Selected Key Terms Standards of Practice for the Pharmacy Technician (First Edition) Lesson Plans Chapter 8 — The Right Dosage Form and the Right Route of Administration: Working With Accuracy Goals of the Lesson: Cognitive: Students will be able to: Describe the various dosage forms available for medications and explain the routes of administration. Correlate the dosage forms with the appropriate route of administration. Utilize appropriate reference books to verify prescription information. Explain how to apply dosage form and administration route to prescription evaluation. Motor: N/A Affective: Students will understand how to adapt dosage form and administration route for special needs patients Learning Objectives: The lesson plan for each objective starts on the page shown below. 8-1 Describe the various dosage forms available for medications ...........................................................................................3 8-2 Define the routes of administration for medications ..........................................................................................................8 8-3 Correlate the dosage forms with the appropriate route of administration ........................................................................ 10 8-4 Apply dosage form and administration route to prescription evaluation ......................................................................... 13 8-5 Utilize appropriate reference books to verify prescription information ........................................................................... 15 8-6 Adapt dosage form and administration route for special needs patient ......................................................................... 19 You Will Need: Gather the following materials and teaching aids for the following lessons: 8-1 Samples of medications; inert creams, pastes, and gels; gloves 8-2 Patient profiles on index cards, pharmacy reference texts cited in class 8-5 Inserts from a variety of prescription medications Page 1 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Adipose Areolar Alcoholic solution Angina Anhydrous bases Aseptic technique Binders Bioavailability Bolus dose Buccal tablets Compressed tablets Continuous infusion Controlled release Diluents Disintegrates Effervescent tablets Elixirs Enteric coated tablets Fast dissolving tablets Excipients Film coated Glycerite Granules Hydroalcoholic solution Hydrocarbon bases Implant Inhalation Intraarterial administration Intraarticular administration Intracardiac administration Intradermal injection Intramuscular administration Intraperitoneal administration Intrapleural administration Intravenous administration Lubricants Parenteral Percutaneous absorption Stability Subcutaneous administration Sublingual tablets Tincture Transdermal route of administration Vehicle Viscous aqueous solutions Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 2 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-1 Describe the various dosage forms available for medications. Date: Lecture Outline Content Text page Medication administered in variety of forms Accommodate special needs of patient Facilitate delivery Control rate of absorption PPt slide 2 Figures, Tables, and Features Figures 8-1: Compressed tablet, p. 124 8-2: Film-coated tablet, p. 124 Solid oral dosage forms Tablets: Solid dosage form—contains 124active ingredients 125 o May contain other diluents, binders, lubricants Different forms of tablets o Compressed tablets (Fig. 8-1) o Film-coated tablets (Fig. 8-2) o Enteric-coated tablets (Fig. 8-3) o Controlled-release tablets (Fig. 8-4) o Effervescent tablets (Fig. 8-5) o Buccal tablet o Sublingual tablet o Orally disintegrating tablet (Fig. 8-6) 126 Capsules 3-11 8-3 Enteric coated tablet, p. 125 8-4: Controlled release tablet, p. 125 8-5: Effervescent tablet, p. 125 8-6: Orally disintegrating tablets, p. 125 Hard or soft gelatin container Page 3 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Resources and In-Class Activities In-Class Activities Obtain samples of inert creams, pastes and gels and other forms of medication that are safe for the classroom setting. Compare and contrast. Discuss their uses. Materials Samples of medications, inert creams, pastes and gels, gloves Outside Assignments Evaluation Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy with the drug and excipients enclosed (Fig. 8-7) o Some manufacturers have patented capsule shapes Lilly’s Pulvules Parke Davis Kapseals o Some capsules contain pellets To open and sprinkle on applesauce for children (Fig. 8-8) o Soft gelatin capsules may contain— liquid paste powder 12-15 Lozenges, Troches, and 127 Lollipops Oral medication dosage forms Round shape and contains drug in hard candy (Figs. 810, 8-11) Dissolves slowly in mouth o Common uses: o Oral anesthetic o Antiseptic o Antibiotic o Antitussive o Analgesic 128 o Decongestant 16-19 Medicated Chewing Gum Use as a delivery system has increased o Aspirin o Nicotine gum (Fig. 8-12) 8-7: Hard shell gelatin capsule, p. 126 8-8: Capsules with small pellets, p. 127 8-9: Soft shell capsule, p. 125 8-10: Lozenge, p. 125 8-11: Lollipop containing a drug, p. 125 8-12: Medicated chewing gum, p. 128 8-13: Medicated thin strips, p. 128 Medicated thin strips (Fig. 8-13) Thin flavored strip that dissolves in mouth o Cough suppressants Page 4 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy o Analgesics for children o Breath fresheners o Anti-gas medications Suppositories, Rectal, Vaginal and Urethral Solid dosage forms made with cocoa butter base Allows for inclusion of medication and molding of suppository Tapered end for easy insertion Most common—rectal suppository (Fig. 8-14) o Topical remedy for hemorrhoid Adult—2 grams Infant—1 gram o May also contain: Sedatives Analgesics Tranquilizers o Quickly absorbed through mucosa Powders, Granules, and Aerosols (Figs. 8-15, 8-16) Mixtures of drugs and inactive ingredients o Sprinkled on external area for topical effect o Dissolved in liquid and ingested for systemic effect Granules are powders dried to coarse particles—more stable shelf life o Antibiotics for suspension Aerosols (Fig. 8-17) Solid particles finely ground 20-21 8-14: Rectal suppository, p. 128 8-15: Topical powders, p. 129 129 23-24 8-16: Powder granules, p. 129 8-17: Typical aerosol used Page 5 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy and suspended in gas o May be intended for internal use for inhalation conditions Example—asthma o Delivery medication directly to lungs Quick action Minimal side effects o External aerosols for difficult to reach places for inhalation to treat asthma, p. 130 Ointments, Creams, Pastes, and Gels Dosage forms formulated to apply to skin or mucous membrane Utilizes various bases— depends on purpose o Oleaginous or hydrocarbon—soothing o Occlusive—protective o Hydrophobic—repels moisture o Anhydrous—absorbs water Creams are semisolid dosage forms containing drug dissolved or dispersed Pastes are thicker and more absorptive than ointments Gels are semisolid preparation that are water soluble and water washable Transdermal patches (Fig. 8-18) Delivery system with medication enclosed in adhesive patch Delivers drug over set time periods 25 130 8-18: Transdermal patch, p. 131 Page 6 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Absorbed through skin o Example—Nitroglycerin Liquid Dosage Forms Fluid is delivery system for medication—most common vehicles: o Water o Alcohol o Mineral oil 131 Solutions Evenly distributed homogenous mixture of one or more medications dissolved in liquid vehicle Classified by type of vehicle Non aqueous solutions o Alcoholic—e.g. Spirits of peppermint o Hydro-alcoholic solution uses combination of alcohol and water—e.g. elixirs o Glycerites—medications dissolved in glycerin o Tinctures—vegetable material in alcoholic base Aqueous solutions: o Douches o Irrigating solutions o Enemas o o 26 Viscous aqueous solutions Jellies Mucilages Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 7 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-2 Define the routes of administration for medications. Date: Lecture Outline Content Routes of Administration Oral Sublingual—under the tongue Parenteral—injection Intravenous—via needle in a vein Intramuscular—injection into a muscle mass Subcutaneous—injecting small amount of solution or suspension under the skin Intradermal—injection in top layers of skin Intraarticular administration—injection into a joint Intraarterial administration— injection into an artery Intracardiac—injection into heart muscle o Only in extreme lifethreatening emergencies Intraperitoneal administration—administered into the peritoneal or abdominal cavity Intrapleural—injection into the pleural membrane surrounding lungs Implants—medical device Text page PPt slide 132 27-29 Figures, Tables, and Features 30-33 133 134 Resources and In-Class Activities In-Class Activities Divide the class into small groups. Create profiles of several different “patients” and list their required prescription medications. Ask students to research and determine the best route of administration for each medication. For example, a young child taking methylphenidate may need a capsule so that the medication can be sprinkled on applesauce due to the fear of swallowing ‘big pills.” Ask the students to explain their choices. Discuss with class Materials Patient profiles, pharmacy reference books 135 34 Page 8 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Outside Assignments Evaluation Outside Assignments Learning Activity 8.1 Complete and be prepared to discuss with class. Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy o inserted into body permanently or for prescribed amount of time o Examples—birth control or insulin pump Topical applications o Applied to skin Inhalation Transdermal—delivery of drug across top of the skin o Facilitates a systemic effect, bypasses gastrointestinal tract Vaginal administration Ocular, Otic and Nasal routes 35-36 136 137 Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 9 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-3 Correlate the dosage forms with the appropriate route of administration. Date: Lecture Outline Content Dosage forms and route of administration Oral o Tablets (Figs. 8-1, 8-2, 83,8-4, 8-5, 8-6) o Capsules (Figs. 8-7, 8-8, 8-9) o Oral solutions o Oral suspension o Oral emulsions o Orally disintegrating tablets o Buccal tablets (Fig. 8-9) o Lozenges, troches and lollipops (Fig. 8-10, 8-11) o Medicated chewing gum (Fig. 8-12) o Medicated thin strips (Fig. 8-13) o Antibiotic granules for oral suspension (Fig. 8-16) Sublingual—under the tongue o Sublingual tablets Parenteral—injection Intravenous—via needle in a vein (Fig. 8-19) o Solutions Intramuscular—injection into a muscle mass o Solutions or suspensions Subcutaneous—injecting Text page PPt slide 124129 3-19 Figures, Tables, and Features Figures 8-1: Compressed tablet, p. 124 8-2: Film-coated tablet, p. 124 8-3 Enteric coated tablet, p. 125 8-4: Controlled release tablet, p. 125 8-5: Effervescent tablet, p. 125 8-6: Orally disintegrating tablets, p. 125 8-7: Hard shell gelatin capsule, p. 126 8-8: Capsules with small pellets, p. 127 132 8-9: Soft shell capsule, p. 125 8-10: Lozenge, p. 125 133135 8-11: Lollipop containing a drug, p. 125 8-12: Medicated chewing gum, p. 128 8-13: Medicated thin strips, p. 128 8-19 IV Bag, p. 133 Page 10 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Resources and In-Class Activities In-Class Activities Pair students, and ask them to create flash cards with all of the dosage forms and routes of administration outlined in the text. Once this is completed, ask the students to quiz one another. Outside Assignments Evaluation Outside Assignments Learning Activity 8.2 Complete and be prepared to discuss with class. Discussion of Learning Activity 8.2 is available on the IRCD. Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy small amount of solution or suspension under the skin o Solutions or suspensions Intradermal injection— injection into top layers of skin (Fig. 8-20) Intraarticular administration—injection into a joint Intraarterial administration— injection into an artery Intracardiac—injection into heart muscle o Only in extreme lifethreatening emergencies Intraperitoneal administration—administered into the peritoneal or abdominal cavity Intrapleural—injection into the pleural membrane surrounding lungs Implants—medical device inserted into body permanently or for prescribed amount of time o Examples—birth control or insulin pump o Applied to skin o Solid particles finely ground for external aerosol o Ointment, creams, pastes and gels Topical applications (Fig. 815) Inhalation o Solid particles finely ground and suspended in gas—intended for internal 8-16: Powder granules, p. 129 8-20: Injections, p. 134 135 8-15: Topical powders, p. 129 8-17: Typical aerosol used for inhalation to treat asthma, p. 130 Page 11 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy use as inhalation (Fig. 817) Transdermal—delivery of drug across top of the skin o Facilitates a systemic effect, bypasses gastrointestinal tract o Transdermal patch (Fig. 818) Rectal administration Vaginal administration o Creams o Ointments o Gels o Solutions and foams Ocular, otic and Nasal routes o Throat sprays and gargles o ophthalmic solutions and suspensions o Ophthalmic ointments o Otic solutions or suspensions o Nasal solutions may be drops or sprays, suspensions or emulsion Topical applications o Ointments o Creams o Gels and pastes o Solutions o Lotions and sprays 136 8-18: Transdermal patch, p. 131 40 8-14: Rectal suppository, p. 128 137 41 Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 12 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-4 Apply dosage form and administration route to prescription evaluation. Date: Lecture Outline Content Text page PPt slide Figures, Tables, and Features 124 It is vitally important for the technician to correlate directions on prescription label with manufacturer’s direction for uses If there is a discrepancy— check with: o Pharmacist and/or the prescriber Professional Technician should stay current with all new dosage forms—to keep up to date for patients Knowledge of dosage forms and ability to search reference books—necessary for prescription evaluation Double check patient directions printed on label are clear, accurate, and route of administration dispensed as prescribed Technician should match dosage form ordered with the route of administration prescribed in directions to patient Any discrepancy should be verified before prescription entered in the patient profile Page 13 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Resources and In-Class Activities In-Class Activities Read and discuss Case Study 8.1 found in the text. Outside Assignments Evaluation Outside Assignments Learning Activity 8.3 Complete and be prepared to discuss with class. Discussion of Learning Activity 8.3 is available on the IRCD. Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 14 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-5 Utilize appropriate reference books to verify prescription information. Date: Lecture Outline Content Drug information resources Manufacturer’s package insert provides information about: o Drugs o Available strengths o Dosage forms o Routes of administration Technician should become familiar with content and layout of different reference books o Pharmacy reference books are valuable resource to facilitate prescription evaluation Text page PPt slide 137138 43 Figures, Tables, and Features Reference books cited in text: Drug Facts and Comparisons: Most comprehensive and current drug information, monthly updates, contains complete pharmacology, drug interactions, adverse effects, available doses and administration, lists comparable brand and generic products together. American Hospital formulary Service Drug Page 15 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Resources and In-Class Activities In-Class Activities Bring samples of package inserts from several prescription medications. Be sure to select a wide variety of dosage forms and administration routes. Divide students into groups and ask them to review the inserts and list the ten most important facts on the insert as it relates to patient education, and be prepared to defend their “top ten list.” Materials Inserts from a variety of prescription medications Outside Assignments Evaluation Outside Assignments Send the students on an information scavenger hunt. Give the students the name of a medication and ask them five questions about the medication. If possible, require answers to come from multiple reference books. Tell the students to come to class prepared to discuss their findings (and provide their sources, page numbers etc.). Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Information (AHFS): Comprehensive listing of available drugs, containing pharmacology, dosage and administration and adverse effects, updated with three quarterly supplements United States PharmacopeiaNational formulary (USPNF): Official compendium of all approved drug and the required standards of purity and stability for each drug to be considered official. United States PharmacopeiaDrug Information (USP-DI): Volume I contains drug information for the health care professional, Volume II contains advice for the patient in layman’s terms, and Volume III lists approved drug products and legal requirements. Physician’s Desk Reference (PDR): Book of package insert information for drugs chosen by manufacturers to be included, not a comprehensive reference, very few generics, color pictures of tablets, capsules or packaging of included products. Drug Interaction Facts: Lists the drug interactions and ranks them according to severity of the interaction and the likelihood of its occurrence, Redbook: Lists all drugs and Page 16 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy devices and the wholesale prices of the items, also contains many often used tables such as pregnancy category, tablets not to be crushed, addresses of drug companies Orange Book: Listing of generic drugs and rates their bioavailability comparison with the brand name product to determine if they are legally substitutable. American Drug Index: A concise listing of available drugs, dosage forms, drug class and listings of Lookalike-Sound-alike drugs, Pregnancy categories, discontinued drugs and lab values Handbook on Injectable Drugs: Complete information about injectable drugs including admixture procedures, compatibilities stability and dilution information. Handbook of Pediatric Drugs: Lists drugs and doses appropriate for use in children. Remington: The Science and Practice of Pharmacy: Comprehensive information about all aspects of the practice of pharmacy in various practice settings Material Safety Data Sheets (MSDS): Information about Page 17 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy the safe handling of chemicals and hazardous drugs in the workplace including handling chemical spills and treating exposure to hazardous materials Micromedex: A computerized referencing system containing comprehensive clinical information about drugs, toxicology information, and a drug identification system. Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 18 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Objective 8-6 Adapt dosage form and administration route for special needs patient. Date: Lecture Outline Content Orally disintegrating tablets o Originated to prevent psychiatric patients from storing tablets in pouch in cheek o Process called “cheeking” o Does not require water to swallow Capsules—may be opened and pellets sprinkled on applesauce for children o Others who are unable to swallow capsule o Important—pellets can not be chewed—adversely affects release of medication Lollipop form designed to facilitate administration to children and elderly—those with difficulty swallowing Chewing gum is easily portable Suppositories—quickly absorbed into rectal mucosa and delivered to bloodstream Parental administration for patients who are unable to take oral meds o Unconscious o Health condition which Text page PPt slide Figures, Tables, and Features 124125 126127 128 Page 19 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins Resources and In-Class Activities In-Class Activities Outside Assignments Evaluation Evaluation Invite a pediatric nurse and Upon completion of all Learning Objectives for a pharmacist to speak to chapter 8: the class and share their Have students take the insights on the challenges Pharmacy Technician faced by parents when Certification Board administering medication Review Questions (QB) to young children. Ask for chapter 8 (SRCD). them to discuss the dosage Have students complete forms and administration the Reference routes along with any Assignments to practice using reference materials. special tips or techniques they recommend to assist parents. Evaluation Upon completion of all Learning Objectives for chapter 8: Review the case studies, end-of-chapter questions, and professional judgment boxes. Answers to the questions from the text are available on the IRCD. Divide students into two teams and play the game show interactivity for chapter 8 (IRCD). Prepare a chapter test using the test bank provided for chapter 8 Instructor’s Notes Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy prevents swallowing 131 Advantages of liquid dosage forms are: o Faster acting o Easier to swallow o Easier to adjust dose o Easier administration to eye or ear o Easier administration to children or elderly patients Disadvantages of liquid dosage forms o Shorter expiration dates o May need flavoring agents to mask bad taste o Inconvenient –may spill o Require a measuring device o Difficult to store-may require refrigeration Advantages of the oral route 132 of administration are: o Safe and convenient o Usually less expensive than other forms o Can be modified for extended release o Non-invasive Disadvantages of oral administration are: o Not appropriate for unconscious patients o Patient may be unable to swallow o Requires time for absorption and distribution o Absorption time affected by food, drugs, stomach acid and condition of patient Page 20 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins (IRCD). Divide the students into groups and have each group complete a different Reference Assignment (SRCD, IRCD). Standards of Practice for the Pharmacy Technician (First Edition) Chapter 8— The Right Dosage Form and the Right Route of Administration: Working With Accuracy Legend: BTG: Brownstone test generator; IRCD: instructor’s resource CD-ROM; PPt: PowerPoint; QB: quiz bank; SRCD: student resource CD-ROM Page 21 Copyright © 2010 Wolters Kluwer Health Lippincott Williams & Wilkins