MK comes into your local pharmacy with her daughter SK ready to pick up her daughter’s new prescription for an EpiPen. The patient, SK, is a 35kg, 10 yo female who just recently recovered from an anaphylactic reaction to a bee sting. The patient’s pediatrician gave the patient a prescription for an epinephrine auto injector pen and told the patient’s mother the pharmacy could explain how to use it.
Allergies: Anaphylactic reaction to bee stings
Medications: EpiPen IM PRN anaphylaxis (filling today), Prilosec 20 mg PO QD
Which of the following answer choices are counseling points you would make regarding storage and use of the EpiPen? Select all that apply.
A. The EpiPen should be refrigerated and protected from light when not in use.
B. If the patient is stung by a bee it is okay for the patient to first try Benadryl to help with the patient's symptoms and if that does not work then use the EpiPen on the patient.
C. The prescriber should be called and have the Epipen prescription changed to Epipen Jr.
D. To properly inject the epinephrine pen instruct the EpiPen can be injected through clothing and should be injected anterolaterally orange end to the thigh and blue end up.
E. The solution can be seen via a window in the auto injector pen and it should be clear and colorless.
Brand/Generics Covered: EpiPen(epinephrine), Benadryl(diphenhydramine), Prilosec(omeprazole)
EpiPens are intramuscular auto injector devices containing epinephrine to be used during an event of anaphylactic shock. It is incredibly important for a patient’s caregiver to understand how to correctly use an EpiPen device as well as how to store it. EpiPen packs come with two active auto injector pens and one practice autoinjector pen. It can be helpful for a patient new to this device to use the practice autoinjector pen before needing the real pen. A few key points you will want to walk the patient and caregiver through when they come to pick up their new EpiPen include the following:
Always call 911 in the event of an anaphylactic reaction even if there is an EpiPen on hand, because the patient could require more doses of epinephrine.
Always use epinephrine first and foremost, never use Benadryl as a substitute or before epinephrine.
“Blue to the sky, orange to the thigh” is a saying to help remember which end will be injected into the thigh. Once taking the EpiPen out of its protective case, remove the blue cap. The blue cap is the safety release, at this point, the pen is ready to use. A click can be heard to ensure the device is properly injected into the patient’s outer(anterolateral) thigh. Once the pen is injected into the thigh, hold for 3 seconds then remove the needle and rub the area for 10 seconds.
Do not waste time removing clothing to inject, the autoinjector can go through clothing, like jeans.
EpiPens should be kept in their carrier tube and protected from light. They should be kept at room temperature and should not be refrigerated. Before using the device, the caregiver should ensure the liquid is clear and colorless.
Correct Answers: D, E
Answer A: This is incorrect, because EpiPen’s are actually recommended not to be refrigerated per the package insert. However, it is recommended that the pen be protected from light when being stored.
Answer B: It is NEVER recommended to use Benadryl before using epinephrine in patients having an anaphylactic reaction. The medication that will be able to correct the patient’s symptoms is epinephrine.
Answer C: This is incorrect, because the patient's weight supports a regular Epipen. The epinephrine autoinjectors available include: EpiPen and EpiPen Jr., with the EpiPen Jr. being for patients weighing 15-30 kg and the EpiPen being for patients who weigh ≥30 kg.
Answer D: This is correct and remembering which direction to point the EpiPen can be helped by this saying, “blue to the sky, orange to the thigh.” It is also correct to inject the EpiPen intramuscularly into the thigh anterolaterally and through clothing.
Answer E: This is correct, because the solution should be colorless and clear.
Sources: Epipen/Epipen Package Insert: https://www.accessdata.fda.gov/drugsatfda_docs/label/2016/019430s061lbl.pdf
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