medications Flashcards
what is a medicine and what is a drug?
a drug is any substance that alters physiologic function, with the potential for affecting health.
a medicine is a drug that is administered for its potential therapeutic effects.
What is the nurses role in administering medication?
administering the correct med using the right technique and proper precautions
monitoring clients response, knowing incompatibilities and interactions, actions and side effects, know the moral ethical and legal aspects, be familiar with sources of information
have to know how to recognize unsafe and unclear orders and know what to do
help the client administer meds by themselves
what is the nomenclature for drug names
chemical - actual drug composition
generic - ID’s the active ingredient and is given by the manufacturer of the drug
trade - brand name or proprietary names for marketing
official - often the generic name, how the drug is identified in the official publications
how are drugs classified?
effect on body system
chemical composition
clinical indication for its therapeutic action ( antibiotiecs, analgesics )
what is the effect of the body on the drug?
pharmacokinetics
its the movement of the drug through the body in relation to the drug’s absorption, distribution,metabolism, and excretion
what influences absorption of a drug?
route of administration (oral is slowest, injection, then IV)
Lipid solubility (the more lipid soluble the faster)
pH (Acidic drugs in stomach, basic not until small intestines, so they take longer)
Blood Flow (increased with blood flow)
Conditions at the site of administration (the bigger and better the surface, the better the absorption)
Drug dosage ( Larger than normal does given in acute distress will react faster, than a normal maintenance dose)
the goal of a drug is to give a dose that achieves the desired therapeutic effect of the drug… this is called…..
Pharmacotherapeutics
what are the mechanism of drug action (pharmacokinetics)
Absorption
distribution
metabolism
excretion
what factors effect the distribution of a drug?
what are some complications?
blood flow to the tissues, the drugs ability to leave the bloodstream, and the drugs ability to enter the cells
Blood brain barrier, drugs can bind with plasma proteins causing unequal distributions
what is drug metabolism and what is the major site for this occurrence?
what are some other sites that play a role?
(biotransformation), is the change of a drug from its original form to a weaker form.
Liver is primarily responsible (liver function plays a role in this as well as health/disease state)
GI tissues, lungs, kidney, skin
What is excretion?
What organs and structures are responsible?
What are some special requirements and considerations for excretions of drugs?
Once the drugs is broken down to its inactive form then it must be excreted.
Kidneys excrete most drugs
many drugs are excreted through bile in the GI tract
sweat, salivary, mammary glands
Lungs for gaseous excretions
(laws state that drugs have to have details listen concerning the excretion of the drug in elderly pts who may have impaired renal function)
what is the process by which drugs alter cell physiology and affect the body called?
pharmacodynamics
what are adverse effects of drugs?
what are some examples? specifics
Undesirable effects other than the intended therapeutic effects
Allergic - immune system response, evidenced by rash, urticaria, fever, diarrhea, nausea and vomiting
Anaphylactic reaction is the most serious
Drug tolerance - need more to get the desired effect
Toxic effect - when a group of sysptems related to drug therapy can cause permanent damage or death. Can occur from a cumulative effect
Idiosyncratic effect - paradoxical effect is any unusual response to a drug that is manafested by and over response, under response, or opposite response to a drug.
Drug interactions - synergist and antagonistic effects are possibly VERY DANGEROUS FOR ELDERLY ( they see many doctors they dont always bring all their medication, leading to unknown drugs to cause interactions) Interactions can include dietary supplements and herbs.
what are some factors that affect drug action ?
Pregnancy (tetrogenics are drugs that are known to cause developmental defects in the embryo or fetus
Age - older people are sensitive to meds because of physiologic changes during the aging process, may be more susceptible to adverse effects
Weight - kids need smaller doses
gender
religous facters - people may not want/accept or follow orders for medications
Ethnic background and genetics- some ethnic groups obtain a therapeutic response at lower levels than others ( ACE inhibitors for example are less effective in african americans )
Psychological factors - expectations can mess with results, placebo and nocebo effect
Pathology - presence of a disease can effect drug action (liver problems would alter metabolism times and kidney problems would alter excretion times)
Environment - o2 levels, noise, sensory deprivation and overload can all effect positively or negatively
Nutritional state - less proteins in plasma for drugs to bind with mean more active ingredient in blood stream that gives a greater effect
Timing of administration - after meals (some drugs can even react with food), fasting, bed time, etc
What is a therepeutic range?
peak level?
trough level?
half-life?
Onset?
Plateau?
Duration?
the concentration of a drug in the blood serum that produces the desired effect without causing toxicity
highest plasma concentration, measured when absorption is complete
lowest plasma concentration, measured when 30 mins before next administration
the time ti takes for 50% of the substance to be eliminated from the body
time it takes for a med to produce a response
blood serum concentration is reached and maintained
Time medication takes to produce the greatest results
how do hospitals handle meds that a patient has when admitted?
What do they do if the pt is transferred to another clinical service or has surgery?
All meds are discontinued unless ordered otherwise
old perscriptions are stopped and new orders are made at the new facility
What is medication reconciliation?
What is it good for?
When should we be using it ?
process of specifying medications and maintaining a current accurate list of medications the patient is receiving.
It has been shown to decrease pt med errors in transferring pts
Going into and out of a facility
What determines the length of time that an order for narcotics are valid?
State laws
What are the parts of a medication order?
Patients name (FULL NAME)
Date and time order is written
Name of the drug to be administered
Dose
Route
frequency and duration
Signature of person writing the order
When naming a drug to be used, what is the safest way and what do you do if you dont know the drug?
Use the generic name
use the USP-NP
Who decides the frequency in which routine drugs are given?
The nursing service, facility policy, and pharmacy departments
How close to the time for administration can a medicine be given and what is the exception?
30 mins before or after, the exception is for surgery
What are the routes of administration?
Oral (enteral)
Parenteral
Topical
Inhalation
What are the different methods of oral medication administration?
Oral –tablet pills etc
Buccal - in between cheeks and gums
Sublingual - under the toungue
Feeding tube (enteral)
When administering parenteral medication, why is technique so important?
Infection
Nerve injury
Tissue damage
Skin Sloughing
Abscess at injury site
What is the best practice when trying to determine if a pt has had a reaction or is allergic to a medication?
question the patient if they have ever received the medication and if they are aware of any reaction to the medication
If a pt refuses a medication what do you do?
Document any concerns regarding medication orders in the patients medical record and note the contact of the primary care provider, and any related interventions
What are some types of medication orders?
Standing (routine) PRN Single (one time) STAT prescriptions
What are the methods of communicating a medication order?
Handwritten Preprinted Verbal Telephone EMR
What is the three checks and the rights of medication administration!??!?!?!!?!
READ THE LABEL
- When you reach for the medication
- After you get it and compare with the CMAR before you either prepare for administration or pour from a multidose bottle
- WHen replacing the container to the drawer or shelf before the unit dose of medication to the patient
Right medication Right patient Right dose Right route Right Time
Right reason
Right documentation
What is required information for the administration of narcotics?
Name of patient
Amount used
Hour the narcotic was given
Name of the physician who prescribed the narcotic
Name of the nurse who administered the narcotic
What do you do if a narcotic has to be discarded for any reason? (dropped on the floor, medication left in syringe, refused after drawn, etc)
Second nurse should act as a witness and sign the narcotic sheet.
what does the Joint Commission require for identification of a patient?
What does’nt count?
Two identifiers
The pts room number or physical location
When administering medication, what are some key things to remember?
Remain with the pt and make sure the meds are taken
Offer meds one at a time if there is multiple doses
NEVER leave meds at the bedside
Record administration as soon as possible once the medication has actually been taken
when is it ok to break a tablet?
only when it is scored
what is a capsule?
powder or gel form of an active drug enclosed in a gelatinous container
what is an elixir?
medication in clear liquid containing alcohol, water, sweeteners, and flavor
what does enteric coated mean?
tablet or pill coated to prevent stomach irritation by impeding absorption until it leaves the stomach
what does extended release mean?
allows for slow and continuous release over a predetermined period
What is a liniment?
medication mixed with alcohol, oil, or soap, that is rubbed into the skin
what is a lotion?
drug particles in a solution for topical use
what is a lozenge?
small, oval, round, or oblong preparation containing a drug in flavored or sweetened base which dissolves in the mouth and releases the medication (also called a troche)
what is an ointment?
semisolid preparation containing a drug to be applied externally (also called an unction)
what is a pill?
mixture of a powdered drug with a cohesive material, maybe round or oval
what is a powder
single or mixture of finely ground drugs
what is a solution?
a drug dissolved in another substance
what is a suppository?
easily melted medication preparation in a firm base that is inserted into the body
what is a syrup?
medication that is combined in water and sugar solution
what is tablet?
smal, solid dose of medication , compressed or molded
what is a transdermal patch
unit dose of medication applied directly to the skin for diffusion through the skin into the blood stream
what types of medication should one be wary of giving a pt with previous drug or alcohol addiction
elixirs and possibly (although unlikely) liniments
anything that contains a controlled substance or alcohol based
what does parenteral mean?
outside the alimentary canal and intestines
what are the 4 types of injections that nurses give?
intradermal ( just beneath the dermal layer)
Subcutaneous ( placing the drug into the loose connective tissue under the dermis
Intramuscular ( in the muscle)
Intravenous (in veins)
Rate the speed of absorption of medications by injection site from fastest to slowest
IV
Intramuscular
subcutaneous
Intradermal
