U.S. drug legislation Sets official drug standards Defines prescription drugs Regulates controlled substances Improves safety Requires proof of efficacy Nurse Practice Acts Identify nursing responsibilities for administration and client monitoring
Stock Supply: Bulk quantity Central location Not client-specific Unit Dose: Individually packaged Client-specific drawers 24-hour supply
Automated Dispenser: Password-accessible locked cart Computerized tracking Can combine stock and unit doses Self-Administration: Individual containers Kept at client’s bedside
Pharmacokinetics: What happens to the drug in the body Pharmacodynamics: How the drug affects the body
Four processes: Absorption Distribution Metabolism Excretion
Movement of drug into the bloodstream Factors affecting absorption: Route of administration Drug solubility pH/ionization Blood flow
Drug transport to tissues and organs Factors affecting distribution: Local blood flow Membrane permeability Protein-binding capacity
Biotransformation: chemical conversion of drug Factors affecting metabolism: Liver function Health/disease status First-pass effect
Elimination of the drug Factors affecting excretion: Organ function, especially the kidneys, liver, and lungs
Time until onset and peak Therapeutic range Peak level Trough level Therapeutic level Half-life Concentration of active drug
Primary effects: Therapeutic effects Predicted Intended Desired Why the drug was prescribed
Secondary effects: Unintended Nontherapeutic Can be: Predictable Harmless Harmful
Types of secondary effects: Side effects Adverse reactions Toxic reactions Allergic reactions Idiosyncratic reactions Cumulative effect
Antagonistic Synergistic Incompatibilities
Types of medication orders: Written order Automatic “stop” date STAT order Standing order PRN order
Communication of orders: Handwritten Preprinted Orally Telephone
Client’s full name Date and time order was written Name of medication Dosage size, frequency, number of doses Route of administration Signature of prescriber
Three checks: Before you pour: Check the medication label against the MAR After you pour: Verify the label against the MAR At the bedside: Check the medication again
Six Rights: Right drug Right client Right dose Right time Right route Right documentation Other Rights: Right reason Right to know Right to refuse
Tablets, pills, capsules Liquids(syrups, elixers, suspensions, emulsions Buccal Sublingual Enteral medications Troche Oral medications: Most commonly used route Includes:
Lotions, creams, ointments Transdermal patches Eye and ear Nasal Vaginal Rectal Topical medications: Applied directly to body surface/body cavities Local effects:
Respiratory inhalations: Use concept of nebulization Absorption via alveoli and blood supply Atomizers Aerosol Metered dose inhaler
Parenteral medications: Intradermal Subcutaneous Intramuscular Intravenous
Equipment Preparation: Syringe/needle (size, gauge) Medication Preparation: Vials and ampules Reconstituting from powder Two medications in one syringe
Safety issues: Use sharps containers Never recap dirty needle
Use the correct site Wrong site could mean wrong route Be familiar with the technique required for the medication (e.g., heparin, insulin)
Intravenous medications: IV push IV piggyback Medicated drips
Use the six rights Calculate doses carefully; double-check with a second RN Watch for drugs with similar names Watch for clients with same last names
Clarify illegible orders Know and use your resources Keep up with changes in medication orders