Adams Nursing School

PHARMACOLOGY
CONNECTIONS TO NURSING PRACTICE

Second Edition
CHAPTER 3
Principles of Drug Administration
Pharmacology: Connections to Nursing Practice, Second Edition

Michael Patrick Adams • Carol Quam Urban
Drug Administration and
Patient Adherence
3.1 Achieving patient adherence with

pharmacotherapy is a major challenge
for the nurse.

Adherence
• Taking medications in manner

prescribed by health care provider
(pharmacotherapy)
• Correctly following instructions on label
(OTC)
• There is an issue of health care literacy,
we need to be cognizant of this as
nurses

Nonadherence
• Not taking medication at all

• Taking medication at wrong time
• Taking wrong dose of medication
• Affects 50% to 75% of patients each
year

Factors Influencing Nonadherence
• Forgetting doses of drugs or taking too

many
• Expense
• Side effects
• Prolonged need for medication
• Self-adjustment of doses
• Discontinuing use when feeling better

Increasing Medication
Adherence
• Determine if patient takes meds
correctly
• PCP asks for all bottles to be brought to
office
• Observe patient for the following:
– All of medication is taken
– Medication is taken at correct time
– Correct dose of med is taken

Developing a Personalized Plan
of Care
• Address essential information
– Name of medication
– Reason for use
– Expected drug action
– Side effects
– Significant interactions with meds, food,
herbal
– Assess ability for self-administration

Drug Storage and Expiration
• Do not use past expiration date

– Discard any pills past expiration date
– Storage principles
 Store at recommended temperature
 High humidity enhances deterioration
– Scheduled drugs have restricted access
– Check drug for unusual color or textures
– No meds in kitchen or bathroom
– In homes with children should be locked
Prescription Format
• Heading
– Date
– Patient name
– Prescriber’s name, address, phone
number

Prescription Format
• Body
– Drug name
– Drug dosage
– Amount dispensed
– Patient instructions

Prescription Format
• Closing
– Prescriber’s
signature
– Controlled
substances require
a DEA #
– Refill amount if
applicable
– Generic equivalent
substitution

Dosing Intervals
3.4 For maximum effectiveness, drugs

must be administered at the proper
dosing intervals.

Drug Dosing
• Determined by physician and biologic

characteristics of drug
• Usual dosing is 1‒4 times/day
• Times of administration differ with
institutions
• Administration time should enhance
therapeutic effectiveness
• Some drugs given STAT or prn
• Avoid skipping doses and double-dosing
Table 3.2 Medication Administration Abbreviations

Table 3.2 (continued) Medication Administration Abbreviations

Measurement of Drug Doses
3.5 The primary system of

measurement used in pharmacology is
the metric system.

Metric System
• Most common in pharmacology

• Metric volume = liter (L) or milliliter
(mL)
• Metric weight
– Kilogram
– Milligram
– Microgram

Apothecary System
• Basic unit is the grain (gr)

• Infrequently used today
• Unit dosing is common
• Knowledge of dosage calculation
important

Documenting Drug
Administration
3.6 Medication administration should

be properly recorded as soon as
possible after the drug is administered.

Documentation
• Record initials/signature after

medication given
• Utilize institution’s medication
administration record (MAR)
• Document reason for drug omission or
refusal
• Record pertinent patient concerns and
complaints

Routes of Drug Administration
3.7 Enteral drugs are administered by

the oral route or through gastrostomy
or nasogastric tubes.

Enteral Route
• Drug given through the GI tract

• The safest route
• Consider patient’s ability to swallow
• Oral drug forms
– Tablet
– Capsule
– Enteric-coated tablets

Extended Release Tablets
• Most are absorbed in small intestine

• Common endings: XR, XL, LA, SR, -dur
• Allow for longer duration of action
• Do not crush, open, or chew
• Exposure to stomach acid destroys
medication
• Some coated to mask a taste or
prevent staining of the teeth

Figure 3.2a Sublingual medication administration.

Figure 3.2b Buccal medication administration.

Nasogastric and Gastrostomy
• Used for long-term treatment

• NG route used for short-term treatment
• Liquid drug formulation best to use
• Avoid crushing tablets of sustained
release drugs
• Flush tubes to maintain patency
• May crush and dissolve some tablets

Topical Routes
• Dermatological applied to skin

• Instillations and irrigations placed in
body cavities and orifices
• Inhalations applied to respiratory tract
– Inhalations
– Nebulizers
– Positive pressure breathing machine

Topical Drugs
• Can produce a local or systemic effect

• Examples:
– Local effects: nasal steroids
– Systemic effects: nitroglycerin patch
• Identify desired effect of drug
• Avoid application to abraded or open
skin

Transdermal Delivery Systems
• Deliver specific amount of drug through

skin
• Rotate site of application
• Check that previous patch is removed
• Dispose of used patches properly, in
health care agencies in the sharps
container, in homes place inside a
plastic bottle

Figure 3.3a Transdermal patch administration: Protective coating is removed from the patch.

Figure 3.3b Transdermal patch administration: The patch is immediately applied to clean, dry, and hairless
skin and labeled with the date, time, and initials.

Other Topical Drug Routes
• Ophthalmic
• Otic
• Nasal
• Vaginal
• Rectal

Figure 3.4a Ophthalmic administration.

Figure 3.4b Otic administration.
Source: DK Images

Figure 3.4c Intranasal administration.

Parenteral Administration
• Administers drug into skin layers

– Intradermal
– Subcutaneous
– Intramuscular
– Intravenous
• More invasive
• Specialized equipment and techniques
needed

Parenteral Administration
• Avoids digestive enzymes and first pass

effect

Figure 3.6a Intradermal drug administration: Cross section of skin showing the depth of needle insertion.

Figure 3.6b Intradermal drug administration: The needle is inserted with the bevel up at 10–15°.

Subcutaneous Administration
• Subcutaneous site is easily accessible

– Delivers drug to deepest skin layer
– Injection volumes range from 0.5 to 1.0
mL

Figure 3.7a Subcutaneous drug administration: Cross section of skin shows the depth of needle insertion.

Figure 3.7b Subcutaneous drug administration: The needle is inserted at a 45° angle.

Intramuscular Administration
• Drug delivered into muscle

• More rapid response than oral or
subcutaneous
• Select site away from bone, nerves,
and large blood vessels
• Injection volume should not exceed 3
mL
– Deltoid site is limited to 1 mL

Figure 3.8a Intramuscular drug administration: Cross section of skin shows the depth of needle insertion.

Figure 3.8b Intramuscular drug administration: The needle is inserted at a 90° angle.

Intravenous Route
• Drug delivered directly into blood

• Rapid onset of drug action
• Most dangerous route
• Three basic types
– Large-volume infusion
– Intermittent infusion
– Bolus administration

Figure 3.9a Intravenous drug administration: Syringe pump for IV infusion.
Source: © Paul Velgos/istockphoto.com

Figure 3.9b Intravenous drug administration: Injecting a medication by IV push.
Source: Carol Urban


Adams Nursing School

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Adams Nursing School

Uploaded by

Copyright:

Available Formats

PHARMACOLOGY

CONNECTIONS TO NURSING PRACTICE

Pharmacology: Connections to Nursing Practice, Second Edition

3.1 Achieving patient adherence with

Pharmacology: Connections to Nursing Practice, Second Edition

• Taking medications in manner

Pharmacology: Connections to Nursing Practice, Second Edition

• Not taking medication at all

Pharmacology: Connections to Nursing Practice, Second Edition

• Forgetting doses of drugs or taking too

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

• Do not use past expiration date

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

3.4 For maximum effectiveness, drugs

Pharmacology: Connections to Nursing Practice, Second Edition

• Determined by physician and biologic

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

3.5 The primary system of

Pharmacology: Connections to Nursing Practice, Second Edition

• Most common in pharmacology

Pharmacology: Connections to Nursing Practice, Second Edition

• Basic unit is the grain (gr)

Pharmacology: Connections to Nursing Practice, Second Edition

3.6 Medication administration should

Pharmacology: Connections to Nursing Practice, Second Edition

• Record initials/signature after

Pharmacology: Connections to Nursing Practice, Second Edition

3.7 Enteral drugs are administered by

Pharmacology: Connections to Nursing Practice, Second Edition

• Drug given through the GI tract

Pharmacology: Connections to Nursing Practice, Second Edition

• Most are absorbed in small intestine

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

• Used for long-term treatment

Pharmacology: Connections to Nursing Practice, Second Edition

• Dermatological applied to skin

Pharmacology: Connections to Nursing Practice, Second Edition

• Can produce a local or systemic effect

Pharmacology: Connections to Nursing Practice, Second Edition

• Deliver specific amount of drug through

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

• Administers drug into skin layers

Pharmacology: Connections to Nursing Practice, Second Edition

• Avoids digestive enzymes and first pass

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

• Subcutaneous site is easily accessible

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition

Pharmacology: Connections to Nursing Practice, Second Edition