Med admin A Flashcards
What isa medication
a substance used in the prevent, diagnosis, relief, treatment or cure of health alterations
what kind of treatment is medicine
primary (restoration of health)
what is a drug
any chemical that can effect a living process
a nurse is responsible for:
- Evalutating the effect of the medications
- teaching patients about their meds & possible adverse event
- promoting adherence
- evaluating the patients technique for medication delivery
What is pharmacology
The study of how medication: enters the body, absorbed & distributed in to organs tissues & cells and how it alters physiological functions & exits the body
What is pharmokinetics
refers to the ACTION of the substance IN THE BODY (and how it gets to its sites of action) IMPACT OF THE BODY ON THE DRUGS -Absorption -Distribution -Metabolism -Excretion
What is pharmacodynamics
IMPACT OF THE DRUGS ON THE BODY
- once it reaches it’s site of action, it determines the nature & intensity of the response
- binding to receptors
- functional state can influence this
What is half life a part of
pharmacokinetics
What is half life
how long it takes for half of the dose to be metabolized and the be eliminated from the body
Medications can be excreted via:
- kidneys
- liver
- bowels
- lungs
- exocrine glands
All prescriptions must include
- Patients name & ID
- time & date
- Name of the medication
- Dosage
- Route
- Frequency
- purpose of drug when it’s PRN
- Physicians signature MD
To safely & accurately administer medications nurses need knowledge related to:
- Pharmacology
- Pharmacokinetics
- Growth & developement
- Human anatomy
- Pathophysiology
- Psychology
- Nutrition
- Mathamatics
- Safety
What is clinical pharmacology
the study of drugs in humans
what is therapeutics or pharmacotherapeutics
the use of drugs to diagnose, prevent or threat disease of to prevent pregnancy
What are the 3 properties of idea drugs
1) Effectiveness
2) safety
3) selectivity
What are the additional properties of an ideal drug
- reversible action
- predictability
- ease of adminisration
- free from drug interaction
- low cost
- chemical stability
- possession of simple generic names
No drug is ideal because
- They have the potential to produce side affections
- responses are difficult to predict & may be altered by interactions
- drugs may be expensive, unstable or hard to administer
All members of the health care team mist exercise car to promote therapeutic effects &
minimize drug induced harm
The of ejective of a drug therapy
Provide maximum benefit with minimal harm
Is giving medications routine task?
never
Is any med is potent enough to help it is..
potent enough to harm & kill
What are The factors that determine the intensity of drug responses
1) Administered dose
- Drug, Dose, Route, Timing
2) Pharmacokinetics (how much of the drug gets to the site of action)
- Drug absorption, Distribution, metabolism, excretion
What is absorption
the passage of the medication molecules into the blood from the site of administration
what factors influence absorption
1) route of admin
2) Ability for med to dissolve
3) Blood flow to site of administration
4) Body surface area
5) Lipid solubility of medication
What is distribution
after absorption when it goes into the tissues & organs to the specific sites of action
factors of distribution
- Circulation
- Membrane permeability
- Protein binding (meds bound to albumin cannot exert pharmacological activity)
What is happening in metabolism
they are metabolized into a less potent of inactive from
When do bioltransformations occur
when enzymes detoxify. degrade & remove active chemicals (MOST IN THE LIVER)
Pharmacodynamics
The impact of the drug on the body
- Binding to it’s receptor
- patients functional state
- placebo effects
Factors that determine the intensity of drug response
1) Pharmacodynamics
- Bind of the drug to it’s receptor
- pt. functional state
- placebo effects
2) Sources of individual variation
- Drug interactions
- Physiologic variables (AGE WEIGHT GENDER)
- Pathological varables (EFFECTIVNESS OF LIVER & KIDNEYS)
- genetic variables
wil patients response the same to identical drug regimens?
no because all individuals differ
What are the three drug names
1) Chemical
2) Generic
3) Trade
4) Drug identification number
what are the ways drugs can be classified
1) Effects on body system
2) which symptoms relieved
3) Desired effects
What is the generic name
- approved by health canada
- non proprietary / not protected by trademark
what is the trade name
- prorietary name
- indicates a drug registered to the owner of the patent
- production is restricted until patent expires
what is the chemical name
-describes the molecular structure
What is a therapeutic classification
organizing drugs based on their therapeutic usefulness for treating particular diseases (eg. cardiac care drugs)
What is a parhmocological classification
- Address a drugs MECHANISM OF ACTINON or HOW a drug produces an effect on the body
- some are part of more than 1
Why must nurses understand all the effects that medications can have on patients
- Don’t always response the same way to each dose
- Sometimes the game medication causes very different responses in different patients
What are therapeutic effects
-Expected or predictable
what are side effects
- unintended secondary effect
- unavoidable but a medication will PREDICATBLE cause this
what are adverse effects
severe, negative response to medication
- These are unintended, undesirable & often UNPREDICTABLE
- can be intolerable
- They justify immediate discontinuation of the medication
what are toxic effects
medication accumulation in the blood stream
What is an idiosyncratic reaction
-overreaction or underreaction to medication
what is an allergic reaction
- unpredictable response to a medication
- Could be a medication allergy or an anaphylactic reaction
- immunologically sensitized
- antibiotics have a high rate of allergic reactions
what are anaphylactic reactions
SEVER ALLERGIC REACTIONS THAT ARE LIFE THREATENING
- characteized by sudden constriction of bronchial muscles, edema of the pharynx & larynx, severe wheezing, shortness of break & circulatory collapse
- needs immediate treatment with epinephrine, bronchodilators & antihistamines
What are contraindications
many medications should not be taken by some patients due to unwanted, dangerous reactions
What is a medication interaction
where one medication modified the action of the other one
what is a synergistic effect
occurs when the combined effect of two medications is greater than the effect of the meds given separately
What is the goal of prescribing medications
to achieve a constant blood level of medication within a safe therapeutic range
what is onset
time it takes for a medication to produce a response
what is peak concentration
the highest effective concentration reached after medication is administered
What is through concentration
minimum blood serum concentration before next scheduled dose
what is duration
time medication takes to produce greatest results
what is plateau
blood serum concentration reached & maintained
Parenteral routes include
-Intradermal, Subcutaneous, intramuscular, intravenous, epidermal, trathecal, interosseous, intraperitoneal, intrapleural, intra-arterial
Topical routes on administration
-transdermal or mucous membranes
Household/apothecaries measurements
Drops, tablespoons, teaspoons, pints, quarter, ounces, pounds
What does the apothecaries system do
a system of measuring & weighing drugs & solutions in which fraction are used to identify part of the unit
1lb = 16oz
The household system
is considered inaccurate because varying sizes of cups, glasses & eating utensils & this system has been replaced with metrics. It’s important nurse understands the household measurement system to be able to use & teach it to client & families
1 cup = ? oz
8 ounces
2 tbsp = ? oz
1 oz
3 tsp = ? tbsp
1
1 tsp = ? gtt
60gtt
Who can be a prescriber
physician, nurse practioner or pharmacist
Prescriber must document the:
Diagnosis, condition or need for each medication
orders can be:
written (paper or electronic)
verbal or telephone
The orders are faxed or forwarded to the pharmacy & prescribed onto the mar. Who do they need to be signed by
1) two nurses
or 2) a nurse & pharmacist
what do u need to do with telephone or verbal orders
repeat back to the prescriber
What is a routine order
carried out until the prescriber cancels it by writing a new order or until a prescribed number of days have elapsed
What are single dose
given one time only for a specific reason like surgery
STAT vs NOW
stat= given immediately in an emergency now= when a med is needed quickly but not immediately
What is the pharmacists role
-distribution system
Stock supply system, unit dose system, automatic dispensing unit, computers on wheels
Nurses role:
- determine whether the correct medication was ordered
- don’t assume all medications in the patients pill box are to be given
- determine correct time, administration route, & evaluation of effects
- assess patients ability to self administer
- patient & fam education
What provides the framework for medication administration
-The nursing process
Pediatric doses may vary based on
age. weight, body surface area & med amount
Formula
Dose ordered/ dose on hand times amount on hand
Medication administration assessment
1) Medical history includes
- History of allergies, medication data, diet, perception or coordination problems
2) Patients current condition
when do you apply pharmacology in patient care
1) Pre-administration assessment
2) Dosage & administration
3) evaluating & promoting therapeutic effects
What is the goal or pre admin assessment
1) baseline data
2) ID high risk
3) Patients attitude toward medication use
4) Patients knowledge & understanding of medication therapy
5) patients nursing needs
* any meds they’ve every been on, route, eating patterns, religious beliefs about meds, how they pay for them, if they have an questions, how do you remember to take your meds, have you ever stoped taking them what are they for.
What should you know about dosage & Administration n
- Certain drugs have more than 1 indication with different doses for different uses
- many drugs can be admired in more than one rout and dosage & differ depending
- Certain intravenous drugs can cause sever local injury if the drug seeps not the tissues sip-rounding the injury so it must be monitored closely
What are the parts of promoting therapeutic effects
1) Evaluating therapeutic response
2) Promoting adherence
3) Implementing non drug measures
How to mimimize adverse effects
- Identifying high risk patients thought history
- ensure proper administration though education
- teaching patients about actives that may precipitate an adverse event
- thorough drug history
- advising to avoid over the counter drugs that can interact
- monitoring adverse interactions known to occur between the drugs & patient that is taken them
- be alert to not yet know interactions & reactions
To implement a PRN order rationally
a nurse must know the reason for drug use & be able to assess the patients needs for medications
to manage toxicity & minimize harm
must know early signs of toxicity & the procedure for toxicity management
patient must be educated about the following:
- Name & therapeautic category
- dosage & dosing schedule of admin
- route & technique of admin
- expected therapeutic response & onset
- nondrug measures to enhance therapeutic responses
- duration of drug dose
- method of drug storage
- symptoms of major adverse reactions & measures to minimize discomfort & harm
- Method od drug storage
- symptoms of adverse effects & measures to minimize discomfort & harm
- major adverse drug-drug & drug-food interactions
- whom to content in the event of therapeautic failure, severe adverse reaction & severe adverse interactions
Concerns for older persons
poly pharmacy & non adherence
10 Righits
- Right medication
- Right dose
- right patient
- right route
- right time & frequency
- Right documentation
- Right reason
- Right to refuse
- Right patient education
- Right to patient education
- Right evaluation
To refuse…
regardless or consequences
to be informed about..
a medications name, purpose, action & undesired affection
to have a qualified nurse or physician
assess a medication history including allergies & herbal therapies
to be properly advised on:
The experimental nature of medication therapy & give consent to use it
to receive:
- labeled medications safely without discomfort in accordance to 10 rights
- supportive therapy in relation to medication therapy
To not receive:
unnecessary medications
A change in a patients condition can be physiologically related to
health status
medications
or both
What is a medication error
Any event that could cause, INDIRECTLY OR DIRECTION, either administration inappropriate medication therapy or FAILURE TO ADMINISTER APPRORIATE MEDICATIONS
-Can cause or lead to INAPPRORIATE MEDICATION use or patient harm
what are common med errors
Omission, improper dose, wrong time, wrong patient
what do medication errors highly
the importance of determining accountability
What are possible contributing factors to medication errors
-procedures & systems such as product labeling & distribution
What are incident or occurrence reports used to track
incidence patterns & quality improvement
what is an example of culture of safety
“near miss” reporting
when do medication errors often occur
when a patient is being transferred to a different unit
What should you know about an incident report
- Written amount of incident (usually within 24 hours)
- Not a permanent part of medical record & not referred to in the record
- used to track incident patterns & address quality improvement and risk management issues when necessary
- disclosure to family & patients : IMPORTANT
what is included in incident report
- IDentification info
- Location & time of incident
- Accurete, factual description of what occurred & what way done
- The nurses signature
What are the steps to take to prevent medication errors
1) Follow the rights of medication administration
2) Read labels at least 3 times (compare with MAR) -Before, during & after administering med
3) Use at least 2 patient identifiers
4) Do not allow any other activity to interrupt medication administration
5) Double check all calculations & verify with another nurse
6) Do not interpret illegible handwriting, clarify with the prescriber
7) Question unusually small or large doses
8) Document all medications as soon as they are given
9) When you have made an error, reflect on what went wrong & how you could have prevent the error
10) evaluate the context or situation in which a medication error occurred. Helps to determine whether you have the necessary resources for safe med admin
11) When repeated errors occur, identify & analyze the factors that may have caused the error & take corrective action
12) Attend in service programs that focus on the medications commonly administered
What is included in the process for medication reconciliation
1) verify (current list of pt. meds)
2) Clarify ( Ensure accuracy of medication dosages, and frequencies, clarify the content of the list with as many people as necessary: Caregivers, patient, health care providers, pharmacists)
3) Reconcile (Compare new medication orders against the current list … Investigate any discrepancies by contacting the patients health care provider)
4) Transmit (communicate the updated & verified list to caregivers & patients as appropriate)
What is meant by effectiveness
-Elicits the response of which it is given. THIS IS THE MOST IMPORTANT QUALITY. If its not effective there’s no point in giving it & it will not be marketed.
What is meant by safety
will not produce harmful effects even if administered at very high doses for a long time. THIS CAN NEVER BE ELIMINATED
what is selectivity
a drug that elicits only the response for which it is given . No such thing because all drugs have side affects
Reversible action
we want all drugs to subside eventually. excited antibiotics
what is predictability
it would be helpful to know how a patient would respond, but predictions aren’t very accurate. It must be tailored
What is ease of administration
should be simple route, low # of doses. Can enhance adherence & decrease infection
knowing the drug name will..
reduce patient overdose risk
What is a tincture
medicinal alcoholic extract from plant or veg
what is a liniment
applied to skin
Food and drugs act
gave federal government control over the manufacture of all drugs except narcotics
Who sets the standards to strength, quality, purity, packaging, labelling & dosage
-British Pharmacopoeid & canadian formulary
What is bioabavilability
the ability of the drug to breleased from its dosage form and transport ed to drugs site of action
Provinces
indirectly effect sales. They determine how they are ordered, dispensed & administered & what drugs need a perscription
the health institutes
develop polices that conform & are more restrictive than the province. Can be influenced by institution, services, personnel & policy
Except when administer IV … meds take
time to enter the blood stream
when is peak concentration
just before the body absorbs the last of the medication. IT quickly drops after this
When is troufff level
30 mins before a drug is administered
When does the therapeutic range occur
between minimum effective concentration & toxic concentration
Meds are most effective
around the clock & not PRN
When does the pt. receive their next dose
when the first dose reaches its half life
Oral route
easiest & most common
patient prefers
slower onset & more prolonged effect than parenteral
What is sublingual admin
Designed to be absorbed just after being placed on tongue, shouldn’t be swallowed or given liquids
what is buccal admin
solid med against cheek until it dissolves . Alternate cheats so not irritation. Don’t chew or swallow. Acts locally or systemically
Advantages to oral
- Economical
- comfrotable
- easy
- local or systemic efcts
- rarely causes anxiety 1
disadvantages to oral
- aovid with GI tract malfunction (surgery, nausea, reduced motility)
- Gastric secretions destroy some
- some can’t swallow
- may discolour teeth or vitiate or taste bad
- may hold under tongue
- cant be given with gastric suction & some surgeries ect.
Pareneral means
injecting into tissue
What is the intrathecal route
catheter in the subarachnoid space or into ventricles of the brain
long term meds through surgically implanted catheters
what is the intraosseous route
into bone, common in infants & toddlers bc intravascular is hard to get to
- in an emergency
- dont by a physician
- tibia
What is intraperitoneal route
peritoneal cavity where absorbed by circulatory. Chemotherapeautic agents, insulin & antibiotics
What about intra-arterial route
- directly into arteries to deliver plasminogen activators
- often through cathetar
- nurses need to monitor & evaluate
intra-articular
into a joint
Advantages to parenteonal
- Alternative to oral
- more rapid
- good for long term or critical
- can maintain levels over tiem
- if peripheral perfusion is poor IV is better
disadvantages or parentoenal
Risk for infection expensive painful avoided when bleeding tendencies -risk of damage -higher risk for reactions -anciety
When can systemic effects happen bc of topical
when the skin is thin or broken, concentration high or contact to skin is prolonged
what are the advantages to topical
- temporary local effected
- painless
- limited side effects
what are the disadvantages to topical
skin abrasions = systemic
slow absorb
Transdermal patch
12hr to 7 days
- systemic effect
- prolonged with limited adverse effects
- leaves oily or pasty substance on clothes & skin
How long can intraocular stay in
up to a week
Reducing errors for verbal perceptions
- limited to urgent situations
- no verbal or antineoplastic
- needs to be inept
Which has higher errors & lower errors
Stock supply system has high errors & Unit dose & automated are better
Most common errors made by students
- omission
- improrper dose or quantity
- wrong time
- extra dose
- wrong patient
Weh nan error occurs
- assess condition & notify physician ASAP
- after pt. is stable, should be reported within 24hr
History
Allergies medication data diet history perceptual & coordination problems -current condition attitude toward use understand ing & learning needs
Rule of calculations
no period don't add s place space for more than 4 digits use decimals for fractions use leading zero omit unnessesary zeros don't use CC for ML L in let's is capped
what system is most common for medicine
metric (SI IS THE ONLY UNITS USED)
units & milliequivalent are
measures of strength or potency
What is a unit
biological effect that cannot yet to known or defined precisely by SI units
(insulin, hormones, vitamin, penicillin) it is a measure of standardized potency
what is millequivalanrts
measure of combing/ reaction value & power vs mass per volume
strength of ion cocnetretion used for electrolyte replacements
0001 =
zero zero zero one hour (always say hour at the end
A patients trough level
drawn as a sample 30 mins before drug is administered .. tests reveal if the drug is reaching therapeutic level
The greater the half life
the longer it takes to be excreted
short half life = more frequently taken
Plasma half life will increase in clients with
reduced liver or kidney function who are at most risk for toxic levels. So med s are given less frequently at reduced doses
