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Drug Nomenclature

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• Chemical name: identifies drug's atomic and molecular structure • Generic name: assigned by the manufacturer that first develops the drug • Official name: name by which the drug is identified in official publications United States Pharmacopeia (USP) and National Formulary (NF) • Trade name: brand name copyrighted by the company that sells the drug

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Drug preparations

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• Oral - Capsule, pill, tablet, extended release, elixir, suspension, syrup • Topical - Liniment, lotion, ointment, suppository, transdermal patch • Injectable

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extended release

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DONT crush

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topical meds

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- change the location WHY : same place = not proper absorption (could cause redness, swelling)

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Which type of drug preparation is a medication in a clear liquid containing water, alcohol, sweeteners, and flavor? A. Elixir B. Suspension C. Solution D. Syrup

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Answer: A. Elixir rationale: An elixir is a medication in a clear liquid containing water, alcohol, sweeteners, and flavor. A suspension contains finely divided, undissolved particles in a liquid medium. A solution is a drug dissolved in another substance. A syrup is medication combined in a water and sugar solution.

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Drug Classifications

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• Effect on body system (oral VS IV) • Chemical composition () • Clinical indication (USE) or therapeutic action (WHAT DOES IT DO)

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Pharmacokinetics (Effect of Body on Drug)

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• Absorption • Distribution • Metabolism • Excretion

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Factors Affecting Absorption ofMedications

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• Route of administration (speed of ABSORPTION) • Lipid solubility (pt WEIGHT) • pH • Blood flow • Local conditions at the site of administration • Drug dosage

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Pharmacodynamics (CELLULAR LEVEL)

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• Pharmacodynamics is the process by which drugs alter cell physiology and affect the body. • Drugs turn on, turn off, promote, or block responses that are part of the body's processes. • Drug-receptor interaction occurs when the drug interacts with one or more cellular structures to alter cell function. • Drugs may also combine with other molecules in the body to achieve their effect. • Other drugs act on the cell membrane or alter the cellular environment to achieve their effect.

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Adverse Drug Effects

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• Allergic effects: ANAPHYLACTIC reaction --- check for RED band • Drug tolerance -- if pt cant tolerate the drug --> different drug • Toxic effect • Idiosyncratic effect • Drug interactions: antagonistic and synergistic effects

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Factors Affecting Drug Action

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• Developmental considerations (neonate VS old) • Weight • Gender • Genetic and cultural factors • Psychological factors • Pathology • Environment • Timing of administration -- WHY IMPORTANT ------ food in stomach ------ drowsiness ------ diuretic at night ------ 1/2 life ------ Insulin & food ------ frequency : early pain meds request : try diff methods (distractions)

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Drug Dose and Serum Drug Levels

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• *Therapeutic range*: concentration of drug in the blood serum that produces the desired effect without causing toxicity • *Trough level*: the point when the drug is at its lowest concentration, indicating the rate of elimination • *Half-life*: amount of time it takes for 50% of blood concentration of a drug to be eliminated from the body

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Types of Medication Orders

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• *Standing order* (routine order): - carried out until cancelled by another order - specific procedures - certain meds at certain time - routine orders for unexpected situations • *PRN order*: as needed - only when pt request •* Single or one-time order* - supplements ----pt has low K --> give K+ •*Stat order*: carried out immediately --- call pharmacy

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Tell whether the following statement is true or false. Only pain medications may be give to patients without a medication order from a licensed practitioner. A. True B. False

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Answer: B. False Rationale: No medications may be give to patients without a medication order from a licensed practitioner.

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Parts of the Medication Order

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• Patient's name • Date and time order is written • Name of drug to be administered • Dosage of drug • Route by which drug is to be administered • Frequency of administration of the drug • Signature of person writing the order

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Medication Supply Systems

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• Stock supply (PYXIS) • Individual unit dose supply • Medication cart • Computerized automated dispensing system • Bar code-enabled medication cart (BCMA)

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In which of the following medication supply systems are large quantities of medications kept on the nursing unit making them immediately available to the nurse? A. Individual supply B. Stock supply C. Unit dose system D. Bar-coded medication cart

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Answer: B. Stock supply Rationale: With the stock supply system, large quantities of medications are kept on the nursing unit. The medications are readily available to the nurse, but this eliminates the double-check system by the pharmacy.

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Controlled Substances Required Information

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• Name of patient receiving narcotic • Amount of NARCOTIC used -- witness -------- people may steal it -- dispose extra med in a specific way • Hour narcotic was given • Name of physician prescribing narcotic • Name of the nurse administering narcotic

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Metric System Conversions

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• To convert larger unit to smaller unit, move decimal point to right • To convert smaller unit to larger unit, move decimal point to left - 1 kilogram = 1,000 grams - 1 gram = 1,000 milligrams - 1 milligram = 1,000 micrograms

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1.5 grams equals how many milligrams? A. 001.5 B. 15 C. 150 D. 1,500

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Answer: D. 1,500 Rationale: To convert a larger unit into a smaller unit, move the decimal point to the right (the new number is larger than the original). To convert a smaller unit into a larger unit, move the decimal point to the left (the new number is smaller than the original).

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Three Checks of Medication Administration

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• READ THE LABEL: - When the nurse reaches for the container or unit dose package - After retrieval from the drawer and compared with the CMAR, or compared with the CMAR immediately before pouring from a multidose container - Before giving the unit dose medication to the patient or when replacing the multi-dose container in the drawer or shelf

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Rights of Medication Administration MAIN : Patients Do Drugs Round The Day

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• Right medication • Right patient • Right dosage • Right route • Right time • Right reason OTHER CONSIDERATION: • Right assessment data • Right documentation • Right response • Right to education • Right to refuse

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Identifying the Patient

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• Checking the identification bracelet • Validating the patient's name (FIRST IDENTIFIER) • Validating the patient's identification number, medical record number, and/or birth date (second identifier) • Comparing with the CMAR or MAR ----- VERIFICATION • Asking the patient to state his or her name if possible

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Oral Medications

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• Solid form: tablets, capsules, pills • Liquid form: elixirs, spirits, suspensions, syrups

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Administration of Oral Medications

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• *Oral route*: having patient swallow drug • *Enteral route*: administering drug through an enteral tube ----- TUBE FEEDING ----- Flush the line BEFORE and AFTER ------------ with regular tap water ----- crush the pill , mix w/water, draw up med --> tube • *Sublingual administration*: placing drug under tongue • *Buccal administration*: placing drug between tongue and cheek

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Administration of Parenteral Medications

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• *Subcutaneous injection*: subcutaneous tissue • *Intramuscular injection*: muscle tissue • *Intradermal injection*: corium (under epidermis) • *Intravenous injection*: vein • *Intra-arterial injection*: artery • *Intracardial injection*: heart tissue • *Intraperitoneal injection*: peritoneal cavity • *Intraspinal injection*: spinal canal • *Intraosseous injection*: bone

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Criteria for Choosing Equipment for Injections

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• Route of administration • Viscosity of the solution • Quantity to be administered • Body size • Type of medication

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Sites for Intramuscular Injections

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• Ventrogluteal site • Vastus lateralis site • Deltoid muscle site • Dorsogluteal site is no longer recommended.

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Tell whether the following statement is true or false. The recommended intramuscular site for an adult is the vastus lateralis. A. True B. False

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Answer: B. False Rationale: The recommended intramuscular site for an adult is the ventrogluteal or deltoid.

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Preparing Medications for Injection

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• Ampules • Vials • Prefilled cartridges or syringes • Mixing medication in one syringe • Mixing insulins in one syringe • Reconstituting powdered medications

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Intradermal Injections.

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• Administered into the dermis, just below the epidermis. • Has the longest absorption time of all parenteral routes. • Used for sensitivity tests and local anesthesia. • Body's reaction to the substances is easily visible. • Sites commonly used are the inner surface of the forearm and the upper back, under the scapula. • A 1/4? to 1/2?, 25- or 27-gauge needle is used and the angle of administration is 5 to 15 degrees. • The dosage given intradermally is small, usually less than 0.5 mL

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Subcutaneous injections

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• Administered into the adipose tissue layer just below the epidermis and dermis. • Various sites used: - Outer aspect of the upper arm - Abdomen (from below the costal margin to the iliac crests) - The anterior aspects of the thigh - The upper back - The upper ventral or dorsogluteal area

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Intravenous Administration of Medication

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• Delivers the drug directly into the bloodstream • Medication has an immediate effect and cannot be recalled or actions slowed • Route most often used in emergency situations

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Topical Administration of Medications

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• Skin applications • Eye instillations and irrigations • Ear instillations and irrigations • Nasal instillations • Vaginal applications • Rectal instillations

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Medication Errors

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• Check patient's condition immediately; observe for adverse effects. • Notify nurse manager and primary care provider. • Write description of error and remedial steps taken on medical record. • Complete form used for reporting errors, as dictated by the facility policy.

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Type of Medication Errors

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• Inappropriate prescribing of the drug • Extra, omitted, or wrong doses • Administration of drug to wrong patient • Administration of drug by wrong route or rate • Failure to give medication within prescribed time • Incorrect preparation of drug • Improper technique when administering drug • Giving drug that has deteriorated

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Medical Record Documentation

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• Name of the medication • Dosage • Route and time of administration • Name of person administering medication • Site used for an injection • Intentional or inadvertently omitted drugs • Refused drugs • Medication errors

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Patient Teaching

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• Review techniques of medication administration. • Remind the patient to take the medication as prescribed for as long as prescribed. • Instruct the patient not to alter dosages without consulting a physician. • Caution the patient not to share medications.

Chapter 28 : medications (II) – Flashcards

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