True/False: nicotine replacement should be used in conjunction with behavior modification.
True
Excessive use of nicotine replacement therapy may result in:
1.) nausea
2.) vomiting
3.) dizziness
4.) weakness
5.) rapid heartbeat
Brand name of nicotine transdermal patch:
NicoDerm CQ
Duration of action of nicotine patch:
24 hours
Dose of nicotine patch:
A stepwise decrease in dose from 21 mg, to 14 mg, to 7 mg.
Application of nicotine patch:
applied to area of skin that is clean, dry, hairless (ex. upper arm, hip).
site should be rotated each day, and no single site should be repeated within a 7 day period.
Adverse reactions to nicotine patch:
Local skin reactions with initial use:
- itching
- burning
- redness
* These are mild and self limiting
Systemic reactions include:
- sleep disturbances
- dyspepsia
True/False: patient should consult a physician if local skin reactions associated with the nicotine patch do not subside after 4 days.
True.
Schedule for nicotine patch for people who smoke more than 10 cigarettes a day:
21 mg QD for 6 weeks
14 mg QD for 2 weeks
7 mg QD for 2 weeks
(10 week total regimen)
Schedule for nicotine patch for people who smoke less than 10 cigarettes a day:
14 mg QD for 6 weeks
7 mg QD for 2 weeks
(8 week program))
Considerations for nicotine patch regarding:
1.) Administration time
2.) Morning cravings
1.) Apply the patch every morning and take off at bedtime
2.) If patient craves cigarettes in morning, wear patch throughout night unless vivid dreams, insomnia, or other sleep disruptions occur.
True/False: Patient may cut patch in half if half-dosing is desired.
False.
Drug will rapidly evaporate and patch will be useless.
Considerations for nicotine patch regarding:
1.) Continued smoking while using patch
2.) Wearing multiple patches
1.) The nicotine replacement should negate the physiological need to smoke. Smoking will lead to a nicotine overdose, causing adverse side effects. Consider the need as behavioral in nature.
2.) Multiple patches could also lead to overdose.
Dose and frequency of fleet enema:
Adult: 4.5 (or 118 mL) ounce enema as a single dose
Children 2-<5: 1/2 of a 2.25 oz peds enema
Children 5-12: 2.25 oz peds enema as a single dose
Considerations for fleet enema:
1.) How much of a single enema should be used?
2.) Dehydration/electrolytes
3.) Absorption of other medications
4.) Multiple uses in a single day?
1.) Use entire bottle.
2.) Replenish fluids and electrolytes (gatorade, milk) before and after use
3.) Delay using enema until a few hours after oral medications as absorption may be disrupted
4.) Only one enema should be used daily, using multiple enemas may be harmful
Adverse effects of fleet enema:
1.) Dehydration/electrolyte imbalance
2.) Superficial irritation from application of enema
3.) A sense of discomfort will likely be experienced during use
How does fleet enema work?
Saline laxative.
Duration of treatment with fleet enema:
No longer than one week. If symptoms do not subside, see physician.
Questions to ask patient regarding fleet enema:
1.) Currently using any other type of laxative?
2.) Sodium restricted diet?
3.) Abdominal pain, N&V? (rule out obstruction)
Administration steps for fleet enema:
1.) Remove cap from enema bottle/bag
2.) While bearing down (the motion you make when having a bowel movement), gently insert enema into rectum with the tip pointing towards belly button.
3.) Squeeze bottle until almost all of the contents are gone.
4.) Remove enema and remain in that position until urge to evacuate is strong (typically 1-5 minutes, but NO LONGER THAN 10 MINUTES).
Positions for administration of fleet enema:
1.) Lying on side, upper leg with knee towards chest.
2.) While kneeling, lower head and chest to floor until side of head is resting on floor with one arm folded.
Considerations for hydrocortisone:
1.) Fungal infections
2.) Physician referral - related to efficacy and/or duration of use
1.) Skin condition will worsen significantly if it is due to a fungal infection
2.) If symptoms persist for more than 7 days, or if symptoms recur, refer patient to physician.
Active ingredient in fleet enema:
Sodium phosphate
Indications for hydrocortisone:
Temporary relief of itching associated with minor skin irritations, inflammation and rashes due to eczema, psoriasis, poison ivy oak or sumac, insect bites, soaps detergents and cosmetics, jewelry, and for external feminine and anal itching.
Max duration (in days) for which hydrocortisone should be used before referring to a physician:
7 days.
Max OTC concentration of hydrocortisone:
1%
* Just use this strength.
Some brand names of hydrocortisone:
Cortaid, Cortizone.
Adverse effects associated with topical hydrocortisone:
*Not likely to cause dermatologic adverse events if used on minimal surface areas and for a short length of time. Systemic absorption is minimal.
Formulations for topical hydrocortisone:
- ointment
- cream
- gel
- lotion
- spray (this is good for conditions that might worsen if gels or creams are rubbed onto skin)
Administration and frequency of topical hydrocortisone:
Apply a thin film of product to affected area.
Avoid administration to large surface areas.
Apply 2-4 x per day.
Formula for anion gap:
AG = (Na+) - (Cl- + HCO3-)
Formula for BMI:
BMI= (lbs x 703) / (in^2)
BMI= (kg) / (m^2)
Formula for BSA:
Formula for creatinine clearance:
CrCl = (140-age) x (IBW) x (0.85 if female) 72 x Cr
IBW=
50 kg + 2.3 kg for every inch over 5 ft
45.5 kg + 2.3 kg for every inch over 5 ft
Formula for ANC:
Normal range?
ANC = (%neuts + %bands) x WBC
Normal lower limit is 1500 cells per microliter.
Anything less than 500 cells per microliter is considered neutropenia.
Active ingredient in Triaz cleansing cloths:
Benzoyl peroxide.
Frequency of administration of Triaz cleansing cloths:
Wash 1-2 x daily.
Reduce to 1 x daily if excessive drying or peeling occurs and/or reduce the concentration of benzoyl peroxide.
Adverse events associated with benzoyl peroxide (Triaz cleansers):
1.) Skin irritation: stinging, redness, drying or peeling.
2.) Bleaching effect on hair, clothes, or other fabrics.
Considerations regarding Triaz cleansers:
1.) Topical use
2.) Sun exposure
1.) Only use topically, avoid contact with eyes and mouth.
2.) Urge patient to limit prolonged exposure to sunlight and tanning beds. Wear sunscreen when outside.
