Home' Australian Pharmacist : Australian Pharmacist November 2014 Contents Australian Pharmacist November 2014 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
SOLUTIONS THROUGH COMPOUNDING
1. Temozolomide used to treat high
grade gliomas and metastatic
malignant melanoma is:
a) An oral antimetabolite.
b) Freely soluble in water.
c) Able to undergo polymorphic
d) Found to exist as a dehydrate.
e) Not susceptible to hydrolysis.
2. The strength (% w/v)
of temozolomide in the
extemporaneously compounded oral
3. Anhydrous citric acid is included in the
compounded TMZ suspension as a:
a) Suspending agent.
d) pH modifier.
e) Sweetening agent.
4. Ora-blend SF, a commercially
available vehicle used to prepare oral
liquids is a combination of:
a) Ora-plus and Ora-sweet SF.
b) Ora-plus and Ora-sweet.
c) Ora-plus and Ora-blend.
d) Ora-blend and Ora-sweet SF.
e) Ora-blend and Ora-sweet.
5. Conversion of the pro-drug,
temozolomide to its active alkylating
antineoplastic agent, MTIC
4-carboxamide), occurs by:
b) Photolysis (exposure to light).
d) Thermolysis (exposure to heat).
• Hands should be washed well with
soap and water after the medicine is
administered. Contact with the skin
and mucous membranes should be
and if spilt the affected
area should be washed with water.
• The preparation should be stored
protected from light and kept away
from children and pets.
• It is recommended that the
suspension is stored refrigerated
for 28 days. However, if this is not
possible, the suspension should be
stored in a cool place (below 25 °C) for
no longer than 1 week if Ora-Sweet is
used or 2 weeks for Ora-Sweet SF.8
• TMZ is a pro-drug with active
metabolites similar to those produced
• Complete blood count should be
• Prophylaxis against Pneumocystis
carinii pneumonia (PCP) is required
during combined treatment with TMZ
• There is increased risk of neutropenia
and thrombocytopenia in patients
KEY LEARNING POINTS
• Pharmacists can reduce the
potential exposure of healthcare
workers or carers to the deleterious
effects of TMZ by providing an
extemporaneously compounded oral
suspension for those patients who are
unable to swallow TMZ capsules.
• Pharmacists are able to formulate a
suspension to contain appropriate
excipients to ensure the optimum
stability and accurate dosing of the
active pharmaceutical ingredient,
• Pharmacists are able to prepare an
oral suspension containing TMZ in
a protective environment (e.g. class
II cytotoxic drug safety cabinet) using
personal protective equipment.
1. Rossi S, ed. Australian Medicines Handbook. Adelaide:
Australian Medicines Handbook Pty Ltd; 2014. At: www.
2. Temodal CMI. At: www.medicines.org.au/files/mkctemod.
3. Astromide CMI. At: www.betterhealth.vic.gov.au/bhcv2/
4. Temodar Patient Product Information. At: www.merck.
5. Orion temozolomide capsules CMI. At: www.mydr.com.
6. Martindale: The complete drug reference (electronic
resource). London: Pharmaceutical Press; 2014.
7. Trissel LA. Trissel’s Stability of Compounded Formulations.
4th edn. Washington, DC: American Pharmacists
8. Trissel LA, Zhang Y, Koontz S. Temozolomide Stability in
Extemporaneously Compounded Oral Suspensions. IJPC.
9. Babu NJ, Sanphui P, Nangia A. Crystal engineering
of stable temozolomide cocrystals. Chem Asian J
10. US Pharmacopeia – National Formulary (USP 36-NF
31) Online. NF monographs: Vehicle for Oral Solution,
Vehicle for Oral Solution Sugar Free and Vehicle for Oral
Suspension. Rockville, MD: United States Pharmacopeial
11. Sansom LN, ed. Australian Pharmaceutical Formulary and
Handbook. 22nd edn. Canberra: Pharmaceutical Society
of Australia; 2012.
12. Haywood A, Glass B. Voriconazole suspension for
respiratory infections in exotic pets. Aus Pharm
13. Haywood A, Glass B. Liquid dosage forms
extemporaneously prepared from commercially available
products – Considering new evidence on stability. J Pharm
Pharm Sci 2013;16(3):441–55 .
14. Ambados F, Crea J, Chin M, et al. Preparation method and
stability of a temozolomide suspension: A pilot study. J
Pharm Prac Res 2012;42(2):111–4 .
15. Pharmaceutical Society of Australia. Standard 10:
Compounding. Professional Practice Standards. Version
4. Canberra: PSA; 2010. At: www.psa.org.au/download/
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