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Unit I Chapter 25
Medication Administration (White)
| Question | Answer |
|---|---|
| Absorption | passage of a drug from the site of administration into the bloodstream; process whereby the end products of digestion pass through the epithelial membranes in the small and large intestines and into the blood or lymph system |
| Angiocatheter | intracatheter with a metal stylet |
| Aspiration | procedure performed to withdraw fluid that has abnormally collected or to obtain a specimen; also inhalation of secretion or fluids into the pulmonary system |
| Bioavailability | readiness to produce a drug effect |
| Butterfly needles | a short needle with flexible plastic handles that fold for insertion and lay flat for stabilization with adhesive tape |
| Chemical name | precise description of the drug’s chemical formula |
| Distribution | movement of drugs from the blood into various tissues and body fluids |
| Drug allergy | hypersensitivity to a drug |
| Drug incompatibilities | combinations of drugs that produce adverse effects |
| Drug interaction | effect one drug can have on another drug |
| Drug tolerance | reaction that occurs when the body is accustomed to a specific drug that larger doses are needed to produce the desired therapeutic effects |
| Enteral instillation | administration of drugs via a gastrointestinal tube |
| Excretion | elimination of drugs or waste products from the body |
| Extravasation | escape of fluid into the surrounding tissue |
| Flashback | rushing of blood back into intravenous tubing when a negative pressure is created on the tubing; reliving of an original trauma as if the individual were currently experiencing it |
| Flow rate | volume of fluid to infuse over a set period of time |
| Generic name | name assigned by the U.S. Adopted Names Council to the manufacturer who first develops a drug |
| Half life | time it takes the body to eliminate half of the blood concentration level of the original dose of medication |
| Hypervolemia | increased circulating fluid volume |
| Idiosyncratic reaction | very unpredictable response that may be an over response, an under response, or an atypical response |
| Implantable port | device made of a radiopaque silicone catheter and a plastic or stainless steel injection port with a self sealing silicone rubber septum |
| Infiltration | seepage of forgein substances into the interstitial tissue, causing swelling and discomfort at the IV site |
| Intracath | plastic tube for insertion into a vein |
| Intradermal (ID) | within or between the layers of skin |
| Intramuscular (IM) | within a muscle |
| Intravenous (IV) | within or administered into a vein |
| IV push (bolus) | a large volume of fluid or dose of a drug given by IV, rapidly at one time |
| Metabolism | sum total of all the biological and chemical processes in the body |
| Onset of action | time for the body to respond to a drug after administration |
| Parenteral | any route other than oral/gastrointestinal tract |
| Patency | being freely opened |
| Peak plasma level | highest blood concentration of a single dose of a drug until the elimination rate equals the rate of absorption |
| Pharmacokinetics | study of the absorption, distribution, metabolism, and excretion of drugs to determine the relationship between the dose of a drug and the drug’s concentration in biological fluids |
| Phlebitis | inflammation in the wall of a vein w/o clot formation |
| Piggybacked | an IV administered along with another IV |
| Plateu | level at which a drug’s concentration is maintained |
| Stock supplied | medications administered from a supply kept on had that are not prescribed to an individual pt. but are utilized for multiple pt.’s |
| Subcutaneous | injection into the subcutaneous tissue |
| Toxic effect | reaction that occurs when the body cannot metabolize a drug and the drug accumulates in the blood |
| Trade (brand) name | proprietary name assigned by pharmaceutical companies when they market a drug |
| Unit dose | method of preparing medications in which individual does of pt. medications are prepared by the pharmacy and delivered in individual labeled packets to the pt.’s unit to be administered by the nurse |
| Vesicant | agent that may produce blisters and tissue necrosis |
| Medications are prescribed by | a physician, dentist, or other authorized prescriber such as advanced practice nurses as determined by individual state licensing boards |
| Medications are prepared and dispensed by | pharmacists |
| Nurses are responsible for _______ medications | administering |
| Dietitians are involved in medication in what way | identifying possible food/drug interactions |
| The nursing process is involved in medication administration how | by directing nursing decisions about safe drug administration and ensuring compliance with standards of practice |
| A drug is | a chemical substance intended to have a specific effect |
| The nurse assumes before administering any medications | that the drug will be safe for the client if the dose, route, and frequency are within the therapeutic range for that drug |
| The United States Pharmacopeia (USP/1851) and the National Formulary (NF/1898) are | books of drug standards used in the United States |
| The USP and NF list drugs recognized for compliance with legal standards of | purity, quality, and strength |
| The USP and the NF were designated by the Pure Food and Drug Act of 1906 | as the official bodies to establish drug standards |
| The authority to enforce standards belongs to | the FDA |
| The Federal Food, Drug, and Cosmetic Act of 1938 | authorized the FDA to test all new drugs for toxicity before giving approval to market a drug |
| In 1952, the Federal Food, Drug, and Cosmetic Act of 1938 was amended to | differentiate prescription (legend) drugs from nonprescription (OTC) drugs and to regulate prescription dispensing |
| Drug effectiveness testing came with | the Kefauver Harris Act of 1962 |
| In 1914 the Harrison Narcotic Act | classified habit forming dugs as narcotics and began regulating them |
| The Harrison Narcotic Act and other drug abuse laws were replaced with | the Comprehensive Drug Abuse Prevention and Control Act in 1970 |
| What does the Controlled Substance Act define a drug dependent person in terms of | physical and psychological dependence and provides for strict regulation of narcotics and other controlled drugs with five categories of scheduled drugs |
| Pharmacists are employed by the FDA to | inspect records and prescription to discover illicit distribution of these substances |
| All states must adhere to the schedule of controlled substances as | –minimum standards |
| Individual states can pass _____ controls for controlled substances | stricter |
| Drugs are identified by what names | chemical, generic, official, or trade name |
| The chemical name is | a precise description of the drug’s chemical formula |
| The generic name (nonproprietary name) is | assigned by the U.S. Adopted Names council to the manufacturer who first develops the drug |
| When a drug is approved it is given an ___________ name, which may be the same as the nonproprietary name | official name |
| Drugs with proven therapeutic value are listed by their official name in | the USP and NF |
| Trade/brand names (propriety names) are assigned by | pharmaceutical companies when they market a drug |
| What drug names are capitalized | trade names |
| What drug names are not capitalized | generic names |
| Drug action is | a drug’s ability to combine with a cellular receptor |
| Drugs can have what effects depending on the location of cellular receptors | local effect, systemic effect, or both |
| diphenhydramine hydrochloride is aka | Benadryl |
| Schedule C I drugs are | substances for which there is a high abuse potential and no current approved medical use (marijuana, LSD, opiates and opium derivatives) |
| Schedule C II drugs are | drugs that have a high abuse potential and a high ability to produce physical and or psychological dependence and for which there is current approved or acceptable medical use (narcotics, amphetamines) |
| Schedule C III drugs are | drugs for which there is less potential for abuse than drugs in Schedule II and for which there is a current approved medical use (nonbarbituate sedatives, nonamphetamine stimulants, anabolic steroids) |
| Schedule C IV drugs are | drugs for which there is relatively low abuse potential and for which there is a current approved medical use (sedatives, antianxiety agents, and nonnarcotic analgesics) |
| Schedule C V drugs are | drugs in this category consist mainly of preparations containing limited amounts of certain narcotic drugs |
| What schedule drugs are regulated by federal law that limited quantities may be bought without a prescription by an individual 18 years of age | Schedule C V drugs |
| Schedule C V drugs must be purchased from a | pharmacist who must keep appropriate records |
| Some states require that Schedule ____ drugs require a prescription | V |
| Pharmacology is | the study of drug effects on living organisms |
| Half life of medication is | the time it takes the body to eliminate half of the blood concentration level of the original drug dose |
| Drug action is based on | the half life of a drug |
| If a drug has a half life of 8 hours, what percent of the original dose is present in the blood 8 hours after administration | 50% |
| If a drug has a half life of 8 hours, what percent of the original dose is present in the blood 16 hours after administration | 25% |
| What does maintaining a therapeutic drug level ensure | antibiotic effectiveness against bacteria w/I the body, pain medication provides and effective pain threshold |
| Onset of action is | the time for the body to respond to a drug after administration |
| Peak plasma level is | the highest blood concentration of a single drug dose before the elimination rate equals the rate of absorption |
| What does the blood concentration level do once the peak plasma level is reached if another dose is not given | the blood concentration level will decrease steadily |
| What is a plateau | when a series of scheduled drug doses is administered and the blood concentration level is maintained |
| How are drugs generally classified | by the body system with which they interact, or by the drug’s approved therapeutic usage |
| Drugs with several therapeutic uses are usually classified by | their most common use |
| Routes are | how the drug is absorbed |
| Classifications of routes are | oral, Buccal, sublingual, parenteral, topical, and respiratory |
| Can drugs prepared for administration by one route be substituted by the drug prepared for another route | no, never |
| Most drugs are administered via the oral route because | it is the most convenient, least expensive, and the safest method |
| Oral route | by mouth, acts more slowly than the other routes |
| When are drugs not given orally | to clients with GI intolerance, those on NPO status, or those in a coma |
| Buccal or sublingal routes are used | when small amounts of drugs are required, they act quickly because of the oral mucosa’s thin epithelium and large vascular system, allowing the drug to be quickly absorbed |
| Buccal drugs are placed where | in the Buccal pocket (superior/posterior aspect of the internal cheek next to the molars) for absorption by the mucous membrane |
| Sublingual medications are placed where | under the tongue, where they dissolve quickly |
| Parenteral route | drugs administered by injection using sterile technique (intradermal, subcutaneous, intramuscular, intravenous); any route other than the oral/GI tract excluding topical and respiratory routes |
| The four routes that nurses use to administer medication parenterally are | intradermal, subcutaneous, intramuscular, and intravenous |
| Intrathecal or intraspinal, intrapleural, intracardiac, intra arterial, and intra articular routes are | used by physicians and sometimes by advanced practice registered nurses |
| Topical route is | drugs that are given to deliver a drug at or immediately beneath the point of application |
| Topical drugs include | drugs applied to the skin, eye, nose and throat, ear, rectal and vaginal preparations |
| Drugs directly applied to the skin are absorbed into | the dermis, where they have a local effect or are absorbed into the bloodstream |
| The vascularity of the skin does what | varies the drug action |
| Transdermal patches are used to | deliver medications for absorption to produce systemic effects |
| Topical drugs applied directly to the mucous membranes are | absorbed quickly and depending on the drug’s dose (strength and quality), may cause systemic effects |
| Chewable tablets | are chewed before swallowing to increase gastric absorption |
| Buccal and sublingual medications | must dissolve completely before the pt. drinks or eats |
| Suspensions and emulsions are administered | immediately after shaking and pouring from the bottle |
| Inhalants | drugs or dilutions of drugs administered by the nasal or oral respiratory route for a local or systemic effect |
| Solutions | contain one or more soluble chemical substances dissolved in water |
| Solutions include | enemas, douches, suspensions, emulsions, syrups, gargles, mouthwashes, nasal solutions, optic (eye) and otic (ear) solutions, elixirs |
| Enemas are | aqueous solutions for rectal instillation |
| Douches are | aqueous solutions that function as a cleansing or antiseptic agent that may be dispensed in the form of a powder with directions for dissolving in a specific quantity of warm water |
| Suspensions are | particles or powder substances that must be mixed with, not dissolved in, a liquid by shaking vigorously before administration |
| Emulsions are | two phase systems in which one liquid is dispersed in the form of small droplets throughout another liquid |
| Syrups are | substances dissolved in a sugar liquid |
| Gargles are | aqueous solutions |
| Mouthwashes are | aqueous solutions that may contain alcohol, glycerin, and synthetic sweeteners |
| Nasal solutions are | aqueous solutions instilled as drops or sprays |
| Optic (eye) and otic (ear) solutions are | aqueous solutions instilled as drops |
| Elixirs are | soulutions that contain water, varying amounts of alcohol, and sweeteners |
| Oral solids are | tablets, capsules, caplets, powders, granules, troches, lozenges, pastilles, enteric coated tablets, time released capsules and sustained release |
| Tablets are | compressed or molded substances, to be swallowed whole, chewed before swallowing, or placed in the Buccal pocket or under the tongue (sublingual) |
| Capsules are | substances encased in a hard or soft soluble cover or gelatin shell that dissolves in the stomach |
| Caplets are | gelatin coated tablets that dissolve in the stomach |
| Powders and granules are | finely grounded substances |
| Troches, lozenges, and pastilles are | designed to dissolve in the mouth |
| Enteric coated tablets are | coated tablets that dissolve in the intestine |
| Time release capsules are | encased substances that are further enclosed in smaller casings that deliver a drug dose over an extended period |
| Sustained release are | compounded substances that release a drug slowly to maintain a steady plasma level |
| Topicals are | liniments, ointments, pastes, suppositories |
| Liniments are | substances mixed with an alcohol, oil, or soapy emoilient; applied to the skin |
| Ointments are | semisolid substances for topical use |
| Pastes are | semisolid substances, thicker than ointments, absorbed slowly through the skin |
| Suppositories are | gelatin substances designed to dissolve when inserted in the rectum, urethra, or vagina |
| Respiratory route drugs | are inhalants that deliver gaseous or volatile substances that are almost immediately absorbed into systemic circulation |
| The inhalants delivered into the aveoli of the lungs, promote fast absorption due to | permeability of the alveolar and vascular epithelium, abundant blood flow, and very large surface area for absorption |
| Oropharyngeal handheld inhalers | deliver topical drugs to the respiratory tract to create local and systemic effects |
| The three types of inhalers are | the metered dose inhaler (nebulizer), the turbo inhaler, and the nasal inhaler |
| Pharmacokinetics is | the study of the absorption, distribution, metabolism, and excretion of drugs to determine the relationship between the dose of a drug and the drug’s concentration in biological fluids |
| What factors does the degree and rate of absorption, or movement of a drug from administration site into the bloodstream, depend on | the drug’s physicochemical effects, its dosage, its route of administration, its interactions with other substances, and various pt. characteristics such as age |
| Oral preparations | disintegrate into smaller particles so that gastric juices can dissolve and prepare the drug for absorption in the small intestines |
| Intramuscularly administered drugs are absorbed | through the muscle into the bloodstream |
| Suppositories are absorbed | through mucous membranes into the blood |
| Intravenous drugs are | immediately bioavailable because they are directly injected into the blood |
| Distribution is | the movement of medications from the blood into various body tissues and fluids |
| Drug distribution in the body is affected by | cardiac output, cell membrane permeability, protein binding capacity of the medication and body fat |
| A client’s cardiac output can | increase or decrease blood flow |
| Peripheral vascular disease | decreases circulation to body tissues |
| The blood/brain barrier | allows only fat soluble medication through the membrane |
| A malnourished client/one with liver disease | has decreased albumin or protein circulating in the blood which allows a higher concentration of the medication in the blood |
| Drug duration is increased in obese clients, resulting in | slower drug distribution |
| Metabolism is | the physical and chemical processing of a drug by the body |
| Most drugs are metabolized in the | LIVER |
| What determines the rate of metabolism | the presence of enzymes in the liver that detoxify the drugs |
| Excretion is | the elimination of drugs from the body |
| Excretion occurs mainly through | hepatic metabolism and renal excretion, but the lungs, exocrine glands, skin, and intestinal tract can eliminate some drugs |
| Drug interaction is | the effect one drug can have on another drug |
| hydrochlorothiazide (hydroDIURIL) is | a potassium depleting diuretic |
| spironolactone (Aldactone) is | a potassium sparing diuretic |
| When hydrochlorothiazide and spironolactone are combined they | maintain a normal blood level of potassium |
| Not all drug interactions are | therapeutic |
| Some interactions can interfere with the | absorption, effect, or excretion of other drugs |
| Magnesium containing antacids can | cause inadequate absorption of tetracycline (Tetracyn), an antibiotic, in the digestive tract |
| Adverse reactions are | drug effects other than those therapeutically intended and expected (potentially dangerous) |
| A side effect is | a nontherapeutic effect that is mild and predictable |
| What are the types of adverse reactions | drug allergy, drug tolerance, toxic effect, and idiosyncratic reactions |
| A drug allergy is | hypersensitivity to a drug/an antigen antibody immune reaction occurring when an individual previously exposed to a drug has developed antibodies against the drug |
| Drug reactions are often seen | on the skin because of its abundant blood supply |
| Anaphylaxis is | an immediate, life threatening reaction to a drug, marked by respiratory distress, sudden severe bronchospasm, and cardiovascular collapse (can be fatal) |
| What is the treatment for anaphylaxis | administration of epinephrine, bronchodialators, and antihistamines |
| Drug tolerance occurs when | the body is so accustomed to a specific drug that larger doses are needed to produce the desired therapeutic effect |
| A toxic effect occurs when | the body cannot metabolize a drug and the drug accumulates in the blood |
| The cardiac drug Digoxin | has a narrow margin of safety between an effective therapeutic dose and a toxic dose |
| An idiosyncratic reaction is | a very unpredictable response that may be an over response, an under response, or an atypical response |
| Medication management works to avoid | possible food/drug interactions |
| What are the three main types of food/drug interactions | interaction with the absorption, excretion, or use in the body of one or more nutrients, increase/decrease of absorption of a drug into the body, or foods that alter the chemical actions of drugs and prevent the therapeutic effect on the body |
| When do most interaction problems occur | with the use of oral antibiotics, diuretics, anticoagulant, and antihypertensive drugs |
| Why do food/drug interactions vary | depends on the dose and the form of the drug taken and the patient’s age, gender, nutritional status, body weight, and specific medical condition |
| What do herbals do to drugs | they can change their effect |
| What special considerations should be considered with neonates and infants | that they have underdeveloped GI systems, muscle mass, and metabolic enzyme systems and inadequate renal function |
| What special considerations should be considered with elderly clients | they often experience decreased hepatic or renal function and diminished muscle mass |
| What factors influence drug action | individual client characteristics such as genetic factors, age, height, weight, and physical and mental conditions |
| How is drug dosage decided by the physician | by the correlation of the client’s age, height, and weight |
| What can the amount of body fat do to drug distribution | it can alter the effects of the drug |
| What can the physical condition of the client do to drug distribution | it can alter the effects of the drug |
| Medication orders are | written on a physician’s order form in each client record |
| A drug order should contain what seven parts | client’s name, date and time when the order is written, name of the drug to be administered, dosage, route for administration and special directives about its administration, time of administration and frequency, signature of the person writing the order |
| What should the nurse do if they feel a drug order is in error | the nurse is responsible and held accountable for questioning that order |
| The official listing of abbreviations adopted by the medical staff of the agency located | in the agency’s medical records department |
| What are the four types of medication orders | stat, single dose, scheduled, and PRN orders |
| Stat medication orders | are those that should be administered immediately |
| Single dose orders are | one time medications that should be administered either at a time specified by the prescriber or at the earliest convenient time |
| Scheduled orders are | administered as specified until the order is changed or canceled by another order or until the specified number of days has elapsed as set by agency policy |
| Scheduled orders are used to | maintain the desired blood level of the medication |
| Day 1 of a medication order begins | with the administration of the first dose |
| PRN orders (as needed) are | drugs that are administered when, in the nurse’s judgment, the client’s condition requires it |
| What precautions should be utilized when writing an order with a decimal point in it | a zero is not written after a decimal point (1, not 1.0) and a zero is always placed in front of the decimal for values less than 1 (0.5) to prevent errors |
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