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Chapter 3 Drugs, Dose Forms, and Delivery Systems.

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2 Chapter 3 Drugs, Dose Forms, and Delivery Systems

3 Chapter 3 Topics Pharmaceuticals Sources of Drugs Uses of Drugs Comparison of Dose Forms and Delivery SystemsComparison of Dose Forms and Delivery Systems Solid Dose Forms Liquid Dose Forms Inhalation Dose Forms Delivery Systems Drug References Presented for Dr. Ryan Bellacov, chiropractor in West Linn, Oregon.

4 Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it."Back in the Game PHYSICIAL THERAPY We believe that the true goal of physical therapy involves restoration of function through neuromuscular re-education and specialized manual techniques. These techniques restore movement, balance and quality of life. At Back in the Game, we go a step further and instruct people how to keep their bodies stronger and healthier. We do this by teaching proper body mechanics and developing personalized exercises that will help prevent re-injury.PHYSICIAL THERAPY At Back In The Game, it's all about you. You're the reason we're here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. We recognize that you are a unique human being with specific needs which require talented people who truly care and we strive to deliver this care in a professional, yet comfortable environment. Dr. Lambert, a state licensed Chiropractic Physician, who has training in sports medicine, heads Back In The Game.

5 Learning Objectives Define the term drug and distinguish between over-the- counter and legend drugs Explain the parts of a National Drug Code number Categorize drugs by source as natural, synthetic, synthesized, or semisynthetic Explain the uses of drugs as therapeutic, pharmacodynamic, diagnostic, prophylactic, and destructive agents

6 Learning Objectives Define and differentiate between the terms dose form and delivery system Enumerate and explain the properties and identify advantages and disadvantages of the major dose forms and delivery systems for drugs Identify the function of various reference texts commonly used in pharmacy Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

7 Pharmaceuticals A drug is any substance taken into or applied to the body for the purpose of altering the bodys biochemical functions and thus its physiological processes –a medical substance or remedy used to change the way a living organism functions –also called a medication Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

8 Pharmaceuticals Drugs products contain many components: an active ingredient is the biochemically reactive component of the drug inert ingredients or inactive ingredients have little or no physiological effect –stabilize the tablet or liquid formulation –provide the raw material for many topical creams and ointments –ensure sterility of injectable products –assist in the masking of unpleasant tasting medications for pediatric patients

9 National Drug Code (NDC) A National Drug Code (NDC) number is a unique number assigned to a product –identifies the manufacturer, drug, packaging size, and type –appears on all drug labels Contains ten characters –four or five digit labeler code, identifying the manufacturer or distributor of the drug –a three- or four- digit product code, identifying the drug (active ingredient and its dose form) –a two-digit package code

10 National Drug Code (NDC) NDC bar code numbers are used –for drug recalls –to compare medications dispensed in the filling process to minimize medication errors Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

11 Parts of a National Drug Code (NDC) Number Visit the NDC DirectoryNDC Directory

12 Classes of Drugs Drugs are classified as over-the-counter (OTC) or legend legend drugs can be dispensed only with a prescription from a healthcare professional licensed in that state –labeled with the legend, Caution: Federal Law Prohibits Dispensing Without Prescription or an equivalent symbol ( ) –the new legend in the updated labeling law is only drug caution legend

13 Classes of Drugs Drugs with potential for abuse are classified according to five drug schedules based on the potential for abuse and physical and psychological dependence –Schedule II drugs such as narcotics and amphetamines have a high potential for abuse and dependence –Schedule V cough syrups have a low potential for abuse and limited potential for creating physical or psychological dependence Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

14 Classes of Drugs Over-the-counter drugs can be dispensed without a prescription –proven relatively safe to be sold without prescription OTC drug labels –must contain all the information necessary for a consumer to safely take the medication Learn more about the Drug Facts label at the Consumer Healthcare Products Association Web siteConsumer Healthcare Products Association

15 Classes of Drugs Diet supplements, especially herbs, should be considered drugs –can cause side effects, adverse reactions, and drug interactions Do not have the same stringent controls as legend and OTC medications Learn more about independent testing of diet supplements by visiting ConsumerLabs Web siteConsumerLabs

16 Classes of Drugs Diet supplements are considered food supplements to maintain health –a patient should not exceed the recommended daily dose without the knowledge of a physician –the pharmacy technician can assist the pharmacist by gathering information on patient use of diet supplements and adding this data to the computer profile

17 Classes of Drugs Homeopathic medications are very small dilutions of natural drugs claimed to stimulate the immune system Homeopathy is derived from the Greek words homos (i.e., similar) and pathos (i.e., suffering or disease) Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

18 Classes of Drugs Most homeopathics are OTC, but some are prescription only.

19 Discussion What are the differences between the various classes of pharmaceuticals?

20 Discussion What are the differences between the various classes of pharmaceuticals? Answer: OTCs may be purchased without prescriptions while legend drugs require a prescription from an authorized practitioner; controlled substances have abuse potential, and homeopathic medications are natural extracts, usually OTC.

21 drug active ingredient inert ingredient National Drug Code (NDC) over-the-counter (OTC) homeopathic medications Terms to Remember

22 Sources of Drugs Drugs come from various sources Can be classified as: –natural –synthetic (created artificially) –synthesized (created artificially but in imitation of naturally occurring substances) –semisynthetic (containing both natural and synthetic components) Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

23 Drugs from Natural Sources Some drugs are naturally occurring biological products –made or taken from single-celled organisms, plants, animals, and humans Many herbal products come from natural sources Modern-day drugs from natural sources include: –penicillin (extracted from certain molds) –acetylsalicylic acid, commonly known as aspirin, is derived from the bark of the white willow tree

24 A synthesized drug is a drug that is created artificially A synthetic drug is a drug that is created artificially in imitation of naturally occurring substances –to exert a specific pharmacologic effect A semisynthetic drug is a drug that is created artificially and contains both natural and synthetic components Synthetic, Synthesized, and Semisynthetic Drugs

25 Biotechnology combines the science of biology, chemistry, and immunology to produce synthetic, unique drugs with specific therapeutic effects These drugs can be created by means of the recombinant deoxyribonucleic acid (recombinant DNA) techniques of genetic engineering –using living organisms or parts of organisms for specific purposes such as creating a synthetic drug Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

26 Synthetic, Synthesized, and Semisynthetic Drugs Deoxyribonucleic acid (DNA) is the complex, helically shaped molecule that carries the genetic code Contains the instructions, or recipe, for creating messenger ribonucleic acid (mRNA) –mRNA contains the recipe for arranging amino acids into proteins for living organisms By transferring a segment of recombined DNA into a host cell, scientists can change what proteins the cell produces Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

27 Modeling DNA (a) A single nucleotide. (b) A short section of a DNA molecule consisting of two rows of nucleotides connected by weak bonds between the bases adenine (A) and thymine (T), guanine (G), and cytosine (C). (c) Long strands of DNA twisted to form a double helix.

28 Synthetic, Synthesized, and Semisynthetic Drugs Antibodies are a part of the immune system to neutralize antigens or foreign substances in the body Monoclonal antibodies are pure antibodies produced in a laboratory against a known specific antigen –can be used to attack tumors and to diagnose a great variety of conditions Genetic engineering is the hybridization techniques for creating MAbs Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

29 The Human Genome Project is the mapping of the biochemical instructions that make up the human body in health and disease –potential disease can be identified at an earlier date, and new treatments can be specifically designed to treat them Synthetic, Synthesized, and Semisynthetic Drugs Learn more about the Human Genome ProjectHuman Genome Project

30 Discussion Give examples of drugs from various sources.

31 Discussion Give examples of drugs from various sources. Answer: Drugs may come from natural sources (quinine from cinchona bark), may be synthetic (barbiturates), or may be semisynthetic (semisynthetic penicillins), or may result from biotechnology (human insulin).

32 Terms to Remember synthesized drug synthetic drug semisynthetic drug biotechnology recombinant deoxyribonucleic acid (recombinant DNA)recombinant deoxyribonucleic acid (recombinant DNA) deoxyribonucleic acid (DNA)deoxyribonucleic acid (DNA) ribonucleic acid (mRNA)ribonucleic acid (mRNA) antibodies monoclonal antibodiesmonoclonal antibodies genetic engineering

33 Uses of Drugs Medications are used to: –treat and cure illness –aid in diagnosis –prevent illnesses The action of a medication cannot be fully accounted for without considering the dose form selected

34 Therapeutic Agents A therapeutic agent is any drug that helps to: –maintain health –relieve symptoms –combat illness –reverse disease processes

35 Pharmacodynamic Agents A pharmacodynamic agent is one that alters bodily functioning in a desired way –stimulate or relax muscles –dilate or constrict pupils –increase or decrease blood sugar Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

36 Diagnostic Agents A diagnostic agent facilitates an examination or conclusion as to the nature or extent of a disease condition Radiopharmaceuticals are chemicals containing radioactive isotopes, used diagnostically (and also therapeutically) –nuclear pharmacy is the procuring, storage, compounding, dispensing, and provision of information about radiopharmaceuticals Get more information on nuclear pharmacy technician training programs at the American Pharmacists Association Web pageAmerican Pharmacists Association

37 Prophylactic Agents A prophylactic agent prevents illness or disease from occurring –antiseptic –germicidal liquid iodine –any vaccine is considered a prophylactic agent Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

38 Destructive Agents A destructive agent has a -cidal action, meaning it kills bacteria, fungi, viruses, or even normal cells or abnormal cancer cells –many antibiotics are bactericidal (they kill bacteria) –radioactive iodine is used to destroy some of the thyroid gland in patients with hyperthyroidism –antineoplastic drugs used in cancer chemotherapy to destroy malignant tumors Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

39 Discussion Give examples of the various uses of drugs.

40 Discussion Give examples of the various uses of drugs. Answer: Drugs may be used to maintain health (aspirin to prevent heart attack), to relieve symptoms (analgesics), combat illness (antibiotics), or reverse disease processes (antihypertensives).

41 therapeutic agent pharmacodynamic agent diagnostic agent radiopharmaceuticals prophylactic agent destructive agent antineoplastic drug Terms to Remember

42 Comparison of Dose Forms and Delivery Systems Dose form refers to the physical manifestation of a drug as a solid, liquid, or gas that can be used in a particular way –common dose forms include tablets, capsules, creams, ointments, solutions, injections, and aerosols Delivery system may mean any of the following: –device used to deliver the drug –design feature of the dose form that affects the delivery of the drug –means for transporting a drug to its site(s) of action within the body

43 Comparison of Dose Forms and Delivery Systems Delivery systems differ in pharmacological properties –sites of action –rate of delivery –quantities of active ingredient delivered Choice of delivery system depends on –active ingredient to be delivered –amount of active ingredient to be delivered –means or route by which ingredient is to be delivered –to what sites, at what rate, over what period of time, for what purpose

44 dose form delivery system Terms to Remember Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

45 Solid Dose Forms used more frequently than any other form are safest for self-administration

46 Tablets A tablet is a solid dose form produced by compression containing one or more active ingredients and, commonly, other pharmacological ingredients including: –diluents –binders (promote adhesion of materials in tablet) –lubricating agents (give a sheen and aid in manufacturing process) –disintegrates (help break up ingredients) –solubilizers, colorings, flavorings Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

47 Tablets Some tablets are scored once or twice to facilitate breaking into portions for half or even quarter doses Unscored tablets should not be broken because the dose may not be equal in each piece –a tablet-splitter may be used for some unscored tablets –odd-shaped tablets are often difficult to cut, even with a tablet splitter

48 Tablets Careful tablet splitting may be a way to reduce medication costs, but it is not recommended for all drugs Patients must be warned not to take a full tablet if such action would result in an overdose of medication

49 Tablets Compression tablets are the most inexpensive and common dose form Multiple compression tablets (MCTs) are produced by multiple compressions –created for appearance alone, to combine incompatible substances into a single medication, or to provide for controlled release in successive events, or stages (a) Two layers or compressions (b) Three layers or compressions

50 Tablets A caplet is an oblong tablet that is a hybrid of the capsule and tablet –offers the advantage of easier swallowing than a large tablet and more stability (and longer shelf life) than a capsule Most tablets are uncoated A coating is a special outside layer that dissolves or ruptures at the site of application Formulated to –mask bitter taste –prevent drug destruction in stomach –delay release of drug into the intestines

51 Tablets Sugar-coated tablets (SCTs) contain an outside layer of sugar –protects the medication –improves appearance and flavor –BUT makes tablets much larger and heavier and more difficult to swallow Film-coated tablets (FCTs) contain a thin outer layer of a polymer –thinner, lighter in weight, and cheaper to manufacture than sugar coatings –colored to provide an attractive appearance

52 Tablets Enteric-coated tablets (ECTs) are designed to resist destruction by acid of gastric fluids –release the active ingredient once it reaches the higher pH of the intestine ECTs are used for drugs that are: –destroyed by gastric acid –irritating to the esophageal tract or stomach –better absorbed by the intestines

53 Tablets Enteric-coated tablets (ECTs) should not be split.

54 Tablets A controlled-release medication is designed to regulate the rate at which a drug is released from the tablet and into the body May vary the rate of dissolution or the release of the active drug

55 Tablets Controlled-release dose forms should not be split.

56 Controlled-release Medications A delayed-release dose form does not release the active drug immediately after administration An extended-release dose form allows reduced frequency of dosing –also called long-acting, timed-release, and sustained-release dose forms A transdermal system dose form is designed to deliver drugs to systemic circulation by passage through the skin –similar to how the extended-release tablets act by passage through the stomach and/or small intestine

57 Controlled-release Medications Watch the drug labels very carefully! Delayed- release medication is not the same as extended- or controlled-release medication of the same drug!

58 Other Tablet Types Chewable tablets have a flavored and/or colored base –designed to be masticated (chewed) Effervescent tablets are granular salts that release gas –dispense active ingredients into solution when placed in water or juice Buccal tablets (and gum) are placed in the buccal pouch –between the cheek and the gum –dissolved and absorbed by the buccal mucosa Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

59 Other Tablet Types Sublingual tablets are designed to be dissolved under the tongue –medication dissolved under the tongue is absorbed very quickly –immediately enters the bloodstream Vaginal tablets (or inserts) are placed into the vagina –by means of an applicator –dissolved and absorbed through the vaginal mucosa Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

60 Capsules A capsule is a solid dose form consisting of a gelatin shell that encloses the drug –usually swallowed whole –tasteless and are easier to swallow than tablets Contains powders, granules, liquids, or some combination with one or more active ingredients Since a capsule is enclosed, flavorings are not common for this dose form Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

61 Capsules Can be designed in a controlled-release dose form Controlled-release capsules are taken less often –increases compliance Long-acting form may give better control over the disease state –may be initially more expensive –but fewer need to be purchased Takes a longer time for side effects to subside Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

62 Suppositories A suppository is a solid dose forms designed for insertion into body orifices –rectum or the vagina or, less commonly, the urethra May be the preferred dose form in some cases when patient has nausea and vomiting Avoided when possible because of patient discomfort

63 Suppositories The patient must remove the foil before inserting the suppository!

64 Effervescent Salts Effervescent salts are granules or coarse powders containing one or more medicinal agents –contains some combination of sodium bicarbonate with citric acid, tartaric acid, or sodium biphosphate Release carbon dioxide gas when dissolved – causes a distinctive bubbling Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

65 Implants or Pellets Implants, or pellets, are dose forms placed under the skin by means of minor surgery Used for long-term, controlled release of medications Advantages include enhanced patient compliance and convenience Complications at the site of insertion have limited widespread use Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

66 Lozenges, Troches, or Pastilles Lozenges are dose forms containing active ingredients and flavorings that are dissolved in the mouth –also known as troches or pastilles –generally have local effects Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

67 Plasters Plasters are solid or semisolid and medicated or nonmedicated preparations that adhere to the body –contain backing material such as paper, cotton, linen, silk, moleskin, or plastic Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

68 Powders and Granules Usually ordered in bulk, dispensed as needed in the prescribed amount Granules are larger than powders –formed by adding very small amounts of liquid to powders and passing the mixture through a screen or a granulating device Granules –are generally of irregular shape –have excellent flow characteristics –are more stable than powders –may contain colorings, flavorings, and coatings –may have controlled-release characteristics

69 Discussion What factors may influence the choice of a dosage form for a drug?

70 Discussion What factors may influence the choice of a dosage form for a drug? Answer: Choice of dosage form may be influenced by release properties, drug stability, or route of administration.

71 Terms to Remember tablet controlled-release medicationcontrolled-release medication capsule suppository effervescent salt implants lozenges plasters

72 Liquid Dose Forms Liquid dose forms consist of one or more active ingredients in a liquid vehicle Two major categories are: –solutions, in which active ingredients are dissolved in the liquid vehicle –dispersions, in which undissolved ingredients are dispersed throughout a liquid vehicle Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

73 Liquid Dose Forms Advantages over solid dose forms are: –ease of swallowing –ease of adjusting the dose –tablets or capsules cannot always be divided Disadvantage is: –less stable than their solid counterparts

74 Liquid Dose Forms Care should be taken to monitor storage conditions of the liquid dose forms, to rotate stock, and to check expiration dates often.

75 Solutions Solutions are classified by vehicle as: –aqueous (water based) –alcoholic (alcohol based) –hydroalcoholic (water and alcohol based) A solvent is the vehicle that makes up the greater part of a solution A solute is an ingredient dissolved in a solution Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

76 Solutions An enema is usually a water-based solution administered rectally for cleansing the bowel or delivering active drug A collodion is a vehicle that is a volatile liquid dissolved in a mixture of alcohol and ether and used for a variety of topical uses –upon application to skin, the solvent vaporizes, leaving a film coating containing medication Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

77 Solutions Aromatic water is a solution of water containing volatile oils or other substances An elixir is a clear, sweetened, flavored hydroalcoholic solution containing water and ethanol A syrup is an aqueous solution thickened with a large amount of sugar or a sugar substitute –may contain additional flavorings, colors, or aromatic agents –often the preferred vehicle to mask the taste for pediatric medications

78 Solutions An extract is a potent dose form derived from animal or plant sources –from which most or all the solvent has been evaporated –used in the formulation or compounding of medications A fluidextract is a liquid dose form prepared by extraction from plant sources A tincture is an alcoholic or hydroalcoholic solution of extractions from plants Spirits are alcoholic or hydroalcoholic solutions containing volatile, aromatic ingredients

79 Solutions A low-alcohol or alcohol-free product is preferred for most pediatric products.

80 Solutions Parenteral solutions are products that are prepared in a sterile environment for administration by injection Two major delivery systems exist: –intravenous (IV) infusions: fluids administered directly into a vein –injections intravenous (IV) – into a vein intramuscular (IM) – into the muscle subcutaneous (SQ or SC) – under the skin intradermal (ID) – into the skin

81 Dispersions Dispersions are undissolved ingredients mixed throughout a liquid vehicle –Classified by size of the dispersed ingredient(s) into suspensions and emulsions containing: relatively large particles magmas, gels, and jellies (contain fine particles) ultrafines particles, less than a micron in size, called a colloidal dispersion A suspension is a dispersion of a solid in a liquid An emulsion is a dispersion of a liquid in another liquid

82 Dispersions Solutions are classified by route of administration –oral (taken by mouth) –topical (lotions applied to the skin) –injectable suspensions Emulsions vary in their viscosity, or rate of flow. Some common types are: –oil-in-water (O/W) emulsion: emulsion containing a small amount of oil dispersed in water –water-in-oil (W/O) emulsion: emulsion containing a small amount of water dispersed in an oil

83 Suspensions Suspensions should always include a Shake Well label.

84 Dispersions A lotion is a liquid for topical application containing insoluble dispersed solids or immiscible liquids A gel is a dispersion containing fine particles for topical use on the skin –particles are ultrafine –colloidal dimensions –linked to form a semisolid Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

85 Dispersions An ointment is a semisolid emulsion for topical application May be medicated or nonmedicated and may contain various bases: –oleaginous or greasy bases such as petroleum jelly –W/O emulsions such as lanolin –O/W emulsions such as hydrophilic ointment –water-soluble or greaseless bases such as polyethylene glycol ointment

86 Dispersions Pastes are like ointments but contain more solid materials and are stiffer and apply more thickly –Zinc oxide paste –Acetonide dental paste Creams are considered O/W emulsions. Apply smoothly to the skin and leave a very thin film. Most creams are considered vanishing.

87 Discussion Why do the differences between solutions and dispersions have advantages in pharmaceutical practice?

88 Discussion Why do the differences between solutions and dispersions have advantages in pharmaceutical practice? Answer: Solutions do not require shaking, but are only appropriate for particles that dissolve in suitable vehicles. Some dispersions have a thicker consistency that is an advantage for topical use.

89 solution dispersion solvent solute parenteral solution suspension emulsion oil-in-water (O/W) emulsionoil-in-water (O/W) emulsion water-in-oil (W/O) emulsionwater-in-oil (W/O) emulsion ointment paste Terms to Remember

90 Inhalation Dose Forms Inhalations are gases, vapors, solutions, or suspensions intended to be inhaled via the nasal or oral respiratory routes A spray consists of a container with a valve assembly that, when activated, emits a fine dispersion of liquid, solid, or gaseous material –an aerosol is a spray in a pressurized container with a propellant to carry the active ingredient to its location of application –breath-activated devices of powders in place of aerosolized propellants Most sprays and aerosols are for –topical application to skin or to oral mucous membranes –inhalation aerosols breathed in through the nose or mouth

91 Terms to Remember inhalation spray

92 Discussion What are some of the uses for inhalation dose forms?

93 Discussion What are some of the uses for inhalation dose forms? Answer: Sprays and aerosols are often used for nasal decongestants and for inhalation of antiasthmatic drugs. Many anti-inflammatory medications are available both as a nasal spray for allergies and as an aerosol for inhalation for asthma.

94 Delivery Systems A delivery system may be –a device used to deliver the drug –a design feature of the dose form that affects the delivery of the drug –how a medication is formulated to release the active ingredient Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

95 Inhalation Delivery Systems One of the most rapid means of administering medication Gases such as oxygen, nitrous oxide or laughing gas, and ether are administered by inhalation Medicated inhalations intended for the lung are administered via –metered-dose inhalers (MDIs) hand held, breath-activated, propellant-driven inhalers –nebulizers –vaporizers and humidifiers mechanical devices which deliver moisture to the air

96 Inhalation Delivery Systems A nebulizer is a device used to deliver medication in a fine-mist form to the lung –deliver a mist containing extremely small, or micronized, powder –a nebulized mist of medication may be more effective than an aerosolized spray in delivering medications into the deeper areas of the lung in infants and young children

97 Syringe, Injection, and Infusion Delivery Systems Injections of medications act rapidly to control and treat symptoms Syringes are calibrated devices used to accurately draw up, measure, and deliver medication through a needle Injections must be sterile because they introduce medication directly into the body Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

98 Syringe, Injection, and Infusion Delivery Systems Only trained professionals and healthcare providers should give injections, and some risk to the patient is always present.

99 Syringe, Injection, and Infusion Delivery Systems Glass syringes are fairly expensive Plastic syringes are easy to handle, disposable, and come from the manufacturer in sterile packaging –clearly preferred –used both within and outside the hospital setting Different states have different regulations on the sale of syringes –potential diversion for injection of illegal drugs –some states may require a prescription or the placement of syringes behind the prescription counter to control their sales

100 Syringe, Injection, and Infusion Delivery Systems insulin syringe (measures from 30 to 100 U) tuberculin syringe (with cannulas ranging from 0.01 mL to 1 mL [used for skin tests and drawing up very small volumes of solution]) standard hypodermic syringes in sizes from 1mL to 60mL

101 Syringe, Injection, and Infusion Delivery Systems Injections may be administered to almost any organ or part of the body Injectables come prefilled or are filled at the time of injection from single or multidose vials –single-dose vials generally have no preservative –multiple-dose vials, although they contain a preservative, should be dated and discarded (usually after thirty days) –ampules are small glass containers that are opened by breaking off the neck of the container

102 Syringe, Injection, and Infusion Delivery Systems Other devices for injection include: A patient-controlled analgesia (PCA) infusion device used by a patient to deliver small doses of medication for chronic pain Jet injectors, which use pressure rather than a needle to deliver the medication Ambulatory injection devices that the patient can wear while moving about

103 Syringe, Injection, and Infusion Delivery Systems Only the patient should control the PCA pump button.

104 Syringe, Injection, and Infusion Delivery Systems Intravenous (IV) infusion –method for delivering a large amount of fluid over a prolonged period of time at a slow, steady rate –used to deliver blood, water, other fluids, electrolytes, nutrients IV infusions are used to: –deliver pain-killing or blood clot buster medications –replenish body fluids –deliver nutrients to patients who cannot or will not feed themselves

105 Intrauterine and Cervical Delivery Systems An intrauterine delivery system is a way to deliver medication to prevent conception or treat cancer –drug-releasing device placed into the uterus –may contain a progestin hormone to prevent pregnancy on a long-term (1 to 5 years) basis Cervical delivery systems are placed as a ring surrounding the cervix to slowly release medication –replaced monthly by the patient and used as contraceptive aids

106 Intrauterine and Cervical Delivery Systems Occasionally, the patient will expel these devices spontaneously and may experience a high risk of pelvic infection.

107 Transdermal Delivery Systems A transdermal delivery system (TDS) is a method for delivering medications percutaneously (through the skin) Also known as a patch –consists of a backing, a drug reservoir, a control membrane, an adhesive layer, and a protective strip –the strip is removed, and the adhesive layer is attached to the skin Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

108 Transdermal Delivery Systems Drug movement is by osmosis through the control membrane, delivering medication systemically, rather than locally Medication delivery can be controlled over 24 hours or longer –improves patient convenience and compliance Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

109 Other Delivery Systems Unit dose disposable syringes are prefilled syringes that contain a single premeasured dose of medication and are thrown away after use An oral syringe is a device without a needle to administer medication to pediatric or elderly patients unable to swallow tablets or capsules –a calibrated device consisting of a plunger and a cannula, or barrel –used for administration of precisely measured amounts of liquid medication by mouth

110 Other Delivery Systems A bulb syringe is a device used to irrigate eyes or ears with water –bulb is first depressed to expel the air that it contains, and the tip is then inserted into the liquid to be administered –bulb is released while the end is in the liquid, and liquid rises to fill the vacuum created –end of the bulb is then removed from the liquid, and the liquid is administered by depressing the bulb again Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

111 Other Delivery Systems A dropper uses a bulb to create a vacuum for drawing up a liquid –contains a small, squeezable bulb at one end and a hollow glass or plastic tube with a tapering point – may be incorporated into the cap of a vial or other container gtt is an abbreviation for unit of pharmaceutical measurement for droppers and IV infusions to indicate drops –due to the differing viscosities of fluids, the size of a drop varies considerably from medication to medication Droppers are often used for otic or ophthalmic administration, as well as for oral medications

112 Other Delivery Systems Ocular inserts are a type of contact lens device with active medication for administration in the eye –small, transparent membranes –placed between the eye and the lower conjunctiva Hospices and long-term care facilities use straws (long, hollow tubes) prefilled with pain medications Another delivery system for contraceptives is the polyurethane sponge Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

113 Discussion What are some advantages of the specialized medication delivery systems?

114 Discussion What are some advantages of the specialized medication delivery systems? Answer: Delivery systems enable more efficient delivery of medications to their sites of action, greater convenience, and/or patient safety.

115 Terms to Remember nebulizer patient-controlled analgesia (PCA) infusion device intrauterine delivery system transdermal delivery system (TDS) oral syringe bulb syringe ocular insert

116 Drug References Official legal standards for drugs in the U.S. are established by the United States Pharmacopeial Convention (USP) Standards are published in two reference works –the United States Pharmacopeia –National Formulary (NF) –Both are revised every 5 years –also printed in a combined edition United States Pharmacopeia–National Formulary (USP–NF) Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

117 Drug References The Physicians Desk Reference –published annually with reprints of package inserts from the pharmaceutical manufacturers of most drugs –useful for identifying unknown drugs by color, shape, and coding Edited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR

118 Drug References Drug Facts and Comparisons – factual information on: product availability indications administration and dose pharmacological actions contraindications warnings and precautions adverse reactions overdose and patient instructions –updated monthly with new inserts –available on CD-ROM

119 Drug References USP Drug Information –originally published by USP –patient counseling information for the pharmacist The American Hospital Formulary Service (AHFS) – information on drugs commonly used in the hospital The Handbook of Nonprescription Drugs –published by the American Pharmacists Association –provides a good reference for OTC drugs

120 Drug References FDA Electronic Orange Book –officially named Approved Drug Products with Therapeutic Equivalence Evaluations –available online –information on generic equivalency of drugs that may have many sources View the FDA Electronic Orange BookFDA Electronic Orange Book

121 Drug References Remington: The Science and Practice of Pharmacy –useful in compounding pharmacy for drug stability and compatibility information The Lawrence Review of Natural Products –scientific monographs on herbal medications Homeopathic Pharmacopeia of the United States –compilation of standards for the source, composition, and preparation of homeopathic medications Go to this books Information Resources Center (IRC) and visit the Resources page found in the Pharmacy Library for a list of these and other valuable resources

122 Discussion What drug references are available in your practice or educational setting? Have you referred to them? For what kinds of information?

123 Back in the Game Sports Medicine is a clinic dedicated to the treatment of physical injuries to the body. Caring for an injured body involves more than making the diagnosis; it's about understanding and treating the cause to prevent future injuries. The clinic addresses variety of injuries to the body whether it be from a car accident to over-use trauma. When injuries occur, it is no longer enough for people to "take it easy for awhile" or "work through it."Back in the Game PHYSICIAL THERAPY We believe that the true goal of physical therapy involves restoration of function through neuromuscular re-education and specialized manual techniques. These techniques restore movement, balance and quality of life. At Back in the Game, we go a step further and instruct people how to keep their bodies stronger and healthier. We do this by teaching proper body mechanics and developing personalized exercises that will help prevent re-injury.PHYSICIAL THERAPY At Back In The Game, it's all about you. You're the reason we're here. The entire visit is centered around giving you an experience uncommon in today's impersonal medical world. We recognize that you are a unique human being with specific needs which require talented people who truly care and we strive to deliver this care in a professional, yet comfortable environment. Dr. Lambert, a state licensed Chiropractic Physician, who has training in sports medicine, heads Back In The Game.


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