What are the pre-requisites for safe and effective drug administration?
Growth and development
Pure Food and Drug act of 1906
Designated official standards for medications;
specified standards for medication labeling especially those that were habit forming;
also established the Food and Drug Administration (FDA)
Med Watch Program
This voluntary program encourages nurses and other health care professionals to report when a medication, product, or medical event causes serious harm to a client by completing the MedWatch form
Chemical Name for medication....
provides an exact description of the medication's composition and molecular structure.
Nurses rarely use chemical names in clinical practice.
An example of a chemical name is N-acetyl-para-aminophenol. =Tylenol
Generic name of a medication is
a non-proprietary name
The generic name becomes the official name listed in official publications such as the USP
example is acetominaphen = tylenol
The trade name, brand name, or proprietary name is the name under which a manufacturer markets a medication.
The trade name has the symbol™ at the upper right of the name, indicating that the manufacturer has trademarked the medication's name
What are some guidelines for safe narcotic administration and control?
Store all narcotics in a locked, secure cabinet or container
•Narcotics are frequently counted. Usually counts are made on a continuous basis with the opening of narcotic drawers and/or at shift change.
•Report discrepancies in narcotic counts immediately.
•Use a special inventory record each time a narcotic is dispensed. Records are often kept electronically and provide an accurate ongoing count of narcotics used and remaining as well as information about narcotics that are wasted
.•Use the record to document the client's name, date, time of medication administration, name of medication, dose, and signature of nurse dispensing the medication.
•If a nurse gives only part of a premeasured dose of a controlled substance, a second nurse witnesses disposal of the unused portion. This must be recorded
Medication is classified by
the effect of the medication on a body system
the symptoms the medication relieves
or the medication's desired effect
What are some factors that influence absorption?
the route of administration,
ability of the medication to dissolve,
blood flow to the site of administration,
body surface area,
and lipid solubility of medication.
troche s are
Medications are quickly absorbed if placed....
on mucous membranes and respiratory airways because these tissues contain so many blood vessels
Orally administered medications are typically slow because
they must pass through the GI tract
IV medications produce the most rapid absorption because
they enter systemic circulation
Medication is absorbed at a faster rate when there is a ____ surface area
This is why the majority of medications are absorbed in the small intestine rather than the stomach.
Because the cell membrane has a lipid layer, highly lipid-soluble medications easily cross the cell membrane and are absorbed....
What is a therapeutic effect?
the expected or predictable physiological response a medication causes
What is a side effect?
predictable and often unaviodable secondary effects produced at a usual therapeutic dose.
What is an adverse effect?
unintended, undesirable, and often unpredictable severe responses to medications
may often take weeks or months to develop
early recognition is key
what is a toxic effect?
develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion
What is an idiosyncratic reaction?
overreaction or underreaction of a medication or a reaction that is different from normal.
ie children that takes benedryl becomes agitated and excited instead of drowsy
not always predictable
What is an allergic reaction?
unpredictable responses to a medication.
Some clients become immunologically sensitized to the initial dose of a medication.
With repeated administration, the client develops an allergic response to the medication, its chemical preservatives, or a metabolite.
The medication or chemical acts as an antigen, triggering the release of the body's antibodies.
What is an anaphylactic reaction?
life threatening or severe allergic reactions
characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath.
Sublingual administration is
under the tongue
Buccal administration is
when a medication is pushed against the cheek and absorbed through cappilaries
What is a synergistic effect?
the combined effect of the two medications is greater than the effect of the medications when given separately
the time it takes for excretion processes to lower the serum medication concentration by half
the time it takes for the medication to produce a response
Minimum blood serum concentration of medication reached just before the next scheduled dose
Blood serum concentration of a medication reached and maintained after repeated fixed doses
List 2 oral routes
What are 4 major parenteral routes of administration?
1.Intradermal (ID): Injection into the dermis just under the epidermis
2.Subcutaneous (Sub-Q): Injection into tissues just below the dermis of the skin
3.Intramuscular (IM): Injection into a muscle
4.Intravenous (IV): Injection into a vein
Topical administration consists of
mucous membranes (includes vaginal and rectal)
Distribution depends on
Circulation: Heart rate, blood volume (if u are anemic or low blood volume=slow down)
Permeability: does it pass placental barrier? Does pass the blood brain barrier?
Protien binding: the degree by which the med binds to proteins, such as albumin. (albumin decreases in geriatric population which increases the risk of toxic effects
Where does biotransformation occur?
usually in the liver
How is alcohol excreted?
What is a potentiating effect?
a form of synergistic effect
2 meds given together that gives an increased effect of one of the medications
What is an inhibiting effect
2 meds given together that decreases or slows down the effect of one of the medications
A prescriber can be...
a nurse practioner
What is a standing order?
is carried out until the prescriber cancels it by another order or until a prescribed number of days elapse
What is a NOW order
A now order is more specific than a one-time order and is used when a client needs a medication quickly but not right away, as in a STAT order
A unit dose is considered
a 24 hour dose of meds the pt takes
What are some examples of distribution systems
Special medication rooms, portable locked carts, computerized medication cabinets, and individual storage units next to clients' rooms are examples of storage areas used
The 6 rights are
Medication administration record
What kind of technique is administration by injection?
Which syringe is described as having a long thin barrel and a pre attached needle on it?
What are the best sub cutaneous injection sites?
outer posterior aspects of the arm
abdomen above ileac crest
anterior aspects of the thighs
Intra muscular injection sites
Ventrogluteal: find ball of femur and hip bone
Vastus Lateralus: one hand above the knee and other below groin. frequently used in infants
deltoid: where scapula meets clavicle. not used in pts with underdeveloped muscles ( infants). used in toddlers older children and adults
...faster absorption than SubQ
Use Z track method
are used for skin testing (tb)
5- 15 degrees
Intravenous bolus' are usually
they are concentrated and then introduced into systemic circulation