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- Each drug has three names:
- The chemical, generic, and trade name
The chemical name provides?
The exact description of medications composition
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
The trade name is also known as?
As the brand or proprietary name. this is the name that the manufacturer markets the medication
The maker picks the generic name on what criteria normally?
Easy to spell and to remember
The three different classifications of drugs:
The effect of medication on body system, the symptoms the medication relieves, the medications desired effect
Forms medications can be in: (4)
Oral, topical, parenteral, forms for installation into body cavities
Types of medication action- therapeutic effect:
Expected or predicted physiological response. Action we are trying to get.
Types of medication action- side effect:
Predictable and Unavoidable secondary effect, they are usually produced at the therapeutic dose
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.
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
2 reasons why medication may accumulate in bloodstream:
Impaired Metabolism or excretion.
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
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
Three types of adverse effects:
Toxic. idiosyncratic. Allergic.
List all six types of medication action:
Therapeutic. Side effect. Adverse. Idiosyncratic. Allergic. Toxic.
This drug often causes a high amount of allergic reaction?
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.
Can either increase or decrease the actions of one or both of the drugs involved and can be either beneficial or harmful?
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)
What is increased when a person experiences polypharmacy?
Medication interaction. adverse effects. or even effects of the medication to food
Effect of two medications combined is greater than the effects of the medication when given separately. can be positive or negative
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
Amendment of 1952. Specified the criteria for prescription medications and over the counter medications.
Kefauver-Harris Amendment of 1962?
Established the FDA as responsible for approving drugs official names (generic)
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
Schedule 1 drugs?
Often your street drugs. Not considered legitimate for medical use. Examples being heroin LSD and peyote
Schedule 5 drugs?
Very little chance of addiction. Examples being antidiarrheals, antitussives (cough syrup with codeine)
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
Keeping a record of how much was thrown out. And having a witness record how much you threw out in a sharps container and they must sign that they witnessed it
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
Four processes included when considering pharmacokinetics
Absorption. Excretion. Distribution. Metabolism.
In order for drugs to be considered therapeutic they must follow the 6 steps of pharmacokinetics . True or false?
Passage of medication molecules into the blood from the site of administration
Factors that influence absorption: (5)
The route of administration. Ability to dissolve. Blood flow to site of administration. Body surface area. Lipid solubility.
What has the fastest and slowest absorption rate?
Topical has the slowest. IV has the fastest because it goes directly into the bloodstream
Would a larger body surface equal faster or slower absorption?
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)
Occurs after absorption. Occurs within the body to tissues, organs, and specific sites of action
Distribution depends on:
Physical and chemical properties of the medication. Unique physiology of the person taking it.
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
The blood brain barrier only allows what type of soluble medicine to pass to the brain and cerebral spinal fluid?
What three aspects of a person's physiology changes how fast distribution occurs?
Circulation (vascularity), membrane permeability (lipid versus water soluble), protein binding
What allows both water soluble and lipid soluble agents to pass. Considered a nonselective membrane?
Placenta (fat-soluble and nofat-soluble agents often cross the placenta and produce fetal deformities)
Serum protein that a majority of meds bind to partially. Once they bind to it they can't be pharmacologically active (no therapeutic effect)
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)
Once distributed to its specific site Medications are metabolized into what type of form?
less potent or inactive form
Metabolism can also be known as
Under the influence of enzymes that detoxify, breakdown, and remove active chemicals
Main organ where biotransformation occurs
What other organs play a role in biotransformation
Kidneys. blood. Intestines. And lungs
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)
Medications excreted through
The kidneys which is the main one, the bowels, lungs, and exocrine glands
Will help promote excretion of medication in the average normal adult
drinking 2 liters of water a day
Determines the organ of excretion
Chemical makeup of medication
Laxative s and enemas increase excretion through the
The therapeutic range
Occurs between the minimum effective concentration and the toxic concentrations . It is the range the medication producing the desired response
The plasma level of a medication below which the therapeutic effect of the medication occurs
Minimum effective concentration
Tyelon, acetaminophen, N-acetyl-para-aminophenol. Which drug name is which?
Medication dose responses
Onset, trough, plateau, peak, duration, biological half-life
Types of typical allergic reactions
Rash, hives, itching
Minimum blod serum concentration before next scheduled dose
Time it takes for a medication to produce a response
Point at which blood serum concentration is reached and maintained
Idiosyncratic reactions occur most often to what people
Point at which blood serum concentration is reached and maintained
Time at which a medication reaches its highest effective concentration
Time medication takes to produce greatest result
Time for serum medication concentration to be halved
Professionals that can prescribe medication
Physician, nurse practitioner, or physician's assistant
Medication orders can be prescribed 3 ways
Written, verbal, or given by telephone
Every medication order needs to include:
- Patient's name
- Order date
- Medication name
- Time of administration
- Drug indication
- Prescriber's signature
Carried out until canceled by prescriber
PRN or As needed
Given only if patient needs it
Given one time at a specific time
Single dose immediately
Specific one time order, quickly (within 30min) but not STAT
Two types of Distribution Systems
Unit Dose and Automated Medication Dispensing System
Uses a portable cart that contains a drawer for each client's medications for a 24 hour period
Unit Dose (distribution system)
Each nurse has a security code and must select medication or bioidentification(finger print)
Automated medication dispensing system
Assessment for medication administration
- Patient Hx
- Medication Hx
- Diet HX
- Perceptual or coordination problem
- Current condition
- Attittude about medication use
- Knowledge/Understanding of medication Therapy
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
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
Considering the therapeutic range when is it the best time to give another dose
At minimum effective concentration
Six rights of medication administration
Medication, dose, patient, route, time, documentation
As a nurse you must validate the written medication order with the?
MAR (medication adminstration record)
Once you check the MAR and physician's order, ou must validate the medication by?
Comparing the label on medication with MAR three times
Difference between plateau and peak
Basically same thing
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)
Time at which to administer another dose
30 mins after trough so that second dose doesn't take medication into toxic range
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
The half life of a medication in 8hrs, 16hrs, 24hrs, and 32hrs. What is percentage left
50%, 25%, 12.5%, 6.25%
If given a patient 2 grams of medicine after 12hrs, 24hrs, 36hrs, 48hrs how many mgs are left
1gram, 500mg, 250mg, 125mg
Never cut/crush time released meds that say
ER, ST, CR
Acceptable identifers include
Patient's name, identification number assigned by the health care facility, patient's date of birth
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
Otic medications: How to place patient
Side lying position
For otic medications straighten ear canal by (children vs adults)
Pull auricle down and back for children, upward and outward for adults
Try to wait how long between different inhaled medications
2 to 5 mins
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
Repeat putting a opthalmic drop in if?
Client blinks or closes eye or if the drop lands on outer lid margins
After a opthalmic drop is instilled, make sure to do what?
Gently close eye
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
Types of parenteral medication
Subcutaneous, Intramuscular(IM), Intradermal (ID), Intravenous(IV), Insulin
Parts of the syringe
Plunger, barrel, needle hub(or hit): needle including shaft, lumen, bevel
Two types of syringes used:
Luer-Lock, slip tip
Syringe used for IM and subcutaneous
1 to 3mL
Syring used for certain IV meds
3 to 5mL
Syringe used for insulin
Only used for insulin! Each mL contains 100 units of insulin
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
Length of needle determined by:
Patients size, weight, and route of administration
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
Tuberculin syringes hold how many mL
Medications can come supplied in for needles?
Ampule, vial, and prefilled cartridge
Glass container that usually holds a single dose of a drug
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.
Withdraw medication from ampule in upright position, using what type of needle?
Filter needle (dispose afterwards and change to needle for injection)
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.
Glass bottle with sealed rubber cap: range from single to multidose
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).
Rule for injecting air into vial
Add the same amount of air as the amount of medication you remove
If medication dispensed of powder it must be...
Date and initial any vial that?
You open and is going to be used more than once
The smaller the gauge of the needle the...the diameter
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)
Mixing of Medications using one syringe: vial and ampule
Draw up air equal to volume from vial: ampules do not require injection of air
Raised area after intradermal administration injection
Z track method: when you might use it?
For IM injections: medications that are irritating to tissues or stain the tissues may require it
Oral medication types
Tablets. Tablets with interventions. Liquid. Liquid - less than 5 mL. Sublingual. Buccal
First American laww to regulate medications. Simply required all medications to be free of impure products
Pure Food and Drug Act
Set standards for medication strength, quality, purity, packaging, safety, labeling, and dose form
(USP) United States Pharmacopeia
Local governmental bodies do not regulate drugs other than
Alcohol and tobacco
Which are more restrictive? agency policies or governmental controls
Study of how meications enter the body, reach their site of action, metabolize, and exit the body
Mucous membranes and respiratory airways cause medications to absorbed faster because:
Areas of many blood vessels
Orally administered meds pass through the gastrointestinal tract, causing their absorption to be?
Acidic meds pass through what area most rapidly? Basic medications are not absorbed till they reach?
For drugs needing to go to the central nervous system they are antibiotics injected directly where?
Subarachnoid space in the spinal cord
Patients at risk for an increase in medication activity or/and toxicity due to large amount of active form medication after it attachs to albumin.
Patients with liver disease
Easiest and most commonly used route. Slower onset of action and more prolonged effect?
The Sublingual route should not be swallowed and patient is not to?
Drink anything until medication completely dissolved
Mild allergic reaction symptoms: (4)
Rash-reddened raised vesicles
Pruritus- itching of skin
Rhinitis-inflammation of mucous membranes lining nose
Ways to eliminate anesthetic gases more rapidly after surgery: (2)
Deep breathing and coughing
Peristalsis due to (2 things) can prolong effects of medication:
Concerns with vancomycin
Administration based on peak and trough. Trough level drawn 30 minutes before administering the drug. Peak level drawn whenever drug expected to reach peak concentration
Verbal orders; what to do?
Writes complete order or enters it into a computer
Reads it back and receives confirmation from prescriber to confirm acccuracy
Indicates time and name of prescriber who gave order, signs it
Follows agency policy to indicate that it was read back
Time critical medications vs. Non-time critical medications
Time critical are medication in which early or delayed administration of maintenance doses (more than/less than 30 minutes) will most likely cause harm or result in subtherapeutic responses
Non-time critical include medications which the timing of administration will most likely not affect the desired effect if med given 1 to 2 hours before/after scheduled time
In response to medication error the nurse will:
Assess patient's condition and notifies health care provider of the incident as soon as possible
Once patient stable the nurse reports incident to appropriate person in the institution
Responsible for filling written occurrence withing 24 hours.
Incident reports for medication errors include:
- Patient identification
- Accurate factual description of what occurred
- What was done
- Signature of nurse involved
Compare label of medication container with the MAR three times:
- Before removing container from drawer or shelf
- As the amount of medication ordered is removed from container
- At the patient's bedside before administering medication to the patient
The MAR should clearly reflect:
- Patients full name
- Name of ordered medicaiton written out in full
- Time of medication to be admiinstered
Nursing students prohibited from receiving what time of medication orders
Oral medications reach their therapeutic action best if given
30 minutes to 1 hour before meals.
Food, fluid, medications intended for GI administration inadvertently enters respiratory tract.
To reduce aspiration risk?
- Seat patient at 90 degree angle
- Flex head in chin down position
If medication needs to be give on empty stomach or is not compatible with the feeding. Food needs to be held?
At least 30 minutes before or after medication administration
Guidelines for transdermal patches
- Document location on body where medication was place on MAR
- Ask patient if they have an existing one before applying
- Ask patient if he/she takes medications in forms of patches, topical creams, or route other than oral
- Dressing or patch difficult to see apply a noticeable label to patch
- Document removal of patch or medication on MAR
Types of Parenteral Medications (4)
Intradermal administration requires what syringe and what needle?
- 1mL syringe
- 25 to 27 gauge needle with 1/4 to 1/8 inch
Insert needle how far in an intradermal administration? The needle bevel faces which direction?
Angle of an Intradermal administration? Used for dosages of ?
5 to 15 degress
0.1 to 0.5 mL
Body sites used for intradermal injections
- Three to four finger widths below the antecubital space and one hand width above wrist.
- Able to use upper back
- Area needs to be lightly pigmented, free of lesions, and relatively hair-free
Procedure of intradermal injection. Start with cleaning center of site-outwards.
- Hold swab non-dominant hand.
- Pull cap straight off
- Support lower arm
- Needle at 5-15 degrees, bevel up, pierce the skin until resistance felt
- Advance the needle through epidermis 1/8th inch approximately
- Inject slowly noting bleb 1/2 inch in size
- DONT massage
Subcutaneous Administration dosage? Length and gauge of needle?
0.5 to 1mL
1/4th to 5/8th inch needle
25 to 27 gauge needle
Angle of administration
- 45 degress when less than 1 inch adipose tissue can be grasped at site
- 90 degrees when 2 inches of tissue can be grasped
Body sites for subcutaneous injections
- Upper outer aspect upper arms
- Anterior aspect thighs
- Abdomen below umbilicus (no closer than 2 inches)
- Scapular areas upper back
- Upper bentrogluteal and dorsogluteal areas
Procedures for subcutaneous injections starting from cleanin center of site outwards
- Hold swab non-dominant hand
- Pull cap straight off
- Grasp syringe in dominant hand, hold between thumb and fingers(dart)
- Inject 45 to 90 degrees
- DONT aspirate
- Depress plunger with slow even pressure
Size and length of needle in an intramuscular injection depends on?
- Muscle size
- Type of solution
- Amount of adipose tissue covering muscle
- Age of patient
Gauge of IM needle?
18 to 24G
- 1/2 -1 inch needle for thin people
- 1-2 inch needle for average size
- 2-3 inch needle for obese or morbid people
For a deltoid intramuscular injection always use? Maximum dosage?
1.5 inch needle and max dose is 1mL
Procedure for intramuscular adminstration starting with changing needle after drawing up medication.
- Hold upright and expel all air
- Obtain assistance for uncooperative patient
- Put on clean gloves
- Select site. Clean from center outward
- Hold swab in nondominant hand
- Use ulnar side of non-dominant hand to pull skin 1 inch to side
- Hold syringe between thumb and forefinger, pierce skin quickly at 90 degree angle
- Aspirate 5 to 10 seconds
- If no aspiration inject steadily and slowly
- Wait 10 seconds before withdrawing needle
- Apply pressure but don't massage
IM injection sites
- Vastus lateralis
- Rectus femoris
Finding ventrogluteal spot
- Place in lateral position with knee and hip bent
- Place opposite heel hand on greater trochanter
- Point fingers toward patient's head
- Right hand forleft hip, left hand for right hip
- Index finger on the anterior superior iliac spine, stretch middle finger toward buttocks, thumb toward groin. Triange formed is injection site
Finding vastus lateralis
- Located on anterior lateral aspect of thigh
- Divide area between greater trochanter of femur and lateral femoral condyle into thirds and select middle third
- Can assume back laying or sitting position
- (Site for infants)
- Place four fingers across deltoid muscle with first finger on acromion process
- Top of axilla is line that marks the lower border landmark, never below axilla
- Triangle within these boundaries indicates the deltoid approimately 2 inchesbelow acromion process
Finding rectus femoris
- Anterior aspect of thigh
- Used only occasionally
- Chief advantage is poeple who give own injection
- Major disadvantage is may cause considerable discomfort for some
Always aspirate for what type of administration
Infants have to be over what age to use the ventrogluteal site?
Advantage of rectus femoris?
Disadvantage of it?
- Advantage-people who give own injections
- Disadvantage-considerable discomfort
Not choice site
Right documentation of meds
- Make sure MAR is correct
- Record the med administration on the MAR as ssoon as you give it to the patient
- Documetn the site that you gave the medication if its an injection
- If you omit a medication you must document the ommission
- To be informed about a medication
- To refuse a medication
- To have a medication hx
- Be properly advised about experimental nature of medication
- Receive laeled medications safely
- Receive appropriate supportive therapy
- To not receive unncecessary medications
- To be informed if medications are part of a research study
Tablets with interventions
Keep narcotics and medications that require specific assessment, such as pulse measurements, respiratory rate/depth, or blood pressure, seperate from others
Reminds nurse to complete needed assessment
- Placed under tongue
- Readily absorbed and disolved
- Should not be swallowed
- Nitro glycerin
- Not to drink anything till med completely dissolved
- Against mucous membrane in cheek so it dissolves
- Should not chew or swallow
- Alternate cheeks when using
- Acts locally or systemically as it is swallowed in with patient saliva
- Not to be taken with liquids
- Remove cap and place upside down on counter
- Hold bottle so label is next to palm and pour med away from the label
- Hold med at eye level and fill to desired level using the bottom of the meniscus
- Before cappin, wipe lip with a paper towel
When giving small amounts of liquids prepare the med in steril syringe without the needle (less than 5mL)
How long should between eye drops?
Removal of intraocular disk
- Hand hygeine
- Pull down patient's lower eyelid
- Using forefinger and thumb of opposite hand pinch the disk and lift i out of the client's eye
- If client to receive more than one eye medication wait 5 minutes
Otic medications. Instill prescribed drops holding the dropper?
1 cm (1/2 inch) above ear canal
Ask patient to remain side-lying after otic medications for how long? You also can apply pressure to the?
5 to 10 minutes
Tragus of ear
MDI-metered dose inhalor
- Shake 5 to 6 times
- Patient take deep breath and exhale completely
- Place into mouth; 1/2 inch from mouth; into spacer into mouth then have the patient depress to express one metered dose or aerosol medication while slowly inhaling in for 3-5 seconds
- Instruct to hold breath 10 seconds
- Remove MDI and spacer before exhaling
DPI-dry powdered inhalor
- Don't shake
- Hold upright and turn wheel to right and then left until a click is heard
- Place mouthpiece between lips
- Inhale deeply and forcefully through mouth and hold breath for 5-10 seconds
Teach patients about inhalors
- Wait 20 to 30 seconds between inhalations of same medications
- Instruct to wait 2 to 5 minutes between different inhaled medications
- Steroid inhaler should be administered last
- Put on clean gloves
- Assess vaginal area noting appearance of discharge and condition of external gentalia
- Remove suppository and apply liberal amount of sterile water-based lubricant jelly to smooth or rounded end of suppository
- Nondominant hand gently separate and hold the labial folds
- Dominant gloved hand insert rounded end of suppository along posterior wall of vaginal canal the entire length of your finger 3-4 inches, with foam insert the applicator 2-3 inches
Transdermal medications can stay on
Little 12 hours up to 7 days
- Apply gloves
- Assist to Sim's position
- Lubricate suppository and index finger of dominant hand with water and soluable jelly
- Slow deep breath through mouth
- Nondominant hand retract buttocks
- Dominant hand(index for adults, pinky for children) insert suppository gently through anus, past internal sphincter and against rectal wall(4 inches in adults, 2 in children)