Chapter 6: Drug Formulations adn Patient Counseling Flashcards
Olanzapine formulations
IR tablet, ODT, short-acting injection, long-acting injection
Ondansetron formulations
IR tablet, oral solution, ODT, oral film, short-acting injection
Suffixes for long acting formulations:
XL, XR, ER, LA, SR, CR, CRT, SA, TR, cont
Osmotic Release Oral Systems (OROS)
Provides fast drug delivery, followed by an extended release.
Water from the gut is absorbed into the delivery system through osmosis, which increases the pressure inside and forces the drug out through a small opening.
The tablet/capsule shell may be visible in the patients stool (ghost tablet/capsule), but the drug has been released
Reasons for long-acting formulations
Drugs may be designed to release slowly to avoid nausea or to provide a long-duration of action. Providing a smooth level of drug release over time reduces high “peaks”, which reduces side effects and provides a safe level of drug over the dosing interval
Counseling for long-acting formulations
Do not crush or chew any drug that is in a LA formulation. It could release all of the medication at once, and a fatal dose could be released.
Is shaking required for suspensions or solutions?
Required for suspensions to redisperse the medication prior to administration.
What type of chewable tablets are popular for adults?
Chewable calcium tablets
Lozenges/troches
Used to treat a condition in the oral mucosa; the drug is held in the mouth while the troche slowly dissolves
Mycelex
Clotrimazole, for oral thrush
What is the most common cause of dysphagia?
Paralysis of the throat muscles from stroke
What are reasons for ODT formulations?
Dysphagia, children, nausea, vomiting, non-adherence
Patient counseling for granules, powders, or capsules that can be opened or sprinkled
Do not chew any long-acting pellets or beads
If capsule contents are mixed into liquid or food, do not let the mixture sit for too long (take within the time directed)
Do not add to anything warm or hot.
Singulair-motelukast granules instructions
In 5 mL of baby formula or breast milk or in a spoonful of applesauce, carrots, rice, or ice cream
Vyvanse granules instruction
In water, yogurt, or orange juice
Sorbitol metabolism
Produces gas, cramping, and bloating in sensitive patients, including those with IBS
Phenylalanine
Used in many ODT, chewable, and granule medication formulas. Is a dangerous sweetener for those with phenylketonuria (PKU), a genetic deficiency in which the enzyme that degrades phenylalanine is absent.
Lactose
Most common excipient in drug formulations. It many be an issue in patients with lactose intolerance
Subcutaneous injections
Patients can self-administer
Examples- naloxone, Imitrex, insulins
SC administration is used for rapid effect or for drugs that would degrade or not be absorbed if given orally.
Long-acting IM injectinos
Improve adherence or to decrease the need for more frequent injections.
IV Injections
Bypasses the oral route
Fast response, avoids drug loss due to N/V
Glatiramer
Room temp stability
Injection location
Frequency
Room temp stability- 30 days
Injection location- Abdomen, arms, hips, thighs
Frequency- daily or three times per week
Etanercept
Room temp stability
Injection location
Frequency
Room temp stability-14 days
Injection location- Thigh (preferred), abdomen, upper arm
Frequency- once or twice weekly
Humira (adalimumab)
Room temp stability
Injection location
Frequency
Room temp stability- 14 days
Injection location- Abdomen, thigh
Frequency- Every other week
Certolizumab
Room temp stability
Injection location
Frequency
Room temp stability- prefilled syringes up to 7 days
Injection location- abdomen, thigh
Frequency- every 2-4 weeks
Golimumab
Room temp stability
Injection location
Frequency
Room temp stability-up to 30 days
Injection location- Thigh, lower abdomen below navel, upper arm
Frequency- Monthly
Teriparatide (Forteo)
Room temp stability
Injection location
Frequency
Room temp stability- minimize, should be stored in fridge
Injection location- thigh, abdomen
Frequency- daily
Abaloparatide
Room temp stability
Injection location
Frequency
Room temp stability- up to 30 days
Injection location- Abdomen
Frequency- Daily
Enoxaparin
Room temp stability
Injection location
Frequency
Room temp stability- never refrigerated
Injection location -abdomen, > 1 inch from navel
Frequency- 1-2 times daily
Fondaparinux
Room temp stability
Injection location
Frequency
Room temp stability- never refrigerated
Injection location- Abdomen, >1inch from navel
Frequency- Daily
Methotrexate
Room temp stability
Injection location
Frequency
Room temp stability- never refrigerated
Injection location- Abdomen, thigh
Frequency- weekly
Sumatriptan
Room temp stability
Injection location
Frequency
Room temp stability- never refrigerated
Injection location- upper arm, thigh
Frequency- PRN at first sign of migraine
Injectable medication counseling
1.) Wash hands
2.) Prepare injection
3.) Select and clean injection site
4.) Inject
5.) Discard in sharps container
Anticoagulation injections
Do not rub the skin around anticoagualtion injections (enoxaparin, fondaparinux); rubbing can cause severe bruising
How to heat up cold injectable medications?
Let sit at room temperature for 20 min
Safe handling of monoclonal antibodies
Proteins can denature (break apart) if handled incorrectly
Do not shake medication
Avoid exposing to extreme temperatures
Store in fridge prior to use and slowly bring to room temperature prior to injecting
Common application sites for patches
Upper chest, lower and upper back, upper arm, flanks
Exelon
Applied to chest, back, or upper arm. Not flanks
Daytrana
Applied to the hip, alternating right and left hips daily
Transderm Scop
Applied behind the ear at least 4 hours before needing, alternating ears every 72 hrs
Vivelle-Dot
Apply at lower abdomen or buttock
Oxytrol
Apply at abdomen, hip, or buttock
Xulane
Apply to back, abdomen, arm, or buttock
Which patches are changed daily?
Methyphenidate- QAM 2 hours before school
Nicotine
Rivastigmine
Rotigotine
Selegiline
Testosterone
Which patches are applied twice daily?
Diclofenac
Which patches are applied twice weekly?
Estradiol (alora, vivelle-dot)
Oxybutynin
Can be used 3 weeks on and 1 week off
Which patches are applied weekly?
Buprenorphine
Clonidine
Estradiol (Climara)
Estradiol/Levonorgestrel
Ethinyl estradiol/Norelgestromin (Xulane)
Which patches are applied every 72 hours?
Fentanyl- if it wears off after 48 hrs, can change to Q48H
Scopolamine
Which patches are applied daily with special instructions?
Lidocaine- 1-3 patches on for 12 hours and off for 12
Nitroglycerin- on for 12-14 hours, off for 10-12 hours
Can I cut a patch into pieces?
Usually no, except for Lidoderm, which is designed to be cut and applied over painful regions
Can the patch be exposed to heat from an electric blanket, heating pad, or body temp >38 C (100.4F)?
Avoid heat. Heat causes rapid absorption
The patch is bothering my skin. What can I do?
Never apply to skin that is irritated
Alternate the application site
The skin should not be shaved shortly before applying; shaving is irritating to the skin. If needed, cute the short hair with scissors.
A topical steroids, such as hydrocortisone, can be applied after the patch is removed.
Which patches need to be removed prior to an MIR?
Patches containing metal need to be removed prior to an MRI or the metal will burn the skin.
Clonidine, Rotigotine, Scopolamine, Testosterone
Patches containing the same medication (generics) may vary in metal content. It is widely recommended that estradiol patches be removed prior to MRI.
Can the patch be covered with tape if it will not stick or falls off?
Most patches cannot be covered with tape.
Fentanyl and buprenorphine can be covered only with the permitted adhesive film dressings, Bioclusive or Tegaderm
Catapres comes with its own adhesive cover
Never apply patches to oily skin
When applied, patches have to be smoothed out on the skin, and then pressed down for a number of seconds, usually 10-30.
How do I dispose of patches?
In most cases, remove and fold the patch to press adhesive surfaces together for disposal.
Some highly potent narcotic patches (Duragesic, Butrans, Daytrana) can be fatal if ingested by a child or pet and you should flush them
Where is the drug located in a patch?
The drug can be in a raised pouch, reservoir, or directly into the adhesive
Nasal spray route
Has a faster onset than the oral route and is useful for acute condigtions.
Nasal sprays bypass gut absorption; some proteins that would be absorbed by the gut (calcitonin) can be given nasally.
Nasal spray counseling
Shake the bottle gently before use
Prime the pump before first use or when you haven’t used it recently (7-14 days)
Blow your nose to clear the nostrils
Close one nostril, insert nasal applicator into the other nostril
Breathe in through your nose, press firmly and quickly down once on the applicator to release the spray.
Breath out through our mouth
Wipe nasal applicator wiht clean tissue and replace cap.
Use the bottle for the labeled # of sprays and then discard.
DO not blow nose directly after
Eye drop counseling
Before you open the bottle, shake it a few times. Gels should be inverted and shaken once prior to use.
Bend your neck back so that you are looking up. Use one finger to pull down your lower eyelid.
Without letting the tip of the bottle touch your eye, release 1 drop of the medication into the space between your eye and your lower eyelid.
After squeezing in the drop, close your eye and press a finger between your eye and the top of your nose for at least 1 minute.
If you need to use more than 1 drop, wait 5 minutes between drops. Wait at least 5-10 meds before a second medication, 10 minutes before a gel.
Eye drop preservative
If the eye drop contains the preservative benzalkonium chloride (BAK) and you where soft contact lenses, remove lenses prior to administration and wait 15 minutes to reinsert them.
Ear drop counseling
If cold, gently shake the bottle or roll it in your hands for 1-2 minutes.
Lie down or tilt head up do that affected ear faces up.
Gently pull the earlobe up and back for adults to straighten the ear canal.
Pull down and back fr children <3 years.
Administer the prescribed number of drops into the ear canal and keep the ear facing up for about 5 minutes to allow the medication to coat the ear canal.
Best results for rectal products
For best results, empty the bowel immediately before use
Enema patient counseling
Remove the bottle from one pouch and shake well. Remove the protective sheath from the applicator tip. Hold the bottle at the neck to prevent any of the medication from being discharged.
Best results are obtained from lying on the left side with the left leg extended and the right leg flexed forward for balance. Gently insert the medication or applicator tip into the rectum, pointed slightly toward the navel to prevent damage to the rectal wall.
Grasp the bottle firmly and then tilt slightly so that the nozzle is aimed towards the back; squeeze slowly to instill the medication.
Remain in position for at least 30 minutes or preferably all night
Suppositories patient counseling
Detach one suppository from the strip. Remove the foil wrapper carefully while holding the suppository upright. Do not handle the suppository too much; heat from your hands will cause it to melt.
Insert the suppository, with the pointed end first, completely into the rectum, using gentle pressure.
For best results, keep the suppository in your rectum for at least 1-3 hours
Inhalations patient counseling
Drug is delivered directly to the lung and minimizes systemic AR
