Download Chapter 4 - Skills Commons

Routes of Drug Administration and
Dosage Formulations
Created by Jennifer Majeske, Mineral Area
College
 Differentiate
between the terms route of
administration, dosage form, and drug
delivery system.
 Explain the properties of oral, topical, and
parenteral dosage forms.
 Identify inactive ingredients and the various
coatings of tablets and their functions.
 Differentiate between a suspension and an
emulsion liquid dosage form.
 Identify dosage formulations utilizing the
transmucosal route of administration.
Created by Jennifer Majeske, Mineral Area College
 Define
the emulsion characteristics of topical
products such as ointments, creams, lotions,
and gels.
 Explain the advantages and disadvantages of
oral, topical, and parenteral dosage
formulations.
 Discuss the importance of syringe selection
for a diabetic patient.
 Contrast the advantages and disadvantages
for insulin in multi-dose vials and prefilled
insulin syringes.
Created by Jennifer Majeske, Mineral Area College
 Understand
the stability and expiration dates
of insulin at room and refrigerated
temperatures.
 Demonstrate correct techniques for
administration of eyedrops, eardrops,
metered-dose inhalers, and various
parenteral injections.
 Differentiate among enteric-coated,
sustained-release, and extended-release
dosage formulations.
Created by Jennifer Majeske, Mineral Area College
There exists many pharmacological agents with a
variety dosage forms available to customize
patient treatment.
 Pharmaceutics – the study of the release
characteristics of various dosage forms or drug
formulations.
 Medications can be taken: orally, inhaled,
injected, inserted, applied to the skin, and each
route affects the drugs’ onset and duration of
action.
 Pharmacokinetics – the study of how drugs are
absorbed, distributed, metabolized, and
eliminated.

Created by Jennifer Majeske, Mineral Area College
 Route
of administration – a way to get a
drug into or onto the body.
 What are the major routes of administration?
 Dosage form – the physical manifestation of
a drug – such as a tablet, capsule,
suspension, ointment, cream, patch or
injection – that is designed to deliver the
medication by one or more routes of
administration.
 Systemic effect – the series of steps to get a
drug into the bloodstream to exert its
therapeutic effect.
Created by Jennifer Majeske, Mineral Area College
 Delayed

systemic effect:
Tablets, capsules, and oral liquids
 Immediate

systemic effect:
Parenteral injections, IV bolus and infusions
 Localized
effect – when a drug exerts its
pharmacological action at or near the site of
administration.


Drugs administered by the transmucosal,
topical and inhalation route
Example: eardrop in the ear
Created by Jennifer Majeske, Mineral Area College
 Oral
route of administration – medication
administered for absorption along the
gastrointestinal (GI) tract into the systemic
circulation.
 Oral can also refer to applying medication to
the mouth.
 The abbreviation po – from the Latin term
per os, meaning “by mouth”, is used to
indicate the oral route of medication on a
prescription.
Created by Jennifer Majeske, Mineral Area College
 Tablets,
capsules, solutions, suspensions,
syrups and elixirs.
 Tablets and capsules are the two most
common types and are inexpensive to
manufacturer.
 The active ingredient in many tablets,
capsules and suspensions are sometimes
powders or granules.
 Drugs available in salt forms add shelf life to
the product and/or to affect the release
characteristics of the drug.
Created by Jennifer Majeske, Mineral Area College
 Tablet
– a solid dosage form produced by
compression.
 Tablets contain one or more active ingredient
along with inert or inactive ingredients
(excipients).
 Tablets are available in a variety of shapes,
sizes, surface markings and coatings.
Created by Jennifer Majeske, Mineral Area College
 Tablets
can be designed to be easy to
swallow, mask taste or exert an immediate
pharmacological effect.
 Compression tablets are the most
inexpensive and common dosage form.

Acetaminophen (Tylenol)
 Multiple
compression tablet (MCT) is made
by multiple compression cycles and is a
tablet on top of a tablet or a tablet within a
tablet.
 Caplet – a hybrid of a capsule and tablet;
shaped like a tablet, coated like a capsule.
Created by Jennifer Majeske, Mineral Area College
Most compression tablets are not coated.
 Coatings improve flavor, appearance, or ease of
swallowing.

Sugar-coated tablet (SCT) – contains an outside layer
of sugar that protects the medication and improves
appearance and flavor.
 Sugar coating makes tablets larger and heavier thus
more difficult to swallow.
 Film-coated tablet (FCT) – contains a thin outer layer
of a polymer that can either be soluble or insoluble.
 Film coating are colored for an attractive
appearance; taste-masking benefits can be lost if
crushed.

Created by Jennifer Majeske, Mineral Area College
 Most
tablets are designed to be swallowed
whole and dissolve in the GI tract.


Chewable tablet – contains a base that is
flavored and/or colored. It is designed to be
chewed (masticated) and absorbed quickly for
slightly faster onset.
Oral disintegrating tablet (ODT) – designed to
melt in your mouth. ODT’s are useful for
pediatric and geriatric patients who may have
difficulty swallowing or for patients with nausea.
Created by Jennifer Majeske, Mineral Area College
 The
active ingredient of a capsule is in the
form of a granular powder (liquid gel)
enclosed by a gelatin shell.
 The body and cap may be sealed to prevent
tampering.
 Diluent – pharmacologically inert filler used
in capsules.
 Some capsule formulations are designed to
provide better absorption of drugs, with less
side effects.
 Some medications that come in capsule form
are substitutable with a tablet, others are
not.
Created by Jennifer Majeske, Mineral Area College
 Powders
and effervescent salts are used less
frequently by patients, but offer some
advantages over tablets and capsules.
 Powders – preparations in the form of fine
particles.

Goody’s headache powders
 Effervescent
salts – granules or coarse
powders containing one or more medicinal
agents, as well as some combination of
sodium bicarbonate with citric acid, tartaric
acid or sodium bisphosphate.

Alka-Seltzer
Created by Jennifer Majeske, Mineral Area College
 Liquids
– consist of one or more active
ingredient in a liquid vehicle such as a
solution or suspension.
 Most liquids are commercially available as
solutions (elixirs and syrups), suspensions or
emulsions.
Created by Jennifer Majeske, Mineral Area College
 Solution
– a liquid in which the active
ingredients are completely dissolved in a
liquid vehicle.
 Solutions can be classified as aqueous,
alcoholic, or hydroalcoholic.
 Solvent – the vehicle that makes up the
greater part of the solution.
 Solute – the ingredient dissolved in a
solution.
Created by Jennifer Majeske, Mineral Area College
 Solutions
are often classified by their
ingredients; elixirs and syrups are the most
common dosage forms of solutions.
 Elixir – a clear, sweetened, flavored solution
containing water and ethanol.
 Syrup – an aqueous solution thickened with a
large amount of sugar – sucrose – or sugar
substitute.
 Syrups can contain additional flavors, colors
or aromatics.
 Most pediatric formulations are syrups or
elixirs.
Created by Jennifer Majeske, Mineral Area College
Aromatic water – a solution of water containing
oils or other substitutes that have a pungent,
and usually pleasing smell.
 Extract – potent dosage form derived from plant
or animal sources which most or all of the
solvent has evaporated to produce a powder, an
ointment like form, or a solid.
 Fluidextract – a liquid dosage form prepared by
extraction from plant sources and commonly
used in the formulation of syrups.
 Tincture – alcoholic or hydroalcoholic solution of
extractions from plants.
 Spirit – alcoholic or hydroalcoholic solution
containing volatile, aromatic ingredients.

Created by Jennifer Majeske, Mineral Area College
 Suspension
– the state of a substance when
its solid particles are mixed with but
undissolved in a liquid.
 Dispersion – the medication is simply
dispersed or distributed throughout the
vehicle, creating an incomplete mixture of
solid and liquid.
 Suspensions contain inactive ingredients such
as colorings, flavorings and coatings.
 Some suspensions are commercially
available, others come in the form of
powders that must be reconstituted prior to
dispensing.
Created by Jennifer Majeske, Mineral Area College
 Emulsion
– another type of dispersion; a
mixture of two immiscible or unblendable
substances.
 What is an example of an emulsion?
 Emulsions contain an emulsifying agent that
renders the emulsion stable and less prone to
separate.
Created by Jennifer Majeske, Mineral Area College
 Colloid
– a mixture having physical properties
between those of a solution and a fine
suspension.
 Magma – or milk like liquid, is an example of
a dispersion containing ultrafine colloidal
particles that remain distinct in a two-phase
system.
 Microemulsion – another type of colloidal
dispersion; a liquid that is dispersed in
another.
Created by Jennifer Majeske, Mineral Area College
 What
are some common advantages and
disadvantages to administering a drug using
the oral route?
 Tablets
 Capsules
 Liquids
Created by Jennifer Majeske, Mineral Area College
 Patients
should be counseled by the
pharmacist what drinks and foods to take or
not take with medications.
 Patients should be counseled by the
pharmacist on behaviors to avoid while
taking medications.
 Auxiliary labels are affixed to drug
containers to ensure that patients are taking
medications in the correct manner.
 Patients should be reminded of proper
storage conditions.
Created by Jennifer Majeske, Mineral Area College
 Oral
syringe – measures and delivers oral
liquid medications to pediatric patients.
 This type of syringe is a calibrated device
consisting of a plunger and cannula, and is
used without a needle to administer
medications to the mouth.
 Oral syringes can be used to slowly
administer liquid medications.
 Very small doses (less than 1 mL) can be
administered with a tuberculin syringe
(without a needle).
Created by Jennifer Majeske, Mineral Area College
Manufacturers often provide a medication cup
for OTC liquids.
 These are plastic cups that contain specific dose
demarcations in different units of measure.
 Droppers offer the ability to deliver the correct
dosage of smaller volumes of medication.
 Dropper – contains a small squeezable bulb at
one end and a hollow glass or plastic tube with a
tapering point.
 Viscosity – the thickness and flow characteristics
of fluids.

Created by Jennifer Majeske, Mineral Area College
 Transmucosal
route of administration –
allows the drug to be absorbed through or
across the “sieve-like” or permeable mucous
membranes of the mouth, eyes, ears, nose,
rectum, vagina and urethra.
 What advantages are there to using a
transmucosal route of administration?
 Transmucosal dosage forms include: tablets,
gum, and lozenges (sublingual); ointments,
solutions, suspensions, and sprays (eyes,
ears, and nose); suppositories and solutions
(rectum, urethra, and vagina).
Created by Jennifer Majeske, Mineral Area College
 Sublingual
route of administration – sub
meaning “under” and lingua meaning
“tongue”; the tablet is placed under the
tongue, where it is rapidly absorbed by blood
vessels.
Created by Jennifer Majeske, Mineral Area College
 Buccal
route of administration – a drug
absorbed by the blood vessels in the lining of
the mouth.
 What are some examples of drugs
administered via this route?
 Lozenge – troche, solid dosage form
containing active ingredients and flavorings,
that are dissolved in the mouth.
Created by Jennifer Majeske, Mineral Area College
 All
can be delivered to a specific site with a
minimum of systemic side effects.
 Irrigating solution – a solution for cleansing
or bathing an area of the body, can be used
both topically as well as instilled.
 Ophthalmics


Ocular route of administration – application of a
drug into the eye.
Conjunctival route of administration – the
application of a drug to the conjunctival mucosa.
Created by Jennifer Majeske, Mineral Area College
 Otics


Otic route of administration – the application of
a drug into the ear canal.
Eardrops can never be used in the eye, but
eyedrops can be used in the ear.
 Nasal


sprays/solutions
Intranasal route of administration – the
application of a drug into the passages of the
nasal cavity.
Spray – a dosage form that consists of a
container having a valve assembly unit, when
activated, emits a fine dispersion of liquid.
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 Suppository
– an example of a semisolid
dosage form that is created from an inactive
ingredient and formulated to melt at body
temperature and release an active drug.
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 Rectal


suppositories/solutions
Rectal route of administration – used to deliver
drugs into the rectum.
Enema – a water-based solution administered
rectally for cleansing or evacuating the bowel
before a GI procedure.
 Vaginal

suppositories/solutions
Vaginal route of administration – the application
of any drug within the vagina.
 Urethral

suppositories/solutions
Urethral route of administration – the
application of a drug within the urethra.
Created by Jennifer Majeske, Mineral Area College
 Sublingual


Advantage: rapid onset
Disadvantage: short duration
 Buccal


medications
medications
Advantage: faster onset
Disadvantage: “dose dumping”
 Ophthalmics,
otics, and nasal
sprays/solutions


Advantage: fast onset
Disadvantage:
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 Suppositories
and Solutions
 Rectal suppositories/solutions


Advantage: used in both old and young
Disadvantage: patient inconvenience
 Vaginal


suppositories/solutions
Advantage: self-treatment
Disadvantage:
Created by Jennifer Majeske, Mineral Area College
 Sublingual
medications – storage
requirements; nitroglycerin.
 Buccal medications – chewing differences
between regular gum and nicotine gum
 Ophthalmics, otics, and nasal
sprays/solutions



Ophthalmics – administered at or near room
temperature; Fig. 4.2
Otic – store at room temperature; Fig. 4.3
Nasal medications – used for relief of nasal
congestion or prevention of allergy symptoms
Created by Jennifer Majeske, Mineral Area College
 Suppositories
and solutions – certain
preparatory steps and administrative
techniques


Rectal medications – proper storage and
administration
Vaginal medications – use medication for
prescribed time period; Table 4.4 Proper
Technique for Administration of Vaginal
Medications, pg. 126
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 Topical
route of administration – application
of a drug directly to the surface of the skin;
exert local effects; side effects are minimal.
 Ointments, pastes, and plasters




Ointment – a dosage form that is a water-in-oil
(W/O) emulsion – a formulation that contains a
small amount of water dispersed in oil.
Liniment – a medicated topical preparation
Paste – like an ointment that contains more solid
materials, creating a dense consistency.
Plaster – a solid or semisolid that adheres to the
body and contains backing material such as
paper, cotton, linen, silk, moleskin, or plastic.
Created by Jennifer Majeske, Mineral Area College

Creams, lotions, and gels







Cream – an oil-in-water (O/W) emulsion – a small
amount of oil dispersed in water.
Lotion – another O/W emulsion for topical
application.
Gel – contains solid particles in a liquid, but the
particles are fine or ultrafine.
Jelly – a gel that contains a higher portion of water in
combination with a drub substance and a thickening
agent.
Glycerogelatin – a topical preparation made with
gelatin, glycerin, water, and medicinal substances.
Colloid – a mixture with physical properties that fall
between a solution and a fine suspension.
Irrigating solutions – douche, is often
reconstituted from a powder and introduced into
the vaginal cavity for local cleansing.
Created by Jennifer Majeske, Mineral Area College
 Major
advantage of topicals is they have a
fast onset of action with relatively few
systemic side effects.
 Ointments


Advantage: especially good for extremely dry
areas of skin
Disadvantage: appearance and greasy residue
 Creams,


lotions and gels
Advantage: apply more smoothly to the skin and
leave a very thin film
Disadvantage:
Created by Jennifer Majeske, Mineral Area College
 Ointments
– risk of increased absorption;
careful application of topical medications;
nitroglycerin; corticosteroid ointments.
 Creams, lotions, and gels – specific
precautions that patients should follow
during application.
Created by Jennifer Majeske, Mineral Area College
 Inhalation
route of administration – the
application of a drug through inhalation into
the lungs, typically through the mouth.
 Inhalation Dosage Forms:
 Aerosols and MDIs


Aerosol – a spray in a pressurized metered-dose
container that contains a propellant
Metered-dose inhaler (MDI) – a handheld,
propellant-driven device, an MDI provides a
specific measured amount of medication with
compressed gas.
Created by Jennifer Majeske, Mineral Area College
 Sterile

Solutions and Nebulizers
Nebulizer – atomizing machine that delivers
medication as a mist
 Volatile

Medications and Vaporizers
Used to deliver moisture to the air for relief of
cold systems
 Micronized
Inhalers


Powders and Nonaerosolized
Breath-activated powder for inhalation to avoid
propellants
Administers a higher concentration of drug as a
micronized powder into the lungs
Created by Jennifer Majeske, Mineral Area College
 Major
advantage of inhalation dosage forms
is the rapid onset of action, which is only
second to the IV route of administration.
 Major disadvantage is poor inhalation
technique, with all MDIs; higher risk of side
effects with larger amounts of medication.
Created by Jennifer Majeske, Mineral Area College
 The
more immediate-acting drug when using
multiple MDIs should be used first, followed
by the second 5-10 minutes later.
 Table 4.5 Proper Technique for
Administration of an MDI, pg. 132
 Spacer device – the medication is released
into a “storage chamber” where it can be
more easily inhaled by the patient.
 The patient should be sure to rinse their
mouth after administration of an MDI to
prevent an oral fungal infection.
Created by Jennifer Majeske, Mineral Area College
Parenteral solution – a sterile or microbial-free
solution (w/ or w/o medication) that is
administered via a hollow needle or catheter
inserted through one or more layers of skin.
 Parenteral comes from the Greek roots para
meaning “beside” and enteron meaning
“intestine.”
 This route bypasses – or goes “beside” rather
than through – the alimentary canal or GI tract.
 Parenteral route of administration – the
injection of any drug or fluid into the
bloodstream, muscle, or skin.

Created by Jennifer Majeske, Mineral Area College
 IV
Route – one of the more common
parenteral routes of drug and fluid
administration.

Intravenous (IV) infusion – a method for
delivering a large amount of fluid and/or high
concentration of medication directly into the
bloodstream over a prolonged period and at a
slow, steady rate.
 IM
Route – used to administer antibiotics,
narcotics, medications for migraine
headaches…and vaccines.

Injection – administration of a parenteral
medication into the bloodstream, muscle or skin
Created by Jennifer Majeske, Mineral Area College
 Subcutaneous
route – administer medications
below the skin into the subcutaneous tissue.
 What are some common medications
administered subcutaneously?
 ID route – used for diagnostic and allergy skin
testing, local anesthesia, and various
diagnostic tests and immunizations.
 What ID administrations mentioned in your
text?
Created by Jennifer Majeske, Mineral Area College
 The
parenteral route is used for medications
that contain molecules that are unstable, to
large for absorption, or broken down to
quickly in the stomach or liver.
 IV route – preferred route of administration
in an emergency situation; rapid action to
control and treat symptoms.
 IV bolus injection – administration of a drug
all at once.
 IV infusion – continuous amount of needed
medication over a given period.
Created by Jennifer Majeske, Mineral Area College
 Pyrogens
– fever-producing by-products of
microbial metabolism.
 Embolism – blockage of a vessel.
 Phlebitis – a severe painful reaction at the
injection site.
 IM route – offers a more convenient way to
deliver injectable medications; slower onset
than IV administration; duration of action is
much longer, making it more practical for use
outside of a hospital setting; unpredictable
rate of absorption.
Created by Jennifer Majeske, Mineral Area College
 Parenteral
preparations contain ingredients
that are dissolved or reconstituted with
solutions.
 Most parenteral preparations are made up of
ingredients place in a sterile water medium.
 Administration of IV, IM, subcutaneous or ID
must be sterile because they introduce
medication directly into the body.
 Only trained professionals and healthcare
providers are legally allowed to give
parenteral injections.
Created by Jennifer Majeske, Mineral Area College
Parenteral injections are administered via a
syringe and/or needle.
 Syringe – a calibrated device used to accurately
draw up, measure, and deliver medication to a
patient through a needle.
 Common syringes



Insulin syringe
Tuberculin syringe



Cannula – bore area inside the syringe
Hypodermic syringe
Needle – attached to the tip of a syringe and is
used to either draw fluid into or push fluid out of
the syringe; the larger the gauge the smaller the
opening.
Created by Jennifer Majeske, Mineral Area College
 IV
Route – IV medications can be
administered via two routes: IV bolus and IV
infusions.
 Patient-controlled analgesia (PCA) infusion
device – a programmable machine that
delivers a small amount of painkillers upon
patient demand.
Created by Jennifer Majeske, Mineral Area College
IM Route – IM injection doesn’t work as fast
as an IV injection
infusion, but the
pharmacological effect
will last longer.

Subcutaneous Route –
injections
typically
administered on the
outside of the upper arm, top of the
thigh, or lower portion of each
side of the abdomen.

Created by Jennifer Majeske, Mineral Area College
Administration of Insulin – most commonly used
medication that is administered subcutaneously
is insulin.
 Insulin Product Selection – syringe size, needle
length and needle gauge. Insulin vials are 10mL
(containing 1,000 units of insulin); prefilled
syringes contain 3mL.
 Insulin vials – Syringes sizes 0.3mL, 0.5mL, 1mL;
size is determined by dose of insulin; insulin vials
should never be shaken.
 Insulin Pens – a portable device in which the
prescribed dose of medication is “dialed up” to
administer insulin.

Created by Jennifer Majeske, Mineral Area College
What are some of the advantages of the insulin
pens? Disadvantages?
 Storage of insulin – insulin must be protected
against extreme temperatures. Open vials and
pens can be stored at room temperature and
discarded after one month. Unopened vials and
pens should remain refrigerated.
 Insulin Coverage for Insulin Supplies – insurance
companies require a prescription for coverage of
diabetic supplies.
 ID Route – ID injections are given into the
capillary-rich skin layer just below the
epidermis.

Created by Jennifer Majeske, Mineral Area College
Drug delivery system – a design feature of a
dosage form that modifies the release of a drug
by one or more pharmacokinetic parameters of
the drug.
 Improved efficacy and safety is a result of
formulating medications based on the
pharmacokinetic process.
 Tablets or capsules have coatings to delay
release and protect the stomach or extend their
release.
 Transdermal patches release medication slowly
over a certain period of time.
 Vaginal rings and intrauterine devices are
inserted vaginally to prevent pregnancy.

Created by Jennifer Majeske, Mineral Area College
 Most
tablets and capsules are “immediaterelease,” the medication is designed to
activated or released shortly after the drug is
taken.
 Alphabet of release formulations: DR, CR,
CD, XR, SR, XT, and XL.
 Delayed-release (DR) formulations – have a
special coating designed to delay absorption
of the medication and to resist breakdown by
acidic gastric fluids.

Enteric-coated tablet (ECT) – delay-release
formulation.
Created by Jennifer Majeske, Mineral Area College
 Extended-release
(XL) formulations – allow
a reduced frequency of dosing as compared
with immediate-release medications.


Sustained-release (SR) formulations: two doses
every 8-12 hours.
Controlled-release (CR) formulations: one dose
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New drug delivery systems employ scientific and
biotechnologic processes to design medications
to produce long-term effects.
 Matrix-controlled release formulations – a
reservoir-controlled release utilizing an osmotic
pressure principle or an ion exchange resin.

OxyContin (matrix-controlled release)
 Tussionex (ion exchange resin)


Wax matrix systems – the drug is embedded in a
polymer matrix, release takes place by
partitioning of the drug into the polymer matrix
and surrounding medium.
Created by Jennifer Majeske, Mineral Area College
 Osmotic
pressure system – the drug is
delivered to the body by slowly being
“pushed out” into the bloodstream.
 Target drug delivery systems – a drug is
“carried” by a liposome, and released at a
targeted organ site; increasing availability in
the near future.
Created by Jennifer Majeske, Mineral Area College
 Transdermal
dosage form – designed to
deliver a drug contained within a patch or
disk to the bloodstream via absorption
through the skin.
 Therapeutic uses – effects last 24 hours to 1
week.
 Administration – transdermal patches should
be applied to a relatively hair-free area;
localized heat speeds up the movement from
the patch into the body.
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 Vaginal
ring delivery system and intrauterine
device continually deliver hormones to a
female’s reproductive tract.
 NuvaRing
 Intrauterine
device (IUD) – another way to
prevent conception via a drug delivery
device.
Created by Jennifer Majeske, Mineral Area College
 This workforce solution was funded by a grant awarded by
the U.S. Department of Labor’s Employment and Training
Administration. The solution was created by the grantee and
does not necessarily reflect the official position of the U.S.
Department of Labor. The Department of Labor makes not
guarantees, warranties, or assurances of any kind, express
or implied, with respect to such information, including any
information on linked sites and including, but not limited
to, accuracy of the information or tis completeness,
timeliness, usefulness, adequacy, continued availability, or
ownership.
This work by Mineral Area College is licensed under the
Creative Commons Attribution 4.0 International License.
Created by Jennifer Majeske, Mineral Area College
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Picture on slide 15
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Picture on slide 24
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Human head anatomy with external and internal
carotid arteries by Patrick J. Lynch licensed under CC
BY
Picture on slide 33
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Female lips by Pixabay is licensed under CC BY
Picture on slide 29
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Capsule by Pixabay is licensed under CC BY
Suppository by Eric Schulz licensed under CC BY
Picture on slide 64
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Vaginal ring by Victor byckttor licensed under CC BY
Created by Jennifer Majeske, Mineral Area College