MEDICATION MEDICATION King Saud UniversityKing Saud University

College of NursingCollege of Nursing

NUR 122NUR 122

MedicationMedication: substance administered for the : substance administered for the diagnosis, cure, treatment, or relief of a diagnosis, cure, treatment, or relief of a symptom or for prevention of a disease.symptom or for prevention of a disease.

Medication or drugs are given to exert Medication or drugs are given to exert specific physiologic effects on the body.specific physiologic effects on the body.

They play an important role in preventing, They play an important role in preventing, treating, and curing illness, their treating, and curing illness, their administration has become one of the most administration has become one of the most important, complex and risk-laden aspects important, complex and risk-laden aspects of nursing care.of nursing care.

Drug administration

Routes of drug administrationRoutes of drug administration

Oral: Per mouthOral: Per mouth Sublingual: under the tongueSublingual: under the tongue Buccal: against the cheekBuccal: against the cheek Pareneteral: IV, IM, SC, intradermal, intracardiac, Pareneteral: IV, IM, SC, intradermal, intracardiac,

intrathecal,intrapleural, intraosseousintrathecal,intrapleural, intraosseous Topical: skin, eyes, ear, nose, rectum or vagina.Topical: skin, eyes, ear, nose, rectum or vagina.

Effects: local, systematic. Effects: local, systematic. Medication are prescribe by physician.

Medication order includes the name of the drug, the

dose, the route, frequency, date and time.

Effects of DrugsEffects of Drugs

Therapeutic effect = desired effectTherapeutic effect = desired effect– Reason drug is prescribedReason drug is prescribed

Side effect = secondary effectSide effect = secondary effect– Unintended, usually predictableUnintended, usually predictable– May be harmless or harmfulMay be harmless or harmful

Drug toxicityDrug toxicity– Result from overdose, ingestion of external use Result from overdose, ingestion of external use

drugdrug– Buildup of drug in bloodBuildup of drug in blood

Drug allergyDrug allergy– Immunologic reaction to drugImmunologic reaction to drug– Mild to severe reactions (anaphylaxis)Mild to severe reactions (anaphylaxis)

Drug toleranceDrug tolerance– Need increasing doses to maintain therapeutic Need increasing doses to maintain therapeutic

effecteffect

Drug interactionDrug interaction– One drug affecting effect of anotherOne drug affecting effect of another

Actions of Drug on the bodyActions of Drug on the body

Pharmacodynamics:Pharmacodynamics:– Process by which drug changes the body Process by which drug changes the body

(mechanism of action).(mechanism of action).

Pharmacokinetics:Pharmacokinetics:– Study of absorption, distribution, Study of absorption, distribution,

biotransformation, and excretion of drugsbiotransformation, and excretion of drugs

Absorption: movement from the Absorption: movement from the administration site into the bloodstream.administration site into the bloodstream.

Distribution: transportation of the drug from Distribution: transportation of the drug from its site to the site of action.its site to the site of action.

Metabolism: the drug is converted by Metabolism: the drug is converted by enzymes into a less active form that can be enzymes into a less active form that can be excreted, (most drugs are metabolized in excreted, (most drugs are metabolized in the liver).the liver).

Excretion: elimination from the body. The Excretion: elimination from the body. The kidneys are the most important route.kidneys are the most important route.

Pharmacokinetics

Drug NomenclatureDrug Nomenclature Chemical name — describes the chemical Chemical name — describes the chemical

constituents of the drugconstituents of the drug Generic name — assigned by the Generic name — assigned by the

manufacturer that first develops the drugmanufacturer that first develops the drug Trade name — brand name given by the Trade name — brand name given by the

company that sells the drugcompany that sells the drug

Drug PreparationsDrug Preparations

Oral: Oral: – Capsule, pill, tablet, suspension, syrupCapsule, pill, tablet, suspension, syrup

Topical:Topical:– lotion, ointment, suppository, transdermal patchlotion, ointment, suppository, transdermal patch

Injectable:Injectable:

- - Vial, AmpouleVial, Ampoule

Mechanisms of Drug ActionsMechanisms of Drug Actions

Drug-receptor interaction — drug interacts Drug-receptor interaction — drug interacts with one of more cellular structures to alter with one of more cellular structures to alter cell functioncell function

Drug-enzyme interaction — combines with Drug-enzyme interaction — combines with enzymes to achieve desired effectenzymes to achieve desired effect

Acting on cell membrane or altering the Acting on cell membrane or altering the cellular environmentcellular environment

Factors Affecting Drug Factors Affecting Drug AbsorptionAbsorption

Route of administrationRoute of administration Drug solubilityDrug solubility pHpH Local conditions at site of administrationLocal conditions at site of administration Drug dosageDrug dosage Serum drug levelsSerum drug levels

Adverse Effect of MedicationsAdverse Effect of Medications Iatrogenic disease: disease caused Iatrogenic disease: disease caused

unintentionally by medical therapy.unintentionally by medical therapy. Allergic effects: immunologic reaction to the Allergic effects: immunologic reaction to the

drug.drug. Toxic effectsToxic effects Drug interactionsDrug interactions

Signs and Symptoms of Drug Signs and Symptoms of Drug AllergyAllergy

RashRash UrticariaUrticaria FeverFever DiarrheaDiarrhea NauseaNausea VomitingVomiting Anaphylactic reactionAnaphylactic reaction

Factors affectingFactors affectingMedication actionMedication action

Developmental considerationsDevelopmental considerations WeightWeight GenderGender DietDiet Genetic and cultural factorsGenetic and cultural factors Psychological factorsPsychological factors Illness & diseaseIllness & disease Environment, timing of administrationEnvironment, timing of administration

Types of Medication OrdersTypes of Medication Orders

Standing order — carried out until cancelled Standing order — carried out until cancelled by another orderby another order

Prn order — as neededPrn order — as needed Stat order — carried out immediately & onceStat order — carried out immediately & once

Parts of the Medication OrderParts of the Medication Order Patient’s namePatient’s name Date and time order is writtenDate and time order is written Name of drug to be administeredName of drug to be administered Dosage of drugDosage of drug Route by which drug is to be administeredRoute by which drug is to be administered Frequency of administration of the drugFrequency of administration of the drug Signature of person writing the orderSignature of person writing the order

Medication PrescriptionMedication Prescription

The 7 rights

1. Right Medication

2. Right Dose

3. Right Rout

4. Right Time (b.i.d, t.i.d, q.i.d. q8h)

5. Right Client

6. Right information

7. Right Documentation

Controlled Substances Controlled Substances Required InformationRequired Information

Name of patient receiving narcoticName of patient receiving narcotic Amount of narcotic usedAmount of narcotic used The hour narcotic was givenThe hour narcotic was given The name of physician prescribing narcoticThe name of physician prescribing narcotic Name of the nurse administering narcoticName of the nurse administering narcotic

Oral MedicationsOral Medications Solid form — tablets, capsules, pillsSolid form — tablets, capsules, pills Liquid form — suspensions, syrupsLiquid form — suspensions, syrups

– Oral Route — having patient swallow the drug.Oral Route — having patient swallow the drug.– Enteral route — administering drug through an Enteral route — administering drug through an

enteral tubeenteral tube– Sublingual administration — placing drug under Sublingual administration — placing drug under

tonguetongue– Buccal administration — placing drug between Buccal administration — placing drug between

tongue and cheektongue and cheek

Administration of Parenteral Administration of Parenteral MedicationsMedications

Subcutaneous injection — subcutaneous tissue Subcutaneous injection — subcutaneous tissue (0.5-1 ml)(0.5-1 ml)

Intramuscular injection - muscle tissue (1-3ml)Intramuscular injection - muscle tissue (1-3ml) Intradermal injection — corium (under Intradermal injection — corium (under

epidermis) (0.1 ml)epidermis) (0.1 ml) Intravenous injection — into a veinIntravenous injection — into a vein Intracardial injection — heart tissueIntracardial injection — heart tissue Intraperitoneal injection — peritoneal cavityIntraperitoneal injection — peritoneal cavity Intraspinal injection — spinal canalIntraspinal injection — spinal canal Intraosseous injection — boneIntraosseous injection — bone

Sites for Intramuscular InjectionsSites for Intramuscular Injections Ventrogluteal siteVentrogluteal site Vastus lateralis siteVastus lateralis site Deltoid muscle siteDeltoid muscle site Dorsogluteal siteDorsogluteal site

Ventrogluteal siteVentrogluteal site

Vastus Lateralis siteVastus Lateralis site

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Deltoid SiteDeltoid Site

Copyright 2008 by Copyright 2008 by Pearson Education, Inc.Pearson Education, Inc.

Dorsogluteal SiteDorsogluteal Site

Route of administrationRoute of administration Viscosity of the solutionViscosity of the solution Quantity to be administeredQuantity to be administered Body sizeBody size Type of medicationType of medication

Criteria for Choosing Equipment Criteria for Choosing Equipment for Injectionsfor Injections

Topical Administration of Topical Administration of MedicationsMedications

Eye: eye drops, ointmentsEye: eye drops, ointments Ears: ear dropsEars: ear drops Nose: nasal dropsNose: nasal drops Rectal: suppositoriesRectal: suppositories Skin applications: ointment, cream lotionSkin applications: ointment, cream lotion

Medical Record DocumentationMedical Record Documentation Document & sign each dose of medication, Document & sign each dose of medication,

as soon as it is given, and the patient as soon as it is given, and the patient response.response.

Intentional or inadvertent omitted drugs.Intentional or inadvertent omitted drugs. Refused drugs.Refused drugs. Medication errors.Medication errors.

Type of Medication ErrorsType of Medication Errors

Inappropriate prescribing of the drugInappropriate prescribing of the drug Extra, omitted, or wrong dosesExtra, omitted, or wrong doses Administration of drug to wrong patientAdministration of drug to wrong patient Administration of drug by wrong route or rateAdministration of drug by wrong route or rate Failure to give medication within prescribed Failure to give medication within prescribed

timetime Incorrect preparation of a drugIncorrect preparation of a drug Improper technique when administering drugImproper technique when administering drug Giving a drug that has deterioratedGiving a drug that has deteriorated

Medication ErrorsMedication Errors Check patient’s condition immediately; Check patient’s condition immediately;

observe for adverse effects.observe for adverse effects. Notify nurse manager and physician.Notify nurse manager and physician. Write description of error on medical record Write description of error on medical record

and remedial steps taken.and remedial steps taken. Complete special form for reporting errors.Complete special form for reporting errors.

Patient Teaching Patient Teaching

1.1. Review techniques of medication Review techniques of medication administration.administration.

2.2. Remind patient to take the medication as Remind patient to take the medication as prescribed for as long as prescribed.prescribed for as long as prescribed.

3.3. Instruct patient not to alter dosages without Instruct patient not to alter dosages without consulting physician.consulting physician.

4.4. Caution patient not to share medications with Caution patient not to share medications with others even if they have the same disease. others even if they have the same disease.