Transcript Medication Administration Laws CH2

Medication Administration
Laws
Edited by Dr. Ryan Lambert
Bellacov
Violation of Laws and
Regulations
• When cases are filed in court the
– party or person filing the case is called the
plaintiff
– party being sued or that the case is against is
called the defendant
• Burden of proof
– responsibility of plaintiff to prove his /her case
– in crimes against the government the burden of
proof = reasonable doubt . Prosecutor or plaintiff
must provide convincing evidence that the party
committed the act, beyond any “reasonable” doubt
of a normal person.
Violation of Laws and
Regulations
• If the defendant is a licensed healthcare
provider (i.e., physician, nurse, pharmacist)
– the appropriate state medical board may examine
the case and determine whether or not the party’s
license should be revoked or suspended
Civil Law
• Civil law is a term given to areas of the law that
concern the citizens of the United States and the
wrongs they may commit against one another
• Covers issues such as:
– contracts
– tort: a wrong against another
Law of Agency and Contracts
• Law of agency and contracts is based on
the Latin term respondeat superior, which
translates to “let the master answer”
• General principle that applies to the
employee-employer relationship
– contracts made by employees are just as valid as
if the physician or the pharmacist who employed
them made the contract
Law of Agency and Contracts
• A contract is made in the pharmacy when the
technician receives a prescription from the
patient at the window
– by agreeing to get the prescription filled an implied
contract now exists:
• pharmacy and pharmacist are obligated to provide
the patient with a service
• if a mistake is made, the pharmacy and/or
pharmacist may be held liable, even though he or
she was not the one who entered into the contract
to provide service
– The pharmacist must “answer” for all of the acts of
the employees
Torts
• Tort is the term that refers to personal injuries
– a wrong that one citizen commits against another
• In a tort, the injured party sues the party that
caused the injury
• Governments do not take part in tort lawsuits
– the wrong was between two citizens and not against
the government and/or its laws and regulations
• The simplest tort is the “broken” contract
Torts
• Standard of care is a level of care expected
to be provided by various healthcare
providers
• Used to judge the type of care provided to a
patient based on
• Two criteria always taken into account
include:
– the level of training of the healthcare provider
– normal practices for the geographical area in
which the healthcare provider works
• Only those healthcare providers who work in
the same geographical area and have the
Torts
A pharmacy technician is not expected to
provide the same service or standard of care to
a patient as the pharmacist. Similarly, a
cardiologist would be expected to provide a
different service or standard of care than that of
a nurse practitioner at his office.
Torts
• Malpractice a form of negligence in which
the standard of care was not met
• In a case of negligence or malpractice, the
burden of proof is on the plaintiff to prove the
four Ds of negligence:
– duty
– dereliction
– damages
– direct cause
• The burden of proof in civil court is lower than
in a criminal case
– plaintiff must prove his/her case by a
“preponderance of the evidence”
Torts
• In malpractice, a guilty defendant found guilty may
be ordered to pay an award of money to the
plaintiff
– contributory negligence may be determined if two or
more causes are a factor in the negligence and personal
injury to the patient
• All pharmacies, most practicing pharmacists, and
some pharmacy technicians carry professional
liability insurance to protect their business and
personal assets
Torts
• Cases exist where the patient is found to have
contributed to his or her own injury (e.g., not
taking medication as directed) and found to be
comparatively negligent.
• In this case, the total award may be reduced
by a certain percentage, depending on the
judge or
jury’s determination.
Torts
• When a crime is committed in violation of a
state or federal law, the party is prosecuted
– the victim or his or her family also sue the party in
civil court for monetary damages
• The person may be tried twice, facing two
separate plaintiffs
– in the criminal case, the defendant might face
monetary fines, probation, or prison
– the civil case might result in monetary awards to
the victim/plaintiff
Learning Objectives
• Define the term drug and distinguish between
over-the-counter and legend drugs
• Explain the parts of a National Drug Code
number
• Categorize drugs by source as natural, synthetic,
synthesized, or semisynthetic
• Explain the uses of drugs as therapeutic,
pharmacodynamic, diagnostic, prophylactic, and
destructive agents
Pharmaceuticals
• A drug is any substance taken into or applied
to the body for the purpose of altering the
body’s biochemical functions and thus its
physiological processes
– a medical substance or remedy used to change
the way a living organism functions
– also called a medication
Pharmaceuticals
Drugs products contain many components:
• an active ingredient is the biochemically reactive
component of the drug
• inert ingredients or inactive ingredients have little
or no physiological effect
– stabilize the tablet or liquid formulation
– provide the raw material for many topical creams and
ointments
– ensure sterility of injectable products
– assist in the masking of unpleasant tasting medications
for pediatric patients
National Drug Code (NDC)
• A National Drug Code (NDC) number is a
unique number assigned to a product
– identifies the manufacturer, drug, packaging size, and
type
– appears on all drug labels
• Contains ten characters
– four or five digit labeler code, identifying the
manufacturer or distributor of the drug
– a three- or four- digit product code, identifying the
drug (active ingredient and its dose form)
– a two-digit package code
National Drug Code (NDC)
• NDC bar code numbers are used
– for drug recalls
– to compare medications dispensed in the filling process
to minimize medication errors
Parts of a National Drug Code
(NDC) Number
Visit the NDC
Directory
Classes of Drugs
Drugs are classified as over-the-counter (OTC) or
legend
• legend drugs can be dispensed only with a
prescription from a healthcare professional
licensed in that state
– labeled with the legend, “Caution: Federal Law Prohibits
Dispensing Without Prescription” or an equivalent
symbol
(
)
– the new legend in the updated labeling law is “
only”
drug caution
legend
Classes of Drugs
• Drugs with potential for abuse are classified
according to five drug schedules based on the
potential for abuse and physical and
psychological dependence
– Schedule II drugs such as narcotics and
amphetamines have a high potential for abuse
and dependence
– Schedule V cough syrups have a low potential
for abuse and limited potential for creating
physical or psychological dependence
Classes of Drugs
• Over-the-counter drugs can be dispensed
without a prescription
– proven relatively safe to be sold without prescription
• OTC drug labels
– must contain all the information necessary for a
consumer to safely take the medication
Learn more about the Drug Facts label at the Consumer Healthcare
Products Association Web site
Classes of Drugs
• Diet supplements, especially herbs, should
be considered drugs
– can cause side effects, adverse reactions, and
drug interactions
• Do not have the same stringent controls as
legend and OTC medications
Learn more about independent testing of diet supplements by
visiting ConsumerLab’s Web site
Classes of Drugs
• Diet supplements are considered “food
supplements” to maintain health
– a patient should not exceed the recommended daily
dose without the knowledge of a physician
– the MA can assist the providers by gathering
information on patient use of diet supplements and
adding this data to the computer profile
Classes of Drugs
• Homeopathic medications are very small
dilutions of natural drugs claimed to stimulate
the immune system
• Homeopathy is derived from the Greek words
homos (i.e., similar) and pathos (i.e., suffering
or disease)
Classes of Drugs
• Most homeopathics are OTC, but some
are prescription only.
Discussion
What are the differences between the
various classes of pharmaceuticals?
Answer: OTCs may be purchased without
prescriptions while legend drugs require a
prescription from an authorized practitioner;
controlled substances have abuse potential, and
homeopathic medications are natural extracts,
usually OTC.
Sources of Drugs
• Drugs come from various sources
• Can be classified as:
– natural
– synthetic (created artificially)
– synthesized (created artificially but in imitation of
naturally occurring substances)
– semisynthetic (containing both natural and
synthetic components)
Drugs from Natural Sources
• Some drugs are naturally occurring biological
products
– made or taken from single-celled organisms,
plants, animals, and humans
• Many herbal products come from
natural sources
• Modern-day drugs from natural sources
include:
– penicillin (extracted from certain molds)
– acetylsalicylic acid, commonly known as
aspirin, is derived from the bark of the
white willow tree
Synthetic, Synthesized, and
Semisynthetic Drugs
• A synthesized drug is a drug that is created
artificially
• A synthetic drug is a drug that is created
artificially in imitation of naturally occurring
substances
– to exert a specific pharmacologic effect
• A semisynthetic drug is a drug that is
created artificially and contains both natural
and synthetic components
Synthetic, Synthesized, and
Semisynthetic Drugs
• Biotechnology combines the science of
biology, chemistry, and immunology to
produce synthetic, unique drugs with specific
therapeutic effects
• These drugs can be created by means of the
recombinant deoxyribonucleic acid
(recombinant DNA) techniques of genetic
engineering
– using living organisms or parts of organisms for
specific purposes such as creating a synthetic
drug
Synthetic, Synthesized, and
Semisynthetic Drugs
• Deoxyribonucleic acid (DNA) is the complex,
helically shaped molecule that carries the
genetic code
• Contains the instructions, or recipe, for creating
messenger ribonucleic acid (mRNA)
– mRNA contains the recipe for arranging amino acids
into proteins for living organisms
• By transferring a segment of recombined DNA
into a host cell, scientists can change what
proteins the cell produces
Synthetic, Synthesized, and
Semisynthetic Drugs
• The Human Genome Project is the mapping
of the biochemical instructions that make up
the human body in health and disease
– potential disease can be identified at an earlier
date, and new treatments can be specifically
designed to treat them
Learn more about the Human Genome Project
Discussion
Give examples of drugs from various
sources.
Answer: Drugs may come from natural
sources (quinine from cinchona bark), may be
synthetic (barbiturates), or may be
semisynthetic (semisynthetic penicillins), or
may result from biotechnology (human
insulin).
Uses of Drugs
• Medications are used to:
– treat and cure illness
– aid in diagnosis
– prevent illnesses
• The action of a medication cannot be fully
accounted for without considering the dose
form selected
Therapeutic Agents
• A therapeutic agent is any drug that helps
to:
– maintain health
– relieve symptoms
– combat illness
– reverse disease processes
Pharmacodynamic Agents
• A pharmacodynamic agent is one that alters
bodily functioning in a desired way
– stimulate or relax muscles
– dilate or constrict pupils
– increase or decrease blood sugar
Diagnostic Agents
• A diagnostic agent facilitates an examination or
conclusion as to the nature or extent of a disease
condition
• Radiopharmaceuticals are chemicals containing
radioactive isotopes, used diagnostically (and also
therapeutically)
– nuclear pharmacy is the procuring, storage,
compounding, dispensing, and provision of information
about radiopharmaceuticals
Get more information on nuclear pharmacy technician training
programs at the American Pharmacists Association Web page
Prophylactic Agents
• A prophylactic agent prevents illness or
disease from occurring
– antiseptic
– germicidal liquid iodine
– any vaccine is considered a prophylactic agent
Destructive Agents
• A destructive agent has a -cidal action, meaning it
kills bacteria, fungi, viruses, or even normal cells or
abnormal cancer cells
– many antibiotics are bactericidal (they kill bacteria)
– radioactive iodine is used to destroy some of the thyroid
gland in patients with hyperthyroidism
– antineoplastic drugs used in cancer chemotherapy to
destroy malignant tumors
Discussion
Give examples of the various uses of drugs.
Answer: Drugs may be used to maintain
health (aspirin to prevent heart attack), to
relieve symptoms (analgesics), combat illness
(antibiotics), or reverse disease processes
(antihypertensives).
Comparison of Dose Forms and
Delivery Systems
• Dose form refers to the physical manifestation of a
drug as a solid, liquid, or gas that can be used in a
particular way
– common dose forms include tablets, capsules, creams,
ointments, solutions, injections, and aerosols
• Delivery system may mean any of the following:
– device used to deliver the drug
– design feature of the dose form that affects the delivery
of the drug
– means for transporting a drug to its site(s) of action within
the body
Comparison of Dose Forms and
Delivery Systems
• Delivery systems differ in pharmacological
properties
– sites of action
– rate of delivery
– quantities of active ingredient delivered
• Choice of delivery system depends on
–
–
–
–
active ingredient to be delivered
amount of active ingredient to be delivered
means or route by which ingredient is to be delivered
to what sites, at what rate, over what period of time, for
what purpose
Solid Dose Forms
• used more frequently than any other form
• are safest for self-administration
Tablets
• A tablet is a solid dose form produced by
compression containing one or more active
ingredients and, commonly, other
pharmacological ingredients including:
– diluents
– binders (promote adhesion of materials in tablet)
– lubricating agents (give a sheen and aid in
manufacturing process)
– disintegrates (help break up ingredients)
– solubilizers, colorings, flavorings
Tablets
• Some tablets are scored once
or twice to facilitate breaking
into portions for half or even
quarter doses
• Unscored tablets should not be
broken because the dose may not be equal in
each piece
– a tablet-splitter may be used for some unscored
tablets
– odd-shaped tablets are often difficult to cut, even
with a tablet splitter
Tablets
• Careful tablet splitting may be a way to reduce
medication costs, but it is not recommended for all
drugs
• Patients must be warned not to take a full tablet if such
action would result in an overdose of medication
Tablets
• Compression tablets are the most
inexpensive and common dose form
• Multiple compression tablets (MCTs) are
produced by multiple compressions
– created for appearance alone, to combine
incompatible substances into a single medication,
or to provide for controlled release in successive
events, or stages
(a) Two layers or compressions
(b) Three layers or compressions
Tablets
• A caplet is an oblong tablet that is a hybrid of
the capsule and tablet
– offers the advantage of easier swallowing than a
large tablet and more stability (and longer shelf
life) than a capsule
• Most tablets are uncoated
• A coating is a special outside layer that
dissolves or ruptures at the site of application
• Formulated to
– mask bitter taste
– prevent drug destruction in stomach
– delay release of drug into the intestines
Tablets
• Sugar-coated tablets (SCTs) contain an
outside layer of sugar
– protects the medication
– improves appearance and flavor
– BUT makes tablets much larger and heavier and
more difficult to swallow
• Film-coated tablets (FCTs) contain a thin
outer layer of a polymer
– thinner, lighter in weight, and cheaper to
manufacture than sugar coatings
– colored to provide an attractive appearance
Tablets
• Enteric-coated tablets (ECTs) are designed to
resist destruction by acid of gastric fluids
– release the active ingredient once it reaches the
higher pH of the intestine
• ECTs are used for drugs that are:
– destroyed by gastric acid
– irritating to the esophageal tract or stomach
– better absorbed by the intestines
Tablets
Enteric-coated tablets (ECTs) should not be
split.
Tablets
• A controlled-release medication is
designed to regulate the rate at which a drug
is released from the tablet and into the body
• May vary the rate of dissolution or the release
of the active drug
Tablets
Controlled-release dose forms should not be
split.
Controlled-release Medications
• A delayed-release dose form does not release the
active drug immediately after administration
• An extended-release dose form allows reduced
frequency of dosing
– also called long-acting, timed-release, and sustainedrelease dose forms
• A transdermal system dose form is designed to
deliver drugs to systemic circulation by passage
through the skin
– similar to how the extended-release tablets act by
passage through the stomach and/or small intestine
Controlled-release Medications
Watch the drug labels very carefully! Delayedrelease medication is not the same as extended- or
controlled-release medication of the same drug!
Other Tablet Types
• Chewable tablets have a flavored and/or colored
base
– designed to be masticated (chewed)
• Effervescent tablets are granular salts that
release gas
– dispense active ingredients into solution when placed in
water or juice
• Buccal tablets (and gum) are placed in the buccal
pouch
– between the cheek and the gum
– dissolved and absorbed by the buccal mucosa
Other Tablet Types
• Sublingual tablets are designed to be dissolved
under the tongue
– medication dissolved under the tongue is absorbed
very quickly
– immediately enters the bloodstream
• Vaginal tablets (or inserts) are placed into the
vagina
– by means of an applicator
– dissolved and absorbed through the vaginal mucosa
Capsules
• A capsule is a solid dose form consisting of a
gelatin shell that encloses the drug
– usually swallowed whole
– tasteless and are easier to swallow than tablets
• Contains powders, granules, liquids, or some
combination with one or more active
ingredients
• Since a capsule is enclosed, flavorings are
not common for this dose form
Capsules
• Can be designed in a controlled-release dose
form
• Controlled-release capsules are taken less
often
– increases compliance
• Long-acting form may give better control over
the disease state
– may be initially more expensive
– but fewer need to be purchased
• Takes a longer time for side effects to subside
Suppositories
• A suppository is a solid dose forms designed
for insertion into body orifices
– rectum or the vagina or, less commonly, the urethra
• May be the preferred dose form in
some cases when patient has nausea
and vomiting
• Avoided when possible because of
patient discomfort
Suppositories
The patient must remove the foil before inserting
the suppository!
Effervescent Salts
• Effervescent salts are granules or coarse
powders containing one or more medicinal
agents
– contains some combination of sodium bicarbonate
with citric acid, tartaric acid, or sodium
biphosphate
• Release carbon dioxide gas when dissolved
– causes a distinctive bubbling
Implants or Pellets
• Implants, or pellets, are dose forms placed
under the skin by means of minor surgery
• Used for long-term, controlled release of
medications
• Advantages include enhanced patient
compliance and convenience
• Complications at the site of insertion have
limited widespread use
Lozenges, Troches, or Pastilles
• Lozenges are dose forms containing active
ingredients and flavorings that are dissolved
in the mouth
– also known as troches or pastilles
– generally have local effects
Plasters
• Plasters are solid or semisolid and medicated or
nonmedicated preparations that adhere to the
body
– contain backing material such as paper, cotton, linen,
silk, moleskin, or plastic
Powders and Granules
• Usually ordered in bulk, dispensed as needed in
the prescribed amount
• Granules are larger than powders
– formed by adding very small amounts of liquid to
powders and passing the mixture through a screen or a
granulating device
• Granules
–
–
–
–
–
are generally of irregular shape
have excellent flow characteristics
are more stable than powders
may contain colorings, flavorings, and coatings
may have controlled-release characteristics
Discussion
What factors may influence the choice of a
dosage form for a drug?
Answer: Choice of dosage form may be
influenced by release properties, drug stability,
or route of administration.
Liquid Dose Forms
• Liquid dose forms consist of one or more
active ingredients in a liquid vehicle
• Two major categories are:
– solutions, in which active ingredients are
dissolved in the liquid vehicle
– dispersions, in which undissolved ingredients are
dispersed throughout a liquid vehicle
Liquid Dose Forms
• Advantages over solid dose forms are:
– ease of swallowing
– ease of adjusting the dose
– tablets or capsules cannot always be divided
• Disadvantage is:
– less stable than their solid counterparts
Liquid Dose Forms
Care should be taken to monitor storage
conditions of the liquid dose forms, to rotate
stock, and to check expiration dates often.
Solutions
• Solutions are classified by vehicle as:
– aqueous (water based)
– alcoholic (alcohol based)
– hydroalcoholic (water and alcohol based)
• A solvent is the vehicle that makes up the
greater part of a solution
• A solute is an ingredient dissolved in a
solution
Solutions
• An enema is usually a water-based solution
administered rectally for cleansing the bowel or
delivering active drug
• A collodion is a vehicle that is a volatile liquid
dissolved in a mixture of alcohol and ether and
used for a variety of topical uses
– upon application to skin, the solvent vaporizes, leaving
a film coating containing medication
Solutions
• Aromatic water is a solution of water containing
volatile oils or other substances
• An elixir is a clear, sweetened, flavored
hydroalcoholic solution containing water and
ethanol
• A syrup is an aqueous solution thickened with a
large amount of sugar or a sugar substitute
– may contain additional flavorings, colors, or aromatic
agents
– often the preferred vehicle to mask the taste for
pediatric medications
Solutions
• An extract is a potent dose form derived from
animal or plant sources
– from which most or all the solvent has been
evaporated
– used in the formulation or compounding of
medications
• A fluidextract is a liquid dose form prepared by
extraction from plant sources
• A tincture is an alcoholic or hydroalcoholic
solution of extractions from plants
• Spirits are alcoholic or hydroalcoholic solutions
containing volatile, aromatic ingredients
Solutions
A low-alcohol or alcohol-free product is
preferred for most pediatric products.
Solutions
• Parenteral solutions are products that are
prepared in a sterile environment for
administration by injection
• Two major delivery systems exist:
– intravenous (IV) infusions: fluids administered
directly into a vein
– injections
•
•
•
•
intravenous (IV) – into a vein
intramuscular (IM) – into the muscle
subcutaneous (SQ or SC) – under the skin
intradermal (ID) – into the skin
Dispersions
• Dispersions are undissolved ingredients
mixed throughout a liquid vehicle
– Classified by size of the dispersed ingredient(s)
into suspensions and emulsions containing:
• relatively large particles
• magmas, gels, and jellies (contain fine particles)
• ultrafines particles, less than a micron in size, called
a colloidal dispersion
• A suspension is a dispersion of a solid in a
liquid
• An emulsion is a dispersion of a liquid in
another liquid
Dispersions
• Solutions are classified by route of
administration
– oral (taken by mouth)
– topical (lotions applied to the skin)
– injectable suspensions
• Emulsions vary in their viscosity, or rate of
flow. Some common types are:
– oil-in-water (O/W) emulsion: emulsion containing
a small amount of oil dispersed in water
– water-in-oil (W/O) emulsion: emulsion containing
a small amount of water dispersed in an oil
Suspensions
Suspensions should always include a “Shake
Well” label.
Dispersions
• A lotion is a liquid for topical application
containing insoluble dispersed solids or
immiscible liquids
• A gel is a dispersion containing fine particles for
topical use on the skin
– particles are ultrafine
– colloidal dimensions
– linked to form a semisolid
Dispersions
• An ointment is a semisolid emulsion for topical
application
• May be medicated or nonmedicated and may
contain various bases:
– oleaginous or greasy bases such as petroleum jelly
– W/O emulsions such as lanolin
– O/W emulsions such as hydrophilic
ointment
– water-soluble or greaseless bases
such as polyethylene glycol ointment
Dispersions
• Pastes are like ointments but contain more
solid materials and are stiffer and apply more
thickly
– Zinc oxide paste
– Acetonide dental paste
• Creams are considered O/W emulsions.
Apply smoothly to the skin and leave a very
thin film. Most creams are considered
vanishing.
Discussion
Why do the differences between solutions and
dispersions have advantages in pharmaceutical
practice?
Discussion
Why do the differences between solutions and
dispersions have advantages in pharmaceutical
practice?
Answer: Solutions do not require shaking, but are
only appropriate for particles that dissolve in
suitable vehicles. Some dispersions have a thicker
consistency that is an advantage for topical use.
Inhalation Dose Forms
• Inhalations are gases, vapors, solutions, or
suspensions intended to be inhaled via the nasal
or oral respiratory routes
• A spray consists of a container with a valve
assembly that, when activated, emits a fine
dispersion of liquid, solid, or gaseous material
– an aerosol is a spray in a pressurized container with a
propellant to carry the active ingredient to its location of
application
– breath-activated devices of powders in place of
aerosolized propellants
• Most sprays and aerosols are for
– topical application to skin or to oral mucous membranes
– inhalation aerosols breathed in through the nose or
mouth
Discussion
What are some of the uses for inhalation
dose forms?
Answer: Sprays and aerosols are often used for
nasal decongestants and for inhalation of
antiasthmatic drugs. Many anti-inflammatory
medications are available both as a nasal spray
for allergies and as an aerosol for inhalation for
asthma.
Delivery Systems
• A delivery system may be
– a device used to deliver the drug
– a design feature of the dose form that affects the
delivery of the drug
– how a medication is formulated to release the
active ingredient
Inhalation Delivery Systems
• One of the most rapid means of administering
medication
• Gases such as oxygen, nitrous oxide or “laughing
gas,” and ether are administered by inhalation
• Medicated inhalations intended for the lung are
administered via
– metered-dose inhalers (MDIs)
• hand held, breath-activated, propellant-driven inhalers
– nebulizers
– vaporizers and humidifiers
• mechanical devices which deliver moisture to the air
Inhalation Delivery Systems
• A nebulizer is a device used to deliver medication
in a fine-mist form to the lung
– deliver a mist containing extremely small, or
micronized, powder
– a “nebulized” mist of medication may be more
effective than an “aerosolized” spray in delivering
medications into the deeper areas of the lung in
infants and young children
Syringe, Injection, and Infusion
Delivery Systems
• Injections of medications act rapidly to control
and treat symptoms
• Syringes are calibrated devices used to
accurately draw up, measure, and deliver
medication through a needle
• Injections must be sterile because they
introduce medication directly into the body
Syringe, Injection, and Infusion
Delivery Systems
Only trained professionals and healthcare
providers should give injections, and some risk
to the patient is always present.
Syringe, Injection, and Infusion
Delivery Systems
• Glass syringes are fairly expensive
• Plastic syringes are easy to handle,
disposable, and come from the manufacturer
in sterile packaging
– clearly preferred
– used both within and outside the hospital setting
• Different states have different regulations on
the sale of syringes
– potential diversion for injection of illegal drugs
– some states may require a prescription or the
placement of syringes behind the prescription
counter to control their sales
Syringe, Injection, and Infusion
Delivery Systems
insulin syringe
(measures from 30
to 100 U)
tuberculin syringe (with
cannulas ranging from 0.01
mL to 1 mL [used for skin
tests and drawing up very
small volumes of solution])
standard
hypodermic
syringes in sizes
from 1mL to 60mL
Syringe, Injection, and Infusion
Delivery Systems
•
•
Injections may be administered to almost any
organ or part of the body
Injectables come prefilled or are filled at the
time of injection from single or multidose
vials
– single-dose vials generally have no preservative
– multiple-dose vials, although they contain a
preservative, should be dated and discarded
(usually after thirty days)
– ampules are small glass containers that are
opened by breaking off the neck of the container
Syringe, Injection, and Infusion
Delivery Systems
Other devices for injection include:
• A patient-controlled analgesia
(PCA) infusion device used by a
patient to deliver small doses of
medication for chronic pain
• Jet injectors, which use pressure rather than a
needle to deliver the medication
• Ambulatory injection devices that the patient can
wear while moving about
Syringe, Injection, and Infusion
Delivery Systems
Only the patient should control the PCA pump
button.
Syringe, Injection, and Infusion
Delivery Systems
• Intravenous (IV) infusion
– method for delivering a large amount of fluid over a
prolonged period of time at a slow, steady rate
– used to deliver blood, water, other fluids, electrolytes,
nutrients
• IV infusions are used to:
– deliver pain-killing or blood clot buster medications
– replenish body fluids
– deliver nutrients to patients who cannot or will not feed
themselves
Intrauterine and Cervical Delivery
Systems
• An intrauterine delivery system is a way to
deliver medication to prevent conception or
treat cancer
– drug-releasing device placed into the uterus
– may contain a progestin hormone to prevent
pregnancy on a long-term (1 to 5 years) basis
• Cervical delivery systems are placed as a ring
surrounding the cervix to slowly release
medication
– replaced monthly by the patient and used as
contraceptive aids
Intrauterine and Cervical Delivery
Systems
Occasionally, the patient will expel these devices
spontaneously and may experience a high risk of
pelvic infection.
Transdermal Delivery Systems
• A transdermal delivery system (TDS) is a
method for delivering medications
percutaneously (through the skin)
• Also known as a “patch”
– consists of a backing, a drug reservoir, a control
membrane, an adhesive layer, and a protective strip
– the strip is removed, and the adhesive layer is
attached to the skin
Transdermal Delivery Systems
• Drug movement is by osmosis through the control
membrane, delivering medication systemically,
rather than locally
• Medication delivery can be controlled over 24 hours
or longer
– improves patient convenience and compliance
Other Delivery Systems
• Unit dose disposable syringes are prefilled
syringes that contain a single premeasured dose
of medication and are thrown away after use
• An oral syringe is a device without a needle to
administer medication to pediatric or elderly
patients unable to swallow tablets or capsules
– a calibrated device consisting of a plunger and a
cannula, or barrel
– used for administration of precisely measured amounts
of liquid medication by mouth
Other Delivery Systems
• A bulb syringe is a device used to irrigate eyes or
ears with water
– bulb is first depressed to expel the air that it contains,
and the tip is then inserted into the liquid to be
administered
– bulb is released while the end is in the liquid, and liquid
rises to fill the vacuum created
– end of the bulb is then removed from the liquid, and the
liquid is administered by depressing the bulb again
Other Delivery Systems
• A dropper uses a bulb to create a vacuum for
drawing up a liquid
– contains a small, squeezable bulb at one end and a
hollow glass or plastic tube with a tapering point
– may be incorporated into the cap of a vial or other
container
• gtt is an abbreviation for unit of pharmaceutical
measurement for droppers and IV infusions to
indicate drops
– due to the differing viscosities of fluids, the size of a
drop varies considerably from medication to
medication
• Droppers are often used for otic or ophthalmic
administration, as well as for oral medications
Other Delivery Systems
• Ocular inserts are a type of contact lens
device with active medication for administration
in the eye
– small, transparent membranes
– placed between the eye and the lower conjunctiva
• Hospices and long-term care facilities use
straws (long, hollow tubes) prefilled with pain
medications
• Another delivery system for contraceptives is
the polyurethane sponge
Discussion
What are some advantages of the specialized
medication delivery systems?
Answer: Delivery systems enable more efficient
delivery of medications to their sites of action,
greater convenience, and/or patient safety.
Drug References
• Official legal standards for drugs in the U.S.
are established by the United States
Pharmacopeial Convention (USP)
• Standards are published in two reference
works
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–
–
–
the United States Pharmacopeia
National Formulary (NF)
Both are revised every 5 years
also printed in a combined edition
• United States Pharmacopeia–National Formulary
(USP–NF)
Drug References
• The Physician’s Desk Reference
– published annually with reprints of package inserts
from the pharmaceutical manufacturers of most
drugs
– useful for identifying unknown drugs by color, shape,
and coding
Drug References
• Drug Facts and Comparisons
– factual information on:
•
•
•
•
•
•
•
•
product availability
indications
administration and dose
pharmacological actions
contraindications
warnings and precautions
adverse reactions
overdose and patient instructions
– updated monthly with new inserts
– available on CD-ROM
Drug References
• USP Drug Information
– originally published by USP
– patient counseling information for the pharmacist
• The American Hospital Formulary Service
(AHFS)
– information on drugs commonly used in the hospital
• The Handbook of Nonprescription Drugs
– published by the American Pharmacists Association
– provides a good reference for OTC drugs
Drug References
• FDA Electronic Orange Book
– officially named Approved Drug Products with
Therapeutic Equivalence Evaluations
– available online
– information on generic equivalency of drugs that may
have many sources
View the FDA Electronic Orange Book
Drug References
• Remington: The Science and Practice of
Pharmacy
– useful in compounding pharmacy for drug stability
and compatibility information
• The Lawrence Review of Natural Products
– scientific monographs on herbal medications
• Homeopathic Pharmacopeia of the United
States
– compilation of standards for the source, composition,
and preparation of homeopathic medications
Go to this book’s Information Resources Center (IRC) and visit the
Resources page found in the Pharmacy Library for a list of these
and other valuable resources
Discussion
• What drug references are available in your
practice or educational setting?
• Have you referred to them? For what kinds
of information?