The Pharmacy The Pharmacy Technician 4ETechnician 4E

Chapter 7Chapter 7Routes & FormulationsRoutes & Formulations

Chapter OutlineChapter Outline• Enteral FormulationsEnteral Formulations• Oral FormulationsOral Formulations• Sublingual Sublingual • BuccalBuccal• Rectal Rectal • Parenteral FormulationsParenteral Formulations

• Intravenous Intravenous • IntramuscularIntramuscular• Ophthalmic Ophthalmic IntranasalIntranasal Inhalation Inhalation DermalDermal VaginalVaginal

Factors Influencing the Route of Factors Influencing the Route of AdministrationAdministration

Drugs are contained in dosing units called Drugs are contained in dosing units called formulations formulations or or dosage formsdosage forms..AA route of administration route of administration is a way of getting a drug onto or into the body. is a way of getting a drug onto or into the body. It’s classified into two categories: It’s classified into two categories:

ENTERALENTERAL: : refers to anything involving the stomach from the refers to anything involving the stomach from the mouth to the rectum. There are four enteral routes of mouth to the rectum. There are four enteral routes of administration:administration:1.1. OralOral2.2. SublingualSublingual3.3. BuccalBuccal4.4. RectalRectal

PARENTERAL: PARENTERAL: Routes other than enteral Routes other than enteral Drugs come in many different forms and many factors determine the Drugs come in many different forms and many factors determine the

choice of route of administration.choice of route of administration.

Factor Affecting Selection of Route of Factor Affecting Selection of Route of AdministrationAdministration

Drug CharacteristicsDrug Characteristics Ease of administrationEase of administration Site of actionSite of action Onset of actionOnset of action Duration of actionDuration of action Quantity of drug administeredQuantity of drug administered Liver or kidney diseasesLiver or kidney diseases

Drug CharacteristicsDrug Characteristics

Stomach is very acidic (pH 1-2).Stomach is very acidic (pH 1-2). The pH scale The pH scale measures the acidity of the alkalinity of measures the acidity of the alkalinity of

a substance.a substance. pH 7 is neutral (water).pH 7 is neutral (water).

Certain drugs are Certain drugs are degradeddegraded (chemically changed to a (chemically changed to a less effective form) or destroyed by stomach acid.less effective form) or destroyed by stomach acid.

The The absorption absorption of many drugs is affected by the of many drugs is affected by the presence of food in the stomach.presence of food in the stomach.

Ease of AdministrationEase of Administration Prescribers assess characteristics to determine route of Prescribers assess characteristics to determine route of

administration.administration. Some patients are unable swallow.Some patients are unable swallow. Very young or older adult patients might have Very young or older adult patients might have

difficulty swallowing.difficulty swallowing. Avoid solid, oral dose forms in favor of liquid Avoid solid, oral dose forms in favor of liquid

dose forms or non-oral routes of administration. dose forms or non-oral routes of administration. Oral route of administration is inadvisable for a Oral route of administration is inadvisable for a

patient experiencing nausea and vomiting.patient experiencing nausea and vomiting.

Site of ActionSite of Action Choice of route of administration is influenced by Choice of route of administration is influenced by

desired site of action. desired site of action. AA Local Effect: Local Effect: occurs when the drug activity is at occurs when the drug activity is at

the site of administration (e.g. eyes, ears, nose, the site of administration (e.g. eyes, ears, nose, skin). skin).

AA Systemic Effect:Systemic Effect: occurs when the drug is occurs when the drug is introduced into the circulatory system by any route introduced into the circulatory system by any route of administration and carried by the blood to the of administration and carried by the blood to the site of action. site of action.

Onset of ActionOnset of Action

Onset rate varies with route of administration:Onset rate varies with route of administration: Oral medications for systemic use must proceed Oral medications for systemic use must proceed

through a series of steps before they exert their through a series of steps before they exert their therapeutic effect therapeutic effect (desired pharmaceutical action on (desired pharmaceutical action on the body).the body).

Liquid solutions or suspensions work faster than oral Liquid solutions or suspensions work faster than oral tablets or capsules. tablets or capsules. Medication is more readily available for Medication is more readily available for

absorption.absorption.

Onset of ActionOnset of Action Tablets placed under tongue or between cheek and gums work Tablets placed under tongue or between cheek and gums work

quickly. quickly. Medication bypasses stomach and liver, goes directly into Medication bypasses stomach and liver, goes directly into

bloodstream.bloodstream. Drugs injected/infused directly into bloodstream are carried Drugs injected/infused directly into bloodstream are carried

immediately throughout the body. immediately throughout the body. Topical medications work quickly. Topical medications work quickly.

Localized therapeutic effects, especially thoseLocalized therapeutic effects, especially those applied to the skinapplied to the skin inhaled into the lungsinhaled into the lungs instilled into the eye.instilled into the eye.

Duration of ActionDuration of Action

TheThe duration of actionduration of action The length of time a drug gives the desired response or is at The length of time a drug gives the desired response or is at

the therapeutic level (duration of time the drug continues to the therapeutic level (duration of time the drug continues to work).work).

Controlled- /extended-release tablet Controlled- /extended-release tablet May last for 12 to 24 hours compared with 4 to 6 hours for May last for 12 to 24 hours compared with 4 to 6 hours for

same drug in immediate-release formulation.same drug in immediate-release formulation. Transdermal patches Transdermal patches

Delivers small amounts of a drug steadily over many hours or Delivers small amounts of a drug steadily over many hours or even days.even days.

Sustained-duration effect Sustained-duration effect can be achieved by means of can be achieved by means of intravenous (IV) infusion.intravenous (IV) infusion.

Injections into the muscle and skin Injections into the muscle and skin last longer last longer than injections than injections directly into the bloodstream.directly into the bloodstream.

Quantity of DrugQuantity of Drug Sometimes a specific route of administration is chosen Sometimes a specific route of administration is chosen

because of the amount of a drug. because of the amount of a drug. A tablet containing a lot of filler (diluent) might be A tablet containing a lot of filler (diluent) might be

preferred for a drug containing a very small amount of preferred for a drug containing a very small amount of active ingredient. active ingredient.

IV infusion is an excellent method for systemic delivery of IV infusion is an excellent method for systemic delivery of large quantities of large quantities of material.material. Rapidly diluted in the bloodstream.Rapidly diluted in the bloodstream.

IV injections IV injections and infusions can and infusions can deliver a higher dose deliver a higher dose of of medication to the target site.medication to the target site. Important in serious illnesses.Important in serious illnesses.

Metabolism by the Liver or Metabolism by the Liver or Excretion by the KidneyExcretion by the Kidney

Liver metabolism Liver metabolism breaks down breaks down active drug to inactive active drug to inactive metabolites for elimination and to prevent drug metabolites for elimination and to prevent drug accumulation.accumulation.

TheThe first-pass effectfirst-pass effect is theis the extent to which a drug is extent to which a drug is metabolized by the liver before reaching systemic metabolized by the liver before reaching systemic circulation.circulation. Influences activity of several drugs.Influences activity of several drugs. Such drugs have to be given in large oral doses or by Such drugs have to be given in large oral doses or by

another route of administration to bypass or overcome another route of administration to bypass or overcome metabolism by the liver.metabolism by the liver.

Metabolism by the Liver or Metabolism by the Liver or Excretion by the KidneyExcretion by the Kidney

Age-related Age-related (old age) or disease-related changes in liver or (old age) or disease-related changes in liver or kidney disease can cause: kidney disease can cause: Drug accumulation Drug accumulation and thus toxicity.and thus toxicity.

Older patients are often prescribed lower doses of Older patients are often prescribed lower doses of medication.medication.

If patients are on multiple potent prescription drugs, there If patients are on multiple potent prescription drugs, there is a risk of a drug-drug interaction.is a risk of a drug-drug interaction. Drug accumulationDrug accumulation Toxic blood levels increasesToxic blood levels increases

Oral Dosage FormsOral Dosage Forms

Disintegration Disintegration The breaking apart of a tablet into smaller pieces.The breaking apart of a tablet into smaller pieces.

DissolutionDissolution When the smaller pieces of a disintegrated tablet When the smaller pieces of a disintegrated tablet

dissolve in solution.dissolve in solution.

Active vs. Inactive IngredientsActive vs. Inactive Ingredients

Inactive IngredientInactive Ingredient Include binders, lubricants, fillers, diluents, and Include binders, lubricants, fillers, diluents, and

disintegratesdisintegrates Added to help manufacture the formulation and Added to help manufacture the formulation and

to help the dosage form disintegrate and dissolve to help the dosage form disintegrate and dissolve when administeredwhen administered

If a drug X is 50 mg tablet, then the actual weight is If a drug X is 50 mg tablet, then the actual weight is going to be more than 50 mg because of the inactive going to be more than 50 mg because of the inactive ingredients.ingredients.

Oral Routes of AdministrationOral Routes of Administration

The The most frequently most frequently used route of administration.used route of administration. Oral refers to two methods of administration:Oral refers to two methods of administration:

Applying topically to the mouth. Applying topically to the mouth. Swallowing for absorption along the Swallowing for absorption along the

gastrointestinal (GI) tract into systemic gastrointestinal (GI) tract into systemic circulation. circulation.

popo ( (from the Latin from the Latin per osper os) ) is the abbreviation used is the abbreviation used to indicate to indicate oral route oral route of medication administration.of medication administration.

Dose Forms Dose Forms

Common dose forms for Common dose forms for enteral administration are enteral administration are solid formulations. solid formulations. TabletsTablets CapsulesCapsules Bulk powdersBulk powders Rectal formulationsRectal formulations

Other Tablet TypesOther Tablet Types

Bulk powders Bulk powders (e.g., Goody's BC powders) (e.g., Goody's BC powders) contain the active drug in a small powder contain the active drug in a small powder paper or foil envelope. The patient empties paper or foil envelope. The patient empties the envelope into a glass of water or juice the envelope into a glass of water or juice and drinks the contents. and drinks the contents.

Chewable tablets Chewable tablets have a flavored and/or have a flavored and/or colored base designed to be masticated colored base designed to be masticated (chewed)(chewed)

Effervescent tablets Effervescent tablets are granular salts that are granular salts that release gas dispense active ingredients into release gas dispense active ingredients into solution when placed in water or juicesolution when placed in water or juice

CapsulesCapsules  

A A capsulecapsule is ais a solid dose form consisting solid dose form consisting of a gelatin shell that encloses the drugof a gelatin shell that encloses the drug usually swallowed wholeusually swallowed whole tasteless and are easier to swallow tasteless and are easier to swallow

than tabletsthan tablets Contains powders, granules, liquids, or Contains powders, granules, liquids, or

some combination with one or more some combination with one or more active ingredientsactive ingredients

Since a capsule is enclosed, flavorings Since a capsule is enclosed, flavorings are not common for this dose formare not common for this dose form

Buccal AdministrationBuccal Administration

Buccal tablets Buccal tablets (and gum) are placed in (and gum) are placed in the buccal pouchthe buccal pouch Between the cheek and the gum.Between the cheek and the gum. Dissolved and absorbed by the buccal Dissolved and absorbed by the buccal

mucosa. mucosa.

Oral Dose FormsOral Dose FormsModified Release FormulationModified Release Formulation

A A delayed-releasedelayed-release dose form does not release the active drug dose form does not release the active drug immediately after administration.immediately after administration.

An An extended-releasextended-release dose form allows reduced frequency of e dose form allows reduced frequency of dosing.dosing.

Delayed-release medication is Delayed-release medication is NOTNOT the same as extended- or the same as extended- or controlled-release medication of the same drug.controlled-release medication of the same drug.

Controlled-release dose forms should Controlled-release dose forms should NOTNOT be split.be split. Soft or Soft-gel Soft or Soft-gel are capsules that contain liquid instead of are capsules that contain liquid instead of

powders inside the gelatin shell.powders inside the gelatin shell.

Oral Dose Forms: Other Oral Dose Forms: Other formulations formulations

Also called long-acting, timed-release, and Also called long-acting, timed-release, and sustained-release dose forms.sustained-release dose forms.

Sustained Release (SR)Sustained Release (SR) Extended Release (XR, ER)Extended Release (XR, ER) Continuous Release (CR)Continuous Release (CR) Long acting (LA)Long acting (LA)

Liquid FormulationsLiquid Formulations Solutions: Solutions: is a clear liquid (not necessarily colorless).is a clear liquid (not necessarily colorless).

A A solventsolvent is a liquid that can dissolve another is a liquid that can dissolve another substance to form a solution.substance to form a solution.

Aqueous solution Aqueous solution = water is the solvent.= water is the solvent. SuspensionsSuspensions:: are formulations in which the drug does are formulations in which the drug does

not completely dissolve in the liquid. not completely dissolve in the liquid. They should be They should be shaken well shaken well before administration. before administration.

Syrups: Syrups: concentrated (saturated) solutions of sucrose concentrated (saturated) solutions of sucrose (sugar) in water – are more thicker (viscous) than (sugar) in water – are more thicker (viscous) than water.water.

Liquid Formulations Nonaqueous Liquid Formulations Nonaqueous SolutionsSolutions

Solutions that contain solvent other than water Solutions that contain solvent other than water (mostly alcohol).(mostly alcohol).

ElixirsElixirs are sweetened liquids that contain alcohol (5- are sweetened liquids that contain alcohol (5-40%). 40%). They are less sweet and less effective in masking They are less sweet and less effective in masking

taste than syrup.taste than syrup. Spirits Spirits are alcoholic solutions that contain volatile are alcoholic solutions that contain volatile

oils (alcohol 62-85%).oils (alcohol 62-85%). Tincture Tincture are alcoholic solutions (like Spirits) but of are alcoholic solutions (like Spirits) but of

nonvolatile substances.nonvolatile substances.

Liquid Formulations - EmulsionsLiquid Formulations - Emulsions

Liquid Formulations (Emulsions) are solutions of oil and Liquid Formulations (Emulsions) are solutions of oil and water based substances. water based substances.

Emulsifier Emulsifier is a substance that disperses the oil in to is a substance that disperses the oil in to water (o/w emulsion) or water into oil (w/o emulsion).water (o/w emulsion) or water into oil (w/o emulsion).

Creaming Creaming occurs when dispersed droplets merge occurs when dispersed droplets merge together; can be dispersed by shaking. together; can be dispersed by shaking.

Coalescence Coalescence is irreversible separation of the dispersed is irreversible separation of the dispersed phase.phase.

Liquid Formulations - GelsLiquid Formulations - Gels

Made using a substance called gelling agents. e.g.Made using a substance called gelling agents. e.g. Carbopols® 934P, methylcellulose, hydroxy-propyl-Carbopols® 934P, methylcellulose, hydroxy-propyl-

methyl-cellusose, and sodium carboxy-methyl-methyl-cellusose, and sodium carboxy-methyl-cellulose are recommended for oral administration. cellulose are recommended for oral administration.

Usually take 12-24 hours to reach maximum viscosity.Usually take 12-24 hours to reach maximum viscosity. Add the active drug before the gel is formed.Add the active drug before the gel is formed.

Other Delivery SystemsOther Delivery Systems

Unit dose disposable syringes Unit dose disposable syringes are prefilled syringes are prefilled syringes that contain a single premeasured dose of medication that contain a single premeasured dose of medication and are thrown away after use.and are thrown away after use.

AnAn oral syringe oral syringe is ais a device without a needle to device without a needle to administer medication to pediatric or elderly patients administer medication to pediatric or elderly patients unable to swallow tablets or capsules.unable to swallow tablets or capsules.

Effervescent Salts and LozengesEffervescent Salts and Lozenges

Effervescent saltsEffervescent salts are granules or coarse powders are granules or coarse powders containing one or more medicinal agents. containing one or more medicinal agents. Contains some combination of sodium bicarbonate Contains some combination of sodium bicarbonate

with citric acid, tartaric acid, or sodium with citric acid, tartaric acid, or sodium biphosphate. biphosphate.

Release carbon dioxide gas when dissolved.Release carbon dioxide gas when dissolved. LozengesLozenges are dose forms containing active ingredients are dose forms containing active ingredients

and flavorings that are dissolved in the mouth.and flavorings that are dissolved in the mouth. Also known as troches or pastilles.Also known as troches or pastilles. Generally have local effects.Generally have local effects.

Other Delivery SystemsOther Delivery Systems

A A dropper dropper uses a bulb to create a vacuum for drawing up a uses a bulb to create a vacuum for drawing up a liquid.liquid. Contains a small, squeezable bulb at one end and a hollow Contains a small, squeezable bulb at one end and a hollow

glass or plastic tube with a tapering point.glass or plastic tube with a tapering point. May be incorporated into the cap of a vial or other May be incorporated into the cap of a vial or other

container .container . gttgtt is anis an abbreviation for unit of pharmaceutical measurement abbreviation for unit of pharmaceutical measurement

for droppers and IV infusions indicating for droppers and IV infusions indicating drops.drops. Due to the differing viscosities of fluids, the size of a drop Due to the differing viscosities of fluids, the size of a drop

varies considerably from medication to medication. varies considerably from medication to medication. Droppers are often used for otic or ophthalmic administration, Droppers are often used for otic or ophthalmic administration,

as well as for oral medications.as well as for oral medications.

Sublingual AdministrationSublingual Administration

Designed to be dissolved under the tongue. Designed to be dissolved under the tongue. Medication dissolved under the tongue is absorbed very Medication dissolved under the tongue is absorbed very

quickly. quickly. NitroglycerineNitroglycerine is the best known example of sublingual is the best known example of sublingual

formulation (for chest pain).formulation (for chest pain). Advise patients to take a sip of water first and not to eat Advise patients to take a sip of water first and not to eat

food or beverages until the drug is fully absorbed.food or beverages until the drug is fully absorbed.

Oral Dose Forms Oral Dose Forms

CapsulesCapsules are preferred over are preferred over tabletstablets for for patients with difficulty swallowing. patients with difficulty swallowing.

WaterWater preferred beverages to aid in preferred beverages to aid in swallowing swallowing

Some dose forms are designed to be Some dose forms are designed to be sprinkled on foodsprinkled on food when swallowing a when swallowing a solid is difficult.solid is difficult.

Liquid dosesLiquid doses are swallowed more easily are swallowed more easily and are suitable for and are suitable for Patients with swallowing difficulties.Patients with swallowing difficulties. Small children.Small children.

Advantages of the Oral RouteAdvantages of the Oral Route

Ease and safety of administration.Ease and safety of administration.

Active ingredient is generally contained in Active ingredient is generally contained in powders or granules which dissolve in GI tract.powders or granules which dissolve in GI tract.

Sublingual (and buccal) administration has a rapid Sublingual (and buccal) administration has a rapid onset (less than 5 minutes).onset (less than 5 minutes).

Disadvantages of the Oral RouteDisadvantages of the Oral Route

Delayed onset Delayed onset Dose form must disintegrate before absorption.Dose form must disintegrate before absorption.

Destruction or dilution Destruction or dilution of drug by of drug by GI fluids and acid.GI fluids and acid. Food or drink in stomach or intestines.Food or drink in stomach or intestines.

Not indicated in patients whoNot indicated in patients who Have nausea or vomiting. Have nausea or vomiting. Are Are comatose, sedated, comatose, sedated, or otherwise or otherwise unable to swallowunable to swallow

Unpleasant taste Unpleasant taste of some liquid dose formsof some liquid dose forms Must be masked by flavorings to promote compliance.Must be masked by flavorings to promote compliance.

Disadvantages of the Oral RouteDisadvantages of the Oral Route

Sublingual (and buccal) administration has a Sublingual (and buccal) administration has a short duration of action.short duration of action. Less than 30 to 60 minutes.Less than 30 to 60 minutes. Not appropriate for routine delivery of Not appropriate for routine delivery of

medication.medication. Buccal route may haveBuccal route may have

Medicinal taste.Medicinal taste. Local mouth irritation.Local mouth irritation.

Dispensing Oral MedicationsDispensing Oral Medications

Patients need instruction on proper storage of Patients need instruction on proper storage of nitroglycerin.nitroglycerin.

Sublingual Sublingual nitroglycerin tabletsnitroglycerin tablets should be stored in should be stored in their their original containeroriginal container (brown glass bottle). (brown glass bottle). Lid screwed on tightly to prevent sunlight and air Lid screwed on tightly to prevent sunlight and air

from causing potency loss.from causing potency loss. Pillboxes are not recommended. Pillboxes are not recommended. Refill nitroglycerin with a fresh bottle every 6 Refill nitroglycerin with a fresh bottle every 6

months.months.

Rectal Medications- Rectal Medications- SuppositorySuppository

Remove suppository from its package.Remove suppository from its package. Insert small tapered end first with index finger for the Insert small tapered end first with index finger for the

full length of the finger. full length of the finger. May need to be lubricated with a water-soluble gel to May need to be lubricated with a water-soluble gel to

ease insertion.ease insertion. RefrigerationRefrigeration may make insertion of rectal may make insertion of rectal

medications easier in warm climates.medications easier in warm climates.

Rectal Dosage FormsRectal Dosage Forms

• Enemas Enemas create an urge to defecate due to the create an urge to defecate due to the placement of fluid into the rectum.placement of fluid into the rectum.

A cleansing enema A cleansing enema uses water or a cleansing solution. uses water or a cleansing solution. A retention enema A retention enema uses an oil that is held in the uses an oil that is held in the

rectum to soften the stool. rectum to soften the stool. Frequent use of enemas is discouraged as it can have Frequent use of enemas is discouraged as it can have

significant adverse effects.significant adverse effects.

Rectal FormulationsRectal Formulations

Rectal administration is a Rectal administration is a preferred method preferred method when:when: An oral drug might be destroyed or diluted by acidic An oral drug might be destroyed or diluted by acidic

fluids in the stomach.fluids in the stomach. An oral drug might be too readily metabolized by An oral drug might be too readily metabolized by

the liver and eliminated from the body.the liver and eliminated from the body. The patient is unconscious and needs medication.The patient is unconscious and needs medication. Nausea and vomiting or severe acute illness in the GI Nausea and vomiting or severe acute illness in the GI

tract make patient unable to take oral drugs.tract make patient unable to take oral drugs.

Parenteral Routes of AdministrationParenteral Routes of Administration

Parenteral administration Parenteral administration is an injection or infusion by is an injection or infusion by means of a needle or catheter inserted into the body. means of a needle or catheter inserted into the body.

Parenteral forms deserve special attention. Parenteral forms deserve special attention. Complexity, widespread use, and potential for Complexity, widespread use, and potential for

therapeutic benefit and danger.therapeutic benefit and danger. The term The term parenteralparenteral comes from Greek words. comes from Greek words.

parapara, meaning outside, meaning outside enteronenteron, meaning the intestine. , meaning the intestine.

This route of administration This route of administration bypassesbypasses the alimentary the alimentary canal. canal.

Parenteral Routes of AdministrationParenteral Routes of Administration

Injection IndependentInjection Independent

ophthalmicophthalmic intranasalintranasal inhalationinhalation dermaldermal vaginalvaginal oticotic

Injection DependentInjection Dependent

intravenousintravenous intramuscularintramuscular intradermalintradermal subcutaneoussubcutaneous epiduralepidural intrathecalintrathecal

Parenteral Dose FormsParenteral Dose Forms

Parenteral preparations must be Parenteral preparations must be SterileSterile Free of microorganisms.Free of microorganisms.

To ensure sterility, parenterals are prepared using To ensure sterility, parenterals are prepared using Aseptic techniquesAseptic techniques Special clothing (gowns, masks, hair net, gloves)Special clothing (gowns, masks, hair net, gloves) Laminar flow hoodsLaminar flow hoods placed in special rooms.placed in special rooms.

Parenteral Dose FormsParenteral Dose Forms

IV routeIV route Directly into a veinDirectly into a vein

Prepared in hospitals and home healthcare Prepared in hospitals and home healthcare pharmacies.pharmacies. AntibioticsAntibiotics ChemotherapyChemotherapy NutritionNutrition Critical care medications Critical care medications

Parenteral Dose FormsParenteral Dose Forms

INTRA means INTOINTRA means INTO Intravenous into the veinIntravenous into the vein Intradermal into the dermis (skin)Intradermal into the dermis (skin)

Intramuscular (IM) injections Intramuscular (IM) injections Into a muscleInto a muscle

Subcutaneous injectionsSubcutaneous injections Under the skinUnder the skin

Intradermal (ID) injectionsIntradermal (ID) injections Into the skinInto the skin

Syringe Size RecommendationsSyringe Size Recommendations

Route of Administration Needle Gauge Needle LengthRoute of Administration Needle Gauge Needle Length Intravenous (IV) Intravenous (IV) 16–20 16–20 1–1.5˝1–1.5˝ Intramuscular (IM) Intramuscular (IM) 19–22 19–22 1–1.5˝1–1.5˝ Subcutaneous (SC) Subcutaneous (SC) 24–27 24–27 3/8–1˝3/8–1˝ Intradermal (ID) Intradermal (ID) 25–26 25–26 3/8˝3/8˝

Advantages and Disadvantages of Advantages and Disadvantages of the Parenteral Routethe Parenteral Route

The IV route is the The IV route is the fastest method fastest method for delivering for delivering systemic drugs.systemic drugs. Preferred administration in an Preferred administration in an emergency emergency

situation.situation. It can It can provide fluids, electrolytes, and nutrition. provide fluids, electrolytes, and nutrition.

Patients who cannot take food or have serious Patients who cannot take food or have serious problems with the GI tract. problems with the GI tract.

It provides It provides higher concentration higher concentration of drug to of drug to bloodstream or tissues.bloodstream or tissues. Advantageous in serious bacterial infection.Advantageous in serious bacterial infection.

Parenteral RouteParenteral Route Disposable Disposable syringes and needles syringes and needles are used to are used to

administer drugs by injection .administer drugs by injection . Different sizes are available depending on the type Different sizes are available depending on the type

of mediation and injection needed .of mediation and injection needed . IV infusion provides a IV infusion provides a continuous amount continuous amount of needed of needed

medication.medication. Without fluctuation in blood levels of other routes. Without fluctuation in blood levels of other routes.

Infusion rate Infusion rate can be adjusted. can be adjusted. Provides more or less medication as the situation Provides more or less medication as the situation

dictates.dictates.

Parenteral Route CharacteristicsParenteral Route Characteristics

Formulation is limited to: Formulation is limited to: solutions, solutions, suspensions, and suspensions, and Emulsions.Emulsions.

Has to be Has to be STERILESTERILE (bacteria free). (bacteria free). pH pH must match body fluid’s using buffer system.must match body fluid’s using buffer system. Limited volume should be used to avoid pain and Limited volume should be used to avoid pain and

necrosis.necrosis.

Parenteral Route DisadvantagesParenteral Route Disadvantages

Higher Cost.Higher Cost. Require skilled personnel to administer them.Require skilled personnel to administer them. Most difficult to remove once administered if there is Most difficult to remove once administered if there is

an adverse or toxic reaction.an adverse or toxic reaction. Requires a needle injection.Requires a needle injection. Potential for infection or clot formation.Potential for infection or clot formation.

Intravenous FormulationsIntravenous Formulations

Administered directly into a vein.Administered directly into a vein. Takes about 20 seconds to circulate throughout the Takes about 20 seconds to circulate throughout the

body.body. Aqueous solutions are the most common Aqueous solutions are the most common

formulations.formulations. SyringeabilitySyringeability – the ease with which a suspension – the ease with which a suspension

can be drawn from container into a syringe.can be drawn from container into a syringe. Injectablity Injectablity is the ease of flow when a suspension is is the ease of flow when a suspension is

injected into a patient.injected into a patient.

Intravenous Injections or InfusionsIntravenous Injections or Infusions

Intravenous (IV) injections are injected directly Intravenous (IV) injections are injected directly into veins and are administered at a 15- to 20-into veins and are administered at a 15- to 20-degree angles.degree angles.

Intravenous Formulation Intravenous Formulation ComplicationsComplications

Thrombus Thrombus is ais a blood clot. blood clot. PhlebitisPhlebitis is an inflammation of the vein. is an inflammation of the vein. Air emboli Air emboli occurs when air is introduced into the occurs when air is introduced into the

vein.vein. Particulate material Particulate material can include small pieces of glass can include small pieces of glass

that chip from the product’s vial or rubber pieces.that chip from the product’s vial or rubber pieces.

Intravenous Formulations DevicesIntravenous Formulations Devices Syringes Syringes - come in a variety of sizes.- come in a variety of sizes. InfusionInfusion

Is the gradual intravenous injection of a volume of Is the gradual intravenous injection of a volume of fluid into a patient.fluid into a patient.

Usually a large volume (500 ml to 1,000 ml).Usually a large volume (500 ml to 1,000 ml). E.g. dextrose in water 5% (D5W), 0.45% sodium E.g. dextrose in water 5% (D5W), 0.45% sodium

chloride in water (½ NS).chloride in water (½ NS). The solution bag has two ports: an The solution bag has two ports: an administration administration

set port set port and a and a medication port.medication port. Infusion PumpsInfusion Pumps

Ensures consistent and controlled delivery rate.Ensures consistent and controlled delivery rate. Patient controlled analgesia Patient controlled analgesia (PCA) (PCA) are pumps for are pumps for

self administration or pain medications.self administration or pain medications.

Intramuscular InjectionsIntramuscular Injections Care must be taken with Care must be taken with deep IM injections deep IM injections to to

avoid hitting a vein, artery, or nerve.avoid hitting a vein, artery, or nerve. In adults, IM injections are given into upper, In adults, IM injections are given into upper,

outer portion of the outer portion of the gluteus maximus.gluteus maximus. Large muscle on either side of the buttocks.Large muscle on either side of the buttocks.

For children and some adults, IM injections are For children and some adults, IM injections are given into the given into the deltoid muscles deltoid muscles of the shoulders.of the shoulders.

DepotDepot – the area in the muscle where the – the area in the muscle where the formation is injected during an IM injection. formation is injected during an IM injection.

Intramuscular InjectionsIntramuscular Injections

Typical needle is 19- to 22-Typical needle is 19- to 22-gauge 1 to 1.5 inch needle.gauge 1 to 1.5 inch needle.

Intramuscular (IM) injections Intramuscular (IM) injections are administered at a 90-are administered at a 90-degree angledegree angle Volume limited to less Volume limited to less

than 3 mLthan 3 mL

Advantages and Disadvantages of Advantages and Disadvantages of the Parenteral Routethe Parenteral Route

For intramuscular (IM) and subcutaneous For intramuscular (IM) and subcutaneous routes of administration, the injection site routes of administration, the injection site needs to be needs to be “prepped.” “prepped.” using alcohol wipe.using alcohol wipe.

Correct syringe, needle, and technique must Correct syringe, needle, and technique must be used.be used.

Rotation of injection sites Rotation of injection sites with long-term use.with long-term use. Prevents scarring and other skin changes. Prevents scarring and other skin changes. Can influence drug absorption.Can influence drug absorption.

Advantages and Disadvantages of Advantages and Disadvantages of the Parenteral Routethe Parenteral Route

Intramuscular (IM) and subcutaneous routes of Intramuscular (IM) and subcutaneous routes of administration are convenient ways to deliver administration are convenient ways to deliver medications compared with the IV route.medications compared with the IV route. Onset of response of the medication is slower.Onset of response of the medication is slower. Duration of action is much longer.Duration of action is much longer.

Practical for use outside the hospitalPractical for use outside the hospital Used for drugs which are not active orally.Used for drugs which are not active orally.

Subcutaneous InjectionsSubcutaneous Injections

Administer medications below the skin into the Administer medications below the skin into the subcutaneous fat.subcutaneous fat. Outside of the upper arm.Outside of the upper arm. Top of the thigh.Top of the thigh. Lower portion of each side of the abdomen. Lower portion of each side of the abdomen. Not into grossly adipose, hardened, inflamed, or Not into grossly adipose, hardened, inflamed, or

swollen tissue.swollen tissue. Often have a longer onset of action and a longer Often have a longer onset of action and a longer

duration of action. duration of action. Compared with IM or IV injection.Compared with IM or IV injection.

Subcutaneous InjectionsSubcutaneous Injections

Given at a 45-degree Given at a 45-degree angle.angle. 25- or 26-gauge 25- or 26-gauge

needle, 3/8 to 5/8 inch needle, 3/8 to 5/8 inch length.length.

No more then 1.5 mL No more then 1.5 mL should be injected into should be injected into the site.the site. Avoids pressure on Avoids pressure on

sensory nerves causing sensory nerves causing pain and discomfort.pain and discomfort.

Subcutaneous Injections InsulinSubcutaneous Injections Insulin

Given using 28- to 30-gauge short needles Given using 28- to 30-gauge short needles in special syringe that in special syringe that measures in UNITS. measures in UNITS.

Keep insulin Keep insulin refrigerated.refrigerated. Check expiration dates frequently.Check expiration dates frequently.

Opened vials should be discarded Opened vials should be discarded after one month.after one month. A vial of insulin is agitated and warmed by A vial of insulin is agitated and warmed by rolling between the rolling between the

handshands and should and should never be shaken. never be shaken. The rubber stopper should be wiped with an alcohol wipe. The rubber stopper should be wiped with an alcohol wipe. DO NOT DO NOT use use SQ SQ or or SCSC abbreviations. abbreviations.

WrWrite out subcutaneous to minimize potential medication ite out subcutaneous to minimize potential medication errors.errors.

Intradermal InjectionsIntradermal Injections

Given into capillary-rich layer just below epidermis Given into capillary-rich layer just below epidermis for: for: local anesthesialocal anesthesia diagnostic tests diagnostic tests immunizationsimmunizations

Intradermal InjectionsIntradermal Injections

Examples of ID injections include: Examples of ID injections include: Skin test for tuberculosis (TB)Skin test for tuberculosis (TB)

Typical site is the upper forearm, below the Typical site is the upper forearm, below the area where IV injections are given.area where IV injections are given.

Allergy skin testing Allergy skin testing Small amounts of various allergens are Small amounts of various allergens are

administered to detect allergies.administered to detect allergies. Usually on the back.Usually on the back.

Implants and PlastersImplants and Plasters

ImplantsImplants,, or pellets, are dose forms placed under the skin by or pellets, are dose forms placed under the skin by means of minor surgery.means of minor surgery. Used for long-term, controlled release of medications.Used for long-term, controlled release of medications. Advantages include enhanced patient compliance and Advantages include enhanced patient compliance and

convenience.convenience. Complications at the site of insertion have limited Complications at the site of insertion have limited

widespread use.widespread use. E.g: Viadur® - Duros® - Supperlin LA®E.g: Viadur® - Duros® - Supperlin LA®

PlastersPlasters are solid or semisolid and medicated or non- are solid or semisolid and medicated or non-medicated preparations that adhere to the body.medicated preparations that adhere to the body. Contain backing material such as paper, cotton, linen, silk, Contain backing material such as paper, cotton, linen, silk,

moleskin, or plastic.moleskin, or plastic.

Parenteral Topical Routes of Parenteral Topical Routes of AdministrationAdministration

Topical administration Topical administration is the application of a is the application of a drug directly to the drug directly to the surface of the skin. surface of the skin.

Includes administration of Includes administration of drugs to any mucous drugs to any mucous membrane:membrane:

NoseNose EarsEars VaginaVagina UrethraUrethra LungsLungs

Ophthalmic MedicationsOphthalmic Medications Are administered forAre administered for local treatment. local treatment.

Must be at room temperature Must be at room temperature or body temperature before or body temperature before application.application.

Have to be Have to be sterile. sterile. OOnly preparations with preservatives can nly preparations with preservatives can be repeatedly used.be repeatedly used.

A major problem A major problem The immediate loss of a dose by natural spillage from the The immediate loss of a dose by natural spillage from the

eye.eye. About 80% About 80% of a dose will be lost from the eye by overflow.of a dose will be lost from the eye by overflow.

• Unused ophthalmic medications should be Unused ophthalmic medications should be discarded 30 days discarded 30 days after the container is opened. after the container is opened.

• Manufacturer expirations do not apply once a patient has Manufacturer expirations do not apply once a patient has opened the medication.opened the medication.

Ophthalmic Ointments FormulationOphthalmic Ointments Formulation

Tend to keep the drug in contact with Tend to keep the drug in contact with the eye the eye LONGERLONGER than suspension. than suspension.

Most ointments are made of Most ointments are made of mineral oilmineral oil and and white petroleum white petroleum and have a melting and have a melting point close to body temperature. point close to body temperature.

Ointments cause eye Ointments cause eye blurringblurring and should and should be applied at night.be applied at night.

Ophthalmic AdministrationOphthalmic Administration

Before application, patient should wash hands. Before application, patient should wash hands. Prevents contamination of application site. Prevents contamination of application site.

Tube or dropper should not touch the application site.Tube or dropper should not touch the application site. Medication may become contaminated.Medication may become contaminated.

Only sterile ophthalmic solutions or suspensions should be Only sterile ophthalmic solutions or suspensions should be used in the eye.used in the eye.

Ear drops can Ear drops can NEVERNEVER be used in the eye, but eye drops be used in the eye, but eye drops CANCAN be used in the ear.be used in the ear.

Ophthalmic AdministrationOphthalmic Administration

Patient’s head should be tilted back.Patient’s head should be tilted back. After administration, the patient should place a finger in the After administration, the patient should place a finger in the

corner of the eye, next to the nose to close the lacrimal gently. corner of the eye, next to the nose to close the lacrimal gently. Prevents loss of medication through tear duct.Prevents loss of medication through tear duct. A major problem of ophthalmic administration is the A major problem of ophthalmic administration is the

immediate loss of the dose by natural spillage from the eye. immediate loss of the dose by natural spillage from the eye. The main causesThe main causes

Rapid washing of tears. Rapid washing of tears. Rapid turnover (the entire tear volume in the eye turns over every 2-3 Rapid turnover (the entire tear volume in the eye turns over every 2-3

minutes).minutes). Patient should also keep the eyes closed for 1or 2 minutes after Patient should also keep the eyes closed for 1or 2 minutes after

application .application .

Ophthalmic AdministrationOphthalmic Administration

Ophthalmic ointment Ophthalmic ointment tubes are typically small, tubes are typically small, holding approximately holding approximately 3.5 g tube .3.5 g tube .

When multiple drops of more than one When multiple drops of more than one medication are to be administered, the patient medication are to be administered, the patient should should wait 5 minutes wait 5 minutes between different between different medications.medications. The first drop may be washed away. The first drop may be washed away.

If an ointment and a drop are used together, the If an ointment and a drop are used together, the drop is used first. drop is used first. WWait 10 minutes ait 10 minutes before applying the before applying the

ointment.ointment.

Contact Lenses & Ocular InsertsContact Lenses & Ocular Inserts

Contact lensesContact lenses Used to deliver ophthalmic dosages.Used to deliver ophthalmic dosages. HydrogelHydrogel contact lenses that are placed in a solution contact lenses that are placed in a solution

containing a drug are sued.containing a drug are sued. The lenses release the drugs when placed in the eye.The lenses release the drugs when placed in the eye.

Ocular InsertsOcular Inserts Lenses placed in a solution containing a drug such as Lenses placed in a solution containing a drug such as

antibiotic and the lenses absorb the drug solution. antibiotic and the lenses absorb the drug solution. Ocusert® Ocusert® is an ocular insert designed to deliver is an ocular insert designed to deliver

pilocarpinepilocarpine at a controlled rate for up to 7 days. at a controlled rate for up to 7 days.

Intranasal FormulationsIntranasal Formulations

Nasal cavity holds about 20 ml and has a Nasal cavity holds about 20 ml and has a very rich blood supply.very rich blood supply.

May reach drug concentration similar when May reach drug concentration similar when a drug is administered as IV.a drug is administered as IV.

Nasal inhaler is a cylindrical tube with a cup Nasal inhaler is a cylindrical tube with a cup that contains fibrous material impregnated that contains fibrous material impregnated with a volatile drug.with a volatile drug.

Intranasal FormulationsIntranasal Formulations

Applied by: Applied by: drops (instillation)drops (instillation) sprayssprays aerosol (spray under pressure)aerosol (spray under pressure)

Used for:Used for: relief of nasal congestion or allergy relief of nasal congestion or allergy

symptomssymptoms administration of flu vaccineadministration of flu vaccine

Intranasal FormulationIntranasal Formulation

Patient should:Patient should: Tilt head back.Tilt head back. Insert dropper or spray or aerosol tip into Insert dropper or spray or aerosol tip into

the nostril pointed toward the eyes.the nostril pointed toward the eyes. Apply prescribed number of drops or sprays Apply prescribed number of drops or sprays

in each nostril.in each nostril. Breathing should be through mouth to avoid Breathing should be through mouth to avoid

sniffing medication into the sinuses.sniffing medication into the sinuses. Important not to overuse nasal decongestants. Important not to overuse nasal decongestants.

Follow label instructions carefully.Follow label instructions carefully.

Inhaled MedicationsInhaled Medications Intended to Intended to deliver drugs to the lungs.deliver drugs to the lungs.

Lungs are designed for exchange of gases from tissues into Lungs are designed for exchange of gases from tissues into bloodstream.bloodstream.

Usual dose form is an aerosol.Usual dose form is an aerosol. ““Environmental friendly” propellants now required to Environmental friendly” propellants now required to

replace chlorofluorocarbons (CFCs) .replace chlorofluorocarbons (CFCs) . Avoids the problems of: Avoids the problems of:

DegradationDegradation found with oral administration. found with oral administration. Minimizes potential Minimizes potential toxicitytoxicity associated with system associated with system

administration.administration. Common examples are medication for respiratory illness Common examples are medication for respiratory illness

including asthma, COPD, etc.including asthma, COPD, etc.

Inhaled MedicationsInhaled Medications Metered-dose inhalers (MDI) Metered-dose inhalers (MDI)

Provide medication with compressed gas.Provide medication with compressed gas. Deliver specific measured dose with each activation.Deliver specific measured dose with each activation. If a MDI contains a steroid, the patient should If a MDI contains a steroid, the patient should RINSE RINSE the the

mouth thoroughly after dose to prevent oral fungal infection.mouth thoroughly after dose to prevent oral fungal infection. Nebulizers Nebulizers

Create a mist when a stream of air flows over a liquid.Create a mist when a stream of air flows over a liquid. Commonly utilized for young children or elderly patients with Commonly utilized for young children or elderly patients with

asthma or lung disease.asthma or lung disease. A diskus A diskus

A newer dosage form to administer drug to lungs as A newer dosage form to administer drug to lungs as micronized powder.micronized powder.

Inhaled MedicationsInhaled Medications Most inhalation dosage forms are MDI Most inhalation dosage forms are MDI

aerosols that depend on the power of aerosols that depend on the power of compressed or compressed or liquefied gasliquefied gas to expel to expel the drug from a container.the drug from a container.

Particle sizeParticle size of the aerosolized of the aerosolized medication is a critical factor with MDIs.medication is a critical factor with MDIs.

Spacer and adaptersSpacer and adapters MDI requires coordination between MDI requires coordination between

breathing in and activation of the breathing in and activation of the aerosol.aerosol.

There are extension devices to assist There are extension devices to assist the patient who can’t coordinate the patient who can’t coordinate these two processes. these two processes.

Inhaled Medications Proper Administration Inhaled Medications Proper Administration of Aerosolized Medicationsof Aerosolized Medications

1.1. Shake canister well. Shake canister well. 2.2. ““Prime” by pressing down and activating a practice dose. Prime” by pressing down and activating a practice dose. 3.3. Insert canister into a mouthpiece or spacer to reduce the Insert canister into a mouthpiece or spacer to reduce the

amount of drug deposited on the back of the throat. amount of drug deposited on the back of the throat. 4.4. Breathe out and hold spacer between lips making a seal.Breathe out and hold spacer between lips making a seal.5.5. Activate MDI and take a deep slow inhalation. Activate MDI and take a deep slow inhalation. 6.6. Hold breath briefly, and slowly exhale through the nose. Hold breath briefly, and slowly exhale through the nose.

Transdermal Transdermal AdministrationAdministration

Delivers drug to bloodstream via absorption Delivers drug to bloodstream via absorption through the skin via a patch or disk. through the skin via a patch or disk.

Therapeutic effects can last for 24 hours up to 1 Therapeutic effects can last for 24 hours up to 1 week.week.

Chemicals in the patch or disc force drug Chemicals in the patch or disc force drug across membranes of the skin.across membranes of the skin. into layer where absorption into bloodstream into layer where absorption into bloodstream

occurs.occurs. Transdermal patches Transdermal patches should be carefully should be carefully

discarded discarded after use because they could cause after use because they could cause serious side effects if ingested by young children serious side effects if ingested by young children or pets.or pets.

Basic Rule of Percutaneous Basic Rule of Percutaneous AbsorptionAbsorption

More drug is More drug is absorbedabsorbed when the formulation is applied when the formulation is applied to a larger surface area.to a larger surface area.

Formulations or dressings that increase the Formulations or dressings that increase the hydrationhydration of the skin generally improve absorption.of the skin generally improve absorption.

The greater the amount of The greater the amount of rubbing in (inunction) rubbing in (inunction) of the of the formulation, the greater the absorption.formulation, the greater the absorption.

The longer the formulation remains in contact with the The longer the formulation remains in contact with the skin, the greater will be the absorption.skin, the greater will be the absorption.

Topical Dose FormsTopical Dose Forms

Dose forms for topical administration include: Dose forms for topical administration include: Skin:Skin:

creamscreams ointmentsointments lotionslotions gelsgels transdermal patchestransdermal patches disks disks

Ointments, Creams, Lotions, and GelsOintments, Creams, Lotions, and Gels

Dose forms should be applied as directed Dose forms should be applied as directed to the skin.to the skin. lotions, creams, and gels are worked lotions, creams, and gels are worked

into the skin.into the skin. ointments are skin protectants and do ointments are skin protectants and do

not work into the skin but stay on the not work into the skin but stay on the surface.surface.

When using nitroglycerin ointment the When using nitroglycerin ointment the patient or caregiver should wear gloves.patient or caregiver should wear gloves. Avoids absorbing excessive amounts of Avoids absorbing excessive amounts of

drug, which could cause a headache.drug, which could cause a headache.

Ointments, Creams, Lotions, and GelsOintments, Creams, Lotions, and Gels

When using When using topical corticosteroidstopical corticosteroids:: Apply sparingly to affected areas for short periods of time.Apply sparingly to affected areas for short periods of time. Affected area should not be covered up with a bandage unless Affected area should not be covered up with a bandage unless

directed by the physician.directed by the physician. Occlusive dressings can significantly increase drug Occlusive dressings can significantly increase drug

absorption and risk of side effects. absorption and risk of side effects. Overuse of potent topical corticosteroids can lead to serious Overuse of potent topical corticosteroids can lead to serious

systemic side effects.systemic side effects.

Transdermal PatchesTransdermal Patches Site of administration must be Site of administration must be rotatedrotated and relatively and relatively

hair free.hair free. Should not be placed over a large area of scar tissue.Should not be placed over a large area of scar tissue. Some are replaced every day, others maintain their Some are replaced every day, others maintain their

effect for 3 to 7 days.effect for 3 to 7 days. Some patients should remove nitroglycerin patch at Some patients should remove nitroglycerin patch at

bedtime to prevent development of bedtime to prevent development of drug tolerancedrug tolerance where the body requires higher doses of drug to where the body requires higher doses of drug to produce the same therapeutic effect. produce the same therapeutic effect.

Some testosterone patches are applied to the skin of Some testosterone patches are applied to the skin of the scrotum.the scrotum.

Dermal Formulations AdvantagesDermal Formulations Advantages

Local therapeutic effects.Local therapeutic effects. Lower risk of side effects. Lower risk of side effects. Not well absorbed into the deeper layers of the skin or Not well absorbed into the deeper layers of the skin or

mucous membrane.mucous membrane. Offers steady level of drug in the system.Offers steady level of drug in the system.

Vaginal FormulationsVaginal Formulations TheThe vaginal route vaginal route of administration is application of drug via of administration is application of drug via

cream or insertion of tablet into the vagina.cream or insertion of tablet into the vagina. The vaginal route is preferred for:The vaginal route is preferred for:

cleansing cleansing contraceptioncontraception treatment of infectionstreatment of infections

Major disadvantages: Major disadvantages: inconvenienceinconvenience ““messiness”messiness”

uterus

vagina

Vaginal MedicationsVaginal MedicationsApplication should follow a specific technique:Application should follow a specific technique:1. Begin with an empty bladder and washed hands.1. Begin with an empty bladder and washed hands.2. Open the container and place dose in applicator.2. Open the container and place dose in applicator.3. Lubricate applicator with water-soluble lubricant if not 3. Lubricate applicator with water-soluble lubricant if not

pre-lubricated.pre-lubricated.4. Lie down, spread the legs, open the labia with one 4. Lie down, spread the legs, open the labia with one

hand, and insert the applicator about two inches into hand, and insert the applicator about two inches into the vagina with the other hand.the vagina with the other hand.

5. Release labia; use free hand to push applicator 5. Release labia; use free hand to push applicator plunger.plunger.

6. Withdraw the applicator and wash the hands.6. Withdraw the applicator and wash the hands.

Vaginal FormulationsVaginal Formulations

Vaginal tablets Vaginal tablets also calledalso called inserts inserts, they are inserted , they are inserted in the same manner as vaginal suppositories. in the same manner as vaginal suppositories. Patients should be instructed to dip the tablet into Patients should be instructed to dip the tablet into

water before insertion. water before insertion. Patients may want to wear a sanitary napkin to Patients may want to wear a sanitary napkin to

protect nightwear and bed linens. protect nightwear and bed linens. Ointments, Creams, and Aerosol FoamsOintments, Creams, and Aerosol Foams

Contain antibiotics, estrogenic hormonal Contain antibiotics, estrogenic hormonal substances, or contraceptive agents. substances, or contraceptive agents.

Creams and foams are placed in a special Creams and foams are placed in a special applicator tube, and the tube is then inserted high applicator tube, and the tube is then inserted high in the vaginal tract. in the vaginal tract.

Intrauterine Devices (IUDs)Intrauterine Devices (IUDs)

Devices placed in the uterus. Devices placed in the uterus. Have a lower rate of vaginal expulsion due to their Have a lower rate of vaginal expulsion due to their

similarity to the uterine shape. similarity to the uterine shape. They also have higher surface areas of copper and are They also have higher surface areas of copper and are

effective at a rate of greater than 99%. effective at a rate of greater than 99%. ParaGard® is an IUD that has been shown to be ParaGard® is an IUD that has been shown to be

effective for up to 12 years.effective for up to 12 years. Mirena® is another category of IUDs that is based on Mirena® is another category of IUDs that is based on

the release of the hormone progesteronethe release of the hormone progesterone

The Vaginal RingThe Vaginal Ring

A hormone based IUD, but is used in A hormone based IUD, but is used in one month cycles. one month cycles.

The ring is inserted in the vagina for 3 The ring is inserted in the vagina for 3 weeks, removed for 7 days, and then weeks, removed for 7 days, and then reinserted. reinserted.

NuvaRing® NuvaRing® is an example of such a is an example of such a devicedevice..

Toxic Shock Syndrome (TSS)Toxic Shock Syndrome (TSS)

A rare and potentially fatal disease that results from a severe A rare and potentially fatal disease that results from a severe bacterial infection of the blood. bacterial infection of the blood.

In women, it can be caused when bacteria natural to the In women, it can be caused when bacteria natural to the vagina move into the bloodstream. Though primarily vagina move into the bloodstream. Though primarily associated with the use of associated with the use of super absorbency tamponssuper absorbency tampons, it has , it has also been associated with various vaginal dosage forms. also been associated with various vaginal dosage forms.

TSS symptoms include TSS symptoms include a high fever, nausea, skin rash, a high fever, nausea, skin rash, faintness, and muscle ache. It is treated with antibiotics and faintness, and muscle ache. It is treated with antibiotics and other medicines.other medicines.

Otic MedicationsOtic Medications

Must be at room temperature Must be at room temperature or body temperature.or body temperature. Heated drops may cause rupturing of the eardrum.Heated drops may cause rupturing of the eardrum. Cold drops can cause vertigo and discomfort.Cold drops can cause vertigo and discomfort.

Old medication should be removed Old medication should be removed along with any along with any drainage before applying fresh medication. drainage before applying fresh medication.

Alcohol causes pain and burning sensation. Alcohol causes pain and burning sensation. Should not be used if the patient has a ruptured Should not be used if the patient has a ruptured

tympanic membrane (eardrum).tympanic membrane (eardrum).

Otic MedicationsOtic Medications

Tilt head to side with ear facing up.Tilt head to side with ear facing up. 2 to 5 minutes2 to 5 minutes

Cotton swabs placed in the ear after administration of drops will Cotton swabs placed in the ear after administration of drops will prevent excess medication from dripping out of the ear. prevent excess medication from dripping out of the ear. Swabs will not reduce drug absorption. Swabs will not reduce drug absorption. Patients under 3 should have lobes pulled down and back. Patients under 3 should have lobes pulled down and back. Patients over 3 should have lobes pulled up and back.Patients over 3 should have lobes pulled up and back.

Terms to RememberTerms to RememberTerms to RememberTerms to Remember

1. alveolar sacs (alveoli)1. alveolar sacs (alveoli)2. aqueous2. aqueous3. biocompatibility3. biocompatibility4. buccal4. buccal5. buffer system5. buffer system6. colloids6. colloids

7. conjunctiva7. conjunctiva8. contraceptive8. contraceptive9. depot9. depot10. diluent10. diluent11. disintegration11. disintegration12. dissolution12. dissolution

Terms to RememberTerms to RememberTerms to RememberTerms to Remember

13. Emulsions13. Emulsions

14. Hemorrhoid14. Hemorrhoid

15. Hydrates15. Hydrates

16. Injectability16. Injectability

17. Inspiration17. Inspiration

18. Intrauterine 18. Intrauterine devicedevice

(Iud)(Iud)

19. Lacrimal 19. Lacrimal canaliculacanalicula

20. Lacrimal gland20. Lacrimal gland

21. Local effect 21. Local effect

22. Nasal cavity22. Nasal cavity

23. Nasal inhaler23. Nasal inhaler

24. Nasal mucosa24. Nasal mucosa