PP+401+-+8

=Prescription: Fentanyl patch=

//A 72 year old man (Greg Bush as per Rx) comes into your pharmacy and drops off the following prescription. It is an authority prescription for an increased PBS quantity which you have called about and confirmed as valid. He has no dispensing history at your pharmacy.// //Rx Fentanyl patch 75 mcg/hour Sig. 1 every three days Mitte 10 (2 x 5) Rpt x 2//

Problem
Asking for increased dose of fentanyl (patches are available in 12, 25, 50, 75 and 100 micrograms per hour) Possible issues with compliance and/or technique? Constipation from using patches too frequently - turns out it was due to application of extra heat via an electric blanket (leads to more fentanyl being released)

= =

Questions to Ask
Did the doctor specify a reason for the dose increase? What medications are you on? What other medical conditions do you have? How do you apply your patches? (on hairless spot on upper arm/body) Where do you apply them? (does he use different sites for each application?) There is also the possibility that the patch was exposed to extra heat which may have lead to extra fentanyl being released. Can you think of anything that may have caused the patch to be exposed to extra heat - electric blanket, heated pool etc.?

What to do
Treat cause of heat source (electric blanket - maybe use a heater in the room, heated pool - aim to make sure the patch is not submerged in the warm water) Could recommend coloxyl/senna, two tablets at night and should work within 1-3 days (sometimes this is done on a prophylactic basis when starting an opioid, even if transdermal)

Resources
questions -ask about technique of using -how often patch is used, time frame of patch usage -any other s/s and illnesses, medications -any changes in patient's recent life -what has she been using in the cold weather (?? this would seem a strange question to the patient)

patient tells you - she has just moved house - has constipation for a few days - just started fentanyl patches - her techniques were correct - she replaces patches more frequently as it wasn't working as well as before.(TOLERANCE) - due to cold weather she uses electric blanket

counselling points - check technique and frenquency of patch usage (to find problems) - check other medications/illnesses/signs and symptons for more clues - check for any dramatic change in temperature that may affect patch use. - advise on disposal of patches (must fold in half, keep away from kids, give back to pharmacy etc) - advise on constipation (laxatives,hydration/diet, dosing, SE, how to use, timeframe of using)