Nursing process.

 Assessment: subjective/objective data, vitals, establish need for medication, assess for

diagnosis requiring medication (signs of pain, nausea, constipation, diarrhea)

 Plan:when does this patient need medication, what order should the medications be

given, what does the patient need with medication? (OJ with iron pills) Do you have all

of the orders from the physician? Do any orders need to be adjusted? (NPO patient needs

Zofran IV not oral)

 Implementation: Make sure proper medication administration steps are done, make sure

patient knows the medications they are taking and questions are answered.

 Evaluation: What response did the patient have to the medication? It is a desired effect

or is the patient having side effect/adverse effect? Monitor patient

Proper medication administration

 When preparing patients medication before giving medication, nurse needs to ask patient

for name and date of birth while scanning wrist band

 Complete medication profile includes everything related to medications: street drugs,

alcohol use, herbal medications, etc.

 Most important check for a nurse when giving medication is allergies

 9 rights of medication: patient, drug, time, dose, route, documentation, right to refuse,

response, indication

Side effects

 Undesirable, predictable or expected effects of medication. May be transient or perceived

tolerable. Rash, chills, nausea

Adverse effect

 Undesirable occurrence related to administering or failing to administer a prescribed

medication. Shock, liver toxicity, necrosis

First-pass effect

 a drug absorbed from the intestines must first pass through the liver before It reaches

systemic circulation

 Less than 100% of drug is available (IV admin 100% of drug is used)

Agonist

 a drug that binds to and stimulates the activity of one or more receptors in the body

 Two drugs work together to produce a better response in patient

Antagonist

 a drug that binds to and inhibits the activity of one of more receptors: inhibitors

 Two drugs working against each other, can cause adverse effect, or cancel out each other

Synergistic effect

 Drugs from different chemical categories that are used together to create a better response

 Used mostly with opioids so that less opioids are actually used. (NSAIDs and oxy)

Absorption

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 The movement of a drug from Its site of administration into the bloodstream for

distribution to the tissues

 First pass: drugs are absorbed in stomach or intestines

Metabolism

 the biochemical alteration of a drug into an inactive metabolite, a more soluble

compound, a more potent active metabolite, or a less active metabolite

 the organ most responsible is liver

Distribution

 the transport of a drug by the bloodstream to its site of action

 the heart plays a big part here

Excretion

 the elimination of drugs from the body

 Kidneys are biggest mechanism for excretion

Half life

 The time required for ½ of the drug to be removed from the body

 Ex: peak of a given drug 100 mg/L. At 8 hours the drug level is 50 mg/L. The half life

would be 8 hours.

Scheduled drug categories

 Scheduled I – most dangerous and no accepted medical use (heroine, LSD)

 Scheduled II – as above with accepted use such as morphine, fentanyl, codeine, Adderall,

cocaine

 Scheduled III – lower abuse potential, Tylenol with codeine, Vicodin

 Scheduled IV – low abuse rate, mostly prescription medications, Xanax

 Scheduled V – contain only small about of narcotic, minimal risk for abuse

Epoetin alfa

 Hematopoietic drug

 A synthetic derivative of the human hormone erythropoietin (produced by kidney)

 It stimulates the synthesis of erythrocytes by stimulating RBC progenitor cells in the

bone marrow

 Treats anemia with ESRF, chemotherapy induced anemia, and anemia associated with

zidovudine therapy

 Ineffective without adequate body supply of iron and bone marrow function (IT IS

GIVEN WITH ORAL OR IV IRON)

 Darbepoetin (Aranesp) is long acting form of epoetin

 ONLY given by IV (faster) or subq injection(slower)

 DONOT give to patients with uncontrolled hypertension or hemoglobin above 10 for

cancer patients or 11 for renal patients

 RISK for blood clot and tumor growth in patients with head or neck cancer

 Serious adverse effects such as stroke, heart attack, and death can occur when this is

given to a patient with a hemoglobin above 11

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Filgrastim

 Hematopoietic drug-colony stimulating factors that synthesis granulocytes by stimulating

WBC progenitor cells in the bone marrow

 Also called “granulocyte colony-stimulating factor” (G-CSF)

 Most often given to patients with bone marrow destruction caused by chemotherapy to

combat infections due to low WBC count. Helps patient receive high doses of chemo

safely

 Helps the body kill cancer cells, virus’s, and fungus

 Treats febrile neutropenia but must be given before an infection develops

 DONOT give to patient with myeloid blasts (cancer in BM)

 Can cause severe bone pain, fever, muscle ache

 Severe drug interaction with bone marrow suppression antineoplastic drugs (antagonists).

However, can be given 24 hours after a BM suppression agent has been given to prevent

levels from dropping to low

 DONOT give to patients taking lithium or corticosteroids

Iron preparation

 Iron is an essential mineral in the body, oxygen carrier in hemoglobin and myoglobin.

Stored in the liver, spleen, and bone marrow. Iron deficiency results in anemia. Dietary

sources include meats certain vegetables and grains. Dietary iron must be converted by

gastric juices before it can be absorbed

 Enhance iron absorption: orange juice, veal, fish, ascorbic acid

 Impair iron absorption: eggs*, beans*, corn, phytates cereal

 Supplemental iron may be given as a single drug or as a part of a multivitamin

preparation. Oral iron preparations are available as ferrous salts (Fermiron)

 Parenteral: iron dextran (dexferrum), iron sucrose (venofer), ferric gluconate (ferrlecit),

ferumoxytol (feraheme)

 Iron adverse effects- Most common cause of pediatric poisoning deaths, causes nausea,

vomiting, diarrhea, constipation, stomach pain or cramps. Causes black tarry stools, stain

teeth, pain at injection site.

 Iron toxicity – suction and maintenance of the airway, correction of acidosis, control of

shock and dehydration with iv fluid or blood, oxygen, vasopressors. Chelation therapy

with Desferal (deferoxamine) : is used for severe symptoms of iron intoxication such as

coma, shock, or seizures. Ferriprox (Deferipronse) is used in iron overload

 Parenteral iron:

 Iron dextran (INFeD, Dexferrum) may cause anaphylactic reactions, including

major orthostatic hypotension and fatal anaphylaxis. *Test dose of 25 mg of iron

dextran is administered before injection of the full dose and then remainder of

dose is given after 1 hour. Used less frequently now and replaced by ferric

gluconate and iron sucrose.

 Ferric gluconate (ferrlecit) indication for reletion of total body iron content in

patients with iron deficiency anemia who are undergoing hemodialysis. Risk for

anaphylaxis is much less than with iron dextran, and test dose is not required.

Doses higher than 125 mg are associated with increased adverse events, including

abdominal pain, dyspnea, cramps and itching

Folic Acid

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