Pharmacology

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Pharmacology

• Chapter 9
• Administration
• By
• Parenteral Route

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Parenteral Route

• Includes any other route other than the
  gastrointestinal tract
• The most common form of parenteral administration
  is injection form
• Also other routes include eyes, ears, and
  respiratory tract

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Sublingual Buccal routes

• These are placed under the tongue (sublingual) or
  between the gum and cheek (buccal)
• These routes provide great absorption of
  medication
• Meds given this way are unaffected by the
  stomach, intestines or liver
• Name a med we administer this way ___________

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Sublingual Buccal Routes

• Remember to instruct your pt to hold the tablet
  in place with the mouth closed until the med is
  gone (absorbed)
• Tell pt to NOT swallow this med
• Tell the pt to not take food or liquid until the
  med is completely absorbed

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Transcutaneous Drugs

• This delivers the meds to the body by absorption
  through the skin via ointments and patches
• Nitroglycerine ointment is an example
• It can be applied every few hours for angina
  pectoris
• Med patches is another example scopolamine and
  Fentanyl patches. Remember that there are
  different sized particles in these patches that
  absorb at different times, to keep the med
  consistent

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Nitro Patches or ointment

• Sometimes, nitro causes headaches while awake,
  Dr. orders this patch or ointment to be given at
  bedtime so the pt can lay down and sleep through
  the medication while its working. The Dr. may
  order the patch to be removed the next day at noon

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Application of Nitro-ointment

• You must have the special nitro paper
• Squeeze the prescribed amount of nitro ointment
  onto the Appi-ruler paper, twisting it off when
  you reach the correct line on the paper
• DO NOT TOUCH THE OINTMENT OR HEADACHE WILL OCCUR
  TO YOU
• Carefully fold the Appi-paper lengthwise with the
  ointment on the inside to spread it out of the
  strip you made it in to
• Lay this on the pts body part and gently pres
  down, secure with paper tape and write your name
  and the date applied

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• The nurse should wash her hands immediately after
  med is intact
• Be sure to ALWAYS rotate sites to chest, back,
  upper arms, upper legs
• Be sure area of skin is clean or med and tape
  will not adhere

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Patches

• Be sure to always remove the first patch put on
  before applying another one. If you cant find
  the first one, have someone help you with this
• NEVER APPLY 2 PATCHES AT ONE TIMEO.D. ON THE
  MEDBAD

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Inhalation Therapy

• Most common med inhaled is meds for asthma like
  Albuterol
• Also called MDIs (metered dose inhalers)
• Nebulizer
• You may add a spacer on to an MDI if pt can
  breath in full amount of the Albuterol

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Advantages of MDIs

• Rapid action of the drug with minimal local
  effects
• Usually the drugs in this form are pretty potent
  and therefore, you dont need a lot of the med to
  get results
• Convenience to the ptmakes pt more compliant

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Disadvantages of MDIs

• Requires pt to be somewhat coordinated to breath
  in when the med is pressed
• Side effects can come on rapidly d/t how fast the
  inhaler works
• If not cleaned properly, the MDI can be a source
  of infection

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How to use an MDI

• Have pt sit up
• Put inhaler together and shake
• Place mouthpiece between lips forming a seal or
  set up your spacer
• Exhale slowly and completely
• Push down on inhaler while breathing in slowly
• Hold breath for 5-10 seconds
• Exhale slowly through pursed lips

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Important info. r/t inhalers

• If bronchodilators and steroids are ordered
  together, have pt administer the bronchodilator
  1st and then the steroid
• If a steroid inhaler is being used, you must
  rinse your mouth when finished with plain tap
  water to prevent fungus or thrush in the mouth

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Nebulizers

• Used to treat asthmas
• Its A.K.A. the breathing treatment machine
• Nebulizers are usually used when the pt needs to
  open the bronchioles more than just with an
  inhaler
• A nebulizer delivers the deposition of medication
  into the lungs and is powered by an air
  compressor
• Proper cleaning of the nebulizer decreases
  infection

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Side effects of meds given via nebulizer

• Palpitations
• Tremors irritated throat
• Nervousness hoarseness
• Dizziness coughing
• Headache
• Nausea/vomiting

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IPPB

• Intermittent positive pressure breathing
  treatments
• IPPB combines administration of an aerosol with
  mechanical breathing to assist pts who are unable
  to take deep breaths on their own

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INJECTIONS

• Remember
• IM is delivered at a 90 degree angle
• Sub Q is delivered at a 45 degree angle
• Intradermal is delivered at a 15 degree angle

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Syringe

• A syringe has 3 parts barrel, plunger, tip. We
  can place a syringe on the tip

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Needles

• Have a hub that fits on the tip of the syringe
• Needles have a shaft that come in different
  lengths
• Short needles ½ , 3/8, and 5/8 inches long,
  these are for intradermal or sub Q
• Long needles 1 ½ , 2 inches are used for IM
  injections

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Needle gauges

• The thicker the needle, the lower the number for
  example 14 and 16G are extremely thick
• 20, 24, 26 gauge are smaller and thinner

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3 main types of syringes are used

• Standard syringe used most frequently for sub Q
  or IM injections and are marked with (cc)
  milliters
• Tuberculin syringe used for intradermal
  injections, can only hold 1ml of fluid total,
  theses syringes are calibrated in tenths of a
  milliliter .1, .2, .3, .4, .5, .6, .7, .8, .9,
  1.0ml
• Insulin syringe - the total amt it can hold is
  1.0ml
• These syringes come in 50units or 100units MUST
  DOUBLE CHECK YOUR INSULINE WITH ANOTHER NURSE

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Pre-filled syringes

• Are available for certain medications only
• Watch for ½ doses to be given and therefore you
  need to waste some of the medication before
  giving it

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Pre-filled cartridges (carpu-jets)

• These are fancy syringes pre-filled with meds
  such as
• Heparin
• Lovenox
• Again, double check on how much is to be given,
  you may not be administering the whole mount in
  the syringe
• You may need an adapter piece that screws on to
  the back of the plunger that pushes the med out

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Drawing up medication

• We will perfect this in the lab
• Equipment needed
• Vial of medication
• Needle or needless end
• Alcohol
• Medication order

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The use of alcohol

• We use alcohol to clean the skin
• It removes germs and lessens their amount
• We always wash out hands first
• WE ARE NOW GLOVING UP TO GIVE INJECTIONS

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Subcutaneous injection sites

• There are many places to administer sub q
  injections into

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Sub Q injection Sites
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IM Injections

• 5 sites are recommended to administer an IM
  injection into
• 1. Dorsogluteal
• 2. Ventrogluteal
• 3. Deltoid
• 4. Vastus lateralis
• 5. Rectus Femoris

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Z-track method for IM injections

• This method is used for injections that are
  irritating to tissues such as
• Iron
• Dextran
• And some antibiotics

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Z-tract

• You stretch the top surface area of tissue over
  as far as it will go and dart the needle into the
  skin and inject the med in slowly
• You wait 10 seconds before pulling out the needle
• Withdraw the needle and allow the skin to return
  to its normal position (this seals off the needle
  tract)
• Press firmly on the skin DO NOT RUB to avoid
  irritation to sub Q tissue

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Eye Drops

• Remember not to place the drops in the inner
  canthus, only place the drops in the lower
  conjunctival sac
• Instruct the pt to blink slowly as to not squeeze
  out the medication

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Eye Ointment

• Remember to start in the inner part of the eye
  and make a ribbon of ointment on the lower eyelid
  leaving the eye, going towards the temporal area
• Twist and turn the tube to end your ribbon strip

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More than one eye medication

• When more than 1 med is ordered, instill one type
  at a time, waiting 5 minutes between different
  meds
• If eye drops AND ointment are ordered, instill
  eyedrops 1st, wait 5 minutes, then apply ointment

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The End Deltoid

Ventrogluteal