Drug Formulations & Patient Counseling Flashcards
Duragesic patch should be pressed onto the skin for…
30 seconds
Ondansetron formulations…
IR tablet, oral solution, ODT, oral film (Zuplenz) and short-acting injection (useful if patient is vomiting). Oral film can be given for nausea without vomiting. Oral solution is good option for painful esophageal ulcers, strictures, tumors, and NG tubes.
Granisetron comes in a long-acting patch called…
Sancuso that prevents chemo-induced nausea for up to 7 days. Applied before chemo.
Sorbitol metabolism produces…
gas, cramping and bloating in sensitive patients (ex. IBS)
Phenylalanine is used in many ODT, chewable and granule medication formulations. Avoid in patients with…
phenylketouria (PKU)
Lactose is the most commonly used excipient in drug formulations. It is tolerated by some, but not all, patients with…
lactose intolerance
Onzetra Xsail
nasal powder for migraine
Cotempla XR-ODT
long-acting ODT for ADHD
lamotrigine (Lamictal ODT)
for children
mirtazapine (Remeron SolTab ODT)
for nausea, dysphagia, good option for elderly patients
olanzapine (Zyprexa Zydis)
for non-adherence
zolpidem SL tablet (Edluar, Intermezzo)
same benefits of ODTs, but SL/buccal has faster onset of action
nitroglycerin SL tablet (Nitrostat)
same benefits of ODTs, but SL/buccal has faster onset of action
fentanyl (Subsys SL spray, Actiq lozenge, Fentora buccal tablet)
same benefits of ODTs, but SL/buccal has faster onset of action
clotrimazole (Mycelex) troche
for oral thrush
cefixime (Suprax)
chewable tablet for children
montelukast (Singulair)
chewable tablet for children
lamotrigine (Lamictal CD)
chewable tablet for children
dextroamphetamine/amphetamine ER (Adderall XR)
can be sprinkled on applesauce
carvedilol (Coreg CR)
can be sprinkled on applesauce
dexlansoprazole (Dexilant)
can be sprinkled on applesauce
dexmethylphenidate (Focalin XR)
can be sprinkled on applesauce and take ASAP
memantine (Namenda XR)
can be sprinkled on applesauce
esomeprazole (Nexium)
can be sprinkled on applesauce
methylphenidate (Ritalin LA)
can be sprinkled on applesauce
diclofenac potassium powder (Cambia)
can mix in water
Creon and other pancreatic enzyme products
can put on soft food with low pH (applesauce, pureed pears, or banana)
valproic acid (Depakote Sprinkles)
on soft food
morphine (Kadian)
on applesauce or soft food
potassium (Micro-K)
on applesauce or pudding
cholestyramine (Questran, Questran Light)
in 2-6 oz water or non-carbonated liquid
montelukast granules (Singulair)
in 5 mL baby formula or breast milk or in a spoonful of applesauce, carrots, rice or ice cream
lisdexamfetamine (Vyvanse)
in water, yogurt, or orange juice (OJ)
methylphenidate (Concerta)
capsule-shaped, ER tablet
tolterodine (Detrol LA)
Do not chew or crush any drug that has the following suffix that indicates it is long-acting formulation: XL, XR, ER, LA, SR, CR, CRT, SA, TR, TD, or has 24, timecaps or sprinkles in the name, or the ending “cont” for controlled released
sumatriptan (Imitrex) nasal spray
fast onset, alternative to injection
Several other long-acting medications use an osmotic release oral system (OROS ) to provide fast drug delivery, followed by an extended-release in one drug. The tablet/capsule shell may be visible in the patient’s stool (called a ghost tablet/capsule), but the drug has been released. Examples…
Concerta, Cardura XL, Procardia XL, mesalamine (delayed-release Asacol HD), mesalamine (Delzicol)
There a few long-acting formulations that can be cut at the score line- but still not crushed. Ex…
Toprol XL, Sinemet CR
oxymetazoline (Afrin)
for localized nasal symptoms
fluticasone (Flonase Allergy Relief)
for localized nasal symptoms
testosterone (AndroGel)
topical for systemic effect (hypogonadism/testosterone deficiency)
mesalamine enema (Rowasa)
treats local disease (distal ulcerative colitis)
glycerin suppository (Babylax)
treats constipation (stool is in rectum)
acetaminophen suppository (FeverAll)
treats pain/fever
SC injections that patient can self-administer:
- teriparatide (Forteo)
- sumatriptan (Imitrex)
- Insulins, GLP-1 agonists
- enoxaparin (Lovenox)
- abaloparatide (Tymlos)
Long-acting IM injections:
- aripiprazole (Abilify Maintena)
- haloperidol decanoate (Haldol)
- paliperidone (Invega Sustenna, Invega Trinza)
- leuprolide (Lupron Depot)
- risperidone (Risperdal Consta)
- naltrexone (Vivitrol)
- olanzapine (Zyprexa Relprevv)
Must inject in the abdomen > 1 inch from navel:
- enoxaparin (Lovenox)
- fondaparinux (Arixtra)
Most patches (eg. Catapres-TTS, Duragesic) can be applied to one or more of these common application sites, on either side of the body.
- chest (upper)
- back (upper and lower)
- upper arm (on the part facing out)
- flanks (sides of the body, abdomen level)
ethinyl estradiol/norelgestromin (Xulane) patch
- put on weekly for 3 weeks, off for the 4th week
- apply on the back, abdomen, or buttock
methylphenidate (Daytrana) patch
- put on every morning, preferably 2 hours before school
- apply on the hip, alternating right and left hips daily
nicotine (NicoDerm CQ) patch
apply patch daily
rivastigmine (Exelon) patch
apply patch daily
rotigotine patch
apply patch daily
selegiline patch
apply patch daily
testosterone patch
apply patch nightly, not on scrotum
oxybutynin (Oxytrol) patch
apply twice weekly (abdomen, hip, or buttock)
estradiol (Alora, Vivelle-Dot). Very tiny patch.
apply twice weekly (lower abdomen)
diclofenac patch
apply twice daily
buprenorphine (Butrans) patch
apply weekly
clonidine (Catapres TTS) patch
apply weekly (comes its own cover for the patch)
estradiol (Climara) patch
apply weekly
estradiol/levonorgestrel patch
apply weekly
fentanyl (Duragesic) patch
apply every 72 hours, if it wears off after 48 hours, change to 48 hours
scopolamine (Transderm Scop)
apply every 72 hours, if needed
Fentanyl (Duragesic) and buprenorphine (Butrans) can be covered only…
with the permitted adhesive film dressings, Bioclusive or Tegaderm.
Nasal spray counseling:
Before use:
- Shake the bottle gently and remove the cap
- Prime the pump before the first use or when you have not used it recently (1-2 weeks on average)
Using the spray:
- Close one nostril and insert the applicator into the other nostril.
- Start to breath in through your nose, and press firmly and quickly down one cone the applicator to release the spray.
- Breathe out through your mouth.
- If a 2nd spray is needed in that nostril, repeat the above steps. Repeat the above steps in the other nostril.
- Wipe the nasal applicator with a clean tissue and replace cap.
- Use the bottle for the labeled number of sprays then discard, even if it is not completely empty.
- Do not blow your nose right away after using the spray.
Ear drop counseling
- If cold, gently shake the bottle or roll it in your hands for 1-2 minutes to warm the solution.
- Do not drop cold medication into the ear.
- Lie down or tilt the head so that the affected ear faces up
- Gently pull the earlobe up and back for adults (down and back for children < 3 years) to straighten the ear canal
- Administer the prescribed number of drops into the ear canal. Keep the ear facing up for about 5 minutes to allow the medication to coat the ear canal.
- Do not touch the dropper tip to any surface. To clean, wipe with a clean tissue.
Eye drop counseling
- Wash hands before and after using eye drops.
- Before you open the bottle, shake it a few times. Gels should be inverted and shaken once before to use (to help the medication reach the tip)
- Bend your neck back so that you are looking up. Use one finger to pull down your lower eyelid. It is helpful, at least at first, to use a mirror.
- Without letting the tip of the bottle touch your eye or eyelid, release one drop of the medication. The drop should go into the space between your eye and your lower eyelid.
- After you squeeze the drop of medication into your eye, close your eye. Press a finger between your eye and the top of your nose. Press for at least 1 full minute so more of the med stays in your eye.
- Wait at lest 5-10 minutes to put a 2nd med in your eye. If giving a gel, wait 10 minutes after the other medication before use.
- If your eye drop contains benzalkonium chloride (BAK) and you wear soft contact lenses, remove them before administration (wait 15 minutes to reinsert)
ODT and oral film counseling
ODT tablets: do not attempt to push the tablets through foil backing. With dry hands, peel back the foil of one blister and remove the tablet.
- Place the tablet (or film) on the tongue; it will dissolve in seconds. Once dissolved, you may swallow with saliva. Administration with liquid is not necessary. Wash hands after administration.
