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- Each drug has three names
- The chemical, generic, and trade name
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The chemical name provides
The exact description of medications composition
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The generic name is
From the manufacturer who first develops the drug and assigns the name, and then it is listed in the US pharmacopeia
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The trade name is also known
As known as the brand or proprietary name. this is the name that the manufacturer markets the medication
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The marker picks the generic name so that it is
Easy to spell and to remember
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The three different classifications of drugs
The effect of medication on body system, the symptoms the medication relieves, the medications desired effect
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forms medications can be in
Solid, liquid, other oral forms: topical, parenteral, forms for installation into body cavities
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Types of medication action- therapeutic effect
Expected or predicted physiological response. Why we are giving it.
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Types of medication action- side effect
Predictable and Unavoidable secondary effect, they are usually produced at the therapeutic dose
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Types of medication action- adverse effect
Unintended undesirable and often unpredictable. can be immediate but also can .take weeks or months to develop. Often adverse effects are severe enough that they are discontinued by the manufacturer.
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Types of medication action- toxic effect
Accumulation of medication in the bloodstream or develop after a prolonged intake of a medication or because person takes more than therapeutic dose. A type of adverse effect that is predictable
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2 reasons why medication may accumulate in bloodstream
Impaired Metabolism or excretion.
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Type of medication action- Idiosyncratic reaction
Rare unpredictable response at a normal dose. Overreaction or under reaction or different reaction from normal. It is a type of adverse effect
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Type of medication action allergic reaction
It is a type of adverse effect. Unpredictable response to medication. In this case the medication acts as an antigen in checkers the release of antibodies in the body . Allergic responses may differ per individual
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Three types of adverse effects
Toxic. idiosyncratic. Allergic.
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List all six types of medication action
Therapeutic. Side effect. Adverse. Idiosyncratic. Allergic. Toxic.
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This drug often causes a high amount of allergic reaction
Antibiotics
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Severe life threatening reaction to the medication where they get sudden construction of the bronchials. Thier airway gets obstructed. Edema of pharynx and larynx. Severe wheezing and shortness of breath. It is a medical emergency that requires immediate medical attention.
Anaphylactic reaction
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Can either increase or decrease the actions of one or both of the drugs involved and can be either beneficial or harmful
Medication interaction
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What is polypharmacy
The use of many different drugs (prescription or over the counter) concurrently in treating a patient. (Often they have several health problems)
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What is increased when a person experiences polypharmacy
Medication interaction. adverse effects. or even effects of the medication to food
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Synergistic effect
Effect of two medications combined is greater than the effects of the medication when given separately. can be positive or negative
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Established a government agency (fda) to approve all new drugs and determine that the drug was safe with humans . to make sure drugs were free of impurities. And To make sure drugs contain what they say they contain
Food, drug, and Cosmetic Act of 1938
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amendment of 1952. specified the criteria for prescription medications and over the counter medications
Durham-humphrey amendment
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Kefauver-harris amendment of 1962
Established the FDA as responsible for approving drugs official names (generic)
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Established schedule of drugs. Categorizing them according to their potential for abuse. Made it illegal to possess a controlled substance without a legal prescription for it
Comprehensive drug abuse and Control Act of 1970
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Schedule 1 drugs
Often your street drugs. Not considered legitimate for medical use. Examples being heroin LSD and peyote
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Schedule 2 drugs
Consider to have strong potential for abuse but also have a legitimate medical use. Examples being morphine opium cocaine
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Schedule 3 drugs
Drugs and less potential for abuse than schedule 2 or 1, or addiction and have a use for medical purpose . being short acting barbituates and amphetamines. Example is anabolic steroids
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Schedule 4 drugs
Medically useful category of drugs that have left potential for abuse then schedule 3, 2, or 1 . Examples -diazepam, valium, or xanax
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schedule 5 drugs
Very little chance of addiction. Examples being antidiarrheals, antitussives (cough syrup with codeine)
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Controlled substances must be kept locked in a secure place and:
have a special inventory with an ongoing record. wasting. counting for reconciliation of drug each shift, must be seperate from other medications
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Wasting includes
Keeping a record of how much was thrown out. And having a witness record how much you threw out and they must sign that they witnessed it
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The 6 steps of pharmacokinetics
- The study of how medications:
- enter the body
- are absorbed and distributed into cells, tissues, and organs
- reach the site of action
- alter physiological function
- are metabolized
- and exit the body
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Four processes included when considering pharmacokinetics
Absorption. Excretion. Distribution. metabolism.
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in order for drugs to be considered therapeutic they must follow the 6 steps of pharmacokinetics . true or false
True
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passage of medication molecules into the blood from the site of administration
Absorption
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factors that influence absorption
The route of administration. Ability to dissolve. blood flow to site of administration. Body surface area. lipid solubility.
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What has the fastest and slowest absorption rate
Topical has the slowest. IV has the fastest because it goes directly into the bloodstream
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Would a larger body surface equal faster or slower absorption
Faster
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Which is easier to absorb lipid soluble or water soluble medications
lipid soluble (cell membranes made up of lipids and lipids are attracted to lipids)
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Occurs after absorption. Occurs within the body to tissues, organs, and specific sites of action
Distribution
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Distribution depends on
Physical and chemical properties of the medication. Unique physiology of the person taking it.
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The speed of distribution will depend on how vascular areas are. List some highly vascular and less vascular areas.
High vascular organs such as the heart, liver, and brain will deliver medications quicker. It is more slowly distributed in muscle, fat, and skin
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The blood brain barrier only allows what type of soluble medicine to pass to the brain and cerebral spinal fluid
Liquid soluble
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what three aspects of a person's physiology changes how fast distribution occurs
Circulation (vascularity), membrane permeability (lipid versus water soluble), protein binding
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What allows both water soluble and lipid soluble agents to pass. Considered a nonselective membrane.
Placenta
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Serum protein that a majority of meds bind to partially. Once they bind to it they can't be pharmacologically active (no therapeutic effect)
Albumin
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Once attached to albumin. The part that is not attached and remains free is considered the:
Active form of the medication . It is amount that will produce the therapeutic response (more exposed=more distribution)
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Once distributed to its specific site Medications are metabolized into what type of form?
less potent or inactive form
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Metabolism can also be known as
Biotransformation
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Biotransformation occurs
Under the influence of enzymes that detoxify, breakdown, and remove active chemicals
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Main organ where biotransformation occurs
Liver
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What other organs play a role in biotransformation
Kidneys. blood. Intestines. And lungs
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This individual has a decrease in liver function. that occurs with aging. Or maybe they have liver disease such as cirrhosis or hepatitis makes the medication be metabolized ( slower or faster)
slower
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Medications excreted through
The kidneys which is the main one, the bowels, lungs, and exocrine glands
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Will help promote excretion of medication in the average normal adult
drinking 2 liters of water a day
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Determines the organ of excretion
Chemical makeup of medication
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Laxative s and enemas increase excretion through the
Feces !
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The therapeutic range
Occurs between the minimum effective concentration and the toxic concentrations . It is the range the medication producing the desired response
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The plasma level of a medication below which the therapeutic effect of the medication occurs
Minimum effective concentration
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Tyelon, acetaminophen, N-acetyl-para-aminophenol. Which drug name is which?
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Medication dose responses
Onset, trough, plateau, peak, duration, biological half-life
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Types of typical allergic reactions
Rash, hives, itching
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Minimum blod serum concentration before next scheduled dose
Trough
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Time it takes for a medication to produce a response
Onset
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Point at which blood serum concentration is reached and maintained
Plateau
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Idiosyncratic reactions occur most often to what people
Children
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Point at which blood serum concentration is reached and maintained
Plateau
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Time at which a medication reaches its highest effective concentration
Peak
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Time medication takes to produce greatest result
Duration
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Time for serum medication concentration to be halved
Biological half-life
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Professionals that can prescribe medication
Physician, nurse practitioner, or physician's assistant
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Medication orders can be prescribed 3 ways
Written, verbal, or given by telephone
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Every medication order needs to include:
- Patient's name
- Order date
- Medication name
- Dosage
- Route
- Time of administration
- Drug indication
- Prescriber's signature
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Standing orders
Carried out until canceled by prescriber
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PRN or As needed
Given only if patient needs it
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One-Time orders
Given one time at a specific time
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STAT order
Single dose immediately
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Now Orders
Specific one time order, quickly (within 30min) but not STAT
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Two types of Distribution Systems
Unit Dose and Automated Medication Dispensing System
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Uses a portable cart that contains a drawer for each client's medications for a 24 hour period
Unit Dose (distribution system)
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Each nurse has a security code and must select medication or bioidentification(finger print)
Automated medication dispensing system
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Assessment for medication administration
- Patient Hx
- Allergies
- Medication Hx
- Diet HX
- Perceptual or coordination problem
- Current condition
- Attittude about medication use
- Knowledge/Understanding of medication Therapy
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Tips for administration of medications safely
- Avoid distractions and follow same routine
- Administer only meds that you prepare, and never leave prepared meds unattended
- Know meds you are giving
- Keep controlled meds secure
- Use only clearly labeled meds
- Don't use cloudy liquid meds or ones that changed colors
- Calculate accurately
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When considering liver disease why is it important to give smaller doses
Often kidneys unable to excrete medications quickly so it may build up to toxic effects
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Considering the therapeutic range when is it the best time to give another dose
At minimum effective concentration
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Six rights of medication administration
Medication, dose, patient, route, time, documentation
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As a nurse you must validate the written medication order with the?
MAR (medication adminstration record)
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Once you check the MAR and physician's order, ou must validate the medication by?
Comparing the label on medication with MAR three times
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Difference between plateau and peak
Basically same thing
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IV antibiotics (gentamycin and vancomiosen)
If in toxic levels can cause hearing loss and damage kidneys. Very important to recognize therapeutic range(peak or trough)
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Time at which to administer another dose
30 mins after trough so that second dose doesn't take medication into toxic range
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Checking the medication to MAR three times: (the three safety checks)
- While removing from drawer or shelf
- As you remove the amount from container
- At the beside before administrating
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The half life of a medication in 8hrs, 16hrs, 24hrs, and 32hrs. What is percentage left
50%, 25%, 12.5%, 6.25%
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If given a patient 2 grams of medicine after 12hrs, 24hrs, 36hrs, 48hrs how many mgs are left
1gram, 500mg, 250mg, 125mg
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Never cut/crush time released meds that say
ER, ST, CR
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Acceptable identifers include
Patient's name, identification number assigned by the health care facility, patient's date of birth
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How to apply opthalmic ointment
Ask patient to look at ceiling, hold ointment applicator above lower lid margin and apply a thin stream of ointment evenly along the inner edge of lower eyelid on the conjunctiva from the inner canthus to the outer canthus, patient close the eye (not firmly) and roll eye behind closed eyelid
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Otic medications: How to place patient
Side lying position
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For otic medications straighten ear canal by (children vs adults)
Pull auricle down and back for children, upward and outward for adults
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Try to wait how long between different inhaled medications
2 to 5 mins
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Opthalmic administeration:with dominant hand resting on patient's forehead, hold filled medication eye dropper or opthalmic soultion where?
1 to 2 cm(1/2 to 3/4 inch) above conjunctiva sac
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Repeat putting a opthalmic drop in if?
Client blinks or closes eye or if the drop lands on outer lid margins
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After a opthalmic drop is instilled, make sure to do what?
Gently close eye
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Transdermal Medications
Are applied topically to skin, disk holds the medicated ointment to the skin, may stay in place as little as 12 hrs to 7days, rotate site of new patches
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Types of parenteral medication
Subcutaneous, Intramuscular(IM), Intradermal (ID), Intravenous(IV), Insulin
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Parts of the syringe
Plunger, barrel, needle hub(or hit): needle including shaft, lumen, bevel
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Two types of syringes used:
Luer-Lock, slip tip
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Syringe used for IM and subcutaneous
1 to 3mL
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Syring used for certain IV meds
3 to 5mL
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Syringe used for insulin
Only used for insulin! Each mL contains 100 units of insulin
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Disposal of sharps includes:
Use puncture proof container, never throw in waste can, never bend or break before disposal, never recap except under specific circumstances (use 1 scoop method), use safety devices on needle, dispose needle end first in SHARPS container
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Length of needle determined by:
Patients size, weight, and route of administration
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Only time you can recap a needle
It is a clean needle. Such as you have drawn up medications and now have to take to patients room
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Tuberculin syringes hold how many mL
1
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Medications can come supplied in for needles?
Ampule, vial, and prefilled cartridge
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Glass container that usually holds a single dose of a drug
Ampule
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When preparing to use ampule
Hold upright, tap top of ampule, above neck. (To make sure all medication in bottom portion), break ampule at neck, break the neck of the glass away from your body using a gauze.
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Withdraw medication from ampule in upright position, using what type of needle?
Filter needle (dispose afterwards and change to needle for injection)
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Intraocular Disk application
Wear gloves! Gently press fingertip against disk so it adheres to your finger, with other hand gently pull back the client's lower eyelid away from eye. Ask patient to look up. Place disk in conjunctival sac so that it floats on tha sclera between the iris and lower eyelid.
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Glass bottle with sealed rubber cap: range from single to multidose
Vial
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Preparation of medications from vials
Pierce rubber top with needle, if not first person to use make sure to clean stopper with alcohol wipe, inject air prior to withdrawl medicine (equalizes pressure).
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Rule for injecting air into vial
Add the same amount of air as the amount of medication you remove
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If medication dispensed of powder it must be...
Reconstituted
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Date and initial any vial that?
You open and is going to be used more than once
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The smaller the gauge of the needle the...the diameter
Larger
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Mixing of medications using on syringe: 2 vials
Total volume is appropriate for injection site. 2 vials(draw up air equal to both meds: inject air vial 1 then vial 2)(withdraw med from vial 2 the vial 1)
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Mixing of Medications using one syringe: vial and ampule
Draw up air equal to volume from vial: ampules do not require injection of air
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Bleb
Raised area after intradermal administration injection
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Z track method: when you might use it?
For IM injections: medications that are irritating to tissues or stain the tissues may require it
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Oral medication types
Tablets. Tablets with interventions. Liquid. Liquid - less than 5 mL. Sublingual. Buccal
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