Prescription and Medication Order Requirements

Sources of Drug Information

• Drug information sources must be current and up to date.
• Sources can be computerized or printed.
• Many sources exist, but commonly seen ones in pharmacies are discussed.

Physician's Desk Reference (PDR)

• Updated annually, found in most physician offices and pharmacies.
• Contains six sections: Manufacturer Indexing, Generic and Trade Names, Product Category Index, Product Identification Guide, Product Information, and Diagnostic Product Information.
• Lists complete monographs for each drug, including chemical structure and results of drug studies, and a miscellaneous info section.
• Compiles official drug package inserts from manufacturers who pay a fee, so it does not include all available drugs.
• Lists only FDA-approved drugs and contact information of drug manufacturers.
• Available as a hardback book, CD-ROM, and online version free for prescribers.

Drug Facts and Comparisons

• A popular source of drug information, easy to use, it is organized into five sections: Index, Keeping Up, Drug Monographs, Drug Identification, and Appendix.
• Includes indications, dosage strengths, dosage forms, sizes, and manufacturers.
• A loose-leaf version is used in most pharmacies for monthly updates.
• Available in standard, hardback, bound version, pocket-sized version, or as an electronic subscription called Facts and Comparison eAnswers.

Orange Book

• Provided by the FDA, it’s an annually updated, listing of approved drug products and therapeutic equivalence evaluations.
• Best source for determining whether a generic drug is equivalent to a brand name drug.
• Includes approval lists, discontinued drug products, and orphan product designations.
• Searches may be conducted in various ways, including by active ingredient, patient number, applicant holder, application number, or proprietary name.
• Available as a free, annually updated PDF file, with periodic online updates.

Drug Topics RedBook

• One of the oldest sources of drug information, focusing on average and wholesale drug costs and prices.
• More commonly used in community pharmacies than in hospitals.
• Contains 10 sections: Emergency Information, Clinical Reference Guide, Practice Management and Professional Development, Pharmacy and Health Care Organizations, Drug Reimbursement Information, Manufacturer/Wholesaler Information, Product Identification, Prescription Product Listings, Over-the-Counter/Nondrug Products Listing, and Complementary/Herbal Product Referencing.
• Contains quick reference charts by drug type, such as those excreted in breast milk, those that should not be crushed, and those that are either alcohol- or sugar-free.
• Features pharmacy calculation examples and Spanish-language dosing instructions.
• Difficult to reference unless the user knows the section abbreviations.
• Contains lists of nontraditional PharmD programs, requirements, and current enrollment information.
• Published in softcover, CD-ROM, and online versions.

United States Pharmacopeia-National Formulary (USP-NF)

• Accesses FDA official standards and guides users in the tests, procedures, and acceptance criteria related to pharmaceutical manufacturing and quality control.
• Helps pharmacy personnel to comply with official standards and lists new products being developed and approved.
• Available in hardback, CD-ROM, and as an online subscription.

United States Pharmacists' Pharmacopeia

• Includes compounding products and ingredient information, safety information, and products used for specific conditions.
• Includes recent sterile preparation guidelines for U.S. pharmacists, common nonformulary agents, dietary supplements, veterinary compounding, and related laws.
• Available in hardback and as an online subscription.

American Hospital Formulary Service Drug Information

• Favored in hospital pharmacies, provides drug monographs featuring uses, dosages, administration information, interactions, adverse reactions, toxicities, compounding information, chemistry, stability, mechanisms of action, antibiotic spectrum and resistance, pharmacology, pharmacokinetics, and references for laboratories and testing.
• Contributors include medical, pharmacy, and management experts.
• Available in hardback, electronic, and mobile application versions.

Martindale's “The Complete Drug Reference”

• A hardback book that provides information on drugs in clinical use worldwide.
• Includes information on herbal and complementary medicines, vitamins, nutritional agents, vaccines, radiopharmaceuticals, toxic substances, drugs of abuse, recreational drugs, and many other topics.

Pediatric and Geriatric Dosage Handbooks

• Provide information on suggested current dosages for pediatric and geriatric patients.
• Available in hardback or CD-ROM.

American Drug Index

• Lists over 22,000 prescription and over-the-counter drugs.
• Provides information such as active ingredients, dosage forms, drugs that should not be chewed or crushed, look-alike and sound-alike drugs, manufacturers, normal laboratory values and related information, packaging and uses, pronunciations of drug names, storage requirements for USP drugs, strengths, and a trademark glossary.
• Available in electronic and hardback formats.

Goodman & Gilman's "The Pharmacological Basis of Therapeutics"

• Contains information such as drug metabolism pharmacogenomics, drug transport/drug transporters, pharmacokinetics, pharmacodynamics, and principles of therapeutics in all areas of the body system.
• Available as an online subscription and also in hardback format.

Handbook of Nonprescription Drugs

• Published by the American Pharmacists Association (APhA) that provides self-care options for complementary and alternative medicine/therapies, FDA-approved dosing information, FDA-evidence-based research on efficacy and safety considerations of nonprescription, and herbal and homeopathic medications.
• Discusses medical foods, nondrug and preventive measures for self-treatable disorders, nonprescription medications, and nutritional supplements.
• Available as a downloadable e-book and in hardback format.

Remington's "Pharmaceutical Sciences: The science and Practice of Pharmacy"

• Covers all areas of pharmacy, including its history, ethics, and the specifics of pharmacy practice and industrial pharmacy.
• Includes disease state management, immunology, pathophysiology and manifestations of diseases, professional communication, pharmacy practice specialization, and patient care.
• Available in hardback format and online.

Trissel's "Handbook on Injectable Drugs"

• A popular reference book used primarily in the hospital setting that contains information about parenteral medications.
• Monographs discuss administration, drug products, stability, and compatibility with both other drugs and infusion solutions.

The Internet

• Contains numerous sources of drug information, but accuracy and currency vary.
• A good place to start with information posted online by colleges, universities, and publishers.
• Continuing education is also provided by many online sources.

Pharmacy Journals and Magazines

• Available in printed and digital formats.
• Commonly perused pharmacy journals are the American Journal of Health-System Pharmacy and Journal of Pharmacy Technology.
• Commonly read pharmacy magazines include the American Association of Pharmacy Technicians, Computer Talk for the Pharmacist, Hospital Pharmacy, Drug Topics, Today's Technician, Pharmacy Times, Pharmacy Today [JAPhA], The Script Newsletters, and U.S. Pharmacist.

The Prescription

• An order for medication issued by a physician, dentist, or other licensed medical practitioner.
• In certain states, nurse practitioners and even pharmacists can issue prescriptions with certain restrictions.
• Prescription order is a part of the professional relationship among the prescriber, the pharmacist, and the patient, in which quality pharmaceutical care meets the medication needs of the patient.
• There are two broad legal classifications of medications: those that can be obtained only by prescription and those that may be purchased without a prescription (OTC).
• A medication that may be dispensed legally only by prescription is referred to as a prescription drug or legend drug.
• Prescriptions may be written, telephoned, faxed, or sent electronically.
• Component parts of a prescription include: address of the prescriber's office, name and address of the patient, date, medication prescribed (inscription), Rx symbol (superscription), dispensing directions to pharmacist (subscription), directions for patient (signa), Refill and special labeling, and Prescriber's signature and license or Drug Enforcement Agency (DEA) number.

Procedures for Processing Prescriptions

• Involve receiving, reading and checking, numbering and dating, labeling, preparing, packaging, rechecking, delivering and patient counseling, recording and filing, pricing, and refilling.

Receiving the Prescription

• Receiving the prescription order directly from the patient fosters the gathering of essential info such as disease history and other drugs taken.
• Technicians should obtain the patient's name, address, other necessary information, and insurance coverage.
• Ask the patient whether he or she wishes to wait, call back, or have the medication delivered.
• Many pharmacists try to price prescriptions before dispensing.

Reading, Checking, and Computer Entry

• Pharmacy technicians should read the prescription completely and carefully to ensure ingredients or quantities prescribed are clear.
• Technicians should update the patient's profile.
• Technicians should determine the compatibility of the newly prescribed medication with other drugs being taken.
• Technicians must enter the prescription into the computer database, bill the patient's insurance company, and calculate the amount that the patient must pay.
• The pharmacist must verify the pharmacy technician's computer entry for accuracy.
• Technicians must determine whether drug-food or drug-disease interactions are possible.
• If some part of the information is illegible or if it appears that an error has been made, the technician should notify the pharmacist. The pharmacist should consult another pharmacist or the prescriber.
• Unfamiliar or unclear abbreviations are a source of errors in interpreting and filling prescriptions.
• The amount and frequency of a dose must be noted carefully and checked, in which safety considerations include the patient's age, weight, and condition, dosage form prescribed, possible influence of other drugs being taken, and the frequency of administration.
• One of the primary duties of the pharmacy technician is to enter and update prescription and customer information into the computer database.
• For potential drug interactions the pharmacy technician must ask the pharmacist to check the drug interaction warning screen.
• 2000 prescriptions per week in a typical community pharmacy typically results in up to two clinically significant prescription errors.
• Once the prescription has been read, reviewed, and compared with the information in the patient's computer profile, the pharmacy technician must enter the prescription information into the pharmacy computer system and print the prescription label.

Numbering and Dating

• Prescription order must be numbered and that same number must be placed on the label for bottle or package identification.
• Consecutive numbers are assigned by prescription computers or numbering machines.
• Including date prescription is filled on the label is important for determining refill frequency and patient compliance.

Labeling

• Medication labels give information on the dose contained in the package.
• The pharmacy technician must be able to identify and interpret the information.
• Generic name, trade name, dosage strength, form, supply dosage, total volume, route of administration, directions for mixing, and cautions must be recognized.
• Medication labels also contain information such as expiration date, storage information, lot numbers, the name of the drug manufacturer, and a National Drug Code (NDC) number.
• Drug label information includes: generic name, trade name, dosage strength, form, supply dosage, total volume, administration route, directions for mixing, cautions, manufacturer name and address, control or lot number, and NDC number.
• The prescription label may be typewritten or prepared by computer, using pharmacist or technician entered information.
• A prescription label should be professional-appearing, of appropriate size to the prescription container.
• Name, address, and telephone number of the pharmacy are legally required to appear on the label.
• Prescription number, prescriber's name, patient's name, directions for use, and dispensing date are legally required.
• Patient's name and address and strength of the medication are also commonly included.
• Auxiliary labels, or strip labels, are used to emphasize important aspects of the dispensed medication, such as proper use, handling, storage, refill status, warnings, or precautions.

Generic Names

• The established generic (also called nonproprietary) name of a drug appears directly underneath its trade, brand, or proprietary name.
• Generic names must be identified on all drug labels by law.
• Prescribers regularly order generic equivalents of many trade-name drugs.
• It is advisable for the pharmacy technician to cross-check names of all medications.

Trade Names

• Manufacturers' names for their medications are called trade, brand, or proprietary names.
• These names are usually the most prominently printed and may appear in larger or bold type.
• They are often followed by the symbol “®,” indicating that both the name of the drug and its formulation are registered.
• It is essential for the technician to cross-check the names of all medications.

Name of the Manufacturer

• The manufacturer's name is present on all drug labels and usually contains the company's logo and its location (city, state, and zip code).

Control Numbers

• Federal law must identify all medications identified with control numbers, sometimes called lot numbers.
• For drug recalls, these numbers identify a group of medication packages that must be removed from store shelves.

National Drug Code

• Every prescription medication must have a unique identifying number according to federal law.
• The "NDC" number is to appear on every manufacturer's label.

Preparing the Prescription

• Most prescriptions call for dispensing medications already prefabricated into dosage forms by pharmaceutical manufacturers.
• The pharmacist should compare the manufacturer's label with the prescription to be certain it is the correct medication.
• Medications that show signs of poor manufacture or deterioration or for which the stated expiration date on the label has passed should never be dispensed.
• Pharmacy technicians must carefully verify the contents of medication bottles when preparing to fill prescriptions.
• Tablets, capsules, and some other solid dosage forms usually are counted using a counting tray that facilitates rapid counting and transferring.
• The counting tray should be wiped clean, especially after uncoated tablets.
• The pharmacy technician uses a pill counter to count the correct number of pills to fill a prescription.
• Some prescriptions may require compounding, which is the preparation, mixing, assembling, packaging, or labeling of a drug or device, and a small percentage of the total.
• Extemporaneous compounding is essential in the course of professional practice.
• Dispensing requires 100% accuracy.

Packaging

• Pharmacy technicians may select a container from various types with different shapes, sizes, mouth openings, colors, and compositions.
• Selection is based primarily on the type and quantity of medication to be dispensed and the method of its use.
• All legend drugs intended for oral use must be dispensed in containers having child-resistant safety closures, unless the prescriber or the patient specifically requests otherwise.
• Drugs that are used by or given to patients in hospitals, nursing homes, and extended-care facilities need not be dispensed in containers with safety closures unless they are intended for use outside of those institutions.
• When pharmacy technicians place a medication into a container, they must attach the printed label to the container immediately.

Rechecking

• The pharmacist must recheck every prescription that has been dispensed for verification.
• Rechecking is especially important for those drug products available in multiple strengths.
• Pharmacy technicians must carefully review the prescription label and the prescription to be sure they match.

Patient Counseling

• Either the pharmacist or the pharmacy technician may present the prescription medication to the patient or his or her family member, though only the pharmacist should counsel patients.
• Increased awareness has showed labeling instructions being inadequate, where the responsibility for ensuring patient understanding is shared between the pharmacist and prescriber.

Recording and Filing

• A record of the prescriptions dispensed is maintained in the pharmacy through the use of computers and hard copy prescription files.
• The least common method of filing is microfilming of prescriptions.

Pricing

• The charge applied to a prescription should cover the costs of the ingredients, the container and label, the time of pharmacy personnel, the cost of inventory maintenance, and operational costs of the pharmacy.

Refilling

• The prescriber must provide instruction by indicating on the original prescription the number of appropriate refills.
• Federal law does not limit the number of refills of prescriptions for noncontrolled medications, but state laws may impose such limits.
• The refilling of prescriptions for controlled agents is strictly regulated, where Schedule II drugs never have refills and Schedules III-IV have a maximum of five refills over six months.
• No prescription should be renewed indefinitely without patient reevaluation.
• Maintenance of accurate records of refilling is important for complying with federal and state laws and for providing information on the patient's medication history.
• For most Schedule V drugs, no prescription is required for individuals age 18 or older.
• Nearly 250,000 senior citizens are hospitalized every year because of Rx and OTC medication reactions.

Drug Sources

• The five basic sources of drugs are plant, animal, mineral, synthetic (chemical), & engineered (investigational).

Plant Sources

• Plant sources are grouped by their physical and chemical properties.
• Alkaloids are organic compounds that have been combined with acids to make a salt.
• Examples of alkaloid chemical compounds include nicotine, morphine sulfate, and atropine sulfate.
• An example is Digoxin, which is made from digitalis, derived from the foxglove plant.

Animal Sources

• Animal sources, such as the body fluids and glands of animals, can produce drugs.
• The drugs include enzymes such as pancreatin and pepsin, and hormones such as thyroid and insulin.

Mineral Sources

• Minerals from the earth and soil are used to provide inorganic materials unavailable from plants and animals and are used as they occur in nature.
• Minerals used in medications include iron, potassium, silver, and gold. One example is Sodium chloride (table salt).
• Gold is used to control severe rheumatoid arthritis, and coal tar is used to treat seborrheic dermatitis and psoriasis.

Synthetic Sources

• New drugs may be created from chemistry, biology, and computer technology from living organisms (organic substances) or nonliving materials (inorganic substances).
• These drugs are called synthetic or manufactured.
• Examples of synthetic drugs include meperidine (Demerol®), sulfonamides, and oral contraceptives.
• Propylthiouracil is both organic and inorganic but is an antithyroid hormone.

Bio or Genetically Engineered Sources

• The newest area of drug origin involves gene splicing or genetic engineering where newer forms of human insulin have been made.

Dosage Strength

• The amount of the medication per unit of measure is called the dosage strength.
• Refers to its dosage weight where milligrams are common dosage measurements.
• Some drugs have different but equivalent dosage strengths, such as "milligrams per tablet” and “units per tablet.”
• A bottle may contain 50 capsules, but the dosage strength specifies milligrams per capsule.
• A syrup may have a total volume of 240 mL, but the dosage strength is 15 mg/mL.

Form

• The form of a drug identifies its structure and composition.
• Solid dosage forms include tablets and capsules.

Solid Drugs

• Powders and granules can be directly combined with food and beverages.
• Some must be reconstituted and measured precisely, either in milliliters, drops, or ounces.
• Clear solutions (crystalloids) or suspensions are those in which the liquid contains solid particles separated in its container.
• Injections may be available in solution or in a dry powder form then reconstituted.
• After reconstitution, they are measured in cubic centimeters or milliliters.

Tablets

• A tablet is a pharmaceutical preparation made by compressing the powered form of a drug and bulk filling material under high pressure.
• Special forms of tablets include sublingual tablets and enteric-coated tablets where most tablets are to be swallowed.
• Some are intended to be dissolved in the mouth, dissolved in water, or inserted as suppositories that come in various sizes, shapes, and colors.

Chewable Tablets

• Chewable tablets must be chewed with a flavored or sugar base.
• Often for children who cannot swallow other forms of medication where antacids and antiflatulents commonly take this form.
• Sublingual tablets must be dissolved under the tongue for rapid absorption like nitroglycerin for angina pectoris.
• Buccal tablets are placed between the cheek and the gum until dissolved and absorbed.
• An enteric-coated tablet has a special coating to protect against stomach acid.
• A buffered tablet can prevent ulceration or severe irritation of the stomach wall used to reduce irritation to the active ingredients.
• Some tablets are coated with specific substances that prevent them from dissolving in the mouth or stomach which allows more to reach the intestine.

Pill

• A single-dose unit of medicine is made by mixing the powdered drug with a liquid such as syrup and rolling it into a round or oval shape.

Plaster

• Any composition of liquid and powder that hardens when it dries may be solid or semisolid like the salicylic acid plaster for corns.

Capsule

• A medication dosage form in which the drug is contained in an external shell that typically made of gelatin and sized for a single dose.
• Enclose or encapsulate powder, granules, liquids, or some combinations that are used to counter unpleasant odor or taste.
• Can be pulled apart to add the contents as powder to food for hard swallowing.
• Some forms of capsules provide a sustained-release (SR) or timed-release dosage that should never be crushed or dissolved.
• Available in various sizes, ranging from the number 000 to 5, where 000 is the largest.

Caplet

• A caplet is shaped like a capsule but has the form of a tablet, with a shape and film-coated covering.

Gelcap

• Oil-based medication enclosed in a soft gelatin capsule.

Powder

• A drug that is dried and ground into fine particles, usually for antifungal foot medications to keep the area dry.
• Examples include nystatin powder and potassium chloride powder (Kato powder).

Granule

• A small pill, usually accompanied by many others encased within a gelatin capsule which are specially coated to gradually release medication over a period of up to 12 hours.

Troche or Lozenge

• A hard or semisolid dosage form for local application in the mouth or throat.
• Flattened disks that are placed on the tongue or between the cheek and gum and left in place until dissolved for cough and sore throat
• Example is clotrimazole in troche form and cetylpyridinium chloride in lozenge form.

Semisolid Drugs

• Semisolid drugs are often used as topical (applied to the surface of the body) applications.
• Includes suppositories, ointments, creams, gels, lotions, and pastes
• May be administered by patches for transdermal absorption

Suppository

• A bullet-shaped dosage form intended to be inserted into rectum, vagina, and urethra.
• Contains medication that is usually intended to provide a local effect at the site of insertion and maintains shape at room temperature.

Ointment

• A drug combined with an oil base, resulting in a semisolid medication that is intended for external application.
• May be anti-inflammatory, topical anesthetic, & antibiotics like erythromycin ophthalmic ointment and Ben-Gay® ointment.

Cream

• A semisolid preparation that is usually white and nongreasy and has a water base intended for external application like hydrocortisone and betamethasone creams.

Gel

• A jelly-like substance for topical medication like bullfrog and naftifine gel.
• Some gels have alcohol content which can cause stinging if applied to broken skin

Lotion

• A semisolid preparation applied externally to treat a dermatologic disorder like hydrocortisone and ammonium lactate lotions.

Paste

• A topical, semisolid formulation containing a pharmacologically active ingredient in a fatty base of zinc oxide paste.

Patches

• Transdermal patches are medicated adhesive patches placed on the skin that deliver a medication into the bloodstream directly through the skin in a controlled basis.
• Scopolamine was the first administered drug.

Liquid Drugs

• Liquid preparations include syrups, solutions, spirits, elixirs, tinctures, fluidextracts, liniments, emulsions, mixtures, suspensions, aromatic waters, sprays, and aerosols and are classified by site or route of administration.
• Liquid drugs may be administered through the skin, mouth, eye, ear, rectum, urethra, vagina by mouth or by injection
• Four basic types of transdermal patches are single-layer, multi-layer, reservoir (with separated drug and adhesive layer) and matrix (with adhesive surrounds the drug layer).
• Examples include nitroglycerin, antidepressants, hormonal contraceptives, and various drugs for ADHD

Syrup

• A drug dosage form that consists of a high concentration of a sugar in water added with medicinal substances like ipecac and metaproterenol syrups.

Solution

• A solution is a drug or drugs dissolved in a solvent like normal saline.

Spirit

• An alcohol-containing liquid that is also known as an essence such as peppermint and camphor spirits.

Elixir

• A drug vehicle that consists of water, alcohol, and sugar (with caution for diabetics/alcohol abuse as some pediatric forms retain the name although without the alcohol).
• Include theophylline and phenobarbital elixirs.

Tincture

• An alcoholic preparation of a soluble drug and may contain water of iodine and digitalis.
• Elixirs differ from tinctures in that elixirs are sweetened.

Fluidextract

• A concentrated solution of a drug from a plant source made of vegetable drugs that are not intended to be administered directly
• Used to provide a source of drug in the manufacture of final dosage forms such as glycyrrhiza fluidextract.

Liniment

• A liniment is a mixture of drugs with oil, soap, water, or alcohol is intended for external application.
• Most liniments are counterirritants for muscle or joint pain

Emulsion

• A pharmaceutical preparation with two agents that cannot ordinarily be combined or mixed including oil being dispersed inside water such as Petrogalar Plain® and cod liver oil.

Mixture and Suspension

• In a mixture or a suspension, an agent is mixed with a liquid but not dissolved to be shaken before being taken such as milk of magnesia.

Aromatic Water

• In pharmacy, a mixture of distilled water with an aromatic volatile oil such as peppermint and camphor.

Spray and Aerosol

• A liquid or fine powder that is sprayed in a fine mist for respiratory and skin treatments of asthma.
• Most aerosolized medicines are liquids but some are small powder particle.

Gaseous Drugs

• Pharmaceutical gases include the anesthetic gases such as nitrous oxide and halothane with compressed gases including oxygen and carbon dioxide.

Principles of Drug Administration

• The route of a drug refers to how it is administered to the patient where it determines rate and intensity effects.
• A route may require different dosage forms.
• The route is determined by the following: the action of the medication on the body, the physical/emotional of the patient, & the characteristics of the drug along with other such as age (pediatric/geriatric), the disease being treated metabolic elimination of the drug.
• The three methods of administration are oral, parenteral, and topical.

Oral Route

• Safest and most convenient made with solid and liquid (syrup) medications whose absence/presence of food in the of food in the stomach affect the absorption.
• Swallowed or are taken by the buccal (cheek) or sublingual.
• Liquid medications vary in the type of substance dissolving with Water/oil/alcohol
• Should be taken with water, for children use oral syringes, & teeth stains can be avoided with a straw.
• Don't give solid drugs to children until they are old enough to safely swallow.

Equipment Needed for Oral Administration

• Three measuring devices that are administered for oral medications are the medicine or water cup, the medicine dropper/oral syringe, & the calibrated spoon.

Sublingual Route

• Placed and held under the tongue in which rapid action is desired, for example, ergotamine tartrate (Ergostat®) for migraines and nitroglycerin for angina pectoris.

Buccal Route

• Placement between the gum and cheek that is used induce labor with oxytocin.

Parenteral Route

• Administration of drugs other than through the digestive system using injections.
• Medications are injected into the body using a using a syringe and a needle for rapid effect and absorption into the muscles, veins, skin (intradermal or subcutaneous), and the spinal column.
• Needles consists of hub, a shaft, and a bevel where gauges range in size from 13-31 G.
• Two needles are both disposable and nondisposable are commonly used where larger the gauge means smaller the lumen.
• Syringes consist disposable and nondisposable are sterilized, prepackaged, nontoxic & ready for use where size varies from 0.5-60 cc.
• Disposable syringe units consist of syringe attached to a needle, distinguished by uses where sizes by sizes of 1, 3, 5, 10, 20, 30 cc commonly used for intramuscular injections and several types including needle-less syringes.
• The insulin syringes are calibrated in units (U) with varying sizes of 0.3, 0.5 and 1.0 cc for diabetic where International Unit (IU) amount substance.
• Tuberculin syringes are used for allergy injections as they are used for injected small quantities less than 1mL.
• Prefilled syringes are sterile disposed cartridge ready to administer made my the manufacturer used as one-time use then discarded.
• To avoid injuries retract the needless which is required by occupation safety and health admin.
• Medication containers such as ampules, vials, & sterile cartridges provide with measured are needed in injections.
• Ampules are small hermetically sealed glass container that can have a weak area.
• Vials are small bottles with a rubber stopper, where single and multidose can be from 200-100, & precautions should always be taken when inserting needles.
• Solutions and powders for the mixture and suspension of one substances dissolved of dry particles.
• Never recap the needle.

Parenteral Administration Routes

• Parenteral medication can be administered through several routes, such as intradermal, subcutaneous, intramuscular, intravenous, epidural with most common as following.

Intradermal Injection

• An intradermal injection is given within the skin where a wheal occurs with a 3/8-inch, 27- or 28-G needle at an angle between 10-15 degrees almost parallel, such as forearm and upper chest.
• Commonly used for allergy and tuberculin screening also the tine test not as accurate at the Mantoux test involving injection of 0.2mL.
• During allergy testing there are between 10-15 allergens at once can be used.

Subcutaneous Injection

• A subcutaneous injection is given just below the skin and the layer of fatty tissue called adipose tissue.
• Includes the deltoid area, anterior thigh, abdomen, and upper back injected at angle of 45 or 90 degrees.
• The amount of drug administered should not be more than 2 mL.

Intramuscular Injection

• A drug is injected into a muscle due to the irritating to skin tissues at 90 degree especially where preferred sites are the gluteus, deltoid, & vatus lateralis.
• In infants the safest site of administration are the vastus lateralis site where infants and children shouldn't be given more than 2mL.
• The needle is usually 1 to 3 inches where gauges ranges from 20-23 G to avoid a leakage from injection site by Z-track method not massaged to avoid the spread.

Intravenous Injection

• Intravenous injection is used during emergency and large doses are needed such as to the hands veins.
• For long term use central venues catheter should be inserted
• Pumps are electronic flow between intravenous fluid into patient

Urethral Route

• Application through insertion via a Catheter of solution of suppressories to treat incontinence and impotence
• Disadvantages is inconvenience and pain

Topical Route

Topical -Apply to surface of the body the skin and mucus membranes to serve as local such as lotions some topical like fentanyl that systemically effects .

• Mucous membranes useful local such as ophthalmics and is use to administer topical to the lungs like nitroglycerin estrogen...

Transdermal

Transdermal patches release minute amounts of drug (skin) that release minute amounts of a drug at a consistent rate

Inhalation Administration

• Medications are is to achieve local effects for the lungs into the nebulizers

Ophthalmic Administration

• Are instilled into the eye slowly and affect are where preparations has must to minimize minimize burning use for anesthetics.

Otic Route Administration

• Sterile solutions in the ear treats infection after by younger children younger they have in 3 after in the head is inclined

Nasal Route

• Solutions apply locally to treat connection into dropper held by nose then is administered in the top.

Viginal Route

• Supositories deposit into to threat the.

Rectal Route

Rectal-When oral use isn't available, they're often used via supasotities or in enemas to bowel evacuation with Fleet.

Summary of Drug Administration

• Drug and sources and their names as how to use.
• Injections are used to place into the muscle and veins. Medications are placed with what with skin.

In Hospitals

• The practice combines supported with new methods to handle with medication is dispense in the medication technicians in a high fashion is an ongoing duty.

In what type of system

To support and organize support systems medication is and to support to in a good

System use include

• The doctor must is support the systems.
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Policies and procedures

Manual to the process, and always follow what that process or task is to

Hospitals Protocol

Medication all use that form when to new and use what we needed

Medication Order

The physician generates it. Patients must will what with it and and doctor know for a person

Medical order.

Schedule medical with the IV and medications with and

Point-of the-Entry

Provide to doctor and all personal. Use for doctor to give information to the center

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Computer Physicians entry

Provide to enter and support a more. The system always can not have that code and is support to in there time and has.

Points a to B

• To the a is used

Roles to do

• Following police Medication is prepared

Follow up for them

Is the use

Drug Sources

• Plant
• Animals
• Minerals
• The synthetic as man made in the law
• Engineered

Hospital pharmacy staff

• The director
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Compounding

Is the process of coming to the formula by looking at all written and to come out it all.

Pharmacy and Techs need to

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In to them

• A medication
• Has and to that you.
• Medications

At the is

They are for other. At that same moment