Chapter 6: Drug Formulations & Patient Counseling

Question 1

Which 5HT3-RA comes in a long-acting patch?

Answer 1

Granisetron

Question 2

Which sweetener added to some drug formulations causes gas, cramping, and bloating in sensitive patients (i.e. patients with IBS)?

Answer 2

Sorbitol

Question 3

Which sweetener is dangerous for those with phenylketonuria (PKU)?

Answer 3

Phenylalanine

Question 4

What is the most commonly used excipient in drug formulations?

Answer 4

Lactose

Question 5

What should you instruct patients on when using granules, powders or capsules that can be opened and sprinkled into soft food and water?

Answer 5

• Do not chew any long-acting pellets or beads that are emptied out from a capsule
• Do not let the mixture sit too long if capsule contents are mixed in food or liquid
• Do not add to anything warm or hot

Question 6

T or F: you can crush or chew long-acting medications

Answer 6

false; this could lead to a fatal dose

Question 7

What are osmotic release oral systems?

Answer 7

They provide fast drug delivery followed by an extended release in one drug

Question 8

What is an important counseling point about osmotic release oral systems (OROS)?

Answer 8

The tablet/shell may be visible in the patient’s stool (called a ghost tablet/capsule)

Question 9

Why are long-acting medications used?

Answer 9

• To avoid nausea or provide a long duration of action

- Reduces high “peaks” which reduces side effects

Question 10

T or F: some long-acting opioid capsules can be opened and the contents sprinkled on certain foods

Answer 10

True

Question 11

Which long-acting medications can be cut at the score line?

Answer 11

Toprol XL and Sinemet CR (carbodopa/levodopa)

Question 12

Where on the body can patches be placed?

Answer 12

chest (upper), back (upper and lower), upper arm (on the part facing out), flanks (sides of the body, abdomen level)

Question 13

Where is Daytrana patch applied?

Answer 13

To the hip, alternating between right and left hip daily

Question 14

Where is Transderm Scop patch applied?

Answer 14

Behind the ear at least 4 hours before needed, alternating ears Q72H

Question 15

Which patch can be cut into pieces?

Answer 15

Lidoderm

Question 16

What happens if you apply heat to a patch?

Answer 16

Heat causes rapid absorption of the medication

Question 17

Which patches can be covered with adhesive film if it does not stick?

Answer 17

Fentanyl (duragesic) and buprenorphine (Butrans) only with the permitted adhesive film dressings, Bioclusive or Tegaderm

Catapres-TTS comes with its own adhesive cover

Question 18

T or F: you can flush some highly potent narcotic patches down the toilet to remove it from the home immediately?

Answer 18

True - these include Duragesic, Butrans and Daytrana

Question 19

What are some counseling points for all monoclonal antibodies?

Answer 19

Do not shake the medication and avoid exposing the drug to extreme temperatures (hot or cold)

Question 20

How many times should a gel eyedrop be shaken prior to use?

Answer 20

once

Question 21

How long should you wait to use another medication in your eye after using an eye drop?

Answer 21

5-10 minutes

Question 22

How long should you wait to use a gel in your eye after using an eye drop?

Answer 22

10 minutes

Question 23

What should you do if your eye drop contains a preservative called benzalkonium chloride (BAK) and you wear soft contact lenses?

Answer 23

remove the lenses prior to administration (wait 15 min to reinsert)

Question 24

When using eardrops on an adult, how would you pull the ear when administering?

For a child?

Answer 24

adult: up and back
child: down and back if < 3 years

Question 25

How long should you keep your ear facing up after administering an ear drop

Answer 25

5 minutes

Question 26

When would an ODT be useful

Answer 26

Patients with dysphagia, children, nausea, vomiting, non-adherence

Question 27

Why would sublingual or buccal delivery with a tablet, film, powder or spray be useful

Answer 27

Has a faster onset of action & less drug is lost to gut deterioration & first-pass metabolism

Question 28

Singulair granules can be mixed in 5 ml baby formula or breast milk or:

Answer 28

Spoonful of applesauce, carrots, rice or ice cream

Question 29

Exelon patch is NOT applied to which part of the body that most patches can be placed

Answer 29

flanks (sides of body, abdomen level)

Question 30

How is lidocaine patch applied

Answer 30

1-3 patches, on for 12 hours, then off for 12 hours (as needed)

Question 31

How is nitroglycerin patch applied

Answer 31

On for 12-14 hrs then off for 10-12 hrs

Question 32

When applying an eye drop, how long should you press down between your eye and the top of your nose after applying a drop

Answer 32

one full minute

Question 33

Patches that are applied daily

Answer 33

Daytrana patch - QAM, 2 hours prior to school
Nicotine (NicoDerm CQ) patch
Rivastigmine (Exelon) patch
Rotigotine patch
Selegiline patch
Testosterone patch - nightly (not on scrotum)

Question 34

Which two patches are applied Q72H

Answer 34

Fentanyl and Scopolamine

Question 35

Which patches are applied weekly

Answer 35

buprenorphine (Butrans)
Clonidine
Estradiol (Climara)
Estradiol/Levonorgestrel

Question 36

Which patches are applied twice weekly

Answer 36

Estradiol (Alora, Vivelle-Dot)

oxybutinin (Oxytrol)

Question 37

Which patch is applied weekly for 3 weeks, off for the 4th week

Answer 37

Ethinyl estradiol/Norelgestromin (Xulane)

Question 38

Which patch is applied twice daily

Answer 38

Diclofenac - (remember, di=2)