Introduction to

Pharmacology in
Nursing

Donna Penn RN MSN C

 Nurses need to have

knowledge about the
actions and effects of
medications
To safely and
accurately administer
medications nurses
need to have an
understanding of
pharmacologic
principles

Pharmacologic
Principles

Drug Names

Chemical name
Describes the drugs
chemical composition and
molecular structure

Generic name

(nonproprietary name)
Name given by the United
States Adopted
Name Council
Trade name (proprietary
name)
The drug has a registered
trademark; use of the name
restricted by the drugs
patent owner
(usually the manufacturer)

Drug Names
(cont'd)

Chemical name
(+/-)-2-(p-isobutylphenyl)
propionic acid

Generic name
ibuprofen

Trade name
Motrin, Advil

Figure2-1 The
chemical, generic, and
trade names for the
common analgesic
ibuprofen are listed
next to the chemical
structure of the drug.

Pharmacological
Concepts:
Classification

Classification- Nurses
learn to categorize
meds with similar
characteristics by their
class
Medication
classification indicates
the effect of the med on
the body system, the
symptom the med
relieves, or the meds
desired effect (e.g. oral
hypoglycemics)

Pharmacological
Concepts:
Classification

A medication may
also be part of more
than one class
Aspirin is an
analgesic,
antipyretic, antiinflammatory, and
anti-platelet

 Medications are
Pharmacological available in a variety of
Concepts:
forms and preparations
Medication
The form of the med will
Forms
determine its route of
administration
Composition of med is
designed to enhance its
absorption &
metabolism
Many meds are
available in several
forms

Medication
Forms

Tablet
Capsule
Elixir
Enteric-coated
Suppository
Suspension
Transdermal patch

Pharmacologic
Principles

Pharmaceutics
Pharmacokinetics
Pharmacodynamics
Pharmacotherapeuti
cs
Pharmacognosy

Pharmaceutics

The study of how various

drug forms influence
pharmacokinetic and
pharmacodynamic
activities

Pharmacokineti
cs

The study of what

the body does to the

drug
Absorption
Distribution
Metabolism
Excretion

Pharmacodynami
cs

The study of what the

drug does to the body

The mechanism of drug

actions in living tissues

Figure2-2 Phases of Drug Activity.

(From McKenry LM, Salerno E: Mosbys
pharmacology in nursingrevised and
updated, ed 21, St. Louis, 2003,
Mosby.)

Pharmacotherapeuti
cs

The use of drugs and

the clinical indications
for drugs to prevent
and treat diseases

Pharmacognosy

The study of natural

(plant and animal)
drug sources

Pharmacokinetics:

Absorption

The rate at which a

drug leaves its site
of administration,
and the extent to
which absorption
occurs
Bioavailability
Bioequivalent

Factors That
Affect
Absorption

Administration route of
the drug
Ability of Med to Dissolve
Food or fluids
administered with the
drug
Body Surface Area
Status of the absorptive
surface
Rate of blood flow to the
small intestine
Lipid Solubility of Med
Status of GI motility

Routes of
Administration

A drugs route of
administration
affects the rate and
extent of absorption
of that drug
Enteral (GI tract)
Parenteral
Topical

Enteral Route

Drug is absorbed
into the systemic
circulation through
the oral or gastric
mucosa, the small
intestine, or rectum
Oral
Sublingual
Buccal
Rectal

First-Pass Effect
The metabolism of a drug
and its passage from the
liver into the circulation
A drug given via the oral
route may be extensively
metabolized by the liver
before reaching the systemic
circulation (high first-pass
effect)
The same druggiven IV
bypasses the liver,
preventing the first-pass
effect from taking place, and
more drug reaches the
circulation

Box 2-1 Drug Routes and First-Pass Effects

Parenteral
Route

Intravenous (fastest
delivery into the
blood circulation)
Intramuscular
Subcutaneous
Intradermal
Intrathecal
Intraarticular

Topical Route

Skin (including
transdermal
patches)
Eyes
Ears
Nose
Lungs (inhalation)
Vagina

Distribution
The transport of a drug in
the body by the
bloodstream to its site of
action
Protein-binding
Water soluble vs. fat soluble
Blood-brain barrier
Areas of rapid distribution:
heart, liver,
kidneys, brain
Areas of slow distribution:
muscle, skin, fat

Metabolism
(Also Known As
Biotransformation)
The biologic
transformation of a drug
into
an inactive metabolite, a
more soluble compound,
or a more potent
metabolite

Liver (main organ)

Kidneys
Lungs
Plasma
Intestinal mucosa

Metabolism/Biotransformati
on (cont'd)

Delayed drug
metabolism results
in:
Accumulation of drugs
Prolonged action of the
drugs

Stimulating drug
metabolism causes:
Diminished
pharmacologic effects

Excretion

The elimination of
drugs from the body

Kidneys (main organ)

Liver
Bowel
Biliary excretion
Enterohepatic circulation

1. You are caring for a client who has diabetes

complicated by kidney disease. You will need to make a
detailed assessment when administering medications
because this client may experience problems with:
A. Absorption
B. Biotransformation
C. Distribution
D. Excretion

35 - 34

 Study of the
Pharmacodynami
mechanism of drug
cs
actions in living
tissue
Drug-induced
alterations to normal
physiologic function
Positive changeTherapeutic effectGoal of therapy

Mechanism of
Action

Ways in which a drug

can produce a
therapeutic effect
The effects that a
particular drug has
depends on the cells
or organ targeted by
the drug
Once the drug hits
its site of action it
can modify the rate
at which a cell or
tissue functions

Mechanism of
Action

Receptor Interaction
Enzyme Interaction
Non-Specific
Interaction

Receptor
Interaction

Drug structure is essential

Involves the selective
joining of drug molecule
with a reactive site on the
cell surface that elicits a
biological effect
Receptor is the reactive
site on a cell or tissue
Once the substance binds
to and interacts with the
receptor, a pharmacologic
response is produced

Receptor
Interaction

Affinity- degree to
which a drug binds with
a receptor
The drug with the best
fit or affinity will elicit
the best response
Drug can mimic bodys
endogenous substances
that normally bind to
receptor site
Drugs that bind to
receptors interact with
receptors in different
ways to either block or
elicit a response

Receptor
Interaction

Agonist-Drug binds
to receptor-there is a
response (Adrenergic
Agents)
Antagonist-drug
binds to receptor-no
response-prevents
binding of agonists
(Alpha & Beta
Blockers)

Enzyme
Interaction

Enzymes are substances

that catalyze nearly
every biochemical
reaction in a cell
Drugs can interact with
enzyme systems to alter
a response
Inhibits action of
enzymes-enzyme is
fooled into binding to
drug instead of target
cell
Protects target cell from
enzymes action (ACE
Inhibitors)

Non-Specific
Interaction

Not involving a receptor

site or alteration in
enzyme function
Main site of action is
cell membrane or
cellular process
Drugs will physically
interfere or chemically
alter cell process
Final product is altered
causing defect or cell
death
Cancer drugs,
Antibiotics

The nurse is giving a medication that has a

high first-pass effect. The physician has
changed the route from IV to PO. The nurse
expects the oral dose to be:
1. Higher because of the first-pass effect.
2. Lower because of the first-pass effect.
3. The same as the IV dose.
4. Unchanged.

A patient is complaining of severe pain

and has orders for morphine sulfate. The
nurse knows that the route that would
give the slowest pain relief would be
which route?

1. IV
2. IM
3. SC
4. PO

Type of
Medication
Action

Therapeutic Effect
Side Effects
Adverse Effects
Toxic Effect
Idiosyncratic Reactions
Allergic Reaction
Medication Interactions
Iatrogenic Response

Therapeutic
Effect

The expected or
predictable
physiological
response a
medication causes
A single med can
have several
therapeutic effects
(Aspirin)
It is important for the
nurse to know why
med is being
prescribed

Side Effects

Unintended secondary
effects a medication
predictably will cause
May be harmless or
serious
If side effects are serious
enough to negate the
beneficial effect of meds
therapeutic action, it
may be D/Cd
People may stop taking
medications because of
the side effects

Adverse Effects

Undesirable response of
a medication
Unexpected effects of
drug not related to
therapeutic effect
Must be reported to FDA
Can be a side effect or
a harmful effect
Can be categorized as
pharmacologic,
idiosyncratic,
hypersensitivity, or
drug interaction

Adverse Effects

Adverse Drug Events

Adverse Drug
Reactions (ADR)

Toxic Effect

May develop after

prolonged intake or
when a med
accumulates in the
blood because of
impaired metabolism or
excretion, or excessive
amount taken
Toxic levels of opioids
can cause
resp.depression
Antidotes available to
reverse effects

Idiosyncratic
Reactions

Unpredictable effectsoverreacts or under

reacts to a medication or
has a reaction different
from normal
Genetically determined
abnormal response
Idiosyncratic drug
reactions are usually
caused by abnormal
levels of drugmetabolizing enzymes
(deficiency or
overabundance)

Allergic
Reaction

Unpredictable response
to a medication
Makes up greater than
10% of all medication
reactions
Client may become
sensitized
immunologically to the
initial dose, repeated
administration causes
an allergic response to
the med, chemical
preservative or a
metabolite

Allergic Reaction Medication acts as an

antigen triggering the
release of the bodys
antibodies
May be mild or severe
Among the different
classes of meds,
antibiotics cause the
highest incidence of
allergic reaction
Severe reactionAnaphylactic reaction
Mild reaction-hives,
rash, pruritis

2. A postoperative client is receiving morphine sulfate

via a PCA. The nurse assesses that the clients
respirations are depressed. The effects of the morphine
sulfate can be classified as:
A. Allergic
B. Idiosyncratic
C. Therapeutic
D. Toxic

35 - 59

Other Drug
Reactions

TeratogenicStructural effect in
unborn fetus
(thalidomide)
Carcinogenic-Causes
cancer
Mutagenic- Changes
genetic composition
(radiation,
chemicals)

Drug
Interactions

Occurs when one med

modifies the action of
another
Common in people
taking several
medications at once
One med may
potentiate or diminish
the action of another
or alter the way it is
absorbed, metabolized
or eliminated
Warfarin and
Amiodarone

Iatrogenic
Responses

Unintentional adverse
effects that occur during
therapy
Treatment-Induced
Dermatologic-rash,
hives, acne
Renal DamageAminoglycoside
antibiotics, NSAIDS,
contrast medium
Blood DyscrasiasDestruction of blood
cells (Chemotherapy)
Hepatic Toxicity-Elevated
liver enzymes (hepatitislike symptoms)

Synergistic
Effect

Effect of 2 meds
combined is greater than
the meds given
separately
Alcohol &
Antihistamines,
antidepressants,
barbiturates, narcotics
Not always undesirable,
physician may combine
meds to create an
interaction that will have
beneficial effects
(Vasodilators & diuretics
to control high BP)

Medication
Dose Responses

Except when administered

IV, meds take time to
enter bloodstream
The quantity &
distribution of med in
different body
compartments change
constantly
Goal is to keep constant
blood level within a safe
therapeutic range
Repeated doses are
required to achieve a
constant therapeutic
concentration of a med
because a portion of med
is always being excreted

Medication
Dose Responses

Serum Half-Life:Time it
takes for excretion
processes to lower the
serum medication
concentration by
Regular fixed doses must
be given to maintain
therapeutic concentration
Dosage schedules set by
institutions (TID, q8h, HS,
AC, STAT, PRN)
Peak & Trough levels
Therapeutic drug
monitoring

Half-life

The time it takes for

one half of the original
amount of a drug in the
body to be removed
A measure of the rate
at which drugs are
removed from the body

Onset, Peak,
and Duration

Onset

The time it takes for the

drug to elicit a
therapeutic response

Peak

The time it takes for a drug

to reach its maximum
therapeutic response

Duration

The time a drug

concentration is sufficient
to elicit a therapeutic
response

Pharmacotherapeutics: Types
of Therapies

Acute therapy
Maintenance therapy
Supplemental
therapy
Palliative therapy
Supportive therapy
Prophylactic therapy
Empiric therapy

Monitoring

The effectiveness of
the drug therapy
must be evaluated
One must be familiar
with the drugs:
Intended therapeutic
action (beneficial)
Unintended but
potential side effects
(predictable, adverse
reactions)

Monitoring
(cont'd)

Therapeutic index
The ratio between a
drugs therapeutic
benefits and its toxic
effects

Monitoring
(cont'd)

Tolerance
A decreasing
response to repetitive
drug doses

Monitoring
(cont'd)

Dependence
A physiologic or
psychological need
for a
drug

Monitoring
(cont'd)

Interactions may occur

with other drugs or
food
Drug interactions: the
alteration of action of
a drug by:
Other prescribed
drugs
Over-the-counter
medications
Herbal therapies

Monitoring
(cont'd)

Drug interactions
Additive effect
Synergistic effect
Antagonistic effect
Incompatibility

Monitoring
(cont'd)

Medication
misadventures
Adverse drug events
Adverse drug
reactions
Medication errors

Monitoring
(cont'd)

Some adverse drug

reactions are
classified as side
effects
Expected, well-known
reactions that result in
little or no change in
patient management
Predictable frequency
The effects intensity and
occurrence are related to
the size of the dose

Adverse Drug
Reaction

An adverse outcome
of drug therapy in
which a patient is
harmed in some way
Pharmacologic
reactions
Idiosyncratic reactions
Hypersensitivity
reactions
Drug interactions

Other DrugRelated Effects

Teratogenic
Mutagenic
Carcinogenic

Toxicology

The study of poisons

and unwanted
responses to
therapeutic agents

Table2-9 Common
Poisons and
Antidotes

The Nursing
Process (cont'd)

Assessment
Nursing diagnosis
Planning (with
outcome criteria)
Implementation
Evaluation

The Nursing
Process

An organizational
framework for the
practice of nursing
Orderly, systematic
Central to all nursing
care
Encompasses all
steps taken by the
nurse in caring for a
patient
Flexibility is important

The Nursing
Process (cont'd)

Assessment
Data collection
Subjective, objective
Data collected on the
patient, drug,
environment

Medication history
Nursing assessment
Physical assessment
Data analysis

The Nursing
Process (cont'd)

Nursing diagnosis
Judgment or
conclusion about the
need/problem
(actual or at risk for)
of the patient
Based upon an
accurate assessment
NANDA format

The Nursing
Process (cont'd)

Planning
Identification of
goals and outcome
criteria
Prioritization
Time frame

The Nursing
Process (cont'd)

Goals
Objective,
measurable, realistic
Time frame
specified
Outcome criteria
Specific standard(s)
of measure
Patient oriented

The Nursing
Process (cont'd)

Implementation
Initiation and
completion of the
nursing care plan
as defined by the
nursing diagnoses and
outcome criteria
Follow the five rights
of medication
administration

The Five
Rights

Right drug
Right dose
Right time
Right route
Right patient

Another RightConstant
System Analysis
A double-check
The entire system of
medication
administration
Ordering, dispensing,
preparing,
administering,
documenting
Involves the physician,
nurse, nursing unit,
pharmacy department,
and patient education

Other
Rights

Proper drug storage

Proper
documentation
Accurate dosage
calculation
Accurate dosage
preparation
Careful checking of
transcription of
orders
Patient safety

Other
Rights
(cont'd)

Close consideration
of special situations
Prevention and
reporting of
medication errors
Patient teaching
Monitoring for
therapeutic effects,
side effects, toxic
effects
Refusal of medication

Evaluation

Ongoing part of the

nursing process
Determining the
status of the goals
and
outcomes of care
Monitoring the
patients response to
drug therapy
Expected and
unexpected responses

The day shift charge nurse is making rounds. A

patient tells the nurse that the night shift nurse
never gave him his medication, which was due at
11 PM. What should the nurse do first to
determine whether the medication was given?
1. Call the night nurse at home.
2. Check the Medication Administration Record.
3. Call the pharmacy.
4. Review the nurses notes.

The patients Medication Administration Record lists two

antiepileptic medications that are due at 0900, but the
patient is NPO for a barium study. The nurses
coworker suggests giving the medications via IV
because the patient is NPO. What should the nurse do?
1. Give the medications PO with a small sip of water.
2. Give the medications via the IV route because the
patient is NPO.
3. Hold the medications until after the test is completed.
4. Call the physician to clarify the instructions.

Life Span
Considerations

Life Span
Considerations

Pregnancy
Breast-feeding
Neonatal
Pediatric
Geriatric

Pregnancy

First trimester is the

period of greatest
danger for druginduced
developmental
defects
Drugs diffuse across
the placenta
FDA pregnancy
safety categories

Table 3-1
Pregnancy safety
categories

Breast-feeding

Breast-fed infants
are at risk for
exposure to drugs
consumed by the
mother
Consider risk-tobenefit ratio

Table 3-2 Classification

of young patients

Pediatric Considerations:
Pharmacokinetics
Absorption

Gastric pH less acidic

Gastric emptying is
slowed
Topical absorption
faster through the
skin
Intramuscular
absorption faster and
irregular

Pediatric Considerations:
Pharmacokinetics (cont'd)
Distribution
TBW 70% to 80% in
full-term infants, 85%
in premature newborns,
64% in children 1 to
12 years of age
Greater TBW means fat
content is lower
Decreased level of
protein binding
Immature blood-brain
barrier

Pediatric Considerations:
Pharmacokinetics (cont'd)
Metabolism
Liver immature, does
not produce enough
microsomal enzymes
Older children may
have increased
metabolism, requiring
higher doses
Other factors

Pediatric
Considerations:
Pharmacokinetics
(cont'd)
Excretion
Kidney immaturity
affects glomerular
filtration rate and
tubular secretion
Decreased perfusion
rate of the kidneys

Summary of
Pediatric
Considerations

Skin is thin and permeable

Stomach lacks acid to kill
bacteria
Lungs lack mucus barriers
Body temperatures poorly
regulated and dehydration
occurs easily
Liver and kidneys are
immature, impairing drug
metabolism and excretion

Methods of Dosage
Calculation for Pediatric
Patients
Body weight dosage
calculations
Body surface area
method

Geriatric
Considerations

Geriatric: older than

age 65
Healthy People 2010:
older than age 55

Use of OTC
medications
Polypharmacy

Table 3-4 Physiologic changes in the

geriatric patient

Geriatric Considerations:
Pharmacokinetics
Absorption
Gastric pH less acidic
Slowed gastric emptying
Movement through GI
tract slower
Reduced blood flow to
the GI tract
Reduced absorptive
surface area due to
flattened intestinal villi

Geriatric Considerations:
Pharmacokinetics (cont'd)
Distribution
TBW percentages
lower
Fat content increased
Decreased production
of proteins by the
liver, resulting in
decreased protein
binding of drugs

Geriatric Considerations:
Pharmacokinetics (cont'd)
Metabolism
Aging liver produces
less microsomal
enzymes, affecting
drug metabolism
Reduced blood flow
to the liver

Geriatric Considerations:
Pharmacokinetics (cont'd)
Excretion
Decreased glomerular
filtration rate
Decreased number of
intact nephrons

Geriatric Considerations:
Problematic Medications
Analgesics
Anticoagulants
Anticholinergics
Antihypertensives
Digoxin
Sedatives and
hypnotics
Thiazide diuretics

Legal, Ethical,
and Cultural
Consideration
s

U.S. Drug
Legislation

1906: Federal Food

and Drug Act
1912: Sherley
Amendment (to the
Federal Food and Drug
Act of 1906)
1914: Harrison
Narcotic Act
1938: Federal Food,
Drug, and Cosmetic
Act (revision of 1906
Act)

U.S. Drug
Legislation
(cont'd)

1951: DurhamHumphrey
Amendment (to the
1938 act)
1962: KefauverHarris Amendment
(to the 1938 act)
1970: Controlled
Substance Act

U.S. Drug
Legislation
(cont'd)

1983: Orphan Drug

Act
1991: Accelerated
drug approval

New Drug
Development

Investigational new
drug (IND)
application
Informed consent
Investigational drug
studies
Expedited drug
approval

U.S. FDA Drug

Approval Process Preclinical

investigational drug
studies
Clinical phases of
investigational drug
studies
Phase I
Phase II
Phase III
Phase IV

Ethical Nursing
Practice

American Nurses
Association (ANA)
Code of Ethics for
Nurses

Cultural
Considerations

Assess the influence of

a patients cultural
beliefs, values, and
customs
Drug polymorphism
Compliance level with
therapy
Environmental
considerations
Genetic factors
Varying responses to
specific agents

Cultural
Assessment

Health beliefs and

practices
Past uses of
medicine
Folk remedies
Home remedies
Use of
nonprescription
drugs and herbal
remedies
OTC treatments

Cultural
Assessment
(cont'd)

Usual response to
treatment
Responsiveness to
medical treatment
Religious practices
and beliefs
Dietary habits

Medication
Errors:
Preventing
and
Responding

Medication
Misadventures

Medication errors
(MEs)
Adverse drug events
(ADEs)
Adverse drug
reactions (ADRs)

Medication
Misadventures
(cont'd)

By definition, all
ADRs are also ADEs
But all ADEs are not
ADRs
Two types of ADRs
Allergic reactions
Idiosyncratic
reactions

Medication
Errors

Preventable
Common cause of
adverse health care
outcomes
Effects can range from
no significant effect to
directly causing
disability or death

Box 5-1 Common classes of medications

involved in serious errors

Preventing
Medication Errors

Minimize verbal or
telephone orders
Repeat order to prescriber
Spell drug name aloud
Speak slowly and clearly

List indication next to

each order
Avoid medical
shorthand, including
abbreviations and
acronyms

Preventing
Medication Errors
(cont'd)

Never assume anything

about items not specified
in a drug order (i.e.,
route)
Do not hesitate to
question a medication
order for any reason
when in doubt
Do not try to decipher
illegibly written orders;
contact prescriber for
clarification

Preventing
Medication Errors
(cont'd)

NEVER use trailing

zeros with
medication orders
Do not use 1.0 mg;
use 1 mg
1.0 mg could be
misread as 10 mg,
resulting in a tenfold
dose increase

Preventing
Medication
Errors (cont'd)

ALWAYS use a
leading zero for
decimal dosages
Do not use .25 mg;
use 0.25 mg
.25 mg may be
misread as 25 mg
.25 is sometimes
called a naked
decimal

Preventing
Medication Errors
(cont'd)

Check medication
order and what is
available while using
the 5 rights
Take time to learn
special administration
techniques of certain
dosage forms

Preventing
Medication Errors
(cont'd)

Always listen to and

honor any concerns
expressed by patients
regarding medications
Check patient allergies
and identification
Medication
Reconciliation

Medication
Errors

Possible consequences to
nurses
Reporting and responding
to MEs
ADE monitoring programs
USPMERP (United States
Pharmacopeia Medication
Errors Reporting Program)
MedWatch, sponsored by
the FDA
Institute for Safe
Medication Practices (ISMP)

Notification of patient
regarding MEs

3. Nurses are legally required to document

medications that are administered to clients. The nurse
is mandated to document:
A. Medication before administering it
B. Medication after administering it
C. Rationale for administering the medication
D. Prescribers rationale for prescribing the medication

35 - 138

4. If a nurse experiences a problem reading a

physicians medication order, the most appropriate
action will be to:
A. Call the physician to verify the order.
B. Call the pharmacist to verify the order.
C. Consult with other nursing staff to verify the order.
D. Withhold the medication until the physician makes
rounds.

35 - 139

Medication
Administration

Preparing for
Drug
Administration

Check the 5 rights

Standard Precautions:
Wash your hands!
Double-check if unsure
about anything
Check for drug allergies
Prepare drugs for one
patient at a time
Check three times

Preparing for Drug

Administration
(cont'd)
Check expiration dates
Check the patients
identification
Give medications on time
Explain medications to
the patient
Open the medications at
the bedside
Document the
medications given before
going to the next patient

Drug Routes &

First Pass
Effects

First Pass RoutesOral, Rectal

Non-First Pass RoutesAural, Buccal, Inhaled,
Intraarterial,
Intramuscular,
Intranasal,
Intraocular, Vaginal,
Intravenous,
Subcutaneous,
Sublingual,
Transdermal

Oral Route

Easiest, most
commonly used
Slower onset of
action
More prolonged
effect
Preferred by clients
Sublingual
Administration
Buccal
Administration

Enteral
Drugs

Giving oral medications

Giving sublingual or
buccal medications
Liquid medications
Giving oral medications
to infants
Administering drugs
through a nasogastric or
gastrostomy tube
Rectal administration

Parenteral Route

Injecting a
medication into body
tissues
Subcutaneous (SQ)
Intramuscular (IM)
Intravenous (IV)
Intradermal (ID)
Advanced
techniques

Parenteral
Drugs

Never recap a used

needle!
May recap an
unused needle with
the scoop method
Prevention of
needlesticks
Filter needles

Parenteral
Drugs
(cont'd)

Removing
medications from
ampules
Removing
medications from
vials
Disposal of used
needles and syringes

Injections

Needle angles for

various injections
Intramuscular (IM)
Subcutaneous (SC or
SQ)
Intradermal (ID)

Z-track method for

IM injections
Air-lock technique

Injection
Techniques

Intradermal
injections
Subcutaneous
injections
Insulin administration
Heparin
administration

Injection
Techniques
(cont'd)

Intramuscular
injections
Ventrogluteal site
(preferred)
Vastus lateralis site
Dorsogluteal site
Deltoid site

Preparing
Intravenous
Medications

Needleless systems
Compatibility issues
Expiration dates
Mixing intravenous
piggyback (IVPB)
medications
Labeling intravenous
(IV) infusion bags when
adding medications

Intravenou
s
Medication
s

Adding medications to
a primary infusion bag
IVPB medications
(secondary line)
IV push medications
(bolus)
Through an IV lock
Through an existing IV
infusion

Intravenous
Medications
(cont'd)

Volume-controlled
administration set
Using electronic
infusion pumps
Patient-controlled
analgesia (PCA)
pumps

Topical
Drugs
Eye medications
Drops
Ointments

Ear drops
Adults
Infant or child younger
than 3 years of age

Topical
Drugs
(cont'd)

Nasal drugs
Drops
Spray

Inhaled drugs
Metered-dose
inhalers
Small-volume
nebulizers

Topical
Drugs
(cont'd)

Administering
medications to the
skin
Lotions, creams,
ointments, powders
Transdermal patches

Vaginal medications
Creams, foams, gels
Suppositories