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NAPLEX Review > Drug Formulations > Flashcards

Drug Formulations Flashcards

1
Q

What is the most common formulation type and the least expensive to manufacture?

A

Compressed tablets

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2
Q

What formulations is Olanzapine available in?

A

Immediate-release (IR) tablet, orally disintegrating tablets (ODT), short-acting injection and long-acting injection

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3
Q

Why are the different formulations of Olanzapine beneficial?

A

A long-acting injection can improve adherence. ODTs dissolve quickly in the mouth; they are useful to prevent the patient from hiding the medication in the mouth and then spitting it out when no one is watching. The short-acting injection works quickly and is useful for acute agitation

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4
Q

What formulations is Ondansetron available in?

A

IR tablet, oral solution, ODT, oral film and short-acting injection

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5
Q

Why are different formulations of Ondansetron beneficial?

A

An injection would be useful when a patient is vomiting. An ODT or oral film can be given for nausea without vomiting. An oral solution is preferable to patients with dysphagia, painful esophageal ulcers, strictures or tumors.

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6
Q

What are some common oral formulations?

A

Long-acting oral tablets/capsules, liquid oral suspensions, liquid oral solutions, chewable tables, lozenges, orally disintegrating tablets, sublingual (SL) or buccal delivery, granules, powders or capsules that can be opened and sprinkled

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7
Q

How does an osmotic release oral system (OROS) work?

A

Water from the gut is absorbed into the delivery system by osmosis, which increases the pressure inside and forces the drug out through a small opening. The tablet/capsule shell may be visible in the patient’s stool but the drug has been released

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8
Q

What is the reason for using long-acting oral tablets?

A

Drugs may be designed to release slowly to avoid nausea or to provide a long duration of action. Providing a smooth level of drug release over time reduces high “peaks” which reduces side effects and provides a safe level of drug over the dosing interval

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9
Q

What are some counseling points of long-acting oral tablets?

A

Patients must be counseled to not crush or chew any drug that is a long-acting formulation. It could release all medication at once and a fatal dose could be released (includes ER opioids)

*Some long acting opioid capsules can be opened and the contents sprinkled on certain foods. The capsule contents should not be crushed or chewed

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10
Q

What is the reason for use of liquid oral suspensions/solutions?

A

Useful in patients with swallowing difficulty or who are unable to follow directions. Liquid medications can be administered in the side of mouth using a dropper, and most can be administered via tube

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11
Q

What are some counseling points of oral suspensions/solutions?

A
  • Suspensions must be shaken to disperse the medication prior to administration
  • Shaking is not required for solutions; drug is evenly distributed in the solvent
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12
Q

What is the reason for use of chewable tablets?

A

Primarily used for children who are unable to swallow tablets

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13
Q

What is the reason for use of lozenges?

A

Used to treat a condition in the oral mucosa; the drug is held in the mouth while the troche slowly dissolves

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14
Q

What is the reasons for use of orally disintegrating tablets and sublingual or buccal delivery with a tablet, film, powder or spray?

A

Dysphagia, children who are unable to swallow tablets/capsules, nausea, non-adherence

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15
Q

What is the advantage of sublingual or buccal tablets over regular?

A

With SL/buccal absorption, the onset of action is faster than with a tablet or capsule that is swallowed; the drug is readily absorbed into the venous circulation right under the absorption site. Less drug is lost to gut degradation and first-pass metabolism

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16
Q

What are the reasons for use of granules, powders or capsules that can be opened and sprinkled into soft food or water?

A

These formulations are primarily for geriatric and pediatric patients who have difficulty swallowing. It is also usually cheaper for hospital to give an oral medication via NG tuber rather than converting to IV administration

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17
Q

What are some counseling points of granules, powders or capsules that can be opened and sprinkled into soft food or water?

A

Do not chew any long-acting pellets or beads that are emptied out from a capsule. If capsule contents are mixed in food or liquid, do not let the mixture sit too long. Do not add to anything warm or hot.

*Always refer to the product labeling for instructions; not all capsule medications should be opened and administered

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18
Q

What are some examples of unique formulations?

A

Injections, patches, topicals, nasal sprays, eye and ear drops, rectal medications, inhalations

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19
Q

Why do IM injections generally hurt more?

A

IM injections generally hurt more due to the longer needle length and subsequent muscle soreness

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20
Q

What are monoclonal antibodies?

A

Monoclonal antibodies are injectable proteins used to treat many diseases. Most monoclonal antibodies can cause injection reactions and can require premedication to prevent severe symptoms

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21
Q

What is the reason for use of injections that patients can self-administer, mostly subcutaneous?

A

SC administration is used for rapid effects or for drugs that would get destroyed or not absorbed if given by oral administration

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22
Q

What is the reason for use of long-acting intramuscular injections?

A

Various drugs come as long-acting injections to improve adherence or to decrease the need for more frequent injections

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23
Q

What is the reason for use of intravenous injections?

A

Bypasses the oral route for patients who are intubated or sedated; fast response, can achieve high concentrations, avoids loss of drug due to N/V

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24
Q

What are some examples of refrigerated self-administered injections?

A

Glatiramer, Etanercept, Adalimumab, Certolizumab Golumumab Teriparatide, Abaloparatide

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25
Q

What are some examples non-refrigerated self-administered injections?

A

Enoxaparin, Fondaparinux, Methotrexate, Sumatriptan

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26
Q

What are the steps to injecting medication?

A

1) Wash hands
2) Prepare injection
3) Select and clean injection site
4) Inject
5) Discard syringes, pen needles or entire assembly in sharps container

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27
Q

What are some injectable medication counseling points?

A
  • Inject at least 1 inch away from previous injection site
  • Never use the same needle more than once
  • Some injections “click” when the needle enters the skin and/or “click” when the injection is complete
  • If single-use, discard needle or entire assembly (with attached needle) in sharps container
  • Do not rub skin near anticoagulant injections; rubbing can cause severe bruising (enoxaparin, fondaparinux)
  • Do not use any device to heat up cold injections; let the injection sit at room temperature for ~20 minutes
  • Liquids can degrade; if solution is discolored or contains particles, do not use. Do not use beyond expiration date
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28
Q

What are some counseling points of safe handling of monoclonal antibodies?

A

Patients should be instructed not to shake the medication, and to avoid exposing the drug to extreme temperatures (hot or cold). These drugs should be stored in the refrigerator prior to use, and slowly brought to room temperature prior to injecting (injecting cold drug is painful)

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29
Q

What are common application sites for patches?

A

Chest (upper), back (upper and lower), upper arm (on the part facing out), flanks (sides of the body, abdomen level)

30
Q

Where can the Exelon patch be applied to?

A

Only chest, back and upper arm

31
Q

Where can the Butrans patch be applied?

A

Chest, back, upper arm, flanks, except rather than the sides of the body near the abdomen, it is applied to the sides of the body, level to the chest

32
Q

Where is the Daytrana patch applied?

A

Daytrana is applied on the hip, alternating right and left hips daily

33
Q

Where is the Transderm Scop applied?

A

Transderm Scop is applied behind the ear, at least four hours before needed, alternating ears every 72 hours

34
Q

What are examples of patches that are applied daily?

A

Methylphenidate, Nicotine, Rivastigmine, Rotigotine, Selegiline, Testosterone

35
Q

What are some examples of patches with the are applied daily with special instructions?

A

Lidocaine (1-3 patches, on for 12 hours, then off for 12 hours), Nitroglycerin (on for 12-14 hours, then off for 10-12 hours)

36
Q

What is an example of a patch that is twice daily?

A

Diclofenac

37
Q

What is an example of patches that are applied twice weekly?

A

Estradiol, oxybutynin

38
Q

What is an example of patches that are applied weekly?

A

Buprenorphine, Clonidine, Estradiol, Estradiol/Levonorgestrel, Ethinyl estradiol/Norelgestromin

39
Q

What are examples of patches applied every 72 hours?

A

Fentanyl, Scopolamine

40
Q

Can patches be cut into pieces?

A

Usually no, except Lidoderm, which is designed to be cut and applied over the painful regions

41
Q

Can patches be exposed to heat from an electric blanket, heating pad or body temperature > 38 degrees celsius?

A

Avoid heat exposure with most patches. Heat causes rapid absorption of the medication from the patch, result in toxicity. With fentanyl and buprenorphine, this can be quickly toxic (fatal)

42
Q

What is a counseling point if a patch is bothering skin?

A
  • Never apply to skin that is irritated in any manner
  • Alternate the application site. An alternative site (if permitted) may be beneficial
  • The skin should not be shaved shortly before applying; shaving is irritating to the skin. If needed, cut the hair short with scissors. A topical steroid, such as hydrocortisone, can be applied after the patch is removed
43
Q

Which patches need to be removed prior to an MRI?

A
  • Patches containing metal need to be removed prior to an MRI or the metal will burn the skin (e.g. Clonidine, Rotigotine, Scopolamine, Testosterone)
  • Some patches vary in metal content between different manufacturers, and this may change from time to time. It is widely recommended that estradiol patches be removed prior to an MRIS. Other patches with variable recommendations include nitroglycerin, oxybutynin, diclofenac, nicotine and fentanyl
44
Q

Can patches be covered with tape if it will not stick?

A
  • Most patches cannot be covered with tape. A few patches an be taped around the edges
  • Fentanyl and buprenorphine can be covered only with the permitted adhesive film dressings, Bioclusive or Tegaderm
  • Catapres-TTS comes with its own adhesive cover, which goes over the patch to hold it in place
  • Never apply patches to skin that is oily
  • When applied, patches have to be smoothed out on the skin, and then pressed down for a number of seconds, usually 10-30 seconds
45
Q

How do you dispose of used patches?

A
  • In most cases, remove and fold the patch to press adhesive surfaces together for disposal. Used drugs should be disposed of according to manufacturer’s instructions, which can include throwing it away in a lidded container or flushing it down the toilet
  • Some highly potent narcotic patches and Daytrana can be fatal, especially if ingested by a child or pet. For these drugs, the FDA and/or manufacturer recommend flushing the used patch down the toilet to remove it from the home immediately
46
Q

Where is the drug located on a patch?

A

The drug can be in a raised pouch, a reservoir (containing a gel or a semi-solid form) or directly incorporated into the adhesive of the patch (the side that adheres to the patient’s skin)

47
Q

What do topical treatments used for local effects do?

A

Topical treatments used for local effects have a decreased incidence of systemic side effects and generally provide faster relief

48
Q

What are examples of topical treatments?

A

Creams, ointments, gels and solutions are commonly used for localized effect

49
Q

What are common conditions treated topically?

A

Muscle/joint pain, cold sores, acne, eczema, inflammation, mild infections, hair loss, rash, fungal infections

50
Q

What are the benefits of using nasal sprays?

A

The nasal route has a faster onset than the GI route and is useful for acute conditions that should be treated quickly including pain. Nasal sprays bypass gut absorption; proteins that would get destroyed in the gut can be given nasally

51
Q

What are some examples of nasal sprays?

A

Iitrex, Afrin, Flonase allergy relief

52
Q

What are some counseling points before using nasal sprays?

A
  • Shake the bottle gently and remove the cap
  • Prime the pump before the first use or when you have not used it recently (7-14 days on average)
  • Blow your nose to clear your nostrils
53
Q

What are some counseling points of using a nasal spray?

A
  • Close one nostril and insert the nasal applicator into the other nostril
  • Start to breathe in through your nose and press firmly and quickly down once on the applicator to release the spray
  • Breathe out through your mouth
  • If a second spray is needed, repeat the above steps
  • Wipe the nasal applicator with a clean tissue and replace cap
  • Use the bottle for the labeled number of sprays then discard, even if it is not completely empty
  • Do not blow your nose right after using the nasal spray
54
Q

What are eye drops and ear drops used for?

A

Eye drops and ear drops are used for local effects; they treat symptoms and conditions of the eye and ear

55
Q

What are the requirements of eye drops?

A

Eye drops must be sterile for administration and close to the pH of the body

*Because of this, eye drops an be administered in the ear, but ear drops can never be administered in the eye

56
Q

What are some counseling points of eye drops?

A
  • Wash your hands before and after using eye drops
  • Before you open the bottle, shake it a few times. Gels should be inverted and shaken once prior to use
  • Bend your neck back so that you are looking up. Use one finger to pull down your lower eyelid
  • Without letting the tip of the bottle touch your eye or eyelid, release one drop of the medication by either squeezing the bottle or pushing on the bottom of the bottle. The drop should go into the space between your eye and your lower eyelid.
  • After you squeeze the drop of medication into your eye, close your eye. Press a finger between your eye and the top of your nose. Press for at least one full minute so more of the medication stays in your eye and you are less likely to have side effects
  • If you need to use more than one eye drop (wait at least 5-10 minutes to put a second medication in your eye and if administering a gel, wait 10 minutes after the other eye medication before use)
  • If your eye drop contains BAK and you wear soft contact lenses, remove the lenses prior to administration
57
Q

What are some counseling points about ear drops?

A
  • If cold, gently shake the bottle or roll it in your hands for 1-2 minutes to warm the solution. Do not drop cold medications into the ear. Ear drops that are too cold are uncomfortable and can cause dizziness
  • Lie down or tilt the head so that the affected ear faces up
  • Gently pull the earlobe up and back for adults to straighten the ear canal. Pull down and back for children < 3 years
  • Administer the prescribed number of drops into the ear canal. Keep the ear facing up for about five minutes to allow the medication to coat the ear canal
  • Do not touch the dropper tip to any surface. To clean, wipe with a clean tissue
58
Q

What are rectal medications used for?

A

Medications given rectally are used for either for localized treatment or for systemic treatment. Suppositories can be used when the patient is NPO and systemic treatment is needed

59
Q

What are examples of common rectal medications?

A

Rowasa, Pedia-Lax, FeverAll

60
Q

What is a counseling point for all rectal products?

A

For best results, empty the bowel immediately before use

61
Q

What are counseling points of enemas?

A
  • Remove the bottle from the pouch and shake well. Remove the protective sheath from the applicator tip. Gold the bottle at the neck to prevent any of the medication from being discharged
  • Best results are obtained by lying on the left side with the left leg extended and the right leg flexed forward for balance. Gently insert the medication or applicator tip into the rectum, pointed slightly toward the navel to prevent damage to the rectal wall
  • Grasp the bottle firmly and then tilt slightly so that the nozzle is aimed towards the back; squeeze slowly to instill the medication. Steady hand pressure will discharge most of the medication. After administering, withdraw and discard the bottle
  • Remain in position for at least 30 minutes, or preferable all night for maximum benefit
62
Q

What are some counseling points of suppositories?

A
  • Detach one suppository from the strip. Remove the foil wrapper carefully while holding the suppository upright. Do not handle the suppository too much; heat from your hands and body can cause it to melt
  • Insert the suppository, with the pointed end first, completely into your rectum, using gentle pressure. You can put a little bit of lubricating gel on the suppository if you have trouble
  • For best results, keep the suppository in your rectum for at least 1-3 hours
63
Q

What do inhaled medications provide?

A

Inhaled medications provide immediate (rescue) and long-lasting (maintenance) benefits in lung disorders

64
Q

How is the drug delivered in inhalers?

A

The drug is delivered directly to the lungs and this minimizes systemic toxicities

65
Q

What is the general rule for missed doses?

A

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the next dose at your regularly scheduled time. Do not take two doses at the same time unless instructed by your healthcare provider

66
Q

What are medications that do not follow the general rule for missed doses?

A

High-risk drugs, oral contraceptives, drug that must be taken at specific times

67
Q

What are some counseling points of medication storage?

A

Most mediations can be stored in any cool, dry place

68
Q

What do pharmacists review to assess adherence?

A

Refill histories

69
Q

What can be implied if a patient is nonadherent to medications that are used to prevent/control a disease?

A

The patient does not understand how to use their medication or the importance of medication, is experiencing side effects or requires assistance in remembering to take the drug

70
Q

What can a refill history refill reveal about a medication used as needed?

A

It can reveal how well the patient’s condition is controlled. Infrequent use of a rescue/as needed medication means that the patient is not having symptoms frequently, whereas frequent use can imply that the patient is suffering from symptoms or not using the medication correctly

71
Q

What is important when assessing adherence?

A

When assessing adherence, remember to evaluate the reason for the drug first. Then use a refill history to better understand what issues may be impacting medication use

72
Q

What is motivational interviewing?

A

Motivational interviewing is a counseling approach that focuses on the patient’s priorities to help facilitate change. Asking open-ended questions, employing empathy and reserving judgements will help to build patient relationships

NAPLEX Review (45 decks)

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