6. Drug Formulations + Patient Counseling Flashcards

1
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

How does osmotic controlled-release oral delivery system (OROS) work?

A

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).

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

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

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

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

A

suspensions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

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

A

solutions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some examples for chewable tablets

A

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

Typically for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are some examples for lozenges

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are some examples of ODT

A

Lamictal ODT (lamotrigine, for seizures)
Nurtec (rimegapant, for migraines)
Remeron SolTab (mirtazapine, for depression)
Zyprexa Zydis (olanzapine, for schizophrenia)
Ondansetron (for nausea, dysphagia)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

When is ODT/SL often helpful?

A

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

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

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

A

Sorbitol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

____ 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.

A

Phenylalanine
Phenylketonuria (PKU)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

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

A

Lactulose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are common application sites for patches?

A

Chest, back, upper arm, flanks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

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

A

Exelon (Rivastigmine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

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

A

Daytrana (methylphenidate, for ADHD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

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

A

Transderm Scop (Scopolamine, for N/V)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Patch frequency: Diclofenac

A

Twice daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Patch frequency: methylphenidate (Daytrana)

A

QAM, 2 hrs prior to school

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Patch frequency: nicotine (Nicoderm CQ)

A

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Patch frequency: rivastigmine (Exelon)

A

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Patch frequency: rotigotine (Neupro)

A

Daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Patch frequency: Selegiline (Emsam)

A

daily

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Patch frequency: Testosterone (Androderm)

A

Nightly, not on scrotum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Patch frequency: lidocaine (Lidoderm)

A

1-3 patches prn, on for 12 hrs, off for 12 hrs

27
Q

Patch frequency: nitroglycerin

A

On for 12-14 hours, then off for 10-12 hours

28
Q

Patch frequency: fentanyl

A

Q72H, if it wears off after 48 hrs, change to Q48H

29
Q

Patch frequency: scopolamine (Transderm Scop)

A

Q72H, prn

30
Q

Patch frequency: estradiol (Alora, Vivelle-Dot)

A

Twice weekly

31
Q

Patch frequency: oxybutynin (Oxytrol)

A

Twice weekly

32
Q

Patch frequency: Donepezil (Adlarity)

A

Weekly

33
Q

Patch frequency: Buprenorphine (Butrans)

A

Weekly

34
Q

Patch frequency: clonidine (Catapres-TTS)

A

Weekly

35
Q

Patch frequency: estradiol (Climara)

A

Weekly

36
Q

Patch frequency: Estradiol/levonorgestrel

A

Weekly

37
Q

Patch frequency: Ethinyl estradiol/norelgestromin (Xulane, Zafemy) and ethinyl estradiol/levonorgestrel (Twirla)

A

Weekly for 3 weeks, off for 1 week

38
Q

Patient asks “Can I cut the patch into pieces?”
What is your response?

A

Usually no, except Lidoderm and Qutenza which are designed to be cut and applied over painful regions

39
Q

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?

A

Avoid heat exposure with most patches - heat = rapid absorption, may be fatal (esp fentanyl, buprenorphine)

40
Q

Patient asks “The patch is bothering my skin. What can I do?”
What is your response?

A

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

41
Q

Patient asks “Which patches need to be removed prior to an MRI?”
What is your response?

A

Patches that contain metal (e.g. aluminum):
clonidine (Catapres-TTS)
rotigotine (Neupro)
Scopolamine (Transderm Scop)
Testosterone (Androderm)

42
Q

Patient asks “Can I cover the patch with tape if it does not stick or falls off?”
What is your response?

A

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

43
Q

Patient asks “How do I dispose used patches”
What is your response?

A

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

44
Q

Patient asks “Where is the drug located in the patch?”
What is your response?

A

A reservoir or in the adhesive

45
Q

What are some examples of nasal sprays

A

Imitrex (sumatriptan, fast onset, alt to injection)
Afrin (oxymetazoline)
Flonase Allergy Relief (fluticasone)

Note: Afrin and Flonase are typically used for localized nasal symptoms

46
Q

Nasal Spray counseling points

A

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

47
Q

T/F: eye drops and ear drops can be used interchangeably

A

False - eye drops can go into the ear but ear drops cannot go into eye

48
Q

When using eye drops wait at least ___ to put a second medication in the same eye. If administering a gel, wait ___

A

5-10 min
10 min

49
Q

If the eye drop contains a preservative called ___ and you wear soft contact lenses, removed lenses prior to administration and wait ___ before reinserting

A

Benzalkonium chloride (BAK)
wait 15 mins

50
Q

When using ear drops, pull earlobe __ and __ for adults to straighten ear canal.
Pull earlobe __ and __ for children < 3 yo.

A

Adults = up and back
Children = down and back

51
Q

After administering ear drops, keep the ear facing up for about ___ to allow medication to coat the ear canal

A

5 min

52
Q

For rectal edemas, what positioning provide best results?

A

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

53
Q

After administering rectal edema, how long should you stay in position?

A

Remain in position for at least 30 min or preferably all night for max benefit

54
Q

For rectal suppositories, how long should it be kept in your rectum for best results?

A

at least 1-3 hours

55
Q

What are 3 examples of drugs that need to taken before a meal

A

Phosphate binders
Pancreatic enzymes
Insulin

56
Q

Patient was prescribed osmotic controlled-release oral delivery system methylphenidate (Concerta). What are some benefits of using this formulation?

A

Decrease frequency of drug administration
Extended drug release
Fast drug delivery (overcoat rapidly dissolves = quicker onset)
Reduced fluctuations in serum drug level

57
Q

How many Lidocaine 5% patches (Lidoderm) can you wear at the same time?

A

3 max

58
Q

How do you use Lidocaine 5% patches (Lidoderm)

A

Apply daily; worn 12 hrs on, 12 hrs off
Can cut into smaller pieces as needed, apply to clean dry, intact skin for pain

59
Q

Which patches can be covered with Tegaderm or Bioclusive films?

A

Duragesic (fentanyl and Butrans (buprenorphine)

60
Q

This patient has phenylketonuria (PKU). Which formulations should be avoided in this patient?

A

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)

61
Q

Which transdermal patches can be applied to the buttock?

A

Xulane (birth control) and the oxybutynin patch

62
Q

What are some advantages of using a long-acting injectable antipsychotic therapy like Risperdal Consta or Zyprexa Relprevv?

A

Increased med adherence
Decreased pill burden
Decreased drug level fluctuations
Decrease potential for relapse

63
Q

Which patch comes with its own adhesive cover to hold the patch in place?

A

Clonidine (Catapres-TTS)