VU Nurse-Midwife “Drug Diary”: State of Medical Management

Six rights of drug control

The purpose of the VU School of Nursing and Midwifery student-moderated Drug Journal is to provide students with an understanding of drug administration and management. Registered nurses and midwives are health professionals regulated by law and are certified by the Australian Nursing and Midwifery Board (NMBA) https://www.nursingmidwiferyboard.gov.au/Codes-guideline-statements/professional-standards.aspx be responsible for In addition, the safe and effective use of drugs in clinical practice is regulated by national safety and quality standards to support drug management.

https://www.safetyandquality.gov.au/standards/nsqhs-standards

The six fundamental rights to drug administration must always be respected. Some hospitals may have up to 11 drug custodians in place, and it is your professional duty to know the policies of the facility you work for and follow their requirements. Right person, right drug, right dose, right method, right time, right documentation

Medicines can be classified according to their effect on our body. So it’s important to understand this. For example, pain relievers relieve pain, antihypertensives lower blood pressure, and antidepressants help relieve depression. These drugs are further classified according to their individual therapeutic effect. For example, if you are taking two different drugs that are classified as antihypertensives, drug A may lower blood pressure differently than drug B. Because caregivers are responsible for the drugs they administer, it is important to be clear about how the drugs work.

If you use this “medicine diary”, enter all your unfamiliar medications in this diary and take the time to consolidate the information you enter. This will allow you to know better about the medicines you are administering. Try paraphrasing in your own words to get a better understanding of the drug. Try grouping drugs on the same page if necessary. Painkillers, antiemetics, etc.

McKenna, L. & Milkoff, S. (2019). McKenna’s Drug Handbook for Nursing and Midwifery in Australia and New Zealand. The Wolters Kluwer is a great little manual that you can easily carry to and from the clinic. This also includes nursing care.

It comes with a larger, more detailed text in case you need more information.

McKenna, L. & Gigi Lim, A. (2020). McKenna’s Pharmacology for Nursing and Health Professionals (Second Edition, Revised). Walters Kluwer.
Simmons, K & Armor, J (2020). Australian Injectable Handbook (8th Edition). The Australian Association of Hospital Pharmacists is what we call nursing’s ‘yellow bible’. It is available in all acute care hospitals and is easily accessible electronically (registration required) or in paper form. You do not need to purchase this manual.

 Key Terms/AbbreviationsMening
Pharmacokineticsthe absorption, distribution, metabolism and excretion of drugs
Pharmacodynamicsthe scientific interactions between the chemistry of the living systems and the foreign chemicals that have been introduced to those systems
Loading Dosesome medications need an initial higher dose to obtain the desired effect in a timely manner
Half Lifethe time it takes for a medication to reduce to half of its peak level
Peak Levelhighest concentration of the medication in the bloodstream
Generic Namethe original medication name that receives approval for use (eg.Paracetamol)
Brand Namethe name given to the generic medication by the company making it (eg. Panadol, Panamax, Dymadon)
DailyOnce a day, at the same time each day
ManeIn the morning
NocteAt night
BdTwice a day, usually 12 hours apart
TdsThree times a day, usually eight hours (8/24) apart
QIDFour times a day, usually six (6/24) apart
PRNWhen necessary or as required
SRSlow or sustained release
IRImmediate release
 Key Terms/AbbreviationsMening
POPer oral (by mouth)
PRPer Rectum
NEBNebuliser
MDIMetered Dose Inhaler
TOPTopical (on the skin)
BEBoth Eyes
S/LSub Lingual (under the tongue)
BuccalBetween the cheek and gums
S/C:Sub cutaneous
IMIntramuscular
IVIntravenous
NGNasogastric
PEGPercutaneous Endoscopic Gastrostomy tube

https://www.safetyandquality.gov.au/sites/default/files/migrated/Recommendations-for-terminology-abbreviations-and-symbols-used-in-medicines-December-2016.pdf

Anti-Anxiety
Generic Medication Name ( And Brand Names) & Drug Class (Include Drug Schedule)Actions (Link To Patho) & IndicationsAdverse Reactions (Most Common) And Interactions (Including Drug Interactions If Any)Methods Of Administration.  Is There An Antidote?Nursing Considerations/Patient Education
eg.  Paracetamol (Panadol, Panamax, Dymadon) Analgesia & Antipyretic (S4)Used for mild pain and fever. Blocks pain impulses. It prevents the synthesis of prostaglandins and other substances that sensitize pain receptors in the CNS. Lowers fever by acting on the hypothalamusLiver damage at toxic doses. Increased anticoagulation when taking warfarin, alcohol may increase risk of liver damage, caffeine may increase analgesic response, barbiturates/carbamazepine/hydantoin/rifampicin/sulfirazon: at high or long doses ↓ Therapeutic effect and ↑ Possibility of liver toxicity Periodic usage: Do not use togetherPO (tablets, capsules, syrup, elixir, chewable, soluable, IV, PRN-Acetylcycteine (NAC) can be used in overdoseBe careful if liver disease, be careful of other medications that contain paracetamol, for short term use only, seek dr advice if being used for high temps
Diazepam (Valium)Benzodiazepines (S4)Indicated for the treatment of anxiety disorders and acute stress reactions. It has anxiolytic, antispasmodic and amnestic properties. It works by promoting the activity of gamma-aminobutyric acid (GABA). When the drug allosterically binds to her GABA-A receptor, the frequency of chloride channel opening increases. This further contributed to decreased neuronal excitability (Dhaliwal, Rosani & Saadabadi, 2021).Serious effects of diazepam include suicidal tendencies, respiratory depression, withdrawal symptoms, and dependence. Other common side effects include sedation, fatigue, irritability and confusion. Known to interact with opioids, alcohol, marijuana, and antihistamines.PO (capsule or syrup) flumazenil can be used as an antidote for overdose (Kurlawala et al., 2018).Nursing staff should exercise caution when using this drug in certain patient populations, such as pregnant women and older patients. Vital sign monitoring is important after drug administration. They should also provide information about side effects and foods to avoid when taking the drug.
ANTIdepressants
Generic Medication Name ( And Brand Names) & Drug Class (Include Drug Schedule)Actions (Link To Patho) & IndicationsAdverse Reactions (Most Common) And Interactions (Including Drug Interactions If Any)Methods Of Administration.  Is There An Antidote?Nursing Considerations/Patient Education
Fluoxetine (Prozac, Sarafem)Selective serotonin reuptake inhibitors (H1)Fluoxetine can be used to treat depression, obsessive-compulsive disorder, and bulimia nervosa. This drug blocks the reuptake of serotonin into presynaptic serotonergic neurons and increases the reuptake of transport proteins. Reuptake of serotonin produces a revitalizing effect (Sohel, Shutte & Molla, 2020).This drug is known to cause side effects such as bleeding, seizures, mania, weight loss, muscle weakness, and decreased orgasms. Metabolism with CYP2D6 isoenzymes has numerous drug-drug interactions. These are drugs such as anticonvulsants, lithium salts, anxiolytics, calcium channel blockers and antidepressants (Bahar et al., 2018).PO (liquid, tablet, capsule) fluoxetine is started at a dose of 20 mg per day. There is no antidote for this medicine. In cases of overdose, supportive care including respiratory protection, electrocardiography, and administration of benzodiazepines for sedation can be given (Sohel, Shutte, & Molla, 2020).Nurses should not administer this drug to patients taking linezolid and should use it with caution in patients with a history of seizures. Patient education should focus on providing knowledge of doses, necessary precautions, and signs that should be communicated promptly to the medical team.
Antipsychotic
Generic Medication Name ( And Brand Names) & Drug Class (Include Drug Schedule)Actions (Link To Patho) & IndicationsAdverse Reactions (Most Common) And Interactions (Including Drug Interactions If Any)Methods Of Administration.  Is There An Antidote?Nursing Considerations/Patient Education
Olanzapine (Zyprexa)Atypical antipsychoticsFor the treatment of symptoms of bipolar disorder and agitation in patients with schizophrenia. Affects dopamine and serotonin receptors, blocking the action of dopamine at postsynaptic receptors.Commonly observed side effects include drowsiness, dizziness, upset stomach and weight gain. Known interactions with patients taking opioid drugs, alcohol, marijuana, and metoclopramide.PO (tablet form) Overdose can cause drug toxicity, and clinical features of overdose include agitation, sedation, convulsions, delirium, and tachycardia. There is no specific antidote for olanzapine. There is evidence that supportive management is the primary treatment (Keyal et al., 2017).When administering olanzapine to a patient, it is important to regularly monitor and monitor the patient’s blood glucose levels. Education about proper nutrition and exercise is also important. Patients should be informed about the reasons for drug use and the need for treatment. Nursing staff should take precautions and avoid using drugs in women who are breastfeeding. Mental status, blood glucose levels, and hemodynamic status should also be assessed after administration of olanzapine (Kizior & Hodgson, 2021).
Mood stabilizing
Generic Medication Name ( And Brand Names) & Drug Class (Include Drug Schedule)Actions (Link To Patho) & IndicationsAdverse Reactions (Most Common) And Interactions (Including Drug Interactions If Any)Methods Of Administration.  Is There An Antidote?Nursing Considerations/Patient Education
Lithium  (Camcolit)Antimanic agents (S4)  Used to treat manic episodes in patients with depression and abnormal moods. This drug works by affecting the release of neurotransmitters and other chemicals in the human body. It reduces presynaptic dopamine activity and inactivates G proteins. This effect reduces excitatory neurotransmission in the brain. Patients with bipolar disorder have higher numbers of dopamine-related G-protein units. Lithium alters the function of these subunits and corrects dopamine dysregulation (Malhi et al., 2013).Side effects of the drug may include weakness, excessive thirst, urination, seizures, and jerky movements. This drug is known to interact with ACE inhibitors, NSAIDs and diuretics.Take PO (tablets, capsules, solutions) 3-4 times a day. It should be taken exactly as directed by your doctor. An overdose of the drug can cause severe nausea, vomiting, confusion, and blurred vision. There is no antidote for lithium toxicity and it can be removed by hemodialysis. This is necessary if the patient shows severe signs of lithium poisoning or is developing renal failure (Hedya, Avula & Swoboda, 2018).It should be used with caution in patients with renal impairment and the elderly. Nursing staff should evaluate patients for hypersensitivity to tartrazine, history of renal or cardiovascular disease, pregnancy, lactation, and patients taking diuretics. It is important to examine the patient for normal urine output, normal fluid intake, and voiding patterns. Patients should be monitored closely in the early stages. Patients should be educated to take their medications as prescribed, drink plenty of fluids, and have regular check-ups. If tremors or drowsiness occur, the drug should be discontinued (Finley, 2016).

Bahar, M. A., Kamp, J., Borgsteede, S. D., Hak, E., & Wilffert, B. (2018). The impact of CYP2D6 mediated drug–drug interaction: a systematic review on a combination of metoprolol and paroxetine/fluoxetine. British journal of clinical pharmacology, 84(12), 2704-2715.

Dhaliwal, J. S., Rosani, A., & Saadabadi, A. (2021). Diazepam. StatPearls [Internet].

Finley, P. R. (2016). Drug interactions with lithium: an update. Clinical pharmacokinetics, 55(8), 925-941.

Hedya, S. A., Avula, A., & Swoboda, H. D. (2018). Lithium toxicity. https://www.ncbi.nlm.nih.gov/books/NBK499992/

Keyal, N., Shrestha, G. S., Pradhan, S., Maharjan, R., Acharya, S. P., & Marhatta, M. N. (2017). Olanzapine overdose presenting with acute muscle toxicity. International journal of critical illness and injury science, 7(1), 69–71. https://doi.org/10.4103/2229-5151.201962

Kizior, R. J., & Hodgson, K. (2021). Saunders nursing drug handbook 2022 E-book. Elsevier Health Sciences.

Kurlawala, Z., Roberts, J. A., McMillan, J. D., & Friedland, R. P. (2018). Diazepam toxicity presenting as a dementia disorder. Journal of Alzheimer’s Disease, 66(3), 935-938.

Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential mechanisms of action of lithium in bipolar disorder. CNS drugs, 27(2), 135-153.

Sohel, A. J., Shutter, M. C., & Molla, M. (2020). Fluoxetine. StatPearls [Internet].  

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