CH 29: Medications

PRN order

"as needed" order for medication

inhalation

(1) act of breathing in; (2) administration of a drug in solution via the respiratory tract

metabolism

(1) chemical changes in the body by which energy is provided; (2) breakdown of a drug to an inactive form; also referred to as biotransformation

Adverse Drug Effects

-Allergic effects: anaphylactic reaction -Drug tolerance -Toxic effect -Idiosyncratic effect -Drug interactions: antagonistic and synergistic effects

Components of Medication Order

-Client's name -Date and time order is written -Name of drug to be administered -Dosage of drug -Route by which drug is to be administered -Frequency of administration of the drug -Signature of person writing the order

Factors Affecting Drug Action

-Developmental considerations -Weight -Gender -Genetic and cultural factors -Psychological factors -Pathology -Environment -Timing of administration

Types of Medication Errors

-Inappropriate prescribing of the drug -Extra, omitted, or wrong doses -Administration of drug to wrong client -Administration of drug by wrong route or rate -Failure to give medication within prescribed time -Incorrect preparation of drug -Improper technique when administering drug -Giving drug that has deteriorated

Controlled Substance Required Information

-Name of client receiving narcotic -Amount of narcotic used -Hour narcotic was given -Name of physician prescribing narcotic -Name of the nurse administering narcotic

Factors Affecting Absorption

-Route of administration -Lipid solubility -pH -Blood flow -Local conditions at the site of administration -Drug dosage

factors affecting drug action: developmental considerations

-pregnancy: many drugs are contraindicated because of their possible adverse effects on the fetus -infants: especially sensitive to medications because of their immaturity of their organs and blood-brain barrier -older people: sensitive to medications because their bodies have experienced physiologic changes associated w/ the aging process (decreased gastric motility, muscle mass, acid production, blood flow) which affect drug absorption

factors affecting drug action: environment

-sensory deprivation and overload -loud environment -nutritional state of person

Steps to take after a medication error:

1. check pt's condition, observe for the development of adverse effects related to the error 2. notify nurse manager and primary care provider to discuss possible courses of action, depending on pt's condition 3. report the incident using whatever method is appropriate for your institution

parts of the medication order

1. pt's name and a secondary identifier 2. date and time the order is written 3. name of drug to be administered 4. dosage of the drug 5. route by which the drug is to be administered 6. frequency of administration of the drug 7. signature of the prescribing provider

3 checks of drug administration

1. when nurse reaches for the unit dose package or container 2. after retrieval from the drawer and compared w/ the eMAR/MAR, or compared with the eMAR/MAR immediately before pouring from a multidose container 3. before giving the unit dose medication to the pt, or when replacing the multidose container in the drawer or shelf

ID

5-15 degrees

IM

90 degrees

subcutaneous

90 or 45 degrees

enteric coated

A tablet or pill coated to prevent stomach irritation

suppository

An easily melted medication preparation in a firm base such as gelatin that is inserted into the body (rectum, vagina, urethra)

Medication Errors

Check client's condition immediately; observe for adverse effects. Notify nurse manager and primary care provider. Write description of error and remedial steps taken on medical record. Complete form used for reporting errors, as dictated by the facility policy. -Special event, event, unusual occurrence report.

Identifying the Client

Checking the identification bracelet Validating the client's name (first identifier) Validating the client's identification number, medical record number, and/or birth date (second identifier) Comparing with the CMAR or MAR Asking the client to state his or her name if possible

Drug Nomenclature

Chemical name: identifies drug's atomic and molecular structure Generic name: assigned by the manufacturer that first develops the drug Official name (monograph): name by which the drug is identified in official publications United States Pharmacopeia (USP) and National Formulary (NF) (typically generic name) Trade name: brand name copyrighted by the company that sells the drug

drug classifications

Classified by effect on body system; chemical composition; clinical indication or therapeutic action

lotion

Drug particles in a solution for topical use

Pharmacokinetics

Effect of body on drug absorption, distribution, metabolism, and excretion

suspension

Finely divided, undissolved particles in a liquid medium; should be shaken before use

common types of medication errors:

Inappropriate prescription Extra, omitted, or wrong doses Administration to the wrong patient Administration by wrong route, incorrect rate Medication not given in the prescribed interval Incorrect preparation of the drug Improper technique when administering Giving a drug that has deteriorated

placebo

Latin word meaning, "I shall please"; an inactive substance that gives satisfaction to the person using it

pill

Mixture of a powdered drug with a cohesive material; may be round or oval

Drug Preparations

Oral = Capsule, pill, tablet, extended release, elixir, suspension, syrup Topical = Liniment, lotion, ointment, suppository, transdermal patch Injectable

Enteral route

Oral Medication administering drug through an enteral tube

Oral route

Oral Medication having client swallow drug

Sublingual administration

Oral Medication placing drug under tongue

capsule

Powder or gel form of an active drug enclosed in a gelatinous container; may also be called liquigel

extended release (ER)

Preparation of a medication that allows for slow and continuous release over a predetermined period; may also be referred to as CR or CRT (controlled release), SR (sustained or slow release), SA (sustained action), LA (long acting), or TR (timed release)

Therapeutic class

Refers to the clinical indication for the drug or therapeutic action (e.g., analgesic, antibiotic, or antihypertensive).

Pharmaceutical class

Refers to the mechanism of action (MOA), physiologic effect (PE), and chemical structure (CS) of the drug

Rights of Medication Administration

Right medication* Right client* Right dosage* Right route* Right time* Right documentation Right assessment data Right reason Right response Right to education Right to refuse

ointment

Semisolid preparation containing a drug to be applied externally; also called an unction

powder

Single or mixture of finely ground drugs

lozenge

Small oval, round, or oblong preparation containing a drug in a flavored or sweetened base, which dissolves in the mouth and releases the medication; also called troche

tablet

Small, solid dose of medication, compressed or molded; may be any color, size, or shape; enteric-coated tablets are coated with a substance that is insoluble in gastric acids to reduce gastric irritation by the drug

Medication Orders

Standing order (routine order): carried out until cancelled by another order PRN order: as needed Single or one-time order Stat order: carried out immediately

Pharmacodynamics

The process by which drugs alter cell physiology and affect the body. Drugs turn on, turn off, promote, or block responses that are part of the body's processes. Drug-receptor interaction occurs when the drug interacts with one or more cellular structures to alter cell function. Drugs may also combine with other molecules in the body to achieve their effect. Other drugs act on the cell membrane or alter the cellular environment to achieve their effect

Drug Dose and Serum Drug Levels

Therapeutic range: concentration of drug in the blood serum that produces the desired effect without causing toxicity Trough level: the point when the drug is at its lowest concentration, indicating the rate of elimination Half-life: amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

Three Checks for Medication Administration

When the nurse reaches for the container or unit dose package. After retrieval from the drawer and compared with the eMAR/MAR or compared with the eMAR/MAR immediately before pouring from a multidose container. Before giving the unit dose medication to the client or when replacing the multi-dose container in the drawer or shelf.

solution

a drug dissolved in another substance

subcutaneous injections

administered into the adipose tissue layer just below the epidermis and dermis; this tissue has few blood vessels, thus drugs administered here have a slow, sustained rate of absorption into the capillaries

Half-life

amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

intramuscular injection

an injection into deep muscle tissue, usually of the buttock, thigh, or upper arm

topical applications

application of a substance directly to a body surface

factors affecting drug action: psychological factors

attitudes and expectations of drug therapy also directly impact compliance, especially with long-term drug therapy

synergistic effect

combined effect of two or more drugs is greater than the effect of each drug alone

Therapeutic range

concentration of drug in the blood serum that produces the desired effect without causing toxicity

trade name

drug name selected and trademarked by the company marketing the drug; also called brand name or proprietary name

pharmacotherapeutics

dynamic that achieves the desired therapeutic effect of the drug without causing other undesirable effects

factors affecting drug action: weight

expected responses to drugs are based largely on the reactions that occur when the drugs are given to healthy adults (18-65, 150 lb (~68 kg))

vial

glass bottle with self-sealing stopper through which medication is removed; may be single or multiple dose

ampule

glass flask containing a single dose of medication for parenteral administration

peak level

highest plasma concentration of a drug

peak level

highest plasma concentration, of the drug should be measured when absorption is complete, typically drawn 1 hr after a drug has been administered (depends on route)

generic name

identifies the drug's active ingredient, is the name assigned by the manufacturer who first develops a drug; it is often derived from the chemical name -not owned by any drug company and is universally accepted

allergic effect

immune system response that occurs when the body interprets an administered drug as a foreign substance and forms antibodies against the drug

intradermal injection

injection administered into the dermis, just below the epidermis; has the longest absorption time

subcutaneous injection

injection into the subcutaneous tissue that lies between the epidermis and the muscle

intravenous route

injection of a solution into the vein

teratogenic

known to have potential to cause developmental defects in the embryo or fetus

syrup

medication combined in a water and sugar solution

elixir

medication in a clear liquid containing water, alcohol, sweeteners, and flavor

liniment

medication mixed with alcohol, oil, or soap, which is rubbed on the skin

pharmacokinetics

movement of drug molecules in the body in relation to the drug's absorption, distribution, metabolism, and excretion

distribution

movement of drugs by the circulatory system to the site of action

parenteral

outside of intestines or alimentary canal; popularly used to refer to injection routes

factors affecting drug action: timing of administration

presence of food in stomach can delay the absorption of orally administered medications; some medications should be given with food to prevent gastric irritation

pharmacodynamics

process by which drugs alter cell physiology and affect the body

absorption

process by which drugs are transferred from the site of entry into the body to the bloodstream

medication reconciliation

process of creating an accurate list of all medications a patient is taking, including drug name, dosage, frequency, and route, and comparing the list to the physician's admission, transfer, or discharge orders, with the goal of providing correct medications to the patient at all transition points within the hospital

factors affecting drug action: cultural and genetic factors

religious restrictions and beliefs or cultural practices may affect the patient's acceptance of, response to, and compliance with certain drug therapies ethnicity and race influence responses to certain medications

excretion

removal of a drug from the body

piggyback delivery system

requires the intermittent or additive solution to be placed higher than the primary solution container

anaphylactic reaction

severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse

anaphylaxis

severe reaction occurring immediately after exposure to a drug; characterized by respiratory distress and vascular collapse

stat order

single order carried out immediately

toxic effect

specific groups of symptoms related to drug therapy that carry risk for permanent damage or death

pharmacology

study of actions of chemicals on living organisms

ethnophrmacology

study of the effect of ethnicity on responses to prescribed medications, especially drug absorption, metabolism, distribution, and excretion

Z-track technique

technique used to administer medications intramuscularly that ensures that the medication does not leak back along the needle track and into the subcutaneous tissue, reducing pain and discomfort

drug tolerance

tendency of the body to become accustomed to a drug over time; larger doses are required to produce the desired effects

therapeutic range

that concentration of drug in the blood serum that produces the desired effect without causing toxicity

half-life

the amount of time it takes for 50% of the serum concentration of a drug to be eliminated from the body

factors affecting drug action: biological sex

the difference in the distribution of body fat and fluids in men and women is a minor factor affecting the action of some drugs

monograph

the name by which the drug is identified in publications such as the United States Pharmacopeia and National Formulary; official name

Trough level

the point when the drug is at its lowest concentration, indicating the rate of elimination

trough level

the point when the drug is at its lowest concentration, indicating the rate of elimination, typically drawn 30 mins before the next dose is scheduled to be administered

factors affecting drug action: pathology

the presence of disease can affect drug action

bioavailability

the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect

pharmacogenetics

the study of how genetic variation affects an individual's response to drugs

adverse drug reactions (ADRs)

undesirable effects other than the intended therapeutic effect of a drug

transdermal patch

unit dose of medication applied directly to skin for diffusion through skin and absorption into the bloodstream

idiosyncratic effect

unusual, unexpected response to a drug that may manifest itself by overresponse, underresponse, or response different from the expected outcome