DRUG FORMS THAT SHOULD NOT BE CRUSHED OR CHEWED

1. Enteric Coated Tablets Coated with substance to prevent it to be dissolved into the stomach but allows to be dissolve into small intestines Sustained Release Forms Ex. Sustained Action or Time Release Capsule has small impregnated beads or small particles that require varying amounts of time to be dissolved; reduces no. of doses to be administered; takes effect within 12 24 hours. Often have suffixes attached to drug name: a. Dur duration b. SR Sustained Release c. CR Controlled or Continuous Release d. SA / SR Sustained Action or Sustained Release e. Contin Continuous Ex. Theodur, Alaxan FR f. g. h. i. j. k. FR Fast Release FA Fast Acting CRT Controlled Released Tablet TR Time Release LA Long Acting DR Delayed Release

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Trade names (Brand Names) that imply sustained release a. Caplets capsule & tablet (ex. Enervon) d. Extencaps b. Spansules span (time) e. Gyrocaps peak action c. Extentabs exten (extension) f. Plateau Caps peak action Trade Names (Brand Names) with BID abbreviation in the drug name a. Cardabid cardiac drug e. Lithobid b. Cyclabid f. Isosorbide Dinitrate or Isodil c. Chlorambid g. Theobid - bronchodilator d. Ebid anti tuberculosis Liquid Containing Capsules Buccal (BC) Sublingual (SL) Drugs with powdery texture and exerts teratogenic effect Ex. PROSCAR teratogenic just by touching; for Benign Prostatic Hypertrophy; Male Baldness and Decreases Erection

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5. 6. 7. 8.

Reasons why you dont crush or chew some drug forms 1. 2. 3. 4. 5. 6. 7. 8. Oral Mucosa Irritants May burn Oral Mucosa (sensitive areas of the mouth) Extremely Bitter Contains Dyes (stains the teeth) Inactivates Drug Components Decreases Effect of Drugs Slows the Action of Drugs Only small amounts of drug are absorbed

Route of Administration
1. Oral (Mouth) Effect is 2 4 hours minimum effect; 72 hours maximum effect Nursing Implications a. Most safest, economical, and convenient way of giving meds. b. Given with a glass of water Disadvantages: a. Have unpleasant taste b. Irritates gastric mucosa (some has high acid content) c. Harms the teeth Use straw if applicable to the patients condition. Tetracyclines causes decalfication of bones and teeth; not given <8 years old;; not for pregnant woman during 4th month of fetal development and if given can cause bone retardation, absence of skull or set of teeth, weakens bones and teeth c. Contraindicated to Patients: Unconscious Unable to Swallow and Lacks Gag Reflex Patients with Nasogastric Tube (NGT) Nausea and Vomiting (causes aspiration) Cant be used w/ certain laboratory tests or surgical tests (ex. Urine or Blood Exam) Decreases motility of GIT 2. Buccal and Sublingual Buccal Site: between the inner lining of cheek and molar teeth Sublingual Site: under the tongue Nursing Implications a. Usually systemic than localized to the mouth b. For Dissolution (decomposition and disintegration) c. Rapid Absorption & Drug Action thru a vast network of blood vessels d. Greater potency without affecting liver, gastric, and intestinal mucosa e. Doesnt break skin barrier f. Not to be swallowed g. Not to take a water until absorbed h. Check V/S 15 30 minutes after administration (Check for Signs of Hypotension)

3. Opthalmic Installation (Eyes) Position: Sitting or Supine Procedure: Instruct patient to look at the ceiling and expose lower conjunctival sac by drawing the skin downward. a. Eye drops Place Dropper at 1 2 cm above the eyes Start at the center of lower conjunctival sac Using a tissue, apply gentle pressure to inner eye canthus for 1 2 minutes. Nursing Implications: a. Applying pressure ensures adequate concentration of the drug b. Applying pressure prevents medication to enter the canal that will absorb the drug in the vascular mucosa of the nose and produce systemic effect. c. If > 1 type of eye drop is ordered for the same eye, wait for 5 10 mins. b. Eye Ointment Apply from inner canthus to outer canthus (lateral aspect) Nursing Implication a. Tell patient to close the eyes and move eyes with lids shut (as if looking around the room) to spread medication b. Do not touch eyelid and eyelashes to avoid contamination c. Tell patient not to rub the eye. 4. Otic Installation (Ears) Position: Side lying or head at the side with ear facing upward Nursing Implication a. Assist patient to remain in that position for 5 mins b. Below 3 years old: Pull pinna DOWN AND BACK (straighten auditory canal) c. Over 3 years old and Adult: Pull pinna UP AND BACK (straighten auditory canal) d. Place 2 3 drops into ear canal w/o touching the dropper to the ear. e. Place gentle pressure on Tragus for 1 minute. 5. Nasal Instillation (NOSE AND PARANASAL SINUSES) Position: Back lying with head at the edge of the bed, raise chin up, and immobilize Nursing Implication a. Tell patient to remain in that position for 5 10 minutes for solution to flow into desired areas. b. Tell patient to blow the nose gently before administration of drops and sprays c. Tell patient that overuse of nose drops & spray can cause REBOUND EFFECT (irritation and swelling of nasal passages resulting to nasal congestion)

a. NOSE DROPS Using FOOTBALL HOLD 2 Important Head Positions 1. Proetz head tipped backward to treat ETHMOID and SPHENOID sinuses 2. Parkinsons head turned towards the side to treat MAXILLARY and FRONTAL sinuses b. NASAL SPRAYS Position Sitting in upright position Procedure: 1. Block one nostril 2. Shake bottle then hold upright 3. Insert tip into nostril and squeeze and puff while inhaling thru the open nostril at the same time. Note: 1. Most nasal inhalers are meter dosed 2. Less likely to cause irritation 3. Equal distribution of medication once squeezed DISTRIBUTION drugs are transported by body fluids to the site of action BIOTRANSFORMATION biological or metabolic changes of drug once absorbed and distributed. EXCRETION most important route is the KIDNEYS. Some are eliminated in feces, respiratory tract, breast milk, saliva, sweat, tears.