INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.

Exercise 5

Pharmaceutical Dosage Forms

Dosage Form
also known as pharmaceuticals.

It is define as preparation devised to make possible administration of medications in measured or prescribed amount.

Terms
Parenteral Dosage Forms are preparation introduced into the body by injection through the skin, the mucous, or the serous membranes Dosage forms for inhalation are preparations intended to be finally dispensed or vaporized to the mucous membranes of the lower part of the respiratory tract.

Terms
Oral Dosage Forms - are preparations intended to be taken orally. Rectal Dosage Forms - are preparations employed for systemic effect or a local action through the rectum.

Term
Dosage Forms For Topical application are preparations intended to be applied on the skin or instilled into eyes, nose, or ears.

LIQUIDS
A. Solutions a homogenous mixture that is prepared by dissolving a solid or liquid or gas in another liquid; it represents a group of preparations in which the molecules of the solute or dissolved substances are dispersed among those of the solvent

Solutions
Water used mainly as a vehicle and as a solvent

for the desired flavoring or medicinal ingredients. Aromatic water also known as medicated water, clear saturated aqueous solutions of volatile oils or aromatic or volatile substances. Aqueous acids official inorganic acids and certain acids although of minor significance as therapeutic agents are great importance in chemical and pharmaceutical manufacturing.

Solutions
Diluted acids aqueous solutions of suitable

strength usually 10% w/v except diluted acetic acid which is 6% w/v Douches aqueous solutions directed against a part or into a cavity of the body Enemas also known as evacuation enemas. They are rectal injections employed to evacuate bowel retention enemas to influence the general system by absorption, or to effect locally the seat of disease.

Solutions
Gargles aqueous solutions used for

treating the pharynx and nasopharynx by forcing air from the lungs through the gargle which is held in the throat. Mouthwashes aqueous solutions which are most often used for their deodorant, refreshing, or antiseptic effect. Juices prepared from fresh ripe fruits, aqueous in character and used in making syrups which are employed as vehicles.

Solutions
Nasal solutions usually aqueous solutions

which are deigned to be administered to the nasal passages in drops or spray form. Otic solutions aqueous preparations dispensed in a container which permits the administration of drops to the ear

NON-AQUEOUS
Collodion liquid preparations containing

pyroxillin in a mixture of ethyl ether and ethanol. Elixirs clear, pleasantly flavored sweetened hydro-alcoholic liquids intended for oral use. Glycerites solutions or mixtures of medicinal substances in not less than 505 by weight of glycerin

NON-AQUEOUS
Inhalations are solutions of drugs

administered by the nasal or oral respiratory route for local or systemic effect. Liniments solutions or mixtures of various substances in oil, alcoholic solutions of soap or emulsions. Oleovitamins fish liver oils diluted with edible vegetable oil or solutions of volatile substances of the indicated vitamins or vitamin concentrates (usually A and D) in fish liver oil.

NON-AQUEOUS
Spirits known as essences; are alcoholic

hydro-alcohol solutions of volatile substances. Toothache drops preparations used for temporary relief of toothache by application of cotton saturated with the product into tooth cavity

 EMULSION a two phase system prepared

by combining two immiscible liquids one of which is uniformly dispersed through the other; they consist of globules that have diameters equal to or greater than those of the largest colloidal particles.
SUSPENSIONS a two-phase system

consisting of finely divided solid dispersed in a solid, liquid, or gas.

 GELS semi-solid systems of either

suspension made up of small inorganic particles or large organic molecules interpenetrated by a liquid.
LOTIONS usually liquid suspension or

dispersions intended for external application to the body.

 MAGMAS and MILK aqueous suspensions

of insoluble inorganic drugs; they differ from gels mainly in that the suspended particles are layers. TINCTURES alcoholic or hydroalcoholic solutions prepared from vegetable materials or from chemical substances

 FLUIDEXTRACTS liquid preparation of vegetable

drugs containing alcoholic as a solvent or as preservative or both, so made that each mL contains the therapeutic constituents of 1 g of the standard drug that it represents
EXTRACTS concentrated preparations of

vegetable or animal drugs obtained by removal of the active constituents of the respective drugs with suitable menstruum.

 PARENTERAL PREPARATION sterile

preparations intended to be administered by injection under or through one or more layers of skin or mucous membranes
INTRAVENOUS ADMIXTURES mixture of

intravenous fluids and drugs to be administered by injection

OPHTHALMIC PREPARATIONS sterile preparations to be used on the eyes

Solutions intended for the eye; clear, sterile

solution to be instilled into the eyes by the use of a dropper. Suspensions dispersion of finely divided relatively insoluble drug substances in an aqueous vehicle containing suitable suspending and dispersing agent. Ointment intended for the eyes; they contain medicinal agents added to the ointment base of white petrolatum and mineral oil either as a solution or as a micronized powder.

LENS CARE PRODUCTS sterile preparations intended to protect the lens 1. wetting solutions 2. cleaning solutions 3. disinfection solutions 4. soaking solutions 5. artificial tears

MEDICATED
OINTMENT semi-solid preparations

intended for external applications to the skin or mucous membranes. CATAPLASM a soft moist mass of meals, herb, seed usually applied hot in clothes. PASTES concentrates of absorptive powders dispersed in petrolatum or hydrophilic petrolatum

 POWDERS for external use are usually

described as dusting powders, usually contain starch, talc, and zinc stearate DRESSINGS external applications resembling ointment usually used as a covering or protection. CREAMS viscous liquid or semi-solid emulsions of either the oil in water or water in oil type

 PLASTERS substances intended for

external application; they are made of such materials and of such consistency as to adhere to the skin and attach to a dressing SUPPOSITORIES solid dosage forms of various weights and shapes usually medicated for insertion into the rectum, vagina, or the urethra

POWDERS
Oral powders generally supplied as finely

divided or effervescent granules Dentifrices may be prepared in the form of a bulk powders generally containing soap or detergent, mild abrasive and anticariogenic agent Douche powders soluble powders intended to be dissolved in water prior to use as antiseptic or cleaning agents for a body cavity.

 Dusting powders locally applied non-toxic

preparations that are intended to have no systemic action. Insufflations finely divided powders introduced into the body cavities. Triturations dilutions of potent powdered drugs prepared by intimately mixing them with a suitable diluent in 1:10 dilutions

ORAL SOLID DOSAGE FORMS

TABLET solid dosage form containing drug

substances with or without suitable diluents and prepared either by compression or molding methods. CAPSULES solid dosage forms in which the drug substance is enclosed in either a hard or soft soluble container or of a suitable form of gelatin PILLS small, round, solid dosage forms containing medicinal agents and intended for oral administration

ORAL SOLID DOSAGE FORMS

TROCHES also known as lozenges or

pastilles; they are discoid shaped solid containing the medicinal agent in a suitably flavored base. CACHETS related to capsules in as such as they provide an edible container for oral administration of solid drugs. PELLETS small, sterile cylinders about 3.2 mm in diameter by 8 mm in length, formed by compression from medicated masses

 AEROSOLS both oral and topical; they

contain therapeutically active ingredients dissolved, suspended, or emulsified in a propellant or in a mixture of solvent and propellant
RADIOPHARMECUTICALS radioisotopes

used in medicine for therapeutic and diagnostic purposes

BIOLOGICAL PRODUCTS
Vaccines a suspension of attenuated (live) or

inactivated (killed) microorganisms or fraction thereof administered to induce immunity and thus prevent infectious disease. Toxoid a modified antigen from an infectious organism used as a vaccine Immune globulin a solution containing antibodies from the pooled plasma of not less than 1,000 normal individuals Hyperimmune serum a special preparation obtained from human donor polls selected for high antibody titer against a specific disease

Examples Dosage Forms

Omega Pain Killer (Methyl salicylate, menthol,

camphor) Liniment Cold Rub (Camphor, Menthol, Eucalyptus oil) Ointment Aceiti Manzanilla Solution Acrinol Tincture White Henna Powder Sebo De Macho Ointment Caladryl (Calamine) Lotion Nizoral (Ketoconazole) Cream, Shampoo, Tablet

Examples Dosage Forms

Dermovate (Clobetasol propionate) Cream,

Ointment, Solution Dulcolax (Bisacodyl) - Tablet, Suppository Dimetapp (Brompeniramine maleate) - Syrup Ponstan (Mefenamic Acid) Capsule SF 250 mg; Tablet 500 mg; Suspension Nitro-Dur (Nitroglycerin) Transdermal Patch Nitroglycerin Tablet; Transdermal Patch

Five reasons for the need for dosage forms.

1. 2. 3. 4. 5. 6.

To protect the drug substance from destructive influences of atmospheric oxygen To protect the drug from the destructive influence of gastric acid after oral administration To conceal the bitter, salty, or offensive taste or odor of a drug substance. To provide liquid preparations of substance that are insoluble in desired vehicle To provide for insertion of a drug into one of the bodys orifices To provide optimal drug action from topical administration sites, etc.

Examples of Tablets
1. Poten-Cee Ascorbic acid Pascual 2. Alaxan Ibuprofen, Paracetamol

Therapharma 3. Tylenol Paracetamol - Janssen 4. Neozep Phenylpropanolamine,chlorphenamine maleate, paracetamol Myra/Unilab 5. Flanax Naproxen Roche

Example of Capsules
1. Velosef Cephradine Squibb

2. Tegopen Cloxacillin Bristol

3. Omnipen Ampicillin Wyeth 4. Imodium Loperamide Janssen 5. Darvon Aspirin, caffeine,

propoxyphene Lilly

Advantages and disadvantages of different dosage forms

1.
2. 3. 4. 5. 6. 7.

Ease of administrations Stability purposes Portability/ conveniently carried Elegance Accurate dosage Manufactured at lower cost Optimal drug action and others

INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.

Exercise 6

THE PRESCRIPTION
Nelson T. Tubon, M.D. 3JR Pacific Medical Center Blk 6 Lot 1 Nepo Homes Subdivision Km 37 Pulong Buhangin, Sta. Maria, Bulacan

Patients Name De La Cruz, Mario 28/M Address Novaliches, Quezon City

Date: 10/10/08

Omeprazole 20 mg/cap ----- # 21 (Losec) Sig. Take one cap daily for three weeks

Nelson T. Tubon, MD Lic. No.: 95555 PTR No. 123456789 TN: 967854321

PRESCRIPTION
from the Latin words: prae before and

scribo I write. A prescription is an order for medication issued by a physician, dentists, veterinarian or other properly licensed practitioner.

Parts of Prescription
1. Prescribers Information. The name of the

physician or dentist, his specialty, clinic address, contact number and clinic hours.
2. Patient information. The full name and address

of the patient are necessary for identification purposes.

3. Date. Prescriptions are dated at the time they are

written. The date is important in establishing the medication record of the patient especially in filling prescriptions for controlled substances

Parts of Prescription
4. Rx Symbol or Superscription. The Rx symbol is a Latin verb

recipe, meaning take thou or you take

5. Medication Prescribed or Inscription. Body or main part of the of

the Rx order. It contains the names and quantities of the prescribed ingredients or drugs, dosage form and potency

The name of the product must be written both in Nonproprietary (generic name) Proprietary (brand) Chemical Dosage form- the physical entity of medication (tablet, capsule) Strength potency of drug (250 mg, 100IU) Quantity to be dispensed this includes the amount and the unit of measure (grams, milligrams, tablets)

Parts of Prescription
6. Dispensing Directions to Pharmacist or Subscription.

Directions to the pharmacist for preparing the prescription These can be used for: Preparations (compounding) Labeling ( information to be put on the label )
7. Directions for the Patient or Transcription. Instructions on

the number of dosage units per dose (one tablet), route of administration, frequency of dosing (every 4 hours), duration of dosing (one week, for one month) and use of the drug (optional)

Parts of Prescription
8. Refill Information. If refill information is

not supplied, it is generally assumed that no refills are authorized

9. Prescribers Signature. The name and

signature of the physician or dentist who wrote the prescription order. Below the signature of the physician are the licensed number to practice his profession, PTR ( Privilege Tax Receipt) no. and TIN

Dispensing Procedures
1. Dispensing should be done by

Pharmacist 2. Partial Filling is allowed and must be reflected in the prescription

Filling and Recording Procedures

1. The prescription once filled must be

retained by the pharmacist for a period of two years 2. The prescription must be recorded in Rx book and ready for inspection by BFAD FDROs when the outlet is open for operation anytime

Questions
1. Enumerate at least two responsibilities

of the pharmacist in providing the medication needs of the patient a. Provide information about drugs to the health profession and to the public legally responsible for dispensing prescription. b. Translate and communicate the dangers of drug to the patient, and others

Questions
2. Enumerate the instructions that pharmacist should be given to the patient in filling, refilling and dispensing legend prescriptions A. Filling of Prescriptions a. danger of overdosage b. side effects c. proper storage for stability d. need to discard unused medication e. dangers to be mixed in one container

B.

Refilling Prescription a. taking drugs for longer period of time unless it is under supervision b. taking other medications with identical composition which provides the same therapeutic effect which are sometimes prescribed by other doctor c. taking food found in the diets that are contraindicated to the prescribed drugs d. letting other members of the family or friends to use his medicine

C.

Dispensing Prescription a. the proper use of drugs b. the need to discontinue the use of the drug if certain reactions develop c. the need to see the doctor if serious reactions develop, if the condition has been a long term problem d. the danger of using the OTC drugs when prescribed medication is the possible duplication of the drug or therapeutic action e. the danger of self-diagnosis and self medication

3. Enumerate the types of Prescription based on the number of ingredients

A. Based on the number of ingredients 1. Simple prescription with only one ingredient 2. Compound prescription with one more than one ingredient 3. Polypharmacal prescription with ten or more than ten ingredients B. Magistral prescription is a prescription which is prescribed very often by the same doctor, of the same ingredients, and compounded by the same pharmacist C. Coded prescription is also called blind prescription and consists of words, symbols, to represent the name of the drugs. This is unethical practice of doctors and pharmacist

PARTS OF PRESCRIPTION
1. 2. 3. 4.

5.
6.

7.
8.

Patient Information Date Superscription or Rx symbol Inscription or medication prescribed Subscription or dispensing direction Transcription, signs and signature or the direction to the patient Refill, special labeling or other instruction Prescribers signature, address, and other pertinent information

INTERPRETATIONS
1. 2. 3. 4.

5. 6. 7. 8.

9.

Nembutal 100 mg (at bed time) ( if there is a need) ( by mouth ) Propranolol hydrochloride 40 mg (by mouth) (twice a day) Ampicillin 1 g (Intavenous piggyback) (every 6 hours) Demerol 50 mg (Intramuscularly) (every 4 hours) (if there is a need) for pain Tylenol 325 mg tablets (2) (by mouth) (at once, immediately) Pilocarpine (2) (drops) (both eyes) (every 3 hours) Scopolamine 0.8 mg (subcutaneously) (immediately) Milk of magnesia 1 (tablespoon) (by mouth) (at bed time) (every night) Septra DS tablet (double strength) (1) (every day) (by mouth)

Prohibited Drugs
Opium Brown mixture Tablet and Liquid Codein Codeine sulfate H.T. and T.T. Pethidine Demerol Ampul and Vial Codein Dolo-Adamon Supplement and Tablet Opium + alcohol Elixir Paregoric Fentanyl Innovar Injection Morphine Morphine Sulfate H.T., Ampule, Tablet 8. Alfentanyl Rapifen Injection 9. Hydrocodone Deka Syrup 10. Dihydrocodeinone Ruminon syrup

1. 2. 3. 4. 5. 6. 7.

Regulated Drugs
1.

Amobarbital Amytal Tablet, Capsule, Ampul 2. Amphetamine Benzedrine Tablet 3. Butabarbital Butisol Sodium 4. Hydrocodone + Pentobarbital - Calciudrine syrup 5. Methamphetamine Desoxyn Tablet 6. Amobarbital + Dexamphetamine Dexamyl Spansule No.1 7. Dexamphetamine Dexedrine Spansule 8. Propoxyphene napsylate Doloxene Plain Tablet 9. Propoxyphene hydrochloride Doloxene compound 65 capsule 10. Pipradol Gadexyl Tablet

Regulated Drugs

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Methaqualone Mandrax Tablet Nitrazepam Mogadon tablet Pentobarbital Nembutal Sodium Chloralhydrate Noctec liquid Methylprylon Noludar Tablet Mecloqualone Nubarene Tablet Paraldehyde Paraldehyde ampul Pentothal - Pentothal sodium Ethchlorvynol Placidyl Capsule Aprobarbital + Barbital + Phenobarbital Plexonal

Regulated Drugs
1.

2.
3. 4. 5. 6.

Flunitrazepam Robypnol Tablet Secobarbital Seconal Sodium Capsule Ethinamate Valamin Tablet Pentazocine Sosegon Tablet Ephedrine Pseuephedrine

INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.

Exercise 7

PROCESSING PRESCRIPTION

R
Prescription written by authorized prescriber Patient presents prescription to the pharmacy Prescription is checked for completeness; prescriber info, drug name, strength, dose, and directions Correct patient info is entered into computer system

LABEL

Prescription is prepared. Correct amount of med prescribed is measured and placed into container

Pharmacy label is generated. Make sure all the legal items are identified

Prescription is interpreted and confirmed by pharmacy system. Third party is billed online (optional)

Prescription is prepared by pharmacy technician, and final check done by pharmacist

Patient receives script, pharmacy assistant must offer counseling to the patient. Then script is rung on cash register, and insurance log signed

Pharmacist provides counseling on the medication prescribed and all medically related questions

1. How is a prescription processed?

receiving the packaging

prescription reading and checking the prescription numbering and dating Labeling preparing the prescription

rechecking
delivering and patient

counseling recording and filling pricing the prescription

3. What is the purpose of numbering and dating the prescription?

The same number of the original prescription

should appear at the label of the filled prescription to avoid error in dispensing
The date of the prescription is not the same

date that should be placed on the filled prescription for identification purposes

4. Information to be recorded in the prescription book.

1.
2. 3. 4. 5. 6.

name of physician name of the drug quantity date when dispensed balance (quantity if any) pharmacist signature, etc