Lecture 2 Flashcards
condition or circumstance for which drug has been approved
A particular drug may have multiple indications
Indication
the use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration
Off-label indication
Condition that renders treatment improper or undesirable
Contraindication
a representative drug from a class that is used as a point of comparison for related versions of that drug
Learning one drug can allow nurse to extend knowledge to other similar drugs within that class
Prototype Drug
Rate/extent to which active ingredient is absorbed from the drug and then becomes available at site of drug action
Bioavailability
Means by which a drug carries out a therapeutic effect
Mechanism of Action
Describes the mechanism by which the therapeutic effect is achieved
Examples: beta-blockers, diuretics, ACE inhibitors, calcium-channel blockers
Pharmacological Classification
Describes condition for which drug is being given
Examples: antibiotics, antihypertensives, antidepressants, anticoagulants
Therapeutic Classification
Inhibiting blood clotting
Anticoagulants
Lowering blood cholesterol
Antihyperlipidemics
Lowering blood pressure
Antihypertensives
Restoring normal cardiac rhythm
Antidysrhythmics
Treating angina
Antianginals
Lowering plasma volume
Diuretic
Blocking heart calcium channels
Calcium channel blocker
Blocking hormonal activity
Angiotensin-converting enzyme inhibitor
Blocking stress-related activity
Andrenergic antagonist
Dialating peripheral blood vessls
Vasodilator
A drug has only one chemical name
IUPAC
7-chloro-1,3-dihydro-1-methyl-5-phenyl-2H-1,4-Benzodiazepin-2-one” “diazepam”
NaCl
Chemical names
(International Non-Proprietary Name) lower case and most commonly used by HCPs
Generic names
(proprietary or brand name) Often the original patented name is best known (20 years of exclusive use).
Trade names
drugs with more than one active generic ingredient
New trade name.
Look “active ingredients” list the generic drug names in the product.
Combination drugs
Advil, ibuprofen.
Labelling
By prescription only and provided by a pharmacist, includes:
All prescription drugs
Schedule F: “Pr”
Controlled drugs (Part G)
Narcotic Drugs
Schedule I
Dispensed by pharmacist, no public access
Schedule II
Available at the pharmacy, but OTC
Schedule III
Available in any store
Unscheduled
carried out until the prescriber cancels it by writing a new order or until a prescribed number of days have elapsed
Routine
given when the patient requires it
PRN (“as-needed”)
given one time only for a specific reason at a specific time (e.g., before surgery)
Single (one-time, x1)
written in advance for specific conditions
Standing Orders
STAT: given immediately in an emergency
med is needed quickly but not stat
NOW
varies by agency, like a ‘forced review’
Automatic Stop
to be taken outside the hospital
Prescriptions
Sublingual, buccal, feeding tubes, by mouth (liquid, solid, crushed)
Enteral
(no first-pass effect)
Intradermal (ID), subcutaneous (SC), intramuscular (IM), intravenous (IV), epideral
Intrathecal, intraosseous, intraperitoneal, intrapleural, intra-arterial
Parenteral
Lotions, creams
Transdermal patches
Optic
Otic (ear)
Inhaled
Vaginal
Rectal
Topical
Incident report + med errors need to be disclosed to ________: important
patients or family members
RCA stands for
Root Cause Analysis
Potential for significant harm should error happen
Concentrated Electrolyte Solutions (KCl)
Heparin
Insulin
Morphine
Neuromuscular medications (paralyzing agents)
Chemotherapy medications
High alert medications
Need a two nurse check
High alert medications
$$$
Not covered by insurance
Complicated dosing regimens, with or without polypharmacy issues
Adverse / side effects that impact lifestyle choices
Headaches and dizziness
GI effects
impotence
Factors affecting adherence
The right medication
The right dose
The right patient
The right route
The right time and frequency
The right documentation
The right reason
The right to refuse
The right patient education
The right evaluation
10 Rights
Capsule: particles/powder in gelatin shell
Tablet: powder compressed into caplet
Enteric-Coated tablet: coated tablet, dissolves in intestine
Pill: any solid medication
Sustained Release: tablet or capsule, contains small particles
Lozenge: flat, dissolves in the mouth
Solid Forms (Oral)
Elixir: meds, water, alcohol, clear
Extract: Syrup or dried; evaporated
Oral Solution: Medication dissolved in water
Oral Suspension: Fine particles dispersed in liquid, settle to bottom
Syrup: Med dissolved in [ ] sugar; shake well!
Aerosol: spray; absorbed in mouth/upper airway
Liquid Forms
Infection Prevention and Control
Swallowing Safety
Assess for dysphasia
Assess LOC
Patient positioning
Special Assessments
Heart Rate
Blood Pressure
Crush pills safely
Oral administration
Medication administered under the tongue
Sublingual
medicine given between the gums and the inner lining of the mouth cheek
buccal
Wear gloves if you are placing the tablet into the mouth
Patient instructions: dissolve completely, do not swallow tablet or saliva
Not taken with fluids
Buccal: Alternate sides
Give after other oral meds are swallowed
Document on MAR
Monitor for therapeutic response and adverse reactions
Sublingual & Buccal
Container that cannot be reused, and is developed to hold a drug quantity intended for single-dose administration
Unit Dose Container
If a fluid is concave in the measure device measure the _______ of the curve
bottom
If the fluid is convex in the measuring device, measure at the ______ of the curve
top
Stay with patient until med is swallowed. If you are unsure:
ask patient to open mouth and inspect
Always wear gloves
Gastric Residual volume
Positioning
Compatibility with feed
Compatibility of medication with crushing
Technique: clamping, pinching!
Enteral medication administration
NG tubes may be placed for different reasons:
Food/meds
Gastric Decompression (double lumen)
Medications administered by enteral tubes should be liquid, but oral medication tablets may be administered if crushed or dissolved first.
Meds through a feeding tube
Take barrel (plunger) out while syringe is attached to patient and pour meds in one-by-one
Gravity
vacuum up your prepared med into the syringe then connect to the patient and push on the plunger to administer (Do not force)
Syringe
document in nurses’ notes and EHR the method used to check placement of enteral tube, GRV, and pH of stomach aspirate
For enteral
Document __________ that each medication was administered on MAR immediately after administration, NOT BEFORE. Include initials or signature
actual time
- Assess patient’s sensory functions, including sight, hearing, touch, and physical coordination.
- Patients often receive more than one oral medication at a time.
- Always assess for medication allergies.
- Evaluate whether patient can take medication with food.
- For all medications administered, review the prescription for patient’s name and medication, dosage, route, and time of administration.
- For all medications, use the correct equipment for administering the medication.
- For all medications administered, gather information pertinent to the medication(s) prescribed, including purpose, normal dosage and route, common side effects, time of onset and peak, contraindications, and nursing implications.
- Determine whether medications require any specific nursing actions before administration.
- If patients are mentally and physically able, prepare them for discharge by instructing them in self-administration techniques.
- Check the expiration date for all medications.
Safety Guidelines
