Drug Applications

• The lecture covers drug applications, aiming to equip students with the practical skills required for proper drug administration.

Learning Objectives

• Grasp the definition of drugs.
• Categorize different types of drugs.
• Understand how drugs affect the body.
• Explain the proper procedures for requesting, supplying, and storing medications.
• Know the various methods of drug administration.
• Apply appropriate drug administration techniques.

Course Content Overview

• Defines what a drug is.
• Describes drug classifications.
• Elucidates how drugs act.
• Lists elements that affect drug influence in patients.
• Outlines medication storage and supply protocols.
• Explains how physicians prescribe medication.
• Discusses different ways to give medication.
• Covers enteral drug applications.
• Discusses parenteral drug applications.

What are Drugs?

• Drugs originate from animal, vegetable, mineral, and synthetic sources.
• They are chemical substances altering bodily functions when taken.
• Medicines come in varied forms tailored for specific uses.

Drug Administration

• Safe and correct drug administration is a core skill that demands technical expertise.
• This requires comprehensive medication knowledge, technique, and skill.

Drug Classification

• Drugs are classified by dosage forms, which include solid, liquid, semi-solid, and gaseous forms.
• Solid dosage forms include tablets and capsules.
• Liquid dosage forms are syrups, lotions, solutions, suspensions, and emulsions.
• Semi-solid dosage forms include creams, ointments, pastes, gels, suppositories, and pessaries
• Gaseous dosage forms are aerosols and inhalations.

Factors Affecting Drug Activity

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

Drug Interactions

• Synergism occurs when drugs combine to create enhanced efficacy.
• Additional effect is when taking the same drug together is increased.
• Potentialization results when two drugs together produce an effect greater than their sum.
• Antagonism is when one drug diminishes another's effect, such as naloxone reducing narcotic effects.

Drug Metabolism

• Completed via absorption, transport/distribution, change/disintegration, and excretion/elimination.

Medicine Supply and Storage

• Lock all drugs in a dedicated room.
• Keep in a clean, closed, and cool place.
• Seal bottles tightly to avoid moisture and evaporation.
• Refrigerate oily or diluted medicines, keeping in mind the expiration dates.
• Vaccines/serums kept in the refrigerator.
• Expired medications should not be used.
• Storage cabinets include sufficient artificial light.
• Keep emergency medicine in a separate spot.
• Store medications with similar effects together.
• The medicine cabinet should hold all patient medications.
• Keep addictive (narcotic) drugs double-locked and documented with a signature upon use.
• Red labels should mark all poisonous drugs.

Physician Medication Order

• Physician medication orders must be written.
• Drug administration without an order is prohibited, except in emergencies.
• Requests are either regular, necessary, or urgent (single dose).

Physician Medication Order Components

• Patient name
• Date and time
• Drug names to administered
• Appropriate Dosage
• Routes of drug administration
• Frequency of the drug application
• Signature of the physician

Physician Medication Order Process

• Orders are reviewed daily by healthcare staff, adjusting times as needed.
• Chart recording is done via observation sheets.
• Consult a physician if any request is doubtful.
• Dates and times should be recorded after checking medication and under the doctor's orders.
• Draw a line to avoid writing

10 Rights of Medication Administration

• Right Patient: Confirm identity via wristband and double-check name, birth date, and allergies.
• Right Medication: Triple-check labels in the process, and never administer unsigned or prepared medication from others.
• Right Dosage: Confirm the dosage with the medication label and the doctor’s order.
• Right Time: Verify the schedule and stay within 30 minutes of the schedule.
• Right Route: Administer drugs via route specified.
• Right Documentation: Record only after providing medication, including details and signatures.
• Right Client Education: Educate on the drug’s effects and inquire about patient allergies.
• Right to Refuse: Respect patients’ or responsible caretaker refusal rights after informing them of the consequences and documenting the event.
• Right Assessment: Check any conditions that could be a contraindication to the drug.
• Right Evaluation: Monitor responses and carefully record.

Principles of Drug Applications

• Understand the 10 Rights.
• Perform hand hygiene, and use gloves.
• Properly introduce yourself and inform the patient.
• Respect patient confidentiality and position them appropriately.
• Ensure all materials are in the tray
• Be sure the patient takes his/her medications
• Observe the before and after administrations
• All allergies should be questioned

Drug Administration Considerations

• A bright environment aids in drug preparation.
• Maintain a tidy medicine tray.
• Store prepared medications securely until administration.
• Triple-check medications when taking bottles, pouring liquids, and replacing bottles.
• Check patient IDs prior to administration.
• Verify that medications are swallowed.
• Administer missed drugs ASAP.
• Have enough drug knowledge, and educate the patient.

Special Rules for Narcotic Drugs

• Keep it locked up.
• Track all counts per shift.
• Require 2 nurse signatures upon use.
• If an ampoule has leftover drug, either destroy it or keep it in a syringe for no more than 24 hours.
• Green/red prescription drugs fall here.

Measurements of Drug Administration

• 1 cc, 1 ml, 10 dizy, 100 units, and 20 drops are equivalent.
• 4-5 ml equals 1 dessert spoon.
• 15 ml equals 1 tablespoon.
• 250 ml equals 1 glass of water.
• 100 ml equals 1 tea glass.

Modes of Action

• Drugs offer local or systemic effects.
• Their work and effectiveness hinge on how they're given.
• Patient factors, dosage, method, and metabolism affect outcomes.

Local vs. Systemic Administration

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, dragee, capsule, film-coated tablet, enteric tablet, chewable tablet, effervescent tablet, granule.
• Liquid Forms: Syrup, solution, suspension, drops (concentrated solution).

Systemic Administration (Parental)

• Used in SC, IM and IV
• Forms are Solution or suspension for injection, emulsion(ampoule, vial, powder to be diluted).

Systemic Administration (Inhalation & Transdermal)

• Inhalation - Gas, vapor, aerosol, inhaler, nebulizer
• Transdermal - Flaster (TTS)

Epidermal Application

• Absorption here changes based on site.
• Topical drug use induces systemic results.
• Use lotions, creams, and/or gels this way.
• The skin you use these forms of medicine on will need to be clean and dry, and old residuals need to be gone. Then, you can follow up use by warming.

Ophthalmic (Eye) Medications

• Pre-application eye care from inner to outer canthus is vital.
• To prevent contamination, don't allow the dropper to touch the eyeball.
• Avoid sharing drug drops and/or preparations between patients.
• To treat both eyes, begin with the healthier eye, and then treat an affected eye.
• Wait 5 mins before doing the same in other eye.
• Suspension drops will be shaken well before use.

Intranasal (Nose) Applications

• It is best for a patient to be in a semi-fowler position.
• Don't let the medicine drop or come in contact with nasal mucosa.
• Keep their heads extended.

Intravaginal Applications

• Patient privacy is a big deal in this situation.
• Place patient in the needed position.
• Medicine is generally introduced by gel, foam or in suppository form.
• Prior to medication, keep it heated in your palms.

Ear Applications

• When administering to children, pull and hold ear lobe down and back.
• In adults, pull the ear lobe up and back.
• Always heat drops in your palms for best results.

Systemic Applications

Types of systemic applications include:

• Enteral
• Transdermal
• Inhalation
• Parenteral

Enteral Applications Points

• This application type occurs by oral application
• You must wait for the patient to swallow.

Preparation for Oral Drugs

In preparing the patient for oral drug administration, you must:

• Be in the patients room.
• The patient needs to be identified.
• Give the medicine on a tray.
• Be patient until they swallow.
• Observe side effects.

Oral Medications Should Not Be Given If;

• If they are unconsious, not able to swallow, are vomiting, diarrhoea, or have convulsions

Sublingual Drug Administration

• Effect begins quickly and is a method used in emergency situations.

Buccal Druge Administration

• Delivers drug via cheek after being placed between the gums.

Rectal Administration

• Patient privacy should be considered with position.

Administration Type (Transdermal)

• This is the application by patch.
• Used in applications such as nicotine patches, or hormone replacement therapy.

Administration (Inhilation)

• Advantages are a super effective lung membrane, and high blood flow.

Nebulizer Use

• For the application, DO NOT USE TWO DIFFERENT DRUGS and RINSE WELL afterward.

Parenteral Drug Application

• Parenteral - therapeutic drugs through routes other than the digestive system.

Types of Administration

• Parenteral administration can be:
  • Subcutaneous (SC) injection (<1ml), at a 45° angle.
  • Intradermal injection: ID
  • Intramuscular injection: IM, at a 90° angle
  • Intravenous injection: IV

Injection Points For Parenteral Administration

• You decide syringe size depending on the medicine and it's solution type, the body size, and application route.

Withdrawing Medicine Process

• Clean the piece and grasp the neck in order to snap off, away from you.

Injecting After Withdrawing

• Keep with your steril syringe at the opening.

Solution Prep

• There should be some dilution, and the vessel needs to dissolve in the proper solution.

Administration in SC

• Under the skin, 1 mg max

Locations in SC

• Lateral is in the upper arm, front is in the upper leg, and abdominal is near the umbilical

Things to DO in Regards to the Application

• You do not want to aspirate the areas. As long as this is not done, there is also no damage to be concerned with.

The Process of Getting It Done

• Be sure it has the 10 principles under action.

Types of injections

• A new needle and syringe are used for each injection.
• All should be removed for MM and IV injections.

Things To Consider With These Practices

• Have you cleaned and disinfected? are these the 10 steps?

SC Injection

• A small air bubble of .2 to .3 mL is drawn into the syringe during and administered.

Other Aspects

• In these injections, make sure they are applied to different areas.
• There should be alcohol on hand to wipe and clean.

Intradermal

• It's a slow, subcutaneous injection that uses tuberculosis and allergens to make sure.
• • The most common sites will be the inner are of the forearm and it will need to be free with the rest of your body.
• Then, be prepared to inject in an ID, where it is drawn after skin touch.

Intramuscular

• It's injected straight into the muscle of the upper arm or thigh, and held like a dart.

Intramuscular Injection Sites

• Deltoid is used heavily in different vaccines.
• To find the site, remember it will be found about two fingers down the underarm.

Process

• Hands are cleaned
• Tool are prepared
• The process is explained.
• An correct area of injection is selected

Before You Start The Shot

• Stretch then. Remember, when there is blood, pull and being with a sterile syringe.

Precautions

• This must be done, and must be correct, so be careful .

Z-Track Injections

• Z-track injections are given in 1 area.
• Skin must be pulled.
• No need to massage.
• Use this for IM and SC injections.

IV injections

• Rapid effect upon entering the blood, can use in many, various applications
• Followed with surgical treatment due to possible complications like infection and bleeding
• The term is "entervenous" in vein.

IV Injections Continued

• The blood is desired when you can't use orally due to its gastrointestinal effects

Use of IV Injection

• You are to obey the rule of 10 principles in a safe treatment area.

IV Injection Site Maintenance

• 2 - 6 inches away from injection point
• Should check sterility and integrity of the medical setting.

Application of Injection

• Needles must always be inside the syringe to be pushed the air bubbles out, so there is always clean delivery.

After Application

• Date and information should always be kept.

IV (Intravenous) Med Admin

• IV push is giving medicine directly to the vessel
• All should be done with safety, as well as being recorded for safety.

For All IV

• There should be great, good records taken, and in all situations, great care.
• Be certain on fluid and solution,
• There should be no fluid inside during the process.

Following Up in a Patient With Tranfusion

• The process must be mixed well
• Do not give with other administration process
• Check signs and regular monitoring

What to to After Allergic Reations

• Do make any touch with the same syringe.

Check and Double Check for These Indications

• Always look for dehydration.
• Keep the fluids maintained (all should match the specifications and regulations)

Dosage Calculation:

• 1 milliliter is equal to cc, or 20 drops
• 1000 microliters = 1 milligram

Tips

• A person with 250 milligram will generally need 1 tablet .