1
Q
What is the difference between chemical, generic and trade names of medications?
A
Chemical names describe to chemical components of the medication
Generic names are the name of the active ingredient, given by the first manufacturer
Trade names are given by manufacturers of subsequent variants of the same medication
2
Q
What are the different forms medication can come in?
A
- aerosol spray / foam
- aqueous solution
- aqueous suspension
- caplet
- capsule
- cream
- elixer
- extract
- gel/jelly
- linament
- lotion
- lozenge
- ointment (salve, unction)
- paste
- pill
- powder
- suppository
- syrup
- tablet
- tincture
- transdermal patch
3
Q
What laws govern medications in Western Australia?
A
- Therapeutic Goods Act 1989 (Commonwealth)
- Therapeutic Goods Regulations 1990 (Commonwealth)
- Narcotic Drugs Act 1967 (Commonwealth)
- Poisons Act 1964 (WA specific)
- Poisons Regulations 1965 (WA specific)
4
Q
What are the Schedules of drugs in Australia?
A
- Schedule 1: not currently in use
- Schedule 2: Pharmacy medicine
- Schedule 3: Pharmacist only medicine
- Schedule 4: Prescription only OR prescription animal remedy
- Schedule 4R: Restricted prescription medicine
- Schedule 5: Caution
- Schedule 6: Poison
- Schedule 7: Dangerous Poison
- Schedule 8: Controlled drug
- Schedule 9: Prohibited substance
- Schedule 10: substances of such danger as to prohibit sale, supply and use
5
Q
What are the laws around Schedule 8 drugs in hospitals?
A
- drugs are locked in a cabinet
- special inventory is kept
- two nurses to sign for each administration
- S8 balance is checked each shift (every 8hours)
- all imbalances are investigated
- all discarded doses must be recorded
6
Q
What are the 6 rights of medication administration?
A
- right person
- right medication
- right dose
- right time
- right route
- right documentation
7
Q
What are other medication rights that should be considered outside the 6 rights?
A
- right education
- right to refuse
- right assessment
- right evaluation
8
Q
What is the definition of a medication error?
A
Any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in the control of the health care professional, patient, or consumer
9
Q
What are the consequences of medication errors?
A
- harm to the patient (up to and including death)
- psychological harm to the medicine administrator
- lost patient and public trust
- monetary costs
10
Q
What are the most common types of medication errors?
A
- similar-sounding medication names
- administration without a prescription
- the wrong medication
- the wrong dosage (overdose/underdose)
- the wrong patient
- negligent injection
- failure to note an order change
- failure to administer medication (omission)
- failure to discontinue medication
- use of an unsterile needle
- allergic reactions; and
- failure to assure patient taking medications
11
Q
How do you calculate the tablets needed?
A
dose prescribed / stock strength = number of tablets
12
Q
How do you calculate solution dose volume?
A
Dose prescribed / stock strength x stock volume = dose volume (mL)
13
Q
What are the main sources of medication?
A
Natural
- plants
- animals
- minerals
laboratory synthesis
14
Q
What needs to be recorded on a Schedule 8 register?
A
- the name of the patient
- the prescribed drug and dose
- the prescribing doctor’s name
- the date and time of administration
- the signature of two nurses (or a nurse and a doctor) who checked, prepared and gave the drug
- the balance of ampoules/capsules/tablets in supply in the stock cupboard
- wasted or discarded doses
15
Q
How do you calculate IV rates?
A
Total volume prescribed (mL) / Infusion time required (hr) = flow rate (mL/hr)
16
Q
How do you calculate IV rate drop rates?
A
Total volume prescribed (mL / Infusion time required (min) x drop factor = drops per minute
17
Q
What are the drop factors for standard clear solution, blood, and paediatric?
A
standard = 20 blood = 15 paediatric = 60
18
Q
How do you calculate paediatric doses based on body weight?
A
child’s dose = child’s weight (kg) x (per kg per day dose prescribed)
19
Q
What are the common effects of drugs?
A
- therapeutic effect (aka desired effect) - what the drug is designed to do
- side effect - what the drug also does (eg, nausea)
- adverse effects - severe, unwanted side effects
- drug toxicity - damage caused by overdose, ingested medicines meant for external use, or cumulative effects. Drugs where cumulative toxicity is likely, Therapeutic drug monitoring against international normalised ratio (INR) is required.
- drug allergy - immunological reaction to a medication
- anaphylaxis - severe, life-threatening immunological reaction to medication
- drug tolerance - the need for a higher dose to maintain therapeutic effect
- drug interaction - two drugs interact with each other, causing an effect not seen or intended in each individually
- potentiating effect - a drug interaction that enhances the effect of one or both drugs
- inhibiting effect - a drug interaction that inhibits the effect of one or both drugs
20
Q
What are the common symptoms of mild drug allergies?
A
- skin rash
- pruritus (itching)
- angioedema
- rhinitis
- lacrimal tearing
- nausea and/or vomiting
- wheezing and/or dyspnoea
- diarrhoea
21
Q
What are the two types of drug dependence?
A
- physiological - when the body (particularly the nervous system) now needs the drug to function normally
- psychological - when the person now needs the drug to maintain a feeling of emotional/mental wellbeing
22
Q
What is pharmacodymanics?
A
the process by which the drug changes the body. Drugs may be agonist (causes a reaction) or antagonist (prevents a reaction)
23
Q
What is pharmacokinetics?
A
the study of the absorption, distribution, biotransformation and excretion of drugs
24
Q
What is biotransformation?
A
AKA detoxification or metabolism, is a process by which a drug is converted to a less active form
25
What are the different routes of medication administration?
- oral (PO)
- intravenous (IV)
- intramuscular (IM)
- sublingual (subling)
- subcutaneous (subcut)
- rectal
- vaginal
- transdermal
- buccal (cheek)
- topical
- intradermal
- inhalation
26
What are the advantages of oral medication?
- Most convenient
- Usually least expensive
- Safe, does not break skin barrier
- Administration usually does not cause stress
- Some new oral medications are designed to rapidly dissolve on the tongue, allowing for faster absorption and action
27
What are the disadvantages of oral medication?
- Inappropriate for people with nausea or vomiting
- Drug may have unpleasant taste or odour
- Inappropriate when gastrointestinal tract has reduced motility
- Inappropriate if a person cannot swallow or is unconscious
- Cannot be used before certain diagnostic tests or surgical procedures
- Drug may discolour teeth, harm tooth enamel
- Drug may irritate gastric mucosa
- Drug can be aspirated by seriously ill people
28
What are the advantages of sublingual and buccal medications?
- Convenient
- Usually inexpensive
- Safe, do not break skin barrier
- Administration usually does not cause stress
- Drug can be administered for local effect
- More potent than oral route because drug directly enters the blood and bypasses the liver
- Drug is rapidly absorbed into the bloodstream
29
What are the disadvantages of sublingual and buccal medications?
- If swallowed, drug may be inactivated by gastric juice
- Drug must remain under tongue/in the cheek until dissolved and absorbed. May cause stinging or irritation of the mucous membranes
30
What are the advantages of rectal medication?
- Can be used when drug has objectionable taste or odour
- Drug released at slow, steady rate
- Provides a local therapeutic effect
31
What are the disadvantages of rectal medication?
- Dose absorbed is unpredictable
- May be perceived as unpleasant by the person
- Limited use
32
What is the advantage of vaginal medication?
Provides a local effect
33
What is the disadvantage of vaginal medication?
May be messy and may soil clothes
34
What are the advantages of topical medication?
- Few side effects
- Avoids gastrointestinal absorption problems
- Onset of drug action faster than oral
35
What are the disadvantages of topical medication?
- Drug can enter body through abrasions and cause systemic effects
- Leaves residue on the skin that may soil clothes
36
What are the advantages of transdermal medication?
- Few side effects
- Avoids gastrointestinal absorption problems
- Onset of drug action faster than oral
37
What are the disadvantages of transdermal medication?
- Must involve sterile technique because breaks skin barrier
38
What are the advantages of subcutaneous medication?
- Less invasive than intramuscular
| - Easier to educate a person for self-administration
39
What are the disadvantages of subcutaneous medication?
- More expensive than oral
- Can administer only small volume
- Slower than intramuscular administration
- Some drugs can irritate tissues and cause pain
- Can produce anxiety
- Breaks skin barrier
40
What are the advantages of intramuscular medication?
- Can administer larger volume than subcutaneous
| - Drug is rapidly absorbed
41
What are the disadvantages of intramuscular medication?
Can produce anxiety
42
What are the advantages of intradermal medication?
Absorption is slow (this is an advantage in testing for allergies)
43
What are the disadvantages of intradermal medication?
Amount of drug administered must be small
Breaks skin barrier
44
What are the advantages of intravenous medication?
Rapid effect
45
What are the disadvantages of intravenous medication?
Limited to highly soluble drugs
Drug distribution inhibited by poor circulation
46
What are the advantages of inhalation medication?
Introduces drug throughout respiratory tract
Rapid localised relief
Drug can be administered to an unconscious person
47
What are the disadvantages of inhalation medication?
Drug intended for localised effect can have systemic effect
Of use only for the respiratory system
48
What are some of the more common routes for parenteral administration (by injection?)
intradermal—under the epidermis (into the dermis)
subcutaneous (hypodermic)—into the subcutaneous tissue, just below the skin
intramuscular—into a muscle
intravenous—into a vein.
49
What are some of the less common routes for parenteral administration (by injection?)
intra-arterial (into an artery)
intracardiac (into the heart muscle)
intra-osseous (into a bone)
intrathecal or intraspinal (into the spinal canal)
intrapleural (into the pleural space)
epidural (into the epidural space)
intra-articular (into a joint)
50
What are the accepted abbreviations for "in the morning" and "at night"
morning - mane
night - nocte
51
What are the accepted abbreviations for "once a day", "twice a day", "three times a day" and "four times a day"
once - once daily
twice - bd
three - tds
four - qid
52
What are the accepted abbreviations for "as required" and "immediately"?
as required - prn
| immediately - stat
53
Which routes of administration must be written in full?
- epidural
- inhale, inhalation
- intra-articular
- intrathecal
- intranasal
- irrigation
- topical
54
What are the accepted abbreviations for:
- intravenous
- intramuscular
- subcutaneous
- sublingual
- IV
- IM
- subcut
- subling
55
What are the accepted abbreviations for:
percutaneous enteral gastrostomy
naso-gastric
peripherally inserted central catheter
- PEG
- NG
- PICC
56
```
What are the accepted abbreviations for:
oral
nebulised
per vagina
per rectum
```
- PO
- NEB
- PV
- PR
57
Which units of measurement must be written in full?
- International unit(s)
| - unit(s)
58
```
What are the accepted abbreviations for:
gram
milligram
microgram
litre
millilitre
millimole
```
```
g
mg
microg
L
mL
mmol
```
59
What dose forms must be written in full?
- cream
- ear drops
- ear ointment
- eye drops
- eye ointment
- mixture
- powder
- injection
60
```
What are the accepted abbreviations for:
capsule
metered-dose inhaler
pessary
suppository
tablet
patient-controlled analgesia
```
- cap
- inhaler, MDI
- pess
- supp
- tab
- PCA
61
What are the four common types of medication orders?
A stat order indicates that the medication is to be given immediately and only once (e.g. morphine 10 mg IM stat).
The single order or once only order is for medication to be given once at a specified time (e.g. phenobarbital 100 mg before surgery).
The standing order may or may not have a termination date. A standing order may be carried out indefinitely (e.g. multiple vitamins daily) until an order is written to cancel it or it may be carried out for a specified number of days (e.g. morphine 10 mg IM every 4 hours × 5 days).
A prn order, or as-required order.
62
What are the essential elements of a drug order?
Full name of the person.
Date and time the order is written.
Name of the drug to be administered.
Dosage of the drug.
Frequency of administration.
Route of administration.
Signature of the person writing the order.
63
What do NIMC and MAR mean?
- National Inpatient Medication Chart
| - Medication Administration Record
64
What do you do if you believe a medication order is unclear, inaccurate, or unusual?
Contact the doctor and discuss the rationale for believing the medication or dosage to be inappropriate.
Document in notes the following: when the doctor was notified, what was conveyed to the doctor and how the doctor responded.
If the doctor cannot be reached, document all attempts to contact the doctor and the reason for withholding the medication.
If someone else gives the medication, document data about the person’s condition before and after the medication.
If an incident report is indicated, clearly document factual information.
65
In what ways is medication administration affected in the elderly?
Altered memory.
Decreased visual acuity.
Decrease in renal function, resulting in slower elimination of drugs and higher drug concentrations in the bloodstream for longer periods.
Less complete and slower absorption from the gastrointestinal tract.
Increased proportion of fat to lean body mass, which facilitates retention of fat-soluble drugs and increases potential for toxicity.
Decreased liver function, which hinders biotransformation of drugs.
Decreased organ sensitivity, which means that the response to the same drug concentration in the vicinity of the target organ is less in older people than in the young.
Altered quality of organ responsiveness, resulting in adverse effects becoming pronounced before therapeutic effects are achieved.
Decrease in manual dexterity due to arthritis and/or decrease in flexibility.
66
What are the 3 medication checks a nurse performs before administering medication?
check the label on the medication:
1- when it is taken from the medication trolley,
(2) before withdrawing the medication, and
(3) after withdrawing the medication.
67
What are the three sites for intramuscular injections?
- deltoid
- gluteal
- quadricep
68
Why is the ventrogluteal muscle a preferred site for IM injections?
contains no large nerves or blood vessels
provides the greatest thickness of gluteal muscle consisting of both the gluteus medius and gluteus minimus
is sealed off by bone
contains consistently less fat than the buttock area, thus eliminating the need to determine the depth of subcutaneous fat.
69
Which muscle groups are suitable IM injection sited in the quadricep?
rectus femoris
vastus lateralis
70
Which muscle groups are suitable IM injection sited in the gluteus?
ventrogluteus
| dorsogluteus
71
What site is the preferred IM injection site for infants?
vastus lateralis
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