| Pharmacological concepts: Medication names: Provides the exact description of medication's composition.
Example: N-acetyl-para-aminophenol | Chemical |
| Pharmacological concepts: Medication names: The manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. pharmacopoeia.
acetaminophen | Generic |
| Pharmacological concepts: Medication names: Also known as brand or proprietary name. This is the name under which a manufacturer markets the medication.
Tylenol, Panadol, Tempra | Trade |
| Pharmacological concepts: Classification: | Effect of medication on body system
Symptoms the medication relieves
Medication's desired effect |
| Pharmacological concepts: Medication forms: | solid, liquid, other oral forms; topical, parenteral; forms for instillation into body cavities. |
| Drug form: Liquid drugs: | 1 Solutions
2 Tinctures
3 Suspensions
4 Emulsions
5 Elixirs
6 syrups |
| Drug form: Liquid drugs: 1: Generally water based. May be oil based. | Solutions |
| Drug form: Liquid drugs: 2: Prepared using an alcohol extraction process. Alcohol usually remains in the final drug preparation. | Tinctures |
| Drug form: Liquid drugs: 3: Solid does not dissolve in the solvent | Suspensions |
| Drug form: Liquid drugs: 4: Suspensions with an oily in the solvent. | Emulsions |
| Drug form: Liquid drugs: 5: Alcohol and water solvent. Often with an additive for flavor | Elixirs |
| Drug form: Liquid drugs: 6: Sugar, water, and drug solutions | Syrups |
| Drug form: Solid drugs: | 1 pills
2 Powders
3 Tablets
4 Suppositories
5 Capsules |
| Drug form: Solid drugs: 1: Shaped like a sphere and easy to swallow | Pills |
| Drug form: Solid drugs: 2: | Powder |
| Drug form: Solid drugs: 3: Powders compressed into a disk like form | Tablets |
| Drug form: Solid drugs: 4: Drugs mixed with a wax that are designed to dissolve at body temperature. Used for vaginal and rectal absorption. | Suppositories |
| Drug form: Solid drugs: 5: Gelatin capsules filled with powder | Capsules |
| Common abbreviations: CD | Controlled-diffusion |
| Common abbreviations: CR | Continuous/controlled-release |
| Common abbreviations: CRT | Controlled-release tablet |
| Common abbreviations: LA | Long acting |
| Common abbreviations: SA | Sustained-action |
| Common abbreviations: SR | Sustained/slow release |
| Common abbreviations: TD | Time-delay |
| Common abbreviations: TR | Time-release |
| Common abbreviations: XL | Extra-Long |
| Common abbreviations: XR | Extended-release |
| Common abbreviations: MR | Medium-release |
| Common abbreviations: FR | Fast Release |
| Pharmacokinetics as the basis of medication actions: The study of how medications: | Enter the body
Are absorbed and distributed into cells, tissues, or organs
Reach their site of action
Alter physiological functions
Are metabolized
Exit the body |
| Passage of medication molecules into the blood from the site of administration: | Absorption |
| Factors that influence absorption: 1: | Route of administration |
| Factors that influence absorption: 2: | Ability of a medication to dissolve |
| Factors that influence absorption: 3 | Blood flow to the site of administration |
| Factors that influence absorption: 4 | Body surface area |
| Factors that influence absorption: 5 | Lipid solubility |
| Factors that influence absorption: | 1
2
3
4
5 |
| After distribution, occurs within the body to tissues, organs, and specific sites of action. | Distribution |
| Distribution depends on: 1: | Physical and Chemical properties of the medication |
| Distribution depends on: 2:
Circulation
Membrane permeability
Protein binding | Physiology of the person taking it |
| Metabolism: Medications are metabolized into a? | less-potent or an inactive form |
| Metabolism: occurs under the influence of enzymes that detoxify, break down, and remove active chemicals | Biotransformation |
| Metabolism: Most biotransformation occurs in the? | liver |
| Metabolism: What play a role? (there are three organ or parts of organ) | Kidneys, blood, intestines, and lungs |
| Medications exit the body through the: | Kidney
Liver
Bowel
Lungs
Exocrine glands |
| Excretion: Determines the organ of excretion | Chemical makeup of medication |
| Types of medication Action: Expected or predicted physiological response | Therapeutic effect |
| Types of medication Action: Unintended, undesirable, often unpredicatble | Adverse effect |
| Types of medication Action: Adverse effect: Predictable, unavoidable secondary effect | Side effect |
| Types of medication Action: Adverse effect: Accumulation of medication in the bloodstream | Toxic effect |
| Types of medication Action: Adverse effect: Overreaction of underreaction or different reaction from normal | idiosyncratic reaction |
| Types of Medication action: Unpredictable response to a medication | Allergic reaction |
| Types of Medication action: When one medication modifies the action of another | Medication interactions |
| Administration Preparation: 1: | Obtain patients medication record. Medication record may be a drug card, medication sheet, or drug kardex (medex), depending on the method of dispensing medications in your faculty |
| Administration Preparation: 2: | Compare the medication record with the most recent physician order |
| Administration Preparation: 3: | Wash your hands |
| Administration Preparation: 4: | Gather necessary equipments |
| Administration Preparation: 5: | Remove the medication from the drug box or tray or medication cart or cubicle |
| Administration Preparation: 6: | Compare the label on the medication bottle or wrapper to the medication record |
| Administration Preparation: 7: | Check that medication to be administered via the right method, right time or base on the 5 rights |
| Administration Preparation: 8: | Calculate dosage if necessary |
| Administration Preparation: 9:
Level of consciousness (LOC)
Ability to cooperate
Potential known allergies | Do your patients assessment |
| The route of administration (ROA) that is chosen may have a profound effect upon the | speed and efficiency with which the drug acts |
| Routes of administration: Oral routes: 1 | Sublingual administration |
| Routes of administration: Oral routes: 2 | Buccal administration |
| Routes of administration: 1 | Oral routes |
| Routes of administration: 2 | parenteral routes |
| Routes of administration: Parenteral routes: Four major sites of injection: | Intradermal
Subcutaneous
Intramuscular
Intravenous |
| Routes of administration: Parenteral routes: other routes: | Epidural, intrathecal, intraosseous, intraperitoneal, intrapleural, and intraarterial |
| Routes of administration: Parenteral routes: Routes usually limited to physicians | Intracardiac and intraarticular |
| Types of Orders in Acute Care Agencies: Administered until the dosage is changed or another medication is prescribed | Standing or routine |
| Types of Orders in Acute Care Agencies: Given one time only for a specific reason | Single (one-time) |
| Types of Orders in Acute Care Agencies: Given when the patient requires it | prn |
| Types of Orders in Acute Care Agencies: Given immediately in an emergency | STAT |
| Types of Orders in Acute Care Agencies: Medication to be taken outside of the hospital | Prescriptions |
| Types of Orders in Acute Care Agencies: When a medication is needed right away, but not STAT | Now |
| Some of the common Latin prescription abbreviations include: ac (ante cibum): | means "before meals" |
| Some of the common Latin prescription abbreviations include: bis (bis in die) | means "twice a day" |
| Some of the common Latin prescription abbreviations include: gt (gutta) | means "drop" |
| Some of the common Latin prescription abbreviations include: hs (hora somni) | means "at bedtime" |
| Some of the common Latin prescription abbreviations include: od (oculus dexter) | means "right eye" |
| Some of the common Latin prescription abbreviations include: os (oculus sinister) | means "left eye" |
| Some of the common Latin prescription abbreviations include: po (per os) | means "by mouth" |
| Some of the common Latin prescription abbreviations include: pc (post cibum) | means "after meals" |
| Some of the common Latin prescription abbreviations include: prn (pro re nata) | means "as needed" |
| Some of the common Latin prescription abbreviations include: q3n (quaque 3 hora) | means "every three hours" |
| Some of the common Latin prescription abbreviations include: qd (quaque die) | means "every day" |
| Some of the common Latin prescription abbreviations include: qid (quater in die) | means "four times a day" |
| Some of the common Latin prescription abbreviations include: sig (signa) | means "write" |
| Some of the common Latin prescription abbreviations include: tid (ter in die) | means "three times a day" |
| Health Care Provider's Role: Prescriber can be: | physician, nurse practitioner, or physician's assistant |
| Health Care Provider's Role: Orders can be: | written (hand or electronic), verbal, or given by telephone |
| Health Care Provider's Role: The use of abbreviations can cause? | errors; use caution |
| Health Care Provider's Role: Prepares and distributes medication | Pharmacist's role |
| Health Care Provider's Role: Determining medications ordered are correct, assessing patient's ability to self-administer, determining whether patient should receive medications at a given time, administering medications correctly, and closely monitoring effects
Cannot be delegated
Includes patient teaching | Nurse's role |
| Medication Errors: 1: | Report all medication errors |
| Medication Errors: 2: When an error occurs, what is top priority? | Patient safety is top priority when an error occurs |
| Medication Errors: 3: | Documentation is required |
| Medication Errors: 5: Nurses play an essential role in? | medication reconciliation |
| Critical Thinking: Six rights: 1 | Right medication |
| Critical Thinking: Six rights: 2 | Right dose |
| Critical Thinking: Six rights: 3 | Right patient |
| Critical Thinking: Six rights: 4 | Right route |
| Critical Thinking: Six rights: 5 | Right time |
| Critical Thinking: Six rights: 6 | Right time |
| Critical Thinking: Six rights: 7 | right response |
| Critical Thinking: Six rights: 8 | right reason |
| Critical Thinking: Six rights: 9 | right assessment and evaluation |
| Critical Thinking: Six rights: 10 | right client education |
| Critical Thinking: Six rights: 11 | right to refuse medication |
| Critical Thinking: Six rights: 12 | right expiration date |
| Critical Thinking: Six rights: | 1 right medication
2 right dose
3 right patient
4 right route
5 right time
6 right documentation
7 right response
8 right reason
9 right assessment and evaluation
10 right client education
11 right tot refuse medication
12 right expiration date |
| Maintaining patient's rights: A patient has the right: 1 | To be informed about a medication |
| Maintaining patient's rights: A patient has the right: 2 | To refuse a medication |
| Maintaining patient's rights: A patient has the right: 3 | To have a medication history |
| Maintaining patient's rights: A patient has the right: 4 | To be properly advised about experimental nature of medication |
| Maintaining patient's rights: A patient has the right: 5 | To receive labeled medications safely |
| Maintaining patient's rights: A patient has the right: 6 | To not receive appropriate supportive therapy |
| Maintaining patient's rights: A patient has the right: 7 | To not receive unnecessary medications |
| Maintaining patient's rights: A patient has the right: 8 | To be informed if medications are part of a research study |
| Medication administration: | oral
topical
inhalation
irrigation
parenteral
injection |
| Caution: should or should we not? Leave medications in the patient's possession without a specific physician's order to do so. | Do not leave medications in the patient's possession without a specific physician's order to do so. |
| Medication administration: Easiest and most desirable route
Food sometimes affects absorption
Aspiration precautions
Enteral or small-bore feedings: | Oral administration |
| Medication administration: oral administration: Enteral or small-bore feedings: | Verify that the tube location is compatible with medication absorption.
Use liquids when possible
If medication is to be given on an empty stomach, allow at least 30 minutes before or after feeding.
Risk of drug-drug interactions is higher |
| Warning: keme lang HAHAHAHHAHA
DO NOT administer oral medications to patients with a decreased level of consciousness. Check with supervisor for instructions.
NEVER directly touch oral medications. Some medications can be absorbed through the skin, also the medication will become contaminated | hehehe |
| How to give oral medication: Goal: | To provide a safe effective method of giving drugs intended for absorption in stomach and small intestine |
| How to give oral medication: 1: | Gather equipment. Check each medication order against original physicians order according to agency policy. Clarify any inconsistencies. Check patients chart for allergies |
| How to give oral medication: 2: | Know actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of medications to be administered |
| How to give oral medication: 3: | Perform hand hygiene |
| How to give oral medication: 4 | Move medication cart outside the patients room or prepare medication |
| How to give oral medication: 5 | Prepare the medicine |
| How to give oral medication: 6 | Place or pour the medicine on the medicine cup with the medicine card under it |
| How to give oral medication: 7 | Bring prepared medication at the patients room/bedside |
| How to give oral medication: 8 | identify the patient carefully |
| How to give oral medication: 9 | Assist the patient on the upright position, if possible |
| How to give oral medication: 10 | Check if the medicine is best to be swallowed whole, chewed, allowed to melt under the tongue to coat the pharyngeal area. |
| How to give oral medication: 11 | Provide a glass of water |
| How to give oral medication: 12 | Give the drug |
| How to give oral medication: 13 | Remain with the patient until each medication is swallowed |
| How to give oral medication: 14 | Document |
| Skin applications
Follow directions for each type of medication
Transdermal patches | Topical medication applications |
| Topical Medication Applications: Skin applications: | use gloves and applicators; clean skin first
use sterile technique if the patient has an open wound |
| Topical Medication Applications: Transdermal patches: | Remove old patch before applying new
Document the location of the new patch
Ask about patches during the medication history
Apply a label to the patch if it is difficult to see
Document removal of the patch as well |
| Nasal Instillation: | Spray
Drops
tampons |
| Eye Instillation: | Avoid the cornea
Avoid the eyelids with droppers or tubes to decrease the risk of infection
Use only on the affected eye
Never share medications |
| Intraocular instillation: | Disk resembles a contact lens
Teach patients how to insert and remove the disk
Teach about adverse effects |
| Ear instillation: | Instill eardrops at room temperature.
Use sterile solutions
Check for eardrum rupture if patient has ear drainage
Never occlude the ear canal |
| Administering Medications by Inhalation: | Pressurized metered-dose inhalers (pMDIs)
Breath-actuated metered-dose inhalers (BAIs)
Dry powder inhalers (DPIs) |
| Parenteral Administration of Medications: Equipment: syringes: | Luer-Lok
Non-Luer-Lok |
| Syringe tip selection: secure screw type connection | Luer Lok Tip |
| Syringe tip selection: Slip or push-on connection | Slip tip |
| Syringe tip selection: Off center tip used for surface veins or artery injections. | Eccentric tip |
| Syringe tip selection: Longer and tapered slip design used for irrigation or with tubing | Catheter tip |
| Parts of Luer-Lok Syringe: | barrel fl*nge |
| Parts of Luer-Lok Syringe: | Barrel |
| Parts of Luer-Lok Syringe: | Luer lock |
| Parts of Luer-Lok Syringe: | Plunger fl*nge |
| Parts of Luer-Lok Syringe: | Plunger |
| Parts of Luer-Lok Syringe: | Seal |
| Parenteral Administration of Medications: Needles: | Hub
Shaft
Bevel
(Gauge number) |
| Parenteral Administration of Medications: Preparing an injection from an ampule: | Snap off ampule neck
Aspirate medication into syringe using filter needle
Replace filter needle with an appropriate size needle or needless device
Administer injection |
| Parenteral Administration of Medications: Preparing an injection from a vial: | if dry, use solvent or diluent as needed
Inject air into vial
Label multidose vials after mixing
Refrigerate remaining doses if needed |
| Mixing medications: Mixing medications from a vial and an ampule: | Prepare medication from the vial first
Use the same syringe and filter needle to withdraw medication from the ampule |
| Parenteral Administration of Medications: Mixing medications from two vials: | Do not contaminate one medication with another
Ensure that the final dose is accurate
Maintain aseptic technique |
| Parenteral preparation: Insulin preparation: | Insulin is the hormone used to treat diabetes
It is administered by injection because the GI tract breaks down and destroys an oral form of insulin.
Use the correct syringe: 100-unit insulin syringe or an insulin pen to prepare U-100 insulin
Insulin is classified by rate of action: rapid, short, intermediate, and long-acting
Know the onset, peak, and duration for each of your patient's ordered insulin doses |
| Parenteral Administration of Medications: Mixing Insulins: | patients whose blood glucose levels are well controlled on a mixed-insulin dose need to maintain their individual routine when preparing and administering their insulin.
Do not mix insulin with any other medications or diluents unless approved by the health care provider
Never mix insulin glargine (lantus) or insulin detemir (Levemir) with other types of insulin.
Inject rapid-acting insulins mixed with NPH (neutral protamine Hagedorn) insulin within 15 minutes before a meal.
Verify insulin doses with another nurse while preparing the injection. |
| parenteral Administration of Medications: Subcutaneous injections: | Medications placed into loose connective tissue under dermis |
| Parenteral Administration Medications: Intramuscular injections: | Faster absorption than subcutaneous route
Many risks, so verify the injection is justified
Angle of administration: 90 degrees
Body mass index (BMI) and adipose tissue influence needle size selection |
| Parenteral Administration Medications: Intramuscular injections: Amounts: | Adults: 2 to 5 ml (4 to 5 ml unlikely to be absorbed properly)
Children, older adults, thin patients: up to 2 mL
Small children and older infants: up to 1 mL
Smaller infants: up to 0.5mL |
| Parenteral Administration of Medications: Ventrogluteal: | Gluteus medius
Deep and away from major nerves and blood vessels
Preferred and safest site for all adults, children, and infants
Recommended for volumes greater than 2 mL
Index finger, the middle finger, and the iliac crest form a V-shaped triangle
Injection site is the center of the triangle |
| Parenteral Administration of Medications: Vastus lateralis: | used for adults and children
Use middle third of muscle for injection
Often used for infants, toddlers, and children receiving biologicals |
| Parenteral Administration of Medications: use the Z-track method in intramuscular injections: | Zigzag path seals needle track
Medication cannot escape from the muscle tissue |
| Parenteral Administration of Medications: Intradermal injections: | Used for skin testing (tuberculosis [TB], allergies)
Slow absorption from dermis
Skin testing requires the nurse to be able to clearly see the injection site for changes
Use a tuberculin or small hypodermic syringe for skin testing
Angle of insertion is 5 to 15 degrees with bevel up
A small bleb will form |
| Safety in administering Medications by Injection: Needleless devices: | Most needlestick injuries are preventable
Needlestick safety and prevention act
Safety syringes |
| Safety in administering Medications by Injection: Dispose of sharps in marked containers: | Use puncture-and leak-proof containers
Never force needles into receptacle
Never place used needles into wastebaskets, your pockets, or patient's tray or bedside |
| Parenteral Administration of Medications: Intravenous Administration: Three methods: | As mixtures within large volumes of IV fluids
By injection of a bolus or small volume of medication through an existing IV infusion line or intermittent venous access (heparin or saline lock)
By "piggyback" infusion of a solution containing the prescribed medication and a small volume of IV fluid through an existing IV line. |
| Parenteral Administration of Medications: Large-Volume Infusions: | Safest and easiest method of IV administration.
Large volumes (500 or 1000 mL) are used.
If infused too rapidly, patient is at risk for overdose and fluid overload.
Best practices:
Standardized concentrations and dosages
Standardized procedures for ordering, preparing ,and administering IV medications
Ready-to-administer doses when possible |
| Parenteral Administration of Medications: Intravenous bolus: | Introduces a concentrated dose of medication directly into the systemic circulation
Advantageous when the amount of fluid that a patient can take is restricted
The most dangerous method for medication administration because there is no time to correct errors
Confirm placement of the IV line in a healthy site.
Determine the rate of administration by the amount of medication that can be given each minute. |
| Parenteral Administration of Medications: Volume-Controlled infusions | Uses small amounts (50 to 100 mL) of compatible fluids
Three types of containers: volume-control administration sets, piggyback sets, and syringe pumps
Advantages of volume-controlled infusion:
Reduces the risk of rapid-dose infusion by IV push
Allows for administration of medications that are stable for a limited time in solution
Allows control of IV fluid intake |
| Parenteral Administration of Medications: A small (25 to 250 mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access | Piggyback |
| Parenteral Administration of Medications: Small (150-mL) containers that attach just below the primary infusion bag or bottle | Volume-control administration |
| Parenteral Administration of Medications: Battery operated
Allows medications to be given in very small amounts of fluid (5 to 60mL) within controlled infusion times using standard syringes | Syringe pump |
| Drug calculations: The formula for this calculation can be applied to many situations:
Note: Do basic conversion if necessary | dose ordered/dose on hand x amount on hand = amount to administer
Desired dose/Available dose x Volume = exact dosage |
