Medications

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AngelGoosie
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291442
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Medications
Updated:
2014-12-13 17:41:55
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Medications
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Module IV, Unit A – Medication Administration
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  1. the branch of medicine and biology concerned with the study of drug action
    Pharmacology
  2. Study of drug movement in the body
    Pharmacokinetics
  3. What does ADME stand or?
    • Absorption
    • Distribution
    • Metabolism
    • Excretion
  4. Process that occurs from the time a drug enters the body to the time it enters the bloodstream
    Absorption
  5. The portion of a drug's dose that reaches the systemic circulation  & is available to act on the body
    (drug's) bio-availability
  6. An IV drug's bioavailabilty is _______ 

    An oral drug's bioavailability is always less than ______
    100%

    Less than 100%
  7. Many drugs are ______ in liver before reaching systemic circulation
    metabolized
  8. The more lipid soluble the drug, more _____ it will pass thru cell membrane
    easily
  9. The more _____ the drug, the better it will absorb in stomach
    acidic
  10. Why do drugs absorb less rapidly when a patient has impaired circulatory function
    Drugs rely on blood flow to to move throughout the body (and get to its intended destination)
  11. Movement of drug throughout the body after it has absorbed into the bloodstream
    Distribution
  12. What are some factors that affect distribution of a drug throughout the body?
    Blood flow to the tissues (adequacy of blood circulation)

    Drug’s ability to leave the bloodstream

    Drug’s ability to be able to enter the cells

    Effects of not penetrating the Blood Brain Barrier

    Whether drug binds to plasma proteins, causing unequal distribution
  13. Another word for Biotransformation
    Metabolism
  14. Change of drug from original form to new form
    Metabolism or Biotransformation
  15. The ______ is primary site of drug metabolism
    Liver
  16. ______ are products of the metabolism
    Metabolites
  17. Drugs that are initially inactive & exert no pharmacologic effects until they are metabolized
    Pro-Drug
  18. What is the First-Pass Effect?

    What is another name for it?
    When the liver extensively metabolizes a drug so that only a portion of the drug actually reaches systemic circulation for distribution

    aka Pre-systemic Metabolism
  19. Process of removing a drug or its metabolites from the body
    Excretion
  20. Most drugs are excreted by ______  & eliminated in ________
    • kidneys
    • urine
  21. The process by which drugs alter cell physiology & affect the body
    Pharmacodynamics
  22. What are some examples categorized as Non-receptor Drug Actions
     


    Very few drugs in this category

    • Antacids
    • Neutralize hydrochloric acid in GI
    • Raise pH of gastric fluid 

    • Osmotic Diuretics (mannitol)
    • Increase osmolarity of plasma
    • Pulls water out of tissues into bloodstream 

    • Drugs structurally similar to nutrients required by body
    • Can be incorporated into cellular constituents Examples: purines, pyrimidines, some anti-cancer drugs 

    • Metal chelating agents
    • Combine with toxic metals to form a complex more readily excreted
  23. Receptor Theory of Drug Action
    Most drugs fall into this category

    Exert effect by binding to receptors at cellular level

    Resulting drug-receptor complex initiates or inhibits cellular functions
  24. Sustained & Controlled Release Dose
    Designed to release a drug at a predetermined rate

    • To maintain a constant drug
    • concentration for a specific period of time
  25. What are some examples of enteric coated medications?
    • Aspirin irritates the stomach, enteric coating
    • prevents absorption there

    Coating fish oil supplements because dissolving in stomach = fishy reflux
  26. Enteric Coating
    Polymer barrier applied on oral medication

    Protect drugs from the low pH i.e. of the stomach

    • Will not dissolve in the acidic
    • juices of the stomach (pH less than 3)

    Will dissolve alkaline (pH 7-9) environment of small intestine
  27. What is the Peak Level?

    When is it?
    Highest plasma concentration of drug in body

    Usually 1.5 hours after administration (varies with the drug)
  28. What is the Trough (pronounced troff) Level?

    When is it?
    Lowest plasma concentration of drug in the body

    Usually 30 minutes before next dose is due
  29. Any undesired responses to drug
    Adverse Effect
  30. The desired response to drug
    Therapeutic Effects
  31. Serious Adverse Event
    Life threatening & requires intervention to prevent death or permanent impairment

    May lead to death, hospitalization, disability, or congenital anomaly
  32. Allergic Effect (drug)
    Immune system response when body interprets drug as foreign

    Often times no reaction to first administration

    Body forms antibodies against the drug

    Next time administered drug, there is a reaction

    Symptoms may get worse each time drug introduced to body
  33. Symptoms of drug allergy
    • rash
    • urticarial (hives)
    • fever
    • diarrhea
    • nausea
    • vomiting
  34. Life threatening allergic reaction (to a drug) is called ______

    What are the symptoms?
    What is it treated with?


    Anaphylactic Reaction aka Anaphylaxis

    • Respiratory distress
    • Sudden severe bronchospasm
    • Cardiovascular collapse

    • vasopressors
    • bronchodilators
    • corticosteroids
    • oxygen
    • IV fluids
  35. Cumulative Effect
    Body cannot metabolize one dose of a drug before the next is administered

    Each new dose increases total quantity in body creating toxic effects
  36. Unusual or peculiar response to a drug

    Sometimes related to patient’s unique response resulting from genetic enzyme deficiencies
    Idiosyncratic Effect aka Paradoxical Effect
  37. Black Box Warnings

    Examples of drugs who have them
    Required label by FDA after significant number of SAEs have occurred

    Usually added several years after drug is on market

    • Antidepressants
    • non-opioid analgesics
      oseltamivir (Tamiflu)
  38. Historically responses to drugs use to be based on one specific demographic which was…
    Healthy adult white male (age 18-65) weighing 150-175 lb
  39. Special dose (larger) at beginning of drug therapy

    For rapid blood level of drug
    Loading Dose
  40. Quantity of drug needed to keep blood & tissue levels at constant level
    Maintenance Dose
  41. Antidote


    Drug that is given to antagonize the toxic effects of another

    • Example
    • naloxone for morphine for respiratory depression
  42. Drug Tolerance
    Body is accustomed to a particular drug over time
  43. Cross Tolerance
    Tolerance to a pharmacologically related drug

    • Example
    • Person who has high tolerance for alcohol needs higher doses of sedative / general
    • anesthesia to produce effect
  44. As Needed (p.r.n.) Order
    Type of standing order

    Patient receives medication when requested or required

    Common for pain medication, sleep aids
  45. Carried out until it is canceled by another order

    Can be carried on for x number of days and then is canceled automatically
    Standing Order
  46. Identify the parts of a medication order
    • Patient’s (Full) Name
    • Date & Time the order is written
    • Name of Drug
    • Dosage of Drug
    • Route
    • Frequency of administration
    • Identification of one writing the order
  47. ______ administration is thru a peg tube
    Enteral
  48. Sublingual
    • Pharmacological route of administration
    • Drug is put under the tongue
    • Diffuses into the blood through tissues under the tongue
  49. Inhaled medication uses the ________ route
    pulmonary
  50. What are the three (but actually four) correct medication checks a nurse does?
    Medication label should be checked before administration

    When pick up package at machine

    When comparing with CMAR (Computer-generated Medication Administration Record)

    When returning the unneeded to drawer / shelf

    Before administration
  51. The “Rights” of Medication Administration
    There are technically 7 but actually 8
    • Drug
    • Dose
    • Route
    • Patient
    • Time

    • Reason
    • (to) Refuse
    • Documentation
  52. Suppository
    A drug delivery system that is inserted into

    • Rectum (rectal suppository)
    • Vagina (vaginal suppository)
    • Urethra (urethral suppository)

    Where it dissolves or melts and is absorbed into the blood stream

    Used to deliver both systemically and locally acting medications
  53. The window of time to administer a drug is
    Common practice is in 30 min window 

    Can give drug that should be administered at 9am between 8:30-9:30am

    Does not apply to pre-op meds
  54. Creams
    Semi-solid emulsion, half oil and half water.

    • Always packaged in a tub or a tube
    • too thick to be dispensed in a pump
  55. Lotions
    Thinner than creams, and are often packaged in a pump

    Absorb very quickly and feel very light on the skin

    Easier to distribute on hairy areas

    Most over-the-counter body moisturizers are lotions
  56. Ointments
    • Are 80% oil and 20% water
    • Feel greasy, do not absorb well
    • Generally not easy to use on large areas

    Are ‘occlusive,’ meaning it traps moisture & heat in very well

    Promote medication absorption over all other formulations

    If an ingredient is in an ointment, it is always more potent

    • Example: Amcinonide is a topical steroid
    • In an ointment it is considered high potency
    • In a cream or lotion it is considered medium-high potency
  57. Gels
    • Emulsions that contain oil-in-water
    • Usually have an alcohol base
    • Dry into a thin, greaseless, non-staining film
    • Ideal for spreading on hairy & large areas
  58. Reconstituted (Drug)
    A drug that was in powder form in vile and has been mixed liquid

    So that it can be injected IV or IM

    • Usually with normal saline or bacteriostatic
    • water (bsw)

    • Ampicillin
    • Kept in powdered form because of short shelf life in liquid form (8 hours)
    • Nurse has to reconstitute the medication for injection
  59. Suspension
    • Heterogeneous mixture of solid particles
    • Will eventually settle over time if left undisturbed

    An example would be sand in water
  60. Homogenous mixture of a solute in a solvent

    Dissolved substance (solute) does not exist as a solid
    Solutions
  61. Elixir (Medication)
    • Alcohol & water mixture
    • Less viscous than syrup
  62. Syrup (Medication)
    • Water & sugar mixture
    • Very viscous & difficult to pour
  63. EMLA

    What is it?
    What does it stand for?
    Eutectic Mixture of Local Anesthetics

    • Lidocaine & prilocaine combination
    • Comes in spay & cream
    • Used in dermal applications

    Put on patient & wait 30-60 minutes (Definitely 60 minutes with children)
  64. What are some circumstances where EMLA is used?
    • IV catheter insertion
    • Superficial surgical procedures
    • Cleaning & debridement of ulcers
    • Tattooing & laser hair removal
    • Circumcision
  65. Ampule or Ampoule
    Small sealed vial containing a usually a liquid

    Specific pre-measured quantity ready for injecting

    Usually glass, although plastic ampoules do exist

    Commonly used to contain drugs that must be protected from air and contaminants
  66. ac / pc (medical prescription)
    • ac - before meals
    • dc - after meals
  67. ad lib (medical prescription)
    as desired, freely
  68. am / pm (medical prescription)
    • morning, before noon
    • evening, before midnight
  69. cap / tab (medical prescription)
    • capsule
    • tablet
  70. supp / susp (medical prescription)
    suppository / suspension
  71. IV / IM
    Intravenous / Intramuscular
  72. IVPB
    IV Piggyback
  73. EC (medical prescription)
    Enteric Coated
  74. elix (medical prescription)
    Elixir
  75. KVO stands for (medical prescription)
    Keep Vein Open
  76. NPO / PO
    Nothing Per Mouth / By Mouth
  77. PRN (medical prescription)
    • When necessary
    • As needed
  78. SL (medical prescription)
    Sublingual
  79. STAT (medical prescription)
    Immediately

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