Demonstrate Understanding of the
Use of
Various Dosage Forms
(oral,
topical,parenteral,inhalational)
Definition:
A) Route of administration is the path by which a
drug, fluid, poison or other substance is brought into
contact with the body.
B) Dosage forms are the means by which drug
molecules are delivered to sites of action within the
body.
Every dosage form is a combination of the drug and
different kinds of non drug components called as
excipients or additives.
Types of dosage forms :
They are classified according to:
Route of administration Physical form
Oral Solid
Topical Semisolid
Rectal liquid
Parenteral
Vaginal
Inhaled
Ophthalmic
Otic
Oral route
It is intended for systemic effects resulting
from drug absorption through the
various epithelia and mucosa of the
gastrointestinal tract.
ORAL DOSAGE FORM
Checklist
Drug label should be checked for date of expiry.
Ensure that the drug name, strength and dosage
form match with that on prescription.
Per Oral
Take with adequate quantity of water, so that it
does not stuck in the upper GIT
Always sit straight while taking the drug
Information regarding association with food,
diurnal variation, drug interation should be
explained
Fig. 3.8: Pattern of drug release from oral controlled release tablet/capsule;
30% of the dose outside the semipermeable membrane is released immediately,
While 70% of the dose is released slowly through the membrane over the next
4–8 hours
Sublingual
To be placed under the tongue
Not to be crushed , chewed or swallowed
Not to be spitted
Buccal
To be placed in buccal pouch
Not to be crushed , chewed or swallowed
EYE DROPS- Checklist
Wash your hands.
Do not touch the dropper tip while opening.
Ask the patient to look upward.
Pull the lower eyelid down to make a gutter.
Bring the dropper as close to the gutter as possible without
touching it to the eye.
Apply the prescribed amount of drops in the gutter.
Close the eye for about 2 min by pressing nasolacrimal duct, donot
shut the eye too tight
Excess fluid can be removed with a tissue.
Wait at least five minutes for applying next drop if any
If burning sensation last longer consult a doctor
Eye ointment
Wash your hands.
Do not touch the tip of the ointment tube.
Ask patient to tilt his head backwards a little.
Pull the lower eyelid down to make a gutter.
Bring the tip of the tube as close to the gutter as possible
without touching it to the eye.
Apply the prescribed amount of ointment in the gutter.
Close the eye for about 2 min, donot shut the eye too tight
Excess fluid can be removed with a tissue.
Clean the tip of tube with another tissue.
NASAL DROP
Ask the patient to clean the nose.
Sit with the head tilt backwards or lie down with a pillow
under the shoulders.
Insert the dropper at 1cm into one nostril.
Apply the amount of drops prescribed.
Sit up after a few seconds, the drops will drip down the
pharynx.
Breath through the mouth.
Repeat the procedure for other nostril.
Rinse the tip of the dropper with boiled water.
NASAL SPRAY
Ask the patient to clean the nose.
Sit with the head slightly forward
Shake the spray
Insert the tip in one nostril
Close the other nostril and mouth.
Spray by squeezing the vial
Remove the tip from the nose and sit up after a few seconds, the
spray will drip down the pharynx.
Breath through the mouth.
Repeat the procedure for other nostril
Rinse the tip of the spray bottle with boiled water.
EAR DROP
CHECKLIST
Warm the ear drops by keeping them in the hand for few
minutes.
Tilt head sideways or lie on one side with the ear upward
Gently pull the lobe to expose the ear canal.
Apply the amount of drops prescribed.
Wait for 5 min before turning.
Use cotton to close the ear canal after applying the drops if
mentioned.
Repeat the procedure for other ear if indicated.
Transdermal Route
• Transdermal route is used for percutaneous
drug absorption
• It comprises a drug impregnated adhesive patch
which can be applied over skin
• The patch delivers drug at a constant rate
• Absorption occurs via skin by diffusion
22
Transdermal patches
23
Transdermal patches
• Sites for application:
Chest, abdomen, upper arm,
lower back, mastoid region
• Examples:
– Hyoscine: Motion sickness
– Nitroglycerine: Angina
– Estrogens: HRT
24
Drug matrix
Transdermal patch
25
Sites of patch application
26
Steps of application of Suppository
1. Wash your hands.
2. Remove the covering (unless too soft).
3. If the suppository is too soft let it harden first by cooling it (fridge or hold under cold
running water, still packed!) then remove covering.
4. Remove possible sharp rims by warming in the hand.
5. Moisten the suppository with cold water.
6. Lie on your side and pull up your knees.
7. Gently insert the suppository, rounded end first, into the back passage.
8. Remain lying down for several minutes.
9. Wash your hands.
10. Try not to have a bowel movement during the first hour.
Steps of application of
Vaginal tablet / pessary with applicator
1. Wash your hands.
2 Remove the wrapper from the tablet.
3. Place the tablet into the open end of the applicator.
4. Lie on your back, draw your knees up a little and spread them apart.
5. Gently insert the applicator with the tablet in front into the vagina as far as possible,
do NOT use force!
6. Depress the plunger so that the tablet is released.
7. Withdraw the applicator.
8. Discard the applicator (if disposable).
9. Clean both parts of the applicator thoroughly with soap and boiled, lukewarm water (if not
disposable).
10. Wash your hands.
Steps 4 and 5 Step 6
Parenteral Dosage Forms
Parenteral route of administration
Route of administration that
delivers the drug directly into blood or tissue
without having to cross the
intestinal mucosa
Different types of parenteral
routes
• Intradermal
• Subcutaneous
• Intramuscular
• Intravenous
• Intrathecal
• Inhalational
• Transdermal
31
Advantages
Faster action
No gastric irritation or vomiting
Useful in uncooperative, unconscious pt.’s,
or patients with vomiting
First pass metabolism bypassed
No interference by food or digestive juices
Disadvantages
Invasive procedure
Sterile precautions to be maintained
Less convenient and expensive 32
General rules for injecting
• Use aseptic technique
– Washing hands
– Disinfecting skin at site of injection
– Protective cover on the needle
• Check label of drug before injecting
• Two needle technique- One for filling, another for injecting
• No air bubbles in the solution
• Proper disposal of used syringe & needles
33
Checklist before injection
• Whether the label has all the necessary
information
– Name of preparation ( generic / trade name)
– Constituents and their strengths
– Intactness of package
– Colour changes or impurities
– Date of expiry
– Method of reconstitution, if needed
– Route of administration
34
Parenteral Dosage Forms
• Solutions
• Suspensions
• Dry powder
with distilled water for reconstitution
Containers
• Ampoules
• Vials
• Infusion bottles
35
Aspirating from ampoules
Wash your hands
Choose a syringe
twice the volume required
Fix the needle on the syringe
File around the neck of ampoule
If glass ampoule, protect your fingers
Plastic ampoules – twist the top
Aspirate fluid from ampoule
Remove air from syringe before injecting
36
Aspirating from ampoules
37
Aspirating from vials
Wash your hands
Choose a syringe
twice the volume required
Fix the needle on the syringe
Disinfect the top of vial
2 needle technique
Suck air equal to the amount of solution
to be aspirated
Insert needle into vial & turn upside – down
Pump air into vial
Aspirate little more than required amount of solution
Pull the needle out of the vial
Remove air from syringe before injecting
39
Aspirating from vials
40
Injectable routes
41
Needle selection
Injection Type Gauge Length Volume
(Inches) injected
(ml)
Intradermal 25-27 3/8 - ½ 0.01 – 0.1
Subcutaneous 25-27 ½-1 0.5 – 2
Intramuscular 20-24 1-2 0.5-5
Intravenous 15-22 ½-1 Large
volumes 42
Intramuscular injection
Wash hands
Reassure patient & explain procedure
Disinfect the skin
Insert needle at an angle of 90° deep into the muscle
Aspirate briefly to check that the needle is not in a blood
vessel
Inject slowly (less painful)
Withdraw needle
Press sterile cotton wool
Clean up & dispose
43
Intramuscular injection
44
Z-Track technique of IM injection
Used for drugs that stain or
irritate subcutaneous tissue
1. Skin is laterally displaced
away from injection site
2. IM injection is given
at 90 degree
3. Skin is released only after
needle has been withdrawn
so that the track is sealed
45
Subcutaneous injection
Wash your hands
Disinfect skin at site of injection
Reassure the patient & explain procedure
“Pinch” fold of the skin
Insert needle in the base of skin fold at an angle of 45°
Aspirate briefly to check that the needle is not in a blood
vessel
Inject & Withdraw needle
Press sterile cotton wool
Clean up & dispose
46
Subcutaneous injection
47
Intravenous injection
Wash your hands
Reassure patient & explain procedure
Uncover arm, apply tourniquet
& look for suitable vein
Disinfect the skin
Stabilize vein
by pulling skin taut in longitudinal direction of vein by
other hand
Insert needle at an angle of around 30°
Puncture the skin & move needle into vein
Aspirate briefly to check whether the needle is in vessel
Loosen tourniquet & inject slowly
Withdraw needle swiftly & press sterile cotton
Clean up & dispose
48
Intravenous injection
49
Intradermal injection
• Drug is injected into layers of skin
• Injection is given at an angle of 150
• Small thin bore needle( 25-27 G, ½ inch) used
• Volume given is small & thus given by small 1 ml
syringe
• Site: Inner aspect of arm, deltoid area
Examples:
– BCG vaccine
– Small pox vaccination
– Testing drug sensitivity 50
Intradermal injection
51
52
Intrathecal Injection
• This route is used when local & rapid effect on
the meninges or cerebrospinal axis is desired
• Lumbar puncture needle is used to inject drug
into spinal subarachnoid space
Examples:
– Spinal anesthesia
– Acute CNS infections
53
Intrathecal Injection
54
Inhalational Route
1) MDI
2) Rotahaler / MDI with Spacer
3) Nebulizer
55
4) Terbohaler
Inhalational Route
• Drugs can be administered as aerosols or powders
by inhalation
• Aerosols are fine (1 nm to 100 µm) drug droplets in air
Advantages:
– Quick onset of action
– Drug delivered to site of action in pulmonary disease like
Bronchial asthma, COPD
– Minimized systemic side effects
Disadvantages:
– Special equipment required
– Need training for use
56
Devices for inhalational administration
• Metered Dose Inhaler (MDI)
• Spacer
• Rotahaler/ Spinhaler
• Handheld device for inhaled insulin
• Nebulizer 57
MDI
58
Correct way of using MDI
1. Remove the cap and check whether the mouth piece
is clean
2. Shake the Inhaler well
3. Breathe out gently, place mouth piece between teeth
& close/purse lips around it
4. Start breathing in via mouth & press down canister to
release a puff while continuing to breathe in deeply
5. Hold breath for 10 seconds
6. If a second dose is needed, wait for one minute and
repeat steps 1-6
7. Rinse mouth thoroughly after use
59
Points to remember
• Release one puff into air before first use, or if using after a gap of
more than a week
• Practice well before a mirror for proper co-ordination
• Repeat a puff if mist escapes
from top of inhaler or side of mouth
• Discontinue if there are any reactions like bronchospasm,
hypersensitivity reactions
• Clean the plastic body in lukewarm water
at least once a week and let it dry
60
MDI
61
Drugs administered by MDI
• Salbutamol 100 mcg/puff
• Salmeterol 50 mcg/puf
• Levosalbutamol
• Salmeterol+Fluticasone 25-50 + 50-100 mcg/puff
• Formoterol+Budesonide 6-12 + 200-400 mcg/puff
• Beclomethasone 100-200 mcg/puff
• Salbutamol+ Beclomethasone
• Ipratropium bromide 20-40 mcg/puff
• Ipratropium+levosalbutamol 62
Spacer
• Spacer is a device used to obviate the
need for hand-lung coordination
• It is a plastic tube that fits between
inhaler and patients mouth
• Inhaler releases the drug into spacer
and the patient inhales from the spacer
• There is improvement in ratio of inhaled
to swallowed drug
• It is especially useful in children
63
Spacer
64
Correct use of a spacer
• After shaking the MDI well, the wider end of
spacer is attached to mouthpiece of MDI
• The other end is held in mouth tightly.
• Canister is pressed.
• Deep inhalations through mouth are taken for
one minute.
• Exhalation done through nose
• Proper rinsing of oral cavity
Rotahaler / MDI with Spacer
• Trebohaler dry powder
device – COPD
– Terbutaline 1mg
– Salbutamol 400 µg
4 times daily
– Ipratropium 160 µg
66
Use of rotahaler
• Insert a rotacap, transparent end first, into raised hole of
rotahaler
• Press firmly to make its top end level with hole
• Rotate the base so that the fin in base separates two
halves of rotacap
• Breathe out fully, grip the mouth piece between teeth
and seal the lips around
• Tilt head backwards and breathe in through mouth as
deep as possible
• Hold breath for 10 seconds
• Rinse mouth thoroughly after use
• Open rotahaler, discard empty shell & reassemble
• Wash twice a week under running water
67
Rotahaler
68
Drugs administered by rotahaler
• Salmeterol+fluticasone 25-50 + 125-250 mcg
• Ipratropium 40 mcg
• Triotropium 18 mcg
69
Nebulizer
70
Nebulizer
• Nebulization is the process of making fine
particles( mist, spray) from liquid
• Nebulizer is the apparatus used for nebulization
by high frequency vibration of liquid drug
• The fine mist is inhaled through a mouth piece or
mask
• Nebulizer can be used to deliver bronchodilators
or anticholinergic (like ipratropium) in asthma &
COPD
71
Terbohaler (Dry powder)
• As convenient as nebulizer
• 5 mg ( 10 puffs )
• 10 mg ( 20 puffs )
• Mouthpiece is better than facemask
• If using facemask,
avoid droplets going into eyes
• Put adhesive tape
73
Terbohaler (Dry powder)
74
Tables and Diagrams
Parenteral Dosage Forms
Tables and Diagrams
• Make these tables and diagrams on left
side page of your practical note book
• Use lead pencil
• Make these at appropriate place facing the
text
• Label the diagrams appropriately
76
Needle selection
Injection Type Gauge Length Volume
(Inches) injected
(ml)
Intradermal 25-27 3/8 - ½ 0.01 – 0.1
Subcutaneous 25-27 ½-1 0.5 – 2
Intramuscular 20-24 1-2 0.5-5
Intravenous 15-22 ½-1 Large
volumes 77
Injectable routes
78
Subcutaneous injection
79
Drug matrix
Transdermal patch
80
Sites of patch application
81
82
Z- Track Technique Of IM injection
Step 1
Step 3
Step 2
83
Intravenous injection
84
Fig. 3.8: Pattern of drug release from oral controlled release tablet/capsule;
30% of the dose outside the semipermeable membrane is released immediately,
While 70% of the dose is released slowly through the membrane over the next
4–8 hours
THANK YOU
