CS is a 70 yo M brought to your emergency department from an outside facility due to concerns for febrile neutropenia. He has colorectal cancer and is undergoing treatment with leucovorin, fluorouracil, and oxaliplatin. 

PMH:
Stage III Colorectal Cancer
Hypothyroidism

Dyslipidemia

Hypertension

Allergies: No known allergies

Current Medications:

Synthroid 125 mcg PO QD

Lipitor 40 mg PO QD

Benicar 40 mg PO QD

Norvasc 5 mg PO QD

Duragesic 25 mcg/hour 1 patch TD Q72H

Reglan 10 mg PO Q6H prn

Vitals and Labs:
Wt: 78 kg

Ht: 5’8”

HR: 85 BPM
RR: 20 BPM

BP: 116/84
Temp: 101.2 F

ANC: 400 cells/mm3 (ref: 2500-7000 cells/mm3)

The nurse notices that the patient has a Duragesic patch on and asks you a few questions about use and administration of the transdermal patch. Which of the following is correct? Select all that apply.

A - When replacing a Duragesic patch, the new patch should be placed on a different site than the previous patch.

B - Duragesic patches are resistant to water and heat. 

C - Duragesic patches can be cut into smaller sizes prior to removal of the release liner.

D - Duragesic patches may be used as needed for pain or chronic pain.

E - Patches may be placed on the upper torso, back, flank, or upper arms.

Transdermal patches allow the controlled delivery of a medication through the skin. As with other dosage forms, each transdermal medication patch has unique instructions for use that the pharmacist should be knowledgeable of. For example, some patches may be cut into smaller sizes or worn in water while others may be negatively affected by these things.

Duragesic (fentanyl) patches are used for the treatment of chronic pain in patients with opioid-dependence. Similar to other dosage forms of fentanyl, the transdermal patch carries risks for addiction and life-threatening respiratory depression and should be handled with caution to prevent overdoses. Pharmacists should be able to counsel family members and healthcare workers on administration of Duragesic patches to ensure appropriate use and prevent unnecessary exposure to the medication.

Answer A is correct. After 72 hours, the old patch should be removed, folded in half, and properly disposed of. Then, the new patch should be placed on a different administration site to avoid skin irritation.

Answer B is incorrect. Although Duragesic patches can get wet, they are not heat-resistant. Unlike other transdermal patches that should be kept away from water, Duragesic patches are not negatively affected by water exposure. However, these patches should not come into direct contact with external heat sources as this can increase the absorption of fentanyl and the risk of overdose. Patients should avoid heating pads, hot baths, and sunbathing.

Answer C is incorrect. Fentanyl patches should not be cut or modified prior to placement. If an alternate dose is needed, a new patch strength should be selected. However, other transdermal patches such as lidocaine patches may be cut prior to removal of the release liner for use on a smaller area of skin. 

Answer D is incorrect. Fentanyl patches are contraindicated for acute pain and as-needed use. These patches should be reserved for the treatment of chronic pain in patients with opioid-dependence.

Answer E is correct. Unlike some other transdermal patches, fentanyl patches do not need to be placed directly on the site of pain to exhibit their effects. They may be placed on a dry, clean spot with little hair on the upper torso, back, flank, or upper arms. 

Medications: Duragesic (fentanyl), Synthroid (levothyroxine), Lipitor (atorvastatin), Benicar (olmesartan), Norvasc (amlodipine), Reglan (metoclopramide)

Area 3 - Develop or Manage Treatment Plans

3.5 - Drug route of administration, dosage forms, or delivery systems

3.6 - Drug contraindications, allergies, or precautions

Area 5 - Compound, Dispense, or Administer Drugs, or Manage Delivery Systems

5.1 - Physicochemical properties of drug products affecting compatibility, stability, delivery, absorption, onset, duration, distribution, metabolism, or elimination

5.4 - Equipment or delivery systems

5.5 - Instructions or techniques for drug administration

5.6 - Packaging, storage, handling, or disposal