Exercise 5

Pharmaceutical Dosage Forms

Dosage Form

• also known as pharmaceuticals. It is define as preparation devised to make possible administration of medications in measured or prescribed amount.

Terms

• Parenteral Dosage Forms – are preparation introduced into the body by injection through the skin, the mucous, or the serous membranes

• Dosage forms for inhalation – are preparations intended to be finally dispensed or vaporized to the mucous membranes of the lower part of the respiratory tract.

Terms

• Oral Dosage Forms - are preparations intended to be taken orally.

• Rectal Dosage Forms - are preparations employed for systemic effect or a local action through the rectum.

Term

• Dosage Forms For Topical application are preparations intended to be applied on the skin or instilled into eyes, nose, or ears.

LIQUIDS

• A.     Solutions – a homogenous mixture that is prepared by dissolving a solid or liquid or gas in another liquid; it represents a group of preparations in which the molecules of the solute or dissolved substances are dispersed among those of the solvent

Solutions     • Water – used mainly as a vehicle and as a solvent for the

desired flavoring or medicinal ingredients.• Aromatic water – also known as medicated water, clear

saturated aqueous solutions of volatile oils or aromatic or volatile substances.

• Aqueous acids – official inorganic acids and certain acids although of minor significance as therapeutic agents are great importance in chemical and pharmaceutical manufacturing.

Solutions   • Diluted acids – aqueous solutions of suitable

strength usually 10% w/v except diluted acetic acid which is 6% w/v

• Douches – aqueous solutions directed against a part or into a cavity of the body

• Enemas – also known as evacuation enemas. They are rectal injections employed to evacuate bowel retention enemas to influence the general system by absorption, or to effect locally the seat of disease.

Solutions

• Gargles – aqueous solutions used for treating the pharynx and nasopharynx by forcing air from the lungs through the gargle which is held in the throat.

• Mouthwashes – aqueous solutions which are most often used for their deodorant, refreshing, or antiseptic effect.

• Juices – prepared from fresh ripe fruits, aqueous in character and used in making syrups which are employed as vehicles.

Solutions

• Nasal solutions – usually aqueous solutions which are deigned to be administered to the nasal passages in drops or spray form.

• Otic solutions – aqueous preparations dispensed in a container which permits the administration of drops to the ear

NON-AQUEOUS

• Collodion –liquid preparations containing pyroxillin in a mixture of ethyl ether and ethanol.

• Elixirs – clear, pleasantly flavored sweetened hydro-alcoholic liquids intended for oral use.

• Glycerites – solutions or mixtures of medicinal substances in not less than 505

by weight of glycerin

NON-AQUEOUS• Inhalations – are solutions of drugs

administered by the nasal or oral respiratory route for local or systemic effect.

• Liniments – solutions or mixtures of various substances in oil, alcoholic solutions of soap or emulsions.

• Oleovitamins – fish liver oils diluted with edible vegetable oil or solutions of volatile substances of the indicated vitamins or vitamin concentrates (usually A and D) in fish liver oil.

NON-AQUEOUS

• Spirits – known as essences; are alcoholic hydro-alcohol solutions of volatile substances.

• Toothache drops – preparations used for temporary relief of toothache by application of cotton saturated with the product into tooth cavity

• EMULSION – a two phase system prepared by combining two immiscible liquids one of which is uniformly dispersed through the other; they consist of globules that have diameters equal to or greater than those of the largest colloidal particles.

• SUSPENSIONS – a two-phase system consisting of finely divided solid dispersed in a solid, liquid, or gas.

• GELS – semi-solid systems of either suspension made up of small inorganic particles or large organic molecules interpenetrated by a liquid.

• LOTIONS – usually liquid suspension or dispersions intended for external application to the body.

• MAGMAS and MILK – aqueous suspensions of insoluble inorganic drugs; they differ from gels mainly in that the suspended particles are layers.

• TINCTURES – alcoholic or hydroalcoholic solutions prepared from vegetable materials or from chemical

substances

• FLUIDEXTRACTS – liquid preparation of vegetable drugs containing alcoholic as a solvent or as preservative or both, so made that each mL contains the therapeutic constituents of 1 g of the standard drug that it represents

• EXTRACTS – concentrated preparations of vegetable or animal drugs obtained by removal of the active constituents of the respective drugs with suitable menstruum.

• PARENTERAL PREPARATION – sterile preparations intended to be administered by injection under or through one or more layers of skin or mucous membranes

• INTRAVENOUS ADMIXTURES – mixture of intravenous fluids and drugs to be administered by injection

OPHTHALMIC PREPARATIONS – sterile preparations to be used on the eyes

• Solutions – intended for the eye; clear, sterile solution to be instilled into the eyes by the use of a dropper.

• Suspensions – dispersion of finely divided relatively insoluble drug substances in an aqueous vehicle containing suitable suspending and dispersing agent.

• Ointment – intended for the eyes; they contain medicinal agents added to the ointment base of white petrolatum and mineral oil either as a solution or as a micronized powder.

LENS CARE PRODUCTS – sterile preparations intended to protect the lens

• 1.      wetting solutions• 2.      cleaning solutions• 3.      disinfection solutions• 4.      soaking solutions• 5.      artificial tears

MEDICATED

• OINTMENT – semi-solid preparations intended for external applications to the skin or mucous membranes.

• CATAPLASM – a soft moist mass of meals, herb, seed usually applied hot in clothes.

• PASTES – concentrates of absorptive powders dispersed in petrolatum or hydrophilic petrolatum

• POWDERS for external use are usually described as dusting powders, usually contain starch, talc, and zinc stearate

• DRESSINGS – external applications resembling ointment usually used as a covering or protection.

• CREAMS – viscous liquid or semi-solid emulsions of either the oil in water or water in oil type

• PLASTERS – substances intended for external application; they are made of such materials and of such consistency as to adhere to the skin and attach to a dressing

• SUPPOSITORIES – solid dosage forms of various weights and shapes usually medicated for insertion into the rectum, vagina, or the urethra

POWDERS

• Oral powders – generally supplied as finely divided or effervescent granules

• Dentifrices – may be prepared in the form of a bulk powders generally containing

soap or detergent, mild abrasive and anticariogenic agent

• Douche powders – soluble powders intended to be dissolved in water prior to use as antiseptic or cleaning agents for a body cavity.

• Dusting powders – locally applied non-toxic preparations that are intended to have

no systemic action.• Insufflations – finely divided powders

introduced into the body cavities.• Triturations –dilutions of potent powdered

drugs prepared by intimately mixing them with a suitable diluent in 1:10 dilutions

ORAL SOLID DOSAGE FORMS• TABLET – solid dosage form containing drug

substances with or without suitable diluents and prepared either by compression or molding methods.

• CAPSULES – solid dosage forms in which the drug substance is enclosed in either a hard or soft soluble container or of a suitable form of gelatin

• PILLS – small, round, solid dosage forms containing medicinal agents and intended for oral administration

ORAL SOLID DOSAGE FORMS

• TROCHES – also known as lozenges or pastilles; they are discoid shaped solid containing the medicinal agent in a suitably flavored base.

• CACHETS – related to capsules in as such as they provide an edible container for oral administration of solid drugs.

• PELLETS – small, sterile cylinders about 3.2 mm in diameter by 8 mm in length, formed by compression from medicated masses

• AEROSOLS – both oral and topical; they contain therapeutically active ingredients dissolved, suspended, or emulsified in a propellant or in a mixture of solvent and propellant

• RADIOPHARMECUTICALS – radioisotopes used in medicine for therapeutic and diagnostic purposes

BIOLOGICAL PRODUCTS

• Vaccines a suspension of attenuated (live) or inactivated (killed) microorganisms or fraction thereof administered to induce immunity and thus prevent infectious disease.

• Toxoid – a modified antigen from an infectious organism used as a vaccine

• Immune globulin – a solution containing antibodies from the pooled plasma of not less than 1,000 normal individuals

• Hyperimmune serum – a special preparation obtained from human donor polls selected for high antibody titer against a specific disease

Examples Dosage Forms

• Omega Pain Killer (Methyl salicylate, menthol, camphor) – Liniment

• Cold Rub (Camphor, Menthol, Eucalyptus oil) – Ointment• Aceiti Manzanilla – Solution• Acrinol – Tincture• White Henna – Powder• Sebo De Macho – Ointment• Caladryl (Calamine) – Lotion• Nizoral (Ketoconazole) – Cream, Shampoo, Tablet

Examples Dosage Forms

• Dermovate (Clobetasol propionate) – Cream, Ointment, Solution

• Dulcolax (Bisacodyl) - Tablet, Suppository• Dimetapp (Brompeniramine maleate) - Syrup • Ponstan (Mefenamic Acid) – Capsule SF 250

mg; Tablet 500 mg; Suspension• Nitro-Dur (Nitroglycerin) – Transdermal Patch• Nitroglycerin – Tablet; Transdermal Patch

Five reasons for the need for dosage forms.

• 1.      To protect the drug substance from destructive influences of atmospheric oxygen

• 2.      To protect the drug from the destructive influence of gastric acid after oral administration

• 3.      To conceal the bitter, salty, or offensive taste or odor of a drug substance.

• 4.      To provide liquid preparations of substance that are insoluble in desired vehicle

• 5.      To provide for insertion of a drug into one of the body’s orifices• 6.      To provide optimal drug action from topical administration

sites, etc.

Examples of Tablets

• 1.  Poten-Cee – Ascorbic acid – Pascual• 2.  Alaxan – Ibuprofen, Paracetamol –

Therapharma• 3.  Tylenol – Paracetamol - Janssen• 4.  Neozep –

Phenylpropanolamine,chlorphenamine maleate, paracetamol – Myra/Unilab

• 5.  Flanax – Naproxen – Roche

Example of Capsules

• 1.  Velosef –Cephradine – Squibb• 2.  Tegopen – Cloxacillin – Bristol• 3.  Omnipen – Ampicillin – Wyeth• 4.  Imodium – Loperamide – Janssen• 5.  Darvon – Aspirin, caffeine,

propoxyphene – Lilly

Advantages and disadvantages of different dosage forms

• 1.      Ease of administrations• 2.      Stability purposes• 3.      Portability/ conveniently carried • 4.      Elegance• 5.      Accurate dosage• 6.      Manufactured at lower cost• 7.      Optimal drug action and others

Exercise 6Nelson T. Tubon, M.D.

3JR Pacific Medical CenterBlk 6 Lot 1 Nepo Homes Subdivision

Km 37 Pulong Buhangin, Sta. Maria, Bulacan

Patient’s Name De La Cruz, Mario 28/M Date: 10/10/08 Address Novaliches, Quezon City

 

Omeprazole 20 mg/cap ----- # 21(Losec)

 

Sig. Take one cap daily for three weeks 

Nelson T. Tubon, MDLic. No.: 95555PTR No. 123456789TN: 967854321

THE PRESCRIPTION

PRESCRIPTION

• from the Latin words: prae – before and scribo – I write. A prescription is an order for medication issued by a physician, dentists, veterinarian or other properly licensed practitioner.

Parts of Prescription

• 1. Prescriber’s Information. The name of the physician or dentist, his specialty, clinic address, contact number and clinic hours.

• 2. Patient information. The full name and address of the patient are necessary for identification purposes.

• 3. Date. Prescriptions are dated at the time they are written. The date is important in establishing the medication record of the patient especially in filling prescriptions for controlled substances

Parts of Prescription

• 4. Rx Symbol or Superscription. The Rx symbol is a Latin verb recipe, meaning take thou or you take

• 5. Medication Prescribed or Inscription. Body or main part of the of the Rx order. It contains the names and quantities of the

prescribed ingredients or drugs, dosage form and potency

The name of the product must be written both inNonproprietary (generic name)Proprietary (brand)Chemical

Dosage form- the physical entity of medication (tablet, capsule)Strength – potency of drug (250 mg, 100IU)Quantity to be dispensed – this includes the amount and the unit

of measure (grams, milligrams, tablets)

Parts of Prescription

• 6. Dispensing Directions to Pharmacist or Subscription. Directions to the pharmacist for preparing the prescription

These can be used for:Preparations (compounding)Labeling ( information to be put on the label )

• 7. Directions for the Patient or Transcription. Instructions on the

number of dosage units per dose (one tablet), route of administration, frequency of dosing (every 4 hours), duration of dosing (one week, for one month) and use of the drug (optional)

Parts of Prescription

• 8. Refill Information. If refill information is not supplied, it is generally assumed that no refills are authorized

• 9. Prescriber’s Signature. The name and signature of the physician or dentist who wrote the prescription order. Below the signature of the physician are the licensed number to practice his profession, PTR

( Privilege Tax Receipt) no. and TIN

Dispensing Procedures

• 1.  Dispensing should be done by Pharmacist

• 2.   Partial Filling is allowed and must be reflected in the prescription

Filling and Recording Procedures

• 1. The prescription once filled must be retained by the pharmacist for a period of two years

• 2. The prescription must be recorded in Rx book and ready for inspection by BFAD FDRO’s when the outlet is open for operation anytime

Questions

• 1.  Enumerate at least two responsibilities of the pharmacist in providing the medication needs of the patient

• a.   Provide information about drugs to the health profession and to the public legally responsible for dispensing prescription.

• b.   Translate and communicate the dangers of drug to the patient, and others

Questions

2.      Enumerate the instructions that pharmacist should be given to the patient in filling, refilling and dispensing legend prescriptions

• A.     Filling of Prescriptions• a.       danger of overdosage• b.      side effects• c.       proper storage for stability• d.      need to discard unused medication• e.       dangers to be mixed in one container

B.     Refilling Prescription• a. taking drugs for longer period of time unless it is under

supervision• b. taking other medications with identical composition

which provides the same therapeutic effect which are sometimes prescribed by other doctor

• c. taking food found in the diets that are contraindicated to the prescribed drugs

• d. letting other members of the family or friends to use his medicine

C.     Dispensing Prescription• a.  the proper use of drugs• b.  the need to discontinue the use of the drug if certain

reactions develop• c. the need to see the doctor if serious reactions develop, if

the condition has been a long term problem• d. the danger of using the OTC drugs when prescribed

medication is the possible duplication of the drug or therapeutic action

• e. the danger of self-diagnosis and self medication

A. Based on the number of ingredients• 1. Simple prescription – with only one ingredient• 2. Compound prescription – with one more than one ingredient• 3. Polypharmacal prescription – with ten or more than ten

ingredientsB. Magistral prescription – is a prescription which is prescribed very often by the same doctor, of the same ingredients, and compounded by the same pharmacistC. Coded prescription is also called “blind prescription” and consists of words, symbols, to represent the name of the drugs. This is unethical practice of doctors and pharmacist

3. Enumerate the types of Prescription based on the number of ingredients

PARTS OF PRESCRIPTION

• 1.      Patient Information• 2.      Date• 3.      Superscription or Rx symbol• 4.      Inscription or medication prescribed• 5.      Subscription or dispensing direction• 6.      Transcription, signs and signature or the direction

to the patient• 7.      Refill, special labeling or other instruction• 8.      Prescriber’s signature, address, and other

pertinent information

INTERPRETATIONS • 1.      Nembutal 100 mg (at bed time) ( if there is a need) ( by mouth )• 2.      Propranolol hydrochloride 40 mg (by mouth) (twice a day)• 3.      Ampicillin 1 g (Intavenous piggyback) (every 6 hours)• 4.      Demerol 50 mg (Intramuscularly) (every 4 hours) (if there is a

need) for pain• 5.      Tylenol 325 mg tablets (2) (by mouth) (at once, immediately)• 6.      Pilocarpine (2) (drops) (both eyes) (every 3 hours)• 7.      Scopolamine 0.8 mg (subcutaneously) (immediately)• 8.      Milk of magnesia 1 (tablespoon) (by mouth) (at bed time)

(every night)• 9.      Septra DS tablet (double strength) (1) (every day) (by mouth)

Prohibited Drugs

• 1.      Opium – Brown mixture Tablet and Liquid• 2.      Codein – Codeine sulfate H.T. and T.T.• 3.      Pethidine – Demerol Ampul and Vial• 4.      Codein – Dolo-Adamon Supplement and Tablet• 5.      Opium + alcohol – Elixir Paregoric• 6.      Fentanyl – Innovar Injection• 7.      Morphine – Morphine Sulfate H.T., Ampule, Tablet• 8.      Alfentanyl – Rapifen Injection• 9.      Hydrocodone Deka Syrup• 10.  Dihydrocodeinone – Ruminon syrup

Regulated Drugs • 1.      Amobarbital – Amytal Tablet, Capsule, Ampul

• 2.      Amphetamine – Benzedrine Tablet• 3.      Butabarbital – Butisol Sodium• 4.      Hydrocodone + Pentobarbital - Calciudrine syrup• 5.      Methamphetamine – Desoxyn Tablet• 6.      Amobarbital + Dexamphetamine – Dexamyl Spansule No.1• 7.      Dexamphetamine – Dexedrine Spansule• 8.      Propoxyphene napsylate – Doloxene Plain Tablet• 9.      Propoxyphene hydrochloride – Doloxene compound – 65

capsule• 10.  Pipradol – Gadexyl Tablet

Regulated Drugs• 1.      Methaqualone – Mandrax Tablet• 2.      Nitrazepam – Mogadon tablet• 3.      Pentobarbital – Nembutal Sodium • 4.      Chloralhydrate – Noctec liquid• 5.      Methylprylon – Noludar Tablet• 6.      Mecloqualone – Nubarene Tablet• 7.      Paraldehyde – Paraldehyde ampul• 8.      Pentothal - Pentothal sodium• 9.      Ethchlorvynol – Placidyl Capsule• 10.  Aprobarbital + Barbital + Phenobarbital –

Plexonal

Regulated Drugs

• 1.      Flunitrazepam – Robypnol Tablet• 2.      Secobarbital – Seconal Sodium Capsule• 3.      Ethinamate – Valamin Tablet• 4.      Pentazocine – Sosegon Tablet• 5.      Ephedrine • 6.      Pseuephedrine 

Exercise 7

PROCESSING PRESCRIPTION

Prescription written by authorized prescriber

Patient presents prescription to the pharmacy

Prescription is checked for completeness; prescriber info, drug name, strength, dose, and directions

Correct patient info is entered into computer system

Prescription is prepared. Correct amount of med prescribed is measured and placed into container

Pharmacy label is generated. Make sure all the legal items are identified

Prescription is interpreted and confirmed by pharmacy system. Third party is billed online (optional)

Prescription is prepared by pharmacy technician, and final check done by pharmacist

Patient receives script, pharmacy assistant must offer counseling to the patient. Then script is rung on cash register, and insurance log signed

Pharmacist provides counseling on the medication prescribed and all medically related questions

R

LABEL

1. How is a prescription processed?

• receiving the prescription• reading and checking the

prescription• numbering and dating• Labeling• preparing the prescription

• packaging• rechecking• delivering and patient

counseling• recording and filling• pricing the prescription

3. What is the purpose of numbering and dating the prescription?

• The same number of the original prescription should appear at the label of the filled prescription – to avoid error in dispensing

• The date of the prescription is not the same date that should be placed on the filled prescription – for identification purposes

4. Information to be recorded in the prescription book.

• 1.      name of physician• 2.      name of the drug• 3.      quantity • 4.      date when dispensed• 5.      balance (quantity if any)• 6.      pharmacist signature, etc