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Pharmacy Technician > Routes & Formulations > Flashcards

Routes & Formulations Flashcards

1
Q

Formulations or Dosage Forms

A

Drugs are contained in dosing units

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2
Q

Route of Administration

A

A way of getting a drug into or onto the body.

  • Enteral
  • Parenteral
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3
Q

Enteral

A

Refers to anything involving the stomach from the mouth to the rectum

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4
Q

Parenteral

A

Routes other than enteral

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5
Q

Enteral Formulations

A
  • oral (po)
  • sublingual (sl)
  • buccal
  • rectal (pr)
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6
Q

Parenteral Formulations

A
  • intravenous (IV)
  • intramuscular (IM)
  • ophthalmic
  • intranasal
  • inhalation
  • dermal
  • vaginal
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7
Q

Factors Affecting Selection of Route & Method of Administration

A
  1. Drug characteristics
  2. Ease of administration
  3. Site of action
  4. Onset of action
  5. Duration of action
  6. Quantity of drug administered
  7. Liver or kidney diseases
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8
Q
  1. Drug Characteristics

pH Scale

A
  • measures the acidity of the alkalinity of a substance
  • pH 7 is neutral (water)
  • stomach is very acidic (pH 1-2)
  • certain drugs are degraded or destroyed by stomach acids
  • absorption of many drugs is affected by the presence of food in the stomach
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9
Q
  1. Drug Characteristics

pH Level

A
  • stomach if very acidic (pH 1-2)
  • duodenal pH is higher (closer is neutral)
  • colonic pH is neutral to slightly alkaline
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10
Q
  1. Drug Characteristics

Drug Research Process

A

The influence of drug characteristics is examined and the formulations approved will have compensated for this

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11
Q
  1. Ease of Administration
A
  • prescribers assess patient characteristics to determine route of administration
  • difficulty in swallowing?
  • consider liquid dose forms or non-oral routes of administration
  • PO route may be inadvisable for patients w/ nausea and vomiting
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12
Q
  1. Site of Action
A
  • route of administration may be influenced by desired site of action
  • local effect
  • systemic effect
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13
Q
  1. Site of Action

Local Effect

A

Site of drug activity and administration are one in the same

e.g. eyes, ears, nose, skin

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14
Q
  1. Site of Action

Systemic Effect

A

The drug is introduced into the circulatory system by any route of administration and carried by the blood to the site of action

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15
Q
  1. Onset of Action

Oral Medication

A

Since oral medications for systemic use need to go into solution to exert their effect, solutions or suspensions may work faster than oral tablets or capsules

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16
Q
  1. Onset of Action

Buccal or Sublingual (SL)

A

Medications placed under tongue or between cheek and gums work quickly because they bypass stomach and liver and go directly into bloodstream

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17
Q
  1. Onset of Action

IV

A

Drugs given IV directly are carried immediately throughout the body

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18
Q
  1. Onset of Action

Localized Therapeutic Effects

A

Those applied to the skin, inhaled into the lungs or instilled into eye

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19
Q
  1. Duration of Action
A

Length of time a drug gives the desired effect or is at the therapeutic level

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20
Q
  1. Duration of Action

Controlled or Extended Release

A

Drug effect lasts longer

e.g. 12 to 24 hrs

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21
Q
  1. Duration of Action

Transdermal Patches

A

Delivers small amounts of a drug steadily over many hours or even days

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22
Q
  1. Duration of Action

IV

A

Sustained duration effect can be achieved by means of intravenous infusion

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23
Q
  1. Duration of Action

IM and SQ

A

Injections into the muscle and skin last longer than injections directly into the bloodstream

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24
Q
  1. Quantity of Drug
A
  • sometimes route of administration is chosen because of the amount of a drug
  • IV infusion is an excellent method for systemic delivery of large quantities of material
  • IV injections and infusions can deliver a higher dose of medication to the target site
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25
Q
  1. Metabolism by the Liver or Excretion by the Kidney

Liver Metabolism

A

Breaks down active drug to inactive metabolites for elimination and prevents drug accumulation

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26
Q
  1. Metabolism by the Liver or Excretion by the Kidney

First-pass Effect

A
  • is the extent to which a drug is metabolized by the liver before reaching systemic circulation
  • influences activity of some drugs
  • such drugs have to be given in larger oral doses or by different route to bypass metabolism by the liver
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27
Q
  1. Metabolism by the Liver or Excretion by the Kidney

Effects of Age or Disease-related Change

A
  • age or disease-related changes in liver or kidney function can cause:
  • drug accumulation
  • and potential toxicity
  • drug dosage often needs adjustment in the elderly
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28
Q
  1. Metabolism by the Liver or Excretion by the Kidney

Multiple Potent Prescription

A

If patients are on multiple potent prescription drugs, there is a risk of a drug-drug interaction

  • drug accumulation
  • toxic blood levels increases
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29
Q

Oral Dosage Forms

Disintegration

A

The breaking apart of a tablet into smaller pieces

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30
Q

Oral Dosage Forms

Dissolution

A

When the smaller pieces of a disintegrated tablet dissolve in solution

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31
Q

Inactive Ingredients

A
  • include binders, lubricants, fillers, diluents, and disintegrates
  • added to help manufacture the formulation & to help the dosage form disintegrate & dissolve when administered
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32
Q

Most Frequent Route of Administration

A
  • is PO
  • oral refers to two method
  • applying topically to the mouth for local effect
  • swallowing for absorption through the GI tract into systemic circulation
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33
Q

Common Dose Form for Enteral

A

Solid Formation

  • tablets
  • capsule
  • bulk powders
  • rectal formulations
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34
Q

Tablet - Bulk Powders

A

Contain the active drug in a small powder paper or foil envelop. The patient empties the envelop into glass of water or juice and drinks the contents

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35
Q

Tablet - Chewable Tablets

A

Are flavored and are designed to be chewed

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36
Q

Tablet - Effervescent Tablets

A

Are granular salts that release gas and the active ingredient into solution when placed in water or juice

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37
Q

Capsules

A
  • a solid dosage form consisting of a gelatin shell that encloses the drug
  • usually swallowed whole
  • tasteless and are easier to swallow than tablets
  • contains powders, granules, liquids, or some combo w/ one or more active ingredients
  • flavorings are not common for this dose form
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38
Q

Capsule - Soft or Soft-gel

A

Are capsules that contain liquid instead of powders inside the gelatin shell

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39
Q

Buccal Tablets and Gum

A
  • placed in the buccal pouch
  • between the cheek and the gum
  • dissolved and absorbed by the buccal mucosa
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40
Q

Oral Dose Form

Delayed-release

A
  • does not release the active drug immediately after administration
  • avoid destruction in the stomach
  • reduce GI upset
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41
Q

Oral Dose Form

Extended-release

A

Allows reduced frequency of dosing

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42
Q

Oral Dose Form

Modified Release Formulation

A
  • delayed-release medication is not the same as extended- or controlled-release medication of the same drug
  • modified-release dose forms should not be split
43
Q

Oral Dose Form

Other Formulation

A
  • long-acting, timed-release, and sustained-release dose forms
  • sustained release (SR)
  • extended release (XR, ER)
  • continuous release (CR)
  • long acting (LA)
44
Q

Liquid Formulation

Solutions

A

A clear liquid

45
Q

Liquid Formulation

Solvent

A

A liquid that can dissolve another substance to form a solution

46
Q

Liquid Formulation

Aqueous Solution

A

Water is the solvent

47
Q

Liquid Formulation

Suspensions

A
  • are formulations in which the drug is not dissolved in the liquid
  • suspensions should be shaken well before dispensing or administration
48
Q

Liquid Formulation

Syrups

A

Are concentrated solutions of sucrose (sugar) in water and are thicker than water

49
Q

Non-aqueous Liquid Formulations

A

Solutions that contain solvent other than water

  • elixirs
  • spirits
  • tinctures
50
Q

Non-aqueous Liquid Formulations

Elixirs

A
  • are sweetened liquids that contain alcohol (5-40%)

- they are less sweet and less effective in masking taste than syrup

51
Q

Non-aqueous Liquid Formulations

Spirits

A

Are alcoholic solutions that contain volatile oils (alcohol 62-85%)

52
Q

Non-aqueous Liquid Formulations

Tinctures

A

Are alcoholic solutions (like spirits) but of nonvolatile substances

53
Q

Liquid Formulation

Emulsions

A

Are solutions of oil and water based substances

  • emulsifier
  • creaming
  • coalescence
54
Q

Liquid Formulation - Emulsions

Emulsifier

A

Is a substance that disperses the oil in to water (w/o emulsion) or water into oil (w/o emulsion)

55
Q

Liquid Formulation - Emulsions

Creaming

A

Occurs when dispersed droplets merge together; can be dispersed by shaking

56
Q

Liquid Formulation - Emulsions

Coalescence

A

Is irreversible separation of the dispersed phase

57
Q

Liquid Formulation

Gels

A
  • made using a substance called gelling agents
  • usually takes 12-24 hours to reach maximum viscosity
  • add the active drug before the gel is formed
58
Q

Unit Dose Disposable Syringes

A

Prefilled syringes that contain a single premeasured dose of medication and are thrown away after use

59
Q

Oral Syringe

A

A device without a needle to administer medication to pediatric or elderly patients unable to swallow tablets or capsules

60
Q

Effervescent Salts

A

Contain one or more medicinal agents and

  • some combination of sodium bicarbonate w/ citric acid, tartaric acid, or sodium biphosphate
  • release carbon dioxide gas when dissolved
61
Q

Lozenges

A

Contain active ingredients and flavorings that are dissolved in the mouth

  • also known as troches or pastilles
  • generally have local effects
62
Q

Dropper

A
  • contains a small, squeezable bulb at one end and a hollow glass or plastic tube with a tapering point
  • frequently incorporated into the cap of a vial or other container
  • often used for otic or ophthalmic administration
63
Q

gtt

A

Abbreviation for drops

64
Q

Sublingual Administration

A
  • designed to dissolve under the tongue and very quickly
  • nitroglycerin (NTG) is the best known example of SL formulation
  • advise patients to take a sip of water first and not to eat food or beverages until the drug is fully absorbed
65
Q

Oral Dose Form

A
  • capsules are preferred over tablets for patients with difficulty swallowing
  • water preferred over beverages to aid in swallowing
  • some dose forms are designed to be sprinkled on food when swallowing a solid is difficult
  • liquid doses are swallowed more easily and are suitable for
  • patients with swallowing difficulties
  • small children
66
Q

Advantages of Oral Route

A
  • ease and safety of administration
  • active ingredient is generally contained in powders or granules which dissolve in GI tract
  • sublingual (and buccal) administration has a rapid onset (less than 5 minutes)
67
Q

Disadvantages of Oral Route

A
  • delayed onset, dose form must disintegrate before absorption
  • destruction or dilution of drug by GI fluids and acid or food or drink in stomach or intestines
  • not indicated in patients who have N&V or are comatose, sedated, or unable to swallow
  • unpleasant taste of some liquid dose forms, must be masked by flavorings to promote compliance
  • some drugs given SL or buccally have a short duration of action
  • buccal route may have medicinal taste or local mouth irritation
68
Q

Dispensing Oral Medications - NTG

A
  • patients need instruction on proper storage of NTG
  • SL NTG tablets should be stored in their original container (brown glass bottle)
  • lid screwed on tightly to prevent loss of potency
  • pillboxes should be discouraged
  • refill NTG with a fresh bottle every 6 months
69
Q

Rectal Medication - Suppository

A
  • remove suppository from its package
  • insert tapered end first w/ index finger for the full length of the finger
  • may need to be lubricated w/ a water soluble gel to ease insertion
  • refrigeration may make insertion of rectal medications easier in warm climates
70
Q

Rectal Formulations

A

Is preferred when

  • oral drug might be destroyed by acidic fluids in the stomach
  • oral drug might be too readily metabolized by the liver and eliminated from the body
  • patient is unconscious and needs medication
  • N&V or severe acute illness in the GI tract make patient unable to take oral drugs
  • the site of action is local to the rectum
71
Q

Parenteral Routes of Administration

A
  • an injection or infusion by means of a needle or catheter inserted into the body
  • parenteral forms deserve special attention, complexity, potential for therapeutic benefit and danger including risk of infection
  • this route of administration bypasses the GI tract
72
Q

Parenteral Routes of Administration

Injection Independent

A
  • ophthalmic
  • intranasal
  • inhalation
  • dermal
  • vaginal
  • otic
73
Q

Parenteral Routes of Administration

Injection Dependent

A
  • intravenous
  • intramuscular
  • intradermal
  • subcutaneous
  • epidural
  • intrathecal
74
Q

Parenteral Forms for Injection

A
  • parenteral preparations must be sterile
  • parenterals are prepared using
  • aseptic techniques
  • special clothing (gowns, masks, hair net, gloves)
  • laminar flow hoods placed in special rooms
75
Q

Parenteral Dosage Forms

A
  • IV route directly into a vein
  • prepared in hospitals and home healthcare pharmacies
  • antibiotics
  • chemotherapy
  • analgesics
  • nutrition
  • critical care medications
76
Q

Needle Size Recommendation

A
  • Intravenous 16-20 gauge, 1-1.5” length
  • Intramuscular 19-22 gauge, 1-1.5” length
  • Subcutaneous 24-27 gauge, 3/8-1” length
  • Intradermal 25-26 gauge, 3/8” length
77
Q

Parenteral Route

A
  • disposable syringes and needles are used to administer drugs by injection
  • different sizes are available depending on the type of medication and injection needed
  • IV infusion can provide a continuous amount of needed medication without fluctuation in blood levels of other routes
  • infusion rate can be adjusted, provides more or less medication as the situation dictates
78
Q

Intravenous Formulation

A
  • administered directly into a vein
  • takes about 20 seconds to circulate throughout the body
  • aqueous solutions are the most common formulation
  • syringeability
  • injectibility
79
Q

Syringeability

A

The ease with which a material can be drawn from container into a syringe

80
Q

Injectibility

A

The ease of flow when a material is injected into patient

81
Q

Intravenous Injections or Infusions

A

Intravenous injections are injected directly into veins and are administered at a 15-20 degree angle

82
Q

Intravenous Administration Devices

Infusion

A
  • gradual IV injection of a volume, usually 500-1000ml, of fluid into a patient
  • e.g. dextrose in water 5% (D5W), 0.9% sodium chloride in water (NS)
  • solution bag has two ports: an administration set port and a medication port
83
Q

Intravenous Administration Devices

Infusion Pump

A
  • ensures consistent and controlled delivery rate

- patient controlled analgesia (PCA) are pumps for self administration or pain medication

84
Q

Parenteral Route Advantages

A
  • IV route is the fastest method for delivering systemic drugs, preferred route in an emergency situation
  • can provide fluids, electrolytes, and nutrition; patients who cannot take food or have serious problems w/ GI tract
  • provides higher concentration of drug to bloodstream or tissues; advantageous in serious bacterial infection
85
Q

Parenteral Route Disadvantages

A
  • formulation is limited to solutions, suspensions, and emulsions
  • has to be sterile (bacteria free)
  • pH must match body fluid’s using buffer system
  • limited volume should be used to avoid pain and necrosis
  • higher cost, drug and auxiliary devices
  • required skilled personnel to administer them
  • most difficult to remove once administered if there is an adverse or toxic reaction
  • requires a needle for injection
  • potential for additional adverse events, e.g. infection or clots
86
Q

IV Formulation Complications

A
  • thrombus formation
  • phlebitis
  • air emboli
  • particulate material can include small pieces of glass that chip from the product’s vial or rubber pieces from the stopper
87
Q

Intramuscular Injections

A
  • care must be taken with deep IM injections to avoid hitting a vein, artery, or nerve
  • in adults, IM injections are given into upper, outer portion of the gluteus maximus
  • for children and some adults, IM injections are given into the deltoid muscles of the shoulders
  • depot - the area in the muscle where the formulation is injected
88
Q

Intramuscular Injections Needle

A
  • typical needle is 22 to 25 gauge, 1/2 to 1 in needle
  • IM injections are administered at a 90 degree angle
  • volume limited to less than 3 ml
89
Q

Advantages and Disadvantages of the IM Route

A
  • IM and subcutaneous routes of administration are convenient ways to deliver medications compared with IV route
  • onset of response of medication may be slower
  • duration of action can be longer
  • practical for use outside hospital
  • used for drugs which are not active orally
  • injection site needs to be “prepped” using alcohol wipe
  • correct syringe, needle, and technique must be used
  • rotation of injection site with long-term use to prevent scarring and other skin changes and can influence drug absorption
90
Q

Subcutaneous Injection

A
  • administer medications below the skin into the subcutaneous fat
  • outside of the upper arm
  • top of the thigh
  • lower portion of each side of the abdomen
  • not into grossly adipose, hardened, inflamed or swollen tissue
  • often have a longer onset of action and a longer duration of action when compared w/ IM or IV
91
Q

Subcutaneous Injection Needle

A
  • given at a 45 degree angle
  • 25-26 gauge needle, 3/8 to 5/8 in length
  • no more than 1.5 ml should be injected into the site; avoids pressure on sensory nerves causing pain and discomfort
92
Q

Subcutaneous Injection Insulin

A
  • given using 30-32 gauge short needles, special syringe that measures in units
  • keep insulin refrigerated
  • check expiration dates frequently, open vials should be discarded after 28 days
  • vial of insulin is mixed by rolling between the hands and never shaken
  • rubber stopper should be wiped w/ an alcohol wipe
93
Q

Intradermal Injection

A
  • given into capillary-rich layer just below epidermis for
  • local anesthesia
  • diagnostic tests
  • immunizations
94
Q

Examples of Intradermal Injections

A
  • skin test for TB, typical site is upper forearm, below area where IV injections are given
  • allergy skin testing
  • small amounts of various allergens are administered to detect allergies
  • usually on the back
95
Q

Implants (or Pellets)

A
  • are dosage forms placed under the skin by means of minor surgery
  • used for long-term, controlled release of medications
  • enhanced patient compliance and convenience
  • complications at the site of insertion have limited use
  • e.g. viadur, duros, supperlin LA
96
Q

Plasters

A

Are solid or semisolid preparations that adhere to the body

97
Q

Topical Routes of Administration

A
  • the application of a drug directly to the surface of the skin
  • includes administration of drugs to any mucous membrane:
  • nose
  • ears
  • vagina
  • urethra
  • colon
  • lungs
98
Q

Ophthalmic Medication

A
  • administered for local treatment
  • must be at room temperature or body temperature before application
  • have to be sterile; only preparations w/ preservatives can be repeatedly used
  • major problem is the immediate loss of dose by natural spillage from eye and about 80% of a dose will be lost from the eye overflow
  • unused ophthalmic mediations should be discarded 30 days after container is opened
  • manufacturer expirations do not apply once opened
99
Q

Ophthalmic Ointments Formulation

A
  • tend to keep the drug in contact with the eye longer than solutions
  • most ointments are made of mineral oil and white petroleum and have a melting point close to body temperature
  • ointment cause blurring of vision and should be applied at night
100
Q

Ophthalmic Administration (Preparation)

A
  • before application, patient should wash hands, prevents contamination of application site
  • tube or dropper should not touch the application site, medication may become contaminated
  • only sterile ophthalmic solutions or suspensions should be used in the eye
  • ear drops can never be used in the eye, eye drops can be used in the ear
101
Q

Ophthalmic Administration

A
  • patient’s head should be tilted back
  • after administration, patient should place a finger in the corner of the eye, next to the nose to close the lacrimal gently, prevents loss of medication through tear duct
  • patient should also keep the eyes closed for 1-2 minutes after application
  • when multiple drops of more than one medication are administered, the patient should wait 5 minutes between different medication
  • if an ointment and a drop are used together, the drop is used first, wait 10 minutes before applying the ointment
102
Q

Contact Lenses

A

-if patient is allowed to wear contact lenses, the lens should be put in the eye 5 minutes after the solution is used

103
Q

Ocular Inserts

A
  • Ocusert is an ocular insert designed to deliever pilocarpine at a controlled rate for up to 7 days
  • lenses placed in a solution containing a drug and the lenses absorb the drub solution

Pharmacy Technician (3 decks)

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