Drug Administration Fundamentals

• Dr. Funda KARAMAN is the lecturer.
• The aim is to have the ability to fulfil to necessary practices for drug administration.

Objectives of applications

• Understand definition of drugs
• Classify drugs
• Acknowledge the effects of drugs on the body
• Explain the way to request, supply and store drugs
• Know the administration of drugs
• Apply drug practices

Contents

• Description of a drug
• Classification of drugs
• Modes of action of drugs
• Factors that play a role in drugs affecting the patient
• Supply and storage of medicine
• Physician medication order
• Ways of Administration of drugs
• Drug applications include enteral and parenteral drug applications

Drugs

• Drugs are obtained from animal, vegetable, mineral, or synthetic sources.
• Drugs are chemical changes given to diagnose, cure, or prevent disease.
• Drugs change the body's functions when taken by a living organism.
• Medicines have different forms, each with special content.

Drug administration

• Drug administration is a core function involving technical skills.
• Adequate knowledge of medications, along with the skills to administer said medications, is a necessity.

Classification of Drugs

• Dosage forms include Solid, Liquid, Semisolid and Gaseous.
• Solid dosage forms include unit dosages like tablets and capsules, and bulk dosages like tooth and dusting powders.
• Liquid dosage forms include Monophasic liquids like syrups and lotions, and Biphasic liquids such as suspensions and emulsions
• Semisolid forms include creams, ointments, pastes, gels, suppositories, and pessaries
• Gaseous forms such as aerosols and inhalations

Factors Affecting Drug Activity

• Growth period (newborn, elderly)
• Weight
• Gender
• Genetic and cultural factors
• Psychological factors
• Illnesses
• Environment
• Treatment time
• Adverse effect of drug
• Individual differences

Drug Interactions

• Synergism occurs when two or more drugs used together show more efficacy; for example, with tuberculosis treatment.
• Additional effect is the increase in the effect of drugs on the body by taking the same effective drug together.
• Potentialization is when the effect of two drugs given together is more than the sum of the effects of these drugs alone.
• Antagonism is when the effect of a drug is reduced by another drug; for example, naloxone administered to reduce the effect of narcotics.

Drug Metabolism

• Drug metabolism is completed in four basic stages: absorption, transport (distribution), change (disintegration), and excretion (elimination).

Supply and Storage of Drugs

• Drugs should be kept locked in the same room.
• Drugs should be stored in a clean, closed, dry, and cool place.
• Bottles should be tightly closed to prevent the drugs from evaporating and becoming moist.
• Oily, diluted medicines should be kept in the refrigerator or cold, within their expiration date.
• Vaccines and serums stored in refrigerators
• If dirty, medicine labels replaced
• Expired medicines with altered color/odor shouldn't be used
• Artificial light where medicine cabinet is located
• Emergency meds in separate compartment
• Group meds having same effect together
• A medicine cabinet should be large enough to hold all medications for patients.
• Addictive drugs (narcotics) should be kept in a double-locked cabinet, and should be taken and given with a signature.
• A red label must be placed on poisonous drugs.

Physician Medication Order

• The Physician Medication Order writing requirement ensures safety
• Drug administration is prohibited legally without a written order, except in emergencies.
• Types of physician medication orders: Regular, request if necessary, urgent (single dose)

Parts of a Medication Order

• Name of the patient
• Date and time
• Name of the drug to be administered
• Dose of drug
• Drug administration routes
• Drug application frequency
• Signature of the doctor who wrote order

Doctor Orders

• Healthcare professionals check doctor's orders every morning, adjusting hours and transferring them to their own recording system.
• Observation sheets used for recording.
• Consult physician if there is doubt about the request.
• Date, time and doctor must be noted.

Rights of Medication Administration

• Right Patient
• Check patient's identification bracelet.
• Ask patient to state their name and birth date.
• Compare medication order to identification bracelet and patient’s stated name and birth date
• Verify patient’s allergies with chart and with patient.
• Right Medication:
• Perform a triple check on the medication’s label
• When retrieving the medication
• When preparing the medication.
• Before administering medication to patient.
• Always check the medication label with the physician’s order
• Never administer medication that is not labeled or from another person
• Right Dosage:
• Check label for medication concentration.
• Compare prepared dose with medication order.
• Triple all medication calculations.
• Check all medication calculations with another nurse.
• Verify that dosage is within the appropriate dose range.
• Right Time:
• Verify the medication schedule with the order.
• Date, time, and specified period of time.
• Last dose given to patient must be checked
• Administer within 30 minutes of schedule
• Right Route:
• Verify medication route with medication order before administering.
• Administer only via specified route.
• Right Documentation:
• Never document before medication is administered
• Document
• Medication
• Dosage
• Route
• Date and Time
• Signature and credentials
• signature of other nurse checking medication
• Right Client Education
  • Inform patient of medication being administered
  • Inform patient of desired effects
  • Inform patient of side effects
  • Check allergies
• Right to Refuse:
• The legally responsible party has the right to refuse any medication.
• Inform them of consequences.
• Verify responsibility and understanding of consequences.
• Notify and document physician’s order.
• Right Assessment:
• Verify safe and effective medication based on assessment.
• Notify the ordering physician and document notification if anything is deemed unsafe or inappropriate with notification
• Document if medication was skipped and reason
• Right Evaluation:
• Assess patient for any adverse side effects and effectiveness of medication.
• Compare prior status with post-medication status.
• Document patient’s response.

Basic Principles of Drug Applications

• 10 rights of drug administration should be known.
• Hands washed, gloves worn.
• Introduce yourself to the patient
• The patient should be informed about the procedure.
• Verbal informed consent has to be obtained.
• Patient confidentiality is important
• Position the patient
• Materials in the tray
• Make sure the patient takes medicines.
• Observe patient before and after administration
• A healthcare worker makes medicines
• Doctors must edit all illegible orders.
• A Patient’s drug allergy must be questioned.

Drug Administration Considerations:

• The drug preparation environment should be well lit
• A medicine tray should be tidy, and after preparing should be stored until given.
• Perform triple check
• When taking the bottle from its place
• While pouring the medicine into the glass
• When replacing the medicine bottle
• Check patient ID
• Withhold administering oral medications until the patient swallows them.
• Check that meds are given asap
• The patient and their family require sufficient info/knowledge about the drug

Narcotic Drug Considerations:

• Green and red prescription drugs MUST be kept locked.
• The number counted on each shift change
• Two nurses need to provide signatures when in use
• Used ampule should be destroyed (or syringe w/ amount remains < 24h)

Drug Absorption Rates

• Intracardiac: 15 seconds
• Intravenous: 30-60 seconds
• Inhalation: 3 minutes
• Endotracheal: 3 minutes
• Sublingual: 3-5 minutes
• Intramuscular: 10-20 minutes
• Subcutan: 15-30 minutes
• Rectal: 5-30 minutes
• Intradermal: 15-30 minutes
• Oral: 30-90 minutes
• Dermal: it can change

Common Measurements in Drug Applications:

• 1cc = 1mL = 10 dizy = 100 units = 20 drops
• 4-5mL = 1 dessert spoon
• 15mL = 1 tablespoon
• 250mL = 1 glass water
• 100mL = 1 tea glass

Administration

• Drugs have local or systemic effects after being taken into the body.
• The way drugs work is related to how they are administered.
• The effects depend on the the patient, the dose of the drug, the route, and the metabolism of drug

Local Administration Sites

• Epidermal (on the skin): ointment, pomade, cream, lotion, powder, solution
• Conjunctival sac: ophthalmic drops and ointment
• Intranasal: nasal (nose) drops and spray
• Intravaginal: vaginal ovule (suppository, tablet, ointment, gel, foam)
• External ear canal: otic (ear) drops (solution, suspension)

Systemic Administration

• Enteral: solid forms (tablet, capsule etc); liquid forms (syrup, suspension, drops)
• Parenteral: injection, emulsion
• Inhalation: gas, vapor, aerosol
• Transdermal: Flaster (TTS)

Local Administration Sites

Epidermal (Skin)

• Absorption varies depending on the application site. Systemic effects may occur with corticosteroid topical applications.
• Forms used:
• Powder, Ointment, cream, oil and lotion
• The skin needs to be clean and dry
• Previous drug residues must be removed
• Lotions, should be shaken
• Medicine should be warmed

Opthalmic (eyes)

• Eye care before meds and dropper must never contact the eyeball
• Unused drugs in 1 eye must not be used on another patient
• Meds introduced to healthy eyes, followed by infected ones
• Suspension drops should be shaken
• Clean before drop

Intranasal (Nose)

• The patient is given a supine or semi-fowler position.
• The drug mustn't be contacted with the nasal mucosa
• The head should be applied in hyperextension and remain like this for a few minutes

Intravaginal

• PATIENT PRIVACY IS IMPORTANT!
• Patient is given position
• Drugs can be table, cream, gel, or suppository
• Suppository from fridge
• Heat prior to admiminatration

Ears

• The ear is pulled based on the age group
• Down and back for kid
• Up for Adults
• The palm requires heat, which will cause pain if it is too cold

Systemic Application

Enteral

• Applies drug to the digestive tract and gut
• It is the more commonly introduced application

Preparation of Oral Drugs

• It's important the correct medication be given following the doctor’s orders
• Always check for expiry date
• Meds in clear pill box
• Liquid meds must be kept at eye length
• Verify meds after being introduced
• Bed Side Administration necessary
• Assess/Record all effects and sides

Don't give medications in these situations:

• Unconscious patient
• A patient with breathing difficulty
• A patient with a swallowing reflex
• A patient with Nausea/Vomiting
• A patient with diarrhea
• A patient with Convulsions

Sublingual Drug Administration

• Stay under the tongue to be absorbed into the bloodstream.
• It gets administered quickly, usually during an emergency.
• Don’t chew it

Buccal Drug application

• Introducing drugs between the gums or check
• It should be introduced to the bloodstream.
• Do not chew or eat it.

Rectal

• The patient must be in Sims
• Only use it during admin or with suppositories