ADMINISTRATION OF MEDICATIONS

1. ADMINISTRATION OF MEDICATIONS

2. ADMINISTRATION OF MEDICATIONS • Alteration in health related to acute or chronic conditions lead clients to seek relief of symptoms through various treatments options one of which is the medication regime. Successful medical therapy depends on the partnership of the patient and the medical staff (including the nurse). This increased collaboration among health care providers demand in-depth understanding of drug, actions, interactions, therapeutic and adverse effect and the exercise of judgment in drug administration.

3. ADMINISTRATION OF MEDICATIONS • Thus implementation of prescriptions or orders of the physician/pharmacist involves far more than merely carrying out tasks. As an educated, independently licensed health care provider, the nurse is always responsible for any care given (including administration of drugs) whether prescribed by the physician or planned by the nurse.

4. ADMINISTRATION OF MEDICATIONS • The nurses’ first responsibility is to understand the ordered therapy, its goal for the patient and how it is to be carried out. If a physician orders a medication and it is observed that the written dosage is ten times the usual dosage for that medication, instead of giving the medication because “the doctor ordered it”, call the doctor and discuss the order. More so since the patient’s state is not static, understand his condition in relation to the medication. If an oral medication is prescribed for a vomiting patient, an understanding nurse should inform the physician for change instead of just giving the drug just because “the doctor wrote it”.

5. ADMINISTRATION OF MEDICATIONS • What is a drug? Drug is any substance other than food which when administered alters the physiological process of the biological being. It is a chemical substance intended for use in the diagnosis, treatment,cure,mitigation or prevention of a disease. Drug is a general term used for both legal and illegal substances (either than food) which alters physiological processes. Medication or medicine is more appropriate for drugs used for therapeutic purposes.

6. ADMINISTRATION OF MEDICATIONS • Uses of Drugs • Prevention- used as prophylaxis to prevent diseases e.g. vaccines; fluoride-prevents tooth decay. • Diagnosis- establishing the patient’s disease or problem e.g. radio contrast dye; tuberculosis (Mantoux) testing. • Suppression- suppresses the signs and symptoms and prevents the disease process from progressing e.g. anticancer, antiviral drugs.

7. ADMINISTRATION OF MEDICATIONS • Treatment- alleviate the symptoms for patients with chronic disease e.g. Anti-asthmatic drugs. • Cure- complete eradication of diseases e.g. anti-biotics, anti-helmintics. • Enhancement aspectsof health- achieve the best state of health e.g. vitamins, minerals

8. ADMINISTRATION OF MEDICATIONS • Legal Aspects of Medication • Preparation, dispensing and administration of medications are all covered by laws in every country. • The DDA - Dangerous Drug Act. It is an act that governs the procurement and use of some drugs especially the narcotics e.g. morphine, pethedine, cocaine etc. These drugs are prescription only drugs hence cannot be bought or administered without prescription. Dangerous drugs are always kept under lock and key in the Dangerous Drug Cupboard under the care of trusted senior nurses.

9. ADMINISTRATION OF MEDICATIONS • Section - 34 - Dangerous Drugs Record. • (1) A person who supplies Class A or B, drugs shall keep on the premises from which he supplies these drugs a book of the prescription to be known as the `Dangerous Drugs Record'.(2) Before any person supplies Class A drugs he shall record in the Dangerous Drugs Record the following-(a) the name and quantity of the drug to be supplied;

10. ADMINISTRATION OF MEDICATIONS • (b) the name, and address, signature or thumbprint of the person to whom it is supplied;(c) the signature of the person who supplies the drug; and(d) the date of supply.(3) Where a drug is supplied under a prescription which is retained by the supplier of the drug and an entry is made in the Dangerous Drug Record book enabling the prescription to be referred to, no entry need be made in the Dangerous Drug Record or any particulars specified in the prescription.

11. ADMINISTRATION OF MEDICATIONS • The procurement, supply, administration and wastage (accidental during preparation of administration) are always under strict observation through recording in the appropriate books and usually shift to shift handing over especially in the wards. The student should be alert to institutional policies guiding the supply and administration of Dangerous Drugs in the various hospitals where he/she may find him/herself.

12. ADMINISTRATION OF MEDICATIONS • It is worth knowing that nurses are responsible for their own actions regardless of the presence of a written order. If a nurse gives an overdose of a drug because it is written by a doctor, the error is accounted to the nurse and not the doctor. The nurse should bear in mind that ALL substances are poisons: there is none that is not a poison. The right dose differentiates a poison from a remedy.

13. Drug Nomenclature • One drug can have as much as 4 different names as follows: • Chemical Name - any typical organic name; this precisely describes the constituents of the drug • E.g. N-(4-hydroxyphenyl)acetamide for paracetamol

14. Drug Nomenclature • Generic Name - is given by the manufacturer who first develops the drug; it is given before the drug becomes official. It is the name by which the drug will be known throughout the world no matter how many companies manufacture it. This name is usually agreed upon by the WHO. Often the generic name is derived from the chemical name. E.g. acetaminophen

15. Drug Nomenclature • Official Name – this is the name by which a drug is listed in official publications such as USP (United States Pharmacopoeia), BP (British Pharmacopoeia), BPC (British Pharmacopoeia Codex), and NF (National Formulary). The above mentioned documents are sources of drug information.

16. Drug Nomenclature • Trade/Proprietary/BrandName - is the name given to drug by the manufacturing company and so the company is the legal owner of that name. So, a single generic name can be sold under ten different trade names. Because of this trade names should not be used in writing prescriptions as it can e misleading (Kinaquine is from Kinapharma Company, and Efpac from the Effah Pharmacy and by other names from other Companies).

17. Classification of Medication Medications may be classified according to: • The body system that the medicine is targeted to interacts wit; e.g. cardiovascular medications, nervous system medication etc. • Therapeutic usages of the medicine; e.g. antihypertensives ,neuroleptics, • The diseases the medicine is used for; e. g. anticancer drugs, antimalaria drugs antihelminthics etc.

18. Classification of Medication • The action of the medication can also be used to classify the it; e.g. beta-adrenergic blocking agents • The overall effect of the medication on the body can also be a criteria for its classification; e.g. sedatives, antianxiety drugs etc.

19. Forms of Drugs Solids • Capsule- powder, liquid or oil form of medication enclosed in a gelatine shell. • Tablet-a powdered form of medication compressed into a hard small disk or cylinder. May be a variety of colours or sizes. Enteric coated tablets are covered with a substance that is insoluble in gastric acids, thus reducing the possible gastric irritation.

20. Tablets Capsule

21. Forms of Drugs • Lozenge-flat round preparation containing drug in a flavoured or sweetened base that dissolves in the mouth to release the medication; it is also called troche. • Suppository-one or more drugs mixed into a firm base, such a gelatin, designed for insertion into a body cavity. The preparation melts at body temperature releasing the medication for absorption

22. Forms of Drugs • Pill-a mixture of powdered drug with cohesive material in a round, oval, or oblong shape. • Powder-a drug ground into fine particles from a solid for inhalation or application to the skin.

23. Forms of Drugs Semi-solids • Ointment-semisolid preparation of one or more drugs applied to the skin • Liniment-medication mixed with alcohol, oil or soapy emollient, which is applied to the skin. • Paste-semisolid preparation, thicker and stiffer than ointment; absorbed more slowly than ointment that penetrates through the skin.

24. Forms of Drugs • Cream-a non-greasy semi-solid preparation used on the skin • Gel or Jelly- a clear translucent semi-solid that liquefies when applied to the skin

25. Forms of Drugs • Elixir-medication is a clear liquid containing alcohol, water, sweeteners, and flavouring. Designed for oral use. • Lotion-drug in liquid suspension designed for topical use. • Solution-a drug dissolved in another liquid substance; may be used orally, parenterally, or externally • Suspension-fine drug particles dispersed in a liquid medium. Must be shaken before use • Syrup-medication dissolved in a concentrated sugar solution to mask unpleasant taste

26. Forms of Drugs • Tincture-an alcohol or water and alcohol solution prepared from drugs derived from plants

27. Forms of Drugs • These form/preparations of drugs are packaged as ampoules, vials, blister packs, sachets etc. • Aam • ampoules

28. Blister Packs Vials

29. Storage of Medications • Medications are dispensed by the pharmacy to nursing units. Once delivered, proper storage becomes the responsibility of the nurse. All medications must be stored in a cool dry place (usually in cabinets, medicine carts or fridges)

30. All medications must be stored in a cool dry place (usually in cabinets, medicine carts or fridges)

31. Storage of Medications • In less advanced countries, 3 cupboards are usually used for drug storage. • Cupboard I-used for drugs for external use only; e.g. calamine lotion, detol, methylated spirit etc. These drugs are contained in distinctive bottles, usually ridged with deep colours (dark green, blue, brown) with red label marked POISON and FOR EXTERNAL USE ONLY.

32. Storage of Medications • Cupboard II-contains drugs for internal use only e.g. tablets, suspension, mixtures etc. All drugs must be labelled. • Cupboard III-contains the dangerous drug; drugs of addiction. E.g. Morphine, pethedine etc. All drugs should be kept away from direct sunlight and at a temperature suggested by the manufacturer.

33. Storage of Medications • Another cupboard called the Emergency Cupboard may be stationed at or near the nurses bay for easy access. This cupboard contains drugs for emergency situations e.g. aminophylline (for asthma), hydralazine (for severe hypertension), oxytocin (for maternal bleeding), intravenous infusions (for rehydration) etc.

34. Storage of Medications • In advanced hospitals, use is made of computer controlled dispensing units for a more secure storage of medications. This is made possible through soft wares on computers which has patient’s particulars and medication orders. With a password, the nurse selects the medication needed; the drawer with the medication opens and the drug is delivered.

35. Storage of Medications • Some medications such as insulin, vaccines and ATS (anti-tetanol serum) must be stored in medication refrigerators to preserve their potency.

36. ROUTES OF DRUG ADMINISTRATION • The route of drug administration is the path by which a drug is brought into contact with the body. • Drugs are introduced into the body by several routes; it is paramount for the nurse to ensure that the pharmaceutical preparation is appropriate for the route specified

37. Enteral– administering medication through the gastro-intestinal route; e.g. • Oral • Sub-lingual • Rectal

38. 2. Parenteral Route • Intravenous • Intramuscular • Intrathecal • Intradermal • Subcutaneous etc.

39. Routes Of Drug Administration 3. Topical Route (usually for local effect) • On the skin • Nasally • On the cornea • In the ear etc. 4. Inhalation [Pls Read and make notes on 3 and 4 above]

40. Enteral Route Drug is administered through the gastro-intestinal route • Oral route – it is the most commonly used route for most drugs because it is • Safe • Convenient • Least expensive

41. Routes Of Drug Administration • The medicine is swallowed with fluid or is given through a tube. This route is contra-indicated in patient on nil per os, or patients with operations of the GIT. 2. Sub-lingual; the drug is placed under the tongue to dissolve slowly and be absorbed.

42. Routes Of Drug Administration • drugs can also be administered into the buccal cavity (into the superior posterior aspect of the cheek next to the molars. Drugs administered through these routes act quickly due to the thin and large vascularisation which permits quick absorption into the blood stream

43. Routes Of Drug Administration 3. Drugs can also be administered into the rectum. The suppository gradually dissolves at body temperature and releases the drug which is then absorbed through the mucous .Rectal administration of drug is contraindicated in diarrhoea, rectal prolapse or rectal surgeries.

44. Routes Of Drug Administration Parenteral Route – this means introduction of medicines by injection into body tissues or blood vessels. Because this is an invasive procedure, sterile technique must always be applied. It has the following advantages: • Rapid and predictable absorption • By pass GIT enzymes and gastric acid hence used for drugs that can be destroyed by gastric acid and GIT enzymes

45. Routes Of Drug Administration • Can be used for unconscious and uncooperative patients. However, it • Needs strict asepsis • Pain is associated with the injection • More expensive • Self administration is difficult because it is difficult/needs skilled person • Difficulty in correcting overdose errors • Risk of infection or local irritation

46. Routes Of Drug Administration • Intramuscular injection- the drug is administered into the muscle and it passes through capillary walls to enter the blood stream. Advantages • More rapid absorption than subcutaneous injection; onset of action is about 10 -15 minutes • Absorption can be hastened by drug preparation (aqueous is faster than oil)

47. Routes Of Drug Administration • More painful than SQ. • Vasoconstriction cannot be used to slow down preparation Subcutaneous Route-drug is injected beneath the skin to permeate capillary wall and enter the blood stream Advantages • Slow absorption rate (onset of action about 20minutes)

48. Routes Of Drug Administration • Rate of absorption can be altered by preparation of drug (oil preparations are slow to be absorbed, local vasoconstriction. Disadvantages • Only smaller volumes can be administered compared to IM injections • Irritating drugs may produce severe pain and local necrosis.

49. Routes Of Drug Administration • Intravenous Route- drug is administered directly into the blood stream. Advantages • Rapid onset of action within 1-2 minutes • Most irritating substances may be given • Very large volumes of drug may be given • Preferred route of medication in emergencies • 100% bioavailability of drug.

50. Routes Of Drug Administration • Dangerous complications e.g. embolism and immediate toxic effects • Very technical; getting the vein regulating the right dose per minute • Requires greater care.