2.  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

3. Stock Supply:  Bulk quantity  Central location  Not client-specific Unit Dose:  Individually packaged  Client-specific drawers  24-hour supply

4. Automated Dispenser:  Password-accessible locked cart  Computerized tracking  Can combine stock and unit doses Self-Administration:  Individual containers  Kept at client’s bedside

5. Pharmacokinetics:  What happens to the drug in the body Pharmacodynamics:  How the drug affects the body

6. Four processes:  Absorption  Distribution  Metabolism  Excretion

7.  Movement of drug into the bloodstream  Factors affecting absorption: Route of administration Drug solubility pH/ionization Blood flow

8.  Drug transport to tissues and organs  Factors affecting distribution: Local blood flow Membrane permeability Protein-binding capacity

9.  Biotransformation: chemical conversion of drug  Factors affecting metabolism: Liver function Health/disease status First-pass effect

10.  Elimination of the drug  Factors affecting excretion: Organ function, especially the kidneys, liver, and lungs

11.  Time until onset and peak  Therapeutic range Peak level Trough level Therapeutic level  Half-life  Concentration of active drug

12. Primary effects:  Therapeutic effects  Predicted  Intended  Desired  Why the drug was prescribed

13. Secondary effects:  Unintended  Nontherapeutic  Can be: Predictable Harmless Harmful

14. Types of secondary effects:  Side effects  Adverse reactions  Toxic reactions  Allergic reactions  Idiosyncratic reactions  Cumulative effect

15.  Antagonistic  Synergistic  Incompatibilities

16. Types of medication orders:  Written order  Automatic “stop” date  STAT order  Standing order  PRN order

17. Communication of orders:  Handwritten  Preprinted  Orally  Telephone

18.  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

19. 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

20. Six Rights:  Right drug  Right client  Right dose  Right time  Right route  Right documentation Other Rights:  Right reason  Right to know  Right to refuse

21. Tablets, pills, capsules Liquids(syrups, elixers, suspensions, emulsions Buccal Sublingual Enteral medications Troche Oral medications:  Most commonly used route  Includes:

22. Lotions, creams, ointments Transdermal patches Eye and ear Nasal Vaginal Rectal Topical medications:  Applied directly to body surface/body cavities  Local effects:

23. Respiratory inhalations:  Use concept of nebulization  Absorption via alveoli and blood supply Atomizers Aerosol Metered dose inhaler

24. Parenteral medications:  Intradermal  Subcutaneous  Intramuscular  Intravenous

25. Equipment Preparation:  Syringe/needle (size, gauge) Medication Preparation:  Vials and ampules  Reconstituting from powder  Two medications in one syringe

26. Safety issues:  Use sharps containers  Never recap dirty needle

27.  Use the correct site Wrong site could mean wrong route  Be familiar with the technique required for the medication (e.g., heparin, insulin)

28. Intravenous medications:  IV push  IV piggyback  Medicated drips

29.  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

30.  Clarify illegible orders  Know and use your resources  Keep up with changes in medication orders