Evaluation of Dosage and Stability of Drugs Prepared by Modification of Commercial Drugs for Administration to Patients in Pediatrics Clinic

• Published in: Archives of health science and research Vol. 10; no. 3; pp. 208 - 215
• Main Authors: Kurudirek, Fatma, Cetin, Meltem, Miloglu, Fatma Demirkaya, Arikan, Duygu, Irgac, Gamze
• Format: Journal Article
• Language: English
• Published: AVES 01-10-2023
• Subjects: Analysis; Children; Health aspects; High performance liquid chromatography; Medical research; Medicine, Experimental; Nurses; Pediatric clinics; Pediatric nursing; Pharmacists; Spironolactone
• ISSN: 2687-6442; 2687-6442; 2687-4644
• DOI: 10.5152/ArcHealthSciRes.2023.23050

Objective: The aim of this study was to assess whether nurses, when modifying commercial solid dosage forms (crushing and suspending), successfully provide targeted doses. Methods: This solely in vitro study involved no pediatric patients. To examine the impact of drug modification techniques performed by 3 different nurses on the targeted dose administered, these nurses were instructed to prepare targeted drug doses from tablets and capsules, mimicking their routine practices in the pediatric clinic. Three commonly utilized commercial solid dosage forms (2 tablets and 1 capsule), containing levothyroxine sodium, spironolactone, or lansoprazole, were selected. In this study, we crushed the tablet, suspended the powder in isotonic saline solution (0.9% sodium chloride solution), mixed tablets directly with isotonic saline solution to allow dispersion, and opened the capsule to mix its content (the enteric-coated lansoprazole micropellets) with isotonic saline solution. Following drug modification, samples were extracted from the dispersions prepared by the nurses and analyzed using a high- performance liquid chromatography method. Results: Crushing the tablet, immersing the tablet into the liquid to allow dispersion, and opening the capsule to dilute its content in isotonic saline solution resulted in under-dosing (in the range of relative error: -1.597% to -76.030%) or over-dosing (in the range of relative error: 0.893% to 43.041%) of the targeted drug doses. Furthermore, it was determined that the nurses incorrectly modified the capsule containing the enteric-coated- lansoprazole micropellets. Conclusion: We observed that these nurses lack any electronic or printed resources for modifying solid dosage forms, and their knowledge on the subject is insufficient. Solutions may include developing age-appropriate doses or dosage forms, creating electronic and printed resources to guide solid dosage form modifications for pediatric clinic nurses, educating nurses on drug modification/resource use, and consulting a pharmacist about the safety of opening capsules or crushing tablets. If feasible, a pharmacist should perform these modifications to solid dosage forms. Keywords: Crushing, drug modification, medical, pediatric clinic, HPLC, suspending