1 Copyright © 2012, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved....

1Copyright © 2012, 2007, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved.

Chapter 5Chapter 5

Dosage Forms, Abbreviations, Dosage Forms, Abbreviations, Routes of Administration, Drug Routes of Administration, Drug

Abbreviations, and Medical TerminologyAbbreviations, and Medical Terminology


IntroductionIntroduction

For a technician to become proficient, For a technician to become proficient, it is necessary to interpret orders correctly.it is necessary to interpret orders correctly.

Many doctors’ handwriting is referred Many doctors’ handwriting is referred to as “chicken scratch,” and it is the to as “chicken scratch,” and it is the responsibility of the pharmacy to interpret and responsibility of the pharmacy to interpret and clarify orders if necessary.clarify orders if necessary.

Many abbreviations used in prescribing Many abbreviations used in prescribing medication look very much alike.medication look very much alike.


Where Did Pharmacy Abbreviations Where Did Pharmacy Abbreviations Originate?Originate?

Terminology in pharmacy and medicine comesTerminology in pharmacy and medicine comes from the Latin and Greek languages. from the Latin and Greek languages.

Because pharmacy began in Europe, most ofBecause pharmacy began in Europe, most of the abbreviations have their origins in a foreign the abbreviations have their origins in a foreign language. language.

Latin and Greek serve as the universalLatin and Greek serve as the universal language that all medical personnel can language that all medical personnel can understand. understand.


Interpreting Doctors’ OrdersInterpreting Doctors’ Orders

It is very important for the pharmacy staff to It is very important for the pharmacy staff to interpret doctors’ orders correctly.interpret doctors’ orders correctly.

When writing out the various abbreviations, be When writing out the various abbreviations, be sure to write as neatly as possible because other sure to write as neatly as possible because other technicians and pharmacists will be reading your technicians and pharmacists will be reading your handwriting.handwriting.

Technicians must learn all of the dosage forms Technicians must learn all of the dosage forms and abbreviations to decipher doctors’ orders.and abbreviations to decipher doctors’ orders.


Do Not Use ListDo Not Use List

Drug errors that have occurred from the Drug errors that have occurred from the misinterpretation of medication orders led to misinterpretation of medication orders led to the creation of the do not use list.the creation of the do not use list. The list outlines the most common misread The list outlines the most common misread

abbreviations.abbreviations. These abbreviations should be avoided.These abbreviations should be avoided.

See Box 5-1.See Box 5-1.


Dosing InstructionsDosing Instructions

Dosing times are abbreviated on Dosing times are abbreviated on prescriptions.prescriptions.

Many pharmacy computers are programmed Many pharmacy computers are programmed to accept these abbreviations.to accept these abbreviations.

See Table 5-1.See Table 5-1. Computerized Doctor Order Entry


Classification of MedicationsClassification of Medications

Each drug can be broken down into Each drug can be broken down into groupings based on: groupings based on: Pharmacology Pharmacology Intent of use Intent of use Route of useRoute of use How the drug affects the body-by-body systemHow the drug affects the body-by-body system


Dosage FormsDosage Forms

A dosage form refers to the package or A dosage form refers to the package or container of which the drug has taken the container of which the drug has taken the shape.shape.

For example, it might be a tablet or a capsule.For example, it might be a tablet or a capsule. There is more than one type of tablet or There is more than one type of tablet or

capsule.capsule. Tablets come in a wide variety of shapes and Tablets come in a wide variety of shapes and

sizes.sizes.


Dosage Forms Dosage Forms (cont’d)(cont’d)

Much of what determines the dosage form of a Much of what determines the dosage form of a medication is determined by the drug’s medication is determined by the drug’s effectiveness.effectiveness.

Manufacturers prepare certain medications with Manufacturers prepare certain medications with the ability to release the active ingredient over an the ability to release the active ingredient over an extended period.extended period.


Three major categories of dosage forms:Three major categories of dosage forms: Solids- tablets, chewable tabs, enteric-coated tab, Solids- tablets, chewable tabs, enteric-coated tab,

capsulescapsules Liquids- syrups, elixirs, sprays, suspensionsLiquids- syrups, elixirs, sprays, suspensions Semisolids- creams, lotions, gels, ointments, Semisolids- creams, lotions, gels, ointments,

powders, suppositoriespowders, suppositories

Dosage Forms Dosage Forms (cont’d)(cont’d)


Solid agents can be contained in various Solid agents can be contained in various packages and administered by almost all routes packages and administered by almost all routes except parenterally (IV).except parenterally (IV).

Most tablets contain fillers (inert substancesMost tablets contain fillers (inert substances that have that have no active ingredient), sugar coatings, no active ingredient), sugar coatings, and certain additives.and certain additives.

SolidsSolids


Tablets are made to be administered sublingually Tablets are made to be administered sublingually (SL) or vaginally.(SL) or vaginally.

Chewable tablets are convenient for persons who Chewable tablets are convenient for persons who have difficulty swallowing and for children.have difficulty swallowing and for children.

Tablets can be scored or unscored and coated or Tablets can be scored or unscored and coated or uncoated. uncoated.

Solids(cont)Solids(cont)


Solids Solids (cont’d)(cont’d)

Unscored tablet Scored tablet



Tablets can be enteric coated (EC)Tablets can be enteric coated (EC)to protect the drug through the acidic to protect the drug through the acidic environment of the stomach or to delay release environment of the stomach or to delay release of the drug.of the drug.

Extended-releaseExtended-release types are made to control the types are made to control the amount of drug distributed over a set time.amount of drug distributed over a set time.



Plain tablets Scored tablets Enteric-coated tablets


Tablets/CapletsTablets/Caplets

Most common type of tablet contains some type Most common type of tablet contains some type of filler. of filler.

Fillers are composed of inert substances Fillers are composed of inert substances (no active ingredient) that serve to fill space or (no active ingredient) that serve to fill space or cover the tablet (sugar coatings).cover the tablet (sugar coatings). Coating improves taste and covers unpleasant odors.Coating improves taste and covers unpleasant odors.

Chewable tablets are also made.Chewable tablets are also made.


Tablets/Caplets Tablets/Caplets (cont’d)(cont’d)

Caplets are smooth sided and easier to Caplets are smooth sided and easier to swallow.swallow.

Many medications have extended-release Many medications have extended-release forms and regular forms.forms and regular forms.


CapsulesCapsules

Capsules can have either a hard or soft Capsules can have either a hard or soft outer shell.outer shell.

Hard capsules are composed of sugar, Hard capsules are composed of sugar, gelatin, and water.gelatin, and water.

Pulvule: This is a type of capsule that is Pulvule: This is a type of capsule that is shaped differently for identification purposes.shaped differently for identification purposes.


Capsules Capsules (cont’d)(cont’d)

Spansules are capsules that can be pulled Spansules are capsules that can be pulled apart to sprinkle the medication onto food for apart to sprinkle the medication onto food for childrenchildren

Soft-gelatin capsules (gel-caps) cannot be Soft-gelatin capsules (gel-caps) cannot be pulled apart, and often hold medications in pulled apart, and often hold medications in liquid formliquid form


Types of CapsulesTypes of Capsules

Capsules Extended-release capsules


Capsule SizesCapsule Sizes

Capsules come in different sizes: see Capsules come in different sizes: see Figure 5-5. Figure 5-5.

Capsuls vary in color, transparency, identifying Capsuls vary in color, transparency, identifying marks.marks.

Larger half is called Larger half is called bodybody; shorter half is ; shorter half is called called cap.cap.

Not all capsules are meant to be swallowed; Not all capsules are meant to be swallowed; content can be sprinkled on food.content can be sprinkled on food.


Lozenges/TrochesLozenges/Troches

These are other forms of tablets that are not These are other forms of tablets that are not meant to be swallowed but to dissolve in the meant to be swallowed but to dissolve in the mouth, which releases the medication more mouth, which releases the medication more slowly; similar to hard candy.slowly; similar to hard candy.

Cough dropsCough drops Troches are larger than normal-sized tablets Troches are larger than normal-sized tablets

and are flat; chalky consistency.and are flat; chalky consistency.


BiomaterialsBiomaterials

Biomaterials are polymers that combine with Biomaterials are polymers that combine with or encapsulate a drug.or encapsulate a drug. Can be capsules, tablets, or implantsCan be capsules, tablets, or implants

Activity of the drug can be activated due to Activity of the drug can be activated due to pH or solubility and released over a period of pH or solubility and released over a period of anywhere from 12 hours to several years.anywhere from 12 hours to several years.

Also known as excipients.Also known as excipients.


ImplantsImplants

A special type of capsule can be implanted A special type of capsule can be implanted under the skin and left in place for up to 5 years.under the skin and left in place for up to 5 years.

Contraceptives containing progestin are Contraceptives containing progestin are implanted.implanted.

Medication is released in a stair-step method.Medication is released in a stair-step method.


Transdermal PatchesTransdermal Patches Transdermal patches are solid pieces of material Transdermal patches are solid pieces of material

that hold a specific amount of medication to be that hold a specific amount of medication to be released into the skin over time.released into the skin over time.

They are easily administered and eliminate a They are easily administered and eliminate a possible upset stomach.possible upset stomach.

Uses:Uses: For angina, nitroglycerinFor angina, nitroglycerin For chronic pain, DuragesicFor chronic pain, Duragesic For motion sickness, scopolamineFor motion sickness, scopolamine

Patch overload


LiquidsLiquids

They are composed of various solutions.They are composed of various solutions. They can be administered by all routes.They can be administered by all routes. SyrupsSyrups are are sugar-based solutions that have sugar-based solutions that have

medications dissolved in them, which improves medications dissolved in them, which improves the taste of the drug. They tend to be thicker than the taste of the drug. They tend to be thicker than water.water.


Liquids Liquids (cont’d)(cont’d)

ElixirsElixirs are agents are agents that contain dissolved that contain dissolved medication in either an alcohol base or water medication in either an alcohol base or water and alcohol (hydroalcoholic) base.and alcohol (hydroalcoholic) base.

Alcohol usually covers up the bad taste of the Alcohol usually covers up the bad taste of the drug.drug.

Elixirs have the same consistency as water.Elixirs have the same consistency as water.


SpraysSprays

Sprays are composed of various bases such as Sprays are composed of various bases such as alcohol or water in a pump-type dispenser.alcohol or water in a pump-type dispenser.

Nasal decongestants or sunscreensNasal decongestants or sunscreens Nitroglycerin translingual spray that is used Nitroglycerin translingual spray that is used

under the tongue for relief of anginal painunder the tongue for relief of anginal pain


Inhalants and AerosolsInhalants and Aerosols Inhaler agents come in a variety of forms but all Inhaler agents come in a variety of forms but all

must be easily inhaled into the lungs.must be easily inhaled into the lungs. Common devices available OTC are vaporizers Common devices available OTC are vaporizers

and humidifiers.and humidifiers. Respiratory therapists use nebulizers to give Respiratory therapists use nebulizers to give

breathing treatments to hospital patients.breathing treatments to hospital patients. Patients can also be trained to use nebulizers Patients can also be trained to use nebulizers

at home.at home.


Inhalants and Aerosols Inhalants and Aerosols (cont’d)(cont’d)

Anesthetics are inhaled solutions that are Anesthetics are inhaled solutions that are administered by an anesthesiologist during administered by an anesthesiologist during surgery.surgery.

Prescribed inhalants contain drugs that treat Prescribed inhalants contain drugs that treat asthma and allergies.asthma and allergies.

Metered dose inhalers (MDIs) dispense a Metered dose inhalers (MDIs) dispense a specific amount of drug with each puff or specific amount of drug with each puff or inhalation.inhalation.


EmulsionsEmulsions

The mixture of water and oil when used with an The mixture of water and oil when used with an emulsifier binds the two together.emulsifier binds the two together.

Many different types of emulsifiers are used.Many different types of emulsifiers are used.


SuspensionsSuspensions

These are liquids that have very small, solid These are liquids that have very small, solid particles suspended in the base solution.particles suspended in the base solution.

They can be used orally by children and seniors.They can be used orally by children and seniors. Suspensions have a “Shake well” sticker and a Suspensions have a “Shake well” sticker and a

date of expiration.date of expiration. Reconstituted medication will need to be shaken Reconstituted medication will need to be shaken

and refrigerated.and refrigerated.


EnemasEnemas

Enemas might be administered for two different Enemas might be administered for two different reasons: retention or evacuation.reasons: retention or evacuation.

They can be used to deliver medication to the They can be used to deliver medication to the body, bypassing the stomach while being body, bypassing the stomach while being absorbed.absorbed.

Most common use is to evacuate the lower Most common use is to evacuate the lower intestine to prepare for surgeries or for women in intestine to prepare for surgeries or for women in labor.labor.


SemisolidsSemisolids

Semisolids contain both liquids and solids.Semisolids contain both liquids and solids. They are meant for topical application.They are meant for topical application. Creams have medications in a base that is part oil Creams have medications in a base that is part oil

and part water and for topical use.and part water and for topical use. Lotions are thinner than creams because their Lotions are thinner than creams because their

base contains more water.base contains more water.


Semisolids Semisolids (cont’d)(cont’d)

Ointments contain medication in a glycol or oil Ointments contain medication in a glycol or oil base; they cover the skin surface and keep out base; they cover the skin surface and keep out moisture.moisture.

Gels contain medication in a very viscous (thick) Gels contain medication in a very viscous (thick) liquid that easily penetrates the skin.liquid that easily penetrates the skin.

Pastes contain a smaller amount of liquid base Pastes contain a smaller amount of liquid base than solids. They are able to absorb skin than solids. They are able to absorb skin secretions, unlike other topical agents.secretions, unlike other topical agents.


SuppositoriesSuppositories

They can be used both rectally and vaginally.They can be used both rectally and vaginally. Rectal suppositories bypass the stomach, which Rectal suppositories bypass the stomach, which

is important if the patient has nausea and is important if the patient has nausea and vomiting.vomiting.

Vaginal suppositories are used mainly to treat Vaginal suppositories are used mainly to treat vaginal infections.vaginal infections.


PowdersPowders

Powders are solids, yet they can be packaged in Powders are solids, yet they can be packaged in some forms that allow them to be sprayed, some forms that allow them to be sprayed, similar to liquid dosage forms.similar to liquid dosage forms.

One of the main uses is to decrease the amount One of the main uses is to decrease the amount of wetness of an area.of wetness of an area.

Antifungal foot agentsAntifungal foot agents They can also be spread over a wide area.They can also be spread over a wide area.


InjectablesInjectables

Normally used for rapid response.Normally used for rapid response. Storage temperatures are important.Storage temperatures are important. Available in many types of containers:Available in many types of containers:

AmpulesAmpules Glass bottlesGlass bottles Glass and plastic vialsGlass and plastic vials BagsBags Add-O-vials Add-O-vials


Routes of AdministrationRoutes of Administration

By mouth or oral medications are very By mouth or oral medications are very convenient, do not need to be measured, less convenient, do not need to be measured, less expensive, systemic, and safe.expensive, systemic, and safe.

The downside is that they do not work as quickly The downside is that they do not work as quickly as parenterals(IV’s).as parenterals(IV’s).

Some drugs cannot be taken orally because they Some drugs cannot be taken orally because they are not as effective.are not as effective.


Sublingual and Buccal AgentsSublingual and Buccal Agents

Nitroglycerin, which treats anginal attacks, is the Nitroglycerin, which treats anginal attacks, is the most commonly used sublingual tablet.most commonly used sublingual tablet.

Buccal agents are placed between the gum and Buccal agents are placed between the gum and cheek, where the medication penetrates the cheek, where the medication penetrates the mouth lining and then enters the bloodstream.mouth lining and then enters the bloodstream.

See Figure 5-11.See Figure 5-11.


RectalRectal

Rectal (R) agents are used for a person who is Rectal (R) agents are used for a person who is vomiting and cannot take oral medications.vomiting and cannot take oral medications.

To reduce inflammation, either ointments or To reduce inflammation, either ointments or creams can be used in addition to suppositories.creams can be used in addition to suppositories.

They work on a specific site and not They work on a specific site and not systemically(through the body system).systemically(through the body system).

Downside: they are uncomfortable and the actual Downside: they are uncomfortable and the actual amount of drug absorbed is hard to predict.amount of drug absorbed is hard to predict.


TopicalTopical

Topical (TOP) preparations effects range from Topical (TOP) preparations effects range from systemic to localized for rashes.systemic to localized for rashes.

There are agents to fight skin infections, There are agents to fight skin infections, inflammation, and UV rays of the sun.inflammation, and UV rays of the sun.

They work at the site of action and systemically.They work at the site of action and systemically. An advantage is easy application.An advantage is easy application. A downside is that they might cause a reaction.A downside is that they might cause a reaction.


Parenteral comes from the Greek and means “side Parenteral comes from the Greek and means “side of intestine” or “outside of intestine.”of intestine” or “outside of intestine.”

The most common parenteral medications are The most common parenteral medications are given IV, IM, or SC.given IV, IM, or SC.

Very-smallVery-small––gauge needles are used, and the gauge needles are used, and the length depends on the site being injected.length depends on the site being injected.

A benefit is speed of action.A benefit is speed of action.

Parenteral: Intravenous, Intravenous Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, SubcutaneousPiggyback, Intramuscular, Subcutaneous


Parenteral: Intravenous, Intravenous Piggyback, Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, SubcutaneousIntramuscular, Subcutaneous (cont’d)(cont’d)

Parenteral drugs work within a few minutes.Parenteral drugs work within a few minutes. This is important for emergency situations, for This is important for emergency situations, for

those who are combative, or for those who are those who are combative, or for those who are unable to swallow.unable to swallow.

A disadvantage is the increased risk of infection.A disadvantage is the increased risk of infection. Narcan


Parenteral: Intravenous, Intravenous Piggyback, Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, SubcutaneousIntramuscular, Subcutaneous (cont’d)(cont’d)

Injections are more expensive and require Injections are more expensive and require preparation and administration by trained preparation and administration by trained personnel.personnel.

Another downside is that once a drug is Another downside is that once a drug is injected, there is little time to alter its course if injected, there is little time to alter its course if an allergic reaction takes place or too much an allergic reaction takes place or too much drug is given.drug is given.


All eye agents are sterile and are to be kept sterile All eye agents are sterile and are to be kept sterile during use.during use.

Doctors often use eye solutions to treat ear Doctors often use eye solutions to treat ear conditions, but ear solutions cannot be used to conditions, but ear solutions cannot be used to treat eye conditions because the eye is sterile.treat eye conditions because the eye is sterile.

Eye treatments are for infections, inflammation, Eye treatments are for infections, inflammation, and glaucoma.and glaucoma.

A main disadvantage of solutions for the eye, if A main disadvantage of solutions for the eye, if not kept sterile, is that they can introduce bacteria not kept sterile, is that they can introduce bacteria into the area being treated.into the area being treated.

Eye, Ear, NoseEye, Ear, Nose


Eye, Ear, Nose Eye, Ear, Nose (cont’d)(cont’d)

Ophthalmics do not last as long as other Ophthalmics do not last as long as other treatments because of the blinking of the eye treatments because of the blinking of the eye and tearing.and tearing.

Ointments make it hard to see clearly.Ointments make it hard to see clearly. For the eye, ear, and nose, there are different For the eye, ear, and nose, there are different

types of agents, including ointments, solutions, types of agents, including ointments, solutions, and suspensions.and suspensions.


Eye, Ear, Nose Eye, Ear, Nose (cont’d)(cont’d)

Otic preparations are not necessarily sterile Otic preparations are not necessarily sterile because they treat the ear canal and do not because they treat the ear canal and do not penetrate a sterile environment.penetrate a sterile environment.

Most ear treatments are for clearing up infections Most ear treatments are for clearing up infections or cleaning out ear wax buildup.or cleaning out ear wax buildup.

Most nasal sprays are used to treat colds and Most nasal sprays are used to treat colds and allergies.allergies.

These dosage forms work on the specific site These dosage forms work on the specific site rather than the whole body.rather than the whole body.

Nasal Spray Addiction


Represent many different components Represent many different components concerning the actions of a drugconcerning the actions of a drug

Considerations such as:Considerations such as: Levels of the drug throughout the blood and tissuesLevels of the drug throughout the blood and tissues Absorption or movement of the drug throughout the Absorption or movement of the drug throughout the

bodybody Overall distribution Overall distribution

Pharmacokinetics vs. Pharmacokinetics vs. PharmacodynamicsPharmacodynamics


Pharmacokinetics vs. Pharmacokinetics vs. Pharmacodynamics Pharmacodynamics (cont’d)(cont’d)

MetabolismMetabolism Excretion of the drugExcretion of the drug Reaction of the drugs with other drugsReaction of the drugs with other drugs Patient compliancePatient compliance Life of the drug that includes bioavailability, Life of the drug that includes bioavailability,

half-life, bioequivalence, and excretionhalf-life, bioequivalence, and excretion


AbsorptionAbsorption

Medications are made to get through natural Medications are made to get through natural body barriers, such as the skin, stomach, body barriers, such as the skin, stomach, intestines, blood-brain barrier, and other intestines, blood-brain barrier, and other membranous tissues.membranous tissues.

How well the drug passes through these How well the drug passes through these barriers is the one factor that determines its barriers is the one factor that determines its ultimate effectiveness.ultimate effectiveness.


DistributionDistribution

After the absorption of a medication, it is After the absorption of a medication, it is distributed throughout the body from the distributed throughout the body from the bloodstream into tissues, membranes, and, bloodstream into tissues, membranes, and, ultimately, organs of the body.ultimately, organs of the body.

The distribution of a drug is not necessarily equal The distribution of a drug is not necessarily equal throughout the whole body.throughout the whole body.


MetabolismMetabolism

Most metabolism takes place in the liver.Most metabolism takes place in the liver. Metabolism changes the chemical structure Metabolism changes the chemical structure

of the original drug.of the original drug. There are different influences that can alter There are different influences that can alter

metabolism such as age, gender, genetics, metabolism such as age, gender, genetics, diet, and other chemicals digested.diet, and other chemicals digested.


Excretion/EliminationExcretion/Elimination

Excretion is the last phase of a drug’s life in the Excretion is the last phase of a drug’s life in the body.body.

There are many ways a drug can be excreted There are many ways a drug can be excreted from the body: via the kidneys, feces, from the body: via the kidneys, feces, exhalation, sweat glands, breast milk.exhalation, sweat glands, breast milk.

Urination and bowel movements are the most Urination and bowel movements are the most common methods of excretion.common methods of excretion.


BioavailabilityBioavailability

This is the rate at which the drug makes it to its This is the rate at which the drug makes it to its destination and is available to the site of action destination and is available to the site of action for which it was intended.for which it was intended.

Many drugs travel into the liver before they Many drugs travel into the liver before they have a chance to be absorbed into the whole have a chance to be absorbed into the whole system.system.

This is known as the “first-pass effect.”This is known as the “first-pass effect.”


Half-LifeHalf-Life

Half-life refers to the measurement of the time it Half-life refers to the measurement of the time it takes the body to break down and excrete one takes the body to break down and excrete one half of the drug.half of the drug.

This is an important factor in the creation of This is an important factor in the creation of drugs because it tells the manufacturer how drugs because it tells the manufacturer how long it takes the body to rid itself of the drug.long it takes the body to rid itself of the drug.


BioequivalenceBioequivalence

This is the comparison between drugs either from This is the comparison between drugs either from different manufacturers or in the same company different manufacturers or in the same company but from different batches of a drug.but from different batches of a drug.

Generic drug manufacturers strive to achieve the Generic drug manufacturers strive to achieve the same equivalence to compete with brand name same equivalence to compete with brand name manufacturers.manufacturers.


Packaging and Storage RequirementsPackaging and Storage Requirements

Medications are packaged according to Medications are packaged according to manufacturers’ specifications to ensure manufacturers’ specifications to ensure effectiveness and shelf life of the drugeffectiveness and shelf life of the drug

All medications have a package insert that All medications have a package insert that describes the storage and stability of the drug.describes the storage and stability of the drug.

All dosage forms are approved through the FDA.All dosage forms are approved through the FDA.


Medical TerminologyMedical Terminology

Medical terms have their origins in Greek Medical terms have their origins in Greek and Latin.and Latin.

There are four segments of word parts:There are four segments of word parts: PrefixPrefix SuffixSuffix Root wordRoot word Combining formCombining form

See Box 5-3 and Table 5-9.See Box 5-3 and Table 5-9.

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