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it’s the passage of medication molecules into the blood
from the site of medication administration. The absorption rate can be influence by route and how fast the absorption occurs.
Passive absorption(transport) = diffusion
Active absorption (transport) = a carrier is needed
Drug absorption is affected by:
∗Blood Flow – sublingual route (SL) has a rich blood flow as compared to subcutaneous (subQ) which has a poor blood flow
∗Solubility of the Drug – the more soluble the drug the more rapidly absorbed – lipid solubility enhances absorption
∗Nature of the Absorbing Surface – transport of drug molecule is faster through a single layer of cells (intestinal epithelium) than several layers (skin). Surface area is also important – small intestine offers a massive absorbing area and a drug is more rapidly absorbed than in the stomach which has a smaller absorbing surface area
•Most oral meds are absorbed into the surface area of the small intestine
∗Dosage Form – the drug can be combined with a resin from which it is slowly released
∗Drug Concentration |
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Adverse drug event
An injury resulting from the use of a drug. Adverse Drug Events may results from medication errors but most do not |
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| are unintended, undesirable, and often unpredictable serves responses for medication. Every medications has an adverse effect, some have a potential harmful effect to the client. |
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•Factors such as age, body mass, gender, environment, time of administration, pathologic state, genetics, and psychological characteristics can alter an individuals response to drug therapy
-Older adults are usually highly responsive to medications
-Drug doses need to be adjusted in proportion to body mass
-Differences in relative proportions of fat and water in men and women may effect drug solubility
-Oxygen deprivation at high altitudes may ↑ sensitivity to some drugs
-Drugs administered on an empty stomach are more readily absorbed
∗ Effect of a drug action may vary from a predicated drug response because of genetic factors or hereditary influence
*Succinylcholine – induced paralysis – usually brief – Usually attributed to genetic characteristics that alter the person’s drug-metabolizing enzymes |
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| In immunology, the strength of binding interaction between antigen and antibody molecules |
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| block response. stops reaction from occuring |
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unpredicted responses to a medication.
-You can develop an allergy to a medication that is administered repeatedly.
*antibiotics cause a high incidence of allergic reactions
* Always check if your patient has any allergies to medications |
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aka: painkiller
Relieves pain. |
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Metabolism.
After a medication reaches its site of action it becomes metabolized into a less active or inactive form that is easier to excrete. Biotransformation occurs under the influence of enzymes that detoxify, break down, and remove biologically active chemicals.
Most biotransformation occurs in the liver (lungs, kidneys, blood and intestines also metabolize medications).
Decrease in liver function or liver disease= medication eliminated more slowly. |
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Term
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Definition
•Peak drug level is the highest serum level of drug at a specific time
∗Indicates the rate of absorption
∗PO peak level may be 1 – 3 hours
∗IV peak level may be in 10 minutes
∗Draw blood level to determine peak at proposed peak time |
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the lowest plasma concentration of drug at a specific time
∗Indicates the rate at which the drug is eliminated
∗Drawn immediately before the next dose is administered |
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| The time it takes for the drug to elicit a therapeutic response (minimum effective concentration) after the drug has been administered |
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| Occurs when the drug reaches its highest blood or plasma concentration (maximum therapeutic response) |
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∗Is the length of time the drug has a pharmacologic effect
∗Some drugs produce effects for minutes and others may have an effect for hours or days |
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level of medication is the concentration of a drug needed to elicit a desired clinical response without causing toxic effects
•The safety of a drug is a major concern; the therapeutic index is the ratio between a drug’s therapeutic benefits and its toxic effect
•The therapeutic index estimates the margin of safety of a drug by using a ratio that measures the effective therapeutic dose in 50% of persons or animals and lethal dose in 50% of animals
•Drugs with a low therapeutic index have a narrow margin of safety
*Narrow range between a therapeutically active dose of the drug and a toxic dose
*A drug with a low therapeutic index has a greater likelihood of causing an adverse reaction and therefore requires close monitoring (e.g. assessing plasma levels of the drug)
*Drug dose may need adjustment because of the small safety range between effective dose and lethal dose
•Drugs with a high therapeutic index have a wide margin of safety and there is less danger of producing toxic effects therefore plasma drug levels do not need to be monitored routinely |
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Definition
•The main route of drug elimination is the kidneys
-A common change with aging is a ↓ in kidney function = ↑ risk drug toxicity
-Creatinine clearance (CrCl) is a test used to measure the glomerular filtration rate (GFR) of the kidney
•Other routes of excretion are: GI tract, lungs, sweat, breast milk |
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Definition
•Physiologic effects not related to a desired drug effect
•Are usually predictable and dose related e.g. drowsiness caused by antihistamines
•May be desirable or undesirable
•Nurses need to be familiar with a drugs potential side effects & monitor for them |
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Definition
1. Absorption
2. Distribution
3. Metabolism/ Biotransformation
4. Excretion/ Elimination |
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The transport of a drug in body fluids from the bloodstream to various tissues of the body and finally to its site of action
Drug distribution is influenced by:
∗Adequacy of Blood Circulation (which is affected by cardiac function)
-Drugs are distributed rapidly to organs with a large blood supply e.g. heart, liver, kidney
∗Plasma Protein-Binding
-As drugs are distributed in the plasma many are bound to varying degrees with protein (primarily albumin) |
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| Describe nursing practices that will prevent medication errors when preparing and administering drugs |
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Definition
•Follow the 6 rights of medication administration (right medication, right dose, right client, right route, right time, right documentation)
•Be sure to read labels at least 3x before administering the medication
•Use at least 2 client identifiers
•Do not allow any other activity to interrupt administration of medication client
•Double- check all calculations, and verify with another nurse
•Do not interpret illegible handwriting; clarify with prescriber
•Question unusually large or small doses
•Document all medications as soon as they are given
•When you have made an error, reflect on what went wrong and ask, how you could have prevented the error
•Evaluate the context or situation in which a medication error occurred. This helps determine if nurses have the necessary resources to safe medication administration
•When repeated medication errors occur within a work area, identify and analyze the factors that may have cause the errors and take corrective actions
•Attend in-service programs that focus on the medications commonly administered |
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| Describe physiologic factors and variables that affect drug actions in the body including absorption, distribution, metabolism, and excretion |
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Definition
Absorption
o Factors that influence medication absorption are:
o Route of Administration
• IV produces most rapid absorption
• Mucous membranes and respiratory airways are quickly absorbed because their tissues contain many blood vessels
o Ability of Medication to dissolve
• Acidic medications pass through the gastric mucosa rapidly
o Blood Flow to the Site of Administration
• Areas that have more blood supply with experience enhanced absorption, facilitating the passage of the medication into blood
o Body Surface Area
• Large surface area= fast rate of absorption
o Lipid Solubility of a Medication
• High lipid solubility= fast rate of absorption
Distribution
o The rate and extent of distribution depend on the physical and chemical properties of medications and the physiology of the person taking the medication
o Rate depends on vascularity of tissues and organs
o Conditions that limit blood flow or blood perfusion inhibit distribution of a medication
o To be distributed to an organ, a medication has to pass through all of organs tissues and biological membranes
o The degree to which medications bind to serum proteins such as albumin affects medication distribution.
Metabolism
o Liver degrades many harmful chemicals before they become distributed to the tissues
Excretion
o Kidneys are the main organs for medication excretion
o GI tract= another route for med excretion |
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| Discuss factors that influence drug pharmacokinetics |
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Definition
•Absorption
•Distribution
•Metabolism
•Excretion |
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| Discuss factors that influence drug action |
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Definition
Varies from drug to drug
Drug – Receptor Interaction
∗Reversible – degree and duration of binding are functions of how well the drug fits the receptor, nature of the bond, and concentration of the drug at the site of the receptor
∗Selective – if the drug fits the receptor tightly or is strongly attracted to the receptor it is considered to have high affinity with the receptor
∗Graded – a threshold number of receptors must be filled with the drug before a pharmacologic response is observed. Once all receptors are occupied a further increase in the drug concentration will not produce an added effect
∗Agonistic, Partial Agonistic, or Antagonistic
• Drugs that bind to a receptor and produce a response are called agonists
• Drugs that bind to a receptor and block a response are called antagonists
Drug – Enzyme Interaction
∗Drugs can inhibit the action of certain enzymes
• Nonspecific Drug Interaction
∗Produce general effects on cell membranes and cellular processes |
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| List essential components of a drug order and describe different types of orders e.g. stat, pm, scheduled |
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Definition
Essential Components of a Drug Order
•Patient’s Name & Identification Number
•Date & Time Order was Written
•Name of the Medication Ordered
•Exact Dosage to be Administered
•Frequency of Administration (e.g. daily, q 6 h, prn)
•Route of Administration (e.g. po, SubQ)
•Physician's Signature
Types of Orders
•Standing / Routine Medication Orders
-Carried out until MD cancels or specified amount of time
(e.g. Amoxicillin 500mg po TID x 10 days)
•STAT / One Time Orders
-Single dose of medication to be given immediately and only once
•PRN Orders
-When the patient requires/requests the medication |
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| Six Rights for Drug Administration |
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Definition
•Right Drug
-Check MD’s order (administering the wrong drug is the most common type of medication error)
-Joint Commission has listed a number of drugs with sound alike names
•Right Dosage
-Need to Look at Drug Reference Guide (e.g. Davis’s Drug Guide, FDA website) & compare dose MD prescribed with usual dose for the route ordered
•Right Time
-Need to know the 24 hour clock e.g. 2000 = 8 pm
-Administering the medication at the correct time is critical to maintaining specific blood-drug level, or avoid interactions with other drugs
•Right Route
-PO, SubQ, IM, IV, ID etc.
•Right Patient
-Check 2 unique patient identifiers – patient must state name and e.g. birth date or address, do not ask are you Mr. Smith? A confused patient may say yes.
•Right Documentation
-Time the drug was administered
-Patient Teaching: name, dose, route, frequency, therapeutic effect, side effects, drugs, foods, herbs, and behaviors to avoid during therapy |
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| Describe health promotion activities appropriate for clients who are taking medications |
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Definition
Client & Family Teaching
-Provide info about the purpose of the medications and their actions and effects in terms that clients can understand
-Teach family or friends how to give injections in case the client becomes ill
-Educate about the benefits of medication and integrate the clients health beliefs and cultural practices
Community Resources
-Make referrals to community resources if the client is unable too afford or cannot arrange transportation to obtain necessary medication |
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| Describe the role of the RN in preparation and administration of medications |
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Definition
6 RIGHTS!
•Asses that the medication ordered is the correct medication
•Assess the clients ability to self-administer medications
•Determine whether a client should receive a medication at a given time
•Administer medications correctly and monitor prescribed medications
•Educate family’s and clients about proper medication administration
•Monitor
•Use the nursing process to integrate medication therapy into care |
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| Describe the role of the RN in relation to other members of the health care team associated with medication administration |
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Definition
| Nurses often collaborate with the prescriber, the pharmacist and case managers to ensure that clients receive medications safely and that clients are able to afford their medications |
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