Advantage and disadvantage of different routes of medication administration
- IV
- Advantages: dependable effects, faster absorption, hits systemic circulation immediately
- Disadvantages: expensive, labor intensive, infection, local reactions
- PO
- Advantages: Easy, preferred by patients
- Disadvantages: NPO patients, vomiting patients, slower absorption
- Rectal
- Advantages: good absorption
- Disadvantages: not suitable after rectal surgeries, patients do not prefer
- Inhalation
- Advatnages: rapid onset and insant absorption
- Disadvantages: requires special equipment
- Transdermal
- Advantages: provide sustained effect
- Disadvantages: slow onset, inflammation, reaction
Medical errors and how to prevent them
- Drug regimen process
- Reporting medication errors
- How to prevent: Rights of medication
- Right drug
- Right dose
- Right patient
- Right route
- Right time
- Right reason
- Right documentation
- Right patient education
- Right evaluation
- Right to refuse the medication
Terms related to Adverse Drug reactions
- Allergic: immune response
- Idiosyncratic effect: resulting from a genetic predisposition
- Iatrogenic: disease produced by health care
- Toxicity: caused at excessive dosing, or an individual whose organs are not functioning properly
- Paradoxical: happens when a person experiences the opposite of what the drug is intended to do
- Carcinogenic: cause cancer
, - Teratogenic: drug induced birth effects
- Physical dependence: body adapts to drug exposure
Major lab indicators and clinical symptoms for renal and hepatic toxicity monitoring
- Renal
- BUN (blood urea nitrogen)
- Creatinine
- Albumin
- Decreased urine output
- Fluid retention, causing swelling in legs ankles and feet
- Shortness of breath\
- Fatigue
- Confusion
- Nausea
- Weakness
- Irregular heartbeat
- Nausea
- Vomiting
- Loss of app
- Muscle cramps
- Hepatic
- ALT and AST
- Albumin
- Yellowing of the skin and whites of eyes (jaundice)
- Itching
- Ab pain
- Stomach stomach
- Nausea
- Rash
- Vomiting
- Dark colored urine
- Light colored bowel movements
- Jaundice
- Loss of appetite
- Fever
Individual variations in drug response
- Pregnancy consideration
- May affect the absorption, distribution, metabolism, and elimination of medications
, - These pharmacokinetic changes may result in lower psychotropic drug levels and loss of
clinical effectiveness
- May affect baby; weigh risk of exposure to the fetus with the benefits of treatment
- Must consider timing of exposure, dosage, duration of use, and fetal susceptibility
- Teratogenesis
- The process by which congenital malformations are produced in an embryo or fetus.
- Major characteristics of pediatric patients
- Drug dosage calculations based on child’s age, weight, or body surface
- Decreased oral absorption (decreased gastric acid production and slower gastric emptying
time)/ Thinner skin (increased topical absorption)
- Decreased plasma protein concentration distribution, increased free protein-bound drug
availability, increased extracellular fluid in neonate
- Decreased elimination, metabolism (neonate/ infant)
- BSA/ weight based dosing is important
- Major characteristics of geriatric patients
- Sensory impairment vision hearing and taste
- Physical impairments
- Pain
- Increased body fat
- Decreased muscle mass
- Changes in renal and liver function and CNS
- Can cause adverse drug reactions
- Woman vs man
- Medication compliance issue in geriatric patients
- Older patients are generally more sensitive to drugs than younger adults
- Individualization of therapy for the elderly is essential
- Symptoms in elderly are often nonspecific
- Dizziness, cognitive impairment
- Altered gastrointestinal absorption is not a major factor in drug sensitivity
- The percentage of an oral dose that is absorbed does not change with age
- The rate of absorption may slow with age
- Delayed gastric emptying and reduced splanchnic blood flow also occur
- Increased percentage of body fat
- Storage depot for lipid-soluble drugs
- Decreased percentage of lean body mass
- Decreased total body water
- Distributed in small volume; thus concentration is increased and the effects are
more intense
- Reduced concentration of serum albumin
- May be significantly reduced in the malnourished
- Causes decreased protein binding of drugs and increase in levels of free drugs
- General information about beers list
- Refers to medications that could be potentially inappropriate for use in older adults
- Analgesics, antibiotics, antidepressants, antihypertensives, diabetes drugs
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