Chapter 5

1. Dosage Forms, Abbreviations, Routes of Administration, Drug Abbreviations, and Medical Terminology Chapter 5

2. Introduction For a technician to become proficient, it is necessary to interpret orders correctly. Many doctors’ handwriting is referred to as “chicken scratch,” and it is the responsibility of the pharmacy to interpret and clarify orders if necessary. Many abbreviations used in prescribing medication look very much alike.

3. Where Did Pharmacy Abbreviations Originate? Terminology in pharmacy and medicine comes from the Latin and Greek languages. Because pharmacy began in Europe, most of the abbreviations have their origins in a foreign language. Latin and Greek serve as the universal language that all medical personnel can understand.

4. Interpreting Doctors’ Orders It is very important for the pharmacy staff to interpret doctors’ orders correctly. When writing out the various abbreviations, be sure to write as neatly as possible because other technicians and pharmacists will be reading your handwriting. Technicians must learn all of the dosage forms and abbreviations to decipher doctors’ orders.

5. Do Not Use List Drug errors that have occurred from the misinterpretation of medication orders led to the creation of the do not use list. The list outlines the most common misread abbreviations. These abbreviations should be avoided. See Box 5-1.

6. Dosing Instructions Dosing times are abbreviated on prescriptions. Many pharmacy computers are programmed to accept these abbreviations. See Table 5-1. Computerized Doctor Order Entry

7. Classification of Medications Each drug can be broken down into groupings based on: Pharmacology Intent of use Route of use How the drug affects the body-by-body system

8. Dosage Forms A dosage form refers to the package or container of which the drug has taken the shape. For example, it might be a tablet or a capsule. There is more than one type of tablet or capsule. Tablets come in a wide variety of shapes and sizes.

9. Dosage Forms (cont’d) Much of what determines the dosage form of a medication is determined by the drug’s effectiveness. Manufacturers prepare certain medications with the ability to release the active ingredient over an extended period.

10. Three major categories of dosage forms: Solids- tablets, chewable tabs, enteric-coated tab, capsules Liquids- syrups, elixirs, sprays, suspensions Semisolids- creams, lotions, gels, ointments, powders, suppositories Dosage Forms (cont’d)

11. Solid agents can be contained in various packages and administered by almost all routes except parenterally (IV). Most tablets contain fillers (inert substances that have no active ingredient), sugar coatings, and certain additives. Solids

12. Tablets are made to be administered sublingually (SL) or vaginally. Chewable tablets are convenient for persons who have difficulty swallowing and for children. Tablets can be scored or unscored and coated or uncoated. Solids(cont)

13. Solids (cont’d) Unscored tablet Scored tablet

14. Solids (cont’d) Tablets can be enteric coated (EC)to protect the drug through the acidic environment of the stomach or to delay release of the drug. Extended-releasetypes are made to control the amount of drug distributed over a set time.

15. Solids (cont’d) Plain tablets Enteric-coated tablets Scored tablets

16. Tablets/Caplets Most common type of tablet contains some type of filler. Fillers are composed of inert substances (no active ingredient) that serve to fill space or cover the tablet (sugar coatings). Coating improves taste and covers unpleasant odors. Chewable tablets are also made.

17. Tablets/Caplets (cont’d) Caplets are smooth sided and easier to swallow. Many medications have extended-release forms and regular forms.

18. Capsules Capsules can have either a hard or soft outer shell. Hard capsules are composed of sugar, gelatin, and water. Pulvule: This is a type of capsule that is shaped differently for identification purposes.

19. Capsules (cont’d) Spansules are capsules that can be pulled apart to sprinkle the medication onto food for children Soft-gelatin capsules (gel-caps) cannot be pulled apart, and often hold medications in liquid form

20. Types of Capsules Capsules Extended-release capsules

21. Capsule Sizes Capsules come in different sizes: see Figure 5-5. Capsuls vary in color, transparency, identifying marks. Larger half is called body; shorter half is called cap. Not all capsules are meant to be swallowed; content can be sprinkled on food.

22. Lozenges/Troches These are other forms of tablets that are not meant to be swallowed but to dissolve in the mouth, which releases the medication more slowly; similar to hard candy. Cough drops Troches are larger than normal-sized tablets and are flat; chalky consistency.

23. Biomaterials Biomaterials are polymers that combine with or encapsulate a drug. Can be capsules, tablets, or implants Activity of the drug can be activated due to pH or solubility and released over a period of anywhere from 12 hours to several years. Also known as excipients.

24. Implants A special type of capsule can be implanted under the skin and left in place for up to 5 years. Contraceptives containing progestin are implanted. Medication is released in a stair-step method.

25. Transdermal Patches Transdermal patches are solid pieces of material that hold a specific amount of medication to be released into the skin over time. They are easily administered and eliminate a possible upset stomach. Uses: For angina, nitroglycerin For chronic pain, Duragesic For motion sickness, scopolamine Patch overload

26. Liquids They are composed of various solutions. They can be administered by all routes. Syrups are sugar-based solutions that have medications dissolved in them, which improves the taste of the drug. They tend to be thicker than water.

27. Liquids (cont’d) Elixirs are agents that contain dissolved medication in either an alcohol base or water and alcohol (hydroalcoholic) base. Alcohol usually covers up the bad taste of the drug. Elixirs have the same consistency as water.

28. Sprays Sprays are composed of various bases such as alcohol or water in a pump-type dispenser. Nasal decongestants or sunscreens Nitroglycerin translingual spray that is used under the tongue for relief of anginal pain

29. Inhalants and Aerosols Inhaler agents come in a variety of forms but all must be easily inhaled into the lungs. Common devices available OTC are vaporizers and humidifiers. Respiratory therapists use nebulizers to give breathing treatments to hospital patients. Patients can also be trained to use nebulizers at home.

30. Inhalants and Aerosols (cont’d) Anesthetics are inhaled solutions that are administered by an anesthesiologist during surgery. Prescribed inhalants contain drugs that treat asthma and allergies. Metered dose inhalers (MDIs) dispense a specific amount of drug with each puff or inhalation.

31. Emulsions The mixture of water and oil when used with an emulsifier binds the two together. Many different types of emulsifiers are used.

32. Suspensions These are liquids that have very small, solid particles suspended in the base solution. They can be used orally by children and seniors. Suspensions have a “Shake well” sticker and a date of expiration. Reconstituted medication will need to be shaken and refrigerated.

33. Enemas Enemas might be administered for two different reasons: retention or evacuation. They can be used to deliver medication to the body, bypassing the stomach while being absorbed. Most common use is to evacuate the lower intestine to prepare for surgeries or for women in labor.

34. Semisolids Semisolids contain both liquids and solids. They are meant for topical application. Creams have medications in a base that is part oil and part water and for topical use. Lotions are thinner than creams because their base contains more water.

35. Semisolids (cont’d) Ointments contain medication in a glycol or oil base; they cover the skin surface and keep out moisture. Gels contain medication in a very viscous (thick) liquid that easily penetrates the skin. Pastes contain a smaller amount of liquid base than solids. They are able to absorb skin secretions, unlike other topical agents.

36. Suppositories They can be used both rectally and vaginally. Rectal suppositories bypass the stomach, which is important if the patient has nausea and vomiting. Vaginal suppositories are used mainly to treat vaginal infections.

37. Powders Powders are solids, yet they can be packaged in some forms that allow them to be sprayed, similar to liquid dosage forms. One of the main uses is to decrease the amount of wetness of an area. Antifungal foot agents They can also be spread over a wide area.

38. Injectables Normally used for rapid response. Storage temperatures are important. Available in many types of containers: Ampules Glass bottles Glass and plastic vials Bags Add-O-vials

39. Routes of Administration By mouth or oral medications are very convenient, do not need to be measured, less expensive, systemic, and safe. The downside is that they do not work as quickly as parenterals(IV’s). Some drugs cannot be taken orally because they are not as effective.

40. Sublingual and Buccal Agents Nitroglycerin, which treats anginal attacks, is the most commonly used sublingual tablet. Buccal agents are placed between the gum and cheek, where the medication penetrates the mouth lining and then enters the bloodstream. See Figure 5-11.

41. Rectal Rectal (R) agents are used for a person who is vomiting and cannot take oral medications. To reduce inflammation, either ointments or creams can be used in addition to suppositories. They work on a specific site and not systemically(through the body system). Downside: they are uncomfortable and the actual amount of drug absorbed is hard to predict.

42. Topical Topical (TOP) preparations effects range from systemic to localized for rashes. There are agents to fight skin infections, inflammation, and UV rays of the sun. They work at the site of action and systemically. An advantage is easy application. A downside is that they might cause a reaction.

43. Parenteral comes from the Greek and means “side of intestine” or “outside of intestine.” The most common parenteral medications are given IV, IM, or SC. Very-small–gauge needles are used, and the length depends on the site being injected. A benefit is speed of action. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous

44. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous(cont’d) Parenteral drugs work within a few minutes. This is important for emergency situations, for those who are combative, or for those who are unable to swallow. A disadvantage is the increased risk of infection. Narcan

45. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous(cont’d) Injections are more expensive and require preparation and administration by trained personnel. Another downside is that once a drug is injected, there is little time to alter its course if an allergic reaction takes place or too much drug is given.

46. All eye agents are sterile and are to be kept sterile during use. Doctors often use eye solutions to treat ear conditions, but ear solutions cannot be used to treat eye conditions because the eye is sterile. Eye treatments are for infections, inflammation, and glaucoma. A main disadvantage of solutions for the eye, if not kept sterile, is that they can introduce bacteria into the area being treated. Eye, Ear, Nose

47. Eye, Ear, Nose (cont’d) Ophthalmics do not last as long as other treatments because of the blinking of the eye and tearing. Ointments make it hard to see clearly. For the eye, ear, and nose, there are different types of agents, including ointments, solutions, and suspensions.

48. Eye, Ear, Nose (cont’d) Otic preparations are not necessarily sterile because they treat the ear canal and do not penetrate a sterile environment. Most ear treatments are for clearing up infections or cleaning out ear wax buildup. Most nasal sprays are used to treat colds and allergies. These dosage forms work on the specific site rather than the whole body. Nasal Spray Addiction

49. Represent many different components concerning the actions of a drug Considerations such as: Levels of the drug throughout the blood and tissues Absorption or movement of the drug throughout the body Overall distribution Pharmacokinetics vs. Pharmacodynamics

50. Pharmacokinetics vs. Pharmacodynamics (cont’d) Metabolism Excretion of the drug Reaction of the drugs with other drugs Patient compliance Life of the drug that includes bioavailability, half-life, bioequivalence, and excretion