Chapter 29Medications

Drug NomenclatureDrug Nomenclature

• Chemical name — identifies drug’s atomic and molecular structure

• Generic name — assigned by the manufacturer that first develops the drug

• Official name — name by which it is identified in official publications USP and NF

• Trade name — brand name copyrighted by the company that sells the drug

Drug PreparationsDrug Preparations

• Oral

– Capsule, pill, tablet, extended release, elixir, suspension, syrup

• Topical

– Liniment, lotion, ointment, suppository, transdermal patch

• Injectable

Drug ClassificationsDrug Classifications

• Body system

• Symptoms relieved

• Clinical indication

Mechanisms of Drug ActionsMechanisms of Drug Actions

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

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

• Acting on cell membrane or altering cellular environment

Pharmacokinetics Pharmacokinetics

• Absorption — drug is transferred from site of entry into bloodstream

• Distribution — drug is distributed throughout the body

• Metabolism — drug is broken down into an inactive form

• Excretion — drug is excreted from the body

Factors Affecting Drug AbsorptionFactors Affecting Drug Absorption

• Route of administration

• Drug solubility

• pH

• Local conditions at site of administration

• Drug dosage

• Serum drug levels

Adverse Effect of MedicationsAdverse Effect of Medications

• Iatrogenic disease

• Allergic effects

• Toxic effects

• Idiosyncratic effects

• Drug interactions

Signs and Symptoms of Drug AllergySigns and Symptoms of Drug Allergy

• Rash

• Uticaria

• Fever

• Diarrhea

• Nausea

• Vomiting

• Anaphylactic reaction

Variables Influencing Effect of MedicationsVariables Influencing Effect of Medications

• Developmental considerations

• Weight

• Sex

• Genetic and cultural factors

• Psychological factors

• Pathology

• Environment, timing of administration

Types of Medication OrdersTypes of Medication Orders

• Standing order — carried out until cancelled by another order

• Prn order — as needed

• Stat order — carried out immediately

Parts of the Medication OrderParts of the Medication Order

• Patient’s name

• Date and time order is written

• Name of drug to be administered

• Dosage of drug

• Route by which drug is to be administered

• Frequency of administration of the drug

• Signature of person writing the order

Medication Supply SystemsMedication Supply Systems

• Stock supply

• Individual supply

• Medication cart

• Computerized medication system

• Bar coded medication cart

Systems of MeasurementSystems of Measurement

• Metric — meter (linear), liter (volume), gram (weight)

• Apothecary — less convenient and concise; basic unit or weight is grain

• Household — least accurate system; teaspoons, tablespoons, teacup and glass used

Metric System ConversionsMetric System Conversions

• To convert larger unit to smaller unit, move decimal point to right.

• To convert smaller unit to larger unit, move decimal point to left.

– 1 kilogram = 1000 grams

– 1 gram = 1000 milligrams

– 1 milligram = 1000 micrograms

Three Checks of Medication AdministrationThree Checks of Medication Administration

• Read the label:

– When the nurse reaches for the container or unit dose package

– Immediately before pouring or opening medication

– When replacing the container to the drawer or shelf

Five Rights of Medication AdministrationFive Rights of Medication Administration

• The nurse should give:

– The right medication

– To the right person

– In the right dosage

– Through the right route

– At the right time

Controlled Substances Required InformationControlled Substances Required Information

• Name of patient receiving narcotic

• Amount of narcotic used

• The hour narcotic was given

• The name of physician prescribing narcotic

• Name of the nurse administering narcotic

Oral MedicationsOral Medications

• Solid form — tablets, capsules, pills

• Liquid form — elixirs, spirits, suspensions, syrups

Administration of Oral MedicationsAdministration of Oral Medications

• Oral Route — having patient swallow drug

• Enteral route — administering drug through an enteral tube

• Sublingual administration — placing drug under tongue

• Buccal administration — placing drug between tongue and cheek

Administration of Parenteral MedicationsAdministration of Parenteral Medications

• Subcutaneous injection — subcutaneous tissue

• Intramuscular injection — muscle tissue

• Intradermal injection — corium (under epidermis)

• Intravenous injection — vein

• Intraarterial injection — artery

• Intracardial injection — heart tissue

• Intraperitoneal injection — peritoneal cavity

• Intraspinal injection — spinal canal

• Intraosseous injection — bone

Sites for Intramuscular InjectionsSites for Intramuscular Injections

• Ventrogluteal site

• Vastus lateralis site

• Deltoid muscle site

• Dorsogluteal site

• Route of administration

• Viscosity of the solution

• Quantity to be administered

• Body size

• Type of medication

Criteria for Choosing Equipment for InjectionsCriteria for Choosing Equipment for Injections

Preparing Medications for InjectionPreparing Medications for Injection

• Ampules

• Vials

• Prefilled cartridges

Topical Administration of MedicationsTopical Administration of Medications

• Vaginal

• Rectal

• Inunction

• Instillation

• Irrigation

• Skin application

Medical Record DocumentationMedical Record Documentation

• Each dose of medication, give as soon as possible after it is given

• Intentional or inadvertent omitted drugs

• Refused drugs

• Medication errors

Type of Medication ErrorsType of Medication Errors

• Inappropriate prescribing of the drug

• Extra, omitted, or wrong doses

• Administration of drug to wrong patient

• Administration of drug by wrong route or rate

• Failure to give medication within prescribed time

• Incorrect preparation of a drug

• Improper technique when administering drug

• Giving a drug that has deteriorated

Medication ErrorsMedication Errors

• Check patient’s condition immediately; observe for adverse effects.

• Notify nurse manager and physician.

• Write description of error on medical record and remedial steps taken.

• Complete special form for reporting errors.

Patient Teaching Patient Teaching

• Review techniques of medication administration.

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

• Instruct patient not to alter dosages without consulting physician.

• Caution patient not to share medications.