SAFE MEDICATION ADMINISTRATION & METROLOGY

Pharmacology

Study of chemicals that affect body function

Chemical name

Describes the chemical composition of the medication

Generic name

Official name of a medication

Examples of generic names

Acetaminophen and Metoprolol

Trade (brand) name

Given by the manufacturer

Examples of brand names

Tylenol and Lopressor

One generic medication may have

Multiple brand names

Pharmaceutical classification

Based on mechanism of action or physiologic effect

Therapeutic classification

Based on clinical use or therapeutic effect

Pharmacokinetics

Effect of the body on the drug

Remember for pharmacokinetics

ADME

Absorption

Movement of medication from administration site into bloodstream

Distribution

Movement of medication throughout the body

Metabolism

Chemical alteration of medication, primarily in the liver

Excretion

Removal of medication from the body, primarily by the kidneys

Pharmacodynamics

Effect of the drug on the body

Pharmacodynamics includes

Drug-receptor interactions, drug-enzyme interactions, effects on cells and tissues

Therapeutic effect

Desired effect of a medication

Adverse effect

Undesirable effect of a medication

Side effect

Secondary effect that is expected and usually harmless

Cumulative effect

Medication accumulates in the body over time

Toxic effect

Harmful effect due to excessive drug levels

Drug tolerance

Decreased response after repeated use

Idiosyncratic effect

Unexpected or unusual response

Allergic reaction

Immune response ranging from rash to anaphylaxis

Antagonistic effect

One drug decreases the effect of another

Synergistic effect

Two drugs together produce a greater effect than either drug alone

Factors affecting medication action

Age, pregnancy, weight, gender, culture, genetics, psychological factors, disease processes, environment, nutrition, time of administration

Who can prescribe medications

MD, DO, CRNP, PA

Nursing scope of practice is determined by

State Nurse Practice Acts

Medication administration is a

Dependent nursing intervention

RN responsibilities

What medication, how much, when, and how it is administered

The nurse must understand

Indications, interactions, side effects, and adverse effects

Legal responsibility

The nurse is legally responsible for medication administration

Important medication principle

Question suspicious orders

Never blindly follow

Medication orders

Medication preparation rule

You prepare, you give

Standing order

Remains in effect until discontinued

PRN order

Administered as needed

Single order

Given one time only

Stat order

Given immediately

Required parts of a medication order

Patient name, date, time, medication, dose, route, frequency, prescriber signature

Decimal safety with doses

Always lead with a zero

Correct decimal example

0.5 mg

Incorrect decimal example

.5 mg

Trailing zero rule

Never use trailing zeros

Correct trailing zero example

5 mg

Incorrect trailing zero example

5.0 mg

Reason trailing zeros are dangerous

Can cause tenfold overdoses

Enteral routes

Oral, sublingual, buccal, rectal

Topical routes

Topical, transdermal, inhalation, vaginal

Parenteral routes

Intradermal, subcutaneous, intramuscular, intravenous, epidural, intrathecal

Six rights of medication administration

Right patient, medication, dose, route, time, reason

Additional rights of medication administration

Documentation, assessment, education, evaluation

First medication check

When removing medication

Second medication check

Before preparing medication

Third medication check

Before administration

Solid oral medications

Tablets, capsules, pills

Liquid oral medications

Elixirs, syrups, suspensions

Medications that should never be crushed

EC, SR, XL, SA, LA, CRT

Before giving oral medications

Assess NPO status, swallowing ability, and gag reflex

Important oral medication consideration

Ensure the patient actually swallows the medication

Feeding tube medication preference

Liquid form whenever possible

Crushed medications through feeding tubes

Mix with 15–30 mL water

Feeding tube administration

One medication at a time

Flush amount between tube medications

15–30 mL water

Purpose of flushing feeding tubes

Prevent interactions and tube occlusion

Sublingual medications

Placed under the tongue and allowed to dissolve

Buccal medications

Placed between the cheek and gum and allowed to dissolve

Transdermal patch considerations

Wear gloves, remove old patch, clean skin, rotate sites, date and time patch

Eye medication administration

Pull lower lid downward and instill into conjunctival sac

Never place eye drops

Directly on the cornea

After eye drop administration

Apply gentle pressure to the inner canthus

Ear medication administration

Pull ear upward and gently press tragus

Rectal medication position

Left lateral position

Rectal suppository insertion depth

3–4 inches past the internal sphincter

Parenteral medications

Administered outside the GI tract

Types of parenteral medications

Intradermal, subcutaneous, intramuscular, intravenous

Intradermal injections are used for

TB testing and allergy testing

Intradermal needle size

26–27 gauge

Intradermal needle length

¼–½ inch

Maximum intradermal volume

Less than 0.5 mL

Intradermal injection angle

5–15°

Intradermal site

Inner forearm

Subcutaneous injections are used for

Insulin and anticoagulants

Subcutaneous needle size

25–30 gauge

Maximum subcutaneous volume

Less than 1 mL

Subcutaneous angle

45–90°

Subcutaneous sites

Abdomen, upper arm, anterior thigh

Intramuscular injections are used for

Vaccines, antibiotics, hormones

Intramuscular needle size

18–25 gauge

Intramuscular injection angle

90°

Maximum deltoid volume

1 mL

Maximum volume in children and older adults

2 mL

Maximum volume in adults

4 mL

Preferred IM site for infants

Vastus lateralis

Safest IM site

Ventrogluteal

Deltoid injections are used mainly for

Vaccinations

Deltoid maximum volume

1 mL

Deltoid site limitation

Not used in infants under 1 year