Module 4: Medication Types & Storage | QMAP

Prescription vs. Over-the-Counter (OTC)

Type	Definition	QMAP Requirement
Prescription (Rx)	Medications ordered by a licensed medical practitioner. A prescription is required to purchase.	Written physician order AND pharmacy label required before administering
Over-the-Counter (OTC)	Medications available for purchase without a prescription (e.g., Tylenol, Benadryl, antacids)	A written order is STILL required from a physician before a QMAP can administer OTC medications

Critical Rule: ALL medications — both prescription and OTC — must be ordered by a licensed practitioner before a QMAP can administer them. Even common OTC medications like Tylenol require a physician's written order.

Brand Name vs. Generic Name

Every drug has three names:

Chemical name — the precise molecular formula (rarely used in clinical settings)
Generic name — the official, non-proprietary name
Brand (Trade) name — the name given by the manufacturer who holds the patent; designed for marketing

Example: The brand name Lasix is the same drug as the generic furosemide. The brand name Tylenol is the same as generic acetaminophen.

        QMAP Tip: Always verify that the brand name and generic name on the label match the physician's order. If you have any doubt, look up the drug in your reference manual or contact the pharmacy before administering.
      

Controlled Substances — Schedule Classification

Controlled substances are medications with potential for abuse. The DEA classifies them into five schedules based on medical use and risk of abuse:

Schedule	Risk Level	Examples
Schedule I	Highest — no accepted medical use	Heroin, LSD, marijuana (federally)
Schedule II	High abuse potential	Oxycodone, fentanyl, morphine, Adderall
Schedule III	Moderate abuse potential	Codeine combinations, anabolic steroids
Schedule IV	Lower abuse potential	Xanax, Valium, tramadol, Ambien
Schedule V	Lowest	Cough preparations with <200mg codeine/100mL

Double Lock Requirement: All controlled substances (Schedules II–V) must be double-locked. For refrigerated controlled medications: a locked box must be kept in a locked refrigerator (not just any refrigerator). Report any missing medications or count discrepancies to your supervisor immediately — not the next business day.

Forms of Medications — Solids

Form	Description	Key Rules
Plain Tablet	Compressed powder; most common form	Can be scored (split) only with a written order
Scored Tablet	Has a line allowing it to be split accurately	May only be split with written physician order
Caplet	Elongated/capsule-shaped tablet; same properties as round tablets	Same rules as tablets
Enteric Coated	Tablet coated to resist stomach acid; dissolves in the intestine	NEVER crush or split — coating is protective
Capsule	Gelatin container with powdered medication inside	DO NOT OPEN without a written physician order
Spansule	Extended-release capsule	Never crush; releasing all at once is dangerous
Troche/Lozenge	Large flat disc dissolved in the mouth	Not to be swallowed whole; held in mouth until dissolved

Forms of Medications — Semi-Solids & Liquids

Semi-Solids

Cream — water-based; absorbed into skin
Ointment — oil-based; sits on skin surface; occlusive
Gel — clear, semi-solid; often used for topical pain relief

Liquids

Elixir — drug in sweetened alcohol base (e.g., NyQuil)
Solution — drug completely dissolved in solvent; clear
Suspension — drug particles suspended in liquid; cloudy — must be shaken before use
Syrup — drug in sweetened water base; masks bitter taste
Emulsion — oil mixed with water base
Tincture — alcoholic dilution of a drug for topical absorption (e.g., Tincture of Iodine)
Concentrate — highly concentrated liquid; must be diluted per instructions

Other Forms

Suppository — solid form inserted into rectum or vagina; melts at body temperature
Patch (Transdermal) — medication-impregnated adhesive patch applied to skin
Inhaler / Nebulizer — aerosolized medication inhaled via mouth
Gel Cap — liquid-filled soft gelatin capsule

Medication Metabolism — The 4 Phases

Phase	Where	How	Result
Absorption	Digestive tract, lungs, muscle, or skin	Via route of administration	Gets medication into the body
Distribution	Bloodstream	Partially broken-down drug transported via blood	Gets medication to target cells
Metabolism	Liver (primarily)	Drug broken down to active form	Drug becomes active at target site
Excretion	Kidneys, liver, bowel, lungs	Waste products filtered and eliminated	Drug is removed from body

Safe Medication Storage

All medications must be stored safely in accordance with your agency's written policy. Key storage rules include:

Storage cabinets must be cool and dry with limited light exposure to prevent medication degradation
Medications requiring refrigeration must be kept in a designated medication refrigerator or in a lockable container secured in the refrigerator
All controlled substances must be double locked
Medications for refrigerated controlled substances: locked box in a locked refrigerator
Medications transporting for community activities must be in original blister packs, MRBs, or labeled zip-lock bags — maintained by the person who will administer them
Medications must NEVER be stored with disinfectants, insecticides, bleaches, household cleaning solutions, or poisons — store separately in a clearly labeled, secured area

        Self-Administering Clients: Clients who self-administer their own medications may have their medications in their own room. No external labeling is required since the client is in control of their own property.
      

Medication Disposal

Each service agency must have a written plan for medication disposal. The QMAP must know and follow their agency's policy. Acceptable disposal methods may include:

Return to pharmacy (preferred for controlled substances)
Community medication take-back programs
Approved disposal using special pouches or medication disposal sites

Return to Client or Legal Representative First: Before disposing of any medication, it must be returned to the resident, client, or their legal representative, OR there must be written documentation that they have given consent for disposal. You cannot simply discard a client's medications without authorization.

Unlabeled Containers: Any medication container that has no label must be destroyed immediately. Never administer medications from an unlabeled container under any circumstances.

        Patch Disposal: Medication patches should be disposed of in a sharps container (not the trash, not kitty litter, and not down the toilet). Fold the patch in half with the sticky side in, then place in the sharps container.
      

Medications that are discontinued, contaminated, deteriorated, or have expired must be removed from the active medication supply and disposed of per agency policy.

Drug Diversion Awareness

Drug diversion is the theft, misuse, or unauthorized use of a client's medications — by anyone, including staff, family members, other residents, or visitors. It is a criminal offense.

Controlled Substance Accountability

For controlled substances (Schedules II–V), QMAPs must maintain strict accountability at all times:

Count: Count controlled substances at every shift change — record in the controlled substance log
Storage: Must remain double-locked at all times (see storage rules above)
Administering: Document dose, amount remaining, and any waste immediately after administration
Documenting: Every dose removed from the supply must be accounted for in writing — who gave it, when, how much, and how much remains
Discrepancies: Any count discrepancy must be reported to your supervisor immediately — not at shift end, not the next business day

Signs of Possible Diversion

Medication counts that don't match documented records
Pills appearing tampered with or replaced
Client reporting medication isn't working as expected
Missing medications or incomplete documentation

Your Duty: If you suspect diversion, report it to your supervisor immediately. Do not investigate on your own or confront anyone. Document what you observed with specific details: date, time, what was missing, and what you witnessed.

Medication Types, Forms, Storage & Disposal