test 3

reasons for drug rash (ADR)

• allergic reaction

• buildup of drug that causes toxicity to skin

• drug makes skin more sensitive to sunlight

• interaction of two or more drugs

onset

how quickly med acts

peak

how long for max effect

duration

how long it lasts

Absorption

• entrance of drug into blood stream after administered

• affected by: route, age, gender, emotional state

Distribution

how drug is distributed in tissues and fluid of body after absorption

Metabolism

how the med is broken down. liver enzymes convert most drugs into water soluble compound for excretion

Excretion

how drugs are eliminated from body metabolism by liver & excretion by kidney

HIGH ALERT

• logo above name header that indicates greater potential for harm

• ex: chem agents, anticoagulants, insulins, narcotics

Schedule I

• drugs with high abuse potential and no medical use

• ex: Heroin, Hallucinogens, Marijuana (recreational)

Schedule II

• drugs with high abuse potential and accepted medical use

• ex: NARCOTICS= morphine, fentanyl, oxycodone, hydrocodone-acetaminophen; Adderall, Ritalin, pentobarbital

Schedule III

• drugs with moderate abuse potential and accepted medical use; prescription may be refilled

• ex: anabolic steroids, ketamine, TYL. w/ codeine, marijuana (therapeutic)

Schedule IV

• drugs with low abuse potential and accepted medical use

• ex: Ambien, valium, Xanax

Schedule V

• drugs with limited abuse potential and accepted medical use

• ex: antihistamine, antitussives, Phenergen

Therapeutic Class

what class of illness drug is used for

Indications

what it’s used for & approved by FDA

Action

how it works

Half-life

time it takes for ½ the medicine to be excreted

Contraindications

situations in which drug use should be avoided. Risk in RED

Routes and Dosage

routes of administration grouped together include recommended doses for adults, children/elderly

Available forms

lists strengths & concentrations of available dose forms

Adverse reactions

effects of a drug, NOT the intended therapeutic effect~ ranges from benign to fatal

Interactions

gives drug-drug interactions and the physiological effects. Significant food-drug interactions are noted

Patient & Family Teaching

• Guidelines for teaching patients about medication

• explains drug’s purpose

• specific information to teach patient about taking medication

• Preventing adverse reactions

Medications

• modify, restore, or maintain body functions

• used to prevent disease and/or pregnancy

• aid in diagnosis or treatment of disease

• ordered by prescribing entity~ MD, NP, PA

• dispensed by a Doctor of Pharmacy (Pharm D) or Registered Pharmacist (RPh)

• administered by licensed nursing staff~ PVN, Psych Tech, or RN

Controlled Substances

• inventory checked regularly per facility policy~ ex: Q shift and with exchange of key set

• controlled drug count signature record with current and oncoming shift

• kept in double-locked area

• keys must be in possession of a licensed RN, LVN, or PT at all times

Patient Rights

• right to know name, action, and possible side effects of their medications

• right to refuse medications, unless a court order is in place (or during a medical emergency)

• right to request generic forms of medications (to decrease expense of tx)

Prescriptions

• identifying information about the patient (full name, DoB, pt #)

• date and time the order was written~ may include additional start and discontinue date

• name of drug (brand/generic)

• dose to be given, # of tablets, mg/ml solution ratio and total mg or ml to be given

• time & frequency of dose (Q, BID, TID, QID, HS)

• method/route (PO,IM, SC/SQ)

• prescribing physician’s name/sig

Telephone or Verbal Orders for Meds

• order may be taken by a licensed RN, LVN, PT

• indicate T.O. before writing the actual order

• include all requirement of a regular prescription

• Name of person taking the order must be included

• the order must be read back to the prescribing physician

• the physician must sign the order within 12-24 hours, per policy

7 Rights of Med Administration

Right Patient, Right Medication, Right Dosage, Right Route, Right Timing, Right Indication, Right Documentation

3 Checks

1. when taking medication from drawer

2. before putting the sealed package into a cup

3. before opening package and giving med

Right Patient, Right Medication

• check patient’s name on the Medication Administration Record (MAR) matches the name on the med

• medication on MAR must match med that you are dispensing

• verify medications between brand and generic name on medication pack and MAR

Time of Administration

• time on med pack must match time on MAR

• the time you are giving a med must fall within the window~ 1 before or after

• frequency: BID, TID, QID, HS

Time medication

important when determining onset, peak, and duration of medication

PO meds with meal increases _ time

absorption

Some PO meds must be taken at _ to decrease GI upset

mealtime

Some meds must be taken _ to be effective

ac (before meals)

Diuretics

should not be given at night because they cause frequent voiding

• give in AM

Antidepressants & Vitamins

given in the morning to avoid sleep disruption

Sedating meds

given in late afternoon or early morning, if possible~ sleep good

• Tramadol, Ativan, not in AM because decreased awareness during the day

Insulin

given according to mealtime~ 10-15 minutes before mealtime

• meal w/o insulin= high blood sugar

• insulin but refuse meal= hypoglycemia

PO route

• Tabs/Caplets/Capsule- whole, crushed, opened

• Sublingual- dissolves under the tongue~ ondansetron (Zofran)

• Translingual- spray, lozenge, or orally disintegrating tablet placed on tongue~ lozenges, Hals

• Buccal- placed between cheek and gum~ Nicorette gum, dextrose gel

• Suspension- liquid poured in a measuring cup laid on flat surface~ Milk of Magnesium

PO Meds: Extended Release

• designed to release medication overtime

• Sustained release (SR), Delayed release (DR), Extended Release (XR, ER)

• never crushed

Inhalant Route

• always read the administration instructions

• wear gloves

• shake medication

• pt. exhale completely, then inhale deeply while depressing the canister

• hold breath, breathe out slowly through pursed lips

Topical, Rectal, Vaginal, Urethral Route

• Instillations- eye or ear drops

• Irrigations- ear lavage, bladder irrigation, wound cleaning

• Enemas- stimulate a BM or administer meds

• Suppositories- stimulate BM

• Cream & Pastes- antifungal

• Medicated shampoos- selenium sulfide/dandruff

Ophthalmic Instillations: Eye Drops

• read instructions/wear gloves

• client lie down or sit up, client looks up

• retract lower eyelid and administer drops into lower conjunctival sac

• close eyes, pressure on inner canthus~ 2-3 minutes

• for ointment, apply in thin line from inner to outer canthus

Otic Instillations: Ear Drops

• read instructions/wear gloves

• side-lying, pull ear up, back and outward

• hold dropper above external auditory canal opening

• side of ear canal/ don’t let dropper touch ear

• massage tragus

Enemas

• instructions/ hand hygiene/ wear gloves/ possibly a mask

• 99°F-102°F

• Cleansing enema: Sim’s, Retention enema: Knee chest

• waterproof pad under client

• lubricate tip and prime tubing using clamp

• 12” to 18” above rectum

• dizzy? patient hydration before procedure. nausea? small meal. cramp/discomfort? lower bag.

Suppositories

• read instructions/ wear gloves

• use left Sim’s~ opens rectum to specific alignments

• Lubricate/ insert at least 4 inches

• position for 15-20 minutes

• document

Transdermal Route

• patch or paste that circumvents gastrointestinal metabolism, allowing for greater medication absorption

• released over time

• wearing gloves, remove current patch, fold it in half and dispose of it in the hazardous waste

• remove backing from new patch, place it on clean, dry, hairless area, pressing firmly

• write date and time applied on the patch with black marker~ around medicated area

• ex: Fentanyl, NicoDerm, Nitroglycerin, Estrogen, Lidocaine

Injection Route

• SC/SQ: subcutaneous (beneath the skin)~ enoxaparin, insulin

• IM: intramuscular (into muscle tissue)~ vaccines

• IV: intravenous (directly into blood vessels)~ electrolytes

• IT: intrathecal (into the area surrounding the spinal cord)~ chemotherapy, pain pump

Dose

single amount of medication administered at a time (may vary depending on age and weight)

Therapeutic dose

amount of medication required to obtain the desired effect (may be monitored using blood serum levels of the drug)

Loading Dosage

larger than the usual dose, given to establish a minimum blood level

Minimal dose

smallest amount of medication necessary to produce a therapeutic effect

Maximal dose

largest amount that can be safely given without causing an adverse reaction

Toxic dose

amount of medication that cause sx of poisoning or toxicity

Lethal dose

amount that will cause death

Documentation

• accurately record meds given after administration (right patient, med, time, dose, route)

• assessment findings (ex: VS, blood glucose)

• refusals or withholdings (ex: hold for HR<50)

• reason for giving PRN medication (ex: constipation)

• PRN follow up (ex: 1 hour after giving)

• part of body injection was administered (ex: Rt deltoid)

Scheduled medication

given at a certain time of a day for a specific dx
(Give Omeprazole ER 20 mg PO q day at 0600 for GERD)

PRN medication

given ‘as needed’ with time increments and sx parameters
(Give Tylenol 650 mg PO q 4 hours PRN for temperature >100.4°F

STAT

medication must be given immediately
(aggressive patient~ imminent danger to self/others)~ Ativan~ sedative

Stock/House Meds

• over-the-counter (OTC) medications

• multiple patients, same bottle,

• won’t have patient’s name

• acetaminophen, throat lozenges, Maalox, milk of magnesium, vitamins & minerals

Preparing Administration

• check meds with the MAR (1st check)

• everything must match exactly; discrepancies=check original order in chart

• never give med if you can’t read label

• know what the medications are indicated for

• know what the classifications of the medications are

• check med compatibility

Setting Up Meds

gather equipment, sanitize work-station and hands, set up order of the MAR, check meds with the MAR (2nd check), check allergies, check expiration dates & open date, keep meds with you or locked up at all times, be aware of how control meds are accounted for

Patient teaching

• names of meds and reason for prescription

• dosage, frequency

• how to self-administer

• expected side-effects/possible adverse effects

• how long the client will take the medication

• onset, peak, duration

• signs & symptoms to report

therapeutic effects

desired effect or result

side effect

an unintended response that is relatively minor and treatable

adverse effect

an unintended response that is disabling or potentially fatal

Anaphylaxis

severe, immediately life-threatening allergic reaction manifested by vasodilation, low blood pressure and shock

toxicity

harmful, undesirable effect resulting from a medication blood level that is too high

potentiation

when the effects of two medications together are greater than the individual effects

paradoxical effect

the client’s response to a medication is opposite to that what is desired

local

effects are limited to the surrounding area~ topical creams

systemic

absorbed into the general circulation; affecting the entire body via the circulatory system

mL - oz

30mL = 1oz

tsp - mL

1tsp = 5mL

lbs - kg

(lbs.) / 2.2

tsp- mL- tbsp

3tsp = 15mL = 1 tbsp