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Chapter 29 Medications Drug Nomenclature • Chemical name — identifies drug’s atomic and molecular structure • Generic name — assigned by the manufacturer that first develops the drug • Official name — name by which it is identified in official publications USP and NF • Trade name — brand name copyrighted by the company that sells the drug Drug Preparations • Oral – Capsule, pill, tablet, extended release, elixir, suspension, syrup • Topical – Liniment, lotion, ointment, suppository, transdermal patch • Injectable Drug Classifications • Body system • Symptoms relieved • Clinical indication Mechanisms of Drug Actions • Drug-receptor interaction — drug interacts with one of more cellular structures to alter cell function • Drug-enzyme interaction — combines with enzymes to achieve desired effect • Acting on cell membrane or altering cellular environment Pharmacokinetics • Absorption — drug is transferred from site of entry into bloodstream • Distribution — drug is distributed throughout the body • Metabolism — drug is broken down into an inactive form • Excretion — drug is excreted from the body Factors Affecting Drug Absorption • Route of administration • Drug solubility • pH • Local conditions at site of administration • Drug dosage • Serum drug levels Adverse Effect of Medications • Iatrogenic disease • Allergic effects • Toxic effects • Idiosyncratic effects • Drug interactions Signs and Symptoms of Drug Allergy • Rash • Uticaria • Fever • Diarrhea • Nausea • Vomiting • Anaphylactic reaction Variables Influencing Effect of Medications • Developmental considerations • Weight • Sex • Genetic and cultural factors • Psychological factors • Pathology • Environment, timing of administration Types of Medication Orders • Standing order — carried out until cancelled by another order • Prn order — as needed • Stat order — carried out immediately Parts of the Medication Order • Patient’s name • Date and time order is written • Name of drug to be administered • Dosage of drug • Route by which drug is to be administered • Frequency of administration of the drug • Signature of person writing the order Medication Supply Systems • Stock supply • Individual supply • Medication cart • Computerized medication system • Bar coded medication cart Systems of Measurement • Metric — meter (linear), liter (volume), gram (weight) • Apothecary — less convenient and concise; basic unit or weight is grain • Household — least accurate system; teaspoons, tablespoons, teacup and glass used Metric System Conversions • To convert larger unit to smaller unit, move decimal point to right. • To convert smaller unit to larger unit, move decimal point to left. – 1 kilogram = 1000 grams – 1 gram = 1000 milligrams – 1 milligram = 1000 micrograms Three Checks of Medication Administration • Read the label: – When the nurse reaches for the container or unit dose package – Immediately before pouring or opening medication – When replacing the container to the drawer or shelf Five Rights of Medication Administration • The nurse should give: – The right medication – To the right person – In the right dosage – Through the right route – At the right time Controlled Substances Required Information • Name of patient receiving narcotic • Amount of narcotic used • The hour narcotic was given • The name of physician prescribing narcotic • Name of the nurse administering narcotic Oral Medications • Solid form — tablets, capsules, pills • Liquid form — elixirs, spirits, suspensions, syrups Administration of Oral Medications • Oral Route — having patient swallow drug • Enteral route — administering drug through an enteral tube • Sublingual administration — placing drug under tongue • Buccal administration — placing drug between tongue and cheek Administration of Parenteral Medications • Subcutaneous injection — subcutaneous tissue • Intramuscular injection — muscle tissue • Intradermal injection — corium (under epidermis) • Intravenous injection — vein • Intraarterial injection — artery • Intracardial injection — heart tissue • Intraperitoneal injection — peritoneal cavity • Intraspinal injection — spinal canal • Intraosseous injection — bone Sites for Intramuscular Injections • Ventrogluteal site • Vastus lateralis site • Deltoid muscle site • Dorsogluteal site Criteria for Choosing Equipment for Injections • Route of administration • Viscosity of the solution • Quantity to be administered • Body size • Type of medication Preparing Medications for Injection • Ampules • Vials • Prefilled cartridges Topical Administration of Medications • Vaginal • Rectal • Inunction • Instillation • Irrigation • Skin application Medical Record Documentation • Each dose of medication, give as soon as possible after it is given • Intentional or inadvertent omitted drugs • Refused drugs • Medication errors Type of Medication Errors • Inappropriate prescribing of the drug • Extra, omitted, or wrong doses • Administration of drug to wrong patient • Administration of drug by wrong route or rate • Failure to give medication within prescribed time • Incorrect preparation of a drug • Improper technique when administering drug • Giving a drug that has deteriorated Medication Errors • Check patient’s condition immediately; observe for adverse effects. • Notify nurse manager and physician. • Write description of error on medical record and remedial steps taken. • Complete special form for reporting errors. Patient Teaching • Review techniques of medication administration. • Remind patient to take the medication as prescribed for as long as prescribed. • Instruct patient not to alter dosages without consulting physician. • Caution patient not to share medications.