pharma drugs

7/29/2019 PhaRMA DRUGS

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Introduction to

Pharmacology in

Nursing

Donna Penn RN MSN CNE


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Nurses need to haveknowledge about the

actions and effects ofmedications

To safely and

accurately administermedications nursesneed to have anunderstanding ofpharmacologicprinciples


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Pharmacologic

Principles


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Drug Names Chemical name Describes the drugs chemical

composition and molecular

structureGeneric name (nonproprietary

name)

Name given by the United

States AdoptedName Council

Trade name (proprietary name) The drug has a registered

trademark; use of the namerestricted by the drugs patentowner(usually the manufacturer)


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Drug Names

(cont'd)

Chemical name (+/-)-2-(p-isobutylphenyl)

propionic acid

Generic name ibuprofen

Trade name Motrin, Advil


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Figure 2-1 The chemical,

generic, and trade names

for the common analgesic

ibuprofen are listed next tothe chemical structure of

the drug.


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Pharmacological

Concepts:

Classification

Classification- Nurses learnto categorize meds withsimilar characteristics bytheir class

Medication classificationindicates the effect of the

med on the body system,the symptom the medrelieves, or the medsdesired effect (e.g. oral

hypoglycemics)


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Pharmacological

Concepts:

Classification

A medication may alsobe part of more than

one class Aspirin is an analgesic,

antipyretic, anti-

inflammatory, and anti-platelet


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Pharmacological

Concepts:

MedicationForms

Medications are availablein a variety of forms andpreparations

The form of the med willdetermine its route ofadministration

Composition of med isdesigned to enhance itsabsorption & metabolism

Many meds are available inseveral forms


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Medication Forms Tablet

Capsule

Elixir Enteric-coated

Suppository

Suspension

Transdermal patch


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Pharmacologic

Principles

Pharmaceutics

Pharmacokinetics

Pharmacodynamics Pharmacotherapeutics

Pharmacognosy


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Pharmaceutics The study of how variousdrug forms influencepharmacokinetic andpharmacodynamic activities


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Pharmacokinetics The study of what thebody does to the drug

Absorption Distribution

Metabolism

Excretion


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Pharmacodynamics

The study of what thedrug does to the body

The mechanism of drugactions in living tissues


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Figure 2-2 Phases of Drug Activity. (From

McKenry LM, Salerno E: Mosbys

pharmacology in nursingrevised and

updated, ed 21, St. Louis, 2003, Mosby.)


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Pharmacotherapeutics

The use of drugs and theclinical indications for

drugs to prevent andtreat diseases


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Pharmacognosy The study of natural(plant and animal) drug

sources


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Pharmacokinetics: Absorption

The rate at which adrug leaves its site ofadministration, and the

extent to whichabsorption occurs

Bioavailability

Bioequivalent


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Factors That Affect

Absorption Administration route of the

drug Ability of Med to Dissolve

Food or fluidsadministered with the drug

Body Surface Area Status of the absorptive

surface

Rate of blood flow to thesmall intestine

Lipid Solubility of Med

Status of GI motility


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Routes of

Administration

A drugs route ofadministration affects

the rate and extent ofabsorption of that drug

Enteral (GI tract)

Parenteral Topical


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Enteral Route Drug is absorbed intothe systemic circulation

through the oral orgastric mucosa, thesmall intestine, orrectum

Oral

Sublingual

Buccal

Rectal


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First-Pass Effect

The metabolism of a drug and

its passage from the liver intothe circulation

A drug given via the oral routemay be extensively metabolized

by the liver before reaching thesystemic circulation (high first-pass effect)

The same druggiven IVbypasses the liver, preventingthe first-pass effect from takingplace, and more drug reachesthe circulation


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Box 2-1 Drug Routes and First-Pass Effects


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Parenteral Route Intravenous (fastestdelivery into the blood

circulation) Intramuscular

Subcutaneous

Intradermal Intrathecal

Intraarticular


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Topical Route Skin (includingtransdermal patches)

Eyes Ears

Nose

Lungs (inhalation) Vagina


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Distribution

The transport of a drug in thebody by the bloodstream toits site of action

Protein-binding

Water soluble vs. fat soluble

Blood-brain barrier

Areas of rapid distribution:

heart, liver,kidneys, brain

Areas of slow distribution:muscle, skin, fat


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Metabolism(Also Known As Biotransformation)

The biologic transformationof a drug intoan inactive metabolite, a

more soluble compound, or amore potent metabolite Liver (main organ)

Kidneys

Lungs Plasma

Intestinal mucosa


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Metabolism/Biotransformation

(cont'd)

Delayed drug metabolismresults in:

Accumulation of drugs

Prolonged action of thedrugs

Stimulating drugmetabolism causes:

Diminished pharmacologiceffects


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Excretion The elimination of drugsfrom the body

Kidneys (main organ) Liver

Bowel

Biliary excretion

Enterohepatic circulation


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1. You are caring for a client who has diabetes complicatedby kidney disease. You will need to make a detailed assessmentwhen administering medications because this client mayexperience problems with:

A. Absorption

B. Biotransformation C. Distribution

D. Excretion

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Pharmacodynamics Study of the

mechanism of drug

actions in living tissue Drug-induced

alterations to normal

physiologic function Positive change-

Therapeutic effect-Goalof therapy

W i hi h d


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Mechanism of Action Ways in which a drug

can produce atherapeutic effect

The effects that aparticular drug hasdepends on the cells ororgan targeted by the

drug Once the drug hits its

site of action it canmodify the rate at

which a cell or tissuefunctions


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Mechanism of Action Receptor Interaction

Enzyme Interaction

Non-Specific

Interaction

l


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Receptor Interaction Drug structure is essential

Involves the selectivejoining of drug moleculewith a reactive site on thecell surface that elicits abiological effect

Receptor is the reactive siteon a cell or tissue

Once the substance bindsto and interacts with thereceptor, a pharmacologicresponse is produced

Affi it d t hi h


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Receptor

Interaction

Affinity- degree to which adrug binds with a receptor

The drug with the best fit

or affinity will elicit thebest response Drug can mimic bodys

endogenous substancesthat normally bind to

receptor site Drugs that bind to

receptors interact withreceptors in different ways

to either block or elicit aresponse


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Receptor

Interaction

Agonist-Drug binds toreceptor-there is a

response (AdrenergicAgents)

Antagonist-drug binds

to receptor-noresponse-preventsbinding of agonists(Alpha & Beta Blockers)


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E b


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Enzyme Interaction Enzymes are substances

that catalyze nearly everybiochemical reaction in a

cell Drugs can interact with

enzyme systems to alter aresponse

Inhibits action of enzymes-enzyme is fooled intobinding to drug instead oftarget cell

Protects target cell fromenzymes action (ACEInhibitors)

N t i l i t


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Non-Specific

Interaction

Not involving a receptorsite or alteration in enzymefunction

Main site of action is cellmembrane or cellularprocess

Drugs will physically

interfere or chemically altercell process

Final product is alteredcausing defect or cell death

Cancer drugs, Antibiotics


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The nurse is giving a medication that has a

high first-pass effect. The physician has

changed the route from IV to PO. The nurseexpects the oral dose to be:

1. Higher because of the first-pass effect.

2. Lower because of the first-pass effect.

3. The same as the IV dose.

4. Unchanged.


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. A patient is complaining of severe pain

and has orders for morphine sulfate. The

nurse knows that the route that would

give the slowest pain relief would bewhich route?

1. IV

2. IM3. SC

4. PO

Th i Eff


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Type of Medication

Action

Therapeutic Effect

Side Effects

Adverse Effects Toxic Effect

Idiosyncratic Reactions

Allergic Reaction

Medication Interactions

Iatrogenic Response

Th t d


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Therapeutic Effect The expected or

predictablephysiological responsea medication causes

A single med can haveseveral therapeutic

effects (Aspirin) It is important for the

nurse to know whymed is being prescribed

U i t d d d


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Side Effects

Unintended secondaryeffects a medicationpredictably will cause

May be harmless or serious

If side effects are seriousenough to negate the

beneficial effect of medstherapeutic action, it maybe D/Cd

People may stop taking

medications because of theside effects

Undesirable response of a


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Adverse Effects Undesirable response of amedication

Unexpected effects of drug

not related to therapeuticeffect

Must be reported to FDA

Can be a side effect or aharmful effect

Can be categorized aspharmacologic,idiosyncratic,hypersensitivity, or druginteraction

Ad Eff Ad D E t


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Adverse Effects Adverse Drug Events

Adverse DrugReactions (ADR)

M d l ft


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Toxic Effect May develop after

prolonged intake or whena med accumulates in the

blood because of impairedmetabolism or excretion, orexcessive amount taken

Toxic levels of opioids cancause resp.depression

Antidotes available toreverse effects

Idios ncratic U di t bl ff t


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Idiosyncratic

Reactions

Unpredictable effects-overreacts or under reactsto a medication or has a

reaction different fromnormal

Genetically determined

abnormal response Idiosyncratic drug

reactions are usuallycaused by abnormal levels

of drug-metabolizingenzymes (deficiency oroverabundance)

Unpredictable response to


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Allergic Reaction Unpredictable response to

a medication

Makes up greater than 10%

of all medication reactions Client may become

sensitized immunologicallyto the initial dose, repeated

administration causes anallergic response to themed, chemical preservativeor a metabolite

Medication acts as an


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Allergic Reaction Medication acts as an

antigen triggering therelease of the bodys

antibodies May be mild or severe

Among the differentclasses of meds, antibiotics

cause the highest incidenceof allergic reaction

Severe reaction-Anaphylactic reaction

Mild reaction-hives, rash,pruritis


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2. A postoperative client is receiving morphine sulfate via aPCA. The nurse assesses that the clients respirations aredepressed. The effects of the morphine sulfate can be classifiedas:

A. Allergic

B. Idiosyncratic C. Therapeutic

D. Toxic

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Teratogenic Structural


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Other Drug

Reactions

Teratogenic-Structuraleffect in unborn fetus

(thalidomide) Carcinogenic-Causes

cancer

Mutagenic- Changesgenetic composition(radiation, chemicals)

D Occurs when one med


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Drug

Interactions

Occurs when one medmodifies the action ofanother

Common in peopletaking severalmedications at once

One med may

potentiate or diminishthe action of another oralter the way it isabsorbed, metabolized

or eliminated Warfarin and

Amiodarone

Iatrogenic Unintentional adverse


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Iatrogenic

Responses

Unintentional adverseeffects that occur duringtherapy

Treatment-InducedDermatologic-rash, hives,acne

Renal Damage-Aminoglycoside

antibiotics, NSAIDS,contrast medium

Blood Dyscrasias-Destruction of blood cells

(Chemotherapy) Hepatic Toxicity-Elevatedliver enzymes (hepatitis-like symptoms)

Synergistic Effect of 2 meds combined


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Synergistic

Effect

Effect of 2 meds combinedis greater than the medsgiven separately

Alcohol & Antihistamines,antidepressants,barbiturates, narcotics

Not always undesirable,

physician may combinemeds to create aninteraction that will havebeneficial effects

(Vasodilators & diuretics tocontrol high BP)

Medication Dose Except when administered


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Medication Dose

Responses

Except when administeredIV, meds take time to enterbloodstream

The quantity & distributionof med in different bodycompartments changeconstantly

Goal is to keep constant

blood level within a safetherapeutic range

Repeated doses arerequired to achieve a

constant therapeuticconcentration of a medbecause a portion of med isalways being excreted

Medication Dose Serum Half-Life:Time it


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Medication Dose

Responses

Serum Half Life:Time ittakes for excretionprocesses to lower the

serum medicationconcentration by

Regular fixed doses mustbe given to maintain

therapeutic concentration Dosage schedules set by

institutions (TID, q8h, HS,AC, STAT, PRN)

Peak & Trough levels Therapeutic drug

monitoring

Half life The time it takes for one


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Half-life The time it takes for onehalf of the original amountof a drug in the body to be

removed A measure of the rate at

which drugs are removed

from the body

Onset Peak and


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Onset, Peak, and

Duration

Onset The time it takes for the drug

to elicit atherapeutic response

Peak The time it takes for a drug

to reach its maximumtherapeutic response

Duration The time a drug

concentration is sufficient toelicit a therapeutic response

Pharmacotherapeutics: Types of


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Pharmacotherapeutics: Types of

Therapies

Acute therapy Maintenance therapy

Supplemental therapy

Palliative therapy Supportive therapy

Prophylactic therapy

Empiric therapy

Monitoring The effectiveness of the


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Monitoring The effectiveness of thedrug therapy must be

evaluated One must be familiarwith the drugs:

Intended therapeuticaction (beneficial)

Unintended butpotential side effects

(predictable, adversereactions)

Monitoring (cont'd) Therapeutic index


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Monitoring (cont d) Therapeutic index

The ratio between adrugs therapeuticbenefits and its toxiceffects

Monitoring (cont'd) Tolerance


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Monitoring (cont d) Tolerance

A decreasing responseto repetitive drug doses

Monitoring (cont'd) Dependence


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Monitoring (cont d) Dependence

A physiologic orpsychological need for adrug

Monitoring (cont'd) Interactions may occur


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Monitoring (cont d) Interactions may occurwith other drugs or food

Drug interactions: thealteration of action ofa drug by:

Other prescribed drugs

Over-the-countermedications

Herbal therapies

Monitoring (cont'd) Drug interactions


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Monitoring (cont d) Drug interactions

Additive effect

Synergistic effect Antagonistic effect

Incompatibility

Monitoring (cont'd) Medication


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Monitoring (cont d) Medicationmisadventures

Adverse drug events

Adverse drug reactions

Medication errors

Monitoring (cont'd) Some adverse drug


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Monitoring (cont d) Some adverse drugreactions are classifiedas side effects

Expected, well-knownreactions that result in littleor no change in patient

management Predictable frequency

The effects intensity and

occurrence are related tothe size of the dose

Adverse Drug An adverse outcome of


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Adverse Drug

Reaction

An adverse outcome ofdrug therapy in whicha patient is harmed insome way

Pharmacologic reactions

Idiosyncratic reactions

Hypersensitivity reactions

Drug interactions

Other Drug-Related Teratogenic


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Other Drug Related

Effects

e atoge c

Mutagenic

Carcinogenic

Toxicology The study of poisons


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Toxicology y pand unwantedresponses totherapeutic agents


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Table 2-9 Common

Poisons and Antidotes

The Nursing


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Process (cont'd) Assessment

Nursing diagnosis Planning (with outcome

criteria)

Implementation Evaluation

The Nursing An organizational


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g

Process

gframework for thepractice of nursing

Orderly, systematic

Central to all nursing

care Encompasses all steps

taken by the nurse incaring for a patient

Flexibility is important

The Nursing Assessment


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Process (cont'd) Data collection

Subjective, objective

Data collected on the patient,drug, environment

Medication history

Nursing assessment Physical assessment

Data analysis

The Nursing( )

Nursing diagnosis


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Process (cont'd)g g

Judgment or conclusion

about theneed/problem (actualor at risk for) of thepatient

Based upon an accurateassessment

NANDA format

The Nursing

( )Planning


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Process (cont'd)g

Identification of goals

and outcome criteria Prioritization

Time frame

The Nursing Goals


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Process (cont'd) Objective, measurable,

realistic Time frame specified

Outcome criteria

Specific standard(s) ofmeasure

Patient oriented

The NursingI l t ti


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Process (cont'd) Implementation

Initiation and completion

of the nursing care planas defined by the nursingdiagnoses and outcome

criteria Follow the five rights of

medication

administration

The Five


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The Five

Rights Right drug

Right dose Right time

Right route

Right patient

Another RightConstant


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Another Right Constant

System Analysis

A double-check The entire system of

medication

administration Ordering, dispensing,

preparing, administering,documenting

Involves the physician,nurse, nursing unit,pharmacy department,and patient education

Other Rights Proper drug storage


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g p g g

Proper documentation

Accurate dosagecalculation

Accurate dosage

preparation Careful checking of

transcription of orders

Patient safety

Other Rights Close consideration of


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g

(cont'd) special situations

Prevention andreporting of medicationerrors

Patient teaching Monitoring fortherapeutic effects, sideeffects, toxic effects

Refusal of medication

Evaluation Ongoing part of the


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nursing process

Determining the statusof the goals andoutcomes of care

Monitoring thepatients response todrug therapy

Expected and

unexpected responses


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The day shift charge nurse is making rounds. Apatient tells the nurse that the night shift nurse

never gave him his medication, which was due at

11 PM. What should the nurse do first to

determine whether the medication was given?

1. Call the night nurse at home.

2. Check the Medication Administration Record.

3. Call the pharmacy.

4. Review the nurses notes.


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The patients Medication Administration Recordlists two antiepileptic medications that are due at

0900, but the patient is NPO for a barium study.

The nurses coworker suggests giving the

medications via IV because the patient is NPO.

What should the nurse do?

1. Give the medications PO with a small sip of water.

2. Give the medications via the IV route because the

patient is NPO.3. Hold the medications until after the test is

completed.

4. Call the physician to clarify the instructions.


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Life Span

Considerations

Life Span Pregnancy


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Considerations Breast-feeding

Neonatal Pediatric

Geriatric

Pregnancy First trimester is the


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period of greatestdanger for drug-induced developmentaldefects

Drugs diffuse across the

placenta FDA pregnancy safety

categories


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Table 3-1 Pregnancy

safety categories

Breast-feeding Breast-fed infants are at


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risk for exposure todrugs consumed by themother

Consider risk-to-benefitratio


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Table 3-2 Classification of

young patients

Pediatric Considerations:


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Pharmacokinetics

Absorption Gastric pH less acidic Gastric emptying is

slowed

Topical absorption fasterthrough the skin

Intramuscular

absorption faster andirregular



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Pharmacokinetics (cont'd)

Distribution TBW 70% to 80% in full-

term infants, 85% inpremature newborns, 64%in children 1 to 12 yearsof age

Greater TBW means fatcontent is lower

Decreased level of proteinbinding

Immature blood-brainbarrier


Ph ki i ( 'd)


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Metabolism

Liver immature, doesnot produce enough

microsomal enzymes Older children may have

increased metabolism,requiring higher doses

Other factors



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Excretion

Kidney immaturity

affects glomerularfiltration rate andtubular secretion

Decreased perfusion rate

of the kidneys

Summary of Pediatric

Considerations


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Considerations Skin is thin and permeable

Stomach lacks acid to killbacteria

Lungs lack mucus barriers

Body temperatures poorlyregulated and dehydrationoccurs easily

Liver and kidneys areimmature, impairing drugmetabolism and excretion

Methods of Dosage Calculation

for Pediatric Patients


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for Pediatric Patients

Body weight dosagecalculations

Body surface areamethod

Geriatric

C id ti

Geriatric: older than65


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Considerations age 65

Healthy People 2010:older than age 55

Use of OTCmedications

Polypharmacy


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Table 3-4 Physiologic changes in the geriatric patient

Geriatric Considerations:

Ph ki ti


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Pharmacokinetics

Absorption Gastric pH less acidic

Slowed gastric emptying

Movement through GItract slower

Reduced blood flow to theGI tract

Reduced absorptivesurface area due toflattened intestinal villi



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Distribution

TBW percentages lower

Fat content increased

Decreased production ofproteins by the liver,resulting in decreased

protein binding of drugs


Ph ki ti ( t'd)


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Metabolism

Aging liver producesless microsomal

enzymes, affecting drugmetabolism

Reduced blood flow to

the liver



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Excretion Decreased glomerular

filtration rate

Decreased number ofintact nephrons

Geriatric Considerations: Problematic

Medications


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Medications

Analgesics

Anticoagulants

Anticholinergics

Antihypertensives Digoxin

Sedatives and

hypnotics Thiazide diuretics


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Legal, Ethical,and Cultural

Considerations

U.S. Drug

L i l ti

1906: Federal Food andDrug Act


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Legislation Drug Act

1912: SherleyAmendment (to theFederal Food and DrugAct of 1906)

1914: Harrison NarcoticAct

1938: Federal Food,Drug, and Cosmetic Act(revision of 1906 Act)

U.S. Drug Legislation

(cont'd)


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(cont d) 1951: Durham-

HumphreyAmendment (to the1938 act)

1962: Kefauver-HarrisAmendment (to the1938 act)

1970: ControlledSubstance Act

U.S. Drug Legislation

(cont'd)


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(cont d)

1983: Orphan Drug Act

1991: Accelerated drugapproval


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New Drug

Development

Investigational newdrug (IND) application


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Development drug (IND) application

Informed consent

Investigational drugstudies

Expedited drugapproval

U.S. FDA Drug

Approval Process Preclinical


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Approval Process Preclinicalinvestigational drug

studies

Clinical phases ofinvestigational drug

studies Phase I

Phase II

Phase III Phase IV

Ethical Nursing

Practice

American NursesAssociation (ANA)


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Practice Association (ANA)Code of Ethics for

Nurses

Cultural

Considerations


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Considerations Assess the influence of a

patients cultural beliefs,values, and customs Drug polymorphism Compliance level with

therapy Environmental

considerations Genetic factors

Varying responses tospecific agents

Cultural

Assessment

Health beliefs andpractices


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Assessment practices

Past uses of medicine

Folk remedies

Home remedies

Use of nonprescriptiondrugs and herbalremedies

OTC treatments

Cultural Assessment

(cont'd)


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( )

Usual response to

treatment Responsiveness to

medical treatment

Religious practices andbeliefs

Dietary habits


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MedicationErrors:

Preventingand

Responding

Medication

Misadventures

Medication errors(MEs)


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Misadventures (MEs)

Adverse drug events(ADEs)

Adverse drug reactions(ADRs)

Medication

Misadventures (cont'd)


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By definition, all ADRs

are also ADEs But all ADEs are not

ADRs

Two types of ADRs Allergic reactions

Idiosyncratic reactions

Medication Errors


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Preventable Common cause of

adverse health care

outcomes Effects can range from no

significant effect to

directly causing disabilityor death

Box 5-1 Common classes of medications involved

in serious errors


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Preventing Medication

Errors


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Minimize verbal ortelephone orders Repeat order to prescriber

Spell drug name aloud

Speak slowly and clearly

List indication next toeach order

Avoid medical shorthand,including abbreviationsand acronyms


Errors (cont'd)


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Never assume anything

about items not specified ina drug order (i.e., route)

Do not hesitate to question

a medication order for anyreason when in doubt

Do not try to decipherillegibly written orders;contact prescriber forclarification


Errors (cont'd)

NEVER t ili


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NEVER use trailing

zeros with medicationorders

Do not use 1.0 mg; use

1 mg 1.0 mg could be

misread as 10 mg,resulting in a tenfolddose increase

Preventing

Medication Errors


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(cont'd) ALWAYS use a

leading zero fordecimal dosages

Do not use .25 mg; use0.25 mg

.25 mg may be misreadas 25 mg

.25 is sometimes

called a nakeddecimal


Errors (cont'd)


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Check medication order

and what is availablewhile using the 5 rights

Take time to learn specialadministrationtechniques of certain

dosage forms


Errors (cont'd) Always listen to and


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honor any concerns

expressed by patientsregarding medications

Check patient allergiesand identification

MedicationReconciliation

Medication Errors

Possible consequences to


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qnurses

Reporting and responding toMEs

ADE monitoring programs

USPMERP (United StatesPharmacopeia MedicationErrors Reporting Program)

MedWatch, sponsored by theFDA

Institute for Safe MedicationPractices (ISMP)

Notification of patient

regarding MEs


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3. Nurses are legally required to document medications that

are administered to clients. The nurse is mandated to document:

A. Medication before administering it

B. Medication after administering it

C. Rationale for administering the medication

D. Prescribers rationale for prescribing the medication

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4. If a nurse experiences a problem reading a physiciansmedication order, the most appropriate action will be to:

A. Call the physician to verify the order.

B. Call the pharmacist to verify the order.

C. Consult with other nursing staff to verify the order.

D. Withhold the medication until the physician makesrounds.

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Medication

Administration


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Preparing for Drug

Administration


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Check the 5 rights

Standard Precautions:Wash your hands!

Double-check if unsureabout anything

Check for drug allergies

Prepare drugs for onepatient at a time

Check three times

Preparing for Drug

Administration (cont'd)


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Check expiration dates Check the patients

identification Give medications on time

Explain medications to thepatient Open the medications at

the bedside

Document the medicationsgiven before going to thenext patient

Drug Routes &

First Pass Effects

First Pass Routes- Oral,Rectal


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Non-First Pass Routes-Aural, Buccal, Inhaled,Intraarterial,

Intramuscular,Intranasal, Intraocular,Vaginal, Intravenous,Subcutaneous,

Sublingual,Transdermal

Oral Route

Easiest, mostcommonly used


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y

Slower onset of action

More prolonged effect

Preferred by clients

SublingualAdministration

Buccal Administration


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Enteral

Drugs


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Drugs Giving oral medications

Giving sublingual or buccalmedications

Liquid medications

Giving oral medications toinfants

Administering drugsthrough a nasogastric or

gastrostomy tube Rectal administration

Parenteral Route Injecting a medicationinto body tissues


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Subcutaneous (SQ)

Intramuscular (IM)

Intravenous (IV)

Intradermal (ID) Advanced techniques

Parenteral

Drugs

Never recap a usedneedle!


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Drugs

May recap an unusedneedle with the scoopmethod

Prevention ofneedlesticks

Filter needles

Parenteral

Drugs

Removing medicationsfrom ampules


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Drugs

(cont'd) Removing medicationsfrom vials

Disposal of usedneedles and syringes

Injections Needle angles forvarious injections


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Intramuscular (IM)

Subcutaneous (SC or SQ)

Intradermal (ID)

Z-track method for IMinjections

Air-lock technique

Injection

Techniques

Intradermal injections


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Techniques

Subcutaneous injections Insulin administration Heparin administration


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Injection

Techniques

Intramuscularinjections


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Techniques

(cont'd)

Ventrogluteal site

(preferred) Vastus lateralis site

Dorsogluteal site

Deltoid site


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Preparing

Intravenous


158/171

Intravenous

Medications Needleless systems Compatibility issues

Expiration dates

Mixing intravenouspiggyback (IVPB)medications

Labeling intravenous (IV)infusion bags whenadding medications


159/171


160/171

Intravenous

Medications Adding medications to a


161/171

Medications gprimary infusion bag

IVPB medications(secondary line)

IV push medications(bolus) Through an IV lock

Through an existing IVinfusion


162/171


163/171

Intravenous

Medications

( t'd)


164/171

(cont'd) Volume-controlledadministration set

Using electronicinfusion pumps

Patient-controlledanalgesia (PCA) pumps


165/171

Topical

Drugs


166/171

Drugs

Eye medications Drops

Ointments

Ear drops

Adults

Infant or child youngerthan 3 years of age


167/171

Topical

Drugs

Nasal drugs

Drops


168/171

g

(cont'd)

Spray

Inhaled drugs

Metered-dose inhalers

Small-volume nebulizers


169/171

Topical

Drugs

Administeringmedications to the skin

L ti


170/171

g

(cont'd)

Lotions, creams,

ointments, powders Transdermal patches

Vaginal medications Creams, foams, gels

Suppositories


171/171

pharma drugs

Documents