Pharmacology and Medication Administration

Medication Parameters

Parameters are specific conditions under which a medication should or should not be administered.

• These parameters are usually written on the medication order or displayed with the patient's vitals.

• A common parameter is to "hold" a medication if the heart rate is below a certain level (e.g., 60 bpm).

• Importance of Parameters: Always adhere to the specified parameters, even if the patient's heart rate or other vital signs are normally lower. Parameters are the doctor's orders, and deviating from them can have legal and medical consequences.

Digoxin

Digoxin is a potent medication, thus its administration requires monitoring of digoxin levels in the blood. High levels can lead to digoxin toxicity.

Digoxin Toxicity

• Symptoms:

  • Nausea, vomiting, diarrhea (common side effects, less specific)

  • Bradycardia (slow heart rate) - most common

  • Dysrhythmias, specifically PVCs (premature ventricular contractions)

  • Vision changes: Yellow-green halos in vision (very specific to digoxin)

Side Effects of Digoxin

• Bradycardia

• Nausea

• Vision changes (yellow-green halos)

Erythromycin

Erythromycin is an anti-infective medication often used post-surgery to prevent infections.

Side Effects of Erythromycin

• Hepatotoxicity:

  • Damage or toxicity to the liver.

  • In practice, liver enzymes should be monitored when administering erythromycin.

• Prolonged QT Interval:

  • Refers to a specific measurement on an EKG (electrocardiogram).

  • The QT interval represents ventricular depolarization and repolarization.

  • A prolonged QT interval increases the risk of dysrhythmias.

  • EKG bsp;Components: P, Q, R, S, T

    • P wave: represents atrial depolarization.

    • Q wave: initial downward deflection.

    • R wave: upward deflection.

    • S wave: downward deflection following the R wave.

    • T wave: represents ventricular repolarization.

• Dysrhythmia (change in heart rhythm)

Administration

• Route: PO (by mouth), usually a pill.

• Frequency: q12h (every 12 hours).

Humulin (Insulin)

Humulin is a mix of two types of insulin: regular (R) and NPH. The ratio mentioned in the transcript is five units of regular and five units of NPH.

Types of Insulin (by Speed of Action)

1. Rapid-acting

2. Regular (faster acting)

3. NPH (intermediate-acting)

4. Long-acting

• Regular insulin acts faster than NPH.

• The combination of regular and NPH provides an intermediate action profile, balancing speed and duration.

Administration Considerations

• When drawing insulin, injecting air into the vial helps maintain pressure and allows for easier withdrawal of the medication.

• It doesn't matter if you put air for the first vial, and then put air in the second vial, etc.

• If air bubbles form when drawing up the medication, flick the syringe and push the air back into the vial.

• Insulin is administered based on parameters, such as blood sugar levels.
  * Example: Hold if blood sugar is below 120 mg/dL.

• The normal range of blood sugar: usually 70 to 100 mg/dL.

Side Effects

• Low blood sugar (hypoglycemia)

• Injection site pain or redness

Injection Site

• Medication is given subcutaneously

• Common sites: abdomen, back of the arm

• Avoid areas with protein buildup or bruising from repeated injections at the same site.

Timing:

• Administer insulin before meals (QAC - per meals)

• Given before meals to help maintain blood sugar levels and prevent spikes after eating

Morphine

Side Effects

• Respiratory Depression:

  • It is very important

  • Morphine can slow down breathing

• CNS Depression:

  • Can cause lethargy or reduced mental alertness.

  • Do not administer if the patients alreadylethargic or difficult to arouse.

• Nausea, vomiting

• Constipation (common with opioids)

  • Instruct patients not to strain during bowel movements.

Administration

• Route: IM (Intramuscular)

• Frequency: q6h PRN (every 6 hours as needed)

• Sites: Deltoid, vastus lateralis (thigh)

• Technique: Z-track injection

Z-Track Injection Technique

1. Pull the skin to one side.

2. Inject the medication.

3. Release the skin.

The Z-track technique locks the medication into the muscle and prevents leakage into subcutaneous tissue.

Assessment Before Administration

• Check vital signs, including pain level (pain is often considered the "fifth vital sign").

• Assess lab results, especially glucose levels for insulin administration.

General Medication Administration Guidelines and Rights

• Medication Rights:

  • Patient, medication, dose, route, time, documentation, etc.

• Communicate clearly with the provider (using SBAR - Situation, Background, Assessment, Recommendation).

• Verify orders by reading them back to the provider.

• Clarify any discrepancies (e.g., NPO status with PO medications).

• Explain the medication to the patient, including its purpose and potential side effects.

PO Medications

• Always assess the patient's ability to swallow before administering oral medications.

Subcutaneous Injections

• Shorter needle length (e.g., 5/8 inch).

• Thinner gauge needle (higher number, e.g., 25 gauge or higher such as a 31 gauge).

• Insulin syringe are probably these ones

Intramuscular Injections

• Longer needle length (e.g., 1 inch).

• Thicker gauge needle (lower number, e.g., 22 gauge).

• Use one inch twenty-two as example

Needle Handling

• Avoid recapping needles after administration.

• Use the safety mechanism on the syringe to cover the needle.

• Dispose of used needles in a sharps container.

Dosage Calculations

• Be prepared to perform medication calculations, including converting between units (e.g., milligrams to milliliters).

• The calculations on the test will be simple and shouldn't require a calculator.

• Formula:
  Desired
  bsp;Dose / Dose on hand = Amount to administer

Communication with Provider

• SBAR is Situation, Background, Assessment, Recommendation.

Medication Parameters Parameters are specific conditions under which a medication should or should not be administered. - These parameters are usually written on the medication order or displayed with the patient's vitals. - A common parameter is to "hold" a medication if the heart rate is below a certain level (e.g., 60 bpm). -

Importance of Parameters:

Always adhere to the specified parameters, even if the patient's heart rate or other vital signs are normally lower. Parameters are the doctor's orders, and deviating from them can have legal and medical consequences. ## Digoxin Digoxin is a potent medication, thus its administration requires monitoring of digoxin levels in the blood. High levels can lead to digoxin toxicity. ### Digoxin Toxicity -

Symptoms:

• Nausea, vomiting, diarrhea (common side effects, less specific) - Bradycardia (slow heart rate) - most common - Dysrhythmias, specifically PVCs (premature ventricular contractions) - Vision changes: Yellow-green halos in vision (very specific to digoxin) - Other symptoms can include confusion, loss of appetite, and abdominal pain. - Risk Factors: - Hypokalemia (low potassium levels) increases the risk of digoxin toxicity. - Renal impairment can also elevate digoxin levels ### Side Effects of Digoxin - Bradycardia - Nausea - Vision changes (yellow-green halos) ## Erythromycin Erythromycin is an anti-infective medication often used post-surgery to prevent infections. ### Side Effects of Erythromycin -

Hepatotoxicity:

• Damage or toxicity to the liver. - In practice, liver enzymes should be monitored when administering erythromycin. -

Prolonged QT Interval:

• Refers to a specific measurement on an EKG (electrocardiogram). - The QT interval represents ventricular depolarization and repolarization. - A prolonged QT interval increases the risk of dysrhythmias. - EKG bsp;Components: P, Q, R, S, T- P wave: represents atrial depolarization. - Q wave: initial downward deflection. - R wave: upward deflection. - S wave: downward deflection following the R wave. - T wave: represents ventricular repolarization. - Dysrhythmia (change in heart rhythm) - Drug Interactions: - Erythromycin interacts with several other medications, potentially leading to increased drug levels and toxicity. - Examples include certain antiarrhythmics, antihistamines, and antifungals. ### Administration - Route: PO (by mouth), usually a pill. - Frequency: q12h (every 12 hours). ## Humulin (Insulin) Humulin is a mix of two types of insulin: regular (R) and NPH. The ratio mentioned in the transcript is five units of regular and five units of NPH. ### Types of Insulin (by Speed of Action) 1. Rapid-acting 2. Regular (faster acting) 3. NPH (intermediate-acting) 4. Long-acting - Regular insulin acts faster than NPH. - The combination of regular and NPH provides an intermediate action profile, balancing speed and duration. ### Administration Considerations - When drawing insulin, injecting air into the vial helps maintain pressure and allows for easier withdrawal of the medication. - It doesn't matter if you put air for the first vial, and then put air in the second vial, etc. - If air bubbles form when drawing up the medication, flick the syringe and push the air back into the vial. -

Insulin is administered based on parameters, such as blood sugar levels.

• Example: Hold if blood sugar is below 120 mg/dL. - The normal range of blood sugar: usually 70 to 100 mg/dL. - Sliding Scale: - Insulin is often administered using a sliding scale, where the dose is adjusted based on pre-meal blood glucose levels. - This helps provide individualized glycemic control. ### Side Effects - Low blood sugar (hypoglycemia) - Injection site pain or redness ### Injection Site - Medication is given subcutaneously - Common sites: abdomen, back of the arm - Avoid areas with protein buildup or bruising from repeated injections at the same site. - Rotation: - Rotate injection sites to prevent lipohypertrophy (protein buildup) or lipoatrophy (loss of fat tissue). ### Timing: - Administer insulin before meals (QAC - per meals) - Given before meals to help maintain blood sugar levels and prevent spikes after eating ## Morphine ### Side Effects -

Respiratory Depression:

• It is very important - Morphine can slow down breathing -

CNS Depression:

• Can cause lethargy or reduced mental alertness. - Do not administer if the patients alreadylethargic or difficult to arouse. - Nausea, vomiting - Constipation (common with opioids)- Instruct patients not to strain during bowel movements. #### Interventions for Constipation 1. Increase fluid intake 2. Increase fiber intake 3. Administer stool softeners or laxatives as prescribed ### Administration - Route: IM (Intramuscular) - Frequency: q6h PRN (every 6 hours as needed) - Sites: Deltoid, vastus lateralis (thigh) - Technique: Z-track injection ### Z-Track Injection Technique 1. Pull the skin to one side. 2. Inject the medication. 3. Release the skin. The Z-track technique locks the medication into the muscle and prevents leakage into subcutaneous tissue. ### Assessment Before Administration - Check vital signs, including pain level (pain is often considered the "fifth vital sign"). - Assess lab results, especially glucose levels for insulin administration. - Allergy: - Always check for any known allergies to morphine or related opioids. ## General Medication Administration Guidelines and Rights -

Medication Rights:

• Patient, medication, dose, route, time, documentation, etc. - Communicate clearly with the provider (using SBAR - Situation, Background, Assessment, Recommendation). - Verify orders by reading them back to the provider. - Clarify any discrepancies (e.g., NPO status with PO medications). - Explain the medication to the patient, including its purpose and potential side effects. ### PO Medications - Always assess the patient's ability to swallow before administering oral medications. ### Subcutaneous Injections - Shorter needle length (e.g., 5/8 inch). - Thinner gauge needle (higher number, e.g., 25 gauge or higher such as a 31 gauge). - Insulin syringe are probably these ones ### Intramuscular Injections - Longer needle length (e.g., 1 inch). - Thicker gauge needle (lower number, e.g., 22 gauge). - Use one inch twenty-two as example ### Needle Handling - Avoid recapping needles after administration. - Use the safety mechanism on the syringe to cover the needle. - Dispose of used needles in a sharps container. ### Dosage Calculations - Be prepared to perform medication calculations, including converting between units (e.g., milligrams to milliliters). - The calculations on the test will be simple and shouldn't require a calculator. - Formula:

Desired
bsp;Dose / Dose on hand = Amount to administer ### Communication with Provider - SBAR is Situation, Background, Assessment, Recommendation.