Med-Administration-2of-3-FINAL-DRAFT
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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 - 1906
Harrison Narcotic law of 1914 – defined
narcotic
Federal 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 nonprescription drugs.
Laws and Regulations
Controlled Substance Act 1970
Categorizes
controlled substances
Limits
refills
Established 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 medications
Name,
of drug, purpose, action, possible
adverse side effects.
Consumer Rights
Patients have a right to:
To
refuse any medications
To have qualified person assess medication
history including allergies
Not to be given unnecessary medications
Safety
The Joint Commission
Oxycontin
vs. Oxycodone
Hydromorphone vs. Morphine
Ephedrine vs. Epinephrine
Hydralazine vs. Hydroxyzine
ISMP Institute for Safe Medication
Practices
http://www.ismp.org
Schedule of Controlled Substances
Schedule I: High potential for abuse
No
medical use exists
Heroin
Schedule II: Potential for abuse, physical
and psychological dependence
Has
accepted medical use
No refills
Methadone, Morphine, Fentanyl, Oxycontin,
Percocet
Schedule of Controlled Substances
Schedule III: intermediate potential for
abuse
Has
accepted medical use
May Refill 5 times
Vicodin, Tyl. #3
Schedule IV: Less abuse potential.
May
refill 6 times within 6 months
Benzodiazepines, Ambien
Schedule V: Minimal abuse potential
Cough
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
bloodstream
better
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 Disease
Chronic
renal insufficiency
Diabetes
CKD-dialysis dependant
Labs
– GFR
– Creatinine
Special Dosing Considerations
Liver Disease
Cirrhosis
Hepatitis
ETOH
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
Obese
Normal
Developmental Factors/drug action
Developmental factors:
Pregnancy
Infants
Older
adults
Diet
Food
alters drug absorption rate, metabolism
Nutrition 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
Environmental
Time
of administration
Stress
Exposure to heat and cold
Cultural, ethnic, genetic
Ethnopharmacy
Cultural
factors and practices
Mechanism…Nursing Implications
Analgesics
Morphine, Dilaudid, Percocet, Vicodin
Mechanism:
Binds
to opiate receptors in CNS
Produces generalized CNS depression
Opiate effects cause vasodilation,
decreased peristalsis
Nsg.
Implications…
Classifications/Nursing Implications
Analgesics
Mild
Tylenol
NSAIDS
Ibuprofen, Aspirin
Moderate
Opiod Narcotics po
– Tylenol #3, Vicodin, Percocet
Severe
Opiod Narcotics IV
– Morphine, Dilaudid, Fentanyl
Anticoagulants
Warfarin (Coumadin)
Mech of Action
Uses
Nursing implications
INR (0.9-1.2)…11-13 seconds clotting time
2-3 therapeutic
Heparin
Mech of action
Vitamin K clotting factors
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)
Inhibitors
Lisinopril,
Enalapril
Mechanism:
Blocks
the conversion of angiotensin I to
vasoconstrictor angiotensin II.
Net effect: systemic vasodilation
Nsg.
Implications…
Classifications/Nursing Implications
Loop Diuretics
Mechanism:
Furosemide (Lasix)
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 occur
Synergistic
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 therapy
Ex:
liver failure after prolonged use of Tylenol
Amiodarone and pulmonary fibrosis
Pregnant 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??
History
Allergies
Shellfish…Iodine
Med
data
Clients condition
Clients 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