basic pharmacology for nurses 01

2NUR 106: Course ScheduleNUR 106: Course Schedule 1/24: Ch: 1,2 1/31: Ch: 3,7,8 2/7: Ch: 9, 10 2/14: Exam 1 2/21: Ch: 11,12, 142/21: Ch: 11,12, 14 2/28: Ch: 16,20,23 3/7: Ch: 25,29 3/14: Exam 2

Slide 4Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc .

NUR 106: Course Schedule ContdNUR 106: Course Schedule Contd

3/21: Ch: 30,33 3/28: Ch: 34,35 4/4: No Classes 4/11: 27,36 4/18: Exam 34/18: Exam 3 4/25: Ch: 42, 46 5/2: Ch: 48 5/9: Last Day of Class- Exam 4


Chapter 1Chapter 1Definitions, Names, Standards, and Informational Sources


Foundations of Pharmacology

3Types of Drug Names:Types of Drug Names:

Chemical

Generic

Official


Trademark (brand)

Proprietary

CHEMICAL NAMECHEMICAL NAME


Sources of Drug InformationSources of Drug Information American Drug Index American Hospital Formulary Service Drug Interaction Facts Drug Facts and Comparisons Handbook on Injectable Drugs


Handbook on Injectable Drugs Handbook of Nonprescription Drugs MartindaleThe Complete Drug Reference Package inserts Natural Medicines Comprehensive Database Physicians Desk Reference (PDR) Nursing journals

4Sources of Patient Sources of Patient InformationInformation

United States Pharmacopeia Dispensing Information (USPDI)


Therapeutic Choices

U.S. Drug LegislationU.S. Drug Legislation

Federal Food, Drug, and Cosmetic Act (1938, 1952, 1962)


Controlled Substances Act (1970)

Foundations of Pharmacology Foundations of Pharmacology

Drug review process


5Chapter 2Chapter 2Principles of Drug Action and Drug Interactions

Slide 1Mosby items and derived items 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Basic principlesBasic principles

A strong understanding of the human bodys processes are important to grasp drug actions and drug interactions in the body

Slide 14Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Examples:Examples:

Antagonistbeta blockers

Agonistepinephrine


Partial agonistpentazocine

6Drug Stages After AdministrationDrug Stages After Administration

Absorption

Distribution


Metabolism

Excretion

Categories of Drug Administration

Enteral route: PO, Rectal, NG

Parenteral route: subQ, IM, IV

Percutaneous route: inhalation, sublingual,Percutaneous route: inhalation, sublingual, topical

HalfHalf--life of Drugslife of Drugs

Factors modifying the quantity of drug reaching a site of action after a single oral dose


7Terms used in relationship to Terms used in relationship to medicationsmedications

Desired action

Side effects/ Adverse effects

Allergic reactions: i.e. hives, urticaria

Idiosyncratic reactions

Carcinogenicity

TeratogenSlide 19

Copyright 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc.

Principles of Drug Action and Principles of Drug Action and Drug InteractionsDrug Interactions

Desired effect: when a drug enters a patient, is absorbed and distributed, and produces the expected response

Adverse effect: Any noxious, unintended and d i d ff t f d hi h t


undesired effect of a drug, which occurs at doses used in humans for prophylaxis, diagnosis or therapy (World Health Organization)

Principles of Drug Action and Principles of Drug Action and Drug Interactions (contd)Drug Interactions (contd)

Drug interaction

Drug interactions represent 3% to 6% of preventable in-hospital adverse drug reaction cases


cases

Drug interactions are a major component of the number of hospital emergency department visits and admissions

8Factors Influencing Drug Action

Age Body weight Metabolic rate Illness Psycological aspectsPsycological aspects Tolerance Drug dependence Cumulative effect

Chapter 3 Chapter 3 Drug Action Across the Life Span


Drug Action Across the Life SpanDrug Action Across the Life Span

Age and gender affect drug therapy

Gender-specific medicine

A d l i i th t t di th


A developing science that studies the differences in the normal function of men and women and how people of each sex perceive and experience disease

9Across The Life SpanAge

10

Drug Absorption: Age ConsiderationsDrug Absorption: Age Considerations

Topical administration in infants is effective because:

Outer layer of skin (stratum corneum) not fully de eloped


developed

Skin more fully hydrated; plastic diaper increases skin hydration

Inflammation (diaper rash) increases absorption


Difficult to predict in geriatric patients

Dermal thickness decreases with age and may enhance absorption


Drying, wrinkling, and decreased hair follicles decrease absorption

Decreased cardiac output and diminishing tissue perfusion also affect absorption


Gastrointestinal absorption influenced by:

Gastric pH


Gastric emptying time

Enzymatic activity

Blood flow of mucous lining and intestines

11

Drug Absorption: Gender ConsiderationsDrug Absorption: Gender Considerations

Increased potential for toxicity and slower absorption times in women

Empty solids more slowly


Have greater gastric acidity

Have lower gastric levels of alcohol dehydrogenase needed to metabolize alcohols

Drug DistributionDrug Distribution Depends on pH, body water concentrations,

presence and quantity of fat tissue, protein binding, cardiac output, and regional blood flow

I f t h l l f t t t


Infants have larger volume of water content and require higher dose

With age, total body water decreases and fat increases

Drug DistributionDrug Distribution

Highly fat-soluble drugs take longer to act and accumulate in fat tissues, increasing potential for toxicity

P i bi di


Protein binding Drugs that are relatively insoluble are

transported in circulation by binding to plasma proteins

12

Drug DistributionDrug Distribution

Age considerations Some drugs have lower protein binding in

neonates and require larger loading dose Albumin levels decrease with age


Gender considerations Some differences between men and

women in globulin proteins

Drug MetabolismDrug Metabolism Drug metabolism

Process by which the body inactivates medicine


Affected by genes, diet, age & maturity of enzyme systems

Liver weight and hepatic blood flow decrease with age

Routes of Medication Excretion Routes of Medication Excretion

Primary Routes Renal tubules: into the urine GI tract: through feces

Minor RoutesMinor Routes Evaporation: through skin Exhalation: from the lungs Secretion: in saliva & breast milk


13

Drug ExcretionDrug Excretion

Metabolites of drugs (and sometimes the drug itself) eventually excreted

Preterm infant has 15% of adult renal


capacity; fully functional by 9 to 12 months

Drug Excretion (contd)Drug Excretion (contd)

Decreased renal function with age

No prediction of renal function can be based solely on age because of wide individual


y gvariation in changes

Percentages of Body WaterPercentages of Body Water


14

Therapeutic Drug MonitoringTherapeutic Drug Monitoring

Entails measurement of a drugs concentration in biologic fluids to correlate the dosage administered and the level of medicine in the body with the pharmacologic response


Timing of drugs administration and collection of specimen are crucial to accurate interpretation

Use of Monitoring ParametersUse of Monitoring Parameters

Before administering medicine, assess expected therapeutic actions, side effects, reportable adverse effects, probable drug interactions


Monitoring parameters related to patients age

Monitoring Parameters:Monitoring Parameters:Pediatric PatientsPediatric Patients

Infants and young children more susceptible to dehydration

Weight variation affects dosage


g g

Aspirin never to be administered to children

Allergic reactions occur rapidly in children, most commonly to antibiotics

15

Monitoring Parameters: Older Adult PatientsMonitoring Parameters: Older Adult Patients

Factors that place older patient at risk:

Reduced renal and hepatic function

Chronic illness


Polypharmacymultiple-drug therapy required by chronic illness

A greater likelihood of malnourishment due to polypharmacy

Monitoring Parameters: Older Adult PatientsMonitoring Parameters: Older Adult Patients

Drug therapy

Take thorough drug history and nutritional assessment Determine whether new symptoms have


y pbeen induced by existing medicines Gradually taper dosage when discontinuing

drug Start at one third to one half normal dosage

when initiating therapy; gradually increase Review regimen periodically

Potentially Inappropriate Medications Potentially Inappropriate Medications for Older Adult Patientsfor Older Adult Patients


16

Use of Monitoring Use of Monitoring Parameters: Pregnant WomenParameters: Pregnant Women

Avoid drugs if at all possible

When taking womans history, be alert to possibility of pregnancy

I i id d l h l


Instruct patient to avoid drugs, alcohol, tobacco

Try nonpharmacologic treatments before using medicines

Avoid herbal medicines

Drugs Known to Be Drugs Known to Be TeratogenicTeratogenic


Use of Monitoring Parameters: Use of Monitoring Parameters: BreastBreast--Feeding PatientsFeeding Patients

Some drugs are known to enter breast milk and harm nursing infant

Discuss all medications with physician


Take medicine immediately after breast-feeding or just before infants longest sleeping period

17

Chapter 7 Chapter 7 Principles of Medication Administration


Legal and Ethical Legal and Ethical ConsiderationsConsiderations

Standards of care: developed by the states nurse practice act, state and federal law, JCAHO, professional organizations

Before administering medication, nurse must have:

C t li t ti


Current license to practice Clear policy statement authorizing the act Signed medication order Understanding of rationale for drug use Understanding of drug action, dosing, dilution,

route and rate of administration, side effects, adverse effects to report, contraindications

Contents of Patient ChartsContents of Patient Charts

Summary sheet Consent forms Physicians order form History and physical exam form

P t


Progress notes Critical pathways Nurses notes Laboratory tests record

18

Contents of Patient ChartsContents of Patient Charts Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or


Medication administration record (MAR) or medication profile

PRN or unscheduled medication record Case management Patient education record

Legal and Ethical Legal and Ethical ConsiderationsConsiderations

Standards of care: developed by the states nurse practice act, state and federal law, JCAHO, professional organizations

Before administering medication, nurse must have:

C t li t ti


Current license to practice Clear policy statement authorizing the act Signed medication order Understanding of rationale for drug use Understanding of drug action, dosing, dilution,

route and rate of administration, side effects, adverse effects to report, contraindications

Contents of Patient ChartsContents of Patient Charts Summary sheet Consent forms Physicians order form History and physical exam form Progress notes


Progress notes Critical pathways Nurses notes Laboratory tests record

19

Contents of Patient Charts Contents of Patient Charts (contd)(contd)

Graphic record Flow sheets Consultation reports Other diagnostic reports Medication administration record (MAR) or


Medication administration record (MAR) or medication profile

PRN or unscheduled medication record Case management Patient education record

The KardexThe Kardex


Drug Distribution SystemsDrug Distribution Systems

Floor or ward stock system

Individual prescription order system

C t t ll d di i t


Computer-controlled dispensing system

Unit dose system

Long-term care unit dose system

20

Narcotic Control SystemsNarcotic Control Systems


The Drug OrderThe Drug Order Stat order

Standing order

Renewal order


PRN order

Verbal orders

Electronic transmission of patient orders

Medication ErrorsMedication Errors Prescribing errors

Transcription errors

Dispensing errors


Dispensing errors

Administration errors

Monitoring errors

21

Nurse ResponsibilitiesNurse Responsibilities Verification Nurse makes professional judgment regarding

acceptability and safety of the drug order, including type of drug, dose and dose preparation, therapeutic intent, route, potential allergic reactions, or contraindications


allergic reactions, or contraindications

Transcription Nurse is responsible for verification of orders

transcribed by others

The Six RightsThe Six Rights 1. Right drug Compare exact spelling and concentration of

drug with medication card and drug container; drug label should be read three times

2. Right time


g Standard abbreviations Standardized administration times Maintenance of consistent blood levels Maximum drug absorption Diagnostic testing PRN medications

The Six Rights (contd)The Six Rights (contd) 3. Right dose Abnormal hepatic or renal function Nausea and vomiting Accurate dose forms Accurate calculations Correct measuring devices


Correct measuring devices

4. Right patient Bracelet checking Pediatric and older adult patients

22

The Six RightsThe Six Rights 5. Right route IV route Intramuscular route Intravenous route Subcutaneous route Oral route


Oral route

6. Right documentation Safety/ethical considerations Legal considerations Always include date/time, drug name, dose,

route, site of administration

Special Documentation Special Documentation CircumstancesCircumstances

Patient refuses medication Thoroughly record incident and reason for

refusal in nurses notes Notify physician


Medication error occurs Notify physician Complete incident report

Chapter 8Chapter 8Percutaneous Administration


23

Percutaneous AdministrationPercutaneous Administration Application of medications to the skin or

mucous membranes for absorption

Includes: Topical application of ointments, creams,

lotions or powders to the skin


lotions, or powders to the skin Inhalation of aerosolized liquids or gases Installation of solutions into the mucous

membranes of the mouth, eye, ear, nose, or vagina

Always follow the six rights of drug administration

PercutaneousPercutaneous AdministrationAdministration

Premedication assessment and explanation Patient teaching Hygiene requirements Proper application techniques and timing

Cautions particular to drug or drug


Cautions particular to drug or drug administration Side effects When to contact physician

PercutaneousPercutaneous AdministrationAdministration

Documentation

Date, time, drug, dosage, route


Record ongoing assessment data, including signs of adverse drug effects

24

Creams, Lotions, OintmentsCreams, Lotions, Ointments Wash hands, put on gloves, position patient

Clean area

Wear gloves


Shake lotion bottle; use tongue blade to remove desired amount of ointment or cream from container

Use dressings according to orders

Patch TestingPatch Testing Method to identify sensitivity to contact

materials (soaps, pollen, dyes)

Allergens on patch placed in contact with back, arms, or thighs


Patch left in place for 48 hours

Site aired for 15 minutes, then read

Emergency equipment must be available in case of anaphylactic response

Patch TestingPatch Testing Wash hands, put on gloves,position patient

Clean the area

Wear gloves


g

Apply dose-measuring applicator paper

Do not rub in ointment

Cover area with plastic wrap

25

Transdermal Drug DeliveryTransdermal Drug Delivery Disk or patch providing controlled release of

medication

Wash hands,put on gloves,position patient

Apply topical disk or patch


Apply topical disk or patch

Application frequency depends on drug

Wash hands after application

Label disk with time, date, nurse initials

Topical PowdersTopical Powders Particles of medication in a talc base

Wash hands, put on gloves

Position the patient


Position the patient

Wash and thoroughly dry area

Apply powder, smooth over area for even coverage

Sublingual and Buccal Sublingual and Buccal TabletsTablets

Sublingual tablets: placed under the tongue

Buccal tablets: held in the buccal cavity

Advantage: rapid absorption and onset of


Advantage: rapid absorption and onset of action

Action is usually systemic, rather than localized to the mouth

26

Eye Drops, Ointments, and Eye Drops, Ointments, and DisksDisks

OD (right eye), OS (left eye), OU (both eyes)

Wash hands, put on gloves,position patient

Inspect affected eye


Inspect affected eye

Expose lower conjunctival sac

Approach eye from below

Never touch eye with dropper, tube

Ear DropsEar Drops Ensure ear is clear of wax

Warm medication to room temperature

Younger than age 3: pull earlobe downward and back


and back

Older than age 3 and adults: pull earlobe upward and back

Patient should remain on side for a few minutes

Nose Drops, Nasal SprayNose Drops, Nasal Spray Patient should blow nose gently Nose drops Position patient lying down with head hanging

back Nose spray


Patient is upright Block one nostril Shake bottle and insert tip into nostril Spray while patient inhales

27

Nebulizers and InhalersNebulizers and Inhalers Nebulizers Prepare medication and fill nebulizer Patient exhales Put nebulizer in mouth; do not seal completely Patient inhales


Metered-dose inhalers Follow instructions on inhaler

Dry powder inhalers Follow instructions on inhaler

Vaginal MedicationsVaginal Medications Wash hands, put on gloves Fill applicator Place patient in lithotomy position, elevate

hips with pillow Spread labia and insert applicator or


p ppsuppository

Chapter 9Chapter 9Enteral Administration


28

Administration of Oral Administration of Oral MedicationsMedications

Enteral is direct administration to the GI tract Most drugs are available in oral dose forms: Capsulessmall, cylindrical gelatin containers

used to administer unpleasant tasting medications; timed-release capsules (provides a gradual and continuous release of the drug);


gradual and continuous release of the drug); lozenges or trochesflat disks in a flavored base

Tablets (powdered drugs that have been compressed)

Elixirsdrugs dissolved in water and alcohol Emulsions of water-in-oil or oil-in-water Liquid suspensions and syrups

Administration of Oral Administration of Oral MedicationsMedications

Common methods used to administer oral medications

Unit dose packaging providing a single dose Souffl cups Medicine cups


Medicine cups Medicine droppers Teaspoons Oral syringes: plastic syringes calibrated and used

to measure liquid medications Nipples with additional holes, used for infants

Administration of SolidAdministration of Solid--Form Form Oral MedicationsOral Medications

Two techniques for administering medications: the medication card and unit dose distribution

Perform premedication assessment in all cases

All techniques follow FIVE RIGHTS procedure:


All techniques follow FIVE RIGHTS procedure: RIGHT patient RIGHT drug RIGHT route of administration RIGHT dose RIGHT time of administration

ALWAYS check or recheck the FIVE RIGHTS

29


General principles apply to all distribution systems Give the most important medications first Do not touch the medication with your hands Encourage liquid intake to ensure swallowing

Remain with patient while medication is taken; DO


Remain with patient while medication is taken; DO NOT leave the medication at bedside unless an order to do so exists

Discard the medication container

Provide complete documentation of administration and responses to therapy


Documentation of medication administration and responses to drug therapy is called the Sixth Right

General principles apply to all medication administration Chart date, time, drug name, dosage, and route of

d i i t ti


administration Regularly record patient assessments to evaluate

therapeutic effectiveness Chart and report any sign of adverse drug effects

Perform and validate essential education about drug therapy and other aspects of intervention for the individual

Administration of LiquidAdministration of Liquid--Form Form Oral MedicationsOral Medications

General procedures are the same as with solid-form oral medications

Perform premedication assessment in all cases


All techniques follow the FIVE RIGHTS procedure

30

Administration of LiquidAdministration of Liquid--Form Form Oral Medications (contd)Oral Medications (contd)

General principles for infants, children, and adults Give adults and children the most important

medications first NEVER dilute medications without specific

orders. DO NOT leave a medication at the


bedside without an order to do so Check an infants ID and be certain the infant

is alert


Administration of LiquidAdministration of Liquid--Form Form Oral MedicationsOral Medications

Measuring techniques vary according to receptacle used

With a measuring cup: Cover label to prevent smearing; place

fingernail at exact level on measuring cup;


fingernail at exact level on measuring cup; read the volume at the level of meniscussee Figure 9-13. Recheck FIVE RIGHTS.

With an oral syringe: Select syringe of appropriate size. Draw up

prescribed volume of medication from bottle or medicine cup

Administration of Medications Administration of Medications by Nasogastric Tubeby Nasogastric Tube

Drugs are administered via NG tube for specific patients, using a liquid form whenever possible. Remember: Always flush the tube before and after

administration Perform premedication assessment


p Assemble equipment before administration

31

Administration of Medications Administration of Medications by Nasogastric Tube (contd)by Nasogastric Tube (contd)

Prepare doses as for administration of solid-form or liquid-liquid form oral medications

Three methods for checking NG tube location Follow procedure for administering

di i


medication DO NOT attach suction for 30+ minutes Provide complete documentation of

administration and responses to therapy

Administration of Enteral Feedings via Administration of Enteral Feedings via Gastrostomy of Jejunostomy TubeGastrostomy of Jejunostomy Tube

Enteral formulas are in several mixtures to meet individual needs

Assemble equipment beforehand Prescribed enteral formula should be

checked


Administration of Enteral Feedings Via Administration of Enteral Feedings Via Gastrostomy or Jejunostomy Tube (contd)Gastrostomy or Jejunostomy Tube (contd)

Formula should be fully labeled Discard unused formula every 24 hours Follow the guidelines specific for patients

receiving general nutrition via intermittent or


continuous feedings Follow FIVE RIGHTS RIGHT patient, RIGHT drug (formula), RIGHT

route of administration, RIGHT dose (amount, dilution, strength), RIGHT time

32

Administration of Enteral Feedings via Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube (contd)Gastrostomy or Jejunostomy Tube (contd)

Verify tube placement and initiate feeding Flush, then clamp tube Proceed with tube feeding technique Intermittent: use Toomey syringe


y y g Continuous: use disposable feeding container

and enough formula for a 4-hour period Provide complete documentation of

administration and responses to therapy

Administration of Rectal Administration of Rectal SuppositoriesSuppositories

Suppositories are solid medication designed to dissolve inside a body orifice

Equipment is simple: Finger cot or disposable glove Water-soluble lubricant

P ib d it


Prescribed suppository Perform standard premedication assessment

Administration of Rectal Administration of Rectal Suppositories (contd)Suppositories (contd)

Technique begins with FIVE RIGHTS Explain procedure and check pertinent

parameters Patient bends uppermost leg

A l l b i t t ti f it Pl


Apply lubricant to tip of suppository. Place suppository about 1 inch beyond orifice, past internal sphincter


33

Administration of a Disposable Administration of a Disposable EnemaEnema

The dose form will be a prepackaged, disposable-type enema solution

Equipment is simple Perform standard premedication assessment


Administration of a Disposable Administration of a Disposable Enema (contd)Enema (contd)

Technique begins with FIVE RIGHTS Explain procedure and check pertinent

parameters Time of last defecation

P ti t b d t l


Patient bends uppermost leg Apply lubricant to rectal tube Insert lubricated tube and insert solution


Parenteral AdministrationParenteral Administration Parenteral means drug administration by any

route other than the gastrointestinal tract

Parenteral route Intradermal


Subcutaneous Intramuscular (IM) Intravenous (IV)

34

Chapter 10Chapter 10Parenteral Administration: Safe Preparation of Parenteral Medications


Equipment Used in Parenteral Equipment Used in Parenteral AdministrationAdministration

The syringe has three parts: barrel, plunger, and tip

Syringes are calibrated in minims, milliliters, or cubic centimeters

Tuberculin syringes are used to measure ll l f di ti t l


small volumes of medication accurately

Equipment Used in Parenteral Equipment Used in Parenteral Administration (contd)Administration (contd)

The insulin syringe has a special scale for measuring insulin

In the United States, insulin is manufactured in U-100 concentration


in U-100 concentration The U-100 syringe holds 100 units of insulin

per milliliter Low-dose insulin syringes are used for

patients receiving 50 units or less of U-100 insulin

35


Prefilled syringes are disposable and have a premeasured amount of medication

Advantages: time saved in preparation, less h f t i ti


chance of contamination

Disadvantages: additional expense, different holders for different cartridges, volume of second medication limited


The needle has three parts: Hub Shaft Beveled tip


The needle gauge is the diameter of the hole through the needle

Needle selection depends on age of patient, and site (subcutaneous, IM, or IV)see Table 10-1


Major safety development: needleless systems

Provide an alternative to needles for routine


Provide an alternative to needles for routine procedures, reducing the risk of needlesticks with contaminated sharps

36


Other safety devices have been developed

BD Safety-Lok Syringe BD SafetyGlide Shielding Hypodermic Needle


BD SafetyGlide Shielding Hypodermic Needle BD SafetyGlide Syringe Tiny Needle Technology BD Integra Syringe

Parenteral Dose FormsParenteral Dose Forms Ampules Glass containers usually containing a single

dose

Vials


Glass containers that contain one or more doses

Mix-O-Vials Glass containers with one dose, two

compartments

Preparation of Parenteral Preparation of Parenteral MedicationMedication

Equipment needed for preparation of parenteral medications

Drug in sterile, sealed container


Syringe of the correct volume Needles of the correct gauge and length Needleless access device Antiseptic swab MAR or medication profile

37

Preparation of Preparation of ParenteralParenteralMedicationMedication

Techniques for preparing all parenteral medications

Use the five RIGHTS: Right Patient, Right D Ri ht R t f Ad i i t ti Ri ht


Drug, Right Route of Administration, Right Dose (Amount and Concentration), Right Time of Administration

Check the drug dose form ordered against the source you are holding

Preparing a Medication from Preparing a Medication from an Ampulean Ampule

Move solution to the bottom of the ampule

Cover the ampule neck with a sterile gauze pledget or antiseptic swab while breaking off top


top

Using an aspiration needle, withdraw medication from ampule

Preparing a Medication from Preparing a Medication from an an AmpuleAmpule

Remove the needle from the ampule and point the needle vertically

Pull back the plunger. Replace the aspiration needle with a new sterile needle


needle with a new sterile needle

Push plunger until medication is at tip of needle

38

Preparing a Medication from a Preparing a Medication from a VialVial

Cleanse the top of the vial of diluent

Pull plunger of syringe to fill with an amount of air equal to the volume of the solution to be withdrawn


withdrawn

Insert the needle or needleless access device through the diaphragm, inject air

Withdraw the measured volume of diluent required to reconstitute the powdered drug

Preparing a Medication from a VialPreparing a Medication from a Vial

Tap the vial of powdered drug to break up caked powder; cleanse the rubber diaphragm with swab

Insert the needle or needleless access device i th di h d i j t th dil t i th


in the diaphragm and inject the diluent in the powder

Mix thoroughly to dissolve powder

Change needle to correct gauge and length to administer the medication to the patient

Preparing a Medication from a Preparing a Medication from a MixMix--OO--VialVial

Tap the container a few times to break up the caked powder

Remove the plastic lid protector


Push firmly on the diaphragm-plunger

Mix thoroughly

Cleanse the rubber diaphragm and remove drug using syringe to administer to patient

39

Special PreparationsSpecial Preparations

Occasionally two medications may be drawn into the same syringe for a single injection

M di ti d t b d f i


Medications need to be prepared for use in the sterile field during a surgical procedure

basic pharmacology for nurses 01

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