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95 Cards in this Set
- Front
- Back
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Drugs are Classified by:
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1)Chemical structure
2)Mode of action 3)Physiologic action 4)Therapeutic effect |
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Purpose of drug classifications:
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- Indicates the effect of the medication on a body system, the symptoms the medication relieves, or the medications desired effect
- Usually, each class contains more than one medication that can be prescribed. - A prescriber chooses a particular medication based on client characteristics, cost, efficiency, dosing frequency, of prescriber experience with the medication. - A medication may belong to more than one classification. EX: aspirin is an analgesic, antipyretic, and an anti-inflammatory medication. |
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3 phases of drug action:
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1. Pharmaceutic Phase (Solid or liquid form)
2. Pharmacokinetic Phase (Absorption, Distribution, Metabolism/Biottransformation, Excretion) 3. Pharmocodynamic Phase ( Drug action- Onset Peak Duration, Receptors, Enzymes, Hormones) |
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1. Pharmaceutic Phase
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- The dissolution stage, the first stage of drug action.
- A drug needs to be in solution to be absorbed. - Either in Solid form or Liquid form. 2 parts: Disintegration & Dissolution. - Enteric coated drugs can not be crushed- they do not disintegrate in the stomach, but in the Small Intestines. |
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2. Pharmacokinetic Phase
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The process of drug movement to achieve drug action.
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4 processes of the Pharmacokinetic phase:
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a. Absorption
b. Distribution c. Biotransforamtion d. Elimination |
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a. absorption is the movement of drug particles by 3 types of actions
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1. active transport (requires a carrier ex: enzyme or protein, that aids in the absorption of that substance)
2. passive transport (by diffusion) 3. pinocytosis (the cells engulf the particle). |
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The drug must be in a solution to be absorbed
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- Water soluble drugs need a carrier because they are harder to absorb.
- Lipid soluble passes easily. |
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Factors that Affect Bioavailability:
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• Drug form
• Route of administration • Blood flow to area of absorption • Body surface area • GI mucosa and motility • Food and other drugs • Lipid solubility of a medication • Changes in liver metabolism |
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b. distribution
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- The process in which drugs become available to body fluids and body tissue (plasma-protein binding).
- The dispersal of the drug from the site of absorption to the site of action. |
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distribution is Influenced by:
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- pathophysiology
- affinity of tissue - protein-binding effect - circulation - membrane permeability |
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c. biotransformation (metabolism)
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- After the med reaches its site of action, it becomes metabolized into a less active, or inactive form that is more easily excreted.
- This occurs under the influence of enzymes that detoxify, degrade (breakdown), and remove biologically active chemicals. - Most biotransformation occurs in the liver, some in the lungs, kidneys, blood, and intestines. - In some cases, the liver can produce a chemical alteration that makes the resulting molecule more active than the original. |
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d. elimination
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After medications are metabolized, they are excreted from the body through the kidney (urine), liver (bile), bowel (feces), lungs (breath), and exocrine glands (saliva, sweat, breast milk).
The main route is through urine. |
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3. Pharmacodynamic Phase
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- The effects of a drug on cellular physiology and biochemistry and the drugs mechanism of action. Can have a primary (desirable effect) and secondary effect (undesirable effect), or both.
ex: benadryl |
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3 actions of a drug
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- Onset action - The time it takes to reach the minimum effective concentration (MEC) after a drug is administered.
- Peak action - Occurs when the drug reaches its highest blood or plasma concentration. - Duration of actions – The length of time the drug has a pharmacologic effect. |
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Receptors are found on the glycocalyx of cell membranes
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- cell membrane- embedded enzymes
- ligand- gated ion channels - G protein- coupled receptor systems - transcription factors - Drug receptor interactions: • Agonist drugs (speeds up the drug) – epinephrine • Weak agonist (partial agonist) • Antagonist (Blocks the drug) – Metoprolol (Lopressor, Toprol XL) |
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Therapeutic Index (TI)
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- Estimates the margin of safety of a drug by using a ratio that measures the effective dose (ED) in 50% and a lethal dose (LD) in 50% of animals (principal trials).
- The higher the index, the safer the drug. - The closer the ratio is to 1, the greater the danger of toxicity. TI= LD50/ED50 |
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Therapeutic Drug Monitoring (TDM) and Toxicology Screens
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• Patient condition & tolerance
• Plasma drug concentrations – Peak and Trough Levels – Therapeutic range (target range, therapeutic window) • Toxicology Screens – Blood and Urine |
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Therapeutic Range
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A drug concentration in plasma should be between the minimum effective concentration (MEC) in the plasma for obtaining desired drug action and the minimum toxic concentration (MTC), the toxic effect.
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Peak drug levels- The highest plasma concentration of drug at a specific time.
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• Oral: ≈ 1-3 hrs after drug administration
• Intramuscular: ≈ 1 hr after administration • Intravenous (IV): ≈ 10-30 min. • Indicates the rate of absorption |
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Trough drug levels
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- The lowest plasma concentration of a drug and measures the rate at which a drug is eliminated.
- Levels are usually obtained shortly before (0-15) the next scheduled dose. |
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Therapeutic Drug Monitoring (TDM)
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• Measurements of blood drug levels to determine effective drug dosages and to prevent toxicity.
• To identify noncompliant patients. • Helpful in patients who take other medicines that may affect the drug levels or act in a synergistic or antagonistic manner with the drug to be tested. • Helpful in prescribing medicines that have a very narrow therapeutic margin (index). |
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Common Drugs That Require Blood Drug Levels
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• Antibiotics – Gentamycin, Tobramycin, Vancomycin
• Anticonvulsants – Phenobarbital, Phenytoin • Cardiovascular Drugs – Digoxin, Lidocaine, Procainamide, Quinidine • Respiratory Drug – Theophylline • Antirejection Drug – Cyclosporine |
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Variables in the absorption of the drug:
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1)Route of administration
2)Ability of the medication to dissolve 3)Blood flow to the area of absorption 4)Body surface area 5)Lipid solubility of a med |
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Variables in the distribution of the drug:
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1)Circulation
2)Membrane permeability 3)Protein binding (# of unbound particles) |
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Therapeutic effects- The expected or predictable physiological response a medication causes
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• Curative
• Palliative- alleviate pain meds • Supportive (maintenance) - vitamins • Substitutive- Insulin • Chemotherapeutic • prophylactic- preventative |
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Side effects
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- Unintended, secondary effects a medication predictably will cause.
- Side effects can be injurious or harmless. - Not normally a reason to stop medication |
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Adverse effects
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- Severe responses to medication.
- Reportable, usually lead to discontinuation, can lead to anaphylactic shock |
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Toxic effects
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- When a medication accumulates in the blood because of impaired metabolism or excretion.
- Can have a lethal effect depending on the medication’s action. - Can be measured by urine or blood sample. |
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Idiosyncratic reactions
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- When medications cause unpredictable effects such as when the patient over/under reacts to the medication or if the reaction to the med is different from the normal response
ex: benadryl makes you drowsy, but it makes someone hyperactive. |
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Allergic reactions
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- When a patient has an allergic response to a medication, its chemical preservatives, or its metabolites.
- The med is an antigen epitope and the body’s immune system reacts to it…can be mild or severe. - Local ex hives - Systemic (anaphylaxis) |
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Medication interactions
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- When one medication modifies the action of another.
- Not all actions are undesirable; some meds in combination have a synergic effect…stronger together then when alone. |
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Drug-drug interactions
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- The effects of a combination of drugs may be greater than, equal to, or less than the effects of a single drug.
- Some drugs may compete for the same receptor types. - An adverse reaction may lead to toxicity or an adverse reaction such as anaphylaxis. - In the case of polypharmacy administration, the nurse makes sure all drugs are compatible. |
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Drug-food interactions
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- The effects of selected foods may speed, delay, prevents absorption of specific drugs.
- Prior to giving med’s, the nurse makes sure contraindicated foods/beverages aren’t consumed by the patient. – Mevacor (Lovastin)- an antihyperlipidemic must be taken with food – Tetracycline- take 1 hr. AC or 2 hrs. PC should not be taken with dairy products |
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Drug-laboratory interactions
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- Serum electrolyte concentrations can be greatly affected by some drug therapies. (particularly potassium)
– Abnormal plasma or serum electrolyte concentrations can affect certain drug therapies Ex. Digoxin toxicity may result when there is ↓ K, ↓ Mg, or ↑ Ca serum levels. |
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2 more types of drug interactions:
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- Drug-induced photosensitivity
- Drug Incompatibility |
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Additive
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- A substance added intentionally, can enhance the effect of the drug, change acidity/alkalinity, etc…
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Potentiating /synergistic
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The effect of two meds combined is greater than the effect of the drugs being given separately
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Inhibiting
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Slows or stops a process
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Antagonistic
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Drugs that block a response
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routes of administration for drugs:
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- Oral- Most common and easiest to use, Given by mouth and swallowed with fluid, Has a slower onset of action, Have prolonged effect than parentreal medications.
- Buccal- - Sublingual- |
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Topical administration:
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- Medications applied to the skin.
- Applied by a Gloved hand, Tongue blade, or Cotton-tipped applicatior - Transdermal disk (ex: NTG- Nitroglycerine) - Ointments - Creams - Powders |
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routes of administration for drugs:
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- Otic-
- Nasal- - Ophthalmic - Transdermal- |
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Rectal- Suppositories
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• Capillaries in the rectal area promote local or systemic absorption
• Lubricate suppositories • Let patient remain on his/her side for 5 min after insertion |
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4 major sites of Parenteral injection:
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- Subcutaneous- (Sub-Q)
- Intramuscular- (IM) - Intradermal- (ID) - Intravenous- (IV) |
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8 types of parenteral administration:
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- Epidural
- Intrathecal - Intraosseous - Intraperitoneal - Intrapleural - Intraarterial - Intracardiac - Intraarticular |
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Vaginal- suppositories
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- lithotomy position
- provide patient with sanitary pad |
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Inhalation
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• Hand-held nebulizers
• MDI – Spacers: enhances delivery of medications – Semi or high fowler’s position – Nebulizer (aerosol) changes a liquid medication into fine mist – Oral care |
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Instillation- Liquid medications administered as drops, Ointments or Sprays
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- Eye drops
- Eye ointments - Ear drops - Nose drops/ sprays |
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Nasogastric & Gastrostomy Tubes:
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• Check for proper placement
• liquid, dissolved powder or crushed tablet • Do not crush enteric-coated or timereleased drugs • Always flush tube (20-30 ml of water) |
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5 Dosage forms of oral medication
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1) Liquids such as elixirs, emulsions, and suspensions
2) Solids- Tablet, capsule, etc… 3) Syrups, solutions 4) Sublingual 5) Buccal |
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Dosage forms of topical medication
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1)Creams, lotions, ointments, gels
2) Optic, otic 3) Vaginal, anal |
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7 Components of a complete medication order:
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1)Patient’s full name
2)Date and Time the order is written 3)Name & dosage of medication (can be generic/trade name, metric/apothecary/household measure) 4)Route of administration 5)Time and frequency of administration 6)Physician’s signature 7)Any special instructions (for holding and /or adjusting dosage) |
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A medication order:
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• Legal prescription pad
• Physician’s order form (patient’s chart) • Computer terminal • Telephone Order (TO) to an RN • Verbal Order to an RN • Uses prescription abbreviations |
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Pre-op
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Prior to surgery, usually for pain relief
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PRN
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- As necessary, when the patient requires it
Ex: Morphine Sulfate 4 mg IV q 4 hrs PRN for pain |
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Routine
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Carried out until the prescriber cancels it by another dose or until a prescribed number of days elapses
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Single
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- A one time only order, given only once at a specific time.
- Common for pre-op meds or prior to diagnostic testing. Ex: Restoril 25 mg PO at bedtime tonight for insomnia |
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Standing
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- Same as a routine order, but may indicate a final date or number of treatment doses.
Ex: Lopressor 50 mg PO daily (hold for SBP < 90, HR <60) |
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Stat
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A single dose to be given immediately and only once. (usually for emergencies)
Ex: Reglan10 mg IM STAT |
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6 patient rights in medication administration:
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1) The right medication
2) The right dose 3) The right route 4) The right time 5) The right person 6) The right Documentation |
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The 3 checks of safe medication administration:
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1) Check that the medication order is complete and legible
2) Know the reason for which the client is receiving the medication 3) Check the drug label 3 times before administration - at the time of contact with the drug bottle or container - as the drug being counted/measured is removed from the container - before returning the container to storage |
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Nursing responsibilities associated with the administration of controlled substances:
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- In administering controlled substances, the nurse must properly document the administration on a (MAR) medication administration record.
– Account for all controlled drugs – Keep records of required information – Countersign all discarded or wasted medication – Ensure that records and drugs on hand match – Keep locked – Only authorized staff have access (keys or password) |
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Nurse’s responsibilities in the event of a medication error:
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- A medication error is any event that could cause or lead to a client receiving inappropriate medication therapy or failing to receive appropriate medication therapy.
- In the case of a medication error, the nurse must complete an incident report describing the nature of the incident. |
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Be aware of:
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– Similar products (Lanoxin, Levoxine)
– Abbreviations – Medication orders not clearly written – Drug administered not documented (double dosing) – Labeling & packaging – Wrong 6 “Rights” – Same patient’s last or first names |
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Nursing Implications
• Regulation of nursing practice related to medication therapy |
– Nurse Practice Act
– Standards of Care – Institutional Policies and Procedures |
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Nursing Implications
• Legal Liability Nurses: |
- are responsible for their actions even when there is a written medication order
- along with physicians and pharmacists, participate in the system to maintain medication safety • A nurse is the LAST STOP in the system - are responsible to ensure that the “6 rights” are executed |
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Nursing Implications
• Legal Liability Nurses: |
– are responsible for assessing patient’s condition in relation to the use of the ordered medication
– must have knowledge of the effects and potential effects of every drug administered – take measures to protect the patients from safety hazards that may be expected from a medication’s effects |
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Malpractice
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• A form of negligence or professional misconduct
– Includes actions that are bad, wrong, or injudicious in the professional care of the client that result in injury, unnecessary suffering, or death to the client/patient (such as serious medication error). – This may also occur through omission of a necessary act, that is, failure to give an ordered medication. |
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Special considerations in giving medications to older adult:
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1)They may be polypharmacy, thus there is a high risk of medication interactions with other meds or foods
2)Self-prescribing of meds because of various symptoms experienced such as pain, constipation, indigestion, insomnia |
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Special considerations in giving medications to older adult:
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3)The use of over the counter (OTC) meds whose ingredients can cause undesirable side effects or adverse reactions.
4)Misuse of medication- overuse, under use, erratic use, and contraindicated use. 5)Noncompliance- deliberate misuse of medication, don’t stick to the regimen because of ineffectiveness or uncomfortable side effects. |
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Risk of Polypharmacy – Induced Drug Interactions
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2 - 6%
5 - 50 % 8 - 100% |
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Nursing diagnosis associated with medication administration:
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1)Knowledge deficit- the nurse implements an extensive teaching plan and follow-up. The client must be taught the medication’s purpose, the importance of a regular dose schedule, proper administration, and side effects to gain compliance.
2)High risk for injury (re: adverse drug event)- stop the administration of the drug and notify patients doctor |
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Suggestions for safe medication administration for the patient who’s going home:
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1) Collaborate with the client’s family or friends
2) They know where and how to obtain medication 3) That they know how to read medication labels 4) That they are able to self administer meds |
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Effects of aging on pharmacokinetics:
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- Changes in absorption
- Ability of the meds to dissolve - Blood flow - Metabolism - Excretion. - Drug- receptor interaction - Circulation - Distribution |
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Cultural Considerations
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• Cultural competence: refers to a complex integration of attitudes, knowledge and skills that direct the nurse to provide care in a culturally sensitive manner.
– Dietary needs – Individual response to medications based on ethnic and racial differences – Respect traditional healing practices – Recognize and overcome language barriers – Avoid stereotyping – Be aware of cultural preferences- space and distance, touch, eye contact, time, diet |
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Drug components in meds:
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1) Salts- compounds consisting of + and – ions that tend to form crystals. They are very soluble
2) Alkaloids- organic compounds from plants that contain nitrogen and have a basic ph, ends in - ine 3) Glycosides-derived from plants, when hydrolyzed, yield a sugar and an aldehyde/acid/or alcohol * Usually a drug contains a combination of these components. Ex: salts so the drug dissolves easier. * |
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Infants & children
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– Vary in age and weight, surface area, ability to absorb and metabolize and excrete medication
– May require special psychological preparation – Praise and reward after administration – Parents’ help needed |
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PREGNANCY SAFETY CATEGORIES CATEGORY DESCRIPTION
Category A |
- Studies indicate no risk to the human fetus
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PREGNANCY SAFETY CATEGORIES CATEGORY DESCRIPTION
Category B |
- Studies indicate no risk to animal fetus; information in humans is not available.
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PREGNANCY SAFETY CATEGORIES CATEGORY DESCRIPTION
Category C |
- Adverse effects reported in animal fetus; information in humans is not available.
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PREGNANCY SAFETY CATEGORIES CATEGORY DESCRIPTION
Category D |
- Possible fetal risk in humans reported; however, considering potential benefit vs. risk may, in selected cases, warrant the use of these drugs in pregnant women
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PREGNANCY SAFETY CATEGORIES CATEGORY DESCRIPTION
Category D |
- Fetal abnormalities reported and positive evidence of fetal risk in humans is available from animal and/or human studies.
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Don’ts in Medication Administration
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• Do not be distracted when preparing medication
• Do not give drugs poured by others • Do not pour drugs from containers with labels that are difficult to read, or whose labels are partially removed or have fallen off • Do not transfer drugs from one container to another • Do not pour drugs into your hand • Do not give medications for which the expiration date has passed |
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Don’ts in Medication Administration
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• Do not guess about drugs and drug doses. Ask when in doubt
• Do not use drugs that have sediments, are discolored, or are cloudy (and should not be) • Do not leave medications by the bedside or with visitors • Do not leave prepared medications out of sight • Do not give drugs if the client says he or she has allergies to the drug or drug group |
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Don’ts in Medication Administration
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• Do not call the client’s name as the sole means of ID
• Do not give drug if the client states the drug is different from the drug he/she has been receiving… Check the order. • Do not re-cap needles. Use universal precaution • Do not mix with large amounts of food/beverage or food that are contraindicated |
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Patient Teaching
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• Provide information about purpose of medication, their actions & effects
• Must understand the importance of taking the full prescription • Must be aware of the symptoms of medication side effects or toxicity • Proper storage of medication |
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Assessment: Objective data
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• Recent Dx of IDDM (type I diabetes)
• New insulin regimen of regular and NPH • Anxious look on face |
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Assessment: Subjective data
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• States “knows very little about diabetes”
• States “fearful and feels unable to perform self injections” |
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• Defining Characteristics:
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– New diagnosis of NIDDM
– New prescription for insulin therapy – Uncertain and anxious look on face – Stated, “I know very little about diabetes. This is the first time I was told I have diabetes and I really am fearful about injecting myself with insulin. I am afraid of needles. I don’t think I can do it”. |
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• Nursing Dx
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– Knowledge deficit regarding new treatment regimen with insulin r/t lack of information.
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• Planning (Expected Outcomes)
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– Patient understands and adheres to new insulin treatment as evidenced by:
• Will state reasons for taking insulin therapy to help regulate blood sugars. • Will demonstrate safe “drawing-up” of insulin and injection technique with rotation of sites for injection. |
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• Implementation (Nursing Intervention)
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– Teach patient and family about DM, its treatment with insulin, and side effects of therapy.
– Use AV aids, films, pamphlets and demonstration for education about insulin therapy and injection sites. |
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• Evaluation
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– Monitors blood sugars daily
– Exhibits normal blood sugars – Able to continue insulin therapy at home |
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- More Nursing Dx
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• Anxiety r/t new treatment regimen
• Noncompliance to medication regimen r/t misunderstanding of information. • Noncompliance to medications r/t undesirable side effects of medicines. • Non compliance to medication therapy r/t sensory and or perceptual changes |
