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Drugs and the elderly
DRUGS AND THE ELDERLY Topical Analgesics BETSY TODD Analgesic ointments and liniments are available over the counter and are relatively inexpensive. This contributes to their popularity as remedies for muscle and joint pain. Also, rubbing these over a sore spot seems to add emoiional comfort. Most topical analgesics produce their effect through a counterirritant oi" anesthetic action. Counterirritants stimulate sensory nerve endings in the skin to conduct an intense feeling of w a r m t h or cooling, "block" pain sensation impulses, and distract attention from joint or muscle discomfort. Topical anesthetics inhibit the conduction of any sensory nerve impulses in the area, usually leaving a feeling of numbness. Adverse Effects
Although these drugs are applied topically, small amounts of most are absorbed systemically. This absorption is rarely enough to produce an internal analgesic effect (for instance, topical salicylates do not work like oral aspirin) or toxic reactions. Systemic toxicity is possible, however, especially under conditions that tend to increase drug absorption, as when the topical agents are applied to abraded skin or over large areas. T h e thinner skin of the elderly tends to promote topical drug absorption. But this effect m a y be offset by the decrease in peripheral circulation that sometimes occurs with age. Systemic toxicity from topical anesthetics may be manifested by central nervous system stimulation (nervousness, dizziness, blurred vision, tremors, convulsions) or by cardiac depression (hypotension, bradycardia, cardiac arrest). Resorcinol, a counterirritant, can depress thyroid Betsy Todd, RN, BS, is a part-'time staff nurse at Cabrini Hospice, New York, N.Y., and a lecturer/consultant on drug use. 152 Geriatric Nursing May/June 1983
COMMON INGREDIENTS IN TOPICAL ANALGESICS Counterirritants
Topical Anesthetics
allyi isothiocyanate (oil of mustard) ammonia water camphor (also a mild anesthetic) capsicln capsicum (from cayenne pepper) cinnamon eucalyptus oil histamine dihydrochloride menthol (also a mild anesthetic) methyl nicotinate methyl salicylat8 (oil of wintergreen) myfistica (nutmeg) oil of clove phenol resorcinoi thymol (also antifungal and antibacterial) turpentine oil
function if excessive amounts of this topical preparation are absorbed. It is extremely dangerous to swallow any topical analgesics. Methyl saiicylate, probably the most common ingredient in these products, is very toxic if taken internally. As little as one teaspoonful can be fatal to a child. Because the smell and taste of topical analgesics can be tempting to children, keep these preparations locked up or well out of a child's reach. Pets, too, may be attracted by the smell, so do not allow them to lick the skin after topical medicine has been applied. Skin irritation may lead to blisters and infection, especially when topical products are applied frequently and vigorously. Allergic r e a c t i o n s - either to an active ingredient or to something in the vehicle, such as a lanolin b a s e - - a r e not uncommon. Drug interactions can occur even with topical agents. The anesthetics benzocaine and tetracaine, because they are derivatives of para-aminobenzoic acid, can antagonize the antibacterial action of sulfonamides.
benzocaine dibucalne
dyclonine lidocaine pramoxine tetracaine
Dimethyl sulfoxide will increase the absorption of virtually anything else applied with it. Never use D M S O with any other topical drugs. Camphor, present in many topical analgesics, will counteract homeopathic remedies, such as pulsatilla or arnica. Advise anyone taking homeopathic medication not to apply camphor-containing analgesics. Other Topical Products Dimethyl sulfoxide and topical hydrocortisone are not analgesics, but they are often used to treat painful conditions. D M S O has been employed as an industrial solvent (degreasing agent) since the 1940s. It is approved for medical purposes in the United States only as a sterile bladder irrigation or for veterinary use. In Canada, it is applied topically to treat scleroderma. D M S O is available in some other countries for use on athletic injuries, and there is a growing demand in the U.S. to use D M S O for arthritis, othContinued on page 192
ELASE| (flbdnolysin and desoxyribonucleose, combined [bovine]}
ELASE OINTMENT (fibdnolysin and desoxyribonucleose, combined [bovine], ointment) Before prescribing, pleasesee full prescribing Information. A Brief Summary follows: INDICATIONS. Elase is indicated for topical use as a debriding agent in a variety of inflammatory and infected lesions. These include (1) general surgical wounds; (2) ulcerative lesions--trophic, decubitus, stasis, arteriosclerotic; (3) second-and third-degree burns; (4) circumcision and episiotomy Erase is used intravaginally in (1) cervicitis--benign, postpartum, and postconization, and (2) vaginitis. Elase (fibrinorysin and desoxyribonuclease. combined [bovine]) solution is used as an irrigating agent in (1) infected wounds--abscesses, fistulae, and sinus tracts; (2) otorhinolaryngologic wounds: (3) superficial hematomas (except when the hematoma is adjacent to or within adipose tissue). CONTRAINDICATION. Elase is not recommended for parenteral use because the bovine fibrinofysin may be antigenic. PRECAUTIONS. The usual precautions against allergic reactions should be observed, particularly in persons with a history of sensitivity to materials of bovine origin or to mercury compounds. To be maximally effective. Elase solutions must be freshly prepared before use. The loss in activity is reduced by refrigeration; however, even when stored in a refrigerator, the solution should not be used 24 hours or more after reconstitution. ADVERSEREACTIONS. Side effects attributable to the enzymes have not been a problem at the dose and for the indications recommended herein. With higher concentrations, side effects have been minimal, consisting of local hyperemia. Chills and fever attributable to antigenic action of profibrioolysin activators of bacterial origin are not a problem with Elase. PREPARATION OF ELASE SOLUTION. The contents of each vial may be reconstituted with 10 ml of isotonic sodium chloride solution9Higher or lower concentrations can be prepared if desired by varying the amount el the diluent. DOSAGEAND ADMINISTRATION. Because the conditions for which Elase is helpful vary considerably in severity, dosage must be adjusted to the individual case; however, the following general recommendations can be made: Successful use of enzyme debridement depends on several factors: (1) dense, dry eschar, if present, should be removed surgically before enzymatic debridement is attempted; (2) the enzyme must be in constant contact with the substrate; (3) accumulated necrotic debris must be pefiociicatly removed; (4) the enzyme must be replenished at least o n c e daily; and (5) secondary closure or skin grafting must be employed as soon as possible after optimal debridement has been attained. It is further essential that wound-dressing techniques be performed carefully under aseptic conditions and that appropriate systemically acting antibiotics be administered concomitantly if. in the opinion of the physician, they are indicated. General TopicalUses: Selection of the product form and the duration of treatment must to a great extent be left to the discretion of the physician. Local application of the appropriate product should be repeated at intervals for as long as enzyme action is desired. Elase solution may be applied topicany as a liquid, spray, or wet dressing. Application of a gentle spray of the solution can be accomplished by using a conventional atomizer. After application. Elase. especially in solution, becomes rapidly and progressively tess active and is probably exhausted for practical purposes at the end of 24 hours. The dry material for solution and the ointment are stable at room temperature through the expiration date printed on the package. IntravaginalUse: In mild to moderate vaginitis and cervicitis. 5 ml of E~aseOintment should be deposited deep in the vagina once nightly at bedtime for approximately five applications, or until the entire contents of one 30-g tube of Erase has been used. The patient should be checked by her physician to determine possible need for further therapy In more severe cervicitis ;and vaginitis, some physicians prefer initially to instill 10 ml of the Elase (fibrinolysin and desoxyribonuclease. combined [bovine]) solution intravaginally, wait one or two minutes for the enzyme to disperse, and then inserl a cotton tampon in the vaginal canal. The tampon should be removed the next d a y . followed by as many applications of Elase Ointment as necessary Abscesses, empymnacavities, fistulae, sinus tracts, or subcutaneoushematomas:Despite the contraindication against parenteral use. Elase has been used in irrigating these specific conditions. The Elase solution should be drained and replaced at interval~ of six to ten hours to reduce the amount of by-product accumulation and minimize loss of enzyme activity Traces of blood in the discharge usually indicate active filling in of the cavity ZF
PARKE-DAVIS D i v of W a r n e r - L a m b e r t C o M o r r i s Plains. N J 0 7 9 5 0 U S A PD-27-JA-0285-P-I (6-81)
I92 Geriatric Nursing May/June 1983
DRUC & ELDERLY Continued f r o m page 152
er muscle andjoint pain, strokes, and spinal cord injuries. It is said to provide symptomatic relief of pain, muscle spasms, and inflammation. Although DMSO is applied topically, it is absorbed rapidly through skin and mucous membranes. Virtually all of the DMSO now available through health food stores and other outlets is industrial grade, in a high concentration and with many impurities. Because DMSO moves freely across skin and mucous membrane barriers, it pulls impurities in the solution along with it. Systemic absorption of these impurities is probably the greatest risk of DMSO at this time. The pure DMSO used in animal experiments appears to be relatively nontoxic, at least for short-term use. A "garlic" taste and odor on the breath appear within a few minutes of DMSO application---evidence of its quick systemic absorption. Photophobia, temporary problems with color vision, headaches, nausea, diarrhea, and burning on urination have been reported. Severe allergic reactions can occur. Long-term use in animals has produced some evidence of cataracts, other vision changes, and birth defects. DMSO seems to hold promise as an analgesic or antiinflammatory drug. In its currently available form, however, DMSO's impurities, high concentration, and--like many FDA-approved drugs--its high cost cause problems. Hydrocortisone is marketed as on OTC drug primarily as an antipruritic agent. Applied topically, it causes vasoconstriction and an antiinflammatory effect, which decrease redness and itching. Hydrocortisone is not an analgesic. Unfortunately, many consumers have heard that corticosteroids are potent and have rushed to buy the OTC form and use it for almost anything, including pain and stiffness. The misuse of topical hydrocortisone has led to both local and systemic problems, among them, skin rashes and thinning, petechiae, and changes in pigmentation. Infections may result from these skin changes. Hydrocortisone may increase the spread of viral infections, so advise Continued on page 196
Information Service For GN Readers PRODUCT ADVERTISERS No.
Pg.
1. C i b a P h a r m a c e u t i c a l Company .................................................. 142,143 2. B u d g e t
U n i f o r m C e n t e r ............... 1 9 8
3. D u n d e e H e s l t h c a r e P r o d u c t s ....... 185 4. G e r i - C a r e P r o d u c t s Inc . . . . . . . . . 1 5 0 , 1 5 1 5. J o h n s o n & J o h n s o n P r o d u c t s Inc. C o v e r II, 131
...........................................
6. M c N e i l L a b o r a t o r i e s ....... 1 8 6 , 1 8 7 , 1 8 8 7. C.V. M o s b y C o m p a n y ................ 1 5 2 A 8. P a r k e - D a v i s Company .... 1 9 0 , 1 9 1 , 1 9 2 9. J.T. Posey Company .................... 196 10. P r o c t e r & Gamble Company ..................................... 1 3 8 , 1 3 9 , 1 4 0 , 1 4 1 11. P r o f e s s i o n a l M e d i c a l P r o d u c t s 180,181
..................................................
12. P y r a m i d F i l m & V i d e o .................. 147 13. R o e r i g a d i v i s i o n o f P f i z e r P h a r m a c e u t i c a l s .................................... 144,145,146 14. R o s s L a b o r a t o r i e s
.......................
135
15. R o s s L a b o r a t o r i e s ....................... 149 16. R o w e , L a b o r a t o r i e s Inc ........ C o v e r III 17. Rystan Company
.........................
196
18. R y s t a n C o m p a n y
.........................
197
19. S a n d o z P h a r m a c e u t i c a l s ............. 132
20. Sandoz Pharmaceuticals
. . . . . . . . . . .
152B
21. Stand-A d o f Iowa Inc ................... 195 2 2 . V e s t a l L a b o r a t o r i e s ..................... 179 2 3 . W a r n e r - L a m b e r t C o m p a n y ... C o v e r IV
EIPLOYMENT ADVERTISERS No. Pg. 2 4 . B o s w e l l M e m o r i a l H o s p i t a l , A z ..... 195 2 5 . H a l i f a x H o s p i t a l M e d i c a l C e n t e r , FI ......................................................... 182 26, Manor Heaithcare Corporation, Md ......................................................... 182 2 7 . St. A n t h o n y ' s H o s p i t a l , FI ............. 195 28, St. C r o i x T h e r a p y , M n 2 9 . St. M a w - o f - t h e - W o o d s ....................
..................
1R2
C o l l e g e , In.
.....................................
149
3 0 . U n i v e r s i t y o f P e n n s y l v a n i a , P a ..... 147 3 1 . W i l m i n g t o n M e d i c a l C e n t e r , De .... 183
DRUGS & ELDERLY Continued f r o m page 192
a natural
problem
Derifil
(chlorophyllin anti-malodor tablet)
the natural answer
Not a spray or cover-up, Oral DERIFIL is the natural, effective way to eliminate unpleasant odors associated with ... 9 Fecal/urinary incontinence 9 Ostomies 9 Infected wounds 9 Body odor and other malodorous conditions Thousands of institutions and individuals have discovered that DERIFIL can banish unpleasant odor, improve patient morale, enhance patient care. And DERIFIL is... Safe. No Rx needed, 25-year safety record. Convenient. Easy oral administration. Economical. One tablet daily is usually effective against odors of incontinence; dosage varies for other conditions. Available in several bottle sizes to suit your needs. Send us your order, or request a trial supply.
Oral Derifil .. the natural answer company #tc. 470 Mamaroneck Ave., White Plains, NY 10605
196 Geriatric Nursing May/June 1983
patients not to apply it on or near chicken pox or herpes lesions. Allergic reactions are possible and systemic corticosteroid side effects will result from excessive absorption. Rubbing enhances the counterirritant action of external analgesics, so apply these products firmly but gently, especially to the very thin skin of older people. T h e site of application, amount of rubbing, and time the drug is in contact with the skin all affect absorption. 9 Do not apply topical analgesics to large areas or on or near mucous membranes, in order to minimize systemic absorption. 9 Use topical analgesics sparingly if at all under breast or abdominal folds because the w a r m t h and moisture in s k i n fold areas will tend to increase absorption. 9 Avoid application to broken or bruised Skin. Doing so will not only increase drug absorption but m a y cause irritation and infection. 9 Do not apply occlusive dressings, plastic wrap, or excessive amounts of tape. These hold in w a r m t h and moisture, and increase systemic absorption. The choice of the vehicle, or base, is a m a t t e r of preference. Some liniments and lotions are alcohol based, and may dry an older person's skin. Ointments, often made with petroleum jelly or mineral oil, m a y be inconveniently greasy. W h e n you encounter patients who are using topical analgesic products, don't assume that their complaints are minor. Assess the pain. W h e n does it occur? How long has it been present? Are there other symptoms? W h a t tho patient has interpreted as " r h e u m a t i s m " could be due to thrombophlebitis (leg pain), kidney disease (back/flank pain), a pathological fracture, or cancer metastases. Encourage and practice nondrug measures for pain relief. H e a t ban be comforting, but use it c a u t i o u s l y - never " t h e hotter the b e t t e r " - - e s p e cially on a sleeping person, unconscious patient, or a diabetic. Don't apply heat over topical analgesics. Massage with a nonmedicinal oil such as Aura Glow skin lotion (Heritage Products, Virginia Beach, Va.) often provides the most relief.
P O S E Y W h e e l c h a i r Belt
I
L
Economical belt fits across patient's lap to help prevent sliding forward. Fastens to rear kick spurs, out of reach. Green nylon webbing. #4130
POSEY Convoluted Cushion
Reticulated foam offers excellent air circulation-perfect for long-term patients. Quick-drying. Three inch thick cushion measures 16" x 18". # 6510
POSEY ' ~ " Wheelchair i~ Safety Belt ~i
Special three-loop design fits any size patient to prevent slumping or sliding forward or to the side. Attaches quickly to rear handles and kick spurs. Adjusts easily to different wheelchair sizes and styles, fr~ # 4120 Quality for ~~ ] Place your over 40 years p("~o s yE, ~ ' ~ order |oday!
Although these drugs are applied topically, small amounts of most are absorbed systemically. This absorption is rarely enough to produce an internal analgesic effect (for instance, topical salicylates do not work like oral aspirin) or toxic reactions. Systemic toxicity is possible, however, especially under conditions that tend to increase drug absorption, as when the topical agents are applied to abraded skin or over large areas. T h e thinner skin of the elderly tends to promote topical drug absorption. But this effect m a y be offset by the decrease in peripheral circulation that sometimes occurs with age. Systemic toxicity from topical anesthetics may be manifested by central nervous system stimulation (nervousness, dizziness, blurred vision, tremors, convulsions) or by cardiac depression (hypotension, bradycardia, cardiac arrest). Resorcinol, a counterirritant, can depress thyroid Betsy Todd, RN, BS, is a part-'time staff nurse at Cabrini Hospice, New York, N.Y., and a lecturer/consultant on drug use. 152 Geriatric Nursing May/June 1983
COMMON INGREDIENTS IN TOPICAL ANALGESICS Counterirritants
Topical Anesthetics
allyi isothiocyanate (oil of mustard) ammonia water camphor (also a mild anesthetic) capsicln capsicum (from cayenne pepper) cinnamon eucalyptus oil histamine dihydrochloride menthol (also a mild anesthetic) methyl nicotinate methyl salicylat8 (oil of wintergreen) myfistica (nutmeg) oil of clove phenol resorcinoi thymol (also antifungal and antibacterial) turpentine oil
function if excessive amounts of this topical preparation are absorbed. It is extremely dangerous to swallow any topical analgesics. Methyl saiicylate, probably the most common ingredient in these products, is very toxic if taken internally. As little as one teaspoonful can be fatal to a child. Because the smell and taste of topical analgesics can be tempting to children, keep these preparations locked up or well out of a child's reach. Pets, too, may be attracted by the smell, so do not allow them to lick the skin after topical medicine has been applied. Skin irritation may lead to blisters and infection, especially when topical products are applied frequently and vigorously. Allergic r e a c t i o n s - either to an active ingredient or to something in the vehicle, such as a lanolin b a s e - - a r e not uncommon. Drug interactions can occur even with topical agents. The anesthetics benzocaine and tetracaine, because they are derivatives of para-aminobenzoic acid, can antagonize the antibacterial action of sulfonamides.
benzocaine dibucalne
dyclonine lidocaine pramoxine tetracaine
Dimethyl sulfoxide will increase the absorption of virtually anything else applied with it. Never use D M S O with any other topical drugs. Camphor, present in many topical analgesics, will counteract homeopathic remedies, such as pulsatilla or arnica. Advise anyone taking homeopathic medication not to apply camphor-containing analgesics. Other Topical Products Dimethyl sulfoxide and topical hydrocortisone are not analgesics, but they are often used to treat painful conditions. D M S O has been employed as an industrial solvent (degreasing agent) since the 1940s. It is approved for medical purposes in the United States only as a sterile bladder irrigation or for veterinary use. In Canada, it is applied topically to treat scleroderma. D M S O is available in some other countries for use on athletic injuries, and there is a growing demand in the U.S. to use D M S O for arthritis, othContinued on page 192
ELASE| (flbdnolysin and desoxyribonucleose, combined [bovine]}
ELASE OINTMENT (fibdnolysin and desoxyribonucleose, combined [bovine], ointment) Before prescribing, pleasesee full prescribing Information. A Brief Summary follows: INDICATIONS. Elase is indicated for topical use as a debriding agent in a variety of inflammatory and infected lesions. These include (1) general surgical wounds; (2) ulcerative lesions--trophic, decubitus, stasis, arteriosclerotic; (3) second-and third-degree burns; (4) circumcision and episiotomy Erase is used intravaginally in (1) cervicitis--benign, postpartum, and postconization, and (2) vaginitis. Elase (fibrinorysin and desoxyribonuclease. combined [bovine]) solution is used as an irrigating agent in (1) infected wounds--abscesses, fistulae, and sinus tracts; (2) otorhinolaryngologic wounds: (3) superficial hematomas (except when the hematoma is adjacent to or within adipose tissue). CONTRAINDICATION. Elase is not recommended for parenteral use because the bovine fibrinofysin may be antigenic. PRECAUTIONS. The usual precautions against allergic reactions should be observed, particularly in persons with a history of sensitivity to materials of bovine origin or to mercury compounds. To be maximally effective. Elase solutions must be freshly prepared before use. The loss in activity is reduced by refrigeration; however, even when stored in a refrigerator, the solution should not be used 24 hours or more after reconstitution. ADVERSEREACTIONS. Side effects attributable to the enzymes have not been a problem at the dose and for the indications recommended herein. With higher concentrations, side effects have been minimal, consisting of local hyperemia. Chills and fever attributable to antigenic action of profibrioolysin activators of bacterial origin are not a problem with Elase. PREPARATION OF ELASE SOLUTION. The contents of each vial may be reconstituted with 10 ml of isotonic sodium chloride solution9Higher or lower concentrations can be prepared if desired by varying the amount el the diluent. DOSAGEAND ADMINISTRATION. Because the conditions for which Elase is helpful vary considerably in severity, dosage must be adjusted to the individual case; however, the following general recommendations can be made: Successful use of enzyme debridement depends on several factors: (1) dense, dry eschar, if present, should be removed surgically before enzymatic debridement is attempted; (2) the enzyme must be in constant contact with the substrate; (3) accumulated necrotic debris must be pefiociicatly removed; (4) the enzyme must be replenished at least o n c e daily; and (5) secondary closure or skin grafting must be employed as soon as possible after optimal debridement has been attained. It is further essential that wound-dressing techniques be performed carefully under aseptic conditions and that appropriate systemically acting antibiotics be administered concomitantly if. in the opinion of the physician, they are indicated. General TopicalUses: Selection of the product form and the duration of treatment must to a great extent be left to the discretion of the physician. Local application of the appropriate product should be repeated at intervals for as long as enzyme action is desired. Elase solution may be applied topicany as a liquid, spray, or wet dressing. Application of a gentle spray of the solution can be accomplished by using a conventional atomizer. After application. Elase. especially in solution, becomes rapidly and progressively tess active and is probably exhausted for practical purposes at the end of 24 hours. The dry material for solution and the ointment are stable at room temperature through the expiration date printed on the package. IntravaginalUse: In mild to moderate vaginitis and cervicitis. 5 ml of E~aseOintment should be deposited deep in the vagina once nightly at bedtime for approximately five applications, or until the entire contents of one 30-g tube of Erase has been used. The patient should be checked by her physician to determine possible need for further therapy In more severe cervicitis ;and vaginitis, some physicians prefer initially to instill 10 ml of the Elase (fibrinolysin and desoxyribonuclease. combined [bovine]) solution intravaginally, wait one or two minutes for the enzyme to disperse, and then inserl a cotton tampon in the vaginal canal. The tampon should be removed the next d a y . followed by as many applications of Elase Ointment as necessary Abscesses, empymnacavities, fistulae, sinus tracts, or subcutaneoushematomas:Despite the contraindication against parenteral use. Elase has been used in irrigating these specific conditions. The Elase solution should be drained and replaced at interval~ of six to ten hours to reduce the amount of by-product accumulation and minimize loss of enzyme activity Traces of blood in the discharge usually indicate active filling in of the cavity ZF
PARKE-DAVIS D i v of W a r n e r - L a m b e r t C o M o r r i s Plains. N J 0 7 9 5 0 U S A PD-27-JA-0285-P-I (6-81)
I92 Geriatric Nursing May/June 1983
DRUC & ELDERLY Continued f r o m page 152
er muscle andjoint pain, strokes, and spinal cord injuries. It is said to provide symptomatic relief of pain, muscle spasms, and inflammation. Although DMSO is applied topically, it is absorbed rapidly through skin and mucous membranes. Virtually all of the DMSO now available through health food stores and other outlets is industrial grade, in a high concentration and with many impurities. Because DMSO moves freely across skin and mucous membrane barriers, it pulls impurities in the solution along with it. Systemic absorption of these impurities is probably the greatest risk of DMSO at this time. The pure DMSO used in animal experiments appears to be relatively nontoxic, at least for short-term use. A "garlic" taste and odor on the breath appear within a few minutes of DMSO application---evidence of its quick systemic absorption. Photophobia, temporary problems with color vision, headaches, nausea, diarrhea, and burning on urination have been reported. Severe allergic reactions can occur. Long-term use in animals has produced some evidence of cataracts, other vision changes, and birth defects. DMSO seems to hold promise as an analgesic or antiinflammatory drug. In its currently available form, however, DMSO's impurities, high concentration, and--like many FDA-approved drugs--its high cost cause problems. Hydrocortisone is marketed as on OTC drug primarily as an antipruritic agent. Applied topically, it causes vasoconstriction and an antiinflammatory effect, which decrease redness and itching. Hydrocortisone is not an analgesic. Unfortunately, many consumers have heard that corticosteroids are potent and have rushed to buy the OTC form and use it for almost anything, including pain and stiffness. The misuse of topical hydrocortisone has led to both local and systemic problems, among them, skin rashes and thinning, petechiae, and changes in pigmentation. Infections may result from these skin changes. Hydrocortisone may increase the spread of viral infections, so advise Continued on page 196
Information Service For GN Readers PRODUCT ADVERTISERS No.
Pg.
1. C i b a P h a r m a c e u t i c a l Company .................................................. 142,143 2. B u d g e t
U n i f o r m C e n t e r ............... 1 9 8
3. D u n d e e H e s l t h c a r e P r o d u c t s ....... 185 4. G e r i - C a r e P r o d u c t s Inc . . . . . . . . . 1 5 0 , 1 5 1 5. J o h n s o n & J o h n s o n P r o d u c t s Inc. C o v e r II, 131
...........................................
6. M c N e i l L a b o r a t o r i e s ....... 1 8 6 , 1 8 7 , 1 8 8 7. C.V. M o s b y C o m p a n y ................ 1 5 2 A 8. P a r k e - D a v i s Company .... 1 9 0 , 1 9 1 , 1 9 2 9. J.T. Posey Company .................... 196 10. P r o c t e r & Gamble Company ..................................... 1 3 8 , 1 3 9 , 1 4 0 , 1 4 1 11. P r o f e s s i o n a l M e d i c a l P r o d u c t s 180,181
..................................................
12. P y r a m i d F i l m & V i d e o .................. 147 13. R o e r i g a d i v i s i o n o f P f i z e r P h a r m a c e u t i c a l s .................................... 144,145,146 14. R o s s L a b o r a t o r i e s
.......................
135
15. R o s s L a b o r a t o r i e s ....................... 149 16. R o w e , L a b o r a t o r i e s Inc ........ C o v e r III 17. Rystan Company
.........................
196
18. R y s t a n C o m p a n y
.........................
197
19. S a n d o z P h a r m a c e u t i c a l s ............. 132
20. Sandoz Pharmaceuticals
. . . . . . . . . . .
152B
21. Stand-A d o f Iowa Inc ................... 195 2 2 . V e s t a l L a b o r a t o r i e s ..................... 179 2 3 . W a r n e r - L a m b e r t C o m p a n y ... C o v e r IV
EIPLOYMENT ADVERTISERS No. Pg. 2 4 . B o s w e l l M e m o r i a l H o s p i t a l , A z ..... 195 2 5 . H a l i f a x H o s p i t a l M e d i c a l C e n t e r , FI ......................................................... 182 26, Manor Heaithcare Corporation, Md ......................................................... 182 2 7 . St. A n t h o n y ' s H o s p i t a l , FI ............. 195 28, St. C r o i x T h e r a p y , M n 2 9 . St. M a w - o f - t h e - W o o d s ....................
..................
1R2
C o l l e g e , In.
.....................................
149
3 0 . U n i v e r s i t y o f P e n n s y l v a n i a , P a ..... 147 3 1 . W i l m i n g t o n M e d i c a l C e n t e r , De .... 183
DRUGS & ELDERLY Continued f r o m page 192
a natural
problem
Derifil
(chlorophyllin anti-malodor tablet)
the natural answer
Not a spray or cover-up, Oral DERIFIL is the natural, effective way to eliminate unpleasant odors associated with ... 9 Fecal/urinary incontinence 9 Ostomies 9 Infected wounds 9 Body odor and other malodorous conditions Thousands of institutions and individuals have discovered that DERIFIL can banish unpleasant odor, improve patient morale, enhance patient care. And DERIFIL is... Safe. No Rx needed, 25-year safety record. Convenient. Easy oral administration. Economical. One tablet daily is usually effective against odors of incontinence; dosage varies for other conditions. Available in several bottle sizes to suit your needs. Send us your order, or request a trial supply.
Oral Derifil .. the natural answer company #tc. 470 Mamaroneck Ave., White Plains, NY 10605
196 Geriatric Nursing May/June 1983
patients not to apply it on or near chicken pox or herpes lesions. Allergic reactions are possible and systemic corticosteroid side effects will result from excessive absorption. Rubbing enhances the counterirritant action of external analgesics, so apply these products firmly but gently, especially to the very thin skin of older people. T h e site of application, amount of rubbing, and time the drug is in contact with the skin all affect absorption. 9 Do not apply topical analgesics to large areas or on or near mucous membranes, in order to minimize systemic absorption. 9 Use topical analgesics sparingly if at all under breast or abdominal folds because the w a r m t h and moisture in s k i n fold areas will tend to increase absorption. 9 Avoid application to broken or bruised Skin. Doing so will not only increase drug absorption but m a y cause irritation and infection. 9 Do not apply occlusive dressings, plastic wrap, or excessive amounts of tape. These hold in w a r m t h and moisture, and increase systemic absorption. The choice of the vehicle, or base, is a m a t t e r of preference. Some liniments and lotions are alcohol based, and may dry an older person's skin. Ointments, often made with petroleum jelly or mineral oil, m a y be inconveniently greasy. W h e n you encounter patients who are using topical analgesic products, don't assume that their complaints are minor. Assess the pain. W h e n does it occur? How long has it been present? Are there other symptoms? W h a t tho patient has interpreted as " r h e u m a t i s m " could be due to thrombophlebitis (leg pain), kidney disease (back/flank pain), a pathological fracture, or cancer metastases. Encourage and practice nondrug measures for pain relief. H e a t ban be comforting, but use it c a u t i o u s l y - never " t h e hotter the b e t t e r " - - e s p e cially on a sleeping person, unconscious patient, or a diabetic. Don't apply heat over topical analgesics. Massage with a nonmedicinal oil such as Aura Glow skin lotion (Heritage Products, Virginia Beach, Va.) often provides the most relief.
P O S E Y W h e e l c h a i r Belt
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Economical belt fits across patient's lap to help prevent sliding forward. Fastens to rear kick spurs, out of reach. Green nylon webbing. #4130
POSEY Convoluted Cushion
Reticulated foam offers excellent air circulation-perfect for long-term patients. Quick-drying. Three inch thick cushion measures 16" x 18". # 6510
POSEY ' ~ " Wheelchair i~ Safety Belt ~i
Special three-loop design fits any size patient to prevent slumping or sliding forward or to the side. Attaches quickly to rear handles and kick spurs. Adjusts easily to different wheelchair sizes and styles, fr~ # 4120 Quality for ~~ ] Place your over 40 years p("~o s yE, ~ ' ~ order |oday!