Pharmacology Clear and Simple – Ch. 10 – Parenteral Medications and Administration

Parenteral medications include:
all medications that are not injested or introduced into the gastrointestinal system

Parenteral meds: (types)
topical, ophthalmic, otic, vaginal, nasal, inhaled, and injectable (intradermal ID), subcutaneous (SC), intravenous (IV)

ID
intradermal

IM
intramuscular

SC
subcutaneous

IV
intravenous

when giving any medication, you must:
wash your hands, observe the 7 rights of medication administration (right patient, drug, dose, time, route, documentation, technique), compare order with container 3x, document the administration of the drug

topical medications are:
applied directly to the skin as a patch, ointment, cream, lotion, or gel and are absorbed transdermally (through the skin)

topical medications are sometimes used:
if patients have difficulty swallowing or cannot take oral medications because of severe nausea

some medications are applied topically to achieve a system effect by maintaining:
continuous release of therapeutic doses of the drug

transdermally
through the skin

semisolid preparations include:
creams, ointments, gels and plasters, and are applied to the surface of the skin

ointments are ___ based
petroleum based; work to keep the medication in contact with the skin

overdose
cumulative effects of medication

common ointments include
antibiotic ointments such as Bactroban ointment placed on a wound and hydrocortisone cream used for itchy skin patches

creams are medications in a ___ base
water base; absorb into skin and disappear

Kwell:
is lindane, a prescription cream used for treatment of lice and scabies

Oxy 10 Balance:
another cream, medicated, used on existing blemishes

gels are ____ ____
semisolid suspensions; particles of drugs are suspended in a thickened water base; example is MetroGel for acne

plasters are :
medicated preparations that adhere to the skin with materials such as paper, linen, moleskin, or plastic; examples include salicylic acid plaster, used for warts, and bandages that are saturated with antibiotics

plasters can be used for ____ and _____
diabetes neuropathy and arthritis; plasters must be placed on healthy, intact skin only; examples are capsaicin plaster and 5% lidocaine medicated plaster

linaments or salves and lotions are also ____ preparations
semisolid

liniments are rubbed:
onto the skin; have an ingredient, usually camphor, wintergreen, or alcohol, that irritates skin, and causes blood flow to increase to affected area and decrease pain; examples are Bengay and IcyHot

lotions are used for:
externally for skin disorders, such as itchy skin with chickenpox or poison ivy

lotions are ____ based
water

creams are ___% water and ___%oil
50% water and 50% oil

lotions are ___ on
patten on (not rubbed into skin) to allow medication to stay on target area and not absorb into skin (example is calamine lotion, apply with a cotton ball)

topical meds are also available in a ___ form
solid, such as a powder or patch

powders are often applied to skin to treat:
fungal disease or reduce moisture

Desenex:
medicine, miconazole nitrate, powder to put on toes to prevent or treat athlete’s foot

transdermal patch purpose:
holds a specific amount of medication over a specific area and delivers medication over time

patches can be used for:
nausea, pain relief, alleviate nicotine addiction, control angine, provide hormonal treatment such as birth control and hormone replacement therapy

advantages of a transdermal patch:
ease of application and removal, effectiveness over time, reliable results based on even drug distribution in the body

disadvantages of a transdermal patch:
difficultry keeping patch in place; some patients have patch fall off because of excessive dryness or oiliness

failure to wipe away leftover medication at site when changing patches:
can lead to medication overdose

NicoDerm patch:
delivers very small amounts of nicotine through skin to help curb nicotine cravings when a person is trying to quit smoking

nitroglycerin
used to treat and prevent angina; is a vasodilator that helps coronary blood vessels open up and allow more efficient blood flow to heart

angina
chest pain caused by decreased blood flow to heart

wear ____ so medication does not enter your body from patch
gloves

be sure skin area is free of:
tattoos, scarring, and redness, as these features may alter absorption of medication

in a transdermal delivery system, the medication is contained in a:
drug reservoir, which is released through a membrane when the patch is applied to the skin by an adhesive backing

a patch you may have to prepare on your own:
nitroglycerin

ophthalmic medications are placed:
directly in the eye for infections, glaucoma treatment and prevention, and to facilitate examination and treatment; can be drops or ointment

eye drops are absorbed where:
through the inner canthus of the eye

ophthalmic ointments are:
thickened drug solutions that are applied to the inside lower eyelids

ocular inserts are:
small transparent membranes that contain medication; have advantage of prolonging contact of medication with eye surface

Lacrisert
hydroxypropylcellulose, insert used to treat chronic dry eye

inserts are placed
between the eye and lower conjunctiva and release medications over a period of time

when placing medications in a patient’s eye,
wear gloves and be careful not to touch dropper to eye itself to avoid spread of infection or contamination

have patient look ____ as you drop in the exact number of drops ordered
upward

put eye drops in before ______
ointment

nasolacrimal duct
runs from inside corrner of eye to the nose; have patient close eyes after insertion of eyedrops

otic medications are for the:
ear

otic medications are placed directly into the:
ear canal, to treat infections of both inner and outer ear

cerumen
ear wax

ear drops and eye drops should be at ___ temperature
room

pinna
outer ear

for ear drops in adults,
pull pinna up and back

for ear drops in children,
pull pinna down and back, straighten ear canal for best absorption

vaginal medications are usually used for ___ effect
local

vaginal medications are available in:
foams, gels, jellies, lotions

foams deliver meds via:
aerosolized foam

VCF
vaginal contraceptive foam

gels and jellies are solid particles of meds in:
viscous (thick)suspensions

metronidazole vaginal jel used to treat:
bacterial infections of the vagina

antigungal creams often used to treat:
yeast infections

IUD
intrauterine device, a contraceptive device implanted into uterus by advanced practioner; some are coated with and release the hormone progesterone

nasal medications are used to treat conditions:
seasonal allergies, asthma, congestion due to colds, and other sinus conditions

nasal medications form of:
spray, inhaler, instillation

nasal sprays are:
fine droplets inhaled from droppers or small spray bottles

before having patient use nasal drop,
have patient blow the nose before giving nasal drops to clear the mucosa for maximum absorption

have patient tilt head:
backward for nasal drops

make sure nasal dropper:
is clear and rinsed off

squueze nostril to prevent:
medicine from leaking

spray inhaler is used:
mist is sprayed into nose via a pump, bottle is not rinsed, only one per patient

CPAP
continuous positive airway pressure machine

admin meds through inhalation into respiratory system through:
cannulas, maks, and CPAPs, inhalers and nebulizers

in asthma, lungs are:
inflammed

MDIs
metered dose inhalers, used to ensure that as patient inhales, meds enter lungs; rapid method of adminstration, ideal for delivering certain kinds of drugs that break up congestion in the lungs

Mucomyst:
acetylcysteine, medicine, like albuterol, that dilates the airways to assist a patient in breathing

MDI’s are used through a ___ device
handheld, drugs are easily inhaled and begin working almost immediately at site of distress

spacer used in a MDI:
allow patient some control over when med is inhaled, its an extension tunnel that attaches to an inhaler and allows med to be held and admin when patient can inhale; useful for children and adults who are cognitively impaired or disabled

nebulizer
sometimes powders or drugs in solutions are added to special equipment called a nebulizer; this introduces the med by using compressed air or oxygen to aerosolize or suspend medication into small particles in a fine mist for inhalation into lungs through face mask or mouth piece

asthmatic patients use a nebulizer for:
ease their breathing, med opens and relaxes passages to the lungs

cystic fibrosis patients use nebulizer for:
delivering med to break up abnormally thich secretions in thei lungs and allow them to be exhaled

CPAP machine function:
forces room air or oxygen into the lungs even when patients forget to breathe

CPAP machine helps patients with:
sleep apnea, in which patient stops breathing for short periods of time in their sleep

oxygen given to patient in CPAP through:
nasal cannula or mask, order written as L/minute

nasal cannula disadvantage:
only lower concentrations of oxygen can be delivered

nasal mask advantage:
higher concentrations of oxygen can be delivered, but not as comfortable, some patients think they’re being suffocated

patients should add _____ to special chambers in CPAP machine to humidify the air
distilled water; chemicals are not added to the machine this way

injectable medications are available from manufacturer in ___ or ___ form
liquid or powder

powders must be mixed with ___ ____
sterile water or bacteriostatic sodium chloride solution

injectable meds are admin’d via:
needle and syringe and drawn up from ampules or vials

4 different routes of admin with injectible meds:
1. intradermal
2. intramuscular
3. subcutaneous
4. intravenous

ID method
intradermal, just below the epidermis, into the dermis itself (2nd layer)

ID injections used for:
TB testing and allergy testing

usual sites for ID injections:
inner aspect of forearm and upper back

in ID injection, hold the skin ___ and insert needle at ___ degrees
taut, 10-15 degrees, just under the epidermis

A ___needle is used for ID injection
short, small-gauge (diameter) needle

if injection is correct on an ID, a ___ forms
wheal

do or do not aspirate for blood in ID injection?
DO NOT

wheal
slight elevation of skin

do or do not massage site in ID injection
DO NOT

if medication leaks or wheal doesn’t form in ID injection:
you must do it again

IM injections:
allow medications to be absorbed quickly into bloodstream because of plentiful blood supply to muscles

Rocephin
antibiotic used for strep throat, injection

IMs are used for:
vaccinations and pain meds

onset of drug action in IM:
10-15 minutes

IM injections inserted at ___ angle
90 degree angle into a muscle

if IM is not done correctly, this damage can occur:
damage to major blood vessels, bones and nerves, and muscles at injection site

sites for IM injections depend on:
viscosity of liquid, size and development of muscle, and patient’s preference

do not inject into:
scar or tattoo, as tissues underneath may not have good blood supply

4 possible injection sites for IM:
1. deltoid
2. dorsogluteal
3. ventrogluteal
4. vastus lateralis

deltoid IM site:
upper arm, triangular muscle, 1 mL is max amount of fluid to inject, and needle length is 1 inch or less

dorsogluteal IM site:
in buttocks, more than 1 mL, safe for patients >2years; danger of hitting sciatic nerve; safest area is upper outer quadrant

ventrogluteal IM site:
used when patient can’t stand, and lies on side; not as commonly used; patients > 2 years

vastus lateralis IM site:
thigh muscle, large muscle on thigh side; for al age groups, choice in infants and small children

Z-track method
used when med is irritating to skin or may cause skin discoloration

Imferon:
med that needs to use Z-track method or else patient will have permanent discoloration of skin at site

subcutaneous injection:
if med needs to be absorbed more slowly; placed med into fat under skin

insulin & heparin are injected:
in SC layer or fatty layer

SC injections are put:
fleshy part of upper arm, the abdomen, and thigh

SC injection is at ___ angle
45 degree

IV route:
injects med right into a vein

most rapid method for admin med into bloodstream:
through an IV

IV advangates:
rapid absorption, quick relief of symptoms, fastest in an emergency

IV fluids and meds are:
admin directly to vein to treat illness, prevent illness, as part of a diagnostic procedure, or provide nutrition and hydration

disadvantages of IV therapy:
meds may be incompatible, risk of complications, like infiltrations, embolus, and infection; costs more; clots can form in IV catheter or port, making it useless

TPN
total parenteral nutrition

3 main types of fluids/solutions in an IV:
1. Dextrose
2. Saline
3. Lactated Ringer’s

Dextrose solution:
sugar and water solution.

Dextrose 2.5% in water
D2.5W

Dextrose 5% in water
D5W

Dextrose 10% inw ater
D10W

dextrose can also come in:
combos of 20-70%, but these are for patients with extremely low blood glucose levels, like diabetic patients, infants, severly malnourished patients, and only given under very controlled circumstances

Saline solution:
saline or sodium chloride (salt) solution may be prescribed; sodium is a vital electrolyte for body, helps cells function normally along with other electrlytes such as potassium and magnesium

Saline formulas:
usual is 9% NaCl, called NSS
1/2 NSS (0.45% NaCl)

NSS can be added to dextrose solutions:
D5NS or D10/0.45 NaCl

Lactated Ringer’s solution:
created by Sidney Ringer, English physiologist, mixed dextrose, potassium chloride, sodium, & calcium to make a healthful mixture for patients
also has Ringer’s lactate (RL) and dextrose 5% in lactated Ringer’s (D5LR)

crystalloids
simple solutions (IVs) used to increase fluid volume when a patient is dehydrated or in shock from bleeding. Kept in dark cabinet because the can deteriorate if exposed to light for long periods of time

drug infusion by IV has 3 routes:
1. infusion
2. piggyback line
3. IV push

infusion is:
slow IV administration of a large volume of fluid
can contain additives such as meds, electrolytes, or minerals; usually 250-1000 mL bag or bottle
hangs on a pole higher than heart

IV fluid flows to patient via ___ or ____
gravity or infusion pump

PCA
patient-controlled analgesia pumps

PCAs allow:
patients to push a button and receive meds, usually pain meds, like morphine or Demerol

dialysis
IV treatment solution option for patients who have kidney problems

piggyback solution used when:
patient needs meds/electrolytes several times/day over short period of time

piggyback solution conists of:
separate IV bag and tubing connected to primary IV tubing

piggyback may contain:
for example, antibiotic or potassium or vitamins that is given every 4 hours in 100 mL of fluid

IV push:
quick delivery of a small amount of med in a syringe; can’t be used for drugs that irritate vein, for drugs that can be fatal if given too quickly, or for a large amount of meds

TPN is given:
when patient’s digestive system needs a complete rest; aka hyperalimentation; is a nutritional solution infused (flowed) directly into veins to give patient complete nutrition; placed directly into a large vein

TPN provides patient with:
a well-rounded supply of fluids and electrolytes, calories from fats, proteins, and vitamins

TPN fluids require
use of special long-term catheters placed by a doctor, usually in the subclavian bein; end of catheter lies in superior vena cava

peripheral lines:
IV lines placed in veins in arms, hands or feet or scalp of small child

central lines:
IV lines inserted in large veins such as subclavian vein or internal jugular vein

central lines are used:
give additives that irritate small veins, such as total parenteral nutrition

PICC
peripherally inserted central catheter lines

PICC lines are:
similar to central lines in that they terminate in large vein close to the heart, but they are inserted from peripheral site such as lower arm

lipids or fats may be added to:
IV solutions

commercial lipid solutions contain:
soybean oil or safflower oil, which is added to water, glycerin, and egg yolks

blood and blood products can be admin’d through :
an IV line

whole blood provides:
complete correction of blood loss; restores not only fluid volume but also components cuch as platelets and WBCs that were depleted

one unit of blood is___ mL
500

patients with hemophilia require only:
clotting factors and platelets, not whole blood

before blood or blood product can be given, the :
patient’s blood type must be checked against what is to be admin’d

“type and cross”
process checking patient’s blood type against what is to be admin’d

transfusion reaction:
serious negative response to admin of blood or blood products

transfucion reaction signs/symptoms:
rapid change in vital signs, dyspnea, restlessness, fever, chills, blood in urine, pain in chest, back or flank

hematuria
blood in the urine

to discontinue a blood transfusion:
clamp line infusing blood and open line infusing NSS that is hung like a Y with the blood

ampule
small glass container holds one dose of a med in solution for injections

ampule is broken by:
placing gauze around neck of container, to protect hand and keep glass from falling into med

draw solution from ampule into a:
syringe with a filtered needle and then change to a different needle to inject solution into patient; this reduces chance broken glass will enter patient

most injectable solutions are supplied in ____ instead of ampules
vials

vials are:
glass or plastic containers sealed on top with rubber stoppers; this makes inside of container sterile

viales are either ____ or ____
multiple-dose or unit-dose

when an injection is given, ____ are used to puncture skin
needles, to deliver meds to desired location

when an IV infusion is started,
a needle is used to puncture the skin and place a plastic catheter

needles are based on:
length and circumference

a shorter needs is used for:
ID injections

a longer needs is used for:
IM injections

a ____ needle is used in children or adults with ___ muscles
small, small

a ____ needle is used in adults with large muscles
longer

needle’s gauge:
determined by width or circumference of the lumen

lumen
inside of the needle

gauges vary from ____ to ____
14 (largest) to 27 (smallest)

viscosity of fluid given determines the:
gauge

20 gauge needle may be needed for ____ fluid
thick

thin fluid can pass through a ____ gauge needle
27 gauge needle

OSHA
Occupational Safety & Health Administraition, run under the Department of Labor

OSHA requires that employers:
protect employees from accidental needle sticks

needle protectors
safety devices that OSHA requires, protecting employees from blood-borne pathogens; either retract needle before it’s pulled out of patient or cover needle after use

scoop method:
lay the cap on a flat surface and scoop it into the needle

various needle lengths:
3/8″ 1/2″ 1″ 1 1/2″

syringe:
holds the fluid to be admin’d

syringe has 3 parts:
1. barrel
2. tip
3. plunger

barrel is the:
hollow part of the syringe that holds liquid medication and through which the plunger passes

needle is:
attached to tip of syringe

plunger is part:
that pushes med through barrel and needle to deliver med to intended site

3 basic syringe types:
1. tuberculin TB
2. insulin
3. standard

tuberculin syringe:
for TB testing or other ID injections, little fluid is injected, and therefore a narrow, finely calibrated syringe is used; calibrated to 1/100 of a mL (0.01 mL); used frequently for newborns and children because doses of meds are small

insulin syringe is:
calibrated in units instead of mL; holds <1mL

standard U-100 syringe
has 100 units calibrated on barrel, and each line usually equals 2 units; each mark = 1 unit, not 2

all insulin syringes are used solely for :
insulin because an error in measurement can be fatal; no other syringe should be used for insulin; usually have orange in coloring to ID them as insulin syringes

hypodermic syringe:
standard syringe, available in sizes from 3-60mL

syringes are available w/o needles to deliver meds into the:
mouth

in emergency situations, some drugs are available in:
a prefilled cartridge

IM (Deltoid) injections go:
into arm muscles, volume 0.5-1 mL, 23-25 gauge, 5/8 inch, and 90 degrees

IM (ventrogluteal) injections go:
into muscles, 1-2mL, 18-23 gauge, 1 1/4 – 3 inches, 90 degrees

IM (Vastus lateralis) in adults injections go:
thigh muscle, 1-2mL, 20-23 gauge, 1 1/4 – 1 1/2 inch, 90 degrees

IM (vastus lateralis in child) injections go:
thigh muscle, 0.5-1mL (infants) <2 mL children, 23-25 gauge, 5/8 inch - 1 inch, 90 degree

IM (dorsogluteal) injections go:
muscle, 1-2 mL, 18-23 gauge, 1 1/4 – 3 inch, 90 degree

SC injections go:
subcutaneous tissue, <1mL, 25-29 gauge, 5/8 inch, 45 degree angle

ID injections go:
under epidermis, 0.1-0.2 mL, 25-27 gauge, 5/8 inch, 10 to 15 degrees

“spikes” the bag
inserting the end of the tubing into the outlet port of the bag or bottle; cap on spike section of IV tubing is removedjust before it’s inserted into IV container

drip chamber:
below the spike, allows flow of fluid from bag after it’s been primed (emptied of air) by squeezing it

length of IV tubing varies from ____ to ____ inches
6 to 120 inches, depending on need

rigid parts of IV set are made from
plastic or polymerized chloride

most common needle sizes for IV infusions are:
14 (largest) to 24 (smallest) gauges

needle can be two types:
1. winged “butterfly” type
2. straight needle within a catheter, called Angiocath

tourniquet should never be placed on patient for more than:
2 minutes

after inserting IV line, document:
1. size & device type
2.date & time inserted
3. site location
4. solution type
5. name of person who inserted IV catheter or hung IV bag
6. any additives added to IV solution
7. flow rate
8. number of attempts at insertion (successful & unsuccessful)
9. complications, if any
10: patient teaching

how to stop IV therapy:
put on gloves, loosen securing tape, pull out needle/catheter, dispose of it, apply pressure to site w/gauze, assess patient, document removal & time/date

IV site could have:
redness and swelling, warmth at site, patient complains of tendernedd or pain, or site feels like a firm rope, or cannula is no longer in a vein, notify your supervisor immediately, do not remove IV line w/o permission

IV complications:
bleeding, infection, phlebitis, infiltration, catheter dislodgment, occlusion, vein irritation, severed catheter, hematoma, venous spasm, thrombosis, thrombophlebitis, circulatory overload, nerve, tendon or ligament damage, systemic infection, air embolism, allergic reaction, incompatibility of meds, irreversible med error

infiltration occurs when:
IV catheter becomes displaces and allows IV fluids and meds to leak into tissue surrounding vein

thrombus or phlebitis:
blood clot or vein inflammation: can result from extremes in solution pH, needle or catheter trauma, particulate material, irritating drugs, slection of a vein too small for volume of solution infused; check vein for inflammation sign (redness, swelling, warmth to touch) or pain

air emboli can occur:
(bubbles released into bloodstream) if air enters vein; rapidly injecting air into vein can be fatal

particulate material can cause:
(small particles)vein irritation; small pieces of glass can chip away from vial or bottle; many IVs have final filter in line

True or False: Signs and symptoms of infection are redness, heat, swelling and pain.
True

True or False: IV tubing is clamped off with a filter
False

True or False: IM injections are given at a 90 degree angle
True

True or False: An ampule is usually broken to remove the solution
True

True or False: Vials come only in single-dosage units
False

True or False: A 27 gauge needle is larger than a 20 gauge needle
False

True or False: IM injections usually use a 3/8 inch needle
False

True or False: Drug viscosity determines needle length
False

True or False: Tuberculin syringes are used to give insulin
False

True or False: An U-100 insulin syringe holds 200 mL
False

True or False: Cartridge holders are disposed of with the prefilled cartridge
False

True or False: Otic medications go in the eye
False

True or False: Always wash an ear dropper with soap and water after use
False

True or False: Place used needles in biohazard containers after use
True

True or False: Otic and ophthalmic solutions are interchangeable
False

You are monitoring a patient who is receiving a blood transfusion, and he suddenly complains of chills and begins to have trouble breathing. What do you do?
Before blood or a blood product is given, the patient’s blood type must be checked against what is to be administered, called “type and cross.” It is quite possible that the patient is having a reaction to the blood in the transfusion. Signs and symptoms of a reaction include a rapid change in vital signs, dyspnea, restlessness, fever, chills, blood in urine, and pain in chest, back or flank. You will want to stop the blood transfusion in this case. To do so, you fill first clamp the line infusing the blood and the open the line infusing NSS(Natural Saline Solution) that is hung like a Y with the blood. You should closely watch the patient’s vital signs, including pulse, temperature, RR, BP, when transfusing blood products.

By which route is insulin usually given?
Subcutaneous

At which angle is a TB Test given?
10 to 15 degrees

An IM injection in an infant should be injected into which muscle?
Vastus lateralis

What is not true about Z-track injections?
Release the skin before removing the needle

Allergy testing is done via which route?
ID

Childhood vaccinations are administered via which route?
IM

A 90 degree angle is used with which of the following injections?
IM

Minute amounts of medication such as 0.1 mL are usually administered via which rote?
ID

Which route allows medication to reach the bloodstream the fastest?
IV

Ophthalmic medications are given in the:
Eye

A suppository is a type of medication that can be given via what route?
Anal or vaginal

An IV solution can include all of the following EXCEPT:
250NS

Dialysis is a procedure involving IV fluids for a condition affecting this organ:
Kidney failure

An IV catheter should be discontinued during which circumstance?
Phlebitis, Infiltration, Signs of Infection

A “Y”-tubing setup is used to administer:
Blood and blood products

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