PH2107 - Oral Suspensions & liquids Flashcards
Which patients may need to be prescribed an oral liquid medicine?
Patients who are unable to swallow oral solids easily
Patients who require a dose which is difficult to deliver accurately through available solid oral dosage forms
Also in certain patients / conditions where a faster onset of action is required vs. solid oral form
What are the disadvantages to using oral liquid medicines?
Cost is usually higher
Less stable
Why might patients have difficulty in swallowing?
- psychological aversion
- age (old and young)
- dysphagia
What factors do pharmacists need to be aware of when supplying medicines to children?
- age, development level etc. can all factor into decision over what is best dosage form
- yet a study showed 35% of parents/guardians didn’t feel involved in decisions about their child’s care or treatment
- younger children more likely to have medicines administered by their parent/guardian while older children more likely to take responsibility for their own medication
- younger children are likely to focus on taste mainly
- older children may be more sensitive to stigma of taking medication e.g. at school and may prefer more transportable forms
What factors do pharmacists need to be aware of when supplying medicines to elderly patients?
- reduction of saliva production / weakening of muscles involved in swallowing
- estimates from 60 - 90% of elderly have some degree of difficulty swallowing solid dosage forms
What two types of dysphagia can patients suffer from?
- acute e.g. sore throat
- longer term e.g. stroke, Parkinson’s, muscular dystrophy, oesophageal cancer
How many patients suffer from dysphagia?
Studies suggest that dysphagia has been found to affect up to:
- 15% of residents in general care homes for older people
- 30% patients in hospices
What factors in taking medicine are important to patients?
- ease of dosing
- palatability
- acceptability of excipients
What factors need to be considered with ease of dosing?
Frequency - usually not unique to oral liquid formulations as patients prefer less frequent doses Volume - amount needed to be taken at a time - large volumes mean taste more relevant - volume per bottle - convenience - large doses need large bottles which are hard to carry around Administration - how is it measured and administered
What is palatability?
The overall appreciation of a medicinal product in relation to its smell, taste, aftertaste and texture (i.e. feeling in the mouth)
What is a key factor affecting acceptability of oral medication by children and the elderly
Palatability
What flavour medication do children prefer?
Fruit flavours - strawberry or banana
Cola
Chocolate
What flavour medication do older patients prefer?
Loss of taste with age so prefer stronger flavours e.g. mint
What flavour do patients expect GI medicines to be?
Mint or aniseed flavoured
Why is colour an important consideration in medicines?
Psychological impact of colours
Expectations - e.g. never see blue liquid medicines - doesn’t feel right
What three excipients are often added to medicines?
- sugar
- alcohol
- colourants
Why is sugar often added to medicines?
To increase palatability
Why are sugar free medicines often preferred?
Negative health impacts of sugar becoming increasingly important to patients
What effect can sugar free preparations have?
Laxative effect e.g. sorbitol
What problems do colourants have in medications?
Link to hyperactivity in some children
Which three points should storage of oral liquid medicines be considered?
Manufacture to wholesale
In the pharmacy before it is dispensed
At the patient’s home
Why is “Keep out of the sight and reach of children” important?
Of particular importance in the patient’s home
- oral liquids can be tempting to children (flavour)
How can children be protected from dangerous medicines?
Keep out of the sight and reach of children warning label
Child-resistant closure
Keep medicines in an inaccessible place
Why is the expiry date of a medication important?
Depends on individual product (e.g. freshly/recently prepared)
Shorter use by date (than expiry date) if reconstituted
What things need to be considered when dispensing an oral liquid medication?
Quantities to prescribe / dispense - original pack size? - reconstitution? Labelling Spoons/syringes Different strength
How much medicine should be supplied?
You should supply a manufacturer’s original pack wherever possible BUT if a prescriber orders a quantity that does not match an original then you will need to measure out the correct amount, unless it is in a “special container”
What should measured volumes of oral liquid medicines be dispensed in?
A suitable container with a child-resistant closure
What needs to be done to a suspension before measuring it out?
The bottle needs to be shaken
What volume of reconstituted antibiotics should be dispensed?
If amount prescribed doesn’t match the pack size, then you should round UP
- e.g. if 140ml ordered, but pack size is 100ml, then reconstitute and supply 2 x 100 ml bottles
- warn patient that excess has been dispensed
If course / amount prescribed exceeds the expiry date once reconstituted, you’ll need to provide part supply and patient will need to return for the remainder
How will the patient measure the medication accurately so they get the correct dose?
Provide the appropriate means and, where possible, refer to this on the label i.e. using the oral syringe provided give . . .
How might a patient know if they are taking a different strength of a tablet?
If it usually a different size or colour
Why might patients take a different dose to that expected with an oral liquid medication?
Liquid medications (especially unlicensed ones) are less obvious if they are different strengths. Patients may take the same volume as usual, but end up with a very different dose
How can problems with dosing oral liquid medications be avoided?
Be sure to communicate clearly if you are dispensing a different strength preparation from what the patient has had in the past
Who should you counsel when dispensing oral liquid medications?
Wherever possible, you should counsel the person who will be administering the medication
- in most cases this is the patient themselves
should a pharmacist counsel a child when dispensing oral liquid medications?
- communicating with children about their medications can significantly impact on their willingness to take, and adherence to, their medication
- consider discussing medicines with children as well as their parent/guardian
- GPhC requires pharmacists to communicate effectively
- tailoring and adapting your communication to ensure the patient understands - consider this carefully when communicating with children in particular
What are the most important administration points to cover?
The usual counselling points (e.g. dose frequency)
Instructions on storage
Need to shake the bottle before administration (where appropriate)
How to measure the dose correctly
As patients can only remember a limited amount of information at one time, how can information be delivered?
Highlight other sources of information
- label
- PIL
Describe the disperse phase in an emulsion
