1:02:51
19th PHARM REVIEW!!!! 4.20.2026 @DR. DJAMINA HANDOJO (INA)
Djamina Handojo
Overview
This video provides a comprehensive review of various medications and administration techniques relevant to nursing practice. It covers essential concepts such as patient assessment, prioritization (ABC, stat orders, pain management), and safe medication administration routes (optic, nasal, otic, rectal, IM, intradermal, subcutaneous, NG/G tubes). The lecture details specific drug classes including anticholinergics, antihypertensives, diuretics, vasodilators, antiplatelets, anticoagulants, hematological agents, antibiotics, antivirals, antifungals, anti-Parkinsonian drugs, and medications for gout, TB, and alcohol withdrawal. Emphasis is placed on understanding drug mechanisms, common side effects, adverse reactions, contraindications, and key nursing considerations for each medication or class.
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Chapters
- Prioritize patient assessment before intervention, unless the situation is life-threatening.
- Utilize the ABCs (Airway, Breathing, Circulation) for patient prioritization.
- Understand various medication administration routes and their specific techniques, such as pressing the nasolacrimal duct for eye drops or pulling the earlobe down and back for children.
- Ensure medications are at room temperature before administration, especially ear drops.
- Confirm NG/G tube placement via X-ray and monitor gastric pH (4 or less) to prevent respiratory aspiration.
These fundamental principles and techniques are crucial for ensuring patient safety and medication efficacy, forming the basis of safe nursing practice.
For ear drops, remember 'D' for Down and Back for children, and 'U' for Up and Back for adults.
- For rectal suppositories, ensure the rectum is free of stool and instruct the patient to retain the suppository for at least 20 minutes.
- Intramuscular (IM) injections are typically given at a 90-degree angle; aspiration is necessary for certain sites like the dorsogluteal to avoid blood vessels and nerves, but not typically for the vastus lateralis.
- Intradermal injections (10 degrees) aim to create a 'wheal,' while subcutaneous injections (45 degrees) are often used for insulin and heparin.
- When administering medications via NG/G tube, flush with 30ml of warm water before and after to prevent clogging.
- Proton pump inhibitors (PPIs) with granules, like omeprazole, should not be crushed; mix granules with applesauce or apple juice before administration via NG/G tube to prevent clogging.
Understanding the nuances of each administration method prevents complications, ensures proper drug absorption, and enhances patient comfort and safety.
When administering omeprazole granules via NG tube, mix with a little applesauce or apple juice to break down the granules and prevent clogging.
- Always verify patient identity using at least two identifiers (e.g., full name and date of birth) against their wristband.
- Avoid dangerous abbreviations (e.g., U for unit, QD, QOD, trailing zeros like 10.0) to prevent misinterpretation.
- Repeat verbal orders back to the prescriber to confirm accuracy of medication, dosage, route, and time.
- Recognize drug classes by their common suffixes, such as '-olol' for beta-blockers, '-pril' for ACE inhibitors, and '-sartan' for ARBs.
Minimizing medication errors through vigilant practices and understanding drug nomenclature is paramount for patient safety and effective treatment.
Instead of '10.0 mg,' write '10 mg' to avoid confusion with '100 mg' if the decimal point is missed.
- Anticholinergic medications cause 'dry, dry, dry' effects (dry mouth, dry eyes, urinary retention, constipation) and should be used cautiously in patients with conditions like BPH.
- Beta-blockers ('-olol') can cause bradycardia; hold if the patient's heart rate is below 60 bpm.
- ACE inhibitors ('-pril') can cause a dry cough and hyperkalemia; Angiotensin Receptor Blockers ('-sartan') may cause muscle pain.
- Calcium channel blockers should be used cautiously in patients with heart failure.
- Diuretics like spironolactone retain potassium (risk of hyperkalemia), while furosemide and hydrochlorothiazide excrete potassium (risk of hypokalemia).
Understanding the specific actions and contraindications of these drug classes is vital for preventing adverse effects and managing cardiovascular and other conditions effectively.
Patients on anticholinergic drugs may need sugarless gum or hard candy for dry mouth and eye drops for dry eyes.
- Nitroglycerin (vasodilator) can cause dizziness and headache; administer sublingually for acute chest pain, ensuring the patient is seated and has a sip of water if needed.
- Aspirin is used as an antiplatelet for heart attack prevention, not primarily for pain relief in that context.
- Monitor PTT for heparin and PT/INR for warfarin (Coumadin) when administering anticoagulants.
- Protamine sulfate is the antidote for heparin and enoxaparin toxicity, while Vitamin K is the antidote for warfarin.
- Avoid massaging the injection site after subcutaneous heparin or enoxaparin to prevent bruising.
These medications are critical for managing cardiovascular emergencies and preventing thromboembolic events, requiring careful monitoring for efficacy and bleeding risks.
For acute chest pain, administer sublingual nitroglycerin, wait 5 minutes, and reassess; a second dose can be given if pain persists, after calling 911.
- Epoetin alfa stimulates RBC production, potentially leading to hypertension; Neupogen stimulates WBC production; Oprelvekin stimulates platelet production.
- When administering antibiotics, always check for allergies, especially to penicillin and sulfa drugs.
- Aminoglycosides ('-mycin') are ototoxic and nephrotoxic, requiring peak and trough level monitoring.
- Antiviral medications typically end in '-vir' and are used for viral infections like herpes (acyclovir) or influenza.
- Collect specimens for culture and sensitivity *before* starting antibiotics to ensure accurate identification of the pathogen.
These agents target specific cellular processes to treat infections, anemia, or low blood counts, necessitating careful monitoring for side effects and efficacy.
If a patient is allergic to penicillin, they are likely also allergic to cephalosporins (e.g., cefaclor, cephalexin).
- Tetracyclines can stain teeth in children under 8 and interact with calcium supplements and dairy products; take 1-2 hours apart.
- Medications causing agranulocytosis (e.g., PTU, methimazole, clozapine, carbamazepine) require monitoring for signs of infection.
- Levothyroxine and bisphosphonates (for osteoporosis) should be taken on an empty stomach in the morning, remaining upright for 30-60 minutes after administration.
- Chlordiazepoxide is the primary medication for alcohol withdrawal symptoms; benzodiazepines (e.g., diazepam, lorazepam) are alternatives.
- MAOIs (e.g., phenelzine) require a strict low-tyramine diet to prevent hypertensive crisis and should not be combined with SSRIs or triptans due to serotonin syndrome risk.
Understanding the unique administration requirements, potential side effects, and critical interactions of these diverse drug classes is essential for safe and effective patient care.
Patients on MAOIs must avoid aged cheeses, cured meats, and red wine due to their high tyramine content.
- Pain assessment is subjective; use tools like Wong-Baker FACES or FLACC for non-verbal patients.
- Opioids (morphine, fentanyl) are potent analgesics but can cause respiratory depression and constipation; monitor respiratory rate closely.
- NSAIDs (ibuprofen, naproxen) are used for mild to moderate pain but carry risks of bleeding and GI upset; acetaminophen is hepatotoxic.
- Sumatriptan is used for migraines and causes vasoconstriction; do not combine with other vasoconstrictors or MAOIs/SSRIs.
- Anti-Parkinsonian drugs like levodopa/carbidopa help manage dopamine deficiency but can cause dark urine, sweat, and saliva.
Effective pain management and treatment of neurological conditions require a thorough understanding of drug mechanisms, side effects, and appropriate patient selection.
Opioid overdose is indicated by pinpoint pupils; conversely, stimulant overdose causes dilated pupils.
Key takeaways
- Patient assessment and prioritization are the cornerstones of safe nursing practice, guiding all interventions.
- Understanding drug administration routes and techniques is critical for ensuring medication efficacy and preventing complications.
- Recognizing drug classes by suffixes and understanding common side effects and contraindications are essential for safe prescribing and administration.
- Anticipating and managing adverse drug reactions, such as bleeding with anticoagulants or hyperkalemia with certain antihypertensives, is a key nursing responsibility.
- Patient education regarding medication administration, potential side effects, and dietary restrictions is vital for adherence and safety.
- The risk of medication errors can be significantly reduced by adhering to strict identification protocols and avoiding dangerous abbreviations.
- Specific drug classes have unique administration requirements (e.g., empty stomach, time of day) that must be followed precisely.
- Monitoring laboratory values (e.g., PTT, PT/INR, electrolytes, drug levels) is crucial for managing medications with narrow therapeutic windows or significant risks.
Key terms
Nasolacrimal ductVastus lateralisIntradermalSubcutaneousProton pump inhibitor (PPI)AnticholinergicBeta-blockerACE inhibitorAngiotensin Receptor Blocker (ARB)DiureticVasodilatorAntiplateletAnticoagulantEpoetin alfaAminoglycosideAgranulocytosisBisphosphonateAlcohol withdrawalMAOIHypertensive crisisSerotonin syndromeNSAIDOpioidSumatriptanLevodopa/CarbidopaExtrapyramidal Syndrome (EPS)GoutTuberculosis (TB)RIPE'S mnemonicCAPS mnemonic
Test your understanding
- What are the key differences in administering ear drops to a child versus an adult, and why are these differences important?
- How can a nurse prevent medication errors when administering medications to a patient in a hospital setting?
- Explain the 'dry, dry, dry' effects of anticholinergic medications and identify two patient populations for whom these drugs would be contraindicated.
- What are the critical nursing considerations when administering nitroglycerin for acute chest pain, and what is the rationale behind these actions?
- Describe the monitoring required for patients receiving aminoglycoside antibiotics (e.g., gentamicin) and explain the purpose of peak and trough levels.
- What dietary restrictions are essential for a patient taking MAOIs, and what is the severe consequence of non-adherence?
- Compare and contrast the nursing responsibilities when administering NSAIDs versus opioids for pain management, focusing on potential adverse effects and monitoring.