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Pharmacokinetics
The study of drug concentration
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What are the pre-requisites for safe and effective drug administration?
- Pharmacokinetics
- Growth and development
- Nutrition
- Mathematics
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Pure Food and Drug act of 1906
- Designated official standards for medications;
- specified standards for medication labeling especially those that were habit forming;
- also established the Food and Drug Administration (FDA)
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Med Watch Program
This voluntary program encourages nurses and other health care professionals to report when a medication, product, or medical event causes serious harm to a client by completing the MedWatch form
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Chemical Name for medication....
- provides an exact description of the medication's composition and molecular structure.
- Nurses rarely use chemical names in clinical practice.
- An example of a chemical name is N-acetyl-para-aminophenol. =Tylenol
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Generic name of a medication is
- a non-proprietary name
- The generic name becomes the official name listed in official publications such as the USP
- example is acetominaphen = tylenol
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Trade name
- The trade name, brand name, or proprietary name is the name under which a manufacturer markets a medication.
- The trade name has the symbol™ at the upper right of the name, indicating that the manufacturer has trademarked the medication's name
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What are some guidelines for safe narcotic administration and control?
- Store all narcotics in a locked, secure cabinet or container
- •Narcotics are frequently counted. Usually counts are made on a continuous basis with the opening of narcotic drawers and/or at shift change.
- •Report discrepancies in narcotic counts immediately.
- •Use a special inventory record each time a narcotic is dispensed. Records are often kept electronically and provide an accurate ongoing count of narcotics used and remaining as well as information about narcotics that are wasted
- .•Use the record to document the client's name, date, time of medication administration, name of medication, dose, and signature of nurse dispensing the medication.
- •If a nurse gives only part of a premeasured dose of a controlled substance, a second nurse witnesses disposal of the unused portion. This must be recorded
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Medication is classified by
- the effect of the medication on a body system
- the symptoms the medication relieves
- or the medication's desired effect
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What are some factors that influence absorption?
- the route of administration,
- ability of the medication to dissolve,
- blood flow to the site of administration,
- body surface area,
- and lipid solubility of medication.
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Medications are quickly absorbed if placed....
on mucous membranes and respiratory airways because these tissues contain so many blood vessels
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Orally administered medications are typically slow because
they must pass through the GI tract
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IV medications produce the most rapid absorption because
they enter systemic circulation
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Medication is absorbed at a faster rate when there is a ____ surface area
- large.
- This is why the majority of medications are absorbed in the small intestine rather than the stomach.
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Because the cell membrane has a lipid layer, highly lipid-soluble medications easily cross the cell membrane and are absorbed....
quickly.
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What is a therapeutic effect?
the expected or predictable physiological response a medication causes
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What is a side effect?
predictable and often unaviodable secondary effects produced at a usual therapeutic dose.
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What is an adverse effect?
- unintended, undesirable, and often unpredictable severe responses to medications
- may often take weeks or months to develop
- early recognition is key
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what is a toxic effect?
develop after prolonged intake of a medication or when a medication accumulates in the blood because of impaired metabolism or excretion
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What is an idiosyncratic reaction?
- overreaction or underreaction of a medication or a reaction that is different from normal.
- ie children that takes benedryl becomes agitated and excited instead of drowsy
- not always predictable
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What is an allergic reaction?
- unpredictable responses to a medication.
- Some clients become immunologically sensitized to the initial dose of a medication.
- With repeated administration, the client develops an allergic response to the medication, its chemical preservatives, or a metabolite.
- The medication or chemical acts as an antigen, triggering the release of the body's antibodies.
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What is an anaphylactic reaction?
- life threatening or severe allergic reactions
- characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath.
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Sublingual administration is
under the tongue
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Buccal administration is
when a medication is pushed against the cheek and absorbed through cappilaries
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What is a synergistic effect?
the combined effect of the two medications is greater than the effect of the medications when given separately
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serum half-life
the time it takes for excretion processes to lower the serum medication concentration by half
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onset
the time it takes for the medication to produce a response
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Through
Minimum blood serum concentration of medication reached just before the next scheduled dose
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Plateau
Blood serum concentration of a medication reached and maintained after repeated fixed doses
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What are 4 major parenteral routes of administration?
- 1.Intradermal (ID): Injection into the dermis just under the epidermis
- 2.Subcutaneous (Sub-Q): Injection into tissues just below the dermis of the skin
- 3.Intramuscular (IM): Injection into a muscle
- 4.Intravenous (IV): Injection into a vein
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Topical administration consists of
- skin
- mucous membranes (includes vaginal and rectal)
- inhalation
- intraocular
- otic (ear)
- nasal
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Distribution depends on
- Circulation: Heart rate, blood volume (if u are anemic or low blood volume=slow down)
- Permeability: does it pass placental barrier? Does pass the blood brain barrier?
- Protien binding: the degree by which the med binds to proteins, such as albumin. (albumin decreases in geriatric population which increases the risk of toxic effects
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Where does biotransformation occur?
usually in the liver
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How is alcohol excreted?
the lungs
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What is a potentiating effect?
- a form of synergistic effect
- 2 meds given together that gives an increased effect of one of the medications
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What is an inhibiting effect
2 meds given together that decreases or slows down the effect of one of the medications
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A prescriber can be...
- a nurse practioner
- physician
- physicians assistnat
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What is a standing order?
is carried out until the prescriber cancels it by another order or until a prescribed number of days elapse
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What is a NOW order
A now order is more specific than a one-time order and is used when a client needs a medication quickly but not right away, as in a STAT order
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A unit dose is considered
a 24 hour dose of meds the pt takes
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What are some examples of distribution systems
Special medication rooms, portable locked carts, computerized medication cabinets, and individual storage units next to clients' rooms are examples of storage areas used
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The 6 rights are
- Right:
- medicaton
- dose
- patient
- route
- time
- documentation
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MAR
Medication administration record
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What kind of technique is administration by injection?
Aseptic
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Which syringe is described as having a long thin barrel and a pre attached needle on it?
tuberculin syringe
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What are the best sub cutaneous injection sites?
- outer posterior aspects of the arm
- abdomen above ileac crest
- anterior aspects of the thighs
- 45-90 degrees
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Intra muscular injection sites
- 90 degrees
- Ventrogluteal: find ball of femur and hip bone
- Vastus Lateralus: one hand above the knee and other below groin. frequently used in infants
- deltoid: where scapula meets clavicle. not used in pts with underdeveloped muscles ( infants). used in toddlers older children and adults
- ...faster absorption than SubQ
- Use Z track method
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Intradermal injections
- are used for skin testing (tb)
- 5- 15 degrees
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Intravenous bolus' are usually
- pain meds
- they are concentrated and then introduced into systemic circulation
- rapid onset
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