206- Medication Administration

3 types of drug names

Chemical name, Generic (official) name, Trade (brand) name.

Ex: Acetaminophen (generic) = Tylenol (brand).

What does ADME stand for?

Absorption, Distribution, Metabolism, Excretion.

Which route has the fastest absorption?

IV (intravenous).

What increases drug absorption the most?

Lipid-soluble (fat-soluble) drugs.

Rationale: Highly lipid-soluble medications are absorbed very quickly because cell membranes are composed of a phospholipid (fatty) bilayer. (Allowing easy pass)

What does “free drug” mean?

Drug not bound to protein (active form).

Rationale: Active form allows drug to exert its pharmacological effect (Distribution)

Inactive drugs are bound to proteins

Drug metabolism location

Liver converts the drug into a less potent or inactive form

What is the first-pass metabolism/effect?

Oral drugs are metabolized by the liver before reaching circulation.

Rationale: Greatly reduces the drugs concentration

Drugs that bypass: IV, Sublingual, Transdermal, Supposiories

Routes that bypass first-pass metabolism

IV, sublingual (under tongue), transdermal (patch)

Organ responsible for drug excretion

Kidneys

Impairment = drug toxicity (drug accumulation in the blood)

What patients are at highest risk for drug toxicity?

Elderly and patients with liver or kidney disease.

Therapeutic range of drugs

Safe drug level between minimum effective and toxic concentration.

Trough level

The trough is the lowest concentration, indicating the rate of elimination

Tip: Draw trough blood samples immediately before administering the next dose

Tip Vancomycin: Draw trough before 4th dose

Half-life

Time for 50% of the drug to be eliminated.

Tip: Negligible (no) effect occurs after 4 half-lives

Ex: After 1 half-life (4 hrs) → 50% remains

• After 2 half-lives (8 hrs) → 25% remains

• After 3 half-lives (12 hrs) → 12.5% remains

• After 4 half-lives (16 hrs) → ~6% remains

Adverse drug event (ADE)

Any harmful reaction to medication (mild-severe).

Anaphylaxis

Life-threatening allergic reaction causing airway and circulatory collapse.

Stevens-Johnson Syndrome (SJS)

Severe skin reaction with blistering rash 1-14 days after drug administration; medical emergency.

6 Rights of medication administration

1. Right patient

2. Right medication

3. Right dose

4. Right route

5. Right time

6. Right documentation.

Additional rights to support safe med administration (4)

1. Right to refuse

2. Right assessment

3. Right education

4. Right evaluation/response.

3 medication checks

1) At dispensing

2) after retrieval

3) at bedside before giving.

Medications requiring double-checking

High-alert meds (insulin, heparin, opioids, IV potassium).

What must a valid medication order include?

Patient name, drug, dose, route, frequency, indication, provider signature.

What is priority after a medication error?

Assess patient FIRST.

Can nurses document an incident report in patient chart?

No; file an occurrence (incident)

Medication reconciliation

Comparing home meds with new orders at admission, transfer, discharge.

What must be done before giving enteral tube meds?

Verify placement + flush before (30ml), between (5ml), and after meds (30ml).

Tip: Dont crush and mix meds together (do individually, then flush 5ml)

Sublingual meds

Placed under tongue

DONT: swallow or eat/drink until dissolved.

Applying transdermal patches

Remove old patch, rotate site, wear gloves, label new patch.

Optic medication admin.

Eye drops: Into conjunctival sac + press nasolacrimal duct after., (30-60 secs)

Ointment: Place thin ribbon from conjuctiva across lower eyelid

Ear drops adult positioning

Pull auricle up and back.

Tip: Kids= down & back

What is required when opening an ampule?

Use filter needle.

Rationale: To prevent glass particles from being drawn up.

What must be done with vials before withdrawing meds?

Inject air equal to dose.

Rationale: Vial is a closed system and that requires pressure to withdraw liquid

What insulin is drawn up first?

Regular insulin (clear before cloudy).

This method prevents the faster-acting Regular insulin from being contaminated by the slower-acting, modified NPH protein.

Best site for intradermal injections

Inner forearm or upper back.

Preferred site for heparin injection

Abdomen (≥2 inches from umbilicus).

Heparin: anticoagulant ("blood thinner") used to treat and prevent blood clots

Preferred IM site for adults

Ventrogluteal (side of hip)

IM injection angle

90°.

Tip: 23-gauge needle

usually available in 5/8", 1", or 1.5" lengths

Z-track method

Seals the needle track to prevent medication leakage into subcutaneous tissue.

Tip: Leave needle in for 10 secs

IV complications

Phlebitis: causes warmth, redness, tenderness

Infiltration: causes swelling and cool skin (IV enters tissues)

Tip: Warm compress for both

Formula method for dosage calculation

(Desired ÷ Have) × Quantity.

How many mL in 1 tsp?

5 mL.

How many mL in 1 tbsp?

15 mL.

How many kg in 1 lb?

2.2 lb = 1 kg.

How do you calculate IV pump rate?

Total mL ÷ total hours.

What should always be included in medication teaching?

Name, purpose, side effects, timing.

Best method to confirm patient understanding?

Teach-back method.

How should medication times be explained to patients?

Use everyday language (e.g., “morning/evening,” not BID).

What does “EC” mean on a medication?

Enteric-coated (dissolves in intestines, not stomach)

Rationale: protect the stomach from irritation (e.g., aspirin, NSAIDs), prevent stomach acid from destroying the drug

Tip: Do not crush

What do XL, SR, and CR stand for?

Enteric-coded (EC) Drug is designed to release the active ingredient slowly into the bloodstream over a prolonged period, usually 12 or 24 hours, rather than all at once.

XL/ER- Extended-release

SR- Slow Release

CR- Controlled Release

Tip: Never crush; it can cause toxicity

Side effect vs. Adverse effect

Side: A predictable, often mild secondary effect

Adverse: A harmful, unintended, potentially serious reaction

Intradermal (ID) Injections

Angle: 5-15 degrees

Needle: 25-27 gauge; ¼ - ½ inches long

Volume: 0.01 - 0.1 mL