MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES.

PHARMACOLOGY PRACTICAL NOTES

COMPILED BY

Y.A.MAKEJA
THE ROUTES OF ADMINISTRATION

Subcutaneous route(SC)

The sites of administration include

1. Outer aspect of upper arm(deltoid)

2. Abdominal region
3. Middle thigh
4. Upper buttock

The needle gauge size used is 26-30. The larger the gauge size the smaller is the needle size.

The syringe volume is 1-2 cc

Eg for warfarin heparin, insulin

At administration the angle of the needle should be 90 to 45 degrees

Intramuscular(IM)

It is done by injection. The injection sites are

1. Deltoid muscle
2. Gluteus muscle
3. Rectus muscle
4. Femoris muscle

The injection gauge size is 19-25 for the adult and 25-27 for the children.

The angle for injection is 90-45 degrees and the syringe volume is 3-5 cc

Administration by this route is used for antibiotics and synthetic hormones eg aldosterone
INTRADERMAL ROUTE(ID)

Lift up the skin

The sites for injection are upper back, chest and the upper arm(anterior aspect).

The needle gauge used is 26-28, volume volume is 1cc and the angle of administration is 10
to 15 degrees.

BCG vaccine is administered by this route

INTRAVENOUS ROUTE

Median Cubital Vein EgAminogycosides

Intravenous therapy (IV therapy or iv therapy in short) is the infusion of liquid substances
directly into a vein. Intravenous simply means "within vein". Therapies administered
intravenously are often included in the designation of specialty drugs. The aim is to ensure
slow and continuous administration of the drug.

gauge size 21-23

angle of injection to skin is 450 but not less than 300
Other routes for injection are

Intraosceous(IOCC)is done through the bone.

The route is indicated in severe burn, dehydrated patients in which veins are not seen

For tibial bonesuperficial, medial and beneath the skin

Central venous access

In critical ill patients in ICU. Is done via per external jugular and internal vein

THE DOSAGE FORMULATIONS

There are four dosage formulations

1. Solid eg tablets
2. Liquids
3. Semi solid
4. Gaseous form

SOLID

Can be tablet, powered or capsule. Examples of the solid drugs are

The difference between the enteric, sugary and non coated drugs is the key for the solid
drugs

From left; capsule, tablet and powered drugs

Enterically coated drugs

an oral dosage form in which a tablet is coated with a material to prevent or minimize
dissolution in the stomach but allow dissolution in the small intestine. This type of
formulation either protects the stomach from a potentially irritating drug (aspirin) or
protects the drug (erythromycin) from partial degradation in the acidic environment of the
stomach

example is asprin
sugar coated drugs

coated with sugar or a flavoring to mask the taste

Metronidazoleis sugar coated,

LIQUID DRUGS

Include sunspension, syrup, solution

Syrup-is the heavy liquid. The drugs can be of various taste. Some solution drugs dont
have taste.

Sunspension-powdered form to increase the shelf life

OINTIMENTS

Eg hydrocortisone, ketokonazolel, calamine lotion and cream

Ointment has a lot of of oil and cream is more water soluble than lotion

Ointment stays much longer

THE DEVICES USED IN DRUG ADMINISTRATION

SYRINGES

They are used to administer drug by injection

The parts of the syringe

Needle gauge- is the diameter of the syringe

Bevel-is the slant portion of the syringe. Should be placed upward during puncturing

Gauge size is the length of the needle

The Smaller The Gauge The Wider The Diameter

Features of the injection site

1. Free From Swelling

2. Free From Tattoos
3. Free From Scars

INFUSION SETUP

Infusion is a continuous/intermittent drug administration for a period of time

INFUSION FLUIDS

The infusion fluids include

1. Normal saline(NS)
2. Dextrose
3. Blood and blood products
Reconstitutionis the process of mixing the powered drug with water to make the
solution(not to mean dilution). It should be noted that volume of reconstitution does not
affect the volume of injection.

MATERIALS USED IN IV SET UP

DRIP STAND

Is used for holding infusion bag and other infusion fluids eg normal saline

GIVING SET

Canular or scalp vein

Infusion set up is used for fluids containing drug and blood

TWO MAJOR FLUIDS

1.crystalloids NS, RL

RL has K+,NS has no K+

Dextrose 5%, 10%, 50%

2.COLLOID( the plasma expander)

Eg dextran

GIVING SET FOR BOTH

Needle part, roller clamp, drip chamber, tubing system

GIVING SET FOR BLOOD SET

Filter inside drip chamber. The other giving set do not.they have the filter because the blood
may have clot

Roller clamp adjust fluid flow. It operates as upper for open and down for close

CANNULAR FOR IV

Colour indicates size of the needle

Yellow-smallest one(highest gauge ie 23, 24, 25). The size of the chamber affects the flow
rate. Grey- for big one and pink-for small
THE TWO SITES FOR THE IV ADMINISTRATION

1. Metacarpal region
2. Cubital forsa

The preferred site is the metacarpal region

Insert the cannular upward as the blood flow

THE DROP FACTOR

For crystalloid or colloids is 20. That for blood is 15 due to its viscosity

The drop factor is used for calculation of infusion rate or drop per minute

The formular for calculation of the infusion rate for both fluid and blood is

Infusion rate=total volume x drop factor

Total time in minutes

1500 Ml Iv Saline Is Ordered Over 12 Hours. Using A Drop Factor Of 15 Drops / Ml, How
Many Drops Per Minute Need To Be Delivered?

From the formula

Infusion rate= 1500ml x 15drops/mil
(12 x 60 minutes)

Infusion rate = 31 drops/min

The new technique
The infusion pump makes calculations easy
Enter the number of drops required to be infused for 1minute
Example
100mls in 50minutes with the drop rate of 20
100x20/50= 40 drops

Before administration make sure that the fluid is intact

Plicking the drop induces atmospheric pressurewhich pushes the fluid. The technique is not
safe
If the vein is safe after flushing and no kinking or clot
For the adult the major site for the infusion is cubital forsa and the metarcarpal
For children the major site is scalpl vein, femoral vein

AMPULES
Is the device made of glass only and can be used only once.

Needs to be broken to access the material. is a small sealed vial which is used to contain and
preserve a sample, usually a solid or liquid. Ampoules are commonly made of glass, although
plastic ampoules do exist.
Modern ampoules are most commonly used to contain pharmaceuticals and chemicals that
must be protected from air and contaminants.
VIAL
is a small glass or plastic vessel or bottle, often used to store medication as liquids, powders
orcapsules.Has a cap or a cock. It can be used indefinitely. It needs not to be broken.

INSULIN SYRINGE
Is use to administer insulin by injection subcutaneously

INSULIN PEN

incorporate the insulin and syringe in a single unit and have been found to address some of
the barriers to adherence, as compared to conventional vials/syringes.2they are prefered
devices because they are easier to use, are more discrete, and elicit less fear in terms of self-
injection. Additionally, pens have greater dosing accuracy, compared with vials and
syringes.2 Because insulin is the peptide the insulin pen should be stored in the refrigerator

INHALER

Is used to administer the drug in gaseous formulation.

Eg administration of Corticosteroids

NASAL SPRAY
NEBULIZER

The drug is used to more varieties of the solutions. Can be used to mix more than one drug
and the drug concentration can be adjusted as desired. Is generally easy to use especially for
the very young or very old.

The drug is however expensive and requires a long time for treatment. The medicine can be
easily be contaminated in inadequate cleaning

ROTOR INHALER

The medical device of inspanidual use intended for prevention and treatment of a
respiratory organs by aerosols of mineral waters, alcohol - and water-soluble medicines.The
device creates a powerful, dense and homogeneous stream of an aerosol which density can
be regulated the built-in mechanism.
Unique feature of this model is absolute noiselessness and usability.
The inhaler is used To Administer Drug In Powdered Form. Eg Salbutamol

SPACER

The device is easy to use for the children and the elderly. Efficient to to administer the drug
and it concentrates the drug from the inhaler.

DRUG PRESCRIPTION
Before the drug is administered the following are considered

1. Dose Forms
2. Nutritional Status
3. Prescription Writing
4. Routes Of Drug Administration

PRESCRIPTION WRITING

The four elements in the prescription forms

1. Formulation dosage eg tablets

2. Generic name
3. Dose(strength)
4. Frequency of administration
 5. Duration of treatment

Generic name is to be used and the brand name. eg cefriaxone 1g 12hourly for 5 days

COMPOSITION IN THE PRESCRIPION FORM

1. Patient particulars such as name, age etc

2. \the five components of the prescription
3. The particulars of the prescriber eg code no of the date
4. Particulars of the dispenser