How is That Drug Supplied? Trivia Quiz

Answer: Intravenous injection

Many drugs are available as injections only. Succinylcholine (or 'sux,' as it is sometimes called) is a powerful paralyzing agent used to facilitate intubation (insertion of a tube into the trachea as a means for artificial respiration or general anesthesia). Vecuronium and rocuronium are two other drugs used for this purpose. Sux should be stored in the refrigerator for the long term, but unopened vials are good at room temperature for up to 90 days.

Answer: Oxycodone

Also available as a capsule or an oral liquid, oxycodone is a powerful narcotic painkiller. Levalbuterol is meant to be inhaled, and hetastarch is an injectable fluid. Propofol (brand name Diprivan) is a milky-white injectable emulsion that some entertainment buffs may have heard of: it's likely that an overdose of propofol caused the death a celebrity whose name shall remain nameless here.

Answer: Inhalation

Hydrocortisone is a corticosteroid that mimics chemicals that occur naturally in the body. Possessing powerful anti-inflammatory properties, it comes in a plethora of dosage forms and is used to treat myriad disease states. Ever wonder what the 'H' in 'Preparation H' stands for? Yep, it's hydrocortisone.

Some corticosteroids (fluticasone and budesonide, for example) are available as inhaled agents to treat asthma, but hydrocortisone is not.

Answer: Mannitol

Mannitol is one of the many drugs that can only be used intravenously. It is a powerful osmotic diuretic used to relieve intracranial or intraocular pressure. Interestingly, mannitol can form crystals at room temperature - beautiful and fascinating to look at, but very destructive when injected into a vein. Therefore, mannitol vials and I.V. bags are usually stored in a warmer (somewhere around 100 degrees F), and administered with an in-line filter.

If you picked mesalamine, don't feel too bad - it became available in suppository form only fairly recently.

Answer: Subcutaneous injection

Insulin aspart is also called NovoLog. I once asked a pharmacist if the name referred to its pharmacokinetic activity in the body being represented by a logarithmic curve. She responded with "That's a good question."

Nicotine can take chewing gum form, but insulin, unfortunately, must always be injected (a small amount just below the skin, or sometimes into a vein, as in the case of insulin drips used in hospitals). The epidural route involves injecting drugs into the outermost covering of the spinal cord - insulin should not be injected there.

Answer: Clonidine

Clonidine (brand name: Catapres) is an alpha receptor stimulator used to treat a whole slew of conditions.

A side note on desmopressin (one of the other answer choices): given intravenously, it affects blood clotting. Taken orally or as a nasal spray, it does something completely different: it is used to treat enuresis (bed-wetting). So here we have an interesting example of a drug's route of administration determining its therapeutic effect. (I should mention here that the nasal route has been banned in the U.S. due to safety concerns, but the oral route is still used.)

Answer: Transdermal patch

Ranitidine is mainly used to treat heartburn. You may know it by its trade name, Zantac. Ranitidine is a non-formulary drug at the hospital where I work. That basically means that instead of writing orders for ranitidine, our prescribers should request an alternative drug that has a similar effect, but that we can obtain at a better price. (Pharmacists routinely make these automatic substitutions.) The exception in this case is for our newborn patients; doctors may request ranitidine oral liquid for these patients without obtaining special permission.

Answer: Methylergonovine

Methylergonovine (Methergine) can be used to stop the hemorrhaging associated with the delivery of newborns. It comes in 0.2 mg tablets as well as glass ampules of injectable liquid that should be stored in the refrigerator and protected from light.

Sodium polystyrene sulfonate (also called SPS or Kayexalate) is a potassium binder (used to treat excessive potassium levels in the body) that is also supplied in enema form. If you ever need to take this drug, you may wish to consider the enema, as the oral liquid is very thick, gritty, and unpleasant to consume.

Answer: Vaginal insert

If you saw that Cervidil "ripens" the CERVIx, or DILates it (giving it its brand name) and induces labor, you might have been able to guess its form and route of administration. This drug can be very expensive, and should be stored in a freezer until time of use.

Answer: Cephalexin

Powder for oral suspension is a popular form for antibiotics, including cephalexin. When the drug is to be dispensed, a pharmacist or technician adds an appropriate amount of sterile or distilled water to the bottle containing the powder, shakes to mix, and gives a new expiration date to the resulting liquid. Some oral suspensions should be stored in the refrigerator, while others may be stored at room temperature.

Levetiracetam (an anti-convulsant) comes in tablet form, as well as an (often grape-flavored) oral solution. Oral suspension refers to very small solid particles of a drug being "suspended" in a liquid vehicle, while an oral solution is a pure, homogeneous liquid.

Butorphanol is a narcotic sometimes given for migraine headaches. It is available as an I.V. injection or a nasal spray.

Olanzapine is an anti-psychotic that comes in tablet, orally disintegrating tablet, and intramuscular injection forms.