug, in mL, not cc or cm 3

Avoid giving too much drug

Avoid giving the drug too long, except for chronic disease

Pediatrics receipe ( less than 12 y.o), write age and weight

Avoid write abbreviation that confusing

If there is more than 1 R/ in 1 receipe, give sign between it

Each receipe must be completed by signatura

Continued…

Each receipe must be given initial or signature

Consider the socio-economy condition, suggested to write the generic name

Ideally, keep the copy of each receipe

- Law protection ( wrong drug, stealing the paper of R/)

- Complete the patient’s file

Write the receipe in front of the patient :

- don’t be doubt,

- look at book,

- don’t streak the receipe

- frazzle the wrong receipe

Continued…

Before give to the patient, read and check the receipe

Give counseling to patient, explain about:

- name of drug and the purpose,

- signature,

- side effect and what patient do to overcome it

- caution and prohibition during take the drug

Continued…

“Recording” in medical record

- patient status ( name, sex, age, address

anamnese, diagnose, and the past medical history )

- history of hypersensitive or allergy of drug or food.

- status don’t be given to the patient.*

LANGUAGE IN WRITING receipe

Latin language is used in writing receipe because:

1. Died language,

2. Internasional language in Medical/Pharmaceutical

3. Not provoke dualism about the definition of substance

4. Patient psycology doesn’t need to know about the drug

Example Latin Abbreviation in receipe

Aa : ana R/ Ac Salisilic

Ac Boric aa 5 gm

Ac : ante coenam S 3 dd tab I , ½ h ac

An : ante noctam S prn an tab I

Ad libit : ad libitum

Dc : durante coenam S 3 dd tab I dc

Pc : post coenam

Dd : de die

1 dd = s dd , 2 dd = bid , 3 dd = tid , qid

Dext et si : dextter et sinestra

O d / os : occulus dexter et sinester

Example

D c form : da cum formula

Dtd ; da tales dosis Mf pulv dtd No X

F : fiat, fac, fiant

F la : fac lege artis M f l a potio ad 60 ml

Gtt : guttae S 3 dd gtt I ODS

gtt auric, gtt ophth, gtt nasal

Hm : hora matutina

Hs : hora somni

Imm : in manum medici S imm

o h : omni hora

o b h , o t h , o q h

M et v : mane et vespere

Example

Prn : pro renata S prn 3 dd tab I panas

Sns : si necesse sit, sos : si opus sit

Qs : quantum satis/sufficit

Pulv : pulvers / pulvis

Uc : usus cocnitus

Un : usus noctus

Ue : usus externus

IMMEDIATE DRUG REQUEST

If patient necessary to get the drugs immediately,give

sign at up left side with:

1. Cito atau CITO ! (underlined and give exclamation

mark or initial )

2. Statim (extremely immediate)

3. Urgens

4. P.I.M (Periculum In Mora = dangerous if delayed)

PLACE FOR TAKING THE DRUGS

WITH receipe

A. Hospital Pharmacy:

receipe from hospital’s physician.

Contain of letter receipe:

- name of hospital

- servicing unit ( internal medicine, pediatric,Ophtalmology, etc)

- name of prescriber.

Physician’s individual receipe can’t be serviced

B. Private Pharmacy:

Private pharmacy serve physician’s receipe and sale over the counter drugs

LEGAL ASPECT AND ETHICS receipe

& DRUG

Legal aspect in handling receipe & drugs that written in

receipe, regulate in legislation and government

regulation.

Supression on implementation profession’s practice for

physician and pharmacist.

LEGAL ASPECT AND ETHICS receipe

AND DRUGS

Special legislation and government regulation in health care are :

1. Undang-undang RI no. 23 Th. 1992 Tentang Kesehatan

2. Peraturan PerMenKes no. 919 Per X 1993 Tentang Kriteria Obat yang duiserahkan tanpa resep

3. SK. Menkes No. 924 / PER/X/1993 Tentang daftar obat wajib apotek

4. Undang-undang RI no. 5 Th. 1997 Tentang Psikotropik

5. Undang-undang RI no. 22 Th. 1997 Tentang Narkotik

ETHICS ASPECT

Pharmacy and Medical Ethics attached on Medical &

Pharmaceutical code ethics.

Ethical standard in practicing professional duty: “ All

action is for patient & society’s courtesy and

consideration”

INTRA & INTER PROFESSIONAL

RELATIONSHIP BETWEEN PHYSICIAN

& PHARMACIST :

1. receipe is a privacy

- privacy for physician, pharmacist and patient.

- involve occupation privacy for physician & pharmacist; it can’t be given for undeserved people

2. Physician can’t sale the drugs directly to the patient

3. Physician can’t motivate the patient to the certain pharmacy in order to buy the drugs.

Continued..

2. Patient Medication Record must be saved & don’t be

given to the patient

3. Physician can’t accept or request high honorarium from

drug industry, because it may increase the price of the

drugs

INCORRECT PRESCRIPTION

“Shotgun prescription” 6-10 kinds of drug in one receipe

Gives “obat konveksi”, patent drugs that not suitable yet to all patient

Too much amount drugs, except for chronic disease, for symptomatic therapy the receipe recommended only for 3-7 day

Gives antibiotics for URI , diarrhea during 2-3 days can cause resistence

Gives expensive drug without consider socio economics condition

Didn’t know the compound of patent drug

DRUG CLASSIFICATION BASED ON

LEGISLATION & GOVERNMENT

REGULATION

Obat bebas

Obat bebas terbatas = daftar W = daftar P

Obat keras = daftar G

Obat golongan narkotika = obat bius = daftar O

Obat golongan psikotropik

OBAT BEBAS

The drug can buy without a prescription

Available in pharmacy, drug store or store

Its symbol is green circle surround with black lines

For example: vitamins, antacids

OBAT BEBAS TERBATAS

The drug can buy without a prescription in pharmacy and

drug store with certainty:

- Sale on original packaging

- Sale with precaution

Its symbol is blue circle surround with black lines

Continued… Drug composition contain toxicity substance

Precaution Sign ( P1 – P6 ) black, size 5 cm x 2 cm (suitable with the packaging)

P 1 : awas ! obat keras ! baca aturan pakainya (Antimo)

P 2 : awas ! obat keras ! hanya untuk kumur. Jangan ditelan

(Gargarisma Kan)

P 3 : awas ! obat keras ! hanya untuk bagian luar badan

(solotio povidon iodine)

P 4 : awas ! obat keras ! hanya untuk dibakar (rokok asma)

P 5 : awas ! obat keras ! tidak boleh ditelan (s 5 mg)

P 6 : awas ! obat ketas ! obat wasir tidak ditelan (haemoroide

suppositoria)

OBAT KERAS = DAFTAR G

Obat keras is a toxic ingredient that cure, invigorate and

decontaminate the human body.

Obat daftar G can only be given by prescription, except

to technical needs.

Can’t be repeated

Usually have maximal dose the highest dose that still

secure if administered to adult

Continued..

receipe that higher than maximal dose is not allowed

given or made by pharmacy except the physician gives

initial or exclamation mark

Drugs:

1. Injectable drugs ( except Narcotics & Psychotropics )

2. antibiotics, sulfa, hormones

3. papaferin, noskapin and its salt

4. beladona, adrenaline, digitalis

NARCOTICS

Narcotics is drugs that affect central nervous systems and give:

- CNS depression: opium, morphine, pethidine, phentanyl & heroine

- CNS stimulation : cocain

Narcotics come from

- plants: papaver somniferum, erytroxylon

Coca and Cannabis sativa

- synthetics ( Pethidine, methadone, phentanyl )

NARCOTICS

Only with prescription

Can’t be repeated, must with a new prescription

Narcotics receipe that contain injectable drug, the

amount of drug equip with lettering in order to avoid

falsification.

R/ Pethidine 100 mg inj amp No I ( one )

Some other narcotics not for therapy and

prescription such as cocain, heroine, and canabis

Continued…

Pharmacy that served narcotic prescription must

report kinds of drug, amount, and residue of drugs

monthly

Especial for morphine, pethidine and phentanyl must

be equip with name, patient’s address and physician

completely

There is law punishment of narcotics misuse in

legislation in 1997

that are prison for life until capital punishment

PSYCHOTROPICS

This drug legislated at March, 11th 1997

Psychotropics are natural or synthetics substance or drugs (not narcotics that psychoactive on CNS and cause specifics alteration on behavior and mental activities)

These drug contribute in :

- CNS depression (benzodiazepines , barbiturate and

metaqualone),

- CNS stimulation (amphetamine) and halucination

(LSD)

Dosage Form

influence to:

Patient compliance

Easy and comfortability of patient in using/administering the drugs

Patient’s recovery

Reach the outcomes of therapy

notable :

characteristics of drugs substance,

stability,

age of patient,

site of action,

general condition of patient and

aims of therapy.

Classification of Dosage Form

Solid

a. Pulvis e. Caplets

b. Pulvers f. Suppositoria

c. Capsule g. Ovula

d. Tablets h. Pilulae

Semisolid

a. Ointment/unguentum c. Cream

b. Linimentum d. Gel

Liquid

a. Potio f . Guttae ( drop )

b. Lotio - Guttae ophthalmicae

c. Injection - Guttae auricurales

d. Aerosol - Guttae nasales

e. Nebulizer - Oral drop

A. Solid

Pulvis or Powder

Homogenous admixture of substance that relatively dry, for internal (per-oral) or external use

Per Oral Pulvis :

R / Oralit 200 sachet no X

S 1 sachet in a glass of water, ad libit

R/ Antacida pulv sachet no XV

S 3 dd pulv I, ½ h ac

R/ Carbocystein 200 mg pulv sachet no. X

S Prn 3 dd Pulv I

Pulvis for External Use :

R/ Salicil powder 2 % 50 grams

S ue

R/ Neomicin- Bacitracin powder fl no I

S uc

R/ Acidum Salicylicum 1 %

Mentholum 0,5 %

Zink oxida 5,0 %

Talcum venetum ad 100

Mfla pulv adspers

S ue

2. Pulvers

A divided powder in small paper package, for internal or external use

a. Pulvers for External Use :

R/ Kalium Permanganas 1

Mf pulv dtd No. VII

S 1 packet in 1 L of water

for bottom dye

or

S uc or S un

b. Per Oral Pulvers

Butong, 5 year , weight 18 kg. Diagnosed ISPA

Dose Amoxycillin ( 30 – 50 mg/kg/day ), Paracetamol ( 30–60 mg/ kg/day) , Dextromethorphan Hbr ( 1 – 2 mg/kg/day ), Pseudophedrine HCL ( 1 mg/kg/X )

R / Amoxycillin 200 mg

Paracetamol 175 mg

Dektromethorphan HBr 6 mg

Pseudophedrine HCl 17,5 mg

Glucose qs

Mf pulv dtd no XV

S 3 dd pulv I pc

Soal

1. Buat resep bila pasien umur 7 bulan,

Berat badan 8 kg untuk terapi 4 hari dengan aturan

pakai 3 kali sehari 1 bungkus 30 menit sessudah

makan

2. Bila anak yang memerlukan antihistamin Mebhidrolin

dengan dosis 1mg/kgBB/x , tablet memhidrolin 50 mg.

berapa tablet dosis perkali untuk anak umur 5 tahun

berat badan 20 kg

3. Capsule

The Advantages of Capsule:

Masking unpleasant taste, bitter or fishy

Can be single or a combination drugs

Adjustable dose with necessity

Easy to swallow/drink

Example :

R/ Chloramfenikol 250 mg caps No XX

S 3 dd caps I , ½ h pc

R/ Enatin soft caps no XV

S 3 dd caps I

R/ Paracetamol 300 mg

Diazepam 1 mg

Coffein 20 mg

Mf pulv da in caps dtd No. XXI

S Prn 3 dd caps I ( head pain )

4. Tablet / caplet

The Advantages :

The physician will be faster in writing a prescription

Pharmacy will be faster in servicing the drugs

Practical and handy

Easy to swallow

The Disadvantages :

Fixed composition, difficult to apply an individualizedtherapy

The dosage might be unsuitable for each individual

Dissolution and disintegrating time can’t meet requirements / substandart

a. Tablet for External Use

R/ Nystatin 100.000 IU Vag .tab. No. VII

S 1 dd vag tab I , hs

R/ Formalin 500 mg tablet No. XX

S uc

Tablet Per Oral

Dragee

R/ Neurotropic vitamin dragee no XII

mis: Neurobion dragee

S 2 dd dragee I - 1 h pc

Enterocoated tablet

R/ Diclofenac 50 mg tablet No. XV

S prn 2 dd tab I , ½ h pc

Tablet hisap = Lozenges

R/ Dequalinium tablet No. XII

S 4 dd tab I , hisap

Sub lingual tablet

R/ Isosorbide dinitrat 5 mg tablet No. XX

S mane et vesp tablet I, sub lungual

Sustained release tablet

R/ Avil retard tablet No V

S 1 dd tabl I

5. Suppositoria and ovula

Suppositoria per analia, ovula per vagianal, both of the dosage forms using vehiculum that melt in the body temperature.

Systemic Effect

R/ Metronidazole 1000 mg supp No. V

S 1 dd supp I an

R/ Piroxicam 10 mg suppositoria No. VI

S Prn 2 dd supp I , severe pain

Local Effect

R/ Anti Hemmorrhoid Supp no. III

S 1 dd supp I an or hs

R/ Bisacodyl 10 mg supp No I

S 1 dd supp I, prn difficult for defecation

R/ Metronidazol – Nistatin Ovula No. VII

S 1 dd Ovulla I, night

B. Semisolid

Usually for external use in anti infectious, anti inflammation, analgesic, allergy, anti fungal, and anti septic. Partially, semi solid also for internal use ( anti fungal and antiseptic)

Unguentum/oinment

R/ unguentum 2-4 10 g

Suc

mengandung As Salisilat 2%, Sulfur 4 % and Vaselin

R/ Gentamisin ointment tube I

Sue

2. Cream and Gel

R/ Hydrocortison 2,5 % cream tube I

S ue, spread fairy

R/ Oxytetracyclin 3 % cream tube I

S ue

R/ Ketoconazole 2 % cream tube I

S ue

R/ Myconazole 2 % oral gel tube I

S 3 dd Cth I , gargle and then swallow

R/ Diclofenac 1 % gel tube No I

S 2 dd ue, spread in pain location

3. Eye ointment / Opthalmic ointment / Occulenta

R/ Gentamycin 0,3 % eo tube No. I

S 3 dd Occul DS

R/ Chloramfenicol 1 % SM tube No I

S 3 dd oint occula S

4. Liniment

A dosage form that is viscous or fluid, lubricate to the skin

It can be water in the oil or oil in the water

R/ Gondopura oil 50 ml

S ue

R/ Salon pas liniment fl no I

S ue

C. Liquid

1. Potio

A liquid form used per oral, into the GI tract

Forms of potio : solutio, suspension or emulsion. It can be syrup or dry syrup.

a. Single Drug

R/ Chloramphenicol syr fl No. I

S 3 dd Cth I ( 5 ml )

R/ Erithromycin syr fl No I dry syrup

S 3 dd Cth I ( 5ml ) pc

R/ Paracetamol elixir fl No I syrup with alcohol

S 3 dd Cth I ( 5 ml ) prn fever

Soal

Buat resep untuk anak Bani 8 th/25 kg yang

memerlukan terapi erithromisin sirup, parasetamol sirup

dan dektromethorphan sirup untuk terapi 4 hari.

Eritromisin sirup mengandung 200mg/sendok takar ( 5

ml ), dektromethorphan sirup 10 mg/sendok takar,

parasetamol sirup 120 mg/sendik takar

Dosis eritromisin 30 – 50 mg/kgBB/hari, parasetamol

30-60 mg/kgBB/hari, dkstromethorphan 1-2 mg/kgbb/x

2. Lotio

A liquid form, for external use and the dosage forms are solutio, emulsion or suspension.

R/ Povidon iodine solution 60 ml fl No. I

S ue

R/ Povidon iodine gargle 100 ml fl No I

S 3 dd garg

R/ Nystatin 2 tablet

Borax glycerine 10 ml

Mf lotio

S 3 dd ue spread in lips

R/ Caladril lotion 60 ml fl No. I

S 3 dd ue

Drops / Guttae

Usual form is liquid or a mixture of liquid that

homogenous and not precipitate

The application need an instrument

For internal or external use

International standard: 1 ml = 20 gtt

a. Guttae Ophtamicae/ Eye Drops

The specification of Eye Drops

1. sterile

2. clear / transparent

3. isohydris

4. isotonic

Solvent

- water

- vegetable oil

Antibiotics, anaesthetics, antiseptics, antihistamine

R/ Chloramphenicol 0,5% ED fl No I

S 6 dd gtt I ODS

R/ Atropine Sulphat 1% ED fl No. I

S 2 dd gtt I OD

R/ Y Rins fl No. I

S 3 dd collyrium

b. Guttae Auricurales / Ear Drops

The specification of Ear Drops

• the solvent : oil or glycerine, not water

• clear / transparent or doesn’t contain dispersed particles

in solution

• sterile

Antibiotics, antiseptics and local anesthetics

R/ Gentamycin ggt auric/ED fl No. I

S 3 dd gtt III auric dextra

R/ Perhydrol 3% 25 ml

S 3 dd ear wash

R/ Carbo Glycerine 10 ml

S 3 dd gtt V auric sin

Guttae Nasales / Nasal Drops

The specification of Nasal Drops:

Water solvent, not oil

Clear / transparent

Isotonic

Dosage forms :

Drops

Spray

Antihistamine, decongestans

R/ Glucophedrine 1% nose drop 10 ml

S 3 dd gtt II

R/ Otrivin adult Nose drop fl No I

S 3 dd gtt II nasal

R/ Afrin nasal spray fl No I

S 3 dd nasal spray

Oral Drops

Liquid / transparent solution

Using drop instrument, the dose in ml or amount of drops

Antibiotics, antipyretics, antiemetics, antianaemia,

vitamins, antiseptics, iodine

R/ Paracetamol drop fl I

S 3 dd 0,8 ml, prn fever

R/ Multivitamins drop fl No I

S mane 0,5 ml

R/ Solutio Lugoli 30 ml

S 3 dd gtt V ( in a glass of water)

Injectio

Sterile solution, emulsion, suspension or sterile powder

that must be diluted immediately before use

Parenterally, with an injection through inside tissue or

penetrate skin or muscous membrane

Injectio

The Advantages

Rapid onset

Drug effect can be predicted nicely

Bioavailability ( almost ) perfect

Not influenced by GI tract

Helping coma patient or severe ill

The Disadvantages

Pain

Psychological effect ( afraid with injection )

Wrong administering/dose will be difficult to be corrected

Administered by doctor of nurse only

Injection Administering & Package

Administered by:

o Sub cutan - Intramuscular

o Intravena bolus - Infuse (IV drip)

o Intra arteri - Intraspinal

o Intrathecal - Intracysternal

o Intraarticular - Intracardial

o Intrapleural - Intradermal

o Intraperithonial (dialysis)

Package

o A. single dose : ampoule, vial, flash/bag

o B. multiple dose : vial

Solvent for Injection

Usually using water

The specification of water as a solvent:

o Sterile

o Bidestilated

o Demineralization

o Pyrogens free

o Clear / transparent

Example of Injectable Drug

R/ Atropin sulfate 0,25 mg inj amp no L

S imm

R/ Morphine 10 mg inj amp no I ( one )

S imm

R/ Ampicillin 1000 mg inj vial no V

R/ Gentamycin 80 mg inj vial no III

R/ Duradryl inj vial No III

R/ Dextrose infuse 5% fl No X

R/ Normal Saline infuse No IV

Aerosol

Colloid system of liquid or solid that finely dispers in gas

Gas can be diluted with pressure and have force to

spray the drug outside the container through the valve

The advantages :

o Relatively easy to use

o Not contaminated

o Measuring dose

o Aerosol (inhalation) work faster and its side effect less than per oral

o Drug doesn’t influenced/damage by stomach acid

Example of Spray

R/ Ventolin spray fl No I

S prn t dd puff I

R/ Bricasma inh fl No I

S UC

R/ Berotec aerosol fl No I

R/ Inflamide spray fl No I

R/ Alupent aerosol measured dose fl No I