CLINICAL PHARMACOLOGY PRACTICALS AND .

DEMONSTRATION FOR
UNDERGRADUATE STUDENTS (MD, DDS AND BSC.NURSING).

GENERAL PHARMACOLOGY SECTION

PART 1

DOSAGE FORMULATIONS AND PRESCRIPTIONS.

MAIN AIM: To demonstrate different dosage formulations of medicines and prescription

writing.

OBJECTIVES
At the end of this demonstration a student should be able to

● Identify different dosage formulation.

● Understand the reason for coating a drug ( Enteric coated, sugar coated and film coated drug).
● List down examples of each dosage forms.
● Identify drugs with special formulation.
● Understand the Prescription.
● Understand the Common routes of drug administration (Topical route, Enteric route and
parenteral Routes of drug administration and nasal delivery route).
● Understand Common terms of drug formulations (Tablets, Capsules, Powdered, Solution,
Suspension, Syrup, Ointment, Cream, Gel, Lotion and inhalants).
● Understand how to write a standard prescription.
● Understand the elements of a standard prescription.

A: DOSAGE FORMULATIONS
S/NO STATE DOSAGE EXAMPLES
FORMS
01 SOLID Tablets Enteric Aspirin and Metronidazole
coated
Non coated PCM tablets
Capsules Amoxicillin and ampiclox

Powder Ampicillin injection

02 LIQUID Solution Diclofenac injection
Suspension Nystatin oral suspension

Syrup Cough syrup i.e. amoxicillin syrup

03 SEMI SOLID Ointments Hydrocortisone ointment

Creams Ketoconazole
Gel Ketoconazole Gel
Lotion Calamine lotion

04 GASEOUS/Aerosol Inhalants Salbutamol inhaler

Sugar coating
Tablet coating developed originally from the use of sugar to mask the taste and
provide an attractive appearance to at the core.
Organic film coating

The process involves spraying of a solution of polymer, pigments and plasticizer

onto a rotating tablet bed to form a thin, uniform film on the tablet surface.

The choice of polymer mainly depends on the desired site of drug release
(stomach/ intestine), or on the desired release rate.

The objectives of tablet coating are as follows:

i. To mask the disagreeable odor, color or taste of the tablet.
ii. To offer a physical and/or chemical protection to the drug.
iii. To control and sustain the release of the drug from the dosage form.
iv. To incorporate another drug which create incompatibility problem
v. To protect an acid-labile drug from the gastric environment.
vi. Increasing the mechanical strength of the dosage form
Drugs for enteric route

Definition
Enteral route of drug administration is the route which involves the mouth, Esophagus,
Stomach, Small and Large intestine.

Method of administration include: Oral, Sublingual and Rectal.

Examples of medicines
Tablets
Is a solid form of medicine comprised of the active substances and excipients usually in
Powdered form but pressed or compacted from powdered form to solid form.

Capsules
Is the medicine enclosed in a gel like covering allowing it to pass the barriers such as
Stomach acids.

Types of capsules
● Hard shelled capsules which contain dry powdered ingredients sometimes pellets
● Soft shelled capsules which contain oils or active ingredients in liquid form.

Powdered medicine are medicine which exist in powdered form, they need
reconstitution
for final use (examples ampicillin injection vial).

QN: What is the difference between a solution and Suspension?

Syrup is a medication which is sticky and containing concentrated sugar with or without the
addition of flavored ingredients.

Drug for Topical route

Definition

Topical route is the route of drug administration which involves most the
application of drug on the skin surface.

Examples of drugs

Ointments, Gel, Cream and lotions. The table below shows the properties of each
of the four medicines listed above.
Table 2.

S/N TOPICAL % % STICKINESS. GREASY. SKIN

O FORM OF OF OF CONDITION
MEDICATION H2O. OIL.
01 Ointments 20 80 Most Stickier ✔ Most dry skin
infection(condition)
but not preferred in
the visible areas
02 Gel 50 50 Stickier - Wet and dry skin
condition(scalp)
03 Cream 50 50 Stickier - Wet and dry skin
condition(dry,
rough, scaly)
04 Lotion ˃50 50˂ Waterly - Itching skin
irritation from
chicken pox,
insects bites, sting
etc.

Here are some guidelines for deciding when to use an ointment and when to use a
cream:

1. Creams are best when covering large areas of the skin or to avoid the
greasiness associated with an ointment.
2. Wet or “weeping” skin lesions, such as eczema or poison ivy, are best
treated with a cream (or gel).
3. Ointments are best when treating dry skin conditions, such as psoriasis.
4. Ointments allow greater penetration of the active ingredient in the topical
medication, whether it is an antibiotic, steroid, or anti-fungal medication.
5. The best moisturizers are in ointment form.
6. Ointments may be better to use on sensitive skin since many creams are
manufactured with sensitizing preservatives.

Drugs for nasal delivery route

Definition
Nasal delivery route is the route of administration in which the drug is insufflated
through the nose, is used as a local treatment of nasal congestion and allergic
rhinitis.

Drug delivery mechanisms using aerosols are an integral part of the treatment of
respiratory disorders (e.g., Asthma, obstructive lung disorders, cystic fibrosis,
pulmonary arterial hypertension, infectious pulmonary disease).

B: PRESCRIPTION

Five elements of prescription

i. Formulation.
ii. Generic name.
iii. Dose/strength
iv. Frequency of administration.
v. Duration of treatment.

Composition of prescription forms

i. Patient particulars (name, age and address)
ii. Prescription (composed of five elements)
iii. Particulars of prescriber (name ,signature ,code number and date)
iv. Particulars of dispenser(name ,date and signature)
 PRESCRIPTION FORMS

RSM NTABAHUNGU UNIVERSITY HOSPITAL

P.O.BOX 10001, DAR ES SALAAM
PRESCRIPTION FORM

Hospital Reg No:

Patient Name:
Address:
Age: Sex: Weight:
Ward/Clinic: Diagnosis:

Rx

___________________________ ______________________

Prescriber Name Signature

__________________________ ______________________

Code No: Date

Examples of prescription
1. Tabs.paracetamol 500mg tds×3/7
2. Inj.Ceftriaxone 1g od×5/7
3. IV quinine 600 mg in 500mls 0f 5%dextrose 8 hourly×3/7

PART 2

DRUG DELIVERY DEVICES

MAIN AIM: To demonstrate different drug delivery devices and the mechanism of action.

OBJECTIVES
At the end of this demonstration a student should be able to

✓ Understand on how to instruct the patient on the proper use of the device.
✓ Understand the mechanism of action of each drug delivery devices.
✓ Understand and instruct the patient on the safety procedure of using the devices.

Routinely Drug delivery devices, include but not limited to the following.

1. Syringe and Needle

2. Metered dose inhaler and spacer
3. Nebulizer
4. Insulin Pen
5. Infusion Pump
Parts of the Syringe and Needle

Metered dose inhaler and spacer

A device that delivers a measured amount of medication as a mist the patient can
inhale.

It is a pressurized canister of medicine in a plastic holder with a mouthpiece. When

sprayed, it gives a reliable, consistent dose of medication.

A spacer is a chamber that can be attached to a metered-dose inhaler (MDI).

It allows the medicine to be held in the chamber before it is inhaled.
A spacer may be used with an inhaler, especially one that contains corticosteroids.
Do not use a dry powder inhaler (DPI) with a spacer.
This way you can inhale the medicine in one or many breaths, depending on your
ability.

i. Helps prevent getting a yeast infection in your mouth (candidiasis) or

making your voice sound hoarse (dysphonia).
ii. Increases the amount of medicine delivered directly to your airways, even if
you have difficulty using your inhaler.
iii. Reduces the amount of medicine swallowed, which minimizes side effects.
Using an MDI with Spacer

✓ Remove the cap from the MDI and chamber. Shake well.
✓ Insert the MDI into the open end of the chamber (opposite the mouthpiece).
✓ Place the mouthpiece of the chamber between your teeth and seal your lips
tightly around it.
✓ Breathe out completely.
✓ Press the canister once.
✓ Breathe in slowly and completely through your mouth. If you hear a "horn-
like" sound, you are breathing too quickly and need to slow down.
✓ Hold your breath for 10 seconds (count to 10 slowly) to allow the
medication to reach the airways of the lung.
✓ Repeat the above steps for each puff ordered by your doctor. Wait about 1
minute in between puffs.
✓ Replace the cap on your MDI when finished.
✓ If you are using a corticosteroid MDI, rinse your mouth and gargle using
water or mouthwash after each use. You should always use a chamber with a
steroid MDI.

Nebulizer

Is a machine which helps to convert a liquid medicine into a mist which will be
inhaled by the people for their treatment.

It is often used when the use of an inhaler is difficult.

These nebulizers will limit the side effects of medications for example like steroids
since the medicines are directly delivered into the respiratory system.

Procedure of using nebulizer

 i. Make sure the nebulizer and its necessary articles are clean and ready to use
always so that in case of emergency also we can use immediately.
ii. Get comfortable—during the treatment time we can engage ourselves like
watching TV, listening to music, reading books or just relax during the
process.
iii. Always the straight posture is recommended so the medicine is delivered
properly.
iv. Place the mouthpiece between your teeth and seal your mouth around it, or,
we should ensure that there are no gaps and its secured well in case of mask.
v. Once when we switch on the power then take slow, deep breaths from the
mouthpiece or mask. The person should hold each breath for few seconds
before exhalation.
vi. Sometimes, some patients may feel dizzy or strange during treatment. If this
happens, remove the mask or mouthpiece, we can also turn off the machine,
and provide rest for 5 minutes before beginning again, then breathe slowly.
vii. When the treatment is finished, after we switch off the power, deep breathing
should be done several times and we need to cough so that the secretions are
cleared. Spit out the secretions.
viii. Wash hands thoroughly
ix. Finally, we need to check the supplies and accessories to make sure you'll be
ready for the next treatment.
Insulin Pen
Some general facts about the pen to consider include:

✓ type and brand of insulin available

✓ size of the insulin dose it can hold
✓ increments by which the dose of insulin can be adjusted
✓ material and durability (if reusable)
✓ how it indicates remaining insulin levels
✓ ability to correct dose levels that are put in wrong
✓ size of the numbers on the dose dial
✓ level of dexterity required to use the pen

Advantage
Research shows that, people with diabetes are happier of using insulin pens,
particularly prefiled disposable pens than the vial and syringe technique because of
safety ,accuracy and convenient.

Some other advantages include:

✓ ease of use, particularly for older adults and children

✓ ability to fine-tune and deliver highly accurate doses
✓ portable, discreet, and convenient nature of the pens
✓ small and thin needle sizes that reduce fear and pain
✓ ability to accurately pre-set doses using a dial
✓ time-saving benefits due to prefilled and pre-set insulin levels
✓ memory features to show when and how much the last dose was
✓ range of accessories to allow for easier storage and use

Disadvantage
 ✓ not all types of insulin can be used
✓ not possible to mix two different types of insulin
✓ can only be used for self-injection
✓ more expensive than the vial and syringe method
✓ some insulin is wasted with each use
✓ not universally covered by health insurance

General guide for using insulin pens is as follows:

✓ If using a new pen, take it out of the refrigerator 30 minutes before use.
✓ Check the expiration date.
✓ Check the insulin is the correct type and strength.
✓ If necessary, insert a new cartridge into a reusable pen.
✓ Mix the insulin by gently rolling the pen between the palms of the hands.
✓ Tilt the pen up and down until the insulin is clear and smooth.
✓ Wash hands.
✓ Remove the pen cap and clean the top with alcohol.
✓ Firmly attach a new needle to the pen.
✓ Remove the needle caps (retaining the outer cap).
✓ Turn the dial to the correct dose.
✓ Double-check the dose before injecting.
✓ Clean the chosen injection site with alcohol and allow to dry.
✓ Do not inject into areas which have wounds or bruising.
✓ If possible, vary the injection site to avoid lumps or swelling.
✓ Hold the pen to the injection site as per instructions.
✓ Press the injection button.
✓ Wait ten seconds before removing the needle from the skin.

✓ Press on the injection site for 5 to 10 seconds, but do not rub the skin.
✓ Remove and safely dispose of the needle.
✓ Replace the cap on the pen
Infusion Pump

Is a medical device that delivers fluids, such as nutrients and medications, into a
patient’s body in controlled amounts i.e insulin or other hormones, antibiotics,
chemotherapy drugs, and pain relievers.

Advantage

✓ The ability to deliver fluids in very small volumes

✓ The ability to deliver fluids at precisely programmed rates or automated
intervals. They can deliver nutrients or medications, such as insulin or other
hormones, antibiotics, chemotherapy drugs, and pain relievers.
Many infusion pumps are equipped with safety features, such as alarms or other
operator alerts that are intended to activate in the event of a problem.

Some pumps are designed to alert users when air or another blockage is detected in
the tubing that delivers fluid to the patient.

Some newer infusion pumps, often called smart pumps, are designed to alert the
user when there is a risk of an adverse drug interaction, or when the user sets the
pump’s parameters outside of specified safety limits.

PART 3

PARENTERAL ROUTE OF DRUG ADMINISTRATION

MAIN AIM: To demonstrate on Parenteral route of drug administration.

OBJECTIVES
At the end of this demonstration a student should be able to

✓ Understand and locate the parenteral route of drug administration

✓ Understand and locate the injection site for parenteral drug administration
 ✓ Understand the relationship between needle gauge size, angle of injection and nature of
the injection site.
✓ Understand how to calculate the volume of injection from a reconstituted drug.
✓ Understand how to set up an IV infusion and priming of IV.
✓ Understand how to calculate the volume flow rate in drops per minute.

QN: What is the parenteral route of drug administration

i. parenteral of drug administration

ROU INJ SITE NEEDLE INJECTI SYRINGE TYPE OF MEDICATION/

TE GAUGE ON VOLUME FLUID
ANGLE
IV -Cubital vein 21-23G 450 1-10ml -0.9% normal saline
-Metacarpal 5% Dextrose
vein -Blood and blood products

SC -The outer 26-30G 450 for 5/8 1-2 ml -Insulin

Pediatr aspect of the 900 for 3/8 - Heparin
ic to upper arm
adult. -The upper
back
-Abdominal
region
-Middle thigh
- Upper
buttocks
IM -Deltoid 19-25 G 900 or 450 3-5ml Antibiotics eg Gentamicin,
muscle adults. Benzylpenicillin.
-Gluteal 25-27G In Synthetic hormone eg
muscle children testosterone.
-Vastus Benzodiazepine eg
lateralis Lorazepam.
-rectus femoris Opioid analgesic eg
codeine, morphine.
Vaccines eg Diphtheria
vaccine, pertussis vaccine,
tetanus vaccine,
haemophilus influenza B,
hepatitis A and B.
Pneumococcal vaccine.
ID -Anterior 26-28G 100 -150 1ml BCG Vaccine
Pediatr aspect of Implants eg contraceptives.
ic to forearm.
adult. -The upper
back.
-The upper
chest.
-The back of
upper arm

ABBREVIATION

IV-Intravenous

SC-Subcutaneous

IM-Intramuscular

ID-Intradermal

ii. Volume of injection

(HOW TO PREPARE INJECTABLE MEDICATIONS)

Powdered drug reconstitution technique and drawing of a reconstituted drug from

the vial and ampoule.

Calculation of volume of injection

NB:

The volume of injection is calculated by taking the amount of drug prescribed

multiply by the total volume then the results divide by the stock strength.
Vol of injection=(Amount of drug prescribed*Total volume)
Stock strength
QN.1
A patient has been prescribed 50mg of pethidine for injection. The stock strength
available is 100mg in 1ml.How many mils do you give the patient?

QN.2

A patient has been prescribed 2mg of pethidine. The stock strength you have is
10mg in 1ml.How many ml do you give the patient?

QN.3

Mrs. X is 45 and weighs 70kg; she needs to be given 3 mg of Morphine which

comes as 10mg in 2ml.How much do you draw up?

QN.4

40 units of insulin have been prescribed .It is dispensed as 100 units in 1ml.How
much do you give?

IV INFUSION SETUP

i. Parts of iv infusion set

NO PART FUNCTION
1 Stand Hold the Drip system at a desired
Height and position
2 Cannula Connect the drip system with the
venous blood
3 Drip chamber Prevents air from entering the
blood (air embolism) and allows
an estimation of low rate
4 Vented spike Used for tubing
5 Roller clamp Controls volume flow rate
6 Solution filter Filter the contents of the solution
in the drip chamber
7 Protection cap
8 Male luer lock and cap
9 Vented air cap
10 Drip chamber orifice
Prevent contamination of the drip
system
A point where cannula and tubing
system is connected
Used to control air flow in the
tubing system
Allow connection of a vented
spike to a desired solution
IV infusion set up

Materials required
i. IV set
ii. Stand
iii. Cannula
iv. Ringer lactate(Ringer-Locke solution)i.e saline or dextrose
Procedure

Priming on IV line

i. Take out from the pack-mark to scratch in the packet

ii. Clamp it
iii. Never touch the connector
iv. Open the cap of fluid bottle and connect the line
v. Open the line till half of the syringe fills
vi. Open fully and allow fluid to come out to assure no air bubbles inside
vii. Connect to the cannula

CALCULATING FLOW RATE/INFUSION RATE

Drops per minute is equal to total volume to be infused multiplied by drop factor
then divide the result by total time in minutes. Drop factor for blood is 15 and for
other fluid the drop factor is 20.

Drop per min=(Total volume*Drop factor)/Total time

QN.1
800ml of blood is to be given to a patient over 5 hours.What is the infusion rate in
drops per minute if the drop factor is 15?
QN.2
A patient need one liter of normal saline for 8 hours.The drop factor is 20.What is
the rate in drops per minute?
QN.3
100ml is to be given for 50 minutes with a drop factor of 20.What is the infusion
rate in drops per minute?