DOSAGE FORMS, ABBREVIATIONS, AND ROUTES OF ADMINISTRATION Chapter 5 2007- 2nd edition

Terms & Abbreviations Dosage Forms Buccal tablet Capsule Chewable tablet Cream Elixir Enema Enteric-coated tablet Gel cap Gelatin Liquid Lotion Lozenge Metered dose inhaler Ointment Patch, transdermal Powder Spray Suppository Suspension Syrup Tablet Tincture Troche Vaginal Cream Vaginal tablet

Abbreviation buccal cap chew tab cr elix enema EC tab cap gel liq lot loz MDI ung, oint top top spry supp susp syr tab tinc troches vag cr vag tab

Main Routes of administration Right ear Left ear Both ears Gastrostomy tube

Abbreviations AD AS Au GT

Inhalant Intradermal Intramuscular Intravenous Intravenous piggyback Nasogastric Nasogastric tube Right eye Left eye Both eyes Orally or by mouth Rectal, per rectum Subcutaneous Sublingual Topical

INH ID IM IV IVPB NG NGT OD OS OU PO PR SQ/SC SL TOP

Terms & Definitions: Absorption- The taking in of nutrients from food and liquids. Bioavailability- The amount of drug that reaches its intended destination by being absorbed into the bloodstream. Bioequivalence- The difference between a drug that is manufactured in a different dosage form or by a different company: includes the rate of absorption, distribution, metabolism, and excretion. Distribution-The ability of a drug to pass into the bloodstream. Excretion- Elimination of waste products through stools and urine. Half-life 1. The amount of time it takes a chemical to be decreased by one half. 2. The time required for half the amount of a substance such as a drug in a living system to be eliminated or disintegrated by natural processes. 3. The time required for a concentration of a substance in a body fluid (blood plasma) to decrease by half. Instill- To place into: instructions used for ophthalmic or otic drugs. Metaabolism-The physical and chemical changes that take place within an organism. OTC-Over-the-counter Parenteral medication- Medication administered by injection, such as intravenously or intramuscularly. Pharmacokinetics-The life of the drug, which includes absorption, metabolism, distribution, and excretion.

Dosage Forms: All the different forms can be broken down into three major categories that are composed of subcategories: 1. Solids: tablets, chewable tablets, enteric-coated tablets, extended-release agents, capsules, caplets, lozenges, troches, implant capsules, patches 2. Liquids: syrups, elixirs, sprays, inhalants, emulsions, suspensions, solutions, enemas 3. Semisolids: creams, lotions, ointments, powders, gelatins, suppositories CD- controlled diffusion CR-Continuous/controlled-release CRT-Controlled release tablet LA-Long-acting SA-Sustained-action SR-Sustained/slow release TD-Time-delay TR-Time-release XL-Extra-long XR-Extended release ***Tech note-Dosage forms that are especially made to release over time should not be crushed or broken into two. This would alter the delayed process. Some companies have their own unique names for extended-release agents. For example, Slo-Bid is a theophylline agent that is released over 12 hours, which is why the company has named it Slo-Bid (taken only twice daily) Capsules are composed of a gelatin container. Caplet dosage forms are related closely to tablets, but they are smooth sided and are therefore easier to swallow. Capsules come in different sizes. They vary in color, transparency, and identifying marks. The larger half of the capsule is known as the body, and the shorter half is known as the cap. Lozenges and troches are other forms of tablets that are not meant to be swallowed but to dissolve in the mouth, which releases the medication more

slowly. Troches are larger than normal-size tablets and are flat: they usually have a chalky consistency in order to dissolve in the mouth. A special type of capsule can be implanted under the skin and left in place for up to 5 years. Capsule sizes Number 000 00 0 1 2 3 4 5

quantity 1.37 ml 0.95 ml 0.68 ml 0.5 ml 0.37 ml 0.3 ml 0.2 ml 0.13 ml

*****Tech note- Never discard a medication patch after use. Because the medication is in a form that enables it to penetrate through the skin, a child might get hold of a potentially dangerous drug from the trash. The best approach is to wrap the patch in such a way that a child would not be able to grasp it. Patches are solid pieces of material that hold a specific amount of medication to be released into the skin over time. LIQUIDS: Liquids are composed of various solutions. Syrups are sugar-based solutions that have medication dissolved into them. Elixirs contain dissolved medication in an alcohol base or water and alcohol base. Sprays are composed of various bases such as alcohol or water in a pump dispenser. Inhalants and aerosols need to be able to get medication directly to the source of inflammation. Emulsions are a mixture of water and oil may be used with an emulsifier to bind the two together.

Suspensions are liquids that have very small, solid particles suspended in the base solution. Enemas may be administered for two different reasons-retention or evacuation. ****Tech note: Most inhalants are propelled out by the use of various gases. In the past, most propellants contained chlorofluorocarbons, which have been found to destroy the ozone. When ozone is decreased, ultraviolet light is allowed to enter the atmosphere at levels that are known to cause skin cancer. Because of this finding, new guidelines have been put into effect to switch over to another source of propellant. The replacements for chlorofluorocarbons must not harm the environment or alter or destroy the medication. ****Tech note: an emulsifier is a substance that binds oil to a water base. An emulsifier binds to both substances and holds them together. For example, take a look at mayonnaise. Mayonnaise is composed of oil and water and uses egg yolks as an emulsifier, which allows the product to form a smooth consistency. Oil can have water as a base: in some cases, water is contained in an oil base. Although most emulsions are used topically, a few parenteral emulsion agents can be given-such as lipids, also known as fatthat are used for nutritional parenteral feedings. Various types of emulsion preparations can be administered topically, orally, and even parenterally. SEMISOLIDS: Semisolids contain solids and liquids, they normally are meant for topical application. Creams usually have medications in a base that is part oil and part water and is meant for topical or local use. Lotions are thinner than creams because their base contains more water. They penetrate well into the skin and do not leave an oily residue after application. ****Tech note: It is always important to shake most suspensions before using. One exception is some types of insulin suspensions that should be rolled, not shaken.

Ointments contain medication in a glycol or oil base. Ointments can be used rectally, topically and as an ophthalmic agent. Gels contain medication in a viscous liquid that easily penetrates the skin and does not leave a residue. Pastes contain a lesser amount of liquid base than solids. They are used for topical application and are able to absorb skin secretions, unlike other topical agents. Suppositories can be used rectally and vaginally. Powders do not fit neatly into semisolids. Powders are solids, yet they are packaged in some forms that allow them to be sprayed similar to liquid dosage forms. Injectables are used for rapid response. The onset of an injectable drug only takes a few minutes as opposed to the 45 minutes that oral medications can take to work. ***Tech note: The determine how much medicine is left in an inhaler, float the container in water. If it sinks, it is full: if it floats on top of the water, it is empty. If the container is half submerged, it is about half full. ****Tech note: Remember that suspensions and inhalers always need to be shaken before use. Shaking evenly distributes the drug throughout the liquid to attain an even dosage of drug. ****Tech alert: Not all generic drugs are bioequivalent to the trade/brand drugs. Even if a generic drug has the same active ingredient, it may vary in additional additives, making it different. An example is albuterol inhalant: although all generics contain the same main ingredients and propellants, they differ in types of additives. Also the size of the valve differs between trade/brand that may alter the amount of medicine being dispensed.

COMMON ABBREVIATIONS USED WITH DOSAGE FORMS ABBREVIATIONS

ROUTE OF ADMINISTRATION

SPECIFIC SITE OF ACTION

DOSAGE FORMS

PO

Oral

Absorbed into bloodstream

SL

Sublingual

Buc PR

Buccal Per rectum

Under the tongue In the cheek Rectum

IV IM SQ IT IA TOP

Intravenous Intramuscular Subcutaneous Intrathecal Intraarterial Epicutaneous or percutaneous

In the vein In the muscle Under the skin In the spine In the artery On the skin surface

Transdermal

Tablet Capsule Solution Syrup Suspension Powder Elixir Tincture Troche Tablet Sprays Lozenge/troche Suppository Solution Enema Ointment Solution/suspension Solution/suspension Solution/suspension Solution Solution Ointment Cream Paste Powder Spray Solution Lotion Patch Disk Suspension Ointment Solution Lens Suspension

OS, OD, OU

Ophthalmic

On the skin surface Eye

AS, AD, AU

Otic

Ear

NAS

Intranasal

Nose

Inh

Inhalant

Mouth

Va

Vaginal

Vagina

Urethral

Urethral

Urethra

Solution Solution Spray Inhalant Solution Aerosol Solution Ointment Foam Gel Suppository Sponge Solution Suppository

DESCRIPTION OFADDITIVES TYPE OF ADDITIVE

EXAMPLE OF CHEMICAL

REASON

Weak salt acid/base

Hydrochloric acid

Perservative Sweetener Flavoring Coloring Buffer Antifungal Base

Phenol Sucrose Cherry Yellow dye No. 5 Sodium acetate Benzoic acid Petrolatum

Filler

Starch, powdered cellulose

Helps dissolve drug easier once it arrives in the gastrointestinal system Increases shelf life Improves taste Improves taste Improves visual appeal Adjusts pH Prevents fungal growth Main component to which medication is added for ointments and creams To increase size of dosage form

DESCRIPTION OF DOSAGE FORMS Dosage forms

Oral tablet

Coated tablet

Sublingual/buccal Chewable tablet Capsule

Types Layered Film coated Extended released Compressed Sugar & colored Caplet Colored Gel Enteric coated Dissolving Soft compressed

Result Slow released Protects against stomach acid Releases medication slowly Hard dissolves slower: soft dissolves faster Protect drug: covers taste Hard, capsule shaped tablet Appearance Smaller than a capsule, easier to swallow Delayed release: easier to swallow Dissolve in the mouth on contact Dissolves in mouth Chewed

Gelatin cover Spansule Pulvule Dry fill

Hard gelatin Soft gelatin

Wet fill

Injectable vial

Multiple-dose vial Single-dose vial Add-O-Vial

EXAMPLES OF STORAGE REQUIREMENTS Medication Location Suppository

Drug shelf or refrigerator

Latanoprost

Refrigerator

Metronidazole IV

At room temperature

Vaccines

Refrigerator

Insulin

Refrigerator

Allows for pharmacy compounded agents: easy to swallow Capsule holds small pellets or beads Manufacturer prepared (bullet shaped) Filled with powder Filled with a tablet inside Filled with pellets Filled with another capsule Filled with a liquid Filled with a paste May be used more than once Must be discarded after one use Rubber stopper is pushed, releasing diluent into powder product

Considerations Meant to melt at body temperature Stored in the refrigerator (2-8 C) until opened; may be kept up to 6 weeks at room temperature after opening Most premade intravenous medications are stored in the freezer until thawed for use: store at 15-30 C and protect from light Kept in the refrigerator (2-8 C) Although insulin is kept in the refrigerator, it may be kept at room temperature

Pencillin

Drug shelf or refrigerator

Mannitol

At room temperature

for up to 1 month Must be stored in refrigerator after reconstitution Mannitol crystallizes at room temperature: temperature of drug must be raised before using