Medications

• Medications

Assessing Your Understanding: Fill in the Blanks

• A liquid medication called a suspension should be shaken before use.
• The generic name is assigned by the drug's developer and identifies its active ingredient.
• The trade name, also called the brand name, is selected by the pharmaceutical company and is trademark protected.
• Clinical manifestations of a drug allergy can include rash, urticaria, fever, diarrhea, nausea, and vomiting; the most serious allergic effect is anaphylaxis.
• Drug tolerance occurs when the body becomes accustomed to a drug's effects over time, requiring larger doses for the desired effect.
• Toxic effects are specific groups of symptoms related to drug therapy that carry risk for permanent damage or death.
• An idiosyncratic effect (or paradoxical effect) is any unusual or peculiar response to a drug, such as overresponse, under-response, or the opposite of the expected response.
• Teratogenic drug effects can cause developmental defects in the embryo or fetus.
• Body surface area, expressed in square meters (m²), is used to calculate drug doses, especially for infants and children.
• When administering otic medication to an adult, the pinna of the ear should be positioned up and back.
• A patient with liver disease is at risk for toxicity when taking a medication metabolized by the liver.
• Because of the risk of small glass shards, use a filter needle to remove medication from an ampule.
• Ensure that two drugs are compatible before mixing them in one syringe.
• Insulin is typically available in multidose vials with a U100 designation, meaning 100 units of insulin are contained in 1 ml of solution.
• The technique of adding a diluent to a powdered drug is called reconstitution.

Assessing Your Understanding: Calculate Medication Dose

• To calculate the proper medication dose, include a numeric answer and the units for administration (e.g., tablet(s), mL).
• Prescription: gentamicin 60 mg IV, Available: gentamicin 80 mg/2 mL, Administer 1.5 mL.
• Prescription: Mestinon 30 mg orally, Available: Mestinon 60 mg/tab, Administer 0.5 tab.
• Prescription: amitriptyline 75 mg orally, Available: amitriptyline 25 mg/tab, Administer 3 tabs.
• Prescription: penicillin V 250 mg orally, Available: penicillin V 500 mg/tab, Administer 0.5 tab.
• Prescription: naproxen 250 mg orally, Available: naproxen 500 mg/tab, Administer 0.5 tab.
• Prescription: Pro-Banthine 15 mg orally, Available: Pro-Banthine 5 mg/tab, Administer 3 tabs.
• Prescription: Lanoxin 0.125 mg via NG tube, Available: Lanoxin 0.250 mg/tab, Administer 0.5 tab.
• Prescription: furosemide 20 mg orally, Available: furosemide 10 mg/tab, Administer 2 tabs.
• Prescription: Dexamethasone 4 mg IV, Available: Dexamethasone 8 mg/mL, Administer 0.5 mL.
• Prescription: levofloxacin 750 mg orally, Available: capsules of 1 g, 500 mg, and 250 mg, Administer 1 capsule of 500mg and 1 capsule of 250mg.

Matching Exercise 1

• Trade names are capitalized while generic names are presented in lowercase.
• Drug classifications, or drug classes refers to groups of drugs that share similar characteristics, whether by their pharmaceutical or therapeutic properties.
• Pharmacotherapeutics is a subtopic of pharmacology addressing "therapeutic uses and effects of drugs," also known as the clinical indication(s).
• Bioavailability is the portion of a drug that reaches the systemic circulation and can act on the cells.
• Loading dose is larger than normal dose to quickly achieve the therapeutic effect.

Matching Exercise 2

• Ointment is a semisolid preparation containing a drug to be applied externally; also called an unction.
• Capsule is a powder or gel form of an active drug enclosed in a gelatinous container; may also be called liquigel.
• Tablet is a small, solid dose of medication, compressed or molded; may be any size or shape, or enteric coated.
• Elixir is a medication in a clear liquid containing water, alcohol, sweeteners, and flavoring.
• Suppository is an easily melted medication preparation in a firm base, such as gelatin, that is inserted into the body.
• Syrup is medication combined with water and sugar solution.

Matching Exercise 3

• Subcutaneous injection delivers medication below the skin, into fatty tissue.
• Intramuscular injection delivers medication into the muscle.
• Intravenous injection delivers medication into the Vein.
• Intra-arterial injection delivers medication into the Artery.
• Inhalation delivers medication into the Pulmonary.
• Intraosseous injection delivers medication into the Bone.

Short Answer

• For drug classification. the two categories are Pharmaceutical-Mechanism, effect, structure and Therapeutic-clinical indication.
• Drugs alter cell physiology by; Drug-receptor interactions: Drug interacts with one or more cellular structures to atter cell function and Drug-enzyme Interactions: Drug combines with enzymes to promote the desired effect.
• Factors affect drug action, Developmental stage of patient: A_child's dose is smaller than an adult dose, Weight: Children-dose based on weight. Adult-dose based on reference adult, Genetic factors: Asian partients mag require smaller doses because it metabolizes at a smaller rate, Cultural factors thebal remedies may interfere with or counteract the action of prescribed medication, Hepatic disease: May slow the metabolism Of drugs., Time of administration: Presence of food in Stomach delays absorption of oral medications.
• Situations that you would question a medication prescription: a. The patient is allergic to the drug, b. Difficulty reading the order, c. Know its harmful to the patient.
• Types of medication supply systems, Stock supply system (computerized automated dispensing cabinets [ADCs]): Large cabinet accessed by username and password, listing meds only for each pation, Unit-dose dispensing system: Packaged and labeled by 24-hour period, Medication cart: Individually labekd drawers for each patient Move cart room to room, Barcode-enabled medication administration (BCMA): Barcodes for patients and drugs to match and/or identify mistakes.
• The nurse carries out the three checks and eleven rights of administering medication; Three checks: when reaching for medication ,after retrieval and comparison to MAR, Before giving medication to patient b. Eleven rights: Right medication, patient, dose, route, time, reason, data, documentation, response, education, right to refusal.
• Your patient tells you that they refuse to take the medication prescribed because It tastes "disgusting." List three techniques you could use to mask the taste; Crush it appropriate; add to food/chink, Suck on ice to rumb tastebuds, brive with generous amounts of water.
• How the following factors would affect the type of equipment a nurse would choose for an injection; Route of administration: Longer needle for Im than for ID or sus-a, Viscosity of the solution: Higher viscosity requires larger lumen, Volume to be administered: Larger volume requires greater syringe capacity, Body size:, Ouese person requires bager needle, Type of medication: Insulin or tuberculin require Special needles
• List four steps that should be followed when a medication error occurs; Observe patient condition/adverse effects, Notify nurse manager and provider, Report incident following institutional policy, Don't document filing of incident report.
• Describe the use of the following types of prepackaged medications; Ampules: Glass flask-single dose tor parenteral administration, Vials, Prefilled cartridges: Glass bottle with Self-sealing Stopper through which medication is remored.

Fill in the missing information

• Atenolol (Tenormin), 50 mg, PO BID, hold for BP less than 110 systolic: Upon entering the room, the nurse introduces themselves and performs hand (1) hygiene. The nurse recognizes the medication name atenolol as the (2) generic name, when the patient refers to it as Tenormin. Next, the nurse (3) identifies. the patient using (4) name and (5) date of birth comparing it to the eMAR. The nurse assesses the patient's (6) vital sings prior to administration to avoid adverse reactions. The nurse teaches the patient that this medication is given by the (7) oral route and will be given (8) two times daily. Prior to administering this antihypertensive medication, the nurse notes the blood pressure is 102/70. Based on this assessment, the nurse plans to (9) with hold the medication and (10) notify the prescriber. Documentation in the MAR and electronic health record will include (11) notation medi with he, notation medi with hel, (12) patient's BP, (13) physician notified and (14) changes in prescription.
• Heparin 5,000 unit subcutaneously twice daily; After hand hygiene and patient (1) identification the nurse explains that the medication is being given to prevent blood clots and that the injection will be given in the (2) abdomen. The nurse then selects an appropriate syringe for the (3) volume. of medication (generally of 1 or 3 mL). First, the nurse injects a volume of air equivalent to the volume of heparin needed, keeping the vial on a flat surface. The nurse then inverts the vial, withdrawing the medication, ensuring there are no air (4) bubbles that could interfere with accurate dosing. The nurse performs the (5) recheck to the dose of medication and vial against the MAR (second check), and, prior to putting the vial away, checks the dose, syringe, and vial again (third check). The nurse gathers a fold of skin on the patient's abdomen and injects the medication at a 90-degree angle (45 degrees if the patient is extremely slender). When withdrawing the needle, the nurse applies (6) pressure, without rubbing the Injection site.
• NPH insulin 45 units daily SQ in the am: After hand hygiene, active patient Iden- tification, and the first check of the vial of insulin against the eMAR, the nurse withdraws insulin from the vial using a(n) (1) insulin syringe.

Prior to administering the insulin injec- tion

• Prior to administering the insulin injec- tion, the nurse attestes the patient's (2) fingerstick blood glucose, whether they have (3) eaten or had beverages, and the (4) Site routinely used at that time of day. The nurse continues (5) premeal glucose monitoring and observes for symptoms of (6) hypoglycemia
• Nitroglycerin ointment (Nitro-Bid) 1/2 inch or 7.5 mg to anterior chest wall q8 hours: The nurse applies clean (1) gloves; removes the old patch, folding it, medica- tion side facing (2) inward; and wipes the area as needed. Using the supplied paper, the nurse measures out 112 inch(es). The nurse writes the (4) date (5) time, and their initials on a piece of tape long enough to cover the patch. The nurse places the patch on a new, non-(6) hairy area on the anterior chest wall and secures it with tape, then documents the removal and new site of application. The nurse assesses the patient's blood (7) -pressure before and after administration and for (8) Chest pain and dizziness.
• Oxycodone 5 mg with acetarninophen 325 mg 1 tablet PO q4 hours PRN for pain When the patient reports pain, clarify the (1) kcation and (2) severity of the patient's pain. Verify allergies and when the last doses were administered to ensure the (3)4-hour interval has elapsed, and the maximum daily dose of acetaminophen is not (4) exceeded Administer one tablet orally if indicated. Evaluate the medication's (5) effectiveness after administration. Assess for (6) sedation and presence of (7) constipation
• Ciprofloxacin information should be gathered upon preparing a patient for discharge in the chart is as followed; Dosage range is 250-750mg, Possible route PO, Frequency/schedule is BID, Desired effects , Cure treat Infection, Possible adverse effects is GI upset, nausea, diarrhea, Signs and symptoms of toxic drug effects CNS Stimulation, dizziness, Special instructions Avoid antacids, vitamins, Nursing/collaborative management of adverse effects Report Severe diarrhea to provider

Prior to administering medications

• Prior to administering medications, a nurse notes the therapeutic level of a medication is twice the therapeutic value, the nurse should withhold and contact provider. Document withheld medication
• A nurse is preparing to carry out a prescription to draw a peak and trough level of the antibiotic vancomycin for a patient, to properly carry out this prescription the nurse should, Draw level just before dose and 1 hour after administration.
• A nurse retrieves a controlled substance from the automated dispensing cabinet. The system states that there are 25 tablets left and asks the nurse to confirm, but the nurse finds 24 tablets. To rectify the situation the nurse should, Recount, make variance report. Notify nurse manager and pharmacy.
• Per the 2020 National Patient Safety Goals, the nurse takes the steps to administer medications in a facility using barcode scanning with the electronic medication administration record, Scun barcode of the patient, the medication and the compares to MAR

To respond to this medication error

• The nurse might implement the five rights of medication administration, Patient receives prescribed medication, nurse adheres to safety systems, knowledge of medications, routes and effects, Ability to safely administer Vantibiotics, Use active identifiers, medication inspection, and follow rights of medications.