For handouts log on: www.dyci_sirglennhandouts@ yahoogroups.com Drug Administration By: MYLA KISON, RN, MAN For handouts log on: www.dyci_sirglennhandouts@ yahoogroups.com

Drug 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 Preparations Oral Topical Injectable Capsule, pill, tablet, extended release, elixir, suspension, syrup Topical Liniment, lotion, ointment, suppository, transdermal patch Injectable

Drug Classifications Body system Symptoms relieved Clinical indication

Mechanisms 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 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 Absorption Route of administration Drug solubility pH Local conditions at site of administration Drug dosage Serum drug levels

Adverse Effect of Medications Iatrogenic disease Allergic effects Toxic effects Idiosyncratic effects Drug interactions

Signs and Symptoms of Drug Allergy Rash Uticaria Fever Diarrhea Nausea Vomiting Anaphylactic reaction

Variables Influencing Effect of Medications Developmental considerations Weight Sex Genetic and cultural factors Psychological factors Pathology Environment, timing of administration

Types 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 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 Systems Stock supply Individual supply Medication cart Computerized medication system Bar coded medication cart

Systems 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 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 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 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 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 Medications Solid form — tablets, capsules, pills Liquid form — elixirs, spirits, suspensions, syrups

Administration 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 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 Injections Ventrogluteal site Vastus lateralis site Deltoid muscle site Dorsogluteal site

Criteria for Choosing Equipment for Injections Route of administration Viscosity of the solution Quantity to be administered Body size Type of medication

Preparing Medications for Injection Ampules Vials Prefilled cartridges

Topical Administration of Medications Vaginal Rectal Inunction Instillation Irrigation Skin application

Medical Record Documentation Each dose of medication, give as soon as possible after it is given Intentional or inadvertent omitted drugs Refused drugs Medication errors

THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR MAKING MISTAKES” high volume patients high volume prescription illegible, unclear orders MD high volume MD orders highly sensitive impatient patients high variety, myriad cases, symptoms high turnover medical staff high stress, overworked medical staff high speed emergencies

Type 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

LOOK-ALIKE SOUND-ALIKE PRODUCT NAMES LOSEC LASIX HYDROXYZINE HYDRALAZINE FORADIL TORADOL PLAVIX PAXIL ACCUPRIL MONOPRIL ULTRACET ULTRACEF SERZONE SEROUEL ZYRTEC ZYPREXA CELEBREX CEREBYX ACTRAPID ACTRAPHANE SINECOD SINEMET

DANGEROUS ABBREVIATIONS- INSTRUCTIONS 10U 100 0.01 mg 0.001 mg .5 mg 5 mg 5.0 mg 50 mg D/C (discharge) D/C (discontinue) µg mg HCl KCl every Monday every morning 1:10,000 mg/mL 1:1,000 mg/mL X (yes) X (no)

LOOK-ALIKE PRODUCTS AND PACKAGING suppository oral capsule HEPARIN 10ml INSULIN 10ml water alcohol cephalexin dolfenal A B KCl distilled water

SIMILAR-LOOKING CONTAINERS FOR DRUGS AND NON-DRUGS poison drug fixative soap

THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR MAKING MISTAKES” high risk, irreversible procedures dangerous equipment potent chemicals KCl use of invasive devices potent drugs infectious environment look-alike, sound-alike drugs, chemicals, fluids potent body fluids

Medication 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.

THE HIGH RISK ENVIRONMENT OF HEALTH CARE “THE PERFECT SET UP FOR HIDING MISTAKES” incoherent, inarticulate patients disease can mask medical error collegial silence punitive culture IR incomplete, error-prone documentation multiple handoffs hierarchical culture dual management most errors are near misses, slight effects

1 million hospitalized patients in the U.S. 16 doses of medication daily each 16 million doses per day 2% medication rate 320,000 medication errors daily

A Medication Error Story HIS for ordering medications is broken Nurse gives the patient a medication to which he is allergic Nurse borrows medication from another patient Tube system for obtaining medications is broken Patient arrests and dies Reason

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.

11 Golden Rule’s in giving medications Administer the right Drug Administer right drug to right patient Administer with right dose Administer Right drug with right route Administer right drug at right time Document each drug you administer Teach your patient about the drug he is receiving. Take a patient complete pt. drug history Find out if the patient has any drug allergies Be aware of potential drug to drug , and Drug to food reactions, The right of the patient to refuse medications.

Clarifying Orders Illegible Incomplete Incorrect Route or dosage Not expected of patients current diagnosis.

Know your Medications Mode of action & the purpose of medication Side effects or contraindication of medication Antagonist of medication Safe dosage range of medication Interaction with other medication Proper administration technique

Principle in Size of Needle The higher the number the smaller the gauge of the needle. The smaller the number the bigger the size of the lumen.

Degrees of Insertion Intramuscular – 72 to 90 degrees Subcutaneous – 45 degrees Intradermal- 10 to 15 degrees

Subcutaneous Subcutaneous injection should not contain no more that 1 ml in an insertion site . The normal angle of insertion is 45 to 90 degrees Subcutaneous injection sites: Abdomen, scapula, thigh, upper back, upper dorso gluteal region.

Intramuscular Intramuscular injection should not contain no more than 3 to 5ml,the smaller the muscle being injected ,the smaller the amount should be. Injection sites: Vastus lateralis, Ventrogluteal, deltoid , dorso gluteal. Insertion site selection depends on: Amount of medication/ Viscosity of medication/ Age of pt & Development of muscle tissue , preference of pt. or nurse.