Pharmacy technician training- Unit 2, lessons 6-15

Medication errors

Preventable, chance to cause harm, occurs while medication is in the hands of medical professional

Liquid preparations

Syrups, solutions, emulsions, suspensions

Solid preparations

Tablets, capsules, lozenges and semisolid creams and ointments

Solid preparation benefits

Easier self administration

Longer shelf life, easier transport

More accurate dosing, slower release

Little or no taste

Solid preparation disadvantages

Difficulty of swallowing large pills

Cannot be unconscious or have nasal or mouth tubes for ventilation

Longer time to be broken down, absorbed and distributed through body

Tablet lubricating agent

Gives sheen and aids in manufacturing

Tablet Disintegrates

Breaks up ingredients in tablets

Effervescent tablets

Granular salts that release gas and dispense active ingredients in water, juice, ect

Sublingual Tablets

Dissolve under tongue, medication absorbed very quickly

Buccal tablets

Placed in buccal pouch (between gums and cheek) and absorbed by buccal mucosa

Vaginal tablets/inserts

Placed in vagina with applicator, dissolved and absorbed by vaginal mucosa

Capsule

Gelatin shell encapsulating powder, granules, or liquid drug, or a combination, tasteless, easier to swallow than tablet

Can be controlled release, which can be taken less often and increases compliance

Long acting forms can control the disease state better and may be more expensive initially, side effects take longer to subside

Liquid preparation advantages

Easier to swallow for those who have difficulty swallowing, faster absorption, more flexibility to get correct dose

Liquid preparation disadvantages

Shorter shelf life and may have specific storage needs, can have bad taste, more difficult administration due to pouring/spilling, harder to measure correctly

Viscous preparation

Intended to surface, such as throat or vagina, can be water or petroleum based, jellies protect and lubricate, syrups are usually sweetener based, mucilages are very thick and used when medication is insoluble but cannot be taken as solid, medication particles often visible

Nonaqueous solutions

Liquid solutions used when medication is more effective in other liquids, including alcohol, glycerin, propylene glycol

Elixir

Solution with water an alcohol, between 2-30% alcohol, do not always contain medication, can be sweeteners, use with caution with kids and elderly and those taking other medications

Alcoholic solutions

All alcohol, usually ethyl and ethanol alcohols

Collodions

Contain pyroxylin, found in cotton fibers, usually topical since alcohol evaporates and leaves thin film of medication

Spirits

Dissolved in either alcohol or alcohol and water, contains volatile and aromatic ingredients, speed up dissolving and can create higher concentrations, usual oral, but can be inhalant or spray

Glycerite solution

Dissolved in glycerin, made of fats and sweet oils, flexible vehicle since it can be with or without water, can be for rectal suppositories

Water in oil emulsions

Concentration of substance is very even, spreads evenly, interacts with oil on skin

Suppositories

Solids inserted into body to melt and be absorbed

Inhalant

Fine powder delivered into fine mist into the mouth or nose, almost instant absorption

Liniments

Topical, can be called balms, rubbed into skin, usually for relieving pain of muscles or arthritis, contains quickly evaporating solvent and aromatic compounds

Oil in water emulsions

Oily, greasy substances dissolved in water or other liquids, less uniform, tends to break apart into globules when spread, can be easier to wash away, moisturizing and cooling effects, orally used

Suspensions

Mixture of liquid with solid particles that do not dissolve, usually separate when left standing, must be shaken, includes gels, magmas and milks, extractives, and lotions

Magmas and milks

Cloudy, thick liquids made form undissolved medications in water, must be shaken

Lotions

Thick suspensions intended for topical use, powdered medication in a liquid mixture, easily applied over large areas

Gels

Very small particles dissolved in water, clear appearance, oral or topical use

Extractives

Liquids made of concentrated organic ingredients

Powders

Oral, internal, external, or topical use, dissolved for oral, can be irritating to respiratory tract

Granules

Pharmaceutical powders wet and dried, then ground up into non uniform particles, mixed with distilled water and shaken until fully dissolved, reduces dusting, caking and scooping

Aerosols

Fine mist of densely dissolved particles, pressure from gas in packaging ejects aerosol in fine mist, topical or inhaler

Extended release (ER) Dosage forms

Delayed release dose does not immediately release drug after administering, reduced frequency of dosing, increased patient compliance, decreased cost

Transdermal release

Deliver drugs to systemic circulation by passage through skin, similar to how ER tablets in intestine works

Routes of administration (ROA)

Optimum route depends on desired affect, physical state (ex cannot swallow), age, overall medical condition (paralysis making oral or inhaler difficult), ability to tolerate side effects

Oral medication advantages

Safer, more convenient, easier to store, readily available in pharmacy, less expensive, immediate release or extended release, no extra administration supplies, easier self administration

Oral medication disadvantages

Not always appropriate for children or elderly, difficult to swallow, needs to be broken down to be absorbed

Transdermal medication advantages

Easier to store, can be more convenient than daily use tablets, remain on body for long time

Transdermal medication disadvantages

Skin irritation, pull on body hair

Parenteral routes of administration

Intradermal, subcutaneous, intramuscular, intravenous, implant, intra articular, ect

Intradermal administration

Into top layer of skin

Subcutanous administration

Into tissue immediately under skin,

Implant administration

Temporary or permanent, slow medication release

Intra articular administration

Directly into joints

Intracardiac administration

Directly into heart

Intraperitoneal administration

Directly into abdomen or peritoneal cavity

Intrapleural administration

Injection into sac (pleura) surrounding lungs

Intrathecal administration

Injection into cerebrospinal fluid surrounding spinal cord

Intraventricular administration

Injection into brain cavities or ventricles

Intravesicular administration

Injection into urinary bladder

Intravitreal administration

Injection directly into vitreous body of the eye

Parenteral administration advantages

Fast absorption and distribution, convenient for those who cannot take oral, varied rate of delivery (seconds to several hours)

Parenteral administration disadvantages

Action can be immediate, no reversal of drug amount administered, little to no way to reverse adverse effects, very invasive, can be very painful, risk of bacteria and infection entering

Inhalation and nasal administration

Fast relief, but short lived, usually spray or swab

Ophthalmic administration

Quick acting, easy to self administer and store, must manipulate small objects and requires dexterity, high risk of contamination

Rectal administration

Often anti nausea to avoid vomiting, does not require swallowing or patient aid, discomfort or embarrassment risk

Otic administration

Rapid relief, hard to test for full insertion, especially in kids

Topical administration

Easy to apply, but short lived, and do not normally enter blood

Vaginal administration

Relatively easy to insert but can be dislodged if patient is mobile

Roles in Drug information

Research often done by techs, communicated by pharmacist

Drug information

Strengths available, dosage forms, drug interactions, side effects, compatibility for parenteral medications, formulas for extemporaneous (without prep) compounds, costs of drug, discount programs, off label usage regulation, manufacture and its contact information

Steps for using drug information resource

1: Which resource has needed information

2: Look up drug using organization system, index, table of contents, ect, know ow each resource is organized

3: Locate needed information and interpret it

Drug resource organization by drug name

Organized by both trade names and generic with cross referencing OR only by generic

Drug resource organization by class or therapeutic usage

Organized by what system the drug effects, may be in multiple groups

Drug monograph

In FDA required insert, has drug description, clinical pharmacology, indications and usage, contraindications, precautions, abuse and dependance, adverse reactions, dosage and how it was supplied

Drug description

Visual elements of drug and packaging, basic chemical structure

Clinical pharmacology

Mechanism of action, absorption, distribution, metabolism, elimination, and administration, notes about specific patient demographics

Indications and usage

Specific conditions or symptoms a drug has been approved for by FDA

Contraindications

Those who should not take the medication

Precaution

All potential side effects of drug

Drug abuse and dependance

Notification if drugs has been proven to show signs for potential abuse or dependance

Adverse reactions

Reactions that are unexpected and life threatening

Dosage

Recommended dose by age or weight, especially important for pediatrics and neonates

How supplied

Available strengths, dosage formats, and storage requirements

Drug Facts and Comparisons Reference

Monographs of 22,000 Rx drugs, 6,000 OTC drugs, arranged by therapeutic or pharmacological group, appendix of treatment guidelines, list of manufacturers and distributers, Canadian trade name index

A to Z drug facts

Summary drug reference resource

Off label drug facts

Identifies published information about a specific drug usage not currently approved by FDA

Brigg’s Drugs in Pregnancy and Lactation

Definitive resource of drug use on pregnant and lactating women

Risk evaluation and mitigation strategies (REMS)

Provides detailed information of REMS programs required by FDA and specified by manufacturer

Medication guides

Created by manufacturer, approved by FDA, contain information for patient on how to use a medication safely.

Natural products data base

Objective assessment of the latest medical and scientific studies on natural products, including medically active foods, using peer reviewed monographs

Boxed warnings

Contains links to 600+ Black Box Warnings, which are the most serious warnings

Manufacturer index

Alphabetical list of manufacturers

Don’t crush/chew list

Alphabetical list of drugs that should not be crushed or chewed

Immunization schedules

Resource for routine and special immunization needs for children and adults

Patient assistance program information

Information to assist healthcare professionals to aid patients who are having difficulty obtaining information

Additional information links

Provides links to medically based, qualified websites and literature including other reference resources

Drug Facts and Comparisons, including comparative charts

Electronic Drug Facts and Comparisons resource, including comparative charts

Physican’s Desk Resource (PDR)

Used by provider, organized by drug name, detailed information on 1,000 most common drugs, includes chemical information, function, indications and contraindications, side effects/warnings, trial research, includes drug alerts, recalls, and drug approvals

American Hospital Formulary Service (AHFS) Drug Information (AHFS DI)

Used by pharmacies and providers, published by ASHP drug monographs of most drugs available in US, pharmacologic-therapeutic organization, indexed by trade of name, generic name, synonym, abbreviation, pharmacy equivalent name, former names

American Society for Health System Pharmacists (ASHP)

Published American Hospital Formulary Service Drug Information (AHFS DI)

Published American Hospital Formulary Service Drug Information (AHFS DI) Contents

Drug interactions, adverse reactions, cautions/toxicity, therapeutic perspective, specific dosage and administration information, preparations, chemistry and stability, pharmacology and pharmacokinetics, contraindications

Martindale: The Complete Drug Reference

Detailed monographs and preparation information on drugs used worldwide, 49 chapters organized by clinical usage

Includes:
Standard Prescription drugs

Investigational and veterinary drugs

Herbal medicines

Pharmaceutical excipients

Vitamins

Vaccines
Radiopharmaceuticals

Contrast and diagnostic agents

Recreational drugs

Toxic substances, disinfectants, pesticides

Manufacturer directory

Multilingual (European) index for pharmaceutical terms and routes of administration

General index

USP-NF

Combination of United States Pharmacopeia and the National Formulary, 4,500 monographs with drug identity, strength, quality, purity, packaging and labeling for substances and dosage forms, 230 general chapter with step by step instructions on assays, tests, and procedures

Handbook on Nonprescription Drugs

FDA Orange Book

Approved Drug Products with Therapeutic Equivalence Evaluations, Identifies drugs approved by FDA on the basis of effectiveness and safety

Searchable by proprietary name, active ingredient, or application number, applicant company, dosage form, or route of administration

Red Book

200,000 prescription and OTC drugs with:

Average and wholesale prices, federal upper price limit for prescription drugs, suggested retail price for OTC

NDC for all FDA approved drugs, complete package information (dose, route of administration, strength, size)

Orange Book Codes

Interaction summaries for alcohol, tabaco, and food)

Sugar, alcohol, lactose or galactose free and sulfite containing listings

Nationally recognized wholesale price

AWP