Transdermal Patches

Outline:
Hour One I. Introduction II. Skin a. Components i. Largest organ of the body ii. Layers b. Functions i. Sensation ii. Protection iii. Heat regulation iv. Absorption III. Transdermal Drug Delivery System a. How it works i. Medication administered through a patch on the skin ii. Medication is absorbed through skin b. Purpose i. Effective, less invasive medication delivery ii. Alternate route to the bloodstream iii. Alleviates some medication adverse effects c. The “Patch” i. Components ii. Types of patches iii. Single layer drug-in-adhesive iv. Multiple layer drug-in-adhesive v. Reservoir vi. Matrix d. Advantages i. Minimize adverse effects ii. Frequency of dosage iii. Mostly painless iv. Person more willing to use patch than needle/pill e. Disadvantages i. Not all medications can be absorbed through skin ii. Possible skin irritation iii. Record keeping iv. Damaged patches v. Overdose and/or under dose vi. Difficulty administering f. Learning Engagement Questions (matching) IV. Common Medications and Precautions a. Common transdermal medications used for adults i. Scopolamine 1. Precautions 2. Adverse effects ii. Nicotine 1. Precautions 2. Adverse effects iii. Fentanyl 1. Precautions 2. Adverse effects iv. Rivastigmine 1. Precautions 2. Adverse effects v. Hormonal: Testosterone and Estrogen 1. Precautions 2. Adverse effects vi. Lidocaine 1. Precautions 2. Adverse effects vii. Learning Engagement Activity: Questions (matching) b. Transdermal medications and children i. Special precautions 1. Use or access to 2. Dosage (less) 3. Side effects – children can be more sensitive ii. Common medications used for children 1. Methylphenidate - ADHD a. Precautions b. Adverse effects 2. Fentanyl - pain a. Precautions b. Adverse effects 3. Scopolamine – motion sickness a. Precautions b. Adverse effects iii. Learning Engagement Activity: Questions (matching) V. Assisting with Medication Administration in California i. Regulations ii. What does “assist” mean? iii. PRN medication requirements iv. Learning Engagement Activity: Questions (multiple choice) VI. Applying the Patch a. Steps i. Wash hands, don gloves ii. Remove old patch (if one exists), fold over on itself iii. Find a hairless spot (or closely crop/cut hair from area with scissors) iv. Clean and dry area before applying v. Open package, remove patch vi. Peel one half of the liner, throw away vii. Press patch on skin and remove other half of liner viii. Hold firmly over patch and press down edges ix. Disposal of old patch (if needed) x. Remove gloves, wash hands b. Need to remember i. Never apply more patches than what has been prescribed ii. Do not apply patches to skin with cuts and/or scrapes iii. Monitor the patch to make sure it stays in place c. Learning Engagement Questions (ordering activity: steps of assisting with transdermal medication administration by dragging in place) VII. Complications a. FDA warning in 2009 of burns with MRI b. Torn patches c. Record keeping d. Errors in administration e. Skin irritation f. Resident monitoring VIII. Conclusion and Summary IX. Final Exam (posttest)

Cynthia McDaniel MSN RN, is a nurse and administrative consultant in long term care. She is the CEO of ElderWise Inc, a senior living consulting and education group. Cynthia has worked as a nurse consultant for the States of Oregon and Washington,  a geriatric care manager, a regional director of clinical operations for a senior living company, and an assistant professor at Oregon Health & Science University School of Nursing. Her research in assisted living focused on the characteristics of residents in assisted living communities and the role of the nurse in assisted living. Cynthia holds a Master's of Science in Nursing from Gonzaga University in nursing education. She is a Fellow of the Sigma Theta Tau/John A. Hartford Foundation Geriatric Nursing Leadership Academy.  Disclosure: Cynthia McDaniel, MSN, RN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.

Jennifer S. Mensik, PhD, MBA, RN, NEA-BC, FAAN is currently the Division Director of Care Management at Oregon Health and Science University in Portland Oregon and an instructor for Arizona State University College of Nursing and Health Innovation. Jennifer previously served as vice president for CE Programming at OnCourse Learning and currently serves as a Consultant for OnCourse Learning. Dr. Mensik earned a PhD in Nursing from the University of Arizona College of Nursing with a major focus in health systems and a minor in public administration from the Eller College of Management. Disclosure: Jennifer Mensik, PhD, MBA, RN, NEA-BC, FAAN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.

Holly Carlson, MS, RN, CCRN, was a subject matter expert for Relias. She has 25 years of healthcare experience in both acute and post-acute healthcare environments. Her experience includes leadership and management across the healthcare spectrum. She has owned and operated an assisted living business. Carlson's clinical practice includes acute care, long-term acute care, home health and hospice. Carlson has served for over a decade in various board positions for State Nursing Associations, including president. She has been a nurse planner for multiple continuing education events and has experience as a leader in the design and implementation of an ANCC-CNE accredited approver unit for a multi-state nursing consortium. Carlson is certified as Critical Care Registered Nurse.    Disclosure: Holly Carlson, MS, RN, CCRN has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.