Transcript Pharmacology Unit 2

Pharmacology
Administration 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
• Right
• Right
• Right
Patient
Drug
Dose
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
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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
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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?