Transcript Compounding - Denton ISD

The Pharmacy Technician
FOUNDATIONS AND PRACTICES
Chapter 10
Introduction to
Compounding
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 10.1
A pharmacy technician compounding a prescription.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Rationale for Compounding
• Certain valuable drugs have been
•
•
discontinued by their manufacturers
The FDA has removed some drugs from
the market
Drugs may not be available in a strength
or dosage form appropriate for a specific
patient
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Rationale for Compounding (cont.)
• Patients may have sensitivities or allergies
•
to preservatives or other substances
A combination therapy may not be
commercially available
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Basic Procedures in Compounding
• Obtaining the recipe or formula
• Writing a worksheet based on the formula
• Collecting all ingredients and equipment
•
•
necessary to prepare the compound
Weighing each ingredient and having
measurements verified by the pharmacist
Following the directions of the formula to
prepare the compounded medication
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Basic Procedures in Compounding
(cont.)
• Packaging and labeling the compounded
•
•
medication in an appropriate container
Having the pharmacist provide a final
check of the compound
Cleaning the workstation and equipment
used
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Table 10.1
Examples of Compounding Equipment
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Table 10.1 (continued)
Examples of Compounding Equipment
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Table 10.1 (continued)
Examples of Compounding Equipment
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 10.5
A technician prepares tablets using a mold.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Solid Dosage Forms
• Capsule—a solid dosage form in which the
•
active ingredient and any excipients are
enclosed in a soluble gelatin shell that will
dissolve in the stomach
Tablet—a solid dosage form that may be
administered orally, sublingually, vaginally,
or as a pellet under the skin
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Solid Dosage Forms (cont.)
• Powder—a solid dosage form made from
•
•
blended active ingredients and excipients
Lozenge—a solid dosage form
administered orally to be dissolved in the
mouth
Troche—interchangeable term for
lozenge, but sometimes prepared in soft
form
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Solid Dosage Forms (cont.)
• Stick—used in topical application of local
•
anesthetics, sunscreens, antivirals, and
antibiotics
Suppository—a solid dosage form used to
administer medication by way of the
rectum, vagina, or urethral tract
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 10.4
Capsule size chart.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Liquid Dosage Forms
• Solution—a water-soluble chemical
•
•
dissolved in water
Suspension—liquids containing
ingredients that are not soluble in the
vehicle
Emulsion—a suspension consisting of two
immiscible liquids and an emulsifying
agent to hold them together
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Semisolid or Soft Solid Dosage Forms
• Ointment—a semisolid topical preparation
•
•
that is applied to the skin or mucous
membranes
Cream—soft solid that is opaque and
usually applied externally
Paste—stiff, or very viscous, ointment that
does not melt or soften at body
temperature
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Semisolid or Soft Solid Dosage Forms
(cont.)
• Gel—semisolid system consisting of
suspension made up of small inorganic
particles or of large organic molecules
interpenetrated by a liquid
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Other Dosage Forms
• Ophthalmic—preparations for the eye
• Otic—preparations for the ear
• Nasal—preparations for the nose or
sinuses
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Psychological Impact of Medication
Flavoring
• Medication with an appealing color/taste is
•
•
perceived as more effective by patients
Successful flavoring helps ensure
medication compliance
Sight and sound play an important role in
flavor experience
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Sensory Roles in Flavoring
• Influenced by taste, smell, sight, touch,
•
and sound
Smell makes a stronger impression on a
person than actual taste
– Females are more sensitive to smell than
males
• Elderly patients may require extra flavoring
• Certain diseases alter a patient’s ability to
taste and smell
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Flavoring Considerations
• Focus on the individual patient
– Be aware of allergies or sensitivities—
chocolate, peanuts, particular preservative or
dye
– What does this patient like?
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Flavoring Considerations (cont.)
• Pediatric flavoring
– Children have more taste buds and are more
sensitive to taste
– Prefer sweet tastes; dislike bitter flavors
– Newborns/babies with less taste “experience”
require less flavor
– Some appropriate flavor choices include
raspberry, bubblegum, marshmallow, berry,
citrus, vanilla
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Flavoring Considerations (cont.)
• Adult Flavoring
– More tolerant of bitter flavors
– Use flavoring agents like coffee, chocolate,
cherry, anise, grapefruit, or mint with
extremely bitter drugs to cut bitterness
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Flavoring’s Impact on Stability,
Solubility, and Ph
• Some flavors may raise or lower pH of
compounded medication and cause
instability
– Aqueous solutions should be flavored with
water-miscible flavors
– Oil preparations require an oil-based flavor
• Some flavoring agents/preservatives in the
flavor may affect the active ingredient in
the compound and cause degradation of
the drug
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Flavoring’s Impact on Stability,
Solubility, and Ph (cont.)
• Use a flavoring agent that will not affect
pH for compounded medications that are
stable only at a certain pH
– Obtain exact pH from the company that
produces the flavoring agent; most provide a
list of flavors and relative pH values
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Four Taste Types
• Sour, sweet, bitter, and salty
• “Fifth” sense is called umami—tastes
•
glutamates and cannot be duplicated by
the combination of any of the other four
tastes
Taste buds contain taste receptors for all
tastes
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Figure 10.20
The four basic taste experiences are sour, sweet, bitter, and salty.
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Basic Flavoring Techniques
• I. Blending uses a flavor that will blend
with the drug taste
– Example: Citrus flavors blend with sour
tastes; bitter tastes can be blended with salty,
sweet, and sour tastes; salt reduces
bitterness and sourness and increases
sweetness
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Basic Flavoring Techniques (cont.)
• II. Overshadowing or overpowering uses a
flavor with a stronger intensity than the
original product
– Examples: Wintergreen, methyl salicylate,
glycyrrhiza (licorice), and oleoresins
• III. Physical methods include formation of
insoluble ingredients into a suspension
and emulsification of oils
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Five Basic Flavoring Techniques (cont.)
• IV. Chemical methods include absorption
•
of the drug with an ingredient that
eliminates the taste of the offensive drug
V. Physiological methods include use of
an additive, such as peppermint, to
anesthetize taste buds and thus reduce
their sensitivity
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Coloring
• Should be appealing and appropriate for
dosage form
– Not always necessary
– Use minimal amount to keep color “light”
• Coloring agent should match flavor of the
product
– Example: Cherry should be red, grape should
be purple, and so on
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.
Coloring (cont.)
• Be aware of patient sensitivities or
allergies to certain dyes
– Dye-free flavoring agents available
The Pharmacy Technician: Foundations and Practices
Mike Johnston, Karen Davis, and Jeff Gricar
Copyright ©2009 by Pearson Education, Inc.
Upper Saddle River, New Jersey 07458
All rights reserved.