Medication forms and types of orders

Semisolid medication forms

Medications come in several physical forms, including semisolid preparations, liquid solutions and suspensions, and slow-release tablets. Examples of semisolid forms include the following:

• Ointment and paste: Semisolid, greasy drug preparations that are applied to the skin, rectum, or nasal mucosa. Pastes are thicker and less penetrating than ointments. One example is Nystatin Ointment.
• Cream: Semisolid drug preparation made of active medication, oil, and water. One example is Nystatin Cream.
• Suppository and pessary: Active medication mixed in an oil base (e.g., cocoa butter). These medications are solid at room temperature but melt at body temperature. Suppositories are typically shaped like a small bullet and are used in the rectum, urethra, or vagina. Pessaries are vaginal suppositories. An example is the Dulcolax suppository.

Liquid medication forms

Liquid medications have various uses. They can be swallowed, rubbed on the skin, or instilled in the nose, eyes, or ears. Liquid medications are easily taken by children, older adults, and those with swallowing problems. With liquid medications, the active medication is mixed with water, alcohol, or both.

If the active medication dissolves in the liquid, the medication is a solution. The following are examples of solutions:

• Tincture: Very potent solution of alcohol or alcohol and water and the active medicine - for example, an iodine tincture.
• Fluid extract: Alcoholic plant source extractions; very concentrated and more potent than tinctures - for example, belladonna fluid extract.
• Spirit: An alcoholic solution with substances that easily evaporate - for example, aromatic ammonia spirit.
• Elixir: Clear sweetened liquid preparation that contains alcohol - for example, digoxin elixir.
• Syrup: A sugar and water solution that contains flavoring and medicinal substance - for example, cough syrup (some syrups contain alcohol).

Examples of acronyms for slow-release tablets

Acronym	Definition
CR	Controlled release
DR	Delayed release
ER	Extended release
LA	Long acting
SR	Sustained release
TR	Time release
XR	Extended release

If the active medication does not dissolve and becomes suspended in the liquid, it is called a suspension. Suspensions settle over time and need to be shaken before use. The following are examples of suspensions:

• Emulsion: A dispersion of two liquids that don’t normally mix, such as oil and water (oil-in-water or water-in-oil) - for example, ophthalmic cyclosporine. This is distinct from a true particulate suspension, since no solid is dissolved or suspended.
• Gel and magma: Suspensions consisting of minerals and water. Gels are semisolids and contain finer particles than magmas. The minerals settle out with standing.
• Liniment: A suspension that is rubbed on the skin; used to reduce pain and stiffness - for example, Ben-Gay.
• Lotion: A water-based suspension that is applied to the skin - for example, calamine lotion.
• Aerosol: A suspension of medication in a gas, usually used for respiratory or sinus conditions - for example, an albuterol metered-dose inhaler.

Alcohol in medications

Several forms of liquid medications contain alcohol. This is a concern for patients who are recovering alcoholics or have other health issues, such as diabetes. An internet search can provide lists of medications with their alcohol content. The drug reference information also provides information on the ingredients.

If a patient mentions being a recovering alcoholic, it is important for the medical assistant first to acknowledge the person’s accomplishment. Then the medical assistant should communicate the information to the provider. This may make a difference in what medication the provider gives to the patient. Giving a patient medication with alcohol may be harmful to the patient’s success and health.

Types of medication orders

A medication order refers to directions given by a provider for a specific medication to be administered to a patient. The medical assistant carries out these orders under the provider’s delegation; what may be delegated, and how, is governed by state law and medical board guidance. The following sections discuss types of medication orders.

Verbal and written orders

The medical assistant receives the information from the provider. A complete medication order includes:

• Patient’s name and health record number or date of birth (DOB) (e.g., Nancy Rodriguez DOB 11/04/1971)
• Medication name, dose, and route (e.g., Tylenol 1 g po)
• For verbal orders, a read-back to the provider confirming the order was heard and recorded correctly

The provider can give the order over the phone or in person. This type of order is called a verbal order, and the medical assistant must write down and read back the order before carrying it out. The provider can also give the medical assistant a written order. Usually, these are written on a prescription pad or in an electronic message. A written order only needs clarification from the provider if the medical assistant cannot read the order or has a question.

Types of orders

In addition to describing how medication orders are given to the medical assistant, they can be described by the type of order. The following are five types of medication orders:

• Routine order: Medication taken at a regular interval until it is canceled or expired. (Most non-narcotic routine orders expire in 12 months.) Examples would be “Vitamin B12 100 mcg IM monthly” and “Synthroid 75 mcg qam po.”
• Standing order: An order that applies to all patients who meet specific criteria. For departments, usually, all providers agree collectively on standing orders and sign the order - for instance, “For patients 18 years or older, with no allergy to acetaminophen and who have a temperature of 103°F or higher: give acetaminophen 650 mg po × 1 dose.”
• PRN order: Medication that is given on an “as needed” basis for specific signs and symptoms. (It is important to indicate these symptoms when documenting the administered medication in the patient’s health record.) One example would be “Acetaminophen 325 mg, 2 tabs po q4-6h prn pain.”
• Single order or one-time order: Medication is administered one time - for example, “Acetaminophen 650 mg po × 1 dose.”
• Stat order: Medication is administered one time right now - for example, “EpiPen 0.3 mg IM stat.”