Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals

Nissen, Lisa; Haywood, Alison; Steadman, Kathryn J.

doi:10.1002/j.2055-2335.2009.tb00436.x

Cited by 45 publications

(86 citation statements)

References 18 publications

(19 reference statements)

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“…Atenolol 50 mg immediate release tablets (Sandoz) was used as a model drug and for being one of the common medicines modified in hospitals (Nissen et al, 2009). Atenolol was also chosen for its high solubility in water and for the presence of a chromophore within the chemical structure to enable analysis using UV spectroscopy.…”

Section: Methodsmentioning

confidence: 99%

“…Crushed medications can be dispersed, sprinkled or mixed with water or other fluid vehicles such as apple sauce, jam, custard, yoghurt, honey, juice or thickened fluids (Nissen et al, 2009, Lee et al, 1996, Gidal et al, 1998, McLean et al, 2001, Fay et al, 2005, Jann et al, 1986, Damle et al, 2002.…”

Section:  Mixing With Food Vehiclesmentioning

confidence: 99%

“…For example, in the UK, 61% of staff in nursing homes crushed or opened medications for patients (Wright, 2002), and 25% of oral doses were altered in a mental institution (Stubbs et al, 2008). In Australia, medications were altered before being given to the patient in 34% of 408 observations in aged care facilities (Paradiso et al, 2002), and nurses at 79% of 97 health facilities altered medicines to ease administration (Nissen et al, 2009). This commonly involves crushing tablets or opening capsules and mixing the contents into food or fluids such as apple sauce, jam, custard, yoghurt, honey or juice (Nissen et al, 2009, Lee et al, 1996, Gidal et al, 1998, McLean et al, 2001, Fay et al, 2005, Jann et al, 1986, Damle et al, 2002.…”

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

“…In Australia, medications were altered before being given to the patient in 34% of 408 observations in aged care facilities (Paradiso et al, 2002), and nurses at 79% of 97 health facilities altered medicines to ease administration (Nissen et al, 2009). This commonly involves crushing tablets or opening capsules and mixing the contents into food or fluids such as apple sauce, jam, custard, yoghurt, honey or juice (Nissen et al, 2009, Lee et al, 1996, Gidal et al, 1998, McLean et al, 2001, Fay et al, 2005, Jann et al, 1986, Damle et al, 2002. Patients suffering from dysphagia often have their fluid and dietary intake managed by the use of thickening agents in order to ensure safe swallowing and avoid aspiration into the airway (Jukes et al, 2012).…”

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

“…Medications for these patients may also be delivered by crushing and mixing with 'thickened fluids' (Nissen et al, 2009), which are liquids such as water or juice thickened to the required viscosity. There are generally three thickness levels used, with the viscosity prescribed often increasing with severity of dysphagia (Jukes et al, 2012).…”

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

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Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Torres¹,

Juliana²

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Medications are often crushed and mixed with foods or fluids to aid drug delivery for those who cannot or prefer not to swallow whole tablets or capsules. Dysphagic patients have the added problem of being unable to safely swallow fluids, so thickeners are added to ensure safe swallowing. These thickened fluids are then also used to deliver crushed medications in replacement of water. This thesis explores the influence of thickened water co-administration on drug release in gastric fluid, the effect of rheological properties of these agents and their contribution to describing the mechanism of release. The literature review (Chapter 1) examines oral dosage form administration, rheological properties of these agents as a means to ensure medication delivery and mechanisms of drug release. It is highlighted that thickened fluids have the potential to alter drug release but prediction of the effect of co-administration is not currently reported.Chapter 2 investigates the delivery of medications with thickened fluids as an indicator for potential compromise of drug bioavailability. In vitro dissolution in simulated gastric fluid is investigated for crushed atenolol immediate release tablets mixed with thickened fluids. Five commercial viscosityincreasing agents of varied polysaccharide composition are used at three thickness levels prescribed for dysphagic patients (levels 150, 400, 900). All types of thickening agents are non-Newtonian shear thinning fluids. The greatest thickness (level 900) significantly restricts dissolution, and products that are primarily based on xanthan gum also significantly delay dissolution at the intermediate thickness level (level 400). The interactions of the polysaccharide chains, particularly the rigid rod type conformation of xanthan gum, traps drug molecules within it resulting in impaired dissolution. Under the conditions of this experiment, the higher concentrations of thickening agents remain in large lumps rather than disintegrating into the media. Drug release is generally affected to a greater extent by high-viscosity fluids than low-viscosity fluids at 50 s -1 , but viscosity at this single shear rate of 50 s -1 is not a good indicator for effect on drug dissolution because viscosity changes with shear rate. The determination of other rheological parameters such as viscoelasticity and the effect of breaking up of the structures may be required.To investigate whether it is possible to improve drug release from thickened fluids, in Chapter 3 the effect of the state of aggregation of the active ingredient with thickened fluids is investigated.Paracetamol is the model drug because it is available in a range of formulations with the drug in solution (elixir, dissolved effervescent tablet) or dispersion (suspension). Xanthan gum, which causes the greatest restriction on dissolution (Chapter 2), is used at level 900 as the thickener.ii Crushed tablets with thickener are prepared using manual (i.e. the standard method in clinical practice) or mechanical mixing. The unthickene...

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Section: Methodsmentioning

confidence: 99%

Section:  Mixing With Food Vehiclesmentioning

confidence: 99%

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

Section: Chapter Investigation Of Drug Delivery From Thickening Agentmentioning

confidence: 99%

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Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Torres¹,

Juliana²

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Compounding Practices in Queensland: Experiences and Perceptions of Pharmacists and Pharmacy Students

Lau¹,

Jones²,

Kairuz

et al. 2013

Pharmacy Practice and Res

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Background Changes in the roles of the contemporary pharmacist has seen a decline in the number and variety of extemporaneously compounded dosage forms. Pharmacy curricula reflect this change with a reduction in the emphasis on extemporaneous compounding practice. Aim To elicit information about extemporaneously compounded dosage forms and perceptions of compounding practice from pharmacists and pharmacy students. Method Self‐administered surveys were mailed to 1063 pharmacists and offered online to 896 pharmacy undergraduates across the 4 years of a Bachelor of Pharmacy program in Queensland. Results 382 (36%) pharmacists and 455 (51%) students completed the survey. Most pharmacists (96%) reported compounding a product in the 12 months prior to the survey, particularly semi‐solids (89%) and liquids (64%) for external use. Most pharmacies (> 96%) owned basic compounding equipment, such as a slab and spatula, mortar and pestle, and cylindrical/conical measures. Half of the pharmacies used mechanical rather than electronic balances. Students expressed greater confidence in their ability to use basic compounding equipment and to perform basic compounding tasks as they progressed through the 4‐year degree course. Pharmacists' views on students' ability to compound basic products at the end of their degree were generally similar to the proportion of final‐year students who reported they could confidently complete the task. Conclusion Despite a decline in extemporaneously compounded products in community pharmacy, pharmacy graduates need to be competent in compounding techniques.

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Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey

Story

Booth³

et al. 2013

Pharmacy Practice and Res

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Aim To determine clinical staff's understanding of managing oral medications in patients with restrictions on oral intake. Method An online survey was designed consisting of 4 scenarios featuring a patient who was fasting pre‐surgery, day 1 post‐surgery, nil‐by‐mouth after stroke or had a nasogastric feeding tube in situ. The target population was clinical staff (nursing, medical, pharmacy, dietetics, speech pathology) involved in the management of oral medications and/or patients' oral intake. Medications studied were: aspirin (Cartia) 100 mg mane; gliclazide (Diamicron MR) 60 mg mane; atorvastatin (Lipitor) 40 mg mane; metoprolol (Betaloc) 50 mg bd; levodopa/carbidopa (Sinemet CR) 200/50 tds; ginkgo 7500 complex mane. Respondents could choose to give, withhold, cease, contact someone for advice, change the formulation before giving or choose ‘other’ and make a comment. Results 622 responses were received from clinical staff. When fasting, respondents would give metoprolol (65%) and levodopa (68%) but not aspirin (70%), gliclazide (63%), atorvastatin (50%) and ginkgo (65%). Approximately 10% of respondents would give oral medications to the nil‐by‐mouth patient. The consensus for the nasogastric feeding tube was to give all the medications via the tube, including modified‐ or controlled‐release medications. Conclusion There appeared to be varying understanding of managing oral medications when patients have restrictions on oral intake. This is concerning as it has the potential to result in adverse patient outcomes.

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Solid Medication Dosage Form Modification at the Bedside and in the Pharmacy of Queensland Hospitals

Cited by 45 publications

References 18 publications

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Understanding the mechanism of drug delivery from thickened fluids to aid swallowing of medications

Compounding Practices in Queensland: Experiences and Perceptions of Pharmacists and Pharmacy Students

Oral Medication Administration in Patients with Restrictions on Oral Intake—A Snapshot Survey

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