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A comprehensive overview of medication administration, covering legal responsibilities, nursing roles, medication forms, and physiological mechanisms of action. It includes key concepts such as the seven rights of medication administration, drug interactions, tolerance, dependence, and medication dose response. The document also explores federal and state regulations related to medication administration, including the pure food and drug act and the controlled substances act. It further delves into the importance of accurate documentation and safe handling of controlled substances, particularly opioids. Valuable for nursing students and professionals seeking to enhance their understanding of medication administration principles and legal considerations.
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The United States Pharmacopeia (USP) and the National Formulary set standards for medication: Strength quality purity packaging safety dose form labeling Discuss legal responsibilities in medication administration: State and Local regulation:
State and local medication laws must conform to: Federal Legislation State and Local regulation: State Additional controls: control of substances not regulated by the federal government State and Local regulation: Local gov't bodies regulate the use of: alcohol and tobacco Discuss legal responsibilities in medication administration: Agency policies: Health care agencies establish indiviidual policies to meet: federal, state, and local regulations
or restrict the intent of the act State nurse practice acts: The primary intent of NPA's is to: Protect the public from: unskilled undereducated unliscened personnel State nurse practice acts: A nurse is responsible for following legal provisions when administering : controlled substances such as opioids State nurse practice acts:
Violations of the controlled substances act are punishable by: Fines imprisonment loss of nurse licensure BOX 31.1 Guidelines for safe opioid (narcotic) administration and Control Where should all narcotics be stored: locked secure cabinet or container Discuss nursing roles and responsibilities in medication administration nurses are responsible for:
Discuss legal responsibilities in medication administration: Federal Regulations: who enforces medication laws
use of controlled substances How do you maintain a running count of opioids: count them whenever you are dispensing them What should you do if you find a discrepancy: correct and report it immediately Special inventory record:
Describe the physiological mechanisms of medication action. Pharmacokinetic Phase: This phase describes the time course and disposition of a drug in the body, based on its absorption, distribution, metabolism and elimination. Describe the physiological mechanisms of medication action. Absorption: Passage of drug molecules into the blood. Factors influencing drug absorption include route of administration, ability of drug to dissolve, and conditions at the site of absorption. Distribution After absorption it is distributed within the body to tissues and organs and ultimately to its specific site of action. The rate and extent of distribution depend on the physical and chemical properties of the medication and the physiology of the person taking it. Metabolism is the term used to describe the biotransformation of pharmaceutical substances in the body so that they can be eliminated more easily. The majority of metabolic processes that involve drugs occur in the liver, as the enzymes that facilitate the reactions are concentrated there.
Excretion: Drug excretion is the removal of drugs from the body, either as a metabolite or unchanged drug. There are many different routes of excretion, including urine, bile, sweat, saliva, tears, milk, and stool. By far, the most important excretory organs are the kidney and liver. TABLE 31.1 FORMS OF MEDICATION Medication Forms Commonly prepared for Administration by oral route: Solid Forms Caplet: shaped like capsule and coated for ease of swallowing enteric coated tablet: Coated tablet that does not dissolve in stomach; coatings dissolve in intestine, where medication is absorbed capsule: medication encased in gelatin shell
aqueous solution substance dissolved in water and syrups Aqueous suspension Finely dissolved drug particles dispersed in liquid medium; when suspension is left standing, particles settle to bottom of container syrup medication dissolved in a concentrated sugar solution tincture alcohol extract from a plant or vegetable Other Oral Forms and Terms Associated With Oral Preparations troche (lozenge) Flat, round tablets that dissolve in mouth to release medication; not meant for ingestion
aerosol Aqueous medication sprayed and absorbed in the mouth and upper airways, not meant for ingestion sustained release Tablet or capsule that contains small particles of a medication coated with material that requires a varying amount of time to dissolve Medication forms commonly prepared for administration by topical route: Ointment (salve or cream) a semisolid preparation, external applied preparation, usually containing one or more medications liniment usually contains alcohol, oil, or soapy emollient applied to skin lotion
Medication forms commonly prepared for instillation into body cavities: intraocular disk Small, flexible oval (similar to contact lens) consisting of two soft, outer layers and a middle layer containing medication; slowly releases medication when moistened by ocular fluid suppository A solid dosage form mixed with gelatin and shaped in pellet form for insertion into a body cavity; melts when it reaches body temperature, releasing medication for absorption Differentiate among different types of medication actions drug interaction is a reaction between two (or more) drugs or between a drug and a food, beverage, or supplement. Taking a drug while having certain medical conditions can also cause a drug interaction. ... A drug interaction can affect how a drug works or cause unwanted side effects. Tolerance
is a person's diminished response to a drug, which occurs when the drug is used repeatedly, and the body adapts to the continued presence of the drug. Resistance refers to the ability of microorganisms or cancer cells to withstand the effects of a drug usually effective against them. Dependence develops when the neurons adapt to the repeated drug exposure and only function normally in the presence of the drug. When the drug is withdrawn, several physiologic reactions occur. These can be mild (e.g., for caffeine) or even life threatening (e.g., for alcohol). This is known as the withdrawal syndrome. Medication Dose Response: Onset Time it takes after medication is administered to produce a response Peak Time it takes for medication to reach its highest effective concentration Trough Minimum blood serum concentration of medication reached just before the next scheduled dose
Allergic reaction: patients become immunologically sensitized to the initial dose of medication, repeated exposure patient develops an allergic reaction.Example, urticaria, rash, pruritis , rhinitis, anaphylactic reaction TABLE 31.2 Mild allergic reactions: Urticaria (hives) raised, irregularly shaped skin eruptions with varying sizes and shapes; eruptions have reddened margins and pale centers rash Small, raised vesicles that are usually reddened; often distributed over entire body pruritus Itching of skin; accompanies most rashes Rhinitis (common cold) inflammation of mucous membranes lining nose, causes swelling and clear, watery discharge
TABLE 31.3 Common drug dosage administration scedules before meals AC As desired ad lib twice each day bid after meals PC Whenever there is a need prn
