Dosage Forms, Routes and Body Systems

The Technician's Scope of Practice and Oral Solid Dosage Forms

In the daily workflow of a pharmacy, pharmacy technicians play a vital supportive role. As permitted by law and under direct pharmacist supervision, technicians may prepare, compound, package, and label medications. However, the legal and professional boundaries of the profession require a strict division of responsibilities. A pharmacist is responsible for the final clinical verification of every prescription, ensuring that drug therapy is safe and appropriate. Even in settings where technician product checks are permitted by law, those checks do not replace final pharmacist review. Technicians must immediately refer clinical questions, drug interaction warnings, dosage evaluations, and patient inquiries regarding side effects, administration techniques, or drug therapy to the pharmacist for patient counseling.

Medications enter the body through several distinct routes, the most common of which is the oral route. The oral route is the most widely utilized, convenient, and noninvasive route of drug administration. After a swallowed drug is absorbed, it may undergo first-pass metabolism in the intestinal wall or liver before reaching systemic circulation; the extent varies by drug. First-pass metabolism refers to the drug metabolism that occurs within the intestinal wall and liver before the swallowed drug can reach the systemic circulation.

Some swallowed solid oral dosage forms are designed to release their ingredients in particular regions of the gastrointestinal tract; others release without site-specific targeting, and sublingual and buccal forms release in the mouth. For example, enteric-coated tablets are designed to pass through the stomach intact and dissolve in the higher pH environment of the small intestine. Crushing or chewing an enteric-coated tablet damages its protective coating, while altering a modified-release tablet can disrupt its release mechanism, which may not involve an outer coating; neither should be crushed or chewed unless product labeling and a pharmacist confirm it is safe. In contrast, effervescent tablets are formulated to dissolve completely in water before the patient ingests the resulting solution.

Other solid dosage forms are designed for absorption directly through the oral tissues. Sublingual tablets are placed under the tongue to dissolve rapidly and absorb directly into the bloodstream, whereas buccal tablets are placed between the cheek and gum to allow drug absorption across the oral mucosa. Drug absorbed through either the sublingual or buccal mucosa generally bypasses first-pass hepatic metabolism, and its onset of action depends on the specific product. For encapsulated solids, hard gelatin capsules typically encapsulate dry powders or pellets, whereas soft gelatin capsules encapsulate liquids or semisolids.