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Year 3 - Script > Formualtion and Administration > Flashcards

Formualtion and Administration Flashcards

1
Q

what should happen when a patient has difficulty swallowing and is unlikely to cope with tablets and capsules

A
  • all medicines should be reviewed
  • appropriate formulation changes

decide whether each one can be:

  1. safely manipulated to aid administration
  2. discontinued
  3. temporarily withheld
  4. switched to an alternative medicine in the same class
  5. switched to an alternative formulation or route
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2
Q

why is it not appropriate to crush all types of medication

A
  • increases the risk of adverse effect

- reduce therapeutic effect

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3
Q

Name some examples of medications that you should not crush

A
  • modified release tablets or capsules
  • any medication that can cause irritation to the stomach.
  • some tablets are meant for slow release so by crushing them this can cause side effects
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4
Q

What are the different forms of medicine that can be administered via the parenteral route

A
  • solution for IV injection
  • solution for IM injection
  • solution for intrathecal injection
  • solution for subcutaneous injection
  • subcutaneous implant
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5
Q

How many different forms of medication can be administered via the enteral route

A
  • Enema
  • Capsule
  • coated tablet
  • effervescent tablet
  • modified release tablet
  • oral solution
  • oral syrup
  • oral suspensions
  • rectal suppository
  • soluble tablet
  • tablet
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6
Q

what is the most appropriate way to give a medicine to a young child

A
  • small volume liquid medicines
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7
Q

what factors do you consider when choosing an appropriate formulation for a child

A
  • age and developmental stage of the child
  • acceptability and palatability
  • frequency of dosing
  • easy of administration
  • convenient and reliable administration
  • impact on lifestyle
  • minimum exposure to excipients
  • whether the formulation can deliver doses variable to age/weight/BSA
  • route of administration needs to be acceptable to the child and their parents/carers
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8
Q

what are excipients

A
  • these are usually pharmacologically inactive substances that are added to formulations to improve or alter the acceptability, shelf-life, stability or carry the active ingredient
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9
Q

who should avoid aspartame

A
  • it is a source of phenylalanine that should be avoided in patients with pheynketonuria this is a genetic disorder the prevents the breakdown of phenylalanine
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10
Q

who should Arachis oil be avoided in

A
  • this should be avoided in peanuts allergic patients

- it is used as an excipient to dissolve the active drug

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11
Q

why should you avoid large doses of syrups

A

syrups can be sucrose base or contain sorbitol

- Sorbitol can cause diarrhoea in large doses

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12
Q

what are the 4 stages of pharmacokinetics

A
  • absorption
  • distribution
  • metabolism
  • excretion
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13
Q

what can interpreting pharmacokinetic information also tell us

A
  • how water or lipid soluble a drug is

- how the drug is cleared from the body (and hence if you need to be concerned about kidney or liver impairment)

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14
Q

in order for most drugs to work unless for a topical effect they need to be…

A

absorbed into the blood stream

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15
Q

where does most drug absorption occur

A
  • most drug absorption occurs in the small intestine and not in the stomach
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16
Q

name factors that affect the process of oral absorption

A
  • chelation
  • solid or solution
  • modified-release preparations
  • enteric coating
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17
Q

what is chelation

A

this is when drugs can be bound to some electrolytes, particularly divalent ions such calcium and iron that will stop absorption

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18
Q

Give some examples of drugs that are affected by chelation

A
  • tetracycline antimicrobials and calcium
  • tetracycline antimicrobials and antacids
  • tetracycline antimicrobials and iron preparations
  • ## quinolone antimicrobials and iron preparations
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19
Q

How long after taking colestryamine should drugs be taken

A
  • binds to other medicines

- other drugs should be given either 1 hour before or 4-6 hours after colestyramine

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20
Q

if the drug is given as a solution…

A

absorption is faster - this isn’t always true - weak acidic drugs such as aspirin may precipitate out in the acidic environment of the stomach

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21
Q

what are modified released preparations

A
  • these are specifically formulated to release over a period of time
  • not always appropriate for patients who have had bowel resection
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22
Q

What is enteric coating

A
  • this technology protects the drug for the acidic environment of the stomach and can protect the stomach from the drug
  • means that the drug will bypass the stomach and enter the small intestine
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23
Q

what problem can an IM injection have in terms of absorption

A
  • poor blood flow will slow the rate of drug absorption

- a very well perfused muscle will have a rapid drug absorption

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24
Q

What other routes of administration depend on absorption through a mucus membrane

A
  • rectal
  • nasal
  • sublingual

Rate will depend on blood flow

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25
Q

What can affect absorption through the skin

A
  • having a hot bath - increases blood flow to the skin - led to fatalities in patients using fentanyl patches
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26
Q

What is bioavailability

A
  • this is the proportion of the medicine that finally makes the systemic circulation where it is available to act at the effector site
27
Q

what way of administering the drug has 100% bioavailability

A

IV drug

28
Q

what can affect bioavailability of a drug

A
  • route that it is administered
29
Q

name drugs whereby there is variation in bioavailability due to the route of administration

A
  • ciprofloxacin
  • digoxin
  • morphine
30
Q

name some examples when a patient wouldn’t be able to take an oral medication

A
  • nausea and vomiting

- dysphagia

31
Q

Name some examples of things that effect IM absorption

A
  • morbid obesity

- muscle wasting

32
Q

What does half life dictate

A
  • frequency of administration

- how long it takes for the drug to be eliminated from the body

33
Q

in what patients do you need to extend the half life

A
  • in patients with renal failure
34
Q

how can you slow down the breakdown of the preparation in modified release preparations

A
  • mixing the drug in a waxy base so that the drug leaches out
  • coating beads of the drug and either compressing them together or filling a capsule with them
35
Q

Name drugs that should be prescribed by brand rather than generically

A
  • dilitazem preparations
  • sone anti-epileptics
  • lithium salts
  • theophylline preparations
  • some immunosuppressant therapies (e.g. tacrolimus)
36
Q

why do some drugs need to be prescribed by brand name rather than generically

A
  • can be a problem with modified release preparations being different
  • all drugs have to be bioequvilance but this is not the same as therapeutic equivalence which can be a problem with drugs that have a narrow therapeutic index
37
Q

oral ciprofloxacin should be…

A

taken at a different time to indigestion remedies

38
Q

What are biological medicines

A
  • those with active ingredients derived from a living source
39
Q

what is prescribing biological medicines subjected to

A
  • prescribing biological medicines is often subject to guidelines from NICE and NHS England since the majority of these therapies have a high associated cost
40
Q

What has biological medicines led to

A
  • the development of biosimilar formulations that re likely to be significantly cheaper than biological medicines
41
Q

What is a biosimilar medicine

A
  • this is a biological medicine that is highly similar and therapeutically equivalent to the reference biological medicine
42
Q

what is the difference between biosimilar and generic medicines

A

generic medicine are not the same as biosimilar medicines

- a generic medicine will be identical in terms of the active ingredient to its reference medicine

43
Q

What is a marketing authorisation for

A
  • necessary before a medicine can be marketed for sale or supply
44
Q

What is off label

A
  • refers to medicines used outside the conditions of their marketing authorisation
45
Q

What are unlicensed preparations

A

this is when there is a need to use a medicine that doesn’t have a product authorisation in the UK

46
Q

What are the three categories of unlicensed preparations

A
  1. the medicine is produced and licensed in another country and imported
  2. the medicine is unlicensed and produced in a licensed manufacturing unit in this country
  3. the medicine is unlicensed and produced in an unlicensed manufacturing facility such as a pharmacy department
47
Q

What is a special

A
  • a special is an unlicensed preparation of a medicine
48
Q

Give examples of specials

A
  • specials are liquids or powder versions of a solid oral dosage form, specifically intended for patients who have swallowing difficulties
49
Q

What patient factors should you consider when you prescribe a medicine that is supplied as a special

A
  • consider the excipients - many medicines are quite unpleasant to taste and digging the taste can entail the use of strong flavours
  • monitor the patient and not change in clinical status
50
Q

What other factors should you consider when prescribing a medicine that is a special

A
  • as specials are unlicensed the responsibility for their use rests with you as the prescriber
  • be aware of your trusts policy for use and documentation
  • ensure a seamless transition between care settings
  • cost
51
Q

why would you not crush a tablet In a tube fed patient

A
  • can lead to blockage of the tube
52
Q

Why is the timing of the dose important

A
  • avoid adverse effects

- optimise therapeutic effect

53
Q

when should statins be administered

A

at night

54
Q

name some medicines that should be prescribed and administered at specific times

A
  • antimicrobials
  • insulin
  • nitrates
  • medicines used in Parkinsons Disease
  • modified released morphine sulfate
  • timolol eye drops
55
Q

why should there be a nitrate free period

A
  • there should be a nitrate free period of at least 8 hours to prevent the patient from developing a tolerance to the medicine
56
Q

How do you give medicines in enteral feeding

A
  • stopping the feed briefly
  • flushing the tube
  • administering the medicine
  • flushing the tube again and restarting the feed
57
Q

what do you do if the feed reduces the absorption of the medicine in enteral feeding

A
  • stop the feed for two hours to allow it to leave the stomach
  • give the required dose
  • restart the feed two hours later
58
Q

if you expect the patient to take the correct medication at the correct time then what do you need to ensure

A
  • a shared decision between you and the patient and the patient has consented to treatment
  • the most effective treatment for the condition
  • in a formulation that the patient is able to take
  • in a formulation that is acceptable to the patient
59
Q

what information must you give before you prescribe

A
  • adverse effects
  • administration
  • alternative treatments
  • effectiveness
  • expected duration of treatment
  • formulation
60
Q

What factors prevent your patient from providing informed consent

A
  • cultural differences
  • difficulty reading
  • health problems
  • lack of capacity to make this type of decision
  • language barriers
  • mental health problems
61
Q

What are the basic principles of the mental capacity act

A
  • a person is assumed to have capacity unless it is established otherwise
  • everyone must be helped to understand and make decisions
  • an unwise decision doesn’t mean a person is incapable
  • if someone lacks capacity you must act in their best interests
  • is there an equally effective, but less restrictive alternative
62
Q

How do you test capacity

A
  • does the patient have a condition which impairs their ability to make decisions
  • does this impairment mean that they are unable to make a specific decision when required
63
Q

How do you know if a person can make a specific decision

A
  • understand information about the decision to be made
  • be able to retain that information
  • be able to use that information to make their decision
  • be able to communicate that decision back to you

Year 3 - Script (11 decks)

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