Ease the pathway for the administration of difficult medications


Medications like inhalers and nasal sprays can be difficult for patients to administer correctly.

Some medications are simply difficult to administer.

One such medication is varenicline solution (Tyrvaya), a prescription nasal spray used to treat the signs and symptoms of dry eye. Since the drug has to be administered to the anterior part of the nasal cavity, and not breathed deep into the nasal cavity, this causes some problems.

“Using a nasal spray to treat dry eye may not make sense to some,” said Meighan LeGrand, PharmD, Shields Health Solutions in Stoughton, Massachusetts, explaining that administering this spray is completely different. a patient’s preconceptions. their experience with other over-the-counter nasal sprays.

Administration of Tyrvaya may also require many steps, including priming the vial with 7 initial sprays (and re-priming if not used for more than 5 days), coordination between administration of the spray while placing its tongue on the roof of their mouth and storage instructions to replace both the clip and the bottle cap after each use.

“With many steps to remember, there’s more opportunity for error and misadministration,” LeGrand said. “There’s a lot of coordination involved in administering this drug that many patients won’t continue to do over time.”

But difficult-to-administer drugs are a challenge pharmacists are used to. Between allergy nasal sprays, inhalers, and injectables, some medications are simply more difficult to administer than others because proper use involves several steps that must be performed with proper technique and in the correct order.

“Challenges with the administration of certain medications may be due to the need for a device such as an inhaler or syringe to introduce the medication into a patient,” said Thomas So, PharmD, senior group director of Consumer Drug Information, FDB. “Often these are not intuitive and require dexterity and coordination.”

Other examples

Consider nasal sprays, which come in several types, such as pressurized canisters or pump bottles. Different types of sprays require different preparation before use. Some must be shaken, some must not be shaken, some must be primed before a dose or not used for a while, and some can be sprayed without priming. This can be difficult for patients to remember, especially if they use multiple sprays.

Chase Parks, PharmD, Director of Pharmacy at Intramed Plus in Columbia, South Carolina, shared several examples he has encountered with patients having difficulty administering medication.

For example, Hizentra, a subcutaneous immunoglobulin injection, may require up to 8 different injection sites in the stomach for 1 dose; injections should be given at the same time and should be 2 inches apart. This makes administration very difficult for the patient.

Then there are albuterol inhalers for children, which can be very difficult as it requires good coordination, which can be difficult for children who do not breathe well.

“The pharmacist’s role is not just to advise the patient on how to use the drug, but to continue to engage the patient to ensure that they are administering the drug correctly frequently,” Parks said.

Keri Hurley, PharmD, MPH, BCACP, assistant clinical professor in the Department of Clinical Practice Pharmacy at the University of California, Irvine, noted that insulin pens are also difficult because patients must store them properly, attach a new needle for each injection, setting the pen to the correct dose, cleaning the injection site, using proper technique to ensure the full dose is delivered, and disposing of needles safely.

“If one of these [steps] are done incorrectly, different problems can arise,” she said. “For example, heat degradation can make the drug less effective, plus there is the possibility of underdosing or overdosing, and risk of infection.”

Counsel patients

The pharmacist can play a key role in ensuring that a patient is counseled on how to use their particular medications, whether they are nasal sprays, oral inhalers or injectable medications such as insulin.

“Many of these types of drugs come with manufacturer’s instructions for use; however, these leaflets can be in font sizes that are difficult for older people to read,” So said. patient education programs that include leaflets with pictograms and the UMS (Universal Medication Schedule) calendar and educational videos that can be watched by patients to learn how to use their medications correctly to get the most from their treatment.”

These materials are available in multiple languages, including Spanish, French, Chinese, Korean, and Russian, if English is not the patient’s primary language. These videos also contain language for grades five through eight to help patients with low levels of health literacy and understanding.

A significant part of pharmacy training is devoted to counseling patients.

“We also have training in how the medication processing devices work, so we can troubleshoot when patients aren’t experiencing favorable outcomes,” Hurley said. “The first thing I do when patients report that they are not getting the expected result from their medication is to ask how they use it, and often show me how they use their device to see if there is any technical issues.”

So told the story of a gentleman diagnosed with diabetes who needed advice on how to administer insulin.

“The teaching included injecting the needle into an orange, because the orange peel simulates the sensation of injecting the needle into the skin of the abdomen,” he says. “Unfortunately, after this training, the gentleman came back to the emergency room with high blood sugar. When asked by the emergency department staff, [if he was using his insulin]he replied, ‘Yes, I injected the orange and then I ate the orange.’ »

So’s story reminds us why it is important for pharmacists to ensure that their advice is understood by patients and understood correctly.


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