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Medical Review Doses and Terminology

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Medical Review: Doses and Terminology

PassAssured's Pharmacy Technician Training Program

Medical Review Doses and Terminology

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Definitions Semi-Solid Dosage Forms Solid Dosage Forms Other Dosage Forms Liquid Dosage Forms Administration Devices Parenteral Medications Definitions Dealing with Inhalation Solutions Drug Therapy

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PassAssured's Pharmacy Technician Training Program

Medical Review Doses and Terminology

Click Here for Glossary Index! Click Here to Print Topic Help File , .pdf (Internet Access is Required for this (Internet Access is Required for this Feature) Feature)

Medical Review: Doses and Terminology

Definitions

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.

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.

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Examples: • Tylenol (acetaminophen) • Motrin (Ibuprofen, doses higher than 200mg require a prescription) • Aspirin, (OTC analgesic department) • 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 laxative) • Imodium brand for Loperamide (OTC treatment for 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

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A Legend Drug is a drug that requires a prescription. • 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 • Schedules I, II, III, IV and V Examples: • Heroin-Schedule I • Morphine- Schedule II • Tylenol #4- Schedule III • Soma- Schedule IV • Lyrica- Schedule V

Dietary Supplements Dietary Supplements are not regulated by the FDA because the suppliers do not make therapeutic claims.

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These products are not reviewed for content and have not been proven effective. Examples: • St. John’s Wart • Ginkgo • Kava • Ginseng

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 them 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

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• 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

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:

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• 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. Examples: • Powder - Keflex, Amoxicillin • Granules/Beads – Fastin, Prevacid • Soft capsules (contain medication in liquid form) -Vitamin E

Pills • 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

People often use "pill" to refer to any solid dosage form.

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"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: Examples: • LA-long acting – Entex LA • SA-sustained action-Depronal SA • SR-sustained release – Cardizem SR • CR-controlled release –Epilim CR • TR-timed release- Melatonin TR • CD-controlled dissolution – Cardizem CD • ER-extended release- Zohydro ER, Razadyne ER • XL-extended release – Procardia XL • XR-extended release – Dilacor XR, Xanax XR

Pastilles, Lozenges • Dissolve in mouth

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• Provide medication to the oral cavity • Look similar to hard candy Example: • Cough Drops

Troches • Can be hard or have gummy consistency • Provide medication to the oral cavity Example: • Mycelex Troches

Powders • 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 Example: • Internal: Questran Powder • External: Tinactin Powder

Suppositories Designed to be inserted into a body cavity: • Rectum • Urethra • Vagina

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• 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. • 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 • Young • Elderly • After oral surgery The physical properties usually differ from solid dosage forms • Can have shorter shelf life

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• May need to be refrigerated • May need to mask taste

Solutions • Prepared by the complete dissolution of medication(s) in a suitable liquid • Can be taken internally Examples: • Internal: Pediacare • External: 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 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

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• 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:

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• Calamine Lotion

Elixirs • Clear sweet combinations of water and alcohol • 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 • Keeping in airtight containers can prevent losses due to evaporation

Foams • 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

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• 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

Colloids • Liquid preparations which dry to form a flexible film that can be removed from the skin 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

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

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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

Creams • 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 Example: • Bactroban Cream

Lotions • Similar to creams

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• Typically, thinner in consistency to aid in covering a greater body area and areas heavily covered with hair Example: • 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

Pastes • 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 Example: • Nitro-paste

Liniments • Contain various substances that give a heat-producing effect used for relief of pain of muscle aches Example:

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• 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 • 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

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• 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

Implants • Surgically placed subcutaneously to release medication over a long period of time • Surgically removed after the period of effectiveness. 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

Spacers • 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 Example: • Aero-chamber

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Nasal Sprays Topical or systemic effects depending on the drug Examples: • Nasonex Nasal Spray( delivers topical medication to the nasal passages) • Stadol Nasal Spray( delivers systemic medication)

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 • 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

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Example: • Cleocin T, ATS are topical solutions and should be stored in the topical section.

Syringes • 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

Infusion Pumps Deliver parenteral medication at a specific rate

Definitions Dealing With Drug Therapy

Absorption Process where a drug is taken up from the site of administration and is transported to the blood stream Occurs: • Orally • Topically

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• Rectally • By inhalation • 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 area that needs relief

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.

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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. 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

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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: • 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:

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• Penicillin & Cephalosporin

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

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Contraindicated When a drug used for one indication cause an increase in severity of another indication. Example: • Pseudoephedrine contraindicated in hypertension

Risk-to-Benefit Ratio A Theoretical Ratio Weigh risks vs. benefits Must be done on an individual basis Example: • Asthma patient should not be on a Beta blocker • Inderal

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