1. Chapter 51 Drug Administration Medical Assisting
PowerPoint® presentation to accompany:
Medical Assisting
Third Edition
Booth, Whicker, Wyman, Pugh, Thompson

2. Learning Outcomes
51.1 Discuss your responsibilities regarding drug administration.
51.2 Perform dosage calculations accurately.
51.3 Describe how to assess the patient before administering any drug.
51.4 Identify the seven rights of drug administration.

3. Learning Outcomes (cont.)
51.5 Describe the various techniques of drug administration.
51.6 Compare different types of needles and syringes.
51.7 Explain how to administer an intradermal, subcutaneous, or intramuscular injection.

4. Learning Outcomes (cont.)
51.8 Explain what information you need to teach the patient about drug use, interactions, and adverse effects.
51.9 Describe special considerations related to drug administration.
51.10 Describe nonpharmacologic ways to manage pain.

5. Introduction
Drug administration is very important and can be a dangerous duty
Given correctly – restore patient to health
Given incorrectly – patient’s condition can worsen
Medical assistant must
Understand principles of pharmacology
Understand fundamentals of drug administration
Routes
Dosage calculations
Techniques for injection
Seven rights
Patient education
You should be familiar with the medications frequently prescribed in your practice.

6. Drug Administration and Scope of Practice
States’ medical practice acts define medical assistants’ exact duties
Know your scope of practice in the state where you will work

7. Dosage Calculations Measurement systems
Metric
Apothecaries
Household
Most doctors use the metric system

8. Dosage Calculations (cont.)
Basic units of volume and weight
Metric system
Liter (L) – volume
Grams (g) – weight
Apothecaries’ system
Fluidounces, fluidram, pints, quarts – volume
Pounds – weight
Household system
Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume

9. Dosage Calculations (cont.)
Conversions between systems
Approximate equivalents
Charts
Calculations
Ratio method
Fraction method

10. Dosage Calculations: Formula Method
Desired dose
Dose on hand
The physician orders aspirin, 10 grains
On hand are 5-grain aspirins
10 grains
5 grains
× Quantity of dose on hand
× 1 tablet = 10/5 or 2 tablets

11. Dosage Calculations: Formula Method (cont.)
Work these problems:
The physician has ordered ampicillin 500 mg, on hand 250 mg capsules. How much would you give?
You have 50 mg metropolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give?
2 capsules
½ tablet

12. Dosage Calculations: Ratio Method
Doctor orders 500 mg of ampicillin. You have 250 mg on hand.
Set up a ratio with the unknown number of capsules needed and the amount of drug ordered X:500 mg
Set up a ratio with a single capsules and the amount of drug in a single capsule 1 tab:250 mg
Create a proportion, multiply the outer and then the inner parts, and solve for X X:500 mg :: 1cap:250 mg
Answer = 2 capsules

13. Dosage Calculations: Fraction Method
The doctor orders 30 mg of Adalat. Each capsule contains 10 mg.
Set up the first fraction with the dose ordered and the unknown number of capsules
30 mg x
Set the second fraction with the amount of drug in a capsule
10 mg
1 cap
Then use both fractions in a proportion:
30 mg mg
x = cap
Solve for X = 3 capsules

14. Dosage Calculations: Pediatric and Geriatric
Metabolism and absorption altered
Require precise calculations
BSA – body surface area
Weight

15. Apply Your Knowledge
Which measuring system is used by most physicians?
ANSWER: Most doctors use the metric system when working with pharmacology principles.
Convert 25 grams to milligrams.
ANSWER:
Add a decimal point to the measurement: 25. g
Add 3 zeros so you can move the decimal point three places to the right: g
Move the decimal point to the right three places: 25,000
Change the unit: 25,000 mg

16. Apply Your Knowledge 3 for 3! Very Good!
Calculate the dose to give for 500 mg Augmentin®.
ANSWER:
20 mL
3 for 3!
Very Good!

17. Preparing to Administer a Drug
Drugs
Local effect – applied directly to skin, tissue, or mucous membranes
Systemic effect – given by routes that allow the drug to be absorbed or distributed into the bloodstream
Pay close attention
Dose
Route
Form of medication
Medical assistant
Close attention to detail
Strong patient assessment skills
Expert technique

18. Preparing to Administer a Drug (cont.)
Assessment
Injection site
Drug allergies
Patient condition – be alert to changes that can affect drug therapy
Consent forms

19. Preparing to Administer a Drug (cont.)
Rules for administration
Give only drugs the doctor orders – use drug reference, if necessary
Wash your hands
Prepare in a well-lit area
Focus on task; avoid distractions
Calculate the dose carefully
Do not leave a prepared drug unattended – never give a drug that someone else has prepared

20. Preparing to Administer a Drug (cont.)
Rules for administration
Identify patient properly
Physician should be in the office
Observe patient following administration
Discard any ungiven medications properly
Report error to physician immediately
Document properly

21. Preparing to Administer a Drug (cont.)
Seven Rights of Drug Administration
Right patient
Right drug
Right dose
Right time
Right route
Right technique
Right documentation

22. Apply Your Knowledge Right!
How do you properly identify the patient before administering a drug?
ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.
Right!

23. Techniques for Administering Drugs
Oral
Tablets, capsules, lozenges, and liquids
Slower absorption through GI tract
Buccal or sublingual
Buccal – placed between the cheek and gum
Sublingual – placed under the tongue
Faster absorption; bypasses GI tract

24. Techniques for Administering Drugs (cont.)
Parenteral
Administration of substance into a muscle or vein
Fast absorption; bypasses GI tract
Safety risks
Rapid administration; rapid action
Exposure to bloodborne pathogens
Methods of injection
Intradermal (ID)
Subcutaneous (SC)
Intramuscular (IM)
Intravenous (IV)

25. Techniques for Administering Drugs (cont.)
Needles
Available in different gauges – the smaller the number, the larger the gauge (inside diameter)
Length – long enough to penetrate the appropriate layers of tissue
Syringes
Barrel
Plunger
With or without needle
Calibrated in milliliters or units

26. Techniques for Administering Drugs (cont.)
Parenteral drug packaging
Ampule – glass or plastic container that is sealed and sterile (open with care)
Cartridge – small barrel prefilled with sterile drug
Vial – small bottle with rubber diaphragm that can be punctured by needle

27. Techniques for Administering Drugs (cont.)
Methods of injection
Intradermal
Into upper layer of skin
Used for skin tests
Subcutaneous
Provides slow, sustained release and longer duration of action
Rotate sites
Intramuscular
More rapid absorption
Less irritation of tissue
Larger amount of drug
Z-track method
Intravenous
Not usually given by medical assistants

28. Techniques for Administering Drugs (cont.)
Inhalation – administered through the mouth or nose
Topical
Direct application of a drug on the skin
Transdermal – use of a medication patch that will release medication slowly and evenly
Urethral – instill liquid drugs directly into the bladder
Vaginal and rectal
Eye or ear – creams, ointments, drops, or irrigations

29. Apply Your Knowledge Super! Matching:
___ Absorption through GI tract A. Topical drug
___ Under the tongue B. Oral drug
___ Small bottle with rubber diaphragm C. Intramuscular drug
___ Less irritation of tissue D. Subcutaneous drug
___ Direct application to skin E. Sublingual drug
___ Need to rotate sites F. Vial
ANSWER: B E F C A D
Super!

30. Educating the Patient About Drug Administration
How to read the prescription drug label
Interactions
Drug-drug interactions
Drug-food interactions

31. Educating the Patient About Drug Administration (cont.)
Adverse effects
Report changes
Recognize significant adverse effects
Instructions on taking the drug
At the right time
In the right amount
Under the right circumstances

32. Bravo! Apply Your Knowledge
What should you instruct the patient about regarding drug administration?
ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly.
Bravo!

33. Special Considerations
Pediatric patients
Physiology and immature body systems may make the drug effects less predictable
Require dosage adjustments and careful measurements of doses
Observe pediatric patients closely for adverse effects and interactions
Administration sites and techniques may differ

34. Special Considerations (cont.)
Pregnant patients
Remember that you are caring for two patients
Giving the mother a drug also gives it to the baby
Check drug information sources for pregnancy drug risk categories

35. Special Considerations (cont.)
Patients who are breast-feeding
Some drugs are excreted in breast milk
Ingestion can be dangerous because baby can’t metabolize or excrete drugs
Check drug information sources for contraindication during lactation

36. Special Considerations (cont.)
Elderly patients
Age-related changes affect
Absorption
Metabolism
Distribution
Excretion
May have increased risk of
Drug toxicity
Adverse effects
Lack of therapeutic effects

37. Special Considerations (cont.)
Patients from different cultures
Can affect a patient’s understanding of drug therapy and compliance with it
Obtain drug information sheets in the languages that are commonly spoken by patients in your office

38. Fantastic! Apply Your Knowledge
What do children and the elderly have in common in relation to drug administration?
ANSWER: Both have alterations in metabolism and absorption of drugs requiring adjustments in dosages.
Fantastic!

39. Charting Medications Progress notes Be sure to have the right chart
Administration
Special problems
New symptoms
Patient’s statements
Patient tolerance
Be sure to have the right chart
Be specific and accurate

40. Nonpharmacologic Pain Management
Biofeedback – evokes relaxation; helps block pain perception
Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxation
Relaxation exercises – breathing techniques

41. helps block pain perception
Apply Your Knowledge I M P R E S V !
You administer a medication to Mr. Max. What and where should you chart?
ANSWER: You should chart in the progress notes the date, time, dosage, route, and name of the medication, as well as how well the patient tolerated it.
True or false:
___ Biofeedback involves special breathing techniques .
___ Audiotapes can be used with guided imagery.
___ Relaxation exercises are used to relax different muscle groups.
ANSWER:
helps block pain perception F T T

42. In Summary Medical assistant Administer drugs safely and effectively
Conversions and calculations
Patient assessment
Observe general rules
Follow seven rights of drug administration
Be aware of patients needing special considerations
Be aware of nonpharmacologic methods for managing pain control

43. End of Chapter 51 Words are the most powerful drug used by mankind.
~Rudyard Kipling