بسم الله الرحمن الرحيم



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King Saud University

College of Pharmacy

Department of Pharmaceutics

Dispensing of Medication 1- PHT 451

Laboratory Assignments

2006 G - 1427

Professor Dr. Mahasen A. Radwan

"I 'm proud to be a Pharmacist"

Your TA: Bushra Al-Quadeib

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments

Successful completion of the laboratory portion of the course will lead to the achievement of the following specific objectives:

1. Given the physical & chemical nature of the components ingredients, you will be able to correctly prepare and label a Rx.

2. You will know the generic name, active ingredient(s), brand name(s), usual dosage, therapeutic use, and the major side effects of the selected drugs mentioned during

lectures.

3. Also you will know what consultations to provide a patient concerning a dispensed Rx to assure its proper safe use.

4. You will know how to effectively use standard pharmacy reference sources for the solution

of specific drug-related problems.

6. Given a Rx containing more than one ingredient, you will be able to recognize the presence or absence of a physical & or chemical incompatibility and to be able to recommend a method of resolving the incompatibility.

7. You will be able to correctly complete all pharmaceutical calculations which you are confronted with.

8. Given a commonly encountered disease state, you will be able to recommend strategies which may be employed to prevent or resolve patient problems.

To attain these specific objectives the following rules must be adhered to in the lab:

1. All students must wear clean, white lab coats while in the laboratory.

2. All students must follow the instructions of their Teaching Assistant (TA).

3. All students must complete all laboratory assignments. If a lab is missed, the reason for the absence must be discussed with the instructor and a makeup lab arranged. A substantial grade reduction will be given for any assignment which is not completed.

4. No aid is to be given or received between students in the lab. Students who exhibit dishonest or unprofessional behavior in the lab may, at the discretion of the instructor receive a failing grade for the laboratory portion of the course.

5. Only a student’s best effort is to be submitted for grading. Receipt of a carelessly prepared Rx will result in a failing grade for the exercise.

6. A name tag with your full name, Pharmacy Student as a title and "I 'm proud to be a Pharmacist" as a badge is a must for every student.

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments

Main subjects which will be covered in the labs.:

1. Compounding, calculations and evaluation of preparations of oral electrolyte

solutions.

2. Physical & Chemical incompatibilities in Rx compounding.

3. Extemporaneous preparations of Capsules & Syringe in Hospitals.

4. Dosage and Compounding of Pediatric and Geriatric prescriptions

5 & 6. Drug - Drug interactions in prescriptions. Drug interactions affecting absorption and

elimination of drugs.

7. Exam.

What are the responsibilities of each students:

1. The attendance of each lab. is a must (from 11:00a.m. to 2:00 p.m.)

2. There will be a quiz/lab. for 3 labs. starting with the 2nd lab about:

a. Problems from the Pharmacy Calculations’ book, esp. ch 12 and 13.

c. Any other calculations covered in the lab.

d. Material covered in the last lecture(s).

3. Lab. Final will include:

a. Subjects covered in labs.

b. Calculations

c. Other assignments (published paper on one of the lab subjects, Summery report of

the work , the important finding, and its significant to patient therapy.

4. The first two hours of each lab will be devoted to explanation of the lab. assignment,

compounding, and quiz, while the last hour will be for Discussion of the quiz and improving your calculation skill.

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments – TA: Miss Bushra Alkadeeb

Lab # 1

Electrolyte Solution

I. Dispense the following Prescriptions (RX) and answer the questions after each one. Show all calculations:

(Na =23, k = 39, Ca = 40, Cl = 35.5, k Acetate = 98, Potassium Bicarb = 100, Potassium Citrate = 324)

1. Pt. name: Susan Ibrahim

RX

Sodium Chloride

Potassium Chloride

Calcium Chloride aa 200 mEq

Cherry Syrup to 120 mL

Sig one teaspoonful TID ac

a. Calculations:

b. How many mEq of each electrolyte are presented per dose?

2. Henry Jackson

RX

Potassium chloride 15%

Calcium chloride 4 gm

Simple Syrup 120 mL

Sig 15 mEq K+ QID

a. Calculations:

b. How many mEq of each electrolyte are presented per dose?

c. Label information

d. How many mOsm of each electrolyte are in the final solution?

3. Haleem ElSaid

RX

Potassium Acetate

Potassium Citrate

Potassium Bicarb aa 0.45 gm

Purified Water 5 mL

Sig one teaspoonful tid

a. Calculations:

b. How many mEq of k+ are presented in each dose?

4. Aly Salem

RX

Potassium Chloride 16%

Cherry Syrup q.s. ad 480 mL

Sig tablespoonful BID

a. Calculations:

b. How many mEq of a Potassium Chloride represented in each prescribed dose?

II. Show the calculations of the following:

1. A solution contains 3.22 of Na+ ions per tablespoonful. How many mOsm are represented per dose and per 100 mL?

2. a. How many ml of the stock solution (60%) is needed to prepare a 500 mL

solution of 100 mg/ml?

b. For how long the solution should be given if it has to be infused at 40 mg/hr?

3. Show how to prepare the following:

1. A 2 L of a 15% dextrose solution from 50% solution.

2. A 30 mL of D25W from 60% solution.

3. A 50 mL 1/4 NS from NS solution.

4. A 30 mL 1/2 NS from NS solution.

4. A patient is to receive 0.2mEq/kg of NaCl. If the patient wt is 132 lb, how many mL of NS should be administered?

5. A medication order for an IV infusion for a patient weighing 120lb called for 0.6

mEq/kg of NH4Cl to be added to 500 mL of D5W infusion.

a. How will the pharmacist manufacture this infusionfrom the available stock solutions containing 100 mEq/20 mL?

b. If the infusion has to be given at a rate of 150 mL/hr, how many mg/min of NH4Cl will the patient receive?

III. Prepare 50 mL of each of the following Solutions:

a. 0.06% acetic acid irrigaring solution.

b. 0.01 N HCl

c. 75% isopropyl alcohol

d. Others as indicated from the available stock solutions.

Department of Pharmaceutics Dispensing of Medication - PHT 451

2002 – 1423/1424 Dr. Mahasen Radwan

Show How to Prepare the following items:

1. 75 ml of 15% dextrose, if the available stock is 70% solution

2. 30 ml of 25% dextrose, if 50% stock is available

3. 50 ml of 3% dextrose, if 5% stock is available

4. 50 ml of ¼ NS, if NS is available

5. 30 ml of ½ NS, if NS is available

6. How many ml of the stock solution 5% dextrose is needed to prepare a 250 ml of 50 mg/ml

7. Prepare 2L of a 15% dextrose from 50% solution

8. 100 ml of 5% CaCl2 from 25% solution, for how long this solution will be infused in hours, if the patient has to take 12.5 mg/hr

9. Prepare a 250 ml of 10% calcium chloride solution from 50% solution. For how long, hr, the solution should be given if the patient has to take 500 mg/hr?

10. Mr. Khalid is an adult male patient (115 Ib, 39 yr.old.) is to be given aminophylline 30 mg/ 50 ml NS via IV infusion. From the available stock solution (15 mg/1ml), how you can prepare it. Write label information?

11. Mr. Hassan is an adult male patient (125 Ib, 39 yr.old.) is to be given adrenaline chloride 3 mg/ 50 ml D5W via IV infusion. From the available stock solution (1mg/ml), how you can prepare it. Write label information?

12. Mr. Ali is an adult male patient (135 Ib, 39 yr.old.) is to be given 15 mg of sodium bicarbonate. From the available stock solution (1mEq =ml) , how you can prepare it. Write label information?

13. A patient is to receive 0.2 mEq of sodium chloride per kilogram of body weight. If the patient weighs 132 Ib, how many ml(s) of an 0.9% sterile solution of sodium chloride should be administered? (m.wt = Na=23, Cl=35.5)

Department of Pharmaceutics Dispensing of Medication - PHT 451

2002 – 1423/1424 Dr. Mahasen Radwan

Lab # 2 # General Incompatibilities

Definition of Incompatibility:

Types of Incompatibility:

I- Pharmaceutical incompatibility: (physical and chemical)

II- Therapeutic incompatibility (drug –drug interaction)

Physical Incompatibility:

- Definition:

- Types (Classification):

1- Incomplete solution

2- Immiscibility

3- Precipitation or salting out

4- Liquification of the solid ingredient

5- Solidification or gel formation

How Does the Pharmacist Detect and Correct the Physical Incompatibility:

I- Change the volume of solvent or change the solvent:

I- Terpine hydrate 1.7 gm

Alcohol 10 ml

Cherry syrup q.s. 100 ml

2- Mercuric iodide 195 mg

Thymol 325 mg

Purified water q.s. 30 ml

3- Sodium salicylate 10 gm

Sodium bicarbonate 10 gm

Aquoes cinnamon q.s. 60 ml

II- Change the form of ingredient

1- Phenobarbital gr iii

Sodium salicylate z ss

Purified water q.s. FlZ i

III- Addition of filler or diluent

1- Aminopyrine gr v

Codiene So4 gr 1/4

Belladonna extract gr 1/6

Acetyl salicylic acid gr iii

IV- Make an emulsion dosage form

1- Sodium sulfate 5 gm

Liquid paraffin 50 gm

Cherry syrup q.s. 120 ml

V- Make a suspension dosage form

VI- Change the dosage form

Chemical Incompatibility:

- Definition:

- Types (Classification):

1- Oxidation

2- Reduction

3- Racemization

4- Precipitation

5- Change in colours

6- Evolution of gas

How Does the Pharmacist Detect and Correct the Chemical Incompatibility:

I- Control the reaction

Ammonium carbonate z i

Ammonium chloride z ii

Dilute acetic acid Fl Z ii

Simple syrup q.s. FlZ iv

II- Replacing one of the reacting ingredient

1- Sodium salicylate z vi

Calcium bromide z iii

Cherry syrup Flz iii

Purified water q.s. FlZ iii

2- NH4 salicylate z i

KHCO3 z i

Peppermint water q.s. FlZ vi

Correction of incompatibility

I – Counsel the physician

II- Use Pharmacist "Know How"

1- modifying the order of mixing

Mg CO3 3.75 gm

NaHCO3 7.5 gm

Citric acid 7.5 gm

Purified water to 250 ml

2- Dispense with "shake well" label

3- Dispense with "store in refrigerator"

4- Complete the reaction before packing

5- Protect from light, moisture and air.

III- Addition of an ingredient

1- Adding suspending agent

2- Adding emulsifying agent

3- Adding inert solubilizing agent

Aspirin 1 gm

Simple syrup to 60 ml

4- Adding inert diluent

IV- Removal of an ingredient

Phenol 0.5 ml

Menthol 0.1 ml

Tragacanth 0.5 gm

Olive oil 50 ml

Lime water to 100 ml

V- Change the vehicle

VI- Change the form of the ingredient

VII- Change the dosage form

VIII- Read the literature, text books, charts.

King Saud University PHT 451 Dept of Pharmaceutics

|Name:----------------------------------------------------ID#------------------------ |

Show all calculations and procedure of the following Rx:

If there is any incompatibility, Prepare it only in the correct way, with the right label

Rx Aspirin 2 gm

Simple syrup to 120 ml

Fiat: solution Mitte: 50 ml Sig.: 5 ml q6h.

-Do you detect any incompatibility?

- What is its nature?

- How do you correct it?

2. RX

Sodium salicylate 5g

Syrup of lemon 20 ml

Aqua To 75 ml

Fiat: solution

Mitte: 50 ml

Sig: 5ml TID

Incompatibility:

Correction:

3. RX

Quinine Hcl grxx

Sodium salicylate ii

Aqua iii

Fiat: Suspension

Mitte: 45 ml

Sig: fl ii q6h.

Incompatibility:

correction:

4. RX

Phenol 4%

Sodium sulfate 5g

water q.s. ad 50 ml

Fiat: Solution

Sig: Ut. dict

Incompatibility:

Correction:

5. RX

Potassium citrate i

Tr. Belladonna i

Spirit mentha ss

Aqua q.s. ad iss

Fiat: Mist

Sig: fl ss qid

Incompatibility:

Correction:

6. RX

Calcium lactate 0.500 g

Ephedrine hydrochloride 0.015 g

Antazoline Hcl 0.050 g

Liquid of liquorice 1.000ml

Water To 15 ml

Fiat: Solution

Mitte: VI doses

Sig: fl ss t.d.s.

Incompatibility:

Correction:

7. RX

Sodium Salicylate vi

Potassium Iodide i

Potassium Bicarbonate iii

Elixir of peptenzyme qs iii

Fiat: Solution

Mitte:45 ml

Sig: fl ss t.d.s.

Incompatibility:

Correction:

8. RX

Phenobarbital 250 mg

Elixir phenobarbital q.s. 30 ml

Fiat: Solution

Sig: 5 ml h.s.

Incompatibility:

Correction:

9. RX

Phenobarbital 0.4g

Orange oil 0.1 ml

Alcohol 25 ml

Glycerin 35 ml

Sucrose 12 g

Water q.s. ad 100 ml

Fiat: Elixir

Mitte: 50 ml

Sig: fl ss h.s.

Incompatibility:

Show all calculations and procedure of the following Rx:

If there is any incompatibility, Prepare it only in the correct way, with the right label

1- Rx Aspirin 2 gm

Simple syrup to 120 ml

Fiat: solution Note: 1 gm aspirin dissolve in 200 ml of distilled water

Mitte: 50 ml Sig.: 5 ml q6h.

-Do you detect any incompatibility?

Yes, there is a suspended particle “insoluble particle” or suspension is formed instead of solution dosage form

- What is its nature?

It is physical incompatibility due to insolubility of aspirin

- How do you correct it?

1- bvby increase the volume of solution, and so, increase dose.

2- Adding solubilizing agent “K-citrate” double amount aspirin>

|Before correction |After correction |

|in a mortar add aspirin, grind it to very fine powder using pestle. |in a mortar add aspirin, grind it to very fine powder using pestle. |

|Add ½ amount the vehicle, gradually, then mix well using pestle. |Add amount of K-citrate, grind. |

|Transfer no.2. into conical measure. |Add ½ amount the vehicle, gradually, then mix well using pestle. |

|Wash the mortar with the remaining amount from the vehicle. |Transfer no.3. into conical measure. |

|Remaining= total - reading |Wash the mortar with the remaining amount from the vehicle. |

|Net result: |Remaining= total - reading |

|Suspension is formed, wrong preparation |Net result: |

| |Solution is formed, right, fix a label |

2. Rx

Sodium salicylate 5g

Syrup of lemon 20 ml

Aqua To 75 ml

Fiat: solution Mitte: 50 ml Sig: 5ml TID

-Do you detect any incompatibility?

Yes, there is a suspended particle “insoluble particle” or suspension is formed instead of solution dosage form

- What is its nature?

It is chemical incompatibility due to formation of salicylic acid ‘’insoluble’’

Sodium salicylate + citric acid ( salicylic acid + sodium citrate

- How do you correct it?

1. by replace lemon syrup = simple syrup + lemon tincture

10 ml = 9 ml + 1 ml

|Before correction |After correction |

|in a conical measure add sodium salicylate, with ½ amount the |in a conical measure add sodium salicylate, with ½ amount the |

|vehicle, gradually, then mix well using glass rod => solution |vehicle, gradually, then mix well using glass rod => solution |

|add syrup of lemon mix well => suspension is formed. |add simple syrup mix well, then add lemon tincture, mix well using |

|Complete with the vehicle. |glass rod => solution is formed. |

| |Complete with the vehicle. |

|Net result: |Net result: |

|Suspension is formed, wrong preparation |Solution is formed, right, fix a label |

3. Rx

Quinine HCl grxx

Sodium salicylate Zii

Aqua Ziii

Fiat: Suspension

Mitte: 3Fl z

Sig: flz ii q6h.

-Do you detect any incompatibility?

Yes, there is a suspended particle “insoluble particle” or suspension is formed instead of solution dosage form, high rate of sedimentation.

- What is its nature?

It is physical incompatibility due to high rate of sedimentation, Not true suspension

- How do you correct it?

1. by adding suspending agent acacia 2% .

|Before correction |After correction |

|in a mortar add quinine HCl, grind it to very fine powder using |in a mortar add quinine HCl, grind it to very fine powder using |

|pestle. |pestle. |

|Add ½ amount the vehicle, gradually, then mix well using pestle. |Add acacia, mix well using pestle. |

|Add amount of sodium salicylate, mix well using glass rod. |Add ½ amount the vehicle, gradually, then mix well using pestle. |

|Transfer no.3. into conical measure. |Add amount of sodium salicylate, mix well using glass rod. |

|Wash the mortar with the remaining amount from the vehicle. |Transfer no.4. into conical measure. |

|Remaining= total - reading |Wash the mortar with the remaining amount from the vehicle. |

|Net result: |Remaining= total - reading |

|Not true suspension is formed, wrong preparation |Net result: |

| |suspension is formed, right, fix a label |

4- Rx Mg CO3 3.75 gm

NaHCO3 7.5 gm

Citric acid 7.5 gm

Purified water to 250 ml

Fiat: solution Mitte: 100 ml Sig.: I tbls ac tid 2/52

-Do you detect any incompatibility?

Yes, there is a suspended particle “insoluble particle” or suspension is formed instead of solution dosage form

- What is its nature?

It is physical incompatibility due to evolution of gas “effervescent”

How do you correct it?

1. by change the order of mixing, MgCO3 then citric acid, then NaHCO3.

|Before correction |After correction |

|in a beaker add MgCO3 , in 1/2 amount of vehicle = milky solution |in a beaker add MgCO3 , in 1/2 amount of vehicle = milky solution |

|add NaHCO3, gradually, mix well after each addition, using glass rod. |add, citric acid gradually, mix well after each addition, using glass|

|Add citric acid gradually, mix well after each addition, using glass |rod, until clear solution is obtained. |

|rod. |Add NaHCO3 gradually, mix well after each addition, using glass rod. |

|Complete volume with water. |Complete volume with water. |

| | |

|Net result: |Net result: |

|Suspension is formed, wrong preparation |Solution is formed, right, fix a label |

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments – TA: Miss Bushra Alkadeeb

Lab # 3

Extemporaneous preparations

RX - 1

Show all calculations and method of preparation of the following:

The Physician prescribed the following RX to M. Nasser (21 kg, 9 years old).

Date _____________________ Time _________________________

RX

------------------- ----- mg/kg/day to be given as BID

Prepare 24 hr unit doses of the above RX in as ready to administer oral syringe= 3.5 ml. Use any necessary auxiliary label(s).

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments – TA: Miss Bushra Alkadeeb

Lab # 3

Extemporaneous preparations

RX - 2

Show all calculations and method of preparation of the following:

The Physician prescribed the following RX to N. Mokhtar (55 Ib, 10 years old).

Date _____________________ Time _________________________

RX

------------ -------- / kg/day to be given as TID

Prepare 24 hr unit doses of the above RX in as ready to administer oral Capsule = 400 mg. Use any necessary auxiliary label(s).

Department of Pharmaceutics Dispensing of Medication 1- PHT 451

2006-1427H Professor Dr. Mahasen A. Radwan

Laboratory Assignments – TA: Miss Bushra Alkadeeb

Lab # 4

Pediatric and Geriatric RX

Neonates 0 - 1 mo Infants 1 - 12 mo

Children 1 - 12 yr Adolescent 12 - 20 yr

Adult 20 - 70 yr elder >70 yr

I. Calculation of Body Surface Area (SA)

Average SA (m2) of an adult (70 kg) = 1.73 m2

(((Infant - adult SA (m2) = Wt (kg)0.5378 * Ht (cm)0.3964 * 0.024265

(used in Hospitals and it is applied to the attached Nomograms).

(((1-14 yr. & adult Classic equation by DuBois:

SA (m2) = 0.007184 * Wt (kg)0.425 * Ht (cm)0.725

II. Calculations of Maitainance Dose _(DM)

SA of child (m2)

* DM of a child = ((((((( * Adult dose (mg/kg)

1.73 (m2)

* Clark’s Rule, based on Wt:

Child Wt in lb

* DM of a child = ((((((( * Adult dose (mg/kg)

150 lb

IV. Solve the following problems, use the attached nomograms when necessary:

Problem #1:

a. Calculate the SA of a 185 cm tall patient (80 kg):

b. Calculate the SA of a 2-day-old newborn, 2.5 kg, and 40 cm tall.

c. Calculate the SA of a 5- year- old child, 20 kg, 100 cm

Problem #2:

Gentamicin dose for a urinary tract infection is 1 mg/kg administered TID for 10 days. What would be: a. a single dose and, b. the total dose for a 15-year-old child weighing 110 lb?

Problem #3:

A child weighing 35 lb is to receive 4 mg/kg phenytoin daily as an anticonvulsant. How many mL of pediatric phenytoin suspension containing 30 mg/5 mL should the child receive?

Problem #4:

The DL of digoxin in premature infants with a birth wt of ................
................

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