This document provides information on 4 subcutaneous medications (Humulin 30/70, Glargine, Humalog, and Dalteparin) and 4 intramuscular medications (Benadryl, Vitamin B12, Dimenhydrinate, and Haldol). It describes the indications, mechanisms of action, dosages, and nursing considerations for each medication. Common nursing priorities for these medications include monitoring for signs of hypoglycemia with the insulin medications, assessing for bleeding with Dalteparin, and watching for sedation and falls with medications like Benadryl and Dimenhydrinate.

1. Dave Jay S. Manriquez
S/C and IM InjectionSkill Checkout
SubcutaneousMedications:
1. Humulin30/70 (NPH/regularinsulinmixture - intermediate actinginsulin)
Indication:Antidiabetic.Control hyperglycemiainpatientswithtype 1 and 2 DM.
Action:Stimulatingglucose uptake inskeletal muscle and fat, inhibitinghepaticglucose
production. Control of hyperglycemiaindiabeticpatients.
Metabolism:liver,spleen,kidneyandmuscle
Onset:30 mins;Peak:2-12 hrs;Duration:24 hrs
N. Dose: 0.5 – 1 unit/kg/day
ContraindicatedandAdverseeffect:hypoglycemia
NursingCons:Assessfor signsof hypoglycemia
2. Glargine (Long-actingInsulin).Lantus
Indication:Antidiabetic.Control hyperglycemiainpatientswithtype 1 and 2 DM.
Action:Stimulatingglucose uptake in skeletal muscle and fat, inhibitinghepaticglucose
production. Control of hyperglycemiain diabeticpatients.
Metabolism:liver,spleen,kidneyandmuscle
Onset:3-4 hrs;Peak:None;Duration:24 hrs
N. Dose: 10 units once daily
ContraindicatedandAdverse effect:hypoglycemia
NursingCons:Assessfor signsof hypoglycemia
3. Humalog (rapidactinginsulins) Lispro
Indication:Antidiabetic.Control hyperglycemiainpatientswithtype 1 and 2 DM.
Action:Stimulatingglucose uptake in skeletal muscle and fat, inhibitinghepaticglucose
production. Control of hyperglycemiain diabeticpatients.
Metabolism:liver,spleen,kidneyandmuscle
Onset:15 mins;Peak:1-2 hrs; Duration:3-4 hrs
N. Dose: 0.5 – 1 unit/kg/day
ContraindicatedandAdverse effect:hypoglycemia
NursingCons:Assessfor signsof hypoglycemia
4. Dalteparin. Fragmin
Indication:Anticoagulants.Heparins(Low MolecularWeight).PreventionofDVT and pulmonary
embolism.
Action:Preventionofthrombus formation.
Half-life:2.1– 2.3 hrs
N. Dose: varieswith differentuses.Eg. Unstable angina and MI – 120 IU/kg q 12 hrs for 5-8 days
Contraindicated:hypersensisitivity
Adverse Effect:bleeding
NursingCons:Assessfor bleedingandhemorrhage.

2. Intramuscular Medications:
1. Benadryl (diphenhydramine)
Indication:Reliefofallergicsymptomscausedby histamine.Allergy,cold and cough remedies,
Antihistamines.
Action:Antagonizesthe effectsofhistamine at H1 – receptorsites;does not bindto or inactivate
histamine.SignificantCNSdepressantand anticholinergicproperties.Decreasedsymptomsof
histamine excess(sneezing,rhinorrhea,nasal and ocular pruritus, ocular tearing and redness,
urticaria).
Metabolism:Liver
Half-life:2.4-7hrs
N. Dose: 25mg to 50mg q 4hrs; not to exceed400mg/day
Contraindicated:acute attackof asthma,hypersensitivity
Adverse Effect:drowsiness,anorexia,drymouth
NursingCons:Assessformotionsickness, sedationorconfusion,watch for falls.
2. VitaminB 12 (cyanocobalamin)
Indication:Vit.B 12 deficiency,perniciousanemia.Antianemics,Vitamins.
Action:Necessarycoenzyme formetabolic processesoffat, carbohydrates, and protein.Correct
manifestationsofperniciousanemia (megaloblasticindices,GIlesions,andneurologicdamage.)
VitaminB12 helpsthe body make healthy redblood cellsand helpskeepnerve cellshealthy.
Half-life:6days
Contraindicated:hypersensitivity
N. Dose: Vit.B12 def 30 mcg/day for 5-10 days; perniciousanemia 100 mcg/day for 6-7 days
Adverse Effect:hypertension,erythema,rash,redurine
NursingCons:Assesspatientforsignsof VitaminB12deficiencybeforeandduringtherapy.
3. Dimenhydrinate
Used:preventingand treating nausea and vomiting,dizzinesscausedby motion sickness.It is an
antihistamine and anticholinergic.Itworksinthe brainto decrease nauseaandvomiting,and
dizziness.
N. Dose: 50mg – 100mg q 4-6 hrs; to a maximum of400mg in 24 hrs
Contraindicated:takingMAOinhibitor(anti-depressants)
NursingCons:maycause drowsiness,anddizziness: watchout for falls
4. Haldol (Haloperidol)
Indication:Antipsychotic.Acute and chronic psychotic disorderincluding:schizophrenia,manic
states, and drug inducedpsychoses. Useful inmanaging aggressive or agitated patients.
Action:Alterseffectofdopamine in the CNS.Diminishedsignsand symptoms of psychoses.It has
anticholinergicand alpha-adrenergicblockingactivity.
Metabolism:liver
Half-life:21-24 hrs
N. Dose: 2mg – 5mg q 1-8 hrs; not to exceed100mg/day
Contraindicated:Hypersensitivity

3. Adverse Effect:extrapyramidal reactions,blurredvision,dryeyes,constipationanddrymouth.
NursingCons:Assessmental status (orientation,mood,behavior) prior to and during therapy.
MonitorBP and pulse.