Module 13 - Special Topics in Medication Administration

Critical Care Drugs

• High-alert, small errors → serious harm/death

• Fast-acting: seconds to minutes

• IV infusion and titrated: adjust based on BP/HR

• Continuous monitoring: cardiac, BP, labs

• Support vital organs (e.g., Epinephrine, Norepinephrine)

• Used with ICU equipment (ventilators, infusion pumps)

Older Adults

BEERS List

• High risk/inappropriate meds for adults ≥ 65 years old (↑ adverse effects)

Swallowing Difficulties

• ↑ aspiration risk

• Avoid solid meds if needed → liquids, crush (if safe), mix with food, alt routes

Overprescribing

• Review meds yearly & after falls/hospitalization

• Consider: benefit, interactions, adverse effects, life expectancy, quality of life

Pain Management

• Often underreported

• Nonverbal signs: agitation, confusion, silence

• ↑ sensitivity → higher risk of side effects

Pediatrics

Toddler

• Simple words, short sentences, use play

• Parent present (lap), engage parents first

• Eye level, build trust

• Consent: parent/guardian decides

• Teaching: no lying (not “candy”)

School-Age

• Explain procedure, use pictures

• Include parent, simple direct language

• Eye level, build trust

• Consent: parent/guardian decides

• Assess nonverbal pain cues

Adolescent

• Private space, involve in care

• Check understanding, provide teaching

• Eye level, build trust

• Consent: decide if “mature minor”

• Use teach-back, support adherence (e.g. “reminders)

General

• Involve parents/guardians

• Allow time for processing/questions

• Build rapport

Complimentary and Alternative Medicine (CAM)

Types

• Conventional: Western medicine

• Complementary: used with conventional medicine

• Alternative: used instead of conventional medicine

• Integrative: evidence-based combo; whole-person focus

CAM Categories

1. Alternative systems (e.g., naturopathy)

2. Mind-body (e.g., meditation)

3. Biologic (e.g., herbs, vitamins)

4. Manipulative (e.g., chiropractic)

5. Energy therapies (e.g., reiki)

Risk/Considerations

• Natural ≠ safe: adverse effects, contamination

• May delay/misdiagnose conditions

• Need evidence-based evaluation

• Must discuss with patient (different health beliefs)

Pregnancy Considerations

Placenta

• Semi-permeable membrane: most drugs cross to fetus

Key Safety

• Fetus exposed to maternal meds

• Highest risk: 18-80 days (organ development)

• Risk vs. benefit: avoid unnecessary withholding

Avoid (high-yield)

• ACE-I/ARBs → fetal renal failure

• NSAIDs → fetal complications

• Warfarin → CNS defects

• Valporic Acid → neural tube defects

• Lithium → cardiag defects

Renal Toxic Drugs

Kidney damage leads to ↓ ability to filter/excrete drugs

↑ risk due to high drug concentrations in kidneys

Causes

• Damage to renal tubules

• Crystalluria: drug precipitates block urinary tract

• Prevention: hydrate, monitor labs, adjust doses

Common Nephrotoxic Drugs

• Antibiotics

• NSAIDs

• ACE-I

• Diuretics

Nursing Tips

• Check renal dosing

• Monitor labs: creatinine, BUN, eGFR

• Hold/clarify meds in renal impairment suspected

Medicinal Cannabis

Uses

• Chronic pain, cancer pain/N&V

• PTSD, sleep disorders

• Appetite/weight gain

• MS muscle spasms

• EOL symptom relief

Assessment/Management

• Full history & physical

• Assess symptoms, diagnoses, substance use risk

• Review past cannabis use

• Set goals

• Educate on side effects & addiction risk

• Monitor response, misues, follow-up

Traditional Indegenous Medicines

Sacred Medicines

• Tobacco: offering to elders/ceremony

• Sweetgrass: purification, psychosocial/spiritual healing

• Sage: cleansing, offering

• Cedar: protection, well-being

• Rat root: natural analgesic

Sweetgrass Effects

• Used in smudging/talking circles

• Believed to purify thoughts/environment

• Traditional use: cough sore throat, congestion

Barriers to Access

• Loss of elders/language & cultural knowledge

• Historical trauma

• Limited access to language for harvesting

• Racial/discrimination

• Poor integration with Western healthcare

• Limited access to Indigenous healers

Traditional Chinese Medicine

Holistic system (mind-body-environment balance)

Energy: Qi flowing through meridians

Health: balance of Yin (low) & Yang (high)

Focus on prevention, harmony, homeostasis

Key Systems

• Wood: liver/gallbladder

• Fire; heart/small intestine

• Earth: spleen/stomach

• Metal: lung/large intestine

• Water: kidney/bladder

Common Therapies

• Acupuncture: restores qi flow

• Cupping therapy: ↑ circulation

• Herbal medicine: teas/formulas (e.g., ginseng)

• Tai Chi: balance, strength, stress reduction

• Moxibustion, gua sha, tui na massage

Peri/Menopause and HRT

Menopause: no menstruation ≥ 12 months (usually 45+)

Perimenopause Cues

• Common: hot flashes, irregular periods, sleep disturbances, mood swings, brain fog, foint pain

• Uncommon: vaginal dryness, dry eyes, hair loss, burning mouth, migraines

HRT Options

• Systemic HRT: estrogen ± progesterone (oral, patch, gel, spray)

• Local therpay: vaginal estrogen (cream/tablet/ring) for GU symptoms

Chemotherapeutic and Hazardous Drugs

Chemotherapy: cancer treatment drugs requiring precautions

Hazardous drugs: cause cancer, infertility, organ damage even at low exposure

Key Risks

• Skin absorption, inhalation, reproductive harm

• Exposure risk to nurses & environment

Preparation

• Double chemo gloves + impermeable gown + head/eye/shoe protection

• Pharmacy-prepared IV when possible

PPE Rules

• Change gloves if contaminated or ~ 30 min

• Remove PPE when leaving area

• No reuse of disposable PPE

• Treat all materials as hazardous waste

• Double bag/container in designated chemo waste