Medicine Management Flashcards
Q: What are the two main categories of drug administration routes?
A:
Enteral: Involves the gastrointestinal tract (e.g., oral, gastric, rectal).
Parenteral: Bypasses the gastrointestinal tract (e.g., injections, inhalation, transdermal).
Q: What is the purpose of selecting different routes of drug administration?
A:
Ensures effective therapeutic response.
Depends on the drug’s required effect, target site, and patient factors.
Influences drug absorption, distribution, metabolism, and excretion (ADME).
Q: What are examples of enteral routes of administration?
A:
Oral (PO): Tablets, capsules, liquids.
Sublingual (SL): Under the tongue (e.g., Glyceryl Trinitrate).
Buccal: Between gum and cheek (e.g., Prochlorperazine).
Rectal: Suppositories and enemas.
Q: What are examples of parenteral routes of administration?
A:
Intravenous (IV): Direct into the bloodstream.
Intramuscular (IM): Injection into muscle tissue.
Subcutaneous (SC): Injection under the skin.
Inhalation: Inhalers and nebulizers (e.g., Salbutamol).
Transdermal: Absorption through the skin (e.g., fentanyl patches).
Q: What is important when administering oral medications?
A:
Swallow tablets whole unless scored.
Do not crush coated or slow-release tablets without pharmacist approval.
Provide with at least 50 mL of water to prevent tablets from sticking in the esophagus.
Q: What are the benefits of sublingual and buccal administration?
A:
Rapid absorption into the bloodstream via oral mucosa.
Bypasses the gastrointestinal tract and first-pass metabolism.
Q: How are medicines administered via feeding tubes?
A:
Use liquid preparations where possible.
Flush the tube with water between medications.
Confirm correct tube positioning before administration.
Q: When is the rectal route appropriate?
A:
For patients who are vomiting or unable to take oral medications.
Used for both local effects (e.g., hemorrhoids) and systemic effects (e.g., antiemetics).
Q: How is the inhalation route used for medication delivery?
A:
Delivers drugs directly into the lungs for rapid absorption.
Includes inhalers (e.g., Salbutamol) and nebulizers.
Q: What precautions should be taken with transdermal patches?
A:
Apply to clean, dry, and hairless skin.
Rotate application sites to avoid skin irritation.
Do not cut patches or expose them to heat.
Q: What is the correct method for aural (ear) medication administration?
A:
Adults: Pull the ear up and back.
Children: Pull the ear down and back.
Administer the correct number of drops as prescribed.
Q: What is the intranasal route and when is it used?
A:
Delivers medications via the nasal mucosa (e.g., Fluticasone for rhinitis).
Provides local or systemic effects.
Q: What are the types of injectable routes and their uses?
A:
Intravenous (IV): Immediate systemic effect.
Intramuscular (IM): Moderate absorption (e.g., vaccines).
Subcutaneous (SC): Slow absorption (e.g., insulin).
Intradermal (ID): Skin testing (e.g., tuberculosis test).
Q: What considerations should be made for topical medications?
A:
Apply only the prescribed amount.
Use gloves to avoid absorbing the medication.
Example: Steroid creams for eczema.
Q: How are vaginal medications administered?
A:
Using an applicator to insert creams or pessaries.
Example: Clotrimazole for fungal infections.
Q: What factors affect the choice of a drug’s route of administration?
A:
Speed of action required.
Target site accessibility.
Patient’s condition and preferences.
Drug formulation and stability.
Q: What is the difference between systemic and local drug effects?
A:
Systemic: Drug is absorbed into the bloodstream and affects the entire body.
Local: Drug acts only at the site of application (e.g., topical creams).
Q: Why must the route of administration be specified on prescriptions?
A:
Prevents confusion when a drug has multiple routes.
Ensures safe and effective drug delivery.
Q: What are risks of improper medication administration?
A:
Reduced drug effectiveness.
Increased risk of adverse effects or toxicity.
Blockage of feeding tubes if medications are crushed improperly.
Q: How does pharmacokinetics (ADME) relate to routes of administration?
A:
Determines how the body absorbs, distributes, metabolizes, and excretes drugs.
Affects the speed and efficacy of medication action.
Q: What are the advantages and disadvantages of the oral route?
A:
Advantages:
Convenient and non-invasive.
Cost-effective.
Suitable for self-administration.
Disadvantages:
Slower absorption.
Affected by food, digestive enzymes, and first-pass metabolism.
Not suitable for patients who are vomiting or unconscious.
Q: What are the advantages and disadvantages of the intravenous (IV) route?
A:
Advantages:
Immediate drug action.
100% bioavailability.
Precise dose control.
Disadvantages:
Invasive and requires trained personnel.
Risk of infection, phlebitis, or air embolism.
Q: What is the Z-Track technique in intramuscular (IM) injections?
A:
Used to prevent medication from leaking into subcutaneous tissue.
Pull the skin laterally before injection and release after withdrawing the needle.
Commonly used for irritating or staining medications (e.g., iron supplements).
Q: How does the speed of absorption vary between different routes of administration?
A:
Intravenous (IV): Immediate effect.
Inhalation: Very rapid (seconds to minutes).
Intramuscular (IM): Moderate (10–20 minutes).
Subcutaneous (SC): Slower than IM.
Oral: Slowest due to digestive processing.
Q: How are controlled drugs managed across different routes of administration?
A:
Require strict documentation and storage in locked facilities.
Routes include oral, intravenous, transdermal patches (e.g., fentanyl).
Administered with extra care to prevent diversion and misuse.
Q: What key points should be included when educating patients on self-administration?
A:
Demonstrate the correct technique (e.g., using insulin pens or inhalers).
Explain dosing schedules and storage requirements.
Instruct on recognizing adverse reactions and when to seek help.
Reinforce the importance of adherence to prescribed therapy.
Q: Why are pre-administration checks important in medicines administration?
A:
To detect and treat any adverse effects early.
Ensures safe administration, especially for vulnerable patients (elderly, children, patients with renal/hepatic diseases).
Prevents medication errors and promotes patient safety.
Q: Which patient groups are at higher risk of adverse effects from medications?
A:
Elderly and children.
Patients with chronic liver or kidney disease.
Critically ill or malnourished patients.
Patients on multiple medications with potential drug interactions.
Pregnant, breastfeeding, or palliative care patients.
Q: What must be explained to the patient to obtain informed consent for medication administration?
A:
Purpose of the medicine.
How and when to take it.
Any special instructions (e.g., with food or on an empty stomach).
Common side effects.
Risks, benefits, and alternative treatments.
Q: What are examples of ethical dilemmas when gaining consent for medications?
A:
A confused patient refusing critical medication.
A patient using illegal substances for pain control.
A dying patient’s family requesting withdrawal of treatment.
A patient with cancer preferring alternative medicine over chemotherapy.
Q: What blood monitoring is required for some medications?
A:
Capillary blood glucose for diabetic patients on insulin.
INR testing for patients on warfarin.
Monitoring drug levels for medications with a narrow therapeutic range (e.g., gentamicin, aminophylline).
Q: Why is recording a patient’s weight important before administering medication?
A:
Doses for certain medications (e.g., paracetamol, heparin) are weight-dependent.
Prevents overdosing or underdosing.
Must be recorded in kilograms (kg).
Q: Why are observations important before administering certain medications?
A:
To assess the patient’s condition and check for safe administration.
Examples: Check blood pressure before administering ramipril or atenolol.
Monitor patients on clozapine for severe side effects.
Q: When is a second checker required during medication administration?
A:
For high-risk medications (e.g., intravenous drugs).
When complex dose calculations are needed.
Local policy defines who can be a second checker and when it is required.
Q: What steps are involved in a second check during medication administration?
A:
Independent verification by two healthcare professionals.
Check calculation accuracy, patient identity, and correct administration.
Be aware of confirmation bias and check independently.
Q: How should allergies be checked before administering medication?
A:
Review the patient’s Medication Administration Record (MAR) for documented allergies.
Confirm with the patient if possible.
Document any allergies clearly to prevent administration errors.
Q: How should healthcare providers handle patients with swallowing difficulties?
A:
Assess for safe swallowing to prevent aspiration.
Consult the prescriber for an alternative route (e.g., IV, liquid forms).
Record any issues in the care plan.
Q: Why is it important to check for supplementary medication charts?
A:
To avoid missing doses on additional charts (e.g., insulin, IV fluids).
Prevent duplicate dosing and drug interactions.
Review both paper and electronic records.
Q: What medications require additional monitoring due to a narrow therapeutic range?
A:
Gentamicin, warfarin, aminophylline.
Cytotoxic medications for cancer treatment.
These drugs require blood level monitoring to prevent toxicity.
Q: What should be done if a medication dose is omitted?
A:
Record the omission using the correct omission code.
Document the reason according to local policy.
Report and escalate if the omission could harm the patient.
Q: How should potential drug interactions be managed?
A:
Check the BNF interactions checker.
Look for cumulative effects of prescribed medications.
Avoid administering drugs with potential severe interactions (e.g., heparin and NSAIDs increasing bleeding risk).
Q: Why is documentation essential in medicine administration?
A:
Provides a legal record of the care given.
Prevents medication errors.
Ensures accurate communication between healthcare professionals.
Q: What additional checks are required for high-risk medications?
A:
Verify the indication still applies.
Consider if the patient is at risk of bleeding or toxicity.
Monitor for side effects with close observation.
Q: What are Time-Critical Medications (TCM), and why must they be administered on time?
A:
Medications where delays can cause harm or reduce effectiveness.
Examples: Insulin, antibiotics, anticoagulants, anticonvulsants, and Parkinson’s medications.
Administer within 30 minutes of the scheduled time to maintain therapeutic effect.
Q: Why is it important to check storage conditions and expiry dates before administering medication?
A:
Ensures medication is safe and effective.
Verify storage requirements (e.g., refrigerated vs. room temperature).
Do not administer expired medications.
Q: How does patient positioning affect medication administration?
A:
Oral medications: Patient should be upright to prevent aspiration.
Enteral feeding tubes: Confirm tube placement and elevate the head of the bed.
Sublingual/Buccal meds: Ensure the patient can hold medication in place.
Q: What precautions should be taken when crushing tablets or diluting medications?
A:
Confirm with the pharmacist if the medication can be safely altered.
Do not crush modified-release or enteric-coated tablets.
Mix with appropriate fluids and administer promptly.
Q: What steps should be followed if a patient refuses medication?
A:
Explore the reason for refusal and address concerns.
Document the refusal and reason in the patient’s notes.
Inform the prescriber or senior nurse if the medication is critical.
Do not force the patient to take the medication.
Q: What are healthcare professionals responsible for during medication administration?
A:
Ensuring patient safety and adhering to ethical and legal standards.
Understanding the medication’s indications, correct dosage, contraindications, side effects, allergies, and route of administration.
Following the Royal Pharmaceutical Society and Nursing and Midwifery Council guidelines.
Q: What are the Six Rights of safe medication administration?
A:
Right Patient – Confirm identity using wristband and Medication Administration Record (MAR).
Right Medicine – Verify medication name, form, and expiry date.
Right Dose – Ensure correct dosage is given; verify calculations if needed.
Right Route – Confirm the correct administration route (oral, IV, etc.).
Right Time – Administer medication at the prescribed time.
Right Documentation – Record the medication administration accurately.
Q: How is the Right Patient verified before medication administration?
A:
Check the wristband and the MAR.
Ask the patient to state their full name and date of birth.
If the patient cannot verbalize, use a second verifier or medical notes.
Q: What must be checked under the Right Medicine principle?
A:
Confirm the generic and brand name of the drug.
Verify the strength, formulation, and expiry date.
Check for correct packaging and avoid using damaged or mislabeled containers.
Q: How is the Right Dose confirmed?
A:
Verify the prescribed dose against the BNF guidelines.
Perform and double-check any required dose calculations.
Be aware of the patient’s weight, age, and comorbidities for dose adjustments.
Q: Why is the Right Route of administration important?
A:
Incorrect routes can alter a drug’s effectiveness and cause harm.
Confirm the patient can tolerate the route (e.g., check for swallowing difficulties for oral meds).
Only use the route specified in the prescription.
Q: What factors are involved in the Right Time for medication administration?
A:
Follow the prescribed timing (e.g., morning, before meals).
Pay close attention to time-critical medications (e.g., antibiotics, insulin).
Adjust administration based on meal times or clinical conditions.
Q: What is included in the Right Documentation?
A:
Sign the MAR after administering each medication.
Record any omissions, refusals, or alterations with a documented reason.
Ensure student practitioners have their signatures countersigned.
Q: How should healthcare professionals monitor patients after administering medication?
A:
Observe for the intended effects and monitor for side effects.
Check vital signs and watch for adverse reactions (e.g., allergic reactions, hypotension).
Encourage patients to report any unusual symptoms.
Q: How are Adverse Drug Reactions (ADRs) managed?
A:
Report suspected ADRs to the MHRA using the Yellow Card Scheme.
Inform the prescriber and pharmacist immediately.
Monitor for serious side effects, especially for drugs marked with a black triangle in the BNF.
Q: What are the guidelines for the safe disposal of medicines?
A:
Return unused or expired medications to the pharmacy.
Dispose of cytotoxic drugs and sharps in designated containers.
Follow local policies for disposing of controlled substances.
Q: What is medicines reconciliation, and why is it important?
A:
It involves creating an accurate medication list during hospital admission.
Helps prevent omissions, duplications, and drug interactions.
Ensures correct medications during transfers and at discharge.
Q: What is the difference between intentional and unintentional non-adherence to medication?
A:
Intentional: Patient chooses not to take medication due to beliefs or side effects.
Unintentional: Patient forgets, misunderstands instructions, or cannot access the medication.
Q: How can healthcare professionals support medication adherence?
A:
Provide clear education on the medication’s purpose and side effects.
Offer practical aids (e.g., dosette boxes, reminders).
Address concerns about cost, side effects, and lifestyle impact.
Q: What steps should be taken if a patient refuses medication?
A:
Explore and document the reason for refusal.
Inform the prescriber if the medication is time-critical.
Do not force administration; respect the patient’s decision.
Q: What precautions are necessary when administering high-risk medications?
A:
Perform a double-check with another healthcare professional.
Follow specific protocols for drugs like chemotherapy, anticoagulants, and opioids.
Use PPE when handling hazardous drugs.
Q: How does polypharmacy affect medication safety?
A:
Increases the risk of drug interactions and side effects.
Requires regular medication reviews to prevent unnecessary prescriptions.
Aim for appropriate polypharmacy by optimizing medications for patient needs.
Q: How does patient belief influence medication adherence?
A:
Cultural or personal beliefs may lead to intentional non-adherence.
Address concerns through open communication and education.
Involve the patient in shared decision-making.
Q: What are the key steps in medication preparation?
A:
Check the prescription against the Medication Administration Record (MAR).
Confirm the correct dose, route, and time.
Prepare medications in a clean and uncluttered area.
Use the correct technique for splitting, crushing, or diluting medications—consult a pharmacist if unsure.
Label prepared medications properly if not administered immediately.
Q: Why is patient positioning important during medication administration?
A:
Oral medications: Patient should be upright to prevent aspiration.
Rectal/vaginal medications: Place the patient in a side-lying or dorsal recumbent position.
Inhalers/nebulizers: Patient should be sitting up for optimal lung expansion.
Subcutaneous/intramuscular injections: Position the body to relax the targeted muscle.
Q: What are the safety procedures for handling Controlled Drugs (CDs)?
A:
Store CDs in a locked cupboard with restricted access.
Record administration in the Controlled Drug Register.
Require a second checker to verify the drug, dose, and patient.
Dispose of unused CDs safely according to local policy.
Q: What steps should be followed if a medication error occurs?
A:
Immediately assess and monitor the patient for harm.
Report the error to a senior nurse or prescriber.
Document the error according to local policy (e.g., incident report).
Reflect on the error and implement preventive measures.
Q: Why is proper medication storage and security important?
A:
Prevents theft, misuse, and deterioration of medications.
Follow manufacturer instructions (e.g., refrigerated or room temperature storage).
Check for expiry dates and dispose of expired medications appropriately.
Keep high-risk medications in secure storage areas.
