Download Chapter 18- Unit 1 Commonly prescribed medications Hydrocodone

Chapter 18- Unit 1
Commonly prescribed medications
1. Hydrocodone with APAP
2. Lipitor
3. Zestril
4. Tenormin
5. Synthroid
6. Amoxil
7. Hydrochlorothiazide
8. Zithromax Z-Pak
9. Lasix
10. Norvasc
11. Toprol- Xl
12. Xanax
13. Albuterol
14. Zoloft
15. Zocor
16. Glucophage
17. Ibuprophen
18. Dyazide
19. Ambien
20. Cephalexin
Entire staff should become knowledgeable about these medications
Pharmaceutical references
1. PDRs for both prescription and nonprescription (OTC) medications
2. Familiarize yourself with references for prescription and
nonprescription medicines
3. Guidelines for using PDR (see text, p. 783)
Writing prescriptions
1. A prescription is often called a script
2. It is a written order for a particular medication or treatment for a
particular patient by a licensed physician
a. Most are handwritten (especially narcotics) with physician’s
signature (see text, p. 784, for contents, and Fig. 18–1)
b. Prescribed medications must be recorded in the patient’s chart
c. Single and multiple script pads
d. Keep prescription pads locked
e. When calling prescription in to pharmacy, ask pharmacist to repeat
back for accuracy
f. Prescription filled by the pharmacy often has an instruction label and
reminder stickers (see text, Fig. 18–2)
g. Patient Education, p. 781
3. In the United States, physicians who dispense, administer, or prescribe
medications must register with the U.S. Department of Justice, Drug
Enforcement Agency (see text, Fig. 18–3), under the Controlled
Substances Act of 1970
a. Form completed with physician’s state license number and signature
and returned with fee
b. If the physician moves, the change of address must be reported to the
nearest DEA field office
c. Must be renewed every three years (see text, p. 784)
d. Physician must comply with 1984 Diversion Control Amendments
requirements to administer, dispense, or prescribe controlled
substances (see text, Table 18–2)
(1) Schedule I prohibits prescriptions
(2) Schedule II
(a) Must be written or typed with physician’s signature and DEA
number
(b) No refills
(3) Schedules III–IV
(a) Prescriptions by phone or written
(b) Five refills within six-month period
(4) Schedule V
(a) Subject to state and local regulations
(b) Prescriptions not necessarily required
Recording medications, p. 785
1. Must be able to read and record many different types of medications
a. Memorize commonly used abbreviations and symbols (see text,
Table 18–3, p. 787)
b. Equivalent weights and measures (see text, Tables 18–4 and 18–5,
p. 788)
c. Record any side effects or reaction
d. Immunization documentation
(1) Name and manufacturer
(2) Lot number of batch with expiration date
(3) Physician’s name, address
2. Expertise in math skills helps to save money in ordering medications
and supplies for office (see text, Table 18-6)
3. Consult pharmaceutical representatives for information about
medications
Storing medications
1. Keep forms, prescription blanks, records, and medications secured in a
locked storage cabinet
2. Rotate medications according to expiration dates
3. Categorize medications by classification (see text, Table 18-1) or
alphabetize
Chapter 18-2
Administering medications
1. Follow a standard format to ensure accurate and efficient administration
2. Prior to administering make sure you have the correct:
a. Patient (identify for accuracy)
b. Medication (read label carefully to avoid error)
c. Dose/amount (be exact)
d. Right method (read order carefully)
e. Technique (how the method is administered, i.e., the skill with which
you give different injections)
f. Time/schedule (expiration date, immunization schedule, time of day)
Methods of administration
1. Oral
a. Swallowed (see text, Fig. 18–5 B, and Procedure on p. 793)
b. Intended for absorption in the small intestine
c. By script or administered in the office
d. Convenient, economical, easily stored; less dangerous than if
injected (if reaction occurs, just discontinue)
2. Sublingual
a. Place medication under tongue
b. Immediate effect in bloodstream, e.g., nitroglycerin for angina
patients
3. Buccal
a. Place in mouth between gums and cheek
b. Absorbed through mucous membrane
c. Avoid eating, drinking, and chewing while medication is in place
[Show Medical Assisting Clinical Skills CD—Skills Menu: Oral
Medications]
4. Inhalation
a. Breathed into respiratory tract
b. Form of gases, sprays, fluids and powders to mix with liquids for use
in a machine that turns the medication to vapor
(1) Instruct patient in use for home
(2) Keep file of all equipment care and operation
c. Oxygen
(1) Form of inhalation medication that should be available for
emergencies in every medical practice
(2) Home oxygen treatment instructions available from companies
for patients
[Show Medical Assisting Clinical Skills CD—Skills Menu:
Nebulized Medications]
5. Topical
a. Applied to skin
b. Sprays, lotions, creams, ointments, paints, salves, wet dressings, and
adhesive patches (see text, Figs. 18–7 and 18–8)
c. Apply as instructed for maximum effect
(1) Apply medication with gentle single strokes to relieve itching
(2) Rubbing increases circulation, producing heat that makes itching
worse
d. Transdermal patch
(1) Placed on skin to release in minute doses the desirable medication
into the tissues
(2) Also called infusion system
(3) Avoid getting on fingers
(a) Priming dose in adhesive edge of patch
(b) Advise patient or person who applies the patch that gloves
should be worn and/or the hands should be washed thoroughly
after applying the patch
(c) Special cautions with nicotine patches
[Show Medical Assisting Clinical Skills CD—Skills Menu:
Skin/Topical Medications]
6. Vaginal
a. Applied to vaginal tissues or inserted into vagina
b. Creams, suppositories, tablets, douches, foams, ointments, tampons,
sprays, and salves (see text, Patient Education, p. 795)
c. Advise patient to use medication even during menses
d. Tell patient to finish all medication
e. Instruct patient in personal hygiene, PRN, and to avoid douching
except by physician’s orders
Considerations affecting how the body responds to a drug
1. Age
a. Pediatric and geriatric patients require smaller doses
b. Dosages must be calculated according to patient’s weight to achieve
a specific blood level
2. Body surface area (BSA)
a. Special medications determined by BSA
b. Plotting patient’s height and weight on nomogram, Fig. 18–9
3. Method of administration
a. Rate at which body uses medication varies
b. Injected medications circulate in the bloodstream rapidly
4. Tolerance may develop if a patient takes a particular medication over a
period of time
5. Allergies
a. Be alert and mark in patient’s chart
b. Notice red ink that signifies allergy
c. Listen for symptoms of allergy
6. Time refers to helping a patient determine an appropriate schedule for
taking medications
7. Interaction refers to helping a patient know what to eat or drink with
medications
CHAPTER 18-3
Injections
1. Given only with physician’s orders
2. Physician must be on site should adverse reaction or anaphylactic shock
occur (see text, pp. 721–722, for symptoms)
3. Procedure for anaphylactic shock
a. Notify physician STAT!
b. By order of physician administer epinephrine just above injection site
and massage area
c. Keep taking patient’s vital signs until stable
4. The term hypodermic means under the skin
5. Parts of syringe and needle (see text, Fig. 18–10)
6. Technique
a. Use an orange to practice inserting different needle sizes at different
angles of insertion (see text, Fig. 18–14)
b. Never recap a needle unless you have not administered the
medication and you use the “scoop” method (see text, Fig. 18–15 A
and B and Fig. 18–16, and demonstrate the technique)
c. Cartridge type injection method
d. Be careful when injecting a patient to avoid injury and infection
(1) Minimum pain and discomfort with proper technique
(2) Get assistance with resisting child
e. Patient preparation
(1) Explain procedure to patient to gain compliance
(2) Children need honesty about pain
(3) Teach parents to avoid using injection threat for discipline
(4) Praise child for cooperation
(5) Obtain proper forms and signatures PRN from parents for
immunizations
(6) Ask patient to remove restrictive clothing from injection site
f. Wear latex gloves
g. Use alcohol to prep the skin
h. Refer to text Procedures 18-2 and 18–3 for withdrawing medications
from an ampule, p. 799, and from a vial, p. 800, and see Figs. 18–11,
18–12, and 18–13
i. Dispose of used needle and syringe intact to biohazardous sharps
container (see text, Fig. 18–18)
[Show Medical Assisting Clinical Skills CD—Withdrawing from an
Ampule, and Medication from a Vial]
Intradermal (ID) injection
1. Used for allergy and tuberculin testing
2. Administered just under the surface of the skin
a. Fine-gauge needle used, either 26G or 27G
b. 3/8- to 5/8-inch long needle
c. 10- to 15-degree angle of insertion (see Procedure 18–4 in text, p.
804, and Fig. 18–17)
3. Sites are the anterior forearm and mid back
4. Position patient for comfort
5. Patient must be observed for 20 minutes or more following
administration and untoward reactions must be reported to physician
6. Small wheal develops at the site, which shows that the medication is in
the dermal layer of the skin
7. Very small amount used, from 0.01 to 0.05 cc administered
8. Record speed of reaction and size of wheal
9. Perform under direct supervision of physician
10.For a hypersensitive reaction, obtain a physician’s order for epinephrine
to be administered just above site
Subcutaneous (SC) injection
1. Used to administer a small dose of medication, not more than 2.0 cc (see
Procedure 18–5 in text, p. 806)
2. Ask patient to sit or lie down for the injection
3. Given in upper outer arm, the abdominal area, or the midvastus lateralis
area of the upper thigh (see text, Fig. 18–19)
a. Length of needle is from 1/2 to 5/8 inch
b. Gauge of needle is from 25G to 27G
c. Administered at 45-degree angle
4. Allergy injections (see text, pp. 805–809)
5. Insulin injections (see pp. 810 and 811 in text for Procedure, Figs. 18–
22, and 18–23 and p. 809, especially Patient Information section)
6. Immunizations (see schedules of administration in text, Table 18–7)
[Show Medical Assisting Clinical Skills CD—Subcutaneous
Medications and Intradermal Medications]
Intramuscular (IM) injection
1. Administered into muscle tissue
2. Medication absorbed quickly into rich blood supply
3. Sites are the deltoid, gluteus medius (upper outer portion of hip), ventrogluteal and vastus lateralis (see text, Fig. 18–20 and Fig. 18–21)
a. Length of needle is 1 to 3 inches
b. Gauge of needle is from 18G to 22G (may be smaller for pediatric
patients)
c. Dosage amounts range from 0.5 to 3.0 cc
d. 90-degree angle of insertion
4. Proper positioning of patient is important for muscle relaxation (see
Procedure 18–6 in text, p. 807)
5. When a substance is irritating to subcutaneous tissue, the Z-track
method is indicated (see Procedure 18–7 in text, p. 808)
6. Special consideration with infants and children
a. Needle length, gauge and medication determinations
b. Aspirate for blood
c. Obtain assistance for injections
d. Use distraction techniques
e. Offer rewards
[Show Medical Assisting Clinical Skills CD—Skills Menu:
Intramuscular Medications and Z-track Injection]
Intravenous (IV) injection
1. Introduced directly into the bloodstream
2. Used in emergency situation and only administered by physician
a. Needle is from 1 to 1.5 inches in length
b. Gauge is usually 20G to 21G
c. Dosage amount varies from a few cc to large dosages given by IV
drip
3. Necessary items for preparation of IV administration
a. Sterile needle and syringe
b. Medication (vial or ampule)
c. Tourniquet
d. Alcohol-saturated gauze or cotton balls
e. IV stand PRN
4. Observe the patient for reactions to medication and report them to the
physician immediately
Diabetic instruction
1. Teach patient self-administration
2. Demonstration necessary (see text, Fig. 18–22)
3. Provide written information (see text, Fig. 18–23)
Immunizations
1. Known also as vaccines
2. Produce artificial immunity against diseases
a. Natural immunity is produced from having had the disease, which
causes the body to produce antibodies
b. Artificial immunity is produced from having had an immunization
(1) Vaccine is made from dead or harmless infectious agents
(2) Triggers immune response in the body to produce antibodies
3. Immunization schedule recommendations for well infants, children, and
adults (see text, Table 18–7)
a. Schedules vary in other countries
b. Schedules in United States recommended by public health officials
4. Check patient’s record and medical history for allergies, and obtain a
signed permission form after patient education regarding vaccine(s)
5. Explain time schedule of immunizations to patients (see text, Fig. 18–
26)
6. Diseases for which there are immunizations
a. Influenza
(1) Caused by myxovirus that affects the respiratory tract
(2) Spread by droplet infection from vapor of coughy sneeze and
from handling soiled items of patient
(3) Incubation period is one to four days
(4) Symptoms are fever, chills, sore throat, cough, muscle aches and
pains, general malaise, and weakness
(5) Treatment consists of bed rest, increased fluid intake, antipyretics, and mild analgesics
(6) Immunizations are available against some strains of influenza for
high-risk patients with chronic illness
b. Pneumonia
(1) Acute inflammation of the lungs caused by the pneumococcus
bacterium (also by virus, rickettsiae, and fungi)
(2) Spread by droplet infection and direct contact with an infected
person
(3) Incubation period is only a few hours from the time of exposure
to bacteria
(4) Symptoms are the abrupt onset of high fever, severe chills,
headache, chest, pain, dyspnea, a rapid pulse, cyanosis, and cough
with blood-stained sputum
(5) Treatment is bed rest, increased fluid intake, analgesics,
antipyretics, and, many times, oxygen
(6) Immunization is called Pneumovax for high-risk patients
c. Haemophilus influenza, Type B (HIB or Hib)
(1) Disease caused by a small gram-negative, nonmotile parasitic
bacterium
(2) Leads to severe destructive inflammation of the larynx, trachea,
and bronchi
(3) Spread by droplet airborne infection
(4) Incubation is from one to three days
(5) Symptoms are the sudden onset of fever, sore throat, cough,
muscle aches, weakness, and general malaise
(6) Treatment is bed rest, increased fluid intake, antipyretics,
antibiotics, and analgesics
(7) Complications of disease are meningitis and epiglottitis
(8) Immunization is given in a series of three SC or IM injections at
ages 2, 4, and 6 months, with a booster at age 18 months
d. Measles (rubeola 10-day measles or old fashioned measles), mumps
(parotitis), and rubella (three-day measles or German measles)
(1) One immunization for all three diseases is given between the ages
of 15 to 18 months, and a booster is given at 4 and 6 years
(2) Rubeola
(a) An acute and highly contagious disease caused by the rubeola
virus
(b) Involves the respiratory tract
(c) Spread by direct contact (droplet infection) or by indirect
contact (soiled items of patient)
(d) Incubation period is 10 to 21 days
(e) Symptoms are fever, runny nose, malaise, cough, sometimes
conjunctivitis, loss of appetite, photophobia, sore throat, and
eventually Koplik’s spots (red skin rash)
(f) Treatment is bed rest, increased fluid intake, antipyretics,
antibiotics, cough medicine, and topical calamine lotion
(3) Mumps
(a) Acute contagious febrile disease
(b) Causes inflammation of the parotid and salivary glands
(c) Transmitted by droplet infection or direct contact
(d) Incubation period is from 14 to 28 days
(e) Symptoms are chills, fever, headache, with pain below and in
front of the ears (with swelling) for five to seven days, (and
pain between the ears with eating or drinking acidic or sour
substances)
(f) Treatment is bed rest, soft diet, increased fluid intake, and cold
packs to reduce swelling of the glands
(4) Rubella
(a) Acute viral disease characterized by URI
(b) Transmitted by droplet infection and direct contact
(c) Incubation period is from 12 to 23 days
(d) If acquired in first trimester of pregnancy, fetal abnormalities
can result
(i) Remind patients in childbearing years of this
(ii) Should not be vaccinated during pregnancy
(e) Symptoms are fever, sore throat, drowsiness, malaise,
arthralgia, swollen glands and lymph nodes, and a diffuse fine
red rash (see text, Fig. 18–25)
(f) Complications of rubella are blindness, deafness, brain
damage, heart defects, enlarged liver, and bone malformations
(g) Treatment is bed rest, liquids, antipyretics, and sponge baths
e. Diphtheria
(1) An acute infectious disease caused by Corynebacterium
diphtheriae (a gram-positive nonmotile, nonspore-forming, clubshaped bacillus)
(2) Transmitted by direct and indirect contact
(3) Incubation period is two to five days
(4) Symptoms are headache, malaise, fever, and sore throat with a
yellowish white or gray membrane
(5) Treatment is liquids, soft diet, antibiotics, bed rest, and in some
cases a tracheostomy
(6) Schick test
(a) ID injection of a minute amount of the toxin to determine the
degree of immunity
(b) Little or no reaction indicates immunity or the presence of
antibodies
f. Pertussis (whooping cough)
(1) An acute infectious disease characterized by respiratory drainage
and a peculiar paroxysmal cough that sounds like the shrill
trumpeting cry of the whooping crane
(2) Most common in children under 4 years old, but can affect all
ages
(3) Caused by the small, nonmotile, gram-negative bacillus
Bordetella pertussis
(4) Transmitted by direct and indirect contact
(5) Incubation period is seven to 14 days
(6) Symptoms occur in stages
(a) Catarrhal stage includes an increase in the WBC count marked
by lymphocytosis, respiratory drainage, sneezing, slight fever,
dry cough, irritability, and a loss of appetite
(b) Paroxysmal stage includes violent coughing with whooping
inspiration sounds, and forceful vomiting that can evoke
hemorrhage
g.
h.
i.
j.
k.
(c) Decline stage includes a decline in coughing and a return to
the normal appetite
(7) A trace cough may last for up to two years
Rabies
(1) Viral disease transmitted in saliva of infected animals
(2) Humans have fever, pain, aggressive behavior, hallucinations,
extreme weakness, and thirst
(3) Requires a series of five injections
(4) Fatal if not treated
Tetanus (commonly called “lockjaw”)
(1) An acute, potentially fatal infectious disease that affects the CNS
(2) Caused by the bacillus Clostridium tetani (toxin of this bacillus is
one of the most lethal)
(3) Commonly transmitted in puncture wounds, abrasions,
lacerations, and burns
(4) Incubation period is from three to five days up to four to five
weeks
(5) Symptoms are stiffness of the jaw and esophageal (and sometimes
neck) muscles, with progressing rigidity and soon a fixed jaw;
altered voice; fever, painful spasms of all body muscles;
irritability; and headache
(6) Treatment includes cleaning and debriding the wound,
maintaining an airway, administering antitoxin, sedation,
controlling muscle spasms (quiet room), maintaining fluid
balance, penicillin G, a tracheostomy, and oxygen PRN
Varicella
zoster/herpes
zoster—VZV
(commonly
called
“chickenpox”)
(1) Highly contagious—primarily in young children
(2) Member of the herpes virus family
(3) Spread by direct contact or droplet
(4) Incubation—two to three weeks
(5) Symptoms are pruritic rash (develops into vesiclar pustules),
fever, headache, loss of appetite, general malaise
(6) Treatment: baking soda paste to control itching eruptions, bed
rest, liquids, antipyretics, oral antihistamines
Hepatitis A
(1) Also known as infectious hepatitis
(2) Vaccine is two injections six months apart
(3) Required for travel to certain countries
Hepatitis B
(1) Highly contagious, potentially fatal disease caused by the
hepatitis B virus (HBV)
(2) Also known as “serum hepatitis”
(3) Transmitted by contaminated serum in blood transfusions or by
using contaminated needles or instruments
(4) Incubation period is 14 to 50 days
(5) Symptoms include the slow onset of fever, malaise, loss of
appetite, nausea and vomiting, progressing to include jaundice,
weakness, dark urine, and whitish stool
(6) Treatment includes bed rest, a forced-fluid intake, and avoiding
alcohol and fats
(7) Hepatitis B vaccine is urged for health care providers, and is now
being given to infants
l. Meningitis (Bacterial)
(1) Prominent in 15-to-24-year-olds
(2) Highly contagious with lasting effects
(3) Can be lethal within 48 hours
(4) Vaccine can prevent
m. Other diseases for which there are vaccines
(1) Polio (infantile paralysis or poliomyelitis)
(a) An infection and inflammation of the gray matter of the spinal
cord
(b) Caused by the polio virus
(c) Transmitted by the oral-fecal route in infants and small
children more so than in adults
(d) Incubation period is seven to 12 days up to 35 days
(e) Symptoms are fever, malaise, headache, nausea and vomiting,
slight abdominal discomfort, general paralysis (if respiratory
muscles are involved it can be fatal)
(f) Treatment is bed rest, mild analgesics, sedatives PRN, fluid
and salt balance, laxatives/enemas PRN, oxygen, respirator,
tracheostomy PRN, and physical and occupational therapy
with recovery
(g) Vaccine comes in frozen form and is administered orally
(h) An injectable form, IPV (inactivated polio vaccine)
(i) Given to infants two times during first year
(ii) Follow-up injections at beginning school and every five
years until age 18
(2) Cholera and typhoid, etc.
(a) Immunizations advised PRN for travel in underdeveloped
countries
(b) Immunization Alert and local and state health departments
may be contacted for up-to-date immunization information for
various countries
(c) Encourage patients to carry updated immunization record with
them at all times
(3) Refer to Table 18–8 for a summary of adolescent/adult
immunization recommendations
Pharmacology Review for Test
You should be familiar with the following topics/Concepts for the test:
Definitions
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Drug
Pharmacology
Pharmacokinetics
Absorption
Indication
Contraindication
Biotransformation
Elimination
Syrup
Solution
Suspension
Emulsion
Tincture
Elixir
Lotion
Liniment
Aerosol
Capsule
Gelcap
Spansule
Tablet
Caplet
Geltab
Suppository
Ointment
Lozenge
PDR
Prescriptions- transactions, procedure for writing, and legal obligations
Documentation of meds given
Drug regulations and controls- drug schedules
Drug classifications from the medication/drug card assignment and from page
782-783 of textbook
Know all abbreviations of the conversion sheet given and page 787 of textbook
Be familiar with metric equivalencies
1kg = 2.2 lbs
Adult dosage calculations
Childrens dosage calculations with a given formula
Medication Administration principles
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Routes of administration
7 rights of medication administration
Safety
Considerations for age, gender, weight, route, timing, tolerance, pt
condition
 Allergic reactions
Parenteral Medication Administration
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Equipment available and use
ID
SQ
IM
Techniques and locations
Pregnancy Categories
Techniques for all routes of medication administration ex. - oral, sublingual,
buccal, inhalation, topical
Insulin administration
Immunizations- major diseases to be prevented, schedule for immunizations