LABORATORY ACTIVITY PHARMACY

Topic :
Prescribing Individual Drugs of Solid dosage form

Learning Objective :
At the end of the activity student should be able to write prescription of individual drugs of solid dosage form

Case 2 Name Symptom Diagnose

: Andi, 10 months old : body temperature 38,50 C, productive cough, dyspnoe : mild bacterial acute bronchopneumonia

Would you write a good use prescription for this patient Medicament treatment : Antibiotic, antipyretic, expectorant antitusive, anti allergy 1.Indivudal drugs : Antibiotic antipyretic expectorant antitusive anti allergic agent

: Amoxicillin : Acetaminophen : Glyceril guaiacolat : dextromethorphan HBr : Chlorpheniramin maleat = CTM

 Pasien Dina 4 tahun, batuk, demam , akan diberi obat Codein HCl, Glyceryl Guaiacolat, lama pengobatan 4 hari, frekuensi pemberian sehari 2 kali 1 bungkus.

Dr Arifin Jln Cilas No 28 Bandung SIP : 345/8.244.

R/

Bandung,.. Codein HCL 5 mg. Acetaminophen 125 mg. Glyceril guaiacolas. 25 mg Sch.lact. q.s m.f.pulv. dtd no.X S.t.d.d.1 -----------: Dina : 4 years : Jl Pasirkaliki 190

Name Age Address

Cases for discussion :

Case 1 : Name : Mrs. Wanti 30 weeks pregnant Symptom : body temperatur 39 0 C, headache, myalgia, productive cough. Diagnose : acute bacterial bronchitis Medicament treatment : Antibiotic, analgesic/antipyretic, antihistamine, expectorant Would you write a good use prescription for this patient

Case 2 : Name Symptom

: Boyke, 4 years old : Body temperature 38,5 0 C, mild dyspnoe caused by obstructive rhinitis, mild productive cough Diagnose : Allergic rhinitis and pharyngeal infection Medicament treatment : Antibiotic, antipyretic, antihistamine, decongestant Would you write a good use prescription for this patient

Antibiotic : Amoxycillin, Erithromycine Analgetic/antipyretic : Acetaminophen , Acetosal, Mefenamic acid Antihistamine : Chlorpheniramin maleate = CTM Expectorant : Glyceril guaiacolate

Doses : Amoxycillin : 500 mg three times daily 5 days Acetaminophen : 500 mg three times daily CTM : 4 mg three times daily 3 days Glyceril guaiacolate : 100 mg three times daily

Topic to be discussed : 1. P- drug (refers to lecturing material of P-drug and drugs that penetrate into placental barrier, producing milk and contra-indication) 2. Route of administration 3. Calculation of regimen dose 4. Dosage form that appropriate for individual patient 5. Management of medication ( time,frequency and duration) 6. Writing prescription order 7. Adverse drug interaction

refers to lecturing material of individual drug

The proper RODA drug therapy Rate , drug absorbed and DOA RODA Oral preparation is preferred
Dose : is a quantity of drug that given within a certain period time The measure of dose : a. Unity of weight : g, mg., gr b. Volume : l, ml c. International unit : IU (Vit. A, Vit.D ) d. percent (%)

Dose may be stated as :

- Single dose - Daily dose (divided the frequency of taking medication )

Official books that provide usual dose is :

- Farmakope Indonesia I, II, III

Other general sources :

Manufacturer catalogs Dosage information inserts on their product ISO, IIMS Pediatric dosage Handbook

Terminology of dose :
Usual dose, regimen dose, therapeutic dose, maximum dose, toxic dose, lethal dose.

FACTOR INFLUENCING DOSE :

1. Age ; infant, children, adult, elderly 2. Body weight, sex, rash, surface area 3. Route of administration 4. Disease : renal and hepatic impairment 5. Obesities

REGIMEN DOSE : proper drug is selected

designing a therapeutic dosage regimen

THERAPEUTIC DOSE ; initial dose adjustment dose

maintenance dose

Properly designed dosage regimen to achieve an optimum conc. of drug at receptor site to produce an optimal therapeutic response with minimal adverse effect

Individualization of dose is unnecessary for drugs that have a large margin of safety (such as ibuprofen, cimetidin, naproxen and others) and its necessary for drugs with narrow therapeutic window such as digoxin, amino glycosides, amtiarrhytmics and antiasmathics such as theopylline.

 The initial dosage regimen is calculated based on body weight after consideration of pharmacokinetic of drugs , and known patients pathophysiology such as renal /and hepatic disease and patient drugs history Makes decision based on empirical clinical data, personal experience and observations In many cases the physicians takes USUAL DOSE that . recommended by literature

The patient monitored for therapeutic response by : physical examination , serum drug level After evaluation make readjustment of dosage regimen

Calculation of regimen dose : - Adult patient usual dose from literature - Infant, baby and children : - Infant and baby dose table - calculate using an appropriate equation Formula for calculating baby and children dose : A. Youngs ( for 2 years and older children ) : n ( age = year) child dose = X adults dose (approx.) n ( age= year) + 12 B. Clarks ( for 2 years and older children ) : weight (lb) Child dose = (approx.) X 150 adult dose

Clarks : weight (kg) Child dose (Approx.) = 68 (kg) X adult dose

C. Frieds ( for infant up to 2 years old ) : age (month)

Child dose = (Approx.)

X adult
150

dose

D.Dilling ( for infant up to 2 years old ) : n (year) Child dose = (Approx.) X adult dose 20

Classified into : - Solid - Semi solid - Liquid

Dosage form must be acceptable to the patient Factors influence choosing of dosage form : 1. Age : - infant, baby : drop, divided powder - children : syrup, divided powder - adult : tablet, capsule, caplet, divided powder, syrup 2. Site of action : - local : - topical : lotion, bulk powder, ointment, cream etc - mouth : lozenges, gargle - systemic : - enteral : tablet, capsule, inhaler - par enteral

3. Onset of action : - immediate : injection, suppositoria, sublingual tablet,nasal preparation - sustained release

4. Condition of patient : - unconscious ; injection, suppositories - nausea - difficult to swallow ; syrup - hyper emesis - post operative of GIT ; injection

Drugs

administered to patient Optimum effect direction for patient = signature taking of medication should be managed

For ex.: S.t.t.d Caps.I 1.h.a.c ( One Capsule three times a day one hour before meal)

CLASSIFICATION :
1.

INTERVAL OF MEDICATION Standard : * Hourly * every .. hours (for ex. every three-hours) * times a day TIME OF MEDICATION Standard : * in the morning, in the midday, in the night * before, after, or during meals; before sleeping * during episode, during attack, after attack TECHNIQUES OF MEDICATION

2.

3.

STANDARD ADMINISTRATION TIMES DAILY

Once Twice Three times Four times : 10.00 (morning)/22.00 (night) : 10.00 , 14.00 : 10.00 , 14.00, 18.00 : 10.00, 14.00, 18.00, 22.00

EVERY
12-hourly 8-hourly 6-hourly 4-hourly : 10.00, 22.00 : 06.00, 14.00, 22.00 : 06.00, 12.00, 18.00, 24.00 : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00

TIMING OF MEDICATION
In the morning : * Steroid * Diureticum * Antihypertension In the night : * Contraceptive pills * Laxative Bisacodyl tablet * Suppositoria * Vaginal tablets * Hypnotics * Cimetidine * Anticholesterolaemi

During daily activities During meal = With meal : - promptly after meal - During Meal Empty Stomach : (without meal) 1 hour before meal 2 hours after meal During episode * angina drugs * Drugs for migraine-cephalgy * Anti asthmatic drugs

Table Drugs with absorption reduced, delayed, increase or not affected by the Presence of food

Reduced Amoxicillin Ampicillin Furosemide Levodopa Tetracycline

Delayed Acetaminophen Amoxicillin Aspirin Digoxin

Increased Griseofulvin Hydralazine Hydrochorthiazide Phenytoin

Not affected Chlorpropamide Glibenclamide Prednisone Theophyline

Drugs that absorption reduced by food

taken on empty stomach : 1 h. a.c. and 2 h.p.c.

Duration therapy : Symptomatic therapy : three days, < or > than three days Causative therapy : eliminate the cause of the case antimicrobial agent eradicate all infecting organism oral administration : 5 7 days or < if given high dose

The component part of a prescription : Prescribers information Date ( include place = city ; Bandung, August, 20th 2005) Superscription = R/ symbol = recipe = you take Inscription = medication prescribed Subscription = direction to pharmacist Signa = direction for patient Refill information Prescriber signature Patient information ; name, age, address

PHYSICIANS PRESCRIPTION

In Indonesia Name : Specialist : Address : License of Practice

Prescriber information Bandung,2005

Date

R/

Superscription

Ampicillin.500mg caps No.XXIV

Inscription
Subscription

S.4. d. d. caps I a.c. Name : Age : Address :

Signatura

Patient information

Dr. Christine SIP No. : Jln. Pasirkaliki No. 196 Bandung

Bandung,2005 R/ Parasetamol 500 mg M.f. Pulv. d.t.d No. X S.t.d.d. pulv. I ..

Dr. Christine SIP No. : Jln. Pasirkaliki No. 196 Bandung Bandung,2005 R/ Parasetamol tab. No. X S. t.d.d. tab. I .

Pro : Ny. Nina Umur : Alamat :

Pro : Ny.Nina Umur : Alamat :

1. Precompounded ( formula officinales ) A drug(s) in dosage form supplied by the Pharmaceutical company in its official or proprietary name 2. Compounded ( Formula magistrales / Extemporanous ) The physician selects and write the drugs, doses, and dosage form desired. The name of drugs can be written as generic name (nonproprietary) or proprietary name. Precompounded : R/ Panadol tab. No. IX S.t.d.d tab.I ... Compounded : R/ Acetaminophen 500 mg M.f. pulv d.t.d No. IX S.t.d.d. pulv I ..

prescribers signature

After writing the prescription order, make avoiding the possibility of occurrence adverse drug interaction.

For ex. :
R/ Erytrin Cap. 500 mg No. XV S.t d.d. Cap. I .... R/ Antacid Tab. No. X S. t.d.d. tab.I ... R/ Erytrin Cap. 500 mg No. XV S.t.d. Cap.I 1.h.a.c. . R/ Antacid Tab. No. X S.t.d.d tab. I 2 h.p.c. ..

How to write a prescription

Proper steps in prescribing medicament : 1. Choose Individual drug ( refers to lecturing material) 2. Choose route of administration 3 Choose dosage form 4. Calculate regimen dose 5. Manage frequency, time and duration of medication 6 Writing prescription order 7. Be aware of possible adverse drug interaction Example Case 1 Name : Mrs Farmawati Symptoms : Body temperatur 38,50 C, headache, pharyngeal pain Diagnose : Acute bacterial tonsilopaharingitis Patient allergy to Ampicillin Medicament treatment : Antibiotic, antipyretic Would you write a prescription order according to above information

Empirical antibiotic for infection of upper respiratory tract. are Ampicillin, Amoxicillin and Erythromycin Antipyretic ; Acetaminophen, Mefenamic acid , Acetosal Prescribing : 1. Individual drug : antibiotic : Erythromycin antipyretic/analgesic : Mefenamic acid 2. Route of administration : Oral 3. Dosage form : solid dosage form for oral administration : tablet, caplet, capsule 4. Dose : Adult woman, take the dose from Official book ( Farrmakope Indonesia) Oral single dose Erythromycin : 250 500 mg mild infection 250 mg, moderate 500 mg Single dose Mefenamic acid : 250 500 mg

5. Management of administration : Erythromycin : Frequency of administration is given every 6 hours ( four times a day ) Available oral solid dosage form are : Capsule 250 mg, Caplet 500 mg Duration of therapy : 5 days, so given 5 X 4 = 20 caplets

Mefenamic acid : Frequency : recommended 500 mg first and followed with 250 mg or 500 mg three times a day Available dosage form are : Capsule 250 mg and Capsule 500 mg Duration of therapy : 3 days, given 3 X 3 = 9 Capsules
Writing prescription : A. Precompounded

B. Compounded

A. Compounded : R/ Erythromycin 500 mg M.f.. Pulv. d.t.d. No XV S.t.d.d. pulv I 1.h.a.c. .. R/ Mefenamic acid 500 mg M.f. pulv. d..t.d. No IX S.t.t.d. pulv I ..

or

R/ Erythromycin 500 mg M.f. pulv. d.t.d No. XV da in cap. S.t.d.d. Cap. I 1.h.a.c. ..
R/ Mefenamic acid 500 mg M.f. pulv d.t.d. No IX da in Cap. S.t.t.d. Cap.I ..

or

B Precompounded : R/ Erytrin Cap. 500 mg No. XV S.t d.d. Cap. I 1 h.a.c. . R/ Ponstan Cap. 500 mg No. IX S.t.d.d. Cap. I .

Case 2 Name Symptom Diagnose

: Andi, 10 months old : body temperature 38,50 C, productive cough, dyspnoe : mild bacterial acute bronchopneumonia

Would you write a good use prescription for this patient Medicament treatment : Antibiotic, antipyretic, expectorant antitusive, anti allergy 1.Indivudal drugs : Antibiotic antipyretic expectorant antitusive anti allergic agent

: Amoxicillin : Acetaminophen : Glyceril guaiacolat : dextromethorphan HBr : Chlorpheniramin maleat = CTM

2. Route of administration : oral 3. Dosage form : divided powder, drop. 4. Calculation of doses : Amoxicillin : oral ; 25 75 mg/kg body weight daily divided into three doses ( Farmakope Ind. ) See body weight on body weight table : 10 months = 8 kg

Single dose = 8 X 50 mg = 133 mg 3 Acetaminophen : Single dose - for 6 12 months is 50 mg ( F.I ) single adult dose 500 mg - Frieds : 10 X 500 mg = 35 mg 150 Glyceril guaiacolate : single adult dose 100 mg 200 mg Single dose : 10 X (100 200) mg = ( 6 - 12 ) mg 150

Dextromethrphan HBr 1 mg/Kg BW divided to three doses Single dose : 8 X 1 mg = 3 mg 3 Chlorpheniramin maleat 0,35 mg/Kg BW divided 4 doses Single dose = 0,35 X 8 = 0,7 mg 4

5. Management of Administration Amoxycillin Frequency : three times a day Duration of therapy : 5 days

given 3 x 5= 15doses

Frequency of : Acetaminophen,Glyceril guaiacolate,Dextromethrphan HBr, Chlorpheniramin maleat are three times a day Duration of therapy : 3 days given 3 x 3= 9 doses

Writing prescription R/ Amoxycillin 133 mg m.f , pulv d.t.d. No XV S. t .d.d. pulv I. -----------

R/ Acetaminophen 50 Glyseril guaiacolas 6 Dextrometorphan Hbr 3 Chlorpeniramin maleas 0.7 m.f . pulv d.t.d. No IX S. t .d.d. pulv I -----------

mg mg mg mg

Cases for discussion :

Case 1 : Name : Mrs. Wanti 30 weeks pregnant Symptom : body temperatur 39 0 C, headache, myalgia, productive cough. Diagnose : acute bacterial bronchitis Medicament treatment : Antibiotic, analgesic/antipyretic, antihistamine, expectorant Would you write a good use prescription for this patient

Case 2 : Name Symptom

: Boyke, 4 years old : Body temperature 38,5 0 C, mild dyspnoe caused by obstructive rhinitis, mild productive cough Diagnose : Allergic rhinitis and pharyngeal infection Medicament treatment : Antibiotic, antipyretic, antihistamine, decongestant Would you write a good use prescription for this patient

Antibiotic : Amoxycillin, Erithromycine Analgetic/antipyretic : Acetaminophen , Acetosal, Mefenamic acid Antihistamine : Chlorpheniramin maleate = CTM Expectorant : Glyceril guaiacolate

Doses : Amoxycillin : 500 mg three times daily 5 days Acetaminophen : 500 mg three times daily CTM : 4 mg three times daily 3 days Glyceril guaiacolate : 100 mg three times daily