7/30/2019 Drug Administration 2011
1/98
DRUG ADMINISTRATION
1
dr. Prajogo Wibowo, M. Kes
7/30/2019 Drug Administration 2011
2/98
2
THE PREPARATION CAN BE
DISTINGUISHED INTO
INTERNAL PREPARATION
ORAL
STOMACH
INTESTINAL
DRUGS LABEL : WHITE
EXTERNAL PREPARATION
ALL OF MEDICATION
but
ORAL INTESTINAL
DRUGS LABEL : BLUE
7/30/2019 Drug Administration 2011
3/98
SYSTEMIC & NON SYSTEMIC MEDICATIONS
3
1. INTERNAL PREPARATION
SYSTEMIC : ANTIBIOTIC (SYSTEMIC)
ANTIHYPERTENSION, ANALGESIC
NON SYSTEMIC : ANTIHELMINTIC
LOCAL ANAESTHETIC, ANTIMICROBIAL(INTESTINAL), LOCAL ANTACID
2. EXTERNAL PREPARATION
SYSTEMIC : PARENTERAL INJECTION
INHALER, SUPPOSITORIA
NON SYSTEMIC : VAGINAL TABLET,
TOPICAL STEROID, GARGLE,SUPP
7/30/2019 Drug Administration 2011
4/98
MANAGEMENT OF MEDICATION
1. INTERVAL OF MEDICATION
2. TIMING OF MEDICATION
3. TECHNIQUE OF MEDICATION
4
7/30/2019 Drug Administration 2011
5/98
5
1. INTERVAL OF MEDICATION
examples :* HOURLY
* EVERY (THREE-HOURS)* THREE TIMES A DAY
2. TIME OF MEDICATION
examples :* in the morning, in the midday, in the night
* before, after, or during meals; before sleeping
* during episode, during attack, after attack
3. TECHNIQUES OF MEDICATION
* ROUTE OF ADMINISTRATION : TOPICAL AND NON-TOPICAL DRUGS
* DRUG DOSAGE FORMS
7/30/2019 Drug Administration 2011
6/98
INTERVAL OF MEDICATION
Determined by :
* HALF-LIFE TIME (t 1/2) OF DRUGS :
Ultrafast, Fast, slow, very slow
Example :
Reserpin has t 1/2 15 minutes and 36 hours of duration
DURATION OF DRUG ACTION / EMERGENCY SETTING
In emergency condition, in particular clinical treatment
6
7/30/2019 Drug Administration 2011
7/98
HALF-LIFE TIME (T 1/2)
ULTRAFAST :amoxicillin, cloxacillin, flurosemide, penicillin-G
FAST :
paracetamol, ampicillin, hydrocortison
SLOW :
doxicillin, griseofulvine, proctolol
VERY SLOW :
barbiturate, diazepam, digitoxin, phenylbutazon
7
7/30/2019 Drug Administration 2011
8/98
STANDARD ADMINISTRATION TIMES
DAILY
Once : 10.00 (morning)/22.00 (night)
Twice : 10.00 , 14.00
Three times : 10.00 , 14.00, 18.00
Four times : 10.00, 14.00, 18.00, 22.00
EVERY12-hourly : 10.00, 22.00
8-hourly : 06.00, 14.00, 22.00
6-hourly : 06.00, 12.00, 18.00, 24.004-hourly : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00
8
7/30/2019 Drug Administration 2011
9/98
TIMING OF MEDICATION
BASED ON :
* CHEMICAL PROPERTIES OF DRUGS* PHYSIOLOGICAL PROPERTIES OF GASTROINTESTINAL
TRACT
POSSIBLE INTERACTIONS :
1. DRUG AGAINST DRUG2. DRUG AGAINST GASTROINTESTINAL CHYME
3. DRUG AGAINST GASTROINTESTINAL PHYSIOLOGY
THE CONSEQUENCES :1. DRUG : reaction occurs --> impaired absorption; break-
down of drug
2. GASTROINTESTINAL TRACT : drug irritation, impairedmotility, delayed gastric emptying, reduced absorption.
9
7/30/2019 Drug Administration 2011
10/98
OVERCOME
1. DETERMINATION OF APPROPRIATE TIMING
IN DRUG ADMINISTRATION
2. MANAGING THE PRIORITY ORDER OF
DRUGS.
3. CHOOSING THE APPROPRIATE DRUG
TYPES
10
7/30/2019 Drug Administration 2011
11/98
TIMING OF MEDICATION
IN THE MORNING :
* Steroid * Laxative Bisacodyl tablet
* Diureticum * Suppositoria
* Antihypertension * Vaginal tablets
* Hypnotics
* Cimetidine
* Anticholesterolemia
IN THE NIGHT :
* Contraceptive pills
DURING DAILY ACTIVITIES
DURING MEALWith meal : - promptly after meal
- During Meal
Empty Stomach : 1 hour before meal
2 hours after meal
11
DURING EPISODE
* Pectoral angine drugs
* Drugs for migraine-cephalgy
* Antiasthmatic drugs
7/30/2019 Drug Administration 2011
12/98
DRUGS & PHYSIOLOGY OF GIT
Factors affecting drug
1. Chemical properties
2. Gastric pH3. GI tract motility
12
7/30/2019 Drug Administration 2011
13/98
13
ANTICHOLINERGIC DRUGS reduce :
* Secretion* Intestinal peristaltic
These drugs should be taken one hour before meal
BELLADONA ALKALOID GROUP : Tinct.BelladonaAtropin extr. Belladona Hormotropin
Scopolamin Oxypheninium
Methylscopolamine Mepenzolate
Butylscopolamine Bevonium
QUATERNARY COMPOUNDS Clidinium
Propanteline
7/30/2019 Drug Administration 2011
14/98
DRUGS AND FOODS
1. Drugs interferred by gastric chyme
ANTIMICROBES :
Ampicillin
AmoxicillinErythromycin
Lincomycin
Oxytetracycline
Penicilline G/VTetracycline
All these drugs should better be taken during "emptystomach"
14
Isoniazide
Rifampicin
OTHERS :
Levodopa
Penicillinamine
PropantelineParacetamol
7/30/2019 Drug Administration 2011
15/98
2. DRUGS THAT SYNCHRONIZED
WITH CHYME (FOOD)ANTIMICROBES :
Doxycycline
Doxycycline hyclateErthromycin ethylsuccinate
Griseofulvin
Nitrofurantoin
The above mentioned drugs should be taken "with meals"
15
OTHERS :
Hydralazine
HydrochlortiazidePropanolol
Metroprolol
Reserpine
7/30/2019 Drug Administration 2011
16/98
3. STOMACH-IRRITATING DRUGS
Aminophylline
Acetyl salicilic acid
Codein
PhenylbutazonFerrosulphate
Hydrocortison
Indomethacine
Isoniazide
1. The possibility not to be taken by patients with gastritis
2. Some are administered in contained stomach or excessive water drinking
3. Some are in favour given with milk 16
Chlorpromazine
Metronidazole
Nitrofurantoin
PrednisoneReserpine
Mephenamic acid
Pirazolone
7/30/2019 Drug Administration 2011
17/98
INTERACTIONS BETWEEN DRUGS
DRUGS THAT INTERACT WITH ANTACIDS IN STOMACH :ANTBIOTICS :
Amoxicillin
Ampicillin
Cloxacillin
Nitrofurantoin
OxytetracyclinePenicillin V
Sulphonamide
Tetracycline
EXAMPLE OF MEDICATION TIMING OF THE INTERACTIVE DRUGSR/ Ampicillin 500 mg cap No. XV
S 3. dd.cap.I (1) hac 1 hour before mealR/ Antacid tab No.XX
S3.dd.tab.I (1) hpc 1 hour after meal 17
OTHERS :
Acetylsalicilic acid
Digitalis
Dicumarol
Phenotiazine
Ferrous preparation
Isoniazid
Chlordiazepoxide
Levodopa
IndomethacinePropanolol
7/30/2019 Drug Administration 2011
18/98
MEDICATION TECHNIQUE
DRUG DOSAGE FORMS
ROUTE OF ADMINISTRATIONSPECIFIC- DRUG MEDICATION
PARENTERAL DRUG MEDICATION
18
7/30/2019 Drug Administration 2011
19/98
METHOD OF MEDICATION
TERMS : SITES :
* Oral Mouth
* Peroral (per os) GI tract system via mouth
* Sublingual Under the tongue* Parenteral Other sites than GI tract (by injection)
* Intravenous into vena
* Intraarterial into artery
* Intracardiac into the heart
* Intraspinal/intrathecal into spine* Intraosseous into bone
* Intraarticular into joint
19
7/30/2019 Drug Administration 2011
20/98
20
Intrasynovial Synovial fluid cavity
Intracoutaneous or intradermal into skin
Subcutaneous under skin
Intramuscular into muscle
Epicutaneous (Topical) Skin surface
Transdermal Skin surface
Conjunctival Conjunctiva
Intraoccular Eye globe
Intranasal Nose
Aural Ear
Intrarespiratory Lung
7/30/2019 Drug Administration 2011
21/98
THE USAGE OF DOSAGE FORMS
Sublingual tablet
trochition and lozenges
Parenteral solution, suspension
Epicutaneous/Transdermal intment, cream, paste, powder,
aerosol, lotion, and transdermal, disc, and solutionattachment
21
7/30/2019 Drug Administration 2011
22/98
THE USAGE OF DOSAGE FORMS
Conjunctival ointment
Intraoccular/intraaural solution, suspension
Intranasal solution, spray, inhalant, ointment
Intrarespiratory aerosolRectal solution, ointment, suppositoria
Vaginal solution, ointment, emulsified
foam, tablet, insert, suppositoria,
sponge
Urethral solution, suppositoria
22
7/30/2019 Drug Administration 2011
23/98
DRUGS THAT ARE USED SPECIFICALLY
1. SUBLINGUAL TABLET
For cardiac diseases : angina / asthma(nitroglycerin,
isoprenalin)
2. CHEWING TABLET
Drugs for gastritis
3. LOZENGESMouth freshener (anti inflammation)
23
7/30/2019 Drug Administration 2011
24/98
MULTI-LAYER TABLET
Tablets that are destroyed in intestine
Tablet :
* Unchewed but powdered
* Without milk, alkaline drinks, or antacid
DRUGS THAT NEED EXCESSIVE DRINK (200-300 ml)
* Sulfa group
* Metronidazol
* Erythromycin
* Amoxicillin
* Aspirin
24
7/30/2019 Drug Administration 2011
25/98
DRUGS THAT ARE WITHOUT
EXCESSIVE DRINK
Antigastritis drug/antacid suspension
DRUGS THAT ARE TAKEN WITHOUT MILK Vitamin C+ Ferrous
Antienteretis
Enteric coated tablet Tetracycline
PEDIATRIC DRUG ADMINISTRATION
Tablet powder/pulveres dissolved into : Honey
Sugar water
Jelly
Corn oil
25
7/30/2019 Drug Administration 2011
26/98
THE APPLICATION OF OPTHALMIC OINTMENT / EYE DROP
1. The hand holds the ointment after washed first to be clean
2. Open the tube's cap then discard the first 1/4 inch length of the
ointment, because this portion is often dry.
3. With one finger, press downward the lower lid meanwhile the
patient is staring upward
4. Press and rub the eye ointment as long as 1/4 - 1/2 inch onto
the inner side of the lid without touching it nor eye globe.
5. Close the eye and rotate the eye globe in all direction (possibly
the vision will become slightly blurred ).
6. Cap the tube immediately without touching the tips of cap nor
tube. 26
7/30/2019 Drug Administration 2011
27/98
1. Cough out the sputum as much as possible.
Aerosol is shaked before use2. Place it as the recommendation of the
manufacterer. It is usually set upside down.
3. Place the oral edge of tube inside the mouth,face upward by moving head posteriorly.
4. Breath out slowly, empty the lung volume asmuch as possible.
5. Press the tube content in order to spraymeanwhile immediately inhalate it deeply withtounge position remains still below.
6. Hold the breath within 10 - 15 seconds.
7. Then, expire the air through nares. 27
7/30/2019 Drug Administration 2011
28/98
28
7/30/2019 Drug Administration 2011
29/98
INHALANT MEDICATION
1. Cough out the sputum as much as possible.
2. Place the capsule into the inhaler container as the
manufacturer's recommendation
3. Breath out slowly, empty the lung volume as much as
possible.
4. Place the oral tip of tube inside the mouth.
5. Face upward by moving head posteriorly.
6. Breth in deeply through inhaler
7. Hold the breath for 10 -15 seconds
8. Exhale the breath through nares.
29
7/30/2019 Drug Administration 2011
30/98
30
7/30/2019 Drug Administration 2011
31/98
NASAL DROP
1. Sit with your head facing upward, or pad your
shoulder with a pillow under.
2. Insert the tip of dropper asdeep as 1cm into the
nares.
3. Drip some drops of the drugs as recommended.
4. Nod downward your head so that the head is over
the knee.
5. Sit up repetitively for several times so that the
drop can enter the pharynx.
31
7/30/2019 Drug Administration 2011
32/98
32
7/30/2019 Drug Administration 2011
33/98
NASAL SPRAY
Nod down the head slightly.
The other nose is closed by pressing the nares with
your finger.
The sprayer is inserted into the opened nares by
pressing the vial, so that its content will be out andinhalte gently, then do the same as the
abovementioned.
33
7/30/2019 Drug Administration 2011
34/98
34
7/30/2019 Drug Administration 2011
35/98
EAR DROP
The best is the head in slanting position
Gently the upper part of the ear lobe is slightlyattracted upward (in adult) and the middle one in
children in order to let the opening is seen clearly.
Drip some ear drops and wait for approximately 5minutes before doing the same into another one.
In some products, it is recommended to close theear opening with cotton ball.
35
7/30/2019 Drug Administration 2011
36/98
36
7/30/2019 Drug Administration 2011
37/98
SUPPOSITORIA
Suppositoria is prepared to be out of the container. When itis too flaccid, it would better be cooled first, whereas if it istoo hard, heat it by placing it inside your fist.
Lay down with slanting position and one of the lowerextremities is abducted to the abdomen.
Insert gently the suppositoria into the anal openingmeanwhile it is rotated foreward with one of your hands.Keep lying for several minutes.
37
7/30/2019 Drug Administration 2011
38/98
38
7/30/2019 Drug Administration 2011
39/98
INTRAVAGINAL MEDICATION
In general, intravaginal medication is limited to thelocalized application for which ointments ortablets are available to insert into vagina andusually by the time of going to bed, such as
metronidazole and primaricin for vaginitis causedby trichomonas and candida.
The drugs may be used in the form of swabbingliquid, others in the forms of spermaticide (to killspermatocyte), foam tablet,and cream.
39
7/30/2019 Drug Administration 2011
40/98
40
7/30/2019 Drug Administration 2011
41/98
SKIN DRUGS
THE TOPICAL DRUGS USED FOR SKIN IN GENERAL
INCLUDE :
1. WATTER (SOLUTION)
2. ALCOHOL (TINCTURE)
3. POWDER
4. WET POWDER (SHAKED POWDER)
5. CREAM
6. PASTE
7. OINTMENT
41
7/30/2019 Drug Administration 2011
42/98
LOCATION
Back and chest
Genitalia
Scalp
Hand and arm
Skin fold
Lower extremities
Face
42
All types Powder, watered powder,
cream solution.
Powder, watered powder,
cream solution. Water (solution), alcohol,
cream.
Powder, water solution,alcohol, ointment, wet powder,paste, cream.
Watered powder (solution),alcohol, ointment, wet powder,cream.
All types except for eye skin.
7/30/2019 Drug Administration 2011
43/98
THE CHOOSING OF DRUGS IS ON THE
BASIS OF THE SKIN DISORDERS,
THUS THE WET CONDITION OF THE
SKIN DISORDERS NEEDSAPPLICATION OF WET PREPARATION,
WHILE THE DRY SKIN USES
SEMISOLID PREPARATION.
43
7/30/2019 Drug Administration 2011
44/98
Vesicles, edema, erythrema Crust, itching infection Water (solution) - wet compression Powder, lotion, sprays Cream (o/w) Cream (w/o) and and ointment
44
Desquamation, erythrematous, itching,
drying
7/30/2019 Drug Administration 2011
45/98
THE ADVANTAGES OF PARENTERAL MEDICATION :
1. The drug action can be reached rapidly, strong, and
complete
2. No irritation or not destroyed by gastric acid
3. Can be administered to the patients with unconsciousness
or swallowing unability
45
Parenteral medication can be undertaken :
1. By injection with syringe
2. Through infusion liquid (more than 10 ml volume)
7/30/2019 Drug Administration 2011
46/98
ADVANTAGES
1. In general, it is expensive and impractical
2. Easy to contaminate
3. Able to damage blood vessel, tissue, and nerve
4. The administration methods should be adjusted,
because of being slow and rapid
46
7/30/2019 Drug Administration 2011
47/98
CONCLUSIVELY, PARENTERAL MEDICATION ARE
BASED ON 2 MAIN CONSIDERATIONS :
1. Expectation of rapid drug action
2. the required drugs are in the form of parenteral
dosage forms
47
7/30/2019 Drug Administration 2011
48/98
INTRAVENOUS ADMINISTRATION NEEDS THE
7/30/2019 Drug Administration 2011
49/98
SKILLFULNESS, GREAT ATTENTION, AND
PRECATIOUSLY WITH ANTISEPTIC TECHNIQUES AND
ALSO NEED CLOSE MONITORING OF DRUG ACTION.
Physicians judge the decision of intravenous medication basedon as follows :
1. whenever other routes of administration are considereimpossible whereas the terapy management must beimplemented promptly. For example :
* Methicillin in stomach will be broken down by acid,whereas via intramuscular method is impossible because oflarge volume required, then the chosen appropriate
method is intraveous route.
* The multiple drug medication in large volume is impossible
to give intramuscularly regarding to giving risepainfulness; similarly, subcutaneous method will result inwider inflammation.
* In very irritative drug by intramuscular and subcutaneousmethod, it can be diluted into infussion.
49
7/30/2019 Drug Administration 2011
50/98
50
In the specific clinical settings, the rapid administration isrequired for patients with serious condition.
In patients with high tendency to be hemorrhagic(thrombocytopenia or hemophilia and anticoagulantadministration), intramuscular and subcutaneousmedication will cause formation of hematoma which ispainful and extensive or bleeding.
For supplementary nutrition, in patients with GIdisturbances, peroral intake is not adequate, and sodoes patient with gastrointestinal post-operative condition.
* Patients with vomiting and nausea at certain level,
such as severe hyperemesis gravidarum,unconsciousness, or swallowing unability.
Beside intravenous drugs and liquid administration, itis also important to give blood or bloodcomp[onen in
certain cases.
INTRODUCTION TO INJECTION DRUGS
7/30/2019 Drug Administration 2011
51/98
INTRODUCTION TO INJECTION DRUGS
Injection drug is a sterilized preparation in the forms of :
1. Liquid, consisting of :
Solution, the active ingredient disolves in it and theavailable packaging is in ampule or vial.
Suspension, unsoluble active ingredient, issuspended thoroughly in the suspension using
suspension agent.Emulsion, the liquid containing the mixture of waterand oil.
2. Dry Powder, including :
Soluble Ingredient, mixed with solvent before use,this ingredient is not long-standing that breaks downin the solution.
Insoluble Ingredient, mixed with liquid when it will beused, because it is not long-standing in solution, but
broken down. 51
7/30/2019 Drug Administration 2011
52/98
DELAYING THE DRUG ABSORPTION INTO THE BLOOD
VESSELS, IN THE REASON TO LENGTHEN THE DRUG
ACTION, SUSPENSION OR SOLUTION IN BEAN OIL OR
SESAME OIL IS FREQUENTLY USED, FOR EXAMPLES,PENICILLIN AND SEXUAL HORMONE SUSPENSION,
GIVEN INTRAMUSCULARLY.
52
7/30/2019 Drug Administration 2011
53/98
THE CONTAINER OF INJECTION DRUGS
1. AMPULES
It is made from glass or plastics with various sizes,from 1 ml (adrenalin) up to 10 ml (aminophyline)
generally for once usage.
53
7/30/2019 Drug Administration 2011
54/98
54
7/30/2019 Drug Administration 2011
55/98
THE PREPARATION TO USE :
With clean hands, align the fine wound line on the
ampule neck, then using alcohol cotton clean it and
break it ; if the ampule head is made from plastics,
rotate the ampule head untill it is separated completely.
55
2 VIAL
7/30/2019 Drug Administration 2011
56/98
2. VIAL
It is made from glass with rubber cap fixed with filmmetal surrounding the bottle lip, generally can be usedrepetitively.
The filling of drug solution into syringe is as follows :
Solution :
Suck the air as much as needed
Make the vial rubber clean using sterilized alcoholcotton
Prick the syringe into the vial while the upside-down position of the vial .
Press the air into the vial then directly pump-in thesolution as much as needed, the needle shouldbe always in the solution border.
Make the syringe free from air and clean it, washthe hands.
56
7/30/2019 Drug Administration 2011
57/98
57
7/30/2019 Drug Administration 2011
58/98
HYPODERMIC EQUIPMENTS
SYRINGE is an equipment to get water or solution into the
body or body cavities.
HYPODERMIC SYRINGE is syringe to use for subcutanous,
intramuscular, and intravenous methods. It is a sucking typeand characterized by the main components including a metal
piston and a tube made from glass with various sizes.
1. Tuberculin syringe : small size with capacity no more than
1 ml .
0.1 - 0.001 ml.
Hypodermic Syringe : Larger size with capacity 2 - 50 ml.
58
7/30/2019 Drug Administration 2011
59/98
59
7/30/2019 Drug Administration 2011
60/98
DISPOSABLE SYRINGE :
Made from plastics with larger size thanTuberculin syringe (5 ml) for once use only,packed with steril state and separated
needle.
In general, it is used the administration ofantibiotics,antihistamine,heparin, tranquilizer,vitamin, etc.
60
7/30/2019 Drug Administration 2011
61/98
61
7/30/2019 Drug Administration 2011
62/98
HYPODERMIC NEEDLES
This needle typically is made from stainless steel,
hyperchromed steel, carbon steel, chromium, platinum,
silver or gold.
The form of hypodermic needles based on :
1. Length
2. Thickness needle
3. Sectioning: sharp-angle sectioned needle
62
7/30/2019 Drug Administration 2011
63/98
63
7/30/2019 Drug Administration 2011
64/98
LONG, SHARP-ANGLED OR LONG THICK NEEDLES ARE
USED FOR INJECTION, LOCAL ANESTHESIA, SUCKING,
HYPODERMOLYSIS AND SUBCUTANEOUS INJECTION.
Figure:
Short-sectioned needle
Long-sectioned needle
64
Short, sharp- angled needles are used for
injections : intravenous, infusion, and transfusion,whereas the special short, sharp-angled needles
are used for intradermal and spinal injections.
NEEDLE SIZE
7/30/2019 Drug Administration 2011
65/98
NEEDLE SIZE
The choosing of needle size on the basis of
1. Safety2. Flow volume
3. Patient's convenience
4. Penetration depth
The unit of needle size is GAUGE referring to the outerdiameter of canula or needle shaft.
In general the size is 1 - 27 gauge, with the length not lessthan 1/4 inch and more than 3.5 inches.
For several biopsies and spinal tranfusion, the needles are
16 - 19 gauge in size and 0.5 - 3.5 inches in length For local anesthesia, the needles are from 26 gauge with
1/2 inch to 20 gauge with ? inches.
For intravenous transfusion, the needles are from 19 gaugewith 1.25 inches to 15 gauge with 2.5 inches.
65
7/30/2019 Drug Administration 2011
66/98
66
7/30/2019 Drug Administration 2011
67/98
THERE ARE ALSO MANY OTHER
UTILITIES :
1. Caudal needle
2. Epidural needle
3. Intravenously anesthetic needle4. Blood transfusion needle
5. Spinal needle
6. Biopsy needle7. Cerebral angiographic needle
67
O S O S O
7/30/2019 Drug Administration 2011
68/98
ROUTES OF ADMINISTRATION IN
INJECTION DRUGS
1. INTRADERMAL OR INTRACUTANEOUS
Dosage form : Solution and Suspension
Volume : 100- 200 I.U per I.C
Purpose : Tuberculine Test and Immunization
Equipments : Disposable syringe with small, short
size needle, Desinfected cottons
68
7/30/2019 Drug Administration 2011
69/98
69
7/30/2019 Drug Administration 2011
70/98
ROUTES OF ADMINISTRATION IN
INJECTION DRUGS
2. SUBCUTANEOUS OR HYPODERMAL INJECTION
Dosage form : Solution or oil
Volume : No more than 2 ml
The injection under skin should be conducted with non-irritantdrugs which are soluble either in water or oil, but the effect is not
as rapid as IM or IV method. It is easy to do by patients
themselves, such as insulin administration.
3. In BCG administration for infants, injection viadermal and subcutaneous methods may developlymphadenitis.
70
7/30/2019 Drug Administration 2011
71/98
71
7/30/2019 Drug Administration 2011
72/98
THIS METHOD IS ALSO USED IN THE
ADMINISTRATION OF HEPARIN ANDEPINEPHRINE SUSPENSIONS.
Skin has poor blood vasculature, thereby the drugs that
will be absorbed by blood vessels and the nonsoluble
drugs diffuse into lymphatic vessels.
72
7/30/2019 Drug Administration 2011
73/98
73
INJECTION TECHNIQUES1 W h th h d th hl
7/30/2019 Drug Administration 2011
74/98
1. Wash the hands thoroughly
2. Localize the injection site on the lateral surface of upper arm,anterior surface of thigh or abdominal region.
3. Clean the skin area with desinfectant4. Pinch the skin as thick as the skin itself
5. Prick the needle into the skin on the base of skinfold with theangle of 20 - 30 degrees
6. The pinch is then released7. Re-suck the syringe to ascertain that it did not prick the blood
vessel (if there is blood in it, repeat the procedure)
8. Inject the drug slowly and gradually within 0.5 - 2 minutes; if
too quick, possibly edema or collapse of blood vesseldevelops
9. The needle is immediately removed, cover the injection sitewith adhesive plaster.
10. Observe the patient condition; attention should be given that
the repeated injection may appear overdosis. 74
7/30/2019 Drug Administration 2011
75/98
3. INTRAMUSCULAR INJECTION
Dosage form : Solution, suspension in water oroil
Volume : No more than 4 ml
In injection into muscles, the soluble drug resorptionwill last within 10 - 30 minutes.
The adventages :
Easy, safer, good tolerated, rapid resorption, andrarely develops necrosis. For very irritative drugs, this
intramuscular method is preferred than subcutanousmethod.
75
7/30/2019 Drug Administration 2011
76/98
76
7/30/2019 Drug Administration 2011
77/98
INJECTION PROCEDURE
Localize the muscle to choose:
Ventro Gluteal : thicker, no main nerve fibers and blood
vessels. Choose the upper lateral quadrant, in Medial
Gluteal, take attention on ischiadic nerves and SuperiorGluteal Artery.And patient position should be facing laterally,
facing downward, or standing.
It is not performed to infants and young children.
77
7/30/2019 Drug Administration 2011
78/98
VASTUS LATERALIS
Middle aspect of thigh : very poor nerve fibers and bloodvasculature.
Position : supine, or sitting
Volume : 2.5 - 3 ml
Deltoid muscle : Easy, with position of facing laterally, sitting, or standing,
needs attention that the area is very limited and the existance of largebone, bood vessels, and nerve fibers.
Drug volume :1. no more than 2 ml.2. Wash hands thoroughly3. Make the patient ensure and explain the procedure
4. Rub desinfectant on the skin5. Ask the patient to let the muscles relaxed, because if the muscle is incontraction will the drug liquid flow into the surrounding tissue leading toirritation and pain sensation.
78
7/30/2019 Drug Administration 2011
79/98
Drug volume :
6. Shoot the needle in perpendicular position (90 degrees)to the skin surface
7. Re-suck to ensure if it shot blood vessel (if it did so,repeat the procedure from point 4, or replace with newsyringe, if any)
8. Inject the drug by pressing the pump slowly and
gradually to diminish pain sensation9. Remove the needle quickly
10. The injection site is press using the other hand withsterilized cotton, fix it with plaster
11. Observe the patient's reaction, necessarily keep the
patient calm12. Clean the hands and used equipments
79
7/30/2019 Drug Administration 2011
80/98
4. INTRAVENOUS DRUG ADMINISTRATION
Materials :
Syringe filled with air-free drug liquid,
Needle of 20 gauge, long and moderate thickness
Desinfectant
Cotton, plasters, and tourniquette
Injection Procedure :
1. Wash the hands thiroughly
2. Ensure the patient and explain what will be done
3. Localize the injection site, choose forearm slightly lower from cubital
fossa. The vein lies more superficially and is not covered and easy toligate.
4. The patient is asked to be relaxed with fisting the related hand.
5. Tourniquette is set up, then see the vein to be swollen while giving
desinfectant on to the skin area.
80
7/30/2019 Drug Administration 2011
81/98
81
4 INTRAVENOUS DRUG ADMINISTRATION
7/30/2019 Drug Administration 2011
82/98
Injection Procedure :
6. Vein is stabilized by replacing the pressing hand to the skin inline with the vein longitudinal axis, using the other hand.
7. Direct cardially the needle to vein with 35 degree of angle,
shoot the needle slowly into 3-5 mm depth of vein
8. Do aspiration, if there is blood inside the syringe, it means that
the needle has aimed to the vein, instead, try again.9. Tourniqette then is removed
10. Inject the drug slowly, observe the pain sensation, swelling or
hematoma; if the needle is still in vein, try to suck again.
11. The needle then should be removed immediately while the
injection site is press with cotton and subsequently cover itwith plaster.
12. Observe the patient's reaction, meanwhile wash your hands
and clean the used equipments
82
4. INTRAVENOUS DRUG ADMINISTRATION
7/30/2019 Drug Administration 2011
83/98
INTRAVENOUS ADMINISTRATION OF FLUID
Intravenous fluids refers to fluid that is administered
intravenously in large amount through infusion.
It is estimated that about 40% of the drugadministration at hospitals were conducted by
injection and it is likely increasing recently.
83
7/30/2019 Drug Administration 2011
84/98
THE CONTAINER OF INFUSION FLUID
1. It is made from glass, consisting of 2 types based onthe difference in air ventilation :
a. Air ventilation is outside of the bottle, at the tip of
infusion set through filter at a bottle spike.
b. Air ventilation through the tube in the bottle, the tubeopening is able to be passed through.
84
7/30/2019 Drug Administration 2011
85/98
85
7/30/2019 Drug Administration 2011
86/98
86
7/30/2019 Drug Administration 2011
87/98
87
7/30/2019 Drug Administration 2011
88/98
2. THE CONTAINER IS MADE FROM FELXIBLE
PLASTICS POLYVINYL CHLORIDE OR SEMIRIGID
POLYOLIVIN. The supporting equipments for infusion administration are
infusion set that is to move the fluid into blood vein. It should
meet the requisites of being sterilized, free-pirogen, and
disposable
Though it is produced by a variety of manufacturers, themain components and parts are the same, including :
1. Spike as the breaker against rubber seal in the spike
hole.
2. Drip chamber
88
THE PURPOSE OF INTRAVENOUS FLUID
7/30/2019 Drug Administration 2011
89/98
THE PURPOSE OF INTRAVENOUS FLUID
ADMINSTRATION IN SOME CLINICAL SETTINGS
IS : To correct the imbalanced body fluid (as replacement) To correct the imbalanced body electrolytes
To provide basic nutritional elements
Voluminous parenteral hyperalimentation that overwhelming
the normal nutrition
As the carrier of other drug adminstration
89
NAME CONCENTRATION PURPOSE
7/30/2019 Drug Administration 2011
90/98
1. AminoAcids (synthetic)
Aminosyn
Veinamine
2. Dextrose (Glucose,D5/W)3. Dextrose&NaCl
4. Lactate's Ringer
(Harmann)
NaCl
KCl
CaCl2Na Lactate
5. Protein (hydrolized)
Aminosol
CPH-5
6. Ringer's
NaClKCl
CaCl2
7. Natrium Lactate
90
5.5-&%
8%
2.5 - 50%
5-20%
NaCl 0.11 - 1.9%
0.60%
0.03%
0.02%0.30
5% casein&fibrin
0.86%
0.03%
0.033%
1/6M
Fluid &nutrition
Fluid & Nutrition
Nutrition & Electrolytes
Systemic alkalizer &
nutrient supplement
Fluid & nutrient
supplement
Fluid & nutrient
supplement
7/30/2019 Drug Administration 2011
91/98
THE INTERMITTEN ADMINISTRATION OF ANTIBIOTICS
AND OTHERS
Such medication may be performed by one of the three following methods :
A. Directly Intravenous Injection : volume of 1 - 5 ml within 1 - 5 minutes.
Orinject the injector of the hanging infusion bottle into the injection site.
This method is appropriate for limited amount of drug and the drug
which endanger if given in multiple method.
B. Volume Control Method : it refers to the infusion adminstration with
accurate dosage in expected flow through volume control set consisting
of a calibrated plastic chamber below the main infusion bottle which is
frequently along with free liquid administration.
91
7/30/2019 Drug Administration 2011
92/98
92
THE PROCEDURE OF INTERMITTENT
7/30/2019 Drug Administration 2011
93/98
THE PROCEDURE OF INTERMITTENT
ADMINISTRATION OF INTRAVENOUS LIQUID WITH
VOLUME CONTROL SET
1. Using aseptic technique, the spike of VC set is inserted intothe main infusion bottle or separated bottle.
2. The tube line is emptied from air by opening the upper
clamp so that the liquid flows.3. Open the clamp over the calibrated chamber to let 25 -
50 ml of liquid enter into it from the bottle.
4. Close the upper clamp.
5. Inject the drug through the connecting hole in therubber
cap of the VC set.6. Re-open the upper clamp to let the flow up to 50 - 150
ml, then close it.
7. Open the lower clamp to make liquid flows
93
7/30/2019 Drug Administration 2011
94/98
94
7/30/2019 Drug Administration 2011
95/98
The administration of this infusion drip is related to thesecond liquid. Through venipuncture, the drug flow will beregulated in one intravenous system.
This administration give rise the following advantages :
1. PB technique can avoid unnecessarily othervenipuncture.
2. The drug solvability is achieved immediately in short time,usually within 30 - 60 minutes.
3. The drug solution that can relieve irritation and obtainhigh serum level rapidly is an important considerationfor therapy such as serious infection,especially inantibiotic administration.
95
7/30/2019 Drug Administration 2011
96/98
96
7/30/2019 Drug Administration 2011
97/98
THE EQUIPMENTS FOR THIS METHOD CONSIST OF INFUSION
BOTTLES, INCLUDING A MAIN BOTTLE AND A MINI BOTTLE
PEGGY BACK OF 250 ML, AND INFUSION SET. THE MINI
PEGGY BACKBOTTLE USUALLY CONTAINS ANTIBIOTICS,
WHILST MAIN BOTTLE IS SIMILAR TO THE CLASSICAL
INFUSION SET WITH A RUBBER Y - SHAPE CHANNEL
APPARATUS BELOW THE CLAMP OF THE MAIN BOTTLE.
THE SECOND BOTTLE IS ALSO PROVIDED WITH THE
REGULATORY CLAMP, WHILE THE OTHER HAS NOT CLAMP
BUT A TAP IN THE Y-SHAPE CHANNEL APPARATUS TO
REGULATE THE FLOW BY OPENING AND SHUTTING
AUTOMATICALLY DEPENDING ON LIQUID PRESSURE. THIS
BOTTLE IS HANGED OVER THE MAIN BOTTLE.
97
TO RESERVE AIR AND CONTROL THE NUMBER OF DRIPPING, THE BOTTLES
ARE CONNECTED TO THE DRIP CHAMBER WITH A CLAMP, FURTHER THE
7/30/2019 Drug Administration 2011
98/98
CHAMBER CONNECTED TO THE TIP OF NEEDLE THROUGH 1.5 - 3 M OF
TUBE LINE. BELOW THE DRIP CHAMBER, A CLAMP REGULATES THE
EXPECTED DROPS. THE PROCEDURES OF PREPARATION AND
ADMINISTRATION OF INTRAVENOUS LIQUID
1. Prick the spike into the rubber bottle cap of the infusion set.
2. Hang the infusion bottles on a stand by the patient's bed, theneject the air in the tube line by flowing the first liquid drop out,regulated by the clamp.
3. Shoot the needle into vein (aseptically, see the previousmentionedintravenous injection procedure), conducted by physician or nurse
4. Loosen the clamp gently to flow the liquid till the expected number ofdrops by observing the drip in the drip chamber. Generally, thismedication lasts within 4 - 8 hours with the volume of 125 ml/hour.
5. The concomitant drugs given along with this infusion are : Dopamin,Lidocaine, Insulin,and Heparin. In the administration of potentdrugs, the speed of dripping depends on the patient's clinical condition.The drip volume depends on the manufacturer's recommendation,ranged: 10, 15, 20, 50, and 60 drops/ml.
In another setting, sterilized solid drug is administered through rubber hole in VC set