Medication Administration and Resources

• Administering medication involves giving it to a patient in the office
• Prescribing involves a provider authorizing the dispensing of a drug
• Dispensing medication means giving it to a patient to be taken home

Common Routes of Admin

• Oral, sublingual, inhalation, buccal, rectal, vaginal, topical, intradermal, subcutaneous, and intravenous routes

PDR Sections

• Commonly utilized in medical offices and contains information on major prescription pharmaceutical products in the U.S
• Sec 1: Lists pharmaceutical manufacturers alphabetically, including their name, address, phone number, and product ID
• Sec 2: Contains a brand and generic name index
• Sec 3: Product Category Index based on action on the body
• Sec 4: Product ID Guide with full color photographs of tablets and capsules
• Sec 5: Product Information, including:
  • Brand name, generic name, dosage, Rx status, and OTC status if available
  • Clinical pharmacology, explaining how the drug functions
  • Indications and Uses as listed by the FDA
  • Contraindications, detailing situations where the drug should not be used
  • Warnings about safety hazards
  • Precautions for special care needed for safe use
  • Adverse Reactions which are undesirable effects that may occur with use
  • Overdosage symptoms related to overdose
  • Dosage and Administration of the recommended adult dosage
  • How Supplied including available forms, units, shape, color, and storage conditions

FDA

• A federal agency of Health and Human Services
• Responsible for determining the safety of foods, drugs, and vaccines before their release
• The agency determines the safety and effectiveness of non-prescription and OTC drugs
• Responsible for determining if a medication will needs a prescription

4 Names of Drugs

• Chemical name: Provides a precise description of the drug's chemical composition
• Generic name: Assigned by the pharmaceutical manufacturer before FDA approval and commonly the official name
• Official name: Name listed under USP and NF
• Brand name: Name under which a pharmaceutical manufacturer markets a drug

Liquid Prep

• Elixir is dissolved in a solution of alcohol, water, and are sweet
• Liniment is a drug combo with oil, soap, alcohol or water
• Lotion which is an aqueous preparation that contains suspended ingredients
• Solution is a liquid preparation containing one or more completely dissolved substance
• Suspension is a drug with insoluble drug particles in a liquid
• Tincture is a drug dissolved in a solution of sugar

The Metric System

• The metric system which is most commonly used, more exact, & easier to use
• Basic metric units include grams for solids, liters for liquids, and meters for length or distance
  • Weight: heaviness
  • Volume: amount of space occupied by a substance
  • Length: a unit of linear measurement of the distance from one point to another

Household System

• More familiar among individuals, more complicated, less accurate
• Basic Unit: Gtt (drop) = 0.6 mL

Controlled Drugs Schedule

• Schedule I drugs have a high potential for abuse and no accepted medical use
• Schedule II drugs have a high potential for abuse but currently accepted medical usage, must be in writing, no refills allowed
• Schedule III drugs have less potential for abuse and currently accepted, can have telephone/fax, refilled 5 x`
• Schedule IV drugs have lower potential, currently accepted, telephone/fax
• Schedule V drugs are low potential for abuse, accepted

Parts of Prescription

• Superscription: Rx (take thou)
• Inscription: I.D name, drug, & dose
• Subscription: designate quantity of drug
• Signatura: info to be included on medication label (directions)
• Generic Prescribing: provider writes prescription using generic rather than the brand name of the drug

Disposal of Medication

• Use drug take back programs:
  • Collection events: Federal, State, or local law enforcements host community drug take backs
  • On-Site collection Receptacle includes a location permanently in a specific location
  • Mail back programs where some pharmacies may offer mail back envelopes to assist in safely disposing of unwanted medication
• Household disposal, recommended method
  • Remove medication from original container
  • Mix medication with an undesirable substance like kitty litter or coffee grounds
  • Place mixture in a disposable container
  • Remove personal info

Function of EHR

• Reduces time needed to prescribe and refill, can transmit prescriptions, can generate and print out prescriptions

Purpose of Medication Record

• To allow the provider to tell at glance what medication, & how much the patient is taking

Factors Affecting Drug Action

• Age: children and elderly respond more strongly
• Route of administration: Orally are absorbed slowly, paternally (injection) are absorbed more quickly
• Size: thin patients req smaller amount of drug
• Time of administration: oral route is absorbed more rapidly when the stomach is empty
• Tolerance: a certain drug over a period of time may develop a tolerance to it

Allergic Drug Reaction & Idiosyncrasy

• Anaphylactic reaction
• Sneezing
• Urticaria (hives)
• Itching
• Erythema (reddening of the skin)
• Angioedema (localized urticaria)
• Disorientation
• Idiosyncrasy: abnormal or peculiar response to a drug that is unexplained and unpredictable, elderly are more prone to these reactions

Oral Administration

• Most convenient, most used, absorption occurs in small intestine
• Advantages as patients find it easier to swallow a tablet or capsule

Parenteral Administration

• Advantages: SQ, IM, and IV are absorbed more rapidly and completely than oral medications, and are sometimes the only way a medication can be given
• Disadvantages: Pain, discomfort, and possibility of infection

Parts of a Needle and Syringe

• Hub: fits onto the top of the syringe
• Shaft: inserted into the body tissue
• Lumen: the opening of the shaft and is continuous with the hub
• Point: at the end of the needle so that it can penetrate the tissue
• Bevel: the top of the needle, is slanted, designed to make a narrow slitlike opening in the skin
• Barrel: holds medication and contains calibrated markings
• Flange: helps inject medication
• Plunger: movable cylinder that slides back and forth

Types of Syringe

• Hypodermic: 2, 2.5, 3, & 5 mL
• Insulin syringe: common type is U- 100 syringes
• TB syringe: . 1 mL, divided into 10ths, and hundredths

Needle Lengths and Gauges

1. 3/8 inch 28 gauge
2. 1/2 inch 27 gauge
3. 5/8 inch 25 gauge
4. 1 inch 22 gauge
5. 1 1/2 inch 21 gauge

Safety Engineered Syringes

• Purpose to prevent needlestick injury and injury among healthcare workers

Vial, Ampule, & Pre-Filled Disposable Syringes

• Vial: closed glass or plastic container with rubber stopper, injectable medication may be available in single-dose vial, multiple-dose vial, or both
• Ampule: a small sealed glass container that holds a single dose of medication.
• Prefilled syringes: do not require drawing up

Reconstitution

• Involves of adding a liquid to a powdered drug
• Diluent: liquid used to reconstitute a powdered drug, consists of sterile water or normal saline
• Examples measles, mumps, and rubella (MMR)

SQ injection

• Injected into adipose(fat) tissue,
• Common sites include Upper lateral of the arm, anterior thigh, upper back, and abdomen, & should not exceed 1 mL
• 1/2 to 5/8 inch & 23 to 25 gauge

IM injection

• Up to 3 mL into gluteal or vastus lateralis muscle, is more rapid in absorption because of more blood vessels
• Common sites: Dorsogluteal, Deltoid, Vastus Lateralis, Ventrogluteal
• 1-3 inches (Adult)
  • 1 1/2 inches (average-sized adult)
  • 1 inch (thin adult or child)
  • 2-4 inches (obese adult)

ID injection

• Absorption is slow, usually 3/8 to 5/8 inch long & 25 to 27 gage
• Common sites: anterior forearm, and middle of the back

Tuberculosis

• Infectious bacterial disease that can occur in any part of the body but most commonly the lungs
• Purpose of TB test
  • I.d individuals who are infected with M. tuberculosis
• Mantoux TB skin test
• named after Charles Mantoux, administered ID, vial must be stored in refrigerator
• 2-step TB test recommended by CDC, for most healthcare workers

Diff Between Active and Latent TB

• Active TB:
  • Symptoms: Patient feels sick, cough & fever
  • TB bacterial status: active tb is present in the bo
  • Diagnostic Test: Patient usually has positive TST or QFT-G blood test result
  • Ability to infect others: Patient is infectious & may spread the disease
  • Treatment: Patient needs treatment
• Latent T:
  • Symptoms: Patient feels fine, has no symptoms
  • TB bacterial status: TB alive but inactive
  • TB test result: patient has positive blood test
  • Diagnosis Test: patient has positive TST or QFT-G blood test result
  • Ability to affect others: Patient is not infectious
  • Treatment: Provider may consider treatment to prevent active Tb

Interpretation of TB Mantoux Test

• Positive reaction
• Induration of 5 mm or more
• Negative reaction
• Induration of 9 mm or les
• Positive reaction
• An induration of 15 mm or more
• Negative reaction
• Induration of 14 mm or less

IGRA's

• Tests used to i.d individuals who are infected with M. tuberculosis, cannot differentiate between active and latent forms of infection
  • QFT-GIT :14 hours
  • T-SPOT 8 hours

Advantage and Disadvantages of IGRA

• Advantages
  • Only needs to visit office one time
  • Results are available within 24 hrs
  • Provide objective evaluation
  • Tests are not affected by the booster effect
  • Provide negative and positive test result
  • BCG does not show false negative result
• Disadvantages
  • Specific time period
  • Errors in collection
  • Cost are higher

In Vitro Allergy Testing

• Measures the amount of IgE antibodies in the blood that respond to common allergens
• Advantages the results are not affected by medications, there is no danger of adverse reactions because the is performed in vitro(outside the body), can be performed on patients who have skin eruptions
• Disadvantages: expensive, does not provide immediate test results

Questions cover prescribing, dispensing, administering medications, routes, and reference resources. Injection techniques and considerations for patient needs are addressed. This includes appropriate medication forms and information sources.