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Page 1-Pharmacology Study Guide for the Medical Assistant test General InformaƟon While you will not be allowed to write a prescripƟon during your medical assistant work, you do need to have a good understanding of common drugs, their use and handling, and regulaƟons governing them. You may be required to administer certain medicaƟons to paƟents, as directed by a doctor or nurse pracƟƟoner, and to call in or otherwise communicate prescripƟons and refills to a pharmacy. Here is what you’ll need to understand. MedicaƟon Terminology and Usage As a medical assistant, you will need to be familiar with mulƟple drug (both generic and brand) names, their general indicaƟons for use, how they are administered and stored as well as their common side effects and contraindicaƟons. In addiƟon, you will need to be familiar with abbreviaƟons commonly used in the medical chart and on prescripƟons. Medicine Names Each drug has a generic and brand name. For example, Lasix is the brand name for a generic drug called furosemide. Brand names are under patent for 20 years, so they may change. Generic names do not. Be aware of different drugs whose names sound similar. Examples include Zantac and Xanax or hydroxyzine and hydralazine. Be familiar with abbreviaƟons used for administraƟon, such as IM or PO, as well as those indicaƟng dosing frequency, such as QD or TID. References Many Ɵmes, all the informaƟon you need to know about a medicaƟon cannot be recalled by memory. You will need to use a reference source available to you in your workplace to recall a drug’s classificaƟon, contraindicaƟons, method of acƟon, administraƟon route, medicaƟon interacƟons, and possible adverse reacƟons. Examples of such resources include the Physician’s Desk Reference (PDR) as well as the drug’s package insert which can be found with any sample you may have of the drug. Indicators All drugs belong to certain therapeuƟc classes that treat specific disease states or health problems. The generic names of these medicaƟons may end in the same suffix. For example, atorvastaƟn and simvastaƟn belong to the “staƟn” family used to treat hypercholesterolemia. You should also recognize the indicaƟons of each drug class. Examples include ACE inhibitors for hypertension and sulfonylureas for type 2 diabetes mellitus. Each class oŌen demonstrates similar side effects, adverse reacƟons, and has the same contraindicaƟons.
PharmacokineƟcs The pharmacokineƟcs of a drug refers to the way it is absorbed, distributed, metabolized, and excreted from the body. Understanding of pharmacokineƟcs is helpful to opƟmize the usefulness and reduce potenƟal harm of a drug. For example, oral drugs cannot be given to a paƟent who has trouble swallowing or is vomiƟng. A drug that is heavily metabolized in the liver should be used with cauƟon in a paƟent with cirrhosis. All drugs have requirements for proper storage that include temperature, humidity, and exposure to light. This ensures their potency at the Ɵme of use. When medicaƟons need to be disposed of, follow all facility guidelines regarding the disposal of sharps and needles. Packaging and Form MedicaƟons come in various forms. Examples include: pills, capsules, suppositories, troches, ointments, gels, and transdermal patches. Parenteral drugs for injecƟon can come premixed for administraƟon or must be prepared. You must be familiar with them and understand how to safely and correctly prepare them for administraƟon. MulƟdose vials can be used to provide medicaƟon to mulƟple paƟents. Care must be taken not to contaminate the remaining medicaƟon in the vial when withdrawing doses. Alcohol should be used to thoroughly clean the rubber stopper before drawing up medicaƟon. Ampules provide a single dose of medicaƟon. They are scored at the neck which allow them to be broken and the drug to be drawn up into a syringe. Unit doses are prepackaged, single doses of oral or injectable drug. They are dispensed sealed and once opened, ready to administer. Prefilled cartridge-needle units are premixed, ready to inject vials with needles that aƩach to the vial when the unit is secured and locked into the plunger. Some medicaƟons come in a powder form as they lose their potency quickly once mixed into soluƟon. These medicaƟons usually come in single-dose vials that will use a diluent, such as normal saline, for reconsƟtuƟon. PrescripƟons and Refills As a member of the medical team, you will be involved in both the issuing and refilling of many prescripƟon medicaƟons. As such, you must be aware of the regulaƟons and documentaƟon requirements involved to perform both tasks. RegulaƟons
- The right Ɵme: Always confirm when the paƟent is to receive the medicaƟon. (This will usually be immediately in an office seƫng.)
- The right dose: Always confirm that the dosage of the medicaƟon you are administering is the same as that in the order.
- The right documentaƟon: Always immediately and completely document all details regarding the administraƟon of the medicaƟon in the paƟent’s medical record, including how the drug was tolerated. Measurement Be aware that there are several units of measurement that may be used for medicaƟons, parƟcularly liquids. A cc is the equivalent to an ml. A teaspoon (abbreviated as tsp) contains 55 cc’s and a tablespoon (abbreviated as tbsp) contains 1515 cc’s. Basic arithmeƟc will be necessary to convert cc/ml amounts to tsp/tbsp and vice versa. For example, the number of cc’s to give if an order is for 234234 tsp is 13.7513.75 cc’s. These calculaƟons should be done using a calculator and it is always helpful to have someone check your work. AdministraƟon Routes As a medical assistant, you will need to be familiar with the various routes of medicaƟon administraƟon and how to administer each. This may include: oral medicaƟons such as pills, liquids, lozenges; medicaƟons for mucosal absorpƟon such as rectal or vaginal suppositories, respiratory inhalers, sublingual tablet; and parenteral medicaƟons such as intradermal, subcutaneous or intramuscular injecƟons. InjecƟons Intradermal, subcutaneous, and intramuscular injecƟons are the most common ways to deliver medicaƟon that cannot be given by another route. OŌenƟmes these medicaƟons would be damaged by or could not be absorbed into the body via the digesƟve system, thereby rendering them ineffecƟve. Three Types Subcutaneous (SQ)—The medicaƟon is injected into the subcutaneous fat. An example of a drug that is delivered SQ is insulin. Intramuscular (IM)—The medicaƟon is injected into the muscle belly itself. An example of an IM drug is corƟcosteroid, such as dexamethasone.
Intradermal (ID)—The medicaƟon is injected very superficially into the dermis, or second layer of skin. The most common use of ID injecƟon is for delivery of PPD, known as the Mantoux test for tuberculosis. Things to Know Site—Sites commonly used for IM injecƟon in adults are the deltoid, dorsogluteal, ventrogluteal, and the vastus lateralis. In children, the vastus lateralis is the prefered site. The maximum volume for an IM injecƟon is 22 ml in the deltoid and thigh and up to 55 ml in the gluteal muscles. For children school age and above, 22 ml is the maximum volume. In infants, no more than 0.50.5 ml and in small children, no more than 11 ml is given at any one Ɵme. Needle length and gauge—The needle length and gauge will depend on the chosen site. As a rule, the deeper the injecƟon the larger the gauge and longer the needle. For IM injecƟons, a 20-2320-23 gauge needle is used and the length will vary depending on the site injected and size of the paƟent. For ID injecƟons, use 1212 inch 30-3130-31 gauge needles. SQ injecƟons require 1212 to 5858 inch, 25-2625-26 gauge needles. Steps to administer— Again, always follow the six rights of medicaƟon administraƟon prior to giving any medicaƟon. Always wear gloves and prepare the injecƟon site using an alcohol wipe to cleanse the skin. If giving an IM injecƟon, aspirate by pulling back on the plunger prior to injecƟng to ensure the Ɵp of the needle has not penetrated a vascular structure. Massage may be used if not contraindicated. A bandage may or may not be applied. Always dispose of the syringe and needle safely and following all facility guidelines. Z-tract—In some instances where the IM medicaƟon is very irritaƟng, the Z-tract method will help ensure the medicaƟon gets into and only stays in the muscular level. It is accomplished by using the non-injecƟng hand to slide the skin and subcutaneous Ɵssue away from the injecƟon site. No massage is used. The Ɵssue is released aŌer injecƟon thereby pulling the needle track away from the medicaƟon depot. This helps prevent leakage of an IM medicaƟon back into the subcutaneous space aŌer injecƟon. Syringe parts—There are four basic parts to a syringe:
- The Ɵp serves as the aƩachment site for the needle to the syringe. Tips can be locking which secures the needle to the syringe when injecƟng under resistance. It allows for needles to be screwed onto the syringe Ɵp, thereby locking them into place. An example of this system is the Luer-Lok syringe.
InsƟllaƟon—InsƟllaƟon is the term used for delivery of a medicaƟon by drops. InsƟllaƟon can be used for the eyes, the ears, or the nose. Examples include eye drops for allergies or infecƟon, ear drops for pain or infecƟon and nasal drops for congesƟon or infecƟon. InstallaƟon requires proper paƟent posiƟoning. Transdermal—Transdermal patches deliver medicaƟon topically, but usually do so slowly over Ɵme. Examples include Fentanyl patches for pain and estrogen patches for hormone replacement therapy. Vaginal—MedicaƟons delivered vaginally typically come in the form of suppositories, pills, or creams. The vaginal ring may also be used as a form of contracepƟon. These all deliver their effect via mucosal absorpƟon of the vagina. Rectal—The rectum provides a mucosal surface for drug absorpƟon that typically produces a rapid effect using smaller medicaƟon doses. This is because medicaƟons given by this route bypass metabolism in the liver. Nausea, anƟ-seizure, and narcoƟc and non-narcoƟc pain medicaƟons are frequently given in this manner. Special Topics In addiƟon to the preparaƟon and administraƟon of common medicaƟons and prescripƟons, medical assistants will likely be involved in the preparaƟon and administraƟon of vaccines for the prevenƟon of disease in both the adult and pediatric populaƟons. In addiƟon, there may be instances where the prescripƟon order must be sent to a specialty pharmacy. This is, typically, because the drug ordered needs to be compounded by a pharmacist, as it is not prepackaged or available at retail pharmacies usually used by paƟents. ImmunizaƟons ImmunizaƟons are available for the prevenƟon of disease for both adults and children. Examples of such vaccines are varicella and polio vaccine for children, HPV vaccine for adolescents, and pneumococcal and zoster vaccine for adults. These vaccines are given on a parƟcular schedule, meaning that they require a certain number of doses given at certain intervals to be effecƟve. Some are given yearly, while others confer immunity once the series is complete. Each immunizaƟon has specific storage instrucƟons to ensure they remain potent. The Center for Disease Control (CDC) provides enhanced training on the storage and handling of vaccines. A Vaccine InformaƟon Statement, or VIS, is a document produced by the CDC, that is specific for each vaccine, that informs the recipient of that vaccine of both the risks and benefits of receiving it. If the vaccine is given to a child, the VIS must be given to the parent or legal guardian. It must be given prior to administraƟon of the vaccine and before every dose in a vaccine series.
DocumentaƟon of immunizaƟons must include the ediƟon date and date the VIS was provided, the name, Ɵtle, and address of the person administering the vaccine, as well as the lot number and date the vaccine was administered. A good rule of thumb is to also include the administraƟon site and the paƟent’s tolerance of the immunizaƟon. Specialty Pharmacies Specialty pharmacies exist to fill prescripƟon orders that are not available at retail pharmacies. An example would be a nuclear pharmacy which compounds and dispenses radioacƟve materials used in certain procedures or therapies. These drugs usually come in the form of liquids or capsules. A compounding pharmacy is one where the pharmacist is trained to compound and dispense medicaƟons that require unique ingredients in specific proporƟons that are not commercially available. Oral medicaƟons in the form of syrups, elixirs, and suspensions may be compounded in addiƟon to topicals such as creams, ointments, and soluƟons. AdministraƟon DocumentaƟon DocumentaƟon of medicaƟon administraƟon is an important and vital task of a medical assistant. Always document medicaƟon administraƟon in the paƟent’s chart immediately aŌer the medicaƟon is given. Document MedicaƟon AdministraƟon In many cases, your workplace will have guidelines that you will have to know and follow when documenƟng medicaƟon administraƟon. In general, documentaƟon should include the date and Ɵme administered, medicaƟon name and dose, route of administraƟon, site of administraƟon (if applicable), the lot and expiraƟon date (if applicable), and the paƟent’s response to the medicaƟon. Document MedicaƟon AdministraƟon Errors If a medicaƟon administraƟon error occurs, it must be documented in the paƟent’s chart. Examples of medicaƟon administraƟon errors can include administraƟon of the wrong drug, the wrong dose, the wrong route of administraƟon, or administraƟon of a drug to the wrong paƟent.
