MEDICATION ADMINISTRATION

DRUG EFFECTS
A. Desired effect (therapeutic effect): action for which drug is Prescribed
B. Adverse effect: harmful unintended reaction
C. Toxic effect: serious adverse effect that occurs when plasma concentration of drug
reaches dangerous, life-threatening level
D. Side effect: response that is unrelated to desired action of drug
E. Cumulative action: when repeated doses of the drug accumulate in body and exert
greater biologic effect than the initial dose
F. Drug dependence: physical or psychologic reliance on chemical agent resulting from
continued use, abuse, or addiction
G. Idiosyncratic response: individual’s unique, unpredictable response
H. Paradoxical reaction: response that contrasts sharply with usual, expected response
I. Tolerance: ability to endure ordinarily injurious amounts of drug or decreasing effect
obtained from established dose; requires increasing dose to possibly toxic level to
maintain same effect
J. Hypersensitivity: excessive allergic reaction to exogenous agent (e.g., drug, food)
(Figure 2-2: Type I hypersensitivity reactions)

FACTORS INFLUENCING DOSAGE AND RESPONSE

A. Therapeutic index (TI): ratio between lethal dose and therapeutic dose; used as guide to
safe dosing; a high TI is preferable to a low TI, which provides a narrow margin of safety
B. Serum concentration of some drugs needs to be monitored; used as guide to safe dosing
1) Peak level: highest concentration of drug; usually within 1 to 2 hours after oral, 1 hour
after intramuscular (IM), and 30 minutes after IV administration
2) Trough (residual) level: lowest concentration of drug; preferably within 15 minutes of
next scheduled dose
C. Concentration and duration of drug action are affected by
1) Individual factors (e.g., age, weight, gender, height, physiologic status, and genetic and
environmental factors)
2) Characteristics of drug (e.g., rate of absorption, distribution, biotransformation, and
excretion)
 3) Inability of body to metabolize or excrete drug effectively (e.g., drug affinity for
particular tissues, ineffectiveness of enzymes required for metabolism of drug,
depressed function of tissues naturally metabolizing (often liver) or excreting drug
(often kidneys)
D. Membrane barriers (e.g., placental, blood-brain) may block or selectively pass drug from
circulating fluids to protected areas

NURSING RESPONSIBILITIES RELATED TO MEDICATION ADMINISTRATION

A. Consider that administration of medications is a dependent function requiring a legally
written prescription that is not blindly followed
B. Make appropriate assessments before administering medications
1) Identify client: ensure that client is wearing identification bracelet; scan bar codes or
use twoidentifiers such as client’s name, birth date, and/or hospital number (these have
reduced incidence of medication errors)
2) Identify medications client was taking before admission, and compare list to
medications prescribed after admission to health care agency (medication
reconciliation)
3) Question client regarding history of allergies; ensure that client is wearing an allergy
bracelet and allergy information is in all appropriate places in clinical record
4) Determine if client is taking any over-the-counter (OTC) medications, herbal products,
or alcohol that may interact with prescribed medications
5) Ensure ability to obtain and afford prescribed medications
6) Establish whether drug is still appropriate based on client’s status
a. Compatibility of medications with other medications or substances in diet
b. Untoward or toxic manifestations to earlier doses
c. Serum drug levels for attainment of therapeutic level, toxic level, and peak and trough
levels
d. Final desired result is attained
C. Know common symbols, equivalents, abbreviations, and calculation of dosage; TJC
recommends that the following should not be abbreviated: every day, every other day,
right or left eye, both ears or eyes, units, cubic centimeters, morphine sulfate, and
 magnesium sulfate; subcutaneous can be indicated by the abbreviation Sub-Q or subQ;
use a “0” before a decimal point for numbers less than 1; and no trailing “0” after a decimal
D. Ensure traditional five rights of medication administration: right client, right medication,
right dose, right route, right time
E. Ensure additional five client rights related to medication administration: right client
education, right documentation, right to refuse, right client assessment, right evaluation of
client response
F. Teach client about therapeutic effects, side/adverse effects, and any other pertinent
information related to medication regimen
G. Respect client’s right to refuse medication
H. Know common routes
1) Oral
a. Most common, convenient, and least expensive
b. Absorption is slow; may be unpredictable; may cause GI irritation
c. Preparations include tablets, capsules, pills, powders, and liquids
(1) Sustained-release or enteric-coated preparations should not be crushed or
broken
(2) Suspensions should be shaken well before pouring
2) Sublingual: placed under tongue; absorbed rapidly and directly into bloodstream
3) Parenteral: requires sterile technique (Figure 2-3, A & B: Sites recommended for
subcutaneous and IM injections)
a. Intradermal: small volume (usually 0.1 mL) under epidermis; most commonly used
for allergy and tuberculin testing
b. Subcutaneous: 0.5 to 2 mL into tissues just below skin
c. Intramuscular: up to 3 mL into muscle depending on site; sites include ventrogluteal,
dorsogluteal (not generally recommended because of proximity to large blood
vessels and sciatic nerve), vastus lateralis, rectus femoris, and deltoid
d. Intravenous: given directly into vein by continuous infusion, intermittent infusion
(intravenous piggy back [IVPB]), intravenous push
4) Transdermal (through skin) preparations
5) Inhalation: metered-dose inhaler or nebulizer
6) Topical preparations: for localized effect on skin or in body cavities (e.g., bladder, eyes,
ears, nose, vagina, oralcavity, and rectum); for systemic effect (e.g., rectal, nasal,
sublingual)
I. Calculate dosage of mediations; use following formulas for ratio and proportion
1) Desired Have Ordered dose Available dose Desired amount e g × ( . ., , )
tabletsmLAvailable amount
2) Desired dose : Supplied dose :: Desired Amount : Available amount
J. Evaluate client’s response to medication
K. Clearly and accurately record and report administration of medications and client’s
response; follow standard practice when counting, wasting, or documenting controlled
substances