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Drug absorption
The movement of the drug from the site of administration into the bloodstream
Drug solubility
How easily the drug is broken down into liquid
How does pH affect medication absorption?
Determines how fast the body will break down/ absorb medication
What does body surface area have to do with medication absorption?
Determining on the patients body surface determines the amount of medication and how fast it will absorb
Ex. Giving a patient a cream it will be different for a adult then a child because the adults surface area is larger then the child’s
What is pharmacokinetics?
How the drug works in your body
Bioavailability?
The portion of the the drug or other substances high enters the circulation when introduced into the body and so is able to have an active effect
Ex. IV drugs have 100% bioavailability due to IV medications goes straight into the blood stream when administered
What is protein bounding capacity ?
The more albumin ( protein molecule) in the body determines the affective mess and amount of drug in the patients body.
Ex. The more protein molecules are in the body the less free drug is in the body. Free drug attached to the protein molecules and it cancels out. The less amount of protein molecules are in the body the more free drug is in the blood stream then which can cause overdose or toxicity
Drug metabolism?
Primary site is the liver, the process by which the body breaks down and eliminates the drug
Drug excretion ?
Primary site is the kidney, removal of the drug molecule from the site of action and the elimination of the medication
what are some common organs for excretion ?
Kidneys
Liver
GI tract
Lungs
Exocrine glands ( sweat and salivary)
What happens when kidneys are not functioning properly ?
If the kidneys are not functioning then the medication is not be excreted which will cause backup of the medication in the kidney
Onset?
Peak?
Duration?
How long until the medication starts working
Highest concentration ( working the most)
How long the medication will work for
Half- life ?
Amount of time it takes for half of the drug to be excreted
Ex. 1000mg for 8 hours the med goes down to 500 mg after 8 hours and keeps cutting dosage in half every 8 hours until all medication is excreted from body
What is pharmacodynamics?
Is the medication working or not?
What is primary/ therapeutic effects ?
What we predict to see when a patient takes a medication
Ex. Insulin = should help the patient with blood sugar levels
Therapeutic range
Knowing if the patient has enough of the medication to be beneficial for the symptoms
Palliative effect
Relives s/s of disease but does NOT affect disease
Ex. Giving pain meds to a patient t with cancer the med will help with the pain but will not do anything for the cancer itself
Supportive effect?
Supports the body functions until other treatments are effective
Ex. Giving Tylenol to a patient for their fever until antibiotic starts working
Trough ?
Checks concentration in the blood, this is done about 10-20 minutes before administering medication
Is trough lab results show low concentration what needs to be done ?
Increase dose
If trough lab results show high concentration what needs to be done ?
Decreased dose
Substitutive effect ?
Replacing fluid or chemicals for the body
Ex. Insulin
Chemotherapeutic effect?
Destroy bacteria \ microorganisms
Ex. Antibiotics
Restorative effect ?
Returning the body or maintaining the body at optimal levels of health
Ex. A patient with fit d levels low so they take fit d supplement to increase for normal level
Unintended or non therapeutical effects ?
unintended, predictable
Ex.side affects that are predictable that we know of and inform the patient of before starting medication
Adverse reactions ?
Unintended, unpredictable potentially harmful reactions
Toxic reactions ?
Dangerous, damaging affects to organs or tissues
Allergic reaction?
Immune reaction to medication
Idiosyncratic reaction ?
Unexpected , abnormal response to the medication
Ex. Having the opposite effect on the patient then what it is meant for
Cumulative effect ?
Taking too much of the medication and the body can not metabolize and excrete it fast enough
Drug-drug interactions ?
One drug alters another drug the patient is taking
Antagonistic relationship ?
Ex. Giving narcan to someone to cancel out another drug
Synergistic relationship
One drug is not enough, so patient needs to take another drug and both drugs working together works better than one alone
Ex. Two pain meds may help better than just one
Incompatibility?
Occur when two trucks are mixed together, usually with IV meds
Drug- food interactions
Ex. Grapefruit
Tolerance
The body ends up building up a tolerance to the medication
Ex. Been taking med for so long it stops working and needs to be increased
Dependence ?
Psychological or physiological dependence to a medication
Ex. The only way you can have a bowel movement is when you take laxatives
Drug misuse?
Improper use of the drug
Ex. Taking Benadryl to get tired but Benadryl makes you hyper
Drug abuse?
Inappropriate intake of substance
Illicit drugs
Street drugs
Non adherence?
Patient is not compliant with taking their medication
Standard orders?
Carried out until the order is cancelled
Automatic stop?
Discontinued after a certain length of time
e
Ex. Antibiotics
PRN meds
Given only when needed
Single (one time) Order ?
Given for one time only
STAT order
Give immediately x1 30 minute period to give when ordered
Verbal / telephone order
When doctor verbally gives you a medication either talking in person or over the phone
Components of medication order ? What is needed on the order before being able to give it to patient ?
Date & time
Drug name
Drug dose
Route
Frequency or duration
Special instructions
Signature from provider
What are the six rights of administration …. Plus three extra
Right drug
Right dose
Right patient
Right route
Right time
Right documentation
Right reason ( as a nurse you need to know the reason for giving the patient this medication and if it’s a right reason)
Right education ( as a nurse you should be able to educate the patient on the medication if they ask)
Right to refuse ( the patient can say no to taking the meds)
Three checks for medication administration?
Proper patient
Proper medication
Proper dosage
Preparation for administering med ?
Have MAR open
Asses the patient and critical thinking
Allergy review
Hand hygiene
One med at a time for the patient
Administering the med ?
Have MAR open
Use references if unfamiliar with drug
Calculate or check therapeutic levels
Three point check of labels
Compare ID band with stated name and DOB from patient
Scan barcodes
Nursing responsibilities for administering medication?
Receiving orders
Correct communication
Accurate dosage calculations
Correct administration
Timely administration and documentation ( don’t document before giving med and you have 1 hour before and 1 hour after time frame to give med)
Patient/ family teaching
NEVER LEAVE MEDICATION ON PATIENTS BED SIDE YOU NEED TO WATCH YOUR PATIENT TAKE THE MEDICATION
Oral medicine
Slower onset but lasts longer
PO by mouth ( liquid, tablet or capsule)
sustained release ?
Slow and regulated
Enteric release ?
The tablet is coated and bypasses the stomach and is to be absorbed in the small intestine
Sublingual ?
Under the tongue
Buccal?
Between the cheeks or gum
What are external medications ?
Medications given through the tube
External medications
Pt in high Fowler
Check tube placement
Flush with 30 ml after every dose ( per textbook)
Follow LAST dose with 30-60 ml of water
Clamp tube
Keep in high Fowler position for an hour after administering med
Ex. NG tube, GI tube , NJ tube
Topical medications
Gel or cream on skin
Topical cream administrations
Use clean gloves if skin is intact and sterile gloves if skin is broken
Privacy
Tongue blade or cotton applicator to get cream out of tube
Don’t double dip
Transdermal patch
Patch on skin for medication administration
Administering transdermal patch
Remove old patch and clean the area before putting new patch on body
Rotate areas
Avoid hairy areas
Instillations
Eyedrops, ear drops, nasal
Instillation (eyedrops) administration
Clean gloves
Removal of eye discharge
Administering in the center of the conjunctivita sack while patient looks up
Gently press with cotton ball after administering for 1-2 minutes to prevent systemic absorption
Avoid cornea
Instillation ( ear drops)
Clean gloves
Med at room temp
Clean visible part of canal
Head tilted to ineffective side
Don’t contaminate the dropper
Adult technique and Child technique for administering ear drops
Adult- pull top of ear UP and BACK
child- pull ear lobe DOWN and BACK
Installations (nasal)
Clean gloves
Have to blow their nose
Remove nose Jewelry if necessary
Pt tilt head bacK
Drop or spray
Breathe through mouth not nose for 1 minute after administering med
Keep head tilted back for 5 minutes after administering med
Rectal medications (suppositories)
Clean gloves
Pt lay down on the left side
tell patient to breathe through mouth to relax sphincter
Lubricant
Gently insert beyond the Anal sphincter
Keep client laying on left side for 20 minutes
Inhalations?
Shake well
Hold 1-2 inch from mouth ( unless using spacer then on side of space will go on inhaler and one end in pt mouth)
Breathe through mouth
Take deep breaths while pushing trigger
Continue to inhale deeply
Exhale slowly through pursed lips
If second dose is required wait two minutes
Rinse mouth to prevent thrush in mouth
Parenteral medications
Anything injectable
Types of parenteral injections
Intradermal
Sub c
Intramuscular
Intravenous
Intraspinal (injection into the spine)
Epidural (injection into extradural space)
Intrathecal (injection into the subarachnoid space around spinal cord)
Ampule
Single dose (glass)
Tap, break away
Use filter straw ( to prevent from getting glass particles from getting into the medication)
Vial
Single or multi dose (glass)
Add air to displace fluid ( to make easier to draw up)
Intramuscular
Use 20-25 gauge needle, 1-3 inch
Aspirate (unless vaccine)
Massage spot after injection
Z -track Method
Moving skin over with your finger injecting the needle then once finished pull out need let go of skin with your finger the skin will move back and place this is so the medication does not leak out
Sites for intramuscular injections ?
Deltoid (shoulder) three fingers below acromin process (under clavicle ) then point your thumb down making a triangle where you will insert the injection
Ventrogluteal (outside of butt top of thigh) palm on greater trochanter, thumb pointed toward groin, middle, ring and pinky together and pointed up the spine and pointer finger is open making a “V” with middle finger injection needle in between pointer and ring fingers
Vastus lateralis (middle of thigh) inject in middle third of outer aspect of thigh
what degree do you injection instramuscular injections
90 degree angle
How do you inject subcutaneous injection
Injection the needle at a 90 or 45 degree angle
Ex. Patients that are very thin and don’t have a lot of sub c tissue you would give them the injection at a 45 degree
Subcutaneous
Use 1-3 ml syringe OR insulin syringe
25-27 gauge , 3/8 -5/8 inch
Volume up to 2.0 ml
No aspiration
Rotate sides
Sites for subcutaneous injections
Fatty parts of the back of arm, front of thigh, abdomen and lower back
Upper back under scapula
What is intradermal injection
Inject needle at a 15 degree angle, under the first layer of skin , a bubble should show if a bubble does not show then the needle went too far underneath of skin
Intradermal injection
Use TB or small syringe
26-28 gauge , 3/8-3/4 inch
Only small volume of med ( 0.01-0.1ml)
Bleep bubble should appear
Sites for Intradermal injection
Inner forearm
Upper back ( over scapula)
Upper chest (over clavicle)
IV push
Generally given over 1- 3 minutes or longer
Assess the patient for response
Some meds need to be pushed fast and other slowly
IV infusion (a drip)
Fluids
Blood
TPN
medications
IV therapy complications
Hematoma (bruising)
Phlebitis (irritation of the veins )
Extravasation and infiltration (not going into the vein going into the tissue around the vein instead)
Air embolism (air bubbles enter the blood stream and block the blood flow)
Infections
Fluid overload
Hypo or hyperglycemia
