Book Flashcards
Routes of medication administration
Oral (GI)
Parenteral (intradermal, intravenous, intramuscular, subcutaneous)
Skin (topical)
Barrier and absorption pattern of oral route
Meds must be able to pass the epithelial layers of GI
Absorption varies greatly due to: stability and solubility of meds (forms of meds: enteric-coated pills and liquids form can resist stomach and absorption occurs in the intestines, GI pH level & emptying time, presence of food in the stomach & intestines, concurrent meds)
Barrier and absorption pattern of subcutaneous and intramuscular route
No significant barrier bc of large space between cells of capillary wall
Absorption rate depends on the solubility of meds (fast =10-30 mins, slow), blood perfusion at the injection site (high blood perfusion= rapid absorption, low blood perfusion= slow absorption)
Enteral or oral route (bc parental route injected to the circulatory system) < Subcutaneous absorption rate < intramuscular (bc there are more blood vessels in muscles than fat just under the epidermis layer)
Barrier and absorption pattern of intravenous route
No barrier
Absorption pattern can be immediate (directly into blood) or complete (reaches blood in its entirety)
Factors influence distribution of meds
Circulation: those have poor circulation that can inhibit blood flow/perfusion = delay medication distribution due to peripheral vascular/cardiac disease
Permeability of cell membrane: For example, meds in GI need to pass through the epithelial layers of GI. Meds that have lipid solubility or have transport system can pass through BBB and placenta
Plasma protein binding: med can binding/compete for protein binding sites, usually with albumin. Medications can also compete with the sites, resulting in toxicity.
Medication prescription include
Client’s full name, date & time of prescription, name of medications (generic or brand), strength and dosage of medication, medication usage, route of medication, time and frequency of administration, (optional: quantity to dispense and number of refills), signature of prescribing provider.
Ex: Sam Smith, 2/6/24, 1200, Tylenol 500 mg PO daily PRN for pain, etc
Safe administration or medications
Review client’s MAR, compare medications with MAR, use 2 identifiers before administration, question dosage if they are seem large or small, contact provider if prescription is illegible, incomplete or not understood, don’t document before administration
Metabolism
Changing meds structure, mostly liver: group of liver enzymes known as cytochrome P450 (nutrition can affect by allowing or inhibit P450 enzymes to function normally), or some kidney and section of small intestines.
Metabolism may transform a specific medication to another form, resulting in a more active or potent form; for example, codeine is transformed to morphine, resulting in increased pain relief. Prodrugs are inactive chemicals that are activated through metabolism to exert their therapeutic effects. Oral medications pass from the small intestine to the hepatic circulation via the mesenteric and portal veins flowing into the liver, before reaching the systemic circulation. The first-pass effect can result in a lower concentration (bioavailability) of the medication reaching the systemic circulation, if a majority of the medication has already been metabolized into an inactive form before it enters the bloodstream.
Drug-food interaction
Drug–food interactions can also impact rate of absorption (delay or enhance). For instance, iron preparations are better absorbed when given with orange juice or foods containing vitamin C, whereas iron is poorly absorbed when given with dairy products or antacids containing magnesium. Medications taken with food or high-fat meals will have a much slower rate of intestinal absorption. Drug–food interactions can also affect metabolism and excretion, potentially leading to medication toxicity. The nurse should instruct the client when medications should be taken with or without food and with any other restrictions. If medications are ordered or recommended to be taken on an empty stomach the nurse should administer that medication at least 1 hour before or 2 hours after a meal.
Medication reconciliation process
- Document an accurate and comprehensive list (name, dose, route, frequency, and purpose) of home medications upon admission.
- Compare the list of home medications to newly prescribed medications during the current hospitalization and reconcile any discrepancies.
- Update the medication list and repeat the comparison and reconciliation process at any transition of care during the client’s hospitalization, as well as at discharge.
- Communicate the reconciled medication list to the next care provider.
- Educate the client and caregivers upon discharge and provide the client with written information about their medication.
Oral route disadvantages and advantages
Advantage: Safer, Less costly, Convenient (variety of forms), Painless, Client can self-administer
Disadvantage: Slow onset of action, Subject to first-pass effect, May have an unpleasant taste, Not appropriate for unconscious clients, Not appropriate for clients with excessive vomiting and/or diarrhea
Site: By mouth/swallow
Rectal route advantages and disadvantages
Advantages: Can be administered to children, unconscious clients, or clients who are unable to swallow, Increased concentration is achieved quickly
Disadvantages: Not liked by clients, Absorption varies, Rectal mucosa can become irritated or swollen
Site: Anus
Intravenous route disadvantages and advantages
Advantages: Rapid onset, Can be used with clients who are unconscious, noncompliant, or unable to tolerate oral medications
Disadvantages: Sterilization and aseptic technique are essential, High cost, Invasive technique is required, Can injure nerves, tissues, or vessels
Site: Into the vein
Buccal route advantages and disadvantages
Advantages: Rapid onset of action, Bypasses first-pass effects, Can be self-administered by the client
Disadvantages: Can cause irritation to open sores in the mouth, Exact site location can be difficult, Decrease in the effect of the medication if it is swallowed, Client may experience nausea and vomiting if the medication has an undesirable taste
Site: Between the cheek and the gum line
Inhalation route advantages and disadvantages
Advantages: Rapid action, Smaller dose required, Medication dosage can be regulated
Disadvantages: Local irritation can precipitate respiratory secretions or bronchospasms
Site: Inhaled through the mouth into the lungs