Pharmacology

1. Pharmacology Chapter 9 Administration By Parenteral Route

2. 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

3. 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 ___________

4. 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

5. 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

6. 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

7. 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

8. 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

9. Patches • Be sure to always remove the first patch put on before applying another one. If you can’t find the first one, have someone help you with this • NEVER APPLY 2 PATCHES AT ONE TIME…O.D. ON THE MED…BAD

10. 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

11. Advantages of MDI’s • Rapid action of the drug with minimal local effects • Usually the drugs in this form are pretty potent and therefore, you don’t need a lot of the med to get results • Convenience to the pt…makes pt more compliant

12. Disadvantages of MDI’s • 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

13. 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

14. 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

15. Nebulizers • Used to treat asthmas • It’s 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

16. Side effects of meds given via nebulizer • Palpitations • Tremors irritated throat • Nervousness hoarseness • Dizziness coughing • Headache • Nausea/vomiting

17. 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

18. 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

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

20. 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

21. 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

22. 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

23. 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

24. 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

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

26. 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

27. Subcutaneous injection sites • There are many places to administer sub q injections into

28. Sub Q injection Sites

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

30. Z-track method for IM injections • This method is used for injections that are irritating to tissues such as: • Iron • Dextran • And some antibiotics

31. 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

32. 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

33. 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

34. 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

35. The EndDeltoid Ventrogluteal