Lab Week 3- Administering Medications

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Automated Dispensing System

Back 1

Computerized dispensing system

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Pharmacokinetics

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Refers to the absorption, distribution, metabolism, and excretion of a drug.
These are four processes determine the intensity and duration of a drug's actions

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Absorption

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Refers to the movement of the drug from the site of administration into the bloodstream
-The rate of absorption determines when a drug decode available to exert its action; it influences metabolism and excretion. It depends on the route of administration, form of drug, drug solubility, effects pf pH, blood flow to the area, and body surface area.

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Local effects

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Occur at the site of application of the drug- so no absorption occurs

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Systemic effect

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The drug must be absorbed into the bloodstream before it can be distributed to a distant location.
-A drug may enter the circulation either by injection into a vein or by absorption from other areas into which it has been placed.

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Drugs are manufactured for specific route of administration

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Oral, sublingual, buccal, inhalent, topical, enteral, and parenteral are absorbed at different rate depending on the route.
-The form (preparation) of a drug usually determines its route of administration

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Solubility

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Refers to the ability of a medication to be transformed into a liquid form that can be absorbed into the bloodstream

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Enteric-Coated

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Drugs cannot be decomposed by the gastric secretions; the coating thus prevents the medication from being diluted before it reaches the intestines
-Coating delays the action of the medication.
-It also decreases irritating effete of the medication on the stomach.

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Timed-realease (sustained-release)

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Medications that are formulated to dissolve slowly, releasing small amounts fro absorption over several hours
-To be absorbed, oral preparations must be water soluble and at least partially lipid soluble

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Liquids (absorption speed)

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Are absorbed faster than tablets or capsules because the medications are already dissolved

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Water-soluble drugs

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Drugs must be water soluble in order to dissolve in aqueous contents of the GI tract

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Lipid-soluble drugs

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Lipid solubility depends partly on the drug's chemical structure and partly on the environment at the site of absorption
-They can penetrate lipid-rich cell membranes and enter the cells

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pH

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(relative acidity or alkalinity) of the local environment also affects the absorption of a drug

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Ionized

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Electrically charged

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Nonionized

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(Neutral or non-charged) Are lipid insoluble and thus cannot pass easily through the phospholopid layer of cell membranes

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Blood Flow to the Area

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Medications are absorbed rapidly in areas where blood flow to the tissue is greatest
-Excessive exercise draws blood away from the stomach and intestines to the muscles

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Distribution

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Is the transportation of a drug in the body fluids (usually bloodstream) to the various tissues and organs of the body

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Local blood flow

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The blood supply of the target site affects distribution of a drug

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Blood-Brain Barrier

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Aloows distribution into the brain and cerebrospinal fluid of only those drugs that are 1. Lipid soluble and 2. not tightly bound to plasma proteins

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Protein-Binding Capacity

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A drug's tendency to bind to plasma roteins in the blood also affects distribution

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Metabolism (or Biotransformation)

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Is the chemical inactivation of a drug through its conversion into a more water-soluble compound or into metabolites that can be exceed from the body.
-Metabolism take place mainly in the liver, but medications can be detoxified also in the kidneys, blood plasma, intestinal mucosa, and lungs. (If liver function is impaired toxic level may accumulate)

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First-Pass Effect

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Oral medications are absorbed from the GI tract and circulate through the liver before they reach the systemic circulation

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Excretion

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Drug molecules must be removed from their sites of action and eliminated from the body.

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Kidneys excretion

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They are the primary site of excretion

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Liver and GI tract excretion

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Some drugs broke down by the liver are excreted into the GI tract and eliminated in the feces.

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Enterohepatic Recirculation

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Drugs that are excreted from the liver reabsorbed by the bloodstream, distributed to the target site, and returned to the liver

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Lungs excretion

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Most drugs removed by the lungs are not metabolized first. Gases and volatile liquids administered by inhalation usually are removed through exhalation

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Exocrine Glands excretion

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Drug excretion through sweat and salivary glands is limited.
-The elimination of metabolites in sweat glands is frequently responsible for such side effects as dermatitis.
-Drugs excreted in the salvia are usually swallowed and absorbed as other orally administered agents

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Onset of Action

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Is the tie needed for a drug concentration to reach a high enough blood level for its effects to appear- this is the Minimus effective concentration

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Peak Action

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Occurs when the drug is at its highest concentration (when absorption is equal to the rate of elimination). After that, metabolic and excretory processes begin to remove the drug from the tissues and blood

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Duration of action

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Is the period of time in which the medication has a pharmacological effect
-If the serum level of a medication falls below the minims effective concentration, then the drug is not effective during that time. If the drug level exceeds he peak level, toxicity occurs

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Therapeutic Level

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Is the concentration of a drug in the blood serum that produces the desired effect without toxicity

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Therapeutic range

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Is the range of therapeutic concentrations. At onset of action, serum drug level is minimal

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Trough Level

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Occur when the drug is at its lowest concentration, right before the next dose is due
-A test called "peak and trough level" helps to ensure the safety and effectiveness of certain drugs

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Biological half-life

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Is the amount of time it takes for half of the drug to be eliminated

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What factors affect Pharmacokinetics?

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Age, body mass (weight), sex, pregnancy, environment, route of administration, timing of administration, fluids, pathological states, genetic factors, psychological factors

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Teratogenic Drugs

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Drugs known to cause developmental defects with pregnancy

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Primary or Therapeutic Effects

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Are effects that are predicted, intended, and desired

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Secondary Effects

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Unintended and non therapeutic

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Supporting Effects

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Support the integrity of body functions until other medications or treatments can become effective

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Palliative Effects

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Relive the signs and symptoms of a disease but have no effect on the disease itself

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Substitutive Effects

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Replace either body fluids or a chemical required by the body for improved functioning

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Chemotherapeutic Effects

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Destroy disease-producing microorganism or body cells
Examples: 1. Antibiotics, used to treat infections by killing or limiting the reproduction of certain bacteria 2. Antineoplastic drugs, used to treat cancer by limiting cell reproduction and destroying malignant cells

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Restorative Effects

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Return the body to or maintain the body at optimal levels of health

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Side Effects

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Are unintended, often predictable, physiological effects that are usually well tolerated by the patient

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Adverse Reactions

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Are harmful, unintended, usually unpredicted reactions to a drug administered at the normal dosage.
-When dose related, the undesired effects result rom known pharmacological effects of the medication.
-When patient sensitivity, they are unusually susceptible to the effects of the drug

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Severe Adverse Reactions

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The FDA defines as 1. Life threatening 2. Require intervention to prevent permanent impairment or death 3. Lead to congenital anomaly, disability, hospitalization, or death

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Toxic Reactions

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Are dangerous, damaging effects to an organ or tissue. Overdosing, accumulation, abnormal sensitivity. Antidotes are available for some medications.

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Allergic Reaction

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The immune systen identifies a medication as a foreign substance that should be neutralized or destroyed

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Anaphylactic Reaction

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Is a life-threatening allergic reaction that occurs immediately after administration

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Idiosyncratic Reaction

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Is an unexpected, abnormal, or peculiar response to a medication

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Cumulative Effect

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Is the increase response to repeated doses of a drug that occurs when the rate of administration is greater than the rate of metabolism and excretion.
-This happens when 1. the body cannot metabolize a dose of the medication before the next dose is given 2. excretion is slowed but absorption is normal or rapid 3. absorption is slow

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Drug Interaction

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When one drug alters or modifies the action of another

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Antagonistic Drug relationship

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One drug interfere with the actions of another and decreases the resultant drug effect- the combined effect is less than that of one drug given alone

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Synergistic Drug relationship

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There is an additive effect; the effect of both drugs together is greater than the individual effects

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Drug Incompatibilities

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Occur when multiple drugs are mixed together, causing a chemical deterioration of one or both drugs

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Tolerance

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Is the decreasing response to repeated doses of a medication

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Drug dependance

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A person's relance on, or need for, a drug constitutes

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Drug Misuse

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Nonspecific indiscriminate or improper use of drugs

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Drug abuse

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Inappropriate intake of a substance

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Illicit Drugs

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AKA street drugs- sold illegally

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Medication Measurement Systems

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Metric System
Apothecary System
Household System

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Milliequivalents (mEq)

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Indicate the strength of the ion concentration in a drug.
-It is the number of grams of a solid contained in one mL of a solution

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Standard Written Prescriptions

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Apply without a renewal date until the prescriber writes a prescription to alter or discontinue the medication or indicates on the original prescription a specific date to stop

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Automatic Stop dates

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Are protocols that hospitals use for discontinuing medications after a certain length of time

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STAT

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One-time prescription- the medication is to be given only once at a specified time

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Standing Orders

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These are officially accepted sets of prescriptions to be applied routinely by nurses for the care of patients under certain conditions or under certain circumstances, like drug allergies or sensitivities

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PRN Prescription

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The care provider may prescribe a medication to be given whenever the patient requires

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Communicated Prescriptions

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Written, verbal, and telephone

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Medication error

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Is any preventable event that may cause or lead to inappropriate medication use or harm to a patient

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Error-Prevention Technology

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Use of smart technologies, computerized prescriber order entry, barcoding medications, automated dispensing units

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Polypharmacy

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The ingestion of numerous medications in an attempt to treat many conditions simultaneously. This increases the potential for adverse reactions and dangerous drug and food interactions

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Noncompliance (non-adherence)

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Is failure to follow the treatment plan

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Giving Medicaiton 3 Checks

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Before you get the medication
After you prepare the medication
At the Bedside

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"Rights of Medication"

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Right Drug, Right Dose, Right Time, Right Route, Right Patient, and Right Documentation

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Right Reason

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This is the right not to receive unnecessary medications

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Right to Know

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The patient has the right to know the name of the medication, why it is being given, its actions, and potential side effects

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Right to refuse

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The patient always has the right to refuse a medication regardless of her reasons and regardless of the consequences

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Buccal and Sublingual Medications

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Although placed in the mouth, are intend for absorption in the mucous membranes rather than the GI tract

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Eternal Medications

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For patients who cannot swallow or who have feeding tubes, give medication through nasogastic NG, gastrostomy, or jejunal tubes

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Medicating Older Adults

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Older adults usually require smaller dosage of drugs.
They have Difficulty swallowing, reduced thirst, slow reflexes and reasoning ability, forgetting to take medications, impaired visual acuity, difficulty opening containers, lack of understating medication purpose, and not seeing the need for medication

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Transdermal Medication

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Designs to be absorbed through the skin, they are prepared pachas made of a special membrane

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Instillation

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Is the insertion of medication into a body cavity so the medication can be retained or absorbed through that body cavity

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Ophthalmic Medications

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Ophthalmic ointments or solutions are used for their local effects, for example to treat eye irritations infections and glaucoma or to lubricate the eye

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Otic Medications

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May be dropped into the ear to treat internal and external ear infections, to apply heat to the area, and to soften and remove earwax

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Rebound effect

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Medication will be effective immediately after administration, but the nasal congestion often reoccurs and even increases when the effects of the drug wear off

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Vaginal Medications

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Jellies, liquids (douches), creams, tablets, and suppositories destroy bacteria in the vagina before sugary, to reduce dryness, to treat itching or infection or to induce labor

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Rectal Medications

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(Enemas) Rectal suppositories and liquid instillations are used to encourage bowel movements or to treat systemic complaints

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Types of Nebulizers

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Atomizers- large droplets
Aerosol Sprayers- in gas
Ultrasonic (handheld)- medication and humidity (mist)
Metered-dose inhaler- delivers measured does of the drug

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Metered-Dose Inhaler (MDI)

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Is a pressurized container refilled with several doses for propelling the medication forward.
Advantages: high does of medication can be quickly instilled in the lungs.
Disadvantages: need for skill in coordinating the inhalation of the medication

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Dry Powder Inhaler (DPI)

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Medication is activated by a pump rather then by inhalation