Download Administration of medications Patch_Cream

Administration of Medicines
Neil Petrie
Consultant Pharmacist
September2016
What we will cover
Application of patches
Bisphosphonate (Fosamax etc)
PRN Medicines
Anginine and Nitrolingual spray
Cytotoxic medicines
Application of creams
Patch’s - What’s on the market
Drug
Brand
Dose
Buprenorphine
Norspan
Weekly
Fentanyl
Durogesic, Denpax , Dutran,
Fenpatch
Every 3-days
Nitrate
Transiderm Nitro, Nitro-Dur,
Minitran
Daily with nitrate free
period
Estraderm and other
hormones
Climara
Weekly
Estraderm
Every 3-days
Nicorette
Daily 16 hours
Nicotine
Nicabate, Nicotinell, QuitX
Rivastigmine
Oxybutynin
Daily 24 hours
Exelon
Daily
Oxytrol
Twice weekly
Why Use Patch Therapy
When resident’s have problems swallowing
Lower doses opioid than SR S8 tablets.
less risk of over narcotic effects.
"flat" steady state effect
no or small peaks / troughs
Convenient - apply & go...
How to Apply
1. Remove old patch and fold sticky sides together
2. Select a new clean, non-irritated area.
– Intact, relatively hairless
3. Clean the site with water and pat dry
4. Remove new patch from sealed packaging
5. Remove clear protective liner
6. Immediately press the patch onto the site with the palm of
the hand for 30 seconds
– Ensure whole patch and edges are in contact with skin
7. Wash your hands
Tips
• Avoid use of soaps, lotions or creams on site
where the patch is to be applied.
• Clip any hair as close to the skin as possible
– Do not shave.
• Patches should not be cut
• Rotate application sites
– To minimise irritation
Disposal of Used Patches
How are they disposed
Fold together so it sticks to itself
Wrap and dispose of in garbage away from children
Still 60% of the drug remaining when taken off.
Durogesic 12mcg/hr = 900mcg over 72 hours
Durogesic 12mcg/hr = Durogesic 2.1mg in each patch
1200mcg left
NPS Radar 2006
Issues of Patch Therapy
Heat increases absorption from patches
No application of excessive heat
Hot packs, heat lamps, electric blankets
Hot sun, hot shower, sauna
If acute fever
Skin irritation
Forgetting to take the old patch off
Slow onset of effect
Norspan
Each patch should be numbered to
indicate the site of application
Do not use same site for 3-4 weeks
Durogesic
Several days should elapse
before using same site
Compact Patch Application form
Application of Patches
Paper tape may be used around the edge
Recording
Important to use “Patient Record Patch application”
Application sites
Apply to clean, dry, non-irritated, non-irradiated, nonhairy skin of torso, upper arm.
Tips
Record on patch with a permanent marker
Time of application
Date of application
Initials of resident
Check and sign daily that the patch is still stuck on.
Potential problems of covering a patch
with a film dressing
Manufacturers have not tested the medicine in
any way other than how it is supplied.
Applying a secondary film dressing may
Increase absorption due to the changed
environment
Decrease or erratic absorption if the primary patch
is not securely affixed.
Nitrate Patches
Why are they not on for 24 hours
Ensure a nitrate-free period of 10–12 hours each day
with patch to avoid tolerance.
Apply
Clean, dry skin
Chest area or upper arm
Be careful with strength between brands
Transiderm 25 = 0.2mg/hour (4.8mg/24 hours)
Minitran 5 or Nitro-Dur 5 (5mg/24 hours)
Release rate per hour
Fosamax and Actonel
Must be administered half an hour before breakfast.
With a full glass of water
Resident must remain upright for 30 minutes after taking.
Actonel EC can be administered with food.
What does PRN stand for?
Pro re nata
When necessary
Perceive the need
Report and Relieve
Note the effects
PRN Medicines
Can assist in managing conditions or symptoms
that are not usually experienced by the resident
on an ongoing basis
Are prescribed for an individual resident and
recorded on the medication chart
Policy and Procedure
PRN orders should specify the condition for
which the medication is to be used for.
Stemetil for dizziness
Coloxyl & Senna for constipation
There is space available on the chart
Policy & Procedure
PRN orders should specify the administration
time range if applicable
Policy & Procedure
Document on the separate designed PRN
section of the Drug Chart and not in the regular
administered section.
Supplied in a separate white Webster.
Policy & Procedure
When administering PRN orders the
Date
Time
Quantity
Should be completed in the history detailing the
reason and result of the administration
Name of RN Div 1 authorising
Policy & Procedure
Familiarise yourself with the indication for use of each
PRN medication.
PRN medicine must be authorised by a RN Div 1
PRN medications are not the same as a nurse initiated
medicine
where a RN Div 1 initiates a medication that is not ordered
for a resident by the residents doctor.
Policy & Procedure
Before administration
Understand the reason for administration
Once administered
Ensure you document the correct time of
administration
Make sure you have signed that it has been given
Follow up
30 minutes later note the effect of the medication
Regular PRNs
If a resident requests or requires a PRN on a
regular basis
Document in history
An assessment by the treating doctor
Slow Release Products
Should not be used for PRN orders
Slow onset of effect
Panadol Osteo may be used
Bilayer tablet with an immediate release component
Anginine
Angina pain/Chest pain
Refer to Chest Pain Protocol
Dissolved under tongue
Usual dose
½-1 repeated every 3-4 minutes until pain is
resolved, to a maximum of 2-3 tablets over 15
minutes.
May be used before exercise
Anginine
Store in original glass container away from
moisture, heat and light.
Write the date on the bottle when you
open it and discard 3 months later.
Nitrolingual spray
Same indication as Anginine
Has a longer shelf life that Anginine
Dose 1-2 sprays under tongue
Common side effects
Headache, flushing, palpitations, hypotension
Practice Points
Prime the spray before using it for the first time by pressing the
nozzle 5 times, spraying it into the air.
Prime it with 1 spray if it hasn't been used for 7 days.
Prime it with 5 sprays if it hasn't been used for more than
4 months.
Behaviours of concern
PRN medications
Are not the preferred management strategy for
behaviours of concern
May be an option when other measures are not
effective
Effectiveness of benzodiazepines and antipsychotics
used in this situation is due to their sedative effects
May be considered a chemical restraint.
Cytotoxic Medicines
What are cytotoxic drugs
Therapeutic agents intended for, but not limited to, the
treatment of cancer.
These drugs are highly toxic to cells.
Many are
Carcinogenic
Mutagenic
Teratogenic
They have potential to cause great harm if they are
not administered and disposed of safely and correctly
Workplace Health and Safety
Exposure may by through
Skin contact
Inhalation of particles
Ingestion
Needle stick injuries
What Medicines are included
Busulphan
Busulfex
Chlorambucil
Leukeran
Cyclophosphamide
Cycloblastin
Hydroxyurea
Hydrea
Lomustine
(CeeNU)
Mercaptopurine
Puri-Nethol
Methotrexate
Methoblastin
Mitomycin (Inj)
Procarbazine
Natulan
Fluorouracil
Efudix
Administration Tips
These medicines should never be
Crushed
Halved
Capsules should never be opened
They should be swallowed whole
Not chewed
As carers
Must use a “no touch” technique
Or wear gloves to minimise any risk.
Administration Tips
Also consider how
Urine/faeces or continence pads are disposed of
Keep handling to a minimum
If possible, only handled by the resident for
whom they are prescribed.
Topical Therapies
Creams, Ointments, Lotions
Dry skin is a common cause of itch
Apply moisturisers liberally after a shower
Use mild/unscented soap or soap substitutes
Pat skin dry – Do not rub.
Lotions are probably better for older people
Finger Tip Units
The “fingertip” unit for steroid creams
The amount of cream needed to treat an area
1 fingertip unit will treat an area the size of the
front & back of ONE adult hand.
Number of Fingertip units needed for different
parts of the body
PRN Consulting Website