Drug Formulations Flashcards
Which drugs have a granule/capsule formulation that can be sprinkled on applesauce? What are other counseling points associated with this?
Drugs:
-Adderall XR
-Coreg CG (carvedilol)
-Dexilant (dexlansoprazole)
-Folacin XR (dexmethylphenidate)
-Namenda XR (memantine)
-Nexium (esomeprazole)
-Ritalin LA (methylphenidate)
Counseling:
-do NOT chew any long-acting pellets or beats emptied out from a capsule
-If capsule contents mixed in food or liquid, do NOT let sit long and use a small mount
-Entire mixture should be ingested to ensure full dose taken
-do NOT add anything warm or hot (contents can dissolve too quickly)
Cambia is the brand of _________ which is a powder that can be mixed in ______.
diclofenac; water
Creon (pancreatic enzymes) can be taken with soft food with low pH such as ____, ______, or ______.
Applesauce, banana, pureed pears
Potassium ER capsules can be sprinkled on _____ or _____.
Applesauce or pudding
Depakote sprinkles (valproic acid) can be taken with ______.
Soft food
Vyvanse (lisdexamphetamine) can be taken how?
In water, yogurt, or orange juice
Singluair (montelukast granules) can be taken how?
In 5mL of baby formula or breast milk OR spoonful of applesauce, carrots, rice, or ice cream
Questran/Questran light (cholestryamine) is a powder that should be taken how?
In 2-6 oz of water or non-carbonated liquid
What are some of the risks associated with adding sweeteners to medications?
Sorbitol: produces gas, cramping, and bloating in sensitive pts including IBS
Aspartame: contains phenyalanine which is dangerous in pts with phenylketonuria (PKU) where phenyalanine cannot be digested
Lactose: commonly used, may be an issue in lactose intolerant pts
Xylitol: poisonous to dogs
ODT and Oral Film Counseling
do NOT push tablet through foil backing (friable)
Using dry hands, peel back the foil of one blister and remove tablet. Place on tongue to let dissolve in seconds. Once dissolved, then can swallow with saliva. Administration with water NOT necessary.
Injectable Medication Counseling
Basics: wash hands –> prepare injection –> select and clean injection site –> inject – > discard syringes/pen needles in sharps container/thick container
Injection: at least one 1 inch away from previous site, do NOT inject in mole or scar tissue
-Intradermal: 15 degree angle on inner arm (tuberculosis skin test)
-Subcutaneous: outer upper thigh (45 degree), adomen (90 degree or 45 degree if not too much fat tissue), or back of arm halfway between shoulder and elbow(45 degree) –> pinch skin prior
-Intramuscular: deltoid muscle in arm, dorsal gluteal (upper outer quadrant of buttocks), thigh –> 90 degree angle for all, hold skin taut
Anticoagulant injections: do NOT rub skin near injection site as this can cause severe bruising
Biologics: often proteins –> do NOT shake as this can easily denature and avoid extreme temperatures
-Biosimilars: have a 4-letter code at end of name (ex. adaliumumab-bwwd); assume requires same special handing as biologic
Patches: administration sites and counseling
Sites: upper chest, upper and lower back, upper arm on the part facing out, flanks (sides of the body, abdomen level)
-Pain patches: can be applied to the area the pain is at
Counseling:
-Rotate the site where patch is placed with exception of pain patches
-Patches cannot be cut into pieces
-do NOT apply patches on irritated skin or skin shaved shortly before applying
-When discarding, remove the patch to press adhesive surfaces together
Explain where the following patch can be placed: Exelon (rivastigmine patch)
Typical sites, except cannot place on flanks
Explain where the following patch can be placed: Daytrana (methylphenidate patch)
Applied on hip, alternating between right and left
Explain where the following patch can be placed: Transderal-Scop (scopolamine patch)
Behind the ear at least 4 hours before needed, alternating ears Q72H
Explain where the following patch can be placed: Xulane (norelgestromin/EE patch)
Back, abdomen, arm, or buttock
Explain where the following patch can be placed: Oxytrol (oxybutynin patch)
Abdomen, hip, or buttock
Explain where the following patch can be placed: Vivelle-Dot (estradiol patch)
Lower abdomen or buttock
If a patch is irritating to the skin, what can a pt do?
Apply hydrocortisone after patch is removed
Majority of patches cannot be cut, except which ones?
Lidoderm (lidocaine patches) and Qutenza (capsaican patches)
Patches that contain metal must be removed prior to an MRI otherwise the metal can burn the skin. Which ones are these?
- Clonidine (Catapres-TTS)
- Rotigotine (Neupro)
- Scopolamine (Transderm-Scop)
- Testosterone (Androderm)
In general, always verify the contents of the patch or if the drug resembles metal in any sort (recommended to remove estradiol patches for this reason prior too).
Can a patch be covered with tape if it does not stick or falls off?
Most patches cannot be covered with tape - a few can be taped around the edges; when appling a patch, smooth out and press down for 10-30 seconds
Fentanyl (Duragesic) and buprenorphine (Butrans) can only be covered w/ permitted adhesive film dressings, Bioculsive or Tegaderm
Catapre-TTS: comes w/ own adhesive cover
What patches do the FDA/manufacturer may recommend to flush down the toilet?
Highly potent narcotic patches as they can be fatal if ingested aafter removal
Nasal Spray Counseling
Before use:
-Shake bottle gently and remove cap.
-Prime pump before use or if you haven’t used recently (usually 7-14 days).
-Blow your nose to clear your nostrils.
Using spray:
-Close one nostril using finger and insert nasal applicator into the other nostril.
-Start to breathe in through your nose and press firmly and quickly down once on the applicator to release spray.
-Breathe out through mouth.
-Repeat steps if a second spray needed.
-Wipe nasal applicator with clean tissue and replace cap.
