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IM
- 72-90 degrees, 5/8-1 1/2'' in needles..
- Ventrogluteal, vastus lateralis, and deltoid sites.
- Deltoid limit to 1 mL. 1-1.5 in needle
- Aqueous solutions- 20 to 25 g
- oil-based- 18-25 g
- 1-4 mL
- children, elderly- 1-2 mL IM injections
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ID
- 26-27 g, usually less than 0.5 mL dose
- 1/4-1/2 in needle
- 5-15 degree angle
- longest absorption time
- forearm, upper back, under scapula
- TB, allergies.. bleb forms
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Sub Q
- into adipose tissue
- Insulin and Heparin (do not aspirate)
- 25-30 g
- 3/8 (90)- 5/8 (45) or 1inch needle
- 45-90 degree angle
- Deltoid, abdomen, anterior thighs, upper back, dorsogluteal area.
- usually, no more than 1 mL given
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Z track
recommended for all IM injections, to make sure that meds do not leak back through needle track into subq tissues.
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Enteral route
Admin though enteral tube
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Intradermal route
Corium (under epidermis)
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injunction route
rubbing drug into skin
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instillation route
placing drug in direct contact with mucus membranes
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pharmacology
study that deal with chemicals that affect the bodys functioning.
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Generic and Trade name
EX; acetaminophen is Generic name and Trade name is Tylenol
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Pharmacokinetics
- the effect of the body in the drug;
- movement of drug molecules in the body in relation to the drugs absorption, distribution, metabolism and excretion.
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Commom Drug preperations
Capsule, elixir (med in liquid), enteric coated (prevent stomach irritation), extended release, liniment (rubbed into skin), lotion, lozenge (candy?) ointment, pill, powder, solution, suppository, suspension, syrup, tab, transdermal patch
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Where does metabolism Primarily occur?
LIVER
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Why would the elderly have hard time metabolising (breaking down drugs)? (Biotransformation)
due to the aging process the liver has impaired functioning
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Where does excretion of drugs primarily occur?
KIDNEYS, or lungs if drugs were inhaled
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Distribution of drug in body
depends on the blood flow to the tissues, drugs ability to leave the bloodstream, and drugs ability to enter the cells
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Pharmacodynamics
process were drugs alter cells physiology and affect the body
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Anaphylactic reaction (Anaphylaxis)
life threatning and results in respiratory distress, sudden severe bronchospasms and cardiovascular collapse.
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Idiosyncratic Effect
Unusual response to med
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IM injection sites
- Deltoid (toddlers, adults) 5/8-1.5
- Vastus lateralis (infants, toddlers) 5/8-1in
- Ventrogluteal (adults) 1.5
- faster onset than SubQ
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ID injection sites
- Forearm
- upper back
- under scapula
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Teratogenic Drugs
potential to cause developmental defects in fetus
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Expected responses to meds based on ...
18-65 year old adults, 150 lbs
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Peak level
highest plasma concentration, should be measured when absorption of drug is complete.
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Trough Level
drug at lowest concentration, specimen usually drawn within 30 mins interval before next dose.
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Half-Life
amount of time it takes for 50% of blood conc of a drug to be eliminated from the body
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Standing Order
carried out as specified until it is cancelled out by another order
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6 Patient RIGHTS
- 1. Right Pt
- 2. Right Med
- 3. Right Dose
- 4. Right Route
- 5. Right Time
- 6. Right Documentation
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Preferred system for Measurement of Drug Admin?
METRIC
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What should be done when admin of meds though NG tube?
- Powders or crushed tabs must be mixed with 15-30 mLs
- Check placement of tube
- Flush with 15-30 mLs of water
- if connected to suction, disconnect for 20-30 after adim of meds.
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How long can an eye disk be used in the eye?
up to 1 week
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Metric units of measurements?
- Meter (length)
- Liter (volume)
- Gram (weight)
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3 Times the label should be checked during med prep and admin?
- 1. when reaching for container
- 2. when comparing with CMAR
- 3. when putting container back and before giving to pt
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When are 2 witnesses needed in drug admin?
when disposing of controlled substance
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Parenteral Route
outside the intestines or alimentary canal
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when do most needle stick injuries occur?
when recapping
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how long is a multidose vial good for?
24 hrs
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Example of med that comes prefilled and should not have air expelled from syringe...
- Lovenox (enoxaparin)
- also provided in prefilled cartidges
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First thing to do when going to mix 2 meds in one syringe?
Make sure the 2 drugs are compatible! do not mix more than 2 drugs in one syringe
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Draw the med in the (BLANK) vial into the syringe FIRST.
- MULTIDOSE
- this prevents contents of the multidose vial from being contamined with meds inthe single dose vial.
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If preparing meds in vial and ampule, which do you draw up first?
Draw meds inthe vial FIRST, then the ampule
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2 Insulin meds prep
First draw air and inject air into cloudy (NPH), then inject air into clear (reg), then draw up reg dose, then draw up cloudy dose.
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which insulins cant be mixed with other insulins?
Lantus and Levemir
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how many units in 1 mL of insulin?
100 U insulin for 1mL of solution
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Reconstitution
adding dilutent to a powdered drug
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Intradermal injections injected were?
- into dermis
- longest absorption time
- TB, allergies test and local anethisia
- tuberculin syringe
- usually less than 0.5 mL dose
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Do NOT aspirate with this med
- HEPARIN
- can result in hematoma formation
- abdomen most common site of injection
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Insulin Syringes
- 28-30 G
- 5/16- 1/2 in needles
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Levonox (enoxaparin)
- Site of injection at lateral aspects of abdomen
- admin with air bubble at 90 degree angle
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Morphine
- can be given SubQ through continuous infusion.
- advantage is longer rate of absorption and convinience.
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Most dangerous route of perenteral drug admin?
- IV
- immidiate absorption
- cannot be recalled or slowed
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Piggyback delivery system
additive solution to be placed higher than the primary solution container
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Volume-control admin set
med is diluted with SMALL amount of solution ot be admin through IV
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CVAD
Central Venous Access Device
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Common Med errors
- incorrect dose, quantity, route
- extra, omitted or wrong dose
- wrong pt
- incorrect rate
- incorrect time
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