NURS 321: Ch 1, Pharmacokinetics and Routes of Administration (part one)
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117 Terms
What are PHARMACOKINETICS?
what the body does to the medication; how it is absorbed, distributed, metabolized, and excreted
What is ABSORPTION?
how the medication gets into the bloodstream
What is DISTRIBUTION?
how the medication travels through the body
What is METABOLISM?
how the body breaks down the medication
Where does medication typically break down?
in the liver
What is EXCRETION?
how the body removes the medication
How is medication usually EXCRETED?
through the kidneys/urine
What is ROUTE OF ADMINISTRATION?
how medication can enter the body
Why does ROUTE OF ADMINISTRATION matter?
determines how fast, how much is absorbed, strength, nursing actions, and safety risks of medication
What are the FOUR routes of administration?
1.) oral/enteral
2.) topical
3.) inhalation
4.) parenteral
How is ORAL/ENTERAL medication taken?
goes through the GI tract
What are examples of ORAL/ENTERAL medication?
Tablets, capsules, liquids, suspensions, elixirs, lozenges, Sublingual, buccal, Nasogastric, and gastrostomy tubes
How is TOPICAL medication taken?
applied to body surface
WHERE can TOPICAL medication be applied?
transdermal aka skin, eyes, ears, nose, rectum, vagina, rectal suppositories
How is INHALED medication taken?
breathed in
What are two types of INHALED medication?
MDIs and DPIs
What are MDIs?
Metered dose inhalers
What are DPIs?
dry powder inhalers
How is PARENTERAL medication taken?
via injection
Does PARENTERAL medication go through the GI TRACT?
No
WHERE can PARENTERAL medication be applied?
intradermal, subcutaneous, intramuscular, intravenous, epidural
How is ORAL medication taken?
swallowed by mouth
How is SUBLINGUAL medication taken?
under the tongue
How is BUCCAL medication taken?
between cheek and gum
How does the speed of an IV medication compare to an ORAL medication
IV is faster because it goes directly into the bloodstream while oral medication takes longer because it goes through the GI tract
Why does INHALED medication work quickly?
the lungs have a large surface area and many capillaries, so medication can absorb rapidly
When is PARENTERAL medication used over ORAL?
when oral meds are not appropriate, when faster action is needed, or when the medication cannot survive the GI tract
What is a TOPICAL MEDICATION with LOCAL EFFECTS?
mainly works where it is placed.
What is a TOPICAL MEDICATION with SYSTEMIC EFFECTS?
absorbed and affects the whole body
LOCAL OR SYSTEMIC TOPICAL MEDICATION: an antibiotic ointment on a wound
local
LOCAL OR SYSTEMIC TOPICAL MEDICATION: a transdermal nicotine patch
systemic
What is the difference between oral and sublingual medication?
Oral medications are swallowed and absorbed through the GI tract, while sublingual medications dissolve under the tongue and absorb through mucous membranes.
Why would a patient need medication through an NG or G-tube?
the patient cannot safely swallow or cannot take medications by mouth
What is INHALATION medication usually used for?
respiratory conditions, such as asthma or COPD
Where is INTRADERMAL medication injected?
dermis layer of the skin
Where is SUBCUTANEOUS medication injected?
fatty tissue under the skin
What are common examples of SUBCUTANOUS medications?
insulin and heparin
Where is INTRAMUSCULAR medication injected?
muscle
What is typically injected via INTRAMUSCULAR injection?
vaccines, antibiotics, or medications
Where is INTRAVENOUS medication injected?
directly into a vein
Where is EPIDURAL medication injected?
epidural space near the spinal cord
What is EPIDURAL medication usually used for?
pain control, such as labor pain or severe pain management
Why are IV medication errors especially dangerous?
The medication enters the bloodstream immediately, so effects and adverse reactions can happen quickly
Why does an IM injection usually absorb faster than a SubQ injection?
Muscle tissue has more blood flow than fatty tissue
What is a NG TUBE?
"nasogastric tube"; tube that goes through the nose, down the throat, and into the stomach
What is a G TUBE?
"gastrostomy tube"; goes directly through the abdominal wall into the stomach
Why are NG tube and G-tube medications considered enteral?
Because the medication still enters the gastrointestinal tract
What is a CONTRAINDICATION in medication?
a reason you should not do something because it could harm the patient
What are 5 CONTRAINDICATIONS for oral medication administration?
vomiting, decreased GI motility, absence of gag reflex, dysphasia, and decreased level of consciousness
Why is VOMITING a contraindication?
they may not keep the medication down, also aspiration risk
Why is DECREASED GI MOTILITY a contraindication?
the medication may not absorb correctly or could sit in the stomach/intestines too long
Why is ABSENCE OF GAG REFLEX a contraindication?
helps protect the airway; without it, the patient is at high risk for aspiration
Why is DYSPHAGIA a contraindication?
If the patient cannot swallow safely, oral meds can go into the airway instead of the stomach
Why is DECREASED LEVEL OF CONSCIOUSNESS a contraindication?
If the patient is drowsy, confused, sedated, or unconscious, they may not be able to swallow safely
What position should a patient be in for oral medication
sitting upright to help with swallowing and to reduce the risk of choking or aspiration
What is an ANALGESIC?
pain medication
What should ANALGESICS be taken with?
a small amount of food because analgesics can irritate the GI tract
Should ALL medications be given WITH FOOD?
No, always follow medication instructions
How can FOOD AND DRINK change how medications work?
can affect absorption and metabolism causing medication levels to become too high
Why can't all medications be crushed or cut?
Some medications have special coatings or release systems. If crushed, patient may receive too much medication too quickly or the medication may irritate the stomach.
What types of medications must be SWALLOWED WHOLE?
enteric-coated and time-release medications
What are ENTERIC COATED MEDICATIONS?
has coating that protects the medication from stomach acid or protects the stomach from irritation; designed to dissolve later, usually in the intestines
What are TIME RELEASE MEDICATIONS?
release slowly over time
Why do SUSPENSIONS need SHAKING?
particles can settle at the bottom, dose may be uneven
How should medication liquid be measured?
on a flat surface, not in the air
What are THREE advantages of ORAL MEDICATIONS?
1.) SAFE; non-invasive, slow onset
2.) INEXPENSIVE
3.) EASY
What are THREE disadvantages of ORAL MEDICATIONS?
1.) Absorption variability
2.) Inactivation in GI tract
3.) Patient must but cooperative and conscious
What TWO PATIENT EDUCATION points should be provided for SUBLINGUAL AND BUCCAL medication?
1.) keep medication in place until fully dissolved
2.) do not eat or drink until medication is fully dissolved
In BUCCAL medication, where does the medication enter?
directly enters bloodstream and bypasses the liver
Why might a patient need medication through an NG or G-tube?
The patient may be unable to swallow safely but still has a working GI tract
Why are tube medications not the same as regular oral medications?
The nurse must check whether the medication can be crushed, dissolved, flushed, and safely administered through the tube
What can happen if medications are not prepared correctly for tube administration?
The tube can clog, the medication may not absorb correctly, or the patient may receive an unsafe dose
When should LIQUID forms of medication be used in NG and G tubes?
after getting a doctors approval, preferred because it is less likely to clog
What medication CANNOT be given through NG TUBE?
sublingual
What type of medication CANNOT be crushed for NG and G tube?
extended/time-release, fluid filled, enteric coated
Should medications be MIXED with enteral feedings?
No because it can cause unwanted interactions, clogging, can stick to tubing, may not receive full dose
How should CRUSHED TABLETS and CAPSULES be administered?
completely dissolve in 15-30mL of sterile water
What FOUR NURSING ACTIONS should be taken for NG and G TUBES in medication administration?
1.) proper tube placement
2.) syringe and push medication with gravity or plunger
3.) flush tubing before and after each medication
4.) flush 15-30mL of warm sterile water after administration
What are ADVANTAGES to TOPICAL MEDICATIONS
painless with limited adverse effects
What NURSING ACTIONS should be taken for TOPICAL MEDICATION application?
apply with glove, wash hands with soap and water, pat dry before applying
What TECHNIQUE must be used when applying TOPICAL medication to OPEN WOUNDS?
surgical asepsis
What CLIENT EDUCATION should be given for TRANSDERMAL medication?
apply patches for proper dosing, wash hands with soap and water and dry thoroughly, place patch on hairless area, rotate sites daily to prevent skin irritation
How should EYE medication be administered by the NURSE?
sit upright with head tilted slightly and look at the ceiling, rest dominant hand on patient's forehead, close eye
What if a patient blinks while administering EYE MEDICATION?
repeat
How long should you wait when applying eye medication to BOTH EYES?
5 minutes between each eye
How should EYE OINTMENTS be placed?
thin ribbon to edge of lower eyelid from inner to outer canthus
How should EAR medication be administered by the NURSE?
patient sit upright or lie on their side, straighten ear canal by pulling the auricle up and out, then instill medication
How LONG should a patient lie on their side after receiving EAR MEDICATION?
2-3 minutes
What should be done to EAR MEDICATION DROPS before administration?
warm with hands because cold drops can cause dizziness
How should NASAL DROPS be administered by the NURSE?
lie supine so medication enters, instruct client to breath through mouth, do not blow nose for 5 minutes
What TECHNIQUE should be used to apply NASAL DROPS?
aseptic technique
How should NASAL SPRAY be administered by the NURSE?
prime the spray, point nozzle away from nose, don't blow nose
How should RECTAL SUPPOSITORIES be administered by the NURSE?
position client in left lateral or lateral semi-prone recumbent and insert the suppository beyond the internal sphinter
What CLIENT EDUCATION should be provided when administering RECTAL SUPPOSITORIES?
remain flat for 5 minutes after insertion to retain suppository and absorption times vary
How should VAGINAL SUPPOSITORIES be administered by the NURSE?
position client with knees bent and feet flat on bed close to hips, provide perineal care if needed, lubricate suppository or fill applicator, apply medication
What CLIENT EDUCATION should be provided when administering VAGINAL SUPPOSITORIES?
remain supine for at least 5 minutes to retain the suppository
How should an MDI medication be administered by a patient?
shake inhaler take a deep breath and exhale, press inhaler and breath slow and deep inhalation, hold breath for 10 minutes to allow medication to deposit in airways
What CLIENT EDUCATION should be provided when using MDIs?
wait at least one minute between inhalations and rinse mouth out with water if using corticosteroid inhaler
How should an DPI medication be administered by a patient?
do not shake, follow manufacturer's directions for preparing medications such as loading medication pellet
Why should a client RINSE OUT their MOUTH when using a INHALER?
to reduce infections