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CHAPTER 4Medication Preparation & Supplies

drug form (drug preparation) – type of preparation in which the drug is supplied most pharmaceutical companies prepare a drug in a form most suitable for route of delivery and means of absorption PDR lists the forms of a drug available – “how supplied”

Common Abbreviations for Drug Administration

DRUG FORMS ROUTES

Cap capsule IM intramuscular

Elix elixir IV intravenous

Gtt drop TOP topical

Supp suppository PO / po oral (by mouth)

Susp suspension R / PR rectal

Tab tablet Subcu subcutaneous

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Nontraditional Drug Forms and Devices

transdermal delivery system drug molecules are present in a variety of sizes and shapes that allow for absorption through the skin at various rates provides a constant even flow of drug over a long period of time (hours / days) first introduced during 1990’s space shuttles – nausea prevention

advantages easy application – minimal discomfort or undesirable taste effectiveness for long periods of time consistent blood levels of drug – released at varying rates

dermal patches vary in shape, size and color most commonly used for angina, motion sickness, chronic pain (Duragesic), smoking cessation (Nicoderm CQ), estrogen replacement (Climera)

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Implantable devices variety of sizes – placed just under the skin near blood vessels where the medication can readily be absorbed into the blood stream diabetic infusion pump (insulin), contraceptives and chemotherapy

new innovative drug form treats glaucoma sandwich drug (Pilocarpine) between very thin plastic membranes – place under the patient’s eye lid allows controlled release of medication over an extended time period little to no discomfort

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Standard Drug Forms

• gastrointestinal tract - oral, nasogastric, gastrostomy tube, rectal• parenteral (not through the GI tract) – injection, topical (skin, mucosal membrane), inhalation

ORAL DRUG FORMS

tablets• disk of compressed drug• variety of shapes / colors• may be coated to enhance swallowing• may be scored (lines dividing tablet into equal parts – break easily)

enteric-coated tablet• tab with a special coating – resists disintegration by gastric juices – the coating dissolves further down the GI tract in intestinal (enteric) region• drugs that are irritating to the stomach• to be effective – do not destroy by chewing / crushing

capsule• drug contained within a gelatin-type container• easier to swallow than non-coated tabs• double chamber may be pulled apart to add drug powder to soft foods / beverages (patients who have difficulty swallowing) – unless contraindicated for absorption

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sustained-release capsule / tablet• cap / tab containing drug particles that have various coatings (different colors) that differ in the amount of time required before the coating dissolves• delivers drug over an extended period of time• advantage - ↓ frequency of administration• do not crush / mixed with foods (unless specifically allowed) –damage may result in the drug being released at once (potential overdose) – swallow whole

lozenge (troche)• tablet containing palatable flavoring • indicated for local soothing on the throat / mouth• patient advised not to swallow lozenge – allow to slowly dissolve in mouth• patient advised not to drink liquids approx 15min after admin –prevent washing of contents from throat / mouth

suspension• liquid form of medication that must be shaken before admin – drug particles settle at the bottom of the bottle• drug is not evenly dissolved in the liquid

emulsion• liquid drug prep that contains oils / fatsin water

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elixir (fluid extract)• liquid drug forms with alcohol base• tightly cap to prevent evaporation• should not be available to alcoholics

syrup• sweetened, flavored, liquid drug form

solution• liquid drug form in which the drug is totally and evenly dissolved – appearance is clear rather than cloudy / settled (suspension)

RECTAL DRUG FORMS

suppository• drug suspended in a substance (cocoa butter) that melts at body temperature

enema• drug may be either a suspension (shake before admin) or a solution

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INJECTABLE DRUG FORMS

liquid – drug suspended (suspension – shake before use) or dissolved (solution) in a sterile vehicle• solutions often have a sterile water base (aqueous (aq) / water-like)• some solutions have an oil base (prolonged absorption time)

powder – dry particles of drugs (mix with a sterile diluting solution (water / saline) – reconstitution• supplied in undiluted powder form because the reconstituted (solution) form is stable for only a short period of time

intravenous – directly into a vein• immediate absorption and availability to major organs (potentially dangerous)• administered by physicians, paramedics or RN

• IV push – small volume of drug (bolus) injected into a peripheral saline lock (PRN adapter) attached to a vein or injected into a port on a primary (continuous injection line)

• IV infusion or drip (gtt) – large volume fluids (often with drugs added) infused continuously into a vein

• IV piggyback (IVPB) – a drug diluted in moderate volume (50-100mL) of fluid for intermittent infusion at specified intervals (q6 – 8h) – the diluted solution is infused into a port on the main IV tubing or into a rubber adapter on the IV catheter

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intramuscular – injected into a muscle by positioning the needle and syringe at 90o angle from the skin – absorption is fairly rapid (vascularity of muscle)

subcutaneous – injection into the fatty layer of tissue below the skin by positioning the needle and syringe at 45o angle from the skin • route of choice for drugs that should not be absorbed as rapidly as IV/IM

intradermal – injection just beneath the skin by positioning the needle bevel up and syringe at a 15o angle from the skin• primarily for allergy skin testing (lack of vascularity – absorption is slow)• TB test (PPD)• greatest reaction local (at site of injection)• when a small amount of drug (0.1 – 0.2mL) is injected intradermally, the amount of redness developed at the injection site can be used to determine if the individual is sensitive to the drug

epidural – injected into a catheter that has been placed by an anesthesiologist in the epidural space of the spinal canal• medications for pain – administered into the catheter by a bolus (measured amount of solution in a syringe) or by continuous infusion (tubing attached to a bag of solution)

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less common parenteral routes

intraosseous – injected directly into the bone marrow (long bones) –cardiac drugs during an MI (direct cardiac injection no longer recommended by ACLS)

intraventricular – drugs injected directly into the brain via catheter (ventriculostomy) placed in a brain ventricle – antibiotics in critical care

intraspinal – drugs injected into the subarachnoid space (contains CSF that surrounds the spinal cord) – generally anesthetics (lack of sensation to body regions distal to injection)

intracapsular (intra-articular) – injected into the capsule of a joint (usually to reduce inflammation)

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TOPICAL DRUG FORMS include drugs for dermal and mucosal application

cream / ointment (not the same) semisolid prep containing a drug – external application rule of thumb – when skin is wet, use cream / when skin is dry, use ointment

lotion liquid prep applied externally – unlike hand lotions, medicated lotions should be patted and not rubbed into the affected skin

liniment prep for external use that is rubbed on the skin as acounterirritant – creates a different sensation (tingling to mask pain)

dermal patch

topical drugs applied to mucosal membranes (local and systemic effect)

eye, ear and nose drops drugs in sterile liquids to be applied by drops (instillation of drops)

eye ointment sterile semisolid prep (antibiotic) only for ophthalmic use

vaginal creams medicated creams (antibiotic / antifungal) – inserted vaginally using an applicator

rectal and vaginal suppositories drugs suspended in a substance (cocoa butter) that melts at body temp for local effect – some have a systemic effect (Tylenol supp for fever)

douche solution sterile solution (antiseptic – providone-iodine and sterile) water used to irrigate the vaginal canal

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buccal tabs tab absorbed via the buccal (cheek) mucosa in the mouth – do not swallow tab / place between cheek and gums and allow to dissolve slowly

sublingual tabs tab that is absorbed via the mucosa under the tongue – do not swallow the swallow / place under the tongue and allow to dissolve slowly

INHALATION DRUG FORMS very fast acting (2nd to IV route) effective at delivering humidity and medication directly into the respiratory system liquid drug is placed into a device that will create a fine mist / aerosol that contains droplets of medication which is rapidly dissolved into the respsystem due to the large surface area and blood supply of pulmonary capillariesspray or mist liquid drug forms that may be inhaled as fine droplets via the use of spray bottles, nebulizers or metered dose inhalers

hospital setting – respiratory therapists use a nebulizer – meds include a bronchodilator, mucolytic agent and sterile saline solution for moisture at home – small-volume nebulizer (SVN), metered-dose inhaler (MDI) or a dry-powdered inhaler (DPI)

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SUPPLIES – used to administer medication

medicine cup two types of disposable cups commonly used – paper for tabs and caps and plastic 1-oz cups with measurement markings (mL, tsp, tbsp or oz) for oral meds

metal pill crusher and pill cutter used in most hospital settings (institutions)

mortar and pestle mortar is a glass cup in which tabs (excluding enteric coated) may be crushed using a pestle (club shaped glass tool)

medication for injection is supplied in an ampule, vial or prefilled syringe

ampule – small glass container that hold a single dose of sterile solution for injection – the neck must be broken to obtain the med

vial – glass container sealed at the top by a rubber stopper to enhance the sterility of contents (solution / powder that need reconstitution) – may be multiple or single dose

multi-dose – large amount of solution (up to 50mL) – doses are withdrawn through the rubber stopper – contain a preservative to stop microbial growth unit-dose (single dose) – small amount of solution (1-2mL) – limits excess and abuse

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needles length varies from short (3/8 in) to medium (1 – 1-1/2in) for standard

injections – long needles (2-5in) are used for intra-articular injections and (5in) are used for intra-spinal or intra-osseous injections

guage – number that represents the diameter of the needle lumen (opening) – vary from 16 (largest) to 27 (smallest)

syringes – three most common (disposable) for parenteral admin of drugs are the standard hypodermic, the tuberculin (TB) and the insulin syringe

standard hypodermic (2-3mL) – prepackaged with needle attached – subcu or IM – marked with 10 calibrations per mL (0.1mL)

insulin (1mL) – used strictly to admin insulin (100U) to diabetics

TB (1mL) – narrow and finely calibrated (100 per mL – 0.01mL) – pediatric doses and subcu skin tests

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SAFETY DEVICES

occupational Safety and Health Administration (OSHA) – mandated that every effort must be made to reduce the risk of needle-stick accidents (potential exposure to HIV, HBV, HCV) safety needles with a protective sheath that covers the needle

automatically or retracts into the syringe after admin needle devices that can be used to access IV tubing (IV, IVP meds)

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