Part 1
Keith Rischer, RN, MA, CEN, CCRN

 State the primary use and nursing implications for drugs in each major classification
 Describe the characteristics of any drug that the nurse is responsible for administering
–Onset, peak, duration and half-life
–Mechanism of action>SE>Nsg Implications
 Calculate fractional dosages of drugs
 Using drug reference text correctly fill out clinical paperwork related to medication administration

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
How many patients die each year because of medication errors in US hospitals?
 500



5000
7000
25,000
How many patients are injured as a result of medication errors annually?




100,000
500,000
1,000,000
1,500,000

Pharmacological Concepts
 Drug Names
 Chemical name –
 name of a drug as the chemist knows it.
 Describes the constituents of the drug
 Ex:
– N-acetyl-para-aminophenol (Tylenol)
– 2-(acetyloxy)benzoic acid. (Aspirin)

 Drug names
 Generic names
 Name given to a drug before it becomes official.
 Name is often listed in the USP as the official name
 Ex: Furosemide, Acetaminophen, Atorvastatin
 Brand name
 Trademark or name given by drug manufacturer.
 More that one manufacturer may make the same drug
 EX: Lasix, Tylenol, Lipitor

 Implications related to administration and assessment/monitoring
 RN responsible for
 V/S
 Timing with meals
 Labs
 I&O
 Dilute? Crush?

Classifications/Nursing Implications
 Anti-hypertensive



Beta Blockers


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Atenolol
Metoprolol
Propranolol
Calcium channel blockers


Diltiazem
Nifedipine
ACE Inhibitors



Captopril
Enalapril
Lisinopril
 Diuretics


Loop of Henle (Furosemide)
Distal tubule-(Hydrochlorothiazide-HCTZ)

Classifications/Nursing Implications
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
Analgesics



Mild-NSAIDS
 Tylenol, Ibuprofen, Aspirin
Moderate-Opiod Narcotics po
 Tylenol #3, Vicodin, Percocet
Severe-Opiod Narcotics IV
 Morphine, Dilaudid, Fentanyl
Anti-bacterial



Penicillins
 Amoxicillin
Cephalosporins
 Keflex
Sulfa
 Bactrim DS

Classifications/Nursing Implications
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
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Anti-inflammatory


NSAIDS
Prednisone
Anti-coagulant


Heparin
Coumadin
Anti-platelet
 Aspirin
 Plavix
Laxative
 Sennakot, Metamucil





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Oral


Capsules/tablets
Syrup/solution
Inhalation
Rectal
 suppository
Topical


Patch ointment
Parenteral




IV (intravenous)
Sub-q (sub-cutaneous)
IM (intra-muscular)
ID (intra-dermal)

 Oral
 60-100 mL of fluid
 Contraindications
 NPO
 GI
 CVA
 Prevent aspiration
(Table 35-16 p.717
P&P)

 Topical
 Remove old patch before applying new
 Date and time new patch
 Use gloves
 Make sure skin is clean and dry
 Examples:
 Fentanyl
 Nitroglycerin
 Nicoderm

 Nasal
 Eye
 Ear

 Inhalers
 Albuterol/Advair
 Spacer
 Vaginal
 Rectal

 Therapeutic/Mechanism of action
 Side effects
 Adverse reactions
 Allergic reactions
 Idiosyncratic reactions
 Toxic effects
 Amiodarone
 Tolerance
 Opiate narcotics

 Onset
 Peak
 Duration
 Trough
 Serum Half life
 Morphine IV
 Vicodin po

 Abbreviations - Pickar

“Do not use” of abbreviations list – Pickar
 MS 2 mg IV q4 hours p.r.n for pain
 Lantus insulin 20u qd
 Maalox 15cc q6 hours prn

D X Q = X
H
Desired X Quantity = Amount
Have

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Heparin subq order for 12,000u due. This injection comes in a vial of 20,000u/cc. What will be the amount you will administer?
Dilaudid 0.25mg IV for pain. The pharmacy dispenses a carpuject/vial of Dilaudid 1mg/cc. What is the amount you will administer?
Solumedrol 25mg IV. It is dispensed as a 40mg/cc vial.
What is the amount you will administer?
Plavix 300mg to be given now. It only comes in 75mg tablets. How many tabs will you administer to give the correct dose?

 MB, 75 yo, admitted to the step down unit with exacerbation of heart failure. She complained of SOB, 3+ pitting edema in lower legs and a weight gain of 8 lbs in 3 days. Her K+ was 3.4 mEq/L in the ED.
 Furosemide 40mg IV was given in the ED with
800cc urine out
 P-96 R-32-BP 160/90 initially in ED
 P-86-R-24 BP 122/78 after Lasix
 Physician has ordered:
 KCL 30 mEq po bid
 Pharmacy has dispensed KCL 20 meq/15cc elixir unit dose tubs x2. What will be the amount (cc) you