Dispensing of Pharmacologic Agents Chapter 3 Dispensing of Pharmacologic Agents

Chapter 3 Topics The Prescription “Rights” for Correct Drug Administration Dosage Forms and Routes of Administration Factors that Influence Drug Action Endogenous Chemicals that Affect Drug Action and Response Teaching Patients Medication Management

Learning Objectives Know the components of the prescription, including the commonly used abbreviations. Understand the rights of correct drug administration. Recognize common dosage forms. Know the routes of administration. Recognize factors that influence the effects of drugs, particularly in the elderly and pediatric populations. Know the effects natural chemicals have on drug action and response. Understand the immunization process.

The Prescription

The Prescription Abbreviation Translation ac before meals bid twice a day c with cap capsule DAW dispense as written D/C discontinue g gram

The Prescription Abbreviation Translation gr grain gtt drop hs at bedtime IM intramuscular IV intravenously L liter mcg microgram

The Prescription Abbreviation Translation mEq milliequivalent mL milliliter NKA no known allergy NKDA no known drug allergy npo nothing by mouth pc after meals PO by mouth

The Prescription Abbreviation Translation prn as needed q every qh every hour q2h every two hours qid four times a day qs a sufficient quantity stat immediately

The Prescription Abbreviation Translation tab tablet tid three times daily ud as directed wk week

Problematic Abbreviations Dangerous Abbreviation Correct Form to Use µg Microgram or mcg qd every day qod every other day U units MgSO4 magnesium sulfate MSO4 morphine sulfate .2 0.2 2.0 2

Problematic Abbreviations Institute for Safe Medication Practices (ISMP) Lists dangerous abbreviations and other safety tips. Check out the site at www.ismp.org. Review Appendix B in the textbook for additional safety tips.

Discussion What makes an abbreviation dangerous? What is the role of the pharmacy technician when a prescription arrives with a dangerous abbreviation?

“Rights” for Drug Administration Right Drug Right Strength Right Patient Right Time Right Route

Discussion How do the “rights” for correct drug administration help avoid dispensing errors? What other things should a pharmacy technician check when dispensing a medication? A pharmacy technician should check to see what other drugs the patient is taking, looking for possible drug interactions. The technician should also check for known drug allergies.

Mediation Label

Dosage Forms and Routes of Administration Peroral (PO, by mouth) Dosage Route Oral (swallowed) Sublingual (under the tongue) Buccal (dissolves in the check)

Dosage Forms and Routes of Administration Parenteral Dosage Route Intravenous (vein) Intra-arterial (artery) Intracardiac (heart) Subcutaneous (beneath the skin) Intramuscular (muscle)

Dosage Forms and Routes of Administration Topical Dosage Route Transdermal (skin surface) Conjunctival (conjunctiva) or Intraocular (eye) Intranasal (nose) Aural (ear) Intrarespiratory (lung) Rectal Vaginal Urethral

Dosage Forms and Routes of Administration Peroral (PO, by mouth) Dosage Forms tablets, capsules, solutions, syrups, elixers, suspensions, magmas, gels, powders, trouches/lozenges

Dosage Forms and Routes of Administration Parenteral Dosage Forms Solutions Suspensions

Dosage Forms and Routes of Administration Topical Dosage Forms ointments, creams, pastes, powders, aerosols, lotions, transdermal patches, sprays, inhalants, suppositories, enemas, emulsions, sponges, gels

Factors that Influence Drug Action Review: What are the four phases of the pharmacokinetic process? Absorption Distribution Metabolism Elimination

Factors that Influence Drug Action Age Pediatric patients and elderly patients may need a reduced dose because of smaller size or inability of liver to metabolize medication Disease Specific diseases may hinder the pharmacokinetic process of some drugs Mental State, Genes, Gender

Considerations for Elderly Patients Physiologic Function Changes Optic Auditory Gastrointestinal Pulmonary Cardiovascular Urinary Hormonal Composition of the body

Considerations for Elderly Patients Altered Drug Responses Adverse Drug Reactions (ADRs) Polypharmacy Noncompliance

Considerations for Pediatric Patients Wide variation between age and degree of organ-system development Reevaluate all doses at regular intervals. Be sure the dosage is appropriate for the child’s age. Always double-check all computations.

Discussion What should a pharmacy technician do when a parent is struggling to determine the best dose of an OTC medication for a pediatric patient?

Discussion What should a pharmacy technician do when a parent is struggling to determine the best dose of an OTC medication for a pediatric patient? Answer: Ask the pharmacist to determine the child’s dose for the caretaker if the dose information is not provided.

Immunization What are the two types of immunity?

What are the two types of immunity? Immunization What are the two types of immunity? Active immunity Passive immunity

Immunization What are the two types of immunity? Active immunity Coming in contact with an infectious agent or an inactivated part of an infectious agent through a vaccine Passive immunity Receiving antibodies that were formed by another person or animal that developed them in response to being infected

Immunization Schedule

Endogenous Chemicals that Affect Drug Action and Response Two types of receptors that histamine acts on: H1 receptors mediate the contraction of smooth muscle of the bronchi and intestine H2 receptors mediate the action of histamine on gastric secretion and cardiac acceleration

Endogenous Chemicals that Affect Drug Action and Response Two types of drugs that block the histamine receptors: Antihistamines block H1 receptors H2 blockers cimetidine (Tagamet) ranitidine (Zantac) famotidine (Pepcid) nizatidine (Axid)

Allergic Response

Allergic Diseases Allergic rhinitis Hay fever Allergic dermatitis, eczema Contact dermatitis Urticaria (hives)

Drug Therapy for Allergies Free environment of allergens (if possible) Corticosteroids Short-term relief of symptoms with antihistamines Long-term desensitization programs

Prostaglandins Mediators of several physiologic processes Include PGA, PGB, PGE, and PGF Actions Endocrine system Cardiovascular system Gastrointestinal system Pulmonary system Inflammatory

Teaching Patients Medication Management Goal: Compliance A patients’ adherence to the dose schedule and other particular requirements of the specific drug regimen

Discussion What kinds of information help improve patient compliance?

Discussion Answer: Methods of administration What kinds of information help improve patient compliance? Answer: Methods of administration How to make swallowing easier Times and time intervals for administration If medication should be taken with food or not Possible side effects How long the medication should be taken

Discussion What can the pharmacy technician do to help patients manage their medications properly?

Teaching Patients Medication Management

Teaching Patients Medication Management