Pharmacology

1. Pharmacology Chapter 4 Medication Preparations & Supplies

2. Drug Form • Refers to the type of preparation in which the drug is supplied • Pharmaceutical companies prepare each drug in the form most suitable for its intended route of delivery and means of absorption

3. Drug Forms • Capsule cap • Elixir elix • gtt drop • Suppository supp • Suspension susp • Tablet tab • Transdermal trans

4. Space-age drug form • Transdermal delivery system • Originated in space when anti-nausea medication was put into patch form and used by the astronauts • The goal is to get the drug molecules that are in various shapes and sizes, to absorb into the skin at various rates.

5. The patch • Provides a consistent even flow of drug release over a long period of time-hours or days • As compared to a pill which has an uneven effect, the patch is more consistent

6. Advantages of a dermal patch • Easy application, no discomfort or undesirable taste • Has effectiveness for long periods of time, hours for some drugs and days for others • Consistent blood levels of the drug because the drug is released at varying rates rather than all at one time

7. Dermal patches • Come in various shapes, sizes and colors • Today, nitro patch, motion sickness patch, and pain patch (duragesic) are most popular types of patches used • New developments of birth control and smoking cessation patches have recently been developed

8. Application of a dermal patch • Patches are usually small • Some are skin colored • Nurses MUST record in the MAR where they placed a patch • ALWAYS remove an old patch before applying a new one • Have assistance from a co-worker to find the other patch

9. Where to put a new patch • Patches can be placed anywhere on skin that is flat and will not be rubbed off (waistline from pants) • Most popular sites are: • Behind ear (motion sickness patches) • Abdomen • Chest • Deltoid are of arm

10. In the future • We will be seeing HTN, ulcer, allergy and cardiac patches • Not all drug molecules may be adaptable to this drug form but researchers are working on it

11. Routes of drugs • Include: • IM - intramuscular • IV - intravenous • IVPB– IV piggyback • PO– by mouth • R- rectal • Sub Q – subcutaneous • NGT– nasogastric tube • GT– gastric tube

12. Oral Drug Forms • Tablet – is a disc of compressed drug • may be of various shape, size and color • May be coated to enhance easy swallowing • May be scored to enhance equal distribution of the drug if it must be broken

13. Enteric-coated tablet • Tablet with a special coating that resists disintegration by gastric juices • The coating dissolves further down the GI tract, in the enteric (small intestinal) region • Some drugs like aspirin or Motrin are irritating to the gastric lining of the stomach and are available in this enteric coated form • To be effective, the coating must never be destroyed by chewing or crushing when it is administered

14. Capsule – drug contained within a gelatin based container or capsule • Capsule form may be easier to swallow than non-coated tablets for some people • The capsule is 2 halves put together, it may be easy to take these halves apart and sprinkle the drug onto soft foods or in beverages for patients who have difficulty swallowing whole pills • An example med is depakote sprinkles for epilepsy

15. Time-released (sustained-release) capsule • Capsule containing drug particles that have various coatings often different colors that differ in the amount of time required before the coating dissolves • This type of drug is designed to release the drug over an extended period of time

16. Time released • An advantage of a time released capsule is that the person taking the med, takes it less times per day because of its slow release • An example is: oxycodone is immediate release and one would have to take this drug every 3-4 hrs = 6-8xs per day • Oxycontin is sustained release and one takes it only 2xs per day • The pt has better pain control d/t the constant slow release of the time released pill

17. Time released • Inside of the caspule are multi colored encapsulated drug particles • NEVER CRUSH OR TAMPER WITH THESE • If you tamper with them, you could cause the entire amount of the med to be released all at one time, can cause death or toxicity

18. Lozenge or (troche) • Tablet containing palatable flavoring, indicated for a local (often soothing) effect on the throat and mouth • Mycostatin is used for fungus or thrush in the mouth of the oncology pts. Their immune system is suppressed and they receive antibiotics, normal flora is gone and fungus arrives. Pts say this med is “yucky”

19. How to administer a lozenge • Tell pt NOT to swallow the troche, it should dissolve in the mouth over a few minutes to work effectively • Tell pt NOT to drink liquids for at least 15 minutes as to not wash away the medication

20. Suspension • Liquid form of medication that must be thoroughly shaken before administering because drug particles settle at the bottom of the bottle • THE DRUG IS NOT EASILY DISSOLVED IN THE LIQUID • An example is Keflex, you must shake it well to mix it

21. Emulsion • Liquid drug preparation that contains oil and fats in the water

22. Elixir, fluid extract • Liquid drug forms with an alcohol base • BE SURE TO TIGHTLY CLOSE THE BOTTLE AS TO NOT LET THE ALCOHOL EVAPORATE • DO NOT administer this type to alcoholics

23. Syrup • Sweetened, flavored liquid drug form. Cherry, strawberry, banana or bubblegum preparations are popular among children. Orange is not a popular flavor usually

24. Solution • Liquid drug form in which the drug is completely dissolved • Appearance is clear rather than cloudy • Such as Metamucil • Power/granules + water= solution

25. OTC • Many drug forms for the oral route are available OTC and include thousands of trade name products • Oral route is the easiest and most natural and probably the cheapest for administration

26. Who to NOT give oral meds to • Emergency related pts, probably need IV • Pts with acute pain, probably need IV • Pts who are NPO • Pts unable to swallow • Diabetics – all liquids or suspensions usually contain some type of sugar to make them palatable, may be too much sugar for the diabetic pt

27. Rectal Drug Form • Rectal drug forms include: • Suppository – drug suspended in a substance such as in cocoa butter that melts at body temperature • Enema solution – drug suspended in a solution to be administered as an enema

28. Types of meds given PR • Sedatives or anticonvulsant – such as valium for seizures • Anti-pyretics – such as Tylenol • Analgesics – such as Tylenol

29. When to administer a med via the rectal route • If the pt is NPO • If the pt cannot swallow • If the pt is unconscious or having a seizure

30. Injectable drug forms • These include: • Solutions IM • Powder Sub Q • Intravenous Epidural • Intradermal Intracardiac • Intraspinal Intracapsular

31. Solution • Drug suspended in a sterile vehicle such as sterile water and are referred to as “aqueous” • Some solutions have an oil base and are referred to as “viscous” , the thick solution hurts when injected into muscle

32. Powder • Dry particles of drugs • These are usually dehydrated in preparation and need fluid to reconstitute to a liquid form for injection • Sterile water or NS are used to reconstitute • Drugs are usually in powder form because of the short period of time they remain stable after dilution. Once mixed in the liquid, they need to be used

33. Injection routes • Differ according to the type of tissue the drug will be injected into

34. Intravenous • Injected directly into a vein • Immediate absorption and availability to major organs makes this route a DANGEROUS one

35. Types of intravenous injections • IVP – IV push, a small volume of drug is injected through a syringe into the saline lock or into the IV tubing such as Pepcid • IVP Bolus – medication is pushed into a saline lock or IV tubing quickly such as Narcan into a saline lock • IV infusion or IV drip – large amount of fluids often with drugs added that continually infuses into a vein • IVPB – a drug placed in a small bag to be delivered intermittently over 20-60 minutes via the main IV tubing

36. Intramuscular • Medication injected into a muscle by positioning the needle at a 90 degree angle from the skin • Depends on how tall the person giving the injection is, may be given at a 45 degree angle if the giver is shorter or taller than the pt • Absorption is fairly rapid due to the vascularity of muscle

37. Subcutaneous • Injected into the fatty layer of tissue below the skin by positioning the needle and the syringe at a 45 degree angle • Such as insulin • Depending on the needle size and the size of the pt and who is administering the med such as the pt, may be injected at a 90 degree angle

38. Intradermal • Injected just beneath the skin by positioning the bevel up and the syringe at a 15 degree angle from the skin • This route is used for allergy testing and TB skin tests • D/t the lack of vascularity in the dermis, absorption is slow • Any reaction is usually to local tissues rather than systemic

39. TB skin testing • A small amount of 0.2ml is injected intradermally • The site is inspected 48-72 hrs later for hardness and swelling • Reddened (erythema) without swelling is usually a (–) test result • Reddened and raised (induration) is measured with a special ruler and the number of millimeters (mm) is documented. This indicated a (+) test result

40. TB Test

42. Epidural • A catheter has been placed by an anesthesiologist in the epidural space of the spinal canal and medication is administered through that catheter • Such meds are numbing meds like Bupivicaine and pain meds such as Fentanyl or even steroids for chronic pain

43. Epidural • Tubing coming from the back can be attached to a programmed pump called a PCA – patient controlled analgesia and the pt can deliver their own medication WHEN they need it PRN • Epidurals have been used for administering analgesics, chemotherapy and are used now mostly for the management of post-operative pain

44. Less common parenteral routes • Remember that parenteral is anything other then through the alimentary canal… • These methods must be administered by a Physician: • Intracardiac – directly into the heart such as adrenaline • Intraspinal – injected into the space where CSF is such as anesthetics • Intracapsular – injected into the capsule of a joint to reduce inflammation or bursitis, into shoulders and knees

45. Topical Drug Forms • Topical agents include: • Drugs for dermal application • Drugs for mucosal application

46. Dermal application • Cream or ointment • Lotion • Liniment • Dermal patch

47. Cream or ointment • A semisolid preparation for dermal application containing a drug for external application • Note: creams and ointments are NOT the same, the dose used differs for each • Nystatin comes in ointment or cream depending on its use

48. RULE OF THUMB • If skin is wet, use cream (ointment won’t stick) • If skin is dry, use ointment • You’ll have to contact the physician to do this

49. Lotion • A liquid preparation applied externally for treatment of skin disorders • DO NOT TREAT MEDICATED LOTIONS LIKE HAND LOTION • Medicated lotion must be patted, not rubbed on affected areas • This is like calamine lotion for poison ivy

50. Liniment • Preparation for external use that is rubbed on the skin as a counterirritant. The liniment creates a different sensation like tingling or burning to mask pain in the skin or muscles • Like Bengay