1. ADMINISTRATION OF MEDICATION Part 1
CHAPTER 11
ADMINISTRATION OF MEDICATION
Part 1

2. Terms Pharmacology: The study of drugs
Includes:
Preparation
Use
Action of drugs in the body
Drug: A chemical that is used for the treatment, prevention, or diagnosis of disease
Most drugs are produced synthetically but can also be obtained from animals, plants and minerals

3. Introduction to Administration of Medication
In the office, medication may be:
Administered: given to patient at office
Prescribed: Physician provides patient with a handwritten or computer-generated prescription to be filled at a pharmacy
Can also be telephoned or faxed to pharmacy
Dispensed: Medication given at office for patient to take at home (e.g., drug samples)
There are certain restrictions on faxed or telephone prescriptions.

4. Legal Aspects Administer medication only under direction of physician
Unlawful to administer medication without physician's consent

5. Routes of Administration
Oral
Sublingual
Inhalation
Rectal
Vaginal
Topical
Parenteral: IM, SC, ID, IV
What are some medications the student is already familiar with in each category?

6. Routes of Administration
Route depends on:
Type of drug
Dosage form
Intended action
Rapidity of response
desired
What is an example of a situation in which we would want a drug to work very quickly?

7. Routes of Administration
Most common route of administration in office:
Parenteral: Refers to sites located outside gastrointestinal (GI) tract
Most commonly used to refer to administration of medication by injection
Ask the students what medications they have had by this route and why they were given this medication.

8. Classification of Drugs Based on Action
Drugs classified according to action they have on body
For common drugs administered in office, MA should know:
Category to which drug belongs
Primary use
Major therapeutic effects
Why is it important to know the category?
What are ways the MA can find out what category the drug is in?

9. Guidelines for Preparation and Administration of Medication
Work in quiet, well-lit atmosphere free from distractions
Always ask if you have a question about a medication order
Know drug to be given
Who would you ask if you have questions about the medication?
What are some reference materials you can consult?

10. Guidelines for Preparation and Administration of Medication, cont.
Select proper drug
Check label three times
When taking it from storage
Before preparing medication
After preparing medication
Do not use if label is missing or difficult to read
Why is it important to check the drug label three times?

11. Guidelines for Preparation and Administration of Medication, cont.
Do not use drug if:
Color has changed
Precipitate has formed
Unusual odor present
6. Check expiration date
What is a precipitate?

12. Guidelines for Preparation and Administration of Medication, cont.
Prepare proper dose
Dose: the quantity of a drug to be administered at one time
Dose too small: will not produce therapeutic effect
Dose too large: could be harmful or fatal
Identify patient: by full name and DOB
Check for allergies to medication
Check patient’s chart
Question patient
If air is drawn up with the medication, what will happen?

13. Guidelines for Preparation and Administration of Medication, cont.
If giving injection: determine route and site
Determined by the type of injection
Examples:
Allergy injection: administered subcutaneously (SC)
Antibiotic: administered intramuscularly (IM)
Site must be free from:
Abrasions
Lesions
Bruises
Edema
Why is it important to administer into the right tissue?

14. Guidelines for Preparation and Administration of Medication, cont.
Use proper technique
Stay with patient after administration
Document information in patient's chart: must be clear and legible
Date and time
Name of medication and lot number (if required)
Why wouldn’t we want to administer an injection into the areas listed on the slide?

15. Guidelines for Preparation and Administration of Medication, cont.
Dose given
If dose contains a fraction of a unit: place a 0 before decimal point
Example: 0.5 mg (not .5 mg)
Never place a decimal point and a zero after a whole number
Example: 20 mg (not 20.0 mg)
So not misread as 200 mg
If a decimal point is used, make sure it is clear and readable.

16. Guidelines for Preparation and Administration of Medication, cont.
Route of administration
Site of administration
Any unusual observations or patient reactions
Sign record with your name and credentials
Why is all of this information that needs to be charted important?
Answer all of the patient’s questions about the medication.

17. Example

18. Seven “rights”
Always follow seven "rights" of preparing and administering medication
Right drug
Right dose
Right time
Right patient
Right route
Right technique
Right documentation
This protects the patient, the physician, and the MA.

19. Oral Administration
Most convenient and most common method to administer medication
Drug is given by mouth (po) in solid or liquid form
Absorption of most oral drugs: small intestine
Why are most drugs developed absorbed in the small intestine and not the stomach?

20. Oral Administration, cont.
Easier for many patients to swallow tablet/capsule with a glass of water
Water should not be offered if patient has taken cough syrup
Water dilutes beneficial effects
What would you say to a patient who wants water after taking cough syrup?
What would you do if a patient complains of solid medications getting stuck in his or her throat?

21. Parenteral Administration
Advantages (SC, IM, IV):
Absorbed more rapidly and completely than oral route
May be only way drug can be given
Unconscious patient
Gastric disturbance
Nausea
Vomiting
What is one medication that a patient gives himself or herself by this route?

22. Parenteral Administration, cont.
MA usually responsible for administering SC, IM, ID
Intravenous administration: when immediate effect is needed
Usually administered by physician in emergency situation
Can an MA start an IV?

23. Parenteral Administration, cont.
Disadvantages
Pain
To minimize pain of an injection:
Insert and withdraw needle quickly and smoothly
Withdraw needle at same angle as that of insertion
Possibility of infection at injection site
What are signs of infection at the injection site?

24. Parenteral Administration, cont.
Injections that are given repeatedly: must rotate sites (e.g., allergy injections):
Prevents irritation and tissue damage
Allows better absorption of drug
Record administration of medication in patient's chart:
Record site of administration
Assists in proper rotation of sites for injections given repeatedly
The MA should be knowledgeable of all sites that parenteral medication can be given.

25. Parenteral Administration, cont.
Use medical asepsis when administering medications (Needle and inside syringe must remain sterile)
Reduces danger of microorganisms entering patient's body
Follow OSHA Bloodborne Pathogens Standard
To Protect MA from bloodborne pathogens
What PPE should the MA use?

26. Parts of a Needle Needle a. Hub: fits onto top of syringe
b. Shaft: inserted into body tissue
c. Lumen: opening in shaft of needle
d. Point: located at end of needle shaft
e. Bevel: slanted tip that makes a narrow, slitlike opening in skin
Refer to slide 143 for diagram.

27. Needle Gauge Gauge: Refers to diameter of lumen
Range: between 18 and 27
As size of gauge increases, diameter decreases
Thick, oily medications: must be given with a large lumen
Large lumen: makes a larger needle track in tissue
Use smallest gauge needle possible: to reduce pain and tissue damage
The MA must make sure the right gauge is used. Where would he or she find this information?

28. Needle Length Length: refers to distance of shaft
Range: between ⅜ and 3 inches
Based on type of injection given (IM, SC, ID) and size of the patient
-Example: Giving an IM injection to an obese adult: requires a longer need to reach muscle tissue
Why is it important to have the right length of needle?

29. Parts of a Syringe Barrel: holds medication
Contains calibrated markings to measure proper amount (cc or ml)
Flange: rim at end of barrel
b. Helps in injecting medication and prevents syringe from rolling
Plunger: moveable cylinder
c. Used to draw medication into and out of syringe
Refer to slide 151 for diagram.

30. Hypodermic Syringe Calibrated in cc Available in 2, 2.5, 3, and 5 cc
Commonly used to administer IM injections

31. Insulin Syringe Designed to administer insulin injections
Calibrated in units
Most common:
U-100

32. Tuberculin Syringe
To administer very small dose of medication (e.g., tuberculin test)
Capacity of 1 cc
Calibrations divided into tenths and hundredths of a cc

33. Safety-Engineered Syringes
Safety-engineered syringes: built-in safety feature to reduce risk of needlestick injury
OSHA requirements:
Reduce needlesticks and other sharps injuries among health care workers
Employers are required to evaluate and implement safer medical devices
There are different types of safety-engineered syringes available.

34. Safety Engineered Syringe

35. Safety Engineered Syringe

36. How Medication is Supplied
Vials
Closed glass container with a rubber stopper
Available in single-dose or multiple dose
c. Vial may require mixing
Examples:
Reconstituting a powdered drug
Roll medication between hands; Do not shake
Some medications in vials may be stored at room temperature, while others need to be refrigerated. How would the MA know where to store the vial?

37. Rolling Vial

38. Removing Medication from Vial
Inject amount of air equal to amount of liquid to be removed
Prevents formation of a partial vacuum: makes it difficult to remove medication
How will the MA know how much air to inject into the vial?

39. Removing Medication from Vial, cont.
Inject air above fluid level
Prevents getting air bubbles into medication
Why would we want air bubbles in the medication?

40. Removing Medication from Vial, cont.
Remove medication by inserting needle opening below fluid level
Prevents air bubbles from entering syringe
Draw up correct amount of medication
Notice the MA is careful not to let the needle touch her hand. What would you do if the needle touched your hand?

41. Removing Medication from Vial, cont.
Remove air bubbles from syringe by tapping barrel with fingertips
Air bubbles take up space medication should take up: prevents patient from receiving full dose of medication
Make sure all bubbles are removed completely from the syringe once you have tapped them up to the top.

42. How Medication is Supplied
Ampule
Small, sealed glass container
Holds a single dose of medication
Constriction in the stem (neck): helps in opening it
Make sure no medication in stem: tap it lightly
What type of medication comes in an ampule? (Phenergen)

43. Removing Medication from Ampule
Open by holding firmly with gauze and breaking off stem
Remove medication from ampule
Do not let needle touch outside of ampule
Do not inject air into ampule
Insert needle below fluid level
Withdraw medication
Why should we open the ampule using gauze?

44. Hazard with Ampule
Small glass particles can get into ampule: when stem broken off
Prevent this by using filter needle to withdraw medication
Where would you discard the filter needle after drawing up the medication?

45. How Medication is Supplied
3. Prefilled syringes and cartridges
Disposable
Do not have to draw up medication
The medication shown is Bicillin. In what category is this drug?

46. Info. Printed on Prefilled Syringe/Cartridge
Name of drug
Dose
Expiration date
Why is the expiration date important?

47. Storage of Medications
Store properly following info in drug package insert
Improper storage may alter effectiveness of medication
If a medication is not stored properly or is expired, what would you do?
Should there be a form to fill out if medication has to be disposed of? Why or why not?

48. Subcutaneous Injections
Administered into subcutaneous tissue
Consists of adipose (fat) tissue
Located just under the skin
SC tissue: located all over body
Certain sites more commonly used
Where bones and blood vessels are not near surface of skin
Name a site where an SC injection is given.

49. Subcutaneous Injections, cont.
SC sites commonly used:
Upper lateral part of arms
Anterior thigh
Upper back
Abdomen
If a patient is giving his or her own insulin injections, what sites are easy for him or her to access?

50. Subcutaneous Injection Sites

51. Subcutaneous Injections, cont.
Angle of insertion: 45 or 90 degrees
When would we give an SC injection at a 90-degree angle?

52. Subcutaneous Injections, cont.
Medication is absorbed through capillaries
Slower absorption rate than IM
Do not give SC injection into tissue that is
Grossly adipose
Hardened
Inflamed
Edematous
Why would we not want to give an SC injection in the sites that are not recommended on the slide?

53. Subcutaneous Injections, cont.
Needle length range: ½ to ⅝ inch
Use 45-degree angle of insertion with ⅝-inch needle
Use 90-degree angle of insertion with ½-inch needle
Needle gauge range: 23 to 25
Use proper length needle to make sure medication is administered into SC tissue
Elderly and dehydrated patients: have less SC tissue
Use shorter needle
Obese patients: have more SC tissue
Use longer needle
Why wouldn’t we want to give an IM injection with a ½-inch needle?

54. Subcutaneous Injections, cont.
SC tissue is sensitive to:
Irritating solutions
Large volumes of
medication
10. Medications administered SC:
Epinephrine
Insulin
Allergy injections

55. Intramuscular Injections
Administered into muscular layer of the body
Located below skin and SC layer
Angle of insertion: 90 degrees to patient’s skin
Why must we wear gloves when giving an injection?

56. Angle of Insertion

57. Intramuscular Injections, cont.
Amount that can be injected:
Gluteal and vastus lateralis sites:
Adults: Up to 3 cc
Very thin adults and older patients: Up to 2 cc
Deltoid site: no more than 1 cc
Absorption more rapid than SC (more blood vessels in muscle tissue)
Medication that is irritating to SC tissue: often given through IM route (fewer nerve endings in muscle tissue)
If 2.5 cc of medication are to be given, where would you give it?

58. Intramuscular Injections, cont.
5. Needle length range: 1 to 3 inches
Average-sized adult: typically use 1-1½ inches
Child or thin adult: 1 inch
Obese patient: 2 inches or more depending on amount of SC tissue
6. Needle gauge range: 18 to 23
Depends upon viscosity of medication
Intramuscular Injection Sites
Located away from large nerves and blood vessels
Should be fully exposed (Permits clear visualization of site)
Why is it important to reach muscle tissue when giving an IM injection?

59. Intramuscular Injection Sites
1. Dorsogluteal Site
Gluteal muscles are well-developed: can absorb large amount of medication
Used for:
Adults
Children older than 3 years of age
Patient position: on abdomen with toes pointed inward (relaxes gluteal muscles)
Show site on a student volunteer.

60. Dorsogluteal Site
Inject medication into upper outer quadrant of gluteal area
Identify landmarks through palpation and visualization
Be extremely careful to maintain proper boundary lines
To avoid injection into sciatic nerve

61. Deltoid Site Deltoid Site Make sure entire arm is exposed
Easily accessible
Patient position: sitting or lying down
Amount: no more than 1 cc should be administered
Site is small because major nerves and blood vessels surround it
Cannot administer large amount of medication
Cannot administer repeated injections
Make sure entire arm is exposed
Completely pull up sleeve or remove arm from sleeve
Tight sleeve constricts arm: causes bleeding from puncture site
Show site on a student volunteer.

62. Deltoid Site, cont. To locate site:
Palpate lower edge of acromion process
Can also be located by placing four fingers horizontally across the deltoid muscle with top finger along acromion process; site located three finger widths below acromion process

63. Vastus Lateralis Site Vastus Lateralis Site
Thick muscle away from major nerves and blood vessels
Recommended for: infants and children younger than 3 years
Gluteal muscles are not well developed yet
Show site on a student volunteer.

64. Vastus Lateralis Site, cont.
To locate site:
Proximal boundary: hand's width below greater trochanter
Distal boundary: hand's width above the knee
Patient position: Easier to give lying down but patient can be sitting

65. Z-Track Method Z-Track Method Used for administering medication that:
Irritate SC tissue or discolors skin
b. To administer injection:
Pull skin and SC tissue to the side
Administer injection and remove needle
Release skin: causes a zigzag path through tissue
Seals off needle track and prevents medication from reaching SC layer or skin surface
For what condition is iron dextran used?

66. Z-Track Method