By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.

INTERNSHIP 1

Exercise 5Pharmaceutical Dosage Forms

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

TermsParenteral 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.

TermsOral 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.

TermDosage 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/vDouches aqueous solutions directed against a part or into a cavity of the bodyEnemas 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.

SolutionsGargles 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.

SolutionsNasal 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-AQUEOUSInhalations 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-AQUEOUSSpirits 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 lens1. wetting solutions2. cleaning solutions3. disinfection solutions4. soaking solutions5. 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 stearateDRESSINGS 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 dressingSUPPOSITORIES solid dosage forms of various weights and shapes usually medicated for insertion into the rectum, vagina, or the urethra

POWDERSOral powders generally supplied as finely divided or effervescent granulesDentifrices may be prepared in the form of a bulk powders generally containing soap or detergent, mild abrasive and anticariogenic agentDouche 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 FORMSTABLET 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 gelatinPILLS small, round, solid dosage forms containing medicinal agents and intended for oral administration

ORAL SOLID DOSAGE FORMSTROCHES 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 vaccineImmune globulin a solution containing antibodies from the pooled plasma of not less than 1,000 normal individualsHyperimmune serum a special preparation obtained from human donor polls selected for high antibody titer against a specific disease

Examples Dosage FormsOmega Pain Killer (Methyl salicylate, menthol, camphor) LinimentCold Rub (Camphor, Menthol, Eucalyptus oil) OintmentAceiti Manzanilla SolutionAcrinol TinctureWhite Henna PowderSebo De Macho OintmentCaladryl (Calamine) LotionNizoral (Ketoconazole) Cream, Shampoo, Tablet

Examples Dosage FormsDermovate (Clobetasol propionate) Cream, Ointment, SolutionDulcolax (Bisacodyl) - Tablet, SuppositoryDimetapp (Brompeniramine maleate) - Syrup Ponstan (Mefenamic Acid) Capsule SF 250 mg; Tablet 500 mg; SuspensionNitro-Dur (Nitroglycerin) Transdermal PatchNitroglycerin Tablet; Transdermal Patch

Five reasons for the need for dosage forms.

1. To protect the drug substance from destructive influences of atmospheric oxygen2. To protect the drug from the destructive influence of gastric acid after oral administration3. 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 vehicle5. To provide for insertion of a drug into one of the bodys orifices6. To provide optimal drug action from topical administration sites, etc.

Examples of Tablets

1.Poten-Cee Ascorbic acid Pascual2.Alaxan Ibuprofen, Paracetamol Therapharma3.Tylenol Paracetamol - Janssen4.Neozep Phenylpropanolamine,chlorphenamine maleate, paracetamol Myra/Unilab5.Flanax Naproxen Roche

Example of Capsules

1.Velosef Cephradine Squibb2.Tegopen Cloxacillin Bristol3.Omnipen Ampicillin Wyeth4.Imodium Loperamide Janssen5.Darvon Aspirin, caffeine, propoxyphene Lilly

Advantages and disadvantages of different dosage forms1. Ease of administrations2. Stability purposes3. Portability/ conveniently carried 4. Elegance5. Accurate dosage6. Manufactured at lower cost7. Optimal drug action and others

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.

INTERNSHIP 1

Exercise 6Nelson T. Tubon, M.D.3JR Pacific Medical CenterBlk 6 Lot 1 Nepo Homes SubdivisionKm 37 Pulong Buhangin, Sta. Maria, BulacanPatients 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

PRESCRIPTIONfrom 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. Prescribers 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)ChemicalDosage 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 prescriptionThese 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 Prescription8. Refill Information. If refill information is not supplied, it is generally assumed that no refills are authorized

9. Prescribers 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 Pharmacist2.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 years2.The prescription must be recorded in Rx book and ready for inspection by BFAD FDROs when the outlet is open for operation anytime

Questions1.Enumerate at least two responsibilities of the pharmacist in providing the medication needs of the patienta.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

Questions2. Enumerate the instructions that pharmacist should be given to the patient in filling, refilling and dispensing legend prescriptionsA. Filling of Prescriptionsa. danger of overdosageb. side effectsc. proper storage for stabilityd. need to discard unused medicatione. dangers to be mixed in one container

B. Refilling Prescriptiona.taking drugs for longer period of time unless it is under supervisionb.taking other medications with identical composition which provides the same therapeutic effect which are sometimes prescribed by other doctorc.taking food found in the diets that are contraindicated to the prescribed drugsd.letting other members of the family or friends to use his medicine

C. Dispensing Prescriptiona.the proper use of drugsb.the need to discontinue the use of the drug if certain reactions developc.the need to see the doctor if serious reactions develop, if the condition has been a long term problemd.the danger of using the OTC drugs when prescribed medication is the possible duplication of the drug or therapeutic actione.the danger of self-diagnosis and self medication

A. Based on the number of ingredients1.Simple prescription with only one ingredient2.Compound prescription with one more than one ingredient3.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 pharmacist3. Enumerate the types of Prescription based on the number of ingredients

PARTS OF PRESCRIPTION

1. Patient Information2. Date3. Superscription or Rx symbol4. Inscription or medication prescribed5. Subscription or dispensing direction6. Transcription, signs and signature or the direction to the patient7. Refill, special labeling or other instruction8. Prescribers signature, address, and other pertinent information

INTERPRETATIONS1. 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 pain5. 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 Liquid2. Codein Codeine sulfate H.T. and T.T.3. Pethidine Demerol Ampul and Vial4. Codein Dolo-Adamon Supplement and Tablet5. Opium + alcohol Elixir Paregoric6. Fentanyl Innovar Injection7. Morphine Morphine Sulfate H.T., Ampule, Tablet8. Alfentanyl Rapifen Injection9. Hydrocodone Deka Syrup10. Dihydrocodeinone Ruminon syrup

Regulated Drugs

1. Amobarbital Amytal Tablet, Capsule, Ampul2. Amphetamine Benzedrine Tablet3. Butabarbital Butisol Sodium4. Hydrocodone + Pentobarbital - Calciudrine syrup5. Methamphetamine Desoxyn Tablet6. Amobarbital + Dexamphetamine Dexamyl Spansule No.17. Dexamphetamine Dexedrine Spansule8. Propoxyphene napsylate Doloxene Plain Tablet9. Propoxyphene hydrochloride Doloxene compound 65 capsule10. Pipradol Gadexyl Tablet

Regulated Drugs1. Methaqualone Mandrax Tablet2. Nitrazepam Mogadon tablet3. Pentobarbital Nembutal Sodium 4. Chloralhydrate Noctec liquid5. Methylprylon Noludar Tablet6. Mecloqualone Nubarene Tablet7. Paraldehyde Paraldehyde ampul8. Pentothal - Pentothal sodium9. Ethchlorvynol Placidyl Capsule10. Aprobarbital + Barbital + Phenobarbital Plexonal

Regulated Drugs1. Flunitrazepam Robypnol Tablet2. Secobarbital Seconal Sodium Capsule3. Ethinamate Valamin Tablet4. Pentazocine Sosegon Tablet5. Ephedrine 6. Pseuephedrine

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.INTERNSHIP 1

Exercise 7PROCESSING 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 prescriptionreading and checking the prescriptionnumbering and datingLabelingpreparing the prescription

packagingrecheckingdelivering and patient counselingrecording and fillingpricing 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 physician2. name of the drug3. quantity 4. date when dispensed5. balance (quantity if any)6. pharmacist signature, etc