Medication Administration 1

Nurses responsibility for Meds

• Interpret

• Transcribe (not students)

• Prepare

• Administer

• Teach

• Document

• Elevate

What are the different medication names?

• Chemical name

• Generic name (non-proprietary)

• trade or brand name (proprietary)

• generic drug

Chemical name

• provides exact description of meds composition and molecular structure

• rarely used in clinical practice

• ex. isobutylphenyl propionic acid

Generic Name (non-proprietary)

• shortened chemical names given by manufacturer

• becomes the official name under which the med is listed in official publications

• ex. ibuprofen

Trade or brand name (proprietary)

• name under which manufacturer markets the meds

• tradename is followed by TM

• Ex. Advil, motrin

Generic drug

• copies of brand name drugs

• contain the same medicinal ingredients as brand name drugs

What happens when a drug is under a patent?

company markets it under its brand name

what happens when a drug is off patent

company may market its product under their generic or brand name

What is drug classification?

• indicates the effects of medication on the body, the symptoms it relieves or its desired effects

• ex. ace inhibitors, beta-blockers, loop diuretics, anticoagulants, etc.

What meds are in more than on classification?

• tylenol

• aspirin

What drug classification does tylenol fall under?

• analgesic (reduce pain)

• antipyretic (reduce fever)

What drug classification does aspirin fall under?

• analgesic

• antipyretic

• anti-inflammatory

• platelet aggregation inhibitors (stops platelets sticking together and making clots)

The ‘blank’ of the med influences ‘blank’ and ‘blank’

• composition

• absorption and metabolism

What is the 4 processes that encompass the pharmacokinetics of a medication

• absorption

• distribution

• metabolism

• excretion

Absorption

• where the med goes from where it enters the body into the bloodstream

• First pass effect

• Bioavailbility

What is the first pass effect?

• affects oral meds

• phenomenon in which a med gets metabolized at a specific location in the body = reduced concentration of active drug before reaching its action site or the systemic circulation

• associated with liver but can occur in lungs, vasculature, GI tract

• reduces bioavailability of the med

Bioavailability

• the amount of med available to reach the target cells after metabolism to produce its intended effect

Distribution

• transportation of the med in the bloodstream to site of blood action

• most meds bind to protein

• albumin is a serum protein made by the liver

• meds bound to albumin cannot exert intended effect

a decrease in the amount of albumin occurs when an individual has what?

• liver failure

• malnourished

• older adults

a decrease in the amount of albumin creates what?

• leads to more unbound or active meds available to the body resulting in an increased risk for drug toxicity

Metabolism

• breakdown of meds into an inactive/less active form

• Pts esp. older adults, chonic disease are at risk for medication toxicity if organs cannot metabolize meds effectively

What does the liver do for metabolism of drugs?

• degrades harmful chemicals before they are distributed to tissues

Decreased liver function

• slower metabolism and accumulation of med

• risk for med toxicity

  • small dose of narcotic to Pt w/ liver disease = hepatic coma

Excretion

• process by which meds exit the body through the lungs, exocrine glands, bowel, kidneys and liver

if excretion happens in lungs

• drugs like anesthetic

• deep breathing and coughing (DB+C) will help clear anesthetic gases more quickly

if excretion happens in sweat glands

• drugs like lipid soluble meds

• need skin care due to the potential for irritation

if excretion happens in bowels

• drugs like enemas suppositories laxatives

• increase peristalsis = increasing rate of excretion and lessening time for drug effects

• decreased peristalsis (from immobility, poor diet) = slows down excretion, keeping meds in the gut longer and prolonging effects

if excretion happens in kidneys

• main organ for med excretion

• decreased renal function = at risk for med toxicity

• often reduced med doses in renal impairments due to toxicity risk

if excretion happens in mammary glands

• breast feeding is affected

What is half-life of medication

• the amount of time it takes for 50% of drug to be eliminated from blood stream

What is serum half life?

• time it takes for excretion process to lower serum med concentration by half

• after initial dose Pt. receives each successive dose when previous dose reaches half life

Medication effects

• therapeutic effects

• side effects

• adverse effects

• toxic effects

• Idiosyncratic reactions

• allergic reactions (anaphylactic)

Therapeutic effect

• intended or desired physiological response of meds

• the reason it is prescribed

• med may have more than one therapeutic effect

Side effect

• unintended secondary effect, usually predictable

• either harmless or potentially harmful

• common reason cited by Pt. as to why they stopped taking their meds

• Morphine can cause pruritis (itchy skin) that can make it unbearable for the Pt. to use it for pain relief

Adverse effects

• a severe negative response to a med (ex. coma) prompting immediate discontinuation of the meds

Toxic effect

• development of toxicity following prolonged intake of meds or after a med accumulated in the blood due to either impaired metabolism or impaired excretion

• there may be an antidote to reverse the effects

  • narcan brand name naloxone is the antidote for opioid toxicity

Idiosyncratic reactions

• unpredictable effects which occur when a Pt. over/under reacts to a med or has a diff reaction that what is expected (normal)

Allergic reactions

• immune response to med following becoming immunologically sensitive to the initial dose of the med

• the next dose(s) are seen by the body as an antigen = triggering antibodies

what are the clinical manifestations of allergic reactions?

• uticaria (hives)

• rash

• pruritis (itching)

• rhinitis

What is an anaphylactic reaction?

• severe life-threatening reaction characterized by bronchoconstriction leading to severe wheezing, shortness of breath + circulatory collapse if not treated quickly