Transdermal medication comes in two forms. Both types are used to ensure that the patient receives a continuous level of medication. They can be left on the skin for a couple hours or for several days.
It is important to rotate sites when placing a new application on the patient. Do not place the patch over hairy areas, and make sure the site is clean and dry.
The first pass effect of drug metabolism is when the concentration of a drug is greatly reduced before it reaches the systemic circulation due to the liver inactivating some or all of the medication, along with GI enzymes. Topical medications avoid this phenomenon because they enter directly into the bloodstream, thereby temporarily bypassing any hepatic inactivation.
Transdermal patches or discs slowly absorb into the skin and then into the systemic circulation. The slow absorption rate allows the medication to have a sustained therapeutic response.
Always clean the skin after removing the old patch to wipe off any medication that might still be on the skin. This eliminates skin irritation and possible transfer of medicine to other individuals if they touch that area.
Always remove the old patch before placing a new one on. To prevent skin irritation and breakdown, always rotate where the new application will be placed.
To improve adhesiveness, ensure that the skin is clean and dry.
Placing a medication patch on recently shaved skin can cause intense skin irritation. However, to improve adhesiveness and absorption make sure that you avoid placing the patch on dense hairy spots.
Heat to the patch will increase the absorption rate. Educate the patient to never place a hot pack on the patch. Patients with fevers could be at risk for increase absorption as well. Monitor the patient’s temperature and possible signs of overdose for that medication.
Always follow provider orders when replacing patches. The frequency of changing out patches will be determined by the half-life of the medicine. Nitroglycerin has no effect after 24 hours, but can be reapplied every 6 hours.
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