Drug Administration

has a local desired effect

topical

means "intestinal"

enteral

drugs that are generally administered orally

enteral

drugs that are generally administered via injection

parenteral

has a systemic effect and is often swallowed

enteral

has a systemic effect and is not swallowed

parenteral

with this type of drug administration, the drug is absorbed into the bloodstream through the stomach and intestines

enteral

auricular

ear

carbamide peroxide

softens ear wax

corticosteroid

reduces swelling and irritation (inflammation)

antibiotic

prevent, inhibit, or attack the infection

conjunctival

the mucous membrane that lines the inner surface of the eyelids and is continued over the forepart of the eyeball

intravitreal

occurring within, or introduced into the vitreous body of the eye

vasoconstrictor

constrict or tighten small, superficial blood vessels

___ usually refers to the administration of anesthesia drugs

inhalation

the brand of a potent inhalation anesthetic is ___

suprane

___ is also called laughing gas. an anesthetic drug which is mild, causing forgetfulness and relaxation

nitrous oxide

a tube inserted into the trachea to provide or maintain an airway and allow inhalation anesthesia is called a ___

endotracheal tube

Vaginal

inserted into the vagina

otic

pertaining to the ear

ophthalmic

inside the eye

inhalation

breathed in

nasogastric

tube passing from the nose to the stomach

suppository

small plug or cone of medicine inserted in a body cavity other than the mouth

PEG

percutaneous endoscopic gastrostomy

G-tube

gastric feeding tube

Most drugs administered via the rectum have a _____ effect.

systemic

Enteral medications are assimilated into the body through the _____.

gastrointestinal system

The trade name suppository for treating constipation is spelled _____.

Dulcolax

The generic name for a suppository for treating constipation is _____.

bisacodyl

A common ingredient in suppositories to treat constipation is _____.

glycerin

Glycerine and glycerin are both accepted spellings—the prior is the preferred British spelling, and the latter is the preferred spelling in the United States.

long action

LA

sustained release

SR

Extended release

ER

Controlled release

CR

Extended release

XL

The patient was instructed to place the tablet under the lip, just above the teeth. This is an example of _____ administration.

buccal

It is possible for the tongue and cheek to be used as drug administration routes because the mucosa is _____.

permeable

A brand name drug used to treat opioid dependence is _____.

Subutex

A generic drug used to treat opioid dependence is _____.

buprenorphine SL

A spray administered under the tongue to alleviate angina-related pain is an example of a ______ administration.

sublingual

Dilating the blood vessels can treat symptoms of angina, or chest pain. A generic drug that does this is _____.

isosorbide dinitrate SL

Bolus

single, large dose

PICC

peripherally inserted central catheter

TPN

total parenteral nutrition

A drug administered slowly over time is a(n) _____.

Intravenous drip

A drug administered all at once is called a(n) _____.

Bolus

Which of the following is NOT a portal for the administration of intravenous drugs?

Total parenteral nutrition

A ____ has the advantage of injecting the drug directly into the heart.

Central IV line

A _____ is inserted into a peripheral vein and then threaded to the superior vena cava or right atrium.

PICC

Subcu or subq are both acceptable ways to represent what type of administration route?

subcutaneous

Which administration type refers to a needle injection directly into a muscle?

intramuscular

Which administration type refers to a needle injection directly into a vein?

intravenous

Which administration type requires a short needle, small in diameter?

subcutaneous

Which administration type requires a long needle, large in diameter?

intramuscular

potency

drug's strength

efficancy

degree to which a drug can produce a certain effect

metabolism

how well the body breaks down the drug

elimination

how the drug is eliminated from the body

absorption

active ingredients of a drug preparation are dissolved and released into the bloodstream

distribution

transportation of a drug to other body tissue

half life

time the total amount of a drug diminishes by one half

Responsibilites of the nurse when administering medication

-what drug is ordered
-name (generic and trade) and drug classification
-intended or proposed use
-effects on the body
-contradictions
-special considerations (e.g., how age, weight, body fat distribution, and individual pathophysiologic states affect pharmacotherapeutic response)
-side effects
-why the medication has been prescribed for this particular patient
-how the medication is supplied by the pharmacy
-how the medication is to be administered, including dosage ranges
-what nursing process considerations related to the medication apply to this patient

Allergic Reaction

-an acquired hyperresponse of body defesnes to a foreign substance (allergen)
-signs of allergic reactions vary in severity and include skin rash with or without itching, edema, runny nose, or reddened eyes with tearing

Anaphylaxis

-a sever type of allergic reaction that involves the massive, systemic release of histamine and other chemical mediators of inflammation that can lead to life threatening shock
-symptoms such as acute dyspnea (difficulty breathing), and the sudden appearance of hypotension or tachycardia following drug administration are indicative of anaphylaxis which must recieve immediate treatment

The Five Rights of Drug Administration

-together, they form the operational basis for the safe delivery of medications
-offer simple and practical guidance for nurses to use during drug preparation, delivery, and administration, and focus on individual performance

1. right patient
2. right medication
3. right dose
4. right route of adminitration
5. right time of delivery

can also include:
-right to refuse medication, the right to recieve drug education, the right preparation, and the right documentation

The Three Checks of Drug Administration

-used in conjuction with the five rights help to ensure patient safety and drug effectiveness
1. checking the drug with the MAR or the medication information system when removing it from the medication drawer, refrigerator, or controlled substance locker
2. checking the drug when preparing it, pouring it, taking it out of the unit-dose container, or connecting the IV tubing to the bag
3. checking the drug before administering it to the patient

Compliance

-taking a medication in the manner prescribed by the health care provider, or in the case of OTC drugs, following the instructions on the label
-patient noncompliance ranges from not taking the medication at all to taking it at the wrong time or in the wrong manner

Reasons for noncompliance

-drug may be too expensive
-the drug may not be approved by the patient's health insurance plan
-patients forget doses of medications, especially when they must be taken three or four times per day
-annoying side effects such as; headache, dizziness, nausea, diarrhea, or impotence (erectile dysfunction)
-impair major lifestyle choices

-patients may self-adjust their doses
--some patients believe that if one pill is good, two must be better
-others believe that they will become dependent on the medication if they take it as prescribed so they only take half of the required dose

STAT order

-refers to any medication that is needed immediately and is to be given only once
-often associated with emergency medications that are needed for life-threatening situations
-comes from the latin word "statim" meaning immediately
-should be administered within 5 minues or less of recieving the written order

ASAP order

-not as urgent as STAT
-as soon as possible
-should be avaliable for administration to the patient with 30 minutes of the written order

Single order

-for a drug that is to be given only once, and at a specific time, such as a preoperative order

PRN order

-latin "pro re nata"
-administered as required by the patient's condition
-the nurse makes the judgement, based on patient assessment, as to when such a medication is to be administered

Routine orders

-orders not written as STAT, ASAP, NOW or PRN
-these are usually carried out within 2 hours of the time the order is written by the physician

Standing order

-written in advance of a situation that is to be carried out under specific circumstances
-example: set of postoperative PRN prescriptions that are written for all patients who have undergone a specific surgical procedure "Tylenol elixir 325mg PO every 6 hours PRN sore throat"
-standing orders are no longer permitted in some facilites because of the legal implications of putting all patients into a single treatment category

ac

-before meals

ad lib

-as desired, as directed

AM

-morning

bid

-twice per day

cap

-capsule

gtt

-drops

h or hr

-hours

IM

-intramuscular

IV

-intravenous

no

-number

pc

-after meals, after eating

PO

-by mouth

PM

-afternoon

PRN

-when needed/necessary

qid

-four times per day

q2h, q4h, q6h, q8h, q12h

-every __ hours

Rx

-take

STAT

-immediately, at once

tab

-tablet

tid

-three times per day

Enteral Drug Administration

-includes drugs given orally and those administered through the nasogastric or gastrostomy tubes
-take advantage of the vast absorptive surfaces of the oral mucosa, stomach, and small intestine

Oral Drug Administration

-oral dugs administration is the most common, most convienient, and usually the least costly of all routes
-considered the safest route because the skin barrier is not compromised
-avaliable in tablet, capsule, and liquid forms

Tablets and Capsules

-the most common forms of drugs
-patients prefer tablets or capsules over other routes and forms because of their ease of use
-some patients, especially children, have difficulty swallowing tablets and capsules
-crushing tablets or openings capsules and sprinkling the drug over food or mixing it with juice will make it more palatable and easier to swallow
-do not crush tablets or open capsules inless the manufacturer specifically states this is permissable
-some drugs are inavtivated by crushing or opening, whereas others severely irritate the stomach mucosa and cause nausea or vomiting
-some drugs can irritate the oral mucosa, are extremely bitter, or contain dyes that stain the teeth

Enteric Coated Drugs

-the strongly acidic contents within the stomach present a destructive obstacle to the absorption of some medications
-tablets may have hard, waxy coatings that enables them to resist the acidity
-enteric coated tablets are designed to dissolve in the alkaline environment of the small intestine
-do not crush these drugs because the medication would then be directly exposed to the stomach environment

Sustained Release Drugs

-compliance declines as the number of doses per day increases
-sustained release tablets or capsules are designed to dissolve very slowly
-this releases the medication over an extended time and results in longer duration of action for the medication
-also called extended-release (XR), long-acting (LA), or slow-release (SR) medications, these forms allow for convienience of once-or-twice-a-day dosing
-extended release medication must not be crushed ot opened