Exam 1: Formulations (smith)

If using two different kinds of eye drops, how long should you wait between each administration?

a. 30 seconds

b. 2 minutes

c. 5 minutes

d. 10 minutes

c. 5 minutes

Which eye drop class is available over the counter?

a. Antibiotic

b. Glaucoma

c. Dry eye

d. Steroid

c. Dry eye

T or F: When instilling ear drops in adults, you shouldpull the ear down and back

FALSE (you pull up for adults)

Which of the following inhalers requires a deep, forceful breath to use the inhaler?

a. metered dose inhaler

b. dry powder inhalers

c. soft mist inhalers

b. dry powder inhalers

Which of the following nicotine replacement therapies (NRT) dosing depends on how many cigarettes are smoked per day?

a. Patch

b. Gum

c. Lozenge7

a. Patch

T or F: Products for a yeast infection cannot be usedduring menstruation

FALSE

What is the best time to administer vaginal creams?

a. In the morning

b. In the afternoon

c. In the evening

d. Prior to going to bed

d. Prior to going to bed

What can you moisten a suppository with before inserting?

a. Vaseline

b. K-Y Jelly

c. Warm water

b. K-Y Jelly

When using an insulin pen, how long should you leave the needle in after seeing the dose window goto zero?

a. Can withdraw the needle immediately

b. 2-3 seconds

c. 5-10 seconds

c. 5-10 seconds

Why should injection sites be rotated?

a. Injection site pain

b. Lipodystrophy

c. Risk of bleeding from the injection site12

b. Lipodystrophy

Administration of eye drops

1. Wash area around eyes.

2. Tilt head back or lie down.

3. Gently grasp __________ outer eyelid below lashes and pull eyelid away from eye to create a ___________.

4. Position dropper over eye, then look up and release one drop.

5. Release the eyelid slowly. Close eyes gently for __________ and position the head downward. Minimize blinking or squeezing of eyelid.

- lower

- pouch

- 3 minutes

Eye Drops Counseling Tips

- contact lenses should be removed (unless product is designed for use with lenses)

- always check expiration dates

- shake well, do not refrigerate suspensions

- Do NOT touch bottle tip to the eye

- apply gentle pressure to tear duct w/ finger

- blot excess solution from around eye

- 5 mins between each eye drop if multiple eye drops (suspensions should go last)

What can patients do to know if they administered the eye drop?

Which formulation does this tip not apply to?

- If unsure eye drops were administered, refrigerate solution

- does NOT apply to suspensions

OTC classes of eyedrops

- Artificial tears

- Antihistamines

- Decongestants

Artificial tears indication and examples

- Alleviate dryness of ocular surface

- for mild dry eye disease

ex: refresh, clear eyes, systane

Antihistamins indication and examples

- allergic conjunctivitis

(first line tx is artificial tears to flush allergens out)

ex: zaditor, pataday

Decongestant eye drop indication and examples

- allergic conjunctivitis-reduces ocular redness by acting as a vasoconstrictor

- does NOT diminish allergic response

ex: Clear Eyes,Visine Advanced Relief, Lumify

Administration of eye ointment

1. Wash hands thoroughly and areas around the eye.

2. Tilt head back

3. Gently pull ___________ eyelid away from eye to create ___________.

4. Place a strip of ointment (______to ____ inch wide) inside the __________ eyelid.

5. Release the eyelid slowly and gently close eye for ____________.

- bottom

- pocket

- 1/4 to 1/2 inch wide

- lower

- 1-2 min

When using both eye drops and ointment, which needs to be administered first?

How long do you need to wait between?

- instill drops first

- wait 10 minutes after eye drops to instill ointment

What is the main side effect of eye ointments?

temporary blurry vision (administer at night)

Administration of ear drops Step 1:

1. Prepare

• Wash your hands.

• Warm ear drops to ___________________ by __________________

• If indicated ________________________

- body temperature by holding in hand

- gently shake the container

Administration of ear drops Step 2:

2. Position

• Tilt the head to the side or lie down with the affected ear up

• Adult: Pull ear ______________ and ______________ to open the ear canal

• Children: pull the ear _____________ and ______________

Adult: backward and upward

Children: backward and downward

Administration of ear drops Step 3:

3. Admin

• Position the open dropper tip near, but _____________, the ear canal opening.

• Place the proper dose or number of drops into the ________

- not inside

- ear canal

Administration of ear drops Step 4:

4. Wait

• Gently press the __________________ over the ear canal opening

• Stay (or keep the patient) in the same position for the length of time indicated in the product instructions (around ______________)

- small, flat skin flap (tragus)

- 3-5 minutes

Do not stick anything smaller than the _____________ into the ear canal.

tip of the elbow

OTC ear drops (2)

- cerumenolytics

- water-clogged ears

Nasal spray administration Step 1. Clear

Clear nasal passages before administering the product.

Nasal spray administration Step 2. Wash

Wash your hands before and after use

Nasal spray administration Step 3. Depress

• Gently depress the __________________ with finger to close off the __________ not receiving the medication

- other side of the nose

- nostril

Nasal spray administration Step 4. Aim

• Aim tip of delivery device _________ from nasal septum to avoid accidental damage to the septum

away

Nasal spray administration Step 5. Breath through

• Breathe through _______ and wait a few minutes after using the medication before ________________.

- mouth

- blowing the nose

Nasal spray pumps need to be primed before ________________________ and if not used for more than ____________.

- using it the first time

- once or 1-2 weeks

OTC classes of nasal products (4)

- corticosteroids

- decongestants

- antihistamines

- saline

Corticosteroids indication and examples

- Rhinitis, itching, sneezing and congestion

- *considered first line in tx of most allergic rhinitis symptoms

ex: buesonide, fluticasone, triamcinolone, mometasone (flonase, nasacort, nasonex)

Decongestants (nasal) indication and examples

- nasal congestion

ex: oxymetazoline, phenylephrine, naphazoline (afrin, neo-synephrine)

Antihistamines (nasal) indication and examples

- rhinitis, sneezing

ex: azelastine (only one currently available)

Saline indication and examples

- congestion, dryness

ex: Ayr, Ocean (sodium chloride 0.65%)

What is the hardest part of using an MDI?

the timing of breath and depressing the canister

How often should a patient's technique be assessed for inhalers?

every time a patient comes picks this up

How many times should you shake the inhaler before using?

10-15 times

Without the inhaler, what do you do first?

How do you place the inhaler in the mouth?

- above the tongue

- between the teeth

- seal lips around inhaler

When do you depress the inhaler?

after the seal, when you begin to breath slowly, press down on the inhaler one time and keep breathing in.

How long should you hold your breath after using an MDI?

5-10 seconds

What is the only OTC inhaler?

an MDI

primatene mist (epinephrine)

What is the difference between DPIs and MDIs with regard to use?

DPI does NOT require breath coordination, but requires a deep, forceful breath to deliver the dose

What is an advantage of a Respimat inhaler (SMIs) over an MDI?

- Release medication in a fine mist that comes out more slowly and lasts longer in the air than MDIs

- Do not depend on inspiration effort

When starting NRT (nicotine replacement therapy), when should tobacco products be discontinued?

on quit day (day one)

Gum and lozenge: What is the dosing based on?

How do you determine which dose of the gum/lozenge to use?

- 4 mg:

- 2 mg:

based on "time to first cigarette"

- 4 mg: Less than or equal to 30 minutes of waking

- 2 mg: Greater than 30 minutes of waking

Patch: what is dosing based on?

How do you determine what dose of the patch to start on?

- 21 mg patch:

- 14 mg patch:

based on how many cigarettes smoked per day

- 21 mg patch: >10

- 14 mg patch: <10

T or F: the patch should be applied to the same place everyday

FALSE

Different sites everyday

(avoid same site for at least a week, avoid new and healing tattoos)

Where should the patch be applied?

clean, dry, hairless area of the skin on the upper body or upper outer part of the arm

How long should you apply pressure to the patch?

10 seconds

How do you discard the nicotine patch?

folding it onto itself, completely covering the adhesive area

What are the most common side effects of the patch?

local skin reactions (itching, burning, redness)

(can cause sleep disruptions)

List the steps for chewing nicotine gum.

1. Begin to chew slowly (15 chews)

2. Stop chewing when you: taste flavor, or experience tinging in the mouth

3. Park the gum between the check and gum until flavor/sensation stops

4. Rotate site each cycle

What will decrease absorption of the gum?

Acidic beverages (coffee, soda, and juices)

drink only water 15 minutes before using gum

What is the max number of pieces that can be chewed per day?

Do not chew more than 24 pieces per day

What happens if you chew the gum too fast?

Will release more nicotine

How long does it take for the regular lozenge to dissolve?

regular: 20-30 minutes

mini: 10 mins

What is the max number of lozenges that can be used per day?

no more than 5 lozenges in 6 hours or more than 20 lozenges per day

Vaginal products for yeast infections are available in what different durations of treatment?

1 day, 3 day, or 7-day treatments

When can you NOT recommend these products for women?

When they are pregnant or under the age of 12

Vaginal administration

1. Initiate at __________________________________.

2. Clean vaginal area with mild soap and water. Dry area completely.

3. Fill applicator (if applicable) as previously outlined.

4. Stand with feet ________________________ and knees _______ OR lie back ______________ and legs ____________________-_.

5. Insert the applicator into the vagina as far as it will go comfortably.

6. Push the plunger of the applicator all the way in until the cream or tablet or suppository is deposited

7. Remove the applicator. If reusable, ___________________________________________.

* Important to use medication for time specified

* Do not use tampons-they reduce absorption of medication

- night prior to going to bed

- lightly apart and knees bent OR lie back with knees bent and legs slightly apart

- take apart and wash with warm water and soap

What can be used for leakage?

a sanitary pad

What can you do if the suppository is too soft before administration?

Hold it under cool water or place it in a refrigerator for a few minutes to harden before removing the wrapper

What other step should be performed prior to administration of suppository?

removing the wrapper

(cutting in half if told)

What can you moisten the suppository with before inserting?

If not this, what else can be moistened and with what?

- Water-soluble lubricant such as K-Y jelly.

- can moisten the rectal area with cool tap water.

*cannot use Vaseline

How far should the suppository be inserted?

Infants:

Adults:

Has to pass muscular sphincter of the rectum

- Infants: About ½ to 1 inch

- Adults: 1 inch in adults

How long should a patient lie down after inserting?

Remain lying down for 5 minutes

How long should one avoid having a BM after suppository insertion?

up to 1 hour

OTC suppositories classes (3)

- pain/fever (acetaminophen)

- hemorrhoids (vasoconstrictor, decreases swelling, phenylephrine)

- laxatives (relieves constipation, glycerin)

What are the different sites where subcutaneous injections can be administered?

Area between the skin & muscle layer

- abdomen, buttock,thigh and back of upper arm

How long should you keep in the needle in after hearing the pen click or the dose counter go to zero?

Leave needle in for 5-10 seconds

At what angle should you inject a pen device?

90- degree angle (children and very thin adults: 45- degree angle)

What does lipodystrophy do to medication absorption?

changes absorptionof medication(irregular)

- important to rotate injection sites