Pharmacology Lecture Notes (VM1)

Medication Names

  • Each medication has three names:
    • Trade name (e.g., Motrin, Advil).
    • Generic name (e.g., Ibuprofen - what's inside).
    • Chemical name (on a chemistry level).
      • Example: acetyl acetyl p amino phenol (for acetaminophen).
      • Aspirin is also known as salicylic acid.
  • Focus for NCLEX is on generic names.
  • Example: Tylenol (brand name) vs. Acetaminophen (generic name).

Common Abbreviations

  • BID: twice a day.
  • TID: three times a day.
  • Stat: immediately.
  • QID: four times a day.
  • Each other day, once a week, etc. These depend on the specific order.

Medication Orders

  • Standing Orders = Routine Orders
    • Most common: Medications given at the same time every day (e.g., every 8 hours, TID).
  • PRN (as needed)
    • Must have a reason for administration stated in the order (e.g., "for pain").
    • Pain level should be assessed (scale of 0-10).
    • If the patient doesn't have the condition, the medication is not given. If the documentation does not have a reason, the order is incomplete.
  • One-Time Orders (Single Orders)
    • Example: Cefazolin 1 gram IV 30 minutes prior to surgery.
    • Given once for a specific situation.
  • Stat Orders
    • Given immediately for something that happened to the patient.
    • Example: Naloxone for an overdose.
    • Delaying a stat order can have serious consequences.
    • If receiving an order by phone, read it back to the doctor to confirm accuracy.
    • Verbal orders are for emergency situations.

Protocols

  • Protocols are like a recipe book for the entire facility.
  • Apply to every patient (e.g., shortness of breath protocol).
    • Example: Administer oxygen via nasal cannula at 2 liters, etc.
  • Designed to avoid bothering doctors for routine interventions.
  • Protocols provide steps to take, and if those steps don't work, you call the provider.
  • Protocols are different from PRN medications, which apply only to specific patients.

Rights of Medication Administration (6 Rights)

  • Right patient.
  • Right medication name.
  • Right dose (includes right concentration).
  • Right time and frequency.
  • Right route.
  • Right to refuse.

Medication Handling

  • If you mix or open any multi-dose medication (eye drops, vials, insulin), write the date it was opened.
    • Expiration date changes to the opening date, not that on label.
  • Right documentation.
    • If anything is missing on the order, it's considered wrong documentation.
  • Never administer medication prepared by someone else.
  • Medications should not be left at the bedside.
    • Exceptions exist if the patient self-administers medication per doctor's order.

Narcotics (Controlled Substances)

  • Examples: Morphine, fentanyl, Percocet, diazepam (benzos).
  • Counted every time they are handled.
  • If a patient refuses a narcotic after you pop it out of the blister pack, you need a second nurse to witness the disposal.
  • If giving a narcotic to a patient who is leaving, have a second nurse witness that you gave it to the patient.
  • Narcotics are on a US drug schedule (Schedule I-V, but the numbers in the transcript might be off).
    • Schedule I: High addiction potential (e.g., heroin).
    • Schedule V: Low addiction potential (e.g., some cough medications).
  • Avoid distractions during medication pass.
  • If you know three options are incorrect on a test, select the remaining one.

More on Medication Handling

  • Multidose vials, eye drops, open applesauce container, etc., must be dated when opened.

Grapefruit Juice

  • Grapefruit juice blocks liver enzymes that filter medication.
  • This can lead to overdose or toxicity.
  • Generally avoid grapefruit juice with medications.
  • Apple juice and orange juice are commonly used in facilities.
  • Orange juice is for diabetic patients, and apple juice is for constipation.

Crushing Medications

  • Never crush enteric-coated, extended-release (XR), or sustained-release (SR) medications.
  • Also, delayed-release (DR) medications also should not be crushed.
  • Pantoprazole DR capsules can be opened and mixed with apple juice for G-tube administration because apple juice maintains the pH that preserves the medication.
  • A good doctor puts 'mix with apple juice' on order for these meds.

Vital Signs

  • Check vital signs before giving medications that affect blood pressure, glucose, or heart rate.

Medication Errors

  • Medication errors should never be documented in the patient chart.
  • Complete an incident report and notify the manager.
  • The manager may notify the doctor, family, and patient.
  • Check the patient first then notify if you realize you gave the wrong medication.
  • If a patient has an allergic reaction because of your error, they can bring a malpractice suit.
  • Always have your own private insurance because the hospital protects itself first.

Allergic vs. Anaphylactic Reactions

  • Allergic reaction: Rash, itching, mild swelling (not life-threatening).
    • Hold the medication, notify the doctor, and give Benadryl.
  • Anaphylactic shock (anaphylaxis): Life-threatening.
    • Need epinephrine (EpiPen/adrenaline).
    • Signs/Symptoms:
      • Wheezing.
      • Shortness of breath.
      • Low blood pressure (more dangerous than high blood pressure because the brain and organs don't get enough blood).
      • Swollen lips/tongue (indicates airway swelling).
  • Adrenaline (epinephrine) increases heart rate.
  • There should be a protocol for EpiPen use in case of anaphylaxis.

Pregnancy Considerations

  • When administering medication to a pregnant patient, check a drug book to ensure safety.
    • A & B: Safe.
    • C & D: Questionable.
    • X: Contraindicated, harmful to the fetus.

Reconciliation of Medications

  • Collect a complete list of the medications a patient takes including:
    • Prescribed medications.
    • Over-the-counter medications.
    • Herbs.
    • Patches.
    • Eye drops.
  • If patients are at home, tell them to bring their medications in labelled containers.
  • The purpose is to identify medication duplication or unnecessary medications.
  • Polypharmacy for older adults starts when they are taking six or more medications.
  • Do reconciliation:
    • On admission.
    • When transferring patients.
    • On a regular schedule (e.g., every three months).

Additional Information

  • Patients are generally not allowed to have medications at the bedside unless it's water or creams approved by staff.
  • Therapeutic Index
    • effectiveness of the medication without risk for toxicity. The higher therapeutic index, the safer the medication, and the lower indicates toxicity.
  • Blood-Brain Barrier (BBB)
    • Not everything can cross into the brain.
    • Fat-soluble medications can cross the BBB.
    • Water-soluble medications are unlikely to cross.
    • Side effects like confusion and dizziness can occur if medication crosses the BBB.
  • Placenta
    • A barrier for the fetus.
    • Some things can cross (alcohol, nicotine), while others cannot.

Side Effects vs. Adverse Effects

  • ATI uses these terms interchangeably.
  • Side effects:
    • Side effects is when expect the patient will have it . We continue, typically, we continue to give that medication
      • Adverse effects:
      • Adverse is whem we see it, we stop the medication because it's. That's dangerous and life threatening
      • Anaphylaxis is an adverse effect.

Synergistic, Agonist, and Antagonist Effects

  • Synergistic Effect: Two medications work together for the same purpose, enhancing each other.
  • Agonist: Activates receptors in the cells.
    *Opiods activate receptors in the cells that are actually called apioid receptors
  • Antagonist: Blocks receptors.
    *Naloxone is an antagonist
  • Antidote: Reverses the effect of an overdose.
    • Example: Naloxone (Narcan) is an antidote for opioid overdose.
      *Vitamin K Is an antidote for Warfarin

Considerations for Infants and Children

  • Organs are still maturing (especially liver and kidneys).

  • Weigh the baby and calculate dosages based on weight in kilograms.

  • Risk for toxicity due to immature organs.

  • Albumin: Lack of protein affects metabolism of meds.
    *Many medications bind to Albumen to be delivered to the kidney and liver. If not enough Albumen, a lot of medication will be left in the blood circulating and that can cause toxicity.

  • Medications in the brain
    * If overdose is done, the patient may become confused, have seizures, feel dizzy, and not be where they are.