Oral Medication Lab

Theory Slides and Preparation for Lab

September, 2024
Oral Medications Lab Theory
 Giving Meds
• One of the most important and dangerous
nursing responsibilities that you will have

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• Giving medications is one of those skills that
nurses practice frequently
• About 7% of patients reports a drug error
• UNB students make errors
 “It’s Not Just Giving a Pill”
• Knowledge about the drug
• Assessment skills
• Skill to prepare and
administer
• Teaching and learning skills
 Pharmacology
Pharmacology is the branch of science that studies drugs and their

The science or
interactions with living organisms. It encompasses the discovery,
development, composition, effects, and uses of drugs, as well as how they
interact with the body and biological systems.

study of drugs
Key Areas of Pharmacology:
1. Pharmacodynamics:
• Focuses on what the drug does to the body, including the

and their effects

mechanisms of action and the biological effects.

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2. Pharmacokinetics:
• Examines what the body does to the drug, including absorption,
distribution, metabolism, and excretion (ADME).

on living 3. Therapeutics:
• The study of how drugs are used to prevent, treat, or manage
diseases.
4. Toxicology:

organisms • The study of the harmful effects of drugs and chemicals on the body.
5. Pharmacogenomics:
• Explores how genetic differences affect individual responses to
drugs.
6. Clinical Pharmacology:
• The application of pharmacology principles in clinical settings to
optimize drug use and patient outcomes.

Importance of Pharmacology:

Pharmacology is essential for understanding how drugs work, ensuring

their safe and effective use, developing new treatments, and managing
adverse effects. It bridges multiple disciplines, including biology, chemistry,
Giving Meds: Requires a Synthesis
of Knowledge Coming Together
– Pharmacology
– Pharmacokinetics
– Human growth and development
– Pathophysiology
– Psychology
– Nutrition
– Mathematics
– CRITICAL THINKING!
Nursing
Responsibilities:
•Preparing
•Administering
•Teaching
•Evaluating

•Nursing Process
 Drug Information
- Pharmacopoeia – a book (drug reference) that
lists names of medications and a description of
the products. In Canada- (CPS 2024)
Compendium of Pharmaceuticals and
Specialities
- Various drug handbooks
- Nursing or medical Journals
- Hospital or community pharmacies
 Names, Names, Names
• N-acetyl-para-aminophenolol

• Do you know what this is?

• In general, nurses do not need to know the

chemical names for medications
 Drug Names
• Trade (proprietary or brand) – usually a
trademark. How the drug is marketed.
• Chemical – helpful to chemists and engineers
• Generic – the official name of the drug and
recorded in pharmacopoeia. Typically
prescribers use these names. It will usually
appear on packaging
 Drug Administration and the Law
The Food and Drug Act (Health Canada- HPB)
- New medications - standards of composition,
strength, potency, purity, quality, etc.

Controlled Drugs Loading…

and Substances Act
- Drugs that affect the mind
- Enforcement by police
 OTC
• Over-the-counter
• All approved drugs have a DIN
• Herbal meds and supplements may not
• All substances have some effect on the body
• Potential for serious interactions
 Pharmacokinetics
• Absorption
• Distribution
• Metabolism
• Elimination
Pharmacokinetics refers to the study of how the body absorbs, distributes, metabolizes, and excretes a drug. It focuses on what the body does to the drug and
is often summarized with the acronym ADME:
1. Absorption:
• How the drug enters the bloodstream after administration (e.g., through the stomach, intestines, skin, or lungs).
2. Distribution:
• How the drug moves from the bloodstream into tissues, organs, and cells.
• This depends on factors like blood flow, protein binding, and the ability of the drug to cross cell membranes (e.g., the blood-brain barrier).
3. Metabolism:
• How the drug is chemically altered in the body, usually by the liver.
• Metabolism often converts the drug into more water-soluble forms for easier elimination.
4. Excretion:
• How the drug or its metabolites are eliminated from the body, typically through urine (kidneys), bile (liver), sweat, or breath.

Key Terms in Pharmacokinetics:

• Half-Life (t½): The time it takes for the concentration of the drug in the blood to decrease by half.
• Bioavailability: The proportion of the drug that enters the circulation and is available to have an effect.
• Clearance: The rate at which the drug is removed from the body.

Pharmacokinetics helps answer the question: What does the body do to the drug, and how long does it stay active?
 Pharmacodynamics
• Therapeutic Effect Pharmacodynamics refers to the study of how a drug affects the body. It explains
the biochemical and physiological effects of a drug, including:

• Side-Effects 1. Mechanism of Action: How the drug interacts with receptors, enzymes,
or other cellular targets to produce its effects.
2. Drug Effects: The therapeutic effects (desired outcomes) and side
effects (undesired outcomes) of the drug.

• Adverse Reactions 3. Dose-Response Relationship: How the intensity of the drug’s effect
changes with different doses.

In simple terms, pharmacodynamics answers the question: What does the drug do

• Toxic Effect to the body, and how does it do it?

For example, in the case of oxazepam:

• It binds to GABA-A receptors in the brain.

• Synergistic Effect • This enhances the inhibitory effects of GABA, leading to sedation, anxiety
relief, and muscle relaxation.

Let me know if you’d like more details!

• Allergic Reactions
 Synergistic Effect
• Synergistic Effect – when 2 or more drugs have
a combined effect that is greater than the effect
of the medications given separately

• Tylenol #1 =
Acetaminophen + codeine +
caffeine
 • Onset of Action
Actions of • Peak Plasma Level
Drugs on • Half Life (t ½)
the Body • Plateau (or therapeutic
concentration)
• Can a patient refuse a medication?
 3 Conditions to Give a Medication
• A valid medication order
• A licensed prescriber
• The nurse must be knowledgeable regarding
the medication to be given
 Terminology
• Classification – a grouping of medications
based on how they work on the body
• Form – engineering for best absorption and
function:
– EC – won’t dissolve in stomach
– Aq – Aqueous suspension
– SR/XR – sustained/extended release
– S/L - sublingual
 Many Medication Forms
Aerosol spray or foam Lotion
Aqueous solution Lozenge
Aqueous suspension Ointment
Caplet Paste
Capsule Pill
Cream Powder
Elixir Suppository
Extract Syrup
Enteric coated Tablet
Gel or jelly Tincture
Inhalation Transdermal
Liniment
Many Routes of Administration
• Oral
• Sublingual
• Buccal
• Rectal/Vaginal
• Topical
• Transdermal
• Parental
• Ophthalmic
 Types of Medication Orders
Standing or Routine
Single Dose or One Time Dose
Stat
PRN “Pro Re Nata”
Protocol
 Parts of a Medication Order
• Client
• Date
• Time
• Name of medication
• Dosage
• Frequency
• Administration Route
• Signature of person writing order
 How to Read a Drug Label
Trade name
Generic name
Form of the medication
Dosage strength
Route of administration
Instructions for mixing
Recommended dose
Expiration date
 Drug Calculations:
1. Convert to units of measurement (ml, mg,
etc.)
Three Steps
2. Estimate the answer. Think....Is it
reasonable?
3. Calculate by using the formula
D (dose ordered) x Q (amt. on hand) = amt. given
H (dose on hand)
D = dose ordered/prescribed
H = dosage you have on hand/supplied/on label
 An Oral Antibiotic
The order reads Keflex 0.5 G po q6h. The supply
dosage is labelled Keflex 500 mg per capsule
How many capsules are given?
 An Oral Antibiotic
The order reads Keflex 0.5 G po q6h. The supply
dosage is labelled Keflex 500 mg per capsule
Convert to same measurement:
1 gram = 1000 mg
D (desired) x Q (quantity) = amount given
H (have)
500mg x 1 capsule = 1 capsule
500mg
….you give 1 capsule
 A Diuretic
The order reads Lasix 10 mg po bid. The
medication is supplied in 20 mg tablets.

How many tablets are given?

 A Diuretic
The order reads Lasix 10 mg po bid. The
medication is supplied in 20 mg tablets.

How many tabletsLoading…

are given?
D (desired) x Q (quantity) = amount given
H (have)
10 x 1 = ½ tab given
20
 An Antipsychotic
The order reads Risperdal 3 mg PO TID. Give as
liquid. The supply dose is labelled risperidone
tartrate 1 mg/5 ml.
How many mls are given?
 An Antipsychotic
The order reads Risperdal 3 mg PO TID. Give as
liquid. The supply dose is labelled risperidone
tartrate 1 mg/5 ml.
How many mls are given?
DxQ=?
H
3 mg x 5 ml = 15 ml is given
1 mg
 Administering Medication Safely:
The “10” Rights
1. Right medication
2. Right dose
3. Right patient
3. Right route
4. Right time
5. Right documentation
• reason, refusal, teaching, & evaluation
Steps of Medication Administration
• Identify the client (2 ways)
• Client assessment/allergies
• Inform the client
• Administer the medication
• Provide other interventions
• Record medication administered in MAR
• Evaluate the client’s response to the drug and
record in the chart
Oral Medication Lab Preparation
The scenario
• Your patient was admitted to a
hospital unit after presenting to a
primary care clinic with a sudden
worsening of longstanding
Congestive Heart Failure (CHF).
Your patient experiences chronic
constipation, is anxious getting to
sleep. Less than a week ago your
patient started antibiotics for a lung
infection. The medications are as
 follows:

• Lasix 40mg PO BID

• Amoxil 500 mg PO BID
• Digoxin 0.25 mg PO OD
• Lactulose 10 grams BID
• Serax 30 mg qHS
• Tylenol pl i-ii q4h prn
Prepare for giving these 2
medications
• Digoxin
• Serax (oxazepam)

• As a student, how to I learn a 7

commit to memory medication
information?
Reference Materials
• See Lab Preparation Guide
• Drug Guides
● Lippincott
● Davis
• Electronic Resources
● http://www.lib.unb.ca
 Medication Regime
Medication How does it Why is this What is the List two Relevant Nursing
Name and work? (in your patient on this safe dosage (2) Considerations
Classificatio own words) medication? range? common (specific nursing
n Side actions pre/post
(In clinical, is
Effects administration,
the dose
(primary with food or not,
prescribed
action side crush or not, any
within this
effects are specific
range?)
an information to
extension include when
of the teaching patient,
intended etc...)
action)

Digoxin
Drug Cards?
• Helpful to learn client’s medications
• As an ongoing reference
• Index cards are convenient
• Use the various online resources as
well as your own drug book
Look for the following info
• Generic & trade name(s)
• Drug class
• Therapeutic action(s)
• Indication(s)
• Normal dosage range
• Possible side effects
• Adverse reactions
• Contraindications
• Nursing considerations
 CARD #1

Study Guide for Digoxin Study Guide for Serax (Oxazepam)

Generic & Trade Name(s): Generic & Trade Name(s):

• Generic Name: Digoxin • Generic Name: Oxazepam
• Trade Names: Lanoxin, Digitek • Trade Name: Serax

Drug Class: Drug Class:

• Cardiac Glycoside • Benzodiazepine

Therapeutic Action(s): Therapeutic Action(s):

• Increases the force of myocardial (heart muscle) contractions (positive inotropic effect). • Enhances the effects of gamma-aminobutyric acid (GABA), a neurotransmitter that inhibits activity in the central
• Decreases heart rate by slowing conduction through the atrioventricular (AV) node (negative chronotropic nervous system (CNS).
effect). • Provides anxiolytic (anti-anxiety), sedative, and muscle-relaxing effects.
• Improves cardiac output and efficiency.
Indication(s):
Indication(s): • Management of anxiety disorders or short-term relief of anxiety symptoms.
• Heart failure (to improve symptoms and quality of life). • Acute alcohol withdrawal to manage agitation and tremors.
• Atrial fibrillation (to control ventricular rate). • Insomnia associated with anxiety.
• Atrial flutter (to control rate in certain cases).
Normal Dosage Range:
Normal Dosage Range: • Adults with Anxiety: 10–30 mg, 3–4 times daily as needed.
• Adults: 0.125 mg to 0.25 mg once daily. • Alcohol Withdrawal: 15–30 mg, 3–4 times daily.
• Adjust dosage in older adults or those with impaired renal function. • Dosage should be individualized based on the patient’s response and condition.
• Therapeutic serum digoxin level: 0.5 to 2.0 ng/mL.
Possible Side Effects:
Possible Side Effects: • Drowsiness or sedation
• Fatigue • Dizziness
• Dizziness or headache • Fatigue
• Nausea or vomiting • Impaired coordination or ataxia
• Diarrhea • Memory impairment
• Visual disturbances (e.g., blurred vision, yellow-green halos)
Adverse Reactions:
Adverse Reactions: • Respiratory depression, especially when combined with alcohol or other CNS depressants.
• Digoxin toxicity: Symptoms include severe bradycardia, arrhythmias, confusion, and visual changes. • Dependence or withdrawal symptoms with prolonged use or abrupt discontinuation.
• Life-threatening arrhythmias: Ventricular fibrillation or tachycardia. • Paradoxical reactions: Increased agitation, restlessness, or anxiety (rare).
• Severe hypokalemia or hyperkalemia: May exacerbate toxicity. • Severe sedation in elderly or debilitated patients.

Contraindications: Contraindications:
• Hypersensitivity to digoxin. • Hypersensitivity to oxazepam or other benzodiazepines.
• Ventricular fibrillation or tachycardia not caused by heart failure. • Severe respiratory insufficiency or sleep apnea.
• Hypokalemia, hypercalcemia, or severe hypomagnesemia (may increase risk of toxicity). • Acute narrow-angle glaucoma.
• Advanced AV block without a pacemaker. • Caution in patients with a history of substance abuse or addiction.
• Severe renal impairment without dosage adjustment.
Nursing Considerations:
Nursing Considerations: 1. Pre-Administration:
1. Pre-Administration: • Assess for symptoms of anxiety, agitation, or withdrawal.
• Check apical pulse for 1 full minute. Hold the dose if the pulse is: • Obtain a history of substance use or potential dependence.
• <60 bpm in adults. • Monitor baseline liver function, as oxazepam is metabolized in the liver.
• <70 bpm in children. 2. Post-Administration:
• <90 bpm in infants. • Monitor for excessive sedation, dizziness, or respiratory depression.
• Assess baseline potassium, magnesium, and calcium levels (imbalances increase toxicity risk). • Observe for signs of dependency or misuse in long-term therapy.
• Ensure recent serum digoxin level is within the therapeutic range. • Watch for paradoxical reactions (e.g., increased anxiety or agitation).
2. Post-Administration: 3. Administration:
• Monitor for signs of digoxin toxicity: nausea, vomiting, confusion, visual changes, and bradycardia. • Administer orally with or without food; giving with food may reduce gastrointestinal upset.
• Regularly check electrolyte levels, renal function, and digoxin serum levels. • Do not crush or chew tablets unless specified.
3. Administration: • Avoid abrupt discontinuation after prolonged use to prevent withdrawal symptoms.
• Administer at the same time daily. 4. Patient Teaching:
• May be taken with or without food, but avoid high-fiber meals as they can decrease absorption. • Instruct patients to avoid alcohol or other CNS depressants while taking oxazepam.
4. Patient Teaching: • Warn about possible drowsiness and advise against driving or operating machinery until they know how the drug
• Teach the patient how to check their pulse and when to hold the medication. affects them.
• Instruct to report symptoms of toxicity (e.g., nausea, vision changes, or palpitations). • Emphasize taking the medication exactly as prescribed to avoid dependence.
• Warn against using over-the-counter medications without consulting their provider, as many can interact with • Teach patients to report worsening anxiety, mood changes, or signs of misuse.
digoxin. 5. Special Considerations:
5. Special Considerations: • Use cautiously in elderly patients, as they are more susceptible to sedation and falls.
• Use cautiously in elderly patients or those with renal impairment due to slower drug clearance. • Oxazepam is preferred in patients with liver impairment because it does not require oxidative metabolism.
• Digoxin has a narrow therapeutic window, so frequent monitoring is critical. • Avoid long-term use due to the risk of dependency and tolerance.