Intro to Routes and Formulations

Considerations for Choosing the Route & Formulation

1. Where you want the drug to work

2. Onset time

3. Duration of action

4. Blood concentration level attained

5. Age and condition of patient (child, NPO, dysphagia)

Enteric-coated

Won't dissolve in the gastronomical

Film-coated

Mask the flavor

Effervescent Tablets

Dissolve in water; then pt drinks the water

Gel Caps

These capsules contain liquid (fish oil) inside the gelatin shell

Volatile

Liquid which has a tendency to vaporize and evaporate

Emulsion

Uses water & oil-based solvents

Syrups

Contains sugar in water

Gels

Thickened liquids

Solutions

Clear homogeneous liquid

Suspensions

Drugs don't completely dissolve

Nonaqueous

Uses solvent other than water

Spirits

Alcohol and volatile substances

Elixirs

Clear, sweet, and some alcohol

Tinctures

Alcohol and nonvolatile substances (dried active ingredients)

Sublingual

Under the tongue

Buccal

Between gum and cheek

Ophthalmic Route

• Indications: Pain, infection, eye disease

• Formulations: Suspensions, solutions, ointments

• How to apply eye-drops: Place bottle in dominant hand, use non-dominant hand to hold lower eyelid, raise bottle, squeeze gently for 1 eye-drop.

Otic Route

• Indications: Pain, infection

• Formulations: Solutions, suspensions, ointment

  • How to apply ear-drops: Wash your hands with soap and water, warm the ear drops in your hand, if instructed gently shake bottle for 10 sec, remove the cap from ear drop bottle, tilt your head to one side, gently pull the top ear back (if kids then pull the lobe back), gently put the drops in the ear

Nasal Route

• Indications: Decongestant, allergies, flu vaccine, insulin

• Rapid absorption

• Formulations: Suspension, solution, ointment, gel

• How to apply nasal sprays: Blow nose gently before using spray, wash hands with soap and water, if instructed gently shake the bottle for 10 sec, Need to be primed if new or been too long since used (spray in the air), with head upright and tilted forward press finger on other nostrils, with the other hand spray the spray in your opened nostril with the white applicator, breathe in the nose, out the mouth

Inhalation Route

• Inhaled into lungs

• Indications: Anesthesia, to open airways, allergies

• Formulation: Aerosol (drug suspended in gas)

• MDI: Metered dose inhaler

• Spacer: hollow chamber attached to MDI that helps assure better delivery of drug

• Dry powder inhalers: inhaler contains powdered drug

• Nebulizer: drug suspended in mist

• How to apply for inhalation medication: Shake, take cap off, check if its clean, let breath out, put it in your mouth, press on it while you breathe in, hold for 3-5 sec, then breathe

Dermal Route

• Applied to skin

• Indications: moisture skin, infection, route for systemic drugs

Collodion

Evaporates & leaves protective film on skin

Liniment

Alcohol or oil base, rubbed into skin

Ointment

Drug in petrolatum (wax mixture) or polyethylene glycol base

Creams

 Semi-solid emulsions that disappear into skin with rubbing

Gels

Solid drugs in a jelly-like substance

Lotions

Suspensions of a solid drug in an aqueous substance

Paste

Stiffer than ointments - protect skin and absorb secretions from skin lesions

Plasters

• Solid or semi-solid drug applied to a backing (paper, cotton)

  • Short term effect

    • Local effect

Transdermal Patch

•  Medication on a patch

  • Long term effect

    • Systemic effect

Gauzes

Medication on Gauze

Powders

mixture of drug and talcum or corn starch

Aerosols

 Sprays applied to the skin

Vaginal Route

• Indication: Infection, birth control, hormone supplements

• Formulations: Solutions, ointments, creams, aerosols, suppositories, tablets

Standard Syringes Sizes

3cc, 5cc, 10cc, 20cc, 60cc, 100cc

Barrel

the body of the syringe

Plunger

what dispenses the medicine

Graduated markings

markings on the barrel

Finger flange

Where you hold the syringe

Thumb rest

where you push the medicine with your thumb

Gauge

larger diameter of needle, smaller the gauge number (19-27 G)

Usual Length

3/8" - 1 1/2

Luer-Lock Tips

Needle screws on and locks in place

Standard Syringe

• Syringe with or without needle

• Cap over needle

Safety Syringe

• Needle protected with plastic shield to prevent accidental needle sticks

Insulin Syringe

• Used to only measure and administer insulin

• Measures in unit

• Most common form of insulin is U-100

  • Contains 100 u of insulin per cc

Tuberculin Syringe

• Used for TB skin test, vaccines, or when <1 cc of drug needed

Pre-filled Syringe

• Come from a manufacturer filled with  single, standard dose of drug

Intravenous (IV)

• Delivered directly into veins

Infusion

• A gradual injection of a large volume of fluid into a patient

IVPB/Intravenous Piggyback

• Mini-bags of medication that are plugged into the main IV

IVP/Intravenous Push

• Small volume given directly into vein or through IV tubing

Properties of IV injectables

• Must be sterile

• Usually solutions

Complications of IV Injectables:

• Thrombus (blood clot)

• Phlebitis (Inflammation of vein)

• Emboli (Air in vein)

  • Particulate matter in IV fluid

Intradermal Injection

• Into top layer of skin

• For diagnosis, immunization

• Fluid injected forms a wheal (raised blister-like area)

• Usually given into anterior forearm

• Needles 3/8 inch long

• 0.1 ml maximum volume

• Angle: 15 degrees

Subcutaneous Injection

• Into fat layer under skin

• Used for insulin, heparin

• Common sites: back of upper arm, front of thigh, abdomen

• Needles 3/8" - 1" long

• Max on 1 cc

• Angle: 45 degrees

Intramuscular Injection

• Into muscle tissue

• Used for multiple drugs

• Common sites: upper arm, hip, buttocks

• Needles: 1-1 1/2 inch long

• Angle: 90 degree

• Max volume: 5 mL