2. CHAPTER © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 2 Drug Administration

3. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-2 Introduction Drug administration is very important and can be a dangerous duty –Given correctly – restore patient to health –Given incorrectly – patient’s condition can worsen Medical assistant must –Understand principles of pharmacology –Understand fundamentals of drug administration Routes Dosage calculations Techniques for injection Rights of medication administration Patient education You should be familiar with the medications frequently prescribed in your practice.

4. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-3 Drug Administration and Scope of Practice States’ medical practice acts define medical assistants’ exact duties Know your scope of practice in the state where you will work

5. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-4 Dosage Calculations Measurement systems –Metric –Apothecaries –Household TJC recommends using metric units

6. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-5 Dosage Calculations (cont.) Basic units of volume and weight for: Metric system –Liter (L) – volume –Grams (g) – weight Apothecaries’ system –Fluid ounces, fluid drams, pints, quarts – volume –Pounds – weight Household system –Drops, teaspoons, tablespoons, ounces, cups, pints, gallons, quarts – volume

7. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-6 Dosage Calculations (cont.) Conversions between systems –Approximate equivalents –Charts –Calculations Ratio method Fraction method

8. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-7 Formula Method Desired dose Dose on hand The physician orders aspirin, 10 grains On hand are 5-grain aspirins 10 grains 5 grains × Quantity of dose on hand × 1 tablet = 10/5 or 2 tablets

9. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-8 Formula Method (cont.) Work these problems: 1.The physician has ordered ampicillin 500 mg, on hand 250 mg capsules. How much would you give? 2.You have 50 mg metoprolol as a scored tablet on hand and the doctor tells you to give 25 mg. How much would you give? 2 capsules ½ tablet

10. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-9 Ratio Method 1.Doctor orders 500 mg of ampicillin. You have 250 mg capsules on hand. 2.Set up a ratio with the unknown number of capsules needed and the amount of drug ordered X:500 mg 3.Set up a ratio with a single capsule and the amount of drug in a single capsule 1 tab:250 mg 4.Create a proportion, multiply the outer and then the inner parts, and solve for X. X:500 mg :: 1cap:250 mg Answer = 2 capsules

11. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-10 3. Set the second fraction with the amount of drug in a capsule 10 mg 1 cap 4. Then use both fractions in a proportion: 30 mg 10 mg x = 1 cap 1. The doctor orders 30 mg of Adalat. Each capsule contains 10 mg. 2. Set up the first fraction with the dose ordered and the unknown number of capsules 30 mg x Solve for X = 3 capsules Fraction Method

12. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-11 Pediatric and Geriatric Considerations Metabolism and absorption altered Require precise calculations –BSA – body surface area –Weight

13. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-12 Apply Your Knowledge 1. Which measuring system is used by most physicians? ANSWER: Most doctors use the metric system when working with pharmacology principles. 2. Convert 25 grams to milligrams. ANSWER: 1.Add a decimal point to the measurement: 25. g 2.Add 3 zeros so you can move the decimal point three places to the right: 25.000 g 3.Move the decimal point to the right three places: 25,000 4.Change the unit: 25,000 mg

14. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-13 Apply Your Knowledge 3.Calculate the dose to give for 500 mg Augmentin ®. ANSWER: 20 mL

15. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-14 Preparing to Administer a Drug Drugs –Local effect – applied directly to skin, tissue, or mucous membranes –Systemic effect – given by routes that allow the drug to be absorbed or distributed into the bloodstream Pay close attention –Dose –Route –Form of medication Medical assistant –Close attention to detail –Strong patient assessment skills –Expert technique

16. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-15 Preparing to Administer a Drug (cont.) Assessment –Injection site –Drug allergies –Patient condition – be alert to changes that can affect drug therapy –Consent forms

17. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-16 Rules for Drug Administration Give only drugs the doctor orders – use drug reference, if necessary Wash your hands –Prepare in a well-lit area –Focus on task; avoid distractions Calculate the dose carefully Do not leave a prepared drug unattended – never give a drug that someone else has prepared

18. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-17 Rules for Drug Administration (cont.) Identify patient properly Physician should be in the office Observe patient following administration Discard any ungiven medications properly Report error to physician immediately Document properly

19. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-18 Rights of Drug Administration Basic rights –Right patient –Right drug –Right dose –Right time –Right route Additional rights –Right technique –Right documentation –Right to know –Right to refuse –Right reason

20. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-19 Apply Your Knowledge How do you properly identify the patient before administering a drug? ANSWER: To ensure that you have the right patient, you should check the name and date of birth on the patient record and ask the patient to state his/her name and date of birth.

21. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-20 Techniques for Administering Drugs Oral –Tablets, capsules, lozenges, and liquids –Slower absorption through GI tract Buccal or sublingual –Buccal – placed between the cheek and gum –Sublingual – placed under the tongue –Faster absorption; bypasses GI tract

22. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-21 Techniques for Administering Drugs (cont.) Parenteral –Administration of substance into a muscle or vein –Fast absorption; bypasses GI tract –Safety risks Rapid administration Rapid action Exposure to blood-borne pathogens

23. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-22 Techniques for Administering Drugs (cont.) Needles –Available in different gauges – the smaller the number, the larger the gauge (inside diameter) –Length – long enough to penetrate the appropriate layers of tissue Syringes –Barrel –Plunger –With or without needle –Calibrated in milliliters or units

24. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-23 Techniques for Administering Drugs (cont.) Parenteral drug packaging –Ampule – glass or plastic container that is sealed and sterile (open with care) –Cartridge – small barrel prefilled with sterile drug –Vial – small bottle with rubber diaphragm that can be punctured by needle

25. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-24 Techniques for Administering Drugs (cont.) Methods of injection –Intradermal (ID) Into upper layer of skin Used for skin tests –Subcutaneous (sub-q) Provides slow, sustained release and longer duration of action Rotate sites –Intramuscular (IM) More rapid absorption Less irritation of tissue Larger amount of drug Z-track method –Intravenous (IV) Not usually given by medical assistants

26. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-25 Techniques for Administering Drugs (cont.) Inhalation – administered through the mouth or nose Topical –Direct application of a drug on the skin –Transdermal – use of a medication patch that will release medication slowly and evenly Urethral – instill liquid drugs directly into the bladder Vaginal and rectal Eye or ear – creams, ointments, drops, or irrigations

27. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-26 Apply Your Knowledge Matching: ___ Absorption through GI tractA.Topical drug ___ Under the tongueB.Oral drug ___ Small bottle with rubber diaphragm C.Intramuscular drug ___ Less irritation of tissueD.Subcutaneous drug ___ Direct application to skinE.Sublingual drug ___ Need to rotate sitesF.Vial ANSWER: F E D C B A

28. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-27 Educating the Patient about Drug Administration How to read the prescription drug label Interactions –Drug-drug interactions –Drug-food interactions

29. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-28 Educating the Patient about Drug Administration (cont.) Adverse effects –Report changes –Recognize significant adverse effects Instructions on taking the drug –At the right time –In the right amount –Under the right circumstances

30. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-29 Apply Your Knowledge What should you instruct the patient about regarding drug administration? ANSWER: The patient should be taught how to read the prescription label, drug-drug and drug-food interactions, adverse effects, and how to take the drug correctly. Bravo!

31. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-30 Special Considerations Pediatric patients –Physiology and immature body systems may make the drug effects less predictable –Require dosage adjustments and careful measurements of doses –Observe pediatric patients closely for adverse effects and interactions –Administration sites and techniques may differ

32. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-31 Special Considerations (cont.) Pregnant patients –Remember that you are caring for two patients –Giving the mother a drug also gives it to the baby –Check drug information sources for pregnancy drug risk categories

33. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-32 Special Considerations (cont.) Patients who are breast- feeding –Some drugs are excreted in breast milk –Ingestion can be dangerous because baby can’t metabolize or excrete drugs –Check drug information sources for contraindication during lactation

34. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-33 Special Considerations (cont.) Elderly patients –Age-related changes affect Absorption Metabolism Distribution Excretion –May have increased risk of Drug toxicity Adverse effects Lack of therapeutic effects

35. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-34 Special Considerations (cont.) Patients from different cultures –Can affect a patient’s understanding of drug therapy and compliance with it –Obtain drug information sheets in the languages that are commonly spoken by patients in your office

36. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-35 Apply Your Knowledge What do children and the elderly have in common in relation to drug administration? ANSWER: Both have alterations in metabolism and absorption of drugs requiring adjustments in dosages. Fantastic!

37. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-36 Charting Medications Progress notes –Administration –Special problems New symptoms Patient’s statements Patient tolerance Be sure to have the right chart Be specific and accurate

38. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-37 Nonpharmacologic Pain Management Biofeedback – evokes relaxation; helps block pain perception Guided imagery – patient envisions being in a calm, nurturing place; promotes relaxation Relaxation exercises – breathing techniques

39. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-38 Apply Your Knowledge 1. You administer a medication to Mr. Max. What and where should you chart? ANSWER: You should chart in the progress notes the date, time, dosage, route, and name of the medication, as well as how well the patient tolerated it. 2. True or false: ___ Biofeedback involves special breathing techniques. ___ Audiotapes can be used with guided imagery. ___ Relaxation exercises are used to relax different muscle groups. F T T helps block pain perception ANSWER: I M P R E S S I V E !

40. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-39 In Summary 51.1As a medical assistant, you must be able administer or assist with administering medications by various routes, perform drug dosage calculations accurately, and provide patient education as necessary. 51.2Dosage calculations must be done accurately using the formula, ratio, or fraction method. If you are unsure of your calculation results, you should double-check yourself, check with a coworker, or ask the physician.

41. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-40 In Summary (cont.) 51.3Before administering a medication, assess the patient for allergies; evaluate any drug-drug interactions; and check all injection sites for abnormalities. Additionally, you should be aware of the patient’s condition and have the patient sign a consent form if necessary. 51.4The rights of drug administration include the right patient, right drug, right dose, right time, right route, right technique, right documentation, right to know, and right to refuse.

42. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-41 In Summary (cont.) 51.5You may be asked to assist or administer medications by any of the following routes: oral, buccal, sublingual, intradermal, intramuscular, intravenous, inhalation, eye, ear, rectal, subcutaneous, sublingual, topical, transdermal, urethral, and vaginal. Your responsibilities will vary based upon the facility where you practice. You should be familiar with the routes and medications used at your facility. 51.6Needles vary in length from ½ to 3 inches. They vary in gauge (diameter) from 18 to 26; the smaller the number, the larger the diameter of the needle.

43. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-42 In Summary (cont.) 51.7The three most common injection routes are intradermal, subcutaneous, and intramuscular. All injections are given using aseptic technique. Intradermal (ID) injections are administered between the upper layers of skin and create a wheal. Subcutaneous (sub-Q) injections are administered just under the skin. Intramuscular (IM) injections are administered into a muscle.

44. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-43 In Summary (cont.) 51.8Patients should be aware of possible interactions and taught to report all medications including OTC, supplements, and herbal remedies. They should know how to read the prescription label and in some cases the package insert. Patients should be aware of the possible adverse effects of medications and what and when to report them to the health-care facility.

45. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-44 In Summary (cont.) 51.9Pediatric and geriatric patients require extreme care when calculating doses due to the differences in how their bodies absorb, metabolize, eliminate, and distribute the medications. Treat pediatric patients with special care and communication to make the experience as positive as possible. Restraining may be necessary. Checking medications given to pregnant and breastfeeding patients for possible adverse effects is essential. Being considerate to patient’s cultural differences is also part of a medical assistant’s role.

46. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-45 In Summary (cont.) 51.10To avoid the overuse or abuse of pain medications, other types of pain therapy have gained popularity. Some examples include biofeedback, guided imagery, and relaxation exercises.

47. © 2011 The McGraw-Hill Companies, Inc. All rights reserved. 51-46 End of Chapter 51 Words are the most powerful drug used by mankind. ~Rudyard Kipling