Medication Administration

• Drug Standards


  Rigorously defined criteria, guidelines, and regulations mandated to ensure the safety, quality, efficacy, and proper marketing of medications
• Drug standards are pivotal in verifying that pharmaceutical products strictly adhere to established specifications regarding composition, labeling, storage, and distribution
• Nurses' comprehension and adherence to drug standards


  Paramount to safeguard patient well-being, guarantee optimal therapeutic outcomes, and uphold legal and ethical practice standards
• Implications for Nurses

  • Knowledge and Compliance
  • Patient Safety and Advocacy
  • Professional Responsibility
• Knowledge and Compliance


  Nurses are required to possess a comprehensive understanding of drug standards to ensure the accurate, safe, and effective administration of medications, in line with prevailing legal and ethical norms
• Patient Safety and Advocacy


  Proficiency in drug standards empowers nurses to champion patient safety, advocating for the provision of medications that meet the highest benchmarks of quality and safety
• Professional Responsibility


  Keeping abreast of drug standards is integral to a nurse's continuous professional growth and adaptation to evolving healthcare landscapes, research findings, and regulatory updates
• Philippine Laws and Regulations for Medication Administration by Nurses

  • Republic Act No. 9173 (Philippine Nursing Act of 2002)
  • Republic Act No. 2382 (The Medical Act of 1959)
  • Republic Act No. 10918 (Philippine Pharmacy Act)
  • Administrative Order No. 2007-0027 (DOH Guidelines)
  • Department of Health Policies and Administrative Orders
  • Hospital and Institutional Policies
• Philippine Guidelines/Laws

  • Philippine Food and Drug Administration (FDA)
  • Philippine National Drug Formulary (PNDF) and Related Laws
  • Quality Control and Drug Manufacturing Standards
  • Pharmacovigilance and Adverse Drug Reactions (ADRs)
  • Legal Framework for Drug Distribution and Administration
  • Patient Rights and Medication Safety
• Drug


  A chemical substance of known structure, other than a nutrient or an essential dietary ingredient, which, when administered to a living organism, produces a biological effect
• Medication


  A substance administered for the diagnosis, treatment, or relief of a symptom or for the prevention of a disease
• Chemical Name


  Describes the chemical structure (Eg: N-(4-hydroxyphenyl)acetamide = Acetaminophen Aka: Paracetamol)
• Generic Name


  The generally-agreed upon official name for a drug (Eg: Acetaminophen / Paracetamol)

  
• Trade/Brand Name


  The brand name/registered trademark (Eg: Tylenol / Panadol / Biogesic)

  
• Pharmacodynamics


  Describes the drug's effect on the body at the receptor level, including efficacy, potency, agonism and antagonism
• Pharmacokinetics


  The relationship between drug administration, time-course/rate of absorption & distribution, concentration changes in the body, and the drug's removal from the body
• Agonist


  A drug capable of binding and activating a receptor, leading to a pharmacological response that may mimic that of a naturally occurring substance. Can be classified as full, partial or inverse
• Antagonist


  Does not produce a biological response on binding to a receptor but instead blocks or reduces the effect of an agonist. It may be competitive or non-competitive
• Efficacy


  Used to describe agonist responses in relation to receptor occupation. High efficacy agonists can produce a maximal response whilst occupying a relatively low proportion of receptors
• Half-life (t½)


  The metabolic half-life of a drug in vivo is the time taken for its concentration in plasma to decline to half its original level. Clearance and distribution of a drug from the plasma are important parameters for half-life determination
• Potency


  Measure of the effective concentration of a drug. It is a vague term and it is advisable to further categorize the measurement

  
• Nurses are responsible for following legal provisions when administering controlled substances (dangerous drugs)

  
  

  Punishment = Fines/Imprisonment/Loss (revocation) of license
• Examples of Controlled Substances/Drugs in the Philippines

  • Opioids (e.g., Morphine, Fentanyl)
  • Benzodiazepines (e.g., Diazepam, Alprazolam)
  • Stimulants (e.g., Methylphenidate, Amphetamine)
  • Barbiturates (e.g., Phenobarbital, Pentobarbital)
  • Cannabis (Marijuana)
• Routes of Administration


  • Enteral Administration
  • Parenteral Administration
  • Topical Administration
• Enteral Administration


  The delivery of medication directly into the gastrointestinal tract, typically through oral, sublingual, buccal, or rectal routes, leveraging the digestive system for absorption
• Parenteral Administration


  The introduction of medication bypassing the gastrointestinal tract, commonly through intravenous, intramuscular, or subcutaneous routes, ensuring direct, often faster absorption into the systemic circulation
• Topical Administration


  The application of medication on the skin or mucous membranes, primarily for localized treatment but can also deliver drugs systemically through transdermal absorption
• Choice of administration route depends on drug properties, desired onset, duration of action, pH of entry environment, & bioactivation requirements (eg: Prodrugs)

  
• Considerations for Enteral (Peroral) Administration

  • Stability: Ability to withstand and remain effective under various conditions (e.g., acidic environment of the stomach)
  • Absorption Barriers: Capability to cross biological membranes and barriers to reach systemic circulation
• Medication must resist degradation in the stomach's acidic conditions for enteral administration
• Medication must have the ability to be absorbed in the intestines for enteral administration
• Topical administration


  Applied directly to the skin or mucous membranes; local or systemic effects
• Topical applications


  • Antifungal creams (local)
  • Transdermal patches like clonidine (systemic)
• Factors influencing route selection

  • Drug properties
  • Desired onset
  • Duration of action
  • pH of entry environment
  • Bioactivation requirements (e.g. prodrugs)
• Chemical properties of medication

  • Stability: Ability to withstand and remain effective under various conditions
  • Absorption barriers: Capability to cross biological membranes and barriers to reach systemic circulation
• Considerations for Enteral (peroral) administration

  • Acidic environment: Medication must resist degradation in the stomach's acidic conditions
  • Intestinal absorption: Ability to penetrate intestinal walls to enter the bloodstream
  • First-pass metabolism: Medications are often metabolized in the liver after absorption from the gastrointestinal tract, potentially reducing efficacy
• Implications of First-pass metabolism

  • Efficacy reduction: Medications extensively metabolized into inactive forms in the liver may have reduced efficacy when administered orally
  • Route alternatives: For medications with significant first-pass effects, alternative routes like IV bypass the gastrointestinal tract and liver metabolism, ensuring direct delivery into the bloodstream and improved bioavailability
• Dosing regimen


  • Schedule of dosage, including frequency and amount
  • Tailored based on patient's needs, medication properties, and route of administration

  
• Factors influencing route selection

  • Chemical properties of medication
  • Absorption and metabolism considerations

  
• Selection of the administration route and dosing regimen is critical for achieving desired therapeutic effects, minimizing adverse effects, and ensuring patient compliance