Fundamentals Week 2: Medication Administration

Generic Name

assigned by the manufacturer that first develops the drug; derived from the chemical name

Trade/Brand Name

 brand name copyrighted by the company that sells the drug

• Ex: Acetaminophen (generic) = Tylenol (trade/brand)

4 Types of Drug Preparations

1. Oral

2. Topical

3. Parenteral (Injectable, infusion, implantation)

4. Pulmonary

2 Types of Drug Classifications

1. Pharmaceutical Class:

   1. Refers to mechanism of action (MOA), physiologic effect (PE), and chemical structure (CS) of the drug

      1. Ex: is the drug working through the kidney or liver?

2. Therapeutic Class:

   1. Refers to the clinical indication for the drug or therapeutic action (ex: analgesic, antibiotic, or antihypertensive) --> which type of pain does it help? 

Pharmacokinetics (effect of body on drug)

1. Absorption: how the drug gets into the bloodstream

2. Distribution: how the drug travels through the body to its target tissues

3. Metabolism: how body breaks down the drug (mostly in the liver)

4. Excretion: how the drug leaves the body (mostly kidneys)

Factors Affecting Absorption of Medications

• Route of administration: drugs given orally take longest to be absorbed (liquids absorbed quicker than pills or capsules)

• Lipid solubility: lipid soluble meds pass more easily through cell membrane

• pH: some meds are absorbed well in stomach others in small intestine

• Blood-flow: consider impaired blood flow

• Local conditions at site of administration

• Drug dosage

Drug Dose and Serum Drug Levels (Therapeutic Range)

• Therapeutic range: concentration of drug in the blood serum that produces the desired effect without causing toxicity

  • Take about 6 weeks to get to therapeutic range for SSRIs (antidepressants)

• Peak level: highest plasma concentration of a drug

• Trough level: the point when the drug is at its lowest concentration, (usually right before next does is due) indicating the rate of elimination

• Half-life: amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

Rights of Medication Administration

1. Right medication

2. Right patient

3. Right dosage

4. Right route

5. Right time

6. Right reason
   ——

7. Right assessment data

8. Right Documentation

9. Right Response

10. Right to education

11. Right to refuse

Types of Medication Orders

1. Standing order (routine order): carried out until cancelled by another order, no end time

2. PRN order: as needed

3. Single or one-time order

4. Stat order: carried out immediately

Parts of the Medication Order

1. Patient's name

2. Date and time order is written

3. Name of drug to be administered

4. Dosage of drug

5. Route by which drug is to be administered

6. Frequency of administration of the drug

7. Signature of person writing the order

• can be telephone/verbal order but must read back order to prescriber

Medical Record Documentation

• Name and dosage of the medication

• Route and time of administration

• Name of person administering medication

• Site used for an injection

• Location of topical or transdermal applications

  • Naris, eye, or ear used for those administrations

• Intentional or inadvertently omitted drugs

• Refused drugs or medication errors

Medication Administration Record (MAR) and Bar Code-Assissted Medication Administration

Three Checks to Avoid Errors!!

1. When the medication is retrieved from Pyxis, med drawer, etc.

2. When the medication is prepared for administration (reconstitution, pulling into syringe, etc)

3. AT THE PATIENT'S BEDSIDE IMMEDIATELY PRIOR TO ADMINISTRATION!

The Problem with Zeroes

DO NOT PUT 5.0 OR .5 —> do 5 OR 0.5

• no trailing zero

Controlled Substances Required Information

• Name of patient receiving controlled substance

• Amount of substance used

• Hour the controlled substance was given

• Name of the prescribing provider

• Name of the nurse administering the substance

If a portion of controlled substance is used and remainder must be destroyed, 2 LICENSED INDIVIDUALS must witness the waste & sign

Oral Medications - 6 types

• Solid form: tablets, capsules, pills

• Liquid form: elixirs, spirits, suspensions, syrups

• Oral route: having patient swallow drug

• Enteral route: administering drug through an enteral tube

• Sublingual administration: placing drug under tongue

• Buccal administration: placing drug between tongue and cheek

 

Parenteral Medications (IV) - 9 types

• Subcutaneous injection: subcutaneous tissue

• Intramuscular injection: muscle tissue

• Intradermal injection: corium (under epidermis)

• Intravenous injection: vein

• Intra-arterial injection: artery

• Intracardial injection: heart tissue

• Intraperitoneal injection: peritoneal cavity

• Intraspinal injection: spinal canal

• Intraosseous injection: bone

Angles of Insertion for Various Injections (parenteral)

1. intradermal (5-15° angle)

2. subcutaneous (45-90° angle)

3. intramuscular (90° angle)

1. Intradermal Injections

1. Injected into dermis (below epidermis)

2. Longest absorption time

3. Max volume: 0.5 mL

4. 26-27 gauge needle --> ¼” to ½” length

5. Insert needle at 5-15° angle'

6. Common site: forearm

Ex: tuberculosis test

2. Subcutaneous Injections

1. Injected into adipose tissue underneath dermis

2. Max volume: 1 mL

3. 25-30 gauge needle

4. ⅜” to ⅝” length

5. Inject at 45-90° angle

6. Common sites: arms, abdomen, thighs

rotate sites of chronic use

Ex: insulin

3. Intramuscular Injection

1. Injected into muscle

2. Fast absorption and onset, long duration

3. Volume: 1-3 mL

4. 20-25 gauge needle

5. Length varies

6. Inject at 90° angle

Ex: flu shot

Preparing to Administer Medication

1. Check order

2. Determine preparation on hand

3. Determine how many tabs, mLs, drops to give

4. Ask yourself, is your dose appropriate?

Reconstitution of Liquids

• Identify amount of medication in the bottle

• Identify what TYPE and AMOUNT of liquid must be added

• Identify the concentration after the solution has been reconstituted

Methods of Med Calculation

1. ratio proportion (use = sign, same unit on numerator and denominator and cross multiply)

2. dimensional analysis (use x sign, opposite unit to cancel out, multiply ACROSS) mainly for converting units!

3. dose desired/available dose x quantity on hand = desired quantity

Insulin Dosages - 4 types

1. Rapid-acting insulin (lispro) onset of 15-30 min

2. Short-acting insulin (regular) = onset of 30-60 min, peaks 2-3 hours --> given
   subcutaneously but is the only one that can also be given via IV for critically ill patients

3. Intermediate-acting insulin (NPH) = onset of 1-1.5 hours, peaks 4-12 hours

4. Long-acting insulin (glargine detemir) = onset of 3-6 hours, no peak!