ADMINISTRATION OF MEDICATION

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CHAPTER 11

• ADMINISTRATION OF MEDICATION
• Part 2

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Drug References

• For drugs used in office, MA must be familiar
  with
• Indications
• Adverse reactions
• Route of administration
• Dosage
• Storage

3
Drug References

• Package insert (PI)
• Manufacturer includes with each medication
• Contains information on the drug
• Drug References
• Contain drug information
• Example Physician's Desk Reference (PDR)
• Contains information on major prescription
  pharmaceutical products available in U.S.
• Consists of actual drug PI

4
Food and Drug Administration

• Federal agency in DHHS (Department of Health and
  Human Services)
• Responsible for determining if the following are
  safe before human use
• New food products
• Vaccines
• Medical devices
• Cosmetics
• Determines safety and effectiveness of both
  prescription and OTC drugs
• 4. Drug manufacturer must submit application
  for a new drug to FDA for review/approval before
  product can be released for human use

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Food and Drug Administration, cont.

• FDA also determines if medication will be
  available with or without a prescription
• Prescription drugs must bear following label
• Caution Federal law prohibits dispensing without
  a prescription
• Nonprescription medication FDA determines to be
  safe and effective for use without physician
  supervision
• Has low incidence of adverse reactions when used
  properly
• Examples Mild pain relievers, topical
  antibiotics, cold medicines

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Drug Nomenclature

• Each drug has four names
• Chemical Name precise description of chemical
  composition
• Used most by manufacturers and pharmacists
• EX Chemical name for Vicodin 4,5a-epoxy-3-methox
  y-17-methylmorphinan-6-one tartrate (11) hydrate
  (25)
• Generic Name assigned by manufacturer who
  developed the drug
• Often shortened derivative of chemical name
• EX generic name for Vicodin hydrocodone and
  acetaminophen

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Drug Nomenclature, cont.

• 3. Official Name name under which drug is
  listed in official publications (usually same as
  generic name)
• Sets standards for each drug to regulate the
  following
• Strength - Safety
• Purity - Labeling
• Packaging -Dosage form
• 4. Brand Name name under which pharmaceutical
  manufacturer markets the drug
• A drug may be marketed by more than one company
• Generic drug may have several brand names
• EX Brand names for Vicodin Liquicet, Lorcet,
  Lortab, Maxidone, Norco, Vicodin, etc.

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Drug Nomenclature, cont.

• MA must be familiar with generic and brand name
• For each drug prescribed or administered in the
  office

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The Prescription

• Physician's order authorizing the dispensing of a
  drug by a pharmacist
• Can be authorized in different forms
• Handwritten
• Computer-generated
• Telephoned to pharmacy
• Faxed to pharmacy

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The Prescription, cont.

• Abbreviations and symbols used to
• Write a prescription
• Record medication info in patient's chart
• Keep all prescription pads in a safe place
• Out of reach of individuals who may want to
  obtain drugs illegally
• Stock supply should be locked in a drawer

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Parts of a Prescription

• Date
• Pharmacist cannot fill prescription without date
• Prescription expires after a certain length of
  time after being issued
• Usually 1 year except for controlled drugs
• Physician's name, address, telephone number, and
  fax number
• Preprinted on form
• Provides info if pharmacist has a question and
  needs to contact office

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Parts of a Prescription, cont.

• Patient's name and address
• Used for insurance billing and to properly
  dispense medications
• Patient's age
• Important in dispensing medications
• Pharmacist double-checks physician's order
• Makes sure proper dose is being dispensed based
  on age

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Parts of a Prescription, cont.

• Superscription
• Rx symbol Latin for recipe and means "take"
• Inscription
• Name of drug and dosage
• Example Amoxil 250 mg

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Parts of a Prescription, cont.

• Subscription
• Directions to pharmacist
• Generally used to designate number of doses to be
  dispensed
• To prevent prescription from being altered
• Use both numbers and letters to indicate quantity
• Example 30 (thirty)

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Parts of a Prescription, cont.

• Signatura (sig)
• Latin for write or label
• Indicates information to be included on
  medication label
• Directions for taking medication at home
• Name of medication
• EX take 1 po qd

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Parts of a Prescription, cont.

• Refill
• Number of times medication can be refilled
• Physician's signature
• Prescription cannot be filled without physician's
  signature
• DEA number
• Must appear on prescription for a controlled drug

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Parts of a Prescription
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Generic Prescribing

• Physician writes prescription using generic name
• Pharmacist can fill prescription with drug that
  offers best savings to patient
• Physician writes prescription using brand name
• In most states pharmacist has option of filling
  prescription with a generic drug
• Physician wants prescription to be filled with a
  specific brand
• Must indicate Dispense as Written (DAW) on
  prescription form

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Completing a Prescription Form

• If delegated by physician, MA can complete
  prescription form
• Physician must thoroughly review to make sure
  info is correct
• Physician signs form
• MA must carefully follow prescription writing
  guidelines

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The Medication Record

• Office may use a preprinted form
• Medications that should be recorded
• Prescription
• Over-the-counter
• Vitamin supplements
• Herbal products

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The Medication Record, cont.

• Detailed information included for each medication
• Informs physician what patient is taking and how
  much
• Should be part of every patient's medical record
• MA may be responsible for documenting medication
  information
• Medication record includes
• Patient's name and date of birth
• Any drug allergies

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The Medication Record, cont.

1. Date medication prescribed (Rx) or date patient
   started taking (over-the-counter)
2. Name and dosage of medication
3. Frequency of administration
4. Route of administration
5. Whether prescription or over-the-counter
6. Refills (prescription medication only)
7. Date patient stopped taking medication

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Medication Record
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Intradermal Injections

• Administered in dermal layer of skin
• Angle of insertion almost parallel to skin
  (10-15 )

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Intradermal Injections, cont.

• Absorption is slow
• Only small amount of medication can be injected
  (0.01 to 0.2 cc)
• ID injection sites where skin is thin
• Anterior forearm (most common)
• Needle length range ? to ? inch
• Needle gauge range 25 to 27

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Intradermal Injections, cont.

• Tuberculin syringe used
• Capacity of syringe is small 1 cc
• Calibrations divided into tenths and hundredths
  of a cubic centimeter
• Can administer very small amount of medication

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Intradermal Injections, cont.

• Used to administer skin tests
• Allergy tests
• Tuberculin test

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Intradermal Injections, cont.

• Procedure for skin testing
• Medication is injected until a wheal forms
• Wheal small raised area because of distention of
  skin

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Intradermal Injections, cont.

• Results are read and interpreted at proper time
• Allergy tests 15 to 20 minutes
• Tuberculin test 48 to 72 hours
• If no reaction occurs
• Wheal disappears within a short period of time
• Puncture site only visible sign left
• Positive reaction results in induration and
  erythema
• Only criteria used to assess reaction extent of
  induration (not erythema)

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Tuberculosis (TB)

• Infectious disease that usually attacks lungs
• Caused by tubercle bacillus (Rod-shaped
  bacterium)
• Symptoms
• Fatigue, weakness, unexplained weight loss,
  low-grade fever, Night sweats, cough producing
  sputum, occasional hemoptysis (coughing up
  blood), chest pain
• Not highly contagious

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Tuberculosis, cont.

• Individuals who are infected may not develop
  disease
• Body defenses protect them as follows
• Fibrous wall (capsule) builds around TB organisms
• Some bacteria may remain alive in capsule in
  dormant (inactive) state
• Patient experiences no symptoms
• Cannot spread disease to others
• Patient is said to have a latent tuberculosis
  infection (LTBI)
• Usually has a positive reaction to TB test

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Tuberculosis, cont.

• LTBI may develop into active TB
• Shortly after infection or many years after
  infection
• TB bacteria break out of capsule cause symptoms
  of active TB
• Occurs in 10 of patients with LTBI
• Most likely to occur when body defenses are
  weakened
• During a serious illness
• Patients with immune disorder (e.g., AIDS)

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Purpose of Tuberculin Testing

• Detect presence of tuberculin infection
• Recommended for
• Patients who have close day-to-day contact with
  someone who has active TB
• Individuals who have symptoms of TB
• Individuals with lowered immunity (e.g., human
  immunodeficiency virus HIV)
• Used as screening measure for early detection of
  TB (before patient becomes symptomatic)
• May be part of health screen or required for
  entrance to college, military or employment

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Purpose of Tuberculin Testing, cont.

• MA responsible for
• Administering TB test
• Interpreting results
• MA must follow procedure exactly
• To ensure accurate test results
• If not performed correctly
• Patient with TB may not react to test

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Tuberculin Test Reactions

• Tuberculin Consists of purified protein
  derivative (PPD)
• Extracted from a culture of tubercle bacilli
• If patient has active or latent TB
• Tuberculin causes induration (abnormally hard
  spot caused by accumulation of lymphocytes)
• TB test reactions based on amount of induration
  present
• Interpreted according to manufacturer's
  instructions

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Tuberculin Test Reactions, cont.

• Positive reaction indicates presence of TB
  infection
• Does not differentiate between active and latent
  forms
• Further diagnostic procedures must be done to
  make a diagnosis
• Chest x-ray study
• Microbiologic examination of sputum

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Tuberculin Testing Methods

• Mantoux test
• Most commonly used
• Administered using intradermal needle and syringe

• More specific and accurate test

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Tuberculin Testing Methods, cont.

• Tine test
• Consists of sterile plastic unit containing four
  tines
• Impregnated with tuberculin
• Patient inoculated intradermally to a depth of 1
  to 2 mm
• Disc is pressed onto the skin depositing
  tuberculin into skin layers
• Amount of tuberculin cannot be precisely
  controlled
• Rarely used anymore

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Mantoux Test

• Administered through intradermal injection
• Using a tuberculin syringe
• Needle length ? to ½ inch
• Needle gauge 26 to 27
• Dosage 0.10 ml of PPD containing 5 TU
  (tuberculin units)

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Mantoux Test, cont.

• Draw up proper amount of tuberculin solution
• Too much may elicit reaction not caused by a TB
  injection
• Too little may be insufficient solution to
  elicit a reaction
• 4. Inject solution into superficial skin layers
  to form wheal
• If injected into SC layer wheal will not form
• If injection too shallow leakage of solution
  onto skin

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Mantoux Test
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Mantoux Test, cont.

• 5. Do not apply pressure after injecting solution
• Solution not intended to be absorbed into tissues
• May cause leakage of solution
• Do not cover site with adhesive bandage
• Wheal disappears on its own in a few minutes

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Guidelines for Administering a Mantoux Test

• Use anterior forearm 4 inches below bend in
  elbow
• Areas to avoid
• -Hairy areas

• -Areas with visible veins
• -Scar tissue
• -Red, swollen areas
• -Bruises
• - Dermatitis or other skin irritation

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Guidelines for Administering a Mantoux Test,
cont.

• Cleanse site with antiseptic and allow to dry
• Inject tuberculin into superficial layers of skin
• Blood at puncture site will not affect results
• Read results 48 to 72 hours following
  administration

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Guidelines for Reading Mantoux Test Results

• Read in good lighting
• Use both inspection and palpation to read results
• If induration is present
• Rub finger lightly from area of normal skin to
  indurated area
• Measure induration in millimeters

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Guidelines for Reading Mantoux Test Results, cont

• 4. Induration only criteria used to determine
  a positive reaction
• If erythema present without induration results
  are negative

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Guidelines for Reading Mantoux Test Results, cont

• Record reaction in mm
• No induration present record as 0 mm
• Never record results as positive or negative

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Allergy

• Abnormal hypersensitivity of body to substances
  that are ordinarily harmless (allergens)
• Allergen A substance that is capable of causing
  an allergic reaction
• Allergens enter body by
• Being inhaled
• Being swallowed
• Being injected
• Coming into contact with skin

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Allergy, cont.

• Exact cause of allergies not fully understood
• May be inherited
• Allergies can develop at any age
• Most likely to develop in children

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Allergic Reaction

• First time allergen enters body
• Stimulates body to produce antibodies to the
  allergen
• Antibodies combine with allergen results in
  allergen-antibody reaction
• Histamine released in significant amounts
• Causes allergic symptoms
• Allergic symptoms can range from mild to very
  severe (anaphylactic reaction)

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Diagnosis

• Detailed medical history obtained by physician
• PE performed to detect conditions resulting from
  allergies (nasal polyps, wheezing, skin rashes,
  urticaria)
• Allergy testing performed
• Direct skin testing
• Skin-prick testing
• Intradermal testing
• Radioallergosorbent test (RAST)

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Treatment

• Avoidance of allergen (if possible)
• Drug therapy
• Antihistamines, decongestants, bronchodilators
• Allergy injections (desensitization injections)
• Decreases sensitivity of body to allergen