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INTERNSHIP 5 7 by NgZcbk7f

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									                     INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.
Exercise 5

       Dosage Forms
Dosage Form
 also known as pharmaceuticals.
 It is define as preparation devised
 to make possible administration of
 medications in measured or
 prescribed amount.
 Parenteral Dosage Forms – are
  preparation introduced into the body by
  injection through the skin, the mucous, or the
  serous membranes

 Dosage forms for inhalation – are
  preparations intended to be finally dispensed
  or vaporized to the mucous membranes of the
  lower part of the respiratory tract.
 Oral Dosage Forms - are preparations
    intended to be taken orally.

 Rectal Dosage Forms - are preparations
    employed for systemic effect or a local
    action through the rectum.
 Dosage Forms For Topical application
    are preparations intended to be applied on
    the skin or instilled into eyes, nose, or ears.

 A. Solutions – a homogenous mixture
  that is prepared by dissolving a solid or liquid
  or gas in another liquid; it represents a group
  of preparations in which the molecules of the
  solute or dissolved substances are dispersed
  among those of the solvent
 Water – used mainly as a vehicle and as a solvent
     for the desired flavoring or medicinal
 Aromatic water – also known as medicated water,
     clear saturated aqueous solutions of volatile
     oils or aromatic or volatile substances.
 Aqueous acids – official inorganic acids and
     certain acids although of minor significance as
     therapeutic agents are great importance in
     chemical and pharmaceutical manufacturing.
 Diluted acids – aqueous solutions of suitable
     strength usually 10% w/v except diluted
     acetic acid which is 6% w/v
 Douches – aqueous solutions directed
     against a part or into a cavity of the body
 Enemas – also known as evacuation
     enemas. They are rectal injections
     employed to evacuate bowel retention
     enemas to influence the general system
     by absorption, or to effect locally the seat
     of disease.
 Gargles – aqueous solutions used for
     treating the pharynx and nasopharynx by
     forcing air from the lungs through the
     gargle which is held in the throat.
 Mouthwashes – aqueous solutions which
     are most often used for their deodorant,
     refreshing, or antiseptic effect.
 Juices – prepared from fresh ripe fruits,
     aqueous in character and used in making
     syrups which are employed as vehicles.
 Nasal solutions – usually aqueous solutions
     which are deigned to be administered to
     the nasal passages in drops or spray
 Otic solutions – aqueous preparations
     dispensed in a container which permits
     the administration of drops to the ear

 Collodion –liquid preparations containing
      pyroxillin in a mixture of ethyl ether and
 Elixirs – clear, pleasantly flavored sweetened
      hydro-alcoholic liquids intended for oral
 Glycerites – solutions or mixtures of
      medicinal substances in not less than 505
      by weight of glycerin
 Inhalations – are solutions of drugs
     administered by the nasal or oral
     respiratory route for local or systemic
 Liniments – solutions or mixtures of various
     substances in oil, alcoholic solutions of
     soap or emulsions.
 Oleovitamins – fish liver oils diluted with
     edible vegetable oil or solutions of volatile
     substances of      the indicated vitamins or
     vitamin concentrates (usually A and D) in
     fish liver oil.
 Spirits – known as essences; are alcoholic
     hydro-alcohol solutions of volatile
 Toothache drops – preparations used for
     temporary relief of toothache by
     application of cotton saturated with the
     product into tooth cavity
 EMULSION – a two phase system prepared
 by combining two immiscible liquids one of
 which is uniformly dispersed through the
 other; they consist of globules that have
 diameters equal to or greater than those of
 the largest colloidal particles.

 SUSPENSIONS – a two-phase system
 consisting of finely divided solid dispersed in a
 solid, liquid, or gas.
 GELS – semi-solid systems of either
     suspension made up of small inorganic
     particles or large organic molecules
     interpenetrated by a liquid.

 LOTIONS – usually liquid suspension or
     dispersions intended for external
     application to the body.
 MAGMAS and MILK – aqueous suspensions
      of insoluble inorganic drugs; they differ
      from gels mainly in that the suspended
  particles are layers.
 TINCTURES – alcoholic or hydroalcoholic
      solutions prepared from vegetable
      materials or from chemical substances
 FLUIDEXTRACTS – liquid preparation of vegetable
      drugs containing alcoholic as a solvent or as
      preservative or both, so made that each mL
      contains the therapeutic constituents of 1 g of the
      standard drug that it represents

 EXTRACTS – concentrated preparations of
      vegetable or animal drugs obtained by removal
      of the active constituents of the respective drugs
      with suitable menstruum.
 preparations intended to be administered by
 injection under or through one or more layers
 of skin or mucous membranes

 intravenous fluids and drugs to be
 administered by injection
sterile preparations to be used on the eyes
  Solutions – intended for the eye; clear, sterile
   solution to be instilled into the eyes by the use of a
  Suspensions – dispersion of finely divided
   relatively insoluble drug substances in an aqueous
   vehicle containing suitable suspending and
   dispersing agent.
  Ointment – intended for the eyes; they contain
   medicinal agents added to the ointment base of
   white petrolatum and mineral oil either as a solution
   or as a micronized powder.
     preparations intended to protect the lens
 1.   wetting solutions
 2.   cleaning solutions
 3.   disinfection solutions
 4.   soaking solutions
 5.   artificial tears

 OINTMENT – semi-solid preparations
    intended for external applications to the
    skin or mucous membranes.
 CATAPLASM – a soft moist mass of meals,
    herb, seed usually applied hot in clothes.
 PASTES – concentrates of absorptive
    powders dispersed in petrolatum or
    hydrophilic petrolatum
 POWDERS for external use are usually
    described as dusting powders, usually
    contain starch, talc, and zinc stearate
 DRESSINGS – external applications
    resembling ointment usually used as a
    covering or protection.
 CREAMS – viscous liquid or semi-solid
    emulsions of either the oil in water or
    water in oil type
 PLASTERS – substances intended for
    external application; they are made of
    such materials and of such consistency as
    to adhere to the skin and attach to a
 SUPPOSITORIES – solid dosage forms of
    various weights and shapes usually
    medicated for insertion into the rectum,
    vagina, or the urethra
 Oral powders – generally supplied as finely
     divided or effervescent granules
 Dentifrices – may be prepared in the form of
     a bulk powders generally containing soap
     or detergent, mild abrasive and
     anticariogenic agent
 Douche powders – soluble powders
     intended to be dissolved in water prior to
     use as antiseptic or cleaning agents for a
     body cavity.
 Dusting powders – locally applied non-toxic
      preparations that are intended to have no
      systemic action.
 Insufflations – finely divided powders
      introduced into the body cavities.
 Triturations –dilutions of potent powdered
      drugs prepared by intimately mixing them
      with a suitable diluent in 1:10 dilutions
 TABLET – solid dosage form containing drug
     substances with or without suitable
     diluents and prepared either by
     compression or molding methods.
 CAPSULES – solid dosage forms in which
     the drug substance is enclosed in either a
     hard or soft soluble container or of a
     suitable form of gelatin
 PILLS – small, round, solid dosage forms
     containing medicinal agents and intended
     for oral administration
 TROCHES – also known as lozenges or
    pastilles; they are discoid shaped solid
    containing the medicinal agent in a
    suitably flavored base.
 CACHETS – related to capsules in as such
    as they provide an edible container for
    oral administration of solid drugs.
 PELLETS – small, sterile cylinders about 3.2
    mm in diameter by 8 mm in length, formed
    by compression from medicated masses
 AEROSOLS – both oral and topical; they
     contain therapeutically active ingredients
     dissolved, suspended, or emulsified in a
     propellant or in a mixture of solvent and

     used in medicine for therapeutic and
     diagnostic purposes
 Vaccines a suspension of attenuated (live) or
  inactivated (killed) microorganisms or fraction
  thereof administered to induce immunity and thus
  prevent infectious disease.
 Toxoid – a modified antigen from an infectious
  organism used as a vaccine
 Immune globulin – a solution containing
  antibodies from the pooled plasma of not less than
  1,000 normal individuals
 Hyperimmune serum – a special preparation
  obtained from human donor polls selected for high
  antibody titer against a specific disease
Examples Dosage Forms
 Omega Pain Killer (Methyl salicylate, menthol,
    camphor) – Liniment
   Cold Rub (Camphor, Menthol, Eucalyptus oil) –
   Aceiti Manzanilla – Solution
   Acrinol – Tincture
   White Henna – Powder
   Sebo De Macho – Ointment
   Caladryl (Calamine) – Lotion
   Nizoral (Ketoconazole) – Cream, Shampoo, Tablet
Examples Dosage Forms
 Dermovate (Clobetasol propionate) – Cream,
  Ointment, Solution
 Dulcolax (Bisacodyl) - Tablet, Suppository
 Dimetapp (Brompeniramine maleate) - Syrup
 Ponstan (Mefenamic Acid) – Capsule SF 250
  mg; Tablet 500 mg; Suspension
 Nitro-Dur (Nitroglycerin) – Transdermal Patch
 Nitroglycerin – Tablet; Transdermal Patch
Five reasons for the need for dosage
 1.   To protect the drug substance from destructive influences
       of atmospheric oxygen
 2.   To protect the drug from the destructive influence of gastric
       acid after oral administration
 3.   To conceal the bitter, salty, or offensive taste or odor of a
       drug substance.
 4.   To provide liquid preparations of substance that are
       insoluble in desired vehicle
 5.   To provide for insertion of a drug into one of the body’s
 6.   To provide optimal drug action from topical administration
       sites, etc.
Examples of Tablets

 1. Poten-Cee – Ascorbic acid – Pascual
 2. Alaxan – Ibuprofen, Paracetamol –
 3. Tylenol – Paracetamol - Janssen
 4. Neozep –
     maleate, paracetamol – Myra/Unilab
 5. Flanax – Naproxen – Roche
Example of Capsules
 1. Velosef –Cephradine – Squibb
 2. Tegopen – Cloxacillin – Bristol
 3. Omnipen – Ampicillin – Wyeth
 4. Imodium – Loperamide – Janssen
 5. Darvon – Aspirin, caffeine,
     propoxyphene – Lilly
Advantages and disadvantages of
different dosage forms

 1.   Ease of administrations
 2.   Stability purposes
 3.   Portability/ conveniently carried
 4.   Elegance
 5.   Accurate dosage
 6.   Manufactured at lower cost
 7.   Optimal drug action and others
                   INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.
                       THE PRESCRIPTION
Exercise 6
                       Nelson T. Tubon, M.D.
                     3JR Pacific Medical Center
                Blk 6 Lot 1 Nepo Homes Subdivision
             Km 37 Pulong Buhangin, Sta. Maria, Bulacan

        Patient’s Name De La Cruz, Mario 28/M       Date: 10/10/08
        Address Novaliches, Quezon City

                Omeprazole 20 mg/cap ----- # 21

        Sig. Take one cap daily for three weeks

                                            Nelson T. Tubon, MD
                                            Lic. No.: 95555
                                            PTR No. 123456789
                                            TN: 967854321
 from the Latin words: prae – before and
 scribo – I write. A prescription is an
 order for medication issued by a
 physician, dentists, veterinarian or other
 properly licensed practitioner.
Parts of Prescription
 1. Prescriber’s Information. The name of the
      physician or dentist, his specialty, clinic address,
      contact number and clinic hours.

 2. Patient information. The full name and address
      of the patient are necessary for identification

 3. Date. Prescriptions are dated at the time they are
      written. The date is important in establishing the
      medication record of the patient especially in
      filling prescriptions for controlled substances
Parts of Prescription
 4. Rx Symbol or Superscription. The Rx symbol is a Latin verb
        recipe, meaning take thou or you take

 5. Medication Prescribed or Inscription. Body or main part of the of
        the Rx order. It contains the names and quantities of the
        prescribed ingredients or drugs, dosage form and potency

        The name of the product must be written both in
                 Nonproprietary (generic name)
                 Proprietary (brand)
        Dosage form- the physical entity of medication (tablet, capsule)
        Strength – potency of drug (250 mg, 100IU)
        Quantity to be dispensed – this includes the amount and the unit
                 of measure (grams, milligrams, tablets)
Parts of Prescription
 6. Dispensing Directions to Pharmacist or Subscription.
       Directions to the pharmacist for preparing the prescription
       These can be used for:
       Preparations (compounding)
       Labeling ( information to be put on the label )

 7. Directions for the Patient or Transcription. Instructions on
       the number of dosage units per dose (one tablet), route of
       administration, frequency of dosing (every 4 hours),
       duration of dosing (one week, for one month) and use of
       the drug (optional)
Parts of Prescription
 8. Refill Information. If refill information is
      not supplied, it is generally assumed that
      no refills are authorized

 9. Prescriber’s Signature. The name and
      signature of the physician or dentist who
      wrote the prescription order. Below the
      signature of the physician are the licensed
      number to practice his profession, PTR
      ( Privilege Tax Receipt) no. and TIN
Dispensing Procedures

 1. Dispensing should be done by
 2. Partial Filling is allowed and must be
     reflected in the prescription
Filling and Recording Procedures
 1. The prescription once filled must be
      retained by the pharmacist for a period of
      two years
 2. The prescription must be recorded in Rx
      book and ready for inspection by BFAD
      FDRO’s when the outlet is open for
      operation anytime
 1. Enumerate at least two responsibilities
     of the pharmacist in providing the
     medication needs of the patient
 a. Provide information about drugs to the
     health profession and to the public legally
     responsible for dispensing prescription.
 b. Translate and communicate the dangers
     of drug to the patient, and others
2.      Enumerate the instructions that pharmacist should
     be given to the patient in filling, refilling and dispensing
     legend prescriptions
    A. Filling of Prescriptions
    a.    danger of overdosage
    b. side effects
    c.    proper storage for stability
    d. need to discard unused medication
    e.    dangers to be mixed in one container
B.      Refilling Prescription
    a. taking drugs for longer period of time unless it is
          under supervision
    b. taking other medications with identical
          composition which provides the same therapeutic
          effect which are sometimes prescribed by other
    c. taking food found in the diets that are
          contraindicated to the prescribed drugs
    d. letting other members of the family or friends to
          use his medicine
C.      Dispensing Prescription
    a. the proper use of drugs
    b. the need to discontinue the use of the drug if
          certain reactions develop
    c. the need to see the doctor if serious reactions
          develop, if the condition has been a long term
    d. the danger of using the OTC drugs when
          prescribed medication is the possible duplication
          of the drug or therapeutic action
    e. the danger of self-diagnosis and self medication
3. Enumerate the types of Prescription based on the number of

  A. Based on the number of ingredients
 1. Simple prescription – with only one ingredient
 2. Compound prescription – with one more than one ingredient
 3. Polypharmacal prescription – with ten or more than ten
  B. Magistral prescription – is a prescription which is
       prescribed very often by the same doctor, of the same
       ingredients, and compounded by the same pharmacist
  C. Coded prescription is also called “blind prescription” and
       consists of words, symbols, to represent the name of the
       drugs. This is unethical practice of doctors and pharmacist

 1.   Patient Information
 2.   Date
 3.   Superscription or Rx symbol
 4.   Inscription or medication prescribed
 5.   Subscription or dispensing direction
 6.   Transcription, signs and signature or the direction
              to the patient
 7.   Refill, special labeling or other instruction
 8.   Prescriber’s signature, address, and other
              pertinent information
 1.      Nembutal 100 mg (at bed time) ( if there is a need) ( by
          mouth )
 2.      Propranolol hydrochloride 40 mg (by mouth) (twice a day)
 3.      Ampicillin 1 g (Intavenous piggyback) (every 6 hours)
 4.      Demerol 50 mg (Intramuscularly) (every 4 hours) (if there is a
          need) for pain
   5.    Tylenol 325 mg tablets (2) (by mouth) (at once, immediately)
   6.    Pilocarpine (2) (drops) (both eyes) (every 3 hours)
   7.    Scopolamine 0.8 mg (subcutaneously) (immediately)
   8.    Milk of magnesia 1 (tablespoon) (by mouth) (at bed time)
          (every night)
 9.      Septra DS tablet (double strength) (1) (every day) (by
Prohibited Drugs
   1. Opium – Brown mixture Tablet and Liquid
   2. Codein – Codeine sulfate H.T. and T.T.
   3. Pethidine – Demerol Ampul and Vial
   4. Codein – Dolo-Adamon Supplement and Tablet
   5. Opium + alcohol – Elixir Paregoric
   6. Fentanyl – Innovar Injection
   7. Morphine – Morphine Sulfate H.T., Ampule,
 8.   Alfentanyl – Rapifen Injection
 9.   Hydrocodone Deka Syrup
 10. Dihydrocodeinone – Ruminon syrup
Regulated Drugs
 1.     Amobarbital – Amytal Tablet, Capsule, Ampul
   2. Amphetamine – Benzedrine Tablet
   3. Butabarbital – Butisol Sodium
   4. Hydrocodone + Pentobarbital - Calciudrine syrup
   5. Methamphetamine – Desoxyn Tablet
   6. Amobarbital + Dexamphetamine – Dexamyl Spansule No.1
   7. Dexamphetamine – Dexedrine Spansule
   8. Propoxyphene napsylate – Doloxene Plain Tablet
   9. Propoxyphene hydrochloride – Doloxene compound – 65
   10. Pipradol – Gadexyl Tablet
Regulated Drugs
   1.    Methaqualone – Mandrax Tablet
   2.    Nitrazepam – Mogadon tablet
   3.    Pentobarbital – Nembutal Sodium
   4.    Chloralhydrate – Noctec liquid
   5.    Methylprylon – Noludar Tablet
   6.    Mecloqualone – Nubarene Tablet
   7.    Paraldehyde – Paraldehyde ampul
   8.    Pentothal - Pentothal sodium
   9.    Ethchlorvynol – Placidyl Capsule
   10.   Aprobarbital + Barbital + Phenobarbital –
Regulated Drugs
 1.   Flunitrazepam – Robypnol Tablet
 2.   Secobarbital – Seconal Sodium Capsule
 3.   Ethinamate – Valamin Tablet
 4.   Pentazocine – Sosegon Tablet
 5.   Ephedrine
 6.   Pseuephedrine
                   INTERNSHIP 1

By: Nelson T. Tubon, B.S. Pharm.; B.S. S. Ed.; R.Ph.; M.S. Pharm.; Ph.D. B.M.
Exercise 7

Prescription written                                              Prescription is checked for
                               Patient presents
by authorized                                                     completeness; prescriber                    Correct patient info is
                               prescription to the
prescriber                                                        info, drug name, strength,                  entered into computer
                                                                  dose, and directions                        system


               Prescription is prepared.
                                                     Pharmacy label is generated.
               Correct amount of med                                                             Prescription is interpreted and
                                                     Make sure all the legal items
               prescribed is measured and                                                        confirmed by pharmacy system.
                                                     are identified
               placed into container                                                             Third party is billed online (optional)

                                                                                                Pharmacist provides counseling
        Prescription is prepared by           Patient receives script, pharmacy
                                                                                                on the medication prescribed and
        pharmacy technician, and              assistant must offer counseling to the
                                                                                                all medically related questions
        final check done by                   patient. Then script is rung on cash
        pharmacist                            register, and insurance log signed
1. How is a prescription processed?

 receiving the             packaging
    prescription            rechecking
   reading and checking    delivering and patient
    the prescription         counseling
   numbering and dating    recording and filling
   Labeling                pricing the prescription
   preparing the
3. What is the purpose of numbering and
dating the prescription?
 The same number of the original prescription
  should appear at the label of the filled
  prescription – to avoid error in dispensing

 The date of the prescription is not the same
  date that should be placed on the filled
  prescription – for identification purposes
4. Information to be recorded in the
prescription book.

  1.   name of physician
  2.   name of the drug
  3.   quantity
  4.   date when dispensed
  5.   balance (quantity if any)
  6.   pharmacist signature, etc

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