1. Dosage Forms, Abbreviations, Routes of Administration, Drug Abbreviations, and Medical Terminology
Chapter 5

2. Types and Classification of Medications and Their Abbreviations
Lesson 5.1
Types and Classification of Medications and Their Abbreviations
Demonstrate the ability to translate abbreviations for dosage forms and routes of administration.
List the types of medications along with their classification.

3. Lesson 5.2 Dosage Forms of Drugs
List the most common dosage forms of drugs.
3a. Define the common abbreviations for extended-release agents.
3b. Explain how pH plays a part in the reactivity of drug administration.

4. Lesson 5.3 Common Routes of Drugs
List the most common routes of drugs, including pros and cons of each route, and at least three reasons why certain drugs need to be given by certain routes.

5. Lesson 5.4
Drugs in the Body, Components of Drugs, Drug Storage, and Medical Terminology 
Explain the difference between pharmacokinetics and pharmacodynamics.
List and explain the absorption, distribution, metabolism, and excretion of drugs in the body.
Discuss the different components of medications and how a drug's composition affects its bioavailability and pharmacological effectiveness.
7a. Define first pass as it relates to metabolism any why it’s important in drug delivery.

6. Lesson 5.4
Drugs in the Body, Components of Drugs, Drug Storage, and Medical Terminology (cont’d) 
Define half-life and describe factors that influence it.
Define the bioequivalance of drugs and its relationship to the Orange Book.
Describe why additives are necessary in the production of medications.
List three different common drugs and their storage requirements.
Define medical terminology abbreviations.
List the segments that make up medical terms and provide examples of each.

7. Introduction
For a technician to become proficient, it is necessary to interpret orders _________.
Many doctors’ handwriting is referred to as “chicken ______________,” and it is the responsibility of the pharmacy to interpret and clarify orders if necessary.
Many abbreviations used in prescribing medication look very much alike.
One company in Philadelphia offers handwriting workshops to help physicians write legibly and even faster.

8. Where Did Pharmacy Abbreviations Originate?
Terminology in pharmacy and medicine comes from the Latin and ___________ languages.
Because pharmacy began in Europe, most of the abbreviations have their origins in a foreign language.
Latin and Greek serve as the universal language that all ____________ personnel can understand.
Sometimes knowing the origin of a word or abbreviation can help a person to remember it.
For example, the D and S, used in abbreviations such as OD and OS, come from the Latin words dexter (right) and sinister (left). The right side was once associated with skill, as reflected in the word dexterous. In contrast, the left side was associated with evil, such as in the word sinister.

9. Interpreting Doctors’ Orders
It is very important for the pharmacy staff to interpret doctors’ orders correctly.
When writing out the various abbreviations, be sure to write as __________ as possible because other technicians and pharmacists will be reading your handwriting.
Technicians must learn all of the __________ forms and abbreviations to decipher doctors’ orders.

10. Do Not Use List
Drug ________ that have occurred from the misinterpretation of medication orders led to the creation of the do not use list.
The list outlines the most common misread abbreviations.
These abbreviations should be avoided.
See Box 5-1.

11. Dosing Instructions
Dosing ___________ are abbreviated on prescriptions.
Many pharmacy computers are programmed to accept these abbreviations.
See Table 5-1.

12. Classification of Medications
Each drug can be broken down into groupings based on:
Pharmacology
___________ of use
Route of use
How the drug affects the body-by-body system

13. Different Types of Drug Sales
Three classifications of drugs describing their _________________ to consumers:
Over-the-counter
Legend drugs
Behind-the-counter

14. Dosage Forms
A dosage form refers to the package or container of which the drug has taken the shape.
For example, it might be a tablet or a _____________.
There is more than one type of tablet or capsule.
Tablets come in a wide variety of shapes and sizes.

15. Dosage Forms (cont’d)
Tablets can be ____________ or unscored and coated or uncoated.
Much of what determines the dosage form of a medication is determined by the drug’s effectiveness.
Manufacturers prepare certain medications with the ability to release the active ingredient over an ______________ period.
Most scored tablets can be split without altering the medicine’s effectiveness.

16. Dosage Forms (cont’d) Unscored tablet Scored tablet
Figure 5-1
What are the benefits and drawbacks of scored tablets? (It’s possible to save money by buying a higher-dose tablet and using a pill splitter to cut it into smaller-dose tablets. This is an option if a physician recommends a smaller dose midway through a prescription. Some HMOs even endorse or require pill splitting, even though studies have shown that not all patients can safely and accurately split their medicines.)
Unscored tablet
Scored tablet

17. Dosage Forms (cont’d)
This allows the patient to take the medication less __________, which increases compliance.
Three major categories of dosage forms:
Solids
Liquids
Semisolids

18. Dosage Forms (cont’d)
Solid agents can be contained in various packages and administered by almost all ______________ except parenterally.
Most tablets contain fillers (inert substances that have no active ingredient), sugar coatings, and certain additives.
Inert ingredients might have one or more of the following purposes:
Fillers to increase volume so that the pill is easy to handle
Binders to hold the tablet together
Disintegrants to help the tablet dissolve within the USP-required 15 to 30 minutes
Colorants to give the tablet a distinguishable appearance

19. Dosage Forms (cont’d)
Tablets are made to be administered sublingually (SL) or vaginally.
Tablets can be scored to allow for dosage to be ________ ______ ____________.
Chewable tablets are convenient for persons who have difficulty swallowing and for children.
What does sublingual mean? (Under the tongue)

20. Dosage Forms (cont’d)
Tablets can be enteric coated (EC) to protect the drug through the acidic environment of the stomach or to delay release of the ___________.
Extended-release types are made to control the amount of drug distributed over a set time.

21. Dosage Forms (cont’d) Plain tablets Scored tablets
Figure 5-2
Plain tablets
Scored tablets
Enteric-coated tablets

22. Tablets/Caplets
Most common type of tablet contains some type of _____________.
Fillers are composed of inert substances (no active ingredient) that serve to fill space or cover the tablet (sugar coatings).
Coating improves taste and covers unpleasant odors.
_______________ tablets are also made.

23. Tablets/Caplets (cont’d)
Caplets are smooth __________ and easier to swallow.
Many medications have extended-release forms and regular forms.

24. Capsules Capsules can have either a _______ or soft outer shell.
Hard capsules are composed of sugar, gelatin, and water.
Pulvule: This is a type of capsule that is shaped differently for _________________ purposes.

25. Capsules (cont’d)
Spansules are capsules that can be pulled apart to sprinkle the medication onto ________ for children
Soft-gelatin capsules (gel-caps) ________ be pulled apart, and often hold medications in liquid form

26. Types of Capsules
Figure 5-4
Capsules
Extended-release capsules

27. Capsule Sizes Capsules come in different sizes: see Figure 5-5.
Capsules vary in___________, transparency, identifying marks.
Larger half is called body; shorter half is called ________.
Not all capsules are meant to be swallowed; content can be sprinkled on food.

28. Lozenges/Troches
These are other forms of tablets that are not meant to be swallowed but to dissolve in the mouth, which releases the medication more slowly; similar to hard candy.
Cough drops
Troches are larger than normal-sized tablets and are flat; chalky consistency.
Troche is pronounced “TRO-key” with a hard k because it’s a Greek word; some people pronounce it as “trosh” with a long o.
Clotrimazole, an antifungal, is one of the more common troches.

29. Biomaterials
Biomaterials are polymers (long chains of _______________________) that combine with or encapsulate a drug.
Can be capsules, tablets, or implants
Activity of the drug can be activated due to pH or solubility and released over a period of anywhere from 12 hours to several ____________.

30. Implants
A special type of capsule can be implanted under _____ _________and left in place for up to 5 years.
Contraceptives containing progestin are implanted.
Medication is released in a stair-step method.
Progestin birth-control implants are effective within 24 hours of insertion.

31. Transdermal Patches
Transdermal patches are solid pieces of material that hold a specific amount of __________________ to be released into the skin over time.
They are easily administered and eliminate a possible upset stomach.
Uses:
For angina, nitroglycerin
For chronic pain, Duragesic
For motion sickness, scopolamine
What other types of patches are popular today? (Nicotine and contraceptive patches are popular (and heavily advertised).

32. Liquids They are composed of various _____________.
They can be administered by all routes.
Syrups are __________-based solutions that have medications dissolved in them, which improves the taste of the drug. They tend to be thicker than water.
Why is liquid medication often a good option for young children? (Very young children or those with developmental delays might not have enough control of the swallowing reflex to handle solid medication. It is easy to adjust the dose of a liquid for a child’s weight.)

33. Liquids (cont’d)
Elixirs are __________ that contain dissolved medication in either an alcohol base or water and alcohol (hydroalcoholic) base.
______________ usually covers up the bad taste of the drug.
Elixirs have the same consistency as water.

34. Sprays
Sprays are composed of various ______ such as alcohol or water in a pump-type dispenser.
Nasal decongestants or sunscreens
Nitroglycerin translingual spray that is used under the ____________ for relief of anginal pain

35. Inhalants and Aerosols
Inhaler agents come in a variety of forms but all must be easily inhaled into the lungs.
Common devices available OTC are vaporizers and humidifiers.
Respiratory therapists use _______________ to give breathing treatments to hospital patients.
Patients can also be trained to use nebulizers at home.
How are orally inhaled agents often wasted? (If the patient does not use the device correctly, he or she will swallow most of the medication instead of inhaling it into the lungs.)

36. Inhalants and Aerosols (cont’d)
Anesthetics are _________ solutions that are administered by an anesthesiologist during surgery.
Prescribed inhalants contain drugs that treat _______________ and allergies.
Metered dose inhalers (MDIs) dispense a specific amount of drug with each puff or inhalation.
Many pharmacies now provide the FluMist nasal flu vaccine.
FluMist contains a portion of the live virus, so it should not be administered to people who have weaker immune systems, such as small children or seniors.

37. Emulsions
The mixture of water and ______ when used with an emulsifier binds the two together.
Many different types of emulsifiers are used.
Antacids are common OTC emulsions.
Homogenized milk is a stable emulsion: the tiny fat particles are bound to water by emulsifying proteins.

38. Suspensions
These are liquids that have very _______, solid particles suspended in the base solution.
They can be used orally by children and _____________.
Suspensions have a “Shake well” sticker and a date of expiration.
Remember to mix bulk doses of suspensions well before dispensing or repackaging.

39. Enemas
____________ might be administered for two different reasons: retention or evacuation.
They can be used to deliver medication to the body, bypassing the stomach while being absorbed.
Most common use is to _______________ the lower intestine to prepare for surgeries or for women in labor.

40. Semisolids Semisolids contain both liquids and solids.
They are meant for ____________ application.
Creams have medications in a base that is part oil and part water and for topical use.
Lotions are ____________ than creams because their base contains more water.

41. Semisolids (cont’d)
Ointments contain medication in a glycol or oil base; they cover the skin surface and keep out moisture.
Gels contain medication in a very viscous (thick) liquid that easily penetrates the skin.
Pastes contain a smaller amount of liquid base than solids. They are able to absorb skin secretions, unlike other topical agents.

42. Suppositories They can be used both rectally and vaginally.
Rectal suppositories bypass the stomach, which is important if the patient has nausea and vomiting.
Vaginal suppositories are used mainly to treat vaginal infections.
There are also some urethral suppositories.
Suppositories are solid while dry at room temperature, but they melt, soften, or dissolve in the body.
Compounding pharmacies use different bases for suppositories depending on the desired speed of effect.

43. Powders
Powders are solids, yet they can be packaged in some forms that allow them to be sprayed, similar to liquid dosage forms.
One of the main uses is to decrease the amount of wetness of an area.
Antifungal foot agents
They can also be spread over a wide area.

44. Injectables Normally used for rapid response.
Storage temperatures are important.
Available in many types of containers:
Ampules
Glass bottles
Glass and plastic vials
Bags
Add-O-vials

45. Routes of Administration
By mouth or oral medications are very convenient, do not need to be measured, less expensive, systemic, and safe.
The downside is that they do not work as quickly as parenterals.
Some drugs cannot be taken orally because they are not as effective.
How long does it take for an oral medication to become active? (Between 30 minutes and 1 hour)
What is the abbreviation for oral administration? (PO--PO is the abbreviation for the Latin per os, by mouth.)

46. Sublingual and Buccal Agents
Nitroglycerin, which treats anginal attacks, is the most commonly used sublingual tablet.
Buccal agents are placed between the gum and cheek, where the medication penetrates the mouth lining and then enters the bloodstream.
See Figure 5-11.
Buccal means cheek, but it is sometimes used to refer to the tongue (as in a buccal smear, in which cells are swabbed from the tongue for lab testing).

47. Rectal
Rectal (R) agents are used for a person who is vomiting and cannot take oral medications.
To reduce inflammation, either ointments or creams can be used in addition to suppositories.
They work on a specific site and not systemically.
Downside: they are uncomfortable and the actual amount of drug absorbed is hard to predict.

48. Topical
Topical (TOP) preparations effects range from systemic to localized for rashes.
There are agents to fight skin infections, inflammation, and UV rays of the sun.
They work at the site of action and systemically.
An advantage is easy application.
A downside is that they might cause a reaction.

49. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous
Parenteral comes from the Greek and means “side of intestine” or “outside of intestine.”
The most common parenteral medications are given IV, IM, or SC.
Very-small–gauge needles are used, and the length depends on the site being injected.
A benefit is speed of action.
What do the abbreviations IV, IM, and SC mean? (Intravenous, intramuscular, and subcutaneous)
What is another abbreviation for subcutaneous? (SQ)
Parenterals can also be administered intradermally (abbreviated ID). ID injections are administered just under the skin’s surface.
Typical uses of ID injections include skin testing for tuberculosis and allergies.

50. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous (cont’d)
Parenteral drugs work within a few minutes.
This is important for emergency situations, for those who are combative, or for those who are unable to swallow.
A disadvantage is the increased risk of infection.

51. Parenteral: Intravenous, Intravenous Piggyback, Intramuscular, Subcutaneous (cont’d)
Injections are more expensive and require preparation and administration by trained personnel.
Another downside is that once a drug is injected, there is little time to alter its course if an allergic reaction takes place or too much drug is given.
In 30 states, pharmacists can be authorized to administer IM and SC vaccines as prescribed by physicians.
Technicians who work in community pharmacies that offer vaccinations should be prepared to help respond to medical emergencies, such as allergic reactions.

52. Eye, Ear, Nose
Doctors often use eye solutions to treat ear conditions, but ear solutions cannot be used to treat eye conditions because the eye is sterile.
All eye agents are sterile.
Otic preparations are not necessarily sterile because they treat the ear canal and do not penetrate a sterile environment.

53. Eye, Ear, Nose (cont’d) All ophthalmics need to be kept sterile.
For the eye, ear, and nose, there are different types of agents, including ointments, solutions, and suspensions.
Most ear treatments are for clearing up infections or cleaning out ear wax buildup.

54. Eye, Ear, Nose (cont’d)
Most nasal sprays are used to treat colds and allergies.
Eye treatments are for infections, inflammation, and glaucoma.
These dosage forms work on the specific site rather than the whole body.
The latest generation of nasal sprays includes antihistamines, which can treat allergic reactions that result in nasal congestion at the site of the reaction.

55. Eye, Ear, Nose (cont’d)
A main disadvantage of solutions for the eye, if not kept sterile, is that they can introduce bacteria into the area being treated.
Ophthalmics do not last as long as other treatments because of the blinking of the eye and tearing.
Ointments make it hard to see clearly.

56. Inhalants Inhalants (INH) are used to treat lung diseases.
Dosage forms are limited but very effective if used properly.
MDIs are used for asthma, bronchitis, or emphysema.
Corticosteroids are also available in MDIs for more chronic conditions.

57. Inhalants (cont’d) There are two types: propellant and dry powder.
Onset of action is very quick.
Most aerosols come in handheld units and are very convenient.
The downside is that, if not used properly, little if any of the drug is able to get into the lungs.

58. Injectable
Long-acting parenteral drugs are available that can be used in place of daily dosing.
These should never be given intravenously.

59. Miscellaneous Routes
Miscellaneous routes include vaginal or uretheral dosage forms—suppositories, ointments, foams, and gels.
They are used for treatments of infections and inflammation; vaginal foams are used as a contraceptive.
Advantage: they bypass a systemic effect and affect a specific site.
Disadvantage: they are not easily applied and are uncomfortable.

60. Other Considerations: Form and Function
Dosage forms are created based on the results from many clinical trials that delve into the pharmacokinetics of the medication or the function of the drug in experiments.
Pharmacokinetics refers to the way the body handles a drug.

61. Pharmacokinetics vs. Pharmacodynamics
Represent many different components concerning the actions of a drug
Considerations such as:
Levels of the drug throughout the blood and tissues
Absorption or movement of the drug throughout the body
Overall distribution

62. Pharmacokinetics vs. Pharmacodynamics (cont’d)
Metabolism
Excretion of the drug
Reaction of the drugs with other drugs
Patient compliance
Life of the drug that includes bioavailability, half-life, bioequivalence, and excretion

63. Absorption
Medications are made to get through natural body barriers, such as the skin, stomach, intestines, blood-brain barrier, and other membranous tissues.
How well the drug passes through these barriers is the one factor that determines its ultimate effectiveness.
The blood–brain barrier (BBB) is a natural phenomenon in which capillaries around the brain prevent some substances from being absorbed by brain tissue.
In this way, the brain is protected from many common infections.

64. Absorption (cont’d)
Important chemicals and drugs are able to pass a lock-and-key mechanism by latching onto receptor sites that allow the chemical or drug to pass into the organ to reach the final site of action intended for the drug.

65. Distribution
After the absorption of a medication, it is distributed throughout the body from the bloodstream into tissues, membranes, and, ultimately, organs of the body.
The distribution of a drug is not necessarily equal throughout the whole body.
Most drugs will bind to blood proteins to some degree or another.
Drugs such as warfarin (a “blood thinner” or anticoagulant) and phenytoin (an anticonvulsant) are examples of types of drugs in which alterations in protein binding can become clinically important to the amount of drug available for distribution and therapeutic effect.

66. Metabolism Most metabolism takes place in the liver.
Metabolism changes the chemical structure of the original drug.
There are different influences that can alter metabolism such as age, gender, genetics, diet, and other chemicals digested.
Metabolism includes all the changes that a substance is subjected to in the body.

67. Excretion/Elimination
Excretion is the last phase of a drug’s life in the body.
There are many ways a drug can be excreted from the body: via the kidneys, feces, exhalation, sweat glands, breast milk.
Urination and bowel movements are the most common methods of excretion.

68. Bioavailability
This is the rate at which the drug makes it to its destination and is available to the site of action for which it was intended.
Many drugs travel into the liver before they have a chance to be absorbed into the whole system.
This is known as the “first-pass effect.”
Orally administered drugs both affect the liver and are affected by the liver.
What are ways to avoid the first-pass effect? (Drugs administered by other routes, such as sublingual, buccal, and parenteral routes, avoid the destructive effects of gastric fluids.)

69. Half-Life
Half-life refers to the measurement of the time it takes the body to break down and excrete one half of the drug.
This is an important factor in the creation of drugs because it tells the manufacturer how long it takes the body to rid itself of the drug.

70. Bioequivalence
This is the comparison between drugs either from different manufacturers or in the same company but from different batches of a drug.
Generic drug manufacturers strive to achieve the same equivalence to compete with brand name manufacturers.
A bioequivalence variation of 20% between generic and brand name drugs is legal, but actual variance averages 3.5%.
Drugs that are given in very small amounts, such as digoxin for heart failure, are less reliably interchangeable between brand name and generic because of the small margin of safety between a therapeutic dose and a harmful dose.
The FDA publishes bioequivalencies in the Orange Book.

71. The Use of Excipients
All medications are prepared with additives (excipients).
These include coloring, flavorings, fillers, and preservatives (Table 5-5).
Some patients may be allergic or intolerant to these additives.
Other types of excipient include those that increase the dispersing of the drug once it reaches the intestines and others that release the medication over a longer period of time.
The recipe for the same USP drug might vary between manufacturers because of different additives.

72. Manufactured Products
All types of dosage forms must be made and approved by the Food and Drug Administration (FDA).

73. Manufactured Products (cont’d)
Figure 5-8
Medication in Vials
Medication in Ampules

74. Packaging and Storage Requirements
Medications are packaged according to manufacturers’ specifications to ensure effectiveness and shelf life of the drug
All medications have a package insert that describes the storage and stability of the drug

75. Medical Terminology
Medical terms have their origins in Greek and Latin.
There are four segments of word parts:
Prefix
Suffix
Root word
Combining form
See Box 5-3 and Table 5-9.