Administration of Medicines Flashcards
Dysphagia can be caused by:
Physical obstruction of the pharynx or oesophagus
Disease of the brain
Disease of smooth muscle of oesophagus or skeletal muscle of pharynx
Reduced saliva
Medical term for difficulty with swallowing
Dysphagia
Mode of action of swallowing
Swallowing is a complex action involving the muscles and nerves within the pharynx and oesophagus and the swallowing centre in the brain
In the UK medicines are primarily given via the ____ route
oral
Possible solutions for oral medications
Training on swallowing, (think like a frog)
Considering shape
Dispersing a non-dispersible
Crushing or breaking
Changing to another product eg liquid, dispersible
SALT assessment
What types of tablets cannot be crushed or broken?
Enteric-Coated (EC)
Modified-release (MR)
Disadvantages of crushing or breaking tablets
May lead to: Toxicity ADRs Lack of effect S/C may just make them taste nasty
Define enteric coating
The coating is designed to hold together in acid conditions and break down in non-acid conditions and therefore release the drug into the intestines.
3 reasons for putting such a coating on a tablet or capsule ingredient:
- To protect the stomach from the drug
- To protect the drug from the stomach
- To release the drug after the stomach e.g. in the intestines
Drugs which most commonly cause stomach ulcers
aspirin, diclofenac and naproxen
[This is why enteric-coated tablets for these drugs are given in this form, to stop stomach ulcers caused by the drugs]
What drug is used either for the treatment of arthritis or for the treatment of Crohn’s disease (inflammation of the intestines)
Sulfasalazine
TRUE OR FALSE?
When used for arthritis, it is very often given without an enteric coating so that it can be absorbed more quickly
TRUE
TRUE OR FALSE?
For Crohn’s, it is needed to work in the intestines so it is given an enteric coating
TRUE
Is omeprazole a drug which stops the stomach from producing acid?
Yes
Does omeprazole generally have an enteric-coating (EC) or modified-release (MR)?
Enteric-coating (EC)
…either as a granule in the capsules or as a granule in the dispersible form
What does modified-release tablet mean?
the escape of the drug from the tablet has been modified in some way
TRUE OR FALSE?
Modified-release: Slow the release of the drug so that the medicine does not have to be taken too often and therefore makes it easier to remember to take.
TRUE
One advantage of taking modified-release tablets
the concentration of the drug in the body goes up slowly, is less likely to go very high and therefore reduces the chance of side effects.
Examples of modified-release tablets
Diffundox MR Elantan LA Dilzem XL Calcicard CR Dilcardia S
What abbreviations would you see on tablets or capsules with modified release
MR LA XL CR SR
What are film coated tablets?
very thin layers of a safe ingredient are placed around the tablet to again protect the tongue from the flavour of the contents and protect the contents from moisture and light.
How are film-coated tablets broken down in the body?
The film will break down with agitation and significant amounts of moisture (saliva or stomach acid) and therefore does not significantly affect the way in which the drug is absorbed into the body.
TRUE OR FALSE?
Each tablet or capsule holds a relatively small dose of the drug, crushing the formulation significantly decrease the maximum serum levels and reduces the minimum serum levels. Consequently, crushing cannot cause side effects and periods where the drug is not working at all.
FALSE
Correct statement:
Each tablet or capsule holds a relatively large dose of the drug, crushing the formulation significantly increases the maximum serum levels and reduces the minimum serum levels. Consequently, crushing can cause side effects and periods where the drug is not working at all.
Crushing tablets with small therapeutic effects or those with peak effects increases/decreases the chances of side effects and times when the drug is less likely to work.
increases
Capsules which you would need to open, does the drug need to be consumed WITH or WITHOUT food?
With
What types of food would you need to have with opened and sprinkled capsules?
Soft food
Capsules that need to be sprinkled and consumed with foods, do you have to eat in one go or can you save it and eat later?
Eat in one go
Could liquid medications be a solution for swallowing difficulties?
Yes
What should you consider when switching from a solid to liquid dose form?
Dose equivalence. Calculations may be required due to differing bioavailability.
Concerning liquid medications:
The consistency of liquid formulation is/isn’t an important
consideration.
Is
If a liquid medication is too runny what does this cause?
Aspiration
Aspiration is when something enters the airway or lungs by accident. It may be food, liquid, or some other material
If a liquid medication is too viscous would this be suitable for the patient?
No
For patients with difficulty swallowing what could you do for the patient?
SALT referral
(Speech and Language Therapy Service provide evidence-based services that anticipate and respond to the needs of individuals who experience speech, language, communication or swallowing difficulties)
What does the abbreviation ‘SALT’ referral mean?
Speech and Language Therapy
What are pharmaceutical specials medicines?
Specials, like all unlicensed medicines, should only be
prescribed when there is no available licensed medicine
which fully meets the patient’s special clinical needs.
When should ‘Specials’ be prescribed?
when it is judged by the prescriber and agreed with the patient or carer that, on the basis of available information, the use of a Special is the most appropriate option for the patient.
Specials may have short/long expiry dates?
Short. (7 days)
What issue do pharmaceutical specials have?
Consistency of supply and cost
TRUE OR FALSE?
Switching patients with uncontrolled hypertension from
effervescent preparations of paracetamol containing
sodium bicarbonate or carbonate to non-effervescent
preparations reduces BP
TRUE
What is the daily salt target for adults in the UK?
6g
• 6g = 2.4g or 100mmol of sodium
What is the daily salt target for children 11+ in the UK?
6g
• 6g = 2.4g or 100mmol of sodium
What can’t go in the Monitored Dosage System (MDS)?
- Liquids
- Creams
- Inhalers
- Patches
- Effervescent/dispersible products
- S/L, buccal etc
- Hygroscopic products
- Where packaging is part of the licence eg Epilim
- CDs?
- PRNs
