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How can drugs be administered?
- orally
- subcutaneously
- intramuscular
- intravenous
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What are the three phases drugs act orally?
- pharmaceutic
- pharmacokinetic
- pharmacodynamic
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What are the four processes during the dissolution phase that achieves drug action?
- absorption
- distribution
- metabolism
- excretion
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What do drugs do in the absorption phase?
during the absorption phase, movement of drug particles go from the GI tract to body fluids.
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What kinds of absorption are there?
- passive absorption-primarily diffusion
- active absorption-requires carrier
- pinocytosis-cells cary drugs across the membrane
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What affects absorption?
- lipids and non-ionized absorb faster
- pain, stress, food effect absorption
- im drugs absorv faster in muscles with more blood vesssels
- S.Q. absorb slower
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What does bioavailability mean?
- Bioavailability is the percentage of drug that reaches circulation.
- orally less than 100%
- IV usually 100%
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What are the factors that alter bioavailability?
- drug form
- route of administration
- GI mucosa with motility
- food, other drugs
- changes in liver metabolism
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What is distribution of drugs?
process by which drug becomes available to body fluids/tissues
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How is the distribution of drugs influenced?
- influenced by
- blood flow
- tissue affinity
- protein-binding effect
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What is a protein-binding effect?
- drugs bound to protein in varying degrees
- portion of drug bound is inactive
- free drugs active with cause pharmacologic response
- two highly protein-bound drugs concurrently compete
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How are drugs metabolized?
- liver primary site
- most drugs inactivated by liver enzymes then converted
- half-life
- time it takes for ½ of the drug concentrate to be eliminated.
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How are drugs excreted?
- main route kidneys
- other routes include:
- hepatic, bile, feces, lungs, saliva, sweat, breast milk
- protein-bound not filtered through kidneys
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What does kidney disease result in?
Lower GFR
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What does creatinine clearance determine?
- determines renal function
- varies with age and gender
- normal 85-135 ml/min.
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What is the Pharmacodynamic phase?
- study of drug concentration and body effects
- includes primary and secondary effects
- primary = desirable
- secondary = undesirable
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What are the 10 pharmacodynamic phases?
- 1. dose response and maximal efficacy
- 2.onset, peak, duration
- 3.receptor theory
- 4.therapeutic index/range
- 5.peak and trough levels
- 6.loading dose
- 7.side effects/reactions
- 8.pharmacogenetics
- 9.tolerance
- 10.placebo effect
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What is the dose response?
- relationship between minimum and maximum amount of drug needed to produce desired response
- maximal efficacy
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What do onset, peak, and duration mean?
- onset—time it takes to reach minimum effective concentration
- peak—highest blood concentration
- duration—length of pharmacologic effect
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What is the receptor theory?
- 4 receptor families
- kinase—linked
- ligand—gated ion channels
- G protein—coupled
- nuclear
- act through receptors to initiate or block responses
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What are the 2 receptor theory responses?
- Agonists—produce response
- Antagonists—block response
- lack specific and selective effects
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What are the 4 categories of drug action?
- stimulation/depression
- replacement
- inhibition or killing
- irritation
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What does the length of action depend on?
the half-life of a drug
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What is the therapeutic index?
- estimates margin of safety
- ration measures the effective dose and the lethal dose
- closer the ratio to 1, the greater the danger
- low therapeutic index = narrow margin of safety
- high therapeutic index = wide margin
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What are the peak and trough levels?
- peak level = highest plasma concentration
- indicate the rate of absorption
- trough level = lowest concentration
- measures rate at which drug eliminated
- drawn immediately before next dose
- use for drugs with low therapeutic index
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What is a loading dose?
- immediate response desired
- Digoxin
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What do
Side Effects
Adverse Reactions
Toxic
mean?
- Side Effects
- not related to desired drug effects
- all drugs
- Adverse Reactions
- more severe
- always undesirable
- must be reported
- Toxic
- monitor plasma
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What does pharmacogentics mean
- effect of drug that varies from a predicted drug response
- hereditary or genetic factors
- African-Americans and Ace inhibitors
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What is the tolerance phase?
- decreased responsiveness
- tachyphylaxis = rapid ↓
- narcotics, barbiturates, laxatives, psychotropics
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What is a placebo effect?
- psychological benefit from compound
- 1/3 of persons benefit
- participants told they may receive placebo
- participants told they may receive placebo
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A tablet undergoes which of the following two processes before it is absorbed?
- metabolism, dissolution
- disintegration, distribution
- biotransformation, distribution
- +disintegration, dissolution
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Steps in the Nursing Process
- Assessment
- Planning
- Implementation
- Evaluation
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What processes are in the assessment phase?
- subjective/objective data
- ask about prescriptions, vitamins, herbs, contraceptives, ASA, antihistamines, caffeine, nicotine
- assess major organs for signs of reaction
- identify high risk clients
- nursing diagnosis?
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What is in the planning phase?
- characterized by goal setting
- develop interventions
- effective goals
- client centered
- acceptable
- realistic/measurable
- shared
- realistic deadlines
- need to be evaluated
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What is in the implementation phase?
- nursing actions/interventions to accomplish goals
- client education/teaching are key
- ongoing
- including family or friends = excellent idea
- client teaching may include:
- general information
- self administration
- diet
- side effects
- cultural considerations
- charts, pictures, graphs
- media
- community resources
- spacing
- preparing/sorting
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What is in the evaluation phase?
- address effectiveness and attainment of goals
- ongoing
- goals not met, revise
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You record client teaching in which phase of the nursing process?
in the implementation phase
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Principles of Drug Administration
- nurses are accountable for safe administration of medications
- know all components of a drug order
- legally liable for incorrect or contraindicated drug
- liable for predicted effects
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The Five Rights of Drug Administration:
“Dr. Tim”
- Right Client
- Right Drug
- Right Dose
- Right Time
- Right Route
-
right client
2 forms of ID
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Right Drug
- drug prescribed
- telephone or verbal order cosigned within 24-hours
- components of a drug order:
- date/time
- drug name
- dosage
- route of administration
- frequency/duration
- special instructions
- physician or HCP signature or name (T.O., V. O.)
- signature of practitioner taking order
- read label three (3) times
- time of contact with bottle/container
- before pouring
- after pouring
- know reason for getting medication
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Four main categories of drug orders:
- standing
- ongoing, given for specific number of doses
- one-time
- PRN as needed
- client request
- STAT = at once
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Right Dose
- dose prescribed for particular client
- nurse calculates correctly
- stock method or unit dose method frequently used
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Right Time
- twice a day = (bid)
- three times a day = (tid)
- four times a day = (qid)
- every 6 hours = (q6h)
- military time
- administration of drugs 0.5 hours before or after time prescribed
- check for testing, expiration, gastric irritation
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Right Route
- oral = by mouth
- sublingual = under tongue
- buccal = between gum and cheek
- inhalation = aerosol
- topical = applied to skin
- instillation = nose, eye, ear
- suppository = rectal, vaginal
- parenteral = IM, SQ, IV
- assess ability to swallow
- no mixing without consulting pharmacist
- aseptic technique
- make sure medicine is swallowed
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Other Rights
- right assessment
- appropriate data collected
- right documentation
- document adm./response
- right to education
- knowledge of medication
- right evaluation
- expected outcome?
- right to refuse
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Tablets and Capsules
- not given if vomiting, lack gag reflex, comatose
- enteric and time-released swallowed whole
- adm. irritating with food
- empty stomach if food interferes
- sublingually remain
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Liquids
- elixirs = sweet
- emulsions = mixture
- suspensions = particles mixed
- dilution or shaking required
- meniscus is at the line of desired dose
- many require refrigeration
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Transdermal
- stored in a patch placed on skin
- systemic effect
- more consistent blood levels
- avoid GI upset
- should be rotated
- cutting not recommended
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Topical
- applied to skin via glove, tongue blade, or applicator
- no double-dipping
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Instillations
- liquids usually administered as drops, ointments, or sprays
- eye drops = expose conjuctival sac
- ear drops—adult
- up and back
- ear drops—child
- down and out
- nose drops
- keep head tilted back
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Inhalations
- preferred position is semi or high Fowler’s
- nebulizers (aerosols) change liquid into mist
- metered-dose inhaler (MDI) convenient
- many MDI’s use spacers
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Nasogastric/Gastrostomy
- check for proper placement
- flush tubing after medication
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Suppositories
- rectally for local and systemic absorption
- refrigerate
- lubricate
- client lies on left side and breaths through mouth
- lie on side for 20 mins. after insertion
- vaginal = lithotomy position
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Parenteral
- types:
- intradermal
- subcutaneous
- intramuscular
- z-track
- intravenous
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Intradermal
- local effect
- used for observation of inflammatory reaction
- TB testing, allergies, immunotherapy
- clavicular, scapular, ventral mid-forearm
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Subcutaneous
- systemic
- usually slower onset than IM
- small doses of non-irritating, water-soluble drugs
- abdomen, upper hips, upper back, lateral-upper arms, lateral thighs
- rotate sites
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Intramuscular
- systemic
- used for irritating drugs, aqueous solutions, solutions in oil
- ventrogluteal, dorsogluteal, deltoid, vastus laterals
- assess for adequate muscle
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Z-Track
- prevents medication from leaking back into SQ tissue
- gluteal site preferred
- pull skin, hold, inject medication, withdraw needle, release skin
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Intravenous
- systemic
- more rapid than IM, SQ
- cephalic, cubital, dorsal veins preferred
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Joint Commission announced hospitals no longer use these abbreviations:
- U
- IU
- QD
- QOD
- always use zero “0” before a decimal point
- no decimal point or zero “0” after whole number
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Your client refuses to take his prescribed medications. The nurse’s best response is to
- explain benefits and side effects of the drug.
- leave medication at bedside to be taken later.
- coerce client into taking medication.
- explain risks of not taking medications.
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Digoxin to maintain blood level at 0.5 – 2 nglme.” This is an example of what category of drug?
standing
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