Medications

1. Medications Shurouq Qadose 22/3/2008

2. Medication; is a substance administered for the diagnosis, cure, treatment, or relief of a symptom or for prevention of disease. Prescription; is a written direction for the preparation and administration of a drug. Pharmacology; is the study of the effect of drugs on living organisms. Pharmacist; is the person licensed to prepare and dispense drugs. The physician is legally responsible for prescribing medications on a prescription TheNurse is responsible to administer the medication correctly.

3. Legal aspects of drug administration Mechanisms of Drugs Action - Onset of action: The time after administration when the body initially responds to the drug - Drug half – life (elimination half – life): The time required for the elimination process to reduce the concentration of the drug to one – half what it was at initial administration.

4. Peak level; or highest plasma concentration of the drug should be measured when absorption is complete Trough level; is the point when the drug is at its lowest concentration and this specimen is usually drawn in the 30 minutes interval before the next dose.

5. Pharmacodynamics; is the process by which a drug changes the body (e.g., alters cell physiology). Pharmacokinetic; is the study of the movement of drug molecules in the body in relation to drug’s absorption, distribution, metabolism and excretion.

6. Absorption; is the process by which a drug is transferred from its site of entry into the body to the bloodstream. It is influenced by several factors: • Route of administration; the injection medications are usually absorbed more rapidly than oral medications • Drug solubility; liquid medication are absorbed more rapidly than solid preparations • PH; the form in which the drug is found depend on the pt of the environment; acidic drugs are well absorbed in the stomach.

8. Local conditions at the site of administration; a pt with burn would have poor absorption from intramuscular injection, also food in the stomach can delay the absorption of some medications. • Drug dosage; a loading dose or a large than normal dose is usually given when the pt is in acute distress and it is necessary to achieve the maximum therapeutics effects as quick as possible.

9. - Distribution; is the transportation of a drug from its site of absorption to its site of action. When a drug enters the blood stream, it is carried to the most vascular organs- that is, liver, kidneys, and brain. - Biotransformation; also called detoxification or metabolism, is a process by which a drug is converted to a less active form. Biotransformation may be altered if a person is very young, is older, or has an unhealthy liver.

10. -Excretion; is the process by which metabolites and drugs are eliminated from the body. Most metabolites are eliminated by the kidneys in the urine; however, some are excreted in the feces, the breath, perspiration, saliva, and breast milk.

11. Factors affecting medication action • Developmental factors; during pregnancy, drugs taken during pregnancy pose a risk throughout the pregnancy, but pose the highest risk during the first trimester, due to the formation of vital organs and functions of the fetus during this time.

12. Most drugs are contraindicated because of their possible adverse effects on the fetus and certain drugs referred to as teratogenic drugs are known to have potential to cause developmental defects in the embryo or fetus. Infant usually require small dosages because of their body size and the immaturity of their organs, especially the liver and kidneys.

13. Weight; nurses should know the weight especially before the operation in order to calculate the correct dose for drugs. • Gender; differences in the way men and women respond to drugs are chiefly related to the distribution of body fat and fluid and hormonal differences. • Cultural, Ethnic, and Genetic factors

14. Psychological factors; a client’s expectations about what a drug can do can affect the response to the medication. For example, a client who believes that codeine is ineffective as an analgesic may experience no relief from pain after it is given.

15. Illness and disease; the presence of a disease affect the action of drugs. For example, aspirin can reduce the body temperature of a feverish client but has no effect on the body temperature of a client without fever. The liver is the primary organ for drug breakdown and the pathologic conditions that involve the liver may slow down metabolism

16. Environment; for example receiving medication in an environment that lack of oxygen effects drug reaction, also pt who receives pain medication or sedative in a busy, noisy environment may not benefit as fully as if the environment were quiet and peaceful.

17. Time of administration; the presence of food in the stomach delays the absorption of oral administration of medication, some medications should be given with the food to prevent gastric irritation. • Diet; nutrients can affect the action of a medication, for example, vitamin K found in green leafy vegetables can counteract the effect of an anticoagulant such as warfarin.

18. Routes of administration 1- Oral Medication Advantages:- • Absorption of oral medication occurs in stomach & small intestine • Most commonly used, most convenient and comfortable and safe

19. Disadvantages:- • Unpleasant taste of the drugs • Irritation of the gastric mucosa • Irregular absorption from the gastrointestinal tract, slow absorption • May harm the client’s teeth • Inappropriate for clients with nausea or vomiting • Sometimes pt hides medication in the mouth or cheek, so the nurse should make sure that the pt swallowed med. before recording

20. Inappropriate if client cannot swallow or is unconscious • Cannot be used before certain diagnostic tests or surgical procedures • Certain situation that oral med shouldn’t be administered: • Pt has difficulty in swallowing • Unconscious • NPO

21. Forms of oral medication are: - Solid; include tablets, capsules, and pills - Liquid; such as elixir, syrup, suspension and can be taken either by measured cup or syringes, syringes should be placed between the gum and cheeks and the pt should be upright position or side lying to prevent chocking and aspiration.

22. 2- Sublingual Medication - A drug is placed under the tongue where it dissolves - More potent than oral route because drug directly enters the blood and bypasses the liver - May cause stinging or irritation of the mucous membranes.

23. 3- Buccal Medication “pertaining to the cheek’’ A medication (e.g., a tablet) is held in the mouth against the mucous membranes of the cheek until the drug dissolves.

25. 4- Parenteral Medication Defined as other than through the alimentary or respiratory tract; that is by needle. The following are some of the more common routes for parenteral administration: - Subcutaneous (Hypodermic) – into the subcutaneous tissue, just below the skin.

26. - Intramuscular – into the muscle - Intradermal – under the epidermis (into the dermis) - Intravenous – into a vein Some of the less commonly used routes for parenteral administration are intra – arterial (into an artery). Intracardiac (into the heart muscle), intraosseous (into a bone), intrathecal or intraspinal (into the spinal canal), intrapleural (into the pleural space), epidural (into the epidural space), and intraarticular (into a joint).

27. Intra dermal Intra osseous

28. Intra articular (into a joint).

29. 5- Topical Medication Are those applied to a circumscribed surface area of the body. They affect only the area to which they are applied. They include the following: - Dermatologic preparations – Applied to the skin - Instillations and irrigations – Applied into body cavities or orifices, such as the urinary bladder, eyes, ears, nose, rectum, or vagina - Inhalations – administered into the respiratory tract by nebulizer.

31. Medication Orders; no medication given to a client without order from physician or nurse practitioners 1- Types of medication orders; there are several types of orders that a physician may write: A standing order may be carried out as specified until an order is written to cancel it, or it may be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h × 5 days).

32. As Needed or prn ; the pts receives medication when it is requested or needed, usually written for postoperative orders pain management Single order or one – time order is for medication to be given once at a specified time by the physician such as a medication to be administrative immediately before surgery Stat order indicates that the medication is to be givenimmediately and only once.

33. 2- Essential parts of the medication order: • Client’s full name; full name is used • Date & time the order is written in order to prevent errors • Name of the drug to be administered • Frequency of administration such as Q 4 hours, Bid. • Dosage of the drug • Route by which the drug to be administered • Signature of the person writing the order; the name signature and title, it is important for a legal reason.

34. Checking the medication order; that is written on a Kardex 3 times • Questioning the medication order, because the nurse is legally responsible for the drug administer any order suspected to be an error should be questioned guessing is a gross carelessness rechecking with the person who wrote the order is the only safe procedure.

35. Calculating Dosages REMEMBER 1000µg =1mg 1000mg =1g 1000g =1kg 1kg=202 Ib 1000ml=1L

36. Several formulas can be used to calculate drug dosages. One formula uses ratio: Dose on hand = dose desired Quantity on hand quantity desired For example, erythromycin 500mg is ordered. It is supplied in a liquid form containing 250mg in 5 ml. Calculate the dosage by using this formula.

37. Pediatric calculation Calculation according to the child’s weight or body surface “BSA” and the formula calculating child dose are: BSA “child” (m2) X normal adult dose = child’s dose 1.7m2 For example, a child who weighs 10 kg and is 50cm tall has a body surface area of 0.4m2, Therefore, the child’s dose of tetracycline corresponding to an adult dose of 150mg would be?

38. The Ten Rights of Medication AdministrationThe six rights can be used as a mental checklist to assist those administering medication to remember and clarify the critical elements of the process. They are the: Right medicine. Administer the correct medication. Check three times, prior to administration. Right dose. Administer the right amount of medication. Right time. Administer medication at the prescribed time. This can usually be within 30 minutes earlier or later than the designated time unless otherwise specified by the provider or the pharmacist. Right route. Use the prescribed method of medication administration.

39. Right client. Properly identify the patient before administering the medication, ask the patient to state his or her name). Right client education. Explain information about the medication to the client Right documentation. Promptly and accurately document the medication administration Right to refuse. Adult clients have the right to refuse any medication. Right assessment. Some medication requires specific assessments prior to administration (e.g., apical pulse, blood pressure, lab result). Right Evaluation. Was the desired effect achieved or not?

40. CheckThree Times for safe Medication Administration Safety measures are the most important while preparing the medication. The label of the medication container should be checked 3 times during medication preparation. First Check - Read the medication administration record - Compare the label of the medication against the MAR - Check the expiration date of the medication Second Check - During preparing the medication Third check • Recheck the label on the container before returning to its storage place.

41. Maintaining a safe environment Such as good lighting when preparing the medication better for the nurse while preparing the drugs to be alone, no distraction, locked the drawer after preparing, each pt, giving drug recording is important. Caring for controlled substance safety • Caring through locked drawer or container • Caring for Narcotic • Checks the identification cart or bracelet before giving the medication

43. Figure 29-6 Computer-controlled Dispensing System

44. THANKS