1. Chapter 29 Medications

2. 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

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

4. Drug Classifications
Body system
Symptoms relieved
Clinical indication

5. 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

6. 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

7. Factors Affecting Drug Absorption
Route of administration
Drug solubility pH
Local conditions at site of administration
Drug dosage
Serum drug levels

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

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

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

11. Types of Medication Orders
Standing order — carried out until cancelled by another order
Prn order — as needed
Stat order — carried out immediately

12. 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

13. Medication Supply Systems
Stock supply
Individual supply
Medication cart
Computerized medication system
Bar coded medication cart

14. 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

15. 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

16. 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

17. 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

18. 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

19. Oral Medications Solid form — tablets, capsules, pills
Liquid form — elixirs, spirits, suspensions, syrups

20. 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

21. 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

22. Sites for Intramuscular Injections
Ventrogluteal site
Vastus lateralis site
Deltoid muscle site
Dorsogluteal site

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

24. Preparing Medications for Injection
Ampules
Vials
Prefilled cartridges

25. Topical Administration of Medications
Vaginal
Rectal
Inunction
Instillation
Irrigation
Skin application

26. 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

27. 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

28. 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.

29. 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.