Chapter 30 Medication Administration

Exam 2

absorption

transfer of a drug from its site of entry into the body to the bloodstream

adverse drug reaction (ADR)

harmful or undesirable response to a drug that may require intervention or discontinuation

allergic effect

immune-system response in which the body indentifies a drug as foreign and forms antibodies against it

ampule

glass container holding a single dose of parenteral medication; opened by breaking the neck

anaphylactic reaction / anaphylaxis

severe, life threatening allergic reaction associated with respiratory disease, severe bronchospasm, and cardiovascular collapse

bioavailability

portion of a drug that reaches systemic circulation and is available to act on cells

distribution

transport of drug molecules through the bloodstream to sites of action after absorption/injection. Depends on circulation, protein binding, and barriers such as the blood brain barrier

drug tolerance

decreased response after repeated exposure; larger doses are required to produce the same desired effect. Ex. long term opioid use

ethnopharmacology

study of medication responses across cultural/ethnic populations and, in modern use, differences in absorption, distibution, metabolism, and excretion associated with genetic and population variation

excretion

removal of a drug or its metabolites from the body

generic name

universal, nonproprietary name that indentifies a drug’s active ingredient. Usually lowercase

half life

time required for 50% of the serum concentration of a drug to be eliminated

idiosyncratic effect

unusual or unexpected response to a medication that is particular to an individual

intradermal injection

injection into the dermis just below the epidermis

intramuscular injection

injection through skin/subcutaneous tissue into muscle

intravenous route

administration directly into the bloodstream, immediate effect and greatest danger because the medication cannot be recalled once administered

medication reconciliation

comparison of current medication orders with patient report, medical record, and prior prescriptions, especially during transitions in care. Prevents duplication, omission, and interaction problems

metabolism / biotransformation

conversion of an active drug from its original form to an inactive or new form

parenteral

outside the intestines/alimentary canal; commonly refers to medication given by injection or infusion

peak level

highest plasma concentration of a drug. Typically measured after absorption is complete; timing depends on drug and route

pharmacodynamics

what the drug does to the body - drug effects at target cells and mechanisms of action.

pharmacodynamics

Receptor, enzyme, membrane, and physiologic response effects

pharmacogenetics

study of how genetic variation contributes to differences in drug response. Can influence effective dose, metabolism, and adverse effects

pharmacokinetics

what the body does to the drug: absorption, distribution, metabolism, and excretion (ADME)

pharmacology

study of drugs and their effects on body functioning

pharmacotherapeutics

therapeutic uses and effects of drugs - why a drug is given and what outcome is desired

piggyback delivery system

secondary IV system used to deliver an intermittent medication through a primary IV line.

placebo

pharmacologically inactive substance used. Ex. clinical trial. Response influenced by expectations despite lack of active drug.

PRN order

medication order to administer a drug as needed when the order’s clinical and timing parameters are met.

stat order

single medication order that must be carried out immediately

subcutaneous injection

injection into adipose tissue beneath the epidermis and dermis. Slow, sustained absorption; common for insulin and heparin

substance use disorder

term encompassing problematic substance use, including patterns formerly described as abuse/depedence/addiction.

synergistic effects

two drugs together produce a greater effect than expected from either alone; one may potentiate the other.

teratogenic

capable of causing developmental defects in an embryo or fetus

therapeutic range

serum drug concentration that produces the desired effect without toxicity

topical application

medication applied to skin or mucous membrane, often for local effect; some formulations scuh as transdermal patches provide systemic absorption

toxic effect

drug-related symptoms that carry risk of permanent damage or death

trade name / brand name

name selected by the company marketing a drug and protected by trademark; capitalized, can have multiple of these names

trough level

lowest drug concentration, usually measured shortly before the next dose. Reflects elimination and helps detect accumulation

vial

plastic or glass medicaiton container with a self-sealing rubber stopper. May contain one or multiple doses; use sterile technique with each entry

Z-track technique

IM injection method that displaces skin before injection so medication is sealed in muscle after the tissue returns in position. Reduces leakage into subcutaneous tissue, irritation, and discomfort

pharmaceutical class

mechanism of action, physiologic effect, and/or chemical structure. Ex. drugs grouped by how they work

therapeutic class

clinical indication or therapeutic action. Ex. analgesic, antibiotic, antihypertensive

clinical indication

the reason a medication is given - the condition or desired therapeutic effect it is inteded to address

absorption

drug moves from entry site to bloodstream. Route, formulation, lipid solubility, pH, blood flow, surface area, food, GI transit

distribution

drug travels through bloodstream to tissues/sites of action. Circulation, protein binding, blood-brain barrier placeneta/breast milk

metabolism

drug is chemically changed to inactive or new forms. Primarily liver; aging/liver disease can slow this

excretion

drug/metabolites are removed. Primarily kidneys; also lungs, bile/feces, minimally skin

oral

____ drugs generally absorb more slowly than IM or SUBQ drugs

first-pass effect / presystemic metabolism

reduction in drug bioavailability when an orally administered drug travels from the GI tract through the portal circulation to the liver and is extensively metabolized before reaching systemic circulation

additive

drugs with similar pharmacologic actions combine

synergistic

different sites / MOA combine and one potentiates the other

antagonisitc

drugs oppose / negate one another

interference

one drug interferes with metabolism of another

displacement

one drug displaces another from protein-binding sites

goal of therapy for drugs requiring serum monitoring

why does therapeutic range matter?

helps assess whether concentration becomes excessive

why does a peak serum drug level matter?

reflects elimination and accumulation

why does a trough serum drug level matter

influences dosing interval and time to steady concentration

why does half life matter in serum drug levels?

steady concentration

balance between tissue/serum concentrations with consistent dosing

standing order type

predetermined order set used for defined patients/conditions. Ex. standard orders for a clinical service

time-limited routine/standing order type

stops automatically after stated number of days/doses. Ex. antibiotic for a specified course

One-time order type

administered once at a specified time. Ex. preoperative medication

patient’s name and secondary identifier (DOB or medical record number), date and time when the order is written, name of drug, dosage, route, frequency, signature/indentification of prescribing provider

what are the parts of a medication order

1. when reaching into cabinet/drawer, pull out medication, check if you select the correct one using MAR

2. after retrieval, compare with the MAR/eMAR before opening medication

3. at bedside before you touch patient, after identifying patient and before administering meds

what are the 3 checks in medication?

right time, right patient, right route, right drug, right dose

what are the rights of medication administration

patient name, amount used, time given, prescribing provider, name of nurse administering

what is usually included in a controlled-substance record

reconstitution

adding the prescribed diluent to powdered medication to create a solution. Follow the vial label/package insert or pharmacist guidance for diluent and final concentration

ventrogluteal, vastus lateralis, deltoid

what are the the IM sites

MAR / eMAR

the administration record/order list used during care