Transdermal systems

Euture electrotransport therapeutic systems will differ substantially from those just described. They will draw on advances in microelectronics and transdermal system technology to provide transdermal therapy for compounds with low passive permeation rates, patterned or pulsed dmg deHvery,... 

The Minitran system, by 3M Health Care, is a monolithic transdermal system that deUvers nitroglycerin at a continuous rate of 0.03 mg/(cm h) (81). The dmg flux through the skin is higher than the previous two systems thus the Minitran system is a smaller size for equivalent dosing. For example, the 0.1 mg/h dose is achieved with a 3.3 cm system rather than the 5 cm systems of Transderm-Nitro or Nitro-dur. Because the skin is rate-controlling in a monolithic system and the Minitran flux is higher than the similar monolithic Nitro-dur system flux, it appears that 3M Health Care has included an additive to increase the skin flux to 0.03 mg/(cm h). Whereas this information is not apparent in Reference 81, patent information supports the hypothesis (96). 

Nicotrol, developed by Cygaus Corp. and to be marketed by Warner-Lambert, is the fourth nicotine transdermal system to be approved ia the Uoited States. It dehvers nicotine only duriag wakiag hours to mimic better the habits of smokers (109). la oae coatroUed study, ao statistical differeaces ia efficacy and good tolerabihty were observed for the wakiag and continuous regimen (112). 

Fentanyl transdermal is a transdermal system that is effective in the management of the severe pain associated with cancer. The transdermal system allows for a timed-release patch containing the drug fentanyl to be activated over a 72-hour period. A small number of patients may require systems applied every 48 hours. The nurse monitors for adverse effects in the same manner as for other narcotic analgesics (eg, the nurse notifies the primary health care provider if the respiratory rate is 10/min or less). 

To administer die transdermal system, remove the system from die package and immediately apply it to die skin of die upper torso. To ensure complete contact widi die skin surface, press for 10 to... 

Buclizine may be taken without water. The patient is instructed to place the tablet in the mouth and allow it to dissolve or to chew or swallow the tablet whole. When given for motion sickness, one 50-mg dose is usually effective. For more extensive travel, a second 50-mg dose may be taken alter 4 to 6 hours. When administering scopolamine, one transdermal system is applied behind the ear approximately 4 hours before the antiemetic effect is needed. About 1 gof scopolamine will be administered every 24 hours for 3 days. If the disk detaches from the body, discard it and place a fresh one behind the opposite ear. (See Fhtient and Family Teaching Checklist Applying Transdermal Scopolamine.)... 

Mr. Collins is prescribed transdermal scopolamine to relieve motion sickness. Discuss the rationale you would give him to stress the importance of wadiing his hands after applying or removing the transdermal system. 

Instructions for application of the topical ointment or transdermal system are available with the product. Read tiiese instructions carefully. 

Be sure die area is clean and thoroughly dry before applying die topical ointment or transdermal system, and rotate die application sites. Apply the transdermal system to die chest (front and back), abdomen, and upper or lower arms and legp. Firmly... 

When using the topical ointment form or transder-mal system, cleanse old application sites witii soap and warm water as soon as the ointment or transdermal system is removed. 

Antihypertensive drugp are contraindicated in patients with known hypersensitivity to the individual dm. When an antihypertensive is administered by a trans-derrnal system (eg, clonidine), the system is contraindicated if the patient is allergic to any component of the adhesive layer of the transdermal system. Use of the angiotensin II receptor antagonists during the second and third trimester of pregnancy is contraindicated... 

When the testosterone transdermal system Testoderm is prescribed, the nurse places the system on clean, dry scrotal skin. Optimal skin contact of the transdermal system is achieved by dry shaving scrotal hair before placing the system. 

Another transdermal system is Testoderm TTS. This system is applied at about the same time each day and worn for 24 hours. The adhesive side is placed on a clean, dry area of skin on the arm, back, or upper buttocks immediately upon removal from the protective pouch. This system is not applied to the scrotum. The system is pressed firmly in place with the palm of the... 

Androderm, anotiier transdermal system, is applied nightly to clean, dry skin on the abdomen, tiiigh, back, or upper arm. This system is not applied to die scrotum. Sites are rotated, witii 7 days between application to any specific site The system is applied immediately after opening the pouch and removing die protective covering. If the patient has not exhibited a therapeutic response after 8 weeks of tiierapy, another form of testosterone replacement therapy should be considered. 

Testosterone transdermal system—Apply according to the directions supplied witii die product. (See Promoting an Optimal Response to Therapy .) Be sure the skin is clean and dry and die placement area is free of hair. Do not store outside die pouch or use damped systems. Discard systems in household trash in a safe manner to prevent ingestion by children or pets. 

Local—pain at injection site, sterile abscess, redness and irritation at the application site with transdermal system... 

FIGURE 52-1. This low-dose estrogen transdermal patch, available as the trade name Estraderm (Estradiol Transdermal System), is transparent and about the size of a silver dollar. It releases small amounts of estrogen directly into the bloodstream at a constant and controlled rate to a female requiring estrogen replacement therapy for postmenopausal symptoms. 

The transdermal system is applied in the morning and removed either before bedtime or the next morning. Among individuals smoking 10 or more cigarettes per day, the highest dose patch should be used to start an intermediate... 

IR, immediate-release LA, long-acting TCAs, tricyclic antidepressants TDS, transdermal system XL, extended-release, investigational. Doses provided are those best supported by clinical trials to date. 

Oxybutynin transdermal system has similar efficacy but is better tolerated than oxybutynin IR presumably because this route avoids first-pass metabolism in the liver, which generates the metabolite thought to cause adverse events, especially dry mouth. 

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