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Battery-powered relief

One of my patients has been prescribed a sumatriptan transdermal patch for migraine. What do I need to know about this unique drug delivery system? -L.J., MASS.

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FDA-approved for treating migraine headaches, the sumatriptan iontophoretic transdermal system (Zecuity) is a battery-powered patch indicated for acute treatment of migraine with or without an aura in adults. To use this drug delivery system, the patient applies a patch to dry, intact, nonirritated skin of the upper arm or thigh at the onset of migraine symptoms and presses a button to deliver a 6.5-mg dose of sumatriptan, which is absorbed through the skin over 4 hours. An activation light signals drug delivery; when it turns off, the patient removes the patch and disposes of it according to state and local regulations. If pain continues or returns, the patient can apply a new patch to the opposite arm or leg and administer a second dose, but no sooner than 2 hours after the first dose. The patient should take no more than 2 doses in a 24-hour period. Consult the product insert for more information.



Zecuity (sumatriptan ionophoetic transdermal system). Prescribing information.



Keeping the medical record under wraps

I'm caring for an older adult with advanced Alzheimer disease who was admitted to the hospital with pneumonia and malnutrition. She lives with her son, who has her power of attorney for healthcare. Suspecting elder abuse or neglect, the patient's healthcare provider is refusing to let the son see her medical record. Doesn't the Healthcare Insurance Portability and Accountability Act (HIPAA) require the provider to grant him access?-D.E., N.Y.


Not necessarily. As a general rule, someone with power of attorney for healthcare is considered the patient's personal representative and thus entitled to full access to the patient's medical records. But if the patient's healthcare provider suspects that the patient is a victim of domestic violence, abuse, or neglect by the personal representative, he or she "may choose not to treat that person as the individual's personal representative, if in the exercise of professional judgment, doing so would not be in the best interests of the individual."1 Under HIPAA, this exception also applies to suspected child abuse or neglect.



1. U.S. Department of Health and Human Services. Health information privacy. [Context Link]



Clearing secretions like magic

After my patient underwent sinus surgery, her surgeon said she could use a neti pot to help keep her nasal passages clear. What's this device and how does it work?-K.V., ILL.


Designed for mechanical nasal irrigation, the neti pot is a small plastic or ceramic device that may resemble a little teapot or Aladdin's magic lamp. The pot may be packaged with a powdered saline mixture that patients reconstitute with water before use, or patients can make their own saline solutions. The patient places the pot's tip snugly against one nostril and, while tilting the head away from the pot, allows the solution to flow gently into the nostril until solution exits from the opposite nostril. The process is repeated for the opposite nostril.


Although the neti pot is generally safe and effective for clearing nasal secretions, warn the patient to take precautions to prevent infections. In 2011, two deaths from amebic encephalitis were linked to improper use of neti pots.1


Per the CDC and FDA, the saline solution must be made with distilled, filtered, sterile, or boiled and cooled water-not tap water unless it's been filtered or boiled. Boiled water can be safely stored in a clean closed container for up to 24 hours before use. The pot should be rinsed with safe water after use and allowed to air dry. Patients should discard or replace the pot after several months of use as directed by the manufacturer.1-3




1. FDA. Is rinsing your sinuses safe? 2013. [Context Link]


2. CDC. Sinus rinsing and Neti pots.


3. Li JTC. What is a Neti pot? And why would you use one? 2012. Mayo Clinic. [Context Link]