Mel's Medication Administration Lecture Oct 2006

Front 1

Drug Legislation: FDA
* What Act brought the FDA into being in what year?
* What does the FDA do?

Back 1

FDA came into being in 1938 from the Pure Food and Drug Act.
FDA governs prescription and OTC drugs.

Front 2

Drug Legislation: Harrison Narcotic Act; Controlled Substance Act

Back 2

*1914 Harrison Narcotic Act became the Controlled Substance Act (1970)
* DEA enforces compliance
* Narcotic count done after each shift

Front 3

Drug Legislation: In addition to federal regulations...3 other bodies that govern nurses and administration of drugs

Back 3

* State regs
* Nurse practice Act: State regulations that ensure minimal compentency
* Healthcare institutions have their own regulations and tests

Front 4

Nurse's Role in Medication Administration (4 things)

Back 4

1. Accurate administration
2. Patient teaching
3. Evaluating response to medication (looking for desired effect)
4. Documenting administration and desired effect being reached.

Front 5

Pharmocological Concepts: Drug Nomenclature (3 names)

Back 5

1. Chemical Name (N acetyl para aminophenol)
2. Generic Name (Acetaminophen)
3. Trade Name (Tylenol)

Front 6

Pharmacological Concepts: Classification (Pharm vs. Therapeutic)

Back 6

Know: effect drug has on the body and symptoms relieved

Front 7

6 Safe Guidelines for Administering Medication

Back 7

1. Never sign the MAR until after drug is administered
2. Never administer a drug someone else prepared
3. Always listen to client "I never took this before"
4. If you withhold a drug, document why
5. Never leave a medication at a patient's bedside
6. Educate "Never borrow someone else's medication"

Front 8

Forms of Medication (Oral) Abbreviations: SR, XL, CR, SA, LA

Back 8

SR: sustained release, XL: extended release, CR: controlled release, SA: short acting, LA: long acting

Front 9

Forms of Medication (Oral) Liquids: Elixir, Extract, Solution, Suspension, Troche

Back 9

Elixir: liquid + alcohol base, Extract: concentrated form from original source, solution: liquid, suspension: drug in a liquid that needs to settle so you need to shake, syrup=with sugar, troche: lozenge

Front 10

Pharmokinetics of a drug

Back 10

1.Absorption
2. Distribution
3. Metabolism
4. Excretion

Front 11

Loading Dose of a drug

Back 11

Dose given one time to quickly elevate level of drug in the blood

Front 12

Maintenance Dose of a drug

Back 12

Dose required to keep blood level steady and to achieve the desired therapeutic effect

Front 13

Absorption of a drug

Back 13

Passage of the medication into the bloodstream and the drug starts taking effect

Front 14

5 Factors affecting the Absorption of a medication

Back 14

1. route
2. ability of drug to dissolve
3. blood flow to site (elderly have less blood flow)
4. body surface (bigger people need a larger dose)
5. Lipid solubility of drug (some drugs dissolve better in the stomach--effected by having food in the stomach)

Front 15

Factors affecting the Distribution of Medication

Back 15

1. Circulation
2. Membrane Permeability
3. Blood-Brain Barrier
4. Placenta-Teratogenic
5. Protein-Binding
6. Metabolism
7. Excretion
8. pH of Drug

Front 16

What are the four parts comprising the "Pharmokinetics" of Medications?

Back 16

1) Absorption
2) Distribution
3) Metabolism
4) Excretion

Front 17

What is a "Loading Dose" of a Medication?

Back 17

The loading dose is a 1 time dosage of the drug in an amount to quickly elevate the level of the drug in the bloodstream

Front 18

What is the "Maintenance Dose" of a Drug?

Back 18

the dosage required to keep the blood level steady and get the desired therapeutic effect of the drug

Front 19

Name 5 factors that effect the absorption of a medication.

Back 19

1) Route: oral is the slowest, IV/IM quickest, SL faster than oral
2) Ability for an oral medication to dissolve
3) Blood flow to the site (elderly have poorer circulation--slower absorption time)
4) Body surface--bigger people need a bigger dose
5)Lipid solubility of drug: pH is important here--some drugs dissolve better in the stomach and are effected by having food in the stomach

Front 20

What is the "Absorption" of a drug?

Back 20

absorption is the passage of medication into the bloodstream

Front 21

What is meant by the "Distribution" of a drug?

Back 21

distribution of a drug is the movement of drugs from the bloodstream to the various bodily fluids and tissues

Front 22

Name 4 factors that effect the distribution of a medication.

Back 22

1) cardiac output and circulation
2) cell membrane permeability--to be distributed to tissue, cell membranes must allow drug in.
3)Placenta--teratogenic effects
4)Protein binding

Front 23

What is the blood-brain barrier with regards to distribution of medications?

Back 23

The blood brain barrier allows only fat soluble medications to pass through (e.g. alcohol, general anesthetics, penicillin G)

Front 24

What is meant by "protein-binding" with regards to medications?

Back 24

* When a drug is circulating in the blood stream, it may become attached to serum proteins (mostly albumin).
*This binding decreases the amount of free drug available to reach the site of action because the protein-drug molecule is too big to diffuse through the cell memberane.
* some diseases decrease amount of albumin in bloodstream--be careful with dosages of medications for toxic effects

Front 25

What is meant by "Metabolism" or biotransformation of a drug or medication?

Back 25

* The process of metabolism refers to the chemical and physical processing of the drug, inactivating the drug and changing it into a water-soluble compound that can be excreted by the body.
* The liver is the primary source of biotransformation.

Front 26

Name 4 factors effecting metabolism

Back 26

1) The presence of specific enzymes in the liver that process drugs
2) Health of the liver (diseases such as cirrohsis effect the body's ability to process medications).
3) Circulation to the liver (age), and other substances in the liver also effect the speed at which the body can metabolize a medication
4) race and heritage also can effect the metabolism of drugs

Front 27

What is involved in the excretion of a medication?

Back 27

Excretion is the elimination of drugs from the body, involving the movement of a drug or its metabolites from the tissues back into circulation and from the circulation into the organs of excretion.

Front 28

Name 3 factors that affect the kidney's ability to excrete drugs and their metabolites

Back 28

1) maturity of the kidneys
2) circulation
3) disease of kidneys
**important implications for the elderly as kidney funtion decreases, there can be an accumulation of drugs, resulting in toxicity.
**other organs, such as exocrine glands, the skin , gi tract and lungs contribution to the excretion of some drugs

Front 29

7 General Factors that affect the pharmokinetics (absorption, distribution, metabolism, excretion) of a drug

Back 29

1) Weight of patient: the higher the weight, the higher the dose needed
2) Gender: women respond differently to medications due to their higher fat content
3) Age: elderly have a slower metabolic process, more difficult to excrete--children have a lower threshold
4) genetic/cultural factors
5) other pathologies
6) environmental issues (ex: nutrition, people working night shift, etc)
7) psychological factors

Front 30

Describe liniment medications

Back 30

topical medication mixed with alcohol, oil or soapy emollient--like a cream

Front 31

Describe ointment medications

Back 31

semi-solid substances for topical use--like a & d ointment

Front 32

Describe paste medications

Back 32

semi-solid substances for topical use that is thicker than ointment--absorbed slowly through the skin

Front 33

Describe tincture medication

Back 33

alcohol in water solution

Front 34

Describe sublingual / buccal medication

Back 34

placement under tongue or in the buccal pocket for disintegration and absorption through mucus membranes

Front 35

Describe troches, lozenges or pastilles

Back 35

preparations of drugs designed to dissolve in the mouth

Front 36

Describe caplet medications

Back 36

gelatin - coated tablets that dissolve in the stomach

Front 37

Describe transdermal patch medications

Back 37

contain medication that is absorbed throught the skin over an extended period of time

Front 38

Describe suppository medications

Back 38

gelatin substances designe to dissolve when inserted into the rectum, urethra or vagina

Front 39

Describe inhalant medications

Back 39

drugs or dilution of drugs administered by the nasal or oral respiratory route for a local or systemic effect

Front 40

Describe enema medications

Back 40

aqueous solutions for rectal instillation

Front 41

Describe douche medications

Back 41

aqueous solutions that function as a cleansing or antiseptic agent that may be dispensed in the form of a powder with directions for dissolving in a specific quantity of warm water

Front 42

Describe tablet medications

Back 42

compressed or molded substances to be swallowed whole, chewed before swallowing, or placed in the buccal pocket or under the tongue

Front 43

Describe capsule medications

Back 43

substances encased in either a hard or soft soluble container or gelatin shell that dissolves in the stomach

Front 44

Describe enteric-coated medications

Back 44

tablets that dissolve in the intestines

Front 45

Describe time-release capsules

Back 45

Encased substances that are further enclosed in smaller casings that deliver a drug dose over an extended period of time

Front 46

Describe medications that are suspensions

Back 46

particle or powder substances that must be dissolved in a liquid (shaken vigorously) before administration

Front 47

Describe medications that are in emulsion form

Back 47

Emulsion is a two-phase system in which one liquid is dispersed in the form of small droplets throughout another liquid

Front 48

Describe syrup medications

Back 48

substances dissolved in sugar liquid

Front 49

Describe gargle medications

Back 49

aqueous solutions

Front 50

Describe mouthwash medications

Back 50

aqueous solutions that may contain alcohol, glycerin and synthetic sweeteners and surface-active flavoring and coloring agents

Front 51

Describe nasal solution medications

Back 51

aqueous solutions in the form of drops or sprays

Front 52

Types of Medication Interaction: What is meant by "cumulative effect"?

Back 52

Effect of all of the medications taken together (go to the same pharmacy each time)

Front 53

Types of Medication Interaction: What is meant by "antagonistic effect"?

Back 53

When 2 drugs cancel each other out--no effect

Front 54

Types of Medication Interaction: What is meant by "synergystic effect"?

Back 54

When 2 drugs support eachother in such a way that you could have lower doses of medication

Front 55

Types of Medication Interaction: Describe common types of allergic reactions

Back 55

Allergic reactions are unpredictable. Common reactions are:
1) mild: hives, rash, itching
2) severe: anaphylaxis,

Front 56

Types of Medication Interaction: Describe drug tolerance

Back 56

When the body becomes so accustomed to a specific drug that larger doses are needed to produce the desired therapeutic effect.

Front 57

Types of Medication Interaction: Describe 3 primary types of interaction with food or drugs

Back 57

1. certain drugs may interfere with the absorption, excretion or use in the body of one or more nutrients.
2. Certain foods may increase or decrease the absorption of a drug into the body
3. Certain foods may alter the chemical actions of drugs, preventing their therapeutic effect on the body.
* most interactions happen with diuretics, oral antibiotics, anticoagulant and antihypertensive drugs

Front 58

Routes of 4 parenteral drug administration (know degrees of needle entry)

Back 58

1. subcutaneous 45
2. IM 90
3. IV 25
4. ID 10 - 25

Front 59

7 Other Routes of Medication Administration

Back 59

1) Epidural
2) Intrathecal
3) Intraosseus
4) Intraperitoneal
5) Intrapleural
6) Intrarterial
7) Intracardiac

Front 60

5 Types of Medication Orders

Back 60

1) Routine order: typically in office visit for episodic event
2) Standing order: specific- "if a patient has temp over 101 you may administer x mg of y"
3) prn: as needed, eg pain meds
4) single order: one time dose
5) stat: NOW

Front 61

7 Parts of the Medication Order

Back 61

1) Name of client
2) Date and time written (esp for STAT med orders)
3) Name of drug
4) dose
5) route
6) time and frequency of administration
7) signature of prescriber

Front 62

5 Rights of Drug Administration + 1 Right Documentation

Back 62

1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time

Front 63

The nurse needs to check the label written on the container against the MAR 3 times

Back 63

1. when removing the drug container from the client's drawer
2. when removing it from the container
3. before returning it to the client's medication drawer

Front 64

List 5 situations that change medication orders

Back 64

1. lack of availability of drug
2. condition of the patient
3. surgery (cancels all med. orders)
4. transfer to a different unit
5. discharge

Front 65

Describe 3 drug supply and storage systems in the acute care setting

Back 65

1. unit-dose form: unit dose is a system of packaging and labeling each dose of medication for a patient for a 24 hour period
(stored in medication cart).
2. stock supplied: certain drugs (such as tylenol) are dispensed in large quantities on the floor and are stored in the medication room
3. computer controlled dispensing system for narcotics

Front 66

Medication Dose Response: What is meant by the drugs "onset"?

Back 66

The time it takes to produce a response

Front 67

Medication Dose Response: What is meant by the drug's "peak"

Back 67

The time it takes for a drug to reach its highest blood level concentration after a plasma level single dose before elimination rate equals the rate of absorption (generally the peak is 30 min after the drug is taken)

Front 68

Medication Dose Response:
What is meant by the drug's "trough"

Back 68

The lowest blood level before the next dose (generally 30 min before the next dose is taken)

Front 69

Medication Dose Response:
What is meant by the drug's "duration"?

Back 69

The duration is the time a drug remains in the system in a concentration great enough to have a therapeutic effect

Front 70

Medication Dose Response: What is meant by a drug's "plateau"?

Back 70

The plateau is the blood concentration level that is maintained after a series of scheduled drug doses is administered.

Front 71

Medication Dose Response:
What is meant by a drug's "half-life"?

Back 71

The time it takes the body to eliminate half the blood concentration level of the original drug dose

Front 72

Questioning a Medication Order--YOU ARE LIABLE--5 good reasons to refuse to give a medication

Back 72

1. Illegible
2. Error in the way it was written
3. Questionable purpose of the order--does it make sense
4. Allergic response or change in patient's condition
5. Interaction or possible interaction with other drugs

Front 73

7 Most Common Medication Errors

Back 73

1. Extra/omitted/wrong dose
2. Medication not ordered for client
3. Incorrect rate of administration
4. Not prescribed time
5. Incorrect preparation of drug (e.g. do not crush)
6. Improper technique
7. Expired drug

Front 74

Nursing Process: Knowledge Deficit in Medications being administered--describe PIE (eg contraception)

Back 74

1. Planning: set attainable goals; you and client have to agree
2. Implementation: teaching not only what but how and why it is important
3. Evaluation: is the patient compliant with medicinal regimen?

Front 75

Drug Administration: describe 7 major parts of on-going assessment

Back 75

1. Medical/Drug History including allergies, past/current medication use including herbs and OTC drugs and complementary therapy (acupuncture, etc)
2. Biographical data (age, education, insurance coverage, occupation)
3. Ethnic culture and factors effecting patient's compliance to medical regimen
4. Lifestyle and beliefs
5. Sensory and cognitive status: ability to prepare and take medications correctly
6. Current physical condition (heart rate for example)
7. Diagnostic and Lab Data

Front 76

Drug Administration: 10 things to include in client teaching

Back 76

1. drug name, purpose, actions, side effects
2. take at same time each day
3. interactions with food, meds, otc drugs
4. what to do with missed doses
5. take as long as prescribed?
6. do not alter dosage
7. call provider when side effects occur
8. keep meds with you when traveling
9. do not share
10. proper storage

Front 77

Describe 5 parts to transcribing a medication order onto the MAR

Back 77

1) check MAR
2) check name, room, bed #, medication, dose, route frequency
3) check MAR with ORIGINAL ORDER (make sure you are looking at most recent date)
4) calculation and measurement of medications
5) 3 checks, 6 rights

Front 78

3 Important points specific to the documentation form for narcotics

Back 78

1) 2 nurses sign administration of meds
2) 2 nurses sign for count of narcotics
3) 2 nurses sign for wasting medication

Front 79

4 Reasons a medication dosage may be omitted

Back 79

1) fasting (ex: npo to go to surgery)
2) problem no longer exists
3)suspected allergy or untoward effect
4) patient refuses (DOCUMENT!)