Dosage Forms

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• Dosage Forms Strength
• technical presentation 2 of 4

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Main Goal To be able to Accurately Complete the
Audit Sheet Correctly

• By the end of this presentation you should be
  able to
• Look at a package of medicine and determine the
  dosage form
• Look at a package of medicine and determine its
  strength
• Understand why strength is always listed with the
  generic name

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Dosage Form
The physical form of a medication.The route of
administration is dependent uponthe dosage form.

• ORAL
• Tablets
• Syrup
• Suspension
• Granules

• RECTAL
• Suppository
• INTRA-MUSCULAR/
• INTRAVENOUS
• Injection (powder liquid)

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Tablets

• The most common dosage form for antimalarials
  that you will find will be tablets. But it is
  still important to be familiar with the other
  dosage forms when you come across them.
• Capsules and pills are
• considered tablets in
• this study.

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A Closer Look at Dosage Forms that are not as
Common Granules
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A Closer Look At Other Dosage Forms Suspensions
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A Closer Look at Dosage Forms that are not as
Common Powder Injection
Powders injections are often accompanied by a
liquid solvent in a vial. The two are blended for
injection in a syringe.
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Suppositories
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Units of Measurement

• Medicines are usually measured in milligrams (mg)
  and milliliters (mL)
• This section will explain each of these units

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A Brief Review of Units of Measurement There
are 3 Things that we Measure

• Distance/Length

Weight
Volume
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For Medicine, We Need Small Units milligram
(mg)

• 20 grains of salt weigh about 1 mg
• A paperclip weighs about 1000 mg

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For Medicine, We Need Small Units milliliter
(mL)

• 15 drops about 1 mL

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Strength of a Medication

• The strength of a medication tells how much
  active ingredient is contained within the
  medicine

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Strength for Tablets Suppositories
Tablet Suppository Audit Sheet
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Important Points of Medicine Strengths

• The strength of a medicine is always listed with
  the active ingredient (generic name)
• If a medicine has 2 active ingredients, then it
  will have 2 strengths one strength per active
  ingredient

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Important Points

• For tablets and suppositories, strength is
  expressed in mg
• Strength indicates how much active ingredient is
  contained within a single tablet or suppository

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Important Point1 The Strength of a Medication
is Always Listed with the Active Ingredient on
the Package

• 1 active ingredient
• Quinine, 250 mg
• This means there is 250 mg of quinine in each
  tablet

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Important Point2 There is a Strength for each
Active Ingredient in a Medicine

• 2 active ingredients both active ingredients
  contained in a single tablet
• sulfadoxine-pyrimethamine, 500mg-25mg
• This means each SP tablet contains 500mg of
  sulfadoxine and 25mg of pyrimethamine

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Important Point2 There is a Strength for each
Active Ingredient in a Medicine

• 2 active ingredients separate tablets per active
  ingredients
• Artesunate (50mg) / Mefloquine (250mg)

50 mg of Artesunate per tablet
250 mg Mefloquine per tablet
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Why is the Strength Always Listed with the Active
Ingredient?

• The same medicine can come in several different
  strengths
• Example Artesunate tablets are available in
  several different strengths.

Artesunate 200 mg
Artesunate 100 mg
Artesunate10 mg
Artesunate 40 mg
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Q1,Q2 Q3 What is the Generic Name, Strength
and Dosage Form?
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Q1,Q2 Q3 What is the Generic Name, Strength
and Dosage Form?
No Brand name
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Q1,Q2 Q3 What is the Generic Name, Strength
and Dosage Form?
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Suppositories

• A suppository is a small capsule-like medication
  designed for insertion into the rectum, where it
  melts. It is often given to patients who are to
  sick to take medication by mouth. 

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Example

• Strength 50mg of Artesunate is in each
  suppository

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Q1,Q2 Q3 What is the Generic Name, Strength
and Dosage Form?
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Activity

• Using the antimalarial medicines from the first
  exercise, record the strength on the Activity
  Sheet.
• Do you notice anything different between the
  strengths of the first set of antimalarials and
  the strengths of the second set of antimalarials
  (ones with hydrochloride, sulfate, or phosphate
  in the generic name)?

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Strengths of Active Ingredients Presented with an
Extra Chemical

• Recall
• Certain medicines have an extra chemical in the
  name
• The active ingredient alone may be written as
  base on the packaging
• Hydrochloride
• Phosphate
• Sulfate
• From what you have seen, how does this extra
  chemical effect the strength?

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Important Points about Strengths of Medicines
with an Extra Chemical

• Mefloquine hydrochloride, 275 mg
• Equivalent to
• Mefloquine base, 250 mg
• Equivalent to is also sometimes listed

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Some Examples

• Artesunate (200mg) Mefloquine hydrochloride
  (275mg) equivalent to
• Artesunate (200mg) Mefloquine base (250mg)

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Which Strength Should I Record?

• You should record the base strength only
• Mefloquine, 250 mg
• And not
• Mefloquine hydrochloride, 275 mg
• WHY?

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Review Strength of Tablets

• One active ingredient
• Artesunate, 40mg
• One active ingredient with an extra chemical
• Mefloquine base, 250mg equivalent to
• Mefloquine hydrochloride, 275mg
• Two active ingredients
• SP, 500mg-25mg
• Artemether/Lumfantrine, 20mg/120mg
• Two active ingredients with an extra chemical
• Artesunate Amodiaquine base (250mg)
  equivalent to
• Artesunate (50mg) Amodiaquine hydrochloride
  (275mg)

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Review Strength of Tablets

• Question A tablet is considered a _____ form.
• Answer Dosage form
• Question What is the unit of measurement for
  strength for tablets?
• Answer milligrams (mg)
• What this means In each tablet, there is a
  certain weight of the active ingredient.

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Until this Point, We Have Only Discussed Tablets
and Suppositories

• How is strength expressed for dosage forms other
  than tablets and suppositories?

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What about Strengths of Other Dosage Forms?
For dosage forms other than tablets and
suppositories, use the Non-Tablet Audit Sheet
Note about granules. Their strength is actually
expressed in mg however they will be recorded
on this audit sheet, but leaving the mL section
blank.
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What does mg/mL mean?
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It is important to remember which dosage form has
its strength expressed in mg vs.mg/mL
Why? There can be lots of numbers listed on a
medicine box
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Example Strength of Suspension
There can be lots of numbers listed on medicine
package.

• Artemether, 300mg/100mL

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Example - Strength of Liquid Injection

• Chloroquine, 200mg/ 5 mL
• equivalent to
• Chloroquine phosphate, 322.5mg/ 5 mL

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(No Transcript)
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Example Strength of Syrups

• Chloroquine,
• 25mg/5mL

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Strength may be written like this for liquids
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Example Recording Strength of Liquid Injectable
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Example - Strength with 2 Active Ingredients
in each 5mL
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We Have Just Discussed the Dosage Forms that use
Mg/Ml for Strength

• Syrups
• Suspension
• Liquid injection
• Powder injectables are less common and are not
  covered here. Recording strength for this dosage
  forms follow the same pattern. Refer to
  Fieldworkers Manual on how to record its strength.

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Dosage Forms with Strength Measured in mg recall

• Tablets
• Suppository
• Q Why is there a need for 2 different audit
  forms?
• A To accommodate for the 2 different ways in
  which strength is expressed mg or mg/mL

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Review

• What are the two ways that the strength of a
  medication can be written?
• mg or mg/mL
• What determines if the strength will be in mg or
  mg/mL?
• The dosage form

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You Must Pay Very Close Attention Look at ALL
Sides of the Box

• This is the front of the box. Based on this, what
  is the generic name and strength?
• Based on this, would you think the strength of
  Amodiaquine base is greater than or less than 200
  mg?

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Front Side
Always look at every side of the packaging. The
front of this package is misleading.
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Questions

• 1. Name all of the dosage forms of antimalarial
  medicines.
• Tablets, syrups, suspensions, injections (liquid
  powder), suppository, granule
• 2. What does the strength of a medicine describe?
• The amount of active ingredient in a medicine
• 3. On a medicine package, the strength is always
  listed alongside what?
• With the generic name/active ingredient (s)
• 4. What are the 2 units used for strength?
• mg or mg/mL

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You Should Now Be Able To

• Look at a package of medicine and determine the
  dosage form of the medicine
• Look at a package of medicine and determine the
  strength of the medicine
• Understand why strength is always listed with the
  generic name

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• Questions
• ?

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Activity

• Get into groups of 4 or 5 each.
• The facilitators will pass out a group of
  medicines
• Record answers on Activity Sheet B
• Every person must complete an Activity Sheet
• You may help each other
• Remember We are only auditing antimalarials!