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Medication Administration
Unit VI
Part 2 (lecture)
Keith Rischer, RN, MA, CEN, CCRN
Today’s Objectives…
Differentiate the various effects of drugs on the body
Explain how age, illness, time of administration, & absorption affect drug action
Describe the relationship between mechanism of action of most commonly used drugs and nursing assessment and implications for the nurse
Minnesota Nurse Practice Act
Legal aspects r/t the nurse(6) Engaging in unprofessional conduct, including,
but not limited to, a departure from or failure to conform to board rules of professional or practical nursing practice … to the minimal standards of acceptable and prevailing professional or practical nursing practice, or any nursing practice that may create unnecessary danger to a patient's life, health, or safety. Actual injury to a patient need not be established under this clause.
Laws and Regulations
Drug legislation in the U.S.Pure Food and Drug Act - 1906Harrison Narcotic law of 1914 – defined
narcoticFederal Food, Drug and Cosmetics Act of
1938 established the FDA, set standards r/t safety, potency, efficacy.
Durkham-Humphrey Amendment of 1952 differentiates between prescription and non-prescription drugs.
Laws and Regulations
Controlled Substance Act 1970Categorizes controlled substancesLimits refillsEstablished programs to prevent and treat
drug dependence FDA instituted the MedWatch program in
1993
Consumer Rights
Drugs are safe, pure, effective and reliable Clients have the right to quality health
information r/t drugs and medicationsName, of drug, purpose, action, possible
adverse side effects.
Consumer Rights
Patients have a right to:To refuse any medicationsTo have qualified person assess medication
history including allergiesNot to be given unnecessary medications
Safety
The Joint Commission Oxycontin vs. OxycodoneHydromorphone vs. Morphine Ephedrine vs. EpinephrineHydralazine vs. Hydroxyzine
ISMP Institute for Safe Medication Practices
http://www.ismp.org
Schedule of Controlled Substances
Schedule I: High potential for abuseNo medical use exists
Heroin
Schedule II: Potential for abuse, physical and psychological dependenceHas accepted medical useNo refills
Methadone, Morphine, Fentanyl, Oxycontin, Percocet
Schedule of Controlled Substances
Schedule III: intermediate potential for abuseHas accepted medical useMay Refill 5 times
Vicodin, Tyl. #3
Schedule IV: Less abuse potential.May refill 6 times within 6 monthsBenzodiazepines, Ambien
Schedule V: Minimal abuse potentialCough suppressants with codeine
Controlled Substances
Drugs kept in locked drawer Forms for recording the use of these drugs Nurse verifies the number of a specific
drug available If drug wasted, second nurse acts as a
witness Drugs are counted each shift with 2 RNs
Pharmacokenetics
Study of action of drugs within the body Must consider before
administering meds
Absorption Distribution Metabolism Excretion
Pharmacokenetics: Absorption
Process by which drug passes into the bloodstreambetter the blood supply faster the absorption
GI tract: variable IV: immediate Subcutaneous: depends on local blood flow Intramuscular: depends on local blood flow Topical: slow, incomplete Inhalation: rapid Rectal: may be erratic
Pharmacokenetics: Absorption
Factors influencing absorption Dose form and route Influence of pH Blood flow to site Solubility of drug
Time Action Profile Onset Peak Duration
Pharmacokenetics: Distribution
Transportation of drug from site of absorption to site of action.
Vascular organs receive drug first, then skin and muscles.
Chemical/physical make up of the drug determines to which area of body drug will be attracted.
Pharmacokenetics: Metabolism
The process of altering or changing the drug into a less active form.
Caution: this process may be impaired in the elderly or in someone with liver disease
Biotransformation
Pharmacokenetics: Excretion
Process by which drug is eliminated from the body.
Caution: since the kidneys/liver of older adults are less efficient, they may require smaller doses of a drug.
Promote adequate fluid intake
Medication Pharmokinetics
Morphine Tylenol Ibuprofen Atenolol Coumadin
Why is pharmokinetics relevant if your patient has renal or liver disease?
Special Dosing Considerations
Renal DiseaseChronic renal insufficiencyDiabetesCKD-dialysis dependant
Labs– GFR– Creatinine
Special Dosing Considerations
Liver DiseaseCirrhosisHepatitisETOH
Labs– AST– ALT– Bili– Albumin
Special Dosing Considerations Heart failure
CHF Diastolic Systolic
Cardiomyopathy Body size
Underweight/pediatric calculated by weight or body surface area
ObeseNormal
Developmental Factors/drug action
Developmental factors:Pregnancy InfantsOlder adults
DietFood alters drug absorption rate, metabolismNutrition can affect the action of a drug
Ex: Vitamin K – found in green leafy vegetables can counteract the effect of an anticoagulant – Coumadin
Factors affecting drug action: Elderly
Use w/caution Digoxin Nifedipine Benzodiazepines
Alprazolam Diazepam
Increased fall risk ACE inhibitors Beta blockers Ca++ channel blockers Vasodilators Diuretics Opiod narcotics Anti-depressants Benzodiazepines
Factors affecting drug action
EnvironmentalTime of administrationStress Exposure to heat and cold
Cultural, ethnic, genetic EthnopharmacyCultural factors and practices
Mechanism…Nursing Implications
Analgesics Morphine, Dilaudid, Percocet, Vicodin
Mechanism:Binds to opiate receptors in CNSProduces generalized CNS depressionOpiate effects cause vasodilation,
decreased peristalsis Nsg. Implications…
Classifications/Nursing Implications
AnalgesicsMild
TylenolNSAIDS
Ibuprofen, AspirinModerate-
Opiod Narcotics po– Tylenol #3, Vicodin, Percocet
Severe- Opiod Narcotics IV
– Morphine, Dilaudid, Fentanyl
Anticoagulants
Warfarin (Coumadin) Mech of Action Uses Nursing implications
Vitamin K clotting factors INR (0.9-1.2)…11-13 seconds clotting time
2-3 therapeutic Heparin
Mech of action Prevents conversion of fibrinogen to fibrin
Uses Nursing implications
Aspirin Mech of action Uses Nursing implications
Mechanism…Nursing Implications
Calcium Channel Blockers Diltiazem
Mechanism: Inhibits transport of calcium into myocardial and
vascular smooth muscle cells during the cardiac action potential phase.
Causes systemic vasodilation and coronary artery vasodilation as well as slowing AV node conduction and decreased cardiac contractility
Nsg. Implications…
Mechanism…Nursing Implications
Angiotensin Converting Enzyme (ACE) InhibitorsLisinopril, Enalapril
Mechanism:Blocks the conversion of angiotensin I to
vasoconstrictor angiotensin II.Net effect: systemic vasodilation
Nsg. Implications…
Classifications/Nursing Implications
Loop Diuretics Furosemide (Lasix)
Mechanism: Inhibits the
reapsorption of sodium and chloride from the loop of Henle and distal renal tubule
Increases renal excretion of water, Na+, Cl-, Mg+, and K+ causing loss of excess fluid and drop in BP
Nsg. Implications…
Medication interactions
When one medication modifies the action of another, this can occurSynergistic effect: effect of 2 drugs when
combined is greater than when meds given separately.
Beneficial: give Tylenol with oxycodone to reduce the total amount of narcotic needed.(additive effect)
Harmful: Alcohol taken with antihistamines, antidepressants, barbiturates and narcotic analgesics
Medication interactions
Iatrogenic disease: disease caused unintentionally by medical therapyEx: liver failure after prolonged use of TylenolAmiodarone and pulmonary fibrosisPregnant woman takes medication that
results in malformations in the fetus.
Nursing implications
What can nursing do to enhance desired effect/decrease adverse effects and ensure safety??HistoryAllergies
Shellfish…IodineMed dataClients conditionClients knowledge/learning needs
Drug Medication Systems
Stock Supply Unit-Dose Automated
Medication Dispensing (Pyxis)
Bar Code Medication – use of scanner
Self-administered PCA, Inhalers,
ointments etc