Medications (Reference: Kozier 8th Edition)

Medication or Drug substance administered for diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. Prescription written direction for preparation & administration of a drug One Drug has 4 Drug Names 1. Generic Name given before drug becomes officially an approved medication; usually used throughout the drugs use. 2. Official Name name under which it is listed in one of the official publications 3. Chemical Name name which a chemist knows it; describes the constituents of the drug 4. Trade Name name given by drug manufacturer; usually short and easy to remember; sometimes called Brand Name, b/c one drug may be manufactured by several companies. Pharmacology - study of drug effects on living organisms. Pharmacy art of preparing, compounding, & dispensing drugs; place where drugs are prepared and dispensed. Pharmacist- licensed person who prepare & dispense drugs and make prescriptions. Clinical Pharmacist a Specialist who guides a Physician in prescribing drugs. Drug Standards 1. Natural (source: plants, animals, and minerals) 2. Chemical (Synthesized in the laboratory) Legal Aspects of Drug Administration If a Physician writes an incorrect order, a nurse who administers the written incorrect dosage is responsible for the error as well as the Physician. Nurses should question any order that appears unreasonable and refuse to give medication until order is clarified. Effects of Drugs 1. Therapeutic Effect or Desired Effect Primary effect intended; reason why drug is prescribed. (ex. Diazepam is relief for anxiety) Kinds of Therapeutic Action of Drugs a. Palliative relieves symptoms of disease but doesnt affect disease itself (Ex. aspirin for pain, morphine sulfate) b. Curative cures disease or condition (Ex. penicillin for infection) c. Supportive supports body function until other treatments or bodys response can take over (ex. aspirin for high body temp) d. Substitutive replaces body fluids or substances (Ex. Insulin for DM, thyroxine for hyperthyroidism ) e. Chemotherapeutic destroys malignant cells (ex. Busulfan for leukemia) f. Restorative returns body to health (ex. vitamins and minerals)

2. Side Effect / Secondary Effect effect that is unintended; usually predictable; harmless or harmful 3. Adverse Effects more severe side effects; not predictable; discontinue use of drug 4. Drug Toxicity deleterious effects of a drug; results from over dosage, ingestion of a drug unintended for external use; buildup of drug in the blood b/c of impaired metabolism or excretion (cumulative effect) 5. Drug Allergy immunologic reaction of drug; when a client is first exposed to a foreign substance (antigen), body may react by producing antibodies; an allergic reaction can occur anytime from a few minutes to 2 weeks after administration. a. Mild Allergic Reactions Skin Rash Pruritus Angioedema Rhinitis Lacrimal Tearing Nausea, Vomitting Wheezing and Dyspnea Diarrhea Either epidermal vesicle rash or rash typified by an urticanal or macular eruption; rash is usually generalized over the body Itching of skin with or without rash Edema due to increased permeability of blood capillaries Excessive watery discharge from the nose Excessive tearing Stimulation of these centers in the brain Shortness of breath and wheezing on inhalation and exhalation due to accumulated fluids and swelling of respiratory tissues Irritation of mucosa of the Large Intestine

b. Severe Reaction / Anaphylactic Reaction fatal if symptoms are noticed immediately; occurs immediately after administration of drug; earliest symptoms are subjective feeling of mouth and tongue swelling, acute hypotension, acute tachycardia, and acute shortness of breath. 6. Drug Tolerance exists in a person who has unusually low physiologic response to a drug and requires increase in dosage to maintain therapeutic effect. (ex. Opium, Barbituarates, Ethyl Alcohol) 7. Cumulative Effect increasing response to repeated doses of a drug that occurs when rate of administration exceeds rate of metabolism. As a result, drug builds up in the body unless dosage is adjusted; toxic symptoms may occur. 8. Idiosyncratic Effect unexpected and may be individual to client; under response or over response; drug may have different effect from the normal one or cause unpredictable symptoms to a particular client. 9. Drug Interaction administration of one drug before, at the same time as, or after another drug alters the effect of one or both drugs. a. Potentiating increased effect Additive 2 same types of drugs increase the action of each other Synergistic 2 different drugs increase the action of one or another drug. b. Inhibiting decreased effect

Iatrogenic Disease - disease caused unintentionally by medical therapy (can be d/t drug therapy) Drug Misuse improper use of commone medications that lead to acute or chronic toxicity. Drug Abuse inappropriate intake of substance; either continually / periodically; abusive if society considers it abusive. 2 Main Facets of Drug Abuse 1. Drug Dependence persons reliance or need to take a drug; if a dependent person who stops experiences withdrawal symptoms. a. Physiologic Dependence biochemical changes in body tissues, esp nervous system; b. Psychologic Dependence emotional reliance on a drug to maintain sense of well being. 2. Drug Habituation Mild form of psychological dependence Habit of taking the drug and feels better after taking it even if injurious to health. Illicit Drugs or Street Drugs drugs sold illegally that has mood altering effect (can make a person happy or relaxed) a. Drugs unavailable for purchase (such as heroin) b. Drugs available with prescription that are being sold thru illegal channels. Actions of Drugs on the Body (OPDP) 1. Onset Action time after administration when body initially responds to the drug. 2. Peak Plasma Level highest plasma level achieved by a single dose when elimination rate of a drug = absorption rate 3. Drug Half Life / Elimination Half Life time required to reduce concentration of drug to half 4. Plateau maintained concentration of a drug in the plasma (blood) Pharmacodynamics process by w/c a drug changes the body (Ex. Alters cell physiology) Pharmacokinetics study of absorption, distribution, biotransformation, and excretion of drugs. a. b. c. d. Absorption drug passes into the bloodstream Distribution transportation of drug from site of absorption to site of action Biotransformation or Detoxification or Metabolism drug is converted to a less active form. Excretion drugs are eliminated from the body

Factors Affecting Medication 1. 2. 3. 4. 5. 6. 7. 8. Developmental Factors Gender Cultural, Ethnic, and Genetic Factors Diet Environment Psychological Factors Illness and Disease Time of Administration Oral administration meds are absorbed more quickly if the stomach is empty Oral meds taken 2 hours before meals act faster than those taken after meals.

Routes of Administration 1. Oral (Mouth) Most common, safe, convenient, least expensive Drug is swallowed For patients who can swallow and can retain drug in the stomach Contraindicated a. NPO b. lacks gag reflex c. unconscious d. vomiting, e. w/ gastric or intestinal suction Disadvantages a. Slow absorption b. unpleasant taste c. irritation of gastric mucosa d. harmful to teeth (use straw) Solid tablet, capsule Liquid syrup, suspension c. Sublingual (SL) Drug placed under the tongue where it dissolves. (Ex. Nitroglycerine; Hypertensive Drugs) d. Buccal Drug held in mouth against mucous membranes of the cheek until it dissolves. e. Parenteral Thru alimentary canal or respiratory tract by needle. 4 Common Parenteral Routes a. b. c. d. Subcutaneous (hypodermic) into subcutaneous tissue; below the skin, below dermis Intramuscular into muscle Intradermal under epidermis; into dermis Intravenous into a vein

Topical Medications Applied to circumscribed surface of the body and affect only the area which they are applied. a. Dermatologic Preparations - to skin b. Instillations & Irrigations - into body cavities or orifices (bladder, eyes, ears, nose, rectum, vagina) c. Inhalations - into respiratory tract by nebulizer or (+) pressure breathing apparatus; air , oxygen, and vapor are generally used

Common Types of Medication Orders 1. Stat Order medication given immediately and only once. (ex. Demerol 100 mg IM stat) 2. Single Order or One time Order given once at a specified time (ex. Seconal 100 mg hs before surgery) 3. Standing Order may or may not have a termination date; may be carried indefinitely (ex. multiple vitamins daily) until an order is written to cancel it, or may be carried for a specific no. of days. (ex. Demerol 100 mg IM q4h x 5 days) 4. Prn Order or As Needed Order permits nurse to give medication when, in nurses judgment, client requires it.; nurse must use good judgment when medication is needed. 7 Essential Parts of Drug Order 1. 2. 3. 4. 5. 6. 7. Clients Full Name Date and Time order is written Name of Drug Dosage of Drug Route of Administration Frequency of administration Signature of person writing the order (unsigned order is not valid)

Medication Supply System 1. Stock Supply System large quantities of medications are stored and dispensed to all patients from the same containers. a. Advantages: always available, cost efficient b. Disadvantages: drug errors are more prevalent with multiple pourers, more risk of abuse of Health Care Workers, less accountability of amount med used, inability to track medication usage 2. Unit Dose Supply System medications are packed and labeled a. Advantages: saves time, no dosage calculations needed, specific dosage of meds, more accountability, less chance for contamination b. Disadvantages: potential delay and receiving, not immediately replaceable if contaminated, more expensive. Systems of Measurement 1. Metric System Organized into units of 10; decimal system Basic units can be multiplied or divided by 10 to form secondary units. Multiplies are calculated by moving decimal point to the right, and division by moving to left. Basic units of measurement are: meter (length), liter (volume), and gram (weight). 2. Apothecaries System (Oldest System of Measurement) Basic unit of weight is grain (gr) Basic unit of volume is minim 3. Household System- accurate measures are not required. (ex. teaspoon)

Medication Reconciliation - creating the most accurate list of all medications a patient is taking; and comparing it against Physicians admission, transfers and or discharge orders. Medication Dispensing Systems 1. Medication Cart on wheels allowing nurse to move cart outside the clients room. 2. Medication Cabinet locked cabinet in clients room; contains unit dose medications and MAR; no controlled substances; use of key or special code. 3. Medication Room central location for stock medications, controlled medications, and or drugs for emergencies; with key or special code. 4. Automated Dispensing Cabinet (ADC) computerized access system for distribution, management, and control of medications; similar to ATM Process of Administering Medications 1. Identify the client at least 2 client identifiers; acceptable identifiers are persons name, assigned ID no, telephone no., or other person specific identifier, wristband, and hospital identification no. 2. Inform the Client 3. Administer the Drug 4. Provide Adjunctive Measurements 5. Record the drug administered 10 Rights of Medication Administration 1. 2. 3. 4. 5. 6. 7. Right Assessment prior medication Right Client Right Client Education Right to Refuse Right Medication Right Dose Right Time (right frequency; medications given 30 mins before or after schedule are considered to meet the right time considered) 8. Right Route 9. Right Documentation 10. Right Evaluation Parenteral Medications absorption of medications are faster than oral medications and irretrievable once injected Equipment for Parenteral Medications 1. Syringe a. Tip connected with needle b. Barrel outside part; where scales are printed c. Plunger inside the barrel Nurse may touch outside of barrel and handle of plunger. Avoid any sterile object to touch tip or inside barrel, shaft of plunger, and tip of the needle.

Parts of Needle: 1. Hub fits into the syringe 2. Cannula or Shaft attached to hub 3. Bevel slanted part at the tip of needle 3 Variable Characteristics of Needle 1. Length of Bevel a. Short ID, IV b. Long provide sharpest needles and less discomfort; for SC and IM 2. Length of Shaft 3. Gauge (Diameter of Shaft) Varies from #18 28 Larger gauge # = low diameter of shaft; for viscous medication(ex. Penicillin) Smaller gauge # - low tissue trauma Preventing Needle Stick Injuries 1. Passive needle retracts immediately into barrel 2. Active ex. Nurse retract needles into syringe barrel, after injection, manually pulls and plastic sheath or guard over needle Preparing Injectable Medications withdraw meds from ampule or vial into sterile syringe a. Ampule glass container used to hold a single dose of drug; 1 10 ml or more b. Vial small glass bottle with sealed rubber cap; varies from single to multiple doses. Reconstitution technique of adding diluents to a powdered drug to prepare it for administration 3 most common syringes 1. Hypodermic Syringe (Standard) marked in tenths (0.1) in milliliters and in minims 2. Insulin Syringe for insulin only; marked in 100 units 3. Tuberculin Syringe marked in tenths and hundredths (0.01) of cubic milliliters and in minims; for tuberculin solution; for small precise measurement (ex. Pediatric dosage) Intrarterial into the artery Intracardiac into heart muscles Intraspinal into spinal cord Intraosseous into the bone