This document provides information on oral medication administration procedures. It discusses key terminology like enteric coated and sustained release medications. It outlines best practices for oral medication administration, including positioning, use of fluids, and monitoring swallowing. Safety considerations are mentioned. The document then covers pharmacokinetic concepts like absorption, distribution, metabolism, excretion, therapeutic effects, toxic effects, and allergic reactions. It also discusses tolerance, dependence and addiction. Finally, it touches on concepts like onset, peak and duration of medication effects.

1. ORAL MEDICATION PROCEDURE
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2. TERMINOLOGIES
• Enteric coated
• Potency of Drug
• Sustained Release

3. MEDICATION BY MOUTH
• Medication is usually given orally, which is generally the most comfortable and convenient
route for the patient. Medication given orally has a slower onset and a more prolonged, but
less potent, effect than medication administered by other routes (Lynn, 2011).
• Prior to oral administration of medications, ensure that the patient has no contraindications to
receiving oral medication, is able to swallow, and is not on gastric suction. If the patient is
having difficulty swallowing (dysphagia), some tablets may be crushed using a clean mortar
and pestle for easier administration. Verify that a tablet may be crushed by consulting a drug
reference or a pharmacist.
• Medications such as enteric-coated tablets, capsules, and sustained-release or long-acting
drugs should never be crushed because doing so will affect the intended action of the
medication. Tablets should be crushed one at a time and not mixed, so that it is possible to
tell drugs apart if there is a spill. You may mix the medication in a small amount of soft food,
such as applesauce or pudding.
• Position the patient in a side-lying or upright position to decrease the risk of aspiration. Offer
a glass of water or other oral fluid (that is not contraindicated with the medication) to ease
swallowing and improve absorption and dissolution of the medication, taking any fluid
restrictions into account.
• Remain with the patient until all medication has been swallowed before signing that you
administered the medication.

4. SAFETY
CONSIDERATIONS

5. STEPS OF MEDICATION
ADMINISTRATION

6. RATIO AND THE
PROPORTION METHOD

11. PHARMOCOLOGICAL
CONCEPTS
MEDICATION NAMES
:
CHEMICAL NAME : N-
Acetyl para-amino-
phenol (exact chemical
composition and
molecular structure)
Generic Name :
Acetaminophen
(chemical name and its
same no matter how
many companies
makes a medicine)
Trade names : Dolo,
Calpol, Crocin. (brand
name)

12. PHARMACOKINETICS
THINK OF
PHARMACOKINETICS
AS A DRUG’S
JOURNEY THROUGH
THE BODY, DURING
WHICH IT PASSES
THROUGH FOUR
DIFFERENT PHASES:
ABSORPTION,
DISTRIBUTION,
METABOLISM, AND
EXCRETION (ADME).
Absorption: Describes how
the drug moves from the site
of administration to the site
of action.
Distribution: Describes the
journey of the drug through
the bloodstream to various
tissues of the body.
Metabolism: Describes the
process that breaks down
the drug.
Excretion: Describes the
removal of the drug from the
body.

13. ABSORPTION
• Absorption is the movement of a drug from its site of administration to the
bloodstream. The rate and extent of drug absorption depend on multiple factors,
such as:
• Route of administration, The formulation and chemical properties of a drug, Drug-
food interactions.
• The administration (e.g., oral, intravenous, inhalation) of a drug influences
bioavailability, the fraction of the active form of a drug that enters the bloodstream
and successfully reaches its target site.
• When a drug is given intravenously, absorption is not required, and bioavailability is
100% because the active form of the medicine is delivered immediately to the
systemic circulation. However, orally administered medications have incomplete
absorption and result in less drug delivery to the site of action. For example, many
orally administered drugs are metabolized within the gut wall or the liver before
reaching the systemic circulation. This is referred to as first-pass metabolism, which
reduces drug absorption.

14. FACTORS
THAT
AFFECT
ABSORPTIO
N
• Route of Administration – Topical, oral, buccal
mucosa, IM, SC, IV.
• Medication forms – solutions and suspensions >
tablets and capsules. Acidic and basic medications.
• Blood flow to the site of administration – rich blood
supply means faster medication absorption
• Body surface area – larger surface area faster
absorption (stomach and small intestine)
• Lipid solubility of medication. – because cell
membranes are made up of lipid layer. There-fore
highly lipid soluble medications cross the cell
membrane easily and are absorbed quickly
• Food and drug interactions.

15. DISTRIBUTION AND CIRCULATION
A drug will move from the absorption site to tissues around the body, such as brain tissue, fat, and muscle.
The rate and extent of distribution depend on the physical and chemical properties of medication and the
physiology of the person taking it.
Circulation: once a medication enters the bloodstream, the blood carries it throughout the tissues
and organs of the body.
High vascularity = faster the reach of drug to the intended site.
Example : heart-failure – impaired circulation – slower delivery to the intended site.
Membrane permeability : Tissues ability to allow a medication to pass through and enter target cells for
distribution to an organ.
Some membranes serve as barriers to the passage of medications. For example, the blood brain barrier
allows only fat soluble medications to pass into the brain and cerebrospinal fluid.
Protein binding : degree to which medications bind to serum proteins such as albumin reducing their
distribution.
Most medications partially bind to albumin , reducing the drugs pharmacological activity. The unbound or
free medication is its active form.
Example : older adults with liver disease and malnutrition have decreased albumin in the blood stream.

16. METABOLISM
• After a medication reaches its site of action, it becomes metabolized into a less active or inactive form
that is easier to excrete.
• Many drugs undergo chemical alteration by various bodily systems to create compounds that are more
easily excreted from the body(with a chemical reaction). These chemical alterations occur primarily in the
liver and are known as bio-transformations.
• Patients are at risk for medication toxicity if organs that metabolizes medications are not functioning
correctly.
• Cytochrome P450 (CYP450) enzymes are responsible for the biotransformation or metabolism of about
70-80% of all drugs in clinical use.
• What are some factors that affect drug metabolism?
• Genetics can impact whether someone metabolizes drugs more quickly or slowly.
• Age can impact liver function; the elderly have reduced liver function and may metabolize drugs more
slowly, increasing risk of intolerability, and new-borns or infants have immature liver function and may
require special dosing considerations.
• Drug interactions can lead to decreased drug metabolism by enzyme inhibition or increased drug
metabolism by enzyme induction.

17. EXCRETION
• Elimination involves both the metabolism and the excretion of the drug through the
kidneys, liver , bowel, lungs etc.,) and to a much smaller degree, into the bile. (liver
breaks down the medications that enter the hepatic circulation and excretes them into
bile.)
• Excretion into the urine through the kidneys is one of the most important mechanisms of
drug removal.
• Many factors affect excretion, such as:
• Direct renal dysfunction, which could prolong the half-life of certain drugs and
necessitate dose adjustments.
• Age, which can contribute to differing rates of excretion and impact dosing of
medications.
• Pathologies that impact renal blood flow, such as congestive heart failure and liver
disease can make drug excretion less efficient

18. MEDICATION ACTION
• Pharmacodynamics is the action of the medication on the body.
• Pharmacokinetics is the action of the body on a particular drug.
Therapeutic Effects
• When a medication is administered, it has an expected or desired physiological response.
the therapeutic effect. The therapeutic effect is usually predictable.
• Each medication has its own desired effect or therapeutic effect. When you know what the
effect should be, you are better able to determine the patient’s response to the medication.
•

19. TOXIC EFFECTS
A toxic effect occurs when there is an accumulation of medication in the blood. The body
has an inability to metabolize or excrete the medication before the next dose of medication.
The medication then accumulates in the body.
If an excess amount of medication accumulates in the body, there can be severe
consequences. The toxicity of the medications can cause organ damage, system
damage, or even death.
This happens when one of the organs that metabolize or excrete the medication is slowed
or impaired. Therefore the medication is not metabolized or eliminated. And, the patient
eventually becomes toxic. The nurse should always monitor for toxic effects of medications
especially in the elderly.

20. IDIOSYNCRATIC EFFECTS
When a patient has a reaction to a medication that is not desired, predicted,
or expected, this is an idiosyncratic effect. In this situation, the patient will
overreact, or underreact to the medication.
Some patients will have a totally different reaction. These reactions are
unusual and completely opposite of the response that is expected. When a
patient has an idiosyncratic effect, it tends to be unique to that patient.
Again, monitor your patient and listen to patient complaints. Be aware that
idiosyncratic effects occur.

22. ALLERGIC REACTIONS
Another unpredictable response to
medications is an allergic reaction. An
allergic reaction may also occur hours
to days after an initial dose.
The patient may develop the allergic
response with the first dose or with
repeated doses. The medication, its
preservatives, or a metabolite may be
what causes the allergic response.
An allergic reaction varies from one
patient to another. The reactions can
range from a minor reaction to a more
serious reaction. With continued
administration, the symptoms of the
reaction may become more severe.
An anaphylactic reaction is the most
serious of the allergic reactions. This
anaphylactic reaction or anaphylaxis is
a life-threatening condition that can
cause respiratory distress due to
constriction of the bronchiolar muscles.
This eventually culminates in
cardiovascular collapse. Anaphylaxis
can occur suddenly and without
warning.
The nurse should always be aware of
the patient’s history especially
monitoring for any previous allergic
reactions to medication or medication
within the same family.

23. SYNERGISTIC EFFECT
A synergistic effect happens when two medications with
different mechanisms of action produce a greater effect
than if they were given separately.
This type of effect is sometimes desired. A healthcare
provider may prescribe medications for their combined
reaction in order to cause a beneficial effect for the
patient.

24. TOLERANCE
If you develop a tolerance to a substance, it
becomes less effective for you. For example, if
you take a sedative to sleep, it may work very
well at the first dose. But over time, you can
develop a tolerance. That means you need a
higher dose to get the same results.
The same thing happens with alcohol. When
you first start drinking alcohol, it may have taken
only a few drinks for you to feel drunk. But over
time, you may need more drinks, more often, for
the same effect.
Becoming tolerant to a drug isn’t unusual,
especially if you take it for a long time. Tolerance
can lead to addiction in some people, but it is
not the same thing as addiction. Being drug-
tolerant doesn’t necessarily mean you will
become addicted. But it could be a warning sign
for you to be careful.
Speak with your doctor if you develop a
tolerance to your medication or any other
substance.

25. PHYSICAL DEPENDENCE
• Physical dependence on a drug is also different from addiction. But physical
dependence can lead to addiction.
• Unlike tolerance, which focuses on how much of the substance you need to
feel its effect, physical dependence happens when your body starts to rely on
the drug.
• If you were to suddenly stop using it, you would likely experience some harsh
symptoms.
• Caffeine is an example of a common substance that causes physical
dependence. If you can’t function properly in the morning without your cup of
coffee, it could be that you are caffeine-dependent. When you miss your
morning cup, you might develop physical withdrawal symptoms, like a
headache, fatigue, difficulty concentrating, and more.
• Dependence is rare when patients receive medications for a short time such as
post operative pain

26. MEDICATION DEPENDENCE
PSYCHOLOGICAL
DEPENDENCE (ADDICTION)
ADDICTION IS A DISEASE BUT
TOLERANCE AND
DEPENDENCE AREN’T
Patients who are addicted to a drug use it even if it has no
medical benefit.
They use the substance no matter what and despite the
consequences.
Addictions are more likely to result in serious harm, including
suicide, unlike tolerance and physical dependence.
Many drugs can cause addiction, but the addictive drugs used
most often include:- Sedatives or tranquilizers called central
nervous system (CNS) depressants, like alprazolam ,
(Dextromethorphan, found in over-the-counter cough
suppressants

27. EFFECT OF A MEDICATION
• Three additional principles related to the effect of a medication on a patient are
onset, peak, and duration.
• Onset: the onset of medication refers to when the medication first begins to take
effect
• Peak: the peak of medication refers to the maximum concentration of medication
the body, and the patient shows evidence of greatest therapeutic effect
• Duration: the duration of medication refers to the length of time the medication
produces its desired therapeutic effect
•

28. CRITICAL THINKING
• Consider this patient care example and apply the principles of onset, peak, and
duration:
• A 67-year-old female post-operative patient rings the call light to request medication
for pain related to the hip replacement procedure she had earlier that day. She notes
her pain is “excruciating, a definite 9 out of 10.” Her brow is furrowed, and she is
grimacing in obvious discomfort.
• As the nurse providing care for the patient, you examine her post-operative
medication orders and consider the pain medication options available to you. In
reviewing the various options, it is important to consider how quickly a medication will
work (onset), when the medication will reach maximum effectiveness (peak), and how
long the pain relief will last (duration). Understanding these principles is important in
effectively relieving the patient’s pain and constructing an overall plan of care.

29. THINK???
• At 0500, your patient who had a total knee replacement yesterday rates his pain while walking
as 7 out of 10. Physical therapy is scheduled at 0900. The patient has acetaminophen (Tylenol)
625 mg ordered every four hours as needed for discomfort. What should you consider in
relation to the administration and timing of the patient’s pain medication?
• Nursing considerations when administering pain medication include efficacy, dose-response
based on the dosage selected, onset, peak, duration, and half-life of the drug. The patient has
physical therapy scheduled at 0900, so the nurse should administer acetaminophen now to
relieve the pain and evaluate the effectiveness in 60 minutes. The nurse should also plan on
reassessing the patient’s pain and potentially administering a second dose of acetaminophen
just prior to the physical therapy appointment because the half-life of acetaminophen is two to
three hours. Additionally, acetaminophen has a 24-hour dose restriction, so the nurse should
calculate how many total milligrams the patient has received over the past 24 hours prior to
administering the medication.

30. MEDOCATION DOSE
RESPONSE
• Therapeutic Window
• For every drug, there exists a dose that is minimally effective (the Effective
Concentration) and another dose that is toxic (the Toxic Concentration).
Between these doses is the therapeutic window, where the safest and
most effective treatment will occur
• CpL – Concentration in plasma .
• For example, warfarin (Coumadin) is a medication used to prevent blood
clotting and is monitored using a blood test called INR.
• Too high of a dose of warfarin would cause the INR to increase above the
therapeutic window and put the patient at risk of bleeding.
• Conversely, too low of a dose of warfarin would cause the INR to be below
the therapeutic window and put the patient at risk of clotting.
• It is vital that the nurse frequently monitors INR levels for a patient
receiving warfarin to ensure the dosage appropriately reaches the
therapeutic window and does not place the patient at risk for bleeding or
clotting.

31. PEAK AND TROUGH LEVELS
• Now let’s apply the idea of therapeutic window to the administration of medications requiring the monitoring of peak
and trough levels, which is required in the administration of some IV antibiotics.
• It is important for the dosage of these medications to be titrated to achieve a desired therapeutic effect for the patient.
• Titration is often accomplished by closely monitoring the blood levels of the medication.
• A drug is said to be within the “therepeutic window” when the serum blood levels of an active drug remain consistently
above the level of effective concentration (so that the medication is achieving its desired therapeutic effect) and
consistently below the toxic level (so that no toxic effects are occurring).
• A peak drug level is drawn at the time when the medication is being administered and is known to be at the highest
level in the bloodstream.
• A trough level is drawn when the drug is at its lowest in the bloodstream right before the next dose is given.
• Medications have a predicted reference range of normal values for peak and trough levels. These numbers assist the
pharmacist and provider in gauging how the body is metabolizing, protein-binding, and excreting the drug, and assist in
the adjustment of the prescribed drug doses to keep the medication within the therapeutic window.
• When administering IV medications that require peak or trough levels, it is vital for the nurse to time the administration
of the medication according to the timing of these blood draws.

32. • Mr. Parker has been receiving gentamicin 80 mg IV three times daily to treat his infective
endocarditis. He has his gentamicin level checked one hour after the end of his previous gentamicin
infusion was completed. The result is 30 mcg/ml. Access the link below to determine the nurse’s
course of action.
• Normal range is : Gentamicin: 5 to 10 mcg/mL
• The normal lab values of gentamicin are 5 to 10 mcg/mL (or 10.45 to 20.90 micromol/L), so 30
mcg/ml is too high. This abnormal result could indicate the patient has renal impairment affecting
metabolism and excretion of this medication. The doctor and pharmacist should be notified to
adjust the next dose of gentamycin before it is administered.

33. Thankyou