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Pharmacology: Key Concepts & Medication Administration

  • Pharmacotherapeutics overview

    • Pharmacotherapeutics: using drugs to diagnose, prevent, and treat diseases; includes studying drugs’ effects in patients vs. healthy individuals or a placebo

    • Nurses can call into pharmacotherapeutics discussions to inform care

  • Ideal drug: three core characteristics

    • Effective: drug does exactly what it is supposed to do; if not effective, pointless to use (e.g., a cholesterol medication that fails to affect cholesterol is not useful)

    • Safe: minimal or no harmful effects; acceptable safety profile even with long-term use or high doses

    • Selective: acts only for its intended purpose with minimal or no adverse effects beyond that purpose

  • Reality of drug development

    • No perfect drug exists; all drugs have some side effects or additional uses beyond their intended purpose

    • Off-label use: meds are sometimes used for indications not originally approved; it reflects evolving understanding of a drug’s effects

  • Other important drug properties (beyond the top three)

    • Reversible actions: ability to reverse effects when needed (e.g., anesthesia drugs that wear off)

    • Predictability: how consistently a patient will respond; recognition of individual variation due to genetics, history, etc.

    • Ease of administration: preference for convenient routes (oral vs. injections)

    • Freedom from interactions: minimal interactions with foods, drinks, or other meds

    • Low cost: affordability for patients and health systems

    • Chemical stability: retains potency over time (shelf-stable)

    • Simple generic name: easier to pronounce and remember; trade/brand names are often more complex

  • Names of medications

    • Chemical name: technical chemistry-style name (often long and unwieldy)

    • Generic name: standard, non-branded name (e.g., acetaminophen, ibuprofen); typically lowercase

    • Brand/trade name: marketing-friendly, capitalized, easier to read; must be approved by the FDA; does not imply efficacy (e.g., ibuprofen brand names like Motrin, Advil)

    • Practice tip: Health professionals should default to generic names to avoid brand-name confusion

  • Practical example: look-alike/sound-alike names

    • Hydroxyzine vs. hydralazine as a potential source of error due to similar pronunciation

    • Emphasizes the need for careful verification of drug orders and patient identity

  • Reading medication orders and responsible nursing practice

    • An order should include: patient name, drug name (generic, sometimes with brand in parentheses), dose, route, timing, reason, and provider signature

    • Example order: Ultram (tramadol) 50 mg PO q4h PRN moderate pain; provider’s signature missing in the example; if unclear, call provider to clarify

    • It is a nurse’s responsibility to verify orders and ensure all required fields are present before administration

  • Key nursing considerations before giving meds

    • Know why the patient is receiving the medication

    • Confirm dosage safety for the patient

    • Understand the route of administration and how the drug will be delivered

    • Check for potential interactions with foods, beverages, or other meds

    • Review patient allergies

    • Plan patient education on the medication and its expected effects

  • Rights and process of medication administration

    • Seven rights (often taught as seven checks) to prevent errors:

    • Right patient

    • Right drug

    • Right dose

    • Right route

    • Right time

    • Right reason

    • Right documentation

    • Documentation should be done immediately after administration, including time, route, site (if injections), and any deviations

  • Seven ranks of medication administration (common term in this program)

    • Right patient, Right drug, Right dose, Right route, Right time, Right reason, Right documentation

  • Systems and methods for medication administration

    • Unit-dose or single-dose packages: one dose used for a patient at a time

    • Automated dispensing systems: Pyxis, Omnicell, provide secure access, inventory control, and a verification step

    • Best practice: double-check patient and medication against MAR to prevent errors

  • Routes of administration: overview and key notes

    • Oral (PO): swallow and absorb through the GI tract; includes liquids, tablets, capsules, and granules; enteric-coated tablets delay dissolution; rapid-release formulations exist

    • Sublingual: under the tongue; dissolves quickly; do not swallow or drink until dissolved; avoid moving contents, especially if using capsule contents

    • Buccal: between the gum and cheek; similar absorption to sublingual; avoid chewing or moving the tablet to prevent changing the route

    • Nasogastric (NG) and Gastrostomy (G tube): meds can be delivered via tubes; meds often crushed and dissolved in water; flush before and after to clear the line and prevent interactions; pause tube feeds as needed

    • Intravenous (IV): fast onset; straight into circulation

    • Intramuscular (IM): into muscle; various injection sites (deltoid, ventrogluteal, dorsogluteal, vastus lateralis); needle sizes vary by route and patient

    • Subcutaneous (SubQ): into fat tissue; common for insulin and certain anticoagulants

    • Intradermal (ID): just under the skin (e.g., TB test)

    • Epidural: into the epidural space; often for pain management during/after surgery

    • Intraosseous (IO): into bone marrow; used when veins are not accessible

    • Intrathecal: into the spinal canal; faster onset than some other parenteral routes

    • Intra-arterial: into an artery; rare and highly specialized

    • Topical: on the skin (creams, ointments, lotions)

    • Ophthalmic: eye drops or solutions

    • Ototic: ear medications

    • Nasal: nose sprays or drops

    • Rectal/Vaginal: suppositories or irrigations

    • Inhalation: nebulizers or inhalers

    • Intraocular: injections into the eye

  • Practical notes on common routes

    • Oral administration requires evaluation of the patient’s ability to swallow, or alternatives (liquids, crushed forms where allowed)

    • Enteric-coated tablets should not be crushed; coating delays release and protects the stomach; crushing defeats the purpose

    • For sublingual and buccal meds, avoid drinking until fully dissolved

    • NG/G-tube meds require crushing and dissolving in water; ensure tube patency and prevent blockages

    • Always flush lines before and after tube administration to ensure the full dose reaches the patient

  • Syringes, needles, and device safety

    • Syringe sizes vary (e.g., 3 mL, 60 mL) depending on dose and route

    • Needle gauges range from 14G to 29G; smaller gauge = larger needle, larger gauge = thinner needle

    • TB test uses a 27G needle; vaccines typically use around 22G; common injections may use ~25–27G

    • Insulin and heparin are often used with specialized syringes (IU or unit-based dosing)

    • Any needle or device that breaks skin must be disposed of in a sharps container; improper disposal is a safety violation and can lead to penalties

    • Do not administer medications prepared by another nurse unless the package is unopened and clearly labeled; ensure accountability and traceability

  • Vials and ampoules

    • Vials: multi-dose; rubber stopper; can withdraw multiple doses; may require dilution if powder

    • Ampoules: single-dose glass containers; require breaking the neck and using a filter needle to withdraw contents safely

  • Injection sites (IM/ID/SubQ) basics

    • Intramuscular (IM): deltoid, ventrogluteal, dorsogluteal, vastus lateralis

    • Intradermal (ID): just under the skin (e.g., TB test)

    • Subcutaneous (SubQ): into fat tissue (back of arm, abdomen, buttocks)

    • IV: into a vein; maintains quick onset and precise control of dosing

  • Abbreviations and common dosing language

    • qd: every day

    • bid: twice daily

    • tid: three times daily

    • qid: four times daily

    • HS: hour(s) of sleep; time-of-day indication for dosing

    • AC: before meals (ante cibum)

    • PC: after meals (post cibum)

  • Medication orders: essential components and quality checks

    • Required elements in an order: patient name, drug name (generic preferred), dose, route, time/frequency, reason, and provider signature

    • Types of orders:

    • Routine orders: scheduled and given at the same time each day or for a defined period

    • PRN orders: given as needed, contingent on patient condition or symptoms

    • Standing orders: pre-approved actions a nurse can perform in specific emergency or predefined situations (e.g., STEMI protocol) without a physician order for each action

    • One-time orders: performed once (e.g., imaging, administration of a single dose)

    • Stacked orders: multiple orders to be carried out in sequence or as soon as possible

    • Telephone, fax, or electronic orders: Orders received through remote communication channels require verification and documentation

  • Documentation and post-administration assessment

    • Document immediately after administration: time, route, and injection site (if applicable)

    • Document any doses not given and the reason (patient refusal, parameters not met, etc.)

    • PRN orders: document assessment of need and whether the dose was given; logical rationale if dose was not given due to not meeting criteria

    • Some meds require dual verification (double sign-off) for safety (e.g., insulin, other high-risk meds)

    • After administration, reassess therapeutic effects and adverse effects; pain medications require especially prompt reassessment of effectiveness

  • Swiss cheese model and the nurse’s role in safety

    • The Swiss cheese analogy: multiple safeguards exist, but gaps can align to permit an error; the nurse is the last line of defense before medication reaches the patient

    • Emphasizes accountability, diligence, distraction-free zones, and thorough checks

  • Safety, ethics, and professional practice in medication management

    • Nurse practice acts and scope: Nurses are accountable for their own actions, even when following a prescriber’s order; they cannot prescribe or independently dispense medications

    • Educator and patient advocate role: provide medication education, discuss dosing, timing, and administration technique; assess patient understanding and adherence

    • Cultural, ethical, and practical considerations:

    • Cultural beliefs and traditions can influence medication acceptance; be aware and respectful; collaborate to find culturally appropriate approaches

    • Religious beliefs may affect treatment choices; aim for respectful, patient-centered care

    • Legal and regulatory environment:

    • Controlled substances: high potential for abuse; securely stored, counted, and require dual verification; strict policies govern access and administration

  • Clinical practice implications and takeaway themes

    • Always understand why a patient needs each medication and its expected onset and duration of effect

    • Use resources to verify drug information and ensure safe prescribing and administration practices

    • Maintain vigilance for potential adverse effects, interactions, and patient-specific factors (liver, kidney function, allergies, concurrent therapies)

    • Proactively educate patients and families to support adherence and safety

    • Seek clarification for any ambiguous orders and confirm details with the prescriber when necessary

    • Recognize that medication safety is a shared, systemic responsibility across physicians, pharmacists, nurses, and other care team members

  • Practice questions and critical thinking prompts (from lecture)

    • True/false: Drug names are a common cause of medical errors due to look-alike/sound-alike names; answer: True

    • Which route provides the fastest absorption? IV, followed by intramuscular, subcutaneous, then intradermal

    • When deciding whether an oral medication can be crushed, what coatings matter? Enteric coating should generally not be crushed; capsules may be opened only if appropriate and advised by guidelines

    • What are the seven rights of medication administration? Right patient, right drug, right dose, right route, right time, right reason, right documentation

  • Summary of clinical relevance

    • The core objective of pharmacology and nursing practice is to maximize patient benefit while minimizing harm

    • While ideal drugs do not exist, nurses play a critical role in choosing, administering, monitoring, and educating patients about medicines to safeguard patient health

    • A strong foundation in drug naming, administration routes, order types, documentation, and safety systems (BCMA, Pyxis/Omnicell, etc.) is essential for safe patient care

  • Foundational connections to prior and next topics

    • Ties to foundational pharmacology concepts (drug action, metabolism, excretion, interactions)

    • Builds on nursing process steps (assessment, planning, implementation, evaluation) with emphasis on assessment data specific to medications (history, allergies, current meds, labs)

    • Sets up further exploration of pharmacokinetics/dynamics, dose calculations, and complex clinical scenarios in subsequent lectures