1. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 0 Drug Information and Drug Forms 1. What are local and systemic actions of medications? 2. Mrs. Jones daughter is concerned about the size of a capsule found with the medication ordered by the physician. She is aware that her mother has difficulty swallowing capsules because they stick to her tongue; large tablets are also a problem because they dissolve in her mouth. What could be a reason that Mrs. Jones has a problem with capsules? What type of tablets might make swallowing of the tablet easier for Mrs. Jones? 3. Sarah, an allied health student, is on externship and is asked to administer a medication to a patient in the ambulatory care setting. The medication is not one that she has administered before and is a new medication that she has not yet studied. What materials could Sarah find in the setting, and how important is it that Sarah is aware of the indications for and manifestations of the medication?

2. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 1 Learning Objectives  Determining the different means of classifying medications  Discussing what is meant by off-label medications  Contrasting drug names – generic, legend, over-the-counter, and chemical  Using main sources of drug information

3. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 2 Learning Objectives (cont’d.)  Using the Physicians’ Drug Reference® (PDR®) or other drug reference guide to list brand and generic names, drug classifications, product identification by shape and color, major precautions, available forms, dosage, and manufacturer.  Identifying and describing drug forms.

4. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 3 Drug Classifications  Complex system  Drug may be classified by  Therapeutic action on body organs  General use  Families of drugs  One drug may have more than one classification and may affect more than one body system

5. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 4 Off-Label Uses of Medications  “Off-label” – label lists medication’s FDA- approved purpose but not its alternative use.  The desired use may be therapeutic although it is not an approved use.  Physicians report unrelated effects of medications on patients and use the drug for that therapeutic effect  Example – Rogaine was developed as an antihypertensive but it has an off-label use of prevention of balding

6. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 5 Drug Nomenclature  Chemical name Name that identifies the exact chemical compound and its molecular structure Example – (ibuprofen) 2-(4-isobutylphenyl)propionic acid  Generic or nonproprietary name – drug’s official name found in the United States Pharmacopoeia (USP)  Not protected by a trademark  May be used on all products that are the same  Example - ibuprofen

7. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 6 Drug Nomenclature (cont’d.)  Brand or proprietary name  May also be called trade name or brand name  Belongs to the manufacturer  Marked with an ®  Example – Motrin, Advil designed to be easily remembered  first letter always capitalized  after 20 years, other companies can manufacture the drug; cannot use original brand name

8. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 7 Drug Nomenclature (cont’d.)  Legend drug  Drug sold by prescription  OTC drug  Does not require a prescription

9. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 8 Drug Information Sources  USP/NF – official drug list recognized by U.S. government  USP/DI – United States Pharmacopoeia/ Dispensing Information  Package Inserts  Physician’s Desk Reference (PDR)

10. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 9 PDR (cont’d.)  Seven sections  Section I (white) – manufacturer index  Section II (pink) – brand and generic names  Section III (blue) – product category index  Section IV (gray) – product identification guide Includes full-color, actual-size photos of drugs Includes full-color, actual-size photos of drugs  Section V (white) – production information section  Section VI (white) – diagnostic product information  Section VII (white) – miscellaneous information

11. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 10 Other Drug Resources  GenRx – published by Elsevier  Drug Facts and Comparisons  Drug Reference Manuals  Include most frequently used drugs in easy-to-read form  Reliable Web sites such as Rxlist.com or epocrates.com

12. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 11 Drug Forms and Drug Delivery Systems  solid  semisolid  liquid  gas

13. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 12 Oral Medications  solid, liquid, powder forms  convenient, economical, safe  absorbed slowly at unpredictable rate  affected by:  peristalsis  gastric secretions

14. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 13 Solid Oral Preparations Tablets:  enteric-coated  sustained-release  chewable  sublingual  Buccal  buffered  caplets  oral dissolving  unscored tablets  scored tablets

15. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 14 Safe Administration of Tablets

16. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 15 Solid Oral Preparations (cont’d.)  Capsules  sustained-release capsules  Delayed-release capsules  Gelcaps (semisolid, capsule containing liquid)  Troches or lozenges

17. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 16 Facts for Administering Capsules

18. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 17 Liquid Oral Preparations  active ingredients in liquid medium  two major categories  Solutions: active ingredient dissolved in liquid  Dispersions (suspensions): medication particles suspended in liquid

19. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 18 Liquid Oral Preparations (cont’d.) Solutions: Solutions:  syrups: aqueous-based solutions, sweetened with sugar or sugar substitutes  elixirs: solutions that contain sweetener, alcohol, and water  extracts: highly concentrated preparations achieved through evaporation of a solution  tinctures: very potent therapeutic medications  spirits: alcoholic or hydroalcoholic solutions containing volatile aromatic ingredients

20. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 19 Liquid Oral Preparations (cont’d.) Dispersions: Dispersions:  medication not dissolved in liquid; distributed throughout liquid  classified by size of ingredients  large particles suspensions, emulsions suspensions, emulsions  fine particles gels, magmas, milks (minerals in liquids) gels, magmas, milks (minerals in liquids)

21. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 20 Miscellaneous Oral Medications  Granules  Finely ground drug particles  Effervescent powders  Coarsely ground drug agents that are mixed with an effervescent salt that releases carbon dioxide when mixed in a liquid

22. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 21 Percutaneous Medications  ointments  pastes  gels or jellies  plasters  aerosol foams  liniments  colloids  tinctures  lotions  creams

23. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 22 Topical vs Transdermal Medications  Topical  Applied directly to skin  Transdermal  Absorption of drug through skin from patch or paper impregnated with medication

24. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 23 Percutaneous Medications (cont’d.) Transdermal patches:  drug-infused patch applied to skin for absorption  drug’s molecules are different sizes to allow absorption over various time periods  Used for:  angina  smoking cessation  chronic pain  estrogen replacement therapy

25. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 24 Percutaneous Medications (cont’d.) Ophthalmic preparations:  must be in sterile solution or ointment  Ocular inserts: small transparent membranes placed between the eye and lower conjunctiva (pilocarpina)

26. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 25 Percutaneous Medications (cont’d.) Otic preparations:  Drops administered for infections, or as a local anesthetic agent.  Warm eardrops to body temperature to prevent vertigo.  Tilt head away from affected side to prevent medication from draining from ear. Ear drop administration. From Potter PA, Perry AG (2001). Fundamentals of nursing (5 th ed.). St. Louis: Mosby.

27. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 26 Percutaneous Medications (cont’d.) Suppositories:  medication housed in cocoa butter, vegetable oil, glycerinated gelatin  solid for insertion— may need refrigeration  melts at body temperature Figure 3-12. Typical shapes of suppositories.

28. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 27 Percutaneous Medications (cont’d.) Respiratory medications:  nasal sprays: emit fine dispersion of liquids  aerosols: liquids in pressured container  metered dose inhalers: deliver fine medication mist into respiratory tract  nebulizers: deliver fine powder spray into respiratory tract  Inhalants are being increasingly used to treat respiratory conditions as well as for local effects.

29. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 28 Parenteral Medications  medications given by injection  must be sterile  stored in vials, ampules, premeasured cartridges Figure 3-6. Typical containers for injectable medications.

30. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 29 Parenteral Medications (cont’d.) Reconstituted medications:  Used with medications unstable as liquids  powders mixed with sterile liquid  limited shelf life after reconstitution  use sterile water or sterile normal saline as reconstitutional agent  Record date, time, strength of reconstitution, and the initials of person reconstituting the medication.  Gently mix medication until no sediment is visible.

31. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 30  implants or pellets: placed under skin for long-term, controlled release  tampons: drug-impregnated cotton packs, pads, and plugs  douches: water-based solutions to irrigate any body part or cleanse surgical wounds  enemas: liquids administered via the rectum Other Forms of Medication

32. Elsevier items and derived items © 2009 by Saunders, an imprint of Elsevier Inc. Some material was previously published. Slide 31 Packaging for Patient Compliance  Novolin pens: automatic insulin-delivery system  Useful for patients with visual problems and arthritis  Cartridge of insulin that is attached to pen and remains attached throughout use