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© Paradigm Publishing, Inc. 1 1 Chapter 4 Dosage Forms and Routes of Administration.

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1 © Paradigm Publishing, Inc. 1 1 Chapter 4 Dosage Forms and Routes of Administration

2 © Paradigm Publishing, Inc. 2 Solid Dosage Forms A dosage form is the physical manifestation of a drug: –Solid –Liquid –Gas Drug delivery system affects how the drug is released in the body.

3 © Paradigm Publishing, Inc. 3 Terms to Remember dosage form the physical manifestation of a drug (e.g., capsule, tablet) drug delivery system a design feature of the dosage form that affects the delivery of the drug; may protect the stomach or delay the release of the active drug

4 Safety Note © Paradigm Publishing, Inc. 4 4 Solid Dosage Forms Although tablets and capsules may have distinctive markings and colors, the pharmacy technician should rely on the drug label and the NDC (National Drug Code) number, not the look of the medication, when confirming the identity of a drug.

5 © Paradigm Publishing, Inc. 5 Solid Dosage Forms Tablets Capsules Lozenges, Troches, or Pastilles Powders and Granules

6 © Paradigm Publishing, Inc. 6 Tablets Available in a variety of sizes and shapes Produced by compression Contain one or more active ingredients plus inactive ingredients (see Table 4.1)

7 © Paradigm Publishing, Inc. 7 Tablets

8 © Paradigm Publishing, Inc. 8 Tablets Multiple compression tablet (MCT) is either a –Tablet on top of another tablet, or –Tablet within a tablet –Core and shells or layers each contain different medicine

9 © Paradigm Publishing, Inc. 9 Terms to Remember tablet the solid dosage form produced by compression and containing one or more active and inactive ingredients multiple compression tablet (MCT) a tablet formulation on top of a tablet or a tablet within a tablet, produced by multiple compressions in manufacturing

10 © Paradigm Publishing, Inc. 10 Tablets Caplet just tablet shaped like capsule Solid interior, unlike capsule Advantages –Easier to swallow than large tablet –Longer shelf-life than capsule –More tamper-proof than capsule

11 © Paradigm Publishing, Inc. 11 Tablets Chewable tablets contain a flavored and/or colored base: –Antacids –Antiflatulents –Vitamins –Children’s tablets Oral disintegrating tablets (ODT) melt in the mouth; preferred for those who have difficulty swallowing

12 © Paradigm Publishing, Inc. 12 Terms to Remember caplet a hybrid solid dosage formulation sharing characteristics of both a tablet and a capsule

13 Terms to Remember chewable tablet a solid oral dosage form meant to be chewed; readily absorbed; commonly prescribed for school-age children oral disintegrating tablet (ODT) a solid oral dosage form designed to dissolve quickly on the tongue for oral absorption and ease of administration without water

14 © Paradigm Publishing, Inc. 14 Tablets Coatings can be used to improve –Appearance –Flavor –Ease of swallowing

15 © Paradigm Publishing, Inc. 15 Tablets Common tablet coatings –Sugar-coated tablet (SCT): improves taste and appearance; easier to swallow –Film-coated tablet (FCT): improves appearance; can lessen side effects –Enteric-coated tablet (ECT): designed to bypass stomach and be absorbed in small intestine

16 Safety Note © Paradigm Publishing, Inc. 16 © Paradigm Publishing, Inc. 16 Tablets ECT or delayed-release tablets should not be split.

17 © Paradigm Publishing, Inc. 17 Capsules Consist of a gelatin shell that encloses the drug Contain powders, granules, or liquids May also contain –Inert filler (diluent) –Disintegrants –Solubilizers –Preservatives

18 © Paradigm Publishing, Inc. 18 Terms to Remember capsule the dosage form containing powder, liquid, or granules in a gelatin covering diluent an inactive ingredient that allows for the appropriate concentration of the medication in the tablet or capsule; also used to reconstitute parenteral products

19 © Paradigm Publishing, Inc. 19 Capsules Most tablets and capsules are immediate-release. Some are not immediate-release: –Controlled-release: intended to regulate the rate at which a drug is released –Sustained-release (SR): dosing reduced from immediate-release –Extended-release : dosing reduced from immediate-release and most sustained- release forms

20 © Paradigm Publishing, Inc. 20 Terms to Remember controlled-release dosage form the dosage form that is formulated to release medication over a long duration of time; also called delayed release

21 Terms to Remember sustained-release (SR) dosage form a delayed-release dosage form that allows less frequent dosing than an immediate-release dosage form extended-release (XL) dosage form a tablet or capsule designed to reduce frequency of dosing compared with immediate-release and most sustained- release forms

22 Safety Note © Paradigm Publishing, Inc. 22 © Paradigm Publishing, Inc. 22 Capsules Watch drug labels very carefully! A sustained-release (SR) dosage form is not the same as an extended- release (XL) dosage form of the same drug.

23 © Paradigm Publishing, Inc. 23 Lozenges, Troches, or Pastilles Contain active ingredients and flavorings that are dissolved in the mouth Usually have a local therapeutic effect Examples include –OTC lozenges for sore throat –Prescription drugs such as nystatin or clotrimazole –Some narcotic medications

24 © Paradigm Publishing, Inc. 24 Terms to Remember lozenge a medication in a sweet-tasting formulation that is absorbed in the mouth

25 © Paradigm Publishing, Inc. 25 Powders and Granules Powders are milled and pulverized by machines. Examples include –Bacitracin zinc –Antacids –Brewer’s yeast –Laxatives

26 © Paradigm Publishing, Inc. 26 Powders and Granules Granules are larger than powders. Granules are formed by adding small amounts of water to powders. Granules can be compressed into tablets or enclosed in capsules. Granules generally have –An irregular shape –Excellent flow characteristics –Greater stability than powders

27 © Paradigm Publishing, Inc. 27 Powders and Granules Effervescent salts are coarse powders or granules containing both –Medicinal agent(s) –Sodium bicarbonate with an acid When dissolved in water, effervescent salts release carbon dioxide gas, causing distinctive bubbling.

28 © Paradigm Publishing, Inc. 28 Terms to Remember powders fine particles of medication used in tablets and capsules

29 Terms to Remember granules a dosage form larger than powders that is formed by adding very small amounts of liquid to powders effervescent salts granular salts that release gas and dispense active ingredients into solution when placed in water

30 © Paradigm Publishing, Inc. 30 Semisolid Dosage Forms An emulsion is a mixture of two unblendable substances. An oil-in-water emulsion contains a small amount of oil dispersed in water as a cream or lotion. A water-in-oil emulsion contains a small amount of water dispersed in oil as an ointment.

31 © Paradigm Publishing, Inc. 31 Semisolid Dosage Forms Ointments Creams Gels Suppositories

32 © Paradigm Publishing, Inc. 32 Ointments Can be medicated or nonmedicated May contain various bases –Oleaginous, such as mineral oil or petroleum jelly –W/O emulsions such as lanolin or cold cream –O/W emulsions such as hydrophilic ointment –Water-soluble bases such as polyethylene glycol

33 © Paradigm Publishing, Inc. 33 Terms to Remember ointment a semisolid emulsion for topical use on the skin

34 © Paradigm Publishing, Inc. 34 Ointments A paste is like an ointment but with more solids, such as zinc oxide paste. A plaster is a preparation that adheres to the body and contains a backing material.

35 © Paradigm Publishing, Inc. 35 Terms to Remember liniment a medicated topical preparation for application to the skin, such as Ben Gay

36 Terms to Remember paste a water-in-oil (W/O) emulsion containing more solid material than an ointment plaster a solid or semisolid, medicated or non- medicated preparation that adheres to the skin

37 © Paradigm Publishing, Inc. 37 Creams Creams are a O/W emulsion and are usually invisible once applied. Lotions are topical O/W emulsions that are easily absorbed: –Calamine lotion (to relieve itching) –Benzoyl peroxide (for acne)

38 © Paradigm Publishing, Inc. 38 Terms to Remember cream a cosmetically acceptable oil-in-water (O/W) emulsion for topical use on the skin lotion a liquid for topical application that contains insoluble dispersed solids or immiscible liquids

39 © Paradigm Publishing, Inc. 39 Gels A gel contains solid particles in liquid. A jelly is a type of gel that contains a higher proportion of water. A glycerogelatin is a topical preparation made with gelatin, glycerin, water, and medicine.

40 © Paradigm Publishing, Inc. 40 Suppositories Have a base of cocoa butter or glycerin Are designed to melt when inserted into a body orifice, such as the rectum or vagina

41 © Paradigm Publishing, Inc. 41 Liquid Dosage Forms Consist of one or more active ingredients in a liquid vehicle Often less stable than solids Allow easier dosage adjustments Often used for children’s medication – can be flavored to improve compliance

42 © Paradigm Publishing, Inc. 42 Liquid Dosage Forms Solutions Dispersions

43 © Paradigm Publishing, Inc. 43 Solutions Active ingredients are completely dissolved in liquid vehicle: –Aqueous (water-based) –Alcoholic (alcohol-based) –Hydroalcoholic (water-and-alcohol- based) Solute is the active ingredient. Solvent is the liquid vehicle.

44 © Paradigm Publishing, Inc. 44 Terms to Remember solution a liquid dosage form in which the active ingredients are completely dissolved in a liquid vehicle solute an ingredient dissolved in a solution or dispersed in a suspension solvent the vehicle that makes up the greater part of a solution

45 © Paradigm Publishing, Inc. 45 Solutions Aromatic water is a solution of water and oils that are easily released into the air (e.g., rose water). An elixir is a clear, sweetened, flavored solution containing ethanol and an active ingredient (phenobarbital elixir). A syrup is an aqueous solution thickened with sugar and often used to mask taste of pediatric medications.

46 Safety Note © Paradigm Publishing, Inc. 46 © Paradigm Publishing, Inc. 46 Liquid Dosage Forms Syrups should be used cautiously in diabetic patients because of high sugar content.

47 © Paradigm Publishing, Inc. 47 Solutions An extract is a potent dosage derived from animal or plant sources, with most of the solvent having been evaporated. A fluidextract is a liquid dosage extracted from plants and commonly used in syrups (such as vanilla). A tincture is an alcoholic or hydroalcoholic solution of plant extractions (such as iodine).

48 © Paradigm Publishing, Inc. 48 Solutions Other solutions include –Spirits, such as camphor or peppermint spirit –Irrigation solutions, used to cleanse the ear, eye, or wounds and incisions

49 © Paradigm Publishing, Inc. 49 Terms to Remember spirit an alcoholic or hydroalcoholic solution containing volatile, aromatic ingredients irrigating solution any solution used for cleansing or bathing an area of the body, such as the eyes or ears

50 © Paradigm Publishing, Inc. 50 Solutions Solutions are sometimes classified by their site or method of administration: –Topical (local) –Systemic (throughout the body) –Epicutaneous (on the skin) –Percutaneous (through the skin) –Oral (by mouth) –Otic (by ear) –Ophthalmic (by eye) –Parenteral (by injection) –Rectal (by rectum) –Urethral (by urethra) –Vaginal (by vagina)

51 © Paradigm Publishing, Inc. 51 Terms to Remember parenteral solution a product that is prepared in a sterile environment for administration by injection

52 © Paradigm Publishing, Inc. 52 Dispersions In a dispersion, medication is distributed throughout the vehicle but is not totally dissolved. A suspension is the dispersion of an undissolved solid in a liquid. Suspensions are useful for those who may have difficulty swallowing solid forms.

53 Safety Note © Paradigm Publishing, Inc. 53 © Paradigm Publishing, Inc. 53 Dispersions The drug stock bottles of liquid suspensions and emulsions for oral use should always be shaken well by pharmacy technicians before being poured into smaller medication bottles.

54 © Paradigm Publishing, Inc. 54 Dispersions Colloids have properties between a solution and a fine suspension. Milk of magnesia and Aveeno (with colloidal oatmeal) are examples. Microemulsion contains one liquid dispersed in another, such as Haley’s M-O and Compound W.

55 © Paradigm Publishing, Inc. 55 Terms to Remember colloid the dispersion of ultrafine particles in a liquid formulation

56 Terms to Remember magma a milklike liquid colloidal dispersion in which particles remain distinct, in a two- phase system (e.g., milk of magnesia) microemulsion a clear formulation that contains one liquid of extremely fine sized droplets dispersed in another liquid (e.g., Haley’s M-O)

57 © Paradigm Publishing, Inc. 57 Inhalation Dosage Forms Inhalations are inhaled through the nose or mouth. Dosages can be delivered via spray or aerosol. Inhalations are often used to treat allergies and asthma.

58 © Paradigm Publishing, Inc. 58 Terms to Remember spray the dosage form that consists of a container with a valve assembly that, when activated, emits a fine dispersion of liquid, solid, or gaseous material aerosol a pressurized container with propellant used to administer a drug through oral inhalation into the lungs

59 © Paradigm Publishing, Inc. 59 Transdermal Dosage Forms Delivers drug to the bloodstream by absorption through the skin Transdermal patch consists of –Backing –Drug reservoir –Control membrane –Adhesive layer –Protective strip

60 © Paradigm Publishing, Inc. 60 Transdermal Dosage Forms Absorption occurs slowly. Effects last 24 hours to 1 week. Used to deliver –Nicotine (smoking cessation) –Nitroglycerine (chest pain) –Narcotic analgesics (chronic pain) –Scopolamine (motion sickness)

61 © Paradigm Publishing, Inc. 61 Terms to Remember transdermal dosage form a formulation designed to deliver a continuous supply of drug into the bloodstream by absorption through the skin via a patch or disk

62 © Paradigm Publishing, Inc. 62 Routes of Administration Route of administration is a way to get a drug into or onto the body. Routes can produce a systemic effect or a local effect.

63 © Paradigm Publishing, Inc. 63 Terms to Remember route of administration a way of getting a drug onto or into the body, such as orally, topically, or parenterally oral route of administration the administration of medication through swallowing for absorption along the GI tract into systemic circulation

64 © Paradigm Publishing, Inc. 64 Routes of Administration Some routes produce a systemic effect: –Oral (by mouth) –Sublingual (under the tongue) –Buccal (between gum and cheek)

65 © Paradigm Publishing, Inc. 65 Terms to Remember systemic effect the distribution of a drug throughout the body by absorption into the bloodstream

66 © Paradigm Publishing, Inc. 66 Terms to Remember sublingual route of administration oral administration in which a drug is placed under the tongue and is rapidly absorbed into the bloodstream buccal route of administration oral administration in which a drug is placed between the gum and the inner lining of the cheek; also called transmucosal route of administration

67 © Paradigm Publishing, Inc. 67 Routes of Administration Other routes produce a local effect: –Topical (on the skin) –Intrarespiratory (inhaled into the lungs) –Ocular (to the eye) –Conjunctival (to the lining of the eyelid) –Otic (to the ear canal) –Nasal (to the nose) –Rectal (to the rectum) –Vaginal (to the vagina) –Urethral (to the urethra)

68 © Paradigm Publishing, Inc. 68 Terms to Remember topical route of administration the administration of a drug on the skin or any mucous membrane such as the eyes, nose, ears, lungs, vagina, urethra, or rectum; usually administered directly to the surface of the skin local effect the site-specific application of a drug

69 © Paradigm Publishing, Inc. 69 Terms to Remember intrarespiratory route of administration the administration of a drug by inhalation into the lungs; also called inhalation ocular route of administration the placement of ophthalmic medications into the eye

70 © Paradigm Publishing, Inc. 70 Terms to Remember conjunctival route of administration the placement of sterile ophthalmic medications in the conjunctival sac of the eye(s) otic route of administration the placement of solutions or suspensions into the ear

71 Terms to Remember nasal route of administration the placement of sprays or solutions into the nose rectal route of administration the delivery of medication via the rectum

72 © Paradigm Publishing, Inc. 72 Terms to Remember vaginal route of administration the administration of a drug by application of a cream or insertion of a tablet into the vagina urethral route of administration the administration of a drug by insertion into the urethra

73 © Paradigm Publishing, Inc. 73 Routes of Administration Some medications must be administered via the parenteral route because their molecules are too large or are broken down too quickly. Drugs are distributed systemically by injection or catheter.

74 © Paradigm Publishing, Inc. 74 Terms to Remember parenteral route of administration the injection or infusion of fluids and/or medications into the body, bypassing the GI tract injection the administration of a parenteral medication into the bloodstream, muscle, or skin

75 © Paradigm Publishing, Inc. 75 Advantages and Disadvantages of the Oral Route Advantages –Convenient –Easy to tolerate –Safe –Simple to administer –Fractional doses can be taken by splitting scored tablets

76 © Paradigm Publishing, Inc. 76 Advantages and Disadvantages of the Oral Route Disadvantages –Delayed onset –Destruction of the drug by GI fluids –Delayed absorption due to food and drink in the stomach –For liquids, potential unpleasant taste –For controlled-release formulations, cannot be split or crushed

77 Safety Note © Paradigm Publishing, Inc. 77 © Paradigm Publishing, Inc. 77 Advantages and Disadvantages of the Oral Route The oral route is not appropriate for patients who are experiencing nausea or vomiting.

78 © Paradigm Publishing, Inc. 78 Dispensing and Administering Oral Medications Pharmacists should tell patients –What foods to take or not take –What behaviors to avoid (sun, driving) –Methods for swallowing pills –How to store medications

79 © Paradigm Publishing, Inc. 79 Dispensing and Administering Oral Medications Measuring utensils are often dispensed with the medications: –Spoons –Cups –Oral syringes (for pediatric meds) –Droppers (for infant meds)

80 © Paradigm Publishing, Inc. 80 Terms to Remember oral syringe a needleless device for administering medication to pediatric or older adult patients unable to swallow tablets or capsules dropper a measuring device used to accurately dose medication for infants

81 © Paradigm Publishing, Inc. 81 Advantages and Disadvantages of the Topical Route Generally, the topical route –Works quickly –Produces a therapeutic effect that is localized –Provides fast relief –Has fewer side effects than with a systemic medication

82 © Paradigm Publishing, Inc. 82 Advantages and Disadvantages of the Topical Route Ointments –Good for extremely dry areas –Greasy feel Transdermal –Steady level of drug, good compliance –Costly, occasional skin irritation

83 © Paradigm Publishing, Inc. 83 Advantages and Disadvantages of the Topical Route Inhalation –Fast acting, delivers metered dose –Often poor technique by patient

84 © Paradigm Publishing, Inc. 84 Terms to Remember metered-dose inhaler (MDI) a device used to administer a drug as compressed gas through the mouth into the lungs

85 Terms to Remember diskus a nonaerosolized powder used for inhalation nebulizer a device used to deliver medication as a mist to the lungs; often used in treating asthma

86 © Paradigm Publishing, Inc. 86 Advantages and Disadvantages of the Topical Route Vaginal and urethral –Higher concentration of medication –Inconvenient and messy to use Rectal –Bypasses digestive system, good for nauseous patients –Inconvenient to use, may cause discomfort

87 © Paradigm Publishing, Inc. 87 Dispensing and Administering Topical Medications Ointments, creams, lotions, and gels –Might require use of gloves to avoid too much drug absorption (nitroglycerin gel) or to avoid irritation (capsaicin) –Might need to be applied sparingly to avoid side effects (corticosteroids)

88 © Paradigm Publishing, Inc. 88 Dispensing and Administering Topical Medications Transdermal patches –Site must be relatively free of hair and scar tissue. –Rotate application site. –Follow patch replacement schedule.

89 © Paradigm Publishing, Inc. 89 Dispensing and Administering Topical Medications Ophthalmic medications –Should be at or near room or body temperature –Must be stored properly –Should be applied with clean hands –Should be applied with proper technique for dispensing drops or ointment into eye

90 © Paradigm Publishing, Inc. 90 Dispensing and Administering Topical Medications Otic medications –Should be at or near room or body temperature –Should be applied with proper technique to ensure medication reaches target

91 Safety Note © Paradigm Publishing, Inc. 91 © Paradigm Publishing, Inc. 91 Dispensing and Administering Topical Medications Eardrops can never be used in the eye, but eyedrops can be used in the ear.

92 © Paradigm Publishing, Inc. 92 Dispensing and Administering Topical Medications Nasal medications –Nasal medications are applied by drops (instillation), sprays, or aerosols. –Proper technique is key to avoid sniffing medication into sinuses. –Patients must not overuse OTC nasal decongestants.

93 © Paradigm Publishing, Inc. 93 Dispensing and Administering Topical Medications Inhaled medications –Proper technique must be followed to ensure that medication reaches the lungs. –With cortisone MDIs, patient should rinse mouth after application to avoid fungal infections. –Spacer devices can be used with inhalers for children.

94 © Paradigm Publishing, Inc. 94 Dispensing and Administering Topical Medications Vaginal medications –The vaginal route is indicated for infections or hormone replacement. –Creams and ointments are often delivered via applicator tube. –For contraception, hormones can be delivered via a ring surrounding the cervix. –Intrauterine devices can deliver medication for contraception or cancer treatment.

95 © Paradigm Publishing, Inc. 95 Dispensing and Administering Topical Medications Rectal medications –Patients should be instructed to remove wrappers before using. –Patients should be instructed on proper orientation of suppository before insertion. –Proper technique should be followed when administering enemas.

96 Safety Note © Paradigm Publishing, Inc. 96 © Paradigm Publishing, Inc. 96 Dispensing and Administering Topical Medications Refrigeration is necessary to store most rectal medications.

97 © Paradigm Publishing, Inc. 97 Advantages and Disadvantages of the Parenteral Route Advantages –Can deliver high concentrations of medi- cation at once or over long period of time –Can be administered to almost any organ or part of the body –Acts quickly

98 © Paradigm Publishing, Inc. 98 Advantages and Disadvantages of the Parenteral Route Disadvantages –Possible injury from needle insertion –Potential for introducing toxic agents into the body Microbes Pyrogens –Must be administered carefully to avoid introduction of air bubbles or particulates

99 © Paradigm Publishing, Inc. 99 Terms to Remember intravenous (IV) infusion the process of injecting fluid or medication into the veins, usually over a prolonged period of time pyrogen a fever-producing by-product of microbial metabolism

100 © Paradigm Publishing, Inc. 100 Dispensing and Administering Parenteral Medications Parenteral medications consist of active ingredients dissolved in sterile water or saline. Injections must be given by a trained healthcare professional.

101 © Paradigm Publishing, Inc. 101 Dispensing and Administering Parenteral Medications A syringe is used to draw up, measure, and deliver medication. The cannula is the bore area inside the syringe.

102 © Paradigm Publishing, Inc. 102 Dispensing and Administering Parenteral Medications Intravenous injections or infusions –Can deliver a variety of medications or other substances –Usually administered in the superficial veins of the arm –Infusion pumps can deliver medication 24/7 or can be controlled by the patient

103 © Paradigm Publishing, Inc. 103 Dispensing and Administering Parenteral Medications Intravenous injections or infusions

104 © Paradigm Publishing, Inc. 104 Terms to Remember patient-controlled analgesia (PCA) infusion device a device used by a patient to deliver small doses of medication for chronic pain relief

105 Safety Note © Paradigm Publishing, Inc. 105 © Paradigm Publishing, Inc. 105 Dispensing and Administering Parenteral Medications Only the patient should control the PCA pump button.

106 © Paradigm Publishing, Inc. 106 Dispensing and Administering Parenteral Medications Intramuscular injections –Can deliver a variety of medications or other substances –Volume limited to 2 to 3 mL –Injection site usually gluteus maximus (in adults) or deltoid (in children)

107 © Paradigm Publishing, Inc. 107 Dispensing and Administering Parenteral Medications Intramuscular injections

108 © Paradigm Publishing, Inc. 108 Dispensing and Administering Parenteral Medications Subcutaneous injections –Medications are administered below the skin to the subcutaneous tissue. –Insulin is the most common type of subcutaneous injection: Insulin must be stored and prepared properly. Patients must know proper method for injecting. –Subcutaneous injections are also used for epinephrine and heparin.

109 Safety Note © Paradigm Publishing, Inc. 109 © Paradigm Publishing, Inc. 109 Dispensing and Administering Parenteral Medications The patient should be instructed to agitate but not shake the insulin vial.

110 © Paradigm Publishing, Inc. 110 Dispensing and Administering Parenteral Medications Subcutaneous injections

111 © Paradigm Publishing, Inc. 111 Dispensing and Administering Parenteral Medications Intradermal injections –Injected into the layer just below the epidermis –Used for Local anesthesia Immunizations Diagnostic tests (tuberculosis, allergy testing)

112 © Paradigm Publishing, Inc. 112 Dispensing and Administering Parenteral Medications Intradermal injections


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