# Page 2 Pharmacology Study Guide for the Medical Assistant test

As a medical assistant, the preparation and administration of medications will be one of the most important tasks you perform. You must take your time and pay great attention to detail when preparing and administering a medication. Make sure to seek clarification if the order is unclear, illegible, or the medication is not available. Never ask someone else to prepare a medication for you to administer or ask someone else to administer a medication you have prepared. Always confirm the patient’s medication allergies and check the expiration dates on all medications prior to administration.

#### Six Rights of Medication Administration

The following are the six rights of medication administration. Each and every time a medication is administered, these six steps must be taken to ensure it is given safely.

1. The right patient: Always confirm the patient’s identity with full name and date of birth.
2. The right drug: Always confirm you are administering the correct medication. Confirm the name of the drug when you receive the order, again when you are preparing it, and a third time just prior to administering it to the patient.
3. The right route: Always confirm the medication you are about to administer can be given in the way directed by the order.
4. The right time: Always confirm when the patient is to receive the medication. This will usually be immediately in an office setting.
5. The right dose: Always confirm that the dosage of the medication you are administering is the same as that in the order.
6. The right documentation: Always immediately and completely document all details regarding the administration of the medication in the patient’s medical record, including how the drug was tolerated.

#### Measurement

Be aware that there are several units of measurement that may be used for medications, particularly liquids. A cc is the equivalent to an ml. A teaspoon (abbreviated as tsp) contains 5 cc’s and a tablespoon (abbreviated as tbsp) contains 15 cc’s. Basic arithmetic will be necessary to convert cc/ml amounts to tsp/tbsp and vice versa. For example, the number of cc’s to give if an order is for $2 \frac{3}{4}$ tsp is 13.75 cc’s. These calculations should be done using a calculator and it is always helpful to have someone check your work.

As a medical assistant, you will need to be familiar with the various routes of medication administration and how to administer each. This may include: oral medications such as pills, liquids, lozenges; medications for mucosal absorption such as rectal or vaginal suppositories, respiratory inhalers, sublingual tablets; and parenteral medications such as intradermal, subcutaneous or intramuscular injections.

##### Injections

Intradermal, subcutaneous, and intramuscular injections are the most common ways to deliver medication that cannot be given by another route. Oftentimes these medications would be damaged by or could not be absorbed into the body via the digestive system, thereby rendering them ineffective.

Three Types

• Subcutaneous (SQ)— The medication is injected into the subcutaneous fat. An example of a drug that is delivered SQ is insulin.

• Intramuscular (IM)— The medication is injected into the muscle belly itself. An example of an IM drug is corticosteroid, such as dexamethasone.

• Intradermal (ID)— The medication is injected very superficially into the dermis, or second layer of skin. The most common use of ID injection is for delivery of PPD, known as the Mantoux test for tuberculosis.

Things to Know

• Site— Sites commonly used for IM injection in adults are the deltoid, dorsogluteal, ventrogluteal, and the vastus lateralis. In children, the vastus lateralis is the prefered site. The maximum volume for an IM injection is 2 ml in the deltoid and thigh and up to 5 ml in the gluteal muscles. For children school age and above, 2 ml is the maximum volume. In infants, no more than 0.5 ml and in small children, no more than 1 ml is given at any one time.

• Needle length and gauge— The needle length and gauge will depend on the chosen site. As a rule, the deeper the injection the larger the gauge and longer the needle. For IM injections, a 20-23 gauge needle is used and the length will vary depending on the site injected and size of the patient. For ID injections, use $\frac{1}{2}$ inch 30-31 gauge needles. SQ injections require $\frac{1}{2}$ to $\frac{5}{8}$ inch, 25-26 gauge needles.

• Steps to administer— Again, always follow the six rights of medication administration prior to giving any medication. Always wear gloves and prepare the injection site using an alcohol wipe to cleanse the skin. If giving an IM injection, aspirate by pulling back on the plunger prior to injecting to ensure the tip of the needle has not penetrated a vascular structure. Massage may be used if not contraindicated. A bandage may or may not be applied. Always dispose of the syringe and needle safely and following all facility guidelines.

• Z-tract— In some instances where the IM medication is very irritating, the Z-tract method will help ensure the medication gets into and only stays in the muscular level. It is accomplished by using the non-injecting hand to slide the skin and subcutaneous tissue away from the injection site. No massage is used. The tissue is released after injection thereby pulling the needle track away from the medication depot. This helps prevent leakage of an IM medication back into the subcutaneous space after injection.

• Syringe parts— There are four basic parts to a syringe:

1. The tip serves as the attachment site for the needle to the syringe. Tips can be locking which secures the needle to the syringe when injecting under resistance. It allows for needles to be screwed onto the syringe tip, thereby locking them into place. An example of this system is the Luer-Lok syringe.

2. The barrel is the clear, tubular structure that holds the medication. It is clearly marked so that volume of injection can be seen at every angle.

3. The flange of the syringe is the structure at the base of the barrel that allows the syringe to be held steadily while force is applied to the plunger. It also keeps the syringe from rolling off of flat surfaces.

4. The plunger and rubber stopper are inserted into the barrel and are usually removable. The plunger provides both the vacuum to draw up medication into the syringe when pulled out of the barrel, as well as the force necessary to inject it.

• Injection systems—These are injection systems that provide a barrel holder, flange, and plunger. The systems involve a pre-filled medication cartridge-needle unit or ampule with an attached, sterile needle that can be inserted and injected immediately. They are convenient and help with both inventory control and fraud.

• Medication availability— Parenteral medications are available in a variety of forms. These include, but are not limited to, multidose vials, single unit dose vials, ampules and prefilled cartridge-needle units.

• Unit disposal—Every facility will have its own guidelines on the safe handling and disposal of syringes, needles, and injection systems involved in the administration of parenteral drugs. In general, all sharps need to be disposed of in a sharps container. There are many safety mechanisms built into both needles and syringes to prevent needle sticks and keep both patients and staff safe.

##### Other Routes

This list represents the other medication administration routes that you will need to be familiar with as a medical assistant.

• Oral— Pills, capsules, syrups, elixirs, and lozenges are all examples of oral medications. However, not all medications given orally are absorbed by the digestive tract. Medications for mucosal absorption may be given sublingually or in the buccal mucosa as well.

• Inhalation— Metered dose inhalers, dry powder inhalers, nebulizers, as well as oxygen by nasal cannula or mask are all examples of inhaled medications. Because the medication is delivered right to the site of action, these medications work very quickly.

• Topical— Creams, ointments, gels, and pledgets are all forms of topical medication. These are applied directly to the skin for absorption. Keep in mind that occluding a topical medication with clothing or bandages may enhance its systemic absorption.

• Instillation— Instillation is the term used for delivery of a medication by drops. Instillation can be used for the eyes, the ears, or the nose. Examples include eye drops for allergies or infection, ear drops for pain or infection and nasal drops for congestion or infection. Installation requires proper patient positioning.

• Transdermal— Transdermal patches deliver medication topically, but usually do so slowly over time. Examples include Fentanyl patches for pain and estrogen patches for hormone replacement therapy.

• Vaginal— Medications delivered vaginally typically come in the form of suppositories, pills, or creams. The vaginal ring may also be used as a form of contraception. These all deliver their effect via mucosal absorption of the vagina.

• Rectal— The rectum provides a mucosal surface for drug absorption that typically produces a rapid effect using smaller medication doses. This is because medications given by this route bypass metabolism in the liver. Nausea, anti-seizure, and narcotic and non-narcotic pain medications are frequently given in this manner.

#### Special Topics

In addition to the preparation and administration of common medications and prescriptions, medical assistants will likely be involved in the preparation and administration of vaccines for the prevention of disease in both the adult and pediatric populations. In addition, there may be instances where the prescription order must be sent to a specialty pharmacy. This is, typically, because the drug ordered needs to be compounded by a pharmacist, as it is not prepackaged or available at retail pharmacies usually used by patients.

##### Immunizations

Immunizations are available for the prevention of disease for both adults and children. Examples of such vaccines are varicella and polio vaccine for children, HPV vaccine for adolescents, and pneumococcal and zoster vaccine for adults. These vaccines are given on a particular schedule, meaning that they require a certain number of doses given at certain intervals to be effective. Some are given yearly, while others confer immunity once the series is complete. Each immunization has specific storage instructions to ensure they remain potent. The CDC provides enhanced training on the storage and handling of vaccines.

A Vaccine Information Statement, or VIS, is a document produced by the Center for Disease Control, or CDC, that is specific for each vaccine, that informs the recipient of that vaccine of both the risks and benefits of receiving it. If the vaccine is given to a child, the VIS must be given to the parent or legal guardian. It must be given prior to administration of the vaccine and before every dose in a vaccine series.

Documentation of immunizations must include the edition date and date the VIS was provided, the name, title and address of the person administering the vaccine, as well as the lot number and date the vaccine was administered. A good rule of thumb is to also include the administration site and the patient’s tolerance of the immunization.

##### Specialty Pharmacies

Specialty pharmacies exist to fill prescription orders that are not available at retail pharmacies. An example would be a nuclear pharmacy which compounds and dispenses radioactive materials used in certain procedures or therapies. These drugs usually come in the form of liquids or capsules. A compounding pharmacy is one where the pharmacist is trained to compound and dispense medications that require unique ingredients in specific proportions that are not commercially available. Oral medications in the form of syrups, elixirs, and suspensions may be compounded in addition to topicals such as creams, ointments, and solutions.