Home' Australian Pharmacist : June 2011 Contents Vol. 30 -- June #06
Continuing Professional Development
Professional Practice Standard:
Compounding sterile preparations.
• Pharmacists should counsel
patients appropriately on the use
of compounded ACsA, especially
in relation to the time taken for
inhalation, due to the viscosity of
1. Corcoran TE. Inhaled delivery of aerosolized
cyclosporine. Adv Drug Deliv Rev. 2006;58(9-10):1119--
2. Corcoran TE. Aerosol drug delivery in lung transplant
recipients. Expert Opin Drug Deliv. 2009;6(2):139--48.
3. McElhiney LF. The use of inhaled cylcosporine to treat
bronchiolitis obliterans syndrome in a lung transplant
patient. IJPC. 2010;14(2):112--5.
4. Christie JD, Edwards LB, Aurora P, et al. The Registry
of the International Society for Heart and Lung
Transplantation: Twenty-sixth Official Adult Lung and
Heart-Lung Transplantation Report-2009. J Heart Lung
5. Groves S, Galazka M, Johnson B, et al. Inhaled
cyclosporine and pulmonary function in lung
transplant recipients. J Aerosol Med Pulm Drug Deliv.
6. Moffatt SD, Demers P, Robbins RC, et al. Lung
transplantation: a decade of experience. J Heart Lung
7. Iacono AT, Johnson BA, Grgurich WF, et al. A
randomized trial of inhaled cyclosporine in lung-
transplant recipients. N Engl J Med. 2006;354(2):141--
8. Burckart GJ. Ciclosporin aerosol in lung transplantation.
Expert Opin Investig Drugs. 2006;15(8):981--6.
9. Martindale: The complete drug reference (electronic
resource). London: Pharmaceutical Press; 2010.
10. British Pharmacopoeia 2010. Volume 1 & 2
Monographs: Medicinal and Pharmaceutical
Substances. Ciclosporin. London: British
11. Keenan RJ, Iacono A, Dauber JH, et al. Treatment of
refractory acute allograft rejection with aerosolized
cyclosporine in lung transplant recipients. J Thorac
Cardiovasc Surg. 1997;113(2):335-40; discussion 40--1.
12. Professional Practice Standards. Version 4.
Compounding Sterile Preparations: Pharmaceutical
Society of Australia; 2010.
13. SHPA MWP. SHPA Guidelines for Medicines Prepared
in Australian Hospital Pharmacy Departments. J Pharm
Pract Res. 2010;40(2):133--43.
14. Australian Medicines Handbook 10th ed. Adelaide:
Australian Medicines Handbook Pty Ltd; 2010.
15. Australian Pharmaceutical Formulary and Handbook.
21st Ed. Canberra: Pharmaceutical Society of Australia;
16. Professional Practice Standards. Version 4.
Compounding: Pharmaceutical Society of Australia;
17. SHPA. Committee of Specialty Practice in Oncology.
SHPA Standards of Practice for the Safe Handling of
Cytotoxic Drugs in Pharmacy Departments. J Pharm
Prac Res. 2005;35(1):44--52.
18. Australian Medicines Handbook. 10th Ed. Adelaide:
Australian Medicines Handbook; 2010.
19. Iacono AT, Corcoran TE, Griffith BP, et al. Aerosol
cyclosporin therapy in lung transplant recipients with
bronchiolitis obliterans. Eur Respir J. 2004;23(3):384--
20. Iacono AT, Keenan RJ, Duncan SR, et al. Aerosolized
cyclosporine in lung recipients with refractory chronic
rejection. Am J Respir Crit Care Med. 1996;153(4 Pt
21. Gilbert BE, Knight C, Alvarez FG, et al.
Tolerance of volunteers to cyclosporine
A-dilauroylphosphatidylcholine liposome aerosol. Am J
Respir Crit Care Med. 1997;156(6):1789--93.
22. Zijlstra GS, Rijkeboer M, Jan van Drooge D, et al.
Characterization of a cyclosporine solid dispersion for
inhalation. AAPS J. 2007;9(2):E190--9.
1. For the extemporaneous
preparation of an inhalation of
cyclosporin, it is important to
note that cyclosporin:
a) should be protected from air and
b) is soluble in propylene glycol.
c) is practically insoluble in 100%
2. Which of the following
statements about aerosolised
cyclosporin for inhalation
a) Inhaled cyclosporin offers the
opportunity to directly treat the
lungs with therapeutic drug doses,
while sparing the patient from high
b) Currently there are medicines
that are approved for post-lung
transplant care and as such off-
label use of drugs is not required.
c) Oral and IV formulations of
cyclosporin are not suitable for
aerosolisation due to the presence
of excipients not appropriate for
3. Which of the following factors
concerning the development
of a commercial aerosolised
inhalation of cyclosporin
(ACsA) is TRUE?
a) ACsA developed in a single centre
have proved to be efficacious in
treating multiple conditions in lung
b) In order for a drug to reach the
market, the FDA do not require
that a multi-centre study or studies
be undertaken to confirm the
c) Large numbers of lung transplants
are performed each year in
comparison with that of other
d) The ACsA solution for inhalation
presents a challenge from a
formulation perspective because of
its non-viscous nature.
e) The nature of this dosage form
does not preclude its use in other
indications, such as refractory
4. Which of the following criteria
in the Professional Practice
Standards for the compounding
of a sterile preparation such as
ACsA must be adhered to by
A score of 4 out of 5 attracts 1 CPD credit.
a) The pharmacist must ensure
that the sterile compounding
environment complies with
b) The pharmacist may use general
laboratory equipment for the
preparation of sterile products.
c) The pharmacist prepares sterile
products in a manner that ensures
the quality and sterility of the final
d) The pharmacist must record details
of sanitisation but is not required
to monitor temperature during
5. A product containing 62.5 mg
of cyclosporin per mL of
propylene glycol, will usually
take approximately how long
for a patient to inhale via a jet
a) 5 to 10 minutes.
b) 10 to 20 minutes.
c) 20 to 30 minutes.
d) 30 to 40 minutes.
e) 40 to 50 minutes.
solutions through compounding
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
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