Oral Solid Medications Solid oral medications come in several forms. Tablets Caplets Capsules Gelcaps Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Oral Solid Medications (cont.) Tablets Combination of an amount of drug with inactive ingredients Administration forms Oral (swallow) Sublingual Buccal Chewable Dissolvable Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Tablets are the most common form of oral solid medication. The inactive ingredient in tablets may be a starch or talc. The combination is formed into a solid disk or cylinder. Administration form may be sublingual – under the tongue. Administration form may be buccal – between cheek and gum. Some tablets can be dissolved in a liquid for drinking. Check the label for correct method of administration.

Oral Solid Medications (cont.) Tylenol caplets 500 mg Caplets Oval-shaped Made with a special coating that makes them easier to swallow Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Oral Solid Medications (cont.) Capsules Oval-shaped gelatin shells containing medication in powder or granule form Learning Outcome: 13.1 Demonstrate administration of solid oral medications. The shell is usually two pieces that fit together that can be separated to remove the medication if the patient cannot swallow the capsule.

Oral Solid Medications (cont.) Gelcaps A liquid medication in a gelatin shell Not designed to be opened Learning Outcome: 13.1 Demonstrate administration of solid oral medications.

Oral Solid Medications (cont.) Scored tablets Score allows the tablet to be divided when smaller doses are ordered. Most often, scored tablets divide into halves. Some divide into thirds or quarters. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Medication is evenly distributed throughout the tablet. Breaking scored tables is not optimal practice. Determine if another dosage is available before breaking scored tablets.

Calculating Dosages – Oral Solid Medications Rule 13-1 Always question and/or verify when your calculation indicates to give a portion of a tablet when the tablet is not scored. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Never attempt to break a tablet that is not scored.

Calculating Dosages – Oral Solid Medications (cont.) Rule 13-2 Question and recheck any calculation that indicates that you should administer more than three tablets or capsules. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Calculating Dosages – Oral Solid Medications (cont.) Rule 13-3 Follow these steps when determining the amount of medication to administer to a patient: Step A Convert Step B Calculate Step C Think! . . . Is It Reasonable? Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. If necessary, convert the desired dose to the same unit of measurement as the dose on hand. Perform dosage calculation using method of choice: proportion; dimensional analysis; or formula method. If necessary, recheck calculation.

Calculating Dosages – Oral Solid Medications (cont.) The order is to give the patient 15 mg mirtazapine PO now. On hand: 30 mg scored tablets Calculate the correct amount of medication to administer using method of choice. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Calculating Dosages – Oral Solid Medications (cont.) H = 30 mg ; Q = 1 scored tablet; D = 15 mg Step A Convert No conversion is necessary. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Step A Dose ordered is the same unit of measure as dose ordered, so no conversion is necessary.

Calculating Dosages – Oral Solid Medications (cont.) Step B Proportion H/Q = D/A or H:Q = D:A 30 mg/1 tab = 15 mg/A 30 x A = 1 tab x 15 30A/30 = 15 tab/30 A = 0.5 tab = 1/2 tab Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Calculating Dosages – Oral Solid Medications (cont.) Step B Dimensional analysis A = Q/H x D/1 A tab = 1 tab/30 mg x15 mg/1 A tab = 15 tab/30 A tab = 0.5 tab = 1/2 tablet Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Calculating Dosages – Oral Solid Medications (cont.) Step B Formula Method 15mg/30 mg x 1 tab = A 15 tab/30 = A 0.5 tab = 1/2 tablet = A A xQ = H D Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Calculating Dosages – Oral Solid Medications (cont.) Step C Think! . . . Is It Reasonable? 15 mg is one-half of 30 mg, so 1/2 tablet is an appropriate answer. Tablets are scored, so 1/2 tablet can be given. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Error Alert Observe patients as they take their medications. Leaving medications at the bedside leads to errors. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Reason for errors: Patients may forget to take their medications or may take them at wrong time. Medications may be spilled or dropped. The patient may have difficulty swallowing the medications leading to possible aspiration.

Crushing Tablets or Opening Capsules Who benefits? Patients who have difficulty swallowing pills Patients who have tube feedings Check the policy May need physician order first Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Crushing Tablets or Opening Capsules (cont.) When mixing with food prepare tablet or capsule; mix with soft foods or liquids. Check for interactions before mixing. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Be sure there are not interactions with food before mixing. Example: Tetracycline should not be given with foods containing milk, antacids, or vitamin and mineral supplements.

Some Common Food and Drug Interactions Antipsychotics Coffee and tea Reduced effectiveness of drug Bronchodilators Caffeine Stimulation of the nervous system CNS depressants Black cohosh, ginseng, kava kava, St. John’s wort, valerian, ETOH Intensified sedative effects of drug Erythromycin Acidic fruits, juices, carbonated beverages Decreased antimicrobial activity Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Some Common Food and Drug Interactions (cont.) Ferrous sulfate Tea Decreased absorption Haloperidol Coffee and tea Insulin Coffee Stimulated excretion MAO inhibitors Foods with tryamine (hard cheeses, chocolate, red wine, and beef or chicken liver) Headache, nosebleed, chest pain, severe hypertension Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Some Common Food and Drug Interactions (cont.) Tetracyclines Dairy products Reduced effectiveness of the drug Antihistamines, cholesterol lowering agents, calcium channel blockers Grapefruit and grapefruit juice Muscle aches, fatigue, increase in side effects Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Crushing Tablets or Opening Capsules (cont.) Tube feedings Dissolve the crushed tablet or opened capsule in a small amount of warm water. If medication cannot be crushed check for an alternative form; ask the physician to change the order. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Warm water (not hot) helps the medication dissolve better.

Crushing Tablets or Opening Capsules (cont.) Enteric-coated tablets: deliver medication that would be destroyed by the stomach acid or that could injure the stomach lining; must never be crushed, broken, or chewed. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Coating dissolves only in an alkaline environment such as the small intestine.

Crushing Tablets or Opening Capsules (cont.) Sustained-Release Medications Drug is released slowly into the bloodstream. Do not crush or dissolve – this allows too much medication to be absorbed at one time. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. If scored, break at scored line; otherwise, do not break it.

Crushing Tablets or Opening Capsules (cont.) Spansules contain granules of medication with different coatings that delay release of some of the medication; may be opened and the granules gently mixed with soft food. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Do not crush or dissolve the granules.

Crushing Tablets or Opening Capsules (cont.) Rule 13-4 To prevent an incorrect dose of medication, do not crush or otherwise alter any of the following: enteric-coated tablets; sustained-release forms of medication; any tablet with a hard shell or coating; Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications.

Crushing Tablets or Opening Capsules (cont.) Rule 13-4 (cont.) any tablet with layers or speckles of different colors; tablets for sublingual or buccal use; capsules with seals that prevent separating the two parts. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications.

Crushing Tablets or Opening Capsules (cont.) Indication of sustained-release drugs: -Bid LA Tempule -Dur CR Chronotab Plateau Cap XL Repetab Span Sequel Tembid SA Spansule SR Extentab Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drugs that must not be crushed / dissolved

Crushing Tablets or Opening Capsules (cont.) Indication of enteric-coated drugs: EC Enseal Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drugs that must not be crushed / dissolved

Patient Education Determining how many pills to take Perform necessary calculations first. Determining whether or not to take with food Drink at least 8 oz of water with any medication. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Know how many pills the patient will have to take prior to starting education process.

Patient Education (cont.) Divided tablets Pharmacist can provide service of dividing the tablets. If patient will do dividing himself, he should: wash his hands; break tablet along scored line; use a knife or pill cutter. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. If the patients will be dividing the tablets, provide a demonstration. Grasp the tablet with the scored line between your fingers. Exert pressure in the same direction—downward or upward—with both hands, until the tablet breaks along the scored line. You may use a knife or pill cutter to break the tablet. Place the tablet on a clean surface, place the blade in the scored line, and press directly downward until the tablet breaks. (Cutting on a slice of bread prevents the halves of the pills from “flying” away.)

Patient Education (cont.) If patients have difficulty swallowing, they can drink water before taking pills; place whole tablet or capsule in food; crush tablets. Place between two spoons. Use pill crusher. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Drinking water first moistens the mouth. The pill will go down when the food is swallowed. Note: Also tell patients which foods should not be used. Warn patients not to crush any medication without first checking with the pharmacist or physician.

Practice Ordered: Ploglitazone HCl 45 mg po On hand: see label (unscored tablet) What is the amount to administer? What action should you take? Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. H = 30 mg Q = 1 tablet D = 45 mg Step A No conversion is needed. Step B 45mg / 30mg x 1 tab = A [cancel units (mg)] 1.5 x 1 tab = A = 1.5 tab Step C Dose ordered is 1.5 times greater than dose on hand, so 1.5 tab is reasonable. Since tablets are not scored, you should check to see if another dosage strength is available. If not, you must contact the physician to change the order. ANSWER: 1 1/2 tablet ANSWER: Do not break tablet; check for another dose; contact physician.

Practice Ordered: Alpraxolam 1.5 mg po q 6 h On hand: see label (scored into fourths) What is the amount to administer? What action do you take? ANSWER: ¾ tablet Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1a. Calculate dosages for solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Step A No conversion is needed. Step B H = 2 mg Q = 1 tablet (scored) D = 1.5 mg 1.5mg/2 mg x 1 tablet = A [cancel units (mg)] 0.75 x 1 tab = 0.75 tab = 3/4 A Step C Dose ordered is greater than half but not as much as dose on hand, so 3/4 tablet is reasonable. Carefully break tablet in half at score, and then break one of halves in half again. Administer the half and the quarter sections of the tablet. ANSWER: break tablet and administer 3/4 tablet

Apply Your Knowledge True or False ___ Any tablet can be broken in half to give a patient the correct dose. ___ Enteric-coated tablets can be crushed and given through an NG tube. ___ Some spansules can be pulled apart so the granules can be given with applesauce. F Only scored tablets should be broken. F Medication could be broken down by stomach acid, or it could injure the stomach lining. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Remember! Granules should never be crushed. T

Apply Your Knowledge Which of the following foods are contraindicated to mix with tetracyclines? Water Orange juice Milk Applesauce Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Tetracycline is inactivated by milk and milk products, as well as antacids, vitamins, and minerals. Orange juice is acceptable unless it has added calcium.

Apply Your Knowledge Which of the following types of medications may be crushed for administration? Scored tablets Enteric-coated tablets Sustained-release tablets Spansules Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. The absorption rates for the other forms of medications may be altered if they are crushed.

Apply Your Knowledge What preparation must be done before administering a crushed medication through a nasogastric tube? Nothing special is needed. Mix the medication with applesauce. Mix the medication with warm water. Mix the medication with ice cream. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. Warm water helps dissolve the medication to make it easier to instill through the NG tube.

Apply Your Knowledge True or False F F T ___ You must write only the date and time you reconstituted the medication on the label.. ___ The physician will only order doses of liquid oral medications in volume of liquid. ___ When reconstituting a medication, select a strength that will provided the desired dose in the smallest volume. F You also have to write your initials and strength, if needed. F Medications are usually ordered in units of drug, rather than volume. Learning Outcome: 13.1 Demonstrate administration of solid oral medications. Learning Outcome: 13.1b Explain principles related to administration of solid oral medications. You must include the strength on the label if the medication can be reconstituted in more than one strength. T