FUE.

D
23.24
[Practical]

Pharma
Practical

I) Dosage forms of Drugs and Routes of Administration

* Routes of Administration:
- Enteral - Parenteral
- Inhalation - Topical
I) ENTERAL DOSAGE ROUTES:
1. Oral 2. Buccal
3. Rectal 4. Other : Gavage
I) Oral Dosage Forms:
- Drugs taken by the mouth & swallowed for local or systemic effect.
- Liquid - Solid
A) Liquid Oral Dosage Forms:: - Aqueous OR - Alcoholic
A. Solution:
• Syrup: Sweetened Aqueous solution
• Elixir: Sweetened Hydroalcoholic solution
• Tincture: Hydroalcoholic solutions of (10-20% alcohol), Ex. Tincture belladonna
B. Suspension:
- Insoluble solids suspended in water (should be shaked), ex: Antibiotics

B) Solid oral dosage form:

•Tablets •Capsules •Powders
1) Tablets:
•Solid dosage form of varying shape, size & weight in which the drug is compressed with inert
substance (excipients).
1-Ordinary 2-Coated (Sugar) 3-Lozenges
4- Controlled-release = Sustained-release = Slow-release = Extended-release = Retard
Different coats with different disintegration time (Long duration →↓ Frequency, ↑ Patient
Compliance)
5- Enteric-coated tablet:
- In which tablets coated with substances which resist dissolution in the acid juice of the
stomach but dissolve in the alkaline juices of the intestine.
- Remain intact in the stomach - But dissolve in the intestine.
* Advantage: Protect the stomach (Na Salicylate)
6- Effervescent tablet 7-Chewable tablet
8- Sublingual pellets:
•Small tablets to be placed under tongue (e.g. nitroglycerine).
•Drug is absorbed through mucosa under the tongue to reach directly to systemic circulation.
* Sublingual tablets should be:
1. Small in size 2. Have good taste. 3. Easily dissolved.

1
Dr/ AboulSoud FUE.D Pharma
Lec (10): Drugs therapy for thrombosis

2) Capsule:
•Drug in a gelatin container. Gelatin shell containing individual doses of drugs; their
purpose is to provide accurate medication of drugs in a tasteless form.
• Hard • Soft
• Spansules (SR) • Enteric coated capsules.

II) Buccal Route:

1. Sublingual e.g, nitroglycerin
2. In the buccal pouch e.g, lozenges.
3. Transbuccal patch e.g, fentanyl

III) Gavage: Introduction Of Food Or Drugs Into Stomach By Flexible Tube.

➢USED IN COMA .
III) Rectal dosage forms:
1-Liquid (enema) 2- Solid (suppository)
Evacuant Enema Retention Enema
- Used as a bowel stimulant to evacuate - Used to administer drug through the
lower GIT (constipation, before surgery or rectum (CS in ulcerative colitis).
colonoscopy).
- 600ml of warm water given rapidly - Rectum is cleaned first by Evacuant
under high pressure. enema,
- Then a 100ml of warm water given
slowly by drip under low pressure.

2- Solid (suppository): Drug is incorporated in a waxy base

Ex: - Glycerine suppositories,
- Medicated suppositories (Theophylline, NSAIDs).

* Advantages & Disadvantages of routes of administrations

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

II. PARENTERAL DOSAGE FORMS:

I. Injections (liquid):
* Dosage form for injections are:
- Solution - Suspension - Powder (to be reconstituted before use)

* Drugs are dispensed in:

- Ampoule (single use) - Vial (single or multiple use)
- Bottle (or IV bags) - Prefilled syringes
The container Should be: ✓Sterile ✓Pyrogen-free
1. Ampules: - Single dose of sterile solution or suspension
2. Vials: May be a multi-dose preparation
3. Prefilled syringes: For drugs requiring accurate dosing as Insulin

II.Solid (S.C. implantation):

e.g: Contraceptive Pellets (Implants)- - -Placed under the skin

* Types of injections:
- Intradermal - Intramuscular - Subcutaneous - Intravenous
I) IV:
•Adult: superficial veins in dorsum of hand and forearm.
•For long term administration: Subclavian common internal or external jugular vein
* Volume: From less than 1ml to liters.

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

* Technique of injection:
• For one time bolus administration use anticubital vein and use a syringe with needle.
• For continues or intermittent infusions lasting a few days: - Veins of the hand, wrist, forearm,
scalp or umbilicus and use a cannula or Central venous line in jagular or subclavian veins.

❖Advantages:
• Immediate onset: Suitable for Emergency
• 100% bioavailability
• Suitable for irritant drugs & large volumes (infusion)

❖ Requirements
•Trained person •Aqueous only.
•Given slowly with monitoring the patients. •N.B. very irritant drugs can be given.

❖Indications:
- Emergency conditions (Shock, convulsions)
- Fluid therapy (saline, blood,…)
- Anesthesia

❖ Precautions:
1. Accurate dose calculation 2. Strict aseptic conditions
3. Slow administration 4. Exclude air out from the syringe to avoid air embolism
5. Aspirate blood to be sure in vein

❖ Disadvantages: Most dangerous

▪ Transmission of diseases as Hepatitise, AIDS,...
▪ If allergy → Anaphylactic shock.
▪ If very irritant → phlebitis & thrombophlebitis
▪ If Extravasation → Necrosis
▪ Pyrogenic reaction
▪ Once injected, No return
▪ Not suitable for oily preparation (fat embolism).
▪ Infection of IV catheter & small thrombi on its tip.
▪Needs trained person

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

2. Intramuscular route:
❖ Volume of IM injection for adults: <5 ml
❖ Sites of injection: Dorso-gluteal ,vastus laterals, fumerus, deltoid
- The anterolateral thigh is the preferred site for IM injection in infants under 12 months of
age.
❖ Precautions:
1- Avoid major blood vessels and nerve in the muscle
2- Change site of injection to avoid damage to muscle

❖Advantages:
✓ Rapid absorption ✓ High bioavailability
✓ Suitable for depot & oily preparation

❖Disadvantages:
✓ Unsuitable for large volumes (>5ml) or irritant drugs.
✓ Some drugs are bound to muscle protein → irregular absorption e.g. diazepam & phenytoin.
✓ Painful ✓ Abscess ✓ Accidental IVI Or nerve injury

3. Subcutaneous (S.C) Injection: Between the dermis and the muscle.

➢Volume of injection: <2 ml
➢Site of injection:
distant from nerves & major vessels as:
- lateral aspect of upper arm .
- Thigh and abdomen for frequent injection
➢Change site of injection.

❖ Advantages:
✓ Prolonged duration of action. ✓ Acceptable for self-administration (insulin).

❖Disadvantages:
- Irritant.
- Erratic absorption, poor absorption (peripheral circulatory failure)
- Lipodystrophy (Hypertrophy or atrophy) .
FACTOR AFFECTING S.C ABSORPTION

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

4.Intradermal (I.D.) injection

❖ Volume: < 0.5 ml of fluid is injected into skin
❖ Site of injection: ventral forearm is the site of choice.
It is used for injection of: vaccines or sensitivity tests.

III) INHALATION ROUTE

❖ Inhalation route: Can be used for local and systemic Drug may be given by inhalation
effects in the following dosage forms:
➢Gas e.g. oxygen, and nitrous oxide (general anesthetic)
➢Volatile-liquid (vapour) e.g, halothane (general anesthetic)
➢Powders: administered through dry-powder inhalers (DPI)
➢Aerosols: Suspensions of a liquid or solid in a gas

Note I: Solution administered as Aerosols

❖ Salbutamol (bronchodilator).
Aerosols provide high local concentration for action on bronchi, minimizing systemic effects.
I. Nebulizers: Nebulizer (turns liquid medicine into a mist), Jet of air (or O2) to spray the drug.

II. METERED-DOSE INHALERS (MDI): Propellent gas & drug in a canister under pressure.
❖Disadvantages of MDI:
- Needs coordination - Not suitable for children
- Presence of a propellant substance (gas).

Note II: Solid: Dry powder inhaler: as a micronized powder finely

➢ e.g. disodium cromoglycate (Intal) used in prophylaxis of bronchial asthma given by a
special inhaling device called "SPINHALER".
❖Disadvantages:
• Not suitable for children <4 yrs. • Pharyngeal deposition
❖ Advantages
• Suitable for patients failed to use metered dose inhaler
• May cause transient bronchoconstriction.

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

❖Advantages of inhalation route:

• High absorption & Rapid onset due to Large surface area , Rich blood supply of the alveoli
• High concentration in respiratory tract
• Less systemic side effects

❖ Disadvantages of inhalation route:

- Irregular absorption - Inaccurate dosing.
- Cooperative patients - Irritation
- Glucocorticoids: candida infection

IV) EXTERNAL (TOPICAL) DOSAGE ROUTES

- External application of the drug to the surface of the skin or mucous membranes.
❖ Topical administration:
A) For Local Effect on Mucous Membranes and skin
B) For systemic action: Transdermal delivery system

A) Topical Skin Forms:

•Lotion: aqueous solution for local application. • Lotions for wet lesions
•Cream: emulsion of oil in water. • Creams for semi-wet lesions
•Ointment: vaseline or oil base. • Ointments are used for dry lesions
•Solid: powder (Antifungal powder)
➢Mouth: Mucous Membranes : Mouth wash, gargle.
➢Eye: - Eye drops, Eye Ointment: - Preparation for eye should be STERILE
Note: Systemic absorption may occur e.g. bronchospasm in asthmatic patients using Timolol
eye drops for glaucoma.
➢Ear: Ear drops, ointment ➢Nose: Nasal drops

B) Systemic Skin Form: Transdermal Patch (NG, Hyoscine).

❖ Advantages of Transdermal patches:
- No 1st pass metabolism - gradual onset , Long duration
- No GIT irritation - Not destroyed by GIT enzymes

❖ Disadvantages:
- Variable absorption - Local allergy

C) Vaginal Dosage Forms

- Liquid: douche, Betadine vaginal solution.
- Semiliquid: creams.
- Solid: vaginal tablets, pessary (suppositories).

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

II) ADVERSE DRUG REACTION REPORTING:

❖ Adverse Drug Reactions:
“A response to a drug that is noxious and unintended and occurs at doses normally used in man
for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological
function”
* National Centers:
➢ MHRA in UK ➢ SWEDIS in Sweden
➢ FDA (MedWatch) in USA ➢ EPVC in Egypt
* International systems:
WHO system: ‘UMC' Uppsala Monitoring Center.
(ADR)
CASE 1.1
A 40-year-old male patient (A.S.H) weighing 80 kg was admitted to the hospital on 19/1/2022.
He complained of lack of muscle control during voluntary movements (mild), which started on
12/1/2022. On examination, it was diagnosed as ataxia. After history taking, it was found that
the patient has started lithium (300 mg tab/8 hours) and risperidone (3 mg tab/12 hours) since
5/1/2022 to control his bipolar disorder. Serum electrolytes, renal function tests & ECG were
normal. So, the doctor stopped lithium on 20/1/2022. On 27/1/2022, his condition was markedly
improved and was discharged from the hospital.
YOU ARE REQUIRED TO:
1. Complete the ADR Report form.
2. Report the number of cases found in MHRA

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

III) PRESCRIPTION
* Parts of a Prescription
a. Date b. Superscription
c. Inscription d. Subscription
e. Transcription f. Signature

10

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

* Prescriptions for controlled substances must be

1.Written on special forms.
2.Dated and signed on the day of their issuance.
3.Dispensed within 5 days.
4.Bear the full name, address and National ID number of the patient.
5.The prescription must be written with ink or indelible pencil or typewritten.

11

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

IV) SOME LOCALLY ACTING DRUGS IN DENTISTRY

I. ASTRINGENTS
• Astringents shrink tissues, such as the skin, causing a temporary tightening effect. They
also remove oil and can be antibacterial.
* Types:
A. Tannic acid precipitates protein in the form of protein tannate.
Preveting bacteria and fungi from spreading in the mouth
B. Salts of heavy metals: e.g Alum or Shabba, silver nitrate & zincsulfate.
C. Alcohol:
a) In disinfectants → precipitates bacterial protein.
b) Skin antiseptic: 70%.

* Indication in dentistry:
1. Treatment of ulcers in mouth cavity. 2. Local hemostatic.

II. LOCALLYACTING ENZYMES

1- Hyaluronidase enzyme: It hydrolyses hyaluronic acid (main component of ground
substance of tissues) →↑ spreading of local anesthetics

2- Streptokinase:
• It liquefies clotted blood or pus (e.g treatment of hematoma) before aspiration.
• streptokinase is a thrombolytic medication activating plasminogen by nonenzymatic
mechanism.
• As a medication it is used to break down clots in some cases of myocardial infarction

3-Thrombin powder:
• It is used as a local hemostatic.
• Thrombin is a proteolytic enzyme that converts fibrinogen to fibrin. Topical thrombin has a
direct clotting effect on exposed blood.

III. ANTISEPTICS AND DISINFECTANTS

A) Antiseptics:
• They are substances applied to living tissues to kill or prevent the growth of
microorganisms e.g. on skin before operations.
* Uses in dentistry:
• Skin preparation before injection of local anesthetics
• Preoperative preparation for oral mucosa
• Prevention of dental plaque • Irrigation of root canal in endodontics
• Washing of operator hands.

12

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

B) Disinfectants: • Antiseptics are less potent than antibiotics and are used for minor
wounds and cuts, while antibiotics are used for more severe infections like pneumonia and
urinary tract infections.
• used extensively in hospitals and other health care settings for a variety of topical and hard
-surface applications.
* Uses:
1. Sterilization of equipments 2. Cleaning of operative department.

Example:
• Hydrogen peroxide
• Chlorine and chlorine compounds, Formaldehyde, glutaraldehyde, and ortho-
phthalaldehyde, which are aldehydes that can inactivate bacteria, viruses, fungi, and
spores.

1.Phenol & Phenol Analogues

• Phenol:
• Antiseptic (80% in water) → denaturizes proteins of microorganisms.
• Local anesthetic action → numbness in the mouth after mouth wash.
• Uses: mouth wash -antipruritic e.g. phenol in calamine lotion
antipruritic, a cauterizing agent, a topical anesthetic

2. Chlorhexideine
• Chlorhexidine is active against Gram-positive and Gram-negative organisms, facultative
anaerobes, aerobes, and yeasts
• Use of a chlorhexidine-based mouthwash in combination with normal tooth care can help
reduce the build-up of plaque and improve mild gingivitis.(mild)
• Extrinsic tooth staining occurs when chlorhexidine rinse has been used for 4 weeks or
longer.

3. Povidone-Iodine: (Betadine solution, spray and mouth wash)

• Releases low iodine conc. moderate & rapid bactericidal effect with minimal skin staining.
• Broader spectrum of antiseptic and disinfectant activity than chlorhexidine.
• Contraindicated in neonates → neonatal hypothyroidism if absorbed.

13

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

V) MEDICAL EMERGENCIES
1) Respiratory distress: • (Acute Asthmatic Attack)
- The most common cause of respiratory distress (RD) seen in dentalpatients is asthma, also
known as acute bronchospasm.
- RD results from bronchoconstriction and mucous plug formation.
- Characterized by:
1. Difficulty in breathing and expiratory wheeze.
2. Sneezing, gasping sounds when attempting to breath.
3. Spasmodic & unproductive cough.
4. Cyanosis.

* Management:
1. Keep patient in upright position (supine position will make patient breathless).
2. Use humidified oxygen inhalation.
3. Drug therapy includes:
a. Salbutamol inhalation ± ipratropium inhalation.
b. Systemic glucocorticosteroids:
- Methylprednisolone IV injection
- Oral prednisone (if patient can swallow) and continue for 5-7days.
c. Epinephrine 0.5 ml 1:1000 S.C (if no contraindication).
4. IV fluids, correction of acid-base balance, electrolytes & dehydration.

* Dental uses of Corticosteroids:

1. Oral lesions; non-infectious inflammatory diseases as gingivitis, Oral lichenplanus,
pemphigus (autoimmune disease), pemphigoid.
2. Recurrent Aphthous stomatitis
(maybe due to dropped immune system or food allergies) ttt cc ointments.
3- Tempromandibular arthritis: intraarticular or systemic (if with other joints).
4- Oral surgery: to reduce postoperative edema e.g. bony impactions,osseous periodontal
surgeries

* Precaution with Dental Patients Taking Corticosteroids:

1. Morning dosing mimics the body’s diurnal release of endogenous cortisol and minimizes the
side effects.
2. No tapering dose of the medication is required if ttt is expected to be less than 2 weeks.
3-If the patient’s corticosteroid therapy was terminated over 30 days ago, then no
supplementation is required.
4-Topical and inhaled corticosteroids do not require supplementation.
5-Prophylactic antimicrobials before dental procedures because chronic steroid therapy -----
immunosuppression & liability to infections.
6- Candidiasis is common with CS & antifungal agents may be needed

14

Dr/ AboulSoud FUE.D Pharma

Lec (10): Drugs therapy for thrombosis

Common Medical Emergencies in Dentistry:

II) Chest Pain
- Angina pectoris and acute myocardial infarction are the two most likely sources of chest
pain that develop in a conscious patient while undergoing dental treatment.
• Patients commonly use terms such as “squeezing,” “tightness,” “fullness,” “constriction,”
“pressure” or “a heavy
* Management:
1. Stop the dental procedure.
2. Place the patient in a comfortable position.
3. Nitroglycerin sublingual tablet → relieves anginal pain in a few minutes. If needed, repeat the
same dose twice more at intervals of 5 minutes.
4. If the pain is not relieved after the repeated doses of nitroglycerin, the dentist must consider
acute myocardial infarction (AMI) and use MONA protocol.

MONA protocol
a. Morphine IM or IV (or use 50:50 ratio of nitrous oxide & O2)
b. Oxygen
c. Nitroglycerin (sublingual)
d. Aspirin (325 mg tab.)
Chest pain Case
• A 52 –year-old man came to dental clinic complaining of dental caries on the upper left second
molar. He was a heavy smoker with a past history of angina. While, the dentist was removing
the dental caries under local anesthesia, the patient suffered chest squeezing or tightness.
The dentist stopped the dental procedure immediately and put his patient in a comfortable
position. The dentist gave him a sublingual tablet (drug X) that relieved his chest pain after 2
minutes.
Questions
1. What are the risk factors for developing chest pain in this patient?
• ………………………………………………………………………
1. The sublingual tablet that relieved pain in this case is most probably
• ……………………………………………………………..……
3- Describe the mechanism of action of drug X in this case
4- If the pain is not relieved after the repeated doses of the drug X, thedentist
must consider ………………………… and use
• …………………….. protocol which includes:

15

Dr/ AboulSoud FUE.D Pharma