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Pharmacy Practice
Medication Formulation Usage
As a pharmacist, there are many reasons as to why it is important to counsel a patient on their new
prescription. One of the reasons is to make sure that the patient understands the proper ways of taking
their medications. Each dosage form requires specific instructions and not all instructions are the same.
Take for instance ophthalmic eye drops, some drops are liquid solutions and others are suspensions.
Although they are somewhat the same, there are little differences in how you apply them to the eye. For
solutions, shaking the bottle is not required in order to distribute the medication. However, for
suspensions, shaking the bottle is required. If the bottle is not shaken, then each drop that is placed into
the eye may have too much medication or not enough. Also, many patients do not know that after putting
drops into the eye, they should tilt their head forward, place their finger on their tear duct, and apply
gentle pressure. This will prevent the medication from leaving the eye by the tear duct and ensuring that
the medication is where it is suppose to be, on the eye.
Another example is enteric-coated tablets. Sometimes when a patient cannot swallow a whole tablet, they
crush it or break it in half. This is fine for some tablets, but not for enteric-coated tablets. These tablets
have a special coating around them that are required to deliver the medication in a certain way or at a
certain time. If the tablets are crushed or broken, the medication may be not work anymore because of the
acid in the stomach, or the effects of the medication needs to work elsewhere instead of the stomach. This
is why it is important to know about the different formulations of a medication.
On the same line of taking medications by mouth, inhalers are another area for confusion. Some inhalers
come as a fine mist and others as a dry powder. Just like eye drops, they require different instructions.
For the fine mist inhalers, these require the patient to shake-well and prime the canister. This will ensure
that the medication is exact every time the patient uses it. However, for the dry powder inhaler, there is
no need to shake or prime the canister, as each dose is exactly premeasured. Doing so will only cause the
patient to waste their medications. Another reason to know the difference between inhalers is that some
contain a steroid and others do not. For inhalers that contain a steroid, the patient should understands that
rinsing their mouth out after each use is important to prevent an infection called “thrush”. If thrush
develops, then the patient may require antifungals that may add on more undue burden. However, on the
other hand, inhalers that do not contain a steroid do not require the patient to rinse their mouth out. These
types of inhalers do not have the effect of causing thrush, but may cause things such as tremors. So
although there may not be a need to counsel on one thing, there may be a need to counsel on another
thing.
Finally, an important information to know is that sometimes patients don’t know what to do when they
forget to take a dose of their medication. One of the many misconceptions that patients have is that if
they forget to take their medication, they can take two to make up for it. This may be okay for some
medications, but not all medications. An example is blood pressure medication. Missing a dose may not
hurt the patient, but taking two doses at the same time may definitely cause unwanted side effects, such as
having very low blood pressure, dizziness, and fainting. Another example of medications that that require
good understanding are drugs that prevent blood clotting, such as warfarin. This medication requires
accurate dosing in order to achieve the desired effect. If a patient forgets to take a dose and then decides
to take two to make up for it, it could take as long as three days before the effects of that dose is seen. At
that time should the patient get a cut, it may take longer than normal for the bleeding to stop, or in some
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cases, the bleeding may not stop.
This is why it is important to counsel patients on new prescriptions to ensure that they have a clear
understanding on how to take their medications and to prevent any unnecessary harm. The more patient
education a pharmacist can provide, the better the patient will be.
Disclaimer: It is out of your scope of practice to educate a real patient on these dosage forms. Only a
registered pharmacist is allowed to educate a patient on a medication. This activity is developed for you to
learn why it is so important to educate patients on their medications.
Resources:
- To purchase the demonstration dosage forms below, please visit www.pocketnurse.com
o Eye drops: http://www.pocketnurse.com/Departments/Optic/06-93-2007N.html
o Inhaler: http://www.pocketnurse.com/Departments/Orals/Demo-Dose-AeroInhaler.html
o Patch: http://www.pocketnurse.com/06-93-3105N_3.html or
http://www.pocketnurse.com/Departments/Transdermal/06-93-3100N.html
Videos on proper usage: Coming soon!
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1. Ophthalmic Drop Usage
a. Wash hands thoroughly with soap and water.
b. Check dropper tip to make sure it is not cracked or broken.
c. Avoid touching the dropper to the eye or the finger or anything else.
d. Tilt head back. Pull down the lower lid of eye with finger to form a pocket.
e. Hold the dropper with the other hand that is not forming the eyelid into a pocket. Hold
dropper as close to the eye as possible without touching the eye.
f. Brace the remaining fingers of the hand holding the dropper against the face for more
stability.
g. With eyelid pocket formed, gently squeeze the dropper so that only one drop falls into the
pocket made by the lower eyelid. Release finger from the lower eyelid holding the pocket.
h. Close eye for 2-3 minutes and tip head down towards the floor. Do NOT blink or squeeze
eyelids.
i. Use a finger to gently apply pressure to the tear duct. This stops the drop from escaping
through the duct.
j. Verbally explain that if a second drop is needed in the same eye, repeat the same
instructions but wait for at least 5 minutes in-between drops.
k. Replace and tighten cap on dropper bottle. Do not wipe or rinse the dropper tip.
l. Wash hands to remove any medication.
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2. Metered-Dose Inhaler Usage
a. Instructions to prime inhaler
i. Explain when you would prime the inhaler. First time use or if the inhaler has not
been used over the last 14 days.
ii. Remove protective dust cap from mouthpiece.
iii. Shake the inhaler well and spray into the air away from the face.
iv. Shake and spray inhaler in a similar manner for two more times. End of priming.
b. Regular use instructions
i. Take off the dust cap and make sure there is nothing obstructing inhaler.
ii. Shake inhaler well before each spray.
iii. Hold inhaler with mouthpiece down.
iv. Breathe out through mouth, pushing out as much air from lungs as possible.
v. Put mouthpiece into mouth and seal lips around the mouthpiece.
vi. Breathe in deeply and slowly through the mouth. While breathing in
simultaneously push down the canister all of the way which will release the
medication in the form of a spray.
vii. After the spray and having breathed in all the way, take inhaler out of mouth and
close mouth.
viii. Hold breath for as long as possible. For up to 10 seconds. Then breathe normally.
ix. Verbally explain that for multiple sprays, it is necessary to wait one minute then
start over with shaking the inhaler.
x. Put dust cap back onto the mouthpiece.
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3. Transdermal Patch Usage (Directions depend on the type of patch available)
a. Select reasonably hair-free application site. Avoid extremities below the knee or elbow,
skin folds, scar tissue, burned or irritated areas.
b. Wash hands before applying.
c. Hold unit in both hands with removable backing facing the body, with line in an up and
down position.
d. Bend the sides of the patch away from the body, then towards the body until a ‘SNAP’ is
heard.
e. Peel off one side of the backing.
f. Apply adhesive of patch to the skin in desired spot on the body.
g. Press down on the patch and smooth down the patch.
h. Remove the second half of the backing and smooth remainder of the patch onto the skin.
i. Wash hands to remove any drug that may have gotten on to skin.
j. Patch Removal
i. Remove patch from skin.
ii. Fold patch over and discard.
iii. Wash skin and hands after removal.
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