Chapter 35

MEDICATIONS

Jan Michael R. Remolado, RN, LPT,

A MEDICATION is a substance administered for the
 Diagnosis
 Cure
 Treatment
 Relief of a symptoms
 Prevention of disease

Generic Name – used throughout the drug’s lifetime

Brand Name/Trade Name – drug manufacturer and identifies it as a
property of that company
EFFECTS of DRUGS
1. Therapeutic effects/desired effect (primary effect intended, that is, the
reason the drug is prescribed)
2. Side effect/secondary effect (unintended, usually predictable, harmless or
potentially harmful)
3. Adverse effect (more severe side effects, discontinuance of a drug)
4. Drug toxicity (harmful effects of a drug on an organisms or tissue, results
from overdosage, ingestion of a drug intended for external use, or buildup
of the drug in the blood because impaired metabolism or excretion)
5. Drug allergy (immunologic reaction to a drug) – skin rash, pruritus,
angioedema, rhinitis, lacrimal tearing, nausea, vomiting, dyspnea, diarrhea
 Therapeutic Actions of Drugs
Drug Type Description Examples
Palliative Relieves the symptoms of a disease Morphine sulfate, aspirin for
but does not affect the disease itself pain
Curative Cures disease or condition Penicillin for infection
Supportive Supports body function until other NE bitrate for low blood
treatments or the body’s response can pressure; aspirin for high
take over blood temperature
Substitutive Replaces body fluids or substances Thyroxine for hypothyroidism,
insulin for DM
Chemotherapeutic Destroys malignant cells Busulfan for leukemia
Restorative Returns the body to health Vitamin, mineral supplements
 Routes of Administration
Route Advantages Disadvantages
Oral Most convenient Inappropriate for client with N/V
Usually least expensive Drug may have unpleasant taste or
Safe, does not break skin barrier odor
Administration usually does not Inappropriate when GI tract has
cause stress reduced motility
Some new oral medications are Inappropriate if client cannot
designed to rapidly dissolve on swallow or unconscious
the tongue, allowing for faster Cannot be used before certain
absorption and action diagnostic tests or surgical
procedure
Drug may discolor teeth, harm
tooth enamel
Drug irritate gastric mucosa
Drug can be aspirated by seriously
ill clients
 Routes of Administration
Route Advantages
Sublingual Same as oral, plus:
Drug can be administered for local
effect
More potent that oral route
because drug directly enters the
blood and bypasses the liver.
Buccal Same as for sublingual
Rectal Can be used when drug has
objectionable tastes or odor
Drug released at slow, steady rate
Provides a local therapeutic effect
Vaginal Provides a local effect
Disadvantages
If swallowed, drug may be
inactivated by gastric juice
Drug must remain under tongue
until dissolved and absorbed. May
cause stinging or irritation of the
mucosa membranes
Drug can be aspirated by seriously
ill clients
Same as for sublingual
Dose absorbed is unpredictable
May be perceived as unpleasant by
the client
Limited use
May be messy and may soil
clothes
 Routes of Administration
Route Advantages Disadvantages
Topical Few side effects Drug can enter body through
abrasions and cause systemic
effects
Transdermal Prolonged systemic effect Rate of delivery may be variable
Few side effects Verify that the previous patch has
Avoids GI absorption problems been removed and disposed of
Onset of drug action faster than appropriately to avoid overdose
oral
Subcutaneous Absorption is slower (an Must involve sterile techniques
advantage for insulin and heparin because break skin barrier
administration) More expensive than oral
Can administer only small volume
Some drugs can irritate tissues and
cause pain
Can produce anxiety
Breaks skin barrier
 Routes of Administration
Route Advantages Disadvantages
Intramuscular Can administer large volume that Can produce anxiety
subcutaneous Breaks skin barrier
Drug is rapidly absorbed
Intradermal Absoprtion is slow (this is Amount of drug administered must
advantage in testing for allergies) be small
Breaks skin barrier
Intravenous Rapid effect Limited to highly soluble drugs
Drug distribution inhibited by poor
circulation
Inhalation Introduces drug throughout Drug intended for localized effect
respiratory tract can have systemic effect
Rapid localized relief Of use only for the respiratory
Drug can be administered to system
unconscious client
Routes of Administration
Routes of Administration
 Types of Medication Orders
1. Stat Order – medication is to be given immediately and only once
2. Single order/One-time order – medication to be given once at a
specified time
3. Standing Order – may or may not have a termination date, may be
carried out indefinitely until an order is written to cancel it, or it may be
carried out for a specified number of days
4. PRN Order/ As-needed Order – permits the nurse to give medication
when, in the nurse’s judgment, the client requires it. The nurse must
use good judgment about when the medication is needed and when it
can be safely administered.
 Essential Parts of a Parts of a
Drug Order Prescription
1. Full name of the client 1. Descriptive information about the client: name,
2. Date and time the address, and sometimes age
order is written 2. Date on which the prescription was written
3. Name of the drug to be 3. The Rx symbol, meaning “take thou”
administered 4. Medication name, dosage, and strength
4. Dosage of the drug 5. Route of administration
5. Frequency of the drug 6. Dispensing instructions for the pharmacist
6. Route of administration 7. Directions for administration to be given to the
7. Signature of the client
person writing the 8. Refill and/or special labelling
order 9. Prescriber’s signature
 Administering Medications
1. Nurses who administer medications are responsible for their own actions. Questions
any order that is illegible or that you consider incorrect. Call the person who
prescribed the medication for clarification.
2. Be knowledgeable about the medications you administer. You need to know why the
client is receiving the medication. Look up the necessary information if you are not
familiar with the medication.
3. Use only medications that are in a clearly labeled container.
4. Do not use liquid medications that are cloudy or have change color.
5. Calculate drug dose accurately. If you are uncertain, ask another nurse to double-
check your calculations.
6. Administer only medications personally prepared.
7. Before administering a medication, identify the client correctly using the appropriate
means of identification, such as checking the identification bracelet.
8. Do not leave medications at the bedside, with certain exceptions (e.g., nitroglycerin,
cough syrup). Check agency policy.
 Administering Medications
9. If a client vomits after taking an oral medication, report this to the nurse in charge, or
the primary care provider, or both.
10. Take special precautions when administering certain medications.
11. When a medication is omitted for any reason, record the fact together with the
reason.
12. When a medication error is made, report it immediately to the nurse in charge, the
primary provider, or both.
13. Always check a medication’s expiration date.

Process of Administering Medications

1. Identify the client
2. Inform the client
3. Administer the drug
4. Provide adjunctive interventions as indicated
5. Record the drug administered
6. Evaluate the client’s response to the drug
Metric System
Administering Oral Medications