Medication Preparations

and Supplies
Drug form
• Refers to the type of preparation in which the drug is supplied.
• Synonymous to drug preparation.

Common Abbreviations for Drug Administration

DRUG FORMS ROUTES
cap capsule IM intramuscular
elix elixir IV intravenous
gtt drop TOP topical
supp suppository PO, po oral
susp suspension R or PR rectal
tab tablet subcu/sc subcutaneous
DRUG FORMS AND DEVICES
Oral Drug Forms

1. Tablet
• Disks of compressed drug
• Comes in a variety of shapes, colors, and may be coated to enhance
swallowing, and may be scored
2. Enteric-coated tablet
• Tablet with a special coating that resists disintegration by gastric juices
3. Capsule
• Double chamber may be pulled apart to add drug powder to
soft foods or beverages for patients who have difficulty
swallowing
4. Sustained-release capsule or tablet
• Drug
particles that have various coatings that differ in the
amount of time required before the coatings dissolve.
• Designed to deliver a dose of drug over an extended period of
time.

5. Lozenge (troche)
• Tablet containing palatable flavouring, indicated for a local
(often soothing) effect on the throat or mouth.
6. Suspension
• Liquid form of medication that must be shaken well before administration because the drug
particles settle at the bottom of the bottle.
7. Emulsion
• Liquid drug preparation that contains oils and fats in water.
8. Elixir
• Liquid drug forms with alcohol evaporation.
• Should be tightly capped to prevent alcohol evaporation.
• Should not be available to alcoholics. Caution in small children.
9. Syrup
• Sweetened, flavoured liquid drug form.
10. Solution
• Liquid drug form in which the drug is totally and evenly dissolved
• Appearance is clear rather than cloudy or settled.
Oral Drug Forms

Tablets Scored tablets Enteric-coated tablets

Capsules Sustained-release capsules Gelatin capsules

Rectal Drug Forms
1. Suppository
• Drug suspended in a substance, such as cocoa butter, that melts at body
temperature.

2. Enema
• Drug may be either a suspension or a solution to be administered as an enema.

Injectable Drug Forms

1. Liquid
• Drug suspended (suspension) or dissolved (solution) in a sterile container.
• Quite often the solution have a sterile water base and are thus referred to as aqueous
(waterlike) solutions.
• Some solutions have an oil base (viscous solutions), which tends to cause a more
prolonged absorption time.
2. Powder
• Dry particles of drugs that must be mixed with a sterile diluting solution to render an
injectable solution (reconstitution)
The various injection routes differ according to the type of tissues into which the drug is
deposited and the rate of absorption.
Intravenous
• Injected directly into a vein.
• Immediate absorption and availability to major organs renders this route a
dangerous one.
• Types of IV injections include the following:
❑IV push, a small volume of drug (bolus) injected into a peripheral saline lock,
attached to a vein. Can also be injected into a port on a primary (continuous) injection
line.
❑IV infusion or IV drip, a large volume of fluids, often with drugs added, that infuses
continually into a vein.
❑IV piggyback (IVPB), a drug diluted in moderate volume (50-100 ml) of fluid for
intermittent infusion at specified intervals.
IV Administration

Peripheral saline lock

IVPB

IV push medication
Intramuscular
• Injected into a muscle by positioning the needle and
syringe at a 90-degree angle from the skin.
• Absorption is fairly rapid due to the vascularity in muscle.

Subcutaneous
• Injected into the fatty layer of tissue below the skin by
positioning the needle and syringe at a 45-degree angle
from the skin.
• Sometimes, especially with self-administration or
a shorter needle, a 90-degree angle is used
Intradermal
• Injected just beneath the skin by positioning the needle bevel up and the syringe at
a 15-degree angle from the skin.
• Used primarily for allergy skin testing.
• Tuberculin (TB) skin tests (PPD) are also administered ID, and the site is inspected
48-72 h later for hardness (induration) and swelling.
Epidural
• Injected into a catheter that has been placed by an anesthesiologist in the epidural
space of the spinal canal.
• Epidurals have become a popular and widely accepted vehicle for the management of
acute postoperative pain.
Intraosseous
• Injected directly into the marrow of long bones.
Intraventricular
• Drugs injected directly into the brain via a catheter (ventriculostomy)
placed in a brain ventricle.
Intraspinal
• Injected into the subarachnoid space, which contains cerebrospinal
fluid that surrounds the spinal cord.
• Drugs injected by this route are frequently anesthetics, which render a
lack of sensation to those regions of the body distal to the intraspinal
injection.
Intraosseous Intraventricular

Intracapsular (glenoid)
Topical Form
Topical drug forms include drugs for dermal application and drugs for mucosal application.
1. Cream or Ointment
• A semisolid preparation containing a drug, for external application.
• Creams and ointments are not the same
• Creams are more aqueous in nature and ointments tend to be thicker or more viscous
2. Lotion
• A liquid preparation applied externally for the treatment of skin disorders.
• Should be patted, not rubbed, on the affected skin.
3. Liniment
• Preparation for external use that is rubbed on the skin as a counterirritant.
• The liniment creates a different sensation to mask pain in the skin or muscles.
4. Transdermal patch
• Skin patch containing drug molecules that can be absorbed through the skin at
varying rates to promote a consistent blood level of the drug between application times.
• Advantages of this method of administration include:
- Easy application, with minimal discomfort or undesirable taste
- Effectiveness for long periods of time, hours for some drugs, and days for others
- Consistent blood level of drug because the drug is released at varying rates
rather than all at one time.
5. Mucosal drugs
❖Eye, ear, and nose drops – Drugs in sterile liquids to be applied by drops.
❖Eye ointment – Sterile semisolid preparation, often antibiotic in nature, only
for ophthalmic use
❖Vaginal creams – Medicated creams, often of antibiotic or antifungal
nature, that are to be inserted vaginally with the use of
a special applicator.
❖Rectal and vaginal suppositories – Drug suspended in a substance, such
as cocoa butter, that melts at body
temperature, for local effect.
❖Douche solution – Sterile solution, often an antiseptic such as povidone-
iodine solution and sterile water, used to irrigate the
vaginal canal.
❖Buccal tablet – Tablet that is absorbed via the buccal mucosa in the mouth.
It is to be placed between the cheek and gums.
❖Sublingual tablet – Tablet that is absorbed via the mucosa under the
tongue.
6. Inhalation Drug Forms
The inhalation route is a very fast acting (second to IV route) and
effective route for delivering humidification and medication
directly into the respiratory system. The inhalation drug forms for the
inhalation route include:
Spray or mist
• In the hospital setting, respiratory therapists instill a liquid into a
chamber of a nebulizer for a patient’s breathing treatment. Often the
liquid contains a bronchodilator, a mucolytic agent, or a sterile
saline solution for moisture.
• In the home, the patient may instill aerosol sprays into the respiratory
system via a small-volume nebulizer (SVN), a metered-dose inhaler
(MDI), or a dry-powdered inhaler (DPI).
SVN MDI

DPI
SUPPLIES
Considering the variety of drug forms you may be administering, you must become
familiar with various supplies to be used:
Medicine cup
• Two types of disposable cups are commonly used: paper cups for tablets and capsules,
and plastic medicine cups with measurements for dispensing oral liquid medications.
Pill crusher and pill cutter
Medication for injection is contained in an
ampule, a vial, or a specified syringe
Ampule
• Small glass container that holds a single
dose of sterile solution for injection.
• The ampule must be broken at the neck to
obtain the solution
Vial
• Glass container sealed at the top by a
rubber stopper to enhance sterility of the
contents.
• Contents may be a solution or a powdered
drug that needs to be reconstituted.
Needles
Needles for injections have two measurements that must be noted
• Length varies from short (3/8 inch) to medium (1-1½ inch) for standard
injections. Long needles (5 inch) may be used for intraspinal or
intraosseous routes.
• Gauge is a number that represents the diameter of the needle lumen
(opening). Gauge 16 (largest) to 31 (smallest)

Syringes
The three most common disposable syringes used for parenteral
administration of drugs are:
1. Hypodermic syringe (standard)
• 2-3 mL; usually with a needle attached
2. Insulin syringe
• Used strictly for administering insulin to diabetics.
• Standard insulin syringe has only a 1-mL capacity, which is equivalent to 100
units
3. TB syringe
• Very narrow and is finely calibrated
• Has a total capacity of 1 mL
• Commonly used for newborn and pediatric dosages and for ID skin tests.
4. Oral syringes
• Some oral liquid medications are dispensed from the pharmacy in disposable
plastic syringes with rubber or plastic covers on the tip.
• These syringes are labeled “Not for injection” or “For oral use only.”
ROUTE OF ADMINISTRATION
 The route can be broadly divided
into:

1. Enteral
2. Parenteral
3. Local
 ENTERAL ROUTE (ORAL INGESTION)

ADVANTAGES:
1.Safest route
2.Most convenient
3.Most economical
4.Drugs can be self-administered
5.Non-invasive route
 ENTERAL ROUTE (ORAL INGESTION)
1.Onset of action is slower as absorption needs time.
2.Irritant and unpalatable drugs cannot be administered.
3.Some drugs may not be absorbed due to certain physical
characteristics, e.g streptomycin.
4.There may be irregularities in absorption.
5.Irritation to the GIT may lead to vomitting .
6.Some drugs may be destroyed by gastric juices.e.g insulin.
7.Cannot be given to unconscious and uncooperative patients.
8.Some drugs may undergo extensive first pass metabolism in
liver.
9.Patients may forget to take the tablet which is the practical
problem.
 ENTERIC COATED TABLET

This will :
1.Prevent gastric irritation.
2.Avoid destruction of the drug by the stomach.
3.Provide higher concentration of the drug in the
small intestine.
4.Slows the absorption ,and thereby prolonged
the duration of action
 ADVANTAGES :
Frequency of administration may be reduced.
Therapeutic concentration may be
maintained for along time specially when
noctural symptoms are to be treated.
DISADVANTAGES :
It is more expensive.
There may be release of the entire amount of
the drug in a short time leading to toxicity.
 PARENTERAL ROUTE

ADVANTAGES :
➢ Action is more rapid and predictable than oral
administration.
➢ These routes can be employed in unconscious
or uncooperative patients.
➢ Gastric irritant can be given parenterally and
therefore irritation to the GIT can be avoided.
 PARENTERAL ROUTE
➢ It can be used in patients with vomitting or those
unable to swallow.
➢ Digestion by the gastric and intestinal juices and the
first pass metabolism are avoided.
DISADVANTAGES :
➢ Asepsis must be maintained.
➢ Injection may be painful.
➢ More expensive less safe and inconvenient.
➢ Injury to nerve and other tissues may occur.
 PARENTERAL ROUTE INCLUDE:

➢ 1.Injections
➢ 2.Inhalation
➢ 3.Transdermal route
➢ 4.Transmucosal route
 PARENTERAL ROUTE :INJECTIONS

➢ Intradermal -The drug is injected into the layers

of the skin by:
➢ Raising a bleb ,e.g . BCG vaccine ,tests for
allergy.
➢ By multiple punctures of the epidermis through
a drop of the drug, e.g. Smallpox vaccine.
➢ Only a small quantity can be administered by
this route and it may be painful.
 PARENTERAL ROUTE :INJECTIONS

Subcutaneous Injection:
Disadvantages
➢ As SC tissue is richly supplied by nerves ,irritant
drugs cannot be injected.
➢ In shock absorption is not dependable because
of vasoconstriction.
➢ Repeated administration at the same site can
cause lipoatrophy resulting in erratic absorption.
 PARENTERAL ROUTE :INJECTIONS

Subcutaneous Injection:
1. Dermojet
2. Pellet implantation
3. Sialistic implants
 PARENTERAL ROUTE :INJECTIONS

INTRAMUSCULAR
➢ Aqueous solution of the drug is injected into
one of the large skeletal muscle –deltoid,
triceps, gluteus or rectus femoris .
 INTRAMUSCULAR INJECTION
ADVANTAGES :
Intramuscular route is reliable.
Absorption is rapid.
DISADVANTAGES :
IM injection may be painful.
It may result in an abcess.
Risk of nerve injury –irritant solutions can damage the
nerve if injected near the nerve.The needle may also
be puncture the blood vessel.
 PARENTERAL ROUTE :INJECTIONS

Intravenous Injection
1.A bolus: the drug is dissolved in a suitable amount of
vehicle and injected slowly.An initial large dose is
given,e.g .heparin.
2.slowly : over 15-20 min,e.g.aminophylline.
3.slow infusion: when constant plasma concentration
are required ,e.g.oxytocin in labor or when large
volumes have to be given,e.g.dextrose, saline.
 INTRAVENOUS INJECTION
ADVANTAGES :
➢ IV route is useful in emergencies because the drug is immediately
available for action.
➢ It gives 100% bioavailability.
➢ Large volume and irritants can be given,they quickly diluted in blood.
➢ Rapid dose adjustments are possible-if unwanted effectes
occur,infusion can be stopped.
DISADVANTAGES :
➢ Once injected ,the drug cannot be withdrawn.
➢ Irritation of the vein may cause thrombophlebitis.
➢ Self medication is difficult.
➢ The solution should be sterile and strict aseptic measures should be
taken.
 PARENTERAL ROUTE :INJECTIONS

Intrathecal Injection
Drugs can be injected into the subarachnoid
space for action on the CNS,e.g .spinal
anesthetics.some antibiotics and corticosteroids
are also injected by this route to produce high
local concentrations.
 PARENTERAL ROUTE :INJECTIONS

Intra-articular Injection
Drugs are injected directly into a joint for the
treatment of arthritis and other diseases of the
joints.strict aseptic precautions are required,e.g
.hydrocortisone is injected into the affected
joint,in rheumatoid arthritis.
 PARENTERAL ROUTE :INJECTIONS

Intra-arterial Injection
Here the drug is injected directly into the
arteries.it is used only in the treatment of
peripheral vascular disease, local malignancies
and angiograms.
 PARENTERAL ROUTE :INJECTIONS

Intramedullary Injection

This route involves injection into a bone marrow

–now this rarely used.
 INHALATION ROUTE

Volatile liquids and gases are given by

inhalation,e.g GA.solution of drug particles and
the fine droplets are inhaled as aerosol, e.g .
Salbutamol.
Inhaled drugs and vapour may act and absorbed
on the pulmonary epithelium and mucous
membranes of the respiratory tract.
 INHALATION ROUTE

ADVANTAGES :
➢ Almost instaneous absorption of the drug is
achieved because large surface area of the lungs.
➢ Hepatic first pass metabolim is avoided.
➢ Absorption and excretion through lunges.
DISADVANTAGES :
➢ Irritant gases may enhance pulmonary secretions
and should be avioded by this route.
 TRANSDERMAL ROUTE
Highly lipid soluble drugs can be applied over the skin
for slow and prolonged absorption ,e.g nitroglycerin
ointment in angina pectoris
a. Adhesive units
b. Inunction
c. iontophoresis
d. jet injection
a. ADHESIVE UNITS
➢ Adhesive patches of different sizes and
shapes made to suit the area of
application
➢ Site of the application are chest,
abdomen , upperarm ,back or mastoid
region,e.g hyosine, nitroglycerin
fentanyl,estrogen,testosterone
transdermal patches
B. INUNCTION
In this route of administration the
drug is rubbed in to the skin and it
gets absorbed to produce systemic
effects.
c. IONTOPHORESIS
In this procedure ,galvanic current is used for
bringing about penetration of lipid insoluble
drugs into the deeper tissues where its action
is required,e.g .salicylates, fluoride
iontophoresis is used in the treatment of
dental hypersensitivity.
c. JET INJECTION
As absorption of drug occurs across
the layers of the skin
 TRANSMUCOSAL ROUTE
Drugs are absorbed across the mucous membranes. It
includes :

Sublingual
nasal
rectal routes
 TRANSMUCOSAL ROUTE
Sublingual (e.g. Nitroglycerin, nifedipine,buprenorphine)
ADVANTAGES :
Absorption is rapid –within minutes the drug reaches the
circulation.
First pass metabolism is avoided.
After the desired effect is obtained ,the drug can be spat
out to avoid the unwanted effects.
DISADVANTAGES :
Buccal ulceration can occur.
 TRANSMUCOSAL ROUTE
Nasal

Drugs can be administered through nasal route .e.g.

Oxytocin spray ,oxymetazoline, budesonide for allergic
rhinitis
 TRANSMUCOSAL ROUTE
Rectum (e.g indomethacin, chlorpromacine, diazepam
can be given rectally)
ADVANTAGES :
Gastric irritation is avoided.
Can be administered by unskilled persons.
Useful in geriatric patient and others with vomiting and
those unable to swallow.
DISADVANTAGES :
Irritation of the rectum can occur.
Absorption may be irregular and unpredictable.
 ENEMA
Enema is the administration of a drug in liquid
form into the rectum.
1.Evacuant
2. Retention enema
 TOPICAL

Drugs may be applied on the skin for local action

as ointment ,cream , gel ,powder, paste,etc,drugs
may also be applied on the mucous membrane
ascin the eyes ,ears , and nose as ointment ,drops
and sprays.
 NURSES RESPONSIBILITIES
➢ Ensure the correct drug is administered by theright
route and in the right dose.
➢ History of allergy should be taken particularly before
parenteral administration of the drugs.
➢ Moniter the adverse effect.
➢ Drugs should be kept in safe place.
➢ Check the prescription ,drug label and the patients
name before the administration of drugs