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Home , Dermal patch, Liniment

10/12/2015

CHAPTER 4 Preparation & Supplies

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  PDR lists the forms of a drug available – “how supplied”

Common Abbreviations for Drug Administration

DRUG FORMS ROUTES

Cap IM intramuscular

Elix IV intravenous

Gtt drop TOP topical

Supp PO / po oral (by mouth)

Susp R / PR rectal

Tab Subcu subcutaneous

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Nontraditional Drug Forms and Devices 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 (Duragesic), 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 (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

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

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 • 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 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 approx 15min after admin – prevent washing of contents from throat / mouth suspension • 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 • liquid drug prep that contains oils / fats in 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 • sweetened, flavored, liquid drug form • 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 • 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 • 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 () 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 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 • 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 / 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  liquid prep applied externally – unlike hand , medicated lotions should be patted and not rubbed into the affected skin  prep for external use that is rubbed on the skin as a counterirritant – creates a different sensation (tingling to mask pain)

topical drugs applied to mucosal membranes (local and systemic effect) eye, 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  drugs suspended in a substance (cocoa butter) that melts at body temp for local effect – some have a systemic effect (Tylenol supp for fever) 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 / that contains droplets of medication which is rapidly dissolved into the resp system due to the large surface area and blood supply of pulmonary capillaries spray or mist  liquid drug forms that may be inhaled as fine droplets via the use of spray bottles, or metered dose  hospital setting – respiratory therapists use a – meds include a bronchodilator, mucolytic agent and sterile saline solution for moisture  at home – small-volume nebulizer (SVN), metered-dose (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)

– 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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