Dosage Forms And Routes Of Administration

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The route of administration which would be the least appropriate for a person who can not swallow would be

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PO

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The term "route of administration" concerns the

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way in which a drug enters the body

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A cream is a __________ dosage form

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semi-solid

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A drug which is coated with a substance designed to remain undissolved until it passes through the stomach is called _______ drug

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an enteric coated

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A dosage form in which the drug product is dissolved in oil droplets which are then suspended in water is called

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an emulsion

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Creams

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This is a form of an emulsion. An emulsion is a product where the drug product is dissolved in oil droplets and the oil droplets are suspended in water. This creates a very smooth, but somewhat fragile product. An emulsion can be separated, or "broken", by exposure to temperature extremes. Freezing or excess heat will ruin the product.

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Lotions

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Lotions are emulsions like creams, but they contain more water so they are thinner than creams.

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Ointments

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Ointments very from a very thick emulsion to a petrolatum based product. They do not absorb into the skin as creams or lotions do. They are more occlusive and can cause the drug portion to be absorbed to a greater extent than creams. This means on a gram per gram basis, an ointment will be more potent than a cream.

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Solution

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A form where the drug is dissolved within a diluent. All the drug product is dissolved within the diluent.

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Suspension

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The dosage form where small solid particles of a drug are suspended in a liquid vehicle. Normally a suspending agent is employed which slows the movement of the particles towards the bottom of the container. The drug product is not dissolved.

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Syrup

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A sweetened vehicle is employed to keep a drug in solution.

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Elixir

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A dosage form where the drug is dissolved in a vehicle which contains a high percentage of alcohol and may be sweetened.

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Extract

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A dosage form where the drug is the oil or active portion of a plant that has been extracted normally using alcohol.

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Tincture

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An alcohol based dosage form which is to be used externally.

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Capsules

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are another solid dosage form. This time the drug ingredients are contained within a gelatin capsule. This method works well for drugs which have an unpleasant taste. The drug will be separated from the taste buds by the gelatin capsule, which will not dissolve completely until the capsule enters the stomach acid. Once it enters the stomach, the contents are released all at once. Normally, this would constitute an immediate release of medicine. However, in some cases, manufacturers have also begun to put enteric coated and sustained release beads of medicine into gelatin capsules. Thus, there are also variations in the capsule formulations available. The comments about enteric coating and sustained release dosage forms in the tablet section would also apply here.

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Tablets

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These include basic compressed oral tablets and progress through tablets that use osmotic membranes and lasers to produce sustained release products. The following table explains the characteristics of the common tablet types.

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Compressed Tablets

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Simple immediate release product which dissolves in the stomach to release the drug product. Contains ingredients such as bulking and binding agents, lubricants, stabilizers, preservatives, and coloring agents in addition to the drug entity. May be coated with a glossy coating.

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Enteric Coated Tablets

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In addition to the tablet ingredients above, EC tablets have a coating which will not dissolve in the acidic environment of the stomach. They will dissolve when they enter the basic pH of the intestines. Note that anything that changes stomach pH to a more basic value will increase the chance of the tablet dissolving in the stomach. Tell the patient to avoid antacids and milk between 1 hour before and 2 hours after the dose. EC is useful for drugs which irritate the stomach.

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Sustained Release Tablets

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These are tablets which are designed to release their contents in a slow, and predictable, manner. Various methods are used to accomplish this. A wax matrix may be employed to allow the drug to slowly leech out of the tablet. Pfizer employs a much more complicated method involving a hard shell tablet with an osmotic membrane on one end and a small laser cut hole on the other. As fluid enters through the membrane, drug is forced out the hole. Since the rate at which the fluid enters is constant and identical between individuals, the rate at which the drug is released is a constant also.

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Sublingual and Buccal Tablets

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These are tablets specifically designed to dissolve in the mouth. Sublingual tablets are meant to dissolve very quickly under the tongue. There is a very rich blood supply under the tongue, and the drug is absorbed into the bloodstream there. Buccal tablets are meant to dissolve slowly in the space between the cheek and the gum.

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An enteral drug

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is one which is administered anywhere along the “tube” which extends from the mouth to the rectum. Anything administered into the mouth, esophagus, stomach, small intestines, large intestines, colon, or rectum would be an enteral drug.

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A parenteral drug

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is anything that goes into the body anywhere else. (ie, an injection, IV, etc.)

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topical products

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Topical products are anything applied to the outside membranes of the body. These may exert their effect externally, or may need to be absorbed through the skin (transdermal) to be effective.

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PO

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By Mouth
Enteral
must be able to swallow

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NG

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Naso-Gastric Tube
Enteral
tube is direct to the stomach - doesn't rely on swallowing

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SL

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Sub-Lingual
Enteral
dissolved beneath the tongue

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BUCCAL

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BUCCAL
Enteral
placed in the pouch between cheek and gum in mouth

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IV-drip

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Intravenous
Parenteral continuous slow infusion over an extended time

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IV-bolus

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Intravenous
Parenteral
a volume of fluid delivered over a short time

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IV-piggyback

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Intravenous
Parenteral
a small volume of IV solution infused through the tubing by which another IV fluid is running

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IM

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Intramuscular
Parenteral
place in the muscle - may give a release over a prolonged period

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SQ (SC)

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Subcutaneous
Parenteral
Placed in the space between skin and muscle

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IC

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Intracardiac
Parenteral
Direct injection into the heart muscle

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Transdermal

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Through the skin
Topical
Absorption occurs through the skin

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Topical

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Applied Externally
Topical
may have effects outside the body or be absorbed

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"Enteral" refers to

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a route which enters the body through the GI Tract

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"Route of Administration" refers to

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how a drug gets into the body