Pharmacology

Medications Affecting Blood

What could go wrong?

Anticoagulants

• Coumadin• Heparin• Lovenox/Arixtra

Anti-Platelet Drugs

• Aspirin• Plavix

Thrombolytics

• Streptokinase

Anemia Medications

• What type of anemia do they have?

Leukocyte Medications

• Neupogen• Leukine

Blood and Blood Product Medications

• Packed Red Blood Cells• Plasma• Platelets• Autologous

• Epogen

• Albumin

Medications Affecting Fluid and Electrolytes

Diuretics

• Loop• Thiazide• Potassium Sparing• Osmotic

Calcium, Potassium, and Magnesium

• Who needs it?

• Who doesn’t need it?

Renal Medications

• Phosphate Binders

Medications for Degenerative Bone Disease

• Biphosphates• Calcitonin

BASIC PRINCIPLES OF MEDICATION ADMINISTRATION

Pharmacokinetics

• Refers to how medication travels through the body. The medication is subjected to a variety of biochemical and physiochemical processes that result in absorption, distribution, metabolism and excretions of the medication

Pharmacokinetics

• Absorption – the movement of a medication from its site of administration to the blood stream.– Most common routes:• Enteral (through the GI tract)• Parenteral (by injection)

– Each of these routes will have a unique pattern of absorption

Pharmacokinetics

• Distribution – transportation of a medication to its site of action by bodily fluids– Influenced by:• Circulation to site of action, • Number of plasma protein binding sites, • Barriers such as the blood brain barrier

Pharmacokinetics• Metabolism (biotransformation) – changes a

medication into a less active form or an inactive form by the action of enzymes. – Occurs primarily in the liver,– May also take place in:• Kidneys• Lungs• Bowel• Blood

Pharmacokinetics

• Excretion – the elimination of a medication from the body primarily through the kidneys.– May also take place through the:• Liver• Lungs• Bowel• Exocrine Glands

Pharmacodynamics

• Describes the interaction between medications and target cells, body systems, and organs to produce pharmacological effects.

• Interactions result in functional changes that are considered the mechanism of action of the medication.

Medication Category and Classification

• Non Prescription Medications– Over the Counter

• Prescription Medication– Uncontrolled Substances– Controlled Substances

• FDA pregnancy Risk Category– (A, B, C, D, X)

Prescription Medication

• Are administered under the supervision of primary care providers.

• These medications may:– Be Habit-forming– Have potential harmful effects– Require supervision

Uncontrolled Substances

• These medications require monitoring by a primary care provider, but do not pose risks of abuse and/or addiction

• Examples:– Antibiotics– Nonsterioidal anti-inflammatory (NSAIDs)– Insulin

Controlled Substances

• Medications that have a potential for abuse and dependence are categorized into schedules.

• Schedule of Drugs I -V– Heroin is a drug in Schedule I and has no medical

use in the US.– Schedule II medications have a ‘high’ potential for

abuse, but are recognized medical treatment (Morphine, Fentanyl, Methadone, Cocaine)

Controlled Substances• Schedule III drugs have a “potential for abuse less

than the drugs …in schedules I and II”. It includes anabolic steroids, ketamine, marinol, hydrocodone/codeine with NSAIDs or Tylenol

• Schedule IV drugs have a low potential for abuse. It includes benzodiazepines, Darvocet, etc.

• Schedule V drugs have less potential for abuse. Includes diphenoxylate, and cough suppressants with small amounts of codeine. http://tinyurl.com/28x2uvf

FDA Pregnancy Risk Category

• Categorizes medication terms of their potential harm during pregnancy, with Category A being the safest and Category X the most dangerous.

• Teratogenesis is most likely to occur during the first trimester.

• Before giving any medication to a woman who is or could be pregnant, determine whether or not it is safe for administration during pregnancy

Considerations for Parenteral medications

• Discard all sharps in designated containers• Use the vastus lateralis site for infants and children

< 2 years of age• After age 2, the ventral gluteal site can be used• Both of these sites can accommodate up to 2 mL of

fluid.• Deltoids are smaller and can only accommodate

1mL of fluid

Considerations for Parenteral medications

• Use a needle gauge and length appropriate to the type of injection and client size.– The gauge of the needle is the size of the diameter

of the needle– The larger the gauge, the smaller the diameter of

the needle• Which is bigger?– A 23- gauge needle or a 16 gauge needle

Considerations for Parenteral medications

• Use a tuberculin syringe for solution volume < 0.5mL. Syringe size should approximate volume of medication.

• Rotate injection sites to enhance medication absorption, and document each site used.

• Wash site with alcohol and allow to dry, use soap and water for insulin injections.

• Avoid the use of injection sites that are edematous, inflamed, or those sites that have moles, birthmarks, or scars.

Mixing Injectable Medications from Two Vials

• Draw air into a syringe equal to the amount of solution to be drawn from the second vial. Then, inject air into this vial, not allowing the needle to touch the solution. Withdraw the needle.

• Draw air into a syringe equal to the amount of solution to be drawn in the first vial. Inject air into the first vial, invert vial, and withdraw the desired amount of solution. Remove the needle from the vial.

• Insert needle into second vial, invert vial, and withdraw the desired amount of solution. Remove needle from the vial.

Managing an Epidural Infusion

• Secure catheter to skin to prevent discomfort• Assess and monitor dressing for drainage• Use surgical aseptic technique when administering

medication• Assess/monitor vital signs and pulse ox for respiratory

depression. D/C infusion if respirations are less than 12/min and notify primary care provider

• Assess for pruritus, nausea, and vomiting• Monitor for I & O, urinary and bowel function

Questions• A nurse is preparing insulin from two different vials. Which

of the following actions indicates that she understands correct medication preparation?

1. The nurse injects fluid from one vial into the other regardless of the medications\

2. The nurse wipes the needle with alcohol prior to injecting air into the vial.

3. The nurse inserts air into the first vial, but not the second one.

4. The nurse discards the medication vials if medications are mixed during preparation.

Questions• A nurse is preparing insulin from two different vials. Which

of the following actions indicates that she understands correct medication preparation?

1. The nurse injects fluid from one vial into the other regardless of the medications\

2. The nurse wipes the needle with alcohol prior to injecting air into the vial.

3. The nurse inserts air into the first vial, but not the second one.

4. The nurse discards the medication vials if medications are mixed during preparation.

Questions

• An older adult client has had a CVA and is prescribed a metered dose inhaler. Which nursing consideration is a priority when teaching the client how to take the medication?

1.Dosage and amount of medication2.Schedule of administration3.Coordination and cognition of the client4.Purpose and goal of medication regimen

Questions

• An older adult client has had a CVA and is prescribed a metered dose inhaler. Which nursing consideration is a priority when teaching the client how to take the medication?

1.Dosage and amount of medication2.Schedule of administration3.Coordination and cognition of the client4.Purpose and goal of medication regimen

Identify the correct client position for each of following routes of administration.

• ___ Oral• ___ Otic• ___Vaginal• ___ Rectal

1. Lying on the left side with right knee brought up to the chest (Sims’ position)

2. Sitting, semi-Fowler’s, or Fowler’s position

3. Supine with knees bent, feet flat on the bed and close to the hips

4. Client lying on side with the ear that is receiving the drops facing up

Questions

• Proper administration of eye drops includes which of the following nursing interventions? (Select all that apply.)

1. Using medical aseptic technique2. Asking the client to look up at the ceiling3. Having the client lie in a side-lying position4. Dropping medication into the center of client's

conjunctival sac5. Instructing the client to close the eye gently

Questions

• Proper administration of eye drops includes which of the following nursing interventions? (Select all that apply.)

1. Using medical aseptic technique2. Asking the client to look up at the ceiling3. Having the client lie in a side-lying position4. Dropping medication into the center of client's

conjunctival sac5. Instructing the client to close the eye gently

Safe Medication Administration

Error Prevention

IV Therapy