Pharmacy Foundations: Drug formulations & patient counseling

Question 1

Reasons to use Long-acting oral tablets/capsules

Answer 1

1. reduce nausea or provide longer duration action
2. reduces peaks conc, leading to reduced side effects
3. some can be opened and sprinkled onto food
4. should not be crushed/chewed, can lead to OD
5. Some can be cut on score line

Question 2

Osmotic Controlled-Release Oral Delivery system

Answer 2

OROS

Water is absorbed via osmosis, increasing pressure in capsule forcing it out through a small opening.

Tablet/Capsule may be visible in patients stool

Question 3

When are suspensions or solutions a good option

Answer 3

1. useful in patients with difficulty swallowing or who are unable to follow directions.

Question 4

Prior to admission, suspensions must be….

Answer 4

shaken to redisperse medication

Question 5

Do solutions need to be shaken prior to administration….

Answer 5

No

Question 6

When are chewable tablets a good option?

Answer 6

For children who cant swallow, or for calcium tablets for adults due to being too big

Question 7

When are ODT a good option?

Answer 7

when patient cant swallow due to dysphagia or has nausea and unable to tolerate

also if adherence issues, dissolve quickly

Question 8

Benefits of sublingual or buccal tablets

Answer 8

same benefits as ODT medications

faster onset of action than tablet or capsules that is swallowed.

Less drug lost to gut degradation and 1st pass metabolism

Question 9

Benefits of granules, powders, or capsules that can be opened or sprinkled onto soft food…

Answer 9

Mostly used for pediatric and geriatric patients

can be given via NG tube rather than IV for certain patients

Question 10

Which sweetener is dangerous for those with phenylketonuria (PKU)

Answer 10

Phenylalanine which is found in sweetener aspartame

Question 11

ODT counseling

Answer 11

don’t push through foil backing as they’re easily broken/crumbled.

peel back foil of one blister and remove tablet

Question 12

Oral film counseling

Answer 12

place on tongue and it will dissolve in seconds, ok to swallow with saliva and then wash hands after

Question 13

Benefits of Subcutaneous (injections)

Answer 13

used for rapid effect or drugs that would degrade/not absorb if given orally

Question 14

Benefits of long-acting intramuscular injections

Answer 14

Improve adherence and decrease need for more frequent injections

Question 15

Benefits of Intravenous injections

Answer 15

Bypass oral route, fast response, avoids drug loss caused by Nausea/vomiting

Question 16

5 Steps for injectable medication

Answer 16

1: wash hands
2: prepare injection
3: select and clean injection site
4. inject
5. discard appropriate stuff into sharps container

Question 17

Which injections should you not rub skin near injection site?

Answer 17

Anticoagulant medications as they can cause bruising

Question 18

Safe handling of Monoclonal Antibodies

Answer 18

should not be shaken and should be stored at normal temperatures and not extreme hot or cold.

Question 19

Patch administration sites

Answer 19

Upper chest
Upper or lower back
Upper arm, facing out
Flanks, sides of body abdomen level

Question 20

Patches with unusual application sites

Answer 20

Xulane: abdomen, back, arm or butt
Daytrana: Hip
Oxytrol: abdomen, hip or butt
Vivelle-Dot: lower abdomen or butt
Transderm-Scop: behind the ear

Question 21

Which patches can you cut?

Answer 21

Lidoderm and Qutenza

Question 22

Which patches need to be removed prior to having an MRI?

Answer 22

Clonidine (Catapres-TTS)
Rotigotine (Neupro)
Scopolamine (Transderm Scop)
Testosterone (Androderm)

Question 23

Can you cover patches with tape?

Answer 23

Most cannot be covered, some can be covered around the edges

Fentanyl & Buprenorphine (Butrans) require special film = Bioclusive & Tegaderm

Question 24

How to dispose of patches properly?

Answer 24

Press adhesive sides together and then dispose of it

More potent narcotic can be flushed

Question 25

Nasal sprays benefits

Answer 25

faster route of onset than oral and used for acute conditions that should be treated quickly

Bypass gut absorption and 1st-pass metabolism, proteins that would get destroyed in the gut can be given nasally

Question 26

Nasal Spray counseling

Answer 26

Before use:
1.Shake bottle gently, and remove cap
2.Prime pump before first use or when you have not used recently
3.Blow nose to clear nostrils

Using:
1.Close one nostril and insert into other nostril
2.Breathe in through nose, press firmly on applicator to release spray
3.Breathe out through mouth
4.Wipe applicator with tissues and replace cap.
5. Don’t blow nose right after using spray

Question 27

Can ear drops be used in the eyes?

Answer 27

No

Eye drops can be used as ear drops but ear drops cannot be used as eye drops

Question 28

Eye drop counseling

Answer 28

1. Wash before and after use
2. Shake few times, gels should be inverted and shaken once prior to use
3. Bend neck back, pull down lower eye lid and release drop without letting tip touch eyes
4. Close eye, place finger between eye/top of nose to keep medication in that area for at least 1 minute
5. If doing second medication, need to wait at least 5-10min. Wait 10 min for gel

Question 29

Which preservative requires removal of contact lenses prior to administration and waiting atleast 15 minutes to put back lenses

Answer 29

Benzalkonium chloride (BAK)

Question 30

Ear Drop counseling

Answer 30

1. If cold, gently shake and roll in hands to warm up
2. Lie down or tilt affected ear up
3. Pul earlobe up n back for adults, down and back for kids < 3
4. Administer drops, keep ear facing up for about 5 minutes

Question 31

Rectal medication enema counseling

Answer 31

Best results, empty bowels immediately before use

1.Shake well before use
2. Best results, lying on the left side with left leg extended and right leg flexed forward for balance
3. Gently insert, pointed slightly towards navel.
4. Grasp firmly, tilt so nozzle faces back, squeeze slowly
5. Remain in position for at least 30 minutes or all night for max benefit

Question 32

Rectal suppositories counseling

Answer 32

1. Do not handle too much so that it doesn’t melt
2. Insert with pointed end first
3. Best results, keep inserted for 1-3 hours

Question 33

General rule for missed medication dose counseling

Answer 33

if missed, take as soon as remember.
if close to next dose, skip missed dose and take next dose as scheduled
do not double up on two doses at same time unless discussed with healthcare provider

Question 34

Medication storage counseling

Answer 34

stored in a cool, dry place (not bathroom, avoid humidity)

Question 35

Adherence counseling and monitoring

Answer 35

1. use motivational interviewing techniques
2. perform refill history to look at adherence
3. lack of adherence could be due to poor understanding or experiencing side effects

Question 36

What is motivational interviewing

Answer 36

technique that focuses on patients priorities to help facilitate change

ask open ended questions, use empathy and reserve judgements to build patient relationships