Unit 3 (Medications and their Administration)
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Name three ways in which orders may be given:
- standing order
If medication must be administered during an emergency situation on a verbal order, how must the ordering of the medication be handled?
it must be written and signed by the ordering physician within 24 hours
What is a standing order?
a written order that is not necessarily written for each specific procedure, but determines how much contrast is used, etc and is determined and updated by the radiologist annually.
What should be included in a standing order?
- advance cathartic preparation (laxatives)
- the name and amount of the drug
- the time to be administered
- any pt. conditions that would preclude implementation of the order
what should all drug orders include?
- the name and amount of the drug to be administered
- the route of administration
- the time of administration
- any patient conditions that would preclude implementation of the order
the science that deals with the origin, nature, effects, and uses of drugs or medications:
______________ is a classified system of names.
In pharmacology, a drug may be classified by:
- its method of legal purchase
how many names does a drug have, and what are they?
- at least three
- chemical name
- generic name
- trade name/proprietary name
What does the FDA require to be on the information sheet of all drugs (7)?
- the trade name
- generic name
- chemical composition
- chemical strength
- usual dose
- indications and contraindications
- reported side effects
an annual publication that contains current product information:
Physicians Desk Reference (PDR)
How are drugs listed in the PDF and what is included?
- on color coded pages by both generic and brand names
- accepted uses
- side effects
the study of how drugs enter the body, are absorbed, reach their site of action, are metabolized, and exit the body:
the process by which a drug enters the systemic circulation in order to provide the desired effect:
Name the forms of absorption of dosage from slowest to fastest (6):
- coated tablets/enteric coated tablets
What forms are necessary for absorption?
liquid or gas form (a solid must be broken down first)
What do we call the crushing of a solid (ex. tablet)?
the means by which a drug travels from the site of absorption to the site of action, usually through the blood stream:
the process by which the body transforms drugs into an inactive form that can be excreted from the body once the body renders it useless:
What is the primary organ for metabolism?
the elimination of drugs from the body after they have been metabolized:
excretion (also elimination)
What is the primary organ for excretion?
the study of the effects of drugs on the normal physiological functions of the body:
the desired outcome or the effect of the drug on cells in the body is the:
the undesired outcome or the consequence other than the one for which a drug is used:
What are some things that can cause a toxic effect (overdose of the drug in the system)?
- inadequate excretion
- impared metabolism
- drug sensitivity
a specific drug that treats a toxic effect:
an unusual reaction that varies from the reaction expected:
idiosyncratic reaction (meta reaction)
a drug that produces a specific action and promotes the desired result:
a drug that attaches itself to the receptor, preventing the agonist from acting:
occurs when a patient has been sensitized to the initial dose of a medication and has built up antibodies against that allergen:
a life-threatening allergic reaction:
anaphylaxis (usually occurs within 5 minutes)
drugs that are classified according to their action or function:
when one medication hinders another:
synergistic (additive) effect
antiallergic medications that are used primarily to treat allergic disorders both acute (sudden) and chronic (on-going):
What are some of the most common antihistamines?
- Benadryl/diphenhydramine (also analgesic)
- Adrenalin/epinephrine (also vasoconstrictor/adrenergic)
How is a generic name usually written?
in all lower-case letters
drugs used to destroy or inhibit the growth of microorganisms:
- ex. for wound infections, skin prep, anything that fights bacteria
name some common antibiotics:
- alcohol and betadine - iodine (skin prep)
- Keflex (cephalosporins)
- Bactrim (specific infections of urinary tract)
- Penicillin (broad spectrum)
drugs that relieve pain without causing loss of consciousness:
name some common analgesics:
- opioids (any drug similar to morphine)
- Morphine sulfate (MS)
- Aspirin/acetylsalicylic acid
- naproxen/naproxen sodium
- Motrin or Advil/ibuprofen
because ___________ are capable of becoming addictibe, they are classified as controlled substances.
name some narcotics (sleep-inducing):
- all opiates
- all sleep-inducing meds
- CNS depressants
- street drugs (controlled substances)
Name some rules when dealing with controlled substances:
- must be in locked containers
- must be counted daily
- patient's name, dose, and name & title of the person administering the med must be recorded
name some anticonvulsants:
drugs used to depress the CNS:
What is a general rule when it comes to a patient that has been given a sedative/tranquilizer?
the pt cannot be left alone
name some cathartics:
- Castor oil
- Magnesium citrate
name some sedatives/tranquilizers:
used to counteract the effects of sedatives and analgesics:
what medication can be used as an antagonist to Valium and Versed?
what medication can be used as an antagonist to morphine and other opiates?
Narcan/naloxone (prevents or reverses respiratory depression, sedation, and low blood pressure)
agents that act on the CNS to produce loss of sensation:
What are the two main types of anesthetics?
- general anesthetics (CNS depressants by producing muscle relaxation and loss of consciousness)
- local anesthetics (block nerve conduction from a specific area of the body to the CNS)
Name some anesthetics:
- Xylocaine/lidocaine (local; arteriograms, also an antiarrhythmic)
- Anectine/succinylcholine chloride, numbs throat for scopes/E.T.tubes; skeletal muscle relaxer
- Pentothal/thiopental sodium
- Fluothane/nitrous oxide
name some hypoglycemics:
- Glucophage/metformin (check bun/creatinine levels, contraindicated in pts with poor kidney function)
what is the first step in administering any type of medication?
check the order!!!!
list the steps in administering any type of medication:
- check the order
- verify the medication and check expiration date
- check for allergies in the chart or get allergy history from pt
- perform hand hygiene before preparing medication
Why do you discard a medication if the expiration date has passed?
it loses its sterility and its potency
how many times should you read the label before administering a medication?
THREE (when you select the medication, while preparing the dose, just before administering it)
list the five rights of medication administration:
- the right dose
- the right medication
- the right patient
- the right time
- the right route
name three routes of medication administration:
- enteral route
- topical route
- parenteral route
list examples of enteral routes:
- NG tube
- medication inhalation
what is meant by administering by a topical route?
through the surface of the skin (paste or disks)
what is meant by administering by a parenteral route?
- any route other than through the digestive system:
What is the easiest and most familiar, but also the slowest route of administering medication?
- must dissolve in the stomach and then pass into the small intestine where most of the absorption takes place
A topical route is absorbed through the skin into the bloodstream for a ____________ effect.
name two examples of administering medicine through a rectal route:
Name four ways to administer medication by a parenteral route (injections):
- Intradermal (ID)
- Subcutaneous (SC)
- Intramuscular (IM)
- Intravenous (IV)
what is the hollow canal of the hypodermic needle?
what is the plastic place the hypodermic needle screws into?
how should the hypodermic needle be positioned to enter the skin?
the slant or tip should be bevel up to pierce the skin more easily
the diameter of the hypodermic needle:
Describe the relationship of hypodermic needle gauges:
- the larger the gauge, the smaller the needle
- example: an 18 gauge needle is larger than a 22 gauge needle
What is the length range of the hypodermic needle and the routine length?
- range: 1/2" to 4 1/2"
- routine: 2 1/2"
What angles are used for the different injection types?
- Intradermal (ID) angled 15 degrees
- Subcutaneous (SC) angled 45 degrees
- Intramuscular (IM) angled 90 degrees
- Intravenous (IV) angled 15 degrees
What gauge needles are common for the different injection types?
- Intradermal (ID) 26 gauge
- Subcutaneous (SC) 23-25 gauge (5/8")
- Intramuscular (IM) 22 gauge (large)
- Intravenous (V) hypodermic (usually for only phlebotomy), butterfly set, or IV catheter (angiocath)
In what locations are the different injection types usually taken?
- Intradermal (ID) anterior forearm
- Subcutaneous (SC) upper arm and outer aspect of thigh
- Intramuscular (IM) deltoid (arm), gluteal muscles (butt), vastus lateralis (thigh) *under 5 yrs - never booty, always thigh
- Intravenous (IV) antecubital veins
What are some reasons for Intradermal injections?
- formerly to test for allergic reactions
- TB skin test
With all IV injections you are looking for __________, while for all muscular injections, you are not.
What is the parenteral route that offers the most immediate results in terms of effect?
Where should the tourniquet be placed when preparing for an IV placement?
3 to 5 inches above intended site (antecubital vein) to dilate the vein
When feeling for a vein for an IV puncture, what should you feel?
vein should feel soft and spongy, not hard
What are some things you can do to locate hard-to-find veins?
- applying a warm compress
- allowing the pt's arm to dangle
- have pt pump their fist
for an IV placement, avoid veins that are:
- tortuous (twisted)
- hard to see
- veins that are used repeatedly
- veins where skin is in poor condition
- veins that lay on an artery
- thin veins
- veins in extremeties compromised by surgery, paralysis, mastectomy
What is the last thing done in administering medication intravenously, after disposing of the syringe and needle properly?
chart all relevant information
In which direction should you snap the neck of an ampule?
away from you
what are the two positions recommended for the ampule when withdrawing the medication?
- invert the ampule
- set on a flat surface
What could happen if you fail to check for/remove air bubbles from a syringe?
- an air bubble can be fatal
- can cause an air embolism (to the brain, heart, etc.)
How is the air/liquid ratio handled when drawing up meds from a vial?
- pull a portion of air into the syringe that is equal to the amount of liquid you want to withdraw.
- insert needle and inject air.
- withdraw amount of liquid necessary
If a vial is used to administer med to a pt, and not all of the medication is used that first time, can you draw from that same vial again?
only for the same patient, and only within 24 hours
Is the vial sterile?
only on first use, wipe for further uses
What type of injection system is an ampule? a vial?
- ampule: open system
- vial: closed system
when fluid escapes into surrounding tissues:
extravasation (also, infiltration)
what are some effects of extravasation?
- causes area to swell
- can be very painful
name some precautions to minimize the risk of extravasation:
- check for backflow of blood
- immobilize catheter/needle at injection site
- stop injection immediately if pt complains of pain/burning or if swelling or resistance is noticed
what steps should be taken if extravasation occurs?
- remove needle and apply pressure until bleeding stops
- apply cold ice packs
- keep applying ice packs for 20 to 60 minutes, repeated 3x a day until swelling is diminished
blood that has escaped or extravasated into surrounding tissue:
Keep IV solution ___________ above the level of the vein.
18-20 (book says 18-24)
what may occur if IV solution is too high?
it may infiltrate into surrounding tissue
what may occur if IV solution is too low?
it may flow back into the IV tubing and clot, causing the fluid to stop flowing
What can happen if an IV infusion runs too fast, and which pts are more susceptible to it?
- may receive more fluid than can be readily assimilated causing pulmonary edema
- especially for pts with conditions like COPD or CHF
What should always be included when charting medication?
- time of day
- name of drug
- route of administration
- identity of person charting (full name and department)
If the radiographer charts medication, what should be done besides signing the full name and department?
must be countersigned by the radiologist
In the case of an emergency situation, make written notations of:
- identification of person administering med
- signature of ordering physician
When is a common use of heparin?
when an artery is cathed because it's an anticoagulant (prevents clotting)
how is Nitroglycerin administered?
sublingually, enteral route
What is the radiographer's principle role in medication administration?
to monitor IV fusions and to assist with emergency medication administration and meds for radiologic procedures
generic medications are the same as, but less expensive than, proprietary medications. true or false?
What is a more common name for an intermittent injection port?
heparin lock or saline lock
adrenaline is used for _________ allergic reactions.
what type of drug relieves pain without loss of consciousness?
what class of drug is Penicillin?
4 1/2" needles are used for what type of injection?
list four complications of antibiotics:
- secondary infection
- developed resistance
- tissue damage or injury
- allergic reaction
How many times should a student try to stick a patient before asking for help?
c (with a like over it):
s (with a line over it)
Name an Adrenergic (vasoconstrictor):
What would you like to do?
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