Core Concepts in Pharmacology and Medication Administration NRS
![Core Concepts in Pharmacology and Medication Administration NRS 110. Core Concepts in Pharmacology and Medication Administration NRS 110.](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-1.jpg)
![Introduction to Pharmacology : Classification of Therapeutic Agents • Drugs or Medicines • Biologics Introduction to Pharmacology : Classification of Therapeutic Agents • Drugs or Medicines • Biologics](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-2.jpg)
![Drug Regulations and Standards • Formulary • Pharmacopoeia • U. S. Pharmacopoeia. National Formulary Drug Regulations and Standards • Formulary • Pharmacopoeia • U. S. Pharmacopoeia. National Formulary](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-3.jpg)
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![Stages for Drug Approval • • Preclinical Investigation Clinical Investigation NDA Review Postmarketing Surveillance Stages for Drug Approval • • Preclinical Investigation Clinical Investigation NDA Review Postmarketing Surveillance](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-6.jpg)
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![Pharmacologic Concepts Pharmacologic Concepts](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-8.jpg)
![Drug Names Chemical name • Describes the drug’s chemical composition and molecular structure Generic Drug Names Chemical name • Describes the drug’s chemical composition and molecular structure Generic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-9.jpg)
![Drug Names (cont'd) Chemical name • (+/-)-2 -(p-isobutylphenyl) propionic acid Generic name • ibuprofen Drug Names (cont'd) Chemical name • (+/-)-2 -(p-isobutylphenyl) propionic acid Generic name • ibuprofen](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-10.jpg)
![Pharmacological Concepts: Classification • Classification- Functional/Therapeutic Class vs Chemical/Pharmacologic Class • Medication classification indicates Pharmacological Concepts: Classification • Classification- Functional/Therapeutic Class vs Chemical/Pharmacologic Class • Medication classification indicates](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-11.jpg)
![Pharmacological Concepts: Classification • A medication may also be part of more than one Pharmacological Concepts: Classification • A medication may also be part of more than one](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-12.jpg)
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![Brand-Name vs Generic Drugs • • • Bioavailability Bioequivalent Negative Formulary List Brand-Name vs Generic Drugs • • • Bioavailability Bioequivalent Negative Formulary List](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-16.jpg)
![Controlled Substances • High potential for addiction or abuse • Placed into 5 categories Controlled Substances • High potential for addiction or abuse • Placed into 5 categories](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-17.jpg)
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![Pharmacological Concepts: Medication Forms • Medications are available in a variety of forms and Pharmacological Concepts: Medication Forms • Medications are available in a variety of forms and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-19.jpg)
![Medication Forms • • Tablet Capsule Elixir Sustained Release Enteric-coated Suppository Suspension Transdermal patch Medication Forms • • Tablet Capsule Elixir Sustained Release Enteric-coated Suppository Suspension Transdermal patch](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-20.jpg)
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![Pharmacokinetics • The study of what the body does to the drug – Absorption Pharmacokinetics • The study of what the body does to the drug – Absorption](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-23.jpg)
![Pharmacodynamics • The study of what the drug does to the body – The Pharmacodynamics • The study of what the drug does to the body – The](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-24.jpg)
![Figure 2 -2 Phases of Drug Activity. (From Mc. Kenry LM, Salerno E: Mosby’s Figure 2 -2 Phases of Drug Activity. (From Mc. Kenry LM, Salerno E: Mosby’s](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-25.jpg)
![Pharmacotherapeutics The use of drugs and the clinical indications for drugs to prevent and Pharmacotherapeutics The use of drugs and the clinical indications for drugs to prevent and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-26.jpg)
![Pharmacokinetics: Absorption • The rate at which a drug leaves its site of administration, Pharmacokinetics: Absorption • The rate at which a drug leaves its site of administration,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-27.jpg)
![Factors That Affect Absorption • Administration route of the drug • Ability of Med Factors That Affect Absorption • Administration route of the drug • Ability of Med](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-28.jpg)
![Routes of Administration • A drug’s route of administration affects the rate and extent Routes of Administration • A drug’s route of administration affects the rate and extent](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-29.jpg)
![Enteral Route • Drug is absorbed into the systemic circulation through the oral or Enteral Route • Drug is absorbed into the systemic circulation through the oral or](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-30.jpg)
![First-Pass Effect • The metabolism of a drug and its passage from the liver First-Pass Effect • The metabolism of a drug and its passage from the liver](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-31.jpg)
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![Box 2 -1 Drug Routes and First-Pass Effects Box 2 -1 Drug Routes and First-Pass Effects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-33.jpg)
![Parenteral Route • Intravenous (fastest delivery into the blood circulation) • Intramuscular • Subcutaneous Parenteral Route • Intravenous (fastest delivery into the blood circulation) • Intramuscular • Subcutaneous](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-34.jpg)
![Topical Route • Skin (including transdermal patches) • Eyes • Ears • Nose • Topical Route • Skin (including transdermal patches) • Eyes • Ears • Nose •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-35.jpg)
![Distribution The transport of a drug in the body by the bloodstream to its Distribution The transport of a drug in the body by the bloodstream to its](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-36.jpg)
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![Metabolism (Also Known As Biotransformation) The biologic transformation of a drug into an inactive Metabolism (Also Known As Biotransformation) The biologic transformation of a drug into an inactive](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-38.jpg)
![Metabolism/Biotransformation (cont'd) Delayed drug metabolism results in: • Accumulation of drugs • Prolonged action Metabolism/Biotransformation (cont'd) Delayed drug metabolism results in: • Accumulation of drugs • Prolonged action](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-39.jpg)
![Excretion The elimination of drugs from the body • Kidneys (main organ) • Liver Excretion The elimination of drugs from the body • Kidneys (main organ) • Liver](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-40.jpg)
![• 1. You are caring for a patient who has diabetes complicated by • 1. You are caring for a patient who has diabetes complicated by](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-41.jpg)
![Pharmacodynamics • Study of the mechanism of drug actions in living tissue • Drug-induced Pharmacodynamics • Study of the mechanism of drug actions in living tissue • Drug-induced](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-42.jpg)
![Mechanism of Action • Ways in which a drug can produce a therapeutic effect Mechanism of Action • Ways in which a drug can produce a therapeutic effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-43.jpg)
![Mechanism of Action • Receptor Interaction • Enzyme Interaction • Non-Specific Interaction Mechanism of Action • Receptor Interaction • Enzyme Interaction • Non-Specific Interaction](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-44.jpg)
![Receptor Interaction • Drug structure is essential • Involves the selective joining of drug Receptor Interaction • Drug structure is essential • Involves the selective joining of drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-45.jpg)
![Receptor Interaction • Affinity- degree to which a drug binds with a receptor • Receptor Interaction • Affinity- degree to which a drug binds with a receptor •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-46.jpg)
![Receptor Interaction • Agonist-Drug binds to receptor-there is a response (Adrenergic Agents) • Antagonist-drug Receptor Interaction • Agonist-Drug binds to receptor-there is a response (Adrenergic Agents) • Antagonist-drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-47.jpg)
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![Enzyme Interaction • Enzymes are substances that catalyze nearly every biochemical reaction in a Enzyme Interaction • Enzymes are substances that catalyze nearly every biochemical reaction in a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-49.jpg)
![Non-Specific Interaction • Not involving a receptor site or alteration in enzyme function • Non-Specific Interaction • Not involving a receptor site or alteration in enzyme function •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-50.jpg)
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![The nurse is giving a medication that has a high first-pass effect. The physician The nurse is giving a medication that has a high first-pass effect. The physician](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-52.jpg)
![. A patient is complaining of severe pain and has orders for morphine sulfate. . A patient is complaining of severe pain and has orders for morphine sulfate.](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-53.jpg)
![Type of Medication Action • • Therapeutic Effect Side Effects Adverse Effects Toxic Effect Type of Medication Action • • Therapeutic Effect Side Effects Adverse Effects Toxic Effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-54.jpg)
![Therapeutic Effect • The expected or predictable physiological response a medication causes • A Therapeutic Effect • The expected or predictable physiological response a medication causes • A](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-55.jpg)
![Side Effects • Unintended secondary effects a medication predictably will cause • May be Side Effects • Unintended secondary effects a medication predictably will cause • May be](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-56.jpg)
![Adverse Effects • Undesirable response of a medication • Unexpected effects of drug not Adverse Effects • Undesirable response of a medication • Unexpected effects of drug not](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-57.jpg)
![Adverse Effects • Adverse Drug Events • Adverse Drug Reactions (ADR) Adverse Effects • Adverse Drug Events • Adverse Drug Reactions (ADR)](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-58.jpg)
![Toxic Effect • May develop after prolonged intake or when a med accumulates in Toxic Effect • May develop after prolonged intake or when a med accumulates in](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-59.jpg)
![Idiosyncratic Reactions • Unpredictable effectsoverreacts or under reacts to a medication or has a Idiosyncratic Reactions • Unpredictable effectsoverreacts or under reacts to a medication or has a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-60.jpg)
![Allergic Reaction • Unpredictable response to a medication • Makes up greater than 10% Allergic Reaction • Unpredictable response to a medication • Makes up greater than 10%](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-61.jpg)
![Allergic Reaction • Medication acts as an antigen triggering the release of the body’s Allergic Reaction • Medication acts as an antigen triggering the release of the body’s](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-62.jpg)
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![• 2. A postoperative client is receiving morphine sulfate via a PCA. The • 2. A postoperative client is receiving morphine sulfate via a PCA. The](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-66.jpg)
![Other Drug Reactions • Teratogenic-Structural effect in unborn fetus (thalidomide) • Carcinogenic-Causes cancer • Other Drug Reactions • Teratogenic-Structural effect in unborn fetus (thalidomide) • Carcinogenic-Causes cancer •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-67.jpg)
![Drug Interactions • Occurs when one med modifies the action of another • Common Drug Interactions • Occurs when one med modifies the action of another • Common](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-68.jpg)
![Iatrogenic Responses • Unintentional adverse effects that occur during therapy • Treatment-Induced Dermatologic-rash, hives, Iatrogenic Responses • Unintentional adverse effects that occur during therapy • Treatment-Induced Dermatologic-rash, hives,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-69.jpg)
![Synergistic Effect • Effect of 2 meds combined is greater than the meds given Synergistic Effect • Effect of 2 meds combined is greater than the meds given](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-70.jpg)
![Medication Dose Responses • Except when administered IV, meds take time to enter bloodstream Medication Dose Responses • Except when administered IV, meds take time to enter bloodstream](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-71.jpg)
![Medication Dose Responses • Serum Half-Life: Time it takes for excretion processes to lower Medication Dose Responses • Serum Half-Life: Time it takes for excretion processes to lower](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-72.jpg)
![Half-life • The time it takes for one half of the original amount of Half-life • The time it takes for one half of the original amount of](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-73.jpg)
![Onset, Peak, and Duration Onset • The time it takes for the drug to Onset, Peak, and Duration Onset • The time it takes for the drug to](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-74.jpg)
![Pharmacotherapeutics: Types of Therapies • • Acute therapy Maintenance therapy Supplemental therapy Palliative therapy Pharmacotherapeutics: Types of Therapies • • Acute therapy Maintenance therapy Supplemental therapy Palliative therapy](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-75.jpg)
![Monitoring • The effectiveness of the drug therapy must be evaluated • One must Monitoring • The effectiveness of the drug therapy must be evaluated • One must](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-76.jpg)
![Monitoring (cont'd) • Therapeutic index – The ratio between a drug’s therapeutic benefits and Monitoring (cont'd) • Therapeutic index – The ratio between a drug’s therapeutic benefits and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-77.jpg)
![Monitoring (cont'd) Interactions may occur with other drugs or food • Drug interactions: the Monitoring (cont'd) Interactions may occur with other drugs or food • Drug interactions: the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-78.jpg)
![Monitoring (cont'd) • Drug interactions – Additive effect – Synergistic effect – Antagonistic effect Monitoring (cont'd) • Drug interactions – Additive effect – Synergistic effect – Antagonistic effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-79.jpg)
![Monitoring (cont'd) • Medication misadventures – Adverse drug events – Adverse drug reactions – Monitoring (cont'd) • Medication misadventures – Adverse drug events – Adverse drug reactions –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-80.jpg)
![Monitoring (cont'd) Some adverse drug reactions are classified as side effects • Expected, well-known Monitoring (cont'd) Some adverse drug reactions are classified as side effects • Expected, well-known](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-81.jpg)
![Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-82.jpg)
![Other Drug. Related Effects • • • Teratogenic Mutagenic Carcinogenic Other Drug. Related Effects • • • Teratogenic Mutagenic Carcinogenic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-83.jpg)
![Toxicology The study of poisons and unwanted responses to therapeutic agents Toxicology The study of poisons and unwanted responses to therapeutic agents](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-84.jpg)
![Table 2 -9 Common Poisons and Antidotes Table 2 -9 Common Poisons and Antidotes](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-85.jpg)
![The Nursing Process • • • Assessment Nursing diagnosis Planning (with outcome criteria) • The Nursing Process • • • Assessment Nursing diagnosis Planning (with outcome criteria) •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-86.jpg)
![The Nursing Process (cont'd) Assessment • Data collection – Subjective, objective – Data collected The Nursing Process (cont'd) Assessment • Data collection – Subjective, objective – Data collected](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-87.jpg)
![The “Seven Rights” • • Right drug Right dose Right time Right route Right The “Seven Rights” • • Right drug Right dose Right time Right route Right](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-88.jpg)
![Another “Right”—Constant System Analysis • A “double-check” • The entire “system” of medication administration Another “Right”—Constant System Analysis • A “double-check” • The entire “system” of medication administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-89.jpg)
![Other “Rights” • • • Proper drug storage Proper documentation Accurate dosage calculation • Other “Rights” • • • Proper drug storage Proper documentation Accurate dosage calculation •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-90.jpg)
![Other “Rights” (cont'd) • Close consideration of special situations • Prevention and reporting of Other “Rights” (cont'd) • Close consideration of special situations • Prevention and reporting of](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-91.jpg)
![Evaluation • Ongoing part of the nursing process • Determining the status of the Evaluation • Ongoing part of the nursing process • Determining the status of the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-92.jpg)
![The day shift charge nurse is making rounds. A patient tells the nurse that The day shift charge nurse is making rounds. A patient tells the nurse that](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-93.jpg)
![The patient’s Medication Administration Record lists two antiepileptic medications that are due at 0900, The patient’s Medication Administration Record lists two antiepileptic medications that are due at 0900,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-94.jpg)
![Psychosocial, Gender and Cultural Influences on Pharmacotherapy • Psychosocial Influences • Cultural and Ethnic Psychosocial, Gender and Cultural Influences on Pharmacotherapy • Psychosocial Influences • Cultural and Ethnic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-95.jpg)
![Life Span Considerations Life Span Considerations](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-96.jpg)
![Life Span Considerations • • • Pregnancy Breast-feeding Neonatal Pediatric Geriatric Life Span Considerations • • • Pregnancy Breast-feeding Neonatal Pediatric Geriatric](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-97.jpg)
![Pregnancy • First trimester is the period of greatest danger for drug-induced developmental defects Pregnancy • First trimester is the period of greatest danger for drug-induced developmental defects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-98.jpg)
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![Breast-feeding • Breast-fed infants are at risk for exposure to drugs consumed by the Breast-feeding • Breast-fed infants are at risk for exposure to drugs consumed by the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-100.jpg)
![Pediatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Gastric emptying Pediatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Gastric emptying](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-101.jpg)
![Pediatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW 70% to 80% in fullterm infants, Pediatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW 70% to 80% in fullterm infants,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-102.jpg)
![Pediatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Liver immature, does not produce enough microsomal Pediatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Liver immature, does not produce enough microsomal](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-103.jpg)
![Pediatric Considerations: Pharmacokinetics (cont'd) • Excretion – Kidney immaturity affects glomerular filtration rate and Pediatric Considerations: Pharmacokinetics (cont'd) • Excretion – Kidney immaturity affects glomerular filtration rate and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-104.jpg)
![Summary of Pediatric Considerations • Skin is thin and permeable • Stomach lacks acid Summary of Pediatric Considerations • Skin is thin and permeable • Stomach lacks acid](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-105.jpg)
![Methods of Dosage Calculation for Pediatric Patients • Body weight dosage calculations • Body Methods of Dosage Calculation for Pediatric Patients • Body weight dosage calculations • Body](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-106.jpg)
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![Geriatric Considerations • Geriatric: older than age 65 – Healthy People 2010: older than Geriatric Considerations • Geriatric: older than age 65 – Healthy People 2010: older than](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-108.jpg)
![Table 3 -4 Physiologic changes in the geriatric patient Table 3 -4 Physiologic changes in the geriatric patient](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-109.jpg)
![Geriatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Slowed gastric Geriatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Slowed gastric](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-110.jpg)
![Geriatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW percentages lower – Fat content increased Geriatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW percentages lower – Fat content increased](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-111.jpg)
![Geriatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Aging liver produces less microsomal enzymes, affecting Geriatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Aging liver produces less microsomal enzymes, affecting](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-112.jpg)
![Geriatric Considerations: Pharmacokinetics (cont'd) • Excretion – Decreased glomerular filtration rate – Decreased number Geriatric Considerations: Pharmacokinetics (cont'd) • Excretion – Decreased glomerular filtration rate – Decreased number](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-113.jpg)
![Geriatric Considerations: Problematic Medications • Analgesics • Anticoagulants • Anticholinergics • Antihypertensives • Digoxin Geriatric Considerations: Problematic Medications • Analgesics • Anticoagulants • Anticholinergics • Antihypertensives • Digoxin](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-114.jpg)
![Medication Errors: Preventing and Responding Medication Errors: Preventing and Responding](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-115.jpg)
![Medication Misadventures • Medication errors (MEs) • Adverse drug events (ADEs) • Adverse drug Medication Misadventures • Medication errors (MEs) • Adverse drug events (ADEs) • Adverse drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-116.jpg)
![Medication Misadventures (cont'd) • By definition, all ADRs are also ADEs • But all Medication Misadventures (cont'd) • By definition, all ADRs are also ADEs • But all](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-117.jpg)
![Medication Errors • Preventable • Common cause of adverse health care outcomes • Effects Medication Errors • Preventable • Common cause of adverse health care outcomes • Effects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-118.jpg)
![Box 5 -1 Common classes of medications involved in serious errors Box 5 -1 Common classes of medications involved in serious errors](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-119.jpg)
![• http: //www. usp. org/pdf/ EN/patient. Safety/ismp. A bbreviations. pdf • http: //www. usp. org/pdf/ EN/patient. Safety/ismp. A bbreviations. pdf](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-120.jpg)
![Preventing Medication Errors • Minimize verbal or telephone orders – Repeat order to prescriber Preventing Medication Errors • Minimize verbal or telephone orders – Repeat order to prescriber](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-121.jpg)
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![Preventing Medication Errors (cont'd) • Never assume anything about items not specified in a Preventing Medication Errors (cont'd) • Never assume anything about items not specified in a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-123.jpg)
![Preventing Medication Errors (cont'd) • NEVER use “trailing zeros” with medication orders • Do Preventing Medication Errors (cont'd) • NEVER use “trailing zeros” with medication orders • Do](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-124.jpg)
![Preventing Medication Errors (cont'd) • ALWAYS use a “leading zero” for decimal dosages • Preventing Medication Errors (cont'd) • ALWAYS use a “leading zero” for decimal dosages •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-125.jpg)
![Preventing Medication Errors (cont'd) • Check medication order and what is available while using Preventing Medication Errors (cont'd) • Check medication order and what is available while using](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-126.jpg)
![Preventing Medication Errors (cont'd) • Always listen to and honor any concerns expressed by Preventing Medication Errors (cont'd) • Always listen to and honor any concerns expressed by](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-127.jpg)
![Medication Errors • Possible consequences to nurses • Reporting and responding to MEs – Medication Errors • Possible consequences to nurses • Reporting and responding to MEs –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-128.jpg)
![• 3. Nurses are legally required to document medications that are administered to • 3. Nurses are legally required to document medications that are administered to](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-129.jpg)
![• 4. If a nurse experiences a problem reading a physician’s medication order, • 4. If a nurse experiences a problem reading a physician’s medication order,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-130.jpg)
![Medication Administration Medication Administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-131.jpg)
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![Preparing for Drug Administration • Check the “ 7 rights” • Standard Precautions: Wash Preparing for Drug Administration • Check the “ 7 rights” • Standard Precautions: Wash](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-133.jpg)
![Preparing for Drug Administration (cont'd) • Check expiration dates • Check the patient’s identification Preparing for Drug Administration (cont'd) • Check expiration dates • Check the patient’s identification](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-134.jpg)
![Drug Routes & First Pass Effects • First Pass Routes- Oral, Rectal • Non-First Drug Routes & First Pass Effects • First Pass Routes- Oral, Rectal • Non-First](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-135.jpg)
![Oral Route • Easiest, most commonly used • Slower onset of action • More Oral Route • Easiest, most commonly used • Slower onset of action • More](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-136.jpg)
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![Enteral Drugs • • • Giving oral medications Giving sublingual or buccal medications Liquid Enteral Drugs • • • Giving oral medications Giving sublingual or buccal medications Liquid](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-138.jpg)
![Parenteral Route Injecting a medication into body tissues • Subcutaneous (SQ) • Intramuscular (IM) Parenteral Route Injecting a medication into body tissues • Subcutaneous (SQ) • Intramuscular (IM)](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-139.jpg)
![Parenteral Drugs • Never recap a used needle! • May recap an unused needle Parenteral Drugs • Never recap a used needle! • May recap an unused needle](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-140.jpg)
![Parenteral Drugs (cont'd) • Removing medications from ampules • Removing medications from vials • Parenteral Drugs (cont'd) • Removing medications from ampules • Removing medications from vials •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-141.jpg)
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![Injections • Needle angles for various injections – Intramuscular (IM) – Subcutaneous (SC or Injections • Needle angles for various injections – Intramuscular (IM) – Subcutaneous (SC or](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-146.jpg)
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![Injection Techniques • Intradermal injections • Subcutaneous injections – Insulin administration – Anticoagulant administration Injection Techniques • Intradermal injections • Subcutaneous injections – Insulin administration – Anticoagulant administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-150.jpg)
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![Injection Techniques (cont'd) • Intramuscular injections – Ventrogluteal site (preferred) – Vastus lateralis site Injection Techniques (cont'd) • Intramuscular injections – Ventrogluteal site (preferred) – Vastus lateralis site](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-154.jpg)
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![Preparing Intravenous Medications • • Needleless systems Compatibility issues Expiration dates Mixing intravenous piggyback Preparing Intravenous Medications • • Needleless systems Compatibility issues Expiration dates Mixing intravenous piggyback](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-156.jpg)
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![Intravenous Medications • Adding medications to a primary infusion bag • IVPB medications (secondary Intravenous Medications • Adding medications to a primary infusion bag • IVPB medications (secondary](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-159.jpg)
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![Intravenous Medications (cont'd) • Volume-controlled administration set • Using electronic infusion pumps • Patient-controlled Intravenous Medications (cont'd) • Volume-controlled administration set • Using electronic infusion pumps • Patient-controlled](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-162.jpg)
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![Topical Drugs • Eye medications – Drops – Ointments • Ear drops – Adults Topical Drugs • Eye medications – Drops – Ointments • Ear drops – Adults](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-164.jpg)
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![Topical Drugs (cont'd) • Nasal drugs – Drops – Spray • Inhaled drugs – Topical Drugs (cont'd) • Nasal drugs – Drops – Spray • Inhaled drugs –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-166.jpg)
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![Topical Drugs (cont'd) • Administering medications to the skin – Lotions, creams, ointments, powders Topical Drugs (cont'd) • Administering medications to the skin – Lotions, creams, ointments, powders](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-168.jpg)
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![Pediatric Drug Administration • • • Infancy Toddlers Preschool and School. Age Children • Pediatric Drug Administration • • • Infancy Toddlers Preschool and School. Age Children •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-171.jpg)
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- Slides: 172
![Core Concepts in Pharmacology and Medication Administration NRS 110 Core Concepts in Pharmacology and Medication Administration NRS 110.](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-1.jpg)
Core Concepts in Pharmacology and Medication Administration NRS 110.
![Introduction to Pharmacology Classification of Therapeutic Agents Drugs or Medicines Biologics Introduction to Pharmacology : Classification of Therapeutic Agents • Drugs or Medicines • Biologics](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-2.jpg)
Introduction to Pharmacology : Classification of Therapeutic Agents • Drugs or Medicines • Biologics • Alternative Therapies • Prescription vs Over-the -Counter (OTC) Drugs
![Drug Regulations and Standards Formulary Pharmacopoeia U S Pharmacopoeia National Formulary Drug Regulations and Standards • Formulary • Pharmacopoeia • U. S. Pharmacopoeia. National Formulary](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-3.jpg)
Drug Regulations and Standards • Formulary • Pharmacopoeia • U. S. Pharmacopoeia. National Formulary (USPNF) • Pure Food and Drug Act 1906 • Food, Drug, and Cosmetic Act 1938 • Dietary Supplement Health and education Act (1994) • Food and Drug Administration (1988)
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![Stages for Drug Approval Preclinical Investigation Clinical Investigation NDA Review Postmarketing Surveillance Stages for Drug Approval • • Preclinical Investigation Clinical Investigation NDA Review Postmarketing Surveillance](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-6.jpg)
Stages for Drug Approval • • Preclinical Investigation Clinical Investigation NDA Review Postmarketing Surveillance Studies • Canadian Drug Standards
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![Pharmacologic Concepts Pharmacologic Concepts](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-8.jpg)
Pharmacologic Concepts
![Drug Names Chemical name Describes the drugs chemical composition and molecular structure Generic Drug Names Chemical name • Describes the drug’s chemical composition and molecular structure Generic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-9.jpg)
Drug Names Chemical name • Describes the drug’s chemical composition and molecular structure Generic name (nonproprietary name) • Name given by the United States Adopted Name Council Trade name (proprietary name) • The drug has a registered trademark; use of the name restricted by the drug’s patent owner (usually the manufacturer)
![Drug Names contd Chemical name 2 pisobutylphenyl propionic acid Generic name ibuprofen Drug Names (cont'd) Chemical name • (+/-)-2 -(p-isobutylphenyl) propionic acid Generic name • ibuprofen](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-10.jpg)
Drug Names (cont'd) Chemical name • (+/-)-2 -(p-isobutylphenyl) propionic acid Generic name • ibuprofen Trade name • Motrin®, Advil®
![Pharmacological Concepts Classification Classification FunctionalTherapeutic Class vs ChemicalPharmacologic Class Medication classification indicates Pharmacological Concepts: Classification • Classification- Functional/Therapeutic Class vs Chemical/Pharmacologic Class • Medication classification indicates](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-11.jpg)
Pharmacological Concepts: Classification • Classification- Functional/Therapeutic Class vs Chemical/Pharmacologic Class • Medication classification indicates the effect of the med on the body system, the symptom the med relieves, or the med’s desired effect (e. g. oral hypoglycemics)
![Pharmacological Concepts Classification A medication may also be part of more than one Pharmacological Concepts: Classification • A medication may also be part of more than one](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-12.jpg)
Pharmacological Concepts: Classification • A medication may also be part of more than one class • Aspirin is an analgesic, antipyretic, antiinflammatory, and antiplatelet
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![BrandName vs Generic Drugs Bioavailability Bioequivalent Negative Formulary List Brand-Name vs Generic Drugs • • • Bioavailability Bioequivalent Negative Formulary List](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-16.jpg)
Brand-Name vs Generic Drugs • • • Bioavailability Bioequivalent Negative Formulary List
![Controlled Substances High potential for addiction or abuse Placed into 5 categories Controlled Substances • High potential for addiction or abuse • Placed into 5 categories](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-17.jpg)
Controlled Substances • High potential for addiction or abuse • Placed into 5 categories or schedules (I-V) • Controlled Substance Act of 1970 • Drug Enforcement Administration (DEA)
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![Pharmacological Concepts Medication Forms Medications are available in a variety of forms and Pharmacological Concepts: Medication Forms • Medications are available in a variety of forms and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-19.jpg)
Pharmacological Concepts: Medication Forms • Medications are available in a variety of forms and preparations • The form of the med will determine its route of administration • Composition of med is designed to enhance its absorption & metabolism • Many meds are available in several forms
![Medication Forms Tablet Capsule Elixir Sustained Release Entericcoated Suppository Suspension Transdermal patch Medication Forms • • Tablet Capsule Elixir Sustained Release Enteric-coated Suppository Suspension Transdermal patch](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-20.jpg)
Medication Forms • • Tablet Capsule Elixir Sustained Release Enteric-coated Suppository Suspension Transdermal patch
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![Pharmacokinetics The study of what the body does to the drug Absorption Pharmacokinetics • The study of what the body does to the drug – Absorption](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-23.jpg)
Pharmacokinetics • The study of what the body does to the drug – Absorption – Distribution – Metabolism – Excretion
![Pharmacodynamics The study of what the drug does to the body The Pharmacodynamics • The study of what the drug does to the body – The](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-24.jpg)
Pharmacodynamics • The study of what the drug does to the body – The mechanism of drug actions in living tissues
![Figure 2 2 Phases of Drug Activity From Mc Kenry LM Salerno E Mosbys Figure 2 -2 Phases of Drug Activity. (From Mc. Kenry LM, Salerno E: Mosby’s](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-25.jpg)
Figure 2 -2 Phases of Drug Activity. (From Mc. Kenry LM, Salerno E: Mosby’s pharmacology in nursing—revised and updated, ed 21, St. Louis, 2003, Mosby. )
![Pharmacotherapeutics The use of drugs and the clinical indications for drugs to prevent and Pharmacotherapeutics The use of drugs and the clinical indications for drugs to prevent and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-26.jpg)
Pharmacotherapeutics The use of drugs and the clinical indications for drugs to prevent and treat diseases
![Pharmacokinetics Absorption The rate at which a drug leaves its site of administration Pharmacokinetics: Absorption • The rate at which a drug leaves its site of administration,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-27.jpg)
Pharmacokinetics: Absorption • The rate at which a drug leaves its site of administration, and the extent to which absorption occurs
![Factors That Affect Absorption Administration route of the drug Ability of Med Factors That Affect Absorption • Administration route of the drug • Ability of Med](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-28.jpg)
Factors That Affect Absorption • Administration route of the drug • Ability of Med to Dissolve • Food or other drugs administered with the drug • Body Surface Area • p. H of the absorptive surface • Rate of blood flow to the small intestine • Lipid Solubility of Med
![Routes of Administration A drugs route of administration affects the rate and extent Routes of Administration • A drug’s route of administration affects the rate and extent](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-29.jpg)
Routes of Administration • A drug’s route of administration affects the rate and extent of absorption of that drug – Enteral (GI tract) – Parenteral – Topical
![Enteral Route Drug is absorbed into the systemic circulation through the oral or Enteral Route • Drug is absorbed into the systemic circulation through the oral or](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-30.jpg)
Enteral Route • Drug is absorbed into the systemic circulation through the oral or gastric mucosa, the small intestine, or rectum – Oral – Sublingual – Buccal – Rectal
![FirstPass Effect The metabolism of a drug and its passage from the liver First-Pass Effect • The metabolism of a drug and its passage from the liver](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-31.jpg)
First-Pass Effect • The metabolism of a drug and its passage from the liver into the circulation – A drug given via the oral route may be extensively metabolized by the liver before reaching the systemic circulation (high firstpass effect) – The same drug—given IV— bypasses the liver, preventing the first-pass effect from taking place, and more drug reaches the circulation
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![Box 2 1 Drug Routes and FirstPass Effects Box 2 -1 Drug Routes and First-Pass Effects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-33.jpg)
Box 2 -1 Drug Routes and First-Pass Effects
![Parenteral Route Intravenous fastest delivery into the blood circulation Intramuscular Subcutaneous Parenteral Route • Intravenous (fastest delivery into the blood circulation) • Intramuscular • Subcutaneous](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-34.jpg)
Parenteral Route • Intravenous (fastest delivery into the blood circulation) • Intramuscular • Subcutaneous • Intradermal • Intrathecal • Intraarticular
![Topical Route Skin including transdermal patches Eyes Ears Nose Topical Route • Skin (including transdermal patches) • Eyes • Ears • Nose •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-35.jpg)
Topical Route • Skin (including transdermal patches) • Eyes • Ears • Nose • Lungs (inhalation) • Vagina
![Distribution The transport of a drug in the body by the bloodstream to its Distribution The transport of a drug in the body by the bloodstream to its](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-36.jpg)
Distribution The transport of a drug in the body by the bloodstream to its site of action • Protein-binding • Water soluble vs. fat soluble • Blood-brain barrier • Areas of rapid distribution: heart, liver, kidney, brain • Areas of slow distribution: muscle, skin, fat
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-37.jpg)
![Metabolism Also Known As Biotransformation The biologic transformation of a drug into an inactive Metabolism (Also Known As Biotransformation) The biologic transformation of a drug into an inactive](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-38.jpg)
Metabolism (Also Known As Biotransformation) The biologic transformation of a drug into an inactive metabolite, a more soluble compound, or a more potent metabolite • • • Liver (main organ) Kidneys Lungs Plasma Intestinal mucosa
![MetabolismBiotransformation contd Delayed drug metabolism results in Accumulation of drugs Prolonged action Metabolism/Biotransformation (cont'd) Delayed drug metabolism results in: • Accumulation of drugs • Prolonged action](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-39.jpg)
Metabolism/Biotransformation (cont'd) Delayed drug metabolism results in: • Accumulation of drugs • Prolonged action of the drugs Stimulating drug metabolism causes: • Diminished pharmacologic effects
![Excretion The elimination of drugs from the body Kidneys main organ Liver Excretion The elimination of drugs from the body • Kidneys (main organ) • Liver](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-40.jpg)
Excretion The elimination of drugs from the body • Kidneys (main organ) • Liver • Bowel – Biliary excretion – Enterohepatic circulation
![1 You are caring for a patient who has diabetes complicated by • 1. You are caring for a patient who has diabetes complicated by](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-41.jpg)
• 1. You are caring for a patient who has diabetes complicated by kidney disease. You will need to make a detailed assessment when administering medications because this patient may experience problems with: • A. Absorption • B. Biotransformation • C. Distribution • D. Excretion 35 - 41
![Pharmacodynamics Study of the mechanism of drug actions in living tissue Druginduced Pharmacodynamics • Study of the mechanism of drug actions in living tissue • Drug-induced](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-42.jpg)
Pharmacodynamics • Study of the mechanism of drug actions in living tissue • Drug-induced alterations to normal physiologic function • Positive change. Therapeutic effect-Goal of therapy
![Mechanism of Action Ways in which a drug can produce a therapeutic effect Mechanism of Action • Ways in which a drug can produce a therapeutic effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-43.jpg)
Mechanism of Action • Ways in which a drug can produce a therapeutic effect • The effects that a particular drug has depends on the cells or organ targeted by the drug • Once the drug hits “site of action” it can modify the rate at which a cell or tissue functions
![Mechanism of Action Receptor Interaction Enzyme Interaction NonSpecific Interaction Mechanism of Action • Receptor Interaction • Enzyme Interaction • Non-Specific Interaction](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-44.jpg)
Mechanism of Action • Receptor Interaction • Enzyme Interaction • Non-Specific Interaction
![Receptor Interaction Drug structure is essential Involves the selective joining of drug Receptor Interaction • Drug structure is essential • Involves the selective joining of drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-45.jpg)
Receptor Interaction • Drug structure is essential • Involves the selective joining of drug molecule with a reactive site on the cell surface that elicits a biological effect • Receptor is the reactive site on a cell or tissue • Once the substance binds to and interacts with the receptor, a pharmacologic response is produced
![Receptor Interaction Affinity degree to which a drug binds with a receptor Receptor Interaction • Affinity- degree to which a drug binds with a receptor •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-46.jpg)
Receptor Interaction • Affinity- degree to which a drug binds with a receptor • The drug with the best “fit” or affinity will elicit the best response • Drug can mimic body’s endogenous substances that normally bind to receptor site • Drugs that bind to receptors interact with receptors in different ways to either block or elicit a response
![Receptor Interaction AgonistDrug binds to receptorthere is a response Adrenergic Agents Antagonistdrug Receptor Interaction • Agonist-Drug binds to receptor-there is a response (Adrenergic Agents) • Antagonist-drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-47.jpg)
Receptor Interaction • Agonist-Drug binds to receptor-there is a response (Adrenergic Agents) • Antagonist-drug binds to receptor-no response -prevents binding of agonists (Alpha & Beta Blockers)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-48.jpg)
![Enzyme Interaction Enzymes are substances that catalyze nearly every biochemical reaction in a Enzyme Interaction • Enzymes are substances that catalyze nearly every biochemical reaction in a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-49.jpg)
Enzyme Interaction • Enzymes are substances that catalyze nearly every biochemical reaction in a cell • Drugs can interact with enzyme systems to alter a response • Inhibits action of enzymesenzyme is “fooled” into binding to drug instead of target cell • Protects target cell from enzyme’s action (ACE Inhibitors)
![NonSpecific Interaction Not involving a receptor site or alteration in enzyme function Non-Specific Interaction • Not involving a receptor site or alteration in enzyme function •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-50.jpg)
Non-Specific Interaction • Not involving a receptor site or alteration in enzyme function • Main site of action is cell membrane or cellular process • Drugs will physically interfere or chemically alter cell process • Final product is altered causing defect or cell death • Cancer drugs, Antibiotics
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-51.jpg)
![The nurse is giving a medication that has a high firstpass effect The physician The nurse is giving a medication that has a high first-pass effect. The physician](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-52.jpg)
The nurse is giving a medication that has a high first-pass effect. The physician has changed the route from IV to PO. The nurse expects the oral dose to be: 1. Higher because of the first-pass effect. 2. Lower because of the first-pass effect. 3. The same as the IV dose. 4. Unchanged.
![A patient is complaining of severe pain and has orders for morphine sulfate . A patient is complaining of severe pain and has orders for morphine sulfate.](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-53.jpg)
. A patient is complaining of severe pain and has orders for morphine sulfate. The nurse knows that the route that would give the slowest pain relief would be which route? 1. IV 2. IM 3. SC 4. PO
![Type of Medication Action Therapeutic Effect Side Effects Adverse Effects Toxic Effect Type of Medication Action • • Therapeutic Effect Side Effects Adverse Effects Toxic Effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-54.jpg)
Type of Medication Action • • Therapeutic Effect Side Effects Adverse Effects Toxic Effect Idiosyncratic Reactions Allergic Reaction Medication Interactions Iatrogenic Response
![Therapeutic Effect The expected or predictable physiological response a medication causes A Therapeutic Effect • The expected or predictable physiological response a medication causes • A](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-55.jpg)
Therapeutic Effect • The expected or predictable physiological response a medication causes • A single med can have several therapeutic effects (Aspirin) • It is important for the nurse to know why med is being prescribed
![Side Effects Unintended secondary effects a medication predictably will cause May be Side Effects • Unintended secondary effects a medication predictably will cause • May be](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-56.jpg)
Side Effects • Unintended secondary effects a medication predictably will cause • May be harmless or serious • If side effects are serious enough to negate the beneficial effect of meds therapeutic action, it may be D/C’d • People may stop taking medications because of the side effects
![Adverse Effects Undesirable response of a medication Unexpected effects of drug not Adverse Effects • Undesirable response of a medication • Unexpected effects of drug not](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-57.jpg)
Adverse Effects • Undesirable response of a medication • Unexpected effects of drug not related to therapeutic effect • Must be reported to FDA • Can be a side effect or a harmful effect • Can be categorized as pharmacologic, idiosyncratic, hypersensitivity, or drug interaction
![Adverse Effects Adverse Drug Events Adverse Drug Reactions ADR Adverse Effects • Adverse Drug Events • Adverse Drug Reactions (ADR)](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-58.jpg)
Adverse Effects • Adverse Drug Events • Adverse Drug Reactions (ADR)
![Toxic Effect May develop after prolonged intake or when a med accumulates in Toxic Effect • May develop after prolonged intake or when a med accumulates in](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-59.jpg)
Toxic Effect • May develop after prolonged intake or when a med accumulates in the blood because of impaired metabolism or excretion, or excessive amount taken • Toxic levels of opioids can cause resp. depression • Antidotes available to reverse effects
![Idiosyncratic Reactions Unpredictable effectsoverreacts or under reacts to a medication or has a Idiosyncratic Reactions • Unpredictable effectsoverreacts or under reacts to a medication or has a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-60.jpg)
Idiosyncratic Reactions • Unpredictable effectsoverreacts or under reacts to a medication or has a reaction different from normal • Genetically determined abnormal response • Idiosyncratic drug reactions are usually caused by abnormal levels of drugmetabolizing enzymes (deficiency or overabundance)
![Allergic Reaction Unpredictable response to a medication Makes up greater than 10 Allergic Reaction • Unpredictable response to a medication • Makes up greater than 10%](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-61.jpg)
Allergic Reaction • Unpredictable response to a medication • Makes up greater than 10% of all medication reactions • Client may become sensitized immunologically to the initial dose, repeated administration causes an allergic response to the med, chemical preservative or a metabolite
![Allergic Reaction Medication acts as an antigen triggering the release of the bodys Allergic Reaction • Medication acts as an antigen triggering the release of the body’s](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-62.jpg)
Allergic Reaction • Medication acts as an antigen triggering the release of the body’s antibodies • May be mild or severe • Among the different classes of meds, antibiotics cause the highest incidence of allergic reaction • Severe reaction. Anaphylactic reaction • Mild reaction-hives, rash, pruritis
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-63.jpg)
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![2 A postoperative client is receiving morphine sulfate via a PCA The • 2. A postoperative client is receiving morphine sulfate via a PCA. The](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-66.jpg)
• 2. A postoperative client is receiving morphine sulfate via a PCA. The nurse assesses that the client’s respirations are depressed. The effects of the morphine sulfate can be classified as: • A. Allergic • B. Idiosyncratic • C. Therapeutic • D. Toxic 35 - 66
![Other Drug Reactions TeratogenicStructural effect in unborn fetus thalidomide CarcinogenicCauses cancer Other Drug Reactions • Teratogenic-Structural effect in unborn fetus (thalidomide) • Carcinogenic-Causes cancer •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-67.jpg)
Other Drug Reactions • Teratogenic-Structural effect in unborn fetus (thalidomide) • Carcinogenic-Causes cancer • Mutagenic- Changes genetic composition (radiation, chemicals)
![Drug Interactions Occurs when one med modifies the action of another Common Drug Interactions • Occurs when one med modifies the action of another • Common](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-68.jpg)
Drug Interactions • Occurs when one med modifies the action of another • Common in people taking several medications at once • One med may potentiate or diminish the action of another or alter the way it is absorbed, metabolized or eliminated • Warfarin and Amiodarone
![Iatrogenic Responses Unintentional adverse effects that occur during therapy TreatmentInduced Dermatologicrash hives Iatrogenic Responses • Unintentional adverse effects that occur during therapy • Treatment-Induced Dermatologic-rash, hives,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-69.jpg)
Iatrogenic Responses • Unintentional adverse effects that occur during therapy • Treatment-Induced Dermatologic-rash, hives, acne • Renal Damage. Aminoglycoside antibiotics, NSAIDS, contrast medium • Blood Dyscrasias- Destruction of blood cells (Chemotherapy) • Hepatic Toxicity-Elevated liver enzymes (hepatitis-like symptoms)
![Synergistic Effect Effect of 2 meds combined is greater than the meds given Synergistic Effect • Effect of 2 meds combined is greater than the meds given](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-70.jpg)
Synergistic Effect • Effect of 2 meds combined is greater than the meds given separately • Alcohol & Antihistamines, antidepressants, barbiturates, narcotics • Not always undesirable, physician may combine meds to create an interaction that will have beneficial effects (Vasodilators & diuretics to control high BP)
![Medication Dose Responses Except when administered IV meds take time to enter bloodstream Medication Dose Responses • Except when administered IV, meds take time to enter bloodstream](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-71.jpg)
Medication Dose Responses • Except when administered IV, meds take time to enter bloodstream • The quantity & distribution of med in different body compartments change constantly • Goal is to keep constant blood level within a safe therapeutic range • Repeated doses are required to achieve a constant therapeutic concentration of a med because a portion of med is always being excreted
![Medication Dose Responses Serum HalfLife Time it takes for excretion processes to lower Medication Dose Responses • Serum Half-Life: Time it takes for excretion processes to lower](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-72.jpg)
Medication Dose Responses • Serum Half-Life: Time it takes for excretion processes to lower the serum medication concentration by ½ • Regular fixed doses must be given to maintain therapeutic concentration • Dosage schedules set by institutions (TID, q 8 h, HS, AC, STAT, PRN) • Peak & Trough levels • Therapeutic drug monitoring
![Halflife The time it takes for one half of the original amount of Half-life • The time it takes for one half of the original amount of](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-73.jpg)
Half-life • The time it takes for one half of the original amount of a drug in the body to be removed • A measure of the rate at which drugs are removed from the body
![Onset Peak and Duration Onset The time it takes for the drug to Onset, Peak, and Duration Onset • The time it takes for the drug to](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-74.jpg)
Onset, Peak, and Duration Onset • The time it takes for the drug to elicit a therapeutic response Peak • The time it takes for a drug to reach its maximum therapeutic response Duration • The time a drug concentration is sufficient to elicit a therapeutic response
![Pharmacotherapeutics Types of Therapies Acute therapy Maintenance therapy Supplemental therapy Palliative therapy Pharmacotherapeutics: Types of Therapies • • Acute therapy Maintenance therapy Supplemental therapy Palliative therapy](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-75.jpg)
Pharmacotherapeutics: Types of Therapies • • Acute therapy Maintenance therapy Supplemental therapy Palliative therapy Supportive therapy Prophylactic therapy Empiric
![Monitoring The effectiveness of the drug therapy must be evaluated One must Monitoring • The effectiveness of the drug therapy must be evaluated • One must](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-76.jpg)
Monitoring • The effectiveness of the drug therapy must be evaluated • One must be familiar with the drug’s: – Intended therapeutic action (beneficial) – Unintended but potential side effects (predictable, adverse reactions)
![Monitoring contd Therapeutic index The ratio between a drugs therapeutic benefits and Monitoring (cont'd) • Therapeutic index – The ratio between a drug’s therapeutic benefits and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-77.jpg)
Monitoring (cont'd) • Therapeutic index – The ratio between a drug’s therapeutic benefits and its toxic effects
![Monitoring contd Interactions may occur with other drugs or food Drug interactions the Monitoring (cont'd) Interactions may occur with other drugs or food • Drug interactions: the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-78.jpg)
Monitoring (cont'd) Interactions may occur with other drugs or food • Drug interactions: the alteration of action of a drug by: – Other prescribed drugs – Over-the-counter medications – Herbal therapies
![Monitoring contd Drug interactions Additive effect Synergistic effect Antagonistic effect Monitoring (cont'd) • Drug interactions – Additive effect – Synergistic effect – Antagonistic effect](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-79.jpg)
Monitoring (cont'd) • Drug interactions – Additive effect – Synergistic effect – Antagonistic effect – Incompatibility
![Monitoring contd Medication misadventures Adverse drug events Adverse drug reactions Monitoring (cont'd) • Medication misadventures – Adverse drug events – Adverse drug reactions –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-80.jpg)
Monitoring (cont'd) • Medication misadventures – Adverse drug events – Adverse drug reactions – Medication errors
![Monitoring contd Some adverse drug reactions are classified as side effects Expected wellknown Monitoring (cont'd) Some adverse drug reactions are classified as side effects • Expected, well-known](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-81.jpg)
Monitoring (cont'd) Some adverse drug reactions are classified as side effects • Expected, well-known reactions that result in little or no change in patient management • Predictable frequency • The effect’s intensity and occurrence are related to the size of the dose
![Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-82.jpg)
Adverse Drug Reaction An adverse outcome of drug therapy in which a patient is harmed in some way • • Pharmacologic reactions Idiosyncratic reactions Hypersensitivity reactions Drug interactions
![Other Drug Related Effects Teratogenic Mutagenic Carcinogenic Other Drug. Related Effects • • • Teratogenic Mutagenic Carcinogenic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-83.jpg)
Other Drug. Related Effects • • • Teratogenic Mutagenic Carcinogenic
![Toxicology The study of poisons and unwanted responses to therapeutic agents Toxicology The study of poisons and unwanted responses to therapeutic agents](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-84.jpg)
Toxicology The study of poisons and unwanted responses to therapeutic agents
![Table 2 9 Common Poisons and Antidotes Table 2 -9 Common Poisons and Antidotes](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-85.jpg)
Table 2 -9 Common Poisons and Antidotes
![The Nursing Process Assessment Nursing diagnosis Planning with outcome criteria The Nursing Process • • • Assessment Nursing diagnosis Planning (with outcome criteria) •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-86.jpg)
The Nursing Process • • • Assessment Nursing diagnosis Planning (with outcome criteria) • Implementation • Evaluation
![The Nursing Process contd Assessment Data collection Subjective objective Data collected The Nursing Process (cont'd) Assessment • Data collection – Subjective, objective – Data collected](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-87.jpg)
The Nursing Process (cont'd) Assessment • Data collection – Subjective, objective – Data collected on the patient, drug, environment • • Medication history Nursing assessment Physical assessment Data analysis
![The Seven Rights Right drug Right dose Right time Right route Right The “Seven Rights” • • Right drug Right dose Right time Right route Right](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-88.jpg)
The “Seven Rights” • • Right drug Right dose Right time Right route Right patient Right to refuse Right documentation
![Another RightConstant System Analysis A doublecheck The entire system of medication administration Another “Right”—Constant System Analysis • A “double-check” • The entire “system” of medication administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-89.jpg)
Another “Right”—Constant System Analysis • A “double-check” • The entire “system” of medication administration • Ordering, dispensing, preparing, administering, documenting • Involves the physician, nurse, nursing unit, pharmacy department, and patient education
![Other Rights Proper drug storage Proper documentation Accurate dosage calculation Other “Rights” • • • Proper drug storage Proper documentation Accurate dosage calculation •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-90.jpg)
Other “Rights” • • • Proper drug storage Proper documentation Accurate dosage calculation • Accurate dosage preparation • Careful checking of transcription of orders • Patient safety
![Other Rights contd Close consideration of special situations Prevention and reporting of Other “Rights” (cont'd) • Close consideration of special situations • Prevention and reporting of](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-91.jpg)
Other “Rights” (cont'd) • Close consideration of special situations • Prevention and reporting of medication errors • Patient teaching • Monitoring for therapeutic effects, side effects, toxic effects • Refusal of medication
![Evaluation Ongoing part of the nursing process Determining the status of the Evaluation • Ongoing part of the nursing process • Determining the status of the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-92.jpg)
Evaluation • Ongoing part of the nursing process • Determining the status of the goals and outcomes of care • Monitoring the patient’s response to drug therapy – Expected and unexpected responses
![The day shift charge nurse is making rounds A patient tells the nurse that The day shift charge nurse is making rounds. A patient tells the nurse that](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-93.jpg)
The day shift charge nurse is making rounds. A patient tells the nurse that the night shift nurse never gave him his medication, which was due at 11 PM. What should the nurse do first to determine whether the medication was given? 1. Call the night nurse at home. 2. Check the Medication Administration Record. 3. Call the pharmacy. 4. Review the nurse’s notes.
![The patients Medication Administration Record lists two antiepileptic medications that are due at 0900 The patient’s Medication Administration Record lists two antiepileptic medications that are due at 0900,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-94.jpg)
The patient’s Medication Administration Record lists two antiepileptic medications that are due at 0900, but the patient is NPO for a barium study. The nurse’s coworker suggests giving the medications via IV because the patient is NPO. What should the nurse do? 1. Give the medications PO with a small sip of water. 2. Give the medications via the IV route because the patient is NPO. 3. Hold the medications until after the test is completed. 4. Call the physician to clarify the instructions.
![Psychosocial Gender and Cultural Influences on Pharmacotherapy Psychosocial Influences Cultural and Ethnic Psychosocial, Gender and Cultural Influences on Pharmacotherapy • Psychosocial Influences • Cultural and Ethnic](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-95.jpg)
Psychosocial, Gender and Cultural Influences on Pharmacotherapy • Psychosocial Influences • Cultural and Ethnic Influences • Gender Influences
![Life Span Considerations Life Span Considerations](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-96.jpg)
Life Span Considerations
![Life Span Considerations Pregnancy Breastfeeding Neonatal Pediatric Geriatric Life Span Considerations • • • Pregnancy Breast-feeding Neonatal Pediatric Geriatric](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-97.jpg)
Life Span Considerations • • • Pregnancy Breast-feeding Neonatal Pediatric Geriatric
![Pregnancy First trimester is the period of greatest danger for druginduced developmental defects Pregnancy • First trimester is the period of greatest danger for drug-induced developmental defects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-98.jpg)
Pregnancy • First trimester is the period of greatest danger for drug-induced developmental defects • Drugs diffuse across the placenta • FDA pregnancy safety categories
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-99.jpg)
![Breastfeeding Breastfed infants are at risk for exposure to drugs consumed by the Breast-feeding • Breast-fed infants are at risk for exposure to drugs consumed by the](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-100.jpg)
Breast-feeding • Breast-fed infants are at risk for exposure to drugs consumed by the mother • Consider risk-to-benefit ratio
![Pediatric Considerations Pharmacokinetics Absorption Gastric p H less acidic Gastric emptying Pediatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Gastric emptying](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-101.jpg)
Pediatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Gastric emptying is slowed – Topical absorption faster through the skin – Intramuscular absorption faster and irregular
![Pediatric Considerations Pharmacokinetics contd Distribution TBW 70 to 80 in fullterm infants Pediatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW 70% to 80% in fullterm infants,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-102.jpg)
Pediatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW 70% to 80% in fullterm infants, 85% in premature newborns, 64% in children 1 to 12 years of age – Greater TBW means fat content is lower – Decreased level of protein binding – Immature blood-brain barrier
![Pediatric Considerations Pharmacokinetics contd Metabolism Liver immature does not produce enough microsomal Pediatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Liver immature, does not produce enough microsomal](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-103.jpg)
Pediatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Liver immature, does not produce enough microsomal enzymes – Older children may have increased metabolism, requiring higher doses – Other factors
![Pediatric Considerations Pharmacokinetics contd Excretion Kidney immaturity affects glomerular filtration rate and Pediatric Considerations: Pharmacokinetics (cont'd) • Excretion – Kidney immaturity affects glomerular filtration rate and](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-104.jpg)
Pediatric Considerations: Pharmacokinetics (cont'd) • Excretion – Kidney immaturity affects glomerular filtration rate and tubular secretion – Decreased perfusion rate of the kidneys
![Summary of Pediatric Considerations Skin is thin and permeable Stomach lacks acid Summary of Pediatric Considerations • Skin is thin and permeable • Stomach lacks acid](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-105.jpg)
Summary of Pediatric Considerations • Skin is thin and permeable • Stomach lacks acid to kill bacteria • Lungs lack mucus barriers • Body temperatures poorly regulated and dehydration occurs easily • Liver and kidneys are immature, impairing drug metabolism and excretion
![Methods of Dosage Calculation for Pediatric Patients Body weight dosage calculations Body Methods of Dosage Calculation for Pediatric Patients • Body weight dosage calculations • Body](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-106.jpg)
Methods of Dosage Calculation for Pediatric Patients • Body weight dosage calculations • Body surface area method
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-107.jpg)
![Geriatric Considerations Geriatric older than age 65 Healthy People 2010 older than Geriatric Considerations • Geriatric: older than age 65 – Healthy People 2010: older than](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-108.jpg)
Geriatric Considerations • Geriatric: older than age 65 – Healthy People 2010: older than age 55 • Use of OTC medications • Polypharmacy
![Table 3 4 Physiologic changes in the geriatric patient Table 3 -4 Physiologic changes in the geriatric patient](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-109.jpg)
Table 3 -4 Physiologic changes in the geriatric patient
![Geriatric Considerations Pharmacokinetics Absorption Gastric p H less acidic Slowed gastric Geriatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Slowed gastric](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-110.jpg)
Geriatric Considerations: Pharmacokinetics • Absorption – Gastric p. H less acidic – Slowed gastric emptying – Movement through GI tract slower – Reduced blood flow to the GI tract – Reduced absorptive surface area due to flattened intestinal villi
![Geriatric Considerations Pharmacokinetics contd Distribution TBW percentages lower Fat content increased Geriatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW percentages lower – Fat content increased](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-111.jpg)
Geriatric Considerations: Pharmacokinetics (cont'd) • Distribution – TBW percentages lower – Fat content increased – Decreased production of proteins by the liver, resulting in decreased protein binding of drugs
![Geriatric Considerations Pharmacokinetics contd Metabolism Aging liver produces less microsomal enzymes affecting Geriatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Aging liver produces less microsomal enzymes, affecting](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-112.jpg)
Geriatric Considerations: Pharmacokinetics (cont'd) • Metabolism – Aging liver produces less microsomal enzymes, affecting drug metabolism – Reduced blood flow to the liver
![Geriatric Considerations Pharmacokinetics contd Excretion Decreased glomerular filtration rate Decreased number Geriatric Considerations: Pharmacokinetics (cont'd) • Excretion – Decreased glomerular filtration rate – Decreased number](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-113.jpg)
Geriatric Considerations: Pharmacokinetics (cont'd) • Excretion – Decreased glomerular filtration rate – Decreased number of intact nephrons
![Geriatric Considerations Problematic Medications Analgesics Anticoagulants Anticholinergics Antihypertensives Digoxin Geriatric Considerations: Problematic Medications • Analgesics • Anticoagulants • Anticholinergics • Antihypertensives • Digoxin](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-114.jpg)
Geriatric Considerations: Problematic Medications • Analgesics • Anticoagulants • Anticholinergics • Antihypertensives • Digoxin • Sedatives and hypnotics • Thiazide diuretics
![Medication Errors Preventing and Responding Medication Errors: Preventing and Responding](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-115.jpg)
Medication Errors: Preventing and Responding
![Medication Misadventures Medication errors MEs Adverse drug events ADEs Adverse drug Medication Misadventures • Medication errors (MEs) • Adverse drug events (ADEs) • Adverse drug](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-116.jpg)
Medication Misadventures • Medication errors (MEs) • Adverse drug events (ADEs) • Adverse drug reactions (ADRs)
![Medication Misadventures contd By definition all ADRs are also ADEs But all Medication Misadventures (cont'd) • By definition, all ADRs are also ADEs • But all](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-117.jpg)
Medication Misadventures (cont'd) • By definition, all ADRs are also ADEs • But all ADEs are not ADRs • Two types of ADRs – Allergic reactions – Idiosyncratic reactions
![Medication Errors Preventable Common cause of adverse health care outcomes Effects Medication Errors • Preventable • Common cause of adverse health care outcomes • Effects](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-118.jpg)
Medication Errors • Preventable • Common cause of adverse health care outcomes • Effects can range from no significant effect to directly causing disability or death
![Box 5 1 Common classes of medications involved in serious errors Box 5 -1 Common classes of medications involved in serious errors](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-119.jpg)
Box 5 -1 Common classes of medications involved in serious errors
![http www usp orgpdf ENpatient Safetyismp A bbreviations pdf • http: //www. usp. org/pdf/ EN/patient. Safety/ismp. A bbreviations. pdf](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-120.jpg)
• http: //www. usp. org/pdf/ EN/patient. Safety/ismp. A bbreviations. pdf
![Preventing Medication Errors Minimize verbal or telephone orders Repeat order to prescriber Preventing Medication Errors • Minimize verbal or telephone orders – Repeat order to prescriber](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-121.jpg)
Preventing Medication Errors • Minimize verbal or telephone orders – Repeat order to prescriber – Spell drug name aloud – Speak slowly and clearly • List indication next to each order • Avoid medical shorthand, including abbreviations and acronyms
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-122.jpg)
![Preventing Medication Errors contd Never assume anything about items not specified in a Preventing Medication Errors (cont'd) • Never assume anything about items not specified in a](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-123.jpg)
Preventing Medication Errors (cont'd) • Never assume anything about items not specified in a drug order (i. e. , route) • Do not hesitate to question a medication order for any reason when in doubt • Do not try to decipher illegibly written orders; contact prescriber for clarification
![Preventing Medication Errors contd NEVER use trailing zeros with medication orders Do Preventing Medication Errors (cont'd) • NEVER use “trailing zeros” with medication orders • Do](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-124.jpg)
Preventing Medication Errors (cont'd) • NEVER use “trailing zeros” with medication orders • Do not use 1. 0 mg; use 1 mg • 1. 0 mg could be misread as 10 mg, resulting in a tenfold dose increase
![Preventing Medication Errors contd ALWAYS use a leading zero for decimal dosages Preventing Medication Errors (cont'd) • ALWAYS use a “leading zero” for decimal dosages •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-125.jpg)
Preventing Medication Errors (cont'd) • ALWAYS use a “leading zero” for decimal dosages • Do not use. 25 mg; use 0. 25 mg • . 25 mg may be misread as 25 mg • “. 25” is sometimes called a “naked decimal”
![Preventing Medication Errors contd Check medication order and what is available while using Preventing Medication Errors (cont'd) • Check medication order and what is available while using](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-126.jpg)
Preventing Medication Errors (cont'd) • Check medication order and what is available while using the “ 7 rights” • Take time to learn special administration techniques of certain dosage forms
![Preventing Medication Errors contd Always listen to and honor any concerns expressed by Preventing Medication Errors (cont'd) • Always listen to and honor any concerns expressed by](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-127.jpg)
Preventing Medication Errors (cont'd) • Always listen to and honor any concerns expressed by patients regarding medications • Check patient allergies and identification • Medication Reconciliation
![Medication Errors Possible consequences to nurses Reporting and responding to MEs Medication Errors • Possible consequences to nurses • Reporting and responding to MEs –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-128.jpg)
Medication Errors • Possible consequences to nurses • Reporting and responding to MEs – ADE monitoring programs – USPMERP (United States Pharmacopeia Medication Errors Reporting Program) – Med. Watch, sponsored by the FDA – Institute for Safe Medication Practices (ISMP) • Notification of patient regarding MEs
![3 Nurses are legally required to document medications that are administered to • 3. Nurses are legally required to document medications that are administered to](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-129.jpg)
• 3. Nurses are legally required to document medications that are administered to clients. The nurse is mandated to document: • A. Medication before administering it • B. Medication after administering it • C. Rationale for administering the medication • D. Prescriber’s rationale for prescribing the medication 35 - 129
![4 If a nurse experiences a problem reading a physicians medication order • 4. If a nurse experiences a problem reading a physician’s medication order,](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-130.jpg)
• 4. If a nurse experiences a problem reading a physician’s medication order, the most appropriate action will be to: • A. Call the physician to verify the order. • B. Call the pharmacist to verify the order. • C. Consult with other nursing staff to verify the order. • D. Withhold the medication until the physician makes rounds. 35 - 130
![Medication Administration Medication Administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-131.jpg)
Medication Administration
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-132.jpg)
![Preparing for Drug Administration Check the 7 rights Standard Precautions Wash Preparing for Drug Administration • Check the “ 7 rights” • Standard Precautions: Wash](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-133.jpg)
Preparing for Drug Administration • Check the “ 7 rights” • Standard Precautions: Wash your hands! • Double-check if unsure about anything • Check for drug allergies • Prepare drugs for one patient at a time • Check three times
![Preparing for Drug Administration contd Check expiration dates Check the patients identification Preparing for Drug Administration (cont'd) • Check expiration dates • Check the patient’s identification](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-134.jpg)
Preparing for Drug Administration (cont'd) • Check expiration dates • Check the patient’s identification (2 identifiers) • Give medications on time • Explain medications to the patient • Open the medications at the bedside • Document the medications given before going to the next patient
![Drug Routes First Pass Effects First Pass Routes Oral Rectal NonFirst Drug Routes & First Pass Effects • First Pass Routes- Oral, Rectal • Non-First](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-135.jpg)
Drug Routes & First Pass Effects • First Pass Routes- Oral, Rectal • Non-First Pass Routes- Aural, Buccal, Inhaled, Intraarterial, Intramuscular, Intranasal, Intraocular, Vaginal, Intravenous, Subcutaneous, Sublingual, Transdermal
![Oral Route Easiest most commonly used Slower onset of action More Oral Route • Easiest, most commonly used • Slower onset of action • More](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-136.jpg)
Oral Route • Easiest, most commonly used • Slower onset of action • More prolonged effect • Preferred by clients • Sublingual Administration • Buccal Administration
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-137.jpg)
![Enteral Drugs Giving oral medications Giving sublingual or buccal medications Liquid Enteral Drugs • • • Giving oral medications Giving sublingual or buccal medications Liquid](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-138.jpg)
Enteral Drugs • • • Giving oral medications Giving sublingual or buccal medications Liquid medications Giving oral medications to infants Administering drugs through a nasogastric or gastrostomy tube Rectal administration
![Parenteral Route Injecting a medication into body tissues Subcutaneous SQ Intramuscular IM Parenteral Route Injecting a medication into body tissues • Subcutaneous (SQ) • Intramuscular (IM)](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-139.jpg)
Parenteral Route Injecting a medication into body tissues • Subcutaneous (SQ) • Intramuscular (IM) • Intravenous (IV) • Intradermal (ID) • Advanced techniques
![Parenteral Drugs Never recap a used needle May recap an unused needle Parenteral Drugs • Never recap a used needle! • May recap an unused needle](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-140.jpg)
Parenteral Drugs • Never recap a used needle! • May recap an unused needle with the “scoop method” • Prevention of needlesticks • Filter needles
![Parenteral Drugs contd Removing medications from ampules Removing medications from vials Parenteral Drugs (cont'd) • Removing medications from ampules • Removing medications from vials •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-141.jpg)
Parenteral Drugs (cont'd) • Removing medications from ampules • Removing medications from vials • Disposal of used needles and syringes • Needle Selection
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-142.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-143.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-144.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-145.jpg)
![Injections Needle angles for various injections Intramuscular IM Subcutaneous SC or Injections • Needle angles for various injections – Intramuscular (IM) – Subcutaneous (SC or](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-146.jpg)
Injections • Needle angles for various injections – Intramuscular (IM) – Subcutaneous (SC or SQ) – Intradermal (ID) • Z-track method for IM injections • Air-lock technique
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-147.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-148.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-149.jpg)
![Injection Techniques Intradermal injections Subcutaneous injections Insulin administration Anticoagulant administration Injection Techniques • Intradermal injections • Subcutaneous injections – Insulin administration – Anticoagulant administration](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-150.jpg)
Injection Techniques • Intradermal injections • Subcutaneous injections – Insulin administration – Anticoagulant administration (Heparin/Lovenox)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-151.jpg)
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![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-153.jpg)
![Injection Techniques contd Intramuscular injections Ventrogluteal site preferred Vastus lateralis site Injection Techniques (cont'd) • Intramuscular injections – Ventrogluteal site (preferred) – Vastus lateralis site](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-154.jpg)
Injection Techniques (cont'd) • Intramuscular injections – Ventrogluteal site (preferred) – Vastus lateralis site – Dorsogluteal site – Deltoid site
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-155.jpg)
![Preparing Intravenous Medications Needleless systems Compatibility issues Expiration dates Mixing intravenous piggyback Preparing Intravenous Medications • • Needleless systems Compatibility issues Expiration dates Mixing intravenous piggyback](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-156.jpg)
Preparing Intravenous Medications • • Needleless systems Compatibility issues Expiration dates Mixing intravenous piggyback (IVPB) medications • Labeling intravenous (IV) infusion bags when adding medications
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-157.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-158.jpg)
![Intravenous Medications Adding medications to a primary infusion bag IVPB medications secondary Intravenous Medications • Adding medications to a primary infusion bag • IVPB medications (secondary](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-159.jpg)
Intravenous Medications • Adding medications to a primary infusion bag • IVPB medications (secondary line) • IV push medications (bolus) – Through an IV lock – Through an existing IV infusion
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-160.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-161.jpg)
![Intravenous Medications contd Volumecontrolled administration set Using electronic infusion pumps Patientcontrolled Intravenous Medications (cont'd) • Volume-controlled administration set • Using electronic infusion pumps • Patient-controlled](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-162.jpg)
Intravenous Medications (cont'd) • Volume-controlled administration set • Using electronic infusion pumps • Patient-controlled analgesia (PCA) pumps
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-163.jpg)
![Topical Drugs Eye medications Drops Ointments Ear drops Adults Topical Drugs • Eye medications – Drops – Ointments • Ear drops – Adults](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-164.jpg)
Topical Drugs • Eye medications – Drops – Ointments • Ear drops – Adults – Infant or child younger than 3 years of age
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-165.jpg)
![Topical Drugs contd Nasal drugs Drops Spray Inhaled drugs Topical Drugs (cont'd) • Nasal drugs – Drops – Spray • Inhaled drugs –](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-166.jpg)
Topical Drugs (cont'd) • Nasal drugs – Drops – Spray • Inhaled drugs – Metered-dose inhalers – Small-volume nebulizers
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-167.jpg)
![Topical Drugs contd Administering medications to the skin Lotions creams ointments powders Topical Drugs (cont'd) • Administering medications to the skin – Lotions, creams, ointments, powders](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-168.jpg)
Topical Drugs (cont'd) • Administering medications to the skin – Lotions, creams, ointments, powders – Transdermal patches • Vaginal medications – Creams, foams, gels – Suppositories
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-169.jpg)
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-170.jpg)
![Pediatric Drug Administration Infancy Toddlers Preschool and School Age Children Pediatric Drug Administration • • • Infancy Toddlers Preschool and School. Age Children •](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-171.jpg)
Pediatric Drug Administration • • • Infancy Toddlers Preschool and School. Age Children • Adolescents
![](https://slidetodoc.com/presentation_image_h/ea6978e874444817dd2b62a44e8cc62c/image-172.jpg)
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