EO 004.01 Interpret a Prescription
for a Compound
(Dari)
AFAMS
01/09/2013
Importance of Lesson
(Dari)
• In the prior lectures you learned
how to dispense prescriptions
for Ready-form medications.
• Whenever possible Ready-form
medications should be used.
• Ready-form medications are
manufactured with Good
Manufacturing Processes and to
high standards.
• However, there will be times in
your pharmacy careers when
the right ready-form medication
will not be available.
Insert Dari
AFAMS
Importance of Lesson
(Dari)
• The purpose of this lecture is to
introduce you to concepts of
pharmacy compounding.
• In future lessons you will
perform actual pharmacy
compounding.
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AFAMS
Overview EO 004.01
(Dari)
•
•
•
•
•
•
•
•
Define pharmacy compounding
Review different compounded
dosage forms.
Describe situations when
compounding should be done.
Sterile vs non-sterile
compounding
Additional steps required upon
receipt of a prescription
Pharmacy compounding
references
Review
Scenarios (not graded)
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AFAMS
Definition
Dari
As you previously learned Ready-form
medications are mass produced to a given
standard. Therefore, they have:
–
–
–
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A fixed quantity of active medication
A fixed recipe of non-active ingredients
(excipients)
A fixed dosage form.
• Therefore, patients requiring lower doses,
changes in excipients due to allergies/
intolerances, who have difficulty swallowing
tablets, or require additional active medications
to those in a single Ready-form medication may
require a compounded prescription.
• Compounded prescriptions are patient
specific.
AFAMS
Definition
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Sterile vs Non-Sterile Compounding:
Insert Dari
The preparation of sterile products involves
more stringent controls than the preparation of
non-sterile products:
• air quality evaluation
• sterility-testing of products
• training and testing of personnel in aseptic
technique
Solutions for injection are the most commonly
compounded sterile products to prevent
microbial contamination which can lead to
significant patient harm.
The compounding of sterile products is not
within the scope of practice of Pharm Techs in
the ANA
Pharmacist’s Letter
AFAMS
Definition
Dari
The following preparations MUST be sterile
when they are administered to patients:
•
•
•
•
•
•
Insert Dari
aqueous bronchial and nasal inhalations
baths and soaks for live organs and tissues
injections (e.g., colloidal dispersions,
emulsions, solutions, and suspensions)
irrigations for wounds and body cavities
ophthalmic drops and ointments
tissue implants
 These can only be compounded under the
aforementioned conditions by trained personnel.
Pharmacist’s Letter
AFAMS
Definition
Dari
Examples of compounding in the non-sterile
pharmacy setting:
Insert Dari
1. Preparation of oral liquids and suspensions,
topicals, or suppositories
2. Conversion of one dosage form into another
3. Preparation of specific dosage forms from
bulk chemicals
4. Preparation of pediatric dosage forms from
adult dosage forms
5. Preparation of cassettes, syringes, and other
devices with medication for administration
in the home setting
Pharmacist’s Letter
AFAMS
Compounded Dosage Forms
Dari
Commonly compounded products:
1. Ointments and creams
2. Solutions and Suspensions
3. Suppositories
4. Capsules
5. Rapid-dissolve tablets
6. Lollipops
7. Trouches
8. Powders
9. Transdermals
Insert Dari
AFAMS
Compounded Dosage Forms
Dari
Commonly compounded products:
1. Ointments and creams
2. Solutions and Suspensions
3. Suppositories
4. Capsules
5. Rapid-dissolve tablets
6. Lollipops
7. Trouches
8. Powders
9. Transdermals
 We will look more in depth at the first
two since they are the most common
formulations.
Insert Dari
AFAMS
Ointments
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Ointments: are semi solid preparations
intended to be applied to the skin or mucous
membrane. Ointments soften but not melt
when applied to the body; it is also used as a
vehicle for external application of medicinal
substances.
•
Insert Dari
Pastes are "thick, stiff ointments that ordinarily do
not flow at body temperature." For this reason, pastes
can serve as protective coatings over the areas to
which they are applied
Three types of Ointments:
1. Oleaginous bases
2. Anhydrous or absorption bases
3. Water soluble bases
AFAMS
Ointments
Dari
Oleaginous bases are ointments that
soothe and protect the skin from the air.
Oleaginous ointments repel water and do
not wash off easily with water. They
commonly provide lubricating effect, do
not allow moisture to escape from the skin
and are greasy to the touch.
Insert Dari
AFAMS
Ointments
Dari
Anhydrous or absorption bases contain
no water and are similar to oleaginous
bases. Anhydrous ointment base do not
repel water but absorbs it and is used to
soften the skin.
Insert Dari
AFAMS
Ointments
Dari
Water soluble bases are non-greasy and
water washable. Non-aqueous or solid
medications are added to this type of
ointment base.
Example: Active drug incorporated in
Polyethylene Glycol Ointment base
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Common Ingredients Ointments
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• An ointment will involve incorporating
active ingredients into prepared ointment
bases, like the Vasoline (petroleum jelly).
• Levigating agents help reduce particle
size. Decreasing particle size helps the
ingredient be evenly mixed throughout the
base.
–
–
–
–
Insert Dari
Mineral oil works well with oleaginous ointment
bases.
Depending on the formulation, water, glycerin,
alcohol, propylene glycol, or mineral oil can be
used as levigating agents with absorption bases.
Polyethylene glycol and propylene glycol are good
for incorporating insoluble powders into watersoluble bases.
Water or glycerin can also be used with watersoluble bases.
AFAMS
Creams
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• Creams are "opaque, soft solids or
thick liquids intended for external
application.“
• Lotions are fluids for external
application. Creams can sometimes be
made into lotions, with the slow addition
of water.
• Creams are semisolid Oil /Water or
Water/Oil emulsions that may or may not
contain medication. Creams are easier to
apply on the skin and not greasy to touch
compare to ointments.
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AFAMS
Emulsion
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Emulsions are mixture of two liquids or
solids that normally do not mix. In an
emulsion, one liquid is broken into small
particles and evenly scattered throughout
the other.
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To keep the two liquids from separating, an
emulsifying agent is added to the
formulation. The emulsifying agent
prevents the small particles of the internal
phase from fusing together and eventually
separating from the external phase to form
two distinct layers.
AFAMS
Emulsion
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Oil-in-Water (O/W)
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Advantages
Improves taste of oral medications
Better absorption of oral medications in the
bloodstream
Light, non-greasy feel when used topically
Water washable
Disadvantages
May easily wash off with water or if patient sweats
Does not spread easily on the skin
AFAMS
Emulsion
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Water-in–Oil (W/O)
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Advantages
Spreads evenly on skin
Soften skins
Not easily washed off
Disadvantages
May stain clothing
Heavy and greasy feel
AFAMS
Ingredients of Creams and Lotions
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• Preparation of creams and lotions (or any
emulsion) typically involves input of energy to
break up and disperse one liquid in another
–
(for example, mechanical agitation via mortar and pestle or
simple shaking via the "bottle method").
• Ingredients for a compound must be mixed
together in a specific order otherwise they will
not go into solution or incorporate into a cream.
• An emulsifier might be needed to make a
cream or lotion. Emulsifying agents help make
two immiscible liquids more miscible, or rather,
help distribute one phase more evenly and finely
though another.
–
(e.g., acacia, glyceryl monostearate, polyethylene glycol
[PEG], sodium lauryl sulfate, Spans, Tweens, etc)
Pharmacist’s Letter
AFAMS
Ingredients of Creams and Lotions
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• Emulsifying agents are "rated" on the
arbitrary numeric hydrophile-lipophile balance
(HLB) system.
–
–
Agents with a lower HLB value are more oilsoluble, and those with a higher HLB value are
more water-soluble.
The value of ten is considered to be the breaking
point between oil- and water-soluble.
• An emulsifier that's oil-soluble is appropriate
for preparing a water-in-oil emulsion.
–
–
–
–
For example, glyceryl monostearate has an HLB
value of 3.8. It would be best for a water-in-oil
emulsion like Eucerin.
Triethanolamine oleate has an HLB value of 12. It
would be best for an oil-in-water emulsion like
Dermabase.
Often, more than one emulsifying agent is used to
prepare an emulsion so all ingredients are properly
mixed.\
HLB values for substances can often be found in
compounding references and texts.
Pharmacist’s Letter
AFAMS
Ingredients of Creams and Lotions
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A levigating agent, like mineral oil or glycerin,
or a wetting agent, like alcohol, might be needed
when an active ingredient is being incorporated
into a prepared or commercially available cream
base.
•
The wetting agent helps increase contact between
solid particles and liquids.
•
Levigating agents help reduce particle size.
Decreasing particle size helps the ingredient be evenly
mixed throughout the base.
• Some commercially available cream bases
include Dermabase and Vanicream (both oil-inwater) and Hydrocream and Eucerin (both waterin-oil).
• It's important to use the correct base when
compounding so the ingredients are properly
incorporated.
Pharmacist’s Letter
AFAMS
SUMMARY CHART: PROPERTIES OF OINTMENT BASES
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Oleaginous Ointment Absorption Ointment Water/Oil Emulsion
Bases
Bases
Ointment Bases
Composition
oleaginous
compounds
Water Content
anhydrous
Affinity for Water
Spreadability
Washability
Stability
Drug Incorporation
Potential
Drug Release
Potential*
Occlusiveness
Uses
Examples
hydrophilic
difficult
nonwashable
oils poor;
hydrocarbons better
oils poor;
hydrocarbons better
poor
hydrophilic
moderate to easy
non- or poorly
washable
unstable, especially
alkali soaps and
natural colloids
solids, oils, and
solids, oils, and
aqueous solutions
aqueous solutions
(small amounts)
(small amounts)
poor, but > oleaginous
fair to good
yes
yes
protectants, emollients protectants, emollients
(+/-), vehicles for
(+/-), vehicles for
hydrolyzable drugs
aqueous solutions,
solids, and nonhydrolyzable drugs
White Petrolatum,
White Ointment
Water-miscible
Ointment Bases
oleaginous base + w/o oleaginous base +
oleaginous base + Polyethylene Glycols
surfactant
water (< 45% w/w) + water (> 45% w/w) +
(PEGs)
w/o surfactant
o/w surfactant
(HLB <8)
(HLB >9)
anhydrous
hydrous
hydrous
anhydrous, hydrous
hydrophobic
difficult
nonwashable
solids or oils (oil
solubles only)
Oil/Water Emulsion
Ointment Bases
hydrophilic
easy
washable
hydrophilic
moderate to easy
washable
unstable, especially
alkali soaps and
natural colloids;
nonionics better
solid and aqueous
solutions (small
amounts)
fair to good
stable
sometimes
no
emollients, cleansing emollients, vehicles
creams, vehicles for for solid, liquid, or
solid, liquid, or non- non-hydrolyzable
hydrolyzable drugs
drugs
Hydrophilic
Cold Cream type,
Petrolatum,
Hydrous Lanolin,
Anhydrous Lanolin, Rose Water Ointment,
Aquabase™,
Hydrocream™,
Aquaphor®,
Eucerin®, Nivea®
Polysorb®
Hydrophilic
Ointment,
Dermabase™,
Velvachol®,
Unibase®
solid and aqueous
solutions
good
no
drug vehicles
PEG Ointment,
Polybase
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Solutions and Suspensions
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SOLUTIONS:
1. Aqueous and viscous aqueous solutions
use purified water as the vehicle.
Aqueous solutions maybe ingested
orally, applied externally or injected into
the bloodstream.
2. Viscous aqueous solutions can be thick,
sticky and sweet. Uses purified water as
vehicle.

Insert Dari
Preparation of solutions and suspensions typically
involves either dissolving or mixing active drug in a
vehicle. For compounding solutions and suspensions,
you will need a vehicle or solvent. This vehicle could
be anything from water to an aqueous liquid (e.g.,
syrup), to a polyhydric alcohol (e.g., glycerin, glycol,
mannitol, etc). The appropriate vehicle will depend
on the qualities of the active ingredient.
AFAMS
Solutions and Suspensions
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SOLUTIONS:
3. Non aqueous solutions are those that
use solvents or dissolving liquids in
addition to or instead of water as the
vehicle.
• Examples of non-aqueous solvents are
alcohol, glycerin and propylene glycol.
a.
Hydroalcoholic solution is a
mixture of alcohol and water.
b.
Alcoholic solutions are nonaqueous solutions that contain alcohol
but no water.
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AFAMS
Solutions and Suspensions
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SOLUTIONS: contain a solvent and a solute:
•
Insert Dari
solute is a substance that creates a solution
when dissolved in a solvent.
–
For example, when sugar (solute) is dissolved in
water (solvent).
• Solute can change its physical state but
solvent and solution are of same phase.
–
e.g sugar is solid before get dissolved in water after
dissolution it changes its phase to liquid.
AFAMS
Solutions and Suspensions
Dari
SUSPENSIONS
• Suspensions are mixtures of fine particles
of an undissolved solid distributed
through a gas, or liquid.
• Suspensions are useful for administering
a large amount of solid medication that is
inconvenient to take as a tablet or
capsule.
• Since drug particles are suspended in
liquid, it is important to shake the
suspension really well before using as
particles may have settled in the bottom
of the container during storage. Oral
suspensions usually use water as the
vehicle. For parenteral suspension, oil is
used as the vehicle.
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AFAMS
Solutions and Suspensions
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TYPES OF SUSPENSIONS
1. Lotions. Lotions are suspensions
intended for external application. They
contain finely powdered medications to
cool, soothe, dry or protect the skin.
Lotions can be worked easily to cover
large areas of the skin. Shake well before
using.
2. Magmas and milks. Magmas and milks
are thick, viscous suspensions of
undissolved drugs in water. They are
usually intended for oral use and must be
shaken well before using.
3. Gels. Gels are similar to magmas and
milk except that the suspended particle
size in gels is smaller. Gel suspensions
are mostly intended for oral
administration. Shake well before using.
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AFAMS
Solutions and Suspensions
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Common Ingredients of Oral Solutions
• There is a long list of commercially
available vehicles for syrups.
• These include:
–
–
–
–
–
–
Insert Dari
cherry syrup;
Ora-Sweet;
Ora-Sweet SF (sugar-free);
syrup,
USP; and
wild cherry syrup.
• The pH (or measure of acidity) and
alcohol content of these vehicles varies,
which may be the reason that one is
preferred over another for a particular recipe.
AFAMS
Compounding Situations
Dari
When compounding might be appropriate:
1. When a medication is discontinued or
unavailable, possibly because the product is
not profitable for a manufacturer (note that
a drug that has been pulled from the market
for safety reasons must not be compounded
for dispensing)
2. When a patient is allergic to preservatives,
dyes, or other inactive ingredients in
commercially available products
3. When a dosage strength is not commercially
available
4. When a patient can't take a commercially
available product by the intended route
5. When medications require flavor additives
to make them more palatable
Insert Dari
Pharmacist’s Letter
AFAMS
Populations Requiring
Compounding
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Populations that are more
likely to require compounded products:
Insert Dari
1. Elderly patients
2. Pediatric patients
3. Patients with conditions like chronic pain,
or diseases like AIDS
4. Patients who require preservative-free
formulations, special flavors, or delivery
systems that aren't commercially available
5. Animals under veterinary care
Pharmacist’s Letter
AFAMS
Receipt of a Prescription
Dari
Steps to follow when a prescription for
a compounded drug product is
received:
1.
2.
Insert Dari
Check to see if there's a
commercially available product.
If there is a commercially available
product, check to see if:
a.
b.
c.
All the ingredients are appropriate
for the condition being treated
The concentrations of the ingredients
in the prescription are reasonable
The physical, chemical, and
therapeutic properties of the
individual ingredients are consistent
with the expected properties of the
drug product that was prescribed.
Pharmacist’s Letter
AFAMS
Receipt of a Prescription
Dari
•
If the answers to all of the previous
questions are POSITIVE, the
Pharmacist should contact the
prescriber to suggest a switch to the
commercially available product.
Insert Dari
Pharmacist’s Letter
AFAMS
Receipt of a Prescription
Dari
•
If the answers to all of the above are
NOT POSITIVE, the Pharmacist
should consider asking the prescriber
the following questions:
Insert Dari
– What is the purpose of the order?
(Ready-form product available?)
– If a formula is provided by the
prescriber, ask where the formula
originated. If possible, obtain a copy of
the original formula.
– How will the compounded product be
used?
– For how long will the compounded
product need to be used?
– Does the patient have other conditions
that must be considered?
Pharmacist’s Letter
AFAMS
Compounding References
Dari
Two excellent references for compounding
recipes are:
Insert Dari
1. Isaac Walton Kilam (IWK) Hospital
http://www.iwk.nshealth.ca/page/iwkcompounding-formulas
2. Hospital for Sick Children
http://www.sickkids.ca/Pharmacy/Compounding
-Service/
 Both are children’s hospitals however;
many of their formulations are also appropriate
for Adults. Children commonly require
compounded prescriptions due to requirement
for smaller dosing or inability to swallow
tablets.
AFAMS
Compounding References
Dari
Isaac Walton Kilam (IWK) Hospital
- Available online
- Canadian Hospital
- Non-sterile compounding only
- Recipes are in PDF format for easy
printing.
- Updated with new formulations
- Formulations reviewed by Pharmacists
Insert Dari
AFAMS
Compound
and Strength
Example/ Dari
Required Equipment
Ingredients
and amount
required
Directions
How it should
be stored once
made
How long it is good for
if stored appropriately
AFAMS
Compounding References
Dari
Hospital for Sick Children
- Available online
- Canadian Hospital
- Non-sterile compounding only
- Recipes are in PDF format for easy
printing.
- Updated with new formulations
- Formulations reviewed by Pharmacists
Insert Dari
AFAMS
Example/ Dari
Ingredients
and amount
required
Compound
and Strength
Required Equipment
Directions
How it should be stored once made
How long it is good for
if stored appropriately
AFAMS
Checking a Compounded Prescription
Dari
Additional Steps:
Obtain compounding formula and verify with prescription:
Dari
-Drug name
-Drug strength (concentration)
-Calculate amount of ingredients required (Have
calculations double checked by Pharmacist)
-Final volume or quantity required
-On “Prescription Insert” write:
oPatient Name
oDrug Name
oDrug Strength
oDirections
oPrescriber Name
oPharmacy Name
oPharmacy Phone Number
o Expiry date and storage conditions
- SIGN back of Prescription as the filler.
- Pass to another Technician or Pharmacist to check.
- Undercontrol Medications must be checked by a Pharmacist.
AFAMS
Questions?
AFAMS
Review
(Dari)
AFAMS
Definition
Dari
Sterile vs Non-Sterile Compounding:
Insert Dari
The preparation of sterile products involves
more stringent controls than the preparation of
non-sterile products:
• air quality evaluation
• sterility-testing of products
• training and testing of personnel in aseptic
technique
Solutions for injection are the most commonly
compounded sterile products to prevent
microbial contamination which can lead to
significant patient harm.
The compounding of sterile products is not
within the scope of practice of Pharm Techs in
the ANA
Pharmacist’s Letter
AFAMS
Definition
Dari
The following preparations MUST be sterile
when they are administered to patients:
•
•
•
•
•
•
Insert Dari
aqueous bronchial and nasal inhalations
baths and soaks for live organs and tissues
injections (e.g., colloidal dispersions,
emulsions, solutions, and suspensions)
irrigations for wounds and body cavities
ophthalmic drops and ointments
tissue implants
 These can only be compounded under the
aforementioned conditions by trained personnel.
Pharmacist’s Letter
AFAMS
Definition
Dari
Examples of compounding in the non-sterile
pharmacy setting:
Insert Dari
1. Preparation of oral liquids and suspensions,
topicals, or suppositories
2. Conversion of one dosage form into another
3. Preparation of specific dosage forms from
bulk chemicals
4. Preparation of pediatric dosage forms from
adult dosage forms
5. Preparation of cassettes, syringes, and other
devices with medication for administration
in the home setting
Pharmacist’s Letter
AFAMS
Ointments
Dari
Ointments: are semi solid preparations
intended to be applied to the skin or mucous
membrane. Ointments soften but not melt
when applied to the body; it is also used as a
vehicle for external application of medicinal
substances.
•
Insert Dari
Pastes are "thick, stiff ointments that ordinarily do
not flow at body temperature." For this reason, pastes
can serve as protective coatings over the areas to
which they are applied
Three types of Ointments:
1. Oleaginous bases
2. Anhydrous or absorption bases
3. Water soluble bases
AFAMS
Ointments
Dari
Oleaginous bases are ointments that
soothe and protect the skin from the air.
Oleaginous ointments repel water and do
not wash off easily with water. They
commonly provide lubricating effect, do
not allow moisture to escape from the skin
and are greasy to the touch.
Insert Dari
AFAMS
Ointments
Dari
Anhydrous or absorption bases contain
no water and are similar to oleaginous
bases. Anhydrous ointment base do not
repel water but absorbs it and is used to
soften the skin.
Insert Dari
AFAMS
Ointments
Dari
Water soluble bases are non-greasy and
water washable. Non-aqueous or solid
medications are added to this type of
ointment base.
Example: Active drug incorporated in
Polyethylene Glycol Ointment base
Insert Dari
AFAMS
Creams
Dari
• Creams are "opaque, soft solids or
thick liquids intended for external
application.“
• Lotions are fluids for external
application. Creams can sometimes be
made into lotions, with the slow addition
of water.
• Creams are semisolid Oil /Water or
Water/Oil emulsions that may or may not
contain medication. Creams are easier to
apply on the skin and not greasy to touch
compare to ointments.
Insert Dari
AFAMS
Emulsion
Dari
Oil-in-Water (O/W)
Insert Dari
Advantages
Improves taste of oral medications
Better absorption of oral medications in the
bloodstream
Light, non-greasy feel when used topically
Water washable
Disadvantages
May easily wash off with water or if patient sweats
Does not spread easily on the skin
AFAMS
Emulsion
Dari
Water-in–Oil (W/O)
Insert Dari
Advantages
Spreads evenly on skin
Soften skins
Not easily washed off
Disadvantages
May stain clothing
Heavy and greasy feel
AFAMS
Receipt of a Prescription
Dari
Steps to follow when a prescription for
a compounded drug product is
received:
1.
2.
Insert Dari
Check to see if there's a
commercially available product.
If there is a commercially available
product, check to see if:
a.
b.
c.
All the ingredients are appropriate
for the condition being treated
The concentrations of the ingredients
in the prescription are reasonable
The physical, chemical, and
therapeutic properties of the
individual ingredients are consistent
with the expected properties of the
drug product that was prescribed.
Pharmacist’s Letter
AFAMS
Receipt of a Prescription
Dari
•
If the answers to all of the previous
questions are POSITIVE, the
Pharmacist should contact the
prescriber to suggest a switch to the
commercially available product.
Insert Dari
Pharmacist’s Letter
AFAMS
Compounding Situations
Dari
When compounding might be appropriate:
1. When a medication is discontinued or
unavailable, possibly because the product is
not profitable for a manufacturer (note that
a drug that has been pulled from the market
for safety reasons must not be compounded
for dispensing)
2. When a patient is allergic to preservatives,
dyes, or other inactive ingredients in
commercially available products
3. When a dosage strength is not commercially
available
4. When a patient can't take a commercially
available product by the intended route
5. When medications require flavor additives
to make them more palatable
Insert Dari
Pharmacist’s Letter
AFAMS
Quiz (Assessment)
Dari
Formative Assessment:
• Not marked
• Used to assess the students
understanding of lectures material.
• Instructors will provide
descriptions of types of compounds
which students must indicate type
of compound.
• Instructor will provide a debrief
at the end of the quiz.
• Time estimate (including
debrief): 20-30 mins
Insert Dari
AFAMS
Quiz (Assessment)
Dari
1.
2.
3.
An opaque soft solid or thick
liquid intended for external
application. Can have a drying
effect.
A fluid emulsion or suspension
for external application. Can
have a lubricating effect.
A semisolid preparation
intended for external
application to the skin or
mucous membranes that
softens or melts at room
temperature.
Insert Dari
AFAMS
Quiz (Assessment)
Dari
4.
5.
6.
A thick, stiff ointment that
ordinarily does not flow at
body temperature. Can be used
as a protective covering.
Consists of one phase dispersed
in a second phase, by an
emulsifying agent.
Liquid preparations containing
one or more drug substances
molecularly dispersed in a
suitable solvent or mixture of
mutually miscible solvents.
Insert Dari
AFAMS
Quiz (Assessment)
Dari
7.
Are sweetened, flavored, liquid
preparations containing the
active drug (or excipients,
when it is prepared from
commercially available drug
products) as insoluble
materials.
Insert Dari
AFAMS
Quiz (Assessment)
Dari
1.
2.
3.
4.
5.
6.
7.
Cream
Lotion
Ointment
Paste
Emulsion
Solutions
Suspension
Insert Dari
AFAMS
End of Lecture
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