Patch Down the Hatch

A 42-year-old man presented with somnolence. His initial vital signs were heart rate 54 bpm, blood pressure 92/68 mm Hg, temperature 37°C, respiratory rate 6, and pulse oximetry 90% on room air. His physical examination was remarkable for depressed level of consciousness, miosis, and bradypnea. His mental status and respiratory rate temporarily improved with the administration of 0.04 mg naloxone. He reports swallowing several “patches” in a suicide attempt.   Popular transdermal patches are listed in the table. Others include diclofenac, buprenorphine, hormone patches (estrogen, contraceptive, testosterone), methylphenidate, and rivastigmine. It is important to consider the potentially significant quantity of drug contained in transdermal patches even after being used.     The patches are designed to deliver small quantities of the drug over a long period of time into the outer layers of skin, and it is absorbed into the deeper layers and then to the bloodstream, which circulates it throughout the body. Several types of transdermal delivery systems are available; fentanyl patches, for example, are available as a reservoir system and matrix system. (Figure 1.)   Reservoir system (left) and Matrix system (right). Derived from Duragesic and Mylan package inserts.   Swallowing, sucking, transmucosal absorption by placement of pieces in mouth, brewing it as a tea to ingest or inject, chewing whole or in pieces, extracting with a needle for injection, elut...
Source: The Tox Cave - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs