Drug Applications

• Lecturer: Assist. Prof. Dr. Funda KARAMAN presents information on drug applications.
• Aim: The goal is to master the practices of drug administration.

Objectives

• Understand what a drug is.
• Be able to classify drugs.
• Know how drugs affect the body.
• Explain how to request, supply, and store drugs correctly.
• Know the different ways to administer drugs.
• Apply drug practices effectively.

Contents

• Description of what constitutes a drug.
• Explanations of how drugs are classified.
• Review modes of action of drugs.
• List factors affecting drug actions for a patient.
• Understand how medicine is supplied and stored.
• How to deal with physician medication orders.
• List ways of administering drugs.
• Describe enteral and parenteral drug applications.

What are Drugs?

• Drugs come from animal, vegetable, mineral, and synthetic sources.
• Drugs bring about chemical changes to diagnose, cure, or prevent a disease.
• Drugs change how the body functions and are taken by a living organism.
• Medicines come in different forms, each with its special content.
• Drug administration requires technical skills and is a core function.
• Proper medication knowledge and skills are needed to administer it effectively.

Classification of Drugs

• Dosage forms include solid, liquid, semi-solid, and gaseous medications.
• Solid dosage forms may include tablets or capsules.
• Liquid dosage forms may include syrups or lotions (monophasic), or emulsions/suspensions (biphasic).
• Semi-solid dosage forms may include creams, ointments, gels, suppositories, or pessaries.
• Gaseous dosage forms include aerosols and inhalations.

Factors Affecting Drug Activity

• Growth variations in newborns, the elderly, or various phases of life can affect the need for dosages.
• Weight, gender, genetic, and cultural differences influence drug activity.
• Psychological conditions, illness, or environment may affect drug activity.
• The treatment time, unwanted effects, and differing individual responses play a role.

Interaction of Drugs

• Synergism: Two or more drugs used together have more efficacy, for example, tuberculosis treatment.
• Additional: Effect of drugs on the body together that have the same effective drug.
• Potentialization: The effect of two drugs given together is more than the sum of their individual effects.
• Antagonism: One drug reduces the effect of another, for example, naloxone reduces the effect of narcotics.

Drug Metabolism

• Drug metabolism finishes in four stages in the human body.
• Absorption
• Transport (distribution)
• Change (disintegration)
• Excretion (elimination)

Supply and Storage of Drugs

• Drugs should be locked up in the same room.
• Medicines require storage in a clean, closed, dry and cool place.
• Bottles must be tightly closed to prevent evaporation and moisture.
• Oily or diluted medicines should be refrigerated if prior to the expiration date.
• Vaccines and serums must be kept in the refrigerator.
• If a medicine label is dirty, replace it with a new one.
• Expired medicines or those with color or odor changes should not be used.
• Medicine cabinets need artificial lighting.
• Emergency medicine should have its own space.
• Chemotherapy drugs must not be exposed to light.
• Medicines with the same effect should be stored together.
• The medicine cabinet must hold medications for every patient.
• Addictive or narcotic drugs require a double-locked cabinet with a signature system.
• Any poisonous drug requires a red label.

Physician Medication Order

• The physician, for safe drug administration, needs to provide a written order.
• Drug administration is legally banned unless it is an emergency without any written orders.
• There are 3 types of requests: regular, those when a request is needed, and single-dose requests.

Physician Medication Order Parts

• Parts include date and time, patient identity, drug, dosage, method, frequency, signature.

Health Care Protocol

• Doctor's orders require checking by health professionals.
• The hour adjustments and adaptation to the recording system must be ensured.
• Always consult a doctor if there is doubt about the orders.
• Always put the date, sign, and time below the doctor's orders after being verified.

10 Rights of Medication

• Right Patient, Right Medication, Right Dosage, Right Route, Right Time, Right Documentation, Right Client Education, Right to Refuse, Right Assessment, Right Evaluation.
• These rights need to be verified before application of any drug.
• Proper safety needs more emphasis than all else.
• These rights are so vitally important.

Right Patient

• Verify the patient’s identification bracelet.
• Ask patients their name and DOB.
• Compare orders of administration paperwork (or digital requests) to identify themselves.
• Check patient's allergies on their chart and by asking the patient themselves.

Right Medication

• Every medication needs a triple check based on its label when retrieved, when prepared, and prior to administration.
• Always verify the label with orders.
• Never delegate, and no unlabeled product goes out.

Right Dosage

• Always check the labels against the correct concentration values.
• Ensure its preparation amounts match with how much is on the actual administration note.
• Perform triple-check calculations.
• Have the calculation be double-checked by qualified second personnel.
• Always verify that these levels are kept within safe ranges.

Right Time

• Before administration, verify the current schedule by asking for prior schedules.
• Know the current/past dates in which to administer medication.
• Ensure that all requirements fall within 30 minutes of tolerance.

Right Route

• Be sure the current routes match the orders.
• Never diverge unless absolutely instructed.

Right Documentation

• Always document at the time of administration.
• All records necessitate: product, quantity, path, timestamp, signature and witness (if possible).

Right Client Education

• Always ensure that a patient has knowledge of these four facts.
• Name of medication, desired effects, potential side-effects, allergens with administration.

Right to Refuse

• Never refuse to respect the right of a patient to undergo denial of medication.
• Have them be fully aware of any potential health risks, document the result, and notify their doctor.

Right Assessment

• A proper test with patient should determine if they are appropriate with proper safety.
• Obtain a consultation from an expert specialist if unsafe.
• If not administered do to harm, document thoroughly.

Right Evaluation

• Assess those who might undergo adverse effects.
• Compare their current chart with current progress.
• Ensure all information has been clearly documented.

Basic Principles of Drug Applications

• Wash hands and glove when applying drug.
• Introduce youself to the patient.
• The patient needs to know about the procedure.
• Verbal consent from the patient is an absolute necessity.
• Patient confidentiality should be taken into consideration
• How a patient is situated physically should be appropriate to application.
• Materials for medication should be in a tray.
• Ensure a healthcare worker prepares the dosage.
• Ensure the patient actually takes their medication.
• Ask the patient about possible drug allergies.
• Ensure to review the after-effects.
• Incorrect or illegible orders necessitate revision.

Drug Administration Considerations

• Drug preparation area needs to be well lit/clean.
• The medicine tray location should be well labeled.
• If medication has been prepared, put it in a location until it is needed for use.
• When bottling is removed and poured for consumption, complete a minimum of at least a triple step.
• Verify a patient actually takes drugs.
• Knowledge of drug needs is priority to application.

Narcotic Drugs

• They must be put under double-lock seals.
• The shift change counts must match logs.
• All nurses must sign.
• If unused ampoule is unused upon opening, destroy, or place in a 24 hour syringe.
• Green or red labeled drugs always go in this group.

Drug Absorption Rates

• Intracardiac (15 sec), Intravenous (30-60 sec), Inhalation (3 min), Endotracheal (3 min), Sublingual (3-5 min), Intramuscular (10-20 min), Subcutan (15-30 dk), Rectal (5-30 min), Intradermal (15-30 min), Oral (30-90 min), Dermal (variable).

Measurement Standards

• 1cc is equal to 1ml, which in turns equals 10 dizy, 100 unit, or 20 drops.
• 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.

Local or Systemic Effects

• Medicines may be used for targeting a local single zone or for systemic widespread results.
• Their modes must match what results to ensure proper methods were obeyed.
• Dosages need to accommodate this; patient specific reactions, and route of administration.

Administration

• Routes for drug delivery are dependent upon needs including epidermal, and conjunctival.
• More include intranasal, intravaginal, and external ear canals.

Systemic Administration Site

• Enteral: Oral administration (p.o), Sublingual, and Buccal Application, Rectal Application.
• Parenteral (SC, IM, IV)
• Inhalation
• Transdermal

Local Administration Sites

• The application area is affected by absorption rates.
• Always note topical corticosteroids with proper systemic side effects.
• Lotion should be applied with a warm palm after being previously shaken.

Ophthalmic (Eye) Application

• When applying, it is critical to care for the eyes: always administer before applying pomade with inner canthus out.
• Dropper parts must never touch the eye.
• Never reuse equipment for another patient.
• The patients should tilt backwards into their fowler position.
• Be sure to be as sterile as possible when applying and make sure eye is cleaned with sterile wash.

Ophthalmic Drugs

• Apply to healthy eye, then the sick eye 5 min after the prior administration.
• Make sure drops must be shaken beforehand before being poured.

Intranasal Doses

• Patient should be tilted back in semi-fowler position.
• Drugs never should interact with internal eye moisture or internal membranes.
• Make sure the person has their head tilted backwards over a timespan.

Intravaginal Use

• Patients are put in a position emphasizing extreme comfort and emphasis upon privacy.
• Drugs, including tablets or cream are always prepared.
• Suppositories need prior refrigeration before handling.

Ear

• Be different depending on the age group.
• Pull babies' ears back, and the ears of adults up and back prior to administration of drug.
• Use palm to warm and help resist any form of shock.

Systemic Application Site

• Enteral (oral application), Sublingual, Buccal Rectal Application.
• Transdermal
• Inhalation
• Parenteral (SC, IM, IV, ID = optional)

Enteral Applications

• Applying directly to a part of their gastrointestinal area.
• Use orul and capsule forms, or syrup-based as needed.

Administration - Oral

• Check chart order, expiration date.
• Put medications in a cup without touching them.
• Keep the top level, and box back into place once measured.
• Transport by tray, check person, ensure swallowing, and then log the events.

Circumstances

• Patients unable to undergo typical oral application include the unconscious, disabled, nauseous, or those with convulsions.

Sublingual Approach

• Absorption: Place medication between lower part of tongue.
• Administration: This is so important, that its effect is dramatic as an emergency setting treatment.
• Always avoid chewing.

Buccal Administration

• The drug is delivered through the cheeks and then achieves its intended goal as a systemic effect.
• Do NOT use on chewing food.

Rectal Entrance

• Patient privacy is a big consideration.
• Always go with Sims position.
• In most cases, paracetamol is administered for babies that can use suppositories.

Rectal Techniques

• Make the opening well-lit, and insert tip into rectum and should be lubricated.
• Compress the bottle firmly in one motion.

Transdermal Techniques

• A patch should be adhered well onto the skin for hormone treatment or analgesics.
• Mark the date, apply to skin, and reapply on a time frame.

Inhalation Drugs

• Be careful and always verify to follow a precise set of instructions using trained personnel with any medication process.
• Ensure equipment is sanitized.

Inhalation - Advantages

• Direct targeting
• Faster effect
• No large dosage
• Few side efforts

Inhaler Varieties

• Turbuhaler, Aerolizer, Handihaler, Discus
• Metered Dose, Spacer Chamber or Nebulized-Nebulized

Nebulizer Application

• Commonly used to expand the air tubes or allow a better solution into the lung to ease breathability for issues like asthma.
• Do not apply two drugs together.

Parenteral Applications: Action

• The process has therapeutic drugs enter without need for passing thru digestive systems.
• This includes: Subcutaneous (SC), Intramuscularly (IM), or Intravenously (IV).

Parenteral Applications: Administerating

• Administer less than 1 milliliter subcutaneously.
• Administer intradermal into an arm.
• Various needles need to align based on body size, type of drug, and specific densities.
• Sterile materials should always be withdrawn from a sterile syringe, wiped, and free of any contaminants.

Subcutaneous: Action

• To be fully beneath the epidural and inside the subdermal tissues.
• Small volumes are critical: no more than 0.5-1ml.
• Insulin and some hormones also go under this section.

Subcutaneous: Action - Sites

• Can be upper arm: Always four fingers between shoulder and elbow.
• Can administer to the abdominal region, 5 cm left or right of the belly button.

Subcutaneous: Action - In practice

• Be certain to do the process as specified to prevent pain.
• In every single process when following the injection, change the areas upon each interval to prevent scarring from insulin.

Needle Process: Procedures

• Disinfect your fingers, and wash your hands throughout.
• Prepare materials and syringes under the supervision
• Follow all required guidelines for a 10 step plan.
• Draw the needle until its tip shows.
• Draw a small amount into needle: 0.2-0.3ml for bubble purposes.

Air-Lock Technique

• Can work as barrier, if first medicine comes in and then in the air.

Cleaning Process and Procedure

• Use alcohol and wipe down, center then out.
• Be sure location has clear sight of the epidural in skin, is not irritated, swollen, or bruised.
• Subcutaneous shots go in various area each time, so chart the proper location.

Parenteral Application - Wash hands

• Gather materials - needles, syringes, alcohol, needle container.
• Prepare the material and needle as specified.

3. Prepare that Inyection

• Make positive you use the right product from the vial, or solution from vial, at said dose in the correct way.
• Use new materials at each injection.

4. Inspect Region

• Make certain your screen has no rash or is irritating you in any way.

Intradermal (ID) Injection

• Only goes 1mm.
• Used to test allergic drugs.
• The administration side effects are for skin to be cleared.
• The location has been disinfected.
• Stretch, taut, but go slow and then pull.

Intramuscular (IM) Injection

• Apply typically only into the muscle of arms and thighs.
• Stretch the injection area but pinch the area (if possible) to help provide an easier injection.

Gluteal Injection

• Never apply vaccine products in this sector for children.
• Apply to the middle hip.

Ventogluteal Injection

• Low level of complications, and an easy injection to administer.
• To find area, place heal onto higher femur and then stretch pointer to illiac anterior portion.

Vastus Lateralis

• Go slowly with the thrust to the part being focused.

Injection points need to fall between 40-50 degrees of thigh

• Try not to pinch too deeply with patients.
• Injection points need to be lower inner body.

Intramuscular Injections

• This can be to the shoulders but volumes larger than 1 milliliter is not necessary due to their density and risks,

Procedures

• Follow a procedure of being as aseptic, as possible.
• Confirm data on form.
• Clean area with alcohol.
• Inject needle in under the arm and thigh.
• This needs be for sure and certain.
• Hold in place.

Z-Track Injections

• Heavy solutions that cannot run well are commonly injected into body.
• This prevents leakage and is an IM injection.
• One hand is needed only to retract skin.

Intravenous (IV) Injections

• Used for quick medications to the blood.
• Often to make a person more comfortable and easier to administer fluid that contains electrolyte.
• These are only to be handled by trained staff per accepted rules.

Details

• The name itself is from inside of the vein.
• It relates to sterile intervention with technique.
• Always handle with precise skill and detail.

Circumstances for IV Application

• This administration is best if someone can’t take that medicine orally (i.e. if unconscious).

Veins

• In the arm there are basilic and cephalic veins.
• To target an area, the location often depends on what must occur, i.e. radial wrist access.

Reasons for Administering an IV

• The goal is to treat an electrolyte imbalance or dehydration.
• Prevent harm due to those various deficiencies, etc.

Application

• Syringes should be used in the process.
• Intravenously, the vein location needs be inserted so a catheter can sit there over a day.
• Proper and consistent location of drip needs to be maintained.

Proper Materials for IV Application

• The use of medical materials such as sterile packages are needed to ensure sterility during the application of venous tools and plastic to the injection site.

Tools

• Can be single, double, or trip ended.
• Heparin is a must due to its sterile benefits and the need for not creating blood clots inside it.

IV Route Applications

• Must also meet other routes or not there is no connection and problems will have been incurred that is not possible to fix.
• Alcohol or disinfectant also must not be used but rather some safer routes.
• IVs also might administer fluids over a long time or slowly use a smaller gauge delivery mechanism.
• Always review any charts.

What may occur in the process?

• Always make note if the device falls out in the stream.

Thrombos, embolisms, or air bubbles

• These can have long lasting side effects and may lead to death.

Follow these procedures

• Prevent or reduce harm due to the situation. Follow the proper directions and never attempt to adjust the fluids on its own

Air Embolism - Action

• Quickly, it does result from the liquid bubble levels and should be quickly addressed otherwise serious side effects may occur

Allergins

• Can include hypersensitivity to something new or used in the medications or application

Side Effects

• These include fevers and difficulty but follow steps of application is critical

The Aftermath

• The process to a successful IV drip session is just what is need to ensure things happen efficiently!

Blood Samples

• There are some reasons that these might be performed including as arterial samples for blood in the veins but it also might include blood gas anaylsis.

Procedures: Vacuum

• A section is needed in order to help inject it.

Procedure in Steps

-A review of previous work, to also including patients that are at risk with the process in every sector -An alcohol to ensure proper sterility and cleansing.

• A turnicate
• A syringe needs to go to an area or sector before a vacuum can be pulled back with it.
• A person is told and is able to keep his arm in the higher level then a normal or even then can a average doctor do..