Topical Drug guide PDF

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Summary

Instructions and guidelines for the use of topical drugs, with a focus on nitroglycerin...

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Topical Drug Nitroglycerin – vasodilator Used in – chest pain - Stabile angina – reduces oxygen demand of myocardium by reducing preload - Variant angina – enhances oxygen supply to heart muscles by relaxing and dilating coronary arteries Hepatic metabolization AE:  Headache  Orthostatic hypotension  Reflex tachycardia  Flushing  Lightheadedness, dizziness, syncope Toxicity – hypotension – anaphylaxis CI - Hypotension - Use of phosphodiesterase inhibitors – Sildenafil/Viagra – Tadalafil/Cialis - R Ventrical infarction Dosages  PO: (sustained release tablet or capsule)  SL: 0.3 – 0.4 mg tablet q 5 minutes for a total of 3 doses  Intravenous Drip: Begin at 5 mcg/min and titrate every 3-5 minutes to therapeutic response and stable vital signs. Titrate NTG infusion until relief of chest pain or maximum of 200 mcg/min dose is achieved.  Topical: Transdermal patch q 24 hours for 10-12 hour duration (with at least 12 hours NTG free out of each 24 hour period) N Implications  Check blood pressure and pulse before each administration of NTG–blood pressure can drop precipitously after a single dose. Hold dose if systolic BP < 90 mm Hg or more than 30 mm Hg below baseline.  NTG is highly unstable and should be stored in light resistant container in cool environment (not the refrigerator).  If SL tablets are not bitter, they have probably lost their potency.  Tolerance occurs during continuous administration of NTG; blood vessels do not respond as well to NTG. Therefore, patches or topical ointments are removed for 12 hours every day to reduce tolerance.  Acute chest pain is treated with either SL tablets or spray or with IV infusion of NTG.  Maintenance therapy to prevent angina is managed with topical applications or sustain-released oral medication.  Intravenous infusion of NTG requires special glass bottles and IV tubing (regular plastic tubing will absorb 40-80% of NTG).  Do not discontinue NTG intravenous infusion abruptly–it may result in precipitous rebound hypertension, angina, or coronary artery vasospasms.  Acetaminophen is generally given PO for relief of headache secondary to NTG therapy.

When discussing the administration route that you chose, please explain how to administer medications safely using this route/ nursing care implications. What do you need to do/ know to give a medication this way? Any specific patient teaching in relation to medication in specific scenario in lab manual? You will be demonstrating how to give the medication in the scenario related to the route chosen.

right medication, right dose, right patient, right route, right time, and right documentation. Right evaluation. Right to refuse. Right response. Right education. systematic effects if it is absorbed through the skin and are more likely to occur if the skin is thin, drug concentration is high, contact with the skin is prolonged, or the drug is applied to nonintact skin. wear gloves or use an applicator when applying topical medications. Avoid applying a heat source, such as a heating pad, over a transdermal patch, because doing so can increase the rate of absorption and have serious adverse effects.z 

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Never apply estrogen transdermal patches on or around breast tissue.

Use a felt-tip pen or other soft-tip pen (not a ball point pen) to write the date and time on a transdermal patch. Ball-point ink may interfere with medication absorption.

Check MAR – providers order Hand hygiene NOD – identify Allergies? 3rd check of MAR Check expiration of meds 6 Rights Clean gloves – if skin not intact, sterile maybe Cream, ointment – expose area Clean and dry area – basin If skin flaky – apply agent with skin still damp Change gloves Put desired amount on gloves Transdermal patch Clean gloves – remove old patch Fold sticky sides together – dispose Felt tip marker – date time initials on new patch Clean gloves Apply to clean dry area – Avoid previous site for a weak – avoid skin oily, burned, less hair Press firmy for 10 seconds Remove gloves, HH Explain precautions – don’t cut it – disturbs drug delivery

- No heating pad, no reusae application site over a week, do not combine with other forms of drug Aerosol spray Patient must turn face away & cover with towel Shake container Hold 6-12 inches away Spray evenly Suspension based lotion Clean gloves Shake container – place lotion on guaze or pad – apply to skin Dab gently over affected area – might be cool to tough, little while to dry Apply powder Skin must be dry Application site – covered in thin layer of powder Document - Med was given – site of application  

Document the condition of the skin before topical medication is applied. Record the time of administration, type and strength of medication applied, and application site in the MAR immediately after administration. For hard copy documentation, include time and initials or signature per institutional policy.

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Record patient teaching and validation of the patient's understanding.

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Record the reason for any withheld medication and follow facility policy for noting withheld doses.

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Record the indication for the medication administration as well as therapeutic response....