Question:
- Maintenance of health and hygiene, checking of the vital signs, correct documentation, Privacy and confidentiality of the clinical data
- Protect the community from farm of medicines and chemicals by imposing boundaries on storage, prescription and supply (Crisp et al.,2016).
- It is a national classification system for controlling the dissemination of the medications to the public.
- a) Schedule 2-Cocaine
- b) Schedule 3 -Acetaminophen
- c) Schedule 4 –alprazolam
- d) Schedule 8 –Nabiximols
- a)Capsules: stored in bottles in a cool and dry place.
- b) Drops- cool and dry place, some inside refrigerators.
- c) Inhalants:should be stored at room temperature.
- d) Liquid medication: in a storage box in a cool and dry place
- e) Lotions and creams: stored in containers or tubes in cool and dry place.
- f) Ointments: stored in collapsible squeeze tubes of plastic or metals.
- g) Patches: should be stored at room temperature away from light and moisture.
- h) Powders: stored at room temperature in dry place
- i) Tablets: In original bottles in cool and dry place.
- j) Wafers: should be stored in wafer box desiccators.
- k) Suppositories: Dry and cool place.
- pharmacodynamics- It is the study that deals with how a drug affects the organism.
Pharmacokinetics- It deals with the circulation, bioavailability, metabolism, distribution and excretion of the drug in the body of an organism.
Pharmaco-therapeutics-It is the clinical purpose of a given drug.
- Polypharmacy- It is the use of a large number of medication; more than five, due to many underlying medical conditions. It is used mainly in elderly.
Elderly people can have more than one co-existing medical conditions that needs different medications. Polypharmacy can cause adverse drug reactions by interacting with other drugs (Gatford & Phillips, 2012).
- Drug metabolism- First pass effect is a phenomenon of metabolism of drugs, where the drug concentration is reduced to a considerable extent before reaching the systemic circulation. It is that fraction of drug that is depleted during the absorption by the liver and the gut wall.
Drug excretion- There is several routes of drug excretion. Majority of the drug are excreted by the renal pathway. Drugs that are lipid soluble does not undergo renal excretion but undergo hepatic metabolism. Drugs entering the hepatic solution can enter the bile and may excrete from duodenum.
- Half-life of a drug- It is the time required to reduce the concentration of the drug to its half. The plasma half life of a drug depends upon how the drug is removed from the plasma.
Drug needs a minimum plasma concentration for showing its effect. The half life of a drug is directly proportional to the volume of distribution of the drug and is inversely proportional to the clearance of the drug (Kizior & Hodgson, 2018).
Half life = 0.693 x Vd/ total body clearance
Alpha half life = plasma / distribution half life
Beta half life = tissue / elimination half life
- After a drug is taken orally, it passes through the liver before absorbing into the blood stream. It is the bloodstream that carries the drug through the body.
- It is the fraction of a drug dose that is absorbed from its administration site and is transported to the systemic circulation in an unchanged form.
The route of the administration determines the amount of the administered dose absorbed in the circulation. When it is added orally the physicochemical property of the drug determines the dissolution in the lumen of the intestine.
- Drug receptors are located in the cell membrane and ae the target site for the drugs.
Drug receptor interaction can involve all known types of bonds such as hydrogen bond, Vander Waals bond.
Agonist- Agonists are those drugs which causes activation of the receptors by binding them. They are capable of producing chain reactions bringing about drug effect.
Antagonist- These drugs binds the receptors but cannot activate them and also prevents agonist binding. Example phenoxy benzamine blocks the catecholemines at the beta receptors.
- Drug toxicology – drug toxicology is a test to detect the approximate amount of illegal or legal drugs in a body.
Anaphylactic reaction – It is a sudden, lethal, and widespread allergic reaction causing symptoms like itching, swelling, hives , respiratory problem and often life threatening condition. It is caused by the exposure of the immune system to something allergic that causes the secretion of immunoglobin E to bind the antigen causing allergic reaction.
Adverse reaction – Adverse reaction is the lethal condition that can be caused in a patient due to many reasons such as allergic drugs, improper treatment and lot more.
Contraindications- It is a condition or the factor due to which a medication, surgery or a procedure should be withheld.
Precautions –Precaution refers to the preventive measures against certain conditions.
Side effects- Side effects refers to the ill effects of something such as ill effects of drug.
- Right medication (drug, medication, medicines)
Right dose- Incorrect dosage may cause side effects and few drugs have narrow therapeutic index hence correct dosage should be followed.
Right route- different medications have specific sites of administration and hence should be strictly followed.
Right time- Medications have to be applied at correct timing to gets its therapeutic value.
Right person- Administration of wrong medications may lead to adverse reaction and even mortality.
Right expiration date- Use of expired medications may cause dangerous clinical condition including death.
Right to refuse- patient has got the autonomy to reject any treatment incase no fruitful outcome is got.
Right prescription (documentation)- Every patient has got the right to get a written information that can act as a legal information and can also help the patients to understand the treatment regimen.
- Oral medications- Taken through mouth. Ex- Aspirin
Sublingual, Buccal- Medicine is placed under the tongue to be absorbed by the body. Ex- Barbiturates
Dry Powder inhalers-It is a device that delivers the medication to the lungs. Ex- Asmanex
Metered dose inhalers- It delivers in the form of a short burst of aerosolized medicine to the lungs. Ex- Ipratropium bromide
Nebulisers- delivers medicine in the form of mist to the lungs. Ex- Formoterol
Oxygen therapy- with the help of face masks.
Subcutaneous injections- short needle used to inject the drug into the tissue layer. Ex- Insulin
Intramuscular injections- Given directly into the muscles. Ex- Haloperidol
Z – Track injections- injection given in the muscles to stop the medication into the subcutaneous tissue. Ex- Haloperidol
Enteral administration – percutaneous gastrostomy (peg) as well as nasogastric tubes – A tube placed in to the stomach or duodenum through nose. Ex- NSAID
Intranasal, including nebulizer medications- deposits drugs to the nasal and paranasal sinus cavities.Ex- Antihistamine.
Ocular- 3 methods are there for the delivery of ocular medications topical, local ocular and systemic.Ex- Xalatan.
Rectal –Administered through anus to the rectum. Ex- Diazepam
Sub-cutaneous injection using pre-loaded syringes or pens- The medication is injected just under the skin with the help of a small needle. Ex- Insulin
Topical, including transdermal – Transdermal patch is kept on the skin for delivering special kind of medications through the skin into the blood stream. Ex- Corticosteroids.
Vaginal- suppository medicine is applied through the vagina or anus. Ex-Clindamycin
Ventrolateral injection technique- The injection is given at a 90 degree angle in the ventrogluteal site.
- Generic names vary by manufacturers and are cost effective than the trade name of the drug.
Chemical name indicates the atomic and the molecular structure of the drug.
Ex. Of a Paracetamol- Acetaminophen
- BETA- BLOCKERS- Manage abnormal heart rhythms by blocking the norepinephrine from binding the beta receptors. Ex- Acetabutolol (Sectral)
Side effects-Diarrhea, stomachs cramps.
CALCIUM CHANNEL BLOCKERS- Treats high blood pressure, chest pain by widening the blood vessels by influencing the muscle cell of the arterial walls (Sheehay, 2013). Ex- Amlodipine (Norvasc).side effects: Lightheadedness, Low blood pressure, slower heart rate, Drowsiness.
ANTI-HYPERTENSIVE- Used to treat hypertension. They can be beta blockers, Calcium channel blockers. Ex- Diuretics, calcium channel blocker. Side effects- Cough, Diarrhea or constipation, Dizziness or lightheadedness, Erection problems. Ex- Bumetanide.
DIURETICS- Increases the excretion of water from the body as urine. Ex- methazolamide.
Side effects: Hypovolemia, metabolic alkalosis, hypotension.
ANTI-CHOLESTROL- Naturally occurring antibody to cholesterol that protects animals from harmful LDL and HDL cholesterol. Ex- Atorvastatin (Lipitor)
Side effects: Liver damage, muscle damage, neurological side effects.
ANTI-CLOTTING- They reduce coagulation of blood by inhibiting the coagulation cascade by the clotting factors. Ex- Warfarin (Coumadin)
Side effects- Bleeding, bruises
SEDATIVES – They are used as hypnotic for inducing sleep by affecting the neurotransmitter, decreasing the brain activity. Ex- Clonazepam (Benzodiazepines)
Side effects: May cause physical and psychological dependence, drowsiness.
ANTIDEPRESSANTS: Used to treat depressive disorders like dysthymia and anxiety by balancing the neurotransmitters affecting the moods and emotions. Ex- Adapin (doxepin)
Side effects: Nausea, fatigue, insomnia.
ANTIPSYCHOTICS: Used for managing psychosis by blocking the receptors of the chemical messengers like Serotonin and Dopamine. Ex- aripiprazole (Abilify)
Side effects: Weight gain, high cholesterol level.
ANTIBIOTICS: Used to treat bacterial infection by destroying the bacterial growth or metabolism. Ex- Quinolones (Fluoroquinolones)
Side effects: Allergies, antibiotic associated diarrhea.
VITAMINS/MINERALS: Vitamin is used in the body to carry out certain reactions. example Vitamin A’s role is to produce retinal which is used by the rod and the cone cells of the eye to produce vision. Ex- Riboflavin.
Side effects: Multivitamin products contain certain minerals that can cause increased urination, tooth staining.
ANTI-REFLUX: They act as a proton pump inhibitor by decreasing the secretion of excess acid. Ex-Nexium.
Side effects: Persistent diarrhea, abdominal pain.
ANTI-EMETICS: protects the lining of the stomach and helps in suppressing the vomiting reflex. Ex- Meclizine (Bonine, Antivert)
Side effects: Drowsiness, dizziness.
ORAL HYPOGLACEMICS: Used in the treatment of Type 2 diabetes by lowering the glucose level in the blood.
Ex- Glimeoiride (Sulfonylureas)
Side effect: skin rash, upset stomach.
APERIENTS: To prevent constipation.Ex- constulose (Senna)
Side effects: Increased dehydration, chronic constipation, increased risk of colon cancer.
INHALED MEDICATIONS: Medications are inhaled into the lungs in the form of dry powder or mists to treat symptoms of COPD and Asthma. Ex- Aerolizer
Side effects: Thrush and hoarseness.
ANALGESICS: Used against pain, by the blockage of the enzyme controlled synthesis of the Prostaglandins. Ex- Aspirin.
Side effects: stomach upset, constipation, drowsiness.
RESPIRATORY MEDICATIONS: Used to prevent respiratory disease such as asthma, bronchitis, pneumonia. Ex- EpiPen (Epinephrine).
Side effects: vomiting, insomnia, irritability.
ANTI-INFLAMATORY: Used for alleviating pain by counteracting with the enzyme cyclogenase. Ex- Ibuprofen
Side effects: Heart burn, stomach pain.
ANESTHETICS: to prevent pain during the surgery by blocking the nerve and preventing the nerves from carrying the brain signals. Ex- Propofol
Side effects: Memory loss, temporary confusion, urination difficulty.
ANTI-VIRAL: Used to treat viral diseases by blocking the viral life cycle. Ex- Acyclovir.
Side effects: Nausea, stomach pain.
OPHTALMIC : They are applied in the eyes to kill infectious agents and prevent it from spreading. Ex- Iquix (Levofloxacin).
Side effects: Itching, burning sensation in eyes.
ANTI- PARKINSONS: Used to treat the symptoms of Parkinson’s diseases by increasing the activity of Dopamine. Ex- Apomorphine.
Side effects: Mild nausea, heartburn, constipation.
ANTI-EPILEPTIC: Used against epileptic seizures by decreasing the excessive electrical activity of the neurones .Ex- Acetazolamide.
Side effects: dizziness, nausea, vertigo.
CONTRACEPTIVE MEDICATIONS: They are manmade Estrogen and Progesterone hormones that are used to inhibit the body’s natural hormones for preventing pregnancy (Kelly, 2012).
Side effects: Mood swings, fungal infection, breast tenderness.
Scenario 1
Pain medication- codeine and morphine can be given in order to manage the pain.
Oxycodone is applied orally. It is a semi synthetic and moderately potent drug that is used to manage pain.
Alternative therapy- Foot reflexology.
PRN chart
Paracetamol-Analgesics
Oxicodone- Narcotic (analgesics)
Metoclopramide- Prokinetic drugs.
All the medications should be stored in a cool and dry place.
I will be reporting the matter of shortage of drugs to the RN or will inform the hospital pharmacy.
Scenario 2
Patient may refuse medication due to its obnoxious taste or due to its side effects like stomach irritation or nausea.
I will report this matter to the RN or will consult with the doctors to give alternative medicines.
I will discuss the effectiveness of amoxicillin as penicillin and amoxicillin belongs to the same class and may have similar adverse effects.
Scenario 3
Education plan about medicines
Mode of action of Metformin -It reduces the amount of glucose released by the liver and makes the body responsive to insulin.
Actrapid -It is fast acting insulin that is administered subcutaneously.
Mr. Larson would continue taking insulin as it would help to control the blood glucose level by transporting the glucose to the cells.
It is necessary to include Mr. Larson’s family in the education plan because families will be able to take care of him as per the treatment regimen.
Mr. Larson’s diet included non-glycemic food such as Low calorie diet, low carbohydrate diet such as green leafy vegetables, cinnamons, and yogurt, Cessation of smoking and alcohol habits.
Mr. Larson’s life style such as his alcohol consumption and diet can affect his treatment.
Referrals should be made to podiatrists, dieticians and clinical psychologists.
References
Crisp, J. Douglas, C. Rebeiro, G. Waters, D. (2017) Potter & Perry’s Fundamentals of Nursing – Australian Version, (5th Edition) Elsevier, ISBN: 978-0-323-32740-4
Gatford, J. & Phillips, N. (2012). Nursing Calculations (9th Ed.). Australia: Churchill Livingstone., ISBN 978-0-70206231-5
In Koutoukidis, G., In Stainton, K., & In Hughson, J. (2017). Tabbner’s nursing care: Theory and practice.
Kelly, T. (2012). Clarke’s analysis of drugs and poisons.
Kizior, R. J., & Hodgson, B. B. (2018). Saunders Nursing Drug Handbook 2018. St Louis: Elsevier.
Law, V., Knox, C., Djoumbou, Y., Jewison, T., Guo, A. C., Liu, Y., … & Tang, A. (2013). DrugBank 4.0: shedding new light on drug metabolism. Nucleic acids research, 42(D1), D1091-D1097.
Perry, A.G. Potter, A.P. & Ostendorf, R. W. (2016). Nursing Interventions & Clinical Skills. (6th Ed.). St. Louis: Elsevier
Peterson, V., Stockert, P., Hall, A., Perry, G., & Potter, P. (2017). Clinical companion for fundamentals of nursing (9th ed.). St.Louis: Elsevier.
Sheehay, S. B. (2013). Sheehay’s MAnual of Emergency Care. (7th Ed.). St. Louis: Elsevier, ISBN 978-0-323-07827-6
Skidmore-Roth, L. (2016). Mosby’s 2016 Nursing Drug Reference (29th ed.). St Louis: Mosby.
Williams, P. (2016). Medications and Older Adults. (6th Ed.).St. Louis:Elsevier
