2Objectives The student will be able to: List three sources of drugs. List the components of a proper medication order.Define the commonly used abbreviations.List the routes of medication delivery.Define "parental administration" and list three types of parental administration.List the four routes of medication delivery via inhalation.List three types of nebulizers used to deliver respiratory medication.Given a route of administration, explain the safety requirements associated with drug administration.
3Objectives The student will be able to: Explain two ways to confirm proper patient identification prior to giving a medication.State the change in pulse rate needed to terminate a respiratory treatment.Describe how the effectiveness of bronchodilators can be objectively measured?List the items that should be documented in the patients chart following each treatment.Describe the procedure you would follow in the event of an adverse reaction.Define terms typically found on a package insert for a drug.Describe how most drugs are metabolized and excreted.
4Web Site www.prenhall.com/colbert Animations Videos Updates Glossary & Drug PronunciationsExtended ConceptsChapter QuizReference & Additional Readings
5Definition of Pharmacology Pharmacology - The study of drugs (chemicals) including their origins, properties, and interactions with living organisms.
6Are these drugs?AspirinMintVodkaVitaminsBlack Cohosh
7Drug Sources Chemical synthesis Animal Plant Mineral Most common Recombinant DNAAnimalPlantMineral
8FDA Federal agency Regulates drug testing Approves new drugs
9Drug Approval Can take up to 12 years and over 200 million dollars. Only 1 in 10,000 chemicals are approved.
10Steps for Drug Approval Identify the chemical structureAnimal studies – toxicology studiesInvestigational New Drug ApprovalPhase I: Healthy volunteersPhase II: Volunteers who have the diseasePhase III: Large multi-center studyNew Drug Application – NDA is filed with the FDA and upon approval it is released for general use. Reporting system in place for 6 months
11Source of Drug Information PDR – Physician Desk ReferenceUSP – United States PharmacopoeiaNational FormularyHospital FormularyFDA Website!
12Study of Drugs Generic and Trade Names Classification Indications ActionsAdverse reactions (side effects)ContraindicationsDosage
13Naming Drugs Chemical Name: Reflects the chemical structure. 4-(5-cyclopentyloxy-carbonylamino 1-methyl-indo-3 ylmethyl)Code Name: Name assigned by a manufacturer to an experimental chemical that shows potential as a drug (SCH 1000).
14Naming Drugs Generic Name: Based on the drugs chemical structure. Assigned by the USAN CouncilExample: isoproterenolTrade Name: Name given by the manufacturer.A generic drug can have 2 or more trade names.Also called brand name.Example: Isuprel
16Prescriptions for Medication Orders Patient’s NameDateName of the drugDosage of drug and amountConcentration if appropriateRoute of administration (delivery device)Frequency or ScheduleNumber of days if appropriateAny additional instructionsPeak flows before and after therapyMonitor tidal volume during IPPB treatmentSignature of Physician
17Examples: John Smith 12/23/89 IPPB therapy with 0.25 mL of 1% Bronkosol and 3 mL Normal Saline four times a day x 3 days. Dr. James JonesJack Doe 3/30/99SVN therapy with 0.3 mL of 5% Alupent and 2 mL of Normal Saline every four hours around the clock. Peak flow before and after treatment. Dr. James Jones
18Example Karen Johnson 4/28/96 MDI Proventil 2 puffs three times a day. Administer with spacer Dr. James Jones
19Abbreviations Lots of changes over the last few years. Due to errors in prescribing, many abbreviations have been eliminated based upon JCAHO recommendations (handout).Many institutions have specific rules that go beyond JCAHO recommendations (handout).
20Frequency Abbreviations BID: Twice a dayTID: Three times a dayPRN: When necessary, as neededSTAT: Immediately
21Eliminated Frequency Abbreviations Some others that have been eliminated:QOD: Use “Every other day”QD: Use “daily”QID: Four times a dayQ4: Every four hoursQ3: Every three hoursQ2: Every two hoursQ4 ATC: Every four hours around the clockQ4 WA: Every four hours while awakeQ4 PRN: Every four hours as neededH.S: Use at “bedtime”
22Other commonly used abbreviations: NS: Normal Saline: With: Withouta.c.: Before Mealsp.c.: After MealsmL: Millilitersgtt: dropqs: Quantity sufficient (as much as required)PO: By mouth, orally
23Other commonly used abbreviations: MDI: Metered Dose InhalerIPPB: Intermittent Positive Pressure BreathingSVN: Small Volume NebulizerSPAG: Small Particle Aerosol GeneratorRx: Prescription or “take”IM: IntramuscularlyIV: IntravenousDPI: Dry Powder InhalerTx: Treatment
24Other commonly used abbreviations: NPO: Nothing by mouthOTC: Over the CounterFDA: Food and Drug AdministrationPDR: Physician Desk ReferenceBS: Breath SoundsPF: Peak FlowPEFR: Peak Expiratory Flow Rate
265 “Rights” Right Drug Right Dose Right Patient Right Time Right Route Patient’s wrist bandRight TimeRight RouteAlsoExpiration DateAllergiesTimely documentation
27Routes of Medication Delivery Oral (Enteral) RouteTabletCapsulePillPowderSolutionsElixirsSyrupsEmulsions/gels
28Routes of Medication Delivery Parenteral Route (route comprising routes that bypass the alimentary tract, i.e. injectable)IntradermalSubcutaneousIntramuscularIntravenousIntra-arterialIntra-spinalIntraosseous (into the tibia or sternum)
29Routes of Medication Delivery TopicalTransdermalCreams and gelsSublingual (under the tongue)EnteralRectalInhalationMDIAerosol (SVN, USN)DPIIPPB
34Continuous Nebulization Occasionally, the nebulized medication must be administered over an extended period of hours instead of minutes.A nebulizer can be adapted to other oxygen delivery equipment to facilitate this process.
35Advantage of Aerosolized Agents Dosage is smaller.Less side effects and less severe side effects.Rapid Onset.Drug delivery is targeted to the respiratory system.Painless, safe and convenient.Patients can administer medication themselves.
36Medications Given by RCP BronchodilatorsMucolyticsSteroidsNon-Steroidal Anti-inflammatoryMast Cell StabilizersLeukotriene InhibitorsAnti-Infective Agents
37Medications given by RCP Nicotine Replacement TherapyArtificial SurfactantsTopical AnestheticsLidocaineGasesOxygenNitric OxideHe/O2 (Heliox)Morphine (?)
38ObjectivesState the change in pulse rate needed to terminate a respiratory treatment.Describe how the effectiveness of bronchodilators can be objectively measured?List the items that should be documented in the patients chart following each treatment.Describe the procedure you would follow in the event of an adverse reaction.Define terms typically found on a package insert for a drug.Describe how most drugs are metabolized and excreted.
39What is the difference between Q4 PRN, Q4 WA, and PRN? Q4 PRN: Every four hours as neededQ4 WA: Every four hours while awakePRN: When necessary, as needed
40Drug Metabolism and Excretion Pharmacokinetics: The movement (kinesis) of the drug throughout the body.AbsorptionLimited by disintegrationBioavailability: The amount of drug that has been absorbed into the circulation.DistributionMetabolismLiverEliminationKidneyGI Tract (feces), Skin, Pulmonary System
42Definition of TermsSelectivity – The extent to which a drug acts at one specific site or receptor.When binding occurs:Ion channel open/closedBiochemical messengers are activated.Normal cellular function is turned on or off.
43Definition of TermsRacemic – A drug which contains two isomers (same chemical components, only bonded differently).Agonist – A drug or chemical that binds to a corresponding receptor and initiates a cellular effect or response – Example: b2 agonistAgonists have an affinity for a receptor site.Antagonist - A drug which binds with a receptor but do not cause activation of the receptor.Explains why some drug’s action is less effective or blocked in the presence of another drug.
44Definition of TermsDrug Affinity – A measure of the tendency of a drug to combine with a particular receptor site.Drug Potency – The amount of drug required to produce the response desired.A more potent drug would require a lower dose to proved a desired effect.Drug Efficacy – The peak or maximum biologic effect.
46Definition of TermsTolerance - Increasing amounts of drug are needed to produce the same effect.Loss of effectiveness.Tachyphylaxis - A rapidly decreasing response to a drug following administration of the initial doses.Desensitization - Loss of tissue responsiveness that can occur with drug exposure.Placebo - An inactive substance resembling a medication that may be given experimentally or for its psychological effects
47Definition of TermsAdditive – The sum of the effects of two drugs given together is equal to each of them given separately but at the same time (1+1 = 2).Synergism – The joint effect of two drugs is greater than the algebraic sum of their individual effects (1+1 = 3).albuterol + ipratropium bromidePotentiation - The effect of two drugs given together where one drug has no effect but increases the response of the other drug (1 + 0 = 2)
48Definition of TermsHalf Life of a drug – The time required to eliminate 50% of the drug from the body after absorption and distribution are complete.Loading Dose – Administration of an initial higher level of the drug to facilitate a steady state (maximal saturation of the receptors in the body).Maintenance Dose – Additional drug which is administered after the loading dose that is used to maintain the steady state.
50Definition of TermsSide Effect – Unwanted symptoms which occur after drug administrationAlso called adverse drug reaction (ADR)Cumulation – Occurs when a drugs rate of removal or inactivation is slower than the rate of administration. This can result in toxicity.Emetic - A substance that induces vomiting.Activated Charcoal – Used to decrease absorption.Teratogenicity – A drug’s potential to damage a fetus in utero when given to a pregnant women.
51Definition of Terms Systemic Effect - Throughout the body Local Effect - Restricted to a specific area (drugs given by aerosol to the lungs)
52Definition of Terms Therapeutic Index = LD50 ED50 LD “Lethal Dose 50”The dose that is lethal to 50% of the test population of animalsED 50 – “Effective Dose 50”The dose that is therapeutically effective in 50% of the test population of animals
53Therapeutic IndexThe higher the therapeutic index, the safer the drug.The lower the therapeutic index, the greater the chance of toxicity.theophylline, lidocaine and digitalis all have low therapeutic indexes.LD mg = 2ED mg
54Safety Requirements for Drug Administration Always check the patient’s chart.Always check the patient’s name band for proper identification.Check the medication label before preparing medication.Check dates on the medication for expiration date.
55Safety Requirements for Drug Administration Check medication color for change.Check the dosage of medication ordered and know the normal and safe range.Always wash hands before preparing and giving a medication.Check previous notes to determine the patients previous response to the medication.
56Safety Requirements for Drug Administration Document the HR before, during and after the therapy.If the heart rate increases more than 20 beats from the baseline, STOP THE TREATMENT and notify your clinical instructor/preceptor.Document patient assessment findings (breath sounds, respiratory pattern, use of accessory muscles, peak flows if using a bronchodilator) before an after therapy.Assure patient safety before leaving the room.Bedrails up, patient restraint, call button in patient’s reach.Document clearly, concisely and accurately.
57Safety Requirements for Drug Administration If you make an error when documenting:Put one line through the charting.Initial.Write “error”.Continue to chart correct information.Never use white-out!
59Adverse Reaction Stop the treatment immediately. Stay with the patient and notify the nurse.When the patient is out of immediate danger, contact your Clinical Instructor or Preceptor.Document the adverse reaction, the patients vital signs at the time you left the room, personnel you contacted and any order change by the physician.
60Adverse ReactionIf the physician changed the medication order or therapy, document all changes on the respiratory therapy treatment sheet.Report the incidence at change of shift; discuss with next therapist taking care of the patient.
61What To Do With an Improper Order As a studentContact your clinical instructor/preceptorThe clinical instructor or preceptor will then follow the steps outlined below.As a therapistContact the physicianContact the department supervisorContact the department managerContact the medical director of the RC department
62Take Home Message SAFETY! Remember: “To Err is human,” but to err in drug administration can be very dangerous!