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Medication Review, Doses and Terminology
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Medication Review
Doses and Terminology
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Medication Dosage Forms
Definitions
Semi-Solid Dosage Forms
Solid Dosage Forms
Other Dosage Forms
Liquid Dosage Forms
Administration Devices
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Medication Review
Doses and Terminology
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Medication Review, Doses and Terminology
Definitions Dealing With Drug Therapy
Absorption
 Process where a drug is taken up from the site of administration and is
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transported to the blood stream

Occurs:
o Orally
o Topically
o Rectally
o By inhalation
o Parenteral
Examples:

ASA goes to stomach - absorbed in stomach

Enteric Coated ASA goes to intestine

SQ Insulin absorbed under skin

IV goes directly into blood stream
Distribution
 Process where a drug, once in the bloodstream, is delivered to specific
organs and tissues in the body to exert its pharmacological effects
Example:

Aspirin goes to the stomach, then to the blood, then to the organ needing
relief. Headache
Metabolism
 Disappearance of a drug, when it changes chemically into another
compound

Takes place in many body organs - Primarily in the liver

Usually enhances excretion and inactivation of a drug
Excretion
 Process by which the drug is eliminated from the body - Primarily by the kidney

Drugs can be excreted via the urine, feces, lungs, skin, etc.
Bioavailability
This is a percentage or fraction of the administered dose of a drug that actually
reaches systemic circulation. Factors affecting oral route of administration include
age, body weight and time of administration.
Therapeutic Incompatibility

When the effectiveness of two drugs is decreased when given together.
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Example:
 Ampicillin and Gentamicin therapeutic incompatibility.
Therapeutic Duplication
 When two drugs from the same class are given together.
Example:
 Cephalexin and Cefaclor are both Cephalsporins. This is an example of
therapeutic duplication.
Adverse Effects

Effects other than the desired ones.
An Anaphylactic Reaction

A severe adverse reaction to the administration of a drug.

This can cause anaphylaxis or anaphylactic shock.
Example:

If a patient has a severe adverse reaction after prior administration of Penicillin.
Side Effects

Effects that are predictable and widely reported

Undesired pharmacological effects of a drug seen when therapeutic doses of
the drug are used.

Often unavoidable, part of the drug's action.
Example:

Nausea,

Drowsiness

Upset stomach

Addiction
Toxicities
 Effects that are harmful and destructive to the body.
Causes:
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
Drug dosage exceeds recommended dosage

Drug is used for longer periods of time than is recommended

Drug is not properly monitored
Example:

Chemotherapy kills good cells
Cross Sensitivity
 Allergy to drugs that are chemically similar
Example:

(Penicillin & Ceflasporin)
Drug Interactions - Tech Should Notify Pharmacist
 A change in the magnitude or duration of the pharmacological response of one
drug because of the presence of another drug
Possible Detrimental Effects:
 Increased risk of side effects

Increased risk of toxicities

Decreased pharmacological response desired
Possible Beneficial Effects:
Additive Response:

Occurs when two or more drugs combined together yield a response when the
drugs by themselves are not enough
Synergistic Response:

Occurs when the effect of two or more drugs is greater than the sum of the
drugs
Examples:

Bactrim,

Septra,

Trimethoprim

Sulfamethoxazole
Risk-to-Benefit Ratio
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A Theoretical Ratio

Weigh risks vs. benefits

Must be done on an individual basis
Example:

Asthma patient should not be on a B blocker

Inderal.
Contraindicated
 When a drug used for one indication cause an increase in severity of another
indication.
Example:
Pseudoephedrine contraindicated in hypertension
Pharmacology
Pharmacology is the study of drugs and their interactions with the human body to
produce therapeutic effects.
Drug
A drug is a substance intended for use in the diagnosis, cure, mitigation (decrease in
severity), treatment, or prevention of disease in human beings or animals.
A Legend Drug is a drug that requires a prescription.
Non-Prescription Drugs
Non-prescription drugs are also referred to as over the counter (OTC) drugs. These
are medications that the FDA has determined to be safe and effective for consumers
to self-medicate when used as directed by the product labeling. An OTC (over the
counter) Drug is a drug that does not require any form of prescription. Often times,
OTC Drugs are prescribed by a physician.
Examples:
 Tylenol (acetaminophen)
 Motrin (Ibuprofen, doses higher than 200mg require a prescription)
 Aspirin, (OTC analgesic department)
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



Domboro tablets
Neosporin ointment
Benadryl cream
Betadine ointment (external OTC products)



Robitussin-CF
Claritin tabs,
Tavist-1, (OTC cough and cold)






Colace
Metamucil
Dulcolax
Bisacodyl tablets
Senokot
Milk of Magnesia ( OTC laxatives)

Imodium brand for Loperamide, (OTC treatment diarrhea)

Cerumenex (OTC ear drop to remove ear wax. Patient information should
include how to instill in ear.)
Selenium shampoo (OTC used to treat dandruff)

Prescription or Legend Drugs

Prescription or Legend Drugs must be taken with the supervision of a physician
and may be harmful if not monitored.

These drugs also require a physician's drug order.

A pharmacist cannot dispense these drugs without a prescription.
Some legend drugs are also available OTC.
Examples:

Antivert (Meclizine) - Legend

Bonine (Meclizine) - OTC
Controlled Substances or Scheduled Drugs

Medications which warrant more restrictive regulation because of their
potential for addiction and abuse
Example:

Schedules I, II, III, IV & V
Dietary Supplements
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Dietary Supplements are not regulated by the FDA because the suppliers do not
make therapeutic claims.
Example:

St. John's Wort
These products are not reviewed for content and have not been proven effective.
Solid Dosage Forms
Tablets

The most common solid dosage forms available

Vary in shape, size, weight, and color, dissolution properties, and method of
delivery

Some are scored with a groove that allows it to be easily broken to provide
additional medication strengths
Buccal Tablets
 Designed to dissolve slowly when placed between the cheek and gums

Bypasses the digestive tract

Gives prolonged release of medication
Sublingual Tablets (SL)
 Designed to dissolve immediately and produce a rapid drug response when
placed under the tongue, not swallowed

Skin underneath the tongue is thin and allows medication to be quickly
absorbed

Bypasses the digestive tract
Example:

Sublingual Nitroglycerin Tablets
Chewable Tablets
 Designed to be easily chewed and then swallowed

Dissolution properties are different than swallowed tablets
Example:

Amoxicillin Chewable Tablets
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Effervescent Tablets
 Uses a chemical reaction (the release of carbon dioxide gas) to hasten tablet
dissolution

Should de dissolved in a glass of water or other liquid before ingestion
Example:

Alka-Seltzer
Enteric-coated Tablets
 Coated to delay the release of medication until the tablet has reached the
intestinal tract

Release of the medication into the stomach may render the medication inactive
or may irritate the stomach lining.
Example:

Enteric Coated Aspirin
Film-Coated
 Used to mask taste
Example:

Tylenol Caplets
Capsules
 Solid dosage forms in which the medication is enclosed in a shell of either hard
or soft gelatin.

Hard capsules contain powders, granules, or beads.

Patients typically find capsules easier to swallow than tablets.
Example:

Powder - Keflex, Granules/Beads - Fastin

Soft capsules contain medication in liquid form
Example:

Vitamin E Caps

Pills were made from powdered natural materials such as plants and animal
organs.

Powder was combined with a sticky material so that it could be rolled into a
round mass called a pill.

Out-dated dosage form
Pills
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People often use "pill" to refer to any solid dosage form.
"I want my little blue pill."
It is more professional to use the appropriate term, "tablet" or "capsule" when referring
to specific medications.
Controlled-Release Products
 Formulated to produce a constant release of medication over an extended
period of time.

Allows for consistent blood level for a longer duration

Reduces the number of doses that must be taken
Designated in various ways:
LA-long acting –
Example:

Entex LA
SA-sustained action
SR-sustained release –
Example:

Cardizem SR
CR-controlled release –
Example:

Cardene SR
TR-timed release
CD-controlled dissolution –
Example:

Cardizem CD
ER-extended release
XL-extended release –
Example:

Procardia XL
XR-extended release –
Example:

Dilacor XR
Pastilles, Lozenges
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
Dissolve in mouth

Provide medication to the oral cavity

Look similar to hard candy
Example:

Cough Drops

Can be hard or have gummy consistency

Provide medication to the oral cavity
Troches
Example:

Mycelex Troches

Solid dosage forms which have been crushed to make a fine powder

Can be used internally or externally

Internally - typically mixed into a liquid to improve the taste and make it
easier to swallow
Powders
Example:

Questran Powder

Externally - topically
Example:

Tinactin Powder
Suppositories
 Designed to be inserted into a body cavity:
o Rectum
o Urethra
o Vagina

Designed to melt at internal body temperature (98.6F or 37C) to release
medication into the body

Can provide a local effect or be absorbed into the blood stream to give
systemic effect
Example:
 Anusol HC Suppositories - local effect, is stable at room temperature.
 Phenergan Suppositories - systemic effect, should be stored in a
refrigerator
 Thorazine - systemic effect, stable at room temperature.
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

Tigan - systemic effect, is stable at room temperature.
Compazine - systemic effect, is stable at room temperature.
Vaginal Tablets
 Inserted into the vagina where they dissolve to provide:

Topical effect

Systemic effect
Liquid Dosage Forms

Provide a route for medication to those patients who cannot swallow solid
dosage forms
o Young
o Elderly
o After oral surgery

The physical properties usually differ from solid dosage forms
o Can have shorter shelf life
o May need to be refrigerated
o May need to mask taste
Solutions
 Prepared be the complete dissolution of medication(s) in a suitable liquid

Can be taken internally –
Example:


Pediacare
Applied externally –
Example:

A.T.S. Topical Solution

Syrups or solutions that contain sugar –
Example:

Zyrtec Syrup used as antihistamine,

Syrup of Ipecac: used to induce vomiting and treatment of poisoning

Tinctures - solutions that contain alcohol
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Example:

Benzoin Compound Tincture
Suspensions
 Liquids in which the medication does not completely dissolve but rather is
suspended in a liquid formulation

In time, the suspended particles will settle to the bottom and must be
redistributed by shaking

Bottles of suspension medications must be shaken before dispensing

A "shake well" auxiliary label should be placed on the prescription bottle

Can be taken internally or applied externally -
Example:

Bactrim Oral Suspension
Reconstituted Liquids
 Require the addition of distilled water within the dispensing pharmacy

Stored as a powder due to the rapid deterioration of the medication when
stored in the liquid form

Needs to be shaken after reconstitution and before use

Most (not all) need to be refrigerated

"Shake well" and when necessary "refrigerate" auxiliary labels should be
placed on the prescription bottle
Example:

Amoxicillin Oral Suspension
Emulsions
 Preparations containing oil and water

Oil is suspended in the water with the help of emulsifying agents

In time, the oil and water separate to form two clearly visible layers

Shaking the emulsion will redisperse the layers

Must be shaken before dispensing and a "shake well" auxiliary label placed
on the patient's prescription bottle
Example:

Calamine Lotion

Clear sweet combinations of water and alcohol
Elixirs
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
Intended for oral use
Example:

Novahistine DH
Fluid Extracts and Tinctures
 Contains plant extracts as the active ingredient in water and/or alcohol
Example:

Tincture of Benzion Compound
Spirits and Essences
 Contain substances that evaporate quickly in ambient conditions

Foams

Keeping in airtight containers can prevent losses due to evaporation
Systems in which gas have been incorporated into a liquid and when released
the entrapped gas gives the product a very light consistency
Example:

Proctofoam
Shampoo
 An easy method to apply medication to the scalp

Due to large amount of hair, other topical preparations are difficult to use in this
area
Example:

Lindane Shampoo - for treatment of head and crab lice

Liquid preparations which dry to form a flexible film that can be removed
from the skin
Colloids
Example:

Duofilm - for treatment of warts.
Mouthwash/Rinse
 Provide medication to the oral cavity

Patients are usually directed to swish and swallow or swish and spit
Example –

Peridex Oral Rinse, Listerine Mouth Wash
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Parenteral Medications
 Sterile products administered by injection or infusion in order to bypass the
gastrointestinal tract

Administration involves the use of a needle to penetrate the skin

Bypassing the skin disrupts the body's major defense against Infection;
therefore, parenteral medications are prepared using aseptic technique to
reduce contamination
Inhalation Solutions
 Placed in a nebulizer to provide topical application of medication to the
respiratory tract
Example:

Albuterol Inhalation Solution
Semi-Solid Dosage Forms
Ointments

Intended for applying medication to the skin or mucous membrane

Good for dry skin or areas that need protection

Greasy and difficult to remove
Example:

Bactroban Ointment

Moisturize the skin without being greasy

Easily rinsed off

Referred to as "vanishing creams" because they are translucent and leave
the skin surface dry and non-tacky
Creams
Example:

Bactroban Cream

Similar to creams

Typically, thinner in consistency to aid in covering a greater body area and
areas heavily covered with hair
Lotions
Example:
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
Hytone Lotion
Gels & Jellies
 Semi-solid system which contains very small particles of liquid medication

Application of gel results in dry surface

Easy to apply to body areas covered with hair
Example:

Retin-A Gel

Ointments to which a large quantity of insoluble solids have been added to
make an ointment stiff

Relatively impermeable to water and create a good protective barrier for the
skin

Ideal for diaper rash and similar conditions
Pastes
Example:

Liniments

Nitro-paste
Contain various substances that give a heat-producing effect used for relief
of pain of muscle aches
Example:

Bengay
Other Dosage Forms
Tape

Quick and easy way to apply topical medications

Medication is allowed to absorb from the tape into the skin

Improves absorption of the medication and provide a protective barrier
Example:

Cordran Tape
Transdermal Patches
 Hold medication in a reservoir designed to provide a continual supply of
medication over a period of time
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 Medication is absorbed into the blood through the skin.
Example:
 Transderm-Nitro, Duragesic (Fentanyl)
 Estraderm (Estradiol patch)
 Catapress TTS (Clonidine)
Aerosols

Provide medication to the respiratory tract

Can be accomplished by using a metered dose inhaler or a nebulizer
system

Medication travels through the air in very small particles or within tiny water
droplets and lands on the mucous membranes of the respiratory tract to
provide a therapeutic effect
Example:

Albuterol MDI or Inhalation Solution

Surgically placed subcutaneously to release medication over a long period
of time

Surgically removed after the period of effectiveness.
Implants
Example:

Norplant
Chewing Gum
 Can be used to deliver medication to the oral cavity or systemically if the
medication is absorbed through the oral mucosa

As the patient chews, the gum releases medication

Release can be controlled with special chewing patterns
Example:

Nicorette Gum
Administration Devices

Some dosage forms require the use of a specific device to aid in proper use

Proper use of these devices can be a challenge for patients to learn;
therefore, it is important for the pharmacist to be sure that the patient
knows how to use them correctly
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Metered Dose Inhalers (MDI)
 Deliver medication the respiratory tract

Can be difficult to use

Require coordination and timing to receive the maximum benefit
Examples:

Atrovent Inhalation Aerosol

Albuterol MDI
Nebulizers
 Deliver medication to the respiratory tract through a mouthpiece or mask

Attached to a source of compressed air that propels medication in the form of
very fine particles or as tiny droplets to the respiratory tract
Example:

Albuterol used in a Nebulizer

Placed on inhaled medication canisters to improve a patient's
administration technique

Available in a variety of shapes and sizes

Require a prescription from a physician
Spacers
Example:

Aero-chamber
Nasal Sprays
 Deliver topical medication to the nasal passages
Example:

Nasonex Nasal Spray

Deliver systemic medication
Example:

Stadol Nasal Spray
Eye/Ear Droppers
 Allows patients to administer accurate doses of medication to the eye or ear
easily

Most medications intended for this use are supplied with a dropper bottle,
although it may need to be assembled
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
Eyedroppers must be sterile
Plunger Applicators
 Used most commonly to apply medication to the vaginal canal

Can be filled with creams or foams to be expelled into the vaginal canal
Example:

Gyne-Lotrimin
Roll-on Applicators
 Provide a convenient way to apply gels, lotions, and other topical dosage
forms

A roller ball is placed on the top of a bottle to allow patients to apply topical
medications without having to touch the medication with their hands
Example:

Cleocin T, ATS are topical solutions and should be stored in the topical
section.

Available in various sizes and can administer a large variety of liquid
medications. Size is based on three variables:

Volume the syringe can hold (e.g., 10cc)

Increments of the marking (e.g., 1/2cc)

Size of the needle, width, length (e.g., 29-gauge ½ inch needle)

In the ambulatory care setting, syringes are most commonly used for insulin
injections by the patients with diabetes

Syringes are commonly used in the hospital setting

Oral or respiratory syringes must not be able to accept a needle
Syringes
Infusion Pumps
 Deliver parenteral medication at a specific rate
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