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what are the three different type names a medication can have?
what is the chemical name of a medication?
provides an exact description of the medication composition (ex. acetlysalicylic acid)
wht is the generic name of a medication?
name given by the manufactuerer who first developed the medication (ex. aspirin)
what is the trade name of a medication?
yhe name under which a manufactuer markets a medication
has the symbol TM at the upper right of the name
can be several trade or brand names (ex. excedrin, bufferin, anacin)
what do medication classifications indicate?
effect the med has on a body system
symtoms that the med relieves
medications desired effect
can a medication be classified in more then one group?
medications with simular characteristics are grouped into ?
the form of the medication determines what?
which route you give the med
list the solid forms of medication and descibe them
caplet - shaped like a capsule and coated for ease of swallowing
capsule - medication encased in a gelatin shell
tablet- powdered medication compressed into hard disk or cylinder
enteric-coated tablet- dissolves in intestines where med is absorbed
pill- contains one or more meds, rarely used because it has been repaced by tablets
list liquid forms of mediation and describe them
elixer- clear fluid containig water and/or mixed with alcohol. often sweetened
extract- syrup or dried form of pharmacologically active meds
aqueous solution- substance dissolved in water and syrups
aqueous suspension- finely devided drug particles dispersed in liquid mediums
syrup- medication dissolved in a consintrated sugar solution
tincture- alcohol extract from a plant or vegetable
list medication forms commonly prepared fpr administration by topicalroute and describe them
ointment (salve or cream)- semisolid, externally applied preperation, usually containing one or more meds
liniment- usually contains alcohol, oil, or soapy emollient applied to skin
lotion- liquid suspension that usually protects, cools, or cleanes skin
paste- thick ointment; absorbed through skin more slowly than ointment, often used for skin protection
transdermal disk or patch - medicated disk or patch obsorbed through skin over a period of time ( usually 24hrs to 1 wk)
the study of how a medication enters the body is what?
what are the four phases of pharmacokenetics (how meds enter the body)?
the first phase of pharmacokenetics, it is the passage of medication molecules into the bloodstream from the site of medication
what factors influence absorption of medication into the body?
ability to dissolve
blood flow to the site
lipid solubility of the med
what are the four routes that meds are absorbed and describe them?
skin- slower due to the make up of the skin
oral- slow because of the passage through the GI tract
mucous membrane & respiratory airways- quicker due to vascularity of tissue
IV (intravenous)- most rapid d/t immediate access to the systemic
the second phase of pharmacokenetics. The medication is distibuted to organs and tissues and to its specific site of action, this is called what?
what are some factors that affect the distribution of medications through the body?
how does body surface area affect the asorption rate of a medication?
the larger the area, the faster the absorption rate
(ex. small intestines- its absorption and effects are quicker d/t larger BSA than absorption in the stomach)
how does blood supply affect the absortion rate of a medication?
sites with increased blood supply will absorb much quicker than sites with less blood supply
(ex. muscle tissue vs. skin)
during absorption, the ability for a med to dissolve depends largely on its form of?
the rate of absorption is faster if the meds are givin on ?
an empty stomach
you may have to give meds on a full stomach if?
GI symptoms present
how does circulation affect distribution of medications
limited blood flow or poor blood supply equals poor distribution
how fast a med gets circulated through the blood stream to a specific area depends on the medication's ?
what are some ways membrane permeability affects the distribution of meds
some membranes serve as barriers to the passage of meds
in older adults, changes in permeability of the blood-brain barrier often cause adverse effects
some membranes are nonselective (ex. placental membrane allows fat and non-fat soluble agents to cross, causing fetal deformities
how does protein binding affect distribution
The degree to which medication bind to serum proteins e.g. albumin affects medication distribution
Medications bound to albumin do not exert any pharmacological activity
Unbound or free drug molecules are considered the active form of the medication
Older adults, patients with liver disease or malnutrition have decreased albumin—>more unbound medication—> Risk for toxicity. this is an example of what?
protein binding during distribution
when does metabolism occur?
after reaching the site of action
Occurs under the influence of enzymes that detoxifies and transforms toxic substances. what is this?
where does metabolism take place?
liver (most often)
If there is a decrease in liver function, the body eliminates medication more slowly. Therefore there is a risk of?
the process of the drug exiting the body is ?
what determines which organ excretes the medication?
chemical makeup of the drug
what are the modes of excretion?
- Kidneys (most common)
- Sweat, salivary glands, milk
renal function is essential for ?
excretion of medications
renal impairment = ?
risk for drug toxicity
if their is a decline in renal function, what must be done to the medication?
dose must be reduced
what amount of fluid intake is adequate to premote proper elimination of medication ?
what type of medication action is "intended or a desired physiological response of a medication" ?
each medication has a desired ?
what is Nitroglycerin's therapeutic effect?
works to lower cardiac workload and raise myocardial oxygen supply, thus eliminating chest pain
why is it important to know the expected therapeutic effect of medication the pt receives?
allows for proper teaching about the intended effect and evaluation of the effectiveness of the drug
what type of medication action is "a predictable and often unavoidable secondary effect produced at a therapeutic dose" ?
when are side effects of drugs usually discovered?
during clinical drug testing
what are some common side effects you'll usually find with medications?
GI upset (N/V, constipation, diarrhea)
what type of medication action is "undesired, unpredictable, unintended responses to medication" ?
"a pt becomes comatose after taking a medication" is an example of what type of medication action?
what must happen if a pt has an adverse affect to a medication?
Medication must be discontinued
you are obligated to report the adverse affect
"overdose, prolonged intake of a drug, medication accumulates in the blood d/t impaired metabolism or excretion" can cause what type of medication action?
"morphine can cause respiratory distress if to much is giving" is an example of what type of med action?
Narcan can reverse the toxic effects of what drug?
"Unpredictable response, Any abnormal or peculiar response, May manifest itself in a number of ways, Overresponse,Underresponse,Response different from the expected outcome", these are what kind of medication actions?
Unpredictable reaction in which the patient becomes immunologically sensitized to a medication after taking the first dose. this is what type of med action?
if a pt has a known history of allergic reactions to a med, the pt needs to have what?
Anaphylatic Reaction is what type of med action?
severe allergic reaction
"Sudden constriction of bronchiolar muscles, Edema of the pharynx and larynx, Severe wheezing" are symtoms of what?
"Antihistamines, Epinephrine, Bronchodilators" are treatments for what?
"When one medication modifies the action of another medication" this is known as what?
"An effect resulting from two drugs—the effect of the two drugs combined is greater than the effects of the medications when given separately" this is what type of medication interaction?
Alcohol is a CNS depressant that has a synergistic effect on antihistamines, antidepressants, barbiturates, and narcotic analgesics. this is an example of what type of medical interaction?
Antihypertensives with diuretics act together to control moderate HTN. this is an example of what type of interaction?
synergistic interaction with a therapeutic effect
An effect resulting from two drugs—the effect of one drug reduces or abolishes the effect of the other drug. this is an example of what type interaction?
Lorazepam can decrease the antiparkinson effects of levodopa. this is an example of what type of interaction?
Narcan reverses the respiratory depression associated with morphine toxicity. this is an example of what type of interaction?
antagonistic results with therapeutic affects
Time it takes after you administer a drug to produce a response
Time it takes for a drug to reach its highest effective concentration
Time during which the drug is present in a concentration great enough to produce a response
Blood serum concentration of a drug reached and maintained after repeated fixed doses
Time it takes for excretion processes to lower the serum medication concentration by half
serum half life
To maintain a therapeutic plateau, patient needs to ?
receive regular fixed doses
for serum half-life; If a drug’s half-life is 8 hours, then the amount of drug in the body is as follows:
- Initially: 100%
- After 8 hours: 50%
- After16 hours: 25%
- After 24 hours: 12.5%
who prescribes a med for the pt ?
health care provider
what kind of medication orders are given when electronic or written communications are not possible?
telephone or verbal orders
what must the nurse do when receiving verbal or telephone orders?
write the name of the prescriber and sign the nurses name
you never give a med without first reiving a?
what are the 5 common types of med orders givin in an acute care setting?
orders carried out until the health care provider cancels it by another order or until a prescribed number of days elapse. the order may indicate a final date or number of dosages. this is what kind of order?
standing or routine order
Medications given only when the patient requires it
Usually has set time intervals to be given. This is what kind of order?
when giving PRN meds, you the nurse need to document what?
Assessment data you used to determine the need of the medication
Evaluate the effectiveness of the medication
Given only once at a specified time
Common for preoperative medications or diagnostic examinations
this is what kind of order?
Medication given immediately & only once
Usually written in emergency situation when there is a sudden change in patient’s condition
this is what kind of order?
More specific than a stat order
Administered quickly, but not immediately
Up to 90 minutes to administer the medication
Only administer now medications one time
Ex: Vancomycin 1 gram IVPB now
this is what kind of order?
when a patient goes to surgery, the surgery automatically cancels ?
all patient preoperative medications
when the patient returns from surgery, the patient’s condition changes after surgery and the MD or the health care provider must ?
write new orders
When the patient is transferred to another health care agency or to a different unit within a hospital or is discharged the prescriber?
reviews the medications and writes new orders as indicated
Special areas used for stocking and dispensing medications (carts, rooms, cabinets, storage units in patient’s rooms)
Portable carts w/drawerslKeep a 24-hour supply of meds for each patient
Each tablet or capsule is individually wrapped
Also contains limited amounts of PRN medication
Designed to reduce number of medication errors and saves steps in dispensing medications
unit dose system
Useful for the control of narcotics
Individual security code for access
Select pt’s name, desired drug, and route
System dispenses desired med, records it, and charges it
computer-controlled dispensing system
Assess the pt’s ability to self-administer meds & determine if a med should be given at a specific time
Administering meds correctly and monitoring effects
Educating the patient about proper and correct administration
these are roles and responsibilities of who?
most common of medical errors
1.5 million patients harmed each year
Costs= $3.5 billion (medical cost treating drug related injuries in hospitals each year)
400,000 PREVENTABLE related injuries in hospitals
530,000 PREVENTABLE related injuries in OP clinics
800,000 PREVENTABLE related injuries in long term care facilities
possible causes for med errors are?
- Inaccurate prescribing
- Administering the wrong medication
- Administering extra doses
- Failing to administer a dose
- Giving the medication at the wrong time
- Wrong amount (too much/too little)
When an error occurs, client safety and well-being are top priority
If an error occurs:
- Assess well-being of patient
- Notify MD or prescriber of the incident as soon as possible
- Report to manager or supervisor
- Complete incident report---usually filled out within 24 hours
Process recommended by TJC that exists for comparing current medications with those ordered for the patient.
obtaining a current list of medications from the pt is what step in the process of reconciliation
making sure the list of current meds is accurate and involving as many people as necessary to do so, is what part of the process of reconciliation
comparing the new med orders with the current list of medications and investigating any discrepancies with the HCP is what step in the process of reconciliation
communicating the updated list to caregivers and clients as needed is what step in the process of reconciliation
what critical thinking skills are extremely important when dispensing meds to a pt
The Six Rights of Medication Administration
- RIGHT MEDICATION
- RIGHT DOSE
- RIGHT PATIENT
- RIGHT ROUTE
- RIGHT TIME
- RIGHT DOCUMENTATION
Order required before giving any medication
ALWAYS compare order in chart with MAR
Meds from Bottles or Containers-Compare the label of the medication container with the medication administration order three (3) times
these are way to make sure the nurse has?
the right med
when getting meds from bottles or containers, when are the three times you check the med?
- Before removing the container from the drawer/shelf
- As you remove the medication ordered from the container Before returning it to storage
how do you make sure you have the right medication when using unit-dose packaged meds
- Check medication label and dosage when taking it out of the medication dispensing system
- Verify ALL medications at the patient’s bedside with the MAR
- Administer ONLY the medications that YOU prepare
how do you ensure the right dose when crushing tablets
- Clean crushing device before using
- Use small amounts of food or liquid when mixing medications
- Not all medications can be crushed
what are ways to verify that you have the right pt
- Ask them to state their name
- ID number on bracelet assigned by health care agency
- Telephone number
If the specified route is not the recommended route, what do you do?
notify the prescriber immediately
what do you do when the route is not specified on an order?
Always consult with prescriber
with injections, use only what?
- Use only preparations designed for parenteral use
- Label reads “For injectable use only”
ALL routine ordered meds should be given within 60 minutes of the prescribed time
30 minutes before or 30 minutes after prescribed time
After administration of medication what do you document?
- Document on MAR according to policy
- Document any other needed information on the MAR
- Record in nursing notes how patient responds to the medication (positive or negative)—if negative, inform MD NEVER document giving a medication prior to giving
- Document any refusal or withholding of medication.
Obtain/review a medical history before giving medications
Provides indications/contraindications for drug therapy
May also discover medications patient may need
what part of the nursing process is this for administering meds?
All allergies and types of reactions should be noted on patient’s ?
admission notes, H&P, and medication records
Assess ALL medications
Length of time patient has been on medication
Current dose schedule
what part of the nursing process is this for administering meds
what type of references can you use when getting a medication history
- PDR (Physician’s Desk Reference)
- Nursing drug handbook
- Medication insert
what are things you need to assess about Patient’s Perceptual or Coordination Problems
- Assess patient’s ability to prepare doses and administer medication
- May need to assess whether family or friends are willing and able to assist
how can a pts attitude affect medication use
- Affects compliance of medication
- May reveal dependence or avoidance
- Observe behavior for evidence of medication dependence or avoidance
- Assess patient’s cultural beliefs
how does knowledge and understanding of a medication affect the pt
- Affects the patient’s ability to comply or adhere
- If patient understands reason of taking a drug, likelihood of compliance is enhanced.
- Teach medication purpose, proper administration techniques, and possible side effects
- If patient cannot afford medications, discuss financial resources.
To assess learning needs of pts, ask patients the ?
purpose of the meds, expected side effects, correct administration techniques, etc. of their meds
The failure of a patient to take their medication as prescribed is known as
what can cause a pt to be Noncompliance/Nonadherence
- Poor education
- Perception that medication is not needed
In older adults…
- Do not like side effects
- Too busy
what are some things yo can give to pt and family to provide info about a med?
- Easy to read pamphlets
what are some things you need to teach pt and family about giving daily injections
- Must learn to prepare and administer injection correctly using aseptic technique
- Good to teach family/caregiver if patient becomes ill or physically unable
what do you need to teach pt and family about side effects and toxicity
- Family/caregiver also needs to be aware of symptoms of medication side effects or toxicity esp. if they are cognitive or behavioral in nature.
- Learning the basic guidelines for medication safety can ensure proper use and storage of medications in the home
what are the components of a med order
- Patient’s full name
- Date and time the order is written
- Name of the medication
- Dosage of the medication
- Route of administration
- Time and frequency of administration
- Signature of the prescriber
Once you receive and process a medication order, what do you do?
place the order on the MAR - Includes Pt’s name,Room/bed number, Names, dosages, routes and frequencies of me
what are things that need to be known about recording medications
- Record immediately after administration.
- Never chart before administering.
- If a dose is missed, explain the reason in the nurses’ notes, e.g.
- If refuses, investigate WHY?
- Follow any other protocol regarding missed dose.
Special Considerations for Administering Medications to Special Age Groups
- Older Adults
- Physiological changes-Sensory or functional changes
- Behavioral changes-Mental or emotional changes
- Economic factors
The use of two or more medications from the same chemical class or similar action to treat an illness
Mixing of herbal products or nutritional supplements with medications
this is known as ?
happens when patients need to take several medications to treat their illnesses, e.g. multiple meds to lower B/P.
happens when patients take more medications than needed, e.g. more than one healthcare provider or self-prescribing