Mode of Action of Drugs and Prevention of Medication Error

Presented by Ganga Tiwari ( BSc. Nursing Fourth Year, Teaching Leanring)
TU, IOM, MNC, Kathamandu Nepal

1. Mode of Action of Drugs and Prevention of Medication Errors Presented by Ganga Tiwari BSc. Nursing Fourth Year, Teaching Learning TU, IOM, MNC, Kathmandu Nepal

2. MODE OF ACTION OF DRUGS General anesthesia : Depresses cerebral function, induce unconsciousness and depress all sensation. E.g. ketamine, propofol , holothene , thiopentone sodium etc. Anesthetics: Drugs which causes loss of sensation are anesthetics. Local anesthesia : Interfere with the function of a nerve or nerve ending and depress all sensation from a localized area without interfering with the consciousness e.g.procaine , lignocaine,bupivacaine etc.

3. Contd.. Analgesics: Drugs which relieves pain. They are classified as narcotic and non-narcotic. Narcotic analgesic drug: Relieves pain probably by selectively acting on receptors situated both in the higher center brain and the spinal cord. e.g. morphin,pethidine,fentanyl,tramadol are narcotic analgesic .they binds with the specific opioid receptors in the central nervous system to reduce pain .

4. Contd.. Non-narcotic analgesics: Relives pain without producing hypnosis or marked impairment or mental activity by central as well as peripheral action. e.g.NSAIDS (non- steroid anti-inflammatory drugs). aspirin,diclofenac,ketorolac,ibuprofen,nimesulide etc.

5. Contd.. Diuretics: These are the drugs which increases the flow of urine. e.g. furosemide,chlorthiazide,amiloride,spironolactone etc. Antipyretics : These drugs reduces body temperature by acting on temperature regulating center on hypothalamus when it is raised above the body temperature. E.g. paracetamol .

6. Contd.. Emetics: Emetics are those drugs which initiate vomiting by irritating mucous membrane of stomach or by stimulating the vomiting center of medulla oblongata .e.g. apomorphine , ipicacaunha used in non-corrosive poisoning

7. Contd.. Laxatives: laxatives are substances that loosen stools and increases bowel movements. they are used to treat or prevent constipation. They can be oral or suppository.eg. oral dietary fibers,sorbitol,lactulose , senna bisacodyl . ( suppository-enema)

8. Contd.. Anti-emetics: These drugs prevents nausea and vomiting e.g. ondansetron , metoclopramide,promethazine,phenargan etc. Expectorants: Drugs which increase the bronchial secretion and help to cough of sputum are expectorant e.g. sodium and potassium iodide, ammonium chloride .

9. Contd.. Carminatives: Causes expulsion of gas from the stomach and intestine. These drugs help to reduce flatulence. It produces mild irritation to the gastrointestinal tract leading to more motility and causes relaxation of sphincters e .g. sodium bicarbonate, peppermint oil, tincture ginger.

10. Contd.. Hypnotic : Those drugs which induces sleep or maintain sleep ,similar to normal arousable sleep e.g. thiopental sodium,Lorazepam,midazolam . Sedatives/ tanquilizer : Those drugs which depress central nervous system and calm patient without inducing sleep. e.g phanobarbitol,conazepam,diazepam

11. Contd.. Diphoretis :Those drugs which increases action of sweat gland and induce sweating. E.g.tramadol,fentanyl,morphine . Tonic: Tonic produces and restores normal tone of health. E.g. vitamin B complex( fortiplex ). Histamine : histamine is chemical mediator of inflammation.it cause smooth muscle contraction,including bronchiolar and small vessel constriction ,increased vascular permeability and secretion of nasal and bronchial glands.

12. Contd.. Anti - Anti- histamine : Drugs which destroys and expel worms e.g. albendazole,mebendazole . inflammatory : Helps to reduce inflammation. E.g. ibuprofen,hydrocortisone,prednisolone . Antidote : Counteract the effects of poisoning .e.g. Naloxone is antidote of morphine poisoning N- acetylcystein is an antidote of paracetamol poisoning Atropine is antidote of organophospate poisoning. Flumazenil is antidote of benzodiazepine poisoning.

13. Contd.. Myotics : Cotracts the pupil of eye.eg. pilocarpine,physostigmine Mydriatrics : Dilates the pupil of eye. E.g. atropine,cyclopentolate,tropicamide . Stimulant : increases the functional activity of organ. E.g. caffeine

14. Contd.. Antacid : Neutralizes gastric acid secretion. E.g. magnesium hydroxide, sodium bicarbonate. Anti -coagulant : Inhibit or decrease blood clotting process. E.g. heparin,warfarin.etc Anti- mycotics : Prevents growth or destroys fungus. Eg . Ketoconazole,nystatin,benzoic acid.

15. PREVENTION OF MEDICATION ERROR THREE CHECKS : 1 . Before pouring, mixing or drawing the medicine, check its label against the entry on cardex . Be sure that name, route, time, patient, dose match the cardex entry . 2. At the bed side check the medicine once again before administering it . 3. After administering the medication and before returning the remaining medicine to the medication cart or discarding .check label against cardex entry again.

16. TEN RIGHTS: 1.RIGHT DRUG: A nurse must always administer a correct medication. Always check the physicians order. if the order is not clear consult the concerned physician. Check the prepared medicine cardex with physician’s order. Select ordered medicine from drug base .

17. Contd.. Perform three checks Avoid selecting medicine based on size and colour.be alert for similar looking labels and similarly spelled names. Administer medicine from clearly labeled container. Be familiar with abbreviation and trade name of drugs. Be sure about changing orders. Do not accept verbal orders

18. 2.RIGHT DOSE Nurse should have knowledge regarding dose of different drugs administered.ci Check the physician order to know the correct dose. Be sure that dose is within the recommended range for patient’s age and conditions. Ensure accuracy in measuring .

19. contd …. Calculate the dose correctly, if the available medication is different from the dose recommended for E.g. if the ordered dose is 500mg tablet and available dose is 1000mg then break the tablet into two equal parts using knife or cutting device.* if the tablet breaks unevenly discard it. When crushing a tablet clean the crushing device before using it to remove any pieces of previously crushed drug and clean it after uses as well Help patient to take all medication.

20. Contd.. 3.RIGHT TIME Medications are administered at a specific time to maintain constant therapeutic level. Check the cardex for the time to give the drug. Know the abbreviations as well. Know the right time to give a drug. E.g. insulin is usually given half an hour before meal. Lasix is normally given in morning and afternoon only. Determine whether the patient is scheduled for any diagnostic procedure ,surgery, blood test that require patient to be in NPO

21. Contd.. 4.RIGHT PATEINT Ask the patient to state his /her name. For unconscious patient, children, mentally ill patient use the identification tag. Or ask the patient’s relatives.

22. Contd.. 5.RIGHT ROUTE Check the cardex to ensure proper form of the route ordered. Know the abbreviations for routes e.g. IM, IV, SC etc. If any error occur immediately inform to ward sister or physician as it can be life threatening.  

23. Contd.. 6.RIGHT REASION Confirm the rationale for the ordered medication .what is the patient’s history? Why is he/ she taking this medication?

24. Contd.. 7. RIGHT DOCUMENTATION After administering a medication document it on patient’s cardex . Be sure to document the name of drug, dose, route, exact time of drug administration and signature of the nurse providing the medication.

25. Contd.. 8.RIGHT EVALUATION Make sure that the drug produced the desired effect .if antihypertensive was given .has his/her blood pressure improved? if a patient is taking insulin then his blood sugar is within normal range or not.

26. Contd.. 9.RIGHT TO REFUSE Give client enough autonomy to refuse after properly explaining the side effects.

27. Contd.. 10.RIGHT EDUCATION Client has right to be educated about the drugs which he or she is prescribed. education can be given on side effects of drugs, precautions to be taken, course of drug therapy dietary consideration etc.

28. References Health learning material center. Institute of medicine of medicine , Tribhuwan University.Fundamentals of nursing ( second edition reprint ,2010). Kathmandu:Heidal Press , Dillibazar . Basvanthappa,B.T . (2004 ). Fundamentals of Nursing. New Delhi : Jaypee Brothers. Perry, A.G. and Potter, P.A. (2007).Basic Nursing Essentials For Practice .(sixth edition): Mosby Giri , M. and Sharma,P . (2013). Essential Fundamental Of Nursing.(first edition).Kathmandu: Medhavi Publication. Pathak , S.and Devkota ,R.(2011).A Textbook Of Fundamentals of Nursing.(second edition). Kathmandu:Vidyarthi Prakashan . Taylor,C.R . and Lillis,C .(2008). Fundamental Of Nursing.(Volume1):Lippincott William and Willikins Skidmere ,L . Nursing Drug Reference(2009): M osby

29. THANK YOU!!!