Medication Administration

chemical name of medication

name of exact ingredients in the medication

generic name of medication

assigned by U.S Adopted Name Council, based on chemical name but shorter version

brand name of medication

trade name of a drug, usually shorter & easier to remember, owned by pharmaceutical company, proprietary name

prescribes the medication

physician, dentist, NP, physician assistant

dispenses the medication

pharmacist

administers the medication

nurse

nurse’s role in medication administration

responsible for: knowledge of meds & their effects, assessing individual needs for & response to meds, ensure individual receives the proper med, assessing for lack of knowledge, documentation of med effects

prescription medication

available w/ written direction from provider w/ prescriptive authority (physicians, NP, PA)

over the counter medications (OTC)

available w/o a prescription, may be bought by consumer for use at recommended dosages, before it can be OTC it has to be determined safe @ that dose

pharmacokenetics

the movement of drugs in the body, and the cycle (absorption, distribution, metabolism, excretion)

absorption

process of substance moving from administration site to bloodstream, speed depends on route, fat solubility, ph, medication concentration, length of contact, food, depth of breathing

systemic administration of meds

oral, intravenous, injection

medications with low ph (acidic)

absorb easily in stomach, stomach acid helps

medication distribution

delivery of drug to the site needed after it’s absorbed into bloodstream the ability to pass thru tissue depends on if it’s lipid-soluble or non lipid-soluble drug

lipid soluble drugs

easily pass through lipid layer of membranes d/t their low molecular size

non-lipid or water-soluble drugs

harder time passing through tissues

barriers to distribution

blood-brain barrier, blood-testicular barrier, blood-placental barrier

medication metabolism (biotransformation)

medication is gradually transformed to less active/inactive form (metabolite), required to break foreign substance down, liver/kidneys/intestines,

organs responsible for metabolism

liver (most of the work), kidneys, intestines

PO drugs r/t metabolism

administered in an inactive form, metabolite desired as a treatment, ex: medication activated in the liver

aging and metabolism

elderly - decreased blood flow, slower metabolism

genetics and metabolism

determines how much certain enzymes we have, and how fast we metabolize meds

diseases and metabolism

ex. those that affect liver, may cause slow metabolism, or medications used may build up in body to toxic levels

medication excretion

process where waste products are removed from body (kidneys), lungs/bile/saliva/sweat excrete small amounts, excretion limits exposure to medication

cumulation

build up of meds in body, leads to illness

half life of medication

the time required for the body’s elimination process to reduce the drug concentration by 1/2, written as half life or T 1/2

issues affecting the drug cycle

therapeutic level: point at which drug has max desired effect (too low, doesn’t work, too high=toxic), drug potency (agonist: drug taken w/ another so they can be more effective, antagonist: drug makes another drug less effective)

plasma concentration levels

onset of action, duration of action, termination of action, loading dose, peak blood level

onset of action

time after administration when body initially responds to drug

duration of action

length of time the drug has an effect on body

termination of action

time when body no longer responds to the drug

loading dose

large initial dose given to pt to achieve therapeutic dose quickly

peak blood level

highest level of drug concentration, gives us info about how well drug is absorbed, tells us if drug levels are greater than therapeautic levels (toxic)

dosage range

dosage prescribed, varies depending on age & body size, nurse needs to be aware of normal dosage range of medication (drug book)

maintenance dose

dose required so the rate of drug administration over any given time so that the level is = to rate of elimination, maintains a therapeutic dose

drug classification

based upon effect produced in body, each classification has specific actions, each action requires specific nursing responsibilities

therapeutic (primary effect)

predicted, intended, desired effect of medication

secondary effects

unintended, non-therapeautic effect (side effects, adverse reactions, allergic reactions, toxicity)

medication effects

desired effect, side effect, adverse effect, allergic reaction, anaphylaxis, toxicity

drug interaction

with other meds, with certain foods, with vitamins, herbal supplements

primary effects

palliative, supportive, substitutive, chemotherapeutic, restorative

side effects

unintended, often predictable, physiological effects that are usually well-tolerated by pts, very important to educate patient on what SE to look for, what SE should they contact provider

adverse reactions

harmful, unintended, usually unpredictable reactions to drug administered at normal dose, causes: age (can alter absorption, metabolism), sensitivities (older adult w/ renal impairment=toxicity)

allergic reaction

response where pt body reacts to med as a foreign invader to destroy, minor or fatal

anaphylactic shock

severe allergic reaction, can be life threatening, usually immediate, 1st sign acute SOB/wheezing/tachycardia/acute hypotension

severe signs & symptoms of an allergic response

SOB, rash, decreased BP, tachycardia, arrhythmia, laryngeal edema

mild signs & symptoms of allergic response

rash, pruritus (itch), rhinitis, tearing, nausea/vomiting, diarrhea

toxicity

too much medication, severe effects such as organ failure, death

idiosyncratic response

unexpected, individualized, under/over responsiveness, unpredictable, unexplainable, paradoxical - opposite to expected i.e agitation to a sedative

iatrogenic

disease caused unintentionally by medical therapy i.e liver damage d/t drug toxicity (acetaminophen)

teratogenic

capable of causing deformity in developing embryo d/t drugs, viruses, radiation

FDA pregnancy categories

Cat A: no risk any trimester, Cat B: none in animals/no human studies done, Cat C: animal studies=bad effects, no human studies Cat D: high risk for fetal abnormalities, Cat X: never used during pregnancy/definite abnormalities

drug interections

when administration of one drug before/at another time changes effect of one/both drugs, additive, antagonist, incompatible

synergistic effect

drug combination produces a more potent effect

routes of administration

oral (PO), sublingual, buccal, mucosal, topical, transdermal, inhalants, IV, IM, ID

enteral medications

any medication that involved GI tract, capsules, tablets, enemas, suppositories, most common route is oral

advantages of oral med administration

less invasive, well tolerated, requires little-no equipment, least expensive

disadvantages of oral med administration

slow absorption, risk of choking/aspiration, stomach acid destroys/inactivates meds, requires pt cooperation, amt of food in stomach affects absorption

contraindications to oral med administration

nausea, vomiting, difficulty swallowing, med inactivated by stomach acid, pt is unconscious

tablet medication

disks of compressed medication, may be scored, most are crushable, enteric-coated (released in intestines, not stomach), buffered tablets (antacids added to prevent stomach irritation)

capsule medication

gelatin coated, time release capsules allow med to take action in small intestine instead of stomach, extended release capsules allow med to be released a little at a time

advantages of oral liquid meds

easier to swallow, works quicker, more quickly absorbed, available in variety of compositions

effervescent salts

granules, coarse powders containing medicinal agents & tartaric acid/sodium bicarbonate, when added to water=carbonation, advantage: medication is already dissolved

elixir medication

contain alcohol (ETOH), helps dissolve med, makes more palatable, keep tightly capped (alcohol will evaporate), contraindicated in children, diabetics, alcoholics

other forms of oral liquid meds

emulsions (oils/fat in water), magmas (liquid/particles in water), powders (finely ground), solutions (med is evenly distributed), suspensions (must shake), syrup (med added to sweetened liquid)

oral medication administration

need calibrated med cup, place on flat surface, read measurement @ eye level, may offer water if thick or bad tasting, unless it’s used to coat the throat

oral liquid medication administration by mouth

oral syringes - for infants/small kids/difficulty swallowing, med is injected slowly & gently into cheek, for infants=semi-reclined

oral liquid medication administration nasogastric/gastric tube

most oral forms may be administered, ask pharmacy for crushing tablets/opening capsules, always flush tube before/after administration, check NG tube placement prior to administering

oral medication administration buccal

in the mouth or throat, troches (lozenge) held in cheek, dissolves

oral medication administration sublingual

under tongue, many capillaries for quick absorption, nitroglycerin - most common drug for this, for relief of chest pain

topical medications

applied to area of body or mucous membrane, affect the local area, includes skin, body cavities, orifices, advantage: can give meds topically that might be toxic if given PO, disadvantage: absorption varies

transdermal medication

medicated dressing in patch form, drug absorbed thru skin at slow & constant dose, for systemic effects, write date/time/initials. wear gloves, rotate sites, use places w/ lease amt of hair

administering ear drops to adult

pull pinna up and back

instilling ear drops for a child

pull pinna down and back

nasal medications

systemic/local effects, to reduce inflammation, facilitate drainage, treat infections, rapidly absorbed, have pt sit upright w/ head forward, will facilitate the med to enter sinus and not down throat

inhalation medication

fine droplets, inhalers & nebulizers, meter-dosed inhalers, dry-powder inhalers, always have pt rinse mouth after

dry powder inhalers

do not use pressurized canister to spray, rely on pt forceful inhalation to dispense dose into lungs, those w/ chronic asthma may not be able to produce enough airflow to properly use these, don’t directly inhale into the inhaler as it wastes the med

rectal medications

use for severe nausea/vomiting, pt not alert enough/unable to swallow, i.e suppositories, enemas, suspensions, ointments

enteral medications

used in pts w/ increased risk of aspiration/unable to swallow/poor nutrition intake, can be reversed, given via feeding tube

NG tube

nasogastric, inserted thru nose to stomach, flush w/ h20 pre & post medication

G tube

gastrostomy tube, surgically placed in stomach

J tube

jejunostomy tube, surgically placed in small intestine

G/J tube combo

surgically placed

medications via G tube

check orders, ensure that it matches in MAR, check for contraindications, check PEG tube site (red, edema, purulent), check placement (aspirate stomach contents, check ph), check residual/facility policy

pH values in the stomach

pH less than or = to 5 suggests presence of gastric contents (acid), ph greater than = to 6 suggests small intestine contents or pleural fluid (alkaline)

nutrition via tube

check orders, HOB 30 degrees, prime, gloves/goggles, check placement w/ air & stomach pH, aspirate & measure residual, return aspirated contents, admin feed if aspiration < 250 mls, flush w/ 30 cc before/after feed, document

drug tolerance

increasing amount of drug that is needed to produce same effect

drug dependence

physiologic: need drug for normal functioning-expeirence withdrawal, tremors, emotional distress, hallucinations, psychological: chracterized by drug craving/out of control drug use

drug misuse

meds used in a manner different than instructed, or for different purpose

drug abuse in nursing

no research shows that nurses abuse drugs at a higher rate than the general population, nurses deal w high work related stress, easy access to drugs, ANA suggests 10% of nurses are dependent on drugs/acohol

controlled substances

schedule I-V, schedule I: highly addictive, no medical purpose, schedule V:lowest probability for abuse

researching medications

nursing drug guides, physician’s desk reference (PDR), pharmacology textbooks, internet resources

prescription

means for dr to communicate to the pharmacist a medicine to dispense for the pt

doctor’s order must include

pt full name, date, drug (generic & brand), dose, route, frequency, dr signature, time of ordert

types of orders

standard written prescription to be given on a daily basis, carried out indefinitely until the dr discontinues medication

automatic stop date

drug has an automatic stop date

STAT

given immediately and only once

single order

given once and at a specified time

standing/routine order

physician’s preference to treat specific symptoms that need attention, in nursing home routine orders include meds for bowel protocols or elevated temp

PRN

given based on nurse’s judgment that the pt needs meds