Medications and Administration

Office of Coordinated School HealthAnnual Data and Compliance Report

2008 (Tennessee Public Schools)

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Definitions

Pharmacology is the study of the action of chemical substances on living tissue.

Therapeutics is identified when the use of chemical substances is primarily beneficial

Toxicology is identified when the use of chemical substances is primarily harmful

Major actions of medications

Stimulate body cells Slow down body cells Kill or invade organisms Replace substances Irritate body cells Relieve symptoms

Factors that influence how medication works…

Age Weight Sex Genetic factors Illness or disease Time of administration Environment

5 processes that affect medication actions…

Reception Absorption Distribution Metabolism Excretion

Phenylketonuria (PKU)

Classic is Autosomal Recessive

Mental Retardation

Seizures

Rash

Tremor

Microcephaly

Developmental Delay

Muscle Spasticity

Hyperactivity

Abnormal Urine Odor

Altered Growth And Development of Social Skills

attentional problems, school problems, lower achievement motivation, decreased social competence,

decreased autonomy, and low-self-esteem. develop depressed mood, generalized anxiety, phobias,

decreased positive emotions, social maturity deficits, and social isolation

The correlation between level of metabolic control and severity of symptoms suggests a biological basis of

psychiatric dysfunction

Additionally, psychosocial factors such as the burden of living with a chronic illness may contribute to

psychological and psychiatric outcomes in PKU

Phenylketonuria (PKU)

PKU Sx

PKU as a Metabolic Model

Tx of PKU

Types of Medication

Major medication classifications

Analgesic Antacid Antianxiety Antiasthmatic Antibacterial/antibiotic Anticoagulant Antidepressant Antidiarrheal Antidote Antiemetic Antifungal Antihistimine

Antihypertensive Antipsychotic Antipyretic Antitussive Antiulcer Antiviral Bronchodilator Cardiovascular agent Diuretic Expectorant Gastrointestinal stimulant Glucocorticoids

More medication classifications

Glucocorticoids Hormones Hypoglycemic

medication Laxative Nonsteroidal anti-

inflammatory agents OTC Psychotropic

Sedative/hypnotic Skeletal muscle

relaxants Stimulants Topical steroids

Purpose of Prescribing Medication

Maintain health Treat disease Relieve symptoms Prevent disease Alter body processes Diagnose disease

Forms of medications

Liquid Solid Semi-solid

Administration Routes

Oral Buccal Sublingual Eye Ear Dermal patch Inhalation

Nasal Rectal Vaginal Subcutaneous Intradermal Intramuscular Intravenous

Actions and Effects of Medication

Action Effect Dose Side effect/adverse reaction Hypersensitivity Interaction Tolerance

Drugs That May Interact Can Seem Harmless

Interaction of SSRI antidepressants with Antihistamines

Interaction of SSRI antidepressants with

Results in

Terfenadine (Seldane) and astemizole (Hismanal)

Fluvoxamine (luvox) may increase levels of terfenadine and astemizole. Fatal heart rhythms can occur

Cyproheptadine (Periactin) May reverse the effects of SSRls

Interaction of SSRI antidepressants with Diabetes Medications

Interaction of SSRI antidepressants with

Results in

Tolbutamide (Orinase) Fluvoxamine (luvox) may increase levels of tolbutamide. Low blood sugar may result.

Insulin Fluvoxamine (luvox) may cause decrease in blood sugar; insulin levels may need to be adjusted

Symptoms of Drug Overdose

Difficulty breathing Slurred speech Lack of coordination or

unsteady walk Shaking or agitation Slow or fast

pulse/heartbeat Low or high body

temperature Small or large eye

pupils

Reddish face Heavy sweating Stomach pain, nausea,

vomiting Drowsiness Violent or aggressive

behavior Delusions and/or

hallucinations Unconsciousness

Accidental ingestion…

Call 911 and/or poison control center Be ready to describe:

What drug was taken (locate container) How much was taken When the drug was taken If the drug was taken with alcohol or other drugs What symptoms is the child experiencing If the child is conscious If the child is breathing

Five Rights

Right Person Right Drug Right Dose Right Time Right Route

Medication Administration

The law authorizes public and private school districts to implement policies and procedures so that students can receive medications at school.

Commonly Used Rx Abbreviations

a.c. = before meals (from "ante cibum," before meals) ad lib: use as much as one desires (from "ad libitum") b.i.d. = twice a day caps = capsules da or daw = dispense as written g (or gm or GM) = gram gtt. = drops (from "guttae," drops) h. = hour mg = milligram ml = milliliter p.c. = after meals (from "post cibum," after meals) p.o. = by mouth, orally (from "per os," by mouth) p.r.n. = when necessary (from "pro re nata," for an occasion that has arisen, as circumstances require, as needed) q.d. = once a day (from "quaque die," once a day) q.i.d. = four times a day (from "quater in die," 4 times a day) q._h.: If a medicine is to be taken every so-many hours (from "quaque," every and the "h" indicating the number of

hours) q.h. = every hour q.2h. = every 2 hours q.3h. = every 3 hours q.4h. = every 4 hours t.i.d. = three times a day (from "ter in die," 3 times a day) ut dict. = as directed (from "ut dictum," as directed)

Always know…

Give medications only with written orders from a licensed authority

Know the intended use of the medication, side effects, dosage

Maintain medication in its original container with the following info: Child’s name, name of medication, dosage, route of

administration, frequency of administration, quantity issued, name of the prescribing provider, prescription number, date meds were dispensed, expiration date, pharmacy name and phone

Each child’s specific medications should be secured in an individual storage compartment and kept at minimum in a locked container in foster homes. In group homes/residential facilities there must be a double-lock barrier.

Medications must be identifiable up to the point of administration.

The child receiving the medication should be told the purpose of the medication and expected effects.

The principles of universal precautions are to be followed when administering medication.

Never take medication from an unmarked or damaged container, or if the label is unreadable.

Keep all containers tightly closed to prevent any changes to the medication from occurring. Any change in color, consistency, or odor must be reported to the designated supervisor, pharmacist, or licensed staff.

Provide privacy to the child during medication administration when it is indicated.

Medications that have been prepared and not given to the child for any reason (refusal, absence, dropped on the floor) are to be discarded. Never return medication to their containers.

The school should NOT be responsible for giving the first dose of any new medication

Medication documentation

Document all medication administered, including OTC, topical ointments, sunscreen, and insect repellent

Use one log for each medication an individual child is taking

Document the medication administration immediately after you give the medication

Write in ink Document the administration in a well-lit

area

Documentation cont.

Write legibly Always document the dose administered, time of

administration and who gave the medication to the child

Document all side effects you observe in the child Document the specific symptoms the child showed

that necessitated the need to give the “as needed” medication

If a medication was NOT given, document why

Documentation cont.

If an error is made while documenting, cross out the incorrect information with a single line and write “error” and your initials next to it. Then write the correct information. DO NOT use white-out.

Example. Dose: Two Drops Error MW Dose: One Drop

Safe Storage

All over-the-counter (OTC) medications and all prescription medications must be single locked

All medication must be stored in the original labeled container or in containers with a label provided by the pharmacy.

Medication cannot be left out for child to take at a later time.

Medications for a child on a self-administration program must be stored in such a way as to make them inaccessible to all other persons.

Medication that requires refrigeration must be stored in a separate locked refrigerator… and NEVER on the door

For children with disabilities…

Communication difficulties Swallowing and movement difficulties Gross motor difficulties and/or immobility

Do’s

DO:☺ Approach the child expecting cooperation☺ Prepare the child☺ Help the child to relax by having him imagine a

favorite place or take deep breaths☺ Have the child participate in the medication taking

process☺ Give as much control as possible☺ Ask a resistant child, “Why don’t you want to take

your medicine?”☺Thank the child for cooperation

and… Don’ts

⊗ Crush pills or open capsules without instructions from the health care provider

⊗ Threaten to give medication as a punishment

⊗ Call medication “candy”

⊗ Restrain the child with force

Oral Administration

Most medications are given orally (p.o. in medical terms)

It is important that tablets are crushed or capsules are only opened with the physician’s permission since this may change the absorption of some medications

Feeding Tube Administration

When medication is being given through the feeding tube, it should not be mixed with the student’s feeding.

Always flush the tube before and after administration

Topical Administration

Creams and ointments should be applied sparingly in thin layers, unless otherwise specified.

Use disposable gloves to administer For skin patches, placement should be in an

area of minimal hair growth

Respiratory Administration

Frequently used in cases of students with asthma, cystic fibrosis, and other respiratory illnesses

Most common methods are through meter dosed inhalers and nebulizers

A nebulizer is an aerosol machine that provides the medication in a mist which is inhaled through a mouth or nosepiece

Nasal Administration

Nasal sprays will differ in their administration. Some sprays will instruct the person to tilt their head back and breath in while spraying the medication (e.g., Imitrex for migranes), while other spray medication will instruct the person not to tilt back their head or inhale while administering the medication (e.g., Migranal for migranes)

Ophthalmologic Administration

Used to treat a variety of eye infections (e.g. conjunctivitis) and diseases (e.g., glaucoma)

Typically applied through the use of an eye dropper or are squeezed directly out of a tube to the eye

Optic Administration

Ear drops are commonly prescribed for certain types of outer ear infections involving fungus or bacteria

Care must be taken that when ear drops are given, they are given at room temperature since cold ear drops can cause vertigo, pain, and/or nausea and if given too warm, they could burn the ear

Rectal Administration

The most common form of rectal medication given in the school setting is typically given in suppository form

Typically given for constipation or when medication cannot be given orally (medication for migrane accompanied with nausea and vomiting)

Administration by Injection

Types of injections: intradermal subcutaneous intramuscular intravenous

It is important that the correct injection type is given with the ordered medication since using the wrong type can result in ineffective medication administration, or in some cases, significant injury

Indwelling Continuous Pumps

Some medications are infused over a continuous time frame through the use of pumps

The pump is programmed to deliver specific amounts of medication over time

Care must be taken to ensure that tubing is not accidentally pulled

Problems and Emergencies

Side Effects Allergic Reactions Tolerance Physical Dependency Missed Dosage & Overmedication Incomplete Administration Wrong Medicine or Dose Choking

ANAPHYLAXIS

Anaphylaxis

A rare, extremely serious form of allergy which may occur in adults or children not previously known to be allergic or hypersensitive. Students with identified allergies should have a current health or action plan on file in the health room. School staff should be notified on an as-needed basis.

Symptoms

Types of Anaphylaxis

Food-induced Insect Stings and Bites/Venom induced Latex –induced Exercise-induced

Food –induced

Not usually outgrown Peanuts Tree nuts Shellfish Fish

Commonly outgrown Milk Egg Soy Wheat

Insect Stings and Bites

Major Bees/Africanized bees Fire Ants & other ants

Minor Scorpions Deer & Horse Flies Triatoma (blood sucking

insects) Mosquitoes

Insect Stings and Bites

Fire Ants

Latex-induced AnaphylaxisPrevention

Avoidance Use latex-free products Alert school about need for latex-free products and

equipment Wear Medic-Alert bracelet Awareness of cross-sensitivity with foods

Banana Avocado Chestnuts Kiwi Stone fruit

Exercise-induced Anaphylaxis

Starts with fatigue, diffuse warmth, itching, redness of the skin, and progresses rapidly

Does not occur with each exercise period May be related to foods eaten within past

few hours

Exercise-induced Anaphylaxis

Foods associated Shellfish-16% Alcohol-11% Tomatoes-8% Cheese-8% Celery-7% Strawberries, milk, wheat, peaches-each 5%

Prevention: Early morning exercise before eating

Treatment

Administer the EpiPen ® immediately! Use the 5 Rights of medication administration! Call 911 Turn student on his/her side Monitor student Notify Principal Call parent Call Area Nurse Document use on Medication Administration Form

Treatment

Antihistamines (Benadryl, Zyrtec, Zantac, Tagamet) Give after epinephrine dose. Delay in administration of

epinephrine may lead to fatality

Have student lie down with feet elevated Sitting upright may increase incidence of death

How does Epinephrine work?

It quickly constricts blood vessels, raising blood pressure

It relaxes smooth muscles in the lungs to improve breathing

It stimulates the heart beat It works to reverse the hives and

swelling around the face and lips

How is Epinephrine handled?

Before using, make sure solution is clear and colorless

Accidental injection into the hands or feet may result in loss of blood flow to the affected area and will require immediate treatment in the Emergency Department.

How is Epinephrine stored?

Stable at room temperature until the marked expiration dateDo not freeze, refrigerate, or

expose to extreme heat or sunlight…it will cause it to oxidize and go bad…and turn brown.