Pharmocology Notes 1

Front 1

The 6 “rights” are

Back 1

1. right medication
2. right dose
3. right time
4. right route
5. right patient
6. right documentation

Front 2

Things to keep in mind when preparing to give medications are:

Back 2

- wash hands
- Hesitate? Double check
- Be punctual (time, dose)
- Obtain drugs one patient at a time
- Check drugs three times: with MAR, before and after opening.
- Check expiration dates
- Check patients bracelet
- Explain drugs, side effects etc
- Open medication on bedside, try not to touch with hands
- Discard drugs that fell on ground
- Chart medication on MAR directly after giving

Front 3

Administering oral drugs

Back 3

- wash hands first: standard precautions
- check for latest MAR, with chart
- beware of some oral medication that require special assessment
- check for allergies/identity patient
- with dysphagia: some tablets can be crushed: one at a time (remember three checks), mix with soft food
- verify if medication can be crushed (not for enteric coated/long acting)
- patient should be sitting
- offer water to drink (4 to 6 ounces) if patient wants other drink: check first
- if placing medication in mouth: wear gloves
- effervescent powders and tablets: mix with water
- stay with patient, check if drug is swallowed

Front 4

Effervescent means

Back 4

Gently boiling or bubbling, by means of the disengagement of gas

Front 5

Standard precautions:

Back 5

- wear gloves when needed
- wash hands after wearing gloves and in between patients
- wear mask, gown, eye protection with spraying blood/mucus
- remove protective gear after exposure
- no: recap/cap/.break/ bend needles
- get rid of contaminated stuff

Front 6

Dysphagia is

Back 6

Difficulty swallowing

Front 7

Sublingual and buccal:

Back 7

- Absorbed by mucous membrane, prevents destruction by GI tract
- Sublingual under tongue, buccal in cheek
- Wear cloves
- Dissolve before swallowing
- No fluids
- Instruct patient not to swallow tablet
- Alternate sides when using buccal route

Front 8

Liquid medication

Back 8

- Can come in single dose, or multi dose bottle: pour in cup or draw in oral –dosing syringe
- Shake bottle, open, put cap upside down, don’t spill on the label.
- Overfill cup? Discard excess in sink.
- Liquid medication under 5 ml: use needle-less syringe

Front 9

Oral medication and infants

Back 9

- use liquids
- use disposable oral dosing syringe
- prevent aspiration: sitting position
- place syringe in mouth next to tongue
- nipple can be used
- prevent aspiration: crying child can easily aspirate
- do not mix with bottle of formula
- make sure all the medication is taken

Front 10

NG tube

Back 10

- wash hands
- position patient in semi fowler position
- asses fluid restriction (need to give water to flush tubing
- check if drug should be taken with full or empty stomach
- if possible give liquid medicine to prevent clogging
- if tablet: crush, administer separately
- follow institutional policy with tubes
- dilute crushed tablets with water (15 to 30 mL)
- put in tube/clamp etc.
- if no flow: put pressure
- after drug: flush
- keep patient in high fowler
- document on MAR

Front 11

Rectal

Back 11

- wash hands/standard precaution
- asses patient for rectal bleeding/diarrhea
- don’t break medicine in smaller pieces
- Sims position (left side, top leg flexed toward waist, provide privacy)
- Palpitate rectum for stool; have patient defecate first, do not put drug in stool: No palpitation after surgery on rectum
- Unwrap and lubricate medication
- Let patient breath and exhale through mouth and insert about 1 inch deep
- Let patient lay on side for about 15/20 minutes, infants sometimes need to keep buttocks together
- Enemas the same way
- Document on MAR

Front 12

Advantages of Transdermal drug delivery

Back 12

- fewer side effects
- improved bioavailability
- more uniform plasma levels
- longer duration of effect
- improved therapeutic effect

Front 13

Drug name

Back 13

- brand ™
- generic name (USAN)
- chemical name

Front 14

Caplet

Back 14

Coated capsule easy swallowing (solid)

Front 15

Capsule

Back 15

Powder, liquid or solid in gelatin shell

Front 16

Elixir:

Back 16

clear fluid with water or alcohol

Front 17

Enteric coated tablet

Back 17

Solid, coated to not dissolve in stomach

Front 18

Extract

Back 18

Concentrated medication form

Front 19

Glycerite

Back 19

Solution of medication with glycering (at least 50%)

Front 20

Intraocular disk

Back 20

Three layers, middles is medication, dissolves in ocular fluids

Front 21

Liniment

Back 21

Preparation for skin containing oil, alcohol or soapy emollient, applied on skin

Front 22

Lotion

Back 22

Liquid suspension to protect skin

Front 23

Ointment

Back 23

Semisolid, containing medication, externally applied

Front 24

Paste

Back 24

Semisolid preparation, thicker than ointment, slower release of medication

Front 25

Semisolid preparation, thicker than ointment, slower release of medication

Back 25

Solid dosage, not often used because of tablet

Front 26

Solution

Back 26

Water with solute

Front 27

Suppository

Back 27

Solid dosage shaped with gelatin for rectal or vaginal use

Front 28

Suspension

Back 28

Finely divided drug particles, floating in liquid: oral only

Front 29

syrup

Back 29

Medication dissolved in sugary liquid

Front 30

Tablet

Back 30

Powdered dosages, compressed into hard disk or cylinder, contains binders, disintegrators, lubricants and or fillers

Front 31

Tincture

Back 31

Alcohol or water-alcohol medication solution

Front 32

Transdermal disk or patch

Back 32

Medication in semi permeable patch that administers the medication through the skin

Front 33

Troche (lozenge)

Back 33

A small, circular medicinal lozenge; a pastille.

Front 34

Medication dose responses
Goal is

Back 34

Constant blood level within a safe therapeutic range

Front 35

Peak concentration

Back 35

Highest concentration

Front 36

Through concentration

Back 36

Lowest concentration

Front 37

Serum half-life

Back 37

Time it takes to lower the concentration to 50%

Front 38

Parental administration is

Back 38

Injecting in body tissue

Front 39

4 ways are
Intradermal (ID)
Subcutaneous (sub-Q)
Intramuscular (IM)
Intravenous (IV)

Back 39

Into dermis, just under epidermis
Injection into tissue just below dermis
Injection into a muscle
Injection into a vein

Front 40

Epidural
Intrathecal
Intraosseous
Intraperitoneal
Intrapleural
intraarterial

Back 40

Epidural space
Subarachnoid into ventricles of brain
Into bone marrow
Lines abdominal cavity
Through chest wall in pleural cavity
Directly into arteries

Front 41

Topical administration

Back 41

Though skin (Transdermal disk/patch) or mucous membrane

Front 42

Inhalation

Back 42

Inhale

Front 43

Administering medication
Types of orders
Standing or routine medication orders

Back 43

Is carried out until new prescription or with end date

Front 44

PRN orders

Back 44

When patient requires it

Front 45

Single orders

Back 45

Given once at certain time

Front 46

Stat orders

Back 46

Emergency

Front 47

prescriptions

Back 47

For outside of hospital

Front 48

Distribution systems

Back 48

Stock supply: large containers
Unit dose: portable carts containing drawer with 24 hour supply
Automated medicine dispense (modern)

Front 49

Impact of HR 1685 “ generic drug access act of 2001” is

Back 49

Requires therapeutic equivalence for generic drugs (so cheaper medicine)

Front 50

Chemical classification of medicines describes

Back 50

Chemical base of Rx

Front 51

physiologic classification of medicines describes

Back 51

Effects on body systems

Front 52

Therapeutic classification of medicines describes

Back 52

It’s use in therapy

Front 53

Can drugs have more than one class?

Back 53

yes

Front 54

Describe 3 checks

Back 54

1. check Rx with order on MAR when obtaining med from source
2. check Rx with order on Mar prior to placing it in dispensing container
3. check Rx at clients bedside prior to administering Rx

Front 55

QD means

Back 55

Every day

Front 56

Stat means

Back 56

Immediately

Front 57

Bid means

Back 57

Twice a day

Front 58

Tid means

Back 58

Three time a day

Front 59

Qid means

Back 59

Four time a day

Front 60

PRN means

Back 60

When necessary

Front 61

PO means

Back 61

oral

Front 62

NPO means

Back 62

Nothing by mouth

Front 63

IM means

Back 63

intramuscular

Front 64

SC/SQ means

Back 64

Subcutaneous

Front 65

IV means

Back 65

Intravenous

Front 66

SL means

Back 66

sublingual

Front 67

PR means

Back 67

By rectum

Front 68

g means

Back 68

gram

Front 69

gr means

Back 69

grain

Front 70

Pc means

Back 70

After meals

Front 71

s.o.s. means

Back 71

Once if needed

Front 72

dr means

Back 72

dram

Front 73

Qod means

Back 73

Every other day

Front 74

OS means

Back 74

Left eye

Front 75

OD means

Back 75

Right eye

Front 76

OU means

Back 76

Both eyes

Front 77

AS means

Back 77

Left ear etc…

Front 78

AC means

Back 78

Before meal

Front 79

Gtt means

Back 79

drop

Front 80

IN means

Back 80

intranasal

Front 81

On means

Back 81

Every night

Front 82

If patients refuses Rx

Back 82

Record date, time and reason for refusal

Front 83

Č should be little line

Back 83

with

Front 84

Š should be little line

Back 84

without

Front 85

P with little line on top

Back 85

after

Front 86

Emulsions and suspensions don’t forget to

Back 86

Shake before use

Front 87

3 important things for safety

Back 87

- sufficient light
- away from distractions
- clean surfaces and hands

Front 88

Nursing process

Back 88

- assessment
- nursing diagnosis
- planning
- implementation
- evaluation

Front 89

Parts of MAR

Back 89

- clients full name
- date and time of order
- drug name
- route
- dosage
- time and freq, of administering
- signature of physician ordering drug
- prescription
- also: allergies, type of drug, therapeutic intent, usual dose, clients tolerance of dose, who to notify if administration is inappropriate.

Front 90

Important with verbal order:

Back 90

Must be signed within 24 hours

Front 91

Important with telephonic order

Back 91

- read the order back to MD, later countersigned by MD, best if 2 nurses listen.

Front 92

Renewal order for narcotics

Back 92

48 hours

Front 93

Renewal order for ATB

Back 93

7 days

Front 94

State practice act:

Back 94

- LPN must be under supervision of an RN or physician
- RN must have an order from a physician to give ANY drugs
- Nurse practitioners van now have prescribing privileges

Front 95

Important when preparing Rx

Back 95

- check name/medication/prescription on mar
- check allergies
- check expiration date
- one patient at a time
- one medication at a time
- verify time and route
- calculate proper dose
- pour/prepare exact
- set up Rx in order of mar

Front 96

How much water with oral medication

Back 96

4-6 ounces

Front 97

MDI is

Back 97

Metered Dose Inhalers

Front 98

Important with MDI is

Back 98

- remove cap, hold inhaler upright, shake inhaler
- tilt head of patient back slightly, breath out
- open mouth with inhaler 1-2 inches from mouth (or with use of spacer in mouth)
- press when patient inhales slowly
- let patient breath slow for 2-3 seconds
- hold breath for 10 seconds
- when second puff is needed, wait 1 minute
- register in MAR

Front 99

5 categories of controlled substances”

Back 99

1. schedule I (high abuse, no medical need, heroin, pot, GHB) 1 prescription for research only
2. schedule II (high abuse, severe dependence, morphine, methadone) triple prescription only
3. schedule III (less abuse than I and II, nonbarbiturate sedatives, some opioids like codeine, order refilled 5 x in 6 mo)
4. schedule IV less abuse than III , anxiolytics, benzodiazepine rewrite after
6 months or 5 x
5. schedule V limited abuse, without prescription: small amount of narcotics (codeine), used as anti-tussives or anti-diarrheals

Front 100

Injections
Subcutaneous angle

Back 100

45-90 °

Front 101

Intramuscular angel

Back 101

90 °

Front 102

Intradermal angle

Back 102

5-15°

Front 103

Subcutaneous needle gauge

Back 103

25 gauge

Front 104

Intramuscular needle gauge

Back 104

21-25 gauge

Front 105

Intradermal needle gauge

Back 105

26-27 gauge

Front 106

Subcutaneous needle length

Back 106

½ - 5/8 inch1

Front 107

Intramuscular needle length

Back 107

½ inch

Front 108

Intradermal needle length

Back 108

¼ - ½ inch

Front 109

Subcutaneous max amount

Back 109

1 ml

Front 110

Intramuscular max amount

Back 110

3 ml

Front 111

Intradermal max amount

Back 111

0.1 ml

Front 112

Subcutaneous sites

Back 112

Abdomen, lower back, top of arm, top of leg, shoulder blade, lower back

Front 113

Intramuscular

Back 113

Dorsoglueal, ventrogluteal, vastus lateralis, rectus femoris, deltoid

Front 114

Intradermal

Back 114

Inside lower arm, shoulder blades, breast ….BEVEL UP…..

Front 115

IM

Back 115

- stick
- stabilize
- aspirate
- inject

Front 116

Mixing insulin

Back 116

Air, air, draw clear, draw cloudy…

Front 117

How many mg in one g

Back 117

1000 mg

Front 118

How many ml in a liter

Back 118

1000 ml

Front 119

One g is how many gr

Back 119

15 gr

Front 120

1 gr is how many mg

Back 120

60 mg

Front 121

1 ounce is how many ml

Back 121

30 ml

Front 122

1 tsp (t) is how many ml

Back 122

5 ml

Front 123

1 tbs (T) is how many ml

Back 123

15 ml

Front 124

1 cup is how many ml

Back 124

240 ml

Front 125

1 cup is how many ounces

Back 125

8 ounces

Front 126

1 pint is how many ml

Back 126

500 ml (half a liter)

Front 127

1 pint is how many ounces

Back 127

16 ounces

Front 128

1 quart is how many ml

Back 128

1000 ml (liter)

Front 129

How many g in a kg

Back 129

1000 g

Front 130

Celsius to Fahrenheit

Back 130

°F = 1.8 (°C) + 32

Front 131

Fahrenheit to Celsius

Back 131

°C = (°F – 32) ÷ 1.8

Front 132

I kg is how many pounds

Back 132

2.2 pounds

Front 133

One pounds is how many kg

Back 133

0.452

Front 134

How many ounces in a pound

Back 134

16 ounces

Front 135

So 2 ounces is how many pounds

Back 135

2 ÷ 16 = 0.12 pounds

Front 136

How many cm in an inch

Back 136

2.54 cm

Front 137

How many cm in a meter

Back 137

100

Front 138

How many mm in a cm

Back 138

10