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Chapter 19 Pharmacology and Drug Administration 441
There are many reasons to use parenteral methods of
administration. Here are some of the most common ones:
Some patients can’t take oral medications.
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Some medications can’t be absorbed through the gas-
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trointestinal system.
A patient’s condition may require fast absorption of
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the drug.
Some drugs can be administered by one route only.
This may be due to their form or chemical composition.
Some may be toxic if given by a certain route. Some
drugs may be absorbed only through one particular
route. Others are effective when administered in a variety of ways. The different routes for drug administration are:
Oral (by mouth)
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Sublingual (under the tongue)
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Injection
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Intravenous (directly into a vein)
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Inhalation
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Topical (on the skin)
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Instillation (eye, ear canal, or nose)
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Rectal
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Vaginal
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Intradermal
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There are advantages and disadvantages to the oral
and parental routes of administration. Several of these
are listed in Table 19-9.
Figure 19-6 Unit dose packets. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Medication by Mouth
Patients often are given a medication to swallow in the
form of a tablet, capsule, pill, or liquid. This method is
preferred by many patients and is the easiest to administer. Drugs given orally in the medical ofce usually come
in unit dose packs that contain a premeasured single
dose of the drug. See examples of single dose packets in
Figure 19-6.
Table 19-9
Oral Medications Parenteral Medications
Advantages: Advantages:
● Easily administered ● Rapid response time to medication
● Economical to administer ● Accuracy of dosage
● Administered with a high degree of safety ● Ability to concentrate the medication in a specic body
Disadvantages: Disadvantages:
● Objectionable taste and odor ● Rapid allergic reactions
● Discoloration of the teeth, mouth, and tongue ● Injury to bone, soft tissue, nerves, or blood vessel
● Irritation to the stomach ● Needle breakage in tissue
● Poor absorption rate due to illness or nature of
medicine
● Failure of patient to take medicine
● Less predictable effects on the body than when given
by an injection
● Patient may be unable to swallow pill, tablet, or capsule
Oral versus Parenteral Medication Administration
area, such as a joint
● Ideal for patients who cannot take medication by
mouth because of an illness or because the stomach
acids would destroy the medication
caused by needle
● Accidental injection into the vein instead of the soft
tissue
442 Section IV Clinical Medical Assistant Skills
Table 19-10
Form Types Description
Solids Buffered caplet Medication has an added agent to decrease stomach acidity and prevent stomach
Liquids Syrup A very sweet form of medication frequently used for children. It’s usually avored in
Forms of Oral Medications
irritation.
Capsule Medication is powdered or granulated in a gelatin sheath. Sheath is designed to be
dissolved by gastric enzymes or high in the small intestine.
Enteric-coated
tablet
Gelcap Oil-based medication in a soft gelatin capsule
Chewable Tablet chewed completely before swallowing in order to release the medication more
Lozenge A rm, compressed form of medication, usually for a local effect in the mouth or throat.
Powder Medication is in a nely ground form that may be difcult for some patients to swallow.
Spansule, or
time-release
capsule
Tablet Medication is shaped or colored for easy identication. Tablets usually dissolve high in
Elixir Medication is dissolved in alcohol and avored. It’s less sweet than syrups and is usually
Emulsion Medication is combined with water and oil. The emulsion must be shaken thoroughly to
Extract Highly concentrated form of medication made by evaporating volatile plant oils (oils
Gel Medication is suspended in a thin gelatin or paste.
Suspension Particles of medication are dissolved in a liquid. Must be shaken well before use
Dry, compressed medication coated to withstand stomach acidity and dissolve in the
intestines. Never crush or break enteric-coated tablets.
quickly into the system
Caution patients to let lozenges dissolve slowly and avoid drinking uids after taking a
lozenge
Medication is inside a gelatin capsule that will dissolve over time rather than all at once.
Never open a time-release capsule unless recommended by the manufacturer.
the GI tract. They may be broken in half only if scored (marked with a line or groove) for
that purpose.
addition to having a high sugar content.
preferred by adults. Not appropriate for alcoholics or diabetics.
disperse the medication evenly.
that vaporize readily). It may be administered as drops and is usually given in a liquid to
disguise the strong taste.
Oral medications are absorbed through the walls of
the gastrointestinal tract. However, medications taken
this way usually are slow to take effect. Also, not
every patient can take medications by this method. See
Table19-10 for the various forms of oral medications.
The oral route is not suitable for patients who:
Are unconscious
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Have nausea and/or vomiting
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Have been ordered to take nothing by mouth
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Under the Tongue and Beside the Cheek
Some medications may be placed in the mouth, but they
aren’t meant to be swallowed. They’re absorbed into
the body through the mucous membranes of the mouth
rather than digested in the stomach.
Sublingual medication—The medication is placed
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under the patient’s tongue. It must not be swallowed.
The drug is dissolved by the saliva in the patient’s
mouth. It’s absorbed directly into the bloodstream
through the mucous membranes covering the sublingual blood vessels. Caution the patient not to eat or
drink until the medication is dissolved. One of the
most common sublingual medications is nitroglycerin, taken by patients with heart-related chest pain.
Buccal medication—Medication is placed between
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the patient’s cheek and gum at the side of the mouth.
The drug is then absorbed through the vascular oral
mucosa. Not many medications are manufactured
for this route. The patient should not chew or swallow the medication or eat or drink until it’s absorbed.
Many lozenges are designed to be absorbed buccally.
Injections
Injection is the most efcient method of parenteral drug
administration. However, it also can be the most hazardous. The effects are quite rapid, and once injected,
Chapter 19 Pharmacology and Drug Administration 443
Figure 19-7 Ampules, vials, prelled cartridges, and
holders. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer;
2016.)
the medication can’t be retrieved. Because the skin is
broken, infections can develop if strict aseptic technique
isn’t followed.
Medications for injections are sometimes supplied in
an
ampule. These are small glass containers that must
be broken at the neck of the ampule. Once they’re broken, the solution is aspirated or removed by suction.
You must use a lter needle when getting medication
from an ampule to prevent small pieces of glass from
being drawn up. All medication inside must be either
used or discarded.
Medications for injections also may be supplied as
vials or prelled cartridges (Fig. 19-7).
Prelled Cartridges
Prelled syringes contain a premeasured amount of
medication in a disposable cartridge with a needle
attached. Figure 19-8 shows the preparation of a pre-
Figure 19-8 Prelled medication cartridges and
injector devices, inserting the cartridge into the
injector device and ready for injection. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
lled cartridge.
The prelled cartridge and needle are placed in a
holder for administration. After a cartridge and holder
are used, the cartridge should be discarded in a sharps
biohazard container. The holder is reusable, but it must
be cleaned rst. This is often done by wiping it thoroughly with an alcohol swab. Some ofces also have
containers lled with alcohol into which the holder can
be placed after use.
Vials
A vial is a glass or plastic container that is sealed at
the top by a stopper. Vials may be single-dose or multiple-dose containers. The contents of vials may be in
the form of a solution or a powder. Powders must be
reconstituted—mixed with a specic amount and type
of diluting agent. The
diluent, or diluting agent, usually
is sterile water or saline. Certain drugs, such as phenytoin (Dilantin), an anticonvulsant, require a special diluent supplied by the manufacturer.
When a powdered drug is reconstituted in a multiple-dose vial, you must write some information on the
label:
Date of reconstitution
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Initials of the person who reconstituted the drug
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Diluent used
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Strength of the medicine that was produced
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Vials intended for multiple doses may hold up to
50ml. They may be used repeatedly by inserting a needle through the self-sealing stopper to remove some of
the solution. Unit dose vials usually contain 1 to 2 ml.
All the solution is removed for a single injection.
444 Section IV Clinical Medical Assistant Skills
Reconstituting Dry Medication
To reconstitute dry medication in a vial, follow these
steps:
1. Check the vial label or manufacturer’s instructions
to nd out how much diluent to add to the powder.
2. Wipe the top of the vial containing the diluent with
an alcohol pad before inserting the needle. Then,
withdraw the correct amount of diluent using aseptic
technique.
3. Add the diluent to the vial containing the powder.
Wipe the top of the vial with an alcohol pad before
inserting the needle.
4. Replace the vial stopper. Roll the vial between your
palms until the powder is dissolved. Don’t shake the
vial. Shaking can cause unnecessary bubbles, which
make it hard to measure the exact amount of medication needed.
The concentration of the mixture will depend on how
the medication will be given. The instructions from the
drug’s manufacturer usually tell how much diluent to
add to the powder if the medication is to be given intravenously (IV), injected into the muscle (IM), or injected
under the skin (SQ).
You must be sure that the concentration of the mixture is right for the method of administration. A dosage
that’s too strong for the method of administration may
harm the patient’s tissues. If the dose is too weak for the
method of administration, the medicine may not have
the proper effect.
Syringes and Needles
Figure 19-9 Syringes from largest on top to smallest on
bottom: 10, 3, and 1 mL or tuberculin, insulin, and lowdose insulin. (Reprinted from Kronenberger J, Ledbetter
J. Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
When choosing a needle, you need to select the right
needle length and gauge for the route of the injection
and the type of medication. The needle length depends
on the route of the injection.
An adult intramuscular injection, or injection into
muscle tissue, requires a needle length of 1 to 3 inches.
Some factors that affect the choice of needle length
are the size of the patient, the muscle being used, and
the fat to muscle ratio. The gauge varies from 20 to
The choice of syringe and needle depends on the type
of injection and the size of the patient. The 3 ml hypodermic syringe is the most commonly used. In a medical
ofce, syringes that hold 5 ml or more usually are used
for irrigation—the process of ushing a wound, cavity,
or medical instrument with water or other uid to clean
it. Examples of syringes are shown in Figure 19-9.
Syringes have three main parts (Fig. 19-10):
The plunger
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The body or barrel
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The needle
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Needle lengths vary from 0.375 to 1.5 inch for standard injections. The needle gauge refers to the diameter of the needle lumen, or opening. Needle gauge
varies from 10 (large gauge) to 33 (small gauge).
Manufacturers package hypodermic needles separately
in color-coded packages or in color-coded envelopes
with the syringe attached. The size is written on the
package (Fig.19-11A, B).
The rule is the smaller the number the larger the
lumen of the needle; the larger the number, the smaller
the lumen of the needle.
Plunger
Barrel
Needle hilt
or hub
Needle
Figure 19-10 Parts of a syringe and needle. (Reprinted
from Cohen BJ. Medical Terminology: An Illustrated
Guide. 6th ed. Philadelphia, PA: Lippincott Williams &
Wilkins; 2011, with permission.)
Shaft
Lumen
Bevel
Chapter 19 Pharmacology and Drug Administration 445
Figure 19-11 Needles. A. Different
gauges and lengths. B. Parts of a
needle. (Reprinted from Kronenberger J,
Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting.
B
5thed. Philadelphia, PA: Wolters Kluwer;
2016.)
25, depending on the thickness of the medication to
be administered. A small-gauge needle, such as 25 or
27, would make it difcult to draw thick medications
into a syringe or inject them into a patient. Examples
of thick medications are penicillin and hormones. A
subcutaneous injection (injection into the fatty layer
just below the skin) is usually given with a short,
small-gauge needle, such as 25 gauge (0.625 inch) or
23gauge (0.5inch).
When preparing an injection, the syringe tip, inside
of the barrel, shaft of the plunger, and the needle must
be kept sterile.
Types of Syringes
All hypodermic syringes are marked with calibrations
showing milliliters and smaller divisions, depending on
the size of the syringe. The other side of the syringe may
be marked in minims (m), a very small uid measure
equaling about a drop.
Two special types of syringes used to administer
medications are tuberculin syringes (1 ml) and insulin
syringes.
Tuberculin (TB) syringes are narrow and have a total
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capacity of 1 ml. Each syringe has 100 calibration
lines. TB syringes are used for newborn and pediatric
doses, for intradermal skin tests, and any time small
amounts of medication are to be given.
Insulin syringes are used only for administering
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insulin. The insulin syringe has a total capacity of 1
ml but uses a different calibration system than other
syringes. The 1-ml volume is marked as 100 units
(U). The units represent the strength of the insulin
per milliliter. Most of the insulin that is used today
is U-100, which means that it has 100 units of insulin per milliliter. On the syringe, large lines mark
each group of 10 units. Five smaller lines divide the
10 units into groups of 2. Each small line represents
2 units.
Types of Injections
Different medications may be injected into different
places in the body. The three main types of injections
are:
Intradermal (ID)
r
Subcutaneous (SC or SQ)
r
Intramuscular (IM)
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The prex intra means into or within. Intradermal
means “into the skin.” Intramuscular means “into the
muscle.” Figure 19-12 demonstrates the proper angle of
90°
90°
Skin Subcutaneous tissue Muscle
Intramuscular injection
Subcutaneous injection
Intradermal injection
Figure 19-12 Required angles of insertion for
intramuscular, subcutaneous, and intradermal injections.
(Reprinted from Cohen BJ. Medical Terminology: An
Illustrated Guide. 6th ed. Philadelphia, PA: Lippincott
Williams & Wilkins; 2011, with permission.)
45°
15°
446 Section IV Clinical Medical Assistant Skills
insertion for intramuscular, subcutaneous, and intradermal injections. It is critical to use the proper angle of
insertion so the medication is delivered into the appropriate layer of tissue.
Intradermal Injections
These injections are administered into the dermis, or
skin. Recommended sites for intradermal injections are
the anterior forearm and the back. Intradermal injections are used to administer different kinds of skin tests
for allergy testing and tuberculosis (TB) screening.
The needle is inserted at angle of 10 to 15 degrees,
almost parallel to the skin surface.
When administered correctly:
The needle tip and lumen are slightly visible under
r
the skin.
The bevel of the needle must be up.
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A small bubble known as a wheal is raised in the skin.
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TB Tests. Two tests are used for the routine screen-
ing of TB—the tine test and the Mantoux test. Both use
puried protein derivative (PPD) from a live tuberculin
bacillus culture to test for tuberculin antibodies.
Tine test—The applicator consists of small tines that
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contain PPD. After cleansing the forearm, press the
applicator rmly into the intradermal layer of the skin.
This test is not considered as useful for diagnostics as
the Mantoux test. A positive tine test usually is followed by a Mantoux test. Figure 19-13 shows the
technique used to administer a time test.
Mantoux test—An injection containing PPD is
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made into the intradermal layer of skin. A positive
Mantoux test indicates only the possibility of exposure to TB. It does not indicate that the patient has
TB. The Centers for Disease Control and Prevention
(CDC) prefers the Mantoux test and considers it the
most accurate TB test.
Both tests must be read within 48 to 72 hours. A positive Mantoux reaction has induration (a hard, raised
area over the injection site) that is larger than 10 mm. A
patient with a positive reaction will require a complete
medical history and further testing, including a chest
x-ray. Induration of <10 mm in a patient with no known
risk factors is considered a negative result.
Subcutaneous Injections
Subcutaneous injections (SQ or SC) are given into the
fatty layer of tissue below the skin. You should position
the needle and syringe at a 45-degree angle. This method
is chosen for drugs that may not be absorbed as rapidly
through intramuscular or other routes. Common sites
for subcutaneous injections include the following:
Upper arm
r
Thigh
r
Back
r
Abdomen
r
Intramuscular Injections
Injecting medication into a muscle requires positioning
of the needle and syringe at a 90-degree angle to the
skin. Absorption is fairly rapid because of the rich vascularity (blood supply) of muscle. If slower absorption is
desired, the medication is mixed with an oil-based diluent rather than saline or water.
As previously noted, a 1- to 3-inch needle is needed
to give an intramuscular (IM) injection to an adult. The
length of the needle depends on the muscle chosen for
the injection and the size of the patient.
The muscle chosen for the injection depends on the
preferences of the medical assistant, the patient, and the
amount of medication to be administered. Drug manufacturers also recommend sites for injecting specic
drugs. You should try to follow their recommendations.
Table 19-11 lists the recommended sites for intramuscular injections.
Figure 19-14 demonstrates the deltoid injection site
in the upper arm. Figure 19-15 shows the location of the
dorsogluteal site in the upper, outer area of the posterior hip. Figure 19-16 shows the location on the side of
the hip that is called the ventrogluteal site. Figure 19-17
shows the location of the vastus lateralis on the side of
the thigh. Figure 19-18 demonstrates the location of the
rectus femoris injection site.
Figure 19-13 Administering the tine test for tuberculosis
screening. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
Z-Track Method. Some medications administered intra-
muscularly may stain and discolor skin and irritate or
damage tissues if they leak back along the line of injection. The Z-track method prevents leakage by sealing off
layers of skin along the route of the needle.
In the Z-track method, the skin is pulled to one side,
and the needle is inserted. After the solution is injected
and the needle is withdrawn, the skin is allowed to return
Chapter 19 Pharmacology and Drug Administration 447
Table 19-11
Recommended Sites for Intramuscular Injections
Injection Site Locating the Muscle Cautions
Deltoid The deltoid muscle is located by palpating
the lower edge of the acromial process. At the
No more than 1 ml should be injected into this
muscle in an adult.
midpoint, in line with the axilla on the lateral
aspect of the upper arm, a triangle is formed.
Medications are administered within the triangle.
Dorsogluteal The dorsogluteal site is lateral and slightly
superior to the midpoint of a line drawn from
the trochanter to the posterior iliac spine.
The site must be identied correctly to avoid dam-
age to the sciatic nerve. No more than 3 ml should
be injected into an adult. Children < 2 years of age
should never receive injections into the gluteal mus-
cle. It’s not well developed until the child is walking.
Ventrogluteal The ventrogluteal site is located by placing the
palm on the greater trochanter and the index
No more than 3 ml should be injected into an
adult.
nger toward the anterior superior iliac spine.
The middle nger is then spread posteriorly
away from the index nger as far as possible.
AV or triangle is formed by this maneuver.
Make the injection in the middle of the triangle.
Vastus lateralis The vastus lateralis site is identied by dividing
the thigh into thirds horizontally and vertically.
The injection is given in the outermost third.
Rectus femoris The rectus femoris site is located on the ante-
rior of the thigh.
The site is preferred for children under 2 years of
age and may be used for adults. The quantity of
the injection should not exceed 2 ml.
Use this site only when other sites are
contraindicated.
Clavicle
Acromial process
Scapula
Axilla
Deltoid muscle
Humerus
Deep brachial
artery
Radial nerve
Figure 19-14 Deltoid muscle IM injection site.
Located by palpating the lower edge of the acromial
process. Atthe midpoint in line with the axilla on the
lateral aspect of the upper arm, a triangle is formed.
Medication is injected within this triangle. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
Posterior superior
Injection site
Upper outer
quadrant
Greater
trochanter
Sciatic n.
Gluteal
fold
iliac spine
Figure 19-15 Dorsogluteal IM injection site. Located
lateral and slightly superior to the midpoint of a line
drawn from the trochanter to the posterior superior iliac
spine. This site minimizes the possibility of accidentally
damaging the sciatic nerve. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
448 Section IV Clinical Medical Assistant Skills
Iliac crest
Figure 19-16 Ventrogluteal IM injection site. Located
by placing the palm on the greater trochanter and the
index nger toward the anterior superior iliac spine.
The middle nger is then spread posteriorly away from
the index nger as far as possible. A “V” or triangle is
formed between the ngers, which is the location for this
injection. (Reprinted from Kronenberger J, Ledbetter J.
Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
Anterior
superior
iliac spine
Injection
site
Greater trochanter
of
femur
Vastus lateralis
(middle third)
to its normal position. This blocks the solution from
escaping from the muscle tissue. If the medication is very
caustic, the instructions may require that you change
the needle after drawing up the solution. Figure19-19
shows the Z-track technique used to administer irritating medications.
The Intravenous Route
For the intravenous (IV) route, a sterile solution of a
drug is injected through a needle or catheter into a vein
by venipuncture. A catheter is a thin, exible tube that
carries uids into or out of the body. Venipuncture is the
process of puncturing a vein with a needle.
Medication acts quickly when administered by IV
because it enters the bloodstream immediately. Only
drugs intended for IV administration should be given
using this route. Figure 19-20 is an example of IV equipment including the uid and tubing.
Starting an IV
In most cases, the nurse or physician administers IV
medication. However, in some states, medical assistants
in ambulatory care centers must set up equipment and
uids for an IV, perform the venipuncture, and regulate
IV uids as directed by a physician or nurse practitioner. Medical assistants are not legally authorized to perform intravenous medication administration. You need
to be aware of the state laws and training requirements
for performing any IV procedures. If the medication
Lateral f
emoral
condyle
Figure 19-17 Vastus lateralis IM injection site. Identied
by dividing the thigh into thirds horizontally and vertically.
The injection is given in the outer middle third. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
instructions recommend a specic site for injection, use
that site.
If you are legally permitted to start an IV, you need
the following equipment:
Fluids, as determined by the physician
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IV catheter
r
Tubing that connects to the catheter with a valve to
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regulate the ow of uids
Once the IV is started, uids are administered through
the vein. These uids either replace uids lost by the
patient or are used to administer medication through
Chapter 19 Pharmacology and Drug Administration 449
Rectus
is
femor
Injection
site
Vastus
lateralis
Figure 19-18 Rectus femoris IM injection site is used
only when other sites are contraindicated. (Reprinted
from Kronenberger J, Ledbetter J. Lippincott Williams
& Wilkins’ Comprehensive Medical Assisting. 5th ed.
Philadelphia, PA: Wolters Kluwer; 2016.)
special ports in the tubing. Some examples of uids that
come prepackaged for use in IV therapy are:
Ringer lactate (RL)
r
Dextrose 5% and water (D5W)
r
0.9% normal saline (NS)
r
0.45% normal saline (NS)
r
Combinations of the above (D5NS, D5RL)
r
The physician or nurse practitioner chooses the type
and amount of uid to be administered. An administration set (tubing) is used. The end of the tubing with the
drip chamber is inserted into the IV uid bag. The other
end is inserted into the IV catheter after it’s in the vein.
IV Problems
You must watch the IV uids and the site of venipuncture carefully. Inltration occurs when IV uid infuses
into tissues surrounding the vein. This usually happens
because the catheter has been displaced.
You usually can prevent this problem by carefully
securing the IV catheter and IV tubing. If inltration
occurs, stop the ow of the uids. Remove the catheter
and notify the physician. Signs of inltration are:
Swelling and pain at the IV site
r
Slow or absent ow rate into the drip chamber when
r
the roller clamp is open
Figure 19-19 Z-track technique for IM injection of
medications that are irritating to subcutaneous tissue.
The skin is pulled to one side, the needle is inserted, and
the solution is injected after careful aspiration. When the
needle is withdrawn and the displaced tissue is allowed
to return to its normal position, the solution is prevented
from escaping from the muscle tissue. (Reprinted from
Kronenberger J, Ledbetter J. Lippincott Williams & Wilkins’
Comprehensive Medical Assisting. 5th ed. Philadelphia,
PA: Wolters Kluwer; 2016.)
Figure 19-20 Intravenous equipment including the uid
and tubing. (Reprinted from Kronenberger J, Ledbetter
J. Lippincott Williams & Wilkins’ Comprehensive Medical
Assisting. 5th ed. Philadelphia, PA: Wolters Kluwer; 2016.)
450 Section IV Clinical Medical Assistant Skills
No blood return or back up into the tubing when the
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uid bag is placed below the level of the heart
If the physician or practitioner orders that the IV be
reinserted, you must use the other arm or a site above
the level of inltration.
Other Medication Routes
Besides orally, by injection, or intravenously, there are
several more ways to administer medications to patients.
By inhalation
r
On or through the skin
r
By instillation into the eyes, ears, and nose
r
By insertion into the rectum or vagina
r
Inhalation
Some medications are administered through inspiration
into the lungs. These medications are absorbed quickly
through the alveolar walls into the capillaries. The alveolar walls are found in small sacs of tissue where air is
exchanged in the lungs. The absorption rate for inhaled
medications may be difcult to predict for patients with
lung diseases.
Patients with chronic pulmonary disorders may selfadminister medications. They use a handheld nebulizer,
or inhaler. Both devices produce a spray of medicated
mist that’s inhaled directly into the lungs through the
mouth or through the mouth and nose.
Most nasal medications are administered by sprays
or nasal inhalers. Some nasal medications have a local
effect, such as relieving nasal congestion or preventing
allergy symptoms. Others have a systemic effect. For
example, butorphanol (Stadol) is a nasal spray used to
relieve moderate to severe pain.
Skin Medications
There are two general types of medications applied to
the skin.
Topical medications include creams, lotions, oint-
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ments, and sprays. They produce local effects.
Transdermal medications typically are administered
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using a patch that’s placed on the skin. They produce
systemic effects. Medication administered transdermally is delivered to the body through absorption by
the skin. Delivery is slow and a steady, stable level of
medication is maintained in the body.
Never cut a transdermal patch—The rate of
absorption of the medication would then be changed.
Transdermal patches may be placed in several locations:
Chest
r
Back
r
Upper arm
r
Behind the ear
r
Eyes, Ears, and Nose
Some medications may be designed for administration
through the eyes, ears, or nose. You may need to administer these medications in the ofce or instruct patients
on how to administer them at home. A common method
of administration for these medications is instillation,
the administration of a liquid drop by drop.
Ophthalmic medications are used to treat eye infections and to soothe eye irritation. They also may be used
to dilate the pupils for diagnostic purposes. Eye medications usually are supplied as an ointment or a liquid and
have a local effect. The label should state clearly that the
medication is formulated for use in the eyes.
Otic medications, or ear medications, relieve ear pain
and swelling, treat infections of the ear canal, or soften
cerumen (ear wax). Ear medications typically come in
the form of liquid drops and have a local effect.
Nasal medications can be administered by instillation. They usually are in the form of drops or sprays.
Their most common use is to reduce swelling or drainage in nasal passages in patients suffering from colds
or allergies. Some hormones also are administered
nasally.
Rectal Administration
Rectal medications are available in suppository or liquid
form. Suppositories have a cocoa butter or glycerin base
that melts at body temperature. They need to be stored
in the refrigerator. Liquid form is administered as an
enema—a procedure where liquid is introduced into the
bowel through a tube. Rectal medications can provide
a local effect or be absorbed through the rectal mucosa
for a systemic effect. Rectal medications may be used for
patients who are NPO (allowed nothing by mouth) or
who have nausea and vomiting. They are never used for
patients who have diarrhea.
Rectal medications rarely are administered in the
medical ofce. However, you may be asked to instruct
patients on the proper technique for administering them
at home. Both enemas and rectal suppositories should
be retained by the patient for 20 to 30 minutes before
elimination.
Figure 19-21 shows examples of suppositories and
method used for rectal insertion.
Vaginal Administration
Vaginal medications include creams, tablets, suppositories, and solutions for douches. Medications prescribed for the vaginal route typically have local effects.
Examples include hormonal creams or antifungal preparations (Fig. 19-22).
Instruct the patient to remain lying down for a while
after the insertion of vaginal medications. For comfort,
the patient may want to wear a light pad to absorb any
drainage.