Dosage Forms & Strength

technical presentation 2 of 4

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

Dosage Form
The physical form of a medication. The route of administration is dependent upon the dosage form. ORAL Tablets Syrup Suspension Granules RECTAL Suppository INTRA-MUSCULAR/ INTRAVENOUS Injection (powder & liquid)

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.

A Closer Look at Dosage Forms that are not as Common: Granules

A Closer Look At Other Dosage Forms: Suspensions

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.

Suppositories

Units of Measurement

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

A Brief Review of Units of Measurement:

There are 3 Things that we Measure

Distance/Length

Weight

Volume

For Medicine, We Need Small Units: milligram (mg)

20 grains of salt weigh about 1 mg

A paperclip weighs about 1000 mg

For Medicine, We Need Small Units: milliliter (mL)

15 drops = about 1 mL

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

Strength for Tablets & Suppositories

Tablet & Suppository Audit Sheet
2. Strength
[__|__|__].[__] mg [__|__|__].[__] mg

3. Dosage form
1 = Tablet 2 = Suppository

[__|__|__].[__] mg

Important Points of Medicine Strengths:

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

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

Important Point#1: 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

Important Point#2: 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

Important Point#2: 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

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 10 mg

Artesunate 40 mg

Artesunate 100 mg

Artesunate 200 mg

Q1,Q2 & Q3 What is the Generic Name, Strength and Dosage Form?
1. Generic name
__________ __________

2. Strength

3. Dosage form
1 = Tablet 2 = Suppository

Amodiaquine [_2_|_0_|_0_].[_0_]mg [___|___|___].[___]mg [___|___|___].[___]mg

Q1,Q2 & Q3 What is the Generic Name, Strength and Dosage Form?
No Brand name

1. 2. 3. Generic name Strength Dosage form Artesunate [_0_|_5_|_0_].[_0_] mg 1 = Tablets Sulfadoxine [_5_|_0_|_0_].[_0_] mg 2 = Suppository Pyrimethamine [_0_|_2_|_5_].[_0_] mg

4. Brand name

Artesunate + SP Pediatrique

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

1.

2.

3.

Generic name
Sulfadoxine
Pyrimethamine _______________

Strength
[_2_|_5_|_0_].[_0_] mg
[_0_|_1_|_2_].[_5_] mg [___|___|___].[___] mg

Dosage form
1 = Tablets
2 = Suppository

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.

Example
Strength: 50mg of Artesunate is in each suppository

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

1. 2. Generic Strength name

Artesunate [_0_|_5_|_0_].[_0_] mg

3. Dosage form
1 = Tablet 2 = Suppository

________
________

[___|___|___].[___] mg
[___|___|___].[___] mg

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)?

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?

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

Some Examples:
Artesunate (200mg) + Mefloquine hydrochloride (275mg) equivalent to Artesunate (200mg) + Mefloquine [base] (250mg)

Which Strength Should I Record?

You should record the base strength only

Mefloquine, 250 mg
And not

Mefloquine hydrochloride, 275 mg WHY?

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)

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.

Until this Point, We Have Only Discussed Tablets and Suppositories

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

What about Strengths of Other Dosage Forms?

For dosage forms other than tablets and suppositories, use the Non-Tablet Audit Sheet 1. Generic name 2. Strength 3. Dosage form
4 = Suspension 5 = Liquid injectable 6 = Powder injectable 7 = Granule

[__|__|__].[__] mg /[__|__|__] mL 3 = Syrup

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.

What does mg/mL mean?

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

Example Strength of Suspension

There can be lots of numbers listed on medicine package.

Artemether, 300mg/100mL

Example - Strength of Liquid Injection

Chloroquine, 200mg/ 5 mL
equivalent to

Chloroquine phosphate, 322.5mg/ 5 mL

1. Generic name Chloroquine __________ __________

2. Strength [_2_|_0_|_0_].[_0_] mg / [_0_|_0_|_5_] mL [___|___|___].[___] mg / [___|___|___] mL [___|___|___].[___] mg / [___|___|___] mL

3. Dosage form 3 = Syrup 4 = Suspension 5 = Liquid Injection 6 = Poudre injection 7 = Granules

Example Strength of Syrups

Chloroquine, 25mg/5mL

Strength may be written like this for liquids:

1. Generic name
Quinine____ ___________ ___________

2. Strength
[_1_|_0_|_0_].[_0_] mg / [_0_|_0_|_5_] mL [___|___|___].[___] mg / [___|___|___] mL [___|___|___].[___] mg / [___|___|___] mL

3. Dosage form
3 = Syrup 4 = Suspension 5 = Liquid Injection 6 = Poudre injection 7 = Granules

Example Recording Strength of Liquid Injectable

1. Generic name Artemether

2. Strength

[_0_|_8_|_0_].[_0_] mg / [_0_|_0_|_1_] mL

3. Dosage form 3 = Syrup 4 = Suspension 5 = Liquid injectable 6 = Powder injectable 7 = Granule

Example - Strength with 2 Active Ingredients

1. Generic name Sulfadoxine__

2. Strength [_2_|_5_|_0_].[_0_]mg/ [_0_|_0_|_5_]mL

3. Dosage form

3 = Syrup 4 = Suspension Pyrimethamine [_0_|_1_|_2_].[_5_]mg/ [_0_|_0_|_5_]mL 5 = Liquid injectable 6 = Powder injectable ____________ [___|___|___].[___]mg / [___|___|___]mL 7 = Granule

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.

Dosage Forms with Strength Measured in mg

Tablets Suppository

recall

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

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

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?

Front

Side

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

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

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

Questions ?

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!