Medications

1. Medications Mrs.Mahdia Samaha Kony Mrs, Mahdia Samaha Kony

2. Pharmacokinetics • Pharmacokinetic; is the study of the movement of drug molecules in the body in relation to drug’s absorption, distribution, metabolism and excretion. • Absorption; is the process by which a drug is transferred from its site of entry into the bodyto the bloodstream. Mrs, Mahdia Samaha Kony

3. Factors influence drug absorption : • Route of administration; the injection medications are usually absorbed more rapidly than oral medications • Drug solubility; liquid medication are absorbed more rapidly than solid preparations • PH; the form in which the drug is found depend on the pt of the environment; acidic drugs are well absorbed in the stomach. Mrs, Mahdia Samaha Kony

4. Factors influence drug absorption : 4. Local conditions at the site of administration; a pt with burn would have poor absorption from intramuscular injection, also food in the stomach can delay the absorption of some medications. 5. Drug dosage; a loading dose or a large than normal dose is usually given when the pt is in acute distress and it is necessary to achieve the maximum therapeutics effects as quick as possible. Mrs, Mahdia Samaha Kony

5. Factors influence drug absorption : 6. Serum drug level: a) Therapeutic range: is the concentration of drug in the blood serum that produces the desired effect without causing toxicity. b) Trough level; is the point when the drug is at its lowest concentration and this specimen is usually drawn in the 30 minutes interval before the next dose. c) Peak level; or highest plasma concentration of the drug should be measured when absorption is complete d) Drug half – life; (elimination half – life): The time required for the elimination process to reduce the concentration of the drug to one – half what it was at initial administration. Mrs, Mahdia Samaha Kony

6. Distribution; Is the transportation of a drug from its site of absorption to its site of action. When a drug enters the blood stream, it is carried to the most vascular organs- that is, liver, kidneys, and brain. Mrs, Mahdia Samaha Kony

7. Metabolism • Metabolism or Biotransformation; also called detoxification or metabolism, is a process by which a drug is converted to a less active form. • Biotransformation may be altered if a person is very young, is older, or has an unhealthy liver. Mrs, Mahdia Samaha Kony

8. Excretion; Is the process by which metabolites and drugs are eliminated from the body. Most metabolites are eliminated by the kidneys in the urine; however, some are excreted in the feces, the breath, perspiration, saliva, and breast milk. Mrs, Mahdia Samaha Kony

9. ADVERSE DRUG ACTION • Allergic effects; occurs in persons previously exposed to the drug and IGE was formed. • Symptoms range from minor to serious and reaction can occur immediately or delayed after hours to days. • Signs and symptoms: • Rash • Urticaria • Fever • Diarrhea • Nausea and vomitting Mrs, Mahdia Samaha Kony

10. Allergic effects • Serious immediate reaction; anaphylactic reaction result I respiratory distress, sudden severe bronchospasm and cardiovascular collapse. • Treatment; epinephrine; antihistamine, bronchodilators. Mrs, Mahdia Samaha Kony

11. ADVERSE DRUG ACTION • Cumulative effect; result when the dose of drug is given before the body excrete the previous dose, if the drug reach the level of toxicity it can damage the body organs such as the liver and kidney. • Idiosyncratic effect; abnormal response to drug that may be manifested as over response, under response or response different from the expected outcome. Mrs, Mahdia Samaha Kony

12. ADVERSE DRUG ACTION • Drug interaction; there is a combined effect of two or more drugs acting simultaneously that result in: • Antagonist effect; the effect of drug is less than that of each drug alone • Synergistic effect; the effect of drug is greater than that of each drug alone. Drug interactions become serious risk with elderly population Mrs, Mahdia Samaha Kony

13. Factors affecting medication action • Developmental factors; During pregnancy; drugs taken during pregnancy pose a risk throughout the pregnancy, but pose the highest risk during the first trimester, due to the formation of vital organs and functions of the fetus during this time. Most drugs are contraindicated because of their possible adverse effects on the fetus and certain drugs referred to as teratogenic drugs are known to have potential to cause developmental defects in the embryo or fetus. Mrs, Mahdia Samaha Kony

14. Developmental factors; • Infantusually require small dosages because of their body size and the immaturity of their organs, especially the liver and kidneys. Mrs, Mahdia Samaha Kony

15. Factors affecting medication action • Weight; nurses should know the weight especially before the operation in order to calculate the correct dose for drugs. • Gender; differences in the way men and women respond to drugs are chiefly related to the distribution of body fat and fluid and hormonal differences. • Cultural and Genetic factors; Pharmacology; is the study of the effect of drugs on living organisms. It study the differences in drug responses in various ethnic or racial groups. Mrs, Mahdia Samaha Kony

16. Factors affecting medication action • Psychological factors; a client’s expectations about what a drug can do can affect the response to the medication. For example, a client who believes that codeine is ineffective as an analgesic may experience no relief from pain after it is given. A placebo; is pharmacologically inactive medication • Pathology; the presence of a disease affect the action of drugs. The liver is the primary organ for drug breakdown and the pathologic conditions that involve the liver may slow down metabolism Mrs, Mahdia Samaha Kony

17. Factors affecting medication action • Environment; for example receiving medication in an environment that lack of oxygen effects drug reaction, also pt who receives pain medication or sedative in a busy, noisy environment may not benefit as fully as if the environment were quiet and peaceful. Mrs, Mahdia Samaha Kony

18. Factors affecting medication action • Time of administration; the presence of food in the stomach delays the absorption of oral administration of medication, some medications should be given with the food to prevent gastric irritation. • Diet; nutrients can affect the action of a medication, for example, vitamin K found in green leafy vegetables can counteract the effect of an anticoagulant such as warfarin. Mrs, Mahdia Samaha Kony

19. Principles of medication administration: • Medication ordered: No medication given to a client without order from physician or nurse practitioners Mrs, Mahdia Samaha Kony

20. Types of medication orders; • A standing order may be carried out as specified until an order is written to cancel it, or it may be carried out for a specified number of days (e.g., Demerol 100 mg IM q4h × 5 days). As Needed or prn ; the pts receives medication when it is requested or needed, usually written for postoperative orders pain management Mrs, Mahdia Samaha Kony

21. Types of medication orders; Single order or one – time order is for medication to be given once at a specified time by the physician such as a medication to be administrative immediately before surgery Stat order indicates that the medication is to be givenimmediately and only once. Mrs, Mahdia Samaha Kony

22. parts of the medication order: • Client’s full name; fullname is used • Date & time the order is written in order to prevent errors • Name of the drug to be administered • Frequency of administration such as Q 4 hours, Bid. • Dosage of the drug • Route by which the drug to be administered • Signature of the person writing the order; the name signature and title, it is important for a legal reason. Mrs, Mahdia Samaha Kony

23. Checking the medication order; that is written on a Kardex 3 times • Questioning the medication order, because the nurse is legally responsible for the drug administer any order suspected to be an error should be questioned, guessing is a gross carelessness rechecking with the person who wrote the order is the only safe procedure. Mrs, Mahdia Samaha Kony

24. Medication supply systems • Stock supply system; large quantities of medications are kept on the nursing unit. • Individual supply system; each patient is supplied with medications needed for a period of time. • Unit dose system; the pharmacist simplifies medication preparation by packing and labeling each dosage for a 24- hour period. • A computerised medication system; has drawers stocked with approved medications, and provides access to the medications ordered for each patient. Mrs, Mahdia Samaha Kony

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27. Dosage calculation systems of measurement Metric system: each unit can be divided into multiple of ten a) Weight 1000µg =1mg 1000mg =1g 1000g =1kg b) Volume 1000ml=1L Mrs, Mahdia Samaha Kony

28. Household • Tea spoon • Table spoon • Tea cup • Glass Mrs, Mahdia Samaha Kony

29. Formulas for computing drug dosages Several formulas can be used to calculate drug dosages. One formula uses ratio: Dose on hand = dose desired Quantity on hand quantity desired For example, erythromycin 500mg is ordered. It is supplied in a liquid form containing 250mg in 5 ml. Calculate the dosage by using this formula. Mrs, Mahdia Samaha Kony

30. Pediatric calculation Calculation according to the child’s weight or body surface “BSA” and the formula calculating child dose are: BSA “child” (m2) X normal adult dose = child’s dose BSA adult ( average 1.7m2) For example, a child who weighs 10 kg and is 50cm tall has a body surface area of 0.4m2, Therefore, the child’s dose of tetracycline corresponding to an adult dose of 150mg would be? Mrs, Mahdia Samaha Kony

31. Safety measures while preparing drugs • Three checks and five rights Three checks; the medication container should be checked • When the nurse reaches for the container or unit dose package. • Immediately before pouring or opening the medication • when replacing the container to the drawer or shelf or before giving the unit dose medication to the pt. Mrs, Mahdia Samaha Kony

32. Five rights of medication • The nurse gives the; • Right medication to the • Right patient in the • Right dosage through the • Right route at the • Right time Mrs, Mahdia Samaha Kony

33. Others add five rights Right client education. Explain information about the medication to the client Right documentation. Promptly and accurately document the medication administration Right to refuse. Adult clients have the right to refuse any medication. Right assessment. Some medication requires specific assessments prior to administration (e.g., apical pulse, blood pressure, lab result). Right Evaluation. Was the desired effect achieved or not? Mrs, Mahdia Samaha Kony

34. Maintaining a safe environment Such as good lighting when preparing the medication better for the nurse while preparing the drugs to be alone, no distraction, locked the drawer after preparing, each pt, giving drug recording is important. Mrs, Mahdia Samaha Kony

35. Caring for controlled substance safety • Caring through locked drawer or container • Caring for Narcotic • Checks the identification cart or bracelet before giving the medication • Healthcare agencies provide forms for keeping such records, and these forms are kept with the narcotics. Although the forms differ, the following information usually is required: • Name of the patient receiving the narcotic • Amount of the narcotic used • Hour the narcotic was given • Name of the physician who prescribed the narcotic • Name of the nurse who administered the narcotic Mrs, Mahdia Samaha Kony

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37. Routes of administration 1- Oral Medication Is the most common, least expensive, convenient, safe. In oral medication the drug is swallowed.  Mrs, Mahdia Samaha Kony

38. Forms of oral medication are: - Solid; include tablets, capsules, and pills • Liquid; such as syrup, suspension and can be taken either by measured cup or syringes. Mrs, Mahdia Samaha Kony

39. Disadvantages:- • Unpleasant taste of the drugs • Irritation of the gastric mucosa • Irregular absorption from the gastrointestinal tract, slow absorption • In some cases harm to the client’s teeth. (e.g., liquid preparation of ferrous sulfate) • Sometimes pt hides medication in the mouth or cheek, so the nurse should make sure that the pt swallowed med. before recording Mrs, Mahdia Samaha Kony

40. Special Techniques The following techniques help disguise or mask an objectionable taste: • Crush the medication and add it to food or a drink so that the patient can swallow it. • Allow the patient to suck on a small piece of ice for a few minutes before taking the medication. • Store oily medications in the refrigerator. Mrs, Mahdia Samaha Kony

41. Special Techniques • Place the medication in a syringe, and place the syringe well back on the tongue, being careful not to trigger the patient’s gag reflex. • Offer oral hygiene immediately after giving the medication. • Give the medication with generous amounts of water or other liquids, if permitted, to dilute the taste. Mrs, Mahdia Samaha Kony

42. Special Techniques • Children. It can be challenging and frustrating to administer medications to infants and children. • Children younger than 5 years have difficulty swallowing tablets and capsules. • Most medications are available in liquid form. • Nursing responsibility also includes teaching and preparing family members to administer medications to a child at home. • Understanding the medication order and the reason for the medication, the caregiver should be able to demonstrate any special techniques involved in administering the prescribed drugs. Mrs, Mahdia Samaha Kony

43. strategies for administering oral medications to children: • Use a dropper to give infants or very young children liquid medications while holding them in a sitting or semi sitting position. Place the medication between the gum and cheek to prevent aspiration. • Crush uncoated tablets or empty a soft capsule and mix the medication with soft foods, such as potatoes for patients who are likely to aspirate liquids. • If a medication has an objectionable taste, warn the child, if he or she is old enough to understand. Mrs, Mahdia Samaha Kony

44. strategies for administering oral medications to children: • Take care when selecting the food to be mixed with the medication. The item should not be an essential part of the child’s diet, such as formula or the child’s favorite food. The child may refuse to eat a food associated with medications. • Offer the child a flavored ice pop or frozen fruit bar immediately before taking the medication. • Praise the child for a job well done after he or she swallows the medication. Mrs, Mahdia Samaha Kony

45. Administering Medications Throughan Enteral Feeding Tube • Use liquid medications or medications that can be crushed and combined with liquid. • Bring the liquid medication to room temperature. • Remove the clamp from the tube and check tube placement in the stomach or intestine. • Flush the tube with 15 to 30 mL water (5 to 10 mL for children) before giving the medication and immediately after giving the medication. Mrs, Mahdia Samaha Kony

46. Give medications separately and flush with water between each drug. • If the tube is connected to suction, keep it disconnected from the suction and clamped for 20 to 30 minutes after administration of the medication to allow absorption. • Disconnect a continuous tube feeding before giving medications, and leave the tube clamped for a short period of time after the medication has been given. • Document the water intake and liquid medication by tube on the intake and output record. Mrs, Mahdia Samaha Kony

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48. See table 35-6 Page 839 Mrs, Mahdia Samaha Kony

49. Certain situation that oral med shouldn’t be administered: • Pt has difficulty in swallowing • Unconscious • NPO Mrs, Mahdia Samaha Kony

50. 2- Sublingual Medication - A drug is placed under the tongue where it dissolves -The drug is largely absorbed into the blood vessels on the underside of the tongue. The medication should not be swallowed. - May cause stinging or irritation of the mucous membranes. Mrs, Mahdia Samaha Kony