6. Preventive Healthcare – Role of Pharmacists

PREVENTIVE HEALTHCARE: A COMPLETE GUIDE FOR PHARMACY STUDENTS

Welcome, future pharmacists and healthcare professionals!

Preventive healthcare aims to prevent health issues from arising and focuses on recognising diseases before symptoms or consequences appear, when the chances of recovery are best. When done correctly, preventive care improves general health and lowers healthcare expenses. The overall purpose of prevention is to lower a person’s chances of getting ill, handicapped, or dying prematurely.

As a pharmacy educator with years of experience teaching Social Pharmacy, I have observed that students often focus on curative aspects of pharmacy while underestimating the critical role of prevention. However, understanding preventive healthcare is essential for every pharmacist because we are uniquely positioned to educate patients, promote healthy behaviours, and prevent diseases. In this comprehensive guide, I will walk you through demography, population control, family planning, mother and child health, immunisation, environmental health, occupational illnesses, and drug abuse. Let us begin our journey.

Dpharmguru’s exam insights:

Preventive healthcare is one of the most frequently tested topics in social pharmacy exams. Remember: Prevention is better than cure—this is the core philosophy. Pharmacists play a vital role in family planning, mother and child health, immunisation, and controlling drug abuse. Pay special attention to the demographic cycle, contraceptive methods, immunisation schedules, and the role of pharmacists in these areas!

2.1. DEMOGRAPHY

The statistical study of human population, their composition, distribution, size, and structure, along with causes and consequences of any change in these characteristics is termed demography. The temporal and/or spatial changes according to birth, ageing, death, or migration are also studied in demography.

Demography includes:

• Population distribution in spaces.
• Change in the population size.
• Population composition.

Demographic Cycle

The demographic cycle comprises of five stages of population growth:

• First Stage (High Stationary Stage): High birth and high death rates. Population remains stable.
• Second Stage (Early Expanding Stage): Declining death and constant birth rates.
• Third Stage (Late Expanding Stage): Further declining death and falling birth rates. Population still grows as births exceed deaths.
• Fourth Stage (Low Stationary Stage): Low birth and low death rates. Population remains constant.
• Fifth Stage (Declining Stage): Lower birth rate than death rate. Population starts declining.

Dpharmguru’s exam insights:

The five stages of the demographic cycle are frequently tested. Remember: Stage 1 (High Stationary), Stage 2 (Early Expanding), Stage 3 (Late Expanding), Stage 4 (Low Stationary), Stage 5 (Declining). India is currently in the late expanding stage—birth rates are falling but population is still growing!

2.2. OVER POPULATION

The entire world is contributing to the explosion of population, and its disadvantages are visible on the surface of earth’s atmosphere. The quality of environment is deteriorating on a daily basis because of the high growth rate of population, especially in developing and underdeveloped countries.

Effects of Population Explosion

• Air Pollution: Deforestation is reducing oxygen levels, leading to increased air pollution.
• Water Pollution: Large parts of water bodies are polluted and portable water is scarce.
• Unemployment and Illiteracy: Rapid population increase leads to unemployment and illiteracy.
• Food Resources: Countries like India and China face shortages of basic resources—50% of children under 4 are malnourished, 30% of infants are underweight, and 60% of women are anaemic.
• Reduction in Savings and Investment: Populous countries have less savings and investment for economic growth.
• Effect on Per Capita Income: Per capita income increases slowly due to constant population growth.

Population Control Measures

• Couple Protection Rate (CPR): Percentage of couples actively involved in birth control and family planning.
• Infant Mortality Rate (IMR): Decreasing IMR encourages small families.
• Industrialisation: Creates employment and improves living standards.
• Female Literacy and Education: Educated people understand the importance of small families.
• Late Marriages: Avoiding early marriages helps control population growth.
• Legal Steps: Strict laws against early marriages and polygamy.
• Family Planning: National movement for educating people about family planning and birth control methods.
• Education and Empowerment: Awareness about consequences of overpopulation and remedial measures.

Dpharmguru’s exam insights:

Population control measures are frequently tested. Remember: CPR (Couple Protection Rate), IMR reduction, female literacy, late marriages, and family planning are key strategies. Pharmacists can play a significant role by educating patients about contraceptives and family planning methods!

2.3. FAMILY PLANNING

An expert committee of the WHO defined family planning as “a way of thinking and living adopted voluntarily on the basis of knowledge, attitudes, and responsible decisions by individuals and couples, in order to promote health and welfare of the family group and thus contribute effectively to the social development of a country.”

Objectives of Family Planning

• To avoid unwanted births.
• To bring about wanted births.
• To regulate the intervals between each pregnancy.
• To control the time at which births occur in relation to the parent’s age.
• To determine the number of children in a family.

Contraceptive Methods

1. Behavioural Methods

• Abstinence: Staying away from intimate genital contact—100% effective.
• Coitus Interruptus: Male withdraws before ejaculation.
• Safe Period or Calendar Method: Based on ovulation occurring 12-16 days before menstruation. Days 1-5 (menstruation), 6-9 (safe), 10-18 (unsafe), 19-28 (safe).

2. Natural Methods

• Basal Body Temperature Method: Temperature increases by 0.3-0.5°C at ovulation.
• Cervical Mucus Method: Mucus becomes watery, clear, and profuse at ovulation.
• Symptothermic Method: Combines temperature, mucus, and safe period estimation.

3. Chemical Methods

• Foam Tablets: Inserted into vagina before intercourse; produce foam that kills sperms.
• Spermicidal Jellies/Creams/Pastes: Applied with an applicator; destroy sperms in the vaginal canal.

4. Mechanical Methods

• Condom or Nirodh: Thin rubber sheath used by males; prevents sperm from entering the vagina.
• Diaphragm or Dutch Cap: Dome-shaped rubber cap inserted in the vagina; blocks the mouth of uterus.
• Intra-Uterine Devices (IUDs): Fitted in the uterus to prevent pregnancy.
• Lippes Loop: First generation, double S-shaped device.
• Copper-T: Second generation, T-shaped IUD wrapped in copper.
• Progestasert: Third generation, T-shaped with progesterone.

5. Hormonal Contraceptives

• Combined Oral Contraceptive Pill (COCP): Contains synthetic oestrogen and progestogen; taken for 21 days with a 7-day break.
• Progestogen-Only Pill (Mini Pill): Taken daily without interruption; increases cervical mucus viscosity.
• Sequential Pills: For women taking combined HRT who experience menopausal symptoms.

6. Terminal Methods

• Vasectomy: Surgical procedure for males—removes a portion of the vas deferens.
• Tubectomy: Surgical procedure for females—removes a portion of fallopian tubes.
• Laparoscopy: Female sterilisation using a laparoscope to block fallopian tubes with clips or rings.

7. Post-conceptional Methods (Emergency Contraception)

• Yuzpe Method: Levonorgestrel (0.5mg) + ethinylestradiol (0.1mg) within 72 hours, repeated after 12 hours.
• Levonorgestrel Regimen: 0.75mg taken twice within 72 hours at 12-hour intervals.
• Mifepristone: 600mg taken once within 72 hours—high success rate and negligible side effects.

Role of Pharmacist in Family Planning

• Exhibiting family planning posters in hospitals and drug stores.
• Counselling people about the importance of family planning and gap years between children.
• Handing out pamphlets on family planning.
• Educating about oral contraceptives and family planning methods.
• Controlling rising population by advising people and conducting educational programmes.
• Instructing and convincing people about the advantages of having small families.
• Advertising programmes that encourage family planning.
• Giving explanation on techniques and usage methods.
• Addressing family planning centres.
• Providing social facilities.

Dpharmguru’s exam insights:

Contraceptive methods are frequently tested. Remember the classification: Behavioural (abstinence, withdrawal, calendar), Natural (temperature, mucus, symptothermic), Chemical (foam tablets, spermicidal jellies), Mechanical (condom, diaphragm, IUDs), Hormonal (COCP, mini pill), Terminal (vasectomy, tubectomy), and Post-conceptional (emergency contraception). Pharmacists play a crucial role in educating patients about these methods!

2.4. MOTHER AND CHILD HEALTH

According to WHO, maternal and child health services are defined as “promoting, preventing, therapeutic, or rehabilitation facility or care for the mother and child.”

Objectives of MCH

• Early diagnosis and treatment of health problems of mothers and children.
• To reduce maternal mortality and morbidity.
• To reduce prenatal and neonatal mortality and morbidity.
• To prevent malnutrition.
• To prevent communicable diseases.
• To promote reproductive health or safe motherhood.
• To regulate fertility so as to have wanted and healthy children.
• To provide basic maternal and child health care to all mothers and children.
• To promote and protect health of mothers.
• To promote and protect physical growth and psycho-social development of children.
• To provide health education and family planning services.
• To ensure child survival.
• To ensure birth of healthy child.
• To promote healthy growth and development.

Breastfeeding

Breast-feeding should be initiated within 30 minutes of childbirth in case of normal delivery and within 4 hours in case of C-section. The mother should breastfeed the child up to 2 years or more if the baby wishes.

Key Points:

• Initiate breastfeeding, especially colostrum feeding, within 60 minutes of childbirth.
• Do not give any pre-lacteal feeds.
• Ensure baby is well-attached to the breast.
• Continue exclusive breastfeeding for six months.
• Breastfeed the baby whenever he/she demands milk.
• Follow the practice of rooming-in.

Benefits of Breastfeeding for Baby

• Contains nutrients (proteins, fats, lactose, vitamins, iron, water) required in the first 6 months.
• Easily digested and assimilated.
• Inhibits growth of harmful bacteria.
• Contains antibodies against infections.
• Contains lactoferrin that binds iron and prevents bacterial growth.
• Reduces incidence of diarrhoea, respiratory and ear infections.
• Facilitates bonding between infant and mother.
• Promotes proper development of jaw and facial structure.
• Reduces incidence of SIDS (Sudden Infant Death Syndrome).

Benefits of Breastfeeding for Mother

• Promotes placenta expulsion and reduces post-delivery bleeding.
• Reduces risk of breast, uterine, and ovarian cancers.
• Protects against osteoporosis and UTIs.
• Helps lose additional fat accumulated during pregnancy.
• Does not need any prior preparation.
• Saves time, effort, and money compared to formula feeding.

Ill Effects of Formula Feeding

• Illness: Higher risk of diarrhoea, ear infections, lung infections, and other infections.
• Allergies: Higher risk of food allergies and asthma.
• Death: Higher risk of death from diseases and SIDS.
• Lower IQ Scores: Breastfed children do better on intelligence tests.
• Chronic Diseases: Higher risk of diabetes, obesity, heart disease, and childhood cancer.
• Lack of Antibodies: Formula milk lacks antibodies present in breast milk.

Dpharmguru’s exam insights:

Breastfeeding is frequently tested. Remember: Initiate within 60 minutes; exclusive breastfeeding for 6 months; continue up to 2 years. Colostrum is the first milk—rich in antibodies. Benefits for both baby and mother are important. Ill effects of formula feeding include higher risk of infections, allergies, and chronic diseases!

2.5. IMMUNITY

Immunity may be defined as the ability of the body to protect itself against foreign substances and microorganisms. The word immunity (Latin immunis meaning exempt) describes the protection against diseases.

Types of Immunity

1. Non-specific/Innate/Neutral Immunity

This type of immunity is present since birth and is affected by genetic and molecular structure. It is independent of previous contact with foreign antigens.

• Species Immunity: Resistance to pathogens found in all members of a species.
• Racial Immunity: Different races of the same species show variations in resistance.
• Individual Immunity: Different individuals of the same race and species show variable resistance.

2. Specific/Acquired/Adaptive Immunity

This type of immunity develops during lifespan due to infection or vaccination. It is the set of responses that the immune system activates to target specific pathogens.

• Active Immunity: Resistance acquired after contact with an antigen.
• Natural Active: From clinical or sub-clinical infections (e.g., chicken pox).
• Artificial Active: From vaccination (e.g., BCG, polio vaccine).
• Passive Immunity: Introduced by preformed antibodies.
• Natural Passive: Antibodies transferred from mother to foetus (via placenta or milk).
• Artificial Passive: Use of convalescent sera, hyperimmune sera, or pooled human γ-globulin.

Differences between Active and Passive Immunity:

Feature	Active Immunity	Passive Immunity
Development	Developed immunity	Produced immunity
Duration	Slowly and long-lasting	Fast and short-lived
Booster Dose	Can be given for lifelong immunity	Does not help maintain immunity
Administration	Antigens administered	Antibodies administered

Dpharmguru’s exam insights:

Immunity types are frequently tested. Remember: Innate is present at birth; Acquired develops during life. Active immunity involves the body producing antibodies; Passive immunity involves receiving preformed antibodies. Natural active (infection), Artificial active (vaccination), Natural passive (maternal antibodies), Artificial passive (antiserum).

2.6. IMMUNISATION

According to WHO, immunisation has been defined as “a process in which a person is made immune or resistant to an infectious disease, typically by the administration of a vaccine.”

Types of Vaccines

• Inactivated-Killed Vaccines: Pathogens killed by heat or chemicals.
• Bacterial: Typhoid, cholera, plague, Haemophilus influenza.
• Viral: Rabies, influenza, hepatitis, polio.
• Live Attenuated Vaccines: Non-virulent microorganisms that retain antigenicity.
• Bacterial: BCG.
• Viral: MMR, polio sabin.

Toxoids

Toxoids are modified bacterial toxins that have been detoxified but retain their ability to stimulate antitoxin formation. Examples: Tetanus toxoid, Diphtheria toxoid.

National Immunisation Schedule

Age	Immunising Agent	Number of Doses
6 weeks to 9 months	DPT, Polio, BCG	DPT 3, Polio 3, BCG 1
9-12 months	Measles	1
16-24 months	DPT (Booster), Polio	DPT 1, Polio 1
5-6 years	DT, Typhoid	1 each
10 years	TT, Typhoid	1 each
16 years	TT, Typhoid	1 each
16-36 weeks pregnancy	TT	1

WHO EPI Immunisation Schedule:

Age	Immunising Agent
At birth	BCG and Oral Polio
6 weeks	DPT and Oral Polio
10 weeks	DPT and Oral Polio
14 weeks	DPT and Oral Polio
9 months	Measles

Dpharmguru’s exam insights:

Immunisation schedules are frequently tested. Remember: EPI (Expanded Programme on Immunisation) launched by WHO covers 6 diseases—diphtheria, whooping cough, tetanus, polio, tuberculosis, and measles. National Immunisation Schedule includes DPT, Polio, BCG, Measles, DT, Typhoid, and TT. BCG is given at birth or 6 weeks; DPT and Polio at 6, 10, 14 weeks; Measles at 9 months!

2.7. EFFECT OF ENVIRONMENT ON HEALTH

The environment affects our health in a number of ways. The World Health Organisation (WHO) estimates that avoidable environmental causes account for thirteen million deaths each year.

Water Pollution

Water pollution can be defined as deterioration of chemical, biological, and physical features of water by human and natural activities up to an extent which becomes a hazard for living organisms.

Common Water-borne Diseases:

• Diarrhoeal Diseases
• Cholera (caused by Vibrio cholerae)
• Giardiasis (caused by Giardia intestinalis)
• Amoebiasis (caused by Entamoeba histolytica)
• Bacillary Dysentery (caused by Shigella, E. coli, Salmonella)
• Typhoid and Paratyphoid (caused by Salmonella Typhi and Salmonella Paratyphi)
• Hepatitis A and E
• Guinea Worm Infection (caused by Dracunculus medinensis)

Air Pollution

Air pollution is defined as “substances put into air by the activity of mankind into concentration sufficient to cause harmful effect to his health, vegetables, property or to interfere with the enjoyment of his property.”

Common Air Pollutants:

• Carbon Monoxide (CO): Colourless, odourless gas; impairs metabolic activities.
• Nitrogen Oxides (NOₓ): Produced from motor vehicles; causes respiratory problems.
• Lead: Toxicity to nervous system.
• Particulate Matter: Single particles or collections of particles.

Noise Pollution

Noise is defined as “wrong sound, in the wrong place at the wrong time.” The unwanted sound dumped into the atmosphere leading to health hazards is known as noise pollution.

Permissible Sound Levels (CPCB):

Area	Day	Night
Industrial area	75 dB	65 dB
Commercial area	65 dB	55 dB
Residential area	50 dB	45 dB
Sensitive areas (hospitals, educational institutions)	50 dB	40 dB

Dpharmguru’s exam insights:

Environmental health is frequently tested. Remember: Water-borne diseases (diarrhoea, cholera, typhoid, hepatitis A); Air pollutants (CO, NOₓ, lead, particulate matter); Noise pollution levels (Industrial 75/65 dB, Commercial 65/55 dB, Residential 50/45 dB, Sensitive 50/40 dB). Pharmacists can educate patients about environmental health risks!

2.8. OCCUPATIONAL ILLNESSES

The disease which results due to the exposure to risk factors arising from work activity is known as an occupational disease.

Classification of Occupational Illnesses

• Due to Physical Agents: Heat (heat hyperpyrexia), Cold (frost bite), Light (occupational cataract), Pressure (caisson disease), Noise (occupational deafness), Radiation (cancer), Dust (eczema).
• Due to Chemical Agents: Gases (gas poisoning), Silica (pneumoconiosis), Metals (mercury—tremors, arsenic—skin cancer).
• Due to Biological Agents: Leptospirosis, anthrax, actinomycosis, tetanus.
• Of Psychological Origin: Industrial neurosis, hypertension, peptic ulcer.

Occupational illnesses are frequently tested. Remember: Physical agents (heat, cold, light, pressure, noise, radiation); Chemical agents (gases, silica, metals); Biological agents (anthrax, tetanus); Psychological (neurosis, hypertension). Prevention includes pre-placement examinations, periodical examinations, and protective devices!

2.9. ENVIRONMENTAL POLLUTION DUE TO PHARMACEUTICALS

Drug pollution is defined as contamination of the environment with pharmaceutical medications and their metabolites that reach the marine environment through wastewater.

Control Measures

• • Proper Drug Disposal: Educate public on proper disposal of old or expired medicines.

• • Tougher Regulations: Limit large-scale flushing of medicines in healthcare institutions.

• • Limit Bulk Purchases: Prevents large bottles of unused pills being disposed improperly.

• • Trashing is Better than Flushing: Unused drugs in trash are incinerated or buried in landfills.

Dpharmguru’s exam insights:

Pharmaceutical pollution is an emerging topic. Remember: Drug pollution is mainly water pollution. Pharmacists can play a key role by educating patients on proper drug disposal. Trashing is better than flushing—crush drugs and seal in a plastic bag with water before throwing!

2.10. PSYCHOSOCIAL PHARMACY

Psychosocial pharmacy or psychopharmacology is “a branch of pharmacy which deals with the study of drugs which affect the mind and behaviour.”

Drugs of Misuse and Abuse

• • Drug Misuse: Use of drugs for a reason other than intended purpose.

• • Drug Abuse: Use of medication without a prescription or in a way other than as prescribed.

• • Drug Addiction: Condition of periodic or chronic intoxication from repeated intake of a drug.

Abuse of Narcotics

Narcotic Dependence: When drug use leads to at least 3 of the following within a year:

• • Tolerance (needs more narcotics to sense effects).

• • Withdrawal symptoms when stopping use.

• • Using more narcotics than intended.

• • Inability to control use.

• • Less time spent with others or at work.

• • Continuous use despite worsening physical or mental condition.

Drugs for Opioid Addiction Treatment:

• • Methadone: Synthetic opioid that removes withdrawal symptoms.

• • Buprenorphine: Synthetic opioid prescribed by a physician.

• • Naltrexone: Long-acting opioid receptor blocker to prevent relapse.

• • Naloxone: Short-acting opioid receptor blocker to treat overdose.

Abuse of Tobacco Products

Nicotine Withdrawal Symptoms:

• • Strong craving for nicotine

• • Anxiety

• • Depression

• • Drowsiness

• • Trouble sleeping

• • Feeling tense, restless, or frustrated

• • Headaches

• • Increased appetite and weight gain

• • Problem in concentrating

Nicotine Replacement Therapy:

• • Gums

• • Inhalers

• • Throat lozenges

• • Nasal sprays

• • Skin patches

Dpharmguru’s exam insights:

Psychosocial pharmacy and drug abuse are frequently tested. Remember: Drug misuse (different purpose), Drug abuse (without prescription), Addiction (chronic intoxication). Narcotic dependence symptoms: tolerance, withdrawal, inability to control. Narcotic overdose treatment: Naloxone. Nicotine withdrawal: anxiety, depression, cravings. Pharmacists play a crucial role in counselling patients on drug abuse prevention!

ROLE OF PHARMACIST IN PREVENTIVE HEALTHCARE

• • Family Planning: Educating patients about contraceptives, counselling on family planning methods.

• • Mother and Child Health: Promoting breastfeeding, educating on antenatal and postnatal care.

• • Immunisation: Administering vaccines, educating patients about immunisation schedules.

• • Environmental Health: Educating patients about water-borne diseases, air pollution, and noise pollution.

• • Occupational Health: Advising workers on protective devices, promoting workplace safety.

• • Drug Abuse Prevention: Counselling patients on the dangers of drug abuse, promoting rational drug use.

FREQUENTLY ASKED QUESTIONS (FAQs)

1. What is the demographic cycle?

The demographic cycle has five stages: High Stationary (high birth and death rates), Early Expanding (declining death, constant birth), Late Expanding (further declining death, falling birth), Low Stationary (low birth and death rates), and Declining (lower birth than death).

2. What are the different contraceptive methods?

Contraceptive methods include: Behavioural (abstinence, withdrawal), Natural (temperature, mucus), Chemical (foam tablets, spermicidal jellies), Mechanical (condom, diaphragm, IUDs), Hormonal (COCP, mini pill), Terminal (vasectomy, tubectomy), and Post-conceptional (emergency contraception).

3. What are the benefits of breastfeeding?

Breastfeeding benefits babies by providing essential nutrients, antibodies, and reducing infection risk. It benefits mothers by reducing cancer risk, promoting uterus contraction, and helping lose pregnancy weight.

4. What is the difference between active and passive immunity?

Active immunity is developed by the body after exposure to antigens (slow, long-lasting). Passive immunity is received from preformed antibodies (fast, short-lived).

5. What is the National Immunisation Schedule?

The National Immunisation Schedule includes: BCG and Polio at birth, DPT and Polio at 6, 10, 14 weeks, Measles at 9 months, DPT and Polio boosters at 16-24 months, DT and Typhoid at 5-6 years, TT and Typhoid at 10 and 16 years, and TT for pregnant women at 16-36 weeks.

6. What are the common water-borne diseases?

Common water-borne diseases include diarrhoeal diseases, cholera, giardiasis, amoebiasis, bacillary dysentery, typhoid, paratyphoid, hepatitis A and E, and guinea worm infection.

7. What is drug abuse?

Drug abuse is the use of medication without a prescription or in a way other than as prescribed, for the experience or feeling elicited. It includes use of illegal substances and misuse of prescription and OTC medicines.

8. What is the role of a pharmacist in preventive healthcare?

Pharmacists play a vital role in family planning, mother and child health, immunisation, environmental health, occupational health, and drug abuse prevention. They educate patients, counsel on preventive measures, and promote rational drug use.

SUMMARY

Preventive healthcare is the cornerstone of public health and pharmacy practice. It aims to prevent health issues from arising and recognises diseases before symptoms appear. Understanding demography helps us understand population dynamics, while population control measures address the challenges of overpopulation.

Family planning offers various contraceptive methods—behavioural, natural, chemical, mechanical, hormonal, terminal, and post-conceptional. Mother and child health focuses on breastfeeding, maternal care, and child development. Immunity and immunisation protect individuals and communities from infectious diseases.

Environmental health addresses water, air, and noise pollution, while occupational illnesses focus on workplace health hazards. Pharmaceutical pollution is an emerging concern, and psychosocial pharmacy deals with drug abuse and misuse. Pharmacists play a crucial role in all these areas, functioning as educators, counsellors, and healthcare advocates.

As I always tell my students: “Prevention is better than cure—and pharmacists are the frontline warriors of preventive healthcare. We have the power to educate, counsel, and empower patients to live healthier lives.”

REFERENCES AND FURTHER READING

• • World Health Organization (WHO). (2022). Immunisation Guidelines. Retrieved from https://www.who.int.

• • World Health Organization (WHO). (2022). Maternal and Child Health Guidelines. Retrieved from https://www.who.int.

• • Ministry of Health and Family Welfare. (2022). National Immunisation Schedule. Government of India.

• • Park, K. (2022). Park’s Textbook of Preventive and Social Medicine (25th ed.). Banarasidas Bhanot Publishers.

• • International Pharmaceutical Federation (FIP). (2022). Role of Pharmacists in Preventive Healthcare. Retrieved from https://www.fip.org.

Disclaimer: This article is for educational purposes only and does not constitute medical advice. Always consult qualified healthcare professionals for medical concerns.

For More Study Materials, Visit: www.dpharmguru.com