6. Drug Formulations + Patient Counseling Flashcards by Yerin M

Drug formulation considerations: Olanzapine: What formulations does it come in?

IR tablet, ODT, short-acting injection, and long-acting injection

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Drug formulation considerations: Ondansetron: What formulations does it come in?

IR tablet, oral solution, ODT, oral film, and short-acting injection

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Which drugs use an osmotic controlled-release oral delivery system (OROS)

Concerta, Cardura XL, Procardia, XL, Asacol HD, Delzicol

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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).

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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

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Augment and Children’s Tylenol are examples of liquid oral ___ and they must be shaken prior to admin

suspensions

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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

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What are some examples for chewable tablets

Suprax (cefixime)
Singulair (montelukast)
Lamictal (lamotrigine)

Typically for children

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What are some examples for lozenges

Mycelex (clotrimazole, for oral thrush)
Cepacol (benzocaine/menthol, for sore throat)

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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)

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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

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___ (sweetener) metabolism produces gas, cramping and bloating in sensitive patients, including those with IBS

Sorbitol

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____ 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)

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___ is the most commonly used excipient in drug formulations. May be an issue in patients with lactose intolerance.

Lactulose

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What are common application sites for patches?

Chest, back, upper arm, flanks

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___ patches are applied to chest back, upper arm, but NOT flanks

Exelon (Rivastigmine)

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____ patches are applied on the hip, alternating righ and left hips daily

Daytrana (methylphenidate, for ADHD)

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___ is applied behind the ear, at least 4 hrs before needed, alternating ears every 72 hrs

Transderm Scop (Scopolamine, for N/V)

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Patch frequency: Diclofenac

Twice daily

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Patch frequency: methylphenidate (Daytrana)

QAM, 2 hrs prior to school

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Patch frequency: nicotine (Nicoderm CQ)

daily

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Patch frequency: rivastigmine (Exelon)

daily

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Patch frequency: rotigotine (Neupro)

Daily

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Patch frequency: Selegiline (Emsam)

daily

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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)