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