PharmacologyAdministration of

Medications

Interpreting Physicians Orders

•Calculations of Drug Dosages – Chapter 10

•Chapter 10 – Table 10-1

–Memorize abbreviations

Reading Medication Labels

Calculations Text: Chapter 11• Be able to identify on Med labels

•Brand/Trade Name •Generic Name•Manufacturer•Dosage •Form •Expiration Date •Lot Number

Medication Storage

•Medication Room•Medication cart - keep locked•Medication refrigerator•Controlled Substance storage

Medication Records

•Patient Chart•MAR

–Medication Administration Record

•Check Allergies

Unit Dose System vs. Stock Dose System

• Unit Dose:– Each dose of medication is packaged

separately– Marked with generic and/or brand

name and dose

• Stock Dose:– Dose is in labeled bottle

Administration of Medications

•Remember primary obligation as an LPN:–DO NO HARM !!!

•Need knowledge in Pharmacology

Code of Ethics

• Maintain individual competence in administration of medications

• recognize/accept responsibility for actions and judgment

The 6 Rights of Medication Administration

• Right Patient • Right Drug• Right Dose• Right Time

• Right Route• Right

Documentation

Routes of Administration

Determined by:

•What the drug is•MD•Patient condition

Type of Desired effect

•Local•Systemic

Enteral Routes•Meds Administered by way

of digestive tract–Oral –Gastric tube –Rectal

Oral or PO

Advantages

•Simple•Convenient•Safe•Economical

Disadvantages• Unpleasant taste, odor• Some harmful to teeth, mucous

membranes• Cannot use with N & V• Cautious with difficulty

swallowing

What can influence PO absorption?

•Peristaltic rate•Empty vs. full stomach•Dilution•Food and drug may be

incompatible

Methods of giving oral drugs

• Swallow via mouth–Pill, tablet, caplet, capsule, liquid

• Med syringe• NG-tube, Peg tube

Solid Oral Dosage Forms

• The basic forms are tablets, capsules, and lozenges (troches).

• Caplets are oblong, like capsules.• Capsules are gelatin-coated and

dissolve in the stomach, or they may be coated to protect them from the acid action of the stomach.

Solid Oral Dosage Forms• Tablets are compressed powders or granules

that, when wet, break apart in the stomach, or in the mouth if they are not swallowed quickly.– Cannot crush:

• Enteric-coated tabs—coating that resists gastric secretions; protects stomach mucosa

• Buffered tabs—prevent stomach irritation by combining drug with buffering agent

• Timed or sustained release (SR) capsules or spansules—dissolve at different rates over period of time

Caplets, Capsules, and Tablets

Scored Tablets

Only those tablets that are scored can be cut in half. This is accomplished with a pill cutter

Liquid Oral Dosage Forms

• Liquid forms differ mainly in the type of substance used to dissolve the drug: water, oils, or alcohol.

• Solutions are drug substances contained in a homogeneous mixture with a liquid.

• There are multiple forms of liquid preparations.

Liquid Medications

• Syrups: Solutions of sugar and water, usually containing flavoring and medicinal substances. Cough syrups are the most common.

• Aromatic waters: Aqueous solutions contain volatile oils such as oil of spearmint, peppermint, or clove.

• Liquors contain a nonvolatile material, such as alcohol, as the solute.

Suspensions

• Suspensions are insoluble drug substances contained in a liquid. – Emulsions: Mixtures of oil and water that

improve the taste of otherwise distasteful products such as cod liver oil.

– Gels and magmas: Minerals suspended in water. Minerals settle, so products containing minerals must be shaken before use (Milk of Magnesia).

Oral Administration• Taken with plenty of water unless designed to

coat mouth or throat (such as cough syrup).• Make sure patient is able to swallow.• Liquid medications best type of administration

for children.• Oral syringes can be used for pediatric

administration.• N/V requires alternative route of administration.• Always remain with patient until medication is

swallowed.

Oral Syringes

Rectal

Rectal administration•Local or systemic effects•Different forms of rectal

drugs:–Suppository–Ointment–Liquid

Rectal Administration

Rectal administration:

– Rapid absorption without irritation to gastric mucosa.

– Suppositories melt and release the medication.

– Administer after bowel movement.– Patient remains lying down for 20 to

30 minutes.– Insert suppository 2 inches above

rectal sphincter.

Inserting suppository• Explain procedure• Sims position

– preferably left Sims

• Use gloves!!!!!!!• Remove from wrapper• Lubricate• Insert tapered end first• Push toward umbilicus, past internal sphincter• Press buttocks together

Rectal Ointments

•Same as suppositories but applicator is attached to tube

•inserted into anus

Percutaneous Routes

•Through the skin and mucous membranes

•Includes:–Topical, Sublingual, Buccal, Eye, Ear, Nose, Vagina, Inhalation

Topical Forms

• Lotions: relieve pruritus, treat localized infection

• Linaments: emulsion; protect skin• Ointments: have a petroleum and

lanolin base• Transdermal patches: absorbed

slowly for a time-released systemic effect (nitro, hormone patches)

Transdermal Meds.

•Absorbed through skin for systemic effects

•Patches / ointments•Examples ???

Transdermal Meds.

• Write application date on patch and document on patient chart.

• Patient may shower with patch intact.

• If ordered to apply every 24 hr, apply new patch at same time every day.

• Remove old patch - ?After 30 min.

• Rotate application sites to prevent irritation.

• Avoid areas with scars or large amount of body hair.

• Use caution when disposing of used patch.

Transdermal Patch

Eye Medication(Opthalmic)

• Liquid drops• Ointments• Have look up and focus on

specific object during administration

Eye Drops• Wash hands• Apply gloves• Retract lower conjunctival sac• Place drop in center of everted lower

lid• Instruct pt. to close eyes• Wipe off excess• Remove Gloves and Wash hands• How long to wait if give more than one

drop or if administer another eye med?

Eye Ointments

• Squeeze thin ribbon along lower lid

• Start at inner canthus• Wipe away excess• Never touch applicator to eye

Ear Medications(Otic)

• Adult = pull pinna up and back• Child = down and back• Do not touch ear with dropper• Instill prescribed drops• Direct against side of canal• Remain on side for ~10 min to

keep med in ear

Nasal / Respiratory Medications

• Have rapid absorption• Inhalants

– Usually administered by hand held devices

– MDI - metered dose inhalant

• Aerosol– Based on use of compressed air or

oxygen forcing mist through tubing to mouthpiece

•Nasal sprays or drops–High Fowlers –Head tilted back –Tip of bottle just inside nares–Squeeze as pt. inhales

Sublingual

•Placed under the tongue•Dissolve and are absorbed

in mucous membranes

Buccal

•Between cheek and gum•Leave there until absorbed

Zydis

•How is a zydis administered?

Vaginal Administration

•Douche•Vag supp, creams, gels•Use applicator•Pt should lie down for 30

min after insertion

Parenteral Routes•Medication administered outside the digestive tract

•Medications administered by injections (needle)

Injection Routes

•Intradermal•Subcutaneous•Intramuscular•Intravenous

Injection Equipment

•Syringes– various sizes

•Needles– various gauges and lengths

Parts of syringe•Barrel

–marked with calibrations•Plunger

–fits inside barrel–rubber flange measures dose

•Tip

Parts of Needle

•Hub•Shaft•Bevel

Sterile Parts??

•Ideas ???

Needles•Various sizes•Gauge and length vary with method of administration -– need to know differences!

Gauge•Needles inner diameter•Larger number = smaller diameter

•29-G to 14-G

Length•3/8 inch to 2 inch•SC - uses shorter needle

•IM - uses longer needle

Medications for injection

•Liquid•Reconstituted powder•May come in: - Ampules - Vials

Cautions•Injections are most hazardous method

•May damage nerves, tissue, blood vessels

•May lead to infections

Avoiding Complications

•Select site carefully•Maintain sterility•Choose proper needle•Think: aspirate?•Establish site rotation

When do we not aspirate?

•Intradermals•SC heparin, Arixtra or insulin

Intradermal Meds•Just beneath epidermis•TB skin test / Allergy testing

•Dose very small - usually 0.1 ml

Intradermal Equipment

•TB syringe (1 ml.) with fine gauge, short needle

•3/8 - 5/8 inch length•25 - 27 G

Intradermal needle angle

•Almost flat against skin (10-15º angle)

•Bevel up•Inserted ~ 1/8 inch•Do not aspirate

Skin prep•Let alcohol dry before•Do not massage after•No bandaid/covering•Almost always given in inner aspect of lower arm

Documentation•Must include site, time•Read in 24, 48, 72 hrs•Can draw circle around site if no site map

Subcutaneous (SC) Injections

•Hypodermic•Under all layers of skin•Given for slower systemic absorption

•Isotonic, watery, nonirritating

Used When:•Med more effective in this route

•Pt can’t/won’t swallow•Med. destroyed in GI tract or irritating

Not used when:•Pt in shock•Bad vascular system•Gross adipose, edema, burns at usual sites

•Skin is diseased

Not used when:•Skin tissue damaged by previous injection

•Drug not recommended for SC route

SC sites•Most common: Arms abdomen, thighs

•Less common: Scapula•Need fat fold of 1 inch

SC Equipment•TB (1 ml) or 3 ml syringe

•Short, fine gauge•1/2 - 5/8 inch•25 - 27 G

SC meds•Most common is insulin•Also see anticoags•Dose usually < or = 1 ml•Max. of 2 ml•Needle angle 45º - 90º

SC Do’s and Don’ts•Do skin prep•Do aspirate… UNLESS?•Inject slowly•Do massage…UNLESS?•Document

Insulin•Gently shake Intermediate or Long Acting

•NR = RN•Air into N, air into R•Draw up R, draw up N

Intramuscular injections

•Given when: - med not in oral form - large dose - Pt condition requires - rapid effect desired

Risks of IM’s•May damage blood vessels, nerves, bone

•Esp. dorsogluteal, sciatic nerve, large bl vessels

5 Basic sites:•Ventrogluteal•Deltoid•Dorsogluteal•Vastus lateralis•Rectus femoris

IM equipment•1 - 3 ml syringe•21 - 23 G•1 - 1.5 inch needle•Need to get to muscle

IM med•Many different meds•Dose = 3 ml max (deltoid – 2 ml max

Angle of needle

•90 degrees

IM Specifics•Choose site carefully•Spread tissue before•Always aspirate•Withdraw quickly•Massage after

Z-track method•Used for irritating drug•Seals off needle tract•Use 1.5 - 2 inch needle•Discard needle used to draw up med

Z-track•Gluteal site only•Pull skin laterally•Insert needle, aspirate and inject

•Wait 10 sec, withdraw, allow skin to return

Z-track•DO NOT MASSAGE!!

Intravenous Injections

•Advantages: - delivers rapidly - predictable effect

Disadvantages•Can irritate vein•Inc risk of complication•Expensive•Inc risk of contaminate•Constant monitoring

Phlebitis•Inflammation of vein•Warmth, erythema

IV infiltrate•IV med / fluid passes out of vein into tissue

•cool, hard, tender, edema

Review IV Formula

•Microdrip = 60•Macro = 10, 15 or 20

•What is the formula?