Medication
Introduction to Pharmacology and Medication Administration
Pharmacology: The broad study of drugs.
Clinical Pharmacology: The branch of pharmacology concerned with the effect of drugs on humans.
Therapeutics: Also known as pharmacotherapeutics; it is the use of drugs to diagnose, prevent, or treat disease, or to prevent pregnancy.
Generic Name: The assigned name given by the manufacturer who first develops the drug (e.g., ibuprofen).
Official Name: The name by which the drug is identified in the official publications, often the same as the generic name.
Chemical Name: A precise description of the drug’s chemical composition.
Trade Name: Specifically copyrighted by the company that sells the drug; also known as the brand name (e.g., Advil, Motrin).
Pharmacy: The preparation and dispensing of drugs.
Medication Commonalities: The focus of NUR101 Unit Eight is on the common principles of nursing care required to promote the safe administration of medications.
Concepts About Drug Therapy
Sources of Drugs: - Natural sources: Plants, minerals, and animals. - Synthetic sources: Medications manufactured/synthesized in a laboratory.
Strength and Activity: Drugs may vary significantly in their strength and activity level.
Uniformity Requirements: To ensure drug dosages have a predictable effect, the drug must be pure and of uniform strength.
Regulatory Standards: Specific standards are developed by governing bodies to ensure uniform equality across batches and manufacturers.
The Imperfect Nature of Drugs: It is explicitly stated that "There is no such thing as a perfect drug."
Agencies Impacting Medication Administration
Food and Drug Administration (FDA): Federal agency responsible for monitoring drug safety and effectiveness.
Drug Enforcement Agency (DEA): Federal agency that enforces laws regarding controlled substances (drugs with high potential for abuse).
NY State Department of Health (NYSDOH): State-level agency regulating health standards and practices within New York.
Joint Commission: An independent organization that accredits and certifies healthcare organizations. They establish National Patient Safety Goals (NPSGs) related to medication safety.
Institute for Safe Medication Practices (ISMP): An organization dedicated entirely to medication error prevention and safe medication use.
Properties of the Perfect Drug
Effectiveness: The most important property; the drug elicits the response for which it is given.
Safety: The drug cannot produce harmful effects, even if administered in very high doses and for long periods.
Selectivity: The drug elicits only the response for which it is given, with no side effects.
Reversible Action: Effects should be reversible (e.g., anesthesia should wear off).
Predictable Response: The nurse and patient know with certainty how the patient will respond.
Easy to Administer: Simple routes increase convenience and patient adherence.
Free from Drug Interactions: Ideally, the drug does not interact with other medications or foods.
Low Cost: The medication should be affordable for the patient.
Chemically Stable: The drug does not lose potency or become toxic over time or with storage.
Simple Generic Name: Names should be easy to remember and communicate.
Common Functional Uses of Medications
Preventative or Prophylactic: Used to ward off disease (e.g., vaccines).
Palliative: Relieves symptoms but does not cure the disease (e.g., morphine for pain in terminal illness).
Restorative: Restores health (e.g., vitamin supplements).
Supportive: Supports body functions until other treatments can take over (e.g., aspirin for high fever).
Substitutive: replaces body fluids or substances (e.g., insulin for diabetes).
Curative: Cures a disease or condition (e.g., antibiotics).
Chemotherapeutic: Destroys malignant cells (e.g., cancer treatment).
Therapeutic: Used to treat clinical conditions.
Diagnostic: Used to help diagnose a medical condition (e.g., contrast dye for imaging).
Actions of Drugs on the Body
Onset of Action: The time it takes after administration for a drug to produce a therapeutic response.
Peak Plasma Level: The highest concentration level of a drug in the patient's bloodstream.
Drug Half-Life: The time required for the amount of drug in the body to decrease by .
Plateau: A maintained concentration of a drug in the plasma during a series of scheduled doses.
Drug Classification Methods: - Physiologic Action: Based on how the drug affects body systems. - Expected Response: Based on the desired outcome. - Local Effects: Acts primarily at the site of application. - Systemic Effects: Absorbed into the bloodstream and distributed throughout the body.
Oral and Enteral Routes of Administration
Oral (PO): - Advantages: Most convenient, most economical, and generally the safest. - Disadvantages: Unpleasant taste, potential stomach irritation, irregular or slow absorption, and potential to discolor teeth or harm tooth enamel.
Sublingual (SL): Place the medication under the tongue until dissolved. This is a highly vascular area allowing for rapid absorption directly into the bloodstream, bypassing the GI tract.
Buccal: Medication is placed in the pouch between the upper cheek and the gum.
Inhalation and Topical Routes
Inhalation: - Administered through the respiratory tract. - Provides rapid localized relief but can trigger systemic responses. - Common types: Anti-asthmatics, Bronchodilators, and Inhaled Corticosteroids.
Suppositories: - Rectal or Vaginal routes. - Technique: Always use clean gloves for administration.
Topical (Transdermal): - Applied to the skin. - Some have local effects; most have systemic effects. - Technique: Always wear gloves during application to prevent personal absorption; rotate application sites to maintain skin integrity.
Ophthalmic (Eye): - Technique: Instruct the patient to look up. Use the outer third of the lower conjunctival sac for administration. Apply gentle pressure to the nasolacrimal duct (inner corner) to prevent systemic absorption.
Otic (Ear): - Infants: Pull the pinna down and back. - Adults: Pull the pinna up and back.
Parenteral Administration: Basics and Safety
Definition: "Not through the GI tract"; specifically refers to administration by injection.
Advantage: Fast absorption rates.
Routes and Insertion Angles: - Intramuscular (IM): Inserted at a angle into the muscle. - Subcutaneous (SQ): Inserted at a angle (into the subcutaneous tissue) for thin to average-sized clients. - Intradermal (ID): Inserted at a angle just under the skin.
Specific Sub-Routes: - Intradermal: Used for allergy testing; has slow absorption. - Subcutaneous: Administer small amounts; faster than oral; may be irritating to the tissue. - Intramuscular: Administered into large muscles; rapidly absorbed; can handle larger volumes; less irritating than SQ.
Safety Measures: - Maintain surgical asepsis (sterility). - Alternate/rotate injection sites. - Aspirate if indicated (check manufacturer or facility policy). - Select the correct needle and syringe size based on the patient and the medication.
Equipment and Anatomy for Injections
Essential Equipment: Sterile needles, syringes, medications, antiseptic swabs, clean gloves, and sharps containers.
Parts of a Syringe and Needle: - Needle: Consists of the Bevel (slanted tip), Shaft, Lumen (hollow opening), and Needle Hub. - Syringe: Consists of the Barrel (holds medication) and Plunger (moves medication).
Intramuscular (IM) Sites: - Ventrogluteal: Preferred site for adults. Landmarks: Anterior superior iliac spine, Iliac crest, Gluteus medius, and Greater trochanter. - Vastus Lateralis: Landmarks: Greater trochanter, Lateral femoral condyle, Rectus femoris, and Patella. Involves the Ilio-tibial tract, Tensor fascia lata, Sartorius, and Femoral artery/vein. - Deltoid: Located in the upper arm. Landmarks: Acromial process, Deltoid muscle, Scapula, Humerus, Deep brachial artery, and Radial nerve.
Z-Track Injection Technique: Pulling the tissue to the side or downward prior to injection to break the injection track after needle removal. This prevents medication from tracking back to the skin surface. It also firms the skin to facilitate needle entry.
Intravenous (IV): - Most rapid route of administration. - Can be continuous or intermittent infusion. - Requires calculation of flow rate for gravity infusion or the use of equipment (Infusion pumps, PCA pumps).
Medication Orders
Types of Orders: - Standing / Scheduled / Routine: Regular recurring doses. - PRN: As needed. - Stat: Immediately and only once. - Single: One-time dose at a specific time. - Telephone/Verbal: Spoken orders (must be signed later). - Computerized Provider Order Entry (CPOE): Digital entry by health care providers.
Essential Components of a Drug Order: - Full name of the patient. - Date and time the order was written. - Name of the drug. - Dosage of the drug. - Frequency of administration. - Route of administration. - Signatures: Both the person writing the order and the person who picked up/entered the order. - Acceptable approved abbreviations.
Rights and Responsibilities
Ten Rights of Medication Administration: 1. Right patient 2. Right medication 3. Right dose 4. Right time 5. Right route 6. Right assessment 7. Right client education 8. Right to refuse 9. Right evaluation 10. Right documentation
Patient’s Rights: - Identification/Care from a qualified nurse. - Education about the drug and its side effects. - The right to refuse a medication.
Nurse’s Professional Responsibilities: - Never take medication responsibility casually. - Report all errors, including "Near Misses." - Never administer a drug prepared by someone else. - Understand drug effects, side effects, dosages, therapeutic effects, and why the patient is receiving it. - Verify patient allergies. - Always follow the "Ten Rights."
Medical and Safety Terminology
Drug Toxicity: Accumulation of drug in bloodstream beyond therapeutic levels.
Drug Allergy: Hypersensitivity; an immune response.
Drug Tolerance: Decreased physiological response to a drug over time.
Cumulative Effect: Body cannot metabolize one dose before another is given; can lead to toxicity.
Idiosyncratic Effects: Abnormal, unexpected, or peculiar responses to a medication.
Drug Interactions: Effects that occur when one drug is affected by another substance.
Iatrogenic Disease: Disease/condition caused by medical treatment.
Paradoxical Effect: A result that is the opposite of the intended effect.
Drug Misuse, Abuse, and Dependence: Improper use of substances, including physical or psychological dependence.
Illicit Drugs: Street drugs/illegal substances.
Storage and Verification
Storage Locations: Medication room, medication cart, Locked boxes/cabinets (e.g., "Pyxis" system).
Refrigeration: Both locked and unlocked units must have medications labeled.
Light Sensitivity: Use dark bottles for light-sensitive medications.
Medication Reconciliation: Ongoing review of drug orders for continuation/discontinuation during: - Admission - Transfer - Change in level of care - Reference bodies: USP, National Academy of Medicine (NAM - formerly IOM), and the FDA.
Factors Influencing Drug Action
Patient Variables: - Age and Body Surface Area (BSA). - Illness, disease, and psychological status. - Absorption and adequacy of circulation. - Distribution of the drug in the body.
Other Variables: - Time of administration. - Dosage and number of divided doses. - Drug formulation (e.g., enteric-coated/EC). - Route of administration. - Environment.
Older Adult Considerations: - Impaired memory. - Decreased visual acuity. - Decrease in renal (kidney) function. - Increase in body fat percentage. - Decrease in liver function (metabolism). - Decrease in organ sensitivity for functioning.
Questions & Discussion
Scenario: Subcutaneous Technique - Question: Which demonstrates proper technique for a subcutaneous injection? - Correct Answer: Do not aspirate or massage after injection.
Scenario: Prescribed Medication Allergy - Question: Finding the patient is allergic to a prescribed medication, what should the nurse do? - Correct Answer: Call the Health Care Provider (HCP) and ask for the medication to be changed.
Scenario: Unexpected Response - Question: How is an abnormal, unexpected response to medication defined? - Correct Answer: An idiosyncratic effect.
Scenario: Verifying Patient Identity - Question: In addition to checking the ID bracelet, how should the nurse verify the patient? - Correct Answer: Asking the patient’s name. (Note: Never ask leading questions like "Are you Mr. Brown?").
Scenario: Transdermal Patch Application Errors - Question: Which action regarding a transdermal patch shows a need for further teaching? - Answer: Holds the patch by touching the adhesive edges. (Correct actions include: selecting a clean/dry area free of hair, removing from the protective covering, and pressing firmly with the palm for about ).