Lecture 6 - Medications

‭Drug Preparations‬ ‭●‬ ‭Oral‬ ‭○‬ ‭Capsule, pill, tablet, extended-release‬ ‭○‬ ‭Elixir, suspension, syrup (liquid)‬ ‭●‬ ‭Topical‬ ‭○‬ ‭Lotion, liniment, transdermal patch‬ ‭○‬ ‭Ointment, suppository‬ ‭○‬ ‭Includes mucous membranes (vaginal, rectal, etc.)‬ ‭●‬ ‭Inhalable‬ ‭●‬ ‭Injectable‬ ‭Drug Nomenclature‬ ‭●‬ ‭Chemical name: N-acetyl-p-aminophenol‬ ‭○‬ ‭Describes atomic/molecular structure‬ ‭●‬ ‭Generic name: Acetaminophen‬ ‭○‬ ‭Identifies the drug’s active ingredient, universally accepted‬ ‭●‬ ‭Official name: Acetaminophen‬ ‭○‬ ‭Used in publications, typically the same as the generic name‬ ‭●‬ ‭Trade name: Tylenol‬ ‭○‬ ‭Selected and trademarked by a pharmaceutical company‬ ‭○‬ ‭One drug can have multiple trade names‬ ‭Administration of Oral Medications‬ ‭●‬ ‭Oral route: Through mouth‬ ‭●‬ ‭Enteral route: Through digestive system; assisted (no‬ ‭swallowing)‬ ‭○‬ ‭Ex. NG tube‬ ‭●‬ ‭Sublingual administration‬ ‭○‬ ‭Ex. nitroglycerin‬ ‭●‬ ‭Buccal administration‬ ‭Topical Administration of Medications‬ ‭●‬ ‭Skin applications‬ ‭●‬ ‭Eye instillations and irrigations‬ ‭●‬ ‭Ear instillations and irrigations‬ ‭●‬ ‭Nasal instillations‬ ‭●‬ ‭Vaginal applications‬ ‭●‬ ‭Rectal instillations‬ ‭Instilling Eye Drops‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭●‬ ‭●‬ ‭‬ ● ‭●‬ ‭ lean the eyelids and eyelashes of any drainage with cotton balls/gauze squares‬ C ‭Tilt the patient’s head back slightly or place their head over a pillow‬ ‭Have the patient look up‬ ‭Place the thumb or two fingers near the margin of the lower eyelid immediately below the‬ ‭eyelashes and exert pressure downward over the bony prominence of the cheek‬ ‭The lower conjunctival sac is exposed as the lower lid is pulled down‬ ‭Hold the dropper close to the eye but avoid touching the eyelids or lashes‬ ‭Squeeze the container and allow the prescribed number of drops to fall in the lower‬ ‭conjunctival sac‬ ‭Do not allow medication to fall onto the cornea; this may injure the cornea or cause the‬ ‭patient to have an unpleasant sensation‬ ‭Release lower lid and ask patient to close eye gently‬ ‭Apply gentle pressure over the inner canthus to prevent drops from flowing into tear duct‬ ‭Instilling Ear Drops‬ ‭●‬ ‭Clean the ear of external drainage with cotton balls‬ ‭●‬ ‭Position patient so affected ear is uppermost‬ ‭●‬ ‭Draw up the amount of solution needed‬ ‭●‬ ‭Straighten the auditoral canal by pulling the cartilaginous portion of the pinna up and‬ ‭back in an adult, straight back for a child older than 3, and down and back in an‬ ‭infant/child younger than 3‬ ‭○‬ ‭Pulling on the pinna helps to straighten the canal properly for ear instillation‬ ‭●‬ ‭Hold the dropper in the ear with its tip above the auditory canal and allow drops to‬ ‭fall on the side of the canal‬ ‭○‬ ‭For an infant or irrational/confused patient, protect the dropper with a piece of‬ ‭soft tubing to prevent injury to the ear‬ ‭○‬ ‭Avoid instilling in the middle of the canal to avoid direct instillation onto the‬ ‭tympanic membrane‬ ‭●‬ ‭Press on the tragus to help drops move into the tympanic membrane‬ ‭●‬ ‭Insert cotton ball if ordered‬ ‭●‬ ‭If drops are ordered for the other ear, wait 5 minutes before repeating the procedure‬ ‭●‬ ‭Document date, time, dose, route of administration, and site of administration‬ ‭Inhaled Medication Device‬ ‭●‬ ‭Metered-dose inhaler (MDI): Aerosolized medication‬ ‭○‬ ‭Shake the inhaler before use (3-4 times)‬ ‭○‬ ‭Remove the inhaler cap‬ ‭○‬ ‭Breathe out completely and slowly‬ ‭○‬ ‭Bring the inhaler to the mouth; place it between the teeth and close lips‬ ‭around it‬ ‭○‬ S ‭ tart breathing in slowly evenly and deeply; press down on the‬ ‭inhaler one time (start breathing in, then press)‬ ‭○‬ ‭Continue to breathe in slowly until you have taken a full breath‬ ‭○‬ ‭Remove the inhaler from the mouth and hold breath for 10‬ ‭seconds (or as long as possible), then breathe out‬ ‭ ‬ ‭MDI with spacer: Improves chances of getting more medicine into the lungs‬ ● ‭○‬ ‭Shake the medicine‬ ‭○‬ ‭Insert the mouthpiece of the inhaler into the rubber-sealed end of the spacer‬ ‭○‬ ‭Breathe all of the air out of the lungs, then put the spacer into the mouth between‬ ‭teeth; make a tight seal around the mouthpiece with lips‬ ‭○‬ ‭Press the MDI down to release a spray of medicine, which‬ ‭will be trapped in the spacer; breathe in slowly and deeply‬ ‭○‬ ‭Hold breath for 5-10 seconds, then breathe out slowly‬ ‭●‬ ‭Dry powder inhaler (DPI)‬ ‭○‬ ‭Have the patient breathe in quickly and deeply through the‬ ‭mouth for longer than 2-3 seconds‬ ‭○‬ ‭Remove the inhaler from the mouth‬ ‭○‬ ‭Instruct the patient to hold their breath for 5-10 seconds‬ ‭then to exhale slowly through pursed lips‬ ‭○‬ ‭Wait 1-5 minutes before administering the next puff‬ ‭●‬ ‭Small-volume nebulizer‬ ‭○‬ ‭Have the patient inhale slowly and deeply through the‬ ‭mouth and hold each breath for a slight pause before‬ ‭exhaling (a nose clip may be necessary)‬ ‭○‬ ‭Continue for about 15 minutes‬ ‭Pharmacokinetics: Absorption‬ ‭●‬ ‭Transfer of drugs across the membrane into the bloodstream; factors include:‬ ‭○‬ ‭Rate of dissolution: How fast it dissolves‬ ‭○‬ ‭Surface area: Area available for absorption (larger is faster)‬ ‭○‬ ‭Blood flow: If it is high, there is faster absorption‬ ‭○‬ ‭Lipid solubility: Lipid-soluble drugs are absorbed more rapidly and can more‬ ‭readily cross membranes that separate them from the blood‬ ‭Pharmacokinetics: Distribution‬ ‭●‬ ‭Movement of drugs to site of action; factors include:‬ ‭○‬ ‭Blood flow to tissues‬ ‭○‬ ‭Ability of a drug to exit the vascular system‬ ‭○‬ ‭The ability of a drug to enter cells‬ ‭Pharmacokinetics: Metabolism‬ ‭●‬ ‭Primary route of metabolism is hepatic‬ ‭●‬ ‭Metabolism has six possible consequences:‬ ‭○‬ ‭Accelerated renal excretion‬ ‭○‬ ‭Drug inactivation‬ ‭○‬ ‭Increased therapeutic action‬ ‭○‬ ‭Activation of prodrugs‬ ‭○‬ ‭Increased toxicity‬ ‭○‬ ‭Decreased toxicity‬ ‭Pharmacokinetics: Excretion‬ ‭●‬ ‭Glomerular filtration: Filtration removes drugs from the blood to urine; protein-bound‬ ‭drugs will not undergo glomerular filtration‬ ‭●‬ ‭Passive reabsorption: Lipid-soluble drugs move badck into the blood; polar and ionized‬ ‭drugs remain in the urine‬ ‭●‬ ‭Active transport: Tubular pumps for organic acids and bases move drugs from blood to‬ ‭urine‬ ‭●‬ ‭Factors affecting renal excretion include:‬ ‭○‬ ‭Age‬ ‭○‬ ‭Lipid solubility‬ ‭○‬ ‭Protein binding‬ ‭○‬ ‭pH and ionization‬ ‭○‬ ‭Competition of active transport‬ ‭○‬ ‭Renal dysfunction‬ ‭Bioavailability‬ ‭●‬ ‭The portion of the drug reaching systemic‬ ‭circulation with the ability to act on cells‬ ‭●‬ ‭F = F‬‭absorbed‬ ‭* (1 - E‬‭gut‬‭)*(1 - E‬‭liver‬‭)‬ ‭●‬ ‭Oral drug absorption‬ ‭○‬ ‭Dose depends on age, sex, disease‬ ‭states‬ ‭●‬ ‭Disintegration and drug dissolution‬ ‭○‬ ‭Food, GI pH, pKa, solubility,‬ ‭lipophilicity, particle size‬ ‭●‬ ‭Gastrointestinal drug permeation‬ ‭○‬ ‭GI pH, lipophilicity, food-drug interactions, uptake and efflux transporters‬ ‭●‬ ‭Drug in the portal vein‬ ‭○‬ ‭Hepatic metabolism (CYP450 enzymes), drug-drug interactions, protein binding‬ ‭●‬ ‭Drug in the hepatic vein of the liver‬ ‭●‬ ‭Drug in systemic circulation‬ ‭Question:‬‭Which of the following is the primary organ‬‭for drug metabolism?‬ ‭a.‬ ‭Liver‬ ‭b.‬ ‭Kidney‬ ‭c.‬ ‭Lungs‬ ‭d.‬ ‭Testes‬ ‭e.‬ ‭Skin, plasma, nervous tissue, and intestines‬ ‭Factors Affecting Drug Absorption‬ ‭●‬ ‭Route of administration‬ ‭○‬ ‭Oral: Longest absorption time‬ ‭■‬ ‭Liquids (no dissolving) have a faster absorption rate than capsules or‬ ‭tablets‬ ‭○‬ ‭IM/sub-Q: Absorbed more rapidly than oral‬ ‭○‬ ‭Transdermal: Local absorption‬ ‭○‬ ‭Mucous membranes: Local and systemic‬ ‭absorption‬ ‭●‬ ‭Lipid solubility‬ ‭○‬ ‭A more lipid-soluble drug has increased‬ ‭absorption because of the cell membrane’s fatty‬ ‭acid layer‬ ‭○‬ ‭It is absorbed more quickly in the blood stream and can exert effects faster‬ ‭●‬ ‭pH‬ ‭○‬ ‭Acidic drugs: Well-absorbed in the stomach‬ ‭○‬ ‭Alkalotic drugs: Remain ionized/insoluble in an acidic environment; absorbed in‬ ‭the small intestine (distal ileum)‬ ‭●‬ ‭Blood flow‬ ‭○‬ ‭Absorption is increased with increased blood flow‬ ‭○‬ ‭Patients with impaired circulation absorb drugs less rapidlyl than patient with‬ ‭normal circulatory function‬ ‭●‬ ‭Location conditions at the site of administration‬ ‭○‬ ‭The more extensive the absorbing surface (skin, mucous membrane), the greater‬ ‭the absorption of drug and more rapid the effect‬ ‭○‬ ‭Food: Can slow or enhance (for poorly soluble drugs) the rate of absorption‬ ‭○‬ ‭Diarrhea and vomiting‬ ‭○‬ ‭Sustained-release preparations‬ ‭○‬ ‭Enteric-coated preparations‬ ‭●‬ ‭Drug dosage‬ ‭○‬ ‭The amount of drug administered directly impacts bioavilability‬ ‭‬ S ○ ‭ erum drug levels help determine correct drug dosage‬ ‭○‬ ‭Loading dose: A larger than normal dose; given for patients in acute stress when‬ ‭the maximum therapeutic effect is desires as quickly as possible‬ ‭○‬ ‭Maintenance dose: A lower dosage that becomes the daily/usual dosage, usually‬ ‭follows a loading dose‬ ‭Factors Affecting Drug Action‬ ‭●‬ ‭Developmental considerations‬ ‭○‬ ‭Teratoigenic drugs‬ ‭●‬ ‭Weight or body surface area (BSA)‬ ‭○‬ ‭Dosage‬ ‭●‬ ‭Cultural and genetic factors‬ ‭●‬ ‭Psychological factors‬ ‭○‬ ‭Placebo effect‬ ‭●‬ ‭Pathology‬ ‭●‬ ‭Environment‬ ‭○‬ ‭External environment‬ ‭○‬ ‭Nutritional state‬ ‭●‬ ‭Timing of administration‬ ‭Aging and Drug Responses‬ ‭●‬ ‭Decreased gastric motility; increased gastric pH‬ ‭○‬ ‭Implication: Irritation, N/V, ulcers, altered absorption‬ ‭○‬ ‭Assess: GI discomfort, stool in blood‬ ‭●‬ ‭Decreased lean body mass and total body water‬ ‭○‬ ‭Implication: More likely for drug toxicity‬ ‭○‬ ‭Assess: Signs of toxicity, drug serum levels, fluid balance (I&O)‬ ‭●‬ ‭Increased adipose tissue‬ ‭○‬ ‭Implication: Accumulation of lipid-soluble drugs‬ ‭○‬ ‭Assess: Interactions or toxicity; blood levels of drugs‬ ‭●‬ ‭Decreased liver function‬ ‭○‬ ‭Implication: Decreased drug metabolism; prolonged drug action‬ ‭○‬ ‭Assess: Toxicity, blood levels, variable hepatic enzymes‬ ‭●‬ ‭Decreased kidney function‬ ‭○‬ ‭Implication: Decreased excretion of drugs, increased serum levels‬ ‭○‬ ‭Assess: Toxicity, NSAID use, blood levels, lab values of creatnine, BUN‬ ‭●‬ ‭Alteration in normal homeostatic responses and peripheral venous tone‬ ‭○‬ ‭Implication: Increased response to CV drugs, hypotensive effects from meds‬ ‭○‬ ‭Assess: Toxicity, vital signs, blood levels, OH‬‭-‬ ‭●‬ ‭Alterations in BBB‬ ‭ ‬ ‭Implications: Increased CNS penetration, altered metnal status‬ ○ ‭○‬ ‭Assess: Toxicity, dizziness, fall safety precautions‬ ‭ ‬ ‭Decreased CNS efficiency‬ ● ‭○‬ ‭Implication: Prolonged drug effects, increased sedation‬ ‭○‬ ‭Assess: Toxicity, neurologic status, VS, pulse oximetry‬ ‭●‬ ‭Decreased production of oral secretions; dry mouth‬ ‭○‬ ‭Implication: Difficulty swallowing oral medications‬ ‭○‬ ‭Assess: Swallow, changing medication forms‬ ‭●‬ ‭Decreased lipid content in and blood supply to skin‬ ‭○‬ ‭Implication: Decreased absorption of transdermal medications‬ ‭○‬ ‭Assess: Effectiveness of transdermal preparations‬ ‭Parts of the Medication Order‬ ‭●‬ ‭Patient’s name and secondary identifier‬ ‭(ex. DOB or MRN)‬ ‭●‬ ‭Name of drugs: Trade/brand or generic‬ ‭name‬ ‭●‬ ‭Dosage of drug: Metric system or‬ ‭household system‬ ‭●‬ ‭Frequency of administration of the drug‬ ‭○‬ ‭Time by a 24-hour clock‬ ‭●‬ ‭Routes: Oral, sublingual, buccal, IV, IM,‬ ‭sub-Q, intradermal, topical, vaginal,‬ ‭rectal, pulmonary (inhalation)‬ ‭●‬ ‭Date and time order is written‬ ‭●‬ ‭Signature of person who wrote the order‬ ‭Types of Medication Orders‬ ‭●‬ ‭Stat: Carried out immediately, urgent circumstances‬ ‭○‬ ‭Ex. benadryl 50 mg PO stat‬ ‭●‬ ‭PRN: As needed; can be requested by the patient and based on symptoms‬ ‭○‬ ‭Ex. acetaminophen 500 mg PO every 4-6 hours‬ ‭●‬ ‭Standing: Carried out until cancelled by another order; does not require provider order‬ ‭○‬ ‭Ex. four chewable aspirin for chest pain‬ ‭●‬ ‭t.i.d: Three times a day‬ ‭●‬ ‭q.i.d: Four times a day‬ ‭●‬ ‭q4h: Every four hours‬ ‭●‬ ‭ac: Before meals‬ ‭●‬ ‭ps: After meals‬ ‭●‬ ‭hs: Hour of sleep‬ ‭Questions:‬‭______ gastric pH decreases drug absorption.‬ ‭a.‬ ‭Increased‬ ‭b.‬ ‭Decreased‬ ‭______ gastric motility decreases drug absorption.‬ ‭a.‬ ‭Increased‬ ‭b.‬ ‭Decreased‬ ‭c.‬ ‭Either/depends‬ ‭Decreased liver function will ______ drug metabolism.‬ ‭a.‬ ‭Increase‬ ‭b.‬ ‭Decrease‬ ‭ ou are administering Voltaren to a patient with psoriasis. How could this type of skin disorder‬ Y ‭potentially impact drug absorption?‬ ‭a.‬ ‭Lipid solubility‬ ‭b.‬ ‭pH‬ ‭c.‬ ‭Blood flow‬ ‭d.‬ ‭Local condition of administration site‬ ‭Which of the following is a developmental consideration for drug action?‬ ‭a.‬ ‭Ability to speak‬ ‭b.‬ ‭Age‬ ‭c.‬ ‭Ability to ambulate‬ ‭d.‬ ‭Weight‬ ‭ uring hospitalization, OTC medicines may be given to patients without a medication order‬ D ‭from a licensed practitioner.‬ ‭a.‬ ‭True‬ ‭b.‬ ‭False‬ ‭Medication Supply Systems‬ ‭●‬ ‭Computerized automated dispensing system (Pyxis)‬ ‭●‬ ‭Individual unit dose supply‬ ‭●‬ ‭Medication cart‬ ‭●‬ ‭Bar code-enabled cart‬ ‭Three Checks of Medication Administration‬ ‭●‬ ‭1st check: Read the medication administration record (eMAR/MAR) and select the‬ ‭proper medication from drawer or supply system‬ ‭●‬ ‭2nd check: After obtaining the medication, compare the medication label with the MAR‬ ‭○‬ ‭Immediately before putting it in a multiuser container‬ ‭●‬ ‭3rd check: Most commonly, at the bedside, re-check labels with the eMAR after‬ ‭identifying the patient and before administration‬ ‭○‬ ‭Depends on facility policy‬ ‭Rights of Administration‬ ‭●‬ ‭Right patient‬ ‭●‬ ‭Right drug/medication‬ ‭●‬ ‭Right dose‬ ‭●‬ ‭Right time (before/after meals)‬ ‭●‬ ‭Right route (oral, sub-Q, nasal, etc.)‬ ‭●‬ ‭Right reason‬ ‭●‬ ‭Right documentation‬ ‭●‬ ‭Additionally includes:‬ ‭○‬ ‭Right assessment‬ ‭○‬ ‭Righ tresponse‬ ‭○‬ ‭Right to education‬ ‭○‬ ‭Right to refuse‬ ‭●‬ ‭Administration of Parenteral Medications‬ ‭●‬ ‭Intramuscular injection‬ ‭●‬ ‭Subcutaneous injection‬ ‭●‬ ‭Intradermal injection‬ ‭●‬ ‭Intravenous injection‬ ‭●‬ ‭Intra-arterial injection‬ ‭●‬ ‭Intracardial injection‬ ‭●‬ ‭Intraperitoneal injection‬ ‭●‬ ‭Intraspinal injection‬ ‭●‬ ‭Intra-osseus injection‬ ‭Preparing Medications for Injection‬ ‭●‬ ‭Ampules‬ ‭●‬ ‭Vials‬ ‭●‬ ‭Prefilled cartridges‬ ‭Angles of Insertion for Various Injections‬ ‭Intradermal Injection‬ ‭●‬ ‭Forearm‬ ‭●‬ ‭A purified derivative (PPD) skin for tuberculosis (TB)‬ ‭Sites for Subcutaneous Injections‬ ‭●‬ ‭Upper arm‬ ‭●‬ ‭Abdomen‬ ‭●‬ ‭Anterior aspects of the thigh‬ ‭●‬ ‭The upper back‬ ‭●‬ ‭The upper dorsogluteal area‬ ‭Subcutaneous Injection‬ ‭●‬ ‭Rotate the injection site to prevent lipoatrophy/lipohypertrophy‬ ‭●‬ ‭No more than 1 mL of solution given‬ ‭●‬ ‭Ex. insulin, heparin‬ ‭Insulin Injection‬ ‭●‬ ‭Insulin doses are calculated in units‬ ‭●‬ ‭100 units of insulin contained in 1 mL of solution‬ ‭○‬ ‭Rapid-acting‬ ‭○‬ ‭Short-acting‬ ‭■‬ ‭RI: Regular insulin‬ ‭○‬ ‭Intermediate-acting‬ ‭■‬ ‭NPH: Neutral protamine hagedorn insulin‬ ‭○‬ ‭Long-acting‬ ‭○‬ ‭Pre-mixed‬ ‭ uestion:‬‭The client has type I diabetes and receives insulin. He asks the‬ Q ‭nurse why he can’t just take pills instead. What is the best response?‬ ‭a.‬ ‭Insulin must be injected because it needs to work quickly.‬ ‭b.‬ ‭Insulin can’t be in a pill since it would be destroyed by digestive‬ ‭enzymes.‬ ‭c.‬ ‭Have you talked to your doctor about taking pills instead?‬ ‭d.‬ ‭I know it’s tough, but you will get used to the shots soon.‬ ‭Sites for Intramuscular Injections‬ ‭●‬ ‭Dorsogluteal site (upper outer quadrant) is no longer recommended‬ ‭because of nerve plexus‬ ‭●‬ ‭Ventrogluteal site (on the side)‬ ‭●‬ ‭Deltoid site‬ ‭●‬ ‭Vastus lateralis site (pediatric)‬ ‭●‬ ‭Z-tract injection‬ ‭○‬ ‭Giving dark-colored medication (iron solution)‬ ‭○‬ ‭Irritation medication (Haloperidol, Hydroxyzine)‬ ‭SIRVA‬ ‭●‬ ‭Shoulder injury related to vaccine administration‬ ‭●‬ ‭Too high:‬ ‭○‬ ‭Risk of injecting into shoulder joint or bursa‬ ‭○‬ ‭Causes inflammation, leading to bursitis, frozen shoulder‬ ‭syndrome, and other complications‬ ‭○‬ ‭Watch for prolonged shoulder pain, weakness, and‬ ‭decreased ROM‬ ‭○‬ ‭Symptoms begin within hours to days‬ ‭○‬ ‭Without treatment, symptoms last‬ ‭months and may never resolved‬ ‭●‬ ‭Too far to side or too low‬ ‭○‬ ‭Can inject into axillary or radial nerve‬ ‭○‬ ‭Can cause paralysis and/or neuropathy‬ ‭○‬ ‭Watch for burning, shooting pain during‬ ‭○‬ ‭Symptoms start immediately‬ ‭No Longer Standard IM Methods‬ ‭●‬ ‭Apirating after inserting a needle‬ ‭●‬ ‭Massaging after removing a needle‬ ‭●‬ ‭Using the dorsogluteal site‬ ‭Criteria for Choosing Injection Equipment‬ ‭●‬ ‭Route of administration‬ ‭●‬ ‭Type of viscosity of the solution‬ ‭●‬ ‭Quantity to be administered‬ ‭●‬ ‭Body size‬ ‭Injection Needles‬ ‭●‬ ‭As the gauge number increases, the needle‬ ‭diameter decreases‬ ‭●‬ ‭As the gauge number decreases, the needle‬ ‭diameter increases‬ ‭●‬ ‭Intravenous: 20-24 gauge (large diameter)‬ ‭●‬ ‭Intramuscular: 22-25 gauge‬ ‭●‬ ‭Subcutaneous/intradermal: 25-40 gauge (small‬ ‭diameter)‬ ‭Adverse Effects of Medications‬ ‭●‬ ‭Allergic effects‬ ‭○‬ ‭Immune system response‬ ‭○‬ ‭The body detects the allergen as a foreign substance and creates antibodies‬ ‭○‬ ‭Reaction can occur immediately after medication or hours/days‬ ‭○‬ ‭Reactions can be increasingly more severe as a drug is introduced‬ ‭○‬ ‭Common symptoms: Rash, urticaria, fever, diarrhea‬ ‭○‬ ‭Anaphylactic shock is the most serious response‬ ‭○‬ ‭Anaphylaxis is life-threatening: Respiratory distress, severe bronchospasms, CV‬ ‭collapse‬ ‭●‬ ‭Toxic effects‬ ‭○‬ ‭Specific group of symptoms on drug therapy; can lead to death or permanent‬ ‭damage‬ ‭○‬ ‭Occur from a cumulative effect, when the body cannot metabolize the dose of a‬ ‭drug before another one is administered‬ ‭○‬ ‭The body absorbs the drug much faster than it excretes it‬ ‭○‬ ‭Older adults are at risk du eto impaired hepatic metabolism or excretion‬ ‭●‬ ‭Iatrogenic complications‬ ‭○‬ ‭Disease that occurs as a result of medical care or treatment‬ ‭ ‬ ‭Unintentionally by drug therapy‬ ○ ‭○‬ ‭Neutropenia due to chemotherapy‬ ‭ ‬ ‭Idiosyncratic effects‬ ● ‭○‬ ‭Unusual response to a drug (either an over-response, under-response, or complete‬ ‭opposite of what is intended) due to genetic enzymes‬ ‭○‬ ‭Abnormal mechanism of drug breakdown‬ ‭●‬ ‭Drug interactions‬ ‭○‬ ‭When a drug interacts another drug, food, or other substance‬ ‭○‬ ‭Synergistic effect: Drugs with different sites/mechanisms of actions result in‬ ‭greater effects when taken together (potentiative)‬ ‭○‬ ‭Antagonistic effect: One drug blocks the other; results in a less total effect‬ ‭Signs and Symptoms of a Drug Allergy‬ ‭●‬ ‭Rash, diarrhea, N/V, urticaria (hives), fever‬ ‭●‬ ‭An anaphylactic reaction is a life-threatening reaction‬ ‭○‬ ‭Causes swelling, dyspnea, dizzines, and tachycardia‬ ‭●‬ ‭Treatment includes epinephrine, IV fluids, and antihistamines‬ ‭●‬ ‭Common drug allergies: Penicillin, sulfonamides, and NSAIDs (ex. ibuprofen, aspirin)‬ ‭Types of Medication Errors‬ ‭●‬ ‭Inappropriate prescribing of a drug‬ ‭○‬ ‭Risks > benefits‬ ‭●‬ ‭Extra, omitted, or incorrect doses‬ ‭○‬ ‭More doses than prescribed or dose not given‬ ‭○‬ ‭Dose is 5% over/under the appropriate amount‬ ‭●‬ ‭Administration of drug to the wrong patient‬ ‭●‬ ‭Administration of drug by the wrong route or rate‬ ‭○‬ ‭Route: Oral drugs incorrectly used in IV‬ ‭○‬ ‭Rate: Medication is too fast or slow‬ ‭●‬ ‭Failure to give medication within prescribed time‬ ‭○‬ ‭With or without food‬ ‭○‬ ‭Early or late‬ ‭●‬ ‭Incorrect preparation of a drug‬ ‭○‬ ‭Compound or specific diluent‬ ‭●‬ ‭Improper technique when administering drug‬ ‭○‬ ‭Drug activation‬ ‭○‬ ‭Tablets or IV‬ ‭●‬ ‭Giving a drug that has deteriorated‬ ‭○‬ ‭Improper storage leads to expired drugs‬ ‭Preventing Medication Errors‬ ‭●‬ ‭Check the patient’s condition immediately; observe for adverse effects‬ ‭○‬ ‭Quickly assess the patient (vital signs, LOC, and specific S/S)‬ ‭○‬ ‭Monitor patient (allergic reactions, changes in heart rate, signs of distress, etc.)‬ ‭●‬ ‭Notify nurse manage or physician‬ ‭○‬ ‭Inform the nurse panager and physician if an error is present‬ ‭○‬ ‭Provide details that are clear and concise‬ ‭●‬ ‭Write description of error and remedial steps taken on medical record‬ ‭○‬ ‭Vital for the healthcare team; may influence further treatment decisions‬ ‭○‬ ‭Give a details description and how the patient will be monitored moving forward‬ ‭●‬ ‭Complete the special form for reporting errors‬ ‭○‬ ‭Reporting helps to identify patterns that may indicate systemic issues, leading to‬ ‭improvements in processes and protocols‬ ‭ uestion:‬‭The nurse enters a client’s romm to administer‬‭medications, and the client calls from‬ Q ‭the bathroom, “Just leave the medicines on my bedside table. I promise I’ll take them as soon as‬ ‭I’m finished.” Which of the following responses is most appropriate?‬ ‭a.‬ ‭I will return with the medications when you are finished in the bathroom.‬ ‭b.‬ ‭I need to wait here until you’re finished. Please hurry.‬ ‭c.‬ ‭I will withhold the dose until the next administration time.‬ ‭d.‬ ‭I’ll need to let your primary carte provider that you won’t take your medications.‬ ‭Patient Teaching‬ ‭●‬ ‭Review techniques of medication administration‬ ‭○‬ ‭Oral, IV, topical, injecftion, infusion, implantation‬ ‭○‬ ‭Timing and frequency‬ ‭●‬ ‭Remind the patient to take the medication for as long as prescribed‬ ‭○‬ ‭Important for effectiveness, preventing relapse, avoiding resistance, and managing‬ ‭chronic conditions‬ ‭●‬ ‭Instruct the patient not to alter doses without consulting a healthcare provider‬ ‭●‬ ‭Caution the patient to not share medications‬ ‭○‬ ‭Every prescription affects everyone differently‬ ‭Calculating Drug Dosages‬ ‭●‬ ‭𝑞𝑢𝑎𝑛𝑡𝑖𝑡𝑦‬‭‭𝑑 ‬ 𝑒𝑠𝑖𝑟𝑒𝑑‬ = ‭𝑞𝑢𝑎𝑛𝑡𝑖𝑡𝑦‬‭‬‭𝑜𝑛‬‭‬‭ℎ𝑎𝑛𝑑‬ ‭𝑑𝑜𝑠𝑒‬‭‬‭𝑜𝑛‬‭‬‭ℎ𝑎𝑛𝑑‬ × ‭‬‭𝑑𝑜𝑠𝑒‬‭‭𝑑 ‬ 𝑒𝑠𝑖𝑟𝑒𝑑‬ ‭ uestions:‬‭Amoxicillin, 625 mg PO is ordered. It is‬‭supplied as a liquid preparation containing‬ Q ‭250 mg in 5 mL. How much does the nurse administer?‬ ‭●‬ ‭5‬‭‭𝑚 ‬ 𝐿‬ ‭250‬‭‬‭𝑚𝑔‬ × ‭625‬‭‬‭𝑚𝑔‬ = ‭12‬. ‭5‭‬‬‭𝑚𝐿‬ ‭1.5 grams equals how many milligrams?‬ ‭a.‬ ‭0.0015‬ ‭b.‬ ‭15‬ ‭c.‬ ‭150‬ ‭d.‬ ‭1,500‬ ‭ ndansetron (Zofran) 0.15 mg/kg is ordered. Ondansetron is available 2 mg/mL. The patient‬ O ‭weighs 30 kg. How much would the nurse administer?‬ ‭a.‬ ‭9 mL‬ ‭b.‬ ‭3 mL‬ ‭c.‬ ‭2.25 mL‬ ‭d.‬ ‭1.5 mL‬ ‭●‬ ‭30‬‭‬‭𝑘𝑔‬ × ‭0.‬ ‭15‬‭‭𝑚 ‬ 𝑔‬‭/‭𝑘 ‬ 𝑔‬ = ‭4.‬ ‭5‭‬‬‭𝑚𝑔‬ ‭●‬ ‭4‬.‭5‬‭‬‭𝑚𝑔‬ ‭2‬‭‬‭𝑚𝑔‬‭/‭𝑚 ‬ 𝐿‬ = ‭2.‬ ‭25‬‭‬‭𝑚𝐿‬ ‭IV Flow Rate‬ ‭𝑣𝑜𝑙𝑢𝑚𝑒‬ ‭𝑡𝑖𝑚𝑒‬ ‭𝑣𝑜𝑙𝑢𝑚𝑒‬‭‬(‭𝑚𝐿‬) ‭Pump formula:‬ ‭𝑡𝑖𝑚𝑒‬‭‬(‭ℎ𝑟‬) = ‭𝑣𝑜𝑙𝑢𝑚𝑒‬‭‬(‭𝑚𝐿‬) ‭Manual IV setup:‬ ‭𝑡𝑖𝑚𝑒‬‭‬(‭𝑚𝑖𝑛‬) ‭●‬ ‭𝑓𝑙𝑜𝑤‬‭‭𝑟‬ 𝑎𝑡𝑒‬ = ‭●‬ ‭●‬ ‭𝑟𝑎𝑡𝑒‬‭‬(‭𝑚𝑙‬‭/‭ℎ ‬ 𝑟‬) × ‭𝑑𝑟𝑖𝑝‬‭‬‭𝑓𝑎𝑐𝑡𝑜𝑟‬‭(‬ ‭𝑔𝑡𝑡‬‭/‭𝑚 ‬ 𝐿‬) = ‭𝑟𝑎𝑡𝑒‬‭‬(‭𝑔𝑡𝑡‬‭/‭𝑚 ‬ 𝑖𝑛‬) ‭○‬ ‭gtt/min: The number of drops which fall in the drip chamber per minute‬ ‭ uestion‬‭: Order is to administer 800 mg/250 mL of‬‭Azithromycin at a rate of 10 mcg/kg/min.‬ Q ‭Patient weights 85 kg. What is the IV flow rate in mL/hr to administer the antibiotic?‬ ( ‭10‬‭‬‭𝑚𝑐𝑔‬ ‭/‭𝑚 ‬ 𝑖𝑛‬) ‭𝑘𝑔‬ × ‭85‬‭‭𝑘 ‬ 𝑔‬ = ‭850‬‭‬‭𝑚𝑐𝑔‬ ‭𝑚𝑖𝑛‬ × ‭60‬‭‭𝑚 ‬ 𝑖𝑛‬ = ‭51000‬‭‬‭𝑚𝑐𝑔‬ ‭ℎ𝑟‬ × ‭1‭‬‬‭𝑚𝑔‬ ‭1000‬‭‭𝑚 ‬ 𝑐𝑔‬ = ‭51‬‭‭𝑚 ‬ 𝑔‬ ‭ℎ𝑟‬ × ‭250‬‭‭𝑚 ‬ 𝐿‬ ‭ 00‬‭‬‭𝑚𝑔‬ 8 = ‭15‬.‭9‬‭‭𝑚 ‬ 𝐿‬ ‭ℎ𝑟‬ ‭Drip Factor‬ ‭●‬ ‭Macrodrip tubing: Commonly used‬ ‭○‬ ‭10 gtt/mL, 15 gtt/mL, 20 gtt/mL‬ ‭●‬ ‭Microdrip tubing: Children and infants or for‬ ‭sensitive medications‬ ‭○‬ ‭60 gtt/mL‬ ‭ uestions:‬‭Order is to administer 0.9% NaCl at 75‬ Q ‭mL/hr. There are no IV pumps available. You will need to calculate and set the drip factor‬ ‭manually. The unit carries 15 gtts/mL tubing. How many gtts/min will you set the drip flow rate?‬ ‭75‬‭‬‭𝑚𝐿‬ ‭ 0‬‭‬‭𝑚𝑖𝑛‬ 6 × ‭15‬‭‬‭𝑔𝑡𝑡𝑠‬ ‭𝑚𝐿‬ = ‭18‬.‭75‬‭‬‭𝑔𝑡𝑡𝑠‬ ‭𝑚𝑖𝑛‬ ‭ he nurse provides care for an infant who is prescribed ceftriaxone, 0.1 mg/kg intramuscular stat‬ T ‭for the treatment of an upper respiratory infection (URI). The infant’s current weight is 3700‬ ‭grams. How many mL of medication does th enurse draw into the syringe when the ceftriaxone‬ ‭is available at a concentration oof 0.4 mg/mL?‬ ‭0‬.‭1‭‬‬‭𝑚𝑔‬ ‭𝑘𝑔‬ × ‭3.‬ ‭7‭‬‭𝑘 ‬ 𝑔‬ = ‭0.‬ ‭37‬‭‬‭𝑚𝑔‬ × ‭1‬‭‭𝑚 ‬ 𝐿‬ ‭0‬.‭4‭‬‬‭𝑚𝑔‬ = ‭0‬. ‭925‬‭‭𝑚 ‬ 𝐿‬