Medication Administration Flashcards
Medication Rights
What are the 8 rights of medication administration?
The right…
(“Do dogs train relentlessly for praise during regular running outings?”)

- Drug
- Dose
- Time
- Route & Form
- Patient
- Documentation
- Reason
- Reponse Occurs
Medication Rights
What are the other rights of medication administration besides the 8?

- The right for the patient to refuse the medication
- The right for the medication to be presented in the right professional manner
Do’s and Don’ts of charting medication errors!
- Chart just the ___(1)_____
- Don’t chart about ___(2)______ or ____(3)___ on the unit
- Don’t mention that an ___(4)______ was filled out
- Don’t use words like ____(5)_____, ____(6)___, or ____(7)______
- Comment on patient’s resopnse….maybe chart a new set of _____(8)_____

- FACTS!
- staffing problems
- conflicts
- incident report
- “accident”
- “mistake”
- “miscalutation”
- vital signs
Names of Medications
Generic Name

Long chemical names
-Every drug has ONE generic name
(memorize generic name for NCLEX)
Names of Medications
Trade Name

The catchy drug company name
-Each drug has SEVERAL trade names
Which is the generic name and which is the trade from the example?
Acetylsalicylic Acid
Aspirin

Generic name: acetysalicylic acid
Trade name: aspirin
Class Overview
In this class, we will be learning about drugs by _____(1)______ (big groups) of medications which usually have a similar use or action.
Then we will learn “____(2)____” or “____(3)___” for each drug classification.

- Drug classifications
- Prototype
- Typical drugs
Pharmacology Terminology
Pharmacodynamics

How the medication works & affects the body on the chemical level
Pharmacology Terminology
Pharmacotherapeutics

Understanding of drug actions for the treatment and prevention of disease
Pharmacology Terminology
Pharmacokinetics

The drug’s actions
Pharmacology Terminology
Absorption

Getting the medication inside the body into the blood
From outside, to the blood
Types of Absorption Routes
“PIE IT”
- Parenteral: Injections
- Enteral
- Intravenous
- Topical
Routes
P.O.

Enteral
Routes
Enteral (P.O.)

By mouth (oral)
Routes
Enteral (P.O.) medicinations are subjected to what effect?

First-pass effect
Routes
First-Pass Effect

When the medication passes through the liver before getting into the blood
Routes
What is the primary organ involved in the first pass effect?

Liver
Routes
What happens to the medication’s effectiveness when it goes through the first pass effect?

The liver starts to break down medications
Limits bioavailability
Routes
Pros of P.O. (enteral) Medications

- Easy, cheap
- Takes 30 minutes to work
- Comes in a variety of different forms:
- Pills, tablets, capsules, and liquids
Routes
Cons of P.O. (enteral) medications?

- Not all drugs can be given P.O. route
- Many things can interfere with oral route:
- Acid or food in stomach
- Small intestine disease
- Poor blood flow to the stomach/intestine
Routes
What are the other variations of enteral (P.O.) medications?
“Soups and Regular Salads are Eat Completely”

- Sublingual
- Rectal Suppositories
- Enteric Coated
Routes
Enteric Coated Medications

- Enteral (PO) route
- Drugs that are destroyed by acid can sometimes be coated until they reach the alkaline pH of the intestine
Routes
Sublingual

- Enteral (PO) route
- Placed under the tongue
- Absorbed into the venous system to bypass the liver
- Avoids the “first-pass” effect
Routes
What can you NOT do to enteric coated medications?

CANNOT CRUSH THESE PILLS OR CAPSULES
Routes
What can you NOT do to sublingual medications?

DO NOT CHEW or SWALLOW
Routes
What is the most common sublingual medication?

Nitroglycerin
(nitro-glyc-er-in)
Routes
Rectal Suppositories

- Not all are used for constipation (local effect)
-
Often used when oral meds can’t be given
- Ex. Children or vomitting patient
- Absorbed uncertainly (stool interferes)
- Avoids the “first-pass” effect (liver
Routes
What enteral (PO) medications bypass the liver (“first-pass” effect)?

- Sublingual
- Rectal suppositories
Routes
Parental medications are also called?

Injections
Routes
Parental (injections) abbreviations:
SQ/SC
IM

SQ/ SC: subcutaneous
IM: intramuscular
Routes
Parenteral: Injections (SQ/SC & IM)

- Aborbed by diffusion into capillaries
- Blood flow is important
Routes
Parenteral: Injections
SQ/SC

- Subcutaneous
- Goes into the fat
- Takes 20-30 minutes to begin
Routes
Parenteral: Injections
IM

- Intramuscular
- Goes into the muscle
-
Faster into the bloodstream
- Takes 10-15 minutes to begin
Routes
What do both SQ/SC & IM parenteral/injections
avoid?

Both avoid the “first-pass” effect by bypassing the liver
Routes

Pros of parenteral: injections
- Quick
- Easy to learn to administer
Routes

Cons of parenteral: injections
- Can damage tissue
- Cannot control precisely
- Can be affected by temperature of the body
Routes
Intravenous (IV)

Into the veins
Routes

Pros of intravenous (IV)
- Fastest method (immediate)
-
Complete absorption
- No barriers
- Can be used for very irritating medications
- Ex. potassium
- 100% bio-available
Routes
Types of topical medication sites
LENSE

- Lungs
- Eyes
- Nose
- Skin
- Ears
Routes
Type of topical medication used on lungs

Inhalers
- Very quick response
- Most for direst action on lungs
Routes
Types of topical medications for skin

- Creams
- Lotions
- Transdermal patches
- Patches are slow
- Patches are used for systemic use
Routes
Types of topical medications used on eyes

- Drops
- Ointments
Routes
Type of topical medication used on ears

- Drops
Routes
Types of topical medications for the nose

- Drops
- Sprays
Routes
Pros of topical medications

- Can have an excellent local affect
- Bypasses the liver
- No “first-pass” effect
Routes
Cons of topical medications

- Does not work quickly or predictably for a systematic effect
Pediatric Variations in Pharmacokinetics
Absorption
- ____(1)______ has less ____(2)___ until ____(3)___.
- ___(4)__ is ___(5)___.
- ___(6)____ is faster d/t ___(7)____.
- ___(8)____ is faster and irregular.

- Stomach
- acid
- age 3
- Peristalsis
- irregular and slow
- Topical absorption
- thin skin
- IM absorption
Geriatric Variations in Pharmacokinetics
Absorption
- Less ___(1)___.
- Slowed ___(2)_____.
- Less ____(3)____.
- ____(4)_____ = less ____(5)____.

- HCl acid in the stomach
- GI emptying
- blood flow to GI d/t decrease cardiac output
- Villi flattening
- absorptive area
Pharmacokinetics

Distribution
Getting the medication from the blood into the cells where it can be used
- Begins to be eliminated by the liver or kidney
Pharmacokinetics
Factors r/t Distribution
- ___(1)____ is key.
- More drug goes to areas where there is more ___(2)___.
- Such as ______(3)______.
- Less drug goes to areas like _____(4)____.

- blood flow
- blood
- organs- heart, liver, brain, kidneys, etc.
- fat and bone
Pharmacokinetics
Blood Brain Barrier
(BBB)

The BBB is a system of special capillaries with limited entry.
Pharmacokinetics

Pros of the blood brain barrier (BBB)
BBB keeps harmful substances out
Pharmacokinetics

Cons of blood brain barrier (BBB)
The BBB keeps helpful substances out
- Drugs must be fat soluble or have their own transport system to get past the BBB
Pharmacokinetics
Fat soluble drugs are…..

…better distributed b/c they don’t bind to proteins.
Pharmacokinetics
Water soluble drugs are …

…less well distributed- proteins whisk them away out of the body.
Pediatric Variations in Pharmacokinetics
Distribution
- Greater ____(1)______.
- Less _____(2)_____.
- Decreased ____(3)_____ d/t _____(4)_____ to make proteins.
- Immature _____(5)_____ (drugs easily cross it).

- total body water
- fat content
- protein binding
- immature liver
- blood brain barrier (BBB)
Geriatric Variations in Pharmacokinetics
Distribution
- ____(1)_____ and less ____(2)_____
- Affects water soluble and fat soluble drugs.
- Less ____(3)____ produced by the ____(4)____.

- more fat
- water
- proteins
- liver
Pharmacokinetics

Metabolism
Transformation of the drug into something that can be excreted or made (AKA bio-transformation) inactive.
Pharmacokinetics
What is the main organ of metabolism?

Liver
Pharmacokinetics
Metabolism is affected by (3):

- Age: the very young have an immature live & the very old have a worn out liver.
- Malnutrition: the liver doesn’t have all the enzymes needed to metabolize medication.
- Route: medication’s contact with the liver
Pediatric Variations in Pharmokinetics
Metabolism
- Immature ____(1)____ doesn’t make many of the enzymes needed to ____(2)____ drugs.
- Older children may actually need _____(3)____ because of their liver is working so well (age 8+).
- liver
- detoxify
- a higher dose
Geriatric Variations
Metabolism
- Decreased __________(1)_________.
- Decreased __________(2)_________.
- enzyme production by liver
- liver blood flow.
T/F
Pediatric and geriatric patients have less stomach acid in the stomach which can impact the distribution of medications.
F
Less stomach acid in the stomach affects absorption NOT distribution
Pharmacokinetics
Excretion
Removal of the drug from the body
Pharmacokinetics
Which is the main organ of excretion?
Kidneys
Pharmacokinetics
Most drugs are excreted in the ______.
Urine
Pharmacokinetics
Other routes that drugs are excreted from
SIBBS
- Saliva
- In expired air
- Bowels
- Breast milk
- Sweat
Pediatric Variations in Pharmacokinetics
Elimination
- _____(1)______ are immature so ______(2)________.
- Less blood flow to the ______(3)______.
- kidneys
- filteration is slower
- kidneys
Geriatric Considerations
S/E: If there is a _______(1)______ in ______(2)______ or _____(3)______, consider the patient’s medications.
- change
- behavior
- consciousness
Pharmacokinetics
Geriatric Variations
Elimination
- Decreased ______(1)_________
- Less _______(2)________.
- number of functioning nephrons
- blood flow to kidneys
Geriatric Considerations
Physiologic changes with advanced age:
- Cardiac:
- GI:
- Hepatic:
- Renal:
- Cardiac: decreased cardiac output (CO) = decreased blood flow
- GI: less acid in stomach & less peristalsis
- Hepatic: decrease in liver enzyme production
- Renal: decrease of blood flow to the kidneys
Geriatric Considerations
Polypharmacy
Multiple drugs take at once for a variety of problems
Geriatric Considerations
Polypharmacy
- Types of drugs used
- More drugs causes what?
- Polypharmacy is likely do to
- Both prescription and OTC
- More drugs = more interactions
- Multiple MDs prescribing
Geriatric Considerations
What is the goal of eliminating polypharmacy?
This goal is to eliminate unneeded drugs, so less drug interactions occur