I.

ROUTE OF ADMINISTRATION
II. INTERVAL OF ADMINISTRATION
III. TIME OF ADMINISTRATION
IV. DURATION OF THERAPHY
V. TECHNIQUE OF ADMINISTRATION
The reasons :
1. Most Convenience (oral)
2. To maximize concentration at the site of action
3. Minimize it else where (topical)
4. To prolong the duration of drug absorption
5. Avoid the first pass effect
6. Economical
7. Safest
 D
I
S
T
I R
I
Dose of N Drug in Blood B Drug in General L
Drug at site of U Circulation
P T O
Absorption I
U S
O
T N S
Drug at sites
of Action

Pharmacologic Effect

Clinical Effect

Toxicity Efficacy

Utility
Classification Of Route Drug Administration

- Enteral route : Oral Route

Sublingual Route
Buccal Route
Rectal Route
- Parenteral route : Intravenous bolus (I.V.)
Intravenous Infusion (I.V.inf)
Intramuscular (I.M.)
Subcutaneous (S.C.)
- Other route : Transdermal
Inhalation
etc
 Enteral Route
Oral route
Drug administered orally pass through various part of GIT/oral cavity
- Esophagus
- Stomach
- Duodenum
- Jejunum
- Illeum
- Collon
Small intestine : transit time 3 4 hours
Absorption is not complete by the time The drug
leave small intestine
Destruction by digestive juice/digestive enzim
Oral cavity : saliva, mucin interact with drug
Esophagus : pH = 5 6
Tablet or capsules may lodge in this area local irritation
Drug dissolution is very little
Stomach : The fasting pH = 2 6
In the presence of food pH = 1.5 2
Basic drug solubilized increase

Duodenum : pH = 6 6.5
Bicarbonat neutralized the acidic chyme
The complex fluid to dissolved drugs with limited
aqueous solubility

Jejunum : Fewer contraction preferred in vivo drug absorption

Illeum : pH = 7 (distal part 8)
Bicarbonat secretion acid drug will dissolved
Bile secretion to dissolved fats and hydrophobic drug

Collon : pH = 5.5 7
Lumen content more viscous semisolid limited drug
absorption
Theophyllin and metoprolol absorbed
Levo dopa and lactulose metabolized by enteric bacteria
(aerobic micro organism)
Absorption of clindamycin and propanolol
 Parenteral Route
Intravenous (I.V.)
- After injection distribused via the circulation to all part of body
- Aqueous solution
- Bioavailability is complete and rapid
- Drug delivery is controlled and achieved with an accuracy and
immediately
- Certain irritating solution of drug can be given
- Unfaforable reaction (high concentration of drug in plasma and
tissues)
Disadvantages : - once injected no retreat
- Drug in oily vehicle, precipitate blood constituent,
hemolized erythrocyte (should not be given)
Intravenous Infusion (I.V.inf) a drug slowly infusion

Intramuscular (I.M.)
- After Intramuscular injection diffuses from muscle into the
surronding tissue fluid the blood distributed via the circulation
- Different muscle tissue have different blood flow
- Aquaeous solution / suspension

Subcutaneous (S.C.)
- Injection under the skin
- The effect < I.V. and I.M.
 Other Route
Transdermal Route
1. Mucouse membrane
- A drug applied to mucouse membranes of the conjunctive
nasopharinx, aropharinx, vagina, collon, urethra, and urinary bladder
- Primary for the local effect
- Absorption readily
2. Skin
- Few drugs readily penetrate the intact skin
- Absorption is dependent on the surface area, lipid solubility and vehicle
of the drugs
- The effect local or systemic
- Eye ; topically applied local effect

Inhalation Route
- Pulmonary absorption / respiratory tract
- Gas on volatile drugs
- Solution of drug atomized
- Avoidance of hepatic first-pass loss
 Some Cracteristics of Common Routes of Drug
Administration
ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGES
Enteral Routes
Absorption may vary. Safest and easiest Some drugs may have
Oral (PO) Generally, slower route of drug erratic absorption, be
absorption rate administration. unstable in the gastoin
compared to IV bolus
or IM injection. May use immediate- testinal tract, or be
release and metabolized by liver
modified-release prior to systemic
drug products. absorption.

Buccal or Rapid absorption No first-pass effect. Some drugs may be

sublingual (SL) from lipid-soluble
drugs. swallowed.
Not for most drugs or
drugs with high doses

Rectal (PR) Absorption may vary Useful when patient Absorption may be
from suppository. can not swallow erratic.
medication. Suppository may migrate
More reliable different position.
absorption from Used for local and
enema (solution). systemic effects. Some patient discomfort.
ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGES
Parenteral
Routes Complete (100%) Drug is given for Increase chance for
Intravenous systemic immediate adverse
(IV) drug absorption. effect. reaction.
Rate of Possible
bioavailability anaphylaxis.
considered
instantaneous.
Intravenous Complete (100%) Plasma drug levels Requires skill in
infusion (IV systemic drug more precisely insertion of
inf) absorption. controlled. infusion set.
Rate of drug Tissue damage at
absorption May inject large site of
fluid volumes.
controlled by
infusion pump. May use drugs with injection
poor lipid solubility (infiltration,
and/or irritating necrosis,
drug. or sterile Abscess).

Intramuscul Rapid from aqueous Easier to inject Irritating drugs may

ar solution. than be very painful.
injection Slow absorption intravenous Different rates of
(IM) from injection.
nonaqueous (oil) Large volumes may absorption
solution. be used depending upon
ROUTE BIOAVAILABILITY ADVANTAGES DISADVANTAGES
Other Routes
Transdermal. Slow absorption, Transdermal Some irritation by
rate may vary. delivery system patch of drug.
(patch) is easy to Permeability of skin
Increased use. variable with condition,
absorption with Used for lipid- anatomic site, age,and
occlusive dressing. soluble drugs with gender.
low dose. Type of cream or
ointment base affects
drug-release and
absorption.

Inhalation Rapid absorption. May be used for Particle size of drug

Local or systemic determines anatomic
Total dose effects. placement in
absorbed is variable.
respiratory tract.
May stimulate cough
reflex.
Some drug may be
swallowed.
 SITE OF ROUTE ADMINISTRATION
RODA 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
* Intrasynovial * Synovial fluid cavity
* Intracoutaneus/Intradermal * Into skin
* Under skin
* Subcutaneous * Into muscle
* Intramuscular - Skin surface
- Epicutaneous (Topical) - Skin surface
- Transdermal - Conjunctiva
- Conjunctival - Eye globe
- Intraoccular - Nose
- Intranasal - Ear
- Aural - Lung
- Intrarespiratory
 THE USAGE OF DOSAGE FORMS

Route Of Drug Administration Dosage Form

Oral Solid and Liquid dosage form
Sublingual Tablet, trochition and lozenges
Parenteral Solution, suspension
Epicutaneous/Transdermal Ointment, Cream, Paste, Powder, Aerosol,
Lotion,Transdermal, Disc, and Solution
Attachment
Rectal Solution, Ointment, Suppositoria
Conjunctival Ointment
Intraoccular/Intraaural Solution, Ointment
Intranasal Solution, Spray, Inhalant, Ointment
Intrarespiratory Aerosol
Vaginal Solution, Ointment, Emulsified foam,
Tablet, Insert, Suppositoria, Sponge
Urethral Solution, Suppositoria
 DRUGS THAT ARE USED SPECIFICALLY
1. SUBLINGUAL TABLET
For cardiac diseases : angina/asthma (nitroglycerin, isoprenalin)
2. CHEWING TABLET
Drugs for gastritis
3. LOZENGES
Mouth freshener (anti inflammation)
4. TABLET
Tablets that are destroyed in intestine :
* Unchawed tablet
* Without milk, alkaline drinks, or antacid
5. DRUG THAT NEED EXCESSIVE DRINK (200 ml 300 ml)
Sulfa group
Metronidazol
Erythromycin
Amoxicillin
Aspirin
6. DRUGS THAT ARE WITHOUT EXCESSIVE DRINK
Anti gastritis drug/antacid suspension

7. DRUGS THAT ARE TAKEN WITHOUT MILK

- Vitamin C+ Ferrous
- Antienteretis
- Enteric coated tablet
- Tetracycline

8. PEDIATRIC DRUG ADMINISTRATION

Tablet / powder dissolved into :
- Honey
- Sugar water
- Jelly
- Corn oil
Determained by: Half life time ( t ) of drugs

a. Ultra fast Amoxicillin, Cloxacillin, Flurosemide,

Penicillin
b. Fast Paracetamol, Ampicillin, Hydrocortison
c. Slow Doxicillin, Griseo fluvine, Proctolal
d. Very slow Barbiturate, Diazepam, Digitoxin
Phenilbutazon
STANDARD ADMINISTRATION TIMES
DAILY
.. times a day
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

EVERY
Every .. hours
12-hourly : 10.00, 22.00
8-hourly : 06.00, 14.00, 22.00
6-hourly : 06.00, 12.00, 18.00, 24.00
4-hourly : 06.00, 10.00, 14.00, 18.00. 22.00, 02.00
Base on :
1. Chemical properties of drugs
Exp : Anticholinergic drugs reduce secretion and peristaltic of intestinal.
These drugs should be taken one hour before meal.

2. Physiological properties of G.I.T.

Exp : Gastric pH absorption
G.I. Mortility absorption

3. Possible interaction :
Interaction between drug
Drug that interact with antacid in stomach
Exp : Amoxicillin, Ampicillin, Cloxacillin, Nitrofurantoin
Interaction Drug and Food
Drug interferred by gastric chyme
Exp : Ampicillin, Amoxicillin, Erythromycin, Lincomycin
(Should be taken during empty stomach)
4. Drugs that synchronized with chyme (food)
Exp : Doxycycline, Doxycycline hyclate, Erthromycin, ethylsuccinate,
Griseofulvin.
(should be taken with meals)

5. Stomach-irritating drugs
Exp : Aminophylline, Acetyl salicilic acid, Codein, Phenylbutazon

EXAMPLE OF ADMINISTRATION TIME OF THE INTERACTIVE

DRUGS

R/ Ampicillin 500 mg cap No. XV

S 3. dd.cap.I (1) hac ------- 1 hour before meal
R/ Antacid tab No.XX
S3.dd.tab.I (1) hpc ------- 1 hour after meal
 Standard administration times
Abbreviation Administration times

qd* = quaque die = each day Usually accepted to mean 10:00 AM

bid* = bis in die = twice a day 10:00 AM, 2:00 PM
tid* = ter in die = three times a day 10:00 AM, 2:00 PM, and 6:00 PM
qid* = quater in die = four times a day 10:00 AM, 2:00 PM, 6:00 PM, and 10:00 PM
hs = hora somni = at bed time Usually accepted to mean 10:00 PM
q12h = quaque duodecin hora = each twice hours 10:00 AM and 10:00 PM
q8h = quaque octo hora = each eight hours 6:00 AM, 2:00 PM, and 10:00 PM
q6h = quaque six = each six hours 6:00 AM, 12:00 AM, 6:00 PM, and 12:00 PM
q4h = quaque quattour = each four hours 6:00 AM, 10:00 AM, 2:00 PM, 6:00 PM, 10:00 PM,
and 2:00 AM
q3h = quaque tres = each three hours 3:00 AM, 6:00 AM, 9:00 AM, 12:00 AM, 3:00 PM,
6:00 PM, 9:00 PM, and 12:00 PM
ac = ante cibos before meals (approximately 30 45 minutes)
pc = past cibos after meals (approximately 1 hour)
* Exceptions:
1. Steroids perhaps should be administered near 7:00 or 8:00 AM when on a qd schedule.
2. Oral hypoglycemic agents and insulin (7:00 AM and/or 4:30 PM) when ordered bid.
3. Antibiotics should be spread evenly over 24 hours. An approximate schedule to avoid meals might be 4:0
AM, 10:00 AM, 4:00 PM, and 10:00 PM.
4. Antihypertensive agents should be spread over the 24 hour period
5. Anticoagulants should be scheduled so as to follow measurement of the patients clotting time.
 FIX TIME OF ADMINISTRATION

- In the morning : Steroid

Diureticum
Antihypertensi
- In the night : Contraceptive agent
Hypnotic agent
- During meal : Drug irritating stomach
Drug that sensitive to gastric pH
Drug absorption increase
- During episode : Antiasthmatic drug
Drug for migraine
Angina pectoris drugs
- Empty stomach : 1 hour before meal 1h.a.c
2 hour after meal 2h.p.c
Symptomatic therapy : > three days <
Causative therapy : should be enough
 DRUG DOSAGE FORMS
ROUTE OF ADMINISTRATION
SPECIFIC- DRUG MEDICATION
PARENTERAL DRUG MEDICATION
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.
1. Cough out the sputum as much as possible.
Aerosol is shaked before use
2. 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 as much
as possible.
5. Press the tube content in order to spray meanwhile
immediately inhalate it deeply with tounge
position remains still below.
6. Hold the breath within 10 - 15 seconds.
7. Then, expire the air through nares.
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.
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.
 Nod down the head slightly.

The other nose is closed by pressing the

nacres with your finger.

The sprayer is inserted into the opened

nacres by pressing the vial, so that its
content will be out and inhale gently, then
do the same as the abovementioned.
 The best is the head in slanting position

Gently the upper part of the ear lobe is slightly

attracted 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

5 minutes before doing the same into another
one.

In some products, it is recommended to close

the ear opening with cotton ball.
 Suppositoria is prepared to be out of the
container. When it is too flaccid, it would better
be cooled first, whereas if it is too hard, heat it
by placing it inside your fist.

Lay down with slanting position and one of the

lower extremities is abducted to the abdomen.

Insert gently the suppositoria into the anal

opening meanwhile it is rotated foreward with one
of your hands. Keep lying for several minutes.
 INTRAVAGINAL
MEDICATION
In general, intravaginal medication is limited to
the localized application for which ointments or
tablets are available to insert into vagina and
usually by the time of going to bed, such as
metronidazole and primaricin for vaginitis
caused by trichomonas and candida.

The drugs may be used in the form of swabbing

liquid, others in the forms of spermaticide (to kill
spermatocyte), foam tablet,and cream.
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
 Back and chest All types
Genitalia Powder, watered powder, cream
Scalp solution.
Powder, watered powder, cream
Hand and arm
solution.
Skin fold Water (solution), alcohol, cream.
Lower extremities Powder, water solution, alcohol,
Face ointment, wet powder, paste,
cream.
Watered powder (solution),
alcohol, ointment, wet powder,
cream.
All types except for eye skin.
The choosing of drugs is on the basis of the
skin disorders, thus the wet condition of the
skin disorders needs application of wet
preparation, while the dry skin uses
 Vesicles, edema, erythrema
Crust, itching infection
Water (solution) - wet compression
Powder, lotion, sprays Cream (o/w)
Cream (w/o) and and ointment

Desquamation, erythrematous, itching,

drying
 Parenteral medication can be undertaken :
1. By injection with syringe
2. Through infusion liquid (more than 10 ml
volume)
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
THE DISADVANTAGES OF PARENTERAL MEDICATION :
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
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

Intravenous administration is one of the most

important clinical treatment compared to the other
parenteral administrations, because :

1. Injected directly toward the blood vessel

2. Rapid and immediate onset
3. Inversely, giving danger such as anaphylactic
shock or severe anaphylactic reactions.
Intravenous administration needs the skillfulness, great
attention, and precatiously with antiseptic techniques
and also need close monitoring of drug action.
Physicians judge the decision of intravenous medication
based on as follows :
1. whenever other routes of administration are considere
impossible whereas the terapy management must be
implemented promptly. For example :
* Methicillin in stomach will be broken down by acid,
whereas via intramuscular method is impossible
because of large 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 rise painfulness; similarly, subcutaneous
method will result in wider inflammation.
* In very irritative drug by intramuscular and
subcutaneous method, it can be diluted into infussion.
In the specific clinical settings, the rapid
administration is required for patients with
serious condition.
In patients with high tendency to be hemorrhagic
(thrombocytopenia or hemophilia and
anticoagulant administration), intramuscular and
subcutaneous medication will cause formation
of hematoma which is painful and extensive or
bleeding.
For supplementary nutrition, in patients with
GI disturbances, peroral intake is not adequate,
and so does patient with gastrointestinal post-
operative condition.
* Patients with vomiting and nausea at certain
level, such as severe hyperemesis gravidarum,
unconsciousness, or swallowing unability.
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 the

available packaging is in ampule or vial.

Suspension, unsoluble active ingredient, is suspended

thoroughly in the suspension using suspension agent.

Emulsion, the liquid containing the mixture of water and oil.

2. Dry Powder, including :

Soluble Ingredient, mixed with solvent before use, this

ingredient is not long-standing that breaks down in the
solution.

Insoluble Ingredient, mixed with liquid when it will be used,

because it is not long-standing in solution, but broken down.

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.
 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.
Glass
Plastic
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.
2. VIAL
It is made from glass with rubber cap fixed with film
metal surrounding the bottle lip, generally can be
used repetitively.
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 alcohol cotton
Prick the syringe into the vial while the upside-down
position of the vial .
Press the air into the vial then directly pump-in the
solution as much as needed, the needle should be
always in the solution border.
Make the syringe free from air and clean it, wash the
hands.
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 type and 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.
DISPOSABLE SYRINGE :

Made from plastics with larger size than

Tuberculin syringe (5 ml) for once use
only, packed with sterile state and
separated needle.
In general, it is used the administration of
antibiotics, antihistamine, heparin,
tranquilizer, vitamin, etc.
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
Needle Size

The choosing of needle size on the basis of

1. Safety
2. Flow volume
3. Patient's convenience
4. Penetration depth
The unit of needle size is GAUGE referring to the outer
diameter of canula or needle shaft.
In general the size is 1 - 27 gauge, with the length not
less than 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
gauge with 1.25 inches to 15 gauge with 2.5 inches.
There are also many other utilities :

1. Caudal needle
2. Epidural needle
3. Intravenously anesthetic needle
4. Blood transfusion needle
5. Spinal needle
6. Biopsy needle
7. Cerebral angiographic needle
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
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-

irritant drugs 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 via dermal

and subcutaneous methods may develop
lymphadenitis.
This method is also used in the
administration of heparin and
epinephrine suspensions.

Skin has poor blood vasculature, thereby the

drugs that will be absorbed by blood vessels and
the nonsoluble drugs diffuse into lymphatic
vessels.
INJECTION TECHNIQUES
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 desinfectant
4. Pinch the skin as thick as the skin itself
5. Prick the needle into the skin on the base of skinfold with the angle of
20 - 30 degrees
6. The pinch is then released
7. 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 vessel develops
9. The needle is immediately removed, cover the injection site with
adhesive plaster.
10. Observe the patient condition; attention should be given that the
repeated injection may appear overdosis.
3. INTRAMUSCULAR INJECTION

Dosage form : Solution, suspension in water

or oil
Volume : No more than 4 ml
In injection into muscles, the soluble drug
resorption will last within 10 - 30 minutes.
The adventages :
Easy, safer, good tolerated, rapid resorption,
and rarely develops necrosis. For very irritative
drugs, this intramuscular method is preferred
than subcutanous method.
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 Superior Gluteal Artery.And patient
position should be facing laterally, facing
downward, or standing.

It is not performed to infants and

young children.
Vestus Lateralis :

Middle aspect of thigh :

very poor nerve fibers and blood vasculature.
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 existence of large bone,
blood vessels, and nerve fibers.
Drug Volume :
1. No more than 2 ml.
2. Wash hands thoroughly
3. Make the patient ensure and explain the procedure
4. Rub disinfectant on the skin
5. Ask the patient to let the muscles relaxed, because if the
muscle is in contraction will the drug liquid flow into the
surrounding tissue leading to irritation and pain sensation.
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 new syringe, if
any)
8. Inject the drug by pressing the pump slowly and gradually
to diminish pain sensation
9. Remove the needle quickly
10. The injection site is press using the other hand with
sterilized cotton, fix it with plaster
11. Observe the patient's reaction, necessarily keep the patient
calm
12. Clean the hands and used equipments
4. INTRAVENOUS DRUG
ADMINISTRATION
Materials :
Syringe filled with air-free drug liquid,
Needle of 20 gauge, long and moderate thickness

Disinfectant
Cotton, plasters, and tourniquet

Injection Procedure :
1. Wash the hands thoroughly
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 to legate.
4. The patient is asked to be relaxed with fisting the related hand.
5. Tourniquet is set up, then see the vein to be swollen while
giving disinfectant on to the skin area.
Injection Procedure :
6. Vein is stabilized by replacing the pressing hand to the
skin in line 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. Tourniquet 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
it with plaster.
12. Observe the patient's reaction, meanwhile wash your
hands and clean the used equipments
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 drug

administration at hospitals were conducted by
injection and it is likely increasing recently.
THE CONTAINER OF INFUSION FLUID
1. It is made from glass, consisting of 2 types
based on the 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
tube
opening is able to be passed through.
2. The container is made from felxible plastics
polyvinyl chloride or semi rigid 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, the main components and parts
are the same, including :
1. Spike as the breaker against rubber seal in
the spike hole.
2. Drip chamber
 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 administration
NAME
1. AminoAcids (synthetic)
CONCENTRATION PURPOSE
Aminosyn 5.5-8% Fluid &nutrition
Veinamine
2. Dextrose (Glucose,D5/W) 8%
3. Dextrose&NaCl
4. Lactate's Ringer 2.5 - 50%
(Harmann)
NaCl
5-20% Fluid & Nutrition
KCl NaCl 0.11 - 1.9% Nutrition & Electrolytes
CaCl2
Na Lactate Systemic alkalizer &
5. Pprotein (hydrolized)
Aminosol nutrient supplement
CPH-5
6. Ringer's
0.60%
NaCl 0.03%
KCl
CaCl2 0.02%
7. Natrium Lactate
0.30 Fluid & nutrient
supplement
5% casein&fibrin

Fluid & nutrient

0.86% supplement
0.03%
0.033%
1/6M
 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.
Or inject 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.
 THE PROCEDURE OF INTERMITTENT
ADMINISTRATION OF INTRAVENOUS LIQUID WITH
VOLUME CONTROL SET

1. Using aseptic technique, the spike of VC set is inserted

into the 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
The administration of this infusion drip is related to
the second liquid. Through venipuncture, the
drug flow will be regulated in one intravenous
system.
This administration give rise the following advantages :

1. PB technique can avoid unnecessarily other venipuncture.

2. The drug solvability is achieved immediately in short time,
usually within 30 - 60 minutes.
3. The drug solution that can relieve irritation and obtain high
serum level rapidly is an important consideration for therapy
such as serious infection,especially in antibiotic
administration.
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
To reserve air and control the number of dripping, the
bottles are connected to the drip chamber with a clamp,
further the 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, then
eject 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 previous mentioned
intravenous injection procedure), conducted by physician or nurse.
4. Loosen the clamp gently to flow the liquid till the expected number
of
drops by observing the drip in the drip chamber. Generally,
this medication 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 potent
drugs, 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 and dissolved with 50 - 150 ml main or reserved solution.