Drugs with Special Administration Instructions

Medications with Detailed Preparation (Click to Expand Answers!)

Administration of Oral Esomeprazole Tablet
both Nexium and Esoz)

Patients without swallowing difficulty 1) Swallow whole with water 2) Do not chew or crush tablet
Patients WITH swallowing difficulty 1) Do not chew or crush tablet 2) Disperse tablet in half a glass of water 3) Stir until the tablet disintegrates into pellets 4) Drink the liquid with pellets immediately or within 30 minutes 5) Rinse the glass with half a glass of water and drink

Patients on Nasogastric Feeding Tube (NGT) 1) Do not crush tablet 2) Put the tablet into a syringe and fill syringe with approximately 25mL (up to 50mL) water and approximately 5mL air 3) Shake the syringe immediately for approximately 2 minutes to disperse the tablet 4) Hold the syringe with the tip up and check that the tip is not clogged 5) Attach the syringe to the tube whilst holding it with the tip up 6) Shake the syringe, then position it with the tip down 7) Inject 5 - 10 mL into the tube immediately 8) Invert the syringe after injection (with the tip pointing up) and shake 9) Turn the syringe with the tip down and inject another 5 - 10mL into the tube immediately 10) Repeat Steps 7 and 8 until the syringe is empty 11) Fill the syringe with 25mL (up to 50mL) of water and 5mL of air 12) Repeat Steps 7 and 8 to wash down any sediment left in the syringe References
1) Esomeprazole Product Inserts (respective brands)
Last Updated 28th June 2017

Preparation of Oral Vitamin K (Phytomenadione)

  1. Break the Vitamin K (10mg/mL) ampoule at the neck
  2. Using the insulin syringe (29 Gauge, long needle, 3/10 cc), syringe out entire contents from Vitamin K ampoule and deposit it into a clean dry plastic cup
  3. Add 9mL of water with a Terumo syringe (no needle). This will give you Vitamin K 10mg in 10mL
  4. Using the Terumo syringe, syringe out the required number of mg (1mg = 1mL) as prescribed
  5. Deposit this into a second plastic cup and add water to make at least 15mL (to increase total volume for easier consumption)
  6. Shake cup slightly to mix well. Give to the patient to drink immediately
  7. If alot of oily liquid is left at the bottom after patient drinks, rinse with water and drink again
  8. Discard the broken Vitamin K ampoule and insulin syringes responsibly into the sharps bin
Last Updated 28th Jun 2017

Preparation of Oral Vancomycin solution

- For Pharmacy Lab to prepare during office hours 1) Reconstitute and dilute 1 vial of Vancomycin (500mg) using 20mL water for injection (WFI) 2) Diluted solution is now of concentration 25mg/mL 3) Store diluted solution in the refrigerator (2 - 8 degrees Celsius) and use within 24 hours * The stipulated 24 hours time frame is for manually prepared oral solution done by non-lab staff

Last updated 28th June 2017

1) White, R., & Bradnam, V. (2015). Handbook of drug administration via enteral feeding tubes. London: Pharmaceutical Press.
2) Drug Product Inserts for respective drugs

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The lists above are NOT exhaustive. The information on this page is for general reference only, and should not be used as a substitute for clinical judgement in patient care. For more information, or for medications not listed here, please consult your friendly pharmacist.