Fentanyl Transdermal Patch Application Sites

English: 2D structure of fentanyl (Photo credit: Wikipedia)

We know that fentanyl patches should be applied to dry, noninflamed, non-irradiated, hairless skin. Body hair may be trimmed but not shaved. Be sure to press the patch firmly in place for 60 seconds or more. If problems with adherence, use Tegaderm or Micropore.

Fact or Fiction From Medscape:

Q: Is it true that fentanyl patches infuse more quickly in patients with very little subcutaneous fat?

A: No. The amount of fentanyl absorbed is proportional to the surface area of the patch. The absorption rate does not vary to any clinically significant extent between the chest, abdomen, and thigh.^[5] Fentanyl is released from the patch into top layers of the skin (stratum corneum and epidermis), and it accumulates within these layers to form a depot. The drug is released slowly into the systemic circulation via small blood vessels within the dermis. Fat tissue should not impair release, as the drug is released directly from the skin into the blood supply.^[2,5]

Furthermore, fentanyl exhibits wide tissue distribution to the lungs, kidneys, heart, spleen, brain, muscles, and body fat -- indicating a high extravascular volume of distribution (3-8 L/kg). It takes about 6 days to reach steady-state plasma concentrations after initiating fentanyl patch therapy.^[5]

^{Reference 5:} 

• Muijsers BBR, Wagstaff AJ. Transdermal fentanyl: an updated review of its pharmacological properties and therapeutic efficacy in chronic cancer pain control. Drugs. 2001;61:2289-2307. Abstract

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Learn Something New qD: Methadone and Verapamil are Structurally Similar

English: Synthesis of methadone Deutsch: Synthese von Methadon (Photo credit: Wikipedia)

structural formula of Verapamil (Photo credit: Wikipedia)

In a new series at OncoPRN, look for unique facts in the world of medications, oncology and palliative care. 

From Medscape:

"Methadone appears to have a molecular structure similar to that of verapamil and may exhibit similar cardiac properties, such as calcium channel blockade.^[10] One study demonstrated that methadone, unlike morphine, significantly lowered heart rate in rats (p<0 .05="" span="">^[10]

10 Seyler DE, Borowitz JL, Maickel RP. Calcium channel blockade by certain opioids. Fundam Appl Toxicol 1983;3:536-42.

The potential of methadone to cause adverse effects similar to verapamil must be taken under consideration clinically in any patient taking methadone or is to start methadone.

Related articles

• Methadone's cardiotoxicity

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No More Needles? 7 Ways Scientists are Attempting to Move Beyond Shots (TED Blog)

No more needles? 7 ways scientists are attempting to move beyond shots | TED Blog:

A shot through a puff of air

"In 2012, Jack You of Seoul National University unveiled a device that delivers drugs through a laser pulse. The pulse lasts 250 millionths of a second and, through a series of reactions described on Phys.org, creates a narrow jet of medicine that is just larger than the width of a human hair. “The impacting jet pressure is higher than the skin tensile strength and thus causes the jet to smoothly penetrate into the targeted depth underneath the skin,” explains Yoh. This device is intended to get medicine to the epidermal level."

Full article link: click here

TED - ideas worth sharing!

Related articles

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• The 20 most popular TED Talks, as of this moment

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Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?

Cover of Final Exit

Final Exit: This doctor sees death daily – but should he help suffering patients end their lives?: "Now, as his province sits poised to legalize doctor-hastened death, Borod raises a blunt question:  Would euthanasia, a lethal injection that would have abruptly stopped her breathing and her heart – a step far more aggressive than the “palliative sedation therapy” he had administered – have been more humane?"

Full article: click here

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Are 'Super-Enhancers' The Key to Cancer Therapy?

Image via CrunchBase

Will Newly Discovered 'Super-Enhancers' Allow Us to Control Genes? - The Doctor's Channel:

"Nancy Simonian, MD, CEO, Syros Pharmaceuticals elaborates on the breakthrough discovery of super-enhancers, large groups of transcriptional enhancers that drive expression of genes that define cell identity. "

Link to video here.

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Tumor Paint: Changing the way surgeons view and fight cancer (CNN)

Tumor Paint: Changing the way surgeons fight cancer - CNN.com:

"Olson and his team were able to identify a small protein, or peptide, in the scorpion's venom and use it to produce Tumor Paint. They grew a brain tumor on a mouse's back and injected the "paint" into a tail vein; within an hour, the cancer was lighting up. Tumor Paint was 500 times more sensitive than an MRI, and it didn't just work for brain cancer but breast, skin, prostate and colon cancers."

Link to full article here.

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Dexamethasone a Potential Treatment for Cancer-Related Fatigue (JOCO)

Dexamethasone (Photo credit: Wikipedia)

Oncology Times: "Dexamethasone helps to reduce cancer-related fatigue in patients with advanced disease, according to a double-blind, randomized, placebo-controlled trial published in the Journal of Clinical Oncology(2013;31:3076-3082)."

Highlight:

"Prior research demonstrating the benefit of steroids in advanced cancer patients is limited, and there are no validated studies using fatigue as a primary outcome,” he said. The study he led (senior author was Eduardo Bruera, MD) used validated tools in a controlled setting that met National Cancer Institute and National Comprehensive Cancer Network criteria. Moreover, the study demonstrated that dexamethasone at 4 mg twice daily was effective in treating cancer-related fatigue for a period of two weeks."

Link to full article here.

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