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AUTHORS’ EXTRA POINT A
DRUG NAMES
As stated in this chapter, drug substances may be prescribed by their
nonproprietary (generic) name or by their brand (trademark) name. The
designation of nonproprietary names is based on nomenclature reflecting
a drug’s chemical structure and/or pharmacologic activity. In the United
States, each nonproprietary name is assigned by the United States
Adopted Names (USAN) Council, which is cosponsored by the American
Medical Association, the United States Pharmacopeial Convention, and
the American Pharmacists Association.
To harmonize the program, the USAN Council works in conjunction
with the federal FDA as well as the World Health Organization (WHO)
and the International Nonproprietary Name (INN) Expert Committee.
Together with the British Approved Names (BANs) and the Japanese
Approved Names (JANs), the USP Dictionary of USAN and
International Drug Names database contains more than 12,800
nonproprietary drug name entries.
c
Many of the same drug substances are approved for marketing and
available internationally. In the United States, this approval is within the
authority of the federal FDA.d There are many multinational
pharmaceutical companies that engage in the worldwide development
and marketing of pharmaceutical products. The brand names assigned to
the same nonproprietary-named drug often differ country to country. The
referenced International Drug Name Database contains more than
40,000 medication names from 185 countries and is presented in
multiple languages.
e
The nonproprietary names used in the calculation problems in this
text are universal; however, the brand names by their very nature are not.
c
https://www.usp.org/products/usp-dictionary.
d
Regulatory approval is within the purview of each country. In Canada, regulatory
authority resides with Health Canada’s Therapeutic Products Directorate (TPD). Within the
European Union (EU), the 28 member countries depend collectively upon the European
Medicines Evaluation Agency (EMEA) for drug approvals and regulation. A list of drug
regulatory agencies worldwide may be found at http://www.regulatoryone.com/p/websitesof-regulatory-agencies.html.
e
http://www.drugs.com/international/.
AUTHORS’ EXTRA POINT B
ELECTRONIC PRESCRIPTIONS
The overall integrated system of electronic health information includes
electronic health records (EHRs), computerized physician order entry
(CPOE), and electronic prescriptions (e-prescriptions). The system
allows health care providers to electronically enter and access patients’
vital medical information.
In the processing of electronic prescriptions, a complex network of
pharmacies, payers, pharmacy benefit managers (PBMs), physicians,
hospitals, health information exchanges (HIEs), and electronic health
record systems must be connected in real time to assure patient
eligibility, formulary data, and clinical requirements. As is shown in
Figures 4.10 and 4.11, this information connectivity is facilitated by
health information networks, which notify providers of authorization
status and requirements.
Figure 4.10. Information connectivity in the processing and
authorization of an e-prescription. (Image provided by
courtesy of athenahealth, Inc. Copyright © athenahealth, Inc.
Used with permission.)
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1.
2.
3.
4.
5.
6.
7.
Figure 4.11. An example of an e-prescription being ordered
during a patient’s visit with medical reference information
embedded (Epocrates) to provide real-time decision clinical
support. (Image provided by courtesy of athenahealth, Inc.
Copyright © athenahealth, Inc. Used with permission.)
References
National Council for Prescription Drug Programs. NCPDP Electronic Prescribing
Standards. Available at:
https://www.ncpdp.org/NCPDP/media/pdf/NCPDPEprescribing101.pdf. Accessed February
18, 2020.
Kilbridge P. E-Prescribing. California HealthCare Foundation; 2001. Available at:
https://www.chcf.org/wp-content/uploads/2017/12/PDF-EPrescribing.pdf. Accessed
February 18, 2020.
Hospital-Forms.com. Engineered Data, LLC. Available at: http://www.hospital-forms.com.
Accessed February 18, 2020.
Burnside NL, Bardo JA, Bretz CJ, et al. Effects of including medication indications on
prescription labels. Journal of the American Pharmacists Association 2007;47:756–758.
Institute for Safe Medication Practices. Available at:
https://www.ismp.org/recommendations/error-prone-abbreviations-list. Accessed February
18, 2020.
Davis NM. A controlled vocabulary for reducing medication errors. Hospital Pharmacy
2000;35:227–228.
The Joint Commission. The Official “Do Not Use” List of Abbreviations. Available at:
https://www.jointcommission.org/-/media/tjc/documents/resources/patient-safetytopics/patient-safety/do_not_use_list_9_14_18.pdf. Accessed February 18, 2020.
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9.
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13.
14.
The American Society on Aging and The American Society of Consultant Pharmacists
Foundation. Improving medication adherence in older adults. Adult Medication. 2006.
Available at: http://learning.rxassist.org/sites/default/files/Adult_Meducation%20All.pdf.
Accessed February 18, 2020.
Center for Health Transformation. 21st Century Intelligent Pharmacy Project: The
Importance of Medication Adherence. 2010. Available at: https://slidex.tips/queue/the-21-stcentury-intelligent-pharmacy-project-the-importance-of-medication-adhe?
&queue_id=-1&v=1582143269&u=MTY0LjU4LjU5LjIx. Accessed February 19, 2020.
World Health Organization (WHO). Adherence to long-term therapies: evidence for action.
2013. Available at: http://www.who.int/chp/knowledge/publications/adherence_report/en/.
Accessed February 19, 2020.
U.S. Food and Drug Administration. Disposal of unused medicines: what you should know.
Available at: https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unusedmedicines-what-you-should-know. Accessed February 19, 2020.
Facts & Comparisons eAnswers [book online]. Baltimore, MD: Wolters Kluwer Clinical
Drug Information Inc. Accessed February 22, 2020.
Drug Quality and Security Act. Available at:
https://www.govtrack.us/congress/bills/113/hr3204/text. Accessed February 18, 2020.
U.S. Department of Health and Human Services, Food and Drug Administration, Center for
Drug Evaluation and Research. Draft Guidance. Pharmacy Compounding of Human Drug
Products Under Section 503A of the Federal Food, Drug, and Cosmetic Act. 2013.
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5
Density and Specific Gravity
OBJECTIVES
Upon successful completion of this chapter, the student will be able to:
Define density and specific gravity, and determine each through
appropriate calculations.
Calculate specific gravity from data derived from the use of a
pycnometer.
Apply specific gravity in converting weight to volume and volume
to weight.
Density
Density (d) is mass per unit volume of a substance. It is usually expressed
as grams per cubic centimeter (g/cc). Because the gram is defined as the
mass of 1 cc of water at 4°C, the density of water is 1 g/cc. For our
purposes, because the United States Pharmacopeia1 states that 1 mL may
be used as the equivalent of 1 cc, the density of water may be expressed
as 1 g/mL.
Density may be calculated by dividing mass by volume, that is:
Thus, if 10 mL of sulfuric acid weigh 18 g, its density is:
Specific Gravity
Specific gravity (sp gr) is a ratio, expressed decimally, of the weight of a
substance to the weight of an equal volume of a substance chosen as a
standard, both substances at the same temperature. It is useful to
understand specific gravity as being a relative value, that is, the weight of
a substance relative to the weight of a standard.
Water is used as the standard for the specific gravities of liquids and
solids; the most useful standard for gases is hydrogen.
Specific gravity may be calculated by dividing the weight of a given
substance by the weight of an equal volume of water, that is:
Thus, if 10 mL of sulfuric acid weigh 18 g and 10 mL of water, under
similar conditions, weigh 10 g, the specific gravity of the acid is:
Substances that have a specific gravity <1 are lighter than water.
Substances that have a specific gravity >1 are heavier than water.
Table 5.1 presents some representative specific gravities. Figure 5.1
depicts the layering of immiscible liquids due to their relative weights.
TABLE 5.1 SOME REPRESENTATIVE SPECIFIC
GRAVITIES AT 25°C
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FIGURE 5.1 Depiction of layering of immiscible liquids in a
test tube, mineral oil being lighter than water and chloroform
being heavier.
Although specific gravities may be expressed to as many decimal places
as the accuracy of their determination warrants, in pharmacy practice,
expressions to two decimal places generally suffice. In the United States
Pharmacopeia, specific gravities are based on data from temperatures of
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25°C, with the exception of that for alcohol, which is based on 15.56°C
by government regulation.
1
Density versus Specific Gravity
The density of a substance is a concrete number (1.8 g/mL in the
example), whereas specific gravity, being a ratio of like quantities, is an
abstract number (1.8 in the example). Whereas density varies with the
units of measure used, specific gravity has no dimension and is therefore
a constant value for each substance. Thus, whereas the density of water
may be variously expressed as 1 g/mL, 1000 g/L, or 62.5 lb/cu ft, the
specific gravity of water is always 1.
Calculating the Specific Gravity of Liquids
Known Weight and Volume
Apply the equation:
1. If 54.96 mL of an oil weigh 52.78 g, what is the specific gravity of the
oil?
54.96 mL of water weigh 54.96 g
2. If a pint of a certain liquid weighs 601 g, what is the specific gravity
of the liquid?
1 pint = 473 mL
473 mL of water weigh 473 g
Pycnometer or Specific Gravity Bottle
A glass pycnometer, or specific gravity bottle, is a special glass bottle
used to determine specific gravity of liquids (Fig. 5.2). These
pycnometers have fitted glass stoppers with a capillary opening to allow
trapped air and excess fluid to escape. Some pycnometers have
thermometers affixed in order to relate the specific gravity, as determined,
with temperature. An aluminum pycnometer is used to determine specific
gravity of viscous liquids and semisolids that may obstruct the narrow
opening in a glass pycnometer. These types of pycnometers consist of
three parts: a cylindrical vessel, a closure with a small opening to allow
trapped air and excess material to escape, and a threaded fitting ring (Fig.
5.3). Pycnometers are generally available for laboratory use in volumes
ranging from 1 to 50 mL.
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