Home' Australian Pharmacist : Australian Pharmacist November 2015 Contents Australian Pharmacist November 2015 I ©Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
In the preparation of compounded
products, the pharmacist should be
guided by the professional standards,
the prescriber and the needs of the
patient. Patient counselling and
education can be adapted from
consumer medicines information
leaflets (CMIs) available for commercially
available products, and the Australian
medicines handbook (AMH).
Directions for use
• ‘Shake well before each use’ to ensure
an accurate dose.
• Use the supplied measuring device to
accurately measure the required dose.
• Store the preparation in a cool place
(below 25 °C) or the refrigerator
(depending on instructions),
protected from light and away from
children and pets.
KEY LEARNING POINTS
• Patients with dysphagia require
solid dosage forms that are modified
to accommodate their swallowing
• Pharmacists need to be able to assist
in making the decision whether
to compound or crush, taking into
account both the drug’s stability and
• Pharmacists need to be able to advise
patients and carers of the appropriate
type and amount of medium to use
when crushing tablets to administer
to patients with dysphagia.
1. Rosenvinge SK, Starke ID. Improving care for patients with
dysphagia. Age Ageing 2005;34(6):587–93 .
2. Karkos PD, Papouliakos S, Karkos CD, et al. Current
evaluation of the dysphagic patient. Hippokratia
3. Kelly J, D ’Cruz G, Wright D. Patients with dysphagia:
experiences of taking medication. J Adv Nurs
1. Which ONE of the following
statements about crushing of tablets
to administer to patients with
swallowing difficulties is FALSE?
a) Swallowing difficulties are commonly
associated with elderly patients, who
often take more medicines than
b) Crushing tablets and mixing the powder
in various media may affect the stability
and bioavailability of the drug.
c) There are no legal implications
to modifying dosage forms for
administration to patients unable to
d) Although mixing crushed tablets with
food-based vehicles or thickening
agents provides a functional approach
to medicine administration for patients
with swallowing difficulties, there is a
potential for unexpected drug release
and dissolution profiles.
2. Which ONE of the following agents
has primarily been implicated in
delaying the release of drugs from
media at various levels of thickness?
c) Orange juice.
e) Xanthan gum.
3. Which ONE of the following
statements about the dissolution of
paracetamol from various media is
a) The US Pharmacopeia (USP) standard for
dissolution is that 70% of paracetamol is
dissolved after 30 minutes.
b) Dissolution rate is not affected by the
nature of the medium.
c) In some cases, the dissolution rate is
affected by the amount of medium
d) The medium is chosen on the basis of
its palatability and inability to mask the
taste of the drug.
e) Crushed tablet and paracetamol
suspension do not have similar
4. When planning the preparation of a
suitable extemporaneous oral liquid:
a) The stability of the active
pharmaceutical ingredient (API) to
heat, light and oxygen needs to be
b) The potential for the API to interact with
the excipients needs to be considered.
c) The interaction between the excipients
and packaging materials need not be
considered, as these are inert.
5. It is particularly important to
consider the in vitro release and
dissolution of medicines when
crushed and mixed with common
food vehicles or thickening agents,
when these medicines have a:
a) Narrow therapeutic index.
b) Sustained release.
c) Broad therapeutic index.
d) Requirement of immediate release for
fast therapeutic action.
4. Manrique YJ, Lee DJ, Islam F, et al. Crushed tablets: does the
administration of food vehicles and thickened fluids to aid
medication swallowing alter drug release? J Pharm Pharm
5. Glass BD, Robertson S, Kockler J, et al. Altering medicines to
meet patient needs: pharmacists are the key to ensuring
quality. Melbourne: 5th FIP Pharmaceutical Sciences World
6. US Pharmacopeia – National Formulary (USP 37–NF 32).
USP monographs: acetaminophen tablets. Rockville, MD:
United States Pharmacopeial Convention; 2015.
7. Burridge N, Deidun D, eds. Australian don’t rush to crush
handbook. Collingwood, Vic: The Society of Hospital
Pharmacists of Australia (SHPA); 2011.
8. Sansom LN, ed. Australian pharmaceutical formulary and
handbook. 23rd edn. Canberra: Pharmaceutical Society of
9. 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 .
10. Glass BD, Haywood A. Stability considerations in liquid
dosage forms extemporaneously prepared from
commercially available products. J Pharm Pharm Sci
11. Haywood A, Glass B. Voriconazole suspension for
respiratory infections in exotic pets. Australian Pharmacist
12. Product brochures. Perrigo Australia. At: www.perrigo.com.
13. Haywood A, Glass BD. Clopidogrel as an oral liquid for
those with swallowing difficulties. Australian Pharmacist
14. Standard 10: Compounding (also known as
Extemporaneous Dispensing). In: Pharmaceutical Society
of Australia. Professional practice standards. Version 4.
Canberra: PSA; 2010. At: www.psa.org.au/download/
SOLUTIONS THROUGH COMPOUNDING
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