Topic 13 Flashcards
Pure Food and Drug Act
This law simply requires all medications to be free of impure products.
Food and Drug Administration (FDA)
a federal agency that enforces medication laws to ensure that all medications on the market undergo vigorous testing before they are sold to the public.
MedWatch Program
This voluntary program encourages nurses and other health care professionals to use the MedWatch form to report when a medication, product, or medical event causes serious harm to a patient.
chemical medication name
provides the exact description of medication’s composition
ex: N-acetyl-para-aminophenol
generic medication name
the manufacturer who first develops the drug assigns the name, and it is then listed in the U.S. Pharmacopeia
ex: acetaminophen
trade medication name
also known as brand or proprietary name. This is the name under which a manufacturer markets the medication.
ex: tylenol
Pharmacokinetics
the study of drug movement throughout the body
Four processes of pharmacokinetics
absorption, distribution, metabolism, excretion
For medications to be therapeutic, they must be…
taken into a patient’s body; be absorbed and distributed to cells, tissues, or a specific organ; and alter physiological functions.
absorption
Passage of medication molecules into the blood from the site of administration
Factors that influence absorption
- Route of administration
- Ability of the medication to dissolve
- Blood flow to the site of administration
- Body surface area
- Lipid solubility
absorption of applying medication to the skin and through the GI is usually..
slow
what medication administration has the fastest absorption rate
IV
The richer the blood supply to the site of administration, the…
faster a medication is absorbed.
distrubution
occurs within the body to carry medication to tissues, organs, and specific sites of action.
distribution depends on
Physical and chemical properties of the medication
Physiology of the person taking it
-Circulation
-Membrane permeability
-Protein binding
Metabolism (biotransformation)
The biochemical process that alters a drug from an active form to a form that is inactive or that can be eliminated from the body.
excretion
the process by which wastes are removed from the body
medications exit the body through…
kidney, liver, bowel, lungs, exocrine glands
what is the main organ for excretion
kidneys
Which type of medications are excreted through the lungs?
Anesthetic gases, alcohol
Why should certain medications not be taken during pregnancy?
Some may pass through the placental barrier or mammary glands.
Biotransformation happens where?
liver
The exocrine glands excrete
lipid soluble medications
therapeutic effect
Expected or predicted physiological response
adverse effect
Unintended, undesirable, often unpredictable
side effect
Predictable, unavoidable secondary effect
toxic effect
Accumulation of medication in the bloodstream
idiosyncratic reaction
Over-reaction or under-reaction or different reaction from normal
allergic reaction
unpredictable response to a medication
medication interaction
When a medication may modify or diminish the actions of another medication
synergistic effect
interaction of two or more medicines that results in a greater effect than when the medicines are taken alone
minimum effective concentration (MEC)
The smallest amount of drug necessary in the blood or target tissue to result in a measurable intended action.
toxic concentration
the plasma level at which toxic effects begin
therapeutic range
that concentration of drug in the blood serum that produces the desired effect without causing toxicity
-falls between the MEC and the toxic concentration
Peak
highest effective concentration
Trough
minimum blood serum concentration of medication reached just before the next scheduled dose
biological half-life
which is the time it takes for excretion processes to lower the amount of unchanged medication by half
To maintain a therapeutic plateau the patient must…
receive regular fixed doses
Time-critical medications
medications in which early or delayed administration of maintenance doses (more than 30 minutes before or after the scheduled dose) will most likely result in harm or subtherapeutic responses in a patient
when do you administer time critical medications
at a precise time or within 30 minutes before or after the scheduled time
when do you administer non- time critical medications
within 1 to 2 hours of their scheduled time
Sublingual administration
drugs are given by placement under the tongue
sublingual instructions
Instruct patients not to swallow a medication given by the sublingual route or drink anything until the medication is completely dissolved to ensure that the medication will have the desired effect
Buccal administration
placing the solid medication in the mouth against the mucous membranes of the cheek until it dissolves
buccal instructions
Teach patients to alternate cheeks with each subsequent dose to avoid mucosal irritation. Warn patients not to chew or swallow the medication or to take any liquids with it
what route is the easiest and the most commonly used route of medication administration
oral route
4 major parenteral routes of administration
intradermal, subcutaneous, intramuscular, intravenous
Intradermal (ID)
Injection into the dermis just under the epidermis
Subcutaneous
Injection into tissues just below the dermis of the skin
Intramuscular (IM)
Injection into a muscle
IV
Injection into a vein
Nurses administer inhaled medications through
asal passages, oral passages, an endotracheal tube, or a tracheostomy tube
topical administration
administration of a substance directly onto the skin or mucous membrane (generally have local effects)
Intraocular medication
delivery involves inserting a medication similar to a contact lens into a patient’s eye. The eye medication disk has two soft outer layers that have medication enclosed in them. The nurse inserts the disk into the patient’s eye, much like a contact lens. The medication remains in the eye for up to 1 week.
solution
a given mass of solid substance dissolved in a known volume of fluid, or as a given volume of liquid dissolved in a known volume of another fluid.
-When a solid is dissolved in a fluid, the concentration is in units of mass per units of volume (e.g., g/L, mg/mL).
health care providers role in medicaton administration
*Prescriber can be physician, nurse practitioner, or physician’s assistant.
*Orders can be written (hand or electronic), verbal, or given by telephone.
*The use of abbreviations can cause errors; use caution.
computerized physician order entry (CPOE)
In using this system, the prescriber completes all computerized fields before the order for the medication is filled, thus avoiding incomplete or illegible orders.
Standing or routine order
Administered until the dosage is changed or another medication is prescribed
PRN, prn
as needed; given when the patient requires it
single (one-time)
given one time only for a specific reason
STAT
given immediately in an emergency
Now order
When a medication is needed right away, but not STAT
prescriptions
Medication to be taken outside of the hospital
When receiving a now order, the nurse has up to ______ to administer the medication
90 mins
how many times are Now orders given
one time
Pharmacist’s Role
Prepares and distributes medication
Nurse’s role in medication administration
*Determining medications ordered are correct, assessing patient’s ability to self-administer, determining whether patient should receive medications at a given time, administering medications correctly, and closely monitoring effects.
*Cannot be delegated
Includes patient teaching
unit dose system
-Pharmacists provide the medications in single-unit packages that contain the ordered dose of medication that a patient receives at one time.
-Nurses distribute the medications to patients.
-Each tablet or capsule is wrapped separately.
-Usually no more than a 24-hour supply of medication is available at any given time.
automatic medication dispensing system (AMDS)
AMDSs control the dispensing of all medications, including narcotics.
-Each nurse accesses the system by entering a security code.
-You select the patient’s name and his or her drug profile before the AMDS dispenses a medication. -In these systems, you are allowed to select the desired medication, dosage, and route from a list displayed on the computer screen.
barcode medication administration (BCMA)
BCMA requires nurses to scan bar codes to identify the patient, the medication, and an identification tag of the nurse administering the medication before recording this information in the patient’s computerized medical record
medication errors
*Report all medication errors.
*Patient safety is top priority when an error occurs.
*Documentation is required.
*The nurse is responsible for preparing a written occurrence or incident report: an accurate, factual description of what occurred and what was done.
*Nurses play an essential role in medication reconciliation.
when a medication error occurs, what do you do first
You first assess and examine the patient’s condition and notify the health care provider of the incident as soon as possible
Six Rights of Medication Administration
- Right medication
- Right dose
- Right patient
- Right route
- Right time
- Right documentation
No-interruption zones (NIZs)
recommended to reduce distractions and interruptions during medication administration
Medication orders need to contain
-patient’s fill name
-the date and time that the order is written
-the medication name, the dosage
-the route of administration
-the time and frequency of administration
-the signature of the health care provider
Polypharmacy
happens when a patient takes multiple medications or potentially inappropriate or unnecessary medications or when a medication does not match a diagnosis
what sometimes affects absorption if oral medication administration
food
Most tablets and capsules need to be swallowed and administered with approximately how much fluid?
60 to 240 mL of fluid (as allowed).
Protect a patient from aspiration by
*assessing his or her ability to swallow
Enteral or small-bore feedings
*Verify that the tube location is compatible with medication absorption.
*Use liquids when possible.
*If medication is to be given on an empty stomach, allow at least 30 minutes before or after feeding.
*Risk of drug-drug interactions is higher.
Nasal Instillation
spray, drops, tampons
Severe nosebleeds are usually treated
with packing or nasal tampons, which are treated with epinephrine, to reduce blood flow
eye instillation administration
*Avoid the cornea.
*Avoid the eyelids with droppers or tubes to decrease the risk of infection.
*Use only on the affected eye.
*Never share medications.
Intraocular instillation
Disk resembles a contact lens.
Teach patients how to insert and remove the disk.
Teach about adverse effects.
ear instillation administration
*Instill eardrops at room temperature.
*Use sterile solutions.
*Check for eardrum rupture if patient has ear drainage.
Never occlude the ear canal
why do you instill ear drops at room temperature
to prevent vertigo, dizziness, or nausea.
follow ___ technique when administering vaginal medications
aseptic
Pressurized metered-dose inhalers (pMDIs)
use a chemical propellant to push the medication out of the inhaler and require the patient to apply
*Need sufficient hand strength for use
*May be used with a spacer
Breath-actuated metered-dose inhalers (BAIs)
release medication when a patient raises a lever and inhales. Release of the medication depends on the strength of the patient’s breath on inspiration
Dry powder inhalers (DPIs)
hold dry powder medication and create an aerosol when the patient inhales through a reservoir that contains a dose of the medication. Some DPIs are unit dosed. These inhalers require patients to load a single dose of medication into the inhaler with each use
To ensure that the patient does not run out of medication, teach him or her to…
refill it at least 7 to 10 days before it runs out.
Administering Medications by Irrigation
-Irrigations cleanse an area, instill a medication, or apply hot or cold to injured tissue.
-Irrigations most commonly use sterile water, saline, or antiseptic solutions on the eye, ear, throat, vagina, and urinary tract.
-Use aseptic technique if there is a break in the skin or mucosa.
-Use clean technique when the cavity to be irrigated is not sterile, as in the case of the ear canal or vagina.
Luer-Lok syringes
have needles that are twisted onto the tip and lock themselves in place
Non-Luer-Lok syringe
*have needles that slip onto the tip. Syringes have safety devices to prevent needlestick injury.
a tuberculin syringe has a capacity of…
1 mL
Insulin syringes are available in sizes that hold…
0.3 to 1 mL and are calibrated in units.
Choose the needle length according to
*a patient’s size and weight and the type of tissue into which the medication is to be injected.
Preparing an injection from an ampule
*Snap off ampule neck
*Aspirate medication into syringe using filter needle
*Replace filter needle with an appropriate size needle or needless device
Administer injection
Ampules
small, sealed glass bottles containing a single dose of medication
Preparing an injection from a vial
-If dry, use solvent or diluent as needed
-Inject air into vial
-Label multidose vials after mixing
-Refrigerate remaining doses if needed
what is commonly used to dissolve medications
Normal saline and sterile distilled water
Mixing medications from a vial and an ampule
Prepare medication from the vial first.
Use the same syringe and filter needle to withdraw medication from the ampule.
Mixing medications from two vials
-Do not contaminate medications
-ensure final dose is accurate
-maintain aseptic technique
insulin is
the hormone used to treat diabetes.
why is insulin administered by injection
because the GI tract breaks down and destroys an oral form of insulin.
what do you use to prepare u-100 of insulin
100-Unit insulin syringe or an insulin pen
What insulin can be given IV?
regular insulin
Rapid acting insulin
Onset - 10-30 minutes
Peak - 30 to 90 minutes
Duration - 1 to 5 hours
Short acting insulin (regular)
Onset 30 minutes
Peak 2.5-5 hours
Duration 4-12 hours
Intermediate acting insulin
Onset 1-2 hours
Peak 4-12 hours
Duration 14-24 hours
Long acting insulin
Onset 1-1.5 hour
Peak none
Duration 24 hours
correction insulin
indicates that small doses of rapid- or short-acting insulins are needed to correct a patient’s elevated blood sugar
-given to reduce an elevated blood sugar level that is not controlled by mealtime insulin
before drawing up cloudy insulin
gently roll between the palms of the hands
If regular and intermediate-acting insulin is ordered…
prepare the regular insulin first to prevent the regular insulin from becoming contaminated with the intermediate-acting insulin
Inject rapid-acting insulins mixed with NPH (neutral protamine Hagedorn) insulin within…
15 minutes before a meal.
Before injecting, know:
- The volume of medication to administer
- The characteristics and viscosity of medication
- The location/anatomical structures underlying injection site
Minimizing Patient Discomfort
-Use a sharp-beveled needle in the smallest suitable length and gauge; position patient comfortably.
-Select the proper injection site.
-Apply a vapocoolant spray or topical anesthetic.
-Divert the patient’s attention from the injection.
-Insert the needle quickly and smoothly.
-Hold the syringe steady while the needle remains in tissues.
-Inject the medication slowly and steadily.
The best subcutaneous injection sites include…
The outer posterior aspect of the upper arms, the abdomen from below the costal margins to the illiac crests, and the anterior aspects of the thighs.
The site most frequently recommended for heparin injections is
the abdomen
The administration of low-molecular-weight heparin (LMWH) (e.g., enoxaparin) requires special considerations:
When injecting the medication, use the right or left side of the abdomen at least 2 inches from the umbilicus (the patient’s “love handles”) and pinch the injection site as you insert the needle
Recommended sites for insulin injections include
he upper arm and the anterior and lateral parts of the thigh, buttocks, and abdomen
IM injections have _____ absorption than subcutaneous route
faster
IM angle of insertion
90 degrees
IM injections amount: adult
2 to 5 mL (4 to 5 mL unlikely to be absorbed properly)
IM injections amount: Children, older adults, thin patients
up to 2 mL
IM injections amount: Small children and older infants
up to 1 mL
IM injections amount: Smaller infants
up to 0.5 mL
ventrogluteal site
involves the gluteus medius; it is situated deep and away from major nerves and blood vessels.
what site is preferred and safest site for all adults, children, and infants
ventrogluteal
The ventrogluteal site is recommended for volume
greater than 2 mL
Locate the ventrogluteal muscle by
*Index finger, the middle finger, and the iliac crest form a V-shaped triangle
*Injection site is the center of the triangle
The vastus lateralis muscle is another injection site for
ts and children.
Use _________ of vastus lateralis muscle for injection
middle third
Deltoid injection site
The injection site is in the center of the triangle, about 3 to 5 cm (1 to 2 inches) below the acromion process.
Holds up to 2cc of medication
Avoid the acromin and humerus
Use of the Z-track method in intramuscular injections
When administering IM injections, the Z-track method is recommended to minimize local skin irritation by sealing the medication in muscle tissue.
*When administering IM injections, the Z-track method is recommended to minimize local skin irritation by sealing the medication in muscle tissue.
Intradermal injections used for
skin testing (tuberculosis [TB], allergies)
Intradermal Skin testing requires
the nurse to be able to clearly see the injection site for changes
ID angle of insertion
*Angle of insertion is 5 to 15 degrees with bevel up
*A small bleb will form
Needlestick Safety and Prevention Act
mandates the use of special needle safety devices to reduce the frequency of needlestick injuries.
Safety syringes
have a sheath or guard that covers a needle immediately after it is withdrawn from the skin. This eliminates the chance for a needlestick injury.
Dispose of sharps in marked containers
-Use puncture- and leak-proof containers
-Never force needles into receptacle
-Never place used needles into wastebaskets, your pockets, or patient’s tray or bedside
Nurses administer medications intravenously by the following methods:
- As mixtures within large volumes of IV fluids
- By injection of a bolus or small volume of medication through an existing IV infusion line or intermittent venous access (heparin or saline lock)
- By “piggyback” infusion of a solution containing the prescribed medication and a small volume of IV fluid through an existing IV line
volume controlled infusions
Uses small amounts (50 to 100 mL) of compatible fluids.
advantages of volume controlled infusions
-Reduces the risk of rapid-dose infusion by IV push
-Allows for administration of medications that are stable for a limited time
-Allows control of IV fluid intake
Piggyback
A small (25 to 250 mL) IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access
Volume-control administration
Small (150-mL) containers that attach just below the primary infusion bag or bottle
Syringe pump
*Battery operated
*Allows medications to be given in very small amounts of fluid (5 to 60 mL) within controlled infusion times using standard syringes
intermittent venous access (saline lock) Advantages:
*Cost savings resulting from the omission of continuous IV therapy
*Effectiveness of nurse’s time enhanced by eliminating constant monitoring of flow rates
*Increased mobility, safety, and comfort for the patient
intermittent venous access (saline lock) Before administration:
Assess the patency and placement of the IV site
intermittent venous access (saline lock) after administration:
Access must be flushed with a solution to keep it patent
Administration of IV therapy in the home
-Usually patients have a central venous catheter.
-Home care nurses assist with monitoring.
-Carefully assess patients and their families to determine their ability to manage this therapy at home.
Begin instruction on IV care management while the patient is still in the hospital. Teach family and patient:
*To recognize signs of infection and complications
*When to notify the home care nurse or health care provider
*How to maintain IV administration equipment
