3.7 Medication Preparation and Administration
Key Takeaways
- Medication preparation requires the three checks: when removing from storage, when preparing, and at the point of administration
- Multi-dose vials must be dated when first opened and discarded after 28 days (or per manufacturer guidelines)
- Reconstitution involves adding a diluent to a powdered medication; follow manufacturer instructions for the correct diluent type and volume
- Insulin types include rapid-acting (lispro, aspart — onset 15 min), short-acting (regular — onset 30 min), intermediate (NPH — onset 1-2 hours), and long-acting (glargine — onset 1-2 hours, 24-hour duration)
- Vaccine administration requires checking the VIS, verifying patient identity and allergies, using the correct route and site, and documenting all required information
- Medication math for the CCMA exam includes basic dosage calculations using the formula: Desired dose ÷ Available dose × Quantity = Amount to administer
Medication Preparation and Administration
Medication administration is one of the most important and commonly tested clinical skills on the CCMA exam. Medical assistants prepare and administer medications under the direction of a licensed provider.
Medication Forms
| Form | Description | Route |
|---|---|---|
| Tablet | Compressed powder; may be scored for splitting | Oral (PO) |
| Capsule | Medication enclosed in a gelatin shell | Oral (PO) |
| Liquid/suspension | Medication in liquid form; shake well before use | Oral (PO) |
| Sublingual tablet | Dissolves under the tongue | Sublingual (SL) |
| Injectable solution | Liquid in a vial or ampule | IM, SubQ, ID, IV |
| Transdermal patch | Absorbed through the skin over time | Topical/transdermal |
| Cream/ointment | Applied to the skin surface | Topical |
| Suppository | Inserted into a body cavity (rectal, vaginal) | Rectal (PR), vaginal |
| Inhaler/nebulizer | Aerosolized medication breathed into lungs | Inhalation |
| Ophthalmic drops | Liquid dropped into the eye | Ophthalmic |
| Otic drops | Liquid dropped into the ear | Otic |
Multi-Dose Vials vs. Single-Dose Vials
| Feature | Multi-Dose Vial | Single-Dose Vial |
|---|---|---|
| Contains | Multiple doses with preservative | One dose; no preservative |
| Dating | Must be dated when first opened | Used immediately; discard remainder |
| Expiration | 28 days after opening (unless manufacturer states otherwise) | Single use; discard after use |
| Contamination risk | Higher (needle enters multiple times) | Lower |
| Best practice | Dedicate to one patient if possible | Preferred for safety |
Reconstitution
Reconstitution is the process of adding a diluent (liquid) to a powdered medication to create a solution for injection:
- Check the manufacturer instructions for diluent type and volume
- Draw up the correct amount of diluent (usually sterile water or normal saline)
- Inject the diluent into the powder vial
- Gently swirl or roll the vial — do NOT shake vigorously (may cause frothing)
- Verify the medication is fully dissolved before withdrawing the dose
- Label the reconstituted vial with: date, time, concentration, your initials, and expiration
- Store per manufacturer instructions (some require refrigeration after reconstitution)
Insulin Types
| Type | Generic Name | Onset | Peak | Duration |
|---|---|---|---|---|
| Rapid-acting | Lispro (Humalog), Aspart (NovoLog) | 10-15 min | 1-2 hours | 3-5 hours |
| Short-acting | Regular (Humulin R, Novolin R) | 30 min | 2-4 hours | 6-8 hours |
| Intermediate | NPH (Humulin N, Novolin N) | 1-2 hours | 4-12 hours | 12-18 hours |
| Long-acting | Glargine (Lantus), Detemir (Levemir) | 1-2 hours | No pronounced peak | 20-24 hours |
| Ultra-long | Degludec (Tresiba) | 1-2 hours | No peak | 42+ hours |
Insulin Administration Tips:
- Administer subcutaneously (SubQ) at 45 or 90 degrees
- Rotate injection sites to prevent lipodystrophy (thickening or thinning of tissue)
- Common sites: abdomen (fastest absorption), outer thigh, upper arm, buttocks
- Do NOT rub the injection site after administration
- When mixing insulin: draw clear (regular/rapid) before cloudy (NPH) — "clear before cloudy"
- Opened insulin vials at room temperature are good for 28 days (check specific product)
Basic Dosage Calculations
Formula: Desired dose ÷ Available dose × Quantity = Amount to administer
D/A × Q = Amount
Example 1: Provider orders 500 mg amoxicillin PO. Available: 250 mg capsules.
- 500 mg ÷ 250 mg × 1 capsule = 2 capsules
Example 2: Provider orders 75 mg of a medication IM. Available: 100 mg/mL.
- 75 mg ÷ 100 mg × 1 mL = 0.75 mL
Example 3: Provider orders 0.5 mg atropine IM. Available: 1 mg/2 mL.
- 0.5 mg ÷ 1 mg × 2 mL = 1 mL
When mixing insulin, which should be drawn into the syringe FIRST?
A provider orders 500 mg of amoxicillin PO. The medication is available as 250 mg capsules. How many capsules should the medical assistant prepare?
A multi-dose vial of medication should be discarded no later than how many days after first opening?
Which type of insulin has the FASTEST onset of action?