Oral Solid Medications

• Solid oral medications come in several forms.

– Tablets– Caplets– Capsules– Gelcaps

Oral Solid Medications (cont.)

• Tablets– Combination of an amount of drug with

inactive ingredients

– Administration forms• Oral (swallow)• Sublingual• Buccal• Chewable• Dissolvable

Oral Solid Medications (cont.)

• Caplets

– Oval-shaped

– Made with a special

coating that makes them

easier to swallow

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

Tylenol caplets

500 mg500 mg

500 mg500 mg

500 mg500 mg

Tylenol caplets

Tylenol caplets

500 mg500 mg

Oral Solid Medications (cont.)

• Capsules

– Oval-shaped gelatin shells containing medication in powder or granule form

Oral Solid Medications (cont.)

• Gelcaps– A liquid medication

in a gelatin shell

– Not designed to be opened

Oral Solid Medications (cont.)

• Scored tablets– Score allows the tablet to be divided

when smaller doses are ordered.

• Most often, scored tablets divide into halves.

• Some divide into thirds or quarters.

Calculating Dosages –Oral Solid Medications

Rule 13-1Rule 13-1

Always question and/or verify when your calculation indicates to give a portion of a tablet when the tablet is not scored.

Never attempt to break a tablet that is not scored.

Calculating Dosages –Oral Solid Medications (cont.)

Rule 13-2 Rule 13-2 Question and recheck any calculation that indicates that you should administer more than three tablets or capsules.

Calculating Dosages –Oral Solid Medications (cont.)

Rule 13-3 Rule 13-3 Follow these steps when determining the amount of medication to administer to a patient:

Step A Convert

Step B Calculate

Step C Think! . . . Is It Reasonable?

If necessary, recheck calculation.

Calculating Dosages –Oral Solid Medications (cont.)

The order is to give the patient 15 mg mirtazapine PO now.

On hand: 30 mg scored tablets

Calculate the correct amount of medication to administer using method of choice.

Calculating Dosages –Oral Solid Medications (cont.)

H = 30 mg ; Q = 1 scored tablet; D = 15 mg

Step A Convert

No conversion is necessary.

Calculating Dosages –Oral Solid Medications (cont.)

Step B Proportion H/Q = D/A or H:Q = D:A

30 mg/1 tab = 15 mg/A

30 x A = 1 tab x 15

30A/30 = 15 tab/30

A = 0.5 tab = 1/2 tab

Calculating Dosages –Oral Solid Medications (cont.)

Step B Dimensional analysis

A = Q/H x D/1

A tab = 1 tab/30 mg x15 mg/1

A tab = 15 tab/30

A tab = 0.5 tab = 1/2 tablet

Calculating Dosages –Oral Solid Medications (cont.)

Step B Formula Method

15mg/30 mg x 1 tab = A

15 tab/30 = A

0.5 tab = 1/2 tablet = A

AxQHD

Calculating Dosages –Oral Solid Medications (cont.)

Step C Think! . . . Is It Reasonable?

15 mg is one-half of 30 mg, so 1/2 tablet is an appropriate answer.

Tablets are scored, so 1/2 tablet can be given.

Error Alert

Observe patients as they take their medications.

Leaving medications at the bedside leads to errors.

Crushing Tablets or Opening Capsules

• Who benefits?– Patients who have difficulty swallowing pills– Patients who have tube feedings

• Check the policy– May need physician

order first

Crushing Tablets or Opening Capsules (cont.)

• When mixing with food– prepare tablet or capsule;– mix with soft foods or

liquids.

• Check for interactions before mixing.

Some Common Food and Drug Interactions

DRUG FOOD INTERACTION

Antipsychotics Coffee and tea Reduced effectiveness of drug

Bronchodilators Caffeine Stimulation of the nervous system

CNS depressants Black cohosh, ginseng, kava kava, St. John’s wort, valerian, ETOH

Intensified sedative effects of drug

Erythromycin Acidic fruits, juices, carbonated beverages

Decreased antimicrobial activity

Some Common Food and Drug Interactions (cont.)

DRUG FOOD INTERACTION

Ferrous sulfate

Tea Decreased absorption

Haloperidol Coffee and tea Decreased absorption

Insulin Coffee Stimulated excretion

MAO inhibitors Foods with tryamine (hard cheeses, chocolate, red wine, and beef or chicken liver)

Headache, nosebleed,

chest pain, severe hypertension

DRUG FOOD INTERACTION

Tetracyclines Dairy products Reduced effectiveness of the drug

Antihistamines, cholesterol lowering agents, calcium channel blockers

Grapefruit and grapefruit juice

Muscle aches, fatigue, increase in side effects

Some Common Food and Drug Interactions (cont.)

Crushing Tablets or Opening Capsules (cont.)

• Tube feedings– Dissolve the crushed tablet or opened

capsule in a small amount of warm water.

– If medication cannot be crushed• check for an alternative form;

• ask the physician to change the order.

Crushing Tablets or Opening Capsules (cont.)

• Enteric-coated tablets:

– deliver medication that would be destroyed by the stomach acid or that could injure the stomach lining;

– must never be crushed, broken, or chewed.

Crushing Tablets or Opening Capsules (cont.)

• Sustained-Release Medications– Drug is released slowly into the

bloodstream.

– Do not crush or dissolve – this allows too much medication to be absorbed at one time.

Crushing Tablets or Opening Capsules (cont.)

• Spansules– contain granules of medication with different

coatings that delay release of some of the medication;

– may be opened and the granules gently mixed with soft food.

Crushing Tablets or Opening Capsules (cont.)

Rule 13-4Rule 13-4 To prevent an incorrect dose of medication, do not crush or otherwise alter any of the following:

enteric-coated tablets;

sustained-release forms of medication;

any tablet with a hard shell or coating;

Crushing Tablets or Opening Capsules (cont.)

Rule 13-4 Rule 13-4 (cont.)

any tablet with layers or speckles of different colors;

tablets for sublingual or buccal use;

capsules with seals that prevent separating the two parts.

Indication of sustained-release drugs:-Bid LA Tempule

-Dur CR Chronotab

Plateau Cap XL Repetab

Span Sequel Tembid

SA Spansule

SR Extentab

Crushing Tablets or Opening Capsules (cont.)

Crushing Tablets or Opening Capsules (cont.)

Indication of enteric-coated drugs:

EC

Enseal

Patient Education

• Determining how many pills to take– Perform necessary calculations first.

• Determining whether or not to take with food– Drink at least 8 oz of water

with any medication.

Patient Education (cont.)

• Divided tablets– Pharmacist can provide service of dividing

the tablets.

– If patient will do dividing himself, he should:

• wash his hands;• break tablet along scored line;• use a knife or pill cutter.

Patient Education (cont.)

• If patients have difficulty swallowing, they can– drink water before taking pills;

– place whole tablet or capsule in food;

– crush tablets.• Place between two spoons.• Use pill crusher.

Practice

Ordered: Ploglitazone HCl 45 mg po

On hand: see label (unscored tablet)

What is the amount to administer?

What action should you take?

ANSWER: 1 1/2 tablet

ANSWER: Do not break tablet; check for another dose; contact physician.

Practice

Ordered: Alpraxolam 1.5 mg po q 6 h

On hand: see label (scored into fourths)

What is the amount to administer?

What action do you take?

ANSWER: ¾ tablet

ANSWER: break tablet and administer 3/4 tablet

Apply Your Knowledge

True or False___ Any tablet can be broken in half to give a

patient the correct dose.

___ Enteric-coated tablets can be crushed and given through an NG tube.

___ Some spansules can be pulled apart so the granules can be given with applesauce.

T

F

FOnly scored tablets should be broken.

Medication could be broken down by stomach acid, or it could injure the stomach lining.

Apply Your Knowledge

Which of the following foods are contraindicated to mix with tetracyclines?

A. Water

B. Orange juice

C. Milk

D. Applesauce

Apply Your Knowledge

Which of the following types of medications may be crushed for administration?

A. Scored tablets

B. Enteric-coated tablets

C. Sustained-release tablets

D. Spansules

Apply Your Knowledge

What preparation must be done before administering a crushed medication through a nasogastric tube?

A. Nothing special is needed.

B. Mix the medication with applesauce.

C. Mix the medication with warm water.

D. Mix the medication with ice cream.

Apply Your Knowledge

True or False___ You must write only the date and time you

reconstituted the medication on the label..

___ The physician will only order doses of liquid oral medications in volume of liquid.

___ When reconstituting a medication, select a strength that will provided the desired dose in the smallest volume.

T

F

F

You also have to write your initials and strength, if needed.

Medications are usually ordered in units of drug, rather than volume.