Nursing Medication

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pharmacology

the science or study of drugs: their preparation and properties and uses and effects

generic name

Assigned by the manufacturer that first develops the drug. Identifies the drug's active ingredients. official name is often the generic name

official name

name that is assigned and used if drug becomes fully approved for general use and admitted to the U.S pharmacopeia-National Formulary (USP-NF)

trade name

brand or proprietary name a drug can have several trade names when produced by different manufacturers

pharmacokinetics

the study of how drugs are introduced into the body and then
1.absorbed,
2. distributed,
3.metabolized,
4. and excreted out of the body

absorption

The process by which medications travel through body tissues until they reach the bloodstream.

absorption is influenced by

Route- IV fastest,IM middle,PO slowest
Lipid Solubility -cell membranes have a fatty
PH- Acidic drugs are well absorbed in stomach due to HCL.
Basic drugs pas thru the stomach not absorbed until they reach the small intestine.
Blood flow- absorption is increased with increased blood flow-Older adults impaired circulation slow absorption
Local conditions at site of administration- food in stomach either speed up or delay absorption , burn victim not intramuscular injection. Enteric coated pills
Drug dose-

loading dose

the initial dose of drug given to get the drug concentration up to the therapeutic range in a very short period of time

maintenance dose

the dose of drug that maintains or keeps the drug in the therapeutic range

pharmacotherapeutic

dynamic that achieves the desired therapeutic effect of the drug without causing other undesirable effects

distribution

how the drug is transported by the blood to the site of action. It requires adequate cardiac output and tissue perfusion
blood brain barrier stops distribution drugs may bind to plasma proteins and never reach their intended site.

Placenta

drugs readily flow across the placenta, causing harmful effects in the fetus -- must be considered before giving someone who is pregnant drugs..

metabolism biotransformation

lipophilic, non-ionized or partially ionized; these compounds are readily reabsorbed from the glomerular filtrate (in the nephron of the kidney); or these lipophilic compounds may be bound to plasma proteins and therefore may not filter at the glomerulus; SO, metabolism and biotransformation transform these compounds (meds) into more polar compounds which allows them to be excreted

excretion

Elimination of med from the body through respiration, perspiration, urination, or defecation

pharmacodynamics

How drugs act on the body. Includes Drug receptors, types of actions that drug can initiate and Therapeutic index drugs turn on, turn off, promote,or block responses that are part pf the body's processes.

mechanism of drug action

The drug acts as a ligand...if it doesn't bind it won't work.
The drug is the key and and the receptor is the lock.

Functions are altered and biochemical and physiological changes are initiated

adverse drug effects

undesirable effects other than the intended therapeutic effect; some are predictable and tolerated ex morphine with constipation.

allergic effect

An immune system response that occurs when the body interprets the drug administered as a foreign substance and forms antibodies against the drug.

anaphylactic reaction

life threatening reaction...causes respiratory distress & cardiovascular collapse....this is a medical emergency, Administer epinephrine (dilate bronchioles), Benadryl (block histamine in bronchioles) corticosteroieds (anti-inflammatory) Vasopressurs- Norepinephrine bitartrate (to increase BP), Albuterol (bronchoconstriction)

drug tolerance

the tendency for larger doses of a drug to be required over time to achieve the same effect

toxic effect

a seriously adverse drug reaction; toxicity refers to an adverse drug reaction caused by excessive dosing the organ or system affected by the toxicity is used to name the toxicity like damage to the liver is hepatotoxicity. can be caused by cummulative effect.

cummulative effect

increasing response to repeated dose of drug when rate of administration exceed the rate of excreation, toxicity may occur

Idiosyncratic effect

a different, unexpected or individual effect from the normal one usually expected from a medication; the occurrence of unpredictable and unexplainable symptoms

Drug interactions

Occur when one drug is affected in some way by another drug, a food, or another substance that is taken at the same time., two drugs or a drug and another element have an effect on each other; can increase or decrease ther effect, create a new effect, or increase incidence of adverse effect

antagonist effect

Combined effect is less than the effect produced by the active drug alone; Examples: Narcan for narcotic overdose; antacids + tetracycline (1+1=0), A cellular response to ligand binding where a ligand occupies the receptor site but does not activate it. This blocking prevents other molecules from activating the receptor.

agonist effect

Drugs that interact with a receptor to produce a response -- fits in the lock( receptor site) and turns (opens the lock)

synergistic effect

interaction of two or more medicines that results in a greater effect than when the medicines are taken alone -- ex alcohol and barbiturates

Factors affecting drug action

1- age/developmental considerations (child vs geriatric dose)
2- patient's weight
3- patient's sex
4- psychological factors (placebo)
5- metabolic rate (smoking increases HR)
6- pathology (involving liver slows down metabolism)
7- genetic factors
8- cultural factors
9. timing of med administration --with food, without

teratogenic

effect of a drug administered to the mother that results in abnormalities in the fetus ex cocaine,alcohol,phenytoin,dilantin

therapeutic range

Blood concentration of a drug that produces the desired effect without toxicity

peak level

the concentration of a drug in the blood plasma that occurs when the elimination rate equals the rate of absorption

trough level

drug level collected when the lowest serum concentration of the drug is expected. usually 30 minutes prior to the administration of the next dose of meds.

half life

amount of time it would take for the drug to be reduced by one-half (plasma level drug, not a protein bound drug)

parts of medication order

1.)Patient name
2.) Date and time the order is written
3.)Name of drug to be administered
4.)Dosage of the drug
5.)Route by which the drug is to be administered
6.)frequency of administration of the drug
7.) Signature of person writing the order

MAR

medication administration record

CMAR

computerized medication administration record
check if transcribed correctly from original order
double check dose
appropriateness of the med

oral route -
enteral-
sublingual-
Buccal-

swallowing
thru enteral tube
under tongue
b/w cheek and gum

Parenteral route

injecting a drug into the body, includes intradermal, SQ, IM, IV routes. Drugs given IV route produce the most rapid actions because they are given directly into the bloodstream.

Topical route

medications can deliver mediction directly to the area needing treatment or they may allow medication to be absorbed to affect the entire body. The medications can be a variety of preparations including: drops or ointment into the eye,drops in to the ear, sprays in the nose or throat, suppositories in the rectum or vagina, and creams or ointment on the skin.

Pulmonary route

A medication route in which medication is administered directly to the pulmonary system through inhalation or injection.

Three checks of medication administration

1.When you reach for the med pack,
2. when you obtain it and compare it to the CMAR,
3. at the bedside before administration

Rights of medication administration

Help to ensure accuracy when administering meds.
1) Right Medication
2) Right Patient
3) Right Dosage
4) Right Route
5) Right Time
6) Right Reason
7) Right Documentation

Controlled substance

specific drugs with a potential for abuse, such as narcotics, tranquilizers, stimulants, and sedatives. Laws regulate how these are prescribed, dispensed, and stored locked up.

Narcotic wasting

If nurse has to discard any narcotic a second nurse must witness and sign the narcotic sheet. Ex If supply is 4 ml and Order is 3 ml . the last 1ml must be wasted and a second nurse must witness.

Oral syringe

Calibrated dropper needleless device for administering medication to pediatric or older adult patients unable to swallow tablets or capsules --after you draw up medication do not place the safety cap back on could cause aspiration ..

Medication label is missing

do not use send back to pharmacy

Oral medications that should never be crushed or chewed

enteric coated, extended release, SR sustained release,XL extended release ,CR controlled release, SA sustained action, LA long acting,

insulin administration

inject air into NPH (cloudy), inject air into regular (clear), withdraw dose from regular, withdraw dose from NPH

intradermal injections

- administered into the dermis
- longest absorption time
- sensitivity tests and local anesthesia
- inner surface of forearm, upper back under the scapula
- tuberculin syringe calibrated in tenths and hundredths of a milliliter with a 1/4 to 1/2"" 26 or 27 gauge needle.
- dosages are usually < 0.5 ml
- deliver at a 5 to 15 degree angle

subcutaneous injections

- administered into adipose tissue
- slow, sustained rate of absorption
- insulin and heparin
- outer aspect of upper arm, abdomen, anterior aspects of the thigh, upper back, upper ventral or dorsogluteal area
- absorption rate varies based on site
- use syringe with volume appropriate for dose with 3/8 to 1""can be used 3/8 and 5/8 needles most commonly used 25 to 30 guage needle
- dosages must be less than 1mL to minimize discomfort
- deliver at a 45 to 90 degree angle
DO NOT Pull back (aspirate) plunger
DO NOT Massage site

insulin that can not be mixed

Lantus and Levemir

prefilled syringes examples when air should not be expelled

Enoxaparin a low molecular weight heparin- (lovenox) admin to the anterolateral and posterolateral wall of abdomen pinch love handles inject. DO NOT expel air bubble before injecting. WOW you inject the air bubble.

Sub Q into the abdomen

avoid area 2 inches around the umbilicus

intramuscular injections

Deliver medication through the skin and subcutaneous tissues into certain muscles. Muscles have a larger and greater number of blood vessels than does subcutaneous tissue, allowing faster onset of action. ex antibiotics, hormones,vaccines

intramuscular injections sites by age

Infants -- Vastus Lateralis
Toddlers and children --- Vastus Lateralis , Deltoid
Adults-- Ventrogluteal or Deltoid

intramuscular injections sites by medication type

Biological infants young children --- Vastus Lateralis
Biological older children and adults -- Deltoid
Hepatitis B / Rabies -- Deltoid
Med's that are know to be irritating ,viscous or oily solutions --Ventrogluteal

intramuscular injection needle length

Vastus lateralis --5/8 to 1 inch
Deltoid (children) -- 5/8 to 1 1/4 inch
Deltoid (adults)-- 5/8 to 1 1/2 inch
Ventrogluteal (adults) 1 1/2 inch

z-track technique

Used to prevent medication from leaking back through the needle track and irritating subcutaneous tissue.
Pull skin and subcutaneous tissue over to one side (1-inch) at the injection site with non-dominant hand. Inject medication through taut skin into the muscle at site selected.
Wait 10 seconds
Remove needle and release the skin. As stretched tissue returns to its original position, the needle track is sealed.
Do not massage the site
Use on all IM injections

IM injections

1 to 4 ml
no more then 1 ml given at Deltoid
Children and elderly 1 to 2 ml
Given at an angle of 72 to 90 degrees

Angles of injections

IM - 72 to 90 degree
Sub Q - 45 to 90 degree
Intradermal - 5 to 15 degree

Intravenous route

Most dangerous route because the drug is placed directly into the bloodstream, can't be recalled, and actions cannot be slowed.

Intravenous bolus ( IV push)

involves introducing a concentrated dose of a medication directly into the systemic circulation.slowly over at least 1 minute

Intermittent IV infusion

A solution of a small to moderate volume infused intravenously over a short period of time at specific time intervals (Ex. 1g of ampicillin in 50ml of NS over 15-20 minutes every 6 hours)

Piggyback delivery system

Requires the intermittent of additive solution to be placed higher than the primary solution container so the primary solution will not back up into the additive bag once it is complete.

volume control administration set

Used for intermittent intravenous infusion, diluted with a small amount of solution
administered through preexisting iv
used when fluid volume infused is a concern ex children critically ill, older adults.

Mini infusion pump

A syringe pump used for intermittent infusion that is battery operated and allows medication mixed in a syringe to be connected to the primary line and delivered by mechanical pressure applied to the syringe plunger.

CVAD

Central Venous Access Device
-multilumen central catheter
-Short term
-3 lumen remain separate to the end - this is so the drugs never mix. Some drugs can crystalize with each other.

Topical application

usually intended for direct action at a particular site although they can also have systemic effects

Skin application

sense organ receptors for touch,pain,pressure and temperature, excretion body temperature storage of water salts, glucose.

inunction

medication incorporated into an agent ointment, oil, lotion, cream that is administered by rubbing it into the skin. Absorbed into the lining of sebaceous glands - clean skin with soap and water before administration of medication heat can help absorption. Gloves should be worn so the nurse does not absorb med.

eye drops

with lower lid pulled down drop the eyedrops on the lower conjunctiveal sac --whatever number of drops ordered.

transdermal patch

hand hygiene gloves, remove old patch locate a new site that is clean dry free from hair, wash site of old patch. write your initials date time on new patch place on new site pressure for 10 seconds do Not message , apply patch at same time of day according to order, document.

eye irrigation

Copius amounts of tap water should be used to remove acid or chemicals for at least 15 minutes then E R . Sohould make sure overflow does not contaminate other eye.

Eye medication disk

disk should be completely covered by lower eyelid, allowing the patient to wear contact lenses swim sleepusually applied at bedtime because they will cause blurred vision at first.

responding to medication errors

Imediate priority is the safety of the patient
1. Check the patient's condition immediately when error is noted Observe for adverse effects related to the error.
2.Notify the nurse manager and primary care provider to SBAR for course of action.
3. Write what error occured on medical record, including remedial steps taken.
4. Complete the form used for reporting errors as dictated by facility.

Digoxin -brand name Lanoxin

Cardiac glycoside -- decrease heart rate while increase heart pumping efficiency (IE C/O) force of contractions increase proper filling of the heart -- for atrial fibrillation..
do not take loop diurectics or Amiodarone
watch potassium and magnesium levels if on diuretics
take potassium supplement

side effects- diarrhea,nausea/vomiting- rash -

removing med from a Ampule

hand hygiene

hypoglycemia

low blood glucose; occurs when there is not enough food intake, too much insulin, or too much exercise; characterized by a blood glucose level of less than 70

hyperglycemia

a condition caused by an increase in blood sugar level in a diabetic client, it is characterized by symptoms such as extreme thirst, excessive hunger, blurred vision, heavy breathing, and unconsciousness

hypokalemia

K+ deficit in ECF (less than 3.5 mEq/L)

K loss from vomit, gastric suction, alkalosis, diarrhea, diuretics, polyuria, steriods, antibiotics

K moves out of cell; Na and H stay in cell to maintain isotonic fluids

muscle weakness, leg cramps, fatigue, paresthesias, dysrhythmias, anorexia, nausea, vomit, decreased BM, polyuria, nocturia, diluted urine, hypotension, EKG changes, tender muscles

tx: digitalis, encourage K intake, avoid laxatives and diuretics, oral supplements, dangers of IV potassium administration

hyperkalemia

abnormally high K+ concentration in the blood
usually due to defective renal excretion, but also do to excessive dietary K+ --cells release --K+ sparing diuretics can lead to K+ retention.
symptoms serum K+ level higher than 5.0 mEq/L . weakness muscle cramps , diarrhea , numbness , slow heart rate low blood pressure, decreased urine output and difficulty breathing.

Administration of Parenteral Medications

Subcutaneous injection—subcutaneous tissue
Intramuscular injection—muscle tissue
Intradermal injection—corium (under epidermis)
Intravenous injection—vein
Intraarterial injection—artery
Intracardial injection—heart tissue
Intraperitoneal injection—peritoneal cavity
Intraspinal injection—spinal canal
Intraosseous injection—bone

Topical administration of medications

Applied to skin or mucous membranes, including eye, ear, nose, rectum, vagina and lungs
Skin- powders, ointments, creams..., also patches (always wear gloves when administering all forms)

Instilling Eye Drops

Perform hand hygiene and don gloves
Offer patient tissues
Tilt patients head back and turned slightly to the affected side
Have pt look up and focus on something on the ceiling
Place the thumb or 2 fingers near the margin of the lower eyelid immediately before the eyelashes
Hold dropper close to eye but avoid touching eyelids or lashes
Squeeze container and allow correct number of drops to fall in lower conjunctival sac
Release lower lid and ask pt to close eye
Apply gentle pressure with gloved finger over the inner canthus

Ear Drops

Perform hand hygiene and don gloves
Offer patient a tissue
Place patient on unaffected side or tilt head so affected ear is uppermost
Straighten the auditory canal by pulling the pinna up and back in an adult or straight back for school aged children or down and back in child under 3.
Hold dropper with tip above the auditory canal, allow the drops to fall on the side of the canal, it is uncomfortable if they fall directly on tympanic membrane

Patient teaching

Review techniques of medication administration
Instruct on drug name and reason for taking, side effects expected and when to call health care provider
Remind patient to take the medication as prescribed for as long as prescribed
Instruct patient not to alter dosages without consulting physician
Instruct patient what to do if a dose of medication is missed
Caution patient not to share medications

SubQ Insulin administration size needle

Gauge needle 28 to 30 --5/16 to 1/2 - usually 5/16 always in units --measured 100 units per mL ---

Intramuscular

Adult Deltoid 5/8 - 1 1/2 gauge 20-25 needle 72 to 90 degrees. 1 mL max in Deltoid.

Intramuscular

Adult Vastis lateralis 5/8 - 1" gauge 20-25 needle 72 to 90 degrees. 1 - 4 mL max. Only 1 - 2 mL for elderly & children.

Intramuscular

Adult Ventrogluteal 1 1/2" gauge 20-25 needle 72 to 90 degrees. 1 - 4 mL max Only 1 - 2 mL for elderly & children.

Intradermal

Inner surface of forearm & upper back, under scapula. 1/4 - 1/2" and 26-27 gauge needle 5 -15 degrees. Max 0.5 mL. (ie: tuberculin test using a tuberculin syringe.)

SubQ (subcutaneous)

Outer aspect of upper arm, abdomen-always 2" away from umbilicus, anterior aspect of thigh, upper back, upper ventral or dorsogluteal area. 3/8 - 1" 25-30 needle gauge 45-90 degree 1 mL max. (abdomen has fastest absorption.)

Choose needle based on:

1. route of administration, 2. viscosity of solution, 3. quantity of drug administered, 4. body size of patient, 5. type of medication.

preferred IM injection adult

Ventrogluteal

half life of 50 mg is 1 hour

how long to reach 25 mg answer 1 hour

penicillin is to be taken on a

on a empty stomach

Alcoholic needs vitamin

B complex and C

blood thinner you should limit vitamin

K

vegetarians need

iron

patient on opiates nursing Dx

Risk for injury r/t sedation

Diabetic wound will not heal

vit C and Zinc

Unsaturated fat

Almonds

how many vegetables

2.5 cups

30 % fats

...

trans dermal patch redness is

...

protein base medications

...

when administering topical ,meds

wear gloves

nasogastric tube meds

crush then add to water

elderly person at risk for pressure ulcer

86 yr old bedfast man

pale spot when the patient was moved

...

to lose 1 lb a week

500 cal a day less

BMI is not reliable for

body builders high muscle mass

when on nasgastric feeding blood sugar is high

you should slow the infusion

discharged teaching

the patients level of disease and medication

ear meds

straighten auditory canal

Pt malnutrition alert the Dr

if Hemoglobin 8.5 normal is 12 -18
know lab value

malnutrition what level

serum albumin

eschar

dead tissue

yellow and thick drainage

purulent

Generic of drug name

is given by manufacture and includes the active ingredients

Heparin is to be injected

two inch from umbilicus

Intradernal injection for tb screening

use a tuberculin

renal function slow

takes long time to excrete the drug.

Drug toxicity

a person with cirrhosis of liver can not metabolize

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