1. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar The Pharmacy Technician FOUNDATIONS AND PRACTICES Chapter 10 Introduction to Compounding

2. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 10.1 A pharmacy technician compounding a prescription.

3. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Rationale for Compounding Certain valuable drugs have been discontinued by their manufacturers The FDA has removed some drugs from the market Drugs may not be available in a strength or dosage form appropriate for a specific patient

4. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Rationale for Compounding (cont.) Patients may have sensitivities or allergies to preservatives or other substances A combination therapy may not be commercially available

5. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Basic Procedures in Compounding Obtaining the recipe or formula Writing a worksheet based on the formula Collecting all ingredients and equipment necessary to prepare the compound Weighing each ingredient and having measurements verified by the pharmacist Following the directions of the formula to prepare the compounded medication

6. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Basic Procedures in Compounding (cont.) Packaging and labeling the compounded medication in an appropriate container Having the pharmacist provide a final check of the compound Cleaning the workstation and equipment used

7. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 10.1 Examples of Compounding Equipment

8. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 10.1 (continued) Examples of Compounding Equipment

9. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Table 10.1 (continued) Examples of Compounding Equipment

10. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 10.5 A technician prepares tablets using a mold.

11. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Solid Dosage Forms Capsule—a solid dosage form in which the active ingredient and any excipients are enclosed in a soluble gelatin shell that will dissolve in the stomach Tablet—a solid dosage form that may be administered orally, sublingually, vaginally, or as a pellet under the skin

12. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Solid Dosage Forms (cont.) Powder—a solid dosage form made from blended active ingredients and excipients Lozenge—a solid dosage form administered orally to be dissolved in the mouth Troche—interchangeable term for lozenge, but sometimes prepared in soft form

13. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Solid Dosage Forms (cont.) Stick—used in topical application of local anesthetics, sunscreens, antivirals, and antibiotics Suppository—a solid dosage form used to administer medication by way of the rectum, vagina, or urethral tract

14. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 10.4 Capsule size chart.

15. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Liquid Dosage Forms Solution—a water-soluble chemical dissolved in water Suspension—liquids containing ingredients that are not soluble in the vehicle Emulsion—a suspension consisting of two immiscible liquids and an emulsifying agent to hold them together

16. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Semisolid or Soft Solid Dosage Forms Ointment—a semisolid topical preparation that is applied to the skin or mucous membranes Cream—soft solid that is opaque and usually applied externally Paste—stiff, or very viscous, ointment that does not melt or soften at body temperature

17. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Semisolid or Soft Solid Dosage Forms (cont.) Gel—semisolid system consisting of suspension made up of small inorganic particles or of large organic molecules interpenetrated by a liquid

18. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Other Dosage Forms Ophthalmic—preparations for the eye Otic—preparations for the ear Nasal—preparations for the nose or sinuses

19. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Psychological Impact of Medication Flavoring Medication with an appealing color/taste is perceived as more effective by patients Successful flavoring helps ensure medication compliance Sight and sound play an important role in flavor experience

20. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Sensory Roles in Flavoring Influenced by taste, smell, sight, touch, and sound Smell makes a stronger impression on a person than actual taste –Females are more sensitive to smell than males Elderly patients may require extra flavoring Certain diseases alter a patient’s ability to taste and smell

21. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Flavoring Considerations Focus on the individual patient –Be aware of allergies or sensitivities— chocolate, peanuts, particular preservative or dye –What does this patient like?

22. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Flavoring Considerations (cont.) Pediatric flavoring –Children have more taste buds and are more sensitive to taste –Prefer sweet tastes; dislike bitter flavors –Newborns/babies with less taste “experience” require less flavor –Some appropriate flavor choices include raspberry, bubblegum, marshmallow, berry, citrus, vanilla

23. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Flavoring Considerations (cont.) Adult Flavoring –More tolerant of bitter flavors –Use flavoring agents like coffee, chocolate, cherry, anise, grapefruit, or mint with extremely bitter drugs to cut bitterness

24. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Flavoring’s Impact on Stability, Solubility, and Ph Some flavors may raise or lower pH of compounded medication and cause instability –Aqueous solutions should be flavored with water-miscible flavors –Oil preparations require an oil-based flavor Some flavoring agents/preservatives in the flavor may affect the active ingredient in the compound and cause degradation of the drug

25. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Flavoring’s Impact on Stability, Solubility, and Ph (cont.) Use a flavoring agent that will not affect pH for compounded medications that are stable only at a certain pH –Obtain exact pH from the company that produces the flavoring agent; most provide a list of flavors and relative pH values

26. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Four Taste Types Sour, sweet, bitter, and salty “Fifth” sense is called umami—tastes glutamates and cannot be duplicated by the combination of any of the other four tastes Taste buds contain taste receptors for all tastes

27. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Figure 10.20 The four basic taste experiences are sour, sweet, bitter, and salty.

28. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Five Basic Flavoring Techniques I. Blending uses a flavor that will blend with the drug taste –Example: Citrus flavors blend with sour tastes; bitter tastes can be blended with salty, sweet, and sour tastes; salt reduces bitterness and sourness and increases sweetness

29. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Five Basic Flavoring Techniques (cont.) II. Overshadowing or overpowering uses a flavor with a stronger intensity than the original product –Examples: Wintergreen, methyl salicylate, glycyrrhiza (licorice), and oleoresins III. Physical methods include formation of insoluble ingredients into a suspension and emulsification of oils

30. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Five Basic Flavoring Techniques (cont.) IV. Chemical methods include absorption of the drug with an ingredient that eliminates the taste of the offensive drug V. Physiological methods include use of an additive, such as peppermint, to anesthetize taste buds and thus reduce their sensitivity

31. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Coloring Should be appealing and appropriate for dosage form –Not always necessary –Use minimal amount to keep color “light” Coloring agent should match flavor of the product –Example: Cherry should be red, grape should be purple, and so on

32. Copyright ©2009 by Pearson Education, Inc. Upper Saddle River, New Jersey 07458 All rights reserved. The Pharmacy Technician: Foundations and Practices Mike Johnston, Karen Davis, and Jeff Gricar Coloring (cont.) Be aware of patient sensitivities or allergies to certain dyes –Dye-free flavoring agents available