2 Drugs, Dose Forms, and Delivery Systems Chapter 3Drugs, Dose Forms, and Delivery Systems
3 Chapter 3 Topics Pharmaceuticals Sources of Drugs Uses of Drugs Comparison of Dose Forms and Delivery SystemsSolid Dose FormsLiquid Dose FormsInhalation Dose FormsDelivery SystemsDrug ReferencesPresented 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."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.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 ObjectivesDefine the term drug and distinguish between over-the-counter and legend drugsExplain the parts of a National Drug Code numberCategorize drugs by source as natural, synthetic, synthesized, or semisyntheticExplain the uses of drugs as therapeutic, pharmacodynamic, diagnostic, prophylactic, and destructive agents
6 Learning ObjectivesDefine and differentiate between the terms dose form and delivery systemEnumerate and explain the properties and identify advantages and disadvantages of the major dose forms and delivery systems for drugsIdentify the function of various reference texts commonly used in pharmacyEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
7 PharmaceuticalsA drug is any substance taken into or applied to the body for the purpose of altering the body’s biochemical functions and thus its physiological processesa medical substance or remedy used to change the way a living organism functionsalso called a medicationEdited 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 druginert ingredients or inactive ingredients have little or no physiological effectstabilize the tablet or liquid formulationprovide the raw material for many topical creams and ointmentsensure sterility of injectable productsassist 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 productidentifies the manufacturer, drug, packaging size, and typeappears on all drug labelsContains ten charactersfour or five digit labeler code, identifying the manufacturer or distributor of the druga 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 usedfor drug recallsto compare medications dispensed in the filling process to minimize medication errorsEdited 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 Directory
12 Classes of DrugsDrugs are classified as over-the-counter (OTC) or legendlegend drugs can be dispensed only with a prescription from a healthcare professional licensed in that statelabeled 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 DrugsDrugs with potential for abuse are classified according to five drug schedules based on the potential for abuse and physical and psychological dependenceSchedule II drugs such as narcotics and amphetamines have a high potential for abuse and dependenceSchedule V cough syrups have a low potential for abuse and limited potential for creating physical or psychological dependenceEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
14 Classes of DrugsOver-the-counter drugs can be dispensed without a prescriptionproven relatively safe to be sold without prescriptionOTC drug labelsmust contain all the information necessary for a consumer to safely take the medicationLearn more about the Drug Facts label at the Consumer Healthcare Products Association Web site
15 Classes of DrugsDiet supplements, especially herbs, should be considered drugscan cause side effects, adverse reactions, and drug interactionsDo not have the same stringent controls as legend and OTC medicationsLearn more about independent testing of diet supplements by visiting ConsumerLab’s Web site
16 Classes of Drugs Safety Note Diet supplements are considered “food supplements” to maintain healtha patient should not exceed the recommended daily dose without the knowledge of a physicianthe 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 DrugsHomeopathic medications are very small dilutions of natural drugs claimed to stimulate the immune systemHomeopathy 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 Safety Note Most homeopathics are OTC, but some are prescription only.
19 DiscussionWhat are the differences between the various classes of pharmaceuticals?
20 DiscussionWhat 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 Terms to Remember drug active ingredient inert ingredient National Drug Code (NDC)over-the-counter (OTC)homeopathic medications
22 Sources of Drugs Drugs come from various sources Can be classified as: naturalsynthetic (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 productsmade or taken from single-celled organisms, plants, animals, and humansMany herbal products come from natural sourcesModern-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 Synthetic, Synthesized, and Semisynthetic Drugs A synthesized drug is a drug that is created artificiallyA synthetic drug is a drug that is created artificially in imitation of naturally occurring substancesto exert a specific pharmacologic effectA semisynthetic drug is a drug that is created artificially and contains both natural and synthetic components
25 Synthetic, Synthesized, and Semisynthetic Drugs Biotechnology combines the science of biology, chemistry, and immunology to produce synthetic, unique drugs with specific therapeutic effectsThese drugs can be created by means of the recombinant deoxyribonucleic acid (recombinant DNA) techniques of genetic engineeringusing living organisms or parts of organisms for specific purposes such as creating a synthetic drugEdited 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 codeContains the instructions, or recipe, for creating messenger ribonucleic acid (mRNA)mRNA contains the recipe for arranging amino acids into proteins for living organismsBy transferring a segment of recombined DNA into a host cell, scientists can change what proteins the cell producesEdited 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 bodyMonoclonal antibodies are pure antibodies produced in a laboratory against a known specific antigencan be used to attack tumors and to diagnose a great variety of conditionsGenetic engineering is the hybridization techniques for creating MAbsEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
29 Synthetic, Synthesized, and Semisynthetic Drugs The Human Genome Project is the mapping of the biochemical instructions that make up the human body in health and diseasepotential disease can be identified at an earlier date, and new treatments can be specifically designed to treat themLearn more about the Human Genome Project
30 DiscussionGive 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 biotechnologyrecombinant deoxyribonucleic acid (recombinant DNA)deoxyribonucleic acid (DNA)ribonucleic acid (mRNA)antibodiesmonoclonal antibodiesgenetic engineering
33 Uses of Drugs Medications are used to: treat and cure illnessaid in diagnosisprevent illnessesThe 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 healthrelieve symptomscombat illnessreverse disease processes
35 Pharmacodynamic Agents A pharmacodynamic agent is one that alters bodily functioning in a desired waystimulate or relax musclesdilate or constrict pupilsincrease or decrease blood sugarEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
36 Diagnostic AgentsA diagnostic agent facilitates an examination or conclusion as to the nature or extent of a disease conditionRadiopharmaceuticals are chemicals containing radioactive isotopes, used diagnostically (and also therapeutically)nuclear pharmacy is the procuring, storage, compounding, dispensing, and provision of information about radiopharmaceuticalsGet more information on nuclear pharmacy technician training programs at the American Pharmacists Association Web page
37 Prophylactic AgentsA prophylactic agent prevents illness or disease from occurringantisepticgermicidal liquid iodineany vaccine is considered a prophylactic agentEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
38 Destructive AgentsA destructive agent has a -cidal action, meaning it kills bacteria, fungi, viruses, or even normal cells or abnormal cancer cellsmany antibiotics are bactericidal (they kill bacteria)radioactive iodine is used to destroy some of the thyroid gland in patients with hyperthyroidismantineoplastic drugs used in cancer chemotherapy to destroy malignant tumorsEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
39 DiscussionGive 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 Terms to Remember therapeutic agent pharmacodynamic agent diagnostic agentradiopharmaceuticalsprophylactic agentdestructive agentantineoplastic drug
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 waycommon dose forms include tablets, capsules, creams, ointments, solutions, injections, and aerosolsDelivery system may mean any of the following:device used to deliver the drugdesign feature of the dose form that affects the delivery of the drugmeans 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 propertiessites of actionrate of deliveryquantities of active ingredient deliveredChoice of delivery system depends onactive ingredient to be deliveredamount of active ingredient to be deliveredmeans or route by which ingredient is to be deliveredto what sites, at what rate, over what period of time, for what purpose
44 Terms to Remember dose form delivery system 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:diluentsbinders (promote adhesion of materials in tablet)lubricating agents (give a sheen and aid in manufacturing process)disintegrates (help break up ingredients)solubilizers, colorings, flavoringsEdited 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 dosesUnscored tablets should not be broken because the dose may not be equal in each piecea tablet-splitter may be used for some unscored tabletsodd-shaped tablets are often difficult to cut, even with a tablet splitter
48 TabletsSafetyNoteCareful tablet splitting may be a way to reduce medication costs, but it is not recommended for all drugsPatients 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 formMultiple compression tablets (MCTs) are produced by multiple compressionscreated 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 TabletsA caplet is an oblong tablet that is a hybrid of the capsule and tabletoffers the advantage of easier swallowing than a large tablet and more stability (and longer shelf life) than a capsuleMost tablets are uncoatedA coating is a special outside layer that dissolves or ruptures at the site of applicationFormulated tomask bitter tasteprevent drug destruction in stomachdelay release of drug into the intestines
51 Tablets Sugar-coated tablets (SCTs) contain an outside layer of sugar protects the medicationimproves appearance and flavorBUT makes tablets much larger and heavier and more difficult to swallowFilm-coated tablets (FCTs) contain a thin outer layer of a polymerthinner, lighter in weight, and cheaper to manufacture than sugar coatingscolored to provide an attractive appearance
52 TabletsEnteric-coated tablets (ECTs) are designed to resist destruction by acid of gastric fluidsrelease the active ingredient once it reaches the higher pH of the intestineECTs are used for drugs that are:destroyed by gastric acidirritating to the esophageal tract or stomachbetter absorbed by the intestines
53 TabletsSafetyNoteEnteric-coated tablets (ECTs) should not be split.
54 TabletsA controlled-release medication is designed to regulate the rate at which a drug is released from the tablet and into the bodyMay vary the rate of dissolution or the release of the active drug
55 TabletsSafetyNoteControlled-release dose forms should not be split.
56 Controlled-release Medications A delayed-release dose form does not release the active drug immediately after administrationAn extended-release dose form allows reduced frequency of dosingalso called long-acting, timed-release, and sustained-release dose formsA transdermal system dose form is designed to deliver drugs to systemic circulation by passage through the skinsimilar to how the extended-release tablets act by passage through the stomach and/or small intestine
57 Controlled-release Medications SafetyNoteWatch 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 TypesChewable tablets have a flavored and/or colored basedesigned to be masticated (chewed)Effervescent tablets are granular salts that release gasdispense active ingredients into solution when placed in water or juiceBuccal tablets (and gum) are placed in the buccal pouchbetween the cheek and the gumdissolved and absorbed by the buccal mucosaEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
59 Other Tablet TypesSublingual tablets are designed to be dissolved under the tonguemedication dissolved under the tongue is absorbed very quicklyimmediately enters the bloodstreamVaginal tablets (or inserts) are placed into the vaginaby means of an applicatordissolved and absorbed through the vaginal mucosaEdited 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 drugusually swallowed wholetasteless and are easier to swallow than tabletsContains powders, granules, liquids, or some combination with one or more active ingredientsSince a capsule is enclosed, flavorings are not common for this dose formEdited 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 oftenincreases complianceLong-acting form may give better control over the disease statemay be initially more expensivebut fewer need to be purchasedTakes a longer time for side effects to subsideEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
62 SuppositoriesA suppository is a solid dose forms designed for insertion into body orificesrectum or the vagina or, less commonly, the urethraMay be the preferred dose form in some cases when patient has nausea and vomitingAvoided when possible because of patient discomfort
63 Suppositories Safety Note 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 agentscontains some combination of sodium bicarbonate with citric acid, tartaric acid, or sodium biphosphateRelease carbon dioxide gas when dissolvedcauses a distinctive bubblingEdited 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 surgeryUsed for long-term, controlled release of medicationsAdvantages include enhanced patient compliance and convenienceComplications at the site of insertion have limited widespread useEdited 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 mouthalso known as troches or pastillesgenerally have local effectsEdited 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 bodycontain backing material such as paper, cotton, linen, silk, moleskin, or plasticEdited 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 amountGranules are larger than powdersformed by adding very small amounts of liquid to powders and passing the mixture through a screen or a granulating deviceGranulesare generally of irregular shapehave excellent flow characteristicsare more stable than powdersmay contain colorings, flavorings, and coatingsmay have controlled-release characteristics
69 DiscussionWhat factors may influence the choice of a dosage form for a drug?
70 DiscussionWhat 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 medication capsule suppositoryeffervescent saltimplantslozengesplasters
72 Liquid Dose FormsLiquid dose forms consist of one or more active ingredients in a liquid vehicleTwo major categories are:solutions, in which active ingredients are dissolved in the liquid vehicledispersions, in which undissolved ingredients are dispersed throughout a liquid vehicleEdited 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 swallowingease of adjusting the dosetablets or capsules cannot always be dividedDisadvantage is:less stable than their solid counterparts
74 Liquid Dose Forms Safety Note 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 solutionA solute is an ingredient dissolved in a solutionEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
76 SolutionsAn enema is usually a water-based solution administered rectally for cleansing the bowel or delivering active drugA collodion is a vehicle that is a volatile liquid dissolved in a mixture of alcohol and ether and used for a variety of topical usesupon application to skin, the solvent vaporizes, leaving a film coating containing medicationEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
77 SolutionsAromatic water is a solution of water containing volatile oils or other substancesAn elixir is a clear, sweetened, flavored hydroalcoholic solution containing water and ethanolA syrup is an aqueous solution thickened with a large amount of sugar or a sugar substitutemay contain additional flavorings, colors, or aromatic agentsoften the preferred vehicle to mask the taste for pediatric medications
78 SolutionsAn extract is a potent dose form derived from animal or plant sourcesfrom which most or all the solvent has been evaporatedused in the formulation or compounding of medicationsA fluidextract is a liquid dose form prepared by extraction from plant sourcesA tincture is an alcoholic or hydroalcoholic solution of extractions from plantsSpirits are alcoholic or hydroalcoholic solutions containing volatile, aromatic ingredients
79 SolutionsSafetyNoteA low-alcohol or alcohol-free product is preferred for most pediatric products.
80 SolutionsParenteral solutions are products that are prepared in a sterile environment for administration by injectionTwo major delivery systems exist:intravenous (IV) infusions: fluids administered directly into a veininjectionsintravenous (IV) – into a veinintramuscular (IM) – into the musclesubcutaneous (SQ or SC) – under the skinintradermal (ID) – into the skin
81 Dispersions Dispersions are undissolved ingredients mixed throughout a liquid vehicleClassified by size of the dispersed ingredient(s) into suspensions and emulsions containing:relatively large particlesmagmas, gels, and jellies (contain fine particles)ultrafines particles, less than a micron in size, called a colloidal dispersionA suspension is a dispersion of a solid in a liquidAn 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 suspensionsEmulsions 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 waterwater-in-oil (W/O) emulsion: emulsion containing a small amount of water dispersed in an oil
83 Suspensions Safety Note Suspensions should always include a “Shake Well” label.
84 DispersionsA lotion is a liquid for topical application containing insoluble dispersed solids or immiscible liquidsA gel is a dispersion containing fine particles for topical use on the skinparticles are ultrafinecolloidal dimensionslinked to form a semisolidEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
85 DispersionsAn ointment is a semisolid emulsion for topical applicationMay be medicated or nonmedicated and may contain various bases:oleaginous or greasy bases such as petroleum jellyW/O emulsions such as lanolinO/W emulsions such as hydrophilic ointmentwater-soluble or greaseless bases such as polyethylene glycol ointment
86 DispersionsPastes are like ointments but contain more solid materials and are stiffer and apply more thicklyZinc oxide pasteAcetonide dental pasteCreams are considered O/W emulsions. Apply smoothly to the skin and leave a very thin film. Most creams are considered vanishing.
87 DiscussionWhy do the differences between solutions and dispersions have advantages in pharmaceutical practice?
88 DiscussionWhy 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.
90 Inhalation Dose FormsInhalations are gases, vapors, solutions, or suspensions intended to be inhaled via the nasal or oral respiratory routesA spray consists of a container with a valve assembly that, when activated, emits a fine dispersion of liquid, solid, or gaseous materialan aerosol is a spray in a pressurized container with a propellant to carry the active ingredient to its location of applicationbreath-activated devices of powders in place of aerosolized propellantsMost sprays and aerosols are fortopical application to skin or to oral mucous membranesinhalation aerosols breathed in through the nose or mouth
92 DiscussionWhat 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 druga design feature of the dose form that affects the delivery of the drughow a medication is formulated to release the active ingredientEdited 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 medicationGases such as oxygen, nitrous oxide or “laughing gas,” and ether are administered by inhalationMedicated inhalations intended for the lung are administered viametered-dose inhalers (MDIs)hand held, breath-activated, propellant-driven inhalersnebulizersvaporizers and humidifiersmechanical 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 lungdeliver a mist containing extremely small, or micronized, powdera “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 symptomsSyringes are calibrated devices used to accurately draw up, measure, and deliver medication through a needleInjections must be sterile because they introduce medication directly into the bodyEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
98 Syringe, Injection, and Infusion Delivery Systems SafetyNoteOnly 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 expensivePlastic syringes are easy to handle, disposable, and come from the manufacturer in sterile packagingclearly preferredused both within and outside the hospital settingDifferent states have different regulations on the sale of syringespotential diversion for injection of illegal drugssome 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)standard hypodermic syringes in sizes from 1mL to 60mLtuberculin syringe (with cannulas ranging from 0.01 mL to 1 mL [used for skin tests and drawing up very small volumes of solution])
101 Syringe, Injection, and Infusion Delivery Systems Injections may be administered to almost any organ or part of the bodyInjectables come prefilled or are filled at the time of injection from single or multidose vialssingle-dose vials generally have no preservativemultiple-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 painJet injectors, which use pressure rather than a needle to deliver the medicationAmbulatory injection devices that the patient can wear while moving about
103 Syringe, Injection, and Infusion Delivery Systems SafetyNoteOnly the patient should control the PCA pump button.
104 Syringe, Injection, and Infusion Delivery Systems Intravenous (IV) infusionmethod for delivering a large amount of fluid over a prolonged period of time at a slow, steady rateused to deliver blood, water, other fluids, electrolytes, nutrientsIV infusions are used to:deliver pain-killing or blood clot buster medicationsreplenish body fluidsdeliver 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 cancerdrug-releasing device placed into the uterusmay contain a progestin hormone to prevent pregnancy on a long-term (1 to 5 years) basisCervical delivery systems are placed as a ring surrounding the cervix to slowly release medicationreplaced monthly by the patient and used as contraceptive aids
106 Intrauterine and Cervical Delivery Systems SafetyNoteOccasionally, 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 stripthe strip is removed, and the adhesive layer is attached to the skinEdited 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 locallyMedication delivery can be controlled over 24 hours or longerimproves patient convenience and complianceEdited 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 useAn oral syringe is a device without a needle to administer medication to pediatric or elderly patients unable to swallow tablets or capsulesa calibrated device consisting of a plunger and a cannula, or barrelused 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 waterbulb is first depressed to expel the air that it contains, and the tip is then inserted into the liquid to be administeredbulb is released while the end is in the liquid, and liquid rises to fill the vacuum createdend of the bulb is then removed from the liquid, and the liquid is administered by depressing the bulb againEdited 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 liquidcontains a small, squeezable bulb at one end and a hollow glass or plastic tube with a tapering pointmay be incorporated into the cap of a vial or other containergtt is an abbreviation for unit of pharmaceutical measurement for droppers and IV infusions to indicate dropsdue to the differing viscosities of fluids, the size of a drop varies considerably from medication to medicationDroppers 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 eyesmall, transparent membranesplaced between the eye and the lower conjunctivaHospices and long-term care facilities use straws (long, hollow tubes) prefilled with pain medicationsAnother delivery system for contraceptives is the polyurethane spongeEdited by Dr. Ryan Lambert-Bellacov, chiropractor for Back in the Game in West Linn, OR
113 DiscussionWhat are some advantages of the specialized medication delivery systems?
114 DiscussionWhat 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 deviceintrauterine delivery systemtransdermal delivery system (TDS)oral syringebulb syringeocular insert
116 Drug ReferencesOfficial legal standards for drugs in the U.S. are established by the United States Pharmacopeial Convention (USP)Standards are published in two reference worksthe United States PharmacopeiaNational Formulary (NF)Both are revised every 5 yearsalso printed in a combined editionUnited 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 Physician’s Desk Reference published annually with reprints of package inserts from the pharmaceutical manufacturers of most drugsuseful for identifying unknown drugs by color, shape, and codingEdited 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 availabilityindicationsadministration and dosepharmacological actionscontraindicationswarnings and precautionsadverse reactionsoverdose and patient instructionsupdated monthly with new insertsavailable on CD-ROM
119 Drug References USP Drug Information originally published by USPpatient counseling information for the pharmacistThe American Hospital Formulary Service (AHFS)information on drugs commonly used in the hospitalThe Handbook of Nonprescription Drugspublished by the American Pharmacists Associationprovides a good reference for OTC drugs
120 Drug References FDA Electronic Orange Book officially named Approved Drug Products with Therapeutic Equivalence Evaluationsavailable onlineinformation on generic equivalency of drugs that may have many sourcesView the FDA Electronic Orange Book
121 Drug References Remington: The Science and Practice of Pharmacy useful in compounding pharmacy for drug stability and compatibility informationThe Lawrence Review of Natural Productsscientific monographs on herbal medicationsHomeopathic Pharmacopeia of the United Statescompilation of standards for the source, composition, and preparation of homeopathic medicationsGo to this book’s Information Resources Center (IRC) and visit the Resources page found in the Pharmacy Library for a list of these and other valuable resources
122 DiscussionWhat 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."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.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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