Medication Administration
Unit VI
Part 2 (lecture)
Keith Rischer, RN, MA, CEN, CCRN
Today’s Objectives…
Differentiate the various effects of drugs on
the body
 Explain how age, illness, time of
administration, & absorption affect drug
action
 Describe the relationship between
mechanism of action of most commonly
used drugs and nursing assessment and
implications for the nurse

Minnesota Nurse Practice Act

Legal aspects r/t the nurse
(6) Engaging in unprofessional conduct, including,
but not limited to, a departure from or failure to
conform to board rules of professional or practical
nursing practice … to the minimal standards of
acceptable and prevailing professional or practical
nursing practice, or any nursing practice that may
create unnecessary danger to a patient's life,
health, or safety. Actual injury to a patient need not
be established under this clause.
Laws and Regulations

Drug legislation in the U.S.
 Pure
Food and Drug Act - 1906
 Harrison Narcotic law of 1914 – defined
narcotic
 Federal Food, Drug and Cosmetics Act of
1938 established the FDA, set standards r/t
safety, potency, efficacy.
 Durkham-Humphrey Amendment of 1952
differentiates between prescription and nonprescription drugs.
Laws and Regulations

Controlled Substance Act 1970
 Categorizes
controlled substances
 Limits
refills
 Established programs to prevent and treat
drug dependence

FDA instituted the MedWatch program in
1993
Consumer Rights
Drugs are safe, pure, effective and reliable
 Clients have the right to quality health
information r/t drugs and medications

 Name,
of drug, purpose, action, possible
adverse side effects.
Consumer Rights

Patients have a right to:
 To
refuse any medications
 To have qualified person assess medication
history including allergies
 Not to be given unnecessary medications
Safety

The Joint Commission
 Oxycontin
vs. Oxycodone
 Hydromorphone vs. Morphine
 Ephedrine vs. Epinephrine
 Hydralazine vs. Hydroxyzine

ISMP Institute for Safe Medication
Practices
http://www.ismp.org
Schedule of Controlled Substances

Schedule I: High potential for abuse
 No


medical use exists
Heroin
Schedule II: Potential for abuse, physical
and psychological dependence
 Has
accepted medical use
 No refills

Methadone, Morphine, Fentanyl, Oxycontin,
Percocet
Schedule of Controlled Substances

Schedule III: intermediate potential for
abuse
 Has
accepted medical use
 May Refill 5 times


Vicodin, Tyl. #3
Schedule IV: Less abuse potential.
 May
refill 6 times within 6 months
 Benzodiazepines, Ambien

Schedule V: Minimal abuse potential
 Cough
suppressants with codeine
Controlled Substances
Drugs kept in locked drawer
 Forms for recording the use of these drugs
 Nurse verifies the number of a specific
drug available
 If drug wasted, second nurse acts as a
witness
 Drugs are counted each shift with 2 RNs

Pharmacokenetics
Study of action of drugs
within the body





Must consider before
administering meds
Absorption
Distribution
Metabolism
Excretion
Pharmacokenetics: Absorption

Process by which drug passes into the
bloodstream
 better







the blood supply faster the absorption
GI tract: variable
IV: immediate
Subcutaneous: depends on local blood flow
Intramuscular: depends on local blood flow
Topical: slow, incomplete
Inhalation: rapid
Rectal: may be erratic
Pharmacokenetics: Absorption

Factors influencing
absorption
Dose form and route
 Influence of pH
 Blood flow to site
 Solubility of drug


Time Action Profile
Onset
 Peak
 Duration

Pharmacokenetics: Distribution
Transportation of drug
from site of absorption
to site of action.
 Vascular organs
receive drug first, then
skin and muscles.
 Chemical/physical
make up of the drug
determines to which
area of body drug will
be attracted.
Pharmacokenetics: Metabolism
 The
process of altering or changing the drug
into a less active form.
 Caution: this process may be impaired in the
elderly or in someone with liver disease
 Biotransformation
Pharmacokenetics: Excretion
Process by which
drug is eliminated
from the body.
 Caution: since the
kidneys/liver of older
adults are less
efficient, they may
require smaller doses
of a drug.
 Promote adequate
fluid intake

Medication Pharmokinetics
Morphine
 Tylenol
 Ibuprofen
 Atenolol
 Coumadin

Why is pharmokinetics relevant if your
patient has renal or liver disease?
Special Dosing Considerations

Renal Disease
 Chronic
renal insufficiency
 Diabetes
 CKD-dialysis dependant

Labs
– GFR
– Creatinine
Special Dosing Considerations

Liver Disease
 Cirrhosis
 Hepatitis
 ETOH

Labs
–
–
–
–
AST
ALT
Bili
Albumin
Special Dosing Considerations

Heart failure
 CHF


Diastolic
Systolic
 Cardiomyopathy

Body size
 Underweight/pediatric

calculated by weight or body surface area
 Obese
 Normal
Developmental Factors/drug action

Developmental factors:
 Pregnancy
 Infants
 Older

adults
Diet
 Food
alters drug absorption rate, metabolism
 Nutrition can affect the action of a drug

Ex: Vitamin K – found in green leafy vegetables
can counteract the effect of an anticoagulant –
Coumadin
Factors affecting drug action: Elderly

Use w/caution
Digoxin
 Nifedipine
 Benzodiazepines



Alprazolam
Diazepam

Increased fall risk
ACE inhibitors
 Beta blockers
 Ca++ channel blockers
 Vasodilators
 Diuretics
 Opiod narcotics
 Anti-depressants
 Benzodiazepines

Factors affecting drug action

Environmental
 Time
of administration
 Stress
 Exposure to heat and cold

Cultural, ethnic, genetic
 Ethnopharmacy
 Cultural
factors and practices
Mechanism…Nursing Implications
 Analgesics
 Morphine, Dilaudid, Percocet, Vicodin
 Mechanism:
 Binds
to opiate receptors in CNS
 Produces generalized CNS depression
 Opiate effects cause vasodilation,
decreased peristalsis
 Nsg.
Implications…
Classifications/Nursing Implications

Analgesics
 Mild
 Tylenol
 NSAIDS
 Ibuprofen, Aspirin
 Moderate
Opiod Narcotics po
– Tylenol #3, Vicodin, Percocet
 Severe
Opiod Narcotics IV
– Morphine, Dilaudid, Fentanyl
Anticoagulants

Warfarin (Coumadin)



Mech of Action
Uses
Nursing implications


INR (0.9-1.2)…11-13 seconds clotting time


2-3 therapeutic
Heparin

Mech of action




Vitamin K clotting factors
Prevents conversion of fibrinogen to fibrin
Uses
Nursing implications
Aspirin



Mech of action
Uses
Nursing implications
Mechanism…Nursing Implications

Calcium Channel Blockers
 Diltiazem

Mechanism:
 Inhibits
transport of calcium into myocardial and
vascular smooth muscle cells during the cardiac
action potential phase.
 Causes systemic vasodilation and coronary
artery vasodilation as well as slowing AV node
conduction and decreased cardiac contractility

Nsg. Implications…
Mechanism…Nursing Implications
 Angiotensin
Converting Enzyme (ACE)
Inhibitors
 Lisinopril,
Enalapril
 Mechanism:
 Blocks
the conversion of angiotensin I to
vasoconstrictor angiotensin II.
 Net effect: systemic vasodilation
 Nsg.
Implications…
Classifications/Nursing Implications

Loop Diuretics


Mechanism:



Furosemide (Lasix)
Inhibits the reapsorption of sodium and chloride from
the loop of Henle and distal renal tubule
Increases renal excretion of water, Na+, Cl-, Mg+,
and K+ causing loss of excess fluid and drop in BP
Nsg. Implications…
Medication interactions

When one medication modifies the action
of another, this can occur
 Synergistic
effect: effect of 2 drugs when
combined is greater than when meds given
separately.


Beneficial: give Tylenol with oxycodone to reduce
the total amount of narcotic needed.(additive
effect)
Harmful: Alcohol taken with antihistamines,
antidepressants, barbiturates and narcotic
analgesics
Medication interactions

Iatrogenic disease: disease caused
unintentionally by medical therapy
 Ex:
liver failure after prolonged use of Tylenol
 Amiodarone and pulmonary fibrosis
 Pregnant woman takes medication that
results in malformations in the fetus.
Nursing implications

What can nursing do to enhance desired
effect/decrease adverse effects and
ensure safety??
 History
 Allergies

Shellfish…Iodine
 Med
data
 Clients condition
 Clients knowledge/learning needs
Drug Medication Systems





Stock Supply
Unit-Dose
Automated Medication Dispensing
(Pyxis)
Bar Code Medication – use of
scanner
Self-administered

PCA, Inhalers, ointments etc