Med Administration Flashcards
***What are the five routes of med administration?
- PO (oral)
- enteral (NG tube, G tube, J tube)
- parenteral (IV, injections)
- sublingual (under tongue)
- buccal (cheek) *used to absorb into mucous membranes rather than GI tract
- topical (lotion, cream, ointment, transdermal patch, inhalations, eye, ear, nasal, rectum, vagina)
What are the different names for medications?
**Chemical- chemical comp and molecular structure
**Generic- nonproprietary name to market it, more simple than chemical name but similar
**Official- US pharmacopeia or National Formulary name
**Brand Name- Tylenol, more expensive, usual capitalized and registration mark
What resources can we reference for drug safety?
- USP or NF
- nursing drug handbook
- physicians desk reference
- internet-based formularies
- med package inserts
- institutional policy and procedures
What drugs would you need a paper prescription for?
narcotics and controlled substances
What do the nurse practice acts identify as nursing responsibilities for medication administration?
administration and monitoring
***What is a stock supply?
most frequent meds kept in bulk quantity (multi-dose bottles)
*cost effective
***What is a unit dose?
- locked, mobile cart
- individually packaged for each patient and refilled q 24 hours
***What is an automated dispenser?
- similar to unit dose but its password protected and dispenses according to documented need
- example: pixis, omnicell
***What is self-administered medication? (SAM)
- individual container at bedside
- encourages independence
- good for patients transitioning to home
***What is pharmocokinetics?
absorption, distribution, metabolism, and excretion of the drug once it enters the body
***What is pharmacodynamics?
- how the drug effects the body
- primary AND secondary effects of drugs
***What is time of onset vs peak?
onset- how long it takes for effects to appear (this is also the minimum effective concentration)
peak- when concentration is highest in the blood
***What is therapeutic level?
concentration of a drug in the blood serum that produces the desired effect without toxicity
***How to determine trough level?
-take blood at the point when the drug is at its lowest concentration, right before next dose
***What is half-life?
amount of time it takes for half of the drug to be eliminated
What factors affect pharmacokinetics?
age- young (less is more), old (higher risk of toxicity)
body mass- bigger the pt the more drug they need
gender- different body composition between men and women
pregnancy- some meds are toxic to the fetus
environment- heat and cold affect circulation
timing of administration- ibuprofen or nsaids should be with meals
fluids- some meds are absorbed better with more water
pathological state- hepatic, renal, or circulatory problems
genetic factors- some meds affect certain pts different
psychological factors- placebo, cognitive state
**What are primary effects?
the effects that are predicted, intended, and desired
***What is palliative effects?
relieves signs and symptoms of disease
***What is substitutive effects? Example!
replace body fluids or a chemical required by the body
example:
***What are supportive effects?
support integrity of body functions until other meds or treatments can become effective
***What are chemotherapeutic effects? Example!!
- destroy disease-producing microorganisms or body cells
- antibiotics and antineoplastic drugs
**What are restorative effects?
- return the body to or maintain the body at optimal levels of health
- example: vitamins/minerals
***What are secondary effects?
unintended, can be harmful
What is drug tolerance?
decreasing response to repeated doses of a medication
What is drug dependence?
reliance on, need for a drug
compulsive
What is drug misuse?
improper use of drugs
What is drug abuse?
inappropriate intake of a substance by amount, type, or situation
What are illicit drugs?
drugs sold illegally
What are the components of a med prescription?
- full name
- date and time
- name of med
- dosage size, freq, number of doses
- route of admin
- signature of provider
What is a written order?
apply without a renewal date until prescriber decides to write another or discontinue
What is automatic stop date?
protocol to discontinue med after a certain amount of time, especially narcotics
What is a stat order?
single dose to be given immediately
***What are nursing responsibilities (legally) regarding med administration, narcotics, and controlled substances?
- we have full legal responsibility
- 3 checks and 10 rights
- abide by institutional practices and state/fed laws
- narcotics must be double locked
- need witness for “waste”
***What are the three checks?
- before you pour
- after you prepare med
- at the bedside
- *checking against MAR
***What are the 12 rights?
- right patient
- right drug
- right dose
- right route
- right time
- right documentation
- right reason
- right to know
- right to refuse
***What is the difference between nebulization, aerosols, and metered dose inhalers?
nebulization- production of a spray of a liquid drug
aerosol sprayers- suspend droplets of medication in O2
MDI- prefilled with several doses, allows for high doses of med to be delivered
***Where are intradermal injections given? What are they most commonly used for? Angle of injection?
- nondominant forearm (or chest/upper back)
- TB or allergy test
- 5-15 degrees
***Where are subcutaneous injections given? What are they commonly used for? Angle of injection?
- abdomen and triceps (fast absorption) anterior thigh and upper buttocks
- insulin, immunization
- not closer than 5cm to belly button, 45-90 degrees
***Where are intramuscular injections given? What are they commonly used for? Angle of injection?
- deltoid, vastus lateralis, ventrogluteal (site of choice) **AVOID DORSOGLUTEAL
- iron, anything really
- 90 degrees
**What does IV push mean?
- a bolus of medication is given at once
- can be irritating to the vessel walls
- have antidote ready
**What does IV piggy back mean?
drug is given as an infusion over 30-60 minutes with a 50-25ml bag containing dextrose or saline
-saline is in primary bag and diluted medication is in the secondary piggyback bag
**When can you mix two meds in a syringe?
- if they are compatible
- if the total dose is within acceptable limits
- if they are both prescribed by the same route
- *if there is a change in color or consistency do not give it!!
***How can med orders be communicated?
- handwritten
- provider order entry
- verbal order (TORB/VORB)
***What is absorption?
movement of drug from site of admin into the bloodstream
***What is distribution?
transportation of a drug in the body fluids to tissues and organs of the body
***What is metabolism?
biotransformation- chemical inactivation of a drug into a water-soluble compound or into metabolites
***What is excretion?
drug molecules must be removed from their sites of action and eliminated by kidneys, liver, GI tract, lungs, and exocrine glands
***What is the first-pass effect?
when oral meds are absorbed in the GI tract they go through the liver before circulation which means half of it becomes inactivated
***What factors affect absorption?
- route of admin
- drug solubility
- PH ionization
- blood flow
***What are factors affecting distribution?
- membrane permeability
- protein binding capacity
- local blood flow
***What factors affect metabolism?
liver function
first pass effect
health/disease status
***What do you know about tylenol?
- tx of mild to moderate pain
- StevensJS, Toxic Epidermal Necrosis, hepatotoxicity, renal failure, anxiety, fatigue, insomnia, hyper or hypo tension, nausea, vomiting
- taking with NSAIDS is bad for renal, taking with warfarin may increase bleeding
- avoid alcohol
- take no longer than 10 days
***What do you know about ibuprofen?
- tx of mild to moderate pain, fever, inflammation
- heart complications (MI, failure, stroke), StevensJS, toxic epidermal necrosis, GI bleeding, hypertension, renal failure
- taking with tylenol is bad for renal, taking with ACE inhibitors reduces their effect, dont take with aspirin
- avoid alcohol, no driving
- take no longer than 10 days
- make sure well hydrated and take with food to minimize GI upset (less absorption though)
***What do you know about Oxycodone?
- moderate to sever pain
- confusion, sedation, resp depression, constipation, dizzy, hallucination, hypotension
- taking with MAO inhibitors increases toxicity, alcohol antihistamines and sedative will add to resp depression
- consider repeat dose at peak if not effective enough
- dont drive
***What do you know about celebrex?
- decreases pain and inflammation
- headache, dizzy, nausea, hypertension, rhinitis, sinusitis, abdominal pain, stevensJS, toxic epidermal necrosis
- dont take with NSAIDS or tylenol, dont take after CABG, could reduce effects of ACE inhibitors, thizaide diuretics, may increase risk of bleeding with other anticoags
- asses ROM and swelling
***What do we know about warfarin?
- management of MI, prevention of blood clot, afib
- causes bleeding, calciphylaxis, cramps, nausea, fever, dermal necrosis
- do not use for uncontrolled bleeding, severe liver or kidney disease, uncontrolled hypertension
- do not use with alcohol (doesnt work as good), many meds make bleeding worse including abx
- *PT INR should be between 2-4.5
- **antidote to warfarin is vit K (limit cranberry juice)
***What do we know about macrodantin?
- used for UTIs a lot
- can cause pneumonitis, pulmonary fibrosis, c-dif, liver problems
- dont use for oliguria/anuria, renal or hpatic impairment
- antacids reduce absorption
- take with food to decrease GI upset
