Medication Administration Flashcards
Patient Rights of Medication
Right:
Patient
Drug
Dose
Route
Time
Documentation
Thing to Do!
Subcutaneous Injections
Fatty part of the body, 45 degree angle
Lateral aspect of upper arm
Posterior aspect of upper arm
Abdomen in umbilical region
Back
Lower loins
Thighs
Intramuscular Injection (Adult)
Deltoid
Ventrogluteal
Rectus femoris
Vastus lateralis
90 degree angle, Z track method
Intramuscular Injection (Pediatric)
Rectus femoris
Deltoid
Gluteus medius
90 degree angle
Intradermal
10-15 degrees, bevel up
Used for: TB screening, allergy testing
IV Safety Checks
CATS PRRR
Compatibilities
Allergies
Tubing correct
Site checked
Pump safety checked
Right rate
Release the clamps
Return and Reassess patient
Drug Contraindication:
Asthma
Beta-blockers
May cause bronchospasms
Drug Contraindication:
Hypertension
NSAIDs
May cause increased blood pressure due to sodium retention
Drug Contraindication:
Parkinson’s Disease
COX-2 Inhibitors
May cause worsening of Parkinson’s symptoms
Drug Contraindication:
Respiratory Failure
Neuroleptics
May cause respiratory depression
Drug Contraindication:
Epilepsy
TCAs, antimalarials, antipsychotics
May cause reduced seizure threshold
Drug Contraindication:
Chronic Liver Disease
Warfarin
May cause increased sensitivity and bleeding
Drug Contraindication:
Congestive Hear Failure
Ca-Channel Blockers, NSAIDS
May cause sodium retention, increased risk of cardiac events
Steroids (prednisone)
May cause sodium and water retention
Pharmacokinetics
What the body does to drugs
Absorption
Distribution
Metabolism (usually by liver)
Excretion (by kidneys –> watch BUN, Cr., and GFR)
Pharmacodynamics
What drug does to the body
Action –> Chemical changes or effects drug has on body cells
Receptor –> Site where medication acts (Agonist or Antagonist)
Half-Life
Time it takes plasma concentration of drug to be reduced by 50%
Generally takes 4-5 half lives to achieve “steady stable” concentration OR to reduce drug level to an insignificant amount
Therapeutic Index
LD50/ED50
Tells about margin of safety
Drugs with narrow window of safety:
Digoxin
Lithium
Warfarin
Effects increased by Grapefruit Juice:
Nifedipine
Consequences of toxicity:
Flushing, headache, tachycardia, hypotension
Effects increased by Grapefruit Juice:
Verapamil
Consequences of toxicity:
Bradycardia, AV heart block, hypotension, constipation
Effects increased by Grapefruit Juice:
Statins (atorvastatin, lovastatin, simvastatin)
Consequences of toxicity:
Headache, GI disturbances, liver and muscle toxicity
Effects increased by Grapefruit Juice:
Midazolam
Consequences of toxicity:
Increased sedation
Effects increased by Grapefruit Juice:
SSRIs (fluoxetine, sertraline)
Consequences of toxicity:
Serotonin syndrome
Drugs which prolong QT interval
CV: amiodarone, nicardipine, sotalol
Abx: Azithromycin, erythromycin, levofloaxin
Anti-fungals: Fluconazole, Voriconazole
Antidepressants: amitriptyline, protriptyline, escitalopram, citalopram, fluoxetine, sertraline
Antispychotics: Haloperidol, quetiapine, risperidone
Other: ondansetrol, lithium, phenylephrine, tacromlimus, pseudoephedrine, terbutaline
Hepatotoxic Drugs
Statins: atorvastatin, lovastatin, rosuvastatin
Antiseizure drugs: carbamazepine, phenytoin, caloric acid
Anti-fungals: fluconazole, ketoconazole, itraconazole
Anti-depressant/anti-psychotics: bupropion, TCAs, trazodone
Antimicrobials: amoxicillin, erythromycin, penicillin
Other: amiodarone, losartan, labetalol, omeprazole, lisinopril, acetaminophen (when taken with alcohol or in excess)
Drug-Drug Interaction:
ACE Inhibitors
Potassium-sparing medication
Risk for hyperkalemia
Drug-Drug Interaction:
Nitroglycerine
Erectile dysfunction medication
Risk for profound hypotension
Drug-Drug Interaction:
Metformin
Contrast dye
Risk for nephrotoxicity
Drug-Drug Interaction:
Monoamine Oxidase Inhibitors (MAOIs)
Other antidepressants
Risk for serotonin syndrome
Drug-Drug Interaction:
St. John’s Wart
Antidepressants
Risk for serotonin syndrome
Drug-Food Interaction:
Ca-Channel Blockers, Statins, Anticoagulants
Grapefruit juice
Blocks enzyme to metabolize drug –> increases level in body –> toxicity
Drug-Food Interaction:
Monoamine Oxidase Inhibitors (MAOIs)
Tyramine containing food (red wine, chocolate, aged cheeses, salami)
Risk for hypertensive crisis
Drug-Food Interaction:
Warfarin
Excessive Vitamin K (daily intake should be consistent)
Risk for clotting and increasing clotting cascade
