Bypassing First-Pass Metabolism with Sublingual Administration

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Ampule
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A small, sealed glass drug container that must be broken to withdraw the medication and a special needle with a filter to draw up the medication and then replaced with a normal needle for administration
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First-pass metabolism
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Metabolism of oral medication by the liver...decreasing the effect of the medication...can be bypassed by using sublingual, buccal, and parenteral routes.
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A medication route that means NOT through the gastrointestinal tract?
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Parenteral route: Includes: intradermal (ID), Subcutaneous (subcut), intramuscular (IM), and intravenous (IV).
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5-rights of delegation
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Right Task Right Circumstance Right Person Right Direction/Communication Right Supervision
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Parts of a syringe
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Barrel Tips (slip-tip or luer-lok tip) Plunger
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Syringe types
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1. Regular Syringe: 3.0, 5.0, or 10 mL IM or subcutaneous 2. TB Syringe: 1.0 mL TB, newborns and infants. 3. Insulin Syringe: ONLY insulin calibrated in units (0.3, 0.5, 1mL) 4. Prefilled Syringe: single dose, ready to use, disposable cartridges
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Parts of a needle
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1. Hub: used o attached the needle to the syringe 2. Bevel: slanted tip of the needle to prevent coring and should always face upward 3. Shaft/cannual: denotes needle length-maintain sterility 4. Safety guard: safety for all once med is administrated
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Gauge of a needle
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The diameter of the needle typically between 14G and 27G. The larger the #, the smaller the gauge
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Length of a needle
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Needles come in different lengths ranging typically from 3/8 to 2-inches.
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Vial
Vial
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A glass or plastic container of medication with a rubber stopper that must be punctured with a needle for medication removal.
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Intradermal injections (ID)
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An injection of a small amount of fluid into the dermis immediately below the epidermis. Given in LVentral forearm with a 20-30G, 1/2 - 5/8 G needle put in at a 15-degree angle to create a "bleb".
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Subcutaneous Injections (Subcut)
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Deposits the medication into the subcutaneous layer below the skin. Given in abdomen with a 3/8-7/8 inch; 24-29 G needle at a 45 or 90-degree angle depending on fat in abdomen. Insulin and heparin most common
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Intramuscular Injections (IM)
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Injections directly into the muscle at 90 degrees using a 20-22G, 1-1.5 inch needle (adults) - Total of 2-3mL into ventrogluteal sites (gluteus medius and glutewus minimus) - Total of 1-2mL into vastus lateralis and rectus femoris - Total of 0.5-1 mL into deltoid - Total of 0.5mL into children and infants
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Z-track injection
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Provides for closure of the needle track when you release the skin and tissue while an IM injection.
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Steps/Method for Z-track method
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- Use side of hand to pull tissue (1-in) taut - Insert needle at 90* while holding tissue - Aspirate - Wait 10-sec - Withdraw needle - Apply pressure but DO NOT massage
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Ventrogluteal sites include which 2-muscles?
Ventrogluteal sites include which 2-muscles?
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Gluteus medius and gluteus minimus muscles in the hip.
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What are the lab values for RBC, WBC, Hgb, INR and Platletes?
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RBC: 4.5-5 WBC: 5-10 HgB: 11-17 INR: 2-3 Platelets: 150-450
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Where is the rectus femoris site located?
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Anterior aspect of the thigh.
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Where is the dorsogluteal site located?
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Upper outer quadrant of the buttocks
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Insulin injection sites are rotated to avoid..?
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- Lipotrophy - breakdown of subcutaneous fat at site - Lipohypertrophy - buildup of sub-fat at site
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What is diabetes mellitus?
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- A group of serious and chronic disorders affecting metabolism of carbohydrates - Glucose is the primary source of energy for the body - Glucose is transported by the blood; entry into the cells is controlled by insulin
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What is insulin?
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- A hormone secreted by beta cells of the Islets of Langerhans in the pancreas - When an inadequate production of insulin or the body is unable to use the insulin it produces, glucose cannot enter the cells and it accumulates in the blood, increasing hyper-glycemia.
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Symptoms of HYPER-glycemia
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- Glycosuria: glucose in the urine - Polyuria: excessive urination - Polydipsia: excessive thrist - Polyphagia: excessive appetite - Loss of weight, weakness, and fatigue
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Complications of HYPR-glycemia
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- Keytones: =end product of rapid or excessive fatty-acid breakdown and made when body breaks down fat for energy; will be present in the urine when the keytones in the blood go above a certain level. - Ketoacidosis: condition in whichacids from keytones accumulate. May lead to diabetic coma, which can result in death. - Blood cells become stiff and rigid - Cause tiny tears along the inside of vessels - Plaque adheres to the tiny tears - Decreased circulation and increased complications - Atherosclerosis: major cause of death in diatetics - Retinopathy: leading cause of blindness - Arterio-scerosis - Kidney disease resulting in dialysis - Neuropathy - Infections; especially in urinary tract
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Etiology of diabetes
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- Unknown - Viruses and obesity may precipitate diabetes
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Classifications of diabetes
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-Prediabetes: precurser to type II - Type I: Insulin Dependent Diabetes Mellitus (IDDM) - Type II: Noninsulin Dependent Diabetes - Gestational: diabetes during pregnancy
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What is prediabetes?
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- Improper use of insulin by the cells of the body - Fasting blood glucose levels ***>110mg/mL but <126mg/mL - May advance to Type II
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What is Type II diabetes and how is it treated?
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- When your body either resists the effects of insulin or doesn't produce enough insulin to maintain a normal glucose level. - Treated with diet, exercise, oral meds
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What is gestational diabetes?
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- Diabetes occuring during preganancy - Occurs between 16th - 28th week of pregnancy - Insulin required IF not responsive to diet and exercise - Usually disappears after the infant is born. - Predisposed to diabetes developing after 5-10 years after pregnancy.
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Very rapid acting insulin...
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- Lipro (Humalog) - Onset: 15-min - Peak: 0.5 to 1.5 hours - Duration: 5 hours
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Rapid acting insulin...
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- Regular Humulin R; Novulin R; and Reg Iletin II - Onset: 0.5 to 1 hour - Peak: 2-4 hours - Duration: 6-8 hours
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Intermediate acting insulin...
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- Humulin U; Humulin N; Novulin N; NPH; Lente Iletin II - Onset: 1-2.5 hours - Peak: 4-15 hours - Duration: 18-25 hours
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Long acting insulin...
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- Humulin U - Onset: 4-8 hours - Peak: 10-30 hours - Duration: 36-hours
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Commercial mixed insulin...
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- Reg Humulin N; Humulin 70/30; Humulin 50/50; and are stable and can be administered without conern for time after withdrawal from vial - Onset: 0.5 - 1 hour - Peak: 4-8 hours - Duration: 24 hours - NOTE: When injected within 15-minutes of being combined - they act as if they have bee injected separately.
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Method/Steps of administering heparin
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- May be administered subct and IV - Dosages are usually very small - Nurse does not aspirate -
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