EXAM 1 STUDY GUIDE Flashcards
class activities/exam review (250 cards)
1
Q
Prevented by NOT giving aspirin to children
A
Reyes
2
Q
Side effects of opioids
A
Euphoria
3
Q
Needs a pregnancy test
A
Teratogenic
4
Q
NSAID given via IV/IM/PO route
A
Ketorolac
5
Q
Most important assessment when giving opioids
A
Respirations
6
Q
Providers order for treatment
A
Prescription
7
Q
When a drug needs a higher dose to work
A
Tolerance
8
Q
A sign the kidneys are in trouble
A
Oliguria
9
Q
Pain that is NOT treated with opioids
A
Adjuvant
10
Q
What happens from too much of a drug
A
Overdose
11
Q
Substances that are NOT regulated by the FDA
A
CAMs
12
Q
Effects of steroids
A
Hyperglycemia
13
Q
Medication assisted therapy (not methadone)
A
Buprenorphine
14
Q
A method to increase medication compliance
A
Education
15
Q
Name for a drug that there can be many of
A
Trade
16
Q
Weakest opioid
A
Codeine
17
Q
Grouping of drugs by disease they treat
A
Therapeutic
18
Q
Test for GI bleed
A
FOBT (Fecal Occult Blood Test)
19
Q
Reliever of Pain
A
Analgesia
20
Q
How long a drug lasts
A
Duration
21
Q
How much of a drug is given
A
dose
22
Q
The organ that excretes most medications
A
Kidney
23
Q
The organ that metabolizes most medications
A
Liver
24
Q
Something that ACTIVATES a receptor in the body
A
Agonist
25
When a drug is used for something other than it official indication
OLU (Off-label-use)
26
When a medication or treatment does NOT work
Refractory
27
When a drug is placed on a list due to having a high risk for abuse and dependency
Controlled Substance
28
A term for a medication that is used to treat an overdose
Reversed Agent
29
When a larger amount of medication is given as the first dose.
Loading Dose
30
A medication that blocks a receptor in the body.
Antagonist
31
The correct term for someone that is not allergic to any meds, but is allergic to bees
NKDA
32
When a medication cannot be given to a patient
Contraindication
33
How well a medication will work
Efficacy
34
The range of medication levels in the body between helpful and toxic
Therapeutic range
35
The term for a medication that is safe to obtain without a prescription
OTC (Over-the-counter)
36
When a patient needs more and more of a medication to work
Tolerance
37
When a medication dose is slowly decreased until it is stopped
Taper
38
The time when a medication begins to help the patient
Onset
39
The drug name that companies market a medication as
Trade/Brand
40
An order for a medication or treatment given by a provider
RX (medical prescription)
41
What needs to be monitored when taking drugs with a narrow therapeutic index
Labs
42
The term for when the fluid given via the IV route leaks into the local tissue
Infiltration
43
Place the medication between the cheek and the gums
Buccal
44
Make sure to rotate sites when using this route
Subcutaneous
45
You should make sure the skin is clean, dry, and hairless, when using this route
Transdermal
46
This is considered the most localized route of administration
Topical
47
The route is used often the least preferred by nurses
Rectal
48
TB test is one of the only uses for this route
Intradermal
49
You should advise your patient to let the medication sit and dissolve, they should not swallow it.
Sublingual
50
Your patient needs to take deep breaths for this route to work
Inhalation
51
This route requires you to cover one nostril during administration
Intranasal
52
You may use this route for otitis externa but not otitis media
Otic
53
This is the most common route of treating conjunctivitis
Ophthalmic
54
Inject the medication at a 90 degree angle in the muscle
IM (Intramuscular)
55
Use this route only when you cannot establish IV access in an emergency
IO (Intraosseous - directly into bone marrow)
56
This route is the most common route of all for medication administration
Oral
57
This route is used to avoid extravasation
CVC (Central venous catheter)
58
The fastest route of medication administration
IV
59
Parenteral route not on this list
Vaginal
60
The way drugs are grouped by their mechanism of action
Drug class
61
The way a drug moves through the body
Pharmacokinetics
62
The way a drug has its effect on the body
Pharmacodynamics
63
Meds (weakest ———> strongest)
1. Ibuprofen
2. Ketorolac
3. Tramadol
4. Codeine
5. Morphine
6. Hydromorphone
7. Fentanyl
64
Adverse effects of systemic steroids
1. weight gain
2. mood disorders
3. Hyperglycemia
4. Hypertension
5. Immunosuppression
6. Loss of bone density (osteoporosis)
7. weakness
8. sleep disturbance
65
What is a common practice in prescribing to address the danger of systemic steroids?
Localized as possible ( Ex: if it's a rash give a cream vs pill)
66
Name 2 conditions that opioids are used to treat besides pain?
1. Chronic coughing
2. Diarrhea
67
What is the most common side effect of opioids?
Euphoria (getting high)
68
What is the second most common side effect of opioids?
Constipation
69
4 recommendations to address constipation
1. Increase activity
2. Increase Fluids
3. Increase fiber
4. Last - give stool softener
70
3 types of pain
1. Phantom
2. Chronic
3. Nociceptive (caused by damage to body tissue. Ex: stubbing your toe)
71
Which pain is treated different from other pains?
Neuropathic = Adjuvant therapy
(facilitate better pain control w/ a reduction in analgesic consumption)
72
A patient is dehydrated and receiving fluids. The order is to give 1500ml over 1 hr followed by 250ml an hr. The 1500 is referred to as the _________ dose & the hourly rate is referred to as the _________ dose.
- Loading
- Maintenance
73
What is the relationship between titrate vs taper?
They are OPPOSITE of each other
Titrate = slow INCREASE of a dose
Taper = slow DECREASE of a dose
74
What medication routes are ALWAYS SYSTEMIC?
- PO
- IV
- IM
- SubQ
- Rectal
75
What is the primary indication for administering Naloxone?
Respiratory depression related to an opioid use
76
What do we use metformin for?
- treat type 2 diabetes
- treat gestational diabetes
77
How would you address a concern for addiction relating to a prescribed opioid?
- Therapeutic communication
- Patient education
78
What safety education would you provide to a patient that takes CAMs
1. Tell me (your nurse) & provider what you are taking
2. Tell patient to take it AS PRESCRIBED on bottle
3. Be aware of where they are getting it from & only from REPUTABLE sources
79
Duration vs. Half life
- Usually the SAME thing
80
Duration
How long the med & effects last
81
Half-life
How long a med in the blood DROPS by HALF
82
2 prescription drug classes that can be used for an acute migraine?
1. Ergot Alkaloids
2. Serotonin 5ht Agonist
83
What OTC options are available for acute migraines?
NSAIDS (like Tylenol)
84
What drug class is most effective for inflammation?
Steroids
85
What drug is related to Reyes syndrome?
Aspirin
86
Why is Reyes syndrome uncommon today?
- We DO NOT GIVE aspirin to anyone under 18 yrs old
- NO KIDS
87
What does synergism mean?
- 2 things together are more than a sums of there parts
- (1+ 1 = 3)
88
Black box warning vs Contraindication
Black box = Caution
Contraindication = DO NOT GIVE
88
Ex: of synergism in body
- physicians treat bacterial heart infections with ampicillin & gentamicin
- cancer patients receive radiation & chemotherapy (or more than one chemo drug at a time
89
What is the HIGHEST PRIORITY nursing assessment for the patient that is treated with an opioid?
Respiratory
90
2 opioids that are available PO only?
- Vicodin
- Percocet
91
What medication can cause ringing in the ears
Aspirin
92
What is the goal in pain relief?
- Minimize
- Not eliminate (we have goals for a reason)
93
Can a patient that is allergic to naproxen take ibuprofen?
NO - Because same drug class
94
What is the highest priority question to ask when a patient reports their medication is not working?
Please tell me how you are taking your meds
95
How should a nurse address a patient refusing their prescribed medication?
- Therapeutic communication
- Patient education
96
Name the two most significant differences between acetaminophen and NSAIDs
Acetaminophen = Hepatotoxic (liver)
NSAIDs = Nephrotoxic (kidney)
97
Name 3 patient teaching points for someone prescribed morphine via a PCA pump
1. These are gonna give you your meds at fixed
2. If you need additional additional medication you can push
3. It will not overdose you
98
What's the most commonly used NSAIDs?
Ibuprofen
99
What can be given IV/IM/PO?
Ketorolac
100
What med is by prescription only?
Indomethacin
101
What med does not block cyclooxyrgenase?
Celecoxib
102
Why can come medications NOT BE CRUSHED up for the patient?
- If they are sustained released, extend released or enteric coated can not be crushed
- Protects our stomach from the pill or pill from your stomach.
103
What are two types of withdrawal a patient may experience with opioid addiction?
1. Physical
2. Psychological
104
Which withdrawal is treated with methadone or Buprenorphine?
physical (also called medication assisted therapy)
105
Which withdrawal is treated with therapy or narcotics anonymous?
Psychological
106
What would you expect when giving naloxone to a patient that has no opioids in their system.
Nothing - NO effect
107
What if you do have opioids in their system with naloxone?
- opioid withdrawal syndrome
- S/S - tremors, anxiety, nausea, headache, hypertension
108
Which drug name does the healthcare system use?
Generic
109
Which drug name do patients usually use?
Trade or Brand
110
What two drugs activate opioid receptors without the patient becoming euphoric?
1. Methadone
2. Buprenorphine
(doesn't get person high)
111
Name 4 components of a respiratory assessment?
1. lung sounds
2. SPO2
3. Respiration Rate
4. Respiratory Depth
112
What is the sign that the kidneys are in trouble?
Oliguria + Anuria = med emergency!!!
113
What is the difference between CAMs and OTCs?
CAMS = Approved as being safe but no proof of efficacy (Not FDA approved)
OTC = Regular meds, safe effective, appropriate/available to the public without prescription
114
What are 3 contraindications of sumatriptan?
1. Patient has uncontrolled hypertension
2. Patient has already taken 9 pills
3. Patient has certain cardiac disease
115
What are 5 CAMS and their uses
1. Echinacea
2. Chamomile
3. Ginkgo
4. St Johns warts
5. Ginger
116
Can you take more than one drug in the same class?
NO
117
Name 3 OTC NSAIDS
1. Naproxen
2. Aspirin
3. Ibuprofen
118
What drug class is known to cause GI bleeding?
NSAIDS
119
Name 3 ways to assess for GI bleeding?
Sign = Blood & Stool
Symptom = Abdominal pain lab (FOBT)
120
What is the primary organ of excretion?
Kidney
121
What is the primary organ of metabolism?
Liver
122
What is the importance of the kidney and liver working properly?
If not working you need to adjust the dose
123
You should always use the strongest medication to treat your patient.
False (Most effective, Not most Potent)
124
You should use therapeutic communication to address treatment refusals
True
125
The strongest medication is the most effective?
False
126
A medication that is by prescription is always better than an OTC option?
False
127
You should still use non pharm interventions if the patient is getting a drug?
True
128
You do not need to ask patients about their OTC or herbal meds?
False
129
All drugs have the same potency or efficacy?
False
130
Holistic treatment may involve prescribing meds?
True
131
A prescription can be referring to more than just medication orders?
True
132
The 1st past effect is most significant for medications given via which route?
PO
133
What is the patient education for a drug that has narrow therapeutic index?
We have to give EXACT RIGHT DOSE
- To little will not do anything
- To much will hurt them
(Frequent Lab testing)
134
Required assessment for - Sumatriptan?
Hypertension
135
Required assessment for - Aspirin?
Ringing in the ears
136
Required assessment for - Morphine?
Bradypnea
137
Required assessment for - Indomethacin?
Black stool
138
Required assessment for - Acetaminophen?
Liver failure
139
What are 3 contraindications for most NSAIDS.
1. Antipyretic
2. Analgesic
3. Anti inflammatory
140
What enzyme do NSAIDs act on?
cyclooxygenase cox 1
141
Can a patient take NSAIDs and Acetaminophen?
Yes
142
What assessments are needed before administering a teratogenic medication?
- HCG = pregnancy test
- Last menstrual cycle = if provider trust patients word
143
What drug classes might be recommended for someone having 8 migraine per month? (chronic meds)
- Beta blockers
- SNRIs
144
What are the 6 rights of medication administration?
1. Right patient
2. Right dose
3. Right time
4. Right drug
5. Right route
6. Right documentation.
145
What are 5 conditions treated with steroids?
- Asthma
- COPD
- Covid 19
- Gout
- Rheumatoid Arthritis
146
What is half life?
How long does it take until drug levels drop in half
147
How is half life related to drug dosing frequency?
When drug level drops in half you give there next dose
148
What assessment is only done after giving a medication, not before?
Assessment related to any side effects that the med can cause.
149
When to not reposition someone?
Someone you had hip surgery
150
When to not turn on the news for someone?
3 year old
151
When to not call the patients family?
Patient hard of hearing
152
When to not go on a walk in the hall?
Patient that is bed bound
153
When to not use guided imagery for someone?
Patient who has dementia?
154
When to not use massage therapy on someone?
- Rash
- Religion
155
When to not turn off the lights for someone?
Kid afraid of the dark
156
Pharmacodynamics
How med changes Body
157
Pharmacokinetics
How drug moves through body
158
Do oral steroids always need to be tapered?
yes
159
What is the relationship between alcohol & opioids?
- alcohol = CNS depressant
- Opioids = also CNS
- avoid taking together
- these 2 can have synergistic effect & amplify another
160
A patient reports they are pregnant and asks about their prescribed daily teratogenic
- Tell doctor immediately
- You are NOT a Dr.
161
What is the term for a large 1st dose of a med?
Loading dose
162
What is correct about administering IV opioids?
You need to administer the drug over several mins
163
What education should the nurse provide when administering naproxen to avoid neg GI effects?
Take with food
164
_______ is to the US as _______ is to Nevada as ________ is to Vegas
- Therapeutic drugs
- Drug class
- Drug
165
Onset
When the drug takes effect
166
Indication
What a drug is used for
167
First line
The most recommended treatment
168
Alternative
Other than first line choice
169
Refractory
Unresponsive to
170
What enzyme causes inflammation?
Cycoxygenase (through production of prostate gland)
171
What other chemical in the body is famous for causing inflammation?
Histamine
172
Agonist
Activates (opioids)
173
Antagonist
Inhibits (NSAIDs or Naloxone)
174
Renal function goes down as your age increases
BUN & creatinin will go up
175
What two assessments are critical before any med admin & what two after?
What are you treating & adverse effects
176
What is the first step in the process of pharmacokinetics?
Absorption
177
Wheezing is a ____
Sign of respiratory depression
178
How long after administering the drug should you monitor for adverse effects
First 15 - 30 mins
179
Four categories of pharmacokinetics
1. Absorption
2. Distribution
3. Metabolism
4. Excretion
180
Give an example of a drug that is an antagonist
Ex: naloxone/narcan
181
What is a teratogen?
Substance to which an embryo or fetus is exposed that causes abnormalities or retardation or death.
182
What is nociceptor pain?
Injury to tissues
183
Somatic pain
- sharp
- localized sensation
184
Visceral pain
- dull
- throbbing
- aching pain
185
Primary use of opioid agonists
- Relieve moderate to severe pain
- Some used for anesthesia
186
What do opioids put patients at high risk for?
Physical & psychological dependence
187
Morphine is a _____
opioid analgesic
188
Naloxone is a _______
treatment pf acute opioid overdose & misuse
189
Aspirin/Acetylsalicylic
- non opioid analgesic
- NSAID
- Antipyretic
190
Morphine side effects
- Lethargic
- Dizziness
- itching
- constipation
- nausea/ vomiting
191
morphine routes for admin?
- PO
- subQ
- IV
- IM
192
morphine - adverse effects
- restlessness
- anxiety
- hallucinations
- RESPIRATORY DEPRESSION
- CARDIAC ARREST
- death
193
Naloxone - adverse effects
- increased BP
- hypertension
- nausea/ vomiting
- drowsiness
194
corticosteroids - adverse effects
- suppression of adrenal gland function
- mood changes
- cataracts
- peptic ulcers
- electrolyte imbalances
- osteoporosis
195
Sumatriptan/ imitrex
- dizzy
- drowsiness
- warming sensation
196
If a pt is using this med, they should be monitored for at least 24 hrs if given as an epidural ____
morphine
197
sumatriptan/imitrex - contraindications
- recent medical information
- hypertension
- diabetes
- acute kidney injury
- hepatic impairment
198
morphine - contraindications
- can mask or intensify pain of gallbladder disease
- avoid in with acute or severe asthma
- GI obstructions
- severe kidney pr liver impairment
199
three MAT programs
- methadone
- combination of buprenorphine + naloxone
- naltrexone
200
MAT programs - methadone
- standard treatment
- will help with withdrawal symptoms, but not with pain
201
10x stronger than morphine
hydromorphone/dilaudid
202
100x stronger than morphine
fentanyl
203
"morphine in PO form"
oxycodone
204
highest risk of abuse due to potency
fentanyl
205
naloxone
opioid receptor antagonist
206
Which of the following meds requires me to educate a patient on diet & exercise / reducing salt?
Steroids
207
Naloxone should be administered when RR is fewer then ____ breaths/min
10
208
Is acetaminophen an NSAID?
no
209
aspirin can reduce fevers
true
210
aspirin is an NSAID
true
211
aspirin is a ___
cox inhibitor
212
aspirin/ acetylsalicylic acid treats ______ pain
mild to moderate
213
aspirin/ acetylsalicylic -MOA
- inhibits COX
- Inhibits platelet aggregation (anti platelet)
214
what is the only NSAID that inhibits platelet aggregation
aspirin
215
what med do you need to STOP 1 week BEFORE surgery
aspirin
216
Aspirin - Adverse effect
- GI upset (take with food)
- bleeding
217
What does a positive occult blood test mean?
GI bleed
218
Aspirin - toxicity / Overdose
tinnitus
219
what pharmacological class is ibuprofen?
cox inhibitor
220
Ketorolac (Toradol)
- for pain after surgery
- non - narcotic non habit forming
- IM, PO, IV
221
Triptans (pharmacological class)
- serotonin agonists
- constricting certain intracranial vessels
222
Medication is metabolized in the liver causing a reduction in the active drug concentration
first pass effect
223
This drug is a
- NSAID
- cox inhibitor
- given on empty stomach but can be given w/ food
- taking with aspirin increases GI bleed
Ibuprofen
224
This med is
- oral opioid
- constipation
- include stool softner
oxycodone
225
The major route for drug extortion and impaired function will decrease drug excretion
kidneys
226
Requires a higher dose to achieve a therapeutic effect
oral route
227
Produces a therapeutic effect at a lower dose
Potency
228
Most controllable pain?
Localized
229
This med is a
- NSAID
- Cox inhibitor
- Antiplatelet
- don't give to kids (Reyes syndrome)
- toxicity - tinnitus
Aspirin
230
Second opioid when used in combo w/ other opioids will speed up tolerance and increased risk of addiction
Hydromorphone
231
- Toxic epidermal necrosis
- characterized by blister lesions & skin sloughing
Stevens johnson syndrom
232
adverse effect thats can cause serious injury or death
black box warning
233
long term use can cause
- fractures
- osteoporosis
- hyperglycemia (need to increase insulin)
- impaired wound healing
- cataracts
- Cushing syndrome
- taper off
steroids
234
number 1 side effect of taking morphine (Goldstein lecture)
euphoria
235
- highest risk of abuse due to high potency
- 100x morphine
Fentanyl
236
- NSAID
- non habit forming
- come IM/ IV/ PO
Ketoroloac
237
- better to use this with KIDNEY disease than NSAIDs
- most serious effect from overdose is hepatotoxicity
acetaminophen
238
- common use is fever
- mild to moderate pain
NSAID
239
- used as supplest but not replacement for opioids in treating severe cancer pain
- used for neuropathic pain to
adjacent analgesics
240
maximum response can be produced from a drug
efficacy
241
rapidly achieves therapeutic response
loading dose
242
- opioid
- avoid other CNS depressants like alcohol
- adverse is respiratory depression
- naloxone as antidote
- injected over 4 - 5 mins
morphine
243
an opioid med used to treat opioid dependency because it causes less euphoria
methadone
244
MAT programs 2 meds
- methadone
- naltrexone
245
cam therapy safety
- check w provider
- seek info from reputable sources
- take recommended or lower doses
246
- meds that relieve acute pain for migraine or are abortive therapy
- triptans
- ergot alkaloids
-OTC
247
those effects after naloxone is administered
- tremors
- vomiting
- increased BP
248
the elderly have an increased production of auto antibodies
- decreased serum creatinine level
- decreased dermal thickness
- experience blunted responses
- no fever
249
meds for prophylactic treatment of migraines
- anti seizure meds
- beta adrenergic blockers
- calcium channel blockers
- tricyclic anti depressants
