Pharmacology Past Paper PDF

10 rights of patients The nurse makes the judgment, based on patient assessment, as 10 when such a 1. Right Drugs medic...

10 rights of patients The nurse makes the judgment, based on patient assessment, as 10 when such a 1. Right Drugs medication is to be administered. 2. “ Patient 3. “ Dose 4. “ Route Routine orders 5. “ Time 6. “ History of Patient Orders not written as STAT, ASAP, NOW, or 7. “ Documentation PRN. 8. “ To refuse medication 9. “ Interaction (Drug to drug) These are usually carried out within 2 hours 10. “ Information (Drug to food) of the time the order is written by the physician Standing order STAT order It is written in advance of a situation that is to It refers to any medication that is needed be carried out under specific circumstances. immediately and is to be given only once. An example of a standing order is a set of It is often associated with emergency postoperative PRN prescriptions that are medications that are needed for written for all patients who have undergone a life-threatening situations. specific surgical procedure. The term STAT comes from statim, the latin A common standing order for patients who word meaning immediately. have had a tonsillectomy is a Tylenol elixir 325 mg PO every 6 hours PRN sore throat. The physician normally notifies the nurse of any STAT order so it can be obtained from the NOTES pharmacy and administered immediately. Agency policies dictate that drug orders be The time between writing the order and reviewed by the attending physician within administering the drug should be 5 minutes or specific time frames, usually at least every 7 less. days. ASAP order Prescriptions for narcotics and other scheduled drugs are often automatically discontinued ASAP order (as soon as possible) should be after 72 hours, unless specifically reordered by available for administration to the patient the physician. within 30 minutes of the written order. Automatic stop order, do not generally apply Not as urgent as STAT order when the number of doses or an exact period of time is specified. Single order It is for a drug that is to be given only once, and at a specific time, such as a preoperative order. PRN (pro re nata)order It is administered as required by the patient's condition. ENTERAL ROUTE teeth. It includes drugs given orally and those The strongly acidic contents within the administered through nasogastric or stomach can present a destructive obstacle to gastrostomy tubes. the absorption of some medications. Oral drug administration is the most common, To overcome this barrier, tablets may have a most convenient, and usually the least costly of hard, waxy coating that enables them to resist all routes. the acidity. It is also considered the safest route because These enteric-coated tablets are designed to the skin barrier is not compromised. dissolve in the alkaline environment of the small intestine. In cases of overdose, medications remaining in the stomach can be retrieved by inducing It is important that the nurse not crush vomiting. Oral preparations are available in enteric-coated tablets because the medication tablet, capsule, and liquid forms. would then be directly exposed to the stomach environment. Medications administered by the enteral route take advantage of the vast absorptive surfaces Sustained-release tablets or capsules are of the oral mucosa, stomach, or small intestine designed to dissolve very slowly. This releases the medication over an extended time and results in a longer duration of action TABLETS AND CAPSULES for the medication. Tablets and capsules are the most common Also called extended-release (XR), forms of drugs. long-acting (LA), or slow-release (SR) medications, these forms allow for the Patients prefer tablets or capsules over other convenience of once- or twice-a-day dosing. routes and forms because of their ease for use Extended-release medications must not be crushed or opened. Some patients, particularly children, have difficulty swallowing tablets and capsules. Crushing tablets or opening capsules and sprinkling the drug over food or mixing it with juice will make it more palatable and easier to swallow. The nurse should not crush tablets or open capsules unless the manufacturer specifically states this is permissible. Some drugs are inactivated by crushing or opening. > Giving medications by the oral route has certain disadvantages. Others severely irritate the stomach mucosa and cause nausea or vomiting. The patient must be conscious and able to swallow properly. Occasionally, drugs should not be crushed because they irritate the oral mucosa, are Certain types of drugs, including proteins, are extremely bitter, or contain dyes that stain the inactivated by digestive enzymes in the  stomach and small intestine. dissolved. Medications absorbed from the stomach and The sublingual mucosa is not suitable for small intestine first travel to the liver, where extended-release formulations because it is a they may be inactivated before they ever reach relatively small area and is constantly being their target organs.(first pass). bathed by a substantial amount of saliva. TABLETS To administer by the buccal route The tablet or capsule is placed in the oral KEYNOTE cavity between the gum and the cheek. For sublingual and buccal administration, The patient must be instructed not to the tablet is not swallowed but kept in the manipulate the medication with the tongue; mouth. otherwise, it could get displaced to the sublingual area, where it would be more rapidly The mucosa of the oral cavity contains a rich absorbed, or to the back of the throat, where it blood supply that provides an excellent could be swallowed. absorptive surface for certain drugs. The buccal mucosa is less permeable to Medications given by this route are not most medications than the sublingual area, subjected to destructive digestive enzymes, providing for slower absorption. nor do they undergo hepatic first-pass metabolism. The buccal route is preferred over the sublingual route for sustained- release delivery because of the greater mucosal surface area of the former. Drugs formulated for buccal administration generally do not cause irritation and are small enough to not cause discomfort to the patient. As with the sublingual route, drugs For the sublingual route administered by the buccal route avoid first-pass metabolism by the liver and the The medication is placed under the tongue and enzymatic processes of the stomach and small allowed to dissolve slowly. Because of the intestine. rich blood supply in this region, the sublingual route results in a rapid onset of action. NASOGASTRIC AND GASTROSTOMY DRUG ADMINISTRATION Sublingual dosage forms are most often formulated as rapidly disintegrating tablets or Patients with a nasogastric tube or enteral as soft gelatin capsules filled with liquid drugs feeding mechanism such as a gastrostomy. tube may have their medications administered When multiple drugs have been ordered, the through these devices. sublingual preparations should be administered after oral medications have A nasogastric (NG) tube is a soft, flexible been swallowed. tube inserted by way of the nasopharynx: with the tip lying in the stomach. The patient should be instructed not to move the drug with the tongue, nor to eat or drink anything until the medication has completely  A gastrostomy (G) tube is surgically placed For example, antibiotics may be applied to the directly into the patient's stomach. skin to treat skin infections. Generally, the NG tube is used for short-term Antineoplastic agents may be instilled into the treatment, whereas the G tube is inserted for urinary bladder via catheter to treat tumors of patients requiring long- term care. the bladder mucosa. Drugs administered through these tubes are Corticosteroids are sprayed into the nostrils to usually in liquid form. reduce inflammation of the nasal mucosa due to allergic rhinitis. Although solid drugs can be crushed or dissolved, titers tend to cause clogging within Local, topical delivery produces fewer side the tubes. effects compared with oral or parenteral administration of the same drug. This is Sustained-release drugs should not be because topically applied drugs are absorbed crushed and administered through NG or G very slowly, and amounts reaching the general tubes. circulation are minimal. Drugs administered by this route are exposed Some drugs are given topically 10 to provide to the same physiologic processes as those for slow release and absorption of the drug in given orally. the general circulation. TOPICAL ROUTE These agents are administered for their systemic effects. Topical drugs are those applied locally to the skin or the membranous linings of the eye, ear, - For example, a nitroglycerin patch is applied nose, respiratory tract, urinary tract, vagina, to the skin not to treat a local skin condition but and rectum. These applications include the to treat a systemic condition, coronary artery following; disease. Dermatologic preparations: Drugs applied to Likewise, prochlorperazine (Compazine) the skin, the topical route most commonly suppositories are inserted rectally not to treat a used. Formulations include creams, lotions, disease of the rectum but to alleviate nausea. gels, powders, and sprays. The distinction between topical drugs given for Instillations and irrigations: Drugs applied local effects and those given for systemic into body cavities or orifices. These include the effects is an important one for the nurse. eyes, ears, nose, urinary bladder, rectum, and vagina. In the case of local drugs, absorption is undesirable and may cause side effects. Inhalations: Drugs applied to the respiratory tract by inhalers, nebulizers, or For systemic drugs, absorption is essential for positive-pressure breathing apparatuses. The the therapeutic action of the drug. most common indication for inhaled drugs is bronchoconstriction due to bronchitis or With either type of topical agent, drugs should asthma; however, a number of illegal, abused not be applied to abraded or denuded skin, drugs are taken by this route because it unless directed to do so. provides a very rapid onset of drug action TRANSDERMAL DELIVERY SYSTEM KEYNOTES The use of transdermal patches provides an Many drugs are applied topically to produce a local effective means of delivering certain effect.  medications. Although the nasal mucosa provides an excellent surface for drug delivery, there is the Examples include nitroglycerin for angina potential for damage to the cilia within the pectoris and scopolamine (Transderm-Scop) nasal cavity, and mucosal irritation is common. for motion sickness. In addition, unpredictable mucus secretion Although transdermal patches contain a among some individuals may affect drug specific amount of drug, the rate of delivery absorption from this site. and the actual dose received may be variable. Drops or sprays are often used for their OPHTHALMIC ADMINISTRATION local astringent effect; that is, they shrink swollen mucous membranes or loosen The ophthalmic route is used to treat local secretions and facilitate drainage. This brings conditions of the eye and surrounding immediate relief from the nasal congestion structures. caused by the common cold. Common indications include excessive dryness, infections, glaucoma, and dilation of The nose also provides the route to reach the the pupil during eye examination. nasal sinuses and the eustachian tube. Proper Ophthalmic drugs are available in the form of positioning of the patient prior to instilling nose eye irrigation, drops, ointments, and medicated drops for sinus disorders depends on which disks sinuses are being treated. The same holds true for treatment of the eustachian tube. OTIC ADMINISTRATION VAGINAL ADMINISTRATION The otic route is used to treat local conditions of the ear, including infections and soft The vaginal route is used to deliver blockages of the auditory canal. medications for treating local infections and to Otic medications include eardrops and relieve vaginal pain and itching. irrigations, which are usually ordered for cleaning purposes. Vaginal medications are inserted as Administration to infants and young children suppositories, creams, jellies, or foams. must be performed carefully to avoid injury to sensitive structures of the ear. It is important that the nurse explain the purpose of treatment and provide for privacy NASAL ADMINISTRATION and patient dignity. The nasal route is used for both local and Before inserting vaginal drugs, the nurse systemic drug administration. should instruct the patient to empty her bladder, to lessen both the discomfort during The nasal mucosa provides an excellent treatment and the possibility of irritating or absorptive surface for certain medications. injuring the vaginal lining. Advantages of this route include ease of use The patient should be offered a perineal pad and avoidance of the first -pass effect and following administration. digestive enzymes. RECTAL ADMINISTRATION Nasal spray formulations of corticosteroids have revolutionized the treatment of allergic The rectal route may be used for either local rhinitis owing to their high safety margin when or systemic drug administration. administered by this route. It is a safe and effective means of delivering drugs to patients who are comatose or who are  experiencing nausea and vomiting. The nurse is expected to identify and use appropriate materials for parenteral drug Rectal drugs are normally in suppository form, delivery, including specialized equipment and although a few laxatives and diagnostic agents techniques involved in the preparation and are given via enema. administration of injectable products. The nurse must know the correct anatomical locations for parenteral administration, and safety procedures regarding hazardous equipment disposal. INTRADERMAL AND SUBCUTANEOUS ADMINISTRATION Injection into the skin delivers drugs to the blood vessels that supply the various layers of the skin. Drugs may be injected either intradermally or subcutaneously. The major difference between these methods is the depth of injection. An advantage of both methods is that they offer a means of administering drugs to patients who are unable to take them orally. - Drugs administered by these routes avoid the hepatic first-pass effect and digestive enzymes. Disadvantages are that only small volumes can KEYNOTES be administered, and injections can cause pain and swelling at the injection site. Parenteral administration refers to the dispensing of medications by routes other than An intradermal ([D) injection is administered oral or topical. into the dermis layer of the skin. Because the dermis contains more blood vessels than the The parenteral route delivers drugs via needle deeper subcutaneous layer, drugs are more into the skin layers, subcutaneous tissue, easily absorbed. muscles, or veins. Intradermal injection is usually employed for More advanced parenteral delivery includes allergy and disease screening or local administration into arteries, body cavities(such anesthetic delivery prior to venous cannulation. as intrathecal), and organs (such as intracardiac). - Intradermal injections are limited to very small volumes of drug. usually only 0.1 to 0.2 mL. Parenteral drug administration is much more invasive than topical or enteral. Because of the The usual sites for ID injections are the potential for introducing pathogenic microbes non-hairy skin surfaces of the upper back, over directly into the blood or body tissues. Aseptic the scapulae, the high upper chest, and the technique must be strictly applied. inner forearm.  A subcutaneous injection is delivered to the recommended. deepest layers of the For example, long-acting insulins should not be Insulin, heparin, vitamins, some vaccines, given IV; therefore, aspiration is justified. and other medications are given in this area Heparin, on the other hand, can be safely because the sites are easily accessible and administered IV, and so aspiration is not provide rapid absorption. required. Body sites that are ideal for subcutaneous Note that tuberculin syringes and insulin injections include the following: syringes are not interchangeable, so the nurse should not substitute one for the other Outer aspect of the upper arms, in the area above the triceps muscle INTRAMUSCULAR ADMINISTRATION Middle two thirds of the anterior thigh area An intramuscular (IM) injection delivers medication into specific muscles. Subscapular areas of the upper back Because muscle tissue has a rich blood supply, Upper dorsogluteal and ventrogluteal areas. medication moves quickly into blood vessels to produce a more rapid onset of action than with Abdominal areas, above the iliac crest and oral, ID, or subcutaneous administration. below the diaphragm, 1.5 to 1 inches out from the umbilicus The anatomical structure of muscle permits this tissue to receive a larger volume of KEYNOTES medication than the subcutaneous region. Subcutaneous doses are small in volume, An adult with well-developed muscles can usually ranging from 0.5 to 1 mL. The needle safely tolerate up to 3 mL of medication in a size varies with the patient's quantity of body large muscle, although only 1 mL is fat. recommended. The deltoid and triceps - The length is usually half the size of a muscles should receive a maximum of 1 mL. pinched/bunched skinfold that can be grasped between the thumb and forefinger. A major consideration for the nurse regarding 1M drug administration is the selection of an It is important to rotate injection sites in an appropriate injection site. orderly and documented manner to promote absorption, minimize tissue damage, and Injection sites must be located away from alleviate discomfort. bone, large blood vessels and nerves. For insulin, however, rotation should be within The size and length of needle are determined an anatomical area to promote reliable by body size and muscle mass, the type of absorption and maintain consistent blood drug to be administered, the amount of glucose levels. When performing adipose tissue overlying the muscle, and the subcutaneous injections, it is usually not age of the patient. necessary to aspirate prior to the injection. It depends upon what is being injected, and the patient's anatomy. Ventrogluteal site: Aspiration might prevent inadvertent administration into a vein or artery in a thin This is the preferred site for IM injections. person. If the medication should not be administered directly into a vessel, aspiration is  INTRAVENOUS ADMINISTRATION Intravenous (IV) medications and fluids are administered directly into the bloodstream and are immediately avaiLable for use by the body. The IV route is used when a very rapid onset of olfaction is desired. So with other parenteral routes, IV medications bypass the enzymatic process of the digestive system and the first-pass effect of the liver. This area provides the greatest thickness of gluteal muscles, contains no large blood vessels or nerves, is sealed off by bone, and contains less fat than the buttock area, thus eliminating the need to determine the depth of subcutaneous fat. It is a suitable site for children and infants over 7 months of age. Deltoid site: This site is used in well-developed teens and adults for volumes of medication not to exceed 1 mL. Because the radial nerve lies in close proximity, the deltoid is not generally used, except for small-volume vaccines, such as for hepatitis B in adults. Dorsogluteal site: This site is used for adults and for children who have been walking for at least 6 months. The site is safe if the nurse appropriately locates the injection landmarks to avoid puncture or irritation of the sciatic nerve and blood vessels. Vastus lateralis site: The vastus lateralis is usually thick and well developed in both adults and children. The middle third of the muscle is the site for IM injections.