Chapter 9:

Medication-------------------------------------------------------------------------
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Pharmacological Concepts,
Chemical - Provides the exact description of medication's composition (Ex. N-
acetyl-para-aminophenol)
Generic - The Manufacturer who fist develops the drug, assigns the name, and then
listed in the U.S. Pharmacopeia
(Ex. acetaminophen]
Trade - Also known as brand or proprietary name; name under which manufacturer
markets the medication.
(Ex. Tylenol, Panadol, Tempra = these are all acetaminophen, but different brands]

Classification:
> Effect of medication on body system
> Symptoms the medication relieves
> Medication's desired effect

Medication Forms:
- Solid
- Liquid
- Other oral forms:
- Topical
- Parenteral
- Forms for instillation into body cavities (ex. eyes, ears)

Liquid Drugs:
Solutions - Generally water based, can be oil based.
Tinctures - Prepared using an alcohol extraction process.
Suspensions - Solid does not dissolve in the solvent.
Emulsions - Suspensions with an oily in the solvent.
Elixirs - Alcohol and water solvent.
Syrups - Sugar, water and drug solutions.

Solid Drugs:
Pills - Shaped like sphere, easy to swallow
Powders - walay description lol
Tablets - Powders compressed into disk-like form
Suppositories - Drugs mixed with a wax that is designed to dissolve at body temp.
(For Vaginal & Rectal absorption)
Capsules - Gelatin capsules filled with powder.

Common Abbreviations:
CD - Controlled-diffusion
CR - Controlled-release
CRT - Controlled-release Tablet
LA - Long acting
SA - Sustained-action
SR - Sustianed-release
TD - Time-delay
TR - Time-release
XL - Extra-long
XR - Extended-release
MR - Medium-release
FR - Fast-release

Pharmacokinetics - The study of how medications;

> Enter the body
> Are absorbed and distributed into cells, tissues, organs
> Reach their site of action
> Alter physiological functions
> Are metabolized
> Exit the body

Absorption - Passage of medication molecules into the blood from the side of
administration.
Distribution - After absorption, distribution occurs within the body to tissues,
organs, and specific sites.
Metabolism - Medications are metabolized into a less-potent or an inactive form.
Excretion - Medications that exit the body through the; Kidney, Liver, Bowel,
Lungs, Exocrine glands

Types of Medication Action:

Therapeutic effect - An expected/predicted physiological response
Adverse effect - Unintended, undesirable, or unpredictable effect.
Side effect - Predictable and unavoidable secondary effect.
Toxic effect - Accumulation of medication in the bloodstream
Idiosyncratic reaction - Overreaction or underreaction or different reaction from
normal
Allergic reaction - Unpredictable resposne to medication
Medication interactions - When one medication modifies the action of another.

Administration Preparation: (Steps)

1. Obtain patient's medical record (Can be drug card, medication sheet, or medex,
which is depending on the method
of dispensing medications in your facility.)
2. Compare medication record with most recent physician order
3. Wash your hands
4. Gather necessary equipment
5. Remove the medication from the drug bux / tray / medication cart / cubicle
6. Compare the label on the medication bottle or wrapper to the medication record
7. Check the medication to be administered via the right method, right time or base
on the 5 rights
8. Calculate dosage if necessary
9. Do your patient's assessment;
> Level of Consciousness (LOC)
> Ability to cooperate
> Potential known allergies

Routes of administration (ROA) That is chosen may have a profoudn effect upon the
speed and efficiency with which
the drug acts.

Oral routes:
Sublingual administration (Absorbed under the tongue)
Buccal administraiton (Absorbed at the cheeks]

Paratenteral routes: (4 major sites)

Intradermal (ID) - On the skin
Subcutaneous (SUBQ) - On the fat
Intramuscular (IM) - On the muscle
Intravenous (IV) - On the veins

Other routes:
Epidural
Intrathecal
Intraosseous
Intraperitoneal
Intrapleural
Intraarterial

Routes limited to physicians:

Intracardiac
Intraarticular

Types of Orders in Acute Care Agencies:

Standing or routine - administered until the dosage is changed, or another
medication is prescribed
Single - Given only one time only for a specific reason
Now - When a medication is needed right away, but not STAT
prn - Given when a patient requires it (prn = Pro re nata = give only when the
circumstances happen)
STAT - Given immediately in an emergency
Prescriptions - Medication to be taken outside of the hospital.

Some latin prescription abbreviations:

ac (ante cibum) - before meals
bid (bis in die) - twice a day
gt (gutta) - drop
hs (hora somni) - at bedtime
od (oculus dexter) - right eye
os (oculus sinister) - left eye
po (per os) - by mouth
pc (post cibum) - after meals
prn (pro re nata) - as needed
q3h (quaque 3 hora) - every 3 hours
qd (quaue die) - every day
qid (quater in die) - 4 times a day
Sig (signa) - write
tid (ter in die) - 3 times a day

Health Care Provider's Role:

Prescriber can be Physician, Nurse practicitioner, or physician's assistant
Orders can be written hand or electronic, verbal or given by telephone.
Use abbrevations cautiously = can cause errors

Pharmacist role - prepare and distribute medication

Nurse role - 1. Determining medications ordered are correct
2. Assessing patient's ability to self-administer,
3. Determining whether patient should receive medications at a given time
4. Adminsitering medications correctly, and monitoring effects.
5. Cannot be delegated
6. Includes patient teaching

Medication Errors:
Report all medication errors
Patient safety is top priority
Documentation is required
The Nurse is responsible for preparing a written occurrence or incident report.
Nurses play an important role in medicaiton reconciliation

Six rights:
1. Right medication
2. Right dose
3. Right patient
4. Right route
5. Righte time
6. Right documentation

Additional:
7. Right response
8. Right reason
9. Right assessment
10. Right client education
11. Right to refuse medication (Patient's right)
12. Right expiration date

Medication Administration:
Oral Administration - Easiest and most desirable route
Topical
Inhalation
Irrigation
Parenteral
Injection

Topical Medication Applications:

Skin applications

Nasal Instillation:
Spray
Drops
Tampons

Eye Instillation:
Instillation (Avoid the cornea, eyelids with droppers or tubes to decrease risk of
infection and only on affected eye)
Intraocular Instillation:
Disk resembles contact lens - (Teach patient how to wear and remove)

Ear instillation:
Instill eardrops at room temperature, use sterile solutions, Check for eardrum
rupture if patient has ear damage

Parenteral Administration of Medications:

Equipment:
Syringes; Luer-lok and Non-Luer-Lok (Luer-Lok is the screw-pattern at the hub)
Parts of Syringe: (Plunger, Barrel, Tip)
Extra parts: (Plunger Flange is the last part of Plunger, Barrel Flange is the last
part of barrel)
Needle parts: (Hub, Shaft, Bevel = Needle Tip)