PH2107 - Oral Suspensions & liquids

Question 1

Which patients may need to be prescribed an oral liquid medicine?

Answer 1

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

Question 2

What are the disadvantages to using oral liquid medicines?

Answer 2

Cost is usually higher

Less stable

Question 3

Why might patients have difficulty in swallowing?

Answer 3

• psychological aversion
• age (old and young)
• dysphagia

Question 4

What factors do pharmacists need to be aware of when supplying medicines to children?

Answer 4

• 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

Question 5

What factors do pharmacists need to be aware of when supplying medicines to elderly patients?

Answer 5

• 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

Question 6

What two types of dysphagia can patients suffer from?

Answer 6

• acute e.g. sore throat

- longer term e.g. stroke, Parkinson’s, muscular dystrophy, oesophageal cancer

Question 7

How many patients suffer from dysphagia?

Answer 7

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

Question 8

What factors in taking medicine are important to patients?

Answer 8

• ease of dosing
• palatability
• acceptability of excipients

Question 9

What factors need to be considered with ease of dosing?

Answer 9

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

Question 10

What is palatability?

Answer 10

The overall appreciation of a medicinal product in relation to its smell, taste, aftertaste and texture (i.e. feeling in the mouth)

Question 11

What is a key factor affecting acceptability of oral medication by children and the elderly

Answer 11

Palatability

Question 12

What flavour medication do children prefer?

Answer 12

Fruit flavours - strawberry or banana
Cola
Chocolate

Question 13

What flavour medication do older patients prefer?

Answer 13

Loss of taste with age so prefer stronger flavours e.g. mint

Question 14

What flavour do patients expect GI medicines to be?

Answer 14

Mint or aniseed flavoured

Question 15

Why is colour an important consideration in medicines?

Answer 15

Psychological impact of colours

Expectations - e.g. never see blue liquid medicines - doesn’t feel right

Question 16

What three excipients are often added to medicines?

Answer 16

• sugar
• alcohol
• colourants

Question 17

Why is sugar often added to medicines?

Answer 17

To increase palatability

Question 18

Why are sugar free medicines often preferred?

Answer 18

Negative health impacts of sugar becoming increasingly important to patients

Question 19

What effect can sugar free preparations have?

Answer 19

Laxative effect e.g. sorbitol

Question 20

What problems do colourants have in medications?

Answer 20

Link to hyperactivity in some children

Question 21

Which three points should storage of oral liquid medicines be considered?

Answer 21

Manufacture to wholesale
In the pharmacy before it is dispensed
At the patient’s home

Question 22

Why is “Keep out of the sight and reach of children” important?

Answer 22

Of particular importance in the patient’s home

- oral liquids can be tempting to children (flavour)

Question 23

How can children be protected from dangerous medicines?

Answer 23

Keep out of the sight and reach of children warning label
Child-resistant closure
Keep medicines in an inaccessible place

Question 24

Why is the expiry date of a medication important?

Answer 24

Depends on individual product (e.g. freshly/recently prepared)
Shorter use by date (than expiry date) if reconstituted

Question 25

What things need to be considered when dispensing an oral liquid medication?

Answer 25

Quantities to prescribe / dispense
- original pack size?
- reconstitution?
Labelling
Spoons/syringes
Different strength

Question 26

How much medicine should be supplied?

Answer 26

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”

Question 27

What should measured volumes of oral liquid medicines be dispensed in?

Answer 27

A suitable container with a child-resistant closure

Question 28

What needs to be done to a suspension before measuring it out?

Answer 28

The bottle needs to be shaken

Question 29

What volume of reconstituted antibiotics should be dispensed?

Answer 29

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

Question 30

How will the patient measure the medication accurately so they get the correct dose?

Answer 30

Provide the appropriate means and, where possible, refer to this on the label i.e. using the oral syringe provided give . . .

Question 31

How might a patient know if they are taking a different strength of a tablet?

Answer 31

If it usually a different size or colour

Question 32

Why might patients take a different dose to that expected with an oral liquid medication?

Answer 32

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

Question 33

How can problems with dosing oral liquid medications be avoided?

Answer 33

Be sure to communicate clearly if you are dispensing a different strength preparation from what the patient has had in the past

Question 34

Who should you counsel when dispensing oral liquid medications?

Answer 34

Wherever possible, you should counsel the person who will be administering the medication
- in most cases this is the patient themselves

Question 35

should a pharmacist counsel a child when dispensing oral liquid medications?

Answer 35

• 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

Question 36

What are the most important administration points to cover?

Answer 36

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

Question 37

As patients can only remember a limited amount of information at one time, how can information be delivered?

Answer 37

Highlight other sources of information

• label
• PIL

Question 38

Describe the disperse phase in an emulsion