Types of Medications
Prescription medications are any medications that must be prescribed by a physician. Physicians today have unlimited information available to them about medications, and pharmacists are also very knowledgeable about various factors concerning medications and can inform the consumer or patient. At the time a patient receives their prescribed medication, they are also given a drug monograph about the medication. The drug monograph provides all the information about the medication, including why it is to be taken, possible side effects, adverse effects, drug interactions, and common dosages.
Controlled drugs are any medications that have a high potential for abuse or addiction. Hospital and retail pharmacies dispense controlled drugs and therefore must be registered with the Alberta College of Pharmacists.
On a nursing unit, controlled drugs are kept in a locked cupboard or locked in a computerized cart, and a nurse carries the key. This helps eliminate the potential for theft and also complies with our drug laws. Every time a medication is required from the locked cupboard or cart, the nurse administering that drug must record the relevant information on the sheet or computer provided. In most cases, the controlled drug must also be double-checked and the order signed by another nurse on the unit to ensure accuracy and decrease errors.
At the University of Alberta Hospital, for example, they have computerized carts called Pyxis carts. You can see an example of a computerized medication cart that is similar to a Pyxis cart in Figure 7.1. These carts are stocked in the pharmacy according to physicians’ orders and taken to the respective units. When a medication for a patient is needed, the cart is unlocked by the nurse with a password. The nurse must enter the patient’s name, the doctor’s name, and the drug and dose. Only the drawer with the specific medication is released. The cart keeps track of the medications for each patient, the number of times it is given, and the nurse who gave it. Using a computerized drug-dispensing system decreases the potential for errors and allows for greater accuracy in accounting for drugs and for billing.
Any medication that a patient can purchase without a prescription is considered an over-the-counter (OTC) medication. Note that these medications can still have side effects and possibly adverse effects if too much is taken. A prescription is not required, and these medications can either be purchased at a pharmacy or at any location that sells such medications. An example of this type of medication would be Tylenol, which is commonly used to treat headaches, or Gravol, which is taken when someone is experiencing nausea.
Alternative medicine has become increasingly popular in recent years. Many members of the general population purchase herbal medicines over the counter, and it is important that they are aware that some of these herbs can interact with any prescribed medications they are taking (Drugs.com, 2021). Unfortunately, many people are under the false assumption that if a medication is “herbal,” it can’t harm you.
Many herbal medications can interact with prescribed or over-the-counter medications (Drugs.com, 2021). The table below provides some examples of just a few herbal medications that can have negative, and in some cases potentially deadly, interactions with prescribed medications.
Table 7.1. Herbal Medications
|Coenzyme 10 (CoQ10)||Used to help with heart damage, but when used with warfarin, may decrease blood thinning|
|Cranberry||Used to treat UTIs, but may increase the effect of blood thinners like warfarin|
|Echinacea||Used to boost the immune system, but use caution with immunosuppressant drugs|
|Evening primrose oil||Provides healthy fatty acids, but may also lower the seizure threshold|
|Garlic||Lowers cholesterol and blood sugar, but also affects blood clotting, so use caution if taking an anticoagulant|
|Ginseng||Used to decrease stress and increase energy, but also decreases the effects of anticoagulants|
Active and Inactive Ingredients
Most medications contain both inactive and active ingredients. Inactive ingredients are generally fillers, dyes, coatings, or solvents. They do not interfere with the action of the medication but are used to colour, keep together, or contain the active ingredients. The active ingredients in medications are the parts that create the desired therapeutic effect that could be, for example, relief of pain or infection.
Brand and Generic Names
All medications have generic names, and these are the same worldwide. They also have brand names, which can vary between parts of the world and are created by the companies that sell the medications. A generic medication could be sold under multiple brand names. Usually the brand names are easier to pronounce and remember, which makes them easier to sell.
The Canadian drug reference is the Compendium of Pharmaceuticals and Specialties (CPS). It is the resource that all pharmacists and physicians use to reference medications. Nowadays, it is available through various online subscriptions as well as an app that can be downloaded and regularly updated. Previously, it was only available in paper format and as such would only be updated annually. In the CPS, brand names are boldface or underlined and generic names are italicized.
Table 7.2. Examples of Brand and Generic Names
|Brand Name||Generic Name|
Although these are just a few examples, typically the brand name is the more recognized name within the general population compared to the generic name, which is generally more complex in nature.
Adverse Effects and Side Effects
When taking any medication, whether over the counter, herbal, or prescribed, there are possible side effects and adverse effects. The two terms are often used interchangeably, and although these effects can be similar in nature, they are actually very different. Side effects occur when a medication is taken and produces an effect other than the intended one. Although this may not be the desired affect, it is generally something that is anticipated by the physician as a result of taking that particular medication. For example, often when someone takes a narcotic medication, they experience constipation as a side effect. An adverse effect, on the other hand, is unintended, but it is also a dangerous effect that occurs when a medication is taken. In many cases, it is severe, unpredictable, and results in the medication having to be discontinued. Anaphylaxis, a severe allergic reaction, would be an example of this.
Note on allergies: We are not always born with allergies and may even develop them later in life. You may, for example, have taken a certain medication without issue, but then later in life you start reacting to it, even to the point of experiencing anaphylaxis, though minor reactions are more common.
Rights of Medication Administration
When a medication is prescribed or ordered for a patient, it is important to ensure that certain “rights” are considered in order to reduce possible errors. These rights are an important aspect of patient care, and when all of them are adhered to, it is possible ensure that potentially harmful, or even deadly, medication errors are avoided. The six rights of medication administration are the following:
- The right patient
- The right drug
- The right dose
- The right time
- The right route
- The right documentation
When medications are taken, there are many differing doses, routes, timings, and medications themselves that can be chosen. As such, it is important to make sure that all of these are the “right” ones for a particular patient. Proper documentation is also important because if medication administration is not documented correctly, then the medication is not considered to have been given properly. We use documentation in hospitals and clinics as a way of knowing what patient care has been completed, and without proper documentation, we cannot know with certainty what treatment a patient has received.
When medications are ordered in the hospital, a pathway for medication responsibility must be followed. Some hospitals may have a different process depending on factors such as the adoption of Connect Care in Alberta, for example. Connect Care is a form of a clinical information system (CIS) that is available province-wide in Alberta. Other areas have similar systems, and using these systems should allow for more comprehensive patient care and reduce the need to process paper orders. Many areas do not have this form of electronic health records, so the pathway given below for medication responsibility is still very important to know and helps ensure patient safety. This step-by-step process includes numerous checks at every level on the pathway for medications ordered in the hospital. Each professional in the chain will work to complete the medication order, but also check the order at the same time to decrease errors and ensure that the patient receives the correct medication.
Pathway for medication responsibility:
- The physician writes the order.
- The health administrative professional processes the order.
- The charge nurse checks the order.
- The pharmacist fills the order.
- The nursing staff gives the medication.
Unless otherwise indicated, material on this page has been adapted from the following resource:
Drugs.com. (2021, October 20). 18 herbal supplements with risky drug interactions. https://www.drugs.com/slideshow/herb-drug-interactions-1069