(2) basic pharmacology 2

8/2/2019 (2) Basic Pharmacology 2

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DGN 109 THERAPEUTIC

INTERVENTION

Basic Pharmacology -Drug

Administration

Fazdillah Husin

3/1/2008


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Learning Objectives

1. State the types of parenteral administration.

2. Explain each type of parenteraladministration.

3. Explain the differences between each typeof parenteral administration.

4. Identify the volume of medication to be given

for each type.5. Aware the correct administration of

medication.


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Drug administration

Drug therapy can be administered byseveral different routes or methods.

These routes of administration requiredifferent preparations or forms of a drug.


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Drug administration routes

Enteral route

Parenteral route

Topical route


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Enteral route

Uses the GI tract for the ingestion andabsorption

Method : oral, nasogastric tube,gastrostomy tube

Oral drug forms : tablet, troches,

capsules, syrups, elixirs, emulsions


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Parenteral route

Administered by a syringe, needle orcatheter.

Method Intradermal (ID) Intramuscular (IM)

Subcutaneous (SC)

Intravenous (IV)

Intrathecal (IT)


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Intradermal

Injections are made into the dermis justbelow the epidermis

A small needle (25G - 27G) and smallvolume syringes (1ml) are used.

Angle of needle insertion for administering

a ID - 150


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Sites of ID injection

Anterior upper chest

Scapula area

Arm


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Subcutaneous

Drugs are administered under the skin into fatand connective tissue.

Low volume (less than 1 ml).

Do not inject more than 1 ml of fluid into SCtissue :

- not comfortable

- absorption not good The SC route used for insulin, vaccine, heparin

and narcotics.


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Injection site (S/C)

Outer layer of upper arm

Anterior aspect of thigh

Abdomen

The upper back of the scapula becausethe skin is thinner there


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SC injection site pg 38


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Intramuscular

Involves injecting drugs into certainmuscle.

Requires specific knowledge of anatomyand aseptic technique.

Amount of drug : 1.5 ml 5 ml

If the dose more than 5ml (adult) and 3 ml(children), divide the dose into 2


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Absorption

Faster than SC

Blood supply better

There are few factors that will be affect

the absoption


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Factors contributing the absorption

Injection site that good blood supply

(deltoid compare gluteal)

Tissue damage, bruise, less musclevolume.

Others massage,warm compress,

vasodilation drugs.


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IM injection sites:

Dorsal gluteal

Ventral gluteal

deltoid

vastus lateralis

and rectus femoris


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Dorsogluteal

The drug injected to gluteus medius muscle(otot tebal di punggung)

Late absorption compare to other muscle.

High risk for sciatic nerve injury, gluteal arteryand bone.

Children below 3 years have higher risk due to

small muscle. Normally, used this muscle for the drugs that

irritate skin and concentrated


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Dorsogluteal

First method

Palpate posterior superior iliac spine and

greater trochanter Do imaginary line between posterior

superior iliac spine and greater trochanter

Injection site at lateral and slightlysuperior to the midpoint of the thigh.


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Dorsogluteal

Second method

Do vertical imaginary line based on crest

of the ileum and gluteal fold Do horizontal imaginary line from medial

fold to lateral aspect of buttock

Give injection at upper outer quadrant


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position

Expose buttock to identify site of injection

Two positions

1. A prone position with the toes pointed inward.2. A lateral position with the upper leg acutely

flexed

Avoid giving injection on standing position.


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ventrogluteal

The drug inject into gluteal minismusmuscle.

For adult and children Advantages :

1. no nerve and big blood supply

2. A far from bone3. Clean (no contaminated stool)

4. Variety


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ventrogluteal

Place a palm to greater trochanter

Use right hand for left buttock and the other way

to search anatomical site. Open index finger and middle finger to make a

V shape from anterior superior illiac spine to

below illiac crest.Jarakkan jari telunjuk dan jari tengah

untuk membentuk V dari anterior superior iliac spine kebetul-betul bawah iliac crest.

Injection site is inside the triangle.


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Deltoid

A drug was injected into deltoid muscle.

Where? Lateral aspect of upper lengan

For adult only Disadvantages :

1. Small muscle (cannot absorb fluid more

than 1 ml)2. Risk for nerve injury and damage of

radial artery


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Deltoid

Palpate at the end of lower acromionprocess.

Palpate the middle dot aspect of lateralarm that same level with axilla.

The triangle within this boundary is

deltoid muscle that is about 5 cm belowacromion process.


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Vastus lateralis

The muscle that covered anterolateral aspectof the thigh

This site is recommended for small childrenand infant whose gluteal muscle is stillundeveloped

Advantages

1. No nerve and big blood supply2. Not covered by joint

3. The site of injection is wide.


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Vastus lateralis

Divide the thigh into 3 divisions vertically

Divide the thigh into 3 divisions

horizontally(between the big trochanter of femur andlateral condile femoral

Injection at middle site.


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Rectus femoris

Anterior of the thigh

Last choice site of injection


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How to choose needle size?

20 -22 G for IM

16 18 G for drug dilution

23 26 G for children and ID


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Characteristics of good muscle

No tenderness

Not tense and hard


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What is IV therapy?

IV therapy is the administration of fluids,

electrolytes, nutrients or medications bythe venous route.


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Intravenous

The fastest way to deliver fluids andmedications throughout the body.

Access device peripheral IV lines

central IV lines

Peripherally inserted

central catheter (PICC)

Central venous catheter(CVC)

Implantable ports


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Types of solutions

IV solution Tonicity

0.9% Saline Isotonic

0.45% Saline Hypotonic

5% Dextrose in 0.9%

Saline

Hypertonic

5% Dextrose in 0.45%Saline

Hypertonic

Ringers Lactate Isotonic


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Intravenous


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Intravenous- tripple lumen


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Intravenous -hickman catheter


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Central venous catheter

A catheter inserted into superior vena

cava to permit intermittent or continuousmonitoring of central venous pressure, toadminister medications or nutrition.


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IV complications

Local

Pain

Sepsis Thrombosis

Infiltration

Extravasation Phlebitis

Systemic

Air embolism

Circulatory overload Anaphylaxis


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What to avoid?

Vein in feet and legs

Areas of flexion

Previous IV site

Injured or surgically compromised area


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Topical route

Applying drug preparations to the skin ormucous membranes including eyes, ears,

nose, rectum, vagina and lungs. Usually act locally, some have systemic

effects.

Example : antiseptics, antifungals,antipyretics, antibiotics.


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Form of drugs for topical route

Skin : lotion, creams, liquids. Ointments

Eye : drops, ointments

Ear : drops Rectum : suppositories, ointments

Vagina : suppositories, creams, forms,

liquids, tablets Nose : liquid sprays, drops, aerosol

Lungs : inhaler


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conclusion

The three routes of drug administration areenteral, parenteral and topical.

The drug route may produce systemic effects,local effects or both.

Onset of drug action is more rapid withparenteral than with the enteral route.

Patient characteristics and drug characteristicsare considered when selecting site for IM.


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Any question?

Thank You

(2) basic pharmacology 2

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