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U.S. drug legislation
• Sets official drug
standards
• Defines prescription drugs
• Regulates controlled
substances
• Improves safety
• Requires proof of efficacy
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Nurse Practice Acts
• Identify nursing
responsibilities for
administration and client
monitoring
Stock Supply:
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Bulk quantity
Central location
Not client-specific
Unit Dose:
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Individually packaged
Client-specific
drawers
24-hour supply
Automated Dispenser:
 Password-accessible locked cart
 Computerized tracking
 Can combine stock and unit doses
Self-Administration:
 Individual containers
 Kept at client’s bedside
Pharmacokinetics:
 What happens to the drug in the body
Pharmacodynamics:
 How the drug affects the body
Four processes:
 Absorption
 Distribution
 Metabolism
 Excretion
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Movement of drug into the bloodstream
Factors affecting absorption:
• Route of administration
• Drug solubility
• pH/ionization
• Blood flow
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Drug transport to tissues and organs
Factors affecting distribution:
• Local blood flow
• Membrane permeability
• Protein-binding capacity
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Biotransformation: chemical conversion of
drug
Factors affecting metabolism:
• Liver function
• Health/disease status
• First-pass effect
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Elimination of the drug
Factors affecting excretion:
• Organ function, especially the kidneys, liver, and
lungs
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Time until onset and peak
Therapeutic range
• Peak level
• Trough level
• Therapeutic level
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Half-life
Concentration of active drug
Primary effects:
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Therapeutic effects
Predicted
Intended
Desired
Why the drug was prescribed
Secondary effects:
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Unintended
Nontherapeutic
Can be:
• Predictable
• Harmless
• Harmful
Types of secondary effects:
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Side effects
Adverse reactions
Toxic reactions
Allergic reactions
Idiosyncratic reactions
Cumulative effect

Antagonistic

Synergistic

Incompatibilities
Types of medication orders:
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Written order
Automatic “stop” date
STAT order
Standing order
PRN order
Communication of orders:
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Handwritten
Preprinted
Orally
Telephone
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Client’s full name
Date and time order was written
Name of medication
Dosage size, frequency, number of doses
Route of administration
Signature of prescriber
Three checks:

Before you pour:
• Check the medication label against the MAR

After you pour:
• Verify the label against the MAR
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At the bedside:
• Check the medication again
Six Rights:
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Right drug
Right client
Right dose
Right time
Right route
Right documentation
Other Rights:
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Right reason
Right to know
Right to refuse
Oral medications:
 Most commonly used route
 Includes:
•
Tablets, pills, capsules
• Liquids(syrups, elixers,
suspensions, emulsions
• Buccal
• Sublingual
• Enteral medications
• Troche
Topical medications:
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Applied directly to body surface/body cavities
Local effects:
• Lotions, creams,
ointments
• Transdermal patches
• Eye and ear
• Nasal
• Vaginal
• Rectal
Respiratory inhalations:

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Use concept of nebulization
Absorption via alveoli and blood supply
• Atomizers
• Aerosol
• Metered dose inhaler
Parenteral medications:
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Intradermal
Subcutaneous
Intramuscular
Intravenous
Equipment Preparation:
 Syringe/needle (size, gauge)
Medication Preparation:
 Vials and ampules
 Reconstituting from powder
 Two medications in one syringe
Safety issues:

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Use sharps containers
Never recap dirty needle

Use the correct site
• Wrong site could mean wrong route

Be familiar with the technique required for the
medication (e.g., heparin, insulin)
Intravenous medications:
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IV push
IV piggyback
Medicated drips

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Use the six rights
Calculate doses carefully; double-check with a
second RN
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Watch for drugs with similar names
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Watch for clients with same last names
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Clarify illegible orders
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Know and use your resources
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Keep up with changes in medication orders