Chamberlain College of Nursing NR224_FINAL. MUST READ.

 Yellow highlight: prior to reviews; things I* think are important.  If it is NOT highlighted, just understand the concept. MED ADMINISTRATION RATE OF ABSORBTION  When applying medications on the skin, absorption is slow because of the physical makeup of the skin. Because orally administered medications pass through the gastrointestinal (GI) tract, the overall rate of absorption is usually slow.  The mucous membrane and the respiratory tract have a quick rate of absorption. Intravenous (IV) administration has the fastest absorption rate. The oral route takes some time owing to the passage of medications through the GI tract.  The blood supply to the site of administration will determine how quickly the body can absorb a drug. The richer the blood supply to the site of administration, the faster a medication is absorbed.  When a medication comes in contact with a large surface area, it is absorbed at a faster rate. This helps explain why the majority of medications are absorbed in the small intestine rather than the stomach.  Because the cell membrane has a lipid layer, highly lipid-soluble medications cross cell membranes easily and are absorbed quickly.  Safe medication administration requires knowledge of factors that alter or impair absorption of prescribed medications.  Because some medications interact with food, it is often appropriate to administer them before or after meals, with meals, or on an empty stomach. EXCRETION  What is the main organ for excretion? Kidneys  Which type of medications are excreted through the lungs? Anesthetic gases, alcohol  Why should certain medications not be taken during pregnancy? Discuss: Some may pass through the placental barrier or mammary glands.  The kidneys are the main organs for medication excretion. Some medications escape extensive metabolism and exit unchanged in the urine. Others undergo biotransformation in the liver before the kidneys excrete them.  The GI tract is another route for medication excretion. Medications that enter the hepatic circulation are broken down by the liver and excreted into the bile. After chemicals enter the intestines through the biliary tract, the intestines resorb them.  Gaseous and volatile compounds such as nitrous oxide and alcohol exit through the lungs.  The exocrine glands excrete lipid-soluble medications. TIMING OF MEDICATION DOSE RESPONSES  Onset: Time it takes after meds are administered for it to produce a response  Peak: Time it takes for a med to reach its highest effective concentration  Trough: Minimum blood serum concentration of meds reached just before the next scheduled dose  Duration: Time during which meds are present in concentration great enough to produce a response  Plateau: Blood serum concentration of medication reached and maintained after repeated fixed doses FORMS OF MEDICATION  If it is “scored” (line through the pills), they can be divided smaller/or split.  DO NOT split, cut, or divide capsules, softgel/gelcaps or meds labeled ER (extended release), IR (immediate release), LA (long acting), etc. TYPES OF MED ACTION  Therapeutic effect: Expected or predicted physiological response  Adverse effect: Unintended, undesirable, often unpredictable  Side effect: Predictable, unavoidable secondary effect  Toxic effect: Accumulation of medication in the bloodstream  Idiosyncratic reaction: Overreaction or underreaction or different reaction from normal  Allergic reaction: unpredictable response to a medication  Medication interactions: when one medication modifies the action of another  PLEASE understand these abbreviations. It can mix you up on a test question. DOSAGE SCHEDULE ABBREVIATION Before meals AC, ac As desired ad lib Twice each day BID, bid, q12h After meals PC, pc As needed Prn Every morning, AM Q am Every hour qh OR q1h Everyday Daily or q24h Every 4 hours q4h 4 times per day QID, qid, q6h Give immediately STAT, stat 3 times per day TID, tid, q8h Q/q = every Know the difference between every 4 hours vs. 4 times per day q4h: EVERY 4 HOURS QID: There are 24 hours in a day. If they need their meds 4 times within a 24-hour period, 24 divided by 4 is 6. So, you will give the medication every 6 hours or q6h. Same with “3 times per day”. It is 24 (hours) divided by 3. That is q8h or TID. ORAL ROUTES Local or systemic effects Contraindications: pts unable to swallow, unconscious, confused, or unable or unwilling to swallow or hold meds under their tongues, pts with gastric suction, before tests or surgery  Sublingual: Place medication under the tongue until absorbed  Buccal: Place medication between cheek and teeth until absorbed (usually tablet form) PARENTAL ROUTES/INJECTION TECHNIQUE IM and IV routes have higher absorption rates, thus placing pt at higher risk for reactions; can cause considerable anxiety  Intradermal: Mostly used for TB (tuberculosis) and allergy testing – Injection into the dermis just under the epidermis. Given at 15 degree angle, usually called a “bleb”. Given on the inner surface of the forearm (not the antecubital!) o  Subcutaneous (SQ): 45-90 degree angle. Injection into the tissues just below the dermis of skin. Upper outer arms, abdomen (2 inches [away] from the umbilicus/belly button/see