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Storing medications safely
Storing Medications Safely Where? For how long? At what temperature?
A new supply of Aminophylline was ordered. The nurse stored it at room temperature, and Ms. Martin's breathing difficulty subsided.
Daniel Hernandez, age 72, was preparing for a walk, his third of the week. It had been three months It is easy to overlook the impor- since his myocardial infarct, and on tance of storing drugs properly, as his physician's advice he had begun 'the experiences of two clients illus- a n exercise program. trate. " I ' d better take a few nitro pills When Anna Martin was in the with me," Mr. H e r n a n d e z said to hospital for treatment of a broken his wife, remembering that his hip, breathing problems caused by clinic nurse, Steven Presser, had -her emphysema were successfully suggested always keeping a supply controlled with liquid theophylline at hand. ethylenediamine (Aminophylline). A m o n t h b e f o r e , Mr. H e r n a n d e z Slow recovery from hip reconstruc- had removed four tablets from the tion led to Ms. Martin's placement brown glass bottle a n d wrapped in a nursing home. T h e r e a nurse, them in a handkerchief. Now he Maria Burns, r e g u l a r l y a d m i n i s put the handkerchief in his pants tered Aminophylline as prescribed, pocket, thinking that the pills but Ms. Martin's respirations grew would be easy to get at if he needed steadily more labored. them while most of his medicine Ms. Burns reported the patient's would still be safe at home. dyspnea, took nursing measures to Like m a n y people starting to exincrease her comfort, and called on ercise, Daniel H e r n a n d e z overdid it the home's consulting pharmacist that day. After walking a mile and for a medication review. a half at a brisk pace, he felt tired, When the pharmacist asked to anxious, and achy in the chest. see all of the patient's medications, With a fair degree of composure, Ms. Burns took analgesics and car- he fished out his nitroglycerin and let diovascular drugs from a medicine one tablet melt under his tongue. N o drawer and removed the Amino- effect. Another tablet, and a third phylline from the refrigerator. Ex- and fourth--still no relief. Now amining the Aminophylline, the very frightened, he called to a teenpharmacist noted crystals at the ager nearby, who drove him to the bottom of the bottle. nearest hospital. " I t looks as though much of the Meeting with Mr. H e r n a n d e z at active agent has crystalized out," the clinic two weeks later, Steven she told the nurse. " W h a t ~,ou've Presser realized he had never told been giving Ms. Martin is mostly his patient how important it is to the inactive liquid base. Amino- protect the potency of nitroglycerphylline is one liquid medication in. "It's extremely sensitive to light, moisture, and heat," Presser now that should not be refrigerated." explained. " K e e p it in the brown glass bottle, tightly sealed, and Robert Skeist, R.N., is manager and Grace Carlson, R.N., B.S.N., is health educator, when you go out carry it in an outSenior's Health Program, Augustana tlos- side jacket p a c k e t or a bag hung from your shoulder." pital and Health Care Center, Chicago. ROBERT SKEIST GRACE CARLSON
These two vignettes, the following guidelines, and the chart "Spe- cial Storage Requirements for Selected Drugs" provide basic information to ensure safe storage.
General Guidelines M a n y pharmaceutical preparations undergo chemical changes and lose potency if overexposed to heat, light, or humidity. Ingesting certain drugs--aspirin, for examp i e - - i f they have been stored improperly may cause the patient harm Or discomfort. Unless otherwise specified, store drugs in a cool, dry place, away from direct natural or artificial light, in their original and tightly sealed containers, and clearly labeled. Some drugs require refrigeration to prolong their storage life, but do not refrigerate a medication unless specifically advised to do so by the manufacturer, pharmacist, or another trustworthy source(1). Refrigeration exposes drugs to high humidity and may cause precipitation of active ingredients from certain suspensions. Phenylpropanolamine HC1 (Ornade), prochlorperazine (Compazine), and chlorpromazine (Thorazine) spansules are three drugs n o t to refrigerate. In an institution, see that the medicine cabinet or cart is not placed by a radiator or a sunny window. Ask your p h a r m a c y for the expiration dates of stock medications. To keep stocks current,'use up old supplies before dispensing from the newest batch(2). Advise your patients who are going home or ihose you meet in community settings not to store drugs in their medicine cabinets. Because most medicine cabinets are located above bathroom sinks, drugs stored there are exposed to a high degree of humidity and heat. For the same
STORAGE REQUIREMENi S t o r e In R e f r i g e r a t o r theophylline ethylenedlamine (AminophyUlne) suppositories; bronchodilator. Refrigerate if in cocoa butter base. ampJciltln _ _ antibiotic. Refrigerate orsI suspension up to 2 weeks or store at room temperature 1 week. amoxicNin (Larotid) antibiotic. Refrigerate suspension and drops up to 2 weeks or store at room temperature t week. eephalexJn (Keflex) antibiotic. Refrigerate suspension up to 2 weeks. chloq)romszine (Thoraz~o) suppositories; antipsychotic, antlemetic. ery~romyctn _
_
antibiotic. Refrigerate IM suspension up to 1 week.
folio acid (Vitamin B Complex). Reffigerate solution. insulin ~ antidlabetic. Once opened, reMgerate at 2 ~ to 8~ (35.6 ~ to 48.4~ foe up to 3 months, or stere at room temperature for Up to I month. Do not freeze. penicillin _ _ antibiotic. Refrigerate suspension up to 2 weeks or store at room temperature 7 days. prochiorperazine (Compazine) suppositories; antiemetic, antipsychoUc trknothobanzaJ~de I - ~ (T~sn) suppositories; entiemetin
Do N o t R e f r i g e r a t e
:.
aminophylline liquid and injectable _ belladonna tincture
_
bronchodilater
cholinerglc blocking agent
B-complex end C vitamins (Bejectsl with C) vttam~ replacement B and C vitamins (A]bee with C) vitamin supplement csmphorsted opium tincture (Psregodc) 8nUdiarThesi cascara sagrada _
_
cathartic
chiorphenkamine maleate, i ~ e n y l p r u p ~ tant
(Or nsde) spsnsuie, deconges-
chtorpromazJne (Thoraz~e) Upansuie, antipsychctic. 8nUemetin hnosemido (Lsslx) injection, tin=eric glyceryt guslacolate (Tlobifussin) syrup, expectorant hydmlazine HCI (Apresoline) injection, antihypertenslve hydromorphone HCI (Dilandid) syrup and injection, narcotic analgesic hydroxyztne HCI (Atarax) syrup, antlanxla~ irnilxsmine HCI ('rofranJl) injection, t~'yclic antldepreMant levothyroxine (Synthroid) synthetlo thyroid preparation potassJum chloride liquid ~
pota~_,~,._.,mreplacement
reserpine (SerpasU) injection, antihypetlensive theuphyUine (Elixophygin) Ixonchodilator tdamclnolone d'mcetate (Adstocort Psranteral Forte) injection, glucocorticoid, antllnflammatorj v l t a n ~ B~= Injection ~
vitamin supplement
reason, avoid medication storage anywhere in the bathroom, "the worst place in the h o m e to store drugs," according to pharmacist Steven Strauss(3). Don't store drugs on the television set, radiator cover, or w i n d o w sills. If there are children or pets at home, store medications out o f their reach, preferably in a locked
cabinet. Good storage places at home include shelves in a kitchen cupboard a~vay from the Stove or steam, and dresser drawers in the bedroom. Keep medications, especially those that come in dark or glass containers, in their original containers. Placing several different drugs in one bottle or pill box is not
advisable. Such a practice may lead to chemical changes in certain medications and to confusion about the identity of each pill. Advise older adults living in the community to shop at pharmacies that have a high turnover of OTC and prescription drugs. Generally, the expiration dates for OTC products appear on the labels. It is sen-
FOR SELECTED DRUGS" A d m i n i s t e r P a r e n t e r a l SoluUons PrompUy a f t e r P r e p a r a t i o n ampioillin
antibiotic. Use within 1 hour.
chlordiazepoxide hydroctdoride (LibritmO sntlanxiety. Use promptly, discard unused solution. methylprednisolone OAedroi) antiinflammatory, antiallerglc Use within 48 houm nitrofurentoin OAaorodantin) urinary antibacterial. Use promptly; discard unused solution. tetracycibles ~
antibiotic. Use within 24 horn's.
warladn sodium (Coumadin) anticoagulant. Use within several days when stored at 4"C (39 2"F)
Particularly I m p o r t a n t t o P r o t e c t f r o m
Ught
camphorated opium tincture (Paregoric) antidlarrheal cl'~orpromazine Ohorazine) antipsychoflc, entlemetio diazepam (Valhun) antianxlaty, skeletal muscle relaxant dlgoxin (Lanoxin) cardiotonic ephedrine, theophylline (Mamx) bronchodilator epinephrine (Adrenalin Chloride) sympathomimetic furosemlde (Lasix) dJuretio imipramine hydroctdoride (Tofrerfil) tricycUc antidepressant indometha~n Ondocin) antiinflammalory, analgesic nitroglycerin _
_
~oronary vasodilator
nystatin (Myo0statin) antifungal prochlorperazine (Compazine injection or concentrate) antlametic, ant/psychotic qutnidJoa sulfate _
_
antlarrhythmJc
tl'doddazine (Melladl) antipsychottc thyroid ~
thyroid replacement
tdfluoperezine (Stekudne liquid) antipsychotlc, anfiemetic vitamins--all
Particularly I m p o r t a n t t o D i s c a r d If O u t d a t e d 9scetylsalioyflc acid (Aspire) anffinflammatow, analgesic, sntipyretio. Decomposition changes drug to saUc~dic acid and acetic acid, which are even more initating to stomach.
tetracydines ~ drag.
antibiotic. Renal injury has resulted from use of outdated
'Drugs are listed by genetic name, with brand name in parentheses. For drugs with multiple brand names, a line replaces the brand name. All lists include representative examples. No list is induslve.
sible to ask the pharmacist how long a prescription drug m a y be used, and to write the expiration date on the label. Strauss n o t e s , that expiration dates are valid only when drugs are stored properly in the home. Expiration dates differ, he points out, from one drug to another, from batch to batch of the same drug,
and from one m a n u f a c t u r e r to another. Some products can be used over a long period, others only for a short time. Some antibiotics, for example, m a y not begin to deteriorate for months or years if stored properly; others m a y start to spoil after a week(4). Some medicine cabinets we've seen in Chicago would be fitting
stops on a historical tour. Pills from years back are saved "just in case." In case, that is, the doctor prescribes them again, the pain returns, or a friend develops symptoms "'like when I was ill and these yellow tablets did the trick." During a home visit, the community nurse should survey all medications on hand and, with the
client's consent, discard anything over two years old, pills for conditions that have cleared up, any drug past its expiration date, and any that has changed its color or odor. W e recommend storing special formulations as follows: 9 Rectal suppositories Store in a cool dry place. If too soft to insert, place under cold tap water until firmer, or briefly in the r e f r i g e r a t o r (not freezer). 9 Nasal spray Wash spray tip with hot s o a p y w a t e r , rinse, and dry with a clean tissue after each use. This advice applies to nose droppers, eye droppers, vaginal-suppository inserters, and other items that
come in contact with body orifices. 9 Inhalants Store inhalants for asthma and other pulmonary conditions at room temperature, away from open flames or direct heat. 9 Liquids Discard if discolored unless m a n u f a c t u r e r or pharmacist states that a change in color for a specific drug is harmless. Consult your pharmacist if you note unexpected precipitates in liquid suspensions. Active ingredients may have left the solution. Dilute or reconstitute liquids in the exact a m o u n t needed and just before administering, because most liquids are less stable after these procedures.
Do not return medications, once poured, to the storage container. Check manufacturers' instructions for storing ophthalmic drugs. Even those with the same chemical base and prescribed for the same condition may have different storage requirements. For example, some pilocarpine preparations, used to treat glaucoma, require refrigeration; others are best stored at room temperature. 9 Aerosol cans Do not store near open flames or intense heat. Don't discard in fire or incinerator. Heated aerosol cans explode. G N References: See page 441.
New Drugs A preview of agents, some with considerable promise for benefiting many older adults. BETSY TODD W h a t new drugs may be prescribed for your older patients in the near future? At this point, only a handful Of real pharmaceutical advances seem to be on the horizon, but many new drugs are on the market or coming soon. Antiinflammatory
Several new agents are available or will be shortly. Only o n e - - a n Betsy Todd, R.N., B.S., is a part-time staff nurse at Cabrini Medical Center, New York. N.Y., and a lecturer/consultant on drug use among elderly persons. For their review of this article, the author thanks Kazuo Kimura, Ph.D., M.D., associate chief for research and development, Wright State University School of Medicine, Dayton, Ohio, and Marcus Reidenberg, M.D., professor of medicine and pharmacology, Cornr University Medical College, New York, N.Y.
oral gold preparation--offers a sig- accumulation and toxicity in the nificant advance over drugs that elderly. Research on other drugs are already in use. h a s shown that half-lives may be Auranofin (Ridaura, Smith doubled or even tripled in older Kiine and French) is an oral form adults. Zomepirac is a chemical relative of gold that may be on the market within two years. It promises of tolmetin (Tolectin). According greater convenience and less toxici- to some studies, a 100 mg. oral dose ty than injectable gold salts, and of Zomepirac provides pain relief should prove helpful for people similar to 10 mg. of injectable morwith moderate to severe arthritis. phine but without morphine's potential for addiction. Zomepirac is The Food and Drug Administration recently approved two nonste- especially good for short-term use roid, antiinflammatory agents: me- (a few days). clofenamate (Meclomen, ParkeIts antiinflammatory effectiveDavis) and zomepirac (Zomax, ness in treating arthritis will have McNeil). A third drug, piroxicam to be evaluated over time. In addi(Feldene, Pfizer), is still an investi- tion to GI side effects similar to asgational agent in the United pirin's, zomepirae is known to affect the central nervous system, States. Meclofen~/mate has a high inci- urinary tract, and circ.ulation. dence of gastrointestinal side efAntimicrobiai fects, including the possibility of severe diarrhea, and it is not recomT h e most exciting recent admended as the drug of first vance in antimicrobial therapy has been the pneumococcal vaccine choice. Piroxicam, with a half-life of 45 (Pneumovax, Merck Sharp and hours, has the advantage of once- D o h m e ) . This prophylactic drug a-day dosage. However, its long could significantly lower the incihalf-life may cause p r o b l e m s with dence of pneumococcal pneumonia
A new supply of Aminophylline was ordered. The nurse stored it at room temperature, and Ms. Martin's breathing difficulty subsided.
Daniel Hernandez, age 72, was preparing for a walk, his third of the week. It had been three months It is easy to overlook the impor- since his myocardial infarct, and on tance of storing drugs properly, as his physician's advice he had begun 'the experiences of two clients illus- a n exercise program. trate. " I ' d better take a few nitro pills When Anna Martin was in the with me," Mr. H e r n a n d e z said to hospital for treatment of a broken his wife, remembering that his hip, breathing problems caused by clinic nurse, Steven Presser, had -her emphysema were successfully suggested always keeping a supply controlled with liquid theophylline at hand. ethylenediamine (Aminophylline). A m o n t h b e f o r e , Mr. H e r n a n d e z Slow recovery from hip reconstruc- had removed four tablets from the tion led to Ms. Martin's placement brown glass bottle a n d wrapped in a nursing home. T h e r e a nurse, them in a handkerchief. Now he Maria Burns, r e g u l a r l y a d m i n i s put the handkerchief in his pants tered Aminophylline as prescribed, pocket, thinking that the pills but Ms. Martin's respirations grew would be easy to get at if he needed steadily more labored. them while most of his medicine Ms. Burns reported the patient's would still be safe at home. dyspnea, took nursing measures to Like m a n y people starting to exincrease her comfort, and called on ercise, Daniel H e r n a n d e z overdid it the home's consulting pharmacist that day. After walking a mile and for a medication review. a half at a brisk pace, he felt tired, When the pharmacist asked to anxious, and achy in the chest. see all of the patient's medications, With a fair degree of composure, Ms. Burns took analgesics and car- he fished out his nitroglycerin and let diovascular drugs from a medicine one tablet melt under his tongue. N o drawer and removed the Amino- effect. Another tablet, and a third phylline from the refrigerator. Ex- and fourth--still no relief. Now amining the Aminophylline, the very frightened, he called to a teenpharmacist noted crystals at the ager nearby, who drove him to the bottom of the bottle. nearest hospital. " I t looks as though much of the Meeting with Mr. H e r n a n d e z at active agent has crystalized out," the clinic two weeks later, Steven she told the nurse. " W h a t ~,ou've Presser realized he had never told been giving Ms. Martin is mostly his patient how important it is to the inactive liquid base. Amino- protect the potency of nitroglycerphylline is one liquid medication in. "It's extremely sensitive to light, moisture, and heat," Presser now that should not be refrigerated." explained. " K e e p it in the brown glass bottle, tightly sealed, and Robert Skeist, R.N., is manager and Grace Carlson, R.N., B.S.N., is health educator, when you go out carry it in an outSenior's Health Program, Augustana tlos- side jacket p a c k e t or a bag hung from your shoulder." pital and Health Care Center, Chicago. ROBERT SKEIST GRACE CARLSON
These two vignettes, the following guidelines, and the chart "Spe- cial Storage Requirements for Selected Drugs" provide basic information to ensure safe storage.
General Guidelines M a n y pharmaceutical preparations undergo chemical changes and lose potency if overexposed to heat, light, or humidity. Ingesting certain drugs--aspirin, for examp i e - - i f they have been stored improperly may cause the patient harm Or discomfort. Unless otherwise specified, store drugs in a cool, dry place, away from direct natural or artificial light, in their original and tightly sealed containers, and clearly labeled. Some drugs require refrigeration to prolong their storage life, but do not refrigerate a medication unless specifically advised to do so by the manufacturer, pharmacist, or another trustworthy source(1). Refrigeration exposes drugs to high humidity and may cause precipitation of active ingredients from certain suspensions. Phenylpropanolamine HC1 (Ornade), prochlorperazine (Compazine), and chlorpromazine (Thorazine) spansules are three drugs n o t to refrigerate. In an institution, see that the medicine cabinet or cart is not placed by a radiator or a sunny window. Ask your p h a r m a c y for the expiration dates of stock medications. To keep stocks current,'use up old supplies before dispensing from the newest batch(2). Advise your patients who are going home or ihose you meet in community settings not to store drugs in their medicine cabinets. Because most medicine cabinets are located above bathroom sinks, drugs stored there are exposed to a high degree of humidity and heat. For the same
STORAGE REQUIREMENi S t o r e In R e f r i g e r a t o r theophylline ethylenedlamine (AminophyUlne) suppositories; bronchodilator. Refrigerate if in cocoa butter base. ampJciltln _ _ antibiotic. Refrigerate orsI suspension up to 2 weeks or store at room temperature 1 week. amoxicNin (Larotid) antibiotic. Refrigerate suspension and drops up to 2 weeks or store at room temperature t week. eephalexJn (Keflex) antibiotic. Refrigerate suspension up to 2 weeks. chloq)romszine (Thoraz~o) suppositories; antipsychotic, antlemetic. ery~romyctn _
_
antibiotic. Refrigerate IM suspension up to 1 week.
folio acid (Vitamin B Complex). Reffigerate solution. insulin ~ antidlabetic. Once opened, reMgerate at 2 ~ to 8~ (35.6 ~ to 48.4~ foe up to 3 months, or stere at room temperature for Up to I month. Do not freeze. penicillin _ _ antibiotic. Refrigerate suspension up to 2 weeks or store at room temperature 7 days. prochiorperazine (Compazine) suppositories; antiemetic, antipsychoUc trknothobanzaJ~de I - ~ (T~sn) suppositories; entiemetin
Do N o t R e f r i g e r a t e
:.
aminophylline liquid and injectable _ belladonna tincture
_
bronchodilater
cholinerglc blocking agent
B-complex end C vitamins (Bejectsl with C) vttam~ replacement B and C vitamins (A]bee with C) vitamin supplement csmphorsted opium tincture (Psregodc) 8nUdiarThesi cascara sagrada _
_
cathartic
chiorphenkamine maleate, i ~ e n y l p r u p ~ tant
(Or nsde) spsnsuie, deconges-
chtorpromazJne (Thoraz~e) Upansuie, antipsychctic. 8nUemetin hnosemido (Lsslx) injection, tin=eric glyceryt guslacolate (Tlobifussin) syrup, expectorant hydmlazine HCI (Apresoline) injection, antihypertenslve hydromorphone HCI (Dilandid) syrup and injection, narcotic analgesic hydroxyztne HCI (Atarax) syrup, antlanxla~ irnilxsmine HCI ('rofranJl) injection, t~'yclic antldepreMant levothyroxine (Synthroid) synthetlo thyroid preparation potassJum chloride liquid ~
pota~_,~,._.,mreplacement
reserpine (SerpasU) injection, antihypetlensive theuphyUine (Elixophygin) Ixonchodilator tdamclnolone d'mcetate (Adstocort Psranteral Forte) injection, glucocorticoid, antllnflammatorj v l t a n ~ B~= Injection ~
vitamin supplement
reason, avoid medication storage anywhere in the bathroom, "the worst place in the h o m e to store drugs," according to pharmacist Steven Strauss(3). Don't store drugs on the television set, radiator cover, or w i n d o w sills. If there are children or pets at home, store medications out o f their reach, preferably in a locked
cabinet. Good storage places at home include shelves in a kitchen cupboard a~vay from the Stove or steam, and dresser drawers in the bedroom. Keep medications, especially those that come in dark or glass containers, in their original containers. Placing several different drugs in one bottle or pill box is not
advisable. Such a practice may lead to chemical changes in certain medications and to confusion about the identity of each pill. Advise older adults living in the community to shop at pharmacies that have a high turnover of OTC and prescription drugs. Generally, the expiration dates for OTC products appear on the labels. It is sen-
FOR SELECTED DRUGS" A d m i n i s t e r P a r e n t e r a l SoluUons PrompUy a f t e r P r e p a r a t i o n ampioillin
antibiotic. Use within 1 hour.
chlordiazepoxide hydroctdoride (LibritmO sntlanxiety. Use promptly, discard unused solution. methylprednisolone OAedroi) antiinflammatory, antiallerglc Use within 48 houm nitrofurentoin OAaorodantin) urinary antibacterial. Use promptly; discard unused solution. tetracycibles ~
antibiotic. Use within 24 horn's.
warladn sodium (Coumadin) anticoagulant. Use within several days when stored at 4"C (39 2"F)
Particularly I m p o r t a n t t o P r o t e c t f r o m
Ught
camphorated opium tincture (Paregoric) antidlarrheal cl'~orpromazine Ohorazine) antipsychoflc, entlemetio diazepam (Valhun) antianxlaty, skeletal muscle relaxant dlgoxin (Lanoxin) cardiotonic ephedrine, theophylline (Mamx) bronchodilator epinephrine (Adrenalin Chloride) sympathomimetic furosemlde (Lasix) dJuretio imipramine hydroctdoride (Tofrerfil) tricycUc antidepressant indometha~n Ondocin) antiinflammalory, analgesic nitroglycerin _
_
~oronary vasodilator
nystatin (Myo0statin) antifungal prochlorperazine (Compazine injection or concentrate) antlametic, ant/psychotic qutnidJoa sulfate _
_
antlarrhythmJc
tl'doddazine (Melladl) antipsychottc thyroid ~
thyroid replacement
tdfluoperezine (Stekudne liquid) antipsychotlc, anfiemetic vitamins--all
Particularly I m p o r t a n t t o D i s c a r d If O u t d a t e d 9scetylsalioyflc acid (Aspire) anffinflammatow, analgesic, sntipyretio. Decomposition changes drug to saUc~dic acid and acetic acid, which are even more initating to stomach.
tetracydines ~ drag.
antibiotic. Renal injury has resulted from use of outdated
'Drugs are listed by genetic name, with brand name in parentheses. For drugs with multiple brand names, a line replaces the brand name. All lists include representative examples. No list is induslve.
sible to ask the pharmacist how long a prescription drug m a y be used, and to write the expiration date on the label. Strauss n o t e s , that expiration dates are valid only when drugs are stored properly in the home. Expiration dates differ, he points out, from one drug to another, from batch to batch of the same drug,
and from one m a n u f a c t u r e r to another. Some products can be used over a long period, others only for a short time. Some antibiotics, for example, m a y not begin to deteriorate for months or years if stored properly; others m a y start to spoil after a week(4). Some medicine cabinets we've seen in Chicago would be fitting
stops on a historical tour. Pills from years back are saved "just in case." In case, that is, the doctor prescribes them again, the pain returns, or a friend develops symptoms "'like when I was ill and these yellow tablets did the trick." During a home visit, the community nurse should survey all medications on hand and, with the
client's consent, discard anything over two years old, pills for conditions that have cleared up, any drug past its expiration date, and any that has changed its color or odor. W e recommend storing special formulations as follows: 9 Rectal suppositories Store in a cool dry place. If too soft to insert, place under cold tap water until firmer, or briefly in the r e f r i g e r a t o r (not freezer). 9 Nasal spray Wash spray tip with hot s o a p y w a t e r , rinse, and dry with a clean tissue after each use. This advice applies to nose droppers, eye droppers, vaginal-suppository inserters, and other items that
come in contact with body orifices. 9 Inhalants Store inhalants for asthma and other pulmonary conditions at room temperature, away from open flames or direct heat. 9 Liquids Discard if discolored unless m a n u f a c t u r e r or pharmacist states that a change in color for a specific drug is harmless. Consult your pharmacist if you note unexpected precipitates in liquid suspensions. Active ingredients may have left the solution. Dilute or reconstitute liquids in the exact a m o u n t needed and just before administering, because most liquids are less stable after these procedures.
Do not return medications, once poured, to the storage container. Check manufacturers' instructions for storing ophthalmic drugs. Even those with the same chemical base and prescribed for the same condition may have different storage requirements. For example, some pilocarpine preparations, used to treat glaucoma, require refrigeration; others are best stored at room temperature. 9 Aerosol cans Do not store near open flames or intense heat. Don't discard in fire or incinerator. Heated aerosol cans explode. G N References: See page 441.
New Drugs A preview of agents, some with considerable promise for benefiting many older adults. BETSY TODD W h a t new drugs may be prescribed for your older patients in the near future? At this point, only a handful Of real pharmaceutical advances seem to be on the horizon, but many new drugs are on the market or coming soon. Antiinflammatory
Several new agents are available or will be shortly. Only o n e - - a n Betsy Todd, R.N., B.S., is a part-time staff nurse at Cabrini Medical Center, New York. N.Y., and a lecturer/consultant on drug use among elderly persons. For their review of this article, the author thanks Kazuo Kimura, Ph.D., M.D., associate chief for research and development, Wright State University School of Medicine, Dayton, Ohio, and Marcus Reidenberg, M.D., professor of medicine and pharmacology, Cornr University Medical College, New York, N.Y.
oral gold preparation--offers a sig- accumulation and toxicity in the nificant advance over drugs that elderly. Research on other drugs are already in use. h a s shown that half-lives may be Auranofin (Ridaura, Smith doubled or even tripled in older Kiine and French) is an oral form adults. Zomepirac is a chemical relative of gold that may be on the market within two years. It promises of tolmetin (Tolectin). According greater convenience and less toxici- to some studies, a 100 mg. oral dose ty than injectable gold salts, and of Zomepirac provides pain relief should prove helpful for people similar to 10 mg. of injectable morwith moderate to severe arthritis. phine but without morphine's potential for addiction. Zomepirac is The Food and Drug Administration recently approved two nonste- especially good for short-term use roid, antiinflammatory agents: me- (a few days). clofenamate (Meclomen, ParkeIts antiinflammatory effectiveDavis) and zomepirac (Zomax, ness in treating arthritis will have McNeil). A third drug, piroxicam to be evaluated over time. In addi(Feldene, Pfizer), is still an investi- tion to GI side effects similar to asgational agent in the United pirin's, zomepirae is known to affect the central nervous system, States. Meclofen~/mate has a high inci- urinary tract, and circ.ulation. dence of gastrointestinal side efAntimicrobiai fects, including the possibility of severe diarrhea, and it is not recomT h e most exciting recent admended as the drug of first vance in antimicrobial therapy has been the pneumococcal vaccine choice. Piroxicam, with a half-life of 45 (Pneumovax, Merck Sharp and hours, has the advantage of once- D o h m e ) . This prophylactic drug a-day dosage. However, its long could significantly lower the incihalf-life may cause p r o b l e m s with dence of pneumococcal pneumonia