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Ultimate Sadness > Chapter 6: Drug Formulations and Patient Counseling > Flashcards

Chapter 6: Drug Formulations and Patient Counseling Flashcards

1
Q

OROS delivery system

A
  • Osmotic Controlled Release Oral Delivery System
  • Water from the gut is absorbed into the delivery syste by osmosis → increase pressure inside and force drug out
  • shell may be visible in patient stool (ghost tablet/capsule)
  • several types of OROS formulatios: Concerta has an outer layer for IR with the inside for ER
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2
Q

when are ODTs useful

A

for people who can’t swallow
- dysphagia (stroke patients)
- children
- N/V
- non-adherence (prevents people from putting drug in cheek)

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3
Q

when are granules, powders, or open-able capsules useful

A
  • for pediatric or geriatric patients who struggle swallowing
  • pts with an NG tube and there’s no IV
  • if mixing with liquid or soft foods do NOT let it sit
  • do NOT add it to warm or hot contents
  • not all caps can be opened and adminstered
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4
Q

counseling for ODT

A
  • do NOT attempt to push tablets through foil
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5
Q

counseling for PO film

A
  • dissolve on tongue, will dissolve in seconds
  • once dissolved, may swallow with saliva
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6
Q

which hurts more, IM or SQ

A

typically IM because longer needle and subsequent muscle soreness

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7
Q

long-acting IM counseling points

A
  • improves adherence
  • decreases the need for more frequent injections
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7
Q

SQ counseling points

A
  • used for rapid effect
  • for drugs that would degade if given PO
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8
Q

IV counseling

A
  • bypass PO route
  • fast response
  • avoid loss of drug
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9
Q

counseling for injecting meds at home

A
  • inject at least 1 inch away from previous injection
  • neer use the sam needle more than once
  • some injecions click when the needle enters the skin and others when the injection is done
  • discard immediately in a sharps container
  • do NOT rub skin (esp if anticoag)
  • do NOT use any device to heat up cold injections, let sit at room temp
  • if discolored do NOT use
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10
Q

monoclonal antibodies counseling points

A
  • injectable protein used to treat many diseases
  • can premedicate to prevent severe symptoms
  • proteins can denature (break apart) do NOT shake and do NOT expose to extreme temp
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11
Q

patch administration sites

A
  • upper chest
  • upper adn lower back
  • upper arm on the outside
  • flanks (sides of bdoy and abdomen)

ROTATE SITES WHEN POSSIBLE

Exeptions
- exelon ca’t go on flanks
- butrans can’t go on side of body near abdomen, only chest
- some pain patches are applied to the site of pain
- daytrana goes on hip
- transderm scopolamine goes behind the ear

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12
Q

Patches that are administered twice daily

A

diclofenac

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13
Q

patches that are administered daily

A
  • methylphendate (daytrana, QAM)
  • nicotine
  • rivastigmine (exelon)
  • rotigotine (neupro)
  • selegiline (emsam)
  • testosterone (androderm, QPM)
  • lidocaine: on for 12, off for 12
  • nitroglycerin: on fro 12-14, off for 110-12
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14
Q

patches applied Q72H (Q3D)

A
  • fentanyl (can change out at 48 h if needed)
  • scoploamine PRN
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15
Q

patches applied twice weeklky

A
  • estradiol: alora, vivelle-dot
  • oxybutinin (oxytrol)
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16
Q

patches applied weekly

A
  • donepezil (Adlarity)
  • buprenorphine (Butrans)
  • clonidine (Catapress-TTS)
  • estradiol (Climara)
  • estradiol/levonorgestrol
  • ethiinyl estradiol/norelgestromin (Xulane, Zafemy): weekly for 3 weeks, off for 1
  • ethinyl estradiol/levonorgestel (Twirla): weekly for 3 weeks, off for 1
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17
Q

Patch counseling questions: “can I cut the patch into pieces”

A

typically no, except for Lidoderm which is designed to be cut up

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18
Q

Patch counseling questions: “Can the patch be exposed to eat from an electric blanket, heating pad, or body tep > 100.4 F?”

A

avoid heat wiith most patches, it can cause rapid absorption (tox)

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19
Q

Patch counseling questions: “The patch is bothering my skin, what can i do”

A
  • do NOT apply patch to skin that is irritated
  • rotate application site
  • skin should not be shaved shortly before applying, if needed, cut the hair short with scissors; topical steroid can be applied after patch is remmoved
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20
Q

Patch counseling questions: “what patches need to be removed prior to an MRI”

A

patches containing metal (because the metal will burn the skin)
- clonidine (Catapress-TTS)
- rotigotine (Neupro)
- scopolamine (Transderm Scop)
- testosterone (Androderm)

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21
Q

Patch counseling questions: “can the patch be covered with tape if it does not stick/falls off?”

A
  • typically no
  • fentanyl and buprenorphinne (Butrans) can be be covered with speicifc adhesives (Bioclusive, Tegaderm)
  • Catapress-TTS comes iwth its own cover

  • do NOT apply patch to oily skin
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22
Q

Patch counseling questions: “how di I dispose of used patches”

A
  • remove and fold the patch to press adhesive surfaces together and through away in a lidded container
  • fentanyl, Butrans, Daytarna may be flushed to avoid a child or pet accessing it after removal
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23
Q

Patch counseling questions: “where is the drug located”

A
  • can be in a raised part of the patch (reservoir)
  • or in adhesive itself
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24
Q

nasal spray counseling points

A

before using
- shake bottle
- prime if first use or haven’t used in a week
- low nose to clear nostrils

using spray
- close one nostrol with finger and insert applicator into toher nose
- star to breath in through your nose and press firmly and quickly down on the applicator
- breath out through mouth
- do nOT blow nose right away

25
Q
A
26
Q

T/F: eye drops can be adminsitered to the ear

A

true, but ear drops can never be adminstered to the eye

ear drops have less stringent requirements

27
Q
A
28
Q

eye drop counseling

A
  • shake it a few times (gels can be inverted adn shaken once to get to the tip)
  • look up and pull down on lower eyelid
  • release one drop of medicaiton into eye (space between eye and lower eyelid), do NOT let tip of bottle touch eye
  • close eye
  • press finger between eye and top of nose (lacrimal gland) for at least one minute
  • if > 1 drop is needed, wait 5-10 min in between meds (if gel, go with 10)
  • if eye drop contains the preservative benzalkonium chloride (BAK) and you wear soft contacts, remove contacts prior to admin and wait 15 min before putting back in
29
Q

ear drop counsleing

A
  • if cold, gently shake bottle or warm up in hands, do NOT admin cold drops
  • lie down or tilt head up with affected ear facing up
  • gently upp ear lobe up and back to straigten ear canal (pull upper ear down and back for children < 3)
  • admin ear drop s and keep ear facing up for 5 min
30
Q

enema counseling

A
  • empty bwel immediately before use
  • lay on left side with left leg extended and right leg flexed forward
  • insert applicator tip into rectum pointed slightly towards navel
  • tilt slightly so that the nozzle is aimed towards th back and squeeze slowly
  • remain in position for at elast 30 min or all night
31
Q

suppository counseling point

A
  • do not handle suppository too much, because it may melt
  • insert suppository with the pointed end first, insert completely into rectum
  • keep suppository in rectum for at elast 1-3 hrs
32
Q

when a pt misses a med, they are typically counseled to take it as soo as they remember, but skip if too close to next dose, and never double up. what are exceptions to that

A
  • hgh risk drugs: anticoag, transplant
  • OC
  • drugs that must be taken at a specific time (drugs with mealtime considerations)
33
Q

patient counseling point: anticholinergic effeccts

A

this medication can cause dry mouth, constipation, difficulty urinating, dry eyes and blurry vision

34
Q

patient counseling point: avoid in preggers

A
  • this medication can cause birth defects if taken during pregnancy
  • if you are pregnant or planning on becoming pregnant, do not use this medication
  • effective conracception is required
35
Q

patient counseling point: cancer

A
  • you are more likely to develop certain types of cacner while on this med
  • increased risk in sking cancer, protect skin from sun and use broadspectrum sunsreen with SPF of at least 30
  • follow recommended cancer screening
36
Q

patient counseling point: delrium

A

this edicaiton may cause confused thinking and unsual behaviors, contact pcp if this happens

37
Q

patient counseling point: dehydratoin in an infant

A
  • dehydration in an infant is dangerous
  • look out for sunken soft spot of head
  • no crying
  • tiredness
  • prodcuts like Pedialyte and Enfalyte can be used to help replace fluids adn minerals
  • severe dehydration requires medical treatment
38
Q

patient counseling point: dehdyration (adult)

A
  • med can cause dehdyration, s/s include dry mouth, increased thirst, less frequent urination, dizziness, headace, dry skin
  • if you develop rapid breathing and dark urine, contact pcp
39
Q

patient counseling point: diarrhea

A
  • drink fludis and electrolytes to prevent dehdyration
  • contact pcp if s/s do not improve in a few days or if there is severe pain, blood in stool, fever (>101 F), you’re pregant, or pt < 6 months old
40
Q

patient counseling point: dry mouth

A
  • this medicatio can cause or worsen dry mouth
  • can try sucking on sugarless hard candy or ice chips, siipping water, or chewing sugarless gum
  • make sure to keep teeth clean to prevent cavities
41
Q

patient counseling point: eye damage

A

contact pcp if you devlop any eye chagnes like blurry vision or seeing halos

42
Q

patient counseling point: gingival hyperplasia

A
  • med can cause growth of gums or swelling
  • brush and floss often
43
Q

patient counseling point: HF

A
  • med can cause or worsen HF
  • contact PCP if you develop SOB, rapid weight gain or swelling in lower extremities
44
Q

patient counseling point: hyperglycemia

A
  • can cause high blood sugar
  • watch out for: increased urination, increasted thirst, and increased hunger
45
Q

patient counseling point: hyperthyroidism

A
  • tell pcp if you develop increased sensitivity to heat, unexplained weight loss, thining of hair, usual sweating, nervousess, irritabliity or restlessness
46
Q

patient counseling point: hypoglycemia

A
  • s/s include dizziness, irritablity, shakines, sweating, hunger, confusion, fast HR, blurred vision
  • check BG and if able, eat or drink something with sugar
47
Q

patient counseling point: hypothyroidism

A

contact pcp if you devleop tiredness, icnreased feeling of coldness, weight gain, constipation, hair looss

48
Q

patient counseling point: infection

A
  • increased risk of infection
  • avoid sick people
  • wash hands frequently
49
Q

patient counseling point: lactic acidosis

A

get immediate medical help if you feal very weak or tired, have unsual muscle pain, have trouble breathing, and/or N/V

50
Q

patient counseling point: injection site reaction

A
  • site where you inject drug may becoe red, swollen, adn itchy
  • if it looks worrisome, contact pcp
51
Q

patient counseling point: liver damage

A

get medical help if you develop, yellowing of skin including whites of eyes, dark colored urine, light colored stool or bad stomach pain and nausea

52
Q

patient counseling point: lung damage

A

get medical help if you devleop: severe/persistent coughing, OSB, chest pain or difficulty/pain wehn breathing

53
Q

patient counseling point: many DDI

A

ask MD or RPh before starting OTC, herbals etc.

54
Q

patient counseling point: nephrotox

A

contact pcp if you have little or no urination, blood in urine, swelling in feet or nakles, or rapid weight gain

55
Q

patient counseling point: pancreatitis

A

get medical help if you fell nauseas nad have sharp pain in upper abdomen that feels like it is radiating to your back

56
Q

patient counseling point: parasthesia

A

“pins and needles” in legs, hands and feet, usually harmless

57
Q

patient counseling point: priapism

A

get medical help right away if you devlop painful erection that lasts > 4 hrs

58
Q

patient counseling point: QT prolongation

A
  • QT prolognaiton: heartbeat is too fast and not regular
  • get medical help if you feel dizzy and or faint suddenly
  • check with RPh before starting new meds
59
Q

patient counseling point: rash

A
  • mild rash: benadryl to ease itching
  • severe rash: flu-like symptoms, get immediate medical help
60
Q

patient counseling point: serotonin syndrome

A

get immediate medical help if: dizzy, shaky, agitated, feversh, racing heart beat

61
Q

patient counseling point: UTI

A

contact pcp if increased urination or urine darker than usual

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