Medication Management-- WI 2012

Nursing 301.01 with Long at Ohio State University - All Campuses

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By: Natalie Buzzelli
Created: 2012-03-13
Size: 97 flashcards
Views: 2

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Drugs

chemical substance that alters an organism's function; may or may not have a therapeutic effect

medications

used for a therepeutic effect

chemical name of drug

N-acetyl-para-aminphenol

also molecular structure name

generic name

nonproprietary name*

assigend to drug when first manufactured

*acetaminophen

official name

name assigned by FDA; most often same as generic

Trade name

proprietary name

brand name; copyright; specific manufacturer

Meds grouped into two categories:

1. prescription

2. OTC or non-prescription

prescriptions have these criteria (8):

1. patient name

2. med name

3. dose

4. route

5. frequency

6. amount to be dispensed

7. number of refills

8. physician signature

Non prescripion/OTC meds

taken to enhance personal health

- no prescription needed; common health problems

Pure Food and Drug Act

1906

- set quality and purity standards

- how it's packaged and chemical composition

FDA

food and drug administration

government responsible for maintaining standards set by law

- distribution

- prescription not needed or not

drug testing

controlled substances

force narcotic law

mind/behavior/abuse potential/habitual

mechanism of action of drug

physiological change caused by a med that results in the body's response to the med

target organ

when med has specific effect on one type of body tissue

therapeutic effect

intended effect

every med has at least one therapeutic effect and some have several

side effect

not intended or planned

italicized in handheld

mild, not harmful

adverse effect

effect that's potentially harmful

in order of frequency in handheld

toxic effect

serious side effect which may be life threatening

CAPITALs or high alert meds( red or black box warning)

ex: low HR with digoxin

allergic reaction

Ag-ATB response

common

previous exposure usually needed

Hypersensitivity reaction

mild allergic reaction

-N/V/D

anaphylaxis

life threatening

bronchoconstriction

laryngospasms

idosyncratic reactions

unpredictable response

"rare"

ex: child becomes hyperexcitable with Benadryl

drug tolerance

diminished therapeutic effect

over time

inc. dosages; common with pain meds

Synergistic effect

drug enhances the effect of another

accidental or planned

ex: alcohol potentiates drug

antagonistic effect

drug negates effect of another

patient who takes multipl emeds

"polypharmacy"

Pharmacokinetics: Absorption

refers to the transference of drug molecules from the point of entry in the body into the blood stream

loading dose

higher than average dose to achieve therapeutic effect

exceeds maintenance dose

meds that need loading dose: amenophylin, dilantin, digoxin, Z-pak

factors affecting absorption:

1. form of med--> liquid v. extended release

2. meals--> primary before or secondary after

3. GI tract--condition of bowel

4. blood to area--IM or SQ

5. local site condition-- scarring, bruising, edema; won't be absorbed quickly

distribution (pharmkinetics)

begins with the absorption of the med in the circulation and ends with the arrival of the med at the site of action

distribution effects of circulation

blood supply at tissue, vasoconstriction or vasodilation

physiological barriers to distribution

BBB

placental barrier

specific meds to cross

effects of proteins on distribution

most meds bound to protein=inactive

active protein exerts TE

low albumin= more circ. of med--> more SE with regular dose--> give lower dose

pharmacokinetics: metabolism

inactivating or breaking down the med

liver and metabolism

most common site

liver functioning decreased with age-- dec. dosage

risk of drug toxicity

less frequent sites for drug met.

kidneys, lung, intestines

pharmacokinetics: excretion

exit of the med from the body

kidneys and excretion

responsible for excretion

need 6-8 glasses of H20/day

other organs of excretion

lungs, sweat, mammary glands, GI tract

lungs and excretion

alcohol, nitrous oxide, ehter

GI and excretion

meds in bile

blood levels--peak serum levels

highest concentration

trough level

lowest concentration

half level

amount of time thebody needs to lower by half the drug's serum concentration by metabolism and excretion

plateau

serum concentration or level of a drug that has been reached and sustained with a series of fixed doses

**optimal results

types of orders (4)

standing

PRN

single

stat

standing order

meds given on routine basis

*HTN/heart meds

PRN orders

given as needed "pro re nata"; pain meds, stool softeners; given after good assessment

single order

one time

pre-op med

stat order

implemented immediately

medication distribution (2)

1. unit dose sytem

2. computer controlled dispensing

unit dose system

med cart

pharm brings it up and replenishes

computer-controlled dispensing

"pixis"

automated med. teller

personal ID needed

meds stored in specific contained

routes of administration (4)

1. oral

2. sublingual

3. buccal

4. enteral

oral administration

swallowed

sublingual

placed under tongue and dissolved

absorbed efficiently as tongue is highly vascular

buccal administration

tablet/lozenge; placed against mucus membrane b/t cheek and gums; near molars

topical

enteral administration

given via nasogastric, gastrostomy, or jejunostomy tube

parenteral admin. (4)

Intradermal

given in dermal layr of skin

--TB test

Subcutaneous

into SQ tissue

heparin, insulin, etc.

intramuscular

not as often

vit. B12, anti-nausea

muscle tissue

intravenous

into a vein, most rapid effect

topical admin.

right to body site

skin, eye, ear, rectum, etc.

inhalation

brins med into respi. tract

factors affecting drug action (9)

age

psych

genetic diff.

gender

ht. and wt.

diseases

rxns to envir.

cultural and lifestyle

socioeconomic

infants and drug actions

immature renal, hepatic, and GI system

lack enzymes for proper drug met.

elderly and drug action

dec. abs., met. and excretion; inc. drug toxicity/adverse effect; synergistic effect possibilities

psych and drug action

pt. chooses to take med

motivation, memory, some ppl like secondary gains of being sick

genetic diff. and drug action

-allergy to PCN runs in family

-certain ethnic groups have diff. rxn to meds

-blacks don't respond well to ACEI's

gender and drug action

diff. amount of fat and muscle

-most research done in males

-unexplained reactions in women

height and weight and drug actions

standard doses are for average adults

diseases and drug action (GI, Heart, Liver/renal)

-impaired GI--> absorption

- heart failure-->imparied distribution

-liver/renal dz-->dec. met. and excretion

reactions to environment

vasoconstriction or vasodilation

some adv. effects to sunlight--> photosensitivity--> sunlight

cultural and lifestyle and drug action

specific foods can trigger drug-food interactins

diuretic--> Ca depleting--> eat food with lots of calcium

socioeconomic and drug action

financially disadvantaged so they don't seek healthcare

25% of americans read at 5th grade level--> can't read drug side effects

Assessment of med admin. (6)

1. allergic hx

2. med hx

3. diet hx

4. knowledge of drug therapy

5. current condition

6. perception and coordination

allergic hx

rlsp. bt drug and food allergies

ex: shellfish--> no iodine based meds; eggs--> avoid some vaccines

med. hx

document all drugs taken

-name, time, dose, includes OTC and herbal supp.

diet history

some meds absorbed best with food

pts. knowledge of drug therapy

inc. knowledge= better compliance

current condition

are meds suff./approp for pt. condition?

-vitals, lab values, etc.

perception and coordination

probs. with cognition, vision, or coordination

when and how many times do you check to make sure it's the right drug?

1. when take med out of container

2. opening package

3. before admin. to pt.

the 6 "rights"

1. the right drug

2. the right dose

3. the right client

4. the right route

5. the right time

6. the right documentation

the right drug

check 3 times; compare it to MAR(med. admin. record)

the right client

check ID bracelet

ask pt. to state name or birthdate

the right route

must be specified in the order

the right time

1 hr. before or after scheduled time

the right documentation

chart immediately in room

pediatric considerations

<5 y.o.= difficult swallowing--> crush or call pharmacy for liquid version or someting to hide taste

geriatric considerations

allow sufficient time to take meds; offer small amount of liquids b4 and after

liquids inc. med. absorption

--1 to 2 pills/ time

-- teach by name not color

four categories of errors

1. no errors

2. error without harm

3. error with harm

4. error resulting in death

no error

could have led to error

error without harm

admin. med a little early or late

reporting an error

prof. responsibility to report our errors

document the incident

report to nurse manager and physician

assessing patients physiological status and safety

1. check vitals

2. complete assessment

3. document

documenting the error

only on event reports*

state factual info

who was notified and follow up actions

About this deck

By: Natalie Buzzelli
Created: 2012-03-13
Size: 97 flashcards
Views: 2

About StudyBlue

“I have used this website for three exams, and I see a huge difference in my test results.”
Naj