Principle of Pharmacology

Medication Management

• Medications on hand must be counted and accounted for daily.
• Off-going shifts should complete a controlled substance count.
• A witness is required when counting and wasting narcotics.

Common Medication Errors & Prevention

• Common medication errors include:
  • Inappropriate prescribing
  • Extra, omitted, or wrong doses
  • Administering to the wrong patient
  • Wrong route or rate
  • Failure to administer within the prescribed time frame
  • Incorrect drug preparation
  • Improper administration technique
  • Expired or deteriorated medication
• If a medication error occurs:
  • Check the patient for adverse effects
  • Advise the nurse manager and physician
  • Document the error in the EMR and quality assurance documentation (incident report)
• Prevention strategies include:
  • Drug Regimen Process: Avoidance of interruption and distractions
  • Series of Checks: By nurse and patient.
  • Reporting Medication Errors
• Never leave prepared medications unattended.

Bar-code Medication System

• Patients have unique identifiers (ID, Stickers)
• Nurses have unique barcodes
• Drugs have unique barcodes that identify:
  • Drug form
  • Dosage
  • National Drug Code (NDC)
• Administering Medication:
  • Scan the patient ID first, then the drug
    • If correct, the system will allow medication administration
    • If incorrect, the system will prevent administration.

Patient Teaching

• Explain the medication and its effects in understandable language before administration.
• Common teaching topics include:
  • Drug name
  • Drug dose
  • Drug action
  • Frequency of administration
  • Storage and preparation (discharge)
• Encourage patients to restate the information to ensure understanding.

Patient Assessment

• Ongoing or after medication administration
• Vital signs and head-to-toe assessment.
• Some medications have special instructions/limitations
• Nursing Diagnoses are developed based on assessment data.
• Patient-centered outcomes are evaluated after implementing a plan of care.

Medicine/Med Identifiers

• Generic vs. Trade
  • Generic: Identifies the drug's active ingredient or chemical name (universally accepted).
  • Trade: Selected by the pharmaceutical company that sells the drug (protected by trademark).
• Form of the Drug: Determines the route of administration
• Slow or Continuous Release:
  • Some tablets are enteric coated (prevent stomach irritation)
• 12 Common Drug Identifiers
  • National Drug Code (NDC)
  • Generic Name
  • Brand Name
  • Drug Dose
  • Warnings
  • Administration
  • Prescription Status
  • Drug Manufacturer
  • Quantity
  • Storage Information
  • Lot Number
  • Expiration Date

Onset, Peak, & Duration

• Onset of Action: Time it takes to reach the minimum effective concentration after drug administration.
• Peak Action: When the drug reaches its highest blood concentration.
• Duration: Length of time the drug has an effect.

Medication Documentation

• Name of medication
• Dosage
• Route and time of administration
• Nurse initials
• Intentional or inadvertently omitted drugs
• Refused drugs
• Medication errors

Factors Affecting Drug Action

• Developmental considerations
• Weight
• Biological sex
• Cultural and genetic factors
• Psychological factors
• Pathology (Presence of disease)
• Environment
• Time of administration

Side Effect vs. Adverse Effect (Interactions)

• Side Effects: Non-therapeutic drug reaction (can be desirable or undesirable).
• Adverse Effects: Unpredictable pharmacological event (considered dangerous).
• Drug Interactions: Patient sensitivity, allergic effect, incorrect dose.

Pharmacokinetics vs. Pharmacodynamics

• Pharmacokinetics: The effect of the body on a drug.

  • Absorption: Transportation of the drug from its site of entry.
    • Influencing Factors: Route of administration, Lipid solubility, pH, Blood flow, Location and condition of administration site, Drug dose.
  • Distribution: Transportation of drug molecules throughout the body.
    • Depends on: Circulation, protein binding capacity, blood-brain barrier.
  • Metabolism: Breakdown of an active drug into an inactivated or new form (primarily by the liver).
  • Excretion: Removal of the drug from the body (primarily by the kidneys). Factors impacting excretion: Impaired renal function, age, disease.

• Pharmacodynamics: How drugs act on specific target cells to alter cellular function.

Drug Orders

• Standing Order (Routine Order): Carried out until canceled.
• PRN (As Needed): Administered when requested by the patient or required by the physician based on specific criteria. (Pain, nausea, sleep medications).
• Stat Order: Immediate, one-time order carried out at once.
• Seven Parts of a Medication Order:
  • Patient Name
  • Date & Time of Order
  • Drug Name
  • Dosage
  • Route of Administration
  • Frequency
  • Signature of Person Writing the Order

9 Rights of Administration

• Right Medication
• Right Patient
• Right Dose
• Right Route
• Right Time
• Right Reason
• Right Assessment
• Right Documentation
• Right Response

Medication Checks

• Three Medication Checks:
  • When the nurse reaches for the unit dose package
  • After retrieval from the drawer and compared with the MAR
  • Before giving the unit dose medication to the patient

Controlled Substances

• Record of narcotics administered should be kept.
• Amount of controlled substances must be accounted for.

Controlled Substances

• Controlled substances must be counted and documented.
• Nurses must check the count of all controlled substances daily.
• A witness, usually another nurse, is required when counting and wasting controlled substances.

Common Medical Errors & Prevention

• Common medical errors include inappropriate prescribing, incorrect dosing, wrong patient or route of administration, missed medication, incorrect drug preparation, improper administration techniques, and expired or deteriorated medication.
• Prevention strategies include the drug regimen process, avoiding interruptions and distractions, performing series of checks (nurse and patient), reporting medication errors, and never leaving prepared drugs unattended.

Bar-Code Medication System

• Patients have unique identifiers (ID, stickers).
• Nurses have unique barcodes that provide access to the medication system (Omnicell, MAR, COW).
• Drugs have unique barcodes that identify the drug form, dosage, and NDC (National Drug Code).
• Nurses scan the patient's ID first, then the drug. If the medication is correct, the system allows administration. If incorrect, the system alerts the nurse and prevents administration.

Patient Teaching

• Before administration, the nurse must describe the medication and its effects in easy-to-understand language.
• Patient teaching includes:
  • Name of the drug
  • Dose of the drug
  • Action of the drug
  • Frequency of administration
  • How to store or prepare the drug for discharge
• The patient should be able to restate the information to demonstrate understanding.

Patient Assessment

• Ongoing assessment is required before and after medication administration.
• Vital signs and a head-to-toe assessment should be performed.
• Certain medications have specific instructions or limitations, for example, medications for blood pressure, heart rate, Lasix, or medications requiring lab testing.

Nursing Diagnosis & Patient-Centered Outcomes

• Nursing diagnoses are created using assessment data.
• Patient-centered outcomes are evaluated after implementing a plan of care.

Medicine/Med Identifiers

• Generic Names:
  • Identifies the drug's active ingredient or chemical name.
  • Universally accepted and not owned by any drug company.
  • Example: acetaminophen
• Trade Names:
  • Brand names selected by the pharmaceutical company selling the drug.
  • Protected by trademark and can have multiple trade names.
  • Example: Benadryl, Tylenol
• Drug Form:
  • Determines the route of administration.
  • Examples: Tablet, injection, transdermal patch, cream.
• Troche:
  • A lozenge or cough drop.
• Slow or Continuous Release:
  • Some tablets are enteric-coated to prevent stomach irritation (Extended Release -> ER).
  • Allows for slow and continuous release in the large intestine.

12 Common Drug Identifiers

• NDC#: National Drug Code number used to identify specific drugs.
• Generic Name
• Brand Name
• Drug Dose: Dose available in the product.
• Warnings: Specific drug warnings.
• Administration: Labels indicating route and dosage.
• Prescription Status: Indicates whether the drug is prescription only.
• Drug Manufacturer: Pharmaceutical house that produces the drug.
• Quantity: Amount of the drug in the package.
• Storage information
• Lot number: Specific drug batch from which the drug was produced (important for recalls).
• Expiration Date: Indicates the date after which the drug is no longer effective.

Onset, Peak, & Duration of Action

• Onset of Action: Time it takes to reach the minimum effective concentration after drug administration.
• Peak Action: Occurs when the drug reaches its highest blood concentration.
• Duration: Length of time the drug maintains its effect.
• Understanding these concepts helps with determining dosage and predicting effects.

Documentation

• The following information must be documented for medications:
  • Name of medication
  • Dosage
  • Route and time of administration
  • Nurse initials
  • Intentionally or inadvertently omitted medications
  • Refused medications
  • Medication errors

Factors Affecting Drug Action

• Developmental Considerations: Age and developmental stage.
• Weight: Body mass affects drug distribution.
• Biological Sex: Hormonal differences can influence drug metabolism and effects.
• Culture & Genetic Factors:
  • Religious restrictions regarding medication use.
  • Genetic predispositions can influence drug responses.
• Psychological Factors: Patient expectations, compliance.
• Pathology: Existing disease processes can affect drug absorption, metabolism, and excretion.
• Environment: Sensory deprivation or overload, oxygen deprivation, nutrition.
• Time of Administration: Food can delay or enhance absorption and affect irritation.

Side Effect vs. Adverse Effect (Interactions)

• Side Effects: Non-therapeutic reaction to a drug, can be desirable or undesirable.
  • Example: Percocet causing drowsiness.
• Adverse Effects: Unexpected, dangerous, and unpredictable pharmacological event.
  • Occur less frequently than side effects.
• Drug Interactions:
  • Patient sensitivity to the drug.
  • Drug causing an unexpected response.
  • Patient taking too much or too little of the drug.
  • Hypersensitivity or allergic reaction.

Pharmacokinetics vs. Pharmacodynamics

• Pharmacokinetics: How the body affects a drug.

  • Absorption: The process of transferring a drug from its site of entry into the bloodstream.
    • Influencing Factors:
      • Route of administration
      • Lipid solubility
      • pH
      • Blood flow
      • Condition of the site of administration
      • Drug dose
  • Distribution: Drug molecules are transported throughout the body after entering the bloodstream.
    • Factors:
      • Blood circulation
      • Protein-binding capacity
      • Selectively permeable blood-brain barrier
  • Metabolism: The change of an active drug from its original form to an inactivated or new form.
    • Primary Source: Liver
    • Other Roles: Gastrointestinal tract, lungs, kidneys
  • Excretion: Removing drug from the body.
    • Primary Route: Kidneys
    • Other Routes: Lungs for gaseous substances
    • Factors Affecting Excretion:
      • Impaired renal function
      • Aging
      • Diseases

• Pharmacodynamics: How drugs act on specific target cells to create a change in cellular function.

Drug Orders

• Standing Order (a.k.a. Routine Order):
  • Carried out until canceled by another order.
  • Includes specific instructions or limitations.
• PRN Order (As Needed):
  • Given when requested by the patient or required by the physician, meeting the specific order criteria.
  • May include clinical parameters or timing between doses.
    • Example: Every 4 hours if the patient's pain level is between 5-7 (usually for pain, nausea, or sleep medications).
• Stat Order: Immediate order, carried out at once. A one-time order.

Seven Parts of a Medication Order

• Patient Name
• Date and time the order was written
• Name of drug to be administered
• Dosage of the drug
• Route of administration
• Frequency of administration
• Signature of the person writing the order

Nine Rights of Medication Administration

• Right Medication
• Right Patient
• Right Dose
• Right Route
• Right Time
• Right Reason
• Right Assessment
• Right Documentation
• Right Response

Med Checks

• Three med checks:
  • When reaching for the unit-dose package
  • After retrieving the package from the drawer
  • Before giving the medication to the patient

Controlled Substances

• Records should be kept for each narcotic administered to the patient.
• The amount of a controlled substance on hand must be accounted for.