PHARMACOLOGY 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16.

Overview Define selected terms related to the administration of medications. Describe legal aspects of administering medications. Identify physiologic factors and individual variables affecting medication action. Describe various routes of medication administration. Identify essential parts of a medication order. List examples of various types of medication orders. State systems of measurement that are used in the administration of medications. List six essential steps to follow when administering medication. State the rights to accurate medication administration. Describe physiologic changes in older adults that alter medication administration and effectiveness. Outline steps required to administer oral medications safely. Outline steps required for nasogastric and gastrostomy tube medication administration. Identify equipment required for parenteral medications. Describe how to prepare selected drugs from ampules and vials. Identify sites used for intradermal, subcutaneous, and intramuscular injections. Describe essential steps for safely administering parenteral medications by intradermal, subcutaneous, intramuscular, and intravenous routes. Describe essential steps in safely administering topical medications: dermatologic, ophthalmic, otic, nasal, vaginal, respiratory inhalation, and rectal preparations.

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Administration of Medications Medication: substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease Prescription: The written direction for the preparation and administration of a drug Generic name: name given before drug becomes officially approved Official name: name which drug is listed in official publications Chemical name: name that describes the constituents of the drug Trade name: name given to drug by manufacturer (brand name) Pharmacology: study of the effect of drugs on living organisms Pharmacy: Art of preparing, compounding, and dispensing drugs Sources of Drugs Some from natural sources e.g. insulin can be extracted from the pancreas of animals Attapulate suspension (e.g. Kaopectate) is derived from natural clays Some bulk-forming laxatives (Metamucil), cardiac drugs (e.g. Digoxin) and cancer chemotherapeutic agents ( e.g. Vincristine) are derived from plants Drug Standards & Legislation Standards are in place to guarantee uniform quality for predictability FDA: a manufacturer who wishes to market a new drug must perform a wide array of animal studies and carry out clinical testing of the drug in human subjects U.S. Drug Legislation Food, Drug, and Cosmetic Act (1938) Durham-Humphrey Amendment (1951) Kefauver-Harris Amendment (1962) Comprehensive Drug Abuse Prevention and Control Act (1970) Canadian Drug Legislation Proprietary or Patent Medicine Act (1908) Canada Food and Drug Act (1953)

Canadian Narcotic Control Act (1961) Legal Aspects of Administering Medications Nursing practice acts Responsibility for actions Question any order that appears unreasonable Refuse to give the medication until the order is clarified Controlled Substances

Kept under lock Special inventory forms Documentation requirements Counts of controlled substances Procedures for discarding Effects of Drugs Therapeutic effect = desired effect Reason drug is prescribed Side effect = secondary effect Unintended, usually predictable May be harmless or harmful Drug toxicity Result from overdose, ingestion of external use drug Buildup of drug in blood Drug allergy Immunologic reaction to drug Mild to severe reactions (anaphylaxis) Drug tolerance Need increasing doses to maintain therapeutic effect Drug interaction One drug affecting effect of another Potentiating effect Effect of one or both drugs is increased Inhibiting effect Effect of one or both drugs is decreased Synergistic effect When two drugs increase the action of one or another drug Drug Misuse

Improper use of medications Drug abuse Drug dependence Physiologic dependence Psychologic dependence Drug habituation Illicit drugs Actions of Drug on Body

Pharmacodynamics Process by which drug changes body Pharmacokinetics Study of absorption, distribution, biotransformation, and excretion of drugs Factors Affecting Medication Action Developmental Gender Cultural, ethnic, and genetic [ETHNOPHARMACOLOGY] Diet Environment Psychologic illness and disease Time of administration Routes of Medication Administration

Oral Sublingual Buccal Parenteral: o Subcutaneous (common meds. given S/C Insulin & Heparin) Parenteral: o Intramuscular Ventrogluteal Site Vastus Lateralis Site Dorsogluteal Site Deltoid Site Rectus Femoris Site o Intradermal

Intravenous Intermittent Volume-Control Intravenous Push Topical Rectal Vaginal Transdermal Inhalation Parts of a Medication Order Full name of the client Date and time the order written Name of drug to be administered Dosage Frequency of administration Route of administration Signature of person writing the order Prescription Types of Medication Orders

Stat order Demerol 100mg IM stat Single Order Seconal 100mg hs before surgery Standing order Demerol 100 mg IM q4h x 5 days PRN order Amphojel 15 mL prn MAR Systems of Measurement

Metric Apothecary Household Use of the metric system strongly suggested for safety reasons

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Administering Medications Identify the client Inform the client Administer the drug Provide adjunctive interventions as indicated Record the drug administered Evaluate the clients response to the drug Ten Rights of Accurate Medication Administration

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Right medication Right dose Right time Right route Right client Elder Considerations

Altered memory Decreased visual acuity Decrease in renal function Less complete and slower absorption from the gastrointestinal tract Increased proportion of fat to lean body mass Decreased liver function Decreased organ sensitivity Altered quality of organ responsiveness Decrease in manual dexterity Administering Oral Medications Things to Consider Nasogastric/Gastrostomy Tube Medication Administration Check with pharmacist for a liquid form Check to see if medication can be crushed Crush a tablet into a fine powder and dissolve in at least 30 mL of warm water

Open capsules and mix the contents with water only with the pharmacists advice Do not administer whole or undissolved medications Assess tube placement Aspirate stomach contents and measure the residual volume Remove the plunger from the syringe Connect syringe to a pinched or kinked tube Put 15 - 30 mL (5 - 10 mL for children) of water into the syringe barrel to flush the tube Pour liquid or dissolved medication into the syringe barrel and allow to flow by gravity into the enteral tube Administer each medication separately and flush in between After administration of all medications, flush again If the tube is connected to suction, disconnect the suction and keep the tube clamped to enhance absorption Parenteral Medications Common nursing procedure Absorbed more quickly than oral Careful and accurate administration Aseptic technique Syringes Types of Syringes - Syringe Tips

Stainless steel Most disposable Parts Hub Cannula or shaft Bevel Needles Characteristics Slant or length of bevel Length of the shaft Gauge Preparing Medications From Ampules Withdrawing medication from a vial Mixing Medications Using One Syringe Mixing Medication From Two Vials

Mixing Medications From One Vial And One Vial Mixing Medication From One Vial And One Ampule Mixing Insulins Administering Intradermal Injections Administering a Subcutaneous Injection Ventrogluteal Site Dorsogluteal Site Deltoid Site Administering Ophthalmic Instillations Mixing Medications Using One Syringe Instilling Medications to The Ear Purpose: To soften wax To provide local therapy To relieve pain Inserting Rectal Suppository Respiratory Inhalation Assessment Medication History contd Allergies Ability to Comply Prescription/OTC Herbals and alternative therapy Pregnancy and Lactation status Culture and Lifestyle Sensory and Cognitive Status Physical Exam Labs. Nursing Diagnoses Knowledge Deficit Ineffective Therapeutic Regimen Management Ineffective Health Maintenance Impaired Physical Mobility Disturbed Sensory Perception Impaired Swallowing Impaired Memory Noncompliance Outcome Identification Client Teaching

Assess the sensory and cognitive status Purpose of the medications Adherence to schedule Instruct in self-monitoring for side effects Potential for interactions from OTC meds. Assess the support system client has in home Planning Assemble Equipment Medication Cart Disposal medication cups/meds/ MAR or computer printout Pill crusher Straws/drinking glass and water or juice Implementation Observe Asepsis Follow Preparation Procedures Observe any special instructions for specific Meds Consult drug guide as needed Administer as directed, provide assistance to client where necessary Evaluation Conduct appropriate follow-up such as desired effect e.g relief of pain, sedation etc. Evaluation is an on-going process Report deviations from normal to the physicians