ROUTES OF DRUG ADMINISTRATION

UNIT 10

ROUTES OF DRUG ADMINISTRATION

Lesson 1

Routes of Drug Administration. Parenteral Route

Text:Routes of Drug Administration. Parenteral Route

Term-element:intra-

Grammar: Review

І. Active Vocabulary

II. Read the following text.

Routes of Drug Administration. Parenteral Route

A route of administration in pharmacology and toxicology is the path by which a drug, fluid, poison, or other substance is taken into the body.

Routes of administration are usually classified by application location. The route or course the active substance takes from application location to the location where it has its target effect is usually rather a matter of pharmacokinetics (concerning the processes of uptake, distribution, and elimination of drugs). The location of the target effect of active substances is usually rather a matter of pharmacodynamics (concerning e.g. the physiological effects of drugs). Furthermore, there is also a classification of routes of administration that basically distinguishes whether the effect is local (in “topical” administration) or systemic (in “enteral” or “parenteral” administration).

To obtain a general effect, the drug is usually given by oral or parenteral route. The choice depends on the drug i.e. the existence of preparations appropriate for these uses and on the state of the patient. Emergency or the impossibility of intake by mouth makes the parenteral route necessary.

To obtain a local effect, special preparations like the ophthalmic solutions may be used, but it should be remembered that a systemic diffusion is always possible after local administration.

Parenteral route. A drug to be injected by parenteral route must be sterile and little irritant. The injection requires a syringe and a needle or a device of administration already set up. One distinguishes:

Intradermal route is especially used for intradermal reactions.

Subcutaneous route. The volume of fluid injected is limited and the rate of resorption variable, depending on local factors: sclerosis, circulatory state (vasodilation, vasoconstriction). Heparin and insulin are among the drugs generally administered by subcutaneous route.

Intramuscular route. The rate of resorption is fast and it is possible to inject aqueous or oily solutions. The intramuscular injection should not be made in a vessel, nor in contact with a nerve. It is contra-indicated if the patient is undergoing anticoagulant therapy.

Intravenous route. There are two possibilities: direct injection with the syringe or administration by perfusion.

The bioavailability is by definition 100%; it is necessary however to pay attention to the speed of administration because it should not be: too rapid (which can be the case with direct administration by a syringe, with risk of severe reactions) or too slow (as observed during certain perfusions, because if the rate of elimination is rapid, the effective therapeutic concentration cannot be reached).

There are implantable devices for intravenous administration, set up surgically and used for long courses, in particular for chemotherapy.

Intra-arterial route is little used, some examples of intra-arterial administration: a vasodilator for arteritis, a thrombolytic to dissolve a clot, an antineoplastic for localized treatment of a cancer.

Intra-osseous infusion (into the bone marrow) is, in effect, an indirect intravenous access because the bone marrow drains directly into the venous system. This route is occasionally used for drugs and fluids in emergency medicine and pediatrics when intravenous access is difficult.

Routes of particular local injections. They are used to introduce a drug for diagnosis or treatment purposes in particular anatomical sites, for examples by intraspinal, intra-articular, intrapleural, intraperitoneal injections.

Answer the following questions on the text.

1. What is a route of administration in pharmacology and toxicology?

2. How are routes of drug administration classified?

3. What routes is the drug given by to obtain a general effect?

4. What is intradermal route used for?

5. Should intramuscular injection be made in a vessel?

6. Why is it necessary to pay attention to the speed of intravenous drug administration?

7. What examples of intra-arterial route do you know?

8. What is called an intra-osseous infusion?

9. What routes of particular local injections do you know?

III. Vocabulary and Speech Exercises

I. Give English equivalents of the following words and word-combinations.

Рідина; прийом, поширення та виведення ліків; розрізняти; стерильний; що спричиняє подразнення; голка; несталий; вазоконстрикція (звуження кровоносних судин); внутрішньом’язовий; олійний розчин; нерв; протипоказаний; антикоагулянтна терапія; внутрішньовенний; ін’єкція; пристрій, що вживлюється; хіміотерапія; тромболітик; розчиняти; протипухлинний засіб; доступ; внутрішньокістковий; внутрішньосуглобовий; внутрішньоочеревинний.

II. Explain the meaning of the following words and word-combinations.

Pharmacology; toxicology; pharmacokinetics; pharmacodynamics; physiological effect; systemic effect; emergency; ophthalmic solution; circulatory state; vasodilation; intra-arterial; pediatrics; intraspinal; intrapleural.

III. Form synonymous pairs from the words given below.

· Route, poison, aqueous, fluid, emergency, rate, variable, fast, oily, clot, cancer, to drain, difficult, purpose, location.

· Toxin, speed, urgency, rapid, changeable, fatty, thrombus, malignant tumour, liquid, aim, site, watery, path, hard, to flow.

IV. Discuss pros and cons of the parenteral route of drug administration.

The most common injections are intravenous (IV), intramuscular (IM), and subcutaneous (subcut).

Advantages:

o Fast: 15-30 seconds for IV, 3-5 minutes for IM and subcut;

o 100% bioavailability;

o Suitable for drugs not absorbed by the gut or those that are too irritant (anti-cancer);

o One injection can be formulated to last days or even months (Depo-Provera, a birth control shot that works for three months);

o IV can deliver continuous medication (morphine for patients in continuous pain, or saline drip for people needing fluids).

Disadvantages:

o Onset of action is quick, hence more risk of addiction when it comes to injecting drugs of abuse;

o Patients are not typically able to self-administer;

o Belonephobia, the fear of needles and injection;

o If needles are shared, there is risk of HIV and other infectious diseases;

o It is the most dangerous route of administration because it bypasses most of the body’s natural defenses, exposing the user to health problems such as hepatitis, abscesses, infections, and undissolved particles or additives/contaminants;

o If not done properly, potentially fatal air boluses (bubbles) can occur;

o Need for strict asepsis.

V. Memorize the meaning of the following prefix.

intra-[Intrq] – prefix of Latin origin denoting within,inside

VI. Skim the text once more looking for the words having the prefixintra- in their structure. Give their definitions.

VIII. Have a bit of fun.

On a busy hospital floor the doctor stops the nurse to brief her on a patient’s condition. “This patient is a fellow physician and my favourite golf partner. His injury is serious and I fear he won’t be able to play golf again unless you follow my orders exactly.”

The doctor then began listing orders: “You must give him an intravenous injection every two hours and an intramuscular injection every half an hour. You must also give a subcutaneous injection in a different location every twenty minutes followed by a second injection exactly five minutes after the first. He must take two pills at exactly every hour followed by one pill every fifteen minutes for eight hours. He must drink no more and no less than ten ounces of water every twenty-five minutes and must void between. Soak his arm in warm water for fifteen minutes then place ice for ten minutes and repeat over and over for the rest of the day. You must do these things exactly as I ordered or his injury won’t heal properly.”

The nurse left the doctor and entered the patient’s room. She was greeted by anxious family and an equally anxious patient. All asked the nurse what the doctor had said about the patient.

The nurse started, “The doctor said that you will live.” Then quickly reviewing the orders, the nurse added, “But you will have to learn a new sport.”

IV. Grammar Exercises

Lesson 2

І. Active Vocabulary

VI. Have a bit of fun.

Patient: It’s been one month since my last visit and I still feel miserable.

Doctor: Did you follow the instructions on the medicine I gave you?

Patient: I sure did. The bottle said “keep tightly closed.”

IV. Grammar Exercises

Lesson 3

І. Active Vocabulary

VI. Translate into English.

1. Шляхи введення ліків в організм можуть бути різними і визначаються залежно від мети їх призначення, типу лікарської форми, властивостей складових компонентів, а також стану організму, характеру основного і наявності супутніх захворювань та інших показників.

2. Парентеральне введення ліків (внутрішньовенно, внутрішньоартеріально, внутрішньом’язово, підшкірно) використовується для надання швидкої допомоги, при введенні ліків у великих об’ємах або при тривалому введені ліків.

3. Ліки, введені сублінгвально, ректально і вагінально, не потрапляють у систему ворітної вени і в печінку; цими шляхами найбільш раціонально вводити ліки з речовинами, які помітно руйнуються в процесі метаболізму першого проходження.

4. Ректальний шлях введення ліків є бажаним для лікарських препаратів з неприємним смаком і запахом, а також у педіатрії (у випадках, коли діти знаходяться в стані непритомності, схильні до блювання, вередливі, відмовляються приймати ліки).

5. Інгаляції будь-яких ліків рекомендується застосовувати до прийому їжі або через 1,5 год після неї, оскільки обмежена діафрагма не дозволяє зробити повноцінний вдих.

6. Трансдермальний шлях введення ліків та через слизову оболонку широко застосовують у лікувальній практиці для місцевої та загальної дії на організм. Лікарські речовини через непошкоджену шкіру всмоктуються повільно. Їх проникність підвищується при пораненні, через ушкоджену ерозивну шкіру, при використанні оклюзивних пов’язок та за наявності активаторів усмоктування, а також при хорошому кровопостачанні ділянки всмоктування.

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VII. Have a bit of fun.

My grandfather always says ,”If you’re ill, go to the doctor after all, he’s got to live. If he prescribes some medicine, then go to the chemist after all, he’s got to live. But as soon as you get back home, throw everything away because, after all, you’ve got to live, too.”

IV. Grammar Exercises

	Active Infinitive	Passive Infinitive
Indefinite	The nurse is always glad to help the patients.	Patients are always glad to be helped by the nurse.
Continuous	The nurse is glad to be helping this patient now.
Perfect	The nurse is glad to have helped the patient.	The patient is glad to have been helped by the nurse.
Perfect Continuous	The nurse is glad to have been helping patients since morning.

I. Translate into Ukrainian paying attention to theInfinitive. Define the function of theInfinitive.

1. It was very important to introduce drugs into bronchial airways avoiding first-pass metabolism.

2. My mother is happy to have been working at this chemist’s for many years.

3. Pulmonary route could be used for drugs such as heparin and insulin.

4. The patient suffering from otitis hopes to be cured with the help of these otic drops.

5. The doctor was satisfied to have administered adequate ophthalmic solution to the patient suffering from severe conjunctivitis.

6. The dermatologist made a list of topical medications to be applied to the skin and mucous membranes.

7. To aid in coughing up sputum the patient was administered mucolytic in the form of spray.

8. She is likely to be wearing some transdermal device to continuously introduce progesterone.

UNIT 11

FORMS OF DRUGS

Lesson 1

Preparations for Oral Route

Text:Preparations for Oral Route

Grammar: The Objective Infinitive Complex

І. Active Vocabulary

Preparations for Oral Route

Knowledge of the various available preparations of the drugs is necessary to physicians. Indeed, if their prescription contains an error, for example “capsule” instead of “tablet”, the pharmacist who dispenses the drug and the patient who takes it can wonder about the error, if it concerns the presentation or the drug itself.

The principal available preparations containing powder (active substance + excipient) are as follows.

Packages and sachets are small disposable bag or pouch containing single-use quantities of medicines (generally about 10 to 20g).

The two main types of capsules are:

Hard-shelled capsules are made in two parts by dipping metal pins in the gelling agent solution. The capsules are supplied as closed units to the pharmaceutical manufacturer. Before use, the two halves are separated, the capsule is filled with powder or spheroids and the other half of the capsule is pressed on.

Soft-shelled capsules can be an effective delivery system for poorly soluble drugs. This is because the fill can contain liquid ingredients that help increase solubility or permeability of the drug across the membranes in the body. Liquid ingredients are difficult to include in any other solid dosage form such as a tablet. Softgels are also highly suited to potent drugs, where the highly reproducible filling process helps ensure each softgel has the same drug content.

Both of these classes of capsules are made from aqueous solutions of gelling agents like animal protein (mainly gelatin) or plant polysaccharides. Other ingredients can be added to the gelling agent solution like plasticizers, colouring agents, preservatives, disintegrants and lubricants.

A tablet is a pharmaceutical dosage form which comprises a mixture of active substances and excipients in powder form, pressed or compacted into a solid dose. The excipients can include diluents, binders or granulating agents, lubricants to ensure efficient tabletting; disintegrants to promote tablet break-up in the digestive tract; sweeteners or flavours to enhance taste; and pigments to make the tablets visually attractive. A polymer coating is often applied to make the tablet smoother and easier to swallow, to control the release rate of the active ingredient, to make it more resistant to the environment (extending its shelf life), or to enhance the tablet appearance.

Sizes of tablets to be swallowed range from a few millimeters to about a centimeter. Some tablets are in the shape of capsules, and are called caplets. Medicinal tablets and capsules are often called pills. This is technically incorrect, since tablets are made by compression, whereas pills are ancient solid dose forms prepared by rolling a soft mass into a round shape.

These “dry” forms (capsules, tablets, caplets, pills, etc) must be taken with a glass of water in a sitting or upright position, but not lying, to facilitate their esophageal transit and to prevent their binding to the esophageal wall which they could damage with possible severe ulcerations.

The available preparations containing fluidare as follows:

Drinkable vials in coloured glass to distinguish them from the injectable vials in transparent glass.

Aqueous or alcoholic solutions, in bottle with a graduated dropper.

Medicated syrups are aqueous solutions containing sugar and at least one water soluble active ingredient. The sugar is mainly used to preserve the finished product, to aid in masking the unpleasant taste of the active ingredient(s) and to enhance the flavour.

The sugar concentration should be between 65 and 67% in weight. A lower percentage of sugar makes the syrup an excellent nutriment for yeast and other microorganisms. A sugar saturated syrup lead to crystallization of a part of the sugar under conditions of changing temperature.

Syrups may also contain the following excipients: preservatives and antioxidants, acids (like citric acid to prevent the recrystallization of sugar), buffering agents, chelating agents, flavouring agents and flavour enhancers, colouring agents, ethyl alcohol (3-4% in volume).

The syrups are administered by spoonfuls and preferably by a spoon/dose provided with each bottle.

Suspensions: the granules contained in a bottle are dispersed in a given quantity of water before use.

Hydrosols are pseudo-solutions containing water-soluble and liposoluble molecules.

VI. Translate into English.

1. Таблетка – це тверда спресована доза ліків різної ваги, розміру та форми, яка містить лікарський препарат у чистому або комбінованому вигляді.

2. Таблетка з ентеросолюбільним покриттям (enteric-coated tablet) вкрита матеріалом, який запобігає виділенню препарату до його потрапляння у тонку кишку.

3. Пілюля – це мала тверда кулька з лікарської речовини, яку ковтають. Окрім активної речовини пілюлі містять розчинник (або наповнювач) для надання їм адгезивності, міцності та пластичності.

4. Суспензія – це препарат із подрібнених ліків, що включені у відповідний рідкий наповнювач найчастіше безпосередньо перед використанням.

5. Перевагою ліків в формі сиропу є можливість легко розрахувати дозування та наявність смакових добавок, завдяки яким можна замаскувати гірку діючу речовину. Ця лікарська форма незамінна для дітей, які не здатні проковтнути велику капсулу або таблетку. У вигляді сиропу випускаються жарознижуючі, протикашльові, антибактеріальні та інші препарати.

6. Перед кожним застосуванням сироп необхідно збовтувати; це дозволяє діючій речовині рівномірно розподілитися, завдяки чому дозування буде максимально точним. Призначену дозу ліків слід відмірювати за допомогою мірного стаканчика або спеціальної ложки, яка, як правило, додається до препарату.

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VII. Have a bit of fun.

A distraught patient phoned her doctor’s office. Was it true, the woman wanted to know, that the medication the doctor had prescribed was for the rest of her life? She was told that it was. There was a moment of silence before the woman continued, “I’m wondering, then, just how serious my condition is. This prescription is marked “NO REFILLS.”

IV. Grammar Exercises

I. Translate into Ukrainian. Pay attention to theObjective Infinitive Complex.

1. The doctor ordered the treatment with this medicated syrup to be continued for several days.

2. He considered vomiting to be caused by his taking the expired tablets.

3. The pharmacist supposes this old man to be mistaken about the presentation of the drug.

4. The customer saw the pharmacist put two coloured glass vials on the front desk.

5. They wanted the professor to deliver a lecture on the principle of soft-shelled capsule manufacturing.

6. We know hydrosols to contain water-soluble and liposoluble molecules.

7. The chemist supposes crystallization of sugar in this medicated syrup to have been caused by a too high sugar concentration.

8. Every pharmaceutical student knows hard-shelled capsules to be made in two parts by dipping metal pins in the gelling agent solution.

II. Use theObjective Infinitive Complexinstead of the subordinate clause.

1. The doctor expects that these drugs will not be deactivated by the liver when they are carried there from the gastrointestinal tract by the hepatic portal vein.

2. He ordered that the tablets should be taken with a glass of water.

3. The students heard that the lecturer spoke about pills, tablets, capsules and caplets.

4. I know that some drugs may be unsuitable for administration by the oral route.

5. Some scientists believe that the oral bioavailability of some drugs may be low due to poor absorption from the gastrointestinal tract.

6. The teacher thought that we would learn in detail the principle of medicated syrup manufacturing.

7. My parents’ desire is that I should become a pharmacist.

8. His wish is that this doctor should administer antibiotics in tablet form instead of administering them in injections.

III. Translate into English using theObjective Infinitive Complex.

1. Що зможе примусити його піти на консультацію до терапевта?

2. Всі чули, що хворий скаржився на сильний головний біль. Лікар рекомендував йому прийняти таблетку знеболювального засобу.

3. Студенти знають, що букальну таблетку тримають між щокою та яснами, що зумовлює пряме всмоктування препарату, який міститься в ній, через слизову оболонку рота.

4. Ми бачили, що фармацевт поклав флакони із ліками у холодильник.

5. Батьки сподіваються, що їх син стане кваліфікованим фармацевтом.

6. Вони думали, що цей сироп допоможе припинити напади кашлю ще до вечора.

7. Лікар передбачав, що передозування цими пігулками призведе до нудоти, блювання, запаморочення і навіть втрати свідомості.

8. Аптекар помітив, що у покупця був висип на обличчі. Він порадив йому прийняти на ніч ось цю каплету.

9. Гастроентеролог дозволив інтернові розказати хворому коли потрібно приймати капсули із пробіотиком.

10. Лікар дав вказівку медсестрі приготувати суспензію і віднести її хворому з другої палати.

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Lesson 2

Suppositories

Text:Suppositories

Grammar: The Subjective Infinitive Complex

І. Active Vocabulary

Suppositories

A suppository is a drug delivery system that is inserted into the rectum (rectal suppository), vagina (vaginal suppository) or urethra (urethral suppository), where it dissolves. They are used to deliver both systemically-acting and locally-acting medications.

The general principle is that the suppository is inserted as a solid, and will dissolve inside the body to deliver the medicine pseudo received by the many blood vessels that follow the larger intestine.

Rectal suppositories are commonly used for:

o laxative purposes, with chemicals such as glycerin or bisacodyl;

o treatment of hemorrhoids by delivering a moisturizer or vasoconstrictor;

o delivery of many other systemically-acting medications, such as promethazine or aspirin;

o general medical administration purposes: the substance crosses the rectal mucosa into the bloodstream; examples include paracetamol (acetaminophen), diclofenac, opiates, and eucalyptol suppositories.

Non-laxative rectal suppositories are to be used after defecation, so as not to be expelled before they are fully dissolved and the substance is absorbed. The use of an examination glove or a finger cot can ease insertion by protecting the rectal wall from fingernail(s).

Vaginal suppositories are commonly used to treat gynecological ailments, including vaginal infections such as candidiasis.

Urethral suppositories. Alprostadil pellets are urethral suppositories used for the treatment of severe erectile dysfunction. Its use has diminished since the development of oral impotence medications.

Liquid suppository involves injecting a liquid, typically a laxative, with a small syringe, into the rectum.

The alternative term for delivery of medicine via rectal, vaginal or urethral routes is pharmaceutical pessary.

Constituents. Some suppositories are made from a greasy base, such as cocoa butter, in which the active ingredient and other excipients are dissolved; this grease will melt at body temperature (this may be a source of discomfort for the patient, as the melted grease may pass through the anus during flatulences). Other suppositories are made from a water soluble base, such as polyethylene glycol. Suppositories made from polyethylene glycol are commonly used in vaginal and urethral suppositories. Glycerin suppositories are made of glycerol and gelatin.

Indications. Suppositories may be used for patients in the event it may be easier to administer than tablets or syrups. Suppositories may also be used when a patient has a vomiting tendency, as oral medication can be vomited out. Drugs which often cause stomach upset, for example diclofenac sodium (Voltaren) are better tolerated in suppository form.

V. Translate into English.

1. Супозиторії – це дозовані лікарські препарати, тверді при кімнатній температурі, які розплавляються або розчиняються при температурі тіла, призначені для введення в порожнини тіла.

2. Існують наступні форми супозиторіїв: а) ректальні: 1 – циліндр (cylinder) із загостреним кінцем, 2 – конус (cone), 3 – торпеда (torpedo); б) вагінальні: 1 – кульки (globule); 2 – овулі, 3 – песарії; в) палички (bacillus).

3. Максимальний діаметр ректальних супозиторіїв складає 1,5 см. Маса одного супозиторія повинна бути в межах від 1 до 4 г. Маса супозиторіїв у дітей повинна бути від 0,5 до 1,5 г.

4. У якості ліпофільних основ для виготовлення супозиторіїв використовують масло какао, рослинні та тваринні гідрогенізовані жири та різноманітні сплави, що дозволені для медичного використання.

5. Метод виготовлення супозиторіїв складається з наступних стадій: приготування основи, введення в основу лікарських речовин, формування та упаковка свічок.

6. Зазвичай супозиторії зберігають у прохолодному місці.

7. Супозиторії з олією обліпихи (sea buckthorn) призначають при хронічних захворюваннях прямої кишки, геморої та колітах.

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VI. Have a bit of fun.

A rather senile old lady went to her doctor complaining of draining and a feeling of fullness in her ear. After the examination, the doctor initiated a conversation that went as follows:

Doctor: Why madam, I think you have a suppository in your ear.

Lady: Eh?

Doctor: Madam, you have a SUPPOSITORY in your Ear!

Lady: EH???

Doctor (shouting): IN YOUR EAR! A SUPPOSITORY!!!

Lady: Oh, thank Goodness – now I know where I put my hearing aid...

IV. Grammar Exercises

I. Translate into Ukrainian. Pay attention to theSubjective Infinitive Complex.

1. These suppositories are unlikely to deliver systemically-acting medications.

2. A suppository is known to be inserted as a solid that will dissolve inside the body.

3. Bisacodyl suppository turned out to have helped with his severe constipation.

4. This patient is sure to have fully recovered.

5. A suppository is believed to deliver the medicine pseudo received by the many blood vessels that follow the larger intestine.

6. Alprostadil pellets are certain to have helped this patient with severe erectile dysfunction.

7. The man was recommended to use these non-laxative rectal suppositories after defecation.

8. The mother is seen to be buying paracetamol suppositories for her infant.

II. Transform the following complex sentences into simple ones using the Subjective Infinitive Complex.

1. It’s known that some suppositories are made from a greasy base, such as cocoa butter.

2. It turned out that the patient had vomiting tendency. It was supposed that he would vomit the tablet out, so the doctor administered a rectal suppository to him.

3. It is probable that a suppository will be a source of discomfort for the patient, as the melted grease may pass through the anus during flatulence.

4. It’s said that drugs which often cause stomach upset are better tolerated in suppository form.

5. It is expected that these diclofenac suppositories will cure the symptoms of rheumatoid arthritis.

6. It is improbable that she will hurt the rectal wall while inserting a suppository in case of wearing an examination glove or a finger cot.

7. It did not seem that the patient’s condition had improved.

8. It turned out that the treatment of this child with rectal suppositories was uneasy.

III. Translate into English using the Subjective Infinitive Complex.

1. Сподівалися, що лікарська речовина, введена у формі свічок, надійде у кров швидше, ніж при підшкірному введенні.

2. Виявилося, що супозиторії виробляються як в промислових так і в аптечних умовах.

3. Навряд, щоб ця свічка у формі палички була призначена для введення у піхву.

4. Очевидно, що лікарські речовини зі свічок всмоктуються у нижній частині прямої кишки через лімфатичну і венозну системи малого таза.

5. Відомо, що супозиторії зберігають у сухому прохолодному місці, якщо не зазначені інші умови зберігання.

6. Повідомляють, що науковий семінар фармацевтів відбувся в Івано-Франківському національному медичному університеті минулого місяця.

7. Спостерігали, як фармацевт виготовляв супозиторії з олією обліпихи.

8. Вважають, що супозоторії доцільно призначати для лікування хворих дитячого і похилого віку.

9. Лікарські речовини зі свічки, очевидно, достатньо швидко купірували (to arrest) гіпертонічний криз у цієї літньої жінки.

10. Не можна очікувати, що супозиторій розчиниться за 5 хвилин.

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Lesson 3

Topical Medications

Text:Topical Medications

Term-element: ep(i)-

Grammar: The Infinitive (Review)

І. Active Vocabulary

Topical Medications

The word topical is derived from the Ancient Greek topos meaning “place” or “location”. In medicine, a topical medication is applied to body surfaces such as the skin or mucous membranes such as the vagina, anus, throat, eyes and ears.

Many topical medications are epicutaneous, meaning that they are applied directly to the skin. Topical medications may also be inhalational, such as asthma medications, or applied to the surface of tissues other than the skin, such as eye drops applied to the conjunctiva, or ear drops placed in the ear, or medications applied to the surface of a tooth. As a route of administration, topical medications are contrasted with enteral and parenteral administration.

Classes of topical medications. There are many general classes, with no clear dividing line between similar formulations. As a result, what the manufacturer’s marketing department chooses to list on the label of a topical medication might be completely different from what the form would normally be called. For example, Eucerin “cream” is more appropriately described as an ointment than as a cream.

Topical solutions are of low viscosity and often use water or alcohol in the base. These are usually a powder dissolved in water, alcohol, and sometimes oil. There is a risk of drying of the skin if alcohol is used in the base and a risk of irritation, depending on the preservatives and fragrances used in the base.

Lotions are similar to solutions but are thicker and tend to be more emollient in nature than solution. They are usually an oil mixed with water, and more often have less alcohol than solutions.

Shake lotion is a mixture that separates into two or three parts with time. It needs to be shaken into suspension before use.

A cream is an emulsion of oil and water in approximately equal proportions. It penetrates the outer layer of skin well. Cream is thicker than lotion, and maintains its shape when removed from its container. It tends to be moderate in moisturizing tendency. Creams have a significant risk of causing immunological sensitization due to preservatives.

An ointment is a homogeneous, semisolid preparation, most commonly greasy and with a high viscosity. Ointments are used as emollients or for the application of active ingredients to the skin for protective, therapeutic, or prophylactic purposes and where a degree of occlusion is desired.

Ointments are used topically on a variety of body surfaces. These include the skin and the mucous membranes of the eye, vagina, anus, and nose. An ointment may or may not be medicated.

Ointmen