Week 10 Administering Medications

Question 1

Name and explain the different drug names

Answer 1

Chemical: the exact description of the drug’s chemical composition and molecular structure

Generic: (nonproprietary) name that is listed in publications, such as the USP and national formulary

Official: also the generic name that is listed in publications, such as the USP and NF

Brand (trade or proprietary): what the drug is sold as in stores; the brand name is easily recognized because it begins with a capital letter and sometimes has a registration mark at the upper right of the name; different manufacturers of the same med may give it a different brand name

Question 2

What is the most important key point to remember when discussing mechanisms to promote drug safety

Answer 2

• looking it up must become second nature

- when in doubt, look it up!

Question 3

What are the two types of medications systems

Answer 3

Stock supply:
- bulk quantity: measure the dose each time a client needs it

Unit dose:
- prescribed amount of drug the client receives at a single time

Automated dispenser:

• computerized system
• locked cart contains all the meds
• meds are packaged in unit doses, but some bulk meds may also be there

Self Administration:
- clients may self administer meds (SAM) that the hospital does not carry; otherwise, all personal meds must be left at home to avoid double dosing

Question 4

Explain pharmacokinetics

Answer 4

What the body does to the drug

four processes determine the intensity and duration of a drug’s actions

• absorption
• distribution
• metabolism
• excretion of a drug

Question 5

Explain pharmacodynamics

Answer 5

What the drug does to the body

Primary and secondary effects of the drugs

Question 6

What must occur for excretion to occur with pharmacokinetics

Answer 6

drug molecules must be removed from their sites of action and eliminated from the body

Common organs of excretion:
- kidneys, liver, GI tract, lungs, exocrine glands (sweat and salivary)

Question 7

Explain the factors the affect absorption

Answer 7

Route of administration

Drug solubility:

• enteric coated drugs; cannot be decomposed by gastric secretions
• coating thus prevents the med from being diluted before it reaches the intestines
• decreases irritating effects of the med on the stomach
• Timed release meds: formulated to dissolve slowly, releasing small amounts for absorption over sever hours (DO NOT CRUSH)

Question 8

Name and explain the factors affecting distribution

Answer 8

Local blood flow:
-rate of distribution depends on the adequacy of local blood flow in the target area and permeability of capillaries to the drug’s molecules

Membrane permeability

Protein-binding capacity

Question 9

What are the factors affecting metabolism

Answer 9

Biotransformation: chemical conversions of a drug

Liver function:

• metabolism takes place mainly in the liver, but meds can be detoxified also in the kidney, blood plasma, intestinal mucosa and lungs
• if liver function is impaired, the drug will be eliminated more slowly and toxic levels may accumulate

Health/disease status: disease states also affect drug metabolism

First-pass effect:

• oral meds are absorbed from the GI tract and circulate through the liver before they reach the systemic circulation
• Many oral meds can be almost completely inactivated in this way
• this inactivation is known as first pass effect
• oral meds are formulated with higher concentration of the drug than are parenteral meds

Question 10

What are the factors affecting excretion

Answer 10

• for excretion to occur, drug molecules must be removed from their sites of action and eliminated from the body

The following are common organs of excretion:

• Kidneys: primary site of excretion
• liver and GI tract: some drugs broken down by liver are excreted into GI tract and then eliminated in the feces
• Lungs: gases and volatile liquids administered by inhalation usually are removed through exhalation
• Exocrine glands: drug excretion through the exocrine glands is limited

Question 11

Name and explain the concepts related to pharmacokinetics

Answer 11

Time until onset:
- time needs to reach a high enough blood level for effects to appear

Duration of drug action:
- length of time that particular drug is effective

Therapeutic range:

• at onset of action, serum drug level is minimal
• Peak level: highest concentration
• Trough level: lowest concentration; right before the next dose
• therapeutic level: concentration of a drug in the blood serum that produces the desired effect

Biological half-life:
- time it take for half of the drug to be eliminated

Concentration of active drug:
- concentration at the intended site

Question 12

What are the factors affecting pharmacokinetics

Answer 12

• age
• body mass (weight)
• gender
• pregnancy
• environment
• route of administration
• timing of administration
• fluids
• pathological states
• genetic factors
• psychological factors

Question 13

What are the primary effects of the drugs with pharmacodynamics

Answer 13

• Primary = effects that are predicted, intended, and desired (what we want to happen

Types of primary effects include:

• Palliative = relieve the signs and symptoms of a disease
• Supportive = support the integrity of body functions
• Substitutive = replace either body fluids or a chemical required by the body for improved functioning
• Chemotherapeutic = destroy disease producing microorganisms or body cells
• Restorative = return the body to or maintain the body at optimal levels of health

Question 14

Explain the secondary effects of drugs when discussing pharmacodynamics

Answer 14

• Secondary effects = all effects other than the intended effect for which the drug was prescribed
• most common side effects are nausea, vomiting, diarrhea, dizziness, drowsiness, dry mouth, abdominal distention or distress, and/or constipation

Can be:

• predictable
• harmless
• harmful

Key point:
- nursing role includes teaching client what side effects to anticipate and how to manage them

Question 15

When discussing pharmacodynamics, what are the types of secondary effects

Answer 15

Adverse reactions:

• harmful, unitended, usually unpredicted reactions
• require discontinuation of the drug
• FDA defines sever adverse reactions as those that are: life threatening, require intervention, lead to problems

Question 16

When discussing pharmacodynamics, what are the toxic reactions that could occur with secondary effects

Answer 16

Toxicity may be caused by any one of the following:

• overdosing
• accumulation of the drug in the tissues
• abnormal sensitivity or allergic responses

Toxic reactions can be:

• Localized
• Reversible (tinnitus caused by aspirin) or Permanent (hearing loss by aminoglycoside antibiotics)
• immediate (can take years to develop or can take months)

Question 17

When discussing the types of secondary effects related to pharmacodynamics, explain allergic reactions, idiosyncratic reactions, and cumulative effect

Answer 17

Allergic reaction:
- key point: life threatening reaction that occurs immediately after administration

Idiosyncratic reactions:
- unexpected, abnormal, or peculiar responses to meds

Cumulative effect:

• increased response to repeated doses of a drug that occurs when the rate of administration is greater than the rate of metabolism and excretion
• unless the dose is changed, the med accumulates in the system until a toxic level is reached

Question 18

Name and explain the different drug interactions

Answer 18

Antagonistic:
- one drug interferes with the actions of another

Synergistic:
- additive effect

Incompatibilities:

• occurs when multiple drugs that have been mixed together cause a chemical deterioration of one or both drugs
• always consult medication resources and compatibility charts before mixing meds
• double check the med for changes in appearance after mixing
• if incompatibility occurs, do not administer the drug

Question 19

Explain drug abuse or misuse

Answer 19

Tolerance:
- decreasing response to repeated doses of a med

Dependence:
- reliance on, or need for, a drug

Drug misuse:
- improper use of drugs

Drug abuse:
- inappropriate intake of a substance

Illicit drugs:
- drugs sold illegally

Question 20

Explain the communication of prescriptions (orders)

Answer 20

Handwritten

Orally:

• when you receive a verbal prescription, you will write the prescription and sign it with the provider’s name followed by your name and credentials
• med names that sound the same can be confusing and lead to administering the wrong drug
• repeat the prescription to the provider and spell the med name to ensure accuracy

Telephone:

• usually this will be in response to a call you have placed to a report a change in the client’s condition or the results of labs or other tests
• provider usually must cosign verbal and telephone prescriptions within 24 hours

Question 21

Explain the reasons that medication errors may occur

Answer 21

• lack of knowledge of the drug is the most common
• lack of information about the client is the second most frequent cause
• wrong route
• faulty communication
• equipment errors
• calculation and measurement errors
• other: med is improperly handled or stored, client’s identity is not checked and the wrong client receives the med, lighting is inadequate, or the nurse is fatigues

Question 22

What should I do if I commit a med error?

Answer 22

• you have a duty to do no harm

You must:

• immediately assess the client, including vital signs and physical status
• notify the nurse manager of your unit and report the events surrounding the event
• report findings to the primary care provider
• Check with your institution for agency-specific policy regarding incident reporting

Question 23

Explain the highlights of medication-related assessments

Answer 23

Before medicating clients:

• measure vitals
• assess whether the client’s general condition is appropriate for the med
• evaluate your knowledge of the med
• identify biological factors that affect drug metabolism

While administering meds, assess:

• mental status
• coordination
• ability to self-administer the drug
• swallowing (for oral meds)

After medicating clients, assess;

• effectiveness of the drug
• side effects
• signs of adverse reactions or toxicity

Question 24

Explain polypharmacy

Answer 24

• the ingestion of numerous meds in an attempt to treat many conditions simultaneously
• many people self-prescribe or rely on over-the-counter meds for symptom relief (insomnia, headaches, joint pains, indigestion)
• they may continue taking them in combination with prescribed medications
• increases the potential for adverse reactions and dangerous drug and food interactions

Question 25

What are the important client teaching points to remember for teaching medication self administration

Answer 25

• Know and understand what you are taking
• Take the drug as prescribed
• Communicate with your prescriber
• think about safety
• dispose of expired meds safely

Question 26

Explain the nursing considerations for medication administration safety

Answer 26

Sources of Error:
- Safe zones: one recommendation is to create a safe zone when preparing or administering medication; you can do this by putting up do not disturb signs, using the medication room, or wearing a bright yellow apron to alert people not to disturb you when you are preparing or giving medication

Checks:
- 3 checks

Question 27

What are the other rights related to medication administration

Answer 27

• 6th right: right documentation
• right reason: includes the right to not receive unnecessary meds
• Right to know: tell the client the name of the med, why it is being given, its actions, and the potential side effects
• Right to refuse: client can always refuse regardless of consequences and his/her reasons

Question 28

What are the most commonly used oral types of meds

Answer 28

• tablets, capsules
• liquids
• buccal and sublingual: intended for absorption in the mucous membranes rather than the GI tract
• enteral meds: for clients that cannot swallow or who have feeding tuber, you can give oral meds through NG, gastrostomy, or jejunal tuber