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2020 Pharmacology I > Injectable Med Module > Flashcards

Injectable Med Module Flashcards

1
Q

prescribed: morphine 5 mg SQ

available: morphine 10 mg/mL

How many mL? (tenth)

A

0.5 mL

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2
Q

prescribed: methylprednisolone acetate 120 mg IM daily

available: methylprednisolone acetate injection 80 mg/mL

How many mL? (tenth)

A

1.5 mL

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3
Q

prescribed: levothyroxine 0.25 mg IV bolus stat

available: levothyroxine injection 100 mcg/mL

How many mL? (tenth)

A

2.5 mL

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4
Q

prescribed: meperidine 100 mg IM stat

available: meperidine injection 75 mg/mL

How many mL? (tenth)

A

1.3 mL

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5
Q

prescribed: digoxin 0.125 mg IV bolus stat

available: digoxin injection 0.25 mg/mL

How many mL? (tenth)

A

0.5 mL

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6
Q

prescribed: chlorpromazine 40 mg IM

available: chlorpromazine 25 mg/mL

How many mL? (tenth)

A

1.6 mL

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7
Q

prescribed: vasopressin 5 units IM

available: vasopressin 20 units/mL

How many mL? (hundredth)

A

0.25 mL

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8
Q

prescribed: lorazepam 2 mg IV bolus 20 min before surgery

available: lorazepam injection 4 mg/mL

How many mL? (tenth)

A

0.5 mL

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9
Q

prescribed: morphine 4 mg IV bolus every 3 hr PRN pain

available: morphine injection 10 mg/mL

How many mL? (tenth)

A

0.4 mL

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10
Q

prescribed: calcitonin 100 units SQ

available: calcitonin 200 units/mL

How many mL? (tenth)

A

0.5 mL

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11
Q

prescribed: digoxin 0.25 mg IV bolus

available: digoxin injection 0.25 mg/mL

How many mL? (whole number)

A

1 mL

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12
Q

prescribed: diazepam 7 mg IV bolus every 4 hr PRN muscle spasm

available: diazepam injection 5 mg/mL

How many mL? (tenth)

A

1.4 mL

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13
Q

prescribed: furosemide 30 mg IV bolus stat

available: furosemide injection 10 mg/mL

How many mL? (whole number)

A

3 mL

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14
Q

prescribed: cefotaxime 1 g IV bolus every 12 hr

available: cefotaxime injection 1 g/50 mL

How many mL? (whole number)

A

50 mL

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15
Q

prescribed: methylprednisolone acetate 60 mg IM weekly

available: methylprednisolone acetate injection 40 mg/mL

How many mL? (tenth)

A

1.5 mL

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16
Q

prescribed: haloperidol 3 mg IM for agitation

available: haloperidol 5 mg/mL

How many mL? (tenth)

A

0.6 mL

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17
Q

prescribed: diphenhydramine 25 mg IV bolus stat

available: diphenhydramine injection 50 mg/mL

How many mL? (tenth)

A

0.5 mL

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18
Q

prescribed: penicillin G benzathine 1,200,000 units IM

available: penicillin G benzathine injection 600,000 units/mL

How many mL? (whole number)

A

2 mL

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19
Q

prescribed: enoxaparin 30 mg SQ

available: enoxaparin 60 mg/0.6 mL

How many mL? (tenth)

A

0.3 mL

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20
Q

prescribed: methylprednisolone acetate 40 mg IM daily

available: methylprednisolone acetate injection 20 mg/mL

How many mL? (whole number)

A

2 mL

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21
Q

prescribed: purified protein derivative 5 TU ID

available: 5 TU/0.1 mL

How many mL? (tenth)

A

0.1 mL

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22
Q

prescribed: meperidine 75 mg SQ every 4 hr PRN pain

available: meperidine injection 100 mg/mL

How many mL? (hundredth)

A

0.75 mL

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23
Q

prescribed: heparin 15,000 units SQ every 12 hr

available: heparin injection 20,000 units/mL

How many mL? (hundredth)

A

0.75 mL

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24
Q

prescribed: phenytoin 100 mg IV bolus every 8 hr

available: phenytoin injection 50 mg/mL

How many mL? (whole number)

A

2 mL

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25
Q

prescribed: diazepam 3 mg IV bolus every 3 hr PRN anxiety

available: diazepam injection 5 mg/mL

How many mL? (tenth)

A

0.6 mL

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26
Q

volume of ID injection

A

usually less than 0.1 mL

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27
Q

best sites for ID injection

A
  • mostly hairless
  • free of lesions, wounds, tattoos
  • usually forearm or upper back
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28
Q

uses for ID injection

A
  • tuberculin testing
  • allergy testing
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29
Q

syringe and needle size for ID injection

A
  • small, usually tuberculin syringe
  • 25- to 27-gauge
  • 1/4-5/8 in
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30
Q

bleb

A

raised area created by ID injection

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31
Q

angle of ID injection

A

5° to 15°

32
Q

steps to administer an ID injection

A
  • cleanse site
  • pull skin taut
  • insert at 5° to 15° angle with bevel up
  • advance about 3 mm (1/8 in)
  • inject slowly, creating small bleb
  • withdraw needle at same angle
33
Q

usual meds given by SC injection

A
  • heparin
  • insulin
  • others that need to absorb slowly
34
Q

sites for SC injections

A
  • outer posterior aspects of upper arm
  • abdomen, 2 in from umbilicus (always for heparin and enoxaparin)
  • upper back
  • upper hip below waist
  • anterior and interior aspects of thighs
  • no skin lesions
  • avoid bony prominences
35
Q

volume range for SC injections

A

0.5 to 1 mL

36
Q

syringe and needle size for SC injections

A
  • depends on site, pt body weight, amt of SC tissue
  • 25 to 30 gauge
  • 5/8 to 1/2 in, or half the width of the injection site skin fold
  • shorter needle, 45°, if skin fold is ≤ 1 in
  • longer needle, 90°, if skin fold is > 1 in
37
Q

complications for IM injections

A
  • nerve injury
  • abscesses
  • fibrosis
  • thrombosis
38
Q

volume of IM injections

A
  • larger muscles (vastus lateralis, ventral gluteal) can take larger volume
    • 1 mL for older infants and young children
    • 2 mL for older children, older adults, thin pts
    • 3 mL for adult with well-developed muscle
  • deltoid: no more than 1 mL
39
Q

needle size for IM injection

A
  • depends on
    • size of pt
    • muscle used
    • viscosity of med - thicker needs bigger gauge
40
Q

sites and site assessment for IM injection

A
  • ventrogluteal
  • vastus lateralis
  • deltoid
  • look for site with
    • no lesions
    • no tenderness
    • no nodules
41
Q

finding ventrogluteal IM injection site

A
  • preferred for children and adults - not close to major blood vessels
  • put palm on greater trochanter with thumb toward groin, index finger on anterior superior iliac spine, and middle finger just under iliac crest (see image)
  • inject in middle of triangle formed by index and middle fingers
42
Q

finding the vastus lateralis IM injection site

A
  • generally well-developed in children and adults
  • preferred site for infants
  • muscle extends from midline of anterior thigh to midline of later aspect of thigh
  • choose area in middle third of thigh between greater trochanter and just above knee (see image)
43
Q

finding deltoid IM injection site

A
  • relatively small, not well-developed in adults
  • mostly used for immunizations in adults and children older than 18 mo
  • near many nerves and arteries
  • center of upper arm 3-5 cm (1-2 in) below acromion process (see image)
44
Q

uses for IV route

A
  • meds
  • fluids
  • electrolytes
  • nutrition
  • blood
  • blood products
45
Q

short peripheral IV

A
  • < 3 inches
  • rests in superficial vein in extremity
46
Q

central line

A
  • terminates in superior vena cava
  • aka central venous catheter (CVC)
  • types
    • PICC - peripherally inserted central catheter
    • tunneled central venous catheter
    • nontunneled central venous catheter
    • implanted ports
47
Q

PICC lines

A
  • special training required
  • inserted into vein in upper arm and threaded to superior vena cava
  • used for
    • long-term IV med admin
    • vesicant meds
    • parenteral nutrition
48
Q

nontunneled CVC

A
  • placed by MD or APRN
  • inserted in subclavian or internal jugular vein and threaded to superior vena cava
  • used in trauma and critical care
49
Q

calibrated syringes

A
  • calibrated by mL
  • depending on size, can show tenths or hundredths of mL
  • Luer-lock (threaded) or slip tip
50
Q

choosing the right syringe size

A
  • pick one with calibration closest to volume of med to be given
  • 3-5 mL: often used for IM, SQ, IV
  • tuberculin (0.3-1 mL): marked in hundredths of mL
  • insulin: marked in units
51
Q

tuberculin syringe properties and use

A
  • long mark = tenths
  • short mark = hundredths
  • used for very small volumes of medication
52
Q

3 mL syringe properties

A
  • calibrated in tenths
  • long mark = 1 mL
  • used for SQ, IM, and IV med admin < 3 mL
53
Q

syringes > 3 mL

A
  • 5 mL: admin meds with dose > 3 mL
  • 10 mL: used to add diluent when reconstituting meds
54
Q

needlestick implications and prevention

A
  • implications: exposure to bloodborne pathogens (hep B and C, HIV)
  • prevention
    • use needleless devices when possible
    • use safety syringe when necessary (passive or active)
    • dispose of needles in sharps container immediately after use
    • if sharps container is full, get a new one
    • do not force syringe into container
    • never leave needles or syringes at bedside
    • never put in pocket or trash can
    • never recap, bend, or break used needle
55
Q

A nurse is preparing to withdraw 1.7 mL of med into a syringe for IM injection. What size syringe should she choose?

A

3 mL

56
Q

A nurse is preparing to withdraw 0.1 mL of medication into a syringe for SQ injection. What syringe should he use?

A

tuberculin or 1 mL

57
Q

How many mL of med are in the syringe? (Round to tenths.)

A

2.4 mL

58
Q

How many mL are in the syringe? (Round to tenths.)

A

0.4 mL

59
Q

How many mL are in the syringe? (Round to tenths.)

A

1.7 mL

60
Q

what to look for on med labels

A
  • dosages vary by manufacturer; double-check units
  • route of admin
  • expiration date
  • storage conditions (refrigeration, room temp, etc. after opening)
  • single- or multidose vial
  • concentration
  • warning label
  • date opened (for multidose vials)
61
Q

insulin injection use

A
  • for pts who have absolute or relative insulin deficiency
  • promotes entry of glucose, potassium, amino acids into cells
  • needed for conversion of glucose into glycogen
62
Q

insulin route of admin

A
  • SQ (all types)
  • IV (four types)
    • regular insulin
    • insulin aspart
    • insulin lispro
    • insulin glulisine
63
Q

What effect does the source of insulin have on its use and why?

A
  • source can affect onset, peak, duration
  • produced using recombinant tech
  • identical to insulin produced in human body
  • modified to alter rate of absorption and duration of action
64
Q

types of insulin

A
  • rapid-acting
  • short-acting (regular)
  • intermediate-acting
    • Lente
    • NPH
  • long-acting
  • premixed
    • 75/25
    • 70/30
    • 50/50
  • glargine
65
Q

rapid-acting insulin

A
  • onset: 10-15 min (most rapid)
  • duration: shortest
  • appearance: clear
  • admin:
    • immediately before meal to prevent hypoglycemia
    • SQ or IV
  • three types
    • insulin lispro
    • insulin aspart
    • insulin glulisine
66
Q

regular insulin

A
  • onset: 30 min
  • duration: short-acting
  • appearance: clear
  • admin
    • SQ or IV
    • IV reserved for DKA
67
Q

intermediate-acting insulin

A
  • onset: 1-2 hr
  • NPH
    • appearance: cloudy
    • suspension with protein to delay onset and duration
    • only insulin type that’s a suspension and requires agitation before drawing
    • often mixed with regular insulin
    • admin: SQ
  • Lente
68
Q

long-acting insulin

A
  • duration: 18-24 hr
  • glargine
    • U-100 (18-24 hr) or U-300 (> 24 hr)
    • ultra long-acting
    • prefilled pen
  • degludec
    • ultra long-acting (> 24 hr)
  • detimir
  • admin
    • in morning, afternoon, or evening
    • give at same time every day
69
Q

premixed insulin preparations

A
  • uses: pts who have trouble mixing (eyesight, dexterity)
  • contain one intermediate-acting and one rapid- or short-acting
  • examples
    • 70% NPH and 30% regular
    • 70% insulin aspart protamine and 30% insulin aspart
70
Q

insulin measurements

A
  • comes in two concentrations
  • U-100: 100 units/1 mL
  • U-500: 500 units/1 mL
    • for pts with severe insulin resistance requiring very high doses
    • not often prescribed
    • only by SQ injection
71
Q

pt education about insulin injections

A
  • start education as soon as they know about diagnosis
  • educate in any setting
  • use interprofessional approach
  • include info about
    • purchage anc storage of insulin
    • syringes
    • monitoring supples
    • prep and admin of insulin
    • identifying and treating complications
    • onset, peak, duration of prescribed insulin
72
Q

insulin pens

A
  • disposable need
  • insulin-filled cartridge
  • dial to measure dose
  • jet injectors: needleless SQ admin; expensive; can cause bruising
73
Q

insulin external infusion pumps

A
  • delivers rapid-acting SQ over 24 hr
  • set to infuse insulin at set basal rate to mimic pancreatic secretion
  • pt can adjust dose or get bolus
  • small, can be worn in pock or on belt
  • contains syringe with insulin connected to SQ needle
74
Q

insulin syringe

A
  • pick syringe that matches concentration of insulin preparation
  • U-100 has orange cap (most common)
  • U-500 has green cap
  • SQ injection
75
Q

how to mix two types of insulin

A
  • determine if types can be mixed
  • mix whenever possible to limit number of injections
  • mix as you would other meds (see image)

2020 Pharmacology I (21 decks)

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