pharmacology. medications affecting blood what could go wrong?
TRANSCRIPT
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Pharmacology
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Medications Affecting Blood
What could go wrong?
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Anticoagulants
• Coumadin• Heparin• Lovenox/Arixtra
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Anti-Platelet Drugs
• Aspirin• Plavix
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Thrombolytics
• Streptokinase
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Anemia Medications
• What type of anemia do they have?
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Leukocyte Medications
• Neupogen• Leukine
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Blood and Blood Product Medications
• Packed Red Blood Cells• Plasma• Platelets• Autologous
• Epogen
• Albumin
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Medications Affecting Fluid and Electrolytes
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Diuretics
• Loop• Thiazide• Potassium Sparing• Osmotic
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Calcium, Potassium, and Magnesium
• Who needs it?
• Who doesn’t need it?
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Renal Medications
• Phosphate Binders
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Medications for Degenerative Bone Disease
• Biphosphates• Calcitonin
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BASIC PRINCIPLES OF MEDICATION ADMINISTRATION
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Pharmacokinetics
• Refers to how medication travels through the body. The medication is subjected to a variety of biochemical and physiochemical processes that result in absorption, distribution, metabolism and excretions of the medication
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Pharmacokinetics
• Absorption – the movement of a medication from its site of administration to the blood stream.– Most common routes:• Enteral (through the GI tract)• Parenteral (by injection)
– Each of these routes will have a unique pattern of absorption
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Pharmacokinetics
• Distribution – transportation of a medication to its site of action by bodily fluids– Influenced by:• Circulation to site of action, • Number of plasma protein binding sites, • Barriers such as the blood brain barrier
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Pharmacokinetics• Metabolism (biotransformation) – changes a
medication into a less active form or an inactive form by the action of enzymes. – Occurs primarily in the liver,– May also take place in:• Kidneys• Lungs• Bowel• Blood
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Pharmacokinetics
• Excretion – the elimination of a medication from the body primarily through the kidneys.– May also take place through the:• Liver• Lungs• Bowel• Exocrine Glands
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Pharmacodynamics
• Describes the interaction between medications and target cells, body systems, and organs to produce pharmacological effects.
• Interactions result in functional changes that are considered the mechanism of action of the medication.
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Medication Category and Classification
• Non Prescription Medications– Over the Counter
• Prescription Medication– Uncontrolled Substances– Controlled Substances
• FDA pregnancy Risk Category– (A, B, C, D, X)
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Prescription Medication
• Are administered under the supervision of primary care providers.
• These medications may:– Be Habit-forming– Have potential harmful effects– Require supervision
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Uncontrolled Substances
• These medications require monitoring by a primary care provider, but do not pose risks of abuse and/or addiction
• Examples:– Antibiotics– Nonsterioidal anti-inflammatory (NSAIDs)– Insulin
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Controlled Substances
• Medications that have a potential for abuse and dependence are categorized into schedules.
• Schedule of Drugs I -V– Heroin is a drug in Schedule I and has no medical
use in the US.– Schedule II medications have a ‘high’ potential for
abuse, but are recognized medical treatment (Morphine, Fentanyl, Methadone, Cocaine)
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Controlled Substances• Schedule III drugs have a “potential for abuse less
than the drugs …in schedules I and II”. It includes anabolic steroids, ketamine, marinol, hydrocodone/codeine with NSAIDs or Tylenol
• Schedule IV drugs have a low potential for abuse. It includes benzodiazepines, Darvocet, etc.
• Schedule V drugs have less potential for abuse. Includes diphenoxylate, and cough suppressants with small amounts of codeine. http://tinyurl.com/28x2uvf
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FDA Pregnancy Risk Category
• Categorizes medication terms of their potential harm during pregnancy, with Category A being the safest and Category X the most dangerous.
• Teratogenesis is most likely to occur during the first trimester.
• Before giving any medication to a woman who is or could be pregnant, determine whether or not it is safe for administration during pregnancy
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Considerations for Parenteral medications
• Discard all sharps in designated containers• Use the vastus lateralis site for infants and children
< 2 years of age• After age 2, the ventral gluteal site can be used• Both of these sites can accommodate up to 2 mL of
fluid.• Deltoids are smaller and can only accommodate
1mL of fluid
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Considerations for Parenteral medications
• Use a needle gauge and length appropriate to the type of injection and client size.– The gauge of the needle is the size of the diameter
of the needle– The larger the gauge, the smaller the diameter of
the needle• Which is bigger?– A 23- gauge needle or a 16 gauge needle
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Considerations for Parenteral medications
• Use a tuberculin syringe for solution volume < 0.5mL. Syringe size should approximate volume of medication.
• Rotate injection sites to enhance medication absorption, and document each site used.
• Wash site with alcohol and allow to dry, use soap and water for insulin injections.
• Avoid the use of injection sites that are edematous, inflamed, or those sites that have moles, birthmarks, or scars.
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Mixing Injectable Medications from Two Vials
• Draw air into a syringe equal to the amount of solution to be drawn from the second vial. Then, inject air into this vial, not allowing the needle to touch the solution. Withdraw the needle.
• Draw air into a syringe equal to the amount of solution to be drawn in the first vial. Inject air into the first vial, invert vial, and withdraw the desired amount of solution. Remove the needle from the vial.
• Insert needle into second vial, invert vial, and withdraw the desired amount of solution. Remove needle from the vial.
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Managing an Epidural Infusion
• Secure catheter to skin to prevent discomfort• Assess and monitor dressing for drainage• Use surgical aseptic technique when administering
medication• Assess/monitor vital signs and pulse ox for respiratory
depression. D/C infusion if respirations are less than 12/min and notify primary care provider
• Assess for pruritus, nausea, and vomiting• Monitor for I & O, urinary and bowel function
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Questions• A nurse is preparing insulin from two different vials. Which
of the following actions indicates that she understands correct medication preparation?
1. The nurse injects fluid from one vial into the other regardless of the medications\
2. The nurse wipes the needle with alcohol prior to injecting air into the vial.
3. The nurse inserts air into the first vial, but not the second one.
4. The nurse discards the medication vials if medications are mixed during preparation.
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Questions• A nurse is preparing insulin from two different vials. Which
of the following actions indicates that she understands correct medication preparation?
1. The nurse injects fluid from one vial into the other regardless of the medications\
2. The nurse wipes the needle with alcohol prior to injecting air into the vial.
3. The nurse inserts air into the first vial, but not the second one.
4. The nurse discards the medication vials if medications are mixed during preparation.
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Questions
• An older adult client has had a CVA and is prescribed a metered dose inhaler. Which nursing consideration is a priority when teaching the client how to take the medication?
1.Dosage and amount of medication2.Schedule of administration3.Coordination and cognition of the client4.Purpose and goal of medication regimen
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Questions
• An older adult client has had a CVA and is prescribed a metered dose inhaler. Which nursing consideration is a priority when teaching the client how to take the medication?
1.Dosage and amount of medication2.Schedule of administration3.Coordination and cognition of the client4.Purpose and goal of medication regimen
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Identify the correct client position for each of following routes of administration.
• ___ Oral• ___ Otic• ___Vaginal• ___ Rectal
1. Lying on the left side with right knee brought up to the chest (Sims’ position)
2. Sitting, semi-Fowler’s, or Fowler’s position
3. Supine with knees bent, feet flat on the bed and close to the hips
4. Client lying on side with the ear that is receiving the drops facing up
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Questions
• Proper administration of eye drops includes which of the following nursing interventions? (Select all that apply.)
1. Using medical aseptic technique2. Asking the client to look up at the ceiling3. Having the client lie in a side-lying position4. Dropping medication into the center of client's
conjunctival sac5. Instructing the client to close the eye gently
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Questions
• Proper administration of eye drops includes which of the following nursing interventions? (Select all that apply.)
1. Using medical aseptic technique2. Asking the client to look up at the ceiling3. Having the client lie in a side-lying position4. Dropping medication into the center of client's
conjunctival sac5. Instructing the client to close the eye gently
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Safe Medication Administration
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Error Prevention
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IV Therapy