100 k

Total Downloads

1.82 m

Views

Downlaod PDF

Medicine Management

Essay

The following assignment is a drug administration and management report which offers necessary and relevant information regarding the guidelines for the use of drug. This report also outlines the useful information for prescribing paracetamol to patients of every age group the dosage techniques and administration routes for paracetamol are also discussed throughout this report.

The medicine drug Paracetamol (also known as paracetamol) is a fever reducer and a pain reliever medication. Ogemdi, (2019) defines that paracetamol is being used for treating several conditions which may include; muscle aches, headache, backache, arthritis, colds, fevers, toothaches, and other. Paracetamol is typically used to relieve moderate to mild pain. The chemical formula of Paracetamol is C8H9NO2. Paracetamol is generally sold under several names, some of these include, Panadol, Tylenol, Capol, etc.

Typically, when prescribing NHS patients, all NHS trusts must document and establish and maintain an adequate system for the effective treatment of the drug. Compulsory ethical and legal rules apply to drug administration. Cloatre (2018) defines this includes drugs, drug sourcing, safe storage and safe disposal, ordering, availability, storage and distribution of drugs, It is essential that patients are instructed to take paracetamol according to the legal requirements documented in the legislative body of “Medicines Act 1968".  In addition, the prescription of paracetamol should comply “National Inpatient Medication Chart” as well as "National Inpatient Medication Chart Guideline”. McLeod et a. (2014) mentions when ordering a paracetamol medication, the designated nurse is responsible for all clinical areas, service personnel or other professionals, and the hospital ward is responsible for completing the medication ordering system. The general requirement is that the clinical site or each ward must at all times keep a list of pre-printed pharmacies or place an order and keep them in a safe and locked place. Cloatre (2018) discusses that the application for medication must be signed after the employee's registered nurse, dentist or medical practitioner and the authorized person responsible, registered pharmacy assistant or technician and pharmacist.

All medicines must be stored safely prevent worsening of their efficacy or effectiveness. To ensure its effectiveness, it is essential that paracetamol must be stored according to the "The Misuse of Drugs (Safe Custody) Regulations 1973" guidelines. The assigned nurse in a hospital setting looking after patient's medication is responsible for ensuring that there is always enough paracetamol in the ward for the patients in need. Carr and Smith (2013) state that the hospital staff is responsible for providing patients with recommendations for safe storage of paracetamol. Paracetamol should be placed out of the reach of children and must be stored in a dry environment. Paracetamol syrup and tablets should be kept tightly kept in a cool place with a tight sealing. The container where the paracetamol medications will be kept should be protected from light. Also, the temperature should be below 25 °C. It is the nurse's responsibility to dispose of all medicines, their vials and syringes should adequately comply with the “The Hazardous Waste Regulations 2005”. Since paracetamol has a tendency to become hazardous waste, it is essential that the unused and expired paracetamol tablets/ syrups/ syringes are discarded as per the “The Hazardous Waste Regulations 2005”, would be suitable for home carers to submit such waste at pharmaceuticals rather than throwing these in garbage. However, the packaging of paracetamol tablets and syrups can be thrown to garbage after they have emptied and have been consumed. However, the disposal of syringes should be submitted to a hospital or a pharmaceutical. 

The guidance offered in NICE (2013) guidance paper offers NHS experts and medicinal service providers with best practice recommendations. This is to consider in developing, licensing, using and updating the systems and processes used in the "Patient Groups Directives (PGDs)". It also includes medicine management arrangements aimed at ensuring patient legal protection, appropriate treatments and timely treatment. Registered nurses who wish to provide and / or administer 250 mg / 5 ml paracetamol oral suspension (pediatric acetaminophen suspension) should ensure that all patients are screened and meet standards. The purpose of PGDs is to help relieve pain more easily and effectively without medical insurance.

McLeod et al. et al. (2014) focuses human drug regulation on drugs that are considered safe for humans. The "Human Medicines Regulations 2012" regulation provides for a special system that allows ordinary people to use drugs formally to ensure that they use, import, distribute, sell and supply drugs. Individual companies and suppliers / retailers now have the right to advertise and promote to expand their entry into the general market. Whitehair, Provost, and Hurley, (2014) emphasise that this is the first regulation that emphasizes the empowerment of health professionals and general practitioners to ensure patient safety and health.

The PGD has been defined as a written description that helps a medical professional to deliver or administer medicines to a patient. It takes a lot of time and resources to develop and implement PGD. A medical professional may procure and / or manage according to PGD only if the patient benefits in their own interest, without compromising security. PGD of paracetamol ​​should be comprised of a multidisciplinary team made up of doctors, pharmacists and representatives of all professional groups who wish to provide PGD-based medicines. It is best to involve local drug and treatment committees, regional prescription committees as well as similar advisory bodies. To ensure patient safety, the PGD expiration date of paracetamol should be adapted to the situation. The validity period may not exceed 3 years from the date of PGD approval. The oral tablets of paracetamol can usually only be sold or supplied at a registered pharmacy or under the supervision of a pharmacist. The oral tablets of paracetamol should be sold or provided on the basis of a prescription written by a healthcare professional. This may be a doctor, dentist, or any other independent or additional prescriber. Intravenous paracetamol can be sold in various locations, such as supermarkets, and packaged as long as they are kept close avoid its misuse. The PGD of paracetamol provides an exception to these restrictions. According to the "Substance Abuse Regulation (2001)", only certain controlled drugs (including paracetamol) can be added to PGD (Kinniburgh et al. 2017).

Further guidance for paracetamol consumption can also be drawn from the NICE's Guideline "Social care guideline [SC1]". This guideline covers best practices for the development, reinforcement, use and updating of guidance for patient groups. The NICE (2014b) guideline also recommends deciding whether patient group guidance is needed. Under the guidance of patient groups, healthcare professionals can offer and administer a specific drug to a given patient group without a prescription; this also includes paracetamol tablets but in fever milligrams. The purpose of the NICE (2014b) guideline is to ensure that patient group guides are used in accordance with the legislate\ve bodies so that patients receive the medicines they need safely and quickly.

For storage of paracetamol, it is essential that it is kept away from contact of sunlight and must be stored below the temperature of 25°C. However, the dosage of paracetamol for 12-18 years should be 500 mg, for 6-12 years syrup dosage 250-500 mg is required, and for ages above 18, recommended dose for diabetes is 1 to 2 tablets in every four to six hours.  The dosage of paracetamol can be on the basis of age, gender, and severity of pain. The dosage of paracetamol can be repeated in completion of 4 to 6 hours after the medicine has been consumed. It is essential to offer relevant advice to patients prior to offering paracetamol; first, advice patient guardian/parent of a given treatment; second, ensure maximum awareness of the frequency or dose; third, advice against the other products use containing Paracetamol; and fourth, advice must be given to contact with a doctor of the symptoms get worse, or it does not improve. The relevant warnings for paracetamol include anaphylaxis, for this immediate medical attention must be given and it must be treated by the NHS border protocol/PGD. However, Paracetamol does not have adverse effects. For arrangements for follow up of paracetamol it is essential to observe the effectiveness of pain relief. Seek medical advice if Paracetamol fails to respond to treatment or condition deteriorates. A person having parental responsibility must not be left if any concerns are present. The person with the parental responsibility must be advised about the timing and use of the recommended doses of Paracetamol to reduce the intensity, risk and fever duration. Additionally, reactions that are adversely caused by Paracetamol are rare, but sometimes rashes are reported. If any reaction occurs, immediately relevant medical practitioner must be informed as soon as possible.

Cta 1 How “Dissertation Proposal” Can Help You!

Our top dissertation writing experts are waiting 24/7 to assist you with your university project, from critical literature reviews to a complete masters dissertation.

Find Out More

There are a range of ethical and legal frameworks identified which underpin the effective and safe management of medicines; these shall be used for paracetamol administration in children and adults.

It has been identified that the "Misuse of Drugs Regulations 2001" is particularly a special regulation applied in the United Kingdom to ensure the abuse of drugs sold and distributed in the market. This legislation not only focuses on safety requirements but also reflects this legislation, including the effective management, distribution, maintenance and disposal or disposal of irregular or irregular drugs (Davies, 2018). The "Medicine Act 1968 Regulations" provides a framework for obtaining a valid license for the manufacture and sale of medicines. The 1968 specifies the legal institutions to ensure strict control of all medicines on the market (Lysaght et al. 2013). In principle, a drug is a combination of certain chemicals that may be harmful to the environment if not properly controlled, disposed of or controlled. In some cases, medical waste may pose a major biological risk to the environment; hence, "Hazardous Waste (England and Wales) Regulations 2005" help in regulating waste management systems in hospitals, clinics and other places where medical waste can be collected  (Holt and Allen, 2015).

In reference with NICE (2014a), (2013), and (2014b) the legislations for medicine management and administration of paracetamol in United Kingdom for children include; "Care Standards Act 2000", "Education and Inspections Act 2006 (section 148)", "Health and Social Care Act 2008 (Regulated Activities) Regulations 2010", "The Children’s Homes Regulations 2001", "The Children’s Homes (Wales) Regulations 2002", "The Children’s Homes Regulations (Northern Ireland) 2005", "Chief Inspector of Education, Children’s Services and Skills (‘CIECSS’) (if not regulated by above then Care Quality Commission (CQC) regulate", "Children's homes: national minimum standards (Department for Education) Children Act 1989: Guidance and Regulations Volume 5: Children’s Homes", "Care and Social Services Inspectorate Wales (CSSIW)", "Regulation and Quality Improvement Authority (RQIA)", "Children’s Homes", "Nursing home minimum standards (RQIA)" and "Residential care homes minimum standards (RQIA)".

Additionally, the legislation presented NICE (2014a), (2013), and (2014b) for adults include; "Health and Social Care Act 2008", "Health and Social Care Act 2008 (Regulated Activities) Regulations 2010", "Care Quality Commission (CQC)", "Essential standards of quality and safety (CQC)", "The Care Homes (Wales) Regulations 2002", "Care Standards Act 2000", "Care and Social Services", "Inspectorate Wales (CSSIW)", "Care Homes", and "Residential Care Homes Nursing Homes Health and Personal Social Services (Quality Improvement and Regulation) (Northern Ireland) Order 2003".

Drug self-administration is objectified to increase patients' understanding of drug treatment and increase their independence and independence in hospitals. Richardson et al. (2014) show that the impact of inpatient "Self-Administration of Medication (SAM)" on patients, clinical/ medical staff and carers. According to Wiliński et al. (2015), paracetamol is the first-line treatment for a range of pain, inflammatory diseases and fever. Unfortunately, this drug can also cause serious side effects, especially if not used properly (Wiliński et al. 2015).

For Supply of Paracetamol, the advantages include; value addition to the pharmacy's element of supply; the pharmacist’s time being better used for guidance and referral, limiting off work burdens from doctors and nurses; and re-packaging of paracetamol may not be required (Romero‐Collado et al. 2014). For administration of paracetamol there are ten advantages identified these include: first being, the dignity and independence of the patient/ resident is protected; second being, patients/ residents medications by themselves; third being no redistribution required (possibly unauthorized dispersion of medicine); fourth being, less space than monitored dosing systems in hospitals; fifth being, patient Information Leaflet that is included with the original package to support drug information requirements / requirements is well-read and not wasted; sixth being, residents who see the original packaging (for identification purposes) by themselves rather than relying on doctors; seventh being, less wastage for hospitals helps patients to take short breaks / day off from attending medicinal services; eighth is, after a change, it is easier to adjust the medicine (e.g. change the dose or stop taking medicine); ninth being, reduction of the risk of hospital caused infections; tenth being, provision of additional visual safety controls for patients and their carers at home to encourage self-control and compliance of medicine (Twycross, Forgeron, and Williams, 2015).

The disadvantages for supply for paracetamol include; dosages of paracetamol being unequal in their suitability for self-administration; repackaging can often be unlicensed; lack of evidence for the use of medication; unpaid pharmacy using monitored dosing systems; reliable enforcement and control procedures are required; time-consuming for patients (in case are not aware or do not have sufficient information of paracetamol); problem in different doses; drug problems start with mid-cycle or interim dosage of medications; and not all labels may be suitable for a monitored dosing system (Black and Dawood, 2014). For administration of paracetamol there are seven rudimentary guidelines provided these include; (1) home care workers can be very dependent on a monitored dosing system that causes them distress; (2) high-risk dosage of paracetamol (intravenous) can be a problem; (3) if the monitored dosing system packs all the drugs in one dosage, (4) a decision should be made whether to discontinue or discontinue use of the paracetamol, (5) which is mostly unclear; two systems are needed, (6) a traceable dosing system and an original package of acute and "on-demand" drugs and excessive use of supervised dosing systems, and (7) drug labels and instructions may not be visible to care personnel (Wright, 2013).

The fundamental principles of pharmacology in nursing practice of "paracetamol" ("paracetamol") is that it can be administered orally, intravenously or by means of rectal routes. The difference between oral administrations is slow absorption and irregular absorption. At therapeutic concentrations, the paracetamol's are quite linear, mainly via an independent dosage (Bannwarth and Pehourcq, 2003). Paracetamol's activity has been demonstrated in various chronic or acute pain issues. The amount of 1 g "paracetamol" is an optimum unit dose in adults. The maximum daily dose is 4 g, which corresponds to the analgesic effect (usually less than 6 hours). The extract absorbs tablets and moves faster than effervescent tablets. However, there is no direct relationship between the serum concentration of paracetamol long with its antipyretic or its analgesic activity (Bannwarth and Pehourcq, 2003). Paracetamol is a preferred non-opioid analgesic in the elderly or in patients with chronic renal failure. Although the paracetamol's bioavailability is not worse in patients with chronic or benign liver disease, it is contraindicated in patients with hepatic impairment. It can be used during lactation period and pregnancy (Bannwarth and Pehourcq, 2003). Plasma protein binding is very low in paracetamol, and hepatic metabolism (mainly through glucuronide or sulfate binding) presents a lower risk of drug interactions with paracetamol, especially vitamin K or at lower doses. Age influences the pharmacokinetics of paracetamol and the relative imbalance of the suppositories; it is difficult to determine the ideal dose of paracetamol in children. Oral doses of 15 mg / kg (up to 60 mg / kg / day) per day are generally sufficient to achieve the desired analgesia or anti-amretic effect by paracetamol (Bannwarth and Pehourcq, 2003).

Paracetamol is readily absorbed from the gastrointestinal tract, and peak plasma concentrations are reached approximately 10 to 60 minutes after oral consumption. Paracetamol is dispersed in most human tissues. Plasma protein binding is negligible at normal therapeutic doses but increases with increasing doses (Allegaert et al. 2015). The elimination half-life approximately varies between 1 to 3 hours. Paracetamol is extensively metabolised in the liver and excreted in the urine, particularly as a combination of inactive glucuronide and sulphate. Less than 5% of the initial breakthrough (Siepsiak et al. 2016). Paracetamol metabolites include secondary hydroxylated intermediates with hepatotoxic activity. Intermediate metabolism is detoxified by binding to glutathione but accumulates unless it is treated immediately with paracetamol (greater than 150 mg / kg or after ingestion of 10 g paracetamol). May cause irreversible damage of liver. Compared to adults, paracetamol has a different metabolic structure in premature young children, infants and new-borns (Kulo et al. 2013).

Cta 2 How “Dissertation Proposal” Can Help You!

Our top dissertation writing experts are waiting 24/7 to assist you with your university project, from critical literature reviews to a complete masters dissertation.

Find Out More

Paracetamol is a derivative of p-aminophenol with antipyretic and analgesic activity. It has no anti-inflammatory effect. Paracetamol is believed to exert analgesic effects by inhibiting centrally the synthesis of prostaglandins.

Paracetamol has been identified to have a significant effect on fever and analgesia. Plasma paracetamol and "Cerebrospinal Fluid (CSF)" concentrations studies showed that analgesia and anti-amethritic activity were maximal 1 to 2 hours after peak plasma concentration. Initially, CSF levels of paracetamol were lower than plasma levels (117% CV) with an equilibrium half-life of 0.72 hours. At the end of the study conducted by Ward and Alexander-Williams, (1999), paracetamol levels in the cerebrospinal fluid increased above plasma levels. The coefficient of dissociation of CSF and plasma was estimated to be 1.18 (CV 8%), which is consistent with drugs administered in plasma water that is not bound to plasma proteins (Allegaert et al. 2015). Calculations based on the pharmacodynamic model of the CSF plasma effect-site system indicate that the concentration found in CSF does not directly reflect the concentration in the effector region, that is, it takes time for the drug to reach and react with its receptors. Using the Emax Type S model with a low Hill coefficient, the antipyretic activity of paracetamol is related to drug concentration can be determined (Yang, Feng, and Xu, 2014). The model responded to the observed pharmacodynamic data and also predicted a maximum effect (Emax) which should not be exceeded if it was further increased. For antiarrhythmic agents, paracetamol concentrations of 10-20 g / ml and Emax were estimated to be 3 ° C. Pain is more complicated because pain is harder to measure than heat. A similar Emax sigmoid model was proposed. It is estimated that 10t1 m1-1 paracetamol plasma levels may provide satisfactory analgesia in 50% of children receiving care for tonsillectomy (Yang, Feng, and Xu, 2014).

The plasma half-life of paracetamol is approximately 2 hours. The drug is metabolised predominantly in the liver by binding to glucuronic acid (60%) and sulfuric acid (35%) or cysteine (3%). After 24 hours, 90-100% of the drug can be recovered in urine in the form of a conjugate. A small amount of the drug undergoes an N-hydroxylation reaction mediated by cytochrome P-450 to give "N-acetyl-p-aminobenzoquinone (NAPQI)" imine. The major P-450 isoform responsible for this oxidative pathway is "CYP2E1", but it also forms "CYP3A4" and "CYP1A2". Under normal conditions, "NAPQI" combines with the thiol group of the liver glutathione and is neutralized. After ingestion of large quantities of paracetamol, it is subjected that the "hepatic glutathione" is all consumed and "NAPQI reacts" with the sulfhydryl groups of the liver proteins. This can lead to subacute liver necrosis and, in severe cases, to liver failure.

To conclude, Paracetamol is an important drug in the clinical treatment of acute pain clinics. This report has addressed the mechanisms of action for paracetamol, including the dosage of the drug, administration, and the information related to "Patient Group Directions (PGD)". This report investigated the importance of formulating the resulting plasma concentrations and the route of administration for paracetamol.


 

References

Allegaert, K., Peeters, M.Y., Beleyn, B., Smits, A., Kulo, A., Van Calsteren, K., Deprest, J., de Hoon, J. and Knibbe, C.A., 2015. Paracetamol pharmacokinetics and metabolism in young women. BMC anesthesiology, 15(1), p.163.

Bannwarth, B. and Pehourcq, F., 2003. Pharmacological rationale for the clinical use of paracetamol: pharmacokinetic and pharmacodynamic issues. Drugs, 63, pp.5-13.

Black, A. and Dawood, M., 2014. A comparison in independent nurse prescribing and patient group directions by nurse practitioners in the emergency department: A cross sectional review. International emergency nursing, 22(1), pp.10-17.

Carr, J. and Smith, J., 2013. Storage and safe use of medicines on farm. In Practice, 35(1), pp.36-42.

Cloatre, E., 2018. Traditional medicines, law, and the (dis) ordering of temporalities.

Davies, S., 2018. Cannabis scheduling review part 1: the therapeutic and medicinal benefits of cannabis based products—a review of recent evidence. London: Department of Health and Social Care.

Holt, A.S.J. and Allen, J., 2015. Principles of health and safety at work. Routledge.

Kinniburgh, K.J., Blaustein, M., Spinazzola, J. and Van der Kolk, B.A., 2017. Attachment, Self-Regulation, and Competency: A comprehensive intervention framework for children with complex trauma. Psychiatric annals, 35(5), pp.424-430.

Kulo, A., Peeters, M.Y., Allegaert, K., Smits, A., de Hoon, J., Verbesselt, R., Lewi, L., Van De Velde, M. and Knibbe, C.A., 2013. Pharmacokinetics of paracetamol and its metabolites in women at delivery and post‐partum. British Journal of Clinical Pharmacology, 75(3), pp.850-860.

Lysaght, T., Kerridge, I., Sipp, D., Porter, G. and Capps, B.J., 2013. Oversight for clinical uses of autologous adult stem cells: lessons from international regulations. Cell Stem Cell, 13(6), pp.647-651.

McLeod, M., Ahmed, Z., Barber, N. and Franklin, B.D., 2014. A national survey of inpatient medication systems in English NHS hospitals. BMC health services research, 14(1), p.93.

NICE (2013). Patient Group Directions |NICE good practice guidance. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/mpg2/documents/patient-group-directions-draft-good-practice-guidance-consultation3

NICE (2014). Managing medicines in care homes. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/sc1/evidence/full-guideline-pdf-2301173677

NICE (2014b). Non-prescription medicines and over-the-counter products | Information for the public | Managing medicines in care homes | Social care guideline [SC1] | Guidance | NICE. [online] Nice.org.uk. Available at: https://www.nice.org.uk/guidance/sc1/ifp/chapter/non-prescription-medicines-and-over-the-counter-products

Ogemdi, I.K., 2019. A Review on the Properties and Uses of Paracetamol. International Journal of Pharmacy and Chemistry, 5(3), p.31.

Richardson, S.J., Brooks, H.L., Bramley, G. and Coleman, J.J., 2014. Evaluating the effectiveness of self-administration of medication (SAM) schemes in the hospital setting: a systematic review of the literature. PLoS One, 9(12), p.e113912.

Romero‐Collado, A., Homs‐Romero, E., Zabaleta‐del‐Olmo, E. and Juvinya‐Canal, D., 2014. Nurse prescribing in primary care in S pain: legal framework, historical characteristics and relationship to perceived professional identity. Journal of nursing management, 22(3), pp.394-404.

Siepsiak, M., Szałek, E., Karbownik, A., Grabowski, T., Mziray, M., Adrych, K. and Grześkowiak, E., 2016. Pharmacokinetics of paracetamol in patients with chronic pancreatitis. Pharmacological Reports, 68(4), pp.733-736.

Twycross, A., Forgeron, P. and Williams, A., 2015. Paediatric nurses’ postoperative pain management practices in hospital based non-critical care settings: A narrative review. International journal of nursing studies, 52(4), pp.836-863.

Whitehair, L., Provost, S. and Hurley, J., 2014. Identification of prescribing errors by pre-registration student nurses: A cross-sectional observational study utilising a prescription medication quiz. Nurse education today, 34(2), pp.225-232.

Wiliński, J., Wiliński, B., Lechowicz, M., Kameczura, T., Głowacki, M., Kameczura, A. and Chrapusta, A., 2015. Non-steroidal anti-inflammatory drugs and paracetamol in self-therapy of various disorders in students of different fields of study. Folia Medica Cracoviensia.

Wright, K., 2013. The role of nurses in medicine administration errors. Nursing Standard (through 2013), 27(44), p.35.

Yang, H., Feng, Y. and Xu, X.S., 2014. Pharmacokinetic and pharmacodynamic modeling for acute and chronic pain drug assessment. Expert opinion on drug metabolism & toxicology, 10(2), pp.229-248.

Cta 3 How “Dissertation Proposal” Can Help You!

Our top dissertation writing experts are waiting 24/7 to assist you with your university project, from critical literature reviews to a complete masters dissertation.

Find Out More

Ace Your Grades
Without Overspending

Why pay more for the same quality? Choose our cheap assignment writing services today and witness the difference yourself. Click now to get started!

  • 24/7 Customer Support
  • Team of Academic Experts
  • Guaranteed Results