MEDICATION

Medication

Medication

a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease.

medication and drug

are generally used interchangeably

Drug

also has the connotation of an illicitly obtained substance such as heroin, cocaine, or amphetamines.

Prescription

The written direction for the preparation and administration of a drug is called a

generic, trade, official, chemical

One drug can have as many as four kinds of names:

Generic Name

is assigned by the United States Adopted Names (USAN) Council and is used throughout the drug’s lifetime.

Trade Name

the name given by the drug manufacturer and identifies it as property of that company.

Official Name

the name under which a drug is listed in one of the official publications (e.g., the United States Pharmacopeia).

Chemical Name

the name by which a chemist knows it; this name describes the constituents of the drug precisely.

Medication

are often available in a variety of forms

Pharmacology

the study of the effect of drugs on living organisms.

Pharmacy

the art of preparing, compounding, and dispensing drugs. The word also refers to the place where drugs are prepared and dispensed.

Pharmacist

prepares, makes, and dispenses drugs as ordered by a physician, dentist, nurse practitioner, or physician assistant.

Clinical Pharmacist

who often guides the primary care provider in prescribing drugs.

Pharmacy Technician

a member of the health team who in some states administers drugs to clients.

Pharmacopoeia

a book containing a list of products used in medicine, with descriptions of the product, chemical tests for determining identity and purity, and formulas and prescriptions.

US National Formulary

lists drugs and their therapeutic value and can include drugs that may still be used but not listed in the USP.

Controlled Substances

can be kept in a locked drawer, cupboard, medication cart, or computer-controlled dispensing system, depending on the agency.

Food, Drug, and Cosmetic Act (1938)

Implemented by the U.S. Food and Drug Administration (FDA); requires that labels be accurate and that all drugs be tested for harmful effects.

Durkham-Humphrey Amendment (1952)

Clearly differentiates drugs that can be sold only with a prescription, those that can be sold without a prescription, and those that should not be refilled without a new prescription.

Kefauver-Harris Amendment (1962)

Requires proof of safety and efficacy of a drug for approval.

Comprehensive Drug Abuse Prevention and Control Act (1970)

Categorizes controlled substances and limits how often a prescription can be filled; established government-funded programs to prevent and treat drug dependence.

Therapeutic Effect

the primary effect intended, that is, the reason the drug is prescribed.

Side Effect

or secondary effect, of a drug is one that is unintended.

Adverse Effects

Some side effects are tolerated for the drug’s therapeutic effect; more severe side effects, also called

Drug Toxicity

results from overdosage, ingestion of a drug intended for external use, or buildup of the drug in the blood because of impaired metabolism or excretion (cumulative effect).

Drug Allergy

an immunologic reaction to a drug. When a client is first exposed to a foreign substance (anti gen), the body may react by producing antibodies.

Anaphylactic Reaction

A severe allergic reaction usually occurs immediately after the administration of the drug and is called an

Cumulative Effect

is the increasing response to repeated doses of a drug that occurs when the rate of administration exceeds the rate of metabolism or excretion.

Drug Tolerance

exists in a client who exhibits an unusually low physiologic response to a drug and who requires increases in the dosage to maintain a given therapeutic effect.

Drug Interaction

occurs when the administration of one drug before, at the same time as, or after another drug alters the effect of one or both drugs.

Synergistic Effect

occurs when two different drugs increase the action of one or another drug. For example, probenecid, which blocks the excretion of penicillin, can be given with penicillin to increase blood levels of the penicillin for longer periods (synergistic effect).

Iatrogenic Disease

(disease caused unintentionally by medical therapy) can be a result of drug therapy.

Drug Misuse

the improper use of common medications in ways that lead to acute and chronic toxicity.

Drug Abuse

the inappropriate intake of a substance, either continually or periodically.

Drug Dependence

the reliance on or need to take a drug or substance. The two types of dependence, physiologic and psychologic, may occur separately or together.

Physiologic Dependence

is due to biochemical changes in body tissues, especially the nervous system. These tissues come to require the substance for normal functioning.

Psychologic Dependence

is emotional reliance on a drug to maintain a sense of well-being, accompanied by feelings of need or cravings for that drug.

Drug Habituation

means a mild form of psychologic dependence. The individual develops the habit of taking the substance and feels better after taking it.

Illicit Drugs

also called street drugs, are those sold illegally. Illicit drugs are of two types: (a) drugs unavailable for purchase under any circumstances, such as heroin (in the United States), and (b) drugs normally available with a pre scription that are being obtained through illegal channels.

Palliative

Relieves the symptoms of a disease but does not affect the disease itself.

Curative

Cures a disease or condition.

Supportive

Supports body function until other treatments or the body’s response can take over.

Substitutive

Replaces body fluids or substances.

Chemotherapeutic

Destroys malignant cells.

Restorative

Returns the body to health.

Peak Plasma Level

When an orally administered drug is absorbed from the gastrointestinal (GI) tract into the blood plasma, its concentration in the plasma increases until the elimination rate equals the rate of absorption. This point is known as

Onset of Action

the time after administration when the body initially responds to the drug

Peak Plasma Level

the highest plasma level achieved by a single dose when the elimination rate of the drug equals the absorption rate

Drug Half-Life

the time required for the elimination process to reduce the concentration of the drug to one-half what it was at initial administration

Plateau

a maintained concentration of a drug in the plasma during a series of scheduled doses.

Pharmacodynamics

the mechanism of drug action and the relationships between drug concentration and resulting effects in the body (Adams, Holland, & Urban, 2020, p. 49).

Receptor

the drug’s specific target, usually a protein located on the surface of a cell membrane or within the cell.

Agonist

When a drug produces the same type of response as the physiologic or endogenous substance, it is referred to as an

Antagonist

Conversely, a drug that inhibits cell function by occupying receptor sites is called an

Naloxone (Narcan)

an opioid antagonist used as an antidote for respiratory depression caused by an opioid drug

Pharmacokinetics

the study of the absorption, distribution, biotransformation, and excretion of drugs.

Absorption

the process by which a drug passes into the bloodstream.

Distribution

the transportation of a drug from its site of absorption to its site of action.

Biotransformation

also called detoxification or metabolism, is a process by which a drug is converted to a less active form.

Metabolites

Most biotransformation takes place in the liver, where many drug-metabolizing enzymes in the cells detoxify the drugs. The products of this process are called

Excretion

the process by which metabolites and drugs are eliminated from the body.

Pharmacogenomics

The study of how genes affect an individual’s response to drugs is called ___________________________, a combination of pharmacology and genomics, to study the role of the genome (all the genes) in response to drugs.

Pharmacogenomics

refers to the study of how DNA variation in a single or few genes influences the response to a single drug

precision medicine

Pharmacogenomics is increasingly becoming a component of ______________________, sometimes called precision health, which focuses on the development of prevention and treatment strategies that include attention to an individual’s variability in genes, environment, and lifestyle,

Vitamin K

found in green leafy vegetables, can counteract the effect of an anticoagulant such as warfarin (Coumadin). 

Stat Order

indicates that the medication is to be given immediately and only once.

Single Order

is for medication to be given once at a specified time

Standing Order

may or may not have a termination date. A __________________________ may be carried out indefinitely (e.g., multiple vitamins daily) until an order is writ ten to cancel it, or it may be carried out for a specified number of days (e.g., KCl twice daily*2 days).

PRN Order

permits the nurse to give a medication when, in the nurse’s judgment, the client requires it

Client’s Full Name

that is, the first and last names and middle initials or names, should always be used to avoid confusion between two clients who may have the same last name.

name of the drug to be administered

must be clearly written. In some settings only generic names are permit ted; however, trade names are widely used in hospitals and health agencies.

dosage of the drug

includes the amount, the times or frequency of administration, and in many instances the strength; for example, tetracycline 250 mg (amount) four times a day (frequency); potassium chloride 10% (strength) 5 mL (amount) three times a day with meals (time and frequency).

route of administration

This part of the order, like other parts, is frequently abbreviated.

Signature

of the ordering primary care provider or nurse (if receiving a verbal or telephone order) makes the drug order a legal request.

Metric System

is prescribed by law in most European countries and in Canada. It is logically organized into units of 10; it is a decimal system.

Household System or Measures

may be used when more accurate systems of measure are not required. Included in household measures are drops, teaspoons, and tablespoons.

Formula = D x V / H = amount to administer

The Basic Formula

H : V :: D : x

The Ratio and Proportion Method

H/V = D/x

The Fractional Equation Method

Dimensional Analysis Method

is often used in the physical sciences when a quantity in one unit of measurement is converted to an equivalent quantity in a different unit of measurement by canceling matching units of measurement.

Body Weight

significantly affects dosage; therefore, dosages are calculated.

body surface calculation

Sometimes the _____________________________ may be used instead of body weight to individualize the medication dosage. It is considered to be the most accurate method of calculating a child’s dose.

Oral Administration

the most common, least expensive, and most convenient route or most clients. In oral administration, the drug is swallowed. Because the skin is not broken as it is for an injection.

Sublingual Administration

a drug is placed under the tongue, where it dissolves (Figure 35.7 ■). In a relatively short time, the drug is largely absorbed into the blood vessels on the underside of the tongue. The medication should not be swallowed.

Buccal

means “pertaining to the cheek.”

Buccal Administration

a medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves (Figure 35.8 ■). The drug may act locally on the mucous membranes of the mouth or systemically when it is swallowed in the saliva.

Parenteral Route

is defined as other than through the alimentary or respiratory tract; that is, by needle.

Topical Applications

are those applied locally to the skin or to the mucous membranes. They affect only the area to which they are applied.

Installations and Irrigations

applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina

Inhalations

administered into the respiratory tract by a nebulizer or positive pressure breathing apparatus. Air, oxygen, and vapor are generally used to carry the drug into the lungs.

Identify the client, inform the client, administer the drug, provide assistive interventions as indicated, record the drug administered, evaluate the client’s response to the drug.

6 Steps to Follow when Administering Medications

Medication, Dose, Time, Route, Client, Client Education, Documentation, to Refuse, Assessment, Evaluation

Ten Rights of Medication Administration

Medication Reconciliation

the process of identifying the most accurate list possible of all medications a patient is taking—including name, dosage, frequency, and route—and using this list to provide correct medications for patients anywhere within the healthcare system. Reconciliation involves comparing the patient’s current list of medications against the physician’s admission, transfer, or discharge orders”

Medication Errors

“Any preventable event that may cause or lead to inappropriate medication use or patient harm, while the medication is in the control of the health care professional, patient, or consumer.”

Medication Cart

on wheels, allowing the nurse to move the cart to outside the client’s rooms.

Medication Cabinet

hold the client’s unit-dose medications and MAR. Controlled substances are not kept in this cabinet but at another location on the nursing unit. The nurse uses either a key or a special code to open the client’s medication cabinet, because it must be locked when not in use.

ADC

This computerized access system automates the distribution, management, and control of medications.

Medication Room

may be used for a variety of purposes. For example, the medication carts, when not in use, may be placed in this room.

First Check

When the nurse reaches for the container or unit dose package