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Nurse 177
Oral, Topical, Mucosal Med
| Question | Answer |
|---|---|
| sublingual route | under the tongue |
| buccal route | between cheek and gum |
| oral route | meds taken through the mouth or oral mucous membrane |
| Referred to as "by mouth" or PO | oral route |
| this route enters bloodstream directly through oral mucosa | oral route |
| this med is broken down by the digestive system and absorbed into the bloodstream | tablet and caplets |
| tablet | made of powdered ingredients compressed into various sizes and shapes |
| caplets | oblong in shape and easier for some to swallow |
| chewing | breaks down med for increased activity in stomach (antacids) |
| enteric-coated | tablets contain an outer coating that does not dissolve until the medication reaches the intestines |
| sustained- release | controlled-release, delayed-release, extended-release, modified-release tablets designed to slow absorption of drug |
| T/F You can crush and mix a sustained-release tablet | FALSE |
| What happens when an enteric-coated tablet is crushed? | cause patient to receive all of drug at one time = adverse effects |
| What happens when a sustained-release tablet is crushed? | cause med to be absorbed in stomach rather than intestine= gastric irritation |
| What happens when buccal tablets are dissolved? | absorbed through the walls of numerous blood vessels in inner cheek |
| Oral disintegrating tablet (ODT) | drug form that dissolves on top of the tongue (provider/ or over the counter) |
| How long should a patient wait to eat or drink after taking a ODT med? | 5 minutes to ensure absorption |
| How should a patient take a ODT? | should not be chewed or swallowed whole; allow to melt on top of tongue |
| capsule | gelatin shell containing a powder or pellets of medication |
| Which medication may be easier to swallow? | capsule |
| You should never put what in ice cream? | crushed tablets or opened capsules |
| Can all capsules be opened and administered? | No |
| Can not be crushed | buccal or sublingual tablets, effervescent tablets, enter-coated, liquid-filled gel caps, medications that may taste too bitter to swallow, mucous membrane irritants, neoplastic agents, orally disintegrating med, sustained-release tablet |
| liquid oral dosage | syrups, elixirs, solutions, and suspensions |
| Who are more likely prescribed liquid meds? | patients who can not swallow solid forms and or with nasogastric or PEG tubes |
| T/F Always shake a suspension before administering it to mix the drug with the liquid? | True |
| What can happen if a liquid med is not mixed properly? | ineffective medication action when doses are poured from top of bottle and an overdose of med when dose are poured from bottom of bottle |
| meniscus | slightly lowered in the middle curved up on sides |
| What level do you read a meniscus? | lowest level |
| unit dose system | liquid meds are packaged in a single dose |
| Should kitchen measurement spoons be used to administer meds to children? | No, they are not uniform in size to syringe, or mL and oz. may be confused |
| Elixir | may contain sweeteners or flavorings, water and alcohol |
| Who should avoid elixirs? | patient with history of alcohol abuse or receiving disulfiram(Antabuse) |
| solution | liquid containing dissolved substance |
| suspension | contains fine particles of mixed meds but not dissolved in a liquid; settlement when rested |
| syrup | concentrated aqueous prep of sugars, w/without flavoring, and medicinal substances |
| When should a straw be used when administering liquid meds? | when using a staining med such as iron preparations, drink full glass of water after |
| Joe has been vomiting for the last 3 hours. His upcoming meds are to be distributed within the next 30 minutes. What should you do? | withhold the medication and notify health-care provider |
| narcotic | made with opium and opium derivatives that control and relieve pain |
| How are narcotics regulated? | by law according to schedules |
| When should you use your nursing judgement when administering narcotics? | prescriber prescribes strong and less potent for pain; assess patient pain level at that time |
| How does a patient save narcotics to attempt suicide? | "cheek" narcotics, save for later and take all at one time |
| Common time to check narcotics | shift change |
| What do you do with a partial narcotic dose? | discard unused and record waste according to facility policies |
| How many mL's are mixed with meds that are administered in a feeding tube? | 20mL |
| Certain capsules that are mixed with juice during tube administration go through what? | large-bore tube |
| Mix omeprazole (Prilosec) and lansoprazole (Prevacid) with and flush tube with? | apple or orange juice; |
| Flush feeding tube with 30 to 60 mL water when | BEFORE meds |
| Flush feeding tube with 20 to 30 mL water when | AFTER meds |
| Meds dissolve best in what kind of water? | room temp or slightly warm |
| How should you administer multiple meds through tube? | one at a time/ DO NOT MIX |
| When administering multiple meds through tube, when should you flush? | between each med with 20 to 30 mL of water |
| When should you resume suction with nasogastric tube with gastric decompression? | in 30 mins to prevent detention, nausea and vomiting from occurring due tube being clamped to long |
| common meds and enteral formula interactions | phenytoin (Dilantin) suspension, carbamazepine (tegretol) suspension, warfarin (coumadin), fluoroquinolones, proton pump inhibitors |
| Meds that cause clumping administered enteral feeding formulas | brompheniramine (Dimetapp), ferrous sulfate (feosol elixir), guaifenesin (robitussin), litium cirate (cibalith-S) monobasic sodium phosphate (fleet phospho-soda), potassium chloride liquid, pseudoephedrine hydrochloride (Sudafed syrup) |
| what are older patients more at risk for? | side effects and med interactions |
| what are children more at risk for? | more resistant to swallowing meds |
| topical route | applying drug to the skin or mucous membranes |
| other topical routes | vagina, anus, eyes, ears |
| what to consider when administering drugs to older adults | difficulty swallowing, metabolism of meds, multiple meds, adverse drug reactions |
| how to improve infant/children med administeration | administration devices, small doses, mask objectionable taste when possible |
| typically are viscous (thick) emulsions, with some emollient (moisturizing) ability. Creams are commonly used for topical steroids and in medications to relieve itching. | topical creams |
| are not as thick as creams. They usually are clear but may contain coloring. Phenergan gel is applied to the inner wrists to help relieve nausea. | topical gels |
| like creams, are emulsions, but are less viscous and moisturizing. Some may be drying, such as calamine lotion for poison ivy. | topical lotions |
| like creams, are highly viscous and have an emollient base. They often are dispensed in tubes. Ointments are used for antibiotic and steroid topical medications. | topical ointments |
| what should be used to apply topical meds? | cotton-tipped swab or tongue depressor |
| how do you prevent contaminations with topical meds? | avoid touching opening of tube or dispenser to patient's skin and wear gloves |
| Why cant all topical meds be covered with dressing? | can alter absorption of drug |
| transdermal route | applying drug to the skin using patch |
| How does transdermal route of meds work? | absorbed through the bloodstream for systemic effect, delivers slow constant dose |
| What should be done before applying patch to patient? | Nurse should write date, time of application and initials on patch |
| Can a patch be placed in the same place as the patch being removed? | NO |
| Why would you choose the upper arm or lower abdomen to apply patch? | least amount of hair present |
| Can you cut to fit a patch? | NO |
| mucosal route | drugs absorbed through mucous membranes in eyes, nose, rectum, vagina, and inhaled into lungs |
| What is the most common mucosal route? | mouth |
| eye meds distribution | place in middle part of the lower conjunctival sac |
| ear med administration | patient lying on side, 3yr-older pull pinna up and back, 3yr and under pinna down and back |
| T/F DO NOT administer eardrops to patients with damage to the tympanic membrane? | TRUE |
| What is important to know about irrigation of ears and eyes? | contraindicated for removal of foreign body that could absorb fluid and enlarge |
| nasal meds | reduce inflammation, facilitate drainage, treat infections in nasal cavity |
| What is not recommended with use of nasal sprays | use more than 3 days |
| How do you administer nasal spray? | head flexed forward, spray enters sinuses and does not go down throat |
| vaginal route | suppositories, creams, aerosol foams, tablets that are inserted into the vagina and dissolve there |
| rectal route | inserted directly and may be ordered when nausea or vomiting is present or meds can not be PO |
| respiratory route | dispersed in fine droplets and inhaled into the lungs and bronchial airways |
| When do you avoid using rectal route? | when a patient has cardiac dysrhythmia or had a recent myocardial infarction; may stimulate vagus nerve and trigger |
| metered-dose inhalers | pressurized med dispensers that spray a premeasured amount of drug |
| Its 7pm Friday, 95 degrees F, can you leave MDI in the car? | NO, may explode or rupture |
| MDI maintenance | wipe mouthpiece after use, if spacer rinse daily in warm water and dry |
| MDI administration | shake, inhale deeply during depress, hold breath for 10 sec, breath out slowly, wait 1 min to repeat if necessary, rinse with water |
| dry-powder inhalers | do not contain pressurized canister, rely on the force of patients own inhalation to dispense a dose of dry -powder med |
| Ensure that the patient does not exhale directly into the DPI because the exhalation will disperse the powder | Ensure that the patient does not exhale directly into the DPI because the exhalation will disperse the powder |
| Common DPI | rotahaler, spinhalerm diskus, handihaler |
Created by:
nursebailey
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