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Focus on
PHARMACOLOGY
ESSENTIALS FOR HEALTH PROFESSIONALS
CHAPTER
4
Administration of
Medications
Multimedia Directory
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Safe Medication Administration
• Medications have the potential to cause
serious harm to the patient.
• All medication orders must come from
the physician or other authorized
health-care professional, per state law.
• Vigilance is needed to prevent errors
and ensure quality patient care.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Principles of
Drug Administration
• Assess patient health and obtain
medication history and use of vitamins,
herbs, or food supplements prior to
giving medications.
• Determine if route of administration is
suitable.
• Assess socioeconomic factors and
ability to self-administer (if applicable).
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Seven Rights of Drug
Administration
1.
2.
3.
4.
5.
6.
7.
Right
Right
Right
Right
Right
Right
Right
patient
drug
dose
route
time
technique
documentation
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Medication Errors
• Inappropriate or incorrect
administration of a drug
• Medication errors should be
preventable through effective system
controls involving all levels of healthcare workers as well as the patient.
• Some errors are caused by
manufacturing mistakes.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Errors Occur in Three Stages
• Prescribing or ordering medication
• Dispensing medication
• Administering medication and
monitoring for side effects
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Why Medication Errors Occur
• Miscommunication
• Missing information
• Lack of appropriate labeling by
manufacturer or pharmacist
• Environmental factors
• Poor management
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Causes of Medication Errors
•
•
•
•
•
•
•
Wrong patient
Incorrect route
Incorrect drug
Incorrect dose
Incorrect time
Incorrect technique
Incorrect information on patient chart
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Manufacturing Errors
• The sulfanilamide disaster of 1937 is an
example of formulation or
manufacturing errors.
• Mislabeling, contamination, wrong
drug, wrong concentration, wrong
doses of drugs, counterfeit drugs, and
undiscovered toxicity are other causes.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Administering
Medications Safely
• Follow all physician orders exactly as
written.
• If unsure about an order, ask for
clarification.
• Administer a medication only after the
order is written in the patient’s chart.
• Use the 7 rights and perform 3 order
and label checks when dispensing and
administering the drug.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Reducing Medication Errors
• Provide adequate, trained staff.
• Use standardized metric measurement
systems.
• Develop consistent error-tracking
systems.
• Establish clear system for review of
drug orders, ordering, dispensing, and
administration.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Reducing Medication Errors
• Maintain medication profiles with
regularly updated allergy and reaction
histories.
• Provide suitable, safe work
environments.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Ensuring Safe
Drug Administration
• Be sure you understand physician’s
order and clarify questions about
medication, dose, route of
administration, and strength with
physician.
• Review adverse effects, precautions,
purpose, and recommended dose in
pharmacology reference book such as
PDR.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Routes of Administration
• Enteral: absorbed through GI tract
– Oral
– Nasogastric or gastrostomy tube
– Sublingual or buccal
• Parenteral: injected
– Intravenous (IV), intramuscular (IM),
subcutaneous, intradermal
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Enteral Route: Oral
• Most common, easiest, and most
economical
• Contraindicated if patient is vomiting,
has gastric or intestinal suction, is
unconscious, or is unable to swallow
• Liquid medications are best for
children.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Medications May
Stain Teeth and Dentures
• Advise elderly patients who have
dentures to remove them before taking
certain medications. Some oral liquid
drugs, such as iron or iodides, may
stain teeth and dentures.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Enteral Route: Nasogastric
and Gastrostomy
• Nasogastric (NG) tube: inserted
through nasopharynx and into stomach
• Gastrostomy tube: surgically placed
directly into stomach
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Enteral Route: Sublingual
• Sublingual: placed under tongue for
dissolving
• Used when rapid action is desired
• Examples include nitroglycerin (for
angina pectoris) and ergotamine
tartrate (for migraines)
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-1
Medication given via the sublingual route.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Enteral Route: Buccal
• Placed between gum and cheek for
dissolving
• Forms include tablets, capsules,
lozenges, and troches
• Should not be swallowed
• Often used over sublingual route for
sustained-release delivery
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-2
Administration of drugs via the buccal route.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Buccal and
Sublingual Medications
• Advise patients not to drink or eat
anything when buccal or sublingual
medications are administered.
• Medications must dissolve completely
before consuming food or drink.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Parenteral Routes
•
•
•
•
More quickly absorbed than oral route
Irretrievable once injected
Require invasive procedure
Aseptic technique must be used to
avoid infection.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Parenteral Equipment
• Needles: pierce the skin to allow
injection
• Syringes: contain and then transfer the
medication into the body through
needle
– Hypodermic, insulin, tuberculin
• Ampules and vials: contain medication
that is then drawn into syringe for
injection
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-3
The parts of a standard syringe: barrel, plunger, and shaft.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Dorling Kindersly, Ltd
Figure 4-4
Various types of syringes, including tuberculin, insulin, and hypodermic.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Unit-dose Injections
• Available as:
– Prefilled syringes that are ready to be used
– Prefilled sterile cartridges and needles that
must be attached to a reusable holder
(injection system) before use
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Michal Heron / Pearson Education / PH College
Figure 4-5
Prefilled unit-dose systems.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Needles
• Most are disposable and made of
stainless steel.
• Special procedure needles may be
reusable and need to be re-sharpened.
• Three parts of needle are:
– Bevel: the slanted part at tip
– Cannula (or shaft): attaches to hub
– Hub: fits onto syringe
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Needle Characteristics
• Gauge (diameter of shaft): varies from
#18 (larger) to #28 (smaller)
• Length of shaft: commonly ranges from
½ to 2 inches; determined by type of
injection, patient’s weight, and muscle
development
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Needle Characteristics
• Slant or length of bevel: longer bevels
for IM and subcutaneous injections;
shorter bevels for IV or intradermal
injections.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Ampules and Vials
• Used to package sterile parenteral
medications
• Ampules: made of clear glass; usually
contain single dose of drug; usually
have prescored neck that is cut open;
medication is then aspirated into
syringe using filter needle
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Ampules and Vials
• Vials: small glass bottles sealed with
rubber cap; pierced with needle to
withdraw medication
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Michal Heron / Pearson Education / PH College
Figure 4-6
Drawing medication from a vial with a syringe.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Intradermal Injection (ID)
• Usually given in inner forearm or upper
back just below epidermis into dermis
• Commonly used for tuberculin or
allergy tests, or to administer local
anesthetics
• Needle enters at 15-degree angle
• Injection produces small wheal on
skin’s outer surface
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Michal Heron / Pearson Education / PH College
Figure 4-7A
Intradermal injection.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Subcutaneous Injection
• Usually given into upper arms, back, or
abdomen
• Commonly used for heparin and insulin
• 45-degree angle usually used, based on
patient’s body weight
• Small volumes of medication (0.5 to
1 mL) are given subcutaneously.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Hofmeester / Dreamstime
Figure 4-7B
Subcutaneous injection.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Heparin Injections
• For subcutaneous heparin injections,
make sure that 0.1 to 0.2 mL of air is
in the syringe to prevent heparin
leakage into tissue, which can cause
localized hemorrhage.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Self-administration of Insulin
• Teach diabetic patients who must selfadminister insulin to rotate insulin
administration sites.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Intramuscular (IM) Injections
• Usually given into upper arm, thigh, or
hip muscles
• Commonly used for drugs that irritate
subcutaneous tissue
• 90-degree angle is usually used; or
Z-track method.
• 1 to 3 mL of medication can be given
IM.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Michal Heron / Pearson Education / PH College
Figure 4-7C
Intramuscular injection.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
IM Injections in Infants
and Young Children
• Use shorter needles (#22 to #25
gauge, 5/8- to 1-inch) for IM injection.
• Use the dorsogluteal site for IM
injection in children younger than 3
years.
• For infants 7 months or younger, use
the vastus lateralis site for IM injection.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
IM Injections in Older Patients
• Older patients have muscle atrophy
(decreased mass).
• A shorter needle may be needed.
• Carefully assess an appropriate
injection site.
• Absorption of medication may occur
more rapidly than expected.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-8A
Angles and depths of injection for intradermal injections.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-8B
Angles and depths of injection for subcutaneous injections.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Figure 4-8C
Angles and depths of injection for intramuscular injections.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Intravenous Injection (IV)
• Injected directly into veins, usually in
arms
• Used for many types of drugs and fluids
• May be administered slowly, rapidly (IV
push), by piggyback infusion, into
existing IV line (IV port), into
intermittent access device (heparin
lock), or added to IV solution
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Intravenous Injection (IV)
• IV needles are inserted into veins at a
short angle to the skin.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Transdermal Medications
• Transdermal patches provide
sustained-release administration.
• Examples include:
– Nicotine
– Nitroglycerin
– Estrogen
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Tomasz Trojanowski / Shutterstock
Michael Keller / Lithium / AGE Fotostock
Figure 4-9
Examples of transdermal patches.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Ophthalmic Route
• Medications are administered to the
eyes using instillations or irrigations
with liquids or ointments.
• Sterile technique is required.
• Prescribed liquids are usually diluted to
less than 1% strength.
• Eye irrigations are used to wash out
conjuctival sac.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
MedicImages / Getty Images
Figure 4-10
Instillation of eye ointment.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Seth Joe / Photodisc / Getty Images
Figure 4-11
Instillation of eye drops.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Otic Route
• Localized infection or inflammation of
the ears is treated by dropping a small
amount of sterilized medication into
ear.
• Patient should remain lying on one side
for 5 minutes to allow coating of inner
ear canal with medication.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Dorling Kindersley, Ltd
Figure 4-12
Instillation of ear medication. © Elena Dorfman.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Nasal Route
• Nasal decongestants are most common
nasal instillations.
• Many of these medications are OTC
drugs.
• Administered with dropper or via
sprays; usually while patient is supine
with head tilted back
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Comnet / Prisma / AGE Fotostock
Figure 4-13
Administration of nasal medications.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Inhalation Route
• Inhalation therapy may involve the
administration of medicines, water
vapor, and gases such as oxygen,
carbon dioxide, and helium.
• Local effects are achieved within the
respiratory tract through aerosols,
nebulizers, Spinhalers, or metered-dose
inhalers.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Inhaled Asthma Medications
• Commonly administered by nebulizer
– Delivers fine fog or mist using atomization
or aerosolization
– Atomization: larger droplets are inhaled
– Aerosolization: droplets are suspended in
gas such as oxygen (the smaller the
droplets, the further they can be inhaled
into the respiratory system)
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Michal Heron / Pearson Education / PH College
Figure 4-14A
A girl breathes mist through a nebulizer with a bite piece in her mouth.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Nebulizer Video
Click on the screenshot to view a video on the topic of nebulizers.
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Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini
Dorling Kindersley, Ltd
Figure 4-14B
A breath-actuated inhaler. © Dorling Kindersley.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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Dorling Kindersley, Ltd
Figure 4-14C
Inhaler with face mask. Tim Ridley © Dorling Kindersley.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
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ballyscanlon / Digital Vision / Getty Images
Figure 4-15
Metered-dose inhaler.
Focus on Pharmacology: Essentials for Health Professionals, Second Edition
Jahangir Moini