Principles of medication administration

Medicines/Drugs
Pharmaceuticals are any substance or mixture of substances that is or are administered to a patient to cure, alleviate symptoms of disease, to affect the functions of the body, to make a diagnosis, or to prevent the onset of disease.

Medicinal product
MPs (Pharmacopreparations) are medicines processed into a form that is dispensed to a patient.

Medication/Medicament

Medicinal substances and medicinal products processed into a suitable form and ready for use (ampoules,...), accurately labelled with an information leaflet

Medicines (Medicaments) are divided into:
 *  solid: 
 * powders - pulveres (pulv.) - for external and internal use (internal: sachets, gelatine capsules),
 * tablets - tabulettae (tbl.) - compressed powders, for internal use,
 * lozenges - dissolving in the mouth,
 * dragees - tabulettae obductae/dragee (drg.) - protective coating (do not damage tooth enamel or decompose only in the lower parts of the GIT), do not crush, do not spill, do not bite,
 * capsules - capsules (cps.) - in a gelatine container (slower dissolution), much to be swallowed
 * granules - granula (gran.) - irregular, by spoonfuls,
 * effervescent tablets - tabulettae effrvescens (eff.) - released when dissolved in water
 *  semi-solid: 
 * ointments - unguenta (ung.) - fat with active substance, on skin and mucous membranes,
 * pastes - pastee (pst.) - fatty base and approx. 50% indif. powder, not adherent to the skin, porous, not absorbed (protection against wetting),
 * gels, jellies - clear semi-solids with gel, for skin (muscles, skin, joints),
 * creams - cremae (crm.) - higher water content
 * suppositories - suppositories (supp.) - conical shape for easier introduction,
 * vaginal globules - globuli vaginales (glob. vagin.) - like suppositories, spherical, ovoid, into the vagina,
 * foam - in a thin layer on the skin,
 * soaps - sapones - with an admixture of medicinal substances (e.g. sulphur), skin medication,
 * patches - emplastra (empl.) - impregnated with a medicinal substance
 *  liquid: 
 * solutions - solutiones (sol.) - substance in a solvent (water, oil, alcohol), dosage by drops or measuring cups, for mouth, nose, eyes, ears, external use -> bath compresses,
 * mixtures - mixturae (mixt.) - several substances in a solvent, must be shaken before application because of insoluble substances,
 * tinctures - tincturae (tct.) - alcoholic solutions of medicines obtained from plants,
 * extracts - extracts (extr) - obtained by leaching from drugs and mixed with water, alcohol,
 * suspensions - suspensiones (susp.) - the substance is dispersed in water (aerosol), in gel, application by mouth intended for the mucous membranes of the respiratory tract (spray), to protect the gastric mucosa,
 * sprays - liquid released by compressed gas on skin or mucous membranes,
 * teas - species (spec.) - from plants; decoction, infusion, extract.

Strength of medicine

 * forte = greater content of the active ingredient,
 * biforte = double the content of the active dose,
 * mite = smaller amount of active ingredient,
 * retard = longer action (slower absorption or conversion into org.).

Expiration time
The expiratory period refers to the time during which a drug is safe to take. It is most often given in the form MM/YY, or as DD.MM.YY

Date of manufacture of the medicine
Usually DDMMYY.

Package leaflet
Instructions for use, storage.

Must be stated here.
 * name, composition, potency, strength,
 * time to be taken (e.g. before/after meals, at bedtime),
 * how the medicine is to be stored,
 * indications,
 * possible side effects,
 * contraindications (condition that prevents or prohibits administration),
 * the exact name and address of the manufacturer.

Storage of medicines
Clearly, visibly, alphabetically and by individual dosage form.

On the ward, in the so-called handy pharmacy (cabinet suitable for storing medicines; separately l. for internal use, external use, injection l., safe for opiates and other psychotropic substances) - no access for unauthorised persons, not near the heating or in the sunlight, locked (keys served by the nurse); some (according to the supplementary leaflet) - in the fridge

Effects of medicines

 * therapeutic = desirable,
 * secondary = undesirable,
 * expected = arising from the properties of the drug,
 * unexpected = allergies and shock,
 * toxic = result of overdose, ingestion of the drug for external use, accumulation of l. in blood or tissues (due to impaired metabolism of l.).

Medical report
In the patient's record: name of drug, dosage form, time of administration, route of administration, exact amount of each dose, daily dose (usually 1-3 times per day). Depends on indication group - ATB, hypnotics - exact timing - give at 9pm etc.

Medication handling principles

 * hygiene principles for handling,
 * concentration and control of the correctness of l., its dose and effect,
 * instructing the patient in its use,
 * regularly and at set times,
 * only from the original packaging,
 * accurate recording in the patient's records.

Methods of administration of medication

 * Oral administration - per os (p.o.) - the most common and most convenient,
 * sublingual administration - necessary until dissolution and absorption (into sublingual vessels),
 * per rectum application
 * parenteral administration (injection route of administration *question 14),
 * topical application - topically to skin or mucous membranes,

Onset of action after drug administration

 * into the artery - immediately,
 * into a vein - in 1 minute,
 * under the tongue, on the nasal mucosa - in 1-2 minutes,
 * into the respiratory tract - in 1-3 minutes,
 * into the muscle - in 5-10 minutes,
 * rectum, vagina, skin - 15 minutes,
 * per os - into the digestive tract - in 30 minutes

Oral administration

 * contraindications: vomiting, connection to gastric or intestinal suction, unconsciousness, inability to swallow,
 * procedure:
 * check the aids to see if the patient is able to swallow, does not need assistance,
 * administer according to the medical record, in the decursus,
 * check the data (patient's documentation, name and dose of the drug, time and method of administration, do not prescribe!),
 * check the name of the drug from the drug card when preparing the medicine,
 * check that the patient has ingested the medicine,
 * record the administration in the medical record.

Sublingual application
Most commonly Nitroglycerin (in ISCHS), the patient waits until the pain subsides, then spits out the rest of the drug.

Per rectum application
Suppositories, ointments and solutions.

Dermal application
Ointments, pastes, creams, gels, sprays, powders and solutions.
 * observe the intervals and method of application,
 * do not irritate the skin by excessive friction, pressure or forcible removal of the previous l..,
 * on a larger area with gloved hands, on a smaller area with a wooden spatula or cotton brush,
 * if the l. is not intended for a single patient, do not return the used brush to the container.

Application to the eyes
Ointments and liquid medications with topical effect.
 * Conjunctival sac lavage - we use an eye bath (half filled, put to the eye, the patient tilts his head and rolls the eye open, the rest is poured into the ejector),
 * instillation of medication (patient sits with head slightly bent or lying down, open eyelids slightly with index finger and thumb, hold a square of pulp under the eye without touching the eye or eyelashes, instill medication into the inner corner, patient closes eyelids and rolls the eye),
 * ointment insertion (as with medication, only: the patient looks up, we apply the ointment from the tube into the conjunctival sac).

Application in the ear
Ointment or dripping (the patient lies on the side, on the healthy ear or sits on a chair sideways to the backrest, healthy ear to the shoulder, we hold a quarter of pulp under the ear, we apply the ointment in a circular motion with a brush into the ear canal, while dripping the patient leaves the head in a bow for 1-2 min).

Application to the respiratory tract
Solutions, ointments (nasal mucosa), substances in the form of gases and vapours - drops, inhalations, sprays
 * In infants, do not drip drops into the nose, but apply with a brush!
 * aerosol and dry powder inhalers (for children, not to be inhaled),
 * nebulisers - inhaled through a mouthpiece, mask.