Engage Fundamentals Medication Administration

Dosage

A prescribed quantity of medication consisting of the dose and the frequency

Pharmacokinetics mnemonic

(ADME)

A- absorption

D-distrinbution

M-metabolism

E-excretion

pharmacokinetics

Study of absorption, metabolism, distribution, and excretion of drugs in the human body

absorption

how will it get in?

Metabolism

Hoe is it broken down?

Excretion

How does it leave?

What factors can affect the rate of absorption?

\-route of administration

\-ionization

\-dissolution

\-blood flow

\-lipid soluability

\-surface area of the absorptive site

\-client-specific factors

Ionization

affects the degree of absorption and the rate at which the drug permeates the cell membranes, which ultimately impacts the distribution of a medication

Dissolution

medication must be dissolved in a solution before absorption takes place. Dissolution of a medication is dependent upon its initial state and route of administration

Orally disintegrating tablets

drug form that rapidly dissolves on the tongue or oral cavity

Which route provides the most rapid rate of absorption?

Intravenous route because the medication is directly injected into the circulatory system through the patient’s vein

Enteral route

medications administered via the mouth, stomach, or intestines

Dose

the amount of the ordered medication

Metabolism or biotransformation

the chemical process of converting a medication’s structure

Toxicity

an adverse effect in which the body is unable to metabolize or excrete a medication, it can cause irreversible damage to organs

Prodrugs

contain inactive chemicals that are activated through metabolism to exert their herapeutic effects

Therapeutic effects

the desired effects of a medication

First-pass effect

passage of oral medications from small intestine to hepatic circulation via mesenteric & portal veins flowing to the liver, before reaching systemic circulation

CYP enzymes

on liver cells role in metabolism by regulating the rate at which medication is brown down and how long it stays in he body

The primary organ responsible for medication excretion ?

the kidneys

The rate of medication excretion is affected by?

\-kidney

\-heart

\-liver

Pharmacodynamics

study of how a drug works, its relationships to drug concentrations and how the body responds

Therapeutic range

method used buy health care providers to monitor drug concentrations to determine therapeutic dose and avoid toxicity

Therapeutic drug monitoring (TDM)

method used by health care providers to monitor drug level concentrations

Peak blood level

highest level of a drug in the bloodstream without being at a toxic level

Trough blood level

lowest concentration of a medication in the systemic circulation

Half life

time it takes for the drug to fall to half its strength through excretion

Onset

the time the medication takes to produce a therapeutic effect after its administration

Peak

effect occurs whens absorption is complete, medication is distributed throughout the body, and medication is at its HIGHEST concentration

Duration

The period of time in which medication maintains its therapeutic effects

Agonist

medication that activates receptors to initiate a preferred response

antagonist

A medication that prevents the activation of a receptor

Adverse drug reactions

unwanted and non-therapeutic effects of medication can range from mild to severe

Adverse drug event

an injury caused from a medical intervention that is linked to a medication

Iatrogenic

an unforseeable or unintended physical condition, injury, or disorder caused by a treatment of procedure

Allergic reaction

a reaction resulting from a hypersensitivity to an antigen or a foreign substance, such as a medication

Steven-Johnson sydrome (SJS)

Potentially fatal medication reaction which develops 1 to 14 days following dose administration

\-symptoms include: respiratory distress, fever, chills, diffuse fine rash followed by blisters

Anaphylaxis

acute allergic reaction to an antigen that may result in life threatening shock, producing vasodilation, bronhcospam, and laryngeal edema

Drug-drug interactions

the effect that two or more drugs that the client is administered have on each other

\-enhance actions or block actions

Drug-food interactions

effects of nutrients on the absorption, distribution, metabolism or excretion of medications

If medications are ordered to be taken on a n empty stomach the nurse should administer the medication when?

At least 1 hour before or 2 hours after a meal

Teratogenic

medications that can cause fetal defects, pregnancy loss, prematurity or developmental disabilities

Polypharmacy

multiple (5 or more) medications that one person is taking

The rights of medication administration (10)

\-right client

\-right medication

\-right dose

\-right route

\-right time

\-right assessment (allergies/vitals)

\-right documentation

\-right to refuse

\-right education

\-right evaluation

How many times should you check for confirmation of the correct client when administering medication?

3 or more times

Medication administration record (MAR)

a record of the medications prescribed for the client by the provider, used by the nurse to record and confirm medication administration per the prescription

Generic

non-trademarked name of a drug assigned by the FDA

STAT medication prescriptions

medications that are required to be given immediately

PRN

as needed, medications given as required for specific conditions such as pain, nausea

Time-critical medications

medications that should be given within either 30 minutes before or after the scheduled administration time

Non-time-critical medications

medications that can be administered between 1 to 2 hours before or after the scheduled time

A complete medication prescpriton should include?

Name of the drug, amount to be given, route and frequency of administration, clients name, fate and time the order wears written and providers name/title

Over the counter (OTC) medications

medications that can be purchased without a healthcare providers prescription

Medication reconciliation process

\-document an accurate & comprehensive list of at home medications

\-compare at home meds with newly prescribed meds

\-update med list (repeat process)

\-communicate reconciled med list to next care provider

\-educate client and caregivers upon discharge, with written info about their meds

Override

the nurse removes a medication for the automatic dispensing system before a pharmacist has reviewed an order

Workaround

the practice of a voiding a policy or procedure in a system that is there to protect client safety

Unit dose medication

a medication that is prepared and packaged by the hospital’s pharmacist or the drug manufacturer in a single unti dose container that is specific to the provider’s prescription for the client

Multi-dose vial

container of medications that holds more than a single dose and can be used for multiple clients

What are the three major categories of medication administration?

Enteral (oral), topical, and Parenteral

Oral (enteral) medication advantages

\-safer

\-cheaper

\-convenient

\-painless

\-silent can self-administer

oral (enteral) medication disadvantages

\-slow onset of action

\-subject to first-pass effects

\-may have an unpleasant taste

\-not appropriate for unconscious clients

\-not appropriate for clients with vomiting/diarrhea

sublingual (SL) medication advantages

\-rapid onset of action

\-bypasses first-pass effects

\-can be self-administered by the client

Sublingual (SL) medication disadvantages

\-not appropriate for children

\-may cause membrane irritation

Rectal (PR) medication advantages

\-can be admistered to children, unconscious clients, clients unable to swallow

\-increased concentration is achieved quickly

rectal (PR) medication disadvantages

\-not liked by clients

\-absorption varies

\-rectal mucosa can’t become irritated/swollen

Intravenous (IV) advantages

\-rapid onset

\-can be used with unconscious clients, non compliant, or unable to tolerate oral medications

intravenous (IV) medication disadvantages

\-sterilization and aseptic technique are essential

\-high cost

\-invasive technique is required

\-can injure nerves, tissues, or vessels

Buccal medication advantages

\-rapid onset or action

\-bypassses first-pass effects

\-can be self-administered by the client

buccal medication disadvantages

\-can cause irritation to open sores in mouth

\-exact site location can be difficult

\-Decrease in the effect of meds if swallowed

\-client may experience nausea/vomiting if med has an undesirable taste

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Inhalation medication advantage

\-rapid onset

\-smaller dose required

\-medication dosage can be regulated

Inhalation medication disadvantage

local irritation can precipitate respiratory secretions or bronchospasms

Intramuscular (IM) medication advantages

\-faster absorption as compared to oral route

\-soluable and suspension substances can be administered

Intramuscular (IM) disadvantages

\-must be administered using aseptic technique

\-painful

\-can cause nerve damage

Subcutaneous medication advantages

\-can be self-admistered by the client

subcutaneous medication disadvantages

\-maximum volkume delivery is 1-2mL

\-slow absorption

transdermal medication advantages

effects can last for several days

transdermal medication disadvantages

medications dosing varies due to client factors

Enteral tube

goes directly into the stomach or small intestine

Buccal route

administration of a tablet by placing it in the oral cavity between gum and cheek

Enteric-coated

medications formulated to be dissolved and released in the small intestines for a slower release and can be administered less frequently during the day

Sustained-release

tablets designed to release medication slowly over am extended period

Transdermal

delivery of a specifically prepared medication designed to be absorbed by the skin

\-should be rotated to different sites to avoid irritation

Ophthalmic

Medication administration into the eyes nurse places index finger at the inner corner of client’s eye maintaining gentle pressure for 30-60 seconds

Otic medications

medication administered in the ears, make sure it is room temperature, pull pinna up back and gently to help straighten ear canal

Nasal

medication administered via the nostrils absorbed through the mucous membranes and into the bloodstream

Vaginal route

Delhi every of a specifically prepared medication designed to be absorbed through the vaginal mucosa

Rectal route

administered via the rectum/anus discuss with clients to wait a minimum of 20 minutes before passing stool to provide enough time for the medication to enter the systemic circulation and have effect

Parenteral route

medication administered by a route that does not involve the GI tract, an injection that is administered by a needle such as IV or IM

What size needle should you use for a TB syringe?

26-27 gauge

Syringe holds a max amount of 1mL and is able to measure amounts to the hundredths (0.01 mL)

PPD

protein derivative test

At what angle should you administer a intramuscular (IM) injection?

90 degree angle

At what angle should you administer a subcutaneous injection?

45-90 degree angle

At what angle should you administer an intradermal angle?

5-10 degree angle

Ampule

glass container that stores liquid medications neck is cored which aids the nurse in breaking the ampule before withdrawing the medication

What syringe should a nurse use when drawing medication from an ampule?

As syringe with a filter needle to prevent glass particles from the ampoule being pulled into the syringe, this needle is not used to administer the medication

What technique should the nurse use when administering injections?

Aseptic technique

Intradermal

medication administered via the dermal layers of the skin

\-often used for allergies/TB

\-max amount to administer would be 0.1mL

Subcutaneous route

a medication administered beneath the skin or dermal layer (adipose tissue)

\-insulin/low molecular weight heparins

\-selected site of injection should be pinched to reduced risk of admistering to the muscle

Lipohypertrophy

the formation of small lumps beneath the skin due to irritated fatty tissue

Aspirate

to pull back on the plunger of a syringe after the needle has been inserted, too determine if the needle is within a blood vessel, if so blood will flow into the syringe