Medication Administration

Question 1

Patient Rights of Medication

Answer 1

Right:
Patient
Drug
Dose
Route
Time
Documentation
Thing to Do!

Question 2

Subcutaneous Injections

Answer 2

Fatty part of the body, 45 degree angle

Lateral aspect of upper arm
Posterior aspect of upper arm
Abdomen in umbilical region
Back
Lower loins
Thighs

Question 3

Intramuscular Injection (Adult)

Answer 3

Deltoid
Ventrogluteal
Rectus femoris
Vastus lateralis

90 degree angle, Z track method

Question 4

Intramuscular Injection (Pediatric)

Answer 4

Rectus femoris
Deltoid
Gluteus medius

90 degree angle

Question 5

Intradermal

Answer 5

10-15 degrees, bevel up

Used for: TB screening, allergy testing

Question 6

IV Safety Checks

Answer 6

CATS PRRR

Compatibilities
Allergies
Tubing correct
Site checked
Pump safety checked

Right rate
Release the clamps
Return and Reassess patient

Question 7

Drug Contraindication:
Asthma

Answer 7

Beta-blockers

May cause bronchospasms

Question 8

Drug Contraindication:
Hypertension

Answer 8

NSAIDs

May cause increased blood pressure due to sodium retention

Question 9

Drug Contraindication:
Parkinson’s Disease

Answer 9

COX-2 Inhibitors

May cause worsening of Parkinson’s symptoms

Question 10

Drug Contraindication:
Respiratory Failure

Answer 10

Neuroleptics

May cause respiratory depression

Question 11

Drug Contraindication:
Epilepsy

Answer 11

TCAs, antimalarials, antipsychotics

May cause reduced seizure threshold

Question 12

Drug Contraindication:
Chronic Liver Disease

Answer 12

Warfarin

May cause increased sensitivity and bleeding

Question 13

Drug Contraindication:
Congestive Hear Failure

Answer 13

Ca-Channel Blockers, NSAIDS

May cause sodium retention, increased risk of cardiac events

Steroids (prednisone)

May cause sodium and water retention

Question 14

Pharmacokinetics

Answer 14

What the body does to drugs

Absorption
Distribution
Metabolism (usually by liver)
Excretion (by kidneys –> watch BUN, Cr., and GFR)

Question 15

Pharmacodynamics

Answer 15

What drug does to the body

Action –> Chemical changes or effects drug has on body cells

Receptor –> Site where medication acts (Agonist or Antagonist)

Question 16

Half-Life

Answer 16

Time it takes plasma concentration of drug to be reduced by 50%

Generally takes 4-5 half lives to achieve “steady stable” concentration OR to reduce drug level to an insignificant amount

Question 17

Therapeutic Index

Answer 17

LD50/ED50
Tells about margin of safety

Drugs with narrow window of safety:
Digoxin
Lithium
Warfarin

Question 18

Effects increased by Grapefruit Juice:
Nifedipine

Answer 18

Consequences of toxicity:
Flushing, headache, tachycardia, hypotension

Question 19

Effects increased by Grapefruit Juice:
Verapamil

Answer 19

Consequences of toxicity:
Bradycardia, AV heart block, hypotension, constipation

Question 20

Effects increased by Grapefruit Juice:
Statins (atorvastatin, lovastatin, simvastatin)

Answer 20

Consequences of toxicity:
Headache, GI disturbances, liver and muscle toxicity

Question 21

Effects increased by Grapefruit Juice:
Midazolam

Answer 21

Consequences of toxicity:
Increased sedation

Question 22

Effects increased by Grapefruit Juice:
SSRIs (fluoxetine, sertraline)

Answer 22

Consequences of toxicity:
Serotonin syndrome

Question 23

Drugs which prolong QT interval

Answer 23

CV: amiodarone, nicardipine, sotalol

Abx: Azithromycin, erythromycin, levofloaxin

Anti-fungals: Fluconazole, Voriconazole

Antidepressants: amitriptyline, protriptyline, escitalopram, citalopram, fluoxetine, sertraline

Antispychotics: Haloperidol, quetiapine, risperidone

Other: ondansetrol, lithium, phenylephrine, tacromlimus, pseudoephedrine, terbutaline

Question 24

Hepatotoxic Drugs

Answer 24

Statins: atorvastatin, lovastatin, rosuvastatin

Antiseizure drugs: carbamazepine, phenytoin, caloric acid

Anti-fungals: fluconazole, ketoconazole, itraconazole

Anti-depressant/anti-psychotics: bupropion, TCAs, trazodone

Antimicrobials: amoxicillin, erythromycin, penicillin

Other: amiodarone, losartan, labetalol, omeprazole, lisinopril, acetaminophen (when taken with alcohol or in excess)

Question 25

Drug-Drug Interaction:
ACE Inhibitors

Answer 25

Potassium-sparing medication

Risk for hyperkalemia

Question 26

Drug-Drug Interaction:
Nitroglycerine

Answer 26

Erectile dysfunction medication

Risk for profound hypotension

Question 27

Drug-Drug Interaction:
Metformin

Answer 27

Contrast dye

Risk for nephrotoxicity

Question 28

Drug-Drug Interaction:
Monoamine Oxidase Inhibitors (MAOIs)

Answer 28

Other antidepressants

Risk for serotonin syndrome

Question 29

Drug-Drug Interaction:
St. John’s Wart

Answer 29

Antidepressants

Risk for serotonin syndrome

Question 30

Drug-Food Interaction:
Ca-Channel Blockers, Statins, Anticoagulants

Answer 30

Grapefruit juice

Blocks enzyme to metabolize drug –> increases level in body –> toxicity

Question 31

Drug-Food Interaction:
Monoamine Oxidase Inhibitors (MAOIs)

Answer 31

Tyramine containing food (red wine, chocolate, aged cheeses, salami)

Risk for hypertensive crisis

Question 32

Drug-Food Interaction:
Warfarin

Answer 32

Excessive Vitamin K (daily intake should be consistent)

Risk for clotting and increasing clotting cascade