Injectable Medications & Reconstitution - GAMMA

A comprehensive set of flashcards covering injectable medications, injection techniques, syringe types, needlestick safety, insulin use, reconstitution, labeling, and practice problems.

Intradermal injections deliver medication into which layer of the skin?

The dermis.

What are the common clinical applications of intradermal injections?

Tuberculin skin tests (Mantoux); allergy sensitivity testing; local anesthetics.

What needle size and length are typically used for intradermal injections?

25–27 gauge; ¼ to ⅝ inch.

What angle is used for intradermal injection and what is the visual sign of proper delivery?

Bevel-up at 5–15° to create a visible wheal (bleb) under the skin.

Where are primary intradermal injection sites?

Volar forearm and upper back.

Subcutaneous injections target which tissue?

Subcutaneous tissue, between the dermis and muscle.

Describe the absorption rate for subcutaneous injections.

Slow, steady absorption.

What is the typical maximum volume for subcutaneous injections in adults?

0.5–1 mL.

List common subcutaneous injection sites.

Abdomen (2 inches from the umbilicus), posterior upper arms, anterior thighs, upper back (scapular areas).

What needle gauge and length are used for subcutaneous injections?

25–31 gauge; ⅜–⅝ inch.

What determines the subcutaneous injection angle (45° vs 90°)?

Angle is 45° if skin fold

Why is site rotation crucial for repeat injections (e.g., insulin/heparin)?

Prevents lipodystrophy.

What tissue do IM injections target and how does absorption compare to subcutaneous routes?

Muscle tissue; faster absorption due to greater vascularity.

Name common clinical applications of IM injections.

Vaccines, antibiotics, hormones, pain medications.

What is the maximum IM volume for adults, children, and infants?

Adults up to 3 mL; children 0.5–1 mL; infants 0.5 mL.

What are the key steps in IM administration technique mentioned?

Z-track method; insert at 90°; aspirate before injection (situation-dependent).

What are the pediatric, average adult, and obese adult needle gauges and lengths for IM injections?

Pediatric: 22–25G, ⅝–1 inch; Average adult: 20–23G, 1–1½ inch; Obese adult: 18–22G, 1½–2 inch; Viscous solutions: 18–20G.

Describe the deltoid IM site landmarks and its typical volume capacity.

Identify acromion; place 2–3 fingers below; inject into triangular deltoid; max 1–2 mL.

Where is the vastus lateralis IM site located and who is it preferred for?

Anterolateral thigh; middle third of lateral thigh; preferred for infants and children.

What is the typical IM capacity for vastus lateralis in adults vs pediatric patients?

Adult: 1–3 mL; Pediatric: 0.5–1 mL.

Describe the ventrogluteal IM site and its capacity.

Hip region; palm on greater trochanter, index on ASIS, middle finger back; inject in center of V; up to 3 mL.

What syringe types are used for injectable meds and what are their primary uses?

Tuberculin syringe (1 mL, 0.01 mL) for precise small doses/ID; Standard syringe (3 mL, 0.1 mL) for most subcutaneous/IM; Large capacity (5–10 mL, 0.2–0.5 mL) for IV push/diluent prep; Insulin syringe (0.3–1 mL, U-100) for insulin.

What safety features are common on syringes?

Luer-Lock; Slip-Tip; Safety Shields; Needleless systems.

What are the high-risk bloodborne pathogens associated with needlestick injuries?

HIV, Hepatitis B, Hepatitis C.

Name key prevention strategies for needlestick injuries.

Safety-engineered devices, proper technique, PPE.

What handling practice should never be done with used needles?

Never recap; maintain visual control of sharps.

How should you dispose of used needles after use?

Activate safety mechanisms immediately; dispose in puncture-resistant containers.

What is the recommended response to a needlestick incident?

Clean exposed area; report immediately; follow post-exposure prophylaxis protocols.

What are the typical insulin onset/peak/duration for rapid-acting insulin?

Onset 5–15 min; peak 1–2 hrs; duration 3–5 hrs.

What are the onset/peak/duration profiles for short-acting insulin?

Onset 30 min; peak 2–4 hrs; duration 5–8 hrs.

What are the onset/peak/duration profiles for intermediate-acting insulin?

Onset 1–2 hrs; peak 4–10 hrs; duration 10–16 hrs.

What are the onset/peak/duration profiles for long-acting insulin?

Onset 1–2 hrs; peak minimal; duration 36+ hrs.

What is the standard U-100 insulin concentration and its syringe color?

100 units/mL; orange cap syringe.

What units and use define U-100 insulin syringes?

0.3 mL, 0.5 mL, 1 mL; for insulin administration only.

What is U-500 insulin and who is it for?

Concentrated: 500 units/mL; green cap syringe; for insulin-resistant patients; requires special education.

What are the main features of insulin pens?

Pre-filled or refillable cartridges; dial-a-dose; disposable needles 4–8 mm; improved dosing accuracy and compliance.

What are the main features of insulin pumps?

Continuous subcutaneous insulin infusion; programmable basal rates; bolus doses; infusion sets changed every 2–3 days; reduces injection frequency.

How should insulin mixing be approached?

Only mix compatible formulations; draw clear insulin first, then cloudy; NPH can be mixed with Regular/Rapid; long-acting analogs generally not mixed.

What patient education is critical for safe insulin administration?

Storage (refrigeration for unopened vials; room temp for in-use), timing relative to meals, self-monitoring of blood glucose, hypoglycemia recognition/management.

What is reconstitution in the context of injectable medications?

Mixing a powdered medication with a diluent to form a liquid solution for administration.

Why are many medications supplied as powders before reconstitution?

They are unstable in liquid form for long-term storage.

Name the four key components of reconstitution.

Powdered medication; diluent; vial; reconstituted solution.

What are the basic steps of the reconstitution process?

Read instructions; prepare the diluent; inject diluent into vial against glass wall; swirl until dissolved; inspect for clarity and absence of particles.

What should you include on the vial after reconstitution?

Final concentration; date and time of preparation; expiration time; storage requirements; preparer's initials.

Why is it important to calculate doses from the reconstituted concentration?

To ensure the correct dose is drawn and administered; discard single-use vials after one use; refrigeration may extend stability.

How long can many reconstituted antibiotics be stored in the refrigerator?

Typically 7–14 days.

What diluents are listed for injectable medications?”

Sterile water for injection; 0.9% sodium chloride (normal saline); bacteriostatic water; 5% dextrose in water (D5W).

What diluents are used for oral medications?

Purified water; tap water (if specified); bottled water; specialized oral diluents.

What essential label information should you look for on medication labels?

Generic and brand name; final strength after reconstitution; required diluent type and exact volume; expiration and storage requirements.

What should you do if a medication label lacks reconstitution information?

Refer to the manufacturer’s package insert for complete instructions.

What is a common caution with Pantoprazole regarding reconstitution labels?

Some medications may have incomplete reconstitution information on the label—check the package insert.

What is the difference between parenteral and oral syringes?

Parenteral syringes are used for injectable medications (IV, IM, SC) and connect with needles/IV systems; oral syringes are for oral meds, have colored tips, and cannot connect to needles.

What is a typical example of Dimensional Analysis in medication calculations from the notes?

Use of Desired Over Have and Ratio-Proportion to determine the correct volume to administer given a prescribed dose and vial concentration.

Practice Problem #1 (Ceftriaxone): If a 1 g vial yields 350 mg per mL, what volume is needed to deliver 1.05 g IM?

3 mL.

Practice Problem #2 (Cefazolin): If you need 375 mg and the vial provides 500 mg in 2 mL, what volume should you draw?

1.5 mL.

Practice Problem #3 (Vancomycin): If 1000 mg are present in 20 mL and you need 750 mg, what volume should you administer?

15 mL.