Book Flashcards
Routes of medication administration
Oral (GI)
Parenteral (intradermal, intravenous, intramuscular, subcutaneous)
Skin (topical)
Barrier and absorption pattern of oral route
Meds must be able to pass the epithelial layers of GI
Absorption varies greatly due to: stability and solubility of meds (forms of meds: enteric-coated pills and liquids form can resist stomach and absorption occurs in the intestines, GI pH level & emptying time, presence of food in the stomach & intestines, concurrent meds)
Barrier and absorption pattern of subcutaneous and intramuscular route
No significant barrier bc of large space between cells of capillary wall
Absorption rate depends on the solubility of meds (fast =10-30 mins, slow), blood perfusion at the injection site (high blood perfusion= rapid absorption, low blood perfusion= slow absorption)
Enteral or oral route (bc parental route injected to the circulatory system) < Subcutaneous absorption rate < intramuscular (bc there are more blood vessels in muscles than fat just under the epidermis layer)
Barrier and absorption pattern of intravenous route
No barrier
Absorption pattern can be immediate (directly into blood) or complete (reaches blood in its entirety)
Factors influence distribution of meds
Circulation: those have poor circulation that can inhibit blood flow/perfusion = delay medication distribution due to peripheral vascular/cardiac disease
Permeability of cell membrane: For example, meds in GI need to pass through the epithelial layers of GI. Meds that have lipid solubility or have transport system can pass through BBB and placenta
Plasma protein binding: med can binding/compete for protein binding sites, usually with albumin. Medications can also compete with the sites, resulting in toxicity.
Medication prescription include
Client’s full name, date & time of prescription, name of medications (generic or brand), strength and dosage of medication, medication usage, route of medication, time and frequency of administration, (optional: quantity to dispense and number of refills), signature of prescribing provider.
Ex: Sam Smith, 2/6/24, 1200, Tylenol 500 mg PO daily PRN for pain, etc
Safe administration or medications
Review client’s MAR, compare medications with MAR, use 2 identifiers before administration, question dosage if they are seem large or small, contact provider if prescription is illegible, incomplete or not understood, don’t document before administration
Metabolism
Changing meds structure, mostly liver: group of liver enzymes known as cytochrome P450 (nutrition can affect by allowing or inhibit P450 enzymes to function normally), or some kidney and section of small intestines.
Metabolism may transform a specific medication to another form, resulting in a more active or potent form; for example, codeine is transformed to morphine, resulting in increased pain relief. Prodrugs are inactive chemicals that are activated through metabolism to exert their therapeutic effects. Oral medications pass from the small intestine to the hepatic circulation via the mesenteric and portal veins flowing into the liver, before reaching the systemic circulation. The first-pass effect can result in a lower concentration (bioavailability) of the medication reaching the systemic circulation, if a majority of the medication has already been metabolized into an inactive form before it enters the bloodstream.
Drug-food interaction
Drug–food interactions can also impact rate of absorption (delay or enhance). For instance, iron preparations are better absorbed when given with orange juice or foods containing vitamin C, whereas iron is poorly absorbed when given with dairy products or antacids containing magnesium. Medications taken with food or high-fat meals will have a much slower rate of intestinal absorption. Drug–food interactions can also affect metabolism and excretion, potentially leading to medication toxicity. The nurse should instruct the client when medications should be taken with or without food and with any other restrictions. If medications are ordered or recommended to be taken on an empty stomach the nurse should administer that medication at least 1 hour before or 2 hours after a meal.
Medication reconciliation process
- Document an accurate and comprehensive list (name, dose, route, frequency, and purpose) of home medications upon admission.
- Compare the list of home medications to newly prescribed medications during the current hospitalization and reconcile any discrepancies.
- Update the medication list and repeat the comparison and reconciliation process at any transition of care during the client’s hospitalization, as well as at discharge.
- Communicate the reconciled medication list to the next care provider.
- Educate the client and caregivers upon discharge and provide the client with written information about their medication.
Oral route disadvantages and advantages
Advantage: Safer, Less costly, Convenient (variety of forms), Painless, Client can self-administer
Disadvantage: Slow onset of action, Subject to first-pass effect, May have an unpleasant taste, Not appropriate for unconscious clients, Not appropriate for clients with excessive vomiting and/or diarrhea
Site: By mouth/swallow
Rectal route advantages and disadvantages
Advantages: Can be administered to children, unconscious clients, or clients who are unable to swallow, Increased concentration is achieved quickly
Disadvantages: Not liked by clients, Absorption varies, Rectal mucosa can become irritated or swollen
Site: Anus
Intravenous route disadvantages and advantages
Advantages: Rapid onset, Can be used with clients who are unconscious, noncompliant, or unable to tolerate oral medications
Disadvantages: Sterilization and aseptic technique are essential, High cost, Invasive technique is required, Can injure nerves, tissues, or vessels
Site: Into the vein
Buccal route advantages and disadvantages
Advantages: Rapid onset of action, Bypasses first-pass effects, Can be self-administered by the client
Disadvantages: Can cause irritation to open sores in the mouth, Exact site location can be difficult, Decrease in the effect of the medication if it is swallowed, Client may experience nausea and vomiting if the medication has an undesirable taste
Site: Between the cheek and the gum line
Inhalation route advantages and disadvantages
Advantages: Rapid action, Smaller dose required, Medication dosage can be regulated
Disadvantages: Local irritation can precipitate respiratory secretions or bronchospasms
Site: Inhaled through the mouth into the lungs
Intramuscular route advantages and disadvantages
Advantages: Faster absorption as compared to the oral route, Soluble and suspension substances can be administered
Disadvantages: Must be administered using aseptic technique, Painful, Can cause nerve damage
Site: Into the muscle
Subcutaneous route disadvantages and advantages
Advantages: Can be self-administered by the client
Disadvantages: Maximum volume delivery is 1.5 mL, Slow absorption
Site: Beneath the skin
Transdermal route disadvantages and advantages
Advantages: Effects can last for several days
Disadvantages: Medication dosing varies due to client factors
Site: Applied to the skin
EFT
Enteral feeding tube: can be surgically inserted through the abdominal wall, into stomach or into the jejunum. Others enteral feeding tube is through the nose such as nasogastric tube into the stomach or nasoduodenal into duodenum.
Transdermal administration
Transdermal applications allow for the medication to be absorbed slowly, providing prolonged medication release lasting for several days. Transdermal patches are generally applied to the upper torso, chest, upper arms, or back, or behind the ears. The medication released by these patches is absorbed through the skin for systemic distribution for a prescribed amount of time. Examples of types of medication delivered via transdermal patches include opioids, antidepressants, contraceptives, nicotine, and antinausea medications.
Ophthalmic medications administration
are applied to the mucous membranes of the eyes or conjunctiva. Ophthalmic solutions are instilled into the lower margin of the eyelid (conjunctival sac). Eye drop medications, such as beta-blockers and alpha agonists, can also enter the bloodstream, causing systemic signs and symptoms. Punctal occlusion, also known as nasolacrimal occlusion, is a method used to prevent the medication from entering into the nasolacrimal duct and into the systemic circulation. After the nurse instills the eye drop(s) and the client closes the eye, the nurse places an index finger at the inner corner of the client’s eye, maintaining gentle pressure there for 30 to 60 seconds. Strict aseptic technique must be maintained when administering any medication to the eyes to avoid contamination or infection. Do not instill medication directly on the cornea, as this can cause the client pain, irritate the cornea, and increase the medication’s systemic effects.
Otic medications administration
are used for the treatment of local infections and inflammation; they are instilled into the outer ear. When administering otic medications, assure that the medication is at room temperature. Never administer cold solutions into the ear canal, as this may cause the client to become dizzy and cause pain. Prior to instilling the eardrops, pull the pinna up and back gently, which helps to straighten the ear canal and facilitates the movement of the medication through the ear canal. Position the client in a side-lying recumbent position with the affected ear facing up, to prevent the medication from exiting the ear canal.
Nasal medications administration
are drops or sprays instilled within the nostrils, then absorbed through the mucous membranes and into the bloodstream. Medications that can be administered via the nasal route include nicotine (smoking cessation), calcitonin (osteoporosis), sumatriptan (migraines), and corticosteroids (allergies). For these nasal medications to be absorbed, the nostrils must be clean of mucus. Decongestant nasal sprays can be purchased as OTC medications for the treatment for congestion. If the nasal decongestant is used too frequently or for too long, the client can experience rebound congestion. As the client increases the use of the nasal spray, the blood vessels in the nose narrow, causing the inside of the nose to shrink. Once the effects of the nasal spray wear off, the nasal tissue swells. Permanent swelling of the tissue can develop with continued use of the nasal spray.
Rectal route administration
Medications given by the rectal route are supplied in the form of suppositories, although creams and ointments may also be prescribed. Rectal medications can be used for clients who have trouble swallowing, an obstructed bowel, or decreased movement in the intestinal tract, or clients who are unconscious. The medication is absorbed through the lining of the rectal vault. The rectum should be empty of stool before administering the medication, as this increases the medication’s effectiveness. Discuss with the client the need to refrain from passing stool for a minimum of 20 minutes once the suppository has been given to provide enough time for the medication to enter the systemic circulation and have an effect. Suppositories should not be administered to clients who have had recent rectal surgery, who have rectal bleeding, or who are at risk for bleeding (low platelet count)
