1. » What you need to know to be a safe and prudent nurse when administering medications

2. » Is qd allowed? » BID = twice a day » BIDAC = twice a day; before breakfast & dinner » BIDPC = twice a day; after breakfast & dinner

3. » TID = three times a day » TIDAC = three times a day before meals » TIDPC = three times a day after meals » QID = four times a day » QIDACHS or ACHS = ??

4. » Q_H = fill in the blank with the number ˃This denotes the time frame to be maintained between doses so q4h means that the dose is to be given every 4 hours » Can be a long interval ˃Some medications can be q48h ˃Must ensure that the patient understands the time frame » Do we stick to the exact time frame? ˃There is some “wiggle room” ˃Generally 30 minutes is acceptable; so with the above, technically a medication on a q4h time frame can be administered every 3.5 hours if warranted ˃Must call prescriber if this happens often

5. » Purpose = to release the drug slowly over time to sustain effects of the medication-may be given rectally if unable to swallow and if appropriate » Long half-life (up to 36 hours in daily doses) » Should never be altered in any way » Side effects will be delayed – why?

6. » Have several ways of denoting status ˃LA = long acting ˃SR = sustained release ˃CR = continuous or controlled release ˃ER = extended release » Should not be given to correct immediate problems » Nurses are responsible for knowing the difference between long acting and short acting medications

7. » Covered in a protective coating » Designed to decrease gastric irritation » Must not be altered in any way » Used in a variety of medications

8. » Can be done if appropriate ˃May not be able to swallow pills ˃May have an enteral feeding or drainage tube in place ˃Other reasons » Controversy ˃Not all medications can be crushed ˃Never to be used to force patients to take meds* ˃May alter mechanism of medication action ˃Does this create altered compounds?

9. » Expected or known issues associated with medications and treatments » Not life-threatening » Can be viewed as annoying or troublesome » NOT considered allergies

10. » Unintentioned or harmful side effects » May not happen immediately » May be related to multiple factors ˃New drugs cannot be tested against all other medications ˃Drugs cannot be tested against all illnesses ˃Human factors-genetics, biology, predisposition ˃Unknowns

11. » If something does occur: ˃Call the prescriber ˃Treat the patient ˃Document everything done ˃Instruct patient to never take drug again » Must be reported to the Food and Drug Administration ˃http://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Fo rms/UCM163919.pdfhttp://www.fda.gov/downloads/AboutFDA/ReportsManualsForms/Fo rms/UCM163919.pdf

12. » Oral (PO) » Intradermal (ID) » Subcutaneous (subq) » Intramuscular (IM) » Rectal (PR) » Topical (Top) » Intravenous (IV, IVP, IVPB) » Eyes (OD, OS, OU)

13. » Ears (AD, AS, AU) » Intravesicular (directly into the bladder) » Intrathecal (directly into the spinal column or brain) » Intrapleural (into the lining of the lung) » Inhaled (into the lungs directly) » Directly into an open wound with dressing changes » Any way we can we will – trust me!

14. » A formal study to investigate the systemic effects of particular medications or the methods in which they are administered » A trial is used for safety, effectiveness and toxicity evaluations » FDA approval is needed for an IND (investigational new drug), or investigational new drug. » Must have Institutional Review Board (IRB) approval to ensure no harm is done » Testing is done in the United States prior to FDA approval and commercial marketing.

15. » Used to research and develop new drugs, treatments, and therapies » Must meet federal safety standards » Follows the premise of “first do no harm” » Very long and complex process

16. » Phase 0 ˃Small study of less than 10 people ˃Usually not beneficial so rarely done » Phase 1 ˃Focus is to find the maximum tolerated dose of a drug and evaluate in what setting the drug will work ˃Usually has several hundred people in the study ˃Evaluates the drug on a specific disease state without comorbidities » Phase 2 ˃Focus is on managing the safest dose and its side effects ˃Study open to several thousand people ˃Very time consuming and expensive

17. » Phase 3 ˃Evaluates the new drug against the standard known therapy ˃Even larger amount of participants ˃Divided into two groups – those that receive the new drug and those that do not ˃Compares results over time to evaluate the effectiveness of the new drug ˃If results are promising, the participants who did not receive the new drug are offered the new drug » Phase 4 ˃Drug receives FDA approval and is marketed ˃Requires long term surveillance of the participants and evaluates any side effects or adverse effects

18. » Drugs that can cause any type of defects in the person who is receiving the drug OR the people who handle the drug » Defects may include: ˃Genetic mutations ˃Organ mutations ˃Birth defects ˃Immunocompromise ˃Sterility ˃Other issues

19. » Nursing is responsible to know what is hazardous » Must follow proper procedures when working with these drugs ˃Must receive additional training to administer the drugs ˃Must wear the proper PPE when handling the drug, containers, and equipment ˃If in doubt, always ask first before administering ˃Educate patient and family on the drug hazards and handling body fluids ˃Not as scary as you may think but does raise cause for concern

20. » Using therapies for purposes other than what it was intended for » Therapy may not have been put through c randomized clinical trial (Level 1 evidence) » May not be covered by insurance unless supportive documentation is provided by prescriber

21. » Do not “thin the blood”! » Work by prevent platelet aggregation or work on some area of the clotting cascade » Patients will take longer to clot but they will » Need to know therapeutic range if one is established for the drug

22. Factor F X F IXaF IX F XIaF XI Surface Contact Collagen FXII activator F XIIaF XII Intrinsic Pathway Ca 2+ Factor F X F VIIF VIIa F III (Tissue Thromboplastin) Tissue/Cell Defect Extrinsic Pathway Ca 2+ Fibrinogen Fibrin monomers Fibrin polymers Thrombin Prothrombin I Factor F Xa Ca 2+ Platelet Factor 3 Crosslinked Fibrin Meshwork F XIIIaF XIII F VF Va F VIIIaF VIII

23. Key is prevention The Needlestick Safety and Prevention Act was signed into law on November 6, 2000. Because occupational exposure to bloodborne pathogens from accidental sharps injuries in healthcare and other occupational settings continues to be a serious problem, Congress felt that a modification to OSHA's Bloodborne Pathogens Standard was appropriate (29 CFR 1910.1030) to set forth in greater detail (and make more specific) OSHA's requirement for employers to identify, evaluate, and implement safer medical devices. The Act also mandated additional requirements for maintaining a sharps injury log and for the involvement of non-managerial healthcare workers in evaluating and choosing devices.

24. » Wash area vigorously with soap and water. » Let faculty know » Call your PCP and seek immediate treatment » Follow treatment plan » Source testing

25. » Need to know what diluent (what the powder is to be mixed with) and how much » Must know the final drug amount in this liquid form » Calculate the correct dosage!

26. » Used to manage diabetes ˃Autoimmune disorder where the pancreas does not produce enough insulin or none at all ˃Body unable to regulate glucose metabolism ˃Glucose does not reach body tissues effectively-stays in the circulating blood » Given subcutaneously

27. » Rapid acting » Short acting acting » Intermediate acting » Long acting » Premixed combinations of short and intermediate acting

28. » Onset- within15 minutes » Peak 1-2 hours » Duration 3-4 hours » Brands ˃Humalog (lispro) ˃Apidra (glulisine)

29. » Onset 30-60 minutes » Peak 2-4 hours » Duration 6-8 hours » Brands ˃Humulin R ˃Novolin R

30. » Onset 2-4 hours » Peak 4-10 hours » Duration 10-16 hours » Brands ˃Humulin N ˃Novolin N

31. » Onset 3-4 hours » No peak-acts like the pancreas and is absorbed slowly » Duration 24 hours » Brands ˃Insulin glargine (lantus) ˃Insulin detemir (levemir)

32. » Only short acting (regular) and intermediate acting insulins can be mixed together in the same syringe » Remember “No River Runs North” ˃Inject air into the NPH bottle; inject air into the Regular bottle; withdraw the Regular insulin; withdraw the NPH insulin