2023 RxPrep Ch. 6 Drug Formulations & Patient Counseling

Common Long-acting oral tablets

- Methylphenidate (children with ADHD)

- Tolterodine (OAB)

Describe the Osmotic Release Oral System (OROS) for oral mediations

Water from the gut enters the delivery system (tablet, capsule, etc) by osmosis and slowly pushes the drug out of the device creating an extended-release product. The empty shell of the delivery device may be seen in the stool and is called a "Ghost capsule/tablet".

What resource can be used to see if a drug can/cannot be crushed?

ISMP's Do Not Crush List

What are some Long-acting medications that CANNOT be crushed, but CAN be cut on their score line?

- Toprol (metoprolol succinate)

- Sinemet (carbidopa/levodopa)

Suspensions vs Solutions, which should be shaken?

Suspensions (drugs are evenly dispersed in solutions)

Common examples of Liquid oral suspensions

- Amoxicillin/clavulanate

- Children's Tylenol

Common examples of Liquid oral solutions

- Constulose (lactulose)

- Neurontin (gabapentin)

- Rapamune (sirolimus)

Common examples of chewable tablets

- Singulair (montelukast)

- Lamictal (lamotrigine)

Are lozenges/troches used to treat localized or systemic conditions?

Localized (treats conditions of oral mucosa)

Common examples of lozenges/troches

- Mycelex (lamotrigine)

- Cepacol (benzocaine/menthol)

Why might an orally disintegrating tablet (ODT) be used?

- Children

- Dysphagia (difficulty swallowing)

- NV

- Nonadherence (Quickly dissolve)

Common examples of ODTs

- Lamictal ODT (lamotrigine)

- Remeron SolTab (mirtazapine)

- Zyprexa Zydis (olanzapine)

- Ondansetron

Why might a sublingual or buccal delivery mechanism be used?

- Children

- Dysphagia (difficulty swallowing)

- NV

- Nonadherence (Quickly dissolve)

- Less drug lost to gut degradation & first pass metabolism

- Onset of action is faster

Common examples of SL or buccal products

- Edular (zolpidem SL tablet)

- Nitrostat (nitroglycerin SL tablet)

- Subsys, Actiq, Fentora (fentanyl)

What are some common medications that can be sprinkled on apple sauce?

"CD ME"

- Adderall XR (dextroamphetamine/amphetamine ER)

- Coreg CR (carvedilol)

- Dexilant (dexlansoprazole)

- Focalin XR (dexmethylphenidate)

- Namenda XR (mematine)

- Nexium (esomeprazole)

- Ritalin LA (methylphenidate)

What mediation can be given in a spoon of applesauce, carrots, rice, or ice cream?

Singulair (montelukast)

What mediation can be given in water, yogurt, or OJ?

Vyvanse (lisdexamphetamine)

ODT counseling

- Place on tongue and let dissolve

- Swallow with saliva once dissolved

Common agents given as "premedication" prior to injections?

- Acetaminophen

- Diphenhydramine

What are some common self-administered injections that do NOT need refrigerated?

- Enoxaparin

- Fondaparinux

- Methotrexate

- Sumatriptan

The skin should NOT be rubbed around the injection site when administering what agents?

Anticoagulants (enoxaparin, fondaparinux - can cause bruising)

If a liquid medication appears like this, do not use it

Discolored & contains particles

How should Monoclonal Antibodies be handled?

- Do NOT shake (denature proteins)

- Avoid extreme temperatures

- Store in fridge prior to use and can be brought slowly to room temp

Most patches can be applied to the following administration sites:

- Chest

- Back

- Upper arms

- Flanks

Daytrana (methylphenidate)

administration site

hips (alternating daily)

Transderm scop (scopolamine)

administration site

behind the ear (alternating Q 72H)

Vivelle-Dot (estradiol)

administration sites

- lower abdomen

- buttocks

Oxytrol (oxybutynin)

administration site

- abdomen

- hip

- buttocks

Patches containing estrogens should never be placed where?

on the breasts

Patches containing testosterone should never be placed where?

on the scrotum

Generally, patches cannot be cut. What is the exception?

Lidoderm

Heat should never be applied to patches due to an (increase/decrease) in absorption.

increase

Should you shave before applying a patch?

No, shaving irritates the skin. Try cutting the hair short with scissors and alternating to another application site if skin is becoming irritable. A topical steroid like hydrocortisone may be applied after the patch is removed of skin is irritated.

Patches containing metal need to be removed prior to an MRI. What are these patches?

- clonidine (Catapres-TTS)

- rotigotine (Neupro)

- scopolamine (Transderm Scop)

- testosterone (Androderm)

Which patches can be covered with permitted adhesive cover which go over the patch to hold it in place?

- fentanyl (Duragesic)

- buprenorphine (Butrans)

- clonidine (Catapres-TTS)

What patches are recommended to be flushed instead of thrown into the trash?

- fentanyl (Duragesic)

- buprenorphine (Butrans)

- methylphenidate (Daytrana)

The nasal route of administration has a QUICKER onset than oral administration (True/False)

True

Nasal Spray Counseling

- Shake gently

- Prime before first use or after 7-14 days of inactivity

- Blow your nose to clear your nostrils

- Close one nostril and insert applicator

- Breathe in and press the down firmly/quickly on applicator

- Breathe out through your mouth

- Do not bow your nose afterward

Even if a nasal spray is not completely out, it should be discarded after you have used the labeled number of sprays (True/False)

True

Eye drops must be (2 characteristics)

- Sterile

- Similar to pH of eyes

Eye drops can be administered in the ear, but ear drops may NEVER be administered into the eyes (True/False)

True

Eye Drop Counseling

- Shake

- Bend neck and look upward

- Pull down on lower eyelid

- release one drop without touching applicator to your eye

- Close your eye and press your finger between your eye & nose for 1 min to help prevent medication loss

If administering a second medication in the same eye, how long should you wait in between?

- drops : 5-10 minutes

- gels : 10 minutes

If an eye drop contains ________________________________, contacts should be removed and not reinserted for at least 15 minutes.

benzalkonium chloride (BAK)

Ear Drop Counseling

- If cold, gently shake or roll the bottle in your hand

- Lie down or tilt head

- Gently pull the earlobe up & out for adult, down and back for children < 3 y/o

- Administer the desired # of drops and leave ear tilted upwards for 5 minutes

Enema Counseling

- Shake well & remove cap

- Lie down on left side with left leg extended and right leg flexed forward

- Gently insert applicator tip pointed slightly toward the naval

- Tilt so that the nozzle is aimed toward the back and slowly squeeze to administer the medication

- Throw away the bottle and remain in this position for at least 30 minutes

Suppository Counseling

- Remove foil wrapper

- Insert with the pointed end first

- Keep suppository there for at least 1-3 hours

When a dose is missed, the general rule is to take the dose as soon as you remember unless it is almost time for your next dose, in which case you would just continue on your normal schedule.

What types of medications do not follow this general rule?

- Anticoagulants

- Transplant drugs

- Oral contraceptives

- Drugs taken at specific times (phosphate binders, pancreatic enzymes, prandial insulin, etc.)

Twice daily patch

- Diclofenac

Twice weekly patch

- Estradiol (Alora, Vivelle-Dot)

- Oxybutynin (Oxytrol)