Glossary of Mel's Medication Administration Lecture Oct 2006

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Drug Legislation: FDA
* What Act brought the FDA into being in what year?
* What does the FDA do?
FDA came into being in 1938 from the Pure Food and Drug Act.
FDA governs prescription and OTC drugs.
Drug Legislation: Harrison Narcotic Act; Controlled Substance Act
*1914 Harrison Narcotic Act became the Controlled Substance Act (1970)
* DEA enforces compliance
* Narcotic count done after each shift
Drug Legislation: In addition to federal regulations...3 other bodies that govern nurses and administration of drugs
* State regs
* Nurse practice Act: State regulations that ensure minimal compentency
* Healthcare institutions have their own regulations and tests
Nurse's Role in Medication Administration (4 things)
1. Accurate administration
2. Patient teaching
3. Evaluating response to medication (looking for desired effect)
4. Documenting administration and desired effect being reached.
Pharmocological Concepts: Drug Nomenclature (3 names)
1. Chemical Name (N acetyl para aminophenol)
2. Generic Name (Acetaminophen)
3. Trade Name (Tylenol)
Pharmacological Concepts: Classification (Pharm vs. Therapeutic)
Know: effect drug has on the body and symptoms relieved
6 Safe Guidelines for Administering Medication
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"
Forms of Medication (Oral) Abbreviations: SR, XL, CR, SA, LA
SR: sustained release, XL: extended release, CR: controlled release, SA: short acting, LA: long acting
Forms of Medication (Oral) Liquids: Elixir, Extract, Solution, Suspension, Troche
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
Pharmokinetics of a drug
2. Distribution
3. Metabolism
4. Excretion
Loading Dose of a drug
Dose given one time to quickly elevate level of drug in the blood
Maintenance Dose of a drug
Dose required to keep blood level steady and to achieve the desired therapeutic effect
Absorption of a drug
Passage of the medication into the bloodstream and the drug starts taking effect
5 Factors affecting the Absorption of a medication
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)
Factors affecting the Distribution of Medication
1. Circulation
2. Membrane Permeability
3. Blood-Brain Barrier
4. Placenta-Teratogenic
5. Protein-Binding
6. Metabolism
7. Excretion
8. pH of Drug
What are the four parts comprising the "Pharmokinetics" of Medications?
1) Absorption
2) Distribution
3) Metabolism
4) Excretion
What is a "Loading Dose" of a Medication?
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
What is the "Maintenance Dose" of a Drug?
the dosage required to keep the blood level steady and get the desired therapeutic effect of the drug
Name 5 factors that effect the absorption of a medication.
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
What is the "Absorption" of a drug?
absorption is the passage of medication into the bloodstream
What is meant by the "Distribution" of a drug?
distribution of a drug is the movement of drugs from the bloodstream to the various bodily fluids and tissues
Name 4 factors that effect the distribution of a medication.
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
What is the blood-brain barrier with regards to distribution of medications?
The blood brain barrier allows only fat soluble medications to pass through (e.g. alcohol, general anesthetics, penicillin G)
What is meant by "protein-binding" with regards to medications?
* 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
What is meant by "Metabolism" or biotransformation of a drug or medication?
* 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.
Name 4 factors effecting metabolism
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
What is involved in the excretion of a medication?
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.
Name 3 factors that affect the kidney's ability to excrete drugs and their metabolites
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
7 General Factors that affect the pharmokinetics (absorption, distribution, metabolism, excretion) of a drug
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
Describe liniment medications
topical medication mixed with alcohol, oil or soapy emollient--like a cream
Describe ointment medications
semi-solid substances for topical use--like a & d ointment
Describe paste medications
semi-solid substances for topical use that is thicker than ointment--absorbed slowly through the skin
Describe tincture medication
alcohol in water solution
Describe sublingual / buccal medication
placement under tongue or in the buccal pocket for disintegration and absorption through mucus membranes
Describe troches, lozenges or pastilles
preparations of drugs designed to dissolve in the mouth
Describe caplet medications
gelatin - coated tablets that dissolve in the stomach
Describe transdermal patch medications
contain medication that is absorbed throught the skin over an extended period of time
Describe suppository medications
gelatin substances designe to dissolve when inserted into the rectum, urethra or vagina
Describe inhalant medications
drugs or dilution of drugs administered by the nasal or oral respiratory route for a local or systemic effect
Describe enema medications
aqueous solutions for rectal instillation
Describe douche medications
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
Describe tablet medications
compressed or molded substances to be swallowed whole, chewed before swallowing, or placed in the buccal pocket or under the tongue
Describe capsule medications
substances encased in either a hard or soft soluble container or gelatin shell that dissolves in the stomach
Describe enteric-coated medications
tablets that dissolve in the intestines
Describe time-release capsules
Encased substances that are further enclosed in smaller casings that deliver a drug dose over an extended period of time
Describe medications that are suspensions
particle or powder substances that must be dissolved in a liquid (shaken vigorously) before administration
Describe medications that are in emulsion form
Emulsion is a two-phase system in which one liquid is dispersed in the form of small droplets throughout another liquid
Describe syrup medications
substances dissolved in sugar liquid
Describe gargle medications
aqueous solutions
Describe mouthwash medications
aqueous solutions that may contain alcohol, glycerin and synthetic sweeteners and surface-active flavoring and coloring agents
Describe nasal solution medications
aqueous solutions in the form of drops or sprays
Types of Medication Interaction: What is meant by "cumulative effect"?
Effect of all of the medications taken together (go to the same pharmacy each time)
Types of Medication Interaction: What is meant by "antagonistic effect"?
When 2 drugs cancel each other out--no effect
Types of Medication Interaction: What is meant by "synergystic effect"?
When 2 drugs support eachother in such a way that you could have lower doses of medication
Types of Medication Interaction: Describe common types of allergic reactions
Allergic reactions are unpredictable. Common reactions are:
1) mild: hives, rash, itching
2) severe: anaphylaxis,
Types of Medication Interaction: Describe drug tolerance
When the body becomes so accustomed to a specific drug that larger doses are needed to produce the desired therapeutic effect.
Types of Medication Interaction: Describe 3 primary types of interaction with food or drugs
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
Routes of 4 parenteral drug administration (know degrees of needle entry)
1. subcutaneous 45
2. IM 90
3. IV 25
4. ID 10 - 25
7 Other Routes of Medication Administration
1) Epidural
2) Intrathecal
3) Intraosseus
4) Intraperitoneal
5) Intrapleural
6) Intrarterial
7) Intracardiac
5 Types of Medication Orders
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
7 Parts of the Medication Order
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
5 Rights of Drug Administration + 1 Right Documentation
1. Right patient
2. Right medication
3. Right dose
4. Right route
5. Right time
The nurse needs to check the label written on the container against the MAR 3 times
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
List 5 situations that change medication orders
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
Describe 3 drug supply and storage systems in the acute care setting
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
Medication Dose Response: What is meant by the drugs "onset"?
The time it takes to produce a response
Medication Dose Response: What is meant by the drug's "peak"
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)
Medication Dose Response:
What is meant by the drug's "trough"
The lowest blood level before the next dose (generally 30 min before the next dose is taken)
Medication Dose Response:
What is meant by the drug's "duration"?
The duration is the time a drug remains in the system in a concentration great enough to have a therapeutic effect
Medication Dose Response: What is meant by a drug's "plateau"?
The plateau is the blood concentration level that is maintained after a series of scheduled drug doses is administered.
Medication Dose Response:
What is meant by a drug's "half-life"?
The time it takes the body to eliminate half the blood concentration level of the original drug dose
Questioning a Medication Order--YOU ARE LIABLE--5 good reasons to refuse to give a medication
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
7 Most Common Medication Errors
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
Nursing Process: Knowledge Deficit in Medications being administered--describe PIE (eg contraception)
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?
Drug Administration: describe 7 major parts of on-going assessment
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
Drug Administration: 10 things to include in client teaching
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
Describe 5 parts to transcribing a medication order onto the MAR
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
3 Important points specific to the documentation form for narcotics
1) 2 nurses sign administration of meds
2) 2 nurses sign for count of narcotics
3) 2 nurses sign for wasting medication
4 Reasons a medication dosage may be omitted
1) fasting (ex: npo to go to surgery)
2) problem no longer exists
3)suspected allergy or untoward effect
4) patient refuses (DOCUMENT!)

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