Drug Absorption and Administration Routes

Absorption Overview

• Absorption marks the first phase of pharmacokinetics, where drugs transition from administration sites into the bloodstream.

Common Routes of Administration

• Oral: Involves swallowing medications, facing challenges like enzyme degradation and first pass metabolism in the liver, reducing bioavailability.
• Enteral: Delivered directly to the gastrointestinal tract, with risks including tube complications, similar to oral medications.
• Rectal: Administered as suppositories; useful when oral medications can't be taken, though absorption reliability may vary.
• Inhalation: Medications inhaled for rapid effects, bypassing both the gastrointestinal tract and liver, ideal for respiratory conditions.
• Intramuscular (IM): Injected into muscle; offers steady absorption with potential pain and localized effects.
• Subcutaneous (SC): Injected into fatty tissue; gradual absorption may be accompanied by discomfort and localized reactions.
• Transdermal: Medications applied to the skin for a slow, steady release; avoids the first pass effect but is limited to small particles.

First Pass Effect

• Oral and enteral medications often face substantial liver metabolism prior to entering systemic circulation, diminishing their bioavailability. Intravenous and transdermal routes can bypass this effect.

Alternative Routes

• Intravenous (IV): Direct bloodstream delivery ensures immediate effects and complete bioavailability, yet carries risks of pain, infection, and sterility concerns.
• Transdermal: Provides consistent drug release for long-term management, restricted to small molecular sizes (e.g., fentanyl).
• Inhalation: Rapid drug delivery particularly effective for respiratory ailments, enhanced by new inhaled medications like insulin powders.

Lifespan Considerations

• Neonates and Pediatrics: Immature gastrointestinal and liver functions can alter drug absorption/metabolism, leading to elevated bloodstream drug levels.
• Older Adults: Reduced gastrointestinal blood flow, altered gastric pH, and lower plasma protein levels can impact drug absorption; transdermal and injectable effectiveness may be decreased due to reduced fat and blood flow.

Route Considerations

• Oral/Enteral: Convenient but susceptible to first pass metabolism, with absorption variability based on formulation and gastric conditions.
• Parenteral (IM, SC, IV): Direct injection into body tissues, presenting cost and pain differences, while IV provides immediate access with potential infection hazards.
• Pulmonary Inhalation: Rapid absorption contingent on particle size and patient technique for effective delivery.
• Topical/Transdermal: Designed for either localized or systemic effects, where absorption relies on skin blood flow and drug molecule characteristics.

Food and Drug Administration (FDA)

• FDA ensures public health by regulating human and veterinary drugs, biological products, medical devices, food, cosmetics, and radiation-emitting products.
• The Center for Drug Evaluation and Research (CDER) evaluates new drugs to ensure safety and efficacy before market approval.
• Drug approval involves extensive research, preclinical testing, and a series of clinical trials to assess safety and health benefits.
• Black Box Warnings highlight serious or life-threatening risks connected to medications, issued after identifying safety concerns post-market.

U.S. Drug Enforcement Agency (DEA)

• DEA enforces controlled substance laws and the Controlled Substances Act (CSA), regulating the manufacture and distribution of controlled medications.
• Only providers with a DEA registration number can prescribe controlled substances; Schedule II prescriptions must follow strict protocols.
• States dictate specific laws regarding prescriptions, refills, and monitoring practices for controlled substances.
• Drug diversion, often involving opioids, refers to the transfer of legally prescribed drugs for illicit use, posing risks to patients and healthcare providers.

Drug Diversion and Substance Use Disorder (SUD)

• Common signs of SUD in nurses include performance changes, absences, medication discrepancies, and behavioral shifts.
• Healthcare professionals are not immune to SUD; awareness of warning signs is crucial for early identification and treatment.
• Supportive environments for nurses returning from SUD treatment are essential for recovery and patient safety.

Prescription Drug Monitoring Programs (PDMP)

• PDMPs are statewide electronic databases that track prescription data to combat abuse and diversion of controlled substances.
• They facilitate collaboration among pharmacies, healthcare professionals, law enforcement, and public health officials.

Joint Commission

• The Joint Commission accredits over 20,000 healthcare organizations to enhance healthcare quality and patient safety.
• Initiatives promoting safe medication use include a focus on developing a Safety Culture, the Speak Up Campaign, and National Patient Safety Goals (NPSG).
• A Safety Culture encourages reporting errors and near misses to improve systems and prevent harm.

National Patient Safety Goals (NPSG)

• Established in 2002 to target specific patient safety issues; current focuses include improving patient identification processes and safe medication administration.
• Emphasizes the need for labeling unlabeled medications and ensuring accurate communication about patients' medications.

Safe Medication Practices

• Two patient identification methods must be used to ensure correct treatments and medications.
• Maintaining and communicating accurate medication lists is vital to prevent errors during transitions in care.
• The Joint Commission's Official Do Not Use List identifies abbreviations that can lead to confusion and errors in patient care.### Centers for Medicare & Medicaid Services (CMS)
• CMS is a federal agency under the U.S. Department of Health and Human Services (HHS) overseeing the Medicare program and collaborating with states for Medicaid administration.
• Implements regulations to ensure patient safety in hospitals funded by Medicare and Medicaid, particularly focusing on medication administration.

Medication Administration Standards

• Administration requires any medication order to be authenticated by a practitioner.
• Essential information for medication orders includes patient identity, drug details, administration route, timing, dosage, and documentation requirements.
• "Five rights" of medication administration are crucial: Right patient, Right drug, Right route, Right time, Right dose, with some advocating for additional rights.

Bar Code Medication Scanning

• Many institutions use bar code scanning to minimize medication errors, ensuring compliance with the "five rights."
• Bar code systems check real-time data to prevent incorrect medication administration.
• Nurses must address any bar code scanning errors thoroughly, acknowledging potential patient safety implications.

Encouraging Reporting of Concerns

• CMS advocates for a culture in hospitals where staff can voice concerns regarding medication orders, fostering open communication with prescribing practitioners.

Patient Monitoring

• Patients must be closely monitored for therapeutic effectiveness and adverse reactions of medications.
• Risk factors, medication properties, and monitoring frequency should be taken into account by nursing staff.
• Timely intervention is crucial for severe adverse reactions, like respiratory depression from narcotics.

Documentation Requirements

• Accurate documentation post-medication administration is a CMS mandate, including patient orders, treatment reports, and monitoring data.
• Documentation must occur after administration to prevent errors; advance documentation is discouraged.

Wisconsin Nurse Practice Act

• Wisconsin has a Nurse Practice Act regulating nursing, enforced by the Board of Nursing to protect public welfare through licensing and education.
• Nurses are accountable for care quality and must practice within their defined scope and competency levels as outlined in the Act.

Standards and Conduct in Nursing

• The Nursing Process includes assessment, diagnosis, planning, implementation, and evaluation, mandatory for RNs in patient care.
• Failure to adhere to the Nurse Practice Act can lead to disciplinary actions including reprimand or license revocation.

Wisconsin Statutes on Controlled Substances

• Chapter 961 of Wisconsin Statutes addresses the regulation of controlled substances, establishing penalties for misuse and abuse, with exceptions for religious practices involving peyote.

Enhanced Prescription Drug Monitoring Program (ePDMP)

• The ePDMP aims to reduce prescription drug abuse by providing vital prescription information to healthcare professionals to make informed decisions.

Professional Assistance Procedure (PAP)

• A voluntary program for healthcare professionals with substance abuse issues, focused on recovery and public safety, allowing monitored practice without disciplinary actions.

Overview of Pharmacokinetics

• Defined as the study of how drugs are absorbed, distributed, metabolized, and excreted in the body (ADME).
• Medications are substances that produce physiological effects upon entering the body.

Stages of Pharmacokinetics

• Absorption: Process where drugs move from the administration site into the bloodstream.
• Distribution: Drugs are transported throughout the body once in circulation.
• Metabolism: Involves the chemical breakdown of drug molecules in the body.
• Excretion: The elimination of drug waste from the body.

Research Methods

• Scientists utilize mathematical models and blood/urine analyses to track drug movement and efficacy.
• Blood levels of liver enzymes can indicate absorption and drug activity levels.

Chemical Reactions

• Pharmacokinetics applies principles of chemistry to understand drug interactions at the molecular level.
• Drug behavior is influenced by its interactions with biological environments like blood and cellular surfaces.

Pharmacodynamics

• Focuses on how drugs affect the body and their mechanisms of action.
• Drug-receptor binding demonstrates a "lock and key" system that influences therapeutic effects.

Bioavailability

• Refers to the extent and rate at which the active ingredient is absorbed and becomes available at the site of action.
• Important consideration for chemists in drug design and formulation.

Individual Variability

• Drug performance may differ between laboratory tests and actual human conditions due to biological variability.
• Unique genetic factors can significantly impact individual responses to medications.

Pharmacogenetics

• The study of the influence of genes on individual responses to drugs, highlighting the role of genetics in pharmacotherapy.

This quiz explores the essential concepts of drug absorption within pharmacokinetics, including various routes of administration such as oral and enteral. It covers the challenges drugs face in the gastrointestinal tract and highlights the importance of understanding these processes for effective medication use.