6. Drug Formulations + Patient Counseling Flashcards
Drug formulation considerations: Olanzapine: What formulations does it come in?
IR tablet, ODT, short-acting injection, and long-acting injection
Drug formulation considerations: Ondansetron: What formulations does it come in?
IR tablet, oral solution, ODT, oral film, and short-acting injection
Which drugs use an osmotic controlled-release oral delivery system (OROS)
Concerta, Cardura XL, Procardia, XL, Asacol HD, Delzicol
How does osmotic controlled-release oral delivery system (OROS) work?
Water from gut is absorbed into the delivery system by osmosis, which increases pressure inside and forces the drug out through a small opening. Tablet/capsule shell may be visible in the patient’s stool (ghost tablet/capsule) but drug has been released (important counseling point).
In general, long-acting formulations should not be crushed or chewed (can release drug all at once, may be fatal)
Some long-acting capsules like __ or ___ can be opened and the contents sprinkled on certain foods. Capsule contents should not be crushed or chewed. Always consult packing labeling.
Some long-acting tablets like __ or ___ cannot be crushed but cut on the score line
Can be sprinkled: Kadian (morphine ER) or Xtampza ER (oxycodone ER)
Can be split on score line but not crushed: Toprol XL (metoprolol XL) or carbidopa/levodopa ER
Augment and Children’s Tylenol are examples of liquid oral ___ and they must be shaken prior to admin
suspensions
Constulose (lactulose, for hepatic encephalopathy), Neurontin (gabapentin), and Rapamune (sirolimus) are examples of liquid oral ____ and they do not need to be shaken prior to admin
solutions
What are some examples for chewable tablets
Suprax (cefixime)
Singulair (montelukast)
Lamictal (lamotrigine)
Typically for children
What are some examples for lozenges
Mycelex (clotrimazole, for oral thrush)
Cepacol (benzocaine/menthol, for sore throat)
What are some examples of ODT
Lamictal ODT (lamotrigine, for seizures)
Nurtec (rimegapant, for migraines)
Remeron SolTab (mirtazapine, for depression)
Zyprexa Zydis (olanzapine, for schizophrenia)
Ondansetron (for nausea, dysphagia)
When is ODT/SL often helpful?
When pt cannot swallow (dysphagia) or children unable to swallow tabs/caps
Nausea but not vomiting (if vomiting, use non-oral option)
Non-adherence: ODT dissolve quickly
Note: Paralysis of throat muscles from stroke is most common cause
___ (sweetener) metabolism produces gas, cramping and bloating in sensitive patients, including those with IBS
Sorbitol
____ is found in the sweetener aspartame, which is used in many ODT, chewable and granule medication formulations. It is a dangerous sweetener for those with ____, a genetic defect in which the enzyme that degrades this substance is absent.
Phenylalanine
Phenylketonuria (PKU)
___ is the most commonly used excipient in drug formulations. May be an issue in patients with lactose intolerance.
Lactulose
What are common application sites for patches?
Chest, back, upper arm, flanks
___ patches are applied to chest back, upper arm, but NOT flanks
Exelon (Rivastigmine)
____ patches are applied on the hip, alternating righ and left hips daily
Daytrana (methylphenidate, for ADHD)
___ is applied behind the ear, at least 4 hrs before needed, alternating ears every 72 hrs
Transderm Scop (Scopolamine, for N/V)
Patch frequency: Diclofenac
Twice daily
Patch frequency: methylphenidate (Daytrana)
QAM, 2 hrs prior to school
Patch frequency: nicotine (Nicoderm CQ)
daily
Patch frequency: rivastigmine (Exelon)
daily
Patch frequency: rotigotine (Neupro)
Daily
Patch frequency: Selegiline (Emsam)
daily
Patch frequency: Testosterone (Androderm)
Nightly, not on scrotum
Patch frequency: lidocaine (Lidoderm)
1-3 patches prn, on for 12 hrs, off for 12 hrs
Patch frequency: nitroglycerin
On for 12-14 hours, then off for 10-12 hours
Patch frequency: fentanyl
Q72H, if it wears off after 48 hrs, change to Q48H
Patch frequency: scopolamine (Transderm Scop)
Q72H, prn
Patch frequency: estradiol (Alora, Vivelle-Dot)
Twice weekly
Patch frequency: oxybutynin (Oxytrol)
Twice weekly
Patch frequency: Donepezil (Adlarity)
Weekly
Patch frequency: Buprenorphine (Butrans)
Weekly
Patch frequency: clonidine (Catapres-TTS)
Weekly
Patch frequency: estradiol (Climara)
Weekly
Patch frequency: Estradiol/levonorgestrel
Weekly
Patch frequency: Ethinyl estradiol/norelgestromin (Xulane, Zafemy) and ethinyl estradiol/levonorgestrel (Twirla)
Weekly for 3 weeks, off for 1 week
Patient asks “Can I cut the patch into pieces?”
What is your response?
Usually no, except Lidoderm and Qutenza which are designed to be cut and applied over painful regions
Patient asks “Can the patch be exposed to heat from an electric blanket, heating pad, or body temp > 38ºC (>100.4ºF)
What is your response?
Avoid heat exposure with most patches - heat = rapid absorption, may be fatal (esp fentanyl, buprenorphine)
Patient asks “The patch is bothering my skin. What can I do?”
What is your response?
Never apply to skin that is irritated
Alternate application site
Skin should NOT be shaved shortly before applying
Topical steroid (ex. hydrocortisone) can be applied after patch is removed
Patient asks “Which patches need to be removed prior to an MRI?”
What is your response?
Patches that contain metal (e.g. aluminum):
clonidine (Catapres-TTS)
rotigotine (Neupro)
Scopolamine (Transderm Scop)
Testosterone (Androderm)
Patient asks “Can I cover the patch with tape if it does not stick or falls off?”
What is your response?
Most patches CANNOT be covered with tape
Fenanyl and buprenorphine (Butrans) can be covered only with permitted adhesive film dressing Bioclusive or Tegaderm
Catapres-TTS comes with its own adhesive cover
Never apply to oily skin
When you apply, smooth patch over skin and press down for 10-30 seconds
Patient asks “How do I dispose used patches”
What is your response?
In most cases, remove and fold to press adhesive surfaces together
Some highly potent narcotic patches (eg. fentanyl, Butrans) and Daytrana can be fatal if ingested by child or pet so FDA and/or manufacturer may reccommend flushing the patch down the toilet
Patient asks “Where is the drug located in the patch?”
What is your response?
A reservoir or in the adhesive
What are some examples of nasal sprays
Imitrex (sumatriptan, fast onset, alt to injection)
Afrin (oxymetazoline)
Flonase Allergy Relief (fluticasone)
Note: Afrin and Flonase are typically used for localized nasal symptoms
Nasal Spray counseling points
Shake the bottle gently and remove cap
Prime pump before first use or when you have not used it recently (7-14 days)
Blow your nose to clear nostrils
Close on nostril and insert applicator into the other nostril
Start to breathe in through your nose and press firmly and quickly to spray
Breathe out through your mouth
Discard after using bottle for the labeled # of sprays (even if not empty)
Do NOT blow nose right after suing nasal spray
T/F: eye drops and ear drops can be used interchangeably
False - eye drops can go into the ear but ear drops cannot go into eye
When using eye drops wait at least ___ to put a second medication in the same eye. If administering a gel, wait ___
5-10 min
10 min
If the eye drop contains a preservative called ___ and you wear soft contact lenses, removed lenses prior to administration and wait ___ before reinserting
Benzalkonium chloride (BAK)
wait 15 mins
When using ear drops, pull earlobe __ and __ for adults to straighten ear canal.
Pull earlobe __ and __ for children < 3 yo.
Adults = up and back
Children = down and back
After administering ear drops, keep the ear facing up for about ___ to allow medication to coat the ear canal
5 min
For rectal edemas, what positioning provide best results?
Lying on the left side with left leg extended and right leg flexed forward for balance. Gently insert the medication and applicator tip into the rectum, pointed slightly toward the navel to prevent damage to the rectal wall
Remain in position for at least 30 min or preferably all night for max benefit
After administering rectal edema, how long should you stay in position?
Remain in position for at least 30 min or preferably all night for max benefit
For rectal suppositories, how long should it be kept in your rectum for best results?
at least 1-3 hours
What are 3 examples of drugs that need to taken before a meal
Phosphate binders
Pancreatic enzymes
Insulin
Patient was prescribed osmotic controlled-release oral delivery system methylphenidate (Concerta). What are some benefits of using this formulation?
Decrease frequency of drug administration
Extended drug release
Fast drug delivery (overcoat rapidly dissolves = quicker onset)
Reduced fluctuations in serum drug level
How many Lidocaine 5% patches (Lidoderm) can you wear at the same time?
3 max
How do you use Lidocaine 5% patches (Lidoderm)
Apply daily; worn 12 hrs on, 12 hrs off
Can cut into smaller pieces as needed, apply to clean dry, intact skin for pain
Which patches can be covered with Tegaderm or Bioclusive films?
Duragesic (fentanyl and Butrans (buprenorphine)
This patient has phenylketonuria (PKU). Which formulations should be avoided in this patient?
Chewable tablets
Granules
ODTs
Phenylalanine may be in these formulations (found in aspartame, which is an artificial sweetener) – elevates phenylalanine levels which may cause neurologic dysfunction)
Which transdermal patches can be applied to the buttock?
Xulane (birth control) and the oxybutynin patch
What are some advantages of using a long-acting injectable antipsychotic therapy like Risperdal Consta or Zyprexa Relprevv?
Increased med adherence
Decreased pill burden
Decreased drug level fluctuations
Decrease potential for relapse
Which patch comes with its own adhesive cover to hold the patch in place?
Clonidine (Catapres-TTS)
