MEDICATION AND IVF CALCULATIONS & SAFETY ADMINISTRATION OF MEDICATIONS

MORE ON DEFINITION OF TERMS SO MAKE SURE TO READ THE POWERPOINT

Medication

Substance administered for diagnosis, cure, treatment, or relief of symptom or for prevention of disease.

Purpose of drug and IVF calculation

Calculating dosages and flow rates, and administering continuous intravenous (IV) infusions are undertaken to make sure the accurate administration of medication is done and to ensure that no medication error can occur.

Right Medication

The medication given was the medication ordered.

Right Dose

• The dose ordered is appropriate for the client.
• Give special attention if the calculation indicates multiple pills/tablets or a large quantity of a liquid medication. This can be an indication that the math calculation may be incorrect.
• Double-check calculations that appear questionable.
• Know the usual dosage range of the medication.
• Question a dose outside of the usual dosage range.

Right Time

• Give the medication at the right frequency and at the time ordered according to agency policy.
• Medications should be given within the agency guidelines.

Right Route

• Give the medication by the ordered route.
• Make certain that the route is safe and appropriate for the client.

Right Client

• Medication is given to the intended client.
• Check the client’s identification band with each administration of a medication.
• Know the agency’s name alert procedure when clients with the same or similar last names are on the nursing unit.

Right Client Education

• Explain information about the medication to the client (e.g., why receiving, what to expect, any precautions).

Right Documentation

• Document medication administration after giving it, not before.
• If time of administration differs from prescribed time, note the time on the M A R and explain the reason and follow-through activities (e.g., pharmacy states medication will be available in 2 hours) in nursing notes.
• If a medication is not given, follow the agency’s policy for documenting the reason why.

Right to Refuse

• Adult clients have the right to refuse any medication.
• The nurse’s role is to ensure that the client is fully informed of the potential consequences of refusal and to communicate the client’s refusal to the health care provider.

Right Assessment

• Some medications require specific assessments prior to administration (e.g., apical pulse, blood pressure, lab results).
• Medication orders may include specific parameters for administration (e.g., do not give if pulse less than 60 or systolic blood pressure less than 100).

Right Evaluation

• Conduct appropriate follow-up (e.g., was the desired effect achieved or not? Did the client experience any side effects or adverse reactions?).

DRUG SCHEDULES

substances, and certain chemicals used to make drugs are classified into five (5) distinct categories or schedules depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential.

Schedule I

drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse.

Some examples of Schedule __ drugs are:
❑ heroin,
❑ lysergic acid diethylamide (LSD),
❑ marijuana (cannabis),
❑ 3,4-methylenedioxymethamphetamine (ecstasy),
❑ methaqualone, and peyote.

Schedule II

drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence.

These drugs are also considered dangerous.
Some examples of Schedule ___ drugs are:
❑ combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin)
❑ cocaine, methamphetamine, methadone,
❑ hydromorphone (Dilaudid),
❑ meperidine (Demerol),
❑ oxycodone (OxyContin),
❑ fentanyl, Dexedrine, Adderall, and Ritalin

Schedule III

drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence.
Schedule ____ drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV.
Some examples of Schedule____ drugs are: products containing less than 90 milligrams of
❑ codeine per dosage unit (Tylenol with codeine),
❑ ketamine,
❑ anabolic steroids,
❑ testosterone

Schedule IV

drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence.
Some examples of Schedule _____ drugs are:
❑ Xanax
❑ Soma
❑ Darvon
❑ Darvocet
❑ Valium
❑ Ativan
❑ Talwin
❑ Ambien
❑ Tramadol

Schedule V

drugs, substances, or chemicals are defined as drugs with lower potential for abuse than
Schedule IV and consist of preparations containing limited quantities of certain narcotics.

Schedule _____ drugs are generally used for antidiarrheal, antitussive, and analgesic purposes.
Some examples of Schedule ___drugs are:
❑ cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC),
❑ Lomotil
❑ Motofen
❑ Lyrica
❑ Parepectolin

TERATOGENIC DRUGS

Drugs that affects fetus and mother (To cause fetal abnormalities)

CATEGORY A

Adequate and well-controlled studies in pregnant women have failed to demonstrate a risk to the fetus in the first trimester of pregnancy

Examples:
Doxylamine
Folic Acid
Levothyroxine

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus, and there are no adequate and well-controlled studies in pregnant women, or animal reproduction studies have shown adverse effects, but well-controlled studies in pregnant women have shown no adverse effects to the fetus

Example:
Amoxicillin
Loratodine
Ondansetron

Category C

Animal reproduction studies have shown an adverse effect on the fetus, or there are no animal reproduction studies and no well-controlled studies in humans

Example:
Flucanazole
Metoprolol
Sertraline

Category D

Positive evidence of fetal risk, but benefits may outweigh risks.

Examples:
Lisinopril
Lithium
Phenytoin

Category X

Positive evidence of fetal risk and risk clearly outweigh any possible benefit
Examples:
Methotrexate
Simvastatin
Warfarin

Synergistic Effect

When two drugs with similar effects enhance each other’s action.
•Example: Combining aspirin and warfarin can increase the risk of bleeding

Antagonistic Effect

When two drugs with opposite effects reduce each other’s efficacy.
•Example: Naloxone (an opioid antagonist) counteracts the effects of opioids like morphine.

Additive Effect

When two drugs with similar actions produce a combined effect that is equal to the sum of their individual effects.
•Example: Taking acetaminophen (Tylenol) with ibuprofen (Advil) for pain relief. Both drugs work differently to relieve pain, and their combined use can result in greater pain relief than either drug alone without increasing the risk of adverse effects as seen in synergism.

Absorption

One drug may alter the absorption of another.
•Example: Antacids can reduce the absorption of tetracycline antibiotics.

Distribution

Drugs may compete for protein binding sites, affecting each other’s distribution. •Example: Aspirin can displace warfarin from plasma proteins, increasing warfarin's effects.

Metabolism

One drug may affect the metabolism of another, usually via cytochrome P450 enzymes.
•Example: Rifampin induces CYP3A4, reducing the effectiveness of oral contraceptives

Excretion

Drugs can affect the renal excretion of others.
•Example: Probenecid inhibits the renal excretion of penicillin, increasing its levels in the blood.

Increased Risk of Toxicity:

Example: Warfarin and antibiotics (e.g., clarithromycin) can interact, increasing the risk of bleeding due to enhanced anticoagulant effects

•Clinical Implication:

Monitoring for signs of toxicity and adjusting drug dosages may be necessary to prevent adverse outcomes.

Reduction in Adverse Effects

Using a beta-blocker (e.g., propranolol) with an alpha-blocker (e.g., prazosin) can reduce the risk of reflex tachycardia commonly seen with alpha-blockers alone.

Adverse Drug Reactions (ADRs):

Definition: When drug interactions lead to unintended and harmful side effects. Example: The combination of SSRIs (e.g., fluoxetine) and MAOIs (e.g., phenelzine) can cause serotonin syndrome, a potentially life-threatening condition.

Warfarin and NSAIDs (e.g., ibuprofen):

Both drugs increase bleeding risk, and their combination can significantly elevate this risk.

ACE Inhibitors (e.g., lisinopril) and Potassium-Sparing Diuretics (e.g., spironolactone):

Can lead to hyperkalemia (high potassium levels).

SSRIs (e.g., fluoxetine) and MAOIs (e.g., phenelzine):

Can cause serotonin syndrome, a potentially life-threatening condition

Statins and Fibrates

Increased risk of muscle toxicity (rhabdomyolysis

Alcohol and Benzodiazepines (e.g., diazepam)

Both are central nervous system depressants, and their combined use can have an additive effect, increasing the risk of sedation, respiratory depression, and potentially dangerous outcomes.

Patient Safety

Avoiding harmful DDIs is crucial for

Effective Therapy

Understanding and managing DDIs can enhance the efficacy of treatment regimens.

Personalized Medicine

Pharmacogenomics can help predict DDIs and personalize drug therapy to minimize risks

Medication Review

Regular review of a patient’s medications can help identify potential DDIs.

Dose Adjustment

Adjusting the dose of one or more drugs may be necessary to avoid interactions

Alternative Therapies

Substituting one drug for another with a similar effect but without the interaction potential.

Monitoring

Close monitoring of drug levels and patient symptoms can help manage DDIs.

Drug interactions

can occur when the combination of a drug with another substance causes different effects than either would individually. These interactions can be dangerous and even life-threatening in some cases.

Direct Influence

Two substances' effects influence each other directly

Indirect Influence

One substance affects how the body processes another, like how it is absorbed, metabolized, or transported around the body

Blood Thinners and Aspirin

Blood thinners and aspirin both prevent blood clots from forming, but taken together, they can prevent blood clotting to a dangerous extent, possibly causing internal bleeding.

Cocaine and Heroin

Cocaine is a stimulant that increases the body's need for oxygen, while heroin is a depressant that slows breathing and reduces the body's oxygen supply. This combination strains the organs and can cause respiratory failure and death

Statins and Grapefruit Juice

Grapefruit binds to the same enzyme that breaks down statins, a class of cholesterol-lowering drugs. This means a greater concentration of the drug stays in the bloodstream for longer, potentially causing kidney failure.

Acetaminophen and Alcohol

Alcohol can alter the function of the enzyme that breaks down acetaminophen, the active ingredient in pain relievers like Tylenol. This can lead to the production of a toxic substance, potentially causing liver damage.

Saint John's Wort and Medications

Saint John's Wort increases the liver's production of an enzyme responsible for breaking down certain drugs. This can cause the drugs to be metabolized too quickly, before they can have their therapeutic effects

Cytochrome P450 (CYP450)

enzymes are a family of membrane-bound heme proteins primarily found in the endoplasmic reticulum and mitochondria of liver cells. Their primary function is to metabolize xenobiotics, or foreign chemicals and drugs, to prepare them for excretion.

• CYP450 enzymes

• are heme proteins with an iron cation in the ferric state

• The metabolic cycle involves the reduction of the iron, the addition of oxygen, and the formation of a more polar metabolite

• This process makes the drug more water-soluble and ready for excretion through the kidneys

• The CYP450 enzyme system

• is responsible for the biotransformation of drugs and other foreign chemicals, making them more water-soluble and ready for excretion

• This is an important process that allows the body to eliminate potentially harmful substances