Special Counseling Points (Patches, ER Tabs/caps, administration) (copy)

What is Exelon?

rivastigmine patch

(dementia)

What Is Oxytrol?

oxybutynin patch

(overactive bladder)

What is Daytrana?

methylphenidate patch

(ADHD med useful for children)

What is Transderm Scop?

scopolamine patch

(N/V incl motion sickness)

What is Xulane?

contraceptive patch (ethinyl estradiol/norelgestromin)

What is Butrans?

buprenorphine patch

(tx opioid abuse)

What is Vivelle-Dot?

estradiol patch

(menopause)

What is NicoDerm CQ?

nicotine patch

(NRT)

What is Neupro?

rotigotine patch

(DA antagonist used for Parkinson's, option that increases adherence)

What is Emsam?

selegiline patch

(MAO-B inhibitor that breaks down DA metabolism, indicated for depression only)

What is Androderm?

testosterone patch

(male hypogonadism)

What is Climara?

estradiol patch

(menopause)

What is Climara Pro?

estradiol/levonorgestrel patch

(menopause)

What is Alora?

estradiol patch

(monopause)

What is Catapress-TTS?

clonidine patch

(alpha-2 agonist for HTN)

What is Duragesic?

fentanyl patch

(severe pain, not for opioid-naive)

What is Lidoderm?

lidocaine patch 5% topical

What is Flector?

diclofenac patch

Where is Lidoderm placed?

on site of pain

Where is Flector placed?

Where is Exelon placed?

anywhere (chest, back, upper arm) besides the flanks

Where is Oxytrol placed?

abdomen, hip, butt

(no chest, back, or arm)

Where is Daytrana placed?

hip (R or L)

Where is Vivelle-Dot placed?

lower abdomen or butt only

Where is Transderm Scop placed?

behind the ear

Where is Xulane placed?

back, abdomen, arm, butt

(no chest)

Where is Butrans placed?

anywhere (chest, back, upper arm) besides the flanks (instead its either side @ chest level)

Where is the Nitro-Dur (nitroglycerin) placed?

anywhere (chest, back, upper arm, flanks), but chest is preferred

What is Daytrana's dosing frequency?

daily, QAM 2h before school

What is NicoDerm CQ's dosing frequency?

daily

What is Exelon's dosing frequency?

daily

What is Neupro's dosing frequency?

daily

What is Emsam's dosing frequency?

daily

What is Androderm's dosing frequency?

daily, QPM

What is the diclofenac patch's dosing frequency?

BID

What is Butrans' dosing frequency?

weekly

What is Catapress-TTS's dosing frequency?

weekly

What is Climara's dosing frequency?

weekly

What is Climara Pro's (estradiol/levonorgestrel) dosing frequency?

weekly

What is Xulane's dosing frequency?

weekly x3w then off x1w

What is Alora's dosing frequency?

twice weekly

What is Vivelle-Dot's dosing frequency?

twice weekly

What is Oxytrol's dosing frequency?

twice weekly, Q4d for OTC

What is Duragesic's dosing frequency

Q72h, if wearing off then Q48h ok

What is Transderm Scop's dosing frequency?

Q72h (Q3d) PRN

What is Nitro-Dur's (nitroglycerin) dosing frequency?

wear x12-14h then remove x10-12h

What is Lidoderm's dosing frequency?

wear x12h, then off x12h

How many Lidoderm patches can be worn at once?

up to 3

Which patches must removed before an MRI?

- Catapress-TTS

- Neupro

- Transderm Scop

- Androderm

What patches can be cut?

Lidoderm

Which patches can be covered?

- Duragesic and Butrans only if with Bioclusive or Tegaderm

- Catapress-TTS come w/ its own adhesive cover

What patches must be flushed?

- Duragesic

- Butrans

- Daytrana

What can be done if a TD patch is irritating the skin?

topical hydrocortisone can be applied after removal

What medications are always given at a specific time and can't follow general missed dose counseling?

- phosphate binders

- pancreatic enzymes

- prandial/SA/bolus insulin

always given before meals

How are ear drops applied in adults vs children?

Adults: pull ear up and back

Children <3years: pull ear down and back

If an injection is kept cold, what can be done before administration?

leave at RT x20m --> do not heat up!

What can Singular granules be given with?

(montelukast)

- applesauce

- mashed carrots

- rice

- ice cream

- breast milk/formula

(mix & take immediately all at once)

What can Vyvanse be given with?

(lisdexamfetamine)

- water

- yogurt

- orange juice

What cannot be done after getting/giving a SC anticoagulation dose?

do not rub the infection site

What long-acting meds cannot be crushed but can be cut along the score line?

- Toprol XL (metoprolol succinate)

- Sinemet CR (carbidopa/levodopa)

What long-acting capsule can be opened & mixed with food for administration??

Kadian (morphine)

*do not chew the granules*

What is an example of chewable tablets commonly preferred in adults?

Ca-containing products (usually are HUGE and hard to swallow)

Who cannot use estradiol patches?

women with hx breast cancer cannot use ANY ESTRADIOL FORMULATION

Where can hormone patches NOT be applied?

breasts or genitals

What formulations may contain phenylalanine?

PO formulations that may need a sweetener to make more palatable:

- granules

- ODT

- suspensions

- solutions

- troches/lozenges

- chewable tabs

if aspartame is used it would contain phenylalanine and cannot be use in pt with PKU

Where should ODTs be places in the mouth?

on top of the tongue (allow to dissolve, no liquids)

Where should lozenges/troches be placed in the mouth?

place the cheek & gum, allow to dissolve, no eat/drink x15 min

Where should SL tabs/liquids be placed in the mouth?

underneath the tongue, if liquid hold there x60s

Spiriva Handilaer Counseling

(tioptropium)

1) remove capsule & insert into container

2) close mouthpiece, press green button, exhale

3) hold horizontally, inhale 1 breathe full & deep

4) inlace 2nd time for full dose

Combivent Respimat Counseling

(ipratropium bromide + albuterol)

1) turn the clear base

2) open the cap

3) press the dose-release button while inhaling

MDI cleaning

weekly but do not submerge

(note that cleaning does not reduce thrush risk/incidence w/ ICS)

DPI cleaning

Except: Pulmicort Flexhaler

no cleaning, keep dry

What is Androgel?

testosterone topical gel

Where can Androgel 1% be applied?

1% strength: abdomen + shoulders

( higher strengths: shoulders only)

Where can Androgen 1.62% be applied?

shoulders only

What is a special Androgel counseling point?

it is flammable until drya

What is Diastat AcuDial?

Diazepam rectal gel

(seizure >5 min + pt not yet in ER/medical facility or benzodiazepine IV/IM not available)

How is Diastat AcuDial given?

1) make sure green ready band visible & correct dose

2) have person lay on side facing you & bend upper leg forward to expose rectum

3) insert applcicator w/ lubricating jelly applied

4) slowly count to 3 while pushing plunger fully

5) count to 3 before removing

6) count to 3 while holding booty cheeks together to prevent leakage

7) call 911 if seizure doesn't stop after 15 min of giving

How many doses come in one Diastat AcuDial package?

each package comes with 2 prefilled rectal syringes

What does a pharmacist need to do before dispensing a Diastat AcuDial gel?

dial to the right dose before dispensing:

1. hold the barrel of the strings w/ cap facing down so dose window is visible.

2. use other hand to grab and turn to adjust dose

3. once correct dose showing hold the locking ring @ bottom of the syringe & push up t lock both sides

4. green "READY" should be visible

4. repeat with 2nd syringe

What is the Orange Lamictal Starter Kit?

- standard dose

- use if no interacting meds

What is the Blue Lamictal Starter Kit?

- lower dose

- use if taking valproate, estrogen PO BC

What is the Green Lamictal Starter Kit?

- higher dose

- use if taking carbamazepine, phenytoin, phenobarbital, primidone, rifampin & not on valproate

Fosphenytoin IV Counseling

- max infusion rate 150 mg PE/min b/c risk cardiac arrythmia

- monitor BP, ECG, respiratory function

- extravasation risk --> purple glove syndrome

Phenytoin IV Counseling

- max infusion rate 50mg/min b/c risk cardiac arrythmia

- monitor BP, ECG, respiratory function

- requires a filter

- dilute in NS

- stable x4h

- keep at RT

- lower risk extravasation & purple glove syndrome

Enoxaparin injection site

R/L sides of abdomen, 2+ inches from umbilicus (belly button)

Enoxaparin Counseling

- do not expel air bubble in syringes prior to injection

- pinch skin & inject @ 90 degree angle

- hold skin pinched while injecting

- do not rub injection site afterward (can cause brusining

Storage = RT

What medications may leave behind a ghost tablet/capsule>

(Osmotic Relese Oral Systems)

- Concerta (methylphenidate)

- Cardura XL (doxazosin)

- Procardia XL (nifedipine)

- Ditropan XL (oxybutynin)