Basic Pharmacology for Nurses 01

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Basic Pharmacology

Welcome to NUR 106Basic Pharmacology

For NursesFor Nurses

Instructor: M Kroning, RN MSN

Basic Pharmacology For NursesBasic Pharmacology For Nurses• Welcome to NUR 106

• Instructor: Maureen Kroning, RN MSN

• Office: Ext: 4707Office: Ext: 4707

• Office location: Academic II Rm: 2305

• Office hours: Wed 1-6pm

Slide 2Copyright © 2007, 2004 by Mosby, Inc., an affiliate of Elsevier Inc .

Basic Pharmacology For NursesBasic Pharmacology For Nurses

• Text book: Authors : Clayton, Stock and Harroun 14th Edition

• Chapters:

1,2,3,7,8,9,10,11,12,14,16,20,23,25,27,29,30,33,34,35, 36, 42,46,48


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NUR 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


NUR 106: Course Schedule Cont’dNUR 106: Course Schedule Cont’d

• 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

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Types 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• Martindale–The Complete Drug Reference• Package inserts• Natural Medicines Comprehensive Database• Physicians’ Desk Reference (PDR)• Nursing journals

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Sources 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


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Chapter 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 body’s 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:

Antagonist—beta blockers

Agonist—epinephrine


Partial agonist—pentazocine

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Drug 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


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Terms 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 (cont’d)Drug Interactions (cont’d)

• 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

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Factors 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

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Across The Life SpanAge

• <38 weeks• 0-1 month• 1-24 months• 1-5 years• 6-12 years• 13-18 years

Title of Stage• Premature• Newborn, neonate• Infant, baby• Young child• Older child• Adolescent• 13-18 years

• 19-54 years• 55-64 years• 65-74 years• 75-84 years• 85+ years

• Adolescent• Adult• Older adult• Elderly• The aged• The very old

Drug Action Across the Life SpanDrug Action Across the Life Span

In nearly every body system, men and women function differently

Men and women perceive and experience disease differently


Fundamental questions remain about how humans function and the effect of disease on function

PharmacogeneticsPolymorphisms

Drug Absorption: Age ConsiderationsDrug Absorption: Age Considerations

• Special considerations for pediatric and older adult patients

Differences in muscle mass, blood flow, and inactivity affect medicines given intramuscularly


intramuscularly

Topical and transdermal administration differs in the very young and the very old

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• 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

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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

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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


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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 (cont’d)Drug Excretion (cont’d)

• 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


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Therapeutic Drug MonitoringTherapeutic Drug Monitoring

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


• Timing of drug’s 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 patient’s 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

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Monitoring Parameters: Older Adult PatientsMonitoring Parameters: Older Adult Patients

• Factors that place older patient at risk:

Reduced renal and hepatic function

Chronic illness


Polypharmacy—multiple-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 assessmentDetermine whether new symptoms have


y pbeen induced by existing medicinesGradually taper dosage when discontinuing drugStart at one third to one half normal dosage when initiating therapy; gradually increaseReview regimen periodically

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


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

• Avoid drugs if at all possible

• When taking woman’s 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 infant’s longest sleeping period

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Chapter 7 Chapter 7 Principles of Medication Administration


Legal and Ethical Legal and Ethical ConsiderationsConsiderations

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

• Before administering medication, nurse must have:

C t li t ti


Current license to practiceClear policy statement authorizing the actSigned medication orderUnderstanding of rationale for drug useUnderstanding 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• Physician’s order form• History and physical exam form

P t


• Progress notes• Critical pathways• Nurses’ notes• Laboratory tests record

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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 state’s nurse practice act, state and federal law, JCAHO, professional organizations

• Before administering medication, nurse must have:

C t li t ti


Current license to practiceClear policy statement authorizing the actSigned medication orderUnderstanding of rationale for drug useUnderstanding 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• Physician’s order form• History and physical exam form• Progress notes


Progress notes• Critical pathways• Nurses’ notes• Laboratory tests record

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Contents of Patient Charts Contents of Patient Charts (cont’d)(cont’d)

• 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

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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

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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

• TranscriptionNurse 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


gStandard abbreviationsStandardized administration timesMaintenance of consistent blood levelsMaximum drug absorptionDiagnostic testingPRN medications

The Six Rights (cont’d)The Six Rights (cont’d)• 3. Right dose

Abnormal hepatic or renal functionNausea and vomitingAccurate dose formsAccurate calculationsCorrect measuring devices


Correct measuring devices

• 4. Right patientBracelet checkingPediatric and older adult patients

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The Six RightsThe Six Rights• 5. Right route

IV routeIntramuscular routeIntravenous routeSubcutaneous routeOral route


Oral route

• 6. Right documentationSafety/ethical considerationsLegal considerationsAlways include date/time, drug name, dose, route, site of administration

Special Documentation Special Documentation CircumstancesCircumstances

• Patient refuses medicationThoroughly record incident and reason for refusal in nurses’ notesNotify physician


• Medication error occursNotify physicianComplete incident report

Chapter 8Chapter 8Percutaneous Administration


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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 skinInhalation of aerosolized liquids or gasesInstallation 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 requirementsProper application techniques and timingCautions particular to drug or drug


Cautions particular to drug or drug administrationSide effectsWhen to contact physician

PercutaneousPercutaneous AdministrationAdministration

• Documentation

Date, time, drug, dosage, route


Record ongoing assessment data, including signs of adverse drug effects

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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


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• Apply dose-measuring applicator paper

• Do not rub in ointment

• Cover area with plastic wrap

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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

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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 uprightBlock one nostrilShake bottle and insert tip into nostrilSpray while patient inhales

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Nebulizers and InhalersNebulizers and Inhalers• Nebulizers

Prepare medication and fill nebulizerPatient exhalesPut nebulizer in mouth; do not seal completelyPatient inhales


• Metered-dose inhalersFollow instructions on inhaler

• Dry powder inhalersFollow 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


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Administration of Oral Administration of Oral MedicationsMedications

• Enteral is direct administration to the GI tract• Most drugs are available in oral dose forms:

Capsules—small, 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 troches—flat disks in a flavored baseTablets (powdered drugs that have been compressed)Elixirs—drugs dissolved in water and alcoholEmulsions of water-in-oil or oil-in-waterLiquid suspensions and syrups

Administration of Oral Administration of Oral MedicationsMedications

• Common methods used to administer oral medications

Unit dose packaging providing a single dose Soufflé cupsMedicine cups


Medicine cupsMedicine 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 patientRIGHT drugRIGHT route of administrationRIGHT doseRIGHT time of administration

• ALWAYS check or recheck the FIVE RIGHTS

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• General principles apply to all distribution systemsGive the most important medications firstDo not touch the medication with your handsEncourage liquid intake to ensure swallowingRemain 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 existsDiscard 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


administrationRegularly record patient assessments to evaluate therapeutic effectivenessChart 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

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Administration of LiquidAdministration of Liquid--Form Form Oral Medications (cont’d)Oral Medications (cont’d)

• General principles for infants, children, and adults

Give adults and children the most important medications firstNEVER dilute medications without specific orders. DO NOT leave a medication at the


bedside without an order to do soCheck an infant’s 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 meniscus—see 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 administrationPerform premedication assessment


pAssemble equipment before administration

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Administration of Medications Administration of Medications by Nasogastric Tube (cont’d)by Nasogastric Tube (cont’d)

• 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 (cont’d)Gastrostomy or Jejunostomy Tube (cont’d)

• 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

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Administration of Enteral Feedings via Administration of Enteral Feedings via Gastrostomy or Jejunostomy Tube (cont’d)Gastrostomy or Jejunostomy Tube (cont’d)

• Verify tube placement and initiate feeding• Flush, then clamp tube• Proceed with tube feeding technique

Intermittent: use Toomey syringe


y y gContinuous: use disposable feeding container and enough formula for a 4-hour period


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 gloveWater-soluble lubricantP ib d it


Prescribed suppository• Perform standard premedication assessment

Administration of Rectal Administration of Rectal Suppositories (cont’d)Suppositories (cont’d)

• Technique begins with FIVE RIGHTSExplain procedure and check pertinent parametersPatient bends uppermost legA 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


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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 (cont’d)Enema (cont’d)

• Technique begins with FIVE RIGHTSExplain procedure and check pertinent parameters• Time of last defecation

P ti t b d t l


Patient bends uppermost legApply 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 routeIntradermal


SubcutaneousIntramuscular (IM)Intravenous (IV)

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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 (cont’d)Administration (cont’d)

• The insulin syringe has a special scale for measuring insulin

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


in U-100 concentrationThe U-100 syringe holds 100 units of insulin per milliliterLow-dose insulin syringes are used for patients receiving 50 units or less of U-100 insulin

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• 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:HubShaftBeveled 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

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• Other safety devices have been developed

BD Safety-Lok SyringeBD SafetyGlide Shielding Hypodermic Needle


BD SafetyGlide Shielding Hypodermic NeedleBD SafetyGlide Syringe Tiny Needle TechnologyBD 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-VialsGlass 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 volumeNeedles of the correct gauge and lengthNeedleless access deviceAntiseptic swabMAR or medication profile

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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

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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

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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

Documents

Basic Pharmacology for Nurses 01