Administration and storage of drugs

Administration and storage of drugs:

Drug: chemical substances used for:
1. Diagnosis of disease.
2. Treatment of disease.
3. Cure disease.
4. Vaccination (prevention).

Factors affecting on the drug activity:

1. Age.
2. Weight.
3. Sex.
4. Physical condition.
5. Methods of drug administration.
6. Excretion of drugs.
7. Tolerance.
8. Habituation.
9. Addiction.
10. Idiosyncrasy.
11. Direct effect.

Methods of drug administration:

Drug administration: A route of drug administration is the path by

which a drug or other substance is brought into contact with the body.
Drugs are introduced into the body by several routes. When administering a
drug, the nurse should ensure that the pharmaceutical preparation is
appropriate for the route specified.
The route of administration is the way through which the dosage form is
administered into the body for treatment of various diseases and disorders.
Classification:-
The various routes of administrations are
Classified into following categories:-
1. Systemic Route: In Systemic route the drug reaches to the systemic
circulation (Blood). So that it is called systemic route.
Systemic Route is again classified into two classes:-

A) Enteral route (b) Parenteral Route

1. Oral 1- Intravenously.
2. Sublingual 2- Intramuscularly.
3. Rectally. 3-Subcutaneously.
4-Vaginally. 4-Intradermally.
5-Urethral. 5-Intraspinally.
6-Inhalation. 6- Intraperitoneally
7-Instillation.
8-Insufflations.
9-Inunction

2-Local/Topical Route of Drug

In this route the drug is applied on the skin and mucous membrane for the
local action.
• Mucosal membranes (eye drops, antiseptic, sunscreen, callous removal,
nasal, etc.)
• Skin
• Dermal - Rubbing in of oil or ointment (local action).
• Transdermal - Absorption of drug through skin (systemic action)
Examples
1. Creams
2. Lotions
3. Gels etc.

Onset of action of different routes is as follows:-

• Intravenous 30-60 seconds
• Inhalation 2-3 minutes
 • Sublingual 3-5 minutes
• Intramuscular 10-20 minutes
• Subcutaneous 15-30 minutes
• Rectal 5-30 minutes
• Oral 30-90 minutes
• Topical/transdermal (topical)

Sublingual: -
In this route of administration the drug is placed under the tongue. And it is
taken without the use of water. When it is placed under the tongue it
disintegrates there and then absorption occurs in mouth. The tablets
are small in size which is to be used through the sublingual route.
Example of Sublingual tablet is Nitroglycerine tablets

Advantages of Sublingual Route:

• Rapid absorption:- It absorbs in the mouth so that its absorption
• Drug stability: - As in this route the drug does not go to the stomach so it is
not destroyed by the enzymes and acids present in the stomach so that
it is stable.
Disadvantages Route of Administration are:-
• Inconvenient: - In this route the drug
is kept in the mouth so it is inconvenient.
• Small Doses: - Small size is required to keep the drug in the mouth.
• Unpleasant taste of some drugs: - The drugs having unpleasant taste can
cause problem because the drug is kept in the mouth.

Rectal Route: -
Many drugs that are administered orally can also be administered rectally as a
Suppository. In this form, a drug is mixed with a waxy substance that dissolves
or liquefies after it is inserted into the rectum. Because the rectum's
 wall is thin and its blood supply rich, the drug is readily absorbed. A
suppository is prescribed for people who cannot take a drug orally
because they have nausea, cannot swallow, or have restrictions on
eating, as is required after many surgical operations. Drugs that are
irritating in suppository form may have to be given by injection.
Vaginal Route:
Some drugs may be administered vaginally to women as a solution, tablet,
cream, gel, suppository, or ring. The drug is slowly absorbed through
the vaginal wall. This route is often used to give estrogen to women at
menopause, because the drug helps prevent thinning of the vaginal
wall, an effect of menopause (see menopause: hormone therapy).
Urethral Route:-
Some drugs are given through the urethra. This route is called urethral route of
drug administration.
Advantages of rectal/urethral/vaginal route:
1. Unconscious patients and children:-
If the patient is unconscious then it is not possible to give the drug orally. So
in this situation the drug can be given through rectal/urethral/vaginal route.
2. If patient is having nauseous or vomiting
Disadvantages:-
1. May cause irritation
2. Absorption may be variable.
Examples:-
1. Suppositories
2. Vaginal Bogies
3. Urethral Bogies
Inhalers/ Aerosols:
In this class the drug is administered to the blood without going to the
gastrointestinal tract. In this class the drug is not administered with the help
of injections. In this administration the drug is administered in the gaseous
form. May be used for a local effect, e.g. bronchodilators.
Can be used for systemic effect, e.g. general anesthesia.
Advantages:-
1. Rapid onset of action due to rapid access to circulation.
2. Pain not occurs because injection is not used.
  Oral administration:
Oral medications are absorbed chiefly in the small intestine, or absorbed in
the mouth and stomach. Medications administered sublingually are
absorbed through the capillaries under the tongue.

Types of oral drugs:

Tablets.
1. Capsules.
2. Liquids.
3. Powders.
4. Torches (sucked).
Advantages of oral method:

1-Convenient - Can be self-administered, pain free, easy to take

2-Absorption - Takes place along the whole length of the gastro intestinal
Tract
3- Cheap - Compared to most other parenteral routes

Disadvantages of oral method:

1. Unpleasant tasting can stimulate nausea and vomiting.

2. Irritating to the gastric mucosa.
3. Some drugs are harmful to the teeth.
4. Inaccurate measure of absorption.
5. Limited use in patients who cannot swallow or have surgery or
unconscious, or in infants and children.
  Injection method:

1. Subcutaneous injection: This involves administration of the drug by injection

just under the skin. Commonly used for insulin injection.

Advantages and disadvantages:

Advantages:
1-Can be given by patient, e.g. in the case of insulin.
2-Absorption can be fast from aqueous solution but slower with depot
formulations.
3-Absorption is usually complete.
4-Improved by massage or heat.
5-Vasoconstrictor may be added to reduce the absorption of a local
anesthetic agent,
6-thereby prolonging its effect at the site of interest.
Disadvantages:
1-Can be painful.
3- Repeat injection can be a problem.
4-Irritant drugs can cause local tissue damage. Maximum of 2 ml injection
thus often small doses limit use.

Site of injection:

The subcutaneous tissue is just below the cutaneous or skin. It has fewer
sensory receptors than the skin itself; therefore once a needle is through the
skin n injection is relative painless. Areas of the upper arms, anterior and
lateral aspects of the thigh, and the lower ventral abdominal wall are
suggested, subscapular area of the back.

Equipments:

Subcutaneous injection involves the use of sterile equipments and supplies.

These include a syringe, a needle, the medication, a swab and a disinfectant
to clean the skin.
Syringes vary in size from 1-5 ml, the 2 ml syringe commonly used for
subcutaneous injections, is calibrated in cubic centimeters. For the
administration of insulin, special 1 ml syringes are often used.
A syringe has 2 parts, the barrel or outer part, and the plunger or inner
part, and the needle. The syringes made of glass or plastic. The maximum
volume of solution that can be given comfortably by this route is thought to
be 20 minims (less than 1.5 ml).
Certainly anything greater than 2 ml will cause pressure on surrounding
tissues and therefore be painful.
The needle for a subcutaneous injection is usually 24, 25, or 26 gauges. The
length that required varies from 1-2.5 cm depending upon the amount of
subcutaneous fat and the degree of hydration of the patient.

Preparation:

Medication for injection come in liquid and powder forms. All these forms
must kept sterile during preparation and administration.

Administration:

1. A site is selected and cleansed with an antiseptic solution.

2. The antiseptic solution is allowed to dry on the skin surface prior to
insertion of the needle to prevent local irritation at the site of the
injection.
3. Air is expelled from the needle.
 4. The needle is inserted through the skin, the angle of insertion depends
on the size of the needle used.
5. If a 1.2 cm (1\2 inch) needle is used, its inserted at a 90˚ angle, that is
perpendicular to the skin surface. Injections with 1.5 cm (5\8 inch)
needle are inserted at a 45˚ angle.
6. After the needle is withdrawn the area is massaged gently with an
antiseptic sponge to facilitate dispersion of the solution.

2. Intradermally injection:

An intradermally injection is the injection of small amount of fluid into the

dermal layer of the skin. It is frequently done as a diagnostic measure as in
tuberculin testing and allergic testing.

Site of injection:

The areas of the body commonly used the medial aspect of the forearm and
the subscapular region of the back. A 1 ml syringe (or a tuberculin syringe)
and a 26 gauge needle 1 cm (3\8inch) in length are commonly used. A
tuberculin syringe is calibrated in tenths and hundredths of a cubic
centimeter in order that minute doses can be measured.
The needle is inserted at a15 degree angle with the bevel up, and the fluid is
injected to produce a small bleb just under the skin.
3. Intramuscular injection: In this route of administration the drug is given into
the muscles with the help of injection. Drug once reaches to the muscles, absorbs into
the blood.

Advantages and disadvantages:

1. I.M. injection is the method of choice for the administration of some

medications.
2. Drugs which are irritating to subcutaneous tissue are often given by
this route.
3. A large amount of fluid can be injected into muscle tissue than into
subcutaneous tissue.
4. Absorption through a muscle is faster than through S.c. tissue because
of the vasularity of the muscle area.
Disadvantage: the danger of damaging nerves and blood vessels, however
is greater
Site of injection:

The selection of an area for I.M. injection depends on a number of factors:

1. The size of the patient and the amount of muscle tissue available for
injection.
2. The proximity of nerves and blood vessels.
3. The condition of the skin around the area.
4. The nature of the drug to be administered.
5. The site should be anatomically safe; that is an area should be chosen
where the danger of hitting a nerve or large blood vessel is minimal.
The tissue in the area should be free of bruising or soreness, there
should be no abrasions on the skin, and areas with hardened tissue
(such as scar tissue) should be avoided.
 6. Various sites are suitable for I.M. injections, areas in the buttocks, the
thigh, and the upper arm are used most frequently.
Equipment:
Similar to that used for a S.c. injection. The quantity of solution to be
administered varies from 2-10 ml nurses are permitted to inject no more
than 5 ml, in any one injection therefore if more than 5 ml is ordered the
amount is given into two injections.
Syringe is used with a No. 19-22 gauge needle, 2.5-5 cm (1-2 inches) long.

Preparation:
The drug is prepared for administration in the same way as for a S.c.
injection.

Administration:
1. For an I.M. injection to the gluteal muscle, the patient lies in a prone
position, in this position the gluteal muscle are relaxed and there is
good visualization of the injection site.

2. The muscle is palpated and the skin is wiped as for a S.c injection.
3. The skin is held tent and the needle is inserted at a 90 degree angle to
the distance required to reach the center of the muscle.
4. When the needle is inserted smoothly and firmly, the skin is then
released and the plunger is withdrawn in order to make sure the needle
has entered a blood vessel.

5. Keeping the needle in place, the solution is injected slowly into the
muscle tissue.
6. The needle then removed quickly and the area is massaged gently with
the disinfectant sponge to aid in dispersion of the solution.
 [Link] infusion:

Advantages:
1. The infusion fluids directly into the peripheral veins are often
indicated when a patient is unable to take fluids orally.
2. Infusion permits the patient to obtain many fluids, electrolytes, and
nutrients that necessary to life.
3. Rapid absorption, which is particularly important in the administration
of some medications.
Site of injection:
The choice of site for I.V. infusion is dependent upon a number of factors.
The condition of the patient’s veins as well as his comfort must be
considered. The veins in the inner aspect of the elbow are used most
frequently.

Equipments:
I.V. flask attached with tubing. Sterile precautions are taken throughout this
procedure in order to protect the patient from the infection. The nurse
requires a tourniquet, an antiseptic swab, a sterile syringe, a standard to hold
the flask, and a receptacle for the discarded fluid.
Administration:
1. After the tubing has been attached to the I.V. flask the flask is hung
upon the standard and the fluid is then run through the tubing.
2. Air is removed so that it will not be introduced into the patient’s vein.
3. Air injected into the vein can result in an air embolus.

Embolus: is a clot or plug that has been transported by a blood from larger
blood vessel to a smaller one, which can result in the blocking of blood
flow.
4. A tourniquet is applied to the patient’s arm above the I.V. site. At the
same time the patient clenches and unclenches his fist to make the
veins in his arm more accessible for vein puncture.
5. Injection site cleansed with antiseptic.
6. A sterile needle (No. 18-21) is then attached to the syringe and
inserted at a 45 degree angle, bevel up into the vein.
7. The plunger of the syringe is drawn back to ascertain that the needle is
in the vein (indicated by obtaining blood).