Drug Applications and Classifications

• The aim of drug applications is to fulfill necessary practices for drug administration.
• The objectives involve understanding drug definitions, classifying drugs, knowing drug effects on the body, and explaining drug requests, supply, storage, and administering practices.
• Topics include description, classification, action modes, and factors affecting drugs. Further topics are medicine supply/storage, medication orders, administration ways, and enteral/parenteral applications.

Drugs

• Drugs come from animal, vegetable, mineral, and synthetic sources.
• Drugs are chemical changes to diagnose, cure, or prevent disease.
• Drugs are substances altering body functions in living organisms.
• Medicines vary in form and special content.
• Drug administration requires technical skills.
• Knowledge of medications and skills to administer medication is a necessary function.

Classification of Drugs

• Dosage forms are classified in terms of being solids, liquids, semi-solids, or gaseous.
• Solid dosage forms include tablets and capsules (unit dosage) plus tooth powder and dusting powder (bulk dosage).
• Liquid dosage forms include syrups and lotions (monophasic liquids) plus suspensions and emulsions (biphasic liquids).
• Semi-solid forms include creams; ointments; pastes; gels; and suppositories and pessaries.
• Gaseous forms include aerosols and inhalations.

Factors Affecting Drug Activity

• Newborns, the elderly, adults, and those in risk groups have different dosages.
• Growth period (newborn and elderly)
• Weight
• Gender
• Genetic and cultural factors
• Psychological factors
• Illnesses
• Environment
• Treatment time
• Adverse drug effects
• Individual differences

Drug Interactions

• Synergism displays more efficacy when two or more drugs are used together, such as in tuberculosis treatment.
• Additional interaction shows an increased drug effects on the body, and taking the same effective drug together.
• Potentialization occurs when the effect of two drugs together exceeds the sum of their individual effects.\
• Antagonism is when one drug reduces the effect of another, such as using naloxone to reduce narcotics effects.

Drug Metabolism

• Drug metabolism completes in four basic stages.
• Absorption
• Transport (distribution)
• Change (disintegration)
• Excretion (elimination)

Supplying and Storing Drugs

• Drugs should be secured in a locked room.
• Storage requires a clean, closed, dry, cool area.
• Bottles should be tightly closed to prevent evaporation and moisture.
• Oily and diluted medicines need refrigeration within their expiration date.

Medicine Storage Guidelines

• Vaccines and serums need to be in refrigerators.
• Replace medicines that have labels that are dirty, or expired.
• Do not use medicines if they are expired, of changed color, odor, or appearance
• Artificial lighting should be installed where the medicine cabinet is located.
• A separate compartment is required for emergency medications.
• Storage requires medicines of the same effect are kept together.
• Chemo drugs should not be exposed to light.
• Medicine cabinets need to be large enough to hold all patients' medications.
• Addictive drugs should be in double-locked cabinets, given with a signature.
• Poisonous drugs needs to have a red label.

Physician Medication Order

• Safe drug administration requires a Physician Mediation Order in writing.
• Drug administration without a written order is prohibited legally, except for emergencies.
• Medication requests can be regular, necessary, or urgent (single dose).
• Medication orders include patient name, date, time, drug name, dosage, routes, frequency, and doctor's signature.
• Doctor orders are checked by healthcare professionals every morning.
• Healthcare professionals adjust doctor's orders to their recording (usually on the doctor's order sheet).
• There should be an observation sheet used.
• Contact a physician if there is any doubt about an original request.
• Dates, times, and signatures need to be put under the doctor's orders after checking.
• After checking, a line should be drawn underneath doctor's order to avoid another medication being written onto an old form.

Rights of Medication Administration

• Medications must be administered by means of right patient.
• Medications must be administered by means of right medication. *Perform a triple check of the medication’s label.
• Medications must be administered by means of right dosage.
• Medications must be administered by means of right route.
• Medications must be administered by means of right time. *Verify schedule of medication with order.
• Medications must be administered by means of right documentation. *Never document before medication is administered.
• Medications must be administered by means of right client education. *Inform patient of medication being administered.
• Medications must be administered by means of right to refuse. *The legally responsible party has the right to refuse any medication.
• Medications must be administered by means of right assessment. *Properly assess patient to determine if medication is safe and appropriate.
• Medications must be administered by means of right evaluation. *Compare patient’s prior status with post medication status.

Right Patient

• Check the patient’s identification bracelet.
• Ask the patient to state their name and birth date.
• Compare the medication order to identification bracelet.
• Cross-verify allergies of patients on patient charts.

Right Medication

• A triple check of the medication’s label should be performed when retrieving, preparing, and administering drugs.
• Check all the label when retrieving drugs, performing preparation, and administering to a patient
• Medications should align with physician's order.
• Never give medications prepared by another person.
• Medications should be labeled right.

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 approved appropriate dose ranges for patient and medication.

Right Time

• Time of date should line up with order
• Time should coincide with dose
• Administer medication within 30 minutes of schedule

Right Route

• Verify medication route with medication order before administering.
• Administer specified route depending on order.

Right Documentation

• Documentation should be done AFTER administering the drug or medication.
• 1. Medication
• 2. Dosage
• 3. Route
• 4. Date and Time
• 5. Signature and credentials
• 6. When appropriate, signature of other nurse checking medication

Right Client Education

• Client education is required for medication being administered
• Desired effects
• Side-effects
• Allergies

Right to Refuse

• Inform legal entity in making proper health decisions about risks in refusing medication
• Notify all necessary parties over refusals

Right Assessment

• Effectiveness of medication needs to be determined through proper assessment of patient.
• Inappropriate prescriptions need notification and documentation.

Right Evaluation

• Assessment requires observation of various effects and side effects to medication
• Medication charts need documentation of patient responses to medications

Principles to Administration

• 10 rights to drug administration should be known
• Gloves and hands should be cleaned
• Verbal consent should be obtained and the patient should be informed
• Confidentiality should be upheld at all times and the patient needs to be positioned appropriately to administer the drug safely.

Things to consider for administrations

• Trays require all materials that are being used to administer a drug to be in there.
• Medications are observed to ensure the patient can take the drug safely.
• The worker administering the drug, should be the worker preparing the drug.
• Unalignmed orders should not be done if there is any confusion and the caregiver must contact whomever prescribed it to ensure orders align
• Drugs are only inquired and administered for those under their specific care.

Drug Preparations

• Preparations require cleanliness and sterilization
• Multiple checks to ensure the right drug is administered
• Check three times when administering

Accuracy To Administer

• When taking the bottle from its place
• While pouring the medicine into the glass
• When replacing the medicine bottle

General Considerations

• Check identification
• Await consumption of drug unless specified otherwise
• Check if there are any reasons for a delay and consult with the provider
• Stay knowledgeable and inform the necessary parties
• Narcotic administration needs to be accounted for and all unused drugs must be logged when administered. Red/or Green drugs tend to be classified as such
• Rate or absorbency are affected based on delivery method and location

Measuring

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

Effect

• Drugs can either have a local or systemic effect on the body, depending on what the doctor orders. The body functions based on how the drug was processed and administered. Other factors affect these including pre-existing effects or conditions.

Administration

• Many things require consideration when drugs are applied to patients. Proper precautions include site direction with regards to proper sanitation.

Localized Administration

• 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 Application

• Enteral: Solid Forms: tablet, dragee, capsule, film-coated tablet, enteric tablet, chewable tablet, effervescent tablet, granule.
• Oral Administration (per oral, p.o)
• Sublingual and Buccal Application
• Rectal Application
• Liquid Forms: Syrup, solution, suspension, drops (concentrated solution).
• Parenteral (SC, IM, IV): Solution or suspension for injection, emulsion(ampoule, vial, powder to be diluted)
• Inhalation: Gas, vapor, aerosol, inhaler, nebulizer
• Transdermal: Flaster (TTS)

Epidural Applications

• Apply depending on site need and usage
• Systemic steroids may be useful during applications

Eye Application

• Proper function requires sanitation to avoid transmission with applications
• Care should be taken to avoid cross contamination with drugs between patients and droppers themselves can not come close to the eye
• Healthier eyes are usually treated first
• 5 minute periods between medication administration is needed to avoid mixing
• Medication also requires drops to be shaken

Application, continued

• Eye drops must come before ointments in application
• Application comes first so its administered with the lower lid where the tear drop forms

Nasal Application

• Patient head requires to be at a 45 Degress angle
• Mucosa should have no cross contact with tip
• Extension is needed for a few minutes, so drugs work

Interior Applications

• Most application areas and those that have tablet forms require privacy
• Medications need to be applied correctly. With some drugs needing heat depending on application location.

Ear Administration

• Children vs adults will require different locations of application, with adults ears being pointed up vs downward for children

System Applications

1. Enteral (Oral Application, Sublingual, Buccal, Rectal Application)
2. Transdermal
3. Inhalation
4. Parenteral (SC, IM, IV, ID)

Enteral applications

• Applies drug to tract for absorbency
• It most happens oral and applications

Pre-Administration

• Patients need medication ready for a variety of routes
• Always double-check medications that are distributed and that all the tools are sterile

DO NOT DO if:

• Patients report being UNCONSCIOUS
• Those with difficulty swallowing or the chance they can aspirate at any point
• Patients with nausea, diharrea and or convulsions

Sublingual and Buccal

• Sublingual goes directly and quickly to the blood vs chewed and swallowed.

Rectal applications

• Requires privacy, proper administration and correct positioning

Transdermal Applications

• Used on hormone replacements and sensitive areas that adhere with an application or patch
• Applications require the time and date and must be timed, drug needs to coincide.

Inherent

• Is highly sensitive, and permeable to medication
• Blood in lungs assists to proper circulation
• Typically uses a nebulizer

Intramuscular Injections - Parenteral Injection (Most Commonly Used)

• Common injection to skin through muscle that are not taken through digestion
• Subcutaneous, inter-dermal, muscular injections

Injection Requirements

• Syringe type affects inject amount
• Route, and substance will determine syringe type and needle length

Vial preparations

• Many components must be applied in sterile conditions to limit adverse conditions

Inject: Subcutaneous and Injected

• Under skin for controlled injections

Action Types

• Control blood functions to administer shots
• Hormones should also be considered when administrating drugs to those patients

Locations of Action

• Belly
• Leg
• Upper Arm (back arm)

Intramuscular Injections

• Injections typically involve the thigh upper arm, or bicep. Actions must all follow standard procedure when administrating a shot.

Deltoid injections to:

.- Help minimize any infections.

• All locations are all typically sanitized before hand.

Subcutaneous Information:

• The needle cap must be removed with a thumb to avoid contamination risk
• Blood must not appear when injecting the body with shots
• Pressure must be constantly applied in that area

Additional Steps

• Be sterile and clean during injects
• Insert and remove during injects
• Check where to and don’t add to site

Intradermal Applications

• Skin to make medication administration, with drugs underneath the dermis, with 15 degrees approach

Rules and Steps:

• Find Area
• Clean the area
• Stretch the area and apply the material
• Be safe
• Do not re-apply

Intramuscular Injection

• Injection sites include

1. buttocks muscles
2. lateral
3. Vastus muscles
4. deltoid muscles
5. Ventrogluteal

Rules

• Injections need to be completed with sterile equipment that is applied with care. The process must then be repeated all times that shots are administered.

Intramuscular Areas of Usage

• With all applications care must be taken into account.

Other important notes/functions

• When using needles be sure to always apply correctly and have a safe plan to maintain the correct use and disposal always.

Intravenous Information

• Quick action via injection as fluids
• Caution if injecting substance as its a direct path

Rules For Actions

• The patient can react badly do to how aggressive a drug is and the effects from it and therefore may require constant checking
• Intravenous or injections also must consider the use of antiseptics

Additional factors/Rules

• Always clean areas
• Give plenty of room when applying or removing the catheter
• Remember those areas that are sensitive and may be prone to error.
• Have an understanding on how those function especially if problems arise due those being the most important sites to be injected it may also be prone for mistakes

IV rules cont

• IV rules require proper attention be paid along with what drugs being added as well
• This can impact both treatment and side effect conditions too

IV - Issues

• If someone is bleeding that can be a sign of concern and must be treated ASAP.

What IV helps in

• Electrolyte, and problems with internal composition requires fluid treatment.
• These instances may impact patient care therefore doctors need to know.

Additional Rules

• All tools are to be opened with sterilization as IV’s have to be sterile

IV Rules To Injections

• A good location should be in mind with what part of the body

Fluid

• Fluid can change so monitoring for damage must be done to maintain balance as saline and sterile are highly potent.

Post Administrantive

• Once done, ensure no air is in the device with a removal technique.
• Maintain cleanliness of tool after use and ensure all procedures in place

Final Checks

• This checks that all parts match the needs and all is set before application.

IV Checklists

• All the above must be checked in order for an intravenous treatment to be completed all at once for the patient

Important.

• Always have someone observe with the administrator to ensure the plan is on track
• Be careful and check as many levels as you can when the drugs or fluids being passed or inserted are of a high level in importance as most levels can become dangerous.
• For all injections remember your safety comes first

Checks before Administration:

• Patients name and information
• Doctor Orders
• If someone is ready to have this type of medication

Transfusional reactions

• Transfusional reactions typically require doctors to have specific steps. As these changes may results in high amounts of pain if the reaction is negative then.

Other Checks

• Always check blood type for transfusions

More Factors to look into

• In certain conditions body weight should be observed.
• Problems with other items can also make the process more difficult.

IV Fluids:

• High to medium range that is fluid with plastic bags.
• There are others however and they all bring important balance to the operation of your patient

To Finish the Plan

• Remove air bubbles first
• Administer the drug or start another drug as needed depending on the plan.
• Always double-check the fluids
• Follow Up