Medication Administration Guidelines
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Questions and Answers

Match the medication with its contraindication:

Acetaminophen (Tylenol) = Liver disease Aminoglycosides = Ototoxicity Amitriptyline (Elavil) = Narrow-angle glaucoma Carbamazepine (Tegretol) = Bone marrow depression

Match the drug with its side effects:

Digoxin = Visual disturbances Diazepam (Valium) = Sedation Doxepin = Blurred vision Lithium = Twitching

Match the medication with its monitoring requirement:

Glucocorticoids = Blood sugars Phenobarbital = Neurologic status Magnesium sulfate = Respiratory rate Propranolol (Inderal) = Blood sugar

Match the medication with its therapeutic onset time:

<p>Amitriptyline (Elavil) = 2 to 6 weeks Diazepam (Valium) = 1 to 2 weeks Lithium = 1 to 3 weeks Doxepin = Varies</p> Signup and view all the answers

Match the drug with its potential adverse reaction:

<p>Salicylate = Tinnitus Quinidine = Cardiotoxicity Theophylline = Seizures Mafenide acetate = Painful on application</p> Signup and view all the answers

Match the medication with its method of application:

<p>Silver sulfadiazine = Buttered on burn wound Mafenide acetate = Open exposure method Lidocaine (Xylocaine) = Applied topically Valproic acid = Oral administration</p> Signup and view all the answers

Match the medication with its common side effects:

<p>Aminoglycosides = Nephrotoxicity Propranolol (Inderal) = Bradycardia Doxepin = Dry mouth Phenobarbital = Staggering</p> Signup and view all the answers

Match the med with its specific patient caution:

<p>Warfarin = Regular INR monitoring Carbamazepine = Carry a medical alert Glucocorticoids = Do not abruptly discontinue Lithium = Maintain sodium intake</p> Signup and view all the answers

Match the drug with a unique feature:

<p>Diazepam (Valium) = CNS depressants contraindicated Digoxin = Uncontrolled arrhythmias contraindicated Phenobarbital = Comatose patients contraindicated Doxepin = Narrow angle glaucoma contraindicated</p> Signup and view all the answers

Match the measurement with its equivalent:

<p>1 ounce = 30cc 1 teaspoon = 5cc 1 tablespoon = 15cc 1 milligram = 1000 mcg</p> Signup and view all the answers

Match the medication safety guideline with its description:

<p>Verify doctor's order = When client questions a new medication Check identification band = Ensures the right person receives medication Do not leave medication unattended = Prevent assumption of medication intake Hold medication if systolic BP &lt; 100 = For blood pressure lowering medications</p> Signup and view all the answers

Match the type of tablet with its requirement:

<p>Enteric-coated tablets = Do not crush Long-acting tablets = Do not crush Soft foods for swallowing = Pudding preferred over liquids Aspirin with meals = To reduce stomach irritation</p> Signup and view all the answers

Match the symptom with its related condition:

<p>Hearing loss = Aspirin overdose Dizziness = Aspirin overdose False urine glucose test = Diabetes on Aspirin Risk of bleeding = Anticoagulants with Aspirin</p> Signup and view all the answers

Match the guideline with the situation:

<p>Do not use aspirin for 5 days before surgery = Including dental surgery Do not give aspirin to children = Risk of Reye’s syndrome Avoid chewable aspirin after surgery = For tonsil removal or tooth extraction Aspirin may increase hypoglycemic reaction = For oral anti-diabetic medication</p> Signup and view all the answers

Match the medication effect with its consequence:

<p>Aspirin with meals = Reduces stomach irritation Aspirin overdose symptoms = Confusion Anticoagulants with aspirin = Increases bleeding risk Aspirin causing low blood glucose = May affect diabetes management</p> Signup and view all the answers

Match the medical term with its definition:

<p>Enteric-coated = Protects from stomach acid Extended release = Sustained action over hours Soft food = Easier to swallow for some Systolic BP = Blood pressure reading to watch</p> Signup and view all the answers

Match the operation with the related medication knowledge:

<p>Verify medication = If client has concerns Check ID = To ensure patient safety Hold medication = If client’s heart rate is &lt; 60 Aspiring side effects = Symptoms like seizures and difficulty breathing</p> Signup and view all the answers

Match the medication to its recommendation:

<p>Aspirin = Take with 8-ounce glass of milk Medication under concern = Recheck before administration BP medications = Hold if systolic BP &lt; 100 Heart rate medications = Hold if heart rate &lt; 60</p> Signup and view all the answers

Match the substance to its risk or effect:

<p>Aspirin and children = Risk of Reye’s syndrome Aspirin overdose symptoms = Ringing or buzzing in ears Diabetics on aspirin = May cause false test results Chewable aspirin = Avoid after dental surgery</p> Signup and view all the answers

Match the following medications with their side effects or precautions:

<p>Prednisone = May cause euphoria and monitor for infection Isoniazid = Vitamin B6 deficiency and GI upset Levodopa-Carbidopa = Watch for orthostatic hypotension Lithium = Toxicity begins at 1.4 mEq/L</p> Signup and view all the answers

Match the following medications with their administration instructions:

<p>Ibuprofen = Take with food or antacids to reduce stomach upset Theophylline = Give with food to prevent GI upset Digoxin = Assess the heart rate before administration Heparin = Do not aspirate or massage the injection site</p> Signup and view all the answers

Match the following medications with their primary use:

<p>Methadone = Heroin detoxification and maintenance Zidovudine = Treat bone marrow problems Coumadin = Long term anticoagulant therapy Amitriptyline = Used as an antidepressant</p> Signup and view all the answers

Match the following drug interactions or contraindications:

<p>Dilantin = Causes gingival hyperplasia Warfarin = Use electric razor to avoid cuts Isoniazid = Avoid Swiss cheese and tuna NSAIDs = Monitor elderly for high blood pressure</p> Signup and view all the answers

Match the following symptoms with their association to medications:

<p>Theophylline toxicity = Dizziness and vomiting Lithium toxicity = Diarrhea and muscle weakness Iron supplements = Constipation and black stools Digoxin toxicity = Visual disturbance (green halo sign)</p> Signup and view all the answers

Match the following medications with their antidotes:

<p>Heparin = Protamine sulfate Opioid overdose = Narcan (Naloxone) Warfarin = Vitamin K Benzodiazepine overdose = Flumazenil</p> Signup and view all the answers

Match the following side effects with the correct medications:

<p>Morphine = Monitor for bradypnea Aminophylline = Hypotension is common Prednisone = May elevate blood glucose Isoniazid = Hepatitis symptoms like jaundice</p> Signup and view all the answers

Match the following medications with their monitoring needs:

<p>Prednisone = Monitor potassium levels Lithium = Monthly blood level checks Zidovudine = Monitor for fever or chills Coumadin = Monitor for signs of bleeding</p> Signup and view all the answers

Match the following medications with their recommended guidelines:

<p>Iron supplements = Take with food to reduce upset Steroids = Avoid infections due to immunocompromised state MAOIs = Avoid tyramine-rich foods Digoxin = Monitor heart rate before administration</p> Signup and view all the answers

Match the following types of insulin with their characteristics:

<p>Regular insulin = Can be given intravenously and is clear NPH insulin = Cloudy and has an onset of 1 to 1 ½ hours Lente insulin = Cloudy and peaks between 8-12 hours 70/30 insulin = Contains 70 units of intermediate insulin and 30 units of regular insulin</p> Signup and view all the answers

Match the following insulin administration techniques with their descriptions:

<p>Drawing up mixed dosage = Regular insulin should be withdrawn first Injection site rotation = Prevents lipodystrophy at the injection site Storage of in-use vials = Should not be refrigerated to prevent local irritation Air injection technique = Inject air into the NPH vial first before regular insulin</p> Signup and view all the answers

Match the following effects with the complementary drugs used alongside insulin:

<p>Black cohosh = Increases antihypertensive effects Garlic = Suppresses platelet aggregation Ginger root = Potential risk of bleeding with anticoagulants Ginkgo = Increases the risk of bleeding when taken with aspirin</p> Signup and view all the answers

Match the following insulin characteristics with their time-related details:

<p>Regular insulin = Onset of 30 minutes to 1 hour NPH insulin = Peaks in 4 to 12 hours Lente insulin = Peaks between 8-12 hours Insulin in use = May be left at room temperature for up to 4 weeks</p> Signup and view all the answers

Match the following statements about insulin syringes with their validity:

<p>100 units in U100 syringe = Each milliliter contains 100 units Only syringe type for insulin = Insulin syringes are the only type used Administration for heparin = Insulin syringes are not used for heparin Intravenous use = Regular insulin can be given intravenously</p> Signup and view all the answers

Match the following insulin storage guidelines with their recommendations:

<p>In-use insulin vials = Should not be refrigerated Cold insulin = Causes local irritation at the injection site Mixing NPH and Lente = Should be thoroughly mixed by rolling gently Sliding scale coverage = Administered based on glucose levels</p> Signup and view all the answers

Match the following insulin action characteristics with their respective types:

<p>Regular insulin = Acts in 30 minutes NPH insulin = Onset in 1 to 1 ½ hours Lente insulin = Peaks between 8-12 hours 70/30 insulin = Has a mix of regular and intermediate insulin</p> Signup and view all the answers

Match the following interactions with their implications:

<p>Salicylates = May cause hypoglycemia when taken with insulin Antihypertensive medications = Should not be used with black cohosh Ginkgo = Increases bleeding risk with anticoagulants Garlic = Suppresses platelet aggregation with aspirin</p> Signup and view all the answers

Match the following insulin properties with their visual characteristics:

<p>Regular insulin = Clear solution NPH insulin = Cloudy appearance Lente insulin = Cloudy due to zinc precipitate Insulin in use = Should be kept at room temperature</p> Signup and view all the answers

Match the following insulin administration facts with their explanations:

<p>Injection site must not be massaged = Prevents irritation at the site Sliding scale coverage = Short term management based on glucose levels Air injection order = Inject air into NPH before regular Fatty masses at injection site = Caused by not rotating injection sites</p> Signup and view all the answers

Study Notes

Medication Administration and Interactions

  • Measurement Conversions:

    • 1 ounce = 30 cc
    • 1 teaspoon = 5 cc
    • 1 tablespoon = 15 cc
    • 1 mg = 1000 mcg
    • 1 gram = 1000 mg

  • General Medication Administration Guidelines:

    • Always double-check medications if a client expresses doubts or concerns.
    • Verify the doctor's order if a client questions a new or unusual medication.
    • Identify the client using their identification band or photo ID in the chart.
    • Do not leave medications at the bedside assuming they will be taken.
    • Hold medications that lower blood pressure if systolic BP is less than 100.
    • Hold medications that slow heart rate if heart rate is less than 60.
    • Do not crush enteric-coated or long-acting tablets.
    • Offer soft foods (e.g., pudding) to clients with swallowing difficulties.
    • Administer aspirin with meals or milk to reduce stomach irritation.
    • Monitor clients taking medication for potential interactions or side effects.

  • Aspirin Usage Precautions and Interactions:

    • Aspirin overdose symptoms: hearing loss, confusion, ringing in ears, dizziness, seizures, difficulty breathing.
    • Aspirin may cause false urine glucose test results in diabetics.
    • Do not use aspirin with anticoagulants.
    • Aspirin may increase the effect of oral anti-diabetics, causing low blood glucose.
    • Avoid aspirin for 5 days before surgery (including dental).
    • Do not give aspirin to children or teenagers with fever or viral infections (risk of Reye's syndrome).
    • Do not use chewable aspirin for 7 days after dental or mouth surgery.

  • Chlorothiazide: Causes water and potassium loss.

  • Prednisone: Raises blood glucose, lowers potassium, and can affect mood. Monitor for infection. Do not discontinue abruptly; taper. Monitor for hyperglycemia with steroid use.

  • Ibuprofen: Take with food or antacid to avoid stomach upset. Contraindicated in stomach ulcer history. Monitor elderly patients for congestive heart failure or high blood pressure.

  • Iron Supplements: Administer with food/meals. Common side effects include constipation, nausea, and black stools. Avoid with antacids. Promote fluids, exercise, and fiber intake to prevent constipation.

  • Low Potassium Symptoms: Dizziness, tiredness, weakness, leg cramps, nausea, and digestive upset.

  • Isoniazid (INH): Used to treat TB, often with Rifampin. Side effects include vitamin B6 deficiency and GI upset. Pyridoxine (vitamin B6) counteracts INH side effects. Liver inflammation (abdominal pain, yellow skin/eyes, dark urine) may signal INH toxicity. Avoid certain foods like Swiss cheese and tuna.

  • Rifampin: Causes discoloration of urine, saliva, tears, sweat, and feces. Negates birth control pills. May cause nausea and vomiting and thrombocytopenia.

  • Streptomycin: Can damage cranial nerve 8.

  • Theophylline (Theo-Dur): Relaxes bronchial smooth muscle. Toxicity signs: dizziness, vomiting, agitation, apical pulse >200 bpm. Give with food.

  • Aminophylline: Most common side effect is hypotension.

  • Digoxin: Essential to assess apical pulse before administration. Toxicity signs include green halo, nausea, vomiting.

  • Levodopa-Carbidopa (Sinemet): Orthostatic hypotension is a common side effect. Protein interferes with absorption, so moderate protein restriction is advised. Effects may not be noticed for several weeks.

  • Morphine: Monitor for bradypnea (breathing rates 8-10).

  • Levothyroxine Sodium: Potential side effects include rapid heartbeat or palpitations.

  • Coumadin (Warfarin): Start after establishing anticoagulation; typically used long-term as outpatient therapy. Electric razor/soft toothbrush use. Report coffee-ground vomit or black/bloody stools immediately.

  • Heparin (Enoxaparin): Do not remove air bubbles from prefilled syringes. Protamine sulfate is the antidote for heparin overdose.

  • Zidovudine: Causes bone marrow problems. Report fever, chills, or sore throat immediately.

  • Steroid/Chemotherapeutic Agents: Teach clients to avoid contact with infected individuals due to immunocompromised state.

  • Dilantin (Phenytoin): Causes gingival hyperplasia. Irritating to GI tissues; may cause constipation and drowsiness. Maintain comprehensive oral hygiene.

  • Lithium: Toxicity begins at 1.4 mEq/L; above 2 mEq/L is toxic. Normal therapeutic range: 0.6-1.2 mEq/L. Toxicity symptoms include diarrhea, nausea, vomiting, drowsiness, muscle weakness, clumsiness; possible coma, convulsions, and death. Treatment includes gastric lavage, correcting fluid balance, using Mannitol to increase urine excretion. Do not take with diuretics, non-narcotics, or anti-inflammatories (these can elevate Lithium). Maintain adequate fluid and sodium intake. Excreted unchanged by the kidneys. Administer with meals. Blood drug levels every month for stable patients.

  • Disulfiram: Alcohol deterrent. Contraindicated if the patient has consumed alcohol within the last 12 hours.

  • Amitriptyline (Elavil): Full effects may take 2-6 weeks.

  • MAOIs: Do not consume tyramine-rich foods.

  • Narcan (Naloxone): Reverses CNS depression caused by opioid overdose.

  • Methadone: Used in heroin detoxification and maintenance; an opioid antagonist.

  • Burns: Silver nitrate (0.5%) used as wet dressing. Silver sulfadiazine (1%) cream (buttered on wound) used with light dressing. Mafenide acetate (Sulfamylon) (buttered on, open exposure method) applied 3-4 times daily. Apply premedicate patient 30-45 minutes before application as it is a painful application.

  • Acetaminophen (Tylenol): Contraindicated in liver disease. Toxicity causes hepatic necrosis.

  • Aminoglycosides: Monitor for ototoxicity (vestibular & cochlear), nephrotoxicity, neurotoxicity, and hypersensitivity reactions (tinnitus, vertigo, hearing loss, rash, dizziness, difficulty urinating).

  • Carbamazepine (Tegretol): Contraindicated in bone marrow depression. Toxicity symptoms (drowsiness, dizziness, ataxia). Sunscreen and medical alert required.

  • Chlordiazepoxide (Librium): Contraindicated with comatose patients or those with CNS depression/narrow-angle glaucoma. Toxicity causes drowsiness and dizziness. Assess for delirium tremens (DTs) if used for alcohol withdrawal.

  • Desipramine (Norpace): Contraindicated in cardiogenic shock, 2nd/3rd degree heart blocks, sick sinus syndrome. Toxicity symptoms include congestive heart failure signs.

  • Diazepam (Valium): Contraindicated in comatose patients and those with CNS depression/narrow-angle glaucoma. Toxicity: sedation, ataxia, dizziness, slurred speech. Initial therapy may see effects in 1-2 weeks.

  • Glucocorticoids: Contraindicated with serious infections and monitor for adrenal insufficiency (hypotension, weight loss, weakness, nausea, vomiting, anorexia, confusion, restlessness). Side effects commonly include mood changes, hypertension, decreased healing, bruising, hyperglycemia, hypokalemia, hypernatremia, fluid retention, osteoporosis and a Cushingoid appearance. Monitor blood sugar, BUN, creatinine. Taper, do not discontinue abruptly.

  • Lidocaine (Xylocaine): Contraindicated in advanced AV block. Toxicity symptoms include confusion, excitation, visual disturbances, nausea, vomiting, ringing in ears, tremors, twitching, convulsions, dyspnea, severe dizziness/fainting, and slow heart rate.

  • Magnesium sulfate: Contraindicated in hypermagnesemia, hypocalcemia, anuria, and heart block. Toxicity symptoms include decreased respiratory rate, bradycardia, arrhythmias, hypotension, drowsiness, flushing, sweating, and hypothermia. Monitor neurologic status frequently. Institute seizure precautions.

  • Phenobarbital: Contraindicated in comatose patients with CNS depression. Toxicity symptoms include confusion, drowsiness, dyspnea, slurred speech, and staggering.

  • Propranolol (Inderal): Contraindicated in uncompensated heart failure, pulmonary edema, cardiogenic shock, bradycardia, and heart block. Toxicity symptoms include bradycardia, severe dizziness/fainting, severe drowsiness, dyspnea, bluish fingernails/palms, and seizures. Monitor blood sugar closely in diabetic clients.

  • Quinidine: Contraindicated in conduction defects and digitalis glycoside toxicity. Toxicity symptoms include tinnitus, hearing loss, visual disturbances, headache, nausea, dizziness, QRS widening; cardiac asystole, ventricular ectopic beats, paradoxical tachycardia, arterial embolism.

  • Salicylate: Contraindicated in aspirin allergy, bleeding disorders, or thrombocytopenia. Toxicity symptoms include tinnitus, headache, hyperventilation, agitation, confusion, lethargy, diarrhea, and sweating.

  • Theophylline: Contraindicated in uncontrolled arrhythmias and hyperthyroidism. Toxicity symptoms include anorexia, nausea, vomiting, stomach cramps, diarrhea, confusion, headache, restlessness, flushing, increased urination, insomnia, tachycardia, and seizures. Monitor closely for tachycardia, ventricular arrhythmias, or seizures as early signs of toxicity.

  • Valproic acid (Depakene): Contraindicated in hepatic impairment. Toxicity symptoms include anorexia, severe nausea and vomiting, yellowing skin/eyes, fever, sore throat, malaise, weakness, facial edema, lethargy, unusual bleeding/bruising, seizures.

Insulin and Insulin Administration

  • Insulin Syringes: Only syringes used to administer insulin.
  • Insulin Units: 100 units per milliliter in U100 syringes.
  • Types of Insulin:
    • Regular (clear): Can be given intravenously.
    • NPH and Lente (cloudy): Zinc precipitate.
    • 70/30 Insulin: 70 units intermediate, 30 units regular.
  • Insulin Onset and Peaks:
    • Regular: 30 min-1 hr; 2-5 hrs
    • NPH: 1-1.5 hrs; 4-12 hrs
    • Lente SC: 8-12 hrs
  • Mixing Insulin: NPH (intermediate) air first, then regular (short-acting) air; draw regular first, then NPH. Thoroughly mix cloudy insulins by rolling between palms.
  • Insulin Storage: In-use vials can be stored at room temperature for up to 4 weeks. Avoid refrigerating insulin in use.
  • Insulin Administration: Subcutaneous injection. Rotate injection sites. Do not massage injection site after injection.
  • Sliding Scale: Insulin administered based on glucose levels for short-term management.
  • Insulin Interactions: Salicylates may interact with insulin and cause hypoglycemia.

Complementary Drug Therapy

  • Black Cohosh: Avoid with antihypertensive medications.
  • Garlic, Ginger, Ginkgo: May increase bleeding risk with aspirin/anticoagulants.

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Test your knowledge on medication administration and measurement conversions. This quiz covers important guidelines for verifying medication orders, client identification, and specific precautions during administration. Perfect for healthcare professionals looking to refresh their skills on safe medication practices.

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