How Extemporaneous preparations are prepared in the Children Emergency Department Pharmacy.

1. Extemporaneous Preparations:
Suspensions
CED Satellite Pharmacy Learning
Issue
Presenter: Heni Oala (Pharmacy Intern)
Preceptor: Sandy Nawara

2. Outline of presentation
• Definition
• Purpose of Extemporaneous suspensions
• List of preparations at Peadiatric Pharmacy
• Example: Frusemide 10mg/5ml
• Guidelines for oral liquid Paediatric
preparations
• Conclusion

3. Definition
• Extemporaneous preparations
– When there is no licensed preparation that fully
meets the patient requirements
• Young
• Elderly
• Unable to swallow
• Less than the standard dose

4. Purpose of Extemporaneous Preps.
• Ensure products meet the patients needs

5. List of Preparations: Pead. Pharmacy
• Frusemide 10mg/5ml
• Spironolactone 5mg/5ml
• Acetazolimide 5mg/5ml
• Captopril 5mg/5ml
• Propanolol 5mg/5ml
• Carbimazole

6. Risks involved with Extemporaneous
preparations
• Effects on stability
• Formulation failure:
– Underdosing/ overdosing
– Drug/excipient binding
– Physical incompatibility
• Microbial contamination
• Calculation errors
• Patient acceptability
• Health and safety risks

7. Example: Frusemide 10mg/5ml in
60mL
• Tritruate 3 x 40mg tabs in mortar
• Gradually add the 12mL syrup
• Transfer to a beaker
• Add water to 60mL mark
• Label
– Amount, time interval
– instructions on storage

8. Example: Frusemide 10mg/5ml in
60ml
• Sample Label:
“SHAKE THE BOTTLE WELL”
FRUSEMIDE SYRUP 10MG/5ML
DOSE: GIVE 2.5ML (HALF-TEASPOON DAILY)
UNTIL FINISH
“ STORE IN A REFRIDERATOR”
BATCH#: 023/2018 DATE:30/07/2018
NAME: JUNIOR HENNZY MR#233029

9. Guide for Oral liquid Preparations
• Consider alt. Drug
• Consider alt. Method
• Consult publications
• Maximum expiry date; preservatives added
• Monitor use of product, physical instability
• Formulation details: keep good records
– Product consistency
– Set procedure

10. Conclusion
• Definition Extemporaneous prepartaions
• Purposes
• Example
• Guide for oral liquid preparations

11. References
• Australian Medicines Handbook, Computer program.
2010 Version. Pharmaceutica Society of Australia
• Woods, DJ. Extemporaneous formulations of oral
liquids: A guide. 1996. NZ Pharn
• Woods, DJ. Extemporaneous formulations-problems
and solutions 1997. Peadiatr Perinatal Drug Ther
1:25-29
• Jackson M, Lowey A . 2010. Handbook of
extemporaneous preparation. Pharmaceutical
Press, India