Download Drug Nomenclature

Drug
Administration
By: MYLA KISON, RN, MAN
For handouts log on: www.dyci_sirglennhandouts@ yahoogroups.com
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
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Route of administration
Drug solubility
pH
Local conditions at site of administration
Drug dosage
Serum drug levels
Adverse Effect of Medications
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Iatrogenic disease
Allergic effects
Toxic effects
Idiosyncratic effects
Drug interactions
Signs and Symptoms of Drug Allergy
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Rash
Uticaria
Fever
Diarrhea
Nausea
Vomiting
Anaphylactic reaction
Variables Influencing Effect
of Medications
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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
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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
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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:
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The right medication
To the right person
In the right dosage
Through the right route
At the right time
Controlled Substances
Required Information
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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
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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
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Ventrogluteal site
Vastus lateralis site
Deltoid muscle site
Dorsogluteal site
Criteria for Choosing Equipment
for Injections
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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
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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
THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR MAKING MISTAKES”
MD
high volume
patients
illegible, unclear orders
high volume
MD orders
high volume
prescription
high variety, myriad
cases, symptoms
high turnover
medical staff
high stress, overworked
medical staff
highly sensitive
impatient patients
high speed
emergencies
Type of Medication Errors
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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
LOOK-ALIKE SOUND-ALIKE PRODUCT NAMES
HYDROXYZINE
HYDRALAZINE
ULTRACET
ULTRACEF
SERZONE
SEROUEL
ACTRAPID
ACTRAPHANE
FORADIL
TORADOL
PLAVIX
PAXIL
ZYRTEC
ZYPREXA
LOSEC
LASIX
ACCUPRIL
MONOPRIL
CELEBREX
CEREBYX
SINECOD
SINEMET
DANGEROUS ABBREVIATIONSINSTRUCTIONS
.5 mg
5 mg
µg
mg
1:10,000 mg/mL
1:1,000 mg/mL
5.0 mg
50 mg
HCl
KCl
X (yes)
X (no)
0.01 mg
0.001 mg
10U
100
D/C (discharge)
D/C (discontinue)
every Monday
every morning
LOOK-ALIKE PRODUCTS AND PACKAGING
10ml
10ml
HEPARIN
suppository
oral
capsule
INSULIN
water
A
alcohol
B
cephalexin dolfenal
KCl
distilled
water
SIMILAR-LOOKING CONTAINERS
FOR DRUGS AND NON-DRUGS
drug
soap
fixative
poison
THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR MAKING MISTAKES”
dangerous
equipment
use of invasive devices
potent chemicals
high risk, irreversible
KCl
procedures
potent body fluids
look-alike, sound-alike
drugs, chemicals, fluids
potent drugs
infectious
environment
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.
THE HIGH RISK ENVIRONMENT OF HEALTH CARE
“THE PERFECT SET UP FOR HIDING MISTAKES”
disease can
mask medical error
collegial silence
incoherent, inarticulate patients
IR
punitive culture
ADMINISTRATOR
hierarchical
culture
MED. DIRECTOR
MANAGER
MANAGER
multiple handoffs
MANAGER
MANAGER
incomplete, error-prone
documentation
dual management
most errors are
near misses, slight effects
1 million hospitalized patients in the U.S.
16 doses of medication daily each
16 million doses per day
2% medication rate
320,000 medication errors daily
A Medication Error Story
Nurse gives the
patient
a medication to
which he
is allergic
Patient arrests and
dies
HIS for ordering
medications
is broken
Tube system
for obtaining
medications
is broken
Nurse borrows
medication from
another patient
Reason
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.
11 Golden Rule’s in giving medications
suppository
oral
capsule
1. Administer the right Drug
2. Administer right drug to right patient
3. Administer with right dose
4. Administer Right drug with right route
5. Administer right drug at right time
6. Document each drug you administer
potent drugs
7. Teach your patient about the drug he is receiving.
8. Take a patient complete pt. drug history
9. Find out if the patient has any drug allergies
10.Be aware of potential drug to drug , and Drug to food
reactions,
11.The right of the patient to refuse medications.
Clarifying Orders
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Illegible
Incomplete
Incorrect Route or dosage
Not expected of patients current diagnosis.
Know your Medications
• Mode of action & the purpose of
medication
• Side effects or contraindication of
medication
• Antagonist of medication
• Safe dosage range of medication
• Interaction with other medication
• Proper administration technique
Principle in Size of Needle
• The higher the number the smaller the
gauge of the needle.
• The smaller the number the bigger the size
of the lumen.
Degrees of Insertion
• Intramuscular – 72 to 90 degrees
• Subcutaneous – 45 degrees
• Intradermal- 10 to 15 degrees
Subcutaneous
• Subcutaneous injection should not contain
no more that 1 ml in an insertion site .
• The normal angle of insertion is 45 to 90
degrees
• Subcutaneous injection sites: Abdomen,
scapula, thigh, upper back, upper dorso
gluteal region.
Intramuscular
• Intramuscular injection should not contain no
more than 3 to 5ml,the smaller the muscle being
injected ,the smaller the amount should be.
• Injection sites: Vastus lateralis, Ventrogluteal,
deltoid , dorso gluteal.
• Insertion site selection depends on:
• Amount of medication/ Viscosity of medication/
Age of pt & Development of muscle tissue ,
preference of pt. or nurse.