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DRUG ADMINISTRATION

Prajogo Wibowo

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3 PHASES OF DRUG DELIVERY
• Drug Administration Phase
• Pharmacokinetic Phase
• Pharmacodynamic Phase

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THE PREPARATION CAN BE
DISTINGUISHED INTO

INTERNAL PREPARATION EXTERNAL PREPARATION

ORAL ALL OF MEDICATION


but
STOMACH ORAL INTESTINAL

INTESTINAL DRUGS LABEL : BLUE

DRUGS LABEL : WHITE


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SYSTEMIC & NON SYSTEMIC MEDICATIONS

SYSTEMIC : ANTIBIOTIC (SYSTEMIC)


ANTIHYPERTENSION, ANALGESIC
1. INTERNAL PREPARATION
NON SYSTEMIC : ANTIHELMINTIC
LOCAL ANAESTHETIC, ANTIMICROBIAL
(INTESTINAL), LOCAL ANTACID

SYSTEMIC : PARENTERAL INJECTION


INHALER, SUPPOSITORIA
2. EXTERNAL PREPARATION
NON SYSTEMIC : VAGINAL TABLET,
TOPICAL STEROID, GARGLE,SUPP

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MANAGEMENT OF MEDICATION

1. INTERVAL OF MEDICATION
2. TIMING OF MEDICATION
3. TECHNIQUE OF MEDICATION

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1. INTERVAL OF MEDICATION
examples :
* HOURLY
* EVERY (THREE-HOURS)
* THREE TIMES A DAY

2. TIME OF MEDICATION
examples :
* in the morning, in the midday, in the night
* before, after, or during meals; before sleeping
* during episode, during attack, after attack

3. TECHNIQUES OF MEDICATION
* ROUTE OF ADMINISTRATION : TOPICAL AND NON-
TOPICAL DRUGS
* DRUG DOSAGE FORMS
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INTERVAL OF MEDICATION

Determined by :
* HALF-LIFE TIME (t 1/2) OF DRUGS :
Ultrafast, Fast, slow, very slow

Example :
Reserpin has t 1/2 15 minutes and 36 hours of duration

DURATION OF DRUG ACTION / EMERGENCY SETTING


In emergency condition, in particular clinical treatment

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HALF-LIFE TIME (t 1/2)
ULTRAFAST :
amoxicillin, cloxacillin, flurosemide, penicillin-G

FAST :
paracetamol, ampicillin, hydrocortison

SLOW :
doxicillin, griseofulvine, proctolol

VERY SLOW :
barbiturate, diazepam, digitoxin, phenylbutazon
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STANDARD ADMINISTRATION TIMES

DAILY
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
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

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TIMING OF MEDICATION
BASED ON :
* CHEMICAL PROPERTIES OF DRUGS
* PHYSIOLOGICAL PROPERTIES OF GASTROINTESTINAL
TRACT

POSSIBLE INTERACTIONS :
1. DRUG AGAINST DRUG
2. DRUG AGAINST GASTROINTESTINAL CHYME
3. DRUG AGAINST GASTROINTESTINAL PHYSIOLOGY

THE CONSEQUENCES :
1. DRUG : reaction occurs --> impaired absorption; break-
down of drug
2. GASTROINTESTINAL TRACT : drug irritation, impaired
motility, delayed gastric emptying, reduced absorption.

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OVERCOME

1. DETERMINATION OF APPROPRIATE TIMING


IN DRUG ADMINISTRATION

2. MANAGING THE PRIORITY ORDER OF


DRUGS.

3. CHOOSING THE APPROPRIATE DRUG


TYPES
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TIMING OF MEDICATION
IN THE MORNING :
* Steroid * Laxative Bisacodyl tablet
* Diureticum * Suppositoria
* Antihypertension * Vaginal tablets
* Hypnotics
* Cimetidine
* Anticholesterolemia

IN THE NIGHT :
* Contraceptive pills

DURING DAILY ACTIVITIES


DURING MEAL
DURING EPISODE
With meal : - promptly after meal
* Pectoral angine drugs
- During Meal
* Drugs for migraine-cephalgy
* Antiasthmatic drugs
Empty Stomach : 1 hour before meal
2 hours after meal
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DRUGS & PHYSIOLOGY OF GIT
Factors affecting drug
1. Chemical properties
2. Gastric pH
3. GI tract motility

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ANTICHOLINERGIC DRUGS reduce :
* Secretion
* Intestinal peristaltic
These drugs should be taken one hour before meal

BELLADONA ALKALOID GROUP : Tinct.Belladona


Atropin extr. Belladona Hormotropin
Scopolamin Oxypheninium
Methylscopolamine Mepenzolate
Butylscopolamine Bevonium

QUATERNARY COMPOUNDS Clidinium


Propanteline

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DRUGS AND FOODS
1. Drugs interferred by gastric chyme
Isoniazide
ANTIMICROBES : Rifampicin
Ampicillin
Erythromycin OTHERS :
Lincomycin Levodopa
Oxytetracycline Penicillinamine
Penicilline G/V Propanteline
Tetracycline Paracetamol

All these drugs should better be taken during "empty


stomach"
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2. DRUGS THAT SYNCHRONIZED
WITH CHYME (FOOD)
ANTIMICROBES : OTHERS :
Doxycycline Hydralazine
Doxycycline hyclate Hydrochlortiazide
Erthromycin ethylsuccinate Propanolol
Griseofulvin Metroprolol
Nitrofurantoin Reserpine

The above mentioned drugs should be taken "with meals"

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3. STOMACH-IRRITATING DRUGS
Aminophylline Chlorpromazine
Acetyl salicilic acid Metronidazole
Codein Nitrofurantoin
Phenylbutazon
Prednisone
Ferrosulphate
Reserpine
Hydrocortison
Indomethacine Mephenamic acid
Isoniazide Pirazolone

1. The possibility not to be taken by patients with gastritis


2. Some are administered in contained stomach or excessive water drinking
3. Some are in favour given with milk

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INTERACTIONS BETWEEN DRUGS
DRUGS THAT INTERACT WITH ANTACIDS IN STOMACH :

ANTBIOTICS : OTHERS :
Amoxicillin Acetylsalicilic acid
Ampicillin
Digitalis
Cloxacillin
Dicumarol
Nitrofurantoin
Phenotiazine
Oxytetracycline
Ferrous preparation
Penicillin V
Sulphonamide Isoniazid
Tetracycline Chlordiazepoxide
Levodopa
Indomethacine
Propanolol

EXAMPLE OF MEDICATION TIMING 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

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MEDICATION TECHNIQUE

• DRUG DOSAGE FORMS


• ROUTE OF ADMINISTRATION
• SPECIFIC- DRUG MEDICATION
• PARENTERAL DRUG MEDICATION

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METHOD OF MEDICATION
TERMS : 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

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 Intrasynovial Synovial fluid cavity
 Intracoutaneous or intradermal into skin
 Subcutaneous under skin
 Intramuscular into muscle

• Epicutaneous (Topical) Skin surface


• Transdermal Skin surface
• Conjunctival Conjunctiva
• Intraoccular Eye globe
• Intranasal Nose
• Aural Ear
• Intrarespiratory Lung

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THE USAGE OF DOSAGE FORMS

Sublingual tablet
trochition and lozenges

Parenteral solution, suspension

Epicutaneous/Transdermal ointment, cream, paste,


powder, aerosol, lotion, and transdermal, disc, and
solution attachment

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THE USAGE OF DOSAGE FORMS

Conjunctival ointment
Intraoccular/intraaural solution, suspension
Intranasal solution, spray, inhalant, ointment
Intrarespiratory aerosol
Rectal solution, ointment, suppositoria
Vaginal solution, ointment, emulsified
foam, tablet, insert, suppositoria,
sponge
Urethral solution, suppositoria

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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)

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MULTI-LAYER TABLET
Tablets that are destroyed in intestine
Tablet :
* Unchewed but powdered
* Without milk, alkaline drinks, or antacid

DRUGS THAT NEED EXCESSIVE DRINK (200-300 ml)


* Sulfa group
* Metronidazol
* Erythromycin
* Amoxicillin
* Aspirin
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DRUGS THAT ARE WITHOUT
EXCESSIVE DRINK
Antigastritis drug/antacid suspension
DRUGS THAT ARE TAKEN WITHOUT MILK
• Vitamin C+ Ferrous
• Antienteretis
• Enteric coated tablet
• Tetracycline

PEDIATRIC DRUG ADMINISTRATION


Tablet powder/pulveres dissolved into :
• Honey
• Sugar water
• Jelly
• Corn oil

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SAMPLES OF DRUG
ADMINISTRATION

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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.

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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.

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INHALANT MEDICATION
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.

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NASAL DROP
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.
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NASAL SPRAY
 Nod down the head slightly.

 The other nose is closed by pressing the nares


with your finger.

 The sprayer is inserted into the opened nares by


pressing the vial, so that its content will be out
and inhalte gently, then do the same as the
abovementioned.

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EAR DROP
 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.

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SUPPOSITORIA
 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.

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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.

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SKIN DRUGS
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

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LOCATION
 Back and chest
 Genitalia  All types
 Scalp  Powder, watered powder, cream
solution.
 Hand and arm  Powder, watered powder, cream
 Skin fold solution.
 Lower extremities  Water (solution), alcohol, cream.
 Face  Powder, water solution, alcohol,
ointment, wet powder, paste, cream.
 Watered powder (solution), alcohol,
ointment, wet powder, cream.
 All types except for eye skin.

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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 semisolid preparation.

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 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
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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

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ADVANTAGES
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

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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

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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.

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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.

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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.
Beside intravenous drugs and liquid administration, it
is also important to give blood or bloodcomp[onen in
certain cases. 53
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. 54
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.

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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.

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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.

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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.

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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.

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DISPOSABLE SYRINGE :

Made from plastics with larger size than


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

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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

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Long, sharp-angled or long thick needles are used
for injection, local anesthesia, sucking,
hypodermolysis and subcutaneous injection.

Figure:
Short-sectioned needle
Long-sectioned needle

Short, sharp- angled needles are used for


injections : intravenous, infusion, and transfusion,
whereas the special short, sharp-angled needles
are used for intradermal and spinal injections.

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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.
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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

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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

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ROUTES OF ADMINISTRATION IN
INJECTION DRUGS
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.

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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.

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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.

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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.

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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.

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VASTUS 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
existance of large bone, bood 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 desinfectant 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.

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Drug volume :
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

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4. INTRAVENOUS DRUG ADMINISTRATION
Materials :
Syringe filled with air-free drug liquid,
Needle of 20 gauge, long and moderate thickness

Desinfectant
Cotton, plasters, and tourniquette

Injection Procedure :
1. Wash the hands thiroughly
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
ligate.
4. The patient is asked to be relaxed with fisting the related hand.
5. Tourniquette is set up, then see the vein to be swollen while giving
desinfectant on to the skin area.
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4. INTRAVENOUS DRUG ADMINISTRATION
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. Tourniqette 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
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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.

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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.

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2. The container is made from felxible plastics
polyvinyl chloride or semirigid 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

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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 adminstration

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NAME CONCENTRATION PURPOSE

1. AminoAcids (synthetic) 5.5-&%


Aminosyn 8% Fluid &nutrition
Veinamine
2.5 - 50%
2. Dextrose (Glucose,D5/W)
5-20%
3. Dextrose&NaCl Fluid & Nutrition
4. Lactate's Ringer NaCl 0.11 - 1.9%
Nutrition & Electrolytes
(Harmann)
0.60% Systemic alkalizer &
NaCl
0.03% nutrient supplement
KCl
CaCl2 0.02%
Na Lactate 0.30
5. Protein (hydrolized)
Aminosol 5% casein&fibrin
Fluid & nutrient
CPH-5
supplement
6. Ringer's
NaCl 0.86%
KCl 0.03% Fluid & nutrient
CaCl2
0.033% supplement
7. Natrium Lactate
1/6M

93
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.

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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

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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.

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The equipments for this method 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 on liquid pressure. This
bottle is hanged over the main bottle.

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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 previousmentioned
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.

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