Pharm Exam 1

Medication Adminstration

1. Assessment- need to know which medications need what type of assessment

2. Nursing Diagnosis- ensure no complications

3. Planning- know when to give meds, when they will become effective, best timing

4. implementation- how to give med (can patient swallow, need crushed pills?)

5. evaluation- what is the timeframe

9 Rights:

• patient

• medication

• documentation

• route

• frequency

• dose

• reason

• response

• to refuse

Lifespan Considerations: Pediatrics

-if pregnant or breastfeeding

-immaturity of organs

• smaller bodies and thinner skin

• smaller stomach- less acid

-developmental stages

• can give baby medication in cup vs. 15 yr old no meds in a syringe

Lifespan Considerations: Older Adult

-different processing times for medications; often fiven smaller amounts

• Cardiovascular changes decrease absorption and distribution

• GI alters absorption and delays emptying

• hepatic decreased metabolism

• renal- decreased excretion

-reconciliation- ensure med list at home and hospital are all the same

-Polypharmacy

• more than 5 medications prescribed simultaneously

• related to: chronic illness, multiple providers, prescribing cascade

• increased risk of adverse drug effects

-Medication Adherence

• taking medications exactly as prescribed

• nonadherence reasoning: socioeconomic, healthcare system, condtion or therapy related, patient related

Cultural Considerations

-alternative therapies

-beliefs related to medicaiton use

-dietary practices- how food is affecting absorption

-systemic racism

-trust of healthcare professionals

Nursing Practice Acts

-administer medcations as prescribed

-be appropriately trained

-document accurately

-cannot prescribe medications

-cannot misappropriate drugs

-impairedprofessionals program

Basic Ethical Principles

-autonomy- respect patient’s right to this

-beneficence- actions are benefitting our patients

-confidentialty-

-justice- fair and equitable treatments

-nonmaleficence- avoiding intentional harm

-veracity- speaking the truth

Pharmacological Principles: Medication Names

-chemical name- chemical breakdown of what is in the medication

• not needed to know for NCLEX

-generic name

• need to know; same no matter what; ie. ibuprfoen

-brand names

• ie. advil, motrin

Pharmacology Phases Medication

-Phase 1- Pharmaceutical

• medications are administered and disintegrate and dissolve in to the body

-Phase 2- Pharmacokinetic

• how body processes a specific drug

• absorption, distribution, metabolism, excretion

-Phase 3- Pharmacodynamic

• how the drug works in your body to give us the effect we want

• drug-receptor interaction

Pharmaceutics

-form affects dissolution and absorption rates

• some medications faster than others

• relateds to form of that medication (how drug is packaged and prepared)

  • ie. liquid, capsules, IV, ointment

Pharmacokinetics: Absorption

-once given, digested into a useable form in the body

• moves into the blod stream

• most medications lose some of what is taken

-bioavailability- how much of that medication is actually absorbed

-first pass effect- once medication is taken, if it is processed else where it will lose some medication in the process as this effect drops the overall level

• usually liver, kidneys

• expect oral medication dosages to be higher than IV as oral meds have first-pass effect (must go through digestive tract first)

-Effect of Route

• enteral- slows transit down

• sublingual/buccal- no first pass effect as they absorb fast

• parenteral (IV, subcut, IM)- IV no first pass effect

• topical- into eyes (no first pass), depends on med

• transdermal- patch consistently gives amounts throughout

• inhaled- reapidly absorbed through alveoli (no first pass if med is for the lungs)

Pharmacokinetics: Distribution

-areas with higher blood flow (ie. heart, liver, brain, kidneys) get medications quicker

-protein binding

• unbound- does not need transporter; free

• bound- needs proteins to be able to leave blood stream; risk of toxicity factors from too much medication

• medications compete for binding sites on protein albumin

-volume of distribution

• water soluble- higher levels of water soluble medications

• fat soluble- faster and larger distribution with lower levels in blood stream; get metabolized faster and not in blood as long

Pharmacokinetics: Metabolism (Biotransformation)

-starts when medication reaches the blood stream

-results

• live changes into inactive metabolite

• some potent medications have prodrug so they turn into active metabolite

• liver can also turn into less active metabolite and increase solubility

-**Cytochrome P-450 enzymes typically metabolize most medications so it is a leading reason to why there are drug interactions

• having multiple medications that need this enzyme to be broken down, can see higher levels as enzyme becomes limited

• do not want to many meds that require this to metabolize

-Enzyme inhibitors and inducers

• inhibitors: inhibit metabolism and enzymes with each dose; can lead to toxicity

  • more absorption as medication is not being metabolized and gotten rid of

• inducers- makes P-450 enzymes work better and faster; more medication into metabolism and excretion process; lower levels of medication overall

  • encourage enzyme to be produced (higher levels) so not a lot of time for affect; less absorption

Pharmacokinetics: Excretion

-kidney excretion- water soluble meds can be easily excreted into the urine

• can also metabolize if pass through liver

-Biliary excretion- circular as it stays in system longer and medications are reused by the body longer

• fat soluble

• Enterohepatic recirculation: medications absorbed → liver metabolizes → excreted through biliary system → bile and bowels → reabsorbed back to liver →restarts

-excretion through lungs, sweat, saliva, and breastmilk less common

Excertion Principles

-half-life- time for half (50%) of the medications to be eliminated from the system (half of peak)

• to be completely eliminated, must go through 5 half lives

-want a steady state (plateau)- amount of medication leaving the body to be the same as what is coming in

• occurs after 4-5 half-lives

• loading does- give large amount initially and then lower doses to sustain for some medications

Drug Effects: Monitoring

-onset of action- where you start to get therapeutic window and see a response

-therapeutic window- just right amount for medication to work

• goal to stay in therapeutic range at all times

-minimum effective concentration- minimum amount of medication to get our desired response

-therapeutic index- ratio of what’s toxic to whats our desired effect

• low- small difference between range of what is desired and what’s toxic; need labs and more close monitoring

• high (wide) index- very rarely have an overdose

-dose response relationship- how body responds to varying amounts of that medication

-tolerance- decrease response to a medication over time

-dependence- phsyical or psychological need for medication

• any stopping of med will cause a response; typically not desirable

Pharmacodynamics: Mechanism of Action

-receptor

• agonist- cell receptor binds with medicaiton to cause a response

• antagonist- binds to receptor to block response

  • competitive- competes for same site

  • noncompetitive- binds to a different site and changes how normal reception site work so nothing can bind

• partial agonist- diminished response

-enzyme

• inhibit- blocks the enzyme in the pathway (ie. ACE inhibitors)

• enhance

-nonselective

• act on cell or cell response; act on mutliple receptors or tissues

• medications can increase pressurel antibiotics can incorporate themselves into bacteria's DNA

Reasons for Medication Therapy

-acute

-maintenance- preventative

-supplemental- adds to normal cell function or sustains it

-palliative- comfort and symptom relief (ie. pain meds)

-supportive- maintains body functions (ie. surgery- IV fluids)

-prophylactic- in advance of something (ie. antibiotics before surgery/dental procedure)

-empiral- high liklihood of needing meds so given while waiting for results

Drug Interactions

-additive- two medications purposefully combined to do their given task better

• can use less of medication because they are given at same time

-synergistic- medications combined together because separately they do not do what they are supposed to

• need both to work

-potentiation- help one drug to work better by giving another

-antagonistic- lower the effects of both medications when given together

• unwanted interaction

-incompatibility- two in same line form precipitate that is solid in IV

• usually IV meds

• cannot be given in the same line

Adverse Responses to Medications: Adverse Drug Events

-Adverse events- how medications interact with the body in both expected and unexpected ways

• Adverse effects (side effects)- predictable side effects that are expected even if they are unwanted

• adverse drug reactions- unexpected; do not anticipate its going to happen; undesirable

  • allergic reactions

Preventing Medication Orders

-computerized prescriber order entry (CPOE)

-Bar code medication administration (BCMA)

-Do not use list (JCAHO< ISMP)

-Tall man letters

-black box warning

-no interruption medication pass

-medication reconciliation

-just culture- talk about when errors occur and near misses so that changes can be made to prevent harm in the future